Soft tissue sarcoma(STS)accounts for 1%of all malignant neoplasms in adults.Their diagnosis and management constitute a challenging target.They originate from the mesenchyme,and 50 subtypes with various cytogenetic pr...Soft tissue sarcoma(STS)accounts for 1%of all malignant neoplasms in adults.Their diagnosis and management constitute a challenging target.They originate from the mesenchyme,and 50 subtypes with various cytogenetic profiles concerning soft tissue and bones have been recognized.These tumors mainly affect middle-aged adults but may be present at any age.Half of the patients have metastatic disease at the time of diagnosis and require systemic therapy.Tumors above 3-5 cm in size must be suspected of potential malignancy.A thorough history,clinical examination and imaging that must precede biopsy are necessary.Modern imaging techniques include ultrasound,computed tomography(CT),new magnetic resonance imaging(MRI),and positron emission tomography/CT.MRI findings may distinguish low-grade from high-grade STS based on a diagnostic score(tumor heterogeneity,intratumoral and peritumoral enhancement).A score≥2 indicates a high-grade lesion,and a score≤1 indicates a lowgrade lesion.For disease staging,abdominal imaging is recommended to detect early abdominal or retroperitoneal metastases.Liquid biopsy by detecting genomic material in serum is a novel diagnostic tool.A preoperative biopsy is necessary for diagnosis,prognosis and optimal planning of surgical intervention.Core needle biopsy is the most indicative and effective.Its correct performance influences surgical management.An unsuccessful biopsy means the dissemination of cancer cells into healthy anatomical structures that ultimately affect resectability and survival.Complete therapeutic excision(R0)with an acceptable resection margin of 1 cm is the method of choice.However,near significant structures,i.e.,vessels,nerves,an R2 resection(macroscopic margin involvement)preserving functionality but having a risk of local recurrence can be an acceptable choice,after informing the patient,to prevent an unavoidable amputation.For borderline resectability of the tumor,neoadjuvant chemo/radiotherapy has a place.Likewise,after surgical excision,adjuvant therapy is indicated,but chemotherapy in nonmetastatic disease is still debatable.The five-year survival rate reaches up to 55%.Reresection is considered after positive or uncertain resection margins.Current strategies are based on novel chemotherapeutic agents,improved radiotherapy applications to limit local side effects and targeted biological therapy or immunotherapy,including vaccines.Young age is a risk factor for distant metastasis within 6 mo following primary tumor resection.Neoadjuvant radiotherapy lasting 5-6 wk and surgical resection are indicated for highgrade STS(grade 2 or 3).Wide surgical excision alone may be acceptable for patients older than 70 years.However,locally advanced disease requires a multidisciplinary task of decision-making for amputation or limb salvage.展开更多
The surgeons adopt the comprehensive treatment method basing on surgery When head and neck tumors involve the carotid artery. At present, there are four surgical treatments, namely, dissection of carotid artery tumor,...The surgeons adopt the comprehensive treatment method basing on surgery When head and neck tumors involve the carotid artery. At present, there are four surgical treatments, namely, dissection of carotid artery tumor, resection of carotid artery, revascularization after carotid resection, endoarterial implantation of covered stent combined with surgical resection. However, there is currently no consensus on the standard surgical approach to choose. This paper describes the four surgical methods, which are expected to be helpful for head and neck surgeons to choose the surgical methods for head and neck tumors involving the carotid artery.展开更多
Introduction: Surgical management of adrenal tumors has greatly improved over the past years, with laparoscopic adrenalectomy being the gold standard. However, Open adrenalectomy is indicated in large adrenal tumors, ...Introduction: Surgical management of adrenal tumors has greatly improved over the past years, with laparoscopic adrenalectomy being the gold standard. However, Open adrenalectomy is indicated in large adrenal tumors, malignant tumors and large phaeochromocytomas. We report surgical outcomes of 18 cases of functional adrenal tumors from 2007 to 2022. Methods: We conducted a retrospective cross-sectional and descriptive study in three tertiary hospitals in Yaounde, Cameroon. We reviewed files of patients who underwent adrenalectomy over a period of 15 years from July 2007 to July 2022. Clinical and diagnostic components of adrenal tumors, indications and surgical outcomes were analyzed. Results: A total of 18 patients were included in our study. The average age of patients was 38.33 years, with a female-to-male sex ratio of 2:1. Weight gain (72.2%) was the most represented clinical sign. The secretory nature of tumor and malignancy represented 55.5% and 33.3% of the operative indications and all 18 (100%) of the patients had open adrenalectomy. Vascular injury was the most common intraoperative complication with 5.63%, while acute adrenal insufficiency (16.7%) was the most common post-operative complication. The average tumor size was 6.22 cm and the mean duration of hospitalization was 11.61 days. Adenoma 7 (38.9%) and adrenocortical carcinoma 5 (27.8%) were the frequent histological types. One patient died two months post-surgery from anemia-related complications. Conclusion: The success of adrenal surgery is linked to multidisciplinary patient care and the experience of the surgeon. Conventional surgery still has indications with satisfactory short- and medium-term results in our context.展开更多
Background:Xanthogranulomatous cholecystitis(XGC)is a rare benign chronic inflammatory disease of the gallbladder that often presents as cholecystitis and most of the times requires surgical management.In addition,dis...Background:Xanthogranulomatous cholecystitis(XGC)is a rare benign chronic inflammatory disease of the gallbladder that often presents as cholecystitis and most of the times requires surgical management.In addition,distinguishing XGC from gallbladder cancer preoperatively is still a challenge.The aim of the present systematic review was to outline the clinical presentation and surgical approach of XGC.Data sources:The present systematic review was designed using the PRISMA and AMSTAR guidelines.We searched MEDLINE,Scopus,Clinicaltrials.gov,EMBASE,Cochrane Central Register of Controlled Trials(CENTRAL)and Google Scholar databases from inception until June 2020.Results:The laparoscopic cholecystectomy rate(34%)was almost equal to the open cholecystectomy rate(47%)for XGC.An important conversion rate(35%)was observed as well.The XGC cases treated by surgery were associated with low mortality(0.3%),limited intraoperative blood loss(58-270 m L),low complication rates(2%–6%),along with extended operative time(82.6–120 minutes for laparoscopic and 59.6–240 minutes for open cholecystectomy)and hospital stay(3–9 days after laparoscopic and 8.3–18 days after open cholecystectomy).Intraoperative findings during cholecystectomies for XGC included empyema or Mirizzi syndrome.In addition,complex surgical procedures,like wedge hepatic resections and bile duct excision were required during operations for XGC.Conclusions:XGC seemed to be a rare,benign inflammatory disease that presents similar features as gallbladder cancer.The mortality and complication rates of XGC were low,despite the complex surgical procedures that might be required in some cases.展开更多
