scholarly journals Surgical excision of wrist ganglia; literature review and nine-year retrospective study of recurrence and patient satisfaction

2009 ◽  
Vol 1 (1) ◽  
pp. 5 ◽  
Author(s):  
Surjit Lidder
Keyword(s):  
Retrospective Study ◽  
Hand Surgery ◽  
Surgical Excision ◽  
Consecutive Series ◽  
Single Institution ◽  
Recurrence Rates ◽  
The Mean ◽  
Open Excision

The main options for the treatment of wrist ganglia are reassurance, aspiration, arthroscopic resection and open excision. Variations within each option have been described and the literature is clouded by widespread variability in the results reported. We present the results of our own long-term retrospective study, review the literature and question the surgical risks and demands placed on healthcare resources. A retrospective review of the surgical results of dorsal and volar wrist ganglia excision between January 1998 and March 2005 was undertaken at a single institution. Of the 152 patients in this consecutive series, 117 (77%) patients responded to a telephone questionnaire. The mean length of follow-up in this series of 117 patients was 4.2 years (range 1.5-8.7 years). The overall recurrence rate following excision of all wrist ganglia in this series was 41.8 %. When looking just at volar ganglia, the risk of recurrence is higher at 46.8%. Should the ganglion recur, the risk of developing a moderate to severely tender scar is 34.6% and the risk of developing an unsightly scar is 8.2%. This study questions the effectiveness of surgical excision in the treatment of wrist ganglia when performed by a mixture of surgeons in that the recurrence rates are very similar to the rates seen in studies that merely observe or aspirate wrist ganglia. We propose that for symptomatic ganglia, specialists in hand surgery may be more appropriate at treating such a pathology.

Long-term outcomes of lumbar microdiscectomy in the pediatric population: a large single-institution case series

2019 ◽  
Vol 24 (5) ◽  
pp. 549-557
Author(s):  
Malia McAvoy ◽  
Heather J. McCrea ◽  
Vamsidhar Chavakula ◽  
Hoon Choi ◽  
Wenya Linda Bi ◽  
...  
Keyword(s):  
Conservative Management ◽  
Functional Outcomes ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Case Series ◽  
Csf Leak ◽  
Single Institution ◽  
The Mean

OBJECTIVEFew studies describe long-term functional outcomes of pediatric patients who have undergone lumbar microdiscectomy (LMD) because of the rarity of pediatric disc herniation and the short follow-up periods. The authors analyzed risk factors, clinical presentation, complications, and functional outcomes of a single-institution series of LMD patients over a 19-year period.METHODSA retrospective case series was conducted of pediatric LMD patients at a large pediatric academic hospital from 1998 to 2017. The authors examined premorbid risk factors, clinical presentation, physical examination findings, type and duration of conservative management, indications for surgical intervention, complications, and postoperative outcomes.RESULTSOver the 19-year study period, 199 patients underwent LMD at the authors’ institution. The mean age at presentation was 16.0 years (range 12–18 years), and 55.8% were female. Of these patients, 70.9% participated in competitive sports, and among those who did not play sports, 65.0% had a body mass index greater than 25 kg/m2. Prior to surgery, conservative management had failed in 98.0% of the patients. Only 3 patients (1.5%) presented with cauda equina syndrome requiring emergent microdiscectomy. Complications included 4 cases of postoperative CSF leak (2.0%), 1 case of a noted intraoperative CSF leak, and 3 cases of wound infection (1.5%). At the first postoperative follow-up appointment, minimal or no pain was reported by 93.3% of patients. The mean time to return to sports was 9.8 weeks. During a mean follow-up duration of 8.2 years, 72.9% of patients did not present again after routine postoperative appointments. The total risk of reoperation was a rate of 7.5% (3.5% of patients underwent reoperation for the same level; 4.5% underwent adjacent-level decompression, and one patient [0.5%] ultimately underwent a fusion).CONCLUSIONSMicrodiscectomy is a safe and effective treatment for long-term relief of pain and return to daily activities among pediatric patients with symptomatic lumbar disc disease in whom conservative management has failed.

scholarly journals Minimal Invasive Surgery for Gastroesophageal Reflux Disease and Hiatus Hernia—Our Experience: A Case Series with Review of Literature

2021 ◽  
Author(s):  
Rafique Umer Harvitkar ◽  
Abhijit Joshi
Keyword(s):  
Retrospective Study ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Operating Time ◽  
Type I ◽  
Type Ii ◽  
The Mean ◽  
Gerd Symptoms

