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.

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 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 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 PP39. 5-AMINOLEVULINIC ACID AIDED RESECTION OF PAEDIATRIC BRAIN TUMOURS: THE UK’S FIRST CASE SERIES

2017 ◽  
Vol 19 (suppl_1) ◽  
pp. i11-i11 ◽  
Author(s):  
Ms Charlotte Burford ◽  
Ms Nida Kalyal ◽  
Dr Anand Pandit ◽  
Mr Jignesh Tailor ◽  
Mr Jose Pedro Lavrador ◽  
...  
Keyword(s):  
Brain Tumours ◽  
Aminolevulinic Acid ◽  
Case Series ◽  
First Case ◽  
Paediatric Brain Tumours

Clinical value of amino acid imaging in paediatric brain tumours

2005 ◽  
Vol 44 (04) ◽  
pp. 131-136 ◽  
Author(s):  
K. Lang ◽  
S. Kloska ◽  
R. Straeter ◽  
C. H. Rickert ◽  
G. Goder ◽  
...  
Keyword(s):  
Amino Acid ◽  
Brain Tumours ◽  
Photon Emission ◽  
Diagnostic Tools ◽  
Emission Computed Tomography ◽  
Gadolinium Enhancement ◽  
Tumour Grading ◽  
Enhanced Mri ◽  
Contrast Enhanced ◽  
Paediatric Brain Tumours

Summary Purpose: To evaluate single photon emission computed tomography (SPECT) using the amino acid l-3-[123I]-α-methyl tyrosine (IMT) and contrast enhanced magnetic resonance imaging (MRI) as diagnostic tools in primary paediatric brain tumours in respect of non-invasive tumour grading. Patients, materials, methods: 45 children with primary brain tumours were retrospectively evaluated. IMT uptake was quantified as tumour/nontumour- ratio, a 4-value-scale was used to measure gadolinium enhancement on contrast enhanced MRI. Statistical analyses were performed to evaluate IMT uptake and gadolinium enhancement in low (WHO I/II) and high (WHO III/ IV) grade tumours and to disclose a potential relationship of IMT uptake to disruption of blood brain barrier as measured in corresponding MRI scans. Results: IMT uptake above background level was observed in 35 of 45 patients. IMT uptake was slightly higher in high grade tumours but the difference failed to attain statistical significance. Grading of individual tumours was neither possible by IMT SPECT nor by gadolinium enhanced MRI. Conclusion: IMT is accumulated in most brain tumours in children. Tumour grading was not possible using IMT or contrast enhancement as determined by MRI. Neither morphological nor functional imaging can replace histology in paediatric brain tumours.

Patellar fractures in cats: Repair techniques and treatment decision-making

2021 ◽  
Vol 23 (7) ◽  
pp. 649-661
Author(s):  
Sorrel J Langley-Hobbs
Keyword(s):  
Decision Making ◽  
Case Reports ◽  
Case Series ◽  
Treatment Decision ◽  
Evidence Base ◽  
Treatment Technique ◽  
Treatment Decision Making ◽  
Fracture Types ◽  
Patellar Fractures ◽  
Repair Techniques

Practical relevance: While feline patellar fractures are not commonly encountered in practice, they tend to be found more often in younger cats; no breed or sex predispositions are recognised. If there is no evidence of a traumatic aetiology, the cat may be suspected of having patellar fracture and dental anomaly syndrome (PADS). Patellar fractures are easy to diagnose on lateral radiographs and there are several different fracture types. The type of fracture, the age of the cat at fracture occurrence and whether there is suspicion of a pathological aetiology are all relevant when considering treatment technique. Clinical challenges: While some cats with patellar fractures will do well with conservative management, surgical treatment is often indicated and decision-making can be challenging. Evidence base: Information and recommendations provided in this review are based on the literature and the author’s own clinical experience. There are several publications on PADS, but there is limited evidence as to what the underlying cause of this condition is, and the best method for managing patellar fractures is still an area where more research is needed. Aim: This review aims to gather the papers, case series and case reports published over the past few decades in order to discuss how best to manage different types of patellar fractures.

scholarly journals Gastric Mixed Neuroendocrine Non-Neuroendocrine Neoplasms: A Western Center Case Series

2021 ◽  
Vol 9 (3) ◽  
pp. 47
Author(s):  
Marcus Fernando Kodama Pertille Ramos ◽  
Marina Alessandra Pereira ◽  
Arthur Youssif Mota Arabi ◽  
Melissa Mello Mazepa ◽  
Andre Roncon Dias ◽  
...  
Keyword(s):  
Gastric Adenocarcinoma ◽  
Tumor Size ◽  
Lymphovascular Invasion ◽  
Comparison Group ◽  
Case Series ◽  
Clinicopathological Characteristics ◽  
Neuroendocrine Neoplasms ◽  
Rare Tumor ◽  
Term Survival

