Efficacy Of Surgery In Patients Research Articles

Surgical Outcomes of Common Peroneal Nerve Entrapment Neuropathy Associated with L5 Radiculopathy.

Impingement of the common peroneal nerve, a branch of the L5 nerve root, causes common peroneal nerve entrapment neuropathy (CPNE). Although there are cases of CPNE associated with L5 radiculopathy, surgical intervention's effectiveness remains to be elucidated. This retrospective case-control study aimed to evaluate the efficacy of surgery in patients with CPNE associated with L5 radiculopathy. Twenty-two patients (25 limbs) with surgically treated CPNE between 2015 and 2022 were retrospectively reviewed. The limbs were classified into two groups: group R (limbs of CPNE associated with L5 radiculopathy) and group O (limbs of CPNE without L5 radiculopathy). The durations from onset to surgery, the nerve conduction studies (NCSs), and postoperative improvement rates for motor weakness, pain, and dysesthesia were compared between the groups. Group R included 15 limbs (13 patients), and group O included 10 limbs (9 patients). There were no significant differences in the duration from onset to surgery or abnormal findings of NCS between the two groups. The postoperative improvement rates were 88% and 100% (p = 0.62) for muscle weakness, 87% and 80% (p = 0.53) for pain, and 71% and 56% (p = 0.37) for dysesthesia in group R and group O, respectively, without significant differences between groups. CPNE associated with L5 radiculopathy is common, and the results of the present study showed that the surgical outcomes in such cases were satisfactory and comparable to those in CPNE without L5 radiculopathy.

Efficacy of Surgery in Patients with Stage I Primary Parotid Gland Lymphoma: A Population-Based Study.

Limited and controversial evidence is available on the efficacy of surgery for patients with stage I primary parotid gland lymphoma. Thus, we aimed to investigate whether surgery can enhance the prognosis of patients with stage I primary parotid gland lymphoma using large sample data. From 1998 to 2015, we searched the Surveillance, Epidemiology, and End Results (SEER) program database and extracted information regarding patients with stage I primary parotid gland lymphoma; we classified these patients into surgery and nonsurgery groups. We calculated overall survival (OS) and cancer-specific survival (CSS) using Kaplan-Meier curves and log-rank testing. Propensity score matching (PSM) analysis was also used to further account for confounding variables before comparing the OS and CSS again. We used the COX proportional hazard regression model in both multivariate and univariate analyses. We enrolled 918 patients with stage I primary parotid gland lymphoma, among which 656 (71.5%) patients underwent surgery. Before PSM, the surgery group had better OS (hazard ratio (HR) = 0.673, 95% confidence interval (CI): 0.519-0.873, and p=0.003) and CSS (HR = 0.595, 95% CI: 0.403-0.879, and p=0.008) than the nonsurgery group. After PSM, surgery was still a beneficial factor for OS (HR = 0.569, 95% CI: 0.399-0.810, and p=0.002) and CSS (HR = 0.384, 95% CI: 0.220-0.669, and p=0.001). Furthermore, in univariate and multivariate analyses, total parotidectomy significantly increased OS (p=0.001 and p=0.021, respectively) and CSS (p=0.001 and p=0.037, respectively). In summary, the prognosis of patients with stage I primary parotid gland lymphoma can be significantly improved by surgery. Moreover, total parotidectomy was a protective factor for OS and CSS before and after PSM analysis, suggesting that surgery acts as a significant component in multimodal therapy for early primary parotid gland lymphoma.

Retrospective analysis of surgical management for spontaneous basal ganglia haemorrhage and outcome: A tertiary institute experience

