Supraselective embolization as a method for the management of renal vascular injuries

Background: Renal injuries are most often caused by traumatic injuries, but they can also be induced iatrogenically, during renal biopsy, percutaneous nephrostomy or lithotripsy. Vascular renal injuries may be treated by embolization, nonsurgical or surgical methods. Case report. In this paper we presented a high-risk patient with poor outcome of an open surgery threatment and a prior attempt of embolization, with gross haematuria caused by traumatic renal arterio-venous (AV) fistula and pyelocalical injury who was managed by supraselective embolization of the irrigating arterial vessel. Conclusion. Supraselective embolization is a first choice method for the treatment of low grade renal vessel injuries. Even patients with the most severe renovascular lesions and major renal destruction (a grade IV injury) can be treated nonsurgically with supraselective embolization, with an excellent chance to preserve the maximal amount of functional renal parenchyma. This method is rapid, effective, tissue preserving, and likely to reduce morbidity and mortality.

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Wide Local Excision for Dermatofibrosarcoma Protuberans: A Single-Center Series of 90 Patients

BioMed Research International ◽

10.1155/2015/642549 ◽

2015 ◽

Vol 2015 ◽

pp. 1-9 ◽

Cited By ~ 5

Author(s):

Byung Jun Kim ◽

Hyeonwoo Kim ◽

Ung Sik Jin ◽

Kyung Won Minn ◽

Hak Chang

Keyword(s):

Local Recurrence ◽

Local Excision ◽

Wide Local Excision ◽

Safety Margin ◽

Dermatofibrosarcoma Protuberans ◽

Low Grade ◽

Recurrence Free Survival ◽

Free Survival ◽

Incomplete Removal ◽

Surgical Methods

Background. Dermatofibrosarcoma protuberans (DFSP), a rare low-grade sarcoma of fibroblast origin, tends to extend in a finger-like fashion beyond macroscopic tumor margins. Therefore, incomplete removal and subsequent recurrence are common. This study aimed to determine the efficacy of wide local excision (WLE) for controlling local recurrence of DFSP.Methods. The medical records of 90 DFSP patients who received WLE at our hospital between June 1992 and January 2015 were retrospectively reviewed. WLE was conducted including a 3 cm (range, 1 to 5 cm) safety margin according to tumor size, location, and recurrence status. Clinical and tumor characteristics and surgical methods were evaluated for risk factor analysis and local recurrence-free survival.Results. DFSP occurred most often in patients in their 30s (30%) and on the trunk (51.1%). Five patients (5.5%) experienced local recurrence during the 43.4-month follow-up period. Recurrence was found at a mean of 10.8 months after WLE. Although no factors were significantly associated with recurrence, recurrences were more frequent in head and neck. Recurrence-free survival was 87% in 6 years and 77% in 7 years.Conclusions. WLE with adequate lateral and deep margins can effectively control local recurrence rate and is a simple and effective method to treat DFSP.

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A multicentre, prospective, randomised controlled trial to evaluate hexaminolevulinate photodynamic therapy (Cevira®) as a novel treatment in patients with high grade squamous intraepithelial lesion: APRICITY Phase 3 study protocol

10.1101/2021.12.02.21266991 ◽

2021 ◽

Author(s):

Fei Chen ◽

Zoltán Novák ◽

Christian Dannecker ◽

Long Sui ◽

Youzhong Zhang ◽

...

Keyword(s):

