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Brain Stem Tumours – Surgical Management
TARIQ SALAHUDDIN
The Professional Medical Journal , 2002,
Abstract: O BJECTIVE: Our main objective was to assess the outcome of surgery in selected group of Brain Stem tumours.PURPOSE OF STUDY: This paper specifically looked at the role of definitive surgical procedures, total or near totalexcision of cystic or focal Brain stem lesions and their outcome as compared to minimal invasive surgery like stereo tacticbiopsy for diffuse tumours. MATERIAL & METHODS: The study comprises of forty patients of brain stem tumourswhich were admitted and operated at the Neurosurgery Department of Allied Hospital, Punjab Medical College,Faisalabad. PERIOD: Jan 1991 to Dec 1998. RESULTS: The age of these patients were between five to forty twoyears, with peak incidence between eleven and fifteen years. There were thirty four children and four adults. The male tofemale ratio was 24/16 (1.5:1). Most of these patients had computerized tomography(70%) or Magnetic ResonanceImaging (30%). The predominant histological type was astrocytomas Grade III (60%) and Grade II (30%).CONCLUSION: All cystic and focal tumours showed better results with radical surgery, compared to more diffusetumours that had stereo tactic biopsy.
Surgical therapy of neuroendocrine tumours of the pancreas
Tadeusz Popiela,Janusz Legutko,Piotr Szybiński
Polish Gastroenterology , 2008,
Abstract: Aim of study: The aim of this study was to report our own findings on diagnosing and treating pancreatic GEP NET in a single centre where ProfessorJan Glatzel carried out the first enucleation of insulinoma in Poland in 1939. Material and methods: The subject of this report were 55 patients with hormonally active pancreatic GEP NET, including 33 lesions producing insulin, 14 producing gastrin and 7 producing glucagon. One female patient was diagnosed with the Verner-Morrison syndrome typical fortumours producing VIP (vasoactive intestinal polypeptide). Each of these tumours demonstrates a separate clinical picture and causes different therapeutic problems. Results: Out of 55 patients with pancreatic GEP NET, 33 were operated with the preoperative diagnosis of insulinoma. lntraoperatively, the lesions were identified and resected in 29 patients, including one case of a bifocal tumour. No tumour could be found in 4 patients, and histopathological examination of surgical specimens revealed nesidioblastosis or beta-cell hyperplasia. Complete healing was achieved in all patients in whom tumours were resected and no relapse was observed overa 20-year observation period. However, relapse of hypoglycaemia requiring conservative therapy was observed in 4 patients with nesidioblastosis at different time intervals after surgery, related to the extent of pancreatic resection. Eleven of 14 patients with gastrinoma were operated. Two patients were treated conservatively with H2-receptor blockers and then proton pump inhibitors. One patient transferred from another department died due to massive gastrointestinal (Gl) haemorrhage caused by multiple gastric ulcers, and the final diagnosis was established at necropsy. Seven patients were qualified forsurgery due to the suspicion of pancreatic cancer. In this group, immunohistochemical tests of the surgical specimen revealed tumours producing glucagon (glucagonoma) and two of them were reported as neuroendocrine cancers. Surgical therapy of GEP NET has evolved similarly to other disciplines of surgery. However, it seems that the principal requirementin such cases is the precise visualisation of the tumour before surgery. The female patient suspected preoperatively for VIPoma under went an explorative laparotomy only, because the tumour could not be located even using intraoperative scintigraphy. The patient was treated conservatively and diarrhoea was controlled with long-acting somatostatin. Conclusions: Current works are also focused on other methods of systemie therapy for patients with GEP NET, and probably combined m
Surgical Treatment of Pancreatic Neuroendocrine Tumours - Clinical Experience
Beata Jab ońska, Daria Dranka-Bojarowska, Hanna Palacz, Adam Lewiński, Pawe Lampe
Polish Journal of Surgery , 2011, DOI: 10.2478/v10035-011-0033-5
