Intraoperative Ultrasound Applications in Intracranial Surgery

The methods and use of intraoperative ultrasound in 33 canine and five feline patients and its ability to localize and identify anatomical structures and pathological lesions in canines and felines undergoing intracranial surgery are described from a case series. All were client-owned referral patients admitted for neurologic evaluation, with an advanced imaging diagnosis of an intracranial lesion, and underwent surgical biopsy or surgical removal of the lesion. Medical records, retrieval and review of imaging reports, and characterization of findings for all canine and feline patients show that intraoperative ultrasound guidance was used in intracranial procedures during the period of 2012 and 2019. Twenty-nine of the canine patients had intracranial tumors. The remainder had various other conditions requiring intracranial intervention. Three of the feline patients had meningiomas, one had a depressed skull fracture, and one had an epidural hematoma. The tumors appeared hyperechoic on intraoperative ultrasound with the exception of cystic portions of the masses and correlated with the size and location seen on advanced imaging. Statistical comparison of the size of images seen on ultrasound and on MRI for 20 of the canine tumors revealed no statistical differences. Neuroanatomical structures, including vascular components, were easily identified, and tumor images correlated well with preoperative advanced imaging. The authors conclude that intraoperative ultrasound is a valuable asset in intracranial mass removals and can augment surgical guidance in a variety of intracranial disorders that require surgery. This is the first known publication in veterinary surgery of using intraoperative ultrasound as a tool in the operating theater to identify, localize, and monitor the removal/biopsy of intracranial lesions in small animals undergoing craniotomy/craniectomy.

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The Site of Origin of Canine Abdominal Masses Correlates with the Risk of Malignancy: Retrospective Study of 123 Cases

Animals ◽

10.3390/ani11040962 ◽

2021 ◽

Vol 11 (4) ◽

pp. 962

Author(s):

Paola Valenti ◽

Valeria Pellegrino ◽

Luisa Vera Muscatello ◽

Barbara Brunetti ◽

Elisa Zambon ◽

...

Keyword(s):

Abdominal Mass ◽

Case Series ◽

Malignant Neoplasm ◽

Common Finding ◽

Surgical Removal ◽

Anatomical Location ◽

Histopathological Diagnosis ◽

Minimum Diameter ◽

Abdominal Masses ◽

The Masses

The detection of an abdominal mass represents a common finding in clinical practice. The aim of this study was to retrospectively describe the tissue distribution and diagnosis of abdominal masses amenable to surgical removal in a canine population. Dogs with abdominal masses with a minimum diameter of 3 cm were selected. Cases were classified, based on the anatomical location, as splenic, gastrointestinal, hepatobiliary, genital, and masses not associated with any organ. Masses were surgically removed and formalin-fixed for the histological examination. Collected data were statistically analyzed. A total of 123 masses were collected from 122 dogs. Sixty-nine masses were classified as malignant neoplasia, 15 as benign, and 39 as non-neoplastic. The abdominal masses were 5.8-fold more likely to be malignant if located in the gastrointestinal tract (p = 0.01). A significant association between the size and the site of the masses was identified, the masses not associated with any organ being larger than the genital and splenic lesions (p = 0.008). This case series describes the most frequent location in association with the histopathological diagnosis of canine abdominal masses and suggests that the gastrointestinal location was related to a higher risk of representing a malignant neoplasm.

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Local Chemotherapy as an Adjuvant Treatment in Unresectable Squamous Cell Carcinoma: What Do We Know So Far?

Current Oncology ◽

10.3390/curroncol28040213 ◽

2021 ◽

Vol 28 (4) ◽

pp. 2317-2325

Author(s):

Luigi Bennardo ◽

Francesco Bennardo ◽

Amerigo Giudice ◽

Maria Passante ◽

Stefano Dastoli ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Gold Standard ◽

