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Second Operation (second + operation)
Selected AbstractsThe value of frozen section in intraoperative surgical management of thyroid follicular carcinoma,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 7 2003Danijel Do, en MD Abstract Background. Preoperative and intraoperative diagnosis of follicular carcinoma (FC), resulting in one-stage surgical treatment of follicular thyroid tumors, is an important issue in thyroid surgery. Methods. In the 10-year period there were 4158 operations performed on thyroid gland. There were 1559 patients with follicular tumors, 70 (4.4%) of them having FC. We analyzed the groups of patients with FC determined on frozen section (FS) and permanent section (PS) according to duration of clinical symptoms, ultrasound (US) examination, tumor size, patient gender and age, intensity of invasion, localization, and multiple or solitary occurrence of tumor. Results. FC was diagnosed in 39 (55.7%) patients on frozen section (FS). Among the encapsulated (minimal invasion) carcinomas, the FS was accurate in 19 of 33 (57.6%) FC and in 5 of 15 (27.8%) Hürthle cell carcinomas (HCC); among extensively invasive carcinoma in 11 of 14 (78.6%) FC and in 4 of 5 (80.0%) HCC. FC was significantly more common in men (p < .001) and in the right lobe (p < .05). We did not find statistically significant differences concerning duration of symptoms, US examination, tumor size, patient age, and multiple or solitary occurrence of the tumor between the patients with FC diagnosed on FS and the patients with FC diagnosed on PS. Conclusions. The intraoperative diagnosis of FC is difficult. Although the percentage of false-negative results was relatively high (44.3%), there were no false-positive results. This means that the second operation was avoided in 55.7% of the patients, and no unnecessary thyroidectomies were performed. FS biopsy is an important method in surgery of follicular tumors. Improved technical support and the ability to analyze a greater number of slides will increase the accuracy of the method. © 2003 Wiley Periodicals, Inc. Head Neck 25: 521,528, 2003 [source] Retention, Distribution, and Effects of Intraosseously Administered Ibandronate in the Infarcted Femoral Head,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 1 2007James Aya-ay Abstract The local distribution, retention, and effects of intraosseous administration of ibandronate in the infarcted femoral heads were studied. Intraosseous administration effectively delivered and distributed ibandronate in the infarcted femoral heads and decreased the femoral head deformity in a large animal model of Legg-Calve-Perthes disease. Introduction: Bisphosphonate therapy has gained significant attention for the treatment of ischemic osteonecrosis of the femoral head (IOFH) because of its ability to inhibit osteoclastic bone resorption, which has been shown to contribute to the pathogenesis of femoral head deformity. Because IOFH is a localized condition, there is a need to explore the therapeutic potential of local, intraosseous administration of bisphosphonate to prevent the femoral head deformity. The purpose of this study was to investigate the distribution, retention, and effects of intraosseous administration of ibandronate in the infarcted head. Materials and Methods: IOFH was surgically induced in the right femoral head of 27 piglets. One week later, a second operation was performed to inject 14C-labeled or unlabeled ibandronate directly into the infarcted head. 14C-ibandronate injected heads were assessed after 48 h, 3 weeks, or 7 weeks later to determine the distribution and retention of the drug using autoradiography and liquid scintillation analysis. Femoral heads injected with unlabeled ibandronate were assessed at 7 weeks to determine the degree of deformity using radiography and histomorphometry. Results: Autoradiography showed that 14C-Ibandronate was widely distributed in three of the four heads examined at 48 h after the injection. Liquid scintillation analysis showed that most of the drug was retained in the injected head, and almost negligible amount of radioactivity was present in the bone and organs elsewhere at 48 h. At 3 and 7 weeks, 50% and 30% of the 14C-drug were found to be retained in the infarcted heads, respectively. Radiographic and histomorphometric assessments showed significantly better preservation of the infarcted heads treated with intraosseous administration of ibandronate compared with saline (p < 0.001). Conclusions: This study provides for the first time the evidence that local intraosseous administration is an effective route to deliver and distribute ibandronate in the infarcted femoral head to preserve the femoral head structure after ischemic osteonecrosis. In a localized ischemic condition such as IOFH, local administration of bisphosphonate may be preferable to oral or systemic administration because it minimizes the distribution of the drug to the rest of the skeleton and bypasses the need for having a restored blood flow to the infarcted head for the delivery of the drug. [source] An analysis of the evidence-practice continuum: is surgery for obstructive