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Enucleation
Kinds of Enucleation Selected AbstractsEnucleation of an advanced esophageal gastrointestinal stromal tumor with liver metastasisJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 2 2006Chien-Sheng Huang [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] Enucleation of renal cell carcinoma with ablation of the tumour baseBJU INTERNATIONAL, Issue 6 2008Alexander Kutikov OBJECTIVE To retrospectively assess the effectiveness of cancer control with enucleation of renal cell carcinoma (RCC), which is surgically expedient, allows preservation of maximal renal parenchyma, and makes intraoperative renal ischaemia unnecessary, by two surgeons routinely enucleating renal tumours and ablating the tumour bed with argon beam and the Nd-YAG laser. PATIENTS AND METHODS Between 1996 and 2006 at our institution, 97 patients had RCC enucleated, with ablation of the tumour base. Patients with lesions other than RCC and those with von Hippel-Lindau disease or Birt-Hogg-Dube syndrome were excluded from the study. The mean follow-up was 24.9 months. Patients were evaluated for RCC recurrence with cross-sectional imaging at least every 6 months for the first 2 years and then annually thereafter. RESULTS The mean (median, range) tumour size was 2.8 (2.5, 0.8,7.0) cm. Of the 97 patients only one had disease progression after a mean follow-up of 24.9 months. This patient presented with a solitary grade 2 clear cell RCC and had a local recurrence 30 months after original surgery. CONCLUSIONS The present series and other available clinical data suggest that enucleation with cavity ablation is an oncologically sound approach that is simple, versatile and obviates the need for renal ischaemia. [source] The lateral periodontal cyst: aetiology, clinical significance and diagnosisDENTAL TRAUMATOLOGY, Issue 4 2000N. P. Kerezoudis Abstract , The lateral periodontal cyst (LPC) is a relatively uncommon but widely recognized odontogenic cyst of developmental origin. It is found mostly in adults and has no sex predilection. LPC is usually discovered during routine radiographic examination, is located mainly between the roots of vital mandibular canines and premolars, and seldom causes pain or other clinical symptoms. The defect appears on radiographs as a round or teardrop-shaped, well circumscribed radiolucency. Due to its location it can easily be misdiagnosed as a lesion of endodontic origin. In this paper, two cases of lateral periodontal cysts are presented. In the first case, the patient (woman, 62 years old) complained of an asymptomatic gingival swelling in the region between the right maxillary canine and premolar. The radiographic examination revealed a well circumscribed radiolucency with a radiopaque margin between the roots of the canine and premolar. The adjacent teeth had vital pulp. Surgical enucleation of the lesion was performed and the histological examination revealed that the lesion was a "lateral periodontal cyst of developmental origin". In the second case, the patient (woman, 44 years old) compained of a swelling in the area of tooth 32. During radiographic examination a well circumscribed radiolucency between the roots of the lateral incisor and the canine was discovered. Surgical enucleation of the lesion was performed and the histological examination revealed that the lesion was a "lateral periodontal cyst of developmental origin". [source] Thoracoscopic enucleation of esophageal leiomyoma: a retrospective study on 40 casesDISEASES OF THE ESOPHAGUS, Issue 3 2009G. Jiang SUMMARY Esophageal leiomyoma is the most common benign esophageal tumor. Thoracoscopic enucleation is currently a preferred approach to most of these lesions. We present our experiences of enucleation of these tumors using thoracoscopic approach. A retrospective review of 40 patients who underwent enucleation of esophageal leiomyoma from 1997 to 2007 in our institute was conducted. Presenting symptoms, operative approach, tumor size, tumor shape, outcomes, and indication for this approach were analyzed. Forty patients were identified. Postoperative histopathology confirmed the leiomyoma in all patients. The thoracoscopic enucleation was completed in 34 cases, and the operation was converted to open procedure in six cases. Reasons for conversion included too small tumors to be visualized in two cases, thoracic cavity adhesion in one case, and the too large tumors in three cases. The median operating time was 70 min (50 to 210 min). Mean tumor size was 3.7 cm (0.5,10 cm). There were no major postoperative complications. Symptoms especially dysphasia were relieved postoperatively. Short- and long-term follow-up was satisfactory with none of the patients having tumor recurrences or other problems. Thoracoscopic enucleation of esophageal leiomyoma is technically safe and effective. It is currently the best choice for management of esophageal leiomyoma 1 to 5 cm in diameter. It can also be tried on a tumor larger than 5 cm, although the possibility of conversion to thoracotomy increases along with tumor growing and surrounding the esophagus. [source] Return to work following unilateral enucleation in 34 horses (2000,2008)EQUINE VETERINARY