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Surgical Strategy (surgical + strategy)

Distribution by Scientific Domains

Medical Sciences	100%

Distribution within Medical Sciences

Surgery & Surgical Specialties	31%
Otolaryngology (Ear, Nose & Throat)	18%
Dermatology	13%

Selected Abstracts

Histological and Clinical Findings in Different Surgical Strategies for Focal Axillary Hyperhidrosis

DERMATOLOGIC SURGERY, Issue 8 2008
FALK G. BECHARA MD
INTRODUCTION Although a variety of different surgical strategies for focal axillary hyperhidrosis (FAH) have proven effective, little is known of intraoperative and postoperative histologies of different surgical methods. OBJECTIVE The objective was to use pre-, intra-, and postoperative histologic findings to evaluate different surgical procedures for FAH in establishing a possible correlation between the interventions and clinical outcome. MATERIAL AND METHODS A total of 40 patients underwent surgery with 15 undergoing liposuction-curettage (LC), 14 radical skin excision (RSE) with Y-plasty closure, and 11 a skin-sparing technique (SST). Before surgery, density and ratio of eccrine and apocrine sweat glands were evaluated with routine histology. Further biopsies were taken directly after surgery in the RSE and SST groups and 1 year postoperatively in all patients. Additionally, gravimetry was performed, side effects were documented, and patients were asked to evaluate the aesthetic outcome of the surgical method by using an analogue scale. RESULTS Preoperatively, the mean density of eccrine glands was 11.1/cm2 compared to 16.9/cm2 apocrine glands (apocrine/eccrine ratio, 1.6). Biopsy specimen directly after surgery showed remaining sweat glands in 7/15 (46.7%) LC patients and in 4/11 (36.4%) of the SST patients. One year after surgery, sweat gland density was significantly reduced in the LC (79.1%) and the SST (74.9%) groups. In the RSE group, only scar formation was present. Gravimetry showed significantly reduced sweat rates 12 months after surgery in all groups (LC, 66.4%; SST, 62.9%; RSE, 65.3% [p<.05]). Most frequent side effects were hematoma (LC, n=3; SST, n=2; RSE, n=3), subcutaneous fibrotic bridles (LC, n=8; SST, n=3; RSE, n=0), skin erosion (LC, n=3; SST, n=4; RSE, n=0), focal hair loss (LC, n=9; SST, n=11; RSE, n=14), and paresthesia (LC, n=4; SST, n=3; RSE, n=5). CONCLUSION Histologic distribution and density of sweat glands were comparable to previous studies. All three surgical procedures evaluated are effective in the treatment of FAH. RSE and SST techniques are associated with a higher risk of side effects and cause more extensive scarring. However, one LC patient (n=1; 6.7%) did not respond to treatment. [source]

Evaluation of a Navigation System for ENT with Surgical Efficiency Criteria,

THE LARYNGOSCOPE, Issue 4 2006
Gero Strau MD
Abstract The aim of this study is the evaluation of a navigation system (NaviBase) for ENT surgery. For this purpose, a new methodology for the evaluation of surgical and ergonomic system properties has been developed. The practicability of the evaluation instruments will be examined using the example of the overall assessment of the system in comparison with the current surgical standard and with other systems using clinical efficiency criteria. The evaluation is based on 102 ENT surgical applications; of these, 89 were functional endoscopic sinus surgeries (FESS). The evaluation of surgical and ergonomic performance factors was performed by seven ENT surgeons. To evaluate surgical system properties, the Level of Quality (LOQ) in 89 cases of the FESS was determined. It compares the existing information of the surgeon with that of the navigation system on a scale of 0 to 100 and with a mean value of 50 and places it in a relationship to the clinical impact. The intraoperative change of the planned surgical strategy (Change of Surgical Strategy) was documented. The ergonomic factors of the system with the categories of Overall Confidence (Trust), awareness of the situation (Situation Awareness), influence on the operating team, requirements for specific skills (Skill Set Requirement), and cognitive load (Workload Shift) were recorded for all surgical procedures as Level of Reliance (LOR). In the evaluation of the surgical system properties, an average evaluation of the quality of the information, as an LOQ of 63.59, resulted. Every second application of the navigation system (47.9%), on average, led to a change in the surgical strategy. An extension/enhancement of the indication of the endonasal approach through the use of the navigation system was shown in 7 of 102 (6.8%) cases. The completion of the resection in the FESS was rated by 74% of group I and 11% of group II as better in comparison with the standard approach. Total confidence shows a positive evaluation of 3.35 in the LOR. To supplement the evaluation of the navigation system, the technical parameters were included. The maximum deviation, Amax, of the displayed position of the reference value amounted to 1.93 mm. The average deviation was at 1.29 mm with an SD above all values, sd, of 0.29. The subsequent economic evaluation resulted in an effective average extra expenditure of time of 1.35 minutes per case. The overall evaluation of the system imparts application-relevant information beyond the technical details and permits comparability between different assistance systems. [source]

