scholarly journals Management Considerations in Ruptured Isolated Radiculopial Artery Aneurysms

2013 ◽  
Vol 19 (1) ◽  
pp. 60-66 ◽  
Author(s):  
A.C.G.M. Van Es ◽  
P.A. Brouwer ◽  
P.W.A. Willems
Keyword(s):  
Surgical Treatment ◽  
Management Strategy ◽  
Clinical Course ◽  
Treatment Strategies ◽  
The Other ◽  
Posterior Spinal Artery ◽  
Appropriate Treatment ◽  
History Of ◽  
Clinical Paradigm ◽  
Slight Growth

Little is known on the natural history of ruptured isolated aneurysms of the posterior spinal artery (PSA). To date, only a few of such cases have been described in the literature. This paper aims to assess the most appropriate management strategy, based on the available literature and two new cases. In one of these, treatment was postponed until day 33, when angiography showed slight growth of the aneurysm. In the other, conservative treatment, requested by the patient, was successful. From these data, we conclude that treatment strategies for ruptured PSA aneurysms may vary. Aside from the recommendation by others to perform prompt surgical treatment, we suggest an alternative clinical paradigm allowing for the evaluation of the early clinical course. This may preclude the unnecessary treatment of spontaneously regressing lesions and still allows for appropriate treatment for persistent lesions.

S138 – Treatment Controversy Incidental Micro-Medullary Carcinoma

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P123-P123
Author(s):  
Jamie M. Swartz ◽  
Thomas Peyton Nowlin
Keyword(s):  
Surgical Treatment ◽  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Previous History ◽  
Treatment Strategies ◽  
Medullary Carcinoma ◽  
Medullary Thyroid ◽  
Appropriate Treatment ◽  
Microscopic Evaluation ◽  
History Of

Objectives 1) Investigate the controversial management dilemma of microscopic foci of medullary thyroid carcinoma found incidentally. 2) Describe appropriate treatment strategies for this rare scenario after critically reviewing the literature. Methods This case is a 33-year-old Caucasian female with a history of a multinodular goiter seen as a referral from an endocrinologist. She had no previous history of parathyroid disease, pheochromocytoma or MEN syndrome. She also had no family history of medullary thyroid carcinoma. The patient underwent total thyroidectomy for multiple nodules with an uneventful operative course and recovery. Results The thyroid was sent for permanent section and evaluated microscopically with an H&E stain. Final microscopic evaluation revealed multiple adenomatous nodules, a 2mm focus of papillary thyroid carcinoma, and a 2 mm focus of medullary thyroid carcinoma. The patient underwent no further surgical treatment. She has undergone chromosomal analysis, evaluation for possible multiple endocrine neoplasia, and serial calcitonin measurements. She is currently disease-free. Conclusions Medullary thyroid carcinoma is a well-described form of thyroid malignancy that typically mandates aggressive surgical treatment; however, there is a paucity of information in the literature concerning sporadic, microscopic foci of medullary thyroid carcinoma. We review the literature and describe appropriate treatment strategies for this rare scenario.

Extratemporal Refractory Epilepsy

2019 ◽  
pp. 117-125
Author(s):  
Vamsidhar Chavakula ◽  
Eun-Hyoung Park ◽  
Joseph R. Madsen
Keyword(s):  
Surgical Treatment ◽  
Refractory Epilepsy ◽  
Treatment Options ◽  
Clinical History ◽  
Postoperative Management ◽  
Metabolic Imaging ◽  
Appropriate Treatment ◽  
Functional Localization ◽  
History Of ◽  
Medically Refractory Epilepsy

Medically refractory epilepsy is defined as the persistence of seizures after appropriate treatment with 2 different medications. A thorough understanding of the clinical history and semiology of seizures is important when considering surgical treatment options, as multifocal epilepsy may not be amenable to resective surgery. Anatomic, functional, and metabolic imaging sequences may assist in identifying a seizure focus, and EEG will provide a functional localization. The surgeon must make a careful and informed decision about the maximal amount of lesion that may be resected without incurring neurologic deficits. Specific postoperative management should be dictated by the natural history of the noted pathology.

