ABSTRACT
BACKGROUND: To compare the outcomes of video-assisted thoracoscopic surgery (VATS) in comparison to open thoracic surgery in pediatric patients suffering from empyema. METHODS: A prospective study was carried out in 80 patients referred to the Department of Pediatric Surgery between 2015 and 2018. The patients were randomly divided into thoracotomy and VATS groups (groups I and II, respectively). Forty patients were in the thoracotomy group (16 males [40%], 24 females [60%]; average age, 5.77±4.08 years) and 40 patients were in the VATS group (18 males [45%], 22 females [55%]; average age, 6.27±3.67 years). There were no significant differences in age (p=0.61) or sex (p=0.26). Routine preliminary workups for all patients were ordered, and the patients were followed up for 90 days at regular intervals. RESULTS: The average length of hospital stay (16.28±7.83 days vs. 15.83±9.44 days, p=0.04) and the duration of treatment needed for pain relief (10 days vs. 5 days, p=0.004) were longer in the thoracotomy group than in the VATS group. Thoracotomy patients had surgical wound infections in 27.3% of cases, whereas no cases of infection were reported in the VATS group (p=0.04). CONCLUSION: Our results indicate that VATS was not only less invasive than thoracotomy, but also showed promising results, such as an earlier discharge from the hospital and fewer postoperative complications.
Subject(s)
Female , Humans , Male , Empyema , Length of Stay , Postoperative Complications , Prospective Studies , Surgical Wound Infection , Thoracic Surgery , Thoracic Surgery, Video-Assisted , Thoracoscopy , ThoracotomyABSTRACT
BACKGROUND@#To compare the outcomes of video-assisted thoracoscopic surgery (VATS) in comparison to open thoracic surgery in pediatric patients suffering from empyema.@*METHODS@#A prospective study was carried out in 80 patients referred to the Department of Pediatric Surgery between 2015 and 2018. The patients were randomly divided into thoracotomy and VATS groups (groups I and II, respectively). Forty patients were in the thoracotomy group (16 males [40%], 24 females [60%]; average age, 5.77±4.08 years) and 40 patients were in the VATS group (18 males [45%], 22 females [55%]; average age, 6.27±3.67 years). There were no significant differences in age (p=0.61) or sex (p=0.26). Routine preliminary workups for all patients were ordered, and the patients were followed up for 90 days at regular intervals.@*RESULTS@#The average length of hospital stay (16.28±7.83 days vs. 15.83±9.44 days, p=0.04) and the duration of treatment needed for pain relief (10 days vs. 5 days, p=0.004) were longer in the thoracotomy group than in the VATS group. Thoracotomy patients had surgical wound infections in 27.3% of cases, whereas no cases of infection were reported in the VATS group (p=0.04).@*CONCLUSION@#Our results indicate that VATS was not only less invasive than thoracotomy, but also showed promising results, such as an earlier discharge from the hospital and fewer postoperative complications.
ABSTRACT
The deadly Schwannomas, as uncommon subtype of soft tissue tumors originate from peripheral nerve sheaths. Retro peritoneum is an uncommon site for these tumors. Here we present the clinical feature and therapeutic implication of a 38-year-old man affected by recurrent retroperitoneal schwannoma who admitted to emergency ward following abdominal pain. Computed Tomorgraphic Scan showed a solid well-differentiated heterogeneous mass, 8.56 cm size in portahepatis beneath liver and right periumbilical. On laboratory tests Cancer Antigen 19-9 and Cancer Embryonic Antigen were in normal range. In surgery, a 78 cm round mass was discovered at juxta renal juxta duodenal retro peritoneum, It was completely adhered to second part of duodenum with no signs of infiltration of the liver and right kidney, unable to simply being enucleated, curative resection was performed by classical whipple procedure. The patient's hospitalization course was uneventful and on the second week he was discharged from the hospital with complete recovery. Due to the high recurrent rate of retroperitoneal Schwannomas even in benign circumstances, radical resection would be the treatment of choice
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In this study we describe the presentation, treatment, and complications of 27 FAP patients. Treatment of Familial adenomatous polyposis [FAP] is centered on early recognition and curative surgery with either restorative proctocolectomy with ileal-pouch-anal-anastomosis [IPAA] or colectomy with ileo-rectal anastomosis [IRA]. All patients diagnosed with FAP at our center from 2008 to 2012 were included in this case series. Either IPAA or IRA was used for treatment. Complications were recorded for 12 months after the procedure. Overall 27 patients were included, 12 [44.44%] index patients, and 15 [55.55%] relatives diagnosed by screening. Eight Index patients presented with rectal bleeding, two with occult fecal blood and two with abdominal masses found to be desmoid