The Surgical Management of Proximal Femoral Metastases: A Narrative Review

The proximal femur is a common location for the development of bony metastatic disease. Metastatic bone disease in this location can cause debilitating pain, pathologic fractures, reduced quality of life, anemia or hypercalcemia. A thorough history, physical examination and preoperative investigations are required to ensure accurate diagnosis and prognosis. The goals of surgical management is to provide pain relief and return to function with a construct that provides stability to allow for immediate weightbearing. Current surgical treatment options include intramedullary nailing, hemiarthroplasty or total hip arthroplasty and endoprosthetic reconstructions. Oligometastatic renal cell carcinoma must be given special consideration as tumor resection and reconstruction has survival benefit. Both tumor and patient characteristics must be taken into account before deciding on the appropriate surgical intervention.

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The use of intrathecal ziconotide to manage refractory malignant pain: Five case studies

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e20737 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e20737-e20737

Author(s):

G. C. McDowell ◽

J. W. Mitchell ◽

T. D. Moore

Keyword(s):

Pain Intensity ◽

Treatment Options ◽

Metastatic Breast ◽

Patient Characteristics ◽

Clinical Observations ◽

Life Improvement ◽

Drug Doses ◽

Cancer Complications ◽

Viable Treatment

e20737 Background: Chronic malignant pain is often difficult to manage. Intrathecal (IT) ziconotide monotherapy has been shown to be effective in treating patients with chronic pain associated with malignancy. Intrathecal admixtures containing ziconotide may also be viable treatment options for refractory malignant pain. Methods: The medical records of 5 patients with malignant pain managed with IT ziconotide as monotherapy or as a component of combination therapy were reviewed. Patient characteristics, medical history, IT drug doses, Numeric Pain Intensity (NPI: 0–10 scale, with higher scores indicating greater pain intensity) scores, and clinical observations (including adverse events [AEs]) were identified. Results: Four women (aged 27, 31, 46, and 68 years) with metastatic breast cancer and a 61-year-old man with metastatic prostate cancer were intolerant of or experienced inadequate analgesia with systemic analgesics and/or IT opioids with or without clonidine or bupivacaine. Ziconotide was either started as monotherapy or used in combination with an IT opioid with or without bupivacaine. Initial ziconotide doses of 0.46 to 1.50 mcg/d were titrated upward to 1.16 to 7.26 mcg/d at the last assessments. Although the 46-year-old woman experienced substantial pain relief (55.6% reduction in NPI score) and quality of life improvement during ∼3 months of ziconotide therapy, she died of cancer complications that were unrelated to ziconotide. From baseline to last assessment, the remaining 4 patients experienced 25% to 83% reductions in NPI scores with ziconotide therapy. Meaningful improvements in patient mobility and functionality were evident. The 68-year-old patient experienced transient dizziness after a 3-mcg bolus trial of ziconotide but did not experience any AEs during continuous infusion of ziconotide. No other ziconotide-related AEs were reported. Conclusions: These cases suggest that ziconotide, alone or in combination with other IT agents, can be a viable treatment option for patients with refractory malignant pain. [Table: see text]

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Degenerative Conditions of the Cervical Spine

10.1093/med/9780199350940.003.0008 ◽

2018 ◽

Author(s):

Samuel C. Overley ◽

Dante Leven ◽

Abhishek Kumar ◽

Sheeraz A. Qureshi

Keyword(s):

Cervical Spine ◽

Cervical Spondylosis ◽

Surgical Intervention ◽

Treatment Options ◽

Disease Process ◽

Natural Aging ◽

Patient Characteristics ◽

Axial Neck Pain ◽

Degenerative Cervical Spine ◽

Patient Presentation

Degenerative disease of the cervical spine, also referred to as cervical spondylosis, is one of the most common pathologies encountered by spine specialists. This degenerative condition is primarily attributed to the natural aging process. However, a subset of patients may exhibit symptoms ranging from axial neck pain to radiculopathy to florid signs of myelopathy. A sound understanding of the spinal anatomy, pathology, patient presentation and treatment options, including surgical intervention, is paramount to evaluating and treating a patient with cervical spondylosis. This chapter focuses on the disease process, its natural history, patient characteristics, and treatment options for one of the most prevalent and potentially problematic spinal pathologies: the degenerative cervical spine.

