Surgical Intervention for Enneking Stage-III Vertebral Hemangiomas and Literature Review

2021 ◽  
pp. 10
Author(s):  
Monerah Annaim
Keyword(s):  
Surgical Intervention ◽  
Treatment Protocol ◽  
Stage Iii ◽  
Spinal Tumors ◽  
Preoperative Embolization ◽  
Comprehensive Treatment ◽  
Treatment Protocols ◽  
Enneking Stage ◽  
Vertebral Hemangiomas

Introduction: Vertebral hemangiomas are benign, slow-growing tumors. They represent 2–3% of spinal tumors and are incidentally found. Various treatment protocols have been described for Enneking stage-III vertebral hemangiomas. However, it is still controversial and a comprehensive treatment protocol is still lacking. Methodology: A retrospective clinical review was conducted on patients diagnosed with Enneking stage-III vertebral hemangiomas at two centers in Riyadh, Saudi Arabia between 2010 and 2020. Result: A total of 11 patients with Enneking stage-III vertebral hemangiomas were included. The mean follow-up period was 47.5 ± 24.1 (9–120 months) months. All patients were symptomatic; the most common presentations were neurological deficit and/or myelopathy (n = 7). Ten patients underwent surgical intervention. Six patients had preoperative embolization, with a mean blood loss of 880.00 ± 334.46 ml. One patient refused surgery and underwent vertebroplasty and repeated sclerotherapy. All patients regained full neurological recovery during follow-up. No recurrence was reported. Conclusion: Intralesional spondylectomy showed good results in treating Enneking Stage-III vertebral hemangiomas. However, larger studies comparing treatment methods are needed to reach a gold standard approach.

scholarly journals Upregulating Positive Affectivity in the Transdiagnostic Treatment of Emotional Disorders: A Randomized Pilot Study

2017 ◽  
Vol 43 (1) ◽  
pp. 26-55 ◽  
Author(s):  
Alberto González-Robles ◽  
Azucena García-Palacios ◽  
Rosa Baños ◽  
Soledad Quero ◽  
Cristina Botella
Keyword(s):  
Emotional Disorders ◽  
Negative Affectivity ◽  
Treatment Protocol ◽  
Specific Treatment ◽  
Attrition Rate ◽  
Effect Sizes ◽  
Positive Affectivity ◽  
Treatment Protocols ◽  
Transdiagnostic Treatment

Transdiagnostic cognitive-behavioral therapy for emotional disorders (ED) has proven to be effective. However, current transdiagnostic treatment protocols address only the regulation of negative affectivity, and they do not include treatment components to more directly target the regulation of positive affectivity. In this study, we propose to evaluate the preliminary efficacy and acceptability of a transdiagnostic treatment protocol for ED that includes, as an innovative feature, a specific treatment component to directly upregulate positive affectivity based on positive psychology interventions. A total of 24 participants were randomized to either a transdiagnostic treatment protocol ( n = 12) or a transdiagnostic treatment protocol with an additional component designed to regulate positive affectivity ( n = 12). Participants completed measures of anxiety, depression, positive and negative affectivity, and quality of life, as well as treatment acceptability at pre- and posttreatment and at the 3-month follow-up. Both interventions led to improvements in all measures at posttreatment, and these outcomes were maintained at the 3-month follow-up, with large effect sizes for all measures. The effect sizes for positive affect were larger in the condition that included the component to upregulate positive affectivity. Attrition rate was low, and both treatment protocols were well accepted by participants. The results obtained in this study indicate the feasibility of testing the treatment protocol in a larger, randomized, controlled trial, and they suggest the potential of including treatment components for directly upregulating positive affectivity in future research on transdiagnostic treatment protocols for ED.

