scholarly journals Osteonecrosis of jaws related to intravenous bisphosphonates: the experience of a Jordanian teaching hospital

2010 ◽  
Vol 92 (6) ◽  
pp. 489-494 ◽  
Author(s):  
Zaid H Baqain ◽  
Faleh A Sawair ◽  
Zaid Tamimi ◽  
Nazzal Bsoul ◽  
Ghazi Al Edwan ◽  
...  
Keyword(s):  
Significant Risk ◽  
Case Series ◽  
Oral Health Status ◽  
University Hospital ◽  
Original Position ◽  
Duration Of Treatment ◽  
Oncology Patients ◽  
Dosing Schedule ◽  
Oncology Unit

INTRODUCTION We describe our experience with oncology patients on a frequent dosing schedule of intravenous (i.v.) bisphosphonates at the Jordan University Hospital (JUH). PATIENTS AND METHODS Patients treated by i.v. bisphosphonates in the medical oncology unit at the JUH were examined for bisphosphonate-related osteonecrosis of the jaws (BRONJ). Diagnosis was made according to the guidelines of the American Association of Oral and Maxillofacial Surgeons (AAOMS) original position paper. RESULTS Of the 41 patients, four developed BRONJ, two in maxilla, one in mandible and one bimaxillary. Patients with BRONJ were older; mean age was 69.3 ±3.1 years compared to 62.8 ± 12.5 years (P = 0.022). Dental co-morbidities were more commonly present in patients with the disease (P = 0.038). Patients who developed BRONJ were on treatment for a longer duration of time; the mean duration of treatment was 23.5 ± 8.4 months compared to 11.9 ± 13.4 months (P = 0.10). CONCLUSIONS The results of this case series demonstrated that age and poor oral health status are significant risk factors of BRONJ for oncology patients on long-term frequent dosing schedule of i.v. bisphosphonates.

Spectrum of conjunctival tumours in a Spanish series: A review of 462 cases

2019 ◽  
Vol 30 (6) ◽  
pp. 1403-1409
Author(s):  
Luis García Onrubia ◽  
Gabriela Estefanía Pacheco-Callirgos ◽  
Alejandro Portero-Benito ◽  
Ciro García-Álvarez ◽  
Ester Carreño Salas ◽  
...  
Keyword(s):  
Precancerous Lesions ◽  
Case Series ◽  
University Hospital ◽  
Malignant Tumours ◽  
Benign Lesions ◽  
Routine Examination ◽  
Retrospective Case ◽  
Main Complaint ◽  
Oncology Unit ◽  
The University

Introduction: To report the spectrum and frequency of conjunctiva tumours in an ocular oncology unit analysing the clinical profile of benign, precancerous and malignant conjunctival lesions. Methods: A retrospective case series of 462 consecutive patients diagnosed at the Ocular Oncology Unit of the University Hospital of Valladolid from 1992 to 2017. Results: Among 462 consecutive patients, the tumour was classified as melanocytic in 252 (54.5%) and non-melanocytic in 210 (45.5). Two hundred forty-eight males (mean age 51.63 (SD = 23.20)) and 214 females (mean age 48.27 (SD = 21.77)) were included. Mean patient age at diagnosis was 50.07 years (range = 1-92 years). The majority of tumours were benign (n = 307 (66.5%)) followed by precancerous (n = 103 (22.3%)) and finally by malignant ones (n = 52 (11.3%)). Benign lesions were predominantly found in younger individuals rather than premalignant (p < 0.05) and malignant ones (p < 0.05). Most of the melanocytic lesions were benign (88.5%), most epithelial ones were precancerous (61.4%) and most lymphoid lesions were malignant (56.3%). Tumours involving one or four quadrants of the ocular surface usually were benign, unlike tumours involving three quadrants that were malignant (16 (48.5%) p < 0.05). The majority of benign lesions were detected on females (n = 163 (53.1%)) by routine examination (n = 178 (86.4%)). However, main complaint in malignant tumours was the growth of the lesion (n = 39 (76.5%)). Conclusion: Most of the conjunctival tumours were melanocytic, mostly benign, closely followed by those of epithelial origin, with a predominance of precancerous lesions. Melanocytic, epithelial and lymphoid tumours accounted for over 90% of cases. A trend was identified with benign lesions being found in younger female patients on routine examination.

