Minimalno invazivne metode u lije^enju raka dojke: pregled protokola

One can find an increasing number of articles with minimally invasive methods in current literature concerning local treatment of breast cancer. The methods can be divided in two groups: percutaneous excision methods and thermal ablation methods. Thermal ablation methods are based on the premise that malignant tissue is more sensitive to hyperthermia than normal cells. We are comparing advantages and disadvantages of current minimally invasive methods for treatment of early stage breast cancers, showing differences and advantages over breast-conserving surgery. Available published studies and protocols are overviewed. Most of the published works emphasize advantages over classic breast surgery such as: lower costs, less trauma for patients and smaller invasiveness. All methods involving thermal procedures require surgical excision afterwards for evaluation of necrosis and patohistological evaluation of the lesion. The effect of these treatment methods should be safety, painlessness, good cosmetic results and lower treatment costs. If results of such methods are to be comparable to BCS, we can expect their integration in clinical practice.U suvremenom pristupu lokalnog liječenja tumora dojke sve više prostora u stručnim publikacijama zauzimaju izvješća o primjeni tzv. minimalno invazivnih metoda, među kojima su dvije osnovne skupine: perkutane ekscizijske metode i termalne ablacijske metode. Temelj termalnih ablacijskih postupaka u liječenju tumora dojke leži u činjenici da tumori pokazuju veću senzitivnost na hipertermička oštećenja od normalnih stanica. U radu se nastoje komparacijom prednosti i nedostataka ovih suvremenih minimalno invazivnih metoda u liječenju tumora dojke nižih stadija, utvrditi razlika i eventualna prednost tih postupaka prema poštednim kirurškim zahvatima . Pregledani su dostupni publicirani protokoli i iskustva u provođenju perkutanih bioptičkih metoda i nekih termalnih ablacijskih metoda u minimalno invazivnoj kirurgiji dojke. U većini pregledanih publikacija i protokola, naglašena je prednost opisanih metoda nad klasičnom kirurgijom dojke, koja je izražena u nižim troškovima, smanjenju psihičkih trauma liječenih bolesnica i niskom razinom invazivnosti. U gotovo svim pregledanim protokolima koji se odnose na tzv. termalne metode uočena je potreba za naknadnom kirurškom ekscizijom radi procjene stupnja nekroze i patohistološke provjere lezije. Uspješnost liječenja tumora dojke ovim metodama bi se trebala temeljiti na sigurnosti, bezbolnosti, dobrim kozmetičkim rezultatima i nižim troškovima liječenja. Ove bi metode mogle doživjeti punu primjenu u kliničkoj praksi ako se njima postigne rezultat ekvivalentan onome koji se postiže sa poštednim kirurškim zahvatima (BCS)

Chondromyxoid fibroma management: a single institution experience of 22 cases

Background: Several different strategies have been reported for the treatment of chondromyxoid fibromas, all with variable outcomes and high recurrence rates. Methods: We report on 22 consecutive cases of chondromyxoid fibromas treated by intralesional curettage, four of which had adjuvant cementation at our institution between 2003 and 2010. We assessed the functional outcome using the Musculoskeletal Tumour Society (MSTS) scoring system. Results: Nine males and 16 females with a mean age of 36.5 years (range 11 to 73) and a mean follow-up of 60.7 months were included in the study. Local recurrence occurred in two patients (9%) within the first 2 years following the index procedure. This was treated by re-curettage only of the residual defect. Two postoperative complications occurred: a superficial wound infection in one patient and a transient deep peroneal nerve neurapraxia in the other. The mean postoperative MSTS score was 96.7%. Conclusions: Intralesional curettage and cementation is as an effective treatment strategy for chondromyxoid fibromas, providing satisfactory functional results with a low recurrence rate. Careful case selection with stringent clinical and radiographic follow-up is recommended

