Canine developmental elbow disease part 2: surgical and non-surgical management

2021 ◽  
Vol 12 (3) ◽  
pp. 124-130
Author(s):  
Rosanne Fernee-Hall ◽  
Jan Janovec
Keyword(s):  
Elbow Joint ◽  
Joint Instability ◽  
Treatment Plan ◽  
Joint Damage ◽  
Joint Surfaces ◽  
Ulna Osteotomy ◽  
Cartilage Injuries ◽  
Underlying Causes ◽  
Surgical Options

Developmental elbow disease is the term encompassing several abnormalities of the elbow joint, including fragmented medial coronoid process (FCP), osteochondrosis of the humerus (OC), ununited anconeal process (UAP), cartilage injuries and incongruity of the elbow joint. These disorders are associated with varying degrees of joint instability, inflammation, and loose fragments within the joint, which result in lameness and osteoarthrosis. Treatment should ideally involve correcting the underlying causes of the disease before significant joint damage has occurred. There are many surgical options for the treatment of developmental elbow disease which aim to unload the medial compartment, replace joint surfaces and manage pain. These include the sliding humeral osteotomy, proximal abducting ulna osteotomy, joint resurfacing and joint replacement. Studies evaluating the different treatments have low case numbers, variable outcome parameters, inconsistent diagnostic criteria and short follow-up times. Non-surgical manangement should always be part of the treatment plan to manage pain and symptoms as virtually all dogs with elbow disease will go on to develop osteoathritis.

Evidence-Based Recommendations for Cancer Fatigue, Anorexia, Depression, and Dyspnea

2008 ◽  
Vol 26 (23) ◽  
pp. 3886-3895 ◽  
Author(s):  
Sydney M. Dy ◽  
Karl A. Lorenz ◽  
Arash Naeim ◽  
Homayoon Sanati ◽  
Anne Walling ◽  
...  
Keyword(s):  
Advanced Cancer ◽  
Treatment Effectiveness ◽  
Treatment Plan ◽  
Evidence Based ◽  
Initial Visit ◽  
Patients With Cancer ◽  
Associated Symptoms ◽  
Hastened Death ◽  
Underlying Causes

Purpose The experience of patients with cancer often involves symptoms of fatigue, anorexia, depression, and dyspnea. Methods We developed a set of standards through an iterative process of structured literature review and development and refinement of topic areas and standards and subjected recommendations to rating by a multidisciplinary expert panel. Results For fatigue, providers should screen patients at the initial visit, for newly identified advanced cancer, and at chemotherapy visits; assess for depression and insomnia in newly identified fatigue; and follow up after treatment for fatigue or a secondary cause. For anorexia, providers should screen at the initial visit for cancer affecting the oropharynx or gastrointestinal tract or advanced cancer, evaluate for associated symptoms, treat underlying causes, provide nutritional counseling for patients undergoing treatment that may affect nutritional intake, and follow up patients given appetite stimulants. For depression, providers should screen newly diagnosed patients, those started on chemotherapy or radiotherapy, those with newly identified advanced disease, and those expressing a desire for hastened death; document a treatment plan in diagnosed patients; and follow up response after treatment. For general dyspnea, providers should evaluate for causes of new or worsening dyspnea, treat or symptomatically manage underlying causes, follow up to evaluate treatment effectiveness, and offer opioids in advanced cancer when other treatments are unsuccessful. For dyspnea and malignant pleural effusions, providers should offer thoracentesis, follow up after thoracentesis, and offer pleurodesis or a drainage procedure for patients with reaccumulation and dyspnea. Conclusion These standards provide a framework for evidence-based screening, assessment, treatment, and follow-up for cancer-associated symptoms.

scholarly journals The Impact of Dental Implant Length on Failure Rates: A Systematic Review and Meta-Analysis

Materials ◽  
2021 ◽  
Vol 14 (14) ◽  
pp. 3972
Author(s):  
Maha Abdel-Halim ◽  
Dalia Issa ◽  
Bruno Ramos Chrcanovic
Keyword(s):  
Treatment Plan ◽  
Meta Analysis ◽  
Implant Failure ◽  
Failure Rates ◽  
Manual Search ◽  
Short Implants ◽  
The Many ◽  
The Impact ◽  
Implant Length