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Weighing Bone-targeted Treatment Options for Patients with Solid Tumours and Skeletal Complications from Metastatic Disease

European Oncology & Haematology ◽

10.17925/eoh.2012.08.3.148 ◽

2012 ◽

Vol 08 (03) ◽

pp. 148 ◽

Cited By ~ 4

Author(s):

Lesley Fallowfield ◽

Roger von Moos ◽

Luis Costa ◽

Alison Stopeck ◽

Mark Clemons ◽

...

Keyword(s):

Daily Living ◽

Treatment Options ◽

Patient Characteristics ◽

Optimal Management ◽

Good Patient ◽

Good Patient Care ◽

Skeletal Complications ◽

Skeletal Related Events ◽

Preserve Function

The complications of metastatic bone disease (MBD) in advanced cancer, especially skeletal-related events (SREs), are a significant cause of morbidity that can seriously impair the quality of patients’ lives. Treatments that prevent SREs, reduce or delay the onset of pain and preserve function and activities of daily living are central to good patient care. In this article, we discuss results from clinical trials that show the relative benefits and harms of different bone-targeted agents, which may be given orally, intravenously or subcutaneously. These data, when considered alongside various patient characteristics, can provide oncologists with better opportunities to individualise care. Optimal management with treatments that enhance efficacy and adherence mean that clinicians can improve the outlook for their patients with MBD, who may consequently experience fewer SREs and less pain and enjoy a better overall quality of life.

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Effectiveness of Local Hemostatic Agents in Epistaxis

International Journal of Head and Neck Surgery ◽

10.5005/jp-journals-10001-1169 ◽

2014 ◽

Vol 5 (1) ◽

pp. 1-5

Author(s):

Tahir Hussain

Keyword(s):

Surgical Intervention ◽

Treatment Options ◽

Tumor Resection ◽

Medical Attention ◽

Management Options ◽

Hemostatic Agents ◽

Surgical Measures ◽

Epidemiological Profile ◽

A Prospective Study ◽

Head Neck

ABSTRACT Background Epistaxis is the commonest otorhinolaryngological emergency affecting up to 60% of the population in their lifetime with 6% requiring medical attention. Objective The aim of this study was to find out the epidemiological profile of epistaxis in our area and to find out the effectiveness of various available eight treatment options. Materials and methods This study was conducted to describe the etiological profile and treatment outcome of epistaxis. This was a prospective study of the cases of epistaxis from July 2012 to May 2013. Till date, the data regarding the management of epistaxis in our setting was not available. The purpose was to evaluate the clinical and management options for epistaxis in our settings. Results A total of 100 patients with epistaxis were studied. Males were affected twice more than the females (2.6:1). Their mean age was 48.63 years (4-82 years). The commonest cause of epistaxis was idiopathic (33%) followed by trauma (21%) and hypertension (18%). Nonsurgical measures, such as light packing with cotton gauze soaked with local hemostatic (hemocoagulase) and antiseptic/antibiotic (36%), silver nitrate cauterization 20 (16%) and anterior nasal packing (15%) and observation alone (11%) were the main intervention methods in 78% of cases. Surgical measures mainly intranasal tumor resection was carried out in 3% of cases. Conclusion The most common etiological factor for epistaxis is idiopathic. Most cases were successfully managed with conservative treatment alone and surgical intervention may not be necessary in most cases and should be the last resort. How to cite this article Hussain T. Effectiveness of Local Hemostatic Agents in Epistaxis. Int J Head Neck Surg 2014;5(1):1-5.

