World journal of surgery
-
World journal of surgery · Aug 2004
Comparative StudyRecurrent laryngeal nerve identification and assessment during thyroid surgery: laryngeal palpation.
Electrical identification and monitoring of the recurrent laryngeal nerve (RLN) has been proposed as an adjunct to standard visual identification of the nerve during thyroid and parathyroid surgery. This study was undertaken to assess laryngeal palpation as an intraoperative technique for identifying and assessing the RLN during surgery and to investigate the relation between laryngeal palpation and associated laryngeal electromyographic (EMG) activity. The postcricoid region of the larynx during surgery was palpated through the posterior hypopharyngeal wall to sense posterior cricoarytenoid muscle contraction in response to ipsilateral RLN stimulation (i.e., the "laryngeal twitch response.") Laryngeal palpation was performed in a series of 449 consecutive thyroid and parathyroid surgeries with 586 RLNs at risk. ⋯ Most importantly, it provides important prognostic information regarding ipsilateral vocal cord function at the completion of the initial side of the thyroid or parathyroid surgery. Intraoperative laryngeal palpation allows the surgeon to stage contralateral surgery if RLN damage is diagnosed, thereby avoiding the potential for bilateral vocal cord paralysis. We believe that laryngeal palpation is useful as an adjunct to formal EMG monitoring during thyroid and parathyroid surgery.
-
World journal of surgery · Aug 2004
Comparative StudyTrue versus mild hyperthermia during isolated hepatic perfusion: effects on melphalan pharmacokinetics and liver function.
Hyperthermic antiblastic isolated hepatic perfusion (IHP) with melphalan has been recently proposed as an alternative therapeutic option for patients with unresectable liver tumors. Although melphalan-heat antiblastic synergism is at a maximum at temperatures higher than 41 degrees C, IHP has so far been performed in humans at lower temperatures. In this experimental work, we compared IHP under mild versus true hyperthermic conditions in terms of drug pharmacokinetics and liver function. ⋯ Liver drug concentrations remained unchanged after true hyperthermia IHP. Under true hyperthermic conditions, neither an increase in liver parenchyma toxicity nor changes in melphalan pharmacokinetics were observed. These findings support the use of true hyperthermia in the clinical setting to exploit fully the antitumor synergism between melphalan and heat.
-
World journal of surgery · Jun 2004
Liver transplantation techniques with preservation of the natural venovenous bypass: effect on surgical resection of renal cell carcinoma invading the inferior vena cava.
Although renal tumors invading the inferior vena cava (IVC) are unusual, they represent a challenge to the surgical team because their accessibility is difficult. Liver transplantation techniques have been developed that preserve the venous collaterals, enhance the exposure, increase the safety of the resection, and avoid cardiopulmonary bypass. We describe our technique for dealing with renal tumors that have invaded the IVC, a combined experience of two centers, and the safety of the procedure and subsequent low morbidity. ⋯ The median follow-up was 36 months, during which time 6 patients developed metastatic disease and 37 were disease-free. We concluded that liver transplantation techniques enhance the surgical management of complicated urologic tumors. Patients with tumor thrombus extending to the IVC can be treated while avoiding thoracotomy and cardiopulmonary bypass.
-
To evaluate the potential dangers of the "nonlethal" 12-gauge single-shot handgun SAPL GC27 with Fun-Tir (FT) and mini-Gomm-Cogne (mGC) ammunition, a ballistic study was performed with both types of ammunition. Nine unembalmed human corpses covered with a cloth sheet were shot through the right and left pectoral regions. With the mGC ammunition, rib fractures were observed when the firing range was less than 2 meters, skin perforation when the range was less than 1.5 meters, with lung injuries at less than 0.2 meter; the heart and the aorta were lacerated at contact range (0 meter). ⋯ Our study shows that the mGC ammunition, shot by the CG27 firearm, can be lethal at contact range and that pellets penetrate the skin at ranges of less than 1 meter. These results led us to conclude that this weapon is too dangerous to be marketed as a "nonlethal" weapon. The term "reduced wounding power weapon" is preferable.
-
World journal of surgery · Mar 2004
Comparative StudyObstructive jaundice in rats: cause of spatial memory deficits with recovery after biliary decompression.
Children with end-stage liver disease have been found to have cognitive deficits. The aim of this study was to examine whether cholestatic jaundice causes spatial deficits in rats and if these cognitive deficits are reversed by biliary drainage. Rats were randomly divided into three groups. ⋯ After biliary decompression for 1 week, the serum albumin concentration in the TBD group still did not return to the level of the SHAM group. The results of this study suggest that long-term cholestasis results in spatial memory deficits in rats that correlate with anemia and hyperbilirubinemia encephalopathy. Early biliary decompression of obstructive jaundice improves spatial memory deficits, possibly related to the recovery of the serum ammonia and hemoglobin levels.