The Use of Intraoperative Doppler Assessment to Guide the Surgical Treatment of Anomalous Right Coronary Arteries

JOURNAL OF CARDIAC SURGERY, Issue 5 2008
Louis H. Stein M.H.S.
Because of this risk, many patients elect surgical correction of this anomaly. Surgical strategies for correction of this include ostioplasty, coronary artery reimplantation, and, more commonly, coronary artery bypass grafting. After coronary artery bypass grafting, some advocate ligation of the proximal RCA, speculating that competitive flow will cause graft failure. As no objective criteria for this have been established, we propose a method using of intraoperative Doppler flow measurements to guide the decision to preserve the proximal anomalous native vessel. We present three cases in which an RCA with an anomalous origin from the left sinus was corrected with coronary artery bypass grafting with the assistance of intraoperative Doppler flow measurements to guide the decision to preserve the proximal anomalous native vessel. In each case, the RCA was bypassed using a saphenous vein graft (SVG) that was used to bypass origin of the RCA. Flow through the graft was compared with and without ligation of the proximal RCA, before creation of the proximal anastomosis. In each case, flow through the SVG was not significantly reduced with the proximal RCA patent and ligation was not performed. [source]

Long-Term Effectiveness of Operative Procedures for Stanford Type A Aortic Dissections

JOURNAL OF CARDIAC SURGERY, Issue 3 2004
Rudolf Driever
Methods: From 1990 to 1999, 50 patients (32 men (64.07%); 18 women, (36.0%); mean age 57.4 ± 11.1 years) underwent operation for ascending aortic dissection. Surgical strategies included aortic root replacement with a composite graft (21/50; 42.0%), valve replacement with supracoronary ascending aortic graft (3/50, 6%), and valve preservation or repair (26/50; 52.0%). Results: Overall hospital mortality rate was 18.0%. Follow-up was completed for 47 patients (94.0%) and ranged from 1 month to 10.5 years (mean 28.8 months). Actuarial survival for patients discharged from the hospital was 84% at 1 year, 75% at 5 years, and 66% at 10 years. There was no significant difference between the various procedures regarding mortality, neurological complications, long-term survival, and proximal reoperations. The ascending aorta alone was replaced in 8 of 50 patients (16%), ascending and hemiarch in 30 of 50 patients (60%), and arch and proximal descending aorta in 12 of 50 patients (24%). Hospital mortality (11.5%, 20.0%, and 16.7%, respectively; p > 0.05) and 5- and 10-year survival (p > 0.05) were not statistically dependent on the extension of the resection distally. Residual distal dissection was not associated with a decrease in late survival. With regard to emergency surgery (36/50) there was no significant difference in hospital mortality (p > 0.05) and 5-year survival (p > 0.05) between those who had undergone coronary angiography (19/36; 52.8%) on the day of surgery with those who had not (17/36; 47.2%). Conclusions: Preservation or repair of the aortic valve can be recommended in the majority of patients with type A dissection. Distal extension of the resection does not increase surgical risk. Residual distal dissection does not decrease late survival. Preoperative coronary angiography may not affect survival in patients undergoing emergency surgery. (J Card Surg 2004;19:240-245) [source]