sleep apnoea contraindicated?JOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2007Adam G. Elshaug BA BSc(Hons) MPH Abstract Rationale, aims and objectives, Currently there are multiple surgical interventions utilized in the treatment of adult obstructive sleep apnoea (OSA). The role of these operations remains controversial, with perspectives on treatment efficacy varying considerably. Despite this, their use is proliferating. Objectives, In this paper, we present the degree of variability that occurs in the application of these procedures, and examine the effectiveness of surgical intervention as a treatment for OSA. Method, A multi-centre retrospective clinical audit of consecutive, unselected surgical cases presenting at the sleep disorder clinics of two teaching hospitals in a major Australian city. Patients acted as their own historical controls, undergoing polysomnography pre and post surgery to gauge effectiveness. Results, On variability demonstrate 94 individuals in this cohort received 220 individual upper airway surgical procedures, 184 occurred in their first operation (mean 2.5 per person; range 1,7) and 36 occurred in a second operation (n = 18; cumulative mean of 4 per person; range 3,7). These 94 individuals received 41 varying combinations of surgery. Results on effectiveness demonstrate an overall physiological success rate of 13% (87% fail). One operation reduced OSA severity by 20% (patients still had severe OSA), and two operations by 35% (still moderate OSA). In contrast, conventional Continuous Positive Airway Pressure therapy controlled OSA (n = 64). Conclusions, This case study demonstrates substantial procedural variability and limited effectiveness. This raises questions as to the quality of care, the treatment-derived health outcomes of this population and of efficient resource allocation. This issue requires greater policy attention. [source] Axillary Ultrasound Assessment in Primary Breast Cancer: An Audit of 653 CasesTHE BREAST JOURNAL, Issue 5 2010FRCR, Pippa Mills MRCP Abstract:, Axillary lymph node status is an important factor in determining the prognosis and treatment in patients with invasive breast cancer. The introduction of the sentinel lymph node biopsy technique in the axilla has significantly reduced the number of patients requiring an axillary clearance procedure. However, a proportion of patients will be found to have axillary metastases after a sentinel node biopsy and will then require a second axillary surgical procedure. A retrospective audit of 653 consecutive patients presenting with invasive breast cancer showed a preoperative diagnosis rate of axillary disease of 23% using axillary ultrasound and fine-needle aspiration (FNA) together. We performed 232 axillary FNAs to diagnose 150 positive axillae. This avoided the need for a second operation in 150 women. The negative predictive value for axillary metastases using this technique was 79%. Overall accuracy was 84%. [source] Organ Preservation Surgery for Advanced Unilateral Glottic and Subglottic Cancer,THE LARYNGOSCOPE, Issue 10 2007Pierre Delaere MD Abstract Objectives: Functional surgery of unilateral T2b to T3 glottic cancer and cricoid chondrosarcoma is possible using the technique of tracheal autotransplantation. The objective of this paper is to report the functional and oncologic outcome of 24 consecutive patients treated with this technique between 2001 and 2007. Methods: Seventeen patients, of whom nine were previously irradiated, had unilateral glottic cancer with impaired mobility of the vocal fold. Clinical staging was T2b to 3N0. Seven patients had a chondrosarcoma of the cricoid cartilage. In a first operation, an extended hemilaryngectomy was performed, and a radial forearm flap, comprising a distal fascial and a proximal skin component, was transferred to the neck. The fascial paddle was wrapped around the upper 4-cm segment of cervical trachea, and the skin paddle was used for temporary closure of the extended hemilaryngectomy defect. The definitive reconstruction was performed after 2 to 3 months and consisted of removal of the skin paddle from the laryngeal defect and a transplantation of a patch of revascularized cervical trachea to reconstruct the laryngeal defect. Results: Swallowing and speech were restored after the first operation. The glottic and subglottic airway lumen was restored during the second operation. The tracheostomy could be closed in 20 patients. After a median follow-up period of 33 (range, 1,66) months or almost 3 years, 23 patients remained free of tumor recurrence. Conclusions: Tracheal autotransplantation can be recommended as a functional treatment for selected T2b to T3 glottic cancers and for unilateral chondrosarcomas of the cricoid cartilage. The technique is oncologically robust while resulting in good postoperative function. [source] Safety of Completion Thyroidectomy Following Unilateral Lobectomy for Well-Differentiated Thyroid Cancer,THE LARYNGOSCOPE, Issue 7 2002Michael E. Kupferman MD Abstract Objectives When a diagnosis of thyroid cancer is returned following unilateral lobectomy, removal of the contralateral lobe is frequently necessary. Morbidity for completion