Pathophysiology of visual disturbances occurring after foam sclerotherapy

Background Visual disturbances (VDs) are reported with an average rate of 1.4% after foam sclerotherapy (FS). Some clinical clues indicate that they could correspond to migraine with aura (MA). Aims To validate the hypothesis that VDs occurring after FS correspond to MA and are not transient ischaemic cerebro-vascular events. Method A prospective multicentre study was carried out by the French Society of Phlebology in collaboration with the Neurology Department of the Marseille University Hospital (France). We included prospectively and consecutively all patients who experienced VDs after FS using air to make the foam. The patients were assessed (1) clinically with a specific form describing procedures of FS and recording neurological symptoms, later analysed by a neurologist specialized in migraine; and (2) by a brain diffusion-weighted magnetic resonance imaging (MRI) (T1, T2, T2*, diffusion) carried out within two weeks and analysed by a neuroradiologist. Results Twenty patients, 16 women and four men, were included in 11 phlebology clinics. All kinds of veins were treated. VDs occurred in average seven minutes after FS. Clinical assessment showed that VDs presented characteristics of MA in all patients, with headache in 10 and without in 10. Paresthesia was observed in five patients and dysphasic speech disturbance in one. Fifteen patients (75%) had a personal history of migraine. Fifteen MRIs were performed within two weeks (mean: 8 days) and three were late (26 days). All of them were normal. MRI was not performed in two patients. Conclusion These results show that VDs occurring after FS correspond to MA and are not transient ischaemic cerebro-vascular events. We suggest a pathophysiological hypothesis resting on the release of endothelin that would reach the cerebral cortex through a paten foramen ovale.

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Spontaneous Breathing for Panendoscopy? Retrospective Cohort and Results of a French Practice Survey

OTO Open ◽

10.1177/2473974x211065015 ◽

2022 ◽

Vol 6 (1) ◽

pp. 2473974X2110650

Author(s):

Pierre Habrial ◽

Maxime Léger ◽

Fabienne Costerousse ◽

Julie Debiasi ◽

Renaud Breheret ◽

...

Keyword(s):

Intensive Care ◽

Tracheal Intubation ◽

Spontaneous Breathing ◽

Odds Ratio ◽

Face Mask ◽

University Hospital ◽

Mask Ventilation ◽

French Society ◽

Laryngeal Tumor ◽

History Of

Objective Avoiding tracheal intubation by using general anesthesia with spontaneous breathing (GASB) is attractive for upper airway panendoscopy. The aim of this study was to estimate the incidence of adverse events during panendoscopy under GASB and to assess the practices of French anesthesiologists. Study Design Two-phase study: monocentric retrospective study and national survey. Setting University hospital center. Methods Patients who underwent a panendoscopy under GASB at the University Hospital of Angers between January 1 and December 31, 2014, were reviewed. Failure of GASB was defined as an episode of hypoxemia (SpO2 ≤88%) or the need for face mask ventilation with or without tracheal intubation. Then, we sent an electronic survey to all members of the French Society of Anaesthesia and Intensive Care. Results Among the 95 included patients, 22 (23%) experienced a failure of GASB: 3 tolerated hypoxemia, 15 had face mask ventilation episodes, and 4 were intubated. Three factors were associated with failure: obesity (odds ratio, 11.94; 95% CI, 3.20-44.64), history of difficult intubation defined as a Cormack score ≥3 (odds ratio, 6.20; 95% CI, 1.51-25.41), and laryngeal tumor (odds ratio, 2.81; 95% CI, 1.04-7.56). Among the 3930 members of the French Society of Anaesthesia and Intensive Care in 2018, 662 (16.8%) responded to the survey. The 2 preferred techniques to perform panendoscopy were intubation (62%) and intravenous sedation with spontaneous breathing (37%). Conclusion Although general anesthesia with orotracheal intubation remains the preferred technique for panendoscopy in France, GASB is an attractive alternative with a low failure rate. Risk factors for failure are obesity, history of difficult intubation, and laryngeal tumor.

