scholarly journals Management of Osteoblastoma and Giant Osteoid Osteoma with Percutaneous Thermoablation Techniques

2021 ◽  
Vol 10 (24) ◽  
pp. 5717
Author(s):  
Antonio Izzo ◽  
Luigi Zugaro ◽  
Eva Fascetti ◽  
Federico Bruno ◽  
Carmine Zoccali ◽  
...  
Keyword(s):  
Osteoid Osteoma ◽  
Gold Standard ◽  
Young Patients ◽  
Surgical Excision ◽  
Term Treatment ◽  
Childhood And Adolescence ◽  
Complication Rates ◽  
Success Rates ◽  
Primary Bone Tumors ◽  
Long Term Treatment

Osteoblastoma (OB) is a rare, benign bone tumor, accounting for 1% of all primary bone tumors, which occurs usually in childhood and adolescence. OB is histologically and clinically similar to osteoid osteoma (OO), but it differs in size. It is biologically more aggressive and can infiltrate extraskeletal tissues. Therapy is required because of severe bone pain worsening at night. Moreover, non-steroid anti-inflammatory drugs (NSAIDs) are not a reasonable long-term treatment option in young patients. Surgical excision, considered the gold standard in the past, is no longer attractive today due to its invasiveness and the difficulty in performing a complete resection. The treatment of choice is currently represented by percutaneous thermoablation techniques. Among these, Radiofrequency ablation (RFA) is considered the gold standard treatment, even when the lesions are located in the spine. RFA is a widely available technique that has shown high efficacy and low complication rates in many studies. Other percutaneous thermoablation techniques have been used for the treatment of OB, including Cryoablation (CA) and laser-ablation (LA) with high success rates and low complications. Nevertheless, their role is limited, and further studies are necessary.

scholarly journals THERAPY OF ENDOCRINE DISEASE: Surgery in microprolactinomas: effectiveness and risks based on contemporary literature

2016 ◽  
Vol 175 (3) ◽  
pp. R89-R96 ◽  
Author(s):  
Metaxia Tampourlou ◽  
Raluca Trifanescu ◽  
Alessandro Paluzzi ◽  
Shahzada K Ahmed ◽  
Niki Karavitaki
Keyword(s):  
Transsphenoidal Surgery ◽  
Young Patients ◽  
Cost Effective ◽  
High Volume ◽  
Term Treatment ◽  
Long Term Results ◽  
Complication Rates ◽  
Management Algorithm ◽  
Long Term Treatment

Microprolactinomas are the most common pituitary adenomas. In symptomatic patients, dopamine agonists are the first-line treatment of choice; when cabergoline is used, biochemical control rates between 85 and 93% have been reported. Long-term treatment is needed in most of the cases with compliance, patient convenience, and potential adverse effects representing areas requiring attention. Based on the literature published in the past 15 years, transsphenoidal surgery can lead to normal prolactin in the postoperative period in usually 71–100% of the cases with very low postoperative complication rates. Surgical expertise is the major determinant of the outcomes, and it may be a cost-effective option in young patients with life expectancy greater than 10 years (provided it is performed by experienced surgeons at high volume centers with confirmed optimal outcomes). Larger series of patients with adequate follow-up could further validate the place of transsphenoidal surgery (particularly through the endoscopic approach for which long-term results are currently limited) in the management algorithm of patients with microprolactinoma.

scholarly journals Fixed duration vs continuous therapy in multiple myeloma

Hematology ◽  
2017 ◽  
Vol 2017 (1) ◽  
pp. 212-222 ◽  
Author(s):  
Heinz Ludwig ◽  
Niklas Zojer
Keyword(s):  
Young Patients ◽  
Progression Free Survival ◽  
Term Treatment ◽  
New Drugs ◽  
Prolonged Treatment ◽  
Severe Toxicity ◽  
Fixed Duration ◽  
Continuous Therapy ◽  
Long Term Treatment ◽  
Risk Patients

