scholarly journals High-pressure balloon dilatation in children: our results in 30 patients with POM and the implications of the cystoscopic evaluation

2020 ◽  
Vol 42 (1) ◽  
Author(s):  
Francesca Destro ◽  
Giorgio Selvaggio ◽  
Federica Marinoni ◽  
Andrea Pansini ◽  
Giovanna Riccipetitoni
Keyword(s):  
High Pressure ◽  
Balloon Dilatation ◽  
Invasive Procedure ◽  
Definitive Treatment ◽  
Ureteral Stenting ◽  
Diagnostic Modalities ◽  
Almost All ◽  
Type 3

Primary Obstructive Megaureter (POM) is a common cause of hydronephrosis in children with spontaneous resolution in most cases. High-Pressure Balloon Dilatation (HPBD) has been proposed as a minimally invasive procedure for POM correction in selected patients. The aim of the paper is to review our experience with HPBD in patients with POM. We performed a retrospective study in a single Centre collecting data on patients’ demographics, diagnostic modalities, surgical details, results and follow-up. In particular, the endoscopic aspect of the orifice permitted the identification of 3 patterns: adynamic ureteral segment, stenotic ureteric ring and pseudoureterocelic orifice. We performed HPBD in 30 patients over 6 years. We had 23 patients with adynamic distal ureteral segment (type 1), 4 with stenotic ring (type 2) and 3 with ureterocelic orifice (type 3). In 3 patients (10%) the guidewire did not easily pass into the ureter requiring ureteral stenting or papillotomy. Post-operative course was uneventful. Five patients (3 pseudoureterocelic) required open surgery during follow-up. HPBD for the treatment of POM is a safe and feasible procedure and it can be a definitive treatment of POM. Complications are mainly due to double J stent and none of our patients had symptoms related to vescico-ureteral reflux. The aspect of the orifice, identified during cystoscopy, seems to correlate with the efficacy of the dilatation: type 1 and 2 are associated with good and excellent results respectively; type 3 do not permit dilatation in almost all cases requiring papillotomy. HPBD can be performed in selected patients of all paediatric ages as first therapeutic line. The presence of a pseudoureterocelic orifice or long stenosis might interfere with the ureteral stenting and seems associated with worse outcomes.

Analysis of Conservative Surgical Treatment and Prognosis of Microinvasive Squamous Cell Carcinoma of the Cervix Stage IA1: Results of Follow-Up to 20 Years

2017 ◽  
Vol 27 (2) ◽  
pp. 357-363 ◽  
Author(s):  
Caio Augusto Hartman ◽  
Julio Cesar Teixeira ◽  
Sergio Bruno Barbosa ◽  
Stephanye Mariano Figueiredo ◽  
Liliana Aparecida Lucci De Angelo Andrade ◽  
...  
Keyword(s):  
Residual Disease ◽  
Disease Free Survival ◽  
Cervical Neoplasia ◽  
Good Prognosis ◽  
Positive Cone ◽  
Definitive Treatment ◽  
Younger Women ◽  
Grade 3 ◽  
Almost All

ObjectiveThe aim of this study was to evaluate the prognosis and recurrence of microinvasive squamous cervical (MIC) cancer stage IA1 in women treated conservatively or by hysterectomy, and followed-up to 20 years.MethodsIt was studied in a cohort of 139 women with MIC, 41 definitively managed by conization and 98 by hysterectomy from January 1994 to December 2003 and followed-up until 2013. The definitive treatment, age, conization technique (loop electrosurgical excision procedure or cold knife conization), cone margin, residual disease in hysterectomy specimen, and the association with recurrence (intraepithelial cervical neoplasia grade 3/intraepithelial vaginal neoplasia grade 3 or worse, and microinvasive or worse) were analyzed.ResultsThere were 2.5 times more conservative treatment in younger women than older (>40 years), and high proportion of residual disease in hysterectomy specimens (67% of intraepithelial cervical neoplasia grade 3 or worse), more common if positive cone margin (74% vs 35%, P < 0.002). There were 2.3% (3/133) recurrences detected as microinvasive or worse, and 6% (8/133) recurrences detected as intraepithelial cervical neoplasia grade 3/intraepithelial vaginal neoplasia grade 3 or worse: 7.3% (3/41) in the conization group and 5.4% (5/92) in the hysterectomy group (P = 0.701). Almost all recurrences (88%, 7/8) were diagnosed until 36 months after treatment, and they were not associated with conization technique. There were no differences in risk of recurrence and overall disease-free survival time related to type of treatment.ConclusionsThis study demonstrates the good prognosis of MIC, regardless the treatment. When fertility is not a concern, hysterectomy should be considered as definitive treatment to avoid the risk of residual disease. Regular follow-up for a long period should be maintained.

Characterisation of macular neovascularisation in geographic atrophy

2021 ◽  
pp. bjophthalmol-2021-318820
Author(s):  
Riccardo Sacconi ◽  
Maria Brambati ◽  
Alexandra Miere ◽  
Eliana Costanzo ◽  
Vittorio Capuano ◽  
...  
Keyword(s):  
Fundus Autofluorescence ◽  
Geographic Atrophy ◽  
Age Related Macular Degeneration ◽  
First Year ◽  
Age Related ◽  
Treatment Naïve ◽  
Type 3 ◽  
Endothelial Growth Factor

AimTo characterise macular neovascularisation (MNV) developing in eyes affected by geographic atrophy (GA).MethodsIn this multicentric longitudinal study involving three retina referral centres, patients previously affected by GA who developed an active MNV were included. Patients were investigated using structural optical coherence tomography (OCT), fundus autofluorescence, OCT-angiography and dye angiographies. Patients were treated with ProReNata antivascular endothelial growth factor (VEGF) injections and were revaluated after treatment.ResultsAmong 512 patients previously diagnosed with GA, 40 eyes of 40 patients (mean age 80.8±7.9 years, mean GA area 8.73±7.39 mm2) presented with treatment-naïve exudative MNV (accounting for an estimated prevalence of 7.81%; 5.49 to 10.13, 95% CIs) and thus were included in the analysis. 67.5% of MNVs were classified as type 2 MNV, 25% as type 1, 2.5% as type 3 and 5% as mixed phenotype. In 92.5% of cases, active MNV in GA showed subretinal hyperreflective material with or without evidence of subretinal/intraretinal hyporeflective exudation. During a mean follow-up of 28±25 months, patients were treated with 6.6±6.3 anti-VEGF injections, with 2.9±1.4 injections in the first year of treatment. No patient developed GA enlargement in the area of MNV.ConclusionsMNVs in GA showed different features and therapeutic response in comparison to previously reported features of MNV in age-related macular degeneration (AMD) without GA. For these reasons, the combined phenotype (ie, GA with neovascular AMD) should be considered as a distinct entity in the research and clinical setting.

scholarly journals Adenovirus, parainfluenza virus and respiratory syncytial virus antibodies in the sera of Jamaicans

1972 ◽  
Vol 70 (3) ◽  
pp. 523-529 ◽  
Author(s):  
Roy Jennings
Keyword(s):  
Respiratory Syncytial Virus ◽  
Respiratory Virus ◽  
Respiratory Viruses ◽  
High Titre ◽  
Parainfluenza Virus ◽  
Age Group ◽  
Syncytial Virus ◽  
Almost All ◽  
Type 3

SUMMARYSurveys for respiratory virus antibodies in the Jamaican population have shown that adenovirus, respiratory syncytial virus and parainfluenza types 1 and 3 virus antibodies are acquired early in life. The incidence of haemagglutination-inhibiting antibodies to parainfluonza viruses increases rapidly with age and almost all adults possess parainfluenza type 3 antibody, usually in high titre. Parainfluenza type 1 antibodies are only slightly less common. Complement-fixing antibodies to the adenovirus group were also observed to increase in incidence with age.Complement-fixing antibody to respiratory syncytial virus was less common in Jamaican sera than antibody to the other respiratory viruses described here. The highest titres were observed in the youngest age-group.

scholarly journals Introduction into the NHS of magnetic sphincter augmentation: an innovative surgical therapy for reflux – results and challenges

