Image Guided Sclerotherapy of Masseteric Venous Malformations

2020 ◽  
Vol 129 (6) ◽  
pp. 548-555 ◽  
Author(s):  
Subhash Kumar ◽  
Kranti Bhavana ◽  
Bindey Kumar ◽  
Amit Kumar Sinha ◽  
Prem Kumar
Keyword(s):  
Masseter Muscle ◽  
Image Guidance ◽  
Clinical Presentation ◽  
Facial Nerve Palsy ◽  
Facial Asymmetry ◽  
Venous Malformations ◽  
First Line ◽  
Image Guided ◽  
The Mean

Objective: To describe results of image guided sclerotherapy of venous malformations (VM) localized in the masseter muscle. Methods: Retrospective review of prospectively maintained data was done to include consecutive cases treated over 5-year period, with minimum 6 months follow-up. Sclerotherapy was done using ultrasound (US) guided needle puncture(s) of the lesions percutaneously, and 3% polidocanol foam injected under image guidance. Results: Seventeen cases (10 male, 7 female) with mean age 15.6 years (range 6-28 years) were identified. Clinical presentation was with facial asymmetry, becoming pronounced on jaw clenching, and three cases had mild local pain. On US, the lesions appeared as partially compressible masses with anechoic spaces, showing color filling on releasing probe pressure. Fourteen had phleboliths. Eight patients had undergone magnetic resonance imaging, lesions appearing as oval, homogenous, lobulated, T2 hyperintense masses, with heterogeneous contrast enhancement. Number of sclerotherapy sessions were—single in four cases, two in eight cases and three in five cases, for total of 35 sessions (average 2.05 session per patient). The mean dose of drug injected per session was 1.85 mL and total mean dose per patient was 2.79 mL. Post-procedure vomiting occurred in one patient while all had local swelling and mild pain, lasting between 3 to 7 days. No facial nerve palsy or sloughing/ulceration/skin necrosis was noted. On US follow-up (6-26 months, mean 15.9 months), 12 patients had small echogenic masses without any vascularity, and five had small anechoic areas <25%. All patients had complete resolution of swelling and pain. Conclusions: For VMs localized to the masseter muscle, image guided sclerotherapy is highly effective and safe, and recommended as first line treatment.

scholarly journals MON-324 Management and Therapeutic Response Comparison in Prolactinomas According to Tumor Size

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Romina Flores-Cardenas
Keyword(s):  
Tumor Size ◽  
Therapeutic Response ◽  
Clinical Presentation ◽  
Common Type ◽  
First Line ◽  
Study Results ◽  
Visual Defects ◽  
The Mean ◽  
Giant Prolactinomas

Abstract Prolactinomas are the most common type of functioning pituitary adenomas and up to 50% of all adenomas in clinical practice. Prolactinomas are more prevalent in women; nonetheless, they may occur at any age and in both genders, and represent the most common cause non-physiological hyperprolactinemia. Prolactin-secreting adenomas are classified by their tumor size as follows: microprolactinomas (&lt;1 cm), macroprolactinomas (&gt;1cm) and giant prolactinomas (&gt;4 cm). The clinical presentation of these tumors might differ from age, sex and size. Dopamine agonists, such as cabergoline or bromocriptine, have become the first line of treatment, since these agents decrease tumor size and prolactin (PRL) secretion. In Mexico, recent studies have focused on giant prolactinomas but there is missing data of the clinical and biochemical manifestations of the tumor size-effect within the three types of prolactinomas in our population. Objective: To determine the effect of the tumor size in the clinical and biochemical presentation, and the follow up in prolactinomas. Methods: This an observational, retrospective, retrolective study. Results: Patients were classified according to their tumor size and 489 patients with confirmed diagnosis of prolactinoma were included. The mean age was 36+-12 years old and 86% were women. The size was different among sex with 14 (2.9%) and 259 (52.9%) patients with microprolactinoma and 34 (6.9) and 152 (31.1%) with macroprolactinoma in men and women, respectively (p &lt;0.001). The median PRL levels were higher among patients with bigger tumors, 115 (97-150) ng/mL for microprolactinomas, 219 (115-777) ng/mL for macroprolactinomas and 2000 (154-4000) ng/m for giant prolactinomas (p &lt;0.001). Clinically, hypogonadism was more prevalent in women with bigger tumor size (p &lt;0.001), as well as visual defects (p &lt;0.001) and headache (p 0.008). Conclusion: The tumor size of prolactinomas affects the clinical and biochemical presentation as well as the years of follow up required. References 1. Lopes M.B.S. (2019). Pathology of prolactinomas: any predictive value? Pituitary doi: 10.1007/s11102-019-00997-1

