Intramedullary tumors in children: analysis of 24 operated cases

Intramedullary tumors are rare. The authors reviewed 24 cases operated between 1996 and 2006. The study assessed the clinical characteristics and surgical results based upon the neurological function. METHOD: Medical records of patients with intramedullary astrocytoma and ependymoma were reviewed. The minimal follow up time was 6 months and, at the end of this period, a comparative analysis of the neurological function was performed based using the McCormick scale score. RESULTS: Most patients had astrocytoma (75%). Male gender was more prevalent (58.3%). The most common type of tumor was graded as I or II, and in three cases these were malignant. The total resection of the tumor was achieved in 20.8% of the cases. The statistical analysis did not show a statistically significant difference between preoperative and postoperative grades at McCormick scale. CONCLUSION: The authors concluded that microsurgery to intramedullary tumors did not significantly alter the neurological function after six months.

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31 Intracranial growing teratoma syndrome (IGTS): An international retrospective study

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2018.295 ◽

2018 ◽

Vol 45 (S3) ◽

pp. S13-S13

Author(s):

George Michaiel ◽

Douglas Strother ◽

Nicholas Gottardo ◽

Ute Bartels ◽

Hallie Coltin ◽

...

Keyword(s):

Surgical Resection ◽

Clinical Characteristics ◽

Progressive Disease ◽

Mature Teratoma ◽

Male Gender ◽

Cell Tumor ◽

Total Resection ◽

Beta Hcg ◽

Median Serum

BACKGROUND: IGTS is a rare phenomenon of paradoxical germ cell tumor (GCT) growth during or following treatment despite normalization of tumor markers. We sought to evaluate the frequency, clinical characteristics and outcome of IGTS in patients in 21 North-American and Australian institutions. METHODS: Patients with IGTS diagnosed from 2000-2017 were retrospectively evaluated. RESULTS: Out of 739 GCT diagnoses, IGTS was identified in 33 patients (4.5%). IGTS occurred in 9/191 (4.7%) mixed-malignant GCTs, 4/22 (18.2%) immature teratomas (ITs), 3/472 (0.6%) germinomas/germinomas with mature teratoma, and in 17 secreting non-biopsied tumours. Median age at GCT diagnosis was 10.9 years (range 1.8-19.4). Male gender (84%) and pineal location (88%) predominated. Of 27 patients with elevated markers, median serum AFP and Beta-HCG were 70 ng/mL (range 9.2-932) and 44 IU/L (range 4.2-493), respectively. IGTS occurred at a median time of 2 months (range 0.5-32) from diagnosis, during chemotherapy in 85%, radiation in 3%, and after treatment completion in 12%. Surgical resection was attempted in all, leading to gross total resection in 76%. Most patients (79%) resumed GCT chemotherapy/radiation after surgery. At a median follow-up of 5.3 years (range 0.3-12), all but 2 patients are alive (1 succumbed to progressive disease, 1 to malignant transformation of GCT). CONCLUSION: IGTS occurred in less than 5% of patients with GCT and most commonly after initiation of chemotherapy. IGTS was more common in patients with IT-only on biopsy than with mixed-malignant GCT. Surgical resection is a principal treatment modality. Survival outcomes for patients who developed IGTS are favourable.

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COVID-19 infection: epidemiological, clinical, and radiological expression among adult population

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-020-00341-9 ◽

2020 ◽

Vol 51 (1) ◽

Author(s):

Eman Ragab ◽

Asrar Helal Mahrous ◽

Ghadeer Maher El Sheikh

Keyword(s):

Serum Ferritin ◽

Clinical Laboratory ◽

Adult Population ◽

Significant Risk ◽

High Serum ◽

Male Gender ◽

Lower Sensitivity ◽

Significant Difference ◽

D Dimer

Abstract Background High-resolution computed tomography (HRCT) has proved to be an important diagnostic tool throughout the COVID-19 pandemic outbreaks. Increasing number of the infected personnel and shortage of real-time transcriptase polymerase chain reaction (RT-PCR) as well as its lower sensitivity made the CT a backbone in diagnosis, assessment of severity, and follow-up of the cases. Results Two hundred forty patients were evaluated retrospectively for clinical, laboratory, and radiological expression in COVID-19 infection. One hundred eighty-six non-severe cases with home isolation and outpatient treatment and 54 severe cases needed hospitalization and oxygen support. Significant difference between both groups was encountered regarding the age, male gender, > 38° fever, dyspnea, chest pain, hypertension, ≤ 93 oxygen saturation, intensive care unit (ICU) admission, elevated D-dimer, high serum ferritin and troponin levels, and high CT-severity score (CT-SS) of the severe group. CT-SS showed a negative correlation with O2 saturation and patients’ outcome (r − 0.73/p 0.001 and r − 0.56/p 0.001, respectively). Bilateral peripherally distributed ground glass opacities (GGOs) were the commonest imaging feature similar to the literature. Conclusion Older age, male gender, smoking, hypertension, low O2 saturation, increased CT score, high serum ferritin, and high D-dimer level are the most significant risk factors for severe COVID-19 pneumonia. Follow-up of the recovered severe cases is recommended to depict possible post COVID-19 lung fibrosis.