JOURNAL, Issue 2 2010M. E. UTTER Summary Reasons for study: The effect of unilateral enucleation on vision and potential loss of performance in horses has received little study. Objective: To evaluate the likelihood of return to prior discipline following unilateral enucleation in horses, assessing the role of age at enucleation, equine discipline, reason for enucleation, time to vision loss and eye enucleated. Hypothesis: Unilateral enucleation has no significant effect on likelihood of return to work in horses, for both right and left eyes, across age and discipline. Method: A retrospective review of medical records identified 92 horses that underwent unilateral enucleation at the University of Pennsylvania New Bolton Center from April 2000,April 2008. Case variables determined from the medical record included breed and sex of horse, age at enucleation, which eye was enucleated, reason for enucleation and onset of vision loss. Pre- and post operative occupations were determined by telephone interview with the owner or trainer of each horse. Results: Based on hospital surgery logs, 92 enucleations were performed over the 8 year period and 77 records were available for review, with follow-up information available for 34 horses. Of these, 29/34 (85%) horses returned to work in pleasure or trail riding (11/13), flat racing (7/10), hunter/jumpers (4/4), dressage (3/3), group lessons (1/1), eventing (1/1), steeplechase (1/1) and as a broodmare (1/1). Four of 5 horses (4/34, or 12% sample) that did not return to work (2 pleasure and 2 racing) were retired due to anticipated or perceived decrease in performance or behaviour change following unilateral enucleation, with the remaining horse retired from racing for lameness issues unrelated to enucleation. Twenty-two of 25 horses (88%) with acute vision loss and 7/9 horses (78%) with gradual vision loss returned to their previous discipline. Conclusions: Horses are able to return to a variety of occupations after unilateral enucleation. [source] Developmental and activity-dependent genomic occupancy profiles of CREB in monkey area V1GENES, BRAIN AND BEHAVIOR, Issue 2 2009J. Lalonde The mammalian neocortex displays significant plastic rearrangement in response to altered sensory input, especially during early postnatal development. It is believed that cyclic AMP-response element-binding (CREB) plays an important role in orchestrating the molecular events that guide neuroplastic change, although the details of its genomic targets during normal postnatal development or in response to sensory deprivation remain unknown. Here, we performed CREB chromatin immunoprecipitation (ChIP) from monkey area V1 tissue and hybridized enriched DNA fragments to promoter microarrays (ChIP chip analysis). Our goal was to determine and categorize the CREB regulon in monkey area V1 at two distinct developmental stages (peak of critical period vs. adulthood) and after 5 days of monocular enucleation (ME) at both ages. Classification of enriched candidates showed that the majority of isolated promoter loci (n = 795) were common to all four conditions. A particularly interesting group of candidates (n = 192) was specific to samples derived from enucleated infant area V1. Gene ontology analysis of CREB targets during early postnatal development showed a subgroup of genes implicated in cytoskeleton-based structural modification. Analysis of messenger RNA expression (quantitative real-time,polymerase chain reaction) of candidate genes showed striking differences in expression profiles between infant and adult area V1 after ME. Our study represents the first extensive genomic analysis of CREB DNA occupancy in monkey neocortex and provides new insight into the multifaceted transcriptional role of CREB in guiding neuroplastic change. [source] Modifications of retinal afferent activity induce changes in astroglial plasticity in the hamster circadian clockGLIA, Issue 2 2001Monique Lavialle Abstract The circadian clock, located in the suprachiasmatic nucleus (SCN) of the hypothalamus in mammals, exhibits astroglial plasticity indicated by GFAP expression over the 24-h period. In this study, we evaluated the role of neuronal retinal input in the observed changes. Modifications of retinal input, either by rearing animals under darkness (DD) or under constant light (LL), or by suppressing afferent input (bilateral enucleation), induced drastic changes in astroglial plasticity. In enucleated animals, a dramatic decrease in GFAP expression was evident in the area of the SCN deprived of retinal projections, whereas persistence of a rhythmic variation was in those areas still exhibiting GFAP expression. By contrast, no changes in astrocytic plasticity were detected in hamsters maintained under LL. These data suggest two fundamental roles for astrocytes within the SCN: (1) to regulate and mediate glutamate released by retinal terminals throughout the neuronal network to facilitate photic signal transmission; (2) to contribute to synchronization between suprachiasmatic neurons. GLIA 34:88,100, 2001. © 2001 Wiley-Liss, Inc. [source] Recurrent pleomorphic adenoma of the parotid gland: Analysis of 108 consecutive patientsHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 