Preoperative diagnosis of vagal and sympathetic cervical schwannomas based on radiographic findings

2017 ◽  
Vol 126 (3) ◽  
pp. 690-697 ◽  
Author(s):  
Christopher S. Graffeo ◽  
Kathryn M. Van Abel ◽  
Jonathan M. Morris ◽  
Matthew L. Carlson ◽  
Jamie J. Van Gompel ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Preoperative Diagnosis ◽  
Case Series ◽  
Preoperative Imaging ◽  
Patient Specific ◽  
Study Cohort ◽  
Retrospective Case ◽  
Radiographic Findings ◽  
Predictive Probability ◽  
Peripheral Enhancement

OBJECTIVE Vagus nerve and sympathetic chain cervical schwannomas (VNCSs and SCCSs) are benign nerve sheath tumors that arise in the head and neck. Despite similar presentations that make accurate preoperative diagnosis more difficult, the potential for morbidity following resection is significantly higher for patients with VNCS. Therefore, the authors analyzed a retrospective case series and performed a comparative analysis of the literature to establish diagnostic criteria to facilitate more accurate preoperative diagnoses. METHODS The authors conducted a blinded review of imaging studies from retrospectively collected, operatively confirmed cases of VNCS and SCCS. They also performed a systematic review of published series that reported patient-specific preoperative imaging findings in VNCS or SCCS. RESULTS Nine patients with VNCS and 11 with SCCS were identified. In the study cohort, splaying of the internal carotid artery (ICA) and internal jugular vein (IJV) did not significantly predict the nerve of origin (p = 0.06); however, medial and lateral ICA displacement were significantly associated with VNCS and SCCS, respectively (p = 0.01 and p = 0.003, respectively). Multivariate analysis demonstrated that ICA and IJV splaying with medial ICA displacement carried an 86% probability of VNCS (p = 0.001), while the absence of splaying with lateral ICA displacement carried a 91% probability of SCCS (p = 0.006). The presence of vocal cord symptoms or peripheral enhancement significantly augmented the predictive probability of VNCS, as did Horner's syndrome or homogeneous enhancement for SCCS. A review of the literature produced 25 publications that incorporated a total of 106 patients, including the present series. Splaying of the ICA and IJV was significantly, but not uniquely, associated with VNCS (p < 0.0001); multivariate analysis demonstrated that ICA and IJV splaying with medial ICA displacement carries a 75% probability of VNCS (p < 0.0001), while the absence of such splaying with lateral ICA displacement carries an 87% probability of SCCS (p = 0.0003). CONCLUSIONS ICA and IJV splaying frequently predicts VNCS; however, this finding is also commonly observed in SCCS and, among the 9 cases in the present study, was observed more often than previously reported. When congruent with splaying, medial or lateral ICA displacement significantly enhances the reliability of preoperative predictions, empowering more accurate prognostication.

Plafond Malreduction and Talar Dome Impaction Accelerates Arthrosis After Supination-Adduction Ankle Fracture

2021 ◽  
pp. 107110072110060
Author(s):  
Michael F. Githens ◽  
Malcolm R. DeBaun ◽  
Kimberly A Jacobsen ◽  
Hunter Ross ◽  
Reza Firoozabadi ◽  
...  
Keyword(s):  
Case Series ◽  
High Energy ◽  
Ankle Fractures ◽  
Posttraumatic Arthritis ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Radiographic Findings ◽  
Posttraumatic Arthrosis ◽  
Patient Reported

