FA07.03: TRACHEO-BRONCHO-ESOPHAGEAL FISTULAE: THE NEW EPIDEMIC?

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 14-14
Author(s):  
Lucile Gust ◽  
Delphine Trousse ◽  
Geoffrey Brioude ◽  
Herve Dutau ◽  
Christophe Doddoli ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Endoscopic Treatment ◽  
Conflicts Of Interest ◽  
Clinical Situation ◽  
Early Postoperative Period ◽  
The Other ◽  
Patient Death ◽  
Anastomotic Fistula ◽  
Post Radiation ◽  
Multimodal Management

Abstract Background Acquired Tracheo-broncho-esophageal fistulae of the adult are uncommon, severe and require a complex management associating medical, endoscopic and surgical treatment. Methods From January 2013 to December 2017, we conducted a monocentric, retrospective study on the etiology, the diagnosis and the management of acquired tracheo-broncho-esophageal fistulae. Results During the last 5 years, 29 consecutive acquired tracheo-broncho-esophageal fistulae were diagnosed in our department (23 men and 6 women), of which 2 malignant fistulae. Sixteen appeared in the early postoperative period after esophagectomy (From 7 to 63 days), and two more later at post-operative day 150 and 154 days. The other 10 tracheo-broncho-esophageal fistulae had variable etiologies: post-radiation (5), traumatic (4), severe reflux. Clinical presentation were of variable severity as well. Six patients were asymptomatic, the fistula diagnosed on systematic radiological or endoscopic examinations. The other patients had respiratory and infectious symptoms, going from iterative pneumopathy to acute respiratory distress with septic shock. The management was complex and specific to each patient, but 3 situations can be described: 1. Endoscopic treatment (7) 2. Surgical treatment, more or less followed by an endoscopic treatment (7) 3. Multiple endoscopic treatment, followed by surgery (13). Regardless of the treatment, the mortality rate was extremely high, 12 patients out of 27 dying in the early follow-up (44,4%). Conclusion The incidence of acquired tracheo-broncho-esophageal fistulae seems to be increasing, especially after esophagectomy. Their treatment is different than from the usual anastomotic fistula. Multimodal management is associated with patient death in about half of the cases. Endoscopic treatment allows the stabilisation of patients in a precarious clinical situation, but where the immediate results can be satisfactory it can later on lead to chronic and harmful situations. Surgery remains the cornerstone of the treatment. Disclosure All authors have declared no conflicts of interest.

scholarly journals Long-Term Clinical Outcomes of Osteochondritis Dissecans Lesions of the Elbow Treated with Arthroscopy

2021 ◽  
Vol 9 (7_suppl4) ◽  
pp. 2325967121S0020
Author(s):  
Michael Ryan ◽  
Benton Emblom ◽  
E. Lyle Cain ◽  
Jeffrey Dugas ◽  
Marcus Rothermich
Keyword(s):  
Surgical Treatment ◽  
Clinical Outcomes ◽  
Failure Rate ◽  
Osteochondritis Dissecans ◽  
Surgical Techniques ◽  
The Other ◽  
Return To Play ◽  
Exclusion Criteria