AIM:To assess the effectiveness of core vitrectomyphacoemulsification-intraocular lens(IOL)implantationcapsulo-hyaloidotomy in treating phakic eye at least 1 mo after the onset of malignant glaucoma.METHODS:A retrospe...AIM:To assess the effectiveness of core vitrectomyphacoemulsification-intraocular lens(IOL)implantationcapsulo-hyaloidotomy in treating phakic eye at least 1 mo after the onset of malignant glaucoma.METHODS:A retrospective analysis were performed on malignant glaucoma patients treated in Zhongshan Ophthalmic Center between 2016 and 2018.Demographic and clinical data were described.The preoperative and postoperative visual acuity(VA),intraocular pressure(IOP),number of IOP-lowering medications used,and anterior chamber depth(ACD)of the case series were compared by Wilcoxon signed-rank test.RESULTS:Thirteen phakic eyes with long time intervals between onset and surgery were identified in this case series.Core vitrectomy-phacoemulsification-IOL implantation-capsulohyaloidotomy reduced the IOP(P=0.046)and the number of IOP-lowering medications used(P=0.004),deepened the ACD(P=0.005).Complete success was achieved in 38.5%of the eyes,and anatomical success was achieved in 100%of the eyes without any recurrence.The only postoperative complication observed is corneal endothelial decompensation.It occurred in two cases.CONCLUSION:Core vitrectomy-phacoemulsification-IOL implantation-capsulo-hyaloidotomy is safe and effective for treatment of long onset phakic malignant glaucoma.展开更多
Coronavirus disease 2019(COVID-19)caused by severe acute respiratory syndrome coronavirus 2 has spread rapidly around the world and is a significant threat to global health.Patients in the Neonatal Surgery Department ...Coronavirus disease 2019(COVID-19)caused by severe acute respiratory syndrome coronavirus 2 has spread rapidly around the world and is a significant threat to global health.Patients in the Neonatal Surgery Department have rapidly progressing diseases and immature immunity,which makes them vulnerable to pulmonary infection and a relatively higher mortality.This means that these patients require multidisciplinary treatment including early diagnosis,timely transport,emergency surgery and intensive critical care.The COVID-19 pandemic poses a threat to carrying out these treatments.To provide support for the health protection requirements of the medical services in the Neonatal Surgery Department,we developed recommendations focusing on patient transport,surgery selection and protection requirements with the aim of improving treatment strategies for patients and preventing infection in medical staff during the current COVID-19 pandemic.展开更多
Objective To improve the life quality of cancer patients with metastasis to long bone and to long bone and to select suitable surgical treatment. Methods Fifty-two patients with metastasis 27 men and 25 women, were Ju...Objective To improve the life quality of cancer patients with metastasis to long bone and to long bone and to select suitable surgical treatment. Methods Fifty-two patients with metastasis 27 men and 25 women, were June 2003 Vol12 No2 treated from 1990 to 1999. Their average age was 56. 8 years (33 - 74). In 16 patients with multiple lesions, underwent surgery at bone shaft (29 patients) and bone epiphysis (26). Thirty patients were treated for pathologic fracture and the rest for impending fracture. Operations included limb-salvage (51 patients) and amputation (4) Limb salvage consisted of intralesional curettage (3 patients ), intramedullary nailing reconstruction (29 ), endoprosthesis ( 18 ), and temporary spacer ( 1 ). 21 patients accepted postoperative chemotherapy or radiotherapy. Results Follow-up of 52 patients for a mean of 28. 2 months (2 - 122 months) showed pain relief (41 patients), (75%) and full or part weight-bearing stability ( 36 ) 69 % . Local tumor recurrence occurred in 11 patients.展开更多
Purpose:The aim of this study is to evaluate the application value of virtual surgical planning in the management of mandibular condylar fractures and to provide a reliable reference.Methods:This was a prospective ran...Purpose:The aim of this study is to evaluate the application value of virtual surgical planning in the management of mandibular condylar fractures and to provide a reliable reference.Methods:This was a prospective randomized controlled study and recruited 50 patients requiring surgical treatment for their mandibular condylar fractures.The inclusion criteria were patients(1)diagnosed with a condylar fracture by two clinically experienced doctors and required surgical treatment;(2)have given consent for the surgical treatment;and(3)had no contraindications to the surgery.Patients were excluded from this study if:(1)they were diagnosed with a non-dislocated or only slightly dislocated condylar fracture;(2)the comminuted condylar fracture was too severe to be treated with internal reduction and fixation;or(3)patients could not complete follow-up for 3 months.There were 33 male and 17 female patients with 33 unilateral condylar fractures and 17 bilateral condylar fractures included.The 50 patients were randomly(random number)divided into control group(25 patients with 35 sides of condylar fractures)and experimental group(25 patients with 32 sides of condylar fractures).Virtual surgical planning was used in the experimental group,but only clinical experience was used in the control group.The patients were followed up for 1,3,6 and 12 months after operation.Variables including the rate of perfect reduction by radiological analysis,the average distance of deviation between preoperative and postoperative CT measurements using Geomagic software and postoperative clinical examinations(e.g.,mouth opening,occlusion)were investigated for outcome measurement.SPSS 19 was adopted for data analysis.Results:The average operation time was 180.60 min in the experimental group and 223.2 min in the control group.One week postoperatively,CT images showed that the anatomic reduction rate was 90.63%(29/32)in the experimental group and 68.57%(24/35)in the control group,revealing significant difference(X^(2)=4.919,p=0.027).Geomagic comparative analysis revealed that the average distance of deviation was also much smaller in the experimental group than that in the control group(0.639 mm vs.0.995 mm;t=3.824,p<0.001).Conclusion:These findings suggest that virtual surgical planning can assist surgeons in surgical procedures,reduce operative time,and improve the anatomic reduction rate&accuracy,and thus of value in the diagnosis and treatment of condylar fractures.展开更多
Posterior placenta accreta spectrum(PAS)disorders are infrequent but potentially associated with significant maternal mortality and morbidity,especially if not diagnosed prenatally.Analysis of published literature is ...Posterior placenta accreta spectrum(PAS)disorders are infrequent but potentially associated with significant maternal mortality and morbidity,especially if not diagnosed prenatally.Analysis of published literature is problematic since most experiences included only a few cases.Knowledge of the risk factors associated with posterior PAS is crucial to identifying mothers at higher risk and ask for high sensitivity studies.Ultrasound has poor diagnostic accuracy in detecting posterior PAS,while magnetic resonance imaging better delineates the posterior uterine wall.In comparison,prenatal imaging’s diagnostic performance in detecting posterior PAS is significantly lower than anterior placenta invasion.Management of posterior PAS depends on several factors,including maternal hemodynamic status,available resources,clinical presentation,and invasion severity.For accreta or increta cases,a compression suture is habitually enough to perform hemostasis.Nevertheless,organ involvement habitually requires a multidisciplinary team with the assistant of a general or coloproctology surgeon.The present article aims to update the risk factors,prenatal diagnosis,and surgical management of pregnancies complicated by posterior PAS.展开更多
