scholarly journals Not All Embolizations Are Created Equally in the Management of Posterior Epistaxis: Discussion of Safety Measures Avoiding Neurological Complications

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Mareike Franke ◽  
Jasper Franke ◽  
Christian Saager ◽  
Sven Barthel ◽  
Randolf Riemann ◽  
...  
Keyword(s):  
Neurological Complication ◽  
Neurological Complications ◽  
Surgical Approaches ◽  
Success Rates ◽  
Artery Ligation ◽  
Retrospective Data Analysis ◽  
First Choice ◽  
Surgical Methods ◽  
Choice Of Treatment ◽  
Meta Analyses

Today, there are still no uniform guidelines for the treatment of epistaxis. Furthermore, it is widely debated whether embolization or surgical approaches should be the first choice of treatment for intractable posterior epistaxis after conservative measures have failed. In several meta-analyses, it is reported that endoscopic sphenopalatine artery ligation and embolization have similar success rates, but embolization was associated with more severe neurological complications. Regarding existing literature, there are many comparative analyses of surgical methods but none for embolization protocols. Against this backdrop of a lack of uniform standards in embolization techniques, we present a retrospective evaluation of what has emerged to be best procedural practice for endovascular treatment of epistaxis in our department using microsphere particles and microcoils, in particular regarding precaution measures to avoid neurological complications. In our retrospective data analysis of 141 procedures in 123 patients, performed between 2008 and 2019, we find success rates very similar to those reported in other studies (95.1% immediate-stop-of-bleeding success and 90.2% overall embolization success) but did not encounter any major neurological complication opposed to other reports. We suggest some aspects of our protocol as precaution measure to avoid neurological complications. More generally and perhaps even more importantly, we make a strong case for standardization for embolization techniques to the level of details in surgical procedure standardization to enable an apples to apples comparison of embolization techniques to each other and of intervention vs. surgery.

scholarly journals Complex ruptures of the quadriceps tendon: a systematic review of surgical procedures and outcomes

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Francesco Oliva ◽  
Emanuela Marsilio ◽  
Filippo Migliorini ◽  
Nicola Maffulli
Keyword(s):  
Systematic Review ◽  
Quadriceps Tendon ◽  
Synthetic Mesh ◽  
Surgical Approaches ◽  
Evidence Based ◽  
Group 4 ◽  
First Choice ◽  
Total Knee ◽  
End To End ◽  
Meta Analyses

Abstract Background Chronic ruptures, ruptures following total knee arthroplasty (TKA), and re-ruptures of the quadriceps tendon (QT) are rare. A systematic review of the current literature was conducted on their treatment and outcome to provide evidence-based indications for their management. Methods We searched published articles in English on chronic ruptures of QT, QT ruptures that occurred after TKA, and re-ruptures in PubMed, Scopus, and Google Scholar up to January 2021. Twenty-five articles were included following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results Data from 25 articles (97 patients) with a mean age of 57 were retrieved. Patients were classified into three groups depending on the type of rupture: 16 patients suffered chronic QTR, 78 a QTR after a TKA, and 9 patients reported a re-rupture. The most frequent surgical approaches were different for each group: Codivilla’s Y-V technique and end-to-end sutures were the most commonly used in the chronic tears group (62.5%), synthetic MESH was the most frequent choice in QTR after a TKA group (38 patients, 53%), while end-to-end sutures were the first choice in the re-rupture group (4 patients, 44%). Conclusions Complex ruptures of the QT can be chronic ruptures, re-ruptures, or ruptures occurring after TKA. The choice of the best surgical technique depends on the macroscopic quality of the tendon stumps rather than the timing of intervention. Evidence-based preventive and therapeutic strategies should be developed.

Severe Aggressive Acute Disseminated Encephalomyelitis–Like Reaction After Aneurysm Coiling

Neurosurgery ◽  
2010 ◽  
Vol 66 (1) ◽  
pp. E222-E223 ◽  
Author(s):  
Leonardo Deus-Silva ◽  
Cheemun Lum ◽  
Christine De Meulemeester ◽  
Marlise P. dos Santos
Keyword(s):  
Interventional Procedures ◽  
Oral Prednisolone ◽  
Acute Disseminated Encephalomyelitis ◽  
Surgical Approaches ◽  
High Dose ◽  
Unusual Complication ◽  
Complex Aneurysm ◽  
First Choice ◽  
Initial Intervention ◽  
Choice Of Treatment

