scholarly journals Acute approach to orbital lymphatic malformations

2020 ◽  
Vol 4 ◽  
pp. 10
Author(s):  
Jackson M. Bennett ◽  
Amit R. Bhatt ◽  
Alex Chau ◽  
Sudhen B. Desai
Keyword(s):  
Vascular Malformations ◽  
Treatment Options ◽  
Tertiary Care ◽  
Case Series ◽  
Neck Region ◽  
Therapeutic Interventions ◽  
Ultrasound Guided ◽  
Lymphatic Malformations ◽  
Treatment Timing ◽  
Eyelid Swelling

Pediatric lymphatic malformations (LMs) represent a rare, benign subtype of vascular malformations that can commonly occur in the head or neck region, specifically in or around the orbit. Orbital LMs typically require a multidisciplinary team of specialists and diagnostic imaging. Historically, treatment options for these periorbital LMs include imaging-guided drainage with sclerotherapy in addition to surgery, at times in conjunction with medical management. There exists debate in terms of an approach for management timing of these lesions across various treatment centers, and interventional radiologists should be informed regarding treatment timing considerations in evaluating patients for potential intervention. The aim of this case series is to review the current standards regarding therapeutic interventions for LMs in the literature and discuss an organized approach to guide the optimal treatment timing for the management of these lesions. In this case series, two pediatric patients – one 2 years old and one 12 years old – presented with a unilateral periorbital LM and received treatment at an academic tertiary care children’s hospital. The first patient was diagnosed with macrocystic periorbital LM after presenting with eye pain and eyelid swelling. After initial ultrasound-guided drainage to relieve eye pressure, the patient rebled into the LM and underwent sclerotherapy intervention. The second case involved a periorbital LM with intralesional hemorrhage presenting as a violaceous eyelid mass diagnosed after bumping into a swing. The patient was treated medically with interval growth of the LM and underwent subsequent sclerotherapy. Both patients responded well to ultrasound-guided sclerotherapy. The management timing and decision to intervene were based on consults from multidisciplinary services, age, risk factors, and clinical stability on presentation. We present two cases of pediatric periorbital LM and review an organized institutional approach for treatment timing based on paradigms in the literature.

scholarly journals Spontaneously Resolved Macrocystic Lymphatic Malformations: Predictive Variables and Outcomes

2017 ◽  
Vol 25 (1) ◽  
pp. 27-31 ◽  
Author(s):  
Michael J. Phang ◽  
Douglas J. Courtemanche ◽  
Marija Bucevska ◽  
Claudia Malic ◽  
Jugpal S. Arneja
Keyword(s):  
Respiratory Tract ◽  
Median Time ◽  
Vascular Malformations ◽  
Neck Region ◽  
Retrospective Chart Review ◽  
Spontaneous Resolution ◽  
Low Flow ◽  
Upper Respiratory Tract ◽  
Lymphatic Malformations ◽  
Upper Respiratory

Introduction: Lymphatic malformations are benign, low-flow vascular malformations that typically present at or near birth. Due to morbidity associated with operative treatment, nonoperative treatment with injection of sclerosant has become the mainstay of therapy. Over the past 15 years, several patients at our centre with macrocystic (>2 cm cyst size) lymphatic malformations have seen their lesions resolve spontaneously while awaiting treatment. In this study, we review features of these patients that may contribute to spontaneous resolution. Method: A retrospective chart review was conducted from our Vascular Anomalies Clinic database (1999-2014) of all macrocystic lymphatic malformations; characteristics of patients with spontaneous resolution were reviewed. Results: Of 61 patients with macrocystic lymphatic malformations, 7 cases (11.5%; 4 females, 3 males) resolved spontaneously. Median age at malformation appearance was 2 years (range: 0-6.5 years), with median age at resolution of 4 years (range: 10 months-7 years). Median time from appearance to resolution was 24 months (range: 3-43 months), with a median follow-up time of 4 years (range: 1-15 years). All but 1 case was associated with local or upper respiratory tract infection antecedent to resolution. Six of the 7 lesions were located in the neck. Conclusion: Among the cases reviewed, there was a common theme of upper respiratory tract or local infection antecedent to spontaneous lesion resolution. Compared to the literature, our proportion of malformations presenting after birth and the proportion of malformations presenting in the neck region were higher than those of other series. Although side effects associated with treatment are generally mild and/or rare, risks related to sclerotherapy and the accompanying requirement for general anesthesia in pediatric populations nevertheless exist. As the median time from lesion appearance to resolution was 24 months, it may be reasonable to observe these malformations for up to 24 months before proceeding with treatment if the lesion does not impair function and disfigurement is not considerable, particularly if the lesion presents after birth and/or is located in the neck region.

