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Surgical courses

Andrea J Dolenc, William Z Morris, John J Como, Karl G Wagner, Heather A Vallier
OBJECTIVES: Controversy exists over association of blood transfusions with complications. The purpose was to assess effects of limited transfusions on complication rates and hospital course. SETTING: level 1 trauma center PATIENTS AND METHODS:: 371 consecutive patients with ISS≥16 underwent fixation of fractures of spine (n = 111), pelvis (n = 72), acetabulum (n = 57), and/or femur (n = 179). Those receiving >3 units PRBC were excluded. MAIN OUTCOME MEASUREMENTS: Fracture type, associated injuries, treatment details, ventilation time, complications, and hospital stay were prospectively recorded...
October 1, 2016: Journal of Orthopaedic Trauma
S Chawla, J Bowman, M Gandhi, B Panizza
BACKGROUND: The skull base is a highly complex anatomical region that provides passage for important nerves and vessels as they course into and out of the cranial cavity. Key to the management of pathology in this region is a thorough understanding of the anatomy, with its variations, and the relationship of various neurovascular structures to the pathology in question. Targeted high-resolution magnetic resonance imaging on high field strength magnets can enable the skull base surgeon to understand this intricate relationship and deal with the pathology from a position of relative advantage...
October 20, 2016: Journal of Laryngology and Otology
Petar Duvnjak, Mario Laguna
The use of live attenuated intravesicular Bacillus Calmette-Guerin (BCG) therapy is a generally accepted safe and effective method for the treatment of superficial transitional cell carcinoma (TCC) of the bladder. Although rare, < 5% of patient's treated with intravesicular BCG therapy may develop potentially serious complications, including localized infections to the genitourinary tract, mycotic aneurysms and osteomyelitis. We present here a case of a 63-year-old male who developed left coronary and multiple peripheral M...
August 2016: Journal of Radiology Case Reports
Jeffrey Gnerre, Yankai Sun, Andrzej Jedynak, Anthony Gilet
Gallbladder varices are a rare form of collateralization that develop in patients with portal hypertension. We present here a case of gallbladder varices accurately diagnosed by contrast enhanced CT imaging of the abdomen and confirmed by Color Doppler Sonography. A 76-year-old patient with hepatocellular carcinoma developed portal vein thrombosis due to tumor extension during the course of treatment and was incidentally discovered to have gallbladder varices. While most commonly asymptomatic, gallbladder varices are associated with increased risk of massive bleeding, either spontaneously or during cholecystectomy...
May 2016: Journal of Radiology Case Reports
Yasmeen Jabeen Bhat, Iffat Hassan, Peerzada Sajad, Atiya Yaseen, Syed Mubashir, Saniya Akhter, Roohi Wani
BACKGROUND: Epidermal naevi are benign hamartomatous growths of the skin which are generally asymptomatic with a benign course but are cosmetically disagreeable. Topical treatments such as steroids, calcipotriol, 5 fluorouracil, podophyllin, retinoids and cryotherapy are ineffective and surgical excision results in scar formation. Therapy is often challenging. AIM OF THE STUDY: To study the response of carbon dioxide (CO2) laser in the management of epidermal naevi...
July 2016: Journal of Cutaneous and Aesthetic Surgery
Junji Kawada, Masaya Nishino, Yohei Hosoda, Hiromitsu Hoshino, Miho Okano, Kenichi Nagai, Masaki Okuyama, Yongkook Kim, Toshimasa Tsujinaka
Patients with esophageal cancer often have various comorbidities, and these sometimes limit treatment choices. We report a case of esophageal cancer surgically treated using laparoscopic transhiatal esophagectomy after chemoradiotherapy in an elderly man with interstitial lung disease. A 77-year-old man who had undergone upper gastrointestinal endoscopic examination was admitted to our hospital with a diagnosis of esophageal cancer and interstitial lung disease. We diagnosed T4 esophageal cancer, and administered chemoradiotherapy...
October 2016: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Takaki Yoshikawa, Tsutomu Sato, Takanobu Yamada, Toru Aoyama, Takashi Ogata, Haruhiko Cho
Adjuvant chemotherapy aims to eradicate residual micro-metastatic tumor cells existing at distant sites outside the surgical field. The current standard adjuvant chemotherapy is S-1 for 1 year or capecitabine plus oxaliplatin for 6 months after D2 gastrectomy. However, there are some rooms in the overall survival of Stage III. Neoadjuvant chemotherapy(NAC)is a promising approach that combines intensive chemotherapy with high compliance; however, it is under development in Japan. Two JCOG phase II trials suggested that NAC was effective for bulky nodal disease...
