Good Results Of Surgical Treatment Research Articles

Delayed Treatment of Acute Subdural Hematomas: Retrospective Outcome Analysis of 215 Patients

BACKGROUND: The preferred treatment method for acute subdural hematoma (aSDH) is surgical intervention. AIM: We aimed to show that, regardless of the good results of surgical treatment, conventional delayed treatment might be very useful in some situations and might lead to chronicity of hematoma as well as reduction of surgical intervention scope and reduce risk of anesthesia. It might also give rise to spontaneous resorption of hematoma. METHODS: In the period March 1, 2013–March 1, 2020, we retrospectively examined 215 aSDH patients. The basic result of the outcome analysis was evaluated on the basis of the Glasgow Outcome Scale (GOS) at discharge after 3-month and 6-month follow-up. RESULTS: A total of 215 patients with aSDH and minor or moderate brain injury were examined, while applying conventional delayed treatment, the following results were obtained: large craniotomy was carried out in 123 patients (57.2%) on the 2nd–3rd day of observation, small craniotomy with drainage was applied in 29 patients (13.5%) and spontaneous resorption of subdural hematoma occurred in 63 patients (29.3%). The median score as per the Glasgow Coma Scale at admission to the hospital was 11.4. CONCLUSION: This study showed that conventional delayed treatment applied in patients with aSDH and minor or moderate craniocerebral injury might lead to chronicity and resorption of aSDH. The outcomes as per the GOS scale also showed good data three and 6 months after hospitalization.

COMPARATIVE RESULTS OF ARTHROSCOPIC ANATOMICAL ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING PATELLAR TENDON AND HAMSTRINGS AUTOGRAFTS

Complete traumatic injuries of the anterior cruciate ligament (ACL) are the most common knee injury among physically active males and females who are fond of both traditional and extreme sports. Surgical restoration of the anatomical structures of the injured joint, even with isolated ACL damage, remains an urgent problem of modern traumatology and orthopedics. The technology of arthroscopic reconstruction of the ACL is developing along the path of improving the technique of surgery, fixators, plastic materials. The article is devoted to the study of the results of arthroscopic anatomical plastic surgery of the anterior cruciate ligament with autografts from the patellar ligament with two bone blocks and the hamstring flexor tendons. The study included 100 patients of the main group and the comparison group with chronic damage to the anterior cruciate ligament and chronic anterior instability of the knee joint, which were divided into two groups depending on the type of transplant used. Long-standing injuries of the anterior cruciate ligament were diagnosed based on the results of a clinical examination, radiography, magnetic resonance imaging, and hardware arthrometry. Excellent and good results of surgical treatment were obtained in most patients of both groups, however, the highest stabilization indicators of the knee joint were noted in the comparison group.

ЗНАЧЕНИЕ ИСПОЛЬЗОВАНИЯ ЭПИДУРАЛЬНОГО ЖИРА В ПРОФИЛАКТИКЕ СИНДРОМА ОПЕРИРОВАННОГО ПОЗВОНОЧНИКА

Objective: Improving the results of microsurgical treatment of recurrences of a herniated inter-vertebral disc (HIVD) in operated spine syndrome. Methods: The results of surgical treatment of 70 patients with lumboishialgia and disco-radicular conflict due to the HIVD were studied. Among the total number of sick women were 26 (37.1%), men – 44 (62.9%). A comprehensive examination of patients included X-ray, tomography and/or MRI of the lumbosacral section of the spinal column, as well as the electromyography study of lower limbs. Dynamic examination of patients was carried out before and after surgery, and the time frame through 3, 6 and 12 months after surgery. Results: In the studying the levels of lesions of the spine divisions, it was found that the most common HIVD was observed at the level of L5 -S1 – in 36 (51.4%); L4 -L5 HIVD was found at 29 (41.4%); and L3 -L4 - at 5 (7.1%) cases. In 40 (57.1%) patients out of 70 had microsurgical discectomy in the traditional way and in 30 (42.9%) cases performed a microsurgical discectomy with the laying of free fat in the interstitial space. The results of the comparative analysis showed that patients in both groups had a decrease in the intensity of pain syndrome compared to the condition before operation. At the same time, in the patients of the main group, this parameter was better though the 6 and 12 months than in the control group (p<0.01). Conclusion: Proposed microsurgical discectomy with the laying of free fat in the interstitial space during re-operation on the recurrence of HIVD, along with its simplicity in performance has shown great efficiency without requiring additional costs. A decrease in the number of unsatisfactory outcomes by 2-3 times was noted with a simultaneous increase in the number of satisfactory and good results of surgical treatment of this disease. Keywords: Operated spine syndrome, epidural fat, osteochondrosis, pain syndrome.

