scholarly journals Video-assisted thoracoscopic extended thymectomy in myasthenic children

2013 ◽  
Vol 5 (1) ◽  
pp. 4 ◽  
Author(s):  
Rita Sonzogni ◽  
Lorenzo Novellino ◽  
Alberto Benigni ◽  
Ilaria Busi ◽  
Magda Khotcholava ◽  
...  
Keyword(s):  
Case Reports ◽  
Preoperative Evaluation ◽  
Surgical Techniques ◽  
Length Of Hospital Stay ◽  
Ventilator Weaning ◽  
New Drugs ◽  
Extended Thymectomy ◽  
Myasthenic Patient ◽  
Surgical Department ◽  
Video Assisted

Myasthenia gravis (MG) is an autoimmune disease marked by weakness of voluntary musculature. Medical and surgical therapy of adult myasthenia is well documented. There is little pediatric surgical evidence, only a few case reports being available. The aim of this paper is to verify whether the surgical and anesthesiological techniques can warrant an early and safe discharge from the operating room. The secondary aim is to assess the presence of perioperative indicators that can eventually be used as predictors of postoperative care. During the years 2006-2009, 10 pediatric patients were treated according to a surgical approach based on video assisted thoracoscopic extended thymectomy (VATET). Standard preoperative evaluation is integrated with functional respiratory tests. Anesthetic induction was made with propofol and fentanyl/remifentanyl and maintenance was obtained with sevoflurane/desflurane/propofol ± remifentanyl. A muscle relaxant was used in only one patient. Right or left double-lumen bronchial tube (Ruesch Bronchopart® Carlens) placement was performed. Six patients were transferred directly to the surgical ward while 4 were discharged to the intensive care unit (ICU); ICU stay was no longer than 24 h. Length of hospital stay was 4.4±0.51 days. No patient was readmitted to the hospital and no surgical complications were reported. Volatile and intravenous anesthetics do not affect ventilator weaning, extubation or the postoperative course. Paralyzing agents are not totally contraindicated, especially if short-lasting agents are used with neuromuscular monitoring devices and new reversal drugs. Perioperative evaluation of the myasthenic patient is mandatory to assess the need for postoperative respiratory support and also predict timely extubation with early transfer to the surgical department. Availability of new drugs and of reversal drugs, the current practice of mini-invasive surgical techniques, and the availability of post anesthesia care units are the keys to the safety and successful prognosis of patients affected by MG who undergo thymectomy.

scholarly journals Perioperative Management of Endocrine Active Adrenal Tumors

2018 ◽  
Vol 127 (02/03) ◽  
pp. 137-146 ◽  
Author(s):  
Florentine Schreiner ◽  
Gurpreet Anand ◽  
Felix Beuschlein
Keyword(s):  
Current Knowledge ◽  
Case Reports ◽  
Perioperative Complications ◽  
Preoperative Evaluation ◽  
Surgical Techniques ◽  
Adrenal Tumors ◽  
Prospective Data ◽  
Retrospective Data Analysis ◽  
Small Series ◽  
Weak Evidence

AbstractEndocrine active adrenal tumors are associated with a relevant risk of complications during surgery, either due to direct hemodynamic effects of the hormone excess or due to hormone related comorbidities. Over the last decades, careful preoperative evaluation and improved peri-interventional medical management of affected patients has resulted in a significant reduction of perioperative complications. In addition, improvement in anesthesia and surgical techniques with the feasibility of laparoscopic adrenalectomy have contributed to reduce morbidity. Nevertheless, there are still several challenges to be considered in the perioperative care of these patients. Due to the rarity of functionally active adrenal tumors, there are no prospective data available to guide clinical management. Accordingly, most recommendations are based on retrospective data analysis, expert opinion or carry weak evidence based on small series or case reports. The aim of this review is to summarize the current knowledge and to suggest practical approaches to reduce perioperative complications in endocrine active adrenal tumors. This review exclusively deals with data from adult patients with functionally active adrenal tumors.

Myasthenia gravis miatt végzett három különböző típusú csecsemőmirigy-eltávolítás sebészeti és korai neurológiai eredményei

2015 ◽  
Vol 68 (6) ◽  
pp. 219-224
Author(s):  
Aurél Ottlakán ◽  
Tibor Géczi ◽  
Balázs Pécsy ◽  
Bernadett Borda ◽  
Judit Lantos ◽  
...  
Keyword(s):  
Myasthenia Gravis ◽  
Thoracoscopic Surgery ◽  
Extended Thymectomy ◽  
Video Assisted ◽  
Video Assisted Thoracoscopic Surgery