Photodynamic Therapy ◽

Low Grade ◽

High Grade ◽

Efficacy And Safety ◽

Squamous Intraepithelial Lesion ◽

Phase 3 ◽

Link Type ◽

Surgical Methods ◽

Intraepithelial Lesion ◽

Randomised Controlled

AbstractIntroductionHigh-risk human papilloma virus (HPV)-associated cervical cancer is the fourth most common cancer in women worldwide. Current treatments of high grade squamous intraepithelial lesion (HSIL) of the cervix are based on invasive surgical interventions, compromising cervical competence and functionality.ObjectiveAPRICITY is a multicentre, prospective, double-blind, randomised controlled Phase 3 study further evaluating the efficacy and safety of Cevira®, an integrated drug- and light-delivery device for hexaminolevulinate photodynamic therapy, which shows promise as a novel, non-invasive therapy for women with HSIL.Methods and analysisPatients with biopsy-confirmed HSIL histology are invited to participate in the study currently being conducted at 47 sites in China and 25 sites in Ukraine, Russia and European Union. The aim is to include at least 384 patients which will be randomised to either Cevira® or placebo group (2:1). All patients will be assessed 3 months after first treatment and a second treatment will be administered in patients who are HPV positive or have at least low grade squamous intraepithelial lesion (LSIL). Primary endpoint is the proportion of the responders at 6 months after first treatment. Secondary efficacy endpoints and safety endpoints will be assessed at 6 months, and data for secondary performance endpoints for Cevira® device will be collected at 3 months and 6 months, in case second treatment was administered. All patients in the Cevira® group will be enrolled in an open, long-term extension study following patients for further 6 months to collect additional efficacy and safety data (study extension endpoints).ConclusionDue to its non-invasiveness and convenient application, Cevira® may be a favourable alternative to surgical methods in treatment of patients with HSIL.Ethics and disseminationThe study was approved by the ethics committee of the Peking Union Medical College Hospital and Hannover Medical University, Germany. Findings will be disseminated through peer review publications and conference presentations.Trial registration numberclinicaltrials.govNCT04484415

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Considerations on cervical anastomoses in postcaustic esophageal reconstruction

Romanian Journal of Rhinology ◽

10.1515/rjr-2015-0025 ◽

2015 ◽

Vol 5 (20) ◽

pp. 215-223

Author(s):

Irina Predescu ◽

Dragos Predescu ◽

Codrut Sarafoleanu ◽

Silviu Constantinoiu

Keyword(s):

Preventive Treatment ◽

Individual Case ◽

Esophageal Reconstruction ◽

Public Health Issue ◽

General Surgeon ◽

Cervical Anastomosis ◽

Postoperative Complication Rate ◽

Major Public Health Issue ◽

Traumatic Injuries ◽

Surgical Methods

Abstract Background. The increased incidence of accidental or non-accidental ingestion of corrosive substances or drug compounds leading to postcaustic esophagitis represents a major public health issue. The treatment of postcaustic esophagitides is difficult and long lasting, calling for a complex team trained in this borderline pathology: gastroenterologist, general surgeon, otorhinolaryngologist, anesthesiologist, psychiatrist. In cases when preventive treatment has failed, the only effective therapy remains the surgical one. Material and methods. Our study involved an analysis of the cases treated and/or operated in the Department of General and Esophageal Surgery of the “Sfanta Maria” Hospital in Bucharest, between 1981-2014; respectively 195 patients who benefited from reconstructive esophageal interventions. Of the selected patients, 191 were operated for corrosive pathology produced by ingestion of caustic soda and only four cases by ingestion of acids. The lesion balance showed that, besides the esophagus, the oropharynx (28 patients), the larynx (7 patients) and the stomach (31 patients) had been affected by the corrosion process, requiring particular surgical solutions. The bypass reconstruction (preserving the esophagus) was the standard treatment, esophagectomy having been performed in only 4 patients. Results. The main remote postoperative complaint was feeding inability, a consequence of various causes: cervical anastomosis stenosis, motor dysfunctions of the graft or of the laryngopharyngeal complex, over-time alteration of the graft, technical vices or the degradation of intra-abdominal assemblies, traumatic injuries of the presternal substituent. Conclusion. One of the most important moments during the esophageal reconstruction surgery remains the duration of the cervical anastomosis, since the postoperative complication rate and the remote functional outcome depend on it. Minimizing postoperative risks and complications requires a complete mastery of surgical methods, of the small technical “artifices” and of the necessary therapeutic refinements adapted to each individual case.

