PERIPHERAL ARTERIOVENOUS MALFORMATIONS AND THEIR RESPONSE TO TREATMENT MODALITIES: A SINGLE SURGEON'S EXPERIENCE AT TERTIARY CARE HOSPITALS

Abstract Background Peripheral arteriovenous malformations (AVMs) are congenital defects resulting in abnormal connections between veins and arteries. We investigated a group of patients with peripheral AVMs to determine whether there were any gender differences in disease presentation and the response of AVMs to various modalities of treatment. Methodology The patients in this cross-sectional study were divided into two groups based on gender and their demographic data, clinical presentation at the time of diagnosis and response to treatment was assessed. Both surgical and nonsurgical treatment options were used. Nonsurgical options employed in the study included immunotherapy, embolotherapy and ultrasound-guided foam sclerotherapy (UGFS) Results Out of 43 patients, 74.4% were females with a male to female ratio of 1:3. The mean age at presentation in males was 27 years and 17 years in females. 60% of the male patients presented with high-flow AVMs while 81% of the female patients presented with low-flow lesions instead. Half of the AVMs in males were on the trunk whereas, in females, 93.9% were on the extremities. UGFS alone was used in 95.3% of patients while 32.5% of patients underwent UGFS followed by surgical excision. One patient was treated with sirolimus. In 4.6% of cases, embolization followed by surgical excision was performed. Recurrence was recorded in 20.9% of cases. Conclusions The clinical presentation of AVMs is notably different among the two genders. Sclerotherapy and embolotherapy proved to be effective treatment options. Larger studies, however, are needed to substantiate these claims. Keywords arteriovenous malformations, vascular malformations, sclerotherapy, embolotherapy, sirolimus

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Evaluating the efficacy of treatment options for anal intraepithelial neoplasia: a systematic review

International Journal of Colorectal Disease ◽

10.1007/s00384-020-03740-6 ◽

2020 ◽

Author(s):

Danielle R. L. Brogden ◽

Una Walsh ◽

Gianluca Pellino ◽

Christos Kontovounisios ◽

Paris Tekkis ◽

...

Keyword(s):

Systematic Review ◽

Treatment Options ◽

Hpv Vaccination ◽

Intraepithelial Neoplasia ◽

Surgical Excision ◽

Anal Intraepithelial Neoplasia ◽

Response To Treatment ◽

Treatment Modalities ◽

Recurrence Rates ◽

Anal Squamous Cell Carcinoma

Abstract Purpose Anal intraepithelial neoplasia (AIN) is the accepted precursor of anal squamous cell carcinoma (ASCC). There has long been a hypothesis that treating AIN may prevent ASCC. Many different treatment modalities have been suggested and studied. We conducted this systematic review to evaluate their efficacy and the evidence as to whether we can prevent ASCC by treating AIN. Methods MEDLINE and EMBASE were electronically searched using relevant search terms. All studies investigating the use of a single treatment for AIN that reported at least one end outcome such as partial or complete response to treatment, recurrence after treatment and/or ASCC diagnosis after treatment were included. Results Thirty studies were included in the systematic review investigating 10 treatment modalities: 5% imiquimod, 5-fluorouracil, cidofovir, trichloroacetic acid, electrocautery, surgical excision, infrared coagulation, radiofrequency ablation, photodynamic therapy and HPV vaccination. All treatment modalities demonstrated some initial regression of AIN after treatment; however, recurrence rates were high especially in HIV-positive patients. Many of the studies suffered from significant bias which prevented direct comparison. Conclusions Although the theory persists that by inducing the regression of AIN, we may be able to reduce the risk of ASCC, there was no clinical evidence within the literature advocating that treating AIN does prevent ASCC.

