Pancreatic Fistulae after Urologic Surgery - A Single Centre Experience

2015 ◽  
Vol 95 (3) ◽  
pp. 346-351 ◽  
Author(s):  
Sebastian Nestler ◽  
Andreas Neisius ◽  
Frederik Roos ◽  
Christian Hampel ◽  
Peter Rubenwolf ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Urothelial Cancer ◽  
Conservative Therapy ◽  
Clinical Course ◽  
Rare Complication ◽  
Urologic Surgery ◽  
First Choice ◽  
Single Centre Experience ◽  
Choice Of Treatment ◽  
Recurrent Malignancy

Introduction: To evaluate incidence, symptoms and management of postoperative pancreatic fistula (POPF) after urologic surgery based on our experience. Material and Methods: Database was searched for clinically evident POPF after urologic surgery between 1998 and 2014. Fistulae were graded using the POPF classification. Clinical course of every POPF patient was evaluated. Results: During this time, 3,200 surgeries for renal, adrenal and retroperitoneal pathologies were performed. Twelve POPF occurred postoperatively in this series. Eight fistulae were POPF grade A, 3 POPF grade B and one POPF grade C. POPF became clinically evident after a median of 3 days (IQR 2-3). In all POPF grade A/B patients, secretion from the pancreatic fistula completely subsided under conservative therapy. In one POPF grade C patient with positive surgical margins of urothelial cancer, conservative treatment failed and the patient died due to POPF-related sepsis. Conclusions: POPF is a rare complication after urologic surgery. Conservative therapy is the first choice of treatment and will be successful in the majority of cases. Pancreatic fistula after surgery of recurrent malignancy may have a poor outcome.

scholarly journals Clinical Course of Laryngeal Granuloma Without Surgical Treatment

2001 ◽  
Vol 7 (3-4) ◽  
pp. 129-133 ◽  
Author(s):  
Satoshi Horiguchi ◽  
Mamoru Suzuki ◽  
Hideo Takagi ◽  
Toshiro Yamanishi ◽  
Kazuhiro Nakamura
Keyword(s):  
Surgical Treatment ◽  
Therapeutic Strategy ◽  
Clinical Course ◽  
Surgical Removal ◽  
Vocal Hygiene ◽  
First Choice ◽  
Choice Of Treatment ◽  
Laryngeal Granuloma

Laryngeal granuloma is a rather common pathological entity, but its therapeutic strategy is still controversial. In general, therapeutic strategy consists of medications such as steroids or tranilast, in addition to vocal hygiene and surgery. Surgical removal is most commonly performed. However, it has recently been reported that recurrence after surgery is high.We successfully treated 19 of 20 cases of laryngeal granuloma without surgical removal. It took 28–328 days for the granulomas to disappear. Therefore conservative treatments should be the first choice of treatment.

Nonsurgical Therapies for Hepatocellular and Cholangiocellular Carcinoma

Swiss Surgery ◽  
1999 ◽  
Vol 5 (3) ◽  
pp. 116-121 ◽  
Author(s):  
Schmassmann
Keyword(s):  
Current Trend ◽  
Percutaneous Ethanol Injection ◽  
Cholangiocellular Carcinoma ◽  
Multidisciplinary Therapy ◽  
Term Survival ◽  
Ethanol Injection ◽  
First Choice ◽  
Tumor Stages ◽  
Choice Of Treatment ◽  
Advanced Stages

Surgical resection is the first choice of treatment for patients with hepatocellular (HCC) and cholangiocellular carcinomas. Prolongation of survival is, however, the only realistic goal for most patients, which can be often achieved by nonsurgical therapies. Inoperable patients with large or multiple HCCs are usually treated with transarterial chemoembolization (TACE) with lipiodol in combination with a chemotherapeutic drug and gelfoam. Three-year survival depends on the stage of the disease and is about 20%. Patients with earlier tumor stages (one or two tumor nodules less than 3cm in size) are suitable for treatment with percutaneous ethanol injection (PEI) alone or in combination with TACE. Several studies have shown that in these early stages, the 3-year survival rate is approximately 55%-70% in the actively treated patients which is significantly higher than in untreated patients. In advanced stages of the disease, TACE and PEI have no effect on survival and should not be performed. Some of these patients have been successfully treated with octreotide. Patients with inoperable cholangiocellular carcinoma are treated by endoscopic or percutaneous stent placement. If stenting does not achieve adequate biliary drainage, multidisciplinary therapy including internal / external radiotherapy or photodynamic therapy should be considered in patients with potential long-term survival. In conclusion, nonresectional therapies play an essential role in the therapy of inoperable hepato- and cholangiocellular carcinomas as they lead to satisfactory survival. Multidisciplinary therapy appears to be the current trend of management.

