Efficacy Of Enucleation Research Articles

IS CYSTIC ENUCLEATION WITH PERIPHERAL OSTEOTOMY SUFFICIENT TREATMENT FOR OKCS OF THE JAWS?

Background - Odontogenic Keratocyst (OKC) is a developmental cyst of odontogenic origin behaving aggressively in term of high recurrence rate. Aggressive behavior and tendency to recur are related to greater proliferative activity of the epithelial lining. There have been many arguments made and still controversial regarding the treatment option for OKCs. Aim- The aim of the study is to investigate the Prevalence and incidence of OKC Riyadh city and the Assessment of recurrence rate of different management scheme for treatment of OKC. Objective- The objective of this study is to study the efficacy of enucleation with peripheral osteotomy versus resection method in management of OKC. Material and Method-Data has been obtained through a retrospective review of patients admitted at five main oral and maxillo-facial surgery departments in Riyadh City with a diagnosis of OKC. A retrospective review of OKC patients was conducted between July 2010 and December 2022. After excluding patient files with incomplete, unclear data. The data of the patients with a diagnosis of OKC, complete record patients were included in the study. The following data were recorded for each patient: Gender, age, medical history, date of diagnosis, radiology type, location, radiology description, associate complications (local/systematic) biopsy date, biopsy type, histopathology, surgery performed, date primary procedure, post-operative complications (numbness/infection/limited mouth opening/lymphadenopathy) and whether it resolved or not, recurrence, date of recurrence, number of recurrence, time between first surgery and recurrence, secondary procedure for the recurrence, date of secondary procedure, type of the second procedure, complications after the second procedure, date of diagnosis of second recurrence, date of third procedure, type of the third procedure, complications of the third procedure, date of forth procedures, type of the forth procedure, complications after the forth procedure, date of follow- up. Results - The total of 30 patients with clear medical records and at least one follow-up record, with the age ranged from 5 to 53 years, the mean age for patients without recurrence was 30.8 ± 11.7 years, while for those with recurrence, it was 25.3 ± 14.3. The p-value of 0.072 suggests that there is no statistically significant difference between the age of patients who had a recurrence and those who did not. Gender-wise, there were 11 (36.7%) females, 3 of them experienced recurrence. and 19 (63.3%) males, and 9 of them experienced recurrence (table 1). The majority of the patients underwent radiology using CT at the rate of 56.7%, followed by CBCT at the rate of 23.3%. The majority of the patients had a mandible location at the rate of 93.3%, with 70% of them diagnosed with a Unicystic radiological description and the rest were Multicystic. Conclusion - Enucleation was the most common first procedure for treating OKCs of the jaws, and most patients did not experience post-operative complications, but about 40% of the cases has been recurred whatever the procedure was except for the decompression procedure there were no recurrence. Patients who required a secondary procedure were most likely to undergo enucleation. Overall, 60% of patients did not have a recurrence, 33.3% had one recurrence, and 6.7% had two recurrences.

Long-term efficacy of enucleation combined with primary orbital implantation in children with retinoblastoma histopathological invasion of optic nerve.

ObjectiveThis study aimed to observe the long-term effect of enucleation combined with primary orbital implantation in children with histopathologic optic nerve invasive retinoblastoma (RB).MethodsWe retrospectively analyzed the clinical data and outcomes of children with RB optic nerve invasion confirmed by histopathology who underwent enucleation combined with primary orbital implantation between March 2010 and April 2014 in Beijing Tongren Hospital. The follow-up time ranged from 81 to 129 months, with a mean follow-up of 96 ± 14 months.ResultsA total of 59 children were included in this study. There were 32 males and 27 females; 52 children were affected in one eye and seven children in both eyes. The time from onset of symptoms to visit was between 3 days and 16 months, with a mean of 2.2 ± 2.8 months. The age at the of surgery was between 2 and 65 months, with an average of 24 ± 13 months. Patients were classified based on the degree of optic nerve invasion into four grades: grade 1 (invasion of prelaminar) in 28 cases, grade 2 (invasion of laminar) in 14 cases, grade 3 (invasion of retrolaminar but not reaching the optic nerve transection) in 16 cases, and grade 4 (invasion of the optic nerve transection) in 1 case. Post-operatively, all children were treated with 0–9 cycles of intravenous chemotherapy based on histopathology results from the removed eye. Of the 59 children, 13 had postoperative complications, and one died from recurrence. The survival rate was 98% (58/59). There was one case of orbital implant exposure, one of orbital cellulitis, six of enophthalmos and superior sulcus deformity, two of blepharoptosis, one of granuloma complicated with blepharoptosis, and one with a subconjunctival cyst.ConclusionFor children with RB histopathologic invasion of the optic nerve, enucleation combined with primary orbital implantation reveals future potential treatment options when combined with a full course of intravenous chemotherapy.