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RETROSPECTIVE ANALYSIS OF EVENTS OF DEATH AT HOME AMONG PATIENTS UNDER FOLLOW-UP OBSERVATION

Perm Medical Journal ◽

10.17816/pmj35168-74 ◽

2018 ◽

Vol 35 (1) ◽

pp. 68-74

Author(s):

Ya P Sandakov

Keyword(s):

Cardiovascular Diseases ◽

Medical Records ◽

Emergency Calls ◽

Significant Difference ◽

Duration Of Disease ◽

The Moment ◽

Age Of Death ◽

At Home

Aim. To study the peculiarities of asking for medical care by patients from among those dead at home, who had been under follow-up observation. Materials and methods. The data, received from ambulatory medical records of 100 dead at home patients with follow-up, were analyzed using the methods of descriptive and inductive statistics. Results. A mean age of death was 74.9 ± 13.4 years, men - 65.8 ± 14.1 years, women - 79.2 ± 10.9 years. Cardiovascular diseases were the cause of follow-up observation in 78 % of cases and the cause of death in 85 %; in 30 % of patients the disease was detected while carrying out prophylactic medical examination. A mean duration of disease by the moment of death was 13.0 ± 8.0 years, among pensioners 13.7 ± 8.5 years, in able-bodied persons 9.6 ± 4.3 years. A mean duration of follow-up observation was 9.2 ± 5.8 years. An average number of planned visits was 2.8 ± 0.89, but the number of real visits during the last year of follow-up observation was 2.4 ± 1.2. Disability was registered in 77.6 % of patients, concomitant diseases - in all patients. For the last year, exacerbations were recorded in 92 % of patients, emergency calls - in 80 %, hospitalization events - 52 %, including 55.8 % - urgent ones. Conclusions. The absence of significant difference regarding the duration of disease between pensioners and able-bodied patients (т = 0.16, р = 1.43) as well as the absence of correlation between the age and duration of disease (χ2 = 0.19, p = 0.2) indirectly prove the influence of duration of disease on its outcome, but not the age. Attendance, characterizing clinical loyalty to treatment, does not depend on age (χ2 = -0.19, р = 0.18), sex (т = 1.0, р = 0.32), way of detecting disease (f = 0.9, p = 0.4), class of main disease (f = 0.91, p = 0.44), duration of disease (χ2 = -0.13, р = 0.49), exacerbations (χ2 = -0.17, р = 0.24), concomitant diseases (χ2 = 0.006, р = 0.9). The number of emergency calls, hospitalizations, urgent hospitalizations does not depend on duration of follow-up observation, regularity and number of real visits to a doctor (p > 0.05) that indicates unsatisfactory quality of follow-up observation.

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Tear Rates of the Ipsilateral ACL Graft and the Contralateral Native ACL Are Similar following ACL Reconstruction

The Journal of Knee Surgery ◽

10.1055/s-0040-1713861 ◽

2020 ◽

Author(s):

Nadia Nastassia Ifran ◽

Ying Ren Mok ◽

Lingaraj Krishna

Keyword(s):

