The difference between stages Ⅰ and Ⅲ of gastric gastrointestinal stromal tumor depends principally on the number of mitosis.According with TNM classification,the presence in the tumor of high mitotic rate determine...The difference between stages Ⅰ and Ⅲ of gastric gastrointestinal stromal tumor depends principally on the number of mitosis.According with TNM classification,the presence in the tumor of high mitotic rate determines the upgrading.Many studies exposed different count techniques in evaluating the number of mitosis.An international standardized method to assess mitotic rate is needed.展开更多
BACKGROUND Short stems are usually uncemented prosthetics and are recommended in the treatment of traumatic or degenerative diseases of hip.In revision procedures for elderly patients with serious comorbidity,applying...BACKGROUND Short stems are usually uncemented prosthetics and are recommended in the treatment of traumatic or degenerative diseases of hip.In revision procedures for elderly patients with serious comorbidity,applying a short stem could reduce peri-and post-operative secondary surgical risks to femoral osteotomy,which are necessary for the removal of parts of the implant or acrylic cement from the medullary canal.There are no cases in the literature that apply a short stem for prosthetic revision by acrylic cement anchorage.CASE SUMMARY A male patient had a left hip replacement in 1995 due to coxarthrosis.At the age of eighty the patient reported an accidental trauma and walked with pain in the left thigh.The X-ray highlighted the stem breakage in the distal section without fracturing the femoral cortex.The patient had various comorbidities(diabetes,anaemia,heart deficiency,and arrhythmia)presenting a high operation risk(ASA 4).During the revision procedure,the distal apex of the stem could not be removed from the femoral cortex.Because of the poor general health of the patient,the surgeon decided not to perform a Wagner femoral osteotomy to remove the distal section of the stem and decided to implant a short stem to avoid removing the stem section of the previous implant.The patient had his left femur X-rayed 15 d post-trauma.CONCLUSION A field of application of short stem may be the development of a cemented short stem to reduce the complexity of the revision procedure.展开更多
AIM: To investigate the role of laparoscopy in diagnosis and treatment of intra abdominal infections.METHODS: A systematic review of the literature was performed including studies where intra abdominal infections were...AIM: To investigate the role of laparoscopy in diagnosis and treatment of intra abdominal infections.METHODS: A systematic review of the literature was performed including studies where intra abdominal infections were treated laparoscopically.RESULTS: Early laparoscopic approaches have become the standard surgical technique for treating acute cholecystitis. The laparoscopic appendectomy has been demonstrated to be superior to open surgery in acute appendicitis. In the event of diverticulitis, laparoscopic resections have proven to be safe and effective procedures for experienced laparoscopic surgeons and may be performed without adversely affecting morbidity and mortality rates. However laparoscopic resection has not been accepted by the medical community as the primary treatment of choice. In high-risk patients, laparoscopic approach may be used for exploration or peritoneal lavage and drainage. The successful laparoscopic repair of perforated peptic ulcers for experienced surgeons, is demonstrated to be safe and effective. Regarding small bowel perforations, comparative studies contrasting open and laparoscopic surgeries have not yet been conducted. Successful laparoscopic resections addressing iatrogenic colonic perforation have been reported despite a lack of literature-based evidence supporting such procedures. In post-operative infections, laparoscopic approaches may be useful in preventing diagnostic delay and controllingthe source.CONCLUSION: Laparoscopy has a good diagnostic accuracy and enables to better identify the causative pathology; laparoscopy may be recommended for the treatment of many intra-abdominal infections.展开更多
Ovarian cancer has as its predominant pattern of dissemination metastases to the peritoneal surfaces and disease spread within the abdomen and pelvis that most commonly causes the patients demise. To combat peritoneal...Ovarian cancer has as its predominant pattern of dissemination metastases to the peritoneal surfaces and disease spread within the abdomen and pelvis that most commonly causes the patients demise. To combat peritoneal metastases, cytoreductive surgery with peritoneal and visceral resections is combined with intraperitoneal and systemic chemotherapy. Chemotherapy given in the operating room after the complete visible removal of ovarian cancer is hyperthermic intraperitoneal chemotherapy. The results of the combined treatment are determined by the extent of prior surgery, the extent of disease as established by the peritoneal cancer index, and the quality of the cytoreduction as measured by the completeness of cytoreduction score. Recent clinical information on patients with recurrent ovarian cancer suggest a median overall survival of up to 60 mo. These data are greatly improved over the one year survival observed in the past.展开更多