Long-term outcomes of lumbar microdiscectomy in the pediatric population: a large single-institution case series

2019 ◽  
Vol 24 (5) ◽  
pp. 549-557
Author(s):  
Malia McAvoy ◽  
Heather J. McCrea ◽  
Vamsidhar Chavakula ◽  
Hoon Choi ◽  
Wenya Linda Bi ◽  
...  
Keyword(s):  
Conservative Management ◽  
Functional Outcomes ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Case Series ◽  
Csf Leak ◽  
Single Institution ◽  
The Mean

OBJECTIVEFew studies describe long-term functional outcomes of pediatric patients who have undergone lumbar microdiscectomy (LMD) because of the rarity of pediatric disc herniation and the short follow-up periods. The authors analyzed risk factors, clinical presentation, complications, and functional outcomes of a single-institution series of LMD patients over a 19-year period.METHODSA retrospective case series was conducted of pediatric LMD patients at a large pediatric academic hospital from 1998 to 2017. The authors examined premorbid risk factors, clinical presentation, physical examination findings, type and duration of conservative management, indications for surgical intervention, complications, and postoperative outcomes.RESULTSOver the 19-year study period, 199 patients underwent LMD at the authors’ institution. The mean age at presentation was 16.0 years (range 12–18 years), and 55.8% were female. Of these patients, 70.9% participated in competitive sports, and among those who did not play sports, 65.0% had a body mass index greater than 25 kg/m2. Prior to surgery, conservative management had failed in 98.0% of the patients. Only 3 patients (1.5%) presented with cauda equina syndrome requiring emergent microdiscectomy. Complications included 4 cases of postoperative CSF leak (2.0%), 1 case of a noted intraoperative CSF leak, and 3 cases of wound infection (1.5%). At the first postoperative follow-up appointment, minimal or no pain was reported by 93.3% of patients. The mean time to return to sports was 9.8 weeks. During a mean follow-up duration of 8.2 years, 72.9% of patients did not present again after routine postoperative appointments. The total risk of reoperation was a rate of 7.5% (3.5% of patients underwent reoperation for the same level; 4.5% underwent adjacent-level decompression, and one patient [0.5%] ultimately underwent a fusion).CONCLUSIONSMicrodiscectomy is a safe and effective treatment for long-term relief of pain and return to daily activities among pediatric patients with symptomatic lumbar disc disease in whom conservative management has failed.

scholarly journals Correction of Temporal Hollowing Deformity Using Serratus Anterior Muscle Flap

2022 ◽  
Vol 2022 ◽  
pp. 1-6
Author(s):  
Lan Sook Chang ◽  
Youn Hwan Kim ◽  
Sang Wha Kim
Keyword(s):  
Muscle Flap ◽  
Operation Time ◽  
Facial Asymmetry ◽  
Free Flaps ◽  
Frontal View ◽  
Serratus Anterior ◽  
Aesthetic Form ◽  
The Mean ◽  
Fascia Flap

Temporal hollowing deformity (THD) is a contour irregularity in the frontotemporal region, which results in facial asymmetry in the frontal view. Here, we present our clinical experience of correction of THD using serratus anterior (SA) muscle and fascia free flaps. Between March 2016 and December 2018, 13 patients presenting with THD were treated with SA free flap. The mean age of the patients was 47.8 years. The patients received craniectomy due to subarachnoid hemorrhage, epidural hematoma, or brain tumor. On average, correction of THD was performed 17 months after cranioplasty. The SA flap size ranged from 5 × 5   cm to 10 × 8   cm . The mean operation time was 107.3 minutes. All of the flaps survived without complications. The mean follow-up duration was 20.3 months. For correction of THD, the SA muscle and fascia flap is among the best candidates to permanently restore aesthetic form and symmetry.

