scholarly journals Surgical management of rectal foreign bodies: a 10-year single-center experience

2017 ◽  
Vol 2 (2) ◽  
pp. 89-95 ◽  
Author(s):  
Pia Kokemohr ◽  
Lars Haeder ◽  
Fabian Joachim Frömling ◽  
Peter Landwehr ◽  
Joachim Jähne
Keyword(s):  
Foreign Body ◽  
Emergency Room ◽  
Case Reports ◽  
Meta Analysis ◽  
Treatment Options ◽  
Clinical Experiences ◽  
Single Center Experience ◽  
Imaging Results ◽  
Standardized Treatment ◽  
Intravenous Analgesia

AbstractBackground:Patients with a rectal foreign body (RFB) are still a rare entity in general surgery departments but with an increasing incidence over the last years. This case is sometimes difficult to treat, and due to a lack of standardized treatment options, the aim of the study was to present our clinical experiences with the diagnostic and therapeutic approach to RFBs and a review of the currently available literature.Materials and methods:Data were collected retrospectively from the patient’s records of 20 patients who were treated due to an RFB between 2006 and 2016. Patient’s demographics, circumstances of insertion, inserted objects, clinical presentation, laboratory and imaging results, as well as surgical treatment and duration of hospital stay were analyzed. Additionally, a review of the literature was performed with the search items “rectal foreign body” and “surgical therapy”. Because many publications were just case reports, we did not perform a meta-analysis or a systematic review.Results:Twenty-two cases in 20 patients (80% male) presented to the emergency room. The mean age was 38.5±13.7 years. In 68.2% of the cases, the cause of RFB was due to sexual preferences. The following objects were inserted: six dildos, three vibrators, two bottles, one glass, one deodorant, one apple, one fever thermometer, multiple glass fragments and razor blades in one patient and six unknown objects. For 18 RFBs, manual peranal removal without anesthesia was possible in the emergency room, but two patients required intravenous analgesia. Two patients were transferred to the operating room and the foreign body was removed via the anus under general anesthesia. Open surgery with a laparotomy was necessary for two complicated cases. One patient was in need of surgery due to a vacuum generated by the RFB, whereas the second patient suffered from a sigmoid perforation. In all cases, there was no morbidity or mortality.Conclusion:In most cases, the removal of an RFB can be performed peranally in the emergency room without further complications, therefore representing the therapy of choice for RFB. Only in cases with perforation, acute abdomen, or failed peranal approaches, surgery is indicated to remove the foreign body.

scholarly journals Indeterminate Cell Histiocytosis – Case Report and Review of Literature

2018 ◽  
Vol 10 (1) ◽  
pp. 18-24
Author(s):  
Aleksandra R. Vojvodić ◽  
Željko Mijušković ◽  
Lidija Kandolf Sekulović
Keyword(s):  
Dendritic Cells ◽  
Case Report ◽  
Case Reports ◽  
Treatment Options ◽  
Disease Recurrence ◽  
Braf V600e ◽  
Histopathological Analysis ◽  
Entire Body ◽  
S 100 ◽  
Standardized Treatment

Abstract Introduction. Indeterminate cell histiocytosis is a rare proliferative disorder of indeterminate dendritic cells, reported in only 50 case reports so far. It is clinically presented as yellow, red or brown papules and nodules that appear in otherwise healthy adult individuals. Indeterminate cells are distinct dendritic cells of the skin that have ultrastructural similarities to the epidermal Langerhans cells but do not contain the characteristic Birbeck’s granules and they are also langerin-negative, unlike LCH. Indeterminate cell histiocytosis is an exceptional entity with variable clinical, histopathologic or immunohistochemical findings, sharing morphologic and immunophenotypic features with both Langerhans- and non-Langerhans cell histiocytoses. Case Report. We present a case of indeterminate histiocytosis in a 77-year-old man with 3-year history of asymptomatic, multiple reddish and brown papules and nodules over the entire body, including the oral mucosa. Skin biopsy was done, and histopathological analysis with immunohistochemistry was performed. The positive ICH staining of cells for CD68, CD1a, and S-100 enabled us to diagnose ICH in our patient. Also, BRAF V600E mutation was detected in tumor tissue. The treatment was started with methotrexate that was effective for 6 months, but due to the disease recurrence, further therapy with thalidomide was advised, without effect. Conclusion. Indeterminate histiocytosis is a rare disease, therefore no standardized treatment has been established and the treatment options are limited.