scholarly journals Acute kidney injury requiring dialysis in obstetric patients: management and clinical outcome in case series of 30 patients in a tertiary care centre

2017 ◽  
Vol 6 (7) ◽  
pp. 2997
Author(s):  
Molina U. Patel ◽  
Yuvraj Jadeja ◽  
Niket Patel ◽  
Nayana Patel ◽  
Smruti Vaishnav ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Tertiary Care ◽  
Case Series ◽  
Kidney Injury ◽  
Therapeutic Interventions ◽  
Risk Category ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
Significant Difference ◽  
The Impact

Background: Acute Kidney Injury is a common medical problem affecting approximately 5% of all hospitalized and 30% of critically ill patients. The incidence in obstetric patients ranges from 1 in 2000 to 1 in 25000 pregnancies. In India till date, the impact of AKI on fetomaternal outcome and pertaining therapeutic interventions is only sparsely studied.Methods: It is a retrospective cross-sectional study. All obstetric patients with AKI on dialysis, admitted to Shree Krishna Hospital, a tertiary care hospital in Karamsad village in Gujarat from January 2013 to August 2015. Multivariate statistical analysis of clinical and laboratory parameters was performed using SPSS program to obtain the results.Results: The incidence of dialysis was 1.6%. HELLP syndrome and pre-eclampsia (80%) was found to be the most common etiology of AKI followed by Congestive cardiac failure (34.5%), hemorrhage and sepsis in 30% resp. All patients were admitted to ICU care. No significant difference was found between SAP II and SOFA monitoring system. Mechanical ventilation was done to support 53.3% and inotropic support was needed by 56.7% patients. According to the RIFLE criteria, majority of the patients fall under risk category followed by injury. 18% of the patients developed End Stage Renal Disease.Conclusions: In view of the multifaceted etiologies and complexity of management of AKI, a multi-disciplinary approach involving nephrologist, intensivists, obstetricians and neonatologists is extremely important.

Antidepressant augmentation and combination in unipolar depression: strong guidance, weak foundations

2011 ◽  
Vol 28 (4) ◽  
pp. i-ix ◽  
Author(s):  
Erik Kolshus ◽  
Leonard Douglas ◽  
Ross Dunne
Keyword(s):  
Depressive Disorders ◽  
Treatment Options ◽  
Tertiary Care ◽  
Treatment Strategies ◽  
Case Series ◽  
Clinical Excellence ◽  
Unipolar Depression ◽  
Cost Effective ◽  
Level Of Evidence ◽  
Levels Of Evidence

Depression will be the second leading contributor to the global burden of disease by 2020. In Ireland, in 2009, 6061 people were hospitalised with depressive disorders. This represents a significant economic and social burden. There is growing awareness of the difficulty in treating depression with medications alone. The likelihood that a patient will achieve remission with the first antidepressant tried is around 30%, and the rates are similar for the second antidepressant tried. This falls to around 15% after three trials. Many patients are exposed to pharmacotherapy for extended periods of time with little beneficial effect, but often with side-effects. Patients are therefore in great need of clear information with regard to their chance of success. Clinicians are in need of clear guidance on prescribing strategies which have proven efficacy. However, this guidance often discusses treatment strategies based on varying levels of evidence. Guiding bodies may approach the problem from varying perspectives. The UK National Institute for Health and Clinical Excellence (NICE) has a clear government mandate with regard to provision of not only effective but cost-effective treatments. The British Association of Psychopharmacology (BAP) is an independent body of interested researchers and therefore may discuss prescribing options from the point of view of tertiary care institutions, and university centres. The South London and Maudsley NHS Foundation Trust publish the popular Maudsley guidelines. These are perhaps more pragmatic in nature, but include very low levels of evidence, including case series.The American Psychiatric Association (APA) is an independent member association which also publishes guidelines. These are published in the American Journal of Psychiatry and the latest guidelines were published in October 2010.All these bodies attempt to weigh their advice according to the level of evidence available and aim to provide clinical guidance in difficult situations. The burden on guiding organisations is to provide some direction and clarity in areas that are often unclear or controversial. Clinical guidelines are one method of providing support and guidance to busy clinicians. However, this clinician-centered approach has limitations. The onus is on the authors of the guidance to provide ever-more treatment options. This may mean that conclusions about the efficacy of medications is overstated or the limitations of the literature not fully explored in explanatory notes.

