1,721,147 research outputs found
Reconstruction with a pectoralis major myocutaneous flap after left first rib and clavicular chest wall resection for a metastasis from laryngeal cancer
Full text linkWe presented a case of recurrent metastasis from epidermoid cancer that occurred in the left clavicle of a patient with a history of laryngeal cancer treated on April 2005 with extended hemilaryngectomy, neck dissection and chemoradiation therapy. On September 2008, he developed a left clavicular metastasis. The disease was initially well controlled by chemoradiotherapy but it recurred 17 months later. The optimal treatment plan was established by several multidisciplinary meetings and the patient subsequently underwent an en bloc resection of the left clavicle, first rib and all the other involved structures. Coverage of the thoracic defect was achieved using pectoralis major myocutaneous flap. The patient had a successful surgical outcome. At 1-year follow-up, he had no evidence of disease, a good cosmetic result and returned to normal daily activity. He died for bone metastasis with an overall 21 months post-surgical survival.We presented a case of recurrent metastasis from epidermoid cancer that occurred in the left clavicle of a patient with a history of laryngeal cancer treated on April 2005 with extended hemilaryngectomy, neck dissection and chemoradiation therapy. On September 2008, he developed a left clavicular metastasis. The disease was initially well controlled by chemoradiotherapy but it recurred 17 months later. The optimal treatment plan was established by several multidisciplinary meetings and the patient subsequently underwent an en bloc resection of the left clavicle, first rib and all the other involved structures. Coverage of the thoracic defect was achieved using pectoralis major myocutaneous flap. The patient had a successful surgical outcome. At 1-year follow-up, he had no evidence of disease, a good cosmetic result and returned to normal daily activity. He died for bone metastasis with an overall 21 months post-surgical survival
A new prosthetic implant for inguinal hernia repair: its features in a porcine experimental model.
No full textEven after more than 100 years of inguinal hernia repair, the rate of complications and recurrence remains unacceptably high. In the last decades, few effective advances in surgical technique and materials have been made. The authors see them as minor adjustments in the shape and materials of the prosthetic implants. Still, the underlying genesis of inguinal hernia remains undefined. Based upon this, it seems the surgical repair of inguinal protrusions cannot be based upon the pathogenesis because the etiology to date has not been addressed. Most hernia repairs are performed with some degree of point fixation (sutures/tacks) to stop the mesh from migrating and creating high recurrence rates. This should be a priority for our considerations, as fixating mesh puts it in stark contrast to the physiology and dynamics of the myotendineal structures of the groin. Following years of surgical practice, implant fixation, mesh shrinkage, and poor quality of tissue ingrowth still represent an unresolved issue in modern hernia repair. Conventional prosthetics used for inguinal hernia repair are static and passive. They do not move in harmony with the dynamic elements of the groin structure and, as a result, induce the ingrowth of thin scar plates or shrinking regressive tissue that colonizes the implants. The authors strongly believe that these characteristics may be a contributing factor for recurrences and patient discomfort. Other complications are reported in the literature to be a direct result of fixation of the implants, such as bleeding, nerve entrapment, hematoma, pain, discomfort, and testicular complications. To improve results by respecting the physiology and kinetics of the inguinal region, we felt that a new type of prosthesis should be designed that induces a more structured tissue ingrowth similar to the natural biologic components of the abdominal wall. This prosthetic device was specifically designed to be placed with no point fixation. This was achieved by using inherent radial recoil, vertical buffering, friction, and delivering the device in a constrained state. A secondary benefit of this "dynamic" design is that the implant moves in a three-dimensional way in unison with the movements of the myotendineal structures of the groin. The results appear to show that the three-dimensional structure not only acts as a suitable scaffold for a full thickness ingrowth of a tissue barrier but also seems to induce an ordered, supple, elastic tissue, which allows for neorevascularization and neoneural growth. The outcomes indicate a reduced impact of fibrotic shrinkage on the implant/scar tissue when compared with shrinkage of polypropylene meshes reported in the literature. This pilot study shows the features of such an implant in a porcine experimental model
OneShot-M: A New Device for Close Laparoscopy Pneumoperitoneum
Full text linkINTRODUCTION: The induction of pneumoperitoneum is the first and most critical phase of laparoscopy, due to the significant risk of serious vascular and visceral complications. The closed technique for the creation of pneumoperitoneum could lead to several surgical complications. The present study aimed to overcome the complications associated with the insertion of Veress needle, improving its use, and facilitating the rapid creation of pneumoperitoneum.
