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1.
Medicine (Baltimore) ; 98(31): e16669, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374043

RESUMO

RATIONALE: With the development of endoscopic technique and the improvement of available accessories, endoscopic therapy became to play an important role in the management of gastrointestinal submucosal tumors (SMTs). PATIENTS CONCERNS: A gastric SMT which was suspected to be gastrointestinal stroma tumor (GIST) was diagnosed in a liver transplant recipient who received transplanted operation 11 months ago. DIAGNOSIS: gastric SMT, post-liver transplantation INTERVENTIONS:: Endoscopic full-thickness resection (EFR) was preformed to remove the tumor. The operation time was 50 minutes and oral immunosuppressant drug was not interrupted in the postoperative period. OUTCOMES: The clinical course was uneventful and slightly elevated liver enzyme was observed on the fourth day after operation. The pathological diagnosis was GIST with complete capsule. LESSONS: Our successful experience showed that EFR is a feasible, safe and efficacious treatment for small (<2 cm) gastric GIST in liver transplant recipients, providing the advantages of little damage, short operative time, stable graft function, without compromising postoperative outcomes.


Assuntos
Gastrectomia/métodos , Tumores do Estroma Gastrointestinal/cirurgia , Neoplasias Gástricas/cirurgia , Transplantados , Adulto , Idoso , Endoscopia/métodos , Tumores do Estroma Gastrointestinal/tratamento farmacológico , Tumores do Estroma Gastrointestinal/patologia , Humanos , Imunossupressores/uso terapêutico , Transplante de Fígado , Masculino , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/patologia , Resultado do Tratamento
2.
Medicine (Baltimore) ; 98(31): e16521, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374013

RESUMO

RATIONALE: Massive intestinal bleeding as a complication of typhoid fever has rarely been reported due to the advent of antibiotics. In addition, although several literatures have been issued on the use and success of endoscopic modalities in cases of massive typhoid ulcer bleeding, few have described hemostasis by endoscopic hemoclipping. PATIENT CONCERNS: We describe a case of a 61-year-old Korean female who presented acute episodes of massive lower gastrointestinal bleeding during admission to local hospital with a provisional diagnosis of acute gastroenteritis. She had returned from a trip to Southeast Asia 3 weeks prior to admission DIAGNOSES:: After the result of blood culture was identified as Salmonella typhi, we could make a diagnosis of typhoid fever complicated by massive intestinal bleeding and acute pancreatitis based on elevated serum lipase and computerized tomography (CT) findings. INTERVENTIONS: The patient was treated successfully by two repeat colonoscopic hemostasis procedures involving the deployment of hemoclips on ulcers in the terminal ileum and 10-day course of intravenous ciprofloxacin OUTCOMES:: The patient was stable and reported no further episodes of intestinal bleeding or fever during the follow-up time. In addition, acute pancreatitis, which is a rare complication of typhoid fever, resolved without complication on follow-up CT and a laboratory study. LESSONS: Considering the risk of procedure-related complications such as perforation of the small intestine wall, which become thin and friable due to ulceration, mechanical hemostasis methods, such as hemoclipping, might be safer than coagulation, when the bleeding spot can be identified and is not multiple, as in our case. In addition, our case demonstrates that S. typhi should be considered in the differential diagnosis of massive lower gastrointestinal hemorrhage, especially in the setting of recent travel in South or Southeast Asia.


Assuntos
Hemorragia Gastrointestinal/etiologia , Pancreatite/etiologia , Febre Tifoide/complicações , Febre Tifoide/cirurgia , Tratamento Conservador , Endoscopia/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Salmonella typhi/patogenicidade
3.
Anticancer Res ; 39(8): 4243-4248, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31366512

RESUMO

BACKGROUND/AIM: This study aimed to clarify the benefits and disadvantages of percutaneous endoscopic gastrostomy (PEG) for patients with esophageal cancer (EC) during preoperative therapy. MATERIALS AND METHODS: We retrospectively reviewed 92 patients who underwent esophagectomy for EC after preoperative therapy. Patients were divided into the PEG group (n=14) and the control group (n=78) and compared regarding patient characteristics, nutritional status, operative variables, and postoperative complications. RESULTS: In the PEG group first nutritional status and tumor stage were significantly worse, but changes of nutritional status from first visit to operation were significantly better. According to the intraoperative thermal imaging, there was no patient with blood flow disturbance in the gastric conduit due to PEG. Short-term surgical outcomes did not significantly differ. CONCLUSION: PEG has less adverse effects on gastric tube production in esophagectomy and may be considered in highly selective patients during preoperative therapy.


