scholarly journals LAPAROSCOPIC DISTAL PANCREATECTOMY WITH SPLEEN PRESERVATION

2018 ◽  
Vol 31 (3) ◽  
Author(s):  
Sergio Renato PAIS-COSTA ◽  
Guilherme Costa Crispim de SOUSA ◽  
Sergio Luiz Melo ARAUJO ◽  
Olímpia Alves Teixeira LIMA
Keyword(s):  
Distal Pancreatectomy ◽  
Case Series ◽  
Laparoscopic Distal Pancreatectomy ◽  
Infectious Complications ◽  
Neoplasm Recurrence ◽  
Open Approach ◽  
Spleen Preservation ◽  
Long Term Outcome

ABSTRACT Background: Laparoscopic distal pancreatectomy has been the choice for resection of distal pancreas lesions due many advantages over open approach. Spleen preservation technique seems minimizes infectious complications in long-term outcome. Aim: To present the results of laparoscopic distal pancreatectomies with spleen preservation by Kimura´s technique (preservation of spleen blood vessels) performed by single surgical team. Methods: Retrospective case series aiming to evaluate both short and long-term outcomes of laparoscopic distal pancreatectomies with spleen preservation. Results: A total of 54 laparoscopic distal pancreatectomies were performed, in which 26 were laparoscopic distal pancreatectomies with spleen preservation by Kimura´s technique. Mean age was 47.9 years-old (21-75) where 61.5% were female. Mean BMI was 28.5 kg/m² (18-38.8). Mean diameter of lesion was 4.3 cm (1.8-7.5). Mean operative time was 144.1 min (90-200). Intraoperative bleeding was 119.2 ml (50-600). Conversion to laparotomy 3% (n=1). Postoperative morbidity was 11.5%. Postoperative mortality was null. Mean of hospital stay was 4.8 days (2-14). Mean time of follow-up period was 19.7 months (2-60). There was no neoplasm recurrence or mortality on evaluated period. There was no infectious complication. Conclusion: Laparoscopic distal pancreatectomy with spleen and splenic vessels preservation is feasible, safe, and effective procedure. This technique presented both low morbidity and null mortality on this sample. There were neither infectious complications nor neoplasm recurrence on long-term follow-up period.

scholarly journals LAPAROSCOPIC DISTAL PANCREATECTOMY WITH OR WITHOUT SPLEEN PRESERVATION: COMPARATIVE ANALYSIS OF SHORT AND LONG-TERM OUTCOMES

2019 ◽  
Vol 32 (3) ◽  
Author(s):  
Sergio Renato PAIS-COSTA ◽  
Guilherme Costa Crispim de SOUSA ◽  
Sergio Luiz Melo ARAUJO ◽  
Olímpia Alves Teixeira LIMA ◽  
Sandro José MARTINS ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Distal Pancreatectomy ◽  
Laparoscopic Distal Pancreatectomy ◽  
Long Term Outcomes ◽  
Spleen Preservation ◽  
Short And Long Term ◽  
The Mean ◽  
Group 1

ABSTRACT Background: Laparoscopic distal pancreatectomy (LDP) is the preferred approach for resection of tumors in the distal pancreas because of its many advantages over the open approach. Aim: To analyse and compare short and long-term outcomes from LDP performed through two different techniques: with splenectomy vs. spleen preservation and splenic vessel preservation. Method: Fifty-eight patients were operated and subsequently divided between two groups: Group 1, LDP with splenectomy (LDPS); and Group 2, LDP with spleen preservation and preservation of splenic vessels (LDPSPPSV). Results: The epidemiological characteristics were statistically similar between the two groups (age, gender, BMI and lesion size). Both the mean of operative time (p=0.04) and the mean of intra-operative blood loss (p=0,03) were higher in Group 1. The mean of resected lymph nodes was also higher in Group 1 (p<0.000). There were no statistic differences between the groups in relation to open conversion, morbidity or early postoperative mortality. The mean hospital stay was similar between groups. Pancreatic fistula (grade B and C) was similar between the groups. The mean of overall follow-up was 37.6 months (5-96). Late complications were similar between the groups. Conclusion: Both techniques were superimposable; however, LDPS presented, respectively, higher intra-operative bleeding, longer duration of the operation and higher number of lymph nodes resected. No differences were observed in the studied period in relation to the appearance of infections or neoplasm related to splenectomy during follow-up. Maintenance of the spleen avoided periodic immunizations in patients in LDPSPSV. It is indicated in small pancreatic lesions with indolent course.