Systemic Chemotherapy ◽

Standard Treatment ◽

Case Reports ◽

Case Series ◽

Surgical Removal ◽

Local Chemotherapy

Background: Squamous cell carcinoma (SCC) is one of the most common cancers involving skin and oral mucosa. Although this condition’s gold-standard treatment is the surgical removal of the lesions, the physician must propose alternative treatments in some cases due to the patient’s ineligibility for surgery. Among the available alternative therapies, local chemotherapy may represent an initial treatment in combination with radiotherapy or systemic chemotherapy due to the low frequency of side-effects and the lack of necessity for expensive devices. Methods: In this paper, we review all available literature in various databases (PubMed, Scopus-Embase, Web of Science), proposing local chemotherapy as a treatment for cutaneous and oral SCC. Exclusion criteria included ocular lesions (where topical treatments are common), non-English language, and non-human studies. Results: We included 14 studies in this review. The majority were case reports and case series describing the treatment of non-resectable localized SCC with either imiquimod or 5-fluorouracil. We also analyzed small studies proposing combination treatments. Almost all studies reported an excellent clinical outcome, with a low risk of relapses in time. Conclusions: Resection of the lesion remains the gold-standard treatment for SCC. When this approach is not feasible, local chemotherapy may represent a treatment alternative, and it may also be associated with radiotherapy or systemic chemotherapy.

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Diagnosis and management of hook of hamate fractures

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193417729603 ◽

2017 ◽

Vol 43 (5) ◽

pp. 539-545 ◽

Cited By ~ 5

Author(s):

Assaf Kadar ◽

Allen T. Bishop ◽

Marissa A. Suchyta ◽

Steven L. Moran

Keyword(s):

Case Series ◽

Clinical Results ◽

Clinical Findings ◽

Advanced Imaging ◽

Level Of Evidence ◽

Historical Case ◽

Treatment Groups ◽

Diagnosis And Management ◽

Time To Diagnosis ◽

Hook Of Hamate

The purpose of this study was to evaluate the time to diagnosis and management of hook of hamate fractures in an era of advanced imaging. We performed a retrospective study of 51 patients treated for hook of hamate fractures. Patients were sent a quickDASH questionnaire regarding the outcomes of their treatment. Hook of hamate fractures were diagnosed with advanced imaging at a median of 27 days. Clinical findings of hook of hamate tenderness had better sensitivity than carpal tunnel-view radiographs. Nonunion occurred in 24% of patients with non-operative treatment and did not occur in the operative group. Both treatment groups achieved good clinical results, with a grip strength of 80% compared with the non-injured hand and a median quickDASH score of 2. Advanced imaging improved the time to diagnosis and treatment compared to historical case series. Nonunion is common in patients treated non-operatively. Level of evidence: IV

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Intratracheal parathyroid gland: an unexpected diagnosis

BMJ Case Reports ◽

10.1136/bcr-2020-239435 ◽

2021 ◽

Vol 14 (2) ◽

pp. e239435

Author(s):

Avery Bryan ◽

Susan Kurian ◽

Ashley B Flowers ◽

Cherie Ann O Nathan

Keyword(s):

Parathyroid Adenoma ◽

Parathyroid Gland ◽

Parathyroid Tissue ◽

Case Series ◽

Rare Occurrence ◽

Laboratory Evidence ◽

The Masses

Ectopic or supernumerary parathyroid tissue has been generally described in the literature in cases found during workup for parathyroid adenoma. We present two unique cases of intratracheal parathyroid gland, a rare occurrence that has not yet been described in the literature. In both cases, the masses were found incidentally and showed no clinical or laboratory evidence of hyperparathyroidism. In both cases, surveillance was chosen as the method of treatment. We present this case series to increase awareness of this potential diagnosis.

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Massive Intravascular Hemolysis From Clostridium perfringens Septicemia

Journal of Intensive Care Medicine ◽

10.1177/0885066613498043 ◽

2013 ◽

Vol 29 (6) ◽

pp. 327-333 ◽

Cited By ~ 36

Author(s):

Tracey G. Simon ◽

Joanna Bradley ◽

Adisa Jones ◽

Gerardo Carino

Keyword(s):