Bone-anchored hearing aids and chronic pain: a long-term complication and a cause for elective implant removal

2012 ◽  
Vol 126 (5) ◽  
pp. 445-449 ◽  
Author(s):  
D Siau ◽  
H Nik ◽  
J C Hobson ◽  
A J Roper ◽  
M P Rothera ◽  
...  
Keyword(s):  
Hearing Aids ◽  
Case Series ◽  
Implant Removal ◽  
University Hospital ◽  
Royal Infirmary ◽  
Legal Implications ◽  
Adults And Children ◽  
Bone Anchored Hearing Aid ◽  
Site Pain

AbstractObjectives:To report a case series of elective removal of bone-anchored hearing aid implants, and reasons for removal.Design:Retrospective review of a prospectively collected database.Setting:Two tertiary referral centres in the Manchester area: Manchester Royal Infirmary and Salford Royal University Hospital.Participants:A series of 499 adults and children who had undergone a total of 602 implant insertions (1984–2008).Main outcome measures:Implant removal rates, and reasons.Results:Twenty-seven of the 602 implants (4.5 per cent) required removal. Of these, 12 were due to pain (2.0 per cent), seven to persistent infection (1.2 per cent), three to failure of osseointegration (0.5 per cent), three to trauma (0.5 per cent) and two to other reasons (0.4 per cent).Conclusion:Chronic implant site pain represents the main reason why implants are removed electively, and affects 2 per cent of all implants. This complication has important medico-legal implications and should be discussed when obtaining informed consent for implantation.

scholarly journals An Assessment of Globe Position Dynamics following Transcranial Lateral and Superior Orbital Wall Resections without Rigid Reconstruction: A Case Series of 55 Patients

2019 ◽  
Vol 81 (03) ◽  
pp. 244-250
Author(s):  
Randall G. Krug ◽  
Elizabeth A. Bradley ◽  
Jamie J. Van Gompel
Keyword(s):  
Skull Base ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Significant Risk ◽  
Case Series ◽  
Time Points ◽  
Orbital Wall ◽  
Skull Base Approach ◽  
Over Time

Background There is no consensus exists regarding which reconstructive approach, if any, should be used after performing transcranial lateral orbital wall resections. Rigid reconstruction is often done to prevent enophthalmos; however, it is not clear if this is a risk with extensive orbital wall resections for transcranial surgery. Objective To assess globe position dynamics in patients that underwent transcranial lateral and superior orbital wall resections without rigid reconstruction to determine if enophthalmos is a significant risk. Methods Preoperative (PO) and postoperative data were retrospectively collected from the electronic medical records of 55 adult patients undergoing lateral and superior orbital wall resections as part of a skull base approach. The globe positions were assessed radiologically at all available time points and used to track relative globe displacements over time. Results An evaluation of PO variables identified a relationship between maximum lesion diameters and globe positions dynamics. The composition of globe position presentations in the population remained relatively stable over time, with only 1 out of 55 patients (1.81%) developing postoperative enophthalmos. An assessment of mean globe displacements revealed improvements in the patients presenting with PO exophthalmos, and stability in the patients presenting with normal PO globe positions. Conclusions Excellent results in long-term postoperative globe position dynamics can be achieved without the use of rigid reconstruction after transcranial lateral and superior orbital wall resections, regardless of the PO globe positioning.

The Failure Risk of Surgical Therapy for Corneal Perforations Using Cryopreserved Donor Corneas

2020 ◽  
Author(s):  
Miki Hata Mizuno ◽  
Yuichi Uchino ◽  
Shigeto Shimmura ◽  
Kazuo Tsubota
Keyword(s):  
Penetrating Keratoplasty ◽  
Corneal Ulcer ◽  
Case Series ◽  
University Hospital ◽  
Long Term Results ◽  
Lamellar Keratoplasty ◽  
Corneal Perforation ◽  
Consecutive Case ◽  
Donor Corneas

Abstract Background To evaluate the long-term results of therapeutic keratoplasty for a consecutive case series of corneal perforation.Methods The cases comprised 41 eyes (41 patients) that underwent therapeutic keratoplasty using cryopreserved donor grafts at the Keio University Hospital between January 2012 and December 2016. The eyes were evaluated regarding the cause of corneal perforation, surgical procedure, size of the perforation, presence of anterior chamber collapse, visual prognosis, and complications.Results The major causative diseases included herpetic keratitis (n = 11), bacterial and fungal corneal ulcer (n = 4), Mooren’s ulcer (n = 5), severe dry eye (n = 4), and neuroparalytic keratitis (n = 4). Penetrating keratoplasty was performed in 28 eyes (68.2%), lamellar keratoplasty in 8 eyes (19.5%), and keratoepithelioplasty in 5 eyes (12.2%).

