Carcinoma of Vulva in Nepalese Women Managed at B. P. Koirala Memorial Cancer Hospital

2019 ◽  
Vol 3 (1) ◽  
pp. 35-38
Author(s):  
Jitendra Pariyar ◽  
Binuma Shrestha ◽  
Bijaya Chandra Acharya ◽  
Suresh Shrestha ◽  
Jaya Shrestha ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Vulvar Cancer ◽  
Stage Iv ◽  
Treatment Modalities ◽  
Delayed Presentation ◽  
Case Record ◽  
Gynecological Malignancy ◽  
Cancer Hospital ◽  
Clinical Presentations

Introduction: This study aims to analyze the clinical presentation and management outcomes carcinoma of vulva managed B. P. Koirala Memorial Cancer Hospital. Methods: A descriptive study was conducted of all carcinoma of vulva cases managed at B. P. Koirala Memorial Cancer Hospital from 1999 to 2009. The case record of all women diagnosed to have carcinoma of vulva were retrieved and socio-demographic characteristics, clinical presentations, histological type, treatment modalities and outcome were obtained and analyzed. Results: There were 5152 gynecological malignancies and vulvar cancer accounted for 87, giving a prevalence of 1.7%. The ages ranged from 17 to 86 years (mean of 48.6 years). Parity was 0-10. Vulva wound and pruritus were the most frequent clinical features with presentations in stage I -8%, stage II- 28%, stage III – 52 % and stage IV -12%. Squamous cell carcinoma (93%) predominated and 62% were grade I. Among the 87 cases, 32% were treated primarily with surgery, 34% primarily with concurrent chemo-radiation and 28% with combined modality. Clinical follow-up of one to five years showed that 26 (30%) cases had local recurrence and 22 (25%) died of disease. Conclusion: Carcinoma of the vulva is a rare gynecological malignancy in Nepal. Surgery and radiotherapy remain to be the mainstay of treatment. Delayed presentation still results in greater morbidity and mortality rates.  

Fifty Years of Experience with Chordomas in Southeast Scotland

Neurosurgery ◽  
1985 ◽  
Vol 16 (2) ◽  
pp. 166-170 ◽  
Author(s):  
P. O'Neill ◽  
B.A. Bell ◽  
J.D. Miller ◽  
I. Jacobson ◽  
W. Guthrie
Keyword(s):  
Clinical Presentation ◽  
Surgical Intervention ◽  
Slow Growth ◽  
Multicenter Trial ◽  
Treatment Modalities ◽  
Therapeutic Approaches ◽  
Slow Growth Rate ◽  
The Past ◽  
New Therapeutic Approaches

Abstract We report the clinical presentation and management of 34 patients with a histologically proven chordoma, treated in the neurosurgical departments in Edinburgh and Dundee, over the past 50 years. Although these tumors are commonly regarded as being locally invasive with a variable, but generally slow growth rate, they can metastasize, and this may precede surgical intervention, as in one of our patients. Our cases are compared to those in previously published series, and a comprehensive review of the treatment modalities for tumors at various sites is presented. The optimal treatment to be recommended from our own experience, and that of others, is aggressive operation and radiotherapy. A combination of hyperthermia and chemotherapy has shown some promise, but remains untested, and highlights the need for a multicenter trial with long follow-up to allow the evaluation of new therapeutic approaches.

scholarly journals A challenging entity of endovascular embolization with ONYX for brainstem arteriovenous malformation: Experience from 13 cases

2017 ◽  
Vol 23 (5) ◽  
pp. 497-503 ◽  
Author(s):  
Hengwei Jin ◽  
Zhan Liu ◽  
Qing Chang ◽  
Chang Chen ◽  
Huijian Ge ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Intracranial Hemorrhage ◽  
Arteriovenous Malformations ◽  
Clinical Presentation ◽  
Gamma Knife Radiosurgery ◽  
Endovascular Embolization ◽  
Treatment Modalities ◽  
Patient Demographics ◽  
Partially Occluded

