scholarly journals Clinical and sonographic evaluation of the diaphragm after plication in adults with unilateral eventration: a retrospective study

2022 ◽  
Vol 16 (1) ◽  
Author(s):  
Mohamed Abdel-Bary ◽  
Alaa Rashad ◽  
Hamed Elgendy ◽  
Mohammed Zaki ◽  
Mahmoud Youssef Abdelhamid ◽  
...  
Keyword(s):  
Fluid Collection ◽  
Safe Procedure ◽  
Diaphragmatic Eventration ◽  
Diaphragmatic Plication ◽  
Paradoxical Movement ◽  
Bedside Test ◽  
The Mean ◽  
Eventration Diaphragm

Abstract Background We aim to assess the role of diaphragm ultrasonography in evaluating the outcome of surgical diaphragmatic plication in adults with symptomatic unilateral diaphragmatic eventration. Results Forty patients with symptomatic unilateral diaphragmatic eventration underwent surgical diaphragmatic plication between 2015 and 2020. The etiology was idiopathic in 34 (85%) cases, and 37 (92.5%) of them were suffering from dyspnea. Diaphragm ultrasonography showed no diaphragmatic movement on the affected side in 10 (25%) patients and a paradoxical movement in 30 (75%) patients. Surgical diaphragmatic plication was done successfully in all cases. Postoperative complications were reported in 3 (7.5%) cases, with no mortality. There was a highly significant improvement in dyspnea at 1 week and 6 months follow-up. CXR showed a highly significant decrease in the mean height of eventration at 1 week 3.7 ± 1.2 cm (P < 0.001), and 6 months 2.6 ± 0.9 cm (P < 0.001), compared to preoperative values (10.1 ± 2.8 cm). diaphragm ultrasonography showed normal motility of the plicated cupola in all cases, and there was a highly significant decrease in the mean height of eventration at 1 week (3.1 ± 1.1 cm, P < 0.001), and 6 months (2.3 ± 0.5 cm, P < 0.001) compared to preoperative values (10.3 ± 2.2 cm). There was a highly significant increase in the diaphragm thickness at 1 week (2.7 ± 0.3 mm, P < 0.001), and 6 months (2.9 ± 0.2 mm, P < 0.001), compared to the preoperative value. There was a highly significant improvement in the degree of excursion 1 week (25 ± 4.3 mm, P < 0.001), and 6 months (28 ± 5.2 mm, P < 0.001), compared to the preoperative value (15 ± 6.2 mm). No fluid collection or surroundings organ injuries were detected. The mean FVC and FEV1 showed a highly significant improvement at 1 week (66.7 ± 6%, 78.2 ± 9.8%), and 6 months (68.8 ± 5.7%, 80.4 ± 10.3%), compared to the preoperative value (58.8 ± 8% and 70.9 ± 10.3%). Conclusions Surgical diaphragmatic plication is an effective and safe procedure that can be performed to treat symptomatic adults with unilateral diaphragmatic eventration. Diaphragm ultrasonography can be used as a simple bedside test to evaluate unilateral diaphragmatic eventration cases and their postoperative follow-up.

scholarly journals The efficacy of diaphragmatic plication in patients with unilateral diaphragmatic paralysis; a two-centre experience

2020 ◽  
Author(s):  
Mohamed Abdel Bary Ibrahim ◽  
Alaa Rashad ◽  
Hamed Elgendy ◽  
Morris Beshay
Keyword(s):  
Recovery Of Function ◽  
Diaphragmatic Paralysis ◽  
Safe Procedure ◽  
Diaphragmatic Eventration ◽  
Thoracic Surgical Procedures ◽  
Diaphragmatic Plication ◽  
Chest X Ray ◽  
Postoperative Improvement ◽  
Postoperative Fev1

