scholarly journals Intraocular Biopsy and ImmunoMolecular Pathology for “Unmasking” Intraocular Inflammatory Diseases

2019 ◽  
Vol 8 (10) ◽  
pp. 1733 ◽  
Author(s):  
Rodolfo Mastropasqua ◽  
Emma Di Carlo ◽  
Carlo Sorrentino ◽  
Cesare Mariotti ◽  
Lyndon da Cruz
Keyword(s):  
Inflammatory Diseases ◽  
Correct Diagnosis ◽  
Surgical Techniques ◽  
Choroidal Melanoma ◽  
Clinical Settings ◽  
Anatomical Site ◽  
Complication Rates ◽  
Clinical Tests ◽  
Diagnostic Use ◽  
Intraocular Tumors

Intraocular inflammation can hide a variety of eye pathologies. In 33% of cases, to obtain a correct diagnosis, investigation of the intraocular sample is necessary. The combined analyses of the intraocular biopsy, using immuno-pathology and molecular biology, point to resolve the diagnostic dilemmas in those cases where history, clinical tests, and ophthalmic and systemic examinations are inconclusive. In such situations, the teamwork between the ophthalmologist and the molecular pathologist is critically important to discriminate between autoimmune diseases, infections, and intraocular tumors, including lymphoma and metastases, especially in those clinical settings known as masquerade syndromes. This comprehensive review focuses on the diagnostic use of intraocular biopsy and highlights its potential to enhance research in the field. It describes the different surgical techniques of obtaining the biopsy, risks, and complication rates. The review is organized according to the anatomical site of the sample: I. anterior chamber containing aqueous humor, II. iris and ciliary body, III. vitreous, and IV. choroid and retina. We have excluded the literature concerning biopsy for choroidal melanoma and retinoblastoma, as this is a specialized area more relevant to ocular oncology.

scholarly journals The CONFINE (Comorbidities and Outcome iN patients with chronic heart Failure: a study in INternal mEdicine units) study: a new epidemiologic observational study on heart failure in the internal medicine departments in Italy

2013 ◽  
pp. 57-64
Author(s):  
P. Biagi
Keyword(s):  
Internal Medicine ◽  
Heart Failure ◽  
Observational Study ◽  
Inflammatory Diseases ◽  
Correct Diagnosis ◽  
Cognitive Disorders ◽  
Epidemiological Data ◽  
Chronic Kidney Failure ◽  
Chronic Obstructive ◽  
Quality Life

BACKGROUND The burden of heart failure (HF) is enormous and its prevalence increases sharply with age. It has been estimated that heart failure affects up to 3% of the general population and 10% of the elderly. It contributes to hospital admission for most of them, mainly elder adults (admitted in internal medicine units) with more than one comorbidity, cognitive disorders, impairment and so on. Despite the increasing prevalence of heart failure, its exact incidence and prevalence remain largely unknown and probably underestimated due to a lack of accurate epidemiological data and difficulties associated with comorbidities and correct diagnosis: over 40% of recurrent hospitalization causes, either cardiac or extracardiac, cannot be determined due to the lack of data. AIM OF THE STUDY The objective of this study estimated the prevalence and the primary care burden associated with comorbidities in internal medicine units. METHOD The design: a longitudinal multicentric observational study using spot analysis three data sheets were filled in during the hospital stay according to three crucial moments: enrolment (“the index day”), admission and discharge. Will be analyzed the following primary outcomes: total and cardiovascular mortality, intensive unit care admission, recurrent cardiovascular disorders, length of stay, hospital readmission, changes in activities of daily living, need for care. Second outcomes: clinical, therapeutic, instrumental and laboratory changes during the admission process. Deep analysis of the following comorbidities will be also taken into account: acute and chronic kidney failure, anaemia, chronic obstructive pulmonary disease, muscle loss, nutritional status, cirrhosis of the liver, neoplasms, blood cell disorders, chronic inflammatory diseases. Further evalutation items: cognitive impairment, self-sufficiency and perception of quality life.

scholarly journals Remeex® System Effectiveness in Male Patients with Stress Urinary Incontinence

2021 ◽  
Vol 10 (10) ◽  
pp. 2121
Author(s):  
Gerardo-Alfonso Márquez-Sánchez ◽  
Bárbara-Yolanda Padilla-Fernández ◽  
Miguel Perán-Teruel ◽  
Pedro Navalón-Verdejo ◽  
Sebastián Valverde-Martínez ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
Surgical Techniques ◽  
High Survival ◽  
Complication Rates ◽  
Exact Test ◽  
Number Of Patients ◽  
Male Stress Urinary Incontinence ◽  
Group B