Enucleation versus hepatectomy for hepatic hemangiomas: A meta-analysis.

ObjectiveTo compare the safety and efficacy of enucleation and hepatectomy for the treatment of hepatic hemangioma (HH).MethodsA systematic literature search was conducted to identify studies evaluating enucleation versus hepatectomy for HH starting from the time of database creation to February 2022. Extraction of the data used in this study was done from the literature. The differences between the two surgical approaches were evaluated by comparing and analyzing the relevant data by means of meta-analysis.ResultsA total of 1,384 patients (726 underwent enucleation, and 658 with hepatectomy) were included in our meta-analysis from 12 studies. Enucleations were associated with favorable outcomes in terms of operation time [mean difference (MD): −39.76, 95% confidence interval (CI): −46.23, −33.30], blood loss (MD: −300.42, 95% CI: −385.64, −215.19), length of hospital stay (MD: −2.33, 95% CI: −3.22, −1.44), and postoperative complications (OR: 0.57, 95% CI: 0.44–0.74). There were no differences between the groups in terms of patients needing transfusion (OR: 0.85, 95% CI: 0.50, 1.42), inflow occlusion time (MD: 1.72, 95% CI: −0.27, 3.71), and 30-day postoperative mortality (OR: 0.23, 95% CI: 0.02–2.17).ConclusionCompared with hepatectomy, enucleation is found to be effective at reducing postoperative complications, blood loss, and operation time and shortening the length of hospital stay. Enucleation is similar to hepatectomy in terms of inflow occlusion time, 30-day postoperative mortality, and patients needing transfusing to hepatectomy.

Wedge resection or enucleation in pulmonary hamartoma?

Background: Wedge resection and enucleation are the most commonly preferred surgical modalities for the treatment of pulmonary hamartomas. There is a concern about the safety and efficacy of enucleation for a pulmonary hamartoma. Aim of the study: To compare wedge resection and enucleation for the surgical treatment of pulmonary hamartomas. Material and Methods: We retrospectively analyzed the data from patients who were surgically diagnosed with pulmonary hamartoma between January 2014 and December 2019. We obtained data on clinical findings, radiological features, surgical modality, postoperative complications, and follow-up results from the hospital electronic database. We compared all these features in the patients who underwent wedge resection with those who received enucleation. Results: A total of 18 patients with pulmonary hamartoma were analyzed. The mean age of the patients was 60.56 ± 9.25 years and 10 (55.6%) were male. Twelve (66.7%) patients had no respiratory symptoms. Ten (55.6%) of the patients underwent wedge resection and 8 (54.4%) patients had enucleation. There were no significant differences in age, gender, symptom distribution, prolonged air leakage, hospital stay length, intensive care unit stay length, mortality, or relapse rate between the patients with wedge resection and enucleation. Nodule size, calcification, metabolic activity, central or peripheral location, and lobar distribution were also similar. Conclusions: We observed that there were no significant differences in the postoperative complications, hospital stay length, mortality or relapse between the patients with wedge resection and enucleation. Minimal parenchymal damage and resection should be the aim of surgical interventions for benign lung diseases. Therefore, we believe that enucleation should be the first choice for the surgical treatment pulmonary hamartomas.