Abstract Background and objective: Diaphragm is not an uncommon problem. is the most presenting in most of the cases. In this study, we used diaphragm (DUS) and to evaluate the outcome of post-surgical diaphragmatic plication (SDP) in adults with unilateral diaphragmatic paralysis (UDP). To our knowledge, no large reports about the efficacy of and the utilization of DUS for these patients were done. Methods: A retrospective analysis of all patients who underwent SDP at two (2014 - 2018) was done. Data of all patients were patients' characteristics, preoperative (chest X-ray, chest computed tomography, DUS, and ) , two years postoperative follow up. Results: Among 47 (UDP) patients. 40 patients underwent SDP. 30 (75%) males (mean age 45±14 years). Left-sided SDP was found in 57% of cases (n=23). Most of the patients were suffering from Dyspnea (n=38). Minor complications occurred in 12% (n=5). Excellent results in 90% (n=36), good results in 7,5% and unsatisfactory in one patient (2,5%). Patients up at one month and 6 months and two years showed a significant increase in FEV1 up to 20% (range 15-40%), P=0.011 and FVC up to 30% (range 10%45%) P=0.024. There was a significant postoperative improvement in (P<0.005). There was a significant correlation between postoperative FEV1 and the height of the copula on CXR and DUS (P<0.001 and P<0.005 respectively). Conclusion: SDP is an effective and safe procedure which can be performed to treat UDP in adult patients suffering from chronic . is a significant improvement in the patient’s functional is correlated to the assessment. Keywords: Diaphragm Diaphragmatic Eventration Diaphragmatic Eventration/surgery diaphragm/ultrasonography, fluoroscopy, Recovery of Function Thoracic Surgical Procedures/methods

scholarly journals Surgical treatment of 125 cases of congenital diaphragmatic eventration in a single institution

2020 ◽  
Author(s):  
Shengliang Zhao ◽  
Zhengxia Pan ◽  
Yonggang Li ◽  
Yong An ◽  
Lu Zhao ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Open Surgery ◽  
Clinical Characteristics ◽  
Clinical Symptoms ◽  
Operation Time ◽  
Diaphragmatic Eventration ◽  
Diaphragmatic Plication ◽  
Paradoxical Movement ◽  
First Choice

Abstract Backgrounds: This study sought to investigate the clinical characteristics of congenital diaphragmatic eventration (CDE) and to compare the efficacies of thoracoscopy and traditional open surgery in infants with CDE. Methods: This study sought to investigate the clinical characteristics of congenital diaphragmatic eventration (CDE) and to compare the efficacies of thoracoscopy and traditional open surgery in infants with CDE. Results: A total of 108 children in this group underwent surgery, of whom 67 underwent open surgery and 41 underwent thoracoscopic diaphragmatic plication. A total of 107 patients recovered well postoperatively, except for 1 patient who died due to respiratory distress after surgery. After 1-9.5 years of follow-up, 107 patients had significantly improved preoperative symptoms. During follow-up, the location of the diaphragm was normal, and no paradoxical movement was observed. Eleven of the 17 children who did not undergo surgical treatment did not have a decrease in diaphragm position after 1-6 years of follow-up. The index data on the operation time, intraoperative blood loss, chest drainage time, postoperative mechanical ventilation time, postoperative hospital stay and postoperative CCU admission time were better in the thoracoscopy group than in the open group. The difference between the two groups was statistically significant (P<0.05). Conclusions: The clinical symptoms of congenital diaphragmatic eventration vary in severity. Patients with severe symptoms should undergo surgery. Both thoracoscopic diaphragmatic plication and traditional open surgery can effectively treat congenital diaphragmatic eventration, but compared with open surgery, thoracoscopic diaphragmatic plication has the advantages of a short operation time, less trauma, and a rapid recovery.　Thus, thoracoscopic diaphragmatic plication should be the first choice for children with congenital diaphragmatic eventration.

scholarly journals SAT0267 ROLE OF AGGRESSIVE IMMUNOSUPPRESSION ON SUBGLOTTIC STENOSIS IN GRANULOMATOSIS WITH POLYANGIITIS: RETROSPECTIVE ANALYSIS OF A MONOCENTRIC COHORT

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1076.1-1077
Author(s):  
L. Moroni ◽  
L. Giudice ◽  
G. A. Ramirez ◽  
S. Sartorelli ◽  
A. Cariddi ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Clinical Characteristics ◽  
Granulomatosis With Polyangiitis ◽  
Balloon Catheter ◽  
Subglottic Stenosis ◽  
Damage Accrual ◽  
The Mean ◽  
The One

