Two-Stage Surgical Treatment of Unresectable Obstructive Rectal Cancer with Synchronous Hepatic Metastases

2007 ◽  
Vol 73 (12) ◽  
pp. 1218-1223
Author(s):  
Konstantinos E. Tsimogiannis ◽  
George K. Pappas-Gogos ◽  
Konstantinos Nikas ◽  
Stella Stefanaki-Nikou ◽  
Konstantinos Gossios ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Surgical Treatment ◽  
Hepatic Metastases ◽  
Rectal Tumor ◽  
The Other ◽  
Open Approach ◽  
Hepatic Tumors ◽  
Two Stage ◽  
Second Stage ◽  
Number Of Patients

Unresectable obstructing rectal cancer with synchronous hepatic metastases is usually a fatal disease. This prospective study was scheduled to treat this difficult condition using a multimodal curative strategy combined with a two-stage surgical treatment. Patients with T4N2 or N3M1 rectal cancer and hepatic metastases underwent a two-stage surgical treatment; in the first stage, a decompressing colostomy plus radiofrequency ablation (RFA) in liver metastases. In the second stage, a colectomy was done with stoma closing and resection of superficial necrotic hepatic tumors, plus repetition of RFA in recurrent or new hepatic tumors. Four patients were included, with 1 to 8 (total 20) hepatic metastases, each <5 cm in diameter. In the first stage, two patients were operated on by open approach and two laparoscopically. All hepatic tumors were treated by RFA to produce at least a 1-cm tumor-free margin. After chemoradiation of the rectal tumor, the second stage of surgical treatment was successful in colectomies and stoma closing. Three had complete necrosis of hepatic tumors and one a recurrent tumor plus two new metastases treated by RFA. Two patients died 14 and 42 months after the first stage of surgical treatment, and the other two patients are alive. One of them is disease-free 54 months after the first stage and the other with new recurrence 52 months after the first stage of the procedure. The multimodal curative strategy for the treatment of unresectable obstructing rectal cancer with synchronous hepatic metastases, containing a two-stage surgical treatment with RFA of hepatic metastases and chemoradiation of the rectal tumor between the two stages of the procedure, is a promising method. A larger number of patients with long-term follow-up is necessary to confirm these findings.

scholarly journals Open vs. Closed Sphincterotomy for Surgical Treatment of Anal Fissures

2021 ◽  
pp. 784-789
Author(s):  
Hisham Abdullah Almottowa ◽  
Hassan Hamdan Almohammadi ◽  
Hamzah Abdulaziz Alwehaimed ◽  
Osamah Salem Alsawat ◽  
Abdullah Sulaiman Alboseer ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Literature Review ◽  
Treatment Choice ◽  
The Other ◽  
Evidence Based ◽  
Open Approach ◽  
Relevant Research ◽  
Management Options ◽  
Anal Fissures ◽  
Exact Etiology

There is currently no specific evidence regarding the exact etiology of anal fissures. However, various management options were reported and validated among the relevant research. Lateral internal sphincterotomy has been validated among relevant investigations in the literature as a valid modality for managing patients with chronic anal fissures. In the present literature review, we formulated evidence based on these studies to compare open and closed techniques of this surgery according to the reported outcomes. However, evidence regarding the superiority of either of the techniques over the other is not consistent among these investigations. For instance, some studies reported that closed sphincterotomy is more favorable than the open approach and should be considered the treatment choice for chronic anal fissures. This is because the technique is associated with less frequent rates of complications, less expensive, safe, and effective. On the other hand, many other relevant studies also demonstrated that the reported outcomes for the two modalities exhibited non-significant differences. Therefore, we suggest that researchers should furtherly conduct additional investigations before drawing any conclusions in this field.

scholarly journals Symptomatic trochanteric non-union following total hip replacement treated with reattachment combined with two-stage revision surgery of the femoral stem

2019 ◽  
Vol 101 (6) ◽  
pp. e133-e135
Author(s):  
E Drampalos ◽  
L Bayam ◽  
J Oakley ◽  
M Hemmady ◽  
J Hodgkinson
Keyword(s):  
Total Hip Replacement ◽  
Hip Replacement ◽  
Posterior Approach ◽  
Femoral Stem ◽  
The Other ◽  
Artificial Joint ◽  
Two Stage ◽  
Non Union ◽  
Total Hip ◽  
Second Stage

We present a case of symptomatic trochanteric non-union following total hip replacement treated initially with a Dall-Miles grip plate. After failure of this treatment, the patient had a two-stage revision. Trochanteric non-union is one of the well-described complications after total hip replacement. It is frequently difficult to treat, while potentially causing weakness, altered gait and instability of the artificial joint. We believe that reattachment of the trochanter combined with a staged revision of the femoral stem using a posterior approach for the second stage could be a valuable technique to be added to the orthopaedic armamentarium for recurrent and symptomatic trochanteric non-unions after primary total hip replacement, particularly after failure to treat with all the other techniques described in literature.

