scholarly journals Management Options for Suprasellar Cystic Craniopharyngioma: Endoscopic Transventricular Approach and Microsurgical Approach

2021 ◽  
Author(s):  
Subhas K. Konar ◽  
Akshay V. Kulkarni ◽  
Dhaval Shukla ◽  
Tejesh Misra ◽  
Bhagavatula Indira Devi ◽  
...  
Keyword(s):  
Hormone Replacement ◽  
Visual Outcome ◽  
Radical Excision ◽  
Invasive Treatment ◽  
Management Options ◽  
Safe Alternative ◽  
Cystic Craniopharyngioma ◽  
Microsurgical Approach ◽  
Cyst Recurrence ◽  
Endoscopic Group

Abstract Objective The treatment of cystic craniopharyngioma in children is varied. The treatment ranges from radical excision to direct radiotherapy. As the morbidity of excision is high, more conservative approaches are used. Transventricular endoscopy is a minimally invasive treatment for cystic craniopharyngiomas. The objective of this study is to compare the outcome of microscopic versus endoscopic transventricular approach for cystic craniopharyngioma. Methods This is a retrospective study of series of children managed with microscopic excision and endoscopic transventricular approach for suprasellar cystic craniopharyngiomas. Operative details, visual outcome, endocrinological outcome, tumor-related cyst recurrence rate, and complication were compared between microscopic and endoscopic groups. Results A total of 28 children underwent microscopic excision and 14 children underwent endoscopic procedure. The anesthesia time was significantly lower with endoscopic as compared to microscopic group (p = 0.0001) as well as blood loss during surgery (p = 0.0001). Hospital stay after surgery was shorter in endoscopic group. Incidence of diabetes insipidus was more in microscopic group (25%) compared to endoscopic group (7.14%). Visual outcome was almost same with approaches. Requirement of hormone replacement was more in microscopic group than in endoscopic group (p = 0.006). Incidence of cyst recurrence was more in microscopic (39.3%) compared to endoscopic group (7.7%). Conclusion Endoscopic transventricular approach is a safe alternative for initial treatment of suprasellar cystic craniopharyngioma in children.

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

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.

BREAST THERMOGRAPHY AS A POTENTIAL NON-CONTACT METHOD IN THE EARLY DETECTION OF CANCER: A REVIEW

2013 ◽  
Vol 13 (02) ◽  
pp. 1330001 ◽  
Author(s):  
MAHNAZ ETEHADTAVAKOL ◽  
EDDIE Y. K. NG
Keyword(s):  
Early Detection ◽  
Tumor Imaging ◽  
Hormone Replacement ◽  
Contact Method ◽  
Invasive Treatment ◽  
Clinical Prognosis ◽  
Breast Thermography ◽  
Utmost Care ◽  
Breast Cells ◽  
Post Menopausal

This review paper discusses recent research achievements in medical thermography with concerns about the possibility of early breast cancer detection. With the advancements in infrared (IR) technology, image processing methods, and the pathophysiological-based knowledge of thermograms, IR screening is sufficiently mature to be utilized as a first-line complement to both health managing and clinical prognosis. In addition, it explains the performance and environmental conditions in identifying thermography for breast tumor imaging under strict indoor controlled environmental circumstances. An irregular thermogram is indicated as a significant biological risk marker for the presence or growth of breast tumors. Breast thermography is completely non-contact, with no form of radiation and compression. It is useful for all women of all ages, for pregnant and breastfeeding women, for women with implants, for women with dense or fibrocystic breasts, for women on hormone replacement therapy, and for pre or post menopausal women. Breast thermography is specifically worthwhile during the early stages of fast tumor growth, which is not yet recognizable by mammography as thermography is a physiological test while mammography is an anatomical one. Often, physiological changes precede anatomical changes. This early detection of irregular tissue liveliness gives breast thermography the potential to be greatly useful and economical as an imaging program and provides the opportunity to apply non-invasive treatment to reform breast tissue activity. The non-radiating nature of thermography also permits repeated images. Thus, changes can be compared over time and the results of protective approaches can be observed to ensure utmost care of breast cells.

scholarly journals Current Management Options in Irvine–Gass Syndrome: A Systemized Review