Abstract OBJECTIVE Neurointerventional procedures are the first choice of treatment for a variety of cerebrovascular pathologies in many centers worldwide. Although less invasive than conventional traditional surgical approaches, interventional procedures are not exempt from complications. We describe a case of an unusual complication after a coiling procedure where the patient developed severe brain edema induced by contrast media and resembling an aggressive acute disseminated encephalomyelitis–like reaction that was reversed with appropriate therapy. CLINICAL PRESENTATION A 53-year-old, right-handed woman presented with an incidental 4 × 6-mm anterior communicating complex aneurysm, which was successfully coiled with balloon assistance. On the third postcoiling day, she presented to the emergency department with global aphasia, dysarthria, right upper motor neuron pattern facial paresis, and right hemiplegia and hemianesthesia. INTERVENTION The initial intervention was a microballoon-assisted coiling of the anterior communicating complex aneurysm. The intervention for the subsequent complication was high-dose intravenous methylprednisolone for 5 days followed by slow tapering of oral prednisolone. At a 4-month follow-up examination, the patient was asymptomatic and neurologically intact. CONCLUSION We present a case of an unusual complication after a coiling procedure. Considering that endovascular interventional procedures are part of the therapeutic armamentarium for cerebrovascular pathologies, it is of fundamental importance to increase awareness of potential complications that could arise from such interventions.

Nonsurgical Therapies for Hepatocellular and Cholangiocellular Carcinoma

Swiss Surgery ◽  
1999 ◽  
Vol 5 (3) ◽  
pp. 116-121 ◽  
Author(s):  
Schmassmann
Keyword(s):  
Current Trend ◽  
Percutaneous Ethanol Injection ◽  
Cholangiocellular Carcinoma ◽  
Multidisciplinary Therapy ◽  
Term Survival ◽  
Ethanol Injection ◽  
First Choice ◽  
Tumor Stages ◽  
Choice Of Treatment ◽  
Advanced Stages

Surgical resection is the first choice of treatment for patients with hepatocellular (HCC) and cholangiocellular carcinomas. Prolongation of survival is, however, the only realistic goal for most patients, which can be often achieved by nonsurgical therapies. Inoperable patients with large or multiple HCCs are usually treated with transarterial chemoembolization (TACE) with lipiodol in combination with a chemotherapeutic drug and gelfoam. Three-year survival depends on the stage of the disease and is about 20%. Patients with earlier tumor stages (one or two tumor nodules less than 3cm in size) are suitable for treatment with percutaneous ethanol injection (PEI) alone or in combination with TACE. Several studies have shown that in these early stages, the 3-year survival rate is approximately 55%-70% in the actively treated patients which is significantly higher than in untreated patients. In advanced stages of the disease, TACE and PEI have no effect on survival and should not be performed. Some of these patients have been successfully treated with octreotide. Patients with inoperable cholangiocellular carcinoma are treated by endoscopic or percutaneous stent placement. If stenting does not achieve adequate biliary drainage, multidisciplinary therapy including internal / external radiotherapy or photodynamic therapy should be considered in patients with potential long-term survival. In conclusion, nonresectional therapies play an essential role in the therapy of inoperable hepato- and cholangiocellular carcinomas as they lead to satisfactory survival. Multidisciplinary therapy appears to be the current trend of management.

Surgery of ulcus cruris venosum

Phlebologie ◽  
2010 ◽  
Vol 39 (03) ◽  
pp. 156-162 ◽  
Author(s):  
C. Schwahn-Schreiber
Keyword(s):  
Subcutaneous Tissue ◽  
Ulcus Cruris ◽  
Healing Time ◽  
Ulcus Cruris Venosum ◽  
Venous Stasis ◽  
Morphological Alterations ◽  
First Choice ◽  
Choice Of Treatment ◽  
Chronic Compartment Syndrome ◽  
Shave Therapy

SummaryAdvanced chronic venous stasis syndrome is characterized by irreversible and self-perpetuating morphological alterations in the lower leg. A chronic inflammatory process results in sclerosis, which progresses from the skin to the subcutaneous tissue and ultimately the fascia, sometimes including muscle and ankle joint and leading to chronic compartment syndrome. To cure these severe alterations with non healing ulcers decompression of the compartments like paratibial fasciotomy with SEPS and crural fasciectomy or removal of sclerosis like shave therapy are successful surgical procedures. Indication should be adapted to the extension of ulcer. Indications of the operations and the techniques are described, complications and results are discussed. Due to ulcer extension especially shave therapy (removal of the sclerotic tissue epifascial) and crural fasciectomy (removal of sclerosis including fascia) are very successful with up to 80% healing rate, even in severe cases and even after long term (up to 8 years). Since shave therapy is easy, short and simple with short healing time, few complications and good aesthetical result it is the first choice of treatment for non healing leg ulcers. Fasci ectomy is reserved for special indications such as deep transfascial necrosis or failure of shave therapy.

scholarly journals Salpingo-oophorectomy versus cystectomy in patients with borderline ovarian tumors: a systemic review and meta-analysis on postoperative recurrence and fertility

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Peng Wang ◽  
Lei Fang
Keyword(s):  
Surgical Procedures ◽  
Postoperative Recurrence ◽  
Pregnancy Rates ◽  
Ovarian Tumors ◽  
Systemic Review ◽  
Cochrane Library ◽  
Risk Of Recurrence ◽  
Borderline Ovarian Tumors ◽  
Surgical Methods ◽  
Meta Analyses