Objectives:Invasive fungal infections(IFIs)are a major cause of morbidity and mortality in acute leukemia patients undergoing chemotherapy or hematopoietic stem cell transplantation(HSCT).Surgical interventions may be...Objectives:Invasive fungal infections(IFIs)are a major cause of morbidity and mortality in acute leukemia patients undergoing chemotherapy or hematopoietic stem cell transplantation(HSCT).Surgical interventions may be necessary to improve the survival outcomes of these patients.The aim of this study is to report a single-center experience using surgical intervention as adjunctive treatment for IFI in adult leukemia patients.Methods:A retrospective review was conducted to obtain clinical characteristics and outcomes of surgically managed IFI patients diagnosed between January 2005 and December 2015 in our center.Results:Nineteen acute leukemia patients,median age 46 years(range 19–65),underwent 20 surgical procedures as management for IFI.Three patients had proven IFI diagnoses prior to surgery.Sixteen patients underwent surgery for both diagnostic and therapeutic purposes.Post-surgery,the diagnostic yield for proven IFI increased by a factor of 5,and 15 patients had definitive IFI diagnoses.Surgical complications included 2 pleural effusions,4 pneumothoraxes,and 1 hydropneumothorax.The median duration of hospitalization for patients with complications was 9 days(range 3–64).Thirteen patients benefited overall from the procedure,3 had temporary clinical benefits,and 2 had progression of IFI.After surgery,the 3-month and 2-year overall survival rates were 89.5%and 57.9%,respectively.The median time from surgery to resumption of chemotherapy or HSCT was 25 days.Conclusions:Surgical interventions for IFI are feasible in selected leukemia patients,as they yield valuable information to guide antifungal therapy or enable therapeutic outcomes with acceptable risk,thereby allowing patients to proceed with curative chemotherapy and HSCT.展开更多
Background: Lipoma is a very rare benign tumour of upper aero-digestive tract with less than 115 cases described in the English-literature. They account for approximately 1% of benign tumours of the larynx and oro/hyp...Background: Lipoma is a very rare benign tumour of upper aero-digestive tract with less than 115 cases described in the English-literature. They account for approximately 1% of benign tumours of the larynx and oro/hypopharynx. The symptoms are variable including progressive horseness, dysphagia and even severe dyspnea which can sometimes be life-threatening. The clinical presentation of lipoma is important particularly during the induction of general anesthesia, for they can cause unpredictable airway obstruction. Surgery is the treatment of choice which includes endoscopic techniques, microscopic laryngeal surgery and external surgical approach (cervicotomy). However, a standard surgical management for large lipomas of the epiglottis has not been present yet. In this article, we present a case report of a huge lipoma of the epiglottis successfully treated with tracheotomy and external surgical approach—cervicotomy with hyoidthyroidpexy without sacrificing any laryngeal structure. Case Presentation: We present a case of a 54-year-old female with a huge lipoma on the lingual surface of the epiglottis that extends upwards to the level of the left aryepiglottic fold narrowing the pyriform sinus, making impossible for our anesthesiologist the glottic visualization and the orotracheal intubation. Following a tracheotomy, the endoscopic and microscopic surgery approach was inadequate to manipulate the epiglottic lipoma. Instead, we performed macroscopic external surgery (cervicotomy with hyoidthyroidpexy) in which the epiglottic lipoma was pulled into the endolaryngeal window with forceps and then dissected from the surrounding tissues “in toto”. Conclusion: Despite epiglottic lipomas are rare and benign, they are important because of being potential cause of laryngeal obstruction. Surgery is the treatment of choice and different procedures are able to manage it. The external surgery approach—cervicotomy with hyoidthyroidpexy after tracheotomy enabled the huge lipoma to be extirpated without leaving any remnants or causing excessive laryngeal damage.展开更多
Clavicle fractures are among the most prevalent types of fractures with numerous treatment strategies that have evolved over time.In the realm of lateral-third clavicle fracture management,several surgical methods are...Clavicle fractures are among the most prevalent types of fractures with numerous treatment strategies that have evolved over time.In the realm of lateral-third clavicle fracture management,several surgical methods are available,with plate and screw constructs being one of the most frequently employed options.Within this construct,numerous choices exist for fixing the fracture.This editorial provides an overview of the common plate options utilized in the management of distal third clavicle fractures underscoring the critical considerations and approaches that guide clinicians in selecting the most appropriate fixation techniques,considering the complex landscape of clavicle fractures and their challenging management.展开更多
Background: An intestinal stoma is a surgical opening of the intestine, mostly sutured to the anterior abdominal wall. Stoma prolapse is one of the common complications of stoma. A significant number of stoma prolapse...Background: An intestinal stoma is a surgical opening of the intestine, mostly sutured to the anterior abdominal wall. Stoma prolapse is one of the common complications of stoma. A significant number of stoma prolapse patients require surgical correction. Aim: The first part of this thesis is a literature review of intestinal stoma prolapse and its surgical treatments. The second part is an evaluation of the effect of surgical treatments of this condition on children at OUS-R. Methods: Literature—A literature search was performed. Fifty-seven English-language studies were selected. Methods: Patients evaluation: Design, Setting, and Participants—A retrospective review of pediatric patients (<13 years) surgically treated for intestinal stoma prolapse at OUS-R. Results: Literature—Incidence of intestinal stoma prolapse for children varies from 8.1% to 25.6%. Many proposed surgical repair procedures for stoma prolapse are available and vary from being ineffective to 100% effective. Results: Patients evaluation at OUS-R—From 2001 to 2013, 14 of the 304 children with stoma (4.6%), experienced stoma prolapse. Nine stoma prolapse were surgically corrected: Median age at stoma formation for the 9 patients was 1.7 years. Surgical procedures and success rate: Median 2, range 1 - 9 operations/person;varies from being ineffective to 50% effective. Conclusion: Limited data suggests stoma prolapse repair is a surgical challenge. Thus, preferably when possible, closure of the stoma would be most suitable. Incidence of stoma prolapse in our series of pediatric patients at Oslo University Hospital is lower than most published incidence in the pediatric medical literature.展开更多