Abstract Introduction Laparoscopic fundoplication (LF) has almost completely replaced the open procedure performed for gastroesophageal reflux disease (GERD) and hiatus hernia (HH). Several studies have suggested that long-term results with surgery for GERD are better than a medical line of management. In this retrospective study, we outline our experience with LF over 10 years. Also, we analyze the factors that would help us in better patient selection, thereby positively affecting the outcomes of surgery. Patients and Methods In this retrospective study, we identified 27 patients (14 females and 13 males) operated upon by a single surgeon from 2010 to 2020 at our institution. Out of these, 25 patients (12 females and 13 males) had GERD with type I HH and 2 (both females) had type II HH without GERD. The age range was 24 to 75 years. All patients had undergone oesophago-gastro-duodenoscopy (OGD scopy). A total of 25 patients had various degrees of esophagitis. Two patients had no esophagitis. These patients were analyzed for age, sex, symptoms, preoperative evaluation, exact procedure performed (Nissen’s vs. Toupet’s vs. cruroplasty + gastropexy), morbidity/mortality, and functional outcomes. They were also reviewed to examine the length of stay, length of procedure, complications, and recurrent symptoms on follow-up. Symptoms were assessed objectively with a score for six classical GERD symptoms preoperatively and on follow-up at 1-, 4- and 6-weeks postsurgery. Further evaluation was performed after 6 months and then annually for 2 years. Results 14 females (53%) and 13 males (48%) with a diagnosis of GERD (with type I HH) and type II HH were operated upon. The mean age was 46 years (24–75 years) and the mean body mass index (BMI) was 27 (18–32). The range of duration of the preoperative symptoms was 6 months to 2 years. The average operating time dropped from 130 minutes for the first 12 cases to 90 minutes for the last 15 cases. The mean hospital stay was 3 days (range: 2–4 days). In the immediate postoperative period, 72% (n = 18) of the patients reported improvement in the GERD symptoms, while 2 (8%) patients described heartburn (grade I, mild, daily) and 1 (4%) patient described bloating (grade I, daily). A total of 5 patients (20%) reported mild dysphagia to solids in the first 2 postoperative weeks. These symptoms settled down after 2 to 5 weeks of postoperative proton-pump inhibitor (PPI) therapy and by adjusting consistency of oral feeds. There was no conversion to open, and we observed no perioperative mortality. There were no patients who underwent redo surgeries in the series. Conclusion LF is a safe and highly effective procedure for a patient with symptoms of GERD, and it gives long-term relief from the symptoms. Stringent selection criteria are necessary to optimize the results of surgery. Experience is associated with a significant reduction of operating time.

Transscleral Red Laser Cyclophotocoagulation for the Treatment of Therapy-Resistant Inflammatory Glaucoma

2007 ◽  
Vol 17 (4) ◽  
pp. 550-556 ◽  
Author(s):  
P.M. Puska ◽  
A.H.A. Tarkkanen
Keyword(s):  
Intraocular Pressure ◽  
Retrospective Study ◽  
Diode Laser ◽  
Laser Power ◽  
Application Time ◽  
Chronic Uveitis ◽  
Phthisis Bulbi ◽  
The Mean

Purpose To evaluate in a retrospective study the long-term usefulness of red 647 nm krypton and 670 nm diode laser for transscleral contact cyclophotocoagulation (CPC) in the treatment of therapy-resistant inflammatory glaucoma. Methods The authors treated 48 eyes of 38 consecutive patients (mean age 36.8 years, range 6–81 years) with therapy-resistant inflammatory glaucoma secondary to chronic uveitis (45/48), chronic scleritis (1/48), or combined scleritis with keratouveitis (2/48) using transscleral red 647 nm Krypton or 670 nm Diode laser. All eyes had failed maximum tolerated medical therapy and 19/48 (40%) eyes also previous antiglaucoma surgery. Laser power at the scleral surface was 0.35 to 0.45 W and the application time 10 seconds each. The follow-up was 42.8± 40.0 (range 2–145) months. Results The mean preoperative intraocular pressure (IOP) of 35.6±8.1 mmHg fell to 6–21 mmHg level in 75% after one or repeated CPC. Among adult patients this was achieved in 85%, among children in 54%. More than one treatment was needed in 52%. No cases of hypotony, phthisis bulbi, or other devastating complications occurred. Conclusions Transscleral CPC using red 647 nm krypton or 670 nm diode laser is an effective and well-tolerated procedure for the treatment of therapy-resistant inflammatory glaucoma in adults. CPC can be considered before incisional antiglaucoma surgery with a shunt or antimetabolites is undertaken

Feline Chondrosarcoma: A Retrospective Study of 67 Cats (1987–2005)

2008 ◽  
Vol 44 (3) ◽  
pp. 124-130 ◽  
Author(s):  
Amy C. Durham ◽  
Catherine A. Popovitch ◽  
Michael H. Goldschmidt
Keyword(s):  
Retrospective Study ◽  
Nasal Cavity ◽  
Axial Skeleton ◽  
Long Bones ◽  
Facial Bones ◽  
Definitive Evidence ◽  
The Mean

