scholarly journals Laparoscopic–Endoscopic “Rendezvous” Procedure in Pediatric Gastrointestinal Surgery—Case Series

Children ◽  
2021 ◽  
Vol 8 (9) ◽  
pp. 770
Author(s):  
Radoica Jokić ◽  
Jelena Antić ◽  
Svetlana Bukarica ◽  
Miloš Pajić ◽  
Ivana Fratrić
Keyword(s):  
Operative Procedure ◽  
Gastrointestinal Surgery ◽  
Case Series ◽  
Pancreatic Tissue ◽  
Resection Margins ◽  
Gastric Schwannoma ◽  
Gastric Trichobezoar ◽  
Conversion Rates ◽  
Gastrointestinal Lesions ◽  
Stone Treatment

Laparoscopic–endoscopic “rendezvous” procedures were introduced in surgery for common bile duct stone treatment but are now widely used in other fields of abdominal surgery. An endoscopist navigates a surgeon during the same operative procedure and, thus, enables a better visualization of the location, resection margins, bleeding control, less thermal damage, etc. Here, we present case series of 11 patients that were treated using a “rendezvous” procedure for gastrointestinal lesions on different parts of the gastrointestinal tract such as juvenile polyps on the colon (transversum, ascendens, cecum, sigma), leiomyomatosis of the stomach, Peutz–Jeghers intestinal polyposis, hyperplastic gastric polyp, ectopic pancreatic tissue in the stomach, gastric trichobezoar, and gastric schwannoma. “Rendezvous” procedures are suitable for intestinal lesions that could not be resected endoscopically due to their size, morphology and/or location. In our experience this procedure should be used for endoscopically unresectable lesions as it decreases the time of surgery, possibility of iatrogenic injury, bleeding and technical inability. Furthermore, this procedure has been shown to better navigate the surgeon during laparoscopic surgery, especially in treating polyps in particularly difficult locations such as the duodenum or cecum, and it decreases conversion rates. However, conversion is sometimes necessary, in order to assure all oncological principals are respected, and the best option in some cases.

scholarly journals Lessons from Laparoscopic Liver Surgery: A Nine-Year Case Series

HPB Surgery ◽  
2008 ◽  
Vol 2008 ◽  
pp. 1-6 ◽  
Author(s):  
Laura Spencer ◽  
Matthew S. Metcalfe ◽  
Andrew D. Strickland ◽  
Elisabeth J. Elsey ◽  
Gavin S. Robertson ◽  
...  
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Liver Surgery ◽  
Operative Procedure ◽  
Case Series ◽  
Disease Recurrence ◽  
Resection Margins ◽  
Laparoscopic Liver Surgery ◽  
Data Set ◽  
Open Operation

Objective. This series describes a developing experience in laparoscopic liver surgery presenting results from 40 procedures including right hemihepatectomy, left lateral lobectomy, and microwave ablation therapy. Methods. Forty patients undergoing laparoscopic liver surgery between September 1997 and November 2006 were included. The data set includes: operative procedure and duration, intraoperative blood loss, conversion to open operation rates, length of hospital stay, complications, mortality, histology of lesions/resection margins, and disease recurrence. Results. Mean age of patient: 59 years, 17/40 male, 23/40 female, 23/40 of lesions were benign, and 17/40 malignant. Operations included: laparoscopic anatomical resections n=15, nonanatomical resections n=11, microwave ablations n=8 and deroofing of cysts n=7. Median anaesthetic time: 120 minutes (range 40–240), mean blood loss 78 mL and 1/40 conversions to open. Median resection margins were 10 mm (range 1–14) and median length of stay 3 days (range 1–10). Operative and 30-day mortality were zero with no local disease recurrence. Conclusion. Laparoscopic liver surgery appears safe and effective and is associated with reduced hospital stay. Larger studies are required to confirm it is oncologically sound.

Operative Outcomes of Grade 3 Turf Toe Injuries in Competitive Football Players

2018 ◽  
Vol 39 (9) ◽  
pp. 1076-1081 ◽  
Author(s):  
Kenneth Smith ◽  
Norman Waldrop
Keyword(s):  
Range Of Motion ◽  
Operative Procedure ◽  
Case Series ◽  
Operative Management ◽  
Return To Play ◽  
First Metatarsophalangeal Joint ◽  
Operative Outcomes ◽  
Turf Toe ◽  
Grade 3