BACKGROUND In orthotopic liver transplantation(OLT)recipients,median arcuate ligament syndrome(MALS)is considered a risk factor for hepatic arterial thrombosis(HAT),which is dreadful for OLT recipients.Different alter...BACKGROUND In orthotopic liver transplantation(OLT)recipients,median arcuate ligament syndrome(MALS)is considered a risk factor for hepatic arterial thrombosis(HAT),which is dreadful for OLT recipients.Different alternative surgical procedures have been proposed to overcome the impact of MALS on transplantation,but clinical evidence is still scarce.AIM To evaluate the feasible surgical management of MALS to reduce complications in OLT patients.METHODS Data for 288 consecutive patients who underwent OLT at The First Hospital of Jilin University between January 2017 and July 2020 were retrospectively reviewed.The surgical management of median arcuate ligament(MAL)and modifications to the arterial anastomosis were recorded.The perioperative and long-term prognosis of MALS recipients were noted.Detailed preoperative and postoperative data of patients were analyzed in a descriptive manner.RESULTS Eight patients with MALS were included in this study.The first patient with MALS received no intervention during the primary surgery and developed postoperative HAT.Salvage liver transplantation with MAL division was successfully performed.Gastroduodenal artery(GDA)preservation with splenic artery ligation was performed on three patients,only GDA preservation was performed on two patients,and no intervention was performed on two patients.No patient developed HAT after surgery and postoperative recovery was satisfactory.CONCLUSION The preservation of collateral circulation between the superior mesenteric artery and celiac trunk via the GDA with or without splenic artery ligation is a safe and feasible alternative to MAL division.展开更多
Laparoscopic cholecystectomy is one of the most frequently performed procedures in gastrointestinal surgery worldwide.Bleeding complications due to vascular injuries represent an important cause of morbidity and morta...Laparoscopic cholecystectomy is one of the most frequently performed procedures in gastrointestinal surgery worldwide.Bleeding complications due to vascular injuries represent an important cause of morbidity and mortality,especially when facing major bleeding during laparoscopy,where bleeding control can be technically challenging in inexperienced hands.Interestingly,the reported incidence rate of conversion to open surgery due to vascular lesions is approximately 0%-1.9%,with a mortality rate of approximately 0.02%.The primary aim of this article was to perform an up-to-date overview regarding the incidence and surgical management of vascular injuries during laparoscopic cholecystectomy according to the available scientific evidence.展开更多
Circumcision remains a frequently performed surgical procedure and could be associated with various complications, ranging from mild to catastrophic. Penile amputation is a rare and severe complication usually complex...Circumcision remains a frequently performed surgical procedure and could be associated with various complications, ranging from mild to catastrophic. Penile amputation is a rare and severe complication usually complex and challenging to manage. We describe three cases of penile amputation injuries following circumcision referred within a week at the urological service of the Yaoundé Central Hospital. The first case was a 5-year-old who had complete penile amputation during circumcision by a nurse assistant at a rural health center. The second was a 7-year-old boy who sustained total penile glans amputation while undergoing circumcision by a nurse under local anesthesia at a rural health facility. The third involved a 6-year-old who had total penile amputation with loss of the amputated stump during circumcision by a traditional practitioner at home. Non-microsurgical penile re-implantations were done with diverse outcomes. The preservation of the amputated stump, the ischemic time and the severity of injury are factors affecting surgical outcome. The aim of this study is to evaluate our management experience and outcome of penile amputation injuries in resource-limited settings. Microsurgical replantation remains the gold standard in the management of penile amputation injuries. However, in resource-limited settings macroscopic replantation could be used as an alternative remedy to salvage the amputated penis.展开更多
Iatrogenic ureteral injuries and strictures are relatively common complication of pelvic surgery and radiation treatment.Left untreated they are associated with severe shortand long-term complications such as urinoma,...Iatrogenic ureteral injuries and strictures are relatively common complication of pelvic surgery and radiation treatment.Left untreated they are associated with severe shortand long-term complications such as urinoma,septic state,renal failure,and loss of a renal unit.Treatment depends on timing of diagnosis,as well as extent of injury,and ranges from simple endoscopic management to complex surgical reconstruction under usage of pedicled grafts.While recent advances in ureteral tissue engineering are promising the topic is still underreported.Historically a domain of open surgery,laparoscopic and robotic-assisted approaches have proven their feasibility in small case series,and are increasingly being utilized as means of reconstructive surgery.This review aims to give an outline of incidence and treatment of ureteral injuries and strictures in light of the latest advances.展开更多
Complex renal calculi remain to be a challenge for the treating urologist due to sheer bulk and the technicalities involved.Percutaneous nephrolithotomy(PCNL)remains the treatment modality of choice in dealing with th...Complex renal calculi remain to be a challenge for the treating urologist due to sheer bulk and the technicalities involved.Percutaneous nephrolithotomy(PCNL)remains the treatment modality of choice in dealing with these large and complex stones.The limiting factor in their treatment continues to be the need for using additional tracts or the use of flexible nephroscopy for complete stone clearance.This systematic review focuses on the need for multi-tract PCNL for complex renal calculi.The literature review was performed using PubMed database using the keywords“multiple tract PCNL”or“multiperc”.We identified original articles published on the usage of multiple tracts for stone clearance in renal calculi between January 2000 to October 2018,and the search was restricted to available literature in English language only.Ten studies with n>20 were included for the final analysis.We analyzed the technical efficacy with respect to the number of tracts and stages that were required for stone clearance,outcomes and complications,especially,procedural bleeding and post-procedure infective complications of multiple-tract PCNL for large burden renal stones.Multiperc is found to be safe,feasible and effective for the management of large burden complex renal calculi with respect to stone clearance and morbidity associated with the procedure.It is cost effective and complete stone clearance as a single procedure is higher in comparison to flexible ureteroscopy and shockwave lithotripsy.展开更多
Tracheal stenosis is a serious, life-threatening disease with increasing incidence. Among these stenoses, the number of complicated tracheal lesions, where a resection and anastomosis is not successful or not applicab...Tracheal stenosis is a serious, life-threatening disease with increasing incidence. Among these stenoses, the number of complicated tracheal lesions, where a resection and anastomosis is not successful or not applicable, is also increasing significantly. These acute situations often need to be managed by a combined surgical technique. The present paper is dedicated to this topic;the management of combined surgical and endoscopic technique in case of complicated long tracheal stenosis.展开更多