Objective Brainstem arteriovenous malformations (AVMs) are rare lesions with a high risk of intracranial hemorrhage and are challenging to treat. We present our experience of endovascular embolization with Onyx in these aggressive lesions. Materials and methods Between 2007 and 2016, 13 patients with brainstem AVMs were embolized with Onyx at our center. Twelve patients presented with intracranial hemorrhage and one with headache. Retrospective examinations of patient demographics, clinical presentation, angiographic features, treatment modalities, postoperative complications and outcomes were carried out. Results The AVMs were in the midbrain in 10 patients (one anterior and nine posterior or dorsal), in the posterior pons in two and pontomedullary in one. Complete occlusion was achieved in three patients. Gamma knife radiosurgery was performed in six patients who were near-completely or partially embolized. Postoperative complications, including five cases of ischemia and one case of hemorrhage, resulted in four cases of neurological deterioration and two deaths. Clinical follow-up was obtained in 10 patients at a mean period of 45.2 months (range 3 to 93 months). During the follow-up, good clinical outcomes were observed in seven patients with posterior or dorsal midbrain AVMs, and one patient with a posterior pons AVM that was partially occluded died of intracranial hemorrhage. Conclusion Endovascular embolization for brainstem AVM with Onyx is a technical challenge and the reflux of Onyx may cause severe complications. Individualized treatment is needed based on the specific subtype of brainstem AVM.

Fracture of the Second Metatarsal Base

2003 ◽  
Vol 93 (1) ◽  
pp. 6-10 ◽  
Author(s):  
Gregory Morris ◽  
Kelly Nix ◽  
Flair D. Goldman
Keyword(s):  
Differential Diagnosis ◽  
Clinical Presentation ◽  
Recovery Period ◽  
Treatment Modalities ◽  
Transverse Fracture ◽  
Imaging Studies ◽  
Improve Treatment ◽  
Second Metatarsal ◽  
The Mean

Fracture of the second metatarsal is a cause of chronic midfoot pain that has not been thoroughly examined in the literature. A retrospective review of medical charts and imaging studies was undertaken to investigate this phenomenon. The clinical presentation, differential diagnosis, results of imaging studies, and treatment modalities are described for eight patients with midfoot pain who were treated for a mean of 3.7 months (range, 0 to 12 months) before imaging studies showed a nondisplaced transverse fracture of the second metatarsal base. Initial radiographs indicated fracture in only one patient. Two patients later had surgical bone grafting, two patients had asymptomatic nonunion, and three patients eventually healed. At the last follow-up examination, one patient was continuing treatment with immobilization and electrical bone stimulation. For the seven patients in whom symptoms resolved, the mean recovery period was 14 months (range, 5 to 23 months). Further research is needed to improve treatment and outcomes for this condition. (J Am Podiatr Med Assoc 93(1): 6-10, 2003)

scholarly journals Intracranial cavernous malformation in children: a single-centered experience with 30 consecutive cases

2013 ◽  
Vol 71 (4) ◽  
pp. 220-228 ◽  
Author(s):  
Marcelo Campos Moraes Amato ◽  
João Flávio Gurjão Madureira ◽  
Ricardo Santos de Oliveira
Keyword(s):  
Clinical Presentation ◽  
Cavernous Malformation ◽  
Neurological Deficits ◽  
Treatment Modalities ◽  
Study Group ◽  
Functional Evaluation ◽  
Cavernous Malformations ◽  
Asymptomatic Patients ◽  
The Mean

Objectives: To determine the clinical presentation and treatment outcome of pediatric intracranial cavernous malformation (CM) in a single-centered institution. Methods: Clinical data review of 30 patients under 18 years-old who had undergone surgery for cavernous malformation from January 1993 to December 2011. Results: The Study Group included 18 males and 12 females (mean age: 8.7 years-old). Symptoms at presentation were seizures (16/30, 53.3%), headache (15/30, 50.0%), and focal neurological deficits (11/30, 36.6%). Multiple cavernous malformations were found in 5/30 (16.6%). According to location, patients were classified in groups: (G1) brain-steam in 5/30 (16.6%), (G2) cerebellum in 2/30 (6.6%), (G3) supratentorial associated with seizures in 16/30 (53.3%), and (G4) supratentorial without seizures in 7/30 (23.3%). Surgical resection was performed in 26 out of 30 (86.6%) patients. The mean follow-up period was 4.1 years. Of 15 children followed-up with preoperative seizures, all were rendered seizure-free after surgery. Conclusions: For symptomatic solitary cavernous malformation, the treatment of choice is complete microsurgical excision preceded by careful anatomical and functional evaluation. For multiple cavernous malformation or asymptomatic patients, the treatment modalities must be cautiously considered.

