Sample records for surgically treated idiopathic

  1. Idiopathic pulmonary artery aneurysm treated with surgical correction and concomitant coronary artery bypass grafting. (United States)

    Arnaoutakis, George; Nwakanma, Lois; Conte, John


    Idiopathic pulmonary artery aneurysm is a rare clinical entity, and therefore the natural course and clinical management are not well established. We present the case of an elderly woman with a symptomatic idiopathic pulmonary artery aneurysm who underwent surgical repair along with simultaneous coronary artery bypass grafting. With long-term follow-up presented in this report, we describe the safety and durability of surgical repair.

  2. Idiopathic chylopericardium treated by percutaneous thoracic duct embolization after failed surgical thoracic duct ligation

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    Courtney, Malachi; Ayyagari, Raj R. [Yale School of Medicine, Yale New Haven Hospital, New Haven, CT (United States); Division of Interventional Radiology, Department of Radiology, 789 Howard Avenue, P.O. Box 208042, New Haven, CT (United States)


    Chylopericardium rarely occurs in pediatric patients, but when it does it is most often a result of lymphatic injury during cardiothoracic surgery. Primary idiopathic chylopericardium is especially rare, with few cases in the pediatric literature. We report a 10-year-old boy who presented with primary idiopathic chylopericardium after unsuccessful initial treatment with surgical lymphatic ligation and creation of a pericardial window. Following readmission to the hospital for a right-side chylothorax resulting from the effluent from the pericardial window, he had successful treatment by interventional radiology with percutaneous thoracic duct embolization. This case illustrates the utility of thoracic duct embolization as a less-invasive alternative to surgical thoracic duct ligation, or as a salvage procedure when surgical ligation fails. (orig.)

  3. An observational study on surgically treated adult idiopathic scoliosis patients' quality of life outcomes at 1- and 2-year follow-ups and comparison to controls. (United States)

    Theis, Jennifer C; Grauers, Anna; Diarbakerli, Elias; Savvides, Panayiotis; Abbott, Allan; Gerdhem, Paul


    Prospective data on health-related quality of life in patients with idiopathic scoliosis treated surgically as adults is needed. We compared preoperative and 1- and 2-year follow-up data in surgically treated adults with idiopathic scoliosis with juvenile or adolescent onset. Results were compared to untreated adults with scoliosis and population normative data. A comparison of preoperative and 1- and 2-year follow-up data of 75 adults surgically treated for idiopathic scoliosis at a mean age of 28 years (range 18 to 69) from a prospective national register study, as well as a comparison with age- and sex-matched data from 75 untreated adults with less severe scoliosis and 75 adults without scoliosis, was made. Outcome measures were EuroQol-5 dimensions (EQ-5D) and Scoliosis Research Society (SRS)-22r questionnaire. In the surgically treated, EQ-5D and SRS-22r scores had statistically significant improvements at both 1- and 2-year follow-ups (all p   up was large ( r  = -0.54) and small-medium ( r  = -0.20) at 2-year follow-up. The effect size of surgery on SRS-22r outcomes was medium-large at 1- and 2-year follow-ups ( r  = -0.43 and r  = -0.42 respectively). At the 2-year follow-up, the EQ-5D score and the SRS-22r subscore were similar to the untreated scoliosis group ( p  = 0.56 and p  = 0.91 respectively), but lower than those in the adults without scoliosis ( p  up, approaching the health-related quality of life of untreated individuals with less severe scoliosis, but remain lower than normative population data.

  4. Acute surgical management in idiopathic intracranial hypertension.

    LENUS (Irish Health Repository)

    Zakaria, Zaitun


    Idiopathic intracranial hypertension is a headache syndrome with progressive symptoms of raised intracranial pressure. Most commonly, it is a slow process where surveillance and medical management are the main treatment modalities. We describe herein an acute presentation with bilateral sixth nerve palsies, papilloedema and visual deterioration, where acute surgical intervention was a vision-saving operation.

  5. Surgical Treatment of Dentofacial Deformities Caused by Juvenile Idiopathic Arthritis. (United States)

    Stoor, Patricia; Hodzic, Zlatan; Arte, Sirpa


    The purpose of our retrospective study was to evaluate the results of orthognathic treatment, distraction osteogenesis, and/or prosthetic reconstruction of the temporomandibular joints in patients with juvenile idiopathic arthritis (JIA).Twelve patients with severely affected temporomandibular joints (TMJs) and reduced ramus height were treated with mandibular advancement with orthognathic surgery (11) and additional bilateral or unilateral mandibular ramus distraction (3) or additional bilateral or unilateral prosthetic reconstruction of the TMJ (3). One patient was treated surgically with bilateral TMJ prosthetic reconstruction only. The patients were followed up clinically and radiologically with emphasis on healing, TMJ function, stability of the occlusion, skeletal stability, and facial appearance for an average of 2.3 years after the final surgery. The mean mandibular advancement was 10.1 mm. The mean relapse at pogonion was 2.1 mm, which represents 20.8% of the surgical advancement. The occlusion was stable in 11/12 patients. The TMJ function was good and the facial esthetics improved in all patients. Orthognathic treatment and mandibular ramus distraction osteogenesis provide beneficial lengthening of the mandibular body in JIA patients with asymptomatic and stabile condyles. In adult patients with relapse of the disease or postoperative condylar relapse prosthetic total joint replacement is a reliable and safe alternative.

  6. Apical wiring technique in surgical treatment of adolescent idiopathic scoliosis: the intermediate outcomes between Lenke types. (United States)

    Chaiyamongkol, Weera; Klineberg, Eric O; Gupta, Munish C


    Retrospective cohort study of apical wiring technique for surgical treatment of adolescent idiopathic scoliosis patients. To evaluate the intermediate outcome of adolescent idiopathic scoliosis patients treated with apical wiring technique. Regarding surgical treatment for adolescent idiopathic scoliosis, there are reports of the superiority of coronal plane correction using all-screw constructs compared with all-hook or hybrid constructs. Major limitations of all-screw constructs are thoracic hypokyphosis and increased proximal junctional kyphosis. There are few reports about apical wiring technique outcomes and no reports of this surgical technique comparing Lenke types. Consecutive adolescent idiopathic scoliosis patients treated with apical wiring technique were analyzed. Inclusion criteria were patient 21 years old or younger, who underwent a posterior only surgical correction with a follow-up of at least 2 years. Radiographic data were analyzed according to the criteria given by Lenke and colleagues. The radiographic parameters included global balance, Cobb angle, curve flexibility, apical vertebral translation, tilt angle of lower instrumented vertebra, angle of caudal disk to the lower instrumented vertebra, thoracic kyphosis, lumbar lordosis, and proximal junctional angle preoperatively and postoperatively. There was a significant improvement of Cobb angle in every Lenke type with an average correction of 74.6%. At latest follow-up, the average loss of correction was 3.5% (1.9 degrees). The greatest loss of correction for the minor curve of Lenke 2 was 14.1% (5.8 degrees). There was an improvement of thoracic kyphosis in hypokyphosis group (1.9-21.1 degrees; Pwiring technique for surgical treatment of adolescent idiopathic scoliosis provides an average correction of 71.1% at 3.4 years of average follow-up with harmonious sagittal plane correction even with preexisting abnormal thoracic kyphosis.

  7. [Surgical Treated Spondylodiscitis Epidemiological Study]. (United States)

    Soares do Brito, Joaquim; Tirado, António; Fernandes, Pedro


    The term spondylodiscitis aims to describe any spinal infection. Medical treatment is the gold standard; nevertheless, surgical treatment can be indicated. The aim of this work was to study the epidemiological profile in a group of patients with spondylodiscitis surgically treated in the same medical institution between 1997 and 2013. Eighty five patients with spondylodiscitis were surgically treated in this period. The authors analysed clinical data and image studies for each patient. We treated 51 male and 34 female patients with an average age of 48 years old (min: 6 - max: 80). The lumbar spine was more often affected and Mycobacterium tuberculosis the most frequent pathogen. The number of cases through the years has been grossly stable, with a slight increase of dyscitis due to Staphylococcus aureus and decrease of the dyscitis without pathogen identification. Paravertebral abscess was identified in 39 patients and 17 had also neurological impairment, mostly located in the thoracic spine and with tuberculous aetheology. Immunosuppression was documented in 10 patients. In this epidemiologic study we found a tuberculous infection, male gender and young age predominance. Despite a relative constant number of patients operated over the years, pyogenic infections due to Staphylococcus aureus seems to be uprising. Paravertebral abscess and neurological impairment are important dyscitis complications, especially in tuberculous cases. Spinal infections requiring surgical treatment are still an important clinical condition. Mycobacterium tuberculosis and Staphylococcus aureus represent the main pathogens with a growing incidence for the latest.

  8. Fuzzy-logic-assisted surgical planning in adolescent idiopathic scoliosis. (United States)

    Nault, Marie-Lyne; Labelle, Hubert; Aubin, Carl-Eric; Sangole, Archana; Balazinski, Marek


    Selection of appropriate curve fusion levels for surgery in adolescent idiopathic scoliosis (AIS) is a complex and difficult task and, despite numerous publications, still remains a highly controversial topic. To evaluate a fuzzy-logic-based surgical planning tool by comparing the results suggested by the software with the average outcome recommended by a panel of 5 expert spinal deformity surgeons. It is hypothesized that, given the same information, the fuzzy-logic tool will perform as favorably as the surgeons. Proof-of-concept study evaluating the use of a fuzzy-logic-assisted surgical planning tool in AIS to select the appropriate spinal curve to be instrumented. A cohort of 30 AIS surgical cases with a main thoracic curve was used. Each case included standard measurements recorded from preoperative standing postero-anterior and lateral, supine side bending, and 1-year postoperative standing radiographs. Five experienced spinal deformity surgeons evaluated each case independently and gave their preferred levels of instrumentation and fusion. The cases were then presented to the fuzzy-logic tool to determine whether the high thoracic and/or lumbar curves were to be instrumented. For each case, a percentage value was obtained indicating inclusion/exclusion of the respective curves in the surgical instrumentation procedure. Kappa statistics was used to compare the model output and the average decision of the surgeons. Kappa values of 0.71 and 0.64 were obtained, respectively, for the proximal thoracic and lumbar curves models, thus suggesting a good agreement of the fusion recommendations made by the fuzzy-logic tool and the surgeons. Given the same information, the fuzzy-logic-assisted recommendation of the curve to be instrumented compared favorably with the collective decision of the surgeons. The findings thus suggest that a fuzzy-logic approach is helpful in assisting surgeons with the preoperative selection of curve instrumentation and fusion levels in AIS.

  9. Clinical observation on vitreous surgery in treating idiopathic macular hole

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    Min Liu


    Full Text Available AIM: To observe the surgical effect and influential factors of idiopathic macular hole(IMHtreated with vitrectomy and internal limiting membrane peeling combined with intravitreal gas tamponade.METHODS: The clinical data of 22 IMH patients(23 eyeswere retrospectively analyzed. All the patients were diagnosed with IMH by optical coherence tomography(OCTand their macular hole patterns were measured before and after surgery by OCT in addition to the routine examinations. All patients were treated with vitrectomy, internal limiting membrane peeling combined with gas injection(air or inert gas. The postoperative visual acuity, macular hole closure rate and the incidence of surgical complications were observed. The correlation between the patients' age, course of disease, preoperative best corrected visual acuity(BCVA, macular hole diameter, the type of vitreous cavity filling gas, the postoperative BCVA, and the macular hole closure rate was analyzed with SPSS 13.0 statistical software.RESULTS: Postoperative OCT examination results showed that the macular hole closure rate was 100%. The macular hole closure rate was 79%(11 eyes of 14 eyesafter the first intravitreal air injection and 100%(9 eyesafter fist intravitreal inert gas injection(100mL/L C3F8. There was no significant difference between the air injection and inert gas injection(χ2=2.1214, P>0.05. The mean preoperational BCVA was 0.11±0.05 and the mean postoperative BCVA 0.23±0.12; there was a statistically significant difference between them(t=4.023,Pt=3.92, PPr=-0.415, P=0.256, duration of disease(r=0.193, P= 0.498, preoperative VA(r=0.152, P=0.673had no significant influence on IMH visual outcomes.CONCLUSION: The vitrectomy combined with internal limiting membrane peeling and intravitreal gas tamponade is an effective treatment for IMH; the macular hole diameter is the major influence factor in the postoperative closure and visual prognosis of IMH; while the preoperative visual acuity

  10. Chronic idiopathic intestinal pseudo-obstruction treated with jejunostomy: case report and literature review

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    Carlos Renato dos Reis Lemos

    Full Text Available CONTEXT: Chronic idiopathic intestinal pseudo-obstruction is a very rare condition. CASE REPORT: This study describes a male patient who had presented obstructive symptoms for 24 years. He had been treated clinically and had undergone two previous operations in different services, with no clinical improvement or correct diagnosis. He was diagnosed with intestinal obstruction without mechanical factors in our service and underwent jejunostomy, which had a significant decompressive effect. The patient was able to gain weight and presented improvements in laboratory tests. Jejunostomy is a relatively simple surgical procedure that is considered palliative but, in this case, it was resolutive.

  11. Idiopathic Intracranial Hypertension After Surgical Treatment of Cushing Disease: Case Report and Review of Management Strategies. (United States)

    Wagner, Jeffrey; Fleseriu, Cara M; Ibrahim, Aly; Cetas, Justin S


    Idiopathic intracranial hypertension (IIH) in patients with Cushing disease (CD), after treatment, is rarely described, in adults. The cause is believed to be multifactorial, potentially related to a relative decrease in cortisol after surgical resection or medical treatment of a corticotroph pituitary adenoma. We investigate our center's CD database (140 surgically and 60 medically [primary or adjunct] treated patients) for cases of IIH, describe our center's experience with symptomatic IIH, and review treatment strategies in adults with CD after transsphenoidal resection. We present the case of a 22-year-old woman who presented with worsening headache, nausea, vomiting, blurry vision, diplopia, visual loss, and facial numbness 14 weeks after surgical resection of adrenocorticotropic hormone-positive pituitary adenoma. Her CD had been in remission since surgery, with subsequent adrenal insufficiency (AI), which was initially treated with supraphysiologic glucocorticoid replacement, tapered down to physiologic doses at the time the IIH symptoms developed. Symptomatic IIH is rare in adult patients but can be severe and result in permanent vision loss. A high index of suspicion should be maintained and a fundus examination is necessary to exclude papilledema, whenever there are suggestive symptoms that initially may overlap with AI. It is possible that some cases of mild IIH are misdiagnosed as GC withdrawal or AI; however, further studies are needed. Treatment consists of reinitiation of higher steroid doses together with acetazolamide with or without cerebrospinal fluid diversion and the priority is to preserve vision and reverse any visual loss. Published by Elsevier Inc.

  12. Changes in life satisfaction and self-esteem in patients with adolescent idiopathic scoliosis with and without surgical intervention. (United States)

    Zhang, Jingtao; He, Dawei; Gao, Juan; Yu, Xiuchun; Sun, Haining; Chen, Ziqiang; Li, Ming


    Pre-/poststudy comparing surgical and nonsurgical treatment. To identify whether orthopedic spinal surgery can effectively improve life satisfaction and self-esteem in patients with adolescent idiopathic scoliosis. There have been many studies about the effect of spinal deformity and its various treatments on the mental health of patients with adolescent idiopathic scoliosis. Scoliosis has been reported to have a negative effect on the life quality and mental health of patients. It has also been reported that no matter what the treatment, the existence of scoliosis is a risk factor for depression. However, there has been no report on whether orthopedic spinal surgery affects the life satisfaction and self-esteem of scoliosis patients. Forty-six patients with Cobb angles of more than 30° were recruited from a group of patients that were treated from January 2007 to August 2007. Twenty-one patients with Cobb angles of more than 40° underwent surgical correction while the remaining patients received regular observation (n = 11) or bracing (n = 14). Self-esteem and life satisfaction were assessed before and approximately 1 year after treatment using previously validated scales. There were no between-group differences in age, sex, or major curve location between the surgically and nonsurgically treated groups. The major curve Cobb angle decreased significantly following treatment in the surgically treated (52° ± 10° to 15° ± 8°, P life satisfaction (8 ± 1 vs. 7 ± 10); however, preintervention self-esteem scores were significantly higher in the nonsurgically treated group (28 ± 4 vs. 25 ± 3, P = 0.008). Postintervention, both life satisfaction (9 ± 1) and self-esteem (31 ± 2) scores improved significantly (P Self-esteem levels decreased significantly in the nonsurgically treated group (P self-esteem and life satisfaction scores were significantly higher in the surgically treated than the nonsurgically treated group (P self-esteem and life satisfaction.

  13. Etiologic revelation and outcome of the surgical management of idiopathic granulomatous mastitis; An Egyptian centre experience. (United States)

    Elzahaby, Islam A; Khater, Ashraf; Fathi, Adel; Hany, Islam; Abdelkhalek, Mohamed; Gaballah, Khaled; Elalfy, Amr; Hamdy, Omar


    Idiopathic granulomatous mastitis (IGM) is a chronic inflammatory condition that is confused with cancer. It usually affects women in child bearing age. The exact aetiology and pathogenesis are still unknown, and the optimal therapeutic modality has not yet been established. Treatment most frequently includes Antibiotics, corticosteroids and immunosuppressant, surgical excision, and even mastectomy. We studied a thirty cases diagnosed with IGM in our locality to find out the leading risk factors and the outcome of our surgical approach which involves excision of the lesion in continuity with duct system. Patients demographic data, history related to lactation and outcome were recorded. All patients were parous women with history of previous breast feeding for all kids. Twenty-six patients (86.66%) had a history of early incomplete nursing care to the affected breast. After our surgical approach, Twenty eight (93.3%) patients showed fast recovery with no detectable recurrences in the median follow up period (18 months) with acceptable cosmoses. History of breast feeding together with early failure of complete nursing from a single breast is the most important risk factors for development of IGM in young aged women. Surgery plays an important role in treating IGM, however, it should be directed towards excision of the present mass (s) together with the pathological and colonized duct system.

  14. Vertebral coplanar alignment technique: a surgical option for correction of adult thoracic idiopathic scoliosis. (United States)

    He, Shouyu; Bao, Hongda; Zhu, Zezhang; Qiu, Yong; Zhu, Feng; Zhou, Hengcai; Sun, Xu; Wang, Bin


    Previous studies have demonstrated vertebral coplanar alignment (VCA) as an effective surgical option for adolescent idiopathic scoliosis (AIS). The purpose of this study is to analyze the outcome of VCA for the surgical correction of adult idiopathic scoliosis (AdIS). 35 AdIS patients (mean age: 24.2 years) undergoing VCA-instrumentation were reviewed. The main thoracic curve and thoracic kyphosis (TK, T5-T12) were evaluated preoperatively, immediate postoperatively, and at the final follow-up (>1 year). All patients were stratified by the TK modifier before surgery: "+" (TK, >40°), "-" (TK, scoliosis with sagittal malalignment.

  15. [Is local bone graft sufficient to maintain the surgical correction in adolescent idiopathic scoliosis curves?]. (United States)

    Mardomingo, A; Sánchez-Mariscal, F; Alvarez, P; Pizones, J; Zúñica, L; Izquierdo, E


    The purpose of this study was to compare postoperative clinical and radiological results in adolescent idiopathic scoliosis curves treated by posterior arthrodesis using autogenous bone graft from iliac crest (CI) versus only local autograft bone (HL). A retrospective matched cohort study was conducted on 73 patients (CI n=37 and HL n=36) diagnosed with adolescent idiopathic scoliosis and treated surgically by posterior arthrodesis. The mean post-operative follow-up was 126 months in the CI group vs. 66 months in the HL group. The radiographic data collected consisted of preoperative, postoperative, and final follow-up antero-posterior and lateral full-length radiographs. Loss of correction and quality of arthrodesis were evaluated by comparing the scores obtained from the Spanish version of the SRS-22 questionnaire. There were significant differences in the post-operative results as regards the correction of the Cobb angle of the main curve (HL 61 ± 15% vs. CI 51 ± 14%, P<.004), however a greater loss of correction was found in the local bone group (CI 4.5 ± 7.3° vs. HL 8.5 ± 6.3°, P=.02). There were no significant differences as regards the correction of the Cobb angle of the main curve at the end of follow-up. There were no clinical differences between the two groups in the SRS-22 scores. At 5 years of follow-up, there was a statistically significant greater loss of radiographic correction at the end of final follow-up in the local bone graft group. However clinical differences were not observed as regards the SRS-22 scores. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  16. Ruptured hepatoblastoma treated with primary surgical resection

    African Journals Online (AJOL)

    The aim of this study was to review two cases of ruptured hepatoblastoma treated with primary surgical resection. Hepatoblastoma is the most common primary liver malignancy of childhood, although it remains infrequent. A rare, but serious condition is when the tumor presents with spontaneous rupture. This is a ...

  17. Idiopathic megacolon in a teenager treated by laparoscopic rectosigmoidectomy

    Directory of Open Access Journals (Sweden)

    Carlos Eduardo Oliveira Sodero


    Full Text Available Chronic constipation in children and adolescents is relatively common and a reason for consultation with pediatricians and proctologists. Most cases respond to medical treatment. Advanced cases of megacolon and megarectum can be treated surgically by Duhamel technique.This case report describes a 15-year-old patient with chronic intestinal constipation refractory to clinical treatment associated with megacolon and megarectum, which was surgically treated. Resumo: A constipação intestinal crônica em crianças e adolescentes é relativamente comum e motivo de consultas a pediatras e coloproctologistas. A maioria dos casos responde ao tratamento clínico. Casos avançados de megacolon e megarreto podem ser tratados cirurgicamente através da cirurgia de Duhamel.Este relato de caso descreve um paciente de 15 anos de idade com quadro de constipação intestinal crônica refratária ao tratamento clínico associada a megacolon e megarreto, o qual foi tratado cirurgicamente. Keywords: Megacolon, Megarectum, Duhamel, Palavras-chave: Megacolon, Megarreto, Duhamel

  18. A multicenter study of the outcomes of the surgical treatment of adolescent idiopathic scoliosis using the Scoliosis Research Society (SRS) outcome instrument. (United States)

    Merola, Andrew A; Haher, Thomas R; Brkaric, Mario; Panagopoulos, Georgia; Mathur, Samir; Kohani, Omid; Lowe, Thomas G; Lenke, Larry G; Wenger, Dennis R; Newton, Peter O; Clements, David H; Betz, Randal R


    A multicenter study of the outcomes of the surgical treatment of adolescent idiopathic scoliosis using the Scoliosis Research Society Questionnaire (SRS 24). To evaluate the patient based outcome of the surgical treatment of adolescent idiopathic scoliosis. A paucity of information exists with respect to patient measures of outcome regarding the surgical treatment of adolescent idiopathic scoliosis. To our knowledge, no prospective outcome study on this topic thus far exists. Using the SRS 24 questionnaire, seven scoliosis centers agreed to prospectively assess outcome for surgically treated patients with adolescent idiopathic scoliosis. Data were collected before surgery and at 24 months after surgery. Data were analyzed using paired and independent samples t test for all seven SRS 24 questionnaire domains (Pain, General Self-Image, Postoperative Self-Image, Postoperative Function, Function From Back Condition, General Level of Activity, and Satisfaction) using Statistical Package for Social Science. The domains were analyzed with respect to the total cohort, gender, curve magnitude, and type of surgery using independent-samples t tests. A total of 242 patients were included in our analysis. A baseline preoperative pain level of 3.68 of 5 was found. This improved to 4.63 after surgery, representing an improvement of 0.95 points. Surgical intervention was associated with improving outcome when compared with preoperative status. Pain, General Self-Image, Function From Back Condition, and Level of Activity all demonstrated statistically significant improvement as compared with preoperative status (P adolescent scoliosis population. Pain scores were improved in our study population at the 2-year postsurgical follow-up. Statistically significant improvements were likewise seen in the General Self-Image, Function From Back Condition, and Level of Activity domains. The present study demonstrates the ability of surgery to improve the outcome of patients afflicted with

  19. Non-Surgical Interventions for Adolescents with Idiopathic Scoliosis: An Overview of Systematic Reviews (United States)

    Płaszewski, Maciej; Bettany-Saltikov, Josette


    Background Non-surgical interventions for adolescents with idiopathic scoliosis remain highly controversial. Despite the publication of numerous reviews no explicit methodological evaluation of papers labeled as, or having a layout of, a systematic review, addressing this subject matter, is available. Objectives Analysis and comparison of the content, methodology, and evidence-base from systematic reviews regarding non-surgical interventions for adolescents with idiopathic scoliosis. Design Systematic overview of systematic reviews. Methods Articles meeting the minimal criteria for a systematic review, regarding any non-surgical intervention for adolescent idiopathic scoliosis, with any outcomes measured, were included. Multiple general and systematic review specific databases, guideline registries, reference lists and websites of institutions were searched. The AMSTAR tool was used to critically appraise the methodology, and the Oxford Centre for Evidence Based Medicine and the Joanna Briggs Institute’s hierarchies were applied to analyze the levels of evidence from included reviews. Results From 469 citations, twenty one papers were included for analysis. Five reviews assessed the effectiveness of scoliosis-specific exercise treatments, four assessed manual therapies, five evaluated bracing, four assessed different combinations of interventions, and one evaluated usual physical activity. Two reviews addressed the adverse effects of bracing. Two papers were high quality Cochrane reviews, Three were of moderate, and the remaining sixteen were of low or very low methodological quality. The level of evidence of these reviews ranged from 1 or 1+ to 4, and in some reviews, due to their low methodological quality and/or poor reporting, this could not be established. Conclusions Higher quality reviews indicate that generally there is insufficient evidence to make a judgment on whether non-surgical interventions in adolescent idiopathic scoliosis are effective. Papers

  20. Predictors of emotional functioning in youth after surgical correction of idiopathic scoliosis. (United States)

    Zebracki, Kathy; Thawrani, Dinesh; Oswald, Timothy S; Anadio, Jennifer M; Sturm, Peter F


    Patients with idiopathic scoliosis, although otherwise healthy, often have significant concerns about their self-image and appearance. In a group of juveniles and adolescents, this can impact adjustment in school, functioning in peer groups, and general sense of well-being. There are limited data to help physicians reliably and precisely identify those who are at higher risk of poor emotional adjustment even after spine deformity correction. The purpose of this study was to determine the predictors of emotional maladjustment in juvenile and adolescent patients after surgical correction of idiopathic scoliosis. A total of 233 juveniles, mean age 11.26 ± 1.02 (range, 8 to 12) years and 909 adolescents, mean age 14.91 ± 1.61 (range, 13 to 21) years, who underwent surgical correction for idiopathic scoliosis and who were participating in a prospective longitudinal multicenter database, were enrolled in the study. Participants completed the Scoliosis Research Society-22 (SRS-22) questionnaire before surgery and 2 years postoperatively. Radiographs were used to measure Cobb angle and surface measurements were used to determine decompensation and trunk shift. Adolescents reported poorer mental health preoperatively (Pself-image (Pself-image (Padolescent group, mental health 2 years postoperatively was predicted by preoperative mental health (Pself-image 2 years postoperatively was predicted by preoperative mental health (Pself-image (PSelf-image and mental health are significantly improved after spine deformity correction in juveniles and adolescents with idiopathic scoliosis. However, consistent with normative development, adolescents are at higher risk for emotional maladjustment than juveniles. Surgical decision making in scoliosis correction should take the emotional status of the patient into consideration.

  1. Clinicopathological study of surgically treated osteoradionecrosis

    International Nuclear Information System (INIS)

    Ohishi, Shin-ichiro


    To evaluate prognostic factors affecting surgically treated osteoradionecrosis (ORN) of the mandible, 13 patients with mandibular bone necrosis caused by irradiation for head and neck cancer were examined chlinicopathologically. The subjects were included 12 men and 1 woman, with a mean age of 65.3 years at surgery. The mean total dose of irradiation was 61.6 Gy. The clinical stage according to Epstein et al. (1987) was IIB in 1 patient, IIIA in 4, and IIIB in 8. The mandible was resected 10 mm or more from the lesion. Delayed healing was found in two patients, and three had recurrence of necrosis of the remaining bone. Patients whose mandibular periosteum had been resected previously who received mandibular reconstruction had a poor outcome. Pathological changes, such as stenosis of the inferior alveolar artery, fibrosis of bone marrow, and low osteocyte density in cortical bone, were found in all resected mandibles. Among them, mandibles lacking sequestra and bone remodeling had poor viability. Therefore, the periosteal blood supply should be conserved and surgical interventions, particularly heat, must be minimized to avoid recurrence of ORN. (author)

  2. Improved restoration of thoracic kyphosis using a rod construct with differentiated rigidity in the surgical treatment of adolescent idiopathic scoliosis

    DEFF Research Database (Denmark)

    Ohrt-Nissen, Søren; Dragsted, Casper; Dahl, Benny


    OBJECTIVE The objective of this study was to compare postoperative sagittal alignment among 3 rod constructs with different rigidity profiles. METHODS This was a dual-center retrospective cohort study involving 2 consecutive cohorts in which patients were surgically treated for adolescent...... idiopathic scoliosis. Lenke Type 5 curves were excluded. Patients were operated on with all-pedicle screw instrumentation using 3 different rod constructs. The first group was operated on using a hybrid construct (HC) consisting of a normal circular rod on the convex side and a beam-like rod (BR......) on the concave side. The second group was operated on with a standard construct (SC) using bilateral BRs in the full length of the fusion. The third group was operated on with a modified construct (MC). The modified rods have a beam-like shape in the caudal portion, but in the cranial 2 or 3 fusion levels...

  3. Prognostic factors for idiopathic sudden sensorineural hearing loss treated with hyperbaric oxygen therapy and intravenous steroids. (United States)

    Hosokawa, S; Sugiyama, K; Takahashi, G; Takebayashi, S; Mineta, H


    This study evaluated the prognosis of idiopathic sudden sensorineural hearing loss when treated with hyperbaric oxygen therapy and intravenous steroids. The clinical data for 334 patients with idiopathic sudden sensorineural hearing loss treated by hyperbaric oxygen therapy and intravenous steroids at our hospital were retrospectively reviewed. These data included the initial averaged five-frequency hearing level, patient age, interval between onset of symptoms and treatment, vertigo as a complication, and co-existence of diabetes mellitus. The overall improvement rate was 69.2 per cent, including better improvement (25.5 per cent), good improvement (21.0 per cent) and fair improvement (22.7 per cent). Hyperbaric oxygen therapy appears to confer a significant additional therapeutic benefit when used in combination with steroid therapy for idiopathic sudden sensorineural hearing loss. If performed early, hyperbaric oxygen therapy may bring about hearing improvement in many patients who are unresponsive to initial therapy.

  4. Adolescent Idiopathic Scoliosis Thoracic Volume Modeling: The Effect of Surgical Correction. (United States)

    Wozniczka, Jennifer K; Ledonio, Charles G T; Polly, David W; Rosenstein, Benjamin E; Nuckley, David J


    Scoliosis has been shown to have detrimental effects on pulmonary function, traditionally measured by pulmonary function tests, which is theorized to be correlated to the distortion of the spine and thorax. The changes in thoracic volume with surgical correction have not been well quantified. This study seeks to define the effect of surgical correction on thoracic volume in patients with adolescent idiopathic scoliosis. Images were obtained from adolescents with idiopathic scoliosis enrolled in a multicenter database (Prospective Pediatric Scoliosis Study). A convenience sample of patients with Lenke type 1 curves with a complete data set meeting specific parameters was used. Blender v2.63a software was used to construct a 3-dimensional (3D) computational model of the spine from 2-dimensional calibrated radiographs. To accomplish this, the 3D thorax model was deformed to match the calibrated radiographs. The thorax volume was then calculated in cubic centimeters using Mimics v15 software. The results using this computational modeling technique demonstrated that surgical correction resulted in decreased curve measurement as determined by Cobb method, and increased postoperative thoracic volume as expected. Thoracic volume significantly increased by a mean of 567 mm (P3D changes in thoracic volumes using 2-dimensional imaging. This is an assessment of the novel modeling technique, to be used in larger future studies to assess clinical significance. Level 3-retrospective comparison of prospectively collected data.

  5. Surgical treatment of chronic idiopathic thrombocytopenic purpura: results in 107 cases

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    Cola, B.; Tonielli, E.; Sacco, S.; Brulatti, M.; Franchini, A.


    Between 1972 and 1985, 107 patients with chronic Idiopathic Thrombocytopenic Purpura underwent splenectomy. Platelet life span and sites of sequestration were studied with labelled platelets and external scanning. Medical treatment was always of scarce and transient effectiveness and had considerable side effects. Splenectomy had minimal complications and mortality and caused no hazard of overwhelming sepsis in adults. The results of splenectomy were very satisfying, especially when platelet sequestration was mainly splenic (remission in about 90% of patients). Surgical treatment is at present the most effective in patients with chronic ITP.

  6. Surgical treatment of chronic idiopathic thrombocytopenic purpura: results in 107 cases

    International Nuclear Information System (INIS)

    Cola, B.; Tonielli, E.; Sacco, S.; Brulatti, M.; Franchini, A.


    Between 1972 and 1985, 107 patients with chronic Idiopathic Thrombocytopenic Purpura underwent splenectomy. Platelet life span and sites of sequestration were studied with labelled platelets and external scanning. Medical treatment was always of scarce and transient effectiveness and had considerable side effects. Splenectomy had minimal complications and mortality and caused no hazard of overwhelming sepsis in adults. The results of splenectomy were very satisfying, especially when platelet sequestration was mainly splenic (remission in about 90% of patients). Surgical treatment is at present the most effective in patients with chronic ITP

  7. Selection of fusion levels in idiopathic adolescent scoliosis treated by Harrington-DDT instrumentation

    DEFF Research Database (Denmark)

    Andersen, G R; Andersen, M O; Christensen, S B


    Clinical records and radiographs of 106 patients treated by Harrington-dorsal transverse traction (DDT) instrumentation for idiopathic adolescent thoracolumbar scoliosis were reviewed. Our strategy was to fuse from one vertebra above the measured curve to two vertebrae below the curve, but to avo...

  8. High risk of adrenal insufficiency in adults previously treated for idiopathic childhood onset growth hormone deficiency

    DEFF Research Database (Denmark)

    Lange, Martin; Feldt-Rasmussen, Ulla; Svendsen, Ole Lander


    The aim was to reevaluate a group of adults treated for idiopathic childhood onset GH deficiency (GHD) after 18 yr without GH treatment. Twenty-six (11 females) patients participated. All but two had isolated GHD. Childhood diagnosis was established by insulin tolerance test (ITT). The patients w...

  9. Outcomes of recalcitrant idiopathic epistaxis in children: Septoplasty as a surgical treatment. (United States)

    Levi, Jessica M; McKee-Cole, Katherine M; Barth, Patrick C; Brody, Robert M; Reilly, James S


    Our objective was to measure short- and long-term outcomes of children presenting with recalcitrant idiopathic epistaxis. The study was an 11-year (2000-2011) retrospective chart review of children evaluated and treated for epistaxis. A retrospective review of patients with diagnostic International Classification of Diseases, Ninth Revision code 784.7 (epistaxis) and 21.5/21.88 (septoplasty) was completed reviewing age at presentation, type of surgery, and number of bleeding events prior to and after surgery. In our cohort, almost 100% of children with idiopathic recurrent epistaxis responded to topical treatments. About 0.2% were refractory (20/9239), and 90% of those (18/20) resolved with either a traditional septoplasty (14/20) or modified septoplasty (6/20) without cartilage excision, with a mean follow-up of 35 months. One of the patients who did not show resolution was found to have Von Willebrand disease, which likely contributed to this outcome. Septoplasty surgery, with or without cartilage removal, appears beneficial for refractory idiopathic epistaxis in children. 4 Laryngoscope, 126:2833-2837, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  10. An intraoperative irrigation regimen to reduce the surgical site infection rate following adolescent idiopathic scoliosis surgery (United States)

    van Herwijnen, B; Evans, NR; Dare, CJ; Davies, EM


    Introduction The aim of this study was to compare the efficacy of a gentamicin antibiotic intraoperative irrigation regimen (regimen A) with a povidone-iodine intraoperative irrigation regimen (regimen B) and to evaluate the ability of adjunctive local vancomycin powder (regimen C) to reduce the surgical site infection (SSI) rate following idiopathic scoliosis correction. Methods This was a retrospective, single centre, two-surgeon cohort study of paediatric scoliosis procedures involving 118 patients under the age of 18 years who underwent correction for idiopathic scoliosis over a period of 42 months. Patients’ baseline characteristics, pseudarthrosis and rates of SSI were compared. Results Baseline characteristics were comparable in all three groups, with the exception of sex distribution. Over a quarter (27%) of patients with regimen B were male compared with 13% and 6% for regimens A and C respectively. Patients were mostly followed up for a minimum of 12 months. The SSI rate for both superficial and deep infections was higher with regimen A (26.7%) than with regimens B and C (7.0% and 6.3% respectively). The SSI rates for regimens B and C were comparable. No patients developed complications related to vancomycin toxicity, metalwork failure or pseudarthrosis. Conclusions Wound irrigation with a povidone-iodine solution reduces SSIs following adolescent idiopathic scoliosis surgery. The direct application of vancomycin powder to the wound is safe but does not reduce the SSI rate further in low risk patients. Additional studies are needed to elucidate whether it is effective at higher doses and in high risk patient groups. PMID:27087324

  11. Idiopathic extensive peliosis hepatis treated with liver transplantation

    DEFF Research Database (Denmark)

    Hyodo, Masanobu; Mogensen, Anne Mellon; Larsen, Peter Nørgaard


    complicating liver cirrhosis. Extensive peliosis with liver cirrhosis is a rare condition. Only two cases, caused by contraceptives and treated by liver transplantation, are reported in the English-language literature. We could find no cause other than alcohol abuse lasting several years in this patient...

  12. Idiopathic sclerosing mesenteritis in paediatrics: Report of a successfully treated case and a review of literature

    Directory of Open Access Journals (Sweden)

    Murray Kevin J


    Full Text Available Abstract A 6 year old female with symptoms of small bowel obstruction underwent an exploratory laparotomy which revealed widespread evidence of inflammatory fibrotic adhesions involving the jejunal mesentery. In view of persistent growth failure, chronic anaemia, elevated acute phase reactants and imaging evidence of a diffuse progressive inflammatory process, the child was treated with corticosteroids and methotrexate with complete response. The literature on juvenile idiopathic sclerosing mesenteritis has been reviewed.

  13. Surgically Treated Symptomatic Prolapsed Lumbar and Sacral ...

    African Journals Online (AJOL)

    The intention of this study is to share the experience of the author in the occurrence, possible causative factors, and treatment of surgically symptomatic prolapsed lumbar and sacral intervertebral discs in females, and to compare this experience in Switzerland, Nigeria, and Jamaica using surgery records for a period of over ...

  14. Preoperative and perioperative factors effect on adolescent idiopathic scoliosis surgical outcomes. (United States)

    Sanders, James O; Carreon, Leah Y; Sucato, Daniel J; Sturm, Peter F; Diab, Mohammad


    Prospective multicenter database. To identify factors associated with outcomes from adolescent idiopathic scoliosis (AIS) surgery outcomes and especially poor results. Because AIS is rarely symptomatic during adolescence, excellent surgical results are expected. However, some patients have poor outcomes. This study seeks to identify factors correlating with results and especially those making poor outcomes more likely. Demographic, surgical, and radiographic parameters were compared to 2-year postoperative Scoliosis Research Society (SRS) scores in 477 AIS surgical patients using stepwise linear regression to identify factors predictive of 2-year domain and total scores. Poor postoperative score patients (>2 SD below mean) were compared using t tests to those with better results. The SRS instrument exhibited a strong ceiling effect. Two-year scores showed more improvement with greater curve correction (self-image, pain, and total), and were worse with larger body mass index (pain, mental, total), larger preoperative trunk shift (mental and total), larger preoperative Cobb (self-image), and preoperative symptoms (function). Poor results were more common in those with Lenke 3 curve pattern (pain), less preoperative coronal imbalance, trunk shift and rib prominence (function), preoperative bracing (self-image), and anterior procedures (mental). Poor results also had slightly less average curve correction (50% vs. 60%) and larger curve residuals (31° vs. 23°). Complications, postoperative curve magnitude, and instrumentation type did not significantly contribute to postoperative scores, and no identifiable factors contributed to satisfaction. Curve correction improves patient's self-image whereas pain and poor function before surgery carry over after surgery. Patients with less spinal appearance issues (higher body mass index, Lenke 3 curves) are less happy with their results. Except in surgical patient selection, many of these factors are beyond physician control.

  15. Incidence of cancer in adolescent idiopathic scoliosis patients treated 25 years previously

    DEFF Research Database (Denmark)

    Simony, Ane; Hansen, Emil Jesper; Christensen, Steen Bach


    PURPOSE: To report the incidence of cancer in a cohort of adolescent idiopathic scoliosis (AIS) patients treated 25 years previously. METHODS: 215 consecutive AIS patients treated between 1983 and 1990 were identified and requested to return for clinical and radiographic examination. The incidence...... of cancer was determined through chart review and follow-up interviews. Using the original radiographic log file that included patient position, mAs, kV and the total number of X-rays taken, a radiation physicist calculated the total radiation dose during treatment and follow-up adjusted for BMI and sex...

  16. The impact of direct vertebral rotation (DVR) on radiographic outcome in surgical correction of idiopathic scoliosis. (United States)

    Urbanski, Wiktor; Wolanczyk, Michal J; Jurasz, Wojciech; Kulej, Miroslaw; Morasiewicz, Piotr; Dragan, Szymon Lukasz; Sasiadek, Marek; Dragan, Szymon Feliks


    Recent developments of spinal instruments allow to address nearly all components of idiopathic scoliosis. Direct vertebral rotation (DVR) maneuver was introduced to correct apical axial vertebral rotation. It is however still not well established how efficiently DVR affects results of scoliosis correction. The object of the study was to evaluate en bloc apical vertebral rotation (DVR) and its impact on coronal and sagittal correction of the spine in patients undergoing surgical scoliosis treatment. Thirty-six consecutive patients who underwent posterior spinal fusion with pedicle screws only constructs for idiopathic scoliosis. Fifteen patients (20 curves) were corrected by rod derotation only and 21 patients (26 curves) had both rod derotation and DVR. Curve measurements were performed on x-rays obtained before and postoperatively-coronal curves, kyphosis (T2-T12, T5-T12). Spine flexibility was assessed on prone bending x-rays. Apical axial rotation was determined on CT scans obtained intraoperatively and postoperatively. Rotation angle (RAsag) was measured according to Aaro and Dahlborn. We observed reduction of RAsag in all patients; however, in DVR group, decrease was greater, by 31.8% comparing to non-DVR group, by 8.6% (p = 0.0003). Mean coronal correction in DVR group was 68.8% and in rod derotation group without DVR 55% (p = 0.002). No significant correlation was found between degree of derotation obtained and coronal correction. In DVR group T2-T12 kyphosis has increased in 28 (65%) patients whereas in non-DVR group in 31 (69%) cases. Mean value of T2-T12 kyphosis growth was 16.7% in DVR and 22.1% in non-DVR group. These differences however did not occur statistically significant. Direct vertebral rotation (DVR) maneuver reduces significantly apical rotation of the spine, enhances ability of coronal correction, and it does not reduce thoracic kyphosis.

  17. Is Obesity in Adolescent Idiopathic Scoliosis Associated With Larger Curves and Worse Surgical Outcomes? (United States)

    Li, Ying; Binkowski, Laura; Grzywna, Alexandra; Robbins, Christopher B; Caird, Michelle S; Farley, Frances A; Glotzbecker, Michael


    A multicenter retrospective study of preoperative characteristics and surgical outcomes in adolescent idiopathic scoliosis (AIS). To determine the effect of obesity on (i) curve magnitude at first presentation to an orthopedic surgeon, and (ii) surgical outcomes. Clinical findings for scoliosis may be less apparent in overweight adolescents. The effect of obesity on curve magnitude at presentation to an orthopedic surgeon has not been studied. It is unclear whether obesity is associated with worse surgical outcomes in AIS. Demographic, radiographic, perioperative, and complications data were collected on AIS patients who had undergone posterior spinal fusion (PSF). Descriptive and inferential analyses were conducted to compare healthy-weight (HW) [body mass index percentile for age (BMI%) ≤ 84], overweight (OW; BMI% ≥ 85), and obese (OB; BMI% ≥ 95) adolescents. We analyzed 588 patients (454 HW, 134 OW, and 71 OB). In comparison with the HW adolescents, major curve magnitude at presentation to orthopedics was larger in the OW adolescents (49.3° vs. 43.9°) (P adolescents (50.4° vs. 43.9°) (P = 0.001). The OW and OB groups had increased preoperative major curve magnitude [(59.1° vs. 55.4°) (P = 0.001); (59.9° vs. 55.4°) (P = 0.001)], preoperative minor curve magnitude [(42.2° vs. 37.2°) (P < 0.0001); (43.0° vs. 37.2°) (P = 0.001)], preoperative thoracic kyphosis [(30.8° vs. 25.7°) (P < 0.0001); (33.7° vs. 25.7°) (P < 0.0001)], and surgical time [(307 vs. 276 mins) (P = 0.009); (320 vs. 276 mins) (P = 0.005)] than the HW group.Subgroup analysis of the patients with a minimum 2-year follow-up (n = 245) showed a trend towards a higher complication rate in the OB group (47.8% vs. 28.3%) (P = 0.054). The OB group had significantly more superficial infections than the HW group (13.0% vs. 1.6%) (P = 0.001). OW patients with AIS have a larger curve magnitude at presentation to an orthopedic surgeon. OW

  18. One-step (standard) versus two-step surgical approach in adolescent idiopathic scoliosis posterior spinal fusion: Which is better? (United States)

    Ramirez, Norman; Valentin, Pablo; García-Cartagena, Manuel; Samalot, Solais; Iriarte, Ivan


    A retrospective cohort study with IRB approval. Significant blood loss remains an important concern in terms of the performance of the posterior spinal fusion in adolescent idiopathic scoliosis. Several strategies have been reported to minimize blood loss during surgery. In order to address the need to minimize blood loss without sacrificing the quality of the fusion, in our hospital, we adopted a two-step surgical approach. This surgical approach consist of the exposure and instrumentation of the lumbar region prior to and followed by an extension of the surgical incision to the thoracic region for its subsequent instrumentation. The main purpose of this study was to compare a two-step surgical approach with the one-step (standard) approach. This study was a review of all the data on consecutive posterior spinal fusion surgeries performed by a specific two-surgeon team during 2004-2013. Demographics, surgical variables, radiographic findings, and outcomes regarding blood loss, morbidity, and the duration of the procedure were evaluated. Eighty-five patients underwent the standard surgical exposure, and 41 patients underwent the two-step surgical technique. With the exception of BMI, neither group showed any statistically preoperative variable significant differences. None of the postoperative outcome variables were statistically significant between both surgical approaches. No differences were detected in terms of using a two-step surgical approach versus the one-step standard surgical approach regarding perioperative blood loss, surgical time, or complications. Level of evidence III.

  19. Evaluation of Patient Outcome and Satisfaction after Surgical Treatment of Adolescent Idiopathic Scoliosis Using Scoliosis Research Society-30


    Ghandehari, Hasan; Mahabadi, Maryam Ameri; Mahdavi, Seyed Mani; Shahsavaripour, Ali; Seyed Tari, Hossein Vahid; Safdari, Farshad


    Background: Adolescent idiopathic scoliosis (AIS) may lead to physical and mental problems. It also can adversely affect patient satisfaction and the quality of life. In this study, we assessed the outcomes and satisfaction rate after surgical treatment of AIS using scoliosis research society-30 questionnaire (SRS-30). Methods: We enrolled 135 patients with AIS undergoing corrective surgery. Patients were followed for at least 2 years. We compared pre- and post-operative x-rays in terms of Co...

  20. [Bilateral tuberculous mastitis nulliparous patient, initially treated as idiopathic granulomatous mastitis]. (United States)

    Ruiz-Moreno, José Luis; Peña-Santos, Genaro


    The breast infection by M tuberculosis is rare, when it occurs, clinical and histologically confused with other forms of granulomatous inflammation, making it essential to use other diagnostic methods also may be negative. We report a patient with fimica mastitis that originally was treated as idiopathic granulomatous mastitis with apparent satisfactory clinical response. However, frequent relapses forced to look for other etiologies. Fortunately, the PCR showed the cause and was managed with specific treatment with disappearance of the disease. Clinical suspicion should be in mind when faced with a case like ours.

  1. Early radiographic risk factors for rigid relapse in idiopathic clubfoot treated with the Ponseti method. (United States)

    Mishima, Kenichi; Kitoh, Hiroshi; Matsushita, Masaki; Sugiura, Hiroshi; Hasegawa, Sachi; Kitamura, Akiko; Nishida, Yoshihiro; Ishiguro, Naoki


    This study aimed at identifying early risk factors for rigid relapse in idiopathic clubfoot using foot radiographs. Thirty-four patients with 43 idiopathic clubfeet treated with the Ponseti method were retrospectively reviewed. There were seven rigid relapse recalcitrant to manipulation and requiring extensive soft-tissue release. Three radiograabphic measurements on the maximum dorsiflexion lateral (MD-Lat) radiograph, talocalcaneal (TaloCalc-Lat), tibiocalcaneal (TibCalc-Lat), and calcaneus-first metatarsal (CalcMT1-Lat) angles, showed significant differences between patients with and without rigid relapse. The TaloCalc-Lat and CalcMT1-Lat angles showed significant hazard ratio for rigid relapse by multivariate survival analysis. Clubfeet demonstrating TibCalc-Lat>90° and CalcMT1-Lat<5° have a 24.9-fold odds ratio to develop rigid relapse compared to those demonstrating TibCalc-Lat≤90° or CalcMT1-Lat≥5°. The TaloCalc-Lat, TibCalc-Lat, and CalcMT1-Lat angles on the MD-Lat radiograph immediately before the tenotomy, probably representing intrinsic tightness of the midfoot and/or hindfoot, are significant risk factors for rigid relapse in patients treated with the Ponseti method. Copyright © 2017 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  2. Small intestinal bacterial overgrowth syndrome in children with idiopathic nephritic syndrome treated with immunosuppressive agents

    Directory of Open Access Journals (Sweden)

    Katarzyna Siniewicz-Luzeńczyk


    Full Text Available Small intestinal bacterial overgrowth syndrome is defined as an increased number of non-pathogenic bacteria over 105 microorganisms in one millilitre of intestinal contents in the initial part of the small intestine. Predisposing disorders include e.g. drug-induced hypochlorydia, congenital and acquired defects of the gastrointestinal tract, immunodeficiency, severe stress situations as well as intestinal microflora imbalance after immunosuppressive therapy. The aim of the study was to assess the incidence of small intestinal bacterial overgrowth in children receiving cyclosporine A due to idiopathic nephritic syndrome. Material and methods: The study included 20 children (11 girls and 9 boys aged 4–16 years (mean age 8.83 ± 3.75 years, diagnosed with idiopathic nephritic syndrome and treated with cyclosporine for over 3 months. The use of antibiotics or probiotics less than 3 months prior to the study was an exclusion criterion. Serum levels of cyclosporin A were measured in all patients. Hydrogen breath test with lactulose was performed as an additional examination. The exhaled breath was analysed using Gastrolyzer (Bedfont. A minimum increase of 20 hydrogen molecules per million air molecules between the maximum value and the fasting level or values in the first hour of the test was considered as a positive test outcome, indicating small intestinal bacterial overgrowth. Results: Negative result of hydrogen breath test, excluding small intestinal bacterial overgrowth, was observed in all 20 children. Conclusions: The  administration of  second line immunosuppressive agents in children with idiopathic nephritic syndrome does not induce non-pathogenic bacterial multiplication in the small intestine.

  3. The morbidity and mortality of surgically treated urological patients ...

    African Journals Online (AJOL)

    Objective: To determine the morbidity and mortality of surgically treated urological patients at Moi Teaching and Referral Hospital (MTRH) and compare them with those of other tertiary centres. Design: A fi ve year hospital based, retrospective study reviewing files of patients who underwent surgery for urological problems in ...

  4. Comparison of surgical treatment in Lenke 5C adolescent idiopathic scoliosis: anterior dual rod versus posterior pedicle fixation surgery: a comparison of two practices. (United States)

    Geck, Matthew J; Rinella, Anthony; Hawthorne, Dana; Macagno, Angel; Koester, Linda; Sides, Brenda; Bridwell, Keith; Lenke, Lawrence; Shufflebarger, Harry


    Multicenter analysis of 2 groups of patients surgically treated for Lenke 5C adolescent idiopathic scoliosis (AIS). Compare patients with Lenke 5C scoliosis surgically treated with anterior spinal fusion with dual rod instrumentation and anterior column support with patients surgically treated with posterior release and pedicle screw instrumentation. Treatment of single, structural, lumbar, and thoracolumbar curves in patients with AIS has been the subject of some debate. Advocates of the anterior approach assert that their technique spares posterior musculature and may save distal fusion levels, and that with dual rods and anterior column support the issues with nonunion and kyphosis have been obviated. Advocates of the posterior approach assert that with the change to posterior pedicle screw based instrumentation that correction and levels are equivalent, and the posterior approach avoids the issues with nonunion and kyphosis. This report directly compares the results of posterior versus anterior instrumented fusions in the operative treatment of adolescent idiopathic Lenke 5C curves. We analyzed 62 patients with Lenke 5C based on radiographic and clinical data at 2 institutions: 31 patients treated with posterior, pedicle-screw instrumented fusions at 1 institution (group PSF); and 31 patients with anterior, dual-rod instrumented fusions at another institution (group ASF). Multiple clinical and radiographic parameters were evaluated and compared. The mean age, preoperative major curve magnitude, and preoperative lowest instrumented vertebral (LIV) tilt were similar in both groups (age: PSF = 15.5 years, ASF = 15.6 years; curve size: PSF = 50.3 degrees +/- 7.0 degrees , ASF = 49.0 degrees +/- 6.6 degrees ; LIV tilt: PSF = 27.5 degrees +/- 6.5 degrees , ASF = 27.8 degrees +/- 6.2 degrees ). After surgery, the major curve corrected to an average of 6.3 degrees +/- 3.2 degrees (87.6% +/- 5.8%) in the PSF group, compared with 12.1 degrees +/- 7.4 degrees (75

  5. Dynamics of body composition and bone in patients with juvenile idiopathic arthritis treated with growth hormone. (United States)

    Bechtold, Susanne; Ripperger, Peter; Dalla Pozza, Robert; Roth, Johannes; Häfner, Renate; Michels, Hartmut; Schwarz, Hans Peter


    GH has a positive impact on growth, bone, and muscle development. The objectives of this study were to demonstrate the effects of GH treatment on regional body composition and bone geometry at final height in patients with juvenile idiopathic arthritis (JIA). In this longitudinal study, parameters of bone mineral density and geometry as well as muscle and fat cross-sectional area (CSA) in the nondominant forearm were recorded using peripheral quantitative computed tomography at yearly intervals until final height in 12 patients (seven females) receiving GH treatment. Data at final height were compared with 13 patients (nine females) with JIA not treated with GH. Patients were treated with GH for a mean of 5.35 +/- 0.7 yr. Correcting for height, total bone CSA (+0.89 +/- 0.5 sd) and muscle CSA (+1.14 +/- 0.6 sd) increased significantly and normalized at final height. Compared with JIA patients without GH at final height, there was a significantly higher muscle CSA and a lower fat CSA in GH-treated patients. Additionally, in relation to total bone CSA, there was significantly more cortical and less marrow CSA in boys with GH treatment. During GH treatment, there was a significant increase and normalization of total bone and muscle CSA at final height. In accordance with an anabolic effect of GH, fat mass stabilized at the lower limit of healthy children. At final height, cortical and marrow CSA, relative to total bone CSA, were normalized in GH-treated patients.

  6. Pharmacotherapeutic considerations for using colchicine to treat idiopathic pericarditis in the USA. (United States)

    Schwier, Nicholas C


    The clinical significance of colchicine in the treatment of acute idiopathic (viral) pericarditis (IP) was only elucidated less than a decade ago. Multiple trials have shown the benefit of colchicine in decreasing the rate of recurrence, primarily in the European population. However, the colchicine formulation used in these trials is not available in Western countries such as the USA. In the USA, two formulations are available: the 0.6 mg capsule and the 0.6 mg tablet. As a result, higher doses than administered in the European trials must be utilized to treat IP. However, the use of these dosage forms has never been studied in the treatment of IP. Pharmacokinetic and pharmacodynamic knowledge of colchicine germane to clinicians such as drug disposition and drug-drug or drug-disease interactions have not been extensively reviewed in recent years. Furthermore, the safety of colchicine in the treatment of IP has not been extensively studied, and literature regarding adverse drug events originates from data in patients treated for familial Mediterranean fever and gout. This review will help the clinician understand pharmacotherapeutic considerations and thereby optimize therapy and ensure patient safety when using colchicine to treat IP.

  7. [Pseudarthrosis following surgically treated forearm fractures in children and adolescents]. (United States)

    Fernandez Fernandez, F; Langendörfer, M; Wirth, T; Eberhardt, O


    Due to the changing attitude of treating paediatric forearm fractures increasingly towards the surgical stabilisation rather than conservatively by the method of elastic stable intramedullary nailing (ESIN), we are confronted with complications which have not been described in childhood previously. Pseudarthrosis following surgically treated forearm fractures in children is only found in single reports with none in the German-speaking area. The goal of this study is to define predisposing factors which may lead to pseudarthrosis after surgery for forearm fractures. From 1990 to 2011 all children having sustained a pseudarthrosis following forearm fractures treated in our institution were included. All children who did not demonstrate a complete consolidation of the forearm fractures after 6 months from injury were considered for the study. Those pseudarthroses which were caused through systemic diseases were excluded. During the time period of 21 years, fourteen children were treated who fulfilled the criteria of having a pseudarthrosis. Nine of the fourteen children had primarily been treated in an outside hospital, five in our institution. The average age was 10.8 years (7-15 years). There were thirteen ulnar shaft and one radius shaft pseudarthroses. In 11 children the pseudarthrosis was located in the middle third and there was one child each with a pseudarthrosis in the proximal and distal third of the ulna. There were 13 ulnar shaft fractures and one monteggia lesion. Twelve of the fractures were primarily closed and there were two open cases. In nine cases an open reduction of the ulna was necessary, the radius was openly reduced in four patients. In five children technical mistakes of the osteosynthesis were identified to contribute to the formation of the pseudarthrosis. Five of the 14 children had experienced a re-fracture. Nine children had revision surgery. These children were treated by plate osteosynthesis or ESIN. In five patients the pseudarthrosis

  8. A commentary on TREAT: The trial of early aggressive drug therapy in juvenile idiopathic arthritis

    Directory of Open Access Journals (Sweden)

    Baildam Eileen


    Full Text Available Abstract Polyarticular juvenile idiopathic arthritis (JIA is a category of JIA where multiple joints are affected by chronic inflammation, and where serious and lasting damage to joints is the expected natural history in untreated disease. There is evidence of response to disease-modifying antirheumatic and biologic drugs, but little evidence of permanent remission from any of the existing therapeutic trials. The TREAT trial by Wallace et al., recently published in Arthritis and Rheumatism, used a collaborative multicenter approach to studying early aggressive treatment of polyarticular JIA in an attempt to achieve full clinical inactive disease after 6 months of treatment. The study's main finding that the earlier in the disease course that treatment is started, the better the chance of disease control, has provided evidence that there is a 'window of opportunity' for treating JIA as there is in adult rheumatoid arthritis (RA. The study provides both a platform and an impetus for concentrating future treatment trials on early rather than established disease and investigating a standard of starting treatment within 10 to 12 weeks.

  9. [Adult height of children with idiopathic short stature treated with growth hormone therapy]. (United States)

    Avilés Espinoza, Carolina; Bermúdez Melero, Carla; Martinez Aguayo, Alejandro; García Bruce, Hernán


    Idiopathic short stature (ISS) is defined as a height of < or = 2 standard deviations (SD) from the mean for age. The use of Growth Hormone (GH) in ISS is controversial, and there are not results for adult height (AH) in Chilean patients with ISS treated with GH. The objective of the study is to compare AH in patients treated with GH with the height prediction at beginning of treatment. AH was considered with bone age ≥ 17 in males and ≥15 in females. The height SD according to the NCHS curves at beginning and ending of treatment were used for the comparison. Height prediction (HP) was calculated by Bayley-Pinneau method. AH was reached by 18/47 patients with ISS treated with GH. Initial height -2.1 ± 0.85 SD (133.1±6.8 cm) and HP -1.94±0.86 SD, and were treated since 11.6 ± 1.2 years old. After one year of treatment their height was -1.64 ± 0.69 SD, and AH was -1.28 +/- 0.62 SD (163.76 +/- 7.22 cm). It is suggested that treatment with GH for ISS is effective to increase AH. Although with wide individual variability, a mean increase of 0.67±0.9 SD (+2.67 cm) was obtained in the AH. This is the first report on Adult Height in Chilean patients. Copyright © 2015 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  10. Tympanotomy with sealing of the round window as surgical salvage option in sudden idiopathic sensorineural hearing loss. (United States)

    Loader, Benjamin; Atteneder, Claudia; Kaider, Alexandra; Franz, Peter


    Tympanotomy with sealing of the round window is a promising surgical alternative as a salvage strategy in younger patients with acute idiopathic sensorineural hearing loss (SNHL) and may be considered as an alternative drug delivery method to the round window. To analyze the potential benefit of the sealing of the round window with special emphasis on the age of treated patients and the influence of time elapsed between symptom onset and surgery. This was a retrospective cohort study of 25 patients (13 males,12 females) with an average age of 55 years (range 31-75 years) with sudden SNHL, who underwent an enaural tympanotomy with sealing of the round niche using triamcinolone-soaked fascia. Pre- and postoperative bone conduction thresholds were compared for each frequency and for the pure-tone average (PTA) measured at 500 Hz, 1 kHz, 2 kHz, and 3 kHZ. The time (days) between primary symptom onset and surgery as well as age was scrutinized. Hearing improvement was described as 'no improvement' (0-9 dB), 'moderate recovery' (10-29 dB), or 'marked recovery' (≥30 dB). The difference in age of patients who improved was compared to those who did not. A statistically significant improvement in PTA values (mean change 20.4 dB) was noted (p = 0.0002). In all, 13/25 (52%) patients exhibited improved bone conduction postoperatively regardless of age and time of treatment. A marked recovery (≥30 dB) could be seen in eight patients (median time to surgery, 9 days; average age, 48.5 years); recovery between 10 and 30 dB in five patients (median time to surgery, 10 days; average age, 46.6 years). Twelve significantly older patients showed no improvement (average time to surgery, 19 days; average age, 61.8 years; p = 0.004). No patient over the age of 65 years showed improvement in bone conduction.

  11. Tissue engineering as a potential alternative or adjunct to surgical reconstruction in treating pelvic organ prolapse

    DEFF Research Database (Denmark)

    Boennelycke, M; Gräs, Søren; Lose, G


    Cell-based tissue engineering strategies could potentially provide attractive alternatives to surgical reconstruction of native tissue or the use of surgical implants in treating pelvic organ prolapse (POP).......Cell-based tissue engineering strategies could potentially provide attractive alternatives to surgical reconstruction of native tissue or the use of surgical implants in treating pelvic organ prolapse (POP)....

  12. Efficacy of Electrical Pudendal Nerve Stimulation versus Transvaginal Electrical Stimulation in Treating Female Idiopathic Urgency Urinary Incontinence. (United States)

    Wang, Siyou; Lv, Jianwei; Feng, Xiaoming; Lv, Tingting


    We compared the efficacy of electrical pudendal nerve stimulation vs transvaginal electrical stimulation to treat female idiopathic urgency urinary incontinence. A total of 120 female patients with idiopathic urgency urinary incontinence refractory to medication were randomized at a ratio of 2:1 to group 1 of 80 patients and group 2 of 40. Groups 1 and 2 were treated with electrical pudendal nerve stimulation and transvaginal electrical stimulation, respectively. To perform electrical pudendal nerve stimulation long acupuncture needles were deeply inserted into 4 sacrococcygeal points and electrified to stimulate pudendal nerves. Outcome measures were the 24-hour pad test and a questionnaire to measure the severity of symptoms and quality of life in women with urgency urinary incontinence. The median severity of symptoms and quality of life score on the urgency urinary incontinence questionnaire (urgency urinary incontinence total score) was 13 (range 7 to 18.75) in group 1 and 11 (range 8 to 16) in group 2 before treatment, which decreased to 2 (range 0 to 6.75) in group 1 and 6.5 (range 3.25 to 10.75) in group 2 (both p Electrical pudendal nerve stimulation is more effective than transvaginal electrical stimulation in treating drug refractory, female idiopathic urgency urinary incontinence. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  13. Anterior Dual Rod Versus Posterior Pedicle Fixation Surgery for the Surgical Treatment in Lenke 5C Adolescent Idiopathic Scoliosis: A Multicenter, Matched Case Analysis of 42 Patients. (United States)

    Geck, Matthew J; Rinella, Anthony; Hawthorne, Dana; Macagno, Angel; Koester, Linda; Sides, Brenda; Lenke, Lawrence; Bridwell, Keith; O'Brien, Mike; Shufflebarger, Harry L


    Multicenter matched case analysis. Compare patients with Lenke 5C scoliosis surgically treated with anterior spinal fusion with dual rod instrumentation and anterior column support versus posterior release and pedicle screw instrumentation. Treatment of single, structural, lumbar and thoracolumbar curves in patients with adolescent idiopathic scoliosis (AIS) has been the subject of some debate. Previous papers directly comparing these approaches are problematic because of heterogeneity of the groups, nonrandomized protocols, and surgeon bias and variation of instrumentation (upper instrumented vertebrae and lower instrumented vertebrae) in relation to the defined Cobb angle (upper end vertebra and lower end vertebrae). This report sought to remedy these flaws by analyzing a database of Lenke 5C AIS and performing matched cases. We analyzed 96 patients with Lenke 5C AIS curves based on radiographic and clinical data at 3 institutions, surgically treated between 2001 and 2005 with minimum 2-year follow-up. Case matched criteria (age within 1 year, sex, curve within 5°, lower end vertebrae, and lower instrumented vertebrae) yielded 21 matched patient pairs. We evaluated and compared multiple clinical and radiographic parameters. We observed no significant statistical differences between groups in any preoperative clinical or radiographic parameters. At final follow-up, the major curve measured 8° (83%) in the posterior spinal fusion group, compared with 13° (72%) in the anterior spinal fusion group (p = .002). Estimated blood loss was similar in both groups. Hospital stay was significantly shorter in the posterior spinal fusion group. There were no differences in radiographic complications, such as proximal junctional kyphosis. At a minimum of 2 years' follow-up in a multicenter, matched case analysis, adolescents with Lenke 5C curves demonstrated statistically significantly better curve correction and shorter hospital stays when treated with a posterior release

  14. Pre- and postoperative photographs and surgical outcomes in patients with Lenke type 1 adolescent idiopathic scoliosis. (United States)

    Albayrak, Akif; Buyuk, Abdul Fettah; Ucpunar, Hanifi; Balioglu, Mehmet Bulent; Kargin, Deniz; Kaygusuz, Mehmet Akif


    Clinical study with pre- and postoperative back photographs and postoperative Scoliosis Research Society-22 survey in patients who had undergone surgery for idiopathic scoliosis. To determine the effect of showing patients their photographs before and after surgery for idiopathic scoliosis on postoperative patient satisfaction. After scoliosis surgery, patient satisfaction may be limited because the patients cannot directly see their back and may forget the preoperative appearance. In 60 patients who had undergone surgery for correction of idiopathic scoliosis (Lenke type 1), pre- and postoperative photographs were taken from the anterior, posterior, and right and left lateral views. After surgery, patients in group 1 (30 patients) were shown the preoperative and most recent follow-up photographs, and patients in group 2 (30 patients) had routine evaluation but were not shown their photographs. All patients completed the Scoliosis Research Society-22 survey. Patients in both groups had similar age, sex, distribution of Lenke type and Risser sign, follow-up, and pre- and postoperative Cobb angles and balance (coronal and sagittal). A significant difference was observed between the groups for survey question 10 (which was about self-image), question 18 (which was about function and activity), and question 21 (which was about satisfaction) (P ≤ 0.05). There were no differences between patients in groups 1 and 2 in Scoliosis Research Society-22 domain or total scores. By showing patients the pre- and postoperative clinical photographs, patient satisfaction may be greater, as measured with some SRS-22 scores. This method may enable clinicians to positively change the patients' self-image perception after surgery for correction of scoliosis. 4.

  15. Dental Personnel Treated for Idiopathic Pulmonary Fibrosis at a Tertiary Care Center - Virginia, 2000-2015. (United States)

    Nett, Randall J; Cummings, Kristin J; Cannon, Brenna; Cox-Ganser, Jean; Nathan, Steven D


    In April 2016, a Virginia dentist who had recently received a diagnosis of idiopathic pulmonary fibrosis (IPF) and was undergoing treatment at a specialty clinic at a Virginia tertiary care center contacted CDC to report concerns that IPF had been diagnosed in multiple Virginia dentists who had sought treatment at the same specialty clinic. IPF is a chronic, progressive lung disease of unknown cause and associated with a poor prognosis (1). Although IPF has been associated with certain occupations (2), no published data exist regarding IPF in dentists. The medical records for all 894 patients treated for IPF at the Virginia tertiary care center during September 1996-June 2017 were reviewed for evidence that the patient had worked as a dentist, dental hygienist, or dental technician; among these patients, eight (0.9%) were identified as dentists and one (0.1%) as a dental technician, and each had sought treatment during 2000-2015. Seven of these nine patients had died. A questionnaire was administered to one of the living patients, who reported polishing dental appliances and preparing amalgams and impressions without respiratory protection. Substances used during these tasks contained silica, polyvinyl siloxane, alginate, and other compounds with known or potential respiratory toxicity. Although no clear etiologies for this cluster exist, occupational exposures possibly contributed. This cluster of IPF cases reinforces the need to understand further the unique occupational exposures of dental personnel and the association between these exposures and the risk for developing IPF so that appropriate strategies can be developed for the prevention of potentially harmful exposures.

  16. Long-term outcomes of adult chronic idiopathic hydrocephalus treated with a ventriculo-peritoneal shunt. (United States)

    Illán-Gala, I; Pérez-Lucas, J; Martín-Montes, A; Máñez-Miró, J; Arpa, J; Ruiz-Ares, G


    Adult chronic idiopathic hydrocephalus (ACIH) is a cause of dementia that can be treated by implanting a ventriculo-peritoneal shunt (VPS). We aim to study clinical and functional outcomes in patients with ACIH corrected with a VPS. Observational cohort study of patients diagnosed with probable ACIH (Japan Neurosurgical Society guidelines) and undergoing shunt placement between 2008 and 2013 in a centre of reference for neurosurgery in Spain. Clinical improvement was classified in 4 categories (resolution, partial improvement, equivocal improvement, and no improvement); functional outcome was assessed on the modified Rankin scale (mRS). The study included 29 patients with a mean age of 73.9 years; 62.1% were male and 65.5% had hypertension. Clinical improvement (complete or partial) was observed in 58% after one year and in 48% by the end of the follow-up period (mean follow-up time was 37.8 months). Older age, presence of hypertension, and surgery-related complications were more prevalent in the group responding poorly to treatment. One patient died, 20.7% experienced severe complications, and 69% were dependent (mRS ≥ 3) by the end of the follow-up period. Age at diagnosis was independently associated with poorer clinical response at one year and a higher degree of dependency by the end of follow-up. Symptomatic benefits offered by VPS were partial and transient; treatment was associated with a high complication rate and poor functional outcomes in the long term, especially in the oldest patients. Copyright © 2015 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  17. Acetabular labral tear complicating idiopathic osteonecrosis of the femoral head treated by labral repair with hip arthroscopy: a case report. (United States)

    Izumida, Hiroyuki; Kanaji, Arihiko; Nishiwaki, Toru; Shimizu, Hidenori; Fujie, Atsuhiro; Tando, Toshimi; Toyama, Yoshiaki; Suda, Yasunori


    It has been well documented that labral tear is frequently associated with femoroacetabular impingement and dysplasia of the hip; however, there have been few reported cases of labral tear associated with idiopathic osteonecrosis of the hip. Here we report the case of a patient with labral tear associated with idiopathic osteonecrosis of the femoral head who was treated by hip arthroscopy, with a favorable short-term outcome. Under the diagnosis of systemic lupus erythematosus, a 28-year-old Japanese woman was treated with the oral administration of steroid in 2007. A year after the treatment, she developed right hip joint pain and was diagnosed with idiopathic osteonecrosis of the femoral head at our institution. In November of 2011, she revisited our hospital when her right hip joint pain exacerbated and she became unable to walk. On the visit, the anterior impingement sign and Patrick test were positive. Radiography and magnetic resonance imaging in 2011 demonstrated neither spreading of the osteonecrosis area nor collapse of the femoral head in the right joint; however, magnetic resonance imaging showed a high-intensity area in the articular labrum in a T2-weighted image, leading to a diagnosis of labral tear. She underwent labral repair with hip arthroscopy in August of 2012. Now, 1 year after surgery, she does not feel any pain during walking and her modified Harris hip score has improved from 20 prior to surgery to 85. The case indicated that it is important to be aware of the possibility of labral tear in patients with idiopathic osteonecrosis of the femoral head, when spreading of the osteonecrosis area or collapse of the femoral head has not been seen on magnetic resonance imaging.

  18. Surgical Outcomes of Lung Cancer Patients with Combined Pulmonary Fibrosis and Emphysema and Those with Idiopathic Pulmonary Fibrosis without Emphysema. (United States)

    Sato, Seijiro; Koike, Terumoto; Hashimoto, Takehisa; Ishikawa, Hiroyuki; Okada, Akira; Watanabe, Takehiro; Tsuchida, Masanori


    Combined pulmonary fibrosis and emphysema (CPFE) is a unique disorder. The aim of this study was to compare the surgical outcomes of lung cancer patients with CPFE and those with idiopathic pulmonary fibrosis (IPF) without emphysema. A total of 1548 patients who underwent surgery for primary lung cancer between January 2001 and December 2012 were retrospectively reviewed. Of the 1548 patients, 55 (3.6%) had CPFE on computed tomography (CT), and 45 (2.9%) had IPF without emphysema. The overall and disease-free 5-year survival rates for patients with CPFE were not significantly worse than those for patients with IPF without emphysema (24.9% vs. 36.8%, p = 0.814; 39.8% vs. 39.3%, p = 0.653, respectively). Overall, 21 (38.1%) patients with CPFE and nine patients (20.0%) with IPF without emphysema developed postoperative cardiopulmonary complications. Patients with CPFE had significantly more postoperative cardiopulmonary complications involving pulmonary air leakage for >6 days, hypoxemia, and arrhythmia than patients with IPF without emphysema (p = 0.048). There was no significant difference in survival after surgical treatment between CPFE patients and IPF patients without emphysema, but CPFE patients had significantly higher morbidity than IPF patients without emphysema.