The histories of 67 cats diagnosed with chondrosarcoma (CSA) from 1987 to 2005 were reviewed. The mean age was 9.6 years, and males were 1.9 times more likely to be affected than females. Chondrosarcomas were diagnosed in the following sites: appendicular and axial skeleton, nasal cavity, facial bones, and extraskeletal sites. Of the 46 (70%) CSA associated with bone, 63% arose in long bones and 37% arose in flat bones. The remaining (30%) CSA arose in the subcutis. In cases available for follow-up (n=24), no definitive evidence of metastases was found. Cats that underwent radical surgical therapies were more likely to achieve long-term control or cure.

scholarly journals Long-Term Outcomes of Scaphoid Malunion

Hand ◽  
2016 ◽  
Vol 12 (1) ◽  
pp. 26-30 ◽  
Author(s):  
Blake P. Gillette ◽  
Peter C. Amadio ◽  
Sanjeev Kakar
Keyword(s):  
Nonoperative Management ◽  
Corrective Osteotomy ◽  
Nonoperative Treatment ◽  
Long Term Outcomes ◽  
Single Institution ◽  
Surgical Evaluation ◽  
Long Term Follow Up ◽  
The Mean

Background: The optimal treatment of patients with a scaphoid malunion remains controversial. The long-term outcomes of operative and nonoperative management have not been established. Methods: We conducted a retrospective review of the outcomes of all scaphoid malunions treated at single institution over a 30-year period. This included patients who underwent corrective osteotomy, salvage procedures (ie, dorsal cheilectomy, radial styloidectomy, and scaphoidectomy with midcarpal fusion), and those who refused operative intervention. The Mayo Wrist Score was determined at the time of surgical evaluation. Patient-Rated Wrist Evaluation (PRWE) and Disabilities of the Arm, Shoulder and Hand (QuickDASH) surveys were sent to all patients for long-term follow-up. Results: Seventeen patients had follow-up at a mean 21.4 years (range, 12-30 years). The mean initial lateral intrascaphoid angle was 58°. Of the 17 patients, 11 proceeded with surgery and 6 opted for nonoperative management. A corrective osteotomy was performed in 4 patients. Of the remaining 7 surgical patients, 5 patients underwent procedures such as cheilectomy and radial styloidectomy, whereas 2 patients had a scaphoidectomy with midcarpal fusion. The final mean PRWE and QuickDASH scores for corrective osteotomy, salvage procedures, and nonoperative treatment were 23 and 6, 18 and 10, and 33 and 22, respectively. Conclusion: Long-term outcomes were similar between operative and nonoperative management.

Hemangiopericytoma of the Nasal Cavity: A Review of 15 Cases over a 40-Year Period

1992 ◽  
Vol 6 (6) ◽  
pp. 203-209 ◽  
Author(s):  
Kenneth V. Hughes ◽  
Michael C. Bard ◽  
Jean E. Lewis ◽  
Jan L. Kasperbauer ◽  
George W. Facer
Keyword(s):  
Local Recurrence ◽  
Nasal Cavity ◽  
Paranasal Sinuses ◽  
Clinical Course ◽  
Recurrence Rates ◽  
Long Term Follow Up ◽  
Vascular Origin ◽  
The Mean

Hemangiopericytomas are rare tumors of vascular origin most commonly found in the extremities or retroperitoneal area. When they originate from the nasal cavity and paranasal sinuses, they tend to be less aggressive and generally do not metastasize. The term “hemangiopericytoma-like lesion” has been coined for sinonasal hemangiopericytomas that display more benign histologic and growth characteristics than do those located elsewhere. Fifteen cases of hemangiopericytoma of the nasal cavity and paranasal sinuses were reviewed over the period 1951 to 1990; included are follow-up data on cases reported earlier from this institution. The clinical course, management, and outcome was evaluated and correlated with the histologic characteristics of the tumors. The recurrence rate in our series was 13.3%; the mean follow-up was 11 years. No patients died of their disease or had evidence of metastatic disease. This clinicopathologic review suggests that sinonasal hemangiopericytomas should not be classified as “hemangiopericytoma-like” lesions; rather, they should be expected to have significant local recurrence rates with low rates of distant metastasis and mortality. Long-term follow-up is essential as there can be local recurrence after many years.

scholarly journals A series Cases study of Carcinomas derived from myoepithelial cells in head and neck regions

2020 ◽  
Author(s):  
Danni Cheng ◽  
Yufang Rao ◽  
Ke Qiu ◽  
Jianqing Qiu ◽  
Yijun Dong ◽  
...  
Keyword(s):  
Head And Neck ◽  
Surgical Resection ◽  
Postoperative Radiotherapy ◽  
Surgical Excision ◽  
Myoepithelial Cells ◽  
Single Institution ◽  
Complete Surgical Excision ◽  
The Mean ◽  
Systemic Therapies