scholarly journals Ganglioneuroma of the External Auditory Canal and Middle Ear

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Hesham Saleh Almofada ◽  
Michael Steven Timms ◽  
M. Anas Dababo
Keyword(s):  
Bone Marrow ◽  
Temporal Bone ◽  
Middle Ear ◽  
External Auditory Canal ◽  
Rare Case ◽  
Clinical Presentation ◽  
Surgical Intervention ◽  
Stage Iv ◽  
Posterior Mediastinum

Objective. We report an extremely rare case of ganglioneuroma involving the external auditory canal and middle ear. Case Report. Ganglioneuromas are rare benign mature tumors thought to originate from sympathetic ganglions, with the highest incidence in the retroperitoneum, adrenal medulla, and posterior mediastinum. We present a case of ganglioneuroma of the external auditory canal and middle ear. At the age of 12 months, the patient was diagnosed with neuroblastoma stage IV with metastasis to the squamous temporal bone, bone marrow, and skull base. He received a high-risk protocol regimen resulting in complete remission. The patient later presented with recurrent right ear discharge at the age of six years and was diagnosed with ganglioneuroma of external auditory canal and middle ear after appropriate investigations. We report in this article the clinical presentation, investigations, surgical intervention, and follow-up. Conclusion. After the literature review and to our knowledge, this is the first reported case of its kind. Ganglioneuroma maturing from neuroblastoma is one of the theories describing pathophysiology of the disease. Ganglioneuroma should be considered in the differential diagnosis of patients presenting with recurrent ear discharge and decreased hearing in treated cases of neuroblastoma with metastases to temporal bone.

scholarly journals An Observational Study of Stroke and its Outcomes in a Tertiary Care Hospital

2020 ◽  
Author(s):  
Amruth Gujjar ◽  
Rekha Walwekar ◽  
AN Dattatri
Keyword(s):  
Drug Therapy ◽  
Clinical Presentation ◽  
Tertiary Care ◽  
Clinical History ◽  
Haemorrhagic Stroke ◽  
Developed Countries ◽  
P Value ◽  
Care Hospital ◽  
Case Record

Introduction: Incidence of stroke is higher in developing countries than in developed countries. India shows prevalence of Cerebrovascular Disease (CVD) in the range of 52 to 843/100,000 population. Stroke causes 9% deaths around the world. The basic principle of managing stroke includes making an accurate diagnosis, choosing the effective drugs and dose for the stroke type. Aim: To analyse the outcomes of pharmacotherapy of stroke based on characteristics and clinical presentation of patients admitted to hospital and to know the adverse effect of drugs used. Materials and Methods: This cohort study was conducted with Department of Medicine and Neurology at Karnataka Institute of Medical Sciences, Hubballi from January 2015 to December 2015. After clearance from Institutional Ethics Committee, 162 cases were selected based on the inclusion and exclusion criteria. The clinical history, in examination modified Rankin score (mRS) at admission, discharge and on follow-up were recorded. The criteria for selecting the drugs, frequency, dosing, duration and change in drug therapy were recorded. The efficacy of drug therapy was assessed by clinical improvement. The adverse events were assessed and recorded. The patients were followed-up at three and six months. The data were entered after defining the variables in SPSS (version 16) from case record form. Descriptive statistics were used to summarise baseline data. Results: Of the 162 patients, 155 completed the six months follow-up. The median age of patients was 60 years for ischaemic and 55 years for haemorrhagic stroke. More males were admitted with strokes {108 (69.67%)} compared to females {47 (30.32%)}; 130 (83.87%) patients had ischaemic strokes, 16 (10.30%) haemorrhagic stroke {15 (9.67%) were intracerebral haemorrhage + 1 (0.63 %) patient had a subarachnoid haemorrhage}, 9 (5.8%) had Transient Ischaemic Attack (TIA). The modified Rankin score calculated for the patients was statistically significant between admission and discharge (1.29, p-value 0.0035), and that between three months and six months (0.9, p-value 0.003) of follow-up.Total 93% of 121 patients with ischaemic stroke received antiplatelet therapy. Amlodipine was the most commonly prescribed antihypertensive. Conclusion: Pharmacotherapy of stroke in the study was evidence-based and satisfactory. However, patients showed reduced compliance to all medications. Clinical presentation and type of stroke were important predictors of morbidity and mortality at the end of six months.