Background: Supination-adduction (SAD) type II ankle fractures can have medial tibial plafond and talar body impaction. Factors associated with the development of posttraumatic arthritis can be intrinsic to the injury pattern or mitigated by the surgeon. We hypothesize that plafond malreducton and talar body impaction is associated with early posttraumatic arthrosis. Methods: A retrospective cohort of skeletally mature patients with SAD ankle fractures at 2 level 1 academic trauma centers who underwent operative fixation were identified. Patients with a minimum of 1-year follow-up were included. The presence of articular impaction identified on CT scan was recorded and the quality of reduction on final intraoperative radiographs was assessed. The primary outcome was radiographic ankle arthrosis (Kellgren-Lawrence 3 or 4), and postoperative complications were documented. Results: A total of 175 SAD ankle fractures were identified during a 10-year period; 79 patients with 1-year follow-up met inclusion criteria. The majority of injuries resulted from a high-energy mechanism. Articular impaction was present in 73% of injuries, and 23% of all patients had radiographic arthrosis (Kellgren-Lawrence 3 or 4) at final follow-up. Articular malreduction, defined by either a gap or step >2 mm, was significantly associated with development of arthrosis. Early treatment failure, infection, and nonunion was rare in this series. Conclusion: Malreduction of articular impaction in SAD ankle fractures is associated with early posttraumatic arthrosis. Recognition and anatomic restoration with stable fixation of articular impaction appears to mitigate risk of posttraumatic arthrosis. Investigations correlating postoperative and long-term radiographic findings to patient-reported outcomes after operative treatment of SAD ankle fractures are warranted. Level of Evidence: Level IV, retrospective case series.

scholarly journals How COVID-19 Patients Were Moved to Speak: A Rehabilitation Interdisciplinary Case Series

2020 ◽  
Vol 16 (S1) ◽  
pp. 56-63
Author(s):  
Brianne Mooney ◽  
Cecelia Lawrence ◽  
Elizabeth Gerosa Johnson ◽  
Amanda Slaboden ◽  
Karen Ball
Keyword(s):  
Physical Therapy ◽  
Case Series ◽  
Interdisciplinary Cooperation ◽  
Patient Specific ◽  
Multidisciplinary Teams ◽  
Speech Language Pathology ◽  
Retrospective Case ◽  
Swallowing Function ◽  
Prolonged Intubation ◽  
Language Pathology

Abstract Background Up to 36% of patients admitted to the ICU for COVID-19 require tracheostomy. While the literature recommends the use of multidisciplinary teams in the management of patients with tracheostomy for other diseases, little is known on the collaborative administration of physical therapy and speech language pathology services in the COVID-19 population. Purpose We sought to determine the outcomes of a collaboration between physical therapy (PT) and speech language pathology (SLP) in the treatment of patients who underwent tracheostomy placement as part of their treatment for COVID-19 at our facility. Methods We conducted a retrospective case series on patients with COVID-19 who had a tracheostomy. We included patients who had undergone mechanical ventilation for 14 days or longer, had a surgical tracheostomy, been discharged from intensive care to a medical unit, and received PT and SLP referrals. We compiled retrospective data from electronic medical records, analyzing days from tracheostomy to achievement of PT and SLP functional milestones, including mobility, communication, and swallowing. Of six critically ill patients with COVID-19 who had tracheostomy placement at our facility, three met inclusion criteria: patient 1, a 33-year-old woman; patient 2, an 84-year-old man; and patient 3, an 81-year-old man. For all patients, PT interventions focused on breathing mechanics, secretion clearance, posture, sitting balance, and upper and lower extremity strengthening. SLP interventions focused on cognitive reorganization, verbal and nonverbal communication, secretion management, and swallowing function. Intensity and duration of the sessions were adapted according to patient response and level of fatigue. Results We found that time to tracheostomy from intubation for the three patients was 23 days, 20 days, and 24 days, respectively. Time from tracheostomy insertion to weaning from ventilator was 9 days for patient 1, and 5 days for patient 2 and patient 3. Regarding time to achieve functional PT and SLP milestones, all patients achieved upright sitting with PT prior to achieving initial SLP milestone of voicing with finger occlusion. Variations in progression to swallowing trials were patient specific and due to respiratory instability, cognitive deficits, and limitations in production of an effortful swallow. Patient participation in therapy sessions improved following establishment of oral verbal communication. Conclusion Interdisciplinary cooperation and synchronized implementation of PT and SLP interventions in three COVID-19 patients following prolonged intubation facilitated participation in treatment and achievement of functional milestones. Further study is warranted.

