Syndromes after resection of a cervical schwannoma.

Cervical schwannomas are rare, as fewer than 250 cases have been reported in the literature. The preferred method of removing a schwannoma is enucleation. Complications of schwannoma excision include Horner syndrome, first-bite syndrome, and Pourfour du Petit syndrome. These complications are usually transient and in most cases do not require treatment. Pourfour du Petit syndrome, which is the converse of Horner syndrome, occurs with stimulation of the sympathetic cervical chain. We report a case of cervical schwannoma in a 44-year-old woman who developed signs suggestive of both Horner syndrome and Pourfour du Petit syndrome following excision of the lesion. We discuss the diagnostic workup, surgical treatment, and likely sequelae of this pathology.

The effect of laparoscopic Roux-en-Y gastric bypass on fibromyalgia.

BACKGROUND: Fibromyalgia is a chronic debilitating disorder affecting 3-5% of the US population. Treatment of this disorder is a challenge. The incidental finding of improvement of fibromyalgia following laparoscopic Roux-en-Y gastric bypass stimulated us to study this phenomenon. METHODS: A retrospective chart review of patients with fibromyalgia who underwent laparoscopic Roux-en-Y gastric bypass. RESULTS: Postoperative decrease in median of BMI from 49.4 to 29.7 was significant (p value = 0.0010). This was associated with statistically significant improvement in median of pain score (p value = 0.0010) and median points of tenderness (p value = 0.0010). CONCLUSION: Significant weight loss following laparoscopic Roux-en-Y gastric bypass is associated with resolution or improvement of fibromyalgia. Consequently, the bariatric surgeon should be a member of the multidisciplinary team approach for treating fibromyalgia.

Advanced age: is it an indication or contraindication for laparoscopic ventral hernia repair?

INTRODUCTION: Ventral hernias are common surgical problems in the geriatric population. Although ventral hernias are electively repaired in younger patients, the safety and efficacy of elective laparoscopic hernia repair in the geriatric age group is not well documented in the literature. METHODS: A review of 155 patients undergoing laparoscopic ventral hernia repair was undertaken. The patients were classified according to their age into 2 groups, Group A (n=126) for those who are 65 years old. The patient demographics, comorbidities, hernia characteristics, and operative and postoperative data were compared. RESULTS: Younger patients were found to have a significantly increased BMI, while the older group had an increased number of comorbidities. No difference was found in the complication or recurrence rates between the 2 groups. CONCLUSION: Elective laparoscopic ventral hernia repair in senior citizens is safe and feasible in our experience. We believe that the decision to perform an elective hernia repair in this patient population should be based on the general condition of the patient rather than the patient's chronological age.

High ligation of the saphenofemoral junction in endovenous obliteration of varicose veins.

BACKGROUND: Endovenous radiofrequency (RF) ablation of the greater saphenous vein has become an accepted treatment modality. This study examines if it is necessary to perform high ligation of the saphenous vein to insure success of the procedure. STUDY DESIGN: A retrospective chart analysis was conducted on 219 patients who underwent RF ablation for venous insufficiency. All procedures were performed by 3 board-certified vascular surgeons. One surgeon always ligated the saphenofemoral junction (SFJ), the second never ligated, and the third ligated selectively. Demographic data were collected and analyzed. RESULTS: A total of 77 patients underwent RF ablation with ligation of the SFJ (group I), and 142 patients underwent ablation without ligation (group II). Both groups had similar ablation success rates (P = .0960), 92% (group I) and 84% (group II). CONCLUSION: Saphenofemoral junction ligation is not indicated on a routine basis to achieve success with endovascular ablation of the greater saphenous vein.

Ultrasound surveillance of endovascular aneurysm repair: a safe modality versus computed tomography.

Routine ultrasound surveillance is adequate and safe for monitoring endovascular aneurysm repairs (EVARs). A retrospective chart review including 160 endograft patients was performed from August 2000 to September 2005. All ultrasound examinations (n = 359) were performed by a board-certified vascular surgery group's accredited laboratory. Registered vascular technologists utilized the same equipment consisting of Siemens Antares high-definition ultrasonography with tissue harmonics and color flow Doppler. An identical protocol was followed by each technologist: scan body and both limbs of the endograft and distal iliac vessels, measure anterior-posterior aneurysm sac size, and detect intrasac pulsatility and color flow. Statistical analysis utilized Pearson's correlation coefficient and the paired t-test. Forty-one endoleaks were discovered out of the 359 exams (11.4%). There were type I (7, 17%), type II (26, 63%), and combined type I with type II (8, 20%) endoleaks. Correlation with computed tomography (CT) was obtained in 35 of these cases. CT discovered three endoleaks that were not seen with ultrasound. However, these particular ultrasound exams were inadequate due to additional factors (bowel gas, body habitus, hernia), which prompted CT investigation and, hence, endoleak discovery. Of the 41 endoleaks found on ultrasound, only 14 were seen on CT. Specifically, 26 type II endoleaks were seen with ultrasound versus only nine during CT. Additional factors addressed included comparison between ultrasound and CT of residual aneurysm sac measurements and conditions limiting ultrasound examination. Although criticized in the past, color flow ultrasonography is a safe and effective modality for surveillance of aortic endografts. Utilizing ultrasound to analyze abdominal aortic aneurysm (AAA) sac dimensions and endoleak detection is statistically sound for screening AAA status post-EVAR.

Chilaiditi's syndrome: what should every surgeon know?

Demetrius Chilaiditi first described an incidental radiological finding of hepatodiaphragmatic interposition of bowel in 1910. The condition could be mistaken for pneumoperitoneum. This radiographic entity, known as Chilaiditi's sign, is found in asymptomatic patients and must be distinguished from Chilaiditi's syndrome, which produces symptomatology associated with the bowel interposition. A review of the literature yielded 27 published cases of Chilaiditi's syndrome. These cases were compiled to evaluate various aspects of this rare but important entity.

Emergency medical services in St. Vincent and the Grenadines.

OBJECTIVE: This descriptive study reports the status of the health care infrastructure and the emergency medical services system in the nation of St. Vincent and the Grenadines, an eastern Caribbean nation made up of a series of small islands located 1,600 miles southeast of Miami. METHODS: Data regarding the health care system and emergency medical services in the nation were gathered from various sources, including the Ministry of Health, government publications, hospital records, accident and emergency department logbooks, and interviews with physicians, nurses, and ambulance workers. RESULTS: The health system is similar in structure to that of the United Kingdom. Generally, the health infrastructure and available staffing are adequate and comparable to those of developed nations. However, out-of-hospital emergency medical services are lacking in both equipment and trained personnel. CONCLUSION: These data should be useful to both policymakers and health professionals in formulating strategies for advancing emergency medical services in St. Vincent and the Grenadines, and may also be instructive to other countries with developing emergency medical services systems.