Dynamic Modelling and Performance of a Two Stage Piezoelectric Servovalve

2016 ◽  
Author(s):  
Johan Persson ◽  
Andrew R. Plummer ◽  
Christopher R. Bowen ◽  
Phil L. Elliott
Keyword(s):  
Closed Loop ◽  
Dynamic Modelling ◽  
Flow Characteristics ◽  
The Other ◽  
Step Response ◽  
Hydraulic Fluid ◽  
Two Stage ◽  
Second Stage ◽  
And Performance ◽  
Spool Valve

This paper describes the design, simulation and testing of a piezoelectrically-actuated two stage spool valve. The first stage is a small spool controlled by a piezoelectric ring bender and the second stage is a closed loop position controlled main spool. A dynamic mathematical model of the valve has been derived. Step response tests for both the first stage and second stage are presented, and experimental second stage frequency response results are shown. The mathematical models for the amplifier, first stage and second stage spool behaviour are validated against experimental data. The second stage spool behaviour is found to be very sensitive to the first stage flow characteristics. In addition, the displacement of the hydraulic fluid by the piezoelectric ring bender, from one side of the piezoelectric ring bender to the other, had a significant impact on the valve characteristics.

scholarly journals Two-Stage Allocations and the Double $Q$-Function

10.37236/1714 ◽  
2003 ◽  
Vol 10 (1) ◽  
Author(s):  
Sergey Agievich
Keyword(s):  
The Other ◽  
Empty Cell ◽  
Two Stage ◽  
Second Stage ◽  
Th Cell ◽  
Asymptotic Expressions ◽  
Q Function

Let $m+n$ particles be thrown randomly, independently of each other into $N$ cells, using the following two-stage procedure.1. The first $m$ particles are allocated equiprobably, that is, the probability of a particle falling into any particular cell is $1/N$. Let the $i$th cell contain $m_i$ particles on completion. Then associate with this cell the probability $a_i=m_i/m$ and withdraw the particles.2. The other $n$ particles are then allocated polynomially, that is, the probability of a particle falling into the $i$th cell is $a_i$.Let $\nu=\nu(m,N)$ be the number of the first particle that falls into a non-empty cell during the second stage. We give exact and asymptotic expressions for the expectation ${\bf E}\nu$.

scholarly journals Design of a 335 GHz Frequency Multiplier Source Based on Two Schemes

Electronics ◽  
2019 ◽  
Vol 8 (9) ◽  
pp. 948 ◽  
Author(s):  
Jin Meng ◽  
Dehai Zhang ◽  
Guangyu Ji ◽  
Changfei Yao ◽  
Changhong Jiang ◽  
...  
Keyword(s):  
Output Power ◽  
High Power ◽  
Power Source ◽  
Terahertz Imaging ◽  
Frequency Multiplier ◽  
The Other ◽  
Two Stage ◽  
Second Stage ◽  
W Band ◽  
On Chip

Based on a W-band high-power source, two schemes are proposed to realize a 335 GHz frequency multiplier source. The first scheme involves producing a 335 GHz signal with a two-stage doubler. The first doubler adopts two-way power-combined technology and the second stage is a 335 GHz doubler using a balanced circuit to suppress the odd harmonics. The measured output power was about 17.9 and 1.5 dBm at 167.5 and 335 GHz, respectively. The other scheme involves producing a 335 GHz signal with a single-stage quadrupler built on 50 µm thick quartz circuit adopting an unbalanced structure. The advantage of the unbalanced structure is that it can provide bias to the diodes without an on-chip capacitor, which is hard to realize with discrete devices. The measured output power was about 5.8 dBm at 337 GHz when driven with 22.9 dBm. Such 335 GHz frequency multiplier sources are widely used in terahertz imaging, radiometers, and so on.

scholarly journals Structures lexico-syntaxiques fondées sur le verbe viser dans l’écrit scientifique. Analyse contrastive franco-polonaise

2021 ◽  
Vol 33 ◽  
pp. 1-12
Author(s):  
Katarzyna Gabrysiak
Keyword(s):  
Subject Matter ◽  
Two Dimensions ◽  
The Other ◽  
Main Body ◽  
Two Stage ◽  
Scientific Text ◽  
Syntactic Structures ◽  
Second Stage ◽  
Stage Process ◽  
The Subject

The paper offers an analysis of lexical-syntactic structures based on the verb form viser typical of a scientific text, that is a text that follows quite a stable and rigid structure. A corpus-based analysis, achieved through the use of the Scientext corpora, runs across two dimensions. The first dimension is constituted by the subject matter of the text while the other dimension concerns the relation between the author of the text and the recipient. The analysis presented is a two-stage process. At the first stage, lexical-syntactic structures are singled out. The second stage is to assign those structures to the particular parts of the text, such as Introduction, Main body, Conclusion.