Efficacy and factors affecting the choice of enucleation and liver resection for giant hemangioma: a retrospective propensity score-matched study

BackgroundLiver resection (LR) and enucleation (EN) are the main surgical treatment for giant hepatic hemangioma (HH), but how to choose the type of surgery is still controversial. This study aimed to explore the efficacy and the factors affecting the choice of open procedure for HH.MethodsThe data for patients with pathologically confirmed HH who underwent open surgery from April 2014 to August 2020 were analyzed retrospectively. Univariate and multivariate analyses with logistic regression were performed to disclose the factors associated with the choice of EN or LR. Propensity score matching (PSM) analysis was used to compare the efficacy of the two procedures.ResultsA total of 163 and 110 patients were enrolled in the EN and LR groups. Following 1:1 matching by PSM analysis, 66 patients were selected from each group. Centrally located lesions (OR: 0.131, 95% CI 0.070–0.244), tumors size > 12.1 cm (OR: 0.226, 95% CI 0.116–0.439) and multiple tumors (OR: 1.860, 95% CI 1.003–3.449) were independent factors affecting the choice of EN. There was no significant difference in the median operation time (156 vs. 195 min, P = 0.156), median blood loss (200 vs. 220 ml, P = 0.423), blood transfusion rate (33.3% vs. 33.3%, P = 1.000), mean postoperative feeding (3.1 vs. 3.3 d, P = 0.460), mean postoperative hospital stay (9.5 vs. 9.0 d, P = 0.206), or the major complication rates between the two groups.ConclusionsPeripherally located lesions, tumors size ≤ 12.1 cm and multiple tumors were more inclined to receive EN. There was no significant difference in the efficacy of EN or LR.

Clinical efficacy of enucleation with packet-covered hydroxyapatite implant

Objective To evaluate the efficacy of enucleation with packet-covered hydroxyapatite implant. Methods The data of 45 eyes of 45 patients who were treated with enucleation with packet-covered hydroxyapatite implantation in our hospital from Jul.2011 to Aug.2017 were retrospectively analyzed. Postoperative follow-up was 12 months. Results Among 45 patients, there were 5 cases with traumatic severe ocular rupture, 9 cases with neovascular glaucoma, 26 cases with keroscleral grape swelling, and 5 cases with severe corneal ulcer perforation. After operation, mild lower eyelid relaxation occurred in 2 cases.No other complication, such as exposure of prosthetic ocular platform occured. All the patients had beautiful eyes. Conclusion Implantation of packet-covered hydroxyapatite with four rectus musles covered is simple and effective.The complications such as hydroxyapatite exposure is not easy to occur. Key words: Hydroxyapatite implantation; Muscle cone; Exposure

The effect of decompression as treatment of the cysts in the jaws: retrospective analysis.

ObjectivesThe purpose of this study is to evaluate the treatment efficacy of enucleation after decompression.Materials and MethodsA total of 17 patients with cystic lesion of the jaw were treated with decompression followed by enucleation. Pre- and postdecompression panoramic radiographs were analyzed.ResultsThe mean percentage of reduction after decompression was 64%. The reaction was graded as good (>80%) in five patients (29.4%), moderate (50%-80%) in nine patients (52.9%), and poor (<50%) in three patients (17.6%). The reduction rate of larger cystic lesions was faster than that of smaller lesions. However, the reduction rate was not affected by age. The duration of follow-up ranged from one to eight years. There were no complications, and one case recurred.ConclusionDecompression is an effective method for the initial treatment of jaw cysts.

Comparison of Efficacy of Enucleation and Pancreaticoduodenectomy for Small (&lt;3 cm) Branch Duct Type Intraductal Papillary Mucinous Neoplasm Located at the Head of Pancreas and the Uncinate Process

PurposeAccurate indications and the extent of surgery for branch duct intraductal papillary mucinous neoplasm (IPMN) of the pancreas are still debatable. In particular, small tumor is located at the head portion of pancreas presents a dilemma. The purpose of this study is to compare the efficacy of enucleation (EN) with that of pancreaticoduodenectomy (PD) in patients with small (2 cm<size<3 cm) branch duct IPMN located at the head of pancreas or uncinate process.Materials and MethodsAmong 155 patients who underwent pancreatic surgery due to pancreatic cystic tumors between January 2000 and December 2007 at Yonsei University Health System in Seoul, Korea, 14 patients with small (2 cm<size<3 cm) branch duct IPMN located at the head of pancreas or uncinate process were included in this study. Ten patients underwent PD, and four patients underwent EN. We compared short term surgical outcomes between the two groups. Correlation of the variables was analyzed using Mann-Whitney test and Fisher's exact test (SPSS Window 12.0). p-values less than 0.05 were considered significant.ResultsThe average age was 62.21 years (±6.71 years) and consisted of 8 men and 6 women. The mean operation time and blood loss were significantly lower in EN group. There were no significant differences in other surgical morbidities.ConclusionThe result suggests that enucleation for small branch duct IPMN located at the head of pancreas or uncinate process is feasible and as safe as PD, despite a high rate of minor complications.

