1,720,989 research outputs found
Re: Invisible scar endoscopic dorsal approach thyroidectomy: a clinical feasibility study
No full textThe endoscopic approach to the neck: a review of the literature and an overview of the various techniques
Full text linkWe thank Dr. Muenscher and collegues for their review of our article on the underlying pros and cons of endoscopic and video-assisted surgical approaches for neck surgery. In our opinion, some points have not been stressed properly. Since its initiation in 1999, the minimally invasive video-assisted thyroidectomy (MIVAT) approach has been widely used for both benign and malignant thyroid lesions in both adult and pediatric patients [1–3]. Although listed as a disadvantage, the operative time for MIVAT resembles that for conventional thyroidectomy after an adequate learning curve period [3]. Both the operative time and the complications rate for MIVAT equal those for open surgery [1–3].
A major criticism is the author’s reported absence of clinical studies investigating the completeness of video-assisted techniques in thyroid cancer. In fact, at least two clinical trials involving patients with low- and intermediate-risk papillary thyroid carcinomas (PTCs) have been reported by our university [4, 5]. We demonstrated that PTC patients who underwent MIVAT had a good outcome during a 5-year follow-up period. The outcome was similar to that for patients treated with conventional thyroidectomy and the same degree of exposure to post-surgical radioactive iodine treatment (I131) [5]
Minimally invasive video assisted parathyroidectomy (MIVAP)
No full textThe first endoscopic approach to parathyroid glands was reported by M. Gagner in 1996. Later, different accesses have been described using either CO2 insufflation or external retraction. Other widespread procedures include the lateral access proposed by J.F. Henry and the central gas-less access proposed by P. Miccoli.
We hereby describe this central access which allows a bilateral exploration of the neck when necessary. Our patient data base consists of 270 patients operated on since February 1997. The mean age was 56.5 years (20–87 years). The female to male ratio was 4:1. The mean operative time of the procedure was 41.1 min (range 15–180 min).
In 13 cases, a video-associated thyroid resection was accomplished during the same operation for associated diseases. Conversion to traditional cervicotomy was required in 20 patients (8.09%). One laryngeal nerve palsy was confirmed 6 months after surgery. We registered one postoperative bleeding, which required us to reoperate on the patient 2 hours after first surgery. The mean operative time and complication rate clearly demonstrate that this approach, like other minimally invasive techniques, can successfully rival the results of traditional surgery for the treatment of primary hyperparathyroidism
Minimally invasive video-assisted thyroidectomy.Report of 16 cases in children old than 10 years
No full textAbstract
METHODS:
From October 1998 to December 2002 in the Department of Surgery at the University of Pisa, 16 patients ages 18 years or younger (14 girls, 87.5%, and 2 boys, 12.5%; range, 11 to 18; mean age, 15 years, 8 months) underwent a surgical operation with video-assisted technique for thyroid pathology. These patients belong to a larger group of 270 patients treated with this technique. Surgical therapy with video-assisted technique was chosen; a lobectomy was used in 15 cases (90.0%) and a total thyroidectomy in 1 case (10%).
RESULTS:
Two patients (12.5%) underwent a second video-assisted operation to complete the thyroidectomy for a false-negative result at extemporal histologic examination during the first operation. The histologic examination found benign pathology in 14 cases (87.5%) and a malignant lesion (papillary type) in 2 cases (12.5%). No postoperative complications were observed.
CONCLUSIONS:
The results of the mini-invasive video-assisted technique for thyroidectomy in this preliminary experience seem to be equal to those of the traditional open surgical technique (200 surgical operations for thyroid pathology for the ages 18 years or younger). Elective indications of the mini-invasive video-assisted technique are the volume of the nodule and hystological type; this technique cannot be used in cases of voluminous goiter, medullary carcinomas and poorly differentiated carcinomas. The advantage that this technique offers, in addition to a better postoperation period, is an improved esthetic result, which is particularly important in young patients
Video-assisted central compartment lymphadenectomy in a patient with a positive RET oncogene: initial experience
No full textAbstract
BACKGROUND: Prophylactic surgery for patients carrying a positive RET proto-oncogene proved to be highly effective in curing those likely to experience the development of a medullary carcinoma. Video-assisted procedures have been proved feasible for central compartment dissection.
METHODS: A total of 15 patients (7 men and 8 women) with a positive RET proto-oncogene underwent total thyroidectomy and central compartment lymphadenectomy via a video-assisted approach. The mean age of the patients was 32.5 years. The echographically estimated mean volume was 10.3 ml, and the mean diameter of the main nodule was 8.8 mm. Preoperative ultrasound showed an absence of lateral neck lymph node involvement in all cases. No drain was used. Direct laryngoscopy was performed in all cases 1 month after surgery.
RESULTS: The mean operative time was 67.3 min. A transient hypoparathyroidism occurred in one patient, and a permanent hypoparathyroidism occurred in another patient. No laryngeal nerve palsy was present. All the patients were discharged on postoperative day 1. Histology showed a medullary carcinoma in 10 patients and diffuse C-cell hyperplasia in 5 patients. The mean number of lymph nodes removed was 5.1. None of these nodes proved to be metastatic. Calcitonin levels were undetectable in all six patients who had a follow-up period longer than 1 year.
CONCLUSION: Video-assisted central compartment lymphadenectomy was proved to be effective and safe. The procedure demonstrated a complication rate comparable with that for the conventional procedure, a better cosmetic outcome, and less postoperative pain. Although the video-assisted access proved to be a valid option for the treatment of patients carrying a positive RET proto-oncogene, a greater number of cases with a longer follow-up period is necessary to estimate the impact of the video-assisted approach on central neck lymphadenectomy
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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