Surgery In Treatment Of Patients Research Articles

Endovascular surgery in treatment of patients with acute impairment of mesenteric circulation in the stage of intestinal ischaemia

Analysed herein are the results of endovascular revascularization of the superior mesenteric artery (SMA). The study included a total of 18 patients with acute impairment of mesenteric circulation in the stage of intestinal ischaemia. The patients underwent multispiral computed tomography (MSCT) and once impairments of blood flow in the SMA were revealed, we performed endovascular revascularization of the artery. Patency of the SMA was assessed by repeat contrast-enhanced MSCT. Thirteen (72.2%) patients were found to have occlusion in the system of the SMA and five (27.8%) were diagnosed as having significant stenoses of the SMA. All 13 patients with occlusion of the SMA underwent vacuum thrombextraction followed by transluminal balloon angioplasty (TBA). Of these, thrombotic masses were obtained in 11 (84.6%) patients. Stents were implanted in 3 cases wherein TBA turned out inefficient. The patients with haemodynamically significant stenoses of the SMA were subjected to TBA followed by stent implantation. Good roentgenoendovascular results of restoration of blood flow through the SMA and its branches were obtained in 83.4% of cases. Assessing blood parameters and patients' condition severity revealed positive dynamics or a tendency towards improvement. The mortality rate amounted to 16.6%. A conclusion drawn is that this technique is efficient and appropriate for SMA lesions of any localization.

Clinical and electrophysiological results of eye muscle surgery in 17 patients with downbeat nystagmus.

Purpose:To test the hypothesis that eye muscle surgery in treatment of patients with acquired downbeat nystagmus results in improvement measures of visual and ocular motor function.Methods:This is a prospective, interventional case series analysis of clinical and electrophyisological data before and after eye muscle surgery in 17 patients with acquired downbeat nystagmus who did not respond to medical treatments. Outcome measures included: 1) routine demography and clinical characteristics, 2) subjective oscillopsia (SO), 3) binocular best-corrected visual acuity in the null position (BVA), 3) primary position strabismic deviation (SD), 5) anomalous head posture (AHP), 6) contrast sensitivity function (CS), and 7) nystagmus slow phase velocity (SPV). All patients were followed at least 12 months. Parametric and non-parametric statistical analysis of outcome measure data above pre- and post-treatment were perfomed using standard software on grouped data using computerized software.Results:Patients’ age ranged from 5 to 85 years (average 27 years). About 59% were male. Follow up ranged from 1–10 years (average 2.0 years). Around 70% had an associated central nervous systemic diagnosis, 100% had an AHP, oscillopsia and decreased CS, 53% had other eye disease, and 59% had strabismus. There were no complications from surgery. There were signficant post-treatment improvements in mean/median group BVA, SO, SD, AHP, CS, and SPV.Conclusion:This study supports the hypothesis that eye muscle surgery as treatments for patients with acquired downbeat nystagmus can result in improvements in multiple aspects of ocular motor and visual functions.

The Chance of Permanent Cure for Micro- and Macroprolactinomas, Medication or Surgery? A Systematic Review and Meta-Analysis.

Background: This meta-analysis aims to evaluate the long-term efficacy of medication treatment vs. surgery treatment in patients with prolactinomas.Methods: An electronic literature search was performed using MEDLINE, EMBASE and Web of Science databases for studies dated before July in 2018. Patients with prolactinomas received primary dopamine agonists (DAs) treatment or primary surgical interventions were included in this study. A systematic review and meta-analysis were performed in pertinent studies meeting eligible criteria. The clinical outcome was measured by the long-term remission rate of prolactin (PRL) in each cohort. The pooled data was analyzed according to a random effect model.Results: Thirteen publications with total 809 patients were included in the final meta-analysis. In the overall patients with prolactinomas, long-term remission rate was achieved in 88% patients treated with surgeries and in 52% patients treated with DAs (P = 0.001). The long-term remission rates in surgery cohort were also significantly higher than medication cohort in both microprolactinomas and macroprolactinomas (91 vs. 60%, P = 0.002; 77 vs. 43%, P = 0.003).Conclusions: Patients with prolactinomas, especially microprolactinomas, can consider transsphenoidal surgery as an alternative first-line treatment strategy. After receiving primary surgical intervention, administration of DAs should be considered based on the postoperative PRL level to achieve the best long-term remission rate.

