Hemostasis of idiopathic recurrent epistaxis in children with microwave ablation: a prospective pilot case series

Abstract Objective We evaluated microwave ablation (MWA) for treatment of idiopathic recurrent anterior epistaxis (RAE) in children, in terms of technical feasibility, efficacy, and safety. Study design A prospective pilot case series. Setting Tertiary university hospital. Methods Children with idiopathic RAE were treated with endoscopic MWA and reevaluated at 1 and 4 weeks and at 6 months thereafter. The primary outcome was successful hemostasis on the day of the procedure. Secondary outcomes were the rebleeding rates after 1 and 4 weeks, and 6 months, and any complications. Results Of the 92 children with idiopathic RAE who met the inclusion criteria, the operation was interrupted in 7 children due to intraoperative noncooperation, and silver nitrate cautery was performed instead. All procedures were completed, and hemostasis was achieved within 10–20 s by MWA in 85 children. Two to four ablations were conducted. No recurrent epistaxis occurred and no severe MWA -related complications, such as septal perforation or synechiae formation, were observed at the 6-month follow-up. Conclusions Endoscopic MWA is a feasible and safe technique for the treatment of idiopathic pediatric RAE in the clinical setting, especially those cases that do not respond to in-office chemical cautery.

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CO2 laser-assisted sclerectomy surgery in the treatment of open-angle glaucoma in Chinese patients

European Journal of Ophthalmology ◽

10.1177/11206721211073035 ◽

2022 ◽

pp. 112067212110730

Author(s):

ZhiYuan Xin ◽

Jeremy Chen ◽

DaJiang Wang ◽

Xing Wu ◽

Ying Han

Keyword(s):

Primary Outcome ◽

Open Angle Glaucoma ◽

Case Series ◽

Chinese Patients ◽

Open Angle ◽

Efficacy And Safety ◽

Success Rates ◽

The Mean ◽

Secondary Outcomes

Purpose To evaluate the efficacy and safety of CO2-Laser Assisted Sclerectomy Surgery (CLASS) with 5-fluorouracil (5-FU) in treating open-angle glaucoma (OAG) in Chinese patients. Methods: This was a retrospective, uncontrolled, interventional case series. All patients from 2016 to 2017 who received CLASS were recruited in this study. The primary outcome was the change in intraocular pressure (IOP) and the number of IOP-lowering medications over a 12-month follow-up period. Adverse events were evaluated as secondary outcomes. Results: Data were collected from forty-two eyes of 31 patients. The average preoperative IOP was 31.33 ± 7.60mmHg. The mean percentage of IOP reduction from baseline at postoperative months (POM) 1, 3, 6, 9, and, 12 were 48.1% ± 24.6%, 51.4% ± 19.3%, 51.2% ± 17.2%, 50.9% ± 15.0%, 49.2% ± 16.3%, respectively (all P < 0.001). The number of glaucoma medications decreased from a baseline of 3.02 ± 0.81 to 0.05 ± 0.22, 0.10 ± 0.37, 0.12 ± 0.40, 0.17 ± 0.44, and 0.24 ± 0.58 at POM 1, 3, 6, 9, and 12, respectively (all P < 0.001). At POM 1, 3, 6, 9, and 12, complete success rates were 66.7%, 73.8%, 76.2%, 69.1%, and 71.4%, respectively. At POM 1, 3, 6, 9, and 12, qualified success rates were 71.4%, 82.0%, 85.3%, 83.3%, and 90.5%, respectively. Major postoperative complications include peripheral iris synechia, iris incarceration, and anterior chamber shallowing. Conclusions: CLASS with 5-FU shows safety and efficacy for decreasing IOP and the number of IOP-lowering medications over a 12-month follow-up period. It could be an alternative treatment for patients with OAG.

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Failed Latarjet procedure: a systematic review of surgery revision options

Journal of Orthopaedics and Traumatology ◽

10.1186/s10195-021-00587-7 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Matteo Buda ◽

Riccardo D’Ambrosi ◽

Enrico Bellato ◽

Davide Blonna ◽

Alessandro Cappellari ◽

...

