scholarly journals Postherpetic Nneuralgia: Review of Treatment Modalities

2000 ◽  
Vol 5 (1) ◽  
pp. 69-74 ◽  
Author(s):  
Philip SL Chan ◽  
Alexander J Clark
Keyword(s):  
Postherpetic Neuralgia ◽  
Tricyclic Antidepressants ◽  
Opioid Analgesics ◽  
Primary Treatment ◽  
Treatment Modalities ◽  
Nerve Blocks ◽  
Varicella Zoster ◽  
Primary Treatment Modality ◽  
Topical Medications ◽  
Physical Modalities

BACKGROUND: Varicella zoster virus (VZV) is the etiological agent for both varicella (chickenpox) and herpes zoster (HZ) (shingles). HZ results from the reactivation of VZV acquired during childhood. Postherpetic neuralgia (PHN) is the most common complication of HZ infection in immunocompetent patients. There is no universally accepted definition of PHN. While the mechanisms producing pain associated with PHN are not fully understood, peripheral and central processes are thought to be important.METHODS: The literature on the pathophysiology and the treatment of postherpetic neuralgia was reviewed for the past 30 years by using Index Medicus.CONCLUSIONS: Many modalities to treat PHN are available; none of them are very effective. The most commonly used modalities are tricyclic antidepressants, anticonvulsants, opioid analgesics, topical medications, physical modalities such as acupuncture and transcutaneous nerve stimulation, and nerve blocks. The tricyclic antidepressants have the most evidence supporting their role in treating PHN, although only half of the patients with PHN benefit. Recent studies support the use of opioid analgesics in PHN. There is a growing body of evidence in support of the use of gabapentin for PHN. Physical modalities and topical medications are probably most useful as adjuncts to centrally acting agents, not as a primary treatment modality. Injections (nerve blocks) are effective in relieving PHN anecdotally, although there are no controlled clinical trials showing efficacy.

Treatment of temporal artery pseudoaneurysms

Vascular ◽  
2013 ◽  
Vol 22 (4) ◽  
pp. 274-279 ◽  
Author(s):  
Irene Thomassen ◽  
Elisabeth G Klompenhouwer ◽  
Edith M Willigendael ◽  
Joep AW Teijink
Keyword(s):  
Superficial Temporal Artery ◽  
Surgical Excision ◽  
Temporal Artery ◽  
Primary Treatment ◽  
Treatment Modalities ◽  
Diagnostic Process ◽  
Thrombin Injection ◽  
Invasive Treatment ◽  
Artery Pseudoaneurysm ◽  
Primary Treatment Modality

Purpose To give an overview of the etiology and diagnostic process of superficial temporal artery pseudoaneurysms and to evaluate different treatment modalities. Basic methods PubMed was used for searching multiple databases for relevant clinical studies. Principal findings A total of 62 studies were included, harboring 82 patients. Surgical excision is the most frequently described treatment, but less invasive treatment modalities as coiling and thrombin injections are gaining popularity. Surgical treatment was successful in all cases (67/67). Endovascular treatment was successful in 69% (9/13); the five cases treated with thrombin injection were all successful. Complementary, a description of our experience with thrombin injection is given. Conclusions Limited evidence of minimal invasive treatment for superficial temporal artery pseudoaneurysm is available. Based on this review combined with our limited experience, we suggest thrombin injections to be considered as the future primary treatment modality. In the case of unsuccessful exclusion of the aneurysm, surgical excision can be performed.

scholarly journals COVID-19 and end stage renal disease treatment modalities in the United States

2021 ◽  
pp. 003-009
Author(s):  
Sullivan John D
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
The United States ◽  
Primary Treatment ◽  
Treatment Modalities ◽  
Health Coverage ◽  
Home Hemodialysis ◽  
Primary Treatment Modality ◽  
Stage Renal Disease ◽  
End Stage

From the establishment of nearly universal health coverage for end stage renal disease in 1972 to 2021, the primary treatment modality has been in-center hemodialysis despite significant advances in home therapies such as peritoneal dialysis and home hemodialysis. There are many theories as to why peritoneal and home hemodialysis lack so far behind in prescriptions with profitability and or a patient’s compliance or support leading the logical explanations. But 2020 was a different year with the surge in COVID-19 cases.