Objectives: While numerous studies exist evaluating the short-term clinical outcomes for patients who underwent arthroscopy for osteochondritis dissecans (OCD) of the capitellum, literature on long-term clinical outcomes for a relatively high number of this subset of patients from a single institution is limited. We performed a retrospective analysis on all patients treated surgically for OCD of the capitellum at our institution from January 2001 to August 2018. Our hypothesis was that clinical outcomes for patients treated arthroscopically for OCD of the capitellum would be favorable, with improved subjective pain scores and acceptable return to play for these patients. Methods: Inclusion criteria for this study included the diagnosis and surgical treatment of OCD of the capitellum treated arthroscopically with greater than 2-year follow-up. Exclusion criteria included any surgical treatment on the ipsilateral elbow prior to the first elbow arthroscopy for OCD at our institution, a missing operative report, and/or any portions of the arthroscopic procedure that were done open. Follow-up was achieved over the phone by a single author using three questionnaires: American Shoulder and Elbow Surgeons – Elbow (ASES-E), Andrews/Carson KJOC, and our institution-specific return-to-play questionnaire. Results: After the inclusion and exclusion criteria were applied to our surgical database, our institution identified 101 patients eligible for this study. Of these patients, 3 were then excluded for incomplete operative reports, leaving 98 patients. Of those 98 patients, 81 were successfully contacted over the phone for an 82.7% follow-up rate. The average age for this group at arthroscopy was 15.2 years old and average post-operative time at follow-up was 8.2 years. Of the 81 patients, 74 had abrasion chondroplasty of the capitellar OCD lesion (91.4%) while the other 7 had minor debridement (8.6%). Of the 74 abrasion chondroplasties, 29 of those had microfracture, (39.2% of that subgroup and 35.8% of the entire inclusion group). Of the microfracture group, 4 also had an intraarticular, iliac crest, mesenchymal stem-cell injection into the elbow (13.7% of capitellar microfractures, 5.4% of abrasion chondroplasties, and 4.9% of the inclusion group overall). Additional arthroscopic procedures included osteophyte debridement, minor synovectomies, capsular releases, manipulation under anesthesia, and plica excisions. Nine patients had subsequent revision arthroscopy (11.1% failure rate, 5 of which were at our institution and 4 of which were elsewhere). There were also 3 patients within the inclusion group that had ulnar collateral ligament reconstruction/repair (3.7%, 1 of which was done at our institution and the other 2 elsewhere). Lastly, 3 patients had shoulder operations on the ipsilateral extremity (3.7%, 1 operation done at our institution and the other 2 elsewhere). To control for confounding variables, scores for the questionnaires were assessed only for patients with no other surgeries on the operative arm following arthroscopy (66 patients). This group had an adjusted average follow-up of 7.9 years. For the ASES-E questionnaire, the difference between the average of the ASES-E function scores for the right and the left was 0.87 out of a maximum of 36. ASES-E pain was an average of 2.37 out of a max pain scale of 50 and surgical satisfaction was an average of 9.5 out of 10. The average Andrews/Carson score out of a 100 was 91.5 and the average KJOC score was 90.5 out of 100. Additionally, out of the 64 patients evaluated who played sports at the time of their arthroscopy, 3 ceased athletic participation due to limitations of the elbow. Conclusions: In conclusion, this study demonstrated an excellent return-to-play rate and comparable subjective long-term questionnaire scores with a 11.1% failure rate following arthroscopy for OCD of the capitellum. Further statistical analysis is needed for additional comparisons, including return-to-play between different sports, outcome comparisons between different surgical techniques performed during the arthroscopies, and to what degree the size of the lesion, number of loose bodies removed or other associated comorbidities can influence long-term clinical outcomes.

scholarly journals Urolithiasis in renal transplantation: Diagnosis and management

2014 ◽  
Vol 86 (4) ◽  
pp. 257 ◽  
Author(s):  
Elisa Cicerello ◽  
Franco Merlo ◽  
Mario Mangano ◽  
Giandavide Cova ◽  
Luigi Maccatrozzo
Keyword(s):  
Renal Transplantation ◽  
Shock Wave Lithotripsy ◽  
Renal Allograft ◽  
Stone Formation ◽  
Urinary Calculi ◽  
The Other ◽  
Ureteral Stent ◽  
Nephrostomy Tube ◽  
Staghorn Calculus ◽  
Multimodal Management