Background: Turf toe is a term used to describe a hyperextension injury to the first metatarsophalangeal joint. Although the vast majority of turf toe injuries can be treated successfully without operative intervention, there are instances where surgery is required to allow the athlete to return to play. Although there is a plethora of literature on turf toe injuries and nonoperative management, there are currently few reports on operative outcomes in athletes. Methods: We obtained all cases of turf toe repair according to the ICD-10 procedural code. The inclusion criteria included: age greater than 16, turf toe injury requiring operative management and at least a varsity level high school football player. The charts were reviewed for age, BMI, level of competition, injury mechanism, football position, setting of injury and playing surface. In addition, we recorded the specifics of the operative procedure, a listing of all injured structures, the implants used and the great toe range of motion at final follow-up visit. The AOFAS Hallux score and VAS was used postoperatively as our outcome measures. Our patient population included 15 patients. The average follow-up time was 27.5 months. Results: The average patient was 19.3 years old with a body mass index of 32.3. The average playing time missed was 16.5 weeks. The average dorsiflexion range of motion at the final follow-up was 42.3 degrees. At final follow-up, the average AOFAS Hallux score was 91.3. The average VAS pain score was 0.7 at rest and 0.8 with physical activity. Conclusion: Complete turf toe injuries are often debilitating and may require operative management to restore a pain-free, stable, and functional forefoot. This study represents the largest cohort of operatively treated grade 3 turf toe injuries in the literature and demonstrates that good clinical outcomes were achieved with operative repair. Level of Evidence: Level IV, case series

scholarly journals Mesoscopic 3D imaging of pancreatic cancer and Langerhans islets based on tissue autofluorescence

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Max Hahn ◽  
Christoffer Nord ◽  
Oskar Franklin ◽  
Tomas Alanentalo ◽  
Martin Isaksson Mettävainio ◽  
...  
Keyword(s):  
Light Sheet ◽  
Pancreatic Tissue ◽  
Three Dimensions ◽  
Ductal Adenocarcinoma ◽  
Resection Margins ◽  
Histopathological Analysis ◽  
Islet Mass ◽  
Optical Projection ◽  
3D Microenvironment ◽  
Insight Into

Abstract The possibility to assess pancreatic anatomy with microscopic resolution in three dimensions (3D) would significantly add to pathological analyses of disease processes. Pancreatic ductal adenocarcinoma (PDAC) has a bleak prognosis with over 90% of the patients dying within 5 years after diagnosis. Cure can be achieved by surgical resection, but the efficiency remains drearily low. Here we demonstrate a method that without prior immunohistochemical labelling provides insight into the 3D microenvironment and spread of PDAC and premalignant cysts in intact surgical biopsies. The method is based solely on the autofluorescent properties of the investigated tissues using optical projection tomography and/or light-sheet fluorescence microscopy. It does not interfere with subsequent histopathological analysis and may facilitate identification of tumor-free resection margins within hours. We further demonstrate how the developed approach can be used to assess individual volumes and numbers of the islets of Langerhans in unprecedently large biopsies of human pancreatic tissue, thus providing a new means by which remaining islet mass may be assessed in settings of diabetes. Generally, the method may provide a fast approach to provide new anatomical insight into pancreatic pathophysiology.

scholarly journals Insulin determination by specific and unspecific immunoassays in patients with insulinoma evaluated by the arterial stimulation and venous sampling test

2004 ◽  
pp. 123-126 ◽  
Author(s):  
P Wiesli ◽  
M Brandle ◽  
T Pfammatter ◽  
J Zapf ◽  
GA Spinas ◽  
...  
Keyword(s):  
Case Series ◽  
Pancreatic Tissue ◽  
Enzyme Linked Immunosorbent Assay ◽  
Specific Enzyme ◽  
Venous Sampling ◽  
Blood Samples ◽  
Calcium Stimulation ◽  
Baseline Values ◽  
Prospective Case Series ◽  
Calcium Injection

OBJECTIVE: The aim of this study was to compare insulin concentrations measured by a traditional radioimmunoassay (RIA) and a more specific enzyme-linked immunosorbent assay (ELISA) in blood samples obtained during the arterial stimulation and venous sampling (ASVS) test in patients with insulinoma. DESIGN: Prospective case series. METHODS: In 14 patients with an insulinoma undergoing an ASVS test, blood samples were obtained from the hepatic vein at baseline and 60 s after calcium injection into an artery supplying the tumour and a control artery (supplying pancreatic tissue without tumour). A selective arterial calcium stimulation was performed in five additional patients without evidence for an insulinoma. We measured insulin by a traditional RIA and a specific immunoassay. RESULTS: In patients with insulinoma, insulin concentrations increased between 2.3- and 24.2-fold (median 8.2-fold) when measured by RIA and between 7.3- and 59.4-fold (median 16) when measured by ELISA following calcium injection into the artery supplying the tumour. Following calcium injection into the control artery, insulin concentrations were 0.6 to 1.3 times (median 1.0) the baseline values by RIA and 0.5 to 2.5 times (median 1.1) the baseline values by ELISA. In patients without insulinoma, insulin concentrations increased following calcium stimulation between 0.7- and 2.1-fold (median 1.3-fold) when measured by RIA and between 0.6- and 4.7-fold (median 1.3-fold) when measured by ELISA. CONCLUSIONS: When insulin is measured by specific immunoassays, a higher cut-off (i.e. five- to sixfold increase) rather than the traditional criterion of a twofold increase should be used to localise an insulinoma during the ASVS test. The increase in insulin concentrations following calcium stimulation is significantly higher when insulin is measured by a specific assay compared with results obtained with traditional RIAs.