2021 ◽  
Vol 10 (19) ◽  
pp. 4375
Author(s):  
Michał Orski ◽  
Maciej Gawęcki
Keyword(s):  
Macular Edema ◽  
Randomized Clinical Trials ◽  
Treatment Strategies ◽  
Case Series ◽  
Functional Results ◽  
Theoretical Background ◽  
Invasive Treatment ◽  
Management Options ◽  
First Line Therapy ◽  
Pubmed Database

Irvine–Gass syndrome (IGS) remains one of the most common complications following uneventful cataract surgery. In most cases, macular edema (ME) in IGS is benign, self-limiting, and resolves spontaneously without visual impairment; however, persistent edema and refractory cases may occur and potentially deteriorate visual function. Despite the relatively high prevalence of IGS, no solid management guidelines exist. We searched the PUBMED database for randomized clinical trials (RCT) or case series of at least 10 cases published since 2000 evaluating different treatment strategies in patients with cystoid macular edema (CME). The search revealed 28 papers that fulfilled the inclusion criteria with only seven RCTs. The scarceness of material makes it impossible to formulate strong recommendations for the treatment of IGS. Clinical practice and theoretical background support topical non-steroidal anti-inflammatory drugs (NSAIDs) as the first-line therapy. Invasive procedures, such as periocular steroids, intravitreal corticosteroids, and anti-vascular endothelial growth factor (anti-VEGF), are usually applied in prolonged or refractory cases. Results of novel applications of subthreshold micropulse laser (SML) are also promising and should be studied carefully in terms of the safety profile and cost effectiveness. Early initiation of invasive treatment for providing better functional results must be examined in further research.

scholarly journals Recurrence of a small primary iris stromal cyst following treatment with Nd:YAG laser photodisruption in an adult

2017 ◽  
Vol 145 (7-8) ◽  
pp. 397-399
Author(s):  
Svetlana Stanojlovic ◽  
Sanja Petrovic-Pajic ◽  
Bojana Dacic-Krnjaja ◽  
Dejan Rasic ◽  
Milos Jovanovic
Keyword(s):  
Nd:Yag Laser ◽  
Treatment Approach ◽  
Ultrasound Biomicroscopy ◽  
Yttrium Aluminium Garnet ◽  
Invasive Treatment ◽  
Cyst Size ◽  
Yttrium Aluminium ◽  
Small Primary ◽  
Iris Cyst ◽  
Cyst Recurrence

Introduction. Primary acquired iris stromal cyst is rare in adults. In this group, they are generally stable lesions which require no treatment. Case outline. We describe a rare case of a small primary iris cyst in a 39-year-old patient, associated with unusual signs of irritation. Ultrasound biomicroscopy demonstrated iris stromal cyst measuring 3 ? 2 mm. A neodymium-doped yttrium aluminium garnet (Nd:YAG) laser cystotomy was engaged as the least invasive treatment approach. However, the cyst recurred soon after repeated laser treatment and sector iridectomy with excision of the cyst was performed. Five years after surgery there was no evidence of recurrence. Conclusion. Although more benign clinical course of primary stromal iris cyst is generally assumed in adults as compared to children, complete cyst removal seems to be mandatory for preventing cyst recurrence regardless of the cyst size or patient age. To the authors? knowledge this is the first documented report of Nd:YAG laser photodisruption of acquired primary iris stromal cyst in an adult.

Colloid cysts

2019 ◽  
pp. 393-402
Author(s):  
Asim Sheikh ◽  
Paul Chumas
Keyword(s):  
Obstructive Hydrocephalus ◽  
Third Ventricle ◽  
Original Description ◽  
Management Options ◽  
Anterior Portion ◽  
Operator Experience ◽  
The Third ◽  
Microsurgical Approach ◽  
Colloid Cysts ◽  
Mass Lesions

Colloid cysts are benign, mostly intraventricular tumours accounting for 0.5 to 2% of all intracranial mass lesions. They are most commonly found in the anterior portion of the third ventricle at the level of foramina of Monro and, if symptomatic, usually present with obstructive hydrocephalus of the lateral ventricles. The original description historically linked them with sudden death in the pre-CT era. They are also known as neuroepithelial cysts. Management options include treatment of hydrocephalus alone, aspiration of the cyst contents, and removal of the cyst endoscopically or via a microsurgical approach. However, the most important factor in the choice of any of these approaches is operator experience.

scholarly journals (P1-60) Clinico-Epidemiological Pattern and Management Options in Patients with Ocular Injuries in the Emergency Room of a Rural Hospital