Abstract The introduction of new drugs with less severe toxicity profiles than those of conventional antimyeloma agents allowed the evaluation of continuous therapy compared with fixed duration therapy. In transplant-eligible patients, consolidation therapy with bortezomib or bortezomib-based regimens showed significant progression-free survival (PFS) benefit in cytogenetic standard-risk patients and to a lesser extent, high-risk patients. Continuous therapy with lenalidomide maintenance treatment after autologous stem cell transplantation resulted in a significant survival gain. In transplant noneligible patients, continuous lenalidomide-dexamethasone therapy improved survival over fixed duration melphalan-prednisone-thalidomide. The concept of prolonged treatment in elderly patients is supported by some other studies, but most of them revealed a gain in PFS only. Young patients with unfavorable prognosis show a greater willingness to accept long-term treatment, whereas the readiness to undergo such treatments and the benefits therefrom decline with increasing age and decreasing fitness, rendering fixed duration therapy a suitable option in elderly frail patients.

Case of Severe Acute-on-Chronic Lithium Intoxication with 8.6 mmol/l and Prompt Hemodialysis

2020 ◽  
Vol 53 (05) ◽  
pp. 235-236
Author(s):  
Robert Haussmann ◽  
Markus Donix ◽  
Michael Bauer ◽  
Simone von Bonin ◽  
Ute Lewitzka
Keyword(s):  
Bipolar Disorder ◽  
Gold Standard ◽  
Therapeutic Index ◽  
Clinical Problem ◽  
Term Treatment ◽  
Optimal Treatment ◽  
Lithium Intoxication ◽  
Narrow Therapeutic Index ◽  
Long Term Treatment

Lithium has been the gold standard in the long-term treatment of bipolar disorder for more than 40 years 1. Due to a narrow therapeutic index lithium intoxication still is a common but potentially avoidable clinical problem 2. The possibility of SILENT-syndrome (syndrome of irreversible lithium-effectuated neurotoxicity) illustrates that prevention and optimal treatment of lithium intoxication is vitally important 3.

scholarly journals Retrospective analysis of ultrasound criteria for newly diagnosed extragenital endometriosis detected during preventive examinations

2020 ◽  
Vol 16 (2) ◽  
pp. 44-49
Author(s):  
O. E. Nechaeva ◽  
I. S. Gruzdev ◽  
Yu. V. Popov ◽  
A. G. Kedrova ◽  
V. N. Lesnyak ◽  
...  
Keyword(s):  
Pathological Condition ◽  
Delayed Diagnosis ◽  
Young Patients ◽  
Rapid Identification ◽  
Term Treatment ◽  
Ultrasound Tomography ◽  
Long Term Treatment ◽  
Extragenital Endometriosis ◽  
Screening Ultrasound

Endometriosis is a common pathological condition characterized by the presence of endometrial glands and stroma outside the uterus, most frequently in the pelvis. Despite the ability to demonstrate infiltrative growth and tendency to local recurrence and invasion, endometriosis is considered as a benign proliferative disease. An increasing incidence of extragenital endometriosis (including that in young patients) and difficulties associated with its visualization during ultrasonography lead to a delayed diagnosis, resulting in an increase in the number of cases of advanced endometriosis, which requires long-term treatment. The improvement of a screening ultrasound tomography technique and development of specific ultrasound criteria for preventive examination will ensure rapid identification of patients requiring treatment. In this retrospective study, we analyzed 57 cases of extragenital endometriosis detected during preventive examinations of women between 2014 and 2019. Each case was analyzed with the consideration of ultrasound characteristics together with clinical and gynecological data. We evaluated location, size, contours, and structure of foci. We propose a method of extended ultrasound examination in women with suspected extragenital endometriosis.

scholarly journals Osteoblastoma: When the Treatment Is Not Minimally Invasive, an Overview

2021 ◽  
Vol 10 (20) ◽  
pp. 4645
Author(s):  
Carmine Zoccali ◽  
Mariangela Novello ◽  
Francesco Arrigoni ◽  
Alessandra Scotto di Uccio ◽  
Dario Attala ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Gold Standard ◽  
Bone Tumors ◽  
Focused Ultrasound ◽  
Surgical Excision ◽  
Late Complications ◽  
High Intensity Focused Ultrasound ◽  
Wide Resection ◽  
Primary Bone Tumors ◽  
Invasive Techniques

