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Gaca PJ, Rejdak R, Toro MD, Lewandowicz M, Kopecky A, Somfai GM, Nowak R, Heindl LM. [Therapeutic management of a kissing nevus of the eyelid]. Ophthalmologie 2024; 121:116-122. [PMID: 38165419 DOI: 10.1007/s00347-023-01963-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 11/01/2023] [Accepted: 12/04/2023] [Indexed: 01/03/2024]
Abstract
Congenital divided melanocytic nevi of the upper and lower eyelid are rare pigmented changes of the eyelids. These processes are also known as "kissing nevi," "panda nevi," and "split ocular nevi," and were first described by Fuchs in 1919. About 120 cases have been described in the literature so far. Congenital melanocytic nevi are either present at birth (small nevi are already found in about 1% of neonates) or manifest predominantly during the first decade of life. These rare melanocytic changes of the eyelids should be controlled regularly, as malignant transformation can occur. The actual incidence of malignant transformation is highly variable in the literature, ranging from 2 to 40% depending on the duration of follow-up, with an average of 14% for the whole lifetime. Moreover, nevi of the eyelids may be considered cosmetically disturbing and cause functional problems. Therapeutic removal (dermabrasion, cryotherapy, laser therapy, and surgical excision with ophthalmoplastic reconstruction) is rarely medically indicated due to the low risk of malignant transformation. Removal can be performed in cases of secondary amblyopia in ptosis, compression of the lacrimal point, epiphora, or cosmetic desire. Treatment becomes necessary not only in case of suspicious manifestation or impairment of eyelid function, but it also helps to avoid possible bullying at school among children and is recommended at age 4 to 6 (before school age).
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Affiliation(s)
- P J Gaca
- Zentrum für Augenheilkunde, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Kerpener Straße 62, 50937, Köln, Deutschland.
- Abteilung für Allgemeine Ophthalmologie und Pädiatrische Ophthalmologie, Medizinische Universität Lublin, Lublin, Polen.
| | - R Rejdak
- Abteilung für Allgemeine Ophthalmologie und Pädiatrische Ophthalmologie, Medizinische Universität Lublin, Lublin, Polen
| | - M D Toro
- Abteilung für Allgemeine Ophthalmologie und Pädiatrische Ophthalmologie, Medizinische Universität Lublin, Lublin, Polen
- Klinik für Augenheilkunde, Abteilung für öffentliche Gesundheit, Universität Neapel Federico II, Neapel, Italien
| | - M Lewandowicz
- Abteilung für onkologische Chirurgie, Multidisziplinäres M. Copernicus Woiwodschaftszentrum für Onkologie und Traumatologie, Lodz, Polen
| | - A Kopecky
- Zentrum für Augenheilkunde, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Kerpener Straße 62, 50937, Köln, Deutschland
- Klinik für Augenheilkunde, Universitätskrankenhaus Ostrava, Ostrava, Tschechien
- Medizinische Fakultät, Universität Ostrava, Ostrava, Tschechien
| | - G M Somfai
- Augenklinik, Stadtspital Zürich, Zürich, Schweiz
| | - R Nowak
- Wojskowy Instytut Medyczny, Klinika Okulistyki, Warszawa, Polen
| | - L M Heindl
- Zentrum für Augenheilkunde, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Kerpener Straße 62, 50937, Köln, Deutschland
- Centrum für Integrierte Onkologie (CIO) Bonn-Düsseldorf-Köln, Köln, Deutschland
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Ziv E, Keller N, Erlich T. Vaginal microflora following the use of a disposable home-use vaginal device and a commercially available ring pessary for pelvic organ prolapse management: a randomized controlled trial. Arch Gynecol Obstet 2024; 309:571-579. [PMID: 37882871 PMCID: PMC10808192 DOI: 10.1007/s00404-023-07260-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/06/2023] [Indexed: 10/27/2023]
Abstract
PURPOSE To investigate whether ProVate, a novel, disposable, self-inserted vaginal device for pelvic organ prolapse management, clinically affects the vaginal microflora, as compared with a commercially available ring pessary, to assess its microbiological safety. METHODS This interventional, prospective, multi-center, open-label, randomized, controlled, statistically powered (noninferiority), home-use, crossover study was conducted at seven sites. Participants were randomized into either group A (using ProVate and then a new reusable commercially available ring pessary [control]) or B (using control device and then ProVate) with a 1:1 ratio. Noninferiority of ProVate over the control was evaluated for the primary endpoint, which was based on meeting one of the failure criteria: significant change in Lactobacillus spp., Gardnerella