Assuntos
Endoscopia/métodos , Neoplasias Esofágicas/cirurgia , Gastrostomia/métodos , Estômago/cirurgia , Adulto , Idoso , Neoplasias Esofágicas/patologia , Esofagectomia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Complicações Pós-Operatórias/patologia , Período Pré-Operatório , Estudos Retrospectivos , Estômago/patologia , Resultado do Tratamento
4.
Medicine (Baltimore) ; 98(27): e16251, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277143

RESUMO

RATIONALE: The traditional maxillary sinus floor elevation has serious postoperative complications and long healing periods, for patients with insufficient residual bone height (RBH). The endoscopic technique improves the blind nature of the sinus floor elevation procedure. Platelet-rich fibrin (PRF) can promote tissue healing and prevent perforation. PATIENT CONCERN: A 25-year-old female with residual roots in the maxillary right second molar visited our hospital for dental implants. DIAGNOSE: CBCT results showed a low-density shadow at the root tip, and the height of the periapical distance from the maxillary sinus floor was less than 1 mm. INTERVENTION: Patient was immediately subjected to implant after root extraction. Two-step sinus floor elevation was performed under endoscopy. A 12 mm-long implant was installed. OUTCOMES: At 10 months after surgery, the hard and soft tissues were stable, and a full-ceramic crown was placed. LESSONS: Immediate implant and endoscope-guided sinus floor elevation through a transcrestal approach by using PRF as the only grafting material is viable in periapical infected sites with a RBH of less than 1 mm.


Assuntos
Implantação Dentária Endo-Óssea/métodos , Endoscopia/métodos , Seio Maxilar/cirurgia , Fibrina Rica em Plaquetas , Levantamento do Assoalho do Seio Maxilar/métodos , Adulto , Humanos , Masculino , Seio Maxilar/diagnóstico por imagem , Osteotomia/métodos , Tomografia Computadorizada por Raios X
5.
J Laryngol Otol ; 133(6): 501-507, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31271349

RESUMO

OBJECTIVE: Prompted by a recurring skull base multidisciplinary team debate on the necessity of securing a definitive tissue diagnosis before initiating treatment for lesions of the orbital apex, a review of anterior skull base procedures over an 11-year period was undertaken. METHODS: Data collected prospectively on cases from 2006 to 2017 were analysed. Presenting symptoms, imaging and histology findings, outcomes, complications, and impact on treatment were evaluated. All surgery was carried out endoscopically with the aid of image guidance. RESULTS: Twenty-one patients undergoing endoscopic orbital apex and/or optic canal biopsy were included. The mean patient age was 49 years. Five malignant tumours were identified, five benign tumours, seven infective cases (two tuberculosis and five fungal) and two cases of immunoglobulin G4 related disease. Two patients had non-diagnostic biopsies (one lesional) and were treated successfully as Tolosa-Hunt syndrome cases. CONCLUSION: A successful diagnosis was achieved in nearly all cases without adverse impact, other than one cerebrospinal fluid leakage case. Management was directly influenced by the outcome in all cases.


Assuntos
Biópsia Guiada por Imagem/métodos , Imagem Tridimensional , Órbita/cirurgia , Neoplasias da Base do Crânio/diagnóstico por imagem , Neoplasias da Base do Crânio/cirurgia , Adulto , Fatores Etários , Idoso , Endoscopia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cavidade Nasal/diagnóstico por imagem , Cavidade Nasal/patologia , Cavidade Nasal/cirurgia , Órbita/diagnóstico por imagem , Órbita/patologia , Medição da Dor , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Neoplasias da Base do Crânio/patologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
6.
Isr Med Assoc J ; 21(6): 376-380, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31280504

RESUMO

BACKGROUND: Hypertrophy of the adenoids is common in children. However, the anatomical site makes the adenoids difficult to assess, and studies evaluating the subject are ambiguous, especially with regard to the use of X-ray as an evaluation tool. OBJECTIVES: To compare medical history with clinical, radiological, and endoscopic evaluations of the adenoids and compare obstructed and non-obstructed children relative to the assessment methods. METHODS: A prospective comparative study was conducted with children who were suspected of having enlarged adenoids. All parents completed a medical history questionnaire and patients underwent clinical evaluation based on Nasal Obstruction Index (NOI) scores, radiological assessment based on the lateral neck X-ray adenoid-nasopharynx (A/N( ratio, and endoscopic evaluation based on anatomical relations. Spearman correlations were used for comparison between methods. RESULTS: We evaluated 36 patients, median age 5.33 years. Correlation measurements for clinical assessment and questionnaire (r = 0.582, P < 0.0001), questionnaire and endoscopy (r = 0.462, P = 0.005), and clinical assessment and nasal endoscopy (r = 0.621, P < 0.0001) were statistically significant. None of the parameters correlated with the radiological findings. A statistically significant difference was found between the obstructed and non-obstructed groups in both questionnaire (P = 0.004) and clinical assessment (P < 0.0001). However, no difference was found in X-ray measurements. CONCLUSIONS: Lateral neck X-ray measurements were not correlated to symptoms, signs, or endoscopic findings. Therefore, medical professionals should use lateral neck radiography when considering adenoidectomy only on a highly selective basis.


