Home About us Contact
|
Home About us Contact | ||
|
|
||
Surgical Manipulation (surgical + manipulation)
Selected AbstractsThe Incidences of Chondritis and Perichondritis Associated With the Surgical Manipulation of Auricular CartilageDERMATOLOGIC SURGERY, Issue 1 2004Andrew L. Kaplan MD Background. The cartilage and soft tissues of the ear are frequently employed as donor sites for tissue used in the repair of defects of the nose and external ear after Mohs surgery. Enthusiasm for using these auricular donor sites is occasionally tempered by surgeons' concerns for the development of Pseudomonal suppurative chondritis, a complication that has been described to follow cartilage manipulation. Objective. To quantify the incidence of postoperative perichondritis and chondritis after Mohs reconstructions involving auricular cartilage manipulations. Methods. We retrospectively reviewed 341 Mohs reconstructions that involved cartilage and soft-tissue donor sites located on the ear. Procedures included full-thickness skin grafts (295) harvested from the conchal bowl and flap repairs (46) incorporating cartilage batten grafts from conchal or anthelix donor sites. When the perichondrium was compromised, patients were routinely prescribed perioperative prophylactic antibiotics with Pseudomonal coverage. Postoperative examinations were performed at 1 week and 4 to 12 weeks. Patients not seen in clinic were interviewed by telephone regarding complications. Results. Complete follow-up information was obtained in 337 of 341 (98.8%) cases. Inflammatory perichondritis was observed in 19 (5.6%) patients. There were no cases of suppurative chondritis. Conclusion. The incidence of inflammatory perichondritis is low after Mohs reconstructions involving auricular cartilage manipulation. When prophylactic antibiotics and appropriate operative technique are used, the historic concern for suppurative chondritis associated with these procedures is unwarranted. [source] Dental management of patients at risk of osteochemonecrosis of the jaws: a critical reviewORAL DISEASES, Issue 8 2009S Fedele Osteonecrosis of the jaw bones is a complication of bisphosphonate (BP) drug usage characterised by trans-mucosal exposure of necrotic bone, often followed by infection and pain. Osteonecrosis is observed in cancer patients on high-potency intravenous BP more frequently than in osteoporotic individuals using low-potency oral BP. The management of osteonecrosis caused by BP is often unsatisfactory and control of risk factors is considered the most effective means of prevention. Surgical manipulation and dental infection of the jawbone are the major risk factors, hence it is suggested that careful management of oral health and relevant dental procedures may decrease the risk of osteonecrosis in individuals on BP. Recommendations for dentists and oral surgeons have been suggested by different groups of clinicians but they are often controversial and there is no clear evidence for their efficacy in reducing the likelihood of osteonecrosis development. This report critically reviews current dental recommendations for individuals using BP with the aim of helping the reader to transfer them into practice as part of pragmatic and non-detrimental clinical decisions making. [source] Laparoscopic adrenalectomy: Troublesome casesINTERNATIONAL JOURNAL OF UROLOGY, Issue 5 2009Gaku Kawabata Among 143 cases of laparoscopic adrenalectomy carried out from 1993 to the present, 13 patients in whom the surgical manipulation presented problems were examined. Problems occurred due to the condition of the adrenal tumors themselves in six patients, whereas problems occurred due to the operative history in four patients. There were three patients with no operative history but with strong intraperitoneal adhesion. In patients with a history of laparotomy in other fields such as open cholecystectomy, gastrectomy or colostomy, operations were possible in most patients by examining the trocar site preoperatively. Patients with strong adhesion even without a history of surgery could be handled by full separation of the adhesion during surgery. In patients with bleeding in the adrenal tumors, large adrenal tumors, or tumors impacted in the liver, methods such as changing the sequence of separation procedures were required. In patients with a history of renal subcapsular hematomas due to extracorporeal shock wave lithotripsy (ESWL), it was not possible