1,052 research outputs found
Drug-Induced Sleep Endoscopy: Clinical Application and Surgical Outcomes
The visualization of the level and pattern of apnea and hypopnea events is of pivotal importance in the diagnosis and therapeutic decision-making for sleep-disordered breathing (SDB). There are numerous techniques available to assess upper airway obstruction, which include imaging, acoustic analysis, pressure transducer recording, and endoscopic evaluation. Drug-induced sleep endoscopy (DISE) is a diagnostic tool that allows the dynamic, three-dimensional evaluation of the patterns of vibration and collapse of the upper airway of SDB patients. DISE may change the initial surgical planning in a high percentage of cases. A universally accepted and methodologically standardized DISE could provide significant insight into its role to improve surgical outcomes. However, up to now the ideal DISE protocol remains an open question
Drug-Induced Sleep Endoscopy: Technique, Indications, Tips and Pitfalls
Drug-induced sleep endoscopy (DISE) is a diagnostic tool to assess the upper airway of snorers and obstructive sleep apnea patients in conditions that mimic natural sleep. Although DISE appears simple and similar to awake endoscopy, there are many aspects that need to be standardized in order to obtain reliable and reproducible information. In this article, we will recommend how to reliably perform DISE, its indications, and how to obtain and interpret the information of the upper airway
Robotic total gastrectomy with intracorporeal robot-sewn anastomosis. A novel approach adopting the double-loop reconstruction method
Gastric cancer constitutes a major health problem. Robotic
surgery has been progressively developed in this field. Although the
feasibility of robotic procedures has been demonstrated, there are
unresolved aspects being debated, including the reproducibility of
intracorporeal in place of extracorporeal anastomosis.
Difficulties of traditional laparoscopy have been described and there
are well-known advantages of robotic systems, but few articles in
literature describe a full robotic execution of the reconstructive phase
while others do not give a thorough explanation how this phase was run.
A new reconstructive approach, not yet described in literature, was
recently adopted at our Center.
Robotic total gastrectomy with D2 lymphadenectomy and a socalled
‘‘double-loop’’ reconstruction method with intracorporeal robotsewn
anastomosis (Parisi’s technique) was performed in all reported
cases.
Preoperative, intraoperative, and postoperative data were collected
and a technical note was documented.
All tumors were located at the upper third of the stomach, and no
conversions or intraoperative complications occurred. Histopathological
analysis showed R0 resection obtained in all specimens. Hospital
stay was regular in all patients and discharge was recommended starting
from the 4th postoperative day. No major postoperative complications
or reoperations occurred.
Reconstruction of the digestive tract after total gastrectomy is one of
the main areas of surgical research in the treatment of gastric cancer and
in the field of minimally invasive surgery.
The double-loop method is a valid simplification of the traditional
technique of construction of the Roux-limb that could increase the
feasibility and safety in performing a full hand-sewn intracorporeal
reconstruction and it appears to fit the characteristics of the robotic
system thus obtaining excellent postoperative clinical outcome
Preoperative charcoal suspension tattoo for the detection of differentiated thyroid cancer recurrence
Recurrent differentiated thyroid carcinoma can easily be detected by means of ultrasound (US) and thyroglobulin, and often requires further surgical intervention. Revision surgery is often a technical challenge with significant risk of complications, considering the altered anatomy, with a possibility of leaving behind residual neoplasm. Preoperative US-guided tattooing localization has been introduced to reduce and prevent these potential problems during revision surgery. Encouraging results have been reported in the literature. Under US guidance, the lesion is identified and 0.5-2 ml of colloidal charcoal is injected in its proximity using a 23 gauge needle. The extraction is accompanied by injection at constant pressure of charcoal in order to leave a trace of pigment along the path of the needle till the skin. From April 2008 to January 2016 we performed revision surgery in 27 patients for lymph-nodes metastasis in differentiated thyroid cancer, using the technique of preoperative charcoal tattoo localization. Our previous study on the first group of 13 patients published in 2012, reported the preliminary results in terms of success rate and complications. The tolerance of charcoal injection was good for all patients and the procedure was demonstrated to be useful, contributing to the removal of metastatic lesion in 93% of procedures. We have registered minor surgical complications during revision in the central compartment of the neck: Transitory hypoparathyroidism in 2 cases (11%) and transitory vocal cord paresis in 3 cases (16%). Based on these results, preoperative charcoal tattoo localization in revision surgery of the neck for differentiated thyroid cancer recurrence can be considered a safe technique, easy to perform, with low-costs and useful during surgical procedures, providing a significant reduction of iatrogenic damage and risks
Oxidative stress and inflammation biomarker expression in obstructive sleep apnea patients