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Child's Craniopharyngiomas About 11 Cases and Review of the Literature

European Journal of Medical and Health Sciences ◽

10.24018/ejmed.2021.3.5.1045 ◽

2021 ◽

Vol 3 (5) ◽

pp. 14-18

Author(s):

T. Mesbahi ◽

A. Rafiq ◽

L. Panu ◽

O. Jamal ◽

A. Naja

Keyword(s):

University Hospital ◽

Endocrine Disorders ◽

Review Of The Literature ◽

Resonance Imaging ◽

Slow Evolution ◽

Magnetic Resonance Imaging Mri ◽

Visual Disturbances

Craniopharyngioma is a benign and rare intracranial tumor. In children, the clinic is characterized by the semiological, neurological, ophthalmological, and endocrine tripod. Medical imaging, represented by computed tomography (CT) and especially magnetic resonance imaging (MRI), has revolutionized the approach to the diagnosis of the latter. It has a slow evolution and likely to recur late. Thus, prolonged clinical-radiological follow-up is important to affirm a cure. The aim of this study is to highlight the epidemiological, clinical, paraclinical, therapeutic and evolutionary characteristics of craniopharyngiomas in children. This work consisted of a retrospective study of 11 pediatric cases of this tumor collected in the Neurosurgery Department of the IBN ROCHD University Hospital in Casablanca between January 2011 and January 2017. In this series, the child's craniopharyngiomas accounted for a rate of 45.8% of all these tumors. The average age of our patients was 9.09 years, with a sex ratio of 0.37. The average time to diagnose was 10 months. The picture was dominated by 100% visual disturbances, signs of intracranial hypertension at 63.63% and endocrine disorders at 36.36%. The lesion was intra and suprasellar seat in 91% of cases and suprasellar seat in 9%. Tumor size was less than 4cm in 54.53% of cases. Hydrocephalus is observed in 27.27% of cases. The fronto-pterrional modus operandi was the most used 72% of cases. Total exeresis was achieved in 9.1% of cases. Overall trends were favorable in 72% of cases without noting mortality. Tumor progressive recovery was observed in 9.1% of cases, but there were no recurrences. Given its location, the treatment of craniopharyngioma can lead to significant consequences in children affecting the long-term quality of life, hence the importance of post-operative follow-up and multidisciplinary management.

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Impact of stroke history on the presence of cerebral microbleeds in hemodialysis patients

BMC Neurology ◽

10.1186/s12883-021-02320-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Toshihide Naganuma ◽

Daijiro Kabata ◽

Yoshiaki Takemoto ◽

Junji Uchida ◽

Ayumi Shintani

Keyword(s):

Multivariable Analysis ◽

Multivariate Logistic Regression Analysis ◽

Cross Sectional Study ◽

Cerebral Microbleeds ◽

Cross Sectional ◽

Ischemic Cerebrovascular Disease ◽

High Prevalence ◽

History Of ◽

Weighted Magnetic Resonance Imaging ◽

Magnetic Resonance Imaging Mri

Abstract Introduction Cerebral microbleeds (CMBs) are detected on gradient-echo T2*-weighted magnetic resonance imaging (MRI). Clinically, CMBs are often detected after stroke, including in cases of intracerebral hemorrhage and ischemic cerebrovascular disease. Hemodialysis (HD) patients are widely known to have a high incidence of stroke, and HD patients without stroke history have been reported to have a high prevalence of CMBs. In this study, we investigated whether history of stroke affects the prevalence of CMBs in HD patients. Methods A cross-sectional study was performed in 241 HD patients who underwent brain T2*-weighted MRI. We compared the prevalence of CMBs between the patients with and without a history of stroke. Moreover, the relationship between history of stroke and presence of CMBs was examined by multivariate logistic regression analysis. Results Among these patients, 22 (9.1%) had a history of stroke. CMBs were detected in 70 patients (29.0%). The prevalence of CMBs was significantly higher in patients with a history of stroke compared to those without this history (54.5 vs. 26.5%, p = 0.012). In the multivariable analysis adjusted for background characteristics, history of stroke was a significant and independent factor related to CMBs (OR: 3.24, 95%CI: 1.18–8.89, p = 0.02). Discussion/conclusions As has been reported for non-dialysis patients, our results showed a high prevalence of CMBs in HD patients with a history of stroke, and indicated that a history of stroke is significantly and independently associated with CMBs in HD patients.