Background:Subglottic stenosis (SGS) is defined as airway narrowing below the vocal cords and is a common and potentially life-threatening manifestation of Granulomatosis with Polyangiitis (GPA), with an estimated prevalence of 16-23% (1). Balloon catheter dilation is effective in GPA-related SGS, but relapses are frequent. Little is known about the role of immunosuppression in this setting.Objectives:to analyse the clinical characteristics of a monocentric GPA cohort, describe phenotype differences among patients with and without SGS and investigate the role of surgical and medical treatments on relapse risk and general outcome.Methods:Biopsy-proven patients with SGS were identified by review of medical charts among a cohort of patients with GPA, classified according to the algorithm of the European Medicine Agency (2). The clinical characteristics of patients with SGS were retrospectively collected over a median follow-up time of 15.9 years and compared to those of patients without SGS.Results:Fourteen patients with SGS-GPA were identified, with a female to male ratio of 1:1 and a prevalence of 29.2% among the cohort. The mean ± SD age at GPA onset was 30.8 ± 14.4 years, with a mean time from GPA diagnosis to SGS onset of 4.7 ± 4.2 years. ANCA were positive in 78.6% (54.0% anti-PR3, 18.1% anti-MPO and 27.9% IFI only). The mean Birmingham Vasculitis Activity Score (BVAS) at onset was 10.0 ± 5.6. The main clinical manifestations associated with SGS were crusty rhinitis (100%), sinusitis (78%), pulmonary disease (72.7%), otitis/mastoiditis (50%), glomerulonephritis (42.9%), orbital pseudotumor (28.6%). Six patients (42.9%) received medical treatment only, other six (42.9%) had one to three balloon dilations and two (14.2%) underwent four or more procedures. Eight patients had no SGS relapse (maximum one dilation) and they all received immunosuppression with rituximab (RTX), cyclophosphamide (CYC) or azathioprine (AZA). All patients who received no immunosuppression, methotrexate (MTX) or mycophenolate (MMF) had at least one relapse. Patients treated with MTX or MMF had a mean relapse-free survival of 13.1 months, which was comparable to the one of patients not receiving medical treatment (40.2 months; p=NS) and shorter than the one of patients receiving CYC or RTX (153.2 months; p=0.032). CYC use also inversely correlated with the number of surgical procedures (r=-0.691, p=0.006). Compared to patients without SGS (31 consecutive patients with at least 4 years of follow-up), patients with SGS-GPA had an earlier disease onset (mean age 30.8 vs 50.4 years; p<0.001), but with lower BVAS (mean 10.0 vs 15.3; p=0.013) and showed a higher prevalence of crusty rhinitis (100% vs 67.7%; p=0.019). No difference was observed in damage accrual over time between the two groups.Conclusion:Subglottic stenosis is highly prevalent in patients with GPA and may define a milder disease subset occurring more frequently in younger patients. MTX and MMF might be insufficient to prevent SGS relapses requiring balloon dilation. Aggressive immunosuppression (CYC or RTX) might have a non-redundant role in this setting and reduce the risk of relapses.References:[1]Quinn KA, et al. Subglottic stenosis and endobronchial disease in granulomatosis with polyangiitis. Rheumatology 2019; 58 (12), 2203-2211.[2]Watts R, et al. Development and validation of a consensus methodology for the classification of the ANCA associated vasculitides and polyarteritis nodosa for epidemiological studies. Ann Rheum Dis 2007; 66: 222-7.Disclosure of Interests:Luca Moroni: None declared, Laura Giudice: None declared, Giuseppe Alvise Ramirez: None declared, Silvia Sartorelli: None declared, adriana cariddi: None declared, Angelo Carretta: None declared, Enrica Bozzolo: None declared, Lorenzo Dagna Grant/research support from: The Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR) received unresctricted research/educational grants from Abbvie, Bristol-Myers Squibb, Celgene, Janssen, Merk Sharp & Dohme, Mundipharma Pharmaceuticals, Novartis, Pfizer, Roche, Sanofi-Genzyme, and SOBI., Consultant of: Prof Lorenzo Dagna received consultation honoraria from Abbvie, Amgen, Biogen, Bristol-Myers Squibb, Celltrion, Novartis, Pfizer, Roche, Sanofi-Genzyme, and SOBI.

scholarly journals THU0517 THE ROLE OF ULTRASOUND-DEFINED SYNOVITIS GRADE I IN PATIENTS PRESENTING WITH INFLAMMATORY ARTHRALGIA, A RETROSPECTIVE STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 497.2-497
Author(s):  
J. Arroyo Palomo ◽  
M. Arce Benavente ◽  
C. Pijoan Moratalla ◽  
B. A. Blanco Cáceres ◽  
A. Rodriguez
Keyword(s):  
Rheumatoid Arthritis ◽  
Inflammatory Arthritis ◽  
Statistical Tests ◽  
Median Number ◽  
Painful Joint ◽  
Significant Difference ◽  
The Mean ◽  
Specialized Unit

