Definitive Treatment Of Choice Research Articles

Comparison of Short-Term Hearing Outcome in Stapedotomy Using either Vein or Fat (Adipose Tissue) as Sealing Material.

Introduction Otosclerosis is a common cause of conductive hearing loss in the adult population that is caused by fixation of the stapes footplate. Cochlear otosclerosis may also present with sensorineural or mixed hearing loss. Surgery is the definitive treatment of choice and, during the procedure, sealing of the oval window with autologous tissue graft around the stapes prosthesis has been routinely done to improve hearing outcome and to mitigate postoperative complications. Objective To evaluate the efficacy of two different types of autologous tissue (vein or fat) grafts as oval window sealing materials in stapedotomy in improving short-term hearing outcomes. Methods In our study, 70 patients with otosclerosis who underwent primary stapedotomy were included. They were divided into group 1 (vein graft) and group 2 (fat graft) based on the type of sealing material used. All patients were followed-up at the end of 3 months, undergoing an audiometric examination to assess the hearing outcome. Results A total of 80% ( n = 28) of the patients in group1 had an air-bone gap (ABG) closure < 10dB, and, in group 2, 85.7% had an ABG closure < 10 dB; this difference was found to be statistically insignificant. A total of 42.9% ( n = 15) of the patients in group 1 and of 31.4% ( n = 11) in group 2 had a significant improvement in bone conduction, while 14.3% ( n = 5) of the patients in group 1 and 17.1% ( n = 6) in group 2 had worsening of average bone conduction postoperatively, which was found to be statistically insignificant. Conclusion Both vein and fat grafts had comparable effects on hearing outcomes when used as sealing materials in stapedotomy.

A Case Report of Diamond-Blackfan Anaemia with RPS19 Mutation

Diamond Blackfan Anaemia (DBA) is a rare disorder which presents with anaemia in early childhood. This heterogenous disorder is mainly autosomal dominantly inherited. Significantproportions of the cases are associated with craniofacial anomalies and some cases may end up developing malignancy. The diagnosis is established by blood investigations, and bone marrow studies in which red cell precursors are reduced or absent. Screening for the mutations including those encoding for ribosomal proteins in the patient and the family members is confirmatory for diagnosis. Human Leukocyte Antigen (HLA) matched hemopoietic stem cell transplantation is the definitive treatment of choice. In other cases, corticosteroids have been tried. The haemoglobin level is maintained with packed red cell transfusion. We are presenting here a male baby who had anaemia soon after birth and was brought to us at the age of 1 year 3 months. The diagnosis of DBA was made since the patient presented with anaemia and supportive biochemical and histological evidence. Genetic screening revealed mutation in ribosomal protein S19 (RPS19) gene in the baby.

Comparison of outcomes and cost-effectiveness of laparoscopic and open appendectomies in public health services.

Acute appendicitis is the leading cause of abdominal emergency surgery worldwide and appendectomy continues to be the definitive treatment of choice. This cost-effectiveness analysis evaluates laparoscopic versus open appendectomies performed in public health services in the state of Bahia (Brazil). We conducted a retrospective observational study using the database from the Department of Informatics of the Unified Health System (DATASUS). Available data on appendectomies between 2008 and 2019 were included, and we evaluated the temporal trend of hospital admissions, procedure-related mortality rates, length of stay, and costs. Statistical analysis was performed using the R-software (R Foundation, v.4.0.3) and the BioEstat software (IMDS, v. 5.3), considering p<0.05 as significant. During 2008-2019, 53,024 appendectomies were performed in the public health services in Bahia, of which 94.9% were open surgeries. The open technique was associated with a higher mortality rate (4.9/1,000 procedures; p<0.05) and a higher risk of death (RR=4.5; p<0.05) compared to laparoscopy (1.1/1,000 procedures). Laparoscopic appendectomy (median of 2.7 days) had a shorter length of stay compared to laparotomy (median of 4.15 days) (p<0.05). There was no difference in the medians of costs nor hospital services, per procedure (p=0.08 and p=0.08, respectively). Laparoscopic professional median costs were higher by US$ 1.39 (p<0.05). Minimally invasive surgery for appendicitis is a safe and efficacious procedure in Brazilian public health care services, as it provides advantages over the open method (including lower procedure-related mortality rate and earlier discharges), and it did not imply higher expenses for public service budgets in the state of Bahia.

Sonography of liver transplantation.

