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PubMed2006

Comparison of endoscopic and open resection for Haglund tuberosity in a cadaver study.

BACKGROUND: About half of patients who have Haglund disease may require treatment by surgical resection of the superior portion of the calcaneal tuberosity. Endoscopic techniques have been described as alternatives to open surgery, but only results of uncontrolled retrospective clinical investigations have been reported. Up to now no research is available which compares these different procedures. METHODS: A controlled laboratory study was done to evaluate the morphologic appearance of the superior portion of the calcaneal tuberosity after endoscopic or open resection. The tuberosity was resected in 15 isolated fresh-frozen human cadaver lower limb specimens with either open (nine) or endoscopic (six) technique. Outcome was measured radiographically. Iatrogenic soft-tissue lesions of the distal Achilles tendon, plantaris tendon and sural nerve caused by the surgical procedure were evaluated by direct observation after anatomic dissection. RESULTS: Radiographs revealed that the slope of the resection line (osteotomy angle) was steeper (p = 0.017) and the resected protruberance was larger (p = 0.003), while the remaining posterior rim was smaller (p = 0.048) after open resection than after endoscopic resection. Macroscopic analysis indicated that both approaches may damage soft tissues particularly the medial Achilles tendon column and in the plantaris tendon (relative risk = 0.5 in either group). Iatrogenic sural nerve injuries were found after both techniques (relative risk = 0.2 for endoscopic and 0.1 for open resection). Residual bursa tissue was detected only after endoscopy (relative risk = 0.3), while loose bony fragments were present only after open surgery (relative risk = 0.4). CONCLUSIONS AND CLINICAL RELEVANCE: The medial column of the Achilles tendon, the plantaris tendon, and the sural nerve are at risk in both open and endoscopic resection for Haglund disease.

Aged↗
PubMedDate not supplied

Subfascial endoscopic perforator vein surgery in patients with post-thrombotic venous insufficiency--is it justified?

Previous results following subfascial endoscopic perforator vein surgery were reported to be worse in post-thrombotic syndrome than in limbs with primary valvular incompetence. This report comprises a larger patient cohort with longer follow-up. The goal of this study was to determine if subfascial endoscopic perforator vein surgery is justified in patients with post-thrombotic venous insufficiency. The clinical data of 91 consecutive patients who underwent subfascial endoscopic perforator vein surgery with or without superficial reflux ablation over a 7-year period from May 1993 to June 2000 were retrospectively analyzed. Fifty-four females and 37 males (median age, 53 years; range, 20-77) underwent 103 subfascial endoscopic perforator vein surgery procedures. Forty-two limbs were classified as C6 (active ulcer), 34 as C5 (healed ulcer), and 24 as C4 (lipodermatosclerosis). Thirty procedures were performed in post-thrombotic limbs. Concomitant superficial reflux ablation was performed in 74 limbs (72%); saphenous vein stripping had been previously performed in 29 (28%). Deep venous incompetence was present in 89% of limbs; 13% had venous outflow obstruction on plethysmography. Cumulative ulcer healing in post-thrombotic limbs was not significantly different from limbs with primary valvular incompetence; 30-, 60-, and 90-day healing rates were 44%, 72%, and 72% vs 39%, 70%, and 87%, respectively (p = 0.35). On univariate analysis, the presence of ulcer greater than 2 cm in diameter was associated with delayed ulcer healing (p = 0.02). Cumulative ulcer recurrence in all limbs was 4%, 20%, and 27% at 1, 3, and 5 years, respectively. Ulcer recurrence in post-thrombotic limbs was higher than in limbs with primary valvular incompetence at 1, 3, and 5 years; 16%, 47%, and 56% vs 0%, 8%, and 15%, respectively (p = 0.001). Recurrent ulcers were small, superficial, and easier to heal. Clinical improvement was significant even in post-thrombotic limbs; median clinical score decreased from 9.5 to 3 (p = 0.001), and median outcome score was +2 (mean 1.9; range, -1 to 3). Median clinical score in patients with primary valvular incompetence improved from 6 to 1.5 (p = 0.0001). Subfascial endoscopic perforator vein surgery with superficial reflux ablation promoted ulcer healing, improved clinical outcome, and resulted in a low long-term ulcer recurrence rate in limbs with primary valvular incompetence. Despite good clinical outcome in post-thrombotic limbs, ulcer recurrence was high. These results imply that the role of subfascial endoscopic perforator vein surgery with superficial reflux ablation in patients with post-thrombotic limbs continues to be controversial.

