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991.
Ando N Kato H Igaki H Shinoda M Ozawa S Shimizu H Nakamura T Yabusaki H Aoyama N Kurita A Ikeda K Kanda T Tsujinaka T Nakamura K Fukuda H 《Annals of surgical oncology》2012,19(1):68-74
Background
Patients with esophageal carcinoma receiving postoperative chemotherapy showed superior disease-free survival than those receiving surgery alone in a Japan Clinical Oncology Group trial (JCOG9204). The purpose of this study was to evaluate optimal perioperative timing??that is, before or after surgery??for providing chemotherapy in patients with locally advanced esophageal squamous cell carcinoma.Methods
Eligible patients with clinical stage II or III, excluding T4, squamous cell carcinoma were randomized to undergo surgery followed (group 1) or preceded (group 2) by chemotherapy consisting of two courses of cisplatin plus 5-fluorouracil. The primary end point was progression-free survival.Results
We randomized 330 patients, with 166 assigned to group 1 and 164 to group 2, between May 2000 and May 2006. The planned interim analysis was conducted after completion of patient accrual. Progression-free survival did not reach the stopping boundary, but overall survival in group 2 was superior to that of group 1 (P?=?0.01). Therefore, the Data and Safety Monitoring Committee recommended early publication. Updated analyses showed the 5-year overall survival to be 43% in group 1 and 55% in group 2 (hazard ratio 0.73, 95% confidence interval 0.54?C0.99, P?=?0.04), where the median follow-up of censored patients was 61.6?months. Concerning operative morbidity, renal dysfunction after surgery in group 2 was slightly higher than in group 1.Conclusions
Preoperative chemotherapy with cisplatin plus 5-fluorouracil can be regarded as standard treatment for patients with stage II/III squamous cell carcinoma. 相似文献992.
Murali R DeSilva C McCarthy SW Thompson JF Scolyer RA 《Annals of surgical oncology》2012,19(4):1089-1099
Background
Some authors have suggested that patients with very small (<0.1 mm) deposits of metastatic melanoma in sentinel lymph nodes (SLNs) should be considered SLN-negative, whereas others have reported that such patients can have adverse long-term outcomes. The aims of the present study were to determine whether extensive sectioning of SLNs resulted in more accurate categorization of histologic features of tumor deposits and to assess prognostic associations of histologic parameters obtained using more intensive sectioning protocols. 相似文献993.
Background
Surgical treatment of advanced hypopharyngeal tumors is still a surgical challenge. We report a case of a hypopharyngeal tumor treated with a pharyngolaryngo-esophagectomy (PLE) and laparoscopic gastric tubulization and interposition.Methods
A 56-year-old man presented with a relapsing hypopharynx carcinoma, after primary chemoradiation therapy. Preoperative workup showed a stage IV cancer with esophageal invasion and multiple cervical lymph node metastases. Surgical treatment consisted of a cervical phase, with larynx, pharynx, and esophagus dissection, radical lymph node dissection, homolateral hemithyroidectomy and definitive tracheostomy, and an abdominal phase with a 4-trocar laparoscopy. The gastrocolic ligament was opened, and short gastric and left gastric vessels were divided preserving an accessory left hepatic artery. Gastric tailoring was carried out with 45-mm linear staplers. The hiatus was opened and the esophagus dissected free with Ultracision (Ethicon Endo-Surgery, Cincinnati, OH) to the tracheal bifurcation. The upper esophagus was bluntly mobilized by finger and sponge stick dissection. The gastric tube was pulled up, and the anastomosis between the stomach and the tongue base was performed with a 2-layer interrupted hand-sewn technique.Results
Total operative time was 390?min (abdominal time 180?min). Estimated blood loss was 400?cc. The number of dissected cervical lymph nodes was 32. Oral feeding was started after 10?days, and the patient was discharged after 14?days. Stage of disease was pT4N1M0 G3 R0.Conclusions
Laparoscopic surgery allows a minimally invasive gastric tailoring and tubulization and transhiatal esophageal dissection and represents a valuable alternative for intestinal reconstruction after PLE.CT scan showing a large hypopharynx carcinoma involving cervical lymph nodes and cervical esophagus 相似文献
994.