  19. The efficacy and safety of onabotulinumtoxinA in treating idiopathic OAB: A systematic review and meta-analysis. (United States)

    Cui, Yuanshan; Zhou, Xin; Zong, Huantao; Yan, Huilei; Zhang, Yong


    We carried out a systematic review and meta-analysis to assess the efficacy and safety of the drug for treating idiopathic OAB. A literature review was performed to identify all published randomized double-blind, placebo-controlled trials of onabotulinumtoxinA for the treatment of idiopathic OAB. The search included the following databases: MEDLINE, EMBASE, and the Cochrane Controlled Trials Register. The reference lists of the retrieved studies were also investigated. Eight publications involving a total of 1,320 patients were used in the analysis, including six RCTs that compared onabotulinumtoxinA with placebo. OnabotulinumtoxinA significantly decreased the mean number of urinary incontinence (UI) per day -2.77 versus -1.01 (the standardized mean difference (SMD) = -1.68, 95% CI = -2.06 to -1.31, P SMD = -1.82, 95% CI = -2.61 to -1.02, P SMD = 63.82, 95% CI = 38.14 to 89.50, P SMD = 33.05, 95% CI = 22.45 to 43.66, P infections (UTI; P < 0.00001) and clean intermittent catheterization (CIC; P < 0.00001). This meta-analysis indicates that onabotulinumtoxinA to be an effective treatment for idiopathic overactive bladder symptoms with side effects primarily localized to urinary tract. © 2014 Wiley Periodicals, Inc.

  20. Adolescent idiopathic scoliosis patients report increased pain at five years compared with two years after surgical treatment. (United States)

    Upasani, Vidyadhar V; Caltoum, Christine; Petcharaporn, Maty; Bastrom, Tracey P; Pawelek, Jeff B; Betz, Randal R; Clements, David H; Lenke, Lawrence G; Lowe, Thomas G; Newton, Peter O


    A multicenter study of changes in Scoliosis Research Society (SRS) outcome measures after surgical treatment of adolescent idiopathic scoliosis (AIS). To evaluate changes in patient determined outcome measures between 2 and 5 years after AIS surgery. Current surgical procedures have been shown to improve subjective measures in patients with AIS. At 2-year follow-up, AIS patients reported significant improvement in all 4 preoperative domains of the SRS questionnaire. In addition, the major Cobb angle was shown to be negatively correlated with preoperative scores in the pain, general self-image, and general function domains. Five-year SRS scores have not been evaluated previously. A multicenter, prospectively generated database was used to obtain perioperative, radiographic, and SRS-24 outcomes data. The inclusion criteria were: a diagnosis of AIS, surgical treatment (anterior, posterior, or combined), a comprehensive set of radiographic measures, and completed preoperative, 2-year, and 5-year SRS questionnaires. Repeated measures analysis of variance was used to compare changes in patient responses for each of the 7 outcome domains. Univariate analysis of variance was used to compare the change in pain score at 5 years to the level of the lowest instrumented vertebrae and surgical approach. A correlation analysis was used to determine the association between changes in any of the radiographic variables and changes in SRS scores. The data were checked for normality and equal variances, and the level of significance was set at P < 0.01. Forty-nine patients (42 women, 7 men; 14.2 +/- 2.1 year old; 5.4 +/- 0.6 years follow-up) met the inclusion criteria for this study. Thirty-seven of 49 (76%) of these patients underwent an open or thoracoscopic anterior procedure. SRS-24 scores improved significantly in 3 of the 4 preoperative domains at the 2-year visit. At 5 years postop, a statistically significant decrease in the pain score (4.2 +/- 0.6 to 3.9 +/- 0.9, P = 0

  1. Clinical experience of surgically treating giant neurofibromatosis-1. (United States)

    Chen, Baoguo; Xu, Minghuo; Song, Huifeng; Gao, Quanwen


    The surgical treatment for giant neurofibromatosis-1 (NF-1) requires comprehensive measures. Presently, there is no systematic description of surgical treatment. Because of its high level of risk, we want to share our clinical experience. From 2011 to 2014, patients (n = 8, 5 female and 3 male patients, aging from 31 to 45 years-old) were included in the study. The tumours were located on the trunk (n = 5) or face (n = 3). In addition to routine examination, blood storage was also prepared. Preoperative consultation from related departments was critical at first. Related artery embolisation was also carried out. In the operation, we checked thromboelastography, based on which reasonable blood component transfusion was implemented. Autologous blood transfusion was also ready. An instrument of copper needle or ring ligation was used to reduce haemorrhage before the surgery. Protruding or drooping portions of the tumours were excised. A pressurised bandage was applied when the surgery was completed. After the surgery, besides the routine monitoring of vital signs, re-haemorrhage should be detected in time. Then, we should decide whether blood transfusion or surgery was required again. Expanders were implanted in one female patient with facial injuries before removing the tumour. Then, expanded flaps were applied to repair the secondary wound. According to the above clinical route, after an average of 1-year follow-up, no patients died, and other unforeseen events did not occur. Wounds healed well in all patients. The tumor was excised as much as possible. No facial nerve paralysis occurred in the facial sites. Expanded flaps necrosis WAS not encountered. It is essential to design the educational clinical route for treating NF-1 when a giant protruding tumour is advised to be excised, which can minimise the risk of surgery and assure us of the maximum range of resection. © 2016 Inc and John Wiley & Sons Ltd.

  2. Can abdominal surgical emergencies be treated in an ambulatory setting? (United States)

    Genser, L; Vons, C


    The performance of emergency abdominal surgery in an outpatient setting is increasingly the order of the day in France. This review evaluates the feasibility and reliability of ambulatory surgical treatment of the most common abdominal emergencies: appendectomy for acute appendicitis and cholecystectomy for acute complications of gallstone disease (acute cholecystitis and gallstone pancreatitis). This study evaluates surgical procedures performed on an ambulatory basis according to the international definition (admission in the morning, discharge in the evening with a hospital stay of less than 12 hours). Just as for elective surgery, eligibility of patients for an ambulatory approach depends on the capacities of the surgical and anesthesia team: to manage the risks, particularly the risk of deferring surgery until the morning); to prevent or treat post-operative symptoms like pain, nausea, vomiting, re-ambulation in order to permit rapid post-operative discharge. Recent studies have shown that appendectomy for non-complicated acute appendicitis can be deferred for up to 12 hours without any increase in danger. Many other studies have shown that early discharge after appendectomy for acute non-complicated appendicitis is feasible and safe. Nonetheless, there is only one published series of truly ambulatory appendectomies. The results were excellent. Patients who presented in the afternoon were brought back for operation the following morning. The appropriate timing for performance of cholecystectomy in patients with acute calculous cholecystitis or gallstone pancreatitis has not been well defined, but is always somewhat delayed relative to the onset of symptoms. To minimize operative complications, cholecystectomy for acute calculous cholecystitis should probably be performed between 24 and 72 hours after diagnosis. Cholecystectomy for gallstone pancreatitis should probably not be delayed longer than a week; the need to keep the patient hospitalized during the

  3. Blood transfusion in the surgical treatment of adolescent idiopathic scoliosis-a single-center experience of patient blood management in 210 cases. (United States)

    Ohrt-Nissen, Søren; Bukhari, Naeem; Dragsted, Casper; Gehrchen, Martin; Johansson, Pär I; Dirks, Jesper; Stensballe, Jakob; Dahl, Benny


    The surgical treatment of adolescent idiopathic scoliosis can be associated with substantial blood loss, requiring allogeneic red blood cell (RBC) transfusion. This study describes the use of RBC and the effect of a standardized perioperative patient blood management program. Patients treated with posterior instrumented fusion were consecutively enrolled over a 6-year period. Patient blood management strategies were implemented in 2011, including prophylactic tranexamic acid, intraoperative permissive hypotension, restrictive fluid therapy (including avoidance of synthetic colloids), restrictive RBC trigger according to institutional standardized protocol, the use of cell savage, and goal-directed therapy according to thrombelastography. In total, 210 patients were included. 64 patients (31%) received RBC transfusions. A decline in the intraoperative rate of RBC transfusion was observed, from 77% in 2011 to 13% in 2016 (p transfusion group had a significantly larger major curve, lower preoperative hemoglobin, higher estimated blood loss, and an increased use of crystalloid volume resuscitation. Multiple logistic regression showed that significant predictors for RBC transfusion were preoperative hemoglobin level (odds ratio [OR], 0.40; 95% confidence interval [CI], 0.27-0.57), estimated blood loss (OR, 1.26; 95% CI, 1.15-1.42), and year of surgery (indicating the effect of patient blood management) (OR per year, 0.76; 95% CI, 0.58-0.99). A perioperative patient blood management program substantially reduced the need for RBC transfusion. A preoperative evaluation of anemia is essential to further minimize transfusion rates. © 2017 AABB.

  4. Quality of life and self-esteem in children treated for idiopathic short stature

    NARCIS (Netherlands)

    Theunissen, N.C.M.; Kamp, G.A.; Koopman, H.M.; Zwinderman, K.A.H.; Vogels, T.; Wit, J.-M.


    Objective: Changes in health-related quality of life (HRQOL) and self-esteem were studied in children with idiopathic short stature (ISS) participating in a study on the effect of growth hormone treatment. Study design: Prepubertal children (n = 36) with ISS were randomly assigned to a treatment or

  5. Influence of Distal Fusion Level on Sagittal Spinopelvic and Spinal Parameters in the Surgical Management of Adolescent Idiopathic Scoliosis. (United States)

    Akgül, Turgut; Sarıyılmaz, Kerim; Korkmaz, Murat; Özkunt, Okan; Kaya, Özcan; Dikici, Fatih


    Retrospective analysis of adolescent idiopathic scoliosis. This study aimed to investigate the influence of distinct distal fusion levels on spinopelvic parameters in patients with adolescent idiopathic scoliosis (AIS) who underwent posterior instrumentation and fusion surgery. The distal fusion level selection in treatment of AIS is the one of milestone to effect on surgical outcome. Most of the paper focused on the coronal deformity correction and balance. The literature have lack of knowledge about spinopelvic changing after surgical treatment and the relation with distal fusion level. We evaluate the spinopelvic and pelvic parameter alteration after fusion surgery in treatment of AIS. A total of 100 patients with AIS (88 females and 12 males) were retrospectively reviewed. Patients were assigned into the following three groups according to the distal fusion level: lumbar 2 (L2), lumbar 3 (L3), and lumbar 4 (L4). Using a lateral plane radiograph of the whole spine, spinopelvic angular parameters such as thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT) were radiologically assessed. The mean age was 15±2.4 years, and the mean follow-up period was 24.27±11.69 months. Regarding the lowest instrumented vertebra, patients were categorized as follows: 30 patients in L2 (group 1), 40 patients in L3 (group 2), and 30 patients in L4 (group 3). TK decreased from 36.60±13.30 degrees preoperatively to 26.00±7.3 degrees postoperatively in each group ( p =0.001). LL decreased from 52.8±9.4 degrees preoperatively to 44.30±7.50 degrees postoperatively ( p =0.001). Although PI showed no difference preoperatively among the groups, it was statistically higher postoperatively in group 3 than in the other groups ( p 0.05). However, mean SS was significantly higher in group 3 ( p =0.042, p <0.05). PT decreased from 15.50±7.90 degrees preoperatively to 15.2±7.10 degrees postoperatively. The positive relationship (28

  6. A sixteen year sample of surgically treated supernumerary teeth. (United States)

    Pippi, R


    Supernumerary teeth represent a numerical dental anomaly in which more teeth than the norm are present in the dentition. A sixteen year sample of supernumerary teeth has been reviewed in order to analyse epidemiological data, morphological and topographic features of these teeth, especially of those located in the praemaxillary region. All cases in which supernumerary teeth were surgically treated from 1991 to 2006 at the Oral Surgery Unit of the Sapienza University of Rome have been reviewed. 118 Caucasian subjects with supernumerary teeth have been reviewed in the range of age comprised between 5 and 42 years: 191 SNTs were collected, 136 from the upper jaw and 55 from the mandible. In the maxilla the incisor region was more frequently involved (67.65%), while in the mandible the one most frequently involved was the premolar region (69.1%). Conoid was the most frequent type of supernumerary teeth. Uneruption of the contiguous permanent teeth was the most commonly associated pathological condition, found in 81 out of the 191 cases of supernumerary teeth (40 patients, 42.4%). Tuberculated, infundibuliform and incisiform-shaped teeth caused uneruption of permanent teeth more frequently than the other morphological types of supernumerary teeth. In the upper incisor area, the extraction of SNT is mandatory as early as they are diagnosed, especially if they are tuberculated, infundibuliform and incisiform-shaped, if they are located palatally or just in the middle of the ridge and when more than one SNT is present.

  7. Real time noninvasive assessment of external trunk geometry during surgical correction of adolescent idiopathic scoliosis

    Directory of Open Access Journals (Sweden)

    Mac-Thiong Jean-Marc


    Full Text Available Abstract Background The correction of trunk deformity is crucial in scoliosis surgery, especially for the patient's self-image. However, direct visualization of external scoliotic trunk deformity during surgical correction is difficult due to the covering draping sheets. Methods An optoelectronic camera system with 10 passive markers is used to track the trunk geometry of 5 scoliotic patients during corrective surgery. The position of 10 anatomical landmarks and 5 trunk indices computed from the position of the passive markers are compared during and after instrumentation of the spine. Results Internal validation of the accuracy of tracking was evaluated at 0.41 +/- 0.05 mm RMS. Intra operative tracking during surgical maneuvers shows improvement of the shoulder balance during and after correction of the spine. Improvement of the overall patient balance is observed. At last, a minor increase of the spinal length can be noticed. Conclusion Tracking of the external geometry of the trunk during surgical correction is useful to monitor changes occurring under the sterile draping sheets. Moreover, this technique can used be used to reach the optimal configuration on the operating frame before proceeding to surgery. The current tracking technique was able to detect significant changes in trunk geometry caused by posterior instrumentation of the spine despite significant correction of the spinal curvature. It could therefore become relevant for computer-assisted guidance of surgical maneuvers when performing posterior instrumentation of the scoliotic spine, provide important insights during positioning of patients.

  8. [Adjuvant systemic antibiotic therapy for surgically treated spondylodiscitis]. (United States)

    Marmelstein, D; Homagk, N; Hofmann, G O; Röhl, K; Homagk, L


    Recognised methods for the treatment of spondylodiscitis in correspondence to the immobilisation are systemic antibiotic therapy. However, the available data for recommendations of specific antibiotic therapy are very heterogeneous. The aim of this study was to focus on the adjuvant antibiotic therapy in surgical treated cases of spondylodiscitis and to reach a guideline regarding its application in patients' spondylodiscitis. Between 01.10.1998 and 31.12.2011 276 inpatient cases of spondylodiscitis were surgically treated, documented and included in the study. The study involved medical history, germ status, localisation and extent of spondylodiscitis and antibiotic treatment. Between 01.01.2012 and 31.12.2013 a further 20 cases of spondylodiscitis were treated according to a standardised treatment regimen of antibiotic therapy and included in the study. The age distribution shows a marked prominence of 60 to 80 year-olds, with a leading localisation of spondylodiscitis in the lumbar spine with 55 % followed by the thoracic spine (33 %) and the cervical spine (12 %). A constant observation during the study periods was the delayed diagnosis of more than 1 month of spondylodiscitis, so that about 60 % of the patients were not receiving any treatment for their disease at the time of hospitalisation. The aetiology of spondylodiscitis is very heterogeneous and remained unknown in 34 % of cases. However, diabetes mellitus appeared as a disease favouring the occurrence of spondylodiscitis since it was concomitant with almost 50 % of patients with spondylodiscitis. The bacterial spectrum is limited in our area to staphylococci, with a predominance of Staphylococcus aureus. At least about 10 % of the germs are multi-drug resistant. In 45 % of cases, pathogen detection was unsuccessful. Clindamycin is the most commonly used antibiotic in the treatment of spondylodiscitis and is used in 26.8 % in combinations with other antibiotics. The antibiotic therapy


    Directory of Open Access Journals (Sweden)

    Gautam Choudhury


    Full Text Available BACKGROUND Long-term success reports by Dr. Ponseti with the Ponseti method in the treatment of congenital idiopathic clubfoot have led to a renewed interest in this method among paediatric orthopaedists. The purpose of this study is to evaluate mid-term effectiveness of Ponseti method for the treatment of congenital idiopathic clubfoot. MATERIALS AND METHODS Of 93 babies (26 girls, 67 boys with idiopathic clubfoot who began treatment at Assam Medical College and Hospital between April 2014 and June 2016. 85 patients (22 girls and 63 boys with 127 clubfeet (71 right feet, 56 left feet were included in the study. 42 cases were bilateral and 43 were unilateral. Minimum age 6 days and maximum age 3 years (SD 0.64 years. Presentation was categorised as either early or late. 26 (30.59% of 85 babies who presented for treatment were 28 days or younger versus 59 (69.41% of 85 babies who presented for treatment were late presenters. RESULTS Mean no. of cast required was 5.1. 26 feet (20% did not require Achilles tenotomy. Higher initial severity scores at presentation were associated with the need for tenotomy. 31 (36% had poor brace use and 54 (63% had good brace use. Of 26 babies who presented early for treatment (28 days or younger, 11 (42.3% had poor brace use and 15 (57.7% had good brace use. However, in 59 babies who presented late, a larger percentage had good brace use (39 babies than poor brace use (20 babies. No additional surgery was required for 60% of the brace intolerant patients. Final dorsiflexion was adequate for 117 (92% of 127 feet. The final ankle motion (i.e., plantar flexion, dorsiflexion was no different between early and late presenters. CONCLUSION Ponseti method is a safe and satisfactory treatment for congenital idiopathic clubfoot with mid-term effectiveness.

  10. Acute non-traumatic idiopathic spinal subdural hematoma: radiographic findings and surgical results with a literature review. (United States)

    Kobayashi, Kazuyoshi; Imagama, Shiro; Ando, Kei; Nishida, Yoshihiro; Ishiguro, Naoki


    Intraspinal hematoma is a serious condition, and early diagnosis is necessary to permit emergency treatment. Among such hematomas, non-traumatic spinal subdural hematoma is a rare occurrence. We have experienced three patients with surgically proven subdural spinal hematoma, and here we report these cases with a review of their clinical and imaging characteristics. All three cases were idiopathic with no history of disease, no coagulopathy, and no trauma. All had acute onset that brought about paralysis of the lower limbs with severe pain. Early surgery was performed, based on a relatively early diagnosis using thoracolumbar MRI and CT. Since the epidural fat is not affected by bleeding, the normal structure remains and the boundary between hematoma and fat is a significant feature in MRI and CT. Partial Gd enhancement in MRI and ring enhancement in contrast CT were also apparent. Two of the cases had subarachnoid hematomas. Preoperative diagnosis of spinal subarachnoid hematoma is difficult because there are no specific radiological findings and confirmation can only occur intraoperatively. In particular, one case had a massive hematoma causing canal stenosis, and it was difficult to distinguish between intradural and extradural hematoma. In all cases of subarachnoid or subdural hematoma, decompression was performed within 24 h after onset, and consequently, the patients had relatively good outcomes.

  11. Clinical Impact of Emphysema Evaluated by High-Resolution Computed Tomography on Idiopathic Pulmonary Fibrosis Diagnosed by Surgical Lung Biopsy. (United States)

    Kohashi, Yasuo; Arai, Toru; Sugimoto, Chikatoshi; Tachibana, Kazunobu; Akira, Masanori; Kitaichi, Masanori; Hayashi, Seiji; Inoue, Yoshikazu


    The prognosis of combined cases of pulmonary fibrosis and emphysema is unresolved partially because radiological differentiation between usual interstitial pneumonia and nonspecific interstitial pneumonia is difficult in coexisting emphysema cases. The purpose of this study was to clarify the clinical impact of emphysema on the survival of patients with idiopathic pulmonary fibrosis (IPF). One hundred and seven patients with interstitial lung diseases were diagnosed by surgical lung biopsies between 2006 and 2012, and 47 patients were diagnosed with IPF through multidisciplinary discussion. Emphysema on high-resolution computed tomography scans was evaluated semiquantitatively by visual scoring. Eight out of the 47 IPF patients showed a higher emphysema score (>3) and were diagnosed to have IPF-emphysema. The median survival time of patients with IPF-emphysema (1,734 days) from the initial diagnosis was significantly shorter than that of patients with IPF alone (2,229 days) by Kaplan-Meier analysis (p = 0.007, log-rank test). Univariate Cox proportional hazard regression analyses revealed that a higher total emphysema score (>3.0) was a significantly poor prognostic factor in addition to Krebs von den Lungen-6, surfactant protein-D, arterial oxygen tension, percent forced vital capacity, and percent diffusing capacity of carbon monoxide (%DLCO). Multivariate Cox proportional hazard regression analyses with the stepwise method showed that higher total emphysema score (>3) and %DLCO were significantly poor prognostic factors. The prognosis of IPF-emphysema was significantly worse than that of IPF alone. © 2016 S. Karger AG, Basel.

  12. Evaluation of Patient Outcome and Satisfaction after Surgical Treatment of Adolescent Idiopathic Scoliosis Using Scoliosis Research Society-30. (United States)

    Ghandehari, Hasan; Mahabadi, Maryam Ameri; Mahdavi, Seyed Mani; Shahsavaripour, Ali; Seyed Tari, Hossein Vahid; Safdari, Farshad


    Adolescent idiopathic scoliosis (AIS) may lead to physical and mental problems. It also can adversely affect patient satisfaction and the quality of life. In this study, we assessed the outcomes and satisfaction rate after surgical treatment of AIS using scoliosis research society-30 questionnaire (SRS-30). We enrolled 135 patients with AIS undergoing corrective surgery. Patients were followed for at least 2 years. We compared pre- and post-operative x-rays in terms of Cobb's angles and coronal balance. At the last visit, patients completed the SRS-30 questionnaire. We then assessed the correlation between radiographic measures, SRS-30 total score, and patient satisfaction. Cobb's angle and coronal balance improved significantly after surgery (Pself-image/cosmesis, mental health, and satisfaction were 27±4.3, 26±2.5, 33±5.2, 23±3.5, and 13±1.8, respectively. The total SRS-30 score was 127±13. Radiographic measures showed significant positive correlation with satisfaction and SRS-30 total scores. There was also a positive correlation between satisfaction and self-image/cosmesis domain scores. The greater the radiographic angles were corrected the higher the SRS-30 total score and patient satisfaction were. It is intuitive that the appearance and cosmesis is of most important factor associated with patient satisfaction.

  13. Surgically treated spinal metastases: Do prognostic scores have a role? (United States)

    Afsar, Afifa; Qadeer, Mohsin; Sharif, Salman


    The outcome for patients with metastatic disease in spine is difficult to predict. Multiple scoring systems were utilized in this study to determine their effectiveness in predicting long-term prognoses. A retrospective analysis of surgically treated patients of spinal metastasis was performed between 2005 and 2016. Data were collected prospectively during which 8 patients were lost to follow-up. Ultimately, data from 63 patients were reviewed. Treatment and prognoses were analyzed utilizing various scoring systems including the SINS, the Tomita, the modified Tokouhashi and Bauer scores. Records of 63 patients, averaging 54 years of age, were analyzed. The Tomita score was applied in 44 patients, a modified Bauer score was studied in 49 patients, while SINS and modified Tokouhashi scores were calculated in all 63 patients. The hazard ratios for the Tomita score were 1, 0.030, 0.622, and 0.272, respectively. The hazard ratios for the modified Bauer scores were 1, 4.663, and 1.622, respectively. The Tokouhashi ratios were 1, 1.656, and 0.501, respectively. Of interest, the Tomita scores provided the highest statistical significance ( P = 0.000) followed by the Bauer ( P = 0.002) and Tokuhashi scores ( P = 0.003). Notably, the SINS score showed no significant correlation in predicting patient survival. For evaluating the metastatic spine disease, this study evaluated the prognostic efficacy of four widely used scores: the Tomita, score, the modified Tokouhashi and Bauer scores, and the SINS scores. The Tomita scores provided the highest statistical significance, followed by the Bauer, and Tokuhashi scores, while the SINS score showed no significant correlation in predicting patient survival.

  14. Minimally invasive surgical approach to treat posterior urethral diverticulum

    Directory of Open Access Journals (Sweden)

    Ossamah Alsowayan


    Full Text Available Urethral diverticulum is a localized saccular or fusiform out-pouching of the urethra. It may occur at any point along the urethra in both male and females. Male urethral diverticulum is rare, and could be either congenital or acquired, anterior or posterior. The mainstay treatment of posterior urethral diverticulum (PUD is the open surgical approach. Here we discuss our minimally invasive surgical approach (MIS in managing posterior urethral diverticulum.

  15. Providence nighttime bracing, in treatment of adolescent idiopathic scoliosis

    DEFF Research Database (Denmark)

    Simony, A.; Beuschau, Inge; Quisth, Lena


    Introduction: Since 2008 the non-surgical treatment of adolescent idiopathic scoliosis (AIS) in the southern part of Denmark, went from full-time bracing with Boston brace, to Providence night-time bracing. Methods: Since 2008, skeletally immature patients diagnosed with AIS and a primary curve......, but it seems like patients treated with Providence braces are more likely to experience back pain than healthy adolescents and surgically treated scoliosis patients....

  16. [Long-term outcome of surgically treated teratology of Fallot]. (United States)

    Ben Khalfallah, Ali; Annabi, N; Ousji, Monia


    Tetralogy of Fallot is the most common cyanotic congenital heart disease. The surgical treatment that is palliative or complete repair has allowed to transform the preview of this heart disorder. We suggests to study the long term outcome in patients undergoing surgical repair of tetralogy of Fallot, by emphasizing the quality of their lives, the complications, as well as the mortality. Ventricular arrhythmia and sudden cardiac death after repair of tetralogy of Fallot are devastating complications in adults survivors and their prediction remains difficult.

  17. Juxtapapillary neovascular membrane secondary to idiopathic intracranial hypertension treated with intravitreal bevacizumab: A case report. (United States)

    Hernández-Ortega, V; Soler-Sanchís, M I; Jiménez-Escribano, R M; Sanz-López, A M


    A 48 year-old woman with visual acuity loss in left eye (0.3). Funduscopic examination showed papillary oedema and neovascular membrane in the left eye. All neurological tests were normal, except the lumbar puncture with opening pressure of 35cmH2O, being diagnosed with idiopathic intracranial hypertension (IIH). After four doses of bevacizumab, the visual acuity of the left eye has not improved and is counting fingers. Pathogenesis of the juxtapapillary neovascular membrane associated with IIH is not well known. An effect was observed after the anti-VEGF treatment. In our case, there was no improvement after four doses of intravitreal bevacizumab. Copyright © 2016 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.

  18. Quality of life and self-esteem in children treated for idiopathic short stature. (United States)

    Theunissen, Nicolet C M; Kamp, Gerdine A; Koopman, Hendrik M; Zwinderman, Koos A H; Vogels, Ton; Wit, Jan-Maarten


    Changes in health-related quality of life (HRQOL) and self-esteem were studied in children with idiopathic short stature (ISS) participating in a study on the effect of growth hormone treatment. Prepubertal children (n = 36) with ISS were randomly assigned to a treatment or control group. Children with ISS, their parents, and the pediatrician completed HRQOL and self-esteem questionnaires 3 times in 2 years. At the start, children with ISS did not have lower scores than the norm population, except for social functioning HRQOL. The pediatrician reported an improvement of HRQOL in the treatment group, the parents reported no change, and the children in the treatment group reported the same, or sometimes even worse, HRQOL or self-esteem than the control group. Changes related to the child's satisfaction with height and hardly to growth itself. The assumption that growth hormone treatment improves HRQOL in children with ISS could not be supported in this study.

  19. Hyperbaric oxygen therapy for treating acute surgical and traumatic wounds

    NARCIS (Netherlands)

    Eskes, Anne; Vermeulen, Hester; Lucas, Cees; Ubbink, Dirk T.


    Hyperbaric oxygen therapy (HBOT) is used as a treatment for acute wounds (such as those arising from surgery and trauma). However, the effects of HBOT on wound healing are unclear. To determine the effects of HBOT on the healing of acute surgical and traumatic wounds. We searched the Cochrane Wounds

  20. Hyperbaric oxygen therapy for treating acute surgical and traumatic wounds

    NARCIS (Netherlands)

    Eskes, Anne; Ubbink, Dirk T.; Lubbers, Maarten; Lucas, Cees; Vermeulen, Hester


    Hyperbaric oxygen therapy (HBOT) is used as a treatment for acute wounds (such as those arising from surgery and trauma) however the effects of HBOT on wound healing are unclear. To determine the effects of HBOT on the healing of acute surgical and traumatic wounds. We searched the Cochrane Wounds

  1. Evaluation of 30 patients with gynecomastia surgically treated

    Directory of Open Access Journals (Sweden)

    Nurettin Yiyit


    Conclusions; Surgery is the most effective  treatment of gynecomastia. The most suitable surgical tecnique should be selected according to the skin redundancy. The target always must be breast reduction by the tecnique to provide the best symmetry and leave at least scar.

  2. [Gastrointestinal stromal tumors: a series of 23 surgically treated cases]. (United States)

    D'Amato, A; Brini, A; Montesani, C; Pronio, A; Chessa, A; Manzi, F; Ribotta, G


    The recently introduced new nosological category, Gastro Intestinal Stromal Tumors, brought the Authors to a revision of their series and to a critical analysis of surgical behaviour for the treatment of that pathology. A series of 23 cases of GIST, observed between 1977 and 1999 has been taken into account. In the earlier cases, histopathological classification has been reviewed according to the most used criterions in international scientific literature. 17 of 23 observed tumors were located on the stomach, 4 on the duodenum and 2 on the jejunum. 20 of these cases derived from muscular tissue and 3 cases derived both from muscular and neural tissues. In 7 cases (30%) tumors were accidentally discovered during surgical intervention or diagnostic procedures for other causes. Surgical treatment was performed in all cases and consisted in 6 gastric resections, 14 gastric free-margin excisions, 2 duodenal resections and 1 jejunal resection. The follow-up (performed on 18 patients, with a minimum of 1 year, a maximum of 17 years and a median of 6 years) showed 2 deaths (11%) due to oncological causes, while 2 of the patients (11%) died for other causes. The only treatment for that group of tumors is, at the moment, surgery. Although that kind of neoplasms has mainly non-aggressive biological behaviour, a radical resection must be performed, due to the absence of macroscopic criterions to help distinguishing, during surgical intervention, aggressive tumors from non-aggressive ones.

  3. Body Image and Quality-of-Life in Untreated Versus Brace-Treated Females With Adolescent Idiopathic Scoliosis. (United States)

    Schwieger, Traci; Campo, Shelly; Weinstein, Stuart L; Dolan, Lori A; Ashida, Sato; Steuber, Keli R


    The Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST) included skeletally immature high-risk patients with adolescent idiopathic scoliosis (AIS) with moderate curve sizes (20°- 40°). BrAIST was a multicenter, controlled trial using both randomized and preference treatment arms into either an observation group or a brace treatment group. The aim of this study was to analyze and compare body image and quality-of-life (QOL) in female AIS patients who were observed or treated with a brace. Brace treatment is an effective means for controlling progressive scoliosis and preventing the need for surgery, but there is no consensus regarding the effect of brace treatment on body image or on QOL in adolescents with AIS. Data from female BrAIST patients in the randomized (n = 132) or preference (n = 187) arms and were observed (n = 120) or brace treated (n = 199) were analyzed. Patients completed the Spinal Appearance Questionnaire (SAQ) and the Pediatric Quality of Life Inventory (PedsQOL) 4.0 Generic Scales at baseline and 6 month follow-up visits up to 2 years. Items on the SAQ measured three body image constructs (self, ideal, and overall). The PedsQOL measured health, activities, feelings, social factors, and school. . In general, there were no significant differences within or between study arms or treatments regarding body image or QOL through 2 years of follow-up. Poorer body image was significantly correlated with poorer QOL during the first 2 years of follow-up regardless of study arm or treatment. Patients who crossed-over to a different treatment and patients with largest Cobb angles ≥ 40 degrees had significantly poorer body image, in particular self-body image, compared with those that did not. This study does not support findings from previous research indicating that wearing a brace has a negative impact on or is negatively impacted by body image or QOL. 2.

  4. Long-term follow-up in dogs with idiopathic eosinophilic bronchopneumopathy treated with inhaled steroid therapy. (United States)

    Canonne, A M; Bolen, G; Peeters, D; Billen, F; Clercx, C


    Treatment of canine idiopathic eosinophilic bronchopneumopathy mainly consists of long-term oral corticosteroid therapy. To avoid side effects, inhaled steroid therapy has been increasingly used but long-term clinical response and potential side effects are sparsely described. Description of clinical response and side effects with long-term fluticasone in dogs with eosinophilic bronchopneumopathy. Case series of dogs with eosinophilic bronchopneumopathy and treated with fluticasone monotherapy for at least 6 months. Clinical response and side effects assessed by physical examination, standardised questionnaire and ACTH (corticotropin) stimulation test. Eight dogs were treated for between 6 months and 5 years. Cough initially improved in all dogs; two dogs remained free of clinical signs, three were well controlled, but three showed severe relapse. Pituitary-adrenal axis inhibition occurred in two dogs treated with fluticasone monotherapy for more than 2 years; only one dog had clinical signs of iatrogenic hyperadrenocorticism. Fluticasone monotherapy allows initial improvement or remission in the majority of dogs but long-term treatment fails to resolve the cough in some individuals. In addition, such therapy may induce pituitary-adrenal axis inhibition. Prospective larger and randomised studies including both fluticasone and orally-treated dogs are needed to define the optimal treatment. © 2016 British Small Animal Veterinary Association.

  5. Platelet Kinetics in Idiopathic Thrombocytopenic Purpura Patients Treated with Thrombopoietin Receptor Agonists (United States)

    Meyer, Oliver; Herzig, Eric; Salama, Abdulgabar


    Aim Thrombopoietin receptor agonists (Tpo RA) increase platelet counts in the majority of chronic autoimmune thrombocytopenia (idiopathic thrombocytopenic purpura; ITP) patients. It is unknown whether this treatment may also improve platelet survival (PS) in these patients. Methods In order to determine platelet survival (PS), autologous platelets were labeled with 111In oxine and retransfused in six patients under treatment with Tpo RA (romiplostim n = 3; eltrombopag n = 3). Results Stable platelet counts of greater than 100 × 103/μl were observed in all 6 patients. Platelet survival was decreased in all cases (mean 2.10 days; range 0.13–3.73 days). No correlation was found between platelet count and PS. Similarly, there was no significant relationship between platelet turnover and platelet count. However, a high platelet turnover, exceeding 25 or three times the norm was observed in 2 patients who presented the lowest PS (0.13 or 0.83 days). Two patients had a moderately shortened PS (1.91 or 2.42 days), and, correspondingly, a moderately increased platelet turnover rate (63,072 or 72,872 platelets/μl/day). Conclusion These results indicate that Tpo RA may not only overcompensate platelet destruction in ITP, but may interfere with other mechanisms, which, in some cases, results in a reduced platelet destruction rate. PMID:22896760

  6. 3D MRI analysis of the lower legs of treated idiopathic congenital talipes equinovarus (clubfoot.

    Directory of Open Access Journals (Sweden)

    Suzanne L Duce

    Full Text Available BACKGROUND: Idiopathic congenital talipes equinovarus (CTEV is the commonest form of clubfoot. Its exact cause is unknown, although it is related to limb development. The aim of this study was to quantify the anatomy of the muscle, subcutaneous fat, tibia, fibula and arteries in the lower legs of teenagers and young adults with CTEV using 3D magnetic resonance imaging (MRI, and thus to investigate the anatomical differences between CTEV participants and controls. METHODOLOGY/PRINCIPAL FINDINGS: The lower legs of six CTEV (2 bilateral, 4 unilateral and five control young adults (age 12-28 were imaged using a 3T MRI Philips scanner. 5 of the CTEV participants had undergone soft-tissue and capsular release surgery. 3D T1-weighted and 3D magnetic resonance angiography (MRA images were acquired. Segmentation software was used for volumetric, anatomical and image analysis. Kolmogorov-Smirnov tests were performed. The volumes of the lower affected leg, muscle, tibia and fibula in unilateral CTEV participants were consistently smaller compared to their contralateral unaffected leg, this was most pronounced in muscle. The proportion of muscle in affected CTEV legs was significantly reduced compared with control and unaffected CTEV legs, whilst proportion of muscular fat increased. No spatial abnormalities in the location or branching of arteries were detected, but hypoplastic anomalies were observed. CONCLUSIONS/SIGNIFICANCE: Combining 3D MRI and MRA is effective for quantitatively characterizing CTEV anatomy. Reduction in leg muscle volume appears to be a sensitive marker. Since 5/6 CTEV cases had soft-tissue surgery, further work is required to confirm that the treatment did not affect the MRI features observed. We propose that the proportion of muscle and intra-muscular fat within the lower leg could provide a valuable addition to current clinical CTEV classification. These measures could be useful for clinical care and guiding treatment pathways, as

  7. Bilateral Extracranial Carotid Artery Aneurysms Treated by Staged Surgical Repair

    Directory of Open Access Journals (Sweden)

    K.-M. Park

    Full Text Available Introduction: Bilateral extracranial carotid artery aneurysms (ECAAs are very rare. The case of a patient with bilateral ECAA who underwent staged surgical repair is reported. Report: A 35 year old man was referred with a slow growing pulsatile neck mass causing mild discomfort. Computed tomography and duplex ultrasound showed a right ECAA, with a 3.0 cm diameter 5 cm long true aneurysm, and a left ECAA, with 2.1 cm diameter 4.5 cm long true aneurysm. In two stages, both aneurysms were excised and bypassed with an interposition graft using saphenous vein. Discussion: ECAAs are rare with an incidence of about 4% of all peripheral aneurysms. Selection of treatment options is largely dependent on the aneurysm anatomy, including size and length. During open repair, it is important to avoid nerve injury. Keywords: Extracranial carotid artery aneurysm

  8. Experiences with surgically treated primary or secondary hepatic sarcoma. (United States)

    Fahrner, René; Dennler, Sandra G C; Dondorf, Felix; Ardelt, Michael; Rauchfuss, Falk; Settmacher, Utz


    Liver resection in hepatic sarcoma is rare, but other alternative treatment options are scarce. Surgery offers the only aggressive approach to achieve a tumour-free state. The aim of this investigation was to evaluate the outcome and survival of these patients at a single hepato-biliary university hospital. Between January 2004 and July 2013, 896 anatomical liver resections were performed. Eleven liver resections (1.2%) were performed due to primary hepatic sarcoma or hepatic sarcoma metastases. The demographic and clinical parameters were collected from the institutional patients' records. In eight patients (83%), liver resection was performed due to hepatic sarcoma metastases. The surgical procedures were as follows: two patients (18%) had segmentectomy, six patients (55%) had hemihepatectomy or extended hemihepatectomy and three patients (27%) had multivisceral resections. In nine patients (82%), the resection margins were tumour free. In 55% (n = 6) of the patients, the maximal tumour diameter was greater than 10 cm. The postoperative morbidity was low with a Clavien-Dindo score of 2 (range 0-5). One patient died on postoperative day 2 after multivisceral resection. During the follow-up of 932 days (range 2-2.220 days) the 1-, 2- and 3-year survival rates were 91, 63 and 45%, respectively. Tumour recurrence was detected in seven patients (63%). Liver resections in patients with primary or secondary hepatic sarcoma are rare. The main goal in these patients is to achieve complete tumour resection because chemotherapy offers no suitable alternative, but the long-term survival rates are limited because of high a recurrence rate even after aggressive surgical approaches.

  9. Steroids combined with levothyroxine to treat children with idiopathic nephrotic syndrome: a retrospective single-center study. (United States)

    Guo, Qing-Yin; Zhu, Qing-Jun; Liu, Yu-Feng; Zhang, Hui-Juan; Ding, Ying; Zhai, Wen-Sheng; Ren, Xian-Qing; Zhang, Jian; Zhang, Xia; Yang, Meng


    The clinical efficacy and safety of low-dose levothyroxine in the treatment of idiopathic nephritic syndrome accompanied by thyroid dysfunction have not been established. One hundred and sixty-four patients were divided into three groups according to the levels of thyroid hormone and treatment. The thyroid status, efficacy and adverse reactions of thyroid treatment were observed in each group. Thyroid dysfunction was found in 73 patients. 40 cases were treated with steroids combined with levothyroxine. Proteinuria, cholesterol and thyroid-stimulating hormone (TSH) levels were significantly higher in patients with thyroid dysfunction, whereas serum albumin and free and total T3 and T4 levels were lower than those of euthyroid patients. The time for proteinuria remission in patients receiving levothyroxine therapy was shorter and their serum albumin higher than for patients without levothyroxine treatment. Thyroid hormonal changes are related to the degree of both proteinuria and serum albumin in patients with INS. Combined treatment with low-dose levothyroxine supplementation and steroids in children with INS and thyroid dysfunction is associated with reduced proteinuria and increased plasma albumin compared with patients treated with steroids only.

  10. Surgical interventions for treating fractures of the olecranon in adults. (United States)

    Matar, Hosam E; Ali, Amjid A; Buckley, Simon; Garlick, Nicholas I; Atkinson, Henry D


    Fractures of the olecranon (the bony tip of the elbow) account for approximately 1% of all upper extremity fractures. Surgical intervention is often required to restore elbow function. Two key methods of surgery are tension band wire fixation and plate fixation. To assess the effects (benefits and harms) of different surgical interventions in the treatment of olecranon fractures in adults. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (22 September 2014), the Cochrane Central Register of Controlled Trials (CENTRAL, 2014, Issue 8), MEDLINE (1946 to September week 2 2014), EMBASE (1980 to 19 September 2014), trial registers, conference proceedings and reference lists of articles. Randomised controlled trials (RCT) and quasi-RCTs that compared different surgical interventions for the treatment of olecranon fractures in adults. Two review authors independently performed study selection, risk of bias assessment and data extraction. The primary outcomes of this review were function, pain and adverse events. We included six small trials involving 244 adults with olecranon fractures. Of these, four were RCTs and two were quasi-RCTs; both of were at high risk of selection bias. All six trials were at high risk of performance bias, reflecting lack of blinding, and four trials were at high risk of detection bias. The quality of the evidence for most outcomes was generally very low because of limitations in study design and implementation, and either imprecision of the results or inadequate outcome measures. Thus, we are very uncertain about the estimates of effect.One trial (41 participants) comparing plate fixation with standard tension band wiring provided very low quality evidence at 16 to 86 weeks' follow-up of a better clinical outcome after plate fixation (good outcome (little pain or loss of elbow motion): 19/22 versus 9/19, risk ratio (RR) 1.82 favouring plate fixation, 95% confidence interval (CI) 1.10 to 3.01). There was very low

  11. Hyperbaric oxygen therapy for treating acute surgical and traumatic wounds. (United States)

    Eskes, Anne; Vermeulen, Hester; Lucas, Cees; Ubbink, Dirk T


    Hyperbaric oxygen therapy (HBOT) is used as a treatment for acute wounds (such as those arising from surgery and trauma). However, the effects of HBOT on wound healing are unclear.  To determine the effects of HBOT on the healing of acute surgical and traumatic wounds. We searched the Cochrane Wounds Group Specialised Register (searched 9 August 2013); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 12); Ovid MEDLINE (2010 to July Week 5 2013); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, August 08, 2013); Ovid EMBASE (2010 to 2013 Week 31); EBSCO CINAHL (2010 to 8 August 2013). Randomised controlled trials (RCTs) comparing HBOT with other interventions such as dressings, steroids, or sham HOBT or comparisons between alternative HBOT regimens. Two review authors conducted selection of trials, risk of bias assessment, data extraction and data synthesis independently. Any disagreements were referred to a third review author.  Four trials involving 229 participants were included. The studies were clinically heterogeneous, which precluded a meta-analysis.One trial (48 participants with burn wounds undergoing split skin grafts) compared HBOT with usual care and reported a significantly higher complete graft survival associated with HBOT (95% healthy graft area risk ratio (RR) 3.50; 95% confidence interval (CI) 1.35 to 9.11). A second trial (10 participants in free flap surgery) reported no significant difference between graft survival (no data available). A third trial (36 participants with crush injuries) reported significantly more wounds healed (RR 1.70; 95% CI 1.11 to 2.61), and significantly less tissue necrosis (RR 0.13; 95% CI 0.02 to 0.90) with HBOT compared to sham HBOT. The fourth trial (135 people undergoing flap grafting) reported no significant differences in complete graft survival with HBOT compared with dexamethasone (RR 1.14; 95% CI 0.95 to 1.38) or heparin (RR 1.21; 95% CI 0.99 to 1.49).Many

  12. Cognitive, emotional and psychosocial functioning of girls treated with pharmacological puberty blockage for idiopathic central precocious puberty

    Directory of Open Access Journals (Sweden)

    Slawomir Wojniusz


    Full Text Available Central precocious puberty (CPP develops due to premature activation of the hypothalamic-pituitary-gonadal (HPG axis, resulting in early pubertal changes and rapid bone maturation. CPP is associated with lower adult height and increased risk for development of psychological problems. Standard treatment of CPP is based on postponement of pubertal development by blockade of the HPG axis with gonadotropin releasing hormone analogs (GnRHa leading to abolition of gonadal sex hormones synthesis. Whereas the hormonal and auxological effects of GnRHa are well researched, there is a lack of knowledge whether GnRHa treatment influences psychological functioning of treated children, despite the fact that prevention of psychological problems is used as one of the main reasons for treatment initiation. In the present study we seek to address this issue by exploring differences in cognitive function, behavior, emotional reactivity, and psychosocial problems between GnRHa treated CPP girls and age-matched controls.Fifteen girls with idiopathic CPP; median age 10.4 years, treated with slow-release GnRHa (triptorelin acetate – Decapeptyl SR ® 11.25 and 15 age-matched controls, were assessed with a comprehensive test battery consisting of paper and pencil tests, computerized tasks, behavioral paradigms, heart rate variability, and questionnaires filled in by the children’s parents. Both groups showed very similar scores with regard to cognitive performance, behavioral and psychosocial problems. Compared to controls, treated girls displayed significantly higher emotional reactivity (p = 0.016; Cohen’s d = 1.04 on one of the two emotional reactivity task conditions. Unexpectedly, the CPP group showed significantly lower resting heart rates than the controls (p = 0.004; Cohen’s d = 1.03; lower heart rate was associated with longer treatment duration (r = - 0.582, p = 0.037. The results suggest that GnRHa treated CPP girls do not differ in their cognitive or

  13. Surgical Resection of Idiopathic Distal Anterior Choroidal Artery Aneurysm Assisted by Frameless Stereotactic System Guidance: Case Report and Literature Review. (United States)

    Ye, Feng; Tao, Chuanyuan; Xiong, Shenghua; You, Chao


    Idiopathic distal anterior choroidal artery (AChoA) aneurysms are particularly rare. Their diagnosis and treatment are difficult because of the particular characteristic of pathological anatomy. Our case mainly presented with intraventricular hemorrhage. His idiopathic aneurysm was located in the trigone of the undilated ventricle. Computed tomographic angiography demonstrated both the precise aneurysm and parent artery even when there was no dilated parent artery for the first time. It is also the first time this tiny aneurysm was resected assisted by frameless stereotactic guidance during operation after absorption of intraventricular blood. Computed tomographic angiography and frameless stereotactic guidance benefit the diagnosis and treatment of this kind of aneurysm. Sacrificing plexual AChoA did not cause any neurologic deficit.

  14. Comparison of Srs-24 And Srs-22 Scores in Thirty Eight Adolescent Idiopathic Scoliosis Patients Who Had Undergone Surgical Correction


    CYW Chan; LB Saw; MK Kwan


    Adolescent idiopathic scoliosis is a spinal deformity that affects patients’ self image and confidence. Surgery is offered when the curvature is greater than 50 degrees based on the likelihood of curvature progression. Outcome measures for scoliosis correction can be described in terms of radiological improvement or improvement of health related quality of life scores. The Scoliosis Research Society 22 (SRS-22) and Scoliosis Research Society 24 (SRS-24) questionnaires are widely accepted and ...

  15. Mortality and health-related quality of life in patients surgically treated for spondylodiscitis

    DEFF Research Database (Denmark)

    Dragsted, Casper; Aagaard, Theis; Ohrt-Nissen, Søren


    PURPOSE: To assess mortality, disability, and health-related quality of life (HRQL) in patients surgically treated for spondylodiscitis. METHODS: A retrospective longitudinal study was conducted on all patients surgically treated for spondylodiscitis over a 6-year period at a single tertiary spine...... with spondylodiscitis not related to recent spine surgery. One-year mortality rate was 6%. In all, 36% and 27% had pre- and postoperative neurological impairment, respectively, with only one patient experiencing deterioration postoperatively. At final follow-up (median 2 years), mean ODI was 31% (SD = 22) and mean EQ-5...... neurological impairment. CONCLUSIONS: Several years after surgery, patients surgically treated for spondylodiscitis have significantly lower HRQL and more disability than the background population. Neurological impairment prior to index surgery predicts adverse outcome in terms of disability and lower HRQL....

  16. Mortality and health-related quality of life in patients surgically treated for spondylodiscitis

    DEFF Research Database (Denmark)

    Dragsted, Casper; Aagaard, Theis; Ohrt-Nissen, Søren


    center. Indications for surgery, pre- and postoperative neurological impairment, comorbidities, and mortality were recorded. A survey was conducted on all eligible patients with the EuroQol 5-dimension (EQ-5D) questionnaire and Oswestry Disability Index (ODI). RESULTS: Sixty-five patients were diagnosed...... neurological impairment. CONCLUSIONS: Several years after surgery, patients surgically treated for spondylodiscitis have significantly lower HRQL and more disability than the background population. Neurological impairment prior to index surgery predicts adverse outcome in terms of disability and lower HRQL.......PURPOSE: To assess mortality, disability, and health-related quality of life (HRQL) in patients surgically treated for spondylodiscitis. METHODS: A retrospective longitudinal study was conducted on all patients surgically treated for spondylodiscitis over a 6-year period at a single tertiary spine...

  17. The natural history of surgically treated but radiotherapy-naïve nonfunctioning pituitary adenomas.

    LENUS (Irish Health Repository)

    O'Sullivan, Eoin P


    Transsphenoidal surgery is indicated for patients with nonfunctioning pituitary adenomas (NFPAs) causing compressive symptoms. Previous studies attempting to define the rate of recurrence\\/regrowth of surgically treated but radiation-naïve NFPAs were somewhat limited by selection bias and\\/or small numbers and\\/or lack of consistency of findings between studies. A better understanding of the natural history of this condition could allow stratification of recurrence risk and inform future management. We aimed to define the natural history of a large, mainly unselected cohort with surgically treated, radiotherapy (RT)-naïve NFPAs and to try to identify predictors of recurrence\\/regrowth.

  18. Blood transfusion in the surgical treatment of adolescent idiopathic scoliosis-a single-center experience of patient blood management in 210 cases

    DEFF Research Database (Denmark)

    Ohrt-Nissen, Søren; Bukhari, Naeem; Dragsted, Casper


    BACKGROUND: The surgical treatment of adolescent idiopathic scoliosis can be associated with substantial blood loss, requiring allogeneic red blood cell (RBC) transfusion. This study describes the use of RBC and the effect of a standardized perioperative patient blood management program. STUDY...... in the intraoperative rate of RBC transfusion was observed, from 77% in 2011 to 13% in 2016 (p transfusion group had a significantly larger major curve, lower preoperative hemoglobin, higher estimated blood loss, and an increased use of crystalloid volume resuscitation. Multiple logistic...... regression showed that significant predictors for RBC transfusion were preoperative hemoglobin level (odds ratio [OR], 0.40; 95% confidence interval [CI], 0.27-0.57), estimated blood loss (OR, 1.26; 95% CI, 1.15-1.42), and year of surgery (indicating the effect of patient blood management) (OR per year, 0...

  19. Postoperative perceived health status in adolescent following idiopathic scoliosis surgical treatment: results using the adapted French version of Scoliosis Research Society Outcomes questionnaire (SRS-22). (United States)

    Chaib, Y; Bachy, M; Zakine, S; Mary, P; Khouri, N; Vialle, R


    Assessing functional outcome from patient-based outcomes questionnaires are essential to the evaluation of adolescent idiopathic scoliosis surgical treatment At the minimum follow-up of 2 years, 45 operated on adolescent idiopathic scoliosis patients were mailed the French version of the Scoliosis Research Society Outcome Instrument (SRS-22) questionnaires containing items on pain, activities of daily living, and satisfaction. Mean values of the SRS-22 domains were 3,66 for the Pain domain, 3,85 for the Self-perceived image domain, 4,32 for the Function domain, 3,52 for the Mental health domain and 4,12 for the Global satisfaction with management domain. Mean value of the global SRS-22 score was 3,88. We showed no differences in functional SRS-22 health status in patients according to the type of curve (Lenke classification). We showed statistically significant correlations between the gain of Cobb angle and Patients self-image and function domain scores. There was a statistically significant correlation between preoperative Cobb angle and patient satisfaction with management. Even if Function and Self-image scores in our patients are close to control group values, indicating good short to mid-term outcome of surgical treatment, scores for pain and mental health status were significantly lower in patients than controls. Long-term follow-up studies conducted by multiple surgeons over successive generations are mandatory to assess clinical significance of these differences. Level IV. Retrospective study. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  20. Cervical spondylodiscitis--a clinical analysis of surgically treated patients and review of the literature. (United States)

    Ozkan, Neriman; Wrede, Karsten; Ardeshiri, Ardeshir; Hagel, Vincent; Dammann, Phillip; Ringelstein, Adrian; Sure, Ulrich; Erol Sandalcioglu, I


    The aim of this study was to analyze our clinical and neurological results of surgically treated patients suffering from cervical spondylodiscitis with focusing particularly on the surgical methods used and to review the literature. We present a series of 21 patients operated with cervical spondylodiscitis between 1998 and 2011. Basic demographic data, comorbidities, the radiological segments involved, the surgical strategy with special consideration of the material used and the clinical outcome were evaluated retrospectively. The mean age of 6 female and 12 male patients was 65 years (range 28-89 years). The mean follow-up was 3.7 years ranging between 4 weeks and 9 years. The leading symptom was neurological deficits rather than pain. The segments C 5/6 (n=8) and C 6/7 (n=7) were most frequently involved. Different surgical methods depending on the location, anatomical and pathological condition and extension of the lesion were performed. In conclusion, cervical spondylodiscitis could effectively be treated in the presented patient cohort by surgical decompression, debridement and PMMA or bone graft implants followed by long term antibiotic therapy. The presented surgical reconstruction technique with PMMA might be a feasible alternative to the use of bone graft or cages. The promising clinical results warrant future prospective studies to further investigate this technique. Copyright © 2013 Elsevier B.V. All rights reserved.

  1. [Primary orbital tumors treated surgically in ENT department of Silesian Medical Academy in Katowice]. (United States)

    Gierek, T; Markowski, J; Majzel, K; Zbrowska-Bielska, D


    Primary tumours of orbital cavity are a difficult diagnostic and therapeutic problem from a borderline of ophthalmology, laryngology and neurosurgery. Particular anatomical relations of orbital cavity surrounded by paranasal sinuses, cranial cavity cause that it has become an interdisciplinary region and the best method of therapy is multispecialistic surgical treatment ("team approach"). In this article the classification and general symptomatology of orbital cavity primary tumours were presented. 37 patients suffering from primary orbital tumours were treated surgically in the ENT Department of Silesian Medical Academy in Katowice. The patients were aged from 23 (woman with neurosarcoma) to 73 (man with melanoma). All patients were treated surgically: 15 of them by orbital exenteration, 10 by lateral orbitotomy m. Kronlein-Reese-Berk, and 12 by canthotomy. Special attention was paid to possible postoperative complications.

  2. Unusual late presentation of metastatic extrathoracic thymoma to gastrohepatic lymph node treated by surgical resection. (United States)

    Billè, Andrea; Sachidananda, Sandeep; Moreira, Andre L; Rizk, Nabil P


    In advanced stages, thymic tumors tend to spread locally. Distant metastatic disease is rare. We present the first report of single metastatic abdominal lymph node in a 37-year-old female patient and 5 years after an extrapleural pneumonectomy for stage IV thymoma followed by radiotherapy with no other evidence of abdominal disease successfully treated by robotic surgical resection.

  3. The confounding effect of the development of idiopathic orthostatic edema and thyrotoxcosis on weight fluctuation related to effects on free water clearance in a woman with long-standing surgically induced panhypopituitarism and diabetes insipidus. (United States)

    Check, J H; Weidner, J


    To evaluate the effect of idiopathic orthostatic edema and the effect of thyrotoxicosis on weight fluctuation and fluid retention in the presence of surgically induced panhypopituitarism and diabetes insipidus controlled with hormone replacement. Dextroamphetamine sulfate was used for weight gain when no other etiologic factor was found. Methimazole was used when weight loss occurred when serum T4 and free T4 indicated thyrotoxicosis. Sympathomimetic amine therapy very effectively controlled the weight gain and methimazole controlled the weight loss. Hypopituitarism and diabetes insipidus controlled with hormone replacement do not protect against fluid retention from idiopathic edema.

  4. Surgical outcome of cats treated for aqueous humor misdirection syndrome: a case series. (United States)

    Atkins, Rosalie M; Armour, Micki D; Hyman, Jennifer A


    To evaluate the clinical outcome of cats treated surgically for aqueous humor misdirection syndrome. A retrospective analysis of cats treated surgically between January 1, 2006, and January 1, 2013, for aqueous humor misdirection syndrome was performed. Signalment, medical therapy, eyes affected, intraocular pressures prior to and after surgery, surgical procedures performed, postoperative complications, and visual status were evaluated. Seven cats (nine eyes) fit the inclusion criteria. Six of seven cats were female, and five of seven cats were diagnosed with bilateral aqueous humor misdirection syndrome. Three surgical approaches were evaluated as follows: (i) phacoemulsification and posterior capsulotomy, (ii) phacoemulsification, posterior capsulotomy and anterior vitrectomy, and (iii) phacoemulsification, posterior capsulotomy, anterior vitrectomy, and endocyclophotocoagulation. The mean age at diagnosis was 12.9 years. Seven of nine eyes had controlled intraocular pressure (≤25 mmHg) during the first 6 months postoperatively. All cats were visual with controlled intraocular inflammation at 1 year postoperatively; however, one eye had an elevated intraocular pressure. All cats were continued on topical antiglaucoma and anti-inflammatory medications following surgery with the mean number of drops per day decreasing from 3.9 drops/day prior to surgery to 2.2 drops/day postoperatively. Surgical management for feline aqueous humor misdirection syndrome may be a viable option to maintain a visual and normotensive status in cats that no longer have successful control of intraocular pressure with medical therapy. © 2016 American College of Veterinary Ophthalmologists.

  5. Comparison of Srs-24 And Srs-22 Scores in Thirty Eight Adolescent Idiopathic Scoliosis Patients Who Had Undergone Surgical Correction

    Directory of Open Access Journals (Sweden)

    CYW Chan


    Full Text Available Adolescent idiopathic scoliosis is a spinal deformity that affects patients’ self image and confidence. Surgery is offered when the curvature is greater than 50 degrees based on the likelihood of curvature progression. Outcome measures for scoliosis correction can be described in terms of radiological improvement or improvement of health related quality of life scores. The Scoliosis Research Society 22 (SRS-22 and Scoliosis Research Society 24 (SRS-24 questionnaires are widely accepted and used to characterize clinical results. Therefore, this prospective study of 38 patients aims to investigate how the SRS-24 and SRS-22 questionnaires compare to each other in terms of scoring when the same group of patients is evaluated. The SRS-22 questionnaire tends to give an inflated value in the overall score, pain and self image domain compared to the SRS-24 questionnaire.

  6. Neurological outcome in surgically treated patients with incomplete closed traumatic cervical spinal cord injury. (United States)

    Singhal, B; Mohammed, A; Samuel, J; Mues, J; Kluger, P


    Retrospective study based on a reference paper. Neurological outcome in patients who were managed surgically with closed traumatic cervical spine injury was evaluated using the ASIA motor scoring system and Frankel grading. To assess the accuracy of motor charting and Frankel grading as tools to evaluate neurological outcome in closed traumatic cervical spine injury, and also to evaluate how the surgically treated patients fared in their neurological recovery by measurement tools as in the reference paper. National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK. Fifty-seven patients were admitted within 2 days of the injury with closed traumatic cervical spine injuries (1997-2004). Thirty-seven (65%) met the inclusion criteria as per the referenced paper, that is, were treated surgically, were Frankel grade B and above and had at least 12 months follow up. The remaining 20 patients were not included as they did not meet the inclusion criteria. The breakdown of the 20 patients is given in Table 1. The mean recovery percentage (MRP) and mean deficit percentage (MDP) were calculated as per the referenced paper. An evaluation of 37 patients surgically treated, who had follow up of at least 12 months, showed that preservation of pin prick below the level of lesion, and preservation of anal tone and perianal sensation were good prognostic indicators. There was no correlation between degree of encroachment of canal or the degree of kyphosis to MDP or MRP. The mean time from injury to mobilization was 7.6 days in 25 out of 37 patients. Twelve of the 37 patients had prolonged immobilization because of ITU stay or because they were initially treated conservatively. Three out of the 37 patients developed DVT/PE. Mean hospital stay was 6.4 months. The neurological outcome in surgically treated patients is comparable to the conservatively treated patients. The Frankel grading and ASIA motor charting combined is a powerful tool in assessing the neurological

  7. Modified lip repositioning: A surgical approach to treat the gummy smile. (United States)

    Rao, Aditya Gopinath; Koganti, Vijay Prasad; Prabhakar, Ashok Kodangala; Soni, Sweta


    Gummy smile has been an esthetic concern for many patients. This clinical report describes a successful surgical coverage obtained by modified lip repositioning, thus surgically treating the gummy smile. The technique was performed to limit the retraction of elevator muscles (e.g., zygomaticus minor, orbicularis oris, leviator anguli oris and levator labi oris.) The technique is fulfilled by removing two strips of mucosa from maxillary buccal vestibule on both the sides leaving the frenum untouched and creating a partial thickness flap between mucogingival junction and upper lip musculature, and suturing the lip mucosa with mucogingival junction, resulting in a narrow vestibule and restricted muscle pull, thereby reducing gingival display. This technique is different from the conventional surgical lip repositioning as labial frenum is left untouched over here as it helps in maintain Litton the midline for lip repositioning and reduces the morbidity associated with it.

  8. Modified lip repositioning: A surgical approach to treat the gummy smile

    Directory of Open Access Journals (Sweden)

    Aditya Gopinath Rao


    Full Text Available Gummy smile has been an esthetic concern for many patients. This clinical report describes a successful surgical coverage obtained by modified lip repositioning, thus surgically treating the gummy smile. The technique was performed to limit the retraction of elevator muscles (e.g., zygomaticus minor, orbicularis oris, leviator anguli oris and levator labi oris. The technique is fulfilled by removing two strips of mucosa from maxillary buccal vestibule on both the sides leaving the frenum untouched and creating a partial thickness flap between mucogingival junction and upper lip musculature, and suturing the lip mucosa with mucogingival junction, resulting in a narrow vestibule and restricted muscle pull, thereby reducing gingival display. This technique is different from the conventional surgical lip repositioning as labial frenum is left untouched over here as it helps in maintain Litton the midline for lip repositioning and reduces the morbidity associated with it.

  9. Surgically treated cases of lumbar spondylolysis and isthmic spondylolisthesis: a multicenter study. (United States)

    Hirano, Kenichi; Imagama, Shiro; Matsuyama, Yukihiro; Kawakami, Noriaki; Yukawa, Yasutsugu; Kato, Fumihiko; Hachiya, Yudo; Kanemura, Tokumi; Kamiya, Mitsuhiro; Deguchi, Masao; Ito, Zenya; Wakao, Norimitsu; Ando, Kei; Tauchi, Ryoji; Muramoto, Akio; Ishiguro, Naoki


    Prospective database study. To grasp the characteristics of surgically treated cases with lumbar spondylolysis or isthmic spondylolisthesis. A detailed analysis of surgically treated cases with spondylolysis or isthmic spondylolisthesis has never been reported. An epidemiological study in Japan conducted on 2000 subjects found the incidence of lumbar spondylolysis in the Japanese general population (population-based study) to be 5.9% (males: 7.9%, females: 3.9%). Among 124 vertebrae with spondylolysis, there were 0.8% L2 lesions, 3.2% L3 lesions, 5.6% L4 lesions, and 90.3% L5 lesions, including 5 cases (4.3%) with multiple-level lesions. We have been registering surgically treated spine cases in our database since 2000. From this database, we prospectively collected cases with lumbar spondylolysis or isthmic spondylolisthesis that were treated surgically between January 2000 and December 2009. We determined the age at surgery, sex, and vertebral level of spondylolysis. Of the 564 spondylolysis patients treated surgically, 66.8% were male and 33.2% were female. The mean age at surgery was 52.5 years (range, 13-84 y). There were 585 vertebrae with spondylolysis including 21 cases (3.7%) with multiple-level lesions. L5 spondylolysis affected 432 vertebrae and was the most common location (73.8%), followed by 125 L4 lesions (21.4%), 24 L3 lesions (4.1%), and 2 L2 lesions (0.7%). The percentage of L4 lesions in our study was significantly higher and of L5 lesions was significantly lower than those lesions' percentages in the population-based study. L4 spondylolysis may be more unstable or cause clinical symptoms more frequently leading to more surgical intervention. The percentage of multiple-level spondylolysis was similar between the 2 studies, suggesting these patients respond relatively well to conservative treatment. The male/female ratio was 2:1 in both studies, indicating that males and females require surgery at a similar frequency.

  10. Prognostic factors in non-surgically treated sciatica: a systematic review. (United States)

    Ashworth, Julie; Konstantinou, Kika; Dunn, Kate M


    When present sciatica is considered an obstacle to recovery in low back pain patients, yet evidence is limited regarding prognostic factors for persistent disability in this patient group. The aim of this study is to describe and summarise the evidence regarding prognostic factors for sciatica in non-surgically treated cohorts. Understanding the prognostic factors in sciatica and their relative importance may allow the identification of patients with particular risk factors who might benefit from early or specific types of treatment in order to optimise outcome. A systematic literature search was conducted using Medline, EMBASE and CINAHL electronic databases. Prospective cohort studies describing subjects with sciatica and measuring pain, disability or recovery outcomes were included. Studies of cohorts comprised entirely of surgically treated patients were excluded and mixed surgically and conservatively treated cohorts were included only if the results were analysed separately by treatment group or if the analysis was adjusted for treatment. Seven adequate or high quality eligible studies were identified. There were conflicting but mainly negative results regarding the influence of baseline pain severity, neurological deficit, nerve root tension signs, duration of symptoms and radiological findings on outcome. A number of factors including age, gender, smoking, previous history of sciatica and heaviness of work do not appear to influence outcome. In contrast to studies of low back pain and purely surgically treated sciatica cohorts, psychological factors were rarely investigated. At present, the heterogeneity of the available studies makes it difficult to draw firm conclusions about sciatica prognosis, and highlights the need for further research for this group of patients. Large scale prospective studies of high methodological quality, using a well-defined, consistent definition of sciatica and investigating psychosocial factors alongside clinical and

  11. Assessment and Determinants of Spinal Pain in the Course of Disc Disorders Treated Surgically


    Jab?o?ska, Renata; ?lusarz, Robert; Kr?likowska, Agnieszka; Haor, Beata; Zaj?c, Magdalena


    Background Intervertebral disc disease is defined as a complex of structural changes in the aftermath of disorders of mutual elements, the structure of which form the discus intervertebralis and the spinal canal. The present work assessed pain in patients who were surgically treated due to spinal discopathy and analyzed factors that determine the condition. Material/Methods The research was carried on a group of 187 patients diagnosed with discopathy of the lumbosacral and cervical segment. T...

  12. A case of idiopathic hypoparathyroidism treated by 1-alpha-OHD3, followed by EEG and CT for five years

    International Nuclear Information System (INIS)

    Komatsuzaki, Satoshi; Okayama, Kenji; Kobayashi, Itsuro; Takemiya, Toshiko; Maruyama, Shoichi


    A 37-year-old male patient with idiopathic hypoparathyroidism is reported. Ca levels returned to normal by the treatment with 1-α-hydroxy-Vitamin D 3 (1α-OHD 3 ). EEG and EMG findings were improved as well. Treatment has continued favorably. Electrophysiological examination revealed no aggravation. Cerebral calcification shown on CT before the treament with 1α-OHD 3 still existed on CT 5 years after the treatment. (Namekawa, K.)

  13. Case of idiopathic hypoparathyroidism treated by 1-alpha-OHD3, followed by EEG and CT for five years

    Energy Technology Data Exchange (ETDEWEB)

    Komatsuzaki, Satoshi; Okayama, Kenji; Kobayashi, Itsuro; Takemiya, Toshiko; Maruyama, Shoichi


    A 37-year-old male patient with idiopathic hypoparathyroidism is reported. Ca levels returned to normal by the treatment with 1- -hydroxy-Vitamin D3 (1 -OHD3). EEG and EMG findings were improved as well. Treatment has continued favorably. Electrophysiological examination revealed no aggravation. Cerebral calcification shown on CT before the treament with 1 -OHD3 still existed on CT 5 years after the treatment.

  14. [Effects of Surgically Treated Pelvic Ring and Acetabular Fractures on Postural Control]. (United States)

    Lang, P; Schnegelberger, A; Riesner, H-J; Stuby, F; Friemert, B; Palm, H-G


    The aim of surgical treatment of pelvic ring and acetabular fractures is to allow rapid mobilisation of patients in order to restore stance and gait stability (postural control), as this significantly correlates with a positive outcome. The regulation of postural stability is mainly controlled by transmission of proprioceptive stimuli. In addition, the pelvis serves as a connection between the legs and the spine and thus is also of great importance for mechanical stabilisation. It remains unclear whether surgical treatment of pelvic ring and acetabular fractures affects the regulation of postural control. Therefore, the aim of this study was to examine the impact of surgically treated pelvic ring and acetabular fractures on postural stability by means of computerised dynamic posturography (CDP) after a mean of 35 months and to compare the results with a healthy control group. A retrospective case control study of 38 patients with surgically treated pelvic ring and acetabular fractures and 38 healthy volunteers was carried out using CDP. The average time of follow-up was 35 (12-78) months. The most important outcome parameter in this investigation was the overall stability index (OSI). Hip joint mobility, the health-related quality of life (SF-12) and pain were supplementary outcome parameters. It was found that surgically treated pelvic ring and acetabular fractures had no influence on postural stability. The OSI was 2.1 ° in the patient group and 1.9 ° in the control group. There was no significant difference between the groups in hip joint mobility. A total of 52 % of patients showed no or only mild pain. Mean health-related quality of life was the same as in the total population. Surgically treated pelvic ring and acetabular fractures do not lead to deterioration in postural control in the mid term. This is of high prognostic importance for rapid mobilisation of the patients. Therefore no increase in the risk of falling is expected after successfully

  15. Adolescent Idiopathic Scoliosis

    Directory of Open Access Journals (Sweden)

    Safak Ekinci


    Full Text Available Scoliosis is called idiopathic when no other underlying disease can be identified. The etiology of adolescent idiopathic scoliosis (AIS is still unknown despite many years of research effort. Theories on AIS's etiology have included mechanical, hormonal, metabolic, neuromuscular, growth, and genetic abnormalities. Skeletally immature patients with adolescent idiopathic scoliosis are at risk of curve progression. The adolescent onset of severe idiopathic scoliosis has traditionally been evaluated using standing posteroanterior radiographs of the full spine to assess lateral curvature with the Cobb method. Scoliosis in children of school age and above primarily occurs in girls. The therapeutic goal in children is to prevent progression. In children, scoliosis of 20 and deg; or more should be treated with a brace, and scoliosis of 45 and deg; or more with surgery. [Arch Clin Exp Surg 2014; 3(3.000: 174-182

  16. Do vertebral derotation techniques offer better outcomes compared to traditional methods in the surgical treatment of adolescent idiopathic scoliosis? (United States)

    Rushton, Paul R P; Grevitt, Michael P


    In recent years, authors have described novel derotation techniques for surgery in adolescent idiopathic scoliosis. These methods include direct vertebral body derotation (DVD) and vertebral coplanar alignment (VCA). By improved derotation it is hoped that there is further reduction in rib hump prominence and corresponding improvement in patients' quality of life. This paper aims to evaluate studies reporting outcomes from DVD and VCA techniques to assess if these methods lead to superior radiographic vertebral derotation, rib hump correction on surface measurements or patient-reported outcomes compared to traditional derotation manoeuvres using similar instrumentation. Literature review. Fifteen reports were identified. Most comparative studies represent class three or four data. DVD and VCA techniques have been shown to reduce apical vertebral rotation by 37-63 %. Few studies compare DVD/VCA techniques with traditional methods. Most DVD/VCA reports with pedicle screw instrumentation have reported superior radiographic derotation on CT compared with conventional techniques. Despite this the majority of studies have found similar corrections of rib hump measurements between DVD/VCA techniques and cantilever or global derotation methods. There is no evidence that DVD/VCA techniques allow greater correction of significant rib hump deformity without an adjuvant thoracoplasty. No studies to date have used patient-reported outcomes prospectively or demonstrated clinically meaningful differences retrospectively between DVD/VCA and conventional techniques. There is little evidence to recommend the widespread adoption of DVD/VCA techniques. Whilst there is some weak evidence to suggest that novel techniques may improve radiographic measures, there is little to suggest that they offer patients improved correction of clinical rib hump or quality of life compared to established techniques. Further well-designed prospective studies are needed in this area.

  17. Prompt surgical management for spinal fracture in the elderly aged over 90 years with diffuse idiopathic skeletal hyperostosis to extend their healthy lifespan. (United States)

    Tanishima, Shinji; Takeda, Chikako; Hamamoto, Yuki; Kondo, Yasumitsu; Nagashima, Hideki


    There is a possibility that the patients with diffuse idiopathic skeletal hyperostosis (DISH) increase with aging of the population and progressive lengthening of life expectancy in developed countries. In the patients with DISH, even a trivial vertebral fracture may actually turn out to be a three-column injury because mechanical stress is applied to the fracture site due to the lever arm effect. Under these circumstances, even a prolonged strict immobilization often results in failure. Recently, elderly people increasingly wish to maintain physical abilities. We present three patients aged over 90 years with DISH sustaining lower thoracic vertebral fracture after minor trauma. Long fusion involving three vertebral levels above and below the fracture site was performed with pedicle screw system, and vertebroplasty was carried out by transpedicular filling with hydroxyapatite blocks. The patients' activities of daily living were maintained close to the pre-injury level 1 year and 9 months, 2 years and 3 months, and 1 year after surgery, respectively. Many reports have recommended surgery over conservative treatments at vertebral fracture complicating DISH; however, there has been no report of vertebral fracture in patients aged over 90 years with DISH. Satisfactory results were obtained by surgical treatment in our three patients despite their age. We recommend posterior fusion with vertebroplasty just after injury for vertebral fracture in the elderly patients of advanced age with DISH to extend their healthy lifespan.

