Spring-Assisted Distraction Osteogenesis for the Treatment of Shunt-Induced Craniosynostosis

2020 ◽  
Vol 57 (11) ◽  
pp. 1336-1339
Author(s):  
Yufan Yan ◽  
Jonathan T. Bacos ◽  
Arthur J. DiPatri ◽  
Arun K. Gosain
Keyword(s):  
Distraction Osteogenesis ◽  
Fundamental Problem ◽  
Rare Complication ◽  
Shunt Infection ◽  
Effective Treatment Modality ◽  
Increased Risk ◽  
Close Proximity ◽  
Shunt Dependency ◽  
Low Incidence ◽  
The Ideal

Shunt-induced craniosynostosis is a rare complication of ventricular shunting for hydrocephalus in pediatric patients. Although the exact pathophysiology of this form of secondary craniosynostosis is not well understood, the current understanding is that persistent drainage of the ventricular shunt causes decreased dural tension, resulting in decreased expansile force on the cranium and premature sutural fusion. Due to the low incidence of this complication, there is no consensus on the ideal treatment for shunt-induced craniosynostosis. In recent years, distraction osteogenesis has been employed with greater frequency, as it is felt to counter the fundamental problem of decreased expansile force on the cranium. However, in a patient with a ventricular shunt, placement of external hardware in close proximity to the shunt could cause significant morbidity due to the increased risk of shunt infection. We present the management of a patient with shunt-induced craniosynostosis who continued to be shunt-dependent. We chose to use fully buried springs to create an expansile force on the cranium as an alternative to external distractors so as to mitigate the risk of infection. We demonstrate that spring-assisted distraction osteogenesis can be an effective treatment modality for patients with shunt-induced craniosynostosis. This method should be considered in patients with contraindications to external distraction devices, such as ongoing shunt dependency.

The Ideal Use of the Power Injectable Peripherally Inserted Central Catheter in the Pediatric Population

2011 ◽  
Vol 16 (2) ◽  
pp. 86-93 ◽  
Author(s):  
Stephanie Juanita Klee
Keyword(s):  
Infection Rate ◽  
Pediatric Population ◽  
Complication Rates ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Increased Risk ◽  
Catheter Complications ◽  
Pediatric Populations ◽  
Low Incidence ◽  
The Ideal

Abstract Introduction: The peripherally inserted central catheter (PICC) is being used more frequently in pediatric populations in both hospital and home care settings in order to provide secure vascular access. In 2007, the Power PICC was introduced to pediatric populations. In contrast to traditional PICCs, the power injectable PICC withstands higher flow rates and can deliver contrast injections. Although effectiveness studies of power injectable PICCs have been performed in adults, only limited published research is available regarding pediatric populations. Purpose: This study aimed to develop criteria for identifying the ideal pediatric candidate for the power injectable PICC. A secondary aim was to identify contraindications and barriers to power injectable catheter use in pediatric populations. Methods: Retrospective and prospective chart reviews were used to analyze complication rates for 97 power injectable PICCs placed in patients aged 4 months to 17 years. Results: A low incidence of catheter complications was identified during and post- insertion. Our documented infection rate of 1.30 per 1000 catheter days was similar to the infection rate of 1.27 per 1000 catheter days found in the Abedin & Kapoor (2008) study. Discussion: The introduction into a pediatric hospital of power injectable PICCs for power injection scans for contrast injection was safe and effective in patients with many disease processes. Conclusion: In properly selected pediatric patients, the power injectable PICC is not associated with an increased risk to thrombosis or infection and can improve patient outcome.

scholarly journals Case report: isolated lower lip lesion following cavernoma resection in prone position

2019 ◽  
Vol 34 (1) ◽  
Author(s):  
Mir Ibrahim Sajid ◽  
Noor Malik ◽  
Rashid Jooma
Keyword(s):  
Cervical Spine ◽  
Prone Position ◽  
Vision Loss ◽  
Rare Complication ◽  
Lower Lip ◽  
Anatomical Structures ◽  
Long Duration ◽  
Increased Risk ◽  
Duration Of Surgery ◽  
Spine Mri

Abstract Background Surgery in a prone position is necessary when access to posterior anatomical structures is needed. A procedure in this position is associated with complications such as injuries to the eyes, peripheral nerves, and pressure points and swelling of the tongue. We report a rare complication of isolated lower lip swelling following neck dissection in the prone position. Case presentation A 25-year-old male patient presented to the clinic with complaint of neck pain for the past 2 months. A cervical spine MRI was done which showed the presence of a cavernoma. C2 laminectomy was performed for resection of the tumor in prone position with the head fixed on a three-point Mayfield clamp. Postoperatively, isolated swelling of the lower lip was observed. The patient was managed conservatively. Conclusion Cervical spine surgeries done in prone positions carry an increased risk of postoperative vision loss and swellings including those of the oropharynx and in the periorbital region. Possible risk factors for such conditions include anemia, hypotension, long duration of surgery, and significant intraoperative hydration.