Femoral Periprosthetic Fractures after Total Knee Arthroplasty: New Surgically Oriented Classification with a Review of Current Treatments.

PurposeAs the number of total knee arthroplasties (TKAs) increases, the incidence of femoral periprosthetic fractures after TKA is also increasing. This review aimed to suggest a new surgically oriented classification system for femoral periprosthetic fractures.MethodsWe investigated the classifications, and current treatment trends for femoral periprosthetic fractures after TKA by means of a thorough review of the relevant literature.ResultsNumerous studies reported good results of surgical treatment with modern fixatives including locking compression plates and retrograde intramedullary nails. However, few classifications of femoral periprosthetic fractures reflect the recent developments in surgical treatment.ConclusionsWe recommend that surgical management be considered the first-line treatment for femoral periprosthetic fractures after TKA. Our new classification will help in deciding the surgical treatment option for femoral periprosthetic fractures after TKA.

Comparative characteristics of the efficiency of different methods of operational treatment for pectus excavatum in children: a multicenter study

Background. Congenital malformations of the chest are observed in 1%–4% of the population, and the most common among these is pectus excavatum (90%).
 Aim. We aimed to conduct a retrospective multicenter study to compare the effectiveness of various methods of operative removal of pectus excavatum in children.
 Material and methods. We retrospectively analyzed the results of the surgical treatment of funnel-like deformity of the thorax in children conducted in clinics of pediatric surgery in seven regions of Russia (1,226 patients). The ratio of boys to girls in the study population was 2.2:1. The study population was divided as per their age into the following groups: 4–7 years (n = 180, 14.7%), 8–14 years (n = 731, 59.6%), and > 14 years (n = 315, 25.7%). The average age at which most children were operated was 11.83 ± 1.24 years. All children underwent a standard preoperative laboratory examination, including a general blood test, urine tests, a biochemical blood test, a hemostasiogram; radiographic diagnostic methods were used with the calculation of the Gizycka index; functional methods of investigation, such as electrocardiography, spirography, and radioisotope scintigraphy of the lungs were also used. Children with second- or third-degree pectus excavatum underwent surgical treatment almost exclusively. The symmetrical forms of the pectus excavatum were more prevalent. In most cases, the main pathological course was complicated.
 Results and discussion. The operated patients were divided into the following 3 groups: the first (n = 62): operations with the resection of the curved cartilages and external fixation of the sternum-rib complex (Bairov’s operation), the second (n = 374): thoracoplasty with the resection of warped cartilages using internal metal fixators by Timoshchenko, Ravitch, Paltia, Kondrashin), and the third (n = 790): minimally invasive operations without resection with internal fixation (Nuss operations: original and modified). In the first group, favorable results of surgical treatment were noted in 80.6% of the patients, satisfactory results were observed in 6.5%, unsatisfactory results were seen in 12.9%, and the overall effectiveness of operative correction was 87.1%. In the second group, good results of surgical treatment were recorded in 88% of the patients, satisfactory in 6.4%, and unsatisfactory in 5.6%; the overall efficiency of operative correction was 94.4%. In the third group, good results of surgical treatment were recorded in 95.3%, satisfactory in 3.8%, and unsatisfactory in 0.9%; the efficiency of operative correction was 99.1%.
 Conclusion. Today, the authors consider acceptable the operations by Timoshchenko and Paltia for complex of indicators, the optimal operation is Nuss.

Dysembryoplastic neuroepithelial tumour: insight into the pathology and pathogenesis.

