scholarly journals Surgical Resection with Boyd Technique for Metastatic Ewing Sarcoma of the Bone Plus Docetaxel/Gemcitabine, Associated with Improved Outcomes in Tumor Activity

2020 ◽  
Vol 3 (1) ◽  
Keyword(s):  
Ewing Sarcoma ◽  
Distal Femur ◽  
Medical Oncology ◽  
Femur Fracture ◽  
Improved Outcomes ◽  
History Of ◽  
Metastatic Activity ◽  
History Of Epilepsy ◽  
Histopathological Result

Ewing sarcoma is a malignant bone tumor that mainly affects children, adolescents and young adults with more than 1.5 cases per million worldwide. Approximately 20-25% of patients present metastatic disease at the diagnosis, that is often resistant to intensive therapy.We present the case of a 19-year-old male with history of epilepsy who started his condition with weight loss, increased volume, pain, swelling after receiving surgical treatment due to a left distal femur fracture, showing tomographic evidence of a 50-cm tumor with multiple lung lesions, so disarticulation was performed with the Boyd technique, obtaining histopathological result of Ewing’s Sarcoma, and was subsequently sent to the medical oncology service for follow-up and adjuvant treatment with significant clinical and radiological improvement in pulmonary metastatic activity.

scholarly journals Trends in the risk of second primary malignancies among survivors of chronic lymphocytic leukemia

2019 ◽  
Vol 9 (10) ◽  
Author(s):  
Vivek Kumar ◽  
Sikander Ailawadhi ◽  
Leyla Bojanini ◽  
Aditya Mehta ◽  
Suman Biswas ◽  
...  
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Hematological Malignancies ◽  
Lymphocytic Leukemia ◽  
Second Primary ◽  
Standardized Incidence Ratio ◽  
Improved Outcomes ◽  
History Of ◽  
Second Primary Malignancies

Abstract With improving survivorship in chronic lymphocytic leukemia (CLL), the risk of second primary malignancies (SPMs) has not been systematically addressed. Differences in risk for SPMs among CLL survivors from the Surveillance, Epidemiology, and End Results (SEER) database (1973–2015) were compared to risk of individual malignancies expected in the general population. In ~270,000 person-year follow-up, 6487 new SPMs were diagnosed with a standardized incidence ratio (SIR) of 1.2 (95% CI:1.17–1.23). The higher risk was for both solid (SIR 1.15; 95% CI:1.12–1.18) and hematological malignancies (SIR 1.61; 95% CI:1.5–1.73). The highest risk for SPMs was noted between 2 and 5 months after CLL diagnosis (SIR 1.57; 95% CI:1.41–1.74) and for CLL patients between 50- and 79-years-old. There was a significant increase in SPMs in years 2003–2015 (SIR 1.36; 95% CI:1.3–1.42) as compared to 1973–1982 (SIR 1.19; 95% CI:1.12–1.26). The risk of SPMs was higher in CLL patients who had received prior chemotherapy (SIR 1.38 95% CI:1.31–1.44) as compared to those untreated/treatment status unknown (SIR 1.16, 95% CI:1.13–1.19, p < 0.001). In a multivariate analysis, the hazard of developing SPMs was higher among men, post-chemotherapy, recent years of diagnosis, advanced age, and non-Whites. Active survivorship plans and long-term surveillance for SPMs is crucial for improved outcomes of patients with a history of CLL.

Decision making in the management of malunion and nonunion of intertrochanteric fractures of the hip

2019 ◽  
Vol 30 (6) ◽  
pp. 793-798 ◽  
Author(s):  
Kaushik Bhowmick ◽  
Thomas Matthai ◽  
Perumal Ramaswamy JVC Boopalan ◽  
Thilak S Jepegnanam
Keyword(s):  
Decision Making ◽  
Functional Outcomes ◽  
Intertrochanteric Fracture ◽  
Distal Femur ◽  
Femur Fracture ◽  
Intertrochanteric Fractures ◽  
Non Union ◽  
Shaft Angle ◽  
Head Shaft Angle

Aim: Intertrochanteric fractures account for almost 50% of hip fractures.Nonunion and malunion of these fractures are relatively uncommon. This study reviews the outcome of 31 cases of intertrochanteric fracture failures. An algorithm for the management of these injuries is also proposed. Methods: 19 patients with intertrochanteric malunion and 12 patients with non-union were included in this study. Treatment of these injuries was initiated according to the algorithm proposed in this study. Treatment outcomes were evaluated by assessing union, pre and postoperative shortening and HSA (head-shaft angle). Functional outcomes were assessed by the Parker mobility scale and presence or absence of pain. Results: All the patients with intertrochanteric malunion with follow-up had united. The postoperative shortening in all patients were ⩽2.5 cms. Patients having intertrochanteric nonunion with follow-up, who underwent internal fixation had united with an acceptable Parker mobility scale score, except in 1 patient who sustained an ipsilateral distal femur fracture. The average HSA correction obtained was 21° (range 3–60°). Conclusion: The algorithm proposed in this study helps streamline the treatment according to each case scenario.It helps in planning and managing patients with intertrochanteric fracture failures.