Background: osteoblastoma is a bone-forming tumor accounting for about 1% of all primary bone tumors and 3% of benign bone tumors. The gold-standard treatment is surgical excision; nevertheless, minimally invasive radiological techniques such as thermoablation and, more recently, high intensity focused ultrasound are gaining more importance. The aim of the present paper is to analyze surgical indications based on our experience and on the evidences in the literature. Methods: all patients affected by osteoblastoma who underwent surgical excision in January 2009 and December 2018 were reviewed; eleven patients were enrolled in the study. The epidemiological aspects, size of the disease and site of onset, symptoms, surgery type, indications, and results are reported for every case. Results: all treatments were based on a preoperative diagnosis; pain was constant in all cases. Intralesional surgeries were performed in 9 out of 11 cases; the remaining 2 cases underwent wide resection. No early or late complications occurred after the surgical procedure. The indications for surgery were lesions very close to nerves or joints, unclear diagnosis, risk of fracture, lesion too large for radiofrequency thermoablation, or failure of minimally invasive treatments. At a medium follow-up of 88 months, no local recurrences were verified. Conclusions: osteoblastoma is a rare tumor with difficult diagnosis. Identification is based on symptoms, imaging, and histology. When possible, minimally invasive techniques is preferred for treatment but surgery is still considered the gold standard.

How to treat a newly diagnosed young patient with multiple myeloma

Hematology ◽  
2009 ◽  
Vol 2009 (1) ◽  
pp. 555-565 ◽  
Author(s):  
Jesús F. San-Miguel ◽  
María-Victoria Mateos
Keyword(s):  
Survival Rates ◽  
Conditioning Regimen ◽  
Young Patients ◽  
Allogeneic Transplantation ◽  
Term Treatment ◽  
Newly Diagnosed ◽  
Long Term Treatment ◽  
Investigational Procedure ◽  
New Strategies

AbstractSurvival rates of young patients with myeloma have increased markedly in the last decade, mainly due to the use of autologous stem cell transplantation (ASCT) and new, highly efficient rescue treatments. In order to improve the survival of newly diagnosed young patients further, the next steps need to focus on increasing the activity of upfront or debulking regimens, improving the efficacy of ASCT, mainly through the conditioning regimen, and increasing the duration of responses through more effective maintenance or consolidation therapies. Nevertheless, this approach is being challenged by the favorable results obtained with long-term treatment with novel agents and the possibility of reserving the ASCT until relapse. Allogeneic transplantation in newly diagnosed patients should be considered as an investigational procedure and used only in well-designed clinical trials. This review covers the new strategies that are currently under investigation with the aim of optimizing the outcome for newly diagnosed young patients with myeloma.

scholarly journals Osteoid osteoma: which is the best mininvasive treatment option?

2021 ◽  
Author(s):  
Anna Parmeggiani ◽  
Claudia Martella ◽  
Luca Ceccarelli ◽  
Marco Miceli ◽  
Paolo Spinnato ◽  
...  
Keyword(s):  
Recurrence Rate ◽  
Osteoid Osteoma ◽  
Focused Ultrasound ◽  
Therapeutic Option ◽  
Standard Procedure ◽  
Invasive Procedure ◽  
Surgical Excision ◽  
Percutaneous Treatment ◽  
Success Rates ◽  
Focused Ultrasound Surgery

AbstractOsteoid osteoma is the third most common benign bone tumor, with well-known clinical presentation and radiological features. Although surgical excision has been the only therapeutic option for a long time, to date it has been replaced by minimally invasive techniques, which proved satisfactory success rates and low complication occurrence. Therefore, the purpose of this literature review was to describe the main updates of these recent procedures in the field of interventional radiology, with particular attention paid to the results of the leading studies relating to the efficacy, complications, and recurrence rate. Nevertheless, this study aimed to analyze the peculiarities of each reported technique, with specific focus on the possible improvements and pitfalls. Results proved that all mininvasive procedures boast a high success rate with slight number of complications and a low recurrence rate. Radiofrequency ablation is still considered the gold standard procedure for percutaneous treatment of osteoid osteoma, and it has the possibility to combine treatment with a biopsy. Interstitial laser ablation’s advantages are the simplicity of use and a lower cost of the electrodes, while cryoablation allows real-time visualization of the ablated zone, increasing the treatment safety. Magnetic resonance-guided focused ultrasound surgery is the most innovative non-invasive procedure, with the unquestionable advantage to be radiation free.