Adult↗
PubMed2005

Immediate endoscopic management of complete iatrogenic anterior urethral injuries: a case series with long-term results.

BACKGROUND: Urethral injury produces partial or complete disruption of the urethral integrity. Advances in endourology have made endoscopic management of most of these injuries feasible without greatly compromising the final result. We report our institutional experience of immediate endoscopic realignment of complete iatrogenic anterior urethral injury. METHODS: From May 1997 to May 2003, seven patients with complete anterior urethral disruption were managed by immediate endoscopy guided splinting of urethra. Retrograde urethroscopy, combined with fluoroscopic guidance and in some cases antegrade cystoscopy through a suprapubic stab cystostomy was performed. A guide wire was negotiated across the disruption. Later, a 16 F Foley catheter was placed for 1-3 weeks. Patients were followed up at 1, 3, 6 and 12 months and then yearly to assess the long-term outcome of endoscopic management. RESULTS: Immediate endoscopic realignment was achieved in all patients. Three patients developed recurrence at six months; that was treated by optical urethrotomy. Only one patient developed multiple recurrences over an average follow-up of 49.2 months (range 7 to 74 months). He was offered open end-to-end urethroplasty at twenty months after third recurrence. Thus immediate endoscopic realignment avoided any further intervention in four patients (57.14%); while after an additional optical urethrotomy, urethroplasty could be avoided in six patients (87.2%). CONCLUSION: Immediate endoscopic realignment of traumatic urethral disruption is a feasible, safe and effective treatment modality for management of patients with iatrogenic complete anterior urethral injuries.

Adult↗
PubMed2006

Endoscopic sinus surgery for maxillary sinus mucoceles.

BACKGROUND: Maxillary sinus mucoceles are relatively rare among all paranasal sinus mucoceles. With the introduction of endoscopic sinus surgical techniques, rhinologic surgeons prefer transnasal endoscopic management of sinus mucoceles. The aim of this study is to describe the clinical presentation of maxillary sinus mucoceles and to establish the efficacy of endoscopic management of sinus mucoceles. METHODS: Between 2003 and 2005, 14 patients underwent endoscopic sinus surgery for maxillary sinus mucocele. The presenting sign and symptoms, radiological findings, surgical management and need for revision surgery were reviewed. RESULTS: There were eight males and six females with an age range of 14 to 65. Ten patients complained of nasal obstruction, five of nasal drainage, five of cheek pressure or pain and one of proptosis of the eye and cheek swelling. The maxillary sinus and ipsilateral ethmoid sinus involvement on computed tomographic studies was seen in 4 patients. Four patients had history of endoscopic ethmoidectomy surgery for ethmoid sinusitis and one had Caldwell-Luc operation in the past. Ethmoidectomy with middle meatal antrostomy and marsupialization of the mucocele was performed in all patients. Postoperative follow-up ranged between 8 to 48 months. All patients had a patent middle meatal antrostomy and healthy maxillary sinus mucosa. No patients need revision surgery. CONCLUSION: The most common causes of mucoceles are chronic infection, allergic sinonasal disease, trauma and previous surgery. In 64% of the patients of our study cause remains uncertain. Endoscopic sinus surgery is an effective treatment for maxillary sinus mucoceles with a favorable long-term outcome.

