Recent Advances In Surgical Treatment Research Articles

Overview of Recent Advances in Surgical Treatments for OSA

To review recent advances in diagnosis and surgical treatment of obstructive sleep apnea (OSA). Drug-induced sleep endoscopy allows for dynamic visual assessment of the upper airway in a sleep-like state. Definitive trials are underway to confirm its validity. Nasal surgery can decrease required continuous positive airway pressure pressures, improving its tolerability. Surgical techniques modifying the airway to prevent obstruction have advanced in recent years through improvements in technique and patient selection. A new and effective procedure employs an implantable nerve stimulation device to maintain airway tone. The literature supporting the safety and efficacy of upper airway diagnostics and surgery continues to grow. Advanced airway diagnostics provide a targeted anatomic evaluation which may help guide therapy. Reliable surgical techniques can address obstruction at the nasal, oropharyngeal, or hypopharyngeal airway. Upper airway stimulation and skeletal surgery target multiple levels of collapse and are particularly efficacious. Level of evidence/study design: Retrospective

Overcoming the Blood-Brain Barrier: Successes and Challenges inDeveloping Nanoparticle-Mediated Drug Delivery Systems for the Treatment of Brain Tumours.

High-grade gliomas are still characterized by a poor prognosis, despite recent advances in surgical treatment. Chemotherapy is currently practiced after surgery, but its efficacy is limited by aspecific toxicity on healthy cells, tumour cell chemoresistance, poor selectivity, and especially by the blood–brain barrier (BBB). Thus, despite the large number of potential drug candidates, the choice of effective chemotherapeutics is still limited to few compounds. Malignant gliomas are characterized by high infiltration and neovascularization, and leaky BBB (the so-called blood–brain tumour barrier); surgical resection is often incomplete, leaving residual cells that are able to migrate and proliferate. Nanocarriers can favour delivery of chemotherapeutics to brain tumours owing to different strategies, including chemical stabilization of the drug in the bloodstream; passive targeting (because of the leaky vascularization at the tumour site); inhibition of drug efflux mechanisms in endothelial and cancer cells; and active targeting by exploiting carriers and receptors overexpressed at the blood–brain tumour barrier. Within this concern, a suitable nanomedicine-based therapy for gliomas should not be limited to cytotoxic agents, but also target the most important pathogenetic mechanisms, including cell differentiation pathways and angiogenesis. Moreover, the combinatorial approach of cell therapy plus nanomedicine strategies can open new therapeutical opportunities. The major part of attempted preclinical approaches on animal models involves active targeting with protein ligands, but, despite encouraging results, a few number of nanomedicines reached clinical trials, and most of them include drug-loaded nanocarriers free of targeting ligands, also because of safety and scalability concerns.

Progress on surgical treatment of isthmic spondylolisthesis

Isthmic spondylolisthesis is a common degenerative disease of the spine and seriously affects people's quality of life. At present, surgical indications for lumbar spondylolisthesis have basically reached consensus. The surgical plan for the disease is mainly isthmus repair, decompression of spinal canal, reduction of spondylolisthesis, and spinal fusion. The principle of treatment is mainly to relieve nerve compression and restore spinal stability, but for each the specific method and degree of implementation of the link still remains controversial. Open surgery can complete decompression, reduction and fusion of severe spondylolisthesis, and rebuild the stability of the spine. However, the surgical trauma is too large. Minimally invasive surgery can reduce the damage of paravertebral soft tissue, reduce intraoperative blood loss, shorten the time of hospitalization and rehabilitation, and reduce the incidence of intraoperative and postoperative complications. Therefore, in recent years, more and more clinicians praise it, but the treatment of severe spondylolisthesis lumbar spondylolisthesis is not effective. This article reviews recent advances in surgical treatment of lumbar spondylolisthesis.

Surgical Treatment of Adult Moyamoya Disease.

Moyamoya disease (MMD) is being increasingly diagnosed with the development of radiological surveillance technology and increased accessibility to medical care. Accordingly, there have been several recent reports on treatment outcomes in MMD. In this review, we summarize recent advances in surgical treatment and outcomes of adult MMD, while addressing related controversies. Recent studies suggest that revascularization surgery leads to significantly more favorable outcomes for stroke prevention, angiographic and hemodynamic changes, and clinical outcomes than does conservative treatment for adult patients with ischemic MMD. Moreover, direct revascularization methods should be considered as the first-line treatment over indirect methods, although the latter may be considered if a direct method is not possible. In cases of hemorrhagic MMD, several studies have demonstrated that surgical treatment is more effective than conservative treatment in preventing further hemorrhage. In addition to revascularization surgery, endovascular treatment is emerging as a breakthrough therapy for hemorrhagic MMD. Accumulating evidence regarding the surgical treatment of adult MMD suggests the benefit of revascularization over conservative management for both ischemic and hemorrhagic patients. However, the benefit of revascularization in asymptomatic adult MMD remains unclear.