Background:Musculoeskeletal ultrasound (MSUS) is frequently used in several rheumatology units to detect subclinical inflammation in patients with joint symptoms suspected for progression to inflammatory arthritis (IA). Synovitis grade I (EULAR-OMERACT combined score) is known to be a casual finding in healthy individuals, but studies headed to unravel its possible role on rheumatic diseases are sparse.Objectives:To investigate the correlation between synovitis grade I, and the diagnosis of IA made after a year follow-up period since MSUS findings, in patients of an MSUS-specialized unit of a Rheumatology Department.Methods:We conducted a descriptive, retrospective and unicentric study. 30 patients were selected from the MSUS-specialized unit of our Rheumatology Department from July-18 to January-19. Patients presenting synovitis grade 0 (exclusively), 2 and/or 3 on combined score were excluded. Data collection at baseline included age, sex, immunological profile and previous physical examination to the MSUS findings, as well as the diagnosis made by the rheumatologist in 1-year visit follow-up: dividing the patient sample into two groups: those who were diagnosed with IA and those not. Non-parametric statistical tests for comparing means were used.Results:The mean age was 51,6 years and 70% were females. 6 (20%) patients were diagnosed with inflammatory arthritis after a year follow-up: 2 (4,8%) psoriatic arthritis, 1 (3,3%) undifferentiated arthritis, 1 (3,3%) rheumatoid arthritis, 1 (3,3%) Sjögren’s syndrome. Non-inflammatory arthropathies were also found 24 (80%), of which, 12 (40%) were non-specific arthralgias and 8 (19%) osteoarthritis.In the group of patients who did not developed an IA the mean C-reactive protein (CPR) value was 3,12 mg/L and erythrocyte sedimentation rate (ESR) was 8,2 mm; all of them were rheumatoid factor (RF) positive and ACPA-negative except one patient. 5 (31,3%) patients presented low antinuclear antibodies (ANAs) levels. In those who HLA B-27 and Cw6 were tested (4,25%); both were negative except for one that was HLA B-27 positive. The median number of swollen and painful joint count was 0, and the mean of joints with MSUS involvement was 3,5; the mean involved metacarpophalangeal (MCP) joints was 1,83; proximal interphalangeal (PIP) joints was 1,48 and distal interphalangeal (DIP) joints 0,21.Among the group of patients that developed an IA the mean of CPR and ESR was 9,27 mg/L and 14,17 mm respectively; 2 (33%) patients were RF- positive, and 1 ACPA-positive. ANAs were positive in 3 cases (50%). The median of swollen joint count was 2 and for painful joint count was 0, the median of joints with MSUS involvement was 4,5. The mean of MSUS involvement was for MCP, PIP and DIP joints: 1,67, 2 and 0. Comparing the means of CPR values in the two groups with Student’s t-test we obtained a statistically significant difference (p=0,023). No other significant differences were found.Conclusion:Despite the limitations and possible statistical bias, the presence of MSUS-defined synovitis grade I and elevated CRP levels could be related to further diagnoses of inflammatory arthropathy. Besides, the absence of synovitis in DIP joints might have a diagnostic role. Normal physical exploration and normal levels of CRP might suggest low MSUS value. However, further research is needed to clarify the role of MSUS-defined synovitis grade I.References:[1]D’Agostino MA et al. Scoring ultrasound synovitis in rheumatoid arthritis: a EULAR-OMERACT ultrasound taskforce-Part 1: definition and development of a standardized, consensus-based scoring system. RMD Open. 2017;3(1):e000428.[2]Van den Berg R et al. What is the value of musculoskeletal ultrasound in patients presenting with arthralgia to predict inflammatory arthritis development? A systematic literature review. Arthritis Research & Therapy (2018) 20:228.Disclosure of Interests:None declared

The role of exudation in chronic subdural hematomas

2007 ◽  
Vol 107 (2) ◽  
pp. 290-295 ◽  
Author(s):  
Mehmet Tokmak ◽  
A. Celal Iplikcioglu ◽  
Sirzat Bek ◽  
Cem Atilla Gökduman ◽  
Mustafa Erdal
Keyword(s):  
Outer Membrane ◽  
Clinical Status ◽  
Ct Scans ◽  
Subdural Hematomas ◽  
The Mean ◽  
Grade 3 ◽  
Age Range ◽  
Exudation Rate