Traumatic Intracavernous Carotid Aneurysm with Massive Epistaxis

Neurosurgery ◽  
1985 ◽  
Vol 17 (4) ◽  
pp. 569-573 ◽  
Author(s):  
Ming-Ying Liu ◽  
Chun-Jen Shih ◽  
Yeou-Chih Wang ◽  
Shin-Han Tsai
Keyword(s):  
Surgical Treatment ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Severe Head Injury ◽  
Internal Carotid ◽  
Clinical Manifestations ◽  
The Other ◽  
Carotid Angiography ◽  
Cavernous Sinus Syndrome ◽  
History Of

Abstract Five cases of traumatic intracavernous carotid aneurysm are presented. All of the patients were young men with a history of severe head injury. The clinical manifestations were massive epistaxis and an ipsilateral cavernous sinus syndrome. The diagnosis was made correctly by carotid angiography. All of the patients developed another episode of massive epistaxis after admission. Emergency trapping of the internal carotid artery was performed. An urgent rescue method was used in one of our patients to prevent exsanguination before definitive surgical treatment. One patient died of exsanguination in spite of emergency ligation of the internal carotid artery. In the other four patients, no epistaxis was experienced after the operation.

scholarly journals Perioperative Management and Outcome after Surgical Treatment of Anterior Cerebral Artery Aneurysms

1991 ◽  
Vol 18 (2) ◽  
pp. 120-125 ◽  
Author(s):  
Issam A. Awad ◽  
John R. Little
Keyword(s):  
Surgical Treatment ◽  
Cerebral Artery ◽  
Management Strategy ◽  
Perioperative Management ◽  
Anterior Cerebral Artery ◽  
Clinical Course ◽  
Therapeutic Strategies ◽  
Channel Blockers ◽  
Hypervolemic Hemodilution ◽  
Grade 3

ABSTRACT:The authors present clinical experience with 28 cases of ruptured anterior cerebral artery (ACA) aneurysms managed personally during a 36 month period, and 10 unruptured ACA aneurysms. The cases included five giant aneurysms and four distal ACA aneurysms. Management strategy was uniform and included early operative intervention (except in the setting of deteriorating neurologic deficit, not attributable to hydrocephalus or hematoma), and vasospasm prophylaxis including calcium channel blockers and hypervolemic hemodilution and arterial hypertension. Modern diagnostic adjuncts including transcranial doppler were used as they became available. Good outcome (outcome grade 1 or 2) was observed at 6 months in 71% (20/28) of ruptured cases and in 90% (9/10) of unruptured cases; fair outcome (outcome grade 3) was observed in 14% (4/28) of ruptured cases and in 10% of unruptured cases; bad outcome (outcome grade 4 or 5) was observed in 14% (4/28) of ruptured cases. There were no instances of rebleeding after admission to the hospital. There was a single mortality in a patient moribund on admission. Delayed ischemic deterioration (DID) was documented in 46% (13 of 28) of the ruptured cases, and was a major source of morbidity in 7 of the 9 instances of fair or poor outcome in the series. Management outcome, including the occurrence of subtle neuropsychological difficulties commonly described in cases with ACA aneurysms, is discussed with relation to the incidence of DID, the clinical course of DID, and the possible impact of various therapeutic strategies.

Impact of surgical treatment on tremor due to posterior fossa tumors

2008 ◽  
Vol 108 (4) ◽  
pp. 692-697 ◽  
Author(s):  
Thomas M. Kinfe ◽  
Hans-Holger Capelle ◽  
Joachim K. Krauss
Keyword(s):  
Surgical Treatment ◽  
Posterior Fossa ◽  
Dentate Nucleus ◽  
Tumor Resection ◽  
Low Grade Glioma ◽  
The Other ◽  
Low Grade ◽  
Posterior Fossa Tumors ◽  
History Of ◽  
The Impact

