scholarly journals Bilateral Porokeratosis Ptychotropica on the Gluteal Cleft: A Case Report and Review of the Literature

2019 ◽  
Vol 3 (6) ◽  
pp. 427-430
Author(s):  
Roya S. Nazarian ◽  
Nikki Vyas ◽  
Noah Scheinfeld ◽  
Robert G. Phelps
Keyword(s):  
Squamous Cell Carcinoma ◽  
Clinical Presentation ◽  
Standard Of Care ◽  
Treatment Modalities ◽  
Evidence Based ◽  
Review Of The Literature ◽  
Limited Evidence ◽  
Evidence Based Treatment ◽  
Proper Diagnosis ◽  
Porokeratosis Ptychotropica

Porokeratosis ptychotropica (PP) is a rare variant of porokoretosis that is distinctive based on its clinical presentation of pruritic, verrucous papules and plaques that often form a “butterfly” shape, commonly located on the perinatal cleft with extension to the buttocks. Similar to other variants of porokeratosis, it is histologically distinguished by the presence of cornoid lamellae. Proper diagnosis is necessary as some studies suggest that PP may predispose to squamous cell carcinoma. Furthermore, there are limited evidence-based treatment options.We report the case of a47 year-old-male who presented with a rash on the buttocks and legs for 3 years. Physical exam revealed erythematous, annular, and verrucous plaques on the bilateral periglueteal area and bilateral distal lower extremities. The patient felt that lesions on the legs were disfiguring but otherwise asymptomatic. Biopsy results demonstrated hyperkeratosis and parakeratosis suggestive of cornoid lamellae. Clinical and histologic findings were suggestive of PP. Lesions on the legs were treated with cryotherapy, which resulted in resolution at a 3-month follow-up.PP remains a diagnostic and therapeutic challenge due to its rarity. No standard of care has been established, though topical calcipotriol, topical imiquimod, topical tretonoin, and cryotherapy have been used with success in the literature. This case highlights unique characteristics of PP in order to aid in early detection and cancer prevention while also describing various treatment modalities.

Championing Change to Save Lives: A Call to Action to Implement Reforms to Increase Use of Medications to Treat Opioid Use Disorder in Correctional Settings

2020 ◽  
pp. 073401682098162
Author(s):  
Sonia L. Canzater ◽  
Regina M. LaBelle
Keyword(s):  
Standard Of Care ◽  
Opioid Use Disorder ◽  
Correctional Facilities ◽  
Evidence Based ◽  
Opioid Use ◽  
Call To Action ◽  
Evidence Based Treatment ◽  
High Prevalence ◽  
Correctional Settings ◽  
Overdose Deaths

The disproportional rates of opioid use disorder (OUD) in U.S. correctional facilities make them prime intervention points to treat OUD utilizing medication to treat opioid use disorder (MOUD), the evidence-based clinical standard of care. MOUD has been shown to be effective to support recovery and reduce recurrence of OUD, overdose deaths, and recidivism for justice-involved persons both while incarcerated and once they reenter their communities. Despite the high prevalence, most jails and prisons do not offer MOUD. Litigation has spurred expanded access in more facilities, but widespread MOUD access can only become a reality through a comprehensive effort of corrections officials, medical experts, advocates, legislators, and other champions to raise awareness and affect ideological and policy change. It is a legal and ethical imperative that the lives of justice-involved persons not be jeopardized by the lack of evidence-based treatment for OUD in correctional settings.

Palliative treatment directives for bone metastases: A quality-directed approach to guiding institutional practice.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 188-188 ◽  
Author(s):  
Lindsay Puckett ◽  
Lucille Lee ◽  
Petrina Zuvic ◽  
Isabella Bingchan Zhang ◽  
Louis Potters ◽  
...  
Keyword(s):  
Bone Metastasis ◽  
Bone Metastases ◽  
Radiation Treatment ◽  
Standard Of Care ◽  
Evidence Based ◽  
Chi Square ◽  
Evidence Based Treatment ◽  
Improve Compliance ◽  
Chi Square Test ◽  
New Treatment

188 Background: The efficacy of single fraction (fx) radiation treatment (RT) has proven to have equipoise for palliation of bone metastases when compared to courses of 10 fx or more. Despite these data, there has been a slow adoption of this practice in the US and worldwide. Examination of our multicenter practice from 2004 - 2016 showed that single fx RT utilization has remained at 17% and hypofractionationed (HFX) courses (1 or 5 fx) have remained at 71% since 2009. We hypothesized that evidence-based, treatment-guiding directives could improve HFX utilization in this population. Methods: Institutionally, palliative bone metastasis treatments are routinely tracked by a Quality Assurance committee. In 2/2016, two consensus-driven and evidence-based clinical directives were created within our electronic health system for use with either simple or complicated bone metastasis, irrespective of primary histology. The simple and complex directives had default prescriptions of 8 Gy/1fx or 20 Gy/5fx, respectively. The directives were reviewed with physician staff to improve compliance; directives were allowed to be edited at the physician’s discretion if an alternative fx was indicated. The chi-square test was used for analysis. Results: From 1/2009-5/2016, there were 1,781 treatment courses of palliative external beam RT. Following implementation in 2/2016, the new clinical directives were used for 96% of cases and were modified in 12 cases (n = 72). Single fx use increased from 17% to 36% among palliative bone metastasis treatments (p ≤ 0.001) and HFX (1 or 5 fx) utilization increased from 71% to 92% compared to other fractionation schemes (10 fx or other) (p = 0.001). Conclusions: The institution-wide adoption of evidence-based, treatment directives proved to be a straightforward and successful intervention which allowed for rapid adoption and increased utilization of the standard of care. Our early data suggests that this may be a useful approach in the setting of reticence to new treatment paradigms. Further examination of evidence based directives is warranted to address issues of overtreatment in palliation and in standardizing oncologic care.

scholarly journals Evidence-based treatment of osteoporotic vertebral compression fracture

2021 ◽  
Vol 64 (3) ◽  
pp. 200-207
Author(s):  
Subum Lee ◽  
Dae-Chul Cho ◽  
Kyong-Tae Kim ◽  
Young-Seok Lee
Keyword(s):  
Surgical Treatment ◽  
Outcome Measurement ◽  
Treatment Guideline ◽  
Treatment Modalities ◽  
Vertebral Compression Fractures ◽  
Controlled Trials ◽  
Evidence Based ◽  
Evidence Based Treatment ◽  
Significant Difference ◽  
Non Surgical Treatment

The prevalence and medical costs of osteoporotic vertebral compression fractures (OVCFs) are on the rise. However, a concrete evidence-based treatment guideline has not yet been established. Despite that numerous randomized controlled trials (RCTs) were performed, the study design and outcome measurement were heterogeneous, and the results were not unified. The purpose of this review is to compare the results of high level-evidence studies to provide a background for evidence-based OVCF treatment. Many reports showed that vertebroplasty has better clinical outcomes than non-surgical treatment for OVCF, but the results of three double-blinded RCTs with the highest level of evidence did not show a significant difference between vertebroplasty and sham procedure. Whether undergoing surgical or non-surgical treatment, OVCF patient management should be started by managing osteoporosis first. Meanwhile, in the results of RCTs related to the comparison of conservative treatment modalities, the benefit of braces and a specific analgesic prescription protocol was also unclear. The presented results of each clinical trial were generally inconsistent and may not be appropriate in all situations. Any decision by clinicians to apply this evidence must be made considering individual patients and available resources. At present, controversy remains about the best treatment modality for OVCF. Large, multicenter, placebo/sham-controlled trials are needed to address this gap and establish strong evidence-based guidelines.

scholarly journals Evidence-Based Treatment Options in Recurrent and/or Metastatic Squamous Cell Carcinoma of the Head and Neck

2017 ◽  
Vol 7 ◽  
Author(s):  
Athanassios Argiris ◽  
Kevin J. Harrington ◽  
Makoto Tahara ◽  
Jeltje Schulten ◽  
Pauline Chomette ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Squamous Cell ◽  
Treatment Options ◽  
Evidence Based ◽  
Evidence Based Treatment ◽  
Metastatic Squamous Cell Carcinoma

Laryngeal Blastomycosis: A Commonly Missed Diagnosis Report of Two Cases and Review of the Literature

2000 ◽  
Vol 109 (3) ◽  
pp. 281-286 ◽  
Author(s):  
Jason M. Hanson ◽  
Gershon Spector ◽  
Samir K. El-Mofty
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
English Language ◽  
Clinical Presentation ◽  
Pathological Findings ◽  
Review Of The Literature ◽  
Proper Understanding ◽  
Inappropriate Treatment ◽  
Missed Diagnosis

Blastomycosis is a relatively uncommon fungal disease that most commonly affects the lungs. Other organs may be involved, usually secondary to dissemination of the organism. Laryngeal blastomycosis may occur in isolation from active pulmonary disease. The signs, symptoms, clinical features, and pathological findings of laryngeal blastomycosis mimic those of squamous cell carcinoma. Misdiagnosis may result in inappropriate treatment with potential morbidity. Proper understanding of the clinical presentation and familiarity with the histopathologic features of this disease are therefore imperative. In this paper, we report 2 cases of laryngeal blastomycosis, 1 of which was misdiagnosed as squamous cell carcinoma, clinically and microscopically, with consequent radiotherapy and laryngectomy. In the other case, a clinical diagnosis of glottic squamous cell carcinoma was rendered. However, blastomycosis was identified in a biopsy specimen. We also review cases of isolated laryngeal blastomycosis that have been reported in the English-language literature during the last 80 years. a number of those cases were misdiagnosed clinically and microscopically as squamous cell carcinoma.

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