Surgery of ulcus cruris venosum

Phlebologie ◽  
2010 ◽  
Vol 39 (03) ◽  
pp. 156-162 ◽  
Author(s):  
C. Schwahn-Schreiber
Keyword(s):  
Subcutaneous Tissue ◽  
Ulcus Cruris ◽  
Healing Time ◽  
Ulcus Cruris Venosum ◽  
Venous Stasis ◽  
Morphological Alterations ◽  
First Choice ◽  
Choice Of Treatment ◽  
Chronic Compartment Syndrome ◽  
Shave Therapy

SummaryAdvanced chronic venous stasis syndrome is characterized by irreversible and self-perpetuating morphological alterations in the lower leg. A chronic inflammatory process results in sclerosis, which progresses from the skin to the subcutaneous tissue and ultimately the fascia, sometimes including muscle and ankle joint and leading to chronic compartment syndrome. To cure these severe alterations with non healing ulcers decompression of the compartments like paratibial fasciotomy with SEPS and crural fasciectomy or removal of sclerosis like shave therapy are successful surgical procedures. Indication should be adapted to the extension of ulcer. Indications of the operations and the techniques are described, complications and results are discussed. Due to ulcer extension especially shave therapy (removal of the sclerotic tissue epifascial) and crural fasciectomy (removal of sclerosis including fascia) are very successful with up to 80% healing rate, even in severe cases and even after long term (up to 8 years). Since shave therapy is easy, short and simple with short healing time, few complications and good aesthetical result it is the first choice of treatment for non healing leg ulcers. Fasci ectomy is reserved for special indications such as deep transfascial necrosis or failure of shave therapy.

scholarly journals Generalized tetanus in an 11-year-old boy: A case report

2021 ◽  
Vol 11 (1) ◽  
pp. 69-75
Author(s):  
Artem A. Kozlov ◽  
Irina V. Shevchuk ◽  
Aleksei E. Zavialov ◽  
Anatoly N. Emelyanov
Keyword(s):  
Case Report ◽  
Respiratory Failure ◽  
Gastrointestinal Tract ◽  
Pain Relief ◽  
Antibiotic Therapy ◽  
Clinical Course ◽  
Treatment Strategies ◽  
Adequate Pain Relief ◽  
Choice Of Treatment ◽  
Severe Tetanus

The study presents a case report of a generalized form of severe tetanus in an unvaccinated 11-year-old child. Pain and convulsive syndromes, respiratory failure, and damage to the gastrointestinal tract prevailed in the acute period. Antibiotic therapy, anti-tetanus serum, adequate pain relief, and anticonvulsant therapy were the leading treatments of the child. Moreover, the paper discusses literature data on the options for the clinical course and choice of treatment strategies. The lack of planned vaccination in children is unsafe.

scholarly journals Not All Embolizations Are Created Equally in the Management of Posterior Epistaxis: Discussion of Safety Measures Avoiding Neurological Complications

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Mareike Franke ◽  
Jasper Franke ◽  
Christian Saager ◽  
Sven Barthel ◽  
Randolf Riemann ◽  
...  
Keyword(s):  
Neurological Complication ◽  
Neurological Complications ◽  
Surgical Approaches ◽  
Success Rates ◽  
Artery Ligation ◽  
Retrospective Data Analysis ◽  
First Choice ◽  
Surgical Methods ◽  
Choice Of Treatment ◽  
Meta Analyses

Today, there are still no uniform guidelines for the treatment of epistaxis. Furthermore, it is widely debated whether embolization or surgical approaches should be the first choice of treatment for intractable posterior epistaxis after conservative measures have failed. In several meta-analyses, it is reported that endoscopic sphenopalatine artery ligation and embolization have similar success rates, but embolization was associated with more severe neurological complications. Regarding existing literature, there are many comparative analyses of surgical methods but none for embolization protocols. Against this backdrop of a lack of uniform standards in embolization techniques, we present a retrospective evaluation of what has emerged to be best procedural practice for endovascular treatment of epistaxis in our department using microsphere particles and microcoils, in particular regarding precaution measures to avoid neurological complications. In our retrospective data analysis of 141 procedures in 123 patients, performed between 2008 and 2019, we find success rates very similar to those reported in other studies (95.1% immediate-stop-of-bleeding success and 90.2% overall embolization success) but did not encounter any major neurological complication opposed to other reports. We suggest some aspects of our protocol as precaution measure to avoid neurological complications. More generally and perhaps even more importantly, we make a strong case for standardization for embolization techniques to the level of details in surgical procedure standardization to enable an apples to apples comparison of embolization techniques to each other and of intervention vs. surgery.