Object The object of this study was to investigate the impact of surgical treatment on tremor caused by posterior fossa tumors. Methods The authors performed a retrospective evaluation of 6 cases involving patients with tremors due to posterior fossa tumors. Patients who had been treated with neuroleptic medication or had a family history of movement disorders were excluded. All patients had postural or kinetic tremors. Tremor was mainly unilateral. The study group included 5 women and 1 man. Mean age at surgery was 59 years. Five patients underwent total or subtotal tumor resection, and 1 patient underwent stereotactic biopsy only. The histological diagnosis was epidermoid tumor in 2 patients, metastasis in 2 others, and vestibular schwannoma and low-grade glioma in 1 each. Results Two patients had no improvement of tremor, postoperatively. In both of these patients the tumor (low-grade glioma in 1, metastasis in the other) involved the dentate nucleus directly. In the other patients, a compressive effect on the dentate nucleus or the dentatothalamic pathways was present without invasion of the cerebellar structures, and immediate or gradual amelioration of the tremor was observed postoperatively. Conclusions The prognosis of tremor due to posterior fossa tumors appears to depend mainly on the involvement of tremor-generating structures. The prognosis appears to be favorable in those patients with compression of these substrates, whereas primary invasion by tumor has a poor prognosis. Caution must be used in generalizing the findings of this study because of the small number of cases in the series.

Angiographically Occult Angiomas: A Report of Thirteen Cases with Analysis of the Cases Documented in the Literature

Neurosurgery ◽  
1985 ◽  
Vol 17 (4) ◽  
pp. 549-556 ◽  
Author(s):  
Susumu Wakai ◽  
Yasuichi Ueda ◽  
Satoshi Inoh ◽  
Masakatsu Nagai
Keyword(s):  
Surgical Treatment ◽  
Arteriovenous Malformation ◽  
Cavernous Angioma ◽  
Pathological Diagnosis ◽  
The Other ◽  
Recurrent Hemorrhage ◽  
Microsurgical Technique ◽  
Computed Tomographic ◽  
History Of ◽  
Symptoms And Signs

Abstract Thirteen cases of angiographically occult angioma (AOA) are reported. Nine of these presented with intraparenchymatous hemorrhage, and the other 4 patients had epilepsy. The pathological diagnosis was arteriovenous malformation in 12 cases and cavernous angioma in 1. All surgical speciments but 2 contained hemosiderin pigment. In addition to these 13 cases, we reviewed 159 cases of AOA reported in the literature and analyzed them in terms of age, sex, symptoms and signs at admission, computed tomographic findings, location and size of angioma, history of previous and recurrent hemorrhage, type of hemorrhage, and outcome of operation to determine the characteristics of AOAs. The results of these analyses are described in detail, and the indications for surgical treatment of suspected AOAs are discussed. Our microsurgical technique for detecting the angioma within or adjacent to the hematoma is also presented.

scholarly journals Acquired Abdominal Intercostal Hernia: A Case Report and Literature Review

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Salim Abunnaja ◽  
Kevin Chysna ◽  
Inam Shaikh ◽  
Giuseppe Tripodi
Keyword(s):  
Clinical Presentation ◽  
Stab Wound ◽  
Treatment Strategies ◽  
Clinical Suspicion ◽  
Appropriate Treatment ◽  
Obese Female ◽  
High Clinical Suspicion ◽  
Intercostal Hernia ◽  
History Of ◽  
Abdominal Intercostal Hernia

Acquired abdominal intercostal hernia (AAIH) is a rare disease phenomenon where intra-abdominal contents reach the intercostal space directly from the peritoneal cavity through an acquired defect in the abdominal wall musculature and fascia. We discuss a case of a 51-year-old obese female who arrived to the emergency room with a painful swelling between her left 10th rib and 11th rib. She gave a history of a stab wound to the area 15 years earlier. A CT scan revealed a fat containing intercostal hernia with no diaphragmatic defect. An open operative approach with a hernia patch was used to repair this hernia. These hernias are difficult to diagnose, so a high clinical suspicion and thorough history and physical exam are important. This review discusses pathogenesis, clinical presentation, complications, and appropriate treatment strategies of AAIH.

