scholarly journals Cirurgia no Aspergiloma Pulmonar: Experiência Mono-Institucional

2014 ◽  
Vol 27 (4) ◽  
pp. 417
Author(s):  
Silvia Da Silva Correia ◽  
Carlos Pinto ◽  
João Bernardo
Keyword(s):  
Postoperative Complications ◽  
Surgical Resection ◽  
Surgical Procedure ◽  
Lung Resection ◽  
Previous History ◽  
Term Treatment ◽  
High Rate ◽  
Long Term Treatment ◽  
Immunosuppressed Patients ◽  
Pulmonary Aspergilloma

<strong>Introduction:</strong> Pulmonary aspergiloma or mycetoma is a saprophytic colonization of a preexisting cavity by aspergilloma. Surgical resection is the only effective long-term treatment, but remains controversial because of the high rate of complications in the perioperative and postoperative time.<br /><strong>Objectives:</strong> Analysis of the experience of a Cardiothoracic Surgery Center for the treatment of pulmonary aspergilloma and evaluation of the prognostic factors after surgery.<br /><strong>Material and Methods:</strong> Retrospective analysis including all the patients with a diagnosis of pulmonary aspergilloma submitted to surgery for a 10 years period, in a single institution (June 2001-June 2011).<br /><strong>Results:</strong> The study included 22 patients (18 men) with a mean age of 51.0 + 17.4 years. Of them, 46% were smokers, 41% were alcoholic and 50% had a previous history of tuberculosis. Most of the patients had a complex aspergilloma (73%) and 17% a simple aspergilloma. The most common presentation was hemoptysis (50%). The common surgical procedure performed was atypical lung resection in 55%, lobectomy in 27% and pneumectomy in 9%. Two patients were submitted to thoracoplasty. There was one operative death (5%). Postoperative complications occurred in 36% and the most frequent were pneumothorax (18%) and empyema (18%). The mean follow-up period was 52 months (3 - 116) and the 5 years mortality rate of 35%. Of them, 4 patients died because of non- related causes and 3 were immunosuppressed patients. The mortality was 40% in the group of complex aspergilloma and 33% in the group of complex aspergilloma.<br /><strong>Discussion:</strong> The most common surgical procedure performed was atypical lung resection. The postoperative complications rate was similar to previous studies.<br /><strong>Conclusion:</strong> Surgical resection of aspergilloma presents a low morbidity and mortality. Therefore, for patients with lung function preserved, it is the preferred treatment.<br /><strong>Keywords:</strong> Aspergillus; Pulmonary Aspergillosis/surgery.

scholarly journals Report of a Young Female With Severe Abdominal Pain: Mesenteric Venous Thrombosis

2020 ◽  
Author(s):  
Ahmad Hormati ◽  
Faezeh Alemi ◽  
Rouhollah Taghavi ◽  
Mohammadreza Ghasemian ◽  
Mahsa Besharati
Keyword(s):  
Abdominal Pain ◽  
Venous Thrombosis ◽  
Young Female ◽  
Term Treatment ◽  
Severe Abdominal Pain ◽  
High Rate ◽  
Oral Contraceptive Pills ◽  
Delay In Diagnosis ◽  
Long Term Treatment ◽  
Drug History

Mesenteric ischemia is a rare disease with a high rate of mortality because of the non-specific symptoms which lead to delay in diagnosis and intervention. The main symptom is abdominal pain, which has a broad list of differential diagnoses. This study introduces a 17-year-old girl who presents to the emergency department with severe abdominal pain and hematemesis. Further evaluations revealed thrombosis in the mesenteric vein which leads to ischemia and gangrene of the small intestine. Her past medical history and drug history were negative, except she was taking levonorgestrel and cyproterone acetate for a 5 months period. Since long-term treatment with oral contraceptive pills, counts as a risk factor for venous thrombosis, this case seems to be uncommon. © 2019 Tehran University of Medical Sciences. All rights reserved. Acta Med Iran 2019;57(7):468-470.