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A STUDY ON MRI-FISTULOGRAM EVALUATION OF PERIANAL DISCHARGE IN AN INDIAN POPULATION

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2018.v11i5.24655 ◽

2018 ◽

Vol 11 (5) ◽

pp. 284

Author(s):

Santosh Kumar Panda ◽

Madhuri Panigrahi

Keyword(s):

Previous History ◽

University Hospital ◽

Fistula Tract ◽

Perianal Fistulas ◽

Number Of Patients ◽

Operative Evaluation ◽

History Of ◽

Magnetic Resonance Imaging Mri ◽

Almost All ◽

Operative Assessment

Objective: Pre-operative assessment of perianal fistulas is very important for best planning of surgery and prevention of relapse. The goal of magnetic resonance imaging (MRI) of perianal discharge is to demonstrate accurately the anatomy of the perianal region. MRI can clearly show the relationship of fistulas to the anal sphincter complex, levator plate, and the ischiorectal/ischioanal fossa. The aim of the study was to find out the various types of fistula and compare MRI fistulogram with surgery findings.Methods: In the present study, 38 number of patients were included who were sent for pre-operative MRI evaluation of perianal discharge and their post-operative data were collected for analysis. Surgical grading was according to Park’s surgical classification. Fistulas were graded in MRI according to St James’s University Hospital MRI classification of perianal fistulas.Results: It was found from the study that most of the patients were adults (35/38), whereas one was a child and one was adolescent. Almost all were male (36/38) except two were female. Around 50% of patients had previous history of surgery and had come for persistent/recurrent lesion. According to MRI, all except one had true fistula, rest one had sinus, and one had ischioanal abscess. Percentage of Grade I, Grade II, Grade III, and Grade IV fistula were 31.58, 13.16, 15.79, and 34.21, respectively. Percentage of intersphincteric (I and II) type was 44.74 (17 in no) and transsphincteric (III and IV) was 55.26 (21 in no.), and supra- and extra-sphincteric type was 0 in number. Most had internal anal canal opening posterior to transverse anal line, out of which most were around 6 o’clock position. MRI successfully described fistula tract in all except for two cases (36/38).Conclusion: MRI is very accurate in pre-operative evaluation and planning for surgery of perianal fistulas.

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Immunoglobulin G4-Related Paratesticular Fibrous Pseudotumor and Retroperitoneal Fibrosis: A Case Report

Urologia Internationalis ◽

10.1159/000362215 ◽

2014 ◽

Vol 94 (3) ◽

pp. 369-372 ◽

Cited By ~ 7

Author(s):

Ki Hwan Kim ◽

Deuk Jae Sung ◽

Na Yeon Han ◽

Beom Jin Park ◽

Min Ju Kim ◽

...

Keyword(s):

Retroperitoneal Fibrosis ◽

Past History ◽

Diffusion Weighted Mri ◽

Resonance Imaging ◽

Immunoglobulin G4 ◽

History Of ◽

Weighted Magnetic Resonance Imaging ◽

Magnetic Resonance Imaging Mri ◽

Paratesticular Mass

A 46-year-old man with a past history of retroperitoneal fibrosis was admitted with an enlarged, hard right testis. The paratesticular lesion showed heterogeneous hypoechogenicity on ultrasonography, low signal intensity on T1- and T2-weighted magnetic resonance imaging (MRI), and lack of diffusion restriction on diffusion-weighted MRI. Following steroid treatment, the paratesticular mass was decreased in size on follow-up computed tomography. The radiologic and clinical features are recognized as a manifestation of immunoglobulin G4-related sclerosing disease involving the paratesticular region and retroperitoneum.

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The pterional approach for the surgical resection of an orbital cholesteatoma: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-020-02579-3 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Parménides Guadarrama-Ortiz ◽

José Alberto Choreño-Parra ◽

Francisco Javier Pacheco-Sánchez ◽

Alberto Iván Rodríguez-Nava ◽

Gabriela García-Quintero ◽

...

Keyword(s):