tumors. Nineteen patients were treated by IPAA, 6 with IRA, and 2 were inoperable due to diffuse desmoid tumors. Daytime stool frequency was the most common side effect [70.37%], followed by bowel discomfort episodes [55.56%], requiring dietary restrictions [37.4%], passive incontinence [25.93%], soiling [22.22%], nighttime stool frequency [18.52%], flatus incontinence [16.0%], and anastomosis leakage [3.70%]. On average patients treated by IPAA experienced less complication than those treated by IRA. compared with previous reports, this series had older age of diagnosis, higher rate of adenocarcinoma at diagnosis, and fewer side effects after IPAA than IRA. The latter may reflect technique improvement with experience, and if supported by future studies, will cement IPAA as the treatment of choice in FAP
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Aim: The present study was designed to assess the impact of neo-adjuvant chemoradiotherapy on the possibility of utilizing sphincter preserving techniques in rectal cancer surgery
Background: For both patients and surgeons anal sphincter preserving surgery serves as the ideal procedure to treat rectal cancer
Patients and Methods: Patients with rectal cancer who were admitted to Shohadaye Tajrish hospital between 2001 and 2011 and underwent sphincter preserving or non-preserving surgery were identified. They were divided into those who had received neo-adjuvant chemo-radiotherapy prior to surgery and those who didn't, and the type of surgical procedure they underwent was compared between the two arms. Data regarding tumor pathology, tumor size and distance from anal verge before and after neo-adjuvant therapy, together with the duration of chemo-radiotherapy were also assessed
Results: 103 patients with documented rectal cancer were included in our analysis. Among 47 patients who had not received neo-adjuvant therapy, 26 [55%] underwent APR while 15[32%] and 6[13%] patients were treated with LAR and VLAR respectively. Of the 56 patients who had gone through chemo-radiotherapy prior to surgery, 30 [53%] underwent APR while 14 [25%] and 10 [18%] patients were treated with LAR and VLAR respectively. 2 patients had unresectable tumor. Tumor staging before and after neo-adjuvant therapy showed a statistically significant difference [p=0.0001]
Conclusion: Neo-adjuvant chemo-radiotherpy can decrease tumor size, increase the distance between the tumor and anal verge, and downgrade the staging. However, it does not necessarily increase the possibility of performing sphincter preserving surgery on patients suffering from low-lying tumors
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Jejunal diverticula have a prevalence of approximately 1% in the general population. Perforation of jejunal diverticulum is a rare. Clinically this diagnosis may be easily confused with other causes of an acute abdomen. In the article, we discuss a 74-year-old man with a 2-day history of constipation and left-sided abdominal pain. The day before admission he developed an abrupt exacerbation his symptoms with pain localized to periumbilical and left lower quadrant. An abdominal computed tomography scan revealed soft tissue stranding within the left upper quadrant, bilateral plural effusions, larger on the left, an opacity with the right and left pulmonary lobes and polypoid lesion with in stomach. Physical examination revealed left upper quadrant fullness. An emergency laparotomy was carried out. This revealed multiple jejunal diverticula, one of which had perforated 40 centimeters distal to the ligament of Treitz
Subject(s)
Humans , Male , Jejunal Diseases , Abdominal Pain , Intestinal Perforation , Acute Disease , Constipation , Tomography, X-Ray Computed , LaparotomyABSTRACT
Endovenous Laser Therapy [EVLT] for Greater Saphenous vein [GSV] insufficiency is a newly established method of treatment only recently made available in Iran. The present study seeks to describe the results of the first 20 patients treated with EVLT at Shohada-e Tajrish Medical Center, Tehran, Iran. 20 patients [16 male, 4 female] with the mean age of 38.9 and an average length of symptoms of 5.9 years, were treated with a 980-nm laser diode under local anesthesia. CEAP classification [Clinical Severity, Etiology, Anatomy, Pathophysiology] and AVSS scores [Aberdeen Varicose Vein Symptom Severity Score] were used to determine disease severity and symptoms before and after the procedure. Outcome was measured by the rate of recurrence as shown in Doppler ultrasonography evaluation. The mean procedure time was 49 minutes, and the mean admission time was 1.1 days. A success rate of 85% percent was recorded at 6-12 months of follow up. The patients showed a significant reduction in AVSS and CEAP scores [PV=0.0001], Pain [PV=0.00001], Parasthesia and Edema [PV=0.001]. EVLT seems promising as a novel method of treatment for GSV insufficiency in the Iranian population with many advantages, including higher success rates in comparison with conventional methods of treatment