Shunting with gravitational valves—can adjustments end the era of revisions for overdrainage-related events?

2012 ◽  
Vol 117 (6) ◽  
pp. 1197-1204 ◽  
Author(s):  
Florian Baptist Freimann ◽  
Christian Sprung
Keyword(s):  
Unsolved Problem ◽  
Surgical Intervention ◽  
Statistical Significance ◽  
Treatment Options ◽  
Signs And Symptoms ◽  
Opening Pressure ◽  
Shunt Insertion ◽  
New Generation ◽  
Valve Pressure

Object Overdrainage of CSF remains an unsolved problem in shunt therapy. The aim of the present study was to evaluate treatment options on overdrainage-related events enabled by the new generation of adjustable gravity-assisted valves. Methods The authors retrospectively studied the clinical course of 250 consecutive adult patients with various etiologies of hydrocephalus after shunt insertion for different signs and symptoms of overdrainage. Primary and secondary overdrainage were differentiated. The authors correlated the incidence of overdrainage with etiology of hydrocephalus, opening valve pressure, and patient parameters such as weight and size. Depending on the severity of overdrainage, they elevated the opening pressure, and follow-up was performed until overdrainage was resolved. Results The authors found 39 cases (15.6%) involving overdrainage-related problems—23 primary and 16 secondary overdrainage. The median follow-up period in these 39 patients was 2.1 years. There was no correlation between the incidence of overdrainage and any of the following factors: sex, age, size, or weight of the patients. There was also no statistical significance among the different etiologies of hydrocephalus, with the exception of congenital hydrocephalus. All of the “complications” could be resolved by readjusting the opening pressure of the valve in one or multiple steps, avoiding further operations. Conclusions Modern adjustable and gravity-assisted valves enable surgeons to set the opening pressure relatively low to avoid underdrainage without significantly raising the incidence of overdrainage and to treat overdrainage-related clinical and radiological complications without surgical intervention.

scholarly journals Operative Treatment of Cervical Myelopathy: Cervical Laminoplasty

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Brett A. Braly ◽  
David Lunardini ◽  
Chris Cornett ◽  
William F. Donaldson
Keyword(s):  
Surgical Technique ◽  
Cervical Spondylotic Myelopathy ◽  
Surgical Intervention ◽  
Treatment Options ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Technical Difficulty ◽  
Cervical Laminoplasty ◽  
Open Door ◽  
Clinical Signs And Symptoms

Cervical spondylotic myelopathy (CSM) is a degenerative process which may result in clinical signs and symptoms which require surgical intervention. Many treatment options have been proposed with various degrees of technical difficulty and technique sensitive benefits. We review laminoplasty as a motion-sparing posterior decompressive method. Current literature supports the use of laminoplasty for indicated decompression. We also decribe our surgical technique for an open-door, or “hinged”, laminoplasty.

scholarly journals Factors that Influence the Duration of Symptom Resolution in COVID-19 Patients in Ethiopia: A Follow up Study Involving 60 Symptomatic Cases.

2021 ◽  
Author(s):  
Saro Abrahim ◽  
Masresha Tesema ◽  
Eshetu Ejeta ◽  
Mahammed Ahmed ◽  
Atkure Defar ◽  
...  
Keyword(s):  
Median Duration ◽  
Proportional Hazards ◽  
Statistical Significance ◽  
Signs And Symptoms ◽  
Cox Proportional Hazards ◽  
Treatment Center ◽  
Symptom Resolution ◽  
Proportional Hazards Regression ◽  
Study Participants