Aim:Brain abscess still poses a public health challenge in spite of the advent of modern neurosurgical techniques and antibiotics.Here,we present our surgical experiences and ultimate outcome in the management of brai...Aim:Brain abscess still poses a public health challenge in spite of the advent of modern neurosurgical techniques and antibiotics.Here,we present our surgical experiences and ultimate outcome in the management of brain abscess.Methods:Totally,162 patients with proved brain abscess who underwent surgical treatment were included in this study.The prospectively recorded data of surgical management of brain abscess and the ultimate outcome(by Glasgow outcome scale)were studied retrospectively.Results:Total number of cases was 162,of which 113 were acute pyogenic abscess while 49 were chronic abscess.Among the chronic abscess,29 were chronic pyogenic abscess,14 were tubercular,3 aspergillus,and 3 abscesses were in malignant brain metastases.In acute cases,common clinical features were headache,fever,vomiting,focal deficit and seizure.In chronic abscesses,common clinical features were mild to moderate headache and progressive focal deficit.Seventy-three(45.06%)patients had adjacent localized sinus,middle ear or cranial infection.The common predisposing factors included postneurosurgery,postpenetrating injury to brain,chronic suppurative otitis media,and congenital heart disease,infective endocarditis,sinusitis and sub optimum immuno-status.Frontal lobe involved in 30.2%cases,temporal lobe is next to involved.Single time burr hole aspiration in 111(68.5%)cases,two or more times burr hole aspiration were done in 34(21%)cases.Pus culture was negative in 129(79.62%)cases.Total number of death was 22(13.58%)cases.Complete resolution of abscess with complete recovery of preoperative neuro-deficit was seen in 80.86%cases and recovery with major neuro-deficit was observed in 5.55%cases.There is a significant association between Glasgow coma scale(GCS)on admission and mortality in brain abscess.Conclusion:In most of the cases,pus culture did not yield growth of any causative organism.Mortality was not directly related to surgical intervention,but GCS on admission has a significant association with mortality.Early diagnosis,optimum follow-up and timely surgical interventions are the keys in the proper management of brain abscess.展开更多
文摘Soft tissue sarcoma(STS)accounts for 1%of all malignant neoplasms in adults.Their diagnosis and management constitute a challenging target.They originate from the mesenchyme,and 50 subtypes with various cytogenetic profiles concerning soft tissue and bones have been recognized.These tumors mainly affect middle-aged adults but may be present at any age.Half of the patients have metastatic disease at the time of diagnosis and require systemic therapy.Tumors above 3-5 cm in size must be suspected of potential malignancy.A thorough history,clinical examination and imaging that must precede biopsy are necessary.Modern imaging techniques include ultrasound,computed tomography(CT),new magnetic resonance imaging(MRI),and positron emission tomography/CT.MRI findings may distinguish low-grade from high-grade STS based on a diagnostic score(tumor heterogeneity,intratumoral and peritumoral enhancement).A score≥2 indicates a high-grade lesion,and a score≤1 indicates a lowgrade lesion.For disease staging,abdominal imaging is recommended to detect early abdominal or retroperitoneal metastases.Liquid biopsy by detecting genomic material in serum is a novel diagnostic tool.A preoperative biopsy is necessary for diagnosis,prognosis and optimal planning of surgical intervention.Core needle biopsy is the most indicative and effective.Its correct performance influences surgical management.An unsuccessful biopsy means the dissemination of cancer cells into healthy anatomical structures that ultimately affect resectability and survival.Complete therapeutic excision(R0)with an acceptable resection margin of 1 cm is the method of choice.However,near significant structures,i.e.,vessels,nerves,an R2 resection(macroscopic margin involvement)preserving functionality but having a risk of local recurrence can be an acceptable choice,after informing the patient,to prevent an unavoidable amputation.For borderline resectability of the tumor,neoadjuvant chemo/radiotherapy has a place.Likewise,after surgical excision,adjuvant therapy is indicated,but chemotherapy in nonmetastatic disease is still debatable.The five-year survival rate reaches up to 55%.Reresection is considered after positive or uncertain resection margins.Current strategies are based on novel chemotherapeutic agents,improved radiotherapy applications to limit local side effects and targeted biological therapy or immunotherapy,including vaccines.Young age is a risk factor for distant metastasis within 6 mo following primary tumor resection.Neoadjuvant radiotherapy lasting 5-6 wk and surgical resection are indicated for highgrade STS(grade 2 or 3).Wide surgical excision alone may be acceptable for patients older than 70 years.However,locally advanced disease requires a multidisciplinary task of decision-making for amputation or limb salvage.
文摘The surgeons adopt the comprehensive treatment method basing on surgery When head and neck tumors involve the carotid artery. At present, there are four surgical treatments, namely, dissection of carotid artery tumor, resection of carotid artery, revascularization after carotid resection, endoarterial implantation of covered stent combined with surgical resection. However, there is currently no consensus on the standard surgical approach to choose. This paper describes the four surgical methods, which are expected to be helpful for head and neck surgeons to choose the surgical methods for head and neck tumors involving the carotid artery.
文摘Introduction: Surgical management of adrenal tumors has greatly improved over the past years, with laparoscopic adrenalectomy being the gold standard. However, Open adrenalectomy is indicated in large adrenal tumors, malignant tumors and large phaeochromocytomas. We report surgical outcomes of 18 cases of functional adrenal tumors from 2007 to 2022. Methods: We conducted a retrospective cross-sectional and descriptive study in three tertiary hospitals in Yaounde, Cameroon. We reviewed files of patients who underwent adrenalectomy over a period of 15 years from July 2007 to July 2022. Clinical and diagnostic components of adrenal tumors, indications and surgical outcomes were analyzed. Results: A total of 18 patients were included in our study. The average age of patients was 38.33 years, with a female-to-male sex ratio of 2:1. Weight gain (72.2%) was the most represented clinical sign. The secretory nature of tumor and malignancy represented 55.5% and 33.3% of the operative indications and all 18 (100%) of the patients had open adrenalectomy. Vascular injury was the most common intraoperative complication with 5.63%, while acute adrenal insufficiency (16.7%) was the most common post-operative complication. The average tumor size was 6.22 cm and the mean duration of hospitalization was 11.61 days. Adenoma 7 (38.9%) and adrenocortical carcinoma 5 (27.8%) were the frequent histological types. One patient died two months post-surgery from anemia-related complications. Conclusion: The success of adrenal surgery is linked to multidisciplinary patient care and the experience of the surgeon. Conventional surgery still has indications with satisfactory short- and medium-term results in our context.