Surgical Resection ◽

Benign Tumors ◽

Histopathological Analysis ◽

Safe Procedure ◽

Orbital Cavity ◽

Pterional Craniotomy ◽

Orbital Wall ◽

History Of ◽

Weighted Magnetic Resonance Imaging ◽

Magnetic Resonance Imaging Mri

Abstract Background Cholesteatomas are benign tumors mainly composed of cholesterol crystals that rarely arise within the orbit. However, orbital cholesteatomas require a complete surgical resection due to their recidivating potential. Transcranial approaches offering a broad surgical exposure of the orbital cavity have been scarcely used for the management of these tumors. Here, we provide evidence of the benefits of the pterional craniotomy for the surgical resection of orbital tumors by sharing our experience in the surgical management of a cholesteatoma of the superotemporal orbital wall. Case presentation A 45-year-old Hispanic man with a 2-year history of progressive proptosis of the left eye attended to our center complaining of diplopia and migraine. At his arrival, physical examination revealed ptosis, palpebral edema, and exophthalmos of the left eye, as well as the abolishment of the ipsilateral photomotor and consensual responses. Fundoscopy showed mild optic atrophy, whereas a T2-weighted magnetic resonance imaging (MRI) of the head showed a hyperintense mass arising at the superotemporal wall of the orbit that was displacing the eyeball. The tumor was resected using a pterional craniotomy without postoperative complications. The histopathological analysis of the tumor revealed a cholesteatoma. The patient recovered the functionality of the left eye with no visual sensitive deficits nor tumor recurrence 1 year after the surgery. Conclusions Our results support the use of the pterional craniotomy as a safe procedure for the surgical resection of cholesteatomas arising at the superotemporal walls of the orbit, with low postoperative morbidity.

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Treatment of varicose tributaries with sclerotherapy with polidocanol 0.5 % foam

VASA ◽

10.1024/0301-1526/a000023 ◽

2010 ◽

Vol 39 (2) ◽

pp. 169-174 ◽

Cited By ~ 7

Author(s):

Reich-Schupke ◽

Weyer ◽

Altmeyer ◽

Stücker

Keyword(s):

Scientific Evidence ◽

Daily Practice ◽

Severe Adverse Effect ◽

Safe Procedure ◽

Efficacy And Safety ◽

Foam Sclerotherapy ◽

History Of ◽

One Year ◽

Additional Therapy

Background: Although foam sclerotherapy of varicose tributaries is common in daily practice, scientific evidence for the optimal sclerosant-concentration and session-frequency is still low. This study aimed to increase the knowledge on foam sclerotherapy of varicose tributaries and to evaluate the efficacy and safety of foam sclerotherapy with 0.5 % polidocanol in tributaries with 3-6 mm in diameter. Patients and methods: Analysis of 110 legs in 76 patients. Injections were given every second or third day. A maximum of 1 injection / leg and a volume of 2ml / injection were administered per session. Controls were performed approximately 6 months and 12 months after the start of therapy. Results: 110 legs (CEAP C2-C4) were followed up for a period of 14.2 ± 4.2 months. Reflux was eliminated after 3.4 ± 2.7 injections per leg. Insufficient tributaries were detected in 23.2 % after 6.2 ± 0.9 months and in 48.2 % after 14.2 ± 4.2 months, respectively. Only 30.9 % (34 / 110) of the legs required additional therapy. In 6.4 % vein surgery was performed, in 24.5 % similar sclerotherapy was repeated. Significantly fewer sclerotherapy-sessions were required compared to the initial treatment (mean: 2.3 ± 1.4, p = 0.0054). During the whole study period thrombophlebitis (8.2 %), hyperpigmentation (14.5 %), induration in the treated region (9.1 %), pain in the treated leg (7.3 %) and migraine (0.9 %) occurred. One patient with a history of thrombosis developed thrombosis of a muscle vein (0.9 %). After one year there were just hyperpigmentation (8.2 %) and induration (1.8 %) left. No severe adverse effect occurred. Conclusions: Foam sclerotherapy with injections of 0.5 % polidocanol every 2nd or 3rd day, is a safe procedure for varicose tributaries. The evaluation of efficacy is difficult, as it can hardly be said whether the detected tributaries in the controls are recurrent veins or have recently developed in the follow-up period. The low number of retreated legs indicates a high efficacy and satisfaction of the patients.

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Magnetic Resonance Imaging of Pseudo-impingement of Rotator Cuff with Strength Training

10.25259/ijmsr_21_2019 ◽

2019 ◽

Vol 1 ◽

pp. 2-6

Author(s):