Acl Reconstruction ◽

Medical Records ◽

Cruciate Ligament ◽

Acl Graft ◽

Increased Risk ◽

Significant Difference ◽

The Mean ◽

Anterior Cruciate ◽

Mean Time

AbstractThe aim of the study is to compare the tear rates of ipsilateral anterior cruciate ligament (ACL) grafts and the contralateral native ACL as well as to investigate the correlation of gender, age at time of surgery, and body mass index (BMI) with the occurrence of these injuries. The medical records of 751 patients who underwent ACL reconstruction surgery with follow-up periods of 2 to 7 years were retrospectively analyzed. Survival analyses of ipsilateral ACL grafts and contralateral native ACL were performed. Univariate and multivariate logistic regression analyses were performed to identify risk factors that were associated with these injuries. The tear rates of the ipsilateral ACL graft and contralateral ACL were 5.86 and 6.66%, respectively with no significant difference between groups (p = 0.998). The mean time of tears of the ipsilateral ACL and contralateral ACL was also similar (p = 0.977) at 2.64 and 2.78 years, respectively after surgery. Both the odds of sustaining an ipsilateral ACL graft and contralateral ACL tear were also significantly decreased by 0.10 (p = 0.003) and 0.14 (p = 0.000), respectively, for every 1-year increase in age at which the reconstruction was performed. However, graft type, gender, and BMI were not associated with an increased risk of these injuries. There was no difference between tear rates of ipsilateral ACL graft and contralateral ACL following ACL reconstruction. Patients who undergo ACL reconstruction at a young age are at an increased risk of both ipsilateral graft and contralateral ACL rupture after an ACL reconstruction. Patients who are young and more likely to return to competitive sports should be counselled of the risks and advised to not neglect the rehabilitation of the contralateral knee during the immediate and back to sports period of recovery. This is a Level III, retrospective cohort study.

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Analysis of live interactive teledermatologic consultations for prisoners in Korea for 3 years

Journal of Telemedicine and Telecare ◽

10.1177/1357633x17732095 ◽

2017 ◽

Vol 24 (9) ◽

pp. 623-628 ◽

Cited By ~ 3

Author(s):

Jung Eun Seol ◽

So Hee Park ◽

Hyojin Kim

Keyword(s):

Infectious Disease ◽

Clinical Outcome ◽

Medical Records ◽

Underserved Populations ◽

Common Type ◽

Face To Face ◽

Different Types ◽

The Mean ◽

Dermatologic Disease

Introduction Teledermatology has contributed to the enhanced accessibility of underserved populations. This study investigated the prevalence and clinical outcomes of dermatologic diseases in prisoners in Korea through live interactive teledermatology (LITD) Method The medical records of patients in a Busan prison, who interacted with a dermatologist using LITD from July 2013 to August 2016, were reviewed retrospectively. Results The mean age of the 406 patients enrolled in the study was 39.0 years and 91.4% were male. Infectious disease (42.8%) was the most common type of disease, followed by eczematous disease (29.4%) and diseases of the skin appendages (14.5%). Among the 187 (38.2%) patients who had a follow-up consultation, 162 (86.7%) showed clinical improvement, whereas 21 showed either no change or a worse clinical outcome. Twenty patients were diagnosed with different types of dermatologic disease at follow-up consultations. Discussion LITD can contribute to a favourable clinical outcome and may thus be an effective alternative to face-to-face consultation in prisoners and other underserved populations.

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Clinical Characteristics of Intermittent Esotropia

Journal of the Korean Ophthalmological Society ◽

10.3341/jkos.2021.62.12.1650 ◽

2021 ◽

Vol 62 (12) ◽

pp. 1650-1656

Author(s):

Young Chae Yoon ◽

Nam Yeo Kang

Keyword(s):

Medical Records ◽

Clinical Characteristics ◽

Age At Onset ◽

Clinical Findings ◽

Main Symptom ◽

Angle Of Deviation ◽

The Mean ◽

Onset Angle ◽

Dissociated Vertical Deviation

Purpose: To evaluate clinical findings and surgical outcomes of intermittent esotropia.Methods: We retrospectively reviewed the medical records of 23 patients (aged 9-42 years) who presented with intermittent esotropia between January 2007 and December 2020. We analyzed the age at onset, angle of deviation, presence of symptomatic diplopia, fusional state, near stereoacuity, and surgical results.Results: The mean age at onset was 19.9 ± 8.0 years and mean duration of esodeviation was 23.4 ± 27.1 months. Mean follow-up time was 13.0 ± 15.6 months. All patients except three had symptomatic diplopia, and 78.3% showed intermittent diplopia. Mean angles of deviation were 21.6 ± 10.3 prism diopters (PD) at distance and 20.2 ± 10.4 PD at near. Twenty-one patients (91.3%) were myopia. No patients had amblyopia and one had dissociated vertical deviation. On Worth’s four-dot test, five patients (21.7%) showed diplopia and four showed suppression at both distance and near. The other patients showed fusion at near or distance. Eleven patients underwent surgical correction. At the final examination, all patients achieved successful motor alignment and fusion with resolution of diplopia. Only two patients (18.2%) achieved normal 60 arcsec stereopsis, and six attained subnormal stereopsis.Conclusions: The main symptom of intermittent esotropia was diplopia. Surgical treatment was effective in achieving good postoperative motor alignment and fusion. However, successful motor alignment did not guarantee recovery of fine stereopsis.

