Revision periarterial sympathectomy for recurrent digital ischaemia: a report with 11 patients

2021 ◽  
pp. 175319342110195
Author(s):  
Megan Rudolph ◽  
Katherine Butler ◽  
Shamit Prabhu ◽  
Donald Browne ◽  
L. Andrew Koman ◽  
...  
Keyword(s):  
Treatment Options ◽  
Symptomatic Improvement ◽  
Digital Ulcers ◽  
Ischemic Pain ◽  
Digital Ulcer ◽  
Level Of Evidence ◽  
Digital Ischemia ◽  
Initial Procedure ◽  
Digital Ischaemia

Following periarterial sympathectomy, patients with recurrent digital ischemia due to vasospastic or vaso-occlusive disease have few remaining treatment options. We performed a retrospective review from 1997 to 2019 to determine the safety and efficacy of revision periarterial sympathectomy. Eleven patients were identified who underwent revision periarterial sympathectomy, performed on average 84 months after their initial procedure. Preoperatively, all patients had worsening ischemic pain and five had non-healing digital ulcers. Revision digital periarterial sympathectomy alone was performed in seven patients, while four had a more extensive sympathectomy. Mean follow-up after revision was 23 months (range 3 to 76). Eight patients had symptomatic improvement and four healed their digital ulcers. Three patients developed new ulcers during follow-up, of which two healed with conservative management and one required three digital amputations. Revision periarterial sympathectomy is effective in providing symptomatic improvement and digital ulcer healing with minimal postoperative complications. Level of evidence: IV

scholarly journals Evaluation of the Meniscal repair in Bucket handle. Systematic review

2018 ◽  
Vol 6 (12_suppl5) ◽  
pp. 2325967118S0020
Author(s):  
Damián Bustos ◽  
Lucas Marangoni ◽  
Pablo Bertiche ◽  
Javier Núñez ◽  
Iván Bitar ◽  
...  
Keyword(s):  
Systematic Review ◽  
Treatment Options ◽  
Meniscal Repair ◽  
Level Of Evidence ◽  
Meniscal Lesions ◽  
Number Of Patients ◽  
Bibliographic Search ◽  
Rate Of Failure ◽  
Bucket Handle

Introduction: Faced with a bucket meniscal lesion we have two treatment options. A frequently practiced option is to remove the bucket handle, another is to repair it. Generally, they are associated with ligament injuries. In this context, it has been shown that meniscal repair has a good result, but the evolution of isolated meniscal repairs is not entirely clear. The purpose of this systematic review is to determine the results after the repair of bucket handle injuries. Materials and Methods: A bibliographic search of the computerized database was carried out pubmed. Eight articles were included according to the inclusion and exclusion criteria. The results of interest included, level of evidence, number of patients, follow-up, average age, surgical technique,% cure,% failure, complications, associated injuries and average time from injury to surgical repair. Results: The works studied, on average, 43 patients, with ages between 16 and 33 years making 341 patients. The follow-up period was focused on 58 months. The percentage of cure varies from 52% to 98%. Conclusion: The isolated repair of this type of meniscal lesions has a good overall evolution associated with a low rate of failure and complications Level of evidence: IV Type of study systematic review

Early Outcomes of 3D Printed Total Talus Arthroplasty

2019 ◽  
Vol 13 (5) ◽  
pp. 372-377 ◽  
Author(s):  
Daniel J. Scott ◽  
John Steele ◽  
Amanda Fletcher ◽  
Selene G. Parekh
Keyword(s):  
Treatment Option ◽  
Treatment Options ◽  
Case Series ◽  
Level Of Evidence ◽  
Ankle Motion ◽  
Motion Data ◽  
Number Of Patients ◽  
3D Printed ◽  
Radiographic Alignment