scholarly journals Antimicrobial agents for the treatment of enteric fever chronic carriage: A systematic review

2021 ◽  
Author(s):  
Naina McCann ◽  
Peter Scott ◽  
Christopher Parry ◽  
Michael Brown
Keyword(s):  
Systematic Review ◽  
Enteric Fever ◽  
Antimicrobial Agents ◽  
Case Reports ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Treatment Options ◽  
Case Series ◽  
Bibliographic Databases ◽  
Chronic Carriage

Background Chronic carriage of S . Typhi or S. Paratyphi is an important source of enteric fever transmission. Existing guidance and treatment options for this condition are limited. This systematic review aims to assess the evidence concerning the efficacy of different antimicrobials in treating enteric fever chronic carriage. Methods We searched major bibliographic databases using relevant keywords between 1946 and September 2021. We included all interventional studies that included patients with confirmed enteric fever chronic carriage and deployed an antimicrobial that remains in clinical practice today. Case reports and case series of under 10 patients were excluded. Two reviewers screened abstracts, selected articles for final inclusion and quality-assessed the included studies for risk of bias. Extracted data was analysed, with pooling of data and eradication rates for each antimicrobial calculated. As only one randomised controlled trial was identified no meta-analysis was performed. Results Of the 593 papers identified by the initial search, a total of eight studies met the inclusion criteria and were included in the systematic review. Evidence was identified for the use of fluoroquinolones and amoxicillin/ampicillin in the treatment for enteric fever chronic carriage. Fluoroquinolones were superior to amoxicillin/ampicillin with 92% of patients eradicated after one antimicrobial course compared to 68% (p = 0.02). The quality of included studies was poor, and all were carried out before 1990. Conclusion This review identified fluoroquinolones and amoxicillin as treatment options for enteric fever chronic carriage, with fluoroquinolones the more effective option. However, this evidence pre-dates rises in antimicrobial resistance in enteric fever and therefore the significance of these findings to today’s practice is unclear. Further research is needed to investigate whether these antimicrobials remain appropriate treatment options or whether alternative interventions are more effective.

Idiopathic Sudden Sensorineural Hearing Loss in Children: A Systematic Review and Meta-analysis

2020 ◽  
pp. 019459982097657
Author(s):  
Leonardo Franz ◽  
Chiara Gallo ◽  
Gino Marioni ◽  
Cosimo de Filippis ◽  
Andrea Lovato
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Case Reports ◽  
Meta Analysis ◽  
Treatment Options ◽  
Case Series ◽  
Sudden Sensorineural Hearing Loss ◽  
Sensorineural Hearing ◽  
Systemic Steroid ◽  
Significant Difference

Objective Idiopathic sudden sensorineural hearing loss (ISSNHL) is uncommon in children, and its treatment and outcome are debated. We aimed to critically review evidence in the literature about treatment options and functional outcomes of pediatric ISSNHL. Additionally, we performed a meta-analysis of the results of combined systemic-intratympanic steroid therapy versus solely systemic treatment. Data Sources A search was run in the PubMed, Scopus, and Google Scholar databases. Review Methods Included articles were original ISSNHL case series, written in English, with a population age ranging from 2 to 19 years. Other study types (single case reports, editorials, and reviews) and case series with known etiology of sudden hearing loss were excluded. Descriptive data of patients, treatments, outcomes, and possible prognostic factors were extracted and recorded for every included study. Results Twelve articles (7 cohort and 5 case-control studies) met all the selection criteria. Based on only the studies that provided sufficient data about clinical outcome, the pooled overall recovery rate was 67.91% (95% CI, 58.34%-77.48%). No studies showed a significant difference between systemic steroid and combined systemic-intratympanic steroid. The pooled odds ratio for combined systemic-intratympanic steroid versus systemic steroid alone was 0.90 (95% CI, 0.36-2.27) based on a random effects model, ruling out any significant difference between these treatment options. Conclusions The results of our meta-analysis did not support combination therapy more than systemic steroid alone. Further prospective clinical trials are necessary to establish evidence-based therapies.

scholarly journals Diagnostic accuracy of adrenal imaging for subtype diagnosis in primary aldosteronism: systematic review and meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e038489
Author(s):  
Yaqiong Zhou ◽  
Dan Wang ◽  
Licheng Jiang ◽  
Fei Ran ◽  
Sichao Chen ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Primary Aldosteronism ◽  
Meta Analysis ◽  
Treatment Options ◽  
Young Patients ◽  
Group Versus ◽  
Contrast Enhanced Ct ◽  
Imaging Results ◽  
Adrenal Imaging ◽  
Meta Regression

