Fungal keratitis: A review of clinical presentations, treatment strategies and outcomes

✓The tethered spinal cord is a fascinating yet controversial condition seen frequently in neurosurgical practice. Treatment decision making is made difficult by the variety of lesions and clinical presentations comprised by this condition and the absence of high-quality clinical outcome data to provide guidance. Clinical presentations may be divided into four general categories or typical scenarios: 1) significant dysraphic abnormality, clear clinical deterioration; 2) significant dysraphic abnormality, clinically normal or stable deficit; 3) incidentally discovered abnormality, other problem; and 4) tethered spinal cord symptomatology, normal imaging. The author provides case examples to illustrate potential treatment approaches and suggests balancing the risks and benefits for each general category. Clearer diagnostic and treatment strategies for the tethered spinal cord will only result from high-quality clinical and basic research. Until the results of such research are available, surgeons should endeavor to maximize benefit and reduce risk for patients who may have a tethered spinal cord, walking the fine line between over- and undertreatment.

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Intraocular Foreign Body: Diagnostic Protocols and Treatment Strategies in Ocular Trauma Patients

Journal of Clinical Medicine ◽

10.3390/jcm10091861 ◽

2021 ◽

Vol 10 (9) ◽

pp. 1861

Author(s):

Hyun Chul Jung ◽

Sang-Yoon Lee ◽

Chang Ki Yoon ◽

Un Chul Park ◽

Jang Won Heo ◽

...

Keyword(s):

Ocular Trauma ◽

Treatment Strategies ◽

Multivariate Regression Analysis ◽

Common Mechanism ◽

Surgical Removal ◽

Trauma Patients ◽

Visual Outcomes ◽

Common Location ◽

Clinical Presentations ◽

Ocular Imaging

Intraocular foreign bodies (IOFBs) are critical ophthalmic emergencies that require urgent diagnosis and treatment to prevent blindness or globe loss. This study aimed to examine the various clinical presentations of IOFBs, determine the prognostic factors for final visual outcomes, establish diagnostic protocols, and update treatment strategies for patients with IOFBs. We retrospectively reviewed patients with IOFBs between 2005 and 2019. The mean age of the patients was 46.7 years, and the most common mechanism of injury was hammering (32.7%). The most common location of IOFBs was the retina and choroid (57.7%), and the IOFBs were mainly metal (76.9%). Multivariate regression analysis showed that poor final visual outcomes (<20/200) were associated with posterior segment IOFBs (odds ratio (OR) = 11.556, p = 0.033) and retinal detachment (OR = 4.781, p = 0.034). Diagnosing a retained IOFB is essential for establishing the management of patients with ocular trauma. To identify IOFBs, ocular imaging modalities, including computed tomography or ultrasonography, should be considered. Different strategies should be employed during the surgical removal of IOFBs depending on the material, location, and size of the IOFB.

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Os Odontoideum: A Single-Center Experience with Controversies in Management and Evolution of Treatment Strategies

Indian Journal of Neurosurgery ◽

10.1055/s-0039-1686960 ◽

2021 ◽

Author(s):

Vamsi Krishna Yerramneni ◽

Neeraj Sharma

Keyword(s):

Treatment Strategies ◽

Craniovertebral Junction ◽

The Body ◽

Os Odontoideum ◽

Review Of Literature ◽

Single Center ◽

Variable Size ◽

Size And Shape ◽

Single Center Experience ◽

Clinical Presentations

AbstractOs odontoideum is an independent ossicle of variable size and shape separated from the body of C2. There are various theories on the etiology. Different hypothesis on etiology include traumatic and congenital. Because of the laxity of the ligaments associated with the anomalous odontoid, there can be associated instability at the craniovertebral junction. The authors presented their experience of treating these anomalies, their clinical presentations, evolution of the treatment strategies over years, and a brief review of literature on etiopathogenesis.

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Equine Cervical Pain and Dysfunction: Pathology, Diagnosis and Treatment

Animals ◽

10.3390/ani11020422 ◽

2021 ◽

Vol 11 (2) ◽

pp. 422

Author(s):

Melinda R. Story ◽

Kevin K. Haussler ◽

Yvette S. Nout-Lomas ◽

Tawfik A. Aboellail ◽

Christopher E. Kawcak ◽

...

