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Retroperitoneoscopic nephrectomy in benign pathology
Quintela, Rodrigo S.;Cotta, Leonardo R.;Neves, Marcelo F.;Abelha Jr, David L.;Tavora, Jose E.;
International braz j urol , 2006, DOI: 10.1590/S1677-55382006000500004
Abstract: introduction: we report our experience with 43 retroperitoneal laparoscopic nephrectomy for benign kidney disease. materials and methods: all patients had a poor function from obstructive uropathology and renal atrophy. none of these patients had a previous lumbotomy. retroperitoneoscopy was performed with 4 trocar port technique in a lateral position. the retroperitoneal space is created by using a gaur's balloon made of sterile glove. the approach to vascular pedicle was done posteriorly and vessels were clipped by metal and hem-o-lock (weck closure systems, north carolina, usa) clips. the sample was intact extracted in an endo-bag prolonging one trocar incision. results: median operative time was 160 minutes and median blood loss was 200 ml. four cases (9%) were converted to open surgery: one case due to bleeding and 3 cases due to technical difficulties regarding perirenal adherences. most patients (39) checked out from the hospital in day two. four of them were left over 3 days due to wound complications. conclusions: retroperitoneoscopy offers a safe, effective and reproductive access to nephrectomy for benign pathologies.
M. Saviano
Jurnalul de Chirurgie , 2010,
Abstract: Total thyroidectomy or subtotal thyroidectomy performed in benign pathology of thyroid? Methods: To answer this question we performed a retrospective study on 1103 cases with this pathology: 1082 cases first intervention and 51 cases for relapse pathology. Preoperative diagnosis included: evaluation of the functionality of the thyroid by lab tests, endocrinology exam, ORL exam, anhéstesiologique exam, chest radiograph, CT/MRI neck and thorax, ultrasound, scintigraphy, fine-needle aspiration cytologic diagnoses. Results: Preoperative diagnosis was multinodular goiter (1040 cs.) and Basedow (63 cs.) and surgical procedures performed were total thyroidectomy in 865 cs and subtotal thyroidectomy in 238 cs. In 92 cs were diving goiter and in 157 patients were diagnosed with large nodular goiter (>100 gr). The surgery made by 123 patients with thyroid carcinoma and 980 patients with benign pathology. Mean postoperative hospital stay was 2.5 days. In the group of 1032 patients without preoperative suspicion of neoplasia (cytology not performed preoperatively or negative) hidden carcinomas were 11.7% (121 patients) what requiring 11 surgical reinterventions for radicalization of subtotal thyroidectomy. In the group of 71 patients with preoperative suspicion of neoplasia by fine-needle aspiration papillary carcinoma were 2.8%, the rest being benign thyroid pathology. In the postoperative complications, recurrent nerve lesions were encountered in 78 cs (3.76% of 2206 nerves at risk). Bilateral paralysis immediate was encountered in 5 cs (0.4%): 2 cs after total thyroidectomy and 3 cs after subtotal thyroidectomy with permanent bilateral paralysis in all cases. The immediate unilateral paralysis was encountered in 73 patients, (6.6%/3.3% nerves): 40 cs (4.6%) after total thyroidectomy and 33 cs (13.8%) after subtotal thyroidectomy (p <0.0001). But permanent unilateral paralysis was recorded in 16 patients (1.4%/0.7% nerves): 9 cs (1.0%/0.5% nerves) after total thyroidectomy and 7 (2.9%/1.4% nerves) after subtotal thyroidectomy with insignificant p 0.030. Postoperative hypocalcemia secondary lesions of parathyroid glands was recorded in 222 patients. The permanent hypocalcemia was encountered in 52 cs (6%) after total thyroidectomy and 14 cs (5.8%) after subtotal thyroidectomy with insignificant p 0.8311. Conclusions: The incidence of recurrent nerve lesions, not higher even than in the total thyroidectomy versus subtotal thyroidectomy. The incidence of residual permanent hypoparathyroidism superimposable between the two techniques. The high incidence of carcinomas
ST Elevation: Telling Pathology from the Benign Patterns
Waleed Tallat Kayani,Henry D Huang,Salman Bandeali,Salim S Virani
Global Journal of Health Science , 2012, DOI: 10.5539/gjhs.v4n3p51
Abstract: Benefits of early reperfusion in patients presenting with acute ST elevation myocardial infarction (STEMI) are well known. The American College of Cardiology / American Heart Association guidelines recommend triage decisions are made within 10 minutes of performing initial electrocardiogram (ECG). Since many patients presenting with ischemic symptoms may have ST elevation (STE) at baseline, not all STE signify transmural ischemia. Benign patterns can be easy to find in some cases. However, patients with benign STE at baseline (left ventricular hypertrophy, early repolarization pattern) may have ongoing ischemia and present with Non-ST elevation myocardial infarction (NSTEMI) or even STEMI superimposed on the benign pattern. The ability of clinicians to distinguish between ischemic and non ischemic STE varies widely and is affected by prevalence of such changes in patient population. More studies need to be done to delineate the criteria to clearly distinguish between ischemic and non ischemic ST elevation.