Extended surgery in treatment of patients with pancreatic cancer

Introduction: Extended pancreatectomy (EP) is the only potential cure for patients with pancreatic cancer with local invasion of surrounding vessels and organs. Methods: In the period 2010-2017 we performed 618 resections in patients with pancreatic adenocarcinoma. Standard resections were performed in 476 (77.0%) patients. Extended pancreatectomy was performed in 142 (23.0%) patients: pancreaticoduodenectomy - in 77 (54.2%), distal resections - in 54 (38.0%), total pancreatectomy - in 11 (7.8%). EP with arterial resections was performed in 11 patients, with venous resections - in 89. Results: Postoperetive complications occurred in 182 (38.2%) patients in the standard resection group and in 58 (40.8%) in the group with extended resections, (c2 = 0.3 p = 0.57). Mortality was 2.3% (14 patients): 5 (3.5%) - after extended resections and 9 (1.9%) - after standard pancreatectomy, (c2 = 1.3, p = 0.25). Median survival and 5-year overall survival rate were reduced in patients after EP compared with those undergoing a standard resection (21 months 26.0% and 28 months 29.0%, c2 = 0.15, p = 0.69). Conclusion: Present results suggest that morbidity and mortality after EP are comparable with standard pancreatectomy. Long term results of the EP are worse, comparable with standard.

Сцинтиграфия и ОФЭКТ/КТ сторожевых лимфатических узлов в планировании оперативного вмешательства при раке молочной железы

Purpose: To increase the effectiveness and quality of surgery treatment for patients with early stages of breast cancer.
 Material and methods: Since 2016, 25 patients with breast cancer were examined and went through surgery. A lymphotropic colloidal radiopharmaceutical labeled with 99mTc was used; it was administered (150 MBq) the day before the operation. 20 patients received this injection intradermally into periareolar zone, 4 patients received it peritumourally (under control of ultrasound), 1 – paratumorally. Lymphoscintigraphy was performed 3 hours after injection, the images were acquired using dual-head gamma camera Symbia E (Siemens, Germany). A static multiplanar imaging (scintigraphy) (anterior, posterior, lateral projections) was performed for the sentinel nodes (SN) mapping. 25 planar examinations were performed. In 3 cases additional SPECT/CT study was performed using a hybrid SPECT/CT Symbia T2 (Siemens, Germany). Surgical intervention was done on the next day after scintigraphy. During the surgery the hand-held gamma probe NEO 2000 (Johnson & Johnson, USA) was used to localize radioactivity. The lymph nodes with the highest count (hot lymph nodes) were removed and sent for immediate histological examination. The results of immediate histological examination were evaluated again during next studies of gross specimen and slides.
 Results: During scintigraphy studies planar and SPECT/CT, 26 SN were detected in 20 women (80 %). In 15 patients only one SN lymph node was found, in 4 patients – 2, and in one case 3 SN were found. Intraoperative search of SN and immediate histological examination was conducted in 22 cases, 33 SN were found, while during planar scintigraphy only 26. In three cases, after histological examination (after obtaining examination results), patient surveillance was changed, these patients did not undergo through intraoperative radiometry and a decision was to conduct a one-stage mastectomy with regional lymphadenectomy. 10 out of 22 patients which underwent intraoperative radiometry and sentinel node biopsy, with immediate histological examination had metastases in the removed nodes, therefore lymphadenectomy had been performed. In the rest 12 patients after immediate histological examination of SN no evidence of tumor growth was found, thus lymphadenectomy was not performed. In case of three patients which did not undergo through intraoperative radiometry, lymphadenectomy was performed and after histological examination only two patients had tumor-involved SN, and one patient was clear. All intraoperative results were confirmed with next follow-up histological examinations. In 5 out of 25 patients (20 %) sentinel nodes were not founded. In these 5 cases during follow up period metastases were found in regional lymph nodes, and one patient had tumor emboli in lymphatic vessels, this considered being the cause of negative scintigraphy result. In 12 cases out of 25 (48 %) it was possible to minimize surgical management, and 13 (52 %) undergo lymphadenectomy.
 Conclusion: 1) The integration of SPECT/CT method of sentinel nodes search allows to plan an optimal surgical management, and can positively affect the long-term follow-up result of treatment of patients with breast cancer, and improve the quality of life. 2) The sensitivity and positive prognostic value (PPV) of planar scintigraphy and intraoperative radiometry of searching for SN are 80, 100 and 73.3, 100 %, respectively. 3) Thanks to the method of lymphoscintigraphy, 12 (48 %) of 25 women it was possible to minimize surgical management without lymphadenectomy.

