The three surgical techniques for otosclerosis: a review of literature

Thesis (Ed.M.)--Boston Universit

Evaluation of functional outcome and patient satisfaction after arthroscopic elbow arthrolysis

Arthroscopic arthrolysis is indicated for stiffness and pain caused by intrinsic stiffness and early arthritis of the elbow joint. Previous studies have demonstrated the benefits in relieving pain and improving motion, but none have reported the specific functional recovery. To understand the functional outcome and patient satisfaction, 26 patients were reviewed at a mean follow-up of 25 months. All were manual workers or strength athletes. Pre- and post-operative evaluation included the Elbow Functional Assessment score, patient satisfaction and return to work and sports. Function improved significantly in 87% and the overall Elbow Functional Assessment score raised from a preoperative 48 to a postoperative 84. Arthroscopic arthrolysis not only improved pain and the range of motion, but also restored the elbow function and returned patients to their desired level of activity

Video-assisted thoracic surgery: Risks and benefits

Summary: Background: Thoracoscopy has been used throughout this century, especially in the treatment of pleural disease. The introduction of video-assistance and especially designed instruments such as stapling devices in 1992 led to a worldwide and enthusiastic application for the treatment of a variety of thoracic pathologies. Methods: This report summarizes our experience gained from 1013 consecutive VATS procedures performed since 1990 for various indications in order to clarify its role for surgery of thoracic pathologies. Results: 234 patients underwent VATS for pleural biopsy, 154 for talcage, 163 for pulmonary wedge resections in order to clarify interstitial diseasee or indetermined nodules, 126 for spontaneous pneumothorax, 91 for decortication of empyema, 63 for symphatectomy, 55 for biopsy of mediastinal lesions, 29 for pericardial effusions (fenestration), 25 for lung volume reduction surgery, 17 for excision of mediastinal cysts and 12 for excision of neurogenic tumors of the posterior mediastinum. Conclusions: Our results demonstrate that VATS has gained established acceptance for several indications, however, caution in application of VATS is clearly indicated for some diseases, especially for thoracic malignancie

Hepatic cyst reduction surgery and its significance for polycystic liver disease

Purpose.Although there have been many studies on polycystic liver disease (PCLD), most have not considered the effectiveness of computed tomography volumetry for liver resection as part of reduction surgery. In this study, we report the techniques used for liver resection in reduction surgery for PCLD and describe the theoretical basis.Methods.We performed clinical and imaging investigations in five patients with PCLD whose chief complaints were abdominal distention and early satiety.Results.The average plasma indocyanine green retention at 15 min (ICG R15), which indicates hepatic functional reserve, was 11.3 ± 6.7%, indicating moderate liver damage. The average galactosyl human serum albumin uptake during single photon emission tomography uptake for assessing asialoscintigraphy was 50.6% ± 17.8%, indicating slightly decreased uptake. The disease was present in both lobes of the liver in all patients except one, in whom PCLD was localized in the left lobe.Because multiple cysts were present in the hepatic radial margin, we only resected cysts without the surrounding parenchyma when possible. The cyst walls were comparatively tough and firm. Because Glisson’s capsule was present between the cysts, resection was performed with double or triple ligation with transfixing sutures to prevent suture failure and postoperative biliary leakage. Only one patient reported symptom recurrence because of enlargement of cyst remnants.The average preoperative and postoperative total liver volumes were 4644 ± 1813 cm3 and 2698 ± 1615 cm3, respectively, indicating a significant decrease (p < 0.01). The average preoperative cyst volume was 3765 ± 1780 cm3, which decreased to 1894 ± 1546 cm3 after surgery, indicating a significant 35% decrease in cyst volume (p < 0.01). The average preoperative and postoperative noncystic volumes were 880 ± 80 cm3 and 805 ± 173 cm3, respectively, indicating no significant loss of liver parenchyma.Conclusion.The goal of liver resection in PCLD is bulk reduction to alleviate abdominal distention and early satiety. All patients in this study were alive at the time of publication, indicating that the surgery allows patients to survive beyond a few years