Obiectives: To report our experience of diagnosis and multimodal management of urolithiasis in renal transplantation. Patients and Methods: From January 1995 to December 2012, 953 patients underwent renal transplantation in the Kidney Transplant Unit of Treviso General Hospital. Ten (10%) of them developed urinary calculi and were referred at our institution. Their mode of presentation, investigation and treatment were recorded. Results: Seven had renal and 3 ureteral calculi. Urolithiasis was incidentally discovered on routine ultrasound in 6 patients, 1 presented with oliguria, 1 with anuria and acute renal failure and in 2 urolithiasis was found at removal of the ureteral stent. Nephrostomy tube was placed in 5 patients. Hypercalcemia with hyperparathyroidism (HPT) was present in 5 patients and hyperuricemia in 3. Two patients were primary treated by shock wave lithotripsy (SWL) and one of them was stone-free after two sessions. Two patients, one with multiple pielocaliceal calculi and the other with staghorn calculus in the lower calyx, were treated with percutaneous nephrolitothotomy (PCNL). Three patients were treated by ureteroscopy (URS) and in one of them two treatments were carried out. One patient had calculus impacted in the uretero-vesical anastomosis and surgical ureterolithotomy with re-do ureterocystoneostomy was performed after failure of URS. Two patients with calculi discovered at removal of the ureteral stent were treated by URS. Conclusions: The incidence of urolithiasis in renal transplantation is uncommon. In the most of patients the condition occurs without pain. Metabolic anomalies and medical treatment after renal transplantation may cause stone formation. Advancements in endourology and interventional radiology have influenced the management of urolithiasis that can be actually treated with a minimal incidence of risk for the renal allograft.

Surgery of the Spastic Hand in Cerebral Palsy

1998 ◽  
Vol 23 (3) ◽  
pp. 334-339 ◽  
Author(s):  
L. B. DAHLIN ◽  
Y. KOMOTO-TUFVESSON ◽  
S. SÄLGEBACK
Keyword(s):  
Cerebral Palsy ◽  
Surgical Treatment ◽  
Upper Limb ◽  
The Other ◽  
Surgical Reconstruction ◽  
Range Of Movement ◽  
Striking Finding ◽  
Hemiplegic Cerebral Palsy

Thirty-six patients with hemiplegic cerebral palsy had surgical treatment for the upper limb and were followed up for 18 months postoperatively. Various operations were done. A striking finding was a significant improvement of stereognosis (ability to describe and recognize objects without vision). Most patients had improvement in different functional grasps following surgical reconstruction. Range of movement in the forearm and wrist also increased in most patients. The thumb-in-palm deformity was completely corrected in 31 of the patients and improved in the other five. Most patients had some or all of their expectations of the procedure fulfilled.

The inconsistencies between conventional and global lab tests in cardiosurgeric patient (a clinical case)

2020 ◽  
Vol 1 (1) ◽  
pp. 68-70
Author(s):  
Eugene Roitman ◽  
◽  
Keyword(s):  
Postoperative Period ◽  
Clinical Case ◽  
Early Postoperative Period ◽  
The Other ◽  
Laboratory Methods ◽  
Hemostatic System

The clinical case demonstrates inconsistencies between the results of thromboelastography and conventional coagulation lab tests at the early postoperative period of patient undergoing cardiosurgery. The analyzing of the revealed discrepancy proves that the opposition of laboratory methods as 'one against the other' for studying the hemostatic system is unacceptable.

Surgical treatment of brainstem cavernous malformations: an international Delphi consensus

2021 ◽  
pp. 1-11
Author(s):  
Philipp Dammann ◽  
Adib A. Abla ◽  
Rustam Al-Shahi Salman ◽  
Hugo Andrade-Barazarte ◽  
Vladimir Benes ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Case Series ◽  
Treatment Decision ◽  
Clinical Situation ◽  
Delphi Consensus ◽  
Consensus Process ◽  
Cavernous Malformations ◽  
Clinical Scenarios ◽  
Developmental Venous Anomalies ◽  
Question Survey