Assuntos
Tonsila Faríngea/diagnóstico por imagem , Tonsila Faríngea/patologia , Endoscopia/métodos , Obstrução Nasal/diagnóstico , Obstrução Nasal/patologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Hipertrofia , Masculino , Anamnese/métodos , Obstrução Nasal/diagnóstico por imagem , Estudos Prospectivos , Radiografia
7.
Curr Opin Ophthalmol ; 30(5): 364-371, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31219833

RESUMO

PURPOSE OF REVIEW: After failed conservative management, most clinicians treat congenital nasolacrimal duct obstruction (CNLDO) in a conventional stepwise fashion: starting with probing, then repeat probing, next silicone intubation and/or balloon dilatation, and finally dacryocystorhinostomy. This approach is based on the patient's age and previously failed procedures and recruits 'one procedure for all' CNLDO. A newly introduced approach is based on the type of obstruction and recruits 'all procedures for one' CNLDO. The aim of this review is to examine the best available evidence regarding CNLDO management. RECENT FINDINGS: Recent articles support the concept that through intraoperative evaluation of obstruction in CNLDO, clinicians may predict probing failure and instantaneously employ more appropriate treatment modalities. This review addresses whether an age-based approach should be changed into a one-stage obstruction-based approach. SUMMARY: An age-based approach treats CNLDO as a homogeneous disease and thus treats all patients with one predetermined procedure. A one-stage obstruction-based approach, however, considers CNLDO to be a heterogeneous disease, and therefore allows recruitment of all procedures simultaneously and selects the best intraoperatively. It may allow replacement of the conventional stepwise approach to CNLDO treatment provided that randomized trials verify its efficacy, safety, and cost-effectiveness.Video abstract http://links.lww.com/COOP/A30.


Assuntos
Dacriocistorinostomia/métodos , Endoscopia/métodos , Intubação/métodos , Obstrução dos Ductos Lacrimais/terapia , Ducto Nasolacrimal/cirurgia , Pré-Escolar , Feminino , Humanos , Lactente , Obstrução dos Ductos Lacrimais/congênito , Ducto Nasolacrimal/anormalidades , Resultado do Tratamento
8.
Indian J Ophthalmol ; 67(7): 1137-1142, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31238429

RESUMO

Purpose: To study the clinical presentation, nasal endoscopic features, and outcomes of nasal endoscopy guided (NEG) bicanalicular intubation (BCI) in children with complex persistent congenital nasolacrimal duct obstruction (pCNLDO). Methods: A prospective, interventional study including eligible children (age ≤ 12 years) having complex pCNLDO. The demographics, number of previous probings, nasal endoscopy findings, and outcomes; were noted in all children who underwent NEG-BCI with Crawford's stents. Matting of eyelashes (MoE, upper, and lower eyelid), tear-film height (TFH), and fluorescein dye disappearance test (FDDT) was assessed pre and postoperatively. The minimum stent in-situ period was 12 weeks, and the minimum follow-up was 6 months (after stent removal). Results: Total 32 children (36 eyes) including 18 females (56.25%) were studied. At a mean age of 4.9 years, all children had epiphora and discharge with MoE (both upper and lower), raised TFH and positive FDDT. Previously, all children underwent conventional probing (s)- once in 12 (33.3%), twice in 18 (50%) and thrice in 6 (16.7%) eyes. The general ophthalmologists performed the majority (n = 21, 58.33%) of those. The BCI was performed under GA in all eyes, and at a mean follow-up of 8.5 months, the "complete" success was noted in 29 eyes (80.5%), 'partial' success in 4 (11.1%) and failure in 3 (8.3%). The stent prolapse was seen in three. Conclusion: NEG-BCI may provide a satisfactory resolution to complex pCNLDO after single or multiple failed probings. NEG provides confident and efficient management of coexistent intranasal complexities related to the inferior turbinate and meatus.