Herpes Zoster and Postherpetic Neuralgia

2018 ◽  
pp. 93-98
Author(s):  
Jianguo Cheng
Keyword(s):  
Herpes Zoster ◽  
Postherpetic Neuralgia ◽  
Dorsal Root ◽  
Skin Lesions ◽  
Intercostal Nerve ◽  
Intrathecal Therapy ◽  
Nerve Blocks ◽  
Varicella Zoster ◽  
Epidural Injections ◽  
History Of

Herpes zoster is caused by reactivation of the latent varicella zoster virus (VZV) that causes chicken pox. VZV remains dormant in the dorsal root and cranial ganglia and can reactivate later in a person’s life and cause herpes zoster, which appears predominantly in older adults, but may also occur in those that are immunocompromised. Postherpetic neuralgia (PHN) is defined as pain in the affected dermatome that is still present 1 month after development of the vesicles. Adults older than 50 should receive the herpes zoster vaccine as part of routine medical care. Shingrix is a new vaccine recently approved and recommended by the FDA, which is a non-live, subunit vaccine. In contrast to Zostavax, Shingrix is 97% effective against shingles and 91% effective against PHN for people 50 and older. The diagnosis of herpes zoster can be made on the basis of characteristic skin lesions and pain and itching in the involved dermatome. During the acute phase, an antiviral given within 72 hours of onset helps reduce pain and complications and shorten the course of the disease. The diagnosis of PHN is based on a history of herpes zoster, typical dermatomal distribution of the pain, and hyperalgesia and/or allodynia on physical examination. First-line pharmacotherapy includes gabapentin or pregabalin, tricyclic antidepressants, and SNRIs. Combination therapies are often necessary. Interventional options such as epidural injections, paravertebral blocks, selective nerve root blocks, sympathetic nerve blocks, intercostal nerve blocks, trigeminal nerve blocks, spinal cord or dorsal root ganglion stimulation, and intrathecal therapy may be considered in refractory cases.

scholarly journals Gamma Knife Radiosurgery for Berry Aneurysms: Quo Vadis

2020 ◽  
Author(s):  
Manjul Tripathi ◽  
Aman Batish ◽  
Sandeep Mohindra
Keyword(s):  
Gamma Knife ◽  
Intracranial Aneurysms ◽  
Vascular Malformations ◽  
Gamma Knife Radiosurgery ◽  
Primary Treatment ◽  
Treatment Modalities ◽  
Invasive Treatment ◽  
Mortality And Morbidity ◽  
Primary Treatment Modality ◽  
Quo Vadis

Abstract Background Intracranial aneurysms are vascular malformations with significant mortality and morbidity profile. Various treatment modalities have been developed to positively impact the outcome profile with gradual shift to the minimally invasive treatment modalities. Gamma knife radiosurgery (GKRS) is an established primary treatment modality for various intracranial arteriovenous malformations (AVMs); however, its efficacy for berry aneurysmal obliteration has been historically dismal. Objective The aim of this study is to evaluate the factors responsible for poor radio surgical outcome for intracranial aneurysms. Methods The literature is reviewed for the differential efficacy of GKRS for aneurysm and AVM. Results Though both are vascular malformations, aneurysm and AVM have inherent differences in angioarchitecture, intracranial location, surrounding neighborhood, radio-sensitivity, and latency for obliteration. The major difference arises because of surrounding neighborhood of connective tissue stroma which stabilizes the irradiated pathology. Conclusion Though considered radioresistant, aneurysms show promising results with animal models of radiosurgery. The future lies in two hypothetical improvements: with a supporting neighborhood or sensitization of the vessel wall that may change the natural history of an aneurysm, especially an unruptured one.

scholarly journals Endoscopic Management of Branchial Fistula: Diagnostic and Therapeutic.

2021 ◽  
Vol 20 (4) ◽  
Author(s):  
Mark Paul ◽  
Bee See Goh
Keyword(s):  
Surgical Excision ◽  
Neck Surgery ◽  
Typical Feature ◽  
Primary Treatment ◽  
Treatment Modalities ◽  
Endoscopic Management ◽  
First Line ◽  
Primary Treatment Modality ◽  
Branchial Fistula ◽  
Endoscopic Assessment

Recurrent neck abscess is a typical feature of branchial anomaly. Open surgical excision has been the primary treatment modality for past decades however several alternative treatment modalities such as endoscopic electrocauterization has recently gained popularity and acceptance universally. This series aims to introduce endoscopic assessment as the first line diagnostic and therapeutic management for branchial fistula. 5 patients underwent examination under general anesthesia via direct laryngoscopy, endoscopic assessment and cauterization in our centre from 2016 to 2019. They were then followed up at our clinic to assess disease progression. Comparison between open neck surgery and endoscopic cauterization of internal sinus tract opening as the primary treatment has reported similar recurrence rate. Proposal of endoscopic assessment as the first line investigation and diagnostic tool  with the aim of therapeutic cauterization at the same setting. MRI may be needed in scenarios such as failed endoscopic treatment or when open surgery is required.

Childhood Hodgkin's disease: patterns of relapse.