OBJECTIVE Indication for surgery in brainstem cavernous malformations (BSCMs) is based on many case series, few comparative studies, and no randomized controlled trials. The objective of this study was to seek consensus about surgical management aspects of BSCM. METHODS A total of 29 experts were invited to participate in a multistep Delphi consensus process on the surgical treatment of BSCM. RESULTS Twenty-two (76%) of 29 experts participated in the consensus. Qualitative analysis (content analysis) of an initial open-ended question survey resulted in 99 statements regarding surgical treatment of BSCM. By using a multistep survey with 100% participation in each round, consensus was reached on 52 (53%) of 99 statements. These were grouped into 4 categories: 1) definitions and reporting standards (7/14, 50%); 2) general and patient-related aspects (11/16, 69%); 3) anatomical-, timing of surgery–, and BSCM-related aspects (22/37, 59%); and 4) clinical situation–based decision-making (12/32, 38%). Among other things, a consensus was reached for surgical timing, handling of associated developmental venous anomalies, handling of postoperative BSCM remnants, assessment of specific anatomical BSCM localizations, and treatment decisions in typical clinical BSCM scenarios. CONCLUSIONS A summary of typical clinical scenarios and a catalog of various BSCM- and patient-related aspects that influence the surgical treatment decision have been defined, rated, and interpreted.

Satisfaction With Life And Disease Acceptance By Patients With A Stomy Related To Surgical Treatment Of The Rectal Cancer – Determinants Of Quality Of Life?

2015 ◽  
Vol 87 (9) ◽  
Author(s):  
Andrzej Nowicki ◽  
Justyna Marciniak ◽  
Paulina Farbicka ◽  
Zbigniew Banaszkiewicz
Keyword(s):  
Rectal Cancer ◽  
Surgical Treatment ◽  
Satisfaction With Life ◽  
Early Postoperative Period ◽  
Moderate Level ◽  
University Hospital ◽  
Satisfaction With Life Scale ◽  
Satisfaction Level ◽  
Level Of Satisfaction ◽  
Acceptance Score

AbstractSatisfaction with life and disease acceptance by patients with a stomy related to surgical treatment of the rectal cancer depend on multiple factors. Such factors as social support, life conditions and time that elapsed after stomy creation, are very important in this context.was to conduct an early evaluation of life satisfaction and disease acceptance by patients with a stomy related to surgical treatment of the rectal cancer.The study was conducted at Dr. Jan Biziel University Hospital No. 2 in Bydgoszcz and at the prof. F. Łukaszczyk Oncology Centre in Bydgoszcz in 2014. The final analysis included 96 subjects aged 41-87 years (median 59 years). Satisfaction With Life Scale (SWLS) and Acceptance of Illness Scale (AIS) adapted by Zygfryd Juczyński, were used in this study.Most patients had satisfaction with life score of 5 or 6, 23 (24%) and 28 (29.2%) subjects, respectively. Twenty nine (30.2%) study subjects had low satisfaction level, while 16 (16.7%) had high satisfaction level. Average disease acceptance score was 23.2 points. Most patients, 71 (74%) had a moderate disease acceptance score, while the lowest number of subjects, 9 (9.4%), had high disease acceptance score. None of the study subjects who were under the care of a psychologist (14/100%) did not have a low acceptance level.Half of the study subjects had a moderate level of satisfaction with life. Most patients with stomy related to surgical treatment of the rectal cancer in an early postoperative period had moderate level of the disease acceptance. Patients with high level of satisfaction with life, accept the disease better. Few patients who used help by a psychologist, were two- and three-fold more likely to have higher level of satisfaction with life and disease acceptance, respectively.

scholarly journals XXVI.—Treatment of Aneurysm by Electrolysis.

1908 ◽  
Vol 28 ◽  
pp. 400-402
Author(s):  
Dawson Turner
Keyword(s):  
Surgical Treatment ◽  
Blood Serum ◽  
The Body ◽  
The Other ◽  
Difficult Question ◽  
Actual Effect