scholarly journals Non-Myeloablative Conditioning Regimen before T-Cell Replete Haploidentical Transplantation with Post-Transplant Cyclophosphamide for Advanced Lymphoma

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4614-4614
Author(s):  
Catalina Montes De Oca ◽  
Thomas Pagliardini ◽  
Stefania Bramanti ◽  
Sabine Furst ◽  
Jean Marc Schiano de Collela ◽  
...  
Keyword(s):  
Research Funding ◽  
Chronic Gvhd ◽  
Disease Status ◽  
Research Support ◽  
Myeloablative Conditioning ◽  
Term Survival ◽  
Gvhd Prophylaxis ◽  
Increased Risk ◽  
Low Incidence

Introduction: allogeneic transplantation (allo-HSCT) is a curative treatment for patients with advanced lymphoma. Haploidentical (haplo-SCT) transplantation extended the accessibility to allo-HSCT, overcoming the issue of donor availability. However, alternative donor allo-HSCT is still considered at higher risk of non-relapse mortality due to the HLA disparity and thus an anticipated higher incidence of GVHD. In this context, the use of a non myeloablative conditioning (NMAC) regimen combined with post transplantation cyclophosphamide (PT-Cy) based GVHD prophylaxis may reduce procedure related toxicity. The aim was to evaluate the toxicity and efficacy of haplo-SCT using NMAC with PT-Cy in advanced lymphoma patients. Methods: We here report the retrospective experience of a bicentric transplantation program. We analyzed a cohort of lymphoma patients undergoing Haplo-SCT and homogeneously receiving NMAC and PT-Cy. Inclusion criteria were: 1) first allo-HSCT for advanced lymphoma between 2009 and 2018; 2) haploidentical donor; 3) NMAC (fludarabine cyclophosphamide and 2 gray TBI GVHD prophylaxis consisted of PT-Cy day+3 and +4 , cyclosporine A and MMF starting from day +5. Multivariate analyses included age, disease type (NHL vs HL), HCT-CI (< vs ≥ 3), graft source (PBSC vs BM), disease status at haplo-SCT (CR vs other). Results: One hundred forty seven patients (73 NHL; 74 HL) with a median age of 46 years (range: 19-71) were included. PBSC (peripheral blood stem cell) was used as graft source in 96 patients (65%). Patients received a median number of 3 conventional chemotherapy lines before haplo-SCT (1-8). Sixty-five (44%) had relapse after Auto-HCT. At the time of haplo-SCT, 96 patients (66%) were in complete remission. The cumulative incidences of day+100 grade 2-4 and 3-4 acute GVHD were 30% and 3%, respectively. The cumulative incidences of 2-year chronic and moderate or severe chronic GVHD were 13% and 8%, respectively. With a median follow up of 39 months (6-114), 2-year NRM was 14%, with a trend for higher risk in patients with HCT-CI ≥ 3 (HR 0.39, 95CI [0.15-1.04] p = 0.061) while age was not associated with an increased risk of NRM (HR 1.01, 95CI [0.98-1.05], p = 0.450). Two-year cumulative incidence of relapse (CIR) was 21% and 18% in HL and NHL patients, respectively. Disease status at the time of haplo-SCT was strongly associated with relapse (HR 2.99, 95CI [1.41-6.35], p = 0.004) In HL patients, 2-year PFS, OS and GRFS were 65%, 77% and 57%, respectively, while corresponding values in NHL patients were 65%, 69% and 55%, respectively. Two-year PFS and GRFS were significantly higher in patients who underwent haplo-SCT in CR (PFS: CR vs. no CR: 72% vs. 55%, p=0.045; GRFS: CR vs. no CR: 63% vs. 42%, p=0.010). There was a trend for better 2-year OS in CR (OS: CR vs. no CR: 78% vs. 63%, p=0.063. Conclusion: We confirm the feasibility of haplo-SCT using NMAC and PT-Cy with low incidence of GVHD (notably severe forms) and NRM. In addition, we observed a relatively low incidence of relapse (19%) in this cohort of heavily pretreated patients, underlining a potent graft-versus-lymphoma effect after haplo-SCT, leading to promising survivals, including high rate of GRFS (>50%), suggesting a preserved long term quality of life in survivors. We conclude that NMAC haplo-SCT with PT-Cy should be considered as a valuable curative option for advanced lymphoma patients, with a favorable toxicity profile and promising long term survival. Figure Disclosures Stoppa: celgene: Other: travel fees, lecture fees; takeda: Other: travel fees. Carlo-Stella:MSD: Honoraria; BMS: Honoraria; Janssen: Other: Travel, accommodations; Boehringer Ingelheim: Consultancy; Genenta Science sr: Consultancy; Sanofi: Consultancy, Research Funding; ADC Therapeutics: Consultancy, Other: Travel, accommodations, Research Funding; Novartis: Consultancy, Research Funding; Servier: Consultancy, Honoraria, Other: Travel, accommodations; F. Hoffmann-La Roche Ltd: Honoraria, Other: Travel, accommodations, Research Funding; Rhizen Pharmaceuticals: Research Funding; Celgene: Research Funding; Amgen: Honoraria; Takeda: Other: Travel, accommodations; Janssen Oncology: Honoraria; AstraZeneca: Honoraria. Chabannon:EBMT: Other: Working Party Chair, Board member; Fresenius Kabi: Other: research support; Miltenyi Biotech: Other: research support; Terumo BCT: Other: speaker's fees; Celgene: Other: speaker's fees; Novartis: Other: speaker's fees; Gilead: Other: speaker's fees, hospitalities; Sanofi SA: Other: research support, speaker's fees, hospitalities. Santoro:Takeda: Speakers Bureau; BMS: Speakers Bureau; Roche: Speakers Bureau; Abb-Vie: Speakers Bureau; Amgen: Speakers Bureau; Celgene: Speakers Bureau; Servier: Consultancy, Speakers Bureau; Gilead: Consultancy, Speakers Bureau; AstraZeneca: Speakers Bureau; Pfizer: Consultancy, Speakers Bureau; Arqule: Consultancy, Speakers Bureau; Lilly: Speakers Bureau; Sandoz: Speakers Bureau; Eisai: Consultancy, Speakers Bureau; Novartis: Speakers Bureau; Bayer: Consultancy, Speakers Bureau; MSD: Speakers Bureau; BMS: Consultancy. Blaise:Sanofi: Honoraria; Jazz Pharmaceuticals: Honoraria; Molmed: Consultancy, Honoraria; Pierre Fabre medicaments: Honoraria.