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Effectiveness of the surgical intervention in the quality of life and survival of patients with metastatic lesions in the spine

Coluna/Columna ◽

10.1590/s1808-18512014130100179 ◽

2014 ◽

Vol 13 (1) ◽

pp. 57-62

Author(s):

Luiz Cláudio Lacerda Rodrigues ◽

Adalberto Bortoletto ◽

Marcelo Hide Matsumoto

Keyword(s):

Quality Of Life ◽

Pain Relief ◽

Surgical Intervention ◽

Neurological Status ◽

Lumbar Region ◽

Metastatic Lesions ◽

Spinal Lesions ◽

Pathologic Fractures ◽

The Impact

OBJECTIVE: To evaluate the impact of surgical treatment of metastatic epidural spinal lesions on the quality of life of patients, pain relief and survival. METHODS: Patients with single or double spinal lesions, in good clinical conditions to undergo surgery, were included. Staging and prognostic evaluation were performed, based on imaging studies, according to the criteria of Enneking and Tokuhashi, and neurological status (Frankel), pain (visual analogue scale, VAS) and quality of life index (Oswestry) were also assessed. Survival was calculated. RESULTS: The study included 67 patients, 34 men and 33 women, aged 13-88 years (mean: 53). Most had the breast (23 cases) as the primary site of the tumor and metastasis in the lumbar region, especially in L2 and L3. Pathologic fractures were diagnosed in 45 patients. The mean VAS score was initially 9 (5-10) reducing in the second day after surgery to 2 (1-7) and to 1 (0-6) in the first and sixth months. Following 6 months, 18 deaths were observed (one intraoperatively, five in the first month and 12 at 6 months). The neurological status was correlated with survival: patients who were Frankel E before surgery showed increased survival. CONCLUSION: The surgery does not influence patient survival, except for patients with neurological deficits, who have a worse prognosis. Treatment of metastatic lesions is often palliative, but patients present improved neurological and pain relief and few complications after surgery, justifying surgical intervention.

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Epicondylopathia humeri radialis

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/a-1340-0931 ◽

2021 ◽

Author(s):

Tim Leschinger ◽

Thomas Tischer ◽

Anna Katharina Doepfer ◽

Michael Glanzmann ◽

Michael Hackl ◽

...

Keyword(s):

Surgical Management ◽

Treatment Options ◽

Lateral Epicondylitis ◽

Diagnostic Workup ◽

Structural Morphology ◽

Chronic Disorder ◽

Building Process ◽

Mechanical Overload ◽

Epicondylopathia Humeri Radialis

Abstract Background Lateral epicondylitis is a common orthopaedic condition often massively restricting the quality of life of the affected patients. There are a wide variety of treatment options – with varying levels of evidence. Method The following statements and recommendations are based on the current German S2k guideline Epicondylopathia radialis humeri (AWMF registry number: 033 – 2019). All major German specialist societies participated in this guideline, which is based on a systematic review of the literature and a structured consensus-building process. Outcomes Lateral epicondylitis should be diagnosed clinically and can be confirmed by imaging modalities. The Guidelines Commission issues recommendations on clinical and radiological diagnostic workup. The clinical condition results from the accumulated effect of mechanical overload, neurologic irritation and metabolic changes. Differentiating between acute and chronic disorder is helpful. Prognosis of non-surgical regimens is favourable in most cases. Most cases spontaneously resolve within 12 months. In case of unsuccessful attempted non-surgical management for at least six months, surgery may be considered as an alternative, if there is a corresponding structural morphology and clinical manifestation. At present, it is not possible to recommend a specific surgical procedure. Conclusion This paper provides a summary of the guideline with extracts of the recommendations and statements of its authors regarding the pathogenesis, prevention, diagnostic workup as well as non-surgical and surgical management.

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Concentric mastopexy for pubertal gynaecomastia in an African child

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa276 ◽

2020 ◽

Vol 2020 (9) ◽

Author(s):

Afieharo I Michael ◽

Olayinka A Olawoye ◽

Odunayo M Oluwatosin

Keyword(s):

Quality Of Life ◽

Children And Adolescents ◽

Surgical Management ◽

Watchful Waiting ◽

Surgical Intervention ◽

Male Breast ◽

African Child

Abstract Gynaecomastia refers to the enlargement of the male breast. It can be psychologically disturbing for children and adolescents as well as adults. While in children watchful waiting is advised as the gynaecomastia could resolve, surgical intervention becomes necessary where there is significant psychosocial disturbance. We present a case of an African child whose quality of life improved after correcting the gynaecomastia. We highlight the concentric mastopexy method in the surgical management of gynaecomastia.

