scholarly journals Solitary cecal ulcer - case report and treatment options according to literature review

2021 ◽  
pp. 108-108
Author(s):  
Vanja Kunkin ◽  
Aleksandar Ognjenovic
Keyword(s):  
Treatment Plan ◽  
Treatment Options ◽  
Treatment Protocol ◽  
Rare Condition ◽  
Interesting Case ◽  
Major Surgery ◽  
Ulcer Case ◽  
Disease Case ◽  
Solitary Ulcer ◽  
Disease Present

Introduction. Solitary cecal ulcer is a benign and extremely rare disease, as less than 300 cases have been reported so far. The etiology is unknown, and it can be diagnosed by pathohistological examination. Often presented as an acute abdomen and rectal bleeding, it can mock various important and urgent conditions. Treatment protocol is not defined. Extensive and radical surgeries are often performed due to this benign disease mimic. Our aim was to indicate this disease, present the treatment of this rare condition, and to facilitate the treatment plan for this disease. Case outline. Female, aged 67, was admitted to the Emergency Department with a clinical manifestation of acute appendicitis. Emergency surgery was indicated after following diagnostic tests. The intraoperative finding revealed an ulcer on the cecum, which was sutured. The patient fully recovered, and subsequent colonoscopy and pathohistological findings indicated a solitary ulcer. Conclusion. It is possible to treat this condition by retaining the organ and avoiding major surgery. Therefore, it is our opinion that it might provide significant assistance to clinicians in a similar situation. Hence, it is undoubtedly an interesting case for archiving, especially since such a case has not been recorded in our country yet.

scholarly journals Celiac artery compression: Dunbar syndrome

2019 ◽  
Vol 18 ◽  
Author(s):  
Giovanna Mezzalira Santos ◽  
Luiz Marcelo Aiello Viarengo ◽  
Marcos Danillo Peixoto Oliveira
Keyword(s):  
Treatment Options ◽  
Rare Condition ◽  
Celiac Trunk ◽  
Celiac Artery ◽  
Interesting Case ◽  
Median Arcuate Ligament ◽  
Extrinsic Compression ◽  
Arcuate Ligament ◽  
Dunbar Syndrome ◽  
Celiac Artery Compression

Abstract Celiac artery compression syndrome, also referred to as median arcuate ligament syndrome, celiac axis syndrome or Dunbar syndrome is a rare disorder consequent to extrinsic compression of the celiac trunk by the median arcuate ligament. Doppler ultrasound, multi-slice computed tomography angiography, magnetic resonance angiography, or invasive selective angiography can identify stenosis of the initial segment of the celiac artery and confirm diagnosis. Treatment options include open surgical or videolaparoscopic section of the median arcuate ligament and the fibers of the celiac plexus, or percutaneous transluminal angioplasty via an endovascular approach. We report herein an interesting case of a 38-year-old woman diagnosed with this rare condition and successfully treated with the surgical strategy.

scholarly journals Concurrent Occurrence of Bilateral Hypodontia and Microdontia in a Nonsyndromic Paediatric Patient: A Case Report

2020 ◽  
Author(s):  
PG Anjali ◽  
Balagopal Varma ◽  
J Suresh Kumar ◽  
Parvathy Kumaran ◽  
Arun Mamachan Xavier
Keyword(s):  
Case Report ◽  
Treatment Plan ◽  
Treatment Options ◽  
Rare Condition ◽  
Permanent Teeth ◽  
Dental Anomalies ◽  
Predicting Factors ◽  
Mini Implants ◽  
Space Closure ◽  
Final Space

Hypodontia is a developmental dental anomaly defined as the absence of one or more primary or permanent teeth excluding third molars. It can be associated with syndrome or nonsyndromic condition accompanied with other developmental dental anomalies like microdontia. Bilateral occurrence of hypodontia alongside microdontia is a rare condition. This case report presents a rare occurrence of bilateral hypodontia and microdontia in a nonsyndromic patient. Owing to its nonsyndromic background, other parameters like developmental delay, height, weight and body mass index are used as the predicting factors for the occurrence of hypodontia. Developmental milestones are one of the important factors in deriving the treatment plan. Treatment options in this case were directed at delaying the treatment until the eruption of the permanent successor teeth followed by the use of mini-implants for hypodontia, porcelain jacket crown for microdontia and the orthodontic treatment for final space closure.

scholarly journals Decision Making from the Experience of Orthognathic Surgery Patients: A Grounded Theory Approach

2021 ◽  
pp. 238008442110144
Author(s):  
N.R. Paul ◽  
S.R. Baker ◽  
B.J. Gibson
Keyword(s):  
Decision Making ◽  
Grounded Theory ◽  
Treatment Options ◽  
Study Data ◽  
Primary Objective ◽  
Major Surgery ◽  
Future Research ◽  
Decision Making Process ◽  
Theory Approach