ObjectivesAccurate subtype classification in primary aldosteronism (PA) is critical in assessing the optimal treatment options. This study aimed to evaluate the diagnostic accuracy of adrenal imaging for unilateral PA classification.MethodsSystematic searches of PubMed, EMBASE and the Cochrane databases were performed from 1 January 2000 to 1 February 2020, for all studies that used CT or MRI in determining unilateral PA and validated the results against invasive adrenal vein sampling (AVS). Summary diagnostic accuracies were assessed using a bivariate random-effects model. Subgroup analyses, meta-regression and sensitivity analysis were performed to explore the possible sources of heterogeneity.ResultA total of 25 studies, involving a total of 4669 subjects, were identified. The overall analysis revealed a pooled sensitivity of 68% (95% CI: 61% to 74%) and specificity of 57% (95% CI 50% to 65%) for CT/MRI in identifying unilateral PA. Sensitivity was higher in the contrast-enhanced (CT) group versus the traditional CT group (77% (95% CI 66% to 85%) vs 58% (95% CI 50% to 66%). Subgroup analysis stratified by screening test for PA showed that the sensitivity of the aldosterone-to-renin ratio (ARR) group was higher than that of the non-ARR group (78% (95% CI 69% to 84%) vs 66% (95% CI 58% to 72%)). The diagnostic accuracy of PA patients aged ≤40 years was reported in four studies, and the overall sensitivity was 71%, with 79% specificity. Meta-regression revealed a significant impact of sample size on sensitivity and of age and study quality on specificity.ConclusionCT/MRI is not a reliable alternative to invasive AVS without excellent sensitivity or specificity for correctly identifying unilateral PA. Even in young patients (≤40 years), 21% of patients would have undergone unnecessary adrenalectomy based on imaging results alone.

Primary leiomyosarcoma of the uterine cervix: report of 4 cases, systematic review, and meta-analysis

2020 ◽  
Vol 106 (5) ◽  
pp. 413-423
Author(s):  
Cigdem Kiliç ◽  
Dilek Yuksel ◽  
Caner Cakir ◽  
Osman Turkmen ◽  
Gunsu Kimyon Comert ◽  
...  
Keyword(s):  
Systematic Review ◽  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Case Reports ◽  
Meta Analysis ◽  
Treatment Options ◽  
Case Series ◽  
Oncologic Outcome ◽  
High Power Field ◽  
First Choice

Background: Primary cervical leiomyosarcomas (CLMS) constitute 21% of all cervical sarcomas. Because of their rarity, to our knowledge, fewer than 40 cases have been reported. The aim of this study is to evaluate the clinical and surgical–pathological features, prognosis, treatment options, and survival of primary CLMS. Methods: A systematic review of the medical literature was conducted to evaluate articles about primary CLMS. The literature was searched between 1959 and May 2019. On final evaluation, there were 29 articles (one consisted of 8 cases; one consisted of 3 cases) and 42 cases with the addition of our 4 cases. Results: Age (⩾48 versus ⩽47 years) (hazard ratio.HR], 4.528; 95% confidence interval.CI], 1.550–13.227; p=0.006) and mitoses count (<10/10 high-power field [HPF] versus ⩾10/10 HPF) (HR, 3.865; 95% CI, 1.046–14.278; p=0.043) are independent prognostic factors for recurrence and age (HR, 5.318; 95% CI, 1.671–16.920; p=0.005) and hysterectomy (performed versus not performed) (HR, 4.377; 95% CI, 1.341–14.283; p=0.014) are independent prognostic factors for death because of disease on multivariate analysis. Conclusions: Information on primary CLMS is sparse and obtained from rare case reports and case series. Hysterectomy must be the first choice of treatment in these patients according to our results on multivariate analysis. The type of hysterectomy does not have an effect on oncologic outcome. Radical hysterectomy is not obligatory and more data are needed to make more accurate conclusions.

scholarly journals Pachychorioidealis kórképek

2021 ◽  
Vol 162 (20) ◽  
pp. 770-781
Author(s):  
Róbert Gergely ◽  
Mónika Ecsedy ◽  
Illés Kovács ◽  
András Papp ◽  
Miklós Resch ◽  
...  
Keyword(s):  
Case Reports ◽  
Treatment Options ◽  
Treatment Protocol ◽  
Subretinal Fluid ◽  
Clinical Experiences ◽  
Micropulse Laser ◽  
Anti Vegf ◽  
Pachychoroid Neovasculopathy ◽  
Multiple Treatments ◽  
Pachychoroid Pigment Epitheliopathy