Asad Naqvi ◽

Timothy Ariyanayagam ◽

Mir Akber Ali ◽

Akhila Rachakonda ◽

Hema N. Choudur

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Rotator Cuff ◽

Strength Training ◽

Radiology Department ◽

Resonance Imaging ◽

Subacromial Space ◽

History Of ◽

Magnetic Resonance Imaging Mri ◽

Training Exercises

Objective: The objective of this study was to outline a novel unique concept of secondary impingement of the muscles, myotendons, and tendons of the rotator cuff from hypertrophy as a result of strength training exercises. Methods: In this retrospective observational study, 58 patients were referred for an magnetic resonance imaging (MRI) by the orthopedic surgeon to the radiology department over a period of 1½ years. All patients gave a history of strength training exercises and presented with clinical features of rotator cuff impingement. Results: We identified features of hypertrophy of rotator cuff muscles, myotendons, and tendons in 12 of these 58 patients. This was the only abnormality on MRI. The hypertrophy of rotator cuff muscles and tendon bulk completely filling the subacromial space to the point of overfilling and resulting in secondary compressive features. Conclusion: Rotator cuff impingement is a common phenomenon that can occur with various inlet and outlet pathological conditions. However, rotator cuff impingement may also result from muscle and tendon hypertrophy from strength training regimens. Hypertrophy of the rotator cuff can result in overfilling of the subacromial space, leading to secondary impingement, which we have termed as “pseudo-impingement.”

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Computed Tomography and Magnetic Resonance Imaging-aided Diagnosis of Primary Essential Cutis Verticis Gyrata: A Case Report with 5-year Follow-up and Review of the Literature

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405614666181005113448 ◽

2019 ◽

Vol 15 (9) ◽

pp. 906-910

Author(s):

Hongzhang Zhu ◽

Shi-Ting Feng ◽

Xingqi Zhang ◽

Zunfu Ke ◽

Ruixi Zeng ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Three Dimensional ◽

Stable Condition ◽

Resonance Imaging ◽

Mri Findings ◽

Cutis Verticis Gyrata ◽

Essential Form ◽

History Of ◽

Magnetic Resonance Imaging Mri

Background: Cutis Verticis Gyrata (CVG) is a rare skin disease caused by overgrowth of the scalp, presenting as cerebriform folds and wrinkles. CVG can be classified into two forms: primary (essential and non-essential) and secondary. The primary non-essential form is often associated with neurological and ophthalmological abnormalities, while the primary essential form occurs without associated comorbidities. Discussion: We report on a rare case of primary essential CVG with a 4-year history of normal-colored scalp skin mass in the parietal-occipital region without symptom in a 34-year-old male patient, retrospectively summarizing his pathological and Computer Tomography (CT) and magnetic resonance imaging (MRI) findings. The major clinical observations on the CT and MR sectional images include a thickened dermis and excessive growth of the scalp, forming the characteristic scalp folds. With the help of CT and MRI Three-dimensional (3D) reconstruction techniques, the characteristic skin changes could be displayed intuitively, providing more evidence for a diagnosis of CVG. At the 5-year followup, there were no obvious changes in the lesion. Conclusion: Based on our observations, we propose that not all patients with primary essential CVG need surgical intervention, and continuous clinical observation should be an appropriate therapy for those in stable condition.

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Gas-filled urachal abscess with a pinging sound in a heifer calf

Veterinární Medicína ◽

10.17221/61/2019-vetmed ◽

2019 ◽

Vol 64 (No. 8) ◽

pp. 362-366 ◽

Cited By ~ 1

Author(s):

R Sato ◽

K Yamada ◽

Y Shinozuka ◽

H Ochiai ◽

K Onda

Keyword(s):

Fistulous Tract ◽

Failure To Thrive ◽

Abdominal Distension ◽

Intravenous Urography ◽

University Hospital ◽

Growth Depression ◽

Poor Growth ◽

History Of ◽

Heifer Calf ◽

Urachal Abscess

A 6-month-old crossbred of a Holstein and Japanese Black heifer calf weighing 95 kg presented with a history of intermittent abdominal distension and failure to thrive. The physical examination identified a pinging sound over the dorsal left flank. The abdominal radiography showed a huge gas-filled mass. The intravenous urography revealed no communication between the mass and the urinary bladder. Although the visual examination and palpation of the umbilicus did not reveal visible abnormalities, an umbilical disease was suspected because the animal exhibited poor growth, depression, and a hunched back posture. When the eschar adhering to the centre of the umbilicus was removed, the presence of a fistulous tract was revealed. The umbilical ultrasound examination revealed an intra-abdominal abscess and the fistulography demonstrated that the abscess communicated with the umbilicus. The abscess, compressing into the rumen, was observed by computed tomography. From these images, it was diagnosed as an umbilical cord remnant abscess and a definitive diagnosis of a urachal abscess was obtained by open abdominal surgery and the subsequent removal of the mass. The calf was discharged from the university hospital on day 14 after the operation. This case shows that a urachal abscess should be considered when a pinging sound is present, even if the animal exhibits no swelling or pain of the umbilicus.

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