Balanitis Xerotica Obliterans

2007 ◽  
Vol 74 (4) ◽  
pp. 206-211
Author(s):  
C. Calcagno
Keyword(s):  
Squamous Cell Carcinoma ◽  
Clinical Presentation ◽  
Local Therapy ◽  
Line Treatment ◽  
First Line ◽  
Balanitis Xerotica Obliterans ◽  
Malignant Lesions ◽  
The Relationship ◽  
First Line Treatment

Balanitis xerotica obliterans (BXO), first described by Stuhmer in 1928, is a chronic, progressive, atrophic, sclerosing process involving prepuce, glans and urethra. Its aetiology is unknown. After a short terminological excursus and a review of the aetiological hypothesis, we have focused on BXO in daily urological practice. We are here describing the clinical presentation and its differential diagnosis with premalignant and malignant lesions of the penis. We tried to define the relationship between BXO and squamous cell carcinoma of the penis. Particular attention was then cast on urethral stenosis. Finally, we focused on the treatment of BXO: corticosteroid local therapy as first line treatment or as adjuvant therapy after circumcision, surgical therapy including circumcision, laser therapy of the glans lesions, meatoplasty in the stenosis of the anterior urethra. We also stressed the need for histological examination of the preputial specimen for a correct follow-up and for medicolegal reasons.

scholarly journals Spontaneous Resolution of Hemorrhagic Pseudocyst-Associated Pseudoaneurysm in Groove Pancreatitis

2020 ◽  
Vol 14 (1) ◽  
pp. 131-136
Author(s):  
Gwang Mo Kim ◽  
Soon Young Ko ◽  
Joon Ho Wang
Keyword(s):  
Pancreatic Duct ◽  
Clinical Presentation ◽  
Healing Process ◽  
Stable Condition ◽  
Pancreatic Head ◽  
Stent Insertion ◽  
First Line ◽  
Groove Pancreatitis ◽  
Pancreatic Sphincterotomy

Hemorrhagic pseudocyst (HP) and pseudocyst-associated pseudoaneurysms (PPs) are complications of pseudocyst. Angiography with embolization has been advocated as the first-line intervention for HP. A 47-year-old man with groove pancreatitis combined with HP near the pancreatic head was treated conservatively. He had relapsed pancreatitis with a newly identified pseudoaneurysm; however, the pseudocyst size was reduced. Although pseudoaneurysm was identified, angiography was not performed because there was no evidence of ongoing bleeding, and he was in a stable condition. Sphincterotomy and stent insertion in the pancreatic duct was applied to prevent relapsed pancreatitis with facilitation of the flow of pancreatic juice. He has done well during the 10-month follow-up, without recurrent pancreatitis. Angiography as an initial approach in HP and PPs may need to be more selective depending on the clinical presentation of the patient. A lysed clot within the strictured pancreatic duct during the healing process has been thought to be the cause of relapsed pancreatitis, and pancreatic sphincterotomy and stent insertion should be the preferred treatment methods.

Fracture of the Second Metatarsal Base

2003 ◽  
Vol 93 (1) ◽  
pp. 6-10 ◽  
Author(s):  
Gregory Morris ◽  
Kelly Nix ◽  
Flair D. Goldman
Keyword(s):  
Differential Diagnosis ◽  
Clinical Presentation ◽  
Recovery Period ◽  
Treatment Modalities ◽  
Transverse Fracture ◽  
Imaging Studies ◽  
Improve Treatment ◽  
Second Metatarsal ◽  
The Mean

Fracture of the second metatarsal is a cause of chronic midfoot pain that has not been thoroughly examined in the literature. A retrospective review of medical charts and imaging studies was undertaken to investigate this phenomenon. The clinical presentation, differential diagnosis, results of imaging studies, and treatment modalities are described for eight patients with midfoot pain who were treated for a mean of 3.7 months (range, 0 to 12 months) before imaging studies showed a nondisplaced transverse fracture of the second metatarsal base. Initial radiographs indicated fracture in only one patient. Two patients later had surgical bone grafting, two patients had asymptomatic nonunion, and three patients eventually healed. At the last follow-up examination, one patient was continuing treatment with immobilization and electrical bone stimulation. For the seven patients in whom symptoms resolved, the mean recovery period was 14 months (range, 5 to 23 months). Further research is needed to improve treatment and outcomes for this condition. (J Am Podiatr Med Assoc 93(1): 6-10, 2003)

scholarly journals BACKACHE IN PREGNANCY;

2013 ◽  
Vol 20 (04) ◽  
pp. 550-555
Author(s):  
NADEEM SHAHZAD ◽  
FARHAT ASLAM ◽  
AISHA MALIK ◽  
ASIF HANIF
Keyword(s):  
Obese Patients ◽  
Inclusion Criteria ◽  
First Line ◽  
Randomized Control Study ◽  
Pregnant Females ◽  
The Mean ◽  
Randomized Control ◽  
The Difference ◽  
Control Study

