scholarly journals Non-Invasive and Surgical Modalities for Scar Management: A Clinical Algorithm

2021 ◽  
Vol 11 (12) ◽  
pp. 1259
Author(s):  
Khaled Dastagir ◽  
Doha Obed ◽  
Florian Bucher ◽  
Thurid Hofmann ◽  
Katharina I. Koyro ◽  
...  
Keyword(s):  
Therapeutic Strategy ◽  
Free Flaps ◽  
Clinical Work ◽  
Functional Impairments ◽  
Medical Subject Headings ◽  
Clinical Algorithm ◽  
Non Invasive ◽  
Scar Treatment ◽  
Scar Management ◽  
Scar Therapy

Scars can lead to aesthetic and functional impairments. The treatment of scars requires meticulous planning and an individually adapted therapeutic strategy. A conceptual algorithm for scar treatment makes everyday clinical work easier for the practitioner and offers more safety for the patient. Based on a retrospective analysis of 1427 patients who presented for treatment of a variety of scars, we developed an algorithm for scar management and treatment. The treatments are presented using case descriptions. Additionally, an electronic search of MEDLINE, EMBASE, and ClinicalTrials.gov databases was performed utilizing combinations of relevant medical subject headings for “scar treatment”, “hypertrophic scar treatment” and “keloid treatment”. Reference lists of relevant articles and reviews were hand-searched for additional reports. Observed outcomes included: conservative scar therapy, minimally invasive scar therapy, and surgical scar therapy using local, regional and free flaps. With this work, we provide an algorithm for safe scar treatment. For better understanding, we have described a clinical case for each algorithm modality.

scholarly journals Pneumothorax in COVID-19 – A New Challenge

2021 ◽  
Vol 5 (10) ◽  
Author(s):  
Sudhir Bhandari ◽  
Govind Rankawat ◽  
Ajeet Singh
Keyword(s):  
Inflammatory Markers ◽  
Therapeutic Strategy ◽  
Medical Illness ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Chronic Medical Illness ◽  
Vulnerable Patients ◽  
Non Invasive Ventilation ◽  
Clinical Conditions ◽  
Mean Time

Background: Coronavirus disease 2019 mainly affect the lungs which can complicate into pneumothorax and require hospitalization. We aimed to discuss the presence of pneumothorax and its possible risk factors in vulnerable patients of COVID-19 to establish an effective preventive and therapeutic strategy for this fatal complication. Methods: This retrospective observational study included 30 admitted patients of COVID-19 associated pneumothorax. The patient’s data concerning demography, clinical manifestation, associated medical illness, point of onset of pneumothorax, mode of oxygenation with FiO2 and PEEP, radiological imaging, and outcome were extracted from their medical records. All collected data were tabulated, compiled, and analyzed to establish possible causality of pneumothorax. Results: All patients of the study group exhibited symptomatic presentations, 73% of patients had severe clinical conditions and 24 patients also had associated chronic medical illness. In our study pneumothorax developed 3rd week onwards after symptoms onset with a mean time of pneumothorax was found to be 23.96 days (23.96±8.06). At the point of diagnosis of pneumothorax, 22 patients were on non-invasive ventilation, 6 on high flow mask, and 2 patients on invasive ventilation, these patients required higher FiO2 (77.66%) and higher PEEP (10.83 cmH2O) to maintain PaO2 within normal range. All patients had raised COVID-related inflammatory markers viz. NLR, D-dimer, CRP, IL-6, and these markers showed a positive correlation with the duration of hospital stay in patients of pneumothorax. Conclusion: Pneumothorax can be suspected in COVID-19 infected patients having severe COVID-19 pneumonia of longer duration with assistant ventilation and raised inflammatory markers going to rapid worsening of symptoms.

Abstract WMP102: Pilot Study of a Non-invasive Radiofrequency Method to Monitor Intracranial Hemorrhage: A First-in-Human Study

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Matthew L Flaherty ◽  
Joseph Korfhagen ◽  
George J Shaw ◽  
Opeolu Adeoye ◽  
William Knight
Keyword(s):  
Human Study ◽  
Clinical Work ◽  
Head Ct ◽  
Non Invasive ◽  
Complete Measurement ◽  
Invasive Method ◽  
Bedside Monitor ◽  
Transmitting Antenna ◽  
The Brain ◽  
Ct Studies