Generation of Red Blood Cells From Human Embryonic Stem Cells (ES) with Increased Efficacy

Abstract 4334It is estimated that for every unit of donated blood, two units are required in North America. The current rate of blood donation is stagnant while the need increases by 6–8% annually. In order to overcome this difficulty, we have developed an improved method to generate red blood cells from human embryonic stem cells (H9) with increased efficacy. In addition to xeno-free conditions and standard cytokine cocktail used for hematopoietic differentiation of human embryonic stem cells (Carrier et al. J Transl Med. 2009; Vol 7: 27), we have introduced a new method of improved growth and differentiation of human ES cells with hypoxia-induced mesenchymal stem cells, obtained from allogeneic adult bone marrow donors. This technique increased efficacy of red blood cell production by 5–25 fold.We have developed a bioscaffold–> microsphere-based culture system with highly porous surface allowing culturing of a very large number of embryonic stem cells per one culture condition. This culture system avoids shear forces and damage to the cells, and facilitates removal and recycling of the microspheres. The in vitro obtained human ES-derived red blood cells are enucleated and do not produce tumors (efficacy of enucleation is 65–95%). The laser-based system is utilized to eliminate nucleated cells from the culture.The problem with hES-derived red blood cells is that they are produced in small numbers and process is very costly. We are developing a 3-phase bioreactor with computerized programming, which will increase every step of the differentiation process and allow recycling of feeder cells and cytokines. In this system we will utilize iron-loaded microspheres coated with hypoxia-processed mesenchymal stem cells as a main culture unit. The in vitro generated human ES-derived red blood cells upscaled in a bioreactor will be used for the off-shelf production of red blood cells for clinical use. Disclosures:Srivastava:Giostar: Employment, Equity Ownership. Azad:Dnamicroarray, Inc.: Employment, Equity Ownership. Carrier:Giostar: Consultancy; Samaritan Pharmaceuticals: Consultancy; Entest Biomedical: Consultancy, Equity Ownership; America Stem Cells: Consultancy, Equity Ownership; Millenium: Speakers Bureau; NovaRx: Employment, Equity Ownership.

Ex Situ Study of the Effectiveness of Enucleation In Patients with Renal Cell Carcinoma

We wished to identify the efficacy of enucleation (excavation) in the treatment of renal cell carcinoma. Surgical specimens from 26 patients with polar or peripheral lesions, 50 per cent of which were found incidentally by computerized tomography scan, were considered amenable to this form of treatment and were studied by ex situ enucleation after standard radical nephrectomy. Eleven patients were determined to have unsuccessful enucleation after histopathological study demonstrated capsular invasion, vascular invasion, residual tumor in the bed or multicentric tumors. Preoperative computerized tomography assessment did not accurately predict success of enucleation. The presence of a fibrous pseudocapsule of compressed renal parenchyma, which might facilitate a dissection plane and successful enucleation, did not correlate with tumor size. Microscopic examination of pseudocapsular integrity frequently revealed areas of thinning, disruption and penetration by neoplasm. When parenchymal preservation is necessary in the treatment of renal cell carcinoma, as wide a margin of adjacent renal parenchyma as possible should be excised with the tumor. In this study enucleation alone was associated with a significant risk of incomplete excision and, therefore, potential for treatment failure. We do not recommend enucleation in the presence of a normal contralateral kidney.

The potential for adjuvant radiotherapy in choroidal melanoma.

Controversy exists regarding the efficacy of enucleation in the management of choroidal melanoma. The effect of any form of ocular therapy on the prevalence of choroidal melanoma metastases is unknown. In a number of other systemic tumors, preoperative irradiation may lessen the occurrence of widespread disease. This type of therapeutic approach might be useful in the management of high-risk choroidal melanoma. In preliminary studies using 2,000 rad of preenucleation irradiation in patients with choroidal melanoma who have a poor prognosis, we have not observed notable morbidity. There are a number of limitations to the use of this adjunct therapy in choroidal melanoma management; however, a prospective national randomized trial of preenucleation irradiation in patients with high-risk choroidal melanoma might allow us to indirectly determine the effect of enucleation on the prevalence of choroidal melanoma metastases as well as delineate the potential role of this type of adjunct therapy in ocular melanoma.