Absztrakt Célkitűzés: A myasthenia gravis (MG) kezelésében számos nyitott, illetve minimálisan invazív thymectomia ismert. A tanulmány ugyanazon intézeten belül a transsternalis (TS), illetve kétféle minimálisan invazív thymectomia (video-assisted thoracoscopic extended thymectomy – VATET; unilateral video-assisted thoracoscopic surgery – UL-VATS) eredményeit hasonlítja össze. Anyag és módszerek: Három különböző időintervallumban 71 betegnél történt thymectomia MG miatt (60 nő, 11 férfi): 23 transsternalis thymectomia (1995. január–2004. szeptember), 22 VATET (2004. szeptember – 2009. augusztus) és 26 UL-VATS thymectomia (2009. szeptember – 2011. december). Az eredmények értékelésénél a műtéti idő, MG-hez társuló neurológiai és a műtét utáni sebészi szövődmények, valamint az MG státuszában az egyéves utánkövetéskor észlelt neurológiai változások szerepeltek. Eredmények: Perioperatív mortalitás nem fordult elő. A műtéti idő 112, 211, 116 perc (p = 0,001), a kórházi napok száma: 8,9, 5,6 és 4 nap (p = 0,001) volt a TS-, VATET- és UL-VATS-csoportban. Az MG-hez kapcsolódó postoperativ neurológiai szövődmények 21,7%, 18,2% és 7,7% (p = 0,365) értékeket mutattak. A sebészi szövődmény 4,3%, 13,7%, 0% (p = 0,118) volt. Az MG tüneteinek javulása 91,3%, 94,7%, 87,5% (p = 0,712), míg komplett remisszió 13%, 10,5%, 11,5% (p = 0,917) volt a TS-, VATET- és UL-VATS-csoportokban. Következtetések: A műtéti idő, valamint a kórházban eltöltött napok száma UL-VATS esetében volt a legrövidebb. A kisebb sebészi beavatkozáshoz alacsonyabb sebészi, illetve MG-s neurológiai szövődmények társultak. Az MG-tünetek javulásában mindhárom módszernél kiváló eredményt értek el.

scholarly journals Fetus in fetu: two case reports from North African country

2021 ◽  
Vol 69 (1) ◽  
Author(s):  
Moutaz Ragab ◽  
Omar Nagy Abdelhakeem ◽  
Omar Mansour ◽  
Mai Gad ◽  
Hesham Anwar Hussein
Keyword(s):  
Histopathological Examination ◽  
Case Reports ◽  
Abdominal Mass ◽  
Mature Teratoma ◽  
Surgical Techniques ◽  
Rare Condition ◽  
Mass Effect ◽  
Fetus In Fetu ◽  
Vascular Connection ◽  
First Case

Abstract Background Fetus in fetu is a rare congenital anomaly. The exact etiology is unclear; one of the mostly accepted theories is the occurrence of an embryological insult occurring in a diamniotic monochorionic twin leading to asymmetrical division of the blastocyst mass. Commonly, they present in the infancy with clinical picture related to their mass effect. About 80% of cases are in the abdomen retroperitoneally. Case presentation We present two cases of this rare condition. The first case was for a 10-year-old girl that presented with anemia and abdominal mass, while the second case was for a 4-month-old boy that was diagnosed antenatally by ultrasound. Both cases had vertebrae, recognizable fetal organs, and skin coverage. Both had a distinct sac. The second case had a vascular connection with the host arising from the superior mesenteric artery. Both cases were intra-abdominal and showed normal levels of alpha-fetoprotein. Histopathological examination revealed elements from the three germ layers without any evidence of immature cells ruling out teratoma as a differential diagnosis. Conclusions Owing to its rarity, fetus in fetu requires a high degree of suspicion and meticulous surgical techniques to avoid either injury of the adjacent vital structures or bleeding from the main blood supply connection to the host. It should be differentiated from mature teratoma.

scholarly journals Vertical bone augmentation of posterior mandibular region: a description of two surgical techniques

2016 ◽  
Vol 64 (3) ◽  
pp. 333-336
Author(s):  
Adalmir Gonzaga dos Santos QUEIROZ ◽  
Yuri Slusarenko da SILVA ◽  
Pedro Jorge Cavalcante COSTA ◽  
Flávio Wellington da Silva FERRAZ ◽  
Maria da Graça NACLÉRIO-HOMEM
Keyword(s):  
Bone Loss ◽  
Dental Implants ◽  
Case Reports ◽  
Surgical Techniques ◽  
The Other ◽  
Bone Maturation ◽  
Oral Rehabilitation ◽  
Autologous Graft ◽  
Mandibular Region ◽  
Graft Interposition

