scholarly journals Idiopathic Megacolon-Short Review

Diagnostics ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 2112
Author(s):  
Adrian Constantin ◽  
Florin Achim ◽  
Dan Spinu ◽  
Bogdan Socea ◽  
Dragos Predescu
Keyword(s):  
Drug Therapy ◽  
Continuous Improvement ◽  
Treatment Options ◽  
Rare Condition ◽  
Short Review ◽  
Clinical Aspects ◽  
Idiopathic Megacolon ◽  
Tactical Decision ◽  
Medical Teams ◽  
Clinical Changes

Introduction: Idiopathic megacolon (IM) is a rare condition with a more or less known etiology, which involves management challenges, especially therapeutic, and both gastroenterology and surgery services. With insufficiently drawn out protocols, but with occasionally formidable complications, the condition management can be difficult for any general surgery team, either as a failure of drug therapy (in the context of a known case, initially managed by a gastroenterologist) or as a surgical emergency (in which the diagnostic surprise leads additional difficulties to the tactical decision), when the speed imposed by the severity of the case can lead to inadequate strategies, with possibly critical consequences. Method: With such a motivation, and having available experience limited by the small number of cases (described by all medical teams concerned with this pathology), the revision of the literature with the update of management landmarks from the surgical perspective of the pathology appears as justified by this article. Results: If the diagnosis of megacolon is made relatively easily by imaging the colorectal dilation (which is associated with initial and/or consecutive clinical aspects), the establishing of the diagnosis of idiopathic megacolon is based in practice almost exclusively on a principle of exclusion, and after evaluating the absence of some known causes that can lead to the occurrence of these anatomic and clinical changes, mimetically, clinically, and paraclinically, with IM (intramural aganglionosis, distal obstructions, intoxications, etc.). If the etiopathogenic theories, based on an increase in the performance of the arsenal of investigations of the disease, have registered a continuous improvement and an increase of objectivity, unfortunately, the curative surgical treatment options still revolve around the same resection techniques. Moreover, the possibility of developing a form of etiopathogenic treatment seems as remote as ever.

scholarly journals Plexiform Neurofibroma of the Larynx: A Challenging Management Dilemma

2013 ◽  
Vol 3 (2) ◽  
pp. 55-57
Author(s):  
Gauri Kapre
Keyword(s):  
Pediatric Population ◽  
Treatment Options ◽  
Plexiform Neurofibroma ◽  
Rare Condition ◽  
Surgical Excision ◽  
Short Review ◽  
Uneventful Recovery ◽  
Type I ◽  
Plexiform Neurofibromas ◽  
Swallowing Difficulties

ABSTRACT Introduction Among the many causes responsible for stridor in the pediatric population, tumors of the larynx are relatively rare. Rarer still is the presence of endolaryngeal neurofibromas. Plexiform neurofibromas are associated with type I neurofibromatosis (NF1). Their typical characteristic is that they are diffuse tumors with indistinct margins, which makes complete resection a challenge and the chances of recurrences higher. Objective To document our experience with endolaryngeal neurofibromas and to discuss the treatment options available for this rare condition. Methods We present two cases of plexiform neurofibromas in pediatric patients. Both children presented with large supraglottic masses which interfered with breathing and swallowing. They also fulfilled the criteria for type I neurofibroma. Endolaryngeal approach with microdebrider and laser-assisted surgical excision was performed in both cases. Result Following surgery, both patients had uneventful recovery and no subsequent breathing or swallowing difficulties. Conclusion The dilemma in the management of endolaryngeal neurofibroma is the choice between endolaryngeal laser and aggressive external approach surgery. A short review of the limited existing literature shows that it is wiser to limit the surgery to as complete a resection as is possible endoscopically. How to cite this article Nerurkar NK, Kapre G. Plexiform Neurofibroma of the Larynx: A Challenging Management Dilemma. Int J Phonosurg Laryngol 2013;3(2):55-57.