1984 ◽  
Vol 2 (2) ◽  
pp. 80-87 ◽  
Author(s):  
K J Russell ◽  
S S Donaldson ◽  
R S Cox ◽  
H S Kaplan
Keyword(s):  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Primary Treatment ◽  
Individual Therapy ◽  
Primary Radiation ◽  
Treatment Modalities ◽  
Combined Modality Treatment ◽  
Combined Modality ◽  
Primary Treatment Modality ◽  
Frequent Relapses

One hundred seventy-nine consecutive children with Hodgkin's disease seen at Stanford University Medical Center between the years 1961-1980 have been analyzed for survival and freedom-from-relapse as a function of clinical versus laparotomy staging as well as primary treatment modalities. Of laparotomy-staged patients, 86% are alive at 10 years after primary radiation with chemotherapy reserved for relapse, as compared with 90% managed by planned combined modality therapy (p = 0.62). Patients who were clinically staged and managed with primary radiation have only a 69% survival (p = 0.05). A favorable subgroup of patients with lymphocyte-predominant Hodgkin's disease experienced a low relapse rate regardless of primary treatment modality. Patterns of relapse in clinically staged patients reflect understaging, with most relapses in distant, nonirradiated sites, whereas the less frequent relapses in laparotomy-staged patients usually reflect regional recurrence. It is concluded that laparotomy staging is highly desirable to allow greatest flexibility in optimizing individual therapy. Routine combined modality treatment for all patients would overtreat certain favorable subgroups, who can be managed more conservatively as long as the information derived from surgical staging is available. For young children, in whom bone growth issues are paramount, combined modality treatment using low-dose radiation is recommended. For older children and adolescents, where concerns over chemotherapy-related leukemogenesis and infertility are more important than height considerations, radiation alone may be used for stages I-IIIA with equal overall success.

scholarly journals Selective Laser Trabeculoplasty in the Treatment of Ocular Hypertension and Open-Angle Glaucoma: Clinical Review

2021 ◽  
Vol 10 (15) ◽  
pp. 3307
Author(s):  
Aleksandra Zgryźniak ◽  
Joanna Przeździecka-Dołyk ◽  
Marek Szaliński ◽  
Anna Turno-Kręcicka
Keyword(s):  
Ocular Hypertension ◽  
Laser Energy ◽  
Open Angle Glaucoma ◽  
Biological Effects ◽  
Primary Treatment ◽  
Treatment Modalities ◽  
Complication Rates ◽  
Open Angle ◽  
Selective Laser Trabeculoplasty ◽  
Laser Trabeculoplasty

Selective laser trabeculoplasty (SLT) is a glaucoma treatment that reduces intraocular pressure (IOP). Its mechanism is based on the biological effects of the selective application of laser energy to pigmented trabecular meshwork (TM) cells, resulting in increased outflow facility. Herein, we review current publications on SLT and summarize its efficacy and safety for different indications in open-angle glaucoma (OAG) and ocular hypertension (OHT) treatment. SLT effectively reduces IOP when used as a primary treatment. In patients whose IOP is medically controlled, SLT helps to reduce medication use, and when maximally tolerated topical therapy is ineffective, SLT facilitates the realization of the target IOP. SLT is a repeatable procedure for which the vast majority of complications are mild and self-limiting. With effective IOP reduction, low complication rates and the potential to repeat the procedure, SLT offers the possibility of delaying the introduction of medical therapy and other more invasive treatment modalities while simultaneously avoiding the accompanying complications. With this knowledge, we suggest that SLT be considered as an essential primary treatment option in OAG and OHT, switching to other treatment modalities only when laser procedures are insufficient for achieving the required target IOP.

STEREOTACTIC RADIOSURGERY FOR CAVERNOUS SINUS OR ORBITAL HEMANGIOMAS

Neurosurgery ◽  
2009 ◽  
Vol 65 (5) ◽  
pp. 914-918 ◽  
Author(s):  
Aftab A. Khan ◽  
Ajay Niranjan ◽  
Hideyuki Kano ◽  
Douglas Kondziolka ◽  
John C. Flickinger ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Cavernous Sinus ◽  
Tumor Regression ◽  
Target Volume ◽  
Symptomatic Improvement ◽  
Primary Treatment ◽  
Vascular Tumors ◽  
Presenting Symptoms ◽  
Primary Treatment Modality