vaginalis, Candida morphotypes, or Staphylococcus aureus levels compared to the baseline (significant change: Nugent score ≥ 7 or > 1 scale unit increase in S. aureus or Candida morphotype), bothersome vaginal infection symptoms, or symptoms requiring treatment for infection. RESULTS The study included 58 participants (mean age: 64.5 years, 91.4% postmenopausal). There were no significant microfloral changes in terms of the four microorganisms mentioned above, the rate of Nugent score ≥ 7 after use was low and comparable between the two devices, and the rate of patients with a > 1 unit-scale change (increase or decrease) from the baseline to the end-of-use phase in any studied microorganism was comparable between the devices. The failure rate was 15.5% for ProVate and 15.5% for control while using 383 ProVate devices over 1647 days or one control device throughout the study. Two patients had bothersome vaginal complaints and one had overt vaginal infection in the control group, but no such cases were observed in the ProVate group. CONCLUSION The primary endpoint of possible vaginal microbial changes, bothersome vaginal symptoms, or treatment-requiring vaginal complaints while using ProVate was successfully met. Our findings show that the vaginal microflora is comparable when using either ProVate or commercially available ring pessary (control) with a relatively low rate of vaginal infections. Trial registration details: ClinicalTrials.gov; URL: https://www. CLINICALTRIALS gov/ct2/show/NCT03345121?term=NCT03345121&draw=2&rank=1 ; No. NCT03345121; Registration date, November 17, 2017; initial enrollment started on August 20, 2017.
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Affiliation(s)
- Elan Ziv
- ConTIPI Medical Ltd, 2 Alon Ha' Tavor St, Southern Industrial Park, 3088900, Caesarea, Israel.
| | - Nathan Keller
- Ariel University, Ariel, Israel
- Sheba Medical Center, Ramat Gan, Israel
| | - Tsvia Erlich
- ConTIPI Medical Ltd, 2 Alon Ha' Tavor St, Southern Industrial Park, 3088900, Caesarea, Israel
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Sengillo JD, Smiddy WE, Lin B, Shoji MK, Townsend J, Yannuzzi NA, Flynn HW Jr. Asymptomatic Rhegmatogenous Retinal Detachments: Outcomes in Patients without Initial Surgical Intervention. Ophthalmol Retina 2023; 7:215-20. [PMID: 36162748 DOI: 10.1016/j.oret.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/30/2022] [Accepted: 09/19/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To report long-term outcomes of patients with asymptomatic retinal detachments (RDs) who did not undergo initial surgical intervention. DESIGN Retrospective case series. METHODS A retrospective chart review of patients diagnosed with asymptomatic RD. Patients with symptoms of photopsias or a visual field defect at presentation were excluded. PARTICIPANTS Eighteen patients seen and evaluated at the Bascom Palmer Eye Institute between 2011 and 2021. MAIN OUTCOME MEASURES Best-corrected visual acuity (BCVA), presence or absence of progression of RD, and whether surgical intervention occurred during follow-up. RESULTS The study group included 18 patients (20 eyes). The mean follow-up duration was 5.1 years (range, 0-30 years). Risk factors included myopia (95%), lattice retinal degeneration (60%), and pseudophakia (5%). Most asymptomatic RDs were located in the inferotemporal quadrant (80%), followed by the superotemporal (15%) and inferonasal (5%). No RDs were confined to the superonasal quadrant. The majority (80%) extended posterior to the equator and were ≤ 3 clock hours in size (65%). Five (25%) patients were previously treated with prophylactic laser demarcation. Final BCVA was 20/40 or better in 19 (95%) eyes and between 20/40 and 20/200 in 1 (5%) eye. During the follow-up, 2 (10%) patients exhibited progression of their asymptomatic RD and underwent surgical intervention. Retinal pathology in fellow eyes was previously diagnosed or identified during follow-up in 14 (78%) of 18 patients, of which 2 (11%) patients had bilateral asymptomatic RDs. CONCLUSIONS Nonsurgical management with observation may be reasonable as an initial management strategy for asymptomatic patients with RDs in select cases. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Yang Z, Yu S, Zhang C, Agrawal R, Feng Y. Nonsurgical Management of Severe Viral Keratitis with Hypopyon and Retrocorneal Plaques: A Case Series. Ophthalmol Ther 2023; 12:599-611. [PMID: 36269489 PMCID: PMC9834490 DOI: 10.1007/s40123-022-00592-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 10/05/2022] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Severe viral keratitis with hypopyon and retrocorneal plaques is easily misdiagnosed as it mimics fungal or bacterial keratitis and is more likely to undergo emergency therapeutic penetrating keratoplasty (TPK) in the presence of active infection, resulting in poor outcomes. This case series offers some important insights for the management strategy of severe viral keratitis. METHODS This retrospective case series involved five patients with unilateral severe infectious keratitis with hypopyon over 3 mm and retrocorneal endothelial plaques. Testing for corneal sensation, microscopy, culture, and anterior segment optical coherence tomography (ASOCT) were performed. RESULTS At presentation, all five cases had visual acuity of counting fingers (CF) or worse, large centrally located ulcer with clean ulcer surface, hypopyon, and retrocorneal plaques with reduced corneal sensation. ASOCT demonstrated the presence of retrocorneal plaques with clear space between corneal endothelium and plaques. All cases received systemic and topical ganciclovir and topical steroids. Two patients received intravenous immunoglobulin (IVIG) weekly for 2 weeks. Complete resolution was achieved in all cases except one patient who underwent TPK because of diffuse anterior synechiae of the iris, with recurrence of infection after 10 days. The patients who received IVIG showed resolution earlier compared to the other patients. CONCLUSIONS Evaluation of characteristics of retrocorneal plaques by ASOCT and reduced corneal sensation are valuable aids in diagnosis of complicated viral keratitis. Conservative medical management may be a viable option even in severe cases. IVIG may have a role in speedy resolution of severe cases, but more research is needed to confirm this.
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Affiliation(s)
- Zhen Yang
- grid.411642.40000 0004 0605 3760Department of Ophthalmology, Peking University Third Hospital, No. 49, North Garden Street, Haidian District, Beijing, China ,grid.411642.40000 0004 0605 3760Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Shuo Yu
- grid.411642.40000 0004 0605 3760Department of Ophthalmology, Peking University Third Hospital, No. 49, North Garden Street, Haidian District, Beijing, China ,grid.411642.40000 0004 0605 3760Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Chun Zhang
- grid.411642.40000 0004 0605 3760Department of Ophthalmology, Peking University Third Hospital, No. 49, North Garden Street, Haidian District, Beijing, China ,grid.411642.40000 0004 0605 3760Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Rupesh Agrawal
- grid.240988.f0000 0001 0298 8161National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore ,grid.59025.3b0000 0001 2224 0361Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore ,grid.272555.20000 0001 0706 4670Singapore Eye Research Institute, Singapore, Singapore ,grid.428397.30000 0004 0385 0924Duke NUS Medical School, Singapore, Singapore
| | - Yun Feng
- grid.411642.40000 0004 0605 3760Department of Ophthalmology, Peking University Third Hospital, No. 49, North Garden Street, Haidian District, Beijing, China ,grid.411642.40000 0004 0605 3760Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
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Lopez-Capdevila L, Rios-Ruh JM, Fortuño J, Costa AE, Santamaria-Fumas A, Dominguez-Sevilla A, Sales-Perez M. Diabetic ankle fracture complications: a meta-analysis. Foot Ankle Surg 2021; 27:832-837. [PMID: 33451907 DOI: 10.1016/j.fas.2020.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 08/04/2020] [Accepted: 10/30/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION This meta-analysis aimed to review complication rates following the treatment of an ankle fracture in diabetic patients and to early detect the subgroup of patients at potential risk in order to minimise this complication rate. METHODS A search of 3 databases was performed for studies published till March 2018. Twelve studies met the eligibility criteria for further statistical analysis. An odds ratio (OR) with a 95% confidence interval (95% CI) for each complication was calculated between the diabetic and non-diabetic groups. RESULTS The overall complication risk after ankle fracture was twice as high in diabetes mellitus (DM) than non-diabetes mellitus (non-DM) patients (OR 1.9, 95%CI: 1.7-2.03). This risk was considerably higher with surgery versus non-surgical treatment (OD 3.7, 95%CI: 2.3-6.2). The risk of infection was 3 times higher in DM than in non-DM patients (OR 3.4, 95%CI: 2.9-9.8). The complication rate was even higher in patients with advanced DM (OR 8.4, 95%CI: 2.9-24.5). CONCLUSION This meta-analysis provides evidence that diabetic patients are at a greater risk of complication after an ankle fracture.
