scholarly journals Intralesional cryotherapy with triamcinolone and onabotulinumtoxinA injections for umbilical keloid: A case report

2021 ◽  
Vol 7 ◽  
pp. 205951312110490
Author(s):  
Jennifer VH Tran ◽  
Shantel DJ Lultschik ◽  
Sheetal Sapra ◽  
Kevin Dong ◽  
Klaudija Gusic ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Side Effects ◽  
Triamcinolone Acetonide ◽  
Treatment Plan ◽  
Treatment Options ◽  
High Patient Satisfaction ◽  
High Satisfaction ◽  
Keloid Scars ◽  
History Of ◽  
Low Rate

Introduction Keloid scars are therapeutically challenging and although many treatment options exist, there are no specific guidelines, and few reports have discussed keloids in the umbilical region. Methods Here, we present a successful treatment of a 31-year-old female with a history of a recurrent keloid in the umbilical region. The keloid was treated using intralesional cryotherapy followed by intralesional onabotulinumtoxinA and triamcinolone acetonide injections. Discussion The patient expressed high satisfaction, minimal side effects, and no recurrence. Conclusion Overall, due to the low rate of side effects, high patient satisfaction, and absence of recurrence, this treatment modality should be considered as an option for umbilical keloids. Lay Summary Background to subject: Keloids are a type of scar that are difficult to treat. There are many treatment options available, but there is no single best treatment for keloids that form around the belly button region. Question being asked: Is intralesional cryotherapy with intralesional onabotulinumtoxinA and triamcinolone acetonide injections effective at treating keloids in the belly button region? How the work was conducted: We treated a 31-year-old female with a keloid around the belly button region that returned after prior treatment. The keloid was treated using combination therapy of freezing the keloid from the inside out, which is called intralesional cryotherapy. This was followed by two types of injections, called onabotulinumtoxinA and triamcinolone acetonide, directly into the keloid. What we learned: Overall, due to the low rate of side effects, high patient satisfaction and the keloid not returning, this treatment plan should be considered as an option for keloids in the belly button region. What we did not learn: This treatment may or may not be effective and safe for all patients of all skin types and demographics as this treatment was performed for only one patient.

Dermal Discoloration Secondary to Triamcinolone Acetonide Injection Observed in Patients with Autoimmune Disorders

2021 ◽  
Vol 111 (4) ◽  
Author(s):  
James A. Wright ◽  
Jessica A. Wenz ◽  
Gabrielle Jackson Madrigal
Keyword(s):  
Psoriatic Arthritis ◽  
Side Effects ◽  
Autoimmune Disease ◽  
Triamcinolone Acetonide ◽  
Current Literature ◽  
Side Effect ◽  
Inflammatory Conditions ◽  
Rare Side Effect ◽  
History Of ◽  
Synthetic Glucocorticoid

Triamcinolone acetonide is a synthetic glucocorticoid used to treat numerous acute and chronic inflammatory conditions. The various side effects of this drug from parenteral administration are well documented in the literature. In this study, three patients present with a rare side effect of violaceous dermal pigmentation. To the best of the authors' knowledge, this finding is rarely presented in the current literature. The purpose of this study is to provide awareness of a less-documented, delayed side effect from triamcinolone acetonide administration. Although all patients presenting in this study had a known history of autoimmune disease (eg, lupus, psoriatic arthritis) further research is needed to suggest a possible association between dermal violaceous change and the use of triamcinolone.

Low Negative Pressure Combined With Supertumescence Microliposuction As a New Method For Repairing Facial Fat Overfilling: A Case Series of 32 Patients

2021 ◽  
Author(s):  
Bo Yin ◽  
Xinyu Zhang ◽  
Lei Cai ◽  
Xuefeng Han ◽  
Facheng Li
Keyword(s):  
Patient Satisfaction ◽  
Negative Pressure ◽  
Case Series ◽  
Muscle Paralysis ◽  
Standard Score ◽  
High Patient Satisfaction ◽  
Satisfaction Rate ◽  
High Satisfaction ◽  
The Face ◽  
High Satisfaction Rate

