Delayed leukoencephalopathy from suspected polymer embolism after neuroendovascular procedures

2021 ◽  
pp. 197140092110291
Author(s):  
Thomas Mellemkjær ◽  
Ronil V Chandra ◽  
Lasse Speiser ◽  
Benedicte P Ulhøi ◽  
Claus Z Simonsen
Keyword(s):  
Polymer Material ◽  
Endovascular Procedures ◽  
Rare Complication ◽  
Diagnostic Process ◽  
Line Treatment ◽  
Review Of The Literature ◽  
First Line ◽  
Stroke Treatment ◽  
Oral Glucocorticoids ◽  
First Line Treatment

As the neurointervention field grows, a new side effect emerges. Delayed leukoencephalopathy (DL) is believed to be an inflammatory or allergic reaction to polymer material that is shed from catheters during endovascular procedures. We present four cases of DL after aneurysm treatment in two patients, endovascular stroke treatment and diagnostic arteriography. We present our diagnostic process, including biopsy results in two patients, our anti-inflammatory treatment and outcomes together with a review of the literature. In our series, prognosis was variable with ongoing seizures in two patients. Our literature review reveals that asymptomatic shedding of polymer material is common, occurring in a third of endovascular stroke procedures, whereas symptomatic DL occurs in <0.5% of therapeutic neuroendovascular procedures. Clinicians should be aware of this rare complication, and oral glucocorticoids seem to be a reasonable first-line treatment strategy.

Diagnosis and First-Line Treatment of Patients with Lung Cancer in Italian General Hospitals

1989 ◽  
Vol 75 (2) ◽  
pp. 163-167 ◽  
Author(s):  
◽  
Alexan Alexanian ◽  
Giovanni Apolone ◽  
Roldano Fossati Roberto Grilli ◽  
Paola Mosconi ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell ◽  
Disease Stage ◽  
Diagnostic Process ◽  
Line Treatment ◽  
First Line ◽  
General Hospitals ◽  
Diagnostic Time ◽  
First Line Treatment

The quality of diagnostic and therapeutic care was examined in a series of 380 consecutive newly diagnosed cases of primary lung cancer seen in 20 Italian general hospitals between January and June 1987. At diagnosis most patients (78%) had one or more symptoms related to the tumor, and in an additional 9 % symptoms were related to the presence of distant metastases. The median diagnostic time lag between first symptoms and final diagnosis was 50 days with a significantly longer delay in patients first seen by their general practitioner compared with those who sought first care in hospital outpatient departments. The diagnostic process was satisfactorily carried out in fewer than two-thirds of the patients leading to complete ascertainment of disease stage and histology in 58% cases with significantly better performance in more specialized institutions. Analysis of the first-line treatment profile indicated a rather aggressive therapeutic attitude In the case of patients with non-small cell lung cancer – 28% of them had chemotherapy despite the lack of any proof of efficacy in controlled clinical trials – and a failure to identify among the patients with small cell disease those amenable to more aggressive treatment. The lack of progress in the treatment of lung cancer over the last decades seems to have resulted in widely varying practice patterns where a mixture of aggressive and laissez-faire attitudes does not take into account that in the absence of effective therapies a more conservative attitude would at least have some advantage in terms of quality of remaining life for many patients.

scholarly journals Management of Pearly Penile Papules: A Review of the Literature

2019 ◽  
Vol 24 (1) ◽  
pp. 79-85 ◽  
Author(s):  
Anthony D. Honigman ◽  
Danielle P. Dubin ◽  
Justin Chu ◽  
Matthew J. Lin
Keyword(s):  
Psychological Distress ◽  
Long Term Results ◽  
Treatment Modalities ◽  
Line Treatment ◽  
Review Of The Literature ◽  
First Line ◽  
Cosmetic Outcomes ◽  
First Line Treatment ◽  
Ablative Laser

Pearly penile papules (PPPs) are benign, dome-shaped lesions found around the corona of the penis. Despite being asymptomatic and benign in nature, the appearance of PPPs may cause a great deal of psychological distress to both the patient and their sexual partner. While patient reassurance may be the first-line treatment, several other treatment modalities including cryotherapy, electrodessication and curettage, and laser therapy have all been used to treat PPPs in order to achieve a cosmetic outcome that satisfies the patient. Based on the evaluation of the existing literature, ablative laser therapies offer satisfactory cosmetic outcomes with good long-term results.