  18. Usefulness of gadolinium in MRI evaluation of non surgically treated herniated disk. (United States)

    Motta, E; Boniotti, V; Miserocchi, L; Caudana, R


    The rationale for the use of Gadolinium (Gd) in the MRI evaluation of non surgically treated herniated disk is based on the known presence of inflammatory granulation tissue and neoangiogenesis which plays an important role in both pain and the spontaneous resorption of the hernia. of this study was to determine the usefulness of Gd in MRI examination for detecting the inflammatory reaction around the discal hernia. Thirty-eight patients (mean age 45 years; range 20-70 years) with non surgically treated herniated disk were evaluated with MRI between January 2000 and July 2004. T2w-FAST-SE sagittal and T1w-SE transaxial and sagittal images were acquired before and after the administration of Gd. Twenty out of 22 patients with acute sciatic pain (symptoms =/discal hernia in the spinal canal. In the remaining 16 with chronic sciatic pain (symptoms > 6 months) the discal hernia did not show peri-hernial enhancement. In MRI evaluation of the herniated disk, peri-hernial enhancement is correlated with inflammatory reaction around the hernia which is associated with acute symptoms. The absence of peri-hernial enhancement in chronic herniated disk is due to the poorly vascular fibrotic tissue. Therefore, peri-hernial enhancement facilitates the differential diagnosis in uncertain cases and represents a reliable prognostic index of response to non-surgical therapy and of the possible spontaneous resorption of discal hernia.

  19. Sex-related differences in patients treated surgically for aneurysmal subarachnoid hemorrhage

    International Nuclear Information System (INIS)

    Horiuchi, Tetsuyoshi; Tanaka, Yuichiro; Hongo, Kazuhiro


    Sex-related differences were examined in the clinical course of patients treated surgically for aneurysmal subarachnoid hemorrhage. Retrospective analyses were carried out to evaluate sex-related differences in aneurysm location, aneurysm size, preoperative neurological condition, preoperative computed tomography findings, and outcome among 2577 patients who underwent surgical repair of ruptured aneurysms. The internal carotid artery was most frequently affected in women and the anterior cerebral artery in men. Intracerebral or intraventricular hematoma was more common in men than in women. Some differences may be related to the location of the aneurysm. Sex-related differences were prominent in the 5th decade of life. These findings might be related to the menopause. Sex hormones may be involved in aneurysm formation. (author)

  20. An outcome analysis of seventeen patients treated surgically for intractable extratemporal epilepsy.

    LENUS (Irish Health Repository)

    Mulholland, D


    We studied the outcomes of seventeen patients treated surgically for extratemporal lobe epilepsy. A retrospective case review of medical charts was performed. Seizure freedom post surgery was appraised using the Engel classification system. Post-operatively seven patients (41%) were seizure free (Engel class I), four patients were class II (23.5%), two in class III (11.76%) and four in class IV (23.5%). Three patients (17.6%) suffered traumatic injuries due to seizures. The mean duration of epilepsy prior to surgery was 12.2 years and the mean number of anti-epileptic medications given was 6.5. Seizure freedom rates for surgical treatment of extratemporal epilepsy in this centre are similar to those of other centres. Post-operative morbidity in this centre was similar to other centres. Any complications resolved with no lasting impairment.

  1. Persistent sciatica induced by quadratus femoris muscle tear and treated by surgical decompression: a case report

    Directory of Open Access Journals (Sweden)

    Tzanakakis George


    Full Text Available Abstract Introduction Quadratus femoris tear is an uncommon injury, which is only rarely reported in the literature. In the majority of cases the correct diagnosis is delayed due to non-specific symptoms and signs. A magnetic resonance imaging scan is crucial in the differential diagnosis since injuries to contiguous soft tissues may present with similar symptoms. Presentation with sciatica is not reported in the few cases existing in the English literature and the reported treatment has always been conservative. Case presentation We report here on a case of quadratus femoris tear in a 22-year-old Greek woman who presented with persistent sciatica. She was unresponsive to conservative measures and so was treated with surgical decompression. Conclusion The correct diagnosis of quadratus muscle tear is a challenge for physicians. The treatment is usually conservative, but in cases of persistent sciatica surgical decompression is an alternative option.

  2. Unruptured Versus Ruptured AVMs: Outcome Analysis from a Multicentric Consecutive Series of 545 Surgically Treated Cases. (United States)

    Cenzato, Marco; Tartara, Fulvio; D'Aliberti, Giuseppe; Bortolotti, Carlo; Cardinale, Francesco; Ligarotti, Gianfranco; Debernardi, Alberto; Fratianni, Alessia; Boccardi, Edoardo; Stefini, Roberto; Zenga, Francesco; Boccaletti, Riccardo; Lanterna, Andrea; Pavesi, Giacomo; Ferroli, Paolo; Sturiale, Carmelo; Ducati, Alessandro; Cardia, Andrea; Piparo, Maurizio; Valvassori, Luca; Piano, Mariangela


    Recent literature strongly challenged indications to perform preventive surgery in unruptured arteriovenous malformation (AVM) claiming that invasive AVM treatment is associated with a significant risk of complications and thus conservative management may be a preferable alternative in many patients. On the other hand, the recent improvement of surgical instrumentation and treatment strategies (both surgical and interventional) yielded better outcomes than those achieved only a decade ago. Therefore, even among specialists, a wide variety of opinions, concerning the treatment of unruptured AVM, can be found. This multicenter retrospective study analyzes a consecutive series of 545 surgically treated AVMs in 10 different hospitals in Italy. Patients with AVMs treated after hemorrhage had an unfavorable (modified Rankin Scale score >1) outcome in more than one third (37.69%) of the cases. Conversely, with proper indications, unruptured AVMs treated preventively have a good outcome in 93.8% of cases, increasing to 95.7%, with no death, if only Spetzler-Martin grades 1-3 are considered (P < 0.05). Outcomes on discharge significantly (P < 0.05) improve at 6 months with the disappearance of many of the initial neurologic deficits that turn out to be transient. In unruptured low-risk AVMs (Spetzler-Martin grades 1-3), over time, the risk of surgery-associated neurologic deficits becomes lower than that linked to spontaneous hemorrhage, with a crossover point at 6.5 years. Because the average bleeding age is less than 45 years, preventive surgery can be advocated to safeguard the patient and overcome the risks associated with the natural history of AVMs. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Converting Scoliosis Research Society-24 to Scoliosis Research Society-22r in a Surgical-Range, Medical/Interventional Adolescent Idiopathic Scoliosis Patient Cohort. (United States)

    Chen, Antonia F; Bi, Wenzhu; Singhabahu, Dilrukshika; Londino, Joanne; Hohl, Justin; Ward, Maeve; Ward, W Timothy


    Prospective questionnaire administration study. To assess the ability to translate total and domain scores from Scoliosis Research Society (SRS)-24 to SRS-22r in a surgical-range, medical/interventional adolescent idiopathic scoliosis (AIS) patient population. Conversion of SRS-24 to SRS-22r is demonstrated in an operative cohort of patients with AIS, but not in a medical/interventional patient population. We simultaneously administered SRS-24 and SRS-22r questionnaires to 75 surgical-range, medical/interventional AIS patients and compared them. We performed analysis by regression modeling to produce conversion equations from SRS-24 to SRS-22r. The total SRS-24 score for these medical/interventional AIS patients was 92.5 ± 9.45 (mean, 3.9 ± 0.39), and the total SRS-22r score was 93.5 ± 9.63 (mean, 4.3 ± 0.44). The correlation between these 2 groups was fair (R 2 = 0.77) and improved to good when mental health or recall questions were removed. The correlation was also fair for total pain domains (R 2 = 0.73). However, there was poor correlation for general self-image (R 2 = 0.6) and unacceptable for post-treatment self-image (R 2 = 0.01), general function (R 2 = 0.52), activity function (R 2 = 0.56), and satisfaction (R 2 = 0.53). Compared with a published population of operative AIS patients, R 2 values for total SRS-24 scores, pain, general self-image, activity function, and satisfaction were similar (p > .05). The R 2 values for general function and combined general and activity function were significantly different between the operative and medical/interventional cohorts. Scoliosis Research Society-24 can be converted to SRS-22r scores with fair accuracy in the surgical-range, medical/interventional AIS patient population for total score, and total pain domains. The SRS-24 translates unacceptably to the SRS-22r in self-image, function, and satisfaction domains. The SRS-24 to SRS-22r conversion equations are similar to operative AIS patients, except for the

  4. Use of a Gonadotropin-releasing Hormone Analog to Treat Idiopathic Central Precocious Puberty Is Not Associated with Changes in Bone Structure in Postmenarchal Adolescents. (United States)

    Iannetta, Renata; Melo, Anderson S; Iannetta, Odilon; Marchini, Júlio S; Paula, Francisco J; Martinelli, Carlos E; Rosa e Silva, Ana Carolina J S; Ferriani, Rui A; Martins, Wellington P; Reis, Rosana M


    To evaluate bone quantity and quality in postmenarchal adolescents treated for idiopathic central precocious puberty (CPP) in childhood with a gonadotropin-releasing hormone analog (GnRHa) and to determine the serum concentrations of bone remodeling markers. This cross-sectional study included 53 postmenarchal adolescent girls who were divided into 2 groups: 27 adolescents who were treated with GnRHa in childhood for idiopathic CPP (the CPP group) and 26 women who presented with physiological development of secondary sex traits (the control group). None. Weight, height, body mass index, age at menarche, time since menarche, body composition, bone mineral density (BMD), bone quality, and serum insulin, glucose, osteocalcin, and carboxyl-terminal telopeptide of type I collagen concentrations were compared in the 2 groups. BMD data were analyzed by using both dual-energy x-ray absorptiometry (DXA) and osteosonography, and body composition was measure with the use of DXA and electrical bioimpedance. BMD and bone quality did not differ significantly between the CPP and control groups when analyzed by using DXA or osteosonography. Serum osteocalcin concentration was significantly lower (P = .02) in the CPP than in the control group. Insulin was higher in the CPP group, and hyperinsulinemia was an independent predictor of bone quantity and quality assessed by using osteosonography. Body mass index and percent fat were determined by using DXA, and the duration of use of GnRHa treatment and the time since GnRHa discontinuation were not independent predictors of bone quantity and quality. Postmenarchal adolescents treated with GnRHa for CPP in childhood did not show a reduction in bone quantity or quality. Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  5. Idiopathic anaphylaxis. (United States)

    Fenny, Nana; Grammer, Leslie C


    Idiopathic anaphylaxis is a diagnosis of exclusion after other causes have been thoroughly evaluated and excluded. The pathogenesis of idiopathic anaphylaxis remains uncertain, although increased numbers of activated lymphocytes and circulating histamine-releasing factors have been implicated. Signs and symptoms of patients diagnosed with idiopathic anaphylaxis are indistinguishable from the manifestations of other forms of anaphylaxis. Treatment regimens are implemented based on the frequency and severity of patient symptoms and generally include the use of epinephrine autoinjectors, antihistamines, and steroids. The prognosis of idiopathic anaphylaxis is generally favorable with well-established treatment regimens and effective patient education. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Health-related quality of life of adolescents conservatively treated for idiopathic scoliosis in Korea: a cross-sectional study. (United States)

    Lee, Hyejung; Choi, Jihea; Hwang, Jin-Ho; Park, Jung Hyun


    Young adolescents with scoliosis are more likely than adults to experience psychological distress affecting health-related quality of life (HRQoL). Adolescence is a sensitive period of psychological development, and thus physical deformity from scoliosis can negatively affect body image and appearance of adolescents. The present study evaluated HRQoL in young Korean adolescents with idiopathic scoliosis and identified related factors. One hundred and ten adolescents with idiopathic scoliosis were recruited from two tertiary hospital outpatient clinics over one year. HRQoL was measured using the Korean version of the Scoliosis Research Society 22 revision (SRS-22r) questionnaire. In addition, participant medical records were reviewed to collect data on severity of scoliosis, type of treatment and age at which they were first diagnosed with the disease. The mean age of the participants was 14.2 years and 48.2 % were first diagnosed at 9-12 years. Most participants (61.8 %) were under observation to follow up the curvature progression and 20.9 % received regular physiotherapy. Almost half the participants (47.3 %) had mild (10°-25°), 41.8 % moderate (25°-40°), and 10.9 % severe (>40°) scoliosis. The total score of the SRS-22r differed significantly between the groups of age at diagnosis (p = 0.033) and type of treatment (p = 0.025). Self-image, a sub-domain of the SRS 22r, was significantly lower in the severe curve deformity group than in the other groups (p = 0.031). An earlier age of scoliosis diagnosis and conservative treatment were related to higher HRQoL scores of Korean adolescents with scoliosis. Although the overall HRQoL did not significantly differ by severity of disease, self-image was significantly decreased in adolescents with severe spinal deformity. HRQoL of adolescent patients with idiopathic scoliosis can be affected by several factors that medical staff needs to consider in order to produce the best and most effective

  7. Mortality and health-related quality of life in patients surgically treated for spondylodiscitis. (United States)

    Dragsted, Casper; Aagaard, Theis; Ohrt-Nissen, Søren; Gehrchen, Martin; Dahl, Benny


    To assess mortality, disability, and health-related quality of life (HRQL) in patients surgically treated for spondylodiscitis. A retrospective longitudinal study was conducted on all patients surgically treated for spondylodiscitis over a 6-year period at a single tertiary spine center. Indications for surgery, pre- and postoperative neurological impairment, comorbidities, and mortality were recorded. A survey was conducted on all eligible patients with the EuroQol 5-dimension (EQ-5D) questionnaire and Oswestry Disability Index (ODI). Sixty-five patients were diagnosed with spondylodiscitis not related to recent spine surgery. One-year mortality rate was 6%. In all, 36% and 27% had pre- and postoperative neurological impairment, respectively, with only one patient experiencing deterioration postoperatively. At final follow-up (median 2 years), mean ODI was 31% (SD = 22) and mean EQ-5D time trade-off score was 0.639 (SD = 0.262); this was significantly lower than that in the normal population ( p spondylodiscitis have significantly lower HRQL and more disability than the background population. Neurological impairment prior to index surgery predicts adverse outcome in terms of disability and lower HRQL.

  8. Systematic review of prognostic factors predicting outcome in non-surgically treated patients with sciatica. (United States)

    Verwoerd, A J H; Luijsterburg, P A J; Lin, C W C; Jacobs, W C H; Koes, B W; Verhagen, A P


    Identification of prognostic factors for surgery in patients with sciatica is important to be able to predict surgery in an early stage. Identification of prognostic factors predicting persistent pain, disability and recovery are important for better understanding of the clinical course, to inform patient and physician and support decision making. Consequently, we aimed to systematically review prognostic factors predicting outcome in non-surgically treated patients with sciatica. A search of Medline, Embase, Web of Science and Cinahl, up to March 2012 was performed for prospective cohort studies on prognostic factors for non-surgically treated sciatica. Two reviewers independently selected studies for inclusion and assessed the risk of bias. Outcomes were pain, disability, recovery and surgery. A best evidence synthesis was carried out in order to assess and summarize the data. The initial search yielded 4392 articles of which 23 articles reporting on 14 original cohorts met the inclusion criteria. High clinical, methodological and statistical heterogeneity among studies was found. Reported evidence regarding prognostic factors predicting the outcome in sciatica is limited. The majority of factors that have been evaluated, e.g., age, body mass index, smoking and sensory disturbance, showed no association with outcome. The only positive association with strong evidence was found for leg pain intensity at baseline as prognostic factor for subsequent surgery. © 2013 European Federation of International Association for the Study of Pain Chapters.

  9. Surgical outcome of displaced middle third clavicular fractures treated with locking compression plate

    Directory of Open Access Journals (Sweden)

    Rakesh Patil


    Full Text Available Conservative management of middle third clavicle fracture has been recently reported with suboptimal outcomes. Despite higher nonunion rates in initial open reduction and internal fixation (ORIF, understanding the problem better and taking in accounts of previous shortcomings, such fractures can be optimally treated by ORIF with locking compression plate (LCP. This study aims at investigating the outcome of middle third clavicle fracture treated with locking compression plating in terms of function using constant score union time, complications, and patient satisfaction. Study includes 98 patients with displaced middle third clavicle fracture treated with ORIF with locking compression plate, which had follow-up for at least 1 year. The mean age was 44 years (15-59, 56 were male patients and 42 were female. Right side was involved in 53.9% of cases. All the fractures united with mean time to union of 9.2 weeks except two, in which the procedure was redone with bone grafting to achieve union. The average constant score was 89. Our study shows that displaced midshaft clavicle fracture can be optimally treated with surgical fixation with the locking compression plate to reduce malunion, unsightly deformity and nonunions. We conclude that precontoured LCP as a reliable option for fixing midshaft clavicle fractures.

  10. Low rate of surgery in juvenile idiopathic scoliosis treated with a complete and tailored conservative approach: end-growth results from a retrospective cohort. (United States)

    Fusco, Claudia; Donzelli, Sabrina; Lusini, Monia; Salvatore, Minnella; Zaina, Fabio; Negrini, Stefano


    The main distinctive aspect of Juvenile Idiopathic Scoliosis (JIS) with respect to Adolescent Idiopathic Scoliosis (AIS) is the high risk of severe deformity and surgery. Approximately 70% of curves in patients with JIS progress and ultimately require surgery. There are presently very few studies with long-term follow-up of JIS and even fewer looking specifically at bracing Purpose To verify the effectiveness of a complete conservative treatment, including bracing and exercises, for JIS. Retrospective cohort observational study nested in a clinical prospective database of consecutive outpatients. Patient Sample Inclusion criteria: JIS, no previous treatment, all consecutive radiographies available from treatment start to end of growth (Risser sign 3). We found 30 patients, 27 females, 10 JIS type 1; mean age at first diagnosis was 7.8 +/-1.5 and mean treatment lasted 5.8 years. Cobb degrees 24.4+/-10 degrees, with 7 cases >30 degrees, and 2 > 45degrees. Outcome Measures Physiological measures. Radiographic and clinical data. Treatment (exercises alone, or elastic-rigid-highly rigid braces plus exercises) was tailored and continuously changed according to Cobb degrees, individual preferences, anthropometric characteristics, pubertal spurt, remaining growth, rotation, hump, lumbar curve take-off, and imbalance. The SOSORT Guidelines for patients' management have been followed. Funding and Conflict of Interest: no. 33.3% (95% Confidence Interval 16.4-50.2%) of patients worsened over the years. At the end of growth, 6.6% (0-15.5%) had surgical deformities (>45degrees). We observed a good correction in the first years of treatment until pubertal growth spurt, when progression was usually noted and treatment changed increasing corrective forces (hours or rigidity of bracing). 23 cases were followed up until they had two consecutive radiographies showing Risser sign 5 and showed stability. Conservative treatment initiated already in childhood may favorably change the

  11. Effects of a training program after surgically treated ankle fracture: a prospective randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Ekdahl Charlotte S


    Full Text Available Abstract Background Despite conflicting results after surgically treated ankle fractures few studies have evaluated the effects of different types of training programs performed after plaster removal. The aim of this study was to evaluate the effects of a 12-week standardised but individually suited training program (training group versus usual care (control group after plaster removal in adults with surgically treated ankle fractures. Methods In total, 110 men and women, 18-64 years of age, with surgically treated ankle fracture were included and randomised to either a 12-week training program or to a control group. Six and twelve months after the injury the subjects were examined by the same physiotherapist who was blinded to the treatment group. The main outcome measure was the Olerud-Molander Ankle Score (OMAS which rates symptoms and subjectively scored function. Secondary outcome measures were: quality of life (SF-36, timed walking tests, ankle mobility tests, muscle strength tests and radiological status. Results 52 patients were randomised to the training group and 58 to the control group. Five patients dropped out before the six-month follow-up resulting in 50 patients in the training group and 55 in the control group. Nine patients dropped out between the six- and twelve-month follow-up resulting in 48 patients in both groups. When analysing the results in a mixed model analysis on repeated measures including interaction between age-group and treatment effect the training group demonstrated significantly improved results compared to the control group in subjects younger than 40 years of age regarding OMAS (p = 0.028, muscle strength in the plantar flexors (p = 0.029 and dorsiflexors (p = 0.030. Conclusion The results of this study suggest that when adjusting for interaction between age-group and treatment effect the training model employed in this study was superior to usual care in patients under the age of 40. However, as only three

  12. Distribution pattern of surgically treated symptomatic prolapsed lumbar and sacral intervertebral discs in males. (United States)

    Nnamdi, Ibe Michael Onwuzuruike


    The pattern of distribution of surgically treated symptomatic prolapsed lumbar and sacral intervertebral discs has been published, though scantily, especially in males. We decided to look at our own series, compare and contrast ours with some of those published. We treated 88 locations of this lesion in 68 males. The clinical features were those of lower back pains, with or without radiation into the lower extremities, sensory loss and paresis of the limbs. There was a case of loss of urinary bladder and ano-rectal control. All lesions were confirmed through cauda-equinograms and treated under general anaesthesia in knee-chest position (MECCA position). The patients were followed up for 3-6 months post-operatively. There were 88 locations in 68 males of 21-70 years of age, with 29 prolapses occurring during the age range 31-40 years, while 54 locations were on the left and 48 at L4/5. The procedures were well tolerated by all patients and there were no post-operative complications. This lesion in our series occurred mostly on the left, at the L4/5 level and peaked at 31-40 years age range. The predictability of occurrence of this disease, using side, level and age is still not feasible in males from our series.

  13. Vitrectomy with internal limiting membrane (ILM) peeling versus vitrectomy with no peeling for idiopathic full-thickness macular hole (FTMH)

    DEFF Research Database (Denmark)

    Spiteri Cornish, Kurt; Lois, Noemi; Scott, Neil


    Several observational studies have suggested the potential benefit of internal limiting membrane (ILM) peeling to treat idiopathic full-thickness macular hole (FTMH). However, no strong evidence is available on the potential benefit(s) of this surgical manoeuvre and uncertainty remains among vitr...

  14. Quality of life, pain, anxiety and depression in patients surgically treated with cancer of rectum. (United States)

    Santos, Letácio José Freire; Garcia, João Batista dos Santos; Pacheco, Jairo Sousa; Vieira, Erica Brandão de Morais; Santos, Alcione Miranda dos


    The rectum cancer is associated with high rates of complications and morbidities with great impact on the lives of affected individuals. To evaluate quality of life, pain, anxiety and depression in patients treated for medium and lower rectum cancer, submitted to surgical intervention. A descriptive cross-sectional study. Eighty-eight records of patients with medium and lower rectum cancer, submitted to surgical intervention were selected, and enrolled. Forty-seven patients died within the study period, and the other 41 were studied. Question forms EORTC QLQ-C30 and EORTC QLQ-CR38 were used to assess quality of life. Pain evaluation was carried out using the Visual Analogical Scale, depression and anxiety were assessed through Depression Inventories and Beck's Anxiety, respectively. The correlation between pain intensity, depression and anxiety was carried out, and between these and the EORTC QLQ-C30 General Scale for Health Status and overall quality of life, as well as the EORTC QLQ-CR38 functional and symptom scales. Of the 41 patients of the study, 52% presented pain, depression in 47%, and anxiety in 39%. There was a marking positive correlation between pain intensity and depression. There was a moderate negative correlation between depression and general health status, and overall quality of life as well as pain intensity with the latter. There was a statistically significant negative correlation between future depression perspective and sexual function, and also a strong positive correlation between depression and sexual impairments. A positive correlation between anxiety and gastro-intestinal problems, both statistically significant, was observed. Evaluation scales showed detriment on quality life evaluation, besides an elevated incidence of pain, depression, and anxiety; a correlation among these, and factors which influence on the quality of life of post-surgical medium and lower rectum cancer patients was observed.

  15. Assessment and Determinants of Spinal Pain in the Course of Disc Disorders Treated Surgically (United States)

    Jabłońska, Renata; Ślusarz, Robert; Królikowska, Agnieszka; Haor, Beata; Zając, Magdalena


    Background Intervertebral disc disease is defined as a complex of structural changes in the aftermath of disorders of mutual elements, the structure of which form the discus intervertebralis and the spinal canal. The present work assessed pain in patients who were surgically treated due to spinal discopathy and analyzed factors that determine the condition. Material/Methods The research was carried on a group of 187 patients diagnosed with discopathy of the lumbosacral and cervical segment. The data are discussed in the context of medical records and the Visual Analogue Scale used for pain assessment. We used a prospective study plan with a 3-time assessment. Results The pain level observed among patients prior to the procedure (M=6.52) was higher than after 7 days (M=3.15) and 6 months from the operation (M= 3.45). The highest level of pain (M=6.88), with a relatively high consistency among the patients (SD=2.25), was observed in the case of left-side hernia (H=7.31; p=0.023). The influence of the analyzed factors on pain experience markedly increased by the third assessment (R2=0.14), and was strongly associated with the type of work performed by the patient. Conclusions Surgical operation significantly reduces pain in patients with disc disorders. The level of pain is predominantly affected by the location of the hernia and the type of work performed by the patient. PMID:27865095

  16. Assessment and Determinants of Spinal Pain in the Course of Disc Disorders Treated Surgically. (United States)

    Jabłońska, Renata; Ślusarz, Robert; Królikowska, Agnieszka; Haor, Beata; Zając, Magdalena


    BACKGROUND Intervertebral disc disease is defined as a complex of structural changes in the aftermath of disorders of mutual elements, the structure of which form the discus intervertebralis and the spinal canal. The present work assessed pain in patients who were surgically treated due to spinal discopathy and analyzed factors that determine the condition. MATERIAL AND METHODS The research was carried on a group of 187 patients diagnosed with discopathy of the lumbosacral and cervical segment. The data are discussed in the context of medical records and the Visual Analogue Scale used for pain assessment. We used a prospective study plan with a 3-time assessment. RESULTS The pain level observed among patients prior to the procedure (M=6.52) was higher than after 7 days (M=3.15) and 6 months from the operation (M= 3.45). The highest level of pain (M=6.88), with a relatively high consistency among the patients (SD=2.25), was observed in the case of left-side hernia (H=7.31; p=0.023). The influence of the analyzed factors on pain experience markedly increased by the third assessment (R2=0.14), and was strongly associated with the type of work performed by the patient. CONCLUSIONS Surgical operation significantly reduces pain in patients with disc disorders. The level of pain is predominantly affected by the location of the hernia and the type of work performed by the patient.

  17. Intraabdominal candidiasis in surgical ICU patients treated with anidulafungin: A multicenter retrospective study. (United States)

    Maseda, Emilio; Rodríguez-Manzaneque, Marta; Dominguez, David; González-Serrano, Matilde; Mouriz, Lorena; Álvarez-Escudero, Julián; Ojeda, Nazario; Sánchez-Zamora, Purificación; Granizo, Juan-José; Giménez, María-José


    Patients with recent intraabdominal events are at uniquely risk for intraabdominal candidiasis (IAC). Candida peritonitis is a frequent and life-threatening complication in surgically ill patients. International guidelines do not specifically address IAC. This study describes clinical features of IAC in critical patients treated with anidulafungin in Surgical ICUs (SICUs). A practice-based retrospective study was performed including all adults with IAC admitted to 19 SICUs for ≥24h treated with anidulafungin. IAC was documented (Candida isolation from blood/peritoneal fluid/abscess fluid and/or histopathological confirmation) or presumptive (host factors plus clinical criteria without mycological support). Total population and the subgroup of septic shock patients were analyzed. One hundred and thirty nine patients were included, 94 (67.6%) with septic shock, 112 (86.2%) after urgent surgery. Of them, 77.7% presented peritonitis and 21.6% only intraabdominal abscesses. Among 56.8% cases with documented IAC, C. albicans (52.8%) followed by C. glabrata (27.8%) were the most frequent species. Anidulafungin was primarily used as empirical therapy (59.7%), microbiologically directed (20.9%) and anticipated therapy (15.8%). Favourable response was 79.1% (76.6% among patients with septic shock). Intra-SICU mortality was 25.9% (28.7% among patients with septic shock). Among IACs managed at SICUs, peritonitis was the main presentation, with high percentage of patients presenting septic shock. C. albicans followed by C. glabrata were the main responsible species. Anidulafungin treatment was mostly empirical followed by microbiologically directed therapy, with a favourable safety profile, even among patients with septic shock.


    Rey, Amanda; Jürgens, Ignasi; Dyrda, Agnieszka; Maseras, Xavier; Morilla, Antonio


    To present the visual outcome and postoperative complications of pars plana vitrectomy and intraocular lenses (IOL) removal with or without IOL exchange of late in-the-bag IOL dislocation after uneventful cataract surgery. Retrospective analysis of a consecutive series of 83 eyes with late in-the-bag dislocated IOL treated with pars plana vitrectomy and anterior chamber IOL (25 eyes), transscleral suture-fixated posterior chamber IOL (38 eyes), or aphakia (20 eyes). High myopia was the major predisposing factor (40%). The interval between cataract surgery and the dislocation was 10.9 years. The complication rate after the second surgery was 43%; being transient hypotony (19%) and hypertension (15%) the most frequent. Postoperative best-corrected visual acuity improvement was statistically significant (P bag IOL dislocation is myopia. Despite a complication rate of 43%, mostly minor and transient, IOL exchange surgery is an effective procedure with a good visual outcome (mean 3 Snellen lines improvement). There were no statistically significant differences in the final best-corrected visual acuity or complication rate between anterior chamber IOL and sutured posterior chamber IOL, thus, both surgical techniques may be considered to treat this condition.

  19. Evaluation of Quality Metrics for Surgically Treated Laryngeal Squamous Cell Carcinoma. (United States)

    Graboyes, Evan M; Townsend, Melanie E; Kallogjeri, Dorina; Piccirillo, Jay F; Nussenbaum, Brian


    for all patients (OS aHR, 0.51; 95% CI, 0.29-0.88; DFS aHR, 0.50, 95% CI, 0.32-0.80) and elective neck dissection yield of 18 lymph nodes or more (DFS aHR, 0.36; 95% CI, 0.14-0.99) were associated with improved survival on multivariable Cox proportional hazards analysis. In this cohort of patients with surgically treated laryngeal SCC, multidisciplinary evaluation and elective neck dissection yield of 18 lymph nodes or more are associated with improved survival. Development of better quality metrics is necessary because increased compliance with metrics described by the AHNS and NCCN is not associated with improved survival. Previously described metrics for surgically treated oral cavity cancer are not prognostic for surgically treated laryngeal SCC. Future multi-institutional collaboration will be required to validate these findings, develop better quality metrics, and evaluate whether quality metrics for head and neck cancer are site specific.

  20. Surgically treated osteonecrosis and osteomyelitis of the jaw and oral cavity in patients highly adherent to alendronate treatment

    DEFF Research Database (Denmark)

    Eiken, P A; Prieto-Alhambra, D; Eastell, R


    . INTRODUCTION: ONJ is a rare event in users of oral bisphosphonates. Our aims were to evaluate if the risk of surgically treated ONJ increases with longer or more compliant treatment with alendronate for osteoporosis and to identify risk factors for surgically treated ONJ. METHODS: Open nationwide register......-based cohort study containing one nested case-control study. Patients were treatment-naïve incident users of alendronate 1996-2007 in Denmark, both genders, aged 50-94 at the time of beginning treatment (N = 61,990). Participants were followed to 31 December 2013. RESULTS: Over a mean of 6.8 years, 107...

  1. Analysis of CT and MRI investigations of patients with lumbar discopathy treated conservatively or surgically

    International Nuclear Information System (INIS)

    Radziszewski, K.


    Imaging investigations (radiculography, X-ray, CT, MRI) constitute an integral part of the therapeutic process in the treatment of patients suffering from lumbar discopathy. The results obtained with the imaging techniques provide the crucial data concerning the stage of disease development; assist the choice of optimal therapy method and the evaluation of the therapeutic actions efficiency. The aim of the study was to analyze the results of CT and MRI investigations carried out on patients suffering from lumbar discopathy, who had been treated with conservative or surgical methods. 665 patients aged between 16 and 76 years with discopathy at L4-L5, L5-S1 levels were enrolled to the study. In the analyzed group, 348 patients received only conservative therapy whereas 317 patients underwent surgical procedures. CT and MRI investigations were applied at the beginning of the observation (W), after three years (III) and after ten years (X) since the operation (or exclusively conservative treatment). The results obtained with imaging techniques were divided into three categories: intradiscal, peridiscal and disc-related changes caused by herniation of vertebral discs. During the subsequent periods of inspection, the rising number of degenerative changes was found. The progression of the imaging technique results concerned both the L4-L5, L5-S1 spaces, which showed distortion initially, and the L3-L4, L2-L3 levels, which were not degenerated in the preliminary examination. The remote examination showed that the number of degenerations in the two examined groups was substantially higher than it had been during the preliminary examination. The total number of degenerative changes among the patients operated on was higher than among the patients in conservative treatment. The number of degenerative changes of the spine grows from level L2-L3 to level L5-S1. The stage of spinal degenerative changes rises along with the duration of the disease. The patients operated on show

  2. Application of surgical navigation in styloidectomy for treating Eagle’s syndrome

    Directory of Open Access Journals (Sweden)

    Dou G


    traditional styloidectomy. The visual analog scale analysis showed that the discomfort in all patients was relieved, while ten patients’ symptoms were improved greatly, and two patients had some improvement.Conclusion: The higher accuracy of surgery, lesser amount of bleeding, decreased duration of surgery and hospitalization, absence of complications, and improved subjective symptoms indicated that SN is an effective and minimally invasive surgical procedure suitable for resection of ESP for treating Eagle’s syndrome. Keywords: elongation of styloid process, intraoperative navigation, oral and maxillofacial surgery, computer-aided surgery

  3. Assessment with Oswestry disability index in surgically treated patients with lumbar spondylolisthesis: experience in 96 patients. (United States)

    Pasha, Ibrahim Farooq; Qureshi, Muhammad Asad; Farooq, Maheen; Talha, Muhammed; Ahmed, Naveed; Ismail, Junaid


    To assess the outcome of surgical treatment in spondylolisthesis of lumbosacral region using Oswestry disability Index. The quasi-experimental study was conducted at the Combined Military Hospital, Rawalpindi from 2006 to 2013 and comprised surgically treated patients with spondylolisthesis. The patients with degenerative and isthmic types with follow-up of at least two years were included. A performa was designed for each patient and records were kept in a custom-built database. Oswestry disability index was used as the assessment tool and assessment was done pre-operatively, at 1, 3 and 6 months and then at 1 year and 2 years. There were 96 patients with mean pre-op Oswestry disability index score of 81.06% (range 42.22-100, SD ±11.99). L5-S1 was affected in 44 (45.83%) patients, L4-L5 in 30 (31.25%), L4-5-S1 in 7 (7.29%) and multi or high level was found in the rest of the cases. One level was involved in 77 (80.2%), 2 in 11 (11.45%), 3 in 7 (7.29%) and 4 in 1 (1.04%). The slip grade as per Meyerding grades was 1 in 31 (32.29%), II in 39 (40.62%), III in 19 (19.79%), IV in 5 (5.2%) and 2 (2.08%) had spondyloptosis. Mean follow-up was 42 months (range 24-63). Mean Oswestry disability score at 1 month was 38.51% (range 11- 62.22%, SD ±11.75); at 6 months 10.02% (range 0-40%, SD ±6.99); at 1 year 4.62% (range 0-24%, SD ±5.36) and at 2 years 4.21% (range 0-15%, SD ±4.2). Surgical treatment of spondylolisthesis gives excellent long-term result in most patients.

  4. Should lower limb fractures be treated surgically in patients with chronic spinal injuries? Experience in a reference centre. (United States)

    Barrera-Ochoa, S; Haddad, S; Rodríguez-Alabau, S; Teixidor, J; Tomás, J; Molero, V

    To report the outcomes of surgical treatment of lower limb fractures in patients with chronic spinal cord injuries. A total of 37 lower limb fractures were treated from 2003 to 2010, of which 25 fractures were treated surgically and 12 orthopaedically. Patients of the surgical group had better clinical results, range of motion, bone consolidation, and less pressure ulcers and radiological misalignment. No differences were detected between groups in terms of pain, hospital stay, and medical complications. There is no currently consensus regarding the management of lower limb fractures in patients with chronic spinal cord injuries, but the trend has been conservative treatment due to the high rate of complications in surgical treatment. Chronic spinal cord injuries patients with lower limb fractures who are treated surgically achieved a more reliable consolidation, practically a free range of motion, low rate of cutaneous complications, and pain associated with the fracture. This allows a quick return to the previous standard of living, and should be considered as an alternative to orthopaedic treatment in these patients. Copyright © 2016 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. A case of lipoma of lateral anterior neck treated with surgical enucleation

    Directory of Open Access Journals (Sweden)

    Francesco Grecchi


    Full Text Available Lipoma arise in almost 50% of all soft tumours. The neck lipomas are rare tumours that may present as painless masses with slow growth, in the lateral portions of the neck. Some lipomas, such as the one studied in our case, grow deep in the subcutaneous tissue, in close contact with muscles. Here, we report a case of lipoma extending from pre-tragal region up to the ascending branch of the mandible in a 62 year old man, treated with enucleation. The inferior margin of lipoma involved the pharyngeal and the superior margin was achieved by the top of the skull base. The mass of lipoma caused breathing difficulties in the patient, preventing regular sleep. No complication was recorded in the post-operative period and no further surgery was performed. The complete resolution after one year′s follow-up, together with the rarity of the anatomical site, makes this case worthy of description. A correct diagnosis facilitated removal of this lesion with a surgical method.

  6. Body mass index is not associated with reoperation rates in patients with a surgically treated perforated peptic ulcer

    DEFF Research Database (Denmark)

    Duch, Patricia; Møller, Morten Hylander


    INTRODUCTION: The aim of the present nationwide Danish cohort study was to examine the association between body mass index (BMI) and reoperation in patients who are sur-gically treated for perforated peptic ulcer (PPU). METHODS: This was a nationwide cohort study of all Danish patients who were...

  7. A Young, Immunocompetent Woman with Small Bowel and Hepatic Mucormycosis Successfully Treated with Aggressive Surgical Debridements and Antifungal Therapy

    Directory of Open Access Journals (Sweden)

    Daniel Vikum


    Full Text Available A 24-year-old woman with coeliac disease and transient neutropenia developed mucormycosis with extensive involvement of the liver and small intestine. She was successfully treated with aggressive surgical debridements and long-term antifungal therapy with liposomal amphotericin B and posaconazole.

  8. Retrospective analysis of 27 cases of bisphosphonate-related osteonecrosis of the jaw treated surgically or nonsurgically

    Directory of Open Access Journals (Sweden)

    Shin-Yu Lu


    Conclusion: Our study demonstrates a high success rate of conservative and surgical treatment of BRONJ. This is the first reported use of GBR to successfully treat oral BPh-related osteonecrosis of the jaw. Irrigation with antimicrobial rinses may result in pain reduction, and regression or even resolution of BRONJ.

  9. Idiopathic thrombosis. (United States)

    Tsuda, Hiroko


    Idiopathic thrombosis involves a group of inherited thrombophilia predisposed to severe thrombosis of early onset and associated with an adverse outcome due to recurrence, and therefore, requires long-term anticoagulation therapy. The causative factors of a predisposition to thrombosis include immobility, dehydration, infection, surgery, injury, cancer, pregnancy, and estrogen use. The inherited deficiencies of antithrombin (AT), protein C (PC), and protein S (PS) are specified as "Specific Pediatric Chronic Diseases." However, medical expense assistance for patients terminates when they reach the age of 20 years. On April 1 st 2017, "Idiopathic Thrombosis due to Inherited Thrombophilia," consisting of inherited AT, PC, and PS deficiencies, was specified as an "Intractable Disease," and aid for medical expenses became available. Accordingly, progress in the research and practice of idiopathic thrombosis is expected in future to improve the medical care system and to construct a database via clinical surveys.

  10. Adults With Idiopathic Scoliosis Diagnosed at Youth Experience Similar Physical Activity and Fracture Rate as Controls. (United States)

    Diarbakerli, Elias; Grauers, Anna; Danielsson, Aina; Gerdhem, Paul


    Cross-sectional. To describe physical activity level and fracture rates in adults with idiopathic scoliosis, diagnosed before maturity, and to compare with a control group. A previous study found a lower level of sporting activities in adults treated for idiopathic scoliosis compared with controls. Other studies have shown a lower bone mass in adults with idiopathic scoliosis compared with controls. One thousand two hundred seventy-eight adults (aged 18-71 yr) with idiopathic scoliosis and 214 controls (aged 18-70 yr) were included and answered the International Physical Activity Questionnaire - Short Form (IPAQ-SF) and questions about previous fractures. The three scoliosis treatment groups (untreated n = 360, brace n = 460, and surgically treated n = 458) were compared. Furthermore, a comparison based on onset (juvenile n = 169 or adolescent n = 976) was performed. Achieved weekly moderate activity level and metabolic equivalent task (MET) minutes/week were assessed for patients and controls. Statistical comparisons were made with analysis of covariance with adjustments for age, body mass index, and sex. The proportion achieving weekly moderate activity level was 962 out of 1278 for individuals with idiopathic scoliosis (75%) and 157 out of 214 (73%) for controls (P = 0.40). The scoliosis patients reported 2016 MET-minutes/week (median value) and the controls 2456 (P = 0.06). Fracture rates did not differ (P = 0.72). Fewer surgically treated individuals achieved moderate activity level (P = 0.046) compared with the untreated and the previously braced individuals. No difference was seen regarding MET-minutes/week (P = 0.86). No differences were seen between individuals with a juvenile onset compared with individuals with an adolescent onset (all P ≥ 0.05). Adults with idiopathic scoliosis have similar physical activity level and do not sustain more fractures compared with controls. Adults with surgically treated

  11. Single Positive Lymph Node Prostate Cancer Can Be Treated Surgically without Recurrence.

    Directory of Open Access Journals (Sweden)

    Dae Keun Kim

    Full Text Available To investigate pN1 prostate cancer (PCa patients treated surgically without immediate adjuvant treatment.We analyzed the database of 2316 patients at our institution who underwent robot-assisted radical prostatectomy (RARP/radical prostatectomy (RP between July 2005 and November 2012. 87 patients with pN1 PCa and received no neoadjuvant and immediate adjuvant therapy were included in the study. Included pN1 PCa patients were followed up for median of 60 months. Biochemical recurrence (BCR-free survival, metastasis-free survival (MFS, cancer specific survival (CSS, and overall survival (OS rates were determined by using Kaplan-Meier analysis. Cox regression analysis was performed to investigate the impact of prostate-specific antigen (PSA level, Gleason score, extraprostatic extension, seminal vesicle invasion, perineural invasion, lymphovascular invasion, positive surgical margin, tumor volume, early post-operative PSA(6 weeks, PSA nadir, lymph node yield, and number of pathologically positive lymph nodes on survival.The 5-year OS rate of patients was 86.1%, while the CSS rate was 89.6%. The metastasis-free and BCR-free survival rates were 71% and 19.1%, respectively, and each was significantly correlated with the number of positive lymph nodes on log rank tests (p = 0.004 and p = 0.039, respectively. The presence of 2 or more pathologically positive LNs (HR:2.20; 95% CI 1.30-3.72; p = 0.003 and a Gleason score ≥8 (HR: 2.40;95% CI: 1.32-4.38; p = 0.04 were significant negative predictors of BCR free survival on multivariable regression analysis. Furthermore, the presence of 2 or more positive lymph nodes (HR: 1.06; 95% CI 1.01-1.11; p = 0.029 were significant negative predictors of metastasis-free survival on multivariable regression analysis. Additionally, in the patients who had no BCR without adjuvant treatment 9 patients out of 10 (90% had single positive LN and 5 patients out of 10 (50% had Gleason score 7. Therefore, single positive LN

  12. Perception of stress level, trunk appearance, body function and mental health in females with adolescent idiopathic scoliosis treated conservatively: a longitudinal analysis. (United States)

    Misterska, Ewa; Glowacki, Maciej; Latuszewska, Joanna; Adamczyk, Katarzyna


    In the presented study, we aimed to assess changes over time in the perception of trunk deformity, body function, stress level and mental health in females with adolescent idiopathic scoliosis (AIS) who were treated conservatively with a Cheneau brace, taking the Trunk Appearance Perception Scale (TAPS), Scoliosis Research Society-22 (SRS-22) and Bad Sobberheim Stress Questionnaires (BSSQ) criteria of evaluation into consideration. The study design was comprised of three questionnaire assessments, with the second and the third evaluation taking place 6 and 12 months after the beginning of the study, respectively. Thirty-six females treated conservatively were asked to fill in the TAPS, SRS-22 and BSSQ forms. In regards to TAPS, the results differed between the 1st and the 2nd assessment in Figure 2 only (p = 0.013). The difference between the 1st and the 3rd evaluation concerned Figure 3 and the total score (p = 0.011 and p = 0.005, respectively). The SRS-22 and BSSQ results of study participants did not differ significantly between the 1st and the 2nd, between the 2nd and the 3rd and between the 1st and the 3rd evaluations. The study indicated that the assessment of girls with AIS concerning body function and mental health did not deteriorate in the course of orthosis treatment. Furthermore, they showed improvement in perceptions particularly in regards to trunk shape. We pointed out that the negative perceptions of mental health, self-image and low level of activity held by females with AIS coexisted with severe emotional distress. Moreover, factors that improved functioning or subjective physical appearance ratings in particular, such as level of activity, were indicated.

  13. Idiopathic inflammatory medial meatal fibrotizing otitis presenting in children. (United States)

    Hopsu, Erkki; Pitkäranta, Anne


    Acquired atresia of the ear canal presents rarely in children. Idiopathic inflammatory medial meatal fibrotizing otitis (IMFO) evidently has its own distinct etiopathologic findings causing acquired ear canal atresia. Two IMFO children treated and followed-up at the Department of Otorhinolaryngology of Helsinki University Hospital. Clinical and radiologic evaluation of 2 children with IMFO solely affecting the glabrous skin over the osseous part of the ear canal and the tympanic membrane. Review of identical cases of the acquired postinflammatory or inflammatory medial meatal atresia in children reported in association with literature. Idiopathic inflammatory medial meatal fibrotizing otitis, affecting solely the glabrous skin on the tympanic membrane and the osseous part of the external ear canals, is manifesting in 2 children without ongoing chronic middle ear infection. The etiopathologic findings or pathophysiology of IMFO is speculative. The success of surgical correction of the already-formed fibrous atresia has not been established.

  14. Clinical and mammographic profile of patients with breast cancer surgically treated

    Directory of Open Access Journals (Sweden)

    Raquel Rodrigues Muradas


    Full Text Available Summary Objective: to analyze the epidemiological, clinical and mammographic profile of women with breast cancer who were treated at the mastology clinic of the University Hospital of Santa Maria and who underwent breast surgery between January 2007 and December 2012. Methods: this was a cross-sectional study, approved by the Ethics in Research Committee. A review of the patients' medical records was performed. The data were then exported to a software program for statistical analysis, namely Minitab 14.1. Results: the patients' profile indicated that they were mostly born and raised in Santa Maria (respectively 11.1%, n=16, and 26.3%, n=68. They were about 55.6 years old (SD±12.3, white (90.2%, n=213, had already given birth and breastfed their children, were nonsmokers, but also overweight (average BMI of 27kg/m2. On physical examination of the first medical consultation, these patients, as described in the records: had a palpable mass (81.1%, n=184 measuring over three centimeters, located in the left breast, precisely in the upper outer quadrant (41.4%, n=81. Mammography (39%, n=109 showed that this lump was classified as BIRADS ® 5 (40%, n=81. On histopathological examination, the lump was diagnosed as an invasive ductal cancer (71.1%, n=191. Surgery was generally a radical mastectomy (84.7%, n=236 with axillary dissection (92.5%, n=222. Conclusion: some of the epidemiological, clinical and mammographic features mentioned above resembled those found in the literature reviewed. However, these patients had advanced disease and underwent non conservative surgical procedures.

  15. Extracapsular extension is a poor predictor of disease recurrence in surgically treated oropharyngeal squamous cell carcinoma. (United States)

    Lewis, James S; Carpenter, Danielle H; Thorstad, Wade L; Zhang, Qin; Haughey, Bruce H


    Extracapsular extension in squamous cell carcinoma nodal metastases usually predicts worse outcome. However, there are no standard histologic grading criteria for extracapsular extension, and there have been few studies on oropharyngeal squamous cell carcinoma alone. We studied the extent of extracapsular extension utilizing a novel grading system and correlated grades with outcomes while controlling for p16 status. A cohort of surgically treated oropharyngeal squamous cell carcinoma cases were reviewed and metastases graded as 0 (within substance of node), 1 (filling subcapsular sinus with thickened capsule/pseudocapsule, but no irregular peripheral extension), 2 (≤1 mm beyond capsule), 3 (>1 mm beyond capsule), or 4 (no residual nodal tissue or architecture; 'soft tissue metastasis'). There were 101 cases, for which p16 was positive in 90 (89%). Extracapsular extension grades did not correlate with nodal size (P=0.28) or p16 status (P=0.8). In follow up, 10 patients (10%) had disease recurrence with only 3 of 64 (5%) grade 0-3 cases and 7 of 37 (19%) with grade 4 recurring (P=0.04). Grade 4 extracapsular extension was associated with poorer survival (PP=0.02), and in multivariate analysis, was not significantly associated with poorer overall (P=0.14) disease-free (P=0.2), or disease-specific survival (P=0.09). The impact of extracapsular extension in nodal metastases is limited in oropharyngeal squamous cell carcinoma. Only extracapsular extension grade 4 associates with poorer outcomes, but not independently of T-stage and other variables.

  16. Central Nervous System Birth Defects in Surgically Treated Infants in Sarajevo Region of Bosnia and Herzegovina

    Directory of Open Access Journals (Sweden)

    Selma Aličelebić


    Full Text Available Congenital anomalies of the central nervous system (CNS are common. The prevalence of these anomalies shows considerable geographical variation and female predominance. The aim of this work was to obtain the frequency of different CNS congenital anomalies types and their sex distribution among cases hospitalized in a Department of Neurosurgery, University of Sarajevo Clinics Center, Bosnia and Herzegovina, during the period January 2001 to December 2004. Retrospective study was carried out on the basis of the clinical records. Standard methods of descriptive statistics were performed for the data analysis. A total of 103 cases were surgically treated in the period from 2001 through 2004. Out of that number 56 (54,4% were female patients, while 47 (46,6% were male patients. Seven different CNS birth defect types were found in this investigation. These were: spina bifida (42 cases or 40,78%, congenital hydrocephalus (35 cases or 33,98%, arachnoid cyst (15 cases or 14,56%, Dandy-Walker syndrome (5 cases or 4,85%, dermoid cyst (4 cases or 3,88%, one of Arnold-Chiari syndrome (0,98% and one of encefalocele (0,98%. According to this investigation, CNS congenital birth defects were slightly higher in females (54,4%. The most frequent types were spina bifida (40,78% both in females (22,33% and in males (18,45%, hydrocephalus (33,98% and arachnoid cyst (14,56%. The anomalies of the other organ systems, associated with CNS anomalies obtained in this investigation, were pes equinovarus, cheiloshisis, cardiomegalia and palatoshisis. They were found in six cases (5,82%, equal in both sexes.

  17. Are diaphyseal clavicular fractures still treated traditionally in a non-surgical way?

    Directory of Open Access Journals (Sweden)

    Pedro José Labronici

    Full Text Available ABSTRACT OBJECTIVE: To evaluate the decision of orthopedics surgeons regarding which cases they would indicate surgery or non-surgical treatment. METHODS: 20 images of radiographs with fracture in the middle third of the collar bone (AO/OTA 15-B in anteroposterior view were analyzed, and divided into four groups: group 1 - fracture type AO/OTA 15-B1 without displacement; group 2 - fracture type AO/OTA 15-B1 with displacement; group 3 - fracture type AO/OTA 15-B2; group 4 - fracture type AO/OTA 15-B3. The evaluator was requested to indicate the choice of treatment, surgical or non-surgical. RESULTS: There was no strong correlation between the amount of surgical indications and the working experience or age of the medical evaluator. It was observed that the average of surgical indications in the total sample was 52%. When indications were studied in different areas of Brazil, there was no significant difference among them. No pattern for the Brazilian regions studied was observed in the case analysis. Even within a group (cases of the same complexity, no specific pattern of surgical indication was observed. CONCLUSION: No association between surgical indication and the length of professional experience was found. The Southern and Southeastern regions were those that most recommended surgeries in groups 2, 3, and 4. In no region the same level of surgical indication for cases of the same complexity rate was kept.

  18. [Juvenile idiopathic epiretinal membrane]. (United States)

    Kontopoulou, K; Krause, S; Fili, S; Hayvazov, S; Schilling, H; Kohlhaas, M


    Idiopathic epiretinal membrane (iERM) is very rare in adolescent patients. The pathogenesis remains unclear although the role of hyalocytes is of major importance. The clinical features in young patients are different from those in older patients. We describe a case of iERM in a 15-year-old girl who presented with metamorphopsia of the right eye. This case report presents the basis for the decision for surgical treatment as well as the clinical features at follow-up examination 9 months after surgery.

  19. Case Reports of Idiopathic Thrombocytopenia Unresponsive to First-Line Therapies Treated With Traditional Herbal Medicines Based on Syndrome Differentiation. (United States)

    Yang, Juno; Lee, Beom-Joon; Lee, Jun-Hwan

    The objective of our study is to present two cases showing the effects of traditional Korean herbal medicines based on traditional Korean medicine (TKM) for the treatment of immune thrombocytopenic purpura (ITP). One patient showed no response to treatment with steroids and an immunosuppressive agent. Moreover, liver toxicity and side effects of steroids were evident. However, after he ceased conventional treatment and started to take an herbal medicine, his liver function normalized and the steroid side effects resolved. Ultimately, he achieved complete remission. Another patient with ITP had sustained remission after steroid therapy in childhood, but extensive uterine bleeding and thrombocytopenia recurred when she was 16 years old. She was managed with steroids again for 2 years, but severe side effects occurred, and eventually she ceased taking steroids. She refused a splenectomy, and was then treated with a herbal medicine for 7 months, ultimately leading to sustained remission again. Many patients with resistance to first-line treatments tend to be reluctant to undergo a splenectomy, considered a standard second-line treatment. In conclusion, herbal medicines, based on TKM, may offer alternative treatments for persistent or chronic ITP that is resistant to existing first-line treatments. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  20. Endoscopic third ventriculostomy in idiopathic normal pressure ...

    African Journals Online (AJOL)

    Objective: To determine the efficacy of endoscopic fenestration of the third ventricle in the treatment of idiopathic normal pressure hydrocephalus. Methods: 16 patients with idiopathic normal pressure hydrocephalus were treated by endoscopic third ventriculostomy. This study lasted three years. All patients were over 50 ...

  1. Urinary System Birth Defects in Surgically Treated Infants in Sarajevo Region of Bosnia and Herzegovina

    Directory of Open Access Journals (Sweden)

    Selma Aličelebić


    Full Text Available Congenital anomalies of the urinary system are relatively common anomalies. In Bosnia and Herzegovina there is no existent unique evidence of congenital anomalies and registries. The aim of this study was to obtain the frequency of different urinary tract anomalies types and their sex distribution among cases hospitalized in the Department of Pediatric Surgery of the University of Sarajevo Clinics Centre, Bosnia and Herzegovina, during the period from January 2002 to December 2006. Retrospective study was carried out on the basis of clinical records. Standard methods of descriptive statistics were performed for the data analysis. Among 289 patients that were surgically treated 62,37% of the patients were male patients, while 37,63% were female patients. Twenty nine different urinary system anomalies types were found in this study. These were: vesicoureteral reflux (99 cases or 30,75%, hypospadias (62 cases or 19,26%, pelviureteric junction obstruction (42 cases or 13,04%, megaureter (35 cases or 10,87%, duplex pelvis and ureter (16 cases or 4,97%, bladder diverticulum (8 cases or 2,48%, ureterocoele (7 cases or 2,17%, stenosis of the external urethral opening (6 cases or 1,86%, ectopic kidney, duplex kidney and pelvis (each 5 cases or 1,55%, polycystic kidneys and urethral stricture (each 4 cases or 1,24%, multicystic kidney (3 cases or 0,93%, kidney agenesis, ureter agenesis, urethral diverticulum, ectopic ureter, horseshoe kidney and fetal kidney (each 2 cases or 0,62%, renal aplasia, urethral atresia, renal cyst, urachal cyst, epispadias, bladder exstrophy, renal hypoplasia, renal malrotation and Prune-Belly syndrome (each 1 case or 0,31%. According to this study, urinary tract anomalies were more common in male than in female patients (62,37%, Generally, the most frequent anomaly type was vesicoureteral reflux in total number of 99 cases, and in females (66 cases, but hypospadias was the most common anomaly in males (62 cases. The anomalies

  2. The functional outcome of surgically treated unstable pelvic ring fractures by open reduction, internal fixation

    Directory of Open Access Journals (Sweden)

    Kaykhosro Mardanpour


    Full Text Available Background:Unstable Pelvic fracture,a result of high energy antero-posterior compression injury, has been managed based on internal fixation and open reduction. The mode of fixation in Unstable Pelvic fracture has, however, been a subject of controversy and some authors have proposed a need to address the issue of partial breach of the pelvic ring elements in these injuries. This study was performed to evaluate the functional and radiological results of treatment of pelvic ring fractures by open reduction, internal fixation. Methods: Thirty eight patients with unstable pelvic fractures, treated from 2002 to2008 were retrospectively reviewed. The mean age of patients’ was 37 years old (range 20 to 67. Twenty six patients were men and 12 women. The most common cause was a road traffic accident (N=37, 97%. There were 11 type-C and 27 type-B fractures according to Tile’s classification. Thirty six patients sustained additional injuries. The most prevalent additional injuries were lower extremity fractures. Open reduction, internal fixation as a definite management was applied for all patients. Quality of reduction was graded according to the grades proposed by Matta and Majeed’s score was used to assess the clinical outcome. The mean period of follow-up was 25 months (ranged from 6 to 109 months. About 81.6% of patients had either good or excellent radiological reduction. Results: The functional outcome was excellent in 66%, good in 15%, fair in 11% and poor in 7% of the patients. There were 4 postoperative infections. No sexual function problem was reported. Nerve deficits recovered completely in 2 and partially in 3 of 11 patients with preoperative neurologic deficiency. There was no significant relation between functional outcome and the site of fracture Conclusion: Unstable pelvic ring fracture injuries should be managed surgically by rigid stabilization that must be carried out as soon as the general ndition of the patient permits, and

  3. Values of iodine metabolism biomarkers in assessing the iodine nutrition status in surgically treated patients with thyroid disease. (United States)

    Han, Jian-hua; Wu, Lian; Yu, Song-lin; Fang, Hui-ling; Kamg, Wei-ming; Cheng, Xin-qi; Lu, Jie; Yu, Jian-chun; Qiu, Ling


    To assess the clinical application value of iodine metabolism biomarkers in assessing iodine nutrition status in surgically treated patients with thyroid disease. Blood,morning urine and 24-hour urine samples were collected in 31 healthy volunteers and in 30 surgically treated patients with thyroid disease before and after surgery. Iodine concentration was analyzed by inductively coupled plasma mass spectrometry. The iodine metabolism biomarkers including serum iodine (SI), morning urine iodine(UI), morning urine iodine/urine creatinine ratio (UI/UCr), 24-hour urine iodine (24 h UI), and 24-hour urine iodine excretion (24 h UIE) were evaluated in these two groups. In addition, the validation coincidence rate of iodine metabolism biomarkers in healthy volunteers to different reference ranges including World Health Organization, Mayo Clinic, and Quest Diagnostics were calculated. The UI/UCr ratio of pre-operative thyroid disease patients was significantly lower than that of healthy volunteers (P0.05) between these two groups. The SI, UI ,and 24 h UI in postoperative thyroid disease patients were significantly higher than those of the pre-operative patients (all Piodine metabolism biomarkers. The UI/UCr ratio may be used for iodine nutrition evaluation in surgically treated patients with thyroid disease.

  4. Clinical effect comparison of different surgical methods for treating diabetic retinopathy

    Directory of Open Access Journals (Sweden)

    Qing Wu


    Full Text Available AIM: To compare the clinical results of different surgical methods for diabetic antipathy. METHODS: Eighty cases(102 eyeswith diabetic antipathy were selected in our hospital from January 2012 to December 2013. Thirty-eight cases(48 eyesin group A received joint surgical treatment, 42 cases(54 eyesin group B took staging of surgical treatment. The clinical effect was observed in both groups.RESULTS: The vision after surgery was improved than that of before surgery in two groups, there were no significant differences(P>0.05. A postoperative complication rate was 16.7% in group A and 22.2% in group B, showed no significant difference(P>0.05. CONCLUSION: Surgery and staging joint surgery are both feasible for diabetic retinopathy patients, can, improve the visionr. Both of them are worthy of clinical application.

  5. An innovative surgical technique for treating penile incarceration injury caused by heavy metallic ring

    Directory of Open Access Journals (Sweden)

    S J Baruah


    Full Text Available Penile incarceration injury by heavy metallic ring is a rare genital injury. A man may place metal object for erotic or autoerotic purposes, for masturbation or increasing erection, and due to psychiatric disturbances are some of the reasons for a penile incarceration injury. The incarcerating injury results in reduced blood flow distal to the injury, leading to edema, ischemia, and sometimes gangrene. These injuries are divided into five grades and their treatment options are divided into four groups. Surgical techniques are reserved for the advanced grades (Grades IV and V. We describe an innovative surgical technique, which can be adopted in Grades II and III injuries.

  6. Radiological findings in intracranial arachnoid cysts treated surgically and conservatively; Radiologische Befunde operativ und konservativ behandelter intrakranieller Arachnoidalzysten

    Energy Technology Data Exchange (ETDEWEB)

    Ernst, S. [Inst. und Poliklinik fuer Radiologische Diagnostik, Univ. Koeln (Germany); Lanfermann, H. [Inst. und Poliklinik fuer Radiologische Diagnostik, Univ. Koeln (Germany); Heindel, W. [Inst. und Poliklinik fuer Radiologische Diagnostik, Univ. Koeln (Germany); Hildebrandt, G. [Klinik und Poliklinik fuer Neurochirurgie, Univ. Koeln (Germany); Lackner, K. [Inst. und Poliklinik fuer Radiologische Diagnostik, Univ. Koeln (Germany)


    To determine which appearances on CT or MRI are indications for surgical treatment of intracranial arachnoid cysts. The images obtained from 26 patients treated either by surgery or conservatively were compared retrospectively. The features evaluated were the size of the cyst, evidence of a space-occupying lesion, cerebral abnormalities near the cyst and skull deformities. In 6 patients (23%), surgical treatment was indicated because of the presence of obstructive hydrocephalus. The presence of all other radiological findings did not differ significantly between the two analysed groups. 92% of the patients treated surgically benefited from the treatment. Fenestration and shunting produced similar results in respect to reduction in size of the cyst and the clinical and neurological symptoms. The only indication for surgery is the presence of obstructive hydrocephalus. The other features were seen equally amongst the patients treated conservatively and the surgical patients and had no influence on the decision to operate. (orig.) [Deutsch] Gibt es mit der CT oder MRT bildmorphologisch fassbare Befunde, die die Indikation zur Entlastung intrakranieller Arachnoidalzysten stuetzen? Die Schnittbilduntersuchungen von je 26 Patienten mit operativ oder konservativ behandelten Arachnoidalzysten wurden vergleichend retrospektiv beurteilt. Auswerteparameter waren Zystengroesse, Raumforderungszeichen, zystenbenachbarte Hirnparenchymdefekte und Kalottendeformierungen. Bei 6 Patienten (23%) war eine operative Entlastung aufgrund eines Hydrocephalus occlusus indiziert. Bei den uebrigen Parametern unterschieden sich die beiden Kollektive nur geringgradig. 92% der operierten Patienten profitierten von der Therapie. Fensterung und Shuntimplantation lieferten vergleichbare Ergebnisse bezueglich der Zystengroessenreduktion und der klinisch-neurologischen Symptomatik. Nur der durch eine Arachnoidalzyste bedingte Hydrocephalus occlusus stellt eine Indikation zur Operation dar. Die

  7. Demography, types, outcome and relationship of surgically treated intracranial suppuration complicating chronic suppurative otitis media and bacterial rhinosinusitis

    Directory of Open Access Journals (Sweden)

    Olufemi Emmanuel Idowu


    Full Text Available Introduction: Surgically treated intracranial suppurations (ICS are uncommon, life-threatening neurosurgical emergencies. They can result from complication of chronic suppurative otitis media (CSOM and bacterial rhinosinusitis (BRS. The objective of this study was to know the frequency of BRS and CSOM and relate it to its rare complication of surgically treated ICS while also describing the demography, type and outcome of ICS that resulted from BRS and CSOM. Materials and Methods: All patients that presented to the Otorhinolaryngological department and Neurosurgical unit of the same institution with clinical and radiological features of CSOM, BRS, and ICS were prospectively studied over a 5-year period. Patients were followed up for a minimum of 3 months. Results: Two thousand, two hundred and seventy-nine patients presented during the 5-year study period. Of all these patients, 1511 had CSOM (66.3% and 768 (33.7% presented with features of BRS. Eleven (0.73% had ICS complicating their CSOM while 8 (1.04% cases of surgically treated ICS followed BRS. Bacterial rhinosinusitis was not more likely to lead to ICS (P = 0.4348. The Odds ratio (OR of a child ≤ 18 years of age with CSOM developing ICS was 5.24 (95% Confidence interval 1.13-24.34; P = 0.0345, while it was 7.60 (95% Confidence interval 1.52-37.97; P = 0.0134 for children with BRS. Conclusions: The most common type of ICS complicating CSOM and BRS was brain abscess and subdural empyema, respectively. Children are more prone to develop surgical ICS following CSOM and BRS. The proportion of males that had ICS was higher in both CSOM and BRS patients. Optimal outcome is achieved in patients that presented with GCS of 13 and above.

  8. Chemotherapy effectiveness and mortality prediction in surgically treated osteosarcoma dogs : A validation study

    NARCIS (Netherlands)

    Schmidt, A F; Nielen, M; Withrow, S J; Selmic, L E; Burton, J H; Klungel, O H; Groenwold, R H H; Kirpensteijn, J


    Canine osteosarcoma is the most common bone cancer, and an important cause of mortality and morbidity, in large purebred dogs. Previously we constructed two multivariable models to predict a dog's 5-month or 1-year mortality risk after surgical treatment for osteosarcoma. According to the 5-month

  9. Surgical Resection of Brain Metastases and the Risk of Leptomeningeal Recurrence in Patients Treated With Stereotactic Radiosurgery

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    Johnson, Matthew D., E-mail: [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan (United States); Avkshtol, Vladimir [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan (United States); Baschnagel, Andrew M. [Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (United States); Meyer, Kurt; Ye, Hong; Grills, Inga S.; Chen, Peter Y.; Maitz, Ann [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan (United States); Olson, Rick E.; Pieper, Daniel R. [Department of Neurosurgery, William Beaumont Hospital, Royal Oak, Michigan (United States); Krauss, Daniel J. [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan (United States)


    Purpose: Recent prospective data have shown that patients with solitary or oligometastatic disease to the brain may be treated with upfront stereotactic radiosurgery (SRS) with deferral of whole-brain radiation therapy (WBRT). This has been extrapolated to the treatment of patients with resected lesions. The aim of this study was to assess the risk of leptomeningeal disease (LMD) in patients treated with SRS to the postsurgical resection cavity for brain metastases compared with patients treated with SRS to intact metastases. Methods and Materials: Four hundred sixty-five patients treated with SRS without upfront WBRT at a single institution were identified; 330 of these with at least 3 months' follow-up were included in this analysis. One hundred twelve patients had undergone surgical resection of at least 1 lesion before SRS compared with 218 treated for intact metastases. Time to LMD and overall survival (OS) time were estimated from date of radiosurgery, and LMD was analyzed by the use of cumulative incidence method with death as a competing risk. Univariate and multivariate analyses were performed with competing risk regression to determine whether various clinical factors predicted for LMD. Results: With a median follow-up time of 9.0 months, 39 patients (12%) experienced LMD at a median of 6.0 months after SRS. At 1 year, the cumulative incidence of LMD, with death as a competing risk, was 5.2% for the patients without surgical resection versus 16.9% for those treated with surgery (Gray test, P<.01). On multivariate analysis, prior surgical resection (P<.01) and breast cancer primary (P=.03) were significant predictors of LMD development. The median OS times for patients undergoing surgery compared with SRS alone were 12.9 and 10.6 months, respectively (log-rank P=.06). Conclusions: In patients undergoing SRS with deferral of upfront WBRT for intracranial metastatic disease, prior surgical resection and breast cancer primary are associated with an

  10. Idiopathic oedema

    DEFF Research Database (Denmark)

    Courtnadge, Christina; Madsen, Flemming; Bygum, Anette


    Idiopathic oedema is a non-inflammatory interstitial oedema seen in fertile women. A hallmark is a daily increase in weight > 1.4 kg from morning until evening due to fluid retention, which shows as facial puffiness in the morning and more often abdominal increase and swollen lower extremities...... during the day. Patients may be disabled due to accompanying symptoms like headache, dizziness, fatigue, anxiety, and depression. The diagnosis is based on clinical features and exclusion of other causes of oedema. Non-pharmacological interventions and pharmacological therapies are reviewed....

  11. Evaluation of therapeutic mammoplasty techniques in the surgical management of female patients with idiopathic granulomatous mastitis with mild to moderate inflammatory symptoms in terms of recurrence and patients' satisfaction. (United States)

    Ahmed, Yasser S; Abd El Maksoud, Walid


    Although idiopathic granulomatous mastitis (IGM) affects young females, its surgical management usually leads to disfigurement of the breasts. To assess the use of therapeutic mammoplasty techniques for management of IGM in terms of recurrence and postoperative patients' satisfaction. This prospective clinical study included thirteen patients who were diagnosed histologically as IGM. Patients with moderate to large breasts, who had a breast mass between 20-50% of the breast size with failed medical treatment or intolerability to steroids were subjected to therapeutic mammoplasty techniques. Only patients with large breasts were offered contra-lateral reduction mammoplasty to resume symmetry and achieve better aesthetic results. Early postoperative bleeding that was encountered in one patient (7.7%) was the only serious postoperative complication. Patient was re-operated and the bleeder was secured. Recurrence occurred in 2 patients (15.4%) at 16 and 24 months after the operation. Kyungpook National University Hospital (KNUH) breast reconstruction satisfaction questionnaire used to assess patients' satisfaction 6 months after the operation and revealed that 10 patients (76.9%) were satisfied after the operation. Using therapeutic mammoplasty techniques in surgical management of IGM in moderate to large breasts seems justifiable with good results regarding recurrence and postoperative patients' satisfaction.

  12. Wound complications and surgical events in de novo heart transplant patients treated with everolimus

    DEFF Research Database (Denmark)

    Rashidi, Mitra; Esmaily, Sorosh; Fiane, Arnt E


    associated with failure of tissue healing. Secondary endpoint was total number of events involving surgical intervention. RESULTS: There were no significant differences between the groups with regards to wound complications (EVE=20, CyA=12)(p=0.08) or total surgical events (EVE=38, CyA=34) (p=0.44). Age>54......OBJECTIVES: The use of mammalian target of rapamycin (mTOR) inhibitors have been limited by adverse events (AE), including delayed wound healing. We retrospectively reviewed all AE and serious AE (SAE) in The Scandinavian heart transplant (HTx) everolimus (EVE) de novo trial with early calcineurin...... (CNI) avoidance (SCHEDULE). The aim of the study was to compare wound complications between EVE and CNI based regimen. MATERIALS AND METHODS: A total of 115 patients (mean age 51 ± 13 years, 73% men) were randomized within five days post-HTx to low dose EVE and reduced dose Cyclosporine (CyA) followed...

  13. Limited left atrial surgical ablation effectively treats atrial fibrillation but decreases left atrial function. (United States)

    Compier, Marieke G; Tops, Laurens F; Braun, Jerry; Zeppenfeld, Katja; Klautz, Robert J; Schalij, Martin J; Trines, Serge A


    Limited left atrial (LA) surgical ablation with bipolar radiofrequency is considered to be an effective procedure for treatment of atrial fibrillation (AF). We studied whether limited LA surgical ablation concomitant to cardiac surgery is able to maintain LA function. Thirty-six consecutive patients (age 66 ± 12 years, 53% male, 78% persistent AF) scheduled for valve surgery and/or coronary revascularization and concomitant LA surgical ablation were included. Epicardial pulmonary vein isolation (PVI) and additional endo-epicardial lines were performed using bipolar radiofrequency. An age- and gender-matched control group (n = 36, age 66 ± 9 years, 69% male, 81% paroxysmal AF) was selected from patients undergoing concomitant epicardial PVI only. Left atrial dimensions and function were assessed on two-dimensional echocardiography preoperatively and at 3- and 12-month follow-up. Sinus rhythm (SR) maintenance was 67% for limited LA ablation and 81% for PVI at 1-year follow-up (P = 0.18). Left atrial volume decreased from 72 ± 21 to 50 ± 14 mL (31%, P Atrial transport function was restored in 54% of patients in SR after limited LA ablation compared with 100% of patients in SR after PVI. Atrial strain and contraction parameters (LA ejection fraction, A-wave velocity, reservoir function, and strain rate) significantly decreased after limited LA ablation. After PVI, strain and contraction parameters remained unchanged. Even limited LA ablation decreased LA volume, contraction, transport function, and compliance, indicating both reverse remodelling combined with significant functional deterioration. In contrast, surgical PVI decreased LA volume while function remained unchanged. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email:

  14. Cutaneous myiasis with Dermatobia hominis (human bot fly) larvae treated both conservatively and surgically. (United States)

    Wild, G


    A case is presented of infestation with the larvae of Dermatobia hominis (human bot fly). This case is unusual in that it provides an example of three different outcomes for separate lesions in the same patient; spontaneous resolution, conservative treatment and surgical intervention. It also illustrates that myiasis should be included in the differential diagnosis of any skin lesion of a patient returning from the tropics.

  15. Idiopathic megarectum in children. (United States)

    Godbole, P P; Pinfield, A; Stringer, M D


    There is scant information about the management of idiopathic megarectum in childhood. Children with idiopathic megarectum referred to a single institution between 1994 and 1998 were identified prospectively. Those with Hirschsprung's disease or an anorectal malformation were excluded. The remaining patient group, 22 boys and 7 girls, had a median age of 8.0 years (range 3.5-14.0 y). Median duration of symptoms prior to referral was 2.0 years (range 0.4-11 y). Chronic soiling was the dominant complaint in 28/29 (97%) cases. 23 children had received regular stimulant laxatives for periods ranging from 1 month to 11 years, and 9 children had been treated with regular enemas. The degree of megarectum assessed by both abdominal palpation and plain radiography was: grade 1 (below umbilical level) n=6; grade 2 (at umbilical level) n=15; and grade 3 (above umbilical level) n=8. Hirschsprung's disease was specifically excluded by rectal biopsy in all cases and no patient had evidence of spinal dysraphism. Three boys with massive megarectums and intractable symptoms were treated by a staged Duhamel sigmoid pull-through with excellent functional results. Fifteen patients (52%) were treated by a single manual evacuation under general anaesthesia followed by a daily Bisacodyl 5-10 mg suppository. After a median follow-up of 16 months, 13 continue to respond well with a daily bowel action and no soiling (4 of the 13 have discontinued treatment and remain well). The remaining 11 patients (38%) have continued conventional treatment with oral laxatives but with limited success. Idiopathic megarectum is poorly described in children. It is more common in boys and is often resistant to laxative therapy alone. After appropriate preparation, treatment with stimulant suppositories can be effective. Surgery has a valuable role in selected patients with a massive megarectum.