scholarly journals Meckel's Diverticulum Series at UCMS, Bhairahawa, Nepal

2013 ◽  
Vol 1 (3) ◽  
pp. 56-57
Author(s):  
P Joshi
Keyword(s):  
Small Bowel ◽  
Meckel’S Diverticulum ◽  
Case Series ◽  
Pancreatic Tissue ◽  
Intestinal Wall ◽  
Meckel's Diverticulum ◽  
Medical Sciences ◽  
Medical College ◽  
Ileocaecal Junction ◽  
Specific Symptoms

Meckel's Diverticulum is the most common congenital malformation of the Gastrointestinal tract. It represent the patent intestinal end of the vitellointestinal duct. It occurs in 2 % of of population in autospy series and usually lie 60 cm from the Ileocaecal junction. It possesses all the three coats of intestinal wall. It has the same microscopic structure as the adjacent small bowel and it has a separate blood supply from the adjacent small bowel mesentery (the omphalomesenteric artery).1   In 20% of the cases, the mucosa contains heterotopic epithelium, namely gastric, colonic and sometimes pancreatic tissue. Although Meckel's diverticulum occurs with equal frequency in both sexes, symptoms usually resulting   from   the epithelium contained in the diverticulum predominantly occur in males.2Complications develop in only 4% of patients with this malformation, with most cases presenting in childhood3. Complications of Meckel's diverticulum include hemorrhage, bowel obstruction, inflammation, and perforation. All of these complications can be challenging to diagnose because patients may present with non-specific symptoms, which produce a clinical  picture that  can  mimic  other  more  common  gastrointestinal  disorders.4 Most  of  the  cases  are  diagnosed intraoperatively. Here, we present a case series of 5 patients in a year 2012 at Universal College of Medical College & Teaching Hospital, Bhairahawa, Nepal.DOI: http://dx.doi.org/10.3126/jucms.v1i3.8767  Journal of Universal College of Medical Sciences Vol.1(3) 2013: 56-57

scholarly journals Combination of ALA-induced fluorescence-guided resection and intraoperative open photodynamic therapy for recurrent glioblastoma: case series on a promising dual strategy for local tumor control

2020 ◽  
pp. 1-11 ◽  
Author(s):  
Stephanie Schipmann ◽  
Michael Müther ◽  
Louise Stögbauer ◽  
Sebastian Zimmer ◽  
Benjamin Brokinkel ◽  
...  
Keyword(s):  
Photodynamic Therapy ◽  
Aminolevulinic Acid ◽  
Diffusion Tensor ◽  
Case Series ◽  
Local Tumor Control ◽  
Resection Margins ◽  
Tumor Control ◽  
Therapeutic Effects ◽  
Local Tumor ◽  
Continuous Irrigation

OBJECTIVEHigh-grade glioma (HGG) prognosis remains dismal, with inevitable, mostly local recurrence. Regimens for improving local tumor control are therefore needed. Photodynamic therapy (PDT) using porfimer sodium has been investigated but was abandoned due to side effects and lack of survival benefits. Intracellular porphyrins induced by 5-aminolevulinic acid (5-ALA) are approved for fluorescence-guided resections (FGRs), but are also photosensitizers. Activated by light, they generate reactive oxygen species with resultant cytotoxicity. The authors present a combined approach of 5-ALA FGR and PDT.METHODSAfter 5-ALA FGR in recurrent HGG, laser diffusors were strategically positioned inside the resection cavity. PDT was applied for 60 minutes (635 nm, 200 mW/cm diffusor, for 1 hour) under continuous irrigation for maintaining optical clarity and ventilation with 100% oxygen. MRI was performed at 24 hours, 14 days, and every 3 months after surgery, including diffusion tensor imaging and apparent diffusion coefficient maps.RESULTSTwenty patients were treated. One surgical site infection after treatment was noted at 6 months as the only adverse event. MRI revealed cytotoxic edema along resection margins in 16 (80%) of 20 cases, mostly annular around the cavity, corresponding to prior laser diffusor locations (mean volume 3.3 cm3). Edema appeared selective for infiltrated tissue or nonresected enhancing tumor. At the 14-day follow-up, enhancement developed in former regions of edema, in some cases vanishing after 4–5 months. Median progression-free survival (PFS) was 6 months (95% CI 4.8–7.2 months).CONCLUSIONSCombined 5-ALA FGR and PDT provides an innovative and safe method of local tumor control resulting in promising PFS. Further prospective studies are warranted to evaluate long-term therapeutic effects.