Assuntos
Endoscopia/métodos , Intubação/métodos , Obstrução dos Ductos Lacrimais/terapia , Ducto Nasolacrimal/cirurgia , Stents , Pré-Escolar , Feminino , Seguimentos , Humanos , Obstrução dos Ductos Lacrimais/congênito , Obstrução dos Ductos Lacrimais/diagnóstico , Masculino , Ducto Nasolacrimal/diagnóstico por imagem , Nariz , Estudos Prospectivos
9.
Pan Afr Med J ; 32: 110, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31223400

RESUMO

This study aims to discuss the role of open surgery in the treatment of renal lithiasis, including coralliform stones, with the advent of new less invasive techniques. We report a series of 53 cases of coralliform stones whose data were collected in our Hospital during a period of 7 years, from January 2011 to January 2018. The patients underwent open nephrolithotomy by lombotomy. The mean post-operative length of stay was 10 days. The immediate and early postoperative outcomes were simple in 36 patients, 6 patients underwent blood transfusion, 2 had severe sepsis in the postoperative period, 5 had infection of the wall and 4 had urinary fistula, secondarily managed by endoscopic drainage. Residual stones were found in 9 cases (16.9%). Stones were essentially treated by extracorporeal lithotripsy. Late outcomes were characterized by renal atrophy in 2 patients, lithiasic recurrence in 9 patients, an improvement in creatinine clearance in 9 patients and a slight worsening in 5 patients. Open surgery presents the risk of multiple complications and it is not recommended for first-line treatment of renal lithiasis. However it is important to determine which patients would benefit from open nephrolithotomy.


Assuntos
Cálculos Renais/cirurgia , Litotripsia/métodos , Nefrolitotomia Percutânea/métodos , Complicações Pós-Operatórias/epidemiologia , Transfusão de Sangue/estatística & dados numéricos , Drenagem/métodos , Endoscopia/métodos , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Sepse/epidemiologia , Resultado do Tratamento , Fístula Urinária/epidemiologia
10.
Int. j. morphol ; 37(2): 452-458, June 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1002242

RESUMO

The aim of this report was to endoscopically evaluate bone quality in vivo in the immediate installation of temporary small-diameter implants, and again after 6 months of function, through an attachments system for overdenture, in the atrophic mandible of a patient. We also histologically evaluated bone-implant interaction in these temporary small-diameter implants, once the success of the osseointegration of the submerged implants was guaranteed. A patient received a total of 6 implants in the atrophic mandible, two of which were immediately loaded with a provisional prosthesis, and four were left to heal in a submerged way. Further, an immersion endoscopic evaluation was performed during bone drilling, and this showed a compact bone structure with limited vascularization and predominantly cortical structure.This immediate loading protocol involving an overdenture retained by two small-diameter implants of 2.9 mm in the atrophic mandible proved to be successful after 6 months of loading. Clinical and histologic osseointegration was consistently achieved for both of the retrieved immediately loaded implants. This modality allows the patient to be restored with a stable, functional, and aesthetic prosthesis during the osseointegration period of submerged implants and soft-tissue healing, before the removal of the provisional implants. The histological evaluation of bone-implant contact found that the space between the implant threads closer to the surface was filled with woven bone and lamellar bone, but the tissue in contact with the cervical portion of the implants was compatible with cortical bone organization. Also, the newly formed bone has a regular cell distribution and characteristics of advanced maturation after 6 months of function in the atrophic mandible. Anchored overdentures in 2 to 4 small-diameter implants (2.9 mm) for edentulous patients with severe atrophy of the mandible with cortical bone would be a minimally invasive alternative.


Assuntos
Humanos , Pessoa de Meia-Idade , Implantes Dentários , Arcada Edêntula/reabilitação , Revestimento de Dentadura , Endoscopia/métodos , Osseointegração , Arcada Edêntula/patologia
11.
BMC Surg ; 19(1): 59, 2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31174520

RESUMO

BACKGROUND: Bezoars are rare but may cause gastrointestinal obstruction and ulcers. To the best of our knowledge, only two cases of bezoars in the reconstructed gastric conduit have been reported, but there has been no report on reconstructed gastric conduit obstruction due to bezoars. CASE PRESENTATION: A 60-year-old man presented to our clinic with abdominal pain and vomiting that occurred suddenly after dinner. Three years before presentation, he had undergone radical thoracoscopic esophagectomy followed by reconstruction of the gastric conduit through the posterior sternum, for esophageal cancer. Enhanced computed tomography scans showed distension of only the gastric conduit without ischemia and distension of the small intestine. According to our findings, we initially diagnosed the patient with postoperative intestinal obstruction caused by adhesions. After conservative treatment failed, the patient underwent an endoscopic study that showed a bezoar at the pylorus ring. We initially failed to remove the bezoar endoscopically because of its large size; hence, we attempted enzymatic dissolution. Three days after the first endoscopic study, the bezoar was disintegrated using a snare and extracted during a second endoscopy. The patient recovered uneventfully and presented with no complications during the 1-year follow-up interval. CONCLUSION: In cases wherein the discharge of materials in the reconstructed gastric conduit is delayed, bezoars should be considered in the differential diagnosis, and an endoscopic study should be performed to verify the cause of obstruction.