scholarly journals Cerebral venous thrombosis and Covid 19: Literature review

2021 ◽  
Vol 11 (2) ◽  
pp. 57-68
Author(s):  
Carlos Alexandre Martins Zicarelli ◽  
Jonathan Vinicius Martins ◽  
Wesley Vieira Doni ◽  
Rafael Rodrigues Pinheiro dos Santos ◽  
Ana Carla Mondek Rampazzo ◽  
...  
Keyword(s):  
Literature Review ◽  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Sinus Thrombosis ◽  
Rare Complication ◽  
Clinical Manifestations ◽  
Risk Of Death ◽  
Cranial Sinus Thrombosis ◽  
Stent Retrievers ◽  
Low Incidence

Introduction: Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) was first detected in December 2019 in the city of Wuhan, China, and has since taken on worldwide proportions. It is known that individuals with Coronavirus disease-19 (COVID-19) have systemic clinical manifestations. Among the multisystemic effects, cerebral venous thrombosis (CVT) is responsible for high mortality rates. In this sense, understanding the association between CVT and SARS-CoV-2 infection directly impacts the disease's morbidity and mortality. Methodology: Literature review in the PubMed and Embase databases, with the following search terms: “COVID-19”, “SARS-CoV-2”, “Venous thromboembolism”, “Thrombosis”, “Cerebral Venous Thrombosis”, “Intracranial Sinus Thrombosis” and “Cranial Sinus Thrombosis”. The selected articles were written in English, which addressed the various aspects of COVID-19. Results and discussion: CVT are a rare complication of COVID-19, with an incidence between 0.02 to 1% of hospitalized patients. However, it can reach about 75% of mortality in affected individuals. Pathophysiology seems to be associated with the state of hypercoagulability and the systemic inflammatory process resulting from viral infection. Thus, recent studies show a consensus on the early anticoagulation of patients affected by the virus, to reduce mortality in these cases. However, the differences between the types of anticoagulation, Low Molecular Weight Heparin (LMWH), Unfractionated Heparin (UFH), Dabigatran have not yet been well established, although there is a predilection for the use of LMWH. Also, thrombectomy is a therapeutic intervention option that should be evaluated, due to the risk of additional endothelial injury from the use of stent retrievers. Conclusion: Although it has a relatively low incidence, CVT aggravates the condition and increases the risk of death for patients with COVID-19. Because of this, early diagnosis and evaluation of therapeutic options for CVT are essential for the development of clinical management.