Comparison of early clinical effects of ablation with surgery treatment in patients with hypertrophic cardiomyopathy

Objective: To compare the early clinical effect of septal myectomy and percutaneous transluminal septal myocardial ablation (PTMSA) on the left ventricular outflow obstruction and the rate of complication in patients with hypertrophic obstructive cardiomyopathy (HOCM). Methods: A total of 204 patients with HOCM who received septal reduction treatment were recruited. These patients were divided into two groups, surgery group (n=135) (65 patients with modified Morrow procedure, 70 patients with non-Morrow myomectomy) and PTMSA group (n=69). The baseline characteristics, disease status, other history of surgery and echocardiography parameters before and after septal reduction were collected, as well as the complication within 1 week after operation. Results: The mean age in surgery group was (46±14) years old, with 76 males (56.3%); mean age was (47±11) years old and with 51 males (73.9%) in PTMSA group. There was no significant difference in age, gender, the time of symptom and diagnosis, syncope, family history and atrial fibrillation between the two groups (all P>0.05). The proportion of mitral valve prolapse in the surgery group was higher than that in PTMSA group (75.8% vs 44.2%, P<0.05). Baseline left ventricular outflow tract (LVOT) gradient was comparable (82.7 mmHg in surgery group vs 77.7 mmHg in PTMSA group, P>0.05). The mean resting LVOT gradient after septal reduction therapy was lower (16.55 mmHg in surgery group, 26.68mmHg in PTMSA group) than that before operation, with lower gradient in surgery group (P<0.05). Compared with PTMSA group, the duration of hospitalization was longer in surgery group (P<0.05). There was similar rate of operation related complications in the two groups. Conclusions: Both septal reduction therapies can improve the LVOT obstruction, more significant in surgery group, but with longer hospital stay. The rate of operation related complication is similar in both groups.

Observation of the efficacy of neoadjuvant chemotherapy combined with conserving-breast surgery in the treatment of patients with stage II, III breast cancer

Objective To observe the efficacy and safety of neoadjuvant chemotherapy combined with conserving-breast surgery in treatment of patients with stage Ⅱ, Ⅲ breast cancer. Methods 85 patients with stage Ⅱ, Ⅲ breast cancer were selected, 42 patients in breast-conserving group and 43 patients in modified radical group.Neoadjuvant chemotherapy was used in breast-conserving, while was not used in modified radical group.Efficacy and follow-up results were observed in the two groups. Results After treatment, the CR and PR in the breast-conserving group was 30 cases and the effective rate was 71.4%, which of the modified radical group was 55.8% with 21 patients of CR and PR.After the comparative analysis, the difference was statistically significant(t=4.518, P=0.034). After followed for 12-36 months, the patients in the breast conserving group were all alive and one case of local recurrence.According to breast shape evaluation criteria, 34 patients were excellent, accounting for 80.9%; good for the five cases, accounting for 11.9%; bad of two cases, accounting for 4.8% and the excellent rate was 92.9%.According to the patients' own judgment on the breast shape, 37 cases were very satisfied, accounting for 88.1%; basic satisfaction for three cases, accounting for 7.1%; dissatisfied 2 cases, accounting for 4.8% and the satisfaction rate was 95.2%. Conclusion Patients with breast cancer of Ⅱ, Ⅲ period before breast-conserving surgery taking chemotherapy can reduce the clinical stage while the postoperative efficacy and breast appearance are good with important clinical value. Key words: Breast neoplasms; Antineoplastic combined chemotherapy protocols; Breast-conserving surgery

