scholarly journals Standard Surgical Approaches to Primary Choledocholithiasis — Definitive Versus Temporary Decompression

HPB Surgery ◽  
1992 ◽  
Vol 6 (1) ◽  
pp. 35-49
Author(s):  
António Castro Mendes de Almeida ◽  
Fernando José Aldeia ◽  
Noel Medina dos Santos ◽  
Caetano Winston Gracias
Keyword(s):  
Revisional Surgery ◽  
Imaging Techniques ◽  
Intraoperative Imaging ◽  
Long Term Results ◽  
Surgical Approaches ◽  
Anastomotic Complications ◽  
T Tube ◽  
Group A ◽  
Group B

The occurrence of retained/recurrent calculi after primary CBDE followed by temporary T-tube decompression, have remained at rates varying from 5.4% to 20.9% over the last 10 years in spite of sophisticated pre and intraoperative imaging techniques. It is postulated that a functional obstruction, due to dysmotility of the SO, lies behind most stone-containing ducts. Thus it seems logical to us that a permanent “fenestration” should be the management of most such ducts.We prospectively followed-up, for one to 10 years, two groups of patients submitted to primary CBDE aiming to assess the short and long-term results of two different surgical approaches to duct lithiasis. In one (Group A) 162 CBDE's were performed, out of 680 CHE's (24%), with a “positivity” of 68% and in the other (Group B) 80 CBDE's, out of 438 CHE's (18%), with a “positivity” of 70%. In Group A a T-tube decompression was used in 79(49%) and a definitive drainage in 83(51%) whereas in Group B the T-tube was employed in only 3(4%) and some form of permanent “fenestration” in 77(96%). There were no significant differences between the operative mortality rates, which were 2.5% in Group A (1 death post T-tube, 3 post CDJ) and 1.3% in Group B (1 death post CDD). The long-term results, though, were significantly worse among patients of Group A whose ducts were temporarily decompressed: 10/79 (12.7%) required further aggressive interventional therapy for retained/recurrent stones while only 3.8% (3/80) in Group A and 1.3% (1/76) in Group B required revisional surgery for bilio-digestive anastomotic complications with cholangitis.It is concluded that it is against the long-term efficiency of the approach utilized in Group B that the new laparoscopic techniques should be compared.

scholarly journals Surgical treatment of pulmonary sequestration in adults and children: long-term results

2020 ◽  
Vol 31 (1) ◽  
pp. 71-77
Author(s):  
Beatrice Trabalza Marinucci ◽  
Giulio Maurizi ◽  
Camilla Vanni ◽  
Giuseppe Cardillo ◽  
Camilla Poggi ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Respiratory Symptoms ◽  
Pulmonary Sequestration ◽  
Adult Patients ◽  
Long Term Results ◽  
Study Results ◽  
Group A ◽  
Group B ◽  
Histological Results

Abstract OBJECTIVES Few experiences comparing paediatric and adult patients treated for pulmonary sequestration (PS) have been reported. Surgical treatment is considered the best choice, but the time of surgery is still controversial. We present our experience in this setting, comparing characteristics, histological results and outcome of paediatric and adult patients undergoing PS resection. METHODS Between 1998 and 2017, a total of 74 patients underwent lobectomy or sublobar resection for PS. Sixty patients were children (group A: ≤16 years old) and 14 were adults (group B: >16 years old). Preoperative diagnosis was radiological. PS was intralobar (42 cases) and extralobar (32 cases). The operation was a muscle-sparing lateral thoracotomy or video-assisted thoracoscopic surgery. Preoperative characteristics, histological results and short-/long-term results of the 2 groups were retrospectively analysed and compared. RESULTS Thirty-seven percent of the patients in group A presented with respiratory symptoms and 79% in group B (P = 0.44). Most symptomatic patients were treated with a lobectomy. In group A, 2 patients (3%) had a malignant transformation of the lesion. Patients with a prenatal diagnosis treated after the age of 1 year became more symptomatic than those operated on before the age of 1 year (57% vs 23%; P = 0.08). No differences were found in postoperative complications. Long-term stable remission of respiratory symptoms was obtained in 91% of patients in group A and 100% in group B. Adulthood (P = 0.03) and the association with congenital cystic adenomatoid malformation (P = 0.03) were negative prognostic factors for the development of respiratory symptoms. CONCLUSIONS Surgical treatment of PS is safe and feasible. Despite the small number of patients included, study results indicated that an early operation during childhood may prevent the subsequent development of respiratory symptoms. Surgical treatment is also recommended to prevent the rare transformation into malignancy.

