Increasing patients’ awareness of their own health: Experiences of participating in follow-up programs after surgical treatment for intermittent claudication

Abstract Here, we report surgical treatment of a patient presenting with pancreatic metastasis (MTS) of renal clear cell carcinoma (RCC) 11 years after nephrectomy. RCC is one of few cancers that metastasise in pancreas. Jaundice, abdominal pain or gastrointestinal bleeding can develop; however, asymptomatic MTS can be discovered by follow-up after removal of the primary tumour. The patient, 67-year-old female was radiologically diagnosed with a clinically silent mass in the pancreatic body and underwent distal pancreatic resection. The postoperative period was smooth. Four months after the surgery, there were no signs of disease progression.

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Patients with “benign” Chiari I malformations require surgical decompression at a low rate

Journal of Neurosurgery Pediatrics ◽

10.3171/2018.10.peds18407 ◽

2019 ◽

Vol 23 (4) ◽

pp. 498-506 ◽

Cited By ~ 9

Author(s):

Tofey J. Leon ◽

Elizabeth N. Kuhn ◽

Anastasia A. Arynchyna ◽

Burkely P. Smith ◽

R. Shane Tubbs ◽

...

Keyword(s):

Surgical Treatment ◽

Posterior Fossa ◽

Multivariate Logistic Regression Analysis ◽

Large Cohort ◽

Initial Evaluation ◽

Published Data ◽

Posterior Fossa Decompression ◽

Signal Abnormality ◽

Chiari I

OBJECTIVEThere are sparse published data on the natural history of “benign” Chiari I malformation (CM-I)—i.e., Chiari with minimal or no symptoms at presentation and no imaging evidence of syrinx, hydrocephalus, or spinal cord signal abnormality. The purpose of this study was to review a large cohort of children with benign CM-I and to determine whether these children become symptomatic and require surgical treatment.METHODSPatients were identified from institutional outpatient records using International Classification of Diseases, 9th Revision, diagnosis codes for CM-I from 1996 to 2016. After review of the medical records, patients were excluded if they 1) did not have a diagnosis of CM-I, 2) were not evaluated by a neurosurgeon, 3) had previously undergone posterior fossa decompression, or 4) had imaging evidence of syringomyelia at their first appointment. To include only patients with benign Chiari (without syrinx or classic Chiari symptoms that could prompt immediate intervention), any patient who underwent decompression within 9 months of initial evaluation was excluded. After a detailed chart review, patients were excluded if they had classical Chiari malformation symptoms at presentation. The authors then determined what changes in the clinical picture prompted surgical treatment. Patients were excluded from the multivariate logistic regression analysis if they had missing data such as race and insurance; however, these patients were included in the overall survival analysis.RESULTSA total of 427 patients were included for analysis with a median follow-up duration of 25.5 months (range 0.17–179.1 months) after initial evaluation. Fifteen patients had surgery at a median time of 21.0 months (range 11.3–139.3 months) after initial evaluation. The most common indications for surgery were tussive headache in 5 (33.3%), syringomyelia in 5 (33.3%), and nontussive headache in 5 (33.3%). Using the Kaplan-Meier method, rate of freedom from posterior fossa decompression was 95.8%, 94.1%, and 93.1% at 3, 5, and 10 years, respectively.CONCLUSIONSAmong a large cohort of patients with benign CM-I, progression of imaging abnormalities or symptoms that warrant surgical treatment is infrequent. Therefore, these patients should be managed conservatively. However, clinical follow-up of such individuals is justified, as there is a low, but nonzero, rate of new symptom or syringomyelia development. Future analyses will determine whether imaging or clinical features present at initial evaluation are associated with progression and future need for treatment.

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Thyroidectomy in a patient with a giant multinodular nontoxic cervical retrosternal goiter

Pacific Medical Journal ◽

10.34215/1609-1175-2020-1-97-99 ◽

2020 ◽

pp. 97-99

Author(s):

U. V. Kukhtenko ◽

O. A. Kosivtsov ◽

L. A. Ryaskov ◽

E. I. Abramian

Keyword(s):

Surgical Treatment ◽

Clinical Case ◽

Clinical Signs ◽

Disease Relapse ◽

Cardiac Pathology ◽

Nontoxic Goiter ◽

Retrosternal Goiter

A clinical case of successful surgical treatment of a patient with a giant cervical retrosternal nontoxic goiter with severe cardiac pathology is presented. Thyroidectomy from cervical access without sternotomy was performed. At the follow-up examination 5 months after the operation, instrumental and clinical signs of disease relapse were not detected.