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Specifics of follow-up observation regarding two diseases

Perm Medical Journal ◽

10.17816/pmj35275-84 ◽

2018 ◽

Vol 35 (2) ◽

pp. 75-84

Author(s):

Ya. P. Sandakov

Keyword(s):

Cardiovascular System ◽

Medical Records ◽

Endocrine System ◽

Observation Time ◽

Individual Motivation ◽

Significant Difference ◽

Duration Of Disease ◽

Pension Age

Aim. To study the specifics of addressing for medical care among patients under follow-up observation regarding two diseases. Materials and methods. The data, obtained from ambulatory medical records of 159 patients under follow-up observation for two diseases, were analyzed using the methods of descriptive and inductive statistics. Results. From among patients, who were under follow-up observation concerning two diseases, there were more women (58.5 %) and pensioners (95.5 %). A mean age was 68,1 ± 11,6 years. The most frequent cause of observation regarding the first disease are the diseases of cardiovascular system (71.7 %), the second – the diseases of endocrine system (52.8 %). A mean duration of the first disease, as the cause of follow-up observation, was 10.8 ± 6.9, the second – 9.9 ± 8.2 years. There is no statistically significant difference between mean duration of disease among pensioners and able-bodied persons (the first disease t = –0.6 p = 0.5; the second disease t = –0.9, p = 0.4). There is no correlation between age and duration of disease: the first disease (χ2 = 0.04, р = 0.8) and the second (χ2 = 0.08, р = 0.6). There is statistically significant difference between mean duration and follow-up observation time of the first disease t = 5.4, р ˂ 0.0001 and the second t = 2.6, р = 0.012. There is statistically significant difference between the number of planned and real visits for the first disease t = 3.5, р = 0.001. Exacerbations were registered in 94.3 %, concomitant diseases – in 90.6 %, emergency calls – in 71.7 %, hospitalization – in 60.4 %, urgent hospitalization – in 36.7 %. Conclusions. In the group of patients under follow-up observation regarding two diseases, there prevail persons of pension age; the main cause of follow-up observation is the diseases of cardiovascular system; profile specialists were randomly addressed to; the basic way of disease detection is follow-up observation; the disease duration, but not the age influence the severity of status; untimely start of observation and unsatisfactory quality of follow-up was revealed; loyalty to treatment depends on individual motivation of patients; follow-up, conducted by narrow specialists, is not more effective, than that by therapeutists.

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The Crazy-paving Pattern in Chest CT of Coronavirus Disease 2019 Patients; an Alarming Sign for Hospitalization

10.21203/rs.3.rs-105075/v1 ◽

2020 ◽

Author(s):

Mehdi Gholamzadeh Baeis ◽

Abolfazl Mozafari ◽

Fatemeh Movaseghi ◽

Mehdi Yadollahzadeh ◽

Ahmad Sohrabi ◽

...

Keyword(s):

Risk Factors ◽

Medical Records ◽

Public Hospital ◽

Human Beings ◽

Epidemiological Features ◽

Significant Difference ◽

Independent Risk Factors ◽

The Mean ◽

Bilateral Lung

Abstract Background: The outbreak of coronavirus disease 2019 (COVID-19) becomes an enormous threat to all human beings. Via this retrospective study conducted on medical records of confirmed COVID-19 pneumonia patients on admission, we investigate the CT manifestation and clinical and laboratory risk factors associated with progression to severe COVID-19 pneumonia and assessed the association among clinical and laboratory records, CT findings, and epidemiological features. The medical records and radiological CT Features of 236 confirmed COVID-19 patients were reviewed at one public hospital and one respiratory clinic in Quom, from 1 August to 30 September 2020. Results: Among a total of 236 confirmed Covid-19 cases, 62 were infected with moderate to severe COVID-19 disease and required hospital admission, and 174 were followed up on outpatient bases. A significant difference was verified in the mean age between outpatients and hospitalized groups. The incidences of bilateral lung involvement, consolidation, linear opacities, crazy-paving pattern, air bronchogram sign, and the number of lobe involvement were significantly higher in hospitalized groups. However, only the crazy-paving pattern was significantly associated with an SpO2 level lower than 90%, with clinical sign of cough severity. Our data indicate that this pattern is also significantly associated with inflammatory levels and the presence of this pattern along with SpO2 level lower than 90%, older age, diabetes, on admission are independent risk factors for COVID-19 progression to severe level.Conclusions: The crazy-paving pattern can predict the severity of COVID-19, which is of great significance for the management and follow-up of COVID-19 pneumonia patients. The clinical factors of aging, male gender, and diabetes, may be risk factors for the crazy-paving pattern, whereas severe coughing is considered to be the most important clinical symptom related to this pattern, and SpO2 level lower than 90%, which is a matter of more severity.