Preoperative Intra-Arterial Mitomycin-C in the Management of Sigmoid Adenocarcinoma: Long-Term Results of a Pilot Study

1994 ◽  
Vol 80 (5) ◽  
pp. 339-343
Author(s):  
Giovanni Battista Secco ◽  
Roberto Fardelli ◽  
Elisabetta Campora ◽  
Mario Roberto Sertoli ◽  
Giovanni De Caro ◽  
...  
Keyword(s):  
Pilot Study ◽  
Sigmoid Colon ◽  
Mitomycin C ◽  
Mesenteric Artery ◽  
Long Term Results ◽  
Curative Surgery ◽  
Arterial Infusion ◽  
Group A ◽  
Group B

Aims and background In patients undergoing potentially curative surgery for colorectal adenocarcinoma, the presence of occult disease is thought to be responsible for distant metastases, particularly of the liver. During the 1980's preoperative intra-arterial chemotherapy was used in patients with adenocarcinoma of the sigmoid colon since it was thought that the biological effects induced by radiation in rectal lesions could be induced by cytotoxic agents in sigmoid cancer which was found to be less sensitive to radiation. The aim of the present paper is to report long-term results of an early pilot study on 20 patients with sigmoid colon adenocarcinoma treated with a 6 preoperative intra-arterial infusion of mitomycin-C followed by curative surgery. Methods From January 1980 to December 1986, 20 patients with adenocarcinoma of the sigmoid colon were treated with a 6 hours preoperative intra-arterial infusion of mitomycin-C followed by potentially curative surgery (Group A). Eighteen hours prior to surgery the patients underwent selective arteriography of the inferior mesenteric artery through puncture of the femoral artery at the inguinal fold. The Seldinger technique was applied and Cook BP6 catheter was used. At the end of the examination, the catheter was positioned in the inferior mesenteric artery and mitomycin-C, 10 mg/m2, was infused in 500 mi of normal saline over a 6 hours period after which the catheter was definitively removed. Within 18 hours following intra-arterial mitomycin-C infusion all 20 patients underwent potentially curative surgery of their sigmoid adenocarcinoma. During the same period, 48 comparable sigmoid colon cancer patients underwent potentially curative resection alone (Group B). Results At 5 years overall recurrence rate was 30% and 39.6% in Group A and B patients, respectively (P = n.s.). In patients with Stage C disease, recurrence was less frequently observed in Group A (44.4%) than in Group B (77.7%) (P = n.s.). Overall survival at 5 years was comparable in the two groups of patients (70% and 64% for Group A and B, respectively) and median survival was >60 months in both groups. In patients with Stage C lesions, there was a trend for improved survival at 5 years in Group A patients (55%; median >60 months) compared to Group B (22%; median 27 months) patients (P = n.s.). Conclusions Although the difference indicating decreased recurrences and improved survival for Stage C patients treated with preoperative intra-arterial mitomycin-C were not statistically significant, the long term results of this small pilot study are encouraging.

