Dorsal defect of the patella: An efficient, safe and mini-invasive treatment by percutaneous sclerosis with radiopaque gelified ethanol (Discogel®)

Abstract. Background: Worldwide prevalence of peripheral artery disease (PAD) is increasing and peripheral vascular intervention (PVI) has become the primary invasive treatment. There is evidence that multidisciplinary team decision-making (MTD) has an impact on in-hospital outcomes. This study aims to depict practice patterns and time changes regarding MTD of different medical specialties. Methods: This is a retrospective cross-sectional study design. 20,748 invasive, percutaneous PVI of PAD conducted in the metropolitan area of Hamburg (Germany) were consecutively collected between January 2004 and December 2014. Results: MTD prior to PVI was associated with lower odds of early unsuccessful termination of the procedures (Odds Ratio 0.662, p < 0.001). The proportion of MTD decreased over the study period (30.9 % until 2009 vs. 16.6 % from 2010, p < 0.001) while rates of critical limb-threatening ischemia (34.5 % vs. 42.1 %), patients´ age (70 vs. 72 years), PVI below-the-knee (BTK) (13.2 % vs. 22.4 %), and rates of severe TASC C/D lesions BTK (43.2 % vs. 54.2 %) increased (all p < 0.001). Utilization of MTD was different between medical specialties with lowest frequency in procedures performed by internists when compared to other medical specialties (7.1 % vs. 25.7 %, p < 0.001). Conclusions: MTD prior to PVI is associated with technical success of the procedure. Nonetheless, rates of MTD prior to PVI are decreasing during the study period. Future studies should address the impact of multidisciplinary vascular teams on long-term outcomes.

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Magnetic stimulation scores modest success as antidepressant trial of non-invasive treatment used new, convincing sham control

PsycEXTRA Dataset ◽

10.1037/e650002010-001 ◽

2010 ◽

Keyword(s):

Magnetic Stimulation ◽

Sham Control ◽

Invasive Treatment ◽

Non Invasive

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Percutaneous Mitral Annuloplasty for Treatment of Functional Mitral Regurgitation

European Cardiology Review ◽

10.15420/ecr.2009.5.1.67 ◽

2009 ◽

Vol 5 (1) ◽

pp. 67

Author(s):

Lutz Buellesfeld ◽

Lazar Mandinov ◽

Eberhard Grube ◽

◽

...

Keyword(s):

Mitral Regurgitation ◽

Coronary Sinus ◽

Standard Of Care ◽

Mitral Annulus ◽

Functional Mitral Regurgitation ◽

Invasive Treatment ◽

Large Variability ◽

Mitral Annuloplasty ◽

Number Of Patients ◽

Anatomical Relationship

Functional mitral regurgitation affects a substantial proportion of patients with congestive heart failure due to myocardial infarction or dilated cardiomyopathy. Functional mitral regurgitation greatly increases morbidity and mortality. Surgical annuloplasty is the standard of care for symptomatic patients with moderate or severe functional mitral regurgitation; however, a large number of patients are refused surgery. Several percutaneous approaches have been developed to address the need for less invasive treatment of mitral annulus dilatation. Devices using coronary sinus to cinch the mitral annulus are relatively easy to use; however, a number of factors may limit their clinical application, such as suboptimal anatomical relationship between the coronary sinus and mitral annulus, risk of coronary artery compression, large variability in the coronary venous anatomy and conflict with other therapies such as ablation or cardiac resynchronisation. Direct mitral annuloplasty is anticipated to be more effective than the coronary sinus approaches; however, it has yet to prove its safety and efficacy in carefully designed clinical trials. The best candidates and the best timing for each percutaneous mitral annuloplasty therapy, whether direct or indirect, have yet to be identified.