Adolescent↗
PubMed2006

Endoscopic transsphenoidal pituitary surgery with intraoperative magnetic resonance imaging.

OBJECTIVE: The two most recent significant advances in pituitary surgery have been the endonasal endoscopic approach and intraoperative magnetic resonance imaging (IMRI). Each provides improved visualization of intra- and parasellar anatomy with the goal of attaining a complete resection. The combination of the two techniques has not been previously reported in the literature. METHODS: We performed endoscopic, endonasal resection of pituitary macroadenomas in 15 patients using the Polestar N-10 (0.12T) IMRI (Odin Medical Technologies, Inc., Newton, MA). Eleven patients had nonfunctioning tumors, three had acromegaly, and one had a medication-resistant prolactinoma. The effect of the magnetic field on the cathode ray tube screen and the image quality of the IMRI images were assessed. The presence of residual tumor on IMRI was noted and then re-examined with the endoscope. RESULTS: Although the Polestar N-10 is a low Tesla magnet, the IMRI caused significant distortion of the cathode ray tube screen regardless of the viewing angle. This was overcome with the use of a wall-mounted plasma screen. IMRI images were obtained in all cases and were of sufficiently high quality to demonstrate adequate decompression of the optic chiasm and the removal of all suprasellar tumor. In three cases, residual tumor was found with IMRI that was resected endoscopically before the completion of surgery. In four other cases, potential residual tumor was examined endoscopically and found to be normal postoperative change. In eight cases no residual intrasellar tumor was seen on the IMRI. Preresection visual deficits improved in all cases and the insulin-like growth factor levels normalized in two of three cases. There were no delayed cerebrospinal fluid leaks. CONCLUSION: Combining intraoperative endoscopy and IMRI is feasible and distortion of the cathode ray tube screen can be overcome with the use of either a plasma or liquid crystal display screen. Each technology provides complementary information, which can assist the surgeon in safely maximizing the extent of resection. In this small series using a low-field magnet, rates of residual tumor following endoscopic transsphenoidal surgery were less than have been reported following microscope-based transsphenoidal surgery.

Adenoma↗
PubMed2006

Simultaneous image-guided and endoscopic navigation without rigid cranial fixation: application in infants: technical case report.

OBJECTIVE AND IMPORTANCE: Infants and young children demonstrate a variety of intraventricular and periventricular lesions. Endoscopy has proven useful in the treatment of many of these lesions, but its benefit is limited if it is applied to complex loculated cysts or if the disease is concealed by normal ependymal boundaries. In adults and older children, endoscopy can be augmented by the simultaneous use of frameless stereotaxy, but this combined modality has not been possible in infants and young children without rigid cranial fixation. We describe a method of achieving simultaneous stereotactic and endoscopic navigation in infants and young children by using a pinless, frameless stereotactic assembly. CLINICAL PRESENTATION: The first patient was a 6-week-old boy with macrocephaly and a bulging fontanelle. Computed tomographic and magnetic resonance imaging revealed a complex arachnoid cyst and obstructive hydrocephalus. The second patient was a 7-month-old, ex-premature (27-wk gestational age) boy who developed posthemorrhagic hydrocephalus. He underwent multiple shunt revisions, one of which was complicated by enterococcal ventriculitis. Despite bilateral ventriculoperitoneal shunts, he developed increasing head circumference, listlessness, and irritability. Imaging revealed an enlarged, multiloculated, and asymmetric ventricular system. INTERVENTION: Simultaneous image-guided and endoscopic neuronavigation was implemented in both patients. Before the procedure, a cranial reference arc was secured to the outer table of the cranium through a small incision adjacent to the operative field. After the stereotactic apparatus was registered, the software was used to plan a trajectory for the approach. A burr hole was then made, and a rigid 6-mm endoscope was inserted for direct visualization. Once advanced past the endoscopic port tip, the electromagnetic coil stylet was used to stereotactically track position and identify areas for fenestration, biopsy, and catheter insertion. CONCLUSION: Endoscopic views of complex hydrocephalus and arachnoid cysts alone are often difficult to interpret. Simultaneous image-guided and endoscopic neuronavigation may be advantageous in the management of complex cases that are anatomically related to the ventricular system in infants for whom rigid cranial fixation could lead to increased procedure-related morbidity.