  16. Long-term survival outcomes in patients with surgically treated oropharyngeal cancer and defined human papilloma virus status. (United States)

    Dale, O T; Sood, S; Shah, K A; Han, C; Rapozo, D; Mehanna, H; Winter, S C


    This study investigated long-term survival outcomes in surgically treated oropharyngeal cancer patients with known human papilloma virus status. A case note review was performed of all patients undergoing primary surgery for oropharyngeal cancer in a single centre over a 10-year period. Human papilloma virus status was determined via dual modality testing. Associations between clinicopathological variables and survival were identified using a log-rank test. Of the 107 cases in the study, 40 per cent (n = 41) were human papilloma virus positive. The positive and negative predictive values of p16 immunohistochemistry for human papilloma virus status were 57 per cent and 100 per cent, respectively. At a mean follow up of 59.5 months, 5-year overall and disease-specific survival estimates were 78 per cent and 69 per cent, respectively. Human papilloma virus status (p = 0.014), smoking status (p = 0.021) and tumour stage (p = 0.03) were significant prognostic indicators. The long-term survival rates in surgically treated oropharyngeal cancer patients were comparable to other studies. Variables including human papilloma virus status and tumour stage were associated with survival in patients treated with primary surgery; however, nodal stage and presence of extracapsular spread were non-prognostic.

  17. Idiopathic Scoliosis

    Directory of Open Access Journals (Sweden)

    Jens Ivar Brox


    Full Text Available Idiopathic scoliosis (IS is a lifetime condition and is defined as a structural, lateral rotated curvature of the spine of >10° on standing coronal plane radiographs. It should be distinguished from other causes of scoliosis. It can be classified as infantile, juvenile, and adolescent according to age. As a rule of thumb, about 80% of all curves are idiopathic, right convex thoracic, and present in otherwise healthy girls at the beginning of puberty. A family member most commonly detects scoliosis. The structural asymmetry of the spine is best observed by asking the patient to bend forward. IS is often seen in more than one member of a family, but the aetiology remains unknown. Multiple genes are likely to be involved with incomplete penetrance and variable expressivity. Early detection by screening allows for monitoring curve progression and timely initiation of bracing, but school screening is controversial and practises vary worldwide. Most patients have minor scoliosis and treatment is generally not recommended for patients with curves 45°. Scoliosis surgery was not successful until the introduction of Harrington’s instrumentation in the 1960s. Modern instrumentation has evolved from the Cotrel-Dubousset system in the 1980s, and a variety of methods are available today. Although scoliosis may be a burden, long-term studies suggest that a good quality of life is maintained in most patients.

  18. Duodenocaval Fistula in a Patient with Inferior Vena Cava Leiomyosarcoma Treated by Surgical Resection and Caval Polytetrafluoroethylene Prosthesis

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    Davide Ippolito


    Full Text Available Inferior vena cava (IVC leiomyosarcoma represents an extremely rare disease that commonly involves the segment between the inflow of the renal veins and the inflow of the hepatic veins (46% of cases. We report the case of a patient affected by an IVC leiomyosarcoma, treated with surgical resection, caval reconstruction with polytetrafluoroethylene (PTFE, and right nephrectomy, followed by external beam radiotherapy. Oncological follow-up was negative for 17 years after this combined treatment, since the patient developed a duodenocaval fistula (DCF.

  19. Mortality in asymptomatic vs. symptomatic patients surgically treated for non-small cell lung cancer (NSCLC)

    DEFF Research Database (Denmark)

    Madsen, Kirsten Riis; Bødtger, Uffe

    , tobacco pack years, or FEV1. Former malignancy was significantly more prevalent among asymptomatic than symptomatic subjects (33 % vs. 11%), with insignificant differences in prevalence of other co-morbidities or in post-surgical TNM (82% vs 85% in stages IA-IIB). 12-months mortality was insignificantly...... higher in asymptomatic than symptomatic subjects (23% vs. 12%), and in patients with former malignancy compared to patients with no former cancer (17% vs. 16%). Discussion: Symptoms at diagnosis per se appear unrelated to mortality in patients with NSCLC referred for surgery. Asymptomatic patients were...

  20. Recurrent Scedosporium apiospermum mycetoma successfully treated by surgical excision and voriconazole

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    Chi-Hsuan Chiang


    Full Text Available Scedosporium apiospermum is an emerging opportunistic fungus that can cause localized infection in healthy hosts or severe disseminated disease in immunocompromised hosts. Most cases are reported in Western Europe, Australia, and North America. We report a 52-year-old immunocompetent Taiwanese woman who presented with a 6-year history of recurrent asymptomatic papulonodular lesions on her right foot after minor trauma. Deep fungal infection caused by Scedosporium sp. was diagnosed after a skin biopsy with fungal culture of the skin specimen. She underwent two surgical excisions, each followed by a 4-month course of oral itraconazole and intralesional injections of amphotericin B as well, but similar lesions recurred at the same location 1 year later. She had another surgical excision and the pathological findings showed mycetoma. The fungus was identified as S. apiospermum by PCR assay of fungal culture specimen using the internal transcriber spacers (ITS1, similarity 99.4%; ITS2, similarity 100% and the D1–D2 (similarity 99.0% regions of the ribosomal operon. After 4 months of oral voriconazole (400 mg/day, no recurrence was noted in the subsequent 2 years.

  1. Surgical Outcome of Treating Grades II and III Meningiomas: A Report of 32 Cases

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    Konstantinos Violaris


    Full Text Available Aim. To evaluate the frequency of atypical and malignant meningiomas and analyze recurrence rate; to study the morbidity and mortality of these tumors compared to benign meningiomas. Methods. During 1992–2007, 16 patients with malignant and 16 patients with atypical meningioma were operated in Neurosurgery Department of Thessaloniki's Papanikolaou Hospital. We analyzed tumor histology, location, and extent of surgical resection with respect to tumor reappearance and patients' outcome and compared the behavior of benign versus nonbenign meningiomas. Results. Malignant meningiomas accounted for 4.4% (16 patients and atypical meningiomas for another 4.4% of the series of patients (353 who were operated for intracranial meningioma at our department that period. Malignant meningiomas recurred at a rate of 75% and atypical meningiomas recurred at a rate of 41.6%. There was a significant association of the histological classification (benign, atypical, and malignant with recurrence (P0.05 was not significant to recurrence. Conclusions. Atypical and malignant meningiomas appeared at a rate of 8.8% of our series of intracranial meningiomas. They showed a significant predisposition to recur. These rare subtypes have higher morbidity and mortality rates than benign meningiomas. Recurrence depends primarily on the extent of surgical removal and on the histological characterization of the tumor as atypical or malignant.

  2. Pattern of Failure in Surgically Treated Patients with Cervical Esophageal Squamous Cell Carcinoma. (United States)

    Cao, Cai-Neng; Liu, Shao-Yan; Luo, Jing-Wei; Gao, Li; Xu, Guo-Zhen; Xu, Zhen-Gang; Tang, Ping-Zhang


    The aim of this study was to analyze the pattern of failure in patients who have undergone surgical resection for cervical esophageal squamous cell carcinoma. Case series with chart review. University hospital. Sixty-two patients who had undergone surgical resection of cervical esophageal squamous cell carcinoma from January 2001 through April 2012. Sites of failure were documented. Twenty-nine patients had developed treatment failure. Of the 29 patients, 14, 13, and 14 had developed local failure, regional failure, and distant metastasis, respectively. Of the 13 regional failures, the images of 2 patients were lost. The other 11 regional failures included left lateral nodal disease at level II (n = 2), level III (n = 4), and level IV (n = 7); right lateral nodal disease at level II (n = 2), level III (n = 3), and level IV (n = 3); and level VI (n = 4). The overall 2-year local failure-free survival rate and regional failure-free survival rates were 79.6% and 58.6% (P = .04) for patients with stage II disease and 79.6% and 59.6% (P = .054) for patients with stage III disease, respectively. The pattern of failure of cervical esophageal squamous cell carcinoma is characterized by early locoregional failure, especially in patients with stage III disease. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.


    Directory of Open Access Journals (Sweden)

    Dan V. Poenaru


    Full Text Available Patients with haemophilia type A or B may develop, over time, haemophilic arthropathy with different degrees of joint dysfunction. This disorder is a consequence of repeated episodes of intraarticular bleeding, with either spontaneous or traumatic aetiology. In the recent years, the therapeutic management of these patients has changed, still, without prompt early diagnosis and prophylactic treatment, the joints deteriorate to such a degree that only a complex multi-disciplinary approach can offer an optimal outcome. Modern high resolution MRI and prophylaxis treatment can detect and delay early signs of haemophilic arthropathy, but, not all patients have access to these types of early interventions. As a result, there are still patients presenting with different of degrees haemophilic arthropathy, which require surgical treatment. Despite the use of modern, minimal invasive approaches, surgical treatment alone can’t offer a good symptom relief and can’t provide a good functional outcome. Thus, the integration of physical therapy and functional rehabilitation in the therapeutic scheme can provide a good support in order for these patients to be socio-economically re-integrated.

  4. Incidence, hospital costs and in-hospital mortality rates of surgically treated patients with traumatic cranial epidural hematoma

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    Atci Ibrahim Burak


    Full Text Available Background: In this study, the patients who were operated in two clinics due to traumatic cranial epidural hematoma (EDH were assessed retrospectively and the factors that increase the costs were tried to be revealed through conducting cost analyses. Methods: The patients who were operated between 2010 and 2016 with the diagnosis of EDH were assessed in terms of age, sex, trauma etiology, Glasgow coma scale (GCS at admission, the period from trauma to hospital arrival, trauma-related injury in other organs, the localization of hematoma, the size of hematoma, length of stay in the intensive care unit (ICU, length of antibiotherapy administration, number of consultations conducted, total cost of in-hospital treatments of the patients and prognosis. Results: Distribution of GCS were, between 13-15 in 18 (36% patients, 9-13 in 23 (46% patients and 3-8 in 9 (18% patients. The reasons for emergency department admissions were fall from high in 29 (58% patients, assault in 11 (22% patients and motor vehicle accident in 10 (20% patients. The average cost per ICU stay was 2838 $ (range=343-20571 $. The average cost per surgical treatment was 314 $. ICU care was approximately 9 times more expensive than surgical treatment costs. The mortality rate of the study cohort was 14% (7 patients. Conclusion: The prolonged period of stay in the ICU, antibiotherapy and repeat head CTs increase the costs for patients who are surgically treated for EDH.

  5. Blood pressure reduction in patients with irreversible pulpitis teeth treated by non-surgical root canal treatment

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    James I-Sheng Huang


    Full Text Available Background/purpose: The hypotension in patients during non-surgical root canal treatment (NSRCT has not yet investigated. This study aimed to assess the mean systolic blood pressure (MSBP, mean diastolic blood pressure (MDBP, and mean arterial blood pressure (MABP reduction percentages in patients with irreversible pulpitis teeth treated by NSRCT. Materials and methods: We prospectively recruited 111 patients with a total of 138 irreversible pulpitis teeth. All patients underwent two NSRCT sessions. The first NSRCT session involved mainly the removal of vital pulp tissue with the direct stimulation of the dental branches of the trigeminal nerve, and the second NSRCT session included the root canal debridement and enlargement with minimal disturbance to the dental nerves. The blood pressure of each patient was recorded before and during both NSRCT sessions. Results: There were significantly higher reduction percentages of MSBP, MDBP, and MABP in the first NSRCT session than in the second NSRCT session for all treated patients (all the P-values < 0.001. If the patients were divided into 2 or more groups according to the clinical variables including the patients' gender, age, tooth type, and anesthesia type, we also found significantly higher reduction percentages of MSBP, MDBP, and MABP in the first NSRCT session than in the second NSRCT session for all treated patients except for patients below 40 years of age and for patients with lower anterior teeth treated (all the P-values < 0.05. Conclusion: The decrease in blood pressure in patients receiving vital pulpal extirpation is a relatively common phenomenon. Keywords: hypotension, irreversible pulpitis teeth, non-surgical root canal treatment, blood pressure, parasympathetic effect, vital pulpal extirpation

  6. Idiopathic hemihypertrophy. (United States)

    Mohanna, Mabrook A; Sallam, Abdul Khalig


    Idiopathic hemihypertrophy is a congenital overgrowth disorder associated with an augmented risk for embryonal tumors. We present 4 cases of hemihypertrophy in Yemeni children living in Sana`a city. They presented to the outpatient clinics in a private hospital in Sana`a city, Yemen, over a period of 3 years from January 2009 to December 2011. The first 2 cases had no complaints apart from asymmetrical size of one side of their bodies (left side hemihypertrophy). The third case presented with left side hemihypertrophy and an abdominal mass, which upon referral to a cancer center was confirmed to be Wilms` tumor. The fourth case had overgrowth of the right leg and foot with polydactyly, and a right sided abdominal mass. He was diagnosed to have an ureteropelvic junction stricture with hydronephrosis and absent left kidney.

  7. Occurrence of methicillin-resistant Staphylococci in surgically treated dogs and the environment in a Swedish animal hospital. (United States)

    Bergström, A; Gustafsson, C; Leander, M; Fredriksson, M; Grönlund, U; Trowald-Wigh, G


    To investigate whether hospitalised dogs treated surgically may become culture positive for methicillin-resistant Staphylococcus pseudintermedius or methicillin-resistant Staphylococcus aureus. Surgically treated dogs (n=45) were sampled for methicillin-resistant Staphylococcus pseudintermedius or methicillin-resistant Staphylococcus aureus on admission, before and after surgery and at the time of removal of surgical stitches. The hospital environment (n=57), including healthy dogs in the veterinary hospital environment (n=34), were sampled for methicillin-resistant Staphylococcus pseudintermedius or methicillin-resistant Staphylococcus aureus. Genetic variations among methicillin-resistant Staphylococcus pseudintermedius or methicillin-resistant Staphylococcus aureus isolates were identified through detection of restriction fragment polymorphisms. No dogs developed a wound infection due to methicillin-resistant Staphylococcus pseudintermedius or methicillin-resistant Staphylococcus aureus. However, there was a significant increase in the number of dogs carrying methicillin-resistant Staphylococcus pseudintermedius after hospitalisation compared to admission (Pmethicillin-resistant Staphylococcus aureus was isolated from dogs, but was present in the environment. Methicillin-resistant Staphylococcus pseudintermedius isolates were recovered from environmental surfaces and hospitalised animals, but not from healthy dogs. Methicillin-resistant Staphylococcus pseudintermedius isolates representing nine different restriction endonuclease digestion patterns were found, with two of these occurring in both the environment and on dogs. Dogs may contract methicillin-resistant Staphylococcus pseudintermedius in association with surgery and hospitalisation. Resistant bacteria may be transmitted between dogs, staff and the environment. Dogs colonised with methicillin-resistant Staphylococcus pseudintermedius may be a source for hospital- and community-acquired infections.

  8. Overcorrection and generalized joint laxity in surgically treated congenital talipes equino-varus. (United States)

    Haslam, Paul G; Goddard, Martin; Flowers, Mark J; Fernandes, James A


    Fifty patients with 70 previously operated clubfeet were assessed for overcorrection (using Tachdjian's flat foot grade) and generalized joint laxity. Twenty-eight patients (40 feet) had signs of generalized joint laxity using the Biro score and of these 25 feet were overcorrected. Of the 22 patients (30 feet) who did not have signs of joint laxity, only three overcorrected. This difference was statistically significant (P<0.001). A significant correlation exists between flat foot grade and laxity score (P<0.01). Overcorrection is a complication largely ignored in the published literature but we believe it is a serious complication of open release often resulting in poor long-term function. For those patients requiring surgery, the authors urge caution and recommend a limited surgical release, particularly if joint laxity is suspected, or the Ponseti method of treatment, which will probably avoid this complication.

  9. Clinical Results of Surgically Treated Medial Humeral Epicondylar Apophyseal Avulsion Injury in Children and Adolescent.

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    Ruban Raj Joshi


    years (SD=2.3. Fifteen (75% dominant elbows were injured in our study and 12(60% elbows had an associated elbow dislocation. On examination in operating room post anaesthesia, all of the elbow injuries revealed some degree of valgus instability. All of our patients(n=20 showed good to excellent results in the MAYO elbow performance score (MEPS. Radiographically, union was achieved in all cases. Three patients developed postoperative ulnar nerve neuropraxia, all recovered at time of final follow up. One patient developed mild lateral heterotrophic ossification but did not require any additional surgical intervention. Conclusion: Our results suggest that open reduction internal fixation of displaced medial epicondyle fractures leads to satisfactory motion and function. A valgus stress test in operating room can reveal the true nature of joint instability that can warrant operative stabilization of medial epicondylar injuries.

  10. [Report of experiences with 31 surgically treated patients with deformity of the femur shaft]. (United States)

    Winter, T; Wolff, R; Bansky, G


    In 1986/1987 we made a follow-up of 31 patients having undergone a surgical treatment of a deformity of the femur shaft in 1971 through 1981. For a better interpretation of the results we divided these patients into three partly overlapping groups: Patients with deformities of the angel or rotation, patients being shortened in case of length-differences and those being elongated. Finally we investigated, that in nine out of ten cases we got a good result by correcting angle-and rotation-deformities and by the shortening osteotomy. The extension osteotomy caused more complications and not so good results than those of the first two groups. We recognized, that the follow-up treatment was very long, and the method of the operation was not standardized but was adapted to the circumstances of the single case.

  11. Radiological predictive factors for the outcome of surgically treated calcaneus fractures. (United States)

    Baptista, Mário; Pinto, Rui; Torres, João


    Calcaneus fractures are fairly common and clinically relevant due to their poor outcome. Thus, solving the controversy regarding treatment and outcome prediction should be a target. This study intends to evaluate the predictive ability of common radiologic tools for the surgical outcome of calcaneus fractures, regardless of treatment modality. 44 patients' records, with operated calcaneus fractures between 2008 and 2013, were retrospectively assessed and imagiology was blindly evaluated. Patients were submitted to percutaneous or open lateral approach. No relevant correlations were found between the measurements on the plain lateral radiograph and the outcome. Fractures were also graded according to the Sanders classification. Type 4 fractures predicted the occurrence of any hazard, such as skin or pain related complications and need for secondary surgery (p=0.051, odds=14.00 [CI=1.30-150.89]). However, it's still not possible to accurately target patients with high risk of postoperative complications. Until then, follow-up protocols should be maintained indiscriminately.

  12. [Perceived self-image in adolescent idiopathic scoliosis: an integrative review of the literature]. (United States)

    Carrasco, Maria Isabel Bonilla; Ruiz, Maria Carmen Solano


    To learn about the experiences of adolescents diagnosed with idiopathic scoliosis. Integrative review of the literature published within a specified time frame. For both sexes, the predominant clinical symptom of this condition appears to be the negative effect that the deformity exerts on perceived self-image. Quantitative studies used numerical scores to assess perceptions of body image but did not analyse emotional aspects. Patients treated surgically were found to have a better self-image than patients treated with a brace. Quality of life was improved by a reduction in the magnitude of the curve. Spinal deformity exerts a psychological effect on adolescent girls.

  13. Perceived self-image in adolescent idiopathic scoliosis: an integrative review of the literature

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    Maria Isabel Bonilla Carrasco


    Full Text Available Objective: To learn about the experiences of adolescents diagnosed with idiopathic scoliosis. Method: Integrative review of the literature published within a specified time frame. Results: For both sexes, the predominant clinical symptom of this condition appears to be the negative effect that the deformity exerts on perceived self-image. Quantitative studies used numerical scores to assess perceptions of body image but did not analyse emotional aspects. Patients treated surgically were found to have a better self-image than patients treated with a brace. Quality of life was improved by a reduction in the magnitude of the curve. Conclusion: Spinal deformity exerts a psychological effect on adolescent girls.

  14. Defining Prolonged Length of Acute Care Stay for Surgically and Conservatively Treated Patients with Spontaneous Intracerebral Hemorrhage: A Population-Based Analysis

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    Marco Stein


    Full Text Available Background. The definition of prolonged length of stay (LOS during acute care remains unclear among surgically and conservatively treated patients with intracerebral hemorrhage (ICH. Methods. Using a population-based quality assessment registry, we calculated change points in LOS for surgically and conservatively treated patients with ICH. The influence of comorbidities, baseline characteristics at admission, and in-hospital complications on prolonged LOS was evaluated in a multivariate model. Results. Overall, 13272 patients with ICH were included in the analysis. Surgical therapy of the hematoma was documented in 1405 (10.6% patients. Change points for LOS were 22 days (CI: 8, 22; CL 98% for surgically treated patients and 16 days (CI: 16, 16; CL: 99% for conservatively treated patients. Ventilation therapy was related to prolonged LOS in surgically (OR: 2.2, 95% CI: 1.5–3.1; P<0.001 and conservatively treated patients (OR: 2.5, 95% CI: 2.2–2.9; P<0.001. Two or more in-hospital complications in surgical patients (OR: 2.7, 95% CI: 2.1–3.5 and ≥1 in conservative patients (OR: 3.0, 95% CI: 2.7–3.3 were predictors of prolonged LOS. Conclusion. The definition of prolonged LOS after ICH could be useful for several aspects of quality management and research. Preventing in-hospital complications could decrease the number of patients with prolonged LOS.

  15. Subarachnoid haemorrhage (SAH): long-term cognitive outcome in patients treated with surgical clipping or endovascular coiling. (United States)

    Latimer, Sophie F; Wilson, F Colin; McCusker, Chris G; Caldwell, Sheena B; Rennie, Ian


    To compare long-term cognitive outcomes of patients treated with surgical clipping or endovascular coiling after subarachnoid haemorrhage (SAH). Retrospective matched cohort study assessed neuropsychological functioning at least 12 months after aneurysmal SAH treatment. Fourteen patients treated by endovascular coiling and nine patients treated by surgical clipping participated. After gaining written consent, a comprehensive neuropsychological battery was completed. Standardised tests were employed to assess pre-morbid and current intellectual functioning (IQ), attention, speed of information processing, memory and executive function as well as psychosocial functioning and affect. Treatment groups were not significantly different in terms of age, pre-morbid IQ, time from injury to treatment or time since injury. A significant effect of treatment on full-scale IQ score (p = 0.025), performance IQ (p = 0.045) and verbal IQ score (p = 0.029), all favouring the coiled group was observed. A medium effect size between groups difference in immediate memory (p = 0.19, partial η(2) = 0.08) was also observed. No significant between group differences on attention, executive functioning and speed of information processing measures or mood and psychosocial functioning were noted. Both groups reported increased anxiety and memory, attention and speed of information processing deficits relative to normative data. Study findings indicate fewer cognitive deficits following endovascular coiling. Cognitive deficits in the clipped group may be due in part to the invasive nature of neurosurgical clipping. Further prospective research with regard to long-term cognitive and emotional outcomes is warranted. IMPLICATIONS OF REHABILITATION: • Treatment of ruptured intracranial aneurysms by either endovascualar coiling or neurosurgical clipping can result in significant long-term physical disability as well as cognitive impairment. • Observed cognitive impairment(s) tend to be less in

  16. [Segmental sternal dislocation in children. Apropos of a surgically treated case]. (United States)

    Norotte, G; Peres, E; Vanderweyen, A; Razafindralasitra, P


    The authors report one operated case of traumatic sternal segmental dislocation in a child, and propose a mechanism for this uncommon lesion. A fourteen year old boy was admitted in emergency for anterior chest pain, occurring during an exercise in parallel bars without any fall. X ray showed traumatic dislocation of the upper sternal segment. After 12 hours, because of bad clinical tolerance (pain, dyspnea with sweats and disphagia) reduction and plate stabilization (Senegas plate) was performed with immediate pain relief. The boy returned to school after 10 days. Plate was removed two months later after healing, with good clinical and radiological results. According to rare published cases, conservative treatment can be proposed in very young children because of dislocation remodeling. By others, in case of bad tolerance, surgical treatment is suggested despite the inconvenient of device's removal. The originality of this case is the indirect lesion mechanism. Hypothesis is given by authors. Treatment by plate is easy and gives immediate pain relief with good clinical and radiological results in teen-agers.

  17. Complete Atlantooccipital Assimilation with Basilar Invagination and Atlantoaxial Subluxation Treated Non-Surgically: A Case Report. (United States)

    Electricwala, Ali J; Harsule, Amita; Chavan, Vishwajeet; Electricwala, Jaffer T


    Atlantooccipital assimilation is a partial or complete congenital fusion between the atlas and the base of the occiput. Most patients with atlas assimilation are asymptomatic, but some may present with neurological problems such as myelopathy. We present the case of a 37-year-old woman who presented with neck and occipital pain, episodic neck stiffness, and dizziness. Medical imaging revealed complete atlantooccipital assimilation associated with basilar invagination, atlantoaxial subluxation, and predisposing anterior spinal cord compression. The patient was treated non-operatively with medications, cervical interferential therapy, and a rigid cervical orthosis.

  18. Chemotherapy effectiveness and mortality prediction in surgically treated osteosarcoma dogs: A validation study. (United States)

    Schmidt, A F; Nielen, M; Withrow, S J; Selmic, L E; Burton, J H; Klungel, O H; Groenwold, R H H; Kirpensteijn, J


    Canine osteosarcoma is the most common bone cancer, and an important cause of mortality and morbidity, in large purebred dogs. Previously we constructed two multivariable models to predict a dog's 5-month or 1-year mortality risk after surgical treatment for osteosarcoma. According to the 5-month model, dogs with a relatively low risk of 5-month mortality benefited most from additional chemotherapy treatment. In the present study, we externally validated these results using an independent cohort study of 794 dogs. External performance of our prediction models showed some disagreement between observed and predicted risk, mean difference: -0.11 (95% confidence interval [95% CI]-0.29; 0.08) for 5-month risk and 0.25 (95%CI 0.10; 0.40) for 1-year mortality risk. After updating the intercept, agreement improved: -0.0004 (95%CI-0.16; 0.16) and -0.002 (95%CI-0.15; 0.15). The chemotherapy by predicted mortality risk interaction (P-value=0.01) showed that the chemotherapy compared to no chemotherapy effectiveness was modified by 5-month mortality risk: dogs with a relatively lower risk of mortality benefited most from additional chemotherapy. Chemotherapy effectiveness on 1-year mortality was not significantly modified by predicted risk (P-value=0.28). In conclusion, this external validation study confirmed that our multivariable risk prediction models can predict a patient's mortality risk and that dogs with a relatively lower risk of 5-month mortality seem to benefit most from chemotherapy. Copyright © 2016 Elsevier B.V. All rights reserved.

  19. Is surgical debridement necessary in the diabetic foot treated with photodynamic therapy? (United States)

    Tardivo, João Paulo; Serrano, Rodrigo; Zimmermann, Lívia Maria; Matos, Leandro Luongo; Baptista, Mauricio S; Pinhal, Maria Aparecida Silva; Atallah, Álvaro N


    Background : Diabetic patients are susceptible to developing foot ulcers with serious complications such as osteomyelitis and amputations. Treatment approaches are still empirical and the benefit of usual procedures such as surgical debridement has not been properly evaluated. Photodynamic Therapy (PDT) is a non-invasive and highly efficient method for the treatment of the diabetic foot, being able to eradicate the infection and to stimulate healing, decreasing considerably the amputation risk. In the day-to-day practice of our service, we have been faced with the question whether debridement is necessary before PDT. In here, we designed a study to answer that question. Methods : Patients were divided in two groups: In one of the groups (n = 17), debridement was performed before PDT and in the other (n = 40) only PDT treatment was performed. PDT sessions were performed once a week in all patients until healing was achieved, as indicated by visual inspection as well as by radiographic and laboratory exams. At the start of the study, the two groups had no statistical differences concerning their clinical features: average age, gender, insulin use, diabetes mellitus onset time and previous amputations. Results : PDT was effective in the treatment of 100% of the patients showing no relapses after one year of follow up. The group submitted to PDT without previous debridement had a statistically significant (p = 0.036, Mann-Whitney) shorter cure time (29 days, ~27%). Conclusion : Our data indicates that debridement is not necessary in the treatment of diabetic foot in patients that have enough peripheral arterial perfusion. In addition, we reproduced previous studies confirming that PDT is an efficient, safe, simple and affordable treatment method for the diabetic foot.

  20. [Esophageal perforation: analysis of seven cases treated by early surgical treatment with good functional results]. (United States)

    Sanna, Stefano; Taurchini, Marco; Mengozzi, Marta; Monteverde, Marco; Argnani, Desiderio; Dell'Amore, Davide


    Esophageal perforation has been considered a catastrophic and often life-threatening event, with very high mortality rates. Most of the cases are due to a complication in endoscopic manouvers and the best treatment, conservative rather than aggressive, remains a controversial topic. In 1995-2005 period we observed 7 cases of esophageal perforation, 5 women and 2 men mean age 73.2 y (range 60-87). Three cases are due to foreign body ingestion, 2 cases to endoscopic manoeuvres, 2 cases were spontaneous. In 3 cases the lesion was in the cervical tract of the esophagus, in the thoracic tract the others. All the patients were admitted very early to our Unit and presented disphagia, vomiting and dyspnoea, 2 out of them also a pleural effusion. In iatrogenic perforation we performed a cervicotomy and a drainage of mediastinic abscess, while in spontaneous lesions mono (one case) or bipolar esophageal exclusion (one case) with primary suture, jujunostomy and drainage of pleural effusion were the treatment. In foreign body perforation we performed thoracotomic and cervicotomic esophagotomy, extraction of the foreign body, direct suture with pleural or muscle protection. We didn't observe any intra or post-operative mortality. About the complications, we observed a bilateral pleural empyema, a chylous fistula, a digestive bleeding due to gastric ulcer, a laparotomic infection, a parossistic FA and a persistent esophageal fistula. Mean hospital stay was 24.3 days (range 10-43). All the patients were discharged to the hospital in good conditions. In conclusion in most of the cases of esophageal perforation the surgical treatment is the treatment of choice for its lower morbidity and mortality and good functional results.

  1. An intact fibula may contribute to allow early weight bearing in surgically treated tibial plateau fractures. (United States)

    Carrera, Ion; Gelber, Pablo Eduardo; Chary, Gaetan; Gomez Masdeu, Mireia; González Ballester, Miguel A; Monllau, Juan Carlos; Noailly, Jerome


    The role of the proximal tibiofibular joint (PTFJ) in tibial plateau fractures is unknown. The purpose of this study was to assess, with finite-element (FE) calculations, differences in interfragmentary movement (IFM) in a split fracture of lateral tibial plateau, with and without intact fibula. It was hypothesized that an intact fibula could positively contribute to the mechanical stabilization of surgically reduced lateral tibial plateau fractures. A split fracture of the lateral tibial plateau was recreated in an FE model of a human tibia. A three-dimensional FE model geometry of a human femur-tibia system was obtained from the VAKHUM project database, and was built from CT images from a subject with normal bone morphologies and normal alignment. The mesh of the tibia was reconverted into a geometry of NURBS surfaces. The fracture was reproduced using geometrical data from patient radiographs, and two models were created: one with intact fibula and other without fibula. A locking screw plate and cannulated screw systems were modelled to virtually reduce the fracture, and 80 kg static body weight was simulated. Under mechanical loads, the maximum interfragmentary movement achieved with the fibula was about 30% lower than without fibula, with both the cannulated screws and the locking plate. When the locking plate model was loaded, intact fibula contributed to lateromedial forces on the fractured fragments, which would be clinically translated into increased normal compression forces in the fractured plane. The intact fibula also reduced the mediolateral forces with the cannulated screws, contributing to stability of the construct. This FE model showed that an intact fibula contributes to the mechanical stability of the lateral tibial plateau. In combination with a locking plate fixation, early weight bearing may be allowed without significant IFM, contributing to an early clinical and functional recovery of the patient.

  2. The activity of gastric ghrelin positive cells in obese patients treated surgically.

    Directory of Open Access Journals (Sweden)

    Artur Bossowski


    Full Text Available Ghrelin is a 28 amino acid peptide hormone regulating food intake and stimulating releasement of growth hormone. It is produced in a distinct endocrine call known as X/A - like cells. The most abundant source of this very important factor in energy homeostasis is gastric fundus. Regulatory mechanisms of ghrelin synthesis and secretion in physiological and pathological states are not discovered completely. The aim of our study was evaluation of the activity of gastric X/A-like cells in obese patients before and after the most popular surgical bariatric procedures - Roux - Y Gastric Bypass (RYGB and Laparoscopic Adjustable Gastric Banding (LAGB. Obese patients in number 18 took part in the study. LAGB was performed in 7 patients and RYGB in 11 patients. Peripheral blood was taken from each patient before operation and first day, seventh day, one month and three months after surgery. Ghrelin level was determined by RIA technique. The specimen of stomach was taken from circular stapler after gastrojejunostomy during RYGB and immunohistochemical study of gastric mucosa, using the EnVision method and specific monoclonal antybodies against ghrelin was performed. The intensity of ghrelin-immunoreactivity in X/A-like cells was analyzed using Olympus Cell D image analysis system. Efficiency of bariatric procedures was estimated by EWL- excess weight loss. We observed very strong immunohistochemical reactions of gastric X/A-like cells, accompanied by lower ghrelin plasma concentration, in comparison to the control group. LAGB procedure induced increase of ghrelin plasma level while RYGB procedure induced decrease of this hormone. The main finding of the present study is the hypoactivity of gastric X/A-like cells in obese patients in comparison to the control group.

  3. Metabolic consequences of 5-year growth hormone (GH) therapy in children treated with GH for idiopathic short stature. Genentech Collaborative Study Group. (United States)

    Saenger, P; Attie, K M; DiMartino-Nardi, J; Hintz, R; Frahm, L; Frane, J W


    In a multicenter study the metabolic effects of 5 yr of GH therapy in children with idiopathic short stature were evaluated. Patients received 0.3 mg/kg.week recombinant human GH. Of the 121 patients who entered the study, data for 62 were analyzed at the final 5 yr point. Routine laboratory determinations were available for all 62 subjects at the 5 yr point. Special laboratory determinations, such as postprandial glucose and insulin, were available for only a subset of patients. Mean insulin-like growth factor I levels rose to 283 +/- 101 micrograms/L, within the normal range using age-appropriate reference standards. T4, cholesterol, triglycerides, blood chemistries, and blood pressure showed no significant changes during the 5-yr period. Mean baseline and 2-h postprandial glucose levels remained unchanged. Both fasting and postprandial insulin levels rose substantively from low normal levels to the normal range (median, 4.9-43 mU/L). Mean hemoglobin A1c levels remained within the normal range throughout the study. In summary, careful monitoring has not revealed any currently discernible metabolic side-effects of clinical significance after GH therapy in this 5-yr study of children with idiopathic short stature.

  4. Autopsy findings in surgical-radiotherapeutically treated bladder carcinoma - conclusions for optimization of radiotherapy

    International Nuclear Information System (INIS)

    Fueller, J.; Kob, D.; Fritzsche, V.


    Autopsy findings in patients with bladder carcinoma, treated by combined operation and radiotherapy, revealed tendencies of tumor spread as well as complications and late effects of radiotherapy. In 24.5% of the cases tumor tissue was found within the bladder and in 30.5% within the minor pelvis. Metastases were found in 24.1% in iliac lymph nodes, in 21.3% in abdominal lymph nodes. Liver, lungs, bones, and kidneys are main organs for hematological metastasizing. Little or undifferentiated carcinomas and squamous cell carcinomas showed a greater tendency to metastasize than highly and medium-differentiated ureteral carcinomas. The least radiotherapeutical complications and late effects were found in a fractionation with daily 1.5 Gy and a total dose of 60 Gy. (author)

  5. Surgical results and MRI findings of cervical myelopathy treated with anterior decompression and fusion

    International Nuclear Information System (INIS)

    Miyazato, Takenari; Teruya, Yoshimitsu; Kinjo, Yukio


    We reviewed 19 patients with cervical myelopathy treated with anterior decompression and fusion. Etiology of cervical myelopathy was cervical disc herniation (CDH) in 13 patients and cervical spondylosis (CSM) in 6. Clinical recovery rate (%) was calculated from preoperative cervical myelopathy score (JOA) and the score at follow-up. Correlation between the clinical recovery rate and MRI findings (area and flatness at the narrowest part of the spinal cord), age at surgery, duration of myelopathy and pre-operative clinical score were analyzed separately in the CDH and CSM groups. Clinical recovery rate averaged 69% in the CDH group and 75% in the CSM group. In the CDH group, average clinical recovery rate in patients younger than 60 years was 80 and in patients over 60 years was 60. There was a significant negative correlation between the clinical recovery rate and age at surgery (p<0.05). No significant correlation was found between the clinical recovery rate and other factors investigated. (author)

  6. Surgical results and MRI findings of cervical myelopathy treated with anterior decompression and fusion

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    Miyazato, Takenari; Teruya, Yoshimitsu [Chubu Tokushukai Hospital, Okinawa (Japan); Kinjo, Yukio [and others


    We reviewed 19 patients with cervical myelopathy treated with anterior decompression and fusion. Etiology of cervical myelopathy was cervical disc herniation (CDH) in 13 patients and cervical spondylosis (CSM) in 6. Clinical recovery rate (%) was calculated from preoperative cervical myelopathy score (JOA) and the score at follow-up. Correlation between the clinical recovery rate and MRI findings (area and flatness at the narrowest part of the spinal cord), age at surgery, duration of myelopathy and pre-operative clinical score were analyzed separately in the CDH and CSM groups. Clinical recovery rate averaged 69% in the CDH group and 75% in the CSM group. In the CDH group, average clinical recovery rate in patients younger than 60 years was 80 and in patients over 60 years was 60. There was a significant negative correlation between the clinical recovery rate and age at surgery (p<0.05). No significant correlation was found between the clinical recovery rate and other factors investigated. (author).

  7. Factors affected by surgical technique when treating total colonic aganglionosis: laparoscopy-assisted versus open surgery. (United States)

    Miyano, Go; Ochi, Takanori; Lane, Geoffrey J; Okazaki, Tadaharu; Yamataka, Atsuyuki


    We compared laparoscopy-assisted Duhamel (Lap-D) with open surgery (Duhamel or Soave = D/S) for treating total colonic aganglionosis (TCA) in children to establish what factors may affect outcome. Fourteen TCA cases treated between 1990 and 2010 were reviewed. Open D/S (O-D/S) through a vertical midline abdominal incision was routine from 1990 to 2005, whereupon Lap-D became routine. Lap-D involves laparoscopic colon resection, ileostomy take-down, and ileum pull-through through an additional Pfannenstiel incision. We compared pre-operative nutrition, operating time, intraoperative blood loss, duration until oral challenge, postoperative analgesic usage, incidence of enterocolitis, early complications that arose within 30 days of surgery, and late complications, and wound cosmesis 1 year postoperatively (Grade-1: unacceptable, Grade-2: passable, Grade-3: excellent). Six had O-D/S (2D, 4S) and eight had Lap-D. Differences in patient demographics, mean ages/weights at surgery, average length of the aganglionic segment from the terminal ileum, operating time, and time taken for oral challenge were all not significant, full feeding took longer in O-D/S (6.7 vs. 5.9 days). Preoperative central vein intravenous hyperalimentation was required for one case in O-D/S and two cases in Lap-D. These three required hospitalization for at least 30 days postoperatively and parenteral nutrition after discharge. Although there were no intraoperative complications in either group, there was one case of transient ileus in O-D/S that resolved conservatively. Cosmesis was significantly better in Lap-D (O-D/S = 1.2; Lap-D = 2.1; p < 0.05). Cosmesis was the only factor that was significantly different between Lap-D and O-D/S; all other factors were similar.

  8. Endophthalmitis associated with Purpureocillium lilacinum during infliximab treatment for surgically induced necrotizing scleritis, successfully treated with 27-gauge vitrectomy. (United States)

    Yoshida, Masaaki; Yokokura, Shunji; Kunikata, Hiroshi; Takada, Naoko; Maruyama, Kazuichi; Toyokawa, Masahiro; Kashio, Kazushi; Kaku, Mitsuo; Nakazawa, Toru


    To report a case of endophthalmitis associated with Purpureocillium lilacinum (P. lilacinum) during infliximab treatment for surgically induced necrotizing scleritis, successfully treated with 27-gauge vitrectomy. A single case report. A 71-year-old man who had undergone immunosuppressive therapy, including infliximab, for surgically induced necrotizing scleritis (SINS) in his left eye complained of visual disturbance and eye pain in the eye. He had a past history of surgery for recurrent pterygium: pterygium excision, amnion transplantation with mitomycin C and limbal transplantation. Visual acuity in the left eye was counting fingers at 30 cm, and intraocular pressure was 3.0 mmHg. Slit-lamp examination revealed the presence of anterior chamber cells (3+), and a B-mode ultrasound scan showed a vitreous opacity. We made a diagnosis of endophthalmitis and performed 27-gauge microincision vitrectomy surgery (27GMIVS) with antibiotic perfusion of ceftazidime, vancomycin and voriconazole. Intraoperative findings included a fungus-like ball-shaped opacity in the vitreous, and a close-to-normal retinal appearance. A vitreous body culture identified the presence of P. lilacinum. After 2 months of antibacterial and antifungal therapy, inflammation decreased and visual acuity recovered to 20/100. This is the first report of a case of endophthalmitis associated with P. lilacinum during infliximab treatment for SINS. Scleral thinning due to necrotizing scleritis, especially during immunosuppressive therapy, is a risk factor for endophthalmitis. We found that 27GMIVS was a useful strategy for such a challenging clinical situation.

  9. [Bracing in Adolescent Idiopathic Scoliosis]. (United States)

    Lo, Yi-Fang; Huang, Yu-Chu


    Scoliosis is a common medical problem, with an incidence of between 0.47% and 5.2% in the general population globally. Adolescent idiopathic scoliosis (AIS) accounts for nearly 80% of all scoliosis. Young people with AIS often experience negative social consequences in association with their condition. Without proper and timely treatment, the potential resulting disabilities range from trunk deformity, pain, and neurological complications to compromised cardiopulmonary function, all of which may cause lifelong suffering. Scoliosis may be treated either conservatively or surgically, based on the severity of the disease. Bracing is the most widely adopted method of conservative treatment. However, the main goal of bracing is to inhibit the progression of the spinal curvature rather than to cure scoliosis. The clinical effectiveness of bracing in Taiwan has often been underutilized as a result of financial or other factors such as the availability of the treatment. The purpose of the present review is to clarify the effectiveness of bracing for AIS by elucidating the pathophysiology of scoliosis and examining the recent clinical evidence. The importance of preventative care and the unique contribution of nursing care to treatment has to date been under-recognized. The positive support that nurses provide to the families of the patients during the early phases of treatment as well as to the patients themselves, including helping them exercise appropriately and wear the brace correctly, is an essential component of effective treatment. Learning how to work with and to adapt to the brace being part of the body is an important part of the treatment as well as a way to avoid pain. Nurses are in an ideal position to facilitate this learning process and, overall, to provide health education.

  10. Gastroduodenal and ileal polyps in patients treated surgically for familial polyposis coli with proctocolectomy and continent ileostomy. (United States)

    Ojerskog, B; Myrvold, H E; Nilsson, L O; Philipson, B M; Ahrén, C


    Eighteen patients, who previously had been treated surgically for familial polyposis coli with proctocolectomy and a continent ileostomy were re-investigated with endoscopy and X-ray for gastric, duodenal and ileal polyps. Gastric and/or duodenal polyps were found in 6 patients and ileal polyps in 2. Altogether upper GI-polyps were found in 7 patients (39%). Most polyps were true adenomas. In one patient with large gastric adenomas, the severe dysplasia called for a gastric resection. It is obvious that familial polyposis may affect the whole gastro-intestinal tract, therefore necessitating regular surveillance of the upper GI-canal as well as the colon and rectum in patients with this hereditary affliction.

  11. Reproducibility of thoracic kyphosis measurements in patients with adolescent idiopathic scoliosis

    DEFF Research Database (Denmark)

    Ohrt-Nissen, Søren; Cheung, Jason Pui Yin; Hallager, Dennis Winge


    BACKGROUND: Current surgical treatment for adolescent idiopathic scoliosis (AIS) involves correction in both the coronal and sagittal plane, and thorough assessment of these parameters is essential for evaluation of surgical results. However, various definitions of thoracic kyphosis (TK) have been...

  12. Idiopathic oedema and diuretics. (United States)

    Dunnigan, M. G.; Denning, D. W.; Henry, J. A.; de Wolff, F. A.


    Diuretic abuse has been invoked as the cause of idiopathic oedema. In this study, eight patients with idiopathic oedema were studied. Symptoms and weight variation continued despite the proven absence of diuretics in seven of them as determined by urinary chromatograms. Idiopathic oedema cannot therefore be attributed to diuretic use alone. PMID:3671223

  13. Study of serum ctx in 50 oral surgical patients treated with oral bisphosphonates (United States)

    Flichy-Fernández, Antonio J.; Alegre-Domingo, Teresa; González-Lemonnier, Sandra; Balaguer-Martínez, José; Jiménez-Soriano, Yolanda; Peñarrocha-Diago, David; Bagán-Sebastián, José V.


    Objectives: To determine whether there is a relationship between the total BP dose administered and the variations in serum CTX concentration. Study design: The study included 50 patients requiring dental implant surgery and treated with oral BPs, seen in an Oral Surgery and Implantology Unit between January 2007 and June 2009. The patients were divided into two groups: those in which the medication was not suspended before obtaining the laboratory test sample, and those patients referred from other dental clinics in which BPs was suspended before reporting to our Unit. The total drug dosage administered and the total dose per kilogram body weight were evaluated for comparison with serum CTX. The data obtained were correlated to the osteonecrosis risk table developed by Marx et al. in 2007. Results: There were no significant differences between the two groups in relation to the total administered dose and the dose in mg/kg b.w. Likewise, in both groups no relationship was observed between the serum CTX value and the total administered dose or the dose in mg/kg b.w. No differences were found between the two patient groups regarding chemical osteonecrosis risk based on the criteria of Marx et al. Conclusions: No relationship was observed between the oral BP dose administered (total dose or expressed in mg/kg b.w.) and serum CTX concentration, and suspension of the medication did not influence the serum CTX levels. Key words:Serum CTX, osteonecrosis, oral bisphosphonates. PMID:22143730

  14. Surgical interventions for treating acute fractures or non-union of the middle third of the clavicle. (United States)

    Lenza, Mário; Faloppa, Flávio


    This review covers two conditions: acute clavicle fractures and non-union resulting from failed fracture healing. Clavicle (collarbone) fractures account for around 4% of all fractures. While treatment for these fractures is usually non-surgical, some types of clavicular fractures, as well as non-union of the middle third of the clavicle, are often treated surgically. This is an update of a Cochrane review first published in 2009. To evaluate the effects (benefits and harms) of different methods of surgical treatment for acute fracture or non-union of the middle third of the clavicle. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (27 June 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 5), MEDLINE (1966 to June week 3 2014), EMBASE (1988 to 2014 week 25), LILACS (1982 to 27 June 2014), trial registries and reference lists of articles. We applied no language or publication restrictions. We considered randomised and quasi-randomised controlled trials evaluating any surgical intervention for treating people with fractures or non-union of the middle third of the clavicle. The primary outcomes were shoulder function or disability, pain and treatment failure (measured by the number of participants who had undergone or were being considered for a non-routine secondary surgical intervention for symptomatic non-union, malunion or other complications). Two review authors selected eligible trials, independently assessed risk of bias and cross-checked data. Where appropriate, we pooled results of comparable trials. We included seven trials in this review with 398 participants. Four trials were new in this update.The four new trials (160 participants) compared intramedullary fixation with open reduction and internal fixation with plate for treating acute middle third clavicle fractures in adults. Low quality evidence from the four trials indicated that intramedullary fixation did not

  15. Sputum eosinophilia in idiopathic pulmonary fibrosis. (United States)

    Birring, S S; Parker, D; McKenna, S; Hargadon, B; Brightling, C E; Pavord, I D; Bradding, P


    Cough is a common symptom in idiopathic pulmonary fibrosis that is difficult to treat and has a major impact on quality of life. We tested the hypothesis that the cough and increased cough reflex sensitivity seen in patients with idiopathic pulmonary fibrosis may be due to airway inflammation in a prospective, cross-sectional study. We measured the induced sputum inflammatory cell profile and cell-free supernatant inflammatory mediator concentrations in 15 patients with idiopathic pulmonary fibrosis, 17 healthy controls and 15 patients with chronic obstructive pulmonary disease. Both the geometric mean sputum differential eosinophil cell count and median eosinophilic-cationic-protein concentration were significantly higher in patients with idiopathic pulmonary fibrosis than controls (2.1% vs 0.3%; p <0.001 and 1.1 mg/ml versus 0.2 mg/ml; p=0.03 respectively). There were no significant differences in sputum eosinophil counts and eosinophilic-cationic-protein concentrations between patients with idiopathic pulmonary fibrosis and chronic obstructive pulmonary disease. Sputum leukotriene-B4 concentrations were significantly lower in patients with idiopathic pulmonary fibrosis (p=0.03) and chronic obstructive pulmonary disease (p=0.008) compared to controls. Idiopathic pulmonary fibrosis is characterised by the presence of active eosinophilic airway inflammation raising the possibility that airway inflammation may contribute to symptoms such as cough.

  16. Muscle strength and functional performance in patients with anterior cruciate ligament injury treated with training and surgical reconstruction or training only: a two to five-year followup

    DEFF Research Database (Denmark)

    Ageberg, Eva; Thomeé, Roland; Neeter, Camille


    surgery in restoring muscle function is unclear. METHODS: Of 121 patients with ACL injury included in a randomized controlled trial on training and surgical reconstruction versus training only (the Knee, Anterior cruciate ligament, NON-surgical versus surgical treatment [KANON] study, ISRCTN: 84752559...... Symmetry Index (LSI; injured leg divided by uninjured and multiplied by 100) value and absolute values were used for comparisons between groups (analysis of variance). An LSI >or=90% was considered normal. RESULTS: There were no differences between the surgical and nonsurgical treatment groups in muscle...... strength or functional performance. Between 44% and 89% of subjects had normal muscle function in the single tests, and between 44% and 56% had normal function in the test batteries. CONCLUSION: The lack of differences between patients treated with training and surgical reconstruction or training only...

  17. Idiopathic portal hypertension

    International Nuclear Information System (INIS)

    Han, Tae Kyun; Ryu, Dae Sik; Kim, Heung Chul; Hur, Hun; Eom, Kyeung Tae; Namkung, Sook; Park, Man Soo; Hwang, Woo Chul; Lee, Kwan Seop


    To describe the radiologic findings of idiopathic portal hypertension and to find the points of differentiation between idiopathic portal hypertension and liver cirrhosis. Four portograms in five patients who for four years had suffered from pathologically confirmed idiopathic portal hypertension were retrospectively analyzed and compared with a portogram obtained from a control subject with liver cirrhosis. Portographic finding s of idiopathic portal hypertension were paucity of medium-sized portal branches, irregular and obtuse-angled division of peripheral branches, abrupt interruption and an avascular area beneath the liver margin. A portogram of idiopathic portal hypertension may be useful in differentiation this and liver cirrhosis

  18. [Rare primary malignant orbital neoplasms treated surgically in the I Clinic of Otolaryngology of the Silesian Medical Academy in Katowice in the years 1992-1995]. (United States)

    Gierek, T; Zbrowska-Bielska, D; Majzel, K; Markowski, J


    14 patients suffering from primary orbital tumours were treated surgically in the Otolaryngological Department in Silesian Medical Academy in Katowice in the years 1992-1995. The patients were aged from 23 (woman with neurosarcoma) to 67 (woman with haemangioma). All patients were treated surgically: 8 of them by lateral orbitotomy m. Krönlein-Reese-Berk, 3 of them by orbital exenteration, and 3 of them by canthotomy. The author analysed 3 very rare cases of primary orbital malignant neoplasms: neurosarcoma, rhabdomyosarcoma and additionally I case with fibrosarcoma, osteosarcoma and chondrosarcoma simultaneously.

  19. Preliminary results from digestive adaptation: a new surgical proposal for treating obesity, based on physiology and evolution

    Directory of Open Access Journals (Sweden)

    Sérgio Santoro

    Full Text Available CONTEXT AND OBJECTIVE: Most bariatric surgical techniques include essentially non-physiological features like narrowing anastomoses or bands, or digestive segment exclusion, especially the duodenum. This potentially causes symptoms or complications. The aim here was to report on the preliminary results from a new surgical technique for treating morbid obesity that takes a physiological and evolutionary approach. DESIGN AND SETTING: Case series description, in Hospital Israelita Albert Einstein and Hospital da Polícia Militar, São Paulo, and Hospital Vicentino, Ponta Grossa, Paraná. METHODS: The technique included vertical (sleeve gastrectomy, omentectomy and enterectomy that retained three meters of small bowel (initial jejunum and most of the ileum, i.e. the lower limit for normal adults. The operations on 100 patients are described. RESULTS: The mean follow-up was nine months (range: one to 29 months. The mean reductions in body mass index were 4.3, 6.1, 8.1, 10.1 and 10.7 kg/m², respectively at 1, 2, 4, 6 and 12 months. All patients reported early satiety. There was major improvement in comorbidities, especially diabetes. Operative complications occurred in 7% of patients, all of them resolved without sequelae. There was no mortality. CONCLUSIONS: This procedure creates a proportionally reduced gastrointestinal tract, leaving its basic functions unharmed and producing adaptation of the gastric chamber size to hypercaloric diet. It removes the sources of ghrelin, plasminogen activator inhibitor-1 (PAI-1 and resistin production and leads more nutrients to the distal bowel, with desirable metabolic consequences. Patients do not need nutritional support or drug medication. The procedure is straightforward and safe.

  20. Long-Term Cognitive Functioning and Psychological Well-Being in Surgically Treated Patients with Low-Grade Glioma. (United States)

    Campanella, Fabio; Palese, Alvisa; Del Missier, Fabio; Moreale, Renzo; Ius, Tamara; Shallice, Tim; Fabbro, Franco; Skrap, Miran


    The aim of this work is to provide an in-depth investigation of the impact of low-grade gliomas (LGG) and their surgery on patients' cognitive and emotional functioning and well-being, carried out via a comprehensive and multiple-measure psychological and neuropsychological assessment. Fifty surgically treated patients with LGG were evaluated 40 months after surgery on their functioning over 6 different cognitive domains, 3 core affective/emotional aspects, and 3 different psychological well-being measures to obtain a clearer picture of the long-term impact of illness and surgery on their psychological and relational world. Close relatives were also involved to obtain an independent measure of the psychological dimensions investigated. Cognitive status was satisfactory, with only mild short-term memory difficulties. The affective and well-being profile was characterized by mild signs of depression, good satisfaction with life and psychological well-being, and good personality development, with patients perceiving themselves as stronger and better persons after illness. However, patients showed higher emotional reactivity, and psychological well-being measures were negatively affected by epileptic burden. Well-being was related to positive affective/emotional functioning and unrelated to cognitive functioning. Good agreement between patients and relatives was found. In the long-term, patients operated on for LGG showed good cognitive functioning, with no significant long-term cognitive sequelae for the extensive surgical approach. Psychologically, patients appear to experience a deep psychological change and maturation, closely resembling that of so-called posttraumatic growth, which, to our knowledge, is for the first time described and quantified in patients with LGG. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Lenke 5C Curves in Adolescent Idiopathic Scoliosis: Anterior vs Posterior Selective Fusion. (United States)

    Dong, Yulei; Weng, Xisheng; Zhao, Hong; Zhang, Jianguo; Shen, Jianxiong; Qiu, Guixing


    The optimal treatment of Lenke 5C curves in adolescent idiopathic scoliosis is still unclear. To compare the outcomes and the spontaneous correction behavior between anterior and posterior selective fusion techniques in a large case series. Demographic and surgical data for patients with Lenke 5C curves treated with anterior or posterior fusion were collected from July 2002 to September 2011. Clinical assessment and radiographic parameters were compared preoperatively and postoperatively and at a minimum of 2 years of follow-up. Fifty-three Lenke 5C adolescent idiopathic scoliosis cases with an average follow-up of 4 years (range, 2-9.6 years) were included. The clinical scores were similar between the 2 groups. Postoperative major thoracic curvature changes were similar. The minor thoracic curve demonstrated a higher spontaneous correction rate in the posterior group. At follow-up, the minor thoracic curve showed a greater loss of correction in the posterior group, and finally both groups were comparable. Surgical time, intraoperative blood loss, and complications were comparable. A total of 5 patients had a final thoracic curve larger than the preoperative degrees. Selective fusion of the major thoracolumbar/lumbar curve in Lenke 5C adolescent idiopathic scoliosis can be achieved by anterior and posterior techniques. The spontaneous correction of the unfused thoracic curve was comparable after an average of 4 years follow-up.

  2. "How I treat" autoimmune diseases: State of the art on the management of rare rheumatic diseases and ANCA-associated systemic idiopathic vasculitis. (United States)

    Roccatello, Dario


    This Special Issue of Autoimmunity Reviews constitutes summaries of presentations at the 20th International Meeting on Immunopathology and Orphan Diseases, held in Torino, Italy, 25-28th January 2017. As such, these presentations represent the state of the art on the pathophysiology of autoimmune diseases as well as the most recent insights into the management of these pathologic conditions. The latter includes both the optimal use of established drugs and approaches as well as novel knowledge on the means and consequences of targeted blocking of molecules or cellular mechanisms. The 2nd Turin Congress on systemic idiopathic vasculitis concluded the works of the International Meeting on Immune Pathology and Orphan Diseases. This Satellite Congress was mainly addressed to the management of antineutrophil cytoplasm antibody (ANCA)-associated vasculitis: advances on induction therapy and maintenance treatment. Guidelines and recommendations were critically discussed, reviewing available evidence and providing experts' insights. New intensive therapeutic approaches had been also reported. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. The so-called unresolved Osgood-Schlatter lesion: a concept based on fifteen surgically treated lesions. (United States)

    Mital, M A; Matza, R A; Cohen, J


    Of 118 patients with 151 knees treated for Osgood-Schlatter disease, fourteen patients (fifteen knees) had a distinct and separate ossicle at the proximal aspect of the tibial tubercle. This ossicle appeared after the child was first seen in all but three of the fifteen knees. When the ossicle failed to unite with the tubercle, the non-union was associated with local discomfort during activity and when direct pressure was applied on the tubercle. The symptoms did not respond to conservative treatment for an average of 3.8 years. Resection of the ossicle along with the adjacent bursa was followed by prompt relief of symptoms. Histological studies showed no evidence of avascularity. All ossicles were attached to the distal part of the undersurface of the ligamentum patellae and were separated from the tubercle by a bursa or scar tissue. The findings strongly support the concept that avulsion of the proximal cartilaginous part of the tibial tubercle is the cause of Osgood-Schlatter disease and they also suggest that once a separate ossicle is formed and becomes symptomatic, surgical excision is necessary to relieve the symptoms.

  4. [The management of post-surgical pain in the patient treated for hallux valgus with percutaneous and minimally invasive technique]. (United States)

    Di Giorgio, L; Sodano, L; Touloupakis, G; Chiominto, M G; Rocco, A


    In today's literature there are no defined guidelines for the treatment of postoperative pain in corrective surgery of hallux valgus. In this study we evaluated the use of a new treatment protocol designed to minimize the postoperative pain related to the surgical treatment of hallux valgus. The study involved 20 female patients (20 feet) treated for moderate to severe hallux valgus between September 2011 and December of 2012 with a percutaneous technique (10 feet) and minimally invasive surgery (Endolog System) (10 feet). All patients received postoperative as analgesic therapy 1 cp etoricoxib 120 mg/ day for 5 days + oxycodone hydrochloride/naloxone 5mg 1cp × 2/day for 15 days. The evaluation forms of pain VAS/VRS have been used for the evaluation of pre and postoperative pain at 15 and 30 days. In both groups we found a significant reduction of pain in the days following surgery. At 30 days the VAS score was similar in between the two groups. Few and mild side effects were reported (1 case). The co-administration of an anti-cox2 and an opioid in the first postoperative hours is useful to reduce soft tissue swelling and to control pain without causing significant side effects. The therapeutic protocol adopted, along with an adequate anesthesiological approach, has proved to be very effective for pain management in peri-and post-operative treatment of hallux valgus.

  5. Hemossiderose pulmonar idiopática tratada com azatioprina: relato de caso em criança Idiopathic pulmonary hemosiderosis treated with azathioprine in a child

    Directory of Open Access Journals (Sweden)

    Clemax Couto Sant`Anna


    Full Text Available A hemossiderose pulmonar idiopática (HPI, principal causa de hemossiderose pulmonar em crianças, cursa com sangramento alveolar intermitente e presença de hemossiderófagos no escarro ou no lavado gástrico. O tratamento é baseado nos corticoesteróides e citostáticos, em condições especiais. Descreve-se o caso de uma menina de sete anos com HPI, que conseguiu controle parcial da doença mediante altas doses de corticoesteróide. O tratamento, no entanto, necessitou ser suspenso gradualmente visto a paciente ter desenvolvido fácies cushingóide. Foi iniciada a associação da azatioprina ao corticóide até a substituição total por azatioprina isolada, cujo uso foi mantido por quatro anos, com ótimo resultado.Idiopathic pulmonary hemosiderosis (IPH, the main cause of pulmonary hemosiderosis in children, is characterized by intermittent alveolar bleeding and hemosiderin-laden macrophages in sputum and in gastric lavage. The treatment is based on corticosteroids and cytotoxic drugs, under special conditions. We describe the case of a 7-year-old girl with IPH who achieved partial clinical remission with high doses of corticosteroids. However, the treatment had to be discontinued because the patient developed Cushing's syndrome. Treatment was started with an azathioprine-corticosteroid combination and then changed to azathioprine alone, which was maintained for four years, with excellent results.

  6. Characteristics of presumptive idiopathic disseminated intravascular coagulation during second-trimester induced abortion. (United States)

    York, Sloane; Lichtenberg, E Steve


    Disseminated intravascular coagulation (DIC) is a serious and relatively uncommon complication of induced or spontaneous abortion or delivery. Occasionally, it has been reported in the absence of predisposing conditions. Little information in the literature describing idiopathic DIC or the treatment of patients with DIC exists. From 2002 through 2008, 24 cases of presumptive idiopathic DIC occurred following dilation and evacuation (D&E) abortion between 13 5/7 and 23 6/7 weeks' estimated gestational age at a Midwestern ambulatory surgical center. The characteristics of each patient, their pregnancies and surgical experiences were examined and compared with a temporally matched control group of D&E patients. We explored whether the index cases had a predominance of any historical, clinical or reproductive characteristics compared with controls matched for demographic and reproductive landmarks. Overall incidence of presumptive idiopathic DIC was 1.8 per 1000 D&E cases. Compared with matched controls, there was a greater likelihood of DIC with more advanced gestation (p=.009); no case of DIC was under 17 weeks' gestational age. Increased bleeding occurred at a mean time of 153 min after completion of surgery (range, 55-491 min; median, 131 min). Nineteen of 24 cases were successfully treated at the surgical center after receiving 6 to 8 units of fresh-frozen plasma (FFP); 5 cases were transferred to a hospital for further treatment. The abnormal bleeding of presumptive DIC typically begins to appear within 2 h after uncomplicated D&E and is more likely to occur at 17 weeks' estimated gestational age and more. With rapid diagnosis and treatment, most patients were able to be treated in an outpatient setting with up to 6 to 8 units of FFP and rehydration. Copyright © 2012 Elsevier Inc. All rights reserved.

  7. Quantitative calcaneal ultrasound parameters and bone mineral density at final height in girls treated with depot gonadotrophin-releasing hormone agonist for central precocious puberty or idiopathic short stature.

    NARCIS (Netherlands)

    Kordelaar, S. van; Noordam, C.; Otten, B.J.; Bergh, J.P.W. van den


    To evaluate the effect of gonadotrophin-releasing hormone (GnRH) agonist treatment on bone quality at final height, we studied girls with central precocious puberty (CPP) and with idiopathic short stature (ISS). A total of 25 Caucasian girls were included: group A (n=14) with idiopathic CPP (mean

  8. Impacts of a Size Ratio on Outcome in Patients with Surgically Treated Unruptured Nondissecting Anterior Cerebral Artery Aneurysms. (United States)

    Matsukawa, Hidetoshi; Kamiyama, Hiroyasu; Miyazaki, Takanori; Kinoshita, Yu; Noda, Kosumo; Ota, Nakao; Saito, Norihiro; Takeda, Rihee; Tokuda, Sadahisa; Tanikawa, Rokuya


    Anterior cerebral artery aneurysms (ACAs) are characterized by higher rupture rate and small size at rupture. It was shown that the aneurysm/vessel size ratio, and not the absolute size, might predict the risk of rupture in small unruptured intracranial aneurysms. The present study aimed to investigate the relationship between a size ratio and outcome in patients with unruptured nondissecting ACA aneurysms (UNDAs). A total of 187 consecutive patients with 12 A1 (6.2%), 149 anterior communicating artery (77%), and 33 distal ACA (17%) aneurysms were retrospectively evaluated. The size ratio was defined as (size of aneurysm)/(size of parent artery). Neurologic worsening (NW) was defined as an increase in score of 1 or more on the modified Rankin Scale (mRS). The mean age of the patient population was 63 ± 11 years and 132 UNDAs (68%) were seen in women. Complete, partial neck clipping, and aneurysm trapping were archived in 188 (97%), 2 (1.0%), and 4 (2.1%) UNDAs, respectively. An excellent outcome (mRS score 0) at 12 months was archived in 177 (93%) UNDAs overall and 177 (95%) in UNDAs with preoperative mRS score of 0 (n = 186). Postoperative ischemic lesions (odds ratio, 193; 95% confidence interval, 17-2205; P 3.0 (odds ratio, 11; 95% confidence interval, 1.2-105; P = 0.031) were related to 12-month NW on multivariate analysis. The aneurysm size was not related to 12-month NW. The present study showed that the size ratio, and not the absolute size, was related to 12-month NW in surgically treated UNDAs. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Influence of postoperative sagittal balance and spinopelvic parameters on the outcome of patients surgically treated for degenerative lumbar spondylolisthesis. (United States)

    Radovanovic, Ingrid; Urquhart, Jennifer C; Ganapathy, Venkat; Siddiqi, Fawaz; Gurr, Kevin R; Bailey, Stewart I; Bailey, Christopher S


    OBJECTIVE The object of this study was to determine the association between postoperative sagittal spinopelvic alignment and patient-rated outcome measures following decompression and fusion for lumbar degenerative spondylolisthesis. METHODS The authors identified a consecutive series of patients who had undergone surgery for lumbar degenerative spondylolisthesis between 2008 and 2012, with an average follow-up of 3 years (range 1-6 years). Surgery was performed to address the clinical symptoms of spinal stenosis, not global sagittal alignment. Sagittal alignment was only assessed postoperatively. Patients were divided into 2 groups based on a postoperative sagittal vertical axis (SVA) spondylolisthesis (p = 0.044), spondylolisthesis at the L3-4 level (p = 0.046), and multiple levels treated with fusion (p = 0.028) were more common among patients in the group with an SVA ≥ 50 mm. Patients with an SVA ≥ 50 mm had a worse SF-36 physical component summary (PCS) score (p = 0.018), a worse Oswestry Disability Index (ODI; p = 0.043), and more back pain (p = 0.039) than those with an SVA spondylolisthesis and multilevel fusion. The spinopelvic parameters differing between the < 50-mm and ≥ 50-mm groups included lumbar lordosis (LL; 56.4° ± 4.7° vs 49.8° ± 4.3°, respectively, p = 0.040) and LL < pelvic incidence ± 9° (51% vs 23.1%, respectively, p = 0.013) after controlling for type of surgical procedure. CONCLUSIONS Data in this study revealed that patient-rated outcome is influenced by the overall postoperative sagittal balance as defined by the SVA.

  10. Gait analysis and functional outcomes after twelve-week rehabilitation in patients with surgically treated ankle fractures. (United States)

    Suciu, Oana; Onofrei, Roxana Ramona; Totorean, Alina Daniela; Suciu, Silviu Cristian; Amaricai, Elena Constanta


    Ankle fractures are the most common type of lower extremity fractures. The objective of our study was to analyse the changes of temporal and spatial gait parameters and functional outcomes in patients with bimalleolar fractures who followed surgery and rehabilitation compared to healthy controls. 49 patients with ankle fractures and 21 age-matched healthy volunteers were recruited. There were two assessments for the study group: T1 - once weight-bearing was allowed and T2 - twelve weeks after exercise-based rehabilitation programme. Each evaluation consisted in a functional questionnaire (Olerud-Molander Ankle Score-OMAS) and temporal and spatial gait parameters analysis. The gait parameters were analysed using a Zebris FDM platform. 30 patients completed the final assessment and their data were analysed. In T1 assessment there were significant differences in all temporal and spatial gait parameters between the patients group and controls. In T2 evaluation step time in affected ankle and non-affected ankle, swing time and stance time on affected ankle, stride time and cadence showed no significant differences in patients compared with controls. The within-group analysis showed significant differences in all temporal and spatial gait parameters except for single support time on non-affected ankle after rehabilitation. The OMAS improved significantly from T1 to T2 in all subscales except for squatting. Median value of OMAS improved from 60 (35-90) to 95 (55-100). Our study revealed significant improvements of all temporal and spatial gait parameters, as well as of the functional outcome in patients with surgically treated ankle fractures after twelve-week rehabilitation. Copyright © 2016 Elsevier B.V. All rights reserved.

  11. Use of the Toric Surgical Marker to Aid in Intraoperative Plaque Placement for the USC Eye Physics Plaques to Treat Uveal Melanoma: A New Surgical Technique. (United States)

    Berry, Jesse L; Kim, Jonathan W; Jennelle, Richard; Astrahan, Melvin


    To describe a new surgical technique for intraoperative placement of Eye Physics (EP) plaques for uveal melanoma using a toric marker. A toric marker is designed for cataract surgery to align the axis of astigmatism; its use was modified in this protocol to mark the axis of suture coordinates as calculated by Plaque Simulator (PS) software. The toric marker can be used to localize suture coordinates, in degrees, during intraoperative plaque placement. Linear marking using the toric marker decreases potential inaccuracies associated with the surgeon estimating 'clock-hours' by dot placement. Use of the toric marker aided surgical placement of EP plaques. The EP planning protocol is now designed to display the suture coordinates either by clock-hours or degrees, per surgeon preference. Future research is necessary to determine whether routine use of the toric marker improves operative efficiency. [Ophthalmic Surg Lasers Imaging Retina. 2015;46:866-870.]. Copyright 2015, SLACK Incorporated.

  12. Does the lower instrumented vertebra have an effect on lumbar mobility, subjective perception of trunk flexibility, and quality of life in patients with idiopathic scoliosis treated by spinal fusion? (United States)

    Sanchez-Raya, Judith; Bago, Juan; Pellise, Ferran; Cuxart, Ampar; Villanueva, Carlos


    Cross-sectional study in patients with idiopathic scoliosis treated with spinal fusion. To measure lumbar spine mobility in the study population; determine low back pain intensity (LBPi), subjective perception of trunk flexibility (TF), and quality of life using validated outcome instruments; and investigate correlations of the lower instrumented vertebra (LIV) with TF, LBPi, and quality of life. The loss of range of motion resulting from spinal fusion might lead to low back pain, trunk rigidity, and a negative impact on quality of life. Nonetheless, these outcomes have not been conclusively demonstrated because lumbar mobility and LIV have not been correlated with validated outcome instruments. Forty-one patients (mean age, 27 y) with idiopathic scoliosis treated by spinal fusion (mean time since surgery, 135 mo) were included. Patients were assigned to 3 groups according to LIV level: group 1 (fusion to T12, L1, or L2) 14 patients; group 2 (fusion to L3) 13 patients, and group 3 (fusion to L4, L5, or S1) 14 patients. At midterm follow-up, patients completed the Scoliosis Research Society (SRS)-22 Questionnaire and Quality of Life Profile for Spine Deformities to evaluate perceived TF, and rated LBPi with a numerical scale. Lumbar mobility was assessed using a dual digital inclinometer. Group 3 (fusion to L4, L5, or S1) showed statistically significant differences relative to the other groups, with less lumbar mobility and poorer scores for the SRS subtotal (P = 0.003) and SRS pain scale (P = 0.01). Nevertheless, LBPi and TF were similar in the 3 groups. TF correlated with SRS-22 subtotal (r = -0.38, P = 0.01) and pain scale (r = -0.42, P = 0.007) scores, and with LBPi (r = 0.43, P = 0.005). LIV correlated moderately with lumbar mobility, health-related quality of life (SRS-22), and spinal pain (SRS-22 pain subscale), but not with intensity of pain in the lumbar area or perceived TF.

  13. Idiopathic pulmonary hemosiderosis


    Sunilkumar, B M; Sathishkumar, K M; Somashekhar, A R; Maiya, P P


    Recurrent or chronic pulmonary hemorrhage is rare in children. Idiopathic pulmonary hemosiderosis (IPH) manifests as hemoptysis, diffuse parenchymal infiltrates on chest radiographs and microcytic hypochromic anemia. The hemoptysis present may be mistaken for more common diseases, delaying the diagnosis and further management. Idiopathic pulmonary hemosiderosis is a disorder of unknown etiology. Treatment of IPH includes immunosuppressive drugs along with supportive measures.

  14. Delay in weight bearing in surgically treated tibial shaft fractures is associated with impaired healing: a cohort analysis of 166 tibial fractures. (United States)

    Houben, I B; Raaben, M; Van Basten Batenburg, M; Blokhuis, T J


    The relation between timing of weight bearing after a fracture and the healing outcome is yet to be established, thereby limiting the implementation of a possibly beneficial effect for our patients. The current study was undertaken to determine the effect of timing of weight bearing after a surgically treated tibial shaft fracture. Surgically treated diaphyseal tibial fractures were retrospectively studied between 2007 and 2015. The timing of initial weight bearing (IWB) was analysed as a predictor for impaired healing in a multivariate regression. Totally, 166 diaphyseal tibial fractures were included, 86 cases with impaired healing and 80 with normal healing. The mean age was 38.7 years (range 16-89). The mean time until IWB was significantly shorter in the normal fracture healing group (2.6 vs 7.4 weeks, p bearing is independently associated with impaired fracture healing in surgically treated tibial shaft fractures. Unlike other factors such as fracture type or soft tissue condition, early resumption of weight bearing can be influenced by the treating physician and this factor therefore has a direct clinical relevance. This study indicates that early resumption of weight bearing should be the treatment goal in fracture fixation. 3b.

  15. Survival and echocardiographic evaluation of dogs with idiopathic dilated cardiomyopathy treated with carvedilol Avaliação ecocardiográfica e de sobrevida de cães com cardiomiopatia dilatada idiopática tratados com carvedilol

    Directory of Open Access Journals (Sweden)

    E.C. Soares


    Full Text Available Sixty dogs with idiopathic dilated cardiomyopathy were randomly treated with traditional therapy - digitalis, diuretics, angiotensin-converting inhibitors - (group A or treated with these drugs plus carvedilol (group B. Echocardiographic variables were measured before and after 3, 13, 26, and 52 weeks of treatment or until death. Comparisons between groups and time were performed. No significant differences between groups were found in the most of the echocardiographic variables. The left ventricular end-systolic diameter indexed to body surface area (LVESDi increased significantly in the group A dogs compared to the group B animals. The survival of groups A and B dogs were not different (P-value=0.1137. In conclusion, the stability of the LVESDi observed in the group treated with carvedilol may represent the beneficial effect over the ventricular remodeling.Sessenta cães com cardiomiopatia dilatada idiopática receberam, aleatoriamente, tratamento convencional - digitálicos, diuréticos, inibidores da enzima conversora de angiotensina - (grupo A ou esses fármacos mais carvedilol (grupo B. As variáveis ecocardiográficas foram avaliadas antes e depois de três, 13, 26 e 52 semanas de tratamento ou até o óbito. Não foram encontradas diferenças significativas entre os grupos de animais quanto à maioria das variáveis ecocardiográficas. O diâmetro sistólico final do ventrículo esquerdo indexado à superfície corpórea (DSVEi aumentou de forma significativa no grupo A quando comparado ao grupo B. Não se observou diferença na sobrevida dos grupos A e B (P=0,1137. Concluiu-se que a estabilização do DSVEi no grupo tratado com carvedilol pode representar o efeito benéfico deste fármaco sobre o remodelamento ventricular.

  16. [A case of refractory deep incisional surgical site infection due to methicillin-resistant Staphylococcus aureus (MRSA) and successfully treated with oral linezolid]. (United States)

    Matsumoto, Hironori; Kawabata, Ryohei; Kishimoto, Tomono; Yamamoto, Emiko; Kimura, Yutaka; Imamura, Hiroshi; Yamamoto, Tameyoshi; Takemoto, Hiroyoshi; Fukunaga, Mutsumi; Ohzato, Hiroki


    We report a case of methicillin-resistant Staphylococcus aureus(MRSA) surgical site infection successfully treated with linezolid. A 66-year-old man had undergone total gastrectomy for gastric cancer after neoadjuvant chemotherapy. Three days after the operation, he was diagnosed with deep incisional surgical site infection due to MRSA, and wound care was started. After discharge, he received adjuvant chemotherapy and wound care, but the wound had not healed in 10 months. We started treatment with oral linezolid and nutritional support, and the wound was fully healed 12 months after the operation. Antibiotic treatment with oral linezolid may be effective for refractory deep incisional surgical site infection due to MRSA in outpatients.

  17. No association between types of unilateral mandibular condylar abnormalities and facial asymmetry in orthopedic-treated patients with juvenile idiopathic arthritis

    DEFF Research Database (Denmark)

    Stoustrup, Peter Bangsgaard; Ahlefeldt-Laurvig-Lehn, Nicole; Kristensen, Kasper Dahl


    asymmetry was compared between the JIA groups and control subjects. Dentofacial asymmetry was expressed as interside ratios and angular measurements. RESULTS: Eighty-seven percent of the JIA patients were being treated or had previously received treatment with a functional orthopedic appliance at the time...

  18. Idiopathic nephrotic syndrome in South African children.

    African Journals Online (AJOL)

    Abstract. Background: Different histo-pathological types and treatment response patterns of Idiopathic nephrotic syndrome (INS) have been associated with differences in ethnicity and geographical location. Objective: To provide an update on the steroid response and renal histo-pathological pattern in children treated for ...

  19. Preoperatively Assessable Clinical and Pathological Risk Factors for Parametrial Involvement in Surgically Treated FIGO Stage IB-IIA Cervical Cancer. (United States)

    Canaz, Emel; Ozyurek, Eser Sefik; Erdem, Baki; Aldikactioglu Talmac, Merve; Yildiz Ozaydin, Ipek; Akbayir, Ozgur; Numanoglu, Ceyhun; Ulker, Volkan


    Determining the risk factors associated with parametrial involvement (PMI) is of paramount importance to decrease the multimodality treatment in early-stage cervical cancer. We investigated the preoperatively assessable clinical and pathological risk factors associated with PMI in surgically treated stage IB1-IIA2 cervical cancer. A retrospective cohort study of women underwent Querleu-Morrow type C hysterectomy for cervical cancer stage IB1-IIA2 from 2001 to 2015. All patients underwent clinical staging examination under anesthesia by the same gynecological oncologists during the study period. Evaluated variables were age, menopausal status, body mass index, smoking status, FIGO (International Federation of Obstetrics and Gynecology) stage, clinically measured maximal tumor diameter, clinical presentation (exophytic or endophytic tumor), histological type, tumor grade, lymphovascular space invasion, clinical and pathological vaginal invasion, and uterine body involvement. Endophytic clinical presentation was defined for ulcerative tumors and barrel-shaped morphology. Two-dimensional transvaginal ultrasonography was used to measure tumor dimensions. Of 127 eligible women, 37 (29.1%) had PMI. On univariate analysis, endophytic clinical presentation (P = 0.01), larger tumor size (P PMI. In multivariate analysis endophytic clinical presentation (odds ratio, 11.34; 95% confidence interval, 1.34-95.85; P = 0.02) and larger tumor size (odds ratio, 32.31; 95% confidence interval, 2.46-423.83; P = 0.008) were the independent risk factors for PMI. Threshold of 31 mm in tumor size predicted PMI with 71% sensitivity and 75% specificity. We identified 18 patients with tumor size of more than 30 mm and endophytic presentation; 14 (77.7%) of these had PMI. Endophytic clinical presentation and larger clinical tumor size (>3 cm) are independent risk factors for PMI in stage IB-IIA cervical cancer. Approximately 78% of the patients with a tumor size of more than 3 cm and endophytic

  20. Improved sperm count and motility in young men surgically treated for cryptorchidism in the first year of life. (United States)

    Feyles, Francesca; Peiretti, Valentina; Mussa, Alessandro; Manenti, Marco; Canavese, Ferdinando; Cortese, Maria Grazia; Lala, Roberto


    The timing of surgery in cryptorchidism has been debated for a long time. Reports on histology suggest better fertility outcomes with early surgery, whereas evidence of long-term improved fertility still lacks sound data. The aim of this study is to analyze sperm count and motility in a cohort of young men operated on during the first 2 years of life for cryptorchidism. A total of 78 young men (age, 18-26 years) surgically treated for cryptorchidism in the second year of life were recalled to evaluate testicular volume and sperm count and motility. Of the 78 young men, 51 accepted to participate to clinical and sperm evaluation. Relationship between total sperm count (TSC), sperm motility (SM), and age at surgery was investigated by Student t-test and Fisher test. Patients were divided into two groups: those patients who were submitted to surgery in their first year of life (Group A) and those patients who were submitted to surgery in their first and the second year of life (Group B). We investigated the ratio of those patients with normal sperm count to those patients with abnormal sperm count (we defined as normal TSC > 15 million and SM > 15%) and compared the mean TSC and SM in the two groups. TSC were slightly but not significantly higher in the first group (45.5 ± 15.5 million/mL vs. 36.5 ± 23.6 million/mL, p = 0.107) and SM (30.5% ± 11.3% vs. 26.5% ± 15.4%, p = 0.341). The percentage of patients with normal sperm count and motility were significantly higher in the first group: normal TSC was found in 26 of 27 patients (96.3%) in Group A versus 18 of 24 patients (75.0%) in Group B (p = 0.042), normal SM was found in 26 of 27 patients (96.3%) versus 16 of 24 patients (66.7%), respectively (p = 0.008). In the two groups, no statistically significant difference was found neither in the proportion of patients with bilateral cryptorchidism, in the position of the testes, nor in the ratio of subjects treated with hormonal

  1. Psychological aspects of idiopathic scoliosis: the specificity of the mother-daughter relationship

    Directory of Open Access Journals (Sweden)

    Galina V. Pyatakova


    Conclusion: General and specific characteristics of the mother-daughter relationship in families of adolescent girls with idiopathic scoliosis and families of healthy adolescent girls were revealed. In the context of complex surgical treatment, preventive measures are necessary to address psychological difficulties in adolescent patients with idiopathic scoliosis.

  2. Long-term health-related quality of life after surgery for adolescent idiopathic scoliosis and spondylolisthesis. (United States)

    Helenius, Ilkka; Remes, Ville; Lamberg, Tommi; Schlenzka, Dietrich; Poussa, Mikko


    The aim of surgical treatment for adolescent idiopathic scoliosis is primarily to prevent progression and secondarily to correct the deformity, whereas the goal of surgical treatment of pediatric spondylolisthesis is mainly to relieve pain and, in patients with a high-grade slip, to prevent progression. The aim of this study was to compare the long-term health-related quality of life after surgery for idiopathic scoliosis and spondylolisthesis in adolescence. One hundred and ninety patients, with a mean age of fifteen years, who were treated surgically for adolescent idiopathic scoliosis and 270 patients, with a mean age of sixteen years, who were treated surgically for low-grade or high-grade spondylolisthesis participated in the present study. The mean duration of follow-up was 14.8 years for the scoliosis group and 17.0 years for the spondylolisthesis group. Radiographs were made preoperatively, at the time of the two-year follow-up, and at the time of the final follow-up. Additionally, a physical examination was performed, and the Scoliosis Research Society-24 and Short Form-36 questionnaires were completed at the final follow-up evaluation. The median total score on the Scoliosis Research Society questionnaire was 102 (range, 63 to 118) for the scoliosis group and 95 (range, 42 to 115) for the spondylolisthesis group (p surgery, gender, and duration of follow-up, the patients with scoliosis had a significantly higher odds ratio for a good total score (> or = 90 points) on the Scoliosis Research Society questionnaire than did patients with spondylolisthesis (odds ratio, 2.65 [95% confidence interval, 1.58 to 4.44]; p = 0.0002). Patients in the scoliosis group had better values for general self-image, postoperative self-image, and postoperative function than did patients in the spondylolisthesis group (p spondylolisthesis group (median, 53.4 points; range, 27 to 59 points) (p = 0.01). Patients have good long-term health-related quality of life after surgery for

  3. Current treatment options for idiopathic angioedema. (United States)

    Shroba, Jodi; Hanson, Jill; Portnoy, Jay


    Idiopathic angioedema is defined as localized swelling of the cutaneous and mucosal tissue that occurs in episodes without a clear etiology. It can be problematic to treat when the underlying pathophysiology is not well understood. To identify successful treatments of idiopathic angioedema reported in the literature. A literature search was performed using PubMed. Published case reports and articles discussing treatment of idiopathic angioedema were used in the formulation of this review. In addition, 2 case reports are provided. Although there are no approved treatments for idiopathic angioedema, several medications used for the treatment of hereditary angioedema, such as bradykinin receptor antagonists (icatibant), kallikrein inhibitors (ecallantide), and C1 inhibitors, were successful in 10 patients. Anti-IgE monoclonal antibody (omalizumab) proved successful in 5 patients. The most widely used and successful medication was tranexamic acid (154 patients). Despite an unknown etiology, this article highlights viable treatment options for idiopathic angioedema. More clinical trials and better markers identifying the cause of angioedema are needed. Copyright © 2015 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  4. Health related quality of life and perception of deformity in patients with adolescent idiopathic scoliosis. (United States)

    Çolak, Tuğba Kuru; Akgül, Turgut; Çolak, Ilker; Dereli, Elif Elçin; Chodza, Mehmet; Dikici, Fatih


    Quality of life and cosmethic appearance have gained importance as outcomes in AIS treatment. Improving aesthetic appearance and quality of life are defined as the primary aims of scoliosis treatment by health professionals. Studies that assess and compare the different treatment results in the field of quality of life and cosmethics are some what limited. A cross-sectional study was designed to compare quality of life and deformity perception in patients with adolescent idiopathic scoliosis (AIS) received conservative (exercise or exercise + brace) or surgical treatment. A total of 68 (58 females) patients aged 10-18 years with AIS received conservative (exercise or exercise+brace) or surgical treatment were invited to participate in the study. Quality of life (Scoliosis Research Society-23 (SRS-23)) and perception of deformity (Walter Reed Visual Assessment (WRVAS)) were assessed. Conservatively treated patients had significantly superior scores in function domain of SRS-23 than surgically treated patients (exercise/surgery, exercise+brace/surgery; p= 0.009, 0.004). Otherwise, surgically treated patients had significantly superior scores in self-image (p= 0.000, 0.000), and satisfaction with management (p= 0.001, 0.006) domains of SRS-23, and WRVAS (p= 0.000, 0.000) than conservative groups. In addition to radiographic assessments, quality of life, aesthetic perception, functionality, satisfaction with management, psycho-social status should carefully be taken into consideration by health professionals in the teratment of AIS.

  5. Incidence of breast cancer in the five-year period (2001-2006 in patients treated surgically in the Cantonal Hospital in Zenica

    Directory of Open Access Journals (Sweden)

    H. Drljević


    Full Text Available Breast cancer is currently one of the most common malignant tumors of human race and at the same it is the most frequent cancer of female population. The war and post-war migrations of population have significantlychanged the demographic and age structure in Bosnia and Herzegovina. Absence of a National Cancer Register and a unique database on malignant diseases makes monitoring of breast cancer even more difficult.Theobjectiveof this retrospective study was to analyze the incidence of breast cancer in Zenica-Doboj Canton, to conduct a survey based on the age of patients in the five-year period starting from 1 January 2001 until 30 November 2005 and results of the study have been compared with 1990. All the patients were treated surgically with pre-surgical clinical examination, ultra-sound examination and mamography, and pathohistological verification of cancer and pathologically determined size of tumor. A total of 297 patients were treated out of the series of 583 breast surgeries.During this five-year survey a continuous increase of breast cancers in Zenica-Doboj Canton was noted.Therehas been an increased incidence of breast cancer in women aged 30-45, the average size of tumor has decreased, and there has been no change in the relationship between the pathohistological types of tumors and tendencies in surgical treatments to use breast conserving surgical methods. The program of early detection of breast cancer or screening of healthy women and search for “small” cancers (screening programs will enable a wider use of breast conserving surgical methods and it requires a more active involvement of the state and society.

  6. Understanding idiopathic intracranial hypertension

    DEFF Research Database (Denmark)

    Markey, Keira A; Mollan, Susan P; Jensen, Rigmor H


    Idiopathic intracranial hypertension is a disorder characterised by raised intracranial pressure that predominantly affects young, obese women. Pathogenesis has not been fully elucidated, but several causal factors have been proposed. Symptoms can include headaches, visual loss, pulsatile tinnitus...

  7. Adolescent Idiopathic Scoliosis (United States)

    ... Radiation Exposure in Scoliosis Kyphosis Adolescent Back Pain Spondylolysis For Adolescents For Adults Common Questions & Glossary Resources ... Radiation Exposure in Scoliosis Kyphosis Adolescent Back Pain Spondylolysis For Adolescents For Adults Juvenile Idiopathic Scoliosis Diagnosed ...

  8. Health-related quality-of-life in adolescent idiopathic scoliosis patients 25 years after treatment

    DEFF Research Database (Denmark)

    Simony, Ane; Hansen, Emil Jesper; Carreon, Leah Y


    BACKGROUND: Since 1962 to the mid eighties the Harrington Rod instrumentation was the Golden standard for surgical treatment of Adolescent Idiopathic Scoliosis (AIS). The Boston braces were introduced in the 1970´s and are still used as a conservative treatment, for curves less than 40°. Very few....... The SF36 PCS and MCS scores in both AIS cohorts were similar to the scores for the general population. CONCLUSION: HRQOLs, as measured by the SRS22R and SF-36, of adult AIS patients treated with Boston brace or PSF during adolescence were similar to the general population. No clinical progression...

  9. The results of 163 Achilles tendon ruptures treated by a minimally invasive surgical technique and functional aftertreatment

    NARCIS (Netherlands)

    Lansdaal, J. R.; Goslings, J. C.; Reichart, M.; Govaert, G. A. M.; van Scherpenzeel, K. M.; Haverlag, R.; Ponsen, K. J.


    BACKGROUND: There is still controversy regarding the optimal surgical technique and post-operative treatment of acute Achilles tendon ruptures. We evaluated a treatment protocol for Achilles tendon ruptures consisting of a minimally invasive Achilles tendon repair combined with early full weight

  10. Idiopathic retroperitoneal fibrosis involving a unilateral renal sinus: A case report and literature review

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Seul Bi; Yoon, Jung Hee; Kim, Seung Ho; Lee, Ye Daum; Kim, Suk Jung; Lim, Yun Jung; Jung, Hyun Kyung; Lee, Jin Soo [Dept. of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan (Korea, Republic of)


    Idiopathic retroperitoneal fibrosis (RPF) is a rare disease entity and its etiology is uncertain. We report two similar cases which showed an uncommon presentation of idiopathic RPF. A 66-year-old woman and an 80-year-old man presented with incidental findings of left renal pelvic mass-like lesions. Computed tomography revealed a soft tissue density mass replacing the left renal pelvis, which was suspicious for renal pelvic cancer, and the diagnosis of idiopathic RPF was surgically confirmed. To the best of our knowledge, a few cases of idiopathic RPF presenting with features of a localized unilateral renal pelvic mass mimicking renal pelvic cancer have been reported.

  11. The influence of the degree of spine curvature on the quality of life assessment among patients treated surgically with the Cotrel-Dubousset method. (United States)

    Gorzkowicz, Bożena; Kołban, Maciej


    Physical appearance and psychomotor ability rank high in the hierarchy of values accepted by children and teenagers. Therefore Idiopathic Scoliosis (IS), which is accompanied by the dysfunction of locomotive organ and often requires troublesome treatment, may lead to poor body image and frustration. Other common effects are a low self-esteem, identity problems and depressive symptoms. Prospective examination was done in two independent groups of IS patients treated in one of Szczecin's clinic. The first group of 35 patients was examined twice: after being selected for surgery and 12 months after surgery. The second group of 52 patients was examined after a minimum of two years from operation. Research tools consisted of: personal data questionnaire, the assessment form of the clinical state and the Scoliosis Research Society (SRS)-22. The results were statistically analyzed using STATISTICA 5 software. Pearson's linear correlation coefficients and Spearman's rank correlation coefficients were calculated to determine the relationship between the pairs of variables. Preoperatively, the Cobb angle of thoracic curves was found to significantly correlate only with the Physical Activity (rs = -0.41, pappears insufficient to decide how advanced the disease is and what the treatment results are. 2. The degree of spinal curvature, especially in the postoperative period, have little effect on quality of patients' lives. 3. Studies with the use of the SRS-22 HRQL instrument suggest that other non-clinical factors may affect the quality of life assessment.

  12. Analysis of Short- and Long-term Outcomes of Patients With Surgically Treated Left-sided Infective Endocarditis: A 5-Year Longitudinal Follow-up Study. (United States)

    Marushchak, Oksana; Cole, Holy; Hiebert, Brett; Lo, Evelyn; Keynan, Yoav; Tam, James; Shaikh, Nasir; Menkis, Alan H; Arora, Rakesh C; Shah, Pallav


    This study aims to analyze survival, repeat hospitalization, and risk factors for surgically treated left-sided endocarditis. Retrospective review of all 166 (114 native and 52 prosthetic) patients operated between January 2004 and March 2015 was performed. Long-term survival and repeat hospitalization data for 134 of 166 patients were obtained via linked clinical databases with the Manitoba Centre for Health Policy. Kaplan-Meier estimates of survival and hospital readmission and Cox multivariable regression analysis of factors influencing outcomes were performed. Survival at 1 and 5 years was 91% and 80%, respectively, and major adverse prosthesis-related event repeat hospitalization rates were 12% and 21%, respectively. Repeat hospitalization because of endocarditis was 7% and 11% at 1 and 5 years, respectively. Survival and repeat hospitalization were similar for aortic and mitral valves. Survival after surgically treated endocarditis was similar to survival for age-, sex-, and valve-matched surgical valve replacements for noninfectious indications (P = 0.53). Viridans Streptococci was the most common organism in native valve endocarditis, and culture negative endocarditis was most common in prosthetic valves. Prosthetic valve endocarditis (P hospital mortality and major postoperative adverse events. Diabetes and renal dysfunction were associated with poor long-term survival, functional survival, and repeat hospitalization. This analysis suggests that surgery remains a very effective tool in management of these complex patients in terms of survival and major adverse prosthesis-related event repeat hospitalization. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Nasomaxillary complex in size, position and orientation in surgically treated and untreated individuals with cleft lip and palate: A cephalometric overview

    Directory of Open Access Journals (Sweden)

    Rohit Khanna


    Full Text Available Background: This cross-sectional retrospective cephalometric study was designed to clarify whether the maxillary deficiency seen in surgically treated individuals with non-syndromic complete unilateral cleft lip and palate (UCLP is due to inherent growth potential or iatrogenicity. Materials and Methods: 72 adult individuals were randomly selected in the age range of 12-20 years, and were divided into two groups. Group I had 47 untreated individuals. Group II consisted of 25 surgically treated individuals. Lateral and frontal cephalograms of the selected individuals were taken and analysed using Nemoceph software. Results: Group II showed a marked reduction in the cranial base angle, maxillary base length, anterior and posterior maxillary positions, palatal plane angle, maxillary width, maxillary height, occlusal plane height, nasal width and nasal height. Conclusion: Surgical intervention does interfere with growth in the facial region. This could be attributed to the scar tissue in lip and palate region, which has a restraining effect on growth in the facial region. These altered functional matrices play a significant role in determining the growth of facial structures.

  14. Radiografias em inclinação lateral como fator preditivo da correção cirúrgica na escoliose idiopática do adolescente Bending radiographs as a predictive factor in surgical correction of adolescent idiopathic scoliosis

    Directory of Open Access Journals (Sweden)

    Alberto Ofenhejm Gotfryd


    Full Text Available OBJETIVO: Avaliar a utilização de radiografias com inclinação lateral ativa em decúbito dorsal como fator preditivo da correção cirúrgica da curva torácica principal em pacientes com escoliose idiopática do adolescente (EIA. MÉTODOS: Foram avaliados, clínica e radiograficamente, 20 pacientes portadores de EIA tipo Lenke 1A e 1B operados por via posterior, utilizando nas montagens apenas parafusos pediculares. A flexibilidade das curvas foi calculada através de radiografias em inclinação lateral supina ativa. Os valores obtidos no pré-operatório para a curva torácica principal foram incluídos em uma equação matemática proposta por Cheung et al com a finalidade de predizer o resultado angular esperado após a correção cirúrgica. Após isto, foi realizado estudo estatístico de significância entre o valor predito e o real pós-operatório. RESULTADOS: Houve significância estatística para todos os casos estudados em relação ao valor predito pré-operatoriamente e os achados radiográficos do pós-operatório imediato (p OBJECTIVE: To evaluate the use of x-rays in dorsal decubitus, as a predictive factor for surgical correction of the main thoracic curve using pedicle screws, on patients with idiopathic adolescent scoliosis. METHOD: Twenty patients with idiopathic adolescent scoliosis of Lenke types 1A and 1B who were operated using a technique only involving pedicle screws by means of the posterior route were evaluated clinically and radiographically. The curve flexibility was calculated by means of active supine lateral oblique radiographs. The postoperative values for the main thoracic curve were included in a mathematical equation proposed by Cheung et al., with the aim of predicting the expected angular result from the surgical correction. The difference between the expected and actual postoperative results was then investigated regarding its statistical significance. RESULTS: There was statistical significance for

  15. QRS Complex Enlargement as a Predictor of Ventricular Arrhythmias in Patients Affected by Surgically Treated Tetralogy of Fallot: A Comprehensive Literature Review and Historical Overview (United States)

    Bassareo, Pier Paolo; Mercuro, Giuseppe


    Tetralogy of Fallot (TOF) is a congenital heart disease frequently treated by surgical repair to relieve symptoms and improve survival. However, despite the performing of an optimal surgical repair, TOF patients are at times characterized by a poor long-term survival rate, likely due to cardiac causes such as ventricular arrhythmias, with subsequent sudden death. In the 80s it was irrefutably demonstrated that QRS prolongation ≥180 msec at basal electrocardiogram is a strong predictor for refining risk stratification for ventricular tachycardia in these patients. The aim of this research was to undertake a review of all studies conducted to assess the impact of QRS duration on the development of life-threatening ventricular arrhythmias in repaired TOF subjects. PMID:23509638

  16. Infantile hypertrophic pyloric stenosis and subsequent ulcer dyspepsia. A follow-up study of medically and surgically treated patients

    DEFF Research Database (Denmark)

    Rasmussen, L; Hansen, L P; Qvist, N


    Infantile hypertrophic pyloric stenosis was treated in 324 cases in 1950-1966. At follow-up 19-35 years later, 296 of the patients could be traced, and 284 replied to a questionnaire concerning ulcer dyspepsia. Among the 80 patients who had been medically treated for pyloric stenosis...

  17. A retrospective study of 113 consecutive cases of surgically treated spondylodiscitis patients. A single-center experience. (United States)

    Shiban, Ehab; Janssen, Insa; Wostrack, Maria; Krieg, Sandro M; Ringel, Florian; Meyer, Bernhard; Stoffel, Michael


    Recommendations for the operative treatment of spondylodiscitis are still a controversial issue. A retrospective review identified 113 consecutive patients who underwent surgical debridement and instrumentation for spondylodiscitis between 2006 and 2010 at our department. The mean age at presentation was 65 years; 78 patients were male (69 %). Distribution of the inflammation was lumbar in 68 (60 %), thoracic in 19 (17 %) and cervical in 20 (18 %) cases. Six patients (5 %) had two concomitant non-contiguous spondylodiscitis foci in different segments of the spine. Epidural abscess was found in 33 patients (29 %). One hundred four patients (92 %) had pain. Neurological deficit was found in 40 patients (35 %). In the thoracic and lumbar cases, dorsal instrumentation alone was considered sufficient in 26 cases; additional interbody fusion from the posterior was performed in 44 cases. A 360° instrumentation was performed in 22 cases. In the cervical cases, only ventral spondylodesis and plating were performed in eight cases, only dorsal instrumentation in five and 360° instrumentation in seven. Postoperative intravenous antibiotics were administered for 14.4 ± 9.3 (mean ± SD) days followed by 3.2 ± 0.8 (mean ± SD) months of oral antibiosis. Complete healing of the inflammation was achieved in 111 (98 %) cases. Two patients died because of septic shock, both with fulminant endocarditis. Pain resolved in all cases. Neurological deficits were completely resolved in 20 patients, and 14 patients had a partial recovery. The results of our retrospective study show that surgical treatment of spondylodiscitis with a staged surgical approach (if needed) and a short 1-2-week period of intravenous antibiotics followed by 3 months of oral antibiotics is appropriate for most patients in whom conservative treatment has failed or is not advisable. Furthermore, surgical treatment of newly diagnosed spondylodiscitis might be recommended as an initial treatment option in

  18. Analysis and treatment of surgical complications after percutaneous transforaminal endoscopic discectomy for treating lumbar disc herniation and lumbar intervertebral foraminal stenosis

    Directory of Open Access Journals (Sweden)

    Guang HAN


    Full Text Available Objective To analyze the causes of surgical complications after treatment of lumbar disc herniation (LDH and lumbar intervertebral foraminal stenosis by percutaneous transforaminal endoscopic discectomy (PTED.  Methods From December 2009 to December 2014, 286 patients with LDH (N = 201 and lumbar intervertebral foraminal stenosis (N = 85 were confirmed by X-ray, CT or MRI and treated by PTED in our hospital. Visual Analogue Scale (VAS was used to evaluate the degree of pain in each paitent before and after operation. The curative effect was evaluated by Macnab score. Surgical complications were recorded to find out the causes and methods to prevent them.  Results All cases were followed up for 3 months, and the VAS score decreased significantly compared with preoperation [1.00 (0.00, 1.05 vs 8.50 (7.75, 9.25; Z = 2.825, P = 0.050]. According to Macnab score, the rate of excellent and good functional recovery was 95.45% (273/286. Procedure-related complications included nerve injury in 8 cases (2.80%, hemorrhage at the operation site and hematoma formation around nerve root in 6 cases (2.10%, rupture of dural sac in one case (0.35%, muscle cramps in 3 cases (1.05%, surgical infection in one case (0.35%, postoperative recurrence in 4 cases (1.40%. All patients with complications were cured after symptomatic treatment. Conclusions The overall effect of percutaneous transforaminal endoscopic discectomy for treating lumbar disc herniation and lumbar intervertebral foraminal stenosis is satisfactory, which has a low incidence rate of postoperative complications. Some tips can effectively reduce the rate of surgical complications such as preoperative evaluation, precise performance, careful hemostasis, shortening the operation time and postoperatively symptomatic treatment, etc. DOI: 10.3969/j.issn.1672-6731.2016.04.007

  19. Manual therapy as a conservative treatment for adolescent idiopathic scoliosis: a systematic review

    Directory of Open Access Journals (Sweden)

    Negrini Stefano


    Full Text Available Abstract Background The treatment of adolescent idiopathic scoliosis is contingent upon many variables. Simple observation is enough for less serious curvatures, but for very serious cases surgical intervention could be proposed. Between these there is a wide range of different treatments. Manual therapy is commonly used: the aim of this paper is to verify the data existing in the literature on the efficacy of this approach. Methods A systematic review of the scientific literature published internationally has been performed. We have included in the term manual therapy all the manipulative and generally passive techniques performed by an external operator. In a more specific meaning, osteopathic, chiropractic and massage techniques have been considered as manipulative therapeutic methods. We performed our systematic research in Medline, Embase, Cinhal, Cochrane Library, Pedro with the following terms: idiopathic scoliosis combined with chiropractic; manipulation; mobilization; manual therapy; massage; osteopathy; and therapeutic manipulation. The criteria for inclusion were as follows: Any kind of research; diagnosis of adolescent idiopathic scoliosis; patients treated exclusively by one of the procedures established as a standard for this review (chiropractic manipulation, osteopathic techniques, massage; and outcome in Cobb degrees. Results We founded 145 texts, but only three papers were relevant to our study. However, no one of the three satisfied all the required inclusion criteria because they were characterized by a combination of manual techniques and other therapeutic approaches. Conclusion The lack of any kind of serious scientific data does not allow us to draw any conclusion on the efficacy of manual therapy as an efficacious technique for the treatment of Adolescent idiopathic scoliosis.

  20. Manual therapy as a conservative treatment for adolescent idiopathic scoliosis: a systematic review. (United States)

    Romano, Michele; Negrini, Stefano


    The treatment of adolescent idiopathic scoliosis is contingent upon many variables. Simple observation is enough for less serious curvatures, but for very serious cases surgical intervention could be proposed. Between these there is a wide range of different treatments. Manual therapy is commonly used: the aim of this paper is to verify the data existing in the literature on the efficacy of this approach. A systematic review of the scientific literature published internationally has been performed. We have included in the term manual therapy all the manipulative and generally passive techniques performed by an external operator. In a more specific meaning, osteopathic, chiropractic and massage techniques have been considered as manipulative therapeutic methods. We performed our systematic research in Medline, Embase, Cinhal, Cochrane Library, Pedro with the following terms: idiopathic scoliosis combined with chiropractic; manipulation; mobilization; manual therapy; massage; osteopathy; and therapeutic manipulation. The criteria for inclusion were as follows: Any kind of research; diagnosis of adolescent idiopathic scoliosis; patients treated exclusively by one of the procedures established as a standard for this review (chiropractic manipulation, osteopathic techniques, massage); and outcome in Cobb degrees. We founded 145 texts, but only three papers were relevant to our study. However, no one of the three satisfied all the required inclusion criteria because they were characterized by a combination of manual techniques and other therapeutic approaches. The lack of any kind of serious scientific data does not allow us to draw any conclusion on the efficacy of manual therapy as an efficacious technique for the treatment of Adolescent idiopathic scoliosis.

  1. A double-barrelled fibula graft restoring pelvic stability after late posterior ring instability related to a surgical treated osteitis pubis: a case report. (United States)

    Pieroh, Philipp; Spindler, Nick; Langer, Stefan; Josten, Christoph; Böhme, Jörg


    Osteitis pubis or symphysitis pubis is a rare occurring non-infectious inflammation of the symphysis, the adjacent pubic bones and surrounding tissue. The therapy might be conservative or surgical by a resection of the symphysis and involved parts of the pubic bone. Nevertheless, this resection might lead to an anterior instability impairing the posterior arch and the sacroiliac joints in the aftermath. Here, we report about a 50-year-old women suffering from osteitis pubis treated by wedge resection of the symphysis and parts of the pubic bone. To maintain stability and for local antibiotic treatment a cement spacer was implemented. By clinical inconspicuous findings and the patient's desire, no further surgery was performed. However, 2 years after surgery the spacer dislocated and the patient complained about pain in the posterior arch due to an impaired mobility. Reconstruction surgery was planned including the bridging of the accrued space with a vascularized double-barrelled fibula graft, plate osteosynthesis and rectus abdominis flap coverage. The performed surgery led to pain relief and increased mobility. The present case highlights the possible complication of surgical treated osteitis pubis leading to anterior arch instability affecting the posterior arch and thus impairing pelvic ring stability and patient mobility. Furthermore, we describe an opportunity to treat this complication or other etiologies contributing to anterior pelvic ring stability with large bone defects using a vascularized double-barrelled fibula graft to restore pelvic stability.

  2. Atypical idiopathic inflammatory demyelinating lesions

    DEFF Research Database (Denmark)

    Wallner-Blazek, Mirja; Rovira, Alex; Fillipp, Massimo


    Atypical lesions of a presumably idiopathic inflammatory demyelinating origin present quite variably and may pose diagnostic problems. The subsequent clinical course is also uncertain. We, therefore, wanted to clarify if atypical idiopathic inflammatory demyelinating lesions (AIIDLs) can be class...

  3. Effectiveness of Maitland Techniques in Idiopathic Shoulder Adhesive Capsulitis


    Kumar, Abhay; Kumar, Suraj; Aggarwal, Anoop; Kumar, Ratnesh; Das, Pooja Ghosh


    Objective. To study the effectiveness of Maitland techniques in the treatment of idiopathic shoulder adhesive capsulitis. Methods. total of 40 patients diagnosed with idiopathic shoulder adhesive capsulitis were recruited and randomly allocated into two groups. In Group A ( ) subjects were treated with Maitland mobilization technique and common supervised exercises, whereas subjects in Group B ( ) only received common supervised exercises. Variables. Shoulder pain and disability index (SPADI)...

  4. Male-female differences in Scoliosis Research Society-30 scores in adolescent idiopathic scoliosis. (United States)

    Roberts, David W; Savage, Jason W; Schwartz, Daniel G; Carreon, Leah Y; Sucato, Daniel J; Sanders, James O; Richards, Benjamin Stephens; Lenke, Lawrence G; Emans, John B; Parent, Stefan; Sarwark, John F


    Longitudinal cohort study. To compare functional outcomes between male and female patients before and after surgery for adolescent idiopathic scoliosis (AIS). There is no clear consensus in the existing literature with respect to sex differences in functional outcomes in the surgical treatment of AIS. A prospective, consecutive, multicenter database of patients who underwent surgical correction for adolescent idiopathic scoliosis was analyzed retrospectively. All patients completed Scoliosis Research Society-30 (SRS-30) questionnaires before and 2 years after surgery. Patients with previous spine surgery were excluded. Data were collected for sex, age, Risser grade, previous bracing history, maximum preoperative Cobb angle, curve correction at 2 years, and SRS-30 domain scores. Paired sample t tests were used to compare preoperative and postoperative scores within each sex. Independent sample t tests were used to compare scores between sexes. A P value of Self-image/appearance had the greatest relative improvement. Males had better self-image/appearance scores preoperatively, better pain scores at 2 years, and better mental health and total scores both preoperatively and at 2 years. Both males and females were similarly satisfied with surgery. Males treated with surgery for AIS report better preoperative self-image, less postoperative pain, and better mental health than females. These differences may be clinically significant. For both males and females, the most beneficial effect of surgery is improved self-image/appearance. Overall, the benefits of surgery for AIS are similar for both sexes.

  5. Enhancing predicted efficacy of tumor treating fields therapy of glioblastoma using targeted surgical craniectomy: A computer modeling study

    DEFF Research Database (Denmark)

    Korshoej, Anders Rosendal; Saturnino, Guilherme Bicalho; Rasmussen, Line Kirkegaard


    Objective: The present work proposes a new clinical approach to TTFields therapy of glioblastoma. The approach combines targeted surgical skull removal (craniectomy) with TTFields therapy to enhance the induced electrical field in the underlying tumor tissue. Using computer simulations, we explore...... the potential of the intervention to improve the clinical efficacy of TTFields therapy of brain cancer. Methods: We used finite element analysis to calculate the electrical field distribution in realistic head models based on MRI data from two patients: One with left cortical/subcortical glioblastoma and one...

  6. Optimal management of idiopathic scoliosis in adolescence (United States)

    Kotwicki, Tomasz; Chowanska, Joanna; Kinel, Edyta; Czaprowski, Dariusz; Tomaszewski, Marek; Janusz, Piotr


    Idiopathic scoliosis is a three-dimensional deformity of the growing spine, affecting 2%–3% of adolescents. Although benign in the majority of patients, the natural course of the disease may result in significant disturbance of body morphology, reduced thoracic volume, impaired respiration, increased rates of back pain, and serious esthetic concerns. Risk of deterioration is highest during the pubertal growth spurt and increases the risk of pathologic spinal curvature, increasing angular value, trunk imbalance, and thoracic deformity. Early clinical detection of scoliosis relies on careful examination of trunk shape and is subject to screening programs in some regions. Treatment options are physiotherapy, corrective bracing, or surgery for mild, moderate, or severe scoliosis, respectively, with both the actual degree of deformity and prognosis being taken into account. Physiotherapy used in mild idiopathic scoliosis comprises general training of the trunk musculature and physical capacity, while specific physiotherapeutic techniques aim to address the spinal curvature itself, attempting to achieve self-correction with active trunk movements developed in a three-dimensional space by an instructed adolescent under visual and proprioceptive control. Moderate but progressive idiopathic scoliosis in skeletally immature adolescents can be successfully halted using a corrective brace which has to be worn full time for several months or until skeletal maturity, and is able to prevent more severe deformity and avoid the need for surgical treatment. Surgery is the treatment of choice for severe idiopathic scoliosis which is rapidly progressive, with early onset, late diagnosis, and neglected or failed conservative treatment. The psychologic impact of idiopathic scoliosis, a chronic disease occurring in the psychologically fragile period of adolescence, is important because of its body distorting character and the onerous treatment required, either conservative or surgical

  7. Olfactory groove meningioma: report of 99 cases surgically treated at the Catholic University School of Medicine, Rome. (United States)

    Pallini, Roberto; Fernandez, Eduardo; Lauretti, Liverana; Doglietto, Francesco; D'Alessandris, Quintino Giorgio; Montano, Nicola; Capo, Gabriele; Meglio, Mario; Maira, Giulio


    We reviewed our series of olfactory groove meningiomas (OGMs) with the aim to relate the surgical approach with outcome and to define clinical and pathologic predictors of prognosis. Ninety-nine patients who underwent 113 craniotomies at our Institution between 1984 and 2010 were entered this study. The relationship between surgical approach (bifrontal, fronto-orbito-basal, and pterional) and either tumor diameter, extent of tumor resection, complication rate, need of reoperation, and Karnofsky Performance Status (KPS) was analyzed. The impact of age (≤ 70 vs. > 70 years), sex, tumor diameter (OGMs published to date, the bifrontal approach was associated with a greater risk of life-threatening complications compared with the lateral pterional and fronto-orbito-basal approaches. The fronto-orbito-basal approach provided greater chances of total tumor removal than the bifrontal and pterional approaches. Two independent factors for overall survival of patients with OGM were identified, namely age and WHO grade. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

  8. [Primary extranodal non-Hodgkin's malignant orbital lymphomas treated surgically in ENT Department of Medical Academy of Silesia in Katowice in the years 1996-2001]. (United States)

    Gierek, Tatiana; Markowski, Jarosław; Zielińska-Pajak, Ewa; Witkowska, Małgorzata; Kajor, Maciej; Pajak, Jacek; Kulesa, Lukasz; Paluch, Jarosław


    The authors presented 7 cases of primary extranodal non-l-odgkin's malignant orbital lymphomas in patients treated surgically in the ENT Department of the Medical University of Silesia in the years 1996-2001. In the course of the diagnostic process we examined the patients carefully to be sure that the cancer had not disseminated. We used some imaging techniques such as: ultrasonography (USG), computer tomography (CT) and magnetic resonance imaging (MRI). We also used the needle aspiration biopsy, as an additional examination. However the material was no significant in the most cases and we were unable to make a definitive diagnosis on the basis of this method alone. After prior examinations we performed the radical operations and removed the tumors. In each case the postoperative material was examined using histopatological and immunohistochemical methods. Afterwards the pathomorphological diagnosis was made by the specialists. Next the patients were observed and treated in the Haematological and Radiotherapy Departments.

  9. The association between preoperative mental distress and patient-reported outcome measures in patients treated surgically for cervical radiculopathy. (United States)

    Skeppholm, Martin; Fransson, Roland; Hammar, Margareta; Olerud, Claes


    Previous research indicates that there might exist a link between the experience of pain and mental distress. Pain can possibly trigger anxiety and chronic pain, as well as also depression. On the other hand, anxiety and depression might also be risk factors for painful conditions and more pronounced subsequent disability and thus, the pathways may be bidirectional. Expanded knowledge of how different factors affect pain and function may help surgeons in preoperative decision-making. The aim of this study was to evaluate the impact of potential preoperative risk factors with special reference to mental distress. This is a prospective outcome study in a cohort from a multicenter randomized controlled trial comparing anterior cervical decompression and fusion with disc replacement. The sample included 151 patients with cervical radiculopathy planned for surgery. Surgical outcome was evaluated with Neck Disability Index (NDI), health related quality-of-life with European Quality of Life-5 Dimensions, and pain with visual analogue scale for arm and neck. Mental distress was preoperatively measured with the Hospital Anxiety and Depression (HAD) scale. Preoperative data regarding possible risk factors for poor outcome were analyzed in multiple linear regression models with postoperative NDI and change of NDI as dependent factors. Patients with high preoperative levels of anxiety or depression (H-HAD), indicating mental distress, were compared with patients scoring low/moderate levels (L-HAD) regarding patient-reported outcome measures (PROMs) preoperatively and at 1- and 2-year follow-up. Outcome data were available for 136 patients at the 2-year follow-up. No statistically significant difference in any outcome data could be demonstrated between the two surgical treatment groups. Mental distress was the variable most strongly associated with NDI at 2 years in the regression analysis. There were 42 patients classified as H-HAD and 94 as L-HAD. The average improvement in

  10. Long-term outcome and quality of life of patients treated in surgical intensive care: a comparison between sepsis and trauma. (United States)

    Korosec Jagodic, Helena; Jagodic, Klemen; Podbregar, Matej


    Our aim was to determine long-term survival and quality of life of patients admitted to a surgical intensive care unit (ICU) because of sepsis or trauma. This was an observational study conducted in an 11-bed, closed surgical ICU at a 860-bed teaching general hospital over a 1-year period (January 2003 to December 2003). Patients were divided into two groups according to admission diagnoses: group 1 included patients with sepsis; and group 2 included patients with trauma (polytrauma, multiple trauma, head injury, or spinal injury). Quality of life was assessed after 2 years following ICU admission using the EuroQol 5D questionnaire. A total of 164 patients (98 trauma patients and 66 patients with sepsis) were included in the study. Trauma patients were younger than patients with sepsis (53 +/- 21 years versus 64 +/- 13 years; P Trauma patients stayed longer on the general ward (35 +/- 44 days versus 17 +/- 24 days; P trauma group (surgical ICU survival: 60% versus 74%; in-hospital survival: 42% versus 62%; post-hospital survival: 78% versus 92%; cumulative 2-year survival: 33% versus 57%; P quality of life in all five dimensions of the EuroQol 5D between groups: 60% of patients had signs of depression, almost 60% had problems in usual activities and 56% had pain. Patients with sepsis treated in a surgical ICU have higher short-term and long-term mortality than do trauma patients. However, quality of life is reduced to the same level in both groups.

  11. Combined detection of preoperative serum CEA, CA19-9 and CA242 improve prognostic prediction of surgically treated colorectal cancer patients. (United States)

    Wang, Jingtao; Wang, Xiao; Yu, Fudong; Chen, Jian; Zhao, Senlin; Zhang, Dongyuan; Yu, Yang; Liu, Xisheng; Tang, Huamei; Peng, Zhihai


    We assessed the prognostic significance of preoperative serum carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9) and carbohydrate antigen 242 (CA242) levels in surgically treated colorectal cancer patients. The relationship of preoperative serum CEA, CA19-9 and CA242 levels with disease characteristics was investigated in 310 patients. Correlation between tumor markers was investigated using Pearson correlation test. Univariate and multivariate survival analyses were used to study the relationship between preoperative tumor markers and prognosis [disease free survival (DFS) and overall survival (OS)]. Kaplan-Meier analysis with log rank test was used to assess the impact of tumor marker levels on survival. Positive rate of preoperative serum CEA, CA19-9 and CA242 were 54.84%, 47.42% and 37.10%, respectively. High preoperative CEA level was associated with tumor size (P = 0.038), T stage (P tumor AJCC stage (P = 0.023). Preoperative CA242 positively correlated with CEA (P markers was of independent prognostic value in CRC (HR = 2.532, 95% CI: 1.400-4.579, P = 0.002 for OS; and HR = 2.366, 95% CI: 1.334-4.196, P = 0.003 for DFS). Combined detection of preoperative serum CEA, CA19-9 and CA242 is of independent prognostic value for management of CRC patients treated surgically.

  12. [Rupture of interventricular septum secondary to blunt chest trauma. Report of a case surgically treated with success (author's transl)]. (United States)

    Gallotti, R; Gordini, V; Botta, M; Pezzano, A


    A case of interventricular septal defect secondary to blunt chest trauma is reported. It was characterized by a disconnection of the interventricular muscolar septal in the anterosuperior part of the heart wall. The diagnosis, suspected by clinical and instrumental parameters, was definitely confirmedy by hemodynamic and contrastographic examination. Repair surgery of the defect with a dacron patch was performed, using extracorporea normothermic circulation seven months after the accident. The patient was examined three months and twelve months after the operation; the clinical examinations did not reveal any cardiac murmur and the patient's health was satisfactory. The incidence, mechanism of rupture of interventricular septum and the main surgical and clinical aspects of this type of pathology are discussed.

  13. Some cardiopulmonary effects of midazolam premedication in clenbuterol-treated bitches during surgical endoscopic examination of the uterus and ovariohysterectomy

    Directory of Open Access Journals (Sweden)

    G.F. Stegmann


    Full Text Available Midazolam was administered intravenously to 8 bitches in a randomised, placebo-controlled clinical trial before propofol induction of surgical anaesthesia. Anaesthesia was maintained with isoflurane-in-oxygen during surgical endoscopic examination of the uterus and ovariohysterectomy. Clenbuterol was administered at the start of surgery to improve uterine muscle relaxation, and to facilitate endoscopic examination of the uterus. Ventilation was controlled. Induction of anaesthesia with propofol to obtain loss of the pedal reflex resulted in a statistically significant (P < 0.05 decrease in minute volume and arterial oxygen partial pressure in the midazolam group. Apnoea also occurred in 50 % of dogs in the midazolam group. The dose for propofol in the midazolam group was 7.4 mg/kg compared to 9.5 mg/kg in the control. Minute volume was significantly (P < 0.05 higher in both groups during isoflurane maintenance, compared to the value after incremental propofol to obtain loss of the pedal reflex. Propofol induction resulted in a 25-26 % reduction in the mean arterial blood pressure in both groups, and the administration of clenbuterol at the start of surgery resulted in a transient, but statistically significant (P < 0.05, decrease in mean arterial blood pressure in the midazolam group during isoflurane anaesthesia. It is concluded that intravenous midazolam premedication did not adversely affect cardiovascular function during propofol induction, but intra-operative clenbuterol during isoflurane maintenance of anaesthesia may result in transient hypotension. Midazolam premedication may increase adverse respiratory effects when administered before propofol induction of anaesthesia.

  14. Optimal management of idiopathic macular holes

    Directory of Open Access Journals (Sweden)

    Madi HA


    Full Text Available Haifa A Madi,1,* Ibrahim Masri,1,* David H Steel1,2 1Sunderland Eye Infirmary, Sunderland, 2Institute of Genetic Medicine, Newcastle University, International Centre for Life, Newcastle, UK *These authors contributed equally to this work Abstract: This review evaluates the current surgical options for the management of idiopathic macular holes (IMHs, including vitrectomy, ocriplasmin (OCP, and expansile gas use, and discusses key background information to inform the choice of treatment. An evidence-based approach to selecting the best treatment option for the individual patient based on IMH characteristics and patient-specific factors is suggested. For holes without vitreomacular attachment (VMA, vitrectomy is the only option with three key surgical variables: whether to peel the inner limiting membrane (ILM, the type of tamponade agent to be used, and the requirement for postoperative face-down posturing. There is a general consensus that ILM peeling improves primary anatomical hole closure rate; however, in small holes (<250 µm, it is uncertain whether peeling is always required. It has been increasingly recognized that long-acting gas and face-down positioning are not always necessary in patients with small- and medium-sized holes, but large (>400 µm and chronic holes (>1-year history are usually treated with long-acting gas and posturing. Several studies on posturing and gas choice were carried out in combination with ILM peeling, which may also influence the gas and posturing requirement. Combined phacovitrectomy appears to offer more rapid visual recovery without affecting the long-term outcomes of vitrectomy for IMH. OCP is licensed for use in patients with small- or medium-sized holes and VMA. A greater success rate in using OCP has been reported in smaller holes, but further predictive factors for its success are needed to refine its use. It is important to counsel patients realistically regarding the rates of success with

  15. Chronic idiopathic constipation

    African Journals Online (AJOL)


    May 12, 2009 ... idiopathic constipation are categorised into three groups: • patients with normal colon transit and evacuation. • patients with evacuatory disorders. • patients with slow colon transit. A colon transit study is the best way to differentiate these categories of patients. Twenty radio-opaque pellets are swallowed.

  16. Idiopathic epiretinal membrane

    NARCIS (Netherlands)

    Bu, Shao-Chong; Kuijer, Roelof; Li, Xiao-Rong; Hooymans, Johanna M M; Los, Leonoor I


    Background: Idiopathic epiretinal membrane (iERM) is a fibrocellular membrane that proliferates on the inner surface of the retina at the macular area. Membrane contraction is an important sight-threatening event and is due to fibrotic remodeling. Methods: Analysis of the current literature

  17. Idiopathic inflammatory myopathies

    NARCIS (Netherlands)

    van der Kooi, A. J.; de Visser, M.


    Idiopathic inflammatory myopathies (IIMs), except for sporadic inclusion body myositis (sIBM), present with subacute symmetrical weakness of the limb girdle muscles, an elevated serum creatine kinase activity, and inflammatory cells in the muscle biopsy (necrotizing autoimmune myopathy being an

  18. Idiopathic Retroperitoneal Hematoma

    African Journals Online (AJOL)

    In the early stages it typically presents as generalized abdominal pain, nausea, anorexia. The symptoms and signs of hypovolemic shock normally present late. As management of idiopathic retroperitoneal hematoma is usually conservative, early diagnosis can save the patient an unnecessary exploration. This will improve.

  19. Idiopathic Interstitial Pneumonias (United States)

    ... Most Often Affected Percentage of Affected People Who Smoke Cigarettes Treatment Outlook Idiopathic pulmonary fibrosis More frequently, men ... HealthDay Vitamin D Linked to Lower Risk of Respiratory Infections News HealthDay Remede System Approved for Sleep Apnea News HealthDay Nasal Swab ...

  20. Idiopathic scrotal calcinosis

    DEFF Research Database (Denmark)

    Tareen, Ali; Ibrahim, Rami Mossad


    INTRODUCTION: Idiopathic scrotal calcinosis is a rare benign condition which presents with asymptomatic multiple nodules on the scrotal skin. PRESENTATION OF CASE: Our patient, a 64-year-old Indian male with Fitzpatrick skin type 4, presented with multiple nodules, which were completely surgicall...

  1. Idiopathic granulomatous orbital inflammation

    NARCIS (Netherlands)

    Mombaerts, I.; Schlingemann, R. O.; Goldschmeding, R.; Koornneef, L.


    PURPOSE: Granulomatous orbital inflammation may occur as an isolated condition of unknown origin. These idiopathic granulomatous lesions are believed to belong to the orbital pseudotumor group by some authors, whereas others consider them sarcoidosis limited to the orbit. The aim of this study is to

  2. Idiopathic ophthalmodynia and idiopathic rhinalgia: two topographic facial pain syndromes. (United States)

    Pareja, Juan A; Cuadrado, María L; Porta-Etessam, Jesús; Fernández-de-las-Peñas, César; Gili, Pablo; Caminero, Ana B; Cebrián, José L


    To describe 2 topographic facial pain conditions with the pain clearly localized in the eye (idiopathic ophthalmodynia) or in the nose (idiopathic rhinalgia), and to propose their distinction from persistent idiopathic facial pain. Persistent idiopathic facial pain, burning mouth syndrome, atypical odontalgia, and facial arthromyalgia are idiopathic facial pain syndromes that have been separated according to topographical criteria. Still, some other facial pain syndromes might have been veiled under the broad term of persistent idiopathic facial pain. Through a 10-year period we have studied all patients referred to our neurological clinic because of facial pain of unknown etiology that might deviate from all well-characterized facial pain syndromes. In a group of patients we have identified 2 consistent clinical pictures with pain precisely located either in the eye (n=11) or in the nose (n=7). Clinical features resembled those of other localized idiopathic facial syndromes, the key differences relying on the topographic distribution of the pain. Both idiopathic ophthalmodynia and idiopathic rhinalgia seem specific pain syndromes with a distinctive location, and may deserve a nosologic status just as other focal pain syndromes of the face. Whether all such focal syndromes are topographic variants of persistent idiopathic facial pain or independent disorders remains a controversial issue.

  3. [Idiopathic thrombosis of the renal vein]. (United States)

    Ignjatović, I; Ilić, M; Marković, N; Stamenić, T


    Renal vein thrombosis (TVR) is not a common disease especially when is not associated with renal parenchymal nephropathy. TVR has no characteristic symptoms, so it is often late recognised. The main procedures for diagnosis of TVR are: echotomography, CT and phlebography. All these procedures, although very informative, have certain limits in the clinical use. Therapy of TVR trombolytic, anticoagulant or surgical: thrombectomy or nephrectomy. In cases where the underlying parenchymal disease exists, aggresive therapeutic approach is not recommended, but in acute idiopathic TVR immediate recanalisation of the renal vein is the most effective.

  4. Quality of Life in Individuals Surgically Treated for Congenital Hydrocephalus During Infancy: A Single-Institution Experience. (United States)

    Khan, Saad Akhtar; Khan, Muhammad Faheem; Bakhshi, Saqib Kamran; Irfan, Omar; Khan, Hamza Abdur Rahim; Abbas, Asad; Awan, Safia; Bari, Muhammad Ehsan


    Congenital hydrocephalus (CH) is a frequently encountered birth anomaly that can hinder long-term neurologic maturity and social well-being of affected children. This study was undertaken to assess quality of life (QOL) 10-15 years after surgical treatment for primary CH during infancy at a tertiary care hospital in a developing country. This retrospective cohort study included individuals who presented to Aga Khan University Hospital, Karachi, Pakistan, between 1995 and 2005 at Hydrocephalus Outcome Questionnaire was used to assess outcomes with respect to QOL. Of 118 patients, 90 patients participated in the study. Mean age at first admission was 6.2 months. Mean length of follow-up was 5.4 years. Of these, 28 patients had died after surgery. Shunt infection (P = 0.012) and delayed milestones (P = 0.003) were found to be statistically significant factors affecting mortality in the patients who died. The mean overall health score was 0.67 ± 0.30. Age Hydrocephalus Outcome Questionnaire (P = 0.039). In our analysis, we assessed the QOL associated with CH. We hope that these results will provide insight for future prospective work with the ultimate goal of improving long-term QOL in children with CH. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Pulmonary function in children with idiopathic scoliosis

    Directory of Open Access Journals (Sweden)

    Tsiligiannis Theofanis


    Full Text Available Abstract Idiopathic scoliosis, a common disorder of lateral displacement and rotation of vertebral bodies during periods of rapid somatic growth, has many effects on respiratory function. Scoliosis results in a restrictive lung disease with a multifactorial decrease in lung volumes, displaces the intrathoracic organs, impedes on the movement of ribs and affects the mechanics of the respiratory muscles. Scoliosis decreases the chest wall as well as the lung compliance and results in increased work of breathing at rest, during exercise and sleep. Pulmonary hypertension and respiratory failure may develop in severe disease. In this review the epidemiological and anatomical aspects of idiopathic scoliosis are noted, the pathophysiology and effects of idiopathic scoliosis on respiratory function are described, the pulmonary function testing including lung volumes, respiratory flow rates and airway resistance, chest wall movements, regional ventilation and perfusion, blood gases, response to exercise and sleep studies are presented. Preoperative pulmonary function testing required, as well as the effects of various surgical approaches on respiratory function are also discussed.

  6. Micro-surgical endodontics. (United States)

    Eliyas, S; Vere, J; Ali, Z; Harris, I


    Non-surgical endodontic retreatment is the treatment of choice for endodontically treated teeth with recurrent or residual disease in the majority of cases. In some cases, surgical endodontic treatment is indicated. Successful micro-surgical endodontic treatment depends on the accuracy of diagnosis, appropriate case selection, the quality of the surgical skills, and the application of the most appropriate haemostatic agents and biomaterials. This article describes the armamentarium and technical procedures involved in performing micro-surgical endodontics to a high standard.

  7. Preliminary study of clinical staging of moderately advanced and advanced thoracic esophageal carcinoma treated by non-surgical methods

    International Nuclear Information System (INIS)

    Zhu Shuchai; Li Ren; Li Juan; Qiu Rong; Han Chun; Wan Jun


    Objective: To explore the clinical staging of moderately advanced and advanced thoracic esophageal carcinoma by evaluating the prognosis and provide criteria for individual treatment. Methods: The authors retrospectively analyzed 500 patients with moderately advanced and advanced thoracic esophageal carcinoma treated by radiotherapy alone. According to the primary lesion length by barium meal X-ray film, the invasion range and the relation between location and the surrounding organs by CT scans the disease category was classified by a 6 stage method and a 4 stage method. With the primary lesion divide into T1, T2a, T2b, T3a, T3b and T4 incorporating the locregional lymph node metastasis, a 6 stage system was obtained, I, IIa , IIb, IIIa, IIIb and IV. The results of this as compared with those of 4 stage system, the following data were finally arrived at. Results: Among the 500 cases, there were T1 23, T2a 111, T2b 157, T3a 84, T3b 82 and T4 43. The survival rates of these six categories showed significant differences (χ 2 =63.32, P 2 =56.29, P 2 =94.29, P 2 =83.48, P<0.05). Conclusions: Both the 6 stage and 4 stage systems are adaptable to predict prognosis of moderately advanced and advanced esophageal carcinoma treated by radiotherapy alone. For simplicity and convenience, the 4 stage classification is recommended. (authors)

  8. Idiopathic facial pain related with dental implantation

    Directory of Open Access Journals (Sweden)

    Tae-Geon Kwon


    Full Text Available Chronic pain after dental implantation is rare but difficult issue for the implant practitioner. Patients with chronic pain who had been performed previous implant surgery or related surgical intervention sometimes accompany with psychological problem and difficult to adequately manage. According to the International Classification of Headache Disorders (ICHD 3rd eds, Cepalagia 2013, painful neuropathies and other facial pains are subdivided into the 12 subcategories; 13.1. Trigeminal neuralgia; 13.2 Glossopharyngeal neuralgia; 13.3 Nervus intermedius (facial nerve neuralgia; 13.4 Occipital neuralgia; 13.5 Optic neuritis; 13.6 Headache attributed to ischaemic ocular motor nerve palsy; 13.7 Tolosa-Hunt syndrome; 13.8 Paratrigeminal oculo-sympathetic (Raeder’s syndrome; 13.9 Recurrent painful ophthalmoplegic neuropathy; 13.10 Burning Mouth Syndrome (BMS; 13.11 Persistent Idiopathic Facial Pain (PIFP; 13.12 Central neuropathic pain. Chronic orofacial pain after dental implant surgery can be largely into the two main categories that can be frequently encountered in clinical basis ; 1 Neuropathic pain, 2 Idiopathic pain. If there is no direct evidence of the nerve injury related with the implant surgery, the clinician need to consider the central cause of pain instead of the peripheral cause of the pain. There might be several possibilities; 1 Anaesthesia dolorosa, 2 Central post-stroke pain, 3 Facial pain attributed to multiple sclerosis, 4 Persistent idiopathic facial pain (PIFP, 5 Burning mouth syndrome. In this presentation, Persistent idiopathic facial pain (PIFP, the disease entity that can be frequently encountered in the clinic would be discussed. Persistent idiopathic facial pain (PIFP can be defined as “persistent facial and/or oral pain, with varying presentations but recurring daily for more than 2 hours per day over more than 3 months, in the absence of clinical neurological deficit”. ‘Atypical’ pain is a diagnosis of

  9. Genetics Home Reference: idiopathic pulmonary fibrosis (United States)

    ... Twitter Home Health Conditions Idiopathic pulmonary fibrosis Idiopathic pulmonary fibrosis Printable PDF Open All Close All Enable Javascript to view the expand/collapse boxes. Description Idiopathic pulmonary fibrosis is a chronic, progressive lung disease. This condition ...

  10. Genetics Home Reference: juvenile idiopathic arthritis (United States)

    ... Home Health Conditions Juvenile idiopathic arthritis Juvenile idiopathic arthritis Printable PDF Open All Close All Enable Javascript ... view the expand/collapse boxes. Description Juvenile idiopathic arthritis refers to a group of conditions involving joint ...

  11. Genetics Home Reference: adolescent idiopathic scoliosis (United States)

    ... Facebook Twitter Home Health Conditions Adolescent idiopathic scoliosis Adolescent idiopathic scoliosis Printable PDF Open All Close All ... Javascript to view the expand/collapse boxes. Description Adolescent idiopathic scoliosis is an abnormal curvature of the ...

  12. Idiopathic laryngotracheal stenosis. Valoration with CT

    International Nuclear Information System (INIS)

    Delgado, I.; Villanueva, J.; Ruiz, R.


    Idiopathic laryngotracheal stenosis is an un-common cause of focal airway structure. It develops in adult patients who present clinical signs such as strider and progressive dyspnea. The patients are usually treated for months or years for asthma or chronic bronchial pathology. It most often involves larynx or sub glottal trachea. The histological study establishes the definitive diagnosis, demonstrating the existence of keloid fibrosis with areas of spindle cells. We present the case of an adult man with idiopathic sub glottal stenosis, presenting a two-year history of respiratory distress showing progression in recent months. The study was based on CT findings revealing the existence of a 4 cm long tracheal structure with a minimum diameter of 7 mm. (Author)

  13. Comparison of autologous bone marrow and adipose tissue derived mesenchymal stem cells, and platelet rich plasma, for treating surgically induced lesions of the equine superficial digital flexor tendon. (United States)

    Romero, A; Barrachina, L; Ranera, B; Remacha, A R; Moreno, B; de Blas, I; Sanz, A; Vázquez, F J; Vitoria, A; Junquera, C; Zaragoza, P; Rodellar, C


    Several therapies have been investigated for equine tendinopathies, but satisfactory long term results have not been achieved consistently and a better understanding of the healing mechanism elicited by regenerative therapies is needed. The aim of this study was to assess the separate effects of autologous bone marrow (BM) and adipose tissue (AT) derived mesenchymal stem cells (MSCs), and platelet rich plasma (PRP), for treating lesions induced in the superficial digital flexor tendon (SDFT) of horses. Lesions were created surgically in both SDFTs of the forelimbs of 12 horses and were treated with BM-MSCs (six tendons), AT-MSCs (six tendons) or PRP (six tendons). The remaining six tendons received lactated Ringer's solution as control. Serial ultrasound assessment was performed prior to treatment and at 2, 6, 10, 20 and 45 weeks post-treatment. At 45 weeks, histopathology and gene expression analyses were performed. At week 6, the ultrasound echogenicity score in tendons treated with BM-MSCs suggested earlier improvement, whilst all treatment groups reached the same level at week 10, which was superior to the control group. Collagen orientation scores on histological examination suggested a better outcome in treated tendons. Gene expression was indicative of better tissue regeneration after all treatments, especially for BM-MSCs, as suggested by upregulation of collagen type I, decorin, tenascin and matrix metalloproteinase III mRNA. Considering all findings, a clear beneficial effect was elicited by all treatments compared with the control group. Although differences between treatments were relatively small, BM-MSCs resulted in a better outcome than PRP and AT-MSCs. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Clinical importance of TERT overexpression in hepatocellular carcinoma treated with curative surgical resection in HBV endemic area. (United States)

    Yu, Jeong Il; Choi, Changhoon; Ha, Sang Yun; Park, Cheol-Keun; Kang, So Young; Joh, Jae-Won; Paik, Seung Woon; Kim, Seonwoo; Kim, Minji; Jung, Sang Hoon; Park, Hee Chul


    This study was designed to investigate the associations between TERT overexpression and the clinicopathologic factors of hepatocellular carcinoma (HCC). A total of 291 patients with HCC were enrolled. The site of first recurrence (anywhere in the liver) was classified as intrahepatic recurrence (IHR). Recurrence was then sub classified as either early or late IHR according to whether it was discovered within 2 years of resection, or after, respectively. TERT overexpression was not significantly correlated with previously recognized prognostic factors. During follow-up, early IHR occurred in 126 (63.6%) patients, while late IHR was detected in 59 patients among 145 patients who remained free of HCC recurrence for ≥ 2 years after surgery. Multivariate analysis showed late IHR was significantly correlated with TERT overexpression (P overexpression (P overexpression was the only significant prognostic factor for late IHR in HCC treated with curative resection. And, the statistical significance of TERT overexpression on late IHR was limited to HBsAg-positive patients.

  15. Acute Idiopathic Scrotal Edema

    Directory of Open Access Journals (Sweden)

    Micheál Breen


    Full Text Available We report a case of acute idiopathic scrotal edema (AISE in a 4-year-old boy who presented with acute scrotal pain and erythema. The clinical features, ultrasound appearance, and natural history of this rare diagnosis are reviewed. In this report, we highlight the importance of good ultrasound technique in differentiating the etiology of the acute scrotum and demonstrate the color Doppler “Fountain Sign” that is highly suggestive of AISE.

  16. Idiopathic pulmonary hemosiderosis presenting in an adult: A case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Khalid M Sherani


    Full Text Available Diffuse alveolar hemorrhage (DAH is characterized by the presence of hemoptysis, anemia, and the presence of diffuse parenchymal infiltrates on imaging studies. Idiopathic pulmonary hemosiderosis (IPH is an uncommon cause of diffuse alveolar hemorrhage (DAH and is classically known to present in childhood. Adult-onset IPH is extremely rare. We report the case of a 48-year-old female patient who presented with hemoptysis and acute hypoxic respiratory failure, requiring intubation and mechanical ventilation. Imaging studies showed diffuse bilateral patchy infiltrates. Bronchoalveolar lavage (BAL confirmed the diagnosis of DAH. Extensive workup including video-assisted thoracoscopic surgical lung biopsy (VATS failed to reveal any vasculitis, infectious, immunological or connective tissue disorder, as the underlying cause for DAH. The patient was successfully treated with high-dose steroid therapy.

  17. [Idiopathic autonomic neuropathy (pandysautonomia)]. (United States)

    Jankowicz, E; Drozdowski, W; Pogumirski, J


    On the basis of current literature, clinical and neuropathologic features of idiopathic autonomic neuropathy is presented. Idiopathic autonomic neuropathy is a disease characterized by acute or subacute onset, monophasic course over a period of several years, it is often preceded by an infection. The spectrum of autonomic changes ranges from cholinergic or adrenergic dysfunction to pandysautonomia, leading to heterogeneity of its clinical features. Possible sympathetic system abnormalities found in autonomic neuropathy are: poor pupillary response to light in darkness, orthostatic hypotension leading to syncope, hypotension without compensatory tachycardia, ejaculation disturbances and vasomotor instability. Possible parasympathetic dysfunctions are: salivation and lacrimation disturbances, absent pupillary constriction to light and near gaze, gastrointestinal tract immobility and impairment of gastrointestinal function, atonic bladder with large residual volume, erectile impotence. Pandysautonomia is thought to result from an immune mediated mechanism and responds well to plasmaferesis and intravenous immunoglobin therapy leading to gradual, sometimes not full, recovery. Moreover in this article we pay attention to the clinical value of many tests like cardiovascular or pharmacological studies in the diagnosis of pandysautonomia and in differentiation of pre- and postganglionic changes. In order to diagnose idiopathic autonomic neuropathy one has to rule out a large number of diseases with autonomic dysfunction e.g.: diabetes, malignant neoplasms, acute intermittent porphyria, Shy-Drager syndrome, Riley-Day's dysautonomia, Parkinson's disease, amyloidosis and others.

  18. Potency following high-dose three-dimensional conformal radiotherapy and the impact of prior major urologic surgical procedures in patients treated for prostate cancer

    International Nuclear Information System (INIS)

    Chinn, Daniel M.; Holland, John; Crownover, Richard L.; Roach, Mack


    Purpose: To assess the impact of high-dose three-dimensional conformal radiotherapy (3DCRT) on potency in patients treated for clinically localized prostate cancer and to identify factors that might predict the outcome of sexual function following treatment. Methods and Materials: One hundred twenty-four consecutive patients treated with 3DCRT for localized prostate cancer at UCSF between 1991-1993 were included in this retrospective analysis. Patient responses were obtained from a mailed questionnaire, telephone interviews, or departmental records. Median follow-up was 21 months. Results: Sixty patients reported having sexual function prior to 3DCRT, including 47 who were fully potent and 13 who were marginally potent. Of the remaining 64 patients, 45 were impotent, 7 were on hormones, 1 was status-postorchiectomy, and 11 were not evaluable. Following 3DCRT, 37 of 60 patients (62%) retained sexual function sufficient for intercourse. Of those with sexual function before irradiation, 33 of 47 (70%) of patients fully potent and 4 of 13 (31%) of patients marginally potent maintained function sufficient for intercourse (p < 0.01). Potency was retained in 6 of 15 (40%) patients with a history of a major urologic surgical procedure (MUSP) and in 31 of 45 (69%) with no history of a MUSP (p < 0.04). Transurethral resection of the prostate was the MUSP in eight of these patients, with four (50%) maintaining sexual function. Conclusions: Patients who receive definitive 3DCRT for localized prostate cancer appear to maintain potency similar to patients treated with conventional radiotherapy. However, patients who are marginally potent at presentation or who have a history of a MUSP appear to be at increased risk of impotence following 3DCRT

  19. Aortic Root Rupture during Transcatheter Aortic Valve Implantation in a Patient with Idiopathic Thrombocytopenic Purpura: Utility of Transesophageal Echocardiography in Early Detection and Description of a Semiconservative Surgical Management Approach. (United States)

    Chandrasekhar, Jaya; Ruel, Marc; Nicholson, Donna; Labinaz, Marino


    An 87-year-old man with idiopathic thrombocytopenic purpura and platelet count of 56 × 10 9 /L underwent transesophageal echocardiography (TEE)-guided transcatheter aortic valve implantation using a femoral approach. Post valve deployment, a new pericardial effusion was noted which was successfully drained. Despite this, the patient became hypotensive needing vasopressor support with reaccumulation of pericardial fluid. Emergent sternotomy was performed and a perforation of the right ventricular apex was noted which was sealed with a pledgeted suture. Continued bleeding prompted further exploration; the aorta was seen to be mottled in conjunction with clear aortic root hematoma on TEE and a diagnosis of root rupture was made. This was semiconservatively managed without conversion to a full aortic root repair or replacement procedure. Multiple sutures were applied to the periaortic space and the bleeding sealed with use of BioGlue (Cryolife Inc., Kennesaw, GA) and Surgicel (Ethicon Inc., Somerville, NJ). The postoperative course was stable and the patient remained well at 3-month follow-up.

  20. Long-term follow-up of conjunctival melanoma treated with topical interferon alpha-2b eye drops as adjunctive therapy following surgical resection. (United States)

    Kikuchi, Iku; Kase, Satoru; Ishijima, Kan; Ishida, Susumu


    The purpose of this study was to report the clinical outcomes of patients with conjunctival melanoma treated with interferon (IFN) α-2b eye drops following local tumor resection. Five eyes of five patients were enrolled in this study. All patients underwent the local resection of tumors, and topical IFNα-2b eye drops were subsequently administered 4 times/day until the complete disappearance of the pigmented lesions determined by slit-lamp examination. Ophthalmological findings, histopathological findings, and imaging modalities were retrospectively analyzed. The age of the patients ranged from 65 to 84 years (mean: 75.4 years). Locations of the tumor were the bulbar conjunctiva in three eyes, multiple palpebral conjunctivas in one eye, and palpebral conjunctiva and caruncle in one eye. All patients received topical IFNα-2b eye drop treatment for 6-10 months. Follow-up periods after resection ranged from 18 to 78 months. Histologically, all excised conjunctival tumors were diagnosed with malignant melanoma, where the surgical margins were completely negative in one patient. No patients had suffered from severe adverse effects related to IFNα-2b. Four out of five patients consequently achieved complete remission. Since one eye in one case showed resistance to the local chemotherapy containing IFNα-2b eye drops and the subconjunctival injection of IFN-β, orbital exenteration was eventually required 12 months after local resection. Topical IFNα-2b eye drops may be safe and one of the useful adjunctive treatments following surgical resection for patients with conjunctival melanoma.

  1. Idiopathic intracranial hypertension in pediatric patients

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    Nada Jirásková


    Full Text Available Nada Jirásková, Pavel RozsívalDepartment of Ophthalmology, University Hospital, Hradec Králové, Czech RepublicPurpose: To evaluate retrospectively the features, treatment, and outcome of idiopathic intracranial hypertension (IIH in children.Methods: Nine patients, 15 years and younger, diagnosed with IIH. Inclusion criteria were papilledema, normal brain computer tomography or magnetic resonance imaging, cerebrospinal fluid pressure greater than 250 mm H2O, normal cerebrospinal fluid content, and a nonfocal neurologic examination except for sixth nerve palsy.Results: Of the nine patients, eight were girls. Five girls were overweight and one boy was obese. The most common presenting symptom was headache (5 patients. Diplopia or strabismus did not occur in our group. Visual field abnormalities were present in all eyes, and severe visual loss resulting in light perception vision occurred in both eyes of one patient. Eight patients were treated medically with acetazolamide alone, and one girl needed a combination of acetazolamide and corticosteroids. This girl also required optic nerve sheath decompression surgery. Resolution of papilledema and recovery of visual function occurred in all patients.Conclusions: Idiopathic intracranial hypertension in prepubertal children is rather uncommon. Prompt diagnosis and management are important to prevent permanent visual loss.Keywords: idiopathic intracranial hypertension, pediatric, treatment

  2. Idiopathic short stature

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    Vlaški Jovan


    Full Text Available Growth is a complex process and the basic characteristic of child- hood growth monitoring provides insight into the physiological and pathological events in the body. Statistically, the short stature means departure from the values of height for age and sex (in a particular environment, which is below -2 standard deviation score, or less than -2 standard deviation, i.e. below the third percentile. Advances in molecular genetics have contributed to the improvement of diagnostics in endocrinology. Analysis of patients’ genotypes should not be performed before taking a classical history, detailed clinical examination and appropriate tests. In patients with idiopathic short stature specific causes are excluded, such as growth hormone deficiency, Turner syndrome, short stature due to low birth weight, intrauterine growth retardation, small for gestational age, dysmorphology syndromes and chronic childhood diseases. The exclusion of abovementioned conditions leaves a large number of children with short stature whose etiology includes patients with genetic short stature or familial short stature and those who are low in relation to genetic potential, and who could also have some unrecognized endocrine defect. Idiopathic short stature represents a short stature of unknown cause of heterogeneous etiology, and is characterized by a normal response of growth hormone during stimulation tests (>10 ng/ml or 20 mJ/l, without other disorders, of normal body mass and length at birth. In idiopathic short stature standard deviation score rates <-2.25 (-2 to -3 or <1.2 percentile. These are also criteria for the initiation of growth hormone therapy. In children with short stature there is also the presence of psychological and social suffering. Goals of treatment with growth hormone involve achieving normal height and normal growth rate during childhood.

  3. Idiopathic intracranial hypertension

    DEFF Research Database (Denmark)

    Yri, Hanne M; Jensen, Rigmor H


    AIMS: The aims of this article are to characterize the headache in idiopathic intracranial hypertension (IIH) and to field-test the ICHD diagnostic criteria for headache attributed to IIH. MATERIALS AND METHODS: We included 44 patients with new-onset IIH. Thirty-four patients with suspected but u...... tinnitus may suggest intracranial hypertension. Based on data from a well-defined IIH cohort, we propose a revision of the ICDH-3 beta diagnostic criteria with improved clinical applicability and increased sensitivity and specificity....


    Yettra, Maurice; Goldenberg, Erwin; Weiner, Herman


    Idiopathic pulmonary hemosiderosis is a rare condition manifested by recurrent pulmonary hemorrhage of unknown cause, diffuse radiologic abnormalities, cough, hemoptysis and moderate to severe hypochromic anemia. Diagnosis can be confirmed by iron stains of the sputum or lung aspiration or by biopsy. Prolonged spontaneous remission may occur without the use of corticosteroid therapy. Studies here reported indicated that the anemia is hypochromic and microcytic anemia of blood loss and iron deficiency, in spite of the presence of large amounts of iron in the pulmonary tissue. Correction of the anemia by intensive iron therapy and transfusion is considered an important part of therapy. ImagesFigure 1.Figure 2.Figure 3. PMID:13787318

  5. Intracranial arachnoid cysts treated surgically

    International Nuclear Information System (INIS)

    Okamoto, Junji; Matsumoto, Keizo


    Craniotomy and an examination of the maximal extent of extirpation of the cystic membrane were performed under an operative microscope in a series of 30 consecutive cases of intracranial arachnoid cysts. From these clinical features and a histological examination of the membrane, the etiologies of the arachnoid cysts may be divided into three fundamental categories: arachnoid cysts due to local brain atrophy or malformation (Category I), arachnoid cysts due to a malformation of the local arachnoid membrane itself (Category II), and arachnoid cysts due to acquired etiology (Category III). The postoperative reduction rates were investigated by means of a serial CT examination over a follow-up period of from 1 month to 6.5 years (average 2 years) in 27 cases. The postoperative reduction rates of 5 cases were less than 20% (Group A), 15 cases had rates from 30 to 80% (Group B), and 7 cases had rates of more than 90% (Group C). Cases of females, large cysts, round-shaped cysts, and cases with positive mass signs and poorly communicating cysts are revealed by metrizamide CT examination seemed to have a tendency for cystic cavity to be reduced well, judging from the postoperative analysis of the clinical findings. Furthermore, from the standpoint of our hypothesis concerning the etiology of the arachnoid cysts, Group A fit in almost all cases in Category I, though a few cases of Group A who had severe secondary local brain damage were in Category II. Group C fit in Category III in almost all cases, though a few cases of Group C who had minimal local brain damage were in Category II. Cases of Group B were considered to show some changes in the local cerebrum of various degrees in the cases of Categories II and III. (J.P.N.)

  6. Empiric medical therapy with hormonal agents for idiopathic male infertility

    Directory of Open Access Journals (Sweden)

    Nicholas N Tadros


    Conclusion: Gonadotropins, SERMs, and aromatase inhibitors may improve semen parameters and hormone levels in men with idiopathic infertility with the best results from SERMs. Testosterone should never be used to treat infertility. Large multicenter randomized controlled studies are needed to better determine the success of empiric use of hormonal therapy on pregnancy rates.

  7. Steroid Use in Idiopathic Sudden Sensorineural Hearing Loss: What ...

    African Journals Online (AJOL)

    Idiopathic sudden sensorineural hearing loss is a disease of unknown etiology. Controversy in the literature argues whether the condition should be treated by steroid therapy. In this case study, a Medline literature search was completed to find out if there is any evidence to support its use in this condition.

  8. Exploratory study of long-term health-related quality of life in patients with surgically treated primary parotid gland cancer. (United States)

    Stenner, Markus; Beenen, Franziska; Hahn, Moritz; Koopmann, Mario; Weiss, Daniel; Hüttenbrink, Karl-Bernd


    Health-related quality of life (HRQOL) has received more and more attention as an outcome in cancer therapy. In this exploratory study, we assessed the long-term HRQOL among 77 surgically treated patients with parotid gland cancer. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30-questions (EORTC-QLQ-C30) and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 Head and Neck 35-questions (EORTC-QLQ-C30-H&N35) questionnaires were used in a cross-sectional design. The mean time-lag between initial diagnosis and completion of the questionnaire was 89.7 months. The HRQOL significantly increased with the time-lag to surgery and decreased with the patients' age. Factors with clinically significant effects in several areas of long-term HRQOL (ie, more than 4 scores) were age, type of neck dissection, preoperative facial nerve palsy, and postoperative radiation therapy. In parotid gland cancer surgery, factors, such as sex, age, type of surgery, facial nerve palsy, and radiation therapy, seem to be associated with clinically meaningful differences in long-term HRQOL scores. © 2015 Wiley Periodicals, Inc.

  9. Adolescent patient with bilateral crossbite treated with surgically assisted rapid maxillary expansion: a case report evaluated by the 3d laser scanner, and using FESA method. (United States)

    Ivanov, Ch I; Velemínská, J; Dostálová, T; Foltán, R


    Our purpose in this case report is to present an orthodontic treatment obtained and the results achieved in 17-year-old white female patient with Angle Class II malocclusion and bilateral posterior crossbite. Patient was treated with bonded acrylic Hyrax appliance and surgically assisted rapid maxillary expansion (SARME). The multiloop system 0.16 TMA (ß titanium) arch wire was used in the alignment phase and on purpose to prohibit bite opening and optimize threedimensional movement control. After treatment bonded lingual retainers were placed in between maxillary central incisors and in mandible canine-to-canine. A functional removable Klammt appliance was used for retention. The 3D Laser Scanner Roland LPX-250 was used in order to obtain digital dental casts. Evaluation of the treatment results was measured on these models and using finite element scaling analysis (FESA). An Angle Class I relationship was obtained after 2½ years of treatment, function and facial aesthetics were improved. The shape of the palate changed significant in the width direction, not significantly in length and high direction. The greatest expansion of palate was found in the region between the palatal cusps of the first molars 26.6%, followed by first 21.9% and second premolars 16.5%. SARME in adult patients with bilateral cross bite and maxillary deficiency lead to satisfactory results. The 3D laser scanned models and their measurements, using advanced software's are successfully used for precise studies.

  10. Perinatal outcomes of idiopathic polyhydramnios (United States)

    Taskin, Salih; Kanmaz, Ahkam Göksel; Kahraman, Korhan; Kurtay, Gülay


    Objective To investigate the perinatal outcomes of cases with idiopathic polyhydramnios. Study Design Retrospective analysis of 160 singleton pregnancies that were under routine surveillance at the department of obstetrics from 2008 to 2010 was performed to assess perinatal outcomes. Finally, 59 cases were included as idiopathic polyhydramnios, and 101 cases were included as controls. Preterm delivery (4000 g), 1- and 5-min APGAR scores polyhydramnios group compared with the control group. Conclusion Although perinatal outcomes are conflicting in literature, idiopathic polyhydramnios warrants close surveillance especially near term. PMID:24265884

  11. Gamma knife radiosurgery for medically refractory idiopathic trigeminal neuralgia

    International Nuclear Information System (INIS)

    Kang, J.H.; Yoon, Y.S.; Kang, D.W.; Chung, S.S.; Chang, J.W.


    Gamma knife radiosurgery (GKS) has been generally considered as a viable therapeutic option for the management of medically refractory idiopathic trigeminal neuralgia (TN). We reviewed our experience with GKS in patients with TN. Between Feb 1996 and May 2006. 77 patients with medical refractory idiopathic TN were treated using GKS. Thirty-six patients who had undergone other previous procedures, previous GKS, or had brain stem lesion, atypical symptoms, were excluded from this study. Pain improvement was achieved in 38 of the patients with TN (pain response rate 92.7 %). Twenty-three patients were pain free and 15 had reduced pain. There were no serious complications. We think that GKS is an effective treatment option for patients with medical refractory idiopathic TN. (author)

  12. A new concept for the non-invasive treatment of Adolescent Idiopathic Scoliosis: the Corrective Movement principle integrated in the SpineCor System. (United States)

    Coillard, Christine; Circo, Alin; Rivard, Charles H


    To evaluate the change in spinal curvature and posture of Idiopathic Scoliosis patients when a curve specific 'Corrective Movement Principle' (CMP) is applied. This prospective interventional study was carried out on a group of 639 patients (92.3% females) having idiopathic scoliosis treated with the SpineCor brace. All girls were premenarchal or less than 1 year postmenarchal. Assessment of brace effectiveness followed the SRS outcome criteria for bracing. The clinical, radiological and postural evaluations assisted to define the patient classification, which guided the unique application of the CMP to each type of curvature. A total of 583 patients met the outcome criteria. Overall, 349 patients have a definitive outcome. Successful treatment was achieved in 259 (74.2%) of the 349 patients from the fitting to the weaning of the brace. Some 51 immature patients (14.6%) required surgical fusion while receiving treatment. Eight mature patients out of 298 (2.7%) required surgery within 2 years of follow-up beyond skeletal maturity. The SpineCor brace is effective for the treatment of adolescent idiopathic scoliosis. Moreover, positive outcomes are maintained after 2 years because 151 (93.2%) of 162 patients stabilized or corrected their end of bracing Cobb angle up to 2 years after bracing.

  13. Idiopathic diaphragmatic paralysis: Bell's palsy of the diaphragm? (United States)

    Crausman, Robert S; Summerhill, Eleanor M; McCool, F Dennis


    Idiopathic diaphragm paralysis is probably more common and responsible for more morbidity than generally appreciated. Bell's palsy, or idiopathic paralysis of the seventh cranial nerve, may be seen as an analogous condition. The roles of zoster sine herpete and herpes simplex have increasingly been recognized in Bell's palsy, and there are some data to suggest that antiviral therapy is a useful adjunct to steroid therapy. Thus, we postulated that antiviral therapy might have a positive impact on the course of acute idiopathic diaphragm paralysis which is likely related to viral infection. Three consecutive patients with subacute onset of symptomatic idiopathic hemidiaphragm paralysis were empirically treated with valacyclovir, 1,000 mg twice daily for 1 week. Prior to therapy, diaphragmatic function was assessed via pulmonary function testing and two-dimensional B-mode ultrasound, with testing repeated 1 month later. Diaphragmatic function pre- and post-treatment was compared to that of a historical control group of 16 untreated patients. All three subjects demonstrated ultrasound recovery of diaphragm function 4-6 weeks following treatment with valacyclovir. This recovery was accompanied by improvements in maximum inspiratory pressure (PI(max)) and vital capacity (VC). In contrast, in the untreated cohort, diaphragm recovery occurred in only 11 subjects, taking an average of 14.9 +/- 6.1 months (mean +/- SD). The results of this small, preliminary study suggest that antiviral therapy with valacyclovir may be helpful in the treatment of idiopathic diaphragm paralysis induced by a viral infection.

  14. Avaliação da qualidade de vida em pacientes com escoliose idiopática do adolescente após tratamento cirúrgico pelo questionário SF-36 Evaluación de la calidad de vida en pacientes con escoliosis idiopática del adolescente después del tratamiento quirúrgico por el cuestionario SF-36 Health-related quality of life in patients with adolescent idiopathic scoliosis after surgical treatment by SF-36

    Directory of Open Access Journals (Sweden)

    Luciano Temporal Borges Cabral


    rio Covas, en Santo André. Todos los pacientes fueron sometidos al tratamiento quirúrgico por vía posterior y artrodesis con instrumentación de tercera generación. Estos pacientes poseían descompensación del tronco y medida del ángulo de Cobb mayor que 50º constituyéndose en indicación quirúrgica. Todos los pacientes fueron sometidos al cuestionario SF-36 preoperatorio y repetidos con un mes, seis meses, un y dos años después del tratamiento quirúrgico. Usamos el programa SPSS (Statistical Package for Social Sciences, versión 13.0, para análisis estadístico de los casos. RESULTADOS: hubo diferencia estadística significativa en cuatro dominios del SF-36: capacidad funcional, dolor, aspecto social y limitaciones por aspectos físicos. En los dominios de salud mental, limitación pos aspectos emocionales, vitalidad y estado general de salud no hubo alguna diferencia estadística entre los momentos observados. CONCLUSIÓN: en este estudio los pacientes con escoliosis idiopática del adolescente, sometidos al tratamiento quirúrgico para corrección de la deformidad, obtuvieron una mejoría en la calidad de vida en aspectos físicos evaluados por medio del cuestionario SF-36.OBJECTIVE: to assess health-related quality of life in patients with adolescent idiopathic scoliosis by SF-36 after surgical treatment, in comparison with questionnaires done before operation. METHODS: between February 2004 and March 2006, 28 patients with adolescent idiopathic scoliosis surgically treated by the spine group of Hospital Mário Covas, in Santo André, were assessed. All the patients were treated surgically by posterior approach and fusion with third generation instrumental. These patients had trunk rotation and Cobb angle more than 50º to have surgical indication. All patients were submitted to SF-36 before and after one month, six months, one year and two years after surgery. The SPSS (Statistical Package for Social Sciences, version 13.0 for statistical analysis was used

  15. ADHD in idiopathic epilepsy

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    Marcos H. C. Duran


    Full Text Available Our aim was to clarify the correlation of attention deficit hyperactivity disorder (ADHD with epilepsy and behavior problems. This was a cross-sectional study. Sixty children with idiopathic epilepsy were interviewed using the MTA-SNAP IV Teacher and Parent Rating Scale, Vineland Adaptive Behavior Scales and Conners’ Rating Scales. We used the chi-square test to analyze the correlation of epilepsy variables in patients with and without ADHD with a significance level of 0.05. Eight patients had ADHD symptoms (13%, seven had the inattentive ADHD subtype and only three had behavioral problems. When epileptic patients with and without ADHD symptoms were compared we found no significant difference in regard to epilepsy variables. All patients were controlled and 43% were either without AED or undergoing withdrawal. Our study revealed a low comorbidity of ADHD symptoms and epilepsy due to low interference of seizures and drug treatment on the comorbid condition.

  16. Idiopathic thrombocytopenic purpura

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    L Kayal


    Full Text Available Idiopathic thrombocytopenic purpura (ITP is defined as a hematologic disorder, characterized by isolated thrombocytopenia without a clinically apparent cause. The major causes of accelerated platelet consumption include immune thrombocytopenia, decreased bone marrow production, and increased splenic sequestration. The clinical presentation may be acute with severe bleeding, or insidious with slow development with mild or no symptoms. The initial laboratory tests useful at the first visit to predict future diagnosis were erythrocyte count, leukocyte count, anti-glycoprotein IIb/IIIa antibodies, reticulated platelets, plasma thrombopoietin level. Treatment should be restricted to those patients with moderate or severe thrombocytopenia who are bleeding or at risk of bleeding. We present a case report on ITP with clinical presentation, diagnosis and management.

  17. Idiopathic Bilateral Bloody Tearing

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    Emrullah Beyazyıldız


    Full Text Available Bloody tear is a rare and distinct clinic phenomenon. We report a case presenting with the complaint of recurrent episodes of bilateral bloody tearing. A 16-year-old girl presented to our clinic with complaint of bloody tearing in both eyes for 3 months. Bloody tearing was not associated with her menses. A blood-stained discharge from the punctum was not observed during the compression of both nasolacrimal ducts. Nasolacrimal passage was not obstructed. Imaging studies such as dacryocystography and gradient-echo magnetic resonance imaging (MRI of nasolacrimal canal were normal. Intranasal endoscopic evaluation was normal. We collected samples from bloody tears two times and pathological examination was performed. Pathological analysis showed lots of squamous cells and no endometrial cells; dysplastic cells were found. Further evaluations for underlying causes were unremarkable. No abnormalities were found in ophthalmologic, radiologic, and pathologic investigations. This condition is likely a rare abnormality and the least recognized aetiology for the idiopathic phenomenon.

  18. Idiopathic Normal Pressure Hydrocephalus

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    Basant R. Nassar BS


    Full Text Available Idiopathic normal pressure hydrocephalus (iNPH is a potentially reversible neurodegenerative disease commonly characterized by a triad of dementia, gait, and urinary disturbance. Advancements in diagnosis and treatment have aided in properly identifying and improving symptoms in patients. However, a large proportion of iNPH patients remain either undiagnosed or misdiagnosed. Using PubMed search engine of keywords “normal pressure hydrocephalus,” “diagnosis,” “shunt treatment,” “biomarkers,” “gait disturbances,” “cognitive function,” “neuropsychology,” “imaging,” and “pathogenesis,” articles were obtained for this review. The majority of the articles were retrieved from the past 10 years. The purpose of this review article is to aid general practitioners in further understanding current findings on the pathogenesis, diagnosis, and treatment of iNPH.

  19. Profile of patients with hepatic hydatid disease not treated surgically Perfil del paciente con hidatidosis hepática al que no se realiza tratamiento quirúrgico

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    José Manuel Ramia


    Full Text Available Background: hepatic hydatid disease (HHD is still an important health problem in certain areas of Spain where it is endemic. The treatment of HHD is usually surgical but certain patients are found to be ineligible after assessment for surgery (asymptomatic disease, comorbidity, patient refusal, or other. Material and methods: description of patients assessed in the Department of Surgery for hepatic hydatid disease. Results: in a group of 70 patients with HHD, 27 patients were not treated surgically (mean age: 72.7 years [range: 47-97], 14 women [51.8%]. The number of cysts presented by these patients was 33, with 1.22 cyst/patient (range: 1-4. The cyst size was 5.5 cm (range: 2.1-12.5 cm. The cysts, according to the WHO classification, were CE1: 3 patients, CE3B: 5 patients, CE4: 10 patients and CE5: 9 patients. The form of presentation was: symptomatic in 9 patients, although only 6 were attributable to HHD (22% and asymptomatic in 18 patients. In these cases, imaging was performed for study of tumor extension in 6 patients and diverse medical reasons in 12. Only two therapeutic interventions were performed: endoscopic retrograde cholangiopancreatography (ERCP with insertion of a bile duct stent, and puncture-aspiration-injection-re-aspiration (PAIR, both in patients who did not wish to undergo surgery. Ten patients had surgical indications: CE1 (3 patients, CE3B (5 patients, CE4 (1 patient, and CE5 (1 patient. The reasons why the patients did not undergo surgical treatment were: refusal (9 patients and advanced neoplasm (1 patient. Surgery was judged necessary in 5 patients. In the mean follow-up period of 17 months (range: 1-37, no surgery was performed. Conclusions: there were various causes for not performing surgical intervention of HHD after medical evaluation: asymptomatic patients, older patients, patients with multiple pathologies and oncologic patients. Usually, they were patients who voluntarily chose not to undergo surgery

  20. CASE REPORT Idiopathic granulomatous mastitis

    African Journals Online (AJOL)

    areolar breast mass which was tender to palpation. The overlying skin was thickened and slightly warm. There was no associated nipple discharge or skin sinus. Idiopathic granulomatous mastitis. Fig. 1. Right cranio-caudal mammogram. Fig. 2.

  1. Idiopathic Intracranial Hypertension (Pseudotumor Cerebri) (United States)

    ... post pubescent teenagers, tends to fit the adult stereotype. How is pediatric idiopathic intracranial hypertension diagnosed? If ... Subscribe to AOJ Allied Health Resources for School Nurses About AAPOS Our Association Staff Contacts Medical Disclaimer ...

  2. A Retrospective Study of 39 Patients Treated With Anterior Approach of Thoracic and Lumbar Spondylodiscitis: Clinical Manifestations, Anterior Surgical Treatment, and Outcome. (United States)

    Yaldz, Can; Özdemir, Nail; Yaman, Onur; Feran, Hamit Günes; Tansug, Tugrul; Minoglu, Mustafa


    The aim of this study is to report our 39 patients treated with anterior debridement and autologous iliac bone grafting with or without anterior instrumentation, which is the presumed treatment of choice for thoracic or lumbar spondylodiscitis.Our patients underwent surgical treatment of spondylodiscitis using anterior debridement and autologous iliac bone grafting with or without anterior instrumentation and were analyzed with a mean follow-up of 8 years (range, 2-11 years). Kaneda 2-rod system instrumentation was used in 12 patients, in total. Clinical outcomes were assessed by the Frankel grade. Radiographic fusion was characterized based on 3-dimensional computed tomography.Of the whole group, 20 patients suffered from tuberculous spondylodiscitis and 19 suffered from hematogenous spondylodiscitis. Pathogens responsible for pyogenic infection included Staphylococcus aureus (4 patients), Pseudomonas aeruginosa (3 patients), and Brucella melitensis (1 patient). Fifteen patients had thoracic involvement, 20 had lumbar involvement, and 4 had thoracolumbar junction involvement. Preoperative neurological deficits were noted in 13 of the 39 patients. In terms of Frankel grade, 8 patients have improved, 4 have remained the same, and 1 patient has worsened during the follow-up period. Imaging-documented fusion was achieved in 23 of 27 patients in the graft group (85% fusion rate) and 11 of 12 patients in the graft + Kaneda instrumentation group (91% fusion rate).There was no instrumentation failure, loosening, or graft-related complication such as slippage or fracture of the graft. This approach demonstrated a good recovery rate of neurological functions and a high fusion rate.

  3. Delayed wound healing and postoperative surgical site infections in patients with rheumatoid arthritis treated with or without biological disease-modifying antirheumatic drugs. (United States)

    Tada, Masahiro; Inui, Kentaro; Sugioka, Yuko; Mamoto, Kenji; Okano, Tadashi; Kinoshita, Takuya; Hidaka, Noriaki; Koike, Tatsuya


    Biological disease-modifying antirheumatic drugs (bDMARDs) have become more popular for treating rheumatoid arthritis (RA). Whether or not bDMARDs increase the postoperative risk of surgical site infection (SSI) has remained controversial. We aimed to clarify the effects of bDMARDs on the outcomes of elective orthopedic surgery. We used multivariate logistic regression analysis to analyze risk factors for SSI and delayed wound healing among 227 patients with RA (mean age, 65.0 years; disease duration, 16.9 years) after 332 elective orthopedic surgeries. We also attempted to evaluate the effects of individual medications on infection. Rates of bDMARD and conventional synthetic DMARD (csDMARD) administration were 30.4 and 91.0 %, respectively. Risk factors for SSI were advanced age (odds ratio [OR], 1.11; P = 0.045), prolonged surgery (OR, 1.02; P = 0.03), and preoperative white blood cell count >10,000/μL (OR, 3.66; P = 0.003). Those for delayed wound healing were advanced age (OR, 1.16; P = 0.001), prolonged surgery (OR, 1.02; P = 0.007), preoperative white blood cell count >10,000/μL (OR, 4.56; P = 0.02), and foot surgery (OR, 6.60; P = 0.001). Risk factors for SSI and medications did not significantly differ. No DMARDs were risk factors for any outcome examined. Biological DMARDs were not risk factors for postoperative SSI. Foot surgery was a risk factor for delayed wound healing.

  4. Spleen hydatidosis treated by hemi-splenectomy: A low-morbidity, cost-effective management by a recently improved surgical technique. (United States)

    Costi, Renato; Castro Ruiz, Carolina; Zarzavadjian le Bian, Alban; Scerrati, Daniele; Santi, Caterina; Violi, Vincenzo


    Splenic hydatidosis is a rare condition and is usually managed by total splenectomy, which is associated to various complications, including overwhelming post-splenectomy sepsis and thrombosis. Probably due to supposed technical difficulties, the partial splenectomy is rarely performed being often unknown to physicians, infectious disease specialists and surgeons. Demographic, clinical and surgical data were collected of four consecutive patients undergoing partial (or hemi-) splenectomy using an original, recently improved technique as a treatment for polar splenic hydatid cyst. The procedure implies a selective vascular ligation, a mechanical stapler-assisted section and haemostatic agents (Surgicel(®)) application on the cutting surface. Three patients were treated by laparotomy (including one affected by both liver and spleen localizations) whereas the last one was approached laparoscopically. Partial splenectomy operative time reached 74 min (range: 60-94 min) and blood loss was 8 ml (range: 5-10 ml). Hospital stay was 5.6 days (range: 5-7 days). At a mean follow-up of 20 months (range: 12-36 months), outcomes were uneventful. Partial splenectomy for hydatidosis is effective and safe. Physicians and surgeons should be aware of such an easy-to-catch option when dealing with benign splenic conditions, such as parasitic cysts. Cost-effectiveness, low morbidity and the possible prevention of splenectomy-related infectious complications should plead in favor of this technique in developing countries, where hydatidosis is endemic and post-splenectomy drugs and vaccines may be lacking. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  5. A rapid and systematic review of the clinical effectiveness and cost-effectiveness of debriding agents in treating surgical wounds healing by secondary intention

    NARCIS (Netherlands)

    Lewis, R.; Whiting, P.; ter Riet, G.; O'Meara, S.; Glanville, J.


    BACKGROUND: Most surgically sutured wounds heal without any complication. However, in some cases wound healing can be delayed due to the presence of infection or wound breakdown. This can result in the wounds becoming cavity wounds and thus necessitate healing by secondary intention. Other surgical

  6. Dysphagia due to Diffuse Idiopathic Skeletal Hyperostosis

    Directory of Open Access Journals (Sweden)

    Masafumi Ohki


    Full Text Available Diffuse idiopathic skeletal hyperostosis (DISH is usually asymptomatic. However, rarely, it causes dysphagia, hoarseness, dyspnea, snoring, stridor, and laryngeal edema. Herein, we present a patient with DISH causing dysphagia. A 70-year-old man presented with a 4-month history of sore throat, dysphagia, and foreign body sensation. Flexible laryngoscopy revealed a leftward-protruding posterior wall in the hypopharynx. Computed tomography and magnetic resonance imaging revealed a bony mass pushing, anteriorly, on the posterior hypopharyngeal wall. Ossification included an osseous bridge involving 5 contiguous vertebral bodies. Dysphagia due to DISH was diagnosed. His symptoms were relieved by conservative therapy using anti-inflammatory drugs. However, if conservative therapy fails and symptoms are severe, surgical treatments must be considered.

  7. Imaging findings in idiopathic pelvic fibrosis

    Energy Technology Data Exchange (ETDEWEB)

    Wiesner, W.; Bongartz, G. [Inst. of Diagnostic Radiology University Hospital Basel (Switzerland); Stoffel, F. [Inst. of Urology, University Hospital Basel (Switzerland)


    Two patients presented with ureteric obstruction, and voiding symptoms and constipation, respectively, and were examined by means of intravenous urography and computed tomography. One patient was additionally examined by means of MR tomography. After CT (performed in both patients) and MRT (performed in one patient) had shown a diffuse, contrast-enhancing, infiltrating process in the small pelvis with infiltration of adjacent organs and vessels, surgical biopsy proved the diagnosis of idopathic pelvic fibrosis. Extension of retroperitoneal fibrosis below the pelvic rim is very rare. Clinical symptoms of pelvic fibrosis are variable and imaging findings may lead to a broad list of differential diagnoses. We present two patients with idiopathic pelvic fibrosis and discuss radiological findings and differential diagnoses of this rare disease. (orig.)

  8. Radiotherapy May Offer a Recurrence and Survival Benefit in Rectal Cancers Treated Surgically with Transanal Endoscopic Microsurgery: A Systematic Review and Meta-analysis. (United States)

    Sideris, Michail; Donaldson, Ana Nora; Hanrahan, John; Grunwald, Matthew; Papagrigoriadis, Savvas


    Several studies report outcomes of Transanal Endoscopic Microsurgery (TEMS) surgery in combination with radiotherapy, however the combination of those treatments is provided mostly on an adhoc individual basis and the role of radiotherapy remains unclear. The aim of this study was to identify the effect of neo-adjuvant or adjuvant radiotherapy in the oncological outcomes of rectal cancer treated surgically with TEMS. We performed a systematic review of the literature on MEDLINE and Pubmed databases. Data were extracted by two independent reviewers and meta-analyzed using an inverse variance heterogeneity model to calculate overall (pooled) effect sizes for survival or recurrence of disease against neo+/-adjuvant treatment. A total of 48 studies were included in the qualitative meta-analysis which included 3,285 patients with rectal cancer. The overall survival odds ratio (OR), was 9.39 (95% CI=6.1-14.4) with a Cochran's Q variable of 151.7 on 47 degrees of freedom (d.f.) (p=0.000). Recurrence-free OR was 8.7 (95%CI=6.58-11.44) with a Cochran's Q variable of Q=145.2 on 44 d.f. (p=0.000). Studies which contained more than 10% of pT3 tumours, and provided neo+/-adjuvant treatment in more than 35% of cases, were associated with survival benefit, as demonstrated by an overall odds of survival of 32.2 (95%CI=16.3-63.5, p=0.001, Q=8.4, p=0.21). Studies that contained more than 10% of pT3 tumours and provided neo+/-adjuvant treatment in more than 20% of the cases had an overall effect size of recurrence-free odds of 20.23 (95%CI=13.84-29.57, p=0.000, Q=2.18, p=0.54). There seems to be a benefit from radiotherapy on overall survival and recurrence-free odds, which is more apparent in cohorts with more than 10% of pT3 tumours. Our results suggest that neo-adjuvant or adjuvant radiotherapy should be considered for inclusion in formal treatment protocols for rectal cancers treated with TEMS as they offer a recurrence and survival benefit. Copyright© 2018, International

  9. Idiopathic pulmonary fibrosis: treatment update.

    LENUS (Irish Health Repository)

    O'Connell, Oisin J


    Idiopathic pulmonary fibrosis (IPF) is the most common of the idiopathic interstitial pneumonias. Despite multiple recent clinical trials, there is no strong evidence supporting a survival advantage for any agent in the management of patients with IPF. The limited effectiveness of current treatment regimes has led to a search for novel therapies including antifibrotic strategies. This article reviews the evidence supporting the treatments currently used in the management of IPF.

  10. Can We Predict the Surgical Margin Positivity in Patients Treated with Radical Prostatectomy? A Multicenter Cohort of Turkish Association of Uro-Oncology

    Directory of Open Access Journals (Sweden)

    Deniz Bolat


    Full Text Available Objective To analyze the parameters that predict the surgical margin positivity after radical prostatectomy for localized prostate cancer. Materials and Methods In this multicenter study, the data of 1607 consecutive patients undergoing radical prostatectomy for localized prostate cancer in 12 different clinics in Turkey between 1993-2011 were assessed. Patients who had neoadjuvant treatment were excluded. We assessed the relationship between potential predictive factors and surgical margin status after radical prostatectomy such as age, cancer characteristics, history of transurethral prostate resection, surgical experience and nerve-sparing technique by using univariate and multivariate Cox regression analyses and t test. Results The overall surgical margin positivity rate was 22.6% (359 patients. In univariate analyses, preoperative prostate specific antigen level, clinical stage, biopsy Gleason score, percentage of tumor involvement per biopsy specimen, transurethral prostate resection history, surgical experience and nerve-sparing technique were significantly associated with positive surgical margin rate. In multivariate analyses, preoperative prostate specific antigen level (OR: 1.03, p=0.06, percentage of tumor involvement per biopsy specimen (OR: 7,14, p<0,001, surgical experience (OR: 2.35, p=0.011 and unilateral nerve-sparing technique (OR: 1.81, p=0.018 were independent predictive factors for surgical margin positivity. Conclusion Preoperative prostate specific antigen level, percentage of tumor involvement per biopsy specimen, surgical experience and nerve-sparing technique are the most important predictive factors of surgical margin positivity in patients undergoing radical prostatectomy for localized prostate cancer.

  11. Abortion - surgical (United States)

    Suction curettage; Surgical abortion; Elective abortion - surgical; Therapeutic abortion - surgical ... Surgical abortion involves dilating the opening to the uterus (cervix) and placing a small suction tube into the uterus. ...

  12. Idiopathic Syringomyelia in a Military Helicopter Pilot. (United States)

    Schiemer, Anthony


    A syrinx is a fluid-filled cavity within the spinal cord. They can lead to a variety of symptoms, including limb weakness and back pain. Incidental finding of syringomyelia provides a challenge for clinicians due to the wide variety of possible symptoms. In military aviation, neurological findings in pilots can result in extensive investigation that can lead to potentially invasive management. Conversely, the potential for chronic progression of a spinal syrinx and subsequent neurological deterioration makes early identification critical. Ultimately, the discovery of a lesion may have implications for flying status and operational capability. A 25-yr-old man working as a navy Seahawk helicopter pilot presented with episodes of right arm paraesthesia and pain between the scapulae. On at least one occasion, these symptoms woke him at night. Upon magnetic resonance imaging, dilatation of the central canal in a syrinx-like pattern in the lower cervical region was noted. Neurology review suggested the finding was persistent and unlikely to be responsible for his symptoms. No surgical input was recommended. His symptoms were attributed to mild cervical spondylosis, which resolved with ongoing physiotherapy, and he was returned to flying status. This case highlights several issues involved with the incidental finding of a syringomyelia. Surgical intervention has been known to worsen symptoms. Conversely, studies have identified minimal radiological progression in cases of idiopathic syringomyelia, with fewer individuals displaying neurological deterioration. For aircrew, potentially unnecessary neurosurgical intervention poses risks to a flying career and overall operational capability.Schiemer A. Idiopathic syringomyelia in a military helicopter pilot. Aerosp Med Hum Perform. 2017; 88(10):962-965.

  13. Complications and long-term results after partial laryngectomy for the treatment of idiopathic laryngeal paralysis in 45 dogs. (United States)

    Ross, J T; Matthiesen, D T; Noone, K E; Scavelli, T A


    Forty-five dogs with severe respiratory signs caused by idiopathic, acquired laryngeal paralysis were treated by partial laryngectomy. The predominant postoperative complications were coughing in 28 dogs and pneumonia in 15 dogs. Eight dogs required a second operation to alleviate persistent or recurrent upper airway obstruction. Results of surgery were considered excellent in 11 dogs (25%), good in 18 dogs (40%), fair in 6 dogs (13%), and poor in 10 dogs (22%). Poorer results were obtained by surgical residents than by more experienced surgeons. Death in the immediate postoperative period was related to pneumonia (8 dogs) and laryngeal collapse (1 dog). Nine dogs died later of respiratory disease. Although partial laryngectomy is effective for the treatment of laryngeal paralysis, it is not recommended because of the high incidence of postoperative complications.

  14. Is circumferential minimally invasive surgery effective in the treatment of moderate adult idiopathic scoliosis? (United States)

    Anand, Neel; Baron, Eli M; Khandehroo, Babak


    Outcomes for minimally invasive scoliosis correction surgery have been reported for mild adult scoliosis. Larger curves historically have been treated with open surgical procedures including facet resections or posterior column osteotomies, which have been associated with high-volume blood loss. Further, minimally invasive techniques have been largely reported in the setting of degenerative scoliosis. We describe the effects of circumferential minimally invasive surgery (cMIS) for moderate to severe scoliosis in terms of (1) operative time and blood loss, (2) overall health and disease-specific patient-reported outcomes, (3) deformity correction and fusion rate, and (4) frequency and types of complications. Between January 2007 and January 2012, we performed 50 cMIS adult idiopathic scoliosis corrections in patients with a Cobb angle of greater than 30° but less than 75° who did not have prior thoracolumbar fusion surgery; this series represented all patients we treated surgically during that time meeting those indications. Our general indications for this approach during that period were increasing back pain unresponsive to nonoperative therapy with cosmetic and radiographic worsening of curves. Surgical times and estimated blood loss were recorded. Functional clinical outcomes including VAS pain score, Oswestry Disability Index (ODI), and SF-36 were recorded preoperatively and postoperatively. Patients' deformity correction was assessed on pre- and postoperative 36-inch (91-cm) standing films and fusion was assessed on CT scan. Minimum followup was 24 months (mean, 48 months; range, 24-77 months). Mean blood loss was 613 mL for one-stage surgery and 763 mL for two-stage surgery. Mean operative time was 351 minutes for one-stage surgery and 482 minutes for two-stage surgery. At last followup, mean VAS and ODI scores decreased from 5.7 and 44 preoperatively to 2.9 and 22 (p surgery in 10 more patients at last followup. cMIS provides for good clinical and

  15. Idiopathic pulmonary fibrosis

    Directory of Open Access Journals (Sweden)

    Noble Paul W


    Full Text Available Abstract Idiopathic pulmonary fibrosis (IPF is a non-neoplastic pulmonary disease that is characterized by the formation of scar tissue within the lungs in the absence of any known provocation. IPF is a rare disease which affects approximately 5 million persons worldwide. The prevalence is estimated to be slightly greater in men (20.2/100,000 than in women (13.2/100,000. The mean age at presentation is 66 years. IPF initially manifests with symptoms of exercise-induced breathless and dry coughing. Auscultation of the lungs reveals early inspiratory crackles, predominantly located in the lower posterior lung zones upon physical exam. Clubbing is found in approximately 50% of IPF patients. Cor pulmonale develops in association with end-stage disease. In that case, classic signs of right heart failure may be present. Etiology remains incompletely understood. Some environmental factors may be associated with IPF (cigarette smoking, exposure to silica and livestock. IPF is recognized on high-resolution computed tomography by peripheral, subpleural lower lobe reticular opacities in association with subpleural honeycomb changes. IPF is associated with a pathological lesion known as usual interstitial pneumonia (UIP. The UIP pattern consists of normal lung alternating with patches of dense fibrosis, taking the form of collagen sheets. The diagnosis of IPF requires correlation of the clinical setting with radiographic images and a lung biopsy. In the absence of lung biopsy, the diagnosis of IPF can be made by defined clinical criteria that were published in guidelines endorsed by several professional societies. Differential diagnosis includes other idiopathic interstitial pneumonia, connective tissue diseases (systemic sclerosis, polymyositis, rheumatoid arthritis, forme fruste of autoimmune disorders, chronic hypersensitivity pneumonitis and other environmental (sometimes occupational exposures. IPF is typically progressive and leads to significant

  16. Prevalence of the middle mesial canal in non surgical root canal treated mandibular first and second molars in a local military population (United States)


    dental denture. Implants are highly successful but a patient may still succumb to implant failure. Fixed partial denture preparations can cause an...Army Post Graduate Dental School Douglas D. Lancaster, COL, DC 3 August 2016 Prevalence of the middle mesial canal in non-surgical root canal...Methods: 7000 dental records were reviewed for non-surgical root canals performed from October 1970 to October 2015. The data collected included

  17. Long-term outcome and quality of life of patients treated in surgical intensive care: a comparison between sepsis and trauma


    Korošec Jagodič, Helena; Jagodič, Klemen; Podbregar, Matej


    Introduction Our aim was to determine long-term survival and quality of life of patients admitted to a surgical intensive care unit (ICU) because of sepsis or trauma. Methods This was an observational study conducted in an 11-bed, closed surgical ICU at a 860-bed teaching general hospital over a 1-year period (January 2003 to December 2003). Patients were divided into two groups according to admission diagnoses: group 1 included patients with sepsis; and group 2 included patients with trauma ...

  18. Outcome in adolescent idiopathic scoliosis after brace treatment and surgery assessed by means of the Scoliosis Research Society Instrument 24. (United States)

    Weigert, Karen Petra; Nygaard, Linda Marie; Christensen, Finn Bjarke; Hansen, Ebbe Stender; Bünger, Cody


    A retrospectively designed long-term follow-up study of adolescent idiopathic scoliosis (AIS) patients who had completed treatment, of at least 2 years, by means of brace, surgery, or both brace and surgery. This study is to assess the outcome after treatment for AIS by means of the Scoliosis Research Society Outcome Instrument 24 (SRS 24). One hundred and eighteen AIS patients (99 females and 19 males), treated at the Aarhus University Hospital from January 1, 1987 to December 31, 1997, were investigated with at least 2 years follow-up at the time of receiving a posted self-administered questionnaire. Forty-four patients were treated with Boston brace (B) only, 41 patients had surgery (S), and 33 patients were treated both with brace and surgery (BS). The Cobb angles of the three treatment groups did not differ significantly after completed treatment. The outcome in terms of the total SRS 24 score was not significantly different among the three groups. B patients had a significantly better general (not treatment related) self-image and higher general activity level than the total group of surgically treated patients, while surgically treated patients scored significantly better in post-treatment self-image and satisfaction. Comparing B with BS we found a significantly higher general activity level in B patients, while the BS group had significantly higher satisfaction. There were no significant differences between BS and S patients in any of the domain scores. All treatment groups scored "fair or better" in all domain scores of the SRS 24 questionnaire, except in post-treatment function, where all groups scored worse than "fair". Improvement of appearance by means of surgical correction increases mean scores for post-treatment self-image and post-treatment satisfaction. Double-treatment by brace and surgery does not appear to jeopardize a good final outcome.

  19. Complications of the surgical treatment early and tardy of supracondylar fractures of the humerus in children: a retrospective study of 111 patients treated at the Hospital Nacional de Ninos Carlos Saenz Herrera in the period January 2010 to January 2011

    International Nuclear Information System (INIS)

    Zuniga Blanco, Adrian


    Supracondylar fractures of the humerus up much of the emergency consultation of any pediatric orthopedic service, of them, Gartland III fractures are usually treated by closed reduction and percutaneous fixation with nails smooth. Often treatment has been delayed by factors such as the unavailability of an orthopedic specialist or local anesthesia or an operating room. At other times, the patient has come belatedly to consult. This retrospective study has analyzed whether a delay greater than 12 hours in the surgical treatment of supracondylar fractures of the humerus in children is associated with an increased risk of perioperative complications. Of 111 children who have been treated surgical in national children's hospital, underwent 59 surgeries before 12 hours from the trauma and 52 underwent surgery after 12 hours of trauma. The groups have developed without significant differences in terms of iatrogenic neurological injury, tract infection of the nails, vascular complications and compartment syndrome. Surgical time and hospital stay neither have had differences. In 2 cases of the tardy treatment group has been necessary to perform a opened reduction. As for the bad union, 9 cases (8%) have been of elbow varus radiological and clinical, of these 5 cases (4.5%) have occurred in the tardy treatment group and 4 cases (3,5) in the group early treatment. Findings of similar studies are confirmed in which the rate of perioperative complications is significantly unchanged if the surgical treatment is carried out before 12 hours or after 12 hours after the trauma. (author) [es

  20. Serum levels of renin, angiotensin-converting enzyme and angiotensin II in patients treated by surgical excision, propranolol and captopril for problematic proliferating infantile haemangioma. (United States)

    Sulzberger, L; Baillie, R; Itinteang, T; de Jong, S; Marsh, R; Leadbitter, P; Tan, S T


    The role of the renin-angiotensin system (RAS) in the biology of infantile haemangioma (IH) and its accelerated involution induced by β-blockers was first proposed in 2010. This led to the first clinical trial in 2012 using low-dose captopril, an angiotensin-converting enzyme (ACE) inhibitor, demonstrating a similar response in these tumours. This study aimed to compare serial serum levels of the components of the RAS in patients before and after surgical excision, propranolol or captopril treatment for problematic proliferating IH. Patients with problematic proliferating IH underwent measurements of serum levels of plasma renin activity (PRA), ACE and angiotensin II (ATII) before, and 1-2 and 6 months following surgical excision, propranolol or captopril treatment. This study included 27 patients undergoing surgical excision (n = 8), propranolol (n = 11) and captopril (n = 8) treatment. Treatment with either surgical excision or propranolol resulted in significant decrease in the mean levels of PRA. Surgical excision or captopril treatment led to significant decline in the mean levels of ATII. All three treatment modalities had no significant effect on the mean levels of ACE. This study demonstrates the effect of surgical excision, propranolol and captopril treatment in lowering the levels of PRA and ATII, but not ACE, supporting a mechanistic role for the RAS in the biology of IH. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  1. Surgical outcome of tuberculous meningitis hydrocephalus treated by endoscopic third ventriculostomy: prognostic factors and postoperative neuroimaging for functional assessment of ventriculostomy. (United States)

    Chugh, Ashish; Husain, Mazhar; Gupta, Rakesh K; Ojha, Bal K; Chandra, Anil; Rastogi, Manu


    Endoscopic third ventriculostomy (ETV) is increasingly being used as an alternative treatment for post-tuberculous meningitis (TBM) hydrocephalus. The aim of this study was to affirm the role of ETV in patients with TBM hydrocephalus and also to study the usefulness of cine phase-contrast MR imaging (cine MR imaging) for functional assessment of the ETV stoma. An additional goal was to identify factors that influence the outcome of ETV, so as to define patients with TBM hydrocephalus in whom ETV is warranted. Twenty-six patients with TBM hydrocephalus treated with ETV were evaluated clinically and with cine MR imaging postoperatively. The duration of follow-up ranged from 1 to 15 months. The authors evaluated flow void changes in the floor of the third ventricle and analyzed parameters from the preoperative data, which they then used as a basis for comparison between endoscopically successful and endoscopically unsuccessful cases. The overall success rate of ETV in TBM hydrocephalus was 73.1% in this case series. Cine MR imaging showed a sensitivity of 94.73% and specificity of 71.42% for the functional assessment of third ventriculostomy in these patients, with the efficacy being maintained during follow-up. The outcome of ETV showed a statistically significant correlation with the stage of illness and presence of intraoperative cisternal exudates. Although duration of symptoms and duration of preoperative antituberculous therapy (ATT) appeared to influence the outcome, their correlation with outcome was not statistically significant. Endoscopic third ventriculostomy should be considered as the first surgical option for CSF diversion (that is, before shunt surgery) in patients with TBM hydrocephalus. Cine MR imaging is a highly effective noninvasive tool for the postoperative functional assessment of stomata. Patients who presented with a history of longer duration and those who were administered preoperative ATT for a longer period had a better outcome of

  2. Two-year post-discharge costs of care among patients treated with transcatheter or surgical aortic valve replacement in Germany. (United States)

    Kaier, Klaus; von Kampen, Frederike; Baumbach, Hardy; von Zur Mühlen, Constantin; Hehn, Philip; Vach, Werner; Zehender, Manfred; Bode, Christoph; Reinöhl, Jochen


    This study presents data on post-discharge costs of care among patients treated with transcatheter or surgical aortic valve replacement over a two year period. Based on a prospective clinical trial, post-discharge utilization of health services and status of assistance were collected for 151 elderly patients via 2250 monthly telephone interviews, valued using standardized unit costs and analysed using two-part regression models. At month 1 post-discharge, total costs of care are substantially elevated (monthly mean: €3506.7) and then remain relatively stable over the following 23 months (monthly mean: €622.3). As expected, the majority of these costs are related to in-hospital care (~98% in month 1 post-discharge and ~72% in months 2-24). Patients that died during follow-up were associated with substantially higher cost estimates of in-hospital care than those surviving the two-year study period, while patients' age and other patient characteristics were of minor relevance. Estimated costs of outpatient care are lower at month 1 than during the rest of the study period, and not affected by the event of death during follow-up. The estimated costs of nursing care are, in contrast, much higher in year 2 than in year 1 and differ substantially by gender and type of procedure as well as by patients' age. Overall, these monthly cost estimates add up to €10,352 for the first and €7467.6 for the second year post-discharge. Substantial cost increases at month 1 post-discharge and in case of death during follow-up are the main findings of the study, which should be taken into account in future economic evaluations on the topic. Application of standardized unit costs in combination with monthly patient interviews allows for a far more precise estimate of the variability in post-discharge health service utilization in this group of patients than the ones given in previous studies. German Clinical Trial Register Nr. DRKS00000797 .

  3. Drug therapy for chronic idiopathic axonal polyneuropathy

    NARCIS (Netherlands)

    Vrancken, A. F. J. E.; van Schaik, I. N.; Hughes, R. A. C.; Notermans, N. C.


    BACKGROUND: Chronic idiopathic axonal polyneuropathy is an insidiously progressive sensory or sensorimotor polyneuropathy that affects elderly people. Although severe disability or handicap does not occur, it reduces quality of life. OBJECTIVES: To assess whether drug therapy for chronic idiopathic

  4. Surgical management of pain

    African Journals Online (AJOL)

    the spinal cord.[4] In this article, the reader is referred back to this illustration to understand the surgical techniques used to manage pain. Pain is caused by ... Injured dorsal root neurons discharge at higher frequencies and more spontaneously than normally. Surgical techniques. The physician should ensure that treat-.

  5. Misdiagnosis of idiopathic hypoparathyroidism (United States)

    Li, Ling; Yang, Haisong; Li, Jian; Yu, Yunli; Wang, Fan; Zhu, Xianghui; Liu, Guicheng


    Abstract Rationale: Idiopathic hypoparathyroidism (IHP) is a rare endocrine condition, which is frequently represented by neuropsychiatric disorders. Hence, the misdiagnosis rate of the disease is rather high, especially for neurologists. Patient concerns: We reported a case of misdiagnosed, atypical IHP. In addition, the literature on IHP and the misdiagnosis published in China in the past 2 decades has been reviewed and summarized. Diagnoses: Blood testing confirmed that parathyroid hormone (PTH) = 0 pg/mL and the final diagnosis was IHP. Interventions and outcomes: With calcium and vitamin D supplementation, the patient's myasthenia improved significantly, and muscle enzymes returned to normal gradually. One-year follow-up demonstrated that the patient's myasthenia disappeared, and the blood calcium and PTH levels were normal. In addition, the literature on IHP and the misdiagnosis published in China in the past 2 decades has been reviewed and summarized. Lessons: The misdiagnosis rate of IHP in China was high in the past 2 decades, which might be attributed to the misdiagnosis as epilepsy or mental diseases. A clinician should be able to understand the disease and emphasize the screening of high-risk population, especially for those patients with hypocalcemia, hyperphosphatemia, and increased blood creatine kinase with unknown causes or nontypical clinical symptoms. PMID:29489687

  6. Idiopathic Retroperitoneal Hematoma

    Directory of Open Access Journals (Sweden)

    Tomoyuki Abe


    Full Text Available A 34-year-old female presented with sudden onset of severe abdominal pain in a flank distribution. A large mass was palpable in the right upper quadrant on physical examination. Abdominal contrast-enhanced computed tomography showed a well-defined, right-sided, retroperitoneal cystic lesion located between the abdominal aorta and the inferior vena cava (IVC. The tumor size was 55 × 58 mm, and it compressed the gallbladder and the duodenum. Upper gastrointestinal radiography revealed a stricture of the second portion of the duodenum by the tumor. T2-weighted magnetic resonance imaging showed that the whole part was hyperintense with hypointense rims, but the inner was partially hypointense. Based on the radiological findings, the preoperative differential diagnosis included retroperitoneal teratoma, Schwannoma, abscess, and primary retroperitoneal tumor. On laparotomy, the tumor was located in the right retroperitoneal cavity. Kocher maneuver and medial visceral rotation, which consists of medial reflection of the upper part of right colon and duodenum by incising their lateral peritoneal attachments, were performed. Although a slight adhesion to the IVC was detected, the tumor was removed safely. Thin-section histopathology examination detected neither tumor tissues nor any tissues such as adrenal gland, ovarian tissue, or endometrial implants. The final pathological diagnosis was idiopathic retroperitoneal hematoma; the origin of the bleeding was unclear. The patient was discharged without any complication 5 days after the operation.

  7. Persistent idiopathic facial pain. (United States)

    Benoliel, Rafael; Gaul, Charly


    Background Persistent idiopathic facial pain (PIFP) is a chronic disorder recurring daily for more than two hours per day over more than three months, in the absence of clinical neurological deficit. PIFP is the current terminology for Atypical Facial Pain and is characterized by daily or near daily pain that is initially confined but may subsequently spread. Pain cannot be attributed to any pathological process, although traumatic neuropathic mechanisms are suspected. When present intraorally, PIFP has been termed 'Atypical Odontalgia', and this entity is discussed in a separate article in this special issue. PIFP is often a difficult but important differential diagnosis among chronic facial pain syndromes. Aim To summarize current knowledge on diagnostic criteria, differential diagnosis, pathophysiology and management of PIFP. Methods We present a narrative review reporting current literature and personal experience. Additionally, we discuss and differentiate the common differential diagnoses associated with PIFP including traumatic trigeminal neuropathies, regional myofascial pain, atypical neurovascular pains and atypical trigeminal neuropathic pains. Results and conclusion The underlying pathophysiology in PIFP is still enigmatic, however neuropathic mechanisms may be relevant. PIFP needs interdisciplinary collaboration to rule out and manage secondary causes, psychiatric comorbidities and other facial pain syndromes, particularly trigeminal neuralgia. Burden of disease and psychiatric comorbidity screening is recommended at an early stage of disease, and should be addressed in the management plan. Future research is needed to establish clear diagnostic criteria and treatment strategies based on clinical findings and individual pathophysiology.

  8. Chronic pain coping styles in patients with herniated lumbar discs and coexisting spondylotic changes treated surgically: Considering clinical pain characteristics, degenerative changes, disability, mood disturbances, and beliefs about pain control


    Misterska, Ewa; Jankowski, Roman; Głowacki, Maciej


    Background Pain catastrophizing, appraisals of pain control, styles of coping, and social support have been suggested to affect functioning in patients with low back pain. We investigated the relation of chronic pain coping strategies to psychological variables and clinical data, in patients treated surgically due to lumbar disc herniation and coexisting spondylotic changes. Material/Methods The average age of study participants (n=90) was 43.47 years (SD 10.21). Patients completed the Polish...

  9. Long-Term Survival in Idiopathic Pulmonary Arterial Hypertension Associated with Massive Pulmonary Artery Dilation

    Directory of Open Access Journals (Sweden)

    Vanja Petrovic


    Full Text Available The present report describes two patients with long-term survival after being diagnosed with idiopathic pulmonary arterial hypertension more than 20 years earlier. Both patients were treated with calcium channel blockers for several years and are currently maintained on bosentan, an oral endothelin receptor antagonist. Severe dilation of the main pulmonary arteries is present in both patients and may be related to long-term survival with idiopathic pulmonary arterial hypertension.

  10. [The Effect of Activation of the Shoulder Girdle Muscles on Functional Outcomes of Rehabilitation in Patients with Surgically Treated Distal Radius Fractures]. (United States)

    Jančíková, V; Opavský, J; Dráč, P; Krobot, A; Čižmář, I


    PURPOSE OF THE STUDY The aim of the study was to assess the functional outcomes of rehabilitation in patients with surgically treated distal radius fractures in the early postoperative period. We compared the functional outcomes of patients undergoing standard rehabilitation with the group of patients whose postoperative rehabilitation was extended with shoulder girdle exercises of the affected upper limb while the wrist was immobilized. Several indices and variables were used for the assessment of the functional therapeutic outcomes of the affected wrist. MATERIAL AND METHODS Forty patients (32 females and 8 males, the mean age 60.5 years) with distal radius fractures treated by internal fixation using volar surgical approach were involved in the study between 2013-2016. The tested subjects were randomized and split into two groups according to the selected method of rehabilitation. The tested subjects with standard rehabilitation extended with shoulder girdle muscles activation were labelled as group I. It included patients (n = 20) of the mean age 59.8 (age range 42-73 years) with immobilized wrist (i.e. for 3-4 weeks) performing shoulder girdle muscles exercises at the same time. Furthermore, standard kinesiotherapy continued after their fixation was removed. The other tested group, labelled as group II (n = 20), the mean age 61.3 (variation 40-74 years of age) involved patients with distal radius fractures. Only standard rehabilitation was performed in this group as late as their forearm fixation was removed. The following indices and parameters were assessed in the early postoperative period (i.e. by 8 weeks after the fixation removal): wrist and fingers range of motion (ROM), hand grip strength (dynamometry), local swelling, pain, scores of a nine hole peg test (NHPT), and a DASH score. RESULTS After the fixation had been removed, the group I reported statistically significantly higher values of movement compared to the values of the contralateral limb in

  11. Initial experience with the providence nighttime bracing in adolescent idiopathic scoliosis

    DEFF Research Database (Denmark)

    Quisth, Lena; Beuschau, Inge; Simony, A.


    Background: Since 2008 the primary non-surgical treatment of adolescent idiopathic scoliosis (AIS) in the southern part of Denmark, went from full-time bracing with Boston brace, to Providence nighttime bracing. Aim: To evaluate the effectiveness of nighttime bracing, with the Providence brace...

  12. Idiopathic polyhydramnios and fetal gender. (United States)

    Stanescu, A D; Banica, R; Olaru, G; Ghinda, E; Birdir, Cahit


    To determine the relationship between idiopathic polyhydramnios and fetal gender in the absence of fetal or maternal abnormalities. This was a retrospective population-based register study. 295 women with singleton pregnancies complicated by idiopathic polyhydramnios (amniotic fluid index (AFI) higher than 24 cm) who were delivered at our institution from January 2002 till December 2012 were included. Only pregnancies with an uncomplicated outcome were accepted in this study. The incidence of the male to female fetuses was compared with the one in the general population. Among pregnancies complicated by idiopathic polyhydramnios, the following gender distribution was found: 72.9% male and 37.1% female. The distribution in the general population was 51.5% female and 48.5% male. The mean AFI was significantly increased in male fetuses (p polyhydramnios is more frequent in male normal fetuses than in female ones.

  13. Predictors of poor response to methotrexate in polyarticular-course juvenile idiopathic arthritis: analysis of the PRINTO methotrexate trial

    NARCIS (Netherlands)

    Vilca, Iris; Munitis, Pablo Garcia; Pistorio, Angela; Ravelli, Angelo; Buoncompagni, Antonella; Bica, Blanca; Campos, Lucia; Häfner, Renate; Hofer, Michael; Ozen, Seza; Huemer, Christian; Bae, Sang Cheol; Sztajnbok, Flavio; Arguedas, Olga; Foeldvari, Ivan; Huppertz, Hans Iko; Gamir, Maria Luz; Magnusson, Bo; Dressler, Frank; Uziel, Yosef; van Rossum, Marion A. J.; Hollingworth, Peter; Cawkwell, Gail; Martini, Alberto; Ruperto, Nicolino


    Objectives To determine whether baseline demographic, clinical, articular and laboratory variables predict methotrexate (MTX) poor response in polyarticular-course juvenile idiopathic arthritis. Methods Patients newly treated for 6 months with MTX enrolled in the Paediatric Rheumatology

  14. Syphilis mimicking idiopathic intracranial hypertension

    DEFF Research Database (Denmark)

    Yri, Hanne; Wegener, Marianne; Jensen, Rigmor


    Idiopathic intracranial hypertension (IIH) is a condition of yet unknown aetiology affecting predominantly obese females of childbearing age. IIH is a diagnosis of exclusion as raised cerebrospinal fluid pressure may occur secondary to numerous other medical conditions. An atypical phenotype...... or an atypical disease course should alert the physician to reevaluate a presumed IIH-diagnosis. The authors report a case of a 32-year-old non-obese male with intracranial hypertension, secondary to a syphilitic central nervous system infection, initially misdiagnosed as being idiopathic. Upon relevant...

  15. Estudo retrospectivo de cães com luxação patelar medial tratados cirurgicamente Retrospective study of dogs with medial patellar luxation surgically treated

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    Mariana Moraes Dionisyio de Souza


    , o que indica a necessidade de realização de estudos acerca de novas condutas.The aim of this study was to evaluate retrospectively 48 medium to toy breed dogs with developmental medial patellar luxation submitted to corrective surgical procedures. In the grade 1 limbs, 46.7% were treated by lateral retinacular overlap and 53.3% by lateral retinacular overlap and deepening of the femoral groove with no complications. In the grade 2 limbs (n=35 were used the techniques of deepening of the femoral groove and lateral retinacular overlap (100% of the cases, medial desmotomy (28.6%, fabello-patellar sutures (2.8% with 14.3% of reluxation. The last evaluation varied from 3 to 9 months, and clinical signs of lameness were still observed in 20% of the limbs. In all grade 3 cases (n=11 were performed deepening of the femoral groove, lateral retinacular overlap, partial quadriceps released, medial desmotomy and lateral transposition of the tibial tuberosiy that was fixated with Kirschner wire or screw. Reluxation occurred in 27.3% of the limbs that were reoperated. In this group 72.7% of the limbs had absence of lameness. In the grade 4 limbs (n=10 were used the same techniques of grade 3, but it was also necessary the femoral corrective osteotomy in 4 limbs. Reluxation was observed in 30% of the limbs that were reoperated. Although 60% of the limbs showed a positive evolution of the locomotion after 5.2 months of evaluation, in general the dogs showed a posture with the hind limbs in a semi-flexed position, due to the inability to fully extend the stifle. In conclusion, the surgical procedures used allowed an improvement of the locomotion, but except to grade 1, the patellar reluxation may occur in the other degrees suggesting the necessity of other protocols.

  16. Anticonvulsants to treat idiopathic restless legs syndrome: systematic review Anticonvulsivantes para a síndrome das pernas inquietas idiopática: revisão sistemática

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    Cristiane Fiquene Conti


    Full Text Available BACKGROUND: Restless legs syndrome (RLS is a sensory motor disorder characterized by a distressing urge to move the legs and sometimes also other parts of the body usually accompanied by a marked sense of discomfort or pain in the leg or other affected body part. Many treatments have been used to minimize the discomfort of the disease, among them the anticonvulsant therapy. AIM: This review aims to evaluate the efficacy and safety of anticonvulsant treatment for idiopathic RLS. METHOD: Systematic review of randomized or quasi-randomized, double blind trials on anticonvulsant treatment for RLS. Outcomes: relief of RLS symptoms, subjective and objective sleep quality, quality of life, and adverse events associated with the treatments. RESULTS: A total of 231 patients were randomized in three cross over studies and one parallel study. Three studies with carbamazepine, one with sodium valproate, and one with gabapentin, and they were very heterogeneous so we could not perform a metanalyses. CONCLUSIONS: There is no scientific evidence on RLS treatment with anticonvulsants for clinical practice.CONTEXTO: A síndrome das pernas inquietas (SPI é uma desordem caracterizada por um impulso de mover as pernas e as vezes outras partes do corpo acompanhado geralmente por desconforto ou da dor nas pernas ou em outra parte afetada. Muitos tratamentos tem sido utilizados para aliviar o desconforto causado pela doença entre eles os anticonvulsivantes. OBJETIVO: Este estudo objetivou avaliar a eficácia e segurança do tratamento da SPI com as drogas anticonvulsivantes. MÉTODO: Revisão sistemática de ensaios clínicos randomizados ou quasi-randomizados, duplo-cegos para o tratamento com anticonvulsivantes para SPI. Desfechos: alívio dos sintomas da SPI, qualidade subjetiva e objetiva do sono, qualidade de vida e efeitos adversos relacionados ao tratamento. RESULTADOS: Um total de 231 pacientes foram randomizados em três estudos cross-over e um estudo

  17. P12.01 Epidemiology in spinal tumors treated surgically at the South Central Hospital of High Specialty from PEMEX in Mexico (United States)

    Hernandez Resendiz, R.; Cordoba Mosqueda, M.; Guerra Mora, J.; Loya Aguilar, I.; Garcia Gonzalez, U.


    Abstract Introduction: The spinal tumors are rare neoplasms, they can be primary or metastatic; in the literature they are divided in extradural and intradural, extramedullary and intramedullary, from which extradural tumors are the most frequent and are usually metastatic, the intramedullary are generally gliomas. From the primary tumors up to 78% are benign and 22% malign, the histological stripe and the involvement to the spinal compartments are of great importance for the results and the treatment which is mainly surgical, individualized and meticulously planned with the support of technological resources such as the electrophysiological monitoring during the surgery. Methods and Materials: Observational study with a range of patients from March 1999- March 2016 to whom surgical resection of the spinal tumor was performed and reported on the Electronic Files of the South Central Hospital of High Specialty PEMEX. A Statistical analysis is made with the SPSS Statistic of disease of the Institution program. Results: 23 patients with spinal tumor surgical resection were found. The median age was 53 ± 10 years. The most common clinical manifestation was radiculopathy (65%). The Karnofsky scale was used for initial evaluation where a 43% of patients had a 90 score at the moment of the diagnosis, while 65% had an ECOG 1. The most frequent tumor was the Spinal Shwannoma (39%), followed in prevalence by the Condroid Cordoma (17%), where the intradural extramedullary location was the most prevalent (78%). The medium rate of survival after the surgical procedure was from 11 months. Conclusions: Our cases and the international statistics coincide. Radiculopathy as high prevalence initial manifestation conceals us to dismiss in the sixth decade of life any possibility for spinal tumor presentation. Most of spinal tumor patients do not have any clinical deterioration in their basal state, which indicates that performing a successful surgical procedure and the right

  18. Idiopathic retroperitoneal fibrosis: A report on 15 patients

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    Hadži-Đokić Jovan


    Full Text Available Background/Aim. Retroperitoneal fibrosis (RPF represents a chronic pathological process characterized by fibrosis which entraps and compresses the ureters and the great blood vessels in the retroperitoneal space. A specific form of RPF is idiopathic RPF, an uncommon collagen vascular disease of unclear etiology. The series of 15 patients which underwent open surgical repair due to idiopathic RPF is presented herein. Methods. From 1989 to 2012, 11 male and 4 female patients underwent surgery due to primary RPF. The ureters were entrapped unilaterally (7 patients, or bilaterally (8 patients. Major symptoms included low back pain due to hydronephrosis (9 patients, uremia (4 patients, and urinary tract infection (2 patients. The diagnosis was based on intravenous urography (IVU, retrograde ureteropyelography and computed tomography (CT. Results. Surgical procedures included intraperitoneal ureteral displacement (8 patients and ureteral wrapping with omental flap (6 patients. One patient underwent bilateral ureteral stenotic segments resection and oblique ureterography, followed by wrapping with omental flap. Pathological examination confirmed primary RPF in all patients. The mean operative time was 3.5 h (range 2.5-4.5 h. The average intrahospital stay was 21 days (range 16-26 days. The mean follow up was 32 months (6-46 months. During the follow up, 12 patients had improvement on IVU. Conclusion. Early recognition of signs and symptoms of RPF is of the utmost importance for the outcome. Surgical procedures, including ureteral wrapping with omental flap, or intraperitoneal ureteral displacement, usually represent definitive treatment.

  19. Temporomandibular joint involvement in juvenile idiopathic arthritis: treatment with an orthodontic appliance

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    M. Gattinara


    Full Text Available Introduction and purpose: About 65% of children suffering from juvenile idiopathic arthritis (JIA shows a more or less marked involvement of temporo-mandibular joint (TMJ with altered mandibular growth, resorption of the condyles, occlusary instability, reduced chewing ability and facial dysmorphia. The purpose of our study is to prevent and to treat the progressive evolution of JIA on craniofacial growth and morphology with a functional appliance; surgery should be considered only in so far as the adequacy of TMJ movement is concemed. Methods: From 1992 until now 72 children with proved JIA and TMJ involvement have been treated (50 females, 22 males, aged 6 to 16 years old. TMJ involvement was bilateral in 61% and unilateral in 39% of patients. A diagnostic workup was carried out involving tomograms of TMJ and cephalometric radiograph and analysis. The authors used a bimaxillary activator in the attempt to modify the unfavourable growth pattern and provide a gradual ante-rotation of the jaw. Results: Almost all JIA patients showed satisfactory long term results, easing of pain, reduced skeletal discrepancy, increased function and good facial profile. Conclusions: The long term results of this study indicate that orthopaedic therapy might control the vicious circle of the malocclusion in children with JIA, preventing exacerbation of mandibular clockwise rotation. Surgical intervention for the improvement of TMJ function should be considered only if a severe restricted state is imminent.

  20. Surgical treatment of post-infarction left ventricular pseudoaneurysm: Case series highlighting various surgical strategies

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    Edvin Prifti, MD, PhD


    Conclusion: In conclusion, this study revealed that surgical repair of post infarct left ventricular pseudoaneurysm was associated with an acceptable surgical mortality rate, that cardiac rupture did not occur in surgically treated patients.

  1. Idiopathic pulmonary hemosiderosis - a diagnostic challenge. (United States)

    Bakalli, Ilirjana; Kota, Luljeta; Sala, Durim; Celaj, Ermela; Kola, Elmira; Lluka, Robert; Sallabanda, Sashenka


    Idiopathic pulmonary hemosiderosis is a rare disorder that can occur at any age and is characterized by the triad of hemoptysis, iron deficiency anemia and diffuse pulmonary infiltrates. The clinical course is exceedingly variable especially in children and a substantial proportion of this age group is undiagnosed. It is probably due to the fact that iron deficiency anemia may be the first and the only manifestation of IPH, preceding other symptoms and signs by several months and IPH is not considered as a rare cause of anemia, unless the typical triad is present. We present a case of IPH in a 13-year-old girl, treated for several months with persistent iron deficiency anemia, without response to therapy.

  2. Cough in idiopathic pulmonary fibrosis

    NARCIS (Netherlands)

    M.J.G. Van Manen (Mirjam); S.S. Birring (Surinder S.); C. Vancheri (Carlo); V. Cottin (Vincent); Renzoni, E.A. (Elisabetta A.); Russell, A.-M. (Anne-Marie); M.S. Wijsenbeek (Marlies)


    textabstractMany patients with idiopathic pulmonary fibrosis (IPF) complain of chronic refractory cough. Chronic cough is a distressing and disabling symptom with a major impact on quality of life. During recent years, progress has been made in gaining insight into the pathogenesis of cough in IPF,

  3. Idiopathic epileptic syndromes and cognition. (United States)

    Hommet, Caroline; Sauerwein, Hannelore C; De Toffol, Bertrand; Lassonde, Maryse


    Epilepsy is frequently associated with cognitive impairments which result from various interacting factors. The present paper deals with the contribution of neuropsychology to the characterization of the type of epilepsy and the possible mechanisms underlying idiopathic epileptic syndromes. The non-lesional, so-called idiopathic epilepsies, constitute an interesting model for assessing the relationship between epileptiform EEG discharges and cognition. Among the idiopathic generalized epilepsies, disorders of social integration and personality have been frequently reported in juvenile myoclonic epilepsy (JME). Since similar disturbances are observed in frontal-lobe-lesioned patients, impairments in other frontal lobe functions (e.g. executive functions) might be expected in JME. This gives rise to speculation about the possible underlying pathophysiological mechanisms in JME. With regard to partial idiopathic epilepsies, benign childhood epilepsy with centrotemporal spikes (BCECTS) may provide a useful model for the study of the relationship between epileptiform EEG discharges in the peri-sylvian region and language functions. Furthermore, the description of mild cognitive dysfunctions in BCECTS, and their persistence into adulthood, can provide information about compensatory mechanisms and may allow for the generation of remedial strategies. Thus, 'lesional' neuropsychology has given way to 'dynamic' neuropsychology based on specific postulates. By using the cognitive profile to specify the mechanism underlying the behavioral disturbances observed in different types of epilepsy, neuropsychology may eventually contribute to a revision of the present classification of epileptic syndromes. In addition, the neuropsychological data may help predict the extent and limits of functional recovery and cerebral plasticity.

  4. Perinatal Outcome in Idiopathic Polyhydramnios. (United States)

    Lallar, Meenakshi; Anam Ul Haq; Nandal, Rajesh


    To study perinatal outcome in idiopathic polyhydramnios. Case-control study was conducted in 500 pregnant women with idiopathic polyhydramnios (study group) and 500 normal pregnant women (control group) attending the outpatient department of SHKM Medical College, Haryana. Perinatal outcomes were recorded in both the groups. Out of 500 cases with idiopathic polyhydramnios, maximum cases were diagnosed between 28 and 36 weeks of pregnancy (84.6 %), and maximum presented with mild polyhydramnios (82 %). In the study and control groups, there were no statistically significant differences in preeclampsia and gestational hypertension (p = 0.445 and p = 0.230). In the study and control groups, 74.6 and 79.6 % women, respectively, had normal vaginal delivery (p = 0.250). The study group recorded much higher number of preterm deliveries than the control group (54 %) (p = 0.000). In the study group, 51.8 % women had maternal complications, while in the control group, 13.6 % women had obstetrical complications. The study group recorded higher perinatal mortality (10.4 %) than the control group. Idiopathic polyhydramnios is associated with higher perinatal morbidity and mortality than normal pregnancy.

  5. Extracorporeal life support for a 5-week-old infant with idiopathic pulmonary hemosiderosis. (United States)

    Gutierrez, Sherrill; Shaw, Susanna; Huseni, Shehlanoor; Sachdeva, Shagun; Costello, John P; Basu, Sonali; Nath, Dilip S; Klugman, Darren


    Idiopathic pulmonary hemosiderosis is a rare disease defined by the triad of iron deficiency anemia, hemoptysis, and diffuse pulmonary infiltrates on chest radiograph. Idiopathic pulmonary hemosiderosis is known to cause dyspnea and, in some cases, acute onset of massive pulmonary hemorrhage which is traditionally treated with conventional mechanical ventilation or high-frequency oscillation in conjunction with immunosuppressive therapy. In this case report, we describe a 5-week-old infant presenting with hemoptysis, massive pulmonary hemorrhage, and significant hypercapnic respiratory failure. The patient failed conventional ventilation but responded well to extracorporeal life support that was initiated early in his course. Idiopathic pulmonary hemosiderosis was suspected in light of his response to high-dose steroids and was confirmed by subsequent lung biopsies. Patients with severe pulmonary hemorrhage secondary to idiopathic pulmonary hemosiderosis can be safely supported with extracorporeal life support when conventional therapies have been exhausted.

  6. Multiple Pyogenic Liver Abscesses Caused by Microperforation of an Idiopathic Cecal Ulcer. (United States)

    Yeom, Dong Han; Sohn, Ki Chang; Chu, Min Su; Jo, Dong Ho; Cho, Eun Young; Kim, Haak Cheoul


    Idiopathic cecal ulcer is a rare disease entity of unknown cause diagnosed by ruling out other known causes of cecal ulceration. The most common complication of an idiopathic cecal ulcer is bleeding; perforation, peritonitis, abscess, and stricture formation have been noted. The authors treated a 53-year-old woman who presented with fever and intermittent right upper quadrant abdominal pain. Multiple pyogenic liver abscess and a solitary cecal ulcer were diagnosed by radiologic, endoscopic, and pathologic examination, followed by laparoscopic cecectomy. After extensive study, we concluded that this patient's liver abscesses were a complication of the idiopathic cecal ulcer. Herein, we report a case of multiple pyogenic liver abscess caused by microperforation of idiopathic cecal ulcer.

  7. Idiopathic Chondrolysis of the Hip ( ICH: Report of three Cases

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    C Dechosilpa


    Full Text Available Idiopathic Chondrolysis of the Hip (ICH is a rare condition, occurring mostly in black female adolescence. It is characterized by the rapidly progressive destruction of articular cartilage in the hip joint resulting in premature degeneration and subsequent joint arthrosis. We report three cases of ICH: a 13-year old boy presented with left knee pain, an 11-year old girl with right hip pain and a 12-year old girl with right thigh pain. All of them had the same characteristic radiographic findings. The initial treatment was started conservatively. Surgical treatment was performed in one patient in order to confirm diagnosis and correct deformity.

  8. Laparoscopic 'sleeve' caecectomy for idiopathic solitary caecal ulcer mimicking appendicitis. (United States)

    Sran, Harkiran; Sebastian, Joseph; Doughan, Samer


    Idiopathic ulcer of the caecum is a rare condition of unknown aetiology. Its clinical presentation may mimic various pathologies, including appendicitis, inflammatory bowel disease and caecal malignancy. A definitive diagnosis is rarely established preoperatively, and is usually only confirmed histologically following surgical resection. We report a case of a young patient with caecal ulceration presenting with symptoms and signs of appendicitis, in whom laparoscopic anterior 'sleeve' caecectomy was performed to excise an inflammatory-looking mass involving the caecum. Histological examination demonstrated a deep mucosal ulcer and subsequent colonoscopy did not reveal any further pathology. 2015 BMJ Publishing Group Ltd.

  9. Multidisciplinary approach to non-surgical management of inguinal disruption in a professional hockey player treated with platelet-rich plasma, manual therapy and exercise: a case report. (United States)

    St-Onge, Eric; MacIntyre, Ian G; Galea, Anthony M


    To present the clinical management of inguinal disruption in a professional hockey player and highlight the importance of a multidisciplinary approach to diagnosis and management. A professional hockey player with recurrent groin pain presented to the clinic after an acute exacerbation of pain while playing hockey. The patient received a clinical diagnosis of inguinal disruption. Imaging revealed a tear in the rectus abdominis. Management included two platelet-rich plasma (PRP) injections to the injured tissue, and subsequent manual therapy and exercise. The patient returned to his prior level of performance in 3.5 weeks. This case demonstrated the importance of a multidisciplinary team and the need for advanced imaging in athletes with groin pain. Research quality concerning the non-surgical management of inguinal disruption remains low. This case adds evidence that PRP, with the addition of manual therapy and exercise may serve as a relatively quick and effective non-surgical management strategy.

  10. Reversal of idiopathic hypogonadotropic hypogonadism. (United States)

    Raivio, Taneli; Falardeau, John; Dwyer, Andrew; Quinton, Richard; Hayes, Frances J; Hughes, Virginia A; Cole, Lindsay W; Pearce, Simon H; Lee, Hang; Boepple, Paul; Crowley, William F; Pitteloud, Nelly


    Idiopathic hypogonadotropic hypogonadism, which may be associated with anosmia (the Kallmann syndrome) or with a normal sense of smell, is a treatable form of male infertility caused by a congenital defect in the secretion or action of gonadotropin-releasing hormone (GnRH). Patients have absent or incomplete sexual maturation by the age of 18. Idiopathic hypogonadotropic hypogonadism was previously thought to require lifelong therapy. We describe 15 men in whom reversal of idiopathic hypogonadotropic hypogonadism was sustained after discontinuation of hormonal therapy. We defined the sustained reversal of idiopathic hypogonadotropic hypogonadism as the presence of normal adult testosterone levels after hormonal therapy was discontinued. Ten sustained reversals were identified retrospectively. Five sustained reversals were identified prospectively among 50 men with idiopathic hypogonadotropic hypogonadism after a mean (+/-SD) duration of treatment interruption of 6+/-3 weeks. Of the 15 men who had a sustained reversal, 4 had anosmia. At initial evaluation, 6 men had absent puberty, 9 had partial puberty, and all had abnormal secretion of GnRH-induced luteinizing hormone. All 15 men had received previous hormonal therapy to induce virilization, fertility, or both. Among those whose hypogonadism was reversed, the mean serum level of endogenous testosterone increased from 55+/-29 ng per deciliter (1.9+/-1.0 nmol per liter) to 386+/-91 ng per deciliter (13.4+/-3.2 nmol per liter, Phypogonadotropic hypogonadism and the Kallmann syndrome was noted after discontinuation of treatment in about 10% of patients with either absent or partial puberty. Therefore, brief discontinuation of hormonal therapy to assess reversibility of hypogonadotropic hypogonadism is reasonable. ( number, NCT00392756 [].). Copyright 2007 Massachusetts Medical Society.

  11. Comparação das alterações do potencial evocado somatosensorial no tratamento cirúrgico da escoliose idiopática entre técnicas com e sem amarrilha sublaminar Comparación de las alteraciones del potencial evocado somatosensorial en el tratamiento quirúrgico de la escoliosis idiopática entre técnicas con y sin amarilla sublaminar Comparison of the somatosensory evoked potentials changes in the surgical treatment of idiopathic scoliosis between two techniques with and without sublaminar wiring

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    Renato Hiroshi Salvioni Ueta


    ón medular por medio de PESS. RESULTADOS: en el Grupo II fue observada una frecuencia mayor de alteraciones del PESS, tanto en la amplitud como en la latencia de onda, durante y al final de la cirugía. En la serie revista, se constató un elevado porcentaje de resultados falsos-positivos. En ningún paciente fue observada cualquier alteración neurológica en el postoperatorio. CONCLUSIÓN: está en discusión cuál es el método más seguro para el tratamiento quirúrgico de la escoliosis idiopática. Los resultados presentados en este trabajo sugieren una menor incidencia de alteraciones en la monitorización neurofisiológica de la médula en los pacientes tratados por el sistema de Cotrel-Dubousset.OBJECTIVE: to compare the number of events with alteration in the somatosensory evoked potentials (SSEP and its repercussion between different techniques of surgical treatment for idiopathic scoliosis, with and without sublaminar wiring. METHODS: twenty-five surgical procedures with flexible curves for treatment of idiopathic scoliosis were reviewed in the period of November 1996 to September 1999. They were divided into two groups: without sublaminar wiring (Cotrel-Dubousset's system (Group I; and with sublaminar wiring (Harrington-Luque's system and rectangle of Hartshill (Group II. In all surgeries, the intraoperative neurophysiologic monitoring with Somatosensory Evoked Potentials (SSEPs was used. RESULTS: according to the findings, a bigger frequency of monitoring changes was observed during and at the end of the surgery in Group II. A high incidence of false-negative changes was also verified. No patient with neurological damages was observed. CONCLUSION: There are still doubts about the safest method for the surgical treatment of idiopathic scoliosis. The results presented in this study suggest a smaller incidence of SSEPs changes in the patients treated with Cotrel-Dubousset's system.

  12. Idiopathic brain herniation. A report of two paediatric cases. (United States)

    Koc, Gonca; Doganay, Selim; Bayram, Ayse Kacar; Gorkem, Sureyya Burcu; Dogan, Mehmet Sait; Per, Huseyin; Coskun, Abdulhakim


    SUMMARY - 'Idiopathic' herniation of the brain is a rare entity previously reported in 13 cases. It may be incidentally encountered in neuroimaging studies acquired for various clinical indications. We herein describe two cases of idiopathic brain herniation that were incidentally diagnosed. A 12-year-old boy presented with a six-month history of daytime sleepiness and sudden spells of sleep. Herniation of the left inferior temporal gyrus was revealed in MRI acquired with the suspicion of epilepsy. His overnight polysomnogram and multiple sleep latency tests were compatible with the diagnosis of narcolepsy. The other case, a two-year-old girl, was transferred from an outside hospital due to partial seizures with the fever. Herniation of the precuneal gyrus was encountered in MRI acquired after controlling her seizures with the initiation of phenytoin. The brain herniations of both patients were considered to be inconsistent with their medical conditions, so that they were symptom-free with only medical treatment for following three and six months, respectively. This is a rare presentation of idiopathic brain herniation as an incidental finding that accompanied narcolepsy and epilepsy. Awareness of this entity would avoid excessive surgical and medical treatments.

  13. Fourth-generation spinal instrumentation: experience with adolescent idiopathic scoliosis at a tertiary care hospital in Pakistan

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    Fazal A


    Full Text Available Akil Fazal1, Riaz H Lakdawala21Hospital for Joint Disease, New York University, New York, USA; 2Section of Orthopaedics, Department of Surgery, The Aga Khan University Hospital, Karachi, PakistanObjective: To evaluate the radiological and functional outcome of surgical treatment of adolescent idiopathic scoliosis using fourth-generation posterior spinal instrumentation at The Aga Khan University, Karachi, Pakistan.Design: Case series.Place and duration of study: The Aga Khan University Hospital after a minimum of 2 years postoperatively.Patients and methods: A total of 20 patients with adolescent idiopathic scoliosis were recruited into the study and evaluated for radiological and functional outcome. The study period was from 2000 to 2005. Radiological outcome was assessed using Cobb angle measurement pre and postoperatively, hence assessing percentage correction. The lower instrumented vertebra was taken as the neutral vertebra and the level was recorded. Functional outcome was determined using the Scoliosis Research Society patient administered questionnaire. All patients were called to the clinic and asked to fill in the form. Those patients who were out of the city were mailed the forms and requested via telephone to complete and return.Results: Of the 20 patients operated on, twelve were female and eight were male. The average age at operation was 12.7 years. The mean Cobb angle was 69° preoperatively and 20° postoperatively, representing a percentage correction of 71%. The average duration of follow-up was 3.6 years. There was one major complication involving neurological injury post-op and two minor complications involving wound infection. The average Scoliosis Research Society score (on a scale of 1–5, with 5 being best for pain was 4.5, self-image was 4.2, functional status was 4.1, mental status was 3.8, and satisfaction was 4.4. There was no relationship between the percentage correction of scoliosis and the functional outcome

  14. Correlation of general and oral health-related quality of life in malocclusion patients treated with a combined orthodontic and maxillofacial surgical approach. (United States)

    Tamme, Johannes Alexander; Rohnen, Michael; Gaßling, Volker; Ciesielski, Robert; Fischer-Brandies, Helge; Wiltfang, Jörg; Koos, Bernd


    The aim of the study was to collect information about the oral health-related quality of life (OHRQoL) after combined orthodontic and maxillofacial surgical treatment as well as its influence on health-related quality of life (HRQoL). The study includes data from a total of 130 subjects, 65 of whom (21 male, 44 female, mean age at baseline: 24 years, mean age at the time of surgery: 26 years) were compared with control subjects matched on the basis of gender and age. The set of questionnaires used consisted of a questionnaire advanced by the authors including 35 general and treatment-specific questions, and the German version of the validated "Orthognathic Quality of Life Questionnaire" (OQLQ) to analyze the specific OHRQoL, and the SF-36 to measure HRQoL. The main reason for treatment was most often a combination of esthetic and functional complaints. In most cases, the treatment results met the expectations of subjects well or very well, particularly in the areas of aesthetics and masticatory function. Postoperative numbness or paresthesia were present in 59% of patients, especially in the chin and lower lip areas. In all, 20% of subjects considered the temporary restriction of mouth opening as very bothersome. A decrease in HRQoL was noted as compared with the control group in the subscales of "role physical" (p oral function" (p maxillofacial surgical treatment. However, even after combined orthodontic and maxillofacial surgical treatment of malocclusion patients, it is possible to detect smaller limitations with regard to the specific OHRQoL, which may have a negative impact on HRQoL. Based on the results, a participatory decision-making process focusing on the individual therapy-related expectations, desires, and psychological factors of the patient concerning the improvements effected by the treatment appears to be advisable. Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  15. Análise bacterioscópica e microbiológica intraoperatória de pacientes submetidos a tratamento cirúrgico de escoliose idiopática do adolescente Análisis bacterioscópica y microbiológica intraoperatoria de pacientes sometidos al tratamiento quirúrgico de la escoliosis idiopática del adolescente Intraoperative bacterioscopical and microbiological analysis in patients undergoing a surgical treatment of adolescent idiopathic scoliosis

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    Guilherme Galvão Barreto Carneiro


    pacientes sometidos a corrección de la escoliosis vertebral.OBJECTIVE: To evaluate the presence and microbiological growth in the operative site in patients undergoing surgical treatment of idiopathic scoliosis in the spine of first, second and third hours of surgery. METHODS: Prospective, descriptive and comparative study that evaluated 34 patients with adolescent idiopathic scoliosis with surgical indication, analyzing contamination at the surgical site through Gram staining and bone culture in the first, second and third hour of surgery. RESULTS: There were positive bacteroscopical growing between the first and the second hour of surgery. The culture confirms the colonization of the wound, increasing between the hours analyzed. CONCLUSIONS: The prolonged surgical time is directly related to higher microbial growth in the surgical site in patients undergoing spinal scoliosis correction.

  16. Radiological, clinical and functional evaluation using the Quick Disabilities of the Arm, Shoulder and Hand questionnaire of children with medial epicondyle fractures treated surgically. (United States)

    Canavese, Federico; Marengo, Lorenza; Tiris, Alexandru; Mansour, Mounira; Rousset, Marie; Samba, Antoine; Andreacchio, Antonio; Dimeglio, Alain


    The main goal of this study was to retrospectively evaluate the clinical, functional and radiographic outcomes of displaced medial epicondyle fractures with or without associated elbow dislocation in children undergoing surgical treatment and to evaluate upper-extremity function with the Quick Disbilities of the Arm, Shoulder and Hand (Quick DASH) questionnaire. The hypothesis was that patients with associated elbow dislocation would have similar functional outcome to patients with displaced fractures with or without intra-articular entrapment of the medial epicondyle. A review of medical charts was performed to identify all children and adolescents who underwent surgical treatment for displaced medial epicondyle humeral fractures managed at a single institution. Patients with a closed fracture on plain radiographs, presence of growth cartilages and managed surgically were included in the study. Fractures were radiologically assessed on anteroposterior and lateral radiographs and rated according to Papavasiliou and Crawford classification. Functional outcome was measured with the Quick DASH questionnaire. Sixty-six patients met inclusion criteria, and 38 children presented with isolated displaced medial epicondyle fracture (Group A: type II and type III) and 28 with medial epicondyle fractures associated with elbow dislocation (Group B: type IV). The Papavasiliou and Crawford system classified 36 fractures as type II (54.6%), two (3%) as type III and 28 as type IV (42.4%). All patients underwent open reduction. Fracture fixation was performed with K-wires in 26 (35%) children and a with single screw in 40 (65%). Mean follow-up was 37.5 months (range, 12-68). Overall complication rate was 18%. In particular, three adverse events (3/38, 8%) were recorded in Group -A and nine (9/28, 32%) in Group B (p = 0.003). Mean Quick DASH score at final follow-up was 4.6 ± 3.8 (range, 0-15.9) and was not significantly different between Groups A (5.4 ± 4.3; range, 0

  17. The effects of unilateral and bilateral spinal anaesthesia on hemodynamic parameters in patients surgically treated for inguinal hernia: Hemodynamic parameters and spinal anesthesia

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    Milosavljević Snežana


    Full Text Available Introduction: Conventional bilateral spinal anaesthesia is commonly used for surgical treatment of inguinal hernia because it causes fast development of block with relatively small dosage of local anaesthetic; furthermore, it is easily administered, reduces the level of metabolic response to stress, reduces the incidence of deep venous thrombosis and respiratory depression. On the other hand, the main side effect is hypotension Objective: The goal of the research was to determine which of the two methods of spinal anaesthesia (conventional bilateral, achieved with regular dosage of long-lasting bupivacaine or hypobaric unilateral, achieved with combined application of bupivacaine and fentanyl ensures higher hemodynamic stability during tension-free hernioplasty in patients from group I and II of ASA classification system. Methods: The research was conducted as a prospective, controlled clinical study with the total amount of 50 patients, males and females, and within the age span ranging from 17 to 77, who all had indications for surgical treatment of one-sided inguinal hernia under spinal anaesthesia. The hemodynamic parameters (heart rate, systolic, diastolic and mean arterial pressure were measured during following intervals: T1 - during preanaesthetic visit, T2 - after premedication and the iv administration of Ringer's lactate solution, T3 - 15 minutes after the administration of spinal anaesthesia, T4 - after the surgical incision, T5 - intraoperatively, T6 - during the placement of the last surgical stitch on the skin, T7 - one hour postoperatively. Results: The results showed that the frequency of clinically relevant hypotension was statistically much higher in patients with bilateral spinal anaesthesia (24 % when compared to patients administered with unilateral spinal anaesthesia (4%. Ten minutes after the application of spinal anaesthesia the mean arterial pressure has decreased by 20% when compared to basic values in group BB, and by

  18. Idiopathic hypereosinophilic syndrome associated with rheumatoid arthritis A case report

    Directory of Open Access Journals (Sweden)

    P. Quattrocchi


    Full Text Available The idiopathic hypereosinophilic sindrome (HES is a disease characterized by persistent blood eosinophilia (> 1500 eosinophils/mm3 > 6 months-in absence of other ethiologies for eosinophilia (parasitic, allergic, immunological or malignant diseases-associated with multiple organ involvement (heart, lung, central nervous system, skin, bone marrow, gastrointestinal tract. Reports on rheumatologic manifestations in patients with HES are very rare. In the case we report a typical rheumatoid arthritis developed in a 58-year-old woman with HES treated with glucocorticoids. Because of the marked glucocorticoids side effects shown by the patient(cushingoid habitus, hyperglycemia, we stopped this treatment and replaced it at first by methotrexate and later by cyclosporin, both of them associated with sulfasalazine. These drugs revealed very efficacious both on articular pathology and on the clinical and laboratory manifestations of HES. These data suggest that common pathogenetic mechanisms are likely acting in rheumatoid arthritis and idiopathic hypereosinophilic syndrome.

  19. Does the surgical approach for treating mandibular condylar fractures affect the rate of seventh cranial nerve injuries? A systematic review and meta-analysis based on a new classification for surgical approaches. (United States)

    Al-Moraissi, Essam Ahmed; Louvrier, Aurélien; Colletti, Giacomo; Wolford, Larry M; Biglioli, Federico; Ragaey, Marwa; Meyer, Christophe; Ellis, Edward


    The purpose of this study was to determine the rate of facial nerve injury (FNI) when performing (ORIF) of mandibular condylar fractures by different surgical approaches. A systematic review and meta-analysis were performed that included several databases with specific keywords, a reference search, and a manual search for suitable articles. The inclusion criteria were all clinical trials, with the aim of assessing the rate of facial nerve injuries when (ORIF) of mandibular condylar fractures was performed using different surgical approaches. The main outcome variable was transient facial nerve injury (TFNI) and permanent facial nerve injury (PFNI) according to the fracture levels, namely: condylar head fractures (CHFs), condylar neck fractures (CNFs), and condylar base fractures (CBFs). For studies where there was no delineation between CNFs and CBFs, the fractures were defined as CNFs/CBFs. The dependent variables were the surgical approaches. A total of 3873 patients enrolled in 96 studies were included in this analysis. TFNI rates reported in the literature were as follows: A) For the transoral approach: a) for strictly intraoral 0.72% (1.3 in CNFs and 0% for CBFs); b) for the transbuccal trocar instrumentation 2.7% (4.2% in CNFs and 0% for CBFs); and c) for endoscopically assisted ORIF 4.2% (5% in CNFs, and 4% in CBFs). B) For low submandibular approach 15.3% (26.1% for CNFs, 11.8% for CBFs, and 13.7% for CNFs/CBFs). C) For the high submandibular/angular subparotid approach with masseter transection 0% in CBFs. D) For the high submandibular/angular transmassetric anteroparotid approach 0% (CNFs and CBFs). E) For the transparotid retromandibular approach a) with nerve facial preparation 14.4% (23.9% in CNFs, 11.8% in CBFs and 13.7% for CNFs/CBFs); b) without facial nerve preparation 19% (24.3% for CNFs and 10.5% for CBFs). F) For retromandibular transmassetric anteroparotid approach 3.4% in CNFs/CBFs. G) For retromandibular transmassetric anteroparotid

  20. Syphilis mimicking idiopathic intracranial hypertension

    DEFF Research Database (Denmark)

    Yri, Hanne; Wegener, Marianne; Jensen, Rigmor


    Idiopathic intracranial hypertension (IIH) is a condition of yet unknown aetiology affecting predominantly obese females of childbearing age. IIH is a diagnosis of exclusion as raised cerebrospinal fluid pressure may occur secondary to numerous other medical conditions. An atypical phenotype...... or an atypical disease course should alert the physician to reevaluate a presumed IIH-diagnosis. The authors report a case of a 32-year-old non-obese male with intracranial hypertension, secondary to a syphilitic central nervous system infection, initially misdiagnosed as being idiopathic. Upon relevant...... antibiotic treatment, signs and symptoms of elevated intracranial pressure resolved completely. Syphilis is a rare, but very important, differential diagnosis that in this case was clinically indistinguishable from IIH....

  1. Microcatheter Embolization of Intractable Idiopathic Epistaxis

    International Nuclear Information System (INIS)

    Leppaenen, Martti; Seppaenen, Seppo; Laranne, Jussi; Kuoppala, Katriina


    Purpose: To assess the efficacy and safety of microcatheter embolization in the treatment of intractable idiopathic epistaxis. Methods: Thirty-seven patients underwent microcatheter embolization in 1991-1998. We evaluated retrospectively the technical and clinical outcome, the number of complications, the duration of embolization in each case, and the number of blood transfusions needed. All embolizations were done with biplane digital subtraction angiography (DSA) equipment. The procedure was carried out under local anesthesia using transfemoral catheterization, except in one case where the translumbar route was used. Tracker 18 or 10 microcatheters were advanced as far as possible to the distal branches of the sphenopalatine artery. Polyvinyl alcohol (PVA) particles were used for embolization in most cases, while platinum coils or a combination of these two materials were occasionally used. The primary outcome was always assessed immediately by angiography. Follow-up data were obtained from patient records, by interviewing patients on the telephone or by postal questionnaires when necessary. The mean follow-up time was 21 months. Results: The embolization was technically successful in all 37 cases. A curative outcome was achieved in 33 cases (89%). The mean duration of the procedure was 110 min. Four patients (8%) had mild transient complications, but no severe or persistent complications were encountered. Twenty-three patients needed a blood transfusion. Slight rebleeding occurred in three patients during the follow-up; all responded to conservative treatment. One patient suffered two episodes of rebleeding within 2 months after primary embolization. Re-embolizations successfully stopped the bleeding. Conclusion: Embolization is the primary invasive modality for treating intractable idiopathic epistaxis. It proved both safe and effective over a relatively long follow-up

  2. Syphilis mimicking idiopathic intracranial hypertension

    DEFF Research Database (Denmark)

    Yri, Hanne; Wegener, Marianne; Jensen, Rigmor


    Idiopathic intracranial hypertension (IIH) is a condition of yet unknown aetiology affecting predominantly obese females of childbearing age. IIH is a diagnosis of exclusion as raised cerebrospinal fluid pressure may occur secondary to numerous other medical conditions. An atypical phenotype or a...... antibiotic treatment, signs and symptoms of elevated intracranial pressure resolved completely. Syphilis is a rare, but very important, differential diagnosis that in this case was clinically indistinguishable from IIH....

  3. Adolescent idiopathic scoliosis: current perspectives


    Miyanji, Firoz


    Firoz MiyanjiBritish Columbia Children's Hospital, Vancouver, BC, CanadaAbstract: Adolescent idiopathic scoliosis (AIS) remains a common and potentially severe musculoskeletal disorder. Although its etiology is largely unknown, ongoing research endeavors continue to improve our understanding of its potential origin and its natural history. Advances in understanding its true three-dimensional nature have sought to improve classification and management strategies. This review will attem...

  4. A Rare Cause of Acute Abdomen: Idiopathic Isolated Cecal Necrosis

    Directory of Open Access Journals (Sweden)

    Ender Özer


    Full Text Available Idiopathic isolated cecal necrosis is a clinical problem characterized by right-sided inferior abdominal pain. It is rarely seen, develops due to decreased blood flow to the colon and, imitates acute appendicitis. Its clinical signs are similar to many illnesses causing sensitivity in the right inferior quadrant and, the diagnosis is generally determined during surgery. An 86-year-old male patient presented with the complaints of abdominal pain, trichiniasis, nausea and vomiting. Surgical intervention was decided when physical examination and laboratory results were taken into consideration. After diagnostic laparoscopy, right hemicolectomy was performed because of cecal necrosis. While the mortality and morbidity rates for ischemic bowel disease are high, prognosis for early diagnosed patients with isolated cecal necrosis is better, provided that timely surgical treatment is decided.

  5. Cervical diffuse idiopathic skeletal hyperostosis (DISH) causing oropharyngeal dysphagia. (United States)

    Candelario, Nellowe; Lo, Kevin Bryan; Naranjo, Mario


    Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory condition characterised by calcification and ossification of the vertebral ligaments. It is most commonly seen to affect the thoracic and lumbar vertebrae and is usually seen among elderly men. The cause of this condition is unknown. Risk factors include male gender, obesity, diabetes and advancing age. The majority of these cases are found incidentally on imaging and patients are generally asymptomatic. Cervical DISH is less common than its thoracic and lumbar counterparts. When symptomatic, it can cause dysphagia or sometimes airway compromise. If this happens, surgical intervention should be performed. Although a rare cause of dysphagia, DISH is easily diagnosed with imaging. When identified, surgical decompression produces very good clinical outcomes. 2017 BMJ Publishing Group Ltd.

  6. The natural history of adolescent idiopathic scoliosis

    Directory of Open Access Journals (Sweden)

    Wong Hee-Kit


    Full Text Available There have been great advances in the conservative and surgical treatment for adolescent idiopathic scoliosis in the last few decades. The challenge for the physician is the decision for the optimal time to institute therapy for the individual child. This makes an understanding of the natural history and risk factors for curve progression of significant importance. Reported rates of curve progression vary from 1.6% for skeletally mature children with a small curve magnitude to 68% for skeletally immature children with larger curve magnitudes. Although the patient′s age at presentation, the Risser sign, the patient′s menarchal status and the magnitude of the curve have been described as risk factors for curve progression, there is evidence that the absolute curve magnitude at presentation may be most predictive of progression in the long term. A curve magnitude of 25º at presentation may be predictive of a greater risk of curve progression. Advances in research may unlock novel predictive factors, which are based on the underlying pathogenesis of this disorder.

  7. Idiopathic polyhydramnios and postnatal findings. (United States)

    Dorleijn, Desirée M J; Cohen-Overbeek, Titia E; Groenendaal, Floris; Bruinse, Hein W; Stoutenbeek, Philip


    Our objective was to investigate the outcome of neonates with idiopathic polyhydramnios in the first year after birth. All patients diagnosed in the Erasmus Medical Centre Rotterdam and the University Medical Centre Utrecht between January 2000 and April 2005 with idiopathic polyhydramnios were studied. The outcome variables included mode of delivery, pre-term delivery, birth weight, macrosomia, large-for-gestational-age (weight > p90), neonatal or infant mortality and infant morbidity at 1 year after delivery. These were related to antenatal findings, including the onset of polyhydramnios and ultrasonographic evidence of macrosomia (estimated fetal weight > p90). Polyhydramnios was diagnosed at a mean gestational age (+/- s.d.) of 31.0 +/- 4.9 weeks. The mean gestational age at birth (+/- s.d.) was 37.9 +/- 3.7 weeks. Macrosomia at birth was present in 25.3% (22/88). Sixty-three of 88 infants were in good health 1 year after birth; 20 infants had an abnormality and 5 children had died. Macrosomia and detection of polyhydramnios in the third trimester was associated significantly with a good outcome. In neonates with idiopathic polyhydramnios, abnormalities were detected during the first year of life in 28.4%. Detection of polyhydramnios in the second trimester and low or normal birth weight are risk factors for associated abnormalities.

  8. Symptomatic spinal metastasis: A systematic literature review of the preoperative prognostic factors for survival, neurological, functional and quality of life in surgically treated patients and methodological recommendations for prognostic studies.

    Directory of Open Access Journals (Sweden)

    Anick Nater

    Full Text Available While several clinical prediction rules (CPRs of survival exist for patients with symptomatic spinal metastasis (SSM, these have variable prognostic ability and there is no recognized CPR for health related quality of life (HRQoL. We undertook a critical appraisal of the literature to identify key preoperative prognostic factors of clinical outcomes in patients with SSM who were treated surgically. The results of this study could be used to modify existing or develop new CPRs.Seven electronic databases were searched (1990-2015, without language restriction, to identify studies that performed multivariate analysis of preoperative predictors of survival, neurological, functional and HRQoL outcomes in surgical patients with SSM. Individual studies were assessed for class of evidence. The strength of the overall body of evidence was evaluated using GRADE for each predictor.Among 4,818 unique citations, 17 were included; all were in English, rated Class III and focused on survival, revealing a total of 46 predictors. The strength of the overall body of evidence was very low for 39 and low for 7 predictors. Due to considerable heterogeneity in patient samples and prognostic factors investigated as well as several methodological issues, our results had a moderately high risk of bias and were difficult to interpret.The quality of evidence for predictors of survival was, at best, low. We failed to identify studies that evaluated preoperative prognostic factors for neurological, functional, or HRQoL outcomes in surgical patients with SSM. We formulated methodological recommendations for prognostic studies to promote acquiring high-quality evidence to better estimate predictor effect sizes to improve patient education, surgical decision-making and development of CPRs.

  9. Phaeoacremonium parasiticum phaeohyphomycosis in a patient with systemic lupus erythematosus treated successfully with surgical debridement and voriconazole: A case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Rima I. El-Herte


    Full Text Available A 26-year old woman presented for evaluation of extensive edema, erythema, sinus tract formation and purulent drainage from the left lower extremity after trauma from a wooden object approximately three months prior. Skin biopsies and blood cultures revealed Phaeoacremonium parasiticum consistent with a diagnosis of phaeohyphomycosis. Despite hospitalization and initial treatment with several antifungals, including voriconazole, her infection progressed. Surgical debridement with split thickness skin grafting was performed. Subsequent clinical improvement allowed a transition from intravenous to oral voriconazole and discharge home. Seven months post presentation she remained on oral voriconazole with significant improvement and no clinical evidence of recurrence. This case illustrates an approach to management where aggressive debridement with split-thickness skin grafting and a prolonged course of intravenous and oral antifungals resulted in a good long-term outcome for the patient.


    NARCIS (Netherlands)


    To determine differences in maxillary and dentoalveolar relationships between untreated and treated patients having unilateral clefts of the lip and alveolus (UCLA) or lip and palate (UCLP), dental cast assessments were done on 70 untreated adult Indonesian patients (UCLA-I, UCLP-I) and 67 Dutch

  11. [Retrosternal luxation of the clavicle. Apropos of 4 cases surgically treated using a temporary screwed anterior plate and review of the literature]. (United States)

    Asfazadourian, H; Kouvalchouk, J F


    The authors report 4 new cases of retrosternal dislocation of the clavicle operated by capsular and ligament restoration, and temporary stabilization by anterior plating. The 4 patients were men with a mean age of 17.5 years. The lesion was caused by a sports injury (football, rugby) in 3 out of 4 cases and was related to an indirect mechanism. Clinical examination allowed the diagnosis, was related to based on painful palpation of a dip over the joint, supported by radiology and computed tomography. CT did not reveal the epiphyseal separation present in two cases. Complications were frequent: 1 case of tracheal compression, 2 cases of temporary paresthesia of the upper limb, 2 cases of venous compression with one case of subclavian and medial jugularis venous thrombosis, 1 hemopneumothorax. Surgical reduction was performed in all 4 cases after 2 failures of attempted orthopedic treatment under general anesthesia. All patients recovered a full range of movement, a painless shoulder and no recurrence has been observed. All complications resolved after reduction. Venous thrombosis responded favourably after 6 months of anticoagulant therapy. One plate breakage was observed with no clinical implications. On the basis of an extensive review of the literature, the authors discuss the epidemiology, pathology and the importance of associated injuries, which are frequent and sometimes serious, justifying urgent reduction. Computed tomography is the most useful radiologic modality, both for diagnosis and for investigation of complications. Orthopedic treatment must be attempted first (especially in children) according to a well systematized technique. One third of attempts fail, and cases of delayed diagnosis and serious vascular complications, then require surgical treatment. The costoclavicular ligament is repaired either by Burrows's ligamentoplasty or by bone suture; the clavicle is stabilized by bone suture or by anterior plating. The authors do not advocate either

  12. A Case of Idiopathic Retroperitoneal Fibrosis Associated With Sjögren's Syndrome. (United States)

    Droz, Nicole C; Mathew, Stephanie D


    After presenting with nonspecific symptoms, a 52-year-old female was found to have a 3.4 × 2.6 cm retroperitoneal mass resulting in hydronephrosis on abdominal computed tomography scan. After extensive workup including surgical debulking, excisional biopsy, and autoimmune panel, she was found to have idiopathic retroperitoneal fibrosis (IRF) with negative staining for immunoglogulin G4 (IgG4). Two years after presentation, the patient developed dyspnea, cough, and xerostomia. Repeat anti-Sjögren Syndrome A and anti-Sjögren Syndrome B titers and labial gland biopsy confirmed the diagnosis of concomitant Sjögren's syndrome (SS). The patient was treated with mycophenolate mofetil with improvement in her symptoms. Most cases of retroperitoneal fibrosis are associated with IgG4-related disease or other autoimmune disease. To our knowledge, this is only the second reported case of SS associated with IRF. Because symptoms of IRF are nonspecific, there is often a delay in diagnosis resulting in end-organ disease such as ureteral obstruction or hydronephrosis. Although IRF is uncommon, it should be considered in patients presenting with abdominal or flank pain, especially in patients with concomitant autoimmune disorders. Early recognition of disease can prevent end-organ damage and, as more cases are diagnosed, its relationship to SS may be elucidated leading to further advances in treatment and surveillance. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

  13. Levocetirizine and rupatadine in chronic idiopathic urticaria. (United States)

    Johnson, Madhulika; Kwatra, Gagandeep; Badyal, Dinesh K; Thomas, Emy A


    Chronic idiopathic urticaria (CIU) is a common dermatological condition. Its pathogenesis involves mainly histamine and also other mediators, including platelet-activating factor (PAF) and tumor necrosis factor-α (TNF-α). In the absence of an exact etiology, H1 -antihistaminics are the mainstay of treatment. Levocetirizine is widely prescribed for CIU. Rupatadine, a newer antihistaminic, has PAF receptor antagonist activity and has shown anti-TNF-α activity in vitro. These additional anti-inflammatory effects may improve its efficacy. This study was conducted to compare the efficacy and safety of rupatadine and levocetirizine, respectively, in CIU patients. A prospective, open, comparative, randomized study was conducted in 100 patients, of whom 50 were treated with levocetirizine and 50 were treated with rupatadine. Efficacy parameters used were urticarial activity score (UAS) and Dermatology Life Quality Index (DLQI) values. Safety was evaluated by monitoring for adverse drug reactions and by using the critical flicker fusion threshold (CFFT) test and a visual analog scale (VAS) at baseline, and at 2, 4, and 6 weeks. The mean UAS decreased to 0.10 in the levocetirizine group and to 0.38 in the rupatadine group. Patients in the levocetirizine group showed a more significant (P drugs caused mild sedation. © 2014 The International Society of Dermatology.

  14. [Comparative study on Chinese medical syndrome typing and treatment combined different surgical methods for treating clomiphene-resistant polycystic ovary syndrome]. (United States)

    Zeng, Lei; Zeng, Cheng; Tao, Li-Li


    To observe the therapeutic efficacy of Chinese medical syndrome typing and treatment combined cold needle puncture drainage operation or unipolar electrocoagulation drilling technique under laparoscope for treating clomiphene-resistant polycystic ovary syndrome (PCOS). Forty infertility patients with clomiphene-resistant PCOS were assigned to two groups using stratified random sampling method according to age, infertility time, and body mass index, 20 in each group. Patients in Group A were treated with Chinese medical syndrome typing and treatment combined cold needle puncture drainage operation, while those in Group B were treated with Chinese medical syndrome typing and treatment combined unipolar electrocoagulation drilling technique. After operation Chinese herbal treatment was administered to all patients according to syndrome typing. The serum levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), androgen (T), estradiol (E2), and prolactin (PRL) were determined before and after operation. The ovulation was monitored. The pregnancy rate and the pregnancy outcomes were recorded after operation. There was no statistical difference in the 3-month spontaneous ovulation rate or the 1-year pregnancy rate (P > 0.05). The levels of LH, T, and PRL were significantly lower after operation than before operation in the two groups (P typing and treatment combined cold needle puncture drainage operation or unipolar electrocoagulation drilling technique could effectively promote the ovulation. The two methods showed similar therapeutic effects.

  15. Adolescent Idiopathic Scoliosis Treatment by a Korean Neurosurgeon: The Changing Role for Neurosurgeons


    Hyun, Seung-Jae; Kim, Woong-Beom; Park, Young-Seop; Kim, Ki-Jeong; Jahng, Tae-Ahn; Kim, Yongjung J.


    Objective The purpose of this study was to evaluate radiographic/clinical outcomes of adolescent idiopathic scoliosis (AIS) patients treated by a Korean neurosurgeon. Methods Ten AIS patients were treated by a single neurosurgeon between January 2011 and September 2013 utilizing segmental instrumentation with pedicle screws. Basic demographic information, curve pattern by Lenke classification, number of levels treated, amount of correction achieved, radiographic/clinical outcomes [by Scolisis...

  16. Chronic Idiopathic Urticaria (CIU) is no longer idiopathic

    DEFF Research Database (Denmark)

    Maurer, M; Bindslev-Jensen, C; Gimenez-Arnau, A


    During recent years our knowledge of the aetiology and pathogenesis of urticaria has advanced considerably allowing us to better characterize urticaria subtypes. However, although the classification of urticaria has undergone some revisions during this time (1), authors still use different names...... for the same type of urticaria, which has implications for comparing study outcomes and drug licensing. Consequently, there is an urgent need for a harmonized and universally accepted nomenclature and classification of urticaria and to avoid the routine use of the outdated aetiological term, chronic idiopathic...... urticaria (CIU)....

  17. Idiopathic nodular glomerulosclerosis- a rare case

    Directory of Open Access Journals (Sweden)

    Jazmin I. Yepez Kuri


    Full Text Available Nodular glomerulosclerosis is considered a signature lesion of diabetes nephropathy, but when it occurs in the absence of diabetes, it is called Idiopathic Nodular Glomerulosclerosis (ING. Idiopathic nodular glomerulosclerosis is a very rare disease and has been associated with obesity, hypertension, and smoking. We report a case of ING presenting as end-stage renal failure requiring hemodialysis.

  18. Evaluation of the prevalence of concomitant idiopathic cyclic edema and cellulite. (United States)

    de Godoy, José Maria Pereira; de Godoy, Maria de Fátima Guerreiro


    The aim of this study was to evaluate the prevalence of concomitant idiopathic cyclic edema with Grade II and III cellulite. All patients treated for Grade II and III cellulite were evaluated for idiopathic cyclic edema in a retrospective, quantitative and cross-sectional study. The study was carried out at the Godoy Clinic in the period from 2006 to 2010. All patients with body mass indexes > 25, Grade I cellulite and other causes of edema were excluded. The diagnosis of idiopathic cyclic edema was based on a clinical history and fluid retention throughout the day, in particular difficulty in removing rings on waking in the morning which improves later in the day. All patients with cyclic edema were treated with 75 mg aminaphtone three times daily. Statistical analysis considered the frequency of edema. Of the 82 women evaluated with ages between 18 and 58 years old (mean of 34.9 years) 41 (50.0%) were diagnosed with idiopathic cyclic edema. Idiopathic cyclic edema is an aggravating factor for cellulite and is frequently associated with the more advanced stages of the disease. Its control is essential in the treatment of cellulite.

  19. Adolescent idiopathic scoliosis: Indications and efficacy of nonoperative treatment

    Directory of Open Access Journals (Sweden)

    Federico Canavese


    Full Text Available The strategy for the treatment of idiopathic scoliosis depends essentially upon the magnitude and pattern of the deformity, and its potential for progression. Treatment options include observation, bracing and/or surgery. During the past decade, several studies have demonstrated that the natural history of adolescent idiopathic scoliosis can be positively affected by nonoperative treatment, especially bracing. Other forms of conservative treatment, such as chiropractic or osteopathic manipulation, acupuncture, exercise or other manual treatments, or diet and nutrition, have not yet been proven to be effective in controlling spinal deformity progression, and those with a natural history that is favorable at the completion of growth. Observation is appropriate treatment for small curves, curves that are at low risk of progression, and those with a natural history that is favorable at the completion of growth. Indications for brace treatment are a growing child presenting with a curve of 25°-40° or a curve less than 25° with documented progression. Curves of 20°-25° in patients with pronounced skeletal immaturity should also be treated. The purpose of this review is to provide information about conservative treatment of adolescent idiopathic scoliosis. Indications for conservative treatment, hours daily wear and complications of brace treatment as well as brace types are discussed.

  20. Adolescent idiopathic scoliosis: Indications and efficacy of nonoperative treatment. (United States)

    Canavese, Federico; Kaelin, André


    The strategy for the treatment of idiopathic scoliosis depends essentially upon the magnitude and pattern of the deformity, and its potential for progression. Treatment options include observation, bracing and/or surgery. During the past decade, several studies have demonstrated that the natural history of adolescent idiopathic scoliosis can be positively affected by nonoperative treatment, especially bracing. Other forms of conservative treatment, such as chiropractic or osteopathic manipulation, acupuncture, exercise or other manual treatments, or diet and nutrition, have not yet been proven to be effective in controlling spinal deformity progression, and those with a natural history that is favorable at the completion of growth. Observation is appropriate treatment for small curves, curves that are at low risk of progression, and those with a natural history that is favorable at the completion of growth. Indications for brace treatment are a growing child presenting with a curve of 25°-40° or a curve less than 25° with documented progression. Curves of 20°-25° in patients with pronounced skeletal immaturity should also be treated. The purpose of this review is to provide information about conservative treatment of adolescent idiopathic scoliosis. Indications for conservative treatment, hours daily wear and complications of brace treatment as well as brace types are discussed.

  1. Biofeedback for treatment of chronic idiopathic constipation in adults. (United States)

    Woodward, Sue; Norton, Christine; Chiarelli, Pauline


    Biofeedback therapy has been used to treat the symptoms of people with chronic constipation referred to specialist services within secondary and tertiary care settings. However, different methods of biofeedback are used within different centres and the magnitude of suggested benefits and comparable effectiveness of different methods of biofeedback has yet to be established. To determine the efficacy and safety of biofeedback for the treatment of chronic idiopathic (functional) constipation in adults. We searched the following databases from inception to 16 December 2013: CENTRAL, the Cochrane Complementary Medicine Field, the Cochrane IBD/FBD Review Group Specialized Register, MEDLINE, EMBASE, CINAHL, British Nursing Index, and PsychINFO. Hand searching of conference proceedings and the reference lists of relevant articles was also undertaken. All randomised trials evaluating biofeedback in adults with chronic idiopathic constipation were considered for inclusion. The primary outcome was global or clinical improvement as defined by the included studies. Secondary outcomes included quality of life, and adverse events as defined by the included studies. Where possible, we calculated the risk ratio (RR) and corresponding 95% confidence interval (CI) for dichotomous outcomes and the mean difference (MD) and 95% CI for continuous outcomes. We assessed the methodological quality of included studies using the Cochrane risk of bias tool. The overall quality of the evidence supporting each outcome was assessed using the GRADE criteria. Seventeen eligible studies were identified with a total of 931 participants. Most participants had chronic constipation and dyssynergic defecation. Sixteen of the trials were at high risk of bias for blinding. Attrition bias (4 trials) and other potential bias (5 trials) was also noted. Due to differences between study populations, the heterogeneity of the different samples and large range of different outcome measures, meta-analysis was not

  2. The Effects of Prognostic Factors in Idiopathic Sudden Hearing Loss. (United States)

    Bulğurcu, Suphi; Şahin, Behçet; Akgül, Gökhan; Arslan, İlker Burak; Çukurova, İbrahim


    Introduction  Sudden hearing loss is one of the otologic emergencies. The treatment of this disease is affected negatively by some prognostic factors. Objective  In this study, the effects of early treatment initiation in patients with idiopathic sudden hearing loss and of prognostic factors in early treated patients were investigated. Methods  Out of the 216 patients admitted between September 2007 and September 2015, 154 were identified as having idiopathic sudden hearing loss; they were followed-up for a mean time of 7.4 months, and evaluated retrospectively. The effects of several parameters on the success of the treatment were statistically evaluated, such as the time the treatment was initiated, being of the female gender, the severity of the hearing loss, having descending type audiogram patterns, being older than 60 years old, and the co-presence of vertigo. Results  Success rates were found to be significantly higher in idiopathic hearing loss patients that were admitted within the first week ( p  hearing loss. However, the outcomes were found to be similar when patients admitted within the first 3 days and 4-7 days after the occurrence of the hearing loss were compared ( p  > 0.05). Parameters such as female gender, severe hearing loss, descending type audiogram, being older than 60 years old, and co-presence of vertigo didn't reveal statistically significant effects on the outcome ( p >0.05). Conclusion  The aforementioned prognostic factors, which are well-known in the literature, did not have significant effects when the idiopathic sudden hearing loss treatment was initiated within the first 7 days of the onset of the hearing loss.

  3. 5-Year Reoperation Risk and Causes for Revision After Idiopathic Scoliosis Surgery. (United States)

    Ahmed, Syed Imraan; Bastrom, Tracey P; Yaszay, Burt; Newton, Peter O


    An actuarial "survivorship" analysis. The aim of this study was to define the incidence and cause of surgical revision 5 years after scoliosis surgery. Data on contemporary revision surgery rates after idiopathic scoliosis surgery beyond the 2 years postoperatively in the adolescent and young adult population are limited. Patients enrolled in a prospective, multicenter, idiopathic scoliosis surgical registry from 1995 to 2009 were reviewed. Any spine reoperation was defined as a "terminal event." An actuarial survivorship analysis that adjusts for patients lost to follow-up was performed to determine cumulative survival. Time intervals were defined as 0 to scoliosis continue to occur well after 2 years with a 5-year survivorship of 93.9%. Reasons for reoperation are not uniformly distributed over time, with implant-related issues and infection the leading cause for early revision, while late infection was the most common cause after 2 years. Long-term follow-up of these postoperative patients remains important. 3.

  4. Outcome in hip fracture patients related to anemia at admission and allogeneic blood transfusion: an analysis of 1262 surgically treated patients

    Directory of Open Access Journals (Sweden)

    Vochteloo Anne JH


    Full Text Available Abstract Background Anemia is more often seen in older patients. As the mean age of hip fracture patients is rising, anemia is common in this population. Allogeneic blood transfusion (ABT and anemia have been pointed out as possible risk factors for poorer outcome in hip fracture patients. Methods In the timeframe 2005-2010, 1262 admissions for surgical treatment of a hip fracture in patients aged 65 years and older were recorded. Registration was prospective from 2008 on. Anemic and non-anemic patients (based on hemoglobin level at admission were compared regarding clinical characteristics, mortality, delirium incidence, LOS, discharge to a nursing home and the 90-day readmission rate. Receiving an ABT, age, gender, ASA classification, type of fracture and anesthesia were used as possible confounders in multivariable regression analysis. Results The prevalence of anemia and the rate of ABT both were 42.5%. Anemic patients were more likely to be older and men and had more often a trochanteric fracture, a higher ASA score and received more often an ABT. In univariate analysis, the 3- and 12-month mortality rate, delirium incidence and discharge to a nursing home rate were significantly worse in preoperatively anemic patients. In multivariable regression analysis, anemia at admission was a significant risk factor for discharge to a nursing home and readmission Conclusions This study has demonstrated that anemia at admission and postoperative anemia needing an ABT (PANT were independent risk factors for worse outcome in hip fracture patients. In multivariable regression analysis, anemia as such had no effect on mortality, due to a rescue effect of PANT. In-hospital, 3- and 12-month mortality was negatively affected by PANT, with the main effect in the first 3 months postoperatively.

  5. Sino-orbital osteoma: a clinicopathologic study of 45 surgically treated cases with emphasis on tumors with osteoblastoma-like features. (United States)

    McHugh, Jonathan B; Mukherji, Suresh K; Lucas, David R


    Osteomas are limited almost exclusively to craniofacial and jaw bones. Histologically, they can be divided into ivory, mature, or mixed types. Osteomas may have osteoblastoma-like areas and distinguishing it from true osteoblastoma can be challenging. Some believe osteomas with osteoblastoma-like features behave more aggressively. To perform a clinicopathologic comparison of sino-orbital osteomas both with and without osteoblastoma-like features. We studied 45 surgically excised sino-orbital osteomas. Tumors were categorized as ivory, mature, or mixed type and presence of osteoblastoma-like areas and Paget-like bone were noted. Clinical features of those with and without osteoblastoma-like areas were compared. Men outnumbered women (3:2); median age was 37 years. Frontal sinus was the most common location (62%) followed by ethmoid and maxillary sinuses. Twelve tumors (27%) involved the orbit, 2 primarily and 10 secondarily. All cases were symptomatic with headache, sinusitis, visual changes, pain, and proptosis being most common. Seventeen tumors (38%) had osteoblastoma-like areas. Extension into an adjacent sinus/anatomic compartment was more common in osteoblastoma-like tumors (47% versus 29%), including more frequent orbital involvement (41% versus 13%). Visual changes were more frequent in the osteoblastoma-like group. Distribution of histologic subtypes and Paget-like bone were similar between the 2 groups. Osteomas with osteoblastoma-like features were more often incompletely excised (25% versus 14%). However, clinical recurrence was less common (8% versus 27%). Osteoblastoma-like features are common in sino-orbital osteomas, but it does not correlate with more adverse clinical features or worse outcome. Osteoblastoma-like areas appear to represent active remodeling within an osteoma rather than defining a distinct clinicopathologic entity. Distinguishing it from osteoblastoma may require careful histologic evaluation and radiographic correlation.

  6. Cytoplasmic Hu-Antigen R (HuR) Expression is Associated with Poor Survival in Patients with Surgically Resected Cholangiocarcinoma Treated with Adjuvant Gemcitabine-Based Chemotherapy. (United States)

    Toyota, Kazuhiro; Murakami, Yoshiaki; Kondo, Naru; Uemura, Kenichiro; Nakagawa, Naoya; Takahashi, Shinya; Sueda, Taijiro


    Hu-antigen R (HuR) is an RNA-binding protein that regulates the stability, translation, and nucleus-to-cytoplasm translocation of messenger RNAs (mRNAs). The aim of this study was to investigate the prognostic significance of HuR in cholangiocarcinoma patients who received adjuvant gemcitabine-based chemotherapy (AGC) after surgical resection. Nuclear and cytoplasmic HuR expression was investigated immunohistochemically in 131 patients with resected cholangiocarcinoma, including 91 patients administered AGC and 40 patients who did not receive adjuvant chemotherapy. The correlation between HuR expression and survival was evaluated by statistical analysis. High nuclear and cytoplasmic HuR expression was observed in 67 (51%) and 45 (34%) patients, respectively. Cytoplasmic HuR expression was significantly associated with lymph node metastasis (p < 0.01), while high cytoplasmic HuR expression was significantly associated with poor disease-free survival [DFS] (p = 0.03) and overall survival [OS] (p = 0.001) in the 91 patients who received AGC, but not in the 40 patients who did not receive AGC (DFS p = 0.17; OS p = 0.07). In the multivariate analysis of patients who received AGC, high cytoplasmic HuR expression was an independent predictor of poor DFS (hazard ratio [HR] 1.77; p = 0.04) and OS (HR 2.09; p = 0.02). Nuclear HuR expression did not affect the survival of enrolled patients. High cytoplasmic HuR expression was closely associated with the efficacy of AGC in patients with cholangiocarcinoma. The current findings warrant further investigations to optimize adjuvant chemotherapy regimens for resectable cholangiocarcinoma.

  7. Preoperative neutrophil-lymphocyte and platelet-lymphocyte ratios as independent predictors of cervical stromal involvement in surgically treated endometrioid adenocarcinoma

    Directory of Open Access Journals (Sweden)

    Wang D


    Full Text Available Dan Wang, Jia-Xin Yang, Dong-Yan Cao, Xi-Run Wan, Feng-Zhi Feng, Hui-Fang Huang, Keng Shen, Yang Xiang Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China Background: The purpose of this study was to evaluate the relationship between preoperative inflammatory markers (neutrophil-lymphocyte ratio and platelet-lymphocyte ratio and cervical stromal involvement in patients with endometrioid adenocarcinoma. Methods: We studied 318 patients with endometrioid adenocarcinoma who underwent comprehensive surgical staging. We used univariate and multivariate analyses of cervical stromal involvement and receiver-operating curves to calculate optimal cutoff values for neutrophil-lymphocyte and platelet-lymphocyte ratios to predict cervical stromal involvement. Results: The presence of cervical stromal involvement was associated with neutrophil-lymphocyte ratio and platelet-lymphocyte ratio (P = 0.009 and P = 0.031, respectively. Multivariate analysis showed that higher neutrophil-lymphocyte and platelet-lymphocyte ratios independently predicted cervical stromal involvement (odds ratio 3.10, 95% confidence interval 1.10–8.76, P = 0.032, and odds ratio 5.27, 95% confidence interval 1.94–14.35, P = 0.001, respectively. At a threshold of 2.01, the neutrophil-lymphocyte ratio was 71.0% sensitive and 63.8% specific for stromal involvement; at a 172.24 threshold, the platelet-lymphocyte ratio was 48.4% sensitive and 88.9% specific. Conclusion: Preoperative neutrophil-lymphocyte and platelet-lymphocyte ratios can help identify the risk of cervical stromal involvement in patients with endometrial cancer. Evaluating these ratios may help select patients who should be particularly watched and tested for cervical stromal involvement. Keywords: neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, endometrioid adenocarcinoma

  8. Prevalence of postoperative pain in adolescent idiopathic scoliosis and the association with preoperative pain. (United States)

    Bastrom, Tracey P; Marks, Michelle C; Yaszay, Burt; Newton, Peter O


    Review of a prospective database registry of surgical patients with adolescent idiopathic scoliosis (AIS). The purpose of this study was to examine the prevalence of postoperative pain and its impact on patient-reported postoperative outcomes using the Scoliosis Research Society (SRS)-22 outcomes questionnaire. Although reportedly rare, postoperative pain can be a devastating situation for the patient with AIS. Most recent studies examining outcomes in AIS surgical treatment use the SRS Pain domain score to assess pain in this population. A prospectively enrolled multicenter database was queried. Patients with minimum 2-year follow-up and 2-year SRS scores were included. Postoperative pain after the acute phase of recovery when reported by the patient to the treating surgeon/clinical team in follow-up is recorded as a complication in the database. Patients included in this series were grouped as either reporting pain or not to the surgeon/clinical team postoperatively. Pre- and postoperative SRS scores were then compared between these 2 groups using analysis of variance (P imaging). These 41 patients had significantly decreased 2-year SRS scores in the domains of Pain, Self-image, Mental health, and Total score (P 0.05). Unexplained pain after the 6-month postoperative period occurred in 7% of the cohort. The results indicate that patients reporting pain to their surgeons/clinical team postoperatively have lower pain scores on a subjective outcome instrument thus further validating the SRS-22 outcome tool. This reported pain seems to be associated with decreases in other SRS-22 domains. Interestingly, these patients also have lower preoperative pain scores than those without postoperative pain. Study into causes of pain in AIS and whether preoperative education and expectations targeted at this population would positively impact outcomes is warranted, especially because on average patients after AIS surgery have less pain. 3.

  9. Wind turbines and idiopathic symptoms

    DEFF Research Database (Denmark)

    Blanes-Vidal, Victoria; Schwartz, Joel


    Whether or not wind turbines pose a risk to human health is a matter of heated debate. Personal reactions to other environmental exposures occurring in the same settings as wind turbines may be responsible of the reported symptoms. However, these have not been accounted for in previous studies. We...... investigated whether there is an association between residential proximity to wind turbines and idiopathic symptoms, after controlling for personal reactions to other environmental co-exposures. We assessed wind turbine exposures in 454 residences as the distance to the closest wind turbine (Dw) and number...... of wind turbines

  10. Idiopathic focal epilepsies: the "lost tribe". (United States)

    Pal, Deb K; Ferrie, Colin; Addis, Laura; Akiyama, Tomoyuki; Capovilla, Giuseppe; Caraballo, Roberto; de Saint-Martin, Anne; Fejerman, Natalio; Guerrini, Renzo; Hamandi, Khalid; Helbig, Ingo; Ioannides, Andreas A; Kobayashi, Katsuhiro; Lal, Dennis; Lesca, Gaetan; Muhle, Hiltrud; Neubauer, Bernd A; Pisano, Tiziana; Rudolf, Gabrielle; Seegmuller, Caroline; Shibata, Takashi; Smith, Anna; Striano, Pasquale; Strug, Lisa J; Szepetowski, Pierre; Valeta, Thalia; Yoshinaga, Harumi; Koutroumanidis, Michalis


    The term idiopathic focal epilepsies of childhood (IFE) is not formally recognised by the ILAE in its 2010 revision (Berg et al., 2010), nor are its members and boundaries precisely delineated. The IFEs are amongst the most commonly encountered epilepsy syndromes affecting children. They are fascinating disorders that hold many "treats" for both clinicians and researchers. For example, the IFEs pose many of the most interesting questions central to epileptology: how are functional brain networks involved in the manifestation of epilepsy? What are the shared mechanisms of comorbidity between epilepsy and neurodevelopmental disorders? How do focal EEG discharges impact cognitive functioning? What explains the age-related expression of these syndromes? Why are EEG discharges and seizures so tightly locked to slow-wave sleep? In the last few decades, the clinical symptomatology and the respective courses of many IFEs have been described, although they are still not widely appreciated beyond the specialist community. Most neurologists would recognise the core syndromes of IFE to comprise: benign epilepsy of childhood with centro-temporal spikes or Rolandic epilepsy (BECTS/RE); Panayiotopoulos syndrome; and the idiopathic occipital epilepsies (Gastaut and photosensitive types). The Landau-Kleffner syndrome and the related (idiopathic) epilepsy with continuous spikes and waves in sleep (CSWS or ESES) are also often included, both as a consequence of the shared morphology of the interictal discharges and their potential evolution from core syndromes, for example, CSWS from BECTS. Atypical benign focal epilepsy of childhood also has shared electro-clinical features warranting inclusion. In addition, a number of less well-defined syndromes of IFE have been proposed, including benign childhood seizures with affective symptoms, benign childhood epilepsy with parietal spikes, benign childhood seizures with frontal or midline spikes, and benign focal seizures of adolescence. The

  11. Protocolo quirúrgico en la reconstrucción de la parálisis facial: nuestra experiencia tras 140 casos tratados Protocol in surgical treatment of facial paralysis after 140 treated cases

    Directory of Open Access Journals (Sweden)

    B. Hontanilla Calatayud


    Full Text Available El objetivo de este trabajo es presentar nuestro protocolo de actuación en el tratamiento quirúrgico de la parálisis facial tras 140 casos tratados entre los años 2000 y 2007. Este protocolo está basado en los resultados obtenidos con un nuevo sistema de captura del movimiento facial en 3D denominado "Facial Clima", que puede ser considerado como un método objetivo de medición de los resultados en la cirugía de reanimación facial. Así podría compararse en pacientes con parálisis facial, la efectividad de los tratamientos entre distintos centros. Exponemos los resultados obtenidos tanto a nivel de la reconstrucción de la sonrisa como a nivel palpebral.The aim of this study is to present our protocol in the surgical treatment of facial paralysis after 140 treated cases since 2000 to 2007. The protocol is based on the results obtained with a new 3-D capture system of the facial movement called "Facial Clima", that could be considered as the adequate tool to assess the outcome of the facial paralysis reanimation surgery. Thus, patients with facial paralysis could be compared among surgical centres such that effectiveness of facial reanimation operations could be evaluated. The results obtained are exposed for smile and lid reconstruction.

  12. Outcome in hip fracture patients related to anemia at admission and allogeneic blood transfusion: an analysis of 1262 surgically treated patients. (United States)

    Vochteloo, Anne J H; Borger van der Burg, Boudewijn L S; Mertens, Bart J A; Niggebrugge, Arthur H P; de Vries, Mark R; Tuinebreijer, Wim E; Bloem, Rolf M; Nelissen, Rob G H H; Pilot, Peter


    Anemia is more often seen in older patients. As the mean age of hip fracture patients is rising, anemia is common in this population. Allogeneic blood transfusion (ABT) and anemia have been pointed out as possible risk factors for poorer outcome in hip fracture patients. In the timeframe 2005-2010, 1262 admissions for surgical treatment of a hip fracture in patients aged 65 years and older were recorded. Registration was prospective from 2008 on. Anemic and non-anemic patients (based on hemoglobin level at admission) were compared regarding clinical characteristics, mortality, delirium incidence, LOS, discharge to a nursing home and the 90-day readmission rate. Receiving an ABT, age, gender, ASA classification, type of fracture and anesthesia were used as possible confounders in multivariable regression analysis. The prevalence of anemia and the rate of ABT both were 42.5%. Anemic patients were more likely to be older and men and had more often a trochanteric fracture, a higher ASA score and received more often an ABT. In univariate analysis, the 3- and 12-month mortality rate, delirium incidence and discharge to a nursing home rate were significantly worse in preoperatively anemic patients.In multivariable regression analysis, anemia at admission was a significant risk factor for discharge to a nursing home and readmission classification were independent risk factors for mortality at all moments, only the mortality rate for the 3-12 month interval was not influenced by ABT. An indication for an ABT was the largest negative contributor to a longer LOS (OR 2.26, 95% CI 1.73-2.94) and the second largest for delirium (OR 1.67, 95% CI 1.28-2.20). This study has demonstrated that anemia at admission and postoperative anemia needing an ABT (PANT) were independent risk factors for worse outcome in hip fracture patients. In multivariable regression analysis, anemia as such had no effect on mortality, due to a rescue effect of PANT. In-hospital, 3- and 12-month mortality

  13. Cat-eye syndrome with isolated idiopathic hypogonadotropic hypogonadism. (United States)

    Matsumoto, Ryusuke; Shimizu, Chikara; Nagai, So; Taniguchi, Satoshi; Umetsu, Masaaki; Kimura, Yasunori; Atsumi, Toshiya; Yoshioka, Narihito; Kubo, Mitsumasa; Koike, Takao


    A 34-year-old Japanese man diagnosed as having cat-eye syndrome (CES) with isolated idiopathic hypogonadotropic hypogonadism (IHH) was treated at our university. He showed preauricular pits/tags, downward slanting palpebral fissures, ocular hypertelorism, and strabismus. However, ocular coloboma and anal atresia, major characteristic features of CES, were negative. Chromosomal analysis revealed malformation in chromosome 22 and eunuchoid features and a low grade development of secondary sexual characteristics were also evident. Endocrinological examinations revealed that this patient was in a state of isolated IHH. Although CES with IHH is extremely rare, endocrine disorders should be given due attention.

  14. [Treatment of idiopathic peripheral facial nerve paralysis (Bell's palsy)]. (United States)

    Meyer, Martin Willy; Hahn, Christoffer Holst


    Bell's palsy is defined as an idiopathic peripheral facial nerve paralysis of sudden onset. It affects 11-40 persons per 100,000 per annum. Many patients recover without intervention; however, up to 30% have poor recovery of facial muscle control and experience facial disfigurement. The aim of this study was to make an overview of which pharmacological treatments have been used to improve outcomes. The available evidence from randomized controlled trials shows significant benefit from treating Bell's palsy with corticosteroids but shows no benefit from antivirals.

  15. Is It Necessary to Specifically Define the Cause of Surgically Treated Biliary Tract Infections? A Rare Case of Raoultella planticola Cholecystitis and Literature Review

    Directory of Open Access Journals (Sweden)

    Suat Can Ulukent


    Full Text Available Raoultella planticola is an aquatic and soil organism that does not notoriously cause invasive infections in humans. Infections in the literature are limited only in case reports. We present a very rare case of R. planticola cholecystitis. A 71-year-old female patient with abdominal pain was diagnosed with acute cholecystitis. Patient received intravenous antibiotic treatment, but the treatment failed and the patient underwent an open cholecystectomy. The final pathological result was gangrenous cholecystitis complicated with R. planticola. Eventually, the patient recovered with appropriate antimicrobial therapy. Patients with acute cholecystitis are usually treated without any microbiological sampling and antibiotic treatment is started empirically. To date, there have only been 5 reported biliary system related R. planticola infections in humans. We believe that Raoultella species might be a more frequent agent than usually thought, especially in resistant cholecystitis cases. Resistant strains should be considered as a possible causative organism when the patient’s condition worsened despite proper antimicrobial therapy. It should be considered safe to send microbiological samples for culture and specifically define the causative microorganisms even in the setting of a cholecystectomized patient.


    Directory of Open Access Journals (Sweden)

    Elitsa G. Deliverska


    Full Text Available Purpose: The goal of this material was to be an example of the complications that can occur in cases of zygoma fractures and to draw the attention of the clinicians to the need of accurate diagnose and early treatment of the associated with zygoma fractures traumas. Materials and methods: Medical records of 276 patients with different traumas in face and neck area treated in our department ware reviewed. Of those 64 suffered from zygoma fractures and they ware classified according to age, sex, cause of trauma, presence or absence of associated trauma, etc.Results: As other studies also show, we determined that the most common cause of injury was assault and road accidents, fallowed by sport, industrial, etc. Males between 20 and 40 years old ware the biggest group of patients, often after alcohol consumption.Associated traumas occurred more frequently in cases of motor vehicle accident than in other cases and ware presented by closed head trauma, ophthalmologic problems, extremities fractures, etc.Conclusion: Delayed treatment of zygoma injuries is feasible and yields in good results when the severity of trauma needs it, but early repair of such injuries prevent late complications and should be preferred when possible.

  17. Surgical Audit

    African Journals Online (AJOL)


    Jan 6, 2010 ... A good way to describe the first surgical audits is that they were 'polite, restrained discussions'. This was the situation before the development of quality assurance in the business world. As this slowly infiltrated into the medical profession the discussions changed to more cri- teria based surgical audits.

  18. US diagnosis of idiopathic hypertrophic pyloric stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Oh, Yeon Hee; Park, Soo Soung [Pohang Hospital Dongguk University, Pohang (Korea, Republic of); Woo, Seong Ku [Dongsan Medical Center, Keimyung University, Daegu (Korea, Republic of)


    Idiopathic hypertrophic pyloric stenosis (IHPS) is one of the most common causes of persistent nonbilous vomiting in early infancy. The authors retrospectively studied 123 patients with nonbilous vomiting and analyzed the ultrasonographic findings of 51 cases of surgically proven IHPS. No false negative or false positive cases by ultrasonography were confirmed by follow-up clinical observation. US was performed with real-time scanners equipped with a 5MHz transducer (Acuson 128) and a 10MHz transducer (Spectra, Diasonic). All symptomatic infants were first screened in as supine position to determine the amount of gastric retention. The pylorus was imaged most often with the infants in the right decubitus 30-degree position. To improve imaging of the pylorus, if necessary, the infants were fed E-solution (60-100cc) and then examined. The average sonographic measurements of pyloric muscle thickness (MT), pyloric diameter (PD), and pyloric canal length (PL) were 5.46mm (range 3.6-7.9mm), 15.4mm (range 12.0-18.3mm), and 22.58mm, (range 18.0-29.9mm). The ratio of pyloric muscle thickness to the pylorus (MT/PD) was 0.36 (range 0.22-0.55). With these measurements, the authors considered the hypertrophic pyloric muscle and the elongated pylorus as a cylinder, and so the pyloric volume was calculated. The pyloric volume (PV), which was equated to 1/4 {pi} xPD{sup 2}xPL, was 4.24mL (range 2.62-6.36mL). It was concluded that high-resolution, real-time sonography is a simple and accurate method for the diagnosis of IHPS and should be the initial imaging modality.

  19. Unexplained childhood anaemia: idiopathic pulmonary hemosiderosis. (United States)

    Siu, K K; Li, Rever; Lam, S Y


    This report demonstrates pulmonary haemorrhage as a differential cause of anaemia. Idiopathic pulmonary hemosiderosis is a rare disease in children; it is classically described as a triad of haemoptysis, pulmonary infiltrates on chest radiograph, and iron-deficiency anaemia. However, anaemia may be the only presenting feature of idiopathic pulmonary hemosiderosis in children due to occult pulmonary haemorrhage. In addition, the serum ferritin is falsely high in idiopathic pulmonary hemosiderosis which increases the diagnostic difficulty. We recommend that pulmonary haemorrhage be suspected in any child presenting with iron-deficiency anaemia and persistent bilateral pulmonary infiltrates.

  20. Adolescent idiopathic scoliosis – to operate or not? A debate article

    Directory of Open Access Journals (Sweden)

    Goodall Deborah


    Full Text Available Abstract Adolescent idiopathic scoliosis (AIS represents a rare condition with a potentially detrimental impact on young patients. Despite vast clinical research and published treatment guidelines and algorithms, the optimal therapeutic choice for these patients remains highly controversial. While advocates of early surgery emphasize the benefits of surgical deformity correction with regard to physical and psychological outcome, the opponents base their arguments on the high risk of complications and a lack of documented subjective long-term outcome. In the present paper, the authors were invited to debate the opposite positions of "pro" versus "contra" surgical treatment of AIS, based on the currently available evidence and published guidelines.

  1. A systematic approach for the diagnosis and treatment of idiopathic peptic ulcers. (United States)

    Chung, Chen-Shuan; Chiang, Tsung-Hsien; Lee, Yi-Chia


    An idiopathic peptic ulcer is defined as an ulcer with unknown cause or an ulcer that appears to arise spontaneously. The first step in treatment is to exclude common possible causes, including Helicobacter pylori infection, infection with other pathogens, ulcerogenic drugs, and uncommon diseases with upper gastrointestinal manifestations. When all known causes are excluded, a diagnosis of idiopathic peptic ulcer can be made. A patient whose peptic ulcer is idiopathic may have a higher risk for complicated ulcer disease, a poorer response to gastric acid suppressants, and a higher recurrence rate after treatment. Risk factors associated with this disease may include genetic predisposition, older age, chronic mesenteric ischemia, smoking, concomitant diseases, a higher American Society of Anesthesiologists score, and higher stress. Therefore, the diagnosis and management of emerging disease should systematically explore all known causes and treat underlying disease, while including regular endoscopic surveillance to confirm ulcer healing and the use of proton-pump inhibitors on a case-by-case basis.

  2. The use of infliximab in a patient with idiopathic granulomatous hepatitis (United States)

    Kapoor, Sabrina Reenu; Snowden, Neil


    We report a therapeutic response to infliximab in a patient with idiopathic granulomatous hepatitis resistant to treatment with methotrexate and corticosteroids. A 41-year-old woman presented with a 12-month history of fever, night sweat, gross hepatomegaly and 13 kg weight loss. Infection and malignancy were carefully excluded and a liver biopsy showed changes consistent with idiopathic granulomatous hepatitis. The patient was treated with high dose steroids and methotrexate, but her clinical symptoms and biochemical and radiological signs did not settle. Introduction of infliximab led to rapid and sustained resolution of symptoms, hepatomegaly and liver function tests (LFTs) after 1 year of follow-up. To our knowledge this is the first successful use of infliximab in idiopathic granulomatous hepatitis. PMID:21686858

  3. Auditory verbal memory and psychosocial symptoms are related in children with idiopathic epilepsy. (United States)

    Schaffer, Yael; Ben Zeev, Bruria; Cohen, Roni; Shuper, Avinoam; Geva, Ronny


    Idiopathic epilepsies are considered to have relatively good prognoses and normal or near normal developmental outcomes. Nevertheless, accumulating studies demonstrate memory and psychosocial deficits in this population, and the prevalence, severity and relationships between these domains are still not well defined. We aimed to assess memory, psychosocial function, and the relationships between these two domains among children with idiopathic epilepsy syndromes using an extended neuropsychological battery and psychosocial questionnaires. Cognitive abilities, neuropsychological performance, and socioemotional behavior of 33 early adolescent children, diagnosed with idiopathic epilepsy, ages 9-14years, were assessed and compared with 27 age- and education-matched healthy controls. Compared to controls, patients with stabilized idiopathic epilepsy exhibited higher risks for short-term memory deficits (auditory verbal and visual) (pmemory deficits (pauditory verbal long-term memory deficits (pauditory verbal memory deficits was related to severity of psychosocial symptoms among the children with epilepsy but not in the healthy controls. Results suggest that deficient auditory verbal memory may be compromising psychosocial functioning in children with idiopathic epilepsy, possibly underscoring that cognitive variables, such as auditory verbal memory, should be assessed and treated in this population to prevent secondary symptoms. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Metastatic spinal cord compression from basal cell carcinoma of the skin treated with surgical decompression and vismodegib: case report and review of Hedgehog signalling pathway inhibition in advanced basal cell carcinoma. (United States)

    McGrane, J; Carswell, S; Talbot, T


    We report a case of a 66-year-old man with locally advanced and metastatic basal cell carcinoma (BCC) causing spinal cord compression, which was treated with spinal surgery and subsequent vismodegib. The patient presented with a large fungating chest wall lesion and a metastasis in T8 that was causing cord compression. He had neurosurgical decompression of the T8 lesion and fixation of the spine. Punch biopsy from the fungating chest wall lesion showed a BCC with some malignant squamous differentiation (basosquamous). Histopathological examination of the metastatic lesion in T8 at the time of surgical decompression identified features identical to the punch biopsy. The patient was referred to the oncology clinic for adjuvant treatment. In light of his metastatic disease and the large area over his chest wall that could not fully be covered by radiotherapy, he was treated with the novel oral Hedgehog signalling pathway (HHSP) inhibitor vismodegib, which led to marked improvement. © 2016 British Association of Dermatologists.