scholarly journals Early debridement with physiotherapy for prevention of postburn contracture of neck: a case series

2020 ◽  
Vol 7 (5) ◽  
pp. 1618
Author(s):  
Girish D. Bakhshi ◽  
Aditya B. Marathe ◽  
Chirag Kamat ◽  
Khadeija Hussain
Keyword(s):  
Tertiary Care ◽  
Case Series ◽  
Neck Region ◽  
Late Presentation ◽  
Favourable Outcome ◽  
High Morbidity ◽  
Care Hospital ◽  
Thermal Burns ◽  
Early Return ◽  
Early Debridement

Hypertrophic scars and contractures are well known sequelae after burns. They result in high morbidity in severely burned patients who are surviving. Present case study was done to establish the usefulness of early debridement and physiotherapy in preventing these sequelae. Present study was conducted on patients admitted in a tertiary care hospital on patients with alleged history of thermal burns to neck and upper chest over a period of 6 months. These patients were subjected to early debridement, daily dressings and early neck physiotherapy. They were assessed for neck mobility and development of neck contracture. Three patients were studied, two had a favourable outcome due to adherence to above measures while one developed contracture due to her late presentation and non-compliance to early physiotherapy. Post burn contractures are common sequelae of thermal burns involving the neck region. Early Debridement, daily dressing of the raw areas with starting of early neck physiotherapy are important and prove beneficial in preventing neck contractures with early return to normal daily activity.

New Treatment Options for Lymphangioma in Infants and Children

2002 ◽  
Vol 111 (12) ◽  
pp. 1066-1075 ◽  
Author(s):  
Chantal M. Giguère ◽  
Nancy M. Bauman ◽  
Richard J. H. Smith
Keyword(s):  
Lymphatic System ◽  
Clinical Presentation ◽  
Treatment Options ◽  
Therapeutic Interventions ◽  
Lymphatic Malformations ◽  
Diagnostic Measures ◽  
The Past ◽  
New Treatment ◽  
In Infants And Children

Lymphangiomas are congenital malformations of the lymphatic system. These lesions occur most often in the head and neck area, and their treatment continues to be a challenge. Fortunately, a number of advances have occurred in the diagnosis and management of lymphatic malformations in the past decade. The purpose of this article is to clarify the embryology, pathogenesis, histopathology, and classification of these lesions, as well as to describe their various forms of clinical presentation. We provide a complete review of the diagnostic measures available and thoroughly discuss new therapeutic interventions proposed to treat lymphangiomas.

scholarly journals RECENT INCREASE IN COLISTIN-RESISTANT EXTENSIVELY DRUG RESISTANT ACINETOBACTER INFECTIONS AT A TERTIARY CARE CENTER IN PAKISTAN

2019 ◽  
Author(s):  
Nosheen Nasir ◽  
Fatima Sharif ◽  
Rubab Mansoor ◽  
Shehryar Ahmed ◽  
Bushra Jamil ◽  
...  
Keyword(s):  
Care Center ◽  
Treatment Options ◽  
Tertiary Care ◽  
Clinical Specimen ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Antimicrobial Treatment ◽  
Common Diagnosis ◽  
Resistant Strains ◽  
Treat All

