جستجوی مقالات مرتبط با کلیدواژه « surgical management » در نشریات گروه « پزشکی »

Schwannoma, a peculiar benign nerve sheath tumour, is frequently hard to differentiate from other nerve tumours, such as neurofibroma. Around 25%-45% of all schwannomas emerge in the head and neck region, but only 0.1-1.5 % involve laryngeal structure. This tumour is most accurately diagnosed with biopsy via direct laryngoscopy; however, at some points this approach cannot detect a definitive diagnosis due to the surrounding capsule of the tumour and its similar histopathologic finding with other nerve sheath tumour.

Case Report:

 Here, a case of 56-year-old female is reported with chief complaints of severe progressive dyspnea and dysphagia. Diagnosis of schwannoma was confirmed on radiological and histopathological examination with certain hurdles. A complete surgical excision via endoscopic approach was done, revealing that the bottom of the mass was attached to the right arytenoid mucosa. The histopathological features showed non-malignant atypical neurofibroma but later confirmed as laryngeal schwannoma from immunohistochemical staining.

Although schwannoma has an excellent outcome and prognosis when occurring elsewhere in the body, laryngeal involvement is an extremely rare area for this lesion. Complete resection with a patient-customized approach to the lesion is required to avoid relapses and provide good functional results.

Relative value units (RVUs) are assigned to Current Procedural Technology (CPT) codes and giverelative economic values to the services physicians provide. This study compared the RVU reimbursements for thesurgical options of proximal humerus fractures in the elderly, which include arthroplasty (reverse [RSA] and total [TSA]),hemiarthroplasty (HA), and open reduction and internal fixation (ORIF). Using the National Surgical Quality Improvement Program, a total of 1,437 patients of at least 65 yearsof age with proximal humerus fractures between 2008 and 2016 were identified. Of those, 259 underwent RSA/TSA(CPT code 23472), 418 underwent HA (CPT codes 23470 and 23616), and 760 underwent ORIF (CPT code 23615).Univariate analysis compared RVU per minute, reimbursement rate, and the average annual revenue across cohortsbased on respective operative times. RSA/TSA generated a mean RVU per minute of 0.197 (SD 0.078; 95%CI [0.188, 0.207]), which wassignificantly greater than the mean RVU per minute for 23470 HA (0.156; SD 0.057; 95%CI [0.148, 0.163]), 23616 HA(0.166; SD 0.065; 95%CI [0.005, 0.156]), and ORIF (0.135; SD 0.048; 95%CI [0.132, 0.138]; p <0.001). This convertedto respective reimbursement rates of $6.97/min (SD 2.78; 95%CI [6.63, 7.31]), $5.48/min (SD 2.05; 95%CI [5.22,5.74]), $5.83/min (SD 2.28; 95%CI [5.49, 6.16]) and $4.74/min (SD 1.69; 95%CI [4.62, 4.87]). After extrapolation,respective average annual revenues were $580,386, $456,633, $475,077, and $395,608. RSA/TSA provides significantly greater reimbursement rates compared to HA and ORIF. Orthopaedicsurgeons can use this information to optimize daily procedural cost-effectiveness in their practices.Level of evidence: III

Papillary thyroid cancer (PTC) in thyroglossal duct cyst (TGDC) is an infrequent condition with less than two hundred cases described in literature, with an incidence likely to be close to 1%. While its management is quite straightforward, there exists significant controversy regarding whether additional treatment is needed to manage incidentally noticed carcinoma in TGDCs.  

A 37-years-old man came to us complaining of a slowly progressive neck mass located in the midline from 4 years ago. Ultrasonography (US) showed a mixed tumor with cyst predominance of 90x79x50 mm and Computed-Tomography (CT) revealed a mixed inframentonian heterogeneous tumor associated with small, mostly peripheral calcifications. The mass was resected using Sistrunk’s surgery. Histologic review reported a moderately differentiated papillary carcinoma in thyroglossal duct cyst, without vascular and lymphatic invasion. After two months, a total thyroidectomy was done, to which the pathological report informed normal thyroid.  

Thyroglossal duct cyst carcinoma is a rare entity. Management should be decided on single risk stratification. In all cases, a Sistrunk surgery would be accomplished in order  to remove the tumor. The reason for thyroidectomy in individuals with a normal thyroid is due to the probability of presenting an intraglandular thyroid cancer concomitantly. It also enables the management with radio-iodine and patient follow up by quantifying thyroglobulin levels.

Quadriceps tendon ruptures (QTR) are uncommon injuries of knee extensor mechanism. Although immediate repair is necessary to re-establish knee extensor continuity, favorable outcome of QTR reconstruction even several years after injury is reported.
The outcome of acute and chronic QTR is rarely investigated. The current study aimed at evaluating the objective and subjective measures of outcome following the surgery of acute and chronic QTR.
A total of 6 QTR injuries, 3 acute and 3 chronic cases, in subjects with the mean age of 31.66 ± 12.7 years and mean follow-up of 4.3 ± 2.5 years were retrospectively evaluated. Pre- and post-operative subjective measures including international knee documentation committee (IKDC), modified Cincinnati knee scores, and objective measures including range of motion (ROM) and extension lag were used to evaluate the outcomes.
ROM improvement was 36.6° in acute and 33.3° in chronic injuries. Extension lag improvement was 28.3° in acute and 26.7° in chronic injuries. IKDC improvement was 72.8 in acute and 62.4 in chronic injuries. Improvement of modified Cincinnati was 72.6 in acute and 64.7 in chronic injuries. No post-operative complications were observed in the studied series, while all cases re-established their pre-operative activity level.
According to the current study results, delayed repair of QTR injury adversely affected the outcome of surgery. Meanwhile, surgical reconstruction of chronic QTR is still warranted regarding the considerable post-surgical improvement of the outcome measures.