2018 ◽  
Vol 100 (4) ◽  
pp. 251-256 ◽  
Author(s):  
D Prakash ◽  
B Campbell ◽  
S Wajed
Keyword(s):  
Invasive Procedure ◽  
Cost Effective ◽  
Business Plan ◽  
Good Alternative ◽  
Surgical Anatomy ◽  
Definitive Treatment ◽  
Innovative Technology ◽  
Magnetic Sphincter Augmentation ◽  
Innovative Therapy

Introduction Gastro-oesophageal reflux disease (GORD) is a common, chronic debilitating condition. Surgical management traditionally involves fundoplication. Magnetic sphincter augmentation (MSA) is a new definitive treatment. We describe our experience of introducing this innovative therapy into NHS practice and report the early clinical outcomes. Methods MSA was introduced into NHS practice following successful acceptance of a cost-effective business plan and close observation of National Institute for Health and Care Excellence (NICE) recommendations for new procedures, including a carefully planned prospective data collection over a two-year follow-up period. Results Forty-seven patients underwent MSA over the 40-month period. Reflux health-related quality of life (GERD-HRQL) was significantly improved after the procedure and maintained at one- and two-year (P < 0.0001) follow-up. Drug dependency went from 100% at baseline to 2.6% and 8.7% after one and two years. High levels of patient satisfaction were reported. There were no adverse events. Conclusions MSA is highly effective in the treatment of uncomplicated GORD, with durable results and an excellent safety profile. This laparoscopic, minimally invasive procedure provides a good alternative for patients where surgical anatomy is unaltered. Our experience demonstrates that innovative technology can be incorporated into NHS practice with an acceptable business plan and compliance with NICE recommendations.

scholarly journals Maxillary ameloblastoma: results of the treatment in 11 patients

2018 ◽  
Vol 24 (1) ◽  
pp. 6-10 ◽  
Author(s):  
Rasmané Béogo ◽  
Tarcissus Konsem ◽  
Mathieu Millogo ◽  
Hèra Michel Kohoun ◽  
Toua Antoine Coulibaly ◽  
...  
Keyword(s):  
Tumor Recurrence ◽  
Wound Closure ◽  
Facial Asymmetry ◽  
Facial Morphology ◽  
Tumor Removal ◽  
Dental Rehabilitation ◽  
Defect Repair ◽  
Type 3

Introduction: Surgery of maxilla ameloblastoma is mutilating and the tumor propensity for recurrence high. Patients and Methods: The oral and visual functions, facial morphology and tumor recurrence in 11 patients after maxillary ameloblastoma surgery are retrospectively reviewed. Results: Facial morphology was satisfactory in 7 patients who had all tumor removal by a type 1 or 2A maxillectomy and surgical wound closure. Out of these patients, 4 who had dental rehabilitation by conventional prosthesis presented satisfactory mastication. Four patients subjected to the tumor removal by a type 3 maxillectomy had all facial asymmetry. Out of these, 1 patient who did not have the orbital floor defect repair presented diplopia and enophtalmos, 2 patients subjected to the palate defect repair by a prosthetic obturator or oral mucosa had elocution impairment. The tumor recurrence occurred in 2 patients after tumor enucleation and in 1 patient after radical surgery out of 8 patients who had a postoperative follow-up. Discussion: In ameloblastoma surgery, achieving both the tumor recurrence prevention and a satisfactory facial reconstruction is challenging. Conclusion: Avoiding the tumor recurrence should be the major goal when patient post-surgical follow-up cannot be guaranteed.

scholarly journals The effects of vertebral body tethering on sagittal parameters: evaluations from a 2-years follow-up

2021 ◽  
Author(s):  
Alice Baroncini ◽  
Aurelien Courvoisier ◽  
Pedro Berjano ◽  
Filippo Migliorini ◽  
Jörg Eschweiler ◽  
...  
Keyword(s):  
Thoracic Kyphosis ◽  
Vertical Axis ◽  
Sagittal Profile ◽  
Sagittal Vertical Axis ◽  
Lumbar Level ◽  
Thoracic Level ◽  
Sagittal Parameters ◽  
Type 3

