scholarly journals Introduction to odontoid fractures: controversies in the management of odontoid fractures

2000 ◽  
Vol 8 (6) ◽  
pp. 1-3 ◽  
Author(s):  
Gregory J. Przybylski
Keyword(s):  
Treatment Options ◽  
Surgical Techniques ◽  
Patient Characteristics ◽  
Epidemiological Studies ◽  
Scientific Data ◽  
Published Data ◽  
Odontoid Fractures ◽  
Technological Advances ◽  
Increased Risk ◽  
Cord Injury

Although odontoid fractures were first classified more than 25 years ago,5 the management of these fractures remains controversial. Whereas the nonoperative management with external immobilization devices often leads to successful healing, certain fracture features and patient characteristics have been associated with an increased risk of bone nonunion.6,17 Recent technological advances in cervical spine instrumentation techniques have provided additional options for the management of these common fractures.1,12,13,24,27,28 However, an absence of rigorous studies in which the investigators compare management methods may contribute to the varying methods used by spine surgeons when approaching similar injuries. In this issue of Neurosurgical Focus, various aspects of the management of odontoid fractures are examined. In an evidence-based analysis of methods for treating odontoid fractures the authors examine the best available published data to determine the level of scientific data supporting the use of various treatment options.3 In epidemiological studies the investigators examine factors contributing to the unusual incidence of spinal cord injury with odontoid fractures as well as the unique considerations that may be attendant on the management of posteriorly displaced fractures. In two other studies the authors discuss the application of specific surgical techniques in treating odontoid fractures, whereas in an additional two reports the authors evaluate the difficulties in managing elderly patients with these injuries. Finally, the use of newer osteoinductive agents is examined as a potential adjunct in the surgical management of bony defects in the dens.

scholarly journals Emerging and Adjunctive Therapies for Spinal Cord Injury Following Acute Canine Intervertebral Disc Herniation

2020 ◽  
Vol 7 ◽  
Author(s):  
Melissa J. Lewis ◽  
Nicolas Granger ◽  
Nick D. Jeffery ◽  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Intervertebral Disc ◽  
Disc Herniation ◽  
Treatment Options ◽  
Surgical Techniques ◽  
Low Level Laser Therapy ◽  
Intervertebral Disc Herniation ◽  
Veterinary Clinic ◽  
Cord Injury

Some dogs do not make a full recovery following medical or surgical management of acute canine intervertebral disc herniation (IVDH), highlighting the limits of currently available treatment options. The multitude of difficulties in treating severe spinal cord injury are well-recognized, and they have spurred intense laboratory research, resulting in a broad range of strategies that might have value in treating spinal cord-injured dogs. These include interventions that aim to directly repair the spinal cord lesion, promote axonal sparing or regeneration, mitigate secondary injury through neuroprotective mechanisms, or facilitate functional compensation. Despite initial promise in experimental models, many of these techniques have failed or shown mild efficacy in clinical trials in humans and dogs, although high quality evidence is lacking for many of these interventions. However, the continued introduction of new options to the veterinary clinic remains important for expanding our understanding of the mechanisms of injury and repair and for development of novel and combined strategies for severely affected dogs. This review outlines adjunctive or emerging therapies that have been proposed as treatment options for dogs with acute IVDH, including discussion of local or lesion-based approaches as well as systemically applied treatments in both acute and subacute-to-chronic settings. These interventions include low-level laser therapy, electromagnetic fields or oscillating electrical fields, adjunctive surgical techniques (myelotomy or durotomy), systemically or locally-applied hypothermia, neuroprotective chemicals, physical rehabilitation, hyperbaric oxygen therapy, electroacupuncture, electrical stimulation of the spinal cord or specific peripheral nerves, nerve grafting strategies, 4-aminopyridine, chondroitinase ABC, and cell transplantation.

scholarly journals Surgical treatment of hemorrhoids: a critical appraisal of the current options

2014 ◽  
Vol 27 (1) ◽  
pp. 66-70 ◽  
Author(s):  
Marlise Mello CERATO ◽  
Nilo Luiz CERATO ◽  
Patrícia PASSOS ◽  
Alberto TREIGUE ◽  
Daniel C. DAMIN
Keyword(s):  
Surgical Treatment ◽  
Postoperative Pain ◽  
Treatment Options ◽  
Surgical Techniques ◽  
Postoperative Recurrence ◽  
Long Term Results ◽  
Published Data ◽  
Complication Rates ◽  
Recurrence Rates

