scholarly journals Malignant Vascular Tumors of the Head and Neck—Which Type of Therapy Works Best?

Cancers ◽  
2021 ◽  
Vol 13 (24) ◽  
pp. 6201
Author(s):  
Susanne Wiegand ◽  
Andreas Dietz ◽  
Gunnar Wichmann
Keyword(s):  
Head And Neck ◽  
Treatment Options ◽  
Age Distribution ◽  
Case Series ◽  
Epithelioid Hemangioendothelioma ◽  
Current Data ◽  
Vascular Tumors ◽  
Retrospective Case ◽  
Standard Medical Therapy ◽  
New Treatment

Malignant vascular tumors of the head and neck are rare neoplasms with variable clinical presentation, wide age distribution, and variable clinical courses. The heterogeneous presentation of angiosarcomas and epithelioid hemangioendothelioma often leads to misdiagnosis and unsuitable treatment. While risk factors for angiosarcomas are previous radiation, chronic lymphedema, and exposure to arsenic, thorium oxide, or vinyl chloride, there are only limited and retrospective data available on prognostic factors in EHE. In both angiosarcomas and EHE, surgery is the mainstay of treatment. There is limited evidence regarding the role of radiotherapy in EHE, although EHE is considered relatively radiosensitive. In angiosarcomas, adjuvant radiotherapy is recommended according to retrospective case series. A standard medical therapy for metastasized malignant vascular tumors is lacking. Chemotherapy, which is effective in angiosarcoma, is mostly ineffective in EHE. Targeted therapy, antiangiogenetic drugs and immunotherapy have been studied as new treatment options. The goal of this review is to summarize the current data regarding malignant vascular tumors along with their diagnosis and management.

Abstract P363: Predictors of Utility of Advanced Cardiac Imaging in Revealing Cryptogenic Stroke Etiology

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Daniel M Schachter ◽  
Micaela Schachter ◽  
Blake Beehler ◽  
Jeffrey Quinn ◽  
Jeremy E Kulacz ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Cardiac Imaging ◽  
Left Atrial ◽  
Cryptogenic Stroke ◽  
Case Series ◽  
Patient Characteristics ◽  
Current Data ◽  
Common Finding ◽  
Retrospective Case ◽  
Patients With Diabetes

Introduction: Advanced cardiac imaging (ACI), including transesophageal echocardiogram (TEE), cardiac CT and cardiac MRI, is widely considered a crucial element in the work-up of cryptogenic and ESUS stroke. Current data on diagnostic yields are variable, though, and selection of patients to undergo such imaging is largely anecdotal. Methodology: We conducted a retrospective case series review of all cryptogenic ischemic strokes who received ACI, admitted to a large urban academic single-center over a 2.5-year period. Patient characteristics and imaging findings were analyzed to determine diagnostic yields and to identify positive and negative predictors that ACI would uncover etiology. Results: Out of 277 total cryptogenic ischemic strokes reviewed, ACI determined etiology in 20 cases (7.2%). Median age was 61 (IQR = 52-73). Patient sex was 49.5% female. Race demographic was 1.8% Asian, 50.9% black, 14.1% latino(a), and 33.2% white. Etiology was found by TEE in 16 of 20 cases, and the most common finding was left atrial thrombus/smoke. Latino(a) race was significantly more likely (15.4%) for ACI to find etiology and white race was significantly less likely (1.1%), p = .03 and .005, respectively. The table included shows other notable findings. Analogous trends were observed in a subgroup analysis of patients greater or equal to 60 years old. Conclusion: Our data indicate that in cryptogenic stroke premorbid non-use of antithrombotic, elevated troponin and left atrial dilatation are each individually associated with increased likelihood that ACI will find an etiology. Meanwhile, patients with diabetes mellitus are significantly less likely to have etiology found by ACI; and, smokers with combined hypertension, hyperlipidemia, and diabetes mellitus trend towards ACI less frequently uncovering etiology. Finally, the data suggest potential racial disparities of finding etiology with ACI, the determinants of which remain to be studied.

Management of feline carpal injuries: What are the options and when is arthrodesis indicated?

