scholarly journals P.093 Thorascopic assisted resection of dumbbell nerve sheath tumors

2017 ◽  
Vol 44 (S2) ◽  
pp. S37-S37
Author(s):  
S Sharma ◽  
R Power ◽  
K Reddy
Keyword(s):  
Length Of Stay ◽  
Case Series ◽  
Tumor Location ◽  
Neurologic Deficit ◽  
Complication Rates ◽  
Nerve Sheath Tumors ◽  
Nerve Sheath ◽  
Patient Reported ◽  
Vertebral Bodies ◽  
Traditional Approaches

Background: Surgery to remove dumbbell nerve sheath tumors (NST) is complex, and is accompanied by significant operative and perioperative challenges. Historically, resection of dumbbell NST required large operations involving opening the chest and laminectomy, often accompanied by instrumentation. We describe a case series of 5 patients who underwent single stage thorascopic-guided resection of dumbbell schwannoma at our institution. Methods: 5 cases presented consisted of moderate to large NST, which contained intraforaminal components. Tumor location ranged from T3-T9, with most tumors spanning 2-3 vertebral bodies. Presentation ranged from discomfort/pain (most common) to one presentation of neurologic deficit with difficulty with ambulation. Results: Thorascopic assisted resection accomplished gross total resection in 4 of the 5 cases. In all cases there was no significant neurologic deficit, although one patient reported transient numbness following the operation and all patients made significant improvement post operatively. The length of stay for these cases ranged from 1-6 days. Conclusions: Thorascopic assisted resection of dumbbell NST can be performed safely and with good outcomes by using the corridor the tumor produces. This approach reduces the need for instrumentation, length of stay and post operative complication rates relative to traditional approaches. To perform this approach effectively, good co-operation between the neurosurgeon and thoracic surgeon needs to be present.

scholarly journals P.098 Evaluation and surgical management of pelvic peripheral nerve sheath tumors: the University of Toronto experience and review of literature

2017 ◽  
Vol 44 (S2) ◽  
pp. S38-S38
Author(s):  
S Wang ◽  
Z Merali ◽  
F Pirouzmand
Keyword(s):  
Peripheral Nerve ◽  
English Language ◽  
Case Series ◽  
Tumor Location ◽  
Presenting Symptoms ◽  
Nerve Sheath Tumors ◽  
Peripheral Nerve Sheath Tumors ◽  
Nerve Sheath ◽  
Imaging Characteristics ◽  
Surgical Technical

Background: Pelvic peripheral nerve sheath tumors (PNST), which includes neurofibroma, schwannoma, and MPNST, are rare tumors located in the retroperitoneum. Methods: The case records of a prospectively maintained database at Sunnybrook Health Sciences Center (SHSC) were reviewed to identify patients with pelvic PNST, managed between 2006 - 2016. Medical records were retrospectively reviewed for patient demographics, presentation, tumor location, symptoms, imaging characteristics, management, and outcome. The surgical technical caveats were described. An English language literature review was performed to describe previously published experiences. Results: The series consisted of 7 patients, ranging from 22 - 74 years of age at presentation. These lesions tend to be large at the time of diagnosis, and presenting symptoms include abdominal, flank, or back pain, as well as leg edema or hydronephrosis from local compression. Most patients in this cohort were managed surgically with midline abdominal transperitoneal exposures. Lastly, 5 tumors were benign schwannomas managed with gross total resection or debulking, while 2 patients had MPNSTs managed with biopsy followed by adjuvant chemoradiation therapy. Conclusions: In this case series, we describe the characteristics, evaluation, and management of 7 patients with pelvic PNST at a major healthcare institution in Toronto, Canada, highlighting the technical aspects of managing this rare and challenging entity.

scholarly journals Retrospective canine skin peripheral nerve sheath tumors data with emphasis on histologic, immunohistochemical and prognostic factors