Background: Spontaneous intracranial haemorrhage (ICH) is the most severe type of stroke with high mortality rates. This entity accounts for 17 to 33% of all strokes and is associated with a higher mortality rate. Approximately, 35–50% of patients with ICH die within the 30 days after event. Long-term survivors are often remaining with permanent deficits, with up to 75% suffering permanent disability and only 12% to 39% of the survivors have favourable outcomes. Several studies aiming to explore the efficacy of surgery for patients with ICH have been carried out. However, the results were inconclusive. To provide evidence for clinical practice, here we present a retrospective study to explore the effect of surgery for patients with spontaneous basal ganglia haemorrhage. Methods: The present study was conducted in the Neurosurgery Department of a tertiary care hospital in the Northern part of India from January 2018 to March 2020. Sixty-one patients aged between 20-70 years of basal ganglia haemorrhage who presented within 24 hours of ictus and operated were included in this study. Results: A total of 61 patients underwent surgical intervention consisting of 49 (80%) males and 12 (20%) females. Their age varied from 27 to 70 with mean age ± SD 51.93 ± 13.19 years. Thirty-six patients were ≥ 50 years of age, out of which 72% patients had unfavourable outcomes (GOS 1-3) and 28% had favourable outcome (GOS 4-5). There were 31 patients with GCS 5-8. Most patients (81%) had GOS 1-3(at the time of discharge). Out of 25 patients with GCS 9-12; 64% had GOS 4-5. The patients with volume of haematoma 40-60 ml, 82% patients had GOS 4-5. The patients with midline shift > 5 mm; 78% patients had GOS 1-3. Patients with midline shift < 5 mm; 82% had GOS 4-5 (P=0.005). The mean hospital stays of unfavourable outcomes group was 28.71 ± 10.25 days and of favourable outcomes group was 22.07 ± 6.32 days (0.000). Conclusions: Early surgery (within 6 hours) along with multi-modality medical management has definite positive role in the outcome of patients with spontaneous basal ganglionic haemorrhage. Patients ≥ 50 years, signs of brain herniation, volume of haematoma ≥ 60ml, hydrocephalic dilatation due the intraventricular haemorrhage, midline shift > 5 mm, and GCS ≤ 8 at presentation had poor prognosis.

Safety and efficacy of transperitoneal laparoscopic nephron sparing surgery in patients with previous abdominal surgery.

The aim of this study is to assess the safety and feasibility of the transperitoneal laparoscopic approach during nephron sparing surgery in patients with previous abdominal surgery. We retrospectively analyzed patients undergoing transperitoneal laparoscopic partial nephrectomy for renal masses. All patients had received a diagnosis of cT1a renal exophytic mass (⩽5 cm). Patients were divided into two groups, those with and without previous abdominal surgery. Patients with solitary kidney or major previous abdominal surgery were excluded in this study. The operative time, estimated blood loss, length of stay, surgical complications, and positive surgical margins were recorded to compare outcomes among two groups. Of the 157 patients who were included in our study, 71 (45.3%) had a history of abdominal surgery (Group 1), while the remaining 86 (54.7%) had not (Group 2). Cholecystectomy was the most common previous surgery performed near the renal fossa. Patients with previous abdominal surgery experienced increased operative time (111.5 vs 83.2 min; p = 0.001). However, no statistically significant difference was found in estimated blood loss (122.1 vs 114.4 mL; p = 0.363), length of stay (4.1 vs 3.8 days; p = 0.465), rate of conversion to open surgery (2.8% vs 2.3%; p = 0.234), and rate of complications (p = 0.121). However, operative time (p = 0.003) and length of stay (p < 0.001) were greater in patients with versus those without previous open cholecystectomy. Our results suggest that laparoscopic partial nephrectomy after minor previous abdominal surgery is safe and feasible in selected patients affected by renal masses with low nephrometry score. However, previous cholecystectomy results in an increased risk of conversion to open surgery and longer hospital stay in patients undergoing right laparoscopic partial nephrectomy.

Survival outcomes following craniotomy for intracranial metastases from an unknown primary

IntroductionManagement of patients with intracranial metastases from an unknown primary tumor (CUP) varies compared to those with metastases of known primary tumor origin (CKP). The National Institute for Health and Care Excellence (NICE) recognizes the current lack of research to support the management of CUP patients with brain metastases. The primary aim was to compare survival outcomes of CKP and CUP patients undergoing early resection of intracranial metastases to understand the efficacy of surgery for patients with CUP.MethodsA retrospective study was performed, wherein patients were identified using a pathology database. Data was collected from patient notes and trust information services. Surgically managed patients during a 10-year period aged over 18 years, with a histological diagnosis of intracranial metastasis, were included.Results298 patients were identified, including 243 (82.0%) CKP patients and 55 (18.0%) CUP patients. Median survival for CKP patients was 9 months (95%CI 7.475–10.525); and 6 months for CUP patients (95%CI 4.263–7.737, p = 0.113). Cox regression analyses suggest absence of other metastases (p = 0.016), age (p = 0.005), and performance status (p = 0.001) were positive prognostic factors for improved survival in cases of CUP. The eventual determination of the primary malignancy did not affect overall survival for CUP patients.ConclusionsThere was no significant difference in overall survival between the two groups. Surgical management of patients with CUP brain metastases is an appropriate treatment option. Current diagnostic pathways specifying a thorough search for the primary tumor pre-operatively may not improve patient outcomes.