Abstract Background Acinetobacter is an important nosocomial pathogen and a major cause of morbidity and mortality in hospitalized patients. Recently, colistin resistant strains of Acinetobacter were reported from different parts of the world. We are describing a case series of 18 patients with colistin resistant Acinetobacter over a span of 4 years. Methods Patients with any clinical specimen positive for colistin resistant Acinetobacter from 2014 to 2017 were identified from the hospital records. Three cases were isolated between 2014 and 2015, six cases in 2016 and 9 cases in 2017. Data on patients’ demographics as well as clinical data was collected retrospectively on a structured proforma from the hospital medical records. Results Mean age of the patients was 50 ± 18 years. Fifteen (83.3%) out of the 18 patients were male. Acinetobacter Pneumonia was the most common diagnosis in n=13(72.2% of the patients). Nine (50%) of the patients developed sepsis. In addition to Colistin resistance, carbapenem and amikacin resistance was documented to be 94% and 61% respectively. Colistin and carbapenem based combinations were used to treat all patients with a mean antibiotic duration of 20 ± 10 days. Median length of hospital stay was 25 days (range 8 - 61), with 14 patients (77.8%) requiring ICU admission. Eight (44.4%) of the patients expired and only 6 (33.3%) achieved microbiological eradication. Conclusion Infections due to Colistin resistant strains of Acinetobacter are rapidly increasing, have limited antimicrobial treatment options and are associated with poor outcomes.

Sclerotherapy of Symptomatic Nonparasitic Splenic Cysts: Excellent Long-Term Treatment Response'

2022 ◽  
Author(s):  
Michael Dölle ◽  
Heiner Wedemeyer ◽  
Michael Gebel ◽  
Andrej Potthoff ◽  
Steffen Zender
Keyword(s):  
Sodium Chloride ◽  
Tertiary Care ◽  
Case Series ◽  
Cyst Fluid ◽  
Ultrasound Guided ◽  
Cyst Size ◽  
Cystic Fluid ◽  
Splenic Cysts ◽  
Long Term Treatment

Abstract Background Splenic cysts are rare and occur in 0.5 to 2% of the population. They are usually asymptomatic and do not require therapy. In case of symptomatic nonparasitic splenic cysts, potential therapy includes partial splenectomy or laparoscopic cyst de-roofing as well as ultrasound-guided sclerotherapy with 1% polidocanol or 10% sodium chloride (NaCl) as an interventional alternative. So far, single-session sclerotherapy of symptomatic nonparasitic cysts is recommended only if clear-transparent cyst fluid is aspirated. Materials and Methods We report a case series of 17 patients with symptomatic macroscopically turbid nonparasitic splenic cyst fluid who underwent ultrasound-guided fine needle sclerotherapy with either polidocanol ± 10% NaCl (n = 12) or 10% NaCl alone (n = 5) and a follow-up of a maximum of 12 years after first intervention. Clinical, sonographic, and laboratory chemistry data were recorded at baseline and during the follow-up. Results The mean follow-up time was 43.65 ± 40.18 months. At the end of the follow-up, a 79% reduction of cyst size was achieved. The maximum size reduction in the polidocanol group was 76 ± 18% and 84 ± 21% in the sodium chloride group (p >0.05). At the end of follow-up, 15 out of the 17 patients did not have any further symptoms. Despite the cystic fluid being turbid, it was hardly possible to detect a microbiological superinfection. Conclusion Sclerotherapy of splenic cysts leads to a significant size regression in all patients, independent of the sclerotherapy agent used with fewer systemic toxic side effects of polidocanol treatment. It was shown that in a tertiary care center with significant experience, sclerotherapy of splenic cysts is also safe and successful and can lead to a drastic regression of cyst size and symptoms. This shows that interventional therapy is a good alternative to surgical procedures.

Delayed Presentation of Lymphatic Malformation of the Cervicofacial Region: Role of Trauma

2002 ◽  
Vol 111 (9) ◽  
pp. 828-831 ◽  
Author(s):  
Reza Rahbar ◽  
Helena Rowley ◽  
Trevor J. McGill ◽  
Antonio R. Perez-Atayde ◽  
Gerald B. Healy
Keyword(s):  
Treatment Options ◽  
Neck Region ◽  
The Body ◽  
Delayed Presentation ◽  
Common Site ◽  
Lymphatic Malformations ◽  
Head And Neck Region ◽  
Airway Compression ◽  
Congenital Lesions

Lymphatic malformations (LMs) are uncommon congenital lesions that may occur throughout the body, although the head and neck region is the most common site. Most LMs are seen at birth. However, they may present in adolescence or adulthood, mainly as a result of trauma or infection. We report the case of a 7-year-old boy who presented with an LM of the cervicofacial region causing airway compression. We discuss the causes of delayed presentation of these congenital lesions. An overview of the causation, natural history, diagnosis, and treatment options is presented.