Abstract Background Face fat overfilling sometimes occurs and is very difficult to repair unfortunately. Objectives The authors report their first experience of micro-liposuction with low negative pressure combined with super-tumescence (LNPST) in a case series of 32 patients. Methods The LNPST micro liposuction was performed in 32 patients aged 22 to 41 (mean, 29.6±4.9) years with facial overfilling. Two independent plastic surgeons intraoperatively monitored and recorded discomfort and bleeding using a grading system. All patients were followed up for haematoma within 1 week postoperatively and for skin numbness and muscle paralysis at 1 week and 3 months postoperatively. In addition, 6 months postoperatively, patient satisfaction with the postoperative aesthetic effects was analysed by Face-Q. Results All patients successfully completed the operation under local anaesthesia. The intraoperative discomfort and blood-loss scores were 1.69±0.62 and 1.22±0.41, respectively. The haematoma score was 1.13±0.34 within 1 W [other scores: postoperative skin numbness (1 W: 1.96±0.62; 3 M: 1.13±0.33) and postoperative muscle paralysis (1 W: 1.22±0.51; 3 M: 1.0±0)]. Overall, neither skin necrosis nor serious complications requiring revision surgery occurred. Seventy-two percent of the patients (n = 23) answered the Face-Q questionnaire (21.8±1.7), covering satisfaction with the outcome score into a standard score (81.7±15.1, from 0 to 100), which verified the high satisfaction rate. Conclusions LNPST technology is a safe and effective method for facial-fat-overfilling repair, with less bleeding, less neuro injury, fewer complications and high patient satisfaction.

Management of Generalized Gingival Enlargement in a Dog — Case Report and Literature Review

2005 ◽  
Vol 22 (3) ◽  
pp. 160-169 ◽  
Author(s):  
John R. Lewis ◽  
Alexander M. Reiter ◽  
Dipl Tzt
Keyword(s):  
High Speed ◽  
Present Report ◽  
Treatment Plan ◽  
Treatment Options ◽  
Gingival Tissue ◽  
Combined Use ◽  
Gingival Enlargement ◽  
Drug History ◽  
History Of ◽  
Scalpel Blade

The present report describes treatment of a dog with generalized gingival enlargement and serves as a review of etiology and treatment options for this condition. The combined use of scalpel blade, electrosurgical equipment, and a 12-fluted bur on a high-speed handpiece with water irrigation allowed for accurate excision of excess gingival tissue and contouring of remaining gingiva. Surgery coupled with professional dental cleaning periodontal therapy can decrease the recurrence of this condition. In addition, home oral hygiene is an important component of the treatment plan. The history of patients with gingival enlargement should be reviewed carefully, including drug history and previous medical conditions, in an attempt to elucidate a specific cause and thus allow for greater long-term success.

scholarly journals The Influence of Immediately Loaded Basal Implant Treatment on Patient Satisfaction

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Fadia Awadalkreem ◽  
Nadia Khalifa ◽  
Asim Satti ◽  
Ahmed Mohamed Suleiman
Keyword(s):  
Patient Satisfaction ◽  
Positive Impact ◽  
Treatment Options ◽  
Rank Test ◽  
Patients Satisfaction ◽  
Signed Rank ◽  
High Satisfaction ◽  
Chi Squared ◽  
Signed Rank Test ◽  
Predominantly Female

Background. Improving patient satisfaction and quality of life is of great importance when considering the different prosthetic treatment options for patients with severely resorbed residual alveolar ridges. We aimed to evaluate and compare patients’ satisfaction when changing from fixed, removable, and/or conventional implant prostheses to basal implant-supported prostheses. Methods. Sixty patients with a history of fixed, removable, and/or conventional implant prostheses who received basal implant-supported prostheses (BCS®, IHDE Implant System) were included in this study. Direct interviews were conducted using a four-section questionnaire that covered sociodemographic data, clinical examination, information on previous prostheses, and new implant information. The obtained data were statistically analysed using a Wilcoxon signed-rank test and chi-squared test. Results. Patients were predominantly female, partially edentulous, and aged between 40 and 59 years. Patients’ general satisfaction with basal implants was very high (7.7 out of 8). Patients’ satisfaction with comfort, mastication, speech, and aesthetics significantly improved with the new basal implants. Males aged between 40 and 59 years and patients who had previously used both fixed and removable prostheses were generally the most satisfied. Although some patients had complaints, they still had high satisfaction and would choose the same treatment modality again. Conclusions. Basal implant-supported prostheses have a positive impact on oral health and highly increase patients’ satisfaction.

scholarly journals Gabapentin abuse: A case presentation on how to manage this growing concern

2018 ◽  
Vol 8 (11) ◽  
pp. 43 ◽  
Author(s):  
Jason A. Gregg ◽  
Ronald L. Tyson ◽  
Anthony W. Alvarez
Keyword(s):  
Side Effects ◽  
Treatment Options ◽  
Dose Titration ◽  
Close Monitoring ◽  
Additional Indication ◽  
Adjunct Treatment ◽  
Off Label ◽  
Cognitive Difficulties ◽  
The Us ◽  
History Of

Gabapentin was first approved by the US Food and Drug Administration in 1993 as an adjunct treatment of epilepsy. In 2004, an additional indication of pain associated with post-herpetic neuralgia was added. Misuse of gabapentinoids dates back to 2010 while surging recently to the tenth most commonly prescribed medication in 2016. Abuse can be as high as 65% for even those who legally obtained the medication through a prescription. It is used off-label up to 95% of the time despite limited evidence of its efficacy particularly with multiple pain types. The surge in misuse can be attributed not only to off-label use but also an assumption of no abuse potential coupled with clinicians seeking alternative treatment options to the opioids. More common side-effects include sedation, dizziness, and cognitive difficulties. However, even normal dosing can produce side-effects similar to other addictive substances including: euphoria, talkativeness, and increased energy (opioids); sedation (opioids, benzodiazepines); and dissociation (hallucinogens). In fact, a few states including Kentucky, Ohio, and West Virginia will or have already added gabapentin to the controlled substance rosters even though no federal designation is in place. Identified risks for gabapentin misuse in the literature are limited with the exception of a history of or current substance abuse, particularly opioids. Unfortunately, gabapentin is often co-prescribed with opioids lending to a heightened risk of opioid-related mortality. Clinicians must understand that gabapentin is not effective for a variety of pain conditions nor is a routine substitute for opioids. In addition, close monitoring practices often associated with opioids and benzodiazepines (i.e., regular monitoring for aberrant drug taking behaviors, limits on supply, guarded dose titration) should be applied to that of gabapentin.

Patient satisfaction with clinic-based medication pick up: Addressing pharmacy-level challenges to buprenorphine access

2021 ◽  
Vol 17 (7) ◽  
pp. 77-86
Author(s):  
Elizabeth Kolb, MS ◽  
Mark Rueth, PharmD
Keyword(s):  
Patient Satisfaction ◽  
Treatment Plan ◽  
Opioid Use Disorder ◽  
Office Visits ◽  
Opioid Use ◽  
Research Strategies ◽  
Positive Health ◽  
Pharmacy Staff ◽  
High Patient Satisfaction ◽  
Retail Pharmacy

Introduction: Pharmacy-level challenges that exist for patients when seeking to fill buprenorphine prescriptions at traditional retail pharmacies can result in a less than optimal treatment experience. High patient satisfaction with treatment for opioid use disorder (OUD), which for oral buprenorphine treatment includes the necessary step of obtaining medication after being prescribed, is associated with positive health outcomes and, therefore, is of great clinical interest. The objective of this study was to examine patient satisfaction when participating in a pharmacy program that coordinated buprenorphine delivery and provision to patients at office visits instead of requiring patients to fill their prescriptions at local pharmacies.Methods: We conducted a voluntary and anonymous survey to assess patient satisfaction when the need to seek a retail pharmacy to fill buprenorphine prescriptions was alleviated. The survey was completed by 714 patients prescribed buprenorphine for OUD treated at 15 office-based opioid treatment clinics that integrated the clinic-based pharmacy program as an extension of their treatment services. The survey consisted of 16 questions evaluating satisfaction with the pharmacy program and prior retail pharmacy experience.Results: Majority of patient respondents reported high levels of satisfaction with the pharmacy program. Specifically, 97.6 percent (n = 697) of respondents noted feeling respected and/or that the pharmacy staff cares about their wellbeing, 91.7 percent (n = 655) of respondents reported that they are more likely to make their treatment appointments and/or stick to their treatment plan when the physical need to seek a pharmacy to fill their prescription was alleviated. The survey resulted in an 83.8 Net Promoter Score, further supporting a high patient satisfaction. Patient responses regarding how the program impacted their recovery illustrated common themes of more convenient, more private, judgment free, quicker, and stress free. The survey responses also validated previously reported pharmacy-level barriers for patients with OUD that the program sought to alleviate. Transportation challenges and/or undue time spent obtaining medication were indicated by 77.6 percent (n = 528) of respondents, 56.8 percent (n = 386) of respondents experienced feelings of stigma or shame at retail pharmacies was experienced by 56.8% (n = 386) of respondents, and pharmacies not reliably stocking their medication was indicated by 37.1 percent (n = 252) of respondents.Conclusions: The survey findings demonstrate that patients were highly satisfied with the provision of pharmacy-dispensed buprenorphine at their treatment visit in place of having to seek to fill prescriptions at retail pharmacies. Responses indicated the pharmacy program may also be a motivating factor for patients to attend treatment appointments. Continuing to develop and research strategies that alleviate physical barriers to buprenorphine access and result in high patient satisfaction, like this clinic-based pharmacy program studied, have meaningful implications for both patients and treatment providers.

scholarly journals Symptomatic Os Subtibiale Following Injury: A Case Report of Failed Conservative Treatment, Leading to Differential Diagnosis Made Intraoperatively