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Colon Interposition for Esophageal Reconstruction in Cancer Patients

International Surgery ◽

10.9738/intsurg-d-17-00119.1 ◽

2018 ◽

Vol 103 (5-6) ◽

pp. 238-247

Author(s):

Martin H. Hangaard ◽

Michael B. Mortensen

Keyword(s):

Cancer Patients ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Colon Interposition ◽

Esophageal Reconstruction ◽

Low Grade ◽

Extensive Review ◽

First Choice ◽

Patient Reported ◽

Esophagectomy For Cancer

Objective: The aim of this study was to report our experience with colon interposition (COI) and to compare the results with an extensive review of the COI literature. Summary of Background Data: The stomach is the first choice as an esophageal substitute following esophagectomy in cancer patients, while COI is reserved for patients where the stomach is not available or must be included in the resection due to cancer. Methods: We retrospectively reviewed the records of cancer patients undergoing colon interposition from 2006 to 2017. Outcomes were compared with an extensive review of the literature published between 2000 and 2017. Results: A total of 13 patients underwent planned COI. Mortality was zero and overall morbidity was 53%; 4 patients suffered from leakage and 2 patients from strictures. None of the patients suffered from necrosis of the interponat and there was no need for subsequent redundancy operations. The extensive review identified 23 publications. Overall study grading was low (grade C). Only 3 studies were prospective, no randomized studies were found, and many outcomes were poorly defined. The rates for 30-day and in-hospital mortality were 1% and 2%, respectively. Overall morbidity was 43%. The reported number of leakages, strictures, necrosis of the interponat, and redundancy operations varied between 0% and 50%, 0% and 21%, 0% and 9%, and 0% and 2%, respectively. Conclusions: COI is a complex technique that is necessary in a relatively small group of selected patients after esophagectomy for cancer. Prospective and comparative studies with strict outcome definitions, long-term follow up, and patient reported outcome measures are lacking.

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Not All Embolizations Are Created Equally in the Management of Posterior Epistaxis: Discussion of Safety Measures Avoiding Neurological Complications

Radiology Research and Practice ◽

10.1155/2020/5710313 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Mareike Franke ◽

Jasper Franke ◽

Christian Saager ◽

Sven Barthel ◽

Randolf Riemann ◽

...

Keyword(s):

Neurological Complication ◽

Neurological Complications ◽

Surgical Approaches ◽

Success Rates ◽

Artery Ligation ◽

Retrospective Data Analysis ◽

First Choice ◽

Surgical Methods ◽

Choice Of Treatment ◽

Meta Analyses

Today, there are still no uniform guidelines for the treatment of epistaxis. Furthermore, it is widely debated whether embolization or surgical approaches should be the first choice of treatment for intractable posterior epistaxis after conservative measures have failed. In several meta-analyses, it is reported that endoscopic sphenopalatine artery ligation and embolization have similar success rates, but embolization was associated with more severe neurological complications. Regarding existing literature, there are many comparative analyses of surgical methods but none for embolization protocols. Against this backdrop of a lack of uniform standards in embolization techniques, we present a retrospective evaluation of what has emerged to be best procedural practice for endovascular treatment of epistaxis in our department using microsphere particles and microcoils, in particular regarding precaution measures to avoid neurological complications. In our retrospective data analysis of 141 procedures in 123 patients, performed between 2008 and 2019, we find success rates very similar to those reported in other studies (95.1% immediate-stop-of-bleeding success and 90.2% overall embolization success) but did not encounter any major neurological complication opposed to other reports. We suggest some aspects of our protocol as precaution measure to avoid neurological complications. More generally and perhaps even more importantly, we make a strong case for standardization for embolization techniques to the level of details in surgical procedure standardization to enable an apples to apples comparison of embolization techniques to each other and of intervention vs. surgery.

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Pediatric Thoraco-Lumbar Paraspinal Arteriovenous Fistulas along the Segmental Nerve

Interventional Neuroradiology ◽

10.1177/15910199060120s127 ◽

2006 ◽

Vol 12 (1_suppl) ◽

pp. 158-162

Author(s):

Y. Niimi ◽

A. Berenstein ◽

P.M. Fernandez ◽

J.L. Brisman ◽

J.K. Song

Keyword(s):

