scholarly journals Hidradenitis suppurativa with SAPHO syndrome maintained effectively with adalimumab, methotrexate, and intralesional corticosteroid injections

2018 ◽  
Vol 6 ◽  
pp. 2050313X1877872 ◽  
Author(s):  
Erika L Crowley ◽  
Ashley O’Toole ◽  
Melinda J Gooderham
Keyword(s):  
Hidradenitis Suppurativa ◽  
Relevant Literature ◽  
Skin Inflammation ◽  
Lifestyle Changes ◽  
Definitive Treatment ◽  
Intralesional Corticosteroid ◽  
Treatment Plans ◽  
Bone Inflammation ◽  
Pain Improvement ◽  
Corticosteroid Injections

Introduction: Hidradenitis suppurativa and synovitis, acne, pustulosis, hyperostosis, osteitis syndrome are chronic, debilitating diseases involving apocrine gland-bearing skin inflammation and bone inflammation, respectively. Although both often present with multiple comorbidities, single patient co-presentation is rare. Methods/Results: This study reports the 8-year treatment course of a 40-year-old man with hidradenitis suppurativa and synovitis, acne, pustulosis, hyperostosis, osteitis syndrome, and reviews relevant literature. Initial oral and topical antibiotics had little effect. Intralesional corticosteroid injections were effective for localized inflammatory lesions but insufficient for hidradenitis suppurativa control. Adalimumab initiation and local excision of a persistent HS lesion led to stabilization. Adalimumab provided dramatic back pain improvement. Synovitis, acne, pustulosis, hyperostosis, osteitis was diagnosed; adalimumab continuation with subsequent methotrexate addition resulted in hidradenitis suppurativa-synovitis, acne, pustulosis, hyperostosis, osteitis control. Conclusions: Literature regarding comorbid hidradenitis suppurativa and synovitis, acne, pustulosis, hyperostosis, osteitis syndrome therapy is scarce but growing. Adalimumab, methotrexate, intralesional corticosteroid, and lifestyle changes successfully maintained a severe hidradenitis suppurativa–synovitis, acne, pustulosis, hyperostosis, osteitis–syndrome case. Further studies beyond a case-based review could yield more definitive treatment plans.

scholarly journals Hidradenitis suppurativa, holistic approach and surgical reconstruction

2021 ◽  
Vol 6 (12) ◽  
Keyword(s):  
Hidradenitis Suppurativa ◽  
Holistic Approach ◽  
Psychological Effects ◽  
Surgical Reconstruction ◽  
Social Psychological ◽  
Complete Surgical Resection ◽  
Treatment Plans ◽  
Definitive Surgery ◽  
Adult Male Patient ◽  
Initial Line

We present a young adult male patient with chronic Hidradenitis Suppurativa (HS) stage Ⅱ-Ⅲ, mostly involving buttocks, thighs and perineum. The patient has been followed initially by a dermatologist for 2 years with trials of Biologic treatments. The ongoing purulent discharges made him quite dysfunctional. Patient was offered a definitive and extensive surgical option. Considering this conditions’ devastating social, psychological effects, such patients should be managed with a multidisciplinary team, elaborated education and counseling. Initial line of treatment plans should be considered as preparatory to the definitive surgical excisional therapy. Patient’s acceptance to the entire package that goes with the definitive surgery is fundamental for a successful and lasting outcome. Complete surgical resection of the disease and reconstruction remains to be the only available option for cure in a fully established HS.

scholarly journals An audit and service evaluation of the use of cone beam computed tomography (CBCT) in a paediatric dentistry department

2019 ◽  
Vol 48 (5) ◽  
pp. 20180393 ◽  
Author(s):  
Laith Mizban ◽  
Mohamed El-Belihy ◽  
Mina Vaidyanathan ◽  
Jackie Brown
Keyword(s):  
Paediatric Patient ◽  
Treatment Planning ◽  
Staff Training ◽  
Service Evaluation ◽  
Paediatric Dentistry ◽  
Definitive Treatment ◽  
European Guidelines ◽  
New Information ◽  
Treatment Plans ◽  
The Impact

Objectives: CBCT exposes the paediatric patient to a higher X-ray dose and risk than normal dental radiographs. This study has two components: an audit and service evaluation. The audit aims to assess whether the use of CBCT in a Paediatric Dentistry department at a London hospital complies with European guidelines (SEDENTEXCT). The service evaluation aims to explore the influence of CBCT on treatment planning. Methods: Two 6 month audit cycles were completed, where CBCT requests were audited to check whether image justifications comply with SEDENTEXCT. For the service evaluation, a total of 50 patient records were examined for the effect of CBCT on definitive treatment plans. Results: The first audit demonstrated 94% compliance with SEDENTEXCT. After instituting staff training in CBCT, compliance improved to 100%. In the service evaluation, 100% of CBCTs were found to provide information that impacted on the clinicians’ treatment planning, diagnosis and/or management. Of most significance, 44% of treatment plans were changed because of new information provided by CBCT. Conclusions: There are few studies investigating the use of CBCT in paediatric dentistry and the impact of this investigation. This service evaluation shows that CBCT can play an important role in optimising paediatric patient outcomes. The need for robust staff training in CBCT referrals to prevent over prescription is demonstrated in the audit cycles.