Keyword(s):

Systematic Review ◽

Case Series ◽

Review Of The Literature ◽

Inclusion Criteria ◽

Latarjet Procedure ◽

Shoulder Stabilization ◽

Recurrent Instability ◽

Level Of Evidence ◽

Radiographic Outcomes

Abstract Background Revision surgery after the Latarjet procedure is a rare and challenging surgical problem, and various bony or capsular procedures have been proposed. This systematic review examines clinical and radiographic outcomes of different procedures for treating persistent pain or recurrent instability after a Latarjet procedure. Methods A systematic review of the literature was performed using the Medline, Cochrane, EMBASE, Google Scholar and Ovid databases with the combined keywords “failed”, “failure”, “revision”, “Latarjet”, “shoulder stabilization” and “shoulder instability” to identify articles published in English that deal with failed Latarjet procedures. Results A total of 11 studies (five retrospective and six case series investigations), all published between 2008 and 2020, fulfilled our inclusion criteria. For the study, 253 patients (254 shoulders, 79.8% male) with a mean age of 29.6 years (range: 16–54 years) were reviewed at an average follow-up of 51.5 months (range: 24–208 months). Conclusions Eden–Hybinette and arthroscopic capsuloplasty are the most popular and safe procedures to treat recurrent instability after a failed Latarjet procedure, and yield reasonable clinical outcomes. A bone graft procedure and capsuloplasty were proposed but there was no clear consensus on their efficacy and indication. Level of evidence Level IV Trial registration PROSPERO 2020 CRD42020185090—www.crd.york.ac.uk/prospero/

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Coronary risk of patients with valvular heart disease: prospective validation of CT-Valve Score

Open Heart ◽

10.1136/openhrt-2020-001380 ◽

2020 ◽

Vol 7 (2) ◽

pp. e001380

Author(s):

Rasmus Bo Hasselbalch ◽

Mia Marie Pries-Heje ◽

Sarah Louise Kjølhede Holle ◽

Thomas Engstrøm ◽

Merete Heitmann ◽

...

Keyword(s):

Heart Disease ◽

Valvular Heart Disease ◽

Primary Outcome ◽

Multislice Ct ◽

Cost Effective ◽

University Hospital ◽

Before And After ◽

History Of ◽

Artery Disease

ObjectiveTo prospectively validate the CT-Valve score, a new risk score designed to identify patients with valvular heart disease at a low risk of coronary artery disease (CAD) who could benefit from multislice CT (MSCT) first instead of coronary angiography (CAG).MethodsThis was a prospective cohort study of patients referred for valve surgery in the Capital Region of Denmark and Odense University Hospital from the 1 February 2015 to the 1 February 2017. MSCT was implemented for patients with a CT-Valve score ≤7 at the referring physician’s discretion. Patients with a history of CAD or chronic kidney disease were excluded. The primary outcome was the proportion of patients needing reevaluation with CAG after MSCT and risk of CAD among the patients determined to be low to intermediate risk.ResultsIn total, 1149 patients were included. The median score was 9 (IQR 3) and 339 (30%) had a score ≤7. MSCT was used for 117 patients. Of these 29 (25%) were reevaluated and 9 (7.7%) had CAD. Of the 222 patients with a score ≤7 that did not receive an MSCT, 14 (6%) had significant CAD. The estimated total cost of evaluation among patients with a score ≤7 before implementation was €132 093 compared with €79 073 after, a 40% reduction. Similarly, estimated total radiation before and after was 608 mSv and 362 mSv, a 41% reduction. Follow-up at a median of 32 months (18–48) showed no ischaemic events for patients receiving only MSCT.ConclusionThe CT-Valve score is a valid method for determining risk of CAD among patients with valvular heart disease. Using a score ≤7 as a cut-off for the use of MSCT is safe and cost-effective.

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Sinus Floor Augmentation—Associated Surgical Ciliated Cysts: Case Series and a Systematic Review of the Literature

Applied Sciences ◽

10.3390/app11041903 ◽

2021 ◽

Vol 11 (4) ◽

pp. 1903

Author(s):

Adrian Kahn ◽

Shlomo Matalon ◽

Rahaf Bassam Salem ◽

Lazar Kats ◽

Liat Chaushu ◽

...

