Liver Resection Using a Four-Prong Radiofrequency Transection Device

2009 ◽  
Vol 75 (10) ◽  
pp. 991-994 ◽  
Author(s):  
Lawrence D. Wagman ◽  
Byrne Lee ◽  
Erick Castillo ◽  
Hisham El-Bayar ◽  
Lily Lai
Keyword(s):  
Blood Loss ◽  
Metastatic Tumor ◽  
New Device ◽  
Time To Recurrence ◽  
Institutional Review ◽  
Long Term Follow Up ◽  
Surgery Outcomes ◽  
Mean Time

Multiple techniques are available for division of hepatic parenchyma. This is the largest United States report examining the use of the Habib 4X tissue coagulator (AngioDynamics, Queensbury, NY). The objective was to collect standard parameters associated with successful, benchmarked liver surgery outcomes using this new device, and in particular, examine the risk of margin failure. Ninety-four consecutive operations using the Habib 4X were analyzed with special attention to local failure at resection margin, blood loss/transfusion, and operative times. An institutional review board approved protocol allowed collection and analysis of demographic information and outcomes for intraoperative, perioperative, and long term follow-up. Eighteen patients had biopsy only. Thirty-one had lobar resections and 46 had wedge or segmental resections. There were 30 primary hepatic and 46 metastatic tumor diagnoses. There were a total of 33 (43%) recurrences with a mean time to recurrence of 212 days (range 15-974). Of the 27 intrahepatic recurrences, four (15%) were at the margin. The OR time ranged from 115 to 642 minutes (average 283 min). The average recorded blood loss was 427 mL; 11 patients were transfused (average 0.43 units). The Habib 4X is a safe tool to use when evaluating the parameters of blood loss, transfusion, and margin recurrence.

scholarly journals Clinical features and outcomes of bowel perforation in primary pediatric gastrointestinal lymphoma

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jiayu Yan ◽  
Yanlong Duan ◽  
Tingting Liu ◽  
Jianlin Guo ◽  
Chunhui Peng ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Bowel Perforation ◽  
Outpatient Department ◽  
Gastrointestinal Lymphoma ◽  
Long Term Follow Up ◽  
The Mean ◽  
Mean Time ◽  
Prompt Diagnosis

Abstract Background Whether surgery can improve the prognosis of patients with primary pediatric gastrointestinal lymphoma (PPGL) who experienced bowel perforation remains controversial. This study aimed to evaluate the prognosis of such patients. Methods Nine patients pathologically diagnosed with PPGL who experienced perforation at our center between January 2010 and December 2020 were enrolled and divided into two groups: those with perforation during (n = 4) and before (n = 5) chemotherapy. Their medical records were reviewed, and long-term follow-up was conducted by telephone in February 2021. Results All patients with perforation during chemotherapy were diagnosed with PPGL in the outpatient department. The mean time from outpatient visit to chemotherapy was 17.3 ± 6.1 days. Two patients experienced perforation during the first chemotherapy regimen and received conservative treatment, while the others developed perforation after multiple chemotherapy regimens and underwent surgery. All of the patients received regular chemotherapy and survived for a mean follow-up time of 3.8 ± 1.9 years. No patient with perforation before chemotherapy had a definite diagnosis in the outpatient department. Among these patients, 4 experienced perforation and underwent surgery, of whom 3 developed perforation-related complications and died; the other recurred after chemotherapy. Only the patient who received conservative treatment was diagnosed with PPGL before chemotherapy, received regular chemotherapy, and survived without a recurrence for 1.0 year. Conclusion Prompt diagnosis and chemotherapy improve the prognosis of PPGL. Surgery does not affect the prognosis of patients with perforation during chemotherapy but may accelerate disease progression in patients with perforation before chemotherapy.

What is the Long-Term Follow-Up of Nonoperatively Treated Patients with Appendicitis?

