scholarly journals Conservative Management of Asymptomatic Adnexal Masses Classified as Benign by the IOTA ADNEX Model: A Prospective Multicenter Portuguese Study

Diagnostics ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 1992
Author(s):  
Marta Espanhol Brito ◽  
André Borges ◽  
Sofia Rodrigues ◽  
Paula Ambrósio ◽  
Raquel Condeço ◽  
...  
Keyword(s):  
Conservative Management ◽  
Surgical Excision ◽  
Spontaneous Resolution ◽  
Multicentric Study ◽  
Adnexal Masses ◽  
Morphological Complexity ◽  
Before And After ◽  
Risk Of Malignancy ◽  
Portuguese Study

This prospective multicentric study aiming to determine the incidence of complications (malignant transformation, torsion or rupture) during conservative management of adnexal masses was performed in two Portuguese tertiary referral hospitals. It included ≥18-year-old, non-pregnant patients with asymptomatic adnexal masses (associated IOTA ADNEX risk of malignancy < 10%) sonographically diagnosed between January 2016 and December 2020. Conservative patient management consisted of serial clinical and ultrasound assessment up to 60 months of follow-up, spontaneous resolution of the formation or surgical excision (median follow-up: 17.8; range 9–48 months). From the 573 masses monitored (328 premenopausal and 245 postmenopausal adnexal masses), no complications were observed in 99.5%. The annual lesion growth rates and increases in morphological complexity were similar in the premenopausal and postmenopausal patients. Spontaneous resolution, evidenced in 16.4% of the patients, was more common in the premenopausal group (p < 0.05). Surgical intervention was performed in 18.4% of the cases; one borderline and one invasive FIGO IA stage cancer were diagnosed. There was an isolated case of ovary torsion (0.17%). These data support conservative management as a safe option for sonographically benign, stable and asymptomatic adnexal masses before and after menopause and highlight the need for expedite treatment of symptomatic or increased-morphological-complexity lesions.

Choledochal Cyst and Malignancy: A Plea for Lifelong Follow-Up

2017 ◽  
Vol 29 (02) ◽  
pp. 143-149 ◽  
Author(s):  
Thomas Wirth ◽  
Joachim Kuebler ◽  
Claus Petersen ◽  
Benno Ure ◽  
Omid Madadi-Sanjani
Keyword(s):  
Choledochal Cyst ◽  
Abdominal Ultrasound ◽  
Current Data ◽  
Elevated Risk ◽  
Long Term Outcomes ◽  
Cyst Excision ◽  
Before And After ◽  
Risk Of Malignancy

AbstractPrevious research has confirmed that patients with choledochal cyst have an elevated risk of cholangiocarcinoma and gallbladder carcinoma. Current data suggest a risk of malignancy of 6 to 30% in adults with choledochal cyst. Malignancy has also occasionally been identified in children and adolescents. Multiple factors, including the age of the patient, cyst type, histological findings, and localization, have an impact on the prognosis. Information on long-term outcomes after cyst excision is limited. However, recent data suggest a lifelong elevated risk of up to 4% of cancer development following operation. This paper presents a review of the literature on cancer in patients with choledochal cyst before and after excision. A postoperative follow-up concept that consists of annual controls of CA19–9 and abdominal ultrasound is introduced.

scholarly journals Safety and Efficacy of Eculizumab Therapy in Multiple Sclerosis: A Case Series

2021 ◽  
Vol 11 (10) ◽  
pp. 1341
Author(s):  
Marco Allinovi ◽  
Angelo Bellinvia ◽  
Francesco Pesce ◽  
Sabrina Milan Manani ◽  
Lorenzo Razzolini ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Disease Activity ◽  
Case Series ◽  
Multicentric Study ◽  
Disease Modifying Therapy ◽  
Relapsing Remitting ◽  
Before And After ◽  
System Activation ◽  
Ms Pathogenesis

(1) Background: Complement system activation has been proposed as one of the different factors that contribute to Multiple Sclerosis (MS) pathogenesis. In this study, we aimed to describe the potential effects of eculizumab, an anticomplement therapy, on MS disease activity in a cohort of relapsing–remitting (RR) MS patients who discontinued IFN-β therapy due to IFN-β-related thrombotic microangiopathy (TMA) onset. (2) Methods: In this retrospective observational multicentric study, we searched for all patients with MS treated by eculizumab with a survey of several nephrological and neurological centers (over 45 centers). (3) Results: Nine patients were included. The mean follow-up time under eculizumab was 3.72 ± 2.58 years. There were no significant differences in disease activity (EDSS, relapses, new T2, and/or Gd-enhancing lesions at MRI) considering the two years before and after eculizumab therapy. No adverse events potentially related to eculizumab therapy were reported during follow-up. (4) Conclusions: In this preliminary study, we described a good safety profile for eculizumab therapy in MS. However, the available data are not sufficient to make firm conclusions about the possible efficacy of eculizumab as a disease-modifying therapy for MS patients.

scholarly journals Functional outcome of platelet rich plasma on lateral epicondylitis of elbow

2017 ◽  
Vol 3 (3) ◽  
pp. 408
Author(s):  
Narayanan V. L. ◽  
Preetha P. ◽  
Maria Joshna J. ◽  
Mishal Dhivya P. J. ◽  
Anbu Selvan
Keyword(s):  
Plasma Treatment ◽  
Conservative Management ◽  
Platelet Rich Plasma ◽  
Lateral Epicondylitis ◽  
Mayo Score ◽  
Plasma Injection ◽  
Before And After ◽  
Elbow Function ◽  
The Mean

<p class="abstract"><strong>Background:</strong> The study was conducted with the aim to explore the efficacy of platelet rich plasma in sixty patients who presented to us with lateral epicondylitis of elbow where conservative management has failed<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> Between 2013 and 2015, 60 patients (M: F- 20: 40) with lateral epicondylitis of elbow were included. All patients presented to us with lateral epicondylitis of elbow where conservative management has failed. All patients are treated with platelet rich plasma injection. Serial follow-up were done at 1, 6 and 12 month.<strong></strong></p><p class="abstract"><strong>Results:</strong> All sixty patients had significant improvement before and after platelet rich plasma injection. The mean VAS score and the Mayo score suggests significant improvement in pain and elbow function following platelet rich plasma treatment<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> Platelet rich plasma improves pain and elbow function in patients suffering from lateral epicondylitis where conservative management has failed. Platelet rich plasma treatment may decrease the overall time for healing, and thereby decreasing the overall need for surgical intervention<span lang="EN-IN">.</span></p>

scholarly journals Benign Aspirates on Follow-Up FNA May Be Enough in Patients with Initial Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Ga Ram Kim ◽  
Jung Hyun Yoon ◽  
Eun-Kyung Kim ◽  
Hee Jung Moon ◽  
Jin Young Kwak
Keyword(s):  
Thyroid Nodules ◽  
Surgical Excision ◽  
Needle Aspiration ◽  
Risk Of Malignancy ◽  
Benign Nodules ◽  
Benign Thyroid Nodules ◽  
Benign Thyroid ◽  
Undetermined Significance

Background.Management of thyroid nodules with benign aspirates following atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) is not well established. We reviewed the risk of malignancy and the role of ultrasound (US) features among thyroid nodules with benign results following initial AUS/FLUS diagnoses.Methods.From December 2009 to February 2011, a total of 114 nodules in 114 patients diagnosed as benign on follow-up fine-needle aspiration (FNA) after AUS/FLUS results were included in our study. Eight among 114 nodules were confirmed pathologically and 106 were clinically observed by a follow-up FNA or US. Suspicious US features were defined as markedly hypoechogenicity, irregular or microlobulated margin, presence of microcalcifications, and taller than wide shape.Results.There were 110 (96.5%) benign nodules and 4 (3.5%) malignant nodules. Two (4.8%) among 42 nodules without suspicious US features and 2 (2.8%) out of 72 nodules with suspicious US features were confirmed as malignancy, but there were no significant associations between the malignancy rate and US features (P=0.625).Conclusion.Clinical follow-up instead of surgical excision or continuous repeat FNA may be enough for benign thyroid nodules after AUS/FLUS. The role of US features might be insignificant in the management of these nodules.