Object Chronic subdural hematomas (SDHs) are a local inflammatory process that causes the formation of a granulation tissue often referred to as the external or outer membrane. This membrane has abnormally permeable macrocapillaries. Therefore, exudation from the macrocapillaries in the outer membrane of chronic SDH may play an important role in the enlargement of chronic SDH. In this study the authors investigated the role of exudation in chronic SDH. Methods The authors examined 24 patients (16 men and eight women; age range 38–86 years [mean age 61.4 years]) with 27 chronic SDHs. The clinical status of the patients was evaluated according to the classification described by Markwalder. The diagnosis was established on computed tomography (CT) scans in all cases. The authors also used the Nomura Classification for judging the lesion's appearance on CT scans. Immediately after the diagnosis, all patients were administered 20 mCi (740 mBq) technetium-99m human serum albumin. Four hours later, blood and SDH samples were taken and radioactivity levels were measured in each. The ratio of activity of the samples taken from chronic SDH to the radioactivity of blood was determined as a percentage and defined as the exudation rate. On the follow-up CT scan obtained on postoperative Day 20, subdural collections thicker than 5 mm were determined to be a reaccumulation. Results The correlations between the exudation rate and age of the patients, clinical grades, CT appearances, and amount of reaccumulation were investigated. In this series the average exudation rate was 13.24% (range 2.05–28.88%). The mean exudation rates according to the clinical grades assigned to patients were as follows: Grade 0, 8.67 ± 5.64% (three patients); Grade 1, 5.07 ± 1.43% (eight patients); Grade 2, 17.87 ± 3.73% (seven patients); and Grade 3, 19.65 ± 7.67% (six patients). Exudation rates in patients with Grades 2 and 3 were significantly higher than those in Grades 0 and 1 (p < 0.05). The mean exudation rates according to the lesion's appearance on CT scans were found as follows: hypodense appearance, 6.55 ± 4.52% (eight patients); isodense appearance, 11.07 ± 6.32% (five patients); hyperdense appearance, 19.47 ± 13.61% (three patients); and mixed-density appearance, 17.40 ± 5.80% (nine patients). The differences among the groups were significant (p < 0.05). The average exudation rate was statistically higher in the patients with reaccumulation (16.30 ± 8.16%) than that in the patients without reaccumulation (9.96 ± 6.84%) (p < 0.05). Conclusions The exudation rate in chronic SDH is correlated with a higher clinical grade (Markwalder Grade 2 or 3), mixed-density CT appearance, and reaccumulation. Therefore, exudation from macrocapillaries in the outer membrane of chronic SDH probably plays an important role in the pathophysiology and the growth of chronic SDH.

scholarly journals Bleeding during laparoscopic partial nephrectomy: Can a hemostatic matrix help to improve hemostasis?

2016 ◽  
Vol 88 (3) ◽  
pp. 228 ◽  
Author(s):  
Faruk Ozgor ◽  
Abdulmuttalip Simsek ◽  
Ozgu Aydogdu ◽  
Onur Kucuktopcu ◽  
Omer Sarilar ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Tumor Size ◽  
Operation Time ◽  
Demographic Characteristics ◽  
Ischemia Time ◽  
Nephrometry Score ◽  
The Mean ◽  
Group 1