9 2007Claus Wittekindt MD Abstract Background Surgery for recurrent parotid pleomorphic adenoma is a challenging problem. Methods One hundred eight patients who underwent 134 reoperations for recurrent parotid pleomorphic adenoma (follow-up, 22 years) were evaluated for histopathologic features and risk factors for recurrence. Results The number of reoperations for tumor recurrence ranged from 1 to 10. Twenty-seven patients (25%) developed permanent facial nerve weakness. The risks for clinically evident rerecurrence after 1, 5, and 15 years were 16%, 42%, and 75%, respectively. Female sex, young age at initial treatment, and enucleation instead of parotidectomy for treatment of the first recurrence were significant risk factors for rerecurrence. The mean number of recurrent tumor nodules was 26. Conclusions Surgery for recurrent parotid pleomorphic adenoma has a high rate of facial nerve morbidity. The chance of rerecurrence is high. Extended parotidectomy seems to be the best approach for the reoperation to reduce the risk of rerecurrence. © 2007 Wiley Periodicals, Inc. Head Neck 2007 [source] Rhabdomyoma of the head and neck: Clinicopathologic features of two casesHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 8 2003Gianfranco Favia MD Abstract Background. Extracardiac rhabdomyomas are rare benign tumors of the head and neck. They are frequently misdiagnosed and possibly overtreated when confused with other aggressive tumors. Methods. This article reports on the clinicopathologic features of two such tumors affecting adult patients and initially seen as slowly-growing, indolent neoplasms. Results. The tumors were of fibrous consistency, mobile, with well-demarcated borders and evident lines of cleavage. Both patients were treated by conservative surgery and remained disease-free after prolonged clinical observation. Histologically, both tumors were composed of large eosinophilic cells intermingled with polyhedral clear cells. Both cell types contained abundant glycogen accumulations. Conclusions. The differential diagnosis is with granular cell tumor and with sarcomas, the former being easily distinguishable morphologically, and the latter be seen with more rapid growth and adherence to the adjacent tissues. On the basis of the preceding features, rhabdomyomas can be suspected at a preoperative stage and adequately managed with enucleation or simple excision. © 2003 Wiley Periodicals, Inc. Head Neck 25: 700,704, 2003 [source] Case Report: Unusual solitary metastasis of the ciliary body in renal cell carcinomaINTERNATIONAL JOURNAL OF UROLOGY, Issue 4 2008Vito Mancini Abstract: Renal cell carcinoma (RCC) usually metastasizes to the lung, liver, bone; ocular metastasis is uncommon. We describe a rare case of metachronous ciliary RCC metastasis in a 42-year-old man who had undergone left radical nephrectomy for conventional RCC (pT3aN0M0, G2 Fuhrman) 6 years earlier. Solitary metastasis of the left eye presented with inflammatory symptoms, but examination of the fundus and bulbar ultrasound revealed a small mass of the ciliary body. Initial radiotherapy was unsuccessful and definitive treatment consisted of ocular enucleation with radical result and no further evidence of local and distant disease. Ocular metastasis of RCC is rare, can appear years after treating the primary tumor and should not be excluded in RCC follow-up. As for other RCC solitary metastasis, the best option remains the radical surgical approach. [source] Holmium laser enucleation for large (greater than 100 mL) prostate glandsINTERNATIONAL JOURNAL OF UROLOGY, Issue 5 2002Janaka A Hettiarachchi Abstract Background: To evaluate the holmium laser enucleation of the prostate (HoLEP) using the transurethral soft tissue morcellator (TUSTM), as a primary surgical treatment for symptomatic benign prostatic hyperplasia (BPH) with prostate glands >,100 mL. Methods: Eighteen patients with preoperative prostate volumes >,100 mL underwent the HoLEP procedure. The criteria for surgery were determined by a preoperative International Prostate Symptom Score (IPSS), a prior failure of medical therapy, and urinary retention. Results: The mean preoperative IPSS and prostate gland size were 13.8 and 142.3 mL, respectively. The total energy used by the laser was 288.4 kJ. The mean catheter time was 23.8 h and, perioperatively, no patients had electrolyte abnormalities or required blood transfusions. The 3-week postoperative IPSS was 2.8, with minimum long-term complications. Conclusions: Holmium laser enucleation of the prostate with TUSTM is a safe and effective alternative to open prostatic surgery for glands >,100 mL. [source] Use of picosecond infrared laser for micromanipulation of early mammalian embryosMOLECULAR REPRODUCTION & DEVELOPMENT, Issue 10 2009Artashes V. Karmenyan A high repetition rate (80 MHz) picosecond pulse (,2 psec) infrared laser was used for the inactivation (functional enucleation) of oocytes and two-cell mouse embryos and also for the fusion of blastomeres of two-cell mouse embryos. The laser inactivation of both blastomeres of two-cell mouse embryos by irradiation of nucleoli completely blocked further development of the embryo. The inactivation of one blastomere, however, did not