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At least 307 records · Page 17Linked to original sources
PubMed2006

Risk factors for postoperative chest wound infections due to gram-negative bacteria in cardiac surgery patients.

Gram-negative bacteria account for up to 35% of postoperative sternal wound infections (SWI) in patients undergoing cardiac surgery. Despite this, risk factors for Gram-negative SWI have not been investigated. The objective of this study was to define risk factors associated with Gram-negative SWI in patients undergoing cardiac surgery. 2590 patients undergoing cardiac surgery between 2002-2005 were prospectively monitored for development of SWI. Patient, operative, and post-operative risk factors were compared among patients that developed Gram-negative SWI and Gram-positive SWI to uninfected controls using univariate and multivariate analysis. A p < 0.05 was considered significant. Surgical site infections developed in 152 (5.9%) patients. Isolates were recovered from the sternum for 128 (5.0%) patients, from the leg donor site for 19 (0.73%) patients, and from the sternum and donor site for 5 (0.19%) patients. Gram-positive pathogens were isolated from 83 (3.3%) patients, Gram-negative pathogens from 42 (1.6%) patients, and mixed pathogens from 27 (1.0%) patients. Hospital admission greater than 48 hours before surgery (OR: 2.25; 95% CI: 1.11 - 4.58), ventilator-dependency preoperatively (OR: 5.32 95% CI: 2.22 - 12.75), and thoracentesis procedure postoperatively (OR: 3.71; 95% CI: 1.45 - 9.49) and diabetes (OR: 2.04; 95% CI: 1.17 - 3.55) were identified as significant risk factors for SWI due to Gram-negative bacteria using multivariate logistic regression. Diabetes, increased age, and peripheral vascular disease were identified as significant risk factors for SWI due to Gram-positive bacteria (p < 0.05, each). The risk factors associated with Gram-negative SWI differed significantly from those associated with Gram-positive SWI. Risk factors associated with Gram-negative SWI were identified. Unique interventions may be necessary to prevent Gram-negative SWI in cardiac surgery patients.

Aged↗
PubMed1999

Redirection of hepatic venous drainage after total cavopulmonary shunt in left isomerism.

BACKGROUND: Conversion from total cavopulmonary shunt (TCPS) to the Fontan circulation can improve cyanosis in patients with potential risks of development of pulmonary arteriovenous fistula (PAVF). METHODS: Inclusion of the hepatic veins in the pulmonary circulation was employed using an intra-atrial tube graft in 5 patients with left isomerism previously undergoing TCPS. Prior to the conversion, abnormal communication was identified between the azygos vein and either the hepatic or the portal vein in all. PAVF was seen in 3. RESULTS: All patients survived the procedure. Postoperative catheterization showed 13 +/- 2 mm Hg of superior caval venous pressure, and 2.3 +/- 0.4 L/min/m2 of cardiac index. Pulmonary arteriovenous fistula progressed markedly in the right lung even after the conversion in 2 patients, in whom the hepatic veins had been exclusively diverted to the left lung. Arterial oxygen saturation became below 65%, with exercise capacity reduced, in these 2 patients. The other patients remain asymptomatic. CONCLUSIONS: Total cavopulmonary shunt can be efficiently converted to the Fontan circulation by appropriately redirecting hepatic venous drainage to perfuse both lungs in a balanced fashion.

Aortography↗
PubMed1991

The healing sternum: a comparison of osseous healing with wire versus rigid fixation.

Although median sternotomy is used for most cardiac procedures, postoperative dehiscence remains a serious and persistent problem. This investigation was designed to assess new bone formation and sternal healing across the linear osteotomy of the sternum and to determine if rigid fixation would enhance bony healing and thus decrease unfavorable sequelae. To test this hypothesis, 14 skeletally mature baboons (Papio anubis) underwent standard median sternotomy; seven sternotomies were closed with interrupted 24-gauge cerclage wires, and seven, with thin Vitallium compression miniplates and transverse lag screws. The sterna from each group were harvested en bloc at 4 and 8 weeks, radiographed, processed, and serially sectioned and stained for histomorphometry to assess the quantity of new bone across the linear osteotomy. Clinical stability was superior with the plated and lag screw group at 4 weeks; however, by 8 weeks, no clinical difference between treatments was apparent. Histomorphometric analysis indicated that the linear osteotomy gap treated with plates and screws was less than the gap associated with the wire group. Rigid fixation of the sternum resulted in earlier union with primary osseous healing, suggesting greater inherent stability. these factors may decrease adverse sequelae for this procedure.