Assuntos
Bezoares/diagnóstico , Endoscopia/métodos , Esofagectomia/métodos , Obstrução Intestinal/diagnóstico , Dor Abdominal/etiologia , Bezoares/cirurgia , Diagnóstico Diferencial , Humanos , Intestino Delgado/patologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Estômago/cirurgia , Vômito/etiologia
12.
Sultan Qaboos Univ Med J ; 19(1): e68-e72, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31198599

RESUMO

Transoral endoscopic thyroidectomy was first described as an experimental sublingual approach. This approach was modified to a vestibular approach to avoid complications. In this report, we describe the results of the first ten cases of a transoral endoscopic thyroidectomy via vestibular approach (TOETVA) performed in Iraq. All operations were performed at Al Shifa General Hospital, Basrah, Iraq, in 2017 using three laparoscopic ports inserted at the oral vestibule. One out of ten patients underwent a near total thyroidectomy, the remaining cases underwent thyroid lobectomies. The average operative time was 113.5 minutes and the average duration of hospital stay was 41.9 hours. One case of mild cervical emphysema and one case of temporary mental nerve palsy were reported but both were treated conservatively without permanent sequelae. In conclusion, TOETVA is a safe, feasible procedure with an excellent cosmetic outcome when the patients are selected carefully.


Assuntos
Endoscopia/métodos , Tireoidectomia/métodos , Adulto , Índice de Massa Corporal , Endoscopia/normas , Feminino , Humanos , Iraque , Masculino , Tireoidectomia/normas , Resultado do Tratamento
13.
Korean J Parasitol ; 57(2): 175-177, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31104410

RESUMO

A 46-year old man visited our outpatient clinic with complaint of foreign body sensation in throat after consuming raw freshwater fish 5 days ago. Laryngoscopic examination revealed a motile worm attached on posterior pharyngeal wall. The worm was removed using biopsy forceps under transnasal endoscopy and evidently identified as Clinostomum complanatum after microscopic examination. Patient's subjective foreign body sensation of throat and hyperemia of laryngeal mucosa remained for approximately 2 weeks post-removal, which were eventually resolved after administration of non-steroidal anti-inflammatory drug and anti-refluxant drug for 2 weeks. Treatment was ended at three weeks since the first visit. C. complanatum infections in humans are rare, and only four cases have been reported in Korea. Symptoms resembling pharyngitis or laryngitis occurs by consumption of raw, infected freshwater fish and treatment is done by mechanically removing the parasite.


Assuntos
Corpos Estranhos/patologia , Faringe/patologia , Faringe/parasitologia , Trematódeos/isolamento & purificação , Infecções por Trematódeos/diagnóstico , Infecções por Trematódeos/patologia , Animais , Anti-Inflamatórios/administração & dosagem , Endoscopia/métodos , Humanos , Coreia (Geográfico) , Masculino , Microscopia , Pessoa de Meia-Idade , Esteroides/administração & dosagem , Resultado do Tratamento , Trematódeos/anatomia & histologia , Infecções por Trematódeos/parasitologia , Infecções por Trematódeos/terapia
14.
J Craniofac Surg ; 30(2): 489-492, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31137451

RESUMO

INTRODUCTION: Fractures of the mandibular condyle represent more than 30% of all mandible fractures. If required, reduction has been performed using either a closed or an open technique with similar outcomes. Endoscopic fracture repair is a minimally invasive approach for open reduction, but there is limited data regarding indications and outcomes. This study aims to systematically review the demographics, features, and outcomes following endoscopic repair of mandibular fractures in adult patients. METHODS: The following databases were searched from their inception to December 31, 2016: PubMed, Cochrane, Web of Science, and the WHO Global Health Library, using terms related to endoscopy and mandibular fractures. Articles were screened and data were extracted by 2 independent reviewers. Disagreements arbitrated by discussion or a 3rd reviewer. RESULTS: Twenty-two manuscripts were included, representing 509 adult patients who had endoscopic repair of a mandibular fracture over 18 years. All endoscopic repairs were of the mandibular condyle, including both subcondylar and condylar neck fractures. The sample-sized weighted mean age was 33.5 years with 74.5% males in the study population. Permanent facial nerve injury was reported once (0.24%) and occlusive complications reported in 31 patients (6.5%). CONCLUSION: This systematic review identifies a large cohort of patients who underwent endoscopic repair of their mandibular fractures. Complications were rare and usually temporary, with permanent complications occurring at a respectable rate. The demographics and outcomes identified in this study can be used as an epidemiologic baseline for future research on endoscopic repair of mandibular fractures.