Abstract Background and Objectives: Carcinomas derived from myoepithelial cells in head and neck regions (CMCHN) are rare. The aim of this study was to demonstrate the clinical behaviors and treatment outcomes of these tumors.Methods: A retrospective review of fifteen CMCHN cases between 2002 and 2019 in a single institution was performed. Results: All of the fifteen patients (100%) underwent primary surgical resection. Eleven patients (73.3%) received conventional postoperative radiotherapy and four (26.7%) received systemic chemotherapy. Consequently, six patients (40%) had frequently recurrence after surgical resection, and seven patients (46.7%) received second or even third operations. Up to the time of last follow-up, only one patient died and the mean survival time was 15.8 years.Conclusions: Currently, complete surgical excision with or without systemic therapy is preferred, but it has limited efficacy on reducing the risk of recurrence. Thus, more effective systemic therapies are required and the researches on the mechanism of CMCHN recurrence should be encouraged.

P–303 Similar long term recurrence rates with cystectomy and CO2-laser vaporization for endometrioma: a retrospective study

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
N Moura. Tawfic ◽  
C Bafort ◽  
C Meuleman ◽  
A Laenen ◽  
D Va. Schoubroeck ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Co2 Laser ◽  
Reproductive Age ◽  
University Hospital ◽  
Laser Vaporization ◽  
Recurrence Rates ◽  
Laparoscopic Excision ◽  
Cyst Recurrence ◽  
The Mean

Abstract Study question Is there a difference in recurrence rate of endometrioma(s) after cystectomy versus CO2-laser vaporization of the cyst wall? Summary answer Similar rates of imaging based recurrence or need for reintervention for endometrioma were observed after cystectomy versus CO2-laser vaporization. What is known already Surgical treatment of endometrioma(s) is mainly performed by 2 types of procedures: cystectomy and ablation. When performing surgery for endometrioma(s), a balance should be made between minimal destruction of normal ovarian cortex and maximal completeness to avoid (early) recurrence. Previous studies have shown that cyst recurrence rates were higher with ablation using bipolar current than after cystectomy. However, only 2 groups have evaluated recurrence rates after cystectomy versus CO2 laser vaporization and found no difference with extended follow-up. Furthermore, ablation with CO2 laser may be less invasive than conventional cystectomy with increased preservation of antral follicles in favor of ablation. Study design, size, duration Single-center retrospective study on data of 271 patients operated between January 2010 and December 2014. Participants/materials, setting, methods Women of reproductive age (18–45 years), undergoing CO2 laser laparoscopic excision of any rAFS-stage endometriosis with at least one endometrioma, were eligible for the study. All 271 included patients were treated in a tertiary referral center for endometriosis of a University Hospital, and underwent complete CO2-laser laparoscopic surgery for endometrioma(s). 155 underwent cystectomy, 77 CO2 laser vaporization, and 46 a mixed technique. Main results and the role of chance The mean duration of follow-up was 58 months. Primary outcome studied was the comparison of recurrence rates between cystectomy and vaporization; secondary outcomes included pregnancy rate and ovarian reserve testing. Recurrence was defined as either imaging based (i.e. cyst recurrence identified at ultrasound and/or MRI) or need for reintervention for suspected cyst recurrence. Imaging based recurrence was reported in 9.92% of patients (n = 12/121) treated with cystectomy and in 11.76% of patients (n = 6/51) who underwent a CO2 laser vaporization (p = .62). The need for reintervention for endometrioma(s) was also similar in both groups, with a rate of 3.23% (n = 5/155) after cystectomy and 4.29% (n = 3/70) after CO2 laser vaporization (p = .567). No difference was seen regarding AMH drop pre- versus postoperatively (p=.233). The 2 study groups were similar, except for the mean cyst diameter, which was higher in the cystectomy group (42.36 ± 25.49 mm) compared to the CO2 laser vaporization group (31.7 ± 26.98 mm) (p = <.001). This suggests that smaller endometriomas might be more likely to undergo CO2 laser vaporization. Limitations, reasons for caution The retrospective character of the study may induce information bias concerning the registration of recurrence. Moreover, regarding the evaluation of imaging-based recurrence, a selection bias cannot be excluded, because most likely only patients complaining about pain would be referred for an ultrasound or planned for a reintervention. Wider implications of the findings: In this study, similar rates of recurrence for endometrioma(s) were observed after cystectomy versus CO2-laser vaporization. Since previous studies suggested that CO2-laser vaporization may cause less damage to the adjacent ovarian tissue, we consider this a valuable alternative technique, especially for women with a future child wish. Trial registration number S59032

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