Endoscopic Supraglottic Laryngectomies. Results on 45 Cases

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P50-P50
Author(s):  
Marc J Remacle ◽  
Georges Lawson ◽  
Jacques Jamart
Keyword(s):  
Neck Surgery ◽  
Long Term Results ◽  
Type I ◽  
Frozen Sections ◽  
Type Iv ◽  
Supraglottic Carcinoma ◽  
Supraglottic Squamous Cell Carcinoma ◽  
Duration Of Hospitalization ◽  
European Laryngological Society

Objective The aim of this study was to evaluate long-term results of transoral CO2 laser-assisted surgery for supraglottic carcinoma. Methods From 1992 to 2004, 45 patients including 38 males and 7 females with a mean age of 62 years and showing a supraglottic squamous cell carcinoma (2 Tis, 9 T1N0, 27T2N0, 2T2N1, 1T2N2, 4 T3N0) underwent different types of endoscopic partial supraglottic laryngectomies according to the European Laryngological Society (ELS) proposal of classification (3 limited excision-type I; 29 medial without resection of the pre-epiglottic space-type II; 4 medial with resection of the pre-epiglottic space-type III; 11 lateral-type IV) in combination with neck dissection performed during the same session. Frozen sections were performed on the laryngeal margins after tumoral resection. No patient had tracheostomy perioperatively. Results Overall survival was 93 ± 4% after 3 years and 89 ± 6% after 5 years. The minimum follow-up was 3 years. Frozen sections were negative in 40 cases and presented only dysplasia in 5 cases. N0 nodes were positive in 8 cases (18%). Two postoperative bleedings were controlled by electrocautery. All of them relearned undisturbed deglutition within 5 days to 3 weeks from surgery. Two patients presented aspiration pneumonia. Mean duration of hospitalization was 12.5 days. Conclusions Endoscopic partial laryngectomies according to the ELS proposal of classification for selected supraglottic SCC prove to be an excellent alternative to radiotherapy and open neck surgery for selected supraglottic carcinoma.

scholarly journals The long-term results of benign bile duct strictures reconstruction

2003 ◽  
Vol 131 (1-2) ◽  
pp. 55-59
Author(s):  
Radoje Colovic ◽  
Dragoljub Bilanovic ◽  
Miodrag Jovanovic ◽  
Nikica Grubor
Keyword(s):  
Bile Duct ◽  
Long Term Results ◽  
Type I ◽  
Unsatisfactory Result ◽  
Type Iv ◽  
Intrahepatic Lithiasis ◽  
Endemic Nephropathy ◽  
Mean Time

Over 27 year period (1.01.1974-31.12.2001) a 168 patients (pts) were operated on for benign bile duct strictures of types I to IV according to Bismuth,s classification. Reconstruction of fresh lesions and lesions and strictures of sectoral or segmental ducts were not taken into account. The later are to be the subject of separate publication. There were 107(63,7%) women and 61(36,3%) men of average age of 46 years (ranging from 14 to 76 years). The average time from injury to our reconstruction was 8,2 years. In 162 pts (96,4%) an operative injury was the cause of the stricture, in 150 (89,3%) during cholecystectomy, in 8 (4,76%) during distal gastrectomy for duodenal ulcer and in 4 (2,38%) during surgery of the central hydatid cyst of the liver. In 112 (66,66%) pts 1 to 6 previous attempts of reconstructions had been performed elsewhere. According to the Bismuth,s classification there were 27 (16,07%) strictures of type I, 46 (27,38%) of type II, 66 (39,28%) of type III and 29 (17,26%) of type IV. The most frequent preoperative complications were intrahepatic lithiasis (34%), fibrosis or cirrhosis of the liver in 9,5%, liver abscesses in 6%, bilioduodenal fistula in 4,16% biliary peritonitis in 4,16% and incisional hernia in 8,9% of pts. Suture mucosa-to-mucosa hepaticojejunostomy with 75 cm long Roux-en-Y jejunal limb described by Blumgart was performed in 161 (95,8%), choledochoduodenostomy in 3 (1,8%) and strictureplasty in 2 (1,2%) while in 2 pts the reconstruction was not technically possible. Three pts died during the first 6 months, 2 in whom the reconstruction was not possible and 1 with chronic endemic nephropathy. Eight of the rest 165 pts were lost from follow up being from Bosnia and Croatia due to well known war events. Six out of the 157 pts died in the mean time, 2 due to variceal bleeding (they had cirrhosis and portal hypertension at the time of reconstruction) an 4 due to unrelated causes (2 due to pancreatic carcinoma, 1 due to myocardial infarction and 1 due to stroke). Out of 151 alive fully followed pts, good result (pts symptom-free as after standard cholecystectomy) was achieved in 121 (80,13%), satisfactory (mild occasional symptoms but not cholangitis) in 27 (17,88%) and unsatisfactory result in 3 pts (2%), 2 of which were successfully reoperated (1 passed into group with good and 1 into group with satisfactory results).

