scholarly journals Mucormycosis during the second wave of COVID-19 in India

2021 ◽  
Vol 7 (11) ◽  
pp. 1738
Author(s):  
Mudit Mittal ◽  
Rakesh Srivastava
Keyword(s):  
Internal Carotid ◽  
Treatment Options ◽  
South East Asia ◽  
Large Numbers ◽  
Surgical Data ◽  
Challenging Situation ◽  
Time Of Presentation ◽  
Anti Fungal ◽  
Second Wave ◽  
D Dimer

<p><strong>Background:</strong> The so called “black fungus epidemic” struck India during the second wave of COVID-19 pandemic. Large numbers of patients were being reported, posing a challenging situation for clinicians. The treatment options were limited, and rescue surgery was mutilating, anti-fungal medicines became short of supply soon, prognosis remained poor. Objective was to understand a unifying pathophysiological picture with a framework to check this post Covid epidemic, especially in context with South-east-Asia. </p><p><strong>Methods</strong>: The clinical, radiological, surgical data of patients presented with symptoms of rhino-orbito-cerebral complications, collected and analyzed.</p><p><strong>Results</strong>: 80.9% of operated patient had thrombosis of identifiable major vessels. The 76.7% patient had cerebral venous thrombosis. The 30% patient had internal carotid artery narrowing on imaging. Fungal staining was positive in 72% patient. We found level of D dimer was high in 81.3% patients and 83.9% patients had blood sugar level raised at the time of presentation.</p><p><strong>Conclusions</strong>: Hyper thrombotic state of COVID-19 in diabetes and injudicious use of steroids predisposed susceptible patients to thromboembolic phenomena, leading to necrosis of tissue and secondary fungal infection.</p>

scholarly journals Internal Carotid Artery Injury in Transsphenoidal Surgery: Tenets for Its Avoidance and Refit—A Clinical Study

2021 ◽  
Vol 11 (1) ◽  
pp. 99
Author(s):  
Dmitry Usachev ◽  
Oleg Sharipov ◽  
Ashraf Abdali ◽  
Sergei Yakovlev ◽  
Vasiliy Lukshin ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cavernous Sinus ◽  
Transsphenoidal Surgery ◽  
Internal Carotid ◽  
Treatment Options ◽  
Carotid Artery Injury ◽  
Anatomical Features ◽  
Stent Grafting ◽  
Internal Carotid Artery Injury

One of the most serious/potentially fatal complications of transsphenoidal surgery (TSS) is internal carotid artery (ICA) injury. Of 6230 patients who underwent TSS, ICA injury occurred in 8 (0.12%). The etiology, possible treatment options, and avoidance of ICA injury were analyzed. ICA injury occurred at two different stages: (1) during the exposure of the sella floor and dural incision over the sella and cavernous sinus and (2) during the resection of the cavernous sinus extension of the tumor. The angiographic collateral blood supply was categorized as good, sufficient, and nonsufficient to help with the decision making for repairing the injury. ICA occlusion with a balloon was performed at the injury site in two cases, microcoils in two patients, microcoils plus a single barrel extra-intracranial high-flow bypass in one case, stent grafting in one case, and no intervention in two cases. The risk of ICA injury diminishes with better preoperative preparation, intraoperative navigation, and ultrasound dopplerography. Reconstructive surgery for closing the defect and restoring the blood flow to the artery should be assessed depending on the site of the injury and the anatomical features of the ICA.

SERUM D-DIMER AS A TOOL FOR ASSESSMENT OF SEVERITY IN PATIENTS OF ACUTE PANCREATITIS

2021 ◽  
pp. 8-10
Author(s):  
Vipul K. Srivastava ◽  
Rahul Khanna ◽  
Ramniwas Meena ◽  
Siddharth Khanna ◽  
Chandradeep Singh ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Degradation Products ◽  
Indirect Measure ◽  
Severity Of Disease ◽  
Classi Cation ◽  
Life Threatening ◽  
A Prospective Study ◽  
Time Of Presentation ◽  
Stable Molecule ◽  
D Dimer

Introduction: Acute Pancreatitis (AP) is a potentially life threatening disease with varying severity of presentation from mild pain to persistent organ failure. D-dimer is an indirect measure of brin degradation products. It is a stable molecule with half-life of 4-8 hours. Material &Method: This is a prospective study done on 60 patients of acute pancreatitis treated at Department of General Surgery, Sir Sunderlal Hospital IMS BHU Varanasi, UPfrom the period of 2016 to 2018. Patients with diagnosis of APas per revised Atlanta classication were taken and D-dimer level was assessed at the time of presentation and patients were followed to assess the severity of disease and outcome. The D-dimer values were correlated with the Glasgow-Imrie score as well as the CTseverity index (CTSI) Result: Median value of D-dimer was found to be 3.68 mg/IFEU among the cases and 0.3 mg/IFEU among healthy volunteers. D-dimer levels increased as per CTSI severity score ranging from 2.97 to >5.70 mg/IFEU along with increased mortality in patients whom D-dimer levels were found to be high. D-dimer also showed positive correlation with Glasgow–Imrie score. Conclusion: Determining the serum concentration of D-dimer on day of admission is helpful in earlier prediction and assessment of severity of AP.

