. The aim of this study was to evaluate the impact of the surgical approach on the management and outcomes of patients with early borderline ovarian tumors (BOTs). Material and methods. We retrospectively reviewed the.... The aim of this study was to evaluate the impact of the surgical approach on the management and outcomes of patients with early borderline ovarian tumors (BOTs). Material and methods. We retrospectively reviewed the medical charts of patients with stage Ia to Ic BOT treated surgically between January 1, 1985, and December 31, 2001. We compared patients initially managed by laparoscopy vs laparotomy in terms of potentially harmful procedures and quality of staging. Results. Of the 118 included patients, 48 (41% ) had laparoscopy for initial surgery, 54 (45% ) had laparotomy, and 16 (14% ) had conversion from laparoscopy to laparotomy. Conservative treatment (57% of patients) was more common with laparoscopy (vs laparotomy, P < 0.05) and in women older than 44 years (vs younger than 44 years, P < 0.001). Intraoperative tumor rupture occurred in 9% of patients and was not associated with the surgical approach (P = 0.1). Bag extraction was used in 19 (40% ) of the 48 laparoscopy patients. Staging was incomplete in 73% of patients overall. By univariate analysis, better quality of staging was associated with bilateral adnexectomy, age >44 years, laparotomy, hysterectomy, and treatment after 1995. By multivariate analysis, bilateral adnexectomy or hysterectomy was associated with better staging. Mean follow-up was 40 months, during which recurrence and survival rates were similar in the laparoscopy and laparotomy groups. Conclusion. Staging of macroscopic early stage BOTs was better in patients requiring radical surgery. After adjustment on disease severity, type of surgical access was not related to staging quality.展开更多
Several investigators have reported the feasibility of mitral valve repair in active endocarditis, but the long-term results are still unknown. Methods and Results-We reviewed 37 consecutive patients who underwent mit...Several investigators have reported the feasibility of mitral valve repair in active endocarditis, but the long-term results are still unknown. Methods and Results-We reviewed 37 consecutive patients who underwent mitral valve repair with the Carpentier technique for active endocarditis in our center between 1989 and 1994. This repair involved prosthetic annuloplasty in 31 patients(84% ), valve resection in 31(84% ), chordal shortening or transposition in 19(51% ), pericardial patch in 16(43% ), and direct suture of leaflet perforation in 4(11% ). Associated procedures were primarily aortic valve repair or replacement in 11(30% ) and tricuspid repair in 2(6% ). Early complications included 1 operative death(3% ; 95% CI, 0 to 15.5) and 1 reoperation for pericardial patch dehiscence. Recurrence of endocarditis was observed in 1 patient(3% ; 95% CI, 0 to 16). The 10-year survival rate and freedom from mitral valve reoperation were 80% (95% CI, 66 to 94) and 91% (95% CI, 81 to 100), respectively. At 10 years, most patients(96% ) were in good functional status(NYHA class I to II) with no or trivial mitral regurgitation(92% ) on echocardiography. Conclusions-Mitral valve repair using Carpentier’ s techniques in patients with active endocarditis offers very good long-term results with a low rate of recurrence or reoperation.展开更多
文摘. The aim of this study was to evaluate the impact of the surgical approach on the management and outcomes of patients with early borderline ovarian tumors (BOTs). Material and methods. We retrospectively reviewed the medical charts of patients with stage Ia to Ic BOT treated surgically between January 1, 1985, and December 31, 2001. We compared patients initially managed by laparoscopy vs laparotomy in terms of potentially harmful procedures and quality of staging. Results. Of the 118 included patients, 48 (41% ) had laparoscopy for initial surgery, 54 (45% ) had laparotomy, and 16 (14% ) had conversion from laparoscopy to laparotomy. Conservative treatment (57% of patients) was more common with laparoscopy (vs laparotomy, P < 0.05) and in women older than 44 years (vs younger than 44 years, P < 0.001). Intraoperative tumor rupture occurred in 9% of patients and was not associated with the surgical approach (P = 0.1). Bag extraction was used in 19 (40% ) of the 48 laparoscopy patients. Staging was incomplete in 73% of patients overall. By univariate analysis, better quality of staging was associated with bilateral adnexectomy, age >44 years, laparotomy, hysterectomy, and treatment after 1995. By multivariate analysis, bilateral adnexectomy or hysterectomy was associated with better staging. Mean follow-up was 40 months, during which recurrence and survival rates were similar in the laparoscopy and laparotomy groups. Conclusion. Staging of macroscopic early stage BOTs was better in patients requiring radical surgery. After adjustment on disease severity, type of surgical access was not related to staging quality.
文摘Several investigators have reported the feasibility of mitral valve repair in active endocarditis, but the long-term results are still unknown. Methods and Results-We reviewed 37 consecutive patients who underwent mitral valve repair with the Carpentier technique for active endocarditis in our center between 1989 and 1994. This repair involved prosthetic annuloplasty in 31 patients(84% ), valve resection in 31(84% ), chordal shortening or transposition in 19(51% ), pericardial patch in 16(43% ), and direct suture of leaflet perforation in 4(11% ). Associated procedures were primarily aortic valve repair or replacement in 11(30% ) and tricuspid repair in 2(6% ). Early complications included 1 operative death(3% ; 95% CI, 0 to 15.5) and 1 reoperation for pericardial patch dehiscence. Recurrence of endocarditis was observed in 1 patient(3% ; 95% CI, 0 to 16). The 10-year survival rate and freedom from mitral valve reoperation were 80% (95% CI, 66 to 94) and 91% (95% CI, 81 to 100), respectively. At 10 years, most patients(96% ) were in good functional status(NYHA class I to II) with no or trivial mitral regurgitation(92% ) on echocardiography. Conclusions-Mitral valve repair using Carpentier’ s techniques in patients with active endocarditis offers very good long-term results with a low rate of recurrence or reoperation.