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Endovascular Intervention for Critical Lower Limb Ischemia; a Review of Outcomes after Percutaneous Transluminal Angioplasty using Balloon Catheter

Medical Science & Healthcare Practice ◽

10.22158/mshp.v3n1p1 ◽

2018 ◽

Vol 3 (1) ◽

pp. 1

Author(s):

Parviz Farshid ◽

Nasrin Noori ◽

Lutz Bluemel ◽

Marion Berndt ◽

Alexander Mundinger

Keyword(s):

Lower Limb ◽

Treatment Options ◽

Balloon Catheter ◽

Limb Ischemia ◽

Patient Characteristics ◽

Transluminal Angioplasty ◽

Life Threatening ◽

Associated Risk Factors ◽

Percutaneous Transluminal

Peripheral Arterial Disease (PAD) of lower limb with variable morbidity can be manifested as an asymptomatic, sever or life threatening disease. It is also a major cause of disability in many cases. The management of patients with PAD can be defined from a number of different treatment options in the terms of conservative-, interventional- and surgical therapies.Percutaneous Transluminal Angioplasty (PTA) using balloon catheter as a revascularization procedure has been used with acceptable outcomes. The method results are highlighted with comparable success—and patency rates, low complications, improving the quality of life and survival. We reviewed published studies and found that PTA is an appropriate alternative in the management of patient with Critical Limb Ischemia (CLI). Better outcomes have been achieved using Drug Coated Balloons (DCB) as well as Drug Eluting Stents (DES). Atherectomy remains with controversial results. Patient characteristics, the presence of associated risk factors, characteristics of lesions and accompanied cardiopulmonary disease may be the main challenges to use of these treatment options in the future.

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Surgical Management in Primary Congenital Glaucoma: Four Debates

Journal of Ophthalmology ◽

10.1155/2013/612708 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 7

Author(s):

Ta C. Chang ◽

Kara M. Cavuoto

Keyword(s):

Surgical Treatment ◽

Surgical Management ◽

Medical Management ◽

Surgical Intervention ◽

Treatment Options ◽

Congenital Glaucoma ◽

Definitive Treatment ◽

Primary Congenital Glaucoma ◽

Compare And Contrast ◽

Early Surgical Intervention

Primary congenital glaucoma is a worldwide diagnostic and therapeutic challenge. Although medical management is often a temporizing measure, early surgical intervention is the definitive treatment. As the abundance of surgical treatment options continues to expand, the authors will compare and contrast the available options and attempt to provide a consensus on surgical management.

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Management of bone metastases

Orvosi Hetilap ◽

10.1556/oh.2014.29781 ◽

2014 ◽

Vol 155 (6) ◽

pp. 217-225

Author(s):

Tamás Nagykálnai ◽

László Landherr

Keyword(s):

Bone Metastases ◽

External Beam Radiotherapy ◽

Treatment Options ◽

Fatal Outcome ◽

Developed Countries ◽

Cord Compression ◽

Pathologic Fractures ◽

Skeletal Complications ◽

The Developed Countries

The skeleton is the most common site to be affected by advanced breast, prostatic, lung, kidney, thyroid and other solid tumors (in addition to myeloma multiplex). Bone metastases cause significant morbidity with nearly always fatal outcome. Over 600 000 new patients diagnosed in the developed countries yearly. On average every 4–6 months patients suffer from series of severe skeletal complications such as pathologic fractures, spinal cord compression, hypercalcemic events, etc., besides the permanent pain. Local external beam radiotherapy, systemic radioisotope-, endocrine-, and chemotherapy, oral and i.v. bisphosphonates and recently s.c. denosumab are the mainstays of treatment, in addition to pain-killers and other usual “classical” interventions. The modern treatments singificantly reduce the probability of skeletal complications and improve the patients’ quality of life and, sometimes, they extend the survival as well. The authors briefly summarize the available treatment options. Orv. Hetil., 2014, 155(6), 217–225.

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