Surgical Versus Non-Surgical Treatment of Calcaneal Fractures in Children: A Long-term Results Comparative Study

2000 ◽  
Vol 21 (10) ◽  
pp. 825-832 ◽  
Author(s):  
Francesco Ceccarelli ◽  
Cesare Faldini ◽  
Franco Piras ◽  
Sandro Giannini
Keyword(s):  
Surgical Treatment ◽  
Skeletal Maturity ◽  
Long Term Results ◽  
Calcaneal Fractures ◽  
Articular Fractures ◽  
Fractures In Children ◽  
Group A ◽  
Group B ◽  
Non Surgical Treatment

This study compared surgical and non-surgical treatment of 46 calcaneal fractures in children aged 3-17 years. Patients were divided into: Group A ranging 3-14 years and Group B 15-17 years, and classified according to surgical or non-surgical treatment. Mean follow-up was 22.8 years. Extra-articular fractures were treated non-surgically and all results were satisfactory. Results of articular fractures in Group A were satisfactory regardless of the type of treatment. Articular fractures surgically treated in group B were satisfactory, and those non-surgically treated were mainly poor. Extra-articular fractures can be treated non-surgically. Articular fractures in skeletally immature children can be treated non-surgically; conversely, those in children with skeletal maturity must be treated surgically.

scholarly journals A comparative study of the effectiveness and safety of injectable combination therapy of keloid and hypertrophic scars with 5-fluorouracil and betamethasone

2020 ◽  
Vol 23 (6) ◽  
pp. 432-442
Author(s):  
Evgeniya V. Ikonnikova ◽  
Larisa S. Kruglova ◽  
Nataliya E. Manturova ◽  
Marina A. Petrii
Keyword(s):  
Long Term Results ◽  
Intralesional Injection ◽  
Hypertrophic Scars ◽  
Average Decrease ◽  
Group A ◽  
Intralesional Injections ◽  
Group B ◽  
Methods Of Treatment

therapy for their reliable removal. Standard methods of treatment often give unpredictable results, are accompanied by various complications, and require the use of expensive equipment. AIM: To investigate the efficacy and safety of intralesional injection of a combination of 5-fluorouracil (5-FU) and betamethasone for the treatment of keloids and hypertrophic scars. MATERIALS AND METHODS: The study involved 26 patients who were divided into two equal groups. Patients in group A received intralesional injections of betamethasone, and those in group B received 5-FU and betamethasone. Three injections were performed with an interval of 3 weeks. The scars were assessed at the beginning of the treatment, on the 3rd and 6th week during the treatment, and 4 and 16 weeks after the end of the treatment. The dynamics of scar condition was evaluated by the average decrease in the scar height and density, changes in subjective sensations, and the presence or absence of complications. RESULTS: At 4 weeks after the end of the therapy, the total effectiveness of reducing the initial scar height was significantly higher in group B (10 patients; 76.9%) than in group A (6; 46.1%). In the comparison of long-term results at 16 weeks after treatment, 92.3% of the patients from group B and 53.8% of the patients from group A showed cessation of scar growth, flattening and softening, diminished itching and pain, smoothing of the scar contour, and a decrease in the color of the border between the scar and surrounding tissues. CONCLUSIONS: The combination of betamethasone with 5-FU is safer and more effective than monotherapy with betamethasone or 5-FU in the treatment of keloid and hypertrophic scars, with a faster and more pronounced decrease in the height and density of the scar, erythema, and subjective sensations. This mode of therapy is characterized by a low relapse rate with prolonged follow-up. The article is of interest to practicing cosmetologists, dermatologists, and plastic surgeons.

