scholarly journals Selective Arterial Embolizations of Renal Angiomyolipomas Using 96% Ethanol: A Case Series of 5 Patients

2020 ◽  
Vol 13 ◽  
pp. 117954762090686 ◽  
Author(s):  
Alexander Rosenov ◽  
Marc Schindewolf ◽  
Iris Baumgartner ◽  
Christoph Saely
Keyword(s):  
Kidney Tissue ◽  
Case Series ◽  
Embolic Agent ◽  
Benign Tumors ◽  
Therapeutic Success ◽  
Available N ◽  
Complex Patient ◽  
Nontarget Embolization ◽  
New Onset

Angiomyolipomas are rare benign tumors of the kidneys, with a risk of spontaneous hemorrhage including severe retroperitoneal bleedings. In this study, we report clinical outcomes of 5 patients who underwent 8 embolization sessions using 96% ethanol, as there is scarce data using this embolic agent for this indication. The primary angiographic success could be achieved in all but 1 lesion, which was not accessible due to vasospasm of the supplying vessel. Therapeutic success could be demonstrated in all treated cases for which follow-up imaging was available (n = 3). In 1 complex patient, a mildly reduced renal function, as well as a new onset of arterial hypertension was detected after treatment. Nontarget embolization of vital kidney tissue was demonstrated in another patient; it remained asymptomatic. Embolization therapy using 96% ethanol is an optional method to treat renal angiomyolipomas.

scholarly journals New-onset super-refractory status epilepticus

Neurology ◽  
2020 ◽  
Vol 95 (16) ◽  
pp. e2280-e2285 ◽  
Author(s):  
Elizabeth Matthews ◽  
Ayham Alkhachroum ◽  
Nina Massad ◽  
Riva Letchinger ◽  
Kevin Doyle ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Medical Center ◽  
Case Series ◽  
Refractory Status Epilepticus ◽  
Hospital Length Of Stay ◽  
Post Discharge ◽  
Refractory Status ◽  
New Onset

ObjectiveTo better understand the heterogeneous population of patients with new-onset refractory status epilepticus (NORSE), we studied the most severe cases in patients who presented with new-onset super-refractory status epilepticus (NOSRSE).MethodsWe report a retrospective case series of 26 adults admitted to the Columbia University Irving Medical Center neurologic intensive care unit (NICU) from February 2009 to February 2016 with NOSRSE. We evaluated demographics, diagnostic studies, and treatment course. Outcomes were modified Rankin Scale score (mRS) at hospital discharge and most recent follow-up visit (minimum of 2 months post discharge), NICU and hospital length of stay, and long-term antiepileptic drug use.ResultsOf the 252 patients with refractory status epilepticus, 27/252 had NORSE and 26/27 of those had NOSRSE. Age was bimodally distributed with peaks at 27 and 63 years. The majority (96%) had an infectious or psychiatric prodrome. Etiology was cryptogenic in 73%, autoimmune in 19%, and infectious in 8%. Seven patients (27%) underwent brain biopsy, autopsy, or both; 3 (12%) were diagnostic (herpes simplex encephalitis, candida encephalitis, and acute demyelinating encephalomyelitis). On discharge, 6 patients (23%) had good or fair outcome (mRS 0–3). Of the patients with long-term follow-up data (median 9 months, interquartile range 2–22 months), 12 patients (71%) had mRS 0–3.ConclusionAmong our cohort, nearly all patients with NORSE had NOSRSE. The majority were cryptogenic with few antibody-positive cases identified. Neuropathology was diagnostic in 12% of cases. Although only 23% of patients had good or fair outcome on discharge, 71% met these criteria at follow-up.

scholarly journals Covid-19 and New Onset Diabetes: A Case Series

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A338-A339
Author(s):  
Marwa Saleem ◽  
Tasneem Zahra ◽  
Vidya Menon ◽  
Julia Vargas-Jerez ◽  
Amara Sarwal
Keyword(s):  
Case Series ◽  
Islet Cell Antibodies ◽  
Insulin Requirement ◽  
Serum Glucose ◽  
Acid Decarboxylase ◽  
Igg Antibody ◽  
History Of ◽  
Diagnosed Diabetes ◽  
New Onset

Abstract Background: During the SARS CoV1 pandemic in 2003, there was much literature published about newly diagnosed diabetes mellitus (DM) in the patient population infected. This phenomenon has not been well established during this SARS CoV2 pandemic. In this case series, we aim to evaluate patients admitted to our facility with new onset DM who had a history of COVID-19 infection. Method: This was a single center case series that included adult patients who presented to our facility with new onset DM during June-October 2020 who had a history of SARS CoV2 positive PCR and/or positive IgG antibody to SARS CoV2. Pregnant patients were excluded. Data was collected from the hospital electronic medical records. Diagnosis of diabetes was determined in these patients via hemoglobin A1C (HbA1C) level greater than 6.5%. Results: Six patients fulfilled our diagnostic criteria. All patients were male with a median age of 54 years. The median BMI is 33.9, with 5 patients considered to be obese and 1 overweight. Other than the increased BMI, 2 patients with pre-DM and 3 patients who had a family history of DM, no other identifiable risk factors for DM were noted in this cohort. Five patients required hospitalization for HHS or DKA and 1 patient was managed as an outpatient. Median random serum glucose on presentation was 761.5 mg/dl and median HbA1C on presentation was 11.5%. Significant dosages of parenteral insulin (0.45 U/Kg) was required for hospitalized patients during their inpatient stay along with immediately after discharge to control their hyperglycemia. Glutamic Acid Decarboxylase and Islet Cell antibodies were done for 2 of the patients and were negative. Three of the patients who had follow up in 2 months showed improvement in their HbA1C (median of 7.1% [5.4–10.7]) and considerably diminished subcutaneous insulin requirement (0.2U/Kg). Two of these patients continued to follow up, and at 4 months from onset of DM, median HbA1C was 5.85% with insulin ceased. Of note, the patient who was lost to follow up was found to have an HbA1C improvement from 11.4% to 5.4% at the 2 month mark. Discussion: Both SARS CoV1 and SARS CoV2 activates the RAAS, causing insulin resistance by altering insulin signaling and increasing oxidative stress leading to dysfunction of pancreatic beta calls. The inflammatory cytokine storm response seen in COVID-19 can also decrease skeletal muscle sensitivity to insulin and decrease peripheral glucose uptake. These mechanisms may be leading to the new-onset DM noticed in our COVID-19 patients. In addition, there may be a possible immune-mediated mechanism given the matched time line between the COVID-19 antibody life span and the duration of DM. It is unknown whether this effect is permanent or temporary, although our results do support the latter. More studies that utilize a larger cohort and longer follow up are needed in order to get a better understanding of the mechanism of DM in COVID-19 infection.

scholarly journals Does COVID-19 Cause New-Onset Diabetes or Unmask Pre-Existing Diabetes?

2021 ◽  
Vol 3 (1) ◽  
pp. 14-19
Author(s):  
Nasser Mikhail ◽  
Keyword(s):  
Retrospective Studies ◽  
Case Reports ◽  
Case Series ◽  
Undiagnosed Diabetes ◽  
Stress Hyperglycemia ◽  
Onset Diabetes ◽  
Hba1c Levels ◽  
New Onset

Background: Many cases of newly diagnosed diabetes were reported in association with coronavirus 2019 (COVID-19) caused by the severe acute respiratory syndrome-associated coronavirus-2 (SARS-CoV-2). Objective: To clarify whether COVID-19 triggers new diabetes or unmask pre-existing undiagnosed diabetes. Methods: PubMed search of literature up to February 3, 2021. Search terms included diabetes, COVID-19, diagnosis, hemoglobin A1c (HbA1c), diabetic ketoacidosis, diabetes ketoacidosis, pancreatitis. Case reports, case series, retrospective studies, reviews, and pertinent in-vitro investigations were reviewed. Results: Retrospective studies and case series suggest that COVID-19 can worsen diabetes control and precipitate hyperglycemic crises in patients admitted to the hospital. Majority of these patients had pre-existing undiagnosed type 2 diabetes as reflected by elevated HbA1c levels on admission. Many patients presenting with hyperglycemia and normal HbA1c levels may have transient stress hyperglycemia. This group of patients are misclassified as new-onset diabetes despite lack of patient follow-up after discharge. Only one case report of possible new-onset diabetes described a patient with pre-diabetes who progressed to severe diabetes 6 weeks following COVID-19 pneumonia. Mechanisms of worsening glycemic control by COVID-19 infection include increased release of cytokines and insulin counter-regulatory hormones. Binding of SARS-CoV-2 to pancreatic β-cells and their subsequent destruction by the virus as another mechanism requires further studies. Conclusion: COVID-19 infection commonly unmasks pre-existing diabetes. Follow-up of patients presenting with new-onset hyperglycemia after hospital discharge is essential to distinguish between stress hyperglycemia and new-onset diabetes.