Delayed appearance of a traumatic intracranial aneurysm

2001 ◽  
Vol 94 (4) ◽  
pp. 637-641 ◽  
Author(s):  
Mokbel K. Chedid ◽  
John R. Vender ◽  
Steven J. Harrison ◽  
Dennis E. McDonnell
Keyword(s):  
Vietnam War ◽  
Intracranial Aneurysms ◽  
Internal Carotid ◽  
Treatment Options ◽  
Artery Aneurysm ◽  
Imaging Studies ◽  
Content Type ◽  
Carotid Artery Aneurysm ◽  
Internal Carotid Artery Aneurysm ◽  
Traumatic Aneurysms

✓ Giant traumatic intracranial aneurysms are rare, and thus their incidence and clinical behavior are poorly understood. In most cases, traumatic aneurysms develop and become symptomatic within months following injury. The authors present the case of a 46-year-old war veteran, in whom a giant internal carotid artery aneurysm developed as a result of a penetrating cranial shrapnel injury sustained 25 years earlier during the Vietnam war. The aneurysm had not been evident on previous imaging studies. At surgery, a piece of shrapnel was found embedded in the dome of the aneurysm. The presentation, diagnosis, management, and treatment options related to this lesion are discussed.

Identifying child victims of the South-East Asia Tsunami in Thailand

2018 ◽  
Vol 27 (4) ◽  
pp. 447-455
Author(s):  
Kirsty Wright ◽  
Amy Mundorff ◽  
Janet Chaseling ◽  
Christopher Maguire ◽  
Denis I. Crane
Keyword(s):  
East Asia ◽  
Child Victims ◽  
South East Asia ◽  
Disaster Victim Identification ◽  
Content Type ◽  
Victim Identification ◽  
Identification Process ◽  
Missing Children ◽  
Large Numbers ◽  
Targeted Testing

Purpose The purpose of this paper is to reveal difficulties associated with identifying child victims of the 2004 South-East Asia Tsunami at the Thai Tsunami Victim Identification (TTVI) operation in Phuket and explores two strategies that increased child identifications. Design/methodology/approach Data allowing comparison of identification proportions between adult and child (defined as ⩽16 years old) victims of six nationalities and the forensic methods used to establish identification were used in this study. Findings The first 100 days of the operation revealed that the proportion of adult identifications far outweighed the proportion of child identifications. Moreover, the younger the child, the longer the identification process took (p<0.0001). Children under the age of 1 year took an average of 195 days to identify compared to 130 days for children aged 16. Identification was extended, on average, 4.3 days for each year that victims younger were than 16. Identifying large numbers of child victims requires targeted protocols. Two efforts increased child identifications for the TTVI operation: using body length to distinguish post-mortem (PM) DNA samples potentially belonging to children for targeted testing, and singling out deceased parents of missing children who were previously identified by a modality other than DNA, in order to retrieve and test their PM samples as references for kinship matching. Disaster victim identification operations with similar characteristics may benefit from implementing a strategy targeting child identifications. Originality/value The implementation of these two strategies at the TTVI helped to overcome initial complexities, namely, the lack of ante-mortem and PM material, and increased child identifications.

Pancreatic Adenocarcinoma in the Older Adult

2010 ◽  
Vol 06 ◽  
pp. 53
Author(s):  
Arlene A Gayle ◽  
Noelle K LoConte ◽  
◽  
Keyword(s):  
Older Adults ◽  
Clinical Research ◽  
Effective Treatment ◽  
Pancreatic Adenocarcinoma ◽  
Older Adult ◽  
Treatment Options ◽  
Medical Conditions ◽  
Future Directions ◽  
Large Numbers

Pancreatic adenocarcinoma is common among older adults, who may be more frail or have comorbid medical conditions that make treatment more challenging. Pancreatic adenocarcinoma is a lethal malignancy with relatively few effective treatment options. To date, most clinical research has not enrolled large numbers of older adults, despite this being the demographic predominantly affected by this illness. In this article, etiology and treatments for pancreatic adenocarcinoma are reviewed with a particular emphasis on studies that have examined matters relating to treating older adults; future directions for research are also explored.