Background: When conservative management fails, patients with stress urinary incontinence (SUI) are considered for surgical treatment. Simpler, more economical and less invasive surgical techniques, such as the Remeex® system, have been developed. Objectives: To analyze the objective effectiveness of the Remeex® system in the treatment of male stress urinary incontinence. To study survival and complication rates of the Remeex® system in male SUI patients. Materials and methods: Prospective observational study between July 2015 and May 2020. Group A (n = 7; GA) patients with mild SUI. Group B (n = 22; GB) patients with moderate SUI. Group C (n = 18; GC) patients with severe SUI. Effectiveness was assessed by the number of patients achieving complete and partial dryness. Complete dryness was defined as patients using 0–1 safety pads per day; partial dryness as a >50% reduction in the number of pads used. Results were analyzed using descriptive statistics, Student’s t-test. Chi2, Fisher’s exact test, ANOVA, and multivariate analysis. Significance was set at p < 0.05. Results: Mean age 69.76 years, mean follow-up 33.52 months. Objective effectiveness was observed in 89.36% of patients with incontinence. The effectiveness was 85.71% in GA, 90.91% in GB and 88.89% in GC. There were no significant differences among groups (p = 1.0000). 34.04% of patients with an implant required at least one readjustment, while 66.00% did not require any. There were no significant differences among groups (p = 0.113) Chi2 = 4.352. 95.74% of implants remained in place by the end of follow-up. We observed complications in 17.02% of patients. Conclusions: Remeex® system is an effective and safe method for male stress urinary incontinence treatment, regardless of the severity of the incontinence, with high survival and low complication and removal rates. System readjustments are required in one-third of the cases.

scholarly journals A comparison of screw versus drill and curettage epiphysiodesis to correct leg-length discrepancy

2018 ◽  
Vol 12 (5) ◽  
pp. 509-514 ◽  
Author(s):  
M. Troy ◽  
B. Shore ◽  
P. Miller ◽  
S. Mahan ◽  
D. Hedequist ◽  
...  
Keyword(s):  
Operative Time ◽  
Surgical Techniques ◽  
Leg Length Discrepancy ◽  
Complication Rates ◽  
Leg Length ◽  
Treatment Groups ◽  
Length Discrepancy ◽  
Baseline Activity ◽  
Significant Difference

Purpose To compare two common surgical techniques of epiphysiodesis: drill/curettage epiphysiodesis (PDED) versus cross screw epiphysiodesis (PETS). The hypothesis is that the two techniques have similar efficacy but demonstrate differences in length of hospital stay (LOS), time to return to activity and complication rates. Methods A retrospective review of growing children and adolescents less than 18 years old who required an epiphysiodesis with leg-length discrepancy (LLD) of 2 cm to 6 cm with minimum two years of follow-up was conducted. Characteristics including age at surgery, gender, epiphysiodesis location, side, operative time, LOS and hardware removal were compared across treatment groups. LLD, expected growth remaining (EGR) and bone age were determined preoperatively and at most-recent visit. The correction ratio (change in EGR) was calculated along with a 95% confidence interval (CI) to assess if correction in leg length was achieved. Results A total of 115 patients underwent epiphysiodesis in the femur (53%), tibia (24%) or a combination (24%). The cohort was 47% male, with a mean age of 12.6 years (7.7 to 17.7) at surgery. Median follow-up was 3.7 years (2.0 to 12.7). In all, 23 patients underwent PETS and 92 patients had PDED. Both treatment groups achieved expected LLD correction. There was no significant difference in median operative time, complication rates or LOS. PETS patients returned to activity at a mean 1.4 months (interquartile range (IQR) 0.7 to 2.1) while PDED patients returned at a mean 2.4 months (IQR 1.7 to 3) (p < 0.001). Conclusion Effectiveness in achieving expected correction, LOS and operative time are similar between screw and drill/curettage epiphysiodesis. Patients undergoing PETS demonstrated a faster return to baseline activity than patients with PDED. Level of Evidence: III

scholarly journals Mitral commissural prolapse

2020 ◽  
Author(s):  
EVA PAPADIMITRAKI ◽  
Alexandros Patrianakos ◽  
Antonis Pitsis ◽  
Maria Marketou ◽  
Aggeliki Zacharaki ◽  
...  
Keyword(s):  
Risk Factor ◽  
Surgical Planning ◽  
3D Imaging ◽  
Correct Diagnosis ◽  
Surgical Techniques ◽  
Valve Repair ◽  
Accurate Identification ◽  
2D Echocardiography ◽  
2D And 3D ◽  
Echocardiographic Findings