Clinical Presentation and Outcomes of Coil Embolization of Remnant or Recurred Intracranial Aneurysm After Clipping

Neurosurgery ◽  
2010 ◽  
Vol 66 (6) ◽  
pp. 1128-1133 ◽  
Author(s):  
Byung Moon Kim ◽  
Dong Joon Kim ◽  
Dong Ik Kim ◽  
Sung Il Park ◽  
Sang Hyun Suh ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Coil Embolization ◽  
Clinical Presentation ◽  
Imaging Modality ◽  
Mass Effect ◽  
Poor Outcome ◽  
Ct Angiogram ◽  
Clinical Presentations ◽  
Complete Obliteration

Abstract OBJECTIVE To evaluate clinical presentation, safety, techniques, clinical and angiographic outcomes, and prognostic factors of coiling for remnant/recurred aneurysm after clipping. METHODS Twenty-four consecutive patients (11 men and 13 women; mean age, 52 years) with 24 recurred/remnant aneurysms after clipping underwent coil embolization between September 2000 and December 2008. Clinical presentations of remnant/recurred aneurysms, safety, techniques, clinical and angiographic outcomes, and prognostic factors of coil embolization were retrospectively evaluated. RESULTS Twenty-two aneurysms initially presented with subarachnoid hemorrhage and the other two, with mass effect. Eight aneurysms presented with rebleeding and 16 aneurysms were found on follow-up CT angiogram (n = 12) or catheter angiogram (n = 4). The interval between clipping and coiling ranged from 8 days to 114 months (mean, 31 months). Twelve were treated by using single-catheter, 6 by stent-assisted, 4 by multicatheter, 1 by both balloon- and catheter-assisted, and 1 by balloon-in-stent technique. Immediate postembolization angiogram revealed complete obliteration (n = 19) or residual neck (n = 5). Procedure-related permanent morbidity and mortality rates were 4.2% (1 of 24) and 0%, respectively. There was no rebleeding during clinical follow-up for 3 to 82 months (mean, 24 months). Presentation with rupture after clipping was the only significant predictor of poor outcome (P < .05). CONCLUSION Coiling seems to be a safe and effective retreatment option for remnant/ recurred aneurysm after clipping. Presentation with rupture after clipping is the only predictor of poor outcome. For routine/regular follow-up after clipping, CT angiography may be the imaging modality advisable for detection of remnant/recurred aneurysm.

scholarly journals Caroticocavernous Fistulae: Clinical Presentation, Imaging, and Endovascular Treatment

2019 ◽  
Vol 03 (03) ◽  
pp. 171-179
Author(s):  
Pushpinder S. Khera ◽  
Pawan K. Garg ◽  
Sarbesh Tiwari ◽  
Binit Sureka ◽  
Taruna Yadav ◽  
...  
Keyword(s):  
High Pressure ◽  
Clinical Presentation ◽  
Imaging Findings ◽  
Endovascular Management ◽  
Common Cause ◽  
Interventional Radiologist ◽  
Clinical Presentations ◽  
Pictorial Essay ◽  
Two Wheeler

AbstractCaroticocavernous fistulas (CCFs) occur due to an abnormal communication between the high-pressure carotid artery system and the relatively lower pressure cavernous sinus system. They present with dramatic clinical presentations comprising among other things a swollen red eye with associated loss of vision to a varying degree. Blunt trauma sustained to the head, especially by two-wheeler riders, is the most common cause of the direct CCF and hence a practicing interventional radiologist in a developing country is very likely to encounter this entity in clinical practice. The authors intend to present a pictorial essay of the clinical presentations, imaging findings, endovascular management, and clinical follow-up for CCFs.