affect the ability of the second intact blastomere to develop into a blastocyst after treatment. Laser inactivation of oocytes at Metaphase II (MII) stage and parthenogenetically activated pronuclear oocytes also completely blocked their ability for further development. Suitable doses of irradiation in cytoplasm region did not affect the ability of embryos and activated oocytes to development. The efficiency of laser induced fusion for blastomeres of two-cell embryos was 66.7% and all the tetraploid embryos developed successfully into blastocysts in culture. Our results demonstrate unique opportunities of the applications of a suitable infrared periodic pulse laser as a universal microsurgery tool for individual living cells. Mol. Reprod. Dev. 76: 975,983, 2009. © 2009 Wiley-Liss, Inc. [source] The oculocardiac reflex in a congenitally anophthalmic childPEDIATRIC ANESTHESIA, Issue 3 2001B Ward MA, MB BChir We report a case of reflex bradycardia due to ophthalmic surgical stimulus in a congenitally anophthalmic child. Although the oculocardiac reflex has been previously reported from the empty orbit following enucleation, we are unaware of other cases involving a congenital absence of the globe. [source] Predictive factors of invasion in eyes with retinoblastoma enucleated after eye salvage treatmentsPEDIATRIC BLOOD & CANCER, Issue 3 2009Julia Balaguer MD Abstract Background The impact of chemotherapy, focal therapies, radiation and co-existing ocular morbidities on histology of eyes with retinoblastoma enucleated following chemoreduction is not well known. Procedure Twenty-five eyes (23 patients) with retinoblastoma enucleated after failing eye-salvage therapy were evaluated. Reasons for enucleation (tumor progression, subretinal or vitreous seeds) and co-morbid conditions (neovascular glaucoma, cataract, vitreous hemorrhage and retinal detachment) were documented. All specimens were reviewed for evidence of ciliary body, choroidal, optic nerve, and scleral invasion. Results The median age at diagnosis was 14 months (range, 1,37 months). Twenty eyes were classified as Reese-Ellsworth Group IV,V at diagnosis. Twenty-four eyes had recurrent disease at enucleation; one eye was enucleated for neovascular glaucoma and vitreous hemorrhage. Co-existing ocular morbidities at enucleation included vitreous hemorrhage (n,=,6), retinal detachment (n,=,9), neovascular glaucoma (n,=,9) and cataracts (n,=,3). Histologic findings included choroidal invasion (n,=,7), ciliary body invasion (n,=,4), optic nerve invasion (n,=,6) and scleral invasion (n,=,3). The median time from diagnosis to enucleation was 11 months. Co-existing retinal detachment and vitreous hemorrhage significantly increased the likelihood of optic nerve invasion (P,=,0.014 and P,=,0.011, respectively). Prolonged time to enucleation was significantly associated with the likelihood of choroidal (P,=,0.010) and ciliary body (P,=,0.021) invasion as well as invasion of multiple sites. Conclusion In eyes with retinoblastoma enucleated after chemoreduction, co-existing ocular morbidities and time to enucleation are predictive of extra-retinal extension. Pediatr Blood Cancer 2009;52:351,356. © 2008 Wiley-Liss, Inc. [source] Management of retinoblastoma with proximal optic nerve enhancement on MRI at diagnosisPEDIATRIC BLOOD & CANCER, Issue 4 2008Saro H. Armenian DO Abstract Background In North America, retinoblastoma rarely presents with gross clinical evidence of tumor involving the optic nerve. Extent of microscopic tumor infiltration into the postlaminar optic nerve is a significant risk factor for metastasis, especially if there is tumor at the cut end. Due to poor outcomes in patients with metastatic disease, historical treatment for patients with clinical evidence of extraocular optic nerve involvement has included upfront enucleation followed by aggressive adjuvant chemotherapy. Additional orbital irradiation is advocated for individuals with optic nerve involvement at the surgical margin. Little is known about the role of neoadjuvant therapy in the setting of orbital optic nerve enhancement on magnetic resonance imaging (MRI) at diagnosis. Methods A retrospective review of consecutive retinoblastoma cases at Childrens Hospital Los Angeles over a 3-year period (2004,2006) found to have gadolinium contrast enhancement in the proximal portion of optic nerve on MRI at diagnosis. Results Nine patients fit the inclusion criteria. Two had secondary glaucoma of a sufficient degree to cause an enlarged eye (buphthalmos). Median age at presentation was 17 months (2,36 months). All patients received neoadjuvant chemotherapy prior to enucleation. Only two received external beam radiation. All are disease-free with a median follow-up of 22 months (12,41 months). Conclusions Neoadjuvant chemotherapy is well tolerated prior to enucleation of retinoblastoma-containing eyes associated with contrast enhancement of the proximal optic nerve on MRI at diagnosis. Such an approach may be used to decrease intensity or duration of chemotherapy and need for external beam radiation. Pediatr Blood Cancer 2008;51:479,484. © 2008 Wiley-Liss, Inc. [source] Salivary gland neoplasms in children: The experience of the Istituto Nazionale Tumori of