Assuntos
Endoscopia/métodos , Fixação Interna de Fraturas/métodos , Fraturas Mandibulares/cirurgia , Adulto , Humanos , Resultado do Tratamento
15.
J Laryngol Otol ; 133(5): 441-444, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31038097

RESUMO

BACKGROUND: In November 2017, a working feasibility analysis commenced of a local anaesthetic endonasal procedures out-patient clinic service at Freeman Hospital, Newcastle upon Tyne. Fundamental to introducing an innovative ambulatory out-patient practice is the development of a novel local safety standard for invasive procedures to support this service. OBJECTIVE: This paper presents the new safety standard developed for this purpose and implemented in our institution. CONCLUSION: Increasingly, there is a shift toward ambulatory services, directed by patient choice, technological advances and the opportunity for cost savings. It is hoped that this local safety standard for invasive procedures will provide a useful template for those considering implementing ambulatory endonasal services, or other novel procedures, within the specialty of ENT.


Assuntos
Instituições de Assistência Ambulatorial/normas , Procedimentos Cirúrgicos Ambulatórios/normas , Endoscopia/normas , Procedimentos Cirúrgicos Otorrinolaringológicos/normas , Gestão da Segurança/métodos , Procedimentos Cirúrgicos Ambulatórios/métodos , Anestesia Local/normas , Anestésicos Locais/uso terapêutico , Endoscopia/métodos , Inglaterra , Humanos , Nariz/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos
16.
Actas urol. esp ; 43(4): 212-219, mayo 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-181087

RESUMO

Objetivos: Valorar el rendimiento diagnóstico de los patrones de micción disfuncional asociados al reflujo vesicoureteral (RVU) en niños mayores de 3 años, en función del resultado del primer tratamiento endoscópico (T1END), agrupados en una clasificación diseñada por nuestro grupo (CMD.URI-La Fe) y su comparación con otras clasificaciones existentes como la de Van Batavia et al. Material y métodos: Estudio transversal ambispectivo de una muestra de 50 niños. Criterios de exclusión: TEND previo, edad ≤ 3 años, anomalías anatómicas o neurológicas y antecedentes de cirugía uretral o abdominopélvica. Previamente al T1END se realizó una valoración de la función de vaciado vesical mediante flujometría + electromiografía (UF-EMG) y del residuo posmiccional (ecografía). Se obtuvieron otras variables procedentes del diario miccional, el espesor de la pared vesical premiccional (ecografía), así como variables clínicas. La corrección del RVU fue valorada mediante cistografía isotópica a los 3 meses del tratamiento. Se realizó una clasificación de los patrones miccionales en función de las variables significativas (URI-La Fe) y se valoró su rendimiento diagnóstico, comparándola al clasificar a los pacientes según propone Van Batavia et al. Resultados: Media de edad: 6,8 ± 2,28 años. Varones/mujeres (44%/56%). Grados de RVU: leve, moderado, severo. Tasa de corrección del RVU T1END: 77% (n = 38). Rendimiento diagnóstico (Van Batavia; URI-La Fe): predicción correcta (37,5%; 75%), sensibilidad (32,4%; 87,8%), especificidad (54,5%; 46,6%), valor predictivo positivo (70,6; 78,3%) y valor predictivo negativo (19,4%; 63,6%). Conclusiones: Nuestros resultados muestran la utilidad del estudio no invasivo y la clasificación de la disfunción miccional del niño mayor de 3 años previo al primer tratamiento endoscópico del RVU