Abstract Background: The newly identified virus, Severe Acute Respiratory Syndrome Corona Virus-two (SARS-CoV-2) has claimed more than a million lives worldwide since it was first recognized in Wuhan, China in December 2019. Understanding the clinical features of COVID-19 and duration for resolution of symptoms is crucial for isolation of patients and tailoring public health messaging, interventions, and policy. Therefore, this study aims to assess the median duration of COVID-19 signs and symptoms resolution and explore it’s predictors among symptomatic COVID-19 patients in EthiopiaMethods: A hospital-based prospective cohort study involving 60 COVID-19 cases was conducted at Eka Kotebe General Hospital, COVID-19 Isolation and Treatment Center. The study participants were all symptomatic COVID-19 adult patients admitted to the hospital from March 18 to June 27, 2020. Physicians at the center recorded the data using a log sheet. Cox proportional-hazards regression model was conducted. Statistical significance was defined at P<0.05. All analyses were done using STATA version 16.1 software.Results: A total of 60 symptomatic COVID-19 patients with a mean age of 34.8 years (+1.8) were involved in the study. The median duration of symptom resolution of COVID-19 was seven days with a minimum of two and a maximum of 68 days. Sex and Body Mass Index (BMI) were statistically significant predictors of the symptom resolution. The hazard of having delayed sign or symptom resolution in males was 55% higher than in females (P=0.039, CI: 0.22 to 0.96) and the hazard of the delayed sign or symptom in those with BMI ≥25 was 48% higher than in those with BMI <25 (P=0.051; CI: 0.272 to 1.003). In this study, age and comorbidity had no association with the duration of sign or symptom resolution in COVID-19 patients.Conclusions: The median duration of COVID-19 symptom resolution was seven days. Being male or having a BMI ≥ 25 were predictors for having a delayed sign or symptom resolution time. Therefore, understanding the duration of COVID-19 sign or symptom resolution helps to guide the patient isolation period and prioritize COVID-19 patients to be shielded.

scholarly journals Pre-interruptive intracoronal resorption: clinical and radiographic follow-up

2017 ◽  
Vol 65 (3) ◽  
pp. 282-285 ◽  
Author(s):  
Sâmila Gonçalves BARRA ◽  
Maria Isabel de Oliveira e Brito VILLALOBOS ◽  
Cláudia Valéria de Sousa Resende PENIDO ◽  
Angela Christina Barroso RECCHIONI ◽  
Maria Augusta Portella Guedes VISCONTI
Keyword(s):  
Surgical Intervention ◽  
Treatment Options ◽  
Panoramic Radiograph ◽  
Conservative Approach ◽  
Dental Clinic ◽  
Routine Examination ◽  
Caucasian Girl ◽  
Radiolucent Lesion ◽  
Unerupted Teeth

ABSTRACT Pre-interruptive intracoronal resorption is a radiolucent lesion localized in dentin, immediately below the amelodentin junction of unerupted teeth. It is rare, asymptomatic, and of idiopathic etiology, generally diagnosed in routine radiographs or in those for orthodontic purposes. A conservative approach, with radiographic follow-up is the treatment recommended until the tooth erupts, and then the intervention is made. However, in cases with symptoms or progression of the lesion, surgical intervention is advisable. To report a case of pre-interruptive intracoronal resorption, with a conservative approach, showing the clinical and radiographic follow-up of this condition. The patient, a nine-year-old Caucasian girl, presented to the Dental Clinic for routine examination. An initial panoramic radiograph was requested, which showed an intracoronal radiolucence in tooth 45 that had not yet erupted. Clinical and radiographic follow-up was made until the affected tooth was completely established in the oral cavity. The treatment recommended for pre-interruptive intracoronal resorption is to have knowledge of the phenomenon, associate its probable etiology and radiographic aspect, as well as its prevalence, occurrence and treatment options, by considering a conservative approach when there are no symptoms.

Infections

2019 ◽  
pp. 995-1002
Author(s):  
Scott D. Oates
Keyword(s):  
Human Activities ◽  
Surgical Intervention ◽  
Fungal Infections ◽  
Treatment Options ◽  
Healthcare Providers ◽  
Signs And Symptoms ◽  
The Body ◽  
Early Surgical Intervention

Because of their exposed nature during human activities, infections of the hand are common. The anatomy of the hand and fingers also lends itself to unique types of infections that do not occur in other areas of the body, such as paronychia, felons, and fungal infections. Because of these unique types of infections, early surgical intervention is often necessary to prevent long-term functional sequelae. This requires healthcare providers to be knowledgeable of the signs and symptoms of these distinct infections in order to effectively treat these patients. This chapter describes many common hand infections and their treatment options.