Orthotopic liver transplant (OLT) is established as the definitive treatment of choice for end stage liver disease. Over the years, refined surgical techniques as well as advancements in organ preservation and immunosuppressive regimens have improved graft and patient survival rates. Imaging has also contributed to improved graft and patient survival. Ultrasound is the initial investigation of choice for evaluation of post-transplant anatomy and for identifying early complications. A thorough knowledge of surgical techniques and normal post-operative appearance of the OLT is needed to accurately identify and characterize graft complications. The objective of this article is to review the sonographic findings of normal liver transplant as well as post-operative complications. Indications and contraindications for OLT as well as different surgical techniques will also be briefly reviewed.

A rare ca(u)se of dysphagia

Achalasia is a rare lower esophageal motility disorder, in which there is destruction of myenteric plexi leading to the loss of esophageal peristalsis and inadequate relaxation of the lower esophageal sphincter in response to swallowing. Although the etiology of achalasia cardia is unclear, it is likely to be caused by autoimmune etiology. It is characterized by dysphagia of solids and liquids, regurgitation, weight loss, chest pain, heartburn, and nocturnal cough. Achalasia can be diagnosed on the clinical history and confirmed by barium swallow, and esophageal manometry which is the gold standard technique for diagnosis. Even though achalasia cannot be cured permanently, pneumatic balloon dilatation and myotomy remain the definitive treatment of choice in spite of availabilities of pharmacological therapies. We report a case of 25-year-old male admitted with chronic dysphagia and weight loss, diagnosed to be having achalasia cardia and treated accordingly.

A Successful Case of Liver Transplantation in an Adult With Congenital Hepatic Arteriovenous Fistulae Associated Cardiac Dilatation and Heart Failure

Congenital hepatic arteriovenous fistulae (CHAVF) are direct communications between the hepatic artery and portal vein or hepatic vein. Clinical symptoms of CHAVF depend mainly on the location, duration, and blood flow volume of the fistulae, which are manifested by portal hypertension, hepatic fibrosis, cardiac enlargement, and eventually heart failure.Here we report a female patient aged 54 who was first admitted to our hospital due to recurrent chest tightness and palpitations in March 2014. Metoprolol tartrate and diltiazem hydrochloride were prescribed to control the symptom since nothing unusual was found in coronary angiography and abdominal ultrasound. Until April 2015, the patient's syndrome relapsed and abdominal computed tomography angiography and digital subtraction angiography revealed diffuse arteriovenous fistulae between the branches of hepatic artery and vein. Subsequently, 3 attempts at hepatic arterial embolization were performed; however, her abdominal pain aggravated and her heart discomfort could not be relieved eventually.Therefore, orthotopic liver transplantation as the salvage treatment was performed using a hepatic graft from a 19-year-old cardiac-death donor performed on January 1, 2017. Upon operation, the enlarged right hepatic artery whose diameter was approximately 1.5 cm in this recipient. And we also demonstrated a novel manner that the graft's celiac artery patch was anastomosed to the recipient's proper hepatic artery and gastroduodenal artery patch, which could reduce the blood flow successfully. The patient recovered uneventfully and was discharged home on the postoperatively 15th day. Since her liver transplantation, she has not complained of cardiac discomfort and abdominal pain, and her heart size has returned to normal on echocardiography. The hepatic artery peak velocity reduced to normal and the heart shadow also recovered.Nevertheless, for complex and diffuse intrahepatic vascular fistulae after failed hepatic artery embolization, liver transplantation should be strongly considered as the definitive treatment of choice.

Solitary Plasmacytoma of Frontal Bone: A Case Report.

A 42years old male presenting with complaints of swelling on the left supraorbital region since-5months. Swelling was gradual in onset and progressive in nature. On examination it was a single swelling 5 × 6cm, with diffuse margins, skin over the swelling was red and stretched, swelling is firm in consistency, fixed, tender on touch, non pulsatile with diffuse irregular margin. FNAC. Smears are positive for malignancy. Bone marrow examination was normal. Excision of the mass from the left frontal sinus, orbit and supraorbital region under GA and sent for HPR. Definitive treatment of choice is: radiotherary 45-50Gy/4-5weeks, chemotherapy and surgery. Prognosis is good with local recurrence (< 10%).