scholarly journals Complex Elbow Dislocations and the “Terrible Triad” Injury

2017 ◽  
Vol 11 (1) ◽  
pp. 1394-1404 ◽  
Author(s):  
Alistair D.R. Jones ◽  
Robert W. Jordan
Keyword(s):  
Radial Head ◽  
Radial Head Fracture ◽  
Significant Risk ◽  
Case Series ◽  
Anterior Dislocation ◽  
Current Evidence ◽  
Rotational Instability ◽  
Terrible Triad ◽  
Radial Head Fractures

Background:The elbow is the second most commonly dislocated joint in adults and up to 20% of dislocations are associated with a fracture. These injuries can be categorised into groups according to their mechanism and the structures injured.Methods:This review includes a literature search of the current evidence and personal experiences of the authors in managing these injuries.Results:All injuries are initially managed with closed reduction of the ulno-humeral joint and splinting before clinical examination and radiological evaluation. Dislocations with radial head fractures should be treated by restoring stability, with treatment choice depending on the type and size of radial head fracture. Terrible triad injuries necessitate operative treatment in almost all cases. Traditionally the LCL, MCL, coronoid and radial head were reconstructed, but there is recent evidence to support repairing of the coronoid and MCL only if the elbow is unstable after reconstruction of lateral structures. Surgical treatment of terrible triad injuries carries a high risk of complications with an average reoperation rate of 22%. Varus posteromedial rotational instability fracture-dislocations have only recently been described as having the potential to cause severe long-term problems. Cadaveric studies have reinforced the need to obtain post-reduction CT scans as the size of the coronoid fragment influences the long-term stability of the elbow. Anterior dislocation with olecranon fracture has the same treatment aims as other complex dislocations with the added need to restore the extensor mechanism.Conclusion:Complex elbow dislocations are injuries with significant risk of long-term disability. There are several case-series in the literature but few studies with sufficient patient numbers to provide evidence over level IV.

Validation and nephrotoxicity of a simplified once-daily aminoglycoside dosing schedule and guidelines for monitoring therapy.

1996 ◽  
Vol 40 (11) ◽  
pp. 2494-2499 ◽  
Author(s):  
J M Prins ◽  
G J Weverling ◽  
K de Blok ◽  
R J van Ketel ◽  
P Speelman
Keyword(s):  
Renal Function ◽  
Creatinine Clearance ◽  
Significant Risk ◽  
High Dose ◽  
Duration Of Treatment ◽  
Dosing Schedule ◽  
Once Daily ◽  
Monitoring Therapy ◽  
Daily Dose ◽  
Trough Levels

There is no established dosing schedule for once-daily aminoglycoside dosing regimens, and accepted guidelines for monitoring therapy are lacking. We derived a simplified schedule from the Hull and Sarubbi (J. H. Hull and F. A. Sarubbi, Ann. Intern. Med. 85:183-189, 1976) nomogram, for which efficacy and safety in a once-daily dosing regimen were previously demonstrated, and prospectively followed serum aminoglycoside levels in patients. The standard treatment was gentamicin or tobramycin at 4 mg/kg of body weight given intravenously once daily. When the renal function was decreased, the daily dose was reduced, as follows: for an estimated creatinine clearance of between 50 and 80 ml/min, the daily dose was 3.25 mg/kg, for an estimated creatinine clearance of between 30 and 50 ml/min, the daily dose was 2.5 mg/kg, and for an estimated creatinine clearance of below 30 ml/min, the daily dose was 2 mg/kg. A total of 221 patients were studied (184 received gentamicin and 37 received tobramycin). First trough levels above 2 mg/liter were recorded in 11% of the patients, and they all had a baseline creatinine clearance below 50 ml/min, or a substantial decrease in clearance between enrollment and the day that the trough level was obtained. A peak level below 6 mg/liter was recorded in 6% of the patients, and half of them received the lowest daily dose. Twenty-five of the 179 evaluable patients (14%; 95% confidence interval, 9 to 19%) fulfilled the criteria for nephrotoxicity. In a multiple regression analysis, the duration of treatment and the use of other nephrotoxic antibiotics or high-dose furosemide, but not trough levels, were significant risk factors. Since the meaning of low peak levels is unclear and since most studies with multiple daily regimens confirm the lack of an association between trough levels and toxicity, we believe that monitoring of serum drug levels can be restricted to monitoring of trough levels in patients with a creatinine clearance below 50 ml/min or with a deteriorating renal function.