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Affiliation(s)
| | - Juan M Rios-Ruh
- Consorci Sanitari Integral, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Jordi Fortuño
- Hospital Universitari Arnau de Vilanova, Lleida, Spain.
| | - Andres E Costa
- Consorci Sanitari Integral, L'Hospitalet de Llobregat, Barcelona, Spain.
| | | | | | - Miquel Sales-Perez
- Consorci Sanitari Integral, L'Hospitalet de Llobregat, Barcelona, Spain.
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Jung MK, Hörnig L, Stübs MMA, Grützner PA, Kreinest M. Analysis of diagnostics, therapy and outcome of patients with traumatic atlanto-occipital dislocation. Spine J 2021; 21:1513-1519. [PMID: 33757869 DOI: 10.1016/j.spinee.2021.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 03/08/2021] [Accepted: 03/16/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Patients' outcome following traumatic atlanto-occipital dislocation (AOD) has been poor. In recent years, an increasing number of patients surviving the initial trauma are admitted to hospital. In order to further improve the management of these patients, the knowledge of diagnostics and therapy as well as possible complications should be increased. PURRPOSE The aim of this study was to evaluate diagnostic parameters, therapy, early complications and outcome of patients with traumatic AOD. STUDY DESIGN Monocentric retrospective cohort study. PATIENT SAMPLE A total of 12 patients were included in this study. OUTCOME MEASURES The main outcome measure was functional patient outcome. Furthermore, radiographic and treatment data were analyzed. METHODS All patients suffering from traumatic AOD within an 8-year time period were included. Demographic data, radiological diagnostic parameters (condylar sum, basion dens interval, basion axis interval, power´s ratio, x-line method), as well as treatment data and complications of every patient were analyzed. Radiological parameters were compared with each other. Outcome was analyzed by a follow up examination. RESULTS The accident mechanisms were motor vehicle accidents (MVA), fall from high and low height. Basion dens interval, basion axis interval, power's ratio and x-line method were not reliable in identifying traumatic AOD (only up to 33% of the patients were identified). Twelve patients could be reviewed. Three patients were treated with surgery, five patients were treated nonsurgically. Four patients died before surgical therapy. All seven surviving patients (survival rate: 58.3%) were re-examined (mean follow-up time: 6.7 months). All patients had a GCS of 15. Three surviving patients suffered from persisting neurological deficits. CONCLUSIONS The most reliable way to diagnose AOD in Computer Topography is using the condylar sum. Surgical and nonsurgical measures can be employed with reasonable outcomes. Patient specific injury burden and clinical presentation should be taken into account when making treatment decisions for AOD.
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Affiliation(s)
- Matthias K Jung
- BG Trauma Center Ludwigshafen, University of Heidelberg, Clinic for Trauma and Orthopaedic Surgery, Ludwig-Guttmann-Straße 13, 67071 Ludwigshafen on the Rhine, Germany
| | - Lukas Hörnig
- BG Trauma Center Ludwigshafen, University of Heidelberg, Clinic for Trauma and Orthopaedic Surgery, Ludwig-Guttmann-Straße 13, 67071 Ludwigshafen on the Rhine, Germany
| | - Michael M A Stübs
- Department of Anesthesiology, Stiftung Krankenhaus Bethanien, Bethanienstraße 21, 47441 Moers, Germany
| | - Paul A Grützner
- BG Trauma Center Ludwigshafen, University of Heidelberg, Clinic for Trauma and Orthopaedic Surgery, Ludwig-Guttmann-Straße 13, 67071 Ludwigshafen on the Rhine, Germany
| | - Michael Kreinest
- BG Trauma Center Ludwigshafen, University of Heidelberg, Clinic for Trauma and Orthopaedic Surgery, Ludwig-Guttmann-Straße 13, 67071 Ludwigshafen on the Rhine, Germany.