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TRATAMENTO CIRÚRGICO DE CANINO INCLUSO EM REGIÃO MENTUAL: RELATO DE CASO

International Journal of Science Dentistry ◽

10.22409/ijosd.v0i54.39874 ◽

2019 ◽

Author(s):

Rodrigo Figueiredo de Brito Resende

Keyword(s):

Surgical Treatment ◽

Key Words ◽

Oral Surgery ◽

Tooth Eruption ◽

Points Of View ◽

The Aesthetic ◽

Relationship Of ◽

Transverse Position

RESUMOO dente denominado incluso nada mais é que um dente retido ou impactado dentro do alvéolo dentário de maneira parcial ou completa que não conseguiu erupcionar por motivos patológicos ou simplesmente anatômicos após o período de rizogênese. O canino, em especial, é de suma importância sob os pontos de vista estético e funcional. O deslocamento do canino incluso ultrapassando, ou se aproximando da linha média antes da erupção dentária do mesmo, é mais frequente na mandíbula do que na maxila. Este trabalho tem por objetivo descrever o caso de um paciente de 21 anos que apresentava um canino incluso na região mentual, em posição transversal, inicialmente visualizado em uma radiografia periapical e posteriormente submetido a radiografia com a técnica de Donavan. Através de uma radiografia oclusal, foi possível observar o posicionamento do dente para a vestibular mentoniana e íntima relação do dente retido com as raízes dos incisivos centrais decíduos do paciente. Foi realizada a extração do dente retido no mento, removendo o mesmo por completo sendo feitas osteotomias e odontossecções. O paciente está em acompanhamento clínico à 1 ano após o tratamento cirúrgico.Palavras – chave: Dente incluso; Cirurgia Oral; Imaginologia. ABSTRACTThe tooth inserted is nothing more than a tooth retained or impacted within the dental socket partially or completely that failed to erupt for pathological or simply anatomical reasons after the period of rhizogenesis. The canine, in particular, is of the utmost importance from the aesthetic and functional points of view. The displacement of the canine, even surpassing or approaching the midline before tooth eruption, is more frequent in the mandible than in the maxilla. This work aims to describe the case of a 21 - year - old patient who had a canine included in the mental region, in a transverse position, which was initially visualized on a periapical radiograph and later submitted to radiography with the Donavan technique. An occlusal radiograph showed the positioning of the tooth for the mental vestibular and the intima relationship of the retained tooth with the roots of the patient's central deciduous incisors. Removal of the tooth retained in the denture was performed, removing the tooth completely and osteotomies and odontosections were performed. The patient is in clinical follow-up at 1 year after the surgical treatment. key words: Tooth included; Oral surgery; Imaginology.

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Surgical treatment of infective endocarditis in intravenous drug abusers

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01491-1 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Alina Zubarevich ◽

Marcin Szczechowicz ◽

Anja Osswald ◽

Jerry Easo ◽

Arian Arjomandi Rad ◽

...

Keyword(s):

Surgical Treatment ◽

Drug Abuse ◽

Infective Endocarditis ◽

Mortality Rates ◽

Blood Cultures ◽

Intravenous Drug ◽

Intravenous Drug Abuse ◽

Enterococcus Species ◽

Function Impairment

Abstract Background Despite current progress in antibiotic therapy and medical management, infective endocarditis remains a serious condition presenting with high mortality rates. It also is a life-threatening complication in patients with a history of chronic intravenous drug abuse. In this study, we analyzed our institutional experience on the surgical therapy of infective endocarditis in patients with active intravenous drug abuse. The aim of the study is to identify the predictive factors of mortality and morbidity in this subgroup of patients. Methods Between 2007 and 2020, a total of 24 patients (7 female, mean age 38.5 ± 8.7) presenting with active intravenous drug abuse underwent a surgical treatment for the infective endocarditis at out center. The primary endpoint was survival at 30th day after the surgery. The secondary composite endpoint included freedom from death, recurrent endocarditis, re-do surgery, and postoperative stroke during the follow-up period. Mean follow-up was 4.2 ± 4.3 years. Results Staphylococcus species was the most common pathogen detected in the preoperative blood cultures. Infection caused by Enterococcus species as well as liver function impairment were identified as mortality predictor factors. Logistic EuroSCORE and EusoSCORE-II were also predictive factors for mortality in univariate analysis. Survival at 1 and 3 years was 78 and 72% respectively. Thirty-day survival was 88%. 30-day freedom from combined endpoint was 83% and after 1 and 3 years, 69 and 58% of the patients respectively were free from combined endpoint. Five patients (20.8%) were readmitted with recurrent infective endocarditis. Conclusion In patients presenting with active intravenous drug abuse, treatment of infective endocarditis should be performed as aggressively as possible and should be followed by antibiotic therapy to avoid high mortality rates and recurrent endocarditis. Early intervention is advisable in patients with an infective endocarditis and enterococcus species in the preoperative blood cultures, liver function deterioration as well as cardiac function impairment. Attention should be also payed to addiction treatment, due to the elevated relapse rate in patients who actively inject drugs. However, larger prospective studies are necessary to support our results. As septic shock is the most frequent cause of death, new treatment options, e.g. blood purification should be evaluated.