Objectives: To evaluate the possible role of an hemostatic matrix on hemostasis, perioperative outcomes and complications in patients who underwent laparoscopic partial nephrectomy (LPN). Materials and methods: Patients charts were analyzed retrospectively and their demographic characteristics, operative parameters and follow-up results were recorded. Patients were divided into two groups, according to those who used an hemostatic matrix as Group 1 (n = 41) and those who did not used as Group 2 (n = 44). Demographic characteristics of patients, tumor features, operation time, clamping of the renal vessels, ischemia time, suturing of the collecting system, perioperative hemorrhage and complications were evaluated. Histopathological results, surgical margin status, creatinine level and recurrence at the 3rd month of follow up were analyzed. Statistical analyses were performed with SPSS 17.0 and significance was set at p value of &lt; 0.05. Results: The mean RENAL nephrometry score was 5.9 ± 2.0 and the mean tumor size was 35 ± 12 mm. All patients had a single tumor and 44 of them had a tumor in the right kidney. The renal artery was clamped in 79 cases and the mean ischemia time was 20.1 ± 7 minutes. The mean tumor size and the mean RENAL nephrometry score was statistically higher in Group 1 (p: 0.016 and p &lt; 0.001, respectively). Pelvicaliceal repair was more common in Group 1 due to deeper extension of tumors in this group (p: 0.038). In Group 1, less hemorrhage and blood transfusion requirement, with shorter ischemia and operation time was detected. Conclusion: The outcomes of the recent study showed that adjunctive use of an hemostatic matrix improves hemostasis and decreases hemorrhagic complications during LPN. Further prospective studies are required to assess the potential role of an hemostatic matrix in LPN.

Dynamic cranioplasty for brachycephaly in Apert syndrome: long-term follow-up study

2001 ◽  
Vol 94 (5) ◽  
pp. 757-764 ◽  
Author(s):  
José Guimarães-Ferreira ◽  
Fredrik Gewalli ◽  
Pelle Sahlin ◽  
Hans Friede ◽  
Py Owman-Moll ◽  
...  
Keyword(s):  
Cell Mass ◽  
Apert Syndrome ◽  
Long Term Results ◽  
Safe Procedure ◽  
Content Type ◽  
Skull Shape ◽  
The Mean ◽  
Fine Print

Object. Brachycephaly is a characteristic feature of Apert syndrome. Traditional techniques of cranioplasty often fail to produce an acceptable morphological outcome in patients with this condition. In 1996 a new surgical procedure called “dynamic cranioplasty for brachycephaly” (DCB) was reported. The purpose of the present study was to analyze perioperative data and morphological long-term results in patients with the cranial vault deformity of Apert syndrome who were treated with DCB. Methods. Twelve patients have undergone surgery performed using this technique since its introduction in 1991 (mean duration of follow-up review 60.2 months). Eleven patients had bicoronal synostosis and one had a combined bicoronal—bilambdoid synostosis. Perioperative data and long-term evolution of skull shape visualized on serial cephalometric radiographs were analyzed and compared with normative data. Changes in mean skull proportions were evaluated using a two-tailed paired-samples t-test, with differences being considered significant for probability values less than 0.01. The mean operative blood transfusion was 136% of estimated red cell mass (ERCM) and the mean postoperative transfusion was 48% of ERCM. The mean operative time was 218 minutes. The duration of stay in the intensive care unit averaged 1.7 days and the mean hospital stay was 11.8 days. There were no incidences of mortality and few complications. An improvement in skull shape was achieved in all cases, with a change in the mean cephalic index from a preoperative value of 90 to a postoperative value of 78 (p = 0.000254). Conclusions. Dynamic cranioplasty for brachycephaly is a safe procedure, yielding high-quality morphological results in the treatment of brachycephaly in patients with Apert syndrome.

A Successful Application of the Intraoperative Parathyroid Hormone Assay in Tertiary Hyperparathyroidism

2007 ◽  
Vol 73 (3) ◽  
pp. 281-283 ◽  
Author(s):  
Leila Thanasoulis ◽  
Juliane Bingener ◽  
Kenneth Sirinek ◽  
Melanie Richards
Keyword(s):  
Parathyroid Hormone ◽  
Success Rates ◽  
Tertiary Hyperparathyroidism ◽  
Equivalent Rate ◽  
Parathyroid Hormone Assay ◽  
The Mean ◽  
Intraoperative Parathyroid Hormone ◽  
Intraoperative Parathyroid Hormone Assay