Összefoglaló. Célunk, hogy közleményünkben összefoglaljuk a pachychorioidealis kórképekkel kapcsolatos ismereteket egy-egy saját esettel illusztrálva. Az irodalmi adatok és a saját klinikai tapasztalatok alapján összegeztük a pachychorioidealis kórképekkel kapcsolatos ismereteinket, az alcsoportok kezelési lehetőségeiről összefoglaló folyamatábrát készítettünk. A pachychorioidealis kórképekbe a következő betegségek tartoznak: centrális serosus chorioretinopathia (CSCR), pachychorioidealis pigmentepitheliopathia (PPE), pachychorioidealis neovasculopathia (PNV), polypoid chorioidealis vasculopathia (PCV), peripapillaris pachychorioidealis syndroma (PPS), focalis chorioideaexcavatio (FCE). A pachychorioidealis kórképek közös jellemzője a chorioidea kvantitatív vagy kvalitatív eltérései, melyekhez gyakran subretinalis folyadékgyülem társul. A betegségcsoportnak jelenleg nincs standard kezelési protokollja; a többféle kezelési mód közül néhány hatékonyabbnak bizonyul, az alcsoportok között azonban lényeges különbségek mutatkoznak. Összegezzük, hogy melyik alcsoportban érdemes eplerenonetablettás kezeléssel, mikropulzuslézer-kezeléssel, verteporfinos fotodinámiás kezeléssel (PDT) vagy intravitrealis anti-VEGF-injekciós kezeléssel kezdeni. Orv Hetil. 2020; 162(20): 770–781. Summary. The aim of this study is to present our knowledge about pachychoroid diseases using case reports, literature review and our own clinical experiences. A summary flow chart of treatment options for the subgroups was prepared, too. Pachychoroid diseases include the following: central serous chorioretinopathy (CSCR), pachychoroid pigment epitheliopathy (PPE), pachychoroid neovasculopathy (PNV), polypoidal choroidal vasculopathy (PCV), peripapillary pachychoroid syndrome (PPS), focal choroidal excavation (FCE). A common feature of pachychoroid diseases is the quantitative or qualitative abnormality of the choroidea, which is often associated with subretinal fluid accumulation. The disease group does not currently have a standard treatment protocol; some of the multiple treatments prove to be more effective, however, there are significant differences between the subgroups. We summarize which subgroup benefits from eplerenone tablet therapy, micropulse laser therapy, verteporfin photodynamic therapy or intravitreal anti-VEGF injection therapy. Orv Hetil. 2020; 162(20): 770–781.

Thrombosis in Cancer Patients Treated with Hematopoietic Growth Factors - A Meta-Analysis

1996 ◽  
Vol 75 (02) ◽  
pp. 368-371 ◽  
Author(s):  
T Barbul ◽  
G Finazzi ◽  
A Grassi ◽  
R Marchioli
Keyword(s):  
Cancer Patients ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
Hematopoietic Growth Factors ◽  
Patients With Cancer ◽  
Cytotoxic Treatment ◽  
Pertinent Data ◽  
Thrombotic Complications ◽  
Vascular Occlusions

SummaryHematopoietic colony-stimulating factors (CSFs) are largely used in patients with cancer undergoing cytotoxic treatment to accelerate neutrophil recovery and decrease the incidence of febrile neutropenia. Clinical practice guidelines for their use have been recently established (1), taking into account clinical benefit, but also cost and toxicity. Vascular occlusions have been recently reported among the severe reactions associated with the use of CSFs, in anedoctal case reports (2, 3), consecutive case series (4) and randomized clinical trial (5, 6). However, the role of CSFs in the pathogenesis of thrombotic complications is difficult to ascertain, because pertinent data are scanty and widely distributed over a number of heterogenous investigations. We report here a systematic review of relevant articles, with the aims to estimate the prevalence of thrombosis associated with the use of CSFs and to assess if this rate is significantly higher than that observed in cancer patients not receiving CSFs.