Focal Spot, Fall/Winter 2000

https://digitalcommons.wustl.edu/focal_spot_archives/1086/thumbnail.jp

Excisional therapy for benign hepatic lesions

With the recent advances in imaging techniques, increased numbers of hepatic lesions are found today, and surgeons are asked frequently for the best course of management. Benign hepatic tumors sometimes cause life-threatening complications and more often trigger disabling or annoying symptoms in otherwise healthy individuals. Although various imaging techniques are quite accurate in identifying cysts and hemangiomas, other benign hepatic lesions, such as adenomas, focal nodular hyperplasia and other benign solid tumors, cannot be differentiated from malignant lesions with a high degree of confidence

Complications à moyen et long terme des opérations de Fontan pour les coeurs univentriculaires

Les ventricules uniques sont des malformations cardiaques que l'on classifie selon la morphologie du ventricule et du type de connexion atrioventriculaire. Un traitement chirurgical est nécessaire pour la survie des patients : seulement 50% des patients sont en vie après 4 ans sans aucune opération (1). Plusieurs interventions chirurgicales palliatives sont nécessaires pour séparer la circulation systémique de la circulation pulmonaire. - Étape 1 : dépend du type de ventricule unique a. Ventricule unique sans sténose pulmonaire : cerclage de l'artère pulmonaire pendant la période néonatale b. Ventricule unique avec sténose pulmonaire : shunt de Blalock-Taussig c. Ventricule unique avec sténose sous-aortique : opération de Damus-Kaye-Stansel, et shunt de Blalock-Taussig. - Étape 2 : anastomose de Glenn, entre 4 et 6 mois de vie. - Etape 3 : opération de Fontan modifiée à l'aide d'un tube extracardiaque. Il s'agit d'une palliation définitive, faite entre 2 et 4 ans de vie. Cette opération permet de séparer les deux circulations. Malgré une mortalité faible, des complications peuvent survenir à long terme : i. ii. iii. iv. v. Anomalies hémodynamiques Arythmies Entéropathie exsudative Complications thromboemboliques Troubles hépatiques Au CHUV, 26 patients moyen et long terme ont été les suivantes ont subi une opération de Fontan entre 1996 et 2013. Les complications à - 2 enfants sont décédés (8%) - 2 enfants ont un trouble thromboembolique (8%) - 3 enfants ont des troubles hépatiques (11.5%) - 7 enfants ont une défaillance hémodynamique (27%) - 6 enfants ont une arythmie (23%) - 3 enfants ont une entéropathie exsudative (11%) Notre étude rétrospective a montré que les complications à moyen terme sont fréquentes mais nous n'avons pas pu identifier de facteurs de risque statistiquement significatifs dans cet échantillon de patients probablement dû au petit collectif

State of the art of the Fontan strategy for treatment of univentricular heart disease [version 1; referees: 2 approved]

In patients with a functionally univentricular heart, the Fontan strategy achieves separation of the systemic and pulmonary circulation and reduction of ventricular volume overload. Contemporary modifications of surgical techniques have significantly improved survival. However, the resulting Fontan physiology is associated with high morbidity. In this review, we discuss the state of the art of the Fontan strategy by assessing survival and risk factors for mortality. Complications of the Fontan circulation, such as cardiac arrhythmia, thromboembolism, and protein-losing enteropathy, are discussed. Common surgical and catheter-based interventions following Fontan completion are outlined. We describe functional status measurements such as quality of life and developmental outcomes in the contemporary Fontan patient. The current role of drug therapy in the Fontan patient is explored. Furthermore, we assess the current use and outcomes of mechanical circulatory support in the Fontan circulation and novel surgical innovations. Despite large improvements in outcomes for contemporary Fontan patients, a large burden of disease exists in this patient population. Continued efforts to improve outcomes are warranted. Several remaining challenges in the Fontan field are outlined