Evolution of Sinonasal Symptoms and Mucosal Healing after Minimally Invasive Pituitary Surgery

2017 ◽  
Vol 31 (2) ◽  
pp. 117-121 ◽  
Author(s):  
Shiven Chaudhry ◽  
Sharang Chaudhry ◽  
Talha Qureshi ◽  
Pete S. Batra
Keyword(s):  
Minimally Invasive ◽  
Pituitary Surgery ◽  
Mucosal Healing ◽  
Postoperative Recovery ◽  
Endoscopic Examination ◽  
Nonparametric Testing ◽  
Kaplan Meier ◽  
Endoscopic Assessment ◽  
Snot 22

Background Minimally invasive pituitary surgery (MIPS) via endoscopy has become widely accepted as the surgical paradigm of choice for pituitary pathology. The objective of the current study was to analyze the evolution of symptom scores and mucosal healing after MIPS. Methods The 22-item Sino-Nasal Outcome Test (SNOT-22) scores and objective endoscopic data of 52 patients were reviewed in a longitudinal manner. Scaled averages of the SNOT-22 and endoscopic scores from different time points were compared with baseline scores by using nonparametric testing. The time to baseline for endoscopic examinations was also analyzed by using Kaplan-Meier curves. Results The rhinologic symptoms subdomain of the SNOT-22 scores showed statistically significant worsening between baseline and 2 weeks after surgery (p = 0.03). Follow-up SNOT-22 scores after 2 weeks showed no significant differences compared with baseline scores, with an overall trend toward improvement in patient symptoms during the subsequent period. Similar analysis for the endoscopic data illustrated statistically significant differences from the baseline scores up to 16 weeks after surgery. The overall trend showed a worsened endoscopic examination, initially with a spike at ∼8 to 10 weeks (p = 0.03) and with a subsequent return to baseline. The Kaplan-Meier estimate curve demonstrated a median time to return to baseline endoscopy at 18.9 weeks (95% confidence interval, 14.9-38.3 weeks). Conclusion The longitudinal data exhibited subjective improvement of patient outcomes based on SNOT-22 scores within 2-4 weeks after MIPS. However, the objective endoscopic data revealed a lag in improvement of the examination, typically at 16-20 weeks, which underscores ongoing careful endoscopic assessment and management to ensure proper mucosal healing beyond just subjective symptoms as the gauge to postoperative recovery.

Pituitary surgery as alternative to dopamine agonists treatment for microprolactinomas, a cohort study

2021 ◽  
Author(s):  
Bertrand Baussart ◽  
Chiara Villa ◽  
Anne Jouinot ◽  
Marie-Laure Raffin-Sanson ◽  
Luc Foubert ◽  
...  
Keyword(s):  
Dopamine Agonists ◽  
Cox Regression ◽  
Disease Free Survival ◽  
Pituitary Surgery ◽  
Cerebrospinal Fluid Leakage ◽  
Neurosurgical Department ◽  
Free Survival ◽  
Kaplan Meier ◽  
Disease Free

Objective: Microprolactinomas are currently treated with dopamine agonists. Outcome information on microprolactinoma patients treated by surgery is limited. This study reports the first large series of consecutive non-invasive microprolactinoma patients treated by pituitary surgery and evaluates the efficiency and safety of this treatment. Design: Follow-up of a cohort of consecutive patients treated by surgery. Methods: Between January 2008 and October 2020, 114 adult patients with pure microprolactinomas were operated on in a single tertiary expert neurosurgical department, using an endoscopic endonasal transsphenoidal approach. Eligible patients were presenting a microprolactinoma with no obvious cavernous invasion on MRI. Prolactin was assayed before and after surgery. Disease-free survival was modeled using Kaplan-Meier representation. A cox regression model was used to predict remission. Results: Median follow-up was 18.2 months (range: 2.8 to 155). In this cohort, 14/114 (12%) patients were not cured by surgery, including 10 early surgical failures, and 4 late relapses occurring 37.4 months (33 to 41.8) after surgery. From Kaplan Meier estimates, 1-year and 5-year disease free survival were 90.9% (95% CI, 85.6%-96.4%) and 81% (95% CI,71.2%-92.1%) respectively. The preoperative prolactinemia was the only significant preoperative predictive factor for remission (P<0.05). No severe complication was reported, with no anterior pituitary deficiency after surgery, one diabetes insipidus, and one postoperative cerebrospinal fluid leakage properly treated by muscle plasty. Conclusions: In well selected microprolactinoma patients, pituitary surgery performed by an expert neurosurgical team is a valid first-line alternative treatment to dopamine agonists.

scholarly journals OP26 The first real-life multicentre prospective validation study of the electronic chromoendoscopy score (Paddington International Virtual ChromoendoScopy ScOre) and its outcome in ulcerative colitis