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Surgical Techniques and the Choice of Operative Approach for Cranioorbital Lesions

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0039-1696684 ◽

2019 ◽

Vol 81 (06) ◽

pp. 686-693

Author(s):

Haiyong He ◽

Meiqin Cai ◽

Manting Li ◽

Lei Wei ◽

Lun Luo ◽

...

Keyword(s):

Retrospective Study ◽

Optic Nerve ◽

Minimally Invasive ◽

Surgical Techniques ◽

Surgical Approaches ◽

Modified Rankin Scale ◽

Pterional Approach ◽

Total Resection ◽

Significant Difference

Abstract Objectives Cranioorbital lesions present a great challenge for neurosurgeons and ophthalmologists. There is no consensus on the choice of surgical approach. The aims of this study were to investigate 49 cases of cranioorbital lesions and evaluate surgical approaches and outcomes. Patients and Methods A retrospective study was done on 49 patients (51 operations) from 2009 to 2018. Information about the lesion was used to decide whether the supraorbital eyebrow approach (SEA) or pterional approach (PA) was performed. Results Twenty-eight patients had surgical resection using SEA, 21 patients received PA, each group included one case of recurrence, who underwent reoperation via the same approach. SEA provided better cosmetic satisfaction, and a shorter incision than PA (p < 0.05). There was no significant difference in total resection rates, visual outcomes, recovery of ptosis, and other new surgical-related complications between SEA group and PA group (p > 0.05). Forty-nine cases of proptosis (94.1%, 49/51) were improved. Thirty-three patients (33/37, 89.2%) who underwent follow-up for longer than 12 weeks had a modified Rankin Scale (mRS) score ≤ 3. Conclusion Surgery is the preferred treatment for cranioorbital lesions, but total resection is difficult. SEA may be a more minimally invasive option for some more limited lesions superior to optic nerve. PA may be more reasonable for the lesion with obvious hyperostosis and more extensive lesions.

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Yttrium-90 microspheres (SIR) verses transarterial chemoembolization (TACE) in the treatment of inoperable metastatic neuroendocrine tumors (NETS).

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.4_suppl.300 ◽

2012 ◽

Vol 30 (4_suppl) ◽

pp. 300-300

Author(s):

Yuhsin V. Wu ◽

Garin Tomaszewski ◽

Adrienne E. Groman ◽

Renuka V. Iyer ◽

Boris W. Kuvshinoff

Keyword(s):

Medical Records ◽

Disease Burden ◽

Progressive Disease ◽

Performance Status ◽

Complete Response ◽

Treatment Modalities ◽

Significant Difference ◽

Yttrium 90 ◽

Radiologic Progression

300 Background: There are limited modalities in the treatment of inoperable liver NET metastases. This study compares the efficacy and safety of liver-directed yttrium-90 microspheres, SIR-spheres, to TACE. Methods: Medical records and axial imaging studies were retrospectively reviewed for all patients with NET liver metastases who underwent SIR or doxorubicin based TACE at our institution from Jan 2001 to Dec 2010. The demographics, immediate effects, and time to radiologic progression were assessed and compared between the two treatment modalities. Results: A total of 99 liver directed treatments were performed on 46 pts (n=19 Y-90, n=27 TACE). Median post-treatment follow-up was 20 months (range 4-103). Pt characteristics including age, performance status, type of primary NET, and systemic therapy were similar in both groups. Pts in the SIR group waited longer from the time of metastatic diagnosis to liver-directed therapy (SIR 35 mo vs. TACE 15 mo (p=0.0015)). SIR patients had less liver burden (65% with <25% liver burden) than TACE patients (23% with <25% liver burden). Immediate treatment response (1-3 mo) was measured radiologically using WHO criteria multiplied by EASL criteria. SIR pts achieved 26% complete response (CR), 51% partial response (PR), 15% stable disease (SD), and 8% progressive disease (PR). TACE pts achieved 13% CR, 59% PR, 8% SD, and 21% PD. SIR (44 mo) had a longer radiologic effect than TACE (12 mo) (p=0.015). SIR patients underwent less treatments (95% with < 2 treatments) than TACE patients (70% with < 2 treatments) (p=0.045). Both treatments were well tolerated with minimal side effects. With only 11/46 (25%) deaths, there was no statistically significant difference in overall survival between the two groups at a median follow up of 104 months (range 12-267). Conclusions: Liver metastasis from NETs can be successfully treated with yttrium-90 radioembolization. Earlier intervention using SIR allows fewer treatments with more durable responses. Prospective studies controlling for rate of disease progression and disease burden are needed to validate these findings.

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