scholarly journals Chronic maxillary sinusitis of dental origin and oroantral fistula: The results of combined surgical approach in an Italian university hospital

2020 ◽  
Author(s):  
Massimo Galli ◽  
Giulia De Soccio ◽  
Fabrizio Cialente ◽  
Francesca Candelori ◽  
Francesca Romana Federici ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Maxillary Sinusitis ◽  
Combined Treatment ◽  
Case Series ◽  
University Hospital ◽  
Sinus Surgery ◽  
Oroantral Fistula ◽  
Dental Origin ◽  
Chronic Maxillary Sinusitis

Unilateral chronic maxillary sinusitis is a possible complication of odontogenic disease or dental treatment and is mainly due to the development of an oroantral fistula (OAF). The management of chronic maxillary sinusitis of dental origin requires a combined treatment via endoscopic sinus surgery (ESS) and intraoral surgical treatment of the odontogenic source. The aim of this study is to present the results of our university hospital unit in the treatment and follow-up of a case series of 34 patients treated with combined surgical approach for chronic maxillary sinusitis of dental origin due to OAF. All patients were treated with ESS combined with an intraoral approach. No intraoperative or immediate postoperative complications were observed; nasal synechia was found in 3 patients (8.82%). The overall success rate after primary intervention was 94.12%; recurrence was observed in 2 cases (5.88%), both were suffering from diabetes mellitus and were tobacco smokers. Our results confirm that simultaneous surgery with a combination of an intraoral and endoscopic approach can be considered the best strategy for the long-term restoration of a normal sinonasal homeostasis in selected patients with chronic odontogenic sinusitis and OAF, guaranteeing an effective treatment with minimal complications in the short and long term.

scholarly journals Vagus Nerve Stimulation in Treatment-Resistant Depression: Long-term Clinical Outcomes

2021 ◽  
Author(s):  
Stella Rosson ◽  
Nicola Bresolin ◽  
Domenico d’Avella ◽  
Luca Denaro ◽  
Alessandro Landi ◽  
...  
Keyword(s):  
Vagus Nerve ◽  
Nerve Stimulation ◽  
Vagus Nerve Stimulation ◽  
Case Series ◽  
University Hospital ◽  
Psychiatric Disease ◽  
Treatment Resistant Depression ◽  
Treatment Resistant ◽  
Resistant Depression

I ntroduction Vagus nerve stimulation (VNS) is a neuromodulation technique approved for Treatment-Resistant Depression (TRD).Evidence regarding its long-term efficacy and safety is still scarce. Objectives To descriptively report a case series of 3 patients undergoing adjunctive VNS for TRD with an over 10-year follow-up. Methods We investigated outcomes of clinical interest in patients with ongoing VNS for at least 10 years after the device implantation. They had participated in a larger single-arm interventional study conducted at the University Hospital of Padua. They were diagnosed with chronic unipolar (1), recurrent unipolar (1), and bipolar (1) TRD. Results Our 3 cases had an average 14-year history of psychiatric disease before surgery. Afterward, all subjects achieved clinical remission within two years. 2 patients experienced relapses within the first 4 years of treatment (respectively, 1 and 2 episodes). The other case showed a recurrent trend of brief relapses every two years. Only 1 individual needed to be admitted to the psychiatric unit once. None of them committed suicidal attempts. Prescription of antidepressants remained almost unchanged after the first two years. 2 individuals improved and 1 maintained their working position. Common adverse events were voice alteration (3/3), neck pain (2/3), and cough (2/3). Conclusions Very few cases of 10-year VNS for TRD have been reported so far. For our subjects, VNS was most likely to have a major impact on the clinical course of the disease. This treatment can be a safe and effective adjunctive intervention in a subgroup of patients with TRD.

scholarly journals Long-Term Clinical Results and Management following Vitrectomy in Undetected Retinoblastoma Eyes