Introduction: Intracerebral hemorrhage (ICH) is a devastating form of stroke. Hemorrhage expansion after ICH occurs in ~40% of patients and leads to worse outcomes. Currently, ICH patients are monitored for hemorrhage expansion by neurologic exam and head CT. CT studies are a source of radiation exposure and can require transporting the patient out of the ICU. There is a clinical need for a non-invasive bedside monitor of ICH. Methods: A radiofrequency based monitor (RFM) was developed as a non-invasive method to monitor ICH at the bedside. The RFM consists of a 9-antenna array mounted around the head, cables, and driving electronics. A 913 MHz signal is transmitted from a given antenna, crosses the brain, and is received by the remaining 8 antennae. A complete measurement consists of one cycle with all antenna serving as the transmitting antenna. As the signal traverses the brain, it is partially scattered and absorbed by the ICH, thus changing the signal at the receiving antennae. The altered signal can be compared to signals at earlier times to detect changes induced by ICH expansion. Based upon pre-clinical work it was hypothesized that ICH expansion of ≥3 ml would be detected by the RFM. The RFM device was approved for human study under an IDE from the FDA. The device was tested on 10 ICH subjects admitted within 24 hours of stroke onset. All subjects received a baseline head CT and a repeat head CT at 12 (+/- 6) hours. ICH volumes were determined by a blinded neuroradiologist. Subjects were scanned with the device every 10 minutes. Results: Data from one subject was lost due to user error. Among the remaining nine, two experienced hemorrhage expansion of ≥ 3ml (3 and 8.2 ml respectively). The RFM readings were 100% concordant with CT scans in identifying presence and absence of hemorrhage expansion. The figure shows monitor readings from a subject with expansion. Conclusion: The RFM may be useful in detection of real-time hemorrhage expansion in ICH patients. A pivotal clinical study is planned.

scholarly journals Partial hydatidiform mole evolving into metastatic trophoblastic tumor: case report

2020 ◽  
Vol 9 (4) ◽  
pp. 1713
Author(s):  
I. Elmouri ◽  
S. Tanouti ◽  
H. Taheri ◽  
H. Saadi ◽  
A. Mimouni
Keyword(s):  
Case Report ◽  
Therapeutic Strategy ◽  
Histopathological Examination ◽  
Hydatidiform Mole ◽  
Myometrial Invasion ◽  
Multiparous Woman ◽  
Partial Hydatidiform Mole ◽  
Non Invasive ◽  
Trophoblastic Tumor ◽  
Partial Mole

Partial hydatidiform mole can evolve into a metastatic trophoblastic tumor. A 36-year-old, multiparous woman, pregnant with a 22-week embryonic hydatidiform mole, having spontaneously expelled. Histopathological examination showed a non-invasive partial mole. During biological monitoring, a trophoblastic tumor was diagnosed with pulmonary metastasis on CT-scan and myometrial invasion by MRI. Authors opted for a monochemotherapy with a good evolution. The potential risk of malignant transformation of the partial hydatidiform mole requires an adequate therapeutic strategy with strict monitoring.

scholarly journals Lasers and ancillary treatments for scar management: personal experience over two decades and contextual review of the literature. Part I: Burn scars

2016 ◽  
Vol 2 ◽  
pp. 205951311664209 ◽  
Author(s):  
Rory B McGoldrick ◽  
Adam Sawyer ◽  
Christopher R Davis ◽  
Evgenia Theodorakopoulou ◽  
Maxwell Murison
Keyword(s):  
Personal Experience ◽  
Evidence Base ◽  
Chemotherapeutic Agents ◽  
Social Consequences ◽  
Review Of The Literature ◽  
Scar Treatment ◽  
Wide Range ◽  
Scar Management ◽  
Carbon Dioxide Co2 ◽  
Developed World

[Formula: see text] [Formula: see text] [Formula: see text] The formation of a wide range of excessive scars following various skin injuries is a natural consequence of healing. Scars resulting from surgery or trauma affect approximately 100 million people per annum in the developed world and can have profound physical, aesthetic, psychological and social consequences. Thus, scar treatment is a priority for the plastic surgeon. We aim to explore new approaches to the management of such scarring. The senior authors current use of laser technology, chemotherapeutic agents, pharmacotherapy and cryosurgery will be reviewed. This is placed in the context of the current literature and evidence base and is illustrated with case studies, starting with burns scars in part I, and focusing on keloid and hypertrophic scars in part II, acne scars in part III and finally pigmented scars in part IV. In Part I we focus on burns scar treatment with fractional ablative 10,600 nm wavelength carbon dioxide (CO2) laser therapy.

scholarly journals Focused Ultrasound Ablation of an Arteriovenous Malformation Model

2021 ◽  
Vol 12 ◽  
Author(s):  
Jesse Jones ◽  
Mark Bolding ◽  
Henrik Ullman ◽  
Naoki Kaneko ◽  
Satoshi Tateshima
Keyword(s):  
Therapeutic Strategy ◽  
Focused Ultrasound ◽  
Vascular Lesions ◽  
Treatment Modalities ◽  
Side Effect Profile ◽  
Non Invasive ◽  
Flow Through ◽  
Ultrasound Ablation ◽  
Brain Avms ◽  
Focused Ultrasound Ablation