Keyword(s):

Cervical Spine ◽

Soft Tissues ◽

Current Knowledge ◽

Treatment Options ◽

Treatment Strategies ◽

Poor Performance ◽

Well Being ◽

Cervical Pain ◽

Clinical Presentations ◽

Starting Point

Interest in the cervical spine as a cause of pain or dysfunction is increasingly becoming the focus of many equine practitioners. Many affected horses are presented for poor performance, while others will present with dramatic, sometimes dangerous behavior. Understanding and distinguishing the different types of neck pain is a starting point to comprehending how the clinical presentations can vary so greatly. There are many steps needed to systematically evaluate the various tissues of the cervical spine to determine which components are contributing to cervical pain and dysfunction. Osseous structures, soft tissues and the central and the peripheral nervous system may all play a role in these various clinical presentations. After completing the clinical evaluation, several imaging modalities may be implemented to help determine the underlying pathologic processes. There are multiple treatment options available and each must be carefully chosen for an individual horse. Provided is a synopsis of the current knowledge as to different disease processes that can result in cervical pain and dysfunction, diagnostic approaches and treatment strategies. Improving the knowledge in these areas will ideally help to return horses to a state of well-being that can be maintained over time and through the rigors of their job or athletic endeavors.

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Headache as unusual presentation in moyamoya disease

Medpusle International Journal of Medicine ◽

10.26611/102111212 ◽

2021 ◽

Vol 11 (2) ◽

pp. 115-118

Author(s):

Pathik Shah ◽

Keyword(s):

Magnetic Resonance ◽

Moyamoya Disease ◽

Treatment Strategies ◽

Rare Condition ◽

Research Committee ◽

Conventional Angiography ◽

Moyamoya Angiopathy ◽

Clinical Presentations ◽

Magnetic Resonance Imaging Mri ◽

Collateral Vessels

Our case highlights basics of clinical presentations, causes, risk factors, epidemiology, physiology, and pathophysiology in Moyamoya diseases, along with introduction to terminologies, prospect of evaluation and various modalities available for diagnosis. Moyamoya angiopathy is characterized by a progressive stenosis of the terminal portion of the internal carotid arteries and the development of a network of abnormal collateral vessels. This chronic cerebral angiopathy is observed in children and adults. It mainly leads to brain ischemic events in children, and to ischemic and hemorrhagic events in adults. This is a rare condition, with a marked prevalence gradient between Asian countries and Western countries. Two main nosological entities are identified. On the one hand, moyamoya disease corresponds to isolated moyamoya angiopathy, defined as being “idiopathic” according to the Guidelines of the Research Committee on the Pathology and Treatment of Spontaneous Occlusion of the Circle of Willis. This entity is probably multifactorial and polygenic in most patients. On the other hand, moyamoya syndrome is a moyamoya angiopathy associated with an underlying condition and forms a very heterogeneous group with various clinical presentations, various modes of inheritance, and a variable penetrance of the cerebrovascular phenotype. Diagnostic and evaluation techniques rely on magnetic resonance imaging (MRI), magnetic resonance angiography (MRA) conventional angiography, and cerebral hemodynamics measurements. Revascularization surgery can be indicated, with several techniques. Characteristics of genetic moyamoya syndromes are presented, with a focus on recently reported mutations in BRCC3/MTCP1 and GUCY1A3 genes. Identification of the genes involved in moyamoya disease and several monogenic moyamoya syndromes unravelled different pathways involved in the development of this angiopathy. Studying genes and pathways involved in monogenic moyamoya syndromes may help to give insights into pathophysiological models and discover potential candidates for medical treatment strategies.

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Paediatric Fungal Keratitis：A Case Series of 45 Children Presenting to a Tertiary Referral Centre

10.21203/rs.3.rs-637362/v1 ◽

2021 ◽

Author(s):

Jing Zhang ◽

Huabo Chen ◽

Xiaomei Wan ◽

Mingming Jiang ◽

Yichao Ding ◽

...

