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Video-assisted thoracoscopic thymectomy for early-stage thymoma: A review 电视胸腔镜胸腺切除术治疗早期胸腺瘤的综述
Pub Date : 2019-01-01 DOI: 10.15761/gos.1000208
S. Takeo, F. Shoji, G. Toyokawa, Yuka Kozuma, K. Yamazaki
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引用次数: 2
Surgical management of malignant gastric gist with organ sparing surgery 保留器官手术治疗恶性胃gist
Pub Date : 2019-01-01 DOI: 10.15761/gos.1000210
G. Soni, B KumarKrishna, Asma Khalife, B. Telang, Deepak Ranvir, R. Joshi
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引用次数: 0
Exceptional long-term survivor (12 years) with metastatic gallbladder cancer 转移性胆囊癌的特殊长期幸存者(12年)
Pub Date : 2019-01-01 DOI: 10.15761/gos.1000213
F. Sacchetti, F. Ardito, Fabio M. Vecchio, F. Giuliante
We present a rare case of exceptional long-term survival (12 years) in a 78-year-old female patient presenting with stage IVb Gallbladder Carcinoma (GBC) with an unusual site of metastasis (left supraclavicular lymph node). After chemotherapy, a metabolic response of the metastatic regional and left supraclavicular lymph nodes was documented during the follow-up for 10 years. Because of biliary colic onset due to the presence of stones in the gallbladder, surgical resection was planned. In order to perform a curative resection, the patient underwent bi-segmentectomy 4b-5 en-bloc with the gallbladder + regional lymphadenectomy, 12 years after GBC diagnosis. At pathology, a G2 pT2 adenocarcinoma of the gallbladder was confirmed with pathologic response in all the 5 retrieved regional lymph nodes. Franco Sacchetti1, Francesco Ardito1*, Fabio M Vecchio2 and Felice Giuliante1 1Catholic University of the Sacred Heart, Italy 2Department of Pathology, Catholic University of the Sacred Heart, Italy
我们报告一位78岁的女性患者,其IVb期胆囊癌(GBC)有一个不寻常的转移部位(左侧锁骨上淋巴结),但有罕见的长期生存(12年)。化疗后,在10年的随访中记录了转移性区域和左侧锁骨上淋巴结的代谢反应。由于胆囊结石引起胆绞痛,计划手术切除。为了进行根治性切除,患者在GBC诊断后12年接受了4b-5双节段切除术,胆囊+局部淋巴结切除术。病理证实为胆囊G2 pT2腺癌,所有5个切除的区域淋巴结均有病理反应。Franco Sacchetti1, Francesco Ardito1*, Fabio M Vecchio2和Felice Giuliante1 1意大利圣心天主教大学2意大利圣心天主教大学病理学系
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引用次数: 0
How to harvest free fibula flap for mandibular reconstruction? Practical tips and tricks 下颌骨重建术中如何获取游离腓骨瓣?实用的技巧和窍门
Pub Date : 2019-01-01 DOI: 10.15761/GOS.1000204
C. Singh, Rajeev Kumar, P. Sakthivel
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引用次数: 1
Constipation in infant with premature birth story may point out colonic stricture 有早产史的婴儿便秘可能提示结肠狭窄
Pub Date : 2019-01-01 DOI: 10.15761/gos.1000202
Ezer S Serin
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引用次数: 0
Chronic osteomyelitis in Sub-Saharan Africa—A Review 撒哈拉以南非洲的慢性骨髓炎:综述
Pub Date : 2019-01-01 DOI: 10.15761/gos.1000207
K. Olivier, Uwizeyimana Eugene, L. Lynn, Lucero-Prisno Don Eliseo III
Background: Chronic osteomyelitis (COM) has remained an orthopaedic clinical challenge for many decades. It poses a socio-economic burden to patients and the health care system. We conducted this study to understand the epidemiological and clinical features of COM in Sub-Saharan Africa (SSA). Methods: A database-based search was done through PubMed, Google Scholar and Bioline for articles focusing on the epidemiology and clinical features of COM in SSA. Thirty-three articles were considered in the study based on the standards of assessing the level of evidence. Analysis and synthesis of the articles were conducted. Results: The incidence of COM in SSA is far greater than high income countries. Tibia is the commonly affected bone with more than 30% of cases, while the peak age is between the interval 10-21 years of age. Sickle cell disease, peripheral vascular disease, diabetes mellitus, Buluri ulcers and septicemia were reported as potential risk factors in SSA. 5093% of patients present with sinus drainage whereas Staphylococcus Aureus is the causative agent in 60-80% of the cases. Standard radiography and CT scan remain useful diagnostic tools in this region. The curative therapy involves radical surgical infection control with adjunct reconstructive procedures and antibiotherapy. Conclusion: COM remains on the rise in SSA. This trend is in line with the rise in exogenous osteomyelitis, road traffic injuries in addition to factors like patient characteristics, ignorance and poverty. Adolescents are more affected where immunosuppressive and vaso-occlusive disorders are main risk factors. We recommend extension of research on COM to overcome scarcity of data seen.