scholarly journals Prognostic Factors in Paranasal Sinus Squamous Cell Carcinoma and Adenocarcinoma: A SEER Database Analysis

2018 ◽  
Vol 80 (03) ◽  
pp. 258-263 ◽  
Author(s):  
Sumit Jain ◽  
Yan Li ◽  
Edward C. Kuan ◽  
Bobby A. Tajudeen ◽  
Pete S. Batra
Keyword(s):  
Squamous Cell Carcinoma ◽  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Cell Carcinoma ◽  
Paranasal Sinus ◽  
Squamous Cell ◽  
Case Series ◽  
Stage Iv ◽  
Retrospective Case ◽  
Female Ratio

Background Outcome studies on sinonasal malignancy are limited to retrospective case series, often with inclusion of diverse histology and short follow-up. The objective of this study was to identify key predictive variables that independently impact survival for paranasal sinus squamous cell carcinoma (SCC) and adenocarcinoma (AC) and to compare these variables in the context of these two distinct clinicopathologic entities. Methods: Analysis was conducted using the Surveillance, Epidemiology, and End Results database from 1973 to 2012 to identify key variables that impact survival for SCC and AC. Results A total of 3,714 cases were included. There were 2,895 SCC cases and 819 AC cases. The mean age at diagnosis was 64.1 years. The male to female ratio for SCC and AC was 1.85 and 1.04, respectively. Patients with SCC and AC were most often diagnosed with stage IV disease in 61.8 and 63.4% of cases, respectively. The majority of patients received combined surgery and radiation (52% for SCC and 43.1% for AC). For SCC, increased age (p < 0.001) and stage (p < 0.001) were negative predictors, and surgery improved survival (p < 0.001) on multivariate analysis. For AC, prognostic factors associated with worse survival include increased age (p < 0.001) and grade (p < 0.001) on multivariate analysis. Overall survival was significantly higher in AC compared with SCC at 5 years (p = 0.001). Conclusion SCC and AC of the paranasal sinuses are both aggressive malignancies with poor survival. For both histological subtypes, increased age predicts worse survival and grade also closely links to survival in AC. These data have important potential implications for treatment planning and pretreatment counseling.

scholarly journals A Retrospective Case Series of Anesthetic Patients With Epiglottic Cysts

2021 ◽  
Vol 68 (3) ◽  
pp. 168-177
Author(s):  
Kazumi Takaishi ◽  
Ryo Otsuka ◽  
Shigeki Josephluke Fujiwara ◽  
Satoru Eguchi ◽  
Shinji Kawahito ◽  
...  
Keyword(s):  
Airway Management ◽  
General Anesthesia ◽  
Oral Surgery ◽  
Case Series ◽  
Preoperative Imaging ◽  
Retrospective Case ◽  
Anesthetic Care ◽  
Retrospective Case Series

Previously undiagnosed or asymptomatic epiglottic cysts may be coincidentally detected during intubation. This retrospective case series identified undiagnosed epiglottic cysts that were discovered during intubation in 4 patients who underwent oral surgery under general anesthesia at our hospital during a 6-year period. Including 2 additional cases, 1 previously diagnosed and 1 detected during preoperative imaging, epiglottic cysts were observed in 6 of 1112 cases (0.54%) total. Among the undiagnosed epiglottic cyst cases, mild dyspnea on effort or snoring was reported in 2 patients, but all others were asymptomatic. Upon discovering previously undiagnosed epiglottic cysts during intubation, it is essential to proceed cautiously, remain alert for potential airway management difficulties, and avoid injuring or rupturing the cysts. In addition, any available preoperative imaging should be reviewed as information pertinent to the airway and any abnormalities may be useful. This report discusses the anesthetic care of 6 patients with epiglottic cysts that were previously known or initially discovered during intubation.