scholarly journals Persistent Atraumatic Knee Pain in a Teenage Female with Bony Protuberance Secondary to Hook-Shaped Osteochrondroma

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Adityanarayan Rao ◽  
Joshua Pryor ◽  
Jaclyn Otero ◽  
Molly Posa
Keyword(s):  
Medical History ◽  
Knee Pain ◽  
Conservative Management ◽  
Plain Radiograph ◽  
Surgical Excision ◽  
Initial Presentation ◽  
Medial Aspect ◽  
Skin Changes ◽  
The Right

A 13-year-old female presented at her pediatrician’s office with a complaint of sharp, intermittent, right-sided knee pain that had been present for the previous three days without any known trauma and no association with activity. Her medical history was significant for fractures, and on physical exam, there was a hard mass palpated on the medial aspect of her distal thigh that was nontender, nonmobile, and without overlying skin changes. The plain radiograph findings were consistent with a hook-shaped osteochondroma of the right medial distal metaphysis. Orthopedics recommended conservative management with continued ibuprofen for pain and six-week follow-up with repeat radiograph to evaluate for progression. The follow-up radiograph showed no interval growth. However, due to continued pain, the patient had surgical excision of the osteochondroma six months after initial presentation, allowing her to finish her current soccer season. The surgery was successful, and the patient did well after operation with no residual pain.

scholarly journals Baker’s cyst in children: conservative management versus surgical excision according to clinical and imaging criteria

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Mohammed A. Mansour ◽  
Mohammed A. Shehata ◽  
Mohammed M. Shalaby ◽  
Mohammed A. Arafa ◽  
Hisham A. Almetaher
Keyword(s):  
Conservative Management ◽  
Surgical Excision ◽  
Popliteal Cyst ◽  
First Year ◽  
Baker’S Cyst ◽  
X Ray ◽  
Persistent Symptoms ◽  
Baker's Cyst ◽  
The Mean

Abstract Background Pediatric patients rarely exhibit Baker’s cysts. This study was conducted on 15 cases (9 males, 6 females) presented with Baker (popliteal) cyst in the last 2 years (from September 2017 to September 2019). The mean age was 8.5 years. The aim of this study was to present our experience in management of these cases based on clinical and imaging criteria. Plain x-ray and knee ultrasonography were routinely done for all cases. If the size of the cyst was less than or equal to 3 cm by ultrasonography, with no or minimal pain, the patients were managed conservatively and were scheduled to followed up visits after 3 months, 6 months, and after 12 months for clinical assessment of symptoms and sonographic size of the cyst. Surgical excision of the Baker’s cyst was considered if the size of the cyst was more than 3 cm with persistent of pain. Results Seven cases had cysts less than 3 cm by ultrasonography and were managed conservatively. In five out of these seven cases, the cysts disappeared with no recurrence within the first year of follow-up. In two cases, the cysts increased in size with increase in pain. These two cases were subjected to surgical excision after 1 year of follow-up. The remaining eight cases had cysts more than 3 cm and were managed by surgical excision. Out of the ten cases which were managed by surgical excision, recurrence occurred in 3 cases within the first post-operative year (after 4 months, 7 months, and 8 months) consecutively. Conclusions The management of Baker’s cysts in children is debatable, with no definite protocol. In this current study, we conclude that surgical excision of large Baker’s cysts (more than 3 cm) with persistent symptoms is crucial providing meticulous dissection without rupture of the cyst and proper closure of the pedicle which connects the cyst with the knee joint, while conservative management and follow-up is effective in small Baker’s cysts (less than 3 cm) with no recurrence.

