Surgical oncology
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Developments in oncological and medical therapies mean that life expectancy of patients with metastatic bone disease (MBD) is often measured in years. Complications of MBD may dramatically and irreversibly affect patient quality of life, making the careful assessment and appropriate management of these patients essential. The roles of orthopaedic and spinal surgeons in MBD generally fall into one of four categories: diagnostic, the prophylactic fixation of metastatic deposits at risk of impending fracture (preventative surgery), the stabilisation or reconstruction of bones affected by pathological fractures (reactive surgery), or the decompression and stabilisation of the vertebral column, spinal cord, and nerve roots. ⋯ The opinion of a spinal surgeon should be sought early, as delays in referral directly correlate to worse functional recovery following intervention. Patients who suffer a slowly progressive deficit, present within hours of complete neurological deficit, or have compression caused by bone alone are those most likely to benefit from surgery. Back pain in the presence of MBD should be regarded as impending spinal cord compression, and investigated urgently to allow intervention prior to the development of neurological compromise.
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The use of totally implantable venous devices (TIVAD) has changed the care and quality of life for cancer patients, these devices allow chemotherapy administration, and blood sampling without the need for repeated venipuncture. These ports are used mainly when IV access is needed only intermittently over a long period of time. We are presenting a brief overview on TIVADs, with focus on the mid and long-term complications associated with these devices with their management.
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With the purpose to reduce the complications of radical cystectomy and intestinal urinary reconstruction a perioperative protocol based on fast-track surgery principles and technical modifications of the original surgical technique was applied to patient candidates for etherotopic bladder substitution. Our protocol included pre-, intra-, and postoperative interventions. The technical variations of the modified Indiana pouch technique were focused on intestinal anastomosis to restore bowel continuity, uretero-colonic anastomoses, and capacity of the reservoir. ⋯ Progress in the perioperative management of major surgery and technical refinements can contribute to reduced complications. In addition, the use of objective reporting tools will facilitate comparison of studies.