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S023-S024 ◽  
Author(s):  
M Iacucci ◽  
S C Smith ◽  
A Bazarova ◽  
U N Shivaji ◽  
P Bhandari ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Validation Study ◽  
Real Life ◽  
Mucosal Healing ◽  
Vascular Changes ◽  
Important Goal ◽  
Kaplan Meier ◽  
Virtual Chromoendoscopy

Abstract Background Mucosal healing is an important goal in the treatment of ulcerative colitis (UC). The newly published PICaSSO score characterises subtle mucosal and vascular changes and defines mucosal healing. We aimed to validate in real-life the PICaSSO score and assess its ability to predict relapse. Methods Patients with UC were prospectively recruited from 11 international centres. Participating endoscopists experienced in IBD received training on PICaSSO before starting the study. The rectum and sigmoid were examined using iScan 1,2 and 3 (Pentax, Japan) and inflammatory activity was assessed using UCEIS and PICaSSO. Biopsies were taken for the histological assessment using Robarts Histological Index (RHI) and Nancy. Follow-up was obtained at 12 months. Results A total of 278 patients were recruited (Table 1). The diagnostic performance in predicting histologic healing is shown in Table 2. When using PICaSSO score of ≤3 for mucosal and vascular architecture the AUROC to predict healing by RHI is 0.79 (95% CI 0.74–0.85) and 0.73 (95% CI 0.68–0.80) respectively and when using the Nancy score the AUROC is 0.78 (95% CI 0.72–0.84) and 0.77 (0.71–0.84). A total PICaSSO score of ≤8 and UCEIS score of ≤1 predicts remission at 12 months with an AUROC of 0.73 (0.65–0.80) and 0.71 (0.64–0.79). A Kaplan–Meier curve shows a favourable survival probability without relapse with a PICASSO score of ≤8 (Figure 1). Conclusion This real-life validation study shows the PICaSSO score can predict accurately histological healing and long-term remission and can be a useful tool in the management of UC.

scholarly journals Clinical Performance of Porcelain Laminate Veneers with Minimal Preparation: A Systematic Review

2016 ◽  
Vol 5 (1) ◽  
pp. 56-59 ◽  
Author(s):  
Boniek Borges ◽  
Giovanna de FA da Costa ◽  
Isauremi V de Assunção
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Minimally Invasive ◽  
Web Of Science ◽  
Clinical Performance ◽  
Cavity Preparation ◽  
Kaplan Meier ◽  
Follow Up Studies ◽  
Laminate Veneers

ABSTRACT Aim To investigate the longevity of ceramic laminates with minimally invasive preparations. Materials and methods The research was conducted in PubMed, Web of Science, and Scopus databases, using the keywords “dental veneers” or “dental porcelain” or “dental laminates” and survival or survivorship or longevity or “follow-up studies” and Kaplan-Meier. The studies selected for analysis were clinical trials where the ceramic laminates were made with anywhere from no cavity preparation to minimum preparation with a 1 mm maximum depth. Results Of 197 citations identified, five studies were included. Conclusion The survival of the ceramic laminates with minimal preparation is satisfactory, which leads us to conclude that the technique has longevity for 10 years. How to cite this article de FA da Costa G, Borges BCD, de Assunção IV. Clinical Performance of Porcelain Laminate Veneers with Minimal Preparation: A Systematic Review. Int J Experiment Dent Sci 2016;5(1):56-59.

scholarly journals Laparoscopic versus Open Surgery for Colorectal Cancer: A Retrospective Analysis of 163 Patients in a Single Institution

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Abdulkadir Bedirli ◽  
Bulent Salman ◽  
Osman Yuksel
Keyword(s):  
Colorectal Cancer ◽  
Laparoscopic Surgery ◽  
Minimally Invasive ◽  
Open Surgery ◽  
Demographic Data ◽  
Postoperative Recovery ◽  
Colorectal Cancers ◽  
Relative Disadvantage ◽  
Pathologic Parameters

Background. The present study aimed to compare the clinical outcomes of laparoscopic versus open surgery for colorectal cancers.Materials and Methods. The medical records from a total of 163 patients who underwent surgery for colorectal cancers were retrospectively analyzed. Patient’s demographic data, operative details and postoperative early outcomes, outpatient follow-up, pathologic results, and stages of the cancer were reviewed from the database.Results. The patients who underwent laparoscopic surgery showed significant advantages due to the minimally invasive nature of the surgery compared with those who underwent open surgery, namely, less blood loss, faster postoperative recovery, and shorter postoperative hospital stay (P<0.05). However, laparoscopic surgery for colorectal cancer resulted in a longer operative time compared with open surgery (P<0.05). There were no statistically significant differences between groups for medical complications (P>0.05). Open surgery resulted in more incisional infections and postoperative ileus compared with laparoscopic surgery (P<0.05). There were no differences in the pathologic parameters between two groups (P<0.05).Conclusions. These findings indicated that laparoscopic surgery for colorectal cancer had the clear advantages of a minimally invasive surgery and relative disadvantage with longer surgery time and exhibited similar pathologic parameters compared with open surgery.