Outcomes of scleral buckle technique performed by trainee doctors in retinal detachment

2021 ◽  
Vol 2 (3) ◽  
pp. 159-163
Author(s):  
Aalok Kumar ◽  
◽  
Sanjiv Kumar Gupta ◽  
Keyword(s):  
Retinal Detachment ◽  
Success Rate ◽  
Care Center ◽  
Treatment Options ◽  
Tertiary Care ◽  
Case Series ◽  
Complication Rates ◽  
Scleral Buckle ◽  
Retrospective Case ◽  
Anatomical Success

AIM: To evaluate the outcomes of patients operated for retinal detachment by scleral buckle technique done by trainee doctors pursuing postgraduate course in ophthalmology. METHODS: This study was a non-comparative retrospective case series to evaluate the demography, clinical features and outcomes of patients underwent rhegmatogenous retinal detachment (RRD) repaired by scleral buckle technique from July 2017 to February 2018 at a tertiary care center in India. Records of all these patients were screened. Statistical analyses were performed and using Fisher's exact test, Mann-Whitney test and Nominal Logistic regression. RESULTS: Totally of 41 patients were included out of which, 32 (78.04%) were males and 9 (21.95%) were females. In our study primary anatomical success rate was 95.12%, with significant visual gain. Postoperative complications were raised intraocular pressure (n=2), new breaks (n=2) and re-detachment in 2 patients which was successfully managed by pars plana vitrectomy (PPV) with internal tamponade and laser. CONCLUSION: The study showed that scleral buckle surgeries done by trainee doctors under supervision can achieve a high success rate in patients of RRD both in terms of postoperative anatomical success, visual acuity and complication rates. Thus, scleral buckle surgery can be an acceptable primary procedure for trainee doctors for management of RRD in selected cases despite the various treatment options now available.

scholarly journals TOPICAL TACROLIMUS 0.1% FOR TREATMENT OF CUTANEOUS MICROCYSTIC LYMPHATIC MALFORMATIONS

Lymphology ◽  
2021 ◽  
Vol 54 (2) ◽  
Author(s):  
S.A. Salvia ◽  
M.A. Amore ◽  
C.M. Papendieck
Keyword(s):  
Systemic Treatment ◽  
Vascular Malformations ◽  
Treatment Options ◽  
Topical Administration ◽  
Complementary Therapy ◽  
High Rate ◽  
Low Flow ◽  
Topical Formulation ◽  
Lymphatic Malformations ◽  
Topical Tacrolimus

Microcystic lymphatic malformations as described in the international literature form a subgroup of low-flow congenital vascular malformations (VM) resulting from irregular embryological development. Microcystic lesions normally manifest as an accumulation of lymph- and blood-filled vesicles that, when externalized, cause skin maceration with consequent pain and potential infection resulting in the impairment of the patient's quality of life. There is no consensus on a standardized algorithm nor clear guidelines for successful treatment of this type of lymphatic malformation, and treatment options employed often result in ambivalent and transient outcomes with a high rate of recurrence. The topical formulation of tacrolimus is a well-known FDA-approved anti-T cell agent that was recently identified as a potent activator of ALK1, which is involved in several processes and functions including angiogenesis. We investigated if topical administration of tacrolimus may be an effective therapy for directly targeting cutaneous microcystic lymphatic malformations as a complement to systemic treatment. The study enrolled four patients with cutaneous microcystic lymphatic malformations: three male (ages: 13, 15, 18) and one female (age: 30). Two of the patients presented lesions on their backs, one patient on the left hand and one on the left lower limb. All four patients received treatment with topical tacrolimus 0.1% twice a day for 10 weeks on a previously selected area for application. Weekly clinical follow-ups were conducted along with close physician-patient contact. All patients displayed a satisfactory response after treatment. Lymphorrhea and bleeding were stopped in all cases and the esthetic aspect of lesions improved in two patients. To date, all patients presented no clinically significant changes to the size or extension of the lesion. Topical tacrolimus treatment is a promising and reasonable option for microcystic lymphatic malformations. Our results encourage further exploration in larger populations with the consideration that it is a safe and effective alternative or complementary therapy to systemic treatment.

Sign in / Sign up

Export Citation Format

Share Document