Hydroxylapatite for Laryngotracheal Framework Reconstruction

1989 ◽  
Vol 98 (9) ◽  
pp. 713-717 ◽  
Author(s):  
Minoru Hirano ◽  
Tetsuji Yoshida ◽  
Shinji Sakaguchi
Keyword(s):  
The Other ◽  
Two Stage ◽  
Second Stage

Hydroxylapatite plates and rings were employed for reconstruction of the laryngotracheal framework in 12 patients. The cause of the framework defect was surgery for stenosis in nine cases and removal of malignancy in the other three. The trough method associated with a two-stage procedure was tolerated in all 12 cases. Hydroxylapatite plates or rings were used to reconstruct the framework during the second stage. The implant was well taken in all cases, without any infection or rejection. Nine of the 12 cases resulted in excellent airways.

Surgical Treatment of Cholesteatoma: The Role of Staging in Closed Operations

1988 ◽  
Vol 97 (6) ◽  
pp. 667-669 ◽  
Author(s):  
Gordon D. L. Smyth
Keyword(s):  
Surgical Treatment ◽  
Combined Approach ◽  
Two Stage ◽  
Left Behind ◽  
Second Stage ◽  
Retraction Pockets ◽  
Long Term Observation ◽  
Two Stages

It has been proposed that closed operations on cholesteatomatous ears should be performed on a two-stage basis in order to detect disease left behind at the first operation and to correct developing retraction pockets. Two groups of patients who had closed operations performed in two stages, 100 combined approach tympanoplasties and 100 mastoid obliterations with tympanoplasty, were observed for 10 years after the second stage. A much greater than expected incidence of eventual cholesteatoma recurrence suggests that even with staging, closed techniques may provide a less than reliable outcome in surgical control of the disease, and long-term observation of ears thus treated is desirable.

HELPING AND SABOTAGING IN TOURNAMENTS

2005 ◽  
Vol 07 (02) ◽  
pp. 211-228 ◽  
Author(s):  
MATTHIAS KRÄKEL
Keyword(s):  
The Other ◽  
Two Stage ◽  
Second Stage ◽  
Asymmetric Equilibria ◽  
The Cost ◽  
Cost Effect

A two-stage, two-person tournament is discussed, in which each player can influence the other one at the first stage by choosing help, sabotage or no action. At the second stage, the players choose effort to win the tournament. Helping and sabotaging have two effects — they influence the likelihood of winning (likelihood effect) and they determine the equilibrium efforts and, therefore, effort costs (cost effect). Depending on the interplay of the two effects, diverse types of equilibria are possible. In particular, if the cost effect dominates the likelihood effect (i.e., both players concentrate on minimizing effort costs), two asymmetric equilibria will coexist in which one player helps his opponent, whereas the other one chooses sabotage and vice versa.

scholarly journals Conventional approach x laparoscopic abdominoperineal resection for rectal cancer treatment after neoadjuvant chemoradiation: results of a prospective randomized trial

2003 ◽  
Vol 58 (3) ◽  
pp. 133-140 ◽  
Author(s):  
Sergio Eduardo Alonso Araujo ◽  
Afonso Henrique da Silva e Sousa Jr ◽  
Fábio Guilherme Caserta Marysael de Campos ◽  
Angelita Habr-Gama ◽  
Rodrigo Blanco Dumarco ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Surgical Treatment ◽  
Abdominoperineal Resection ◽  
Conventional Approach ◽  
Open Approach ◽  
Operative Morbidity ◽  
Distal Rectal Cancer ◽  
Significant Difference ◽  
Laparoscopic Abdominoperineal Resection

OBJECTIVE: The aims of this study were to evaluate the safety and efficacy of laparoscopic abdominoperineal resection compared to conventional approach for surgical treatment of patients with distal rectal cancer presenting with incomplete response after chemoradiation. METHOD: Twenty eight patients with distal rectal adenocarcinoma were randomized to undergo surgical treatment by laparoscopic abdominoperineal resection or conventional approach and evaluated prospectively. Thirteen underwent laparoscopic abdominoperineal resection and 15 conventional approach. RESULTS: There was no significant difference (p<0,05) between the two studied groups regarding: gender, age, body mass index, patients with previous abdominal surgeries, intra and post operative complications, need for blood transfusion, hospital stay after surgery, length of resected segment and pathological staging. Mean operation time was 228 minutes for the laparoscopic abdominoperineal resection versus 284 minutes for the conventional approach (p=0.04). Mean anesthesia duration was shorter (p=0.03) for laparoscopic abdominoperineal resection when compared to conventional approach : 304 and 362 minutes, respectively. There was no need for conversion to open approach in this series. After a mean follow-up of 47.2 months and with the exclusion of two patients in the conventional abdominoperineal resection who presented with unsuspected synchronic metastasis during surgery, local recurrence was observed in two patients in the conventional group and in none in the laparoscopic group. CONCLUSIONS: We conclude that laparoscopic abdominoperineal resection is feasible, similar to conventional approach concerning surgery duration, intra operative morbidity, blood requirements and post operative morbidity. Larger number of cases and an extended follow-up are required to adequate evaluation of oncological results for patients undergoing laparoscopic abdominoperineal resection after chemoradiation for radical treatment of distal rectal cancer.

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