scholarly journals Managerial experiences on Pediatric surgical tumors in Tribhuvan University Teaching Hospital

2013 ◽  
Vol 52 (192) ◽  
Author(s):  
Rameshwar Prasad Pokharel
Keyword(s):  
Large Scale ◽  
Surgical Excision ◽  
University Teaching ◽  
Pediatric Tumors ◽  
Post Surgery ◽  
Standard Management ◽  
Management Protocol ◽  
Results Management ◽  
One Year

Introduction: Pediatric tumors are least prioritized but serious problems. Multidisciplinary management improves survival. Incidences, types and follow up results on Nepalese pediatric tumors have not yet been studied. To highlight our center’s experiences on pediatric tumors management and follow up is aimed. Methods: All pediatric surgical tumors admitted in pediatric surgery unit from 2065-2070 BS werer studied. Patients evaluated with or without chemo / radiotherapy pre or post surgery. Total of 22 cases from age four months to 13 years were studied. Results: Tumor detection shown highest in age group below 3 years, followed by 5-10 years. Mean age was 54 months. Most common problem (22.7 %) was Saccrococcygeal teratoma (histologically matured). 13% Nephroblastoma, 9% ovarian tumor, 9% Neuroblastoma and various others each were 4.45 %. Majority underwent surgical excision of tumors. Three cases pre surgery and 5 post-surgery, received chemotherapy. Rest had only excision of tumor mass.Follow up were from three weeks to five years period. During this period, two patients expired (one due to complication of second cycle of chemotherapy and second one died with severe aspiration after second laparotomy for intestinal obstruction one year after initial Nephroblastoma excision.) One patient lost for follow up after excision of stage V Nephroblastoma and first cycle of chemotherapy. Conclusions: Management of pediatric tumors is complicated. Thus it needs better multidisciplinary centre of excellence for satisfactory results. Management is directed according to incidence, types, standard management protocol, which is not studied yet in Nepal. Research on pediatric tumors is virgin area. Large scale studies need to conduct in detail and a center of excellence is essential to provide better services.  Keywords: follow ups; management; Nepalese population; pediatric tumors; types.    

scholarly journals Gingival Lipoma: A Rare Case Report

2017 ◽  
Vol 1 (1) ◽  
pp. 37-39
Author(s):  
Sweta Shrestha ◽  
Shaili Pradhan ◽  
Ranjita Shrestha Gorkhali
Keyword(s):  
Rare Case ◽  
Surgical Excision ◽  
Soft Tissue Tumors ◽  
Rare Case Report ◽  
Postsurgical Complication ◽  
Benign Tumours ◽  
One Year ◽  
Slow Growing ◽  
Oral Soft Tissue

Lipomas are benign tumours of mesenchymal origin (mature adipocytes) that are comparatively uncommon in the oral cavity corresponding to less than 4.4% of all benign oral soft tissue tumors. Clinically, they present as slow growing, soft, asymptomatic masses. Histopathologically, they appear as thinly encapsulated lesion composed of mature adipocytes with inconspicuous vascularity. The pathogenetic mechanisms of oral lipomas are still unclear. They are usually treated by surgical excision and bear excellent prognosis. Here we report a case of intraoral lipoma in 54 year old male patient in the left lower lingual alveolar mucosal region that was treated by surgical excision using electrocautery without any postsurgical complication. One-year follow-up showed no evidence of recurrence.

482Direct oral anticoagulant rivaroxaban in very old and frail patients: A one-year prospective follow-up of a large-scale cohort (SAFIR-AC)

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
O Hanon ◽  
J Vidal ◽  
E Chaussade ◽  
J P David ◽  
N Boulloche ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Major Bleeding ◽  
Large Scale ◽  
Bleeding Risk ◽  
Geriatric Population ◽  
Very Old ◽  
The Mean ◽  
One Year ◽  
The One