A Sustainable and Scalable Multidisciplinary Airway Teaching Mission: The Operation Airway 10-Year Experience

2020 ◽  
Vol 163 (5) ◽  
pp. 971-978
Author(s):  
Asitha D. L. Jayawardena ◽  
Zelda J. Ghersin ◽  
Marcos Mirambeaux ◽  
Jose A. Bonilla ◽  
Ernesto Quiñones ◽  
...  
Keyword(s):  
Dominican Republic ◽  
El Salvador ◽  
Multidisciplinary Team ◽  
Surgical Outcomes ◽  
Demographic Data ◽  
Operative Procedure ◽  
Case Series ◽  
The United States ◽  
Pediatric Airway ◽  
Airway Reconstruction

Objective To address whether a multidisciplinary team of pediatric otolaryngologists, anesthesiologists, pediatric intensivists, speech-language pathologists, and nurses can achieve safe and sustainable surgical outcomes in low-resourced settings when conducting a pediatric airway surgical teaching mission that features a program of progressive autonomy. Study Design Consecutive case series with chart review. Setting This study reviews 14 consecutive missions from 2010 to 2019 in Ecuador, El Salvador, and the Dominican Republic. Methods Demographic data, diagnostic and operative details, and operative outcomes were collected. A country’s program met graduation criteria if its multidisciplinary team developed the ability to autonomously manage the preoperative huddle, operating room discussion and setup, operative procedure, and postoperative multidisciplinary pediatric intensive care unit and floor care decision making. This was assessed by direct observation and assessment of surgical outcomes. Results A total of 135 procedures were performed on 90 patients in Ecuador (n = 24), the Dominican Republic (n = 51), and El Salvador (n = 39). Five patients required transport to the United States to receive quaternary-level care. Thirty-six laryngotracheal reconstructions were completed: 6 single-stage, 12 one-and-a-half-stage, and 18 double-stage cases. We achieved a decannulation rate of 82%. Two programs (Ecuador and the Dominican Republic) met graduation criteria and have become self-sufficient. No mortalities were recorded. Conclusion This is the largest longitudinal description of an airway reconstruction teaching mission in low- and middle-income countries. Airway reconstruction can be safe and effective in low-resourced settings with a thoughtful multidisciplinary team led by local champions.

Submucosal Lifting Agent ORISE Gel Remnants Histopathologically Mimic Mucin and Malignancy: A Case Series

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S73-S73 ◽  
Author(s):  
Luke Cypher ◽  
Shaoli Sun ◽  
Erin Forster ◽  
Brenda Hoffman ◽  
David Lewin
Keyword(s):  
Colon Cancer ◽  
Epithelial Cells ◽  
Amorphous Material ◽  
Periodic Acid ◽  
Case Series ◽  
The United States ◽  
Periodic Acid Schiff ◽  
Good Communication ◽  
Gastrointestinal Lesions ◽  
Hematoxylin And Eosin

Abstract Introduction There were an estimated 18.1 million new cancer cases in 2018, with colon cancer being the third most common worldwide. Colon cancer development is an accumulation of mutations resulting in normal epithelial cells transforming into adenomas and then adenocarcinomas. In certain scenarios, endoscopic interventions have gained considerable momentum over invasive surgery as an alternative to manage early gastrointestinal lesions. New techniques such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection allow for removal of large, flat sessile polyps. Successful EMR is dependent on expanding the submucosal space to create adequate lift of the polyp to facilitate tissue capture and to avoid perforation and excess bleeding. ORISE gel (Boston Scientific) is a submucosal lifting agent currently in use in the United States. Methods We present three cases of gastrointestinal specimens obtained using ORISE gel. Histological analysis with hematoxylin and eosin revealed submucosal amorphous deposits that appeared to be mucin. Due to the concern for malignancy, additional stains were performed, including periodic acid–Schiff with diastase digestion (DPAS) to identify mucin. DPAS staining for mucin was negative, indicating the mucinous-appearing amorphous material seen on hematoxylin and eosin staining was not mucin but a likely remnant ORISE gel used during EMR. Additional immunohistochemical stains for epithelial cells (cytokeratin AE1/AE3) were also performed to exclude the presence of infiltrating tumor cells. Conclusion These three cautionary cases reveal the importance of good communication between endoscopists and pathology. In an effort to avoid overdiagnosis and/or the usage of unnecessary additional stains, pathologists should be alerted of ORISE gel usage.

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