1,720,975 research outputs found
Outcome of inferior vena cava and noncaval venous leiomyosarcomas
No full textBackground. Leiomyosarcoma (LMS) is a rare tumor arising from the smooth muscle cells of arteries and
veins. LMS may affect both the inferior vena cava (IVC) and non-IVC veins. Because of its rarity, the
experiencewiththeoutcomeofthediseaseoriginatingfromtheIVCcomparedwiththatwithnon-IVCoffspring
isoveralllimited.Inthisstudy,wecomparedtheclinicalfeaturesandoutcomesafteroperativeresectionofIVC
and non-IVC LMS to detect possible significant differences that could affect treatment and prognosis.
Methods. Twenty-seven patients undergoing operative resection of a venous LMS at a single tertiary care
center and one secondary care hospital were reviewed retrospectively and divided into 2 groups: IVC-LMS
(Group A, n = 18) and non-IVC LMS (Group B, n = 9). As primary end points, postoperative mortality
and morbidity, disease-specific survival and, if applicable, patency of venous reconstruction were consid-
ered. Bivariate differences were compared with the v 2 test. Disease-specific survival was expressed by a life-
table analysis and compared using the log-rank test.
Results. No postoperative mortality was observed in either group. Postoperative morbidity was 28% in
group A and 11% in group B (P = .33). The mean duration of follow-up was 60 months (range, 13–
140). Disease-specific survival was 60% in group A and 75% in group B at 3 years (P = .48), and it
was 54% in group A and 62% in group B at 5 years (P = .63). Seven grafts were occluded in group A
(39%) and 1of 3 were occluded in group B (33%) (P = .85).
Conclusion. IVC and non-IVC LMS exhibit similar outcomes in terms of postoperative course and
survival. Operative resection associated with vascular reconstruction, if applicable, eventually followed by
radiation and chemotherapy may be curative and is associated with good functional results
Internal carotid artery rupture caused by carotid shunt insertion
No full textINTRODUCTION: Shunting
is a well-accepted
method of maintaining cerebral perfusion during carotid
endarterectomy (CEA). Nonetheless, shunt insertion may lead to complications including arterial dissec-
tion,
embolization, and thrombosis.
We present a complication of shunt insertion consisting of arterial
wall rupture, not reported previously.
PRESENTATION
OF CASE:
A 78-year-old woman underwent CEA combined with coronary artery bypass
grafting (CABG). At the time of shunt insertion an arterial rupture at the distal tip of the shunt was detected
and
was repaired via a small saphenous vein patch. Eversion CEA and subsequent CABG completed the
procedure whose postoperative course was uneventful.
DISCUSSION:
Shunting during combined
CEA-CABG may be advisable to assure cerebral protection from
possible hypoperfusion due to potential hemodynamic instability of patients with severe coronary artery
disease.
Awareness and prompt management of possible shunt-related complications, including the
newly reported one, may contribute to limiting their harmful effect.
CONCLUSION:
Arterial wall rupture
is a possible, previously not reported, shunt-related complication to
be aware of when performing CEA
Open surgery for aneurysms of the splenic artery at the hilum of the spleen. Report of three cases
No full textIntroduction: Aneurysms of the splenic artery (SAA) located at the hilum of the spleen are not well fit for endovascular or laparoscopic treatment. Open surgery may still be the best option of treatment. Presentation of cases: We report the cases of 3 female patients of a mean age of 59 years (range, 45–68 years) with a hilar (n = 2) or parahilar (n = 1) SAA undergoing successful open surgical resection, through a short left subcostal access. Recovery was uneventful and mean, postoperative length of stay was 4 days (range, 3–5 days). Discussion: Results of this report support surgical resection and splenectomy for the treatment of SAA located at the hilum of the spleen. For this particular location endovascular treatment may not be advised, as coil embolization can be followed by a massive splenic infarction precipitating the need for splenectomy, due to the exclusion of backflow from the left gastroepiploic artery through the short gastric vessels. As well, endovascular exclusion through insertion of an endograft may not be feasible due to the absence of a distal landing zone, as stent grafting requires a normal caliber artery of sufficient length on each side of the aneurysm. Conclusion: Surgical excision and splenectomy, through a short subcostal incision, remains a viable option of treatment for hilar SAA
Schwannoma of the descending loop of the hypoglossal nerve. Case report
No full textSchwannomas of the descending loop of the hypoglossal nerve are very rare. They are slow-growing tumors that may masquerade a carotid body tumor
Hemangiopericytoma of the spleen
No full textIntroduction: Hemangiopericytoma of the spleen is a very rare tumor, with 14 isolated reports. It was our
aim to review our experience and compare it with all the reported cases in an attempt to standardize
surgical treatment, adjuvant treatment and follow-up protocol of this infrequent condition.