Background. Patients with talar avascular necrosis (AVN) have limited treatment options to manage their symptoms. Historically, surgical options have been limited and can leave patients with little ankle motion and have high failure rates. The use of custom 3D printed total talar replacements (TTRs) has arisen as a treatment option for these patients, possibly allowing better preservation of hindfoot motion. We hypothesized that patients undergoing TTR will demonstrate a statistically significant improvement in Foot and Ankle Outcome Score (FAOS) at 1 year after surgery. Methods. We retrospectively reviewed 15 patients who underwent a TTR over a 2-year period. Patient outcomes were reviewed, including age, sex, comorbidities, etiology of talar pathology, number and type of prior surgeries, radiographic alignment, FAOS and Visual Analog Scale (VAS) score, and range of motion. Data analysis was performed with Student t-tests and multivariate regression. Results. FAOSs and VAS scores showed statistically significant improvements postoperatively as compared with preoperative scores. There was a statistically significant decrease in VAS pain scores from 7.0 preoperatively to 3.6 (P < .001). Average follow-up was 12.8 months. With the number of patients available, there was no statistically significant change in radiographic alignment parameters postoperatively as compared with preoperatively (P values ranged from .225 to .617). Conclusion. Our hypothesis that these patients show statistically significant improvements in FAOSs at 1 year was confirmed. TTR represents an exciting treatment option for patients with talar AVN, though longer-term follow-up is needed. Level of Evidence: Level IV: Case series

Pyeloplasty for pelviureteric obstruction junction obstruction

2019 ◽  
Vol 13 (3) ◽  
pp. 185-194
Author(s):  
Benjamin Starmer ◽  
Robin Weston ◽  
Stephen Bromage
Keyword(s):  
Computed Tomography ◽  
Minimally Invasive ◽  
Gold Standard ◽  
Clinical Presentation ◽  
Treatment Options ◽  
Level Of Evidence ◽  
Diuretic Renography ◽  
Common Clinical Presentation ◽  
Key Questions

Pelviureteric junction obstruction (PUJO) is a common clinical presentation. Patients require investigation with biochemistry and imaging in the form of computed tomography and diuretic renography. The gold-standard pyeloplasty treatment is minimally invasive pyeloplasty. Here we discuss a typical presentation of PUJO and discuss key questions in the investigation, management and follow-up of this condition, including a review of the treatment options. Level of evidence: 3a

scholarly journals EQUAL Score Scedosporiosis/Lomentosporiosis 2021: a European Confederation of Medical Mycology (ECMM) tool to quantify guideline adherence

2021 ◽  
Author(s):  
Jannik Stemler ◽  
Michaela Lackner ◽  
Sharon C -A Chen ◽  
Martin Hoenigl ◽  
Oliver A Cornely
Keyword(s):  
Fungal Pathogens ◽  
Fungal Infections ◽  
Treatment Options ◽  
Real Life ◽  
Medical Mycology ◽  
Maximum Point ◽  
Current Guideline ◽  
Level Of Evidence ◽  
Scoring Tool

Abstract Background Invasive scedosporiosis and lomentosporiosis are life-threatening fungal infections in immunocompromised patients with complex diagnostic and treatment patterns. Objectives To develop a scoring tool to facilitate and quantify adherence to current guideline recommendations for diagnosis, treatment and follow-up of invasive scedosporiosis and lomentosporiosis. Methods Experts from European Confederation of Medical Mycology (ECMM) excellence centres reviewed current guidelines for scedosporiosis and lomentosporiosis. Recommendations for diagnosis, treatment and follow-up were summarized, assembled and weighted according to their strength of recommendation and level of evidence (strongly recommended = 3 points; moderately recommended = 2 points; marginally recommended = 1 point; recommended against = 0 points). Additional items considered of high importance for clinical management were also weighted. Results A total of 170 recommendations were identified. A 21-item tool was developed and embedded into the EQUAL score card. Nine items for diagnosis with 18 achievable points were assembled. For treatment, three general recommendation items with a maximal score of 9 were identified, while for specific antifungal treatment the two fungal pathogens were separated. Three and four items were established for scedosporiosis and lomentosporiosis, respectively, with a maximum achievable score of 3 due to the separation of different treatment options with the maximum point value of 3 for voriconazole-based treatment. Follow-up comprised two items (4 points maximum). Key recommendations for clinical outcome were weighted accordingly. Conclusions We propose the EQUAL Score Scedosporiosis/Lomentosporiosis to quantify adherence to current guideline recommendations for management of these rare infections. The score remains to be validated in real-life patient cohorts and correlated with patient outcome.

scholarly journals Platelet-Rich Plasma Injection With Percutaneous Needling for Recalcitrant Lateral Epicondylitis: Comparison of Tenotomy and Fenestration Techniques

2017 ◽  
Vol 5 (12) ◽  
pp. 232596711774207 ◽  
Author(s):  
Michael P. Gaspar ◽  
Michael A. Motto ◽  
Sarah Lewis ◽  
Sidney M. Jacoby ◽  
Randall W. Culp ◽  
...  
Keyword(s):  
Grip Strength ◽  
Tennis Elbow ◽  
Platelet Rich Plasma ◽  
Treatment Options ◽  
Clinical Importance ◽  
Lateral Epicondylitis ◽  
Study Cohort ◽  
Level Of Evidence ◽  
Entire Study