2019 ◽  
Vol 21 (9) ◽  
pp. 809-823 ◽  
Author(s):  
Rachel M Basa ◽  
Kenneth A Johnson
Keyword(s):  
Treatment Options ◽  
Case Series ◽  
Evidence Base ◽  
Careful Examination ◽  
Current Evidence ◽  
Collateral Ligament ◽  
Retrospective Case ◽  
Radial Collateral Ligament ◽  
Current Evidence Base ◽  
Direct Extrapolation

Practical relevance: Feline carpal injuries are usually caused by falls from a height that result in hyperextension injury or antebrachiocarpal luxation or subluxation. Isolated ligamentous damage or fracture of the carpus is unusual; it is more common to have a combination of both in the cat. These injuries can be debilitating since cats climb and jump from great heights, and have a greater range of antebrachial pronation and supination than dogs. Anatomy: There are differences in the anatomy of the feline and canine carpus. In particular, cats only have a single short radial collateral ligament, also known as the medial collateral ligament. This means that, in the cat, antebrachiocarpal subluxation is possible with rupture of the dorsal joint capsule and short radial collateral ligament alone. Clinical challenges: Many feline carpal injuries can be treated without performing pancarpal arthrodesis. However, determining which ligaments and joint levels are affected requires careful examination and often stress radiography. When pancarpal arthrodesis is performed in the cat, it has been reported to reduce the height of jumping and to increase reluctance to climb. This is speculated to be due to reduced pronation and supination movement of the carpus. Evidence base: The current evidence base for management of feline carpal injuries is grade III or IV, with most of the studies being retrospective case series involving cadaveric dissection or direct extrapolation from published information about the dog. There are few guidelines regarding the optimal treatment options for carpal injuries in the cat.

Pathologic Angiogenesis of Malignant Vascular Sarcomas: Implications for Treatment

2018 ◽  
Vol 36 (2) ◽  
pp. 194-201 ◽  
Author(s):  
Jalal A. Khan ◽  
Robert G. Maki ◽  
Vinod Ravi
Keyword(s):  
Treatment Options ◽  
Growth Factor Receptor ◽  
Kaposi Sarcoma ◽  
Clinical Trial Data ◽  
Epithelioid Hemangioendothelioma ◽  
Vascular Tumors ◽  
Angiogenic Growth Factors ◽  
Notch Pathways ◽  
And Behavior ◽  
Endothelial Growth Factor

Angiosarcoma, epithelioid hemangioendothelioma, and Kaposi sarcoma are classified according to the line of differentiation that these neoplastic cells most closely resemble: the endothelial cell. Although these malignant vascular sarcomas demonstrate immunohistochemical and ultrastructural features typical of this lineage, they vary dramatically in presentation and behavior, reflecting oncologic mechanisms unique to each. Antineoplastic therapies offer significant benefit, but because of the rarity of these cancers, novel therapies are slow to develop, and treatment options for these cancers remain limited. Antiangiogenic approaches that have shown benefit in other malignancies have not fully realized their promise in vascular tumors, suggesting that these tumors do not depend entirely on either angiogenic growth factors or on neighboring endothelia that are affected by these agents. Nonetheless, translational studies have begun to unravel these distinct pathologies, identifying novel translocation products, targets of oncogenic virulence factors, and genomic mutations that hijack angiogenic signaling and drive malignant growth. Concurrently, an elaborate and highly regulated model of angiogenesis and lymphangiogenesis involving vascular endothelial growth factor–receptor tyrosine kinase and TGF-β and Notch pathways has emerged that informs treatment of these tumors as well as cancer in general. This review summarizes the literature on malignant vascular sarcomas in the context of current models of angiogenesis and, in light of recent clinical trial data, could help clinician-scientists generate novel therapeutic approaches.

Pediatric Head and Neck Trauma from All-Terrain Vehicle Accidents

2007 ◽  
Vol 137 (2) ◽  
pp. 201-205 ◽  
Author(s):  
Brian S. Wang ◽  
Stacey L. Smith ◽  
Kevin D. Pereira
Keyword(s):  
Soft Tissue ◽  
Head And Neck ◽  
Pediatric Trauma ◽  
Case Series ◽  
Soft Tissue Injuries ◽  
Neck Trauma ◽  
Retrospective Case ◽  
Average Hospital ◽  
Maxillofacial Fractures ◽  
Head And Neck Trauma