Introduction : Surgical treatment of hemorrhoids is still a dilemma. New techniques have been developed leading to a lower rate of postoperative pain; however, they are associated with a greater likelihood of recurrence. Aim : To review current indications as well as the results and complications of the main techniques currently used in the surgical treatment of hemorrhoidal disease. Methods : A systematic search of the published data on the options for treatment of hemorrhoids up to December 2012 was conducted using Medline/PubMed, Cochrane, and UpToDate. Results : Currently available surgical treatment options include procedure for prolapse and hemorrhoids (PPH), transanal hemorrhoidal dearterialization (THD), and conventional hemorrhoidectomy techniques. Excisional techniques showed similar results regarding pain, time to return to normal activities, and complication rates. PPH and THD were associated with less postoperative pain and lower complication rates; however, both had higher postoperative recurrence rates. Conclusion : Conventional surgical techniques yield better long-term results. Despite good results in the immediate postoperative period, PPH and THD have not shown consistent long-term favorable results.

scholarly journals Prevention, identification, and treatment of perioperative spinal cord injury

2008 ◽  
Vol 25 (5) ◽  
pp. E15 ◽  
Author(s):  
Henry Ahn ◽  
Michael G. Fehlings
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Clinical Outcome ◽  
Clinical Studies ◽  
Basic Science ◽  
Treatment Options ◽  
Arterial Blood ◽  
Secondary Damage ◽  
Increased Risk ◽  
Cord Injury

Object In this report, the authors suggest evidence-based approaches to minimize the chance of perioperative spinal cord injury (POSCI) and optimize outcome in the event of a POSCI. Methods A systematic review of the basic science and clinical literature is presented. Results Authors of clinical studies have assessed intraoperative monitoring to minimize the chance of POSCI. Furthermore, preoperative factors and intraoperative issues that place patients at increased risk of POSCI have been identified, including developmental stenosis, ankylosing spondylitis, preexisting myelopathy, and severe deformity with spinal cord compromise. However, no studies have assessed methods to optimize outcomes specifically after POSCIs. There are a number of studies focussed on the pathophysiology of SCI and the minimization of secondary damage. These basic science and clinical studies are reviewed, and treatment options outlined in this article. Conclusions There are a number of treatment options, including maintenance of mean arterial blood pressure > 80 mm Hg, starting methylprednisolone treatment preoperatively, and multimodality monitoring to help prevent POSCI occurrence, minimize secondary damage, and potentially improve the clinical outcome of after a POSCI. Further prospective cohort studies are needed to delineate incidence rate, current practice patterns for preventing injury and minimizing the clinical consequences of POSCI, factors that may increase the risk of POSCI, and determinants of clinical outcome in the event of a POSCI.

Anticoagulation after Iliofemoral Vein Stenting - Old Versus New

2019 ◽  
Vol 24 (38) ◽  
pp. 4525-4533 ◽  
Author(s):  
Anja B. Drebes ◽  
Neil H. Davies
Keyword(s):  
Thrombus Formation ◽  
Treatment Options ◽  
Patient Characteristics ◽  
Published Data ◽  
Antithrombotic Treatment ◽  
Related Factors ◽  
Stent Patency ◽  
Venous Outflow Obstruction ◽  
The Impact

In recent years, there has been an increasing interest in endovascular iliofemoral vein stenting to prevent/ alleviate symptoms related to proximal venous outflow obstruction. Maintaining long-term stent patency is one of the main challenges, and risk factors for the development of re-thrombosis are not well understood. Published data on the safety and efficacy of the procedure predominantly come from cohort studies mainly focusing on mechanical aspects relating to stent placement and flow. Aetiology of thrombus formation and thrombotic tendencies of patients due to underlying medical conditions are not captured well or linked to clinical outcomes, and the impact of choice and length of antithrombotic therapy have not been specifically investigated. Here, we review different procedure-related factors and patient characteristics that might increase the risk of re-thrombosis and the utility of antithrombotic treatment options currently available.

