Current Issue : July - September Volume : 2012 Issue Number : 3 Articles : 6 Articles
Background: Over the last decade there has been a paradigm shift in the management of breast\r\ncancer, subsequent to revised surgical oncology guidelines and consensus statements which were\r\nderived in light of landmark breast cancer clinical trials conducted throughout the latter part of the\r\n20th century. However the sheer impact of this paradigm shift upon all modalities of treatment,\r\nand the current trends in management of the disease, are largely unknown. We aimed to assess the\r\nchanging practices of breast cancer management over the last decade within a specialist tertiary\r\nreferral Breast Cancer Centre.\r\nMethods: Comparative analysis of all aspects of the management of breast cancer patients, who\r\npresented to a tertiary referral Breast Cancer Centre in 1995/1996 and 2005/2006, was\r\nundertaken and measured against The European Society for Surgical Oncology guidelines for the\r\nsurgical management of mammographically detected lesions [1998].\r\nResults: 613 patients'' case profiles were analysed. Over the last decade we observed a dramatic\r\nincrease in incidence of breast cancer [>100%], a move to less invasive diagnostic and surgical\r\ntherapeutic techniques, as well as increased use of adjuvant therapies. We also witnessed the\r\nintroduction of immediate breast reconstruction as part of routine practice\r\nConclusion: We demonstrate that radical changes have occurred in the management of breast\r\ncancer in the last decade, in keeping with international guidelines. It remains incumbent upon us to\r\ncontinue to adapt our practice patterns in light of emerging knowledge and best evidence....
Background: Incisional hernia after abdominal surgery is a well-known complication. Controversy\r\nstill exists with respect to the choice of hernia repair technique. The objective of this study was to\r\nevaluate the long-term recurrence rate as well as surgical complications in a consecutive group of\r\npatients undergoing open repair using an onlay mesh technique.\r\nMethods: Consecutive patients undergoing open incisional hernia repair with onlay-technique\r\nbetween 01/05/1995 and 01/09/2007 at a single institution were included in the study. For followup\r\npatients were contacted by telephone, and answered a questionnaire containing questions\r\nrelated to the primary operation, the hernia and general risk factors. Patients were examined by a\r\nconsultant surgeon in the outpatient clinic or in the patient''s home if there was suspicion of an\r\nincisional hernia recurrence.\r\nResults: The study included 56 patients with 100% follow-up. The median follow-up was 35\r\nmonths (range 4ââ?¬â??151). Recurrent incisional hernia was found in 8 of 56 patients (15%, 95% CI: 6ââ?¬â??\r\n24). The overall complication rate was 13% (95% CI, 4ââ?¬â??22). All complications were minor and\r\nneeded no hospital admission.\r\nConclusion: This study with a long follow-up showed low recurrence and complication rates in\r\npatients undergoing incisional hernia repair with the open onlay technique....
Objective. To identify disabilities caused by Buruli Ulcer Disease (BUD) when it affects the Head and Neck Region (HNR) of\r\npatients in endemic areas and suggest possible ways to overcome the complications involved. Methods. Data for the study was\r\ncollected from six different hospitals in the central part of Ghana from 2004ââ?¬â??2009. Diagnosis of BUD was based on clinical\r\nfindings and confirmed by positive result of Ziehl-Neelson Test for Acid Fast Bacilli, PolymeraseChain Reaction, orHistopathology.\r\nTreatment of BUD involved a combination of surgical interventions and antimycobacterial chemotherapy for 8 weeks. Results. The\r\nage of the 38 patients ranged from 0ââ?¬â??56 years (mean age of 14.3 years), withmales outnumbering females.Most (55.3%, N = 21)\r\nof the patients reported to the facilities with developed BUD deformities. Patients who lost their eyeball (N = 5) recorded the\r\nhighest in terms of functional disability. A mean total hospital stay of 52 days and follow-up period of 2.3 years were recorded for\r\nthe study. Conclusion. Visual impairment was the commonest form of disability recorded in the HNR. Management difficulties\r\nand BUD disabilities could be avoided by early detection of the disease and training of health professionals at district levels....
Autogenous bone is still considered the ââ?¬Å?gold standardââ?¬Â of regenerative and reconstructive procedures involving mandibular defects.\r\nHowever, harvesting of this material can lead to many complications like increasing morbidity, expanding of the surgical time,\r\nand incomplete healing of the donor site. In the last few years many authors looked for the development of effective reconstruction\r\nprocedures using osteoinductive factors without the need for conventional bone grafting. The first-in-human study involving the\r\nuse of BoneMorphongenic Proteins (rhBMP) for mandibular reconstruction was performed in 2001 byMoghadam. Only few articles\r\nhave been reported in the literature since then. The purpose of this study was to search and analyze the literature involving the\r\nuse of rhBMP for reconstruction of mandibular defects. In all the studies reported, authors agree that the use of grown factors may\r\nrepresent the future of regenerative procedures with more research necessary for confirmation....
An increasing number of patients are opting for combining sinus surgery and cosmetic rhinoplasty. The author has been\r\nperforming rhinoplasty with FESS since April of 1990. The technique and equipment used in early cases ismuch different than that\r\nused in more recent surgeries. Specific advances include high definition monitor, intraoperative navigation system, and powered\r\ndissecting instruments. The benefits of these advances are illustrated by a review of the more recent cases performed by the author.\r\nCombined rhinoplasty and FESS can be performed with good results (functional and cosmetic) and minimal complications.\r\nAdvances in sinus surgery technique and equipment have made the procedure safer, faster, more precise, and more comfortable....
Objective. To detail the clinical outcomes of a series of patients having undergone free flap reconstruction of the orbit and periorbita\r\nand highlight the anterolateral thigh (ALT) as a workhorse for addressing defects in this region. Methods. A review of 47 patients\r\nwho underwent free flap reconstruction for orbital or periorbital defects between September 2006 and May 2011 was performed.\r\nData reviewed included demographics, defect characteristics, free flap used, additional reconstructive techniques employed, length\r\nof stay, complications, and follow-up. The ALT subset of the case series was the focus of the data reviewed for this paper. Selected\r\ncases were described to highlight some of the advantages of employing the ALT for cranio-orbitofacial reconstruction. Results. 51\r\nfree flaps in 47 patients were reviewed. 38 cases required orbital exenteration. The ALT was used in 33 patients. Complications\r\nincluded 1 hematoma, 2 wound infections, 3 CSF leaks, and 3 flap failures. Conclusions. Free tissue transfer allows for the safe and\r\neffective reconstruction of complex defects of the orbit and periorbital structures. Reconstructive choice is dependent upon the\r\nextent of soft tissue loss, midfacial bone loss, and skullbase involvement. The ALT provides a versatile option to reconstruct the\r\nmany cranio-orbitofacial defects encountered....
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