The authors report the surgical procedure in two patients with pseudomyxoma peritonei, histologically considered as mucinous adenocarcinoma. In both patients, intestinal loops and other visceras were blocked and it was not possible to localize the tumor´s origin. There was, in both cases, a great volume of mucinous ascitis. In the first patient a laparotomy was performed and a drainage by a five centimeters peritoneostomy in the abdominal upper left quadrant. In the second just a peritoneostomy was performed in the same location. The sequential irrigation of the abdominal cavity controlled the ascitis in a few days. Certainly this approach avoided a second procedure to clean the mucinous ascitis.
Fibrous Dysplasia treatment consists primarily in aesthetic surgical procedure, aiming at improve- ment of facial asymmetry and/or facilitation of the prosthetic rehabilitation and clinical and radiogra- phic follow-up. Being a benign lesion with rare cases of malignant transformation, surgical remo- val of injury may not be indicated, because, besi- des causing a severe facial deformity, can cause a pathological fracture of the region, due to the weakening of this. For these reasons, the majority of patients are treated simply by surgical removal of part of the lesion. In certain cases, it is better to wait for the bone growth plate closure since the injury, even if slowly, continues to grow. Sta- tistically about 25 to 50% of the young patients surgically treated present recurrences after surgical treatment of osteoplasty of the lesion [1, 2, 3, 4, 5, 6, 7, 8, 10, 11].
and moderate to severe mitral regurgitation underwent to this surgical procedure between December 1995 and De- cember 1998. The cohort comprised 10 female and 13 male patients from 25 to 78 years of age (55±24). Sixteen patients were in NYHA class IV (72.7%) and 6 patients were in NYHA class III (27.3%). In spite of having received ade- quate and full medication, all patients had more than three hospital admissions in the prior 6 months. Six patients were in the intensive care unit dependent on inotropic support, and four were on an intraaortic counterpulsation balloon. Seven patients (30.4%) had undergone previous heart sur- gery (five for myocardial revascularization, one for mitral valve repair and one for partial left ventriculectomy). The preoperative ejection fraction (measured by transthoracic echocardiography) ranged from 13 to 44% (mean 30%) [fig. 1 (ventriculography)].
second stage of surgical treatment, because 20 patients (83,3 %), in 6 months after Troyanov — Trendelenburg’s operation, demonstrated the restoration of functional consistency of valves of great saphenous and perforating veins. Conclusion. When determining the indications for urgent disconnection of saphenofemoral junction for patients with acute varicothrombophlebitis and also when choosing surgical treatment approach during remote observation period, it is reasonable to examine the phenotypic characters of undifferentiated dysplasia of connective tissue.
4ª errata - No artigo científico “Surgicalapproach of orbital subperiosteal abscess associated with the orbital fracture” dos autores: Antonio Dionízio de Albuquerque Neto, Thaisa Reis de Carvalho Sampaio, Darlan Kelton Ferreira Cavalcante, Luciano Leocádio Teixeira Nogueira Filho, Pedro Thalles Bernardo de Carvalho Nogueira, José Rodrigues Laureano Filho, publicado na Revista Brasileira de Oftalmologia na edição de setembro-outubro de 2015 (Rev Bras Oftalmol. 2015; 74 (5): 315-8), em sua versão digital em inglês, nas páginas 315 (título em inglês) e 317 (cabeçalho), onde se lê: orbitalsubperiosteal, leia-se: orbital subperiosteal.
consultations for salivary gland lesions at the Pathology Division of Instituto Nacional de Câncer (INCA) was reviewed from January 2001 to December 2012. The diagnoses reached by intraoperative consultation were compared with the gold standard histopathological diagnoses and classiied into: 1) concordant, 2) discordant, and 3) indeterminate. Accuracy was 92%, reinforcing that intraoperative consultation for salivary gland lesions is highly accurate and can contribute to the surgicalapproach.
We assessed: age, gender, tumor side, symptoms upon diagnosis (nasal obstruction, anterior or posterior rhinorrhea, epistaxis, hyposmia, cacosmia, headache and facial pain), comorbidities and habits, Krouse staging, sur- gical approach, intra and postoperative complications, ma- lignization and postoperative recurrence. We also assessed the possibility of correlation between the recurrences with higher preoperative staging, with the surgicalapproach utilized and the presence of malignization utilizing the Pearson’s coefficient. All the patients were submitted to surgery by the same team, by external approach, endonasal endoscopic or a combined approach. The postoperative follow up was carried out by nasal endoscopy in series, weekly in the first month and monthly until the sixth month. Later on, the follow up was every six months. In suspecting clinical recurrence, we carried out a CT scan of the paranasal sinuses.