文摘Background:Xanthogranulomatous cholecystitis(XGC)is a rare benign chronic inflammatory disease of the gallbladder that often presents as cholecystitis and most of the times requires surgical management.In addition,distinguishing XGC from gallbladder cancer preoperatively is still a challenge.The aim of the present systematic review was to outline the clinical presentation and surgical approach of XGC.Data sources:The present systematic review was designed using the PRISMA and AMSTAR guidelines.We searched MEDLINE,Scopus,Clinicaltrials.gov,EMBASE,Cochrane Central Register of Controlled Trials(CENTRAL)and Google Scholar databases from inception until June 2020.Results:The laparoscopic cholecystectomy rate(34%)was almost equal to the open cholecystectomy rate(47%)for XGC.An important conversion rate(35%)was observed as well.The XGC cases treated by surgery were associated with low mortality(0.3%),limited intraoperative blood loss(58-270 m L),low complication rates(2%–6%),along with extended operative time(82.6–120 minutes for laparoscopic and 59.6–240 minutes for open cholecystectomy)and hospital stay(3–9 days after laparoscopic and 8.3–18 days after open cholecystectomy).Intraoperative findings during cholecystectomies for XGC included empyema or Mirizzi syndrome.In addition,complex surgical procedures,like wedge hepatic resections and bile duct excision were required during operations for XGC.Conclusions:XGC seemed to be a rare,benign inflammatory disease that presents similar features as gallbladder cancer.The mortality and complication rates of XGC were low,despite the complex surgical procedures that might be required in some cases.
基金Supported by the National Natural Science Foundation of China(No.81700812)。
文摘AIM:To assess the effectiveness of core vitrectomyphacoemulsification-intraocular lens(IOL)implantationcapsulo-hyaloidotomy in treating phakic eye at least 1 mo after the onset of malignant glaucoma.METHODS:A retrospective analysis were performed on malignant glaucoma patients treated in Zhongshan Ophthalmic Center between 2016 and 2018.Demographic and clinical data were described.The preoperative and postoperative visual acuity(VA),intraocular pressure(IOP),number of IOP-lowering medications used,and anterior chamber depth(ACD)of the case series were compared by Wilcoxon signed-rank test.RESULTS:Thirteen phakic eyes with long time intervals between onset and surgery were identified in this case series.Core vitrectomy-phacoemulsification-IOL implantation-capsulohyaloidotomy reduced the IOP(P=0.046)and the number of IOP-lowering medications used(P=0.004),deepened the ACD(P=0.005).Complete success was achieved in 38.5%of the eyes,and anatomical success was achieved in 100%of the eyes without any recurrence.The only postoperative complication observed is corneal endothelial decompensation.It occurred in two cases.CONCLUSION:Core vitrectomy-phacoemulsification-IOL implantation-capsulo-hyaloidotomy is safe and effective for treatment of long onset phakic malignant glaucoma.
文摘Coronavirus disease 2019(COVID-19)caused by severe acute respiratory syndrome coronavirus 2 has spread rapidly around the world and is a significant threat to global health.Patients in the Neonatal Surgery Department have rapidly progressing diseases and immature immunity,which makes them vulnerable to pulmonary infection and a relatively higher mortality.This means that these patients require multidisciplinary treatment including early diagnosis,timely transport,emergency surgery and intensive critical care.The COVID-19 pandemic poses a threat to carrying out these treatments.To provide support for the health protection requirements of the medical services in the Neonatal Surgery Department,we developed recommendations focusing on patient transport,surgery selection and protection requirements with the aim of improving treatment strategies for patients and preventing infection in medical staff during the current COVID-19 pandemic.
文摘Objective To improve the life quality of cancer patients with metastasis to long bone and to long bone and to select suitable surgical treatment. Methods Fifty-two patients with metastasis 27 men and 25 women, were June 2003 Vol12 No2 treated from 1990 to 1999. Their average age was 56. 8 years (33 - 74). In 16 patients with multiple lesions, underwent surgery at bone shaft (29 patients) and bone epiphysis (26). Thirty patients were treated for pathologic fracture and the rest for impending fracture. Operations included limb-salvage (51 patients) and amputation (4) Limb salvage consisted of intralesional curettage (3 patients ), intramedullary nailing reconstruction (29 ), endoprosthesis ( 18 ), and temporary spacer ( 1 ). 21 patients accepted postoperative chemotherapy or radiotherapy. Results Follow-up of 52 patients for a mean of 28. 2 months (2 - 122 months) showed pain relief (41 patients), (75%) and full or part weight-bearing stability ( 36 ) 69 % . Local tumor recurrence occurred in 11 patients.
基金the Applied and Basic Research Programs of Sichuan Science and Technology Commission(2020YJ0278).
文摘Purpose:The aim of this study is to evaluate the application value of virtual surgical planning in the management of mandibular condylar fractures and to provide a reliable reference.Methods:This was a prospective randomized controlled study and recruited 50 patients requiring surgical treatment for their mandibular condylar fractures.The inclusion criteria were patients(1)diagnosed with a condylar fracture by two clinically experienced doctors and required surgical treatment;(2)have given consent for the surgical treatment;and(3)had no contraindications to the surgery.Patients were excluded from this study if:(1)they were diagnosed with a non-dislocated or only slightly dislocated condylar fracture;(2)the comminuted condylar fracture was too severe to be treated with internal reduction and fixation;or(3)patients could not complete follow-up for 3 months.There were 33 male and 17 female patients with 33 unilateral condylar fractures and 17 bilateral condylar fractures included.The 50 patients were randomly(random number)divided into control group(25 patients with 35 sides of condylar fractures)and experimental group(25 patients with 32 sides of condylar fractures).Virtual surgical planning was used in the experimental group,but only clinical experience was used in the control group.The patients were followed up for 1,3,6 and 12 months after operation.Variables including the rate of perfect reduction by radiological analysis,the average distance of deviation between preoperative and postoperative CT measurements using Geomagic software and postoperative clinical examinations(e.g.,mouth opening,occlusion)were investigated for outcome measurement.SPSS 19 was adopted for data analysis.Results:The average operation time was 180.60 min in the experimental group and 223.2 min in the control group.One week postoperatively,CT images showed that the anatomic reduction rate was 90.63%(29/32)in the experimental group and 68.57%(24/35)in the control group,revealing significant difference(X^(2)=4.919,p=0.027).Geomagic comparative analysis revealed that the average distance of deviation was also much smaller in the experimental group than that in the control group(0.639 mm vs.0.995 mm;t=3.824,p<0.001).Conclusion:These findings suggest that virtual surgical planning can assist surgeons in surgical procedures,reduce operative time,and improve the anatomic reduction rate&accuracy,and thus of value in the diagnosis and treatment of condylar fractures.