Differences in Regional Diagnostic Strategies and in Intended Versus Actual First-Line Treatment of Patients With Advanced Ovarian Cancer in Denmark

2014 ◽  
Vol 24 (7) ◽  
pp. 1195-1205 ◽  
Author(s):  
Carsten Lindberg Fagö-Olsen ◽  
Bent Ottesen ◽  
Henrik Kehlet ◽  
Sofie Leisby Antonsen ◽  
Ib Jarle Christensen ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Gynecological Cancer ◽  
Advanced Ovarian Cancer ◽  
Diagnostic Process ◽  
Clinical Aspects ◽  
Diagnostic Strategy ◽  
Line Treatment ◽  
First Line ◽  
Debulking Surgery ◽  
First Line Treatment

BackgroundTriage of patients with ovarian cancer to primary debulking surgery (PDS) or neoadjuvant chemotherapy (NACT) is challenging. In Denmark, the use of NACT has increased, but substantial differences in the use of NACT or PDS exist among centers. We aimed to characterize the differences between intended and actual first-line treatments in addition to the differences in the triage process among the centers and to evaluate the different diagnostic modalities and the clinical aspects’ influence in the triage process.Materials and MethodsFrom 4 centers, forms containing data about the diagnostic process and intended treatment were prospectively collected and merged with data from the Danish Gynecological Cancer Database and medical records.ResultsOf the 671 completed forms, 540 patients had stage IIIC or IV epithelial ovarian cancer. Of the 238 (44%) referred to PDS, 91% received PDS and 4% never had debulking surgery. Of the 288 patients (53%) referred to NACT, 44% were never debulked. Fourteen patients (3%) were referred to palliative treatment. The use of different imaging modalities, diagnostic laparoscopy, and laparotomy varied significantly among the centers. Diagnostic surgical procedures were considered to be most influential in the triage process. Regardless of the intended first-line treatment or center, the tumor size and dissemination was the most influential clinical aspect.ConclusionsIn Denmark, substantial differences exist between intended and actual first-line treatments as well as in the diagnostic process and use of NACT, calling for further discussion on diagnostic strategy and therapeutically approach for patients with advanced ovarian cancer.

Abiraterone-induced rhabdomyolysis resulting in acute kidney injury: A case report and review of the literature

2017 ◽  
Vol 24 (4) ◽  
pp. 314-318 ◽  
Author(s):  
Michael Dineen ◽  
Elizabeth Hansen ◽  
Elizabeth Guancial ◽  
Lynn Sievert ◽  
Deepak Sahasrabudhe
Keyword(s):  
Prostate Cancer ◽  
Kidney Injury ◽  
Line Treatment ◽  
Castration Resistant Prostate Cancer ◽  
Review Of The Literature ◽  
First Line ◽  
Additional Risk ◽  
Castration Resistant ◽  
Chronic Kidney Injury ◽  
First Line Treatment

Abiraterone, a CYP17 inhibitor, blocks androgen biosynthesis in multiple tissue types. In combination with prednisone, it is approved as a first-line treatment for metastatic castration-resistant prostate cancer. We present a case of rhabdomyolysis associated with abiraterone therapy resulting in acute on chronic kidney injury in a patient with metastatic castration-resistant prostate cancer. Strict monitoring should be employed in patients started on abiraterone who have additional risk factors for developing rhabdomyolysis.

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