Animals↗
PubMed2005

Role of enteral immunonutrition in patients with gastric carcinoma undergoing major surgery.

OBJECTIVE: To evaluate the influence of postoperative immunonutrition on immune and nutritional parameters in patients with gastric carcinoma. METHODS: From September 2002 to August 2003, 40 patients with gastric carcinoma who had undergone major surgery were randomly divided into an immunonutrition group and standard nutrition group, each of 20 patients. On postoperative Day 2, patients in the standard nutrition group received a standard enteral formula, while those in the immunonutrition group received an enteral formula enriched with glutamine, arginine and omega-3 fatty acids. Nutritional support was continued for 7 days. Blood samples were obtained to determine plasma albumin, prealbumin and transferrin on Days 0, 5 and 9. On Days 0, 1 and 9, blood samples were collected to detect immunoglobulin (Ig) A, IgG, IgM, CD4 and CD8 cell counts, the ratio of CD4/CD8, interleukin (IL)-2, IL-6 and tumour necrosis factor (TNF)-alpha, respectively. RESULTS: There were no significant differences between the two groups in protein and immune parameters preoperatively and no significant differences in management perioperatively. No serious adverse effects were recorded with the two formulas. Postoperative procedures were smooth in both groups. On Day 9, serum levels of prealbumin and transferrin were higher in the immunonutrition group than in the standard nutrition group (p<0.01). After 7 days' nutritional support, patients in the immunonutrition group had higher levels of immunoglobulin, CD4 cell counts, CD4/CD8 ratio and IL-2 than those in the control group, whereas IL-6 and TNF-alpha levels were significantly lower in the immunonutrition group. CONCLUSION: Compared with standard enteral nutrition, enteral immunonutrition can improve defence mechanisms and modulate inflammatory action after major elective surgery for gastric carcinoma.

Adult↗
PubMedDate not supplied

Surgical treatment of human echinococcosis.

Hydatid disease may affect several organs in the human body and thus represents a major challenge for the general surgeon. The aim of this study was to analyze the multiple clinical presentations of hydatid disease and the surgical options according to the involved organ. The medical records of 272 adult patients operated on for hydatid disease in our department during the period 1970-1996 were retrospectively reviewed. The most commonly involved organ was the liver (204 patients; 75%), followed by the lung (42 patients; 15.4%) and the spleen (14 patients; 5.1%). In 12 patients, the cysts were located in uncommon sites: in the pancreas (4 patients; 1.5%), the gallbladder (2 patients; 0.74%), the kidney, the thyroid gland, the breast, the pericardium, the supraclavicular region and the thigh (1 patient in each case; 0.37%). Clinical symptomatology varied according to anatomic location and pre-operative diagnosis was accomplished with plain abdominal films, ultrasound, computerized tomography and serological tests. The surgical procedures performed included simple closure with drainage, unroofing of the cyst with omentoplasty (for liver cysts), marsupialization, cyst excision, excision of the involved organ or combinations of procedures. Postoperative morbidity was mainly due to septic complications (n = 41), postoperative bleeding (n = 2), deep vein thrombosis (n = 2) and fistulae (n = 13). Four patients died in the early postoperative period (mortality rate, 1.5%) secondary to septic complications (n = 3) and pulmonary embolism (n = 1). During long-term follow-up, 14 patients developed recurrent disease. In conclusion, hydatid disease should be included in the differential diagnosis of cystic masses in solid organs or other anatomic sites, especially in endemic countries. Since there is not an effective medical treatment, surgery still remains the treatment of choice, offering a good clinical result and an acceptable recurrence rate.

Adult↗
PubMed1996

[Comprehensive prevention of postoperative thrombosis].