2015 ◽  
Vol 35 (12) ◽  
pp. 965-974 ◽  
Author(s):  
Gisele S. Boos ◽  
Daniele M. Bassuino ◽  
Fabiana Wurster ◽  
Neusa B. Castro ◽  
Tatiane T.N. Watanabe ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Protein S ◽  
Skin Neoplasms ◽  
Tumor Location ◽  
Benign Tumors ◽  
Nerve Sheath Tumor ◽  
Nerve Sheath Tumors ◽  
Peripheral Nerve Sheath Tumors ◽  
Nerve Sheath ◽  
S 100

Abstract: In this retrospective study was determined the frequency of canine skin peripheral nerve sheath tumors (PNST) in cases diagnosed by the Setor de Patologia Veterinária of the Universidade Federal do Rio Grande do Sul (SPV-UFRGS), Brazil, between the years 2000 and 2012. The canine profiles, as well as histological, immunohistochemical and prognostic aspects of the tumors were based on 70 samples, comprising 40 females, 29 males and one unspecified sample. Between 2000 and 2012, 2,984 skin tumors of dogs were diagnosed in the SPV-UFRGS, totaling 2.34% of skin neoplasms in dogs. Animals that comprised the largest amount of samples (43%) were those with no breed (SRD), followed by German Shepherds (10%). Females were more affected than males (40/70 - 57% and 29/70 - 41% respectively). Skin PNST of this research showed predominant localization on the limbs (40% in the forelimbs and 29% in the hindlimbs); affecting adult dogs, mostly aged between 8 and 11 years (54%). The samples were routinely processed for hematoxylin and eosin, and were also evaluated by toluidine blue and Masson's trichrome staining, and immunohistochemistry (IHC) anti-vimentin, -S-100, -GFAP, -actin, von Willebrand factor and neurofilament. Anisocytosis and anisokaryosis, mitotic index, intratumoral necrosis, invasion of adjacent tissues, tumor location, local recurrence and metastasis were related to the diagnosis of benign (49/70) or malignant tumor (21/70). The Antoni A histological pattern was observed more frequently in benign tumors. The immunohistochemistry helped to diagnose PNST, and anti-vimentin and anti-protein S-100 showed the highest rates of immunostaining. Throughout statistical analysis of animals with tumor recurrence, it was found that the chance of an animal with a malignant peripheral nerve sheath tumor to develop recurrence is 4.61 times higher than in an animal that had a benign tumor.

scholarly journals Feasibility of laparoscopic abdominal wall reconstruction in an outpatient community-hospital setting using cPTFE prosthetic mesh: a prospective, multicenter case series

2016 ◽  
Vol 44 (6) ◽  
pp. 1506-1513
Author(s):  
Terry Unruh ◽  
Joseph Adjei Boachie ◽  
Eduardo Smith-Singares
Keyword(s):  
Community Hospital ◽  
Abdominal Wall Reconstruction ◽  
Hospital Setting ◽  
Case Series ◽  
Hernia Recurrence ◽  
Complication Rates ◽  
Community Hospitals ◽  
Patient Reported ◽  
Secondary Endpoints

Objective This study investigated the use of prosthetic condensed polytetrafluoroethylene (cPTFE) for laparoscopic ventral hernia repair (LVHR) in an outpatient community-hospital setting. Methods Patients underwent LVHR with cPTFE at one of three community hospitals. Primary endpoint was hernia recurrence at 1-year postoperatively. Secondary endpoints included pain, surgical site infection, medical/surgical complications, and patient-reported outcomes. Results This study included 65 females and 52 males, aged 46.6 ± 13.2 years (mean ± SD; range 18–84 years). Mean prosthetic size was 413.8 ± 336.11 cm2 (range 165–936 cm2). Mean follow-up was 30 months (range 12–46 months). Hernia recurrence rate was 4.3%. Rate of hospitalization in the first postoperative week was 2.6%. Early and late secondary endpoint complication rates were 24.8% and 27.4%, respectively; pain was the most common complication, followed by seroma (8.5%). Conclusions Outpatient LVHR using cPTFE is feasible in community hospitals. Complication rates were similar to previous reports, and the seroma rate was markedly lower.

