57 research outputs found
Open tension free repair of inguinal hernias; the Lichtenstein technique
BACKGROUND: Recurrences have been a significant problem following hernia repair. Prosthetic materials have been increasingly used in hernia repair to prevent recurrences. Their use has been associated with several advantages, such as less postoperative pain, rapid recovery, low recurrence rates. METHODS: In this retrospective study, 540 tension-free inguinal hernia repairs were performed between August 1994 and December 1999 in 510 patients, using a polypropylene mesh (Lichtenstein technique). The main outcome measure was early and late morbidity and especially recurrence. RESULTS: Inguinal hernia was indirect in 55 % of cases (297 patients), direct in 30 % (162 patients) and of the pantaloon (mixed) type in 15 % (81 patients). Mean patient age was 53.7 years (range, 18 – 85). Follow-up was completed in 407 patients (80 %) by clinical examination or phone call. The median follow-up period was 3.8 years (range, 1 – 6 years). Seroma and hematoma formation requiring drainage was observed in 6 and 2 patients, respectively, while transient testicular swelling occurred in 5 patients. We have not observed acute infection or abscess formation related to the presence of the foreign body (mesh). In two patients, however, a delayed rejection of the mesh occurred 10 months and 4 years following surgery. There was one recurrence of the hernia (in one of these patients with late mesh rejection) (recurrence rate = 0.2 %). Postoperative neuralgia was observed in 5 patients (1 %). CONCLUSION: Lichtenstein tension-free mesh inguinal hernia repair is a simple, safe, comfortable, effective method, with extremely low early and late morbidity and remarkably low recurrence rate and therefore it is our preferred method for hernia repair since 1994
Concurrent development of testicular seminoma and choriocarcinoma of the superior mediastinum, presented as cervical mass: a case report and implications about pathogenesis of germ-cell tumours
BACKGROUND: Synchronous presentation of more than one germ cell tumours of different histology in the same patient is considered to be very rare. In these cases of multiple germ cell tumours, strong theoretical and clinical data suggest an underlying common pathogenetic mechanism concerning genetic instability or abnormalities during the pluripotent embryonic differentiation and maturation of the germ cell. CASE PRESENTATION: A 25 year-old young man presented with an enlarging, slightly painful left cervical mass. Despite the initial disorientation of the diagnosis to a possible thyroid disorder, the patient underwent complete surgical resection of the mass revealing mediastinal choriocarcinoma. Subsequent ultrasound of the scrotum indicated the presence of a small lobular node in the upper pole of the left testicle and the patient underwent radical left inguinal orchiectomy disclosing a typical seminoma. Based on these results, the patient received 4 cycles of Bleomycin, Etoposide and Platinum chemotherapy experiencing only mild toxicity and resulting in complete ongoing clinical and biochemical remission. CONCLUSION: The pathogenesis of concurrent germ cell tumours in the same patient remains an area of controversy. Although the genetic instability of the pluripotent germ cell offers an adequate explanation, the possibility of metastasis from the primary, less differentiated tumour to a distant location as a more mature subtype cannot be excluded. Possible development of a metastatic site of different histology and thus biological behaviour (e.g choriocarcinoma) should be anticipated. Furthermore, urologists, pathologists and medical oncologists should be meticulous in the original pathological diagnosis in these patients, since there is a significant frequency of germ cell tumours with mixed or overlapping histological elements with diverse potential of evolution and differentiation
Evaluation of diaphragmatic mobility following intra-abdominal sub-diaphragmatic fixation of a double-layered mesh in rats
Papillary thyroid cancer and cervical lymph mode metastases – optimal preoperative evaluation
Papillary thyroid cancer (PTC) is the most common subtype of thyroid cancer and a highly curable malignancy [1]. However, despite its excellent prognosis, cervical lymph node metastases (CLNMs) are present in a significant percentage of patients with papillary thyroid cancer (PTC) (upto 50% - 60%) [2]
Thyroid nodules; interpretation and importance of fine-needle aspiration (FNA) for the clinician - Practical considerations
Thyroid nodules are very common lesions. Despite that the great majority
is benign, in a significant percentage of them there is an underlying
malignancy. Malignant thyroid nodules should be managed surgically,
while the more common benign thyroid nodules may be managed
conservatively. A systemic and careful diagnostic evaluation is needed
to recognize nodules (overtly malignant or with malignant potential),
and to avoid unnecessary surgery in a large percentage of patients with
benign disease. Fine-needle aspiration (FNA) has a central role in the
diagnostic investigation of the patient with thyroid nodules. FNA is a
safe, useful, and cost-effective procedure. To increase accuracy, FNA
can be performed under ultrasonographic guidance (if needed). Its
results may be particularly helpful in determining the indication for
surgery. In contrast, the role of FNA in selecting the extent of surgery
is limited today. This is due to the fact that during the last decade
there is a clear trend toward radical surgical management of thyroid
nodular disease (both benign and malignant) by total/near-total
thyroidectomy. (C) 2010 Elsevier Ltd. All rights reserved
Sequelae following axillary lymph node dissection for breast cancer
Axillary lymph node dissection (ALND) has a central role in the surgical
management of breast cancer; however, it is associated with a
potentially significant morbidity. Although post-ALND complications are
often minor, in some cases they can persist for a long time following
surgery, thereby affecting the quality of life of breast cancer
survivors. Seroma formation and altered sensation of the upper limb are
the two most common complications following ALND. Lymphedema is the most
common potentially severe long-term complication following ALND. Major
post-ALND complications (such as injury or thrombosis of the axillary
vein and injury to the motor nerves of the axilla) are extremely rare.