Abstract: The aim of the work was the clinical characteristics and analysis of preliminary results for surgical treatment of pancreatic neuroendocrine tumors (PNETs), based on own material. Material and methods. In the period from 2005 to 2009, in the Department of Gastrointestinal Surgery, Silesian Medical University in Katowice, there were 27 patients (15 males and 12 females) treated surgically for pancreatic neuroendocrine tumours, constituting 65.86% (27/41) of all gastroenteropancreatic neuroendocrine tumours. Prior to the surgery, the following diagnostic examinationswere performed: laboratory tests and imaging examinations (abdominal ultrasound and CT scan). The following tumour localisation was established: head of the pancreas - 14, body of the pancreas - 4, tail of the pancreas - 5, body and tail of the pancreas - 1, retroperitoneal space - 4. There were found 24 (88.89%) primary tumours and 3 (11.11%) recurrences. The following methods of surgical treatment were applied: pancreatoduodenectomy - 11, distal pancreatic resection with splenectomy - 6, middle segment resection with anastomosis between the pancreatic tail and jejunal loop: Roux-Y procedure - 1, pancreatic resection by Beger procedure - 1, pancreatic head and body resection with splenectomy - 1, tumour enucleation or local excision - 4, exploratory laparotomy with specimen collection - 3. Results. The mean hospitalisation period was 25 days (4-78 days). The mean procedure duration was 4.2 hours (1.15-9.15 hours). Early post-operative complications were observed in 10 patients (37.04%). The following early complications were observed: intra-abdominal abscess - 2, wound suppuration - 2, pancreatic fistula - 1, acute pancreatitis - 1, pancreaticojejunal anastomosis leak - 1, peritoneal cavity haemorrhage - 1, acute cholangitis - 1, adhesion obstruction - 1, subobstruction - 1, portal vein thrombosis - 1, sepsis - 1, fluid in pleural cavity - 1, acute heart failure - 1. There were performed 2 (7.41%) repeat surgeries: one due to adhesion obstruction and one due to peritoneal cavity haemorrhage. Death of 1 patient (3.71%) was recorded in the post-operative period due to acute heart failure. Conclusions. Pancreatic neuroendocrine tumours constituted the majority of gastroenteropancreatic neuroendocrine tumours in the analysed patient group. Most commonly, PNETs were localised in the head of the pancreas. In the presented material, the mortality rate does not exceed 4%, similarly as in other renowned centres.
The effects of hormonal therapy in natural and surgical menopause  [cached]
Eduard Crauciuc,Daniela Badoi,Mariana Bratu,Eugen Ungureanu
Analele ?tiin?ifice Ale Universit??ii Alexandru Ioan Cuza din Ia?i,Sectiunea II A : Genetica si Biologie Moleculara , 2012,
Abstract: Between 2009 and 2011 we monitored the clinical and paraclinical evolution of 109 patients for 24 months. Hormonal therapy in menopause proved its efficiency, especially for the improvement of the climacteric symptoms, as the long term effects on cardiovascular diseases is still being studied. The patients treated with Climara and Riselle showed, after 2 years of treatment, a libido and a decrease of hot flushes. No matter what the type of menopause you monitor, the LDL cholesterol shows a significant decrease for the lots that are treated with hormones. The average values of HDL cholesterol significantly increased for the patients who were under hormonal treatment. The average values of glycaemia decreased for all the lots under treatment
A Novel Surgical Approach to Lipomatous Tumours of the Deltoid Region  [PDF]
Emad Al Absi,Tamanna Karim,Nigel Colterjohn,Michelle Ghert
Sarcoma , 2010, DOI: 10.1155/2010/495834
Abstract: Resection of large lipomatous tumours in the subdeltoid region remains technically challenging due to the risk of injury to the axillary neurovascular bundle. We describe a novel deltoid release and reinsertion technique for resection of large lipomatous tumours of the sub-deltoid region and report the functional and oncologic outcomes of six patients who underwent this procedure. Three cases were diagnosed histologically as atypical lipoma and three cases were diagnosed as lipoma. There was one local recurrence in a case of an atypical lipoma. Rotator cuff function was comparable to that of the contralateral side in all cases and the average Constant Score adopted by the European Shoulder and Elbow Society was 84 (range 81 to 92) out of 100. We conclude that patients with large sub-deltoid lipomatous tumours who undergo resection through a previously undescribed deltoid release and reinsertion technique have excellent functional outcome with a low risk for recurrence. 