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- Neck dissection with the harmonic scalpel in patients with squamous cell carcinoma of the oral cavity. [JOURNAL ARTICLE]
- J Craniomaxillofac Surg 2013 May 14.
Our purpose was to evaluate the use of the Harmonic scalpel in neck dissections.
MATERIAL AND METHODS:We conducted a randomized prospective intervention study to compare the Harmonic scalpel (32 patients) with the conventional technique (31 patients).
RESULTS:Operative time was lowered by 64 min (p < 0.001) and 7.5 min (p = 0.367); blood lost during surgery was lowered by 80.5 ml (p < 0.001) and 76.6 ml (p < 0.001); the length of time the drains were kept in place was lowered by 1.3 days (p < 0.001) and 1.5 days (p < 0.01); and the volume of drainage was lower by 228.7 ml (p < 0.001) and 187.6 ml (p < 0.01) in selective and comprehensive neck dissections respectively in patients treated with the Harmonic scalpel.
CONCLUSIONS:The Harmonic scalpel shortens operative time in selective dissections. It reduces blood loss during surgery; time drains are kept in place and the amount of drainage in comprehensive and selective neck dissections.
- A phase II study of endoscopic submucosal dissection for superficial esophageal neoplasms. [JOURNAL ARTICLE]
- Gastrointest Endosc 2013 May 13.
BACKGROUND:Most previous studies of endoscopic submucosal dissection (ESD) for superficial esophageal neoplasms were retrospective; prospective studies are scant.
OBJECTIVE:To prospectively assess the efficacy and safety of ESD for superficial esophageal neoplasms.
DESIGN:Phase II study.
PATIENTS:Fifty-two patients (median age 68 years; 48 men) who had a histologic diagnosis of superficial esophageal cancer without metastasis on CT or high-grade intraepithelial neoplasia (HGIN) were enrolled from April 2009 through November 2011.
INTERVENTION:ESD was used to treat 56 lesions. All procedures were done by 4 endoscopists who each had previously performed ESD in more than 100 patients with gastric tumors. MAIN OUTCOME
MEASUREMENTS:The primary endpoint was the R0 resection rate, and secondary endpoints were the safety and the rate of accurately diagnosing tumor depth on endoscopic examination.
RESULTS:The median treatment time was 69 minutes (24-168 minutes). The histopathologic diagnosis was squamous cell carcinoma in 49 lesions, HGIN in 5, and tubular adenocarcinoma in 2. The en bloc resection rate and R0 resection rate were 100% and 94.6%, respectively. The rates of adverse events during ESD and after ESD were 22.2% and 53.8%, respectively, but most events were mild. One patient (1.9%) had mediastinal emphysema without perforation. The rate of accurately diagnosing tumor depth on endoscopic examination was 76.8%.
LIMITATIONS:Single-center, nonrandomized study.
CONCLUSION:Our study showed that ESD was an effective and relatively safe treatment for superficial esophageal neoplasms. ESD may be a useful treatment option for superficial esophageal neoplasms in hospitals with endoscopists who are experts in performing ESD for gastric tumors. (Clinical trial registration number: UMIN000002047.).
- Differentiated thyroid carcinoma of children and adolescents: 27-year experience in the yonsei university health system. [Journal Article]
- J Korean Med Sci 2013 May; 28(5):693-9.
Thyroid carcinomas are uncommon in childhood and adolescence. The aim of this study was to analyze clinical features and clinical outcomes of thyroid cancer in the pediatric population treated in the Yonsei University Health System. From September 1982 to June 2009, 90 patients (75 females, 15 males; female:male ratio of 5:1) with differentiated thyroid carcinoma were identified in our institute. The mean age at diagnosis was 15.8 yr old (range 4.8-19.9 yr). Cervical masses were most common clinical manifestations at diagnosis in 65 patients (72.2%). Forty-two patients underwent less than total thyroidectomy and 18 patients underwent total thyroidectomy. Thirty patients (33.3%) had lateral neck lymph node metastasis and seven patients (7.8%) had lung metastasis at the time of surgery. Among the 90 patients, recurrence occurred in 14 patients (15.5%). Mean follow-up period for patients with differentiated thyroid carcinoma was 81.6 months (13-324 months). No patients died of differentiated thyroid carcinoma. Patients with differentiated thyroid carcinoma who were < 20-yr-of-age were present with aggressive local disease and a high frequency of lymph node and distant metastasis. It is recommended that pediatric thyroid cancer should be managed mostly using proper surgical approach with thyroidectomy and lymph node dissection when indicated.
- Complex endovascular repair of a large dissection of the ascending aorta in a 70-year-old man. [Journal Article]
- Tex Heart Inst J 2013; 40(2):182-5.
We report the case of a 70-year-old man who presented with a large dissection of the ascending aorta related to coronary artery bypass grafting 3 years earlier. One graft was patent; however, a reverse venous graft to the right coronary artery was occluded, and that artery was substantially stenotic. The patient was a high-risk surgical candidate, so we treated a large dissection successfully by endovascular means with a thoracic endograft. This case suggests that this approach can be applied safely and effectively to other high-surgical-risk patients who have complex ascending aortic disease.
- Endovascular treatment of acute type B dissection complicating aortic coarctation. [Journal Article]
- Tex Heart Inst J 2013; 40(2):176-81.