Abstract Background To compare the postoperative recurrence and fertility in patients with borderline ovarian tumors (BOTs) who underwent different surgical procedures: salpingo-oophorectomy versus cystectomy. Methods Potentially relevant literature from inception to Nov. 06, 2020, were retrieved in databases including Cochrane Library, EMBASE (Ovid), and MEDLINE (Pubmed). We applied the keywords “fertility-sparing surgery,” or “conservative surgery,” or “cystectomy,” or “salpingo-oophorectomy,” or “oophorectomy,” or “adnexectomy,” or “borderline ovarian tumor” for literate searching. Systemic reviews and meta-analyses were performed on the postoperative recurrence rates and pregnancy rates between patients receiving the two different surgical methods. Begger’s methods, Egger’s methods, and funnel plot were used to evaluate the publication bias. Result Among the sixteen eligible studies, the risk of recurrence was evaluated in all studies, and eight studies assessed the postoperative pregnancy rates in the BOT patients. A total of 1839 cases with borderline ovarian tumors were included, in which 697 patients (37.9%) received unilateral salpingo-oophorectomy and 1142 patients (62.1%) underwent unilateral/bilateral cystectomy. Meta-analyses showed that BOT patients with unilateral/bilateral cystectomy had significantly higher recurrence risk (OR=2.02, 95% CI: 1.59-2.57) compared with those receiving unilateral salpingo-oophorectomy. Pooled analysis of four studies further confirmed the higher risk of recurrence in patients with cystectomy (HR=2.00, 95% CI: 1.11-3.58). In addition, no significant difference in postoperative pregnancy rate was found between patients with the two different surgical procedures (OR=0.92, 95% CI: 0.60-1.42). Conclusion Compared with the unilateral/bilateral cystectomy, the unilateral salpingo-oophorectomy significantly reduces the risk of postoperative recurrence in patients with BOT, and it does not reduce the pregnancy of patients after surgery. Trial registration PROSPERO CRD42021238177

scholarly journals Supraselective embolization as a method for the management of renal vascular injuries

2006 ◽  
Vol 63 (10) ◽  
pp. 897-901 ◽  
Author(s):  
Novak Milovic ◽  
Vladimir Bancevic ◽  
Olivera Jakovljevic ◽  
Zoran Paunic
Keyword(s):  
High Risk Patient ◽  
Percutaneous Nephrostomy ◽  
Low Grade ◽  
Av Fistula ◽  
Traumatic Injuries ◽  
First Choice ◽  
Surgical Methods ◽  
Renal Vessel ◽  
Renal Vascular ◽  
Renal Injuries

Background: Renal injuries are most often caused by traumatic injuries, but they can also be induced iatrogenically, during renal biopsy, percutaneous nephrostomy or lithotripsy. Vascular renal injuries may be treated by embolization, nonsurgical or surgical methods. Case report. In this paper we presented a high-risk patient with poor outcome of an open surgery threatment and a prior attempt of embolization, with gross haematuria caused by traumatic renal arterio-venous (AV) fistula and pyelocalical injury who was managed by supraselective embolization of the irrigating arterial vessel. Conclusion. Supraselective embolization is a first choice method for the treatment of low grade renal vessel injuries. Even patients with the most severe renovascular lesions and major renal destruction (a grade IV injury) can be treated nonsurgically with supraselective embolization, with an excellent chance to preserve the maximal amount of functional renal parenchyma. This method is rapid, effective, tissue preserving, and likely to reduce morbidity and mortality.

scholarly journals Percutaneous transhepatic drainage is safe and effective in biliary obstruction—A single-center experience of 599 patients

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0260223
Author(s):  
Bálint Kokas ◽  
Attila Szijártó ◽  
Nelli Farkas ◽  
Miklós Ujváry ◽  
Szabolcs Móri ◽  
...  
Keyword(s):  
Success Rate ◽  
Extrahepatic Bile Duct ◽  
Treatment Algorithm ◽  
Success Rates ◽  
Technical Success ◽  
Tertiary Referral Center ◽  
Technical Success Rate ◽  
Percutaneous Transhepatic Drainage ◽  
First Choice ◽  
Transhepatic Drainage

Background Historically, surgical bilioenteric bypass was the only treatment option for extrahepatic bile duct obstruction, but with technological advancements, percutaneous transhepatic drainage (PTD) and endoscopic solutions were introduced as a less invasive alternative. Endoscopic methods may lead to a decreasing indication of PTD in the future, but today it is still the standard treatment method, especially in hilar obstructions. Methods In our retrospective data analysis, we assessed technical success rate, reintervention rate, morbidity, mortality, and the learning curve of patients treated with PTD over 12 years in a tertiary referral center. Results 599 patients were treated with 615 percutaneous interventions. 94.5% (566/599) technical success rate; 2.7% (16/599) reintervention rate were achieved. 111 minor and 22 major complications occurred including 1 case of death. In perihