scholarly journals Endoscopic Management of Branchial Fistula: Diagnostic and Therapeutic.

2021 ◽  
Vol 20 (4) ◽  
Author(s):  
Mark Paul ◽  
Bee See Goh
Keyword(s):  
Surgical Excision ◽  
Neck Surgery ◽  
Typical Feature ◽  
Primary Treatment ◽  
Treatment Modalities ◽  
Endoscopic Management ◽  
First Line ◽  
Primary Treatment Modality ◽  
Branchial Fistula ◽  
Endoscopic Assessment

Recurrent neck abscess is a typical feature of branchial anomaly. Open surgical excision has been the primary treatment modality for past decades however several alternative treatment modalities such as endoscopic electrocauterization has recently gained popularity and acceptance universally. This series aims to introduce endoscopic assessment as the first line diagnostic and therapeutic management for branchial fistula. 5 patients underwent examination under general anesthesia via direct laryngoscopy, endoscopic assessment and cauterization in our centre from 2016 to 2019. They were then followed up at our clinic to assess disease progression. Comparison between open neck surgery and endoscopic cauterization of internal sinus tract opening as the primary treatment has reported similar recurrence rate. Proposal of endoscopic assessment as the first line investigation and diagnostic tool  with the aim of therapeutic cauterization at the same setting. MRI may be needed in scenarios such as failed endoscopic treatment or when open surgery is required.

scholarly journals Gastrointestinal Stromal Tumours: A 10 Year Multicenter Audit

2016 ◽  
Vol 6 (1) ◽  
pp. 1
Author(s):  
Geoffrey Alan Watson ◽  
D. Kelly ◽  
E. Malone ◽  
J. Gleeson ◽  
G. McEntee ◽  
...  
Keyword(s):  
Imatinib Mesylate ◽  
Progressive Disease ◽  
Surgical Excision ◽  
Primary Treatment ◽  
Gi Tract ◽  
Gastrointestinal Stromal Tumours ◽  
First Line ◽  
Primary Treatment Modality ◽  
Tertiary Hospitals ◽  
Personalised Treatment

Background: Gastrointestinal stromal tumours (GISTs) are unique neoplasms of the gastrointestinal (GI) tract. The development of targeted therapeutic agents such as imatinib mesylate (Glivec) has altered the way on how we now manage these rare malignancies. The aim of this study was to evaluate the management of GISTs in three Irish tertiary hospitals. Methods: We performed a retrospective, multicenter audit of patients diagnosed with gastrointestinal stromal tumours over a ten year period (2005-2015). Results: 110 patients were included in the study. Abdominal pain was the most common presenting symptom, reported in 30% of patients, while 31% were incidental findings. The stomach was the most common primary site of disease, observed in 77% of cases. 15 patients had metastatic disease at the time of diagnosis (14%), and 10 of these patients had liver involvement. More than half of patients (61%) were managed with surgical excision alone (61%), while 24 were managed with surveillance and 28 patients treated with adjuvant Glivec, which was generally well tolerated. 18 patients (20%) demonstrated recurrent or progressive disease after first line treatment. 102 patients (93%) are alive today. Conclusion: While surgery is widely regarded as the primary treatment modality for GISTs the addition of imatinib mesylate has enabled physicians to deliver more personalised treatment while optimising patient outcomes.

Treatment of temporal artery pseudoaneurysms

Vascular ◽  
2013 ◽  
Vol 22 (4) ◽  
pp. 274-279 ◽  
Author(s):  
Irene Thomassen ◽  
Elisabeth G Klompenhouwer ◽  
Edith M Willigendael ◽  
Joep AW Teijink
Keyword(s):  
Superficial Temporal Artery ◽  
Surgical Excision ◽  
Temporal Artery ◽  
Primary Treatment ◽  
Treatment Modalities ◽  
Diagnostic Process ◽  
Thrombin Injection ◽  
Invasive Treatment ◽  
Artery Pseudoaneurysm ◽  
Primary Treatment Modality

Purpose To give an overview of the etiology and diagnostic process of superficial temporal artery pseudoaneurysms and to evaluate different treatment modalities. Basic methods PubMed was used for searching multiple databases for relevant clinical studies. Principal findings A total of 62 studies were included, harboring 82 patients. Surgical excision is the most frequently described treatment, but less invasive treatment modalities as coiling and thrombin injections are gaining popularity. Surgical treatment was successful in all cases (67/67). Endovascular treatment was successful in 69% (9/13); the five cases treated with thrombin injection were all successful. Complementary, a description of our experience with thrombin injection is given. Conclusions Limited evidence of minimal invasive treatment for superficial temporal artery pseudoaneurysm is available. Based on this review combined with our limited experience, we suggest thrombin injections to be considered as the future primary treatment modality. In the case of unsuccessful exclusion of the aneurysm, surgical excision can be performed.

scholarly journals Role of Adjuvant Radiosurgery after Thoracoscopic Microsurgical Resection of a Spinal Schwannoma

2012 ◽  
Vol 2012 ◽  
pp. 1-4
Author(s):  
Toba N. Niazi ◽  
Christian A. Bowers ◽  
Meic H. Schmidt
Keyword(s):  
Stereotactic Radiosurgery ◽  
Treatment Modality ◽  
Surgical Excision ◽  
Primary Treatment ◽  
Benign Tumors ◽  
Noninvasive Treatment ◽  
Thoracic Spinal ◽  
Primary Treatment Modality ◽  
Microsurgical Resection ◽  
Spinal Schwannoma

Stereotactic radiosurgery to benign tumors of the spine has not been advocated as a primary treatment modality because of the favorable prognosis for these lesions after gross-total resection. There is even less evidence regarding its use as an adjuvant to neurosurgical resection of benign recurrent spinal disease. We describe the case of a 30-year-old man with a thoracic spinal schwannoma who had an interval increase of his lesion five months after thoracoscopic microsurgical resection. The patient opted for noninvasive stereotactic radiosurgery in lieu of additional surgical excision and has had stable disease 15 months after radiosurgical treatment with the linear accelerator (LINAC) system. In this setting, stereotactic radiosurgery provided a useful adjunct to thoracoscopic microsurgical resection. Future Class I and II evidence should be sought to evaluate the utility of stereotactic radiosurgery as a primary treatment modality or as an adjuvant for microneurosurgical resection of benign spinal lesions in patients who want noninvasive treatment after disease recurrence or who harbor medical comorbidities that would preclude them from being safe surgical candidates.

scholarly journals Postherpetic Nneuralgia: Review of Treatment Modalities

2000 ◽  
Vol 5 (1) ◽  
pp. 69-74 ◽  
Author(s):  
Philip SL Chan ◽  
Alexander J Clark
Keyword(s):  
Postherpetic Neuralgia ◽  
Tricyclic Antidepressants ◽  
Opioid Analgesics ◽  
Primary Treatment ◽  
Treatment Modalities ◽  
Nerve Blocks ◽  
Varicella Zoster ◽  
Primary Treatment Modality ◽  
Topical Medications ◽  
Physical Modalities

BACKGROUND: Varicella zoster virus (VZV) is the etiological agent for both varicella (chickenpox) and herpes zoster (HZ) (shingles). HZ results from the reactivation of VZV acquired during childhood. Postherpetic neuralgia (PHN) is the most common complication of HZ infection in immunocompetent patients. There is no universally accepted definition of PHN. While the mechanisms producing pain associated with PHN are not fully understood, peripheral and central processes are thought to be important.METHODS: The literature on the pathophysiology and the treatment of postherpetic neuralgia was reviewed for the past 30 years by using Index Medicus.CONCLUSIONS: Many modalities to treat PHN are available; none of them are very effective. The most commonly used modalities are tricyclic antidepressants, anticonvulsants, opioid analgesics, topical medications, physical modalities such as acupuncture and transcutaneous nerve stimulation, and nerve blocks. The tricyclic antidepressants have the most evidence supporting their role in treating PHN, although only half of the patients with PHN benefit. Recent studies support the use of opioid analgesics in PHN. There is a growing body of evidence in support of the use of gabapentin for PHN. Physical modalities and topical medications are probably most useful as adjuncts to centrally acting agents, not as a primary treatment modality. Injections (nerve blocks) are effective in relieving PHN anecdotally, although there are no controlled clinical trials showing efficacy.