Clostridium Perfringens ◽

Patient Survival ◽

Case Reports ◽

English Literature ◽

Case Series ◽

Surgical Removal ◽

Chi Square ◽

Data Set ◽

Male Mortality ◽

Time To Death

We describe the case of a patient with hemolysis-associated Clostridium perfringens septicemia and review all similar cases published in the literature since 1990, with specific focus on the relationship between treatment strategy and survival. We searched PubMed for all published cases of C. perfringens-associated hemolysis, using the medical subject terms “clostridia,” “clostridial sepsis,” and/or “hemolysis.” All case reports, case series, review articles, and other relevant references published in the English literature since 1990 were included in this study. There were no exclusion criteria. Each case was examined with respect to presenting features of illness, antibiotic regimen, time-to-antibiotic therapy, additional interventions, complications, and patient survival. These variables were entered into a data set and then systematically analyzed with the aid of a statistician, using serial t tests and chi-square analyses. Since 1990, 50 patients of C. perfringens septicemia with hemolysis have been reported. Median age was 61 years (range 31-84), and 58% were male. Mortality was 74%, with a median time to death of 9.7 hours (range 0-96 hours). Of the patients, 35 (70%) were treated medically, while 15 (30%) received antibiotics and surgery. Surgical intervention was associated with significantly improved survival (risk ratio [RR] 0.23, 95% confidence interval [CI] 0.10, 0.53) as was the use of a combination of penicillin and clindamycin (RR of death 0.46, 95% CI 0.25, 0.83). Four patients utilizing hyperbaric oxygen therapy (HBOT) have been reported, and all patients survived. In cases of clostridial sepsis with hemolysis, strong predictors of survival include early initiation of appropriate antibiotics as well as surgical removal of infected foci. The HBOT may also be associated with survival. The disease often progresses rapidly to death, so rapid recognition is critical for the patient survival.

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Kinematic Changes in Swallowing After Surgical Removal of Anterior Cervical Osteophyte Causing Dysphagia: A Case Series

Annals of Rehabilitation Medicine ◽

10.5535/arm.2014.38.6.865 ◽

2014 ◽

Vol 38 (6) ◽

pp. 865 ◽

Cited By ~ 6

Author(s):

Hyeonghui Jeong ◽

Han Gil Seo ◽

Tai Ryoon Han ◽

Chun Kee Chung ◽

Byung-Mo Oh

Keyword(s):

Case Series ◽

Surgical Removal

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Efficacy of the Surgical Management of Amiodarone-induced Thyrotoxicosis

World Journal of Endocrine Surgery ◽

10.5005/jp-journals-10002-1217 ◽

2017 ◽

Vol 9 (3) ◽

pp. 79-87 ◽

Cited By ~ 1

Author(s):

Marilla Dickfos ◽

Robert Franz

Keyword(s):

Total Thyroidectomy ◽

Surgical Management ◽

Medical Therapy ◽

Clinical Status ◽

Case Series ◽

Primary Treatment ◽

Surgical Removal ◽

Efficient Treatment ◽

Select Group ◽

Small Subgroup

ABSTRACT Introduction Amiodarone can be a life-saving medication; however, it can also cause amiodarone-induced thyrotoxicosis (AIT). Though rare, AIT is a complex and life-threatening side effect, which can cause significant cardiac dysfunction and lead to cardiac failure. Primary treatment is with thionamides, perchlorates, and steroids. However, a small subgroup does not respond and their cardiovascular function continues to deteriorate. This select group is referred for a semi-elective total thyroidectomy. Without surgical removal of their thyroid gland, these patients will continue to deteriorate, with a 30 to 50% mortality rate for those not operated on. Aim The aim of this case series was to assess for any indicators as to when these patients should be referred for total thyroidectomies and the efficacy of this method of treatment. Materials and methods A case series of patients with AIT treated with a total thyroidectomy from 1998 to 2015 was used to assess the efficacy of and indicators for surgery. Results Total thyroidectomy results in efficient and significant improvement in the patient's biochemistry and symptoms. The patient's symptoms and options for medical therapy have an influence on the duration of the trial of medical therapy. Conclusion Surgery is an effective and efficient treatment for AIT. However, there does not appear to be a specific indicator for when this treatment should be instigated. A case-by-case approach should be adopted when treating these complicated patients. Clinical significance Clinicians should see surgery as an effective and efficient treatment for AIT. The timing of surgery should be assessed on a case-by-case basis considering the patient's clinical status and therapeutic options and not as a last resort. How to cite this article Dickfos M, Franz R. Efficacy of the Surgical Management of Amiodarone-induced Thyrotoxicosis. World J Endoc Surg 2017;9(3):79-87.

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Visual Outcome after Microsurgical removal of Craniopharyngioma via Pterional Craniotomy

Journal of Saidu Medical College, Swat ◽

10.52206/jsmc.2020.10.1.288 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Adnan Khaliq ◽

Farooq Azam ◽

Mumtaz Ali ◽

Asadullah , ◽

Akramullah , ◽

...

