ABSTRACT
INTRODUCTION: Intraoperative ultrasonography (IOUS) is the gold standard for tumor staging and operative decision making in liver surgery. Providing dynamic information on tumor-vessel relationships and distribution of intrahepatic veins, IOUS is also an important support for guiding the resection. Few authors report an extensive use of IOUS-guidance as a safe and effective approach. The aim of this study is to investigate the short-term results of an early experience of ultrasound (US) guided liver resection. METHODS: From December 2005 to December 2007 an extensive use of IOUS-guided resection was applied in 11 consecutive patients (8 males and 3 females; median age 74 years). Perioperative data were collected prospectively to assess the influence of this approach on mortality, morbidity and early recurrence. RESULTS: Four patients had hepatocellular carcinoma, 4 liver metastases, 1 peripheral cholangiocarcinoma, 1 hemangioma and 1 inflammatory pseudotumor. A median of 1 (range: 1-4) nodule per patient was resected. Median lesion size was 44 mm. Liver procedures included: 3 wedge resections, 3 subsegmentectomies, 4 segmentectomies and 3 bisegmentectomies. Median blood loss was 235 ml. Median surgical margin in cancer patients was 5 mm (range: 1-12). An average of 1 unit of blood transfusion was administered in 5 patients. Median postoperative hospital stay was 9 days. There was no mortality. Major complications occurred in 1 patient and minor complications in 5 patients. During a median follow-up of 14 months no recurrences were observed. CONCLUSIONS: In this study, use of IOUS-guided liver resection performed in a district general hospital proved to be a safe and effective approach in terms of short-term outcome.
ABSTRACT
In line with data reported in the literature, the authors consider that the careful protection of the tracheal suture with abundant vital tissue is of fundamental importance in the prevention of complications in tracheal resective-reconstructive surgery. This procedure in fact reduces the risk of necrosis and subsequent fistulization of tracheal tissue and prevents decubitus of the suture on the innominate arterial wall, avoiding possible ulceration with fistulization and tracheal hemorrhage.
Subject(s)
Bronchi/surgery , Postoperative Complications/prevention & control , Trachea/surgery , Anastomosis, Surgical , HumansABSTRACT
The authors illustrate the current possibilities and limitations of a leading-edge technique, thoracoscopic surgery, made possible by the enormous technical progress which has led to the creation of specific visual and surgical instruments. On the strength of their personal experience, they list the different diseases which may be treated using video thoracoscopic surgery.
Subject(s)
Thoracic Surgery/methods , Thoracoscopy/methods , Video Recording/methods , Adolescent , Adult , Aged , Anesthesia/methods , Biopsy , Female , Humans , Lung/pathology , Male , Middle Aged , Monitoring, Intraoperative , Pneumonectomy , Preanesthetic Medication , Thoracic Surgery/instrumentation , Thoracoscopes , Video Recording/instrumentationABSTRACT
Twenty patients undergoing lung resections were randomized into two groups: group 1 (n = 10) received mini-tracheotomy postoperatively and group 2 (n = 10) were control patients. The two groups were similarly matched in pulmonary functions (FEV1 < 1.8 1), performance status and surgical procedures (major pulmonary resections). All patients were monitored by serial chest X-ray examinations, arterial blood gases, clinical assessment and response to chest physiotherapy. Postoperative pulmonary complications of atelectasis/bronchopneumonia developed in 1 patient in group A and 4 patients in group B. Two patients of this last group required mini-tracheotomy to treat the pneumonia. The mean overall duration of mini-tracheotomy was 6.3 days. Five patients presented minor temporary symptoms related to mini-tracheotomy, including voice changes, discomfort and stridor. No long term morbidity was observed. We concluded that the use of mini-tracheotomy is safe and effective in decreasing postoperative respiratory morbidity in high risk patients.