Dabigatran Reversal with Idarucizumab in an Emergency Lumbar Puncture: A Case Report

2019 ◽  
Vol 14 (1) ◽  
pp. 40-42 ◽  
Author(s):  
Ornella Spagnolello ◽  
Federica Letteri ◽  
Anne Falcou ◽  
Lorena Cipollone ◽  
Manuela De Michele ◽  
...  
Keyword(s):  
Lumbar Puncture ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Previous History ◽  
Antibody Fragment ◽  
Invasive Procedure ◽  
Bleeding Risk ◽  
Term Treatment ◽  
Emergency Setting ◽  
Long Term Treatment

Introduction: The widespread use of direct oral anticoagulants (DOACs) has been increasing the conditions in which emergency physicians are forced to rapidly reverse anticoagulation in case of life-threatening bleeding or need of urgent surgery or invasive procedures. The recent approval of Idarucizumab, a humanized monoclonal antibody fragment (Fab), offered the opportunity to rapidly and safely neutralize the anticoagulant effect of Dabigatran. However, real-world experience of its effective use in different emergency setting is now required. Lumbar Puncture (LP) is recognized as an invasive procedure at major bleeding risk and is, therefore, contraindicated in anticoagulated patients. Conclusion: We report a successful use of Idarucizumab in an emergency LP of a young woman with a possible diagnosis of encephalitis and a previous history of venous thromboembolism on long-term treatment with Dabigatran 150 mg twice a day.

Long-term effects of ibrutinib on blood pressure in patients with chronic lymphocytic leukemia (CLL).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e19009-e19009 ◽  
Author(s):  
Jade Jones ◽  
Binsah George ◽  
Christine B Peterson ◽  
Jan Andreas Burger ◽  
Nitin Jain ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Tobacco Use ◽  
Term Treatment ◽  
Lymphocytic Leukemia ◽  
High Rate ◽  
Long Term Effects ◽  
Obstructive Sleep ◽  
Long Term Treatment

e19009 Background: Ibrutinb is approved for treatment of CLL. Hypertension (HTN) has been reported as a side effect of ibrutinib in 1-23% of patients. We previously reported HTN in CLL patients after 6 months of treatment with ibrutinib. In this study we describe the effects of long-term treatment with ibrutinib on blood pressure (BP). Methods: We performed a retrospective study, evaluating 150 CLL patients on ibrutinib-based clinical trials from 2010 to 2015. Patient demographics, co-morbidities, tobacco use, anti-HTN therapy were recorded. BP was evaluated at baseline and sequentially for up to 5 yrs. New onset HTN was defined as systolic BP (SBP) of ≥ 130 mmHg and/or diastolic BP (DBP) ≥ 80 on two separate visits with no prior HTN or anti-HTN therapy. An increase in baseline SBP by ≥10 and/or increase in DBP by ≥10 was considered significant regardless of the absolute BP. Univariate logistic regression analysis was performed to assess relationship of HTN risk factors and new HTN. Results: Patients’ median age was 65 yrs (68% male and 88% white). Median follow-up was 3 yrs. Pre-existing HTN was present in 44% of patients, 40% were on anti-HTN therapy prior to ibrutinib. New HTN developed in 65% of patients without prior diagnosis of HTN; 32 % of patients were started on anti-HTN therapy or received additional anti-HTN therapy. Of the patients who experienced an increase in BP, 33% experienced isolated systolic HTN. Median SBP was 130 at baseline, 132 at 1mo, 137 at 3mo, 135 at 6mo, 139 at 12mo, 138 at 3yrs, 144 at 5yrs (mean increase in SBP: 7.2, P < 0.001). In patients whose SBP was < 130 at baseline the median SBP was 119 at baseline, 122 at 1mo, 134 at 3mo, 130 at 6mo, 134 at 12mo, 135 at 3yrs and 141 at 5yrs (mean increase in SBP: 15.7, p < 0.001). 74% of patients experienced and increase in SBP ≥10. New HTN on ibrutinib was not associated with: tobacco use, obesity, chronic kidney disease or obstructive sleep apnea (p > 0.05). Conclusions: In this study we demonstrated a high rate of new HTN in patients on prolonged ibrutinib treatment. HTN in these patients is persistent, linear and independent of other risk factors. The increase in BP remained despite initiation of anti-HTN therapy. Additional studies are ongoing to define cardiovascular and renal complications associated with HTN in these patients.