Recent Advances in Surgical Treatments for Growing Patients with Cleft

Cleft lip and palate is the most common teratologic condition of oromaxillofacial units, probably associated with genetic and environmental causes. The goal of cleft surgery is to optimize facial esthetics and stomatognathic function while minimizing growth disturbances from surgical intervention. In this article, the author suggests the recent surgical strategies that minimize cleft nasal deformity and midfacial skeletal constriction. From the author's surgical experiences and literature reviews, only considerate surgeries would achieve functional improvement and facial esthetics in patients with cleft lip and palate.

Recent advances in surgical treatment of hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is a common and lethal malignancy worldwide that arises within the context of a host of diseases. Surgery is the primary option for tumor treatment and is thus the most effective therapy to allow the best overall survival and recurrence-free survival for patients. One aim of this paper is to present and discuss recent advances in the surgical treatment of HCC such as associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), laparoscopic hepatectomy, and robotic liver resection, and another aim of this paper is to highlight current issues in the surgical treatment of HCC such as extended indications.

Perihilar cholangiocarcinoma: paradigms of surgical management

Cholangiocarcinoma is a lethal disease with increasing incidence worldwide. Perihilar cholangiocarcinoma represents the most common type of cholangiocarcinoma. Despite major development on surgical strategies over the past 20 years, the 5-year survival rate after surgery has remained below 40%, often in the vicinity of 20%. Most perihilar cholangiocarcinomas, however, are unresectable at the time of the diagnosis. The recent use of aggressive approaches based on better image modality, specific perioperative management, and a multidisciplinary approach have enabled to convert the use of palliative therapies to more radical surgery. This review focuses on the recent advances in surgical treatment for perihilar cholangiocarcinoma including liver transplantation with their respective impact on patient survival.

Primary gastric cancer in an oesophageal gastric graft after oesophagectomy

Recent advances in surgical treatment of oesophageal cancer have improved the prognosis of early, locally advanced oesophageal cancer. Primary cancer from oesophageal graft is rare, but has been detected in long-term survivor. We analyzed data from patients who developed primary gastric cancer in an oesophageal graft to evaluate strategies of treatment and their outcomes. We retrospectively reviewed data from patients who developed primary gastric cancer in oesophageal graft at Samsung Medical Center between September 1994 and December 2009. The clinico-pathologic features and prognoses were investigated. Long-term survival rate was determined by Kaplan-Meier analysis. Ten primary gastric graft cancers (five early gastric cancer (EGC), five advanced gastric cancer (AGC)) were diagnosed. The mean age was 69.0 (range 59.6-74.6). Initial operation was Ivor-Lewis transthoracic oesophagectomy in eight cases and three-field lymphadenectomy in two. The median period to detection of the primary gastric graft cancer after oesophagectomy was 50 (9-102) months. Seven gastric graft cancers were diagnosed by regular endoscopic examination. EGCs were treated with ESD in two cases, partial resection of stomach in one, and oesophagocolojejunostomy in three, including one patient who underwent the operation after ESD. AGCs were treated with chemotherapy in one case, supportive care in one, and oesophagocolojejunostomy in three. There was no adjuvant chemotherapy used in any case. The median follow-up period after second operation was 14 months (range 1-97). Six patients survived during this period. Three of the five AGC patients died. The estimated 5-year survival rate of our cases was 70%. In areas of high prevalence of stomach cancer, regular endoscopic examinations of oesophageal gastric grafts may help in the early detection of primary gastric graft cancer. Reoperation with a colon graft is a potential treatment option for primary gastric graft cancer.

Recent advances and limitations of surgical treatment for pancreatic cancer

Recent advances in surgical treatment for pancreatic cancer have been remarkable. Pancreatoduodenectomy is a standard surgical procedure for cancer of the pancreatic head, and is now indicated even for elderly patients over 80 years of age. Pancreatoduodenectomy with combined resection of the peripancreatic vessels has improved survival, but extended resection including lymph nodes is considered to have no extra survival benefit. Furthermore, laparoscopic resection procedures including pancreatoduodenectomy, distal pancreatectomy, enucleation and central pancreatectomy can now be performed safely. Neoadjuvant or adjuvant chemotherapy using gemcitabine may further improve the surgical outcome. An understanding of the oncological aspects of pancreatic cancer and the development of surgical techniques and chemotherapy may further contribute to improving the outcome of surgery for pancreatic cancer.