2011 ◽  
Vol 26 (S1) ◽  
pp. s118-s118
Author(s):  
S. Baisakhiya ◽  
M. Bhatt ◽  
A. Agrawal
Keyword(s):  
Emergency Room ◽  
Visual Outcome ◽  
Rural Hospital ◽  
Medical Sciences ◽  
Management Options ◽  
General Observation ◽  
Wide Range ◽  
Epidemiological Pattern ◽  
Male Patients ◽  
Ocular Injuries

Aims and ObjectivesSuccessful patient outcomes in the setting of ocular emergencies depend on correct recognition and assessment as well as appropriate initial management. The purpose of this study is to describe the clinico-epidemiological findings and management options in patients with ocular injuries in the emergency room of a rural hospital.Material and MethodsIn this retrospective review the records of patients who were treated for ocular trauma from June 2010 to December 2010 in the emergency room of MM Institute of Medical Sciences and Research, Mullana (Ambala) were reviewed. The following data for all patients were recorded: age, sex, date and time of injury, involved eye, circumstance and mechanism of injury, initial visual acuity, details of appropriate investigation, immediate management and outcome.ResultsA total 46 patients were included in the study. Young adult male patients were more commonly involved. Most of the patients presented within 12hours of injury. Left eye was involved in 14 patients; right in 12 and 10 patients had injuries to both eyes. Most common mode of injury was mechanical. The patients who sustained bilateral ocular injuries were due to chemical burns (7 cases) and electrocution (3 cases). Most of the patients were managed conservatively. The surgical treatment offered were repair of corneal tears, removal of foreign bodies. The visual outcome was excellent in most of the patients.ConclusionsOcular injuries can have wide range of etiological factors and presentation and assessment of ocular emergencies can be made difficult by a lack of sophisticated facilities. However, a concise patient history, general observation and basic ocular tests can lead to a firm diagnosis and thereby appropriate management.

scholarly journals Adnexal Masses in Pregnancy: Diagnosis and Management

2007 ◽  
Vol 1 (4) ◽  
pp. 66-74 ◽  
Author(s):  
George M Graham
Keyword(s):  
Surgical Intervention ◽  
Adnexal Mass ◽  
Ultrasound Images ◽  
List Type ◽  
Management Options ◽  
Safe Alternative ◽  
Adnexal Masses ◽  
Increased Risk ◽  
Adverse Pregnancy ◽  
In Pregnancy

Abstract The widespread use of ultrasound in obstetrics has led to an increase in the diagnosis of asymptomatic adnexal masses in pregnancy. Ultrasound is an accurate and safe method for diagnosing the etiology of an adnexal mass and distinguishing benign from malignant pathology. The management of an adnexal mass in pregnancy is controversial. Historically, it was recommended that any adnexal mass be removed electively in the second trimester to exclude malignancy and prevent complications such as torsion, rupture, and obstruction of labor. More recent recommendations have limited surgical intervention in pregnancy to symptomatic adnexal masses and those that are highly suggestive of malignancy. Surgery in pregnancy is associated with an increased risk of adverse pregnancy outcomes. However, laparoscopy appears to be a safe alternative to laparotomy for benign masses when performed by experienced surgeons. Learning objectives To list the differential diagnoses of adnexal masses in pregnancy To interpret ultrasound images of adnexal masses and distinguish benign from malignant masses To describe the management options for adnexal masses in pregnancy, including the indications and options for surgical intervention.

scholarly journals Lingual thyroid gland: it’s time for awareness

2020 ◽  
Vol 2020 ◽  
Author(s):  
Nicolás Cruz-Dardíz ◽  
Nadyeschka Rivera-Santana ◽  
Marina Torres-Torres ◽  
Héctor Cintrón-Colón ◽  
Shayanne Lajud ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Hormone Replacement ◽  
Thyroid Tissue ◽  
Size Reduction ◽  
Ectopic Thyroid ◽  
Lingual Thyroid ◽  
List Type ◽  
Management Options ◽  
Ectopic Thyroid Tissue ◽  
Ectopic Tissue

