Current Issue : April - June Volume : 2017 Issue Number : 2 Articles : 7 Articles
Background: With the development of new surgical techniques in breast cancer, such as oncoplastic breast\nsurgery, increased knowledge of risk factors for poor satisfaction with conventional breast-conserving surgery (BCS)\nis needed in order to determine which patients to offer these techniques to. The aim of this study was to\ninvestigate patient satisfaction regarding aesthetic result and skin sensitivity in relation to patient, tumour, and\ntreatment factors, in a consecutive sample of patients undergoing conventional BCS.\nMethods: Women eligible for BCS were recruited between February 1, 2008 and January 31, 2012 in a prospective\nsetup. In all, 297 women completed a study-specific questionnaire 1 year after conventional BCS and radiotherapy.\nPotential risk factors for poor satisfaction were investigated using logistic regression analysis.\nResults: The great majority of the women, 84%, were satisfied or very satisfied with the overall aesthetic result. The\nrate of satisfaction regarding symmetry between the breasts was 68% and for skin sensitivity in the operated breast\nit was 67%. Excision of more than 20% of the preoperative breast volume was associated with poor satisfaction\nregarding overall aesthetic outcome, as was axillary clearance. A high BMI (ââ?°Â¥30 kg/m2) seemed to affect satisfaction\nwith symmetry negatively. Factors associated with less satisfied patients regarding skin sensitivity in the operated\nbreast were an excision of ââ?°Â¥20% of preoperative breast volume, a BMI of 25ââ?¬â??30 kg/m2, axillary clearance, and\nradiotherapy. Re-excision and postoperative infection were associated with lower rates of satisfaction regarding\nboth overall aesthetic outcome and symmetry, as well as with skin sensitivity.\nConclusions: Several factors affect patient satisfaction after BCS. A major determinant of poor satisfaction in this\nstudy was a large excision of breast volume. If the percentage of breast volume excised is estimated to exceed\n20%, other techniques, such as oncoplastic breast surgery, with or without contralateral surgery, or mastectomy\nwith reconstruction, may be considered....
Background: To estimate the proportion of elderly patients (>70 years) with breast cancer eligible for an Exclusive\nIntraOperative RadioTherapy (E-IORT) and to evaluate their local recurrence-free survival rate.\nMethods: This retrospective study examining two cohorts focuses on patients over 70 years old: a multi-centric\ncohort of 1411 elderly patients and a mono-centric cohort of 592 elderly patients. All patients underwent conservative\nsurgery followed by external radiotherapy for T0-T3 N0-N1 invasive breast cancer, between 1980 and 2008.\nResults: Within each cohort two groups were identified according to the inclusion criteria of the RIOP trial (R group)\nand TARGIT E study (T group). Each group was divided into two sub-groups, patients eligible (E) or non-eligible (nE) for\nIORT. The population of patients that were eligible in the TARGIT E study but not in the RIOP trial were also studied in\nboth cohorts. The proportion of patients eligible for IORT was calculated, according to the eligibility criteria of each\nstudy. A comparison of the 5-year local or locoregional recurrence-free survival rate between eligible vs non-eligible\npatients was made.\nIn both cohorts, the proportion of patients eligible according to the RIOP trial�s eligibility criteria was 35.4 and 19.3%,\nand according to the TARGIT E study criteria was 60.9 and 45.3%.\nThe 5-year locoregional recurrence-free survival rate was not significantly different between RE and RnE groups, TE and\nTnE groups. In both cohorts RE and (TE-RE) groups were not significantly different.\nConclusions: Our results encourage further necessary studies to define and to extend the eligibility criteria for per\noperative exclusive radiotherapy....
Background: Despite the efficacy of pharmacotherapy for gastrointestinal ulcers, severe cases of bleeding or\nperforation due to gastrointestinal ulcers still occur. Giant duodenal ulcer perforation is an uncommon but difficultto-\nmanage pathology with a high mortality rate. We report two cases of giant duodenal ulcer perforation after\nneurosurgery for brainstem tumors that needed reoperation for gastric disconnection because of postoperative\nleakage and bleeding.\nCase presentation: Both cases had undergone neurosurgery for brainstem tumors, and the patients were in a\nshock state for several days with peritonitis due to giant duodenal perforation. In Case 1, antrectomy with Billroth II\nreconstruction was performed. However, reoperation for gastric disconnection was needed because of major\nleakage of gastrojejunostomy and jejunojejunostomy. In Case 2, an omental patch, cholecystectomy, and insertion\nof a bile drainage tube from the cystic duct were performed for the giant duodenal ulcer, but leakage and\nbleeding from the ulcer edge required reoperation for gastric disconnection.\nConclusions: Brainstem tumors in these cases might have been related to duodenal ulcer perforation with late\ndiagnosis that progressed to severe sepsis. For giant duodenal ulcer perforation with poor general condition, simple\nclosure including omental patch or antrectomy with reconstruction is hazardous. Antrectomy with gastric\ndisconnection, meaning gastrostomy, duodenostomy, feeding jejunostomy and cholecystectomy, is recommended...