Comparison of the long-term outcome of cemented Charnley low-friction arthroplasty with hybrid arthroplasty in patients with congenital hip disease

2019 ◽  
Vol 101-B (9) ◽  
pp. 1050-1057
Author(s):  
Kalliopi Lampropoulou-Adamidou ◽  
George Hartofilakidis
Keyword(s):  
Operating Time ◽  
Long Term Results ◽  
Low Friction ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Significant Difference ◽  
Hip Disease ◽  
Group A ◽  
Group B

Aims To our knowledge, no study has compared the long-term results of cemented and hybrid total hip arthroplasty (THA) in patients with osteoarthritis (OA) secondary to congenital hip disease (CHD). This is a demanding procedure that may require special techniques and implants. Our aim was to compare the long-term outcome of cemented low-friction arthroplasty (LFA) and hybrid THA performed by one surgeon. Patients and Methods Between January 1989 and December 1997, 58 hips (44 patients; one man, 43 woman; mean age 56.6 years (25 to 77)) with OA secondary to CHD were treated with a cemented Charnley LFA (group A), and 55 hips (39 patients; two men, 37 women; mean age 49.1 years (27 to 70)) were treated with a hybrid THA (group B), by the senior author (GH). The clinical outcome and survivorship were compared. Results At all timepoints, group A hips had slightly better survivorship than those in group B without a statistically significant difference, except for the 24-year survival of acetabular components with revision for aseptic loosening as the endpoint, which was slightly worse. The survivorship was only significantly better in group A compared with group B when considering reoperation for any indication as the endpoint, 15 years postoperatively (74% vs 52%, p = 0.018). Conclusion We concluded that there was not a substantial difference at almost any time in the outcome of cemented Charnley LFAs compared with hybrid THAs when treating patients with OA of the hip secondary to CHD. We believe, however, that after improvements in the design of components used in hybrid THA, this could be the method of choice, as it is technically easier with a shorter operating time. Cite this article: Bone Joint J 2019;101-B:1050–1057.

scholarly journals Long term results of radiotherapy in vulvar cancer patients in Slovenia between 1997–2004

2017 ◽  
Vol 51 (4) ◽  
pp. 447-454 ◽  
Author(s):  
Helena Barbara Zobec Logar
Keyword(s):  
Vulvar Cancer ◽  
Primary Tumour ◽  
Combined Treatment ◽  
Primary Treatment ◽  
Long Term Results ◽  
Lymph Node Status ◽  
Pelvic Area ◽  
Group A ◽  
Group B

Abstract Background The aim of this retrospective single institution study was to analyse long term results of vulvar cancer treatment with conventional 2D radiotherapy in Slovenia between years 1997–2004. Patients and methods Fifty-six patients, median age 74.4 years +/- 9.7 years, mainly stage T2 or T3, were included in the study. All patients were treated with radiotherapy, which was combined with surgery (group A), used as the primary treatment (group B) or at the time of relapse (group C). Chemotherapy was added in some patients. Histology, grade, lymph node status, details of surgery, radiation dose to the primary tumour, inguinofemoral and pelvic area as well as local control (LC) and survival were evaluated. Results Overall survival (OS), disease specific survival (DSS) and LC rates at 10-years for all patients were as follows: 22.7%, 34.5% and 41.1%, respectively. The best 10-years results of the treatment were achieved in the primary operated patients treated with adjuvant radiotherapy +/-chemotherapy (OS 31.9%, DSS 40.6% and LC 47.6%). Positive lymph nodes had a strong influence on LC. In case of positive nodes LC decreased by 60% (p = 0.03) and survival decreased by 50% (p = 0.2). There was a trend to a better LC with higher doses ≥ 54.0 Gy (p = 0.05). Conclusions The best treatment option for patients with advanced vulvar cancer is combined treatment with surgery and radiotherapy +/- chemotherapy, if feasible. Radiotherapy with the dose of ≥ 54.0 Gy should be considered to achieve better LC if positive adverse factors are present.