Brain AVMs are rare but serious vascular lesions that often pose a management dilemma between the risk of various treatment modalities and uncertain natural history during observation. We describe preliminary data on the use of focused ultrasound as a novel therapeutic strategy. In an AVM model, one session of ultrasound gradually reduced flow through the lesion without inducing rupture. Due to its non-invasive yet immediate ablative effects, focused ultrasound may allow safer treatment of AVMs. However, further studies are needed to clarify its efficacy and side effect profile.

scholarly journals Is Circulating DNA and Tumor Cells in Myeloma the Way Forward?

Hemato ◽  
2022 ◽  
Vol 3 (1) ◽  
pp. 63-81
Author(s):  
Emilie Arnault Carneiro ◽  
Filipa Barahona ◽  
Carolina Pestana ◽  
Cristina João
Keyword(s):  
Tumor Cells ◽  
Peripheral Blood ◽  
Therapeutic Strategy ◽  
Residual Disease ◽  
Scientific Evidence ◽  
Disease Status ◽  
Liquid Biopsies ◽  
Hematological Cancer ◽  
Non Invasive ◽  
Disease Prognosis

Multiple myeloma (MM) is the second deadliest hematological cancer. Despite the enormous innovation on MM treatment in the last decades, still 48% of patients die within 5 years after diagnosis. MM diagnosis and therapeutic strategy mainly rely on direct bone marrow (BM) assessment. Given the MM heterogeneity, BM biopsies do not accurately reflect the whole disease status, hampering accurate disease prognosis. Moreover, biopsies are painful and invasive procedures, highlighting the need for non-invasive and more accurate source of biomarkers. Liquid biopsies are promising sources of biomarkers that may overcome these limitations. Peripheral blood carries circulating myeloma components that are being extensively explored since the last few years as an alternative to BM aspirates. These include circulating tumor cells (CTC), cell-free DNA (cfDNA), and extracellular vesicles containing miRNA and proteins. The current review summarizes scientific evidence establishing BM as a gold standard for the diagnosis, prognosis, and evaluation of minimal residual disease. We discuss the last advances regarding cfDNA and CTC biomarkers from peripheral blood in patients with MM as well as the statistical validations. This paper addresses the technological hurdles associated with liquid biopsies and examines the missing steps for their inclusion into the clinical practice.

scholarly journals Breast Cancer Heterogeneity

Diagnostics ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. 1555
Author(s):  
Caterina Fumagalli ◽  
Massimo Barberis
Keyword(s):  
Breast Cancer ◽  
Tumor Progression ◽  
Tumor Heterogeneity ◽  
Therapeutic Strategy ◽  
Recurrent Disease ◽  
Breast Cancer Patients ◽  
Cancer Heterogeneity ◽  
Non Invasive ◽  
Effective Therapeutic Strategy ◽  
Metastatic Sites

Breast tumor heterogeneity is a major challenge in the clinical management of breast cancer patients. Both inter-tumor and intra-tumor heterogeneity imply that each breast cancer (BC) could have different prognosis and would benefit from specific therapy. Breast cancer is a dynamic entity, changing during tumor progression and metastatization and this poses fundamental issues to the feasibility of a personalized medicine approach. The most effective therapeutic strategy for patients with recurrent disease should be assessed evaluating biopsies obtained from metastatic sites. Furthermore, the tumor progression and the treatment response should be strictly followed and radiogenomics and liquid biopsy might be valuable tools to assess BC heterogeneity in a non-invasive way.

scholarly journals Polyscore of autonomic parameters for risk stratification of the elderly general population: the Polyscore study

EP Europace ◽  
2020 ◽  
Author(s):  
Alexander Steger ◽  
Michael Dommasch ◽  
Alexander Müller ◽  
Daniel Sinnecker ◽  
Katharina M Huster ◽  
...  
Keyword(s):  
General Population ◽  
Clinical Work ◽  
Risk Groups ◽  
The Elderly ◽  
Population Based ◽  
Screening Strategy ◽  
Mortality Prediction ◽  
Non Invasive ◽  
Study Participants