thyroidectomy includes a reported 2% to 5% risk of recurrent laryngeal nerve (RLN) injury and an 8% to 15% incidence of hypoparathyroidism. In this study, to determine morbidity following completion thyroidectomy, we reviewed our results of reoperative surgery among patients with thyroid cancer. Study Design Retrospective chart review. Methods Between 1997 and 2000, 36 consecutive patients, 32 females and 4 males, with a mean age of 43.6 years (range, 19,59 y), underwent completion thyroidectomy. Preoperative fine-needle aspiration revealed follicular derived neoplasm in 32 patients (88.9%), indeterminate in 3 patients (8.3%), and Hürthle cell neoplasm in 1 patient (2.8%). The interval between the first and second operation was a mean of 43.3 days (range, 2,103 d). Results At the primary surgery, 29 patients (80.6%) had a follicular variant of papillary carcinoma, 6 (16.7%) had follicular carcinoma, and 1 (2.8%) had Hürthle cell carcinoma. Of these, 14 had multifocal disease. In the completion lobe, 20 patients (55.6%) had evidence of thyroid carcinoma. There was a 0% incidence of RLN injury, and the mean pre- and post-completion thyroidectomy serum calcium was 8.9 mg/dL and 8.6 mg/dL, respectively. There was one postoperative hematoma, requiring re-exploration. Five patients (13.9%) had a transient postoperative serum calcium (Ca) <8.0 mg/dL, with one being symptomatic. None required vitamin D or prolonged calcium supplementation. Conclusions When completion thyroidectomy is necessary for the treatment of thyroid malignancy, the procedure can be performed safely with low morbidity and is effective for diagnosing and removing occult disease in the remaining thyroid. [source] Anchorage of Titanium Implants with Different Surface Characteristics: An Experimental Study in RabbitsCLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 3 2000Klaus Gotfredsen DDS ABSTRACT Purpose: To compare the anchorage of titanium implants with different surface roughness and topography and to examine histologically the peri-implant bone after implant removal. Materials and Methods: Screw implants with five different surface topographies were examined: (1) turned ("machined"), (2) TiO2 -blasted with particles of grain size 10 to 53 ,m; (3) TiO2 -blasted, grain size 63 to 90 ,m; (4) TiO2 -blasted, grain size 90 to 125 ,m; (5) titanium plasma-sprayed (TPS). The surface topography was determined by the use of an optical instrument. Twelve rabbits, divided into two groups, had a total of 120 implants inserted in the tibiae. One implant from each of the five surface categories was placed within the left tibia of each rabbit. By a second operation, implants were installed in the right tibia, after 2 weeks in group A and after 3 weeks in group B. Fluorochrome labeling was performed after 1 and 3 weeks. Removal torque (RMT) tests of the implants were performed 4 weeks after the second surgery in group A and 9 weeks after the second surgery in group B. Thus, in group A, two healing groups were created, representing 4 and 6 weeks, respectively. The corresponding healing groups in group B were 9 and 12 weeks. The tibiae were removed, and each implant site was dissected, fixed, and embedded in light-curing resin. Ground sections were made, and the peri-implant bone was analyzed using fluorescence and light microscopy. Results: The turned implants had the lowest Sa and Sy values, whereas the highest scores were recorded for the TPS implants. The corresponding Sa and Sy values for the TiO2 -blasted implants were higher when a larger size of grain particles had been used for blasting. At all four observation intervals, the TPS implants had the highest and the turned implants the lowest RMT scores. The differences between the various TiO2 -blasted implants were, in general, small, but the screws with the largest Sa value had higher RMT scores at 6, 9, and 12 weeks than implants with lower Sa values. The histologic analysis of the sections representing 6, 9, and 12 weeks revealed that fractures or ruptures were present in the marginal, cortical peri-implant bone. In such sections representing the TPS and TiO2 -blasted implant categories, ruptures were frequently found in the zone between the old bone and the newly formed bone, as well as within the newly formed bone. Conclusions: The present study demonstrated that a clear relation exists between surface roughness, described in Sa values, and implant anchorage assessed by RMT measurements. The anchorage appeared to increase with the maturation of bone tissue during healing. [source] Delayed stoma formation in Fournier's gangreneCOLORECTAL DISEASE, Issue 6 2004C. S. Bronder Abstract Fournier's gangrene is traditionally treated with prompt surgical debridement and in many cases a diverting colostomy is also fashioned during the same procedure. We present four cases where stoma formation was delayed until the second look procedure. The physiological states at the time of either procedure were compared using POSSUM. The results showed an improvement in the physiological condition in all patients at the time of the second operation, suggesting that a delay can potentially improve prognosis in such cases. [source] | ||||||||||