to understand the conditions of adrenal or perinephritic adhesion in preoperative imaging diagnosis, but resection was possible by changing the order of separation procedures and by using optimal instruments and devices. As with any surgery, including open surgeries, it is necessary to obtain knowledge on how to deal with variations in laparoscopic adrenalectomy to assure safe outcomes and to always consider effective methods for coping with unexpected difficulties. [source] Paxillin modulates squamous cancer cell adhesion and is important in pressure-augmented adhesionJOURNAL OF CELLULAR BIOCHEMISTRY, Issue 6 2006William C. Conway Abstract Paxillin is an adapter protein regulating signaling and focal adhesion assembly that has been linked to malignant potential in many malignancies. Overexpression of paxillin has been noted in aggressive tumors. Integrin-mediated binding through the focal adhesion complex is important in metastatic adhesion and is upregulated by extracellular pressure in malignant colonocytes through FAK and Src activation. Neither head and neck cancers nor paxillin have been studied in this regard. We hypothesized that paxillin would play a role in modulating squamous cancer adhesion both at baseline and under conditions of increased extracellular pressure. Using SCC25 tongue squamous cancer cells stably transfected with either an empty selection vector or paxillin expression and selection vectors, we studied adhesion to collagen, paxillin, FAK, and Src expression and phosphorylation in cells maintained for 30 min under ambient or 15 mmHg increased pressure conditions. Paxillin-overexpressing cells exhibited adhesion 121,±,2.9% of that observed in vector-only cells (n,=,6, P,<,0.001) under ambient pressure. Paxillin-overexpression reduced FAK phosphorylation. Pressure stimulated adhesion to 118,±,2.3% (n,=,6, P,<,0.001) of baseline in vector-only cells, similar to its effect in the parental line, and induced paxillin, FAK, and Src phosphorylation. However, increased pressure did not stimulate adhesion or phosphorylate paxillin, FAK, or Src further in paxillin-overexpressing cells. Metastasizing squamous cancer cell adhesiveness may be increased by paxillin-overexpression or by paxillin activation by extracellular pressure during surgical manipulation or growth within a constraining compartment. Targeting paxillin in patients with malignancy and minimal tumor manipulation during surgical resection may be important therapeutic adjuncts. J. Cell. Biochem. © 2006 Wiley-Liss, Inc. [source] Colon cancer cell adhesion in response to Src kinase activation and actin-cytoskeleton by non-laminar shear stress,JOURNAL OF CELLULAR BIOCHEMISTRY, Issue 2 2004Vijayalakshmi Thamilselvan Abstract Malignant cells shed from tumors during surgical resection or spontaneous metastasis experience physical forces such as shear stress and turbulence within the peritoneal cavity during irrigation, laparoscopic air insufflation, or surgical manipulation, and within the venous or lymphatic system. Since physical forces can activate intracellular signals that modulate the biology of various cell types in vitro, we hypothesized that shear stress and turbulence might increase colon cancer cell adhesion to extracellular matrix, potentiating metastatic implantation. Primary human malignant colon cancer cells isolated from resected tumors and SW620 were subjected to shear stress and turbulence by stirring cells in suspension at 600 rpm for 10 min. Shear stress for 10 min increased subsequent SW620 colon cancer cell adhesion by 40.0,±,3.0% (n,=,3; P,<,0.001) and primary cancer cells by 41.0,±,3.0% to collagen I when compared to control cells. In vitro kinase assay (1.5,±,0.13 fold) and Western analysis (1.34,±,0.04 fold) demonstrated a significant increase in Src kinase activity in cells exposed shear stress. Src kinase inhibitors PP1 (0.1 µM), PP2 (20 µM), and actin-cytoskeleton stabilizer phalloidin (10 µM) prevented the shear stress stimulated cell adhesion to collagen I. Furthermore, PP2 inhibited basal (50.0,±,2.8%) and prevented shear stress induced src activation but phalloidin pretreatment did not. These results raise the possibility that shear stress and turbulence may stimulate the adhesion of malignant cells shed from colon cancers by a mechanism that requires both actin-cytoskeletal reorganization an independent physical force activation of Src kinase. Blocking this pathway might