1. Introduction The upper extremity is affected by bone and soft tissue neoplasms one-third as often as the lower extremity [1]. When soft tissue tumours occur in the upper extremity, these tumours characteristically occur in the shoulder girdle. In the setting of a benign or low-grade tumour, surgical excision requires a balance between the resection margin and optimal functional recovery of the shoulder. Lipomatous tumours of the soft tissues are the most common soft tissue tumours and these lesions can occur at every age and at almost any anatomical location [2, 3]. The shoulder, however, is a region where these tumours may present difficulty in adequate resection due to the proximity of the tumour to neurovascular structures and the functional loss associated with periscapular muscle resection. The deltoid muscle has a multipennate origin from the lateral third of the clavicle, the acromion process and the spine of scapula, and is the largest muscle of the shoulder girdle. Its function is of paramount importance in abduction and flexion. The axillary nerve exits in the quadrangular space below the lower border of teres minor, where it passes around posterior and lateral to the humerus on the deep surface of the deltoid muscle. The nerve then splits into anterior and posterior trunks, both of which run intimately with the deep surface of the deltoid muscle. Tumours in the sub-deltoid region are therefore particularly difficult to resect due to the risk of injury to the axillary nerve [4]. Various techniques of deltoid mobilization have been described, and these techniques vary in the
A Novel Surgical Approach to Lipomatous Tumours of the Deltoid Region  [PDF]
Emad Al Absi,Tamanna Karim,Nigel Colterjohn,Michelle Ghert
Sarcoma , 2010, DOI: 10.1155/2010/495834
Abstract: Resection of large lipomatous tumours in the subdeltoid region remains technically challenging due to the risk of injury to the axillary neurovascular bundle. We describe a novel deltoid release and reinsertion technique for resection of large lipomatous tumours of the sub-deltoid region and report the functional and oncologic outcomes of six patients who underwent this procedure. Three cases were diagnosed histologically as atypical lipoma and three cases were diagnosed as lipoma. There was one local recurrence in a case of an atypical lipoma. Rotator cuff function was comparable to that of the contralateral side in all cases and the average Constant Score adopted by the European Shoulder and Elbow Society was 84 (range 81 to 92) out of 100. We conclude that patients with large sub-deltoid lipomatous tumours who undergo resection through a previously undescribed deltoid release and reinsertion technique have excellent functional outcome with a low risk for recurrence.
Surgical treatment of gastric and small bowel gastrointestinal stromal tumours  [cached]
Luká? Sákra,Ji?í ?iller,Petr Vyhnálek,Marie Hácová
Videosurgery and Other Miniinvasive Techniques , 2011,
Abstract: Aim: This study aimed to evaluate a set of gastrointestinal stromal tumours (GIST) of the stomach and the small bowelmanaged with a laparoscopic technique.Material and methods: The study covers a period from January 1, 2007 until June 1, 2010 during which 13 patientsunderwent the laparoscopic removal of stomach tumours and 2 patients underwent the removal of a small bowelGIST in the General Hospital in Pardubice. In all cases tumours were removed in a laparoscopic way, including thehealthy border of the stomach tissue.Results: No death was observed in our study. Two patients suffered from wound infection (secondary healing), one ofthem requiring repeat surgery owing to the excessive narrowing of the distal part of the stomach. Dehiscence oflaparoscopic sutures or other intra-abdominal complications were not observed. During monitoring all patients werefree of signs of local recurrence, but tumour progression into the liver was observed in 1 patient. Gastrointestinal stromaltumours are very rare tumours but their incidence is increasing. At this time the consensus about the necessity ofpreoperative unambiguous differentiation between malignant or less malignant variants is not available. Strict differentiationis very difficult and the decision whether to choose a more radical surgical approach for more malignantvariants is not clear-cut.Conclusions: In cases of gastric and small bowel GISTs the local removal of a tumour with the healthy border of thestomach tissue may be chosen as an adequate approach. Our results support this local surgical approach.