ABSTRACT Correction of severe vertical bone deficiency in the posterior region of mandibular alveolar ridge requires surgical management if implants are scheduled and cannot have primary stability. The aim of the present study is to report two cases; one treated with alveolar osteogenesis distraction and the other with segmental osteotomy with autologous graft interposition, by describing the surgical steps as well as show the results and experiences acquired with these techniques. We opted for these methods to reconstruct the posterior mandibular region after remarkable vertical bone loss based mainly by the height and thickness of the remaining bone. Alveolar osteogenic distraction is highly advisable when vertical deficiency is severe, and if these cases are treated with the segmental osteotomy and autologous graft interposition, complications as graft failure, necrosis and resorption are more prone to occur due to insufficient vascularization. After bone maturation and bone neoformation secondary to alveolar osteogenic osteogenic distraction and segmental osteotomy with autologous graft interposition, respectively, the two presented case reports were able to securely receive dental implants. In cases of vertical bone loss of the posterior mandibular region, both surgeries currently represent the best choice for bone gain prior dental implants placement for oral rehabilitation, without technical challenges, although biological evidence to assure the superiority of one technique over the other must be further investigated.

Video-Assisted Pericardial Fenestration for Effusions after Cardiac Surgery

2009 ◽  
Vol 17 (5) ◽  
pp. 480-482 ◽  
Author(s):  
Georgios P Georghiou ◽  
Eyal Porat ◽  
Avi Fuks ◽  
Bernardo A Vidne ◽  
Milton Saute
Keyword(s):  
Cardiac Surgery ◽  
Pericardial Effusion ◽  
Surgical Techniques ◽  
Lung Ventilation ◽  
Pericardial Window ◽  
Invasive Approach ◽  
Video Assisted ◽  
Institutional Experience ◽  
Pericardial Fenestration ◽  
Thoracoscopic Technique

Delayed-onset pericardial effusion following cardiac surgery can give rise to significant morbidity due to its presentation as well as management by traditional surgical techniques. An institutional experience of a video-assisted thoracoscopic technique to create a pericardial window, with the advantages of a minimally invasive approach combined with excellent visualization in such patients, was reviewed. A retrospective analysis was conducted on all patients undergoing video-assisted thoracoscopic for delayed pericardial effusion after cardiac surgery from January 2001 to January 2006 at our center. Seven patients with echocardiographically diagnosed delayed tamponade underwent video-assisted thoracoscopy; 5 were receiving anticoagulants after valve replacement, and 2 had undergone heart transplantation. Pericardial windows were created under general anesthesia and single-lung ventilation using 2 to 3 trocars. Mean operative time was 45 min. There were no complications of the thoracoscopic technique. Video-assisted thoracoscopic creation of a pericardial window is safe and effective treatment for loculated pericardial effusions secondary to cardiac surgery.

Open Rhinoplasty

2020 ◽  
Author(s):  
Ginger Xu ◽  
Paul Hwang ◽  
Nargiz Seyidova ◽  
Samuel J. Lin
Keyword(s):  
Key Words ◽  
Preoperative Evaluation ◽  
Surgical Techniques ◽  
Postoperative Management ◽  
Black Box ◽  
Open Rhinoplasty ◽  
Nasal Tip ◽  
Nasal Anatomy ◽  
Nasal Function ◽  
Type Of Surgery

Rhinoplasty is often considered the black box of plastic surgery. This apprehension can be overcome by having a fine-tuned understanding of nasal anatomy, developing an appreciation for nasal aesthetics, and becoming well-versed in the array of surgical techniques available to address specific cosmetic and functional concerns. Technical care and finesse are required in this type of surgery, where even 1 mm of change can result in a profound difference. Nasal function must also be assessed and preserved during rhinoplasty. Aside from these technical points, it is equally important to accurately and thoroughly understand each patient’s goals and to communicate the realistic outcomes and limitations of what can be done through surgery.   Key words: open rhinoplasty, nasal anatomy, nasofacial analysis, rhinoplasty techniques, rhinoplasty preoperative evaluation, rhinoplasty postoperative management, lateral nasal osteotomies, nasal tip grafts, nasal tip suture techniques This review contains 23 figures, 2 tables, and 43 references.

Aortoiliac Reconstruction

2017 ◽  
Author(s):  
Mark K. Eskandari ◽  
Michael J Nooromid
Keyword(s):  
Clinical Decision Making ◽  
Preoperative Evaluation ◽  
Treatment Options ◽  
Surgical Techniques ◽  
Clinical Decision ◽  
Occlusive Disease ◽  
Aortobifemoral Bypass ◽  
Aortoiliac Occlusive Disease ◽  
Atherosclerotic Occlusive Disease ◽  
Aortoiliac Reconstruction

This review outlines the preoperative evaluation, clinical decision making, and surgical treatment options for patients with aortoiliac occlusive disease. It also details the open surgical techniques for the treatment of aortoiliac occlusive disease and reviews endovascular treatment options. The discussion of treatment options includes the potential complications and expected outcomes, as well as steps that can be taken to optimize surgical results. Key words: aortobifemoral bypass, aortoiliac reconstruction, atherosclerotic occlusive disease, endovascular reconstruction, femoral endarterectomy, iliac angioplasty, iliac stenting, peripheral vascular disease 