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Kasuga K, Sakamoto T, Takamaru H, Sekiguchi M, Yamada M, Yamazaki N, Hashimoto T, Uraoka T, Saito Y. Endoscopic reduction of colocolonic intussusception due to metastatic malignant melanoma: A case report. World J Clin Cases 2020; 8:5816-5820. [PMID: 33344579 PMCID: PMC7716302 DOI: 10.12998/wjcc.v8.i22.5816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/08/2020] [Accepted: 10/26/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Intussusception rarely causes intestinal obstruction in adults. Metastatic malignant melanoma is the main cause of intussusception of the small intestine among adults. However, malignant melanoma rarely causes intussusception of the colorectum. Moreover, emergent surgery is usually performed for such cases. Here, we report a case of a patient with colocolonic intussusception caused by a malignant melanoma, for which endoscopic reduction and elective surgery were performed.
CASE SUMMARY The patient was a 64-year-old woman who underwent multiple surgeries and received chemotherapy and immunotherapy for a malignant melanoma. During immunotherapy, she had abdominal pain, diarrhea, and bloody stool. Physical examination and laboratory studies did not reveal any findings that warranted emergent surgery. Computed tomography revealed intussusception in the descending colon without intestinal necrosis and perforation. Intussusception was reduced endoscopically, and elective surgery was performed.
CONCLUSION This report suggests that endoscopic reduction and elective surgery constitute a treatment option for colocolonic intussusception of metastatic malignant melanomas.
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Affiliation(s)
- Kengo Kasuga
- Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Taku Sakamoto
- Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Hiroyuki Takamaru
- Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Masau Sekiguchi
- Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan
- Cancer Screening Center, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Masayoshi Yamada
- Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Naoya Yamazaki
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Taiki Hashimoto
- Division of Diagnostic Pathology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Toshio Uraoka
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Maebashi 371-8511, Gunma, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo 104-0045, Japan
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Chang MK, Lim ZY, Tay SC. Positive Ulnar Fovea Sign - Audit of Patient Outcomes Following Nonsurgical and Surgical Management. J Hand Surg Asian Pac Vol 2019; 24:421-427. [PMID: 31690200 DOI: 10.1142/s242483551950053x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Patients with ulnar-sided wrist pain and positive ulnar fovea sign are usually treated nonsurgically before surgical options are considered. However, the outcomes of nonsurgical management are unknown. Many of these patients also have unstable distal radioulnar joint, but there has been no comparison between the outcomes of these patients with stable and unstable distal radioulnar joint. The objectives of this study are to (1) determine the outcomes of nonsurgical and surgical treatment of patients with positive ulnar fovea sign, and (2) compare the outcomes of patients with stable and unstable distal radioulnar joint. Methods: A retrospective analysis of the outcomes of patients with ulnar sided wrist pain and positive fovea sign was performed from March 2009 to December 2014. Outcomes were measured based on patient-reported pain improvement, grip strength and range of motion of the affected wrist before and after treatment. A total of 100 wrists in 98 patients were reviewed. Results: 54% of wrists managed nonsurgically experienced pain improvement. 83% of wrists managed surgically experienced pain improvement. The mean grip strength increased by 2.8 kg and 2.7 kg, while the range of motion decreased by 14° and 5° after nonsurgical and surgical treatment respectively. When comparing patients with stable and unstable distal radioulnar joint, there were statistically more wrists with unstable distal radioulnar joint that experienced pain improvement after treatment. Conclusions: The study showed that there is a role for nonsurgical treatment for wrists with positive ulnar fovea sign with more than half of the patients experiencing pain improvement. We also found that positive ulnar fovea sign patients with unstable distal radioulnar joint had better pain outcomes compared to those with stable distal radioulnar joint.