Anorectal Melanoma: A 10-Year Study in the North-East of Iran  [cached]
Kazem Anvari,Payam Izadpanahi,Bahram Memar
Iranian Journal of Cancer Prevention , 2012,
Abstract: Background: Anorectal melanoma is one of the rare but significant malignancies of the anorectal area. This malignancy currently accounts for 1% of all types of melanoma and less than 1% of all the anorectal area malignancies. Very rare cases of this disease have been reported worldwide.Anorectal melanoma is mostly diagnosed while treating other benign conditions of this area such as hemorrhoids with conventional modalities. Its treatment of choice has always been a controversial issue.Methods: In this study, clinical pathology and outcome of 7 cases with anorectal melanoma referred to Omid Oncology Teaching Hospital during 2001-2011 were assessed.Results: Out of seven cases, 2 patients had been diagnosed with hemorrhoids and undergone surgery and 2 other cases had been referred with the primary diagnosis of lymphoma. Initially, only in 3 cases melanoma was diagnosed in clinico-pathology setting. Three cases of patients had distant metastases to the liver, lungs, omentum and mesentery, while the other 4 patients had advanced local disease. No patient had been diagnosed in the primary stages of the disease. The mean time duration between symptoms onset to diagnosis of disease had been 8 months. The median survival time was 5 months.Conclusion: Rare anorectal melanoma and its similar manifestations to other common anorectal conditions can delay the diagnosis, therefore should be considered as an uncommon differential diagnosis. The disease's outcome is poor and most probably delay in the diagnosis has an important role in the treatment results.
Ultrastructural Findings, at Micrometric and Nanometric Scales, in Rectal and Muscular Mucosa of Patients with HIV/AIDS and Anorectal Pathology  [PDF]
Annunziato Maria Antonieta, Sardi?as Carlos, Finol Hector, Carvajal Ana, González Roschman, De Gouveia Yetsenia, García Estefanie, Garibaldi Liseth
International Journal of Clinical Medicine (IJCM) , 2018, DOI: 10.4236/ijcm.2018.95041
Abstract: Objective: To determine the ultrastructural findings on Rectal Mucosa (RM) of patients with HIV/AIDS and anorectal pathologies (ARP), at micrometric and nanometric scales. Materials and methods: 5 patients were evaluated, 18 - 55 years old, with ARP (HIV co-infection with HPV, n = 4, and HIV-negative patient with HPV infection) (control n = 1), who were referred to the Coloproctology Unit of the HUC, and subjected to rectoscopy and biopsy. RM samples were identified, placed in a sterile plastic bottle with 1 mL of 2% glutaraldehyde and immediately transported for routine processing of fine cut (60 - 90 nm) to be evaluated via Transmission Electron Microscopy (TEM). They were fixed with Karnovsky solution with Millonig phosphate buffer (pH 7.4 and 320 mOsm) and post-fixed with OsO4 under the same conditions of pH and osmolarity. Results: Ultrastructural findings, at 106 scale: 1) Intestinal mucosa: vacuoles of mucus of different sizes that seem to be fused. 2) Smooth muscle cells: loss of definition of contractile myofilaments mass. 3) Unmyelinated axons and terminals of Schwann cells (SC): Edema and loss of their plasma membranes in some areas of association with axon terminals as well as abundant collagen fibers associated with SC. Ultrastructural findings, at 109 scale: 1) Smooth muscle cells: folded wrapper cores and edema of mitochondria and rough endoplasmic reticulum cisterns (RER). 2) Myelinated axon terminals: Loss of synaptic vesicles. 3) Fibroblasts: One observes mitochondria and cisterns of RER with alterations. All these alterations can generate intestinal and anorectal dysfunction in these patients. Conclusions: The HIV causes changes in rectal and muscular mucosa despite HAART treatment with undetectable viral load.
