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Surgical Options (surgical + option)
Selected AbstractsNontransplant Surgical Options for Congestive Heart FailureCONGESTIVE HEART FAILURE, Issue 1 2003Aftab R. Kherani MD A wide array of surgical options are currently available for the treatment of congestive heart failure ranging from traditional coronary artery bypass grafting to total artificial heart implantation. The indications for each procedure depend on the severity of disease and the individual patient's desires. Some surgical options are indicated for patients with moderate disease and prevent worsening heart failure, whereas other procedures are limited to patients who will only survive with high-risk surgery. Ongoing technologic advances are increasing the number of patients that benefit from the reparative surgical treatment of congestive heart failure. [source] The pharmacology of the internal anal sphincter and new treatments of ano-rectal disordersALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 7 2001T. A. Cook Surgical options for faecal incontinence in the presence of intact sphincters are limited. Furthermore, in patients with fissures, lateral sphincterotomy reduces anal sphincter hypertonia but there has been concern about complications. A greater understanding of the basic pharmacology of the internal anal sphincter has led to the development of novel treatments for both these disorders. A Medline review was undertaken for internal anal sphincter pharmacology, anal fissures and faecal incontinence. This review is based on these articles and those found by further cross-referencing. ,Nitric oxide released from non-adrenergic non-cholinergic nerves is the main inhibitory agent in the internal anal sphincter. Relaxations are also mediated through ,-adrenoceptors and muscarinic receptors. Stimulation of ,-receptors results in contraction. Calcium and its entry through L -type calcium channels is important for the maintenance of tone. Nitric oxide donors produce reductions in resting anal tone and heal fissures but are associated with side-effects. Muscarinic agents and calcium channel antagonists show promise as low side-effect alternatives. Botulinum toxin appears more efficacious than other agents in healing fissures. To date, ,-receptor agonists have been disappointing at improving incontinence. Further understanding of the pharmacology of the internal anal sphincter may permit the development of new agents to selectively target the tissue with greater efficacy and fewer side-effects. [source] Partial Left Ventriculectomy and Limited Heart Transplantation AvailabilityJOURNAL OF CARDIAC SURGERY, Issue 2 2001Ph.D., sa Gradinac M.D. Background and Aim: Partial left ventriculectomy, a novel cardiac volume reduction operation, is applied in countries without a developed heart transplantation program. We sought to determine its impact in our population of patients. Methods: Partial left ventriculectomy was performed in 38 patients during the last 4 years. Basic inclusion criteria were nonischemic dilated cardiomyopathy and poor response to medical therapy for heart failure. Hemodynamic evaluation was carried out before and after operation. A modified surgical technique of mitral valve repair and ventricle suturing was applied. Results: Thirty-day, 6-month, and 2-year survival rates were 82%± 7%, 65%± 8%. and 61%± 9%, respectively. Duration of heart failure symptoms was the only predictor of survival (p = 0.042). A high proportion of noncardiac causes of death was noted. Functional capacity in surviving patients improved at every successive measurement up to 1 year postoperatively. Conclusions: The introduction of partial left ventriculectomy in a country with limited heart transplantation availability had a great impact on the management of end-stage heart failure and may represent the only surgical option for some patients. The average cost per patient was substantially lower when compared to heart transplantation. [source] Insidious Extension of Pituitary Prolactinoma: Two Can't-Miss Findings Depicted on a 3.0-T MR SystemJOURNAL OF NEUROIMAGING, Issue 3 2010Yuichiro Yoneoka MD ABSTRACT BACKGROUND In this article, we present two can't-miss findings on preoperative magnetic resonance imaging (MRI) using a 3.0-T MR system resulting in a better surgical option in prolactinoma treatment after emergent of dopamine agonists. METHODS We reviewed six cases of pituitary prolactinoma; each had vague or occult bulk of adenoma on 1.5-T MR imaging, which were finally confirmed by surgery. Four cases were preoperatively examined with a 3.0-T MR imaging system. With the 3.0-T MR system, 3-dimension-anisotropy-contrast (3DAC) MR imaging and 3-dimension fast spoiled gradient recalled acquisition in the steady state (3D-FSPGR) imaging were used for depiction of the adenoma. RESULTS 3DAC imaging revealed cavernous sinus (CS) pathology in three cases, and multiplanar reconstruction of 3D-FSPGR imaging revealed normal pituitary gland and invasive adenoma into the CS in three cases and creeping extension up to the contralateral side of the CS invasion in four cases. CONCLUSIONS Two can't-miss findings: (1) intrasellar creeping extension up to the opposite side of the adenoma main body and (2) intracavernous-localized adenoma with indistinct intrasellar mass should be carefully considered when neurosurgeons perform adenomectomy for patients with prolactinoma, even in cases of microprolactinoma. [source] Safety of cesarean myomectomyJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 5 2009Byung-Joon Park Abstract