Nano-Neurotherapeutics (NNTs): An Emergent and Multifaceted Tool for CNS Disorders

2020 ◽  
Vol 21 ◽  
Author(s):  
Aashish Sharma ◽  
Romila Manchanda ◽  
Faheem Hyder Pottoo ◽  
Ghulam Md. Ashraf
Keyword(s):  
Central Nervous System ◽  
Neurological Disorders ◽  
Driving Force ◽  
Treatment Options ◽  
Clinical Aspects ◽  
Future Scenarios ◽  
Cns Disorders ◽  
Drug Conjugates ◽  
Novel Treatment ◽  
Pharmacological Targets

: Impressive research steps have been taken for the treatment of neurological disorders in the last few decades. Still effective treatments of brain related disorders are very less due to problems associated with crossing the blood brain barrier (BBB), non-specific therapies, and delay in functional recovery of central nervous system (CNS) after treatment. Striving for novel treatment options for neurological disorders, nanotechnology-derived materials, and devices have gained the ground due to inherent features of derivatization/encapsulation with drugs as per the neurological ailments and pharmacological targets. Facile developments/syntheses of the nanomaterials-drug conjugates have also been the driving force for researchers to get into this field. Moreover, the tunable size and hydro/lipophilicity of these nanomaterials are the added advantages that make these materials more acceptable for CNS disorders. These nano-neurotherapeutics (NNTs) systems provide the platform for diagnosis, theranostics, treatments, restoration of CNS disorders, and encourage the translation of NNTs from “bench to bedside”. Still, these techniques are in primary stages of medical development. This review describes the latest advancements and future scenarios of developmental and clinical aspects of polymeric NNTs.

scholarly journals Health-Related Quality of Life in Adrenocortical Carcinoma

Cancers ◽  
2019 ◽  
Vol 11 (10) ◽  
pp. 1500 ◽  
Author(s):  
Rebecca V. Steenaard ◽  
Laura A. Michon ◽  
Harm R. Haak
Keyword(s):  
Quality Of Life ◽  
General Population ◽  
Adrenocortical Carcinoma ◽  
Treatment Options ◽  
Clinical Aspects ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
The Impact

Insight into the health-related quality of life (HRQoL) impact of adrenocortical carcinoma (ACC) is important. The disease and its treatment options potentially have an impact on HRQoL. For patients with limited survival, HRQoL research is of utmost importance. We will therefore provide an overview of HRQoL studies in patients with ACC. We found six studies that measured HRQoL in 323 patients with ACC (3 cross-sectional, 1 cohort, 2 trials), all indicating a reduced HRQoL compared to the general population. The FIRMACT trial found that HRQoL of patients with ACC was reduced compared to the general population, and that chemotherapy-mitotane further reduced HRQoL even though survival improved. Clinical aspects of the disease, including cortisol and aldosterone production and adrenal insufficiency have shown great impact on HRQoL in benign disease, even after the recovery of hormonal status. However, the impact of malignant adrenal disease and treatment options on HRQoL including adrenalectomy, radiotherapy, mitotane therapy, and chemotherapy have not been sufficiently studied in patients with ACC. Although the number of HRQoL studies in patients with ACC is limited, the existing literature does indicate that ACC has a large impact on patients’ HRQoL, with disease specific aspects. Further HRQoL research in patients with ACC is essential to improve patient-centered care, preferably by using an ACC-specific HRQoL questionnaire.

Stressful Life Events as a Trigger for Autoimmune Disease? A Case Report on Mucous Membrane Pemphigoid

Dental Update ◽  
2021 ◽  
Vol 48 (5) ◽  
pp. 379-382
Author(s):  
Robert Devine ◽  
Melanie Simms
Keyword(s):  
Mucous Membrane ◽  
Patient Outcomes ◽  
Stressful Life Events ◽  
Treatment Options ◽  
Rare Condition ◽  
Corticosteroid Treatment ◽  
Diagnostic Tools ◽  
Mucous Membrane Pemphigoid ◽  
Acute Presentation

This case discusses the acute presentation of a patient with mucous membrane pemphigoid to an emergency dental department. Mucous membrane pemphigoid is a rare condition, but its presentation can be severe and concerning for both the patient and clinician. The case presents the manifestations of florid desquamative gingivitis and extensive mucosal erosions due to burst bullae. We discuss the possible causes of the condition in this patient, likely to be the stress of recent cardiac surgery, as well as exploring the efficacy of diagnostic tools, treatment options and adverse effects of corticosteroid treatment. CPD/Clinical Relevance: Correct and timely diagnosis of vesiculobullous disorders has notable impacts on patient outcomes and quality of life.

Bilateral Nervus Intermedius Sectioning for Geniculate Neuralgia: Case Report and Operative Video

2021 ◽  
Author(s):  
Keaton Piper ◽  
Qizhi Victoria Zheng ◽  
Robert S Heller ◽  
Siviero Agazzi
Keyword(s):  
Side Effects ◽  
Microvascular Decompression ◽  
Treatment Options ◽  
Rare Condition ◽  
Contralateral Side ◽  
Wide Range ◽  
Successful Resolution ◽  
Surgical Options ◽  
Vascular Loop ◽  
Nervus Intermedius

Abstract BACKGROUND AND IMPORTANCE Geniculate neuralgia is a rare condition characterized by excruciating ear pain. Surgical options for geniculate neuralgia include microvascular decompression and sectioning of the nervus intermedius. We report herein a case of bilateral geniculate neuralgia treated by nervus intermedius sectioning without prior microvascular decompression. To our knowledge, this is the first report of this treatment strategy with a subsequent description of the side effects of bilateral nervus intermedius disruption. CLINICAL PRESENTATION A 54-yr-old woman presented with bilateral geniculate neuralgia, worse on the left, refractory to medical therapy. Surgical treatment options were reviewed, including microvascular decompression and sectioning of the nervus intermedius. She opted for left nervus intermedius sectioning. The procedure was uncomplicated and no compressive vascular loop was identified during surgery. Postoperatively, she had complete symptom resolution with no discernable side effects. Three years later, the patient developed worsening geniculate neuralgia on the contralateral side. After the discussion of treatment options, she opted again for sectioning of the contralateral nervus intermedius with successful resolution of all symptoms after surgery. Following surgery, the patient identified partial impairment of lacrimation and gustation. She continued to have functional taste of the anterior two-thirds of the tongue, lacrimation, and hearing bilaterally. CONCLUSION Bilateral sectioning of nervus intermedius may provide benefit in patients with bilateral geniculate neuralgia without egregious side effects. However, lacrimatory and gustatory alterations are a potentially significant side effect with a wide range of symptomatology.

Updates in insomnia diagnosis and treatment

2019 ◽  
Vol 54 (4-5) ◽  
pp. 275-289 ◽  
Author(s):  
Scott Bragg ◽  
JJ Benich ◽  
Natalie Christian ◽  
Josh Visserman ◽  
John Freedy
Keyword(s):  
Drug Therapy ◽  
Behavioral Therapy ◽  
Treatment Plan ◽  
Treatment Options ◽  
First Line ◽  
Safety Concerns ◽  
Diagnostic And Statistical Manual ◽  
First Line Therapy ◽  
Appropriate Treatment ◽  
Central Nervous System Depression

