Treatment Options for Scrotal Migration of Ventriculoperitoneal Shunts: Case Illustration and Systematic Review of 48 Cases

2021 ◽  
Author(s):  
Thomas Hauser ◽  
Christian Auer ◽  
Johanna Ludwiczek ◽  
Wolfgang Senker ◽  
Philip-Rudolf Rauch ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hernia Repair ◽  
Case Reports ◽  
Treatment Options ◽  
Treatment Algorithm ◽  
Shunt Revision ◽  
Illustrative Case ◽  
Ventriculoperitoneal Shunts ◽  
Repeat Migration ◽  
Shunt Migration

Abstract BACKGROUND Scrotal migration of intact or disconnected tubing is a rare complication of ventriculoperitoneal shunts. While some illustrative case reports can be found in the literature, a systematic review on treatment options is lacking. OBJECTIVE To propose the first literature-based treatment algorithm on scrotal shunt migration. METHODS We conducted a literature search using the keywords: “VP,” “ventriculoperitoneal,” “shunt,” and “scrotum.” We identified 36 publications with 48 cases reported including our index case. RESULTS Median age at presentation was 13.5 mo (3 d to 65 yr) which was 4 mo (3 d to 72 mo) after last shunt-related surgery. All patients had scrotal swelling, 39 (81%) patients presented without other symptoms, 4 (8%) had additionally local pain, and 4 (8%) patients presented with symptoms of shunt dysfunction. Treatment was surgically in all but one case where spontaneous resolution without repeat migration occurred. In 3 of 4 patients who had either subcutaneous shortening or abdominal repositioning of the shunt without hernia repair, scrotal shunt migration recurred within the following month. Whereas the surgical treatment with reposition of the migrated catheter back into the peritoneal cavity via a groin incision plus hernia repair yielded a definite treatment in all 26 performed cases, the revision rate was significantly higher in the shunt revision without hernia repair cohort (P = .0009). CONCLUSION Scrotal shunt migration is a rare shunt complication with good recovery when treated surgically. We recommend hernia repair in addition to either manual or surgical repositioning of migrated tubing.

scholarly journals Nonpuerperal Uterine Inversion: What the Gynaecologists Need to Know?

2020 ◽  
Vol 2020 ◽  
pp. 1-12 ◽  
Author(s):  
R. P. Herath ◽  
M. Patabendige ◽  
M. Rashid ◽  
P. S. Wijesinghe
Keyword(s):  
Case Reports ◽  
Treatment Options ◽  
Treatment Algorithm ◽  
Surgical Techniques ◽  
Clinical Problem ◽  
Abdominal Hysterectomy ◽  
Uterine Inversion ◽  
Surgical Access ◽  
Surgical Methods ◽  
Presentation Methods

Introduction. Nonpuerperal uterine inversion (NPUI) is a rare clinical problem with diagnostic and surgical challenges. The objective of our study was to review the literature on NPUI and describe causative pathologies, diagnosis, and different surgical options available for treatment. Materials and Methods. A comprehensive literature review was carried out on MEDLINE and Google Scholar databases to look for NPUI using the term “non-puerperal uterine inversion,” and further went through the cross-references of the published articles. Data are published case reports from 1911 to September 2018. Of the 153 published cases, 133 reports had adequate details of surgery for analysis. These reports were analyzed, concerning the clinical presentation, methods of diagnosis, and surgical treatment. Results. Mean age of the women was 46.3 years (standard deviation: 18, N = 153). Leiomyoma remained the commonest (56.2%) aetiology. While malignancies contributed to 32.02% of cases, 9.2% were idiopathic. High degree of clinical suspicion and identification of unique features on ultrasonography and magnetic resonance imaging enable prompt diagnosis. In cases of uncertainty, laparoscopy or biopsy of the mass was used to confirm the diagnosis. Hysterectomy or repositioning and repair of the uterus are the only treatment options available. The surgical methods implemented were analyzed in three aspects: route of surgical access, method of repositioning, and final surgical procedure undertaken. The majority (48.8%) had only abdominal access, while 27.1% had both abdominal and vaginal access. Haultain procedure was the most useful procedure for reposition (18.0%) of the uterus. The majority (39.7%) required abdominal hysterectomy with or without debulking of the tumour abdominally, while 15.0% had uterine repair after repositioning. We reviewed the different surgical techniques and described and proposed a treatment algorithm. Conclusions. Fibroids were the commonest cause for NPUI. Malignancies accounted for one-third of cases. A combined abdominal and vaginal approach, followed by hysterectomy or repair after repositioning, seems to be better for nonmalignant cases.