Microbial Study of Hormonal and Surgical Contraceptive Methods in Hamadan, Iran  [PDF]
Fatemeh Shobeiri,Frazaneh Soltani,Mansour Nazari
Knowledge & Health Journal , 2010,
Abstract: Introduction: Vaginitis is one of the most common gynecologic problems to which a considerable percentage of out-patient treatments is devoted annually. The purpose of this study was to investigate the prevalent microbial factors in hormonal and surgical contraceptive method users who referred to medical and health centers in Hamadan, Iran.Methods: In this descriptive/analytic, 160 women referring to family planning clinics were selected based on a quota sampling procedure. In addition to the detailed history and demographic characteristics of the subjects, samples of their vaginal discharge for wet mount examination, gram staining and culturing were obtained. SPSS was used to analyze the data descriptively and analytically.Results: The results revealed that majority of the users of natural methods (50%) and surgical methods (72/5%) had positive clinical signs, but 65% of hormonal and 80% of condom users did not have any clinical symptoms. The findings indicate statistically significant differences between clinical signs and contraception methods (P=0.00). Trichomoniasis, vaginalis had the highest prevalence of 5% in surgical method users and 2.5% in hormonal method users, while no case was reported in users of condom and natural methods. Gardnerella was reported in 7.5% of surgical method users, in 5% of hormonal method users and in 2.5% of natural method and condom users. The prevalence of candidiasis in hormonal method users, surgical method and condom users, and natural method users was 7.5%, 5% and 2.5%, respectively. E. coli was also reported in 7.5% of hormonal method and condom users and in 2.5% of natural method users.Conclusion: Noting the high prevalence of bacterial vaginosis, trichomoniasis and candidiasis in the subjects, it is suggested that women using contraception methods be regularly followed-up for clinical examination and counseling.
Surgical Considerations in the Management of Tumours of the Nose and Paranasal Sinuses in a Northern Nigerian Teaching Hospital
K.R Iseh, D Aliyu
West African Journal of Medicine , 2009,
Abstract: BACKGROUND: Tumours of the nose and paranasal sinuses in sub-Saharan Africa are generally characterised by late presentation posing management challenges to the otorhinolaryngologists in the sub-region. OBJECTIVES: To appraise surgical considerations in the management of tumours of the nose and paranasal sinuses in a developing nation from the experiences of an Ear, Nose, and Throat Department of a Nigerian Teaching Hospital. METHODS: This was a chart review of patients with tumours of the nose and paranasal sinuses who underwent various surgical operations over a period of four and a half years.The patients were referred by other physicians or health care workers. They were assessed clinically, backed by laboratory and radiological investigations. RESULTS: A total number of 55 patients underwent 64 surgical operations. There were 31 (56.4%) males and 24 (43.6%) females, giving a male to female ratio of 1.3:1. They were aged between four years and 70 years. In 46(83.6%) patients the tumours had extended beyond the nasal cavity or one sinus cavity to contiguous structures. The surgical operations carried out were lateral rhinotomy in 37(57.8%), intranasal clearance and intranasal antrostomy in 16(25%), total maxillectomy in seven(11%), and anterior craniofacial resection in two (3.1%) patients. The histological examination showed that 43 (78.2%) cases were benign, while 12 (21.8%) cases were malignant. These malignant cases needed radiotherapy and chemotherapy. CONCLUSION: Majority of the cases were characterised by late presentation, requiring surgical approaches such as lateral rhinotomy, total maxillectomy or craniofacial resection depending on the extent of the tumour. Poverty, ignorance, inadequate funding and administration challenges of health resources are factors militating against proper clinical management of tumours of the nose and paranasal sinuses in developing nations. Provision of free medical care and modern facilities for early diagnosis, treatment, and health education are needed to reverse the trend. WAJM 2009; 28(6): 371–375.
Status of adrenals at influence exogenous RNA in the conditions of the experimental blastomogenesis  [PDF]
Khripkov I.S.
Морфолог?я , 2011,
Abstract: The experimental research has been supplied on 70 white rats - males in mass of 140-160 to whom under a skin the tumoral strain of a carcinoma of Guerin has been transplanted. The operation purpose was learning of influence exogenous homologous tumoral RNA on a morfo-functional status of adrenals at animals with tumor. Tumour growth causes a strain of compensator mechanisms of adrenals at cellular level and is accompanied by response from a microcirculatory channel. Introduction exogenous homologous tumoral RNA an animal locks development of reactive changes in a parenchima and an organ stroma.
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