  5. Prevalence of idiopathic normal-pressure hydrocephalus (United States)

    Rabiei, Katrin; Marlow, Thomas; Jensen, Christer; Skoog, Ingmar; Wikkelsø, Carsten


    Objectives: The aim of this study was to determine the prevalence of idiopathic normal-pressure hydrocephalus (iNPH) in elderly persons in a large population-based sample using radiologic and clinical examinations. Methods: We examined representative elderly populations aged 70 years and older that had undergone neuropsychiatric evaluations and CT of the brain between 1986 and 2000 (n = 1,238). Gait was evaluated by clinical examination and history of walking difficulty. Cognitive function was evaluated with the Mini-Mental State Examination and urinary incontinence by self-report. iNPH was diagnosed in concordance with the American-European iNPH guidelines. Exclusion criteria were history of meningitis, severe head trauma, and subarachnoid hemorrhage. Results: The prevalence of probable iNPH was 0.2% in those aged 70–79 years (n = 2) and 5.9% (n = 24) in those aged 80 years and older, with no difference between men and women. Only 2 of these persons had been treated for iNPH. Hydrocephalic ventricular enlargement, i.e., a CT image consistent with NPH, was found in 56 persons (4.5%). An Evans Index >0.3 was found in 256 (20.7%) and occluded sulci at the high convexity in 67 persons (5.4%). All of these findings were more common in the older age groups. Conclusions: Many elderly possess clinical and imaging features of iNPH, especially those older than 80 years. The number of persons with iNPH is probably much higher than the number of persons currently treated. PMID:24682964

  6. Adult idiopathic hypertrophic pyloric stenosis

    Directory of Open Access Journals (Sweden)

    Hsien-Ping Lin


    Full Text Available Idiopathic hypertrophic pyloric stenosis (IHPS is a predominantly infantile disease. The adult type of IHPS is extremely rare but it has been well recognized since the 19th century. We report a case of a 47-year-old male patient who presented with postprandial nausea and vomiting. He underwent upper gastrointestinal endoscopy, and gastric outlet obstruction was discovered. The upper gastrointestinal barium study showed a distended stomach with delayed gastric emptying due to pyloric stenosis. The abdominal computed tomography revealed thickening of the distal stomach. Since gastric malignancy could not be excluded, he underwent antrectomy with Billroth I anastomosis. The pathology revealed no malignancy but showed hypertrophy and hyperplasia of the inner circular muscle of the pylorus, which was compatible with IHPS. We reported the case to remind young physicians of this rare disease.

  7. Pathogenesis of Idiopathic Pulmonary Fibrosis (United States)

    Wolters, Paul J.; Collard, Harold R.; Jones, Kirk D.


    Idiopathic pulmonary fibrosis (IPF) is a fibrosing interstitial lung disease associated with aging that is characterized by the histopathological pattern of usual interstitial pneumonia. Although an understanding of the pathogenesis of IPF is incomplete, recent advances delineating specific clinical and pathologic features of IPF have led to better definition of the molecular pathways that are pathologically activated in the disease. In this review we highlight several of these advances, with a focus on genetic predisposition to IPF and how genetic changes, which occur primarily in epithelial cells, lead to activation of profibrotic pathways in epithelial cells. We then discuss the pathologic changes within IPF fibroblasts and the extracellular matrix, and we conclude with a summary of how these profibrotic pathways may be interrelated. PMID:24050627

  8. Immunology of idiopathic nephrotic syndrome. (United States)

    Colucci, Manuela; Corpetti, Giorgia; Emma, Francesco; Vivarelli, Marina


    The pathogenesis of idiopathic nephrotic syndrome (INS) is as yet unknown, but several lines of evidence indicate that the immune system may play a crucial pathogenic role in non-genetic INS. The most important of these are, first, the effectiveness of therapy based on immunosuppression and, second, a vast body of data derived both from experimental models and from patient studies that implicate T cells and more recently B cells as major players in INS pathogenesis. However, recent findings also suggest a direct role of podocytes as drivers of the disease process, and the interplay between the glomerulus and the immune system is still being elucidated. In this review we provide an overview of current knowledge on the role of different components of the immune system in determining disease. Advances in our understanding of the pathogenesis of INS may help drive new, more tailored therapeutic approaches.

  9. Idiopathic Inflammatory Myopathies: An update

    Directory of Open Access Journals (Sweden)

    Bulent KURT


    Full Text Available Idiopathic inflammatory myopathies (IIM are a heterogeneous group of disease with complex clinical features. It has been sub-classified as: (1 Dermatomyositis, (2 Polymyositis, and (3 Inclusion body myositis (IBM. Nowadays, there are some studies in literature suggest necrotizing autoimmune myopathy and immune-mediated necrotizing myopathy should also be added to this group of disease. There is a debate in the diagnosis of IIMs and up until now, about 12 criteria systems have been proposed. Some of the criteria systems have been used widely such as Griggs et al.'s proposal for IBM. Clinical findings, autoantibodies, enzymes, electrophysiological, and muscle biopsy findings are diagnostic tools. Because of diseases' complexity, none of the findings are diagnostic alone. In this study, we discussed the diagnostic criteria of IMMs and described detailed morphological features. [J Interdiscipl Histopathol 2016; 4(2.000: 41-45

  10. Idiopathic inflammatory myopathies: diagnosis, treatment and outcome

    NARCIS (Netherlands)

    van de Vlekkert, J.


    The idiopathic inflammatory myopathies (IIM) in adults are a heterogenic group of disorders characterized by muscle inflammation and progressive muscle weakness. This group consists of five subacute-onset disorders: polymyositis (PM) which is extremely rare, (clinically amyopathic) dermatomyositis

  11. Idiopathic polyhydramnios and postnatal abnormalities. (United States)

    Abele, Harald; Starz, Sandra; Hoopmann, Markus; Yazdi, Britta; Rall, Katharina; Kagan, Karl Oliver


    To investigate the proportion and type of fetal anomalies that are associated with polyhydramnios and to examine whether in cases with idiopathic polyhydramnios during the course of pregnancy and fetal anomalies only diagnosed after birth, antenatal characteristics differ. This was a retrospective study involving all pregnancies with polyhydramnios defined by a deepest pool of amniotic fluid ≥8 cm and a detailed ultrasound examination, a 75 g glucose tolerance test and a TORCH serology. Between 2004 and 2010, 272 pregnancies fulfilled the inclusion criteria. In 89 (32.7%) and 65 (23.9%) cases, there was a fetal anomaly or diabetes. In 118 (43.4%) pregnancies, polyhydramnios was classified as idiopathic. In 11 (9.3%) of the 118 fetuses, an anomaly was found after birth, mainly gastrointestinal atresia. In these cases, median deepest pool of amniotic fluid was 9.6 cm, and median estimated fetal weight was at the 69th centile, whereas in cases without anomalies diagnosed after birth, median deepest pool was 9.0 cm and median estimated fetal weight at the 90th centile (Mann-Whitney U test: deepest pool p = 0.116, and estimated fetal weight centile p = 0.377). There was also no difference in the maternal and gestational age distribution of these cases (Mann-Whitney U test: maternal age p = 0.293, and gestational age p = 0.499). In about 40% of pregnancies, polyhydramnios remains unexplained during the course of pregnancy. In 10% of these cases, an anomaly will only be found after birth. In this group, antenatal characteristics such as amniotic fluid volume, estimated fetal weight or gestational and maternal age at the time of diagnosis do not help to detect these anomalies before birth. Copyright © 2012 S. Karger AG, Basel.

  12. Idiopathic noncirrhotic portal hypertension in dogs: 33 cases (1982-1998). (United States)

    Bunch, S E; Johnson, S E; Cullen, J M


    To describe clinical signs, diagnostic findings, and outcome in dogs with idiopathic intrahepatic portal hypertension. Retrospective study. 33 dogs. Medical records of dogs with portal hypertension of intra-abdominal origin were reviewed. Dogs with intra-abdominal portal hypertension of vascular causes or with hepatic histopathologic changes consistent with severe diffuse hepatobiliary disease were excluded. History and results of physical examination, clinicopathologic tests, diagnostic imaging studies, histologic examination, and treatment were summarized. Outcome was determined in 26 dogs. Dogs were referred most often because of ascites, intermittent vomiting or diarrhea, and polydipsia of several months' duration. Microcytosis, high serum alkaline phosphatase and alanine transaminase activities, hepatic dysfunction, urine specific gravity anastomoses were the major findings of diagnostic imaging. Hepatic histopathologic changes were consistent with idiopathic noncirrhotic portal hypertension and were indistinguishable from those of dogs with surgically created portocaval anastomosis. Outcome was determined for 19 dogs released from hospital; 13 dogs remained healthy with mostly palliative treatment for periods of 5 months to 9 years. The clinical signs, clinicopathologic test results, portal pressure, and gross appearance of the liver of dogs with idiopathic noncirrhotic portal hypertension may be identical to those of dogs with cirrhosis; therefore liver biopsy is crucial. Because the prognosis for idiopathic noncirrhotic portal hypertension is generally favorable, owners of affected dogs should be discouraged from choosing euthanasia.

  13. Rib osteoblastoma as an incidental finding in a patient with adolescent idiopathic scoliosis: a case report. (United States)

    Lykissas, Marios G; Crawford, Alvin H; Abruzzo, Todd A


    The purpose of this article is to present an unreported case of rib osteoblastoma associated with progressive adolescent idiopathic scoliosis and to discuss thoracogenic scoliosis as a potential cause of curve progression after tumor resection. An 11-year and 8-month-old girl with adolescent idiopathic scoliosis was referred with an incidental finding of an expansile lesion in the posterior left seventh rib. A computed tomography-guided needle biopsy established the diagnosis of benign osteoblastoma. Transarterial embolization was performed followed by wide resection. Sixteen months after surgery the patient underwent posterior spinal fusion to address her scoliosis progression during the growth spurt. Forty-one and 25 months after rib resection and spinal fusion, respectively, the patient remains asymptomatic, without local tumor recurrence, and with excellent correction of her spinal deformity. Although scoliosis secondary to rib osteoblastoma has been described in the literature, rib osteoblastoma may coexist with idiopathic scoliosis. In such a case, surgical management of osteoblastoma should not interfere with treatment of idiopathic scoliosis.

  14. Family history of idiopathic REM behavior disorder

    DEFF Research Database (Denmark)

    Dauvilliers, Yves; Postuma, Ronald B; Ferini-Strambi, Luigi


    To compare the frequency of proxy-reported REM sleep behavior disorder (RBD) among relatives of patients with polysomnogram-diagnosed idiopathic RBD (iRBD) in comparison to controls using a large multicenter clinic-based cohort.......To compare the frequency of proxy-reported REM sleep behavior disorder (RBD) among relatives of patients with polysomnogram-diagnosed idiopathic RBD (iRBD) in comparison to controls using a large multicenter clinic-based cohort....

  15. The efficacy of the use of IR laser phototherapy associated to biphasic ceramic graft and guided bone regeneration on surgical fractures treated with wire osteosynthesis: a comparative laser fluorescence and Raman spectral study on rabbits. (United States)

    Pinheiro, Antônio Luiz Barbosa; Santos, Nicole Ribeiro Silva; Oliveira, Priscila Chagas; Aciole, Gilberth Tadeu Santos; Ramos, Thais Andrade; Gonzalez, Tayná Assunção; da Silva, Laís Nogueira; Barbosa, Artur Felipe Santos; Silveira, Landulfo


    The aim of the present study was to assess, by Raman spectroscopy and laser fluorescence, the repair of surgical fractures fixed with wire osteosynthesis treated or not with infrared laser (λ780 nm, 50 mW, 4 × 4 J/cm(2) =16 J/cm(2), ϕ=0.5 cm(2), CW) associated or not to the use of hydroxyapatite and guided bone regeneration. Surgical tibial fractures were created under general anesthesia on 15 rabbits that were divided into five groups, maintained on individual cages, at day/night cycle, fed with solid laboratory pelted diet, and had water ad libitum. The fractures in groups II, III, IV, and V were fixed with wires. Animals in groups III and V were grafted with hydroxyapatite (HA) and guided bone regeneration (GBR) technique used. Animals in groups IV and V were irradiated at every other day during 2 weeks (4 × 4 J/cm(2), 16 J/cm(2) =112 J/cm(2)). Observation time was that of 30 days. After animal death, specimens were taken and kept in liquid nitrogen and used for Raman spectroscopy. The Raman results showed basal readings of 1,234.38 ± 220. Groups WO+B+L showed higher readings (1,680.22 ± 822) and group WO+B the lowest (501.425 ± 328). Fluorescence data showed basal readings of 5.83333 ± 0.7. Groups WO showed higher readings (6.91667 ± 0.9) and group WO+B+L the lowest (1.66667 ± 0.5). There were significant differences between groups on both cases (pbone healing on fractured bones as a result of the increasing deposition of CHA measured by Raman spectroscopy and decrease of the organic components as shown by the fluorescence readings.

  16. A multicenter study analyzing the relationship of a standardized radiographic scoring system of adolescent idiopathic scoliosis and the Scoliosis Research Society outcomes instrument. (United States)

    Wilson, Philip L; Newton, Peter O; Wenger, Dennis R; Haher, Thomas; Merola, Andrew; Lenke, Larry; Lowe, Thomas; Clements, David; Betz, Randy


    A multicenter study examining the association between radiographic and outcomes measures in adolescent idiopathic scoliosis. To evaluate the association between an objective radiographic scoring system and patient quality of life measures as determined by the Scoliosis Research Society outcomes instrument. Although surgical correction of scoliosis has been reported to be positively correlated with patient outcomes, studies to date have been unable to demonstrate an association between radiographic measures of deformity and outcomes measures in patients with adolescent idiopathic scoliosis. A standardized radiographic deformity scoring system and the Scoliosis Research Society outcome tool were used prospectively in seven scoliosis centers to collect data on patients with adolescent idiopathic scoliosis. A total of 354 data points for 265 patients consisting of those with nonoperative or preoperative curves >or=10 degrees, as well as those with surgically treated curves, were analyzed. Correlation analysis was performed to identify significant relationships between any of the radiographic measures, the Harms Study Group radiographic deformity scores (total, sagittal, coronal), and the seven Scoliosis Research Society outcome domains (Total Pain, General Self-Image, General Function, Activity, Postoperative Self-Image, Postoperative Function, and Satisfaction) as well as Scoliosis Research Society outcomes instrument total scores. Radiographic measures that were identified as significantly correlated with Scoliosis Research Society outcome scores were then entered into a stepwise regression analysis. The coronal measures of thoracic curve and lumbar curve magnitude were found to be significantly correlated with the Total Pain, General Self-Image, and total Scoliosis Research Society scores (P Society domain and total scores. No radiographic measures taken after surgery were significantly correlated with the postoperative domains of the Scoliosis Research Society

  17. Idiopathic Ophthalmodynia and Idiopathic Rhinalgia: A Prospective Series of 16 New Cases. (United States)

    Pareja, Juan A; Montojo, Teresa; Guerrero, Ángel L; Álvarez, Mónica; Porta-Etessam, Jesús; Cuadrado, María L


    Idiopathic ophthalmodynia and idiopathic rhinalgia were described a few years ago. These conditions seem specific pain syndromes with a distinctive location in the eye or in the nose. We aimed to present a new prospective series in order to verify the consistency of these syndromes. We performed a descriptive study of all patients referred to our regional neurologic clinics from 2010 to 2014 because of facial pain exclusively felt in the eye or in the nose fulfilling the proposed diagnostic criteria for idiopathic ophthalmodynia and idiopathic rhinalgia. There were 9 patients with idiopathic ophthalmodynia and 7 patients with idiopathic rhinalgia, with a clear female preponderance, and a mean age at onset in the fifth decade. The pain was usually moderate and the temporal pattern was generally chronic. Only one patient reported accompaniments (hypersensitivity to the light and to the flow of air in the symptomatic eye). Preventive treatment with amitriptyline, pregabalin, or gabapentin was partially or totally effective. The clinical features of this new series parallels those of the original description, thus indicating that both idiopathic ophthalmodynia and idiopathic rhinalgia have clear-cut clinical pictures with excellent consistency both inter- and intra-individually. © 2015 American Headache Society.

  18. Effectiveness of the SpineCor brace based on the new standardized criteria proposed by the scoliosis research society for adolescent idiopathic scoliosis. (United States)

    Coillard, Christine; Vachon, Valerie; Circo, Alin B; Beauséjour, Marie; Rivard, Charles H


    The purpose of this prospective observational study was to evaluate the effectiveness of the Dynamic SpineCor brace for adolescent idiopathic scoliosis in accordance with the standardized criteria proposed by the Scoliosis Research Society Committee on Bracing and Nonoperative Management. They proposed these guidelines to make the comparison among studies more valid and reliable. From 1993 to 2006, 493 patients were treated using the SpineCor brace. Two hundred forty-nine patients met the criteria for inclusion, and 79 patients were still actively being treated. Overall, 170 patients have a definitive outcome. All girls were premenarchal or less than 1 year postmenarchal. Assessment of brace effectiveness included (1) percentage of patients who have 5 degrees or less curve progression, and percentage of patients who have 6 degrees or more progression; (2) percentage of patients who have been recommended/undergone surgery before skeletal maturity; (3) percentage of patients with curves exceeding 45 degrees at maturity (end of treatment); and (4) Two-year follow-up beyond maturity to determine the percentage of patients who subsequently underwent surgery. Successful treatment (correction, >5 degrees, or stabilization, +/-5 degrees) was achieved in 101 (59.4%) of the 170 patients from the time of the fitting of the SpineCor brace to the point in which it was discontinued. Thirty-nine immature patients (22.9%) required surgical fusion while receiving treatment. Two (1.2%) of 170 patients had curves exceeding 45 degrees at maturity. One mature patient (2.1%) required surgery within 2 years of follow-up beyond skeletal maturity. The conclusion drawn from these findings is that the SpineCor brace is effective for the treatment of adolescent idiopathic scoliosis. Moreover, positive outcomes are maintained after 2 years because 45 (95.7%) of 47 patients stabilized or corrected their end of bracing Cobb angle up to 2 years after bracing. Therapeutic study-investigating the


    Pak, Kang Yeun; Park, Keun Heung; Kim, Kyong Ho; Park, Sung Who; Byon, Ik Soo; Kim, Hyun Woong; Chung, In Young; Lee, Joo Eun; Lee, Sang Joon; Lee, Ji Eun


    To investigate retinal displacement in the macula after surgical closure of idiopathic macular hole and to identify factors correlated with displacement. This retrospective multicenter study included 73 eyes of 73 patients having idiopathic macular hole. A custom program was developed to compare the position of the retinal vessels in the macula between preoperative and postoperative photographs. En face images of a 6 mm × 6 mm optical coherence tomography volume scans were registered to calculate the scale. A grid comprising 16 sectors in 2 rings (inner; 2-4 mm and outer; 4-6 mm) was superimposed. The displacement of the retinal vessels was measured as a vector value by comparing the location of the retinal vessels in each sector. The correlation between displacement and various clinical parameters was analyzed. The average displacement was 57.2 μm at an angle of -3.3° (nasal and slightly inferior). Displacement was larger in the inner ring (79.2 μm) than in the outer ring (35.3 μm, P macula was displaced centripetally, nasally, and slightly inferiorly after surgical closure of idiopathic macular hole. Hole closure, contraction of the nerve fiber layer, and gravity are the suggested mechanisms of macular displacement caused by internal limiting membrane peeling.

  20. Surgically Treated Symptomatic Prolapsed Lumbar and Sacral ...

    African Journals Online (AJOL)

    intervertebral discs. It induces coughing, thereby causing marked elevations of intra-disc pressures. There is the possibility of fibrinolytic effect of tobacco.[1,58] The Swiss, like other Caucasians, smoked/smoke a lot, while this habit is just beginning to grow in Nigeria and Jamaica. The majority of herniated discs will heal ...

  1. Ruptured hepatoblastoma treated with primary surgical resection

    African Journals Online (AJOL)

    1]. ... episodes of syncope, with a hematocrit of 23. A computed ... ruptured tumor in the right lobe of the liver. The patient was then taken to the operating room, where a bleeding tumor was noted on the right side of the liter. Intraoperative.

  2. Surgically Treated Symptomatic Prolapsed Lumbar and Sacral ...

    African Journals Online (AJOL)

    Nigerian Journal of Surgery. Jul-Dec 2012 | Volume 18 | Issue 2. Address for correspondence: Dr. M. O. N. Ibe,. Central Medicare, 43 Okigwe Road, Box 453, Owerri,. Imo State, Nigeria. E-mail: INTRODUCTION. Sciatica is a relatively common condition with a lifetime incidence varying from ...

  3. The clinical characteristics of patients with chronic idiopathic anal pain

    Directory of Open Access Journals (Sweden)

    Mao Weiming


    Full Text Available The aim of this study was to investigate the clinical characteristics, treatment outcomes and psychological distress in patients with chronic idiopathic anal pain. The study was conducted on patients referred to Hangzhou Third Hospital for chronic anal pain from January, 2010 to December, 2014. Patient demographics, clinical history, anorectal physiology, and radiological imaging data were recorded for all patients. The treatment outcome was noted for patients treated and followed up for more than 6 month at the present unit. Ninety-six patients with mean age of 45.1 years (range, 17-82 were studied. Seventy-one patients (74.0% had functional anorectal pain(FARP. The main complaints were dull, sharp, stabbing, or spasm pain. Among all patients, 34.3% reported that their pain radiated into other locations. Fifty-one patients (53.1% had bowel dysfunction, while 28.1% patients had urinary dysfunction. The common factors associated with pain relief were day time, lying down and warm water baths; the factors that contributed to aggravated pain were night time, defecation or sitting. 92.7% (89/96 of patients reported symptoms of psychological disturbance. FARP patients exhibited increased depression than non-FARP patients(P<0.05. In addition, female patients were more likely to have depression than male patients (P<0.05. The overall pain treatment success rate was 55.2% (53/96. The pain treatment outcome was better in non-FARP patients than in FARP patients(χ2=3.85, P<0.05. Conclusively, chronic idiopathic anal pain is a complex clinical symptom, involving pelvic floor muscles, the nervous system, endocrine system, and the patients’ psychological conditions. Further research is needed to improve diagnosis and treatment for patients with chronic idiopathic anal pain.

  4. FCGR2A single nucleotide polymorphism confers susceptibility to childhood-onset idiopathic nephrotic syndrome. (United States)

    Rossi, Giovanni M; Bonatti, Francesco; Adorni, Alessia; Alberici, Federico; Bodria, Monica; Bonanni, Alice; Ghiggeri, Gian M; Martorana, Davide; Vaglio, Augusto


    Childhood-onset idiopathic nephrotic syndrome affects 1.15-3.4 children/100,000 children/year in Western Countries. Immune-mediated mechanisms, particularly T cell-mediated, are thought to play a key pathogenic role. The genetic basis of the disease is still poorly understood. We tested the association between single nucleotide polymorphisms (SNPs) of four genes encoding Fc gamma receptors (FCGR2A, FCGR2B, FCGR3A, FCGR3B) and idiopathic nephrotic syndrome in a case-control study of paediatric patients. Children with idiopathic nephrotic syndrome (aged 1-16 years) were included. FCGR2A rs1801274 and FCGR3A rs396991 SNPs were genotyped using real-time PCR with the TaqMan method, while FCGR2B rs1050501 and FCGR3B NA1/NA2 were genotyped using Sanger sequencing. Fisher's exact test was used to explore genetic association. We enrolled 103 idiopathic nephrotic syndrome patients and 181 healthy controls. A significant association was found between idiopathic nephrotic syndrome and FCGR2A rs1801274 SNP (both with the T allele and the TT genotype, p value=0.0009, OR 1.81, 95% CI 1.27-2.59 and p value=0.0007, OR 2.39, 95% CI 1.44-3.99, respectively). No associations were found for the remaining SNPs. Fc gamma receptors might modulate response to rituximab; since 60 of the enrolled patients were treated with rituximab, we also tested the association between the studied SNPs and rituximab efficacy in this patient subgroup, but found only a weak association with FCGR2A CC genotype (p value=0.03). The FCGR2A rs1801274 SNP in the gene encoding the activating receptor CD32A confers susceptibility to idiopathic nephrotic syndrome. Copyright © 2017 European Federation of Immunological Societies. Published by Elsevier B.V. All rights reserved.

  5. Prognostic value of flow cytometry in surgically treated primary gastric lymphoma Valor pronóstico de la citometría de flujo en el linfoma gástrico

    Directory of Open Access Journals (Sweden)

    F. Fernández


    Full Text Available Aim: to investigate whether flow cytometry could help to define the optimal therapeutic strategy of primary gastric lymphomas. Material and method: retrospective study of 46 patients having primary gastric lymphoma -according to Dawson criteria- in Ann Arbor stage I E and II E, who were surgically treated. From selected paraffin-embedded tissue blocks of the tumor, DNA content was studied by flow cytometry (FC. Other pathological tumor features were analysed by hematoxiline-eosine and Giemsa stains as well as immunohistochemical study; any possible influence on postoperative survival was investigated through statistical analysis. Results: the DNA ploidy pattern was diploid in 40 cases (87% and aneuploid (hyperdiploid in 6 (13%. Postoperative survival probability (PSP was 62.7% at 5 years. Statistical analysis showed significant prognostic value for Ann Arbor classification -with higher PSP for stage I E (p = 0.009- and FC parameters: diploid tumors had higher PSP than aneuploid tumors. Also tumors having S-phase (p = 0.044 or G2-M phase values (p = 0.023 under the respective mean values had higher PSP. No influence on PSP was found for wall invasion, Helicobacter pylori infection, Isaacson's histologic type or resection margin involvement. No significant relationship was appreciated between Isaacson's histologic type and DNA ploidy patterns. Conclusion: FC could be useful in assessing gastric lymphoma prognosis.

  6. Doppler ultrasound and magnetic resonance for evaluation of patients treated surgically for aortic coarctation. Ecografia Doppler y resonancia magnetica en la evaluacion de pacientes con coartacion de aorta operada

    Energy Technology Data Exchange (ETDEWEB)

    Canteli, B.; Saez, F.; Garcia, F.; Cabrera, A.; Galdeano, J.M.; Rodriguez, O. (Hospital de Cruzes, Vizcaya (Spain))


    Doppler ultrasound and magnetic resonance were performed in a series of 39 patients who had been treated surgically for aortic coarctation. The purpose was to assess the different Doppler gradients, comparing the findings with morphological data disclosed by magnetic resonance. The aortic caliber in the operative field was pathological in 7 patients (ratio between the caliber at the level of the lesion and that of descending aorta of less than 0.7). When the patients were considered as a group. Doppler ultrasound did not show satisfactory sensitivity (29%-43%), specificity (74%) or positive predictive value (17%-23%). Only the negative predictive value (85%-88%) presented more favorable results. When the Subgroup of patients without associated cardiac abnormalities or collateral circulation was studied alone, the following results were found: sensitivity, 100%; specificity, 81%-90%, positive predictive value, 33%-50%, negative predictive value, 100%, similar to those reported in the literature. Thus, we consider that Doppler ultrasound is a harmless and low cost diagnostic method that is highly suitable for follow-up of these patients, within certain limits. Magnetic resonance is the method of choice for the noninvasive assessment of aortic morphology. (Author)

  7. Parapharyngeal Tumours - Surgical Expertise


    Kinjal Shankar Majumdar


    Introduction We present our experience in the management of parapharyngeal tumours. A conservative trans-cervical approach was found to be feasible and effective in majority of the cases over radical ones, which may be required in malignancies and skull-base involvement.   Methods Fifteen patients with parapharyngeal tumours treated surgically in the Department of ENT, Nilratan Sircar Medical College in last 3 years were included in the study. 80% of the cases were benign, mos...

  8. Parsonage-Turner Syndrome: A Case of Idiopathic Upper Extremity Paresis Following Middle Cranial Fossa Resection of a Vestibular Schwannoma. (United States)

    Prueter, James; Stevens, Shawn M; Andaluz, Norberto; Samy, Ravi N


    In this patient report, Parsonage-Turner syndrome (acute brachial neuropathy) developed in our patient 1 day after resection of a vestibular schwannoma by a middle cranial fossa approach. Aiming to increase awareness of this rare disorder among neurotologists, we describe differential diagnoses, work-up, and management strategies. A 67-year-old man treated for vestibular schwannoma at a single tertiary referral center. Surgery for vestibular schwannoma, electromyography for confirmation of diagnosis, and physical therapy. After ruling out postoperative complications by intracranial imaging and physical examination, electromyography was confirmatory of the suspected diagnosis, Parsonage-Turner syndrome; steroids were not indicated. With physical therapy as treatment, our patient is experiencing gradual recovery of all neurologic deficits, including gross motor function. As a rare condition reported only sporadically in the orthopedic and neurology literature, our patient with Parsonage-Turner syndrome represents (to our knowledge) the first within neurotology literature. This rare, idiopathic disease process is usually self-limiting, and may mimic cerebral-vascular accident or injury from surgical positioning. Its presentation is one of limited motor and sensory neuropathies of the brachial plexus distribution.

  9. Idiopathic membranous nephropathy: outline and rationale of a treatment strategy.

    NARCIS (Netherlands)

    Buf-Vereijken, P.W.G. du; Branten, A.J.W.; Wetzels, J.F.M.


    Idiopathic membranous nephropathy is a common cause of nephrotic syndrome. The treatment of patients with idiopathic membranous nephropathy is heavily debated. Based on literature data and our own experience, we propose a rational treatment strategy. Patients with renal insufficiency (serum

  10. Telltale teeth: Idiopathic Hypergonadotropic Hypogonadism

    Directory of Open Access Journals (Sweden)

    G S Lele


    Full Text Available The detection of any atypical extraoral or intraoral features warrants a thorough investigation, even if the patient is asymptomatic or unaware of these. At times, dental findings help in the diagnosis of an underlying systemic problem. These findings may or may not be associated with any syndrome. Thus, thorough examination and exhaustive investigations should be carried out for every atypical finding to ensure optimal oral and general health for the patient. Case Description: This is a case report of seventeen year old male who presented with peculiar/atypical dentition which ′told the tale′ and led to the diagnosis of underlying endocrinological problem about which the parents were totally unaware. The patient was short with central obesity and microcephaly. Intraorally, there was presence of thirty six microdonts. Consultation with pediatrician and endocrinologist, and thorough investigations confirmed the condition to be of ′Idiopathic Hypergonadotropic Hypogonadism′. The patient underwent not only oral rehabilitation, but also timely consultation and treatment from a pediatrician and an endocrinologist.

  11. Autophagy in idiopathic pulmonary fibrosis.

    Directory of Open Access Journals (Sweden)

    Avignat S Patel

    Full Text Available Autophagy is a basic cellular homeostatic process important to cell fate decisions under conditions of stress. Dysregulation of autophagy impacts numerous human diseases including cancer and chronic obstructive lung disease. This study investigates the role of autophagy in idiopathic pulmonary fibrosis.Human lung tissues from patients with IPF were analyzed for autophagy markers and modulating proteins using western blotting, confocal microscopy and transmission electron microscopy. To study the effects of TGF-β(1 on autophagy, human lung fibroblasts were monitored by fluorescence microscopy and western blotting. In vivo experiments were done using the bleomycin-induced fibrosis mouse model.Lung tissues from IPF patients demonstrate evidence of decreased autophagic activity as assessed by LC3, p62 protein expression and immunofluorescence, and numbers of autophagosomes. TGF-β(1 inhibits autophagy in fibroblasts in vitro at least in part via activation of mTORC1; expression of TIGAR is also increased in response to TGF-β(1. In the bleomycin model of pulmonary fibrosis, rapamycin treatment is antifibrotic, and rapamycin also decreases expression of á-smooth muscle actin and fibronectin by fibroblasts in vitro. Inhibition of key regulators of autophagy, LC3 and beclin-1, leads to the opposite effect on fibroblast expression of á-smooth muscle actin and fibronectin.Autophagy is not induced in pulmonary fibrosis despite activation of pathways known to promote autophagy. Impairment of autophagy by TGF-β(1 may represent a mechanism for the promotion of fibrogenesis in IPF.

  12. Idiopathic aneurysm of pulmonary artery

    Energy Technology Data Exchange (ETDEWEB)

    Pacheco, Julio B. Cota; Pimentel, Patricia N.; Knust, Beatriz S., E-mail: [Clinica de Cardiologia Cota Pacheco, Mogi das Cruzes, SP (Brazil)


    Because it is a very rare isolated lesion, we decided to present this case of idiopathic pulmonary artery aneurysm (IPAA) and review the cases published in the literature in order to correlate our clinical and imaging findings, as well as management based on patient data. IPAA was first described in a case of autopsy by Bristowe in 1860 and later in 1947 by Deterling and Claggett, whose prevalence was lower than eight to one hundred thousand. Although the use of diagnostic imaging methods has been applied in a very large population in recent decades, this lesion has been most often described in postmortem examinations. Therefore, it is important to be aware of possible clinical symptoms, at times non-specific, as well as the signs on imaging studies. In this study, therefore, the report of a case of an asymptomatic patient whose diagnosis was done through color Doppler echocardiography in a routine test in 2012, later confirmed by simple chest computed tomography (chest CT) and cardiac catheterization as IPAA and its branches. We discussed the literature available and the possibilities for treatment and the use of color Doppler echocardiography as an initial diagnostic tool for such a rare and intriguing disease. (author)

  13. Corrective Bracing for Severe Idiopathic Scoliosis in Adolescence: Influence of Brace on Trunk Morphology

    Directory of Open Access Journals (Sweden)

    Edyta Kinel


    Full Text Available Aim. The aim of the work was to study whether wearing a corrective brace by adolescent girls with severe idiopathic scoliosis can influence external shape of the trunk. Methods. Comparison of clinical deformity of two groups of girls matched for age and Cobb angle: group (1 of 23 girls, aged 14.9±1.3 years, Cobb angle 55.0°±6.8°, who refused surgical treatment and have been wearing Chêneau brace for more than 6 months, compared with group (2 of 22 girls, aged 14.1±1.8 years, Cobb angle 59.7°±14.6° never treated with corrective bracing. Clinical deformity was assessed with the Bunnell scoliometer (angle of trunk rotation ATR and surface topography (posterior trunk symmetry index POTSI and Hump Sum HS. Results. The ATR in the primary curvature was 11.9°±3.4° (5°–18° in group 1 versus 15.1°±5.6° (6°–25° in group 2 (P=0.027. The HS was 16.8°±3.8 versus 19.2°±4.6, respectively, P=0.07. The POTSI value did not differ between groups. Conclusion. Girls with Cobb angle above 45 degrees, who have been subjected to brace treatment, revealed smaller clinical deformity of their back comparing to nontreated girls having similar radiological curvatures.


    African Journals Online (AJOL)

    SURGICAL ANATOMY. Rare high origin of the radial artery: a bilateral, symmetrical ease. I. O. ()koro and B. C. J iburum. Department of Anatomy, College of Medicine, lrno State University, Owerri, Nigeria. Reprint requests to: Dr I. O. 0k0r0, Department of Anatomy, [mo State University, P. M. B. 2000. Owerri, Nigeria.


    African Journals Online (AJOL)

    Conclusion:Foraminotomy with or without discectomy is a simple posterior surgical approach to T B spine with good neurological outcome. It is adapted to our ... of the spine also referred to as. (HIV/AIDS) further challenge the outcome. These .... treatment; or for spinal cord or nerve root from 2 weeks depending on patient ...

  16. Supine Lateral Bending Radiographs Predict the Initial In-brace Correction of the Providence Brace in Patients With Adolescent Idiopathic Scoliosis

    DEFF Research Database (Denmark)

    Ohrt-Nissen, Søren; Hallager, Dennis Winge; Gehrchen, Poul Martin


    are used to assess curve flexibility in patients undergoing surgical treatment for adolescent idiopathic scoliosis (AIS). A low rate of in-brace correction (IBC) has been associated with a higher risk of curve progression, but to what extent SLBR can be used to predict IBC before initiating bracing...

  17. Calcium-sensing receptor autoantibodies and idiopathic hypoparathyroidism. (United States)

    Tomar, Neeraj; Gupta, Nandita; Goswami, Ravinder


    Data on calcium-sensing receptor autoantibodies (CaSRAbs) in hypoparathyroidism are variable. We assessed the prevalence and significance of CaSRAbs in idiopathic hypoparathyroidism. This was a case-control study. One hundred forty-seven patients with idiopathic hypoparathyroidism treated during 1998-2011 in a tertiary care setting and 348 controls [healthy, n = 199; type 1 diabetes mellitus (T1DM), n = 99; and chronic lymphocytic thyroiditis (CLT), n = 50] participated in the study. CaSRAb assays included Western blot with CaSR protein expressed in Escherichia coli or human embryonic kidney (HEK)-293 cells, immunoprecipitation (IP) using in vitro-transcribed/translated protein, and indirect immunofluorescence on HEK293-CaSR. Functional significance was assessed by ERK1/2 phosphorylation. PTH and CaSR genes were sequenced for mutations. E coli-Western blot assay revealed 16.3% CaSRAb positivity in idiopathic hypoparathyroidism, which was comparable with healthy subjects and CLT but significantly less than the T1DM controls. The prevalence of CaSRAbs on HEK293-Western blot (24.5%) against 150 kDa and/or 168 kDa protein in hypoparathyroidism was significantly higher than the healthy subjects, T1DM, and CLT. IP assay showed CaSRAbs in 12.9% of the hypoparathyroid patients but not in controls. The sensitivity and specificity of CaSRAbs in E coli and HEK-293-CaSR Western blot and IP assays were 16.3% and 83.1%, 24.5% and 88.9%, and 12.9% and 100%, respectively, and 42.1% of the cases detected were common in the IP assay and HEK293-Western blot. Duration of illness and coexistent autoimmunity were similar in patients with and without CaSRAbs. The CaSRAb-positive sera showed no immunofluorescence and phosphorylated ERK1/2 activity. The CaSR gene sequence was normal in all patients. One of the patients showed a novel p.Met1_Asp6del mutation in the signal peptide region of the PTH gene. IP performed the best in detecting CaSRAbs in 12.9% of hypoparathyroid patients

  18. Solar urticaria successfully treated with intravenous immunoglobulin.

    LENUS (Irish Health Repository)

    Hughes, R


    Idiopathic solar urticaria (SU) is a rare, debilitating photodermatosis, which may be difficult to treat. First-line treatment with antihistamines is effective in mild cases, but remission after phototherapeutic induction of tolerance is often short-lived. Other treatment options include plasma exchange, photopheresis and cyclosporin. We present two cases of severe, idiopathic SU, which were resistant to conventional treatment. Both patients achieved remission after administration of intravenous immunoglobulin (IVIg) and have remained in remission at 13 months and 4 years, respectively. There are only two case reports of successful treatment of solar urticaria with IVIg. In our experience IVIg given at a total dose of 2 g\\/kg over several 5-day courses about a month apart is an effective treatment option for severe idiopathic SU. It is also generally safe, even if certainly subject to significant theoretical risks, such as induction of viral infection or anaphylaxis.

  19. Syncope and Idiopathic (Paroxysmal) AV Block. (United States)

    Brignole, Michele; Deharo, Jean-Claude; Guieu, Regis


    Syncope due to idiopathic AV block is characterized by: 1) ECG documentation (usually by means of prolonged ECG monitoring) of paroxysmal complete AV block with one or multiple consecutive pauses, without P-P cycle lengthening or PR interval prolongation, not triggered by atrial or ventricular premature beats nor by rate variations; 2) long history of recurrent syncope without prodromes; 3) absence of cardiac and ECG abnormalities; 4) absence of progression to persistent forms of AV block; 5) efficacy of cardiac pacing therapy. The patients affected by idiopathic AV block have low baseline adenosine plasma level values and show an increased susceptibility to exogenous adenosine. The APL value of the patients with idiopathic AV block is much lower than patients affected by vasovagal syncope who have high adenosine values. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Idiopathic eosinophilic gastrointestinal diseases in adults. (United States)

    Straumann, Alex


    This review focuses on the latest cognitions, diagnosis and treatment strategies of the three main representatives of the eosinophilic gastrointestinal disorders (EGID): idiopathic eosinophilic oesophagitis (EE), idiopathic eosinophilic gastroenteritis (EGE) and idiopathic hypereosinophilic syndromes (HES) with gastrointestinal involvement. These disorders share important similarities: their origin is unknown and their pathogenesis is due to a histological inflammatory response characterised by eosinophilic tissue infiltration. In spite of these parallels, the courses and prognoses of the diseases differ radically: EE is restricted to the oesophagus, and though it may significantly decrease the patient's quality of life, it has a favourable long-term prognosis. In EGE, the inflammatory process involves several segments of the gastrointestinal tract but this chronic inflammation may also be considered a benign disorder. In contrast, HES is primarily a multisystem disorder that may involve several organs, including the digestive tract, and often has a fatal outcome.

  1. Surgical Management of Calcaneal Malunion

    Directory of Open Access Journals (Sweden)

    Guang-Rong Yu


    Full Text Available Calcaneal malunion is a common complication after conservative treatment or incorrect surgical treatment of calcaneal fracture. The typical pathoanatomies of calcaneal malunion are subtalar joint incongruity, loss of calcaneal height, arch collapse, varus or valgus deformity of the calcaneus, heel widening and so on. Calcaneal malunion often needs to be treated surgically. The classification of calcaneal malunion and the detailed clinical and radiographical assessment play important roles for surgical option. The main surgical methods include in situ subtalar arthrodesis, reconstruction of calcaneal thalamus and subtalar arthrodesis, calcaneal osteotomy with subtalar arthrodesis, corrective calcaneal osteotomy without subtalar arthrodesis. Each option has its different indications, advantages and disadvantages. Thus, the surgical treatment should be individualised.

  2. Assessing idiopathic pulmonary fibrosis (IPF) with bronchoscopic OCT (Conference Presentation) (United States)

    Hariri, Lida P.; Adams, David C.; Colby, Thomas V.; Tager, Andrew M.; Suter, Melissa J.


    Idiopathic pulmonary fibrosis (IPF) is a progressive, fatal form of fibrotic lung disease, with a significantly worse prognosis than other forms of pulmonary fibrosis (3-year survival rate of 50%). Distinguishing IPF from other fibrotic diseases is essential to patient care because it stratifies prognosis and therapeutic decision-making. However, making the diagnosis often requires invasive, high-risk surgical procedures to look for microscopic features not seen on chest CT, such as characteristic cystic honeycombing in the peripheral lung. Optical coherence tomography (OCT) provides rapid 3D visualization of large tissue volumes with microscopic resolutions well beyond the capabilities of CT. We aim to determine whether bronchoscopic OCT can provide a low-risk, non-surgical method for IPF diagnosis. We have developed bronchoscopic OCT catheters that access the peripheral lung and conducted in vivo peripheral lung imaging in patients, including those with pulmonary fibrosis. We also conducted bronchoscopic OCT in ex vivo lung from pulmonary fibrosis patients, including IPF, to determine if OCT could successfully visualize features of IPF through the peripheral airways. Our results demonstrate that OCT is able to visualize characteristic features of IPF through the airway, including microscopic honeycombing (fibrosis, and spatial disease heterogeneity. We also found that OCT has potential to distinguish mimickers of IPF honeycombing, such as traction bronchiectasis and emphysema, from true honeycombing. These findings support the potential of bronchoscopic OCT as a minimally-invasive method for in vivo IPF diagnosis. However, future clinical studies are needed to validate these findings.

  3. Surgical Treatment of Calcaneal Spur.


    Eduardo Sarmiento Sánchez; Horacio Suárez Monzón; Rolando Delgado Figueredo; Juan Carlos Cabrera Suárez


    Background: Pain in the plantar region of the heel is technically known as talalgia, and it is a very frequent complaint in the orthopaedic service in Guyana. Due to its frequent mortality, the current investigation was carried out. Objectives: To characterize the application of the surgical treatment to a group of patients in Guyana. Method: 70 patients surgically treated were studied presenting rebel talalgia with no responses to the conservative treatment. Age, sex, race, educational level...

  4. Management strategies for idiopathic urethritis. (United States)

    Henderson, L; Farrelly, P; Dickson, A P; Goyal, A


    Williams and Mikhael (1971) described idiopathic urethritis (IU) as a self-limiting condition that affects boys aged 5-15 years, with symptoms of urethrorrhagia, dysuria and haematuria. However, a proportion of boys will remain symptomatic for several years, and may develop urethral stricture (Poch et al., 2007; Palagiri et al., 2003). There is no universally effective treatment for IU, although various strategies have been employed. To review the presentation and long-term outcomes of boys with IU, and present the efficacy of management strategies that have been utilised. A retrospective review was performed of all boys with IU. It was based on clinical and cystoscopic findings for presentation, medical history, management and clinical progress. Fifty-four boys were included, with a median age of 11 years (range 5-15 years) at presentation. The median duration of symptoms was 18 months (range 2-132 months). The median follow-up was 18.5 months (range 1-120 months). Seven (13.0%) boys had early urethral stricture at initial cystourethroscopy, and one (1.9%) developed stricture during follow-up. Thirty-six boys (66.7%) had previous circumcision and four (7.4%) had meatal stenosis. Eight (14.8%) had previous hypospadias repair. Whilst 50% of boys with IU do not require any specific treatment, those with severe/unremitting symptoms may benefit from a trial of urethral steroids or short-term urethral catheterisation. The mechanisms of benefit from these modalities are unclear and they require further evaluation. Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  5. Netherton syndrome associated with idiopathic congenital hemihypertrophy. (United States)

    Yerebakan, Ozlem; Uğuz, Ayşen; Keser, Ibrahim; Lüleci, Güven; Ciftçioğlu, Mehmet Akif; Başaran, Erdal; Alpsoy, Erkan


    Netherton syndrome is a rare genodermatosis comprised of anichthyosiform dermatitis, hair shaft defects, and atopic features. Other problems associated with Netherton syndrome are delayed growth and development, immune abnormalities, recurrent infections, and intermittent aminoaciduria. We describe an 18-month-old girl with Netherton syndrome who had idiopathic congenital hemihypertrophy on her right side with contralateral benign nephromegaly in addition to the characteristic clinical signs of the syndrome. To our knowledge, this is the first case of Netherton syndrome associated with idiopathic congenital hemihypertrophy to be reported.

  6. Glucocorticoid pharmacogenetics in pediatric idiopathic nephrotic syndrome. (United States)

    Cuzzoni, Eva; De Iudicibus, Sara; Franca, Raffaella; Stocco, Gabriele; Lucafò, Marianna; Pelin, Marco; Favretto, Diego; Pasini, Andrea; Montini, Giovanni; Decorti, Giuliana


    Idiopathic nephrotic syndrome represents the most common type of primary glomerular disease in children: glucocorticoids (GCs) are the first-line therapy, even if considerable interindividual differences in their efficacy and side effects have been reported. Immunosuppressive and anti-inflammatory effects of these drugs are mainly due to the GC-mediated transcription regulation of pro- and anti-inflammatory genes. This mechanism of action is the result of a complex multistep pathway that involves the glucocorticoid receptor and several other proteins, encoded by polymorphic genes. Aim of this review is to highlight the current knowledge on genetic variants that could affect GC response, particularly focusing on children with idiopathic nephrotic syndrome.

  7. Does reduction in sciatica symptoms precede improvement in disability and physical health among those treated surgically for intervertebral disc herniation? Analysis of temporal patterns in data from the Spine Patient Outcomes Research Trial. (United States)

    Skolasky, Richard L; Scherer, Emily A; Wegener, Stephen T; Tosteson, Tor D


    Pain, pain-related disability, and functional limitations are common consequences of intervertebral disc herniation (IDH). We hypothesized that surgical treatment reduces pain, leading to improvement in pain-related disability and, ultimately, better physical health. The present study aims to evaluate pathways for improvements in quality of life during the first year after surgery for IDH by studying temporal relationships between sciatica symptoms, pain-related disability, and physical health. This is a secondary analysis of a randomized controlled trial using an "as treated" dataset. The sample comprised 803 patients in the Spine Patient Outcomes Research Trial. We used the Sciatica Bothersome Index, Oswestry Disability Index, and the Medical Outcomes Study Short Form 36 physical component score. We included 803 patients in the Spine Patient Outcomes Research Trial who underwent elective decompressive surgery for IDH between 2000 and 2004. Sciatica, pain-related disability, and physical health were assessed preoperatively and at 3 and 12 months postoperatively using the Sciatica Bothersome Index, Oswestry Disability Index, and Medical Outcomes Study Short Form 36 physical component score, respectively. Temporal associations of improvement in sciatica with pain-related disability and physical health were assessed using cross-lagged path analysis. pdisability, and 29.8±8.4 for physical health. After adjustment for patient age and symptom duration, cross-lagged path analysis showed that sciatica reduction at 3 months was correlated with pain-related disability reduction at 3 months (ρ=.76, pdisability at 3 months was predictive of physical health at 12 months (β=-.33, pdisability. Improvements in pain and pain-related disability occurred within 3 months. Early reduction in pain-related disability is important because path analysis indicated that disability at 3 months was predictive of sciatica and physical health at 1 year. Copyright © 2017 Elsevier Inc. All

  8. Chronic pain coping styles in patients with herniated lumbar discs and coexisting spondylotic changes treated surgically: Considering clinical pain characteristics, degenerative changes, disability, mood disturbances, and beliefs about pain control. (United States)

    Misterska, Ewa; Jankowski, Roman; Głowacki, Maciej


    Pain catastrophizing, appraisals of pain control, styles of coping, and social support have been suggested to affect functioning in patients with low back pain. We investigated the relation of chronic pain coping strategies to psychological variables and clinical data, in patients treated surgically due to lumbar disc herniation and coexisting spondylotic changes. The average age of study participants (n=90) was 43.47 years (SD 10.21). Patients completed the Polish versions of the Chronic Pain Coping Inventory-42 (PL-CPCI-42), Beck Depression Inventory (BDI-PL), Coping Strategies Questionnaire (CSQ-PL), Beliefs about Pain Control Questionnaire (BPCQ-PL), and Roland-Morris Disability Questionnaire (RMQ-PL). In the PL-CPCI-42 results, resting, guarding and coping self-statements were frequently used as coping strategies (3.96 SD 1.97; 3.72 SD 1.72; 3.47 SD 2.02, respectively). In the CSQ-PL domains, catastrophizing and praying/hoping were frequently used as coping strategies (3.62 SD 1.19). The mean score obtained from the BDI-PL was 11.86 SD 7.23, and 12.70 SD 5.49 from the RMDQ-PL. BPCQ-PL results indicate that the highest score was in the subscale measuring beliefs that powerful others can control pain (4.36 SD 0.97). Exercise correlated significantly with beliefs about internal control of pain (rs=0.22). We identified associations between radiating pain and guarding (p=0.038) and between sports recreation and guarding (p=0.013) and task persistence (p=0.041). Back pain characteristics, depressive mood, disability, and beliefs about personal control of pain are related to chronic LBP coping styles. Most of the variables related to advancement of degenerative changes were not associated with coping efforts.

  9. Surgical Navigation

    DEFF Research Database (Denmark)

    Azarmehr, Iman; Stokbro, Kasper; Bell, R. Bryan


    body removal, respectively. The average technical system accuracy and intraoperative precision reported were less than 1 mm and 1 to 2 mm, respectively. In general, SN is reported to be a useful tool for surgical planning, execution, evaluation, and research. The largest numbers of studies and patients......Purpose: This systematic review investigates the most common indications, treatments, and outcomes of surgical navigation (SN) published from 2010 to 2015. The evolution of SN and its application in oral and maxillofacial surgery have rapidly developed over recent years, and therapeutic indications...... surgery, skull-base surgery, and foreign body removal were the areas of interests. Results: The search generated 13 articles dealing with traumatology; 5, 6, 2, and 0 studies were found that dealt with the topics of orthognathic surgery, cancer and reconstruction surgery, skull-base surgery, and foreign...

  10. Different Finite Durations of Anticoagulation and Outcomes following Idiopathic Venous Thromboembolism: A Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Aaron B. Holley


    Full Text Available Introduction. Controversy remains over the optimal length of anticoagulation following idiopathic venous thromboembolism. We sought to determine if a longer, finite course of anticoagulation offered additional benefit over a short course in the initial treatment of the first episode of idiopathic venous thromboembolism. Data Extraction. Rates of deep venous thrombosis, pulmonary embolism, combined venous thromboembolism, major bleeding, and mortality were extracted from prospective trials enrolling patients with first time, idiopathic venous thromboembolism. Data was pooled using random effects meta-regression. Results. Ten trials, with a total of 3225 patients, met inclusion criteria. For each additional month of initial anticoagulation, once therapy was stopped, recurrent venous thromboembolism (0.03 (95% CI: −0.28 to 0.35; =.24, mortality (−0.10 (95% CI: −0.24 to 0.04; =.15, and major bleeding (−0.01 (95% CI: −0.05 to 0.02; =.44 rates measured in percent per patient years, did not significantly change. Conclusions: Patients with an initial idiopathic venous thromboembolism should be treated with 3 to 6 months of secondary prophylaxis with vitamin K antagonists. At that time, a decision between continuing with indefinite therapy can be made, but there is no benefit to a longer (but finite course of therapy.

  11. A comparative study of 2-year follow-up outcomes in lumbar spinal stenosis patients treated with physical therapy alone and those with surgical intervention after less successful physical therapy. (United States)

    Minetama, Masakazu; Kawakami, Mamoru; Nakagawa, Masafumi; Ishimoto, Yuyu; Nagata, Keiji; Fukui, Daisuke; Sumiya, Tadashi; Kitagawa, Tomoko; Miyake, Takahiro; Yamamoto, Yoshio; Sakon, Nana; Matsuoka, Toshiko; Nakagawa, Yukihiro


    The efficacy of physical therapy for patients with lumbar spinal stenosis (LSS) has been reported only for the short term, and few reports have compared outcomes of surgical treatment with nonsurgical treatment after physical therapy. The purpose of this study was to assess 2-year outcomes of LSS patients treated with surgery or under follow-up observation after physical therapy for 6 weeks. Patients presenting with neurogenic claudication, radiologically-confirmed central LSS affecting both legs and refractory symptoms to pharmacotherapy of more than 3 months were enrolled. Patients were treated with manual therapy, stretching and strengthening exercises, and body weight-supported treadmill walking once a week for 6 weeks. Clinical outcomes were measured using the Zurich Claudication Questionnaire (ZCQ), visual analog scale of low back pain, leg pain, and numbness, the Japanese Orthopedic Association Back Pain Evaluation Questionnaire and the SF-36. Two years after physical therapy, patients were classified into the observation group (Group I) or the surgery group (Group II), whose patients failed to respond to physical therapy and wanted to undergo surgery. Thirty-eight patients were enrolled; 28 had complete data at 2 years: 21 and 7 in Groups I and II, respectively. Group II had a higher body mass index (BMI) than Group I. There were no significant differences in clinical outcomes at baseline. Six weeks after physical therapy, Group I had significantly better outcomes for symptom severity and physical function on the ZCQ subscales, physical functioning and bodily pain on the SF-36 subscales. These outcomes in Group I were maintained or improved and did not differ significantly between groups at 2-years. However, the physical function on the ZCQ subscales was improved in Group II more than those in Group I (mean difference -0.6; 95% CI: -1.2 to -0.03, P < 0.05) at 2 years. At 2 years, the outcomes except for the change in physical function score in the ZCQ

  12. The impact of idiopathic childhood-onset growth hormone deficiency (GHD) on bone mass in subjects without adult GHD

    DEFF Research Database (Denmark)

    Lange, Martin; Müller, Jørn; Svendsen, Ole Lander


    Despite seemingly adequate growth hormone (GH) treatment during childhood, children with GH deficiency (GHD) have reduced bone mineral density (BMD) at final height. The aim was to evaluate BMD and bone mineral content (BMC) in adults treated for idiopathic childhood-onset (CO) GHD, 18 years after...

  13. Joseph Lister's surgical revolution. (United States)

    Toledo-Pereyra, Luis H


    Joseph Lister (1827-1912), renowned British surgeon-scientist, introduced to the world the use and appreciation of the antiseptic method for the prevention of wound sepsis. Armed with the ideas of Louis Pasteur (1822-1895) regarding the role of microorganisms in infections or the so-called germ theory of disease, he advanced the surgical field by using antiseptics, such as carbolic acid, in the treatment of contaminated wounds. These developments constituted a real surgical revolution. No breakthrough before Lister's, except perhaps the discovery of anesthesia, had contributed to such an incredible advancement in relationship to the surgical arena. After 1867, the year in which Lister published his remarkable paper in Lancet, it was possible to appropriately treat or prevent wound infections with the use of antiseptics at the site of the operated wound. Lister's method was complicated but produced its desired effect--to diminish wound morbidity and patient mortality. His contribution was secured for future generations and a surgical revolution had begun!

  14. Gynecomastia induced by H1-antihistamine (ebastine) in a patient with idiopathic anaphylaxis


    Jung, Hwa Sik; Park, Chan-Ho; Park, Young Tae; Bae, Mi Ae; Lee, Youn Im; Kang, Byung Ju; Jegal, Yangjin; Ahn, Jong Joon; Lee, Taehoon


    H1-antihistamine is generally a well-tolerated and safe drug. However, in resemblance with all other drugs, H1-antihistamines can also prompt adverse drug reactions (ADRs). We recently encountered the very unusual ADR of H1-antihistamine-induced gynecomastia. A 21-year-old man with idiopathic anaphylaxis was treated with ebastine (Ebastel), a second-generation H1-antihistamine, for the prevention of anaphylaxis. Three months later, the patient remained well without anaphylaxis, but had newly ...

  15. Discovery of a fusion kinase in EOL-1 cells and idiopathic hypereosinophilic syndrome


    Griffin, John H.; Leung, Joey; Bruner, Rebecca J.; Caligiuri, Michael A.; Briesewitz, Roger


    Idiopathic hypereosinophilic syndrome (HES) is a myeloproliferative disease of unknown etiology. Recently, it has been reported that imatinib mesylate (Gleevec), an inhibitor of Bcr-Abl kinase useful in the treatment of chronic myeloid leukemia, is also effective in treating HES; however, the molecular target of imatinib in HES is unknown. This report identifies a genetic rearrangement in the eosinophilic cell line EOL-1 that results in the expression of a fusion protein comprising an N...


    Directory of Open Access Journals (Sweden)

    Yu. М. Spivakovsky


    Full Text Available The article describes a case of using methotrexate for subcutaneous injection in a rated dose of 12.5 mg / m2 of body surface per week when treating a child with juvenile idiopathic arthritis. When switching to the parenteral route of administration, methotrexate ensured the development of joint syndrome remission, normalization of laboratory indices of disease activity, and improvement of joint functions. After 6 months the inactive disease stage was detected, and after 12 months — remission.

  17. Surgical Management of Localized Scleroderma. (United States)

    Lee, Jae Hyun; Lim, Soo Yeon; Lee, Jang Hyun; Ahn, Hee Chang


    Localized scleroderma is characterized by a thickening of the skin from excessive collagen deposits. It is not a fatal disease, but quality of life can be adversely affected due to changes in skin appearance, joint contractures, and, rarely, serious deformities of the face and extremities. We present six cases of localized scleroderma in face from our surgical practice. We reviewed six localized scleroderma cases that were initially treated with medication and then received follow-up surgery between April 2003 and February 2015. Six patients had facial lesions. These cases presented with linear dermal sclerosis on the forehead, oval subcutaneous and dermal depression in the cheek. En coup de sabre (n=4), and oval-shaped lesion of the face (n=2) were successfully treated. Surgical methods included resection with or without Z-plasty (n=3), fat graft (n=1), dermofat graft (n=1), and adipofascial free flap (n=1). Deformities of the affected parts were surgically corrected without reoccurrence. We retrospectively reviewed six cases of localized scleroderma that were successfully treated with surgery. And we propose an algorithm for selecting the best surgical approach for individual localized scleroderma cases. Although our cases were limited in number and long-term follow-up will be necessary, we suggest that surgical management should be considered as an option for treating scleroderma patients.

  18. Hypercholesterolemia Is Associated with the Subjective Evaluation of Postoperative Outcomes in Patients with Idiopathic Carpal Tunnel Syndrome Who Undergo Surgery: A Multivariate Analysis. (United States)

    Yano, Koichi; Kawabata, Akira; Ikeda, Mikinori; Suzuki, Keisuke; Kaneshiro, Yasunori; Egi, Takeshi


    Carpal tunnel syndrome is a compression neuropathy of the median nerve at the wrist; its symptoms include neuropathic pain and sensory and motor disturbance distributed by the median nerve. Carpal tunnel syndrome and hypercholesterolemia have similar backgrounds, but the effect of these similarities on postoperative outcomes has not been reported. Using multivariate analysis, the authors analyzed the relationship between prognostic factors, including the presence of hypercholesterolemia, and subjective postoperative outcomes of patients with idiopathic carpal tunnel syndrome. Of 168 hands with carpal tunnel syndrome that were treated surgically, 141 that were followed up and assessed 1 year postoperatively or thereafter were included. The mean postoperative follow-up period was 40.8 months. Surgery was performed through a small palmar skin incision under local anesthesia. The outcomes were postoperative symptoms, including pain and numbness, and overall Kelly assessment. Preoperative numbness and pain resolved and alleviated in 94 of 141 hands and was diminished in 59 of 64 hands. Univariate analysis showed that postoperative numbness and Kelly assessment were significantly associated with hypercholesterolemia. Multivariate analysis showed that postoperative numbness was significantly associated with smoking and hypercholesterolemia, and Kelly assessment was significantly associated with smoking (adjusted OR, 3.3; 95 percent CI, 1.1 to 10; p = 0.04) and hypercholesterolemia (adjusted OR, 2.9; 95 percent CI, 1.4 to 6.3; p = 0.01). Hypercholesterolemia, usually a systemic condition in sites other than the hand, is associated with the subjective evaluation of postoperative symptoms in patients with idiopathic carpal tunnel syndrome. Risk, III.

  19. Controversies: Optic nerve sheath fenestration versus shunt placement for the treatment of idiopathic intracranial hypertension

    Directory of Open Access Journals (Sweden)

    Arielle Spitze


    Full Text Available Background: Idiopathic intracranial hypertension (IIH has been increasing in prevalence in the past decade, following the obesity epidemic. When medical treatment fails, surgical treatment options must be considered. However, controversy remains as to which surgical procedure is the preferred surgical option - optic nerve sheath fenestration (ONSF or cerebrospinal fluid (CSF shunting - for the long-term treatment of this syndrome. Purpose: To provide a clinical update of the pros and cons of ONSF versus shunt placement for the treatment of IIH. Design: This was a retrospective review of the current literature in the English language indexed in PubMed. Methods: The authors conducted a PubMed search using the following terms: Idiopathic IIH, pseudotumor cerebri, ONSF, CSF shunts, vetriculo-peritoneal shunting, and lumbo-peritoneal shunting. The authors included pertinent and significant original articles, review articles, and case reports, which revealed the new aspects and updates in these topics. Results: The treatment of IIH remains controversial and lacks randomized controlled clinical trial data. Treatment of IIH rests with the determination of the severity of IIH-related visual loss and headache. Conclusion: The decision for ONSF versus shunting is somewhat institution and surgeon dependent. ONSF is preferred for patients with visual symptoms whereas shunting is reserved for patients with headache. There are positive and negative aspects of both procedures, and a prospective, randomized, controlled trial is needed (currently underway. This article will hopefully be helpful in allowing the reader to make a more informed decision until that time.

  20. [Severe idiopathic scoliosis. Does the approach and the instruments used modify the results?]. (United States)

    Sánchez-Márquez, J M; Sánchez Pérez-Grueso, F J; Pérez Martín-Buitrago, M; Fernández-Baíllo, N; García-Fernández, A; Quintáns-Rodríguez, J


    The aim of this work is to evaluate and compare the radiographic results and complications of the surgical treatment of adolescents with idiopathic scoliosis greater than 75 degrees, using a double approach (DA) or an isolated posterior approach with hybrid instruments (posterior hybrid [PH]), or with «all-pedicle screws» (posterior screws [PS]). A retrospective review was performed on 69 patients with idiopathic scoliosis greater than 75°, with a follow-up of more than 2 years, to analyze the flexibility of the curves, the correction obtained, and the complications depending on the type of surgery. The Kruskal-Wallis test for non-parametric variables was used for the statistical analysis. There were no statistically significant differences between the 3 patient groups in the pre-surgical Cobb angle values (DA=89°, PH=83°, PS=83°), in the immediate post-surgical (DA=34°, PH=33°, PS=30°), nor at the end of follow-up (DA=36°, PH=36°, PS=33°) (P>.05). The percentage correction (DA=60%, PH=57%, PS=60%) was similar between groups (P>.05). The percentage of complications associated with the procedure was 20.8% in DA, 10% in PH and 20% in PS. Two patients in the PS group showed changes, with no neurological lesions, in the spinal cord monitoring, and one patient in the same group suffered a delayed and transient incomplete lesion. No significant differences were observed in the correction of severe idiopathic scoliosis between patients operated using the double or isolated posterior approach, regardless of the type of instrumentation used. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  1. Treating Infertility (United States)

    ... Patients Search FAQs Treating Infertility Page Navigation ▼ ACOG Pregnancy Book Treating Infertility Patient Education FAQs Treating Infertility Patient Education Pamphlets - Spanish Treating ...

  2. [Bronchiolitis obliterans with organizing pneumonia associated with idiopathic thrombocytopenic purpura]. (United States)

    Presas, J L; Piriz, J; Serra, S L; Paz, E D; Allievi, A; Kartin, D; Olmedo, G


    We report a case of a 35 year-old woman with idiopathic thrombocytopenic purpura (ITP) who, under treatment with immunosuppressive drugs, developed bilateral interstitial pulmonary disease. Previously she had been splenectomized and treated with corticosteroids and cyclosporin. During the clinical course, the patient developed alterations of the hepatogram and presented a positive serology for Epstein-Barr virus. The lung biopsy showed the histologic pattern of obliterative bronchiolitis, interstitial inflammatory infiltration and intraalveolar pneumonia (BOOP). We could not find in the literature a previous report in which ITP was associated with BOOP. Of interest was the spontaneous remission of the pulmonary disease after suppression of cyclosporin and positive serology for Epstein-Barr virus.

  3. Suppressed without a Cause: A Case of Idiopathic Immune Deficiency. (United States)

    Ayub, Muhammad Talha; Jafar, Munnam S; Khalid, Muhammad; Baig, Muhammad A; Mba, Benjamin


    We report a case of a 45-year-old male who presented with a headache, fever, vomiting, somnolence, and difficulty walking for 10 days. His cerebrospinal fluid studies revealed cryptococcal meningitis. Chest and abdominal computed tomography (CT) scans showed splenomegaly along with mediastinal, retroperitoneal and inguinal lymphadenopathy. CD4 count turned out to be 208 μL -1 . Human immunodeficiency virus (HIV) testing, serum protein electrophoresis, serum light chains and quantitative immunoglobulins were non-diagnostic and CD4 lymphopenia was attributed to acute infection. However, a persistent CD4 lymphopenia was seen in subsequent outpatient testing, which prompted a detailed workup for secondary causes of immunodeficiency. Repeated lymph node biopsies with analytic cytometric immunophenotypic analysis were normal, as was the bone marrow biopsy with detailed immunophenotypic and cytogenetic studies. The patient was hence being treated as a case of idiopathic CD4 lymphocytopenia.

  4. Parapharyngeal Tumours - Surgical Expertise

    Directory of Open Access Journals (Sweden)

    Kinjal Shankar Majumdar


    Full Text Available Introduction We present our experience in the management of parapharyngeal tumours. A conservative trans-cervical approach was found to be feasible and effective in majority of the cases over radical ones, which may be required in malignancies and skull-base involvement.   Methods Fifteen patients with parapharyngeal tumours treated surgically in the Department of ENT, Nilratan Sircar Medical College in last 3 years were included in the study. 80% of the cases were benign, most common being Schwannoma. Most important investigation was found to be MRI.   Conclusion The study gives an overview regarding the surgical approach, based upon the extent and histology of the tumour. Trans-cervical approachwas found to be the most effective.

  5. Idiopathic hypertrophic pachymeningitis presenting with occipital ...

    African Journals Online (AJOL)

    Herein, we have described, for the first time to our knowledge, a case of idiopathic pachymeningitis revealed by isolated occipital neuralgia. We found one similar case reported in the literature, but occipital neu- ralgia was not isolated as the patient also presented with tinnitus and deafness at admission. Corticosteroids did.

  6. Idiopathic Thrombocytopenic Purpura in children. Integral Care

    Directory of Open Access Journals (Sweden)

    Carmen Tamara González Fernández


    Full Text Available Idiopathic thrombocytopenic purpura or ITP is an autoimmune bleeding disorder more common in children. The Nursing Care Process, from a holistic perspective, will hold the child care with ITP. The main nursing objetives to these processes are control and reduce the number of hemorrhagic episodes besides the family health education.

  7. The lived experience with idiopathic pulmonary fibrosis

    DEFF Research Database (Denmark)

    Overgaard, Dorthe; Kaldan, Gudrun; Marsaa, Kristoffer


    The disease course in idiopathic pulmonary fibrosis (IPF) is variable, but patients experience a progressive decline in lung function and increased symptom burden leading to death. Little is known about the patients' experience and their needs during the disease course or about the burden on family...

  8. Diffuse idiopathic skeletal hyperostosis in ancient clergymen.

    NARCIS (Netherlands)

    Verlaan, J.J.; Oner, F.C.; Maat, G.J.


    Diffuse idiopathic skeletal hyperostosis (DISH) is a common but often unrecognized systemic disorder observed mainly in the elderly. DISH is diagnosed when the anterior longitudinal ligament of the spine is ossified on at least four contiguous spinal levels or when multiple peripheral enthesopathies

  9. Diffuse idiopathic skeletal hyperostosis in ancient clergymen

    NARCIS (Netherlands)

    Verlaan, J.J.; Oner, F.C.; Maat, G.R.J.


    Diffuse idiopathic skeletal hyperostosis (DISH) is a common but often unrecognized systemic disorder observed mainly in the elderly. DISH is diagnosed when the anterior longitudinal ligament of the spine is ossified on at least four contiguous spinal levels or when multiple peripheral

  10. [Idiopathic pulmonary hemosiderosis with dendriform pulmonary ossification]. (United States)

    Barrera, Ana Madeleine; Vargas, Leslie


    Pulmonary ossification is a rare and usually asymptomatic finding reported as incidental in lung biopsies. Similarly, idiopathic pulmonary hemosiderosis is a rare cause of pulmonary infiltrates. We report the case of a 64-year old man with chronic respiratory symptoms in whom these two histopathological findings converged.

  11. Pirfenidone treatment in idiopathic pulmonary fibrosis

    DEFF Research Database (Denmark)

    Salih, Goran Nadir; Shaker, Saher Burhan; Madsen, Helle Dall


    BACKGROUND: Pirfenidone was approved by the European Medicines Agency and introduced in most European countries in 2011 for treatment of idiopathic pulmonary fibrosis (IPF). OBJECTIVE: To describe the national Danish experiences of pirfenidone treatment for IPF during 30 months with respect...

  12. Infections and Thrombocytopenia in Chronic Idiopathic ...

    African Journals Online (AJOL)

    This is a case report to study the association between episodes of thrombocytopenia and bacterial infections in a patient with chronic idiopathic thrombocytopenic purpura (ITP).The case was a 31 year old female patient, with a history of chronic ecchymosis, melaena stool and menorrhagia, who presented at the female ...

  13. Exercise therapy in juvenile idiopathic arthritis

    NARCIS (Netherlands)

    Takken, T.; van Brussel, M.; Engelbert, R. H. H.; van der Net, J.; Kuis, W.; Helders, P. J. M.


    Exercise therapy is considered an important component of the treatment of arthritis. The efficacy of exercise therapy has been reviewed in adults with rheumatoid arthritis but not in children with juvenile idiopathic arthritis (JIA). To assess the effects of exercise therapy on functional ability,

  14. Contemporary Management of Idiopathic Laryngotracheal Stenosis. (United States)

    Donahoe, Laura; Keshavjee, Shaf


    Idiopathic laryngotracheal stenosis is a rare but well-described indication for subglottic tracheal resection. Initially described by Pearson in 1975, the 1-stage subglottic tracheal resection with reconstruction of the airway ensures preservation of the recurrent laryngeal nerves while resulting in an effective and durable repair of the stenosis. Copyright © 2018 Elsevier Inc. All rights reserved.

  15. Acute Lymphoblastic Leukaemia presenting as Juvenile Idiopathic ...

    African Journals Online (AJOL)

    Background: Acute Lymphoblastic Leukaemia in children commonly presents with osteo articular manifestations that may mimic Juvenile Idiopathic Arthritis. This may create considerable diagnostic difficulty and lead to delay in commencing appropriate treatment. Case: An eight year old boy who presented with multiple ...

  16. Juvenile idiopathic arthritis and the temporomandibular joint ...

    African Journals Online (AJOL)

    Background: The temporomandibular joint (TMJ) is one of the most underdiagnosed and undertreated conditions of juvenile idiopathic arthritis (JIA) because its involvement is often asymptomatic and the joint is difficult to examine. Objectives: The aim of this study was to investigate clinical as well as magnetic resonance ...

  17. Capsaicin in Idiopathic Rhinitis A Hot Topic

    NARCIS (Netherlands)

    J.B. van Rijswijk


    textabstractIn chapter I the currently known causes for nonallergic noninfectious rhinitis and possible treatments are summarised. Also possible pathophysiological mechanisms underlying idiopathic rhinitis (IR) are discussed. In chapter II the aims of the studies are presented. This thesis comprises

  18. Idiopathic trigeminal neuropathy in a poodle

    Directory of Open Access Journals (Sweden)

    Carlos Eduardo Aparicio


    Full Text Available A seven years old, male poodle is examined presenting acute mandible paralysis (dropped jaw, drooling and difficulty for the apprehension and chewing; not evidence of an other alteration of cranial nerves. The muscular biopsy rules out a myositisof masticatory muscles. The disorder is resolved completely in 3 weeks confirming diagnosis of idiopathic trigeminal neuropathy.

  19. Idiopathic neonatal pneumoperitoneum, a case report

    Directory of Open Access Journals (Sweden)

    Sarah Magdy Abdelmohsen


    Conclusion: This case demonstrated that laparotomy is not a true routine in neonates with idiopathic pneumoperitoneum if a timely diagnosis is established. Future research is still necessary to understand the source of the free gas in the abdomen, as well as the underlying causes of delayed postoperative gas underdiaphragm and postoperative abdominal drain bag gas expansion.

  20. Unusual Presentation Of Idiopathic Retroperitoneal Fibrosis: Case ...

    African Journals Online (AJOL)

    Idiopathic retroperitoneal fibrosis (IRF) is an uncommon entity described as progressive proliferation of connective tissues leading to a fibrous plaque-like lesions that encases the aorta and inferior vena cava inferior to the level of the renal arteries. Mass forming retroperitoneal fibrosis is rare. We present a rare case of a ...