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Affiliation(s)
- Min Kai Chang
- Duke-NUS Medical School, Singapore General Hospital, Singapore
| | - Zeus Yiwei Lim
- Biomechanics Laboratory, Singapore General Hospital, Singapore
| | - Shian Chao Tay
- Biomechanics Laboratory, Singapore General Hospital, Singapore.,Department of Hand Surgery, Singapore General Hospital, Singapore
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Osada H, Teramoto S, Kaijima H, Segawa T, Miyauchi O, Nagaishi M, Shozu M, Kato K, Gomel V. A Novel Treatment for Cervical and Cesarean Section Scar Pregnancies by Transvaginal Injection of Absolute Ethanol to Trophoblasts: Efficacy in 19 Cases. J Minim Invasive Gynecol 2018; 26:129-134. [PMID: 29723645 DOI: 10.1016/j.jmig.2018.04.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 04/21/2018] [Accepted: 04/25/2018] [Indexed: 02/06/2023]
Abstract
STUDY OBJECTIVE To evaluate the efficacy of a nonsurgical treatment for cervical pregnancy (CP) and cesarean section scar pregnancy (CSP). DESIGN Retrospective clinical study (Canadian Task Force classification III). SETTING Private assisted reproductive technology practice. PATIENTS Nineteen women with CP (n = 16) or CSP (n = 3), including 6 patients with positive fetal heartbeat. INTERVENTION Transvaginal local injection of absolute ethanol (AE) into the hyperechoic ring (lacunar space) around the gestational sac under ultrasound guidance. MEASUREMENTS AND MAIN RESULTS Serum beta-human chorionic gonadotropin (β-hCG) was measured at frequent intervals, and ultrasound and/or magnetic resonance imaging was used to observe the gestational sac. In 9 patients, the serum β-hCG level was effectively reduced with a single AE injection at 2 hours. In the remaining 10 patients, the level decreased but then increased in 4 and slowly decreased in the other 6; all of these 10 patients required 2 to 5 repeat AE injections. In all patients, serum β-hCG level was reduced by 50% within 3 days and decreased to <10% of the initial level within 14 days. In 18 patients (95%), the level was decreased to 1.0 mIU/mL within 40 days. Seven patients were treated on an outpatient basis. Twelve patients received no anesthesia. Five patients subsequently became pregnant, and each had a live birth. There was no recurrent CP or CSP. The procedure was successful in all 19 patients. CONCLUSION This procedure is an effective treatment for CP or CSP that could be used in place of conventional surgical interventions and medical treatment using MTX.
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Affiliation(s)
- Hisao Osada
- Natural ART Clinic Nihombashi, Tokyo, Japan.
| | | | | | | | | | - Masaji Nagaishi
- Department of Obstetrics and Gynecology, Nihon University School of Medicine, Tokyo, Japan
| | - Makio Shozu
- Department of Reproductive Medicine, Chiba University Postgraduate School of Medicine, Chiba, Japan
| | | | - Victor Gomel
- Department of Obstetrics and Gynaecology, The University of British Columbia, Vancouver, Canada
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Karunakaran JV, Abraham CS, Karthik AK, Jayaprakash N. Successful Nonsurgical Management of Periapical Lesions of Endodontic Origin: A Conservative Orthograde Approach. J Pharm Bioallied Sci 2017; 9:S246-S251. [PMID: 29284973 PMCID: PMC5731023 DOI: 10.4103/jpbs.jpbs_100_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Periapical lesions of endodontic origin are common pathological conditions affecting periradicular tissues. Microbial infection of pulpal tissues is primarily responsible for initiation and progression of apical periodontitis. The primary objective of endodontic therapy should be to restore involved teeth to a state of normalcy nonsurgically. Different nonsurgical management techniques, namely, conservative root canal therapy, decompression technique, method using calcium hydroxide, aspiration-irrigation technique, lesion sterilization and tissue repair therapy, active nonsurgical decompression technique, and the apexum procedure have been advocated. New techniques which use drug-loaded injectable scaffolds, simvastatin, and epigallocatechin-3-gallate have been tried. Surgical option should be considered when intra- or extra-radicular infections are persistent. Incidence of nonendodontic periapical lesions has also been reported. An accurate diagnosis of the periapical lesion whether it is of endodontic or nonendodontic origin has to be made. Surgical methods have many disadvantages, and hence should be considered as an option only in the case of failure of nonsurgical techniques. Assessment of healing of periapical lesions has to be done periodically which necessitates a long-term follow-up. Even large periapical lesions and retreatment cases where the lesion is of endodontic origin have been successfully managed nonsurgically with orthograde endodontic therapy.
