Current Issue : October - December Volume : 2018 Issue Number : 4 Articles : 6 Articles
A 65-year-old man was admitted to our hospital following 6 months of dysphagia.\nAt first, conventional endoscopy showed a reddish and depressed lesion\nin the stomach and an elevated lesion in the posterior wall of the hypopharynx.\nAn endoscopic biopsy showed adenocarcinoma in the stomach, and\nsquamous cell carcinoma in the hypopharynx. On the further examination,\ntrans-nasal endoscopy with narrow band imaging (NBI) was performed.\nDuring the trumpet maneuver, a huge protruded lesion was observed and it\nreached to the orifice of the esophagus. Other superficial lesion located at left\npyriform sinus was detected by NBI system as brownish area with brown dots.\nFurthermore, superficial esophageal cancer in the cervical esophagus was detected.\nFinally, 4 carcinomas in upper gastrointestinal tract were detected.\nAmong them, the hypopharyngeal cancer was the most advanced (T3N0). The\npatient hoped to preserve his voice and swallowing function, endoscopic laryngo-\npharyngeal surgery (ELPS) was performed for the hypopharyngeal\ncancer. Endoscopic mucosal resection (EMR) was performed for the esophageal\ncancer, and Endoscopic submucosal dissection (ESD) was performed for\nthe gastric cancer. Under collaboration between a head and neck surgeon and\nan endoscopist, the tumor was resected en-bloc. The histopathological find-ings of hypopharyngeal cancer were squamous cell carcinoma, subeipthelial\ninvasion, 29 Ã?â?? 28 Ã?â?? 4.2 mm. The others were diagnosed as mucosal cancers.\nThe patient is currently alive with no recurrence at 28 months after the surgery;\nthere is no stricture at the cervical esophagus. Endoscopic laryngopharyngeal\nsurgery for the tumor of pharyngo-esophageal junction can provide a\nless invasive treatment....
Objectives. During anesthesia emergence, patients are extubated and the upper airway can become vulnerable to obstruction.\nNasal trumpets can help prevent obstruction. However, we have found no manuscript describing how to place nasal trumpets after\nnasal surgery (septoplasties or septorhinoplasties), likely because (1) the lack of space with nasal splints in place and (2) surgeons\nmay fear that removing the trumpets could displace the splints. The objective of this manuscript is to describe how to place nasal\ntrumpets even with nasal splints in place. Materials and Methods.The authors describe techniques (Double Barrel Technique and\nModified Double Barrel Technique) that were developed over three years ago and have been used in patients with obstructive sleep\napnea (OSA) and other patients who had collapsible or narrow upper airways (i.e., morbidly obese patients). Results. The\ntechnique described in the manuscript provides a method for placing one long and one short nasal trumpet in a manner that helps\nprevent postoperative upper airway obstruction. The modified version describes a method for placing nasal trumpets even when\nthere are nasal splints in place. Over one-hundred patients have had nasal trumpets placed without postoperative oxygen\ndesaturations. Conclusions.The Double Barrel Technique allows for a safe emergence from anesthesia in patients predisposed to\nupper airway obstruction (such as in obstructive sleep apnea and morbidly obese patients). To our knowledge, the Modified\nDouble Barrel Technique is the first description for the use of nasal trumpets in patients who had nasal surgery and who have nasal\nsplints in place....
Introduction: Literature reveals several peritoneal dialysis laparoscopic catheter\ninsertion techniques developed to improve long-term results for treatment\nchronic kidney failure with the technic of peritoneal dialysis. The purpose\nof the study is evaluation of developed and recommended minimally invasive\nlaparoscopic technic for chronic peritoneal dialysis catheter placement\nusing specially constructed trocar. Materials and Methods: Retrospective\nstudy included 804 patients in 10 departments of surgery. Surgical and non\nsurgical complications related to PD catheter placement were analysed:\nbleeding, dialysate leak, early SSI, peritonitis, catheter tip migration, catheter\nobstruction, omental wrapping and visceral perforations. Available software\n(Microsoft�® Excel for Windows 10, MedCalc, Mariakerke, Belgium) was used\nfor statistical analysis (presented as percentages, mean �± SD or median). Con-clusions: The presented technique with specially constructed trocar is a simple\nand effective procedure with fewer complications comparing to literature.\nThe advantages of this method include long rectus sheath tunnel with the\ndeep cuff placed pre-peritoneally, the small size of the entrance into the peritoneum\nand accurate position and control of catheter tip in the pelvis....
