Oculomotor nerve palsy due to posterior communicating artery aneurysm: Clipping vs coiling.

OBJECTIVE: Posterior communicating artery aneurysms (PCoAA) usually present with brain hemorrhage, but they might present with oculomotor nerve palsy (ONP) in about one out of five patients. Treatment options include endovascular coiling and surgical clipping. The present analysis aims to compare the two treatment options for ONP due to PCoAA in terms of complete recovery and related parameters. METHODS: A comprehensive literature search was performed for studies published between 2000 and 2019 on ONP due to PCoAA. The included studies were divided into two categories-surgical clipping (group A) and endovascular coiling (group B). The collected data were statistically processed with SPSS version 25. RESULTS: There was a significant difference between the two treatment groups regarding complete recovery of ONP (P<0.001), suggesting superiority of the surgical clipping. The correlation analysis showed no correlations for group A. Group B had negative and positive correlations, showing that endovascular coiling results in higher rates of complete ONP recovery for elderly patients. CONCLUSION: Surgical clipping is superior to endovascular coiling in terms of complete recovery among patients with ONP due to PCoAAs. Endovascular coiling seems to benefit older patients. While no recommendations exist for the treatment of ONP due to intracranial aneurysms, an increasing number of studies imply the superiority of operative clipping.

Symptomatic abdominal simple cysts: is percutaneous sclerotherapy with hypertonic saline and bleomycin a treatment option?

Aim. To evaluate the feasibility of percutaneous sclerotherapy of symptomatic simple abdominal cysts, using hypertonic saline and bleomycin, as an alternative to surgery. Materials and Methods. This study involved fourteen consecutive patients (ten women, four men, mean age: 59.2 y) with nineteen symptomatic simple cysts (liver n = 14, kidney n = 3, and adrenal n = 2) treated percutaneously using a modified method. Initially CT-guided drainage was performed; the next day the integrity of the cyst/exclusion of extravasation or communications was evaluated under fluoroscopy, followed by two injections/reabsorptions of the same quantity of hypertonic NaCl 15% solution and three-time repetition of the same procedure with the addition of bleomycin. The catheter was then removed; the patients were hospitalized for 12 hours and underwent follow-ups on 1st, 3rd, 6th, and 12th months. Cyst's volumes and the reduction rate (%) were calculated in each evaluation. Results. No pain or complications were noted. A significant cyst's volume reduction was documented over time (P < 0.001). On the 12th month 17 cysts disappeared and two displayed a 98.7% and 68.9% reduction, respectively. Conclusion. This percutaneous approach constitutes a very promising nonsurgical alternative for patients with symptomatic simple cyst, without complications under proper precautions, leading to eliminating the majority of cysts.

Incidental thyroid carcinoma diagnosed after total thyroidectomy for benign thyroid diseases: incidence and association with thyroid disease type and laboratory markers.

Objective. Currently, total thyroidectomy (TT) is widely used to treat benign thyroid diseases and thyroid carcinoma. The differential diagnosis between benign and malignant thyroid disorders and the potential identification of thyroid microcarcinomas with biochemical markers remain controversial. This retrospective study aimed to estimate the prognostic validity of thyroid autoantibodies, thyroglobulin (Tg), and the thyroid disease type in diagnostic approaches regarding the co-existence of incidental thyroid carcinoma (ITC) with benign thyroid diseases. Methods. A cohort of 228 patients was treated with TT for benign thyroid disorders between 2005 and 2010. Thyroid autoantibodies and Tg were preoperatively estimated. Patients were classified according to the preoperative and histologically established diagnoses, and the median values of the biochemical markers were compared between the groups. Results. ITC was detected in 33/228 patients and almost exclusively in the presence of nontoxic thyroid disorders (P = 0.014). There were no statistically significant differences in the median values of the biochemical markers between the benign and malignant groups. There was also no significant association between ITC and chronic lymphocytic thyroiditis. Conclusions. The co-existence of ITC with benign and especially nontoxic thyroid diseases is significant, and treatment of these disorders with TT when indicated can lead to the identification and definitive cure of microcarcinomas. Further studies are required to establish precise markers with prognostic validity for TC diagnosis.