Xanthogranulomatous pyelonephritis: An uncommon entity with review of literature

Xanthogranulomatous pyelonephritis (XGP) is an uncommon entity affecting predominantly females between the ages 45-55 years. The disease is usually associated with urinary tract infection and the patient presents with flank pain, dysuria and fever. It has to be differentiated from various benign and malignant conditions including tuberculosis (TB) and renal cell carcinoma. Surgery is the definitive treatment of choice. Hereby, a case of 45-year-old, hypertensive female, who presented with uncommon condition is being reported.

Tu1370 Elective Endotracheal Intubation Prior to Emergent EGD in Patients With Suspected Variceal Hemorrhage: an Evaluation of Outcome and Complications

Variceal hemorrhage is a lethal complication of portal hypertension with reported mortality of 15-50% and a rebleeding risk of 70-80%. EGD therapy is the definitive treatment of choice. Large volume of blood located in the stomach is considered as the potential risk of aspiration during emergent EGD. Elective intubation is more commonly adopted in nowadays to prevent aspiration. However, despite widely in utilization, there is limited evidence that reveals prophylactic intubation improves patient outcomes.

Gangrenous Sigmoid Volvulus – A Case Report with review of literature

Sigmoid volvulus is a life threatening surgical emergency which demands early surgical intervention. The condition is prevalent all over the world. Both sexes can be involved but more common in males. Mostly it is a disease of elderly males but can occur in neonates to young individuals. The condition presents in two distinct form gangrenous and non gangrenous sigmoid volvulus. Gangrenous volvulus is associated with high morbidity. Volvulus patient presents with pain, distension of abdomen and absolute constipation. Plain X-ray erect abdomen will give us definite diagnosis. In doubtful cases double contrast barium enema will clinch the diagnosis. In non gangrenous sigmoid volvulus sigmoidopexy either by endoscopic or open surgery is the procedure of choice. Otherwise sigmoid resection with end to end anastomosis is a definite treatment of choice. In gangrenous sigmoid volvulus, Hartmann procedure with end colostomy is the safe and life saving procedure. We had a case of gangrenous sigmoid volvulus presented with pain, distension and absolute constipation with toxic symptoms. After taking X-ray erect abdomen the case was diagnosed as volvulus sigmoid. Hartmann's procedure was done after patient was resuscitated. Patient recovered well and discharged with a plan to close the colostomy after two months. We wish to present this case because it is a life threatening condition, death is certain if not treated early. We reviewed the literature regarding type of treatment since every surgeon is having his own line of approach to the problem.

Surgical treatment of primary hyperparathyroidism: description of techniques and advances in the field.

Primary hyperparathyroidism is a disease commonly seen in patients above 60years of age. It is the most common cause of asymptomatic or symptomatic hypercalcemia, usually found incidentally on routine check-ups. Surgical treatment is the only definitive treatment of choice in the symptomatic patient; however, it can also be employed in asymptomatic patients. First described in 1925, bilateral neck exploration is the gold standard of treatment for primary hyperparathyroidism. The recent interest in minimally invasive surgeries has led to better and improved techniques of neck exploration with improved cosmetic results and lesser chances of transient or permanent hypoparathyroidism due to inadvertent removal of normally functioning parathyroid tissue. These include unilateral neck explorations, minimally invasive parathyroidectomies and minimally invasive radio-guided parathyroidectomy. The intact parathyroid hormone assays have greatly added to the detection of normal and abnormal functioning glands, hence better surgical outcomes.

Liposuction with Diode Laser Ablation for Treatment of Axillary Osmidrosis

The main characteristic of axillary osmidrosis is excessive malodor originating from the apocrine glands which is induced by the influence of androgens and thus is often associated with hyperhidrosis [1]. There are many methods of treatment of osmidrosis. In other word, there is no definite treatment of choice. Every treatment method has its own advantages and disadvantages. One of the most common disadvantages is recurrence and dissatisfaction of patient. Conventional surgical interventions such as en bloc resection, dermal shaving, subdermal defatting of axillary hear bearing skin have low recurrent rate but they have high perioperative morbidity have such as hematoma, skin necrosis and massive scar causing limit of motion. And simple methods such as ultrasonic aspiration, liposuction and laser treatment have low perioperative morbidity but they have inconsistent effectiveness and high recurrent rate. There are also nonsurgical procedures such as application of aluminum compounds, iontophoresis, oral medication, injection of botulinum toxin A [2-7]. Nowadays, patients who seek more ideal treatment modality need not only a high success rate, but also fewer complications, less scarring, and faster recovery. Liposuction and laser ablation for treatment of osmidrosis are leading treatment methods for osmidrosis and have less complication compare to conventional surgical method. We treated patients with the two methods simultaneously.