Abstract Introduction While the effects of VBT on coronal parameters have been investigated in various studies, this has not yet been the case for sagittal parameters. This is of particular relevance considering that VBT does not allow direct correction of the sagittal profile. Thus, we investigated the effects of VBT on sagittal parameters in patients with adolescent idiopathic scoliosis. Materials and methods Retrospective, 2-Center study. Patients who underwent VBT and presented a 2-years follow-up were included. The differences in sagittal parameters were evaluated, along with modifications of sagittal profile following Abelin-Genevois’ classification. Results Data from 86 patients were obtained. Mean Cobb angle was 52.4 ± 13.9° at thoracic level and 47.6 ± 14.3° at lumbar level before surgery, and 28.5 ± 13.6 and 26.6 ± 12.7° at the 2-year follow-up, respectively. Mean thoracic kyphosis increased from 28.3 ± 13.8 to 33 ± 13°, the lumbar lordosis (LL) was unvaried (from 47.5 ± 13.1 to 48.4 ± 13.5°), PT decreased from 9.4 ± 8.5 to 7.4 ± 6.1°, the sagittal vertical axis SVA decreased from 4.5 ± 31.4 to − 3.6 ± 27.9 mm. No kyphotic effect on LL in patients who underwent lumbar instrumentation was observed. Before surgery, 39 patients had a type 1 sagittal profile, 18 were type 2a, 14 type 2b and 15 type 3. Postoperatively, 54 were type 1, 8 were 2a, 13 were 2b and 11 were type 3. Conclusions VBT positively influences sagittal parameters and does not have a kyphotic effect on LL.

Maintenance Efficacy of Low Dose Imiglucerase for Gaucher Disease

2020 ◽  
Author(s):  
Zhengqing Qiu ◽  
Baohui Zhang ◽  
Yuhang Song ◽  
Hongbing Zhang ◽  
Yuting Wu
Keyword(s):  
Gaucher Disease ◽  
Low Dose ◽  
Standard Dose ◽  
Mineral Density ◽  
Recommended Treatment ◽  
Type 3 ◽  
Term Maintenance

Abstract Background Imiglucerase is the recommended treatment for Gaucher disease (GD), a hereditary metabolic disease. In high risk adults and all children, the minimum recommended dose for long-term maintenance is 30 U/kg/2 weeks. However, the extremely high cost of this enzyme largely hinders its clinical use. The minimal maintenance dose of imiglucerase has thus been a subject of debate. We aimed to analyze the long-term maintenance outcomes of imiglucerase at dosage < 20 U/kg/2 weeks after standard dose. Methods Seventeen patients with GD type 1 or GD type 3 were enrolled for analysis. We evaluated maintenance efficacy of imiglucerase on hemoglobin, platelet, visceral volumes and bone conditions during the 7-year follow-up. Results Parameters on hemoglobin, platelet, liver, and spleen volumes of all patients were stabilized or improved. Seven out of 14 patients showed bone mineral density improvement. Three out of 16 patients showed worse bone pain; 6 out of 15 patients showed worse Erlenmeyer flask; 6 out of 15 patients showed worse bone infarction; 1 out of 16 patients showed worse marrow infiltration and 3 out of 15 patients showed worse osteonecrosis. Conclusions Imiglucerase less than 20 U/kg/2 weeks is enough to maintain blood and visceral parameters, but is not sufficient to stabilize skeletal conditions.

scholarly journals Are There Clinical Differences in Limited Systemic Sclerosis according to Extension of Skin Involvement?

2014 ◽  
Vol 2014 ◽  
pp. 1-5
Author(s):  
Marina Scolnik ◽  
Luis J. Catoggio ◽  
Eliana Lancioni ◽  
Mirtha R. Sabelli ◽  
Carla M. Saucedo ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Interstitial Lung Disease ◽  
Skin Involvement ◽  
Male Ratio ◽  
Limited Systemic Sclerosis ◽  
Anticentromere Antibodies ◽  
Type 3