reduce tumor metastasis during surgical resection. Published 2004 Wiley-Liss, Inc. [source] Detection of vascular endothelial growth factor and its receptor expression in human hepatocellular carcinoma biopsy specimensJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 6 2000Takeshi Shimamura Abstract Background: Vascular endothelial growth factor (VEGF) exerts its actions on the microvasculature, by interacting with specific endothelial cell receptors, and thus, contributes to angiogenesis and growth in many tumours. Methods: Using nested reverse-transcription,polymerase chain reaction, we examined the biopsy specimens of 14 patients with human hepatocellular carcinoma (HCC) and cirrhosis, for the expression of hepatic VEGF, and the VEGF receptors KDR and flt-1. To avoid the influence of hypoxia or ischaemia induced by surgical manipulation, we used biopsy specimens of the liver instead of resected specimens. Results: Vascular endothelial growth factor mRNA expression was detected in the tumour portion of the specimens in 13 of 14 patients (93%), and in the corresponding non-tumour portion of the specimens in eight patients (57%; P = 0.08). No differences were found between the tumour portion and the corresponding non-tumour portion in relative concentrations of VEGF mRNA. However, mRNA expression of the VEGF receptors, KDR and flt-1, was detected in 14 (100%) and 11 (79%) of the tumour portions, respectively, and in four (29%) and five (36%) of the corresponding non-tumour portions, respectively (,2 test: KDR, P < 0.01; flt-1, P = 0.08). The relative concentration of KDR mRNA in the tumour portions was significantly higher than in the non-tumour portions (Mann,Whitney U -test: P < 0.001) but no differences were detected for flt-1. Conclusions: KDR mRNA is significantly overexpressed in HCC lesions and could be associated with the angiogenesis and tumour growth induced by VEGF. [source] Tubeless combined high-frequency jet ventilation for laryngotracheal laser surgery in paediatric anaesthesiaACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2000G. Ihra Background: High-frequency jet ventilation (HFJV) is an alternative ventilatory approach in airway surgery and for facilitating gas exchange in patients with pulmonary insufficiency. We have developed a new technique of combined HFJV utilising two superimposed jet streams. In this study we describe the application of tubeless supralaryngeal HFJV during laryngotracheal laser surgery in infants and children. Methods: Tubeless combined HFJV characterised by the simultaneous supralaryngeal application of a low-frequency (LF) and a high-frequency (HF) jet stream was evaluated in a clinical study in 10 children undergoing elective laryngotracheal CO2 laser surgery. Additionally, pressure and flow characteristics were determined with the use of a paediatric test lung. HFJV was applied by means of a modified Kleinsasser laryngoscope with integrated metal injectors. In addition to pulse oximetry, monitoring of ECG, heart rate and blood pressure, supraglottic airway pressure was measured and arterial blood gases were analysed. Results: Tubeless combined HFJV was used in 10 infants and children (mean age 4.6 yr, range 2 months,10 years) undergoing 17 consecutive endoscopic procedures with CO2 laser microsurgery of the larynx or the trachea under general anaesthesia. The mean duration of supralaryngeal HFJV was 46 min (range 15,75 min). Mean driving pressures of the HF and the LF jet streams were 0.75 bar and 0.95 bar, respectively. Inspiratory oxygen ratios were in the range 0.4,1.0. HFJV resulted in mean PaO2 and PaCO2 values of 19.7 kPa and 6.1 kPa, respectively. No complications during HFJV were observed. In the test lung, combined HFJV applied with driving pressures of 0.7,1.0 bar and 0.9,1.2 bar for HF and LF jet ventilation, respectively, resulted in maximum peak and baseline distal airway pressures of 17.6 cm H2O and 5.4 cm H2O, respectively. Conclusion: The application of the combined double frequency HFJV was effective in maintaining gas exchange in the presence of laryngeal or tracheal stenoses. It provided good visibility of anatomical structures and offered space for surgical manipulation, avoiding the use of combustible material inside the larynx or trachea. [source] Supplementing desflurane with intravenous anesthesia reduces fetal cardiac dysfunction during open fetal surgeryPEDIATRIC ANESTHESIA, Issue 8 2010ANNE BOAT MD