A New Classification for Pathologies of Spinal Meninges, Part 1: Dural Cysts, Dissections, and Ectasias

Neurosurgery ◽  
2017 ◽  
Vol 81 (1) ◽  
pp. 29-44 ◽  
Author(s):  
Jörg Klekamp
Keyword(s):  
Structural Changes ◽  
Long Term Results ◽  
Type I ◽  
Type Ii ◽  
New Classification ◽  
Type Iii ◽  
Dural Sac ◽  
Spinal Cord Herniation ◽  
Dural Defects

Abstract BACKGROUND: The clinical significance of pathologies of the spinal dura is often unclear and their management controversial. OBJECTIVE: To classify spinal dural pathologies analogous to vascular aneurysms, present their symptoms and surgical results. METHODS: Among 1519 patients with spinal space-occupying lesions, 66 patients demonstrated dural pathologies. Neuroradiological and surgical features were reviewed and clinical data analyzed. RESULTS: Saccular dural diverticula (type I, n = 28) caused by defects of both dural layers, dissections between dural layers (type II, n = 29) due to defects of the inner layer, and dural ectasias (type III, n = 9) related to structural changes of the dura were distinguished. For all types, symptoms consisted of local pain followed by signs of radiculopathy or myelopathy, while one patient with dural ectasia presented a low-pressure syndrome and 10 patients with dural dissections additional spinal cord herniation. Type I and type II pathologies required occlusion of their dural defects via extradural (type I) or intradural (type II) approaches. For type III pathologies of the dural sac no surgery was recommended. Favorable results were obtained in all 14 patients with type I and 13 of 15 patients with type II pathologies undergoing surgery. CONCLUSION: The majority of dural pathologies involving root sleeves remain asymptomatic, while those of the dural sac commonly lead to pain and neurological symptoms. Type I and type II pathologies were treated with good long-term results occluding their dural defects, while ectasias of the dural sac (type III) were managed conservatively.

Anterior Palatoplasty for the Treatment of OSA

2009 ◽  
Vol 141 (2) ◽  
pp. 253-256 ◽  
Author(s):  
Kenny P. Pang ◽  
Raymond Tan ◽  
Puravi Puraviappan ◽  
David J. Terris
Keyword(s):  
Body Mass Index ◽  
Clinical Stage ◽  
Long Term Results ◽  
Apnea Hypopnea Index ◽  
Type I ◽  
Obstructive Sleep ◽  
The Mean ◽  
Anterior Palatoplasty

OBJECTIVE: Review long-term results of the modified cautery-assisted palatoplasty (mod CAPSO)/anterior palatoplasty for the treatment of mild-moderate obstructive sleep apnea (OSA). STUDY DESIGN: Prospective series of 77 patients. All patients were >18 years old, type I Fujita, body mass index (BMI) < 33, Friedman clinical stage II, with apnea-hypopnea index (AHI) from 1.0 to 30.0. The mean follow-up time was 33.5 months. The procedure involved an anterior soft palatal advancement technique with or without removal of the tonsils. The procedure was done under general or local anesthesia. RESULTS: There were 69 men and eight women; the mean age was 39.3 years old; and mean BMI was 24.9 (range 20.7–26.8). There were 38 snorers and 39 OSA patients. The AHI improved in patients with OSA, 25.3 ± 12.6 to 11.0 ± 9.9 ( P < 0.05). The overall success rate for this OSA group was 71.8 percent (at mean 33.5 months). The mean snore scores (visual analog score) improved from 8.4 to 2.5 (for all 77 patients). Lowest oxygen saturation also improved in all OSA patients. Subjectively, all patients felt less tired. CONCLUSION: This technique has been shown to be effective in the management of patients with snoring and mild-moderate OSA.