Docetaxel plus oxaliplatin in combination with capecitabine as first-line treatment for advanced gastric cancer.

OBJECTIVE: In the present phase II study, we evaluated the efficacy and safety of a docetaxel-oxaliplatin-capecitabine combination as a first-line treatment in patients with advanced gastric cancer. PATIENTS AND METHODS: A total of 27 patients (18 males) with histologically confirmed inoperable gastric adenocarcinoma were recruited. Docetaxel was given (50 mg/m(2) i.v.) on day 1 followed by oxaliplatin (75 mg/m(2) i.v.) also on day 1. Capecitabine (2,750 mg/m(2)) was given orally as two daily divided doses from days 1 to 7. Cycles were repeated every 2 weeks. All patients had measurable disease and 18 of them had a performance status (WHO) of 0. RESULTS: A total of 240 treatment cycles were administered. All patients were evaluable for toxicity. Four patients who discontinued treatment early (having received only 3 chemotherapy cycles) were included as non-responders in an intention-to-treat response analysis. Complete response, partial response, stable disease and progressive disease were observed in 4 (15%), 12 (44%), 3 (11%) and 8 (30%) patients, respectively. The observed response rate was 59%, and the disease control rate (complete response + partial response + stable disease) was 70%. At the time of analysis, 6 patients were still alive and the median survival was 18.0 months. The most common grade III/IV toxicities observed were neutropenia (5%), diarrhea (2%), palmar-plantar erythrodysesthesia (2%) and neurotoxicity (1%). All other toxicities were mostly of grade I/II and easily manageable. CONCLUSION: The combination of docetaxel, oxaliplatin and capecitabine in the described mode of administration represents a relatively active and well-tolerated regimen in patients with advanced gastric cancer and warrants further evaluation.

Epidemiology and survival of patients with well-differentiated thyroid cancer subjected to total thyroidectomy in Thrace area, Northern Greece: a 20-year experience.

AIM: The aim of this study was to evaluate epidemiology and survival of patients with well-differentiated thyroid cancer (WTC) treated with total thyroidectomy (TT) in the area of Thrace, Northern Greece. METHODS: The study was conducted on 80 patients who underwent total thyroidectomy from January 1985 to December 2004 for WTC. Patients' medical records and demographics, including age, sex, histological type (papillary, follicular, mixed type papillary-follicular, Hurthle), stage according to TNM staging, coexistence or future postoperative occurrence of local recurrence or distal metastases and overall and specific survival were analyzed and survival rates were calculated. RESULTS: Papillary carcinoma was found in 56.3% and follicular in 43.8%. Statistical analysis revealed significant correlation of male gender with the high-risk population (P = 0.017), follicular carcinoma with high-risk population (P < 0.0001) and high-risk population with local recurrence or metastatic disease (P < 0.0001). Overall year, 5-year and 10-year survival were 100%, 94% and 91.8% respectively. Further analysis showed a significant reduction in survival regarding to age > 45 years (P = 0.03), follicular type (P = 0.009), high-risk population (P = 0.008), presence of local recurrence or metastatic disease (P < 0.0001) and not significant correlation with male gender (P = 0.086). CONCLUSION: In conclusion, total thyroidectomy should be the surgical treatment of choice in all cases with WTC, especially in male patients > 45 years of age since they have a higher frequency of advanced malignant disease at presentation, a fact that affects prognosis. Patients must be accurately categorized postoperatively, and follow-up must be personalized, in order to diagnose recurrence as early as possible.

Multifocality of thyroid carcinomas: a "privilege" of papillary tumors or not?