<i>Dysembryoplastic neuroepithelial tumour (DNT) is categorized as a benign glioneuronal neoplasm affecting children and young adults with chronic epileptic seizures. It is characterized by predominant intracortical localization and nodular architecture. Dysembryoplastic neuroepithelial tumour usually demonstrates a distinctive morphological pattern with a specific glioneuronal element but occasionally, its morphological picture is heterogeneous and unspecific. Thus, considering the morphology of DNT, three different histopathological subtypes are distinguished: simple, complex, and non-specific and diffuse. The DNT lesions are often related with focal cortical dysplasia (FCD) type IIIb, which is postulated to play a role in epileptogenicity. Moreover, the accompanying inflammation process might be implicated in DNT-related epileptogenesis. Dysembryoplastic neuroepithelial tumour is generally characterized by favourable prognosis and good results of surgical treatment. The pathogenesis and molecular mechanisms involved in DNT development remain uncertain. The main molecular findings are connected with BRAF alterations and activation of RAS/ERK, PI3K/AKT and mTOR signalling pathways. The present review summarizes the clinical, histopathological and molecular findings of DNT. The classification controversy, morphological heterogeneity and diagnostic problems are also discussed. </i>.

CONGENITAL CHOLESTEATOMA WITH EXTERNAL EAR CANAL ANOMALIES

To the Editor: We read with great interest the article "Congenital Cholesteatoma in a Case of Congenital Aural Atresia" (Otol Neurotol 2006;27:934-936) by RJ Caughey, RA Jahrsdoerfer, and BW Kesser (1). Authors presented a case of an 8-year-old child with congenital cholesteatoma and congenital aural atresia. Our compliments on having diagnosed such an unusual case and achieving very good results of surgical treatment. We have several comments regarding their diagnosis and treatment paradigm. Incidence of congenital cholesteatoma is very low (2). Establishing the origin of cholesteatoma remains difficult and controversial. More often one can observe cholesteatomas in ears, where congenital abnormalities of the external auditory canal (EAC) are present. In a normal case, the ectoderm canalizes from medial to lateral to form the EAC. If this process is arrested, stenosis or atresia of the EAC is a result. In such developmental disorders, when tympanic membrane is not formed, ectodermal epithelium is "lost" next to tympanic cavity. This "lost" ectodermal epithelium may initiate the growth of cholesteatoma that later grows into tympanic cavity between ossicles. It is difficult to explain how squamous epithelium got into tympanic cavity; it is possible that this took place by the end of intrauterine life (2). We agree with author's suggestion that cholesteatoma grew as a result of the ear developmental disorders before 33rd week of intrauterine life (according to epidermoid formation theory of Michaels) (3). The origin and nature of cholestatoma may be assessed by MRI and by histopathological and molecular examinations. Magnetic resonance imaging finds the hyperintensity on T2-weighted images with little peripheral enhancement on post-contrast T1-weighted images. Huang et al. (3) in immunohistochemical examinations observed that epidermoid formation in human fetal middle ear had the same staining patterns of middle ear mucosa for CK13, CK18, and CK19, and they were different from the EAC skin. Authors suggest that hyperplastic epidermoid formation may acquire certain properties of epidermis and develop into congenital cholesteatoma. Liang et al. (4) showed that expression of the cytokeratine pattern of the epidermoid formation was found in a total of 116 of these structures in 22 temporal bones aged from 16 weeks to 8 months. Histopathological examination of congenital cholesteatoma may be valuable in distinguishing congenital and acquired cholesteatomas. Acquired and congenital cholesteatomas presented so far do not show convincing evidences for morphological differences between these two types of cholesteatoma. Congenital cholesteatoma mainly contains keratin masses and poorly developed matrix, without stroma. Matrix of congenital cholesteatoma contains from 2 to 5 layers of squamous epithelium, whereas acquired cholesteatoma contains many more of these layers. In the microphotography of cholesteatoma presented by authors, the matrix contains over a dozen layers of squamous epithelium. The assessment of telomeres length in keratinocytes would be helpful in distinguishing congenital and acquired cholesteatoma. Chromosomal telomers of congenital cholesteatoma are longer than telomers of acquired ones (5). Jerzy Kuczkowski, M.D., Ph.D. Waldemar Naroz˙ny, M.D., Ph.D. Boguslaw Mikaszewski, M.D., Ph.D. Department of Otolaryngology Medical University of Gdańsk Gdańsk, Poland