背景:慢性骨髓炎(COM)几十年来一直是骨科的临床难题。它给患者和卫生保健系统带来了社会经济负担。本研究旨在了解撒哈拉以南非洲地区(SSA) COM的流行病学和临床特征。方法:通过PubMed、谷歌Scholar和Bioline数据库检索有关SSA中COM的流行病学和临床特征的文章。根据评估证据水平的标准,本研究考虑了33篇文章。对所得产物进行了分析和合成。结果:SSA地区的COM发病率远高于高收入国家。胫骨是最常见的受累骨,超过30%的病例,高峰年龄在10-21岁之间。镰状细胞病、周围血管疾病、糖尿病、布鲁里溃疡和败血症被报道为SSA的潜在危险因素。5093%的患者表现为鼻窦引流,而60-80%的病例的病原体是金黄色葡萄球菌。标准x线摄影和CT扫描仍然是该地区有用的诊断工具。治疗包括根治性手术感染控制,辅助重建手术和抗生素治疗。结论:SSA中COM呈上升趋势。这一趋势与外源性骨髓炎、道路交通伤害以及患者特征、无知和贫困等因素的增加是一致的。青少年更容易受到影响,免疫抑制和血管闭塞性疾病是主要的危险因素。我们建议扩展COM的研究,以克服所见数据的稀缺性。
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引用次数: 9
Perspective Randomized-controlled clinical trial in patients submitted to self-expanding metal stents for colo-rectal cancer with bowel obstruction. Single center experience. Preliminary data 自膨胀金属支架治疗结直肠癌伴肠梗阻的随机对照临床研究。单中心体验。初步的数据
Pub Date : 2019-01-01 DOI: 10.15761/gos.1000212
S. Giungato, L. Fazzolari, A. Deluca, R. Palazzo, M. Ferrante, A. Asciano, F. Marangolo, A. Brunetti, D. Gm, C. Dimito, Pepe As
Introduction: Since the early 1990s, self- expanding metal stents (SEMS) have been used to treat malignant colonic obstruction. This kind of endoscopic procedure is mostly used for palliative treatment of colo-rectal cancer buti it is also used as “bridge to surgery”. Materials and methods: This perspective randomized-controlled clinical trial was performed from January 2017 to October 2019. We have recruited all patients admitted in our Emergency Hospital with diagnosis of colonic obstruction. All patients submitted to CT-scan. Patients was divided in 3 Groups: Group A (control group, composed by patients submitted only to emergency surgery) were 17; Group B (patients submitted to SEMS positioning and surgery) were 10; Group C (patients submitted to only SEMS positioning) were 14. The same Metal stent was used for all patient submitted to SEMS positioning (Colonic WallflexTM Boston Scientific 9 cm). Results: Analysis of comparison between Group A vs B highlighted statistical significance for diverting stoma performe (p-value: one-tailed 0.00035; two-tailed 0.00075; p<0.001), equal 70,5% of patients (12 out of 17). Also the comparison between Group A and B, in relation of survival rate (13 patients out of 17, equal to 70,58% in Group A and 10 patients out of 10, equal to 100%, in Group B after two years follow-up), statistical significance shows (p-value one-tailed 0.0010; two- tailed; p<0.005). Comparison of Group B plus C (24 patients), submitted to SEMS, shows time procedure was 25,17 minutes (range 10 - 40) and nobody patients showed stent dislocation or bowel obstruction signs after 48 h from endoscopic procedure. 1 case of Tenesmo in rectal SEMS and 2 colonic perforation after 73 days and 15 days (8%). They submitted early food intake. In our clinical controlled trial, even if is a preliminary data, demonstred that SEMS positioning is a the best palliative procedure with high success rate (95,8%) and a good survival. Mean days of hospitalization of 3,4 days. Conclusion: Our clinical randomized trial shows that SEMS positioning is feasibility as palliative therapy for obstructive colo-rectal cancer and it’s safe procedure as “bridge to surgery”. Other patients are ruled but a greater follow-up will be necessary to make our study more effective.