scholarly journals Melioidosis of the Musculoskeletal System

2019 ◽  
Vol 29 (2) ◽  
pp. 121-127 ◽  
Author(s):  
Rajamani Perumal ◽  
Abel Livingston ◽  
Sumant Samuel ◽  
Santhosh Kumar Govindaraju
Keyword(s):  
Surgical Treatment ◽  
Soft Tissue ◽  
Septic Arthritis ◽  
Musculoskeletal System ◽  
Medical Management ◽  
Clinical Presentation ◽  
Treatment Modalities ◽  
Soft Tissue Abscess ◽  
Musculoskeletal Involvement

Objective: Recent studies indicate that India is an endemic region for Burkholderia pseudomallei infection. We aimed to describe the clinical presentation of B. pseudomallei infection of the musculoskeletal system and summarise the various treatment modalities used in our clinical practice. Subjects and Methods: Patients with confirmed microbiological diagnosis of B. pseudomallei infection involving the musculoskeletal system treated from January 2007 to December 2016 with a minimum follow-up of 1 year were included. A retrospective review of medical records was carried out and patients’ demographic data, co-morbidities, clinical presentation, and details of medical and surgical treatment were documented. Results: Of 342 patients diagnosed with B. pseudomallei infection, 37 (9.2%) had musculoskeletal involvement; 26 patients (23 males) followed up for at least a year were included in the study. Four patients (15%) had multisystem involvement and 10 (37%) had multiple musculoskeletal foci of infection; 15 patients (58%) had osteomyelitis, 10 (38%) had septic arthritis with or without osteomyelitis, and 1 patient (4%) presented with only soft tissue abscess. All patients required surgical intervention in addition to medical management. Surgical treatment varied from soft tissue abscess drainage, arthrotomy for septic arthritis, decompression and curettage for osteomyelitis, and/or use of antibiotic (meropenem or ceftazidime)-loaded polymethylmethacrylate bone cement for local drug delivery. At final follow-up (average: 37 months, range: 12–120), all patients were disease free. Conclusion: We found the rate of musculoskeletal involvement in B. pseudomallei infection to be 9.2%. Appropriate surgical treatment in addition to medical management resulted in resolution of disease in all our patients.

scholarly journals Acute renal and splenic infarctions: a review

QJM ◽  
2019 ◽  
Author(s):  
E Weber ◽  
F Grangeon ◽  
Q Reynaud ◽  
A Hot ◽  
P Sève ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Arterial Injury ◽  
University Hospitals ◽  
Short Term ◽  
Exclusion Criteria ◽  
Diffuse Abdominal Pain ◽  
Organ Volume ◽  
Clinical Presentations ◽  
Few Data

Abstract Background Renal and splenic infarctions are close entities, with few data concerning their clinical, biological and radiological features. Aim The aim of this study was to compare the clinical presentations, etiologies and outcomes of acute renal infarctions (RI) and splenic infarctions (SI). Design A retrospective multicentric cohort study included patients of the 6 university hospitals in Lyon with RI, SI, or associated RI-SI infarctions was conducted. Methods All consecutive cases diagnosed by CT imaging, between January 2013 and October 2016, were included. The exclusion criteria were causes of infarction that did not require additional investigations. Results A total of 161 patients were selected for analysis: 34 patients with RI, 104 patients with SI and 23 patients with both RI-SI. Mean ± SD age of patients was 63.2 ± 16.6 years; 59.6% were male. Only 5/161 (3.1%) were healthy prior to the event. The main symptoms were diffuse abdominal pain (26.4%), followed by nausea/vomiting (18.3%) and fever (16.4%).The causes of RI or SI varied significantly within the three groups. Hypercoagulable state was associated with SI, and embolic disease and arterial injury were associated with RI. Extensive (i.e.>2/3 of organ volume) (OR 6.22, 95%CI 2.0119.22) and bilateral infarctions (OR 15.05, 95%CI 1.79–126.78) were significantly associated with hemodynamic shocks. The survival at 1 month follow-up did not significantly differ between the three groups. Conclusion Acute RI and SI are heterogenous entities in regards to their clinical presentation, etiology, associated venous or arterial thrombosis, but prognoses were not different at short term follow-up.

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