scholarly journals Glucocorticoid Replacement and Mortality in Patients with Nonfunctioning Pituitary Adenoma

2012 ◽  
Vol 97 (10) ◽  
pp. E1938-E1942 ◽  
Author(s):  
Thomas Zueger ◽  
Paul Kirchner ◽  
Coline Herren ◽  
Stefan Fischli ◽  
Marcel Zwahlen ◽  
...  
Keyword(s):  
Hpa Axis ◽  
Cox Regression ◽  
Treatment Guidelines ◽  
Positive Association ◽  
Pituitary Surgery ◽  
Time Pattern ◽  
Tertiary Referral Center ◽  
Kaplan Meier ◽  
Overall Mortality

Abstract Context: Current treatment guidelines generally suggest using lower and weight-adjusted glucocorticoid replacement doses in patients with insufficiency of the hypothalamic-pituitary-adrenal (HPA) axis. Although data in patients with acromegaly revealed a positive association between glucocorticoid dose and mortality, no comparable results exist in patients with nonfunctioning pituitary adenomas (NFPA). Objective: Our objective was to assess whether higher glucocorticoid replacement doses are associated with increased mortality in patients with NFPA and HPA axis insufficiency. Design, Participants, and Intervention: We included 105 patients receiving glucocorticoid replacement after pituitary surgery due to NFPA and concomitant HPA axis insufficiency. Patients were grouped according weight-adapted and absolute hydrocortisone (HC) replacement doses. Mortality was assessed using Kaplan-Meier methodology as well as multivariable Cox regression models. Setting: This was a retrospective analysis conducted at a tertiary referral center. Main Outcome: We evaluated overall mortality based on HC replacement doses. Results: Average age at inclusion was 58.9 ± 14.8 yr, and mean follow-up was 12.7 ± 9.4 yr. The groups did not differ according to age, follow-up time, pattern of hypopituitarism, and comorbidities. Kaplan-Meier survival probabilities differed significantly when comparing individuals with differing weight-adjusted HC dose (P = 0.001) as well as absolute HC dose (5–19, 20–29, and ≥30 mg, P = 0.009). Hazard ratios for mortality increased from 1 (0.05–0.24 mg/kg) to 2.62 (0.25–0.34 mg/kg) to 4.56 (≥0.35 mg/kg, P for trend = 0.006) and from 1 (5–19 mg) to 2.03 (20–29 mg) to 4 (≥30 mg, P for trend = 0.029), respectively. Conclusion: Higher glucocorticoid replacement doses are associated with increased overall mortality in patients with NFPA and insufficiency of HPA axis. This further substantiates the importance of a balanced and adjusted glucocorticoid replacement therapy in these patients.

scholarly journals Small spherical foreign bodies in the genitourinary tract and their management

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
You Jia ◽  
Li Shuang ◽  
Wang Jun ◽  
Li Gang ◽  
Chen Hai-tao
Keyword(s):  
Minimally Invasive ◽  
Doppler Ultrasonography ◽  
Foreign Bodies ◽  
Color Doppler ◽  
Postoperative Recovery ◽  
Fistula Formation ◽  
First Line ◽  
Urethral Strictures ◽  
Imaging Characteristics

Abstract Background Urogenital small foreign bodies (FBs) have rarely been reported in children, and their management is still challenging. This study aimed to describe the characteristics and treatment of spherical FBs no larger than 0.6 cm in the children’s genitourinary tracts.  Methods The clinical data of spherical FBs removed in our hospital from June 2013 to June 2020 were recorded and retrospectively analyzed, including demographics, location, symptoms, imaging examinations and treatment methods. Results A total of 10 patients were enrolled: 6 girls and 4 boys. Their ages ranged from 5.1 to 16.8 years old, with a mean age of 9.2 years. The course of the disease ranged from 3 h to 1 year, and symptoms recurred in some cases. Their imaging characteristics were reviewed and analyzed, 6 patients underwent color Doppler ultrasonography, 1 patient was suspected to have an FB in the vagina, 7 patients underwent an X-ray examination, and FBs were revealed in 6 patients. All FBs were removed under endoscopic minimally invasive surgery. Six vaginal FBs were successfully retrieved via vaginoscopy, and in the other four cases, removal by transurethral cystoscopy failed because of mutual attraction, which was eliminated by laparoscopy under pneumovesicum. Postoperative recovery was uneventful; in a follow-up of 3 months to 2 years, there was no perforation or fistula formation, and there were no urethral strictures in boys. Conclusion Small spherical FBs are clinically rare; they are sometimes difficult to detect by imaging examinations and can be easily overlooked. Minimally invasive endoscopy remains the first-line approach for the diagnosis and removal of genitourinary spherical FBs.