The present review aimed to evaluate the impact of implant length on failure rates between short (<10 mm) and long (≥10 mm) dental implants. An electronic search was undertaken in three databases, as well as a manual search of journals. Implant failure was the outcome evaluated. Meta-analysis was performed in addition to a meta-regression in order to verify how the risk ratio (RR) was associated with the follow-up time. The review included 353 publications. Altogether, there were 25,490 short and 159,435 long implants. Pairwise meta-analysis showed that short implants had a higher failure risk than long implants (RR 2.437, p < 0.001). There was a decrease in the probability of implant failure with longer implants when implants of different length groups were compared. A sensitivity analysis, which plotted together only studies with follow-up times of 7 years or less, resulted in an estimated increase of 0.6 in RR for every additional month of follow-up. In conclusion, short implants showed a 2.5 times higher risk of failure than long implants. Implant failure is multifactorial, and the implant length is only one of the many factors contributing to the loss of an implant. A good treatment plan and the patient’s general health should be taken into account when planning for an implant treatment.

scholarly journals Utility of diffusion tensor imaging studies linked to neuronavigation and other modalities in repeat hemispherotomy for intractable epilepsy

2016 ◽  
Vol 17 (4) ◽  
pp. 483-490 ◽  
Author(s):  
Erin N. Kiehna ◽  
Elysa Widjaja ◽  
Stephanie Holowka ◽  
O. Carter Snead ◽  
James Drake ◽  
...  
Keyword(s):  
Diffusion Tensor Imaging ◽  
Diffusion Tensor ◽  
Intractable Epilepsy ◽  
Seizure Freedom ◽  
Rasmussen’S Encephalitis ◽  
Initial Procedure ◽  
Surgical Options ◽  
Failed Surgery ◽  
Association Fibers

OBJECT Hemispherectomy for unilateral, medically refractory epilepsy is associated with excellent long-term seizure control. However, for patients with recurrent seizures following disconnection, workup and investigation can be challenging, and surgical options may be limited. Few studies have examined the role of repeat hemispherotomy in these patients. The authors hypothesized that residual fiber connections between the hemispheres could be the underlying cause of recurrent epilepsy in these patients. Diffusion tensor imaging (DTI) was used to test this hypothesis, and to target residual connections at reoperation using neuronavigation. METHODS The authors identified 8 patients with recurrent seizures following hemispherectomy who underwent surgery between 1995 and 2012. Prolonged video electroencephalography recordings documented persistent seizures arising from the affected hemisphere. In all patients, DTI demonstrated residual white matter association fibers connecting the hemispheres. A repeat craniotomy and neuronavigation-guided targeted disconnection of these residual fibers was performed. Engel class was used to determine outcome after surgery at a minimum of 2 years of follow-up. RESULTS Two patients underwent initial hemidecortication and 6 had periinsular hemispherotomy as their first procedures at a median age of 9.7 months. Initial pathologies included hemimegalencephaly (n = 4), multilobar cortical dysplasia (n = 3), and Rasmussen's encephalitis (n = 1). The mean duration of seizure freedom for the group after the initial procedure was 32.5 months (range 6–77 months). In all patients, DTI showed limited but definite residual connections between the 2 hemispheres, primarily across the rostrum/genu of the corpus callosum. The median age at reoperation was 6.8 years (range 1.3–14 years). The average time taken for reoperation was 3 hours (range 1.8–4.3 hours), with a mean blood loss of 150 ml (range 50–250 ml). One patient required a blood transfusion. Five patients are seizure free, and the remaining 3 patients are Engel Class II, with a minimum follow-up of 24 months for the group. CONCLUSIONS Repeat hemispherotomy is an option for consideration in patients with recurrent intractable epilepsy following failed surgery for catastrophic epilepsy. In conjunction with other modalities to establish seizure onset zones, advanced MRI and DTI sequences may be of value in identifying patients with residual connectivity between the affected and unaffected hemispheres. Targeted disconnection of these residual areas of connectivity using neuronavigation may result in improved seizure outcomes, with minimal and acceptable morbidity.

scholarly journals Penile Mondor’s in a Covid-19 patient on prophylactic anti-thrombosis with rivaroxaban: a case report

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Murat Tuğrul Eren ◽  
Hakan Özveri ◽  
Hilal Kurtoğlu
Keyword(s):  
Male Patient ◽  
Antibody Test ◽  
Inflammatory Cells ◽  
Thromboembolism Prophylaxis ◽  
Case Presentation ◽  
Subacute Phase ◽  
Dorsal Vein ◽  
Wide Range ◽  
Underlying Causes