Background: Mixed neuroendocrine non-neuroendocrine neoplasms (MiNENs) represent a rare tumor composed of adenocarcinoma and neuroendocrine carcinoma components. This study reports a case series of gastric MiNEN and discusses issues related to its diagnosis, management, and outcomes. Methods: We retrospectively analyzed data from patients with gastric MiNEN who underwent surgical resection at our service from 2009 to 2020. Patients with gastric adenocarcinoma served as a comparison group. Clinical, pathologic, and surgical characteristics were compared. Results: During the selected period, 5 gastric MiNEN patients and 597 patients with gastric adenocarcinoma were included. Among the clinical variables, age, sex, BMI, and laboratory exams were similar between the two groups. Only ASA classification was different (p = 0.015). Pathological variables such as tumor size, lymphovascular invasion, number of retrieved lymph nodes, and pTNM staging were also similar between both groups. Lastly, early surgical outcomes and long-term survival did not differ between gastric MiNEN and adenocarcinoma patients. Conclusion: A MiNEN is a rare tumor that represents less than 1% of GC patients undergoing curative treatment, and demonstrated clinicopathological characteristics and outcomes similar to gastric adenocarcinoma.

scholarly journals Classification of paediatric brain tumours by diffusion weighted imaging and machine learning

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jan Novak ◽  
Niloufar Zarinabad ◽  
Heather Rose ◽  
Theodoros Arvanitis ◽  
Lesley MacPherson ◽  
...  
Keyword(s):  
Diffusion Coefficient ◽  
Apparent Diffusion Coefficient ◽  
Posterior Fossa ◽  
Brain Tumours ◽  
Diffusion Weighted Imaging ◽  
Regions Of Interest ◽  
Apparent Diffusion Coefficients ◽  
Diffusion Weighted ◽  
Apparent Diffusion ◽  
Paediatric Brain Tumours

AbstractTo determine if apparent diffusion coefficients (ADC) can discriminate between posterior fossa brain tumours on a multicentre basis. A total of 124 paediatric patients with posterior fossa tumours (including 55 Medulloblastomas, 36 Pilocytic Astrocytomas and 26 Ependymomas) were scanned using diffusion weighted imaging across 12 different hospitals using a total of 18 different scanners. Apparent diffusion coefficient maps were produced and histogram data was extracted from tumour regions of interest. Total histograms and histogram metrics (mean, variance, skew, kurtosis and 10th, 20th and 50th quantiles) were used as data input for classifiers with accuracy determined by tenfold cross validation. Mean ADC values from the tumour regions of interest differed between tumour types, (ANOVA P < 0.001). A cut off value for mean ADC between Ependymomas and Medulloblastomas was found to be of 0.984 × 10−3 mm2 s−1 with sensitivity 80.8% and specificity 80.0%. Overall classification for the ADC histogram metrics were 85% using Naïve Bayes and 84% for Random Forest classifiers. The most commonly occurring posterior fossa paediatric brain tumours can be classified using Apparent Diffusion Coefficient histogram values to a high accuracy on a multicentre basis.

scholarly journals Impact of SARS-COV-2 Pandemic on Kidney Cancer Management

Kidney Cancer ◽  
2021 ◽  
pp. 1-14
Author(s):  
Melissa Bersanelli ◽  
Camillo Porta
Keyword(s):  
Survival Rates ◽  
Delayed Diagnosis ◽  
Case Series ◽  
Cost Benefit ◽  
Original Data ◽  
Immune Checkpoint Blockade ◽  
Retrospective Case ◽  
Renal Masses ◽  
Term Survival ◽  
Cancer Management

Background: The SARS-CoV-2 pandemic still has a huge impact on the management of many chronic diseases such as cancer. Few data are presently available reagarding how the management of renal cell carcinoma (RCC) has changed due to this unprecedented situation. Objective: To discuss the challenges and issues of the diagnosis and treatment of RCC in the COVID-19 era, and to provide recommendations based on the collected literature and our personal experience. Methods: Systematic review of the available Literature regarding the management of RCC during the SARS-CoV-2 pandemic. Results: Our review showed a prevalence of narrative publications, raising the issue of the real relevance of the evidence retrieved. Indeed, the only original data about RCC and COVID-19 found were a small retrospective case series and two surveys, providing either patients’ or physicians’ viewpoints. Conclusions: The expected delayed diagnosis of RCC could lead to an increase of advanced/metastatic cases; thus, proper therapeutic choices for patients with small renal masses should be carefully evaluated case by case, in order to avoid negative effects on long-term survival rates. The controversial interaction between immune checkpoint blockade and COVID-19 pathogenesis is more hypothetical than evidence-based, and thus immunotherapy should not be denied, whenever appropriate. To avoid treatments which won’t have an impact on patients’ survival, a honest and accurate evaluation of the cost/benefit ratio of each treatment option should be always performed. Finally, SARS-CoV-2 swab positivity should not prevent the continuation of ongoing active treatments in asymptomatic cases, or or after symptoms’ resolution.

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