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Percutaneous Minimally Invasive Treatment for the Trigeminal Neuralgia: A Review

Journal of Anesthesia and Perioperative Medicine ◽

10.24015/japm.2015.0023 ◽

2015 ◽

Vol 2 (3) ◽

pp. 167-174

Author(s):

Xiang-Fei Guo ◽

Jun Ma

Keyword(s):

Trigeminal Neuralgia ◽

Minimally Invasive ◽

Minimally Invasive Treatment ◽

Invasive Treatment

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Percutaneous Sacroplasty for Sacral Insufficiency Fractures: Case Series and Review of Presentation, Diagnosis, and Treatment

American Journal of Interventional Radiology ◽

10.25259/ajir-55-2018 ◽

2019 ◽

Vol 3 ◽

pp. 4

Author(s):

Andrew C. Clark ◽

Devang Butani

Keyword(s):

Low Back Pain ◽

Elderly Population ◽

Case Series ◽

The Elderly ◽

Treatment Method ◽

Open Reduction Internal Fixation ◽

Low Back ◽

Insufficiency Fractures ◽

Invasive Treatment ◽

Sacral Insufficiency Fractures

Sacral insufficiency fractures (SIFs) are a cause of debilitating low back pain that is often difficult to diagnosis and manage. The diagnosis of SIF is often delayed due to inaccurately attributing symptoms to spondylosis, which is a commonly present in the elderly population where SIFs are most prevalent. Historically, treatment consisted of medical management and open reduction internal fixation reserved for severe cases. However, percutaneous sacroplasty has emerged as a minimally invasive treatment option which provides early pain relief without significant complications. The objective of this article is to raise awareness of SIFs and percutaneous sacroplasty as an effective and safe treatment method.

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Gamma knife surgery for trigeminal neuralgia: improved initial response with two isocenters and increasing dose

Journal of Neurosurgery ◽

10.3171/sup.2005.102.s_supplement.0185 ◽

2005 ◽

Vol 102 (Special_Supplement) ◽

pp. 185-188 ◽

Cited By ~ 4

Author(s):

Tracy E. Alpert ◽

Chung T. Chung ◽

Lisa T. Mitchell ◽

Charles J. Hodge ◽

Craig T. Montgomery ◽

...

Keyword(s):

Radiation Dose ◽

Trigeminal Neuralgia ◽

Gamma Knife ◽

Linear Regression Analysis ◽

Initial Response ◽

Gamma Knife Surgery ◽

Invasive Treatment ◽

Content Type ◽

Improvement Score ◽

Fine Print

Object. The authors sought to evaluate the initial response of trigeminal neuralgia (TN) to gamma knife surgery (GKS) based on the number of shots delivered and radiation dose. Methods. Between September 1998 and September 2003, some 63 patients with TN refractory to medical or surgical management underwent GKS at Upstate Medical University. Ten patients had multiple sclerosis and 25 patients had undergone prior invasive treatment. Gamma knife surgery was delivered to the trigeminal nerve root entry zone in one shot in 27 patients or two shots in 36 patients. The radiation dose was escalated to less than or equal to 80 Gy in 20 patients, 85 Gy in 21 patients, and greater than or equal to 90 Gy in 22 patients. Pain before and after GKS was assessed using the Barrow Neurological Institute Pain Scale and the improvement score was analyzed as a function of dose grouping and number of shots. Sixty patients were available for evaluation, with an initial overall and complete response rate of 90% and 27%, respectively. There was a greater improvement score for patients who were treated with two shots compared with one shot, mean 2.83 compared with 1.72 (p < 0.001). There was an increased improvement in score at each dose escalation level: less than or equal to 80 Gy (p = 0.017), 85 Gy (p < 0.001), and greater than or equal to 90 Gy (p < 0.001). Linear regression analysis also indicated that there was a greater response with an increased dose (p = 0.021). Patients treated with two shots were more likely to receive a higher dose (p < 0.001). There were no severe complications. Five patients developed mild facial numbness. Conclusions. Gamma knife surgery is an effective therapy for TN. Initial response rates appear to correlate with the number of shots and dose.