scholarly journals Chondromas of the Lumbar Spine: A Systematic Review

2020 ◽  
pp. 219256822090155
Author(s):  
Luis A. Robles ◽  
Greg M. Mundis
Keyword(s):  
Systematic Review ◽  
Case Reports ◽  
Lumbar Disc ◽  
Spinal Tumor ◽  
Clinical Findings ◽  
Illustrative Case ◽  
Rim Enhancement ◽  
Disc Herniations ◽  
Meta Analyses ◽  
Lumbar Spinal

Study Design: Systematic review and illustrative case. Objectives: Lumbar spinal chondromas (LSCs) are rare spine tumors. The characteristics of these intraspinal lesions are not well described in the literature. The goal of this article is to describe the features of this rare spinal tumor. Methods: A PubMed and Scopus search adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed to include studies reporting patients with LSCs. The data gathered from this review was analyzed to characterize LSCs. Results: The search yielded 14 cases of patients with LSCs. All studies were case reports (Level V of evidence). Different characteristics of LSCs are described, including demographics, clinical findings, imaging, and treatment. Conclusions: The results of this review show that LSCs are almost exclusively seen in the extradural space and may adopt a dumbbell shape. LSCs frequently manifest in a very similar way to lumbar disc herniations; therefore, they should be considered in the differential diagnosis of sciatica, especially if magnetic resonance imaging with gadolinium shows peripheral rim enhancement of the lesion. Different degrees of improvement are usually observed after surgical treatment of these patients.

scholarly journals Adult primary liver sarcoma: systematic review

2020 ◽  
Vol 47 ◽  
Author(s):  
ANTONIO CAVALCANTI DE ALBUQUERQUE MARTINS ◽  
DUÍLIO CABRAL DA COSTA NETO ◽  
JÚLIO DOURADO DE-MATOS E SILVA ◽  
YGOR MONTEIRO MORAES ◽  
CRISTIANO SOUZA LEÃO ◽  
...  
Keyword(s):  
Systematic Review ◽  
Prognostic Factors ◽  
Case Reports ◽  
Treatment Options ◽  
Case Series ◽  
Epithelioid Hemangioendothelioma ◽  
Treatment Modalities ◽  
R0 Resection ◽  
Rare Type ◽  
Degree Of Differentiation

ABSTRACT Introduction: primary liver sarcoma is a rare type of tumor, more common in children. Among adults, it represents a spectrum of neoplasms with reserved prognosis. There is no consensus on the treatment of choice of these lesions, justifying a systematic review of the literature on treatment options, prognostic factors, and survival. Material/Methods: a systematic review of articles published in Pubmed, Medline, LiLacs e SciElo, from 1966 to March/2019, presenting the keywords: primary-liver-sarcoma and primary-hepatic-sarcoma was undertaken. Studies including patients older than 18 years, and published in English, Portuguese and Spanish were included. Case reports, metastatic tumors and multiple oncologic diagnosis were excluded. The initial search listed 1,318 articles. 1,206 did not meet the inclusion criteria. After reviewing 112 eligible articles, 15 were selected (14 case series and 1 retrospective-cohort). Results: proposed treatment modalities for primary liver sarcoma included surgery and/or chemotherapy and/or radiotherapy or liver transplantation. The most common histological types were angiosarcoma (32%), leiomyosarcoma (29%), epithelioid hemangioendothelioma (15%) and embryonal sarcoma (7%). Histology, degree of differentiation and R0 resection were mentioned positive prognostic factors. Median survival ranged from two to 23 months. Five-year survival rate varied from 0% to 64%, on average 21%. Conclusion: surgical resection (R0 resection) is the main treatment for primary liver sarcomas. Development of effective systemic therapies are required to improve prognosis of patients harboring this type of tumor.