Estrogen and Progesterone Therapy and Meningiomas

Endocrinology ◽  
2021 ◽  
Author(s):  
Mirella Hage ◽  
Oana Plesa ◽  
Isabelle Lemaire ◽  
Marie Laure Raffin Sanson
Keyword(s):  
Hormonal Treatment ◽  
Epidemiological Studies ◽  
Published Data ◽  
Duration Of Treatment ◽  
Sexual Hormones ◽  
Fertility Treatments ◽  
Dependent Relationship ◽  
Nomegestrol Acetate ◽  
Increased Risk ◽  
Favorable Clinical Outcome

Abstract Meningiomas are common intracranial tumors with female predominance. Their etiology is still poorly documented. The role of sexual hormones has long been evoked, and data have been conflicting across studies. However, a dose-dependent relationship between the incidence and growth of meningiomas and hormonal treatment with the progestin cyproterone acetate (CPA) has recently been established. CPA- associated meningiomas seem to be mainly located in the anterior and middle skull base, are more likely to be multiple; may harbor P1K3CA mutations in up to 1/3 of cases and are favored by a longer duration of treatment. A similar but lower risk of meningiomas has been recently reported with the use of chlormadinone acetate and nomegestrol acetate as progestin treatments. Concerning hormonal replacement therapy (HRT) in menopausal patients, evidence from epidemiological studies seem to favor an increased risk of meningiomas in treated patients although a recent study failed to show an increased growth of meningiomas in HRT treated vs. non treated patients. Until larger studies are available, it seems wise to recommend avoiding HRT in patients with meningiomas. Evidence from published data does not seem to support an increased risk of meningiomas with oral contraceptive (OC) use. Data are too scarce to conclude on fertility treatments. Based on studies demonstrating the expression of hormonal receptors in meningiomas, therapies targeting these receptors have been tried but have failed to show an overall favorable clinical outcome in meningioma treatment.

scholarly journals Combined pulmonary fibrosis and emphysema: an increasingly recognized condition

2014 ◽  
Vol 40 (3) ◽  
pp. 304-312 ◽  
Author(s):  
Olívia Meira Dias ◽  
Bruno Guedes Baldi ◽  
André Nathan Costa ◽  
Carlos Roberto Ribeiro Carvalho
Keyword(s):  
Pulmonary Fibrosis ◽  
Current Knowledge ◽  
Treatment Options ◽  
Lower Lobe ◽  
Published Data ◽  
Increased Risk ◽  
Pulmonary Arterial ◽  
Former Smokers ◽  
Severe Pulmonary Arterial Hypertension

Combined pulmonary fibrosis and emphysema (CPFE) has been increasingly recognized in the literature. Patients with CPFE are usually heavy smokers or former smokers with concomitant lower lobe fibrosis and upper lobe emphysema on chest HRCT scans. They commonly present with severe breathlessness and low DLCO, despite spirometry showing relatively preserved lung volumes. Moderate to severe pulmonary arterial hypertension is common in such patients, who are also at an increased risk of developing lung cancer. Unfortunately, there is currently no effective treatment for CPFE. In this review, we discuss the current knowledge of the pathogenesis, clinical characteristics, and prognostic factors of CPFE. Given that most of the published data on CPFE are based on retrospective analysis, more studies are needed in order to address the role of emphysema and its subtypes; the progression of fibrosis/emphysema and its correlation with inflammation; treatment options; and prognosis.

scholarly journals Biodegradable coronary scaffolds: their future and clinical and technological challenges

2018 ◽  
Vol 114 (8) ◽  
pp. 1063-1072 ◽  
Author(s):  
Jarkko P Hytönen ◽  
Jouni Taavitsainen ◽  
Santeri Tarvainen ◽  
Seppo Ylä-Herttuala
Keyword(s):  
Treatment Options ◽  
Current Treatment ◽  
Metallic Stent ◽  
Elastic Recoil ◽  
Biological Responses ◽  
Technological Advances ◽  
Increased Risk ◽  
Artery Disease ◽  
And Function