METHODS: Thirty large white female pigs were enrolled in our study. A common plunger was modified in order to allow the passage of a 15-cm long Veress needle. This method was applied to 26 laparoscopic procedures (26 pigs) of several specialist branches.
RESULTS: OneShot-M close laparoscopy pneumoperitoneum creation device allowed us to obtain pneumoperitoneum quickly in all attempts, without any intraoperative and postoperative complications related to the use of the Veress needle.
CONCLUSION: The use of the proposed device showed an induction time as quick as the standard laparoscopic closed abdominal entry. The patented device is cheap and allows a safe abdominal entry. In addition, abdominal entry is much faster than the classic open technique
Late, giant brachial artery aneurysm following hemodialysis fistula ligation in a renal transplant patient: case report and literature review.
No full textBrachial artery aneurysm (BAA) following long-standing arteriovenous fistula ligation after renal transplantation is uncommon. Herein, we describe the case of a 64-year-old man who developed a giant symptomatic BAA 21 years after ligation of the fistula. He was submitted to surgical excision of the aneurysm followed by interposition prosthetic graft
Is it possible to create a "mechanical" arteriovenous fistula in hemodialysis patients?
No full textManual suturing still remains the best technique
for the creation of vascular anastomoses on uremic patients
with excellent results, despite being time consuming, difficult
to perform with small vessels, and associated with a
significant learning curve. We created a full mechanical
arteriovenous fistula on a 65-year-old uremic patient with a
new device already used in cardiac bypass surgery. The
fistula was created automatically and rapidly, without
the need for temporary occlusion of the artery, reducing the
risk of blood clotting.We believe that mechanical devices
may be useful to produce precise and fast anastomoses
requiring minimal training for the surgeon
The use of video-assisted thoracic surgery in the management of Pancoast tumors
Full text linkWe describe our experience using video-assisted thoracic surgery (VATS) as an adjunct to the surgical management of Pancoast tumors.
Between March 2004 and November 2009, 13 patients with Pancoast tumors were included in this study. Surgery was performed by
positioning the patient to allow either an anterior or a posterior thoracotomy. VATS was employed to explore the pleural cavity, to optimize
the surgical access and as an assistance during surgical resection. Three patients with pleural carcinosis at thoracoscopy did not undergo
further surgery. Seven lobectomies and three wedge resections were performed with an en bloc chest-wall resection and mediastinal
lymphadenectomy. The surgical approaches were a transmanubrial L-shaped incision (ns1), a posterior thoracotomy (ns8), and a combined
transmanubrial and posterior thoracotomy (ns1) which were dictated by the thoracoscopic findings. The average operative time was
200 min (range: 185–280 min); the average blood loss was 325 ml (range: 250–1200 ml). The average hospitalization was nine days (range:
8–30 days). Our study indicates that VATS may be an effective and safe adjunct to standard surgical resection in patients with Pancoast
tumors. It reduces the magnitude of surgery, either by sparing the patient a useless thoracotomy or, by optimizing the site of the thoracotomy. It may also have a significant educational role
Ultrasound-guided port-a-cath positioning with the new one-shoot technique: thoracic complications
No full textPort-a-cath catheterization is often required for those patients who need long-term therapies (malnutrition, neoplasm, renal failure, other severe diseases). The use of ports for a wide range of indications is not exempt from complications. Ultrasound-guided central venous catheterization (CVC) is a safe and fast technique for the introduction of the catheter inside a central vein. This retrospective study reports our experience with US-guided CVC in patient eligible for port-a-cath implantation
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
ENDOSCOPIC FINDINGS IN CHRONIC RENAL FAILURE: REVIEW OF LITERATURE
No full textChronic kidney Disease (CKD) is associated with several gastrointestinal diseases, documented with endoscopy. we revisited internation experience about endoscopic pictures in these patients, analyzing only the pre-transplantation period. Gastritis, esophagitis, duodenitis, gastrointestinal bleeding, intestinal ischaemia, angiodysplasia and diverticula are the most common findings, but others are reported too. Every author has different data and percentages, and further studies are necessary to assess the relation between CKD and gastrointestinal diseases. CKD is often part of a multisystem damage, that makes the management of the patinet critical. The aim of this review is to consider patients with CKD as an object of a multidisciplinary team, in order to analyze and prevent all the possible endoscopic-surgical complication, and this can be done with a serial endoscopic follow-up in centers where nephrology, internal medicine and surgery can work in close cooperation
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