Introduction Insomnia is the most commonly reported sleep disorder and remains undertreated in many patients. New changes to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, have changed the way insomnia is diagnosed. In patients who suffer from insomnia, a number of available treatment options exist including both behavioral therapy and medications. Literature Review: First line therapy for insomnia should always include behavioral modifications such as sleep hygiene and insomnia-oriented cognitive behavioral therapy. In patients deemed to need pharmacotherapy, first line medications include nonbenzodiazepine hypnotics (i.e., z-drugs) and antidepressants depending on the patients’ needs and comorbidities. The risk of next day impairment, parasomnias, and central nervous system depression are some of the most feared side effects with z-drugs. Second line drug therapy includes melatonin and suvorexant. Several concerns exist for suvorexant similar to other insomnia medications, but melatonin remains one of the safest medication alternatives. Other medication options such as benzodiazepines, antihistamines, and antipsychotics should rarely be used because of weak effectiveness data or serious safety concerns. Discussion The most appropriate treatment plan needs to be tailored to meet the needs of individual patients. Many patient factors (e.g., age, other comorbidities, specific problems with sleep) need to be considered before prescribing drug therapy for patients suffering from insomnia. Medications with the best evidence and fewest safety concerns should be prioritized when clinicians work with patients to determine the most appropriate treatment plan. Conclusions Nondrug treatment should be the emphasis for managing insomnia, but several options exist for patients needing multimodal therapy to improve their symptoms and maximize their quality of life. Z-drugs and antidepressants are first line medications options, but other options may be considered when tailored to individual patients. Medications should only be used intermittently and short term until nondrug treatments help to change a patient’s sleep routine.

scholarly journals A Rare Prostate Pathology: Mantle Cell Lymphoma: A Case Report and Literature Review

2021 ◽  
Author(s):  
Selman Ünal ◽  
Halil Uzundal ◽  
Turker Soydaş ◽  
Asım Özayar ◽  
Arslan Ardıçoğlu ◽  
...  
Keyword(s):  
Mantle Cell Lymphoma ◽  
Cell Lymphoma ◽  
Treatment Options ◽  
Specific Antigen ◽  
Rare Condition ◽  
Additional Treatment ◽  
Appropriate Treatment ◽  
Histopathologic Diagnosis ◽  
Mantle Cell ◽  
Secondary Lymphoma

Primary or secondary lymphoma of the prostate is a rare condition. Mantle cell lymphoma (MCL) represent 4-9% of all lymphomas. Prostate involvement with MCL is very rare, with only 11 reported cases up to now. Here we present a case with lower urinary tract symptoms and prostate-specific antigen (PSA) elevation diagnosed with MCL of the prostate. Prostate biopsy was performed in a 70-year-old patient due to increased PSA. After the pathology result was reported as prostatic MCL, imaging studies and sampling of additional pathological specimens were performed for staging. An improvement was observed in the urinary system complaints of the patient who started chemotherapy regimen. While prostatectomy was performed in some of the prostatic MCL cases reported previously, in some, no additional treatment was required after chemotherapy. Our case is the only prostatic MCL case with elevated PSA levels, but did not receive the diagnosis of prostate cancer. Physicians should keep in mind that, prostatic MCL can present with nonspecific symptoms. Staging should be performed in patients whose histopathologic diagnosis is lymphoma of the prostate so as to determine appropriate treatment options.

scholarly journals Barriers in Implementing the Dying Patient Law: The Israeli Experience - A Qualitative Study

2020 ◽  
Author(s):  
Avi Zigdon ◽  
Rachel Nissanholtz-Gannot
Keyword(s):  
End Of Life ◽  
Family Doctor ◽  
Clinical Aspects ◽  
Human Aspects ◽  
Life Issues ◽  
End Of Life Issues ◽  
Medical Teams ◽  
Depth Interviews ◽  
Training Physicians

Abstract Background Coping with end-of-life issues is a major challenge for governments and health systems. Despite progress in legislation, many barriers exist to its full implementation. This study is aimed at identifying these end-of-life barriers in relation to Israel.Methods Qualitative in-depth interviews using professionals and decision makers in the health-care and related systems (n=37) were carried out, along with two focus groups based on brainstorming techniques consisting of nurses (n=10) and social workers (n=10). Data was managed and analyzed using Naralyzer software.Results Qualitative analysis showed identification of six primary barriers: 1) law, procedures, and forms; 2) clinical aspects; 3) human aspects; 4) knowledge and skills of medical teams; 5) communication; and 6) resource allocation. These were further divided into 44 sub area barriers.Conclusions This study highlights the role of the family doctor in end-of-life by training physicians in decision-making workshops and increasing their knowledge in the field of palliative medicine. Effectively channeling resources, knowledge, and support for medical teams, by accounting for the structure and response of the units for home treatment will improve patient's access to information on and support for end-of-life laws, as well as reduce legislative barriers in other countries that face the same issues.