Gastric lipoma presenting with massive upper gastrointestinal bleeding.

A case of massive upper gastrointestinal bleeding in a 37-year-old female is presented showing a submucosal mass in the gastric body. At laparotomy a pedunculated submucosal mass was found located on the posterior wall at the junction of the body and antrum of the stomach, 8 cm from the pylorus. Pathology confirmed that it was a 4 cm benign gastric lipoma with a bleeding central ulcer. Gastric lipomas are rare, benign, typically submucosal tumors occurring in the gastric antrum. They are usually asymptomatic but can become symptomatic depending on size, location, and if there is ulceration of the lesion. These lesions may be mistaken as malignant tumors or present with upper GI bleeding or intussusception. The diagnosis can be made using a combination of upper endoscopy, endoscopic ultrasound, CT, and MRI with surgical excision being the definitive treatment of choice. We hope that this case highlights the fact that these lesions can present with massive upper GI haemorrhage and should be included in the diagnosis when appropriate.

Quality of Life and Patient Satisfaction After Video-Assisted Thoracic Sympathicolysis for Essential Hyperhidrosis: A Follow-Up of 138 Patients

Essential hyperhidrosis (EH) is defined as excessive functioning of the sudomotor sweat system. Definitive treatment of choice is video-assisted thoracoscopic sympathetic interruption. Success rates are high, but compensatory hyperhidrosis (CH) remains a troublesome side effect. The aim of this study was to document patient satisfaction and side effects at least 6 months after thoracoscopic sympathicolysis. Between 2001 and 2005, 246 patients underwent bilateral ablation of the sympathetic chain at the thoracic level T2, T3, and/or T4. Questionnaires using open questions and scoring systems were sent at least 6 months after procedure and were returned by 138 patients (56%). From the 138 patients (56 males/82 females), 39 suffered from cranial (±facial blushing), 34 from palmar, and 34 from axillary hyperhidrosis. Thirty-one patients were treated for a combination. No conversion to open surgery or deaths occurred. For the whole group, average quality of life was 4.5±2.5 before and 8.4±1.8 after surgery (P<.001). Ninety-one percent were very satisfied (score ≥7) and 80% showed an increased quality of life of ≥2. Compensatory sweating occurred in 76% of the patients, only 6% reported this as disabling. Comparing subgroups, a significant improvement in primary complaint score was found in 90%, 94%, and 91% for the T2, T3, and T4 patients, respectively. In the T4 group, the prevalence of CH was markedly lower (53%) and none of these patients were dissatisfied. Thoracoscopic ablation of the sympathetic chain is an effective treatment for EH; CH occurs in the majority of patients, but only rarely impairs postoperative quality of life.

Abdominal pseudocyst complicating incisional hernia repair: our experience and literature review

Giant pseudocyst is a rare complication of incisional hernia repairs whose etiology and incidence remains unknown. We have reviewed all cases of abdominal incisional hernia repair in our abdominal wall unit since its creation 6 years ago. Pseudocyst formation was observed in seven cases out of 871 incisional hernia repair operations. Four of them underwent surgical exploration with excision of the mass. To the best of our knowledge, only 18 cases of giant pseudocyst have been described in the literature. From both our personal experience and the reported literature, we understand that abdominal pseudocyst is an extremely rare or underreported late complication of hernia repair surgery. The complete excision of the cyst and its fibrous wall is the definitive treatment of choice.

Fatal thyrocardiac event

Atrial fibrillation occurs frequently (2–20%) in chronic hyperthyroidism patients. Poorly treated thyrotoxic patients may present with a life-threatening cerebrovascular accident giving little scope to revert the situation. At times, it is difficult to make a patient euthyroid with conventional management. The definitive treatment of choice is 131I, radioiodine. An adjusted dose of an oral anticoagulant is highly efficacious for the prevention of all types of strokes. Timely intervention by a skilled airway manager with right instruments is the key to success in airway management. A 50-year-old thyrotoxic, semiconscious male presented with a sudden onset of haemiplegia. He had chronic AF, a huge thyroid swelling with gross tracheal deviation and dilated cardiomyopathy. A CT scan showed infarction in the left middle cerebral artery territory. After initial improvement with conservative management, patient’s condition deteriorated in the next 48 h. Repeat CT scan showed increase in the infarct size with haemorrhage and midline shift. Finally, he died despite all resuscitative measures.