scholarly journals Results of treatment of congenital clubfoot after soft tissue release in children

2020 ◽  
pp. 81-85
Author(s):  
O. Holubenko ◽  
◽  
A. Levytskyi ◽  
O. Karabenyuk ◽  
◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Surgical Techniques ◽  
Term Treatment ◽  
Soft Tissue Release ◽  
Idiopathic Clubfoot ◽  
Congenital Clubfoot ◽  
Cuboid Bone ◽  
Long Term Treatment ◽  
Plaster Casts

Topicality. Widespread use of the method of I. Ponseti allows to significantly reduce the number of reconstructive surgeries and/or reduce their volume. However, if presence the rigid, severe deformities that cannot be corrected with staged plaster casts, or recurrences, surgical treatment is advisable. The literature describes many surgical techniques, the main purpose of which is to reduce the frequency of postoperative complications. And at the same time find the most convenient access to eliminate contractures, further wound healing by primary tension with minimal formation of connective tissue elements. Objective: to reduce the incidences of complications in the surgical treatment of congenital clubfoot by using a modified surgical approach. Materials and methods. In the Department of Orthopedics and Traumatology of NCSH «OKHMATDYT» 57 children (72 feet) with a diagnosis of congenital clubfoot underwent surgical treatment using a modified Carroll approach for the period from January 2014 to September 2018. The mean age of patients was 3±0.4 years. 41 of them boys and 16 girls. Bilateral deformity was observed in 12 patients. 48 patients (58 feet) were underwent surgical treatment after initial treatment with staged plaster casts according to the method of I. Ponseti. Recurrences of deformity after surgery was observed in 9 patients (14 feet). Results. When assessing the immediate results during surgery in all patients, complete correction of foot deformity was achieved. No postoperative complications were noted. Long-term treatment results 2 years after surgery showed that good results were in 12 patients (21±9.53%), satisfactory in 39 (68.4±27.14%) and unsatisfactory in 6 (7±2.18%). Four patients with unsatisfactory results and residual manifestations of deformity in the form of passively corrected isolated adduction of the anterior foot, subsequently underwent surgery to transplant the anterior tibialis tendon to the lateral cuneiform bone. And 2 patients – wedge-shaped resection of the cuboid bone. Indication of which was not the possibility of passive correction of deformity. Conclusions. The comparative analysis of the obtained results and literature data testifies to the effectiveness of the proposed method of treatment of idiopathic clubfoot in children (using three approaches), as well as in the presence of residual deformity after conservative and surgical treatment. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of participating institution. The informed consent of the patient was obtained for conducting the studies. Key words: clubfoot, children, posteromedial release, surgical treatment.

scholarly journals Hamlet’s augury: how to manage discontinuation of mood stabilizers in bipolar disorder

2021 ◽  
Vol 11 ◽  
pp. 204512532110006
Author(s):  
Mutahira M. Qureshi ◽  
Allan H. Young
Keyword(s):  
Bipolar Disorder ◽  
Treatment Guidelines ◽  
Term Treatment ◽  
Mood Stabilizers ◽  
High Rate ◽  
Future Research ◽  
High Quality Research ◽  
Medication Discontinuation ◽  
Long Term Treatment