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Zosteriform Nevus Comedonicus

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11ispl4.4565 ◽

2020 ◽

Vol 11 (SPL4) ◽

pp. 2609-2612

Author(s):

Babbita S ◽

Thillaikkarasi A ◽

Sathyanarayanana R ◽

Narasimhalu CRV ◽

Sulochana Sonti

Keyword(s):

Topical Therapy ◽

Treatment Options ◽

Neck Region ◽

Surgical Excision ◽

Hair Follicles ◽

Treatment Modalities ◽

Developmental Defect ◽

Linear Distribution ◽

Head And Neck Region ◽

Typical Morphology

Nevus comedonicus is an uncommon cutaneous developmental defect of follicular apparatus characterized by unilateral and linear distribution of bundles of dilated hair follicles filled with keratin plugs. It is usually seen on the head and neck region, trunk and upper arm. This condition may be present at birth or can occur later in life. The term nevus comedonicus is a misnomer as there are no true comedones and is better termed as follicular keratotic nevus. It is also known as nevus zoniforme or nevus acneiformis unilateralis. There are two types of nevus comedonicus, namely inflammatory and non-inflammatory (non-pyogenic). When nevus comedonicus is manifested with other extracutaneous symptoms, it is termed as nevus comedonicus syndrome. Diagnosis is mainly clinical, based on history and typical morphology. As the disease runs a benign course, no aggressive treatment is required. Patients seek treatment, especially for cosmetic purposes and inflammatory type of lesions. Various treatment modalities like topical therapy, surgical excision, lasers are available and treatment options are individualized based on the size and extent of the lesion. We herein present a case of unilateral nevus comedonicus with no systemic associations in a 30-year-old female on her lower limb which is not a common site of occurrence.

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Surgical Management and Early Outcome of Encephalocele

Journal of Nobel Medical College ◽

10.3126/jonmc.v10i1.37946 ◽

2021 ◽

Vol 10 (1) ◽

pp. 42-45

Author(s):

Prakash Kafle ◽

Mohan Raj Sharma ◽

Sushil Krishna Shilpakar ◽

Gopal Sedain ◽

Amit Pradhanang ◽

...

Keyword(s):

Cleft Lip ◽

Care Center ◽

Tertiary Care ◽

Surgical Excision ◽

Clinical Profile ◽

Bony Defect ◽

Female Ratio ◽

Early Outcome ◽

Good Outcome ◽

Occipital Encephalocele

Background: There are limited studies pertaining to management of encephalocele in Nepal. So the present study seems justifiable to bridge the gap in the literature on encephalocele from Nepal on its clinical profile and early outcome. This study aims to characterize the clinical profile, management and outcome of largest series of encephalocele at tertiary care center in Nepal. Materials and Methods: A retrospective analysis of encephalocele, managed surgically at two tertiary care centers between 2015 and 2020, was performed. Results: Total of 25 cases was surgically managed in the present study. The median age of study population was 2.5 months. There were 11 male and 14 female with male to female ratio of 1:1.26. Occipital encephalocele was the most common variant. Lump in the head (n=11) was the commonest clinical presentation followed by hyperteliorism (n=10). One patient presented with cleft lip and one had CSF discharge in a case of occipital encephalocele. Bony defect was the common radiological findings. Excision and repair was the most common mode of surgery leading to good outcome. Mortality rate was 4% with morbidity of 20%. Conclusion: Early surgical excision and tight dural closure with repair of bony defect is the standard treatment with relatively good outcome.

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Current Treatment Recommendations for Leishmaniasis

Annals of Pharmacotherapy ◽

10.1177/106002809202601120 ◽

1992 ◽

Vol 26 (11) ◽

pp. 1452-1455 ◽

Cited By ~ 7

Author(s):

Jeffrey T. Moss ◽

James P. Wilson

Keyword(s):