PS01.005: HIGH-RESOLUTION MANOMETRY GUIDING SURGICAL PROCEDURE FOR TREATMENT OF ACHALASIA OF THE ESOPHAGUS. LONG-TERM RESULTS OF A PROSPECTIVE STUDY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 51-51
Author(s):  
Tania Triantafyllou ◽  
Georgia Doulami ◽  
Charalampos Theodoropoulos ◽  
Georgios Zografos ◽  
Dimitrios Theodorou
Keyword(s):  
High Resolution ◽  
Prospective Study ◽  
Conflicts Of Interest ◽  
Long Term Results ◽  
Type I ◽  
Laparoscopic Myotomy ◽  
Term Outcome ◽  
Long Term Outcome ◽  
High Resolution Manometry

Abstract Background Laparoscopic myotomy and fundoplication for the treatment of achalasia presents with 90% success rate. The intraoperative use of manometry during surgery has been previously introduced to improve the outcome. Recently, we presented our pilot study proposing the use of the HRM during surgery. The aim of this study is to evaluate the long-term outcome of the intraoperative use of High-Resolution Manometry (HRM) in achalasia patients. Methods In this prospective study, consecutive achalasia patients underwent laparoscopic myotomy and fundoplication along with real-time use of HRM. Eckardt scores (ES) and HRM results were collected before and after surgery. Results Twenty-three achalasia patients (22% Type I, 57% Type II, 22% Type III, according to Chicago Classification v3.0) with a mean age 48 years underwent calibrated and uneventful myotomy and fundoplication. Eleven myotomies were further extended, while sixteen fundoplications were intraoperatively modified, according to manometric findings. During postoperative follow-up, mean resting and residual pressures of the LES were significantly decreased after surgery (16,1 vs. 41,9, P = 0 and 9 vs. 28,7, P = 0, respectively). The ES was also diminished (1 vs. 7, P = 0). Conclusion The intraoperative use of HRM during laparoscopic myotomy and fundoplication for the treatment of achalasia of the esophagus is a safe, promising and efficient approach aiming to individualize both myotomy and fundoplication for each achalasia patient. Disclosure All authors have declared no conflicts of interest.

Double Prosthetic Repair for Complex Incisional Hernia Repair: Long-term Results and Evolution of the Technique

2015 ◽  
Vol 81 (11) ◽  
pp. 1138-1143 ◽  
Author(s):  
Alfredo Moreno-Egea
Keyword(s):  
Hospital Stay ◽  
Average Length ◽  
Incisional Hernia Repair ◽  
Postoperative Recovery ◽  
Long Term Results ◽  
Abdominal Wall Defects ◽  
Type I ◽  
Prosthetic Repair ◽  
Group 2

No single approach has emerged as the best way to close complex incisional hernias. The aim of this report is to present the long-term results with a double prosthetic repair. In this prospective observational study over 12 years (Group 1, 8 years; Group 2, 4 years), the following data were collected: age, gender, previous surgery, comorbidities, situation and size of defect, hospital stay, postoperative complications, and recurrence. There were 53 lateral cases and 31 midline cases. About 88.6 per cent of the lateral defects were repaired without needing to approach the intraabdominal cavity (Type I), whereas in the patients with large medial defects this was only achieved in 6.5 per cent of the cases (93.5% required a Type II). The average length of the defects was 18 cm. Global morbidity was 18 per cent early, and 7 per cent late. The statistical analysis over time shows significant differences in the operative time, hospital stay, and consumption of analgesics ( P < 0.001). The recurrence rate has not varied despite the modifications to the technique (use of lighter meshes and fixation with tacks and glue). Complex abdominal wall defects can be corrected using the double prosthetic repair technique with low morbidity rates and with practically no long-term recurrence. The combination of two meshes reduces their density and the use of combined fixation (tacks + glue) improves postoperative recovery.

LONG-TERM RESULTS OF LIVER TRANSPLANTATION IN FAMILIAL AMYLOIDOTIC POLYNEUROPATHY TYPE I

1997 ◽  
Vol 64 (4) ◽  
pp. 646-649 ◽  
Author(s):  
P. Parrilla ◽  
P. Ramirez ◽  
L. F. Andreu ◽  
S. F. Bueno ◽  
R. Robles ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Long Term Results ◽  
Familial Amyloidotic Polyneuropathy ◽  
Type I

scholarly journals In vitro glycoxidation alters the interactions between collagens and human polymorphonuclear leucocytes