The natural history of type 2 endoleaks after endovascular aneurysm repair justifies conservative management

Vascular ◽  
2018 ◽  
Vol 26 (5) ◽  
pp. 524-530 ◽  
Author(s):  
Mark Ajalat ◽  
Russell Williams ◽  
Samuel E Wilson
Keyword(s):  
Natural History ◽  
Conservative Management ◽  
Endovascular Aneurysm Repair ◽  
Spontaneous Resolution ◽  
Type 2 Endoleak ◽  
History Of ◽  
Tomographic Angiography ◽  
Aneurysm Repair

Objective Management of type 2 endoleaks after endovascular aneurysm repair has been controversial. Some advocate for conservative management, while others believe that intervention is indicated. This study investigated the natural history of type 2 endoleaks in order to derive direction in management. Methods Patients who had endovascular aneurysm repair at the Veterans Affairs Long Beach were retrospectively identified and computerized tomographic angiography was independently reviewed by a radiologist and a vascular surgeon. Type 2 endoleaks were analyzed for the following outcomes: rupture, duration of endoleak, spontaneous resolution, changes in the size of the aneurysm sac, and reintervention rates. Results Of the 160 patients who had completed required follow-up to date (mean 3 years) after endovascular aneurysm repair, 39 (24.4%) patients were identified as having a type 2 endoleak on computerized tomographic angiography imaging. 6 (15.4%) of these 39 patients required repair due to aneurysm sac growth >1 cm. 2 (5.13%) were repaired with an open procedure and 4 (10.3%) with an endovascular approach. Of these 6 aneurysm leaks requiring repair, 4 (66.7%) had a simultaneous endoleak (types 1 or 3) in addition to the identified type 2 endoleak. Spontaneous resolution of type 2 endoleaks occurred in 16 (41.0%) patients. 4 patients (10.3%) had delayed type 2 endoleaks that presented 4, 9, 12, and 23 months after their 30 day post op computed tomography was normal. None of the 4 patients with delayed type 2 endoleaks required reintervention and none had aneurysm sac growth greater than 5 mm. Conclusions Overall, we found that 85% of patients who had type 2 endoleaks did not require intervention after a mean follow-up time of 3 years. The association of a type 1 or 3 endoleak with a type 2 endoleak was more likely to require correction due to aneurysm expansion >1 cm, thus type 2 endoleaks associated with another type of endoleak require more aggressive management.

scholarly journals Confocal Microscopy and Lentigo Maligna: An in vivo Pilot Study for the Assessment of Response to Imiquimod Therapy

Dermatology ◽  
2018 ◽  
Vol 235 (2) ◽  
pp. 150-155 ◽  
Author(s):  
Flurin L. Brand ◽  
S. Morteza Seyed Jafari ◽  
Robert E. Hunger
Keyword(s):  
Confocal Microscopy ◽  
Histopathological Examination ◽  
Surgical Excision ◽  
Lentigo Maligna ◽  
Noninvasive Technique ◽  
Important Benefit ◽  
Before And After ◽  
Atypical Cells

Background: Reflectance confocal microscopy (RCM) is a noninvasive technique that provides real-time in vivo images of the epidermal layer. Imiquimod has been recommended as an alternative treatment in lentigo maligna (LM) when surgical excision is not the treatment of choice. In the present study we compare the results of in vivo RCM to the histopathological examination before and after treatment of LM with topical imiquimod. Methods: Thirty-four patients with confirmed LM were included. Imiquimod 5% was applied until a weeping erosion appeared in the LM-affected skin. Evaluation was performed by clinical examination, dermatoscopy, histopathology and RCM. Results: During the follow-up, 27 of 34 patients (79.42%) demonstrated a total tumor clearance by imiquimod treatment. In the treated area, a significant decrease of atypical cells was detected using RCM (p < 0.0001). Furthermore, a significant positive correlation in the detected atypical cells was shown using confocal microscopy and histology (p = 0.0001, r = 0.7335, respectively). Conclusion: In patients not suitable for surgical intervention imiquimod treatment is an appropriate treatment alternative. Thereby, in vivo RCM was demonstrated to be an excellent examining device, which not only allows diagnosis of LM, but also therapy and follow-up examinations. An important benefit of RCM, in contrast to conventional histopathology, is the simple handling with in vivo examination of epidermal skin without any pain for the patient.

scholarly journals Study of impact of surgical intervention (adenotonsillectomy) and conservative management on quality of life in patients with SDB

2018 ◽  
Vol 4 (2) ◽  
pp. 448
Author(s):  
Arshed Ali ◽  
Jasif Nisar ◽  
Ihsan Ali ◽  
Rauf Ahmad
Keyword(s):  
Quality Of Life ◽  
Conservative Treatment ◽  
Conservative Management ◽  
Pediatric Patients ◽  
Surgical Intervention ◽  
Diagnostic Methods ◽  
Before And After ◽  
The Impact

