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Surgical Modalities (surgical + modality)
Selected AbstractsThe Efficacy of Electrosurgery and Excision in Treating Patients with Multiple Apocrine HidrocystomasDERMATOLOGIC SURGERY, Issue 4 2001Somesh Gupta MD Background. Apocrine hidrocystomas are adenomatous cystic proliferations of the apocrine glands. They typically occur as solitary lesions, though rarely may occur as multiple lesions. Management of multiple hidrocystomas can be difficult, particularly if they are large. Surgical modalities may be required for effective therapy. Objective. To compare the results of electrosurgery and excision in treating multiple apocrine hidrocystomas. Methods. A 50-year-old man presented with multiple apocrine hidrocystomas ranging in size from 1 to 12 mm. The lesions were located over the periorbital skin, cheeks, and pinnae. Excision and electrodessication were utilized for therapy. At a 1-year follow-up, the patient was evaluated for recurrences and cosmetic result. Results. There were no recurrences until 1 year after surgery. In the areas treated with electrodessication, no visible scars were identified. In the areas treated with excision, localized scars were observed. Conclusions. Both electrodessiation and excision are effective therapies for multiple apocrine hidrocystomas. We suggest that tumors less than 1 cm be treated with electrodessication and lesions greater than 1 cm with excision. [source] A Refined Surgical Treatment Modality for Bromhidrosis: Double W Incision Approach with Tumescent TechniqueDERMATOLOGIC SURGERY, Issue 8 2009HANG LI PHD BACKGROUND Axillary bromhidrosis has a strong negative effect on one's social life. A high success rate and few complications are criteria for an ideal treatment method. OBJECTIVE To evaluate a new surgical treatment modality for bromhidrosis: Double W incision with full-exposure excision under tumescent anesthesia. MATERIALS & METHODS Twenty patients with bromhidrosis were treated. Patients were placed in a supine position with their treated arms abducted to 110°. After injection of 60 mL of tumescent solution into each axilla, two small W incisions were made at the superior and inferior axillary poles of the hair-bearing area. The whole hair-bearing skin was undermined at the level of the superficial fat to obtain adequate skin eversion. The flaps were everted to offer full exposure of the apocrine glands, and meticulous excision of each gland was performed. Finally, the incisions were re-approximated, and bulky compressive dressings were applied to the area for 72 hours. RESULTS Of the 40 axillae (20 patients), 32 (80.0%) showed excellent results, and eight (20.0%) had good results. Malodor was significantly decreased. There were no serious complications. CONCLUSION This technique can produce excellent results with a lower complication rate than most other surgical modalities and can be performed without costly equipment. [source] Cutaneous melanoma: therapeutic lymph node and elective lymph node dissections, lymphatic mapping, and sentinel lymph node biopsyDERMATOLOGIC THERAPY, Issue 6 2005David B. Pharis ABSTRACT:, Early clinical observation in cancer patients suggested that tumors spread in a methodical, stepwise fashion from the primary site, to the regional lymphatics, and only then to distant locations. Based on these observations, the regional lymphatics were believed to be mechanical barriers, at least temporarily preventing the widespread dissemination of tumor. Despite evidence now available disputing its validity, this barrier theory has guided the surgical management of the regional lymphatics in cancer patients for more than a century, influencing the use of such surgical modalities as therapeutic lymph node dissection, elective lymph node dissection, and most recently lymphatic mapping and sentinel lymph node biopsy. No published randomized controlled trial exists that demonstrates improved overall patient survival for cancer of any type, including melanoma, after surgical excision of regional lymphatics. This article will review the biology of lymphatics as it relates to regional tumor metastasis, and based on available information, offer practical recommendations for the clinical dermatologist and their patients who have cutaneous melanoma. [source] Comparison of gingival blood flow during healing of simplified papilla preservation and modified Widman flap surgery: a clinical trial using laser Doppler flowmetryJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 10 2007M. Retzepi Abstract Aim: This prospective randomized-controlled clinical trial compared the gingival blood flow responses following simplified papilla preservation (test) versus modified Widman flap (control). Materials and Methods: Twenty contra-lateral upper sites with pocket depth 5 mm after initial treatment in 10 chronic periodontitis patients were randomly assigned to either test or control treatment, using a split-mouth design. Laser Doppler flowmetry recordings were performed pre-operatively, following anaesthesia, immediately post-operatively and on days 