Minimalno invazivne metode u lije^enju raka dojke: pregled protokola

One can find an increasing number of articles with minimally invasive methods in current literature concerning local treatment of breast cancer. The methods can be divided in two groups: percutaneous excision methods and thermal ablation methods. Thermal ablation methods are based on the premise that malignant tissue is more sensitive to hyperthermia than normal cells. We are comparing advantages and disadvantages of current minimally invasive methods for treatment of early stage breast cancers, showing differences and advantages over breast-conserving surgery. Available published studies and protocols are overviewed. Most of the published works emphasize advantages over classic breast surgery such as: lower costs, less trauma for patients and smaller invasiveness. All methods involving thermal procedures require surgical excision afterwards for evaluation of necrosis and patohistological evaluation of the lesion. The effect of these treatment methods should be safety, painlessness, good cosmetic results and lower treatment costs. If results of such methods are to be comparable to BCS, we can expect their integration in clinical practice.U suvremenom pristupu lokalnog liječenja tumora dojke sve više prostora u stručnim publikacijama zauzimaju izvješća o primjeni tzv. minimalno invazivnih metoda, među kojima su dvije osnovne skupine: perkutane ekscizijske metode i termalne ablacijske metode. Temelj termalnih ablacijskih postupaka u liječenju tumora dojke leži u činjenici da tumori pokazuju veću senzitivnost na hipertermička oštećenja od normalnih stanica. U radu se nastoje komparacijom prednosti i nedostataka ovih suvremenih minimalno invazivnih metoda u liječenju tumora dojke nižih stadija, utvrditi razlika i eventualna prednost tih postupaka prema poštednim kirurškim zahvatima . Pregledani su dostupni publicirani protokoli i iskustva u provođenju perkutanih bioptičkih metoda i nekih termalnih ablacijskih metoda u minimalno invazivnoj kirurgiji dojke. U većini pregledanih publikacija i protokola, naglašena je prednost opisanih metoda nad klasičnom kirurgijom dojke, koja je izražena u nižim troškovima, smanjenju psihičkih trauma liječenih bolesnica i niskom razinom invazivnosti. U gotovo svim pregledanim protokolima koji se odnose na tzv. termalne metode uočena je potreba za naknadnom kirurškom ekscizijom radi procjene stupnja nekroze i patohistološke provjere lezije. Uspješnost liječenja tumora dojke ovim metodama bi se trebala temeljiti na sigurnosti, bezbolnosti, dobrim kozmetičkim rezultatima i nižim troškovima liječenja. Ove bi metode mogle doživjeti punu primjenu u kliničkoj praksi ako se njima postigne rezultat ekvivalentan onome koji se postiže sa poštednim kirurškim zahvatima (BCS)

Cervical Hemilaminectomy in the Management of Degenerative Cervical Spine Myelopathy: Utilization and Outcome from a Neurosurgical Institution in Nigeria

Introduction: Hemilaminectomy is one of the surgical options for managing cervical spondylotic myelopathy. However, it has not gained the expected popularity. This paper aims to review the utilization of hemilaminectomy, the outcome, and complications observed among patients managed with the procedure for advanced multilevel degenerative cervical myelopathy. Methods: Retrospective longitudinal analysis was done at a neurosurgical hospital in Enugu, Nigeria, between years 2010 and 2019. The Study analyzed 46 patients that had cervical hemilaminectomy for multilevel degenerative cervical myelopathy. Excluded from the study were patients offered cervical hemilaminectomy for other indications including tumor and trauma. Patients were assessed by comparing preoperative, and follow‐up modified Japanese Orthopedic Association (mJOA) score and Cobb lordotic angles. The minimum postoperative follow-up period was for 1 year. Results: The mean age was 61 (43–88) years; male‐to‐female ratio was 3.6:1. Symptoms duration ranged from 6 months to 10 years, and 31 (67.4%) patients had significant comorbidities. The average operation time was 2 h 36 min (0.5–3.0 h). The mean blood loss was 260 mL (100–800 mL). Right hemilaminectomy was done for 37 (80.4%) patients. The average preoperative and postoperative Cobb lordotic angles were 10.90° ± 2.4° and 9.98° ± 2.1°. The mean preoperative mJOA was 8.2 ± 1.4. On follow-up 1 year after surgery, the mean mJOA score was 12.2 ± 1.1 (P = 0.0001). The neurological recovery rate at 1-year follow-up was 50.5%. One patient each experienced a transient postoperative drop in neurology, postoperative respiratory distress, and surgical site infection. Conclusion: Cervical hemilaminectomy for multilevel degenerative cervical spine myelopathy has the potential to achieve clinically satisfactory neurological improvement without significantly compromising stability and other serious long‐term complications