Subject(s)
Lung/surgery , Tracheotomy/methods , Aged , Bronchopneumonia/etiology , Humans , Middle Aged , Postoperative Care , Postoperative Complications/etiology , Prospective Studies , Pulmonary Atelectasis/etiology , Risk FactorsABSTRACT
Between 1971 and 1986 11 patients suffering from pulmonary aspergilloma were seen in the thoracic surgery service at Genova-Sampierdarena Hospital. Nine patients underwent thoracotomy. Lobectomy was the most frequent operation. Complications occurred in 3 patients (33%). There were no recurrent symptoms in any of them over a mean follow-up of 4 years. The remaining two patients were treated by instillation of antifungal agents into the aspergilloma cavity. There was no systemic toxicity and in one patient the mycetoma resolved. The authors conclude that pulmonary resection can provide effective long-term treatment, while intracavity infusion of antifungal agent can be a successful nonoperative method in critically ill patients.
Subject(s)
Aspergillosis/surgery , Lung Diseases, Parasitic/surgery , Administration, Topical , Adult , Aged , Amphotericin B/administration & dosage , Aspergillosis/diagnostic imaging , Aspergillosis/drug therapy , Female , Humans , Lung/diagnostic imaging , Lung Diseases, Parasitic/diagnostic imaging , Lung Diseases, Parasitic/drug therapy , Male , Miconazole/administration & dosage , Middle Aged , Pneumonectomy , RadiographyABSTRACT
This study is based on the analysis of the survival data in patients with N2 disease reported by Martini, Pearson, Shields et al. Many factors appear to influence survival of this group of patients. We made a retrospective analysis of a series of 91 patients with N2 disease between January 1980 and March 1985. Sixty-nine patients (71.5%) presented clinically N2 disease; 44 patients (63.7%) were treated with complete resection and postoperative irradiation, the actuarial five year survival was 11%. Twenty-two patients (24.2%) were discovered to have N2 disease at thoracotomy. Twenty-one patients underwent resection and the actuarial five year survival was 29%. We conclude that surgery can be effective in a highly selective group of patients.
Subject(s)
Carcinoma, Bronchogenic/surgery , Carcinoma, Non-Small-Cell Lung/surgery , Lung Neoplasms/surgery , Lymphatic Metastasis , Carcinoma, Bronchogenic/mortality , Carcinoma, Non-Small-Cell Lung/mortality , Humans , Lung Neoplasms/mortality , Mediastinum , Prognosis , Retrospective StudiesABSTRACT
The paper described the treatment of a series of 47 mediastinal goitres. The importance of a thorough preoperative assessment of the lesion and of careful planning of the operative technique are underlined. Cervical collar incision provided adequate exposure in most patients. The Authors conclude that surgical treatment should be recommended in all cases.
Subject(s)
Goiter, Substernal/surgery , Adult , Aged , Female , Goiter, Substernal/diagnostic imaging , Goiter, Substernal/pathology , Humans , Male , Middle Aged , Prognosis , RadiographyABSTRACT
Efficacy of automatic staplers in broncho-pulmonary surgery was evaluated in a series of 316 consecutive patients. The results confirm that utilization of staplers has drastically reduced the incidence of post-resection bronchial fistulae; moreover on parenchymal tissue such instruments guarantee excellent haemostasis and air tightness. On the contrary, indications for their use on pulmonary vessels seem to be very limited.
Subject(s)
Bronchi/surgery , Lung/surgery , Surgical Staplers , Suture Techniques , Bronchial Fistula/etiology , Evaluation Studies as Topic , Humans , Postoperative ComplicationsSubject(s)
Hernia, Diaphragmatic, Traumatic/diagnosis , Adult , Aged , Aged, 80 and over , Female , Hernia, Diaphragmatic, Traumatic/surgery , Humans , Male , Middle Aged , Time FactorsSubject(s)
Hernia, Diaphragmatic, Traumatic/diagnosis , Accidents, Home , Accidents, Traffic , Adult , Aged , Aged, 80 and over , Female , Hernia, Diaphragmatic, Traumatic/complications , Hernia, Diaphragmatic, Traumatic/etiology , Hernia, Diaphragmatic, Traumatic/surgery , Humans , Middle Aged , Time FactorsSubject(s)
High-Frequency Jet Ventilation , Pneumonectomy , Aged , High-Frequency Jet Ventilation/instrumentation , Humans , Male , Middle AgedABSTRACT
The authors describe the different clinical and histologic features of solitary papilloma, multiple papillary lesions and diffused papillomatosis, and point out the different surgical approach in the three forms described.