Background: Recalcitrant lateral epicondylitis (LE) is a common debilitating condition, with numerous treatment options of varying success. An injection of platelet-rich plasma (PRP) has been shown to improve LE, although it is unclear whether the method of needling used in conjunction with a PRP injection is of clinical importance. Purpose: To determine whether percutaneous needle tenotomy is superior to percutaneous needle fenestration when each is combined with a PRP injection for the treatment of recalcitrant LE. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 93 patients with recalcitrant LE were treated with a PRP injection and percutaneous needle fenestration (n = 45) or percutaneous needle tenotomy (n = 48) over a 5-year study interval. Preoperative patient data, including visual analog scale for pain (VAS-P), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), and Patient-Rated Tennis Elbow Evaluation (PRTEE) scores and grip strength, were obtained from a chart review and compared with postoperative values obtained prospectively. Secondary outcomes included the incidence of complications, need for additional interventions, return to work, and patient satisfaction. Results: At a mean follow-up of 40 months, significant improvements in VAS-P (mean, –6.1; 95% CI, –6.8 to –5.5; P < .0001), QuickDASH (mean, –46; 95% CI, –52 to –40; P < .0001), and PRTEE (mean, –57; 95% CI, –64 to –50; P < .0001) scores and grip strength (mean, +6.1 kg; 95% CI, 4.9 to 7.3; P < .0001) were observed across the entire study cohort, with no significant differences noted between the fenestration and tenotomy groups. Nine of 45 patients (22%) underwent additional procedures to treat recurrent symptoms in the fenestration group compared with 5 of 48 patients (10%) in the tenotomy group ( P = .05). No complications occurred in any patients, and no patients expressed dissatisfaction with their treatment course. Conclusion: A PRP injection with concomitant percutaneous needling is an effective treatment for recalcitrant LE, with sustained improvements in pain, strength, and function demonstrated at a mean follow-up of longer than 3 years. Although the method of concomitant needling does not appear to have a significant effect on treatment outcomes, more aggressive needle tenotomy is less likely to require conversion to open tenotomy than needle fenestration in the short term to midterm.

A trial of antithrombotic therapy in patients with refractory migraine and antiphospholipid antibodies: A retrospective study of 75 patients

Lupus ◽  
2021 ◽  
pp. 096120332098391
Author(s):  
Jill R Schofield ◽  
Hannah N Hughes ◽  
Marius Birlea ◽  
Kathryn L Hassell
Keyword(s):  
Retrospective Study ◽  
Major Bleeding ◽  
Antiphospholipid Antibodies ◽  
Antithrombotic Therapy ◽  
Treatment Options ◽  
High Rate ◽  
Level Of Evidence ◽  
Minor Response ◽  
Refractory Migraine

Objective It has been reported that patients with antiphospholipid antibodies (aPL) and refractory migraine may experience symptomatic improvement with antithrombotic therapy, but this phenomenon has not been well studied. This study was undertaken to detail the response to trials of antithrombotic therapy in these patients. Methods This is a retrospective study of 75 patients with refractory migraine and aPL who were given a 2–4 week trial of aspirin, clopidogrel and/or anticoagulation. Major response was defined as 50–100% improvement in frequency and/or severity of migraine; minor response: 25–49% improvement; no response: <25% improvement. Results 66 patients were given a trial of aspirin: 47% responded (21% major); 60 patients were given a trial of clopidogrel: 83% responded (67% major); and 34 patients were given a trial of anticoagulation (usually apixaban): 94% responded (85% major). The response rate to any anti-thrombotic therapy was 89% (83% major). Many patients also noted improvement in non-headache symptoms. No patient experienced stroke. There was no major bleeding during any 2–4 week treatment trial and only 3 of 69 patients maintained on an antithrombotic regimen for a median follow up of 29.9 months (5–100) experienced major bleeding. Conclusions There was a high rate of symptomatic response to antithrombotic therapy in this context and long-term follow up suggested an individualized symptom-derived antithrombotic regimen may be associated with a low bleeding risk. Our data support consideration of a 2–4 week trial of antithrombotic therapy, usually starting with antiplatelet therapy, in aPL-positive patients with refractory migraine, particularly if other treatment options have been exhausted. As a retrospective study, our data provide only Class IV level of evidence, but they suggest randomized controlled trials are warranted to validate these encouraging findings.

