544 Vasculitic Subglottic Stenosis: A Question of Immunosuppression?

Abstract Introduction Subglottic stenosis (SGS) is the commonest manifestation of tracheobronchial disease in granulomatosis with polyangiitis (GPA) and carries a high degree of morbidity. Management of SGS-GPA is a double-edged sword. Delayed treatment may cause respiratory compromise and infectious complications. However, aggressive surgical management may initiate a systemic inflammatory response, reactivating the vasculitic cascade and potentially lead to long-term complications including renal vasculitis and consequential end-stage renal failure. There is currently no internationally agreed management strategy for this disease. Method This retrospective review was undertaken to analyse our unique combination of surgical dilatations and immunosuppressive-focused adjuvant management strategy between years 2011-2020. Results Sixteen of our one hundred and nine GPA patients (14.7%) had SGS and were included in our analysis. Whilst three patients (18.8%) improved solely on medical treatment, thirteen (81.3%) required combined surgery and immunosuppression (consisting of cyclophosphamide or Rituximab regimens). Thirty-nine surgical dilatations and two tracheostomies were performed over a mean 53-month follow-up period, with a calculated mean procedure rate of one every 24.8 months (2.7 - 89 months). Conclusions Our current management strategy affords a lower procedure rate at every 24.8 months compared to other published studies with combined procedure rate at every 14.9 months.

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Use of the Microdebrider in the Surgical Management of Rhinophyma

Ear Nose & Throat Journal ◽

10.1177/0145561318097001-210 ◽

2018 ◽

Vol 97 (1-2) ◽

pp. E42-E45

Author(s):

Winsion Chow ◽

Goran Jeremic ◽

Leigh Sowerby

Keyword(s):

Ease Of Use ◽

Sebaceous Glands ◽

Connective Tissues ◽

Revolution Speed ◽

Surgical Tool ◽

Acne Rosacea ◽

End Stage ◽

High Degree ◽

Superficial Tissue ◽

Surgical Option

Rhinophyma is a disfiguring end-stage manifestation of acne rosacea. It is characterized by a painless hyperplasia of the sebaceous glands and connective tissues of the nose. Numerous surgical modalities—including scalpel surgery, dermabrasion, CO2 laser ablation, and electrocautery—have been reported with varying results. We describe our experience with using a microdebrider to treat 2 patients—a 65-year-old man and a 74-year-old man—who presented with rhinophyma. The instrument we used was the Medtronic Straight-shot M4 Microdebrider. Using a low revolution speed, we easily excised the bulky superficial tissue. At higher revolution speeds with the use of a small shaver tip, we were able to achieve delicate contouring of the nasal tip and ala without causing scarring. Postoperatively, both patients exhibited an excellent cosmetic outcome and expressed a high degree of patient satisfaction. We conclude that the microdebrider is an excellent surgical tool for treating rhinophyma lesions. Its ease of use and its availability at most surgical centers makes it a favorable surgical option.

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Current Management Strategy for Penile Cancer and Future Directions

Current Oncology Reports ◽

10.1007/s11912-017-0615-4 ◽

2017 ◽

Vol 19 (8) ◽

Cited By ~ 4

Author(s):

Tanya B. Dorff ◽

Leslie K. Ballas ◽

Anne K. Schuckman

Keyword(s):

Management Strategy ◽

Penile Cancer ◽

Current Management ◽

Future Directions ◽

Current Management Strategy

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Evaluation of the efficacy of a novel perfusion solution for normothermic ex vivo lung perfusion compared with Steen solution™ (animal experimental study)

Russian Journal of Transplantology and Artificial Organs ◽

10.15825/1995-1191-2021-3-82-89 ◽

2021 ◽

Vol 23 (3) ◽

pp. 82-89

Author(s):

S. V. Gautier ◽

O. M. Tsirulnikova ◽

I. V. Pashkov ◽

N. V. Grudinin ◽

D. O. Oleshkevich ◽

...