Efficacy of surgery and prophylactic cranial irradiation in stage II and III small cell lung cancer.

Background: The role of surgery for stage II and III small cell lung cancer (SCLC) remains controversial. The use of prophylactic cranial irradiation (PCI) for resected SCLC was limited. This study aimed to assess the efficacy of surgery in patients with stage II and III SCLC, and evaluate the value of PCI on resected disease.Methods: A total of 269 consecutive patients with stage II-IIIA SCLC were retrospectively reviewed from January 2010 to December 2015. Of these, 116 patients received surgical resection, and 153 underwent non-surgical treatment. Resected patients were matched 1:1 with non-surgical patients (n=70 in each group).Results: The median follow-up was 30 months. The 1-, 3- and 5-year overall survival (OS) for matched patients were 80.0%, 44.3% and 31.7% in surgical group, and 80.0%, 24.3% and 20.0% in non-surgical group (P=0.009), respectively. Multivariate analysis in matched patients showed that surgery (HR=0.603, 95%CI: 0.404-0.900) and PCI (HR=0.637, 95%CI: 0.427-0.950) were independent prognostic factors for OS. In subgroup analysis, OS benefit related to surgery was marginal for stage II (P=0.09) and IIIA patients (P=0.061), but was significant for selected stage IIIA patients who received adjuvant chemo-radiation and PCI (P=0.01). PCI was associated with improved OS for non-surgical patients (P=0.036), and stage IIIA of surgical patients (P=0.047).Conclusions: These findings suggest a potential OS benefit of surgery in stages II and IIIA patients, particularly in selected stage IIIA patients who received adjuvant chemo-radiation and PCI. The use of PCI for surgical patients with stage IIIA was associated with improved OS.

Role of surgery in the treatment of osteoradionecrosis and its complications after radiotherapy for nasopharyngeal carcinoma.

The purpose of this study was to review the efficacy of surgery for patients with osteoradionecrosis (ORN) after radiotherapy for nasopharyngeal carcinoma (NPC). Between 2000 and 2016, we identified 162 patients with skull base ORN, among which 58 patients required surgery. A retrospective medical chart review was performed and the indications and results of surgical interventions were recorded. All surgeries were performed for the treatment of secondary complications of ORN, including central nervous system (CNS) infection (48.4%), blowout bleeding (24.1%), and severe pain (17.2%). Endoscopic debridement was done in 12 patients, whereas the rest required either maxillary swing or mandibulotomy, depending on the location of the necrosis. The majority of the patients required free vastus lateralis flap (72.5%) for reconstruction. Surgery was effective in the control of infection, bleeding, and pain. Multivariate analysis identified reirradiation and bone exposure on MRI as the significant independent risk factors predicting the future need of surgery. Surgery is effective in the treatment of secondary complications of skull base ORN after previous radiotherapy for NPC.

Numerical analysis for the efficacy of nasal surgery in obstructive sleep apnea hypopnea syndrome

In the present study, we reconstructed upper airway and soft palate models of 3 obstructive sleep apnea—hypopnea syndrome (OSAHS) patients with nasal obstruction. The airflow distribution and movement of the soft palate before and after surgery were described by a numerical simulation method. The curative effect of nasal surgery was evaluated for the three patients with OSAHS. The degree of nasal obstruction in the 3 patients was improved after surgery. For 2 patients with mild OSAHS, the upper airway resistance and soft palate displacement were reduced after surgery. These changes contributed to the mitigation of respiratory airflow limitation. For the patient with severe OSAHS, the upper airway resistance and soft palate displacement increased after surgery, which aggravated the airway obstruction. The efficacy of nasal surgery for patients with OSAHS is determined by the degree of improvement in nasal obstruction and whether the effects on the pharynx are beneficial. Numerical simulation results are consistent with the polysomnogram (PSG) test results, chief complaints, and clinical findings, and can indirectly reflect the degree of nasal patency and improvement of snoring symptoms, and further, provide a theoretical basis to solve relevant clinical problems.

