Thoracoscopic splanchnicectomy for pain control in irresectable pancreatic cancer

Disabling pain of many patients with irresectable pancreatic cancer is poorly managed and can remain a significant problem until their deaths. The aim of this study was to evaluate the safety and efficacy of thoracoscopic splanchnicectomy for pain control in patients with irresectable pancreatic cancer. Thirty patients suffering from intractable pain due to irresectable pancreatic cancer underwent 15 attempted thoracoscopic splanchnicectomy procedures. All patients were opiate dependent. Right-sided splanchnicectomy was preformed for a dominantly right-sided pain, whereas a centralized bilateral, or left-sided pain was managed by left splanchnicectomy. If pain recurred, patients were offered to have the procedure repeated on the contralateral side. Thoracoscopic splanchnicectomy procedure was a technical failure because of pleural adhesions in one patient. Fourteen [10 left-and 4 right-sided] thoracoscopic splanchnicectome were successfully completed in 12 patients. Immediate pain relief was achieved in all 12 patients after unilateral thoracoscopic splanchnicectomy. Pain relief persisted till death in 8 patients and till latest postoperative follow-up visit at 5 months in one patients. Two patients required a contralateral procedure for pain recurrence. A third patient had a recurrent pain but refused contralateral intervention. Eoccept the later, non of me patients requiredopioids. Thoracoscopic splanchnicectomy is a safe, simple, and effective minimally invasive procedure. It offers a substantial relief of pain in patients with unresectable pancreatic cancer

Results of percutaneous coronary intervention in the elderly patients >/= 75 years presenting with acute coronary syndromes

In the setting of Percutaneous Coronary Intervention [PCI], older age [>/= 75 years] is one of the most major variables associated with an increased risk of complications. To investigate the prognosis of an invasive treatment in the elderly patients presenting with acute coronary syndromes [ACS[s]] in the clinical practice. Between September 2002 and March 2006, 219 patients aged 75 years or more presented with ACSS were reviewed. They were divided into two main groups: 84 [38.4%] underwent coronary angiography then revascularization, and 135 [61.6%] were treated medically. In the invasive group PCI was performed in [81%] of the patients whereas [19%] underwent coronary. Artery bypass grafting [CABG] within the hospital stay. In-hospital death/myocardial infarction [20.7% vs 10.7%, P=0.004] and 30-day outcome death / myocardial infarction [13.6% vs 2.6%, p=0.001] occurred significantly less often in patients with invasive strategy. The mean follow-up time was 26 +/- 12 months. Long-term follow-up showed a trend towards less hard end point events in the invasive group but this was not statistically significant [30% vs 20.1%, p=0.1]. The whole population was divided into a second two main groups: 44 patients presented with ST elevation myocardial infarction [STEMI] and 175 with non-ST elevation myocardial infarction [NSTEMI]. In-hospital as well as the long-term follow-up hard end point events were significantly less in the invasive group in patients with NSTEMI rather than the STEMI group; [18.9% vs 9.4% p=0.04], [25.3% vs 13%, p=0.04] and [29.2% vs 15%, p=0.1], [53.3% vs 50%, p= 0.5] consecutively. In clinical practice, an invasive strategy in the elderly patients presenting with NSTEMI improved in-hospital and 2 years outcome

Video-assisted thoracoscopic versus transsternal thymectomy for myasthenia gravis: our early experience

Thymectomy is an accepted surgical modality of therapy for patients with myasthenia gravis. This study aimed at examining the thoracoscopic and transsternal approaches and to compare their surgical outcomes. A prospective cohort study of twenty patients with myasthenia gravis who underwent thymectomy between November 2003 and October 2004. Ten patients [50%] had thoracoscopic surgery while the other ten patients underwent resection by the transsternal route. The patients were followed up for twelve months. Statistical significance was determined by the Student t test or the Fisher's Exact Test. The thoracoscopic group had a mean operating time of 65.5 minutes compared to 76.3 minutes in the transsternal group [P=0.004]. The mean postoperative tube drainage was 54.5 mIs in the thoracoscopic group while it was 118.3 mls in the transsternal group [P=0.0001]. Surgical site infection was the most common complication in the transsternal group occurring in 30% of patients compared to 0% in the thoracoscopic group [P=0.05]. While four patients in the thoracoscopic group [40%] were in remission at 12 months, there were three [30%] in the transsternal group though this was not significant [P=0.23]. Thymectomy through the thoracoscopic approach is a safe and prefecred option for non-thymomatous myasthenia gravis as well as for very small encapsulated thymomas due to the shorter operating time, low complication rates and shorter hospital stay. However, both thoracoscopic and the transsternal routes achieved similar response rates in the short-term