文摘Posterior placenta accreta spectrum(PAS)disorders are infrequent but potentially associated with significant maternal mortality and morbidity,especially if not diagnosed prenatally.Analysis of published literature is problematic since most experiences included only a few cases.Knowledge of the risk factors associated with posterior PAS is crucial to identifying mothers at higher risk and ask for high sensitivity studies.Ultrasound has poor diagnostic accuracy in detecting posterior PAS,while magnetic resonance imaging better delineates the posterior uterine wall.In comparison,prenatal imaging’s diagnostic performance in detecting posterior PAS is significantly lower than anterior placenta invasion.Management of posterior PAS depends on several factors,including maternal hemodynamic status,available resources,clinical presentation,and invasion severity.For accreta or increta cases,a compression suture is habitually enough to perform hemostasis.Nevertheless,organ involvement habitually requires a multidisciplinary team with the assistant of a general or coloproctology surgeon.The present article aims to update the risk factors,prenatal diagnosis,and surgical management of pregnancies complicated by posterior PAS.
文摘Objectives:Invasive fungal infections(IFIs)are a major cause of morbidity and mortality in acute leukemia patients undergoing chemotherapy or hematopoietic stem cell transplantation(HSCT).Surgical interventions may be necessary to improve the survival outcomes of these patients.The aim of this study is to report a single-center experience using surgical intervention as adjunctive treatment for IFI in adult leukemia patients.Methods:A retrospective review was conducted to obtain clinical characteristics and outcomes of surgically managed IFI patients diagnosed between January 2005 and December 2015 in our center.Results:Nineteen acute leukemia patients,median age 46 years(range 19–65),underwent 20 surgical procedures as management for IFI.Three patients had proven IFI diagnoses prior to surgery.Sixteen patients underwent surgery for both diagnostic and therapeutic purposes.Post-surgery,the diagnostic yield for proven IFI increased by a factor of 5,and 15 patients had definitive IFI diagnoses.Surgical complications included 2 pleural effusions,4 pneumothoraxes,and 1 hydropneumothorax.The median duration of hospitalization for patients with complications was 9 days(range 3–64).Thirteen patients benefited overall from the procedure,3 had temporary clinical benefits,and 2 had progression of IFI.After surgery,the 3-month and 2-year overall survival rates were 89.5%and 57.9%,respectively.The median time from surgery to resumption of chemotherapy or HSCT was 25 days.Conclusions:Surgical interventions for IFI are feasible in selected leukemia patients,as they yield valuable information to guide antifungal therapy or enable therapeutic outcomes with acceptable risk,thereby allowing patients to proceed with curative chemotherapy and HSCT.
文摘Background: Lipoma is a very rare benign tumour of upper aero-digestive tract with less than 115 cases described in the English-literature. They account for approximately 1% of benign tumours of the larynx and oro/hypopharynx. The symptoms are variable including progressive horseness, dysphagia and even severe dyspnea which can sometimes be life-threatening. The clinical presentation of lipoma is important particularly during the induction of general anesthesia, for they can cause unpredictable airway obstruction. Surgery is the treatment of choice which includes endoscopic techniques, microscopic laryngeal surgery and external surgical approach (cervicotomy). However, a standard surgical management for large lipomas of the epiglottis has not been present yet. In this article, we present a case report of a huge lipoma of the epiglottis successfully treated with tracheotomy and external surgical approach—cervicotomy with hyoidthyroidpexy without sacrificing any laryngeal structure. Case Presentation: We present a case of a 54-year-old female with a huge lipoma on the lingual surface of the epiglottis that extends upwards to the level of the left aryepiglottic fold narrowing the pyriform sinus, making impossible for our anesthesiologist the glottic visualization and the orotracheal intubation. Following a tracheotomy, the endoscopic and microscopic surgery approach was inadequate to manipulate the epiglottic lipoma. Instead, we performed macroscopic external surgery (cervicotomy with hyoidthyroidpexy) in which the epiglottic lipoma was pulled into the endolaryngeal window with forceps and then dissected from the surrounding tissues “in toto”. Conclusion: Despite epiglottic lipomas are rare and benign, they are important because of being potential cause of laryngeal obstruction. Surgery is the treatment of choice and different procedures are able to manage it. The external surgery approach—cervicotomy with hyoidthyroidpexy after tracheotomy enabled the huge lipoma to be extirpated without leaving any remnants or causing excessive laryngeal damage.
文摘Clavicle fractures are among the most prevalent types of fractures with numerous treatment strategies that have evolved over time.In the realm of lateral-third clavicle fracture management,several surgical methods are available,with plate and screw constructs being one of the most frequently employed options.Within this construct,numerous choices exist for fixing the fracture.This editorial provides an overview of the common plate options utilized in the management of distal third clavicle fractures underscoring the critical considerations and approaches that guide clinicians in selecting the most appropriate fixation techniques,considering the complex landscape of clavicle fractures and their challenging management.
文摘Background: An intestinal stoma is a surgical opening of the intestine, mostly sutured to the anterior abdominal wall. Stoma prolapse is one of the common complications of stoma. A significant number of stoma prolapse patients require surgical correction. Aim: The first part of this thesis is a literature review of intestinal stoma prolapse and its surgical treatments. The second part is an evaluation of the effect of surgical treatments of this condition on children at OUS-R. Methods: Literature—A literature search was performed. Fifty-seven English-language studies were selected. Methods: Patients evaluation: Design, Setting, and Participants—A retrospective review of pediatric patients (<13 years) surgically treated for intestinal stoma prolapse at OUS-R. Results: Literature—Incidence of intestinal stoma prolapse for children varies from 8.1% to 25.6%. Many proposed surgical repair procedures for stoma prolapse are available and vary from being ineffective to 100% effective. Results: Patients evaluation at OUS-R—From 2001 to 2013, 14 of the 304 children with stoma (4.6%), experienced stoma prolapse. Nine stoma prolapse were surgically corrected: Median age at stoma formation for the 9 patients was 1.7 years. Surgical procedures and success rate: Median 2, range 1 - 9 operations/person;varies from being ineffective to 50% effective. Conclusion: Limited data suggests stoma prolapse repair is a surgical challenge. Thus, preferably when possible, closure of the stoma would be most suitable. Incidence of stoma prolapse in our series of pediatric patients at Oslo University Hospital is lower than most published incidence in the pediatric medical literature.
基金Supported by the Science and Technology Department of Jilin Province,No.20190101002JH.
