Treatment Strategies
Recently Published Documents





2021 ◽  
Vol 24 (6) ◽  
Fabin Han ◽  
Yanming Liu ◽  
Mei Mo ◽  
Juanli Chen ◽  
Cheng Wang ◽  

Cancers ◽  
2021 ◽  
Vol 13 (20) ◽  
pp. 5131
David F. Moreno ◽  
Laura Rosiñol ◽  
María Teresa Cibeira ◽  
Joan Bladé ◽  
Carlos Fernández de Larrea

Monoclonal gammopathy of undetermined significance (MGUS) is defined as the presence of a monoclonal protein (M-protein) produced by a small amount of plasma cells. The majority of patients remain asymptomatic; however, a fraction of them develop clinical manifestations related to the monoclonal gammopathy despite not fulfilling criteria of multiple myeloma or other lymphoproliferative disorder. These patients constitute an emerging clinical issue coined as monoclonal gammopathy of clinical significance (MGCS). The mechanisms involved are poorly understood, and literature is scarce regarding management. The clinical spectrum involves symptoms related to renal, neurologic, skin, ocular, or bleeding manifestations, requiring a multidisciplinary approach. Treatment strategies rely on the basis of symptomatic disease and the M-protein isotype. In this review, we focus on MGCS other than renal, as the latter was earliest recognized and better known. We review the literature and discuss management from diagnosis to treatment based on illustrative cases from daily practice.

2021 ◽  
Vol 11 (3) ◽  
pp. 351-358
Svetlana Yu. Komarova ◽  
Natalya A. Tsap ◽  
Il’ya A. Karachev

AIM: This study improves the diagnosis of testicular inversion in children to select different treatment strategies by determining the effectiveness of conservative and surgical testicular detorsion criteria. MATERIALS AND METHODS: The clinical data from 2010 to 2020 included 110 children with testicular torsion. In 64% of cases, the left testicle predominated. Testicular torsion occurred in 50% of children in the 12- to 14-year-old age group. The time from disease onset to seeking medical help ranged from 1.5 hours to 11 days. It was less than 6 hours in 41.8% of children, from 6 to 12 hours in 13.6% of boys, 12 to 24 hours in 11% of patients, and more than 24 hours in 33.6% of boys and adolescents. The protocol for the diagnosis, treatment and rehabilitation of all children included various techniques for ultrasound examination of the scrotal organs. RESULTS: The analysis showed the absence of reliable criteria for detecting testicle torsion in the early periods (61%100%): spiral course of the spermatic vessels (63.9%), change in the position of the testicle (19.8%), increase in the volume of the testicle and appendage (98.3%), a change in testicle shape and the inability to withdraw its poles (47.5%), and a hydrocele (67.2%). The index of false-negative results of the ultrasound scan of the scrotal organs reaches 40%. Conservative navigation detorsion was performed in 39 (35.5%) boys and adolescents during the early disease stages. The ultrasound criteria for the effectiveness of conservative detorsion were established. The main criteria normalized blood flow in the testis (100%). Surgical treatment of testicular inversion was performed in 71 (64.5%) boys and adolescents. CONCLUSIONS: Compliance with the protocol for diagnosing, treating, and rehabilitating children in different age groups with testicular torsion allowed us to determine adequate emergency treatment strategies and follow-up. An ultrasound differential diagnosis is performed with testicular hydatid torsion and inflammatory diseases of the scrotal organs. The informativeness of the ultrasound methods amounted to 60%.

Eun Hee Hong ◽  
Yong Un Shin ◽  
Heeyoon Cho

Cancers ◽  
2021 ◽  
Vol 13 (20) ◽  
pp. 5095
Sang Hyun Shin ◽  
Ho Kyoung Hwang ◽  
Jin-Young Jang ◽  
Hongbeom Kim ◽  
Sang Jae Park ◽  

Given the rare incidence of pancreatic acinar cell carcinoma (PACC), its post-resection clinical outcomes remain unclear. Treatment strategies for PACC have relied on those of pancreatic ductal adenocarcinoma (PDAC). The present study retrospectively investigated clinicopathologic characteristics of resected PACC registered in the Korea Tumor Registry System Biliary Pancreas database. Among 59 patients with a mean age of 59.2 years and a male predominance (83.1%), 43, 5, 7, and 4 had pure PACC, ductal differentiations, mixed neuroendocrine carcinomas, and intraductal and papillary variants, respectively. The mean tumor size was 4.6 cm, consisting of eight at T1, 26 at T2, and 25 at T3 stages. Metastasis to regional lymph node was identified in 15 (25.4%) patients. Thirty-one (52.5%) patients received adjuvant therapy. Five-year survival rate was 57.4%. The median survival was 78.8 months. In survival comparison according to the stage with AJCC system, N stage (lymph node metastasis), but not T stage, showed significant differences (p = 0.027). Resected PACC appeared to have clinical outcomes distinct from those of PDAC in this nationwide study. Therefore, large-scale multinational studies are needed to overcome the rarity of PACC and to establish an appropriate treatment strategies and staging system.