MilanPEDIATRIC BLOOD & CANCER, Issue 6 2006Marco Guzzo MD Abstract Background Epithelial salivary gland tumors are very uncommon in pediatric age. We report a series of 52 cases treated at the Istituto Nazionale Tumori of Milan, Italy, over a 30-year period. These results are presented in conjunction with a literature review of salivary tumors with a view to providing an up-to-date overview of the clinical course, prognosis, and treatment options for this rare tumor. Procedure Fifty-two cases of epithelial salivary tumors were reviewed and the clinical-pathological information concerning tumor characteristics, therapy, and follow-up were collected. Patients' age ranged between 4 and 18 years. Results The major salivary glands were the main site of tumor occurrence (79% of cases arose in parotid glands); 37 patients had benign tumors (pleomorphic adenoma), 15 had malignant tumors (12 mucoepidermoid carcinoma, 9 low grade). All the patients were treated by surgery; local relapses after parotidectomy were 4% and 25%, in benign and malignant tumors, respectively. When tumor enucleation was performed, recurrences occurred in 50% of benign neoplasms. At the time of the report, all patients with benign tumors were alive, 35(95%) without evidence of disease; only one patient with malignant tumor died of disease. Conclusions Epithelial salivary glands tumor in children had different characteristics compared with their adult counterpart with respect to the frequency of histotypes and site of occurrence, but their prognosis seems to be similar. Parotidectomy (total or superficial) is the best choice for achieving good cure rates in both benign and malignant tumors. Pediatric Blood Cancer 2006;47:806,810. © 2006 Wiley-Liss, Inc. [source] Benign pineal cysts in children with bilateral retinoblastoma: A new variant of trilateral retinoblastoma?PEDIATRIC BLOOD & CANCER, Issue 7 2006Maja Beck Popovic MD Abstract Purpose Patients with hereditary retinoblastoma (Rb) develop in 4%,8% a malignant midline tumor called trilateral Rb (TRb). We report in this study on benign pineal cysts observed in patients investigated for TRb. Patients and Methods Between September 1990 and December 2001, 172 patients were screened for TRb. Ninty-five had bilateral, 77 unilateral disease. The median age at diagnosis of Rb was 7 months (range 1,26). Treatment included enucleation, local treatment with cryotherapy or photocoagulation, first-line chemotherapy (CT), thermo-chemotherapy (TCT), Ruthenium plaque, and, rarely, external beam radiation (EBR). Results TRb was found in 5/95 patients (5.3%) with bilateral disease. Interestingly, five other patients (5.3%) presented a pineal cyst on magnetic resonance imaging (MRI). No cysts were recorded in the 77 patients with unilateral disease. This difference was statistically significant (P,<,0.05). The median age at diagnosis of the pineal cyst was 26 months (range 16,80), much younger than reported in literature for healthy children. Four of five patients with TRb died of the disease, while all the patients with pineal cysts remained stable and asymptomatic during a median follow-up of 41 months (range 37,54). Conclusions This report describes benign cystic lesions of the pineal gland in patients with hereditary Rb, suggesting a benign variant of TRb. Underlying possible pathogenetic mechanisms are discussed. © 2005 Wiley-Liss, Inc. [source] Access of autonomic nerves through the optic canal, and their orbital distribution in manTHE ANATOMICAL RECORD : ADVANCES IN INTEGRATIVE ANATOMY AND EVOLUTIONARY BIOLOGY, Issue 1 2003Gordon L. Ruskell Abstract The notion that autonomic nerves from the internal carotid plexus are transmitted to the orbit with the ophthalmic artery through the optic canal has been variously assumed, disregarded, or denied, but never demonstrated. The objective of this study was to examine the contents of the canal, identify any autonomic nerves, and follow their passage within the orbit. The soft tissues of the optic canal, and the apical tissues of the orbit were removed and examined histologically using 10 cadaver preparations. Additionally, tissues from an orbital exenteration and 10 ocular enucleation or donor specimens were prepared. Some of the latter material was examined with an electron microscope. Numerous autonomic nerves (four to 25, ranging in diameter from 23 to 130 ,m) entered the orbit from the internal carotid plexus in the periosteum of the optic canal, the optic nerve dura mater, or the adventitia of the ophthalmic artery. In the orbit they advanced in the loose connective tissue covering the optic nerve dura and joined ciliary nerves close to the eye or entered the eye directly. None were observed to penetrate the dura, apart from a nerve accompanying the central retinal artery. Others were distributed with the ophthalmic artery and its branches. It is concluded that the optic canal is a regular, and often major, route for autonomic nerve distribution to the eye and orbit. Anat Rec Part A 275A:973,978, 2003. © 2003 Wiley-Liss, Inc. [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] Histopathology of Pleomorphic Adenoma in the Parotid Gland: A Prospective Unselected Series of 100 Cases,THE LARYNGOSCOPE, Issue 12 