Summary Lingual thyroid (LT) gland is the most common type of ectopic thyroid tissue, but it is an extremely rare presentation. We present a case of a 41-year-old Hispanic female patient complaining of dysphonia and dysphagia. As part of the evaluation, fiber optic flexible indirect laryngoscopy (FIL) was performed which revealed a mass at the base of the tongue. The morphological examination was highly suspicious for ectopic thyroid tissue and the diagnosis was confirmed with neck ultrasound and thyroid scintigraphy. Although the patient presented subclinical hypothyroidism, levothyroxine therapy was initiated with a favorable response which included resolution of symptoms and mass size reduction. Our case portrays how thyroid hormone replacement therapy (THRT) may lead to a reduction in the size of the ectopic tissue and improvement of symptoms, thus avoiding the need for surgical intervention which could result in profound hypothyroidism severely affecting the patients’ quality of life. Learning points: Benign LT and malignant LT are indistinguishable clinically and radiographically for which histopathology is recommended. THRT, radioactive iodine 131 (RAI) therapy, and surgical excision are potential management options for LT. THRT may lead to size reduction of the ectopic tissue and resolution of symptoms avoiding surgical intervention.

scholarly journals A study of submental intubation for anaesthesia in patients with faciomaxillary injuries

2016 ◽  
Vol 3 (3) ◽  
pp. 132 ◽  
Author(s):  
Geeta A. Patkar ◽  
Nilam Dharma Virkar ◽  
Anusha M. S. ◽  
Bharati Anil Tendolkar
Keyword(s):  
Bone Fractures ◽  
Nasotracheal Intubation ◽  
Nasal Bone ◽  
Orotracheal Intubation ◽  
Anesthesia Induction ◽  
Management Options ◽  
Safe Alternative ◽  
Submental Intubation ◽  
Careful Handling ◽  
Paramedian Incision

<p class="abstract"><strong><span lang="EN-US">Background: </span></strong>Surgical repair of faciomaxillary trauma requires intraoperative occlusion of teeth that precludes orotracheal intubation. Airway management options in these patients are either nasotracheal intubation or tracheostomy. However nasal intubation is contraindicated in nasal bone fractures, skull base fractures. Tracheostomy, being a morbid procedure is not always a good option. Submental intubation allows a safe alternative in such patients.</p><p class="abstract"><strong><span lang="EN-US">Methods: </span></strong>25 Patients were studied with faciomaxillary trauma where submental intubation was indicated. After standard anesthesia induction patients were intubated with reinforced endotracheal tube (ETT), which is converted to submental route by a paramedian incision. At the end of the procedure, all patients had inter-maxillary wiring, were shifted to recovery room. Once they are recovered from the neuromuscular blockade ETT was removed through the submental tunnel.</p><p class="abstract"><strong><span lang="EN-US">Results: </span></strong>This was a prospective observational study in 25 adult patients undergoing faciomaxillary surgeries requiring submental intubation. The mean apnoea time was 1.28±0.38 minutes and induction to submental intubation time was 9.68±1.82 minutes. In one case there was damage to the pilot balloon while pulling the tube through the submental tunnel. Two patients had right endobronchial migration of the ETT. On postoperative follow up, one patient had infection at the submental incision site.  </p><p class="abstract"><strong><span lang="EN-US">Conclusions: </span></strong><span lang="EN-US">Submental intubation is a safe, effective, alternative for short term tracheostomy in faciomaxillary sugeries. Careful handling of the ETT is must to avoid damage while passing through the submental tunnel. Avoid extra length of the tube introrally to prevent endobronchial migration of the ETT.</span></p>

Upper tract obstruction, loin pain, hydronephrosis

2019 ◽  
pp. 501-514
Author(s):  
John Reynard ◽  
Simon F Brewster ◽  
Suzanne Biers ◽  
Naomi Laura Neal
Keyword(s):  
Emergency Management ◽  
Treatment Options ◽  
Urine Flow ◽  
Invasive Treatment ◽  
Management Options ◽  
Upper Tract ◽  
Renal Obstruction ◽  
Related Disease ◽  
Igg4 Related Disease ◽  
Loin Pain

This chapter covers upper tract obstruction, loin pain, and hydronephrosis. A comprehensive discussion of causes and management of unilateral and bilateral hydronephrosis is included. The pathophysiology of renal obstruction is detailed, including the physiology of urine flow from the kidney to the bladder. An overview of the management of non-pelviureteric junction obstruction (PUJO) ureteric strictures is included, including minimally invasive treatment options. The causes of retroperitoneal fibrosis are outlined, and this fourth edition includes the newer diagnosis of IgG4-related disease (causative in up to half of previously considered idiopathic cases). Common presentations, investigation, and management options are detailed, including both emergency management and longer-term treatments.

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