			Home About us Contact

Surgical Parameters (surgical + parameter)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Salvage laryngectomy and pharyngocutaneous fistulae after primary radiotherapy for head and neck cancer: A national survey from DAHANCA

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 9 2003
Cai Grau MD, DMSc
Objective. In 1998, the Danish Society for Head and Neck Oncology decided to conduct a nationwide survey at the five head and neck oncology centers with the aim of evaluating the surgical outcome of salvage laryngectomy after radiotherapy with special emphasis on identifying factors that could contribute to the development of pharyngocutaneous fistulae. Patients. A total of 472 consecutive patients undergoing postirradiation salvage laryngectomy in the period July 1, 1987,June 30, 1997 were recorded at the five head and neck oncology centers in Denmark. Age ranged from 36 to 84 years, median 63 years, 405 men and 67 women. Primary tumor site was glottic larynx (n = 242), supraglottic larynx (n = 149), other larynx (n = 45), pharynx (n = 27), and other (n = 9). All patients had received prior radiotherapy. Results. Median time between radiotherapy and laryngectomy was 10 months (range, 1,348 months). A total of 89 fistulae lasting at least 2 weeks were observed, corresponding to an overall average fistulae risk of 19%. The number of performed laryngectomies per year decreased linearly (from 58 to 37), whereas the annual number of fistulae increased slightly (from 7 to 11), which meant that the corresponding estimated fistulae risk increased significantly from 12% in 1987 to 30% in 1997. Other significant risk factors for fistulae in univariate analysis included younger patient age, primary advanced T and N stage, nonglottic primary site, resection of hyoid bone, high total radiation dose, and large radiation fields. Multiple logistic regression analysis of these parameters suggested that nonglottic tumor site, late laryngectomy period (1987,1992 vs 1993,1997), and advanced initial T stage were independent prognostic factors for fistulae risk. Surgical parameters like resection of thyroid/tongue base/trachea or radiotherapy parameters like overall treatment time or fractions per week did not influence fistulae risk. Conclusions. The risk of fistulae is especially high in patients initially treated with radiotherapy for nonglottic advanced stage tumors. A significant decrease in the number of performed salvage laryngectomies over the 10 years was seen. Over the same time period, the annual number of fistulae remained almost constant. The resulting more than doubling of fistulae rate could thus in part be explained by less surgical routine. © 2003 Wiley Periodicals, Inc. Head Neck 25: 711,716, 2003 [source]

Aggressiveness and Quantification of Epithelial Proliferation of Middle Ear Cholesteatoma by MIB1

THE LARYNGOSCOPE, Issue 2 2003
Y. Mallet MD
Abstract Objective To assess an easy method that predicts cholesteatoma aggressiveness. Study Design An experimental prospective study. Methods Monoclonal antibody MIB1 was used to determine epithelium proliferation in 91 cholesteatomatous ears. Clinical and surgical parameters were compared with proliferation activity to determine pathological and clinical correlation. Results Statistical correlations were established between hyperproliferation of the cholesteatoma and severe bone erosion (leading to major cholesteatoma complications) and between hyperproliferation and middle ear inflammation (associated with more surgical difficulties and a higher risk of recurrence). A high proliferation index was also found in children's cholesteatoma, which is known to have more aggressive behavior. Conclusion Immunohistochemical use of the MIB1 antibody is a simple technique that can help to determine the aggressiveness of a cholesteatoma. [source]

Withdrawal of antiepileptic drugs after neocortical epilepsy surgery

ANNALS OF NEUROLOGY, Issue 2 2010
Kyung-Il Park MD
Objective This study investigated the prevalence of successful antiepileptic drug withdrawal and identified predictors of seizure recurrence after antiepileptic drug reduction following resectional operation for intractable neocortical epilepsy. Methods We retrospectively assessed 223 patients (100 with neocortical temporal lobe epilepsy, 69 with frontal lobe epilepsy, 23 with parietal lobe epilepsy, 25 with occipital lobe epilepsy, and 6 with multifocal epilepsy) who underwent surgery. The mean period of observation was 84.4 months (range, 24,152 months) after surgery and 72.6 months (range, 12,138 months) after initial reduction. Clinical characteristics, magnetic resonance imaging, and surgical parameters were evaluated for their potential to predict recurrence associated with antiepileptic drug withdrawal. Results Antiepileptic drug reduction was attempted in 147 patients (65.9%), 78 (53.1%) of whom had seizure recurrence after initial reduction. Discontinuation was achieved in 73 patients (32.7%), and 59 (80.8%) of these remained seizure free until final assessment. Multivariate analysis revealed that early drug tapering, normal magnetic resonance imaging results, seizure before reduction, and longer epilepsy duration were associated with recurrence. Finally, 27.4% of patients were seizure free without drugs, and 26.9% were seizure free with drugs. Compared with preoperative status, the number of antiepileptic drugs needed decreased in 50.7% of patients, did not change in 19.3%, and increased in 30.0% after surgery. Interpretation The complete-cure rate of intractable neocortical epilepsy by resectional surgery was 27.4%. When patients undertake early tapering, and have normal magnetic resonance imaging results, seizure before reduction, and longer disease duration, further withdrawal should be done cautiously because of the high risk of relapse. ANN NEUROL 2010;67:230,238 [source]

Computer-assisted dosage calculation for strabismus therapy in myopic patients

ACTA OPHTHALMOLOGICA, Issue 1 2008
Martina Koch
Abstract. Purpose:, The published dosage recommendations for the surgical correction of horizontal strabismus in non-myopic patients show large, unexplained differences. For patients with high myopia, the situation becomes even more complex because the increase in the size of the bulb also affects the geometry of the oculomotor muscles. In this study, we wanted to investigate whether computer simulations of the oculomotor plant can be used to find accurate surgical parameters. Methods:, In a retrospective study, we investigated pre- and postoperative strabismus patterns in 13 patients affected by convergent (seven patients) or divergent (six patients) strabismus and high myopia. Postoperative checks were made 1 day, 1 week, 3 months and 1,6 years after the operation. For each patient, we simulated the presurgical strabismus pattern with SEE++ (see ,Further Information' for manufacturer details), a biomechanical simulation program of the oculomotor plant. The individual results of the simulations were then compared to the measured postoperative strabismus patterns. Results:, We found a trend of under-correction in the postoperative situation, resulting in four patients having a large remaining strabismus angle of more than 5 degrees. The computer simulations were able to reproduce this under-correction, and suggested an increase in dosage. Conclusion:, We conclude that realistic biomechanical simulations of the oculomotor plant can predict the postoperative result for myopic patients accurately. The results of the computer simulation correlate well with the postoperative outcome of the patient. [source]