Background: Immediate laparoscopic cholecystectomy is the accepted standard for the treatment of acute\ncholecystitis. The aim of the present study was to evaluate the feasibility of a standardized approach with tailored\ncare maps for pre- and postoperative care by comparing pain, nausea and patient satisfaction after elective and\nemergent laparoscopic cholecystectomy.\nMethods: From January 2014 until April 2015, data on pain and nausea management were prospectively recorded\nfor all elective and emergency procedures in the department of visceral surgery. This prospective observational\nstudy compared consecutive laparoscopic elective vs. emergency cholecystectomies. Visual analogue scales (VAS)\nwere used to measure pain, nausea, and satisfaction from recovery room until 96 hours postoperatively.\nResults: Final analysis included 168 (79%) elective cholecystectomies and 44 (21%) emergent procedures.\nDemographics (Age, gender, BMI and ASA-scores) were comparable between the 2 groups. In the emergency\ngroup, patients did not receive anxiolytic medication (0% vs.13%, p = 0.009) and less postoperative nausea and\nvomiting (PONV) prophylaxis (77% vs. 97% p = <0.001). Perioperative pain management was similar in terms of\nopioid consumption (median amount of fentanyl 450ug [IQR 350-500] vs. 450ug [375-550], p = 0.456) and wound\ninfiltration rates (24% vs. 25%, p = 0.799). Postoperative consumption of paracetamol, metamizole and opiod\nmedications were similar between the 2 groups. VAS scores for pain (p = 0.191) and nausea (p = 0.392) were low\nfor both groups. Patient satisfaction was equally high in both clinical settings (VAS 8.5 �± 1.1 vs. 8.6 �± 1.1, p = 0.68).\nConclusions: A standardized pathway allows equally successful control of pain and nausea after both elective and\nemergency laparoscopic cholecystectomy.\nThis study was retrospectively registered by March 01, 2016 in the following trial register: www.researchregistry.com\n(UIN research registry 993)...
Background: Binostril endoscopic transsphenoidal approach (BETA) provides sufficient manipulation space and\nwide endoscopic vision, although it increases the trauma of nose. Mononostril endoscopic transsphenoidal\napproach (META) has minimal trauma of nose, at the expense of space within the operation. We describe a oneand-\na-half nostril endoscopic transsphenoidal approach (OETA) that combines the advantages of BETA and\nMETA.\nMethods: We introduced OETA for pituitary adenomas with a detailed technical description. A retrospective analysis\nwas also performed on 57 consecutive patients who underwent one-and-a-half nostril endoscopic transsphenoidal\nsurgery between March 2014 and June 2015 at Jinling hospital.\nResults: The gross total resection rate was 79%. The gross complete resection rate of Knosp grade 3 tumors were 63.6,\nand 27.3% in grade 4 tumors. Postoperative hormone remission was achieved in 14 out of 18 (77.8%) patients\nwith secreting adenomas. Postoperative abnormal visual function improvement was achieved in 23 out of 32\npatients (73%) with preoperative visual dysfunction. The overall intra-operative CSF leak was 17.5%, with the\npostoperative CSF leak decreased to 3.5% after the sellar reconstruction with the unilateral ââ?¬Å?rescueââ?¬Â nasoseptal\nflap procedure. The main sinonasal complaints 2 weeks after surgery were: loss of sense of smell (28%), decrease in\nsense of taste (4%), trouble breathing during the day (18%), thick nasal discharge (36%), post nasal discharge (8%),\ndried nasal material (6%), and headache (6%). Three months after surgery, there were no reports of decrease of taste,\npost nasal discharge, or dried nasal material. Other complaints were decreased significantly. Six months after surgery,\nthe main complaints of sinonasal quality of life were negligible, and overall health status was near complete recovery\nto preoperative status.\nConclusions: The one-and-a-half nostril endoscopic transsphenoidal approach for pituitary adenomas is a simple and\nreliable technique. It provides not only a sufficient surgical corridor for a 2-surgeon/4 or 3-hands technique, but also\nensures minimal invasion of the nasal canal....