Surgical treatment of giant plexiform neurofibroma associated with pectus excavatum

Plexiform neurofibromas are benign tumors originating from subcutaneous or visceral peripheral nerves, which are usually associated with neurofibromatosis type 1. They are almost always congenital lesions and often cause the surrounding soft tissue and bone to grow aberrantly. We treated a 12-year-old boy who presented with asymmetric pectus excavaum and an anterior chest wall plexiform neurofibroma. The pectus excavaum was corrected by modified Nuss procedure, followed by simultaneous resection of the giant mass. The patient is doing well at the 4 years follow-up visit

The outcome of Endoscopic Supraorbital Eyebrow Approach: A Case Series Reported from PINS, Pakistan

Objective:  The study was conducted to evaluate the technique and results of the endoscopic supraorbital eyebrow craniotomy for resection of extra-axial skull base lesions. Material and Methods:  A case study of 70 patients who underwent the endoscopic supraorbital eyebrow approach was conducted. The patients' lesion location, the extent of excision, hospital stay, complications, and cosmetic results were all examined. A 48-hour postoperative CT scan was conducted, followed by a 6-week MRI to check for residuals. Total resection (complete), near-total resection (>90 percent), and subtotal resection (< 90 percent) were the three types of resection rates. At the follow-up appointment, the wound was evaluated for aesthetic reasons as well as any neurological impairment. Results:  There were 39% male patients and 61.4% female patients. The mean age of the patients was 37 years. Craniopharyngioma (88.57%) was reported in most of the patients. In the majority (93%) of the cases, total resection was performed. No complication was observed in 70% of the patients. 14% of patients reported Diabetes insipidus. No intraoperative complications like bleeding or tissue injury were observed. 88.57% of patients were satisfied with the surgical management. Conclusion:  With outstanding aesthetic outcomes, the endoscopic supraorbital eyebrow approach is a safe and effective minimally invasive Keyhole method to remove extra-axial anterior skull base and sellar, suprasellar, and parasellar lesions

Three-dimension-printed custom-made prosthetic reconstructions: from revision surgery to oncologic reconstructions

Background The use of custom-made 3D-printed prostheses for reconstruction of severe bone defects in selected cases is increasing. The aims of this study were to evaluate (1) the feasibility of surgical reconstruction with these prostheses in oncologic and non-oncologic settings and (2) the functional results, complications, and outcomes at short-term follow-up. Methods We analyzed 13 prospectively collected patients treated between June 2016 and January 2018. Diagnoses were primary bone tumour (7 patients), metastasis (3 patients), and revision of total hip arthroplasty (3 patients). Pelvis was the most frequent site of reconstruction (7 cases). Functional results were assessed with MSTS score and complications according to Henderson et al. Statistical analysis was performed using Kaplan-Meier and log-rank test curves. Results At a mean follow-up of 13.7 months (range, 6 \u2013 26 months), all patients except one were alive. Oncologic outcomes show seven patients NED (no evidence of disease), one NED after treatment of metastasis, one patient died of disease, and another one was alive with disease. Overall survival was 100% and 80% at one and two years, respectively. Seven complications occurred in five patients (38.5%). Survival to all complications was 62% at two years of follow-up. Functional outcome was good or excellent in all cases with a mean score of 80.3%. Conclusion 3D-printed custom-made prostheses represent a promising reconstructive technique in musculoskeletal oncology and challenging revision surgery. Preliminary results were satisfactory. Further studies are needed to evaluate prosthetic design, fixation methods, and stability of the implants at long-ter