Thromboembolic disease with its high mortality and morbidity is currently one of the most serious postoperative complications. Its occurrence in high-risk patients in surgical wards is 25-50%. Since 1979, the authors have examined 160 risk patients in whom no prevention had been performed. In this group of patients they detected the occurrence of profound venous thrombosis by means of the accumulation fibrinogen test, targeted phlebography under skiascopic control. At the same time the clinical symptomatology was followed in detail. Since the thrombosis is a multifactorial process, the effective preventive measure must affect and normalize as many disturbed homeostatic processes as possible. Into the group of 176 high-risk patients, the authors introduced a complex prevention into surgical routine residing in classical low-dose heparinization by 5000 u.s.c. with the first dose administered 1 hours prior to surgery, preoperational haemodilution with the administration of minimally 500 ml of Dextran and in preoperation administration of antiaggregants (Acylpyrin). by means of this tactic, the greatest antithrombotic effect is brought about preoperatively and in the first postoperative hours while the patient is protected minimally 5 to 7 postoperative days. Both preoperative and postoperative procedures are monitored by means of a complex haemocoagulation examination of the basic 10 haemocoagulation factors. The occurrence of thrombosis in patients without prevention with minimally 5 thrombogenetic risk factors during the control by means of the accumulation fibrinogen test was 32.4% and during the control by means of targeted phlebography is 24%. The differences are not statistically significant. In the group of patients with prevention the occurrence is 5.6%. In this group the screening is represented by the accumulation fibrinogen test and its positivity is verified by its localization by means of selective phlebography. The occurrence of deep vein thrombosis in the group with prevention and in the control groups statistically highly significant p > 0.0005. Haemocoagulation examination is aimed at the determination of the normalization impact of prevention on the state of hypercoagulation ability associated with the depression of spontaneous fibrinolysis in patients without prevention. The thrombi detected in patients with prevention are localized in short segments of crural veins. Clinically more significant bleeding in the group of patients with prevention occurred only in 2 patients, i.e. in 1%. Complex multifactorial prevention is not only simple and safe for patients, but also highly effective in the group of patients with high risk of postoperative thrombosis. The clinical diagnosis is unreliable and misleading with low sensitivity and specificity. (Tab. 2, Fig. 2, Ref. 28.).

Anticoagulants↗
PubMed1999

[Transpedicular implantation of screws in the thoracolumbar spine. Results of a survey of methods, frequency and complications].

Pedicular fixation has found great acceptance as a modality for spinal fusions. Being a "blind technique" it is associated with a potential high risk of neural and vascular morbidity. In an attempt to evaluate and/or establish a uniformly accepted concept of surgical management we designed a questionnaire composed of seventeen questions dealing with different pre-, intra- and postoperative procedures in transpedicular fixation. This was sent to 31 experienced surgeons organized in the working group "spine" of the german trauma association. Half of the answers to each question were similar. The other half however, showed a wide variation of thought. It is thus deduced that although some concepts are frequently applied there is no general agreement to an optimal method of surgical handling. Most surgeons use conventional operative cushions for positioning the patients (22/31). Access is usually proceeded by sharp dissection of the lumbodorsal fascia using a scalpel instead of catheterization (21/31), consciously avoiding traumatisation of paravertebral muscle insertion to the transverse processes (22/31), as well as sparing the dorsal branch of segmental arteries (25/31). Intraoperative orientation is attained by inspection coronary and fluoroscopy sagittal (15/31). Most surgeons remove cortical bone using a Rongeur (22/31), transpedicular drill hole is prepared by means of a k-wire (11/31), for orientation again the fluoroscope is made use of (15/31). On perforating the medial boundary of the pedicle thirteen operators correct the direction on drilling, on perforating the lateral boundary twelve medialise the screws on fixation, and eleven surgeons would leave the screws in place if firm holding is warranted. Half of the questioned surgeons simply lateralise the screws if cerebrospinal fluid leaked from the drill holes. If a malposition of the pedicle screws is not suspected no control computer tomography is performed (21/31). Regarding these facts a comparative evaluation of the different techniques used in transpedicular fixation is lacking. In our opinion further multicenter evaluation is necessary to establish a unified method and thus optimize postoperative results.

Bone Plates↗
PubMed2006

Minimal access surgery for the Symphonix/Med-El Vibrant Soundbridge middle ear hearing implant.