scholarly journals Apple Peel Small Bowel, A Review of Four Cases: Surgical and Radiographic Aspects

2011 ◽  
Vol 31 (3) ◽  
pp. 227-234 ◽  
Author(s):  
RA Akinola ◽  
RL Osuoji
Keyword(s):  
Surgical Management ◽  
Radiographic Finding ◽  
Case Series ◽  
Intestinal Atresia ◽  
Retrospective Case ◽  
Radiographic Findings ◽  
Mortality And Morbidity ◽  
Resource Limited ◽  
Apple Peel ◽  
Operative Findings

Background: Although apple peel intestinal atresia is rare and is associated with a high mortality and morbidity, there is a dearth of its report in African literature. This study reviews four of the cases seen in a state teaching hospital in Lagos, considering the radiographic findings, surgical management and outcome. A brief review of literature is also undertaken. Aims and Objectives: To correle the plain radiographic findings with the surgical findings of neonates gathered over a six year period and to evaluate their surgical management, hoping to further help improve management of such neonates’ in future in resource limited regions such as ours. Methodology: It was a retrospective case series of four neonates who were brought in over a period of six years and operated after an initial plain abdominal X-ray. They were done as emergency cases, consent was obtained from their parents and the study was approved by the research and ethics committee. Operative findings were subsequently correlated with their radiographic findings and the surgical outcomes and follow up were documented. Conclusion: This study revealed that “the triple bubble sign” is a common radiographic finding in Apple Peel deformities, as well as gangrene of the jejunum and ileum at surgery. Key words: Apple peel atresia; Jejunoileal atresia; Plain Abdominal Radiography; Parenteral nutrition; Short Bowel Syndrome. DOI: http://dx.doi.org/10.3126/jnps.v31i3.5037 J Nep Paedtr Soc 2011;31(3): 227-234  

scholarly journals Early Experience With Virtual and Synchronized Augmented Reality Platform for Preoperative Planning and Intraoperative Navigation: A Case Series

2021 ◽  
Author(s):  
Robert G Louis ◽  
Gary K Steinberg ◽  
Christopher Duma ◽  
Gavin Britz ◽  
Vivek Mehta ◽  
...  
Keyword(s):  
Augmented Reality ◽  
Preoperative Planning ◽  
Case Series ◽  
Preoperative Imaging ◽  
Patient Specific ◽  
Total Resection ◽  
Surgical Performance ◽  
Aneurysm Clipping ◽  
User Friendly ◽  
Anatomic Information

Abstract BACKGROUND Virtual reality (VR) allows for presurgical planning. Intraoperatively, augmented reality (AR) enables integration of segmented anatomic information with neuronavigation into the microsurgical scene to provide guidance without workflow disruption. Combining VR and AR solutions may help guide microsurgical technique to improve safety, efficiency, and ergonomics. OBJECTIVE To describe a VR/AR platform that provides VR planning and intraoperative guidance via microscope ocular injection of a comprehensive AR overlay of patient-specific 360°/3D anatomic model aligned and synchronized with neuronavigation. METHODS Custom 360° models from preoperative imaging of 49 patients were utilized for preoperative planning using a VR-based surgical rehearsal platform. Each model was imported to SyncAR, the platform's intraoperative counterpart, which was coregistered with Medtronic StealthStation S8 and Zeiss or Leica microscope. The model was injected into the microscope oculars and referenced throughout by adjusting overlay opacity. For anatomic shifts or misalignment, the overlay was reregistered via manual realignment with known landmarks. RESULTS No SyncAR-related complications occurred. SyncAR contributed positively to the 3D understanding of patient-specific anatomy and ability to operate. Preoperative planning and intraoperative AR with 360° models allowed for more precise craniotomy planning and execution. SyncAR was useful for guiding dissection, identifying critical structures including hidden anatomy, understanding regional anatomy, and facilitating resection. Manual realignment was performed in 48/49 surgeries. Gross total resection was achieved in 34/40 surgeries. All aneurysm clipping and microvascular decompression procedures were completed without complications. CONCLUSION SyncAR combined with VR planning has potential to enhance surgical performance by providing critical information in a user-friendly, continuously available, heads-up display format.