Keyword(s):

Treatment Strategies ◽

Case Series ◽

Northern China ◽

Fungal Keratitis ◽

Tertiary Referral Centre ◽

Laboratory Findings ◽

Neutrophil Lymphocyte Ratio ◽

Peripheral Blood Neutrophil ◽

Fungi Infection ◽

Fusarium Fungi

Abstract Purpose：To analyze the etiology, characteristics, and treatment outcomes of paediatric fungal keratitis in northern China.Methods：The medical records of children (< 18 years old) diagnosed with fungal keratitis at the Shandong Eye Institute from 1996 to 2017 were reviewed for demographic features, risk factors, seasonal variation, clinical characteristics, laboratory findings, and treatment strategies.Results：Forty-five children (46 eyes) were included. Fungal keratitis in children accounted for 16.4% of all of the children with infectious keratitis, which was lower than that in adults (59.4%, p < 0.001). Unexplained fungal keratitis accounted for 26.1%. Plant trauma (23.9%) and wind and sand into the eyes (21.7%) ranked second and third, respectively. Fusarium fungi infection was found in 69.9%, and 31.0% were infected by Aspergillus fungi. The corneal ulcer area was positively correlated with a peripheral blood neutrophil/lymphocyte ratio (NLR) at the first visit (r = 0.310, p = 0.036). Voriconazole had the highest drug sensitivity rate. A total of 67.4% (31 eyes) underwent therapeutic keratoplasty (PKP 21 eyes; LKP 10 eyes). The recurrence rate was 3.2% (due to an Aspergillus infection). The best corrected visual acuity (BCVA) after treatment in children ≤ 8 years (median 20/60) was lower than the BCVA in children > 8 years (median 20/50, p = 0.035).Conclusions：Fungal keratitis are less common in children than in adults. The main infection was due to Fusarium fungi. The preferred antifungal drug was voriconazole. LKP treatment is preferred for Fusarium infection keratitis.

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Evolution of the Management of Tentorial Dural Arteriovenous Malformations

Neurosurgery ◽

10.1227/01.neu.0000053221.22954.85 ◽

2003 ◽

Vol 52 (4) ◽

pp. 750-762 ◽

Cited By ~ 111

Author(s):

Patrick R. Tomak ◽

Harry J. Cloft ◽

Akihiko Kaga ◽

C. Michael Cawley ◽

Jacques Dion ◽

...

Keyword(s):

Arteriovenous Malformations ◽

Therapeutic Strategy ◽

Transarterial Embolization ◽

Treatment Strategies ◽

Venous Drainage ◽

Neurological Deficits ◽

Transvenous Embolization ◽

Single Institution ◽

Clinical Presentations

Abstract OBJECTIVE Tentorial dural arteriovenous malformations (DAVMs) are uncommon lesions associated with an aggressive natural history. Controversy exists regarding their optimal treatment. We present a single-institution series of tentorial DAVMs treated during a 12-year period, address the current controversies, and present the rationale for our current therapeutic strategy. METHODS Twenty-two patients with tentorial DAVMs were treated between 1988 and 2000. Treatment consisted of transarterial or transvenous embolization, surgical resection, disconnection of venous drainage, or a combination of these therapies. The clinical presentations, radiological features, treatment strategies, and results were studied. RESULTS Eighteen patients (82%) presented with intracranial hemorrhage or progressive neurological deficits. Retrograde leptomeningeal venous drainage was documented in 22 cases (100%), classifying the lesions as Borden Type III. Angiographic follow-up monitoring was performed for 0 to 120 months and clinical follow-up monitoring for 1 to 120 months. Posttreatment angiography demonstrated obliteration in 22 cases (100%). Two patients experienced neurological decline after endovascular treatment and died. All of the 20 surviving patients exhibited clinical improvement; there were no episodes of rehemorrhage or new neurological deficits. Outcomes were excellent in 17 cases (77%), good in 2 cases (9%), and fair in 1 case (5%), and there were 2 deaths (9%). CONCLUSION Tentorial DAVMs are aggressive lesions that require prompt total angiographic obliteration. Disconnection of the venous drainage from the fistula may be accomplished with transarterial embolization to the venous side, transvenous embolization, or surgical disconnection of the fistula. We think that extensive nidal resections carry more risk and are unnecessary. We do not think there is a role for stereotactic radiosurgery in the treatment of these lesions.