Mitral commissural prolapse or flail, either isolated or combined with more extensive degenerative valve disease imposes several challenges both on its diagnosis and management whilst being a risk factor for valve reoperation after mitral valve repair. Accurate identification of the prolapsing segment is often not feasible with transthoracic 2D echocardiography, with transesophageal 3D imaging then required for correct diagnosis and surgical planning. Various surgical techniques employed alone or in combination, have yielded good results in the repair of commissural prolapse. Herein, we analyze the specific characteristics of commissural disease focusing our attention on 2D and 3D echocardiographic findings and we briefly comment on techniques employed for surgical correction of the disease.

scholarly journals BMI Specific Complications Following Implant-Based Breast Reconstruction after Mastectomy

2021 ◽  
Vol 10 (23) ◽  
pp. 5665
Author(s):  
Helena Sophie Leitner ◽  
Reinhard Pauzenberger ◽  
Ines Ana Ederer ◽  
Christine Radtke ◽  
Stefan Hacker
Keyword(s):  
Postoperative Complications ◽  
Breast Reconstruction ◽  
Positive Impact ◽  
Surgical Techniques ◽  
Study Cohort ◽  
Complication Rates ◽  
Impaired Wound Healing ◽  
Reconstruction Methods ◽  
Study Results ◽  
The Impact

Background: Breast reconstruction has a positive impact on body image and quality of life for women after experiencing the physically and psychologically demanding process of mastectomy. Previous studies have presented body mass index (BMI) as a predictor for postoperative complications after breast reconstruction, however, study results vary. This retrospective study aimed to investigate the impact of patients’ BMI on postoperative complications following implant-based breast reconstruction. Methods: All implant-based breast reconstructions performed at the Department of Plastic, Reconstructive and Aesthetic Surgery at the Medical University of Vienna from January 2001 to March 2018 were evaluated. A total of 196 reconstructed breasts among 134 patients met eligibility criteria. Demographic data, surgical techniques, as well as major and minor complications within a one-year follow-up period were analyzed. Results: Patients’ BMI did not show a significant impact on complication rates. The overall incidence of postoperative complications was 30.5% (40/131) of which 17.6% required reoperation. Impaired wound healing (18.3%), seroma (6.1%), hematoma (4.6%), capsular contraction (4.6%) and infection (3.8%) were the most common complications. Conclusion: In our study cohort, BMI was not associated with a significantly higher risk of complications. However, postoperative complications significantly increased with a longer operative time and resulted in an extended length of hospital stay.

Approach to the patient in the diagnosis of Choroidal Malignant Melanoma. Question and Answer

2019 ◽  
pp. 317-320
Keyword(s):  
Risk Factor ◽  
Malignant Melanoma ◽  
Diagnostic Method ◽  
Choroidal Melanoma ◽  
Intraocular Tumors ◽  
Indirect Ophthalmoscopy ◽  
Choroidal Malignant Melanoma ◽  
Choroidal Melanomas ◽  
Venous Phase ◽  
Treatment Changes

The most valuable diagnostic method in intraocular tumors is indirect ophthalmoscopy. USG is very important in determining the thickness of the lesion and documenting post-treatment changes. However, in today's conditions, we have important auxiliary examination opportunities. OCT is especially important in detecting macular edema and fluid. In choroidal melanomas, thickening and edema of the macula may be observed before treatment due to increased VEGF levels in the eye. OCT is important in detecting such changes. Since FAF shows the amount of lipofuscin in the lesion, it reveals the activity of the lesion. Hyperotofluorescence of> 50% of the lesion surface, in other words, the diffuse pattern is a risk factor for growth and metastasis. On fluorescein angiography, choroidal melanoma shows focal hyperfluorescence starting from the late venous phase and gradually increasing.

scholarly journals Comorbid pain in axial spondyloarthritis, including fibromyalgia

2020 ◽  
Vol 12 ◽  
pp. 1759720X2096612
Author(s):  
Clementina López-Medina ◽  
Anna Moltó
Keyword(s):  
Back Pain ◽  
Vertebral Fractures ◽  
Structural Damage ◽  
Axial Spondyloarthritis ◽  
Inflammatory Diseases ◽  
Correct Diagnosis ◽  
Degenerative Changes ◽  
Inflammatory Back Pain ◽  
Management Options ◽  
Biomechanical Stress