Introduction: Patients’ decisions to undergo major surgery such as orthognathic treatment are not just about how the decision is made but what influences the decision. Objectives: The primary objective of the study was to identify the key processes involved in patients’ experience of decision making for orthognathic treatment. Methods: This study reports some of the findings of a larger grounded theory study. Data were collected through face-to-face interviews of patients who were seen for orthognathic treatment at a teaching hospital in the United Kingdom. Twenty-two participants were recruited (age range 18–66 y), of whom 12 (male = 2, female = 10) were 6 to 8 wk postsurgery, 6 (male = 2, female = 4) were in the decision-making stage, and 4 (male = 0, female = 4) were 1 to 2 y postsurgery. Additional data were also collected from online blogs and forums on jaw surgery. The data analysis stages of grounded theory methodology were undertaken, including open and selective coding. Results: The study identified the central role of dental care professionals (DCPs) in several underlying processes associated with decision making, including legitimating, mediating, scheduling, projecting, and supporting patients’ decisions. Six categories were related to key aspects of decision making. These were awareness about their underlying dentofacial problems and treatment options available, the information available about the treatment, the temporality of when surgery would be undertaken, the motivations and expectation of patients, social support, and fear of the surgery, hospitalization, and potentially disliking their new face. Conclusion: The decision-making process for orthognathic treatment is complex, multifactorial, and heavily influenced by the role of DCPs in patient care. Understanding the magnitude of this role will enable DCPs to more clearly participate in improving patients’ decision-making process. The findings of this study can inform future quantitative studies. Knowledge Transfer Statement: The results of this study can be used both for informing clinical practice around enabling decision making for orthognathic treatment and also for designing future research. The findings can better inform clinicians about the importance of their role in the patients’ decision-making process for orthognathic treatment and the means to improve the patient experience. It is suggested that further research could be conducted to measure some of the key constructs identified within our grounded theory and assess how these change during the treatment process.

scholarly journals The effects of a preoperative multidisciplinary conference on outcomes for high-risk patients with challenging surgical treatment options: a retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Masayoshi Koike ◽  
Mie Yoshimura ◽  
Yasushi Mio ◽  
Shoichi Uezono
Keyword(s):  
Patient Safety ◽  
Retrospective Study ◽  
High Risk ◽  
Treatment Plan ◽  
Treatment Options ◽  
High Risk Patients ◽  
Appropriate Treatment ◽  
Risk Patients ◽  
Treatment Plans ◽  
Multidisciplinary Conference

Abstract Background Surgical options for patients vary with age and comorbidities, advances in medical technology and patients’ wishes. This complexity can make it difficult for surgeons to determine appropriate treatment plans independently. At our institution, final decisions regarding treatment for patients are made at multidisciplinary meetings, termed High-Risk Conferences, led by the Patient Safety Committee. Methods In this retrospective study, we assessed the reasons for convening High-Risk Conferences, the final decisions made and treatment outcomes using conference records and patient medical records for conferences conducted at our institution from April 2010 to March 2018. Results A total of 410 High-Risk Conferences were conducted for 406 patients during the study period. The department with the most conferences was cardiovascular surgery (24%), and the reasons for convening conferences included the presence of severe comorbidities (51%), highly difficult surgeries (41%) and nonmedical/personal issues (8%). Treatment changes were made for 49 patients (12%), including surgical modifications for 20 patients and surgery cancellation for 29. The most common surgical modification was procedure reduction (16 patients); 4 deaths were reported. Follow-up was available for 21 patients for whom surgery was cancelled, with 11 deaths reported. Conclusions Given that some change to the treatment plan was made for 12% of the patients discussed at the High-Risk Conferences, we conclude that participants of these conferences did not always agree with the original surgical plan and that the multidisciplinary decision-making process of the conferences served to allow for modifications. Many of the modifications involved reductions in procedures to reflect a more conservative approach, which might have decreased perioperative mortality and the incidence of complications as well as unnecessary surgeries. High-risk patients have complex issues, and it is difficult to verify statistically whether outcomes are associated with changes in course of treatment. Nevertheless, these conferences might be useful from a patient safety perspective and minimize the potential for legal disputes.