Abstract Background/Introduction Age is one of the strongest predictors/risk factors for ischemic stroke in subjects with atrial fibrillation (AF). Direct oral anticoagulants (DOACs) have been shown to be effective in the prevention of this condition; however, clinical evidence on bleeding risk with this therapeutic strategy in very old and frail geriatric patients is poor. Purpose To assess bleeding risk in French geriatric patients aged ≥80 years and diagnosed with AF newly treated with rivaroxaban. Methods Subjects, presenting to one of 33 geriatric centers, with non-valvular AF and recent initiation of a treatment with rivaroxaban were enrolled in the study and followed-up every 3 months for 12 months. Clinical and routine laboratory data and evaluation scores, such as HAS-BLED, HEMORR2HAGES, ATRIA, and CHA2DS2-VASc, as well as comprehensive geriatric evaluation were reported. Major bleeding, as defined in ROCKET AF study, was reported at each visit, and this primary outcome was adjudicated by an independent committee. Results of this cohort were compared with findings from a similar cohort treated with vitamin K antagonists (VKAs) from the same centers (n=924). Results A total of 1045 subjects were enrolled in the study of whom 995 (95%) had a one-year follow-up (analyzed population). The mean (standard deviation (SD)) age was 86.0 (4.3) years, with the majority of patients being female (61%), 23% aged 90 years or older, and 48% having an estimated glomerular filtration rate (eGFR) <50 mL/min. The main comorbidities were hypertension in 77% of subjects, malnutrition 49%, anemia 43%, dementia 39%, heart failure 36%, and falls 27%. The mean (SD) score for CHA2DS2-VASc was 4.8 (1.4), HAS-BLED 2.4 (0.9), Mini-Mental State Examination (MMSE) 21.5 (6.9), Activities of Daily Living (ADL) 4.4 (1.9), and Charlson Comorbidity Index 6.7 (2.0). The one-year rate of major bleeding events was 6.4% of which 0.8% were fatal and 1.1% intracranial hemorrhages (ICH), whereas the one-year rate of ischemic stroke was 1.4% and all-cause mortality 17.9%. Computed with VKA cohort findings and adjusted for age, gender, eGFR and Charlson score, this would result in a hazard ratio of 0.54 (95% confidence interval [CI], 0.38 to 0.78) for major bleeding, 0.36 (0.17 to 0.76) for ICH, 0.62 (0.29 to 1.33) for ischemic stroke, and 0.82 (0.65 to 1.02) for all-cause mortality, in favor of rivaroxaban. Conclusions This is the first large-scale prospective study in geriatric population in AF subjects treated with DOAC (rivaroxaban) Major bleeding risk appeared higher in very old than younger population, however major bleeding and ICH rates were significantly lower with rivaroxaban than with VKAs when used in the same geriatric population. This study indicates that Rivaroxaban can be used in very old and frail patients for the treatment of non-valvular AF. Acknowledgement/Funding Unrestricted grant from Bayer

scholarly journals Pyogenic granuloma - report of three cases in rare sites

2013 ◽  
Vol 12 (4) ◽  
pp. 445-448
Author(s):  
AN Sulabha ◽  
S Choudhari ◽  
G Suchitra
Keyword(s):  
Oral Cavity ◽  
Buccal Mucosa ◽  
Hard Palate ◽  
Medical Science ◽  
Surgical Excision ◽  
Pyogenic Granuloma ◽  
Patient Treatment ◽  
Young Females ◽  
One Year

Pyogenic granuloma is a benign, localized mass of exuberant granulation tissue produced in response to various stimuli. It is inflammatory hyperplasia of oral cavity commonly seen on gingival area and rarely on other parts of oral cavity such as lips, tongue, palate and buccal mucosa. It is seen predominantly in 2nd to 3rd decade of life in young females. Clinically manifesting as small red erythematous exophytic lesion, it must be biopsied to rule out other serious conditions. This article aims to present three cases of extra gingival pyogenic granulomas occurring in rare sites such as buccal mucosa, anterior hard palate and alveolar mucosa of completely edentulous ridge in maxilla. Pyogenic granuloma on buccal mucosa and anterior hard palate were seen in female patients with age of 40 years and 34 years respectively and pyogenic granuloma on alveolar mucosa of edentulous ridge in maxilla was noted in 70 years old male patient. Surgical excision was performed for all the lesion and follow up of one year did not show any recurrence. Please add little description of patient + treatment + followup results. DOI: http://dx.doi.org/10.3329/bjms.v12i4.16667 Bangladesh Journal of Medical Science Vol. 12 No. 04 October ’13 Page 445-448

