scholarly journals Management of chyle leaks following esophageal resection: a systematic review

2021 ◽  
Author(s):  
Robert Power ◽  
Philip Smyth ◽  
Noel E Donlon ◽  
Timothy Nugent ◽  
Claire L Donohoe ◽  
...  
Keyword(s):  
Thoracic Duct ◽  
Prospective Studies ◽  
Case Series ◽  
Esophageal Resection ◽  
Evidence Base ◽  
Treatment Modalities ◽  
Optimal Management ◽  
Retrospective Case ◽  
High Quality ◽  
Chyle Leakage

Summary Background Chyle leakage is an uncommon but potentially life-threatening complication following esophageal resections. The optimal management strategy is not clear, with a limited evidence base. Methods Searches were conducted up to 31 December 2020 on MEDLINE, Embase, and Web of Science for randomized trials or retrospective studies that evaluated the management of chyle leakage following esophageal resection. Two authors independently screened studies, extracted data, and assessed for bias. The protocol was prospectively registered on PROSPERO (CRD: 42021224895) and reported in accordance with preferred reporting items for systematic reviews and meta-analyses guidelines. Results A total of 530 citations were reviewed. Twenty-five studies, totaling 1016 patients met the inclusion criteria, including two low-quality clinical trials and 23 retrospective case series. Heterogeneity of study design and outcomes prevented meta-analysis. The overall incidence of chyle leak/fistula was 3.2%. Eighteen studies describe management of chyle leaks conservatively, 17 by surgical ligation of the thoracic duct, 5 by pleurodesis, and 6 described percutaneous lymphangiography with thoracic duct embolization or disruption. Conclusions The evidence base for optimal management of chyle leakage postesophagectomy is lacking, which may be related to its low incidence. There is a paucity of high-quality prospective studies directly comparing treatment modalities, but there is some low-certainty evidence that percutaneous approaches have reduced morbidity but lower efficacy compared with surgery. Further high-quality, prospective studies that compare interventions at different levels of severity are needed to determine the optimal approach to treatment.

scholarly journals 628 Management of Chyle Leaks Following Oesophagectomy: A Systematic Review

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
R Power ◽  
P Smyth ◽  
N E Donlon ◽  
T Nugent ◽  
C L Donohoe ◽  
...  
Keyword(s):  
Thoracic Duct ◽  
Prospective Studies ◽  
Meta Analysis ◽  
Case Series ◽  
Evidence Base ◽  
Treatment Modalities ◽  
Optimal Management ◽  
Retrospective Case ◽  
High Quality ◽  
Chyle Leakage

Abstract Aim Chyle leakage is a rare but potentially life-threatening complication following oesophageal resection. The optimal management strategy is not clear. Method Searches were conducted up to 31/12/2020 on MEDLINE, Embase and Web of Science for randomised trials or retrospective studies that evaluated the management of chyle leakage following oesophageal resection. Two authors independently screened studies extracted data and assessed for bias. The protocol was prospectively registered on PROSPERO (CRD: 42021224895) and reported in accordance with PRISMA guidelines. Results A total of 530 citations were reviewed. Twenty-five studies, totaling 1016 patients met the inclusion criteria, including 2 low-quality clinical trials and 23 retrospective case series. Heterogeneity of study design and outcomes prevented meta-analysis. The overall incidence of chyle leaks was 3.2% but no consistent risk factors were found across studies. Eighteen studies describe management of chyle leaks conservatively, 17 by surgical ligation of the thoracic duct, and 6 described percutaneous lymphangiography with thoracic duct embolisation (TDE) or disruption (TDD). There is a paucity of high-quality prospective studies directly comparing treatment modalities, but there is some low-certainty evidence that percutaneous approaches have reduced morbidity, but lower efficacy compared to surgery. Conclusions The evidence-base for optimal management of chyle leakage post-oesophagectomy is lacking, which may be related to its low incidence. Further high quality, prospective studies that compare interventions at different levels of severity are needed to determine the optimal approach to treatment.

scholarly journals Intralesional cryotherapy for hypertrophic scars and keloids: a review