Epileptiform Activity in Electroencephalogram of Normal Children

2017 ◽  
Vol 48 (05) ◽  
pp. 356-362
Author(s):  
Azza Alshahawy ◽  
Walid El-Shehaby ◽  
Amira Darwish
Keyword(s):  
Epileptiform Activity ◽  
Psychological Disorder ◽  
Normal Children ◽  
Unprovoked Seizure ◽  
Seizure Disorders ◽  
Epileptiform Discharges ◽  
Egyptian Children ◽  
History Of ◽  
History Of Epilepsy

Objectives This prospective cohort study assessed the prevalence of epileptiform discharges (EDs) in a cohort of healthy Egyptian children aged 1 to 18 years. Methods Children with a history of unprovoked seizure disorders, family history of epilepsy, neurological or psychological disorder, or any other chronic illness were excluded. Digital electroencephalogram (EEG) was recorded under resting condition for a minimum of 20 minutes including activation methods. Results The study included 1,382 healthy Egyptian children with no history of unprovoked seizures. Twenty-nine normal children had EDs, which represents 2.1% of total number of studied children. Centrotemporal spikes were detected in 19 children. The prevalence of EDs was significantly higher in children aged 6 to 12 years (3.59%) compared with children aged 13 to 18 years (1.2%) and children aged 1 to 5 years (0.45%). Conclusions EDs can be observed in nonepileptic normal children. Centrotemporal spikes are the most common epileptiform pattern in EEG of normal children. None of normal children with EDs developed seizures or other neurological disorders during follow-up.

Distal Femur Tumor Megaprosthesis for Non-union of Supracondylar Femur Fracture after Failed Osteosynthesis. An Ingenious Solution.

2021 ◽  
Vol 11 (9) ◽  
Author(s):  
Bikram Kesari Kar ◽  
Mukund Madhav Ojha ◽  
Sandeep Kumar Yadav ◽  
Alok Chandra Agrawal ◽  
Sharath Kowshik
Keyword(s):  
Distal Femur ◽  
Femur Fracture ◽  
Poor Quality ◽  
Implant Failure ◽  
Geriatric Population ◽  
Early Ambulation ◽  
Non Union ◽  
Distal Femur Replacement ◽  
Knee Society Function Score

Introduction: Incidence of non-union of fracture involving the supracondylar region of femur in an elderly is increasing due to bone loss from trauma and availability of poor quality bone in geriatric population. Distal femur megaprosthesis can provide a single stage solution for resistant non-union of supracondylar femur. Case Report: We are reporting two cases of non-union of supracondylar femur with implant failure treated with distal femoral tumor megaprosthesis. We achieved excellent improvement of the Knee Society Score from 15 to 75; Knee Society Function Score from 0 to 60, good range of motion, and pain free ambulation without support at 3 months follow-up. Conclusion: Management of non-union of supracondylar femur with implant failure is challenging task. Distal femur replacement using tumor megaprosthesis is useful option for such resistant cases in achieving early ambulation and overall good functional outcome. Keywords: Non-union, distal femur fracture, megaprosthesis, supracondylar femur fracture.

scholarly journals Primary Extra-Osseous Ewing Sarcoma of the Thyroid: A Case Report and Review of the Literature

2021 ◽  
Author(s):  
Amanda H. Seipel ◽  
Hiba Mechahougui ◽  
Nicolas Mach ◽  
Frédéric Triponez ◽  
William C. Faquin ◽  
...  
Keyword(s):  
Ewing Sarcoma ◽  
Ultrasound Examination ◽  
Fusion Transcript ◽  
Differentiated Thyroid Carcinoma ◽  
Surgical Specimen ◽  
Pet Ct ◽  
History Of ◽  
Poorly Differentiated ◽  
Pet Ct Scan