Cephalometric Evaluation of Facial Soft Tissue Changes after Orthodontics and Bimaxillary Orthognathic Surgery Treatment in Patients with Skeletal Class III Discrepancy

Background Severe skeletal class III malocclusions usually need a combined treatment of orthodontics and orthognathic surgery. Knowing about changes occurred following such treatments lead to improve facial esthetics and better treatment results. Objectives This study was done to determine cephalometric changes of facial soft tissue after combined treatment in patients with skeletal class III problem. Methods 25 patients with skeletal class III discrepancy who needed a combined treatment, were selected. Changes in nasolabial angle , upper lip and lower lip to E-line distance, angle of convexity , lip-chin-throat angle and lower anterior facial height were measured before and 6 - 12 months after surgery. Changes in parameters were analyzed with Paired t-test. Results Upper lip to E-line distance (P < 0.0001) and angle of convexity (P < 0.001) changed significantly following surgical procedures while changes of other parameters were not significant. Conclusions Clinical changes in the soft tissue following a combination of orthodontic treatment and orthognathic surgery in patients with skeletal class III discrepancy are significant while these changes mostly improves esthetics of patient’s facial profile.

Evaluation of the results of surgery treatment in patients with congenital chest deformity

Purpose Present study is designed to evaluate usefulness of sternochondroplasty and other surgical techniques in repairing congenital chest deformity.

Combined Surgery for Simultaneous Treatment of Congenital Ptosis and Coexisting Strabismus.

To evaluate the clinical outcomes of single-stage surgery for treatment of patients with congenital ptosis and coexisting strabismus. A retrospective analysis was performed on 10 patients (17 eyes) with congenital ptosis and coexisting strabismus. Patients were treated with levator resection or frontalis suspension for ptosis and ocular muscle surgery for strabismus, performed as a single-stage procedure. Levator resection was performed in 9 patients (15 eyes) and frontalis muscle flap suspension was performed in 1 patient (2 eyes) with blepharophimosis. Seven patients (11 eyes) simultaneously underwent exotropia correction, and inferior oblique myectomy was performed in 3 patients (3 eyes) with congenital superior oblique palsy. Satisfactory efficacy of single-stage surgery for correction of congenital ptosis and coexisting strabismus was achieved without complications. Comprehensive preoperative examination is vital to determine the appropriate diagnosis and guide surgical decision-making. Single-stage surgery for congenital ptosis and coexisting strabismus is effective and a shortened treatment period is beneficial to patients. [J Pediatr Ophthalmol Strabismus. 2017;54(5):288-294.].

The experience of using thoracoscopic surgery for treatment of patients with acute nonspecific parapneumonic pleural empyema

Objective. To evaluate the effectiveness of thoracoscopic operations and to study the clinical and epidemiological characteristic of patients with pleural empyema (PE). Materials and Methods. A retrospective analysis of 51 patients with PE treatment results has been done. All participants were examined by standard clinical and laboratory tests, X-rays and CT scans of the chest, ultrasound of pleural cavities. All patients (n = 51, 100%) were subject to thoracoscopic interventions. Results. The average age of patients was 44.4 ± 14.7 years. Men prevailed among them - 36 (71%). The first stage of PE was diagnosed in 18 (35%) patients, and the second - in 33 (65%). Almost all patients (50 patients – 98%) had been treated in other hospitals before hospitalization to a specialized department. Diagnostics of PE and patients admission to the thoracic surgery department took place on the 2 - 3 week of disease in 70% of cases. The main types of surgery on the first stage of PE were: 1) thoracoscopy with targeted drainage of pleural cavity and pleural biopsy (n = 4, 22%), 2) video-assisted thoracoscopic surgery (VATS) with destruction of fibrinous adhesions (n = 14; 78%). It has been done at the second stage of PE: 1) VATS pneumolysis (n = 22; 67%) and 2) VATS decortication of lung (n = 11; 33%). The positive results of pleural exudates bacteriological analysis have been obtained from 9 patients (18%). The median of pleural exudation duration at the first stage of PE was 5 days (4, 6), at the second stage - 6 (5, 9) days (p = 0.058). Good results were obtained in 33 patients (65%), satisfactory - in 15 (29%), unsatisfactory - in 3 (6%). The median of hospital stay duration was 18 (16; 21). There have not been lethal outcomes. Conclusions. Diagnosis of pleural empyema is a complex task and requires a broad introduction of modern techniques (CT and ultrasound). Standard microbiological testing is not effective in the diagnosis of PE pathogens, due to imperfection of anaerobic bacteria methods of detection and previous antibiotic therapy. The use of VATS in patients with PE on the first and the second stage is effective and reasonable, leads to good and satisfactory results in 95 % and 94 % of cases respectively.