Objectives: To assess the diagnostic performance of urinary dysfunction patterns associated with vesicoureteral reflux (VUR) in children over the age of 3 according to the result of the first endoscopic treatment (ENDT1), grouped into a classification designed by our group (CMD.URI-La Fe). Comparison with other current classifications such as that of Van Batavia et al. Material and methods: Ambispective cross-cutting study of a sample of 50 children. Exclusion criteria: previous ENDT, age ≤ 3 years, anatomical or neurological anomalies and a history of ureteral or abdominopelvic surgery. Prior to the ENDT1, a bladder voiding function assessment by uroflowmetry+electromyography (UF-EMG) and post-mictional residue (ultrasound). Other variables from the bladder diary, pre-mictional bladder wall thickness and other clinical variables. The correction of VUR was assessed by isotope cystography 3 months after the treatment. Urinary patterns were classified according to the significant variables (URI-La Fe), and the diagnostic performance of this classification was assessed, comparing it to the classification of patients as proposed by Van Batavia et al. Results: Mean age: 6.8±2.28 years. Males/females (44%/56%). Grades of VUR (mild/moderate/severe). ENDT1 VUR correction rate: 77% (n=38). Diagnostic performance (Van Batavia; URI-La Fe): correct prediction (37.5%; 75%), sensitivity (32.4%; 87.8%), specificity (54.5%; 46.6%), positive predictive value (70.6; 78.3%) and negative predictive value (19.4%; 63.6%). Conclusions: Our results show the usefulness of the non-invasive test and the classification of urinary dysfunction in children aged over 3 years prior to the first endoscopic treatment of VUR


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Refluxo Vesicoureteral/cirurgia , Endoscopia/métodos , Micção/fisiologia , Criança , Refluxo Vesicoureteral/fisiopatologia , Prognóstico , Transtornos Urinários/fisiopatologia , Urodinâmica/fisiologia , Diagnóstico , Estudos Transversais
17.
Medicine (Baltimore) ; 98(18): e15451, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31045817

RESUMO

BACKGROUND: Lumbar decompressive surgery is a standard surgical technique for lumbar spinal stenosis. Many new surgical techniques have been introduced, ranging from open surgery to minimally invasive procedures. Minimally invasive surgical techniques are preferred because patients experience less postoperative pain and shorter hospital stays. However, the success rate of minimally invasive techniques have been controversial. The object of this study was to assess the feasibility of spinal decompression using biportal technique/endoscopic surgery compared with microscopic surgery. METHODS: Seventy lumbar spinal stenosis patients undergoing laminectomy were included in this study. A number table was used to randomize the patients into two groups: a biportal technique/endoscopic surgery group (BG-36) and a microscopic surgery group (OG-34). One surgeon performed either biportal technique/endoscopic decompression or microscopic decompression using a tubular retractor, depending on the group to which the patient was randomized. Perioperative data and clinical outcomes at postoperative 6 months were collected and analyzed. RESULTS: The demographic data and level of surgery were comparable between the two groups. A shorter operation time (36 ±â€Š11 vs 54 ±â€Š9 min), less hemovac drain output (25.5 ±â€Š15.8 vs 53.2 ±â€Š32.1 ml), less opioid usage (2.3 ±â€Š0.6 vs 6.5 ±â€Š2.5 T) and shorter hospital stay (1.2 ±â€Š0.3 vs 3.5 ±â€Š0.8 days) were shown in BG. The BG experienced no significant differences in clinical outcomes compared with OG. Favorable clinical outcomes were shown at 6 months after surgery in both groups. CONCLUSION: Lumbar decompressive surgery using biportal technique/endoscopy showed favorable clinical outcomes, less pain and a shorter hospital stay compared to microscopic surgery in patients with lumbar spinal stenosis.


Assuntos
Endoscopia/métodos , Laminectomia/métodos , Vértebras Lombares/cirurgia , Microcirurgia/métodos , Estenose Espinal/cirurgia , Idoso , Endoscopia/instrumentação , Feminino , Humanos , Laminectomia/instrumentação , Masculino , Microcirurgia/instrumentação , Pessoa de Meia-Idade , Duração da Cirurgia , Dor Pós-Operatória/etiologia , Estudos Prospectivos , Resultado do Tratamento
18.
Medicine (Baltimore) ; 98(22): e15541, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31145274

RESUMO

RATIONALE: Thoracic disc herniation (TDH) is an infrequent spinal disease and difficult to treat well. Various surgical approaches and procedures were introduced in many literatures. The authors report a patient with dorsal migrated TDH compressing the spinal cord at T10-11 level. PATIENT CONCERNS: A 65-year-old male patient presented with complaints of severe paresthesia of both legs and progressive motor weakness for 1 week. DIAGNOSES: Magnetic resonance imaging (MRI) of the thoracic and lumbar spine revealed TDH and migration of dorsal side on spinal cord at T10-11 level. INTERVENTIONS: Successful decompressive surgery was performed through a posterior interlaminar approach using only endoscopic instruments. OUTCOMES: After the operation, patient's symptoms, paraparesis and paresthesia, immediately improved. LESSONS: The successful results of this case suggest that full endoscopic laminotomy and discectomy may be an attractive minimally invasive surgical technique for treating TDH with dorsal migrated fragments.