Primary Calvarial Ewing Sarcoma: A Case Series

2021 ◽  
Author(s):  
Sandeep Mohindra ◽  
Manjul Tripathi ◽  
Aman Batish ◽  
Ankur Kapoor ◽  
Ninad Ramesh Patil ◽  
...  
Keyword(s):  
Ewing Sarcoma ◽  
Tumor Resection ◽  
Case Series ◽  
Radical Excision ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Intradural Tumor ◽  
Age Range

Abstract Background Calvarial Ewing tumor is a relatively rare differential among bony neoplasms. We present our experience of managing primary calvarial Ewing sarcoma (EWS), highlighting their clinical and radiological findings. Method In a retrospective analysis, we evaluated our 12-year database for pathologically proven EWS. A literature search was conducted for the comparative presentation and update on the management and outcome. Result From January 2008 to December 2020, we managed eight patients (male:female = 5:3; age range 6 months to 19 years, mean 11.5 years) harboring primary calvarial EWS. All cases underwent wide local excision; two patients required intradural tumor resection, while one required rotation flap for scalp reconstruction. Mean hospital stay was 8 days. All patients received adjuvant chemo- and radiotherapy. Three patients remained asymptomatic at 5 years of follow-up, while two patients died. Conclusion Primary calvarial EWS is a rare entity. It usually affects patients in the first two decades of life. These tumors can be purely intracranial, causing raised intracranial pressure symptoms, which may exhibit rapidly enlarging subgaleal tumors with only cosmetic deformities or symptoms of both. Radical excision followed by adjuvant therapy may offer a favorable long-term outcome.

scholarly journals Long term outcome of combined phacoemulsification and excisional goniotomy with the Kahook Dual Blade in different subtypes of glaucoma

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ahmed Al Habash ◽  
Abdulrahman Albuainain
Keyword(s):  
Case Series ◽  
Angle Closure ◽  
Combined Surgery ◽  
Visual Rehabilitation ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Kahook Dual Blade ◽  
Significant Cataract

AbstractTo characterize changes in intraocular pressure (IOP) and IOP-lowering medications through up to 2 years of follow-up in patients undergoing combined phacoemulsification and excisional goniotomy with the Kahook Dual Blade (phaco-KDB), with simultaneous goniosynechialysis in cases of angle-closure glaucoma. Prospective, non-comparative, interventional case series. Consecutive patients with medically-treated glaucoma and visually-significant cataract underwent combined surgery. Analysis was conducted on open-angle (OAG) and angle-closure (ACG) glaucoma groups separately. Thirty-seven patients with OAG (24 with primary OAG and 13 with pseudoexfoliation glaucoma) and 11 with ACG were enrolled. In OAG eyes, mean (standard error) baseline IOP was 21.1 (0.9) mmHg and through 24 months of follow-up was reduced by 6.4–7.7 mmHg (24.6–32.1%; p ≤ 0.0001 at all time points). In ACG eyes, mean baseline IOP was 20.8 (1.6) mmHg and was reduced by 6.1–8.77 mmHg (23.4–39.0%; p ≤ 0.0353). Mean medications were reduced by 61.9–89.1% (p ≤ 0.0001) in OAG eyes and by 56.3–87.3% (p ≤ 0.0004) in ACG eyes. Phaco-KDB significantly lowered IOP ~ 30% and medications by > 50% through 24 months. This combined procedure provides meaningful long-term reductions in IOP and need for IOP-lowering medication and does not adversely affect visual rehabilitation in eyes with cataract and glaucoma.

Abstract 9860: Safety and Clinical Outcome of Catheter Ablation of Ventricular Arrhythmias Using Contact Force Sensing, Consecutive Case Series

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Astrid A Hendriks ◽  
Ferdi Akca ◽  
Lara Dabiri Abkenari ◽  
Muchtiar Khan ◽  
Rohit E Bhagwandien ◽  
...  
Keyword(s):  
Contact Force ◽  
Ventricular Arrhythmias ◽  
Case Series ◽  
Long Term Outcome ◽  
Major Complications ◽  
Acute Success ◽  
Vt Ablation ◽  
Procedural Success