Introduction: Backache is a common problem during pregnancy that is faced by almost one quarter of all pregnant womenworldwide. Objectives: To find an association between backache and pregnancy with respect to obesity and to evaluate the effect ofphysiotherapy for relief of pain. Methodology: This longitudinal observational & randomized control study was conducted on pregnantfemales for a period of six months. 150 females fulfilling the inclusion criteria were enrolled into two groups i.e. obese patients (BMI>29.9) and non obese patients (BMI<29.9). All information was recorded on a Performa that was later entered and analyzed usingSPSS-11.5. Results: The mean age of all patients was 33.67±6.73 years with overall average gestational age of 27.47±5.19 weeks.Flexed posture was observed in 90(60%) patients and 60(40%) had very bad sitting habit. There were 80 (53.3%) obese and 70 (46.7%)non-obese patients. Lordosis was observed in 50 cases, straight spine was observed in 90 cases while 60 patients had no straight spine.st Most females reported that pain started during the 1 trimester (110) but only 40 females reported that they developed pain in the 2ndtrimester.100 females reported that pain was continuous while 50 had intermittent. There were 50 (33%) patients who had severebackache while 100 (66.7%) had worse possible pain which was regressed to no pain in 140(93.3%) patients at final follow up visit andonly 10 (6.7%) had moderate pain after physiotherapy. The difference between pre and post physiotherapy was statistically significant.Both obese and non-obese patients were reported to be benefited but better results were found in non-obese patients. Conclusions: Weconclude that physiotherapy is effective in reducing the backache in pregnant females and has no side effects on fetus and mother. Also,more effective results can be achieved through physiotherapy in non-obese patients compared to obese patients. Thus, Physiotherapycan be recommended as the first line treatment for pregnant females.

Sclerotherapy treatment of a large venous malformation invading the bladder wall related to Klippel-Trenaunay syndrome

2020 ◽  
Vol 13 (12) ◽  
pp. e229823
Author(s):  
Luke Foster ◽  
Narayan Karunanithy ◽  
Ramesh Thurairaja
Keyword(s):  
Image Guidance ◽  
Venous Malformation ◽  
Symptom Control ◽  
Bladder Wall ◽  
Multidisciplinary Team Meeting ◽  
Large Area ◽  
First Line ◽  
Macroscopic Haematuria ◽  
Klippel Trenaunay Syndrome

We report the case of a 35-year-old woman who presented with recurrent macroscopic haematuria and known diagnosis of Klippel-Trenaunay syndrome. Imaging and cystoscopy identified an extensive venous malformation involving a large area of the bladder wall. Holmium laser therapy was ineffective at obtaining symptom control. Following a multidisciplinary team meeting, transvenous sclerotherapy with sodium tetradecyl sulphate was performed under image guidance. A reduction in venous density was observed on cystoscopy and the patient has had complete resolution of symptoms within 6 weeks and continued to be asymptomatic up to 24-month follow-up. We propose that transvenous sclerotherapy is considered first-line treatment in this clinical setting.

scholarly journals Predictors of first-line antiretroviral therapy failure among adults and adolescents living with HIV/AIDS in a large prevention and treatment program in Nigeria

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Nicaise Ndembi ◽  
Fati Murtala-Ibrahim ◽  
Monday Tola ◽  
Jibreel Jumare ◽  
Ahmad Aliyu ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Virologic Failure ◽  
Resistance Mutations ◽  
First Line ◽  
Drug Resistance Mutations ◽  
Entry Points ◽  
The Mean ◽  
Living With Hiv ◽  
Hiv 1