AIM: To study the frequency of multifocality in well-differentiated non-medullary thyroid carcinomas and correlate it with various epidemiological factors, as well as with patients' survival. PATIENTS AND METHODS: A retrospective study was conducted on 80 patients who underwent total thyroidectomy from January 1985 to December 2004 in the First Department of Surgery of University General Hospital of Alexandroupolis, Democritus University of Thrace, Greece, for well-differentiated non-medullary thyroid cancer (papillary and follicular). Patients' medical records and demographics, including age, gender, histological type (papillary, follicular), multiple foci of tumors, overall and specific survival were analyzed. RESULTS: Multifocality was established in 17/80 patients (21,25%). Multifocal tumors were found in 4/20 male patients (20%) and 13/60 female ones (21,67%), percentages which are almost identical. Increased rates of multifocal tumors were found in the age groups of 20-29, 30-39 and 70-79 years old, while low rates were documented in the age groups of 0-9, 10-19 and 60-69 years old. Follicular tumors had a 20% rate, similar to papillary tumors (22,2%), and an impressive multifocal rate of mixed papillary-follicular neoplasms (75%) was found. Finally, survival was not found to be influenced by the multifocality of the tumor, under the prerequisition that total thyroidectomy is applied. CONCLUSIONS: Multifocality should not be considered as a "privilege" of papillary thyroid tumors, but as a privilege of thyroid carcinomas in general. If total thyroidectomy is applied in all benign and malignant thyroid diseases, the presence of multiple foci does not affect the prognosis and the survival of the patients.

Creation of a permanent colostomy with the use of an intraluminal stapler device.

We present our experience with the use of the intraluminal stapler device for the purpose of creating of a permanent dermal colostomy in patients requiring acute emergency operations and for regularly scheduled procedures. The advantages of this method for surgeons who use stapling devices are controlled safety of the colostomy, reduced operation time, and the creation of a stable diameter of the colostomy. Furthermore, this method can be used in patients where a secondary operation is needed due to shrinkage or stricture of the primary colostomy during the first operation. This method has now been used in our clinic for five years with excellent results. All patients, including those having procedures related to colon cancer, are placed on a follow up protocol for three years and are closely monitored. This protocol has allowed us to closely follow these patients and any related complications such as stricture, stenosis, prolapse, in situ hernia, and ecstomosis.

Pelvic reconstruction of the retroperitoneum after abdominoperineal resection of the rectum using full-thickness skin grafts.

BACKGROUND: To find a safe and effective method of pelvic reconstruction after abdominoperineal resection in order to prevent small intestine from descending into the pelvis. This allows safe delivery of optimal doses of radiation therapy, which exceed radiation tolerance of the small intestine, in advanced stages of colorectal cancer. MATERIALS: Prospective, ongoing study examining patients who underwent abdominoperineal resection and pelvic reconstruction with full-thickness skin grafts. METHODS: Nine (9) patients underwent abdominoperineal resection of the rectum and pelvic reconstruction with full-thickness skin grafts for colorectal cancer stage C. Subsequently they were referred for adjuvant radiation therapy and followed up regularly for surgical complications and disease recurrence. RESULTS: All patients successfully completed postoperative radiation therapy and there were no serious surgical complications pertaining to the initial operation and the skin homeotransplantation. None of the patients needed reoperation, so the long-term outcome of the transplantation was not surgically evaluated. CONCLUSIONS: Reconstruction of the peritoneal gap after abdominoperineal resection of the rectum with full-thickness skin graft is a safe and effective method. The small intestine was effectively excluded from the pelvis allowing successful completion of adjuvant radiation therapy with minimal irradiation of the small intestine and effective prevention of radiation enteritis.

Use of intraluminal stapler device for creation of a permanent colostomy.

We present our experience with the use of the intraluminal stapler device for the purpose of creating of a dermal permanent colostomy, in cases of acute emergency operations and of regular programmed operations. The advantages of this method for those surgeons who use stapling devices are: controlled safety of the colostomy, shorter operation time and the creation of a stable diameter of the colostomy. All patients of this category as well as those having been operated on for colon cancer have been placed on a protocol follow up for three years and are closely monitored. This has allowed us to closely follow these patients in cases of complications.