Primary hypophysitis: Experience of a Single Tertiary Center

2019 ◽  
Vol 129 (01) ◽  
pp. 14-21 ◽  
Author(s):  
Serdar Sahin ◽  
Ozge Polat Korkmaz ◽  
Hande Mefkure Ozkaya ◽  
Tugce Apaydin ◽  
Emine Sebnem Durmaz ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Clinical Outcomes ◽  
Treatment Modality ◽  
Initial Treatment ◽  
Steroid Treatment ◽  
Treatment Modalities ◽  
Bright Spot ◽  
Radiologic Findings ◽  
Appropriate Treatment ◽  
Primary Hypophysitis

Abstract Purpose The authors review the clinical outcomes of patients with primary hypophysitis (PH). Methods Patients with PH who were followed up between 2007 and 2018 at our clinic were evaluated. Clinical, endocrinologic, pathologic, radiologic findings and treatment modalities were assessed. Results Seventeen patients with PH were assessed. The median follow-up was 24 (range, 6–84) months. Histologic confirmation was available in 8 patients (6 lymphocytic hypophysitis, 1 lymphocytic-granulomatous hypophysitis, 1 xanthomatous hypophysitis). None of the cases were diagnosed after pregnancy. Two patients had an autoimmune disease. The most commonly seen symptom was headache. The most common anterior pituitary deficiencies were hypocortisolemia and hypothyroidism. The radiologic findings of the patients at the time of diagnosis revealed various results including space-occupying lesion (41.2%), loss of posterior hypophysis bright spot (47.1%), pituitary stalk thickening (41.2%), uniform contrast enhancement (17.6%), partially empty sella (11.8%), optic chiasm compression (11.8%). The most frequent initial treatment modality was observation. Ten patients who were followed up conservatively had no endocrinologic deterioration; additional treatment was not needed in 8 of these 10 patients. The second most frequent initial treatment modality was pituitary surgery. Five patients received steroid treatment. We found serious adverse effects during steroid treatment in 3 of 5 (60%) patients; unilateral avascular necrosis of the femoral head (n=2), diabetes mellitus(n=1). Conclusion Correctly diagnosing PH and giving appropriate treatment is challenging. It is unclear whether active treatment with steroids improves clinical outcomes. The serious adverse effects of steroids are also taken into account. Observation, surgery and/or radiotherapy can be appropriate treatment modalities for selected patients.

Accuracy of teledentistry examinations at predicting actual treatment modality in a pediatric dentistry clinic

2016 ◽  
Vol 23 (8) ◽  
pp. 710-715 ◽  
Author(s):  
Sean W McLaren ◽  
Dorota T Kopycka-Kedzierawski ◽  
Jed Nordfelt
Keyword(s):  
Treatment Modality ◽  
Initial Treatment ◽  
New York State ◽  
Pediatric Dentistry ◽  
Treatment Modalities ◽  
Treatment Recommendation ◽  
Live Video ◽  
Exact Test ◽  
Fisher's Exact Test ◽  
Fisher’S Exact Test

Objectives The purpose of this study was to assess the accuracy of predicting dental treatment modalities for children seen initially by means of a live-video teledentistry consultation. Methods A retrospective dental record review was completed of 251 rural pediatric patients from the Finger Lakes region of New York State who had an initial teledentistry appointment with a board-certified pediatric dentist located remotely at the Eastman Institute for Oral Health in Rochester, NY. Proportions of children who were referred for specific treatment modalities and who completed treatment and proportions of children for whom the treatment recommendation was changed were calculated. Fisher’s exact test was used to assess statistical significance. Results The initial treatment modality was not changed for 221/251 (88%) children initially seen for a teledentistry consultation. Thirty (12%) children had the initial treatment modality changed, most frequently children who were initially suggested treatment with nitrous oxide. Based on the initial treatment modality, changes to a different treatment modality were statistically significant (Fisher’s exact test, p < 0.0001). Conclusions Our data suggest that the use of a live-video teledentistry consultation can be an effective way of predicting the best treatment modality for rural children with significant dental disease. A live-video teledentistry consultation can be an effective intervention to facilitate completion of complex treatment plans for children from a rural area that have extensive dental needs.

The Effects of Antimicrobial Resistance and the Compatibility of Initial Antibiotic Treatment on Clinical Outcomes in Patients With Diabetic Foot Infection

2021 ◽  
pp. 153473462110041
Author(s):  
Nese Saltoglu ◽  
Serkan Surme ◽  
Elif Ezirmik ◽  
Ayten Kadanali ◽  
Ahmet Furkan Kurt ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Antimicrobial Resistance ◽  
Clinical Outcomes ◽  
Diabetic Foot ◽  
Initial Treatment ◽  
Methicillin Resistance ◽  
Major Amputation ◽  
Diabetic Foot Infection ◽  
Vascular Insufficiency ◽  
Klebsiella Spp

We aimed to determine pathogen microorganisms, their antimicrobial resistance patterns, and the effect of initial treatment on clinical outcomes in patients with diabetic foot infection (DFI). Patients with DFI from 5 centers were included in this multicenter observational prospective study between June 2018 and June 2019. Multivariate analysis was performed for the predictors of reinfection/death and major amputation. A total of 284 patients were recorded. Of whom, 193 (68%) were male and the median age was 59.9 ± 11.3 years. One hundred nineteen (41.9%) patients had amputations, as the minor (n = 83, 29.2%) or major (n = 36, 12.7%). The mortality rate was 1.7% with 4 deaths. A total of 247 microorganisms were isolated from 200 patients. The most common microorganisms were Staphylococcus aureus (n = 36, 14.6%) and Escherichia coli (n = 32, 13.0%). Methicillin resistance rates were 19.4% and 69.6% in S aureus and coagulase-negative Staphylococcus spp., respectively. Multidrug-resistant Pseudomonas aeruginosa was detected in 4 of 22 (18.2%) isolates. Extended-spectrum beta-lactamase-producing Gram-negative bacteria were detected in 20 (38.5%) isolates of E coli (14 of 32) and Klebsiella spp. (6 of 20). When the initial treatment was inappropriate, Klebsiella spp. related reinfection within 1 to 3 months was observed more frequently. Polymicrobial infection ( p = .043) and vancomycin treatment ( p = .007) were independent predictors of reinfection/death. Multivariate analysis revealed vascular insufficiency ( p = .004), hospital readmission ( p = .009), C-reactive protein > 130 mg/dL ( p = .007), and receiving carbapenems ( p = .005) as independent predictors of major amputation. Our results justify the importance of using appropriate narrow-spectrum empirical antimicrobials because higher rates of reinfection and major amputation were found even in the use of broad-spectrum antimicrobials.

scholarly journals 778 Management of Colorectal Anastomotic leaks: The East of England Experience

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
M Aker ◽  
A Askari ◽  
M Rabie ◽  
M Aly ◽  
S Adegbola ◽  
...  
Keyword(s):  
High Mortality ◽  
Initial Treatment ◽  
Surgical Intervention ◽  
Management Strategies ◽  
Treatment Modalities ◽  
Anastomotic Leaks ◽  
Consensus Approach ◽  
Multi Centre Study ◽  
Population Mortality ◽  
Radiological Intervention

Abstract Introduction Colorectal anastomotic leaks (AL) are an unfortunate occurrence and are associated with a high mortality. The aim of this multi-centre study is to explore the different management strategies used and compare outcomes in the management of AL. Method All patients who had an AL were included at seven hospitals across the East of England. Morbidity, mortality, and survival were compared across the different management strategies. Results A total of 247 consecutive patients were included of which 60.3% were male and the median age was 68 (IQR 57-77). Half of patients were initially managed conservatively, a further 10.5% had a radiological procedure. 39.7% required surgery as an initial treatment. Of those who initially did not have a surgical intervention (n = 149), 10.7% (n = 16/149) eventually required laparotomy. Ultimately, 42.7% (n = 106/248) required a laparotomy. The 30- and 90-day across the entire population mortality were 3.6% and 4.9% respectively. There were no significant differences in mortality or long-terms survival between the different initial treatment modalities. Conclusions Despite initial conservative, antibiotic and radiological intervention being successful in the majority of patients, two out of five patients will still require a laparotomy. A consensus approach is required to standardise management in these difficult scenarios.

scholarly journals Survival Associations between Patient Age and Treatment Modality in Olfactory Neuroblastoma: A Retrospective Population-Based Study

2021 ◽  
Vol 10 (12) ◽  
pp. 2685
Author(s):  
Andre J. Burnham ◽  
Phillip A. Burnham ◽  
Edwin M. Horwitz
Keyword(s):  
Treatment Modality ◽  
Age Groups ◽  
Olfactory Neuroblastoma ◽  
Population Based ◽  
Treatment Modalities ◽  
Long Term Outcomes ◽  
Patient Age ◽  
Population Based Study ◽  
Patient Âgé

Olfactory neuroblastoma (ONB) is a rare neuroepithelial-derived malignancy that usually presents in the nasal cavity. The rarity of ONB has led to conflicting reports regarding associations of patient age and ONB survival and outcome. Moreover, long-term outcomes of chemotherapy and other treatment modalities are speculated. Here, we aimed to compare survival outcomes across age groups through time and determine associations between treatment modality and survival. In this retrospective population-based study, we analyzed the SEER 2000–2016 Database for patients with ONB tumors. Using Kaplan–Meier survival analysis, a significant effect of age and cancer-specific survival (CSS) was observed; geriatric ONB patients had the lowest CSS overall. Generalized linear models and survival analyses demonstrated that CSS of the pediatric patient population was similar to the geriatric group through 100 months but plateaued thereafter and was the highest of all age groups. Radiation and surgery were associated with increased CSS, while chemotherapy was associated with decreased CSS. GLM results showed that tumor grade, stage and lymph node involvement had no CSS associations with age or treatment modality. Our results provide insight for future investigations of long-term outcomes associated with ONB patient age and treatment modality, and we conclude that survival statistics of ONB patients should be analyzed in terms of trends through time rather than fixed in time.

scholarly journals Analysis of response of vitiligo to treatment with NBUVB

2019 ◽  
Vol 5 (1) ◽  
pp. 37
Author(s):  
J. Madhava Praveen ◽  
Jatin Sidhwa
Keyword(s):  
Adverse Effects ◽  
Skin Disorder ◽  
Environmental Risks ◽  
Treatment Modalities ◽  
Duration Of Treatment ◽  
Autoimmune Attack ◽  
Self Worth ◽  
Good Treatment Response ◽  
Dynamic Interplay

<p class="abstract"><strong>Background:</strong> Vitiligo is an acquired skin disorder characterised by white (depigmented) patches in the skin, due to the loss of functioning melanocytes. The disease can have devastating consequences on an individual’s relationships with others and internal feelings of self-worth. Vitiligo is caused by a dynamic interplay between genetic and environmental risks that initiates an autoimmune attack on melanocytes in the skin. Long term phototherapy has shown good response in the management of vitiligo. In this study we explore the efficacy of phototherapy in management of our vitiligo patients.</p><p class="abstract"><strong>Methods:</strong> 30 subjects were included in the study. Subjects were started on NBUVB at 300mj/cm<sup>2</sup>. Weekly 3 doses were given. Doses were increased after every 3<sup>rd</sup> sitting by 10%. In case of adverse effects treatment is withheld till resolution of symptoms following which NBUVB is given at 50% of the last dose and patient managed based on the response.<strong></strong></p><p class="abstract"><strong>Results:</strong> A majority of the subjects showed significant and persistent improvement within the first 3 months of initiation of treatment. The proportion of the patients showing improvement increased with duration of treatment.</p><p class="abstract"><strong>Conclusions:</strong> Our study has revealed the standard and significant role the phototherapy plays in the treatment of vitiligo as a monotherapy or as an adjuvant with other treatment modalities. With good treatment response and minimal side effect incidence, phototherapy is an important treatment modality in the management of vitiligo.</p><p> </p>

scholarly journals Listeria monocytogenes meningitis in an immunocompetent 18-year old patient as a possible diagnostic and therapeutical problem

2013 ◽  
Vol 70 (10) ◽  
pp. 976-978
Author(s):  
Miodrag Vrbic ◽  
Marina Dinic ◽  
Maja Jovanovic ◽  
Aleksandar Rankovic ◽  
Lidija Popovic-Dragonjic ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Case Report ◽  
Listeria Monocytogenes ◽  
Bacterial Meningitis ◽  
Initial Treatment ◽  
Clinical Effect ◽  
Complete Recovery ◽  
Cell Mediated Immunity ◽  
The Third ◽  
Appropriate Treatment

Introduction. Listeria monocytogenes is the third most frequent cause of bacterial meningitis in adults. It commonly affects persons with defective cell-mediated immunity or advanced age, and only a few patients with no underlying predisposition have been reported. Case report. We presented an previously healthy, 18-year-old man with typical clinical features of meningitis. On the account of earlier treatment with ceftriaxone and cerebrospinal fluid finding, an assumption of partially treated bacterial meningitis was made. The initial treatment with vancomycin and ceftriaxone, substituted on day 4 with meropenem, did not produce any clinical effect. On day 6 Listeria monocytogenes was isolated and, even as late as that, the administration of ampicillin was followed by complete recovery of the patient. Conclusion. In younger, immunocompetent individuals, in spite of the existent diagnostic and therapeutic problems, the subacute course of Listeria monocytogenes meningitis provides enough time for appropriate treatment and favorable disease outcome.