2017 ◽  
Vol 3 ◽  
pp. 205951311770216 ◽  
Author(s):  
Ciaran P O’Boyle ◽  
Holleh Shayan-Arani ◽  
Maha Wagdy Hamada
Keyword(s):  
English Language ◽  
Meta Analysis ◽  
Case Series ◽  
Evidence Base ◽  
Treatment Modalities ◽  
Hypertrophic Scars ◽  
Published Evidence ◽  
Keloid Scarring ◽  
Comparative Trials ◽  
Scar Reduction

Introduction: Hypertrophic and keloid scarring remain notoriously troublesome for patients to tolerate and frustratingly difficult for clinicians to treat. Many different treatment modalities exist, signifying the failure of any method to achieve consistently excellent results. Intralesional cryotherapy is a relatively recent development that uses a double lumen needle, placed through the core of a keloid or hypertrophic scar, to deliver nitrogen vapour, which freezes the scar from its core, outwards. Methods: This article provides a comprehensive review of the literature on intralesional cryotherapy for hypertrophic scars and keloids. A systematic review or meta-analysis was not possible, since the existing articles did not permit this. Results: A search of English language, peer-reviewed literature was carried out. The evidence base was found to be low (level 4). In addition, much of the published evidence comes from a very few groups. Despite this, consistent findings from case series suggest that the technique is safe and achieves good scar reduction with very few treatments. Adverse effects include depigmentation, recurrence and pain. Pain and recurrence appear to be uncommon and depigmentation may be temporary. Discussion: Well-constructed, prospectively recruited comparative trials are absent from the literature. These are strongly encouraged, in order to strengthen general confidence in this technique and in the repeatability of outcomes reported thus far.

scholarly journals Illustrative Case Series and Narrative Review of Therapeutic Failure of Immunotherapy for Allergic Rhinitis

2020 ◽  
Vol 11 ◽  
pp. 215265672094382 ◽  
Author(s):  
Lisa Campisi ◽  
Patrick F. K. Yong ◽  
Bogumila Kasternow ◽  
Mohammed Yousuf Karim
Keyword(s):  
Allergic Rhinitis ◽  
Allergen Immunotherapy ◽  
Case Series ◽  
Evidence Base ◽  
Therapeutic Failure ◽  
Illustrative Case ◽  
Evidence Based ◽  
Optimal Management ◽  
Patient Subgroup ◽  
Early Relapse

This is a series of 4 cases (3 therapeutic failure and 1 early relapse) in adult patients treated with allergen immunotherapy (AIT) for allergic rhinitis (AR) in our immunotherapy clinic, which treats 110 new patients per year. AIT includes both subcutaneous and sublingual routes. The current national/international AIT recommendations and the literature have been searched to identify guidance for the optimal management of therapeutic failure of AIT in AR. There is scant information available to support clinicians when treatment failure and/or intolerable side effects occur. The importance is highlighted for developing the guidance and evidence base for the benefit of this patient subgroup. The potential strategies that clinicians have proposed are discussed in this article, though it is acknowledged that these are mostly not evidence-based.

Management of feline carpal injuries: What are the options and when is arthrodesis indicated?

2019 ◽  
Vol 21 (9) ◽  
pp. 809-823 ◽  
Author(s):  
Rachel M Basa ◽  
Kenneth A Johnson
Keyword(s):  
Treatment Options ◽  
Case Series ◽  
Evidence Base ◽  
Careful Examination ◽  
Current Evidence ◽  
Collateral Ligament ◽  
Retrospective Case ◽  
Radial Collateral Ligament ◽  
Current Evidence Base ◽  
Direct Extrapolation

Practical relevance: Feline carpal injuries are usually caused by falls from a height that result in hyperextension injury or antebrachiocarpal luxation or subluxation. Isolated ligamentous damage or fracture of the carpus is unusual; it is more common to have a combination of both in the cat. These injuries can be debilitating since cats climb and jump from great heights, and have a greater range of antebrachial pronation and supination than dogs. Anatomy: There are differences in the anatomy of the feline and canine carpus. In particular, cats only have a single short radial collateral ligament, also known as the medial collateral ligament. This means that, in the cat, antebrachiocarpal subluxation is possible with rupture of the dorsal joint capsule and short radial collateral ligament alone. Clinical challenges: Many feline carpal injuries can be treated without performing pancarpal arthrodesis. However, determining which ligaments and joint levels are affected requires careful examination and often stress radiography. When pancarpal arthrodesis is performed in the cat, it has been reported to reduce the height of jumping and to increase reluctance to climb. This is speculated to be due to reduced pronation and supination movement of the carpus. Evidence base: The current evidence base for management of feline carpal injuries is grade III or IV, with most of the studies being retrospective case series involving cadaveric dissection or direct extrapolation from published information about the dog. There are few guidelines regarding the optimal treatment options for carpal injuries in the cat.