Different Therapeutic Approaches and Outcome in the Treatment of Pterygium

1998 ◽  
Vol 8 (3) ◽  
pp. 148-152 ◽  
Author(s):  
C. H. Karabatsas ◽  
G. W. Marsh ◽  
A. M. Cook ◽  
S. D. Cook
Keyword(s):  
Surgical Treatment ◽  
Surgical Techniques ◽  
Surgical Excision ◽  
Lamellar Keratoplasty ◽  
Therapeutic Approaches ◽  
Therapeutic Modalities ◽  
Results Of Treatment ◽  
One Year

Purpose This study was initiated to investigate the role of different therapeutic modalities in the outcome of the surgical treatment of pterygium. Methods The results of treatment of pterygia with a variety of surgical techniques were studied in 56 eyes (49 patients) operated on at Bristol Eye Hospital during a period of five years. The surgical techniques included simple excision; bare sclera; conjunctival autograft; sliding conjunctival flap; lamellar keratoplasty and penetrating keratoplasty. Twelve eyes received additional beta irradiation in a fractionated total dose of 40 Gys. Results The incidence of recurrence was 23.2% for the 43 treated primary pterygia, and 23% for the 13 recurrent pterygia. All recurrences occurred between 2.5 and 11 months postoperatively. None of the 11 cases where additional beta irradiation was used showed any recurrence or other complication within the study period. In the recurrent pterygia group, the cases treated with a combination of surgical excision and beta irradiation, showed significantly lower recurrence rate (p<0.001) compared to those cases treated with surgical excision alone. Conclusions Beta irradiation as a complement to surgical treatment of pterygium, is successful in treating high risk cases such as reoperations, whereas for the majority of primary pterygia surgical excision alone is adequate. Additionally, follow up of one year will reveal any recurrences.

Does Teacher Training Actually Work? Evidence from a Large-Scale Randomized Evaluation of a National Teacher Training Program

2019 ◽  
Vol 11 (3) ◽  
pp. 128-154 ◽  
Author(s):  
Prashant Loyalka ◽  
Anna Popova ◽  
Guirong Li ◽  
Zhaolei Shi
Keyword(s):  
Teacher Training ◽  
Teacher Professional Development ◽  
Student Outcomes ◽  
Large Scale ◽  
Causal Chain ◽  
Randomized Evaluation ◽  
Teacher Professional ◽  
One Year ◽  
To Receive

Despite massive investments in teacher professional development (PD) programs in developing countries, there is little evidence on their effectiveness. We present results of a large-scale, randomized evaluation of a national PD program in China in which teachers were randomized to receive PD; PD plus follow-up; PD plus evaluation of the command of PD content; or no PD. Precise estimates indicate PD and associated interventions failed to improve teacher and student outcomes after one year. A detailed analysis of the causal chain shows teachers find PD content to be overly theoretical, and PD delivery too rote and passive, to be useful. (JEL I21, I28, J24, J45, O15, P36)

scholarly journals An Interesting Case of Intramuscular Myxoma with Scapular Bone Lysis

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Jérôme Tirefort ◽  
Frank C. Kolo ◽  
Alexandre Lädermann
Keyword(s):  
English Literature ◽  
Surgical Excision ◽  
Deltoid Muscle ◽  
Interesting Case ◽  
Intramuscular Myxoma ◽  
Bone Lysis ◽  
Magnetic Resonance Imaging Mri ◽  
One Year ◽  
Growing Mass