Objectives. To examine the characteristics of our patients with limited systemic sclerosis (lSSc) for differences between Barnett Type 1 (sclerodactyly only) and Type 2 or intermediate (acrosclerosis-distal but may reach up to elbows and/or knees plus face) subsets.Methods. Records of patients between January 1, 2000, and December 31, 2011, with SSc or those with anti-Scl-70, anticentromere, or antinucleolar antibodies were reviewed. Only cases fulfilling ACR 1980 criteria were included and classified as diffuse or limited according to LeRoy’s criteria. Limited SSc was separated into sclerodactyly and acrosclerosis (Barnett’s Types 1 and 2).Results. 234 SSc patients (216 females) fulfilled criteria. Female/male ratio was 12 : 1; 24% had dSSc and 76% lSSC (64% Type 1 and 12% Type 2). Total follow-up was 688 patient-years. Within lSSC, the Type 2 group had significantly shorter duration of Raynaud’s and more anti-Scl-70 and less anticentromere antibodies. In particular, interstitial lung disease (ILD) was significantly more prevalent in Type 2 group and similar to Type 3.Conclusions. These results appear to confirm that extension of skin involvement within limited SSc may identify two different subsets with clinical and serologic characteristics.

scholarly journals Interlocking intramedullary nailing in comminuted femoral shaft fractures

2012 ◽  
Vol 1 (2) ◽  
pp. 57-63
Author(s):  
Abul Kalan Mohammad ◽  
Ram Kewal Shah ◽  
Awais Syed ◽  
Pradeep Gupta
Keyword(s):  
Intramedullary Nailing ◽  
Femoral Fractures ◽  
Invasive Procedure ◽  
Femoral Shaft ◽  
Short Operative Time ◽  
Medical College ◽  
Almost All ◽  
A Prospective Study

A prospective study of 20 comminuted femoral fractures, open and close, treated with interlocked intramedullary nailing. The mechanical strength of the nail and less invasive procedure has made the procedure preferable. Short Operative time and less blood loss was seen during surgical procedure. Out of 20 cases , 10 cases were taken from Nepal Medical College, Kathmandu and 10 cases from Nobel Medical College, Biratnagar, during years 2009 to 2011, which had been completed at least six months follow up. Almost all cases were relatively free from long term complication. The results were promising .All fractures healed within 6 months.DOI: http://dx.doi.org/10.3126/jonmc.v1i2.7300 Journal of Nobel Medical College (2012), Vol.1 No.2 p.50-56

scholarly journals Evaluation of Results of Fixation of Unstable Distal Radial Fractures by Volar Locking Plating System

2017 ◽  
Vol 11 (2) ◽  
pp. 62-66
Author(s):  
Md Maiyeen Uddin ◽  
Anadi Ranjan Mondal ◽  
Narayan Chandra Karmakar ◽  
Md Masudur Rahman ◽  
Syed Asif Ul Alam
Keyword(s):  
Locking Plate ◽  
Volar Locking Plate ◽  
Wrist Flexion ◽  
Distal Radial Fractures ◽  
Surgical Fixation ◽  
Single Bone ◽  
Trauma Surgeons ◽  
Type 3

Distal radial fractures are most common fractures accounts 15% of whole skeletal injuries, as high as 40% to 49% are considered to be unstable that requires surgical fixation. The purpose of the study was to ascertain good functional hand by using volar locking plate & screws, as with locking system, distal screws are locked to the plate, which stabilized the screws against lateral movement (toggle effect), thus providing a "single bone-plate-screws construct" which producing a scaffold in the mostly cancellous distal radial metaphysis, so preventing from collapse. This study was done from January 2007 to December 2008 at National Institute of Traumatology & Orthopaedic Rehabilitation (NITOR). Total numbers of cases were 17. All patients were admitted in hospital & most of them returned home within 4 days. Most patients were managed early within 1-10 days of injury. Most patients were Fernandez type 1, type 2, and type 3. Most patients were in the age group of 4th decade. All patients were followed up for a period of at least 3 months, mean follow up period was 6 months. Results showed that wrist pain, wrist stiffness, reduced grip strength were minimum with volar locking plate & screws as there is minimal radial shortening, radial angulation, volar tilt & ulnar variance and wrist flexion, wrist extension, ulnar deviation, supination, pronation were very good. So, the trauma surgeons can safely use this procedure.Faridpur Med. Coll. J. Jul 2016;11(2): 62-66

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