ABSTRACT
OBJECTIVE: Very few reports investigated techniques of closure of the basal wound area to reduce severe complications like mediastinitis after endoscopic laser diverticulotomy. In this study, we report our experiences after routine use of a collagen-fibrin sealant patch for basal wound covering after laser diverticulotomy in consideration of postoperative complications and recurrence rates. PATIENTS AND METHODS: This retrospective study was conducted in a tertiary referral center and university hospital. Endoscopic laser diverticulotomies performed in our hospital between January 2006 and July 2018 were included. After complete transection of the laser septum of the diverticulum, we placed a collagen-fibrin patch onto the basal wound area to cover the opening to the mediastinum. Patient records were evaluated to assess the occurrence of perioperative complications, and the data were compared with those reported in the literature. RESULTS: A total of 127 endoscopic laser diverticulotomies were performed in 109 patients (71 men, 38 women) suffering from Zenker's diverticulum. Morality rate was 0%, in particular no mediastinitis was observed. Mediastinal emphysema was observed in two patients (1.6%), and temporary or persistent recurrent nerve palsy in one patient (0.8%) each. The mean follow-up period was 71.6±5.16 months. Recurrent symptomatic diverticulum was observed in 19.3% of the patients. CONCLUSIONS: These findings suggest that use of a collagen-fibrin sealant patch in endoscopic laser diverticulotomy may contribute to the safety of endoscopic controlled laser diverticulotomy without comprising the success rates.
Subject(s)
Collagen/pharmacology , Fibrin Tissue Adhesive/pharmacology , Wound Healing/drug effects , Zenker Diverticulum/drug therapy , Aged , Aged, 80 and over , Esophagoscopy , Female , Humans , Laser Therapy , Lasers , Male , Middle Aged , Postoperative Complications/drug therapy , Postoperative Complications/surgery , Retrospective Studies , Treatment Outcome , Zenker Diverticulum/surgeryABSTRACT
BACKGROUND: Tumors of the lacrimal drainage system are rare but potentially life-threatening. The purpose of this study was to investigate the applicability of selective lacrimal sac biopsy in 500 cases of external dacryocystorhinostomy for acquired dacryostenosis. PATIENTS AND METHODS: Lacrimal sac biopsy was obtained selectively for atypical clinical and/or intraoperative findings. The frequency and spectrum of biopsies were recorded and correlated with the follow-up results. RESULTS: Lacrimal sac biopsy was performed in 19 external dacryocystorhinostomies (3.8%) including non-Hodgkin B-cell lymphoma (3), squamous carcinoma (2), mucoepidermoid carcinoma (1), malignant melanoma (1), oncocytoma (1), pyogenic granuloma (4), Wegener's granulomatosis (4) and sarcoidosis (3). Within 5 years none of the patients without biopsy developed systemic inflammatory diseases or lacrimal neoplasms. The 5-year survival was 87% in patients with significant lacrimal sac pathology and 96% in patients without significant pathology. CONCLUSION: External dacryocystorhinostomy with selective biopsy for atypical clinical and intraoperative findings allows safe diagnosis and management of potentially life-threatening lacrimal lesions.
Subject(s)
Biopsy , Dacryocystorhinostomy/methods , Eye Neoplasms/pathology , Lacrimal Apparatus Diseases/pathology , Lacrimal Duct Obstruction/pathology , Nasolacrimal Duct/pathology , Adult , Aged , Aged, 80 and over , Diagnosis, Differential , Female , Follow-Up Studies , Humans , Male , Middle Aged , Tomography, Optical CoherenceABSTRACT
By continuous parenteral administration of carbohydrates, combined with essential amino acids and L-histidine, a significant improvement in urea nitrogen and plasma protein metabolism could be obtained in 24 patients during the first ten days after abdominal surgery. A comparable control group of 15 patients who received only water, electrolytes and vitamins in the postoperative phase showed significantly worse results. The observation that under the influence of parental nutrition the beginning azotemia and the deficit of immunoglobulins especially of the complement components improved more quickly after the stress of surgery seems to be an important clinical aspect. At the same time it became evident that adequate parenteral nutrition can have a significant effect on the postoperative behaviour of some plasma proteins (retinol-binding protein, albumin,transferrin, prealbumin).
Subject(s)
Blood Proteins/analysis , Parenteral Nutrition , Adult , Aged , Amino Acids, Essential/metabolism , Blood Urea Nitrogen , Carbohydrate Metabolism , Female , Histidine/metabolism , Humans , Immunoglobulins/analysis , Male , Middle Aged , Postoperative CareABSTRACT
A significant improvement in urea nitrogen and plasma protein metabolism during the first 10 days after abdominal surgery was obtained in 24 patients who received parenteral carbohydrates combined with essential amino acids and histidine. A control group of 15 patients who only received water and electrolyte balance in the post-operative phase showed significantly worse results. The observation that immunoglobulins (IgG) and complement components (C1q, C3 activator) recovered more quickly from the stress of surgery under the influence of parenteral nutrition seems to be particularly important.