scholarly journals COVID-19 and Total Laryngectomy—A Report of Two Cases

2020 ◽  
Vol 130 (1) ◽  
pp. 104-107
Author(s):  
Alberto Paderno ◽  
Milena Fior ◽  
Giulia Berretti ◽  
Francesca Del Bon ◽  
Alberto Schreiber ◽  
...  
Keyword(s):  
Airway Management ◽  
Total Laryngectomy ◽  
Oxygen Therapy ◽  
Clinical Course ◽  
Support Staff ◽  
Vulnerable Population ◽  
Case Presentation ◽  
Anatomical Changes ◽  
Choice Of Treatment

Objective: To date, no cases have been reported on the effects of COVID-19 in laryngectomees. Case Presentation: We herein presented two clinical cases of laryngectomized patients affected by COVID-19, detailing their clinical course and complications. Discussion: In our experience, permanent tracheostomy did not significantly affect the choice of treatment. However, dedicated devices and repeated tracheal toilettes may be needed to deal with oxygen-therapy-related tracheal crusting. Conclusion: In conclusion, laryngectomees should be considered a vulnerable population that may be at risk for worse outcomes of COVID-19 due to anatomical changes in their airways. The role of the ENT specialist is to guide airway management and inform the support-staff regarding specific needs of these patients.

scholarly journals Treatment of Intramedullary Arteriovenous Malformations of the Spinal Cord

2000 ◽  
Vol 6 (1_suppl) ◽  
pp. 203-207 ◽  
Author(s):  
S. Ushikoshi ◽  
K. Hida ◽  
Y. Kikuchi ◽  
Y. Iwasaki ◽  
K. Miyasaka ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Arteriovenous Malformations ◽  
Radical Excision ◽  
Arteriovenous Fistulas ◽  
First Choice ◽  
Choice Of Treatment ◽  
Technical Complication ◽  
Surgical Manipulation ◽  
Residual Lesions

We retrospectively reviewed our treatment results for spinal intramedullary arteriovenous malformations (AVMs). Fifteen consecutive patients were included in this syudy. Five patient underwent particulate embolization. Surgery was performed in ten patients (including two patient who were treated embolization initially). Five patients, at the beginning of our experience, underwent radical excision of the nidus via the posterior myelotomy. Recent five patients underwent interruption of the feeding pedicles on the surface of the spinal cord. Especially when arteriovenous fistulas (AVFs) or aneurysms were demonstrated, accurate obliteration of them were performed. Four patients, including two with residual AVM after the surgery, underwent irradiation therapy. Anatomically, four AVMs disappeared completely and the other 11 patients have a residual lesions after the treatment. Clinically, three patients improved, six remained unchanged, and six worsened. The causes of neurological deterioration after the treatment were technical complication of embolization in one patient and surgical manipulation in five. There was no patient who experienced hemorrhage during the follow-up period ranged from 6 months to 17 years, with a mean of 7.5 years. In conclusion, particulate embolization should be considered as the first choice of treatment if feasible. Surgical treatment is indicated for the dangerous anatomical features such as AVFs or aneurysms.

scholarly journals Pseudophacocele following a Bicycle Handle Injury: A Case Report

2018 ◽  
Vol 10 (1) ◽  
pp. 94-97
Author(s):  
Sahil Thakur ◽  
Parul Ichhpujani ◽  
Suresh Kumar
Keyword(s):  
Visual Acuity ◽  
Case Report ◽  
Blunt Trauma ◽  
Surgical Management ◽  
Clinical Course ◽  
Rare Complication ◽  
Vitreous Haemorrhage ◽  
Visual Outcomes ◽  
Subconjunctival Space ◽  
The Right