Venous Drainage ◽

Imaging Features ◽

Av Fistula ◽

Arteriovenous Fistulas ◽

Thoracic Level ◽

Segmental Nerve ◽

First Choice ◽

Diagnostic Angiography ◽

Choice Of Treatment ◽

Detachable Coils

To characterize the clinical presentation, imaging features and endovascular treatment of paraspinal non-vertebral arteriovenous fistulas along the segmental nerve. Retrospective review was performed on the five patients identified in our database covering 1985 to 2003. All patients presented with an incidentally found continuous murmur over the upper paraspinal or parasternal regions before three years old. In four patients, the AV fistula was in the mid-thoracic level and at L3 in one. All AV fistulas were a high-flow single-hole fistula at the neural foramen with venous drainage into paraspinal and epidural veins without intradural reflux. All fistulas were endovascularly occluded in the same session as the diagnostic angiography. The fistula was occluded with detachable coils in one case and with N-butylcyanoacrylate (NBCA) with flow control in four cases. Complete occlusion of the fistula was obtained in all cases and all patients remained neurologically intact at the last follow up (average six years). Non-vertebral paraspinal arteriovenous fistula along the segmental nerve is a specific disease entity seen in children. Embolization is the first choice of treatment for this disease.

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Surgery for pediatric craniopharyngiomas: is less more?

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2014-0417 ◽

2015 ◽

Vol 28 (1-2) ◽

Cited By ~ 9

Author(s):

Jörg Flitsch ◽

Jens Aberle ◽

Till Burkhardt

Keyword(s):

Surgical Complication ◽

Imaging Techniques ◽

Third Ventricle ◽

Minimal Invasive ◽

Interdisciplinary Treatment ◽

Childhood And Adolescence ◽

Complication Rates ◽

First Choice ◽

Surgical Methods

AbstractSurgery for craniopharyngiomas, especially in childhood and adolescence, has evolved from an era of aggressive strategies – with the primary goal of gross total removal and accepting an impaired functional outcome – to a more individually tailored therapy that avoids immediate treatment-related and long-term morbidity. Modern imaging techniques and a wider understanding of hypothalamic risk factors have led to surgical strategies adapted to the localization of these inhomogenously grown pathologies. Whereas purely infradiaphragmatic as well as supradiaphragmatic/infrachiasmatic tumors have a favorably surgical outcome with higher gross total resection rates in experienced hands, lesions within the third ventricle extending beyond the mammillary bodies remain a problem. The same is valid for lesions beyond 3 cm in diameter, more or less independent of their localization. Aside from the traditional microscopic approach via the subfrontal or pterional craniotomy, transsphenoidal approaches and other minimal invasive surgical methods, e.g., catheter implantation into cystic formations of the tumor have become popular. Radiotherapy, with its risks and limitations, can effectively be added to avoid recurrences. Nowadays, surgery as part of an interdisciplinary treatment strategy is still the typical first choice. However, taking the patient’s long-term prognosis into considertaion, the surgical complication rates have to be minimized.

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Minimally Invasive Approaches in the Thoracic Surgery

10.5772/intechopen.98367 ◽

2021 ◽

Author(s):

Güntuğ Batıhan ◽

Kenan Can Ceylan

Keyword(s):

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Thoracic Surgery ◽

Invasive Surgery ◽

Minimally Invasive Techniques ◽

The Past ◽

Minimally Invasive Surgical ◽

First Choice ◽

Surgical Methods ◽

Invasive Techniques

Minimally invasive techniques in thoracic surgery have made great progress over the past 20 years and are still evolving. Many surgical procedures performed with large thoracotomy incisions in the past can now be performed with much smaller incisions. With many studies, the advantages of minimally invasive surgery have been clearly seen, and thus its use has become widespread worldwide. Today, minimally invasive surgical methods have become the first choice in the diagnosis and treatment of lung, pleural and mediastinal pathologies. Minimally invasive approaches in thoracic surgery include many different techniques and applications. In this chapter, current minimally invasive techniques in thoracic surgery are discussed and important points are emphasized in the light of the current literature.

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Surgical treatment of 125 cases with congenital diaphragmatic eventration in a single institution

10.21203/rs.3.rs-35679/v2 ◽

2020 ◽

Author(s):

Shengliang Zhao ◽

Zhengxia Pan ◽

Yonggang Li ◽

Yong An ◽

Lu Zhao ◽

...