Radiofrequency coblation for treatment of advanced laryngotracheal recurrent respiratory papillomatosis

2009 ◽  
Vol 124 (5) ◽  
pp. 510-514 ◽  
Author(s):  
A S Carney ◽  
A S Evans ◽  
S Mirza ◽  
A Psaltis
Keyword(s):  
Surgical Treatment ◽  
Case Series ◽  
Recurrent Respiratory Papillomatosis ◽  
Adult Patients ◽  
Treatment Modalities ◽  
Attractive Alternative ◽  
Alternative Technique ◽  
Retrospective Case ◽  
Retrospective Case Series ◽  
Laser Vaporisation

AbstractBackground:A variety of treatment modalities are currently used to treat recurrent respiratory papillomatosis. We aimed to study the efficacy of radiofrequency cold ablation (coblation) for the treatment of laryngotracheal recurrent respiratory papillomatosis, by comparing treatment intervals for coblation and CO2 laser vaporisation.Method:Retrospective case series of adult patients with advanced laryngotracheal recurrent respiratory papillomatosis.Results:Six patients were treated for at least two years by CO2 laser vaporisation with or without intralesional cidofovir. All six subsequently underwent treatment with radiofrequency coblation with or without intralesional cidofovir. Coblation resulted in longer periods between interventions, compared with CO2 laser (p = 0.03).Conclusion:Radiofrequency coblation appears to be an attractive alternative technique to CO2 laser for the surgical treatment of advanced laryngotracheal papillomata.

scholarly journals 1151. Clinical Characteristics of Persistent Staph Aureus Bacteremia in Children

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S667-S667
Author(s):  
Nicholas Venturelli ◽  
Palak Bhagat ◽  
Allison Nelson ◽  
Madan Kumar
Keyword(s):  
Clinical Characteristics ◽  
Methicillin Resistance ◽  
Total Duration ◽  
Case Series ◽  
Venous Catheter ◽  
Treatment Modalities ◽  
Retrospective Case ◽  
Gram Positive ◽  
Duration Of Therapy ◽  
Epidemiological Features

Abstract Background Persistent Staphylococcus aureus bacteremia (pSAB) is a poorly defined entity, but associated with significant morbidity and mortality in children. We aim to better describe the epidemiological features of this clinical entity. Methods We performed a retrospective case series analysis of pediatric patients with pSAB at a single center children’s hospital using electronic medical data from 2016 – 2020. Bacterial persistence was defined as culture growth > 72 hours after first blood culture. Results Twenty-two patients with pSAB were included in the analysis. Sources of persistent infection were endovascular infection (n=11, 50%), osteoarticular infection (n=6, 27%,), isolated central line associated blood stream (n=4, 18%), isolated skin and soft tissue infection (n=2, 9%), and no known primary infectious site (n=1). Methicillin resistance occurred in 41% (n=9) of cases of pSAB. Total duration of therapy varied, with a median of 4 weeks from negative cultures (range of 2 – 8 weeks). Total days of positive cultures in pSAB were not significantly associated with methicillin susceptibility of the bacterial isolate, use of double gram-positive coverage, nor presence of a central venous catheter. Use of double gram-positive coverage occurred in 50% of cases with a mean duration of therapy of 11 days, most frequently in cases of septic thrombophlebitis (Table 1). Rifampin and gentamicin were the most commonly used agents. Table 1. Clinical Characteristics of Children Treated with Double Gram-Positive Coverage Conclusion Children presenting with persistent S. aureus bacteremia present with a heterogenous group of underlying conditions and epidemiological features. While pediatric recommendations for double gram-positive coverage for synergy have not been established, their use for pSAB is common, especially in endovascular infections where culture persistence is often an expected outcome. Further research should examine risk factors for pSAB and define optimal treatment modalities and duration. Disclosures All Authors: No reported disclosures

Osteochondral Lesions of the Talus: Predictors of Clinical Outcome

2011 ◽  
Vol 32 (11) ◽  
pp. 1045-1051 ◽  
Author(s):  
Daniel J. Cuttica ◽  
W. Bret Smith ◽  
Christopher F. Hyer ◽  
Terrence M. Philbin ◽  
Gregory C. Berlet
Keyword(s):  
Clinical Outcome ◽  
Treatment Plan ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Nonoperative Treatment ◽  
Treatment Modalities ◽  
Osteochondral Lesions ◽  
Foot And Ankle ◽  
Retrospective Case ◽  
Level Of Evidence

Background: Osteochondral lesions of the talus (OLT) are a common and challenging condition treated by the orthopedic foot and ankle surgeon. Multiple operative treatment modalities have been recommended, and there are several factors that need to be considered when devising a treatment plan. In this study, we retrospectively reviewed a group of patients treated operatively for osteochondral lesions of the talus to determine factors that may have affected outcome. Methods: A retrospective chart review of clinical, radiographic and operative records was performed for all patients treated for OLTs via marrow stimulation technique. All had a minimum followup of 6 months or until return to full activity, preoperative magnetic resonance imaging (MRI) of the OLT to determine size, and failure of nonoperative treatment. Results: A total of 130 patients were included in the study. This included 64 males and 66 females. The average patient age at the time of surgery was 35.1 ± 13.7 (range, 12 to 73) years. The average followup was 37.2 ± 40.2 (range, 7.43 to 247) weeks. The average size of the lesion was 0.84 ± 0.67 cm2. There were 20 lesions larger than 1.5 cm2 and 110 lesions smaller than 1.5 cm2. There were 113 contained lesions and 17 uncontained lesions. OLTs larger than 1.5 cm2 and uncontained lesions were associated with a poor clinical outcome. Conclusions: The treatment of osteochondral lesions of the talus remains a challenge to the foot and ankle surgeon. Arthroscopic debridement and drilling will often provide satisfactory results. However, larger lesions and uncontained lesions are often associated with inferior functional outcomes and may require a more extensive initial procedure. Level of Evidence: IV, Retrospective Case Series

scholarly journals Intravitreal Melphalan Chemotherapy for Vitreous Seeds in Retinoblastoma

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Yacoub A. Yousef ◽  
Amal M. Noureldin ◽  
Iyad Sultan ◽  
Rasha Deebajah ◽  
Maysa Al-Hussaini ◽  
...  
Keyword(s):  
Case Series ◽  
Complete Response ◽  
Retinal Toxicity ◽  
Treatment Modalities ◽  
Injection Technique ◽  
Stage At Diagnosis ◽  
Retrospective Case ◽  
Salvage Rate ◽  
Vitreous Seeds

Objective. To evaluate our experience with intravitreal melphalan chemotherapy as a second-line regimen for RB patients with refractory or recurrent vitreous seeds. Methods. A retrospective case series of 16 eyes from 16 patients with intraocular RB who received intravitreal melphalan chemotherapy using the antireflux injection technique. Data included demographics, stage at diagnosis, treatment modalities, side effects, eye salvage, and survival. Results. The total number of injections was 64 (median, 3 injections per eye; range, 3–8), and the median age at time of injection was 22 months (range, 9–63 months). Nine (56%) patients were males, and 13 (81%) patients had bilateral RB. Complete response was seen in 13 (81%) eyes: in 9 (100%) eyes with focal vitreous seeds and in 4 (57%) eyes with diffuse vitreous seeds (P=0.062). At a median follow-up of 18 months (range, 6–48 months), the eye salvage rate was 81%, local retinal toxicity confined to the site of injection was seen in 2/3 of the eyes, 2 (12%) eyes had cataract, and none of the patients had orbital recurrence and distant metastasis or was dead. Conclusion. Intravitreal melphalan is a promising modality for treatment of vitreous seeds, and the dose of 20–30 μg of melphalan sounds to be safe and effective for refractory and recurrent vitreous seeds.

scholarly journals QOL-14. A BIOPSYCHOSOCIAL APPROACH TO BRAIN INJURY REHABILITATION FOLLOWING TREATMENT FOR PAEDIATRIC BRAIN TUMOURS: CAN PHARMACOTHERAPY AID NEUROPSYCHOLOGICAL OUTCOME?

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii433-iii433
Author(s):  
Jo Phillips ◽  
Mark Brougham
Keyword(s):  
Brain Injury ◽  
Brain Tumours ◽  
Case Series ◽  
Evidence Base ◽  
Treatment Modalities ◽  
Neuropsychological Outcome ◽  
Term Survival ◽  
Biopsychosocial Approach ◽  
Neuropsychological Profile ◽  
Paediatric Brain Tumours

Abstract Long term survival following paediatric brain tumours has vastly improved in recent decades. Consequently there is a drive towards improved quality of survivorship. Brain tumours, surgical resection and adjuvant therapies represent mechanisms for brain injury and can therefore negatively impact a child’s neuropsychological trajectory; affecting cognition, behaviour, emotional and adaptive functioning and educational/occupational outcomes. A biopsychosocial approach to rehabilitation should target each of these domains through supported remediation, environmental modification and psychoeducation for young people and the key systems around them (e.g. families, education). There is a growing evidence base for the role of concordant psychopharmacologies to improve neuropsychological outcome. Since 2015 children treated at RHSC Edinburgh for brain tumours have been offered pharmacotherapy alongside usual rehabilitation approaches if they demonstrate significant difficulties with Attention, Processing Speed and/or Executive Function on formal neuropsychological assessment. Patients are referred to a Consultant Psychiatrist or Paediatrician (as per local protocol) for medication selection, titration and monitoring. A short case series (N=14) is presented outlining brain tumour pathologies, treatment modalities, neuropsychological profile and rationale for recommending pharmacotherapy. Approximately 50% of patients took up the offer. The treatment/s offered and self or parents reported outcomes is summarised. Pharmacotherapy was broadly effective; “it’s been like night and day”, although for one case (N=1) the side effects outweighed any benefit; “she became even more emotional”. Findings indicate that pharmacotherapy should be considered alongside conventional neurorehabilitation techniques for CYP with specific cognitive difficulties following treatment for paediatric brain tumours.

Matricidal cavernous aneurysms: a multicenter case series

2019 ◽  
Vol 11 (6) ◽  
pp. 584-590 ◽  
Author(s):  
Mallory R Dacus ◽  
Chris Nickele ◽  
Babu G Welch ◽  
Vin Shen Ban ◽  
Andrew J Ringer ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Cavernous Sinus ◽  
Case Series ◽  
Treatment Modalities ◽  
Parent Artery ◽  
Retrospective Case ◽  
Parent Vessel ◽  
Elastic Compression ◽  
Presenting Symptoms ◽  
Atherosclerotic Stenosis

BackgroundCavernous carotid artery aneurysms (CCAs) represent a unique subset of intracranial aneurysms due to their distinct natural history and the anatomy of the cavernous sinus. Enlarging CCAs can cause elastic compression of the parent internal carotid artery (ICA). We suggest defining aneurysms that cause luminal stenosis of their parent vessels as ‘matricidal aneurysms.’Though many patients are asymptomatic, presenting symptoms of CCAs include ophthalmoplegia with resulting diplopia, vision changes, pain, ptosis, facial numbness, and cavernous-carotid fistula. Less commonly, patients with CCAs can present with epistaxis, subarachnoid hemorrhage, and—in cases of matricidal aneurysms—ischemia due to stenosis. The proper management of stenosis caused by a matricidal CCA is not well established and may not be intuitive.MethodsWe present a multicenter retrospective case series of patients with matricidal CCAs.ResultsForty patients with matricidal aneurysms presented with both asymptomatic and symptomatic stenosis. These patients were either treated with conservative medical management, coiling, flow diversion, or endovascular sacrifice of the parent artery. Planned treatment modalities were not executed in 11 cases (28% treatment failure rate). Presenting symptoms, patient outcomes, and follow-up data are presented for all cases.ConclusionMatricidal aneurysms require careful consideration and planning. The restricted anatomy of the cavernous sinus can make successful execution of endovascular interventions more difficult. Direct elastic compression of the parent artery does not respond to angioplasty and stenting in the same way atherosclerotic stenosis does. Because of this, planning for the possibility of parent vessel sacrifice is important.

Sign in / Sign up

Export Citation Format

Share Document