Tripod allograft in reconstruction of incudal lesions

1994 ◽  
Vol 108 (3) ◽  
pp. 206-211 ◽  
Author(s):  
Michal Luntz ◽  
Talia Mark Bentacur ◽  
Jacob Sadé
Keyword(s):  
Pathological Condition ◽  
Long Term Results ◽  
Indication For Surgery ◽  
Retraction Pocket ◽  
Graft Extrusion ◽  
Group A ◽  
Group B ◽  
Better Than

AbstractLong-term results of allograft ossiculoplasty with erosion of the long process of the incus in 44 patients are described. The pyramidal-shaped allograft leans on the stapes, the remaining part of the incus and the side of the malleus - forming a ‘tripod’ shape or construction.The study includes two groups of patients: group A (34 patients) in whom the pre-operative three-frequency average air-bone gap was 20 dB or more and group B (10 patients), in whom the pre-operative air-bone gap was less than 20 dB. In the latter group the indication for surgery was not their hearing loss, but a different pathological condition (infected retraction pocket, a cholesteatoma, etc.) which necessitated surgical disconnection of the chain during the operation.The average period of follow-up 46 months for group A and 24.9 months for group B. In group A, the preoperative average air-bone gap was 33 dB. Following surgery, the air-bone gap was 20 dB or less in 27 ears (79 per cent), and 10 dB or less in 18 of them (53 per cent). In group B, pre-operatively, the average air-bone gap was 11 dB. Following surgery, the air-bone gap was either better than before the operation or did not increase by more than 5 dB in eight patients (80 per cent).Comparison of the audiometric results of 20 patients after mean follow-up times of 23.8 months and 64.9 months shows that no deterioration of hearing occurred in the intervening period. Graft extrusion was not observed in any of the operated ears.

Partial Ipsilateral C7 Transfer to the Upper Trunk for C5-C6 Avulsion of the Brachial Plexus

Neurosurgery ◽  
2011 ◽  
Vol 70 (5) ◽  
pp. 1176-1182 ◽  
Author(s):  
Hua-Wei Yin ◽  
Su Jiang ◽  
Wen-Dong Xu ◽  
Lei Xu ◽  
Jian-Guang Xu ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
External Rotation ◽  
Elbow Flexion ◽  
Suprascapular Nerve ◽  
Long Term Results ◽  
Shoulder Abduction ◽  
Novel Approach ◽  
Group A ◽  
Group B

Abstract BACKGROUND: Ipsilateral whole C7 root transfer has been reported in treating C5-C6 avulsion. To minimize donor deficits, partial ipsilateral C7 (PIC7) transfer was developed. OBJECTIVE: To investigate the long-term results of PIC7 transfer to the upper trunk in treating C5-C6 avulsion of the brachial plexus. METHODS: We prospectively studied 8 young adults with C5-C6 avulsion. Five patients (group A) who also had spinal accessory nerve (SAN) injury underwent PIC7 transfer to the upper trunk. The other 3 patients (group B) without SAN injury underwent a combination of PIC7 to the upper trunk and the SAN to the suprascapular nerve (SSN). Postsurgical evaluations including donor deficits, functional recovery, and co-contraction of the muscles were performed 1 week later and then at intervals of 3 months. RESULTS: After a mean period of 39.2 months, all subjects were found to have gained elbow flexion of 110 to 150° with muscle strength of M4-5. The patients in group B achieved external rotation of 60 to 70° at M3-4, and 2 achieved shoulder abductions approaching 180° at M4. The patients in group A showed no active external rotation and shoulder abduction of 25 to 50° at M2-3. The temporary deficits caused by PIC7 transfer disappeared in all subjects within the first 3 months. Co-contraction of the latissimus dorsi against the deltoid was recorded in group A but not in group B. CONCLUSION: PIC7 transfer, when combined with SAN transfer to SSN as a novel approach, is a safe, easy, and efficacious surgical procedure for patients with simple C5-C6 avulsion.

scholarly journals The use of doxazosin before adrenalectomy for pheochromocytoma: is the duration related to intraoperative hemodynamics and postoperative complications?