Equine non-healing corneal ulcers: a retrospective evaluation of 57 cases (2001–2017)

2020 ◽  
Vol 48 (02) ◽  
pp. 92-97
Author(s):  
Vera J. S. Prucha ◽  
Alexander Tichy ◽  
Barbara Nell
Keyword(s):  
Clinical Symptoms ◽  
Treatment Options ◽  
Treatment Protocol ◽  
Healing Time ◽  
Additional Treatment ◽  
Treatment Protocols ◽  
Corneal Ulcers ◽  
Recorded Data ◽  
Inflammatory Drugs

Abstract Background and objectives Non-healing corneal ulcers (NHCU) are a common problem in equine practice and several treatment options are available with different success and healing times. The aim of this retrospective study was to evaluate and to compare treatment protocols, clinical courses, corneal healing time and outcomes of NHCU. Methods From December 2001 to December 2017, a total of 57 horses with NHCU were presented at the Vetmeduni Vienna. Recorded data included affected eye, signalment, clinical symptoms, season of diagnosis, treatment protocols, complications and corneal healing rate. Results Sixty-three eyes were diagnosed with a NHCU. Follow-up information was available for 48/63 eyes. For those treated medically mean corneal healing time was 15.7 days (± SD 12.0). Medical treatment included topical antibiotics, antimycotics, cycloplegics, and systemic anti-inflammatory drugs. Twelve eyes received treatment with a poly-carboxymethylglucose-sulfate regenerating agent (Cacicol®; Thea Pharma GmbH, Wien, Austria). Other common additional treatments included debridement with an iodine drenched cotton tip (48 eyes; 76.2 %) and diamond burr debridement (30 eyes; 47.6 %). A bandage contact lens (BCL) was used for 10 eyes. Each eye received at least one additional treatment, although none of them led to a statistically significant alteration in healing time. Only usage of a BCL significantly increased healing time when compared to not using a BCL (p = 0.035). When all treatments failed, superficial keratectomy with placement of a conjunctival flap was performed. Secondary complications included stromal cellular infiltration, keratomycosis, keratomalacia, and corneal abscess formation. Conclusions Results correlated with those previously described and thus demonstrated the difficulty and complexity of this disease. Further research is needed to determine an optimal treatment protocol for non-healing ulcers in horses. Clinical relevance Since NHCUs are a commonly encountered problem in equine practice a reliable treatment protocol is required. This study reflects the problems with those ulcers and provides several protocols for possible treatments.

scholarly journals Rapidly Progressive Myelopathy Caused by Aggressive Vertebral Hemangioma

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Kevin A. Moattari ◽  
Rojeh Melikian ◽  
Sanjay K. Khurana
Keyword(s):  
Incidental Findings ◽  
Surgical Intervention ◽  
Rapid Development ◽  
Disease Recurrence ◽  
Benign Tumors ◽  
Vertebral Hemangioma ◽  
Radiological Findings ◽  
Progressive Myelopathy ◽  
Vertebral Hemangiomas

Introduction. Vertebral hemangiomas are the most common benign tumors of the spine, having an incidence of 10-12% in the general population. They are asymptomatic, incidental findings in the vast majority of patients; however, in rare cases, they can expand to cause neural compression. Aggressive lesions of this sort are most commonly found in the thoracic spine, and expansion leads to the subacute development of myelopathy. Case Report. The authors report a rare case of aggressive vertebral hemangioma at the T1 vertebral body which caused rapidly progressive myelopathy over the course of 7 days. Clinical and radiological findings are shown as well as surgical management of the lesion. The patient regained the ability to ambulate, and there was no evidence of disease recurrence at 2-year follow-up. Conclusions. Although aggressive vertebral hemangiomas are a rare cause of myelopathy, they must be kept in mind in the differential diagnosis of cord compressive lesions. In this case, contrary to most, the expansion of the hemangioma led to rapid development of neurological decline necessitating urgent surgical intervention.