Background: Pseudophacocele is a rare complication of blunt trauma in pseudophakic eyes.Case: We present a case of 60-year-old male who presented with pseudophacocele after injury from a bicycle handle. On presentation, visual acuity in the right eye was perception of light (PL) in 2 quadrants (superior and temporal) and left eye was 20/20. A PCIOL was seen superonasally in the right subconjunctival space with total hyphaema. Ultrasound demonstrated vitreous haemorrhage with membranes in right eye. We describe the surgical management and further clinical course of the patient.Conclusion: It is imperative to surgically manage these challenging cases. Despite optimum care visual outcomes are guarded in patients with severe blunt trauma.

scholarly journals Trans-Olecranon Fracture-Dislocations of the Elbow: A Systematic Review

Diagnostics ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. 1058
Author(s):  
Chul-Hyun Cho ◽  
Du-Han Kim ◽  
Sang Soo Na ◽  
Byung-Chan Choi ◽  
Beom-Soo Kim
Keyword(s):  
Systematic Review ◽  
Positive Outcome ◽  
Olecranon Fracture ◽  
Dash Score ◽  
Eligibility Criteria ◽  
First Choice ◽  
Retrospective Clinical Study ◽  
Flexion Extension ◽  
Choice Of Treatment ◽  
Fracture Dislocations

The purpose of this study is to provide a systematic review of the definition, ideal surgical method, complications, and prognosis of trans-olecranon fracture dislocations. An electronic search was performed in the PubMed, EMBASE, Scopus, and MEDLINE databases. The eligibility criteria included retrospective clinical study and review article in subjects older than 18 years with trans-olecranon fracture dislocations. Trans-olecranon fracture dislocations are defined as fractures in which the stability of the ulnohumeral joint is lost due to the intra-articular fracture of the olecranon without disruption of the proximal radioulnar joint. The seven papers were included that met the eligibility criteria for the quantitative synthesis. Findings indicate that a pre-contoured plate was used in 88.3% of cases (68 of 77 reports), with no reports of complications, suggesting that the pre-contoured 3.5 mm plate is the first choice of treatment. Postoperative mean elbow range of motion for the flexion–extension arc was 121.1° and 146.5° for the pronation-supination arc. Methods for postoperative clinical scores included the Broberg/Morrey rating with a result of excellent or good in 82.9% of cases, the ASES score with a mean of 88.7, and the DASH score with a mean of 11.75. Complications included heterotopic ossification in 21.9% (23/105) of cases, arthrosis in 25.7% (27/105) of cases, nerve damage in 18.1% (19/105) of cases, and osteoarthritis in 14.3% (15/105). With better understanding of the mechanism of injury and proper diagnosis and treatment, findings of the current review suggest a positive outcome. PROSPERO registration No.: CRD42019126568.

scholarly journals How to evaluate diagnosis and management of biliary atresia in the era of liver Transplantation in China

2018 ◽  
Vol 1 (1) ◽  
pp. e000002
Author(s):  
Jianghua Zhan ◽  
Yajun Chen ◽  
Kenneth K Y Wong
Keyword(s):  
Liver Transplantation ◽  
Survival Rate ◽  
Early Diagnosis ◽  
Biliary Atresia ◽  
Further Education ◽  
Monitoring Methods ◽  
Kasai Operation ◽  
First Choice ◽  
Choice Of Treatment ◽  
Hepatobiliary Diseases

BackgroundBiliary atresia (BA) is one of the most challenging hepatobiliary diseases in children. Notwithstanding the reasonable outcome of liver transplantation (LT), portoenteral anastomosis (Kasai operation) is still the first choice of treatment for patients with BA. How to improve the survival rate of the patients with BA in the era of LT is a new challenge.Data sourcesBased on recent original publications and the experience with the BA in China, we review many factors that influence BA survival situation, including early diagnosis and screen plan, defects of early treatment, Kasai operation, and LT and indicate present questions about BA diagnosis and treatment in China.ResultsBA diagnosis may also be delayed due to insufficient understanding of BA and lack of jaundice monitoring methods at different levels of the hospitals in China. Further education of the physicians at smaller city hospitals about BA, neonatal jaundice and cholestasis would be helpful in improving early diagnosis of BA. Early surgical intervention is still the only guarantee to improve the survival rate of BA with native liver.ConclusionsIn the era of LT, especially in China, Kasai operation can provide waiting time for living donor LT and improve the success rate of LT and minimize the rapid deterioration of liver function of the children with BA and decrease the mortality in patients with BA.

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