Keyword(s):

Systematic Review ◽

Microscopic Examination ◽

Literature Search ◽

Case Series ◽

Systematic Literature Search ◽

Review Of The Literature ◽

Inclusion Criteria ◽

Sinus Floor Augmentation ◽

Sinus Floor

This study aimed to characterize the demographic and clinical features of underreported surgical ciliated cysts developing after sinus floor augmentation, based on a series of cases from our files and a systematic review of the literature. A series of five cases (four patients) of microscopically confirmed surgical ciliated cysts following sinus floor augmentation procedures from our files are described. A systematic literature search (1991–2020) with strict clinical-, radiological- and microscopic-based exclusion and inclusion criteria was performed to detect additional similar cases. The systematic review revealed only five cases that fulfilled the inclusion criteria. Altogether, surgical ciliated cysts associated with sinus floor augmentation have been rarely reported in the literature, and have not been characterized either demographically or clinically. Graft materials were diverse, implants were placed simultaneously, or up to two years post-augmentation. The associated surgical ciliated cysts developed between 0.5 and 10 years post-augmentation. Although limited in its extent, this study is the first series to characterize possible underreported sequelae of surgical ciliated cysts associated with sinus floor augmentation. It emphasizes the need for long post-operative follow-up and confirmation of lesion by microscopic examination.

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Tubularized proximally-incised plate in distal/midshaft hypospadias repair

La Pediatria Medica e Chirurgica ◽

10.4081/pmc.2017.151 ◽

2017 ◽

Vol 39 (2) ◽

Author(s):

Antonio Marte ◽

Lucia Pintozzi

Keyword(s):

Perioperative Complications ◽

Foley Catheter ◽

Case Series ◽

Functional Results ◽

Inclusion Criteria ◽

Urethral Plate ◽

Age At Surgery ◽

Long Term Follow Up

The aim of this study was to verify the validity, feasibility, and the functional results, by uroflowmetry, of Tubularized proximallyincised plate technique in selected case of distal/midshaft hypospadias. Out of 120 patients scheduled to undergo TIP (or Snodgrass) procedure, 23 were selected between January 2013 and January 2016 (19.1%). This case series comprised 16 patients with distal and 7 with midshaft hypospadias. Mean age at surgery was 2.9 years. The inclusion criteria were a deep and wide glandular groove and a proximal narrow urethral plate. The procedure was carried out as described by Snodgrass but the incision of the urethral plate, including the mucosal and submucosal tissue, was made only proximally, between the original meatus and the glandular groove in no case extending to the entire length of the plate. Postoperatively a foley catheter was left in place from 4 to 7 days. Uroflowmetry was performed when the patients age ranged from 2.5 to 5.7 years (mean age 3.11 years and mean follow-up 1.8 years, body surface 2). No patient presented fistulas nor perioperative complications. At uroflowmetry, eighteen patients presented values above the 25<sup>th</sup> percentile and 5 showed a borderline flow. All patients in this group remained stable without urinary symptoms. In selected cases, the tubularized proximally-incised plate yields satisfactory cosmetic and functional results for the treatment of midshaft proximal hypospadias. A long-term follow-up study is needed for further evaluation. Patient selection is crucial for the success of this technique.

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Effect of Cataract Surgery on Intraocular Pressure in Glaucoma Patients

Pakistan Journal of Ophthalmology ◽

10.36351/pjo.v37i1.1167 ◽

2020 ◽

Vol 37 (1) ◽

Author(s):

Shua Azam ◽

Abdul Hameed Talpur ◽

Mahak Shaheen ◽

Sadia Bukhari

Keyword(s):

Intraocular Pressure ◽

Cataract Surgery ◽

Open Angle Glaucoma ◽

Case Series ◽

Angle Closure ◽

Inclusion Criteria ◽

Primary Angle Closure Glaucoma ◽

Closed Angle ◽

Operative Assessment

Purpose: To determine the change in intraocular pressure after cataract surgery in patients diagnosed with glaucoma. Study Design: Interventional case series. Place and Duration of Study: Glaucoma Clinic. Al-Ibrahim Eye Hospital (AIEH) Karachi, Pakistan from May to October, 2019. Methods: Thirty-eight patients diagnosed with glaucoma and cataract and registered in glaucoma clinic were recruited for this study. Inclusion Criteria was age > 41 years and patients diagnosed with primary open/closed angle glaucoma and cataract. Patients with secondary glaucoma, history of trabeculectomy and any other ocular diseases were excluded from the study. Pre-operative assessment was done for phacoemulsification. In post-operative examination, first and second follow-up IOP was measured. Data analysis was done on statistical package for social science (SPSS) version 20.0. Statistical changes were present in the form of bar chart, frequency and graphs. The mean standard deviation for pre-operative, post-operative 1st and 2nd follow-up IOP was calculated. Results: A total of 38 participants and 48 eyes satisfied the inclusion criteria. Out of 48 eyes, 39 (81.3%) eyes were diagnosed with Primary open angle glaucoma and 9 (18.8%) eyes with Primary Angle Closure Glaucoma. The pre-operative mean IOP was 16.56 ± 6.67 mm Hg and post-operative mean IOP at first follow-up was 13.39 ± 4.04 mm Hg. At second follow-up at one-month mean IOP was 12.14 ± 2.28 mm Hg. Conclusion: Phacoemulsification produces a useful decrease in IOP in glaucoma patients. Key Word: Glaucoma, Cataract, Phacoemulsification, Intraocular Pressure.