Complete and Very Good Partial Responses Are Attainable Endpoints in Elderly Patients (>75 years) with AL Amyloidosis and Are Associated with Improved Overall Survival,

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3975-3975
Author(s):  
Christopher P. Venner ◽  
Julian D Gillmore ◽  
Thirusha Lane ◽  
Darren Foard ◽  
Lisa Rannigan ◽  
...  
Keyword(s):  
Overall Survival ◽  
Partial Response ◽  
Elderly Patients ◽  
Response Assessment ◽  
Stage Iii ◽  
Comprehensive Treatment ◽  
Al Amyloidosis ◽  
Line Therapy ◽  
The Uk

Abstract Abstract 3975 Background: Elderly patients with AL amyloidosis present a unique therapeutic challenge. Both the disease itself and other co-morbidities contribute to organ dysfunction, potentially limiting treatment options. Despite this, durable responses can be achieved leading to both improvements in quality and longevity of life. Here we present our experience with patients > 75 years (yrs) enrolled in the UK-wide ALchemy study. Patients and Methods: ALchemy was designed to collect comprehensive treatment, outcome and toxicity data in newly diagnosed patients attending the National Amyloidosis Centre in the UK. Analysis of prospectively collected data revealed 46 pts > 75 yrs who were enrolled in the study beginning in 2009. 8 patients still alive at last assessment but having < 3m follow-up were excluded. Haematologic response was defined as per the 2005 consensus criteria. The dFLC response (difference between the involved and uninvolved free light chain) was defined as the percent difference in the dFLC at the start of therapy and at response assessment and was considered assessable if the baseline dFLC was >50mg/L. A dFLC between 50–90% defined a partial response (PR) and a dFLC of >90% defined a very good partial response (VGPR). The analysis was performed on an intention-to-treat basis and patients who died prior to response assessment were defined as non-responders. Overall survival (OS) was calculated by the Kaplan-Meier method and calculated from diagnosis until death or last follow-up. Results: The final cohort comprised 38 patients. Median age was 78.0 years. Median follow-up was 8.7 months (m). 37 patients had complete information for Mayo staging and 37% were stage III. 3 patients did not receive therapy. 20 patients received CTD as first line therapy, 4 received Mel/Dex, 4 received MPT, 1 received CVD, 3 received CD, 1 received RCD and 2 received CVP-R given baseline IgM secreting clonal B-cell lymphoproliferative disorders. 46% received less than 4 cycles of the planned upfront therapy. Overall response rate (RR) was 68% (11% attained a CR). 65% attained a partial dFLC response and 22% attained a VGPR. 9 patients received second line therapy. 5 were treated for relapsed disease, none of whom bettered their previous haematologic response but 2 patients attained a VGPR. Of the 4 patients who were treated for sub-optimal response none bettered their previous response. A correlation between receiving at least 3 cycles of therapy and attaining a CR or VGPR was observed (correlation coefficient 0.23, P = 0.09 and 0.42, P = 0.009 respectively). Median OS for the entire cohort was 10.7m. 45% died within one year of diagnosis. Median OS for Mayo stage III patients was 6.2 months. Attaining a VGPR by dFLC criteria correlated with a statistically significant improvement in OS compared with patients who did not achieve this milestone (median not reached vs 9.8m respectively; P = 0.016). A similar trend in OS was seen in patients who attained a CR but this did not reach statistical significance (median not reached vs 9.8m respectively; P = 0.192). Discussion: Treatment of elderly patients with AL amyloidosis remains a challenge. From our analysis despite receiving standard of care, median OS is < 1 year. However, based on this study appropriate treatment resulted in both attainment of CRs and VGPRs. Both endpoints are important treatment milestones previously shown to correlate with improved survival, and this is further corroborated here. Median OS was not reached in patients achieving either a CR or VGPR. Unfortunately, CR and VGPR rates remain < 25% in this population and it appeared that at least one factor is the inability to complete 3 cycles of treatment. Further study examining this distinct group of patients is warranted with the aim to develop therapeutic regimens balancing both effectiveness and tolerability. Disclosures: No relevant conflicts of interest to declare.