Antibiotics ◽  
2021 ◽  
Vol 10 (10) ◽  
pp. 1226
Jean Gibb ◽  
Darren W. Wong

Stenotrophomonas maltophilia is an urgent global threat due to its increasing incidence and intrinsic antibiotic resistance. Antibiotic development has focused on carbapenem-resistant Enterobacteriaceae, Pseudomonas, and Acinetobacter, with approved antibiotics in recent years having limited activity for Stenotrophomonas. Accordingly, novel treatment strategies for Stenotrophomonas are desperately needed. We conducted a systemic literature review and offer recommendations based on current evidence for a treatment strategy of Stenotrophomonas infection.

2021 ◽  
pp. 036354652110361
Deepak V. Chona ◽  
Paul D. Minetos ◽  
Christopher M. LaPrade ◽  
Mark E. Cinque ◽  
Geoffrey D. Abrams ◽  

Background: Hip dislocation is a rare occurrence during sports but carries serious implications for athletes. Purpose: To systematically review treatment strategies and outcomes for hip dislocation in athletes, with the ultimate goal of providing sports medicine physicians with the information necessary to appropriately treat and counsel patients sustaining this injury. Study Design: Systematic review; Level of evidence, 4. Methods: PubMed, MEDLINE, and Embase were searched for studies relating to hip instability and athletics from January 1, 1989 to October 1, 2019. Abstracts and articles were evaluated on the basis of predefined inclusion and exclusion criteria. Inclusion criteria were the following: (1) data from ≥1 patients, (2) native hip dislocation or subluxation occurring during sports, (3) patients aged at least 10 years, and (4) written in English. Exclusion criteria were (1) patients younger than 10 years; (2) nonnative or postoperative hip dislocation or subluxation; (3) a native hip injury without dislocation or subluxation; (4) patients with dislocation or subluxation secondary to neuromuscular, developmental, or syndromic causes; (5) dislocation or subluxation not occurring during sports; (6) patients with physeal fractures; or (7) review articles or meta-analyses. Data were recorded on patient demographics, injury mechanism, treatment strategies, and clinical and radiographic outcomes. Where possible, pooled analysis was performed. Studies were grouped based on reported outcomes. Meta-analysis was then performed on these pooled subsets. Results: A total of 602 articles were initially identified, and after screening by 2 reviewers, 27 articles reporting on 145 patients were included in the final review. There were 2 studies that identified morphological differences between patients with posterior dislocation and controls, including decreased acetabular anteversion ( P = .015 and .068, respectively), increased prevalence of a cam deformity ( P < .0035), higher alpha angles ( P≤ .0213), and decreased posterior acetabular coverage ( P < .001). No differences were identified for the lateral center edge angle or Tonnis angle. Protected postreduction weightbearing was most commonly prescribed for 2 to 6 weeks, with 65% of reporting authors recommending touchdown, toe-touch, or crutch-assisted weightbearing. Recurrence was reported in 3% of cases. Overall, 4 studies reported on findings at hip arthroscopic surgery, including a 100% incidence of labral tears (n = 27; 4 studies), 92% incidence of chondral injuries, 20% incidence of capsular tears, and 84% incidence of ligamentum teres tears (n = 25; 2 studies). At final follow-up, 86% of patients reported no pain (n = 14; 12 studies), 87% reported a successful return to play (n = 39; 10 studies), and 11% had radiographic evidence of osteonecrosis (n = 38; 10 studies). Conclusion: Various treatment strategies have been described in the literature, and multiple methods have yielded promising clinical and radiographic outcomes in patients with native hip dislocation sustained during sporting activity. Data support nonoperative treatment with protected weightbearing for hips with concentric reduction and without significant fractures and an operative intervention to obtain concentric reduction if unachievable by closed means alone. Imaging for osteonecrosis is recommended, with evidence suggesting 4- to 6-week magnetic resonance imaging and follow-up at 3 months for those with suspicious findings in the femoral head.

Medicina ◽  
2021 ◽  
Vol 57 (10) ◽  
pp. 1072
Jamie Burgess ◽  
W. Austin Wyant ◽  
Beatriz Abdo Abujamra ◽  
Robert Kirsner ◽  
Ivan Jozic

Diabetes mellitus is an increasingly prevalent chronic metabolic disease characterized by prolonged hyperglycemia that leads to long-term health consequences. It is estimated that impaired healing of diabetic wounds affects approximately 25% of all patients with diabetes mellitus, often resulting in lower limb amputation, with subsequent high economic and psychosocial costs. The hyperglycemic environment promotes the formation of biofilms and makes diabetic wounds difficult to treat. In this review, we present updates regarding recent advances in our understanding of the pathophysiology of diabetic wounds focusing on impaired angiogenesis, neuropathy, sub-optimal chronic inflammatory response, barrier disruption, and subsequent polymicrobial infection, followed by current and future treatment strategies designed to tackle the various pathologies associated with diabetic wounds. Given the alarming increase in the prevalence of diabetes, and subsequently diabetic wounds, it is imperative that future treatment strategies target multiple causes of impaired healing in diabetic wounds.

Varsha Tiwari ◽  
Manish Kumar ◽  
Abhishek Tiwari ◽  
Biswa Mohan Sahoo ◽  
Sunil Singh ◽  

2021 ◽  
A Hasenburg ◽  
H Plett ◽  
P Harter ◽  
F Heitz ◽  
S Kommoss ◽  

Sign in / Sign up

Export Citation Format

Share Document