Surgical strategies in the laparoscopic therapy of cholecystolithiasis and common duct stones

ANZ JOURNAL OF SURGERY, Issue 8 2002
Kaja Ludwig
Background: The purpose of the present study was to examine the current approach and different strategies adopted for laparoscopic cholecystectomy in Germany. Methods: A retrospective survey was conducted at 859 (n = 1200; 67.6%) hospitals in Germany. Data from 123 090 patients who had undergone cholecystectomy were analysed. Results: 71.9% of the operations were finished laparoscopically (n= 88 537) whereas 22.5% were carried out using the open technique. Conversion to open surgery was required in 7.1% of the laparoscopically started operations. When common bile duct stones were diagnosed preoperatively, 74.4% of the participants favoured the primary endoscopic extraction, following laparoscopic cholecystectomy. In cases of intraoperative diagnoses, laparoscopic cholecystectomy was finished and postoperative primary endoscopic extraction was carried out in more than half of the hospitals (58.4%). Sixteen per cent converted to an open operation with simultaneous exploration of the common duct. Laparoscopic desobstruction of the common bile duct was extremely rare (4.4%). Compared with open cholecystectomy, the results show a lower incidence of postoperative reinterventions (0.9 vs 1.8%) and fatal outcomes (0.04 vs 0.53%) for laparoscopic cholecystectomy. In contrast, common bile duct injuries were more frequent in the laparoscopic cholecystectomy group (0.32 vs 0.12%). The median duration of hospitalization was 6.1 days (range: 2.8,12) in the laparoscopic cholecystectomy group compared with 10.4 days (range: 3,28) in the open cholecystectomy group. Conclusions: Laparoscopic cholecystectomy is the standard procedure for the treatment of uncomplicated gallstone disease. There are reasonable differences between the hospitals in type of cholecystectomy for acute cholecystitis, management of common duct stones and intraoperative diagnostics in laparoscopic cholecystectomy, even after adjustment for differences in patient comorbidities. [source]

Surgical strategies for gastric cancer with synchronous peritoneal carcinomatosis (Br J Surg 2006; 93: 1530,1535)

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 5 2007
T. D. Yan
The Editors welcome topical correspondence from readers relating to articles published in the Journal. Responses should be sent electronically via the BJS website (www.bjs.co.uk). All letters will be reviewed and, if approved,appear on the website. A selection of these will be edited and publishe in the Journal.Letters must be no more than 250 words in length. Copyright @ 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Authors' reply: Surgical strategies for gastric cancer with synchronous peritoneal carcinomatosis (Br J Surg 2006; 93: 1530,1535)

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 5 2007
P. M. Schlag
No abstract is available for this article. [source]

Surgical strategies for faecal incontinence , a decision analysis between dynamic graciloplasty, artificial bowel sphincter and end stoma

COLORECTAL DISEASE, Issue 6 2008
E. K. Tan
Abstract Background Artificial bowel sphincter (ABS) and dynamic graciloplasty (DG) are surgical treatments for faecal incontinence (FI). FI may affect quality of life (QOL) so severely that patients are often willing to consider a permanent end stoma (ES). It is unclear which is the more cost-effective strategy. Method Probability estimates for patients with FI were obtained from published data (ABS, n = 319; DG, n = 301), supplemented by expert opinion. The primary outcome was quality-adjusted life years (QALYs) gained from each strategy. Factors considered were the risk of failure of the primary and redo operation and the consequent risk of permanent stoma. Results were assessed as incremental cost-effectiveness ratio (ICER). Results Over the 5-year time horizon, ES gave a QALY gain of 3.45 for £16 280, giving an ICER of £4719/QALY. ABS produced a gain of 4.38 QALYs for £23 569, giving an ICER of £5387/QALY. DG produced a gain of 4.00 QALYs for £25 035, giving an ICER of £6257/QALY. With the willingness-to-pay threshold set at £30 000/QALY, ES was the most cost-effective intervention. The ABS was most cost-effective after 10 years. Conclusion All three procedures were found to be cost-effective. The ES was most cost-effective over 5 years, while the ABS was most cost-effective in excess of 10. DG maybe considered as an alternative in specialist centres. [source]