MANY attempts have been made to utilise electrolysis in aneurysms, especially in those thoracic ones that are not amenable to ordinary surgical treatment; it has been hoped that the clotting which occurs around the poles might serve as a nucleus for further coagulation and deposits of fibrin, and that the aneurysm cavity might in this way become partially filled up. Such attempts have not met with much success hitherto, and the purpose of this research has been to endeavour to determine by experiments on blood serum outside the body what the actual effect of electrolysis is so far as regards clotting. Various methods of electrolysing the blood in an aneurysm have been used by surgeons. Ciniselli introduced needles connected with both poles, and reversed the direction of the current every five minutes; of 38 cases so treated, 27 were ameliorated, but none were cured. In the unipolar method one pole only was introduced, and the other was connected with an indifferent pad placed in the vicinity. The difficult question was which pole to introduce. The positive pole gave the firmest clot, but it was thought that it might be difficult to withdraw, and that hæmorrhage or even rupture of the vessel might follow.

PS01.184: ESOPHAGEAL CANCER SURGICAL TREATMENT IN BRAZILIAN NATIONAL CANCER INSTITUTE: 25 YEARS EXPERIENCE

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 102-102
Author(s):  
Marco Antonio Guimaraes Filho ◽  
Flávio Sabino ◽  
Daniel Fernandes ◽  
Carlos Eduardo Pinto ◽  
Luis Felipe Pinto ◽  
...  
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Surgical Treatment ◽  
Surgical Resection ◽  
National Cancer Institute ◽  
Conflicts Of Interest ◽  
Morbidity Rate ◽  
Surgical Mortality ◽  
Surgical Morbidity ◽  
Hospitalization Time

Abstract Background Esophageal cancer is the 8th most common cancer in the world. It is an lethal disease, responsible for almost 400.000 deaths by year. Surgical resection is considered the gold standard in esophageal cancer treatment, with a global 15–40% cure rate. In this study, the results of esophageal cancer surgical treatment at Brazilian National Cancer Institute, Abdominal-pelvic Surgical Section, is analyzed. Methods The medical records of 215 patients with esophageal cancer, treated with surgical resection (esophagectomy), between January 1999 and December 2015, were retrospectively studied. The endpoints analyzed in the study were: hospitalization time, operative complications and mortality, and overall survival. Results Esophageal cancer was predominant in male patients; median age was 58 years (27–78). Primary tumor location varied between 7,5 - 41 cm (median 32cm) and tumor extension 1 - 16cm (median 5cm). Median surgical time was 330 minutes (120–720); transhiatal esophagectomy with gastric tube reconstruction was the most used surgical approach. Tumors histopathological types were equaly distributed. ICU (Intensive Care Unit) stay median time was 5 days (1–87) and median hospitalization time was 15 days (5–166). Most common surgical complications were anastomotic leakage (25,5%) and pneumonia (20%), with a surgical morbidity rate of 61,8%. Surgical mortality rate was 12%, with 61% of these cases occuring in the 30 days after surgery. Median 2-year overall survival was 44,3 months. Conclusion Besides the high surgical morbidity, esophagectomy for esophageal cancer remains the standard treatment for patients with ressectable tumors and without clinical contraindications for surgery. Reduction of surgical mortality depends on rigorous patients selection, surgical team expertise and adequate perioperative and postoperative care. Disclosure All authors have declared no conflicts of interest.

PS01.168: IS IT POSSIBLE TO PREVENT GASTRIC TUBE NECROSIS FOLLOWING ESOPHAGECTOMY?

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 97-97
Author(s):  
Katsunori Nishikawa ◽  
Yujiro Tanaka ◽  
Yuichiro Tanishima ◽  
Shunsuke Akimoto ◽  
Fumiaki Yano ◽  
...  
Keyword(s):  
Gastric Tube ◽  
Assessment Tool ◽  
Imaging System ◽  
Conflicts Of Interest ◽  
Tissue Perfusion ◽  
Early Postoperative Period ◽  
Partial Replacement ◽  
Full Thickness ◽  
Intraoperative Assessment ◽  
Vascular Insufficiency