自20世纪90年代初以来,自膨胀金属支架(SEMS)已被用于治疗恶性结肠梗阻。这种内镜手术主要用于结直肠癌的姑息治疗,但也被用作“手术的桥梁”。材料与方法:该前瞻性随机对照临床试验于2017年1月至2019年10月进行。我们招募了所有在我们急诊医院诊断为结肠梗阻的病人。所有患者均行ct扫描。患者分为3组:A组(对照组,仅接受急诊手术的患者组成)17例;B组(接受SEMS定位和手术的患者)10例;C组(仅采用SEMS体位)14例。所有接受SEMS定位的患者均使用相同的金属支架(Colonic WallflexTM Boston Scientific 9 cm)。结果:A组与B组比较,转移造口效果有显著统计学意义(p值:单尾0.00035;双尾0.00075;P <0.001),等于70.5%的患者(17例中的12例)。A组与B组的生存率比较(A组17例患者中有13例,随访2年后为7058%,B组10例患者中有10例,随访2年后为100%),差异有统计学意义(p值单侧0.0010;两个——跟踪;p < 0.005)。B组与C组(24例)进行SEMS的比较显示,手术时间为25,17分钟(范围10 - 40),没有患者在内镜手术48小时后出现支架脱位或肠梗阻迹象。直肠SEMS中Tenesmo 1例,术后73天和15天结肠穿孔2例(8%)。他们提交了早期的食物摄入。在我们的临床对照试验中,即使是初步数据,也证明了SEMS定位是一种最佳的姑息治疗方法,成功率高(95.8%),生存率高。平均住院天数3,4天。结论:我们的临床随机试验表明,SEMS定位作为梗阻性结直肠癌姑息治疗是可行的,是一种安全的“手术过渡”方法。其他患者被控制,但需要更大的随访以使我们的研究更有效。
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引用次数: 1
Liver targeted therapies for hepatocellular carcinoma prior to transplant: contemporary management strategies. 肝细胞癌移植前的肝脏靶向治疗:当代管理策略。
Pub Date : 2018-04-01 Epub Date: 2018-02-15 DOI: 10.15761/GOS.1000171
Mustafa Nazzal, Sameer Gadani, Abdullah Said, Mandy Rice, Obi Okoye, Ahmad Taha, Krista L Lentine

Hepatocellular carcinoma (HCC) is an aggressive neoplastic disease that has been rapidly increasing in incidence. It usually occurs in the background of liver disease, and cirrhosis. Definitive therapy requires surgical resection. However, in majority of cases surgical resection is not tolerated, especially in the presence of portal hypertension and cirrhosis. Orthotopic liver transplant (OLT) in well selected candidates has been accepted as a viable option. Due to a relative scarcity of donors compared to the number of listed recipients, long waiting times are anticipated. To prevent patients with HCC from dropping out from the transplant list due to progression of their disease, most centers utilize loco-regional therapies. These loco-regional therapies(LRT) include minimally invasive treatments like percutaneous thermal ablation, trans-arterial chemoembolization, trans-arterial radio-embolization or a combination thereof. The type of therapy or combination used is determined by the size and location of the HCC and Barcelona Clinic Liver Cancer (BCLC) classification. The data regarding the efficacy of LRT in reducing post-transplant recurrence or disease-free survival is limited. This article reviews the available therapies, their strengths, limitations, and current use in the management of patients with hepatocellular carcinoma awaiting transplant.