OBJECTIVE: To characterize pediatric head and neck trauma from all-terrain vehicles (ATVs) at a single institution. STUDY DESIGN/SETTING: Retrospective case series at a level I pediatric trauma center. RESULTS: Thirty-four patients were admitted: average age was 12 years, with 68% between 12 and 16 years and 32% under 12 years. The patient was the driver in 74% of cases and the passenger in 17% of cases. Driver average age was 12.7 years and passenger average age was 10.5 years. Seventy-six percent of children were not wearing helmets. Average hospital stay was 6 days, with 81% of cases discharged home. Central nervous system injuries were most common, followed by soft tissue injuries. Soft tissue repair was the most frequent procedure, and most maxillofacial fractures required operative intervention. CONCLUSIONS: ATV-related morbidity and mortality in children are significant public health issues amenable to primary prevention by prohibiting passengers on ATVs and requiring helmet use. SIGNIFICANCE: National trends indicate increasing ATV-related injuries in children.

scholarly journals Hydranencephaly treatments: retrospective case series and review of the literature

2020 ◽  
Vol 26 (3) ◽  
pp. 228-231 ◽  
Author(s):  
Grace M. Thiong’o ◽  
Susan S. Ferson ◽  
A. Leland Albright
Keyword(s):  
Palliative Care ◽  
Treatment Options ◽  
Case Series ◽  
Primary Outcome Measure ◽  
Head Size ◽  
Secondary Outcome ◽  
Retrospective Case ◽  
Number Of Patients ◽  
One Year ◽  
Improving Patient Care

OBJECTIVEThe objective of this study was to review treatment options for infants with hydranencephaly and to consider the pros and cons of each treatment modality.METHODSThis paper is a review of hydranencephaly as well as a retrospective analysis evaluating the outcomes of 52 infants with hydranencephaly who were treated at the Kijabe Hospital, Kijabe, Kenya, in one of four ways: ventriculoperitoneal shunt (VPS) insertion, endoscopic choroid plexus coagulation (CPC), open choroid plexectomy (CPlx), and palliative care. The primary outcome measure was control of head size, with the aim of improving patient care. One-year mortality was a secondary outcome.RESULTSOf the 52 patients analyzed, 11 underwent VPS insertion, 17 CPC, 14 CPlx, and 10 were treated palliatively. Head size was controlled at the 3-month evaluation interval in 5 of 7 infants treated with VPS, 10 of 16 of those treated with CPC, 6 of 9 of those treated with CPlx, and 1 of 4 treated palliatively. The number of infants in each category with complete follow-up data that were needed to analyze change in head size was lower than the total number of patients included in each category. Mortality at 1 year of age was 9 of 11 in the VPS group, 14 of 17 in the CPC group, 6 of 14 in the CPlx group, and 7 of 10 in the palliative group.CONCLUSIONSHead size decreased by 1 cm or more in similar proportions (62%–71%) of infants with hydranencephaly who were treated by VPS insertion, CPC, and CPlx, and progressed in those who received palliative care. Mortality at 1 year of age was similar in infants treated by a VPS, CPC, and palliative care (70%–82%), but lower (43%) in those treated with CPlx.

scholarly journals A systematic review on conservative and non-operative treatment options for Osgood-Schlatter disease

2020 ◽  
Author(s):  
Cornelia Neuhaus ◽  
Christian Appenzeller-Herzog ◽  
Oliver Faude
Keyword(s):  
Systematic Review ◽  
Operative Treatment ◽  
Treatment Options ◽  
Grey Literature ◽  
Case Series ◽  
Outcome Data ◽  
Control Group ◽  
Retrospective Case ◽  
Review Articles ◽  
Knee Pathology