scholarly journals Use of Propranolol for the management of haemangioma in children: Our experience

2017 ◽  
Vol 12 (2) ◽  
pp. 71-74
Author(s):  
Md Kamrul Hassan ◽  
Amal Chandra Paul ◽  
Mizanur Rahaman Shibli ◽  
Mahmudul Hasan
Keyword(s):  
Pediatric Surgery ◽  
Case Series ◽  
Chemotherapeutic Agents ◽  
Benign Tumors ◽  
Complete Regression ◽  
National Guidelines ◽  
Female Ratio ◽  
Medical College ◽  
Number Of Patients

Hemangioma is one of the most common benign tumors of infancy and occurs in approximately 5-10% of infants. The treatment options for problematic haemangioma are intralesional and systemic steroids, chemotherapeutic agents including vincristine and interferon-alpha, laser therapy or surgical intervention. In this case series effectiveness of propranolon was observed on haemangioma. This study was conducted in the Department of Pediatric Surgery, Faridpur Medical College Hospital, Faridpur and Shahid Ziaur Rahman Medical College, Bogra. This study period was from January 2013 to December 2015. A total of 38 patients of haemangioma were admitted in Pediatric Surgery ward in FMCH and 26 patients in SZRMCH. These 54 patients were counseled about the study in detail. First dose of propranolol was given at a dose of 3 mg/kg/day in three divided doses. Pulse and blood pressure were recorded during initial 3 hours. Patients were then advised to continue with this treatment at home, with monthly follow-up. Total number of patients were 54. Of them 11 were male and 43 were female, giving a male: female ratio of 1:4. 60 % of the patients (32) were in <6 months. After 1 month, sign of regression was marked in all cases. Complete regression was seen in 6 patients (11.1 %) during second follow-up after 3 months of treatment. Only 4 patient required 9 months to reach the complete recovery. This case series contributes to the growing evidence that oral propranolol is efficacious and safe, with a careful dosing and monitoring. We hope a national guidelines will be developed in time for use of propranolol to treat the haemangioma.Faridpur Med. Coll. J. Jul 2017;12(2): 71-74

scholarly journals Hydrocephalus with lateral ventricular lesions: case series and review of literature

2021 ◽  
Vol 57 (1) ◽  
Author(s):  
Ahmed Mohamed Ahmed Alselisly ◽  
Ahmed Hamdy Ashry ◽  
Ayman Tarek Mahmoud
Keyword(s):  
Prospective Study ◽  
Case Series ◽  
Review Of Literature ◽  
Radiological Data ◽  
Age At Surgery ◽  
Csf Diversion ◽  
The Mean ◽  
A Prospective Study ◽  
New Onset

Abstract Background Lateral ventricular lesions associated with hydrocephalus are considered a challenge to neurosurgeons. Hydrocephalus after surgery of such lesions and its pathogenesis and how to deal with it is a big question facing neurosurgeons. Objectives In this study, we tried to discuss the pathogenesis and different forms of presentation of hydrocephalus in lateral ventricular lesions and how to deal with it. Methods Eleven patients with lateral ventricular lesions associated with hydrocephalus either preoperative or postoperative presenting to our hospital were managed by excision of the lesion. A prospective study was done for these cases including their clinical data, radiological data, the presence, or absence of hydrocephalus either preoperative or postoperative and how we managed it. Results This study included 11 cases. The mean patient age at surgery was 25 years old. Nine cases were presented with radiological signs of hydrocephalus preoperatively. Two cases developed new onset hydrocephalus after lesion excision. Six cases ended with permanent CSF diversion. Conclusion Management of cases with lateral ventricular lesions does not stand on only excision of the lesion. Hydrocephalus should be kept into consideration perioperatively. We should try to avoid events that could lead to ventriculitis. Prolonged follow-up of the patients postoperative is very important as hydrocephalus may develop later after surgery.

Effect of Isolated Medial Patellofemoral Ligament Reconstruction in Patellofemoral Instability Regardless of Predisposing Factors

2020 ◽  
Author(s):  
Jae Ik Lee ◽  
Mohd Shahrul Azuan Jaffar ◽  
Han Gyeol Choi ◽  
Tae Woo Kim ◽  
Yong Seuk Lee
Keyword(s):  
Medial Patellofemoral Ligament ◽  
Trochlear Dysplasia ◽  
Case Series ◽  
Patellofemoral Instability ◽  
International Knee Documentation Committee ◽  
Predisposing Factors ◽  
Mpfl Reconstruction ◽  
Patellar Tilt ◽  
Case Series Study