Scleral Perforation

2013 ◽  
Author(s):  
Jorge L. Rivera-Velez
Keyword(s):  
Rare Complication ◽  
Scleral Buckling ◽  
Shunt Surgery ◽  
Santa Ana ◽  
Shunt Implantation ◽  
Increased Risk ◽  
Shunt Group ◽  
Risk Patients ◽  
Tube Versus ◽  
Tube Shunt

Scleral perforation during tube shunt implantation is a rare complication. In a recent publication of the Tube Versus Trabeculectomy Study, 3 out of 107 patients in the tube shunt group had scleral perforation during placement of a device. Merino-de-Palacios et al reported scleral perforation during tube shunt surgery in 1 of 86 eyes. The type of device used does not seem to be important in the incidence of scleral perforation. In the Tube Versus Trabeculectomy Study, Baerveldt® devices (Abbott Medical Optics, Inc., Santa Ana, California) were used exclusively, and Ahmed™ Glaucoma Valves (New World Medical, Inc., Rancho Cucamonga, California) and Molteno® implants (Molteno Ophthalmic, Ltd., Dunedin, New Zealand) were used in the study by Merino-de-Palacios et al. Serious sequelae, such as endophthalmitis or retinal detachment, have not been reported in recent literature following scleral perforation during tube shunt placement; nonetheless, this complication should be prevented and, if it does occur, managed promptly. Patients who are believed to have an increased risk for scleral perforation are myopic patients (>-6.00 D) and patients with previous extraocular muscle surgery. Patients with previous scleral buckle surgery, autoimmune diseases, scleritis, or any other conditions that cause or perpetuate thinning of the sclera potentially increase the risk. Patients with previous scleral buckling procedures who require tube shunt surgery will benefit from having the device anchored behind the buckle or directly over the buckle. No attempt should be made to dissect under the buckling device, as dissection may lead to the buckle anchoring sutures perforating the eye. The most common site for tube shunt implantation is the superotemporal quadrant, between the superior and lateral rectus muscles. This location offers the benefit of having the implant hidden under the superior eyelid, no oblique muscles in the region, and better intraoperative exposure, allowing the surgeon to place the implant farther from the limbus. The plate of the implant is usually attached to the sclera approximately 8–10 mm posterior to the limbus. This is also the thinnest portion of the sclera. Exposure when implanting the tube shunt is probably the most important factor in avoiding scleral perforation.

Anticoagulation Regimens and Interventional Pain Procedures

2018 ◽  
Author(s):  
Christine Oryhan ◽  
Kevin Vorenkamp ◽  
Daniel Warren
Keyword(s):  
Chronic Pain ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Patient Characteristics ◽  
The United States ◽  
Bleeding Complications ◽  
Risk Of Bleeding ◽  
Increased Risk ◽  
Spinal Epidural ◽  
The Ideal

With the aging population and new anticoagulant medications, such as direct oral anticoagulants, being marketed in the United States, it is very important for pain physicians to be aware of the anticoagulants available and how they affect the safety of interventional pain procedures. In addition to anticoagulant and antiplatelet medications, other medications commonly used in the chronic pain population may put patients at increased risk of bleeding complications. Certain patient characteristics, particularly in the chronic pain population, may also increase a patient’s risk of bleeding. The chapter reviews common and emerging anticoagulant and antiplatelet medications and the ideal holding time before or after interventional pain procedures, particularly in the spine. The chapter also discusses the diagnosis, treatment, and outcomes of spinal epidural hematomas.

scholarly journals Clinical impact of COVID-19 on people with substance use disorders

2020 ◽  
Author(s):  
G Vallecillo ◽  
R Perelló ◽  
R Güerri ◽  
F Fonseca ◽  
M Torrens
Keyword(s):  
Substance Use ◽  
Substance Use Disorders ◽  
Severe Pneumonia ◽  
Epidemiological Studies ◽  
Urban Hospital ◽  
Increased Risk ◽  
Disorder Treatment ◽  
Low Incidence ◽  
The Impact ◽  
Larger Sample