Just the Tip: Resection of a Narcotic Catheter-Tip Granuloma: 2-Dimensional Operative Video

2018 ◽  
Vol 17 (2) ◽  
pp. E52-E52 ◽  
Author(s):  
Joanna Elizabeth Gernsback ◽  
John Paul G Kolcun ◽  
Glen Manzano
Keyword(s):  
Spinal Cord ◽  
Surgical Intervention ◽  
Treatment Options ◽  
Inflammatory Mass ◽  
Opioid Dose ◽  
Neurologic Deficits ◽  
Minimal Improvement ◽  
Catheter Tip ◽  
Catheter Replacement

Abstract The catheter tip “granuloma” is a rare inflammatory mass that forms in about 3% of patients with an intradural catheter, most commonly from a morphine pump. It has also been seen with other narcotic pumps, narcotic-non-narcotic combinations, and baclofen pumps. Mass formation is associated with increased opioid dose and concentration. It typically presents with increasing pain requiring increasing doses of medication, with minimal improvement, although it may present with neurologic deficits or be asymptomatic. On MRI, it appears as a round, rim-enhancing lesion that is low intensity with a hypointense rim on both T1 and T2. In the absence of neurologic deficits, there are many treatment options, ranging from a temporary stopping of the pump to catheter replacement. When the lesion presents with neurologic deficits, surgical intervention, beyond catheter replacement or repositioning, is indicated. A laminectomy is performed, with intradural exploration and careful resection of the mass, which is likely adherent to the spinal cord. Postoperative worsening of symptoms is common due to the mass being densely adherent to the spinal cord, requiring spinal cord manipulation. This worsening is usually temporary, and many patients make excellent recoveries. We present a case of a hydromorphone pump inflammatory mass, which initially presented with increasing pain, then progressive neurologic deficits, requiring referral and mass resection. We achieved only a partial resection due to the lesion's adherent nature. This surgical video demonstrates our intradural technique for resection of this rare and technically difficult mass, with 6-mo patient follow-up. The patient has consented to this case report.

scholarly journals Factors that influence the duration of symptom resolution in COVID-19 patients in Ethiopia: A follow up study involving 60 symptomatic cases. 

2020 ◽  
Author(s):  
Saro Abdella Abrahim ◽  
Masresha Tessema ◽  
Eshetu Ejeta ◽  
Mahammed Ahmed ◽  
Atkure Defar ◽  
...  
Keyword(s):  
Median Duration ◽  
Proportional Hazards ◽  
Statistical Significance ◽  
Signs And Symptoms ◽  
Cox Proportional Hazards ◽  
Treatment Center ◽  
Symptom Resolution ◽  
Proportional Hazards Regression ◽  
Study Participants

Abstract Background: The newly identified virus, Severe Acute Respiratory Syndrome Corona Virus-two (SARS-CoV-2) has claimed more than a million lives worldwide since it was first recognized in Wuhan, China in December 2019. Understanding the clinical features of COVID-19 and duration for resolution of symptoms is crucial for isolation of patients and tailoring public health messaging, interventions, and policy. Therefore, this study aims to assess the median duration of COVID-19 signs and symptoms resolution and explore it’s predictors among symptomatic COVID-19 patients in EthiopiaMethods: A hospital-based prospective cohort study involving 60 COVID-19 cases was conducted at Eka Kotebe General Hospital, COVID-19 Isolation and Treatment Center. The study participants were all symptomatic COVID-19 adult patients admitted to the hospital from March 18 to June 27, 2020. Physicians at the center recorded the data using a log sheet. Cox proportional-hazards regression model was conducted. Statistical significance was defined at P<0.05. All analyses were done using STATA version 16.1 software.Results: A total of 60 symptomatic COVID-19 patients with a mean age of 34.8 years (+1.8) were involved in the study. The median duration of symptom resolution of COVID-19 was seven days with a minimum of two and a maximum of 68 days. Sex and Body Mass Index (BMI) were statistically significant predictors of the symptom resolution. The hazard of having delayed sign or symptom resolution in males was 55% higher than in females (P=0.039, CI: 0.22 to 0.96) and the hazard of the delayed sign or symptom in those with BMI ≥25 was 48% higher than in those with BMI <25 (P=0.051; CI: 0.272 to 1.003). In this study, age and comorbidity had no association with the duration of sign or symptom resolution in COVID-19 patients.Conclusions: The median duration of COVID-19 symptom resolution was seven days. Being male or having a BMI ≥ 25 were predictors for having a delayed sign or symptom resolution time. Therefore, understanding the duration of COVID-19 sign or symptom resolution helps to guide the patient isolation period and prioritize COVID-19 patients to be shielded.