Histological and Clinical Findings in Different Surgical Strategies for Focal Axillary Hyperhidrosis

Intestinal failure: A new era in clinical management

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 2009
Julie E Bines
Abstract Only 50 years ago intestinal failure was considered incompatible with life. Since then, developments in parenteral nutrition, and, more recently, small intestinal transplantation, have provided new therapeutic options with the potential to offer long-term survival with a good quality of life. Current medical and surgical strategies are aimed at enhancing intestinal adaptation, improving absorption to achieve nutritional independence, and minimizing the complications of parenteral nutrition therapy. An integrated, multidisciplinary approach to the management of patients with intestinal failure, closely linked to a transplantation program to facilitate early referral, is recognized as a key factor in optimizing patient outcomes. [source]

Long-term results of the antegrade continent enema procedure for constipation in adults

COLORECTAL DISEASE, Issue 5 2004
N. P. Lees
Abstract Objective The aim of this study was to evaluate the long-term results of the Antegrade Continent Enema (ACE) procedure for treating severe constipation in adults. Methods Over 10 years 37 ACE conduits were created in 32 patients (median age 35 years, 26 women) with constipation caused by slow transit, obstructed defaecation or both. Conduits were created from the appendix (n = 20, 54%), ileum (n = 10, 27%), neoappendix caecostomy (n = 5, 14%) or colon (n = 2, 5%). Clinical records were retrospectively reviewed to determine outcome. Results After a median follow up of 36 (range 13,140) months, 28 (88%) required at least one further procedure on a primary conduit, including reversal in 19 (59%). Five patients had a second conduit fashioned, two successfully. Conduit type and constipation cause did not significantly influence the rates of ACE reversal or major revision. Ileal conduits were associated with fewer minor revision procedures for stenosis (1 in 7 patients) than appendix conduits (21 in 20 patients). There was one (3%) serious complication. Satisfactory ACE function was ultimately achieved in 47% of patients, at last follow up. After ACE reversal, 9 (28%) patients underwent formation of an end stoma and 3 patients had a colectomy. Conclusions Revision procedures are common, but approximately half of patients can expect satisfactory long-term ACE function. ACE conduit reversal does not preclude subsequent alternative surgical strategies to treat this difficult condition. [source]

Use of Off-pump Coronary Artery Bypass Surgery Among Patients with Malignant Disease

JOURNAL OF CARDIAC SURGERY, Issue 1 2010
Ahmad K. Darwazah Ph.D., F.R.C.S.
The surgical strategy among these patients remains controversial. We present our experience of using a two-staged surgical strategy of managing coronary artery disease using off-pump bypass followed by tumor management. Patients and Methods: During a six-year period from 2002 to 2007, 350 patients underwent myocardial revascularization using off-pump bypass. Among these patients, associated malignant disease was found in six patients (1.7%). Two of them had papillary carcinoma of the bladder, one patient had chronic lymphocytic leukemia, and the rest suffer from carcinoma affecting the prostate, colon, and right lung. Their mean age was 54 years. Their data was evaluated. Patients were followed up to evaluate their symptoms and progress of their disease. Results: All patients were managed successfully. Complete revascularization was achieved in all patients except one due to small nongraftable vessels. The mean number of grafts was 1.8 ± 0.8. There was no evidence of postoperative infraction or stroke. The mean hospital stay was 5 ± 1.1 days. Management of cancer was done during the same hospital admission in two patients with bladder cancer. The rest had a mean interval of 6.6 ± 5.4 days. Two patients underwent surgery in the form of left hemicolectomy and right lower lobectomy. The rest had chemotherapy as a sole treatment. All patients were followed up completely for a period of 12 to 84 months (mean 39.2 ± 26.7 months). We had no late mortality. All patients remained asymptomatic except one, who had angina of class III and had recurrence of her bladder tumor, which necessitated two sessions of endoscopic resection. Conclusion: We believe that staged operation to treat coronary artery disease and malignancy can be performed safely. The use of off-pump technique to revascularize the myocardium can be performed without any complications.(J Card Surg 2010;25:1-4) [source]