Aim:, To examine the safety and appropriateness of uterine myomectomy during cesarean section. Methods:, We conducted a retrospective analysis of 97 patients who underwent myomectomy during cesarean section and 60 patients who had uterine myomas, but underwent cesarean section only, between January 2000 and December 2007. Based on the patients' medical records, we conducted an analysis of the characteristics of the uterine myomas, hematologic changes that occurred between the preoperative and postoperative phases, complications, and length of hospital stay. Results:, Changes in hemoglobin values between the preoperative and postoperative phases, indicating the degree of intraoperative bleeding, were evaluated. There were no significant differences between the two groups (cesarean myomectomy group [1.2 ± 1.2 g/dL] versus control group [1.1 ± 1.3 g/dL]). There were no significant differences in the frequency of blood transfusion, incidence of postoperative fever, duration of surgery, and length of hospital stay between the two groups. In patients who received a blood transfusion intraoperatively, the increased amount was added to the hemoglobin changes between the preoperative and postoperative phases (adjusted value). The difference in the adjusted value of hemoglobin change did not reach statistical significance (cesarean myomectomy group [1.3 ± 1.2 g/dL] versus control group [1.2 ± 1.1 g/dL]). When the size of the uterine myoma exceeded 6 cm, the operative time was longer in the cesarean myomectomy group. Conclusion:, Cesarean myomectomy is a safe surgical option with no significant complications if performed by an experienced practitioner. [source] Vascularized Cadaveric Fibula Flap for Treatment of Erectile Dysfunction Following Failure of Penile ImplantsTHE JOURNAL OF SEXUAL MEDICINE, Issue 10 2010Christopher J. Salgado MD ABSTRACT Introduction., Postpriapism erectile dysfunction in patients with sickle cell disease is a particularly devastating condition. Where penile implants have failed, there is no good surgical alternative at present. Free tissue transfer is fraught with risks in patients with sickle cell disease and are not the best option for treatment. Aim., To describe a new surgical technique involving prefabrication of a bone flap for treatment of erectile dysfunction in a patient with sickle cell disease. Methods., The descending branch of the lateral circumflex femoral artery was isolated and implanted within a cadaveric bone segment. The prefabricated flap was then transferred 2 months later as a neophallus for penile autoaugmentation. Results., Bone scan showed viability of the bone flap after transfer. The patient was able to have vaginal intercourse and successfully achieve orgasm 2 months after the second stage surgery. Conclusions., Prefabrication of a cadaveric bone flap and subsequent transfer is a novel and effective technique for treatment of erectile dysfunction refractory to medical management. This technique may be particularly useful for "implant cripples," who have no other surgical option. Salgado CJ, Chim H, Rowe D, and Bodner DR. Vascularized cadaveric fibula flap for treatment of erectile dysfunction following failure of penile implants. J Sex Med 2010;7:3504,3509. [source] Neck Nerve Trunks Schwannomas: Clinical Features and Postoperative Neurologic Outcome,THE LARYNGOSCOPE, Issue 9 2008Carlos Eugenio Nabuco de Araujo MD Abstract Objectives/Hypothesis: To analyze clinical and epidemiological features of neck nerve schwannomas, with emphasis on the neurologic outcome after surgical excision sparing as much of nerve fibers as possible with enucleation technique. Study Design: Retrospective study. Methods: Review of medical records from 1987 to 2006 of patients with neck nerve schwannomas, treated in a single institution. Results: Twenty-two patients were identified. Gender distribution was equal and age ranged from 15 to 61 years (mean: 38.6 years). Seven vagal, four brachial plexus, four sympathetic trunk, three cervical plexus, and two lesions on other sites could be identified. Most common symptom was neck mass. Local or irradiated pain also occurred in five cases. Median growing rate of tumors was 3 mm per year. Nerve paralysis was noted twice (a vagal schwannoma and a hypoglossal paralysis compressed by a vagal schwannoma). Different techniques were employed, and seven out of nine patients kept their nerve function (78%) after enucleation. No recurrence was observed in follow-up. Conclusions: Schwannomas should be treated surgically because of its growing potential, leading to local and neural compression symptoms. When possible, enucleation, which was employed in 10 patients of this series, is the recommended surgical option, allowing neural function preservation or restoration in most instances. This is especially important in the head and neck, where denervation may have a significant impact on the quality of life. [source] BT03 SILASTIC RING MINI GASTRIC BYPASS FOR MORBID OBESITY: THE NEW ZEALAND EXPERIENCEANZ JOURNAL OF SURGERY, Issue 2009K. C. Wong Purpose: , The laparoscopic mini gastric bypass (LMGB) is purportedly a technically simpler, yet equally effective operation to the laparoscopic Roux-en-Y gastric bypass as treatment for morbid obesity. This study reports the early results of LMGB in a major New Zealand bariatric centre. Methodology: , Clinical data was prospectively collected on all patients undergoing LMGB over a two year period. Results: , 142 patients were studied. 