2019 ◽  
Vol 85 (5) ◽  
pp. 462-465
Author(s):  
Andrew Felber ◽  
Deven Catalano ◽  
Caitlin Stafford ◽  
Todd D. Francone ◽  
Patricia L. Roberts ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Care Facility ◽  
Nonoperative Treatment ◽  
Interval Appendectomy ◽  
Tertiary Care Facility ◽  
Long Term Follow Up ◽  
Mean Time ◽  
Emergent Surgery

In this study, we determine outcomes after nonoperative treatment of appendicitis. First, we abstracted data for patients discharged with a diagnosis of appendicitis from a tertiary care facility from August 1, 2007, through June 30, 2017. For patients treated nonoperatively, we collected additional medical treatment for appendicitis, future surgical treatment, and date of last follow-up. In our study, we identified 487 patients treated for appendicitis. From this group, 66 patients were successfully treated nonoperatively. Eight patients (12%) had an interval appendectomy at a mean follow-up time of two months. Of the 58 remaining patients, 20 (34%) did not have any further appendicitis-related issues over a mean follow-up period of 25 months. A total of 38 (66%) had recurring or additional concerns requiring further treatment or emergent surgery within a mean time of four months. A large proportion, 76 per cent (n = 29), required unscheduled or emergent appendectomy. There were more patients diagnosed with an abscess (55%) in the group that had further appendicitis issues. In conclusion, nonoperative treatment of appendicitis is associated with significant likelihood of future appendicitis-related treatment or emergency surgery (66%). In addition, patients diagnosed with an abscess are at particularly high risk of future appendicitis-related issues.

Occipitocervical instrumentation in the pediatric population using a custom loop construct: initial results and long-term follow-up experience

2010 ◽  
Vol 5 (3) ◽  
pp. 285-291 ◽  
Author(s):  
Daniel Couture ◽  
Nathan Avery ◽  
Douglas L. Brockmeyer
Keyword(s):  
Pediatric Population ◽  
Loop System ◽  
Fixation Device ◽  
Occipitocervical Fixation ◽  
Institutional Review ◽  
Posttraumatic Instability ◽  
Long Term Follow Up ◽  
Halo Orthosis

Object Rigid occipitocervical instrumentation for craniovertebral instability is gaining widespread acceptance for use in pediatric patients; however, most of the instrumentation has been modified from adult-sized hardware. The Wasatch loop system (formerly the Avery-Brockmeyer-Thiokol loop system) is a rigid occipitocervical fixation device designed specifically for use in children. It affixes to the occiput and incorporates either C1–2 transarticular screws or C-2 pars screws. It is preformed and is available in a variety of sizes. The authors describe their clinical experience and long-term follow-up experience with the first 22 patients. Methods An institutional review board–approved retrospective review of medical records and radiographs was performed for patients who underwent occipitocervical fusion with the Wasatch loop. The mean patient age was 4.9 years (1.2–13 years), and the overall mean follow-up was 4 years (1.5–6.5 years). Six patients had posttraumatic instability, and 16 patients had congenital instability. Results Twelve patients underwent placement of bilateral C1–2 transarticular screws, 6 patients had placement of a combination of C1–2 transarticular and C-2 pars screws, and 4 patients had placement of bilateral C-2 pars screws. One patient required a halo orthosis; the others were treated postoperatively with a hard cervical collar. All patients had radiographic evidence of solid occipitocervical arthrodesis on last follow-up examination. Conclusions The Wasatch loop system is a novel internal fixation device for children who have posttraumatic or congenital occipitocervical instability. Successful arthrodesis was achieved in all patients with minimal use of halo orthoses.

scholarly journals Incidence of pocket infection during long- term follow- up

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
N Vujadinovic ◽  
NN Radovanovic ◽  
G Milasinovic ◽  
SU Pavlovic ◽  
B Kircanski ◽  
...  
Keyword(s):  
Complete Blood Count ◽  
Complete Removal ◽  
Coagulase Negative Staphylococcus ◽  
New Device ◽  
Cardiac Implantable Electronic Devices ◽  
Number Of Patients ◽  
Long Term Follow Up ◽  
Pocket Infection