Brain Diseases↗
PubMed2005

Endonasal endoscopic repair of anterior skull-base fistulas: the Kuala Lumpur experience.

The purpose of this retrospective study is to determine the pattern of cerebrospinal fluid (CSF) rhinorrhoea presenting to our tertiary referral centre in Kuala Lumpur and to assess the clinical outcomes of endonasal endoscopic surgery for repair of anterior skull base fistulas. Sixteen patients were treated between 1998 and 2004. The aetiology of the condition was spontaneous in seven and acquired in nine patients. In the acquired category, three patients had accidental trauma and this was iatrogenic in six patients (five post pituitary surgery), with one post endoscopic sinus surgery (ESS). Imaging included computed tomography (CT) scan and magnetic resonance imaging (MRI). Endoscopic repair is less suited for defects in the frontal sinuses with prominent lateral extension and defects greater than 1.5 cm in diameter involving the skull base. Fascia lata, middle turbinate mucosa, nasal perichondrium and ear fat ('bath plug') were the preferred repair materials in the anterior skull base, whereas fascia lata, cartilage and abdominal fat obliteration was preferentially used in the sphenoid leak repair. Intrathecal sodium flourescein helped to confirm the site of CSF fistula in 81.3 per cent of the patients. Ninety per cent of the patients who underwent 'bath plug' repair were successful. The overall success rate for a primary endoscopic procedure was 87.5 per cent, although in two cases a second endoscopic procedure was required for closure. In the majority of cases endoscopic repair was successful, and this avoids many of the complications associated with craniotomy, particularly in a young population. Therefore it is our preferred option, but an alternative procedure should be utilized should this prove necessary.

Adolescent↗
PubMed1989

[Assessment of endoscopic embolization in the management of esophageal varices].

Between February 1984 and September 1987, endoscopic embolization (EE) was performed in 26 patients with esophageal varices. The effects of EE were evaluated with endoscopic findings according to the general rules for recording endoscopic findings on esophageal varices as specified by the Japanese Research Society for Portal Hypertension. 1) When the result was regarded as effective if a patient had Cw, F1, R-C sign (-), Li and Lm or disappearance of varices, the improvement was found in 66.7% for Color, 79.2% for R-C sign, 54.2% for Form and 45.8% for Location after EE. 2) Recurrence of varices was found in 50% of the patients (12/24) and 4 of 12 cases (33.3%) had rebleeding. 3) When the endoscopic findings before and after EE were compared between relapsed and unrelapsed cases, relapsed patients had more unfavorable endoscopic findings, furthermore, the extent of improvements was also worse than that of unrelapsed cases. 4) As complications, slight fever, dysphagia and epigastric pain were found in most cases, however, all were cured conservatively. In conclusion, EE is useful and safety tool for the improvement of endoscopic findings of the patients with esophageal varices.

Adult↗
PubMed2004

Determinants of successful endoscopic internal thoracic artery harvesting: a prospective analysis.