77% were females. Mean age was 43.8. Pre-operative mean body weight and body mass index (BMI) were 121.3 kg and 45.4 kg/m2 respectively. Mean BMI at one and two years follow up had decreased to 27.35 and 25.72 kg/m2 respectively. 83% of patients reported obesity associated co-morbidities pre-operatively. Post-operatively, 78% of patients reported a reduction in medication requirement. All surgery was performed laparoscopically. There were no anastomotic leaks and zero mortality. 8% of patients required further operations for complications or revision to a Roux-en-Y gastric bypass. 20% of patients required subsequent endoscopic interventions, the majority for investigation of vomiting and/or pain. 22% of patients required re-admission. 14% of patients reported new onset reflux or worsening of pre-existing reflux after LMGB. 82% of patients reported increased exercise capability post LMGB. 54% of patients required vitamin supplementation. Conclusion: , LMGB achieves significant weight loss and resolution of obesity related co-morbidities with a low short term complication rate. LMGB should be considered as a safe and simple surgical option for morbid obesity. [source] Microendoscopic discectomy for recurrent lumbar disc herniation*ASIAN JOURNAL OF ENDOSCOPIC SURGERY, Issue 2 2010M Matsumoto Abstract Introduction: The purpose of this study is to elucidate the feasibility of microendoscopic discectomy (MED) for the treatment of recurrent lumbar disc herniation. Methods: Thirty-six patients with recurrent lumbar disc herniation were treated using MED (30 men and six women; mean age: 45.7 years, range: 26,80 years; mean follow-up: 24.4 months, range: 12,52 months; mean duration between the primary and revision surgery: 65.9 months, range: 1,320 months) (recurrent group). Sex- and age-matched patients with primary lumbar disc herniation treated by MED served as the control group (primary group). The clinical outcomes were evaluated using the Japanese Orthopaedic Association score for low back pain and questionnaires regarding MED. Results: The average Japanese Orthopaedic Association scores before surgery and at the final follow-up were significantly lower in the recurrent group than in the primary group (10.8 ± 3.4 versus 15.0 ± 4.0 before surgery, P=0.001 and 25.4 ± 2.6 versus 26.8 ± 1.9 at follow-up, P=0.013), while the average recovery rates were not significantly different between the two groups (80.3 ± 14.1% versus 84.5 ± 14.6, P=0.22). The surgical time was significantly longer for the recurrent group than for the primary group (83.0 ± 41.8 min versus 67.1 ± 18.1 min,P=0.042). Of the 18 questionnaire respondents, 17 answered that postoperative pain was milder after MED than after a standard discectomy. Conclusion: MED is a feasible surgical option for recurrent lumbar disc herniation, yielding surgical outcomes comparable to those obtained in primary lumbar disc herniation. [source] Long-term quality-of-life outcome after mesh sacrocolpopexy for vaginal vault prolapseBJU INTERNATIONAL, Issue 11 2009Arun Z. Thomas OBJECTIVE To evaluate the long-term outcome of mesh sacrocolpopexy (MSC, which aims to restore normal pelvic floor anatomy to alleviate prolapse related symptoms) and its effect on patient's quality of life, as women with vaginal vault prolapse commonly have various pelvic floor symptoms that can affect urinary, rectal and sexual function. PATIENTS AND METHODS From January 2000 to June 2006, consecutive patients with confirmed stage 2,4 vaginal vault prolapse subsequently had a MSC. Detailed telephone interviews using the Cleveland Clinic Short Form-20 Pelvic Floor Distress Inventory (PFDI) questionnaire, with Urinary Distress Inventory (UDI), Pelvic Organ Prolapse Distress Inventory (POPDI) and Colorectal-Anal Distress Inventory (CRADI) subscales was completed by all patients to assess symptoms before and after MSC, improvement in sexual function and overall satisfaction. RESULTS In all, 21 patients had abdominal MSC; the median (range) follow-up was 52.2 (21,99) months. Total PFDI scores were significantly better after MSC (mean 44.0/300) than before (mean 113.9/300; P < 0.001). Analysis of the subscale scores showed that all patients reported a significant improvement of symptoms in the POPDI category (P < 0.001). CRADI subscale scores showed no significant change after MSC (before, mean 7.43/100 vs after 8.47/100; P = 0.542). There was an improvement of urinary symptoms on the UDI subscale after MSC but it was not statistically significant (P = 0.08). Analysis of score differences over time after MSC showed an insignificant decreasing slope (P = 0.227), suggesting long-term stability of symptoms after surgery; 90% of patients reported a significant improvement in sexual function and excellent long-term overall satisfaction with MSC. CONCLUSION Our results suggest that MSC is a safe and effective surgical option for treating vaginal vault prolapse, providing symptom improvement and stability in the long term. [source] Nontransplant Surgical Options for Congestive Heart FailureCONGESTIVE HEART FAILURE, Issue 1 2003Aftab R. Kherani MD A wide array of surgical options are currently available for the treatment of congestive heart failure ranging from traditional coronary artery bypass grafting to total artificial heart implantation. The indications for each procedure depend on the severity of disease and the individual patient's desires. Some surgical options are indicated for patients with moderate disease and prevent worsening heart failure, whereas other procedures are limited to patients who will only survive with high-risk surgery. Ongoing technologic advances are increasing the number of patients that benefit