AbstractThe purpose of this study was to evaluate the outcomes of isolated medial patellofemoral ligament (MPFL) reconstruction, regardless of the presence of predisposing factors. A total of 21 knees that underwent isolated MPFL reconstruction from March 2014 to August 2017 were included in this retrospective series. Radiographs of the series of the knee at flexion angles of 20, 40, and 60 degrees were acquired. The patellar position was evaluated using the patellar tilt angle, sulcus angle, congruence angle (CA), and Caton-Deschamps and Blackburne-Peel ratios. To evaluate the clinical outcome, the preoperative and postoperative International Knee Documentation Committee (IKDC) and Lysholm knee scoring scales were analyzed. To evaluate the postoperative outcomes based on the predisposing factors, the results were separately analyzed for each group. Regarding radiologic outcomes, 20-degree CA was significantly reduced from 10.37 ± 5.96° preoperatively to −0.94 ± 4.11° postoperatively (p = 0.001). In addition, regardless of the predisposing factors, delta values of pre- and postoperation of 20-degree CA were not significantly different in both groups. The IKDC score improved from 53.71 (range: 18–74) preoperatively to 94.71 (range: 86–100) at the last follow-up (p = 0.004), and the Lysholm score improved from 54.28 (range: 10–81) preoperatively to 94.14 (range: 86–100) at the last follow-up (p = 0.010). Isolated MPFL reconstruction provides a safe and effective treatment for patellofemoral instability, even in the presence of mild predisposing factors, such as trochlear dysplasia, increased patella height, increased TT–TG distance, or valgus alignment. This is a Level 4, case series study.

A case series of metastatic pheochromocytomas and paragangliomas: patients characteristics, therapeutic approach and follow-up

2019 ◽  
Author(s):  
Anna Angelousi ◽  
Eva Kassi ◽  
Melpomeni Peppa ◽  
Alexandra Chrysoulidou ◽  
George Zografos ◽  
...  
Keyword(s):  
Therapeutic Approach ◽  
Case Series

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.

Mechanical thrombectomy in pediatric stroke: systematic review, individual patient data meta-analysis, and case series

2019 ◽  
Vol 24 (5) ◽  
pp. 558-571 ◽  
Author(s):  
Kartik Bhatia ◽  
Hans Kortman ◽  
Christopher Blair ◽  
Geoffrey Parker ◽  
David Brunacci ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
Neurological Outcomes

OBJECTIVEThe role of mechanical thrombectomy in pediatric acute ischemic stroke is uncertain, despite extensive evidence of benefit in adults. The existing literature consists of several recent small single-arm cohort studies, as well as multiple prior small case series and case reports. Published reports of pediatric cases have increased markedly since 2015, after the publication of the positive trials in adults. The recent AHA/ASA Scientific Statement on this issue was informed predominantly by pre-2015 case reports and identified several knowledge gaps, including how young a child may undergo thrombectomy. A repeat systematic review and meta-analysis is warranted to help guide therapeutic decisions and address gaps in knowledge.METHODSUsing PRISMA-IPD guidelines, the authors performed a systematic review of the literature from 1999 to April 2019 and individual patient data meta-analysis, with 2 independent reviewers. An additional series of 3 cases in adolescent males from one of the authors’ centers was also included. The primary outcomes were the rate of good long-term (mRS score 0–2 at final follow-up) and short-term (reduction in NIHSS score by ≥ 8 points or NIHSS score 0–1 at up to 24 hours post-thrombectomy) neurological outcomes following mechanical thrombectomy for acute ischemic stroke in patients < 18 years of age. The secondary outcome was the rate of successful angiographic recanalization (mTICI score 2b/3).RESULTSThe authors’ review yielded 113 cases of mechanical thrombectomy in 110 pediatric patients. Although complete follow-up data are not available for all patients, 87 of 96 (90.6%) had good long-term neurological outcomes (mRS score 0–2), 55 of 79 (69.6%) had good short-term neurological outcomes, and 86 of 98 (87.8%) had successful angiographic recanalization (mTICI score 2b/3). Death occurred in 2 patients and symptomatic intracranial hemorrhage in 1 patient. Sixteen published thrombectomy cases were identified in children < 5 years of age.CONCLUSIONSMechanical thrombectomy may be considered for acute ischemic stroke due to large vessel occlusion (ICA terminus, M1, basilar artery) in patients aged 1–18 years (Level C evidence; Class IIb recommendation). The existing evidence base is likely affected by selection and publication bias. A prospective multinational registry is recommended as the next investigative step.

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