English Language ◽

Clinical Presentation ◽

Case Reports ◽

Data Extraction ◽

Treatment Options ◽

Medical Personnel ◽

Current Treatment ◽

Treatment Modalities ◽

Management Options ◽

Governmental Institutions

OBJECTIVE: To review the epidemiology, clinical presentation, risk factors for transmission, and pathogenesis of leishmaniasis, as well as current treatment options for this disease. DATA SOURCES/DATA SELECTION: We reviewed unclassified medical-threat briefing material, subject-matter reviews, and case reports from the world's infectious disease literature. We concentrated on literature pertaining to the pathogenesis and management of leishmaniasis indigenous to Southwest Asia. DATA EXTRACTION: Data from subject reviews published in the English language were evaluated. Case reports and clinical trials provided supplemental data on evolving theories and management options. DATA SYNTHESIS: The clinical presentation of leishmaniasis is highly variable. Management relies heavily upon the use of parenteral antimonial drugs. Although these agents are effective in most cases, toxicity and the emergence of resistance limit the usefulness of standard therapies. Alternative treatment modalities include heat, surgical curettage, ketoconazole, metronidazole, pentamidine, rifampin, amphotericin B, aminoglycosides, allopurinol, and immunotherapy. CONCLUSIONS: Although the number of reported cases of leishmaniasis in the US has generally been low, there is a possibility that more cases may be reported in the future because of the large number of military personnel returning to this country from endemic areas. Medical personnel, particularly those working in governmental institutions, should be familiar with the pathogenesis of this unusual infection as well as potential treatment options.

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A challenging entity of endovascular embolization with ONYX for brainstem arteriovenous malformation: Experience from 13 cases

Interventional Neuroradiology ◽

10.1177/1591019917711679 ◽

2017 ◽

Vol 23 (5) ◽

pp. 497-503 ◽

Cited By ~ 5

Author(s):

Hengwei Jin ◽

Zhan Liu ◽

Qing Chang ◽

Chang Chen ◽

Huijian Ge ◽

...

Keyword(s):

Postoperative Complications ◽

Intracranial Hemorrhage ◽

Arteriovenous Malformations ◽

Clinical Presentation ◽

Gamma Knife Radiosurgery ◽

Endovascular Embolization ◽

Treatment Modalities ◽

Patient Demographics ◽

Partially Occluded

Objective Brainstem arteriovenous malformations (AVMs) are rare lesions with a high risk of intracranial hemorrhage and are challenging to treat. We present our experience of endovascular embolization with Onyx in these aggressive lesions. Materials and methods Between 2007 and 2016, 13 patients with brainstem AVMs were embolized with Onyx at our center. Twelve patients presented with intracranial hemorrhage and one with headache. Retrospective examinations of patient demographics, clinical presentation, angiographic features, treatment modalities, postoperative complications and outcomes were carried out. Results The AVMs were in the midbrain in 10 patients (one anterior and nine posterior or dorsal), in the posterior pons in two and pontomedullary in one. Complete occlusion was achieved in three patients. Gamma knife radiosurgery was performed in six patients who were near-completely or partially embolized. Postoperative complications, including five cases of ischemia and one case of hemorrhage, resulted in four cases of neurological deterioration and two deaths. Clinical follow-up was obtained in 10 patients at a mean period of 45.2 months (range 3 to 93 months). During the follow-up, good clinical outcomes were observed in seven patients with posterior or dorsal midbrain AVMs, and one patient with a posterior pons AVM that was partially occluded died of intracranial hemorrhage. Conclusion Endovascular embolization for brainstem AVM with Onyx is a technical challenge and the reflux of Onyx may cause severe complications. Individualized treatment is needed based on the specific subtype of brainstem AVM.

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Chronic granulomatous invasive fungal rhinosinusitis in Nigeria: challenges of management

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20203189 ◽

2020 ◽

Vol 6 (8) ◽

pp. 1417

Author(s):

Chinyere N. Asoegwu ◽

Rita O. Oladele ◽

Okezie O. Kanu ◽

Clement C. Nwawolo

Keyword(s):

