Craniectomy with microvascular flap reconstruction in a patient taking infliximab for vasculitis

2020 ◽  
Vol 13 (12) ◽  
pp. e238614
Author(s):  
Ogonna N Nnamani Silva ◽  
Audrey B Nguyen ◽  
William Y Hoffman

For patients whose vasculitis is managed with biologic medications, no reports or evidence-based guidance exists regarding the perioperative management of microvascular flaps. We present a case of a 78-year-old patient with Takayasu’s arteritis (TA) and diabetes mellitus who was taking infliximab and underwent wide local excision of squamous cell carcinoma, craniectomy and reconstruction with a latissimus dorsi flap. TA, an immune-mediated large cell vasculitis characterised by granuloma formation, tends to affect larger vessels and aortic branches. The typical localisation of this condition raises concerns about potentially compromised pedicle and recipient vessels (ie, superficial temporal arteries), which could hinder postoperative flap success. Discontinuation of infliximab 4 weeks before surgery and resumption 6 weeks after led to favourable results. This case addresses the gap in the literature concerning stopping and restarting biologic drugs in the perioperative setting and documents a successful course of a microvascular procedure in a patient with vasculitis.

1998 ◽  
Vol 10 (3) ◽  
pp. 363-371
Author(s):  
Paul R. Baker ◽  
Wayne Maurer ◽  
Jacob Warman

2019 ◽  
Vol 53 (6) ◽  
pp. 448-451 ◽  
Author(s):  
Muhammad Umar ◽  
Noman Jahangir ◽  
Michael Hughes ◽  
Qasim Malik ◽  
Jalal Kokan ◽  
...  

2008 ◽  
Vol 54 (11) ◽  
pp. 1872-1882 ◽  
Author(s):  
Eva Nagy ◽  
Joseph Watine ◽  
Peter S Bunting ◽  
Rita Onody ◽  
Wytze P Oosterhuis ◽  
...  

Abstract Background: Although the methodological quality of therapeutic guidelines (GLs) has been criticized, little is known regarding the quality of GLs that make diagnostic recommendations. Therefore, we assessed the methodological quality of GLs providing diagnostic recommendations for managing diabetes mellitus (DM) and explored several reasons for differences in quality across these GLs. Methods: After systematic searches of published and electronic resources dated between 1999 and 2007, 26 DM GLs, published in English, were selected and scored for methodological quality using the AGREE Instrument. Subgroup analyses were performed based on the source, scope, length, origin, and date and type of publication of GLs. Using a checklist, we collected laboratory-specific items within GLs thought to be important for interpretation of test results. Results: The 26 diagnostic GLs had significant shortcomings in methodological quality according to the AGREE criteria. GLs from agencies that had clear procedures for GL development, were longer than 50 pages, or were published in electronic databases were of higher quality. Diagnostic GLs contained more preanalytical or analytical information than combined (i.e., diagnostic and therapeutic) recommendations, but the overall quality was not significantly different. The quality of GLs did not show much improvement over the time period investigated. Conclusions: The methodological shortcomings of diagnostic GLs in DM raise questions regarding the validity of recommendations in these documents that may affect their implementation in practice. Our results suggest the need for standardization of GL terminology and for higher-quality, systematically developed recommendations based on explicit guideline development and reporting standards in laboratory medicine.


1982 ◽  
Vol 26 (2) ◽  
pp. 77
Author(s):  
L. F. WALTS ◽  
J. MILLER ◽  
M. B. DAVIDSON ◽  
J. BROWN ◽  
Gordon M. Wyant

2021 ◽  
Vol 21 ◽  
pp. S240
Author(s):  
Ronit Gurion ◽  
Amit Akirov ◽  
Elias Bshara ◽  
Pia Raanani ◽  
Anat Gafter-Gvili ◽  
...  

Author(s):  
Ramakanth R. Yakkanti ◽  
Neil V. Mohile ◽  
Wayne B. Cohen-Levy ◽  
Sagie Haziza ◽  
Matthew J. Lavelle ◽  
...  

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