Intravesical Residual Urine of Patients with Benign Prostate Hyperplasia, Sonography Accuracy
Samad Hazhir Karzar,Kamaloddin Hasanzadeh,Mohamad Goldust,Nazanin Hazhir Karzar
Pakistan Journal of Biological Sciences , 2012,
Abstract: Measurement of intravesical residual urine is experimentally a diagnostic, therapeutic and follow-up criterion in patients with benign prostate hyperplasia. The study aims at evaluating sonography accuracy in measuring intravesical residual urine in comparison with standard and accurate way of measurement through bladder catheterization. The study was conducted on 60 patients hospitalized for benign prostate hyperplasia. Mean age of the patients was 67.10±8.33 years. In all patients with full bladder and after urination, the post void residue was initially measured by sonography at supine position and then immediately through bladder catheterization. This study evaluated 60 patients with mean age of 67.10±8.33 years. The difference between measuring through sonography and catheterization was 7.89±0.86, 14.46±1.87 and 32.73±2.99 mL in postvoid residue less than 50, 51-100 and more than 100 mL, respectively. In patients with benign prostate hyperplasia, transabdominal sonography is a non-invasive method to determine postvoid residue amount.
What every gastroenterologist needs to know about common anorectal disorders  [cached]
Moonkyung Cho Schubert, Subbaramiah Sridhar, Robert R Schade, Steven D Wexner
World Journal of Gastroenterology , 2009,
Abstract: Anorectal complaints are very common and are caused by a variety of mostly benign anorectal disorders. Many anorectal conditions may be successfully treated by primary care physicians in the outpatient setting, but patients tend not to seek medical attention due to embarrassment or fear of cancer. As a result, patients frequently present with advanced disease after experiencing significant decreases in quality of life. A number of patients with anorectal complaints are referred to gastroenterologists. However, gastroenterologists’ knowledge and experience in approaching these conditions may not be sufficient. This article can serve as a guide to gastroenterologists to recognize, evaluate, and manage medically or non-surgically common benign anorectal disorders, and to identify when surgical referrals are most prudent. A review of the current literature is performed to evaluate comprehensive clinical pearls and management guidelines for each topic. Topics reviewed include hemorrhoids, anal fissures, anorectal fistulas and abscesses, and pruritus ani.