October 2016: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Anne M Drewry, Enyo A Ablordeppey, Ellen T Murray, Evan R Beiter, Andrew H Walton, Mark W Hall, Richard S Hotchkiss
BACKGROUND: Identifying patients in the immunosuppressive phase of sepsis is essential for development of immunomodulatory therapies. Little data exists comparing the ability of the two most well-studied markers of sepsis-induced immunosuppression, human leukocyte antigen (HLA)-DR expression and lipopolysaccharide (LPS)-induced tumor necrosis factor alpha (TNF-ɑ) production, to predict mortality and morbidity. The purpose of this study was to compare HLA-DR expression and LPS-induced TNF-ɑ production as predictors of 28-day mortality and acquisition of secondary infections in adult septic patients...
October 20, 2016: Critical Care: the Official Journal of the Critical Care Forum
Ivanka S Nenova, Mariana Y Valcheva, Elina A Beleva, Dora Y Tumbeva, Marianna P Yaneva, Emilia L Rancheva, Zhanet G Grudeva-Popova
INTRODUCTION: Autoimmune disorders have been documented in solid tumors and malignant hematological disorders. They are very common and well studied in lymphomas which are associated with immune imbalance. They are less common in solid tumors and are categorized as paraneoplastic syndromes with unclear pathogenesis. AIM: The aim of the present study was to find the frequency of autoimmune phenomena in solid tumors of various origin, location and status of the tumor...
September 1, 2016: Folia Medica
Giacomo Murana, Mariano Cefarelli, Geoffrey Kloppenburg, Wim J Morshuis, Robin H Heijmen
In adult the patent ductus arteriosus is a rare condition associated sometimes with lethal complications. We describe the case of a 44-year-old woman with a history of systemic lupus erythematosus admitted to our hospital with hoarseness and severe dyspnea. Clinical imaging examinations indicated a saccular aneurysm within a persistent ductus arteriosus with signs of impending rupture. Patient was not considered suitable for transcatheter closure and therefore she underwent open aortic repair. The procedure was uneventful and any significant complications occurred during postoperative course...
October 19, 2016: Future Cardiology
Francesco Ricci, Andrea Paradisi, Giorgio Annessi, Mauro Paradisi, Damiano Abeni
BACKGROUND: The solitary form of Spitz nevus is a common clinical entity in children, typically occurring on the face and extremities. However, less frequent variants of Spitz nevi, such as agminated forms and eruptive disseminated Spitz nevi (EDSN), have been described. The agminated form is characterised by localised clusters or segmental distribution of Spitz nevi on the face, back, or extremities. First described as "eruptive juvenile melanomata", EDSN is the rarest clinical variant, consisting of a widespread eruption of Spitz nevi, most frequently involving the trunk, buttocks, and proximal limbs, and usually occurs in the second to third decade of life...
October 19, 2016: European Journal of Dermatology: EJD
Filippo Landi, Eloy Espín, Victor Rodrigues, Francesc Vallribera, Aleix Martinez, Cecile Charpy, Francesco Brunetti, Daniel Azoulay, Nicola de'Angelis
PURPOSE: Patients with locally advanced rectal cancer and pathologic complete response to neoadjuvant chemoradiation therapy have lower rates of recurrence compared to those who do not. However, the influences of the pathologic response on surgical complications and survival remain unclear. This study aimed to investigate the influence of neoadjuvant therapy for rectal cancer on postoperative morbidity and long-term survival. METHODS: This was a comparative study of consecutive patients who underwent laparoscopic total mesorectal excision for rectal cancer in two European tertiary hospitals between 2004 and 2014...
October 19, 2016: International Journal of Colorectal Disease
Hyun Seok Jang, Jae Kyun Ju, Chang Hyun Kim, Soo Young Lee, Hyeong Rok Kim, Young Jin Kim
PURPOSE: The aim of this study was to evaluate the impact of extended resection of primary tumor on survival outcome in unresectable colorectal cancer (UCRC). METHODS: A retrospective analysis was conducted for 190 patients undergoing palliative surgery for UCRC between 1998 and 2007 at a single institution. Variables including demographics, histopathological characteristics of tumors, surgical procedures, and course of the disease were examined. RESULTS: Kaplan-Meier survival curve indicated a significant increase in survival times in patients undergoing extended resection of the primary tumor (P < 0...