from the reparative surgical treatment of congestive heart failure. [source] A Simple Tool for Teaching Flap Design with Digital ImagesDERMATOLOGIC SURGERY, Issue 12 2001Daniel Berg MD Background. Defects created by excision or Mohs micrographic surgery must be analyzed and surgical options including flaps must be considered. Teaching flap design to dermatology trainees is often done at the bedside of the patient with the trainee describing or marking a proposed flap. Open discussion of the options in this way is sometimes unnerving for the patient. Blackboard discussions or drawings are limited in their realism. Objective. To describe a rapid, simple method using commonly available software to allow a trainee to draw and redraw a proposed flap on a digital image of the defect without the time and cost of printing. Methods. We describe a feature in the widely used presentation program Microsoft PowerPoint which can be used to draw on an imported digital image in various colors. Results. A digital photograph taken at the bedside can quickly be loaded into PowerPoint and viewed as a full-screen picture on a computer. Using an electronic pen, multiple lines can be drawn and erased on the picture, allowing surgical planning and teaching away from the bedside. Conclusion. Design and analysis of potential incision lines for a flap can be done quickly using a digital image and commonly available software, allowing a new option for teaching flap design. [source] Reconstruction of the columella using the prefabricated reverse flow submental flap: A case reportHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 7 2006Onder Tan MD Abstract Background. The reconstruction of columellar defects is still a challenging procedure because of limited local and regional flap options and the characteristics of the anatomy of this site. Although a number of methods are available to repair nasal columella defects, no treatment of choice ensuring an excellent texture- and color-matched tissue in one stage has been determined to date. Method. In this case, we used a reverse-flow submental island flap prefabricated with the costal cartilage for the reconstruction of a complex columellar defect. Result. The flap survived completely with reversible venous congestion. The cosmetic result and nasal respiratory function were acceptable during the follow-up time of 6 months. Conclusion. We propose that the prefabricated reverse submental flap may be an alternative among the surgical options for columellar defects. This flap may also be considered in the reconstructive repertoire of other composite defects of the head and neck region. © 2006 Wiley Periodicals, Inc. Head Neck, 2006 [source] Loco-regional treatment of hepatocellular carcinoma,HEPATOLOGY, Issue 2 2010Riccardo Lencioni Loco-regional treatments play a key role in the management of hepatocellular carcinoma (HCC). Image-guided tumor ablation is recommended in patients with early-stage HCC when surgical options are precluded. Radiofrequency ablation has shown superior anticancer effects and greater survival benefit with respect to the seminal percutaneous technique, ethanol injection, in meta-analyses of randomized controlled trials, and is currently established as the standard method for local tumor treatment. Novel thermal and nonthermal techniques for tumor ablation,including microwave ablation, irreversible electroporation, and light-activated drug therapy,seem to have potential to overcome the limitations of radiofrequency ablation and warrant further clinical investigation. Transcatheter arterial chemoembolization (TACE) is the standard of care for patients with asymptomatic, noninvasive multinodular tumors at the intermediate stage. The recent introduction of embolic microspheres that have the ability to release the drug in a controlled and sustained fashion has been shown to significantly increase safety and efficacy of TACE with respect to conventional, lipiodol-based regimens. The available data for radioembolization with yttrium-90 suggests that this is a potential new option for patients with HCC, which should be investigated in the setting of randomized controlled trials. Despite the advances and refinements in loco-regional approaches, the long-term survival outcomes of patients managed with interventional techniques are not fully satisfactory, mainly because of the high rates of tumor recurrence. The recent addition of molecular targeted drugs with antiangiogenic and antiproliferative properties to the therapeutic armamentarium for HCC has prompted the design of clinical trials aimed at investigating the synergies between loco-regional and systemic treatments. The outcomes of these trials are eagerly awaited, because they have the potential to revolutionize the treatment of HCC. (HEPATOLOGY 2010;) [source] Pediatric Short Bowel Syndrome: Pathophysiology, Nursing Care, and Management IssuesJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 3 2000Louise D. Jakubik ISSUES AND PURPOSE. A comprehensive overview of the etiology, pathophysiology, nursing care, and medical and surgical management of the child with short bowel syndrome (SBS), which follows massive anatomical or functional loss of the small intestine. CONCLUSIONS. The outlook for children with SBS has improved due to recent advances in parenteral and enteral nutrition, pharmacologic interventions, and surgical options. PRACTICE IMPLICATIONS. Nurses whose practice reflects an in-depth knowledge of the etiology, pathophysiology, medical and surgical management, nursing interventions, and complications of SBS will be