OBJECTIVE: Endoscopic internal thoracic artery (ITA) harvesting is employed during minimal-access coronary artery bypass grafting. To improve case selection, we prospectively analyzed our entire experience to identify variables that predict intraoperative conversion to sternotomy. METHODS: We performed a prospective study from September 1999 to November 2003 of 100 consecutive patients with an endoscopically harvested left ITA (LITA). Success was defined as an endoscopic dissection of the LITA sufficient to reach the anastomosis. Multivariate logistic regression analysis was performed to identify independent preoperative and procedural predictors of success. RESULTS: The measured parameters (mean +/- SD) were age (62 +/- 9 years), height (174 +/- 9 cm), weight (81 +/- 14 kg), and logistic Euroscore (2.0 +/- 1.7). Patients comprised 8 (8%) women, 17 (17%) with urgent operations, 42 (42%) with multiple vessel disease, 17 (17%) with a left ventricular ejection fraction <50%, 2 (2%) redo procedures, and 3 (3%) with pleural disease. The Zeus robot was used in 17 patients (17%). Eight-eight (88%) of the LITA were successfully harvested endoscopically. Among the 12 patients who underwent conversions, pleural adhesions were the most common finding (n = 4, 33%). One LITA was unusable. In the final multivariate model, lung disease was a negative predictor of successful endoscopic harvest (odds ratio, 0.13; 95% confidence interval, 0.02-0.63; P =.012). The variables of age, sex, left ventricular function, logistic Euroscore, operative priority, and use of the Zeus robot did not achieve statistical significance. CONCLUSIONS: Acceptable conversion rates and low conduit wastage are achievable during a unit's initial experience. Lung disease is associated with increased conversion frequency, and surgeons embarking on endoscopic harvesting should consider excluding these patients to improve their chances of success. Pleural adhesions increase the technical difficulty of surgery.

Coronary Artery Bypass↗
PubMed2000

[Endoscopic transepto-interforniceal approach to colloid cysts: case report].

The endoscopic treatment of colloid cysts of third ventricle is still controversial. Management of the patient can include observation and serial CT or MRI imaging only, ventriculo peritoneal shunt only, stereotactic aspiration, microsurgery and endoscopy. The author reports the case of a patient with colloid cyst of third ventricle located in a retroforaminal position, in the diencefalic roof, dissecting the raphe fornix, expanding supero-posteriorly, inside the cavum of the septum pellucidum, protruding on the floor of lateral ventricles. The cyst was approached with a rigid neuroendoscope, through a pre-coronal burr hole, 2.5 cm lateral to the midline (Kocheŕs point). Following a transventricular route, the right leaf of the septum pellucidum was endoscopically opened with bipolar, posterior to the septal vein. A yellowish hard lesion was found and partially resected with biopsy forceps, between the two fornices, which were split apart by the uncommon expansion and location of the lesion, allowing a new endoscopic transventricular transepto-interforniceal approach. We also performed endoscopic septostomy and third ventriculostomy. The microsurgical approaches compared with endoscopic approaches, and the possibility of endoscopic alternative routes suitable for selected cases with superior expansion towards the fornix and septum pellucidum is discussed.

Adult↗
PubMed2005

Management of gastroesophageal reflux disease: medications, surgery, or endoscopic therapy? (Current status and trends).