1, 2, 3, 4, 7, 15, 30 and 60, at nine selected sites per flap. Results: Significant ischaemia was observed at all sites following anaesthesia and immediately post-operatively. At the mucosal flap basis, a peak hyperaemic response was observed on day 1, which tended to resolve by day 4 at the test sites, but persisted until day 7 at the control sites. The buccal and palatal papillae blood perfusion presented the maximum increase on day 7 in both groups and returned to baseline by day 15. Both surgical modalities yielded significant pocket depth reduction, recession increase and clinical attachment gain. Conclusions: Periodontal access flaps represent an ischaemia,reperfusion flap model. The simplified papilla preservation flap may be associated with faster recovery of the gingival blood flow post-operatively compared with the modified Widman flap. [source] Incomplete emptying and urinary retention in multiple-system atrophy: When does it occur and how do we manage it?MOVEMENT DISORDERS, Issue 6 2006Takashi Ito MD Abstract Neurogenic urinary retention can be a major cause of morbidity in multiple-system atrophy (MSA). However, the timing of its appearance has not been entirely clear, and neither have the medical and surgical modalities for managing patients. We present the data obtained from our uroneurological assessment and therapeutic interventions at various stages of MSA. We recruited 245 patients with probable MSA. We measured postvoid residuals (PVR) and performed EMG cystometry in all patients. The grand average volume of PVR was 140 mL (range, 0,760) in our patients. The average PVR volume was 71 mL in the first year, increasing to 129 mL in the second year and 170 mL by the fifth year. The percentages of patients with complete urinary retention, acontractile detrusor, and detrusor,sphincter dyssynergia (DSD) also increased. The increase in PVR resulted in a decrease in functional bladder capacity, together with an increase in detrusor overactivity and neurogenic sphincter EMG. Clean intermittent self-catheterization (CISC) was introduced in most patients. Bladder-oriented therapy (cholinergic agents) had a limited value, whereas urethra-oriented therapy benefited patients with DSD (surgery) for up to 2 years, but syncope occurred in a subset of patients (,-blockers). MSA patients present with large PVR by the second year of illness, and that large PVR secondarily causes urinary frequency. CISC is the recommended treatment for most patients. Urethra-oriented medication and surgery benefit patients who would have difficulty performing CISC, although careful consideration of the short-term efficacy and potential adverse effects of these alternatives is mandatory. © 2006 Movement Disorder Society [source] The clinical features and surgical treatment of degenerative lumbar scoliosis: A review of 112 patientsORTHOPAEDIC SURGERY, Issue 3 2009Wei Liu MD Objective:, To investigate the clinical features, radiological characteristics and surgical results of degenerative lumbar scoliosis (DLS). Methods:, One hundred and twelve cases of DLS treated surgically from June 2001 to February 2006 were retrospectively reviewed for clinical features, characteristics of nerve root compression and imaging presentations. According to the preoperative clinical manifestations and imaging findings, different surgical modalities were performed, including simple nerve decompression and decompression with short or long posterior fusion (less or more than three segments, respectively). Results:, The mean age of 47 male and 65 female patients was 54.7 years. Clinical manifestations included lower back pain (76.8%), radiculopathy (79.5%) and claudication (48.2%). Plain lumbar radiograph showed right scoliosis in 87 and left scoliosis in the other 25 cases; the Cobb angle was 10°,46°; the apex of scoliosis mostly located at L3 (48.2%); L3 and L4 nerve roots were usually compressed on the concave side and L5 and S1 nerve roots on the convex side. The Cobb angle and physiologic lordosis angle of patients who underwent multi-segment (>3 segments) fusion improved to a greater extent than did that of patients who had simple decompression without fusion. A mean 5.7-year follow-up showed that the average improvement in Oswestry disability index (ODI) scores was 32.6, 26.3 and 13.5 for long segment fusion, short segment fusion and simple decompression without fusion, respectively. Conclusion:, Decompression surgery with or without fusion, the main purpose of which is to relieve nerve root compression and stabilize the spinal column, is an effective treatment for chronic DLS. The treatment should be individualized according to the patient's age, general and economic factors, severity of deformity and other coexisting lumbar degenerative disorders. [source] The management of regional lymph nodes in cancerBRITISH JOURNAL OF DERMATOLOGY, Issue 5 2003D.B. Pharis Summary Early clinical observation in cancer patients suggested that tumours spread in a methodical, stepwise fashion from the primary site to the regional lymphatics, and only then to distant locations. Based on these