Background: The RANK ligand inhibitor denosumab is being investigated for treatment of giant cell tumor of\nbone, but the available data in the literature remains sparse and controversial. This study analyzes the results of\ncombining denosumab with surgical treatment and highlights possible changes for the oncologic surgeon in daily\npractice.\nMethods: A total of 91 patients were treated surgically for giant cell tumor of bone between 2010 and 2014 in an\ninstitution, whereas 25 patients of the total additionally received denosumab and were part of this study. The\naverage age of the patients was 35 years. Eleven patients received denosumab pre- and postoperatively, whereas\nwith 14 patients, the denosumab treatment was applied either before (7 patients) or after (7 patients) the surgery.\nThe average preoperative therapy duration was 3.9 months and the postoperative therapy 6 months by default.\nResults: Sixteen patients presented a large tumor extension necessitating a resection of the involved bone or joint.\nIn 10 of these patients, the indication for a resection procedure was abandoned due to the preoperative denosumab\ntreatment and a curettage was performed. In the remaining six cases, the surgical indication was not changed despite\nthe denosumab treatment, and two of them needed a joint replacement after the tumor resection. Also with patients\ntreated with curettage, denosumab seems to facilitate the procedure as a new peripheral bone rim around the tumor\nwas built, though a histologic analysis reveals viable tumor cells persisting in the denosumab-induced bone formation.\nAfter an average follow-up of 23 months, one histologically proven local recurrence occurred, necessitating a second\ncurettage. A second patient showed a lesion in the postoperative imaging highly suspicious for local relapse which\nremained stable under further denosumab treatment. No adverse effect of the denosumab medication was observed\nin this study.\nConclusions: Denosumab can be a help to the oncologic surgeon by reconstituting a peripheral rim and switching\nthe stage from aggressive to active or latent disease. But as tumor cells remain in the new-formed bone, the surgical\ntechnique of curettage has to be changed from gentle to more aggressive to avoid higher local recurrence rates....
Background: The aim of this report is to present a new reference for aesthetic mandible surgery using\nthree-dimensional cone-beam computed tomography-based treatment planning for orthognathic surgery which\ncan be implemented in surgical planning and perioperative procedure.\nMethods: To make an objective standard for evaluating aesthetic mandibular outline, we make an aesthetic scoring\ncriteria with consideration of asymmetry, broad mandibular border line, and prominent mandibular angle. Two\nmaxillofacial surgeons and two orthodontists rated their aesthetical evaluation from 1 to 5. Experimental group\nconsisting of 47 female and 38 male patients who had rotational orthognathic two-jaw surgery from 2010 to 2011\nwere chosen according to aesthetic scoring done by two maxillofacial surgeons and two orthodontists. A high\naesthetic score (â�¥16) means the facial contour is symmetric, with no broad and narrow aesthetic mandible frontal\nprofiles. Control A group consisted of ten female and ten male patients who had no orthognathic surgery\nexperience and low aesthetic score (â�¤10). Control B group consisted of ten female and ten male patients who had no\northognathic surgery experience and had anaesthetic mandibular frontal profile and a high aesthetic score (â�¥16). The\nthree-dimensional image of the patient was taken from dental cone-beam CT (DCT) scanning (experimental group and\ncontrol A group: 6 months DCT after surgery, control B group: 1st visit DCT). Each DCT was reformatted to reorient the\n3D image using 3D analyzing program (OnDemand3D, cybermed Inc, CA, USA). After selection of 12 landmarks and\nthe construction of reoriented horizontal, vertical, and coronal reference lines, 15 measurements were taken in 3D\nanalysis of frontal mandibular morphology. Afterwards, horizontal and vertical linear measurements and angular\nmeasurements, linear ratio were obtained.\nResults: Mean Goâ��Rt-Meâ��-Goâ��Lt angular measurement was 100.74 �± 2.14 in female patients and 105.37 �± 3.62 in male\npatients. These showed significant difference with control A group in both genders. Ratio of Goâ��Rt,Goâ��Lt-Meâ�� length to\nsome linear measurements (ratio of Meâ��-Cdâ��RtCdâ��Lt to Meâ��-Goâ��RtGoâ��Lt, ratio of Meâ��-Goâ�� to Meâ��-Goâ��RtGoâ��Lt, ratio of Goâ��Rt-Goâ��Lt\nto Meâ��-Goâ��RtGoâ��Lt) showed significant difference with control A group in both genders.\nConclusion: This study was intended to find some standard measurement of mandible frontal view in 3D analysis of\naesthetic patient. So, these potential measurement value may be helpful for orthognathic treatment planning to have\nmore aesthetic and perspective outcomes....
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