Need for standard outcome reporting systems in craniosynostosis

2011 ◽  
Vol 31 (2) ◽  
pp. E1 ◽  
Author(s):  
Caroline Szpalski ◽  
Katie Weichman ◽  
Fabio Sagebin ◽  
Stephen M. Warren
Keyword(s):  
Health Care Professionals ◽  
Treatment Options ◽  
Case Series ◽  
Functional Results ◽  
Series Data ◽  
Quality Level ◽  
Complication Rates ◽  
Outcome Reporting ◽  
Radiographic Measurements ◽  
Patient Reported

Craniosynostosis is the premature fusion of one or more cranial sutures. When a cranial suture fuses prematurely, skull growth is altered and the head takes on a characteristic pathological shape determined by the suture(s) that fuses. Numerous treatment options have been proposed, but until recently there were no parameters or guidelines of care. Establishing such parameters was an important step forward in the treatment of patients with craniosynostosis, but results are still assessed using radiographic measurements, complication rates, and ad hoc reporting scales. Therefore, clinical outcome reporting in the treatment of craniosynostosis is inconsistent and lacks methodological rigor. Today, most reported evidence in the treatment of craniosynostosis is level 5 (expert opinion) or level 4 (case series) data. Challenges in obtaining higher quality level 1 or level 2 data include randomizing patients in a clinical trial as well as selecting the appropriate outcome measure for the trial. Therefore, determining core outcome sets that are important to both patients and health care professionals is an essential step in the evolution of caring for patients with craniosynostosis. Traditional clinical outcomes will remain important, but patient-reported outcomes, such as satisfaction, body image, functional results, and aesthetic outcomes, must also be incorporated if the selected outcomes are to be valuable to patients and families making decisions about treatment. In this article, the authors review the most commonly used tools to assess craniosynostosis outcomes and propose a list of longitudinal parameters of care that should be considered in the evaluation, diagnosis, and treatment evaluation of a patient with craniosynostosis.

scholarly journals Minimally invasive treatment for gynecomastia: ultrasound-guided vacuum-assisted excision – case series

Mastology ◽  
2020 ◽  
Vol 30 (Suppl 1) ◽  
Author(s):  
Henrique Lima Couto ◽  
Carolina Nazareth Valadares ◽  
Osmar Pellegrini ◽  
Shirley das Graças Ferreira ◽  
Julia Grichtolik Cantagalli Paiva
Keyword(s):  
Postoperative Period ◽  
Breast Tissue ◽  
Case Series ◽  
Complication Rates ◽  
Open Approach ◽  
Ultrasound Guided ◽  
Aesthetic Result ◽  
Postoperative Hematoma ◽  
Areolar Complex ◽  
Patient Reported