Value of Preoperative Imaging and Intraoperative Histopathology in Morton’s Neuroma

2019 ◽  
Vol 40 (9) ◽  
pp. 1032-1036 ◽  
Author(s):  
Tammer Raouf ◽  
Ryan Rogero ◽  
Elizabeth McDonald ◽  
Daniel Fuchs ◽  
Rachel J. Shakked ◽  
...  
Keyword(s):  
Case Series ◽  
Postoperative Treatment ◽  
Preoperative Imaging ◽  
Pathology Report ◽  
Morton’S Neuroma ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Imaging Results ◽  
Histopathologic Diagnosis ◽  
Morton's Neuroma

Background: Recent studies have demonstrated that clinical diagnosis of Morton’s neuroma is highly correlated with operative and histopathologic diagnosis, whereas others have questioned the cost-effectiveness of intraoperative histopathology of excised specimens. The purpose of this study was to determine the utility of both preoperative imaging and intraoperative histology in the treatment of Morton’s neuroma in making an accurate diagnosis, guiding treatment decisions, and altering clinical outcomes. Methods: A retrospective review was performed on all patients who underwent operative resection suspected Morton’s neuroma with 4 fellowship-trained foot and ankle surgeons between 2007 and 2017. Procedures were excluded from the study if the pathology report was not available for review. Diagnoses were made either by clinical examination and/or by the results of preoperative imaging. All pathology reports were reviewed to determine the final diagnosis, considered the “gold standard.” Postoperative chart notes were reviewed to determine if any treatment regimen was altered based on the pathology report revealing an alternate diagnosis other than Morton’s neuroma. Two hundred eighty-seven procedures in 269 patients with 313 clinically suspected neuromas met inclusion criteria. Results: Of the 313 suspected neuromas, 309 (98.7%) were confirmed Morton’s neuromas on histopathologic examination. For no patient did the results of the pathology report alter the postoperative treatment course. Preoperative imaging results were available for 179 (57.2%) suspected neuromas, with magnetic resonance imaging (MRI) and ultrasonography used to preoperatively image 121 and 71 suspected neuromas, respectively, including 13 using both. The total estimated cost of histopathologic analysis for the cohort was $143 667, and the estimated combined cost of preoperative imaging and intraoperative histopathology in our cohort totaled $278 567. Conclusion: Our study found that the diagnosis of Morton’s neuroma could be made clinically with extreme accuracy and positive predictive value, calling into question the utility and costs of other imaging modalities and intraoperative sampling for histopathologic diagnosis. Level of Evidence: Level IV, retrospective case series.

Performance after cochlear implantation in DFNB1 patients

2007 ◽  
Vol 137 (4) ◽  
pp. 596-602 ◽  
Author(s):  
Sarah S Connell ◽  
Simon I Angeli ◽  
Hamlet Suarez ◽  
Annelle V Hodges ◽  
Thomas J Balkany ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Speech Perception ◽  
Cochlear Implants ◽  
Case Series ◽  
Deaf Children ◽  
Retrospective Case ◽  
Open Set ◽  
Language Tests ◽  
Tertiary Center ◽  
Age Appropriate

Objective To evaluate the speech perception and language development with cochlear implants (CI) of DFNB1 children in comparison with non-DFNB1 deaf children. Study Design Retrospective case series. Setting Academic tertiary center. Results Thirty-one congenitally deafened children, screened for GJB2 allele variants, were followed for an average 32 months after CI. With the use of age-appropriate testing, 75% of DFNB1 and 53% of non-DFNB1 children achieved open set word recognition (speech perception category [SPC] level 6). Multivariate analysis showed that SPC was primarily dependent on duration of CI use, but not on the cause of hearing loss. In Reynell language tests, DFNB1 children showed more consistent and quicker gains than non-DFNB1 children. Conclusion Although children with CI with DFNB1 show faster gains in Reynell scores, duration of CI use appears to have a greater effect on speech perception than DFNB1 status. SIGNIFICANCE: Identification of DFNB1 children is useful in counseling of CI outcomes.