BACKGROUND Monteggia fractures are uncommon injuries in paediatric age.Treatment algorithms assert that length-unstable fractures are treated with plate fixation.In this case report,intramedullary fixation of an acute...BACKGROUND Monteggia fractures are uncommon injuries in paediatric age.Treatment algorithms assert that length-unstable fractures are treated with plate fixation.In this case report,intramedullary fixation of an acute length-unstable Monteggia fracture allowed a stable reduction to be achieved,along with an appropriate ulnar length and alignment as well as radio capitellar reduction despite the fact that the orthopaedic surgeon did not use a plate for the ulnar fracture.The scope of treatment is to avoid the use of a plate that causes periosteal stripping and blood circulation disruption around the fracture.CASE SUMMARY A four-year-old girl presented at the Emergency Department following an accidental fall off a chair onto the right forearm.The X-ray highlighted a lengthunstable acute Bado type 1 Monteggia fracture of the right forearm.On the same day,the patient underwent surgical treatment of the Monteggia fracture.The surgeon preferred not to use a plate to avoid a delay in fracture healing and to allow the micromotion necessary for callus formation.The operation comprised percutaneous fixation with an elastic intramedullary K-wire of the ulnar fracture and,subsequently,humeroradial joint reduction through manual manipulation.The orthopaedic surgeon assessed the stability of the radial head reduction under fluoroscopic control through flexion,extension,pronation and supination of the forearm.Healing of the fracture occurred within six weeks after surgery,as indicated by the presence of calluses on at least three cortices on standard radiographs.Dislocation/subluxation or loss of ulnar reduction was not apparent at the final X-ray examination.CONCLUSION Intramedullary fixation of unstable Monteggia fractures results in excellent outcomes,provides reliable reduction and causes fewer complications.展开更多
Data regarding the role of neoadjuvant chemotherapy(NACT) are not definitive. Several randomized trials and meta-analyses demonstrate that this chemotherapy regimen decreases the morbidity and mortality rates and incr...Data regarding the role of neoadjuvant chemotherapy(NACT) are not definitive. Several randomized trials and meta-analyses demonstrate that this chemotherapy regimen decreases the morbidity and mortality rates and increases complete cytoreduction rates. If combined with hyperthermic intraperitoneal chemotherapy(HIPEC), NACT could potentially further improve upon these already promising results. Moreover the use of NACT could help in evaluating the chemo-sensitivity of the cancer, thus preventing unnecessary HIPEC procedures in chemo-resistant patients. NACT should definitely be considered as a preferred regimen in the management of advanced ovarian cancer, especially in association with cytoreductive surgery + HIPEC procedure in the context of a multidisciplinary team management in an experienced cancer centre.展开更多
文摘The difference between stages Ⅰ and Ⅲ of gastric gastrointestinal stromal tumor depends principally on the number of mitosis.According with TNM classification,the presence in the tumor of high mitotic rate determines the upgrading.Many studies exposed different count techniques in evaluating the number of mitosis.An international standardized method to assess mitotic rate is needed.
文摘BACKGROUND Short stems are usually uncemented prosthetics and are recommended in the treatment of traumatic or degenerative diseases of hip.In revision procedures for elderly patients with serious comorbidity,applying a short stem could reduce peri-and post-operative secondary surgical risks to femoral osteotomy,which are necessary for the removal of parts of the implant or acrylic cement from the medullary canal.There are no cases in the literature that apply a short stem for prosthetic revision by acrylic cement anchorage.CASE SUMMARY A male patient had a left hip replacement in 1995 due to coxarthrosis.At the age of eighty the patient reported an accidental trauma and walked with pain in the left thigh.The X-ray highlighted the stem breakage in the distal section without fracturing the femoral cortex.The patient had various comorbidities(diabetes,anaemia,heart deficiency,and arrhythmia)presenting a high operation risk(ASA 4).During the revision procedure,the distal apex of the stem could not be removed from the femoral cortex.Because of the poor general health of the patient,the surgeon decided not to perform a Wagner femoral osteotomy to remove the distal section of the stem and decided to implant a short stem to avoid removing the stem section of the previous implant.The patient had his left femur X-rayed 15 d post-trauma.CONCLUSION A field of application of short stem may be the development of a cemented short stem to reduce the complexity of the revision procedure.