Introduction. Intramuscular myxoma is a rare benign primitive tumor of the mesenchyme founded at the skeletal muscle level; it presents itself like an unpainful, slow-growing mass. Myxomas with bone lysis are even more rare; only 7 cases have been reported in the English literature, but never at the shoulder level. Case Presentation. We describe an 83-year-old patient with a growing mass in the deltoid muscle with unique scapular lysis, without any symptom. Magnetic resonance imaging (MRI) and a biopsy were performed and the diagnosis of intramuscular myxoma has been retained. In front of this diagnosis of nonmalignant lesion, the decision of a simple follow-up was taken. One year after this decision, the patient was still asymptomatic. Conclusion. In the presence of an intramuscular growing mass with associated bone lysis, intramuscular myxoma as well as malignant tumor should be evoked. MRI has to be part of the initial radiologic appraisal but biopsy is essential to confirm the diagnosis. By consensus, the standard treatment is surgical excision but conservative treatment with simple follow-up can be an option.

scholarly journals DORSAL WRIST GANGLION

2016 ◽  
Vol 23 (03) ◽  
pp. 246-250
Author(s):  
Yousaf Jan ◽  
Waqas Ahmad ◽  
Shaukat Hussain ◽  
Muhammad Shah ◽  
Ahmad Din
Keyword(s):  
Surgical Excision ◽  
Success Rates ◽  
Research Committee ◽  
Patients With Cancer ◽  
Group A ◽  
One Year ◽  
Group B ◽  
Study Setting ◽  
Dorsal Wrist Ganglion

Objectives: To evaluate and compare the effect of aspiration plus methylprednisone injection versus surgical excision of the dorsal wrist ganglions in terms of resolution,complications and recurrence. Study Design: Prospective study. Setting: Surgical wardHayatabad Medical Complex, Peshawar. Period: June 2009 to December 2011. Methodology:After taking permission from ethical and research committee. Included patients were all adult ofboth gender with dorsal wrist ganglion. Patients with cancer, bleeding disorders and diabeteswere excluded from the study. The patients were divided in two groups: Group A includedpatients for aspiration and injection treatment, while Group B included patients underwentsurgical excision. All the patients were followed for complete resolution of ganglion, anycomplications of treatment and recurrence within one year. Follow up arranged at 7th day, 1,3, 6 and 12 months. Results: Total of 80 patients was included in the study. Out of 80, 65%(n=52) were females while 35% (n=28) were males. The mean age was 26.37±5.62 years.Group A and group B patients had overall success rates of 75% and 95%, with recurrence of25% and 5% in group A and group B respectively. In methylprednisolone group, mild pain wasreported by 70% (n=28), while in the surgical excision group, all the patients experienced mildto moderate pain postoperatively which necessitated oral analgesics for few days. Conclusion:Surgical excision is superior to injection-aspiration method for dorsal wrist ganglion treatmentbecause of high success and low recurrence rate. As injection-aspiration treatment

scholarly journals A Rare Presentation of Schwannoma as a Purely-Cystic Superficial-Intermuscular Extra-Spinal Swelling over Upper Back.

2020 ◽  
Author(s):  
Srinjoy Saha
Keyword(s):  
Surgical Excision ◽  
Thoracic Vertebrae ◽  
Rare Presentation ◽  
Complete Surgical Excision ◽  
Rare Tumours ◽  
S 100 ◽  
One Year ◽  
Atypical Presentations ◽  
Upper Thoracic

Abstract Schwannomas are rare tumours arising from peripheral nerve sheath. Here, a 44-year-old lady came to our clinic with an asymptomatic progressively-enlarging swelling over her upper back. It was fluctuant, with an absence of pain and tenderness. MRI showed a benign, purely-cystic, superficial-intermuscular, extra-spinal swelling nearby upper thoracic vertebrae. Complete surgical excision proceeded smoothly through a well-defined plane between the swelling and the muscles. It was not attached to any identifiable nerve. A 6.5x5.0x2.5 cm ovoid lesion with a glistening whitish-grey capsule was excised and wound reconstructed in layers. Histopathology showed hypercellular areas with nuclear palisading or oval-shaped Verocay bodies. Only S-100 tested positive amongst the five-antigen immunohistochemistry, thus establishing the diagnosis of a schwannoma. Postoperatively, a one-year follow-up period was uneventful. Schwannomas can surprise clinicians by arising anywhere and with atypical presentations. It needs to be in the differential diagnoses of any asymptomatic slowly-growing lesion.