Background: Skull base tumors presented great challenge for neurosurgeons\nsince decades due to their deep location, associated morbidity and limitation\nof operative field; however modern neurosurgery using the endoscope and/or\nthe microscope served in minimizing peri-operative morbidities and improving\nthe clinical outcome. Objective: To demonstrate the value of endoscope-\nassisted microsurgical technique for resection of skull base tumors. Patients\nand Methods: 30 patients divided into 3 groups (10 patients had medial\nsphenoid wing meningioma constituted group 1, 10 patients had suprasellar\nmeningioma constituted group 2 and 10 patients had Cerbello-Pontine\nAngle (CPA) epidermoids constituted group 3) were operated through Endoscope\nAssisted Microscopic Skull Base Surgery technique at Al-Azhar University\nHospitals during the period starting from January 2016 till the end of\nSeptember 2017 using a rigid endoscope for inspection of tumor boundaries\nand neighboring vascularity in addition to confirm the extent of resection.\nTumor resection was tried in all cases. Intra-operative resection rate and\npost-operative radiological outcomes were assessed. Results: Total gross resection\nwas possible in 27 patients (90%). Subtotal resection was done in the\nother 3 cases (recurrent medial sphenoid wing meningiomas) due to excessive\nbleeding and adhesions of the tumors with vascular structures. Total resection\nof the tumor in post operative radiology was obtained in 24 patients (80%)\nand post-operative residual tumor was noticed in 6 patients in early post\noperative radiology and in only 3 cases at 3 months follow up radiology. Conclusion:\nEndoscopic-assisted microsurgical approach is a reliable, safe and effective\noption for adequate surgical resection of skull base tumors. The technique\nallowed proper inspection of the tumor relations and vascularity, detection\nof any residual portions, providing better chance for gross total resection\nwith minimal tissue damage or vascular injury as well as convenient clinical\noutcome....
Over the recent past few years, there is a huge innovation in plastic surgery\nand orthopedic surgery through implantation of new techniques, which\nenabled a great level of success in hand salvage. Conditions such as trauma,\ntumor, sepsis, or vascular disease, may necessitate hand salvage. The most\nfrequent argument among surgeon from different subspecialties (orthopedics,\nplastics, trauma, and vascular surgery) are characterized by in what way each\none can do his own part of the salvage operation, be it bony fixation, revascularization,\nor soft-tissue coverage, but none of them is sure whether it should\nbe endeavored. What is necessary in such clinical situations is an interdisciplinary\nteam attitude led by individual or groups of clinicians who are conversant\nnot only with their identifiable subspecialized skills but also with those of\ntheir coworkers and the consequences accompanying the joined efforts at\nhand salvage. The perception of orthoplastic surgery is based on such an indication,\nwhere the integrated skills and techniques of the orthopedic surgeon\nand reconstructive microsurgeon are performed in recital to direct efforts\nconcerning hand salvage or choose against it when it is not designated. The\ncurrent article reviews the roles of orthopedic and plastic surgery and how this\nteam can deal with the existing techniques to improve outcomes in hand salvage\nsurgery....
Transcervical approach for tumors of the posterior mediastinum is traditionally\nthought not to be indicated. Hereby we report on a case of a patient with a\nhuge neurogenic tumor of the posterior mediastinum which was successfully\nexcised through a transcervical extended approach and, additionally, the variety\nof surgical approaches used to remove tumors of the posterior mediastinum\nis discussed. The new refined techniques of transcervical extended mediastinal\noperations, which are recently gaining popularity among surgeons,\nallowed for a safe dissection of the tumor, thus patient could benefit from a\nshort painless postoperative course. The authors suggest that surgeons trained\nin these particular techniques should consider the choice of the transcervical\nextended access in selected cases of benign tumors of the posterior mediastinum....
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