Introduction: Poor catheter-to-myocardial contact can lead to ineffective ablation lesions and suboptimal outcome. Contact force (CF) sensing catheters in ventricular tachycardia (VT) ablations has not been studied for their long term efficacy. Hypothesis: The hypothesis is that CF ablation is superior to manual ablation (MAN) and non-inferior to remote magnetic navigation (RMN) ablation for safety and efficacy in acute and long term outcome. Methods: A total of 249 consecutive patients underwent VT ablation, with the use of MAN, CF or RMN catheters were included in this single center cohort study from January 2007 until March 2014. The primary endpoints were procedural success, acute major complications and VT recurrences at follow-up. The average follow-up period was ± 20 months. Results: Acute success was achieved in 191 out of 249 procedures (75.9%). Acute success in manual ablation, CF ablation and RMN ablation was 70.1%, 72.3% and 85.2% respectively (P = 0.038). Major complications occurred in 3.2% and there was a trend towards less major complications (P = 0.055) in the RMN group. Thirty-six percent of the patients with an initially successful procedure had a recurrence during follow-up (CF 41.2% MAN 37.5% RMN 32.0% P = NS). Conclusions: The use of CF sensing catheters does not improve the procedural outcome or safety profile in comparison to non-CF sensing ablation in ventricular arrhythmias. RMN non-CF sensing ablation has the highest procedural success rate. Future studies are necessary to investigate the role of CF in VT ablation and to define the optimal force.

Arthroscopic treatment of fragmented coronoid process with severe elbow incongruity

2013 ◽  
Vol 26 (01) ◽  
pp. 27-33 ◽  
Author(s):  
E. de Bakker ◽  
D. Van Vynckt ◽  
E. Coppieters ◽  
H. van Bree ◽  
B. Van Ryssen ◽  
...  
Keyword(s):  
Clinical Signs ◽  
Case Series ◽  
Term Treatment ◽  
Coronoid Process ◽  
Heavy Exercise ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Long Term Treatment

SummaryThe purpose of this study was to investigate the long-term treatment results of fragmented coronoid process (FCP) in joints with a radio-ulnar step greater than 3 mm. Treatment of these patients only consisted of fragment removal, without correction of the incongruity.The eight Bernese Mountain Dogs (11 joints) included in this study showed obvious clinical signs of elbow disease and were diagnosed with severe elbow incongruity and concomitant FCP in the time period from 1999–2003. At that time, elbow radiography, computed tomography, and arthroscopy were performed. The mean follow-up period was 5.6 years. The follow-up consisted of a telephone questionnaire combined with a clinical and radiographic re-evaluation at our clinic.The questionnaire revealed that all dogs were either free of lameness or only lame following heavy exercise. One dog sporadically required medication after heavy exercise. The owner satisfaction rate was 100%. The clinical re-evaluation did not reveal any signs of pain or lameness in all cases. Range-of- motion was decreased in nine of the 11 elbows. Radiographs revealed an increase in severity of osteoarthritis in every case.In this case series, arthroscopic fragment removal without treatment of incongruity was demonstrated to be a valuable treatment option and may provide a satisfactory long-term outcome.

Complex basilar artery aneurysms treated using surgical basilar occlusion: a modern case series

2011 ◽  
Vol 115 (2) ◽  
pp. 319-327 ◽  
Author(s):  
Christopher P. Kellner ◽  
Raqeeb M. Haque ◽  
Philip M. Meyers ◽  
Sean D. Lavine ◽  
E. Sander Connolly ◽  
...  
Keyword(s):  
Basilar Artery ◽  
Case Series ◽  
Endovascular Techniques ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Complex Aneurysms ◽  
Long Term Follow Up ◽  
Clinical Records