Snapping scapula caused by abnormal angulation of the superior angle of the scapula

Snapping scapula (crepitus between the scapula and the chest wall) is not a rare condition; however, it only occasionally becomes painful and disabling. Boinet1 first described a case of snapping scapula in 1867. The etiology of snapping scapula is classified into two categories: skeletal or soft-tissue abnormalities.2,5-7 Skeletal abnormalities include varied conditions that lead to scapulothoracic incongruity, such as bone tumors of the scapula or ribs (osteochondromas or exostoses), abnormal anterior angulation of the superior angle of the scapula, Luschka's tubercle, bony prominence of the scapula, omovertebral bone, and malunion after fractures of the scapula or ribs. However, in some cases previously reported,2,11 it was difficult to find obvious skeletal abnormalities and the clear cause of the symptoms was unknown. There have been many reports that mostly revealed good results of surgical treatment for snapping scapula;2,3,5-10 however, it is still controversial whether operative treatment is necessary.11

Prise en charge des anévrismes des artères digestives. Étude rétrospective de 23 cas

Study aim: To evaluate symptoms and results of the treatment of aneuryms of digestive arteries. Patients and method: Retrospective study of 23 patients (14 male and 9 female, mean age=51 years) treated in two departements of academic hospital. We studied the aneurysm caracteristics (location, number, size, etiology) the type of treatment, and occurence of post-operative complications. Results: The aneurysms involved the splenic artery in 13 patients (56%), the superior mesenteric artery in 5 patients (22%), the hepatic artery in 3 patients (13%), the gastro-epiploic artery in 2 patients (9%). There were thirty-one aneurysms (24 true aneurysms and 7 pseudo-aneurysms) in 23 patients. Diagnosis was mainly done by the CT-scan. An aneurysm rupture occured in 7 patients (30%). Treatment was surgery for 26 aneurysms (84%) or a radiological embolization in 3; abstention was decided for 2 aneurysms (6%). No death was observed. Conclusion: The bad prognosis after rupture, the lack of predictive factors of rupture combined with the good results of surgical treatment suggest to prefer a surgical treatment at first. Embolization could be reserved for the contre-indication of surgery and when aneurysms are poorly accessible to surgery.

Long-term survival following bronchotomy for polypoid bronchial carcinoid tumours.

Typical bronchial carcinoids are very low grade neuroendocrine neoplasm of the tracheobronchial tree and have very good results in surgical treatment. Surgical treatment varies from bronchotomy-excision to major resective procedures. We presented our results of bronchotomy, simple excision and long-term follow-up. In Atatürk Centre for Chest Disease and Chest Surgery, 16 patients with bronchial carcinoid tumour underwent bronchotomy-excision over a 23-year-period. In all of the cases tumours were in polypoid type. Except these 16 cases 51 patients with bronchial carcinoids underwent operations in the same period. Presenting symptoms were haemoptysis, cough, recurrent pulmonary infection, dyspnea and chest pain. Rigid bronchoscopies were performed on all of the patients preoperatively for diagnosis of the tumour and to determine the surgical procedure and we performed control bronchoscopies on all of the patients in their follow-up period. Patients were checked for periods ranging from 2 to 23 years both radiologically and bronchoscopically. We did not find any recurrences and death related to surgery and morbidity rate were minimal. We think that bronchotomy and simple excision are effective and safe procedures for the treatment of bronchial carcinoid tumours with low morbidity in selected cases like polypoid type lesions and have as good a long-term survival rate as the other surgical treatment methods have.

Good results of surgical treatment of elderly patients with stage I lung cancer

Good results of surgical treatment of elderly patients with stage I lung cancer

Cisto dermoide craniano intradiploico: registro de um caso

A case of intradiploic dermoid cyst of the skull in a female child with seizures is reported. The authors emphasize diagnostic aspects and the surgical procedure. The characteristics of the tumor were cleared at the surgical procedure, and its nature was confirmed by histological examination. The importance of the skull biopsy when radiological aspects are not definite and the benign characteristics of the process are discussed. Good results of surgical treatment and the infrequency of the tumor justify the report.