Sleeve Gastrectomy in the Elderly: A Safe and Effective Procedure with Minimal Morbidity and Mortality

Previously, we demonstrated the safety and efficacy of laparoscopic gastric bypass surgery in patients over 65years of age. The aim of this study is to demonstrate the safety and efficacy of this procedure as a final step for treatment of morbid obesity in the same population. A retrospective review of a prospectively collected database was performed. Between 2004 and 2010, a total of 35 patients age 60 and greater were analyzed from a total of 512 sleeve gastrectomy patients. Demographics, preoperative body mass index, complications, and excess weight loss were recorded and compared to bougie size and follow-up in months. Mean age was 66.3years (range, 60-79years), mean body mass index was 46.3kg/m(2) (range, 33.7-77.6kg/m(2)), and mean excess weight loss was 148.49lb (range, 72-252lb). One patient (2.8%) had an incidental colotomy as a result of trocar insertion, one patient (2.0%) bled, and one patient (2.8%) had small-bowel enterotomy. Overall, morbidity was 8.4% with no mortality. Mean percent excess weight loss results for bougie size 52 were 28, 34, 26, 18, and 27% at 3, 6, 12, 24 and 48months, respectively; for bougie size 46 were 31, 57, 64, 62, and 82% at 3, 6, 12, 24 and 48months, respectively; and bougie size 38 were 37, 50, 55, and 56% at 3, 6, 12 and 24months, respectively. Laparoscopic sleeve gastrectomy is an effective procedure for morbidly obese patients age 60 and greater that can be performed safely.

Quality of life in surgical treatment of metastatic spine disease.

Overall quality of life after surgical management of metastatic disease of the spine was prospectively assessed using a validated global health status quality-of-life instrument-the Edmonton Symptom Assessment Scale. To prospectively evaluate the efficacy of surgery in patients with metastatic spinal disease with respect to quality of life. Management of spinal metastases is palliative and is aimed at improving quality of life at an acceptable risk. Although previous studies have evaluated physical outcomes, improvements in pain, and neurologic function after surgery, a multidimensional assessment of quality of life is more relevant in the palliative patient. Twenty-five consecutive patients undergoing surgery for spinal metastases were prospectively evaluated. Pre- and postoperative assessments were performed using the Edmonton Symptom Assessment Scale. The surgical procedure consisted of decompression and instrumented stabilization. After surgery, the largest improvement was noted in the domain of pain (P < 0.00001). There were also significant improvements noted in the domains of tiredness (P = 0.004), nausea (P = 0.01), anxiety (P = 0.006), drowsiness (P = 0.044), appetite (P = 0.02), and well-being (P = 0.004). The current study demonstrates that in the appropriate patient, surgical management brings about a positive effect on the overall quality of life in patients with spinal metastases. The greatest benefit occurred in the reduction of a patient's level of pain.

Seizure-related outcome after corticoamygdalohippo-campectomy in patients with refractory temporal lobe epilepsy and mesial temporal sclerosis evaluated by magnetic resonance imaging alone

The authors conducted a study to assess the efficacy of surgery in patients who underwent magnetic resonance (MR) imaging alone for localization of foci in temporal lobe epilepsy (TLE). One hundred patients (43 men, 57 women) with a clinical diagnosis of TLE were prospectively studied (mean age 28 +/- 9 years [+/- standard deviation {SD}]). All patients underwent high-resolution MR imaging, and in all unilateral mesial temporal sclerosis (MTS) was diagnosed by visual inspection. All patients underwent interictal preoperative electroencephalography (EEG) and in 87 patients pre- and 1-year postoperative neuropsychological testing was performed. Both EEG and neuropsychological examinations were conducted in a blinded fashion, and these data were not taken into account during the surgery-related decision-making process. All patients underwent a corticoamygdalohippocampectomy at the side of the MTS. Surgery-related outcome was rated as Class I (seizure free or simple partial seizures only) or Class II (> or = 90% improvement). The follow-up period ranged from 18 to 48 months (mean 24 +/- 5 months [+/-SD]). No patient underwent prolonged video-EEG monitoring, Wada testing, positron emission tomography, or single-photon emission computerized tomography. In eighty-nine patients Class I results were achieved, and 11 Class II results were achieved postoperatively. There was no mortality in this series. Except for in two patients who underwent surgery in the dominant temporal lobe, there was no postoperatively cognitive decline. In these two patients verbal memory decline occurred, which was associated with posterior temporal cortical damage, demonstrated postoperatively on MR imaging. Twenty-five percent of the patients experienced improved memory function related to the nonoperated side, and 54% experienced a 10% gain in general intelligence quotient status. In patients with clinically suspected TLE, MR imaging alone is able to localize temporal lobe foci correctly. Ruling out pseudoseizures remains the only indication for prolonged video-EEG recordings in this group of patients.