scholarly journals 15 YEARS OF PARAGANGLIOMA: Imaging and imaging-based treatment of pheochromocytoma and paraganglioma

2015 ◽  
Vol 22 (4) ◽  
pp. T135-T145 ◽  
Author(s):  
Frédéric Castinetti ◽  
Alexander Kroiss ◽  
Rakesh Kumar ◽  
Karel Pacak ◽  
David Taieb
Keyword(s):  
Functional Imaging ◽  
Surgical Intervention ◽  
Imaging Techniques ◽  
Treatment Options ◽  
Review Article ◽  
Whole Body ◽  
Anatomical Imaging ◽  
Imaging Algorithms ◽  
Near Future

Although anatomic imaging to assess the precise localization of pheochromocytomas/paragangliomas (PHEOs/PGLs) is unavoidable before any surgical intervention on these tumors, functional imaging is becoming an inseparable portion of the imaging algorithm for these tumors. This review article presents applications of the most up-to-date functional imaging modalities and image-based treatment to PHEOs/PGLs patients. Functional imaging techniques provide whole-body localization (number of tumors present along with metastatic deposits) together with genetic-specific imaging approaches to PHEOs/PGLs, thus enabling highly specific and sensitive PHEO/PGL detection and delineation that now greatly impact the management of patients. Radionuclide imaging techniques also play a crucial role in the prediction of possible radioactive treatment options for PHEO/PGL. In contrast to previous imaging algorithms used for either assessement of these patients or their follow-up, endocrinologists, surgeons, oncologists, pediatricians, and other specialists require functional imaging before any therapeutic plan is outlined to the patient, and follow-up, especially in patients with metastatic disease, is based on the periodic use of functional imaging, often reducing or substituting for anatomical imaging. In similar specific indications, this will be further powered by using PET/MR in the assessment of these tumors. In the near future, it is expected that PHEO/PGL patients will benefit even more from an assessement of the functional characteristics of these tumors and new imaging-based treatment options. Finally, due to the use of new targeting moieties, gene-targeted radiotherapeutics and nanobodies-based theranostic approaches are expected to become a reality in the near future.

Multicentre prospective clinical application of the T14 paediatric outcome tool

2015 ◽  
Vol 129 (10) ◽  
pp. 980-985 ◽  
Author(s):  
C Hopkins ◽  
R Almeyda ◽  
H Alreefy ◽  
H Ismail-Koch ◽  
J Lim ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Surgical Intervention ◽  
Statistical Significance ◽  
Group Differences ◽  
One Year ◽  
Outcome Tool ◽  
Disease Specific ◽  
Surgical Group

AbstractObjective:This study aimed to measure changes in disease-specific quality of life in children following tonsillectomy or adenotonsillectomy.Methods:A multicentre prospective cohort study was performed involving seven ENT departments in England. A total of 276 children entered the study over a 2-month period: 107 underwent tonsillectomy and 128 adenotonsillectomy. Forty-one children referred with throat problems initially managed by watchful waiting were also recruited. The follow-up period was 12 months. Outcome measures were the T14, parental impressions of their child's quality of life and the number of days absent from school.Results:One-year follow-up data were obtained from 150 patients (52 per cent). The mean baseline T14 score in the non-surgical group was significantly lower (T14 = 23) than in the tonsillectomy group (T14 = 31) or the adenotonsillectomy group (T14 = 35; p < 0.001). There was a significant improvement in the T14 scores of responders in all groups at follow up. The effect size was 1.3 standard deviations (SD) for the non-surgical group, 2.1 SD for the tonsillectomy group and 1.9 SD for the adenotonsillectomy group. Between-group differences did not reach statistical significance. A third of children in the non-surgical group underwent surgery during the follow-up period.Conclusion:Children who underwent surgical intervention achieved a significant improvement in disease-specific quality of life. Less severely affected children were managed conservatively and also improved over 12 months, but 1 in 3 crossed over to surgical intervention.

scholarly journals Comparison of efficacy of mirabegron and darifenacin in overactive bladder- a prospective study