Multiple vertebral hemangiomas with neurological signs

1992 ◽  
Vol 76 (6) ◽  
pp. 1025-1028 ◽  
Author(s):  
Michel Djindjian ◽  
Jean-Paul Nguyen ◽  
André Gaston ◽  
Jean-Marc Pavlovitch ◽  
Jacques Poirier ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Postoperative Radiotherapy ◽  
Surgical Decompression ◽  
Preoperative Embolization ◽  
Postoperative Radiation Therapy ◽  
Content Type ◽  
Satisfactory Outcome ◽  
Progressive Neurological Deficit ◽  
Vertebral Hemangiomas

✓ A case of multiple vertebral hemangiomas with progressive neurological deficit is presented. Successful treatment was accomplished using preoperative embolization, palliative surgical decompression, and postoperative radiation therapy. The patient has remained asymptomatic for 6 years. The authors review the role of current imaging modalities and options for therapeutic intervention. Preoperative embolization, palliative surgical decompression, and postoperative radiotherapy appear to provide a satisfactory outcome in patients with multiple hemangiomas and may represent an effective alternative to more aggressive surgical intervention.

scholarly journals Diagnosis and treatment of pediatric subglottic stenosis: evaluation of our treatment protocol

2020 ◽  
Vol 6 (3) ◽  
pp. 489
Author(s):  
Sanajeet Kumar Singh ◽  
Roohie Singh ◽  
Sunil Goyal ◽  
Ravi Roy ◽  
D. K. Gupta ◽  
...  
Keyword(s):  
Balloon Dilatation ◽  
Surgical Intervention ◽  
Treatment Protocol ◽  
Subglottic Stenosis ◽  
Management Scheme ◽  
Laryngotracheal Reconstruction ◽  
Grade Ii ◽  
A Prospective Study ◽  
Partial Cricotracheal Resection

<p class="abstract"><strong>Background:</strong> The aim was to describe our experience in management of pediatric subglottic stenosis and formulate a management scheme based on our experience.</p><p class="abstract"><strong>Methods:</strong> A prospective study and follow-up was conducted in children diagnosed with subglottic stenosis (SGS) (both congenital and acquired) from January 2016 to January 2019 (36 months). We have proposed further subcategorization of each grade of SGS into mild and severe depending on absence or presence of the described “hard signs” respectively.  </p><p class="abstract"><strong>Results:</strong> A total of 28 patients with SGS were identified. 8 had congenital while 20 had acquired SGS. There were 16 cases of grade II, 7 cases of grade III and 5 cases of grade I stenosis. None had grade 4 stenosis. Most common surgical intervention was microlaryngoscopy and bronchoscopy which had both diagnostic and therapeutic role (in conjunction with other intervention). Other interventions were balloon dilatation, combined laser and balloon dilatation, anterior cricoid split, laryngotracheal reconstruction and Partial cricotracheal resection. As of July 2019, overall recovery rate was 89.2% and decannulation rate was 81.2%. One patient succumbed to death due to because unrelated to SGS. Two patients are still under follow-up.</p><p class="abstract"><strong>Conclusions:</strong> Number of procedures increases with increasing severity of stenosis. Further subcategorization of SGS as mild or severe guides in selecting endoscopic or open surgical management scheme. The type of procedure for each patient needs to be tailored according to requirement.</p>

scholarly journals Traumatic Palatal Defect Closure With Prosthesis Post Surgical Reconstruction: A Team Approach

1970 ◽  
Vol 1 (5) ◽  
Author(s):  
Nungki Ratna Martina ◽  
Prasetyanugraheni Kreshanti ◽  
Siti Handayani ◽  
Kristaninta Bangun
Keyword(s):  
Congenital Malformations ◽  
Surgical Intervention ◽  
Functional Restoration ◽  
Surgical Reconstruction ◽  
Comprehensive Treatment ◽  
Team Approach ◽  
Prosthetic Design ◽  
Aesthetic Outcome ◽  
Palatal Defect