Abstract Background A substantial number of persons living with HIV (PLWH) in Nigeria do not experience durable viral suppression on first-line antiretroviral therapy (ART). Understanding risk factors for first-line treatment failure informs patient monitoring practices and distribution of limited resources for second-line regimens. We determined predictors of immunologic and virologic failures in a large ART delivery program in Abuja, Nigeria. Methods A retrospective cohort study was conducted at the University of Abuja Teaching Hospital, a tertiary health care facility, using data from February 2005 to December 2014 in Abuja, Nigeria. All PLWH aged ≥ 15 years who initiated ART with at least 6-month follow-up and one CD4 measurement were included. Immunologic failure was defined as a CD4 decrease to or below pre-ART level or persistent CD4 < 100 cells per mm3 after 6 months on ART. Virologic failure (VF) was defined as two consecutive HIV-1 RNA levels > 1000 copies/mL after at least 6 months of ART and enhanced adherence counselling. HIV drug resistance (Sanger sequences) was analyzed using the Stanford HIV database algorithm and scored for resistance to common nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs). Univariate and multivariate log binomial regression models were used to estimate relative risks (RRs) and 95% confidence intervals (CIs). Results Of 12,452 patients followed, a total of 5928 initiated ART with at least 6 months of follow-up and one CD4 measurement. The entry point for 3924 (66.2%) was through the program’s own voluntary counseling and testing (VCT) center, while 1310 (22.1%) were referred from an outside clinic/program, 332 (5.6%) in-patients, and 373 (6.3%) through other entry points including prevention of mother to child transmission (PMTCT) and transferred from other programs. The mean CD4 at enrollment in care was 268 ± 23.7 cells per mm3, and the mean HIV-1 RNA was 3.3 ± 1.3.log10 copies/mL. A total of 3468 (80.5%) received nevirapine (NVP) and 2260 (19.5%) received efavirenz (EFV)—based regimens. A total of 2140 (36.1%) received tenofovir (TDF); 2662 (44.9%) zidovudine (AZT); and 1126 (19.0%) stavudine (d4T). Among those receiving TDF, 45.0% also received emtricitabine (FTC). In a multivariate model, immunologic failure was more common among PLWH with female gender as compared to male [RR (95% CI) 1.22 (1.07–1.40)] and less common among those who entered care at the program’s VCT center as compared to other entry points [0.79 (0.64–0.91)], WHO stage 3/4 as compared to 1/2 [0.19 (0.16–0.22)], or CD4 200 + cells per mm3 as compared to lower [0.19 (0.16–0.22)]. Virologic failure was more common among PLWH who entered care at the program’s VCT center as compared to other entry points [RR (95% CI) 1.45 (1.11–1.91) and those with CD4 < 200 cells per mm3 at entry into care as compared to higher [1.71 (1.36–2.16)]. Of 198 patient-derived samples sequenced during virologic failure, 42 (21%) were wild-type; 145 (73%) carried NNRTI drug resistance mutations; 151 (76.3%) M184I/V; 29 (14.6%) had ≥ 3 TAMs, and 37 (18.7%) had K65R, of whom all were on TDF-containing first-line regimens. Conclusions In this cohort of Nigerian PLWH followed for a period of 9 years, immunologic criteria poorly predicted virologic failure. Furthermore, a subset of samples showed that patients failing ART for extended periods of time had HIV-1 strains harboring drug resistance mutations.

DTIC and GM-CSF in the treatment of patients with metastatic melanoma.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e19045-e19045
Author(s):  
Beth Barber ◽  
Zhongyun Zhao ◽  
Song Wang ◽  
Volker Jean Wagner
Keyword(s):  
Metastatic Melanoma ◽  
Charlson Comorbidity Index ◽  
Treatment Duration ◽  
Line Treatment ◽  
First Line ◽  
Gm Csf ◽  
Comorbidity Index ◽  
The Mean ◽  
First Line Treatment

e19045 Background: To describe patients with metastatic melanoma being treated with mono-therapy, dacarbazine (DTIC) or granulocyte-macrophage colony-stimulating factor (GM-CSF). Methods: Using a large U.S. medical claims database, patients were identified between 2005 and 2010 using ≥2 melanoma diagnoses (ICD-9-CM: 172.xx, V10.82) and ≥2 diagnoses for metastasis (ICD-9-CM: 197.xx, 198.xx). Patients who received mono-therapy with DTIC or GM-CSF as the first documented drug therapy after metastatic diagnosis were identified. Patient demographic and clinical characteristics and treatment duration were compared between patients treated with DTIC and those who received GM-CSF. Furthermore, comparisons were also made between the two treatment groups after 1-to-1 matching on age, gender, and baseline comorbidities. Results: A total of 81 patients with metastatic melanoma receiving first-line DTIC and 24 patients with metastatic melanoma receiving first-line GM-CSF were included in this analysis. On average, DTIC patients were 8.5 years older (p = 0.009) and had higher baseline Charlson Comorbidity Index scores (D0.43, p = 0.005) than GM-CSF patients. The mean duration of first line treatment was 94 days on DTIC and 135 days on GM-CSF. The mean length of follow-up from the start of first line was 257 days on DTIC and 451 days on GM-CSF. After each GM-CSF patient was matched with a DTIC patient on age, gender, and baseline Charlson Comorbidity Index score, the mean duration of first line treatment was 79 days on matched DTIC and 135 days on GM-CSF, and the mean length of follow-up from the start of first line was 317 days on matched DTIC and 451 days on GM-CSF. Conclusions: Patients with metastatic melanoma who received DTIC treatment were older and had higher comorbidity index scores but shorter treatment duration than those who received GM-CSF; the difference in treatment duration remained after DTIC patients were matched with GM-CSF patients on age, gender and comorbidity index scores.

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