scholarly journals Spontaneous rupture of liver abscess with biliary communication presenting as a lumbar mass

2021 ◽  
Vol 8 (11) ◽  
pp. 3484
Author(s):  
Ajay Bhandarwar ◽  
Amarjeet Tandur ◽  
Geoffrey Kharmutee ◽  
Akshay Rathod ◽  
Kaustubh Dodke ◽  
...  
Keyword(s):  
Liver Abscess ◽  
Percutaneous Drainage ◽  
Spontaneous Rupture ◽  
Pyogenic Liver Abscess ◽  
Primary Treatment ◽  
Minimal Invasive ◽  
Endoscopic Management ◽  
Primary Treatment Modality ◽  
Biliary Communication ◽  
Minimal Invasive Techniques

Pyogenic liver abscess was first reported in the writings of Hippocrates, which was based on the type of fluid recovered from the abscess related to a high mortality rate ranging between 15% and 19% at that time. However in 1938, Ochsner and De Bakey described the recommended surgical treatment as the primary treatment modality. Surgery remained the therapy of choice until the mid-1980s, when percutaneous drainage was shown to be a safer alternative in many cases. Spontaneous rupture of liver abscess may occur free in the peritoneal cavity or in neighbouring organs, an event which is generally considered as a surgical emergency, while localized rupture can be managed with drainage, either percutaneous or surgical/minimal invasive techniques and addition of appropriate antibiotic treatment. In cases where there is uneventful rupture of abscess and localized to the neighbouring organs and tissues can be successfully treated by a combination of broad-spectrum antibiotics and percutaneous drainage and endoscopic management.

scholarly journals COVID-19 and end stage renal disease treatment modalities in the United States

2021 ◽  
pp. 003-009
Author(s):  
Sullivan John D
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
The United States ◽  
Primary Treatment ◽  
Treatment Modalities ◽  
Health Coverage ◽  
Home Hemodialysis ◽  
Primary Treatment Modality ◽  
Stage Renal Disease ◽  
End Stage

From the establishment of nearly universal health coverage for end stage renal disease in 1972 to 2021, the primary treatment modality has been in-center hemodialysis despite significant advances in home therapies such as peritoneal dialysis and home hemodialysis. There are many theories as to why peritoneal and home hemodialysis lack so far behind in prescriptions with profitability and or a patient’s compliance or support leading the logical explanations. But 2020 was a different year with the surge in COVID-19 cases.

scholarly journals Gamma Knife Radiosurgery for Berry Aneurysms: Quo Vadis

2020 ◽  
Author(s):  
Manjul Tripathi ◽  
Aman Batish ◽  
Sandeep Mohindra
Keyword(s):  
Gamma Knife ◽  
Intracranial Aneurysms ◽  
Vascular Malformations ◽  
Gamma Knife Radiosurgery ◽  
Primary Treatment ◽  
Treatment Modalities ◽  
Invasive Treatment ◽  
Mortality And Morbidity ◽  
Primary Treatment Modality ◽  
Quo Vadis

Abstract Background Intracranial aneurysms are vascular malformations with significant mortality and morbidity profile. Various treatment modalities have been developed to positively impact the outcome profile with gradual shift to the minimally invasive treatment modalities. Gamma knife radiosurgery (GKRS) is an established primary treatment modality for various intracranial arteriovenous malformations (AVMs); however, its efficacy for berry aneurysmal obliteration has been historically dismal. Objective The aim of this study is to evaluate the factors responsible for poor radio surgical outcome for intracranial aneurysms. Methods The literature is reviewed for the differential efficacy of GKRS for aneurysm and AVM. Results Though both are vascular malformations, aneurysm and AVM have inherent differences in angioarchitecture, intracranial location, surrounding neighborhood, radio-sensitivity, and latency for obliteration. The major difference arises because of surrounding neighborhood of connective tissue stroma which stabilizes the irradiated pathology. Conclusion Though considered radioresistant, aneurysms show promising results with animal models of radiosurgery. The future lies in two hypothetical improvements: with a supporting neighborhood or sensitization of the vessel wall that may change the natural history of an aneurysm, especially an unruptured one.