2001Eberhard Stennert MD Abstract Objectives/Hypothesis Histopathological characteristics of pleomorphic adenomas, especially of capsular alterations such as thin capsule areas, capsule-free regions, capsule penetration, satellite nodules, and pseudopodia in the different subtypes, are described. Study Design Prospective unselected series of 100 consecutive cases from 1997 to 2000. Methods Light microscopic examination and semiquantitative analysis of the pleomorphic adenomas. Results Fifty-one (51%) pleomorphic adenomas were classified as myxoid (stroma-rich) type, 35 (35%) specimens as cellular type, and 14 (14%) as classic subtype. Ninety-seven percent of all tumors showed areas with thin (<20 ,m) capsule independent of the tumor subtype. Tumors of myxoid subtype showed the absolute greatest regions of a thin capsule. Especially, tumors of myxoid type (71%) often had a distinct focal absence of encapsulation with tumor merging into normal parotid gland tissue; 11% of the cellular subtype and 43% of the classic subtype presented capsule-free areas. Thirty-three percent of the myxoid pleomorphic adenomas, 23% of the cellular subtype, and 21% of the classic subtype had satellite nodules or pseudopodia. Conclusions Almost all pleomorphic adenomas have focally thin capsules. One-fourth of all pleomorphic adenomas contain abnormalities such as satellite nodules or pseudopodia. More than two-thirds of pleomorphic adenomas of the myxoid (stroma-rich) subtype and at least half of all tumors show a focal absence of the capsule. Therefore, enucleation or local dissection of the pleomorphic adenoma is not a sufficient surgical treatment of this special tumor entity. We recommend, depending on the location of the tumor, a lateral or total parotidectomy as the treatment of choice. [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] Enucleation of renal cell carcinoma with ablation of the tumour baseBJU INTERNATIONAL, Issue 6 2008Alexander Kutikov OBJECTIVE To retrospectively assess the effectiveness of cancer control with enucleation of renal cell carcinoma (RCC), which is surgically expedient, allows preservation of maximal renal parenchyma, and makes intraoperative renal ischaemia unnecessary, by two surgeons routinely enucleating renal tumours and ablating the tumour bed with argon beam and the Nd-YAG laser. PATIENTS AND METHODS Between 1996 and 2006 at our institution, 97 patients had RCC enucleated, with ablation of the tumour base. Patients with lesions other than RCC and those with von Hippel-Lindau disease or Birt-Hogg-Dube syndrome were excluded from the study. The mean follow-up was 24.9 months. Patients were evaluated for RCC recurrence with cross-sectional imaging at least every 6 months for the first 2 years and then annually thereafter. RESULTS The mean (median, range) tumour size was 2.8 (2.5, 0.8,7.0) cm. Of the 97 patients only one had disease progression after a mean follow-up of 24.9 months. This patient presented with a solitary grade 2 clear cell RCC and had a local recurrence 30 months after original surgery. CONCLUSIONS The present series and other available clinical data suggest that enucleation with cavity ablation is an oncologically sound approach that is simple, versatile and obviates the need for renal ischaemia. [source] Peri-operative complications of holmium laser enucleation of the prostate: experience in the first 280 patients, and a review of literatureBJU INTERNATIONAL, Issue 1 2007Hemendra N. Shah OBJECTIVE To evaluate, in a prospective study, the complications in 280 patients undergoing holmium laser enucleation of the prostate (HoLEP) at our institution, and to review previous reports to determine the overall incidence and types of various complications, and analyse their causes and means of prevention. PATIENTS AND METHODS We analysed the patients' demographic, peri-operative and follow-up data, and the complications during and after surgery. RESULTS HoLEP was completed successfully in 268 patients (95.7%); eight required conversion to transurethral resection of the prostate (TURP) during the initial experience. The morcellation device and laser malfunctioned in two patients each. A blood transfusion was required during HoLEP in one patient; other complications included capsular perforation (9.6%), superficial bladder mucosal injury (3.9%) and ureteric orifice injury (2.1%). A blood transfusion was needed after HoLEP in 1.4% of patients and cystoscopy with clot evacuation in 0.7%. Transient urinary incontinence was the commonest complication after HoLEP, in 10.7% of patients, but recovered spontaneously in all except two (0.7%). Other rare complications were re-catheterization (3.9%), urinary tract infection (3.2%), epididymitis (0.7%), meatal and submeatal stenosis (2.5%), bulbar urethral stricture (2.1%), bladder neck contracture (0.35%) and myocardial infarction (0.35%). CONCLUSIONS There was a low incidence of complications with HoLEP; most were minor and easily managed. Our results are comparable with those published previously, and establish HoLEP as safe and reproducible procedure. While gaining experience, HoLEP can be converted to TURP with no harm to the patient. [source] Simultaneous transurethral cystolithotripsy with holmium