Recurrent intra-articular osteoid osteoma of the hip after radiofrequency ablation: a case report and review of the literature

We present a case of a 53-year-old woman with recurrent intra-articular osteoid osteoma of the hip 6 months after initial treatment with percutaneous radiofrequency ablation. En bloc surgical excision of the osteoid osteoma and prophylactic internal fixation for impending stress fracture was performed. The patient is pain free, has returned to normal function and there is no sign of recurrence at the one-year follow-up. Intraarticular osteoid osteoma, present a diagnostic challenge and often they are misdiagnosed. Minimally invasive ablation techniques can fail in significant percentage and then surgical excision with histological confirmation remains the definitive treatment of choice.

Percutaneous and surgical treatment of aortic stenosis

Aortic stenosis due to calcific degeneration is the most common valvular disorder among the elderly. With the growing elderly population, the prevalence of this disease will continue to increase. Based on converging lines of evidence linking calcific aortic stenosis with atherosclerosis, there has been interest in drug therapy to slow the progression of aortic stenosis. Unfortunately, recently completed prospective trials have been disappointing. Mechanical measures remain the principal form of therapy. Among percutaneous techniques, aortic valvuloplasty provides only transient and modest benefit at a significant risk of stroke and vascular injury. However, aortic valvuloplasty can play a useful role in stabilizing patients who require additional attention prior to definitive surgery. Building on this foundation, a bold new technique of percutaneously implanting a balloon-mounted valve has been developed. Although promising, there have been relatively few patients treated in this fashion (at a single center) and with only limited follow-up. Surgical treatment, specifically valve replacement, is still the definitive treatment of choice for patients with symptomatic aortic stenosis. Surgeons and patients must choose between a variety of models of both tissue and mechanical valves and a variety of surgical approaches. Recent trends include the use of tissue valves in increasingly younger patients and continued interest in alternatives to full median sternotomy in approaching the valve.

Choledochal cyst: a 14-year surgical experience with 36 patients.

The presentation and management of 36 patients with cystic dilatation of the biliary tree seen over a 14-year period is reviewed. There were 28 females and 8 males, a ratio of 3.5:1. The classic triad of jaundice, pain and an abdominal mass was seen in only seven cases. Twelve patients suffered recurrent pancreatitis. There were three cases of variceal haemorrhage from portal hypertension secondary to biliary cirrhosis, and one case of biliary peritonitis from a ruptured cyst. Internal drainage (cystenterostomy) was performed in nine patients but five of these eventually needed cyst excision. Cysts have been excised primarily in the last 21 consecutive patients without mortality. Preliminary external drainage with T tubes was used before cyst resection in three patients who presented with complications of choledochal cysts. Cyst excision and hepaticojejunostomy is now the definitive treatment of choice.

Current diagnosis and therapy of esophageal carcinoma

In Germany the incidence of esophageal cancer is 6 - 10 per 100,000. At the time of diagnosis about 75 % of the patients suffer from UICC stage III or IV esophageal cancer. Less than 10 % of patients are diagnosed with early (T1) cancer. Diagnosis and staging relies on esophagoscopy including biopsies, endoscopic ultrasonography, and computerized tomography of the chest and abdomen. Intramucosal early cancer (T1a) and high-grade dysplasia can be treated either by surgery or by endoscopic mucosal resection. Chemoradiation is the definitive treatment of choice for localized squamous cell cancer of the proximal esophagus. As far as overall survival is concerned definitive chemoradiation is not inferior to esophagectomy even in patients with localized squamous cell cancer of the middle or lower esophagus. In case of high surgical risk chemoradiation should be offered to those patients as the therapy of choice. Esophagectomy should be performed in operable patients suffering from resectable adenocarcinoma of the esophagus. Preoperative chemoradiation is recommended in locally advanced (non-resectable) adenocarcinoma. If staging reveals distant metastases, palliative therapy is indicated. Palliative chemotherapy with 5-fluorouracil and cisplatin should be offered to patients with good performance status. Esophageal intubation (with expandable metal stents) is the palliative treatment of choice for firm stenosing, non-resectable tumors, where rapid relief of dysphagia is required.