Subject(s)
Breast Neoplasms , Papilloma , Adult , Aged , Breast/pathology , Breast Neoplasms/diagnosis , Breast Neoplasms/pathology , Breast Neoplasms/surgery , Female , Humans , Middle Aged , Papilloma/diagnosis , Papilloma/pathology , Papilloma/surgeryABSTRACT
The Authors report the remote results of 214 cases of breast cancer, operated in the period August 1963-December 1974, after subdividing the cases they had the opportunity to observe on the basis of the stage of the disease, the surgical treatment and the eventual post-mastectomy precautionary therapy.
Subject(s)
Breast Neoplasms/surgery , Axilla , Breast Neoplasms/drug therapy , Breast Neoplasms/pathology , Breast Neoplasms/radiotherapy , Combined Modality Therapy , Cyclophosphamide/therapeutic use , Female , Follow-Up Studies , Humans , Lymph Node Excision , Mastectomy , Methotrexate/therapeutic useABSTRACT
The Authors, in the present work, describe the clinical and diagnostic features of Myasthenia Gravis, and, on the basis of their casuistry and the international scientific literature, remark the necessity of the surgical operation as the basic therapeutic chance for the resolution and improvement of the disease.
Subject(s)
Myasthenia Gravis/therapy , Thymectomy , Adult , Female , Humans , Lipoma/complications , Lipoma/surgery , Male , Middle Aged , Myasthenia Gravis/diagnosis , Myasthenia Gravis/etiology , Thymoma/complications , Thymoma/surgery , Thymus Neoplasms/complications , Thymus Neoplasms/surgeryABSTRACT
The Authors, after shortly explaining the main anatomo-pathological and clinical features of gastric neurinoma, describe a case they had the opportunity to observe, and appearing, in full welfare, exclusively through the symptoms of a serious gastrointestinal hemorrhage.
Subject(s)
Gastrointestinal Hemorrhage/etiology , Neurilemmoma/pathology , Stomach Neoplasms/pathology , Humans , Male , Middle Aged , Neurilemmoma/complications , Neurilemmoma/surgery , Stomach Neoplasms/complications , Stomach Neoplasms/surgeryABSTRACT
The Authors report an observation of glomic tumour of fingers in a man aged 68. After a reviewing of the literature thereabout, they dwell upon the rareness of this disease and upon its main clinical manifestations. The angiographic study completed is remarkable. The Authors, as a conclusion, confirm the need of a surgical treatment.
Subject(s)
Fingers , Glomus Tumor , Aged , Glomus Tumor/pathology , Glomus Tumor/surgery , Humans , MaleABSTRACT
The authors report their experience about a polychemotherapeutical treatment with CDDP in a woman bearer of 4th stage ovarian cancer. They shortly analyse the biologic features and acting mechanism of CDDP, and outline its indications and limits. The thorough regression observed in the case treated is related to the literature data pointing out the validity of this drug and its usefulness in particular neoplasiae and in carefully selected patients.
Subject(s)
Carcinoma/drug therapy , Cisplatin/administration & dosage , Fluorouracil/administration & dosage , Methotrexate/administration & dosage , Ovarian Neoplasms/drug therapy , Carcinoma/pathology , Carcinoma/surgery , Drug Therapy, Combination , Female , Follow-Up Studies , Humans , Middle Aged , Ovarian Neoplasms/pathology , Ovarian Neoplasms/surgeryABSTRACT
The authors illustrate the peculiar features of breast "phylloid cystosarcoma", and analyse its features of benignity and eventual sarcomatous transformation; moreover, they, point out the different types of surgical treatment.