laser enucleation of the prostate: a prospective feasibility study and review of literatureBJU INTERNATIONAL, Issue 3 2007Hemendra N. Shah OBJECTIVE To report experience with holmium laser enucleation of the prostate (HoLEP) simultaneously with transurethral holmium laser cystolithotripsy (HLC) for managing bladder outlet obstruction (BOO) and associated vesical calculi; we also review previously reported cases of managing vesical calculi and associated BOO. PATIENTS AND METHODS The high-powered holmium laser is a very efficient multifunctional endourological instrument that effectively fragments calculi of all compositions and is capable of haemostatic cutting of tissue, resulting in minimal bleeding after prostatic resection. A prospective study was conducted from April 2003 that included 32 men who underwent simultaneous HoLEP with transurethral HLC at our institution. Demographic, laboratory, peri-operative and follow-up data were analysed. Complications during and after surgery were identified to assess the morbidity of procedure. RESULTS The mean (range) size of bladder calculi was 34.6 (12,70) mm and the preoperative weight of the prostate was 51.9 (11,172) g. Combined HoLEP with transurethral HLC was technically feasible in all patients, and all were stone-free after surgery. The mean operative duration was 97.7 (40,230) min, the weight of prostate tissue removed 34.6 (5,88) g, and the duration of catheterization and hospital stay 29.3 h and 34.8 h, respectively. Complications during and after surgery occurred in 12.5% and 15.6% of patients, respectively; all complication were minor and none caused any residual disability to the patient. No patient required a blood transfusion or developed clot retention. CONCLUSIONS Managing bladder stones and BOO with simultaneous transurethral HLC and HoLEP should be considered the treatment of choice for such cases. Stones of any size and composition, and prostates of practically any size can be treated endoscopically using the holmium laser, with acceptable morbidity once the technique is mastered. The review of previous reports suggested a need for a prospective study comparing endoscopic management of BOO and associated bladder stones, with medical management of BOO and extracorporeal shock wave lithotripsy/endoscopic lithotripsy for bladder stone. [source] Day-case holmium laser enucleation of the prostate for gland volumes of < 60 mL: early experienceBJU INTERNATIONAL, Issue 1 2003T.R.G. Larner OBJECTIVE To examine the safety and effectiveness of holmium laser enucleation of the prostate (HoLEP), as a day-case procedure for selected patients. PATIENTS AND METHODS Thirty-eight men underwent HoLEP as a day-case procedure; they were discharged with an indwelling catheter for 48 h with ,Hospital In The Home' nursing management. They were evaluated for symptomatic and flow rate improvements after 3 months. Morbidity, length of stay, the duration of catheterization and readmission rates were evaluated. RESULTS The objective symptom score and flow-rate improvements were equivalent to those previously published for transurethral resection of the prostate (TURP). There were five minor complications, three of which required readmission to hospital and one repeat surgery. The mean stay after surgery was 302 min. CONCLUSIONS Day-case HoLEP is a safe and effective treatment for symptomatic benign prostatic hyperplasia. The outcomes are equivalent to those from TURP. Whilst there were three re-admissions to hospital, two only required an overnight stay and no patient required a blood transfusion. [source] 1253: Technique and role of biopsies in intraocular tumoursACTA OPHTHALMOLOGICA, Issue 2010BE DAMATO Purpose To discuss the roles of various forms of biopsy of intraocular tumours, to describe the techniques and to highlight the main pitfalls and complications. Methods Intraocular tumours can be sampled by exo- or endo-biopsy. Exo-biopsy can consist of excisional biopsy (e.g., iridocyclectomy), trans-scleral incisional biopsy, or trans-scleral fine-needle aspiration biopsy. Endo-biopsy comprises vitreous biopsy and retinal or choroidal biopsy performed with a fine needle or vitreous cutter. In rare cases, enucleation is the most pragmatic method of establishing the diagnosis, especially if the eye is blind and painful. Results For many years, biopsy was performed mostly for diagnostic purposes the main reasons being to distinguish melanoma from metastasis and lymphoma from various forms of uveitis. Recently, prognostic biopsy has become more popular, the objective being to determine whether or not a uveal melanoma is likely to be life-threatening. Biopsy can profoundly influence the management of an individual patient but requires special expertise both in the operating theatre and in the laboratory. There are many possible complications, which include endophthalmitis, extraocular seeding of tumour, rhegmatogenous retinal detachment, cataract, haemorrhage, inconclusive result, and mis-diagnosis. Conclusion Biopsy of intraocular tumours is invaluable in the management of selected patients, but requires special expertise to ensure that good results are obtained without causing complications. [source] 3364: Cytokines in enucleated