scholarly journals AGGRESSIVE VERTEBRAL HEMANGIOMAS – CASE SERIES AND LITERATURE REVIEW

2020 ◽  
Vol 19 (4) ◽  
pp. 293-296
Author(s):  
LUCAS XAVIER DA LUZ ◽  
MARCELO SIMONI SIMÕES ◽  
BRUNO DE AZEVEDO OLIVEIRA ◽  
GUILHERME JOSÉ MIOTTO ◽  
ERNANI VIANNA DE ABREU
Keyword(s):  
Literature Review ◽  
Treatment Options ◽  
Case Series ◽  
Neurological Deficits ◽  
Subtotal Resection ◽  
Decompression Surgery ◽  
Management Options ◽  
Level Of Evidence ◽  
Vertebral Hemangiomas

ABSTRACT Objectives To present a series of aggressive hemangiomas of the institution, with a review of the management options described in the literature. Methods This is a retrospective survey of aggressive vertebral hemangiomas treated by the service in the last 10 years, with histological confirmation of the diagnosis and a minimum follow-up of 1 year. The case analysis and literature review were conducted with emphasis on treatment options for these injuries. Results Seven cases were found, three with pain and four with severe neurological deficits. Two patients were treated with open decompression, one with open decompression and cementation, one with open decompression and arthrodesis, one with biopsy and cementation, one with percutaneous biopsy, and one with open biopsy followed by decompression surgery. All patients underwent radiotherapy. There was a significant regression of presentation deficits, but one patient developed an irreversible deficit during treatment. There were no recurrences or late complications in the follow-up period. Conclusions Surgical decompression in patients with significant neurological deficit is a point of consensus in the literature. Subtotal resection followed by radiation therapy was effective in treating deficits and controlling pathology. Cases manifesting pain only can be managed with minimally invasive techniques, whether or not they are followed by radiotherapy. Level of evidence IV; Therapeutic study of case series.

scholarly journals Comparison of uterine artery embolization and myomectomy: A long-term analysis of 863 patients

2021 ◽  
Vol 5 ◽  
pp. 1
Author(s):  
Jemianne Bautista Jia ◽  
Emilie T. Nguyen ◽  
Anoop Ravilla ◽  
Eric Mastrolonardo ◽  
Jean Min ◽  
...  
Keyword(s):  
Uterine Artery Embolization ◽  
Uterine Artery ◽  
Uterine Fibroids ◽  
Symptomatic Improvement ◽  
Subsequent Pregnancy ◽  
Artery Embolization ◽  
Secondary Intervention ◽  
Significant Difference ◽  
Initial Procedure

Objectives: The objective of this study is to compare the rates of secondary intervention following uterine artery embolization (UAE) versus myomectomy for the treatment of symptomatic uterine fibroids. Material and Methods: This is a multicenter retrospective cohort study. Eight hundred and sixty-three patients are included in this analysis, 451 patients who underwent UAE and 412 patients who underwent myomectomy between January 1, 2008, and December 31, 2012. The UAE group was significantly older than the myomectomy group with a median age of 46 versus 38 (P < 0.0001). Patient data were collected from electronic medical records between the time of their initial procedure and December 31, 2017. The primary endpoint was secondary intervention rate. Secondary endpoints included time to secondary intervention, post-procedural complications, differences in mean hemoglobin levels following the procedures, symptomatic improvement, and subsequent pregnancy outcomes. All statistical analyses were two sided and performed using SAS EG 7.13 (Cary, NC). Results: The median follow-up for the UAE and myomectomy groups was 7 and 7.3 years, respectively. Overall, the rates of secondary intervention were not statistically significant between the UAE and myomectomy groups, 8.9% and 11.2%, respectively (P = 0.26). However, stratified analysis in women aged 30–39 years old demonstrated an increased rate of secondary intervention in the UAE arm with a hazards ratio of 3.76 (P = 0.0099). In patients ≥40 years old, there was no significant difference in secondary intervention rate. Both groups demonstrated a significant increase in mean hemoglobin at 1 year following initial procedure with a mean difference (SD) of 1.8 (2.1) in the UAE group and 1.8 (2.5) in the myomectomy group (P < 0.0001 for both groups). The myomectomy group had a higher rate of post-procedural blood transfusion than the UAE group, 2.9% versus 0.9%, respectively (P = 0.028). Both groups had comparable rates of post-procedural pelvic infection and rehospitalization. Patients with pre-procedural menorrhagia who received UAE reported a higher rate of symptomatic improvement when compared to the myomectomy group, 75.4% versus 49.5% (P < 0.0001). Both groups reported similar rates of improvement in bulk symptoms, 46.1% and 43.2%, respectively (P = 1.0). Conclusion: Overall, UAE and myomectomy have comparable rates of secondary intervention during a median 7-year follow-up period. However, in women between 30 and 39 years of age, UAE resulted in higher rates of secondary intervention. UAE may be more effective in controlling patients’ menorrhagia and has lower rates of post-procedural blood transfusions.