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Affiliation(s)
- J V Karunakaran
- Department of Conservative Dentistry, JKK Nataraja Dental College, Komarapalayam, Namakkal, Tamil Nadu, India
| | - Chris Susan Abraham
- Department of Conservative Dentistry, JKK Nataraja Dental College, Komarapalayam, Namakkal, Tamil Nadu, India
| | - A Kaneesh Karthik
- Department of Oral and Maxillofacial Surgery, JKK Nataraja Dental College, Komarapalayam, Namakkal, Tamil Nadu, India
| | - N Jayaprakash
- Department of Conservative Dentistry, JKK Nataraja Dental College, Komarapalayam, Namakkal, Tamil Nadu, India
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Najd Mazhar F, Jafari D, Mirzaei A. Evaluation of functional outcome after nonsurgical management of terrible triad injuries of the elbow. J Shoulder Elbow Surg 2017; 26:1342-1347. [PMID: 28734536 DOI: 10.1016/j.jse.2017.05.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 05/08/2017] [Accepted: 05/08/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Terrible triad (TT) is one of the severe injuries of the elbow that generally requires surgery. Nonsurgical treatment has recently been applied in selected cases of TT injury. Evaluation of the results of this treatment was the main aim of this study. METHODS In a prospective cohort study, 10 patients with a mean follow-up of 30.6 months were evaluated. The inclusion criteria included a congruent joint after closed reduction, no indication for surgery of the coronoid and radial head fractures, no block in supination and pronation up to 60°, no intra-articular fragments, and a free and stable joint with ulnohumeral extension up to a minimum of 45°. Mayo Elbow Performance Index and Disabilities of the Arm, Shoulder, and Hand score were used for assessment of the functional outcome. A standard physical examination to record elbow range of motion was also performed. RESULTS For the affected and the contralateral elbows, respectively, the mean extension of the elbow was 11° ± 7° and 0.0° ± 2°; the mean flexion was 131° ± 9° and 140° ± 10°; the mean supination was 58° ± 17° and 85 ± 7°; and the mean pronation was 53° ± 23° and 85° ± 7°. The mean Disabilities of the Arm, Shoulder, and Hand score was 4.76 ± 5.17. The mean Mayo Elbow Performance Index was 95 ± 8.16. CONCLUSION Nonsurgical management of the TT injury can result in acceptable functional outcomes when a patient meets the criteria set for nonsurgical treatment.
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Affiliation(s)
- Farid Najd Mazhar
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Davod Jafari
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Mirzaei
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran.
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Finkelstein P, Sharma R, Picado O, Gadde R, Stuart H, Ripat C, Livingstone AS, Sleeman D, Merchant N, Yakoub D. Pancreatic Neuroendocrine Tumors (panNETs): Analysis of Overall Survival of Nonsurgical Management Versus Surgical Resection. J Gastrointest Surg 2017; 21:855-866. [PMID: 28255853 DOI: 10.1007/s11605-017-3365-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 01/05/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Outcomes of patients with pancreatic neuroendocrine tumors (panNETs) undergoing surgical or nonsurgical management and outcomes of enucleation versus standard resection were compared. METHODS MEDLINE, EMBASE, PubMed, Scopus, and Cochrane were queried (2000 to present). All studies comparing patients undergoing surgical versus nonsurgical treatments, or enucleation versus standard resection, were included. Pooled risk ratios and 95% CI for survival were calculated. RESULTS Eleven studies met criteria with 1491 resected and 1607 nonsurgically managed patients. Meta-analysis showed improved overall survival with resection at 1 year (risk ratio (RR) = 1.281, CI 1.064-1.542, p = 0.009), 3 years (RR = 1.837, CI 1.594-2.117, p < 0.001), and 5 years (RR = 2.103, CI 1.50-2.945, p < 0.001). OS of patients with resected nonfunctioning panNETs was improved at 3 years (RR = 1.847, CI 1.477-2.309, p < 0.001) and 5 years (RR = 1.767, CI 1.068-2.924, p = 0.027). OS was improved when panNETs ≤2 cm were resected at 3 years (RR = 1.695, CI 1.269-2.264, p < 0.001) and 5 years (RR = 2.210, CI 1.749-2.791, p < 0.001). Fifteen articles met criteria for enucleation versus standard resection (n = 1035; 620 were nonfunctioning). Enucleation had shorter operative time (weighted mean difference (WMD) = -95.6 min, 95% CI -131.4 to -59.8, p < 0.01), less operative blood loss (WMD = -172.6 ml, 95% CI -340 to -5.1, p = 0.04), but increased postoperative pancreatic fistula (POPF) (RR = 2.08, 95% CI 1.39-3.12, p < 0.01). CONCLUSION Surgical resection of panNETs, including small and nonfunctioning, appears to be associated with improved OS. Enucleation is associated with shorter operative time, less blood loss, but greater incidence of POPF. Prospective, randomized clinical trials are needed to confirm these results.