Methods: A consecutive case series study, with a mean follow-up of 44 months. Five patients (mean age,
49 years) underwent simple splenectomy for hemangiopericytoma limited to the spleen followed by
adriamycin-based chemotherapy in one patient.
Results: All the patients are alive and free from disease.
Conclusions: For tumors confined to the spleen, simple splenectomy can be considered curative, without
any need for further adjuvant treatment. On review of the medical literature, cure can still be achieved
with complete resection of recurrences, when feasible, with adjuvant chemotherapy being also indicated.
The slow-growing pattern of the tumor suggests a 10-year follow-up
Dual antiplatelet therapy does not increase the risk of bleeding after carotid endarterectomy. Results of a prospective study
No full textBACKGROUND:
The purpose of this study was to evaluate the risk of bleeding and other postoperative complications of carotid endarterectomy (CEA) in patients receiving dual antiplatelet therapy (DAPT).
METHODS:
From January 2005 to December 2015, 188 consecutive patients undergoing CEA and receiving DAPT (aspirin 100 mg + clopidogrel 75 mg) were enrolled in a prospective study. All of them underwent coronary artery stenting with drug-eluting stents during the 6 months preceding CEA. In the entire series, DAPT was continued until the evening before CEA and resumed on the evening of the operation. All patients received intraoperative heparinization (5,000 IU before carotid clamping), which was reversed in 5 patients. In addition, all of them were given 2,000 units of enoxaparin every 12 hr after the operation, beginning 6 hr after completion of the operation, and until discharge. All the patients presented with carotid artery stenosis >70% (North American Symptomatic Carotid Endarterectomy Trial [NASCET] criteria), which was symptomatic in 42 patients (transient ischemic attack, n = 32; minor stroke, n = 10) and asymptomatic in 146. The CEA technique was standard, with prosthetic patch closure in 109 cases (58%) and eversion in 79 (42%). The primary endpoints of the study were occurrence of a postoperative cervical hematoma requiring surgical hemostasis and occurrence of cranial nerve injuries. The secondary endpoint was the combined rate of postoperative mortality, stroke, and myocardial ischemia.
RESULTS:
No postoperative cervical hematoma requiring surgical evacuation occurred in this series. One hypoglossal nerve palsy, regressive within 2 weeks, was observed. Postoperative mortality and neurologic and cardiac morbidity were nil.
CONCLUSIONS:
CEA under DAPT yields results comparable with those obtained in patients receiving a single antiplatelet treatment. No hemorrhagic complications were observed in this prospective series
Laparoscopic modified double stapling technique with transanal resection for low anterior resection of rectal cancer
No full textBACKGROUND AND AIM: Anterior resection of the rectum with a total mesorectal excision is the standard surgical technique for the treatment of rectal cancer. Laparoscopic low anterior resection (LALAR) is an alternative to open surgical approach and was validated in diverse randomized control trials to be as safe and oncologically effective. That said, confronting a low rectal tumor in an obese patient with a narrow pelvis can be technically challenging even for the most expert surgeon. METHODS: We propose a modified double stapling technique with transanal eversion and staple resection of the rectal stump. RESULTS: We applied the above technique in 3 patients with a dubious distal resection margin due to patient/tumor characteristics. The mean length of operation was 272 minutes and a R0 resection with a mean number of 16 nodes could be obtained in all the patients. No recurrence occurred during a follow-up of 28 months. CONCLUSIONS: We conclude that this technique is a feasible, safe and valid adjunct to the double staple technique whenever intraabdominal application of the linear staple is difficult or unsafe. KEY WORDS: Colorectal cancer, Laparoscopic anterior resection, Double, Low colorectal anastomosis, Stapling technique
Resection of recurrent neck cancer with carotid artery replacement
No full textObjective: The management of patients with recurrent neck cancer invading the carotid artery is controversial. The
purpose of this study was to evaluate overall survival rate, primary patency of vascular reconstructions, and qualityadjusted
life-years (QALYs) after en bloc resection of the carotid artery and tumor with in-line polytetrafluoroethylene
(PTFE) carotid grafting, followed by radiotherapy.