The role of the intraoperative parathyroid hormone (IOPTH) assay in patients with tertiary hyperparathyroidism (3HPT) is not well defined. To evaluate the utility of the IOPTH in 3HPT, we compared its use in 72 patients with primary hyperparathyroidism (1HPT) and 3HPT undergoing parathyroidectomy. Sixty-three patients with 1HPT and nine patients with 3HPT were identified. There were 30 men and 42 women (mean age, 58 years). The mean serum calcium and preoperative intact PTH levels in 1HPT were 11.1 mg/dL and 214 pg/mL compared with 11.2 mg/dL and 849 pg/mL in 3HPT (Ca, non significant; PTH, P < 0.05). Intraoperatively, a solitary abnormal gland was found in 62 of 72 (86%) patients. Seven patients with 3HPT had three- or four-gland hyperplasia. The two groups were compared to determine if a 10-minute postexcision IOPTH decline >50 per cent would have similar success rates. Seventy-one of 72 (98.6%) patients had a >50 per cent decline from the baseline IOPTH at the end of the operation. The average reduction from baseline was 85.3 per cent in 1HPT and 88.6 per cent in 3HPT (not significant). Average follow-up was 9.8 months for 1HPT and 11.1 months in 3HPT. Three of 63 patients (4.8%) with 1HPT and five of nine patients (55.6%) with 3HPT had inappropriate elevations in PTH ( P < 0.05). All patients with 3HPT were normocalcemic compared with 62 of 64 (97%) patients with 1HPT (not significant). The IOPTH assay can be used in 3HPT in an identical fashion with an equivalent rate of normocalcemia compared with its applications in 1HPT.

scholarly journals Development of Algorithm for Clinical Management of Sickle Cell Bone Disease: Evidence for a Role of Vertebral Fractures in Patient Follow-up

2020 ◽  
Vol 9 (5) ◽  
pp. 1601 ◽  
Author(s):  
Lucia De Franceschi ◽  
Daniele Gabbiani ◽  
Andrea Giusti ◽  
Gianluca Forni ◽  
Filippo Stefanoni ◽  
...  
Keyword(s):  
Bone Density ◽  
Sickle Cell ◽  
Bone Disease ◽  
Vertebral Fractures ◽  
Cell Disease ◽  
High Incidence ◽  
The Mean

Sickle-cell disease (SCD) is a worldwide distributed hemoglobinopathy, characterized by hemolytic anemia associated with vaso-occlusive events. These result in acute and chronic multiorgan damage. Bone is early involved, leading to long-term disability, chronic pain and fractures. Here, we carried out a retrospective study to evaluate sickle bone disease (SBD) in a cohort of adults with SCD. We assessed bone density, metabolism and turnover. We also evaluated the presence of fractures and the correlation between SCD severity and skeletal manifestations. A total of 71 patients with SCD were analyzed. The mean age of population was 39 ± 10 years, 56% of which were females. We found osteoporosis in a range between 7% and 18% with a high incidence of vertebral fractures. LDH and AST were predictive for the severity of vertebral fractures, while bone density was not. Noteworthy, we identified -1.4 Standard Deviations T-score as the cutoff for detecting the presence of fractures in patients with SCD. Collectively our data allowed us to develop an algorithm for the management of SBD, which may be useful in daily clinical practice to early intersect and treat SBD.

scholarly journals The role of radiosurgery for hemangiopericytomas

2003 ◽  
Vol 14 (5) ◽  
pp. 1-5 ◽  
Author(s):  
Steven D. Chang ◽  
Gordon T. Sakamoto
Keyword(s):  
Stereotactic Radiosurgery ◽  
Distant Metastases ◽  
Residual Tumor ◽  
High Rate ◽  
Tumor Control ◽  
Small Subset ◽  
Patient Database ◽  
The Mean

Object Hemangiopericytomas represent a small subset of meningeal tumors. Despite their relatively uncommon nature, they are aggressive tumors known for recurrence. Resection is the standard treatment in most, although regrowth and metastases are common even after resection. The authors evaluate the role of stereotactic radiosurgery in the treatment of recurrent hemangiopericytomas. Methods In a review of the Stanford radiosurgery patient database between 1989 and 2002, the authors found eight patients with recurrent hemangiopericytoma who underwent stereotactic radiosurgery. The mean age of this population was 45.1 years (range 24–67 years). All patients had been previously treated with resection, and five patients (63%) had undergone conventional radiotherapy. The mean radiosurgery dose to the tumor margin was 20.5 Gy (range 16–24 Gy). The mean clinical and radiographic follow-up period was 44 months (range 8–77 months). Of the eight tumors treated with radiosurgery, six decreased in size and two ultimately progressed. There were no radiosurgery-related complications. Conclusions Stereotactic radiosurgery of hemangiopericytomas can result in increased tumor control and should be considered as a treatment option for patients in whom the diagnosis has been established and in whom residual tumor is demonstrated postoperatively. Close clinical and radiographic follow-up evaluation is necessary in this patient population because of the high rate of local recurrence and distant metastases.

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