Probable Encephalopathy and Spasticity in a Multiple Sclerosis Patient Following Carbapenem Administration: A Case Report and Brief Literature Review

2021 ◽  
pp. 089719002110632
Author(s):  
Claire V Klimko ◽  
James M Sanders ◽  
Meagan L Johns
Keyword(s):  
Risk Factors ◽  
Multiple Sclerosis ◽  
Adverse Effect ◽  
Central Nervous System ◽  
Nervous System ◽  
Case Report ◽  
Adverse Effects ◽  
Multiple Sclerosis Patient ◽  
Specific Patient ◽  
Appropriate Treatment

Purpose: The purpose of this case report is to describe spasticity and encephalopathy that developed in a multiple sclerosis patient following carbapenem administration. Summary: A 55-year-old female with multiple sclerosis developed spasticity and encephalopathy within 24 hours of meropenem and ertapenem administration. This was the second time that she had developed encephalopathy following carbapenem administration. The patient gradually recovered over four days following discontinuation of carbapenem therapy. Conclusion: Carbapenem neurotoxicity, a well-documented adverse effect, has been linked to several risk factors, including central nervous system lesions. Despite this, there is little evidence describing the risk of neurotoxicity in patients with multiple sclerosis. It is important to understand the potential adverse effects of carbapenems in specific patient populations to help guide appropriate treatment of infections.

Current Approaches to Evaluation and Management of Children with Myelomeningocele

PEDIATRICS ◽  
1979 ◽  
Vol 63 (4) ◽  
pp. 663-667
Keyword(s):  
Urinary Tract ◽  
Urinary Diversion ◽  
Treatment Modality ◽  
Artificial Urinary Sphincter ◽  
Treatment Modalities ◽  
Urodynamic Study ◽  
Urinary Sphincter ◽  
The Family ◽  
Limited Applicability

The introduction of CIC and the artificial urinary sphincter have radically altered the management of the urinary tract in children with myelodysplasia. Supravesical urinary diversion is less often needed, although there is still a place for this treatment modality. When diversion is indicated, nonrefluxing intestinal conduits are suggested. The routine use of suprapubic bladder expression has only limited applicability. When possible, the child should undergo urodynamic study, and the family should be made aware of the treatment modalities available. Before proposing a urinary diversion on implantation of an artificial urinary sphincter, detailed explanations of the procedure and the alternatives must be given to parents and patients. This report was reviewed by the present and former members of the committee who have contributed to its contents.

The therapeutic dilemma of idiopathic granulomatous mastitis

2021 ◽  
Vol 50 (8) ◽  
pp. 598-605 ◽  
Author(s):  
Ee Ling Serene Tang ◽  
Chi Shern Bernard Ho ◽  
Patrick Mun Yew Chan ◽  
Juliana Jia Chuan Chen ◽  
Mui Heng Goh ◽  
...  
Keyword(s):  
Treatment Modality ◽  
Median Number ◽  
Subsequent Treatment ◽  
Treatment Modalities ◽  
Granulomatous Mastitis ◽  
Idiopathic Granulomatous Mastitis ◽  
Young Females ◽  
Significant Difference ◽  
Breast Condition ◽  
Recurrent Breast

ABSTRACT Introduction: Idiopathic granulomatous mastitis (IGM) is a rare, benign, chronic breast condition that can cause repeated abscesses or mass formation in bilateral breasts. The condition can severely impact the quality of life of affected women. This study aims to evaluate effective treatment modalities, as well as understand the demographics and clinical presentation of patients with IGM. Methods: An 11-year retrospective review was performed of patients diagnosed with IGM from 1 January 2008 to 31 December 2018 at a tertiary breast unit. Results: A total of 77 patients were included in the study. The median age at presentation was 36 years old. IGM presented most commonly as a breast lump (98.1%). The median number of flares was 2 (1–12). Of the 77 patients, 68.8% (53) were treated with antibiotics, 50.6% (39) with steroids, and 44.2% (34) underwent surgery, in the course of their IGM treatment. Forty-five (59.2%) of the 76 patients with IGM required a multimodal treatment approach to achieve remission. There was no significant difference in the number of flares no matter the initial treatment (P=0.411), or subsequent treatment modality (P=0.343). Smokers had 10 times greater odds of having a “high flare” of IGM compared to those who did not smoke (P=0.031, odds ratio 10.444, 95% confidence interval 1.092–99.859). Conclusion: IGM is a clinical diagnosis. It is a rare, relapsing breast inflammatory condition that affects young females with no superior treatment modality. Smoking is associated with higher number of flares of IGM and should be discouraged in IGM patients Keywords: Breast inflammation, chronic mastitis, idiopathic granulomatous mastitis, recurrent breast abscess

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