Research has generated good quality evidence about the treatment and management of bipolar disorder in acute and, to some degree, sub-acute/continuation phases. This has informed various guidelines about the treatment and management of bipolar disorder (BD). However, for the long-term or maintenance phase of illness, most guidelines peter out and, in the absence of sufficiently high-quality research evidence, remain vague. This is particularly evident for the important clinical question of discontinuing mood stabilizing pharmacological agents after a period of remission has been achieved. The aim of this review is to put together current existing evidence about discontinuing mood stabilizers after a period of remission in order to come up with a structured and coherent strategy for managing such discontinuation and to make recommendations for future research. To this end, we reviewed the main relevant treatment guidelines and subsequent evidence following the publication of these guidelines. The current recommended long-term treatment of BD is usually considered within the same principles applicable to any chronic health condition (e.g. hypertension or diabetes) where the focus is on continuing treatment at minimum effective medication dose often life-long, switching to alternative choice of medication due to side-effects and very few, if any, indications for complete cessation. However, in the absence of strong evidence on long-term treatment and the high rate of non-concordance in BD, medication discontinuation is a very important aspect of the treatment that should be given due consideration at every aspect of the treatment.

scholarly journals Metyrapone for Long-Term Medical Management of Cushing’s Syndrome

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Andrea N. Traina ◽  
Ashley Farr ◽  
Ritu Malik ◽  
Robert J. Bingham
Keyword(s):  
Surgical Resection ◽  
Cushing’S Syndrome ◽  
Treatment Options ◽  
Cushing's Syndrome ◽  
Term Treatment ◽  
Significant Morbidity ◽  
Short Term ◽  
Short Term Treatment ◽  
Long Term Treatment

Cushing’s syndrome is characterized by any cause of excess cortisol in the blood and produces many physiologic consequences. Left untreated, Cushing’s is associated with significant morbidity and mortality. Seventy percent of endogenous cases of Cushing’s syndrome are secondary to a pituitary tumor; because of this, the primary mode of management is surgical resection of the tumor. Should hypercortisolism persist following surgical resection, further treatment options are limited. Metyrapone is an orphan medication that is often used in the diagnosis of the disease and occasionally for short-term treatment prior to surgery. Long-term treatment with metyrapone is usually discouraged due to the contradictory increase in ACTH production, acne, hirsutism, hyperkalemia, edema, and other mineralocorticoid effects. We present a patient with refractory Cushing’s syndrome successfully treated for nearly 6 years with metyrapone with minimal adverse effects. This orphan medication may be a viable long-term treatment option for this difficult disease.

scholarly journals Surgical Resection of a Presacral Solitary Fibrous Tumor with Extension to Iliac Vessels using Karakousis’s Abdominoinguinal Approach: Report of a Rare Case

2021 ◽  
Author(s):  
Diana A. Pantoja Pachajoa ◽  
René M. Palacios Huatuco ◽  
Gabriela Sambuelli ◽  
Germán Viscido ◽  
Alejandro M. Doniquian ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Solitary Fibrous Tumor ◽  
Term Treatment ◽  
Histopathological Study ◽  
Presacral Space ◽  
Lumbosacral Region ◽  
Pelvic Tumors ◽  
Long Term Treatment ◽  
Show Evidence ◽  
Fibrous Tumor

Abstract Background: The solitary fibrous tumor (SFT) is a rare tumor of mesenchymal origin, with a reported incidence of 2.8 cases per 100.000 tumors and with distinctive histopathological and immunohistochemical characteristics. It was initially described as a pleural lesion and subsequently, it was found in different organs and tissues. The abdominoinguinal incision described by Karakousis allows a radical reliable approach for abdominal-pelvic tumors in lower quadrants. We present the case of a patient with a presacral STF extending to iliac vessels, which required the Karakouis’s approach for its surgical resection.Case Presentation: Forty-seven-year-old man with pain in lumbosacral region radiating to left leg since 5 months. MRI and CT show evidence of a 10cm-retroperitoneal mass (presacral space) extending to left iliac vessels. The early diagnosis corresponded to a sarcomatous retroperitoneal tumor. It was decided to carry out the abdominal scan through the Karakousis’s approach for surgical resection with permanent neurovascular control. The immunohistochemistry and histopathological study revealed a CD-34 positive spindle-cell neoplasia, vimentin, Bcl-2, and β-catenin, compatible with a SFT. It was categorized as low risk for developing metastasis and death from disease, according to the new criteria for malignancy. At present, the patient is asymptomatic and disease-free at 17 months after surgery.Conclusion: Presacral SFT is a rare entity, with a scant incidence reported regarding this location and long-term treatment. Surgical resection is needed as the immediate treatment.