文摘AIM: To investigate the role of laparoscopy in diagnosis and treatment of intra abdominal infections.METHODS: A systematic review of the literature was performed including studies where intra abdominal infections were treated laparoscopically.RESULTS: Early laparoscopic approaches have become the standard surgical technique for treating acute cholecystitis. The laparoscopic appendectomy has been demonstrated to be superior to open surgery in acute appendicitis. In the event of diverticulitis, laparoscopic resections have proven to be safe and effective procedures for experienced laparoscopic surgeons and may be performed without adversely affecting morbidity and mortality rates. However laparoscopic resection has not been accepted by the medical community as the primary treatment of choice. In high-risk patients, laparoscopic approach may be used for exploration or peritoneal lavage and drainage. The successful laparoscopic repair of perforated peptic ulcers for experienced surgeons, is demonstrated to be safe and effective. Regarding small bowel perforations, comparative studies contrasting open and laparoscopic surgeries have not yet been conducted. Successful laparoscopic resections addressing iatrogenic colonic perforation have been reported despite a lack of literature-based evidence supporting such procedures. In post-operative infections, laparoscopic approaches may be useful in preventing diagnostic delay and controllingthe source.CONCLUSION: Laparoscopy has a good diagnostic accuracy and enables to better identify the causative pathology; laparoscopy may be recommended for the treatment of many intra-abdominal infections.
文摘Ovarian cancer has as its predominant pattern of dissemination metastases to the peritoneal surfaces and disease spread within the abdomen and pelvis that most commonly causes the patients demise. To combat peritoneal metastases, cytoreductive surgery with peritoneal and visceral resections is combined with intraperitoneal and systemic chemotherapy. Chemotherapy given in the operating room after the complete visible removal of ovarian cancer is hyperthermic intraperitoneal chemotherapy. The results of the combined treatment are determined by the extent of prior surgery, the extent of disease as established by the peritoneal cancer index, and the quality of the cytoreduction as measured by the completeness of cytoreduction score. Recent clinical information on patients with recurrent ovarian cancer suggest a median overall survival of up to 60 mo. These data are greatly improved over the one year survival observed in the past.
文摘BACKGROUND Monteggia fractures are uncommon injuries in paediatric age.Treatment algorithms assert that length-unstable fractures are treated with plate fixation.In this case report,intramedullary fixation of an acute length-unstable Monteggia fracture allowed a stable reduction to be achieved,along with an appropriate ulnar length and alignment as well as radio capitellar reduction despite the fact that the orthopaedic surgeon did not use a plate for the ulnar fracture.The scope of treatment is to avoid the use of a plate that causes periosteal stripping and blood circulation disruption around the fracture.CASE SUMMARY A four-year-old girl presented at the Emergency Department following an accidental fall off a chair onto the right forearm.The X-ray highlighted a lengthunstable acute Bado type 1 Monteggia fracture of the right forearm.On the same day,the patient underwent surgical treatment of the Monteggia fracture.The surgeon preferred not to use a plate to avoid a delay in fracture healing and to allow the micromotion necessary for callus formation.The operation comprised percutaneous fixation with an elastic intramedullary K-wire of the ulnar fracture and,subsequently,humeroradial joint reduction through manual manipulation.The orthopaedic surgeon assessed the stability of the radial head reduction under fluoroscopic control through flexion,extension,pronation and supination of the forearm.Healing of the fracture occurred within six weeks after surgery,as indicated by the presence of calluses on at least three cortices on standard radiographs.Dislocation/subluxation or loss of ulnar reduction was not apparent at the final X-ray examination.CONCLUSION Intramedullary fixation of unstable Monteggia fractures results in excellent outcomes,provides reliable reduction and causes fewer complications.
文摘Data regarding the role of neoadjuvant chemotherapy(NACT) are not definitive. Several randomized trials and meta-analyses demonstrate that this chemotherapy regimen decreases the morbidity and mortality rates and increases complete cytoreduction rates. If combined with hyperthermic intraperitoneal chemotherapy(HIPEC), NACT could potentially further improve upon these already promising results. Moreover the use of NACT could help in evaluating the chemo-sensitivity of the cancer, thus preventing unnecessary HIPEC procedures in chemo-resistant patients. NACT should definitely be considered as a preferred regimen in the management of advanced ovarian cancer, especially in association with cytoreductive surgery + HIPEC procedure in the context of a multidisciplinary team management in an experienced cancer centre.