Survival gains in multiple myeloma from 2003 to 2014.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 98-98
Author(s):  
Rafael Fonseca ◽  
Anupam B. Jena ◽  
Desi Peneva ◽  
Zoe Clancy
Keyword(s):  
Multiple Myeloma ◽  
Survival Data ◽  
Treatment Options ◽  
The United States ◽  
Novel Therapies ◽  
Full Sample ◽  
The Past ◽  
Improvement In Survival ◽  
Second Wave ◽  
Novel Agent

98 Background: Survival probabilities for patients with multiple myeloma have increased considerably over the past several decades, and a conservative estimate of 5-year survival today is approximately 50%, perhaps higher with optimal treatment. Treatment options for multiple myeloma have grown significantly beginning in 2003 with the approval of bortezomib, followed by approvals for lenalidomide and thalidomide in 2006. The second wave of novel agent approvals began in 2012 with carfilzomib, followed by pomalidomide in 2013. The aim of this study was to estimate the survival gains associated with multiple myeloma therapies after the introduction of novel therapies beginning in 2003 in the United States. Methods: We estimated survival gains for multiple myeloma patients diagnosed in the 5-year period from 2010-2014—who had access to newer therapies like lenalidomide, bortezomib, pomalidomide, and carfilzomib—compared with patients diagnosed in the 5 years prior to the approval of bortezomib (1998–2002). We used data from the Surveillance, Epidemiology, and End Results (SEER) Program cancer registry and a generalized gamma regression survival model. The sample from SEER included patients aged > 18 years who had a diagnosis of multiple myeloma between 1983 and 2014. Results: Of 88,462 patients identified in the full sample, 14,446 patients were diagnosed in 1998–2002 and 25,948 patients were diagnosed in 2010–2014. Overall survival was 51% longer ( P< 0.001) in multiple myeloma patients diagnosed in 2010–2014 than in patients diagnosed in 1998–2002. Patients diagnosed in 2010–2014 had median and mean survival of 1.32 and 2.27 years longer, respectively, than patients diagnosed in 1998–2002. Conclusions: Patients diagnosed with multiple myeloma during 2010–2014 had significant improvement in survival relative to patients diagnosed in 1998–2002. This study found continued improvement in survival in multiple myeloma patients in the most recent 5-years of survival data available, demonstrating the considerable progress made since the wave of multiple myeloma innovation began in 2003.

scholarly journals Stent Reconstruction of Carotid Tonsillar Loop Dissection Using Telescoping Peripheral Stents

2018 ◽  
Vol 7 (3-4) ◽  
pp. 189-195 ◽  
Author(s):  
Benjamin M. Zussman ◽  
Bradley A. Gross ◽  
William J. Ares ◽  
Cynthia L. Kenmuir ◽  
Gregory M. Weiner ◽  
...  
Keyword(s):  
Internal Carotid ◽  
Treatment Options ◽  
National Institutes Of Health ◽  
Modified Rankin Scale ◽  
Endovascular Techniques ◽  
Aspiration Thrombectomy ◽  
Patient Demographics ◽  
Clinical Presentations ◽  
Scale Scores

Background: Endovascular treatment options for internal carotid artery (ICA) dissection with tandem intracranial occlusion are evolving. We report 2 cases of stent reconstruction of carotid loop dissections. Methods: Two patients with symptomatic ICA dissections of true 360° tonsillar loops and tandem intracranial occlusions were treated with manual aspiration thrombectomy (MAT) and telescoping Zilver self-expanding peripheral stents. Patient demographics, clinical presentations, endovascular techniques, and clinical outcomes were reviewed. Results: In both cases, MAT achieved modified Treatment in Cerebral Ischemia scale 2B reperfusion, and complete endovascular reconstruction of the dissected extracranial loop was performed. Both patients had improved pre- to postintervention National Institutes of Health Stroke Scale scores (16 to 0 and 14 to 0), and both had modified Rankin scale scores of 1 at 3-month follow-up. Conclusions: Stent reconstruction of complex cerebrovascular anatomy is increasingly feasible with advancements in stent technology and catheter support system design. This technique may be of use to neuroendovascular surgeons who encounter variant ICA anatomy.