Introduction: Gynecomastia (GM) is the benign proliferation of breast tissue in men. Its prevalence is of up to 65% according to age. It can be unilateral or bilateral. The standard surgery is periareolar incision, even though it can lead to asymmetry (AS), anesthetic scar, retraction or necrosis of the nipple-areolar complex (NAC). The vacuum-assisted excision (VAE) is the alternative approach. Objectives: To describe the technique and results of ultrasound-guided VAE for GM. Methods: series of 7 cases of Simon I and II GM, submitted to US-guided VAE (10G needle and ENCOR® BD) between December 20, 2018, and October 26, 2019. The cases were assessed considering clinical, laboratory and imaging aspects with mammography (MMG) and US. The pre-surgical consent form was obtained. US-guided VAE was performed with a 3 mm incision, in the ambulatory, with local anesthesia (2% lidocaine) and no sedation, in the “fine precision” and “dense breast” modes, in order to leave a 1cm flap in the retroareolar region. At the end, a vacuum and/or manual drainage of the cavity was performed to reduce the postoperative hematoma (HMA). In the postoperative period, MMGs were performed 1 and 6 months after the VAE, and the revisions occurred on the 7th and 14th day, and the 1st, 2nd and 6th months. The patients wore vests for 30 postoperative days. The outcomes were good or excellent when the amount of residual breast tissue was minimum, and AS, retractions, necrosis, anesthetic scar or NAC deviation, absent. The patients filled out a form of satisfaction level and perception of the VAE. Results: Mean age was 26.7 years. Mean time of VAE was 28 minutes. The main complaint regarding VAE was aesthetic discomfort, followed by physical deformity. One patient presented with areola skin tear during the procedure. It was sutured and did not impact the aesthetic result. All patients and surgeons reported excellent or sufficient levels of satisfaction. There were no recurrences or re-approach in 6 months. There was no hemorrhage in the peri or postoperative period, with no open approach. No patient required sedation. They all had histology of GM. No cases of breast deviation, necrosis or NAC retraction, infection, AS our anesthetic scar. No patient reported changes in erection or breast sensitivity. They all presented with hemorrhagic suffusion and hematoma with spontaneous resolution in 30 days, without interfering in the outcome. No intervention or hematoma drainage was necessary in the postoperative period. Conclusion: US-guided VAE for GM is alternative to the conventional surgical treatment in Simon I and II cases, with good or excellent results. It presents low complication rates and high satisfaction rates. It is performed in the ambulatory, without intercurrences. Comparative studies of traditional surgery and VAE should be performed.

scholarly journals Targeting Refractory Sarcomas and Malignant Peripheral Nerve Sheath Tumors in a Phase I/II Study of Sirolimus in Combination with Ganetespib (SARC023)

Sarcoma ◽  
2020 ◽  
Vol 2020 ◽  
pp. 1-8 ◽  
Author(s):  
AeRang Kim ◽  
Yao Lu ◽  
Scott H. Okuno ◽  
Denise Reinke ◽  
Ophélia Maertens ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Clinical Benefit ◽  
Phase 1 ◽  
Recommended Dose ◽  
Phase 2 ◽  
Mtor Inhibition ◽  
Nerve Sheath Tumors ◽  
Peripheral Nerve Sheath Tumors ◽  
Nerve Sheath ◽  
Patient Reported

Purpose. Malignant peripheral nerve sheath tumors (MPNSTs) are aggressive soft tissue sarcomas. Combining Hsp90 inhibitors to enhance endoplasmic reticulum stress with mTOR inhibition results in dramatic MPNST shrinkage in a genetically engineered MPNST mouse model. Ganetespib is an injectable potent small molecule inhibitor of Hsp90. Sirolimus is an oral mTOR inhibitor. We sought to determine the safety, tolerability, and recommended dose of ganetespib and sirolimus in patients with refractory sarcomas and assess clinical benefits in patients with unresectable/refractory MPNSTs. Patients and Methods. In this multi-institutional, open-label, phase 1/2 study of ganetespib and sirolimus, patients ≥16 years with histologically confirmed refractory sarcoma (phase 1) or MPNST (phase 2) were eligible. A conventional 3 + 3 dose escalation design was used for phase 1. Pharmacokinetic and pharmacodynamic measures were evaluated. Primary objectives of phase 2 were to determine the clinical benefit rate (CBR) of this combination in MPNSTs. Patient-reported outcomes assessed pain. Results. Twenty patients were enrolled (10 per phase). Toxicities were manageable; most frequent non-DLTs were diarrhea, elevated liver transaminases, and fatigue. The recommended dose of ganetespib was 200 mg/m2 intravenously on days 1, 8, and 15 with sirolimus 4 mg orally once daily with day 1 loading dose of 12 mg. In phase 1, one patient with leiomyosarcoma achieved a sustained partial response. In phase 2, no responses were observed. The median number of cycles treated was 2 (1–4). Patients did not meet the criteria for clinical benefit as defined per protocol. Pain ratings decreased or were stable. Conclusion. Despite promising preclinical rationale and tolerability of the combination therapy, no responses were observed, and the study did not meet parameters for further evaluation in MPNSTs. This trial was registered with (NCT02008877).

scholarly journals Independent assessment and outcomes of 196 short-tapered stems short-term follow-up and review of the literature