scholarly journals Metastatic Pheochromocytomas and Abdominal Paragangliomas

2021 ◽  
Author(s):  
Dan Granberg ◽  
Carl Christofer Juhlin ◽  
Henrik Falhammar
Keyword(s):  
Metastatic Potential ◽  
Somatostatin Analogues ◽  
Primary Treatment ◽  
Treatment Modalities ◽  
Line Treatment ◽  
First Line ◽  
Biochemical Tests ◽  
Pubmed Database ◽  
Tumor Boards ◽  
131I Mibg

Abstract Context Pheochromocytomas and paragangliomas (PPGLs) are believed to harbor malignant potential; about 10% to 15% of pheochromocytomas and up to 50% of abdominal paragangliomas will exhibit metastatic behavior. Evidence Acquisition Extensive searches in the PubMed database with various combinations of the key words pheochromocytoma, paraganglioma, metastatic, malignant, diagnosis, pathology, genetic, and treatment were the basis for the present review. Data Synthesis To pinpoint metastatic potential in PPGLs is difficult, but nevertheless crucial for the individual patient to receive tailor-made follow-up and adjuvant treatment following primary surgery. A combination of histological workup and molecular predictive markers can possibly aid the clinicians in this aspect. Most patients with PPGLs have localized disease and may be cured by surgery. Plasma metanephrines are the main biochemical tests. Genetic testing is important, both for counseling and prognostic estimation. Apart from computed tomography and magnetic resonance imaging, molecular imaging using 68Ga-DOTATOC/DOTATATE should be performed. 123I-MIBG scintigraphy may be performed to determine whether 131I-MIBG therapy is a possible option. As first-line treatment in patients with metastatic disease, 177Lu-DOTATATE or 131I-MIBG is recommended, depending on which shows best expression. In patients with very low proliferative activity, watch-and-wait or primary treatment with long-acting somatostatin analogues may be considered. As second-line treatment, or first-line in patients with high proliferative rate, chemotherapy with temozolomide or cyclophosphamide + vincristine + dacarbazine is the therapy of choice. Other therapies, including sunitinib, cabozantinib, everolimus, and PD-1/PDL-1 inhibitors, have shown modest effect. Conclusions Metastatic PPGLs need individualized management and should always be discussed in specialized and interdisciplinary tumor boards. Further studies and newer treatment modalities are urgently needed.

scholarly journals Endoscopic Management of Recurrent Third Branchial Fistula using Histoacryl Glue

2018 ◽  
Vol 9 (1) ◽  
pp. 2
Author(s):  
M Z Naveed ◽  
A Naveed ◽  
A Irfanullah
Keyword(s):  
Fistulous Tract ◽  
Surgical Excision ◽  
Branchial Arch ◽  
Endoscopic Management ◽  
Cyanoacrylate Glue ◽  
Branchial Cleft Anomalies ◽  
Branchial Cleft ◽  
Branchial Fistula ◽  
Minimally Invasive Methods

Third branchial cleft anomalies are rare accounting for 2-8% of all branchial abnormalities. We report a case of a 9 year old boy who presented with discharging sinus on the left side of neck. A sinogram revealed third branchial arch fistula. The tract was surgically removed, however, on follow up the fistula was recurred. He was later taken for endoscopic cauterization and injection of Histoacryl (n-Butyl cyanoacrylate ) glue into the tract, after which his wound healed swiftly. Historically, surgical excision of the fistulous tract has been the mainstay of treatment. Recently, minimally invasive methods are gaining wider acclaim and may potentially become the treatment of choice in the future.

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