Clinical Presentation ◽

Surgical Excision ◽

Antifungal Drugs ◽

Duration Of Symptoms ◽

Female Ratio ◽

Tropical Regions ◽

Delay In Diagnosis ◽

Fungal Rhinosinusitis ◽

Management Protocol ◽

Invasive Fungal Rhinosinusitis

Background: Chronic granulomatous invasive fungal rhinosinusitis affects mainly immunocompetent patients and has been widely reported in tropical regions such as South East Asia and North Africa. Nigeria has a tropical climate, however, there is paucity of data on this disease condition in Nigeria. This study documents the clinical, diagnostic, therapeutic challenges of managing patients with this condition in Nigeria.Methods: A retrospective study of patients diagnosed and treated for chronic granulomatous invasive fungal rhinosinusitis between 2010 and 2019. Diagnosis was based on clinical presentation, computed tomographic scan findings and confirmed by histopathology and/or microbiology results. Results: Ten patients aged 12 to 49 years with mean age of 33.9±13.8 years were studied. Male to female ratio was 2.3:1. All were immunocompetent. Duration of symptoms before presentation ranged from 3 months to 8 years with a mean duration of 3.5±2.4 years. Commonest clinical presentation was unilateral proptosis 80% followed by nasal mass 50%. Commonest sinus involved was the ethmoid (80%). There was orbital extension in 70% and intracranial involvement in 50%. Aspergillus species was the commonest fungal agent cultured. Treatment was by surgical excision followed by antifungal drugs. Some of the challenges we encountered in the management included; late presentation, delay in diagnosis, limited experience in histopathologic and mycology diagnosis and high cost of treatment amidst scarce resource.Conclusions: Chronic invasive granulomatous rhinosinusitis is not rare in Nigeria. A high index of suspicion is however needed for the diagnosis. Development of a National management protocol for this disease is recommended to avoid misdiagnosis.

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Liver abscess: presentation and an assesment of the outcome with various treatment modalities

International Surgery Journal ◽

10.18203/2349-2902.isj20192992 ◽

2019 ◽

Vol 6 (7) ◽

pp. 2556 ◽

Cited By ~ 1

Author(s):

Sreeramulu P. N. ◽

Srinivasan Dorai Swamy ◽

Vikranth Suresh N. ◽

Suma S.

Keyword(s):

Liver Abscess ◽

Clinical Presentation ◽

Tertiary Care ◽

Pyogenic Liver Abscess ◽

Amoebic Liver Abscess ◽

Treatment Modalities ◽

Tertiary Care Centre ◽

Continuous Drainage ◽

Right Lobe ◽

Upper Abdominal

Background: Liver abscess is a disease of frequent occurrence which is important in the differential diagnosis of upper abdominal and right lower respiratory tract diseases. Liver abscess are space occupying lesion in liver which has a higher incidence of mortality and morbidity. The aim is to study the clinical presentation and compare the outcomes of various treatment modalities.Methods: A Retrospective Study was conducted over a period of 3 years from November 2016 to October 2019, in tertiary care centre, R. L. Jalappa hospital, Tamaka, Kolar, Karnataka, India. 46 cases of liver abscesses were studied. Complete clinical details about the clinical presentation of the cases, investigative work up and treatment modalities adopted were collected. The associated morbidity and mortality of all patients were reviewed.Results: In our study, the mean age was 49.5 years which included male patients most commonly. Pyogenic liver abscess was more common than amoebic liver abscess. Right lobe of the liver was most commonly involved. The common treatment modality was continuous drainage of the abscess cavity by the percutaneous insertion of a pig tail catheter. Surgical intervention for the rupture was done in one patient.Conclusions: In our experience of managing liver abscess, pyogenic liver abscess involving right lobe of the liver was common with the presentation of upper abdominal pain, high grade fever with chills and tender hepatomegaly. Ultrasound abdomen is very useful investigative tool in diagnosis and also in intervention and in the follow up of the condition and to evaluate progression or resolution.

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Use of Triamcinolone in keloid

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20214063 ◽

2021 ◽

Author(s):

Shwetha B. ◽

Sathyaki D. C.