2020 ◽  
Vol 8 (1) ◽  
pp. 196
Author(s):  
Gurpreet Singh Bhangu ◽  
Kamal Preet Kaur ◽  
Darpan Bansal ◽  
Ritansh Bansal
Keyword(s):  
Overactive Bladder ◽  
Drug Treatment ◽  
Comparative Study ◽  
Prospective Study ◽  
Treatment Options ◽  
Signs And Symptoms ◽  
Medical Sciences ◽  
Once Daily ◽  
A Prospective Study

Background: Overactive bladder (OAB) is under reported yet distressing symptoms which can be managed effectively by the drugs available. Aim was to study and compare the efficacy of two drugs, mirabegron and darifenacin in controlling the symptoms of overactive bladder.Methods: This prospective study included a total of 120 cases of overactive bladder reported at Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar from January 2018 to December 2019. This comparative study was done by giving Mirabegron to first five patients and next five patients were given darifenacin up to 120 patients. The drug treatment with once daily administration of 25 mg mirabegron and 7.5 mg of darifenacin was given for a total of 12 weeks. The signs and symptoms were noted at the beginning of the therapy and then follow up was done at 4, 8, 10 and 12 weeks.Results: Total 54 out of 60 patients (90%) on miragaberon and 59 of 60 patients (98.33%) on darifenacin were relieved of symptom of increased frequency of micturition. 53 of 60 pateints (88.33%) on miragaberon and 59 of 60 patients (98.33%) on darifenacin were relieved of symptom of decreased average voiding volume. 28 of 60 pateints (46.67 %) on miragaberon showed nocturia as compared to 25 of 60 patients (41.67%) on darifenacin.Conclusions: It has been concluded that both mirabegron as well as darifenacin are highly efficacious newer treatment options for the management of OAB. Our study found Darifenacin to be relatively more efficacious in the treatment of OAB at a lesser dose and statistically significant differences were observed between the two drugs. 

scholarly journals Ibrexafungerp versus placebo for vulvovaginal candidiasis treatment: a phase 3, randomized, controlled superiority trial (VANISH 303)

2021 ◽  
Author(s):  
Jane R Schwebke ◽  
Ryan Sobel ◽  
Janet K Gersten ◽  
Steven A Sussman ◽  
Samuel N Lederman ◽  
...  
Keyword(s):  
Clinical Improvement ◽  
Clinical Cure ◽  
Oral Treatment ◽  
Treatment Options ◽  
Signs And Symptoms ◽  
Current Treatment ◽  
Vulvovaginal Candidiasis ◽  
Symptom Resolution ◽  
Superiority Trial

Abstract Background Current treatment of vulvovaginal candidiasis (VVC) is largely limited to azole therapy. Ibrexafungerp is a first-in-class triterpenoid antifungal with broad-spectrum anti-Candida fungicidal activity. The objective of this study was to evaluate the efficacy and safety of ibrexafungerp compared with placebo in patients with acute VVC. Study Design Patients were randomly assigned 2:1 to receive ibrexafungerp (300 mg twice for 1 day) or placebo. The primary endpoint was the percentage of patients with a clinical cure (complete resolution of vulvovaginal signs and symptoms [VSS]=0) at test-of-cure (day 11±3). Secondary endpoints included the percentage of patients with mycological eradication, overall success (clinical cure and mycological eradication), clinical improvement (VSS≤1) at test-of-cure, and symptom resolution at follow-up (day 25±4). Results Patients receiving ibrexafungerp had significantly higher rates of clinical cure (50.5% [95/188] vs 28.6% [28/98]; P=0.001), mycological eradication (49.5% [93/188] vs 19.4% [19/98]; P&lt;0.001), and overall success (36.0% [64/178] vs 12.6% [12/95]; P&lt;0.001) compared with placebo. Symptom resolution was sustained and further increased with ibrexafungerp compared with placebo (59.6% [112/188] vs 44.9% [44/98]; P=0.009) at follow-up. Post hoc analysis showed similar rates of clinical cure and clinical improvement at test-of-cure for African American patients (54.8% [40/73] and 63.4% [47/73], respectively) and patients with a body mass index &gt;35 (54.5% [24/44] and 68.2% [30/44], respectively) compared with overall rates. Ibrexafungerp was well tolerated. Adverse events were primarily gastrointestinal and mild in severity. Conclusion Ibrexafungerp provides a promising safe and efficacious oral treatment that mechanistically differs from current azole treatment options for acute VVC.

Sign in / Sign up

Export Citation Format

Share Document