Successful treatment of disseminated granulomatous aspergillosis in an apparently immunocompetent host

2020 ◽  
Vol 50 (4) ◽  
pp. 346-349 ◽  
Author(s):  
Umang Agrawal ◽  
Pratik Savaj ◽  
Kanishka Davda ◽  
Rajeev Soman ◽  
Anjali Shetty ◽  
...  
Keyword(s):  
Granulomatous Inflammation ◽  
Surgical Excision ◽  
Immunocompetent Host ◽  
Short History ◽  
Normal Individuals ◽  
History Of ◽  
One Year ◽  
Work Up ◽  
The Brain

A young Indian man presented elsewhere with a short history of haematuria and cough. Investigations revealed renal and pulmonary lesions. Histopathology of these lesions was reported as mucormycosis. He consulted us two months after onset of symptoms, asymptomatic and clinically well, having received no treatment. In view of clinico-histopathological discordance, a review of the biopsy slides was advised but the patient refused further work-up at that time. One week later, however, he was admitted with left hemiparesis. Brain imaging showed an abscess. He underwent surgical excision of the brain abscess and nephrectomy. Review of previous slides showed septate fungal filaments with granulomatous inflammation. Intraoperative cultures grew Aspergillus flavus. He received voriconazole for one year and is well at his two-year follow-up. His immunological work-up was negative for immunodeficiency. This case illustrates that granulomatous aspergillosis may be an indolent infection in apparently normal individuals and reiterates the importance of interpreting diagnostic reports in conjunction with clinical features.

scholarly journals Promising Clinical Efficacy of Streptomycin-Rifampin Combination for Treatment of Buruli Ulcer (Mycobacterium ulcerans Disease)

2007 ◽  
Vol 51 (11) ◽  
pp. 4029-4035 ◽  
Author(s):  
Annick Chauty ◽  
Marie-Françoise Ardant ◽  
Ambroise Adeye ◽  
Hélène Euverte ◽  
Augustin Guédénon ◽  
...  
Keyword(s):  
Treatment Initiation ◽  
Buruli Ulcer ◽  
Skin Grafting ◽  
Surgical Excision ◽  
Mycobacterium Ulcerans ◽  
Directly Observed Treatment ◽  
Stopping Treatment ◽  
One Year

ABSTRACT According to recommendations of the 6th WHO Advisory Committee on Buruli ulcer, directly observed treatment with the combination of rifampin and streptomycin, administered daily for 8 weeks, was recommended to 310 patients diagnosed with Buruli ulcer in Pobè, Bénin. Among the 224 (72%) eligible patients for whom treatment was initiated, 215 (96%) were categorized as treatment successes, and 9, including 1 death and 8 losses to follow-up, were treatment failures. Of the 215 successfully treated patients, 102 (47%) were treated exclusively with antibiotics and 113 (53%) were treated with antibiotics plus surgical excision and skin grafting. The size of lesions at treatment initiation was the major factor associated with surgical intervention: 73% of patients with lesions of >15 cm in diameter underwent surgery, whereas only 17% of patients with lesions of <5 cm had surgery. No patient discontinued therapy for side effects from the antibiotic treatment. One year after stopping treatment, 208 of the 215 patients were actively retrieved to assess the long-term therapeutic results: 3 (1.44%) of the 208 retrieved patients had recurrence of Mycobacterium ulcerans disease, 2 among the 107 patients treated only with antibiotics and 1 among the 108 patients treated with antibiotics plus surgery. We conclude that the WHO-recommended streptomycin-rifampin combination is highly efficacious for treating M. ulcerans disease. Chemotherapy alone was successful in achieving cure in 47% of cases and was particularly effective against ulcers of less than 5 cm in diameter.

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