Keyword(s):

Recurrence Rate ◽

Tertiary Care ◽

Surgical Excision ◽

Weekly Interval ◽

Treatment Modalities ◽

Care Centre ◽

Tertiary Care Centre ◽

Triamcinolone Injection

Background: Keloids are well known for recurrence. There is no standardized regimen for the treatment of keloids. Many different treatment modalities such as surgical excision, intralesional corticosteroids, radiotherapy, and pressure earrings have been used for keloids. Surgical excision alone may result in recurrence rate of 40-100%. Many different modalities of treatment have been tried to prevent recurrence. Aims and objectives of the study was to evaluate the efficacy of Triamcinolone in preventing recurrence of Keloid.Methods: 40 patients who underwent excision of keloid at a tertiary care centre. Surgery alone was performed in 20 patients and surgery with post operative intra lesional Triamcinolone injection was given weekly interval for 6 weeks in another 20 patients. Patients were followed up for the period of 2 yearsResults: Recurrence was found in 5 patients who underwent excision alone and there was no recurrence among patients who received post operative intra lesional triamcinolone.Conclusions: Multi modality treatment is better to prevent recurrence of Keloid.

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Hemodynamics Associated With Intracerebral Arteriovenous Malformations: The Effects of Treatment Modalities

Neurosurgery ◽

10.1093/neuros/nyx560 ◽

2017 ◽

Vol 83 (4) ◽

pp. 611-621 ◽

Cited By ~ 5

Author(s):

Vernard S Fennell ◽

Nikolay L Martirosyan ◽

Gursant S Atwal ◽

M Yashar S Kalani ◽

Francisco A Ponce ◽

...

Keyword(s):

Arteriovenous Malformations ◽

Treatment Options ◽

Treatment Strategies ◽

Endovascular Embolization ◽

Treatment Modalities ◽

Cerebral Arteriovenous Malformations ◽

Venous Outflow ◽

Comprehensive Literature Review ◽

Flow Through ◽

Changes Over Time

Abstract The understanding of the physiology of cerebral arteriovenous malformations (AVMs) continues to expand. Knowledge of the hemodynamics of blood flow associated with AVMs is also progressing as imaging and treatment modalities advance. The authors present a comprehensive literature review that reveals the physical hemodynamics of AVMs, and the effect that various treatment modalities have on AVM hemodynamics and the surrounding cortex and vasculature. The authors discuss feeding arteries, flow through the nidus, venous outflow, and the relative effects of radiosurgical monotherapy, endovascular embolization alone, and combined microsurgical treatments. The hemodynamics associated with intracranial AVMs is complex and likely changes over time with changes in the physical morphology and angioarchitecture of the lesions. Hemodynamic change may be even more of a factor as it pertains to the vast array of single and multimodal treatment options available. An understanding of AVM hemodynamics associated with differing treatment modalities can affect treatment strategies and should be considered for optimal clinical outcomes.

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Unusual Glomus Tumor of the Penis

Current Urology ◽

10.1159/000442864 ◽

2015 ◽

Vol 9 (3) ◽

pp. 113-118 ◽

Cited By ~ 4

Author(s):

Gautam Dagur ◽

Kelly Warren ◽

Yimei Miao ◽

Navjot Singh ◽

Yiji Suh ◽

...

Keyword(s):

Clinical Presentation ◽

Spindle Cell ◽

Glomus Tumor ◽

Treatment Options ◽

Surgical Excision ◽

Primary Objective ◽

Inclusion Criteria ◽

Glomus Tumors ◽

Clinical Presentations ◽

Epithelial Lesions

Introduction: Glomus tumors are benign neoplasms commonly found in subungual regions of the extremities and rarely located in the penis. Misdiagnosis of glomus tumors is common; therefore, symptoms and clinical presentations should be reviewed. Objective: The primary objective of this review article is to emphasize the pathogenesis, pathology, clinical presentation, symptoms, diagnosis, and treatment methods of glomus tumors in order to better identify and manage the condition. Materials and Methods: Research was conducted using PubMed/Medline. The inclusion criteria required glomus tumor to be present on the penis. Results: Glomus tumors, which appear as symptomatic or asymptomatic lesions, are attributed to dispersion grouping of neoplastic or non-neoplastic lesions in a particular area. Conclusion: Differential diagnosis of glomus tumors includes hemangiomas, neurofibromatosis, epithelial lesions, and spindle-cell lesions. Physical examination and histological findings should be used for diagnosis. Treatment options can be either conservative or invasive, in which the patient undergoes surgical excision.

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