eyesACTA OPHTHALMOLOGICA, Issue 2010MJ JAGER Purpose One of the prognostically bad parameters in uveal melanoma is the presence of an inflammatory phenotype, characterized by an increased expression of HLA antigens and an immunologic infiltrate. We wondered whether the presence of specific chemokines and cytokines in the aqueous humor (AqH) from uveal melanoma-containing eyes is associated with this inflammatory phenotype, with the presence of macrophages, and/or with survival. Methods Directly following enucleation, AqH was obtained from 37 eyes containing uveal melanoma. Samples were stored at -80 °C till use. Using a multiplex bead array, 15 different cytokines were measured. Determination of intratumoral macrophages was performed by immunohistochemistry and immunofluorescence. The presence of specific cytokines was compared to histopathological, genetic and clinical tumor characteristics, as well as patient survival. Results Several cytokines showed a significantly higher expression in the AqH from uveal melanoma-containing eyes compared to the AqH from eyes undergoing cataract surgery. Only MCP-3 was associated with the presence of macrophages and the tumor promoting M2-type macrophage in uveal melanoma patients. Hardly any correlations were found between cytokine levels and known prognostic factors for uveal melanoma. Also, cytokine levels were not of predictive value for survival. Conclusion Although increased levels of inflammation-related cytokines are present in the AqH of uveal melanoma-containing eyes, hardly any associations with the presence of macrophages and their subtypes, with clinical and histopathological parameters, and prognosis were found. [source] 4261: FNA biopsies for genomic analysis and adjuvant therapy for uveal melanomaACTA OPHTHALMOLOGICA, Issue 2010L DESJARDINS Purpose Recent changes in the management of uveal melanoma include the use of biopsies for genomic analysis and the identification of patients with a high risk of metastasis. We wish to describe our first experience with fine needle aspiration (FNA), genome profiling and adjuvant therapy protocol for high risk patients Methods we have started a multicentric adjuvant phase III trial of intravenous fotemustine (FOTEADJ) for high risk uveal melanoma patients. Patients with tumor of 15 mm or more in diameter with retinal detachment or extrascleral extension, patients with tumors of 18 mm or more in diameter and patients with loss of chromosome 3 and gain of entire 8q were considered high risk and eligible. Tumour genome profiling was achieved by array-CGH on a NimbleGen 72K microarray, after whole genome amplification (WGA) in cases of FNAs Local treatment consisted in enucleation or proton beam radiotherapy. FNA was offered to patients treated by radiotherapy for a tumor of 5 mm of thickness or more. Results Between May 2009 and May 2010, 74 patients were offered to participate. Only 16 patients were included because of various reasons: technical problems with the biopsy (13 samples evaluable out of 26 FNA), refusal of the biopsy or the protocol or non inclusion criteria. There has been some improvement in our results since the introduction of WGA for FNA specimens Conclusion Proposing fine needle aspiration biopsy and obtaining sufficient material is not always easy. Including patients in randomized protocols is always a challenge. During the first year for FOTEADJ, only 22% of the eligible patients were enrolled but this percentage is greatly improving with time and experience . [source] 4263: Observation in choroidal melanomasACTA OPHTHALMOLOGICA, Issue 2010C GARCIA-ALVAREZ Purpose The management of suspected small choroidal melanomas is controversial. The purpose of the present study is to assess tumor growth, visual acuity changes, activity factors and survival on choroidal melanoma patients under observation in our Intraocular Tumors Unit. Methods Prospective, consecutive and non-interventional case series. Patients diagnosed with choroidal melanoma from 1990 to 2010 and with observation as therapeutic option were included. Criteria for observation were small size without risk factors for growing; medium and large size: no risk factors for growing (but size), advanced age, bad general health, only eye or treatment rejection. Demographic, tumoral and follow-up data were collected in a data base and analyzed. Results 118 out of 397 patients (29.7%) diagnosed with uveal melanoma were enrolled, with mean age of 66.4 years (SD 14.3). The mean follow-up time was 51.1 months (SD 4.5). Regarding the size, 91 (77.1%) tumors were small and 85 (72.%) were diagnosed in a routine examination. Main reason for observation was tumor small/inactive (80,5%) followed by treatment rejection (17.7%). Mean height was 2.8mm (SD 1.9) and mean base 7.6 (SD 2.8). Along the follow-up, 17 tumors grew; 11 were treated with brachytherapy, 5 with enucleation and one with brachytherapy and enucleation. Only 16 patients died during the follow-up, 2 by melanoma metastasis. Conclusion In our series with more than 4 years of follow up, observation seems to be a safe therapeutic option for selected small choroidal melanomas, allowing the patients to preserve visual function. [source] | |||||||||||||||||||||||||