48 P - Surgery following neoadjuvant chemotherapy (cisplatin, vepesid) in locally advanced non-small cell lung cancer

The efficacy of surgery for patients with locally advanced non-small cell lung cancer is limited. From February 1993 to September 1994 32 patients with non-small cell lung cancer (NSCLC) entered a multimodality treatment study with neoadjuvant chemotherapy (Cisplatin+Vepesid) and surgery at Department of Cardiothoracic Surgery in a Medical Academy in Lublin, Poland. Twenty five patients (22 stage IIIa and 3 stage IIIb) have completed the chemotherapy and are available for evaluation of response, toxicity. surgical eligibility and resection rate. The objective response rate to chemotherapy was 56%. The chemotherapy was well-tolerated. Twenty two patients (88%) had a complete resection. No treatment-related mortality was observed. The postoperative complications were observed in 5 of 22 (23%) complete resected cases. After a median follow-up of 16 months (3–32) IS patients are still alive (60%). The authors conclude that Cisplatin and Vepesid is an effective neoadjuvant regimen for NSCLC in stage III. Applied regimen was not connected with increasing rate of postoperative complications. A longer follow-up is needed to assess the impact of this multimodality approach on long-term survival. The efficacy of surgery for patients with locally advanced non-small cell lung cancer is limited. From February 1993 to September 1994 32 patients with non-small cell lung cancer (NSCLC) entered a multimodality treatment study with neoadjuvant chemotherapy (Cisplatin+Vepesid) and surgery at Department of Cardiothoracic Surgery in a Medical Academy in Lublin, Poland. Twenty five patients (22 stage IIIa and 3 stage IIIb) have completed the chemotherapy and are available for evaluation of response, toxicity. surgical eligibility and resection rate. The objective response rate to chemotherapy was 56%. The chemotherapy was well-tolerated. Twenty two patients (88%) had a complete resection. No treatment-related mortality was observed. The postoperative complications were observed in 5 of 22 (23%) complete resected cases. After a median follow-up of 16 months (3–32) IS patients are still alive (60%). The authors conclude that Cisplatin and Vepesid is an effective neoadjuvant regimen for NSCLC in stage III. Applied regimen was not connected with increasing rate of postoperative complications. A longer follow-up is needed to assess the impact of this multimodality approach on long-term survival.

Work in progress: radioisotopic evaluation of gastroplasty patients.

Radioisotopic gastric emptying studies, using technetium-99m-sulfur-colloid-labeled egg, were performed in 14 patients who had undergone gastroplasty. The radioisotopic method was found to be a good quantitative indicator of the amount of solids that empty from the stomach and a useful tool in the longterm follow-up of gastroplasty patients. It was particularly helpful in evaluating the efficacy of surgery in patients with poor postsurgical weight reduction.

Effects of antiarrhythmic surgery on late ventricular potentials recorded by precordial signal averaging in patients with ventricular tachycardia

In seven patients with documented ventricular tachycardia (VT) and prior myocardial infarction, late potentials (LP) were recorded at the end of or after the QRS complex from the body surface using high-gain amplification and the signal averaging technique (RC filter settings 100 to 300 Hz). In 6 of 7 patients VT could be initiated by programmed right ventricular stimulation; in one case, VT was inducible only from the left ventricle during surgery. Surgery was guided by epi- and endocardial mapping. In most cases besides resection of scar tissue, a partial or complete subendocardial encircling ventriculotomy was performed. Postoperatively, LPs were abolished in five cases, VT being no longer inducible. In the remaining two patients, LPs were still present. VT was still inducible in one of these two cases whereas in the other case, no programmed testing was done postoperatively. These data suggest that the abolition of LPs by surgery is closely related to the disappearance of the propensity to stimulus-induced VT. Thus, the averaging technique represents a new approach to the noninvasive control of the efficacy of surgery in patients with VT and prior myocardial infarction.