Pediatric Heart Transplantation: Current Clinical Review

JOURNAL OF CARDIAC SURGERY, Issue 1 2008
D.Sc., F.I.C.S., M.B.A., M.P.H., M.Sc., Yanto Sandy Tjang M.D.
Its incidence and prevalence is increasing and imposes substantial burden on the health care system. Despite much progress in development of many new drugs and innovations in palliative surgical strategy, nontransplant cardiac surgical procedures and the use of mechanical assist devices, pediatric heart transplantation remains the best treatment option for patients with end-stage heart failure. So far, more than 6000 pediatric heart transplantations have been performed worldwide. This article reviews some clinical aspects of pediatric heart transplantation, including the history, indications and contraindications, donor evaluation and recipient management, surgical techniques, risk factors of mortality, and survival of pediatric heart transplantation. The short- and long-term outcomes of pediatric heart transplantation are encouraging. However, the lack of donor hearts still hampers its clinical application. [source]

Dermatofibrosarcoma protuberans: a population-based cancer registry descriptive study of 66 consecutive cases diagnosed between 1982 and 2002

JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 10 2006
D Monnier
Abstract Background, Dermatofibrosarcoma protuberans (DFSP) is a rare malignant tumour of the skin, with an estimated incidence of 0.8 to five cases per 1 million people per year. Objective, To study epidemiological, immunohistochemical and clinical features, delay in diagnosis, type of treatment and outcome of DFSP from 1982 to 2002. Methods, Using data from the population-based cancer registry, 66 patients with pathologically proved DFSP were included (fibrosarcomatous DFSP were excluded). Each patient lived in one of the four departments of Franche-Comté (overall population of 1 million people) at the time of diagnosis. The main data sources came from public and private pathology laboratories and medical records. The rules of the International Agency for Research on Cancer were applied. Results, The estimated incidence of DFSP in Franche-Comté was about three new cases per 1 million people per year. Male patients were affected 1.2 times as often as female patients were. The trunk (45%) followed by the proximal extremities (38%) were the most frequent locations. DFSP occurred mainly in young adults between 20 and 39 years of age. Mean age at diagnosis was 43 years, and the mean delay in diagnosis was 10.08 years. Our 66 patients initially underwent a radical local excision. Among them, 27% experienced one or more local recurrences during 9.6 years of follow-up. There was one regional lymph node recurrence without visceral metastases. These recurrences were significantly related to the initial peripheral resection margins. We observed a local recurrence rate of 47% for margins less than 3 cm, vs. only 7% for margins ranging from 3 to 5 cm [P = 0.004; OR = 0.229 (95%, CI = 0.103,0.510)]. The mean time to a first local recurrence was 2.65 years. Nevertheless, there was no death due to the DFSP course at the end of the follow-up, and the final outcome was favourable. Conclusion, Our study emphasizes the importance of wide local excision with margins of at least 3 cm in order to prevent local recurrence. However, the recent development of inhibitors of signal transduction by the PDGFB pathway should soon modify the surgical strategy, which is often too mutilating. [source]

Evaluation of a Navigation System for ENT with Surgical Efficiency Criteria,

Successful Living Donor Liver Transplantation in Portomesenteric Thrombosis

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 6 2010
S. G. Iyer
Chronic portal vein thrombosis (PVT) is often considered a relative contraindication for living donor liver transplantation due to the risks involved and higher morbidity. In this report, we describe a surgical strategy for living donor liver transplant in patient with complete PVT using venovenous bypass from the inferior mesenteric vein (IMV) and then using a jump graft from the IMV for portal inflow into the graft. IMV is a potential source for portal inflow in orthotopic liver transplant. [source]