equipped to provide quality care for children and families affected by SBS. [source] Radioguided Parathyroidectomy for Recurrent Hyperparathyroidism Caused by Forearm Graft Hyperplasia,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 5 2003Rebecca S Sippel Abstract One of the surgical options for symptomatic secondary hyperparathyroidism is a total parathyroidectomy with forearm implantation. Recurrence can occur and is most likely caused by hyperplasia of the small fragments of parathyroid tissue implanted in the forearm muscle. Forearm graft hyperplasia can be detected using Tc-99m sestamibi scanning of the forearm, which can show abnormal enhancement at the former graft site. In this report, we present the case of a 49-year-old gentleman with recurrent hyperparathyroidism caused by hyperplasia of forearm graft fragments. Unfortunately, no sutures or clips were placed at his initial surgery to identify the location of the parathyroid tissue in the forearm. Thus, we describe the first reported use of radioguided techniques using Tc-99m sestamibi injection and intraoperative gamma probe to localize parathyroid fragments in the forearm muscle. During our initial exploration, we found that injection of the tracer in the operative arm leads to prohibitively high levels of background activity. During a second exploration, the tracer was injected in the lower extremity, minimizing the background in the forearm and allowing the gamma probe to clearly identify two areas of abnormal parathyroid tissue. The intraoperative radioprobe allowed quick identification and removal of the abnormal parathyroid tissue in a case that was made particularly challenging by the absence of marking sutures. [source] Neoadjuvant therapy for breast cancerJOURNAL OF SURGICAL ONCOLOGY, Issue 4 2010Stephen V. Liu MD Abstract The past few decades have seen an increase in both the role and the complexity of neoadjuvant therapy for breast cancer. Neoadjuvant therapy was initially described as systemic chemotherapy for inflammatory or locally advanced breast cancer but now entails a combination of chemotherapy, endocrine therapy, and targeted therapy. Neoadjuvant systemic therapy is employed for inoperable inflammatory and locally advanced breast cancer, and also for patients with operable breast cancers who desire breast-conserving therapy (BCT) but are not candidates based on the initial size of the tumor in relation to the size of the breast. Neoadjuvant therapy in this subset of patients may impact the surgical options. This review will summarize the benefits of neoadjuvant systemic therapy and implications for BCT, the timing of sentinel node biopsy, and the utility of magnetic resonance imaging (MRI) to predict response to therapy. J. Surg. Oncol. 2010; 101:283,291. © 2010 Wiley-Liss, Inc. [source] Review article: pain and chronic pancreatitisALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 7 2009J. G. LIEB II Summary Background, Pain in chronic pancreatitis chronic pancreatitis is a frustrating and challenging symptom for both the patient and clinician. It is the most frequent and most significant symptom. Many patients fail the currently available conservative options and require opiates or endoscopic/surgical therapy. Aim, To highlight the pathophysiology and management of chronic pancreatitis pain, with an emphasis on recent developments and future directions. Methods, Expert review, utilizing in addition a comprehensive search of PubMed utilizing the search terms chronic pancreatitis and pain, treatment or management and a manual search of recent conference abstracts for articles describing pain and chronic pancreatitis. Results, Pancreatic pain is heterogenous in its manifestations and pathophysiology. First-line medical options include abstinence from alcohol and tobacco, pancreatic enzymes, adjunctive agents, antioxidants, and non-opiate or low potency opiate analgesics. Failure of these options is not unusual. More potent opiates, neurolysis and endoscopic and surgical options can be considered in selected patients, but this requires appropriate expertise. New and better options are needed. Future options could include new types of pancreatic enzymes, novel antinociceptive agents nerve growth factors, mast cell-directed therapy, treatments to limit fibrinogenesis and therapies directed at the central component of pain. Conclusions, Chronic pancreatitis pain remains difficult to treat. An approach utilizing conservative medical therapies is appropriate, with more invasive therapies reserved for failure of this conservative approach. Treatment options will continue to improve with new and novel therapies on the horizon. [source] Anesthesia management of familial dysautonomiaPEDIATRIC ANESTHESIA, Issue 6 2006JENNIE NGAI MD Summary Familial dysautonomia (FD) is an autosomal recessive inherited disorder, predominantly affecting the Ashkenazi Jewish population that is characterized by sensory and autonomic neuropathy. The protean manifestations and perturbations result in high morbidity and mortality. However, as a result of supportive measures and centralized care, survival has improved. As surgical options are increasing to symptomatically treat FD, anesthesiologists need to be familiar with this disorder. Because the Dysautonomia Center at NYU Medical Center is a referral center for FD patients, we have attained considerable anesthetic experience with FD. This article reviews clinical features of FD that could potentially affect anesthetic management and outlines our present practices. [source] Vitiligo Treatment in Childhood: A State