Abstract Aims Present society is constantly ageing and elderly frequently suffer from conditions that are difficult and/or costly to treat if detected late. Effective screening of the elderly is therefore needed so that those requiring detailed clinical work-up are identified early. We present a prospective validation of a screening strategy based on a Polyscore of seven predominantly autonomic, non-invasive risk markers. Methods and results Within a population-based survey in Germany (INVADE study), participants aged ≥60 years were enrolled between August 2013 and February 2015. Seven prospectively defined Polyscore components were obtained during 30-min continuous recordings of electrocardiogram, blood pressure, and respiration. Out of 1956 subjects, 168 were excluded due to atrial fibrillation, implanted pacemaker, or unsuitable recordings. All-cause mortality over a median 4-year follow-up was prospectively defined as the primary endpoint. The Polyscore divided the investigated population (n = 1788, median age: 72 years, females: 58%) into three predefined groups with low (n = 1405, 78.6%), intermediate (n = 326, 18.2%), and high risk (n = 57, 3.2%). During the follow-up, 82 (4.6%) participants died. Mortality in the Polyscore-defined risk groups was 3.4%, 7.4%, and 17.5%, respectively (P < 0.0001). The Polyscore-based mortality prediction was independent of Framingham score, diabetes, chronic kidney disease, and major stroke and/or myocardial infarction history. It was particularly effective in those aged <75 years (n = 1145). Conclusion The Polyscore-based mortality risk assessment from short-term non-invasive recordings is effective in the elderly general population, especially those aged 60–74 years. Implementation of a comprehensive Polyscore screening of this age group is proposed to advance preventive medical care.

scholarly journals Free Periosteal Flaps with Scaffold: An Overlooked Armamentarium for Maxillary and Mandibular Reconstruction

Cancers ◽  
2021 ◽  
Vol 13 (17) ◽  
pp. 4373
Author(s):  
Remo Accorona ◽  
Luca Gazzini ◽  
Roberto Grigolato ◽  
Enrico Fazio ◽  
Letizia Nitro ◽  
...  
Keyword(s):  
Head And Neck ◽  
Donor Site ◽  
Locally Advanced ◽  
Free Flaps ◽  
Mandibular Reconstruction ◽  
Cochrane Library ◽  
Medical Subject Headings ◽  
Promising Tool ◽  
Mesh Terms ◽  
Radial Forearm

Introduction: Head and neck bone reconstruction is a challenging surgical scenario. Although several strategies have been described in the literature, bone free flaps (BFFs) have become the preferred technique for large defects. Revascularized free periosteal flaps (FPFs) with support scaffold represents a possible alternative in compromised patient, BFF failure, or relapsing cancers as salvage treatment. However, only few clinical applications in head and neck are reported in literature. Purpose of the study was to systematically analyse the results of functional and oncologic maxillary and mandibular reconstruction with FPF with scaffold. Materials and Methods: A comprehensive review of the dedicated literature was performed according to the PRISMA guidelines searching on Scopus, PubMed/MEDLINE, Cochrane Library, Embase, Researchgate and Google Scholar databases using relevant keywords, phrases and medical subject headings (MeSH) terms. An excursus on the most valuable FPF’ harvesting sites was also carried out. Results: A total of 7 studies with 55 patients were included. Overall, the majority of the patients (n = 54, 98.1%) underwent an FPF reconstruction of the mandibular site. The most used technique was the radial forearm FPF with autologous frozen bone as scaffold (n = 40, 72.7%). The overall rate of complications was 43.7%. The success rate intended as scaffold integration resulted to be 74.5%. Conclusions: Maxillary and mandibular reconstruction with FPF and scaffold is a possible alternative in patient unfit for complex BFF reconstruction and it should be considered as a valid alternative in the sequential salvage surgery for locally advanced cancer. Moreover, it opens future scenarios in head and neck reconstructive surgery, as a promising tool that can be modelled to tailor complex 3D defects, with less morbidities to the donor site.

scholarly journals The Review of Most Current Therapy for Large Area of Hypertrophic Scar and Keloid

2015 ◽  
Vol 1 (1) ◽  
pp. 29-33
Author(s):  
Wang Xi-Qiao ◽  
Keyword(s):  
Hypertrophic Scar ◽  
Optimal Choice ◽  
Current Therapy ◽  
Large Area ◽  
Pressure Therapy ◽  
Invasive Therapy ◽  
Non Invasive ◽  
Scar Treatment ◽  
Increased Risk ◽  
Unbearable Pain

For the large area scar or keloid, the treatment is still posing a great challenge. Because the invasive therapy has an unbearable pain and increased risk of side effect, like the steroid injection and cryotherapy, so the non-invasive therapy is actually the optimal choice for large area scar and children patients. Here we introduce the major modalities for the treatment of large area scar, like pressure therapy, Silicone, Onion extract, and scar massage. In addition, three aspects are recommended for the scar therapy: early use, combination use and persistent use, which is essential for a successful scar treatment. Keywords: Hypertrophic scar, Keloid, Scar treatment, Large area scar.

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