2018 ◽  
Vol 26 (3) ◽  
pp. 230949901881223 ◽  
Author(s):  
Sam Nahas ◽  
Akash Patel ◽  
Nicola Blucher ◽  
Vikas Vedi
Keyword(s):  
Outcome Measures ◽  
Case Series ◽  
Outcome Data ◽  
Secondary Outcome ◽  
Complication Rates ◽  
Short Term ◽  
Safe Alternative ◽  
Term Outcome ◽  
Patient Reported

Background: Longer term outcome data are now becoming available for short-tapered femoral stems for cementless total hip arthroplasty. The shorter stem has a metaphyseal fit, loading the bone in this area, leading to physiological bone remodelling. It is also bone preserving, as it is 35 mm shorter. It may be easier to insert through a smaller incision and potentially reduce complication rates. We present a retrospective single surgeon case series of 196 patients (>53% follow-up over 5 years). All patients had the cementless ‘Microplasty Taperloc’ (Biomet). Primary outcome measures were femoral component revision rates. Secondary outcome measures included complications, patient-reported functional outcome scores (Oxford hip) and radiographic evidence of loosening. Methods: Patients were identified using electronic software. All were routinely followed up and assessed in clinic since implant introduction in 2009. Oxford hip scores were routinely obtained. A surgeon who had not carried out the procedure independently assessed radiographs. Results: One hundred ninety-six patients were identified. The revision rate was 0.5% due to an intraoperative peri-prosthetic fracture of the femur identified on post-operative radiograph. The complication rate was 2%, attributable to: subsidence of the prosthesis (one hip), post-operative dislocation (two hips), one of which required acetabular revision. Oxford hip scores increased on average from 21 to 45 (pre- to post-operatively). There were no signs of radiographic loosening. Conclusion: The results show that using the short-tapered stem is proving so far to be a reliable and safe alternative to its longer counterpart, with low complication rates in the short term.

Intermediate-term Experience With the STAR Total Ankle in the United States

2018 ◽  
Vol 40 (3) ◽  
pp. 268-275 ◽  
Author(s):  
Evan M. Loewy ◽  
Thomas H. Sanders ◽  
Arthur K. Walling
Keyword(s):  
United States ◽  
Perioperative Complications ◽  
Case Series ◽  
Major Complication ◽  
The United States ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Patient Reported ◽  
The Mean

Background: Limited intermediate and no real long-term follow-up data have been published for total ankle arthroplasty (TAA) in the United States. This is a report of clinical follow-up data of a prospective, consecutive cohort of patients who underwent TAA by a single surgeon from 1999 to 2013 with the Scandinavian Total Ankle Replacement (STAR) prosthesis. Methods: Patients undergoing TAA at a single US institution were enrolled into a prospective study. These patients were followed at regular intervals with history, physical examination, and radiographs; American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale scores were obtained and recorded. Primary outcomes included implant survivability and functional outcomes scores. Secondary outcomes included perioperative complications such as periprosthetic or polyethylene fracture. Between 1999 and 2013, a total of 138 STAR TAAs were performed in 131 patients; 81 patients were female. The mean age at surgery was 61.5 ± 12.3 years (range, 30-88 years). The mean duration of follow-up for living patients who retained both initial components at final follow-up was 8.8±4.3 years (range 2-16.9 years). Results: The mean change in AOFAS Ankle-Hindfoot scores from preoperative to final follow-up was 36.0 ± 16.8 ( P < .0001). There were 21 (15.2%) implant failures that occurred at a mean 4.9 ± 4.5 years postoperation. Ten polyethylene components in 9 TAAs (6.5%) required replacement for fracture at an average 8.9 ± 3.3 years postoperatively. Fourteen patients died with their initial implants in place. Conclusion: This cohort of patients with true intermediate follow-up after TAA with the STAR prosthesis had acceptable implant survival, maintenance of improved patient-reported outcome scores, and low major complication rates. Level of Evidence: Level IV, case series.

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