Study for Clinical Efficacy of Sleep Surgery in Treatment of Patients with Moderate-Severe Obstructive Sleep Apnea

Study for Clinical Efficacy of Sleep Surgery in Treatment of Patients with Moderate-Severe Obstructive Sleep Apnea

Comprehensive approach in treatment of locally disseminated oropharyngeal cancer

The article contains information about current trends of treatment of the locally advanced oropharynx cancer. We analyzed the results of chemoradiation treatment, and surgery treatment of patients with rudimentary tumors after the chemoradiation therapy, taking into account the tumor margin, which gives capacity to perform an adequate operation with good oncological results.

Objective and Subjective Outcomes Following Maxillomandibular Advancement Surgery for Treatment of Patients With Extremely Severe Obstructive Sleep Apnea (Apnea-Hypopnea Index >100)

It is important for patients and treating clinicians to know whether maxillomandibular advancement (MMA) surgery is effective when treating patients with obstructive sleep apnea syndrome (OSAS) and an extremely high apnea-hypopnea index (AHI) score. The purpose of this study was to evaluate objective and subjective treatment outcomes after MMA surgery for the treatment of OSAS in patients with a preoperative AHI score higher than 100. This retrospective study included all patients who underwent MMA surgery for OSAS by members of the Department of Oral and Maxillofacial Surgery, QEII Health Science Centre (Halifax, Nova Scotia, Canada) from November 1996 through February 2014. Objective data were available in the form of polysomnographs (PSGs) obtained before and a minimum of 6 months after surgery. Patients completed a self-administered questionnaire before and after surgery regarding snoring, witnessed apneas, continuous positive airway pressure (CPAP) use, daytime somnolence, and overall satisfaction. Two hundred sixty-five patients had MMA surgery, of which 13 had pre- and postoperative PSGs. PSGs showed a mean preoperative AHI score of 117.9 and a mean postsurgical AHI score of 16.1 (P < .001). Pre- and postoperative questionnaires were available for 9 patients. After surgery, 7 patients denied having any daytime sleepiness and 2 patients reported minimal daytime sleepiness. The mean preoperative Epworth Sleepiness Scale score was 12.9 (standard deviation [SD], 5.5), whereas the postoperative mean score was 5.0 (SD, 4.1; P = .004). Before surgery, all 9 patients reported loud snoring and 8 reported witnessed apneas. After surgery, 2 patients reported minimal snoring and only 1 patient continued to have witnessed apneas. Six patients used CPAP preoperatively and only 1 patient continued to use CPAP after surgery. The results of this study suggest that MMA surgery for treatment of extremely severe OSA can be a highly successful 1-stage surgery, which eliminates the use of CPAP, improves subjective outcomes, and considerably decreases the AHI score.

Methods of Invasive Surgery Treatment in Patients with Lumbar Failed of Etiology Degenerative