Colorectal Liver Metastases - Does the Number of Lesions Determine the Sensibility of Resection?

Swiss Surgery ◽  
2000 ◽  
Vol 6 (1) ◽  
pp. 6-10
Author(s):  
Knoefel ◽  
Brunken ◽  
Neumann ◽  
Gundlach ◽  
Rogiers ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Rank Test ◽  
Log Rank Test ◽  
Kaplan Meier ◽  
Chirurgische Entfernung

Die komplette chirurgische Entfernung von Lebermetastasen bietet Patienten nach kolorektalem Karzinom die einzige kurative Chance. Es gibt jedoch eine, anscheinend unbegrenzte, Anzahl an Parametern, die die Prognose dieser Patienten bestimmen und damit den Sinn dieser Therapie vorhersagen können. Zu den am häufigsten diskutierten und am einfachsten zu bestimmenden Parametern gehört die Anzahl der Metastasen. Ziel dieser Studie war es daher die Wertigkeit dieses Parameters in der Literatur zu reflektieren und unsere eigenen Patientendaten zu evaluieren. Insgesamt konnte von 302 Patienten ein komplettes Follow-up erhoben werden. Die gebildeten Patientengruppen wurden mit Hilfe einer Kaplan Meier Analyse und konsekutivem log rank Test untersucht. Die Literatur wurde bis Dezember 1998 revidiert. Die Anzahl der Metastasen bestätigte sich als ein prognostisches Kriterium. Lagen drei oder mehr Metastasen vor, so war nicht nur die Wahrscheinlichkeit einer R0 Resektion deutlich geringer (17.8% versus 67.2%) sondern auch das Überleben der Patienten nach einer R0 Resektion tendenziell unwahrscheinlicher. Das 5-Jahres Überleben betrug bei > 2 Metastasen 9% bei > 2 Metastasen 36%. Das 10-Jahres Überleben beträgt bislang bei > 2 Metastasen 0% bei > 2 Metastasen 18% (p < 0.07). Die Anzahl der Metastasen spielt in der Prognose der Patienten mit kolorektalen Lebermetastasen eine Rolle. Selbst bei mehr als vier Metastasen ist jedoch gelegentlich eine R0 Resektion möglich. In diesen Fällen kann der Patient auch langfristig von einer Operation profitieren. Das wichtigere Kriterium einer onkologisch sinnvollen Resektabilität ist die Frage ob technisch und funktionell eine R0 Resektion durchführbar ist. Ist das der Fall, so sollte auch einem Patienten mit mehreren Metastasen die einzige kurative Chance einer Resektion nicht vorenthalten bleiben.

Dynamic testing after pituitary surgery: is follow-up re-testing useful?

2008 ◽  
Vol 116 (09) ◽  
Author(s):  
C Berg ◽  
T Meinel ◽  
A Yüce ◽  
H Lahner ◽  
K Mann ◽  
...  
Keyword(s):  
Dynamic Testing ◽  
Pituitary Surgery

Minimally Invasive Transaortic Repair of the Mitral Valve

2011 ◽  
Vol 14 (4) ◽  
pp. 232 ◽  
Author(s):  
Orlando Santana ◽  
Joseph Lamelas
Keyword(s):  
Mitral Valve ◽  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Aortic Valve Replacement ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
Operative Mortality ◽  
The Mean ◽  
Transaortic Approach

<p><b>Objective:</b> We retrospectively evaluated the results of an edge-to-edge repair (Alfieri stitch) of the mitral valve performed via a transaortic approach in patients who were undergoing minimally invasive aortic valve replacement.</p><p><b>Methods:</b> From January 2010 to September 2010, 6 patients underwent minimally invasive edge-to-edge repair of the mitral valve via a transaortic approach with concomitant aortic valve replacement. The patients were considered to be candidates for this procedure if they were deemed by the surgeon to be high-risk for a double valve procedure and if on preoperative transesophageal echocardiogram the mitral regurgitation jet originated from the middle portion (A2/P2 segments) of the mitral valve.</p><p><b>Results:</b> There was no operative mortality. Mean cardiopulmonary bypass time was 137 minutes, and mean cross-clamp time was 111 minutes. There was a significant improvement in the mean mitral regurgitation grade, with a mean of 3.8 preoperatively and 0.8 postoperatively. The ejection fraction remained stable, with mean preoperative and postoperative ejection fractions of 43.3% and 47.5%, respectively. Follow-up transthoracic echocardiograms obtained at a mean of 33 days postoperatively (range, 8-108 days) showed no significant worsening of mitral regurgitation.</p><p><b>Conclusion:</b> Transaortic repair of the mitral valve is feasible in patients undergoing minimally invasive aortic valve replacement.</p>

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