Scrotal swelling

2017 ◽  
Author(s):  
Ates Kadioglu ◽  
Emre Salabaş
Keyword(s):  
Physical Examination ◽  
Gold Standard ◽  
Tunica Albuginea ◽  
Young Patients ◽  
Onset Time ◽  
Complication Rates ◽  
Alternative Treatments ◽  
Scrotal Swelling

Scrotal swelling is a common urological pathology composed of both benign and malign diseases originating from testicles, epididymis, tunical layers, or the scrotum wall itself. Emergencies usually present with pain and short onset time while malign lesions are usually palpated as smooth, solid, painless masses. Hydrocele is the abnormal collection of serous fluids encapsulated between tunica albuginea and vaginalis of the testis. Hydrocele might be primary or occur secondary to trauma, infection, epididymitis, or tumours. Although physical examination is enough for diagnosis, ultrasound should be performed for malignancy exclusion. Surgery is gold standard for young patients with cosmetic problems, discomfort, disability due to hydrocele, and has high success and low complication rates. Alternative treatments such as tetracycline or polidocanol may be considered for patients with high anaesthesia risk.

Canine Giant Hypertrophic Gastritis Treated Successfully with Partial Gastrectomy

2014 ◽  
Vol 50 (1) ◽  
pp. 62-66 ◽  
Author(s):  
Denty P. Vaughn ◽  
Jason Syrcle ◽  
Jim Cooley
Keyword(s):  
Weight Loss ◽  
Treatment Success ◽  
Clinical Signs ◽  
Partial Gastrectomy ◽  
Surgical Excision ◽  
Term Treatment ◽  
Gastric Body ◽  
Hypertrophic Gastritis ◽  
Clinically Normal ◽  
Long Term Treatment

A 4 yr old castrated male Jack Russell terrier was presented with a 2 mo history of vomiting, anorexia, and weight loss. Abdominal radiographs and ultrasound supported the diagnosis of gastric outflow obstruction. Celiotomy and gastrotomy revealed a large, narrowly based mass originating from the mucosa of the dorsal gastric body, occupying the lumen of the stomach and protruding through the pylorus into the duodenum. A partial gastrectomy was performed to excise the mass along with a 1 cm margin of grossly normal tissue. Giant hypertrophic gastritis was diagnosed via histopathology of the excised tissue. Giant hypertrophic gastritis is a rarely diagnosed disease of canines, characterized by giant gastric folds, hypoalbuminemia, and mucosal hypertrophy. Long-term treatment success has not been previously reported. In the case described herein, surgical excision of the affected gastric tissue provided complete resolution of clinical signs. Twelve mo following surgery, no recurrence of either vomiting or weight loss had been noted and the dog was clinically normal.

scholarly journals Trabeculectomy – Prevention and Management of Complications

2018 ◽  
Vol 12 (2) ◽  
pp. 98
Author(s):  
David Cordeiro Sousa ◽  
Luís Abegão Pinto ◽  
◽  
◽  
◽  
...  
Keyword(s):  
Risk Stratification ◽  
Gold Standard ◽  
Complication Rates ◽  
Success Rates ◽  
Preoperative Risk ◽  
Improved Outcomes ◽  
Management Of Complications ◽  
Preoperative Risk Stratification ◽  
Surgical Option

Modern trabeculectomy remains the gold-standard surgical option in glaucoma, with excellent long-term success rates and relatively low serious complication rates. However, these improved outcomes imply a careful preoperative risk stratification, a meticulous intraoperative technique and watchful postoperative care. This review discusses some trabeculectomy-related complications and various strategies to prevent or treat these conditions.

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