Background: Osgood-Schlatter disease (OSD) is a sport- and growth-associated knee pathology with painful osteochondrosis around the tibial tuberosity. Up to 10% of adolescents are affected by OSD. Treatment is primarily conservative or non-operative and includes injections, ice, braces, casts, tape and/or physiotherapy. However, treatment outcomes are often insufficiently described and there is lack of evidence for current best practice.Objective: The aims of this systematic review are to comprehensively identify conservative or non-operative treatment options for OSD, to compare their effectiveness in selected outcomes, and to describe potential research gaps. and to describe potential research gaps.Methods: This systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. CENTRAL, CINAHL, EMBASE and MEDLINE via Ovid, and PEDro were searched through to January 6, 2020. In addition, ongoing and unpublished clinical studies, dissertations, and other grey literature on OSD were retrieved. We included prospective, retrospective, case control, randomised, and non-randomised studies reporting on the effectiveness of any conservative or non-operative treatment of 6- to 28-year-old OSD patients. Studies written in English, German, or French were included. The quality of the included studies was assessed using the PEDro scale and extracted outcome data were narratively synthesized. In addition, we also systematically retrieved review articles for extraction of treatment recommendations.Results: Of 767 identified studies, thirteen were included: two randomised controlled trials (RCTs), two prospective and eight retrospective observational studies, and one case series. Eight studies had no control group. The included studies were published from 1948 to 2019 and included 747 patients (563 male, 119 female, 65 sex not reported) with 937 affected knees. The study quality was poor to moderate. The two included RCTs examined the effectiveness of surplus dextrose-injection in OSD patients treated with local anaesthetics injection and came to opposite conclusions. Other than that, inter-study heterogeneity prohibited any descriptive cumulative analyses. Among the 15 review articles, the most prevalent treatment recommendations were activity modification (15/15), quadriceps and hamstring stretching (13/15), medication (11/15), ice (11/15), strengthening of the quadriceps (9/15), and knee straps or brace (8/15).Conclusion: Conflicting evidence exists to support the use of dextrose injections. Certain therapeutic approaches, such as stretching, seem to work, but no RCT comparing specific exercises with sham or usual care treatment exists. Carefully controlled studies on well- described treatment approaches are needed to establish which conservative or non-operative treatment options are most effective for patients with OSD.

scholarly journals Initial experience in Mexico with convalescent plasma in COVID-19 patients with severe respiratory failure, a retrospective case series

2020 ◽  
Author(s):  
Michel F. Martinez-Resendez ◽  
Fernando Castilleja-Leal ◽  
Alejandro Torres-Quintanilla ◽  
Augusto Rojas-Martinez ◽  
Gerardo Garcia-Rivas ◽  
...  
Keyword(s):  
Viral Load ◽  
Respiratory Failure ◽  
Troponin I ◽  
Therapeutic Option ◽  
Treatment Options ◽  
Case Series ◽  
High Sensitivity ◽  
Retrospective Case ◽  
X Ray ◽  
Chest X Ray

Introduction: Hospital mortality due to COVID-19 in Mexico is high (32%) and as of today, effective treatment options are limited. More effective treatments that shorten hospital stay and reduce mortality are needed. Initial reports for the use of convalescent plasma (CP) therapy for COVID-19 appear promising. We describe a case series of eight patients with impending respiratory failure, who underwent CP therapy. Methods: Six male and two female (ages 31 to 79) patients that were admitted to the intensive-care unit for severe COVID-19 were transfused with two doses of CP (250 mL per dose, anti-SARS-CoV-2 IgG titers > 1:100). Donors were six SARS-CoV-2 infected males who remained asymptomatic for > 7 days and were negative for two nasopharyngeal RT-PCR tests. Clinical characteristics, inflammatory and cellular injury markers, chest X-ray findings and viral loads were analyzed before and after CP administration. Viral load association to disease severity was further analyzed on a separate cohort of asymptomatic vs hospitalized patients with COVID-19. Results: Eight patients with respiratory failure were successfully discharged with a median length of stay of 22.5 (IQR 18.25-29.00). After CP therapy, we observed a reduction of C-reactive protein (CRP) (median, 22.80 mg/dL vs. 1.63 mg/dL), and of procalcitonin (median, 0.27 ng/mL vs. 0.13 ng/mL). High-Sensitivity Cardiac Troponin I (hs-cTnI), Brain Natriuretic Peptide (BNP) and Lactate Dehydrogenase (LDH) were lower, and a mild reduction of pulmonary infiltrates by chest X-ray was observed. Lastly, a reduction of viral load was after CP therapy was found. (log, median [IQR], 1.2 [0.70-2.20] vs. 0.25 [0.00-1.78]). We observed no adverse effects. Conclusions: CP could potentially be an effective therapeutic option for patients with severe COVID-19. Clinical benefit needs to be studied further through randomized controlled trials.

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