Beneficial Effect of Preventative Intra-Aortic Balloon Pumping in High-Risk Patients Undergoing First-Time Coronary Artery Bypass Grafting,A Single Center Experience

ARTIFICIAL ORGANS, Issue 8 2009
Qingcheng Gong
Abstract Although intra-aortic balloon pumping (IABP) has been used widely as a routine cardiac assist device for perioperative support in coronary artery bypass grafting (CABG), the optimal timing for high-risk patients undergoing first-time CABG using IABP is unknown. The purpose of this investigation is to compare preoperative and preventative IABP insertion with intraoperative or postoperative obligatory IABP insertion in high-risk patients undergoing first-time CABG. We reviewed our IABP patients' database from 2002 to 2007; there were 311 CABG patients who received IABP treatment perioperatively. Of 311 cases, 41 high-risk patients who had first-time on-pump or off-pump CABG (presenting with three or more of the following criteria: left ventricular ejection fraction less than 0.45, unstable angina, CABG combined with aneurysmectomy, or left main stenosis greater than 70%) entered the study. We compared perioperatively the clinical results of 20 patients who underwent preoperative IABP placement (Group 1) with 21 patients who had obligatory IABP placement intraoperatively or postoperatively during CABG (Group 2). There were no differences in preoperative risk factors, except left ventricular aneurysm resection, between the two groups. There were no differences in indications for high-risk patients between the two groups. The mean number of grafts was similar. There were no significant differences in the need for inotropes, or in cerebrovascular, gastrointestinal, renal, and infective complications postoperatively. There were no IABP-related complications in either group. Major adverse cardiac event (severe hypotension and/or shock, myocardial infarction, and severe hemodynamic instability) was higher in Group 2 (14 [66.4%] vs. 1 [5%], P < 0.0001) during surgery. The time of IABP pumping in Group 1 was shorter than in Group 2 (72.5 ± 28.9 h vs. 97.5 ± 47.7 h, P < 0.05). The duration of ventilation and intensive care unit stay in Group 1 was significantly shorter than in Group 2, respectively (22.0 ± 1.6 h vs. 39.6 ± 2.1 h, P < 0.01 and 58.0 ± 1.5 h vs. 98.5 ± 1.9 h, P < 0.005). There were no differences in mortality between the two groups (n = 1 in Group 1 and n = 3 in Group 2). Preoperative and preventative insertion of IABP can be performed safely in selected high-risk patients undergoing CABG, with results comparable to those in patients who received obligatory IABP intraoperatively and postoperatively. Therefore, earlier IABP support as part of surgical strategy may help to improve the outcome in high-risk first-time CABG patients. [source]

Sphincter preservation in rectal cancer is associated with patients' socioeconomic status

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 10 2010
L. I. Olsson
Background: Decision making regarding the choice of surgical procedure in rectal cancer is complex. It was hypothesized that, in addition to clinical factors, several aspects of patients' socioeconomic background influence this process. Methods: Individually attained data on civil status, education and income were linked to the Swedish Rectal Cancer Registry 1995,2005 (16 713 patients) and analysed by logistic regression. Results: Anterior resection (AR) was performed in 7433 patients (44·5 per cent), abdominoperineal resection (APR) in 3808 (22·8 per cent) and Hartmann's procedure in 1704 (10·2 per cent). Unmarried patients were least likely (odds ratio (OR) 0·76, 95 per cent confidence interval (c.i.) 0·64 to 0·88) and university-educated men were most likely (OR 1·30, 1·04 to 1·62) to have an AR. Patients with the highest income were more likely to undergo AR (OR 0·80, 0·85 and 0·86 respectively for first, second and third income quartiles). Socioeconomic differences in the use of AR were smallest among the youngest patients. Unmarried patients were more likely (OR 1·21, 95 per cent c.i. 1·00 to 1·48) and university-educated patients less likely (OR 0·78, 95 per cent c.i. 0·63 to 0·98) to have an APR. Conclusion: The choice of surgical strategy in rectal cancer is not socioeconomically neutral. Confounding factors, such as co-morbidity or smoking, may explain some of the differences but inequality in treatment is also plausible. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Ineffective oesophageal motility does not affect the clinical outcome of open Nissen fundoplication