scholarly journals Treatment of paediatric trigger finger: a systematic review and treatment algorithm

2018 ◽  
Vol 12 (3) ◽  
pp. 209-217 ◽  
Author(s):  
M. E. Womack ◽  
J. C. Ryan ◽  
V. Shillingford-Cole ◽  
S. Speicher ◽  
G. D. Hogue
Keyword(s):  
Systematic Review ◽  
Treatment Options ◽  
Treatment Algorithm ◽  
Surgical Techniques ◽  
Rare Condition ◽  
Small Sample ◽  
Trigger Finger ◽  
Review Of The Literature ◽  
Level Of Evidence ◽  
Number Of Patients

Purpose Paediatric trigger finger (PTF) is a rare condition as seen by the lack of studies published about paediatric populations. Due to this general lack of information, the steps to employ to correct this disorder, whether surgically or non-surgically, have not yet reached consensus status. The objective of this study is to review the published literature regarding treatment options for PTF in order to develop a proposed step-wise treatment algorithm for children presenting with trigger finger. Methods A systematic review of the literature was conducted on PubMed to locate English language studies reporting on treatment interventions of PTF. Data was collected on number of patients/fingers seen in the study, the category of the fingers involved, the number of patients/fingers undergoing each intervention and reported outcomes. Results Seven articles reporting on 118 trigger fingers were identified. In all, 64 fingers were treated non-surgically, with 57.8% (37/64) resolving. In all, 54 fingers were initially surgically treated, with 87% (47/54) resolving. In total, 34 fingers did not have resolution of symptoms following primary treatment, and 27 fingers received follow-up treatment, with 92.6% (25/27) resolving. Overall, 92.4% (109/118) of fingers achieved resolution of symptoms after all treatments were completed. Conclusion Limitations for this study included few prospective studies and small sample sizes. This is likely due to the rarity of PTF. This review of the literature indicated that a step-wise approach, including non-operative and surgical techniques, should be employed in the management of PTF. Level of Evidence III This work meets the requirements of the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses).

scholarly journals Structured Expert Consensus on Actinic Keratosis: Treatment Algorithm Focusing on Daylight PDT

2017 ◽  
Vol 21 (1_suppl) ◽  
pp. 3S-16S ◽  
Author(s):  
Piergiacomo Calzavara-Pinton ◽  
Merete Hædersdal ◽  
Kirk Barber ◽  
Nicole Basset-Seguin ◽  
María Emilia Del Pino Flores ◽  
...  
Keyword(s):  
Systematic Review ◽  
Actinic Keratosis ◽  
Consensus Statement ◽  
Treatment Options ◽  
Treatment Algorithm ◽  
Large Field ◽  
Delphi Panel ◽  
Multiple Lesions ◽  
Consensus Statements ◽  
Diagnosis Classification