Increased Incidence of Benign Pancreatic Pathology following Pancreaticoduodenectomy for Presumed Malignancy over 10 Years despite Increased Use of Endoscopic Ultrasound  [PDF]
Shadi S. Yarandi,Thomas Runge,Lei Wang,Zhijian Liu,Yueping Jiang,Saurabh Chawla,Kevin E. Woods,Steven Keilin,Field F. Willingham,Hong Xu,Qiang Cai
Diagnostic and Therapeutic Endoscopy , 2014, DOI: 10.1155/2014/701535
Abstract: Despite using imaging studies, tissue sampling, and serologic tests about 5–10% of surgeries done for presumed pancreatic malignancies will have benign findings on final pathology. Endoscopic ultrasound (EUS) is used with increasing frequency to study pancreatic masses. The aim of this study is to examine the effect of EUS on prevalence of benign diseases undergoing Whipple over the last decade. Patients who underwent Whipple procedure for presumed malignancy at Emory University Hospital from 1998 to 2011 were selected. Demographic data, history of smoking and drinking, history of diabetes and pancreatitis, imaging data, pathology reports, and tumor markers were extracted. 878 patients were found. 95 (10.82%) patients had benign disease. Prevalence of benign finding had increased over the recent years despite using more EUS. Logistic regression models showed that abdominal pain (OR: 5.829, 95% CI 2.681–12.674, ≤ 0.001) and alcohol abuse (OR: 3.221, CI 95%: 1.362–7.261, : 0.002) were predictors of benign diseases. Jaundice (OR: 0.221, 95% CI: 0.084–0.58, : 0.002), mass (OR: 0.145, 95% CI: 0.043–0.485, : 0.008), and ductal dilation (OR: 0.297, 95% CI 0.134–0.657, : 0.003) were associated with malignancy. Use of imaging studies, ERCP, and EUS has not decreased the percentage of benign findings after surgery for presumed pancreatic malignancy. 1. Introduction Pancreatic cancer accounts for 2% of newly diagnosed malignancies, with pancreaticoduodenectomy (The Whipple procedure) being the only potentially curative treatment [1]. Differentiating between pancreatic carcinoma and benign diseases of the pancreas such as chronic pancreatitis is challenging. Pancreatic cancer can present with vague symptoms that overlap with the symptomatology of benign diseases and have an insidious course. The imaging findings also overlap between benign and malignant diseases and no single finding such as pancreatic duct dilation, focal mass, cyst, or abnormal enhancement pattern can reliably make the differentiation. In addition, secondary inflammatory changes are often seen in pancreatic cancer while chronic pancreatitis is associated with an increased risk of pancreatic carcinoma [2]. Although the outcome of the Whipple procedure has improved significantly over the past years and is associated with 1-2% mortality when performed in large volume centers, the morbidity of the procedure remains high [3]. Therefore, constant efforts are being made to improve available diagnostic tools in order to prevent performing Whipple for benign diseases. Despite the advances in imaging
Synergism of verbal autopsy and diagnostic pathology autopsy for improved accuracy of mortality data
Corinne L Fligner, Jill Murray, Drucilla J Roberts
Population Health Metrics , 2011, DOI: 10.1186/1478-7954-9-25
Abstract: The term "autopsy" means "to see or observe for oneself," but traditional use has been reserved for the postmortem examination of a (dead) body by a physician/pathologist, in order to identify diseases and injuries and determine the cause(s) of death. This medical-diagnostic pathology procedure integrates trained observation of the external and internal body with dissection or other invasive procedures, in order to obtain tissue samples, which are evaluated by microscopy and other specialized laboratory modalities, including chemical, toxicologic, genetic, and molecular biologic analyses. Used more broadly, the term "autopsy" reflects the aggregate of procedures used for postmortem medical diagnosis or death investigation, including investigative procedures that identify information about the deceased's medical history and the circumstances and scene of his/her death.To most pathologists and physicians, the term "verbal autopsy" seems a contradiction in terms. However, it is a clearly defined procedure, which allows classification of cause of death and cause-specific mortality by the analysis of data derived from structured interviews of family, friends, and caretakers, as well as review of any available medical records [1]. As more than two-thirds of the world's population lives and dies in countries that lack functional vital registration systems, and in which most deaths occur outside of medical facilities and are neither enumerated nor classified by cause, verbal autopsy has become the primary methodology for determining population-based cause-specific mortality [2,3]. The development of computerized algorithmic systems for determination of cause of death by analysis of verbal autopsy data is a major focus of health metrics research, and emphasis is currently focused on using the recently-completed dataset from the Population Health Metrics Research Consortium (PHMRC) project that will allow analysis of verbal autopsy data collected from more than 12,000 hospita
Ophthalmic pathology: An illustrated guide for clinician  [cached]
Biswas Jyotirmay
Indian Journal of Ophthalmology , 2007,
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