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 8 2004
V. Munitiz
Background: Nissen fundoplication is considered the ,gold standard' in antireflux surgery but some surgeons employ a different surgical strategy when gastro-oesophageal reflux disease (GORD) is associated with motor disorders of the oesophageal body. Methods: Ninety-three patients undergoing surgery for GORD were divided into two groups: 52 patients (group 1) had normal oesophageal body motility and 41 (group 2) had ineffective oesophageal motility (IOM). All patients had a short Nissen fundoplication via a laparotomy. The median follow-up was 5 years in group 1 and 6·5 years in group 2. Results: The clinical outcome was satisfactory in more than 90 per cent of the patients in both groups. Only one of ten patients with IOM and dysphagia before operation still had dysphagia after surgery. One patient in each group developed postoperative dysphagia. Six of 52 patients with normal motility and eight of 41 with IOM had persistent pathological acid reflux after surgery. Significant increases in contractile wave pressure and a decrease in the percentage of non-propagated waves were found in group 2 after fundoplication. Conclusion: Patients with IOM did not have an increased rate of dysphagia after total fundoplication compared with those with normal motility, but they did have a higher rate of recurrence of endoscopic and pH-proven reflux. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

The intracarotid amobarbital or Wada test: unilateral or bilateral?

ACTA NEUROLOGICA SCANDINAVICA, Issue 3 2009
S. G. Uijl
Objective,,, In the Netherlands, presurgical screening for temporal lobe epilepsy (TLE) includes the intracarotid amobarbital procedure (IAP), consisting of two consecutive injections of amobarbital, ipsilateral and contralateral to the epileptic focus. We studied whether a bilateral IAP has added value to a unilateral, ipsilateral IAP. Methods,,, This population-based study included 183 consecutive patients referred for screening for TLE surgery who underwent bilateral IAP. Using multivariable modeling, we assessed the added value of bilateral IAP on the decision for surgery, resection size, amygdalohippocampectomy, post-operative seizure freedom, memory performance, and IQ change. Results,,, Given the results from the unilateral IAP, the bilateral IAP had added prognostic value for postoperative change in verbal memory (P < 0.01) and verbal IQ (P < 0.01), especially if patients had a left-sided focus. In contrast, information provided by the contralateral IAP was not associated with decision-making or surgical strategy. Conclusions,,, A bilateral IAP has added value in predicting post-operative verbal memory and IQ. A bilateral IAP is currently not used to guide surgical strategy, but may be used for this purpose when verbal capacity is of particular concern in patients with a left-sided focus. In other cases, IAP is best performed unilaterally. [source]

Surgical management of intratemporal lesions

CLINICAL OTOLARYNGOLOGY, Issue 5 2001
A Bozorg Grayeli
In order to evaluate the decisional elements in the surgical strategy of deep-seated and/or extensive intratemporal lesions, a retrospective review of cases followed up between 1985 and 1996 in our department was undertaken. Eighty-one adult patients presenting temporal bone lesions located or extending beyond the middle ear limits excluding vestibular schwannomas and surgically treated were included. The population comprised 38 men and 43 women (mean age: 43 years, range: 17,81). Pre-, intra- and postoperative data were collected from medical files. The principal factors influencing the choice of the surgical approach were the location of the lesion and its presumed aggressiveness, the tumour involvement of the internal carotid artery and the labyrinth on preoperative imaging, and the preoperative hearing loss. A coherent algorithm based on these factors can be proposed for the surgical management of intratemporal lesions. High quality preoperative imaging is mandatory for the surgical planning. [source]