scholarly journals Comorbidities Drive Outcomes for Both Malignancy and Non-Malignancy Associated Hemophagocytic Syndrome

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 3261-3261
Author(s):  
Benny Johnson ◽  
Smith Giri ◽  
Sara E. Nunnery ◽  
Eric Wiedower ◽  
Omer Jamy ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Hemophagocytic Syndrome ◽  
Conflicts Of Interest ◽  
Case Series ◽  
Bivariate Analysis ◽  
Study Cohort ◽  
Co Morbidity ◽  
Significant Difference ◽  
Associated Malignancy ◽  
The Impact

Abstract Background Secondary hemophagocytic syndrome (HPS), also known as hemophagocytic lymphohistiocytosis (HLH), is a rare syndrome that develops in the context of infection, autoimmune disease or an underlying malignancy. This results in the unregulated activation of the immune system and an aberrant proliferation of histiocytes and hemophagocytosis. Most of what is clinically known about secondary HPS/HLH is from case reports and case series. We studied the predictors of mortality among adults admitted with HPS with or without an associated malignancy using a large national inpatient database. Patients and Methods Cases of HPS were identified from the Nationwide Inpatient Sample (NIS) 2009-2011 using International Classification of Diseases-9th revision Clinical Modification (ICD-9-CM) codes 288.4 for primary or secondary diagnosis combined with bone marrow examination procedure code (41.31). Cases of malignancy were identified by using ICD-9-CM codes 104-208.9 and the use of inpatient chemotherapy was defined by ICD-9-CM procedure codes 9925 and 8607. Comorbidity assessment was done using Deyo modification of Charlson comorbidity index which takes into account 17 ICD based comorbidities. Malignancy was excluded from co-morbidity assessment. The impact of various patient/hospital related factors on mortality was first assessed using chi-square test or Analysis of Variance (ANOVA). Factors with p value 0.01 or less on bivariate analysis were then subjected to multivariate analysis using logistic regression methods. Statistical analysis was done using STATA 13.0 (StataCorp LP, College Station,TX). All p values were two sided and the level of significance was 0.05. Results A total of 276 patient hospitalizations with HPS were identified. Forty-four had an associated malignancy, out of which 38 (86%) were hematologic. The other cases were associated with systemic lupus erythematosus (n=12; 5%), rheumatoid arthritis (n=21; 9%), histoplasmosis (n=3;1.3%) or HIV (n=1; 0.4%). The median age was 42 (range 18-89 years) and 43% (n=114) were females. A total of 66% (n=182) had Charlson index (CI) of 0, whereas 13% (n=27) had a CI of 1 and 21% (n=57) had a CI of 2 or more. On bivariate analysis, the inpatient mortality rate was significantly higher in malignancy associated HPS (OR 2.07; P =0.04), age ≥ 50 (OR 3.46; P <0.01), CI > 2 (OR, 3.04; P <0.01), and patients with Medicare (OR 2.32; P <0.01). However, there was no statistically significant difference in mortality based on the receipt of chemotherapy (P= 0.90), hospital region i.e. rural versus urban (P=0.43) and teaching status (P= 0.71). In multivariate analysis, CI ≥ 2 remained an independent predictor of survival in the overall study cohort (OR 3.52; 95% CI 1.51-8.18; P <0.01). Conclusion In this large series of adults with HPS, patients with malignancy associated HPS, CI ≥ 2, age> 50, and Medicare patients were associated with a worse in-hospital mortality. In multivariate analysis, patients with a greater co-morbidity burden appeared to be the single most important predictor of mortality. This suggests that outcomes for HPS are predicated by the extent of organ dysfunction at diagnosis. Disclosures No relevant conflicts of interest to declare.

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