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Abhijit Bandyopadhyay
Keyword(s):  
Case Report ◽  
Surgical Treatment ◽  
Conservative Treatment ◽  
Treatment Plan ◽  
Treatment Options ◽  
Distal Tibia ◽  
Radiographic Examination ◽  
Bone Fragment ◽  
History Of ◽  
Os Subtibiale

Introduction: Introduction: Os subtibiale is a rare accessory bone found adjacent to the distal tibia and is mostly asymptomatic. Differentiating it from a medial malleolar fracture is challenging. Most cases of acute ankle trauma that presents with an Os subtibiale are initially diagnosed as fractures by treating physicians at emergency centers. It is therefore critical for an orthopedic surgeon who gets referral for such cases to consider complete history of such patients to understand the cause of their symptoms. The goal is to avoid unnecessary surgical treatment and to realize that a symptomatic Os subtibiale can be successfully managed by conservative means. Nonetheless, certain cases may require surgical treatment if conservative treatment options fail. This is a case report of a patient that was diagnosed as a case of symptomatic Os subtibiale intraoperatively, after conservative options were unsuccessful. Case Presentation: An 18-year-old patient with an injured right ankle was referred to our clinic after failed attempts to resolve his symptoms conservatively. Based on our initial clinical and radiographic examination, the patient was continued on a conservative treatment plan assuming, it was a case of unsuccessful fracture union. After almost a year of failed conservative treatments, surgery was offered to the patient, with the understanding that the bone fragment might either be fused or completely removed based on intraoperative diagnosis. At surgery, it was observed that the bone fragment had the characteristic of an Os subtibiale. It presented as a round, smooth structure with well-formed cortical boundaries, and minimal attachment to the distal tibia. A diagnosis of symptomatic Os subtibiale was made intraoperatively, which was then successfully excised using standard orthopedic instrumentation. The patient healed uneventfully and reported a pain free, normal ankle range of motion at latest follow-up of 18 months. Conclusion: Accurate diagnosis of O

scholarly journals Management of keloid scars: noninvasive and invasive treatments

2021 ◽  
Vol 48 (2) ◽  
pp. 149-157
Author(s):  
Sang Wha Kim
Keyword(s):  
Treatment Plan ◽  
Treatment Options ◽  
Compression Therapy ◽  
Therapeutic Options ◽  
Novel Treatments ◽  
Intralesional Corticosteroid ◽  
Keloid Scars ◽  
Suitable Treatment ◽  
Disease Entities

Scars vary from mature linear scars to abnormal excessive scars such as hypertrophic scars and keloid scars. Keloid scars are fibro-proliferative disease entities that reflect an abnormal process of wound healing. They can cause pain, itching, stiffness, and psychological distress, all of which can affect quality of life. Various treatment options have been advocated as ways to prevent and treat keloid scars. These include noninvasive treatments such as use of silicone gel sheeting and compression therapy, and invasive treatments such as intralesional corticosteroid injections, surgery, and radiotherapy. Novel treatments include chemotherapy, immunotherapy, and anti-inflammatory therapies. Unfortunately, keloids continue to pose a significant challenge due to the lack of efficacious treatments. Therefore, clinicians should be familiar with various therapeutic options and apply the most suitable treatment plan for patients. In this review, we introduce the current therapeutic options for the management of keloid scars.

Case Exercise: Toxic Exposure-Related Illness: Causation, Diagnosis, and Permanent Impairment

2007 ◽  
Vol 12 (2) ◽  
pp. 4-8
Author(s):  
Frederick Fung
Keyword(s):  
Concentration Level ◽  
Treatment Plan ◽  
Toxic Exposure ◽  
Dose Response Relationship ◽  
Specialty Board ◽  
History Of ◽  
Subjective Complaints ◽  
Based Medicine ◽  
Illness Causation ◽  
Rule Out

Abstract A diagnosis of toxic-related injury/illness requires a consideration of the illness related to the toxic exposure, including diagnosis, causation, and permanent impairment; these are best performed by a physician who is certified by a specialty board certified by the American Board of Preventive Medicine. The patient must have a history of symptoms consistent with the exposure and disease at issue. In order to diagnose the presence of a specific disease, the examiner must find subjective complaints that are consistent with the objective findings, and both the subjective complaints and objective findings must be consistent with the disease that is postulated. Exposure to a specific potentially causative agent at a defined concentration level must be documented and must be sufficient to induce a particular pathology in order to establish a diagnosis. Differential diagnoses must be entertained in order to rule out other potential causes, including psychological etiology. Furthermore, the identified exposure at the defined concentration level must be capable of causing the diagnosis being postulated before the examiner can conclude that there has been a cause-and-effect relationship between the exposure and the disease (dose-response relationship). The evaluator's opinion should make biological and epidemiological sense. The treatment plan and prognosis should be consistent with evidence-based medicine, and the rating of impairment must be based on objective findings in involved systems.

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