Current Issue : July - September Volume : 2016 Issue Number : 3 Articles : 4 Articles
A growing number of specialists are now beginning to ascertain that treatment of individuals with\ndescending aortic atherosclerotic aneurysms must be provided by cardiologists on a scheduled\nbasis. Surgery is feasible when there is a risk of aneurysm rupture. It requires for the development\nof conservative treatments and elaboration of indications for surgery. A total of 97 patients with\nthoracic aortic atherosclerotic aneurysms (TAAA) and abdominal aortic aneurysms (AAA) have\nbeen examined over a 5-year period. They received multifaceted anti-inflammatory medical\ntreatment to strengthen the aortic wall and control its possible expansion. Operative treatment\nwas offered only if there was a risk of aneurysm rupture. One of the principal factors adversely affecting\nmortality is the presence of co-morbidities requiring permanent medical corrective treatment\nirrespective of surgical or medical treatment provided. It is also important to outline the indications\nfor surgery based on multifactorial pathogenetic manifestations. Treatment aiming at\nthe reversal of ethiopathogenic mechanisms of disease progression contributes to a significant\nlonger survival in DAA patients....
Background and Importance: Cavernomas of the septum pellucidum represent an extremely rare\nsubtype of CNS cavernous angiomas which are a rare subtype of CNS tumors. Intraventricular cavernomas\nof the body of the lateral ventricle are usually treated by the transcallosal approach. Clinical\nPresentation: We present a case of a fifty-eight year old man with a septum pellucidum cavernoma\nsuccessfully treated operatively by means of the inferior parietal transcortical transventricular\napproach. This unusual and scarcely documented tumor was situated at the posterior third of the\nseptum pellucidum. The patient had a good recovery with no focal deficit. Conclusion: Septum pellucidum\ncavernomas are extremely rare lesions. Inferior parietal transcortical approach is a safe alternative\nto the commonly used transcallosal approach for lesions of the posterior half of the septum\npellucidum....
Background: To identify factors affecting the harvest of lymph nodes (LNs) and to investigate the association\nbetween examining a minimum of 12 LNs and clinical outcomes in stage I-III colorectal cancer (CRC) patients.\nMethods: The clinicopathologic features and the number of examined LNs for 1167 stage I-III CRC patients were\nanalyzed to identify factors affecting the number of LNs harvested and the correlations between clinical outcomes\nand high harvests (�12 LNs) and low harvests (<12 LNs).\nResults: A multivariate analysis showed that age (P = 0.007), tumor size (P = 0.030), and higher T stage (P = 0.001)\nwere independent factors affecting the examinations of LNs in colon cancer and that tumor size (P = 0.015) was the\nonly independent factor in rectal cancer. Patients with low harvests had poorer overall survival with stage II and\nstage III CRC (stage II: P < 0.0001; III: P = 0.001) and poorer disease-free survival for stages I-III (stage I: P = 0.023; II:\nP < 0.0001; III: P = 0.001).\nConclusions: The factors influencing nodal harvest are multifactorial, and an adequate number of examined LNs\n(�12) is associated with a survival benefit. Removal of at least 12 LNs will determine the lymph node status reliably....
Objective: An inverse relationship between volume and mortality in some cardiothoracic surgical\nprocedures has been previously established, leading to suggestions that acute aortic dissection\nshould not be operated in community or low volume heart centers. We therefore reviewed our\nexperience to compare with published data. Methods: Retrospective review of 27 patients who\nunderwent proximal aortic surgery by a single surgeon at an inner city community hospital between\nMay 2004 and April 2015. 16 patients, mean age 51.7 �± 13.6 years old, 75.0% males underwent\nemergency surgery for acute Stanford type A aortic dissection, while 9 with root or ascending\naortic aneurysm, mean age 50.3 �± 15.0 years old, 88.9% males had elective proximal aortic\nsurgery. 2 patients with arch aneurysm were excluded. Results: Four (25.0%) patients with acute\ndissection were in Penn class A, 3 (18.7%) Penn B, 3 (18.7%) Penn C and 6 (37.5%) Penn B+C. 10\n(62.5%) patients underwent emergency root replacement with 60.0% (6/10) mortality all related\nto malperfusion including 2 patients with bloody stools, while 6 (37.5%) underwent supracoronary\ngraft replacement with 16.6% (1/6) mortality from cardiac tamponade. The 5-year survival\nwas 89.0%. In patients with aortic aneurysm, 8 (88.9%) underwent elective root replacement and\n1 (11.1%) supracoronary graft replacement with zero mortality. Conclusion: Supracoronary graft\nreplacement is performed for the majority of uncomplicated acute type A dissections and can be\nundertaken by the average general cardiac surgeon with acceptable results. Visceral malperfusion\nespecially when associated with bloody stools portends a poor prognosis, and aortic dissection\nshould be excluded in any Marfan patient presenting with acute abdomen. Delaying intervention\nin attempting transfer to a tertiary hospital can potentially increase preoperative mortality,\nknown to rise with each passing hour from onset of acute dissection. Patients presenting therefore\nto community hospitals should probably undergo surgery there to avoid complications associated\nwith delay....
Loading....