Gastroesophageal reflux disease (GERD) is a common chronic disorder in the Western world. The basic cause of GERD has been well characterized--the fundamental defect is a loss of integrity of the gastroesophageal barrier. What is less clear is the most appropriate means of addressing this reflux. GERD has a variety of symptoms, ranging from typical presentations of heartburn and regurgitation (without esophagitis) to atypical presentations, such as severe erosive esophagitis and its associated complications. Because of its symptomatic diversity, physicians may select from a variety of therapeutic approaches. Medical therapy aims at decreasing acidity by suppressing proton secretion and has been well established. Available medications include antacids and alginates, H2-receptor antagonists, motility agents, and proton pump inhibitors (PPIs). Antireflux surgery, commonly performed laparoscopically, aims at reinforcing and repairing the defective barrier through plication of the gastric fundus. The earliest performed successful procedures were the Nissen and Toupet fundoplications, to which several modifications have since been made. It has been demonstrated in preliminary studies and long-term outcomes of such open surgery and preliminary studies of such laparoscopic surgery that antireflux surgery is an effective approach, with overall outcomes superior to those achieved with medications. The precise indications for the surgical treatment of patients with GERD, however, remain controversial. In recent years, endoscopic intraluminal antireflux approaches have attracted the attention of physicians, surgeons, and commercial companies, especially after the approval of two endoscopic intraluminal methods by the United States FDA in 2000. The common element is prevention of acid reflux by construction of a functional or controlled barrier in the lower esophageal sphincter zone. Three main methods are currently employed: endoscopic intraluminal valvuloplasty, endoscopic radiofrequency therapy, and endoscopic injection or implantation of foreign material. The endoluminal suturing method is highly demanding technically, and its short-term results are encouraging, although largely dependent on the experience of the endoscopist. Several prospective cohort studies have shown that the radiofrequency procedure (Stretta) significantly improves GERD symptoms and quality of life while reducing esophageal acid exposure and eliminating the need for antisecretory medications in the majority of patients within 6-12 months. Most recently, some researchers have studied the endoluminal implantation of polymers, such as Plexiglas (polymethyl-methylacrylate), Gatekeeper hydrogel, and Enteryx (ethylene vinyl alcohol copolymer). The preliminary results of these studies showed that the implantation method was feasible and safe; however, the only multicenter trial related to outcome that has been published has included just 1 year of follow-up. Here, we review the treatment of GERD: medical, surgical, and endoscopic. In addition, we provide an algorithm based on symptoms and response to treatment for management of these patients.

Algorithms↗
PubMed2001

Radiographic findings and complications after surgical or endoscopic repair of Zenker's diverticulum in 16 patients.

OBJECTIVE: The purpose of our study was to reassess the radiographic findings and complications associated with surgical or endoscopic repair of Zenker's diverticulum. MATERIALS AND METHODS: Sixteen patients who underwent various procedures for repair of Zenker's diverticulum (diverticulectomy and cricopharyngeal myotomy in [n = 8], diverticulopexy and cricopharyngeal myotomy [n = 4], endoscopic stapling diverticulotomy [n = 3], and cricopharyngeal myotomy alone [n = 1]) had radiographic studies with water-soluble contrast material, barium, or both during the early postoperative period (n = 7), late postoperative period (n = 4), or both (n = 5). The radiologic reports and images were reviewed to determine the postoperative findings and complications associated with surgical or endoscopic repair of Zenker's diverticulum. RESULTS: Radiographic studies revealed leaks during the early postoperative period in three (27%) of 11 patients after surgical repair of Zenker's diverticulum and in zero of three patients after endoscopic diverticulotomy. Pharyngeal dysfunction (pharyngeal paresis, decreased epiglottic tilt, laryngeal penetration, or tracheobronchial aspiration) was detected in seven (54%) of 13 patients after surgery and in one (33%) of three patients after endoscopic diverticulotomy; five of these eight patients had follow-up barium studies during the late postoperative period, and all five showed marked improvement in pharyngeal function. An extrinsic cricopharyngeal impression was detected in six (38%) of these 16 patients, a remnant diverticulum in four (25%), and mucosal beaking in three (19%). A suspended or inverted diverticulum was detected in one of the four patients who underwent surgical diverticulopexy. CONCLUSION: Radiologists should be aware of the various postoperative findings and complications associated with surgical or endoscopic repair of Zenker's diverticulum so that appropriate interventions can be taken in patients with this condition.

Adult↗
PubMed2005

MR cholangiopancreatography versus endoscopic sonography in suspected common bile duct lithiasis: a prospective, comparative study.