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Frequency of Success in Surgery of Vesicovaginal Fistula by Layered Closure with Graft Repair

10.53350/pjmhs2115103479 ◽

2021 ◽

Vol 15 (10) ◽

pp. 3479-3481

Author(s):

Anila Mujadid Qureshi ◽

Azra Parveen Rajpar ◽

Ishrat Saba Mari ◽

Khalida Avesi ◽

Kousar Fatima ◽

...

Keyword(s):

Success Rate ◽

Vesicovaginal Fistula ◽

Case Series ◽

University Hospital ◽

Blue Dye ◽

Urogenital Fistula ◽

Vesicovaginal Fistulae ◽

University Setting ◽

Distressing Condition

Introduction: Vesicovaginal fistulae is abnormal communication between bladder and vagina that cause continous dribling of urine. It is physically, mentally and socially distressing condition. There are various approaches for surgeries of these urogenital fistulae with different success-rate that depend upon the experience of surgeon and surgical procedures. This study can help us to estimate the success rate of layered repair with graft in vaginal route to make stragedy to adopted in severe patient. Objective: To determine frequency of success in surgery on vesic-ovaginal fistulae by layered closured with graft repair procedures among patients admitted in Isra University. Setting: Obstetrics & Gynecology department in Isra university hospital Duration: 6 months from 10.2.2014 to 10.8.2014 Study Design: Case series Subject and methods: A total of 100 patients after having surgery for vesicovaginal fistula by layered closure with graft repair was included in this study. History and examination of all subjects were taken. The follow up visit was planned after 3 weeks of surgery. All women was questioned for recurrence of continuous urinary leakage and that without such symptoms proved by absence of leakage on methylene blue dye test was labeled as ‘success’. Results: - Frequency of success in surgery on vesic-ovaginal fistulae by layered closured with graft repair procedures was observed in 88% cases. Conclusion: The success rate of VVF repair by layered closured with graft repair procedures is high. It is concluded that obstetric urogenital fistula is a preventable condition. Keywords: Vesicovaginal fistulae, Layered closured, Graft repair, urogenital fistula

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Use of Biologics in Pityriasis Rubra Pilaris Refractory to First-Line Systemic Therapy: A Systematic Review

Journal of Cutaneous Medicine and Surgery ◽

10.1177/1203475419887731 ◽

2019 ◽

Vol 24 (1) ◽

pp. 73-78

Author(s):

Avee Naidoo ◽

Cathryn Sibbald ◽

Patrick J. Fleming ◽

Vincent Piguet

Keyword(s):

Large Scale ◽

Randomized Clinical Trials ◽

Case Series ◽

Efficacy And Safety ◽

Inclusion Criteria ◽

Treatment Resistant ◽

First Line ◽

Disease Treatment ◽

Pityriasis Rubra Pilaris ◽

Systemic Therapies

Pityriasis rubra pilaris (PRP) is an uncommon, inflammatory, papulosquamous skin disease. Treatment of PRP is challenging as the disease is often refractory to conventional therapies, such as retinoids and methotrexate. There has been an increasing number of studies reporting the successful use of biologic therapy in patients with PRP; however, the data on the efficacy and safety are limited. Our objective was to evaluate the existing evidence for utilizing biologics, whether alone or in combination with established systemic therapies, in patients with treatment-resistant PRP. We systematically reviewed evidence within Medline and Pubmed databases between January 1, 2000, to March 31, 2019. Articles consisted of patients diagnosed with PRP who have failed to respond sufficiently to first-line systemic therapies, or who had comorbidities that precluded their use. In total, 363 unique articles were identified, 56 of which were considered relevant to the clinical question. Of the 56 articles highlighted, 35 met the inclusion criteria and were limited to case series and case studies. Therapy with biologics was found to be successful for both monotherapy (81.1% [27/33]) and when used in combination with existing systemic therapies (87.5% [14/16]). The existing evidence suggests that biologics may be regarded as a tool for PRP treatment alone or in combination therapy with existing treatments, although large-scale randomized clinical trials are necessary to better assess their efficacy and safety.