2020 ◽  
Vol 6 (4) ◽  
pp. 244-250
Author(s):  
Eva Biewald ◽  
Sabrina Schlüter ◽  
Nikolaos E. Bechrakis ◽  
Tobias Kiefer ◽  
Philipp Rating ◽  
...  
Keyword(s):  
Metastatic Disease ◽  
Case Series ◽  
Clinical Results ◽  
University Hospital ◽  
Age At Surgery ◽  
Coats Disease ◽  
Pars Plana ◽  
Preoperative Magnetic Resonance

Introduction: Given the rarity of retinoblastoma and the consequences of accidental vitrectomy in the event of misdiagnosis, reporting on clinical experience in this area is important. Objective: The aim of this study was to analyse the management and complications with a focus on local orbital recurrence and metastatic disease in 10 children vitrectomized in an undetected retinoblastoma eye. Methods: This is a retrospective descriptive case series conducted in a single-centre referral university hospital. Results: From October 1991 to June 2019, 10 patients with a vitrectomy in an unsuspected retinoblastoma eye were included in this study. The main preoperative diagnoses were unilateral inflammation with a suspected lymphoma, uveitis or toxocariasis in 5 cases, vitreous haemorrhage after trauma in 2 cases, and the last 3 were misdiagnosed with Coats disease, rhegmatogenous retinal detachment and congenital cataract. Mean age at surgery was 3 years, ranging from 14 months to 6 and a half years. Nine patients were suffering from unilateral retinoblastoma; these were enucleated and treated with 4–6 cycles of chemotherapy and/or radiation therapy. The sclerotomy sites were infiltrated with tumour cells in 3 cases. In 1 patient, the differential diagnosis of a malignant medulloepithelioma could not be excluded. One patient had bone marrow infiltration on initial presentation; all other patients are healthy without any signs of orbital recurrence or metastatic disease with a mean follow-up of 5.4 years. Conclusion: In children, intraocular tumours, including retinoblastoma and medulloepithelioma, should be ruled out before pars plana vitrectomy is performed. If no doubtless preoperative diagnosis can be established, preoperative magnetic resonance imaging is mandatory. If a vitrectomy in a retinoblastoma eye has been performed, immediate enucleation of the eye with subsequent chemotherapy and orbital radiation is effective to avoid local recurrence and systemic metastases.

Structural Fat Grafting to Improve Outcomes of Vocal Folds’ Fat Augmentation: Long-term Results

2017 ◽  
Vol 158 (1) ◽  
pp. 135-143 ◽  
Author(s):  
Giovanna Cantarella ◽  
Riccardo F. Mazzola ◽  
Michele Gaffuri ◽  
Elisabetta Iofrida ◽  
Pietro Biondetti ◽  
...  
Keyword(s):  
Vocal Fold ◽  
Voice Quality ◽  
Case Series ◽  
Vocal Folds ◽  
Fat Grafting ◽  
University Hospital ◽  
Long Term Results ◽  
Perceptual Evaluation ◽  
Mri Scans

Objective Evaluating the long-term outcomes of vocal fold structural fat grafting. Study Design Case series with chart review. Setting University hospital. Subjects and Methods Seventy-nine dysphonic patients (16-82 years; 55 with unilateral laryngeal paralysis and 24 with vocal fold scarring) underwent vocal fold fat injection. Fat was harvested by low-pressure liposuction and then processed by centrifugation. Refined fat aliquots were placed in the vocal fold and paraglottic space in multiple tunnels to enhance graft neovascularization. All patients were followed for 12 months, 15 for 3 years, and 5 for 10 years with videolaryngostroboscopy, maximal phonation time (MPT) measurement, Voice Handicap Index (VHI) questionnaire, and GRBAS (grade, roughness, breathiness, asthenia, strain) perceptual evaluation. Laryngeal computed tomography (CT) and/or magnetic resonance imaging (MRI) studies were performed in 16 patients 3 to 28 months postoperatively; MRI was repeated in 5 cases 12 to 18 months after the first radiological study. Results The voice quality of all patients improved after surgery, and long-term stability was confirmed by MPT, GRBAS, and VHI ( P ranging between .004 and <.001). The results achieved 1 year postoperatively remained stable at 3 and 10 years. Videolaryn-gostroboscopy showed improved glottic closure in all patients despite a limited amount of fat resorption. CT and MRI demonstrated survival of the fat grafts in all of the 16 examined cases. Serial MRI scans showed no change in graft size over time. Conclusions The reported clinical and radiological data demonstrate that fat is an effective filler for permanent vocal fold augmentation if the refined micro-aliquots are placed in multiple tunnels.

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