OBJECTIVE: Our purpose was to compare the accuracy of MR cholangiopancreatography and endoscopic sonography for the diagnosis of common bile duct stones in patients with a mild to moderate clinical suspicion of common bile duct stones. SUBJECTS AND METHODS: Forty-seven patients were prospectively enrolled. Inclusion criteria included acute pancreatitis, subclinical jaundice, and clinical features of common bile duct stone migration. Radial endoscopic sonography and MR cholangiopancreatography with the single-shot fast spin-echo technique were performed a maximum of 48 hr apart. The gold-standard diagnosis was obtained with ERCP (n = 20) or intraoperative cholangiography (n = 14) if the results of endoscopic sonography or MR cholangiopancreatography were abnormal or if a cholecystectomy was performed, or by clinical and biochemical follow-up (n = 11) if the results of endoscopic sonography and MR cholangiopancreatography were normal. RESULTS: The final diagnosis was common bile duct stones in 16 patients, malignant obstructions in four, and another biliary disease in two (lithiasis migration aspect with papillary edema); 23 patients had no biliary disease. The sensitivity and specificity of MR cholangiopancreatography were, respectively, 90.5% and 87.5% for etiologic diagnosis and 87.5% and 96.6% for the detection of common bile duct stones. The corresponding values for endoscopic sonography were 86.4% and 91.3% for etiologic diagnosis and 93.8% and 96.6% for visualization of choledocholithiasis. Accuracy did not significantly differ between the techniques. CONCLUSION: In cases of mild to moderate suspicion of choledocholithiasis, the accuracies of endoscopic sonography and MR cholangiopancreatography are similar. Because MR cholangiopancreatography is noninvasive, it may be preferred for this indication.

Adult↗
PubMed1993

Revaluation of endoscopic laser therapy for treatment of early cancer in the stomach.

The efficacy and safety of the endoscopic laser therapy for eradication of early cancer in the stomach was revaluated in fourty-eight patients. In 37 of the 42 patients (88%) treated with the laser therapy alone, the procedure was effective and the complete eradication was confirmed at the end of the follow-up period. In seven of fourteen patients with the incomplete treatment, residual cancer cells were successfully removed by repeated laser therapy. The endoscopic mucosal resection was effective in 21 of the 30 patients (70%) with the early gastric cancer. Interestingly, six of the eleven cases with incomplete treatment with the endoscopic mucosal resection underwent the laser therapy and the complete eradication was achieved in all patients. Although the endoscopic mucosal resection is now the main method for the endoscopic treatment of the early gastric cancer, these data favor offering the endoscopic laser therapy as the combined method with the mucosal resection therapy.

Adult↗
PubMed2001

[Upper digestive haemorrhage due to Mallory-Weiss syndrome. Role of endoscopic sclerotherapy].

BACKGROUND: Although Mallory-Weiss syndrome is responsible for between 0.5 and 17% of the cases of upper digestive haemorrhage, the information existing on the endoscopic treatment of this syndrome is scarce. MATERIAL AND METHODS: We made a retrospective study of 71 patients with haemorrhage due to Mallory-Weiss syndrome, dividing them into two groups according to the treatment they had received (medical or medical-endoscopic). Hence, 60 patients (30 with clean laceration, 9 with signs of prior haemostasia and 21 with fresh clotting) had been treated with procinetics and/or antisecretories alone, while the 11 remaining (8 with active haemorrhage, 2 with visible vessel and 1 with fresh clotting) had also received endoscopic treatment with sclerotherapy. We compared the clinical and analytical characteristics and the evolution of both groups of patients, analysing the data by means of the Mann-Whitney U and the chi 2 test. RESULTS: The endoscopic sclerosis group showed maelenas more frequently and more severe analytical data of haemorrhage (p<0.01). Endoscopic sclerosis brought initial control of the haemorrhage in all the patients, with a low index of haemorrhage relapse, similar to the group receiving exclusively medical treatment. CONCLUSIONS: In our series, the patients with Mallory-Weiss syndrome with active bleeding or visible vessel presented a haemorrhage with a greater clinical and analytical repercussion. In this group of patients, endoscopic sclerotherapy controlled the haemorrhage and/or prevented rebleeding, in the absence of complications.

English Abstract↗
PubMedDate not supplied

Osteoplastic flap versus modified endoscopic Lothrop procedure in patients with frontal sinus disease.