Ventral “Spinal Epidural Meningeal Cysts”—Not Epidural and Not Cysts? Case Series and Review of the Literature

Neurosurgery ◽  
2011 ◽  
Vol 70 (2) ◽  
pp. 320-328 ◽  
Author(s):  
Bret Gene Ball ◽  
Patrick H. Luetmer ◽  
Caterina Giannini ◽  
Bahram Mokri ◽  
Neeraj Kumar ◽  
...  
Keyword(s):  
Relevant Literature ◽  
Case Series ◽  
Signs And Symptoms ◽  
Spinal Pain ◽  
Neurological Deficits ◽  
Definitive Treatment ◽  
Dural Defect ◽  
Computed Tomographic Myelography ◽  
Meningeal Cysts ◽  
Spinal Epidural

Abstract BACKGROUND: Ventral spinal epidural meningeal cysts are rare entities for which the pathogenesis is poorly understood. OBJECTIVE: We present the clinical, radiographic, surgical, and pathologic findings of 4 patients with extensive ventral spinal epidural meningeal cysts and review the relevant literature. In addition, we discuss a suspected mechanism for pathogenesis. METHODS: Four patients with anterior spinal epidural meningeal cysts are retrospectively reviewed. RESULTS: Ventral spinal epidural meningeal cysts are often large, extending on average from C2 to L1 in our series. Patients typically present with a prolonged course of symptoms and signs, including segmental muscle weakness and atrophy, subtle myelopathy, mild to moderate spinal pain, and headache. Histopathologic analysis of the cyst wall demonstrates collagenous tissue consistent with dura but without arachnoid features. Dynamic computed tomographic myelography is the study of choice for localization of the primary dural defect. Patient symptoms and neurological deficits routinely improve after appropriate surgical intervention. CONCLUSION: Diverse signs and symptoms herald the presentation of ventral spinal meningoceles. Intraoperative, radiographic, and pathological findings are all suggestive of an intradural dissection as the etiology. Hence, they may be more appropriately named “ventral spinal intradural dissecting meningoceles.” Definitive treatment involves identification and obliteration of the dural defect.

scholarly journals What is the role of intralesional corticosteroid injections for keloids before considering surgery?

2015 ◽  
Vol 126 (3) ◽  
pp. 549-550 ◽  
Author(s):  
Louis Insalaco ◽  
Sarah Saxon ◽  
Jeffrey H. Spiegel
Keyword(s):  
Intralesional Corticosteroid ◽  
Corticosteroid Injections

scholarly journals Adjunct Treatment of Recalcitrant Hand Plaques in Nephrogenic Systemic Fibrosis After Imatinib Therapy

2019 ◽  
Vol 3 (6) ◽  
pp. 438-442
Author(s):  
James Foshee ◽  
Thomas Griffin ◽  
Kristin Cam ◽  
Michael Rivlin ◽  
Matthew Keller
Keyword(s):  
Nephrogenic Systemic Fibrosis ◽  
Functional Limitation ◽  
Lower Extremities ◽  
Functional Improvement ◽  
Adjunct Treatment ◽  
Joint Contractures ◽  
Intralesional Corticosteroid ◽  
Initial Improvement ◽  
Effective Adjunct ◽  
Corticosteroid Injections

Nephrogenic systemic fibrosis (NSF) is a sclerotic disorder presenting with painful indurated plaques and skin thickening involving the trunk and extremities, which can lead to tethering and joint contractures.  NSF most commonly affects patients with renal insufficiency who have been exposed to gadolinium. We present a case of NSF involving the bilateral hands, knees, and lower extremities developing over 10 years after gadolinium exposure.  Initial improvement was noted in the lower extremities after initiation of imatinib mesylate therapy, but recalcitrant, thickened hand plaques caused persistent pain and functional limitation. Adjunct intralesional corticosteroid injections produced durable softening of the recalcitrant lesions with considerable functional improvement in hand mobility. Based on our experience, intralesional corticosteroid injections appear to be an effective adjunct treatment in patients with incomplete response to anti-fibrotic therapies.

Intralesional corticosteroid injection for the treatment of hidradenitis suppurativa: a multicenter retrospective clinical study

2019 ◽  
pp. 1-5 ◽  
Author(s):  
Francisco Javier García-Martínez ◽  
Eva Vilarrasa Rull ◽  
Laura Salgado-Boquete ◽  
Antonio Martorell ◽  
Jose Carlos Pascual ◽  
...  
Keyword(s):  
Clinical Study ◽  
Hidradenitis Suppurativa ◽  
Corticosteroid Injection ◽  
Intralesional Corticosteroid ◽  
Retrospective Clinical Study

Rehabilitation and Injections

2018 ◽  
pp. 323-340
Author(s):  
Joaquin Sanchez-Sotelo
Keyword(s):  
Adverse Effect ◽  
Physical Therapy ◽  
Local Anesthetic ◽  
Nonoperative Management ◽  
Physical Therapists ◽  
Pharmacological Agents ◽  
Imaging Guidance ◽  
Know How ◽  
Treatment Plans ◽  
Corticosteroid Injections

Rehabilitation modalities, particularly physical therapy exercises, are extremely important for the operative and nonoperative management of shoulder conditions. Shoulder surgeons must understand the principles of shoulder rehabilitation so that they can guide physical therapists and patients through treatment plans. Injections of local anesthetic, corticosteroids, or other pharmacological agents are used commonly in the diagnosis and treatment of shoulder conditions. Shoulder surgeons must know how to perform these injections (with and without imaging guidance); they must also be aware of the potential adverse effect of multiple corticosteroid injections to be able to inform patients and prevent unwanted sequelae.

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