Abstract Background Penile Mondor’s disease (PMD) is thrombophlebitis of the superficial dorsal vein of the penis. Following the occurrence of thrombotic events in the affected veins, the lumen often becomes occluded with fibrin and inflammatory cells. A hyper-coagulative state is one of the underlying causes although most cases of PMD are idiopathic. Coronavirus disease-2019 infection (COVID-19) is associated with frequent thrombotic events. Inflammation and thrombosis play a central role in the course and outcome of COVID-19, which can predispose to both venous and arterial thromboembolism. In this report, we present a 33-year-old male patient diagnosed with PMD during the subacute phase of COVID-19 infection while on prophylactic antithrombotic treatment. Case Presentation A 33-year-old male patient was diagnosed as PMD which occurred during the subacute phase of COVID-19 infection, while he was on active treatment of COVID-19 by prophylactic antithrombotic Rivaroxaban 15 mg therapy and curative antiviral medication. There was no recent sexual intercourse or trauma to the genitals. His PCR test for COVID-19 had become negative, and antibody test was positive at the time of his PMD’s onset. Rivaroxaban was replaced by Enoxaparin (8000 IU/0.8 ml.), a low molecular weight heparin administered subcutaneously and twice daily. On the third day of this medication, all coagulative measurements returned to normal. PMD disappeared in the second week. Conclusion Low-dose Rivaroxaban 15 mg is not safe for some COVID-19-associated thromboembolism prophylaxis, and careful follow-up is critical due to the possibility of a wide range of pathologic thrombotic manifestations in COVID-19 infection.

Willingness to Travel for Cellular Therapy: The Influence of Follow-Up Care Location, Oncologist Continuity, and Race

2021 ◽  
pp. OP.21.00312
Author(s):  
Zachary A. K. Frosch ◽  
Esin C. Namoglu ◽  
Nandita Mitra ◽  
Daniel J. Landsburg ◽  
Sunita D. Nasta ◽  
...  
Keyword(s):  
Travel Time ◽  
Cellular Therapy ◽  
Treatment Plan ◽  
Admission Rate ◽  
B Cell Lymphoma ◽  
Travel Times ◽  
Importance Weights ◽  
Follow Up Care ◽  
Treatment Plans

PURPOSE Patients weigh competing priorities when deciding whether to travel to a cellular therapy center for treatment. We conducted a choice-based conjoint analysis to determine the relative value they place on clinical factors, oncologist continuity, and travel time under different post-treatment follow-up arrangements. We also evaluated for differences in preferences by sociodemographic factors. METHODS We administered a survey in which patients with diffuse large B-cell lymphoma selected treatment plans between pairs of hypothetical options that varied in travel time, follow-up arrangement, oncologist continuity, 2-year overall survival, and intensive care unit admission rate. We determined importance weights (which represent attributes' value to participants) using generalized estimating equations. RESULTS Three hundred and two patients (62%) responded. When all follow-up care was at the center providing treatment, plans requiring longer travel times were less attractive ( v 30 minutes, importance weights [95% CI] of –0.54 [–0.80 to –0.27], –0.57 [–0.84 to –0.29], and –0.17 [–0.49 to 0.14] for 60, 90, and 120 minutes). However, the negative impact of travel on treatment plan choice was mitigated by offering shared follow-up (importance weights [95% CI] of 0.63 [0.33 to 0.93], 0.32 [0.08 to 0.57], and 0.26 [0.04 to 0.47] at 60, 90, and 120 minutes). Black participants were less likely to choose plans requiring longer travel, regardless of follow-up arrangement, as indicated by lower value importance weights for longer travel times. CONCLUSION Reducing travel burden through shared follow-up may increase patients' willingness to travel to receive cellular therapies, but additional measures are required to facilitate equitable access.

scholarly journals Phenytoin-Induced Gingival Overgrowth Management with Periodontal Treatment

2015 ◽  
Vol 26 (1) ◽  
pp. 39-43 ◽  
Author(s):  
Bruno César de Vasconcelos Gurgel ◽  
Carlos Roberto Batista de Morais ◽  
Pedro Carlos da Rocha-Neto ◽  
Euler Maciel Dantas ◽  
Leão Pereira Pinto ◽  
...  
Keyword(s):  
Oral Hygiene ◽  
Dental Treatment ◽  
Treatment Plan ◽  
Pocket Depth ◽  
Gingival Overgrowth ◽  
Probing Pocket Depth ◽  
Supportive Periodontal Therapy ◽  
Continuous Use ◽  
Oral Hygiene Instruction

Phenytoin-induced gingival overgrowth (PIGO) is a common complication of the continuous use of medications. This paper presents a case of PIGO hindering oral function and compromising oral hygiene and aesthetics, which was treated with a combination of nonsurgical and surgical periodontal therapies. A 39-year-old male patient was referred for dental treatment with several complaints, especially upper and lower gingival overgrowth that hindered speech and swallowing. Generalized deep probing pockets and bone loss were detected. Diagnosis of gingival overgrowth associated with phenytoin and chronic periodontitis was established. The treatment plan consisted of conservative therapy with education on oral health, motivation and meticulous oral hygiene instruction in combination with scaling and root planing. During the revaluation period, a marked reduction in the clinical parameters was noted, particularly probing pocket depth reduction. Surgical therapy for removal of gingival overgrowth was also performed to achieve pocket reduction. Supportive periodontal therapy was proposed and the patient is currently under follow-up for 4 years. Management of PIGO may be obtained by the use of periodontal procedures combined with good oral hygiene and periodontal supportive care.