Background: A practical and up-to-date consensus among experts is paramount to further improve patient care in actinic keratosis (AK). Objectives: To develop a structured consensus statement on the diagnosis, classification, and practical management of AK based on up-to-date information. Methods: A systematic review of AK clinical guidelines was conducted. This informed the preparation of a 3-round Delphi procedure followed by a consensus meeting, which combined the opinions of 16 clinical experts from 13 countries, to construct a structured consensus statement and a treatment algorithm positioning daylight photodynamic therapy (dl-PDT) among other AK treatment options. Results: The systematic review found deficiencies in current guidelines with respect to new AK treatments such as ingenol mebutate and dl-PDT. The Delphi panel established consensus statements across definition, diagnosis, classification, and management of AK. While the diagnosis of AK essentially rests on the nature of lesions, treatment decisions are based on several clinical and nonclinical patient factors and diverse environmental attributes. Participants agreed on ranked treatment preferences for the management of AK and on classifying AK in 3 clinical situations: isolated AK lesions requiring lesion-directed treatment, multiple lesions within a small field, and multiple lesions within a large field, both requiring specific treatment approaches. Different AK treatment options were discussed for each clinical situation. Conclusions: The results provide practical recommendations for the treatment of AK, which are readily transferable to clinical practice, and incorporate the physician’s clinical judgement. The structured consensus statement positioned dl-PDT as a valuable option for patients with multiple AKs in small or large fields.

scholarly journals Treatment Algorithm for Hyaluronic Acid-Related Complication Based on a Systematic Review of Case Reports, Case Series, and Clinical Experience

2020 ◽  
Vol 13 (4) ◽  
pp. 313-328
Author(s):  
Uri Aviv ◽  
Josef Haik ◽  
Nathaniel Weiss ◽  
Ariel Berl ◽  
Hagit Ofir ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hyaluronic Acid ◽  
Adverse Effects ◽  
Case Reports ◽  
Treatment Algorithm ◽  
Case Series ◽  
Related Complication ◽  
Ocular Manifestations ◽  
Management Of Complications ◽  
Step Algorithm

Study Design: Systematic review of hyaluronic acid (HA)-related complications. Objective: To systematically review all available literature including case reports and case series to identify a pattern for the management of vascular compromise resulting in facial skin ischemia and ocular manifestations following HA injection. Methods: This review was based on a systematic search of 3 electronic databases PubMed, CINAHL, and Scopus for all available literature including case series and case reports from database inception to July 2019. Only a total of 52 case reports/series were eligible for review and included 107 patients. Results: The reviewed literature available was comprised from case reports/series and indicated that management of both impending skin necrosis and visual disturbances is variable with no repetitive pattern of action. Yet, successful management is time dependent as early interventions stopped progression and, in some cases, even reversed adverse effects. Conclusion: Results found no universal protocol for achieving optimal results for adverse effects and as such, we present a step-by-step algorithm for the emergency management of complications following HA injection.

scholarly journals Rosette-forming glioneuronal tumor: an illustrative case and a systematic review

2020 ◽  
Vol 2 (1) ◽  
Author(s):  
Caleb P Wilson ◽  
Arpan R Chakraborty ◽  
Panayiotis E Pelargos ◽  
Helen H Shi ◽  
Camille K Milton ◽  
...  
Keyword(s):  
Systematic Review ◽  
Aggressive Behavior ◽  
Case Reports ◽  
World Health ◽  
Glioneuronal Tumor ◽  
Illustrative Case ◽  
Low Grade ◽  
Search Term ◽  
Who Grade ◽  
Mri Features

Abstract Background Rosette-forming glioneuronal tumors (RGNTs) are rare, low-grade, primary CNS tumors first described in 2002 by Komori et al. RGNTs were initially characterized as a World Health Organization (WHO) grade I tumors typically localized to the fourth ventricle. Although commonly associated with an indolent course, RGNTs have the potential for aggressive behavior. Methods A comprehensive search of PubMed and Web of Science was performed through November 2019 using the search term “rosette-forming glioneuronal tumor.” Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. English, full-text case reports and series with histopathological confirmation were included. Patient demographics, presentations, MRI features, tumor location, treatment, and follow-up of all 130 cases were extracted. Results A 19-year-old man with a history of epilepsy and autism presented with acute hydrocephalus. MRI scans from 2013 to 2016 demonstrated unchanged abnormal areas of cortex in the left temporal lobe with extension into the deep gray-white matter. On presentation to our clinic in 2019, the lesion demonstrated significant progression. The patient’s tumor was identified as RGNT, WHO grade I. One hundred thirty patients were identified across 80 studies. Conclusion RGNT has potential to transform from an indolent tumor to a tumor with more aggressive behavior. The results of our systematic review provide insight into the natural history and treatment outcomes of these rare tumors.