Video-Assisted Thoracoscopic Division of Vascular Rings in Pediatric Patients

2005 ◽  
Vol 71 (4) ◽  
pp. 289-291 ◽  
Author(s):  
Curt S. Koontz ◽  
Amina Bhatia ◽  
Joe Forbess ◽  
Mark L. Wulkan
Keyword(s):  
Aortic Arch ◽  
Pediatric Patients ◽  
Vascular Ring ◽  
Operating Time ◽  
Surgical Techniques ◽  
Retrospective Chart Review ◽  
Ligamentum Arteriosum ◽  
Vascular Rings ◽  
Computed Tomographic ◽  
Video Assisted

Vascular rings are usually repaired via left thoracotomy. We report our series of pediatric patients with vascular rings that were repaired thoracoscopically. From February 2002 to September 2004, 13 patients underwent video-assisted thoracoscopic surgical techniques (VATS) division of their vascular ring. Chest magnetic resonance arterography (MRA) and/or computed tomographic arteriography (CTA) were used to evaluate the vascular ring in most patients. Patients were chosen for VATS repair based on surgeon's choice and type of vascular ring. Data are expressed as mean ± SD. The Children's Healthcare of Atlanta Institutional Review Board approved this retrospective chart review. Age and weight was 1.5 ± 1.8 years (range: 4 months–17 years) and 16.0 ± 12.5 kg (range: 6.0–22.1 kg), respectively (n = 13). Associated diseases included congenital heart disease (n = 2). Symptoms included respiratory complaints (n = 6), dysphagia (n = 2), dysphagia and shortness of breath (n = 1), pneumonia (n = 2), tracheal deviation (n = 1), and one patient was asymptomatic. Vascular ring types included double aortic arch (n = 4) and right aortic arch with an aberrant left subclavian artery and a left ligamentum arteriosum (n = 9). Operating time was 70 ± 20 minutes (range: 46–122 minutes). One patient had to be opened because of a large arch. Length of stay was 1.9 ± 0.9 days (range: 1–3 days). There were no complications, and all patients improved clinically at follow-up. Thoracoscopic repair of certain types of vascular rings seems to be safe and effective in children. More patients, however, need to be studied.

scholarly journals Nonpuerperal Uterine Inversion: What the Gynaecologists Need to Know?

2020 ◽  
Vol 2020 ◽  
pp. 1-12 ◽  
Author(s):  
R. P. Herath ◽  
M. Patabendige ◽  
M. Rashid ◽  
P. S. Wijesinghe
Keyword(s):  
Case Reports ◽  
Treatment Options ◽  
Treatment Algorithm ◽  
Surgical Techniques ◽  
Clinical Problem ◽  
Abdominal Hysterectomy ◽  
Uterine Inversion ◽  
Surgical Access ◽  
Surgical Methods ◽  
Presentation Methods

Introduction. Nonpuerperal uterine inversion (NPUI) is a rare clinical problem with diagnostic and surgical challenges. The objective of our study was to review the literature on NPUI and describe causative pathologies, diagnosis, and different surgical options available for treatment. Materials and Methods. A comprehensive literature review was carried out on MEDLINE and Google Scholar databases to look for NPUI using the term “non-puerperal uterine inversion,” and further went through the cross-references of the published articles. Data are published case reports from 1911 to September 2018. Of the 153 published cases, 133 reports had adequate details of surgery for analysis. These reports were analyzed, concerning the clinical presentation, methods of diagnosis, and surgical treatment. Results. Mean age of the women was 46.3 years (standard deviation: 18, N = 153). Leiomyoma remained the commonest (56.2%) aetiology. While malignancies contributed to 32.02% of cases, 9.2% were idiopathic. High degree of clinical suspicion and identification of unique features on ultrasonography and magnetic resonance imaging enable prompt diagnosis. In cases of uncertainty, laparoscopy or biopsy of the mass was used to confirm the diagnosis. Hysterectomy or repositioning and repair of the uterus are the only treatment options available. The surgical methods implemented were analyzed in three aspects: route of surgical access, method of repositioning, and final surgical procedure undertaken. The majority (48.8%) had only abdominal access, while 27.1% had both abdominal and vaginal access. Haultain procedure was the most useful procedure for reposition (18.0%) of the uterus. The majority (39.7%) required abdominal hysterectomy with or without debulking of the tumour abdominally, while 15.0% had uterine repair after repositioning. We reviewed the different surgical techniques and described and proposed a treatment algorithm. Conclusions. Fibroids were the commonest cause for NPUI. Malignancies accounted for one-third of cases. A combined abdominal and vaginal approach, followed by hysterectomy or repair after repositioning, seems to be better for nonmalignant cases.

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