OBJECTIVE: To develop a minimal access approach for implantation of the Vibrant Soundbridge middle ear hearing implant. This approach ideally uses the smallest skin incision possible, minimal or no hair shave, and the least possible amount of tissue and bone manipulation. This will facilitate the acceptability of the procedure to the general community and reduce the flap-related complication rate. The procedure is similar to the minimal access approach described for cochlear implantation. STUDY DESIGN: Eight patients with various degrees of sensorineural hearing loss and one with a mixed hearing loss who met implant criteria for the Vibrant Soundbridge middle ear hearing implant received the device over a 42-month period. The first two patients underwent the traditional implant procedure with postauricular hair shave, postauricular S-shaped incision, and implant receiver suture fixation to the temporal bone. The following seven consecutive patients received a progressively smaller C-shaped postauricular skin incision, no hair shave, retrograde skull drilling for the implant seat, and no implant suture fixation until the technique closely approximated the minimal access cochlear implant procedure. Postoperative performance of the Soundbridge/Vibrant Med-El was evaluated through audiology testing and subjective patient reports. SETTING: Private neurotology clinic and tertiary care teaching hospital. RESULTS: The technique was feasible in all patients. Follow-up for the minimal access group ranged from 3 years to 5 months. There were no complications related to the approach, and all patients were satisfied users of the implant. The lack of hair shave and small incision size was greatly appreciated and warmly endorsed by the patients. CONCLUSION: The Vibrant Soundbridge/Vibrant Med-El can be safely implanted using the minimal access method that has been popularized for cochlear implant surgery. A large incision, extensive hair shave, risk of flap necrosis, and possibility of unsightly scar may deter patients from pursuing the potential benefits of implanted hearing technology. The technique may make the device more accessible to individuals who have concerns regarding cosmetics and potential flap complications.

Adult↗
PubMed2004

Renal revascularization in Takayasu arteritis-induced renal artery stenosis.

PURPOSE: This study was undertaken to define the long-term effects of renal revascularization on blood pressure, and renal and cardiac function in patients with Takayasu arteritis-induced renal artery stenosis (TARAS). METHODS: Twenty-seven patients (25 women; mean age, 27 years) with TARAS underwent intervention. Primary, primary assisted, and secondary patency rates were determined, and the late effects on blood pressure, renal and cardiac function, and survival were analyzed. RESULTS: All patients had hypertension (mean blood pressure, 167/99 mm Hg; 2.5 antihypertensive medications per patient). Mean estimated glomerular filtration rate in patients not receiving hemodialysis was 76 mL/min, and in five patients serum creatinine concentration was greater than 1.5 mg/dL. Three patients were hemodialysis-dependent, and two had intractable congestive heart failure. Forty interventions were performed, including 32 aortorenal bypass procedures, two repeat implantations, four nephrectomies, and two transluminal angioplasty procedures. Postoperative morbidity was 19%. There were no deaths. During follow-up (mean, 68 months), three graft stenoses, all due to intimal hyperplasia, and three graft occlusions occurred. Two of three graft stenoses were successfully revised. At 1, 3, and 5 years of follow-up, primary patency was 87%, 79%, and 79%, respectively; primary assisted patency was 93%, 89%, 89%, respectively; and secondary patency was 93%, 89%, and 89%, respectively. Intervention resulted in a decrease in blood pressure to a mean of 132/79 mm Hg (P<.0001), and the need for antihypertensive medications was reduced to one per patient (P<.01). Mean glomerular filtration rate increased to 88 mL/min (P<.005), and two patients no longer required hemodialysis. Congestive heart failure resolved in both patients, and did not recur. There were three deaths during follow-up, with 5-year and 10-year actuarial survival of 96% and 80%, respectively. CONCLUSIONS: Renal revascularization to treat TARAS is durable, has a salutary effect on blood pressure, and enhances long-term renal and cardiac function. This response establishes renal revascularization as a successful and durable intervention for TARAS, and a benchmark to which other therapies should be compared.

Adult↗
PubMed2003

Attenuated metabolic response to surgery in tumor-bearing rats.