AbstractExtra-osseous Ewing sarcoma (ES) is a rare and aggressive malignant tumor found in a variety of organs. Primary ES of the thyroid is exceedingly rare and few cases have been documented to date. We describe the case of a 54-year old woman with a history of breast carcinoma in whom a unique hypermetabolic left thyroid nodule was identified during a follow-up PET-CT scan. An ultrasound examination showed a hypoechogenic nodule of 3.7 cm. A cytological diagnosis of poorly differentiated thyroid carcinoma was made, and a total thyroidectomy was performed. The surgical specimen revealed a poorly differentiated neoplasm composed of medium-sized cells with scant cytoplasm, expressing pancytokeratin, CD99 and NKX2.2 but lacking p63 and p40 expression. Molecular analysis revealed a EWSR1-FLI1 fusion transcript supporting the diagnosis of a primary extra-osseous ES of the thyroid. The patient received adjuvant chemotherapy and has no evidence of recurrent disease.

scholarly journals Recurrence of Febrile Convulsions

2018 ◽  
Vol 35 (5-6) ◽  
pp. 118-23
Author(s):  
Taslim S Soetomenggolo
Keyword(s):  
Child Health ◽  
Neurological Disorders ◽  
Febrile Convulsion ◽  
Febrile Convulsions ◽  
Pediatric Neurology ◽  
Neurology Clinic ◽  
History Of ◽  
History Of Epilepsy ◽  
One Year

During two years, 92 patients who experienced first febrile convulsion were followed-up in the Pediatric Neurology Clinic, Department of Child Health, Cipto Mangunkusumo Hospital, Jakarta for at least one year. Of the 92 patients 58 (63%) were males and 34 (37%) females. Most of the patients were less than 4 years, and only 6 patients (6,5%) aged more than 4 years. Eight (8, 7%) of the 92 patients suffered from recurrence of febrile convulsions, and in 5 of them the recurrence occurred within the first 6 months of follow-up. The recurrences of febrile convulsions occurred mostly in patients less than one year of age, those with tonic seizures, those with neurological disorders, and those who had history of epilepsy in their family. In this study the occurrence of recurrent febrile convulsions in patients with normal EEG was higher than that in patients with abnormal EEG.

scholarly journals Craniomegaly in Neonate and Infants Requiring Neurosurgical Intervention: An Experience at Tertiary Care Center

2022 ◽  
Author(s):  
Sangh Mittra ◽  
Hanuman Prasad Prajapati ◽  
Raj Kumar
Keyword(s):  
Head Circumference ◽  
Care Center ◽  
Tertiary Care ◽  
Dandy Walker Malformation ◽  
Improved Outcomes ◽  
History Of ◽  
The Mean ◽  
Walker Malformation ◽  
Age Range

Abstract Background The identification of neurosurgical causes of craniomegaly and early institution of therapy requires for better clinical and functional outcomes. Aims and Objectives The aim of this study was to evaluate the neurosurgical causes, managements, and outcomes of craniomegaly in neonate and infants. Materials and Methods The cases with a history of head enlargement from neonatal period were included in this study. Their causes, managements, and outcomes were recorded retrospectively during the period of January 2010 to February 2013, in neurosurgery department at SGPGIMS Lucknow, and June 2018 to June 2020, at UPUMS, Saifai, Etawah, UP, India. Results Out of 41 cases, there were 30 (73.14%) cases of hydrocephalus, 4 (9.76%) Dandy-Walker malformation, 2 (4.88%) subdural collection, 2 (4.88%) arachnoid cyst, 1 (2.44%) craniosynostosis, and 2 (4.88%) with tubercular meningitis. The age range of our cases was 18 to 178 days and the mean age was 102.54 ± 50.73. Preoperative head circumference range was 39 to 62 cm (mean: 55.27 ± 6.58cm). Majority of the cases (n = 32, 78.05%) were managed with ventriculoperitoneal shunt surgeries. Out of 41 cases, 33(80.49%) had improved outcomes, 7 (17.07%) stabilized, and mortality occurred in 1 (2.44%) case. Postoperatively, there was improvement in the head circumference (range: 39–60 cm and mean: 46.15 ± 5.83 cm) on 6 to 24 months (mean: 17.85 ± 5.18 months) of follow-up. Conclusion Hydrocephalus was the commonest neurosurgical cause of head enlargement in neonate and infants. Shunt surgery was the most common form of management of these cases. Early detection, institution of therapy, and periodic follow-up program for diagnosing and treating complications were the key to successful outcomes in these patients.