肝细胞癌(HCC)是一种侵袭性肿瘤疾病,发病率迅速上升。它通常发生在肝病和肝硬化的背景下。最终治疗需要手术切除。然而,在大多数情况下,手术切除是不耐受的,特别是在门静脉高压和肝硬化的存在。原位肝移植(OLT)已被认为是一种可行的选择。由于捐赠者数量相对较少,预计等待时间较长。为了防止HCC患者因疾病进展而退出移植名单,大多数中心采用局部区域治疗。这些局部区域治疗(LRT)包括微创治疗,如经皮热消融、经动脉化疗栓塞、经动脉放射栓塞或其组合。治疗或联合使用的类型取决于HCC的大小和位置以及巴塞罗那临床肝癌(BCLC)的分类。LRT在减少移植后复发或无病生存方面的疗效数据有限。这篇文章回顾了现有的治疗方法,它们的优势,局限性,以及目前在肝细胞癌等待移植患者管理中的应用。
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引用次数: 2
One single drug combination of bromelain and Boswellia serrata casperome®: effects on postoperative Edema in open incisional abdominal hernia repair. Prospective randomized clinical trial 菠萝蛋白酶与锯齿状乳杆菌单药联合应用:对切开腹疝修补术后水肿的影响。前瞻性随机临床试验
Pub Date : 1900-01-01 DOI: 10.15761/gos.1000214
D. Gm, Tromba A, De Luca A, Franzoso L, Aubed A, Serinelli F, Giungato S
Introduction: Aim of this study is to investigate the significant postoperative benefits on patients about edema of tissues after incisional hernia repair with synthetic mesh using a combination of Bromelain (200 mg) and Boswellia Serrata Casperome® (200 mg), evaluated by ultrasound (US), and compared to control patients group (not treated with drugs). Material and method: From May 2018 to May 2019, fifty adult patients submitted to onlay incisional hernia repair using synthetic mesh with component separation of the abdominal wall and were divided into two homogenous groups (27 females, 23 males, mean age 61 years, mean BMI 32). Only the treated group took one tablet of drug for 30 days on an empty stomach, starting from the first post-surgery day. Checks were made on all patients from the first post-surgery day and going on 15th, 30th and 60th post-surgery days by US linear probe measuring edema, defining its thickness and average diameter. Results: The two groups were homogeneous compared to the initial diameter of the abdominal wall defect (p=0.877). Therefore, the edema thickness was independent of the size of the starting defect in the two groups examined. The edema was already reduced in the treated group compared to the control group at 15 post-surgery days; therefore this reduction became statistically significant starting from US result at 30 post-surgery days of drug treatment (p=0.043) and was even greater in the US result after 60 post-surgery days (p=0.001). Conclusion: Results obtained in this preliminary study showed a rapid and significant improvement in postoperative edema outcome of incisional hernia repair in patients treated with drug. Benefits of treatment are also found in patients even after one month of drug suspension.
本研究的目的是探讨菠萝蛋白酶(200mg)和Boswellia Serrata Casperome®(200mg)联合应用合成补片修复切口疝后患者组织水肿的显著术后获益,超声评估(US),并与对照组(未用药)进行比较。材料与方法:2018年5月至2019年5月,50例成人患者行腹壁组份分离合成补片原位切口疝修补术,随机分为两组(女性27例,男性23例,平均年龄61岁,平均BMI 32)。只有治疗组从术后第一天开始,空腹服用一片药物,持续30天。从术后第一天到术后第15天、第30天、第60天对所有患者进行检查,用US线性探头测量水肿,确定其厚度和平均直径。结果:两组腹壁缺损初始直径比较,差异均无统计学意义(p=0.877)。因此,两组患者的水肿厚度与起始缺损的大小无关。术后15天,与对照组相比,治疗组水肿已经减轻;因此,从术后药物治疗30天的美国结果开始,这种减少具有统计学意义(p=0.043),并且在术后60天的美国结果中更大(p=0.001)。结论:本初步研究结果显示,药物治疗对切口疝修补术后水肿预后有快速而显著的改善。即使停药一个月后,患者也能发现治疗的益处。
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引用次数: 2
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Global surgery (London)
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