scholarly journals ASPERGILLOSIS

2018 ◽  
Vol 25 (06) ◽  
pp. 971-974
Author(s):  
Javaria Rasheed ◽  
Rushan Hassan ◽  
Muhammad Khalid ◽  
Fauzia Zafar
Keyword(s):  
Cystic Fibrosis ◽  
Aspergillus Fumigatus ◽  
Chronic Lung Disease ◽  
Low Dose ◽  
Allergic Bronchopulmonary Aspergillosis ◽  
Treatment Strategies ◽  
Financial Constraint ◽  
Appropriate Treatment ◽  
History Of ◽  
Lung Infiltrates

Allergic bronchopulmonary aspergillosis (ABPA) is an illness caused byhypersensitivity to colonized Aspergillus fumigatus, mostly involving susceptible adult patientswith history of asthma and cystic fibrosis. Timely given appropriate treatment can reduceclinical symptoms, decrease lung infiltrates and stop progression to chronic lung disease. Inliterature review, treatment strategies used in ABPA children are limited. Herein we present acase of 10-year old asthmatic girl who, on developing ABPA, was successfully treated by theuse of low dose corticosteroids combined with itraconazole for 3 months duration. We suggestthat in financial constraint circumstances, ABPA in children can be successfully treated withoutanti-IgE therapy.

SURGICAL TREATMENT OF THE NEWBORN WITH THORACOSHISIS

2021 ◽  
Vol 100 (2) ◽  
pp. 288-291
Author(s):  
D.A. Andreev ◽  
◽  
I.N. Khvorostov ◽  
O.I. Verbin ◽  
V.N. Shramko ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Congenital Malformations ◽  
Abdominal Cavity ◽  
Treatment Strategies ◽  
Preoperative Preparation ◽  
Initial Examination ◽  
Satisfactory Condition ◽  
Appropriate Treatment ◽  
Perinatal Center ◽  
Midclavicular Line

The article presents a case of successful surgical treatment of the newborn with a rare congenital pathology – thoracoschisis. The newborn had been transferred urgently 6 hours after birth from the perinatal center. The initial examination revealed a chest defect measuring 6×3×3 cm in size and located along the midclavicular line from the 4th to 6th ribs through which the additional lobe of the liver prolapsed (Riedel’s lobe). After examination and preoperative preparation, 17 hours after birth, a surgical treatment was carried out – moving the liver to the abdominal cavity, closing defects of the diaphragm and thorax. In the postoperative period, serous pericarditis developed, requiring puncture and pericardial drainage. On the 21st day of life the child was transferred to the somatic hospital in a satisfactory condition. Observations conducted over the two years after the operation indicated the child's satisfactory condition, and revealed no complaints. The extreme rarity of this pathology causes certain difficulties in determining the appropriate treatment strategies, and concomitant congenital malformations contribute to high mortality.

Special Considerations for Evaluation and Treatment of Spanish-Speaking Patients with Cleft Palate

2016 ◽  
Vol 1 (5) ◽  
pp. 41-49
Author(s):  
Ellen Moore
Keyword(s):  
Cleft Palate ◽  
The United States ◽  
Culturally Competent ◽  
Speech Language Pathology ◽  
Spanish Speaking ◽  
Appropriate Treatment ◽  
Oral Pressure ◽  
Language Pathology ◽  
History Of ◽  
Spanish Speaking Population

As the Spanish-speaking population in the United States continues to grow, there is increasing need for culturally competent and linguistically appropriate treatment across the field of speech-language pathology. This paper reviews information relevant to the evaluation and treatment of Spanish-speaking and Spanish-English bilingual children with a history of cleft palate. The phonetics and phonology of Spanish are reviewed and contrasted with English, with a focus on oral pressure consonants. Cultural factors and bilingualism are discussed briefly. Finally, practical strategies for evaluation and treatment are presented. Information is presented for monolingual and bilingual speech-language pathologists, both in the community and on cleft palate teams.

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