observations, the regional lymphatics were believed to be mechanical barriers preventing the widespread dissemination of tumour. Despite evidence now available disputing its validity, this barrier theory has guided the surgical management of the regional lymphatics for more than a century, influencing the use of such surgical modalities as therapeutic lymph node dissection, elective lymph node dissection and most recently sentinel lymph node biopsy. No published randomized controlled trial exists that demonstrates improved overall survival for patients with cancer of any type undergoing surgery of the regional lymphatics. We believe the presence of tumour in the regional lymphatics indicates the presence of systemic disease, and therapeutic interventions should be directed accordingly. [source] 1233: How to choose the best surgical procedure?ACTA OPHTHALMOLOGICA, Issue 2010CJ POURNARAS Purpose Dealing to the localization and sealing retinal breaks, the surgical success rate for the cure of rhegmatogenous retinal detachment greatly changed with the introduction of scleral buckling (SB), intraocular gas injection, and pars plana vitrectomy (PPV). Methods In localized cases, pneumatic retinopexy and scleral buckling surgery (SB) remains the most popular surgical methods. Complicated cases with PVR grade B or C, giant tears, or macular holes are most commonly treated with primary pars plana vitrectomy. A large group of rhegmatogenous RDs with medium severity that comprise about 30% of all primary rhegmatogenous RDs in the Scleral Buckling versus Primary Vitrectomy in Rhegmatogenous Retinal Detachment recruitment study, were treated by SB and PPV. Advances in vitrectomy instrumentation and wideangle imaging systems have increased the popularity of PPV. Results The decision by the surgeon to use scleral buckling rather than PPV depends on a number of factors, including the lens status, size and location of breaks, patient compliance, and individual experience. Initial PPV may be successful for phakic patients. However, the SPR study shows a benefit of SB in phakic eyes with respect to BCVA improvement. Although no difference in BCVA was demonstrated in the pseudophakic trial, PPV was recommend for pseudophakic RD based on a better anatomical outcome. Conclusion There was a significant trend towards more frequently employing primary PPV (with or without SB) for the management of primary RRD. A significant improvement in the primary success rates for RD, were shown for all retinal surgical modalities applied for the treatment of rhegmatogenous retinal detachment. [source] Deep Plane Fixation in Integumental SurgeryDERMATOLOGIC SURGERY, Issue 2 2004Gerard E. Seery MD Background. Standard wound closure techniques are prone to complication in the presence of tension. Objective. To show that deep plane fixation (DPF), a surgical modality based on limited undermining and strategic placement of DPF sutures, affects tension-reduced closure in wounds that would otherwise require skin grafts/flaps or tissue expansion. Methods. The study is based on an analysis of over 2000 scalp operations. Results. Two groupings of identical sagittal scalp reductions were done. DPF was used in one and not the other. In the series with DPF, reduced tension closure was consistently possible, as was significantly increased excision, relative to the series without DPF. Conclusions. DPF narrows the wound base and channels tension forces from superficial to deep and/or nonundermined tissues (where they harmlessly dissipate). This allows relatively increased tissue excision and tension-reduced closure. [source] Evaluation of laparoscopic surgery for Hirschsprung's disease from the standpoint of invasiveness and colonic motility: Prolapsing technique with extra-anal mucosectomyASIAN JOURNAL OF ENDOSCOPIC SURGERY, Issue 3 2009Y Morikawa Abstract Objective: Laparoscopic pull-through has become the standard surgical modality for Hirschsprung's disease in the field of pediatric surgery. This article discusses the minimal invasiveness of the prolapsing technique. This technique allows mucosectomies to be performed under direct vision even at the deepest dissected portion because the procedure is conducted via an extra-anal approach. Method: The laparoscopic prolapsing technique (Lap) is compared with the conventional open Soave technique in terms of the change in CRP and WBC, defecation function, both clinical and manometric, after surgery. Results: As a result, the timing of surgery has become earlier and the patients younger. Soiling occurs in 33% of open Soave and 0% of Lap patients. Manometry after Lap. pull-through revealed a positive recto-anal inhibitory reflex in 39% and evoked high amplitude propagated contraction was demonstrated in 85% of patients. Conclusion: These results suggest that the present technique, including minimal dissections of the mesentery and the preservation of pelvic nerves in combination with fine mucosectomy under direct vision, could be beneficial for postoperative anorectal function in patients with Hirschspurung's disease. [source] | ||||||||||||||||||||||