Keyword(s):

Benign Tumor ◽

Case Series ◽

Visual Outcome ◽

Bimodal Distribution ◽

Visual Disturbance ◽

Surgical Removal ◽

Paired Data ◽

Chi Square ◽

Female Ratio ◽

Number Of Patients

Background: Craniopharyngioma is a benign tumor of sellar & Suprasellar area with bimodal distribution. Visual disturbance isone of the common clinical presentation. Early surgical intervention results in favourable results.Objective: To analyze visual outcome after surgical removal of craniopharyngioma via pterional craniotomy.Material and Methods: This observational descriptive case series was conducted at department of neurosurgery,LRH/Peshawar. Duration of study was 18 months from Jan 2017 to June 2018. The study included patients withcraniopharyngioma, who underwent surgery in elective setup, newly diagnosed cases and patients operated via pterionalapproach. All those patients who presented in crisis like acute hydrocephalus, operated via other approaches and recurrent caseswere excluded from this study. The changes of visual function (visual acuity and field) of the patients were assessed preoperativelyand postoperatively, documented by a predesigned proforma and paired data of this change were compared. Visual assessmentwas done on follow up visits on 2 weeks,1 month,3 months and 6 months. Chi square test was applied as statistical test. Data wasanalysed through SPSS version 17.Results: Total number of patients were (30) with Male to female ratio was 1.5:1.Age of patients were Ranging from 4 year to 62years (mean 35 years).There were 23 Children (76.6%) and 7 Adults (23.3%).Out of 30 patients, 21 patients(70%) presented withvisual disturbance and 9 patients (30%) had non opthalmogical symptoms. Optic atrophy was seen in 6 patients (20%) preoperatively.Per operatively tumor was found in suprasellar area in 24 patients(80%) and in both supra+infrasellar area in 6patients(20%). Tumor size was less than 3cm in 19 patients(63.3%) and more than 3cm in 11 patients(36.6%). Morphology peroperatively was cystic in 19 patients(63.3%), solid in 5 patients(16.6%) and both solid and cystic in 6 patients(20%). Calcification intumor was seen in 16 patients(53.3%). Gross total resection(GTR) of tumor was done in only 21 patients(70%). Post-operativefollow up assessment of visual status showed that (50%) of patients improved.Conclusion: Craniopharyngioma is a benign tumor with malignant behaviour so timely intervention give favourable results.

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Pineal Apoplexy: A Case Series and Review of the Literature

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0041-1723813 ◽

2021 ◽

Author(s):

Martin Majovsky ◽

David Netuka ◽

Radim Lipina ◽

Jan Mraček ◽

Vladimír Beneš

Keyword(s):

Surgical Treatment ◽

Pineal Gland ◽

Clinical Significance ◽

Obstructive Hydrocephalus ◽

Case Series ◽

Surgical Removal ◽

Pineal Tumor ◽

Review Of The Literature ◽

Melatonin Secretion ◽

Pubmed Database

Abstract Background Pineal apoplexy is a rare condition, with unknown incidence and clinical significance. To elucidate this clinical condition, we analyzed our own case series and performed a review of the literature. Methods We enrolled all patients with a hemorrhagic pineal apoplexy who were referred to our department between January 2000 and January 2020. Hemorrhagic pineal apoplexy was defined as the presence of fluid–fluid levels inside the pineal cyst (PC) on an axial or sagittal magnetic resonance scan. In one patient, after PC apoplexy, we performed a circadian melatonin sampling from peripheral blood to determine the function of the pineal gland. The PubMed database was searched for publications using the terms “pineal” and “apoplexy.” Results Eight patients were enrolled, of which three patients underwent surgical treatment and five patients were managed conservatively. One patient was tested for circadian melatonin secretion. Results confirmed melatonin secretion with preserved physiologic circadian rhythm.Our search of the literature led us to 31 studies that comprised 30 patients with apoplectic PC, 9 with apoplectic pineal tumor, and 1 with bleeding into the normal pineal gland. Most patients presented with headache, nausea, and vomiting, less frequently with acute hydrocephalus and gaze palsy. Twenty patients with a PC underwent resection or aspiration. Two patients underwent shunt placement as the only procedure and five received both shunt and surgical removal. Six patients with a PC were observed without surgical treatment. All the nine patients with a pineal tumor were operated on. In indicated cases, four patients received radiation therapy and one received chemotherapy. Conclusion Clinical significance of hemorrhagic pineal apoplexy ranges from an asymptomatic course to rapid deterioration and death. In patients with mild symptoms, observation is indicated, whereas surgical treatment is reserved for severe cases presenting with obstructive hydrocephalus and includes cerebrospinal fluid diversion, resection of apoplectic pineal lesions, or both.

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