Endogenous Clotting Factor Activity and Long-term Outcome in Patients with Moderate Haemophilia

2000 ◽  
Vol 84 (12) ◽  
pp. 977-980 ◽  
Author(s):  
J. G. van der Bom ◽  
E. P. Mauser-Bunschoten ◽  
G. Roosendaal ◽  
F. J. A. Beek ◽  
P. de Kleijn ◽  
...  
Keyword(s):  
Prophylactic Treatment ◽  
Joint Damage ◽  
Clotting Factor ◽  
Factor Activity ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Percent Increase ◽  
Radiological Score

SummaryIn order to address the question of the optimum target level for prophylactic treatment of severe haemophilia patients, the association between endogenous clotting factor activity and outcome was studied in a cohort of 46 patients with moderate haemophilia. Data on treatment and outcome were collected annually.Median follow-up was 8.0 years (range 1-26). Median joint bleed frequency was 1 per year and median radiological score according to Pettersson was 1 point (max. 78) at the age of 25 years. One percent increase in clotting factor level was associated with a 4 months later onset of joint bleeds (95% Confidence Interval (CI): 2-6 months) and a 16% lower Pettersson score (95% CI: 3-27%). No statistically significant effect of clotting factor activity on joint bleed frequency could be demonstrated.These findings confirm that patients with moderate haemophilia experience only mild arthropathy, and provide evidence for a protective effect of higher clotting factor levels on joint damage.

scholarly journals Quadriceps reconstruction with suture anchor and Achilles allograft combination in quadriceps tendon re-rupture after primary surgical repair: A novel technique

2021 ◽  
Author(s):  
Erhan Okay ◽  
Mehmet Cenk Turgut ◽  
Abbas Tokyay
Keyword(s):  
Suture Anchor ◽  
Surgical Repair ◽  
Primary Repair ◽  
Full Range ◽  
Knee Extensor ◽  
Quadriceps Tendon ◽  
Extensor Mechanism ◽  
Surgical Options ◽  
Knee Extensor Mechanism

Quadriceps ruptures are one of the pathological conditions of the knee extensor mechanism, accounting for 3% of all tendon injuries. These injuries cause substantial disability of the extensor mechanism. Primary repair is the treatment of choice in acute presentation. In the setting of chronic conditions, the treatment becomes more challenging. Available surgical options include lengthening procedures, and reconstruction with auto graft or allografts. The traditional Scuderi and Codivilla techniques are challenging to perform in degenerative or traumatic retracted ruptures. There is no standard effective treatment in these patients, which yields the best clinical and biomechanical outcomes. An 18 - year-old male patient with quadriceps re-rupture after a primary repair was managed with allograft reconstruction using suture anchors. At six years of follow-up, the patient gained a full range of motion with excellent clinical outcomes. He returned to his previous work. In conclusion, quadriceps reconstruction using suture anchor and Achilles allograft combination is a feasible technique in neglected cases who present with quadriceps tendon re-rupture after primary surgical repair.

scholarly journals The Evaluation of the Children with Renal Transplant: Single Centre Experience

2020 ◽  
pp. 90-93
Author(s):  
Muhammed Mustafa Özdemir ◽  
Ayşe Seda Pınarbaşı ◽  
Neslihan Günay ◽  
Aynur Gencer-Balaban ◽  
Sibel Yel ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Chronic Kidney Disease Stage ◽  
Clinic Visit ◽  
Disease Stage ◽  
Single Centre Experience ◽  
Ckd Stage ◽  
Underlying Causes ◽  
Stage 1 ◽  
Nephrotic Range Proteinuria

Objective: This study aimed to evaluate patients with renal transplantation in terms of clinical and laboratory parameters. Material and Methods: This study was performed retrospectively with records of 48 patients who underwent renal transplantation before 18 years of age, between June 2008 and July 2019. Results: Congenital malformations of the urinary tract were the most common underlying causes of chronic kidney disease stage 5. Surgical complications occurred in 33.4% of the patients and BK viremia was the most common opportunistic viral infection during the follow-up. At the last clinic visit, 57.4% of our patients had CKD stage 1, hypertension and nephrotic range proteinuria were seen in eight and two patients, respectively. Conclusion: Although renal transplantation is the most ideal renal replacement therapy, patients may experience various complications during the follow-up. Therefore, they should be monitored regularly

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