Abstract OBJECTIVE Hemangiomas are rare but highly vascular tumors that may develop in the cavernous sinus or orbit. These tumors pose diagnostic as well as therapeutic challenges to neurosurgeons during attempted removal. We analyzed our increasing experience using stereotactic radiosurgery (SRS). METHODS Eight symptomatic patients with hemangiomas underwent SRS between 1988 and 2007. The presenting symptoms included headache, orbital pain, diplopia, ptosis, proptosis and impaired visual acuity. The hemangiomas were located in either the cavernous sinus (7 patients) or the orbit (1 patient). Four patients underwent SRS as primary treatment modality based on clinical and imaging criteria. Four patients had previous microsurgical partial excision or biopsy. The median target volume was 6.8 mL (range, 2.5–18 mL). The median prescription dose delivered to the margin was 14.5 Gy (range, 12.5–19 Gy). The dose to the optic nerve in all patients was less than 9 Gy (range, 4.5–9 Gy). RESULTS The median follow-up period after SRS was 80 months (range, 40–127 months). Six patients had symptomatic improvement; 2 patients reported persistent diplopia. Follow-up imaging revealed tumor regression in 7 patients and no change in tumor volume in 1 patient. All the patients improved after SRS. CONCLUSION Our extended experience confirms that SRS is an effective management strategy for symptomatic intracavernous and intraorbital hemangiomas. Our study is the first long-term report on the safety and efficacy of SRS.

Orbital Support Device Via Intranasal Approach – An Unconventional Design

2021 ◽  
Vol 10 (29) ◽  
pp. 2221-2224
Author(s):  
Kasim Mohamed ◽  
Maheshwaran K.S
Keyword(s):  
Maxillary Sinus ◽  
Primary Treatment ◽  
Orbital Floor ◽  
Surgical Reconstruction ◽  
Resection Margins ◽  
Malignant Tumours ◽  
Suspensory Ligament ◽  
Primary Treatment Modality ◽  
Close Relationship ◽  
Visual Apparatus

Maxilla can be considered a hexahedrium with close relationship to surrounding critical anatomic structures, and thereby invariably involved in the resection process of tumours that arise from maxillary sinus, palate, nasal cavity, orbital contents, or intro-oral mucosa.1 Maxillary defects created after tumour ablation can cause severe functional and aesthetic deficits. Orbital floor defects with displacement of the eyeball results in deformities with possible consequences of enophthalmos, diplopia and impaired visual acuity. The eyeball can become displaced either due to alteration in the position of the orbital walls caused by trauma, or due to loss of support of the orbital floor during resection of a lesion. The role of the suspensory ligament of Lockwood in maintaining the superio - inferior position of the visual apparatus is recognized. The preservation of this ligament, which acts like a hammock holding the eyeball in position, prevents any drastic downward displacement except for the small limit which the slack of the ligament allows. Surgical reconstruction of orbital floor defects is the primary treatment modality, but remains nonetheless a challenge for surgeons. Currently various types of materials such as titanium meshes, hydroxyapatite, silica gel, Teflon, Medpor and autogenous bones are used for orbital reconstruction.2,3 Prosthetic rehabilitation of maxillary surgical defects is so predictable and effective that reconstructive surgery is not indicated in most instances.4,5 Prosthetic management of defects with orbital floor resection is usually obturators with extensions to support the visual apparatus.6 In clinical situations involving the resection of the orbital floor and maxillary sinus, without the sacrifice of the floor of maxilla, no oro-antral communication is created. This eliminates the need for an obturator prosthesis. In this scenario the support for the visual apparatus will be solely dependent on surgical reconstruction. However, when dealing with invasive and progressive diseases of fungal and bacterial origin, immediate surgical reconstruction is not generally recommended till complete resolution of the disease is achieved. The potential for recurrence of tumours varies from 10 - 30 % with benign tumours and over 50 % with malignant tumours. This creates a need for long term follow up, to assess the resection margins for signs of recurrence.4

scholarly journals Case-based review: conservative management of appendicitis – are we delaying the inevitable?

2012 ◽  
Vol 94 (4) ◽  
pp. 232-234 ◽  
Author(s):  
S Davies ◽  
A Peckham-Cooper ◽  
A Sverrisdottir
Keyword(s):  
Acute Appendicitis ◽  
Conservative Management ◽  
Surgical Intervention ◽  
Primary Treatment ◽  
Spontaneous Resolution ◽  
Primary Treatment Modality ◽  
Uncomplicated Appendicitis ◽  
Recurrent Appendicitis ◽  
Appendiceal Inflammation ◽  
Surgical Presentation

Acute appendicitis is a common surgical presentation for which surgical intervention, an appendicectomy, has remained a largely unchallenged primary treatment modality. Traditionally, it has been felt that the pathophysiological progressive nature of appendicitis ultimately leads to perforation. A number of recent studies, however, suggest that the process of appendiceal inflammation may follow a more remitting nature with evidence indicating spontaneous resolution. It is hypothesised that the treatment of uncomplicated appendicitis may therefore be amenable to conservative management with antibiotics. This article aims to highlight some of the issues and challenges relating to the conservative management of acute appendicitis and further demonstrates potential diagnostic and treatment difficulties involved in managing the more unfamiliar condition of recurrent appendicitis.

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