BACKGROUND: During cancer, proteins are chronically wasted, including proteins of the gut. Surgical stress acutely increases protein breakdown of the gut. Surgery in cancer patients may thus have a double effect on the gut and lead to exhaustion and functional loss of the gut. METHODS: Female Lewis rats (+/-200 g) were studied bearing a subcutaneous tumor or after sham implantation. Hysterectomy was performed in half of the rats as a standardized operative procedure. Postoperative protein kinetics of the gut were determined using a primed constant infusion of L-[2,6-(3)H]-phenylalanine. Gut function was assessed by testing its permeability for sugar probes lactulose and L-rhamnose. Villus height and crypt depth were measured and polyamine concentrations were measured as markers for mucosal proliferation and differentiation. RESULTS: In control rats, gut protein breakdown increased from 6 +/- 3 to 32 +/- 8 nmol phenylalanine x 100 g body wt x min after hysterectomy. This was accompanied by increased amino acid membrane transport rates and metabolic shunting. In tumor-bearing rats, increased protein breakdown in response to surgery was attenuated (8 +/- 4 vs 17 +/- 4 nmol x 100 g body wt x min). Surgery increased the lactulose/L-rhamnose recovery ratio, indicating increased gut permeability. In the presence of a tumor gut permeability also increased and it increased further after surgery. No changes in villus height or polyamine levels could explain the increased permeability of the gut. CONCLUSION: The study shows that a mild surgical trauma increases protein breakdown of the gut and simultaneously increases gut permeability. In the presence of a tumor the metabolic response to surgery is attenuated. Gut barrier loss was highest in the combined presence of cancer and the surgical insult.

Animals↗
PubMed2003

Controlled risk of stenosis after surgical excision of laryngeal hemangioma.

OBJECTIVE: To evaluate the risk of subglottic stenosis after surgical excision of congenital subglottic hemangioma. DESIGN: Retrospective analysis and case series. SETTING: Tertiary care teaching hospital. PATIENTS: A total of 13 pediatric patients diagnosed with subglottic hemangioma with unilateral, bilateral, or circular lesions and more than 50% airway obstruction between 1992 and 2001. INTERVENTION: Open surgical excision was performed as a single-stage procedure either as primary or secondary intention. The cricoid cartilage was left open at the end of the procedure. Postoperative intubation was carried out in a pediatric intensive care unit. MAIN OUTCOME MEASURE: An adequate airway after surgical excision. RESULTS: All patients were successfully extubated. No recurrence was noted. Three patients developed subglottic stenosis, two grade 1 and one grade 2. All 3 showed a favorable outcome and did not require reintubation. One needed endoscopic management of the stenosis. Of these 3 cases, 2 occurred after carbon dioxide laser treatment (out of 3) and 1 after circumferential dissection (out of 3). CONCLUSIONS: Extubation after surgery was successful in all cases of subglottic hemangioma. Risk of subglottic stenosis was limited and occurred only after circumferential dissection, especially if associated with prior traumatic laser damage of the hemangioma.

Airway Obstruction↗
PubMed2000

Pancreatoduodenectomy for chronic pancreatitis: long-term results in 105 patients.

HYPOTHESIS: For patients with head-dominant, small-duct chronic pancreatitis who require operative intervention, pancreatoduodenectomy can be performed safely and affords satisfactory pain relief in most. DESIGN: Retrospective case series. Follow-up was complete in 86% of study subjects (average, 6.6 years). SETTING: Tertiary care center. PATIENTS: Among 484 consecutive cases of chronic pancreatitis treated surgically from January 1976 through April 1997, 105 (22%) in which pancreatoduodenectomy was performed were reviewed with regard to criteria for selection, operative procedure, postoperative course. and long-term outcome. MAIN OUTCOME MEASURES: The main outcome measure was degree of pain relief. Additionally, late mortality, cause of death, the presence of endocrine and exocrine insufficiency, and quality of life were recorded. RESULTS: There were 72 men (69%) and 33 women (31%) with a mean age of 51 years (range, 24-77 years). The cause of chronic pancreatitis was alcohol related in 58 patients (55%) and idiopathic in 41 (39%). Clinical manifestations included abdominal pain in 86 patients (82%), obstructive jaundice in 27 (26%), and vomiting in 11 (11%). Suspicion of malignant neoplasm was a concern in 67 patients (64%). Operative morbidity was 32%, and mortality, 3%. Mean hospital stay was 16 days (range, 12-82 days). Survival was significantly lower than that of age-matched controls. Among 66 patients with preoperative pain, pain relief was achieved in 59 (89%); it was complete in 44 patients (67%) and partial in 15 (23%). Operation resulted in a significant increase in patients with normal functional status (73 patients [81%] vs 51 [49%]; P<.001). Forty patients (48%) had diabetes. Steatorrhea was observed in 39 patients (43%), while weight maintenance or gain occurred in 59 (66%). CONCLUSIONS: Pancreatoduodenectomy achieves pain relief and good quality of life in a large percentage of selected patients with small-duct, head-dominant disease and is especially useful when a malignant neoplasm must be excluded. Morbidity and mortality are acceptable in experienced hands. Onset of diabetes and steatorrhea, while reflecting the natural course of the disease, is likely accelerated by pancreatoduodenectomy.