Angiogenic biomarkers predict the occurrence of digital ulcers in systemic sclerosis

2011 ◽  
Vol 71 (3) ◽  
pp. 394-399 ◽  
Author(s):  
Jérôme Avouac ◽  
Christophe Meune ◽  
Barbara Ruiz ◽  
Pierre Olivier Couraud ◽  
Georges Uzan ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Growth Factor ◽  
Critical Role ◽  
Univariate Analysis ◽  
Serum Levels ◽  
Circulating Endothelial Cells ◽  
Digital Ulcers ◽  
Digital Ulcer ◽  
History Of

ObjectiveTo evaluate the possible merit of endothelial markers for the prediction of ischaemic digital ulcers in patients with systemic sclerosis (SSc).MethodsCirculating endothelial progenitor cells (EPC), circulating endothelial cells and serum levels of placental growth factor (PlGF), soluble vascular adhesion molecule and vascular endothelial growth factor were measured in a prospective cohort of 100 SSc patients. The primary outcome was the occurrence of one or more new ischaemic digital ulcers during a planned 3-year follow-up.ResultsAfter the follow-up period, 17 patients developed new digital ulcers. By multivariate analysis focused on biomarkers, high PlGF serum levels and low EPC counts were identified as predictors of the occurrence of at least one new digital ulcer. In a secondary model including biomarkers together with clinical SSc characteristics all predictors of digital ulcers defined by p≤0.1 in univariate analysis, high PlGF serum levels (HR 7.26, 95% CI 1.92 to 27.41) and a history of digital ulcers (HR 9.32, 95% CI 1.51 to 59.83) were identified as independent predictors of a new digital ulcer. In an alternative model excluding patients with a history of digital ulcers at baseline, high PlGF serum levels (HR 13.46, 95% CI 1.58 to 114.73) and low EPC counts (HR 7.95, 95% CI 2.09 to 30.09) remained predictive of new digital ulcer occurrence during follow-up.ConclusionThis study identified high PlGF serum levels and low circulating EPC counts as predictors of new digital ulcers in SSc. It highlights the critical role of angiogenesis in this vascular outcome. These markers may improve digital ulcer risk stratification and therefore allow earlier therapeutic intervention.

scholarly journals Distal Peri-Arterial Sympathectomy: The Over-Ratted Option in Management of Peripheral Cyanotic Disorders

2020 ◽  
Vol 2 (4) ◽  
pp. 1-2
Author(s):  
Esmael Ali Hamed ◽  
Keyword(s):  
Patient Satisfaction ◽  
Lower Extremity ◽  
Medical Treatment ◽  
Dramatic Improvement ◽  
Ischemic Pain ◽  
Cold Intolerance ◽  
Digital Ischemia ◽  
Severe Ischemia ◽  
Early Manifestation

Background: Digital ischemia in upper and lower extremity, with ulceration and gangrene can be a manifestation of Raynaud’s phenomenon (RP). The early manifestation of Raynaud’s may be informed of ischemic pain and numbness, cold intolerance and in severe cases manifested as ulceration and gangrene. Aim of the study: to evaluate the results of digital sympathectomy in cases of severe ischemia of digits manifesting as digital ulceration and ischemic pain refractory to medical treatment. Patient and method: Distal sympathectomy of the ulnar and radial arteritis of the affected limb. Results: The patient developed dramatic improvement of symptoms, we were surprised for patient satisfaction and appreciation. We touched firmly the affected finger and the patient was smiling. On follow up, no return of annoying symptoms. Conclusion: Distal sympathectomy is a safe and perfect solution in management of peripheral cyanotic disorders, Raynaud’s, causalgia, digital ischemia.

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