Mechanical thrombectomy in pediatric stroke: systematic review, individual patient data meta-analysis, and case series

2019 ◽  
Vol 24 (5) ◽  
pp. 558-571 ◽  
Author(s):  
Kartik Bhatia ◽  
Hans Kortman ◽  
Christopher Blair ◽  
Geoffrey Parker ◽  
David Brunacci ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
Neurological Outcomes

OBJECTIVEThe role of mechanical thrombectomy in pediatric acute ischemic stroke is uncertain, despite extensive evidence of benefit in adults. The existing literature consists of several recent small single-arm cohort studies, as well as multiple prior small case series and case reports. Published reports of pediatric cases have increased markedly since 2015, after the publication of the positive trials in adults. The recent AHA/ASA Scientific Statement on this issue was informed predominantly by pre-2015 case reports and identified several knowledge gaps, including how young a child may undergo thrombectomy. A repeat systematic review and meta-analysis is warranted to help guide therapeutic decisions and address gaps in knowledge.METHODSUsing PRISMA-IPD guidelines, the authors performed a systematic review of the literature from 1999 to April 2019 and individual patient data meta-analysis, with 2 independent reviewers. An additional series of 3 cases in adolescent males from one of the authors’ centers was also included. The primary outcomes were the rate of good long-term (mRS score 0–2 at final follow-up) and short-term (reduction in NIHSS score by ≥ 8 points or NIHSS score 0–1 at up to 24 hours post-thrombectomy) neurological outcomes following mechanical thrombectomy for acute ischemic stroke in patients < 18 years of age. The secondary outcome was the rate of successful angiographic recanalization (mTICI score 2b/3).RESULTSThe authors’ review yielded 113 cases of mechanical thrombectomy in 110 pediatric patients. Although complete follow-up data are not available for all patients, 87 of 96 (90.6%) had good long-term neurological outcomes (mRS score 0–2), 55 of 79 (69.6%) had good short-term neurological outcomes, and 86 of 98 (87.8%) had successful angiographic recanalization (mTICI score 2b/3). Death occurred in 2 patients and symptomatic intracranial hemorrhage in 1 patient. Sixteen published thrombectomy cases were identified in children < 5 years of age.CONCLUSIONSMechanical thrombectomy may be considered for acute ischemic stroke due to large vessel occlusion (ICA terminus, M1, basilar artery) in patients aged 1–18 years (Level C evidence; Class IIb recommendation). The existing evidence base is likely affected by selection and publication bias. A prospective multinational registry is recommended as the next investigative step.

Anti-toxicant Properties of Saffron and Relevance to Protection from Toxins and Drugs

2020 ◽  
Vol 16 (3) ◽  
pp. 265-283
Author(s):  
Kyriaki Hatziagapiou ◽  
George I. Lambrou
Keyword(s):  
Redox Reactions ◽  
Case Reports ◽  
Meta Analysis ◽  
Reactive Oxygen ◽  
Crocus Sativus ◽  
Protective Effects ◽  
Nitrogen Species ◽  
Eligibility Criteria ◽  
Crocus Sativus L

Background: Reactive oxygen species and reactive nitrogen species, which are collectively called reactive oxygen nitrogen species, are inevitable by-products of cellular metabolic redox reactions, such as oxidative phosphorylation in the mitochondrial respiratory chain, phagocytosis, reactions of biotransformation of exogenous and endogenous substrata in endoplasmic reticulum, eicosanoid synthesis, and redox reactions in the presence of metal with variable valence. Among medicinal plants there is a growing interest in Crocus sativus L. It is a perennial, stemless herb, belonging to Iridaceae family, cultivated in various countries such as Greece, Italy, Spain, Israel, Morocco, Turkey, Iran, India, China, Egypt and Mexico. Objective: The present study aims to address the anti-toxicant role of Crocus sativus L. in the cases of toxin and drug toxification. Materials and Methods: An electronic literature search was conducted by the two authors from 1993 to August 2017. Original articles and systematic reviews (with or without meta-analysis), as well as case reports were selected. Titles and abstracts of papers were screened by a third reviewer to determine whether they met the eligibility criteria, and full texts of the selected articles were retrieved. Results: The authors focused on literature concerning the role of Crocus Sativus L. as an anti-toxicant agent. Literature review showed that Saffron is a potent anti-toxicant agent with a plethora of applications ranging from anti-oxidant properties, to chemotherapy protective effects. Conclusion: Literature findings represented in current review herald promising results for using Crocus Sativus L. and/or its active constituents as anti-toxicant, chemotherapy-induced protection and toxin protection.

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