Adult↗
PubMed2000

A few considerations regarding enhancement of arterialized skin flap survival.

An arterialized skin flap is defined as a flap harvested from the anterior and distal third of the forearm over a venous pathway. It is composed essentially of skin, subcutaneous tissue, and the subdermal plexus of the veins. The flap is perfused at the recipient side by a donor artery at one end and is connected to one or more regional veins at the opposite end. Since it depends on an atypical blood perfusion, leading to edema, epidermolysis, or even some degree of skin necrosis during the immediate postoperative procedure, this skin flap is considered to have a torpid evolution. This article includes some considerations regarding the enhancing of the arterialized skin flap survival, based on our clinical and laboratory experience after its transplantation. The design, construction of its arterial afferent phase, construction of its venous efferent phase, and monitoring are discussed.

Anastomosis, Surgical↗
PubMed1986

Clinical results 1-10 years after highly selective vagotomy in 306 patients with prepyloric and duodenal ulcer disease.

Overall clinical results were assessed 1-10 years after routinely performed highly selective vagotomy (HSV) in 326 consecutive patients suffering duodenal and prepyloric ulcer disease, operated on by 37 surgeons of varying seniority at a district general hospital. Three hundred and six (94 per cent) patients were followed up. No mortality was recorded after 326 primary and 50 reoperative procedures. Postoperative complications were few and diminished during the study period. Persistent moderate to severe dumping was found in 2.3 per cent of the patients; slight and periodic, but in no case disabling, diarrhoea in 11 per cent and gastric retention in 2.1 per cent. The overall clinical ulcer recurrence rate was 13.8 per cent, with a tendency towards better results during the second 5 year period. Significant differences were found between individual surgeons and groups of surgeons. Recurrences tended to be located more proximally than the primary ulcer. Fifty reoperations were performed in forty patients for ulcer recurrence (twenty-five), persistent ulcer-like symptoms (twelve) and gastric retention (three). When all recurrences and reoperations were classified as failures the symptomatic assessment according to Visick showed 67 per cent of the patients in grades I-II and 26 per cent in grade IV but the corresponding figures from the patients' own classification including the results of reoperations were 79 per cent and 7 per cent. It is concluded that for the time being HSV is the method of choice for the elective surgical treatment of duodenal and prepyloric ulcer disease.

Adolescent↗
PubMed1997

Use of a saline breast implant to cover the pelvic floor.

Pelvic exenteration is one of the most radical procedures in the repertoire of gynecologic oncology procedures. Postoperative complications include sepsis, hemorrhage, formation of adhesions resulting in bowel obstruction, and fistulas resulting from large denuded pelvic surfaces. To date there is no clear consensus as to the best way to cover the pelvis after the destructive phase of an exenteration. Herein, we present a different approach to pelvic coverage by placement of a 300 cc saline breast implant. Use of a saline-filled breast implant to fill the pelvis represents a possible approach to addressing the denuded pelvic space created during extensive gynecologic surgery.

Adult↗
PubMed1999

Survival of women with surgical stage II endometrial cancer.