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Long-Term Clinical Outcomes of Osteochondritis Dissecans Lesions of the Elbow Treated with Arthroscopy

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00202 ◽

2021 ◽

Vol 9 (7_suppl4) ◽

pp. 2325967121S0020

Author(s):

Michael Ryan ◽

Benton Emblom ◽

E. Lyle Cain ◽

Jeffrey Dugas ◽

Marcus Rothermich

Keyword(s):

Surgical Treatment ◽

Clinical Outcomes ◽

Failure Rate ◽

Osteochondritis Dissecans ◽

Surgical Techniques ◽

The Other ◽

Return To Play ◽

Exclusion Criteria

Objectives: While numerous studies exist evaluating the short-term clinical outcomes for patients who underwent arthroscopy for osteochondritis dissecans (OCD) of the capitellum, literature on long-term clinical outcomes for a relatively high number of this subset of patients from a single institution is limited. We performed a retrospective analysis on all patients treated surgically for OCD of the capitellum at our institution from January 2001 to August 2018. Our hypothesis was that clinical outcomes for patients treated arthroscopically for OCD of the capitellum would be favorable, with improved subjective pain scores and acceptable return to play for these patients. Methods: Inclusion criteria for this study included the diagnosis and surgical treatment of OCD of the capitellum treated arthroscopically with greater than 2-year follow-up. Exclusion criteria included any surgical treatment on the ipsilateral elbow prior to the first elbow arthroscopy for OCD at our institution, a missing operative report, and/or any portions of the arthroscopic procedure that were done open. Follow-up was achieved over the phone by a single author using three questionnaires: American Shoulder and Elbow Surgeons – Elbow (ASES-E), Andrews/Carson KJOC, and our institution-specific return-to-play questionnaire. Results: After the inclusion and exclusion criteria were applied to our surgical database, our institution identified 101 patients eligible for this study. Of these patients, 3 were then excluded for incomplete operative reports, leaving 98 patients. Of those 98 patients, 81 were successfully contacted over the phone for an 82.7% follow-up rate. The average age for this group at arthroscopy was 15.2 years old and average post-operative time at follow-up was 8.2 years. Of the 81 patients, 74 had abrasion chondroplasty of the capitellar OCD lesion (91.4%) while the other 7 had minor debridement (8.6%). Of the 74 abrasion chondroplasties, 29 of those had microfracture, (39.2% of that subgroup and 35.8% of the entire inclusion group). Of the microfracture group, 4 also had an intraarticular, iliac crest, mesenchymal stem-cell injection into the elbow (13.7% of capitellar microfractures, 5.4% of abrasion chondroplasties, and 4.9% of the inclusion group overall). Additional arthroscopic procedures included osteophyte debridement, minor synovectomies, capsular releases, manipulation under anesthesia, and plica excisions. Nine patients had subsequent revision arthroscopy (11.1% failure rate, 5 of which were at our institution and 4 of which were elsewhere). There were also 3 patients within the inclusion group that had ulnar collateral ligament reconstruction/repair (3.7%, 1 of which was done at our institution and the other 2 elsewhere). Lastly, 3 patients had shoulder operations on the ipsilateral extremity (3.7%, 1 operation done at our institution and the other 2 elsewhere). To control for confounding variables, scores for the questionnaires were assessed only for patients with no other surgeries on the operative arm following arthroscopy (66 patients). This group had an adjusted average follow-up of 7.9 years. For the ASES-E questionnaire, the difference between the average of the ASES-E function scores for the right and the left was 0.87 out of a maximum of 36. ASES-E pain was an average of 2.37 out of a max pain scale of 50 and surgical satisfaction was an average of 9.5 out of 10. The average Andrews/Carson score out of a 100 was 91.5 and the average KJOC score was 90.5 out of 100. Additionally, out of the 64 patients evaluated who played sports at the time of their arthroscopy, 3 ceased athletic participation due to limitations of the elbow. Conclusions: In conclusion, this study demonstrated an excellent return-to-play rate and comparable subjective long-term questionnaire scores with a 11.1% failure rate following arthroscopy for OCD of the capitellum. Further statistical analysis is needed for additional comparisons, including return-to-play between different sports, outcome comparisons between different surgical techniques performed during the arthroscopies, and to what degree the size of the lesion, number of loose bodies removed or other associated comorbidities can influence long-term clinical outcomes.

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