Background: Palatal defect may be a result of congenital malformations, trauma or tumors. In most maxillopalatal trauma, surgical reconstruction is required to restore the function and appearance. Any palatal defect caused by maxillopalatal loss that cannot be achieved with surgical reconstruction needs special and comprehensive treatment. This can be done by prosthodontist prosthesis rehabilitation.Patients and Methods: A 20-year-old man underwent open reduction and internal fixation for severe maxillopalatal fracture and palatal loss. Intraoperative, the palatal defect could not be approximated due to palatal loss. In 3-month-follow up, there was a palatal defect and slight malocclusion due to anterior dental loss. Instead of performing complicated surgical procedures, we collaborate with the prosthodontist to assemble prosthesis with dental prosthesis that accommodate the closure of defect and improve appearance aesthetically. Result: The use of prosthesis improves functional and psychological wellbeing. It does not only close the palatal defect, but it also fills the anterior dental loss thus overcoming the malocclusion. Satisfying functional and aesthetic outcome was achieved. Summary: Rehabilitation of maxillopalatal defect has been well defined for prosthodontists and surgeons. A successful prosthetic design for functional restoration of the palatal defect utilizes the remaining palate and dentition to maximize the support, stability and appearance. In this case,prosthodontist and dentition prosthesis was used as modalities that offer simple solution to close the palatal defect compared to a more complicated surgical intervention.

Painful Heel Syndrome: Results of Nonoperative Treatment

1994 ◽  
Vol 15 (10) ◽  
pp. 531-535 ◽  
Author(s):  
Pamela F. Davis ◽  
Erik Severud ◽  
Donald E. Baxter
Keyword(s):  
Treatment Outcome ◽  
Surgical Treatment ◽  
Surgical Intervention ◽  
Treatment Protocol ◽  
Nonoperative Treatment ◽  
Heel Pain ◽  
Heel Spur ◽  
Stretching Exercises ◽  
Painful Heel

One hundred five patients (70% female and 30% male; average age, 48 years) with 132 symptomatic heels were treated according to a standard nonoperative protocol and then reviewed at an average follow-up of 29 months. The treatment protocol consisted of nonsteroidal anti-inflammatory medications, relative rest, viscoelastic polymer heel cushions, Achilles tendon stretching exercises, and, occasionally, injections. Obesity, lifestyle (athletic versus sedentary), sex, and presence or size of heel spur did not influence the treatment outcome. Ninety-four patients (89.5%) had resolution of heel pain within 10.9 months. Six patients (5.7%) continued to have significant pain, but did not elect to have operative treatment, and five patients (4.8%) elected to have surgical intervention. Despite attention to the outcome of surgical treatment for heel pain in the current literature, initial treatment for heel pain is nonoperative. The treatment protocol used in this study was successful for 89.5% of the patients.

Fifty-Patient Study Evaluating the Efficacy of Modified Collagen With Glycerin in Periwound Skin Management

2018 ◽  
Vol 17 (1) ◽  
pp. 54-61 ◽  
Author(s):  
Harikrishna K. R. Nair
Keyword(s):  
Wound Healing ◽  
Large Scale ◽  
Standard Treatment ◽  
Treatment Protocol ◽  
Complete Healing ◽  
Diabetic Patients ◽  
Treatment Protocols ◽  
Compression Bandaging ◽  
Complete Wound Healing

The management of chronic nonhealing ulcers pose a great challenge because they are associated with morbidity and increased costs. This report presents the observations of standard management along with application of modified collagen with glycerin (MCG) in the periwound area for management of nonhealing wounds. This observational report included 50 patients (33 male, 17 female) aged 24 to 94 years having nonhealing wounds. All wounds were treated using standard treatment protocols (TIME concept), whereas the periwound severity was assessed using the Harikrishna Periwound Skin Classification (HPSC). All patients received once-daily application of MCG lotion directly in the periwound areas and compression bandaging until there was complete wound healing. Patient compliance was ensured by regular follow-up and counseling. All diabetic patients were counseled to ensure glycemic control during the entire follow-up period. The criteria used for wound healing were based on clinical observation, and proper epithelialization of the wound was the end point. The median age of the wounds was 12.0 weeks (95% CI = 8.00 – 58.08). Majority of the non-healing wounds were diabetic foot ulcers with age of wound between 4 weeks to 15 years. The median time to complete wound healing was 12.71 (95% CI = 10.00-16.67) weeks. Standard treatment protocol of TIME principle with periwound area assessment based on HPSC 2015 and treatment accordingly with topical application of MCG along with additional measures has shown complete healing of nonhealing wounds. However, further large-scale comparative studies are needed to substantiate these effects on a larger population.

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