Summary Objective:, To lower the incidence and severity of fetal cardiovascular depression during maternal fetal surgery under general anesthesia. Aim:, We hypothesized that supplemental intravenous anesthesia (SIVA) with propofol and remifentanil would lower the need for high-dose inhalational anesthesia and provide adequate maternal depth of anesthesia and uterine relaxation. SIVA technique would minimize prolonged fetal exposure to deep inhalational anesthetics and significant intraoperative fetal cardiovascular depression. Background:, Fetal hypoxia and significant fetal hemodynamic changes occur during open fetal surgery because of the challenges such as surgical manipulation, hysterotomy, uterine contractions, and effects of anesthetic drugs. Tocolysis, a vital component of fetal surgery, is usually achieved using volatile anesthetic agents. High concentrations of volatile agents required to provide an appropriate degree of uterine relaxation may cause maternal hypotension and placental hypoperfusion, as well as direct fetal cardiovascular depression. Methods:, We reviewed medical records of 39 patients who presented for ex utero intrapartum treatment and mid-gestation open fetal surgery between April 2004 and March 2009. Out of 39 patients, three were excluded because of the lack of echocardiographic data; 18 patients received high-concentration desflurane anesthesia and 18 patients had SIVA with desflurane for uterine relaxation. We analyzed the following data: demographics, fetal medical condition, anesthetic drugs, concentration and duration of desflurane, maternal arterial blood pressure, intraoperative fetal echocardiogram, presence of fetal bradycardia, and need for intraoperative fetal resuscitation. Results:, Adequate uterine relaxation was achieved with about 1.5 MAC of desflurane in the SIVA group compared to about 2.5 MAC in the desflurane only anesthesia group (P = 0.0001). More fetuses in the high-dose desflurane group compared to the SIVA group developed moderate-severe left ventricular systolic dysfunction over time intraoperatively (P = 0.02). 61% of fetuses in the high-dose desflurane group received fetal resuscitative interventions compared to 26% of fetuses in the SIVA group (P = 0.0489). Conclusion:, SIVA as described provides adequate maternal anesthesia and uterine relaxation, and it allows for decreased use of desflurane during open fetal surgery. Decreased use of desflurane may better preserve fetal cardiac function. [source] EMLA® Cream coated on the rigid bronchoscope for tracheobronchial foreign body removal in childrenTHE LARYNGOSCOPE, Issue 1 2009Hai Yu MD Abstract Objectives: Removal of a tracheal or bronchial foreign body is a common emergent surgical procedure in children. The anesthetic management can be challenging. EMLA® Cream (EC) has been widely used to provide topical anesthesia. In the present study, we evaluate the efficacy and safety of EC coated on the rigid bronchoscope for tracheobronchial foreign body removal in children undergoing intravenous anesthesia with spontaneous ventilation. Study Design: The authors conducted a randomized, double-blind, placebo-controlled clinical trial. Methods: Thirty patients were randomized to receive either EC or placebo (lubricant ointment) coated on the rigid bronchoscope. Intravenous anesthesia and spontaneous ventilation were performed in all patients. Heart rate, blood pressure, pulse oxygen saturation (SpO2) and frequency and degree of breath holding were recorded. After surgery, the bronchoscopist rated overall surgical manipulation as excellent, fair, and poor. The durations of postoperative care were also recorded. Results: Episodes of oxygen desaturation (SpO2 < 90%) occurred in 3/15 (20%) patients in the EC group and in 9/15 (60%) patients in the control group (P < .05). Occurrences and degrees of breath holding were less in the EC group than that in the control group (P < .05). Ranks of surgical manipulation were excellent in 80% of patients in the EC group versus 13% of patients in the control group (P < .05). The durations of postoperative care were shorter in the EC group than that in the control group (P < .05). Conclusions: EC coated on the rigid bronchoscope combined with intravenous anesthesia could provide more efficacious and safer anesthesia for tracheobronchial foreign body removal in children under spontaneous ventilation. Laryngoscope, 119:158,161, 2009 [source] | ||||||||||