Obstructive Sleep Apnea Syndrome (OSAS) is a respiratory sleep disorder characterised by repeated episodes of partial or complete obstruction of the upper airway during the night. This obstruction usually occurs with a reduction (hypopnea) or complete cessation (apnea) of the airflow in the upper airways with the persistence of thoracic-diaphragmatic respiratory movements. During the hypopnea/apnea events, poor alveolar ventilation reduces the oxygen saturation in the arterial blood (SaO2) and a gradual increase in the partial arterial pressure of carbon dioxide (PaCO2). The direct consequence of the intermittent hypoxia is an oxidative imbalance, with reactive oxygen species production and the inflammatory cascade's activation with pro and anti-inflammatory cytokines growth. Tumour necrosis factors, inflammatory cytokines (IL2, IL4, IL6), lipid peroxidation, and cell-free DNA have been found to increase in OSAS patients. However, even though different risk-related markers have been described and analysed in the literature, it has not yet been clarified whether specified inflammatory bio-markers better correlates with OSAS diagnosis and its clinical evolution/comorbidities. We perform a scientific literature review to discuss inflammatory and oxidative stress biomarkers currently tested in OSAS patients and their correlation with the disease's severity and treatment
Pre-retrieval reperfusion decreases cancer recurrence after rat ischemic liver graft transplantation
Background & Aims Liver transplantation from marginal donors is associated with ischemia/reperfusion (I/R) lesions, which may increase the risk of post-transplant hepatocellular carcinoma (HCC) recurrence. Graft reperfusion prior to retrieval (as for extracorporeal membrane oxygenation – ECMO) can prevent I/R lesions. The impact of I/R on the risk of cancer recurrence was assessed on a syngeneic Fischer-rat liver transplantation model. Methods HCC cells were injected into the vena porta of all recipients at the end of an orthotopic liver transplantation (OLT). Control donors were standard heart-beating, ischemic ones (ISC), underwent 10min or 30min inflow liver clamping prior to retrieval, and ischemic/reperfused (ISC/R) donors underwent 2h liver reperfusion after the clamping. Results I/R lesions were confirmed in the ISC group, with the presence of endothelial and hepatocyte injury, and increased liver function tests. These lesions were in part reversed by the 2h reperfusion in the ISC/R group. HCC growth was higher in the 10min and 30min ISC recipients ( p =0.018 and 0.004 vs. control, as assessed by MRI difference between weeks one and two), and was prevented in the ISC/Rs ( p =0.04 and 0.01 vs. ISC). These observations were associated with a stronger pro-inflammatory cytokine profile in the ISC recipients only, and the expression of hypoxia and HCC growth-enhancer genes, including Hmox1 , Hif1a and Serpine1 . Conclusions This experiment suggests that ischemia/reperfusion lesions lead to an increased risk of post-transplant HCC recurrence and growth. This observation can be reversed by graft reperfusion prior to retrieval
Dermatome mapping test in the analysis of anatomo-clinical correlations after inguinal hernia repair
Abstract
Background: Nerve identification is recommended in inguinal hernia repair to reduce or avoid postoperative pain.
The aim of this prospective observational study was to identify nerve prevalence and find a correlation between neuroanatomy
and chronic neuropathic postoperative inguinal pain (CPIP) after 6 months.
Material: A total of 115 patients, who underwent inguinal hernia mesh repair (Lichtenstein tension-free mesh
repair) between July 2018 and January 2019, were included in this prospective observational study. The mean age
and BMI respectively resulted 64 years and 25.8 with minimal inverse distribution of BMI with respect to age. Most
of the hernias were direct (59.1%) and of medium dimension (47.8%). Furthermore, these patients were undergoing
Dermatome Mapping Test in preoperatively and postoperatively 6 months evaluation.
Results: Identification rates of the iliohypogastric (IH), ilioinguinal (II) and genitofemoral (GF) nerves were 72.2%,
82.6% and 48.7% respectively. In the analysis of nerve prevalence according to BMI, the IH was statistically significant
higher in patients with BMI < 25 than BMI ≥ 25 P (< 0.05). After inguinal hernia mesh repair, 8 patients (6.9%) had
chronic postoperative neuropathic inguinal pain after 6 months. The CPIP prevailed at II/GF dermatome. The relation
between the identification/neurectomy of the II nerve and chronic postoperative inguinal pain after 6 months was
not significant (P = 0.542).
Conclusion: The anatomy of inguinal nerve is very heterogeneous and for this reason an accurate knowledge of
these variations is needed during the open mesh repair of inguinal hernias. The new results of our analysis is the statistically
significant higher IH nerve prevalence in patients with BMI < 25; probably the identification of inguinal nerve
is more complex in obese patients. In the chronic postoperative inguinal pain, the II nerve may have a predominant
role in determining postoperative long-term symptoms. Dermatome Mapping Test in an easy and safe method for
preoperative and postoperative 6 months evaluation of groin pain. The most important evidence of our analysis is
that the prevalence of chronic pain is higher when the nerves were not identified.
Keywords: Inguinal hernia, Inguinal nerves, Nerve identification, Pain, Follow-up
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