Laparoscopic resection of the pancreatic tail with splenic preservation

OBJECTIVE: Evaluation of feasibility and efficacy of left resection of the pancreas with preservation of the splenic vessels and spleen as a laparoscopic procedure. BACKGROUND: Laparoscopic technique is used less often on the pancreas than on other organs. The most common indications are enucleation of endocrine-active tumors and distal resections for benign primary pancreatic lesions. An important premise of these operations is atraumatic removal of as little of the pancreas as possible and the preservation of the spleen and its main vessels. METHODS: Five patients aged 16 to 56 years, all female, underwent laparoscopic left resection of the pancreas with preservation of the splenic vessels and the spleen. There were 4 cases of benign epithelial tumors of the pancreas and 1 case of a left-sided adrenal cyst, which pre- and intraoperatively gave the impression of a pancreatic cystadenoma. RESULTS: In all 5 cases, the laparoscopic procedure was completed with preservation of the splenic vessels and the spleen itself. No patient required blood transfusion, and there was only 1 postoperative fluid collection at the site of the tumor resection, which was drained percutaneously on the fourth postoperative day. CONCLUSION: Distal pancreas resection can be performed as a laparoscopic procedure, with the usual advantages that this techniques has for the patient. Optimal closure of the cut edge of the pancreas and the preservation of the spleen and its main vessels are the most important aspects of this operation.     

Delayed Diagnosis of Tuberculous Arthritis

Monoarticular tuberculosis （TB） affecting the knee is rare in all forms of TB （0.1-0.3%）. We present the case of a patient with tuberculous arthritis in whom the diagnosis was belated due to a lack of familiarity with the disease; here, we emphasize the difficulties associated with the diagnosing joint TB. A 20-year-old man was referred to our department due to swelling of the right knee and the presence of persistent, mild pain for 4 years. The lack of systemic evidence of this disease, the indolent course of disease, and the presence of non- specific symptoms renders early recognition of this disease difficult. Furthermore, in cases in which a diagnosis cannot be reached simply by culturing the synovial fluid, synovial biopsy cultures should be considered m the diagnostic process, due to the high rate of positivity of such cultures. The diagnosis and treatment of articular TB are both urgent matters; surgical debridement and strict adherence to antituberculous chemotherapy tend to yield a satisfactory functional outcome.     

Comparison of the influence of FOV sizes and different voxel resolutions for the assessment of periodontal defects

Objectives:

This study assessed the influence of different voxel resolutions of two different CBCT units on the in vitro detection of periodontal defects.

Methods:

The study used 12 dry skulls with a maxilla and a mandible. Artificial defects (dehiscence, tunnel, fenestration) were separately created on the anterior, premolar and molar teeth using burrs. A total of 14 dehiscences, 13 fenestrations, 8 tunnels and 16 non-defect controls were used in the study. Images were obtained from two different CBCT units in six voxel sizes (voxel size: 0.080, 0.100, 0.125, 0.150, 0.160 and 0.200 mm³). Kappa coefficients were calculated to assess both intra- and interobserver agreements for each image set.

Results:

Overall intraobserver kappa coefficients ranged between 0.978 and 0.973 for the 0.080-mm³ images and between 0.751 and 0.737 for the 0.160-mm³ images, suggesting notably high intraobserver agreement for detecting periodontal defects. CBCT performed significantly better at detecting fenestrations (p < 0.05) than tunnel and dehiscence defects. No statistically significant difference was found between the detection of dehiscence and tunnel defects (p > 0.05).

Conclusions:

A voxel size of 0.150 mm³ was identified as the cut-off point for overall detection of periodontal defects. CBCT should be considered the most reliable imaging modality for the diagnosis of periodontal defects.     

Total hip arthroplasty after prior surgical treatment of hip fracture is it always challenging?

Salvage total hip arthroplasty (THA) presents a viable solution for failed open reduction internal fixation. This study compares salvage THA in patients with prior femoral neck fractures vs patients with prior intertrochanteric fractures. One hundred fifty-four hips in 152 patients underwent conversion from open reduction internal fixation to THA. Eighty-three patients had previous femoral neck fractures, and 69 patients (71 hips) had prior intertrochanteric fractures. Salvage THA in patients with prior intertrochanteric fractures presented a more technically demanding procedure with longer operative times and larger amounts of blood loss. Although conversion THA presents a technically challenging procedure, it is safe and yields relatively few orthopedic complications.     

Robotic Versus Laparoscopic Resection of Large Adrenal Tumors

Background

Although recent studies have shown the feasibility and safety of robotic adrenalectomy, an advantage over the laparoscopic approach has not been demonstrated. Our hypothesis was that the use of the robot would facilitate minimally invasive resection of large adrenal tumors.