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Affiliation(s)
- Paige Finkelstein
- Division of Surgical Oncology, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB C232, Miami, FL, 33136, USA
| | - Rishika Sharma
- Division of Surgical Oncology, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB C232, Miami, FL, 33136, USA
| | - Omar Picado
- Division of Surgical Oncology, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB C232, Miami, FL, 33136, USA
| | - Rahul Gadde
- Division of Surgical Oncology, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB C232, Miami, FL, 33136, USA
| | - Heather Stuart
- Division of Surgical Oncology, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB C232, Miami, FL, 33136, USA
| | - Caroline Ripat
- Division of Surgical Oncology, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB C232, Miami, FL, 33136, USA
| | - Alan S Livingstone
- Division of Surgical Oncology, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB C232, Miami, FL, 33136, USA
| | - Danny Sleeman
- Division of Surgical Oncology, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB C232, Miami, FL, 33136, USA
| | - Nipun Merchant
- Division of Surgical Oncology, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB C232, Miami, FL, 33136, USA
| | - Danny Yakoub
- Division of Surgical Oncology, Jackson Memorial Hospital/Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14th Street, CRB C232, Miami, FL, 33136, USA.
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Sun M, Becker A, Tian Z, Roghmann F, Abdollah F, Larouche A, Karakiewicz PI, Trinh QD. Management of localized kidney cancer: calculating cancer-specific mortality and competing risks of death for surgery and nonsurgical management. Eur Urol 2013; 65:235-41. [PMID: 23567066 DOI: 10.1016/j.eururo.2013.03.034] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 03/15/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND For elderly individuals with localized renal cell carcinoma (RCC), surgical intervention remains the primary treatment option but may not benefit patients with limited life expectancy. OBJECTIVE To calculate the trade-offs between surgical excision and nonsurgical management (NSM) with respect to competing causes of mortality. DESIGN, SETTING, AND PARTICIPANTS Relying on a cohort of Medicare beneficiaries, all patients with nonmetastatic node-negative T1 RCC between 1988 and 2005 were abstracted. INTERVENTION All patients were treated with partial nephrectomy (PN), radical nephrectomy (RN), or NSM. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Cancer-specific mortality (CSM) and other-cause mortality (OCM) rates were modeled through competing-risks regression methodologies. Instrumental variable analysis was used to account for the potential biases associated with measured and unmeasured confounders. RESULTS AND LIMITATIONS A total of 10 595 patients were identified. In instrumental variable analysis, patients treated with PN (hazard ratio [HR]: 0.45; 95% confidence interval [CI], 0.24-0.83; p=0.01) or RN (HR: 0.58; 95% CI, 0.35-0.96; p=0.03) had a significantly lower risk of CSM than those treated with NSM. In subanalyses restricted to patients ≥ 75 yr, the instrumental variable analysis failed to detect any statistically significant difference between PN (HR: 0.48; p=0.1) or RN (HR: 0.57; p=0.1) relative to NSM with respect to CSM. Similar trends were observed in T1a RCC only. CONCLUSIONS PN or RN is associated with a reduction of CSM among older patients diagnosed with localized RCC, compared with NSM. The same benefit failed to reach statistical significance among patients ≥ 75 yr. The harms of surgery need to be weighed against the marginal survival benefit for some patients.
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Affiliation(s)
- Maxine Sun
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Department of Public Health, Faculty of Medicine, University of Montreal, Montreal, Canada.
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