Stressful Life Events as a Trigger for Autoimmune Disease? A Case Report on Mucous Membrane Pemphigoid

Dental Update ◽  
2021 ◽  
Vol 48 (5) ◽  
pp. 379-382
Author(s):  
Robert Devine ◽  
Melanie Simms
Keyword(s):  
Mucous Membrane ◽  
Patient Outcomes ◽  
Stressful Life Events ◽  
Treatment Options ◽  
Rare Condition ◽  
Corticosteroid Treatment ◽  
Diagnostic Tools ◽  
Mucous Membrane Pemphigoid ◽  
Acute Presentation

This case discusses the acute presentation of a patient with mucous membrane pemphigoid to an emergency dental department. Mucous membrane pemphigoid is a rare condition, but its presentation can be severe and concerning for both the patient and clinician. The case presents the manifestations of florid desquamative gingivitis and extensive mucosal erosions due to burst bullae. We discuss the possible causes of the condition in this patient, likely to be the stress of recent cardiac surgery, as well as exploring the efficacy of diagnostic tools, treatment options and adverse effects of corticosteroid treatment. CPD/Clinical Relevance: Correct and timely diagnosis of vesiculobullous disorders has notable impacts on patient outcomes and quality of life.

In Support of Initial Parenteral Medical Management of Intrathecal Baclofen Withdrawal in Spasticity Patients

2021 ◽  
pp. 875512252110392
Author(s):  
Brian L. LaRowe ◽  
Vicki M. Nussbaum
Keyword(s):  
Case Reports ◽  
Treatment Plan ◽  
Correct Diagnosis ◽  
Treatment Protocol ◽  
Patient Characteristics ◽  
Clinical Problem ◽  
Clinical Situation ◽  
Intrathecal Baclofen ◽  
Wide Range ◽  
Baclofen Withdrawal

Background: Spasticity may present as a wide range of symptoms and conditions. With this protean presentation, a consensus regarding the best course of treatment does not exist. Those patients most severely affected may receive significant benefit from intrathecal baclofen delivery. However, this therapy may itself lead to patient injury in the event of withdrawal. Objective: Withdrawal from intrathecal baclofen may devolve rapidly into a situation in which the patient may incur significant morbidity and even death. A focused, prompt treatment plan would afford the patient the best possible outcome. Methods: The medical literature was reviewed for reports of plans of treatment of baclofen withdrawal and the results obtained. The nature of this problem does not lend itself to a typical study design, depending on case reports and basic pharmacological science application. The paucity of such reports severely limits categorical comparison of patient characteristics and clinical circumstances. Clinical situations, patient characteristics, and therapies were considered and compared. Outcomes of the varied treatments were evaluated for efficacy. Results: Inaccurate diagnoses, delayed correct diagnoses, and the absence of a consistent, treatment plan contributed to widely disparate outcomes. Prompt, correct diagnosis and intensive care unit–based continuous benzodiazepine infusion with titration led to a controlled clinical situation and maximized patient outcomes. Conclusions: Patients going through withdrawal from intrathecal baclofen achieved best outcomes when treated with a continuous infusion and titration of an intravenous benzodiazepine. A well-defined treatment protocol employing this management, reporting serial outcomes, would enable further refinement of the treatment of this clinical problem.

Bilateral Nervus Intermedius Sectioning for Geniculate Neuralgia: Case Report and Operative Video

2021 ◽  
Author(s):  
Keaton Piper ◽  
Qizhi Victoria Zheng ◽  
Robert S Heller ◽  
Siviero Agazzi
Keyword(s):  
Side Effects ◽  
Microvascular Decompression ◽  
Treatment Options ◽  
Rare Condition ◽  
Contralateral Side ◽  
Wide Range ◽  
Successful Resolution ◽  
Surgical Options ◽  
Vascular Loop ◽  
Nervus Intermedius

Abstract BACKGROUND AND IMPORTANCE Geniculate neuralgia is a rare condition characterized by excruciating ear pain. Surgical options for geniculate neuralgia include microvascular decompression and sectioning of the nervus intermedius. We report herein a case of bilateral geniculate neuralgia treated by nervus intermedius sectioning without prior microvascular decompression. To our knowledge, this is the first report of this treatment strategy with a subsequent description of the side effects of bilateral nervus intermedius disruption. CLINICAL PRESENTATION A 54-yr-old woman presented with bilateral geniculate neuralgia, worse on the left, refractory to medical therapy. Surgical treatment options were reviewed, including microvascular decompression and sectioning of the nervus intermedius. She opted for left nervus intermedius sectioning. The procedure was uncomplicated and no compressive vascular loop was identified during surgery. Postoperatively, she had complete symptom resolution with no discernable side effects. Three years later, the patient developed worsening geniculate neuralgia on the contralateral side. After the discussion of treatment options, she opted again for sectioning of the contralateral nervus intermedius with successful resolution of all symptoms after surgery. Following surgery, the patient identified partial impairment of lacrimation and gustation. She continued to have functional taste of the anterior two-thirds of the tongue, lacrimation, and hearing bilaterally. CONCLUSION Bilateral sectioning of nervus intermedius may provide benefit in patients with bilateral geniculate neuralgia without egregious side effects. However, lacrimatory and gustatory alterations are a potentially significant side effect with a wide range of symptomatology.

scholarly journals How the Future of Sonography May Change the Outlook for Patients With Osteosarcoma

2018 ◽  
Vol 34 (5) ◽  
pp. 368-373
Author(s):  
Stacey Hoya ◽  
Linda Wogeman ◽  
Sara Allstadt ◽  
Glen King
Keyword(s):  
Quality Of Life ◽  
Focused Ultrasound ◽  
Treatment Plan ◽  
Treatment Options ◽  
Therapeutic Ultrasound ◽  
Bone Lesions ◽  
Pulsed Ultrasound ◽  
Low Intensity Pulsed Ultrasound ◽  
Ultrasound Applications

Sonography currently provides a variety of tools to support the diagnosis and treatment of osteosarcoma and, with the development of therapeutic ultrasound practices, could play an increasingly important role in the treatment of future patients with osteosarcoma. Currently, computed tomography, magnetic resonance imaging, and radiography are the preferred imaging modalities for bone lesions; treatment options for osteosarcoma primarily include highly toxic chemotherapies and surgeries that often result in limb loss. Unfortunately, osteosarcoma is rarely eliminated, and despite this, patients lose their lives after having a significant reduction in quality of life. Evolving therapies such as high-frequency focused ultrasound, ultrasound-enhanced delivery of photodynamic therapy, and low-intensity pulsed ultrasound may offer these patients an improved quality of life while also increasing efficacy of treatment. This canine case study illustrates the various ways in which sonography might contribute to the treatment plan for patients with osteosarcoma. It may provide a comparable model for the reimagining of treatment for future patients with osteosarcoma using a suite of therapeutic ultrasound applications.

scholarly journals Dupuytren-Like Contracture of the Foot: Ledderhose Disease

2016 ◽  
Vol 02 (03) ◽  
pp. e102-e104 ◽  
Author(s):  
Osman Akdag ◽  
Gokce Yildiran ◽  
Mehtap Karamese ◽  
Zekeriya Tosun
Keyword(s):  
Treatment Options ◽  
Plantar Fascia ◽  
Plantar Aponeurosis ◽  
Steroid Injections ◽  
Medial Side ◽  
Disease Case ◽  
Ledderhose Disease ◽  
Plantar Incision ◽  
Plantar Fibromatosis ◽  
Slow Growing

Introduction Plantar fibromatosis is a rare hyperproliferative disease of plantar aponeurosis and is also called Ledderhose disease. Case properties and treatment are discussed in this report. Case Report A 30-year-old man presented with painful bilateral plantar nodules. He had multiple and bilateral fixed and solid nodules on the plantar and medial side of his feet measuring 1 cm each. Ultrasound was performed and hypoechoic homogeneous nodules were detected. The patient underwent surgery, and the nodes were removed via a plantar incision with 2-cm safety distance. Discussion Ledderhose disease is a rare, hyperproliferative disorder of the plantar aponeurosis. The nodules are slow growing and found in the medial part of the plantar fascia. The precise etiology remains unknown. The treatment options are conservative management, steroid injections, radiotherapy, and surgery. Conclusion The main cause of this disease remains uncertain. Related conditions should be evaluated, and a patient who presents with Dupuytren or Peyronie disease should also be investigated for Ledderhose disease.

Non-operative treatment options for knee osteoarthritis: current concepts

2018 ◽  
Vol 3 (5) ◽  
pp. 274-281
Author(s):  
David A Parker ◽  
Corey Scholes ◽  
Thomas Neri
Keyword(s):  
Knee Osteoarthritis ◽  
Operative Treatment ◽  
Treatment Plan ◽  
Treatment Options ◽  
Primary Care Providers ◽  
Care Plan ◽  
Care Providers ◽  
Coordinated Care ◽  
Management Options ◽  
Functional Benefit

Knee osteoarthritis in younger patients can be a challenging condition to manage. The patient and clinician have a range of non-operative management options available, although the guidance to effectively apply these options is lacking. The following review summarises a range of non-operative treatment options as an accessible reference for primary care providers to establish a coordinated care plan in consultation with the patient as part of a shared decision making process. Options are summarised in non-pharmacological and pharmacological treatments. These options are based on the latest guidelines based on authoritative recommendations, as well as recent articles with a good level of evidence that have not yet been incorporated into these official contents. The coordination of treatment using a range of modalities remains poorly explained in the literature and the current review proposes a conceptual model for coordinated care to be provided. In this model, the patient is central to the interaction between the coordinator and specialist providers, and the treatment plan is tailored to provide the optimal pain relief and functional benefit specific to the patient.

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