Methods

Adrenal tumors ??5?cm resected robotically were compared with those removed laparoscopically from a prospective institutional review board-approved adrenal database. Clinical and perioperative parameters were analyzed using t and chi-square tests. All data are expressed as mean?±?standard error of mean.

Results

There were 24 patients with 25 tumors in the robotic group and 38 patients with 38 tumors in the laparoscopic group. Tumor size was similar in both groups (6.5?±?0.4 [robotic] vs 6.2?±?0.3?cm [laparoscopic], P?=?.661). Operative time was shorter for the robotic versus laparoscopic group (159.4?±?13.4 vs 187.2?±?8.3 min, respectively, P?=?.043), while estimated blood loss was similar (P?=?.147). The conversion to open rate was less in the robotic (4%) versus the laparoscopic (11%) group; P?=?.043. Hospital stay was shorter for the robotic group (1.4?±?0.2 vs 1.9?±?0.1?days, respectively, P?=?.009). The 30-day morbidity was 0 in robotic and 2.7% in laparoscopic group. Pathology was similar between groups.

Conclusions

Our study shows that the use of the robot could shorten operative time and decrease the rate of conversion to open for adrenal tumors larger than 5?cm. Based on our favorable experience, robotic adrenalectomy has become our preferred minimally invasive surgical approach for removing large adrenal tumors.     

Results of total knee arthroplasty in patients with gonarthrosis resulting from the delayed diagnosis of PVNS: a case series

Pigmented villonodular synovitis (PVNS) is a benign tumor that affects synovial lined joints, tendon sheaths and bursae. It is most commonly seen in one knee joint. The recommended treatment is total synovectomy, while radiotherapy can be used as adjuvant therapy for patients at risk for recurrence. The aim of our study was to show that the devastating effects of inactive diffuse PVNS may not be recognized for years and to evaluate the efficiency of aggressive total synovectomy on patients with PVNS during a follow-up period of 5 years. In the present study, 5 knees of four patients who had been previously followed due to gonarthrosis and diagnosed with PVNS during total knee arthroplasty (TKA) were followed and evaluated for a mean duration of 68 months. Mean age of the patients was 61.2 (52–66). All patients were women. One patient had right knee involvement, two had left knee involvement, and one had both knees involved. All patients had diffuse PVNS. Total synovectomy was performed in all patients in addition to TKA. During the follow-up, recurrence was not seen in any of the patients and prosthesis loosening was not detected. The aim of the present study was to evaluate the effectiveness of total synovectomy over the 5 years following the operation and to show that the devastating effects of inactive PVNS may sometimes be overlooked for years before being recognized during the treatment of the gonarthrosis that develops due to the disease. Although the disease is generally monoarticular, the study also presents a patient with bilateral PVNS.     

Inflammatory Pseudotumor of the Spleen: Report of a Case

We report the case of an inflammatory pseudotumor of the spleen in an asymptomatic 55-year-old woman, whose lesion was accidentally found and clinically misdiagnosed to be lymphoma. An inflammatory pseudotumor of the spleen was histopathologically diagnosed following a splenectomy. This lesion is a benign, reactive, and inflammatory process and its etiopathogenesis still remains elusive. The preoperative diagnosis is difficult and the optimal management of the asymptomastic patient with the disease is unclear. This entity should be kept in mind in the differential diagnosis of splenic space-occupying lesions.     

Gemcitabine plus vinorelbine chemotherapy in patients with advanced bladder carcinoma who are medically unsuitable for or who have failed cisplatin-based chemotherapy

Objective: To evaluate the efficacy and toxicity of gemcitabine plus vinorelbine chemotherapy in patients with advanced bladder carcinoma who are unsuitable for or who have failed cisplatin-containing chemotherapy.Patients and Methods: Thirty-one patients with advanced transitional cell carcinoma (TCC) of the bladder were scheduled to receive gemcitabine and vinorelbine chemotherapy. Twenty-one patients had received no prior chemotherapy and their creatinine clearance was below 50 ml/min (group 1), and the remaining 10 patients did not respond to previous cisplatin-containing chemotherapy (group 2).Results: In group 1, objective response rate was 47.6%, including 2 (9.5%) complete and 8 (38.9%) partial responses. In group 2, partial response was observed in 2 (20%) patients. The median survival time for patients in group 1 and 2 were 15 months (range 3–23) and 7 months (range 3–21), respectively. Grades 3 or 4 leukopenia developed in 16.1% of patients. Overall, 12.9% of the patients suffered from grade 3 nonhematologic toxicity.Conclusion: Our preliminary data indicate that the combination of gemcitabine and vinorelbine is active and well tolerated especially in patients with advanced TCC who are unsuitable for cisplatin-based chemotherapy.