Background
Titanium plates represent the predominant implants of choice for fracture care in Central Europe, based on the apparently favourable properties related to improved ??biocompatibility??. The present study was designed to test the hypothesis that the use of stainless steel implants for selected fractures represents a safe and efficient treatment modality, which is not associated with an increased rate of complications and surgical revisions.Methods
We conducted a retrospective analysis of a prospective database during a 5-year study period (01/01/2006?C12/31/2010) at an academic Level 1 Trauma Center on all fractures treated by stainless steel plates. Inclusion criteria consisted of all consecutive patients >15 years of age whose fractures were fixated with a stainless steel plate. All fractures were classified according to the AO/OTA system. Outcome parameters consisted of the rate of complications and surgical revisions, and the data were placed into context with the published complication rates for titanium plates.Results
A total of 1,001 consecutive patients who underwent surgical fixation of fractures in the indication spectrum of this study were screened. Of these, 751 patients fulfilled the inclusion criteria. These patients had 774 fractures which were fixated with 859 stainless steel plates. Open fractures accounted for 9.6% of all injuries (n=74). The complication rate of the 774 fractures treated with stainless steel plates was 8.01% (n=62), with a surgical revision rate of 5.16% (n=40). These data are below the reported incidence of complications and surgical revisions for titanium plates in the identical indication spectrum in the pertinent literature published.Conclusions
The fixation of selected fractures with stainless steel implants represents a safe and efficient treatment option, which does not appear to be associated with increased complication rates. These data challenge the anecdotal superiority of titanium plates and should spur a new discussion on the use of stainless steel implants, particularly under the aspect of cost savings in the DRG era. 相似文献995.
996.
997.
Roman Pfeifer MD Sophie Darwiche MD Lauryn Kohut MA Timothy R. Billiar MD FACS Hans-Christoph Pape MD FACS 《Clinical orthopaedics and related research》2013,471(9):2815-2821
Background
In multiply injured patients, bilateral femur fractures invoke a substantial systemic inflammatory impact and remote organ dysfunction. However, it is unclear whether isolated bone or soft tissue injury contributes to the systemic inflammatory response and organ injury after fracture.Questions/purposes
We therefore asked whether the systemic inflammatory response and remote organ dysfunction are attributable to the bone fragment injection, adjacent soft tissue injury, or both.Methods
Male C57/BL6 mice (8–10 weeks old, 20–30 g) were assigned to four groups: bone fragment injection (BF, n = 9) group; soft tissue injury (STI, n = 9) group; BF + STI (n = 9) group, in which both insults were applied; and control group, in which neither insult was applied. Animals were sacrificed at 6 hours. As surrogates for systemic inflammation, we measured serum IL-6, IL-10, osteopontin, and alanine aminotransferase (ALT) and nuclear factor (NF)-κB and myeloperoxidase (MPO) in the lung.Results
The systemic inflammatory response (mean IL-6 level) was similar in the BF (61.8 pg/mL) and STI (67.9 pg/mL) groups. The combination (BF + STI) of both traumatic insults induced an increase in mean levels of inflammatory parameters (IL-6: 189.1 pg/mL) but not in MPO levels (1.21 ng/mL) as compared with the BF (0.82 ng/mL) and STI (1.26 ng/mL) groups. The model produced little evidence of remote organ inflammation.Conclusions
Our findings suggest both bone and soft tissue injury are required to induce systemic changes. The absence of remote organ inflammation suggests further fracture-associated factors, such as hemorrhage and fat liberation, may be more critical for induction of remote organ damage.Clinical Relevance
Both bone and soft tissue injuries contribute to the systemic inflammatory response. 相似文献998.
Rajarajan PanneerselvanDavid F. Schneider MD MS Rebecca S. SippelHerbert Chen MD FACS 《The Journal of surgical research》2013
Background
Radioactive iodine (RAI) scanning is a method of determining the functional status of thyroid nodules. Historically, practitioners thought “cold” or inactive nodules were more likely malignant. However, surgeons no longer find these scans helpful for preoperative management of euthyroid patients. The purpose of this study was to evaluate the utility of RAI scans.Methods
We retrospectively reviewed cases of euthyroid patients (thyroid-stimulating hormone > 1.0 mIU/L) who underwent RAI scans before thyroid surgery at our institution between 1994 and 2011. We correlated the RAI scan results with final pathology. We considered RAI scans concordant with pathology when we found a malignancy on the same lobe as a cold nodule. We also tabulated the specialty and affiliation of the ordering physicians.Results
A total of 109 euthyroid patients underwent RAI scanning as part of their preoperative workup. Of these, 88 patients (81%) had a cold nodule. A malignancy concordant with the RAI scan findings occurred in only 15 of these patients (17%). Non-surgical specialties ordered 90 scans (95%). Only 11 of these scans (10%) were performed in the past 5 y, and physicians outside the academic institution ordered all 11 (100%) of these. A linear regression of RAI scanning per year yielded a slightly negative slope (m–0.32 per year).Conclusions
Radioactive iodine scanning is not useful for the surgical management of thyroid disease in euthyroid patients because it poorly predicts malignancy. The overall use of RAI scans is trending downward, but they are still ordered by non-surgical referring physicians. 相似文献999.
1000.