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The Obesity-associated Risk in Open and Endovascular Repair of Abdominal Aortic Aneurysm

Current Pharmaceutical Design ◽

10.2174/1381612825666190710112844 ◽

2019 ◽

Vol 25 (18) ◽

pp. 2033-2037 ◽

Cited By ~ 2

Author(s):

Djordje Radak ◽

Slobodan Tanaskovic ◽

Mihailo Neskovic

Keyword(s):

Risk Factor ◽

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Treatment Option ◽

Morbidly Obese ◽

Complication Rates ◽

Obese Patients ◽

Invasive Treatment ◽

Abdominal Aortic ◽

The Subject

: The rising pandemic of obesity in modern society should direct attention to a more comprehensive approach to abdominal aortic aneurysm (AAA) treatment in the affected population. Although overweight patients are considered prone to increased surgical risk, studies on the subject did not confirm or specify the risks well enough. : Associated comorbidities inevitably lead to a selection bias leaning towards endovascular abdominal aortic repair (EVAR), as a less invasive treatment option, which makes it hard to single out obesity as an independent risk factor. The increased technical difficulty often results in prolonged procedure times and increased blood loss. Several smaller studies and two analyses of national registries, including 7935 patients, highlighted the advantages of EVAR over open repair (OR) of abdominal aortic aneurysm, especially in morbidly obese population (relative risk reduction up to 47%). On the other hand, two other studies with 1374 patients combined, concluded that EVAR might not have an advantage over OR in obese patients (P = 0.52). Obesity is an established risk factor for wound infection after both EVAR and OR, which is associated with longer length of stay, subsequent major operations, and a higher rate of graft failure. Percutaneous EVAR technique could present a promising solution to reducing this complication. : EVAR seems like a more feasible treatment option than OR for obese patients with AAA, due to lower overall morbidity and mortality rates, as well as reduced wound-related complication rates. However, there is a clear lack of high-quality evidence on the subject, thus future prospective trials are needed to confirm this advantage.

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Combined Chylothorax and Chylous Ascites Complicating Liver Transplantation: A Report of a Case and Review of the Literature

Case Reports in Transplantation ◽

10.1155/2019/9089317 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5

Author(s):

Tommy Ivanics ◽

Semeret Munie ◽

Hassan Nasser ◽

Shravan Leonard-Murali ◽

Atsushi Yoshida ◽

...

Keyword(s):

Liver Transplantation ◽

Enteral Feeding ◽

Early Recognition ◽

Medium Chain Triglyceride ◽

Serum Triglyceride ◽

Chylous Ascites ◽

Abdominal Distension ◽

Invasive Treatment ◽

Management Options ◽

Early Enteral Feeding

Chyle leaks may occur as a result of surgical intervention. Chyloperitoneum, or chylous ascites after liver transplantation, is rare and the development of chylothorax after abdominal surgery is even more rare. With increasingly aggressive surgical resections, particularly in the retroperitoneum, the incidence of chyle leaks is expected to increase in the future. Here we present a unique case of a combined chylothorax and chyloperitoneum following liver transplantation successfully managed conservatively. Risk factors for chylous ascites include para-aortic manipulation, extensive retroperitoneal dissection, use of a Ligasure device, and early enteral feeding as well as early enteral feeding. The clinical presentation is typically insidious and may include painless abdominal distension. Diagnosis can be made by noting characteristic milky white drainage which on laboratory examination has a total fluid triglyceride level >110 mg/dl, an ascites/serum triglyceride ratio of >1 and a leukocyte count in fluid >1000/uL with a lymphocyte predominance. Chyle leaks may lead to significant morbidity and mortality. Numerous management options exist, with conservative nonoperative measurements leading to the most consistent and successful outcomes. This includes a step-up approach beginning with dietary modifications to a low-fat or medium chain triglyceride diet followed by nil per os with addition of total parenteral nutrition and somatostatin analogues such as octreotide. Rarely do patients require more invasive treatment. Early recognition and appropriate management are imperative to mitigate this complication.

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