Assuntos
Discotomia/métodos , Endoscopia/métodos , Deslocamento do Disco Intervertebral/cirurgia , Laminectomia/métodos , Vértebras Torácicas/cirurgia , Idoso , Humanos , Vértebras Lombares/cirurgia , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Resultado do Tratamento
19.
Expert Rev Med Devices ; 16(5): 373-380, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31044627

RESUMO

INTRODUCTION: Endoscopic spine surgery has been developed as a minimally invasive technique for decompression in patients with lumbar disc herniation or lumbar stenosis. Recent reports have described the use of endoscopic technology in lumbar fusion surgeries, especially for transforaminal lumbar interbody fusion (TLIF). This review aimed to summarize the current techniques of endoscopic TLIF and to discuss the benefits, limitations, and future perspectives of endoscopic lumbar fusion surgery. AREAS COVERED: This review covered the English-language medical literature published in Medline and focused specifically on endoscopic technologies incorporated into minimally invasive TLIF. The endoscopic TLIF techniques are categorized here according to the properties of the endoscope: percutaneous endoscopic TLIF, biportal endoscopic TLIF, and microendoscopic TLIF. Even though most authors have reported favorable clinical and radiological outcomes of endoscopic TLIF, such evidence originates mainly from case series. EXPERT OPINION: Although the current level of evidence is low and the technical relevance of the technique is controversial, the key concept and early results of endoscopic TLIF are promising. Technical advancements to improve safety and reduce technical complexity, as well as comparative cohort studies and randomized clinical trials with long-term follow-up are required to promote the adoption of endoscopic TLIF in clinical practice.


Assuntos
Endoscopia/métodos , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Humanos , Vértebras Lombares/diagnóstico por imagem , Resultado do Tratamento
20.
BMC Surg ; 18(Suppl 1): 19, 2019 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-31074396

RESUMO

BACKGROUND: Robotic thyroidectomy by transaxillary approach (RATS) is regarded as a feasible and safe alternative procedure in selected patients with benign disease or thyroid cancer of low risk, facilitating thyroidectomy with respect to conventional endoscopic approach and offering improved cosmetic results. The Da Vinci Xi surgical system (Intuitive Surgical, Sunnyvale, CA, USA) presents technical advantages over its previous generations, including overhead docking, more compact robotic arms, extended range of motion, and ability for camera to be docked in any arm. This construct supports dissection in smaller spaces with less arm interference and improved view. We present an initial experience of RATS on DVSS Xi in an academic Centre in Italy. METHODS: We conducted a prospective observational study, involving patients with thyroid disease and treated between April 2016 and January 2018. A modified thyroidectomy retractor (Modena retractor, CEATEC Medizintechnik, Germany) was used to lift a musculocutaneous flap and operate gasless. Instrument placement was recorded for each procedure. Each procedure description was broken down into three phases, creation of working space, machine docking with instrument positioning and endoscopic operating technique. Duration of cases was recorded. Patients selected were young women, BMI < 30, thyroid nodule < 5 cm, cytology TIR2 to TIR4 (TIR4:only nodules < 1 cm diameter). RESULTS: Twelve RATS were performed within the learning curve for the robotic technique, 10 lobectomies and 2 total thyroidectomies. No patients required reintervention. Mean duration of surgery was 198.9 min for lobectomy and 210 for thyroidectomy. The same surgical team performed all procedures. No patients presented surgery-related complications, mean stay was 3 days. Decrease in operating time was observed after 8 cases along with more precise preparation of working space. Four arms were used in the first 10 procedures then only three. No recurrent laryngeal nerve dysfunction, no seroma or haematoma were recorded. One patient had transient hypocalcaemia after total thyroidectomy. CONCLUSIONS: Since the early phases of a preliminary experience RATS appeared a safe alternative to open thyroidectomy. Uptake of technique was quick on Xi platform with few technical tweaks over techniques described for Si machines. Careful patient selection is crucial. TRIAL REGISTRATION: Retrospectively registered on 20 july 2018 . TRIAL REGISTRATION NUMBER: researchregistry4272. The Research Registry: https://www.researchregistry.com/browse-the-registry#home/registrationdetails/5b517f08dbc2045aefd7f9b4/.


Assuntos
Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Adulto , Dissecação , Endoscopia/métodos , Feminino , Humanos , Curva de Aprendizado , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Prospectivos , Nódulo da Glândula Tireoide/cirurgia
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