Introduction It is necessary to expose the transcendental forms of invasive treatment for failed back surgery studied in 4 years of follow-up for the benefit of quality of life from patients with chronic spinal pain and functional limitation, and promote replication strategies in community spinal surgeons. Patients and Methods A prospective, descriptive, comparative, randomized study of 48 patients with degenerative lumbar disc disease diagnosis of failed back surgery, from any health center in the country with one or more surgical procedures performed in the anatomic area was conducted lumbar region, related to moderate-to-severe low back pain, with or without, radiculopathy tested before and after the invasive modality with the EVA scale of nociceptive pain, neuropathic pain DN4 scale and the scale of oswestry functional disability. Patients with a history of previous surgery were included in this investigation degenerative disease with intractable pain, to alleviate or relieve pain, with less previous evolution of the 6 months in cases of severe pain, and with persistence or increased symptoms before surgery. Some images evidence reflecting the failure or implant surgical techniques. All patients without previous surgery were excluded and also those with percutaneous interventional approaches of chronic spinal pain, as the only tool treatment lumbar radicular pain, failed back surgery patients with traumatic, tumoral, and infectious origin where by all the patients with established diagnosis of failed back surgery degenerative etiology. Results The analysis included an interpretation of medical records and surgical event clinical evaluation of 48 patients attending consultations and team column in the University Hospital Dr. “Manuel Nunez Tovar” in the city of Maturin, Monagas State, Venezuela. From January 2010 to June 2014, the majority of patients were males 60.42% and females 39.58%, aged 32 to 68 years. It was fulfilled in the total of 48 patients studied, 66 invasive modalities, discriminated into three groups as follows: revision surgery, 13 patients; approach percutaneous interventional analgesic and anesthetic spine chronic pain as Cosman technique, 19 patients; and mixed mode, 16 patients. Repeat percutaneous interventional total in 18 patients. Conclusion The procedures were performed by the same surgical team, using a surgical procedure according to the analysis of symptomatic interpretation of pain, upgrade of the images, affected lumbar level, and characteristic of previous surgery and experience of the team treating surgeons followed by more than 6 months with good and excellent, measurable, and clinically beneficial results.

Factors associated with the failure of arthroscopic surgery treatment in patients with femoroacetabular impingement: A cohort study

ObjectiveThe aim of this study was to evaluate the association of the anatomical and functional characteristics with therapeutic failure in patients with femoroacetabular impingement, who underwent hip arthroscopy. Materials and methodsA cohort study was performed on 179 patients with femoroacetabular impingement who underwent hip arthroscopy between 2004 and 2012. The demographic, anatomical, functional, and clinical information were recorded. A logistic regression model and ANCOVA were used in order to compare the described characteristics with the treatment outcomes of the hip arthroscopy. ResultsThe median time of follow-up for symptoms was 13 months (8–30), and the mean time of follow-up after surgery was 23.83±9.8 months. At the end of the follow-up 3.91% of the patients were considered as a therapeutic failure. The WOMAC score in pain and functional branches, as well as the total WOMAC score, showed significant differences (p<0.05). The mean WOMAC score was higher (0–100 with 0 being a perfect score) in the group of patients who failed after surgery as compared with the group who meet the requirements for a successful treatment, 65.9 vs 48.8, respectively (mean difference 17.0; 95% CI; 1.3–32.6; p=0.033). ConclusionThe poor functional state prior to arthroscopic treatment of femoroacetabular impingement, mainly due to preoperative pain, assessed using the WOMAC scale, is associated with a higher therapeutic failure rate.

Evaluation of the results of surgery treatment in patients with benign lung tumors.

Background:Lung tumors are among the common tumors and can be benign or malignant. Benign lung tumors are less common compared to the malignant types. Recognition of the clinical symptoms, types of tumors, paraclinical findings, and treatment approaches can bring better therapeutic results. The present study aims to evaluate the characteristics, diagnosis methods, and therapeutic approaches of different benign lung tumors.Materials and Methods:In this retrospective study, 32 patients with a diagnosis of benign lung tumor, who had been referred to the Mashhad University of Medical Sciences between 1981 and 2009, were studied. Some of the studied variables were symptoms, the pulmonary location involved, surgery technique, pathology findings, recurrence, and surgery complications. Data were analyzed by SPSS package version 16.Results:The average age of the patients was 51.69 ± 20.5 years. Prevalence of benign lung tumors was equal in both genders. The most common symptom was cough (31.2%); right lung involvement was more common (71.9%), and the most common sampling technique was transbronchial lung biopsy (TBLB) (62.5%); 53.1% of the patients were operated on by thoracotomy and the wedge resection technique. In 78.1% of the patients, no complications occurred after surgery. There was no recurrence. Most operations were performed in one month after the start of the symptoms (68.8%).Conclusions:Benign lung tumors are commonly diagnosed by routine radiography because most of them are asymptomatic. The most common finding in radiography is the presence of mass in the lungs. Transbronchial lung biopsy is a valuable technique to be used for diagnosis. We chose thoracotomy and wedge resection for the treatment of patients. We recommend this approach as a useful method.