OBJECTIVE: The aim of this study was to report survival and determine prognostic factors and results of therapy in women with surgical stage II endometrial cancer. METHODS: Forty-eight consecutive women with surgical stage II endometrial cancer treated at the University of Vermont between March 1984 and March 1998 were reviewed. Patients' characteristics, surgical procedure, postoperative treatment and its complications, and tumor recurrence and its treatment were recorded. In addition, a formal review of their pathological material for confirmation of the diagnosis was performed. RESULTS: The median duration of follow-up was 6.2 years. Three patients (6.3%) had tumor recurrence and two (4.2%) died of their disease. The estimated 5-year overall survival and disease-free survivals were 92.1% (SE = 5.5%, 95% confidence interval: 81.3, 100%) and 89.9% (SE = 5.8%, 95% confidence interval: 78.5%, 100%), respectively. None of the patients treated by total abdominal hysterectomy followed by both whole pelvic and vaginal cuff radiation therapy (the main line of treatment for patients in whom cervical involvement was diagnosed following hysterectomy, n = 20) or by radical hysterectomy (the main line of treatment for patients in whom cervical involvement was known before hysterectomy, n = 11) had tumor recurrence. Three of 17 (17.6%) patients treated with total abdominal hysterectomy followed by either whole pelvic (n = 13) or vaginal cuff (n = 4) radiation therapy had tumor recurrence. The difference between those two groups was statistically significant (0/31 versus 3/17, P = 0.02). There was no difference in survival among women with stage IIA and IIB or women who underwent radical abdominal hysterectomy and those who underwent total abdominal hysterectomy with postoperative pelvic and vaginal cuff radiation. Morbidity secondary to therapy was mild. Age, depth of myometrial invasion, tumor histology, and grade were not significantly related to recurrence. CONCLUSIONS: Survival of women with surgical stage II endometrial cancer is excellent especially among those treated with total abdominal hysterectomy followed by both pelvic and vaginal cuff radiotherapy or by radical abdominal hysterectomy.

Adult↗
PubMed2001

Nongestational pure ovarian choriocarcinoma with contralateral teratoma.

BACKGROUND: Nongestational pure ovarian choriocarcinoma is a rare malignancy with only 29 cases described to date. CASE: We describe a case associated with mature cystic teratoma of the contralateral ovary. Details of all 30 cases including clinical features, associations, surgicopathological findings, operative procedures, postoperative chemotherapy, and outcome are summarized. CONCLUSION: This rare malignancy responds well to surgery and postoperative chemotherapy including the methotrexate-based regimes.

Adolescent↗
PubMedDate not supplied

Diagnostic evaluation and surgical management of hydatid disease of the liver.

Human echinococcosis is still endemic in some areas of the world, including Mediterranean countries. Because there is no effective medical therapy, surgery remains the principal mode of treatment. A consecutive of 132 patients operated on for liver hydatid disease between January 1977 and February 1993 were analyzed. There were 60 men (45.4%) and 72 women (54.6%) aged 31 to 88 years (mean 56 years). The right lobe of the liver was affected in 68 cases (51.5%), the left lobe in 31 cases (23.5%), and both lobes in 14 cases (10.6%); there were multiple liver cysts in 7 cases (5.3%), concomitant cysts in other parenchymal organs in 4 cases (3.0%), and disseminated intraabdominal hydatid disease in 8 cases (6.1%). Clinical symptomatology consisted of abdominal pain, fever, jaundice, urticaria, and an abdominal mass. Preoperative diagnosis was established using imaging studies: plain abdominal films, ultrasonography, computed tomography, and serologic tests. Three patients (2.3%) underwent simple closure without drainage, 7 patients (5.3%) cyst excision, 4 patients (3.0%) marsupialization, 1 patient (0.8%) left lateral segmentectomy, 15 patients (11.3%) external drainage, 69 patients (52.3%) omentoplasty, and 33 patients (25.0%) combinations of procedures. Postoperative morbidity was low and consisted of hepatic abscess development, wound infection, bowel obstruction, and biliary leaks. Six patients (4.5%) had recurrent disease. One patient died during the postoperative period because of septic complications. Among the surgical techniques we used, excision of the cyst (when feasible) and omentoplasty produced the lowest complication rates and the best clinical results.

Adult↗