Pulmonary aspergilloma: surgical outcome of 79 patients in a Moroccan center

2019 ◽  
Vol 27 (6) ◽  
pp. 476-480 ◽  
Author(s):  
Hicham Harmouchi ◽  
Marouane Lakranbi ◽  
Ibrahim Issoufou ◽  
Yassine Ouadnouni ◽  
Mohammed Smahi
Keyword(s):  
Therapeutic Option ◽  
Lung Resection ◽  
High Rate ◽  
Pulmonary Aspergilloma ◽  
Functional Sign ◽  
The Mean ◽  
The Right ◽  
Anatomic Lung Resection ◽  
Clotted Hemothorax

BackgroundPulmonary aspergilloma presents in two clinical and radiological forms: simple and complex aspergilloma. Surgery is the best therapeutic option, most often by anatomic lung resection. Our aim was to report the surgical outcomes according to our experience.MethodsA retrospective study was conducted on data of 79 patients operated on for pulmonary aspergilloma over a period of 10 years. There were 57 (72.15%) men and 22 women (27.84%), with a mean age of 40.45 years.ResultsTuberculosis, all-form combined, was the predominant pathological antecedent in 57 (72.15%) patients, and hemoptysis was the most frequent functional sign in 43 (54.43%). The right side was involved in 39 (49.36%) patients. All patients were operated on via a posterolateral thoracotomy, and an extrapleural plane was necessary in 40 (50.63%). The surgical procedure was a lobectomy in 38 (48.10%) patients and a pneumonectomy in 14 (17.72%). Transfusion of red blood cells was carried out in 10 (12.65%) patients, with one (1.26%) requiring a rethoracotomy for postoperative clotted hemothorax. Two (2.53%) patients presented with empyema after pneumonectomy. The mortality rate was 2.53% (2 patients), and the mean follow-up was 2.5 years.ConclusionSurgery for pulmonary aspergilloma is associated with a high rate of morbidity and mortality. This surgery has been performed in our department with a very acceptable rate of mortality, especially considering that all patients were operated on by open surgery.

Flunarizine in Migraine Prophylaxis: Predictive Factors for A Positive Response

Cephalalgia ◽  
1998 ◽  
Vol 18 (6) ◽  
pp. 349-352 ◽  
Author(s):  
C Lucetti ◽  
A Nuti ◽  
N Pavese ◽  
G Gambaccini ◽  
G Rossi ◽  
...  
Keyword(s):  
Family History ◽  
Predictive Factors ◽  
Positive Family History ◽  
Previous History ◽  
Low Frequency ◽  
Term Treatment ◽  
Migraine Prophylaxis ◽  
Long Term Treatment ◽  
History Of ◽  
Negative Factors

The efficacy of flunarizine in migraine prophylaxis is confirmed in both open and controlled trials. However, it is unknown what factors may influence a good response to prophylaxis with flunarizine. The aim of this study was to determine the possible predictive factors for therapeutic responsiveness to 3 months' treatment with flunarizine. One-hundred headache patients treated with flunarizine were evaluated. We considered “responders” those patients who recorded a reduction in migraine frequency of 75% after treatment. Statistical analysis revealed four factors which might influence therapeutic responsiveness in our patients. Positive factors were a family history ( p<0.01) and high intensity of pain ( p<0.01); negative factors were frequent attacks ( p<0.01) and a history of analgesic abuse ( p<0.001). Patients with no previous history of analgesic abuse, low frequency of attacks at baseline, higher levels of migraine pain, and positive family history constitute the prototype of flunarizine long-term treatment responders.

Hypnotherapy is effective in the long-term treatment of functional dyspepsia

2001 ◽  
Vol 120 (5) ◽  
pp. A115-A115 ◽  
Author(s):  
E CALVERT ◽  
L HOUGHTON ◽  
P COOPER ◽  
P WHORWELL
Keyword(s):  
Functional Dyspepsia ◽  
Term Treatment ◽  
Long Term Treatment
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