Determination of homocysteine in cerebrospinal fluid as an indicator for surgery treatment in patients with hydrocefalus.

Increased homocysteine levels in serum are typical features of neurodegenerative brain diseases including hydrocephalus. The most frequent therapeutic approach consists of the insertion of a shunt, connecting the brain ventricles to an alternative drainage site. To decide whether the patient should undergo this, the lumbar drainage test is usually carried out to distinguish patients who can benefit from the shunt insertion. In searching for other potential biochemical markers for shunt indication we determined homocysteine levels in CSF during the lumbar drainage test. Homocysteine in CSF was measured during the 5-day lumbar drainage test in 27 patients with normal-pressure hydrocephalus (NPH) and in 25 patients with excluded hydrocephalus. A novelized gas chromatography method with flame ionization detection (GC-FID) was developed and evaluated. During the first two days of lumbar drainage, the levels of CSF homocysteine in NPH patients were significantly higher compared to the controls, while on the fifth day, the homocysteine levels in patients with hydrocephalus reached the level of controls. Determination of CSF homocysteine in patients with confirmed or suspected hydrocephalus may serve as an independent marker for deciding on their further treatment strategy.

The New Nitinol Conformable Self-Expandable Metal Stents for Malignant Colonic Obstruction: A Pilot Experience as Bridge to Surgery Treatment

Introduction. Self-expandable metal stents (SEMS) are a nonsurgical option for treatment of malignant colorectal obstruction also as a bridge to surgery approach. The new nitinol conformable stent has improved clinical outcomes in these kinds of patients. We report a pilot experience with nitinol conformable SEMS placement as bridge to surgery treatment in patients with colorectal obstruction. Materials and Methods. Between April and August 2012, we collected data on colonic nitinol conformable SEMS placement in a cohort of consecutive symptomatic patients, with malignant colorectal obstruction, who were treated as a bridge to surgery. Technical success, clinical success, and adverse events were recorded. Results. Ten patients (7 male (70%)), with a mean age of 69.2 ± 10.1, were evaluated. The mean length of the stenosis was 3.6 ± 0.6 cm. Five patients (50%) were treated on an emergency basis. The median time from stent placement to surgery was 16 days (interquartile range 7–21). Technical and clinical success was achieved in all patients with a significant early improvement of symptoms. No adverse events due to the SEMS placement were observed. Conclusion. This pilot study confirmed the important role of nitinol conformable SEMS as a bridge to surgery option in the treatment of symptomatic malignant colorectal obstruction.

Outcome of fertility preserving surgery in early stage ovarian cancer

AimTo assess the role of fertility preserving surgery in treatment of patients with stage IA, G1 or G2 ovarian carcinoma without adjuvant chemotherapy. Patients and methodsFrom 2006 to 2008, a prospective non-randomized study recruited 150 women, with suspicious early malignant ovarian mass. ResultsAmong the 150 explored patients, only 43 (28.6%) patients underwent exploration. Only 32/150 (21.3%) patients had proven stage IA, either G1 or G2, epithelial ovarian cancer. Among the 32 patients, 22 (68.7%) patients were nullipara while 10 (32.1%) had one child. All patients had unilateral tumors; 26 (81.25%) patients had G1 and 6 (18.75%) patients had G2 tumors; 24/32 (75.0%) tumors were serous, 6/32 (18.7%) were mucinous and 2/32 (6.2%) were endometrioid, and none was clear cell type. The median follow up period was 58.5months (ranged: 48–72months). Two patients (6.7%) were lost during follow up; data will be presented for the remaining 30 patients. One patient, at 27th month of follow up, had open abdominal exploration to investigate abnormal pelvic mass on routine ultrasound follow up examination. Frozen section revealed recurrent invasive mucinous tumor. She underwent radical surgery with pelvic and para-aortic lymph node dissection, followed by adjuvant chemotherapy, and remained free of disease, for the remaining 29months of the follow up period. Neither distant metastases nor mortality were reported among our patients. ConclusionFertility preserving surgery can be considered a safe treatment strategy in patients with stage IA, G1 or G2 ovarian carcinoma.