Abstract Funding Acknowledgements Type of funding sources: None. Introduction  Cardiac implantable electronic devices (CIEDs) are being implanted worldwide in increasing numbers, so the incidence of hospitalizations due to their infections is also increasing.  Purpose The aim of this study was to analyze the incidence of pocket infection related to the CIED procedure, as well as clinical presentation, diagnostic approach and methods of treatment during long-term follow- up on large cohort of patients. Methods: This was a retrospective, observational, single-center study. We enrolled patients who underwent CIED procedure between January 2011 and December 2015. The CIED procedure included implantation and replacement of the device. Pocket infection is defined as an infection limited to the generator pocket and can be presented from redness, swelling, pain to the skin erosion with exposure of the generator and/or leads. It may also be associated with lead infections and systemic CIED infections and/or infective endocarditis. All patients with CIED infection underwent the same diagnostics: complete blood count and inflammatory markers, pocket swab, three sets of blood cultures and echocardiography. Results: During the observed period 5 969 CIED procedures were performed (anti-bradycardia pacemakers 68.6%; ICD 21.4%; CRT-P/D 10.0%; CIED replacement 26.1%). CIED infection was registered in 41 patients (0.68%), most often after the ICD procedure (59.0%). In 22 patients (53.6%) the infection occurred after primo-implantation. The average time from intervention to infection was 17 ± 7.3 months. The mean follow-up was 52.2 ± 13.4 months. The most common manifestations of infection were redness (68.1%) and swelling (56.0%), then the protrusion of the generator or electrode (41.5%). Pacemaker pocket swabs and wound swabs were positive in 61.1% of samples and coagulase negative staphylococcus was found to be the most prevalent cause of infection (64.2%). The hemoculture test was positive in 10 patients, and the isolated causative agent matched the swab finding. The valvular vegetation was found in 4 patients. Pacemaker removal and surgical wound treatment were performed in all patients. Complete removal of all leads was achieved in 32 patients. In all pacemaker dependent patients and patients with ICD implanted in the secondary prevention of sudden cardiac death, reimplantation of the new device was performed in the same hospitalization on the opposite side. The remaining patients were operated on 3 to 4 weeks after the end of treatment.  Conclusions: It has been shown that the risk of pocket infection was low in a large number of patients, during long-term follow-up. The risk was higher in patients with ICD devices, and slightly higher after primo-implantation.

scholarly journals Morbidity and Volumetric Progression in Juvenile Nasopharyngeal Angiofibroma in a Long-Term Follow-Up

2018 ◽  
Vol 79 (06) ◽  
pp. 533-537 ◽  
Author(s):  
Marc Mosimann ◽  
Domenic Vital ◽  
David Holzmann ◽  
Lorenz Epprecht
Keyword(s):  
Residual Tumor ◽  
Open Approach ◽  
Nasopharyngeal Angiofibroma ◽  
Symptomatic Recurrence ◽  
Long Term Follow Up ◽  
Magnetic Resonance Imaging Mri ◽  
Mean Time ◽  
Over Time

Objective We compare the open and transnasal approaches for the excision of juvenile nasopharyngeal angiofibromas regarding the rate of morbidity, and residual tumor and its symptomatic recurrence over time. In addition, we present volumetric measurements of juvenile nasopharyngeal angiofibromas over time. Methods All surgically treated patients of our institution were reviewed back to 1969 for type of surgery, residual tumor by magnetic resonance imaging (MRI)-based volumetry, recurrence, and morbidity. We performed a prospective clinical and radiological follow-up on reachable patients. Results In total, 40 patients were retrievable from our records. We were able to follow up on 13 patients after a mean of 15.7 years since surgery (range: 1–47 years). Patients operated by the open approach had a higher rate of postoperative complications and thus a higher morbidity than endoscopic patients (4/4 vs 3/9; p = 0.007), although tumor sizes were equal among groups (p = 0.12). Persisting tumor was noted in 3/4 and 4/9 (p = 0.56) patients, respectively. The corresponding mean volumes of residual tumors were 16.2 ± 14.4 cm3 and 10.8 ± 6.6 cm3 (p = 0.27). No progression could be noted in endoscopically treated patients (p = 0.24, mean time between scans 2 years). Conclusions Our analysis shows that the endoscopic approach results in less morbidity. The open approach does not guarantee freedom from persisting tumor tissue. Age seems to be a most important risk factor for the conversion of an asymptomatic persistence into a symptomatic recurrence.