Meticulous surgical technique and careful selection of patients for
postoperative radiation therapy are mandatory to prevent significant
morbidity following ALND. The introduction of the technique of sentinel
lymph node biopsy in clinical practice has resulted in a significant
reduction in the incidence of post-ALND complications
The genetic basis of hereditary medullary thyroid cancer: clinical implications for the surgeon, with a particular emphasis on the role of prophylactic thyroidectomy
Medullary thyroid cancer (MTC) may occur either sporadically or on a
hereditary basis. Hereditary MTC may be observed with either multiple
endocrine neoplasia syndromes (MEN 2A and MEN 213) or as familial MTC
(FMTC). Despite the rarity of these syndromes, early diagnosis is
especially important, since MTC is a lethal disease if not promptly and
appropriately treated. Recently, the development of genetic testing and
direct DNA analysis allows the identification of asymptomatic patients.
Surgical prophylaxis should be considered in these cases, ideally to
prevent the development of MTC. During the recent decade, the concept of
‘codon-directed’ timing of prophylactic surgery emerged as a reasonable
strategy in the management of these patients. Currently, genetic
analysis offers the possibility to define genotype-phenotype
correlations and to adjust the time of prophylactic surgery. Hereditary
MTC is a model of genetically determined cancer in which both diagnostic
and therapeutic strategies rely on the identification of specific
mutations
Applied vascular anatomy of the colon and rectum: Clinical implications for the surgical oncologist
Surgery remains the most radical method of treatment of many solid
tumors, including colorectal cancer; in these tumors, surgery is the
only method that can offer the chance of cure. To avoid early
postoperative morbidity (mainly, anastomotic leak) and to achieve good
tong-term results (low incidence of tumor recurrence, long overall and
disease-free survival, and optimal quality of life), the surgeon should
have an in-depth knowledge of vascular anatomy of the colon and rectum.
This essential requirement is based on the fact that the actual course
followed by lymph fluid drainage from any part of the coton/rectum is
determined by its blood supply; therefore, the extent of resection for
colorectal cancer follows the principles of blood supply and lymphatic
drainage. Knowledge of the colorectal vascular anatomy and its
variations is of vital importance in the planning of radical surgical
treatment and in appropriately performing cotorectal resections,
particularly in the patient who underwent in the past colectorny or
aortic surgery that has changed the usual pattern of collateral blood
supply to the colon. This review summarizes currently available data
regarding vascular anatomy of the colon and rectum, from a surgical
perspective. (c) 2007 Elsevier Ltd. All rights reserved
Thyroid nodules: Does the suspicion for malignancy really justify the increased thyroidectomy rates?
Thyroid nodules are frequently diagnosed today, mainly due to the wide
use of neck ultrasonography (US). The majority of these are benign;
suspicion for malignancy is an indication for surgery, while benign
thyroid nodules may be managed conservatively. There is evidence that a
large percentage of patients with thyroid nodules (many diagnosed
incidentally) are over-treated. Careful and accurate identification of
patients with thyroid nodules highly suspicious for underlying
malignancy would allow a more reasonable therapeutic approach and would
result in a reduction of the number of unnecessary thyroidectomies.
Fine-needle aspiration cytology (FNAC), in conjunction with
high-resolution thyroid US, are currently the most accurate and
cost-effective diagnostic approach for the evaluation of patients with
nodular thyroid disease. Radionuclide thyroid scanning should be used
selectively. By increasing the use of FNAC, it is expected that the
number of unnecessary thyroidectomies will be further diminished,
thereby avoiding over-treatment, without exposing the patients to the
risk of under-treatment for a highly curable cancer. However, accurate
preoperative diagnosis of thyroid cancer within a thyroid nodule is not
always possible and, although the problem of unnecessary surgery can
further be diminished, it cannot be completely eliminated. (C) 2006
Elsevier Ltd. All rights reserved
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