The Surgical Treatment of Hepatic Metastases in Colorectal Carcinoma

Colorectal carcinoma with hepatic metastases was long considered an incurable disease. Recent advances in surgical treatment have substantially improved the affected patients' prognosis. At first, surgery was only performed in patients whose hepatic tumor burden was small (<4 nodes, <5 cm). Currently, however, the main issue is the feasibility of curative resection of all metastases. The PubMed literature database was selectively searched for articles with the keywords "colorectal liver metastases," "chemotherapy," and "surgery." Particular attention was devoted to studies of large groups of patients, randomized trials, the German guidelines, and an analysis of the authors' own patient population. Only 10% to 20% of all patients are candidates for surgical therapy (hepatic resection), as the rest are disqualified either by extensive liver involvement or by extrahepatic neoplasia. A further 10% of patients have hepatic metastases that are primarily considered inoperable, yet later become amenable to surgery after interdisciplinary treatment involving preoperative chemotherapy, portal-vein embolization, two-stage hepatectomy, and/or locally ablative procedures. Chemotherapy is probably beneficial after hepatic resection, although the benefit has not yet been definitively demonstrated by clinical trials. Therefore, chemotherapy should only be given perioperatively in selected cases, when recommended by an interdisciplinary treatment team. A multimodal approach to the treatment of hepatic metastases of colorectal carcinoma has led to an increase in the number of resections and to an improved long-term survival rate (currently more than 40% at 5 years).

Recent advances in surgical treatment of pancreatic cancer

Recent advances in surgical treatment of pancreatic cancer

1.グリオーマの手術 : 手術は最近どのように変わってきているのか(MS 6 グリオーマ治療の基本 : 最近の進歩を中心に)

1.グリオーマの手術 : 手術は最近どのように変わってきているのか(MS 6 グリオーマ治療の基本 : 最近の進歩を中心に)

Recent advances in surgical treatment have improved the survival of patients with gastric carcinoma

BACKGROUND Mortality resulting from gastric carcinoma is decreasing. This is mainly due to vigorous endoscopic screening and the consequent higher incidence of early detection of the disease. In this study, to evaluate the effect of surgical treatment on the prognoses of patients with gastric carcinoma, the survival of 1579 patients who underwent gastrectomy between 1970 and 1994 was retrospectively analyzed. METHODS The patients were divided into 5 groups at 5-year intervals. Postoperative survival was compared among the groups. RESULTS Postoperative survival was significantly improved in the later groups for patients with Stage I, II, III, and IV disease. A multivariate analysis of prognostic factors revealed that the time period during which the gastrectomy was performed was an independent predictor of survival. CONCLUSIONS It was concluded that survival has been improved by recent advances in the surgical approach to gastric carcinoma. Cancer 1998;82:1233-7. © 1998 American Cancer Society.

Recent advances in surgical treatment have improved the survival of patients with gastric carcinoma

Mortality resulting from gastric carcinoma is decreasing. This is mainly due to vigorous endoscopic screening and the consequent higher incidence of early detection of the disease. In this study, to evaluate the effect of surgical treatment on the prognoses of patients with gastric carcinoma, the survival of 1579 patients who underwent gastrectomy between 1970 and 1994 was retrospectively analyzed. The patients were divided into 5 groups at 5-year intervals. Postoperative survival was compared among the groups. Postoperative survival was significantly improved in the later groups for patients with Stage I, II, III, and IV disease. A multivariate analysis of prognostic factors revealed that the time period during which the gastrectomy was performed was an independent predictor of survival. It was concluded that survival has been improved by recent advances in the surgical approach to gastric carcinoma.

Recent advances in surgical treatment of temporal lobe epilepsy.

Acta Neurologica ScandinavicaVolume 86, Issue S140 p. 71-80 Recent advances in surgical treatment of temporal lobe epilepsy J. Engel, J. Engel Jr. Departments of Neurology and Anatomy and the Brain Research Institute UCLA School of MedicineSearch for more papers by this author J. Engel, J. Engel Jr. Departments of Neurology and Anatomy and the Brain Research Institute UCLA School of MedicineSearch for more papers by this author First published: November 1992 https://doi.org/10.1111/j.1600-0404.1992.tb04474.xCitations: 32AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume86, IssueS140November 1992Pages 71-80 RelatedInformation

Pulmonary atresia with intact ventricular septum. New developments in diagnosis and treatment.

1. Babies with pulmonary atresia and intact ventricular septum rarely survive for more than a few weeks after birth. Prompt diagnosis and recent advances in surgical treatment now offer greatly improved possibilities for long term survival.2. Emergency angiocardiography is necessary for precise preoperative diagnosis.a. Venous or right atrial angiocardiograms are generally inadequate for accurate diagnosis.b. Selective right ventricular angiocardiography best shows the size and position of the right ventricle, the pulmonary valvular atresia and the intact ventricular septum, but poorly demonstrates the left heart and the lung vessels. Tricuspid atresia is ruled out.c. Selective left ventricular angiocardiography shows the left heart, aorta and pulmonary blood supply as well as the distal surface of the atretic pulmonary valve. The right coronary artery position permits an estimate of right ventricular size.d. A combination of both selective right and left ventricular angiocardiograms is ideal. Either exam...