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Comparison of microwave ablation and chemical cautery used to control adult idiopathic recurrent anterior epistaxis

The Journal of Laryngology & Otology ◽

10.1017/s0022215120000390 ◽

2020 ◽

Vol 134 (3) ◽

pp. 222-227 ◽

Cited By ~ 1

Author(s):

Z Lou

Keyword(s):

Silver Nitrate ◽

Success Rate ◽

Nasal Septum ◽

Microwave Ablation ◽

Chart Review ◽

Case Series ◽

Flat Lesions ◽

Secondary Outcomes ◽

Control Adult ◽

Chemical Cautery

AbstractObjectiveThis study compared the efficacy of microwave ablation and silver nitrate cautery as treatments for idiopathic recurrent anterior epistaxis in adults.MethodsA case series with chart review was conducted. Adults with recurrent anterior epistaxis intra-operatively treated via microwave ablation or silver nitrate chemical cautery of the anterior nasal septum were enrolled. The primary outcomes were the proportion of patients in each group for whom bleeding ceased within 24 hours of treatment, and the time to successful haemostasis. The secondary outcomes were re-bleeding rates at 1 and 12 weeks and 6 months, and complications.ResultsThe haemostasis success rate within 24 hours’ treatment of convex lesions was significantly higher in the microwave ablation group than in the cautery-only group. Of patients with convex lesions, the recurrence rate to six months was significantly higher in the cautery group than in the microwave ablation group, but this was not the case for those with flat lesions.ConclusionMicrowave ablation afforded rapid and simple haemostasis for adults with recurrent anterior epistaxis in an out-patient setting. Microwave ablation had significant advantages compared to silver nitrate cautery when used to treat epistaxis in patients with convex lesions.

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Hepatic epithelioid hemangioendothelioma: case series of a rare vascular tumor mimicking metastases

Diagnostic Pathology ◽

10.1186/s13000-020-01039-2 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Nasir Ud Din ◽

Shabina Rahim ◽

Tamana Asghari ◽

Jamshid Abdul-Ghafar ◽

Zubair Ahmad

Keyword(s):

Surgical Resection ◽

Case Series ◽

Liver Function Tests ◽

Vascular Tumor ◽

Metastatic Carcinoma ◽

Epithelioid Hemangioendothelioma ◽

Clinicopathological Features ◽

University Hospital ◽

Detailed Review

Abstract Background Hepatic epithelioid hemangioendothelioma is an extremely rare malignant vascular tumor which is often multifocal and, in many cases, discovered incidentally. Here, we describe the clinicopathological features of hepatic epithelioid hemangioendothelioma cases seen in our practice and present a detailed review of the published literature. Methods All cases of hepatic epithelioid hemangioendothelioma diagnosed in Department of Pathology and Laboratory Medicine, Aga Khan University Hospital between January 1, 2006 and December 31, 2019 were included in the study. Slides were reviewed and follow up was obtained. Results Seven cases were reported during the study period. There were 4 females and 3 males. Age range was 20 to 77 years, mean age was 45 years. Three patients presented with right upper abdominal pain; 1 patient presented with jaundice while 3 patients were asymptomatic. In all 7 cases, lesions were identified on imaging studies. In 5 cases, liver lesions were multifocal. Clinical differential diagnosis in all cases was metastatic carcinoma and multifocal hepatocellular carcinoma. Liver function tests were normal in 5 cases. In 1 patient, tumor had already metastasized to the right lung. On histological examination of liver core biopsies performed in all 7 cases, classic histological features of epithelioid hemangioendothelioma were seen. Tumor cells expressed positivity for vascular markers (CD 34, CD31 and ERG) and were negative for cytokeratins, Hep par 1 and Glypican 3. Surgical resection was not performed in any of the 7 cases and all patients were treated by chemotherapy. Follow up was available in 5 cases. Of these, 3 patients died of disease and another patient was alive with metastases in both lungs, omentum and colon. Conclusion Clinicopathological features of the 7 cases in our series and detailed review of published literature is presented. Prognosis was bad in our cases most likely due to fact that surgical resection could not be performed in any of the cases owing to lack of surgical expertise for liver tumor surgery in most parts of the country.

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