Liver cirrhosis: Child-Pugh grading of cases seen in Nigeria

2005 ◽  
Vol 35 (3) ◽  
pp. 169-171 ◽  
Author(s):  
D A Ndububa ◽  
O S Ojo ◽  
A O Aladegbaiye ◽  
R A Adebayo ◽  
V A Adetiloye ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Liver Disease ◽  
Hepatitis B ◽  
Chronic Liver Disease ◽  
Treatment Options ◽  
Diagnostic Procedures ◽  
Chronic Liver ◽  
Surgical Interventions ◽  
B Virus ◽  
Time Of Presentation

Child-Pugh grading is an important determinant of treatment options, surgical interventions and prognosis in chronic liver disease. Sixty-four liver cirrhosis patients (49 men, 15 women) seen at Ile-Ife, Nigeria were graded according to the Child-Pugh parameters. Only one (1.6%) was in Class A, while 21 (32.8%) and 42 (65.6%) were in Classes B and C, respectively. Thirty-four either had coagulopathy or were already in encephalopathy at the time of presentation. Hepatitis B virus-associated disease was present in 64% of the patients. Most Nigerian cirrhosis patients present with very advanced disease; they are thus poor-risk candidates for diagnostic procedures and surgery. Efforts should be intensified at making the diagnosis at a much earlier stage and universal immunization with the hepatitis B vaccine should be commenced to reduce the incidence of HBV-related chronic liver disease in Nigeria.

Clip reconstruction of an 8 cm giant internal carotid artery bifurcation aneurysm: microsurgical technique

2015 ◽  
Vol 38 (videosuppl1) ◽  
pp. Video20
Author(s):  
Ulas Cikla ◽  
Kutluay Uluc ◽  
Mustafa K. Baskaya
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Vasogenic Edema ◽  
Treatment Options ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Mass Effect ◽  
Carotid Artery Bifurcation ◽  
Bifurcation Aneurysm

Thrombosed giant intracranial aneurysms usually present with symptoms and signs from their mass effect. Although multiple treatment options are available, direct clip reconstruction with thromboendarterectomy remains the gold standard. Here we present a 66-year-old man with seizure, aphasia and hemiparesis. Work-up revealed a giant partially thrombosed aneurysm of the internal carotid artery bifurcation with surrounding vasogenic edema. He underwent clip reconstruction of the aneurysm via a cranio-orbital approach. Although we prepared for bypass with the radial artery and/or the superficial temporal artery, we were able to clip-reconstruct the aneurysm without bypass. The patient improved upon his pre-morbid state after surgery and made an excellent recovery.The video can be found here: http://youtu.be/P_10hRQFuPo.

Endovascular and Surgical Treatment of Internal Carotid Bifurcation Aneurysms

Neurosurgery ◽  
2015 ◽  
Vol 76 (5) ◽  
pp. 540-551 ◽  
Author(s):  
Juergen Konczalla ◽  
Johannes Platz ◽  
Nina Brawanski ◽  
Erdem Güresir ◽  
Stephanie Lescher ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Internal Carotid ◽  
Treatment Options ◽  
Carotid Bifurcation ◽  
Neurological Deficits ◽  
Bleeding Complications ◽  
Treatment Rate ◽  
Surgical Clipping ◽  
Aneurysm Neck

Abstract BACKGROUND: Aneurysms of the internal carotid artery (ICA) bifurcation are rare, and no studies have compared patient outcomes after endovascular vs surgical treatment. OBJECTIVE: To report the safety, efficacy, and follow-up outcome of these 2 treatment options for patients with ICA bifurcation aneurysms. METHODS: Patient and aneurysm characteristics, treatment results, and follow-up outcomes (at 30 months) were analyzed from patient records and review of imaging findings. RESULTS: A total of 58 patients with ICA bifurcation aneurysms were treated. By interdisciplinary consensus, 30 aneurysms were assigned for coiling and 28 for clipping. Patients who underwent surgical clipping were younger and had larger aneurysms. More patients were assigned to coiling if their aneurysms originated only from the ICA bifurcation or projected superiorly. For the combined angiographic endpoint, complete and nearly complete occlusion (Raymond-Roy I + II), similar rates of 96% (coiling) or 100% (clipping) could be achieved. Raymond-Roy I occlusion occurred more often after clipping (79% vs 41% coiling). Follow-up of the endovascular group showed minor recanalization of the aneurysm neck (Raymond-Roy II) in 42%. One patient (4%) showed a major recanalization (Raymond-Roy III) and needed re-treatment. For incidental findings, no bleeding complications or new persistent neurological deficits occurred during follow-up. CONCLUSION: Treatment of ICA bifurcation aneurysms after interdisciplinary assignment to clipping or coiling is effective and safe. Despite significantly more minor recanalizations after coiling, the re-treatment rate was very low, and no bleeding was observed during follow-up. Multivariate analysis revealed that origin only from the ICA bifurcation was an independent predictor of aneurysm recanalization after endovascular treatment.

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