Abstract Background People with substance use disorders are considered at increased risk of COVID-19 and its more serious complications, however data on the impact of COVID-19 are lacking. The study aimed to describe the clinical characteristics and outcomes of COVID-19 on people with substance use disorders. Methods an observational study was carried out including patients aged ≥ years with COVID-19 pneumonia admitted to an urban hospital during March 12 to June 21,2020. Results Among 2078 patients admitted, 27 (1.3%) were people with substance use disorders: 23(85.2%) were men with a median age of 56.1 + 10.3 years and. The main SUD were alcohol in 18(66.7%) patients, heroine in 6(22.2%) and cocaine in 3(11.1%) and 24(88.8%) patients were on ongoing substance use disorder treatment. One or more comorbidities associated to COVID-19 risk were observed in 18(66.6%) of patients. During a median length of stay of 10 days (IQR:7-19), severe pneumonia developed in 7(25.9%) patients, acute respiratory distress syndrome in 5 (18.5%) and none died. Conclusion Larger sample sizes and sero-epidemiological studies are needed to confirm the low incidence of severe COVID-19 on patients with SUD.

scholarly journals Antirelapse effect of pretransplant exposure to rabbit antithymocyte globulin

2019 ◽  
Vol 3 (9) ◽  
pp. 1394-1405 ◽  
Author(s):  
Rosy Dabas ◽  
Kareem Jamani ◽  
Shahbal B. Kangarloo ◽  
Poonam Dharmani-Khan ◽  
Tyler S. Williamson ◽  
...  
Keyword(s):  
T Cells ◽  
Antithymocyte Globulin ◽  
Hematopoietic Cell Transplantation ◽  
Mononuclear Cells ◽  
Negative Impact ◽  
Area Under The Curve ◽  
Increased Risk ◽  
High Incidence ◽  
Rabbit Antithymocyte Globulin ◽  
Low Incidence

AbstractIt remains unknown why rabbit antithymocyte globulin (ATG; Thymoglobulin) has not affected relapse after hematopoietic cell transplantation (HCT) in randomized studies. We hypothesized that high pre-HCT ATG area under the curve (AUC) would be associated with a low incidence of relapse, whereas high post-HCT AUC would be associated with a high incidence of relapse. We measured serum levels of ATG capable of binding to mononuclear cells (MNCs), lymphocytes, T cells, CD4 T cells, or CD33 cells. We estimated pre- and post-HCT AUCs in 152 adult recipients of myeloablative conditioning and blood stem cells. High pre-HCT AUCs of MNC- and CD33 cell–binding ATG were associated with a low incidence of relapse and high relapse-free survival (RFS). There was a trend toward an association of high post-HCT AUC of lymphocyte-binding ATG with a high incidence of relapse and low RFS. High pre-HCT AUCs were also associated with faster engraftment and had no impact on graft-versus-host disease (GVHD) or fatal infections. High post-HCT AUCs were associated with a low risk of GVHD, seemed associated with an increased risk of fatal infections, and had no impact on engraftment. In conclusion, pre-HCT AUC seems to have a positive, whereas post-HCT AUC seems to have a negative, impact on relapse.

scholarly journals Splenic abscess due to Salmonella enteritidis

2012 ◽  
Vol 4 (1) ◽  
pp. 4 ◽  
Author(s):  
Hatice Çabadak ◽  
Ayşe Erbay ◽  
Kerem Karaman ◽  
Süha Şen ◽  
Yasemin Tezer Tekçe
Keyword(s):  
Diabetes Mellitus ◽  
Salmonella Enteritidis ◽  
Rare Complication ◽  
Splenic Abscess ◽  
Increased Risk ◽  
Invasive Infections

Splenic abscess is a very rare complication of non-typhoidal <em>Salmonella</em> infections. We report a case of splenic abscess caused by <em>Salmonella</em> enteritidis. The patient is a 63-year-old woman with diabetes mellitus and underwent splenectomy. This case suggests that the patients with comorbities are at increased risk for invasive infections in non-typhoidal <em>Salmonella</em> infections.

The Double Burden of Infectious Diseases and Diabetes—A Bidirectional Relationship

2015 ◽  
Vol 11 (2) ◽  
pp. 112
Author(s):  
Eugene Sobngwi ◽  
Jean Claude Mbanya ◽  
◽  
Keyword(s):  
Infectious Diseases ◽  
Clinical Presentation ◽  
Noncommunicable Diseases ◽  
Double Burden ◽  
Increased Risk ◽  
Bidirectional Relationship ◽  
Increase Diabetes Risk ◽  
Ideal Method ◽  
The Ideal

There is growing evidence for an etiological interaction between infectious diseases and diabetes, as well as for bidirectional influence of clinical presentation, spread, and outcomes. Some HIV treatments increase diabetes risk, and some infectious diseases may determine unique phenotypes of diabetes. Individuals who have type 2 diabetes have increased risk for tuberculosis and viral hepatitis and have poorer treatment outcomes. Joint noncommunicable diseases (NCDs) and infectious diseases clinics are the ideal method of tackling the double burden of these diseases in developing countries.

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