The main symptom in patients with axial spondyloarthritis (axSpA) is inflammatory back pain, caused principally by inflammation of the sacroiliac joints and the spine. However, not all back pain in patients with axSpA is related to active inflammation: other types of pain can occur in these patients, and may be related to structural damage (e.g. ankylosis), degenerative changes, vertebral fractures or comorbid fibromyalgia, which are not uncommon in these patients. Structural damage and ankylosis may lead to a biomechanical stress, which can lead to chronic mechanical pain; and degenerative changes of the spine may also exist in patients with axSpA also leading to mechanical pain. Osteoporosis is more prevalent in axSpA patients than in the general population, and vertebral fractures may result in acute bone pain, which can persist for several months. Fibromyalgia, which is also more prevalent in patients with chronic inflammatory diseases (including axSpA), presents with widespread pain which can mimic entheseal pain. A correct diagnosis of the origin of the pain is crucial, since treatments and management may differ considerably. Recognizing these causes of pain may be a challenge in clinical practice, especially for fibromyalgia, which can coexist with axSpA and may have a significant impact on biologic drug response. In this review, we provide an update of the most common causes of pain other than inflammatory back pain in axSpA patients, and we discuss the latest management options for such causes.

scholarly journals A rare presentation of an ectopic kidney with pyelonephritis mimicking appendicitis

2019 ◽  
Vol 2019 (11) ◽  
Author(s):  
Yaying Eileen Xu ◽  
Rasika Hendahewa
Keyword(s):  
Early Recognition ◽  
Correct Diagnosis ◽  
Clinical Settings ◽  
Ectopic Kidney ◽  
Rare Presentation ◽  
Lower Quadrant Pain ◽  
Lower Quadrant ◽  
Right Lower Quadrant Pain ◽  
Life Threatening ◽  
Rare Diagnosis

Abstract Acute appendicitis is one of the top differential diagnoses of right lower quadrant pain in the emergency department. There are many other conditions that may mimic appendicitis such as diverticulitis, colitis and gynecological conditions. We report a rare diagnosis of a patient who presents with characteristic clinical and laboratory features of appendicitis with severe sepsis, but later showed acute pyelonephritis of a malrotated right ectopic kidney on computer tomography. An ectopic kidney is very rare with an incidence of 1 in 3000. It is usually asymptomatic, although it may also associate with obstruction, infection and urolithiasis. This case report raises the importance of early recognition of the correct diagnosis using imaging in appropriate clinical settings, and prompt antibiotic treatment can avoid unnecessary surgical intervention, preserve renal function and prevent a life-threatening catastrophe.

A Combined Intracapsular and Extracapsular Fracture of the Hip

2002 ◽  
Vol 12 (1) ◽  
pp. 43-46
Author(s):  
S. Shabat ◽  
G. Mann ◽  
V. Barchilon ◽  
B. Kish ◽  
B. Fredman ◽  
...  
Keyword(s):  
Femoral Head ◽  
Avascular Necrosis ◽  
Blood Supply ◽  
Weight Bearing ◽  
Surgical Techniques ◽  
Optimal Solution ◽  
Anatomical Site ◽  
Rare Type ◽  
Non Union ◽  
Extracapsular Fracture

We report a case of an unusual hip fracture that involved the intracapsular area and continued vertically to the extracapsular region below the trochanteric line. The division between these two types of fractures is based on the anatomical site, the blood supply and the mechanical forces that act on the hip. This division is important and influences the different surgical techniques to treat these individual fractures. Femoral neck fractures (intracapsular), particularly those with displacement, can disrupt the blood supply to the femoral head and may be associated with an increased incidence of complications, especially non-union and avascular necrosis (AVN) of the femoral head. These fractures are usually treated either by reduction and fixation, or by hemiarthroplasty. Non-union and avascular necrosis following extracapsular fractures are rare. Treatment involves reduction of the fracture and insertion of a dynamic hip screw. The combination of these two types of fractures is extremely rare and creates a surgical problem without any optimal solution. The focus of this case report is placed on the mechanical axis and weight-bearing forces that play a role in the hip and on the optional surgical techniques in such a rare type of fracture in an elderly osteoporotic patient.

Sign in / Sign up

Export Citation Format

Share Document