Surgical treatment poses a high risk to patients with concomitant aortic coarctation and dissection, and an interventional approach could be an alternative. We describe the case of a 52-year-old man with a long history of untreated hypertension and aortic coarctation who emergently presented at our institution with an acute Stanford type B dissection. The patient's elevated serum creatinine level, perfusion deficit in the right lower limb, and hypertension did not respond to medical therapy, and he did not consent to surgery. By endovascular means, we used a self-expandable stent-graft to cover the entry point of the dissection; then, we deployed a balloon-expandable bare-metal stent to correct residual stenosis. To our knowledge, this is the first report of the endovascular treatment of aortic coarctation complicated by type B dissection.
- Surgical approach to aortic valve replacement after previous bilateral internal thoracic artery grafting. [Journal Article]
- Tex Heart Inst J 2013; 40(2):170-2.
The authors present a manubrium-sparing sternotomy technique for aortic valve replacement in patients who have undergone previous myocardial revascularization with both internal thoracic arteries. They have found that preoperative 64-multislice computed tomographic imaging facilitates surgical planning by delineating the course of patent grafts and, in particular, the relationship between the sternum and the right internal thoracic artery graft. A manubrium-sparing sternotomy can in such instances avoid injury to the right internal thoracic artery graft during both resternotomy and adhesion dissection, thus reducing surgical risk and operative time.
- The L60V variation in HBV core protein elicits new epitope-specific cytotoxic T lymphocytes and enhances viral replication. [JOURNAL ARTICLE]
- J Virol 2013 May 15.
Mutations in the core protein (HBc) of hepatitis B virus (HBV) are associated with aggressive hepatitis and advanced liver diseases in chronic hepatitis B (CHB). In this study, we identified the L60V variation in HBc that generates a new HLA-A2-restricted CD8(+) T cell epitope by screening an overlapping 9-mer peptide pool covering HBc and its variants. The nonameric epitope V60 were determined by structural and immunogenic analysis. The HBc L60V variation is correlated with hepatic necroinflammation and higher viral levels, and it may be associated with poor prognosis in CHB patients. Immunization with the defined HBV epitope V60 peptide elicited specific cytotoxic T lymphocyte (CTL)-induced liver injury in HLA-A2(+)/HBV transgenic mice. In addition, in vitro and in vivo experiments both demonstrated that the HBc L60V variation facilitates viral capsid assembly and increases HBV replication. These data suggest that the HBc L60V variation can impact both HBV replication and HBV-specific T cell responses. Therefore, our work provides further dissection of the impact of the HBc L60V variation, which orchestrates HBV replication, viral persistence, and immunopathogenesis during chronic viral infection.
- Comparative analysis of oncological outcomes and quality of life after robotic versus conventional open thyroidectomy with modified radical neck dissection in patients with papillary thyroid carcinoma and lateral neck node metastases. [JOURNAL ARTICLE]
- J Clin Endocrinol Metab 2013 May 15.
Objectives:Robotic total thyroidectomy (TT) with modified radical neck dissection (MRND) using a gasless transaxillary approach has been reported safe and effective in patients with N1b papillary thyroid carcinoma (PTC), with notable cosmetic benefits when compared with conventional open TT. We have compared oncological outcomes and quality of life (QoL) in PTC patients undergoing robotic TT and MRND and those undergoing conventional open procedures.Materials and
Methods:Between March 2010 and July 2011, 128 patients with PTC and lateral neck node metastases underwent TT with MRND, including 62 who underwent robotic and 66 who underwent open TT. We compared oncologic outcomes and safety, as well as functional outcomes such as postoperative subjective voice and swallowing difficulties. We also evaluated neck pain, sensory changes, and cosmetic satisfaction after surgery using various QoL symptom scales. Neck and shoulder disability was assessed using arm abduction tests (AAT) and questions from the neck dissection impairment index (NDII).
Results:Although the mean operating time was significantly longer in the robotic (mean, 271.8±50.2 min) than in the open group (mean, 208.9±56.3 min) (p<0.0001), postoperative complication rates and oncologic outcomes, including the results of radioactive iodine scans and postoperative serum Tg concentrations, did not differ significantly. Subjective voice outcomes and postoperative AAT and NDII were also similar, but postoperative swallowing difficulties (p=0.0041) and sensory changes (p<0.0001) were significantly more frequent in the open than in the robotic group. In particular, mean cosmetic satisfaction score was significantly higher in the robotic than in the open group (p<0.0001).
Conclusion:Robotic TT with MRND yielded similar oncologic outcomes and safety as conventional open procedures, with similar recovery of neck and shoulder disability. However, the robot technique resulted in better QoL outcomes, including better cosmetic results and reductions in neck sensory changes and swallowing discomfort.Mini-AbstractWe have compared oncological outcomes and quality of life (QoL) in PTC patients undergoing robotic total thyroidectomy (TT) and modified radical neck dissection (MRND) and those undergoing conventional open procedures. Our results found that robotic and conventional open TT with MRND yielded similar oncologic outcomes and safety. The recovery of neck and shoulder disability after MRND did not differ between the two groups. However, the robot technique was associated with improved QoL, including excellent cosmetic results and reductions in neck sensory changes and swallowing discomfort after surgery.
- Experience with the conventional and frozen elephant trunk techniques: a single-centre study. [JOURNAL ARTICLE]
- Eur J Cardiothorac Surg 2013 May 15.