The aim of the present study was to review the clinical results of osteoplastic flap procedure with abdominal fat obliteration and modified endoscopic Lothrop procedure. Charts of patients with frontal sinus disease who underwent osteoplastic flap procedure with abdominal fat obliteration or modified endoscopic Lothrop procedure were retrospectively reviewed. Forty-three patients with frontal sinus disease underwent osteoplastic flap procedure with abdominal fat obliteration. Frontal sinus disease was chronic sinusitis in 21, mucocele in 18, and papilloma in four. None of the patients had recurrence within 3 to 12 years follow-up period. Six patients had decreased forehead sensation, one had a CSF leak, and one had loss of the fat graft. Fifteen patients with chronic frontal sinusitis underwent modified endoscopic Lothrop procedure. The follow-up period ranged from 0.5 to 2.5 years. Two patients had recurrence of disease 2 and 6 months after surgery and required osteoplastic flap. In patients with chronic frontal sinusitis, both procedures achieved good relief of symptoms; however, follow-up time of modified endoscopic Lothrop procedure was smaller than that of osteoplastic flap procedure. In conclusion, osteoplastic flap procedure with abdominal fat obliteration provides successful treatment in patients with frontal chronic sinusitis, mucocele, or papilloma. Modified endoscopic Lothrop procedure achieves the relief of symptoms in patients with chronic frontal sinusitis. With the future availability of long term follow-up results, modified endoscopic Lothrop procedure may reduce the number of osteoplastic flap procedures in patients with chronic frontal sinusitis.

Adult↗
PubMedDate not supplied

The endoscopic management of chronic frontal sinusitis associated with frontal sinus posterior table erosion.

Expansile inflammatory diseases of the frontal sinuses may produce erosion of the posterior table of the frontal sinus. In these instances, the bone between sinus mucosa and intracranial dura is absent. Over the past decade, endoscopic frontal sinusotomy has emerged as the preferred technique for the treatment of refractory chronic frontal sinusitis. Endoscopic approaches also have a role in the most advanced instances of frontal sinusitis. A retrospective chart review of patients who were treated for frontal sinusitis with erosion of the frontal sinus posterior table was performed. Eight patients were identified. All patients underwent endoscopic frontal sinusotomy; some patients required multiple endoscopic procedures. Complete frontal recess dissection with identification of the frontal ostium was achieved for all involved frontal sinuses. In all cases, this postoperative result was monitored by CT scans (where indicated) and serial nasal endoscopy, which demonstrated good frontal sinus aeration and normal mucociliary clearance. Antibiotics were administered for culture-documented bacterial exacerbations, and systemic steroids were given for management of allergic fungal sinusitis and sinonasal polyposis associated with asthma. No patient underwent frontal sinus obliteration or cranialization. No suppurative intracranial complications were noted during the postoperative period. Endoscopic frontal sinusotomy can be used safely for the definitive management of frontal sinusitis associated with posterior table erosion. In fact, endoscopic techniques may represent the preferred approach for the treatment of this problem. Such an approach avoids the morbidity of more destructive alternatives (such as obliteration), and serves to create a frontal sinus with normal mucociliary clearance.

Adult↗
PubMedDate not supplied

Endoscopic treatment of juvenile nasopharyngeal angiofibroma.

Traditional treatment of juvenile nasopharyngeal angiofibromas (JNAs) has included open surgical approaches for the majority of tumors. At the University of Washington Medical Center (UWMC), endoscopic techniques have been used for the removal of some small JNAs. This report describes the institutional experience in treating these tumors. The medical records of 15 patients at UWMC treated over a 15-year period for JNA were reviewed. Three patients were treated only by an endoscopic approach, and one patient had a combined endoscopic and open procedure. All three of the patients treated only by the endoscopic approach were disease free with a minimum of 24 months follow up. The one patient treated with a combined endoscopic and open approach had recurrence of disease. Endoscopic removal after embolization effectively treated three patients with early stage JNAs. Indications for this procedure are discussed.

Adolescent↗