A malignant small round cell tumor of the thoracopulmonary region arising in childhood has been described by Askin and colleagues. Subsequent descriptions have emphasized refinements (or disagreements) regarding pathology and emphasized the usual poor outcome. Complete excision has not been uniformly attempted in previous series. Our purpose is to describe superior results possible in a multidisciplinary setting emphasizing complete surgical excision.

Adult↗

PubMedDate not supplied

Pleuroperitoneal shunt for malignant pleural effusions: a one-year experience.

Malignant pleural effusions are often debilitating conditions for the patient with advanced cancer. Traditionally, treatment has been repeated thoracentesis or tube thoracostomy with installation of sclerosing agents. This, however, required the patient to be hospitalized and subjected to the pain and inconveniences of the chest tubes. The drainage also had to be low enough for sclerotherapy to be effective. In 1982, the pleurovenous shunt was modified and the pleuroperitoneal shunt became a feasible alternative to sclerotherapy. We started using the Denver pleuroperitoneal shunt in July 1991. Seventeen shunts were inserted into 13 patients over a 1-year period ending June 30, 1992. All patients were relieved of their dyspnea. The average length of patency was 2.5 months, and fewer than 25% of the shunts clotted. Our favorable experience with the shunt has lead us to recommend the Denver pleuroperitoneal shunt for the treatment of recurrent malignant effusions.

Catheterization↗

PubMedDate not supplied

An amphotericin B-resistant case of rhinocerebral mucor mycosis.

A 51-year-old male patient with diabetes mellitus complicated by ketoacidotic imbalance developed a rhinocerebral mucor mycosis that advanced despite early amphotericin B therapy and extensive surgical intervention. The MIC of amphotericin B for the isolated mucor species was 64 mg/l, meaning that in vitro resistance also existed. Only long-term treatment with ketoconazole (600 mg/day, perorally) was successful in curing the disease.

Amphotericin B↗

PubMedDate not supplied

Advances in gynecologic laparoscopic procedures.

Most gynecologic procedures can be accomplished using laparoscopic surgical techniques. Gynecologic laparoscopic procedures are described that involve the reproductive system, lymph node sampling, bowel and urinary tract repair, and abscess therapy. Laparoscopic surgery enhances the outcome of most current gynecologic procedures.

Female↗

PubMedDate not supplied

Uterine myomas: treatment options.

Myomas (also called fibroids) are the most common solid pelvic tumors. Treatment options for myomas include medical and surgical management. The goals of medical management are to shrink the myoma and reduce its blood supply. Surgical interventions include therapies for women who wish to preserve fertility or retain their uterus. Newer treatment options include myomectomy achieved through an abdominal, laparoscopic, or hysteroscopic approach. Nurses assess and counsel women regarding treatment options.

Female↗

PubMedDate not supplied

Reduction of laparoscopic-induced hypothermia, postoperative pain and recovery room length of stay by pre-conditioning gas with the Insuflow device: a prospective randomized controlled multi-center study.

OBJECTIVE: To assess the efficacy and safety of Insuflow (Georgia BioMedical, Inc.) filter heater hydrator device in reducing the incidence, severity and extent of hypothermia, length of recovery room stay and postoperative pain at the time of laparoscopy. DESIGN: Prospective, randomized, blinded, controlled multi-center study. Patients underwent gynecologic procedures via laparoscopy; surgeons, anesthesiologists and recovery room personnel assessed the results. SETTING: Seven North American institutions. PATIENTS: Seventy-two women for safety evaluation and efficacy studies. INTERVENTIONS: Intraoperative pre-conditioning of laparoscopic gas with the Insuflow device (treatment) or standard raw gas (control) during laparoscopic surgery and postoperatively. MAIN OUTCOME MEASURES: Incidence, severity and extent of hypothermia, postoperative pain perception and length of recovery room stay. RESULTS: The Insuflow group had significantly less intraoperative hypothermia, reduced length of recovery room stay and reduced postoperative pain. Pre-conditioning of laparoscopic gas by filtering heating and hydrating was well tolerated with no adverse effects. The safety profile of the Insuflow pre-conditioned gas showed significant benefits compared to currently used raw gas. CONCLUSIONS: Pre-conditioning laparoscopic gas by filtering heating and hydrating with the Insuflow device was significantly more effective than the currently used standard raw gas and was safe in reducing or eliminating laparoscopic-induced hypothermia, shortening recovery room length of stay and reducing postoperative pain.

Adolescent↗