scholarly journals Wilkie’s Syndrome Following Weight Loss in a Trauma Patient

2020 ◽  
pp. 1-3
Author(s):  
George Oosthuizen ◽  
George Oosthuizen
Keyword(s):  
Weight Loss ◽  
Trauma Patient ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Treatment Options ◽  
Rare Condition ◽  
Feeding Tube ◽  
Significant Weight Loss ◽  
The Third ◽  
Wilkie’S Syndrome

Wilkie’s syndrome, or superior mesenteric artery syndrome, is a rare condition of duodenal obstruction caused by compression of the superior mesenteric artery on the third part of the duodenum. The diagnosis should be considered in a patient who has experienced significant weight loss and now presents with persistent vomiting, especially if the vomiting occurs with the patient in the supine position and is alleviated by the lateral or prone position. The diagnosis can be confirmed by imaging studies demonstrating compression of the third part of the duodenum, and the main aim of treatment should be to pass a feeding tube beyond the point of obstruction to allow enteral feeding. The condition improves spontaneously with weight gain. Further treatment options include parenteral feeding and operative bypass in select cases. Here we present a case of Wilkie’s syndrome in a trauma patient with significant weight loss, together with a review of the literature on this interesting topic.

scholarly journals Choledochoduodeninė fistulė: literatūros apžvalga ir klinikinio atvejo aprašymas

2013 ◽  
Vol 12 (4) ◽  
pp. 189-1950
Author(s):  
Giedrė Krištopaitytė ◽  
Edita Kazėnaitė ◽  
Vitalijus Sokolovas
Keyword(s):  
Abdominal Surgery ◽  
Clinical Case ◽  
Treatment Options ◽  
Short Review ◽  
Type Ii ◽  
Ulcer Disease ◽  
Nosological Entity ◽  
Choledochoduodenal Fistula ◽  
Report Presentation ◽  
Upper Gastrointestinal

Choledochoduodeninė fistulė (CDF) yra retas, dažniausiai atsitiktinis virškinimo trakto vaizdinių tyrimų ar intraoperacinis radinys, sudarantis apie 1–2 % visų bilioenterinių fistulių. Dažniausi etiologiniai veiksniai – opaligė (proksimalinės CDF) ir cholelitiazė(distalinės CDF). Simptominių fistulių gydymui taikomos endoskopinės procedūros – ERCP su PST ir stentavimu arba operuojama. Šiame straipsnyje pateikiama trumpa literatūros apie CDF etiologiją ir gydymo metodus apžvalga ir aprašomasklinikinis atvejis, kai ligonė tirta ir gydyta nuo simptominės distalinės II tipo (pagal Ikedos klasifikaciją) fistulės, kuri galėjo susidaryti cholelitiazės fone.Reikšminiai žodžiai: choledochoduodeninė fistulė (CDF), cholelitiazė, endoskopinė retrogradinė cholangiopankreatikografija (ERCP).Choledochoduodenal fistula: literature review and case report presentation Choledochoduodenal fistula (CDF) is a rare nosological entity, commonly encountered as an accidental finding while exploring the upper gastrointestinal tract or during abdominal surgery. They account for 1–2% of all bilioenteric fistulas, the mostcommon etiological causes being peptic ulcer disease (proximal ones) or cholelithiasis (distal ones). For treating symptomatic cases, endoscopic procedures such as endoscopic retrogradic cholangiopancreaticography with papillosphincterotomy andstentation are applied, or the patient undergoes abdominal surgery. This article provides a short review based on this pathology, its etiological causes and treatment options. A clinical case of symptomatic distal choledochoduodenal fistula of type II(Ikeda) due to cholelithiasis is described.Keywords: choledochoduodenal fistula (CDF), cholelithiasis, endoscopic retrogradic cholangiopancreaticography (ERCP).

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