2020 ◽  
Vol 52 (11) ◽  
pp. 2079-2085
Author(s):  
Hao Kong ◽  
Nan Li ◽  
Jie Tian ◽  
Zhengqing Bao ◽  
Lu Liu ◽  
...  
Keyword(s):  
Postoperative Outcomes ◽  
Receptor Blocker ◽  
Surgical Approaches ◽  
Final Dose ◽  
Vasopressor Support ◽  
Preoperative Administration ◽  
Peking University ◽  
Group A ◽  
Group B

Abstract Purpose No conclusion exists for the optimum duration of preoperative administration of doxazosin (DOX) before adrenalectomy for pheochromocytoma. The purpose of this study is to investigate whether perioperative hemodynamics and postoperative outcomes are related to the duration of DOX administration. Methods In total, 132 patients managed preoperatively with single α-receptor blocker DOX were enrolled. All patients underwent adrenalectomy for pheochromocytoma in the Department of Urology, Peking University First Hospital, between January 2001 and July 2019. Patients were divided into three groups based on the duration of preoperative administration of DOX: group A (≤14 days), group B (15–30 days), and group C (>30 days). Patient and tumor characteristics, intraoperative hemodynamics, and postoperative outcomes were recorded and compared. Results These patients included 57 men and 75 women, with an average age of 48 years. Clinical characteristics, preoperative hemodynamics, medicine management and surgical approaches were comparable between the three groups. Among the three groups, we found that group C (>30 days) had the lowest intraoperative minimum heart rate [group A vs. group B vs. group C = 60 (52–67) vs. 59 (50–61) vs. 51.5 (50–58.75), p = 0.024] and highest risk of postoperative hypotension requiring vasopressor support [group A vs. group B vs. group C = 14 (20.3%) vs. 12 (27.9%) vs. 10 (50.0%), p = 0.032]. Conclusion The current study indicated that preoperative management of pheochromocytoma with single α-receptor blocker DOX for more than 30 days after final dose adjustment might lead to intraoperative bradycardia and more postoperative hypotension requiring vasopressor support. Thus, our study does not support long-term (over 30 days) preoperative administration of pheochromocytoma with single α-receptor blocker DOX in the final dose.

Difference in Outcome Following Surgery for Native Aortic and Mitral Valve Infective Endocarditis

2018 ◽  
Vol 67 (08) ◽  
pp. 652-658 ◽  
Author(s):  
Tuukka Kaartama ◽  
Shahab Nozohoor ◽  
Malin Johansson ◽  
Johan Sjögren ◽  
Pedro Timane ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Mitral Valve ◽  
Aortic Valve ◽  
Long Term Results ◽  
Native Valve ◽  
Group A ◽  
Short And Long Term ◽  
The Mean ◽  
Group B

Background We investigated differences in clinical presentation, microbiology, and short- and long-term results according to the affected valve in patients who underwent surgery for left-sided native valve infective endocarditis (IE). Methods This was a single-center retrospective study of 117 patients with isolated mitral valve IE (group M) and 140 patients with isolated aortic valve IE (group A) who underwent surgery between 1998 and 2015. Results The mean age of patients in group M was 62 ± 14 years, whereas in group A the patients were 56 ± 14 years old (p = 0.001). There were 61 females (52% of patients) in group M and 31 females (22% of patients) in group A (p < 0.001). Abscesses were more common in group A than in group B. Staphylococcus aureus was more frequent in group M (47%, n = 55) than in group A (21%, n = 30; p < 0.001). The length of time from symptom onset to surgery was longer in group A than in group M, but the time from diagnosis to surgery was shorter in group A than in group M. Ninety-day mortality was similar in group M and group A in patients operated within 48 hours after diagnosis, but in patients who were operated more than 48 hours after diagnosis the 90-day mortality was 15% in group M and 3% in group A (p = 0.006). Conclusion There were considerable differences in preoperative characteristics, microbiology, timing of surgery, and outcomes between patients who underwent surgery for isolated aortic valve IE and those who were operated for isolated mitral valve IE.

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