scholarly journals Long-term remission and recurrence rates after first and second transsphenoidal surgery for Cushing's disease: care reality in the Munich Metropolitan Region

2014 ◽  
Vol 170 (2) ◽  
pp. 283-292 ◽  
Author(s):  
C Dimopoulou ◽  
J Schopohl ◽  
W Rachinger ◽  
M Buchfelder ◽  
J Honegger ◽  
...  
Keyword(s):  
Transsphenoidal Surgery ◽  
Disease Recurrence ◽  
Metropolitan Region ◽  
Recurrence Rates ◽  
Time To Recurrence ◽  
Remission Status ◽  
Mean Time ◽  
Disease Persistence

ObjectiveTranssphenoidal surgery (TSS) presents the treatment of choice for Cushing's disease (CD). Remission and recurrence rates vary dependent on tumor size, extension, adenoma visibility on magnetic resonance imaging, and neurosurgical expertise. Other than published from single-surgeon neurosurgical series so far, we have aimed to describe long-term remission and recurrence rates of CD in a series incorporating different neurosurgeons, trying to reflect care reality in the Munich Metropolitan Region, which is accommodated by three tertiary university and multiple, smaller neurosurgical centers.DesignWe conducted a retrospective analysis of 120 patients who underwent first and 36 patients who underwent second TSS as treatment for CD between 1990 and 2012.MethodsPatients were divided into three groups according to remission status. Potential risk factors for recurrence, pituitary function, and strategy in persistent disease were assessed.ResultsThree outcome groups were identified according to remission status after first TSS (mean follow-up 79 months): remission, 71% (85/120), disease persistence, 29% (35/120), and disease recurrence, 34% (29/85) (mean time to recurrence 54 months). After second TSS (n=36, mean follow-up 62 months), we documented remission in 42% (15/36), disease persistence in 58% (21/36), and disease recurrence in 40% (6/15) (mean time to recurrence 42 months). Postoperative hypocortisolism after first, though not after second, TSS was associated with a lower risk of suffering disease recurrence (risk=0.72; 95% CI 0.60–0.88; exact significance (two-sided) P=0.035).ConclusionsOur study shows higher recurrence rates of CD after first TSS than previously reported. Second TSS leads an additional 8% of the patients to long-term CD remission.

Long term follow up (LTFU) of adjuvant zoledronic acid (ZOL) in high risk early stage breast cancer (ESBC) defined by bone marrow (BM) disseminated tumor cells (DTC).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e12001-e12001
Author(s):  
Neelima Vidula ◽  
Jimmy Hwang ◽  
Sally Greenberg ◽  
Michelle E. Melisko ◽  
Andrei Goga ◽  
...  
Keyword(s):  
Early Stage ◽  
Disseminated Tumor Cells ◽  
Metastatic Potential ◽  
Risk Of Death ◽  
Median Reduction ◽  
Time To Recurrence ◽  
Long Term Follow Up ◽  
Immunomagnetic Enrichment