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Supraventricular tachycardia

Challenging Concepts in Congenital and Acquired Heart Disease in the Young ◽

10.1093/med/9780198759447.003.0008 ◽

2020 ◽

pp. 99-116

Author(s):

Will Regan ◽

Jasveer Mangat

Keyword(s):

Catheter Ablation ◽

Supraventricular Tachycardia ◽

Medical Management ◽

Treatment Strategies ◽

Invasive Treatment ◽

Child Benefits ◽

Acute Presentation ◽

Clinical Presentations ◽

Current Guidelines ◽

Case Based

This chapter is a case-based discussion of the management of supraventricular tachycardia (SVT) in children. The case illustrates the challenges of medical management of SVT in neonatal life and infancy, both in terms of acute presentation, as well as longer-term medical care and outpatient monitoring to reduce recurrences of paroxysmal tachycardias as the child grows. Ultimately, the child benefits from an electrophysiology study (EPS) and catheter ablation. The chapter more broadly covers the varying clinical presentations of SVT in children and common treatment strategies employed. The electrophysiological mechanisms of SVT commonly seen in children are outlined. There is a review of the evidence behind the medical management of SVT in children, including a practical guide on the choice of anti-arrhythmic medication for different mechanisms of tachycardia, based on current guidelines. Finally, the chapter summarizes the invasive treatment option of EPS and ablation in children.

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Development of an Open-Access Library of Pediatric Congenital Heart Diseases and Treatments: A Tutorial on the Atlas of Human Cardiac Anatomy

2020 Design of Medical Devices Conference ◽

10.1115/dmd2020-9064 ◽

2020 ◽

Author(s):

Amanda C. Tenhoff ◽

Alex J. Deakyne ◽

Tinen L. Iles ◽

Shanti L. Narasimhan ◽

Sameh M. Said ◽

...

Keyword(s):

Congenital Heart ◽

Surgical Planning ◽

Heart Diseases ◽

Treatment Strategies ◽

3D Models ◽

Free Access ◽

Cardiac Anatomy ◽

Congenital Heart Diseases ◽

Clinical Presentations ◽

Future Work

Abstract The major aim of this project is to construct a growing database of information regarding specific manifestations of congenital heart diseases (CHDs), subsequent treatments, clinical cases, and patient outcomes. This will include 3D models generated from clinical imaging of individual patient hearts and respective de-identified clinical case information — all of which will be incorporated onto the free-access Atlas of Human Cardiac Anatomy website (http://www.vhlab.umn.edu/atlas/), where anyone can learn more about these diseases and their complexities [1]. Generated models can also be used for 3D printing, such as for pre-surgical planning, as well as for incorporation into virtual reality in order to expand outreach and education efforts [2]. Future work will incorporate computational modeling to enhance insights relative to treatment strategies and surgical planning. By studying a broad range of these unique individual cases, it will be possible for patients, clinicians, and medical device designers alike to better understand the clinical presentations of congenital heart diseases and develop more effective treatment strategies.

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Thoracic Aortic Emergencies: Presenting Pathologies and Treatment Strategies

Seminars in Interventional Radiology ◽

10.1055/s-0039-3401843 ◽

2020 ◽

Vol 37 (01) ◽

pp. 085-096

Author(s):

Daniel P. Sheeran ◽

Adam M. Zelickson ◽

Luke R. Wilkins ◽

J. Fritz Angle ◽

David M. Williams ◽

...

Keyword(s):

Treatment Algorithm ◽

Treatment Strategies ◽

Clinical Settings ◽

Accurate Identification ◽

Treatment Techniques ◽

Appropriate Treatment ◽

Clinical Presentations ◽

Wide Range ◽

Pathologic Processes ◽

Thoracic Stent Graft

AbstractThoracic aortic emergencies reflect a wide range of etiologies, pathologic processes, and clinical presentations. Accurate identification with an appropriate treatment algorithm is best accomplished in a multidisciplinary setting with interventional radiologists, vascular surgeons, and cardiothoracic surgeons. While knowledge of thoracic stent graft equipment and technique is essential in the treatment of thoracic aortic emergencies, many clinical settings may employ alternative treatment techniques. This article will review the most common thoracic aortic emergencies and treatment strategies.

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