Abstract Angioplasty and stenting are standard treatment options for both stabile occlusive coronary artery disease and acute myocardial infarctions. Over the last years, several biodegradable stent systems have entered pre-clinical and clinical evaluation and into clinical practice. A strong supporting scaffold is necessary after angioplasty to prevent elastic recoil of the vessel but in the long term a permanent metallic stent will only impair normal physiology of the artery wall. Thus, the main advantage of a resorbable system is the potential for better vessel recovery and function in the long term. The new stent systems differ from traditional stents in size and biological responses and questions have risen regarding their mechanical strength and increased risk of stent thrombosis. Here, we present current treatment options with biodegradable scaffolds, discuss further key areas for improvements and review novel technological advances in the context of all up-to-date clinical trial information. New material choices are also covered as well as special considerations for pre-clinical testing.

Epidemiological Trends in Attempted Suicide in Adolescents and Young Adults Between 1996 and 2004

Crisis ◽  
2009 ◽  
Vol 30 (3) ◽  
pp. 115-119 ◽  
Author(s):  
Stephanie De Munck ◽  
Gwendolyn Portzky ◽  
Kees Van Heeringen
Keyword(s):  
Young Adults ◽  
Attempted Suicide ◽  
Suicide Attempts ◽  
Epidemiological Studies ◽  
Adolescents And Young Adults ◽  
University Hospital ◽  
International Studies ◽  
Suicide Attempters ◽  
Increased Risk ◽  
Epidemiological Trends

Background: Notwithstanding the epidemiological studies indicating an increased risk of attempted suicide among adolescents and young adults, there is a scarcity of international studies that examine long-term epidemiological trends in rates and characteristics of this vulnerable group. Aims: This article describes the results of a 9-year monitoring study of suicide attempts in adolescents and young adults referred to the Accident and Emergency Department of the Gent University Hospital (Belgium). Methods: Between January 1996 and December 2004, trends, sociodemographic, and methodrelated characteristics of suicide attempts were assessed by a psychiatrist on data sheets. Results: Attempted suicide rates declined from 1996 to 2001 and then rose until 2004, but did not exceed previous rates. During the 9 years of monitoring, there was a preponderance of female suicide attempters, except for 1997. Rates of attempts and of fatal suicide were negatively correlated. Significantly more males than females deliberately injured themselves. Younger attempters, especially females, significantly more often poisoned themselves with analgesics. In nearly one in five attempts, alcohol was used in combination with other methods, and alcohol intake was more commonly observed in older suicide attempters. Nearly half of the adolescents were identified as repeaters. Conclusions: The results of this study warrant further monitoring of trends and characteristics of young suicide attempters.

EFFECTS OF SMOKING ON THE DISEASE PROGNOSIS IN CANCER PATIENTS

2019 ◽  
Vol 65 (3) ◽  
pp. 321-329
Author(s):  
David Zaridze ◽  
Anush Mukeriya
Keyword(s):  
Smoking Cessation ◽  
Cancer Patients ◽  
Malignant Tumors ◽  
Scientific Data ◽  
Second Primary ◽  
Primary Tumors ◽  
Smoking Intensity ◽  
Risk Of Death ◽  
Disease Prognosis ◽  
Increased Risk

Smoking not only increases the risk of the development of malignant tumors (MT), but affects the disease prognosis, mortality and survivability of cancer patients. The link between the smoking of cancer patients and increased risk of death by all diseases and oncological causes has been established. Mortality increases with the growth of the smoking intensity, i.e. the number of cigarettes, smoked per day. Smoking is associated with the worst general and oncological survivability. The statistically trend-line between the smoking intensity and survivability was observed: each additional unit of cigarette consumption (pack/year) leads to the Overall Survival Reduction by 1% (p = 0.002). The link between smoking and the risk of developing second primary tumors has been confirmed. Smoking increases the likelihood of side effects of the antitumor therapy both drug therapy and radiation therapy and reduces the treatment efficacy. The smoking cessation leads to a significant improvement in the prognosis of a cancer patient. Scientific data on the negative effect of smoking on the prognosis of cancer patients have a major clinical importance. The treatment program for cancer patients should include science-based methods for the smoking cessation. The latter is fundamentally important, taking into account that the smoking frequency among cancer patients is much higher than in the population.

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