Keyword(s):

Surgical Treatment ◽

Open Surgery ◽

Clinical Symptoms ◽

Clinical Manifestations ◽

Operation Time ◽

Diaphragmatic Eventration ◽

Diaphragmatic Plication ◽

Paradoxical Movement ◽

First Choice ◽

Surgical Methods

Abstract Backgrounds This study sought to investigate the clinical characteristics of congenital diaphragmatic eventration (CDE) and to compare the efficacy of thoracoscopy and traditional open surgery in infants with congenital diaphragmatic eventration. Methods We retrospectively analyzed the clinical data of 125 children with CDE(90 boys, 35girls; median age:12.2 months, range 1h-7years;body weight1.99-28.5kg,median body weight 7.87±4.40kg) admitted to our hospital in recent 10years,　and statistically analyzed their clinical manifestations and surgical methods. Results 108 children in this group underwent surgery, of which 67 underwent open surgery and 41 underwent thoracoscopic diaphragmatic plication.107 patients recovered well postoperatively, except for 1 patient died of respiratory distress after surgery.Followed up for 1-9.5 years,107 patients had significantly improved preoperative symptoms.During follow-up, the location of the diaphragm was normal and no paradoxical movement was observed.Eleven of the 17 children who did not undergo surgical treatment did not see a decrease in diaphragm position after 1-6 years of follow-up.In the thoracoscopy group, the index data on the operation time, intraoperative blood loss, chest drainage time, postoperative mechanical ventilation time, postoperative hospital stay and postoperative CCU admission time were better than those in the open group.The difference between the two groups was statistically significant (P＜0.05). Conclusions Clinical symptoms of congenital diaphragmatic eventration varied in severity. Patients with severe symptoms should be operated.Both thoracoscopic diaphragmatic plication and traditional open surgery can effectively treat congenital diaphragmatic eventration,but compared with open surgery, thoracoscopic diaphragmatic plication has the advantages of short operation time, less trauma, rapid recovery,　so it should be the first choice for children with congenital diaphragmatic eventration.

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Systematic Lymph Node Dissection May Be Abolished in Patients With Apparent Early-Stage Low-Grade Mucinous and Endometrioid Epithelial Ovarian Cancer

Frontiers in Oncology ◽

10.3389/fonc.2021.705720 ◽

2021 ◽

Vol 11 ◽

Author(s):

Jiayu Chen ◽

Jie Yin ◽

Yan Li ◽

Yu Gu ◽

Wei Wang ◽

...

Keyword(s):

Ovarian Cancer ◽

Lymph Node ◽

Epithelial Ovarian Cancer ◽

Lymph Node Dissection ◽

Early Stage ◽

Progression Free Survival ◽

Low Grade ◽

Node Dissection ◽

Surgical Methods ◽

Systematic Lymph Node Dissection

ObjectiveTo investigate whether systematic lymph node dissection can confer clinical benefits in patients with apparent early-stage low-grade epithelial ovarian cancer.MethodsPatients with apparent early-stage low-grade epithelial ovarian cancer seen at Peking Union Medical College Hospital from January 1, 2005, to December 31, 2015, were retrospectively enrolled. Patients with other histological types and those who did not receive necessary adjuvant chemotherapy were excluded. Data collection and long-term follow-up were performed. According to the removed lymph node number, three groups based on surgical methods were used: abnormal lymph node resection, pelvic lymphadenectomy, and systematic lymph node dissection to control surgical quality. Their effects on prognosis were analyzed in pathological subgroups.ResultsA total of 196 patients were enrolled; 30.1% of patients had serous, 42.3% of patients had mucinous, and 27.6% of patients had endometrioid carcinoma, of which 51 (26.0%), 96 (49.0), and 49 (25.0%) patients were treated with the above surgical methods, respectively. The occult lymph node metastasis rate was 14 (7.1%), and only five (2.6%) of apparent early-stage patients were upstaged due to lymph node metastasis alone. Systematic lymph node dissection did not benefit progression-free survival or disease-specific overall survival of apparent early-stage low-grade mucinous and endometrioid epithelial ovarian cancer but prolonged progression-free survival of apparent early-stage low-grade serous patients (OR, 0.231, 95% CI, 0.080, 0.668, p = 0.007).ConclusionsSystematic lymph node dissection may be abolished in patients with apparent early-stage low-grade mucinous and endometrioid epithelial ovarian cancer but may be considered for apparent early-stage low-grade serous patients.

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