Keyword(s):

Lung Transplantation ◽

Lung Diseases ◽

Ex Vivo ◽

Infectious Complications ◽

Lung Perfusion ◽

Ex Vivo Lung Perfusion ◽

Perfusion Solution ◽

Number Of Patients ◽

Donor Lung ◽

End Stage

Respiratory diseases, together with infectious complications and hereditary lung diseases, rank third in international mortality statistics. Today, lung transplantation is a recognized method of treating end-stage lung diseases. However, the number of transplant surgeries performed is not much. This is down to the high requirements on the condition of a potential lung donor and directly on the quality of the donor lung. This has significantly limited the number of optimal donors. Rehabilitation of donor lungs to optimal gas exchange indicators can be achieved and objectively assessed in the course of ex vivo lung perfusion (EVLP). The EVLP procedure is widespread in leading transplantation centers in Europe and North America. It allows to significantly expand the pool of donor lungs, thereby serving a greater number of patients in need of lung transplantation. The possibility of EVLP procedure using publicly available perfusion equipment was demonstrated. The optimized protocol fully demonstrated its reliability and efficiency. The developed perfusion solution had no statistically significant differences in comparison with the Steen SolutionTM, which in the future will serve as an alternative for EVLP procedure.

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Peritoneal Dialysis at Ibn Sina Hospital in Rabat: 10 years’ experience

Bulletin de la Dialyse à Domicile ◽

10.25796/bdd.v3i1.52233 ◽

2020 ◽

Vol 3 (1) ◽

pp. 27-35

Author(s):

Meryem Benbella ◽

Aziza Guennoun ◽

Mohamed Belrhiti ◽

Tarik Bouattar ◽

Rabia Bayahia ◽

...

Keyword(s):

Quality Of Life ◽

Renal Failure ◽

Peritoneal Dialysis ◽

Retrospective Study ◽

Infectious Complications ◽

Dialysis Modality ◽

Ibn Sina ◽

End Stage Renal Failure ◽

End Stage

Introduction: The choice of dialysis modality has become an important decision that affects not only the country's health policy in the management of chronic end stage renal failure, but also the quality of life of patients and their survival. Peritoneal dialysis is an alternative for the treatment of these patients. The objective of our work is to report the epidemiological, clinical and biological results in the unit of PD, UHC of Rabat and to clarify the obstacles to the development of PD in Morocco. Material and Methods: We conducted a descriptive retrospective study in our PD unit from July 2006 to July 2017, including all patients who were in PD by choice or necessity and enrolled in the French Peritoneal Dialysis Registry (RDPLF). Results: In 10 years, 159 patients were placed in PD, with an average age of 50.44 +/- 17.42 years and a sex ratio of 1.36. The indication for placement of setting in PD was by choice in 34% of the cases, social in 52% and medical in 14% of cases. Mechanical complications were dominated by catheter migrations. Infectious complications were represented by peritonitis, caused by poor of hygiene in 42% of cases. Conclusion: The obstacles to the development of PD are the lack of knowledge of the technique by the patients, as well as the prejudices or myths about the technique.

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Treatment of patient with end-stage hepatocellular carcinoma by the mineral pulse light stimuli on LV acupoints- case report

10.21203/rs.3.rs-52677/v1 ◽

2020 ◽

Author(s):

yongchol cha ◽

Hyok Choe ◽

Songjin Oh ◽

ZinHwa Cha

Keyword(s):

Hepatocellular Carcinoma ◽

Light Stimulus ◽

Treatment Options ◽

Liver Malignancy ◽

Pulse Light ◽

Light Stimuli ◽

Cirrhotic Patients ◽

Light Stimulator ◽

End Stage ◽

High Degree

Abstract Background; Hepatocellular carcinoma (HCC) represents a major and steadily increasing global health challenge as the most common primary liver malignancy and leading cause of death in cirrhotic patients. The only hope for curative treatment or significant increase in life expectancy is early detection. Once patients have progressed towards end-stage HCC, effective treatment options are extremely limited on the background of a very high degree of heterogeneity in clinical presentation and outcome. Objectives; The purpose of this study is to perform clinical trial on an end-stage HCC patient by mineral pulse light stimulus on LV acupoints without any drugs use. Methods; End-stage HCC patient was stimulated by mineral pulse light stimulator (MPLS). Stimulus acupoints; LV3, LV14, SP6. The selected acupoints were stimulated by MPLS for 50~60 minutes once a day. The same method was performed on the patient for 25days and rested for 5days, and again repeated every month without any drugs use. Results; After treatment, the general patient conditions and alfa-fetoprotein level were improved and hepatoma size was decreased to 9.1×8.5cm from 11.0×9.7cm before treatment (a), and the decay areas was disappeared.Conclusions; End-stage HCC patient was improved by mineral pulse light stimulus on LV acupoints without any drugs use.

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