e12001 Background: BM DTC & peripheral blood CTC indicate metastatic potential. Adjuvant bisphosphonates in postmenopausal patients (pts) result in less bone metastases and better survival. We studied ZOL’s impact on DTC, CTC, and outcomes in ESBC (ASCO, 2010) and now report updated LTFU. Methods: Forty-five pts with ESBC and DTC > 4/mL BM were given ZOL every 4 weeks for 24 months (mo). DTC were quantified at baseline (BL), 12 and 24 mo of ZOL with immunomagnetic enrichment and flow cytometry (Clin Cancer Res, 2015). Serial CTC, survival, recurrence and toxicity were studied. Results: Forty-five pts received ZOL (56% HR+, 18% HER2+, 40% TN, 96% prior chemo). BL median DTC was 13.3/mL (range 4-333). Median DTC decreased from BL to 12 mo (median reduction 6.5/mL, range -57.2 to 23.6) and from BL to 24 mo (median reduction 4.6/mL, range -43.1 to 160.1). For 33 pts with BM at all 3 times, DTC decreased: BL median 11.5/mL (range 4-59.3), 12 mo median 6.8/mL (range 0-28.5), 24 mo median 6.5/mL (range 0.3-168.6). At 12 & 24 mo, 32% & 26% had undetectable DTC respectively. Median CTC was 0.2/mL at BL (n = 45), 0.25/mL at 6 mo (n = 30), 0/mL at 12 mo (n = 22) & 0.2/mL at 24 mo (n = 23). At 123 mo median FU (range 5-154), 9 (20%) pts recurred. Median time to recurrence was 21 mo (range 6-105); 67 % (6/9) TN, 22% (2/9) ER+/HER2+. The first sites of recurrence were CNS in 33% (3), bone & viscera in 22% (2), viscera in 22% (2) and local in 22% (2). BL DTC > 30/mL was associated with higher recurrence (50% > 30 vs. 14% < 30, p = 0.039). All 3 pts with CNS disease had BL DTC > 30/mL. Of the pts who recurred, 4 had ≥ 1 serial BMA; 2/4 had increasing DTC before recurrence. Of 32 disease free pts with BMA at all 3 times, 72% (23) had decreased DTC from BL to 24 mo. Of the 13.3% (6) pts who died, 67% (4) had BL DTC > 30/mL, which was associated with a greater risk of death (50% > 30 vs. 5% < 30, p = 0.006). BL CTC > 0.8/mL was associated with higher recurrence (60% > 0.8 vs. 15% < 0.8, p = 0.047) & death (60% > 0.8 vs. 8% < 0.8, p = 0.013). ZOL was well tolerated. Conclusions: At 123 mo FU, BL DTC > 30/mL and CTC > 0.8/mL correlated with recurrence & death. In this single arm phase II study, adjuvant ZOL decreased DTC over time, supporting the anti-tumor effect of bisphosphonates. Clinical trial information: NCT00295867.

scholarly journals Sequential hormonal changes in 21 patients with recurrent Cushing's disease after successful pituitary surgery

2011 ◽  
Vol 165 (5) ◽  
pp. 729-737 ◽  
Author(s):  
Roula Bou Khalil ◽  
Camille Baudry ◽  
Laurence Guignat ◽  
Carmen Carrasco ◽  
Jean Guibourdenche ◽  
...  
Keyword(s):  
Cushing’S Disease ◽  
Positive Response ◽  
Pituitary Surgery ◽  
Cushing's Disease ◽  
Hormonal Changes ◽  
Long Term Follow Up ◽  
Mean Time ◽  
Midnight Cortisol

ObjectiveTo describe the sequence of hormonal changes during recurrence of Cushing's disease (CD) after successful transsphenoidal surgery (TSS).DesignRetrospective study in a single center.Patients and methodsWe studied 101 of the 127 patients treated by TSS for CD between 1996 and 2009, who had hypocortisolism or eucortisolism for at least 3 months post-TSS. We arbitrarily defined ‘overt recurrence’, as presence of two classical parameters of excess cortisol (increased midnight – either serum or salivary – and 24 h urinary cortisol (UC)), leading to further specific therapeutic action, and ‘mild recurrence’, as presence of a single classical parameter, leading to simple surveillance.ResultsOf the 101 patients, 21 (20.8%) presented with recurrence, ‘mild’ or ‘overt’, during long-term follow-up (median 50.4 months, range 7–99). Recurrence occurred less frequently (16.8 vs 50%, P=0.02), and later (mean 44.7 months, median 43, range 7–94 vs mean 21.5 months, median 17, range 3–61, P=0.05), in patients with early post-TSS hypocortisolism compared with those with eucortisolism. Increase in midnight cortisol occurred in a mean time of 38.2 months, while UC elevation was observed at 50.6 months. Vasopressin analogs and CRH tests were eventually positive in 85 and 93% of all patients respectively; a positive response to one of the two dynamic tests preceded the increase in midnight cortisol or UC in 71 and 64% of the patients respectively.ConclusionA positive response to vasopressin analogs and/or CRH tests occurs early in recurrence, followed by an increase in midnight cortisol, while UC elevation is at a later stage.

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