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">SDB is an important cause of morbidity in children. SDB has been associated with decreased quality of life (QOL). In this study, we tried to determine The impact of surgical intervention (adenotonsillectomy) and conservative management on quality of life in patients with SDB. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">A total of 112 pediatric patients were included with SDB, who visited our OPD. Diagnostic methods include history and physical examination, audiotaping or videotaping, pulse oximetry. OSA 18 questionnaire was used to assess the quality of life with conservative treatment (pre and post-treatment) and after surgical intervention-before and after adenoidectomy or adenotonsillectomy.  </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">We had 112 patients with majority being males 69 (61.60%) and females 43 (38.30%), majority of patients were in the age group of 5-7 yrs (49.10%). In 47 patients (who underwent adenotonsillectomy/tonsillectomy), OSA-18 questionnaire was used pre-operatively, at 2 and 6 months. OSA-18 when used pre-operatively showed majority of patients 33 (70.21%) having score &gt;80, and 14 (29.79%) patients having score between 60-80. No patient was below 60 score. Mean OSA-18 score pre-operatively was 84.15. OSA-18 score at 2 months and at 6 months were 30.06 and 26.40 respectively, which showed a lot of improvement in post-operative score and hence the post –operative quality of life. In 65 patients (conservative treatment) OSA-18 was used pre-conservative, at 2 and 6 months of treatment. OSA-18 when used before conservative treatment<strong> </strong>showed majority of patients 44 (67.6 9%) having score 60-80, and 21 (32.30%) patients having score between &gt;80. No patient was below 60 score. OSA-18 score at 2 months showed improvement in 69.23% patients (&lt;40), OSA-18 at 6 months showed recurrence in 12.33% patients. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">SDB substantially impact QOL in pediatric patients. QOL significantly improves following adenotonsillectomy. There is subset of patients 12.33% with SDB in whom there was recurrence of symptoms after conservative treatment. Thus showing that conservative management is inferior to surgical management in the treatment of SDB. SDB improved after an observation period. Thus, observation with close follow-up is another treatment option.</span></p><p> </p>

Primary Cutaneous CD4+ Small/Medium Pleomorphic T-Cell Lymphoproliferative Disorder: A Case Series

2017 ◽  
Vol 21 (6) ◽  
pp. 502-506 ◽  
Author(s):  
Martina Maurelli ◽  
Chiara Colato ◽  
Paolo Gisondi ◽  
Giampiero Girolomoni
Keyword(s):  
T Cell ◽  
Lymphoproliferative Disorder ◽  
Clinical Course ◽  
Case Series ◽  
Surgical Excision ◽  
Cell Receptor ◽  
Spontaneous Resolution ◽  
Review Of The Literature ◽  
The Face

Background: Primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder (CD4+ PCSM-LPD) is defined by a predominance of small- to medium-sized CD4+ pleomorphic T cells and a favorable clinical course. Objective: We performed a retrospective analysis of 6 patients with CD4+ PCSM-LPD and reviewed the literature to address questions about its diagnosis, treatment, and prognosis. Methods: Patients were 3 men and 3 women with a median age of 50 years. All patients presented with a single erythematous nodule, localised on the head in 4 patients and the upper trunk in 2 cases. No patients showed extracutaneous disease at any evaluation. Histopathologic features were characterised by nodular, diffuse, or, in 1 case, a superficial dense infiltrate of small/medium-sized pleomorphic CD4+/PD1+ T lymphocytes. T-cell receptor clonality was demonstrated in 5 cases. Treatment was surgical excision in 5 cases and radiotherapy in 1 case. Results: All patients achieved complete resolution without relapses, during a median follow-up of 3 years. A review of the literature confirmed that CD4+ PCSM-LPD presents predominantly with a solitary nodular lesion on the face, neck, or upper trunk in adult patients. Surgical excision is the preferred treatment. Spontaneous resolution after biopsy may occur. Conclusions: CD4+ PCSM-LPD is a rare disorder with a favorable course.

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