Object Complex aneurysms of the basilar artery (BA) apex can be successfully treated using surgical occlusion of the proximal BA. Since the introduction of the Guglielmi detachable coil in 1991, the focus on treating BA aneurysms has been on using endovascular techniques. Outcomes with endovascular techniques have been less than optimal for large and complex aneurysms. The authors therefore report on their current 22-year experience with surgical BA occlusion for complex BA aneurysms and long-term outcome. Methods Fifteen patients underwent surgical BA occlusion at Columbia University Medical Center for complex basilar apex aneurysms between 1987 and 2009. The clinical records of each patient were reviewed for details of presentation, hospital course, operative intervention, and outcome. Results Postoperatively, all patient encounters were recorded at discharge, at the 1-month and 1-year follow-up evaluations, and at long-term outcome. Twelve (80%) of 15 patients experienced no new postoperative neurological deficits. Three patients presenting with severe neurological impairment (modified Rankin Scale [mRS] score > 3) made excellent recoveries (mRS Scores 1–2) at long-term follow-up. One patient died, 1 suffered a stroke during the postoperative angiogram which resulted in hemiparesis, and 1 suffered internuclear ophthalmoplegia which resolved by the 1-month follow-up. Long-term follow-up occurred at an average of 3 ± 4.5 years, ranging from 2 months (for a recently treated patient) to 18 years. The average mRS score at long-term follow-up was 1 ± 1.5. No patient experienced postoperative hemorrhage, rebleeding, or delayed neurological deterioration. Conclusions Surgical occlusion of the BA is an effective treatment option offering a high rate of angiographic cure in a single procedure for patients with complex BA aneurysms. The ability to surgically perform point occlusion of the BA without impairment of brainstem perforators, while maintaining collateral blood flow to the posterior circulation branch vessels, may provide an advantage compared with endovascular treatments.

Facet Joint Replacement: Intermediate- and Long-Term Outcome in a Large Case Series

2020 ◽  
Vol 82 (01) ◽  
pp. 034-042
Author(s):  
Ulrich J. Knappe ◽  
David Reinecke ◽  
Michael Flörke ◽  
Peter Horn ◽  
Robert Schönmayr
Keyword(s):  
Lumbar Spine ◽  
Joint Replacement ◽  
Facet Joint ◽  
Case Series ◽  
Leg Pain ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Disk Height

Abstract Background The long-term outcome of facet joint replacement (FJR) still is to be proven. Methods We present a prospective case series of 26 (male-to-female ratio of 1:1; mean age: 61 years) patients undergoing FJR with a follow-up of at least 1 year (range: 12–112; mean: 67 months). Visual analog scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), and the 12-Item Short Form Health Survey (SF-12) were applied pre- and postoperatively (after 3, 6, and 12 months) as well as at the last follow-up (N = 24). Using X-rays of the lumbar spine (N = 20), the range of motion (ROM) and disk height in the indicator and adjacent levels were assessed. Results FJR was performed at L3/L4 (N = 7), L4/L5 (N = 17), and L5/S1 (N = 2). Mean VAS (mm) for back pain decreased from 71 to 18, mean VAS for right leg pain from 61 to 7, and from 51 to 3 for the left leg. Mean ODI dropped from 51 to 22% (for all p < 0.01). Eighty seven percent of patients were satisfied and pretreatment activities were completely regained in 78.3% of patients. Disk height at the indicator and adjacent levels and ROM at the indicator segment and the entire lumbar spine were preserved. No loosening of implants was observed. Explantation of FJR and subsequent fusion had to be performed in four cases (15.4%). Conclusions In selected cases, long-term results of FJR show good outcome concerning pain, quality of life, preservation of lumbar spine motion, and protection of adjacent level.

scholarly journals Management and Outcome of Hindfoot Trauma With Concomitant Talar Head Injury

2021 ◽  
pp. 107110072098002
Author(s):  
Esmee Wilhelmina Maria Engelmann ◽  
Olivier Wijers ◽  
Jelle Posthuma ◽  
Tim Schepers
Keyword(s):  
Functional Outcome ◽  
Case Series ◽  
Ankle Injuries ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Long Term Outcome ◽  
Talar Head ◽  
The Mean

Background: Talar head fractures account for 2.6% to 10% of all talar fractures and are often associated with concomitant musculoskeletal injuries. The current literature only describes a total of 14 patients with talar head fractures and, with that, guidelines for management are lacking. The aim of the current study was to evaluate the management and long-term outcome of patients who have hindfoot trauma with concomitant talar head fractures. Methods: This study includes a retrospective cohort of patients with talar head fractures. Patient characteristics, trauma mechanism, fracture characteristics, treatment, follow-up, and complications were reported. Functional outcome was assessed using the Foot Function Index (FFI) and the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score. Quality of life was measured by the EuroQol-5D (EQ-5D). Twenty-one patients with acute fractures of the talar head were identified. The mean follow-up time was 4.9 years. Results: All patients sustained additional ipsilateral foot and/or ankle injuries. Fifteen patients had operative management of their talar head fracture. There were no postoperative wound infections and no cases of avascular necrosis. All fractures united, and 29% of patients developed posttraumatic osteoarthritis. The overall mean FFI score index was 34.2, and the mean AOFAS score was 70.7. The mean EQ-5D index score was 0.74. Conclusion: Talar head fractures always coincided with other (foot) fractures. Management and long-term functional outcome were affected by the extent of associated injuries. Due to the low incidence and high complexity of talar head fractures, early referral to dedicated foot surgeons and centralization of complex foot surgery is recommended. Level of Evidence: Level IV, retrospective case series.