October 2016: Annals of Surgical Treatment and Research
Aiman Obed, Anwar Jarrad, Abdalla Bashir
BACKGROUND Associated Liver Partition and Portal vein ligation with Staged hepatectomy (ALPPS) leads to rapid hepatic hypertrophy and decreases incidence of post-hepatectomy liver failure in patients with a marginal future liver remnant. Various procedural ALPPS modifications were previously described. Here, we present the first case of a new ALPPS modification, carrying out a left hepatic trisectionectomy with segment 1. CASE REPORT We present the case of a 36-year-old woman with locally advanced sigmoid adeno-carcinoma and extensive left liver metastases extending to segment V and VIII, who received state-of-the-art systemic conversion chemotherapy...
October 19, 2016: American Journal of Case Reports
Giordano Tasca, Matteo Selmi, Emiliano Votta, Paola Redaelli, Francesco Sturla, Alberto Redaelli, Amando Gamba
BACKGROUND: Aortic root aneurysm can be treated with valve-sparing procedures. The David and Yacoub techniques have shown excellent long-term results but are technically demanding. Recently, a new and simpler procedure, the Sleeve technique, was proposed with encouraging results. We aimed to quantify the biomechanics of the initially aneurysmal aortic root (AR) after the Sleeve procedure to assess whether it induces abnormal stresses, potentially undermining its durability. METHODS: Two finite element (FE) models of the physiologic and aneurysmal AR were built, accounting for the anatomical asymmetry and the nonlinear and anisotropic mechanical properties of human AR tissues...
October 15, 2016: Annals of Thoracic Surgery
Tong Qiu, Yandong Zhao, Jianfang Song, Bo Fu, Yunpeng Xuan, Wenjie Jiao
BACKGROUND: Carina resection and reconstruction is a challenging procedure for thoracic surgeons. We describe a novel technique of thoracoscopic carina reconstruction using the natural bifurcation, following pulmonary resection of the lung neoplasm. To our knowledge, it is the first report of this kind. CASE PRESENTATION: A 71-year-old male diagnosed of squamous cell lung cancer received two-port approached video-assisted thoracoscopic right bilobectomy with carina resection after 2 cycles of neoadjuvant therapy...
October 18, 2016: Journal of Cardiothoracic Surgery
Alyssa R Golas, Jamie P Levine, Justin Ream, Eduardo D Rodriguez
An accurate and comprehensive understanding of lower extremity arterial anatomy is essential for the successful harvest and transfer of a free fibula osteoseptocutaneous flap (FFF). Minimum preoperative evaluation includes detailed history and physical including lower extremity pulse examination. Controversy exists regarding whether preoperative angiographic imaging should be performed for all patients. Elevation of an FFF necessitates division of the peroneal artery in the proximal lower leg and eradicates its downstream flow...
October 14, 2016: Journal of Craniofacial Surgery
Kun Liu, Chunxia Yang, Yongna Zhang, Xunhui Yuan, Hang Xiao, Yun'an Bai, Bin Xi
Brain abscess is a rare but potentially lethal infection of brain parenchyma, requiring prompt surgical intervention and high-dose antibiotic therapy. Brain abscess is a known complication of surgically treated intracerebral hemorrhage (ICH), but it is exceptionally rare that it occurs at the same site of a nonoperated ICH. Such cases may result from hematogenous spread from distant foci (pneumonia, infectious endocarditis) or contiguous sites. Herein, the authors report a case of 75-year-old woman presenting with a brain abscess 6 weeks after a nonoperated ICH...
October 14, 2016: Journal of Craniofacial Surgery
Joann J Kang, David C Ritterband, Kevin Lai, Jeffrey M Liebmann, John A Seedor
PURPOSE: To evaluate visual outcomes and complications after Descemet stripping automated endothelial keratoplasty (DSAEK) in patients with previous glaucoma surgery. METHODS: A retrospective chart review was conducted of 129 procedures in 102 eyes of 96 patients who underwent DSAEK and previous glaucoma surgery at New York Eye and Ear Infirmary of Mt Sinai. The mean length of follow-up was 29.1 ± 25.5 months. Patients with postoperative follow-up duration of less than 3 months were excluded from analysis...
October 14, 2016: Cornea
Marko Poglitsch, Ashraf H Ahmed, Michael Resl, Andrea Stoller, Dunja Van Oyen, Cornelia Schwager, Claudia Aigner, Oliver Domenig, Michael Krebs, Manuel Haschke, Michael Stowasser
OBJECTIVE: Primary aldosteronism (PA) is form of hypertension characterized by production of aldosterone by the adrenal that is excessive and relatively autonomous of the renin-angiotensin system. Once detected, unilateral PA can be usually cured by surgical removal of the affected adrenal, while bilateral PA can be specifically treated by medications, which antagonize aldosterone action. Clinical guidelines of Endocrine Societies in Europe and the US recommend screening for PA among most hypertensive patients...
September 2016: Journal of Hypertension
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