Abstract Background Gastric tube necrosis (GN) following esophagectomy is a rare, but critical and life threatening complication. Unlike anastomotic leakage due to local ischemia, GN involves extensive full thickness ischemia resulting from vascular insufficiency. Most cases of GN need total or partial replacement of gastric tube. Although quantitative assessment of tissue perfusion during esophageal surgery contributed to reduce the incidence of postoperative anastomotic complications, GN remains a serious complication to be solved. Methods Data were collected retrospectively from 271 patients who underwent esophagectomy and gastric tube reconstruction at a single center between 2008 and 2018, in which cases of GN were identified. Gastric mobilization was mainly performed laparoscopically using a hand-assisted maneuver. The short gastric and left gastric arteries were divided, and the right gastric and gastroepiploic arteries were both preserved. The gastric tube 3.5 cm in width was created along the greater curvature. Intraoperative assessment of perfusion of the gastric tube was performed using our novel Thermal Imaging System (TIS) in all patients. Quantitative tissue perfusion scores defined as anastomotic viability index (AVI) were calculated at various points from the anastomosis. Results The inpatient mortality rate was 1.8% (n = 5). Anastomotic leak (AL) developed in 8.8% (n = 24) of the study group. The mean AVI score of cases with AL was 0.58, which was significantly lower than that without AL (0.71, P < 0.001). GN occurred in two patients (0.7%). The AVI score of the both GN cases were relatively high at 0.74 and 0.82. In one of the cases, circumferential full thickness ischemia 10 cm in length from the esophagogastric anastomosis was revealed by contrast CT scans and endoscopy, which was later identified to be due to severe vascular impairment. Conclusion TIS can be used as a reliable intraoperative assessment tool for perfusion of the gastric tube. We assume that most AL would be caused by delayed anastomotic healing due to poor vascularization of the gastric tube. On the other hand, obvious difference in AVI scores between AL and GN may indicate the involvement of different etiology. Given that development of GN seemed to be caused by acute failure in vascularization during the early postoperative period. Disclosure All authors have declared no conflicts of interest.

scholarly journals Minimum Invasive Stabilizing and Decompressive-Stabilizing Methods of Surgical Treatment for Degenerative-Dystrophic Lesions of Spine

2011 ◽  
Vol 18 (4) ◽  
pp. 3-10
Author(s):  
A V Krut'ko ◽  
Shamil' Al'firovich Akhmet'yanov ◽  
D M Kozlov ◽  
A V Peleganchuk ◽  
A V Bulatov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Lumbar Spine ◽  
Surgical Techniques ◽  
Pain Syndrome ◽  
Early Postoperative Period ◽  
Main Group ◽  
Control Group ◽  
Surgical Interventions ◽  
Comparative Group ◽  
Operative Wound

Results of randomized prospective study with participation of 94 patients aged from 20 to 70 years with monosegmental lumbar spine lesions are presented. Minimum invasive surgical interventions were performed in 55 patients from the main group. Control group consisted of 39 patients in whom decompressive-stabilizing operations via conventional posteromedian approach with skeletization of posterior segments of vertebral column were performed. Average size of operative wound in open interventions more than 10 times exceeded that size in minimum invasive interventions and made up 484 ± 56 and 36 ± 12 sq.cm, respectively. Mean blood loss was 326.6 ± 278.0 ml in the main group and 855.1 ± 512.0 ml in the comparative one. In the main group no one patient required substitution hemotransfusion, while in 13 patients from the comparative group donor erythrocytic mass and/or fresh-frozen plasma were used to eliminate the deficit of blood components. Intensity of pain syndrome in the zone of surgical intervention by visual analog scale in the main group was lower than in comparative group. In the main and comparative groups the duration of hospitalization made up 6.1 ± 2.7 and 9.7 ± 3.7 bed days, respectively. In no one patient from the main group complications in the zone of operative wound were noted. Three patients from the comparative group required secondary debridement and in 1 patient early deep operative wound suppuration was observed. Application of low invasive surgical techniques for the treatment of patients with degenerative lumbar spine lesions enabled to perform radical surgical treatment with minimal iatrogenic injury. The method possessed indubitable advantages over the conventional open operations especially intraoperatively and in early postoperative period.

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