Vesicoureteral reflux is a common problem in young children. The increased risk of urinary tract infection in these patients is the main cause of renal parenchymal damage. The main managements are prophylactic antibiotics and different surgical interventions. In this study, we evaluate the results of surgical intervention in VUR patients.
This is a cross sectional retrospective study of all our patients with primary reflux who have been managed surgically between 2002 and 2016.
Of 420 patients with VUR, 207 were managed surgically. Eighteen (8.7%) patients with bilateral reflux before intervention and persistent reflux (grade II or III) after intervention, progressed to end stage renal disease (ESRD). There was no significant relation between the grade of reflux, the serum level of the creatinine or frequency of positive urine culture, and progression to ESRD, while a significant relation existed between grade of post-operative VUR and post-operative positive urine culture with ESRD (P = 0.000).
It seems that surgery cannot prevent renal damage in some cases of VUR. Close follow up after surgical intervention particularly in those with persistent reflux (of any grade) for prevention of renal damage is recommended.

Linear frontal bone fractures are common injuries in road traffic accidents. Pneumocephalus and CSF (cerebrospinal fluid) leak are both factors influencing their outcome. Persistent pneumocephalus and CSF leak are main indications for surgical treatment.

Surgical indications are rarely discussed in linear frontal bone fractures. We report results on patients with linear frontal bone fractures, clinical data, management, surgical indications and outcome.

From 2011 to 2015, 121 patients were admitted to our institution with a diagnosis of frontal bone fractures (compound depressed fractures excluded). Fractures were classified into three types, Type A: fracture involving anterior wall of the frontal sinus; Type B: fracture involving posterior wall of the frontal sinus and Type C: fracture of frontobasal region without involving the frontal sinus. All patients were followed for more than 6 months.

A total of 112 patients were conservatively treated with standard pneumocephalus protocol. Nine patients underwent surgical intervention. The indications for surgery were the presence of persistent pneumocephalus in CT scan and persistent CSF leak. The presence of pneumocephalus or CSF leak in Type B patients sinus cranialisation with repair of the defect were the variables mainly influencing the outcome (P < 0.001).

Frontal bone fracture needs careful attention to prevent its complications such as a CSF leak and meningitis. Patients need clinical and radiological evaluation. Patients with persistent CSF leak or pneumocephalus should always be treated surgically and others should be managed conservatively

This study represents a case of extensive perforating internal root resorption in tooth 7 in 22-yearold female, with a history of trauma in the anterior segment of maxilla in childhood. Diagnosis was made by clinical manifestation, intraoral periapical radiograph and cone beam computed tomography (CBCT). CBCT has superior diagnostic accuracy that results in better management of complicated cases. Due to hemorrhage from the perforation site into the canal, and inability to dry the canal space surgical approach was employed to seal the resorptive defect. Clinical and radiographic examination revealed a successful outcome six months after treatment.

Calcifying odontogenic cyst (COC), Central odontogenic fibroma (COF) and aggressive central giant cell granuloma (CGCG) are rare pathologic diseases affecting the jaws. While the Co-existence of two of them is reported in the literature, existence of all three conditions in one patient is an extremely rare entity. In the present report, initial biopsy revealed fibrosarcoma, therefore mandibular resection was performed for the subject. Sectional Histopathologic evaluation revealed the co-existence of three conditions through histopathologic evaluation. This report emphasizes the importance of precise microscopical evaluation of jaw lesions and thorough sectional examination of the lesions to reach the precise diagnosis. Treatment modalities and follow-up radiographs are also provided to help clinicians manage these entities.

Tumors involving the hand skeleton are rare. However, a basic knowledge of hand tumors is necessary for every clinician. This is due to the importance of distinguishing typical benign tumors from life or limb threatening malignant ones. This study is a review of 99 cases of osseous hand tumors presented to the department of orthopedic surgery, Imam Khomeini Hospital in Tehran, Iran, from December 1990 to February 2011. Ninety-one cases were benign osseous tumors of the hand and eight tumors were malignant which four of them were considered as primary and four considered as metastatic type. The most common benign tumors were enchondroma and osteoid osteoma. Other benign tumors were epidermoid bone cyst, giant cell tumor of the bone, aneurysmal bone cyst, osteoblastoma, and osteochondroma. Primary malignant tumors were extremely rare and we have reported two chondrosar- comas, one osteosarcoma and one Ewing’s sarcoma involving the hand skeleton. This study indicates that the history, physical examination, laboratory and radiographic data as well as clini- cians’ knowledge of specific hand tumors are required for the best management strategy. New techniques could lead to earlier diagnosis, prevent complications and indentify the most effective type of treatment.