2000 ◽  
Vol 350 (3) ◽  
pp. 777-783 ◽  
Author(s):  
Jean-Claude MONBOISSE ◽  
Laure RITTIE ◽  
Hasnae LAMFARRAJ ◽  
Roselyne GARNOTEL ◽  
Philippe GILLERY
Keyword(s):  
Diabetes Mellitus ◽  
Type I Collagen ◽  
Inhibitory Effect ◽  
Type I ◽  
Polymorphonuclear Leucocytes ◽  
Type Iv ◽  
And Migration ◽  
Significant Stimulatory Effect

Glycation and glycoxidation processes, which are increased in diabetes mellitus, are generally considered causative mechanisms of long-term complications. With reference to our previous studies, type-I and -IV collagens could induce differentially the adhesion and stimulation of polymorphonuclear leucocytes (PMNs). As PMNs play a role in sustained diabetic oxidative stress, the present study was designed to determine whether in vitro glycoxidation of these macromolecules could alter PMN adhesion, activation and migration. The adhesion of PMNs to in vitro-glycoxidized collagens was significantly increased when compared with control collagens: +37% (P < 0.05) and +99% (P < 0.01) for collagens I and IV, respectively. Glycoxidized type-I collagen increased the chemotactic properties of PMNs without significant stimulatory effect on respiratory burst, whereas pre-incubation of PMNs with glycoxidized type-I collagen induced a priming on subsequent stimulation by N-formyl-methionyl-leucyl-phenylalanine. Glycoxidation of type-IV collagen suppressed its inhibitory effect on further PMN stimulation or migration. Collectively, these results indicate that glycoxidation of two major extracellular-matrix collagens considerably alters their ability to modulate PMN migration and production of reactive oxygen species. This imbalance in PMN metabolism may be a major event in the increased oxidative status that characterizes diabetes mellitus.

Combined Heermann and Tos (CHAT) technique in cholesteatoma surgery: surgical technique and preliminary results

2005 ◽  
Vol 119 (6) ◽  
pp. 429-435 ◽  
Author(s):  
Cem Uzun ◽  
Recep Yagiz ◽  
Abdullah Tas ◽  
Mustafa K Adali ◽  
Muhsin Koten ◽  
...  
Keyword(s):  
Middle Ear ◽  
Long Term Results ◽  
Type I ◽  
Canal Wall ◽  
Auricular Cartilage ◽  
Cortical Mastoidectomy ◽  
Thin Bridge ◽  
Stage 1

The combined Heermann and Tos (CHAT) technique is the combination of Heermann’s ’cartilage palisade tympanoplasty’ and Tos’s ’modified combined approach tympanoplasty = modified intact canal wall mastoidectomy’. The first author (Cem Uzun) performed the CHAT technique as a one-stage operation in 15 ears of 15 patients with cholesteatoma. Two patients (one with a follow up of less than six months and one who did not show up at the final re-evaluation) were excluded from the study. Median age in the remaining 13 patients was 37 years (range: 14–57 years). Cholesteatoma type was attic, sinus (Tos tensa type 1) and tensa retraction (Tos tensa type 2) in six, five and two ears, respectively. Cholesteatoma stage was Saleh and Mills stage 1, 2, 3, 4 and 5 in one, three, four, four and one ear, respectively. The eustachian tube was not involved with cholesteatoma in any ear. After drilling of the superoposterior bony annulus, transcanal atticotomy with preservation of thin bridge and cortical mastoidectomy with intact canal wall, the cholesteatoma was removed, and the eardrum and atticotomy were reconstructed with palisades of auricular cartilage. Type I tympanoplasty was performed in two ears, type II in nine ears and type III (stapes absent) in two ears, with either autologous incus (eight cases), cortical bone (two) or auricular cartilage (one). No complication occurred before, during or after surgery. Oto-microscopy and audiometry were done before and at a median of 13 months after surgery (mean 14 months, range 7–30 months). There was no sign of residual or recurrent cholesteatoma in any patient during the follow-up period. At the final examination, all ears were dry and had an intact eardrum except one with a small, central hole, which had been seen since the early post-operative period. Clean and stable attic retraction with a wide access was observed in two ears. Post-operative hearing at the final evaluation was better (change > 10 dB) than the pre-operative one in nine ears and did not change in the remaining four. Pre- and post-operative mean hearing values were, pure-tone average 47 and 35 dB (p = 0.01) and air-bone gap 30 and 20 dB (p = 0.02), respectively. With the CHAT technique, cholesteatoma can be completely and safely removed from the middle ear, and a durable and resistant reconstruction of the middle ear with reasonable hearing can be achieved. However, a further study should analyse long-term results of a larger patient group.

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