Tibial Apophyseal Percutaneous Pinning in Skeletally Immature Dogs: 25 Cases (2016–2019)

2020 ◽  
Author(s):  
Dirsko J.F. von Pfeil ◽  
Sara Megliolia ◽  
Sarah Malek ◽  
Mark Rochat ◽  
Mathieu Glassman
Keyword(s):  
Tibial Plateau ◽  
Skeletal Maturity ◽  
Case Series ◽  
Skeletally Immature ◽  
Percutaneous Pinning ◽  
Term Outcome ◽  
Avulsion Fractures ◽  
Long Term Outcome

Abstract Objective The aim of this study was to report the clinical experience with fluoroscopically guided tibial apophyseal percutaneous pinning (TAPP) for tibial tuberosity avulsion fractures (TTAF). Study Design This is a retrospective case series. Materials and Methods Medical records of skeletally immature dogs (n = 25) were reviewed. The association of pin design [smooth (SP); negatively threaded (NTP)], pin insertion angles, TTAF-type, age and breed with various outcome variables was statistically evaluated. Long-term follow-up was assessed via direct examination, radiographs, questionnaires and videos. Results Mean age, weight and surgery times were 6.2 months, 9.6 kg and 21 minutes respectively. No major complications occurred among the 19 SP and 6 NTP; no pin broke. Seromas and patellar desmitis rates were higher with SP (11/19; 16/19) versus NTP (0/6; 2/6) (p = 0.02; 0.03). The median horizontal pin cross angles for cases without and with desmitis were 40 and 26 degrees respectively (p = 0.047). Explantation was needed in 5/19 SP and 0/6 NTP cases. The mean tibial plateau angle (TPA) changed significantly between initial (25.6 degrees) and follow-up (18.8 degrees) radiographs (p = 0.0002). Long-term outcome, obtained at a mean of 19.9 months, was excellent in all cases. Conclusion Tibial apophyseal percutaneous pinning can be considered to treat TTAF. Divergent pin placement and using NTP might reduce complications. Tibial plateau angle should be monitored until skeletal maturity has been reached. Long-term outcome post TAPP can be expected to be excellent.

scholarly journals Long-term outcome of neuroparacoccidioidomycosis treatment

2011 ◽  
Vol 44 (1) ◽  
pp. 22-25 ◽  
Author(s):  
Fabio Francesconi ◽  
Marcus Tulius Teixeira da Silva ◽  
Regina Lana Braga Costa ◽  
Valeska Albuquerque Francesconi ◽  
Eleonora Carregal ◽  
...  
Keyword(s):  
Paracoccidioides Brasiliensis ◽  
Pathogenic Fungus ◽  
Case Series ◽  
Neurological Deficits ◽  
Common Finding ◽  
Neurological Sequela ◽  
Long Term Outcome ◽  
Oral Fluconazole

INTRODUCTION: Neuroparacoccidioidomycosis (NPCM) is a term used to describe the invasion of the central nervous system by the pathogenic fungus Paracoccidioides brasiliensis. NPCM has been described sporadically in some case reports and small case series, with little or no focus on treatment outcome and long-term follow-up. METHODS: All patients with NPCM from January 1991 to December 2006 were analyzed and were followed until December 2009. RESULTS: Fourteen (3.8%) cases of NPCM were identified out of 367 patients with paracoccidioidomycosis (PCM). A combination of oral fluconazole and sulfamethoxazole/trimethoprim (SMZ/TMP) was the regimen of choice, with no documented death due to Paracoccidioides brasiliensis infection. Residual neurological deficits were observed in 8 patients. Residual calcification was a common finding in neuroimaging follow-up. CONCLUSIONS: All the patients in this study responded positively to the association of oral fluconazole and sulfamethoxazole/trimethoprim, a regimen that should be considered a treatment option in cases of NPCM. Neurological sequela was a relatively common finding. For proper management of these patients, anticonvulsant treatment and physical therapy support were also needed.

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