Methods: From 2000 to 2014, 31 consecutive patients with recurrent neck cancer invading the carotid artery underwent en
bloc resection and simultaneous carotid artery reconstruction with a PTFE graft, which was associated in 18 cases with a
myocutaneous flap. The primary tumor was a squamous cell carcinoma of the larynx in 17 patients and of the hypopharynx
in 7, an undifferentiated carcinoma of unknown origin in 4, and an anaplastic carcinoma of the thyroid in 3. All
of the patients underwent postoperative radiotherapy (50-70 Gy), and 10 of them also underwent chemotherapy
(doxorubicin and cisplatin).
Results: None of the patients died or sustained a stroke during the first 30 days after the index procedure. Postoperative
morbidity consisted of 6 transitory dysphagias, 3 vocal cord palsies, 2 wound dehiscences, 1 transitory mandibular
claudication, and 1 partial myocutaneous flap necrosis. No graft infection occurred during follow-up. Fifteen patients
(48%) died from metastatic cancer during a mean follow-up of 45.4 months (range, 8-175 months). None of the patients
showed evidence of local recurrence, stroke, or thrombosis of the carotid reconstruction. The 5-year survival rate was
49 6 10%. The overall number of QALYs was 3.12 (95% confidence interval, 1.87-4.37) with a significant difference
between patients without metastasis at the time of redo surgery (n [ 26; QALYs, 3.74) and those with metastasis (n [ 5;
QALYs, 0.56; P [ .005). QALYs were also significantly improved in patients with cancer of the larynx (n [ 17; QALYs,
4.69) compared to patients presenting with other types of tumors (n [ 14; QALYs, 1.29; P [ .032).
Conclusions: Aggressive en bloc resection of recurrent neck cancer with PTFE grafting can be curative in patients without
metastases at the time of redo surgery. In this subset of patients, extensive neck surgery with carotid artery replacement
can lead to excellent local control of the disease with improved quality of survival. (J Vasc Surg 2016;63:1272-8.
Outcome of resection and chemotherapy versus chemotherapy alone for retroperitoneal recurrence of testicular cancer Involving the inferior vena cava. A retrospective cohort study of 22 consecutive patients
No full textOptimal treatment strategy for retroperitoneal recurrence of testicular cancer involving the inferior vena cava (IVC) is uncertain. The purpose of this study was to validate the hypothesis that surgical resection, en-bloc with the involved segment of IVC and its subsequent reconstruction followed by chemotherapy, would yield better oncologic results than chemotherapy alone
Laparoscopic lavage/drainage as a bridge treatment for perforated diverticulitis with purulent peritonitis associated with an abdominal aortic aneurysm A retrospective case-control study
No full textLaparoscopic lavage /drainage (LALA) or surgical resection are both methods of treatment for perforated diverticulitis with purulent peritonitis (Hinchey Stage III). In case of associated abdominal aortic aneurysm (AAA), laparoscopic lavage/drainage could be an interesting bridge option to treat sepsis before endovascular exclusion of the aneurysm and resection of the sigmoid. We performed LALA as a bridge treatment of peritonitis before elective, staged endovascular exclusion of the aneurysm (EE) and elective resection of the colon
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