of the Art ReviewPEDIATRIC DERMATOLOGY, Issue 5 2010Marion Eunice B. Tamesis M.D. Approximately half of the affected individuals develop the disease before adulthood. Etiologic hypotheses for vitiligo include biochemical, neural and autoimmune mechanisms. The most compelling of these suggests a combination of genetic and immunologic factors that result in an autoimmune melanocyte destruction. We reviewed studies carried out on various treatment modalities used in childhood vitiligo. Topical corticosteroids were found to have excellent repigmentation rates, whereas calcineurin inhibitors have comparable efficacy and a better safety profile compared with topical corticosteroids. These two groups of topical medications are good first-line treatment modalities for localized vitiligo. For the treatment of generalized vitiligo, phototherapy has excellent efficacy. Narrow-band ultraviolet B (UVB) has better overall repigmentation rates and safety profile than either topical or oral psoralens and ultraviolet A (PUVA). Other treatment modalities may be considered depending on a patient's specific condition, such as surgical options and depigmentation. With adequate sun protection, the option of no treatment with or without corrective camouflage, is an innocuous alternative to any of these treatment modalities. [source] Breast Cancer in Reduction Mammaplasty Specimens: Case Reports and GuidelinesTHE BREAST JOURNAL, Issue 2 2003Angela J. Keleher MD Abstract: Increasing numbers of women of all ages are electing to have reduction mammaplasty for very large breasts. Breast cancer can be an incidental finding in reduction mammaplasty specimens. We report here the discovery of breast cancer in specimens from four patients who underwent elective breast reduction, three of whom had not had recent mammograms. All four patients underwent modified radical mastectomy. The role of mammography, surgical options, specimen evaluation, and practical guidelines are discussed., [source] Heart Transplantation in the United States, 1998,2007AMERICAN JOURNAL OF TRANSPLANTATION, Issue 4p2 2009J. D. Vega This article highlights trends in heart transplantation from 1998 to 2007, using data from the Organ Procurement and Transplantation Network (OPTN) and the Scientific Registry of Transplant Recipients (SRTR). The number of candidates actively awaiting heart transplantation has declined steadily, from 2525 in 1998 to 1408 in 2007, a 44% decrease. Despite this decline, a larger proportion of patients are listed as either Status 1A or 1B, likely secondary to increased use of mechanical circulatory support. During this time, the overall death rate among patients awaiting heart transplantation fell from 220 to 142 patients per 1000 patient-years at risk; this likely reflects better medical and surgical options for those with end-stage heart failure. This trend was noted across all racial groups, both sexes, all disease etiologies (retransplantation excepted) and all status groups. Recipient numbers were relatively stable over the past decade. In 2007, 2207 transplants were performed, although the proportion of patients transplanted as Status 1A shifted from 34% to 50%. A trend toward transplanting more patients above 65 years of age was seen. Adjusted patient (and graft) survival at 3 months, 1, 5 and 10 years after transplantation has gradually, but significantly, improved during the same period; current patient survival estimates are 93%, 88%, 74% and 55%, respectively. [source] Fatwas and surgery: how and why a fatwa may inform a Muslim patient's surgical optionsANZ JOURNAL OF SURGERY, Issue 12 2009Ann Black BA, BSocWk, LLB(Hons) First page of article [source] Vascular reconstruction in lower limb musculoskeletal tumoursANZ JOURNAL OF SURGERY, Issue 9 2009J. Ian Spark Abstract Background:, Individual experience in the investigative, planning and operative aspects of lower limb musculoskeletal tumours is often small, making comparison between results difficult. The aim of the study was to describe the recent experience of a single tertiary referral unit performing limb salvage surgery, to identify areas of concern that are amenable to intervention and to provide clinicians an understanding of the surgical options. Methods:, Nine patients with peripheral limb musculoskeletal tumours are described. Four patients had a leiomyosarcoma, and one each of osteosarcoma, synovial chondrosarcoma, synovial sarcoma, liposarcoma and recurrent malignant peripheral nerve sheath tumour. Results:, Thirty-day mortality was nil. Two patients (one with a leiomyosarcoma and one with an osteosarcoma) died at 6 months follow-up because of pulmonary metastases. One patient with synovial chondrosarcoma developed a local recurrence and underwent an above-knee amputation. Six patients at 18 months follow-up are alive with no evidence of local recurrence and a functional lower limb. Conclusion:, These cases are a challenge to the clinicians, radiologists and pathologists. Review by a multidisciplinary team can produce successful results with low post-operative morbidity and mortality. Longer follow-up is required to determine the long-term implications. [source] Management of Intraparotid Facial Nerve SchwannomasANZ JOURNAL OF SURGERY, Issue 10 2000K. W. Chong Background: The purpose of the present paper was to review the management of intraparotid facial nerve schwannoma so as to discuss its clinical presentation, evaluate the various possible diagnostic investigations, and compare the various surgical options and outcome. Methods: Case series was undertaken of five (1.3%) patients