scholarly journals Antimicrobial agents for the treatment of enteric fever chronic carriage: A systematic review

2021 ◽  
Author(s):  
Naina McCann ◽  
Peter Scott ◽  
Christopher Parry ◽  
Michael Brown
Keyword(s):  
Systematic Review ◽  
Enteric Fever ◽  
Antimicrobial Agents ◽  
Case Reports ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Treatment Options ◽  
Case Series ◽  
Bibliographic Databases ◽  
Chronic Carriage

Background Chronic carriage of S . Typhi or S. Paratyphi is an important source of enteric fever transmission. Existing guidance and treatment options for this condition are limited. This systematic review aims to assess the evidence concerning the efficacy of different antimicrobials in treating enteric fever chronic carriage. Methods We searched major bibliographic databases using relevant keywords between 1946 and September 2021. We included all interventional studies that included patients with confirmed enteric fever chronic carriage and deployed an antimicrobial that remains in clinical practice today. Case reports and case series of under 10 patients were excluded. Two reviewers screened abstracts, selected articles for final inclusion and quality-assessed the included studies for risk of bias. Extracted data was analysed, with pooling of data and eradication rates for each antimicrobial calculated. As only one randomised controlled trial was identified no meta-analysis was performed. Results Of the 593 papers identified by the initial search, a total of eight studies met the inclusion criteria and were included in the systematic review. Evidence was identified for the use of fluoroquinolones and amoxicillin/ampicillin in the treatment for enteric fever chronic carriage. Fluoroquinolones were superior to amoxicillin/ampicillin with 92% of patients eradicated after one antimicrobial course compared to 68% (p = 0.02). The quality of included studies was poor, and all were carried out before 1990. Conclusion This review identified fluoroquinolones and amoxicillin as treatment options for enteric fever chronic carriage, with fluoroquinolones the more effective option. However, this evidence pre-dates rises in antimicrobial resistance in enteric fever and therefore the significance of these findings to today’s practice is unclear. Further research is needed to investigate whether these antimicrobials remain appropriate treatment options or whether alternative interventions are more effective.

scholarly journals Hypertelorism

2014 ◽  
Vol 47 (03) ◽  
pp. 284-292 ◽  
Author(s):  
Ramesh K. Sharma
Keyword(s):  
Case Reports ◽  
Treatment Options ◽  
Timing Of Surgery ◽  
Long Term Results ◽  
Illustrative Case ◽  
Normal Position ◽  
Vertical Orientation ◽  
Underlying Condition ◽  
Choice Of Procedure

ABSTRACTThe term orbital hypertelorism (ORH) implies “widely apart orbits.” This may also be associated with the abnormal vertical orientation of the orbits (dystopia). This deformity may be unilateral or bilateral, symmetric or asymmetric and may be present in a variety of craniofacial conditions. The treatment is primarily carried out for aesthetic reasons. The timing of treatment is dictated by the underlying condition and the type of procedure envisaged. The mainstay of treatment consists of moving the orbits medially to near normal position. This is accomplished by either an orbital translocation or facial bipartition technique. The choice of procedure is governed by the shape of the maxillary arch and associated occlusal conditions. We must differentiate between the telecanthus (also called pseudo-hypertelorism) and a true ORH as the management differs in these two conditions. The ORH involves extensive intracranial and extracranial operation whereas the telecanthus correction is relatively simpler surgery. The article will discuss the aetiology, classification, presentation, treatment options, timing of surgery and the choice of surgical procedures. Illustrative case reports with long-term results will be used to explain the management of these patients.

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