Massive heterotopic ossification after distal femur fracture

2018 ◽  
Vol 63 (3) ◽  
pp. 95-98
Author(s):  
Gokhan Ozkocak ◽  
Guzin Cakir Kandemirli ◽  
Suheda Ozcakir
Keyword(s):  
Soft Tissue ◽  
Heterotopic Ossification ◽  
Distal Femur ◽  
Femur Fracture ◽  
Femoral Shaft ◽  
Distal Femur Fracture ◽  
Significant Burden ◽  
History Of ◽  
The Right ◽  
Thigh Region

Introduction Heterotopic ossification is the formation of lamellar bone in periarticular soft tissue that can be seen in paralysed patients or following trauma. It can cause significant burden to already debilitated patients. Case presentation A 12-year-old boy with paraplegia due to neuromyelitis optica presented with progressive right knee pain and swelling. There was no history of trauma to the knee. Anteroposterior radiograph of femur at the initial presentation showed a supracondylar femur fracture for which casting was performed. Six weeks later, when casting was removed, swelling along with increased rubor in distal thigh region was noted. Radiography of the right femur revealed an unhealed distal femur fracture along with massive ossification extending from lesser trochanter to fracture line along the soft tissue around the femoral shaft. Conclusion This case presented the clinical and imaging findings of a giant heterotopic ossification in the thigh region following an extra-articular fracture.

scholarly journals Distal Femoral Replacement Following an Intraoperative Periprosthetic Fracture in a Patient with Prior Bone Mulch ACL Reconstruction

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Anthony Gemayel ◽  
Matthew J. Yousif ◽  
William Padget ◽  
Joseph Finch
Keyword(s):  
Acl Reconstruction ◽  
Distal Femur ◽  
Femur Fracture ◽  
Primary Total Knee Arthroplasty ◽  
Femoral Fractures ◽  
Femur Fractures ◽  
History Of ◽  
Total Knee ◽  
Primary Total Knee ◽  
Distal Femoral Replacement

Periprosthetic distal femur fractures can be treated nonoperatively, with open reduction and internal fixation or with more constrained prostheses. Distal femoral replacement is typically a last resort treatment option for comminuted periprosthetic or osteoporotic distal femoral fractures in patients with poor bone stock or resistant nonunions. We report the case of a 54-year-old female with a remote history of bone mulch ACL reconstruction who sustained an intraoperative comminuted bicondylar distal femur fracture during a primary total knee arthroplasty. This patient was treated with a distal femoral replacement and successfully returned to her preoperative function.

scholarly journals 1027. Outpatient Parenteral Antimicrobial Therapy (OPAT) in Injection Drug Users (IDUs): Is It Safe?

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S306-S306
Author(s):  
Hira Rizvi ◽  
Nathalie Baratz ◽  
Hind Hadid ◽  
Ana C Bardossy ◽  
Erica Herc ◽  
...  
Keyword(s):  
Injection Drug Users ◽  
Drug Users ◽  
Illicit Drugs ◽  
Patient Characteristics ◽  
The United States ◽  
Emergency Department Visits ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Improved Outcomes ◽  
History Of

Abstract Background OPAT is widely implemented in the United States. However, there are concerns surrounding discharge of IDU with a peripherally inserted central catheter (PICC). The objective of this study was to evaluate the characteristics and treatment outcomes of IDUs discharged on OPAT. Methods This is a retrospective observational study conducted on patients discharged from an Infectious Diseases unit at a quaternary academic healthcare center in Detroit. Charts of all IDUs discharged on OPAT between 2011 and 2017 were reviewed. Current or former IDU were discharged on OPAT if they met the following criteria: self-reported history of IDU, stable living conditions, controlled psychiatric illness (if present), and willingness to sign a discharge agreement to refrain from using the PICC as a route for illicit drugs. Patients were categorized based on clinic follow-up vs. no clinic follow-up. Outcomes evaluated were: cured (completed treatment and symptom free for 1 month after completion), improved (symptoms were improved but there was no confirmation of treatment completion); and relapsed (readmitted within 30 days for the same infection or sequela). Outcomes of patients with no clinic follow-up were based on chart review of subsequent emergency department visits or admissions. Results Patient characteristics are shown in Table 1. Of the 61 patients evaluated, 33 (54.1%) attended clinic follow-up and 28 (45.9%) did not. Outcomes based on clinic follow-up are shown in Table 2. Of the 18 patients who were cured, 16 attended clinic follow-up vs. two who did not. Conclusion This study demonstrates that some IDUs can be discharged safely on OPAT. Patients with clinic follow-up had improved outcomes compared with those who did not. Further studies are needed to look at other predictors of outcome in this patient population. Disclosures All authors: No reported disclosures.

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