with facial nerve schwannoma out of 400 consecutive parotidectomies at Singapore General Hospital. Results: There were three men and two women with an age range of 29,65 years. Three patients presented with painless parotid lumps while two had painful parotid swellings. None had facial nerve paresis. Only one patient had preoperative diagnosis suspicious of schwannoma by fine-needle aspiration cytology (FNAC). Diagnoses were made intraoperatively. Four patients had excision with cable grafting of the nerve defect, achieving facial nerve grade II,IV (House,Brackmann scale). One patient who underwent enucleation of tumour with nerve preservation achieved grade II. Conclusions: Preoperative diagnosis is difficult but it is important for discussion of the extent and options of surgery. Fine-needle aspiration cytology holds promise in making a preoperative diagnosis. Enucleation with nerve preservation where possible seems to offer better facial function whereas nerve excision with cable graft can give satisfactory results. [source] The economic consequences of introducing deep brain stimulation for the treatment of advanced Parkinson's disease in AustraliaAUSTRALASIAN JOURNAL ON AGEING, Issue 3 2003Bruce P. Hollingsworth Objectives: Parkinson's disease is a debilitating condition, which is increasing in prevalence as elderly populations increase in the developed world. As such, resource consumption will also increase. For advanced Parkinsons, where drug therapy is no longer effective, there are two surgical options - ablative surgery, a one-off procedure which destroys part of the brain, and deep brain stimulation (DBS), which uses electrodes to stimulate part of the brain. The specific question to be answered here is what the costs to the community of DBS are compared to ablative surgery (thalmotomy or pallidotomy) in potentially relieving the symptoms of advanced Parkinson's disease, and if there is any improvement in patients' quality of life. Design: A cost effectiveness study is undertaken. UK and Australian data are made use of and cost-effectiveness estimated in terms of cost per change in functional ability. Setting: Hospital, community and home care. Patients: Those with advanced Parkinson's Disease. Main outcome measures: Frenchay index of functional ability. Results: It is estimated that the incremental extra cost for a small change in ability to undertake daily tasks is at least 23,559. Conclusions: As outcomes evidence is of low quality, at this stage it is not possible to establish that Deep Brain Stimulation offers substantial improvements in quality of life. Extra costs over ablative surgery are estimated to be in the range of 17,830 to 51,385 per patient over a five year period. [source] Choosing medical or surgical terminations of pregnancy in the first trimester: What is the difference?AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2009Felicity GOODYEAR-SMITH Background: Women seeking termination of pregnancy in Auckland, New Zealand can chose between medical and surgical options up to eight weeks gestation. Aims: To assess demographic differences or changes over time between proportions of women choosing medical or surgical abortions at a single centre and determine whether changing the mifepristone,misoprostol interval from two to one day impacted on outcomes. Methods: Retrospective audit of two consecutive years (December 2005,November 2006 and December 2006,November 2007) of first-trimester surgical and medical terminations where the mifepristone-misoprostol interval was reduced from two to one day between years. Analysis using descriptive statistics and assessment of probability of observed differences between groups. Results: A total of 1495 terminations were performed in 2005,2006 and 1588 in 2006,2007. No significant difference (P = 0.4) of eligible women choosing medical (21% and 23%) or surgical abortion between years. Ethnicity, age and residency status did not influence choice. Medical termination of pregnancy was more likely in women who were without previous children (P = 0.009), pregnancies (P = 0.02) or terminations (P = 0.04). Medical termination was similarly effective within six hours with either two- or one-day intervals. Conclusions: Both medical and surgical first-trimester abortions are safe and effective. It is optimal to be able to offer women choice. Reducing the medical interval to one day does not increase adverse outcomes. [source] Long-term follow up of uterine artery embolisation,an effective alternative in the treatment of fibroidsBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 4 2006WJ Walker Objectives, To evaluate the long-term efficacy and complications of uterine artery embolisation (UAE) for treatment of symptomatic uterine fibroids. Design, A prospective observational study. Setting, A district general hospital and two private hospitals in the southeast of England. Population, Women with symptomatic fibroids who had been offered surgical options for treatment. Methods, Postal questionnaire follow up at 5,7 years to assess long-term clinical effects among women who had undergone UAE. Main outcome measures, The questionnaire was subdivided into sections dealing with menstrual flow, amenorrhoea and menopause, fibroid-related symptoms, fertility, vaginal discharge, sexual function, subsequent treatments for fibroids and satisfaction with the procedure. Results, A total of 258 women were identified as being between 5 and 7 years post-UAE and suitable for long-term follow up in October 2004. One hundred seventy-two completed questionnaires were analysed (67% response