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Surgical Treatment Options (surgical + treatment_option)
Selected AbstractsSurgical treatment options for hidradenitis suppurativa and critical review of own experienceEXPERIMENTAL DERMATOLOGY, Issue 6 2006Wolfgang Christian Marsch HS (acne inversa) is a chronic, progressive, initially inflammatory, ultimately a fistulating and scarring disease affecting apocrine gland-bearing skin areas. Late phases afford a broad surgical removal of affected skin areas including subcutaneous fatty tissue, with secondary mesh grafting after a period of granulation tissue formation. Fifty-three patients have been treated surgically at our Dermatology Department. Long-term results are excellent concerning satisfaction of the patients and functional objectives. Local recurrences or development of new lesions in formerly unaffected areas were noticed only in some patients who did not stop smoking. Patient details were as follows: gender distribution: male (M) 20 (38%), female (F) 33 (62%), age: M 19,62 (average 40.7), F 15,56 (average 35.4), onset: M 16,57 (32.2), F 8,50 (25.5), duration: 3 months to 37 years (8.0), F 6 months to 37 years (9.9). Sites mainly affected: axillary and perigenital. Specific regions for men: perineum and rima ani, for women: inguinal, submammary and abdominal. Multiple anatomical regions involved: men 40%, women 91%. Familiarity 0.4%. Associated acne papulo-pustulosa or nodulo-cystica (=conglobata): 19%. Cigarette smokers: men 100%, women 67%. Excised material from each operation was carefully examined histologically. The results endorse the concept of ,acne inversa' by recognizing a perifollicular accumulation of lymphocytes simultaneously at different infrainfundibula of terminal hair follicles. However, a follicular hyperkeratosis seems secondary to this, follicular perforation, and a combination of sinus, abscess and scar formation are most obviously tertiary events. Therefore, HS seems to be an inflammatory, probably an immunological disease with an initially strictly dermal target, even followed by an intradermal horizontal propagation. Laser flux imaging could visualize the subclinical peripheral extension of the basically dermal perifollicular inflammation. Biologics may have a beneficial effect on these early or perpetuating inflammatory events; however, thus far surgery remains the first-line therapy in late phases of the disease. [source] Volume Reduction Surgery for End-Stage Ischemic Heart DiseaseECHOCARDIOGRAPHY, Issue 7 2002Takahiro Shiota M.D. The Dor procedure, or infarction excision surgery, was first used in 1984. It is a surgical treatment option for patients with end-stage ischemic heart failure. In a recently published multicenter study that included a total of 439 patients, average ejection fraction increased from 29 ± 10% to 39 ± 12% after surgery. In our experience, the overall survival rate 18 months after surgery is 89%, and the preoperative mortality rate is 6.6%. These results are similar to the previous reports from Dor,s group, which confirmed the certain value of the surgery. Echocardiography, including intraoperative transesophageal echocardiography, plays an important role in clarifying cardiac anatomies, absolute left ventricular (LV) volumes, ejection fraction, and mitral regurgitation in patients with ischemic heart failure undergoing this surgery. With the development of ultrasound and computer technology, three-dimensional echocardiography may be preferred when evaluating the surgical results, including determination of absolute LV volumes. Communication between experienced cardiac surgeons and echocardiographers in the operating room is essential for successful outcomes and reliable evaluation of the surgery. [source] Endolymphatic Sac Decompression as a Treatment for Meniere's DiseaseTHE LARYNGOSCOPE, Issue 8 2005William F. Durland Jr MD Abstract Objectives/Hypothesis: Endolymphatic sac decompression is a surgical treatment option for patients with medically intractable Meniere's disease. However, effectiveness is debated because published data show great variability. Outcome-based research studies are useful in incorporating the patient's perspective on the success of treatment. To further assess effectiveness of endolymphatic sac decompression, we performed a prospective study to examine both symptom-specific and general health outcomes. Study Design: Prospective, observational outcome study. Methods: Nineteen patients with endolymphatic sac decompression responded to symptom-specific questionnaires and the Medical Outcomes Short-Form 36 Health Survey (SF-36) before and after surgery. Follow-up ranged from 6 to 58 months with a mean duration of 50 months. Results: Overall measures of physical health were significantly improved following endolymphatic sac decompression (P = .04), whereas overall measures of mental health were unchanged (P = .74). Role Physical and Social Functioning scores were significantly improved following endolymphatic sac decompression (P = .04 and P = .03, respectively). Study patients scored significantly lower (P < .05) than SF-36 normative data in 6 of 10 categories before endolymphatic sac decompression but patient scores were not significantly different from normal scores in all but one category (General Health) following endolymphatic sac decompression. The mean number of vertigo episodes was significantly reduced from an average of 8.3 times per month to an average of 2.6 times per month following endolymphatic sac decompression (P = .006). Ninety-five percent of patients (18 of 19 patients) reported improvement in symptoms (frequency, duration, or intensity) of vertigo and 37% (7 of 19 patients) reported complete resolution of vertigo. Conclusion: Endolymphatic sac decompression significantly improved perception of physical health, as well as symptom-specific outcomes, in patients with medically intractable Meniere's disease. [source] ADVANCES IN CLINICAL PRACTICE: New endoscopic and surgical treatment options for early esophageal adenocarcinomaJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 9 2010Susan Gan Abstract Although the outcome for advanced stage esophageal cancer is poor, the early detection and treatment of early stage disease is usually associated with a much better outcome. Until recently, esophagectomy has been the treatment of choice in fit patients. However, morbidity is significant, and this has encouraged the development of newer endoscopic treatments that preserve the esophagus. These techniques include ablation and mucosal resection. Promising results are described, and endoscopic methods might provide a reasonable alternative for the treatment of early esophageal cancer. However, follow-up remains short and endoscopic treatment does not deal with potential lymphatic spread. Hence, careful selection is required. Minimally invasive techniques for esophageal resection have also been shown to be feasible, although there is only limited evidence that they reduce postoperative morbidity. Better data are still required to demonstrate improved outcomes from endoscopic treatment and minimally invasive esophagectomy. [source] Diagnosis and medical management of endometriosisPRESCRIBER, Issue 24 2006Alex Swanton MRCOG The choice of treatment in endometriosis is dictated by symptom severity and whether the patient wishes to conceive. Our Drug Review describes the surgical diagnosis and medical and surgical treatment options, followed by sources of further information and the Datafile. Copyright © 2006 Wiley Interface Ltd [source] 3446: Management and therapy of MGDACTA OPHTHALMOLOGICA, Issue 2010JM BENITEZ-DEL-CASTILLO Purpose Treatment of Meibomian gland dysfunction varies greatly among eye care providers.Practitioners have noted widespread deficiencies in the patient education. As a result, suboptimal and ineffective therapy is commonly practiced and abandoned prematurely as ineffective. The aim of the subcommittee was to review the current practice and published evidence of medical and surgical treatment options for Meibomian gland dysfunction and to identify areas with conflicting or lack of evidence, observations, concepts or even mechanisms were further research is required. Methods To achieve this a comprehensive review of clinical textbooks and scientific literature was performed and the quality of published evidence graded according to an agreed standard, using objective criteria for clinical and basic research studies. Results Lid warming and cleansing, artificial lubricants, systemic tetracyclines, topical antibiotic and or antibiotic-steroid combinations are commonly prescibed. Future developments are described. Conclusion The subcommittee have prsented current and future treatment options for Meibomian gland dysfunction. [source] | ||||||||||