文摘BACKGROUND In orthotopic liver transplantation(OLT)recipients,median arcuate ligament syndrome(MALS)is considered a risk factor for hepatic arterial thrombosis(HAT),which is dreadful for OLT recipients.Different alternative surgical procedures have been proposed to overcome the impact of MALS on transplantation,but clinical evidence is still scarce.AIM To evaluate the feasible surgical management of MALS to reduce complications in OLT patients.METHODS Data for 288 consecutive patients who underwent OLT at The First Hospital of Jilin University between January 2017 and July 2020 were retrospectively reviewed.The surgical management of median arcuate ligament(MAL)and modifications to the arterial anastomosis were recorded.The perioperative and long-term prognosis of MALS recipients were noted.Detailed preoperative and postoperative data of patients were analyzed in a descriptive manner.RESULTS Eight patients with MALS were included in this study.The first patient with MALS received no intervention during the primary surgery and developed postoperative HAT.Salvage liver transplantation with MAL division was successfully performed.Gastroduodenal artery(GDA)preservation with splenic artery ligation was performed on three patients,only GDA preservation was performed on two patients,and no intervention was performed on two patients.No patient developed HAT after surgery and postoperative recovery was satisfactory.CONCLUSION The preservation of collateral circulation between the superior mesenteric artery and celiac trunk via the GDA with or without splenic artery ligation is a safe and feasible alternative to MAL division.
文摘Laparoscopic cholecystectomy is one of the most frequently performed procedures in gastrointestinal surgery worldwide.Bleeding complications due to vascular injuries represent an important cause of morbidity and mortality,especially when facing major bleeding during laparoscopy,where bleeding control can be technically challenging in inexperienced hands.Interestingly,the reported incidence rate of conversion to open surgery due to vascular lesions is approximately 0%-1.9%,with a mortality rate of approximately 0.02%.The primary aim of this article was to perform an up-to-date overview regarding the incidence and surgical management of vascular injuries during laparoscopic cholecystectomy according to the available scientific evidence.
文摘Circumcision remains a frequently performed surgical procedure and could be associated with various complications, ranging from mild to catastrophic. Penile amputation is a rare and severe complication usually complex and challenging to manage. We describe three cases of penile amputation injuries following circumcision referred within a week at the urological service of the Yaoundé Central Hospital. The first case was a 5-year-old who had complete penile amputation during circumcision by a nurse assistant at a rural health center. The second was a 7-year-old boy who sustained total penile glans amputation while undergoing circumcision by a nurse under local anesthesia at a rural health facility. The third involved a 6-year-old who had total penile amputation with loss of the amputated stump during circumcision by a traditional practitioner at home. Non-microsurgical penile re-implantations were done with diverse outcomes. The preservation of the amputated stump, the ischemic time and the severity of injury are factors affecting surgical outcome. The aim of this study is to evaluate our management experience and outcome of penile amputation injuries in resource-limited settings. Microsurgical replantation remains the gold standard in the management of penile amputation injuries. However, in resource-limited settings macroscopic replantation could be used as an alternative remedy to salvage the amputated penis.
文摘Iatrogenic ureteral injuries and strictures are relatively common complication of pelvic surgery and radiation treatment.Left untreated they are associated with severe shortand long-term complications such as urinoma,septic state,renal failure,and loss of a renal unit.Treatment depends on timing of diagnosis,as well as extent of injury,and ranges from simple endoscopic management to complex surgical reconstruction under usage of pedicled grafts.While recent advances in ureteral tissue engineering are promising the topic is still underreported.Historically a domain of open surgery,laparoscopic and robotic-assisted approaches have proven their feasibility in small case series,and are increasingly being utilized as means of reconstructive surgery.This review aims to give an outline of incidence and treatment of ureteral injuries and strictures in light of the latest advances.
文摘Complex renal calculi remain to be a challenge for the treating urologist due to sheer bulk and the technicalities involved.Percutaneous nephrolithotomy(PCNL)remains the treatment modality of choice in dealing with these large and complex stones.The limiting factor in their treatment continues to be the need for using additional tracts or the use of flexible nephroscopy for complete stone clearance.This systematic review focuses on the need for multi-tract PCNL for complex renal calculi.The literature review was performed using PubMed database using the keywords“multiple tract PCNL”or“multiperc”.We identified original articles published on the usage of multiple tracts for stone clearance in renal calculi between January 2000 to October 2018,and the search was restricted to available literature in English language only.Ten studies with n>20 were included for the final analysis.We analyzed the technical efficacy with respect to the number of tracts and stages that were required for stone clearance,outcomes and complications,especially,procedural bleeding and post-procedure infective complications of multiple-tract PCNL for large burden renal stones.Multiperc is found to be safe,feasible and effective for the management of large burden complex renal calculi with respect to stone clearance and morbidity associated with the procedure.It is cost effective and complete stone clearance as a single procedure is higher in comparison to flexible ureteroscopy and shockwave lithotripsy.
文摘Tracheal stenosis is a serious, life-threatening disease with increasing incidence. Among these stenoses, the number of complicated tracheal lesions, where a resection and anastomosis is not successful or not applicable, is also increasing significantly. These acute situations often need to be managed by a combined surgical technique. The present paper is dedicated to this topic;the management of combined surgical and endoscopic technique in case of complicated long tracheal stenosis.
文摘Aim:Brain abscess still poses a public health challenge in spite of the advent of modern neurosurgical techniques and antibiotics.Here,we present our surgical experiences and ultimate outcome in the management of brain abscess.Methods:Totally,162 patients with proved brain abscess who underwent surgical treatment were included in this study.The prospectively recorded data of surgical management of brain abscess and the ultimate outcome(by Glasgow outcome scale)were studied retrospectively.Results:Total number of cases was 162,of which 113 were acute pyogenic abscess while 49 were chronic abscess.Among the chronic abscess,29 were chronic pyogenic abscess,14 were tubercular,3 aspergillus,and 3 abscesses were in malignant brain metastases.In acute cases,common clinical features were headache,fever,vomiting,focal deficit and seizure.In chronic abscesses,common clinical features were mild to moderate headache and progressive focal deficit.Seventy-three(45.06%)patients had adjacent localized sinus,middle ear or cranial infection.The common predisposing factors included postneurosurgery,postpenetrating injury to brain,chronic suppurative otitis media,and congenital heart disease,infective endocarditis,sinusitis and sub optimum immuno-status.Frontal lobe involved in 30.2%cases,temporal lobe is next to involved.Single time burr hole aspiration in 111(68.5%)cases,two or more times burr hole aspiration were done in 34(21%)cases.Pus culture was negative in 129(79.62%)cases.Total number of death was 22(13.58%)cases.Complete resolution of abscess with complete recovery of preoperative neuro-deficit was seen in 80.86%cases and recovery with major neuro-deficit was observed in 5.55%cases.There is a significant association between Glasgow coma scale(GCS)on admission and mortality in brain abscess.Conclusion:In most of the cases,pus culture did not yield growth of any causative organism.Mortality was not directly related to surgical intervention,but GCS on admission has a significant association with mortality.Early diagnosis,optimum follow-up and timely surgical interventions are the keys in the proper management of brain abscess.