rate). Seventy-five percent of women still had either a return to normal or an improvement in menstrual flow compared with how they were prior to UAE. More than 80% of fibroid-related symptoms were still resolved or improved. Sixteen percent of women required further treatment for fibroids. Premature menopause directly following UAE occurred in only one woman in the study group. Eighty-eight percent of women were satisfied with the outcome of the procedure at 5,7 years and would choose it again or recommend it to others. Conclusions, These findings show that UAE is of benefit to women wishing to avoid hysterectomy and it carries a low risk of complications. [source] Results from different patient populations using combined therapy with alprostadil and sildenafil: predictors of satisfactionBJU INTERNATIONAL, Issue 4 2000J.H. Mydlo Objective To evaluate the outcome of combined therapy (using intraurethral alprostadil and oral sildenafil) in private and clinic patients with erectile dysfunction, and thus assess predictors of satisfaction. Patients and methods In all, 360 men were treated for erectile dysfunction using single and/or combined therapy, comprising 214 private-practice and 166 clinic patients. Responses were evaluated using the International Index for Erectile Function (IIEF) questionnaire before and after treatment. Serum testosterone levels, education and socio-economic status were also assessed. Group 1a consisted of 33 private patients and Group 1b of 24 clinic patients who tried the maximum dose of intraurethral alprostadil monotherapy initially, followed by the maximum dose of sildenafil monotherapy, and remained dissatisfied. Group 2a consisted of 32 private patients and group 2b of 31 clinic patients who tried the maximum dose of sildenafil monotherapy initially, followed by the maximum dose of alprostadil monotherapy, and were also dissatisfied. These two groups of 65 private and 55 clinic patients then underwent combined therapy. Results The mean ( sd) score for erectile function was 24.1 (2) for combined therapy (a 123% improvement), and 19.8 (1.8) (83% improvement) and 15.2 (1.6) (41% improvement) for sildenafil and alprostadil monotherapies (P < 0.05 for both patient groups). The men also reported an improvement in their satisfaction with intercourse. However, at 18 months, 60 of the 65 private patients but only 40 of the 55 clinic patients continued with combined therapy; thus, the discontinuation rate was three times greater among clinic than among private patients. Furthermore, the private patients had an overall improvement in the satisfaction score of 128%, compared with 51% for the clinic patients. Conclusion Although there were no significant differences in erectile function improvement within the two satisfied combined therapy groups, the differences in overall satisfaction and long-term withdrawal rates suggests that other factors beside motivation must be involved for success, e.g. education, persistence, realistic expectations, and certain psychological factors. Combined therapy should be considered for those patients who have a suboptimal response to monotherapy and refuse or are not candidates for surgical options. Generally, those patients with a higher education, greater persistence and more realistic expectations were more satisfied with combined therapy. [source] Factors associated with surgical options for breast carcinoma,CANCER, Issue 7 2006Anees B. Chagpar M.D., M.Sc. Abstract BACKGROUND Breast conservation surgery (BCS) and mastectomy have equivalent survival outcomes for women with breast carcinoma, but treatment decisions are affected by many factors. The current study evaluated the impact of patient and physician factors on surgical decision-making. METHODS Statistical analyses were performed on a prospective multicenter study of patients with invasive breast carcinoma. Patient, physician, and geographic factors were considered. RESULTS Of 4086 patients, BCS was performed in 2762 (67.6%) and mastectomy was performed in 1324 (32.4%). The median tumor size was 1.5 cm (range, < 0.1,9.0 cm) in patients undergoing BCS and 1.9 cm (range, 0.1,11.0 cm) in patients undergoing mastectomy (P < 0.00001). The median age of patients undergoing BCS was 59 years (range, 27,100 yrs), whereas patients who underwent mastectomy were older (median age of 63 yrs, range, 27,96 yrs [P < 0.00001]). Physicians in academic practices performed more lumpectomies than those who were not in an academic practice (70.9% vs. 65.7%; P = 0.001). More breast conservation procedures were performed by surgeons with a higher percentage of breast practice (P = 0.012). Geographic location was found to be significant, with the Northeast having the highest rate of breast conservation (70.8%) and the Southeast having the lowest (63.2%; P = 0.002). On multivariate analysis, patient age (odds ratio [OR]: 1.455; 95% confidence interval [95% CI], 1.247,1.699 [P < 0.001]), tumor size (P < 0.001), tumor palpability (OR: 0.613; 95% CI, 0.524,0.716 [P < 0.001]), histologic subtype (P = 0.018), tumor location in the breast (P < 0.001), physician academic affiliation (OR: 1.193; 95% CI: 1.021,1.393 [P = 0.026]), and geographic location (P = 0.045) were found to be significant. CONCLUSIONS Treatment decisions were found to be related to patient clinicopathologic features, surgeon academic affiliation, and geographic location. Future studies will elucidate the communication and psychosocial factors that may influence patient decision-making. Cancer 2006. © 2006 American Cancer Society. [source] | |||||||||||||||||||||||||||||||