In our analysis, we found 8% of valve-related surgery approaching to IE, percentage similar to that observed in national, North American and European casuistic [14-16]. Moreover, we conirmed high 30-day mortality (17%) for patients undergoing CVS in the presence of active infection, as recently reported by Prendergast & Tornos (ranging from 6% to 25%) . However, the surgicalapproach in the presence of IE wasn’t conirmed as an independent predictor of death in our series.
tive analysis conducted by the Mayo clinic using all their cases in the last 20 years provides further evidence of the relative safety of performing a pre-operative biopsy. In this series, they only had 2 hematomas out of 76 biopsies. They also showed that pre-operative biopsy can guide the surgicalapproach and avoid extensive resections in patients with a benign pathology. They showed that the pre-operative biopsy was in concord- ance with the final pathologies at a higher rate than those resulting from the various imaging techniques. 15
The ACOG states that non-surgical creation of a neovagina is the appropriate ﬁrst line approach in most patients 3 and Frank self-dilatation method is still successfully used nowa- days. 31,32 Presently, there are no controlled studies compar- ing the laparoscopic Vecchietti technique to Frank method. Obviously, the latter allows patients to avoid surgery and has few associated risks. However, it requires favorable anatomic conditions, namely a vaginal fovea with some depth, and persistent collaboration of the patient during the long period of time necessary to achieve an appropriate vaginal length. The Vecchietti laparoscopic technique implies a low-risk, minimally invasive surgicalapproach, but can be performed in almost all patients with congenital vaginal aplasia, allow- ing creation of an adequate vaginal length after only a few days of traction and requiring the use of postoperative vaginal dummies for a short period of time. Therefore, it prevents the physical and psychological distress associated to the lengthy and painful self-dilatation procedure.
In order to collect as much information as possible on potential indications, early and long term results, it was created an “International Registry for One and a Half Ventricular Repair”. The Registry was officially announced at the last World Congress of Pediatric Cardiology and Cardiac Surgery in Toronto, in 2001. Only data collection and analysis of a large number of patients will allow better clarification of the possibilities offered by one and a half ventricular repair and therefore facilitate future decision- making progress with regard to this promising surgicalapproach, including patients with Ebstein’s anomaly.
A ntrochoanal polyp (ACP) or Killian polyp is a benign nonatopic lesion of the maxillary sinus. Patients usually present nasal obstruction. Many surgical options for the treatment of ACPs have been suggested to minimize postoperative recurrence. The endoscopic nasal approach is a surgical option for maxillary intrasinusal resection of the polyp implantation through the maxillary ostium or middle meatal antrostomy, with lower morbidity when compared to other surgical approaches. Aim: To evaluate the rate of endoscopic antrochoanal polypectomy with middle meatotomy in the treatment of ACP. Materials and Methods: Were evaluated by means of a retrospective study, 29 patients, who were diagnosed based on history, physical examination, computed tomography, and histological findings, treated between 1997 and 2004. The surgicalapproach was endoscopic polypectomy with middle meatotomy. Results: Twenty-nine patients with ACP, 17(58.6%) were females and 12(41.4%) males, age range, 7-75 years (average of 27.55years) were included in this study. The main symptom were nasal obstruction 24(82%), oral breathing 11(37.9%), snoring nine (31%), rhinorrhea 5(17%), epistaxis 2(6.9%), headache 2(6.9%), and drip one (3.4%). The association with atopy was found in nine (31%). The mean follow-up period was 17 months (3-63 months). Only two patients (6.9%) presented recurrence. Conclusion: The rate of recurrence obtained in our study is no different from literature data, even when compared with former and gold standard procedures.
scope-guided awake nasotracheal intubation followed by general anesthesia proved advantageous for schwannomas that profoundly obstructed the airway (N ¼ 2). 1,5 This techni- que was performed to preserve the airway anatomy and permit intact muscle tone to keep airway structures open, leading to easier visualization of the upper airway. 1,5 Postoperative bleeding and swelling in the pharyngeal cavity and mouth ﬂoor is a common complication that can lead to dangerous obstruction of the airway after excision. 1,5 Thus, nasal intuba- tion and careful postoperative monitoring is recommended to maintain a viable airway even after a successful, complete excision. 14 Proper anesthetic management for surgical exci- sion of schwannoma of the tongue depends on the location, size, and surgicalapproach. 1 Swellings located at the base of the tongue, though asymptomatic, may cause a distorted air- way upon operative proceedings, causing life threatening air- way obstruction after the induction of anesthesia. 1
The authors conclude that an early diagnosis by means of clinical and imaging findings along with an opportune and appropriate surgicalapproach are essential to the success and cure of this particular type of infection. The way this case was dealt followed these principles, and so we could see the success of the short and long term treatment. The patient remains in re- gular follow-up.
Introduction: Intra-atrial catheter (IAC) placement through an open surgicalapproach has emerged as a life-saving technique in hemodialysis (HD) patients with vascular access exhaustion. Objective: To assess the complications of IAC placement, as well as patient and vascular access survival after this procedure. Methods: The authors retrospectively analyzed all seven patients with vascular capital exhaustion, without immediate alternative renal replacement therapy (RRT), who underwent IAC placement between January 2004 and December 2015 at a single center. Results: Seven patients were submitted to twelve IAC placements. Bleeding (6/7) and infections (3/7) were the main complications in the early postoperative period. Two (2/7, 29%) patients died from early complications and 5/7 were discharged with a properly functioning IAC. The most frequent late complication was catheter accidental dislodgement in all remaining five patients, followed by catheter thrombosis and catheter-related infections in the same proportion (2/5). During follow-up, two of five patients died from vascular accesses complications. After IAC failure, one patient was transferred to peritoneal dialysis and a kidney transplant was performed in the other. Only one patient remains on HD after the third IAC, with a survival of 50 months. The mean patient survival after IAC placement was 19 ± 25 (0-60) months and the mean IAC patency was 8 ± 11 (0- 34) months. Conclusion: Placing an IAC to perform HD is associated to significant risks and high mortality. However, when alternative RRT are exhausted, or as a bridge to others modalities, this option should be considered.
In conclusion, the surgicalapproach to the arachnoid cyst is technically simple and apparently without great complications. However, the presented cases confirm that the serious complications in the surgical treatment of big cysts with important midline shift lack special strategy to avoid adversities. Other cases, with severe compression to the midbrain structures, using cautious decompression, have an excellent clinical outcome and anatomical repositioning of the affected structures, indicating neuronal plasticity. Although most of the authors indicate a direct approach, we believe that in these cases a first approach through peritoneal drainage of the arachnoid cyst would permit a slower decompression of the intracranial structures and consequently readaptation of the microcirculation to the circumstantial perfusion pressure. Reevaluation of the clinical case would permit us, with persistence of symptoms, to use the direct approach, always taking into consideration serious complications.
cochleostomy approach, because of the small numbers of patients included in the present study and because a cochleostomy was performed only if the RW approach could not be conducted properly. Former work in this domain have shown that both approaches could lead to satisfying hearing preservation levels provided both are conducted appropri- ately. In a systematic literature review including 170 patients, Havenith and colleagues, 22 could not ﬁnd clear evidence for a superiority of the RW approach compared with cochleos- tomy. Other authors reported that similar levels of low- frequency hearing preservation could be achieved using straight narrow electrode inserted with either approaches. 23–25 One possible difference contrasting both approaches is the relatively important anatomical variability of the round window itself, which could compromise insertion in certain cases and would make the cochleostomy a better option. 26 Extensive studies including more patients and looking at the detailed relationship between ore-opera- tive anatomical characteristics of the RW region and how these should constrain the choice of the surgicalapproach are necessary.
The advantage of the surgicalapproach via PD is that it is a ‘gold standard’ procedure, with a historic legacy that extends from the late 19th century, and specifically 1889, when Codivilla reported the first PD. Over the following years, this approach’s ominous prohibitive mortality was reduced and currently, its mortality rate is less than 2% in reference centers (32). Nevertheless, PD continues to be a very challenging and risky procedure and certain patients do not have adequate clinical conditions for this intervention. For example, in a study by Yoon et al., several patients were not managed surgically because of poor preoperative con- ditions, including advanced age and significant comorbid- ities (29).
cancer, and compared surgery plus 50–70 Gy of adjuvant RT with patients who responded to induction CT with cisplatin + 5-fluorouracil and received 70 Gy of RT following three courses of CT. Median survival times were 25 months in the surgery plus RT group and 44 months in the CT plus RT group (p = 0.006). Loco-regional management rates were similar in both groups, whereas distant failure was more com- mon in the surgery plus RT group (36% vs. 25%; p = 0.041). Other retrospective studies have reported comparable survival for advanced hypopharynx cancer treated with in- duction CT followed by definitive RT with that achieved with the surgicalapproach and postoperative RT (10,11) .
The Cincinnati incision is based on thorough study of anatomy of the foot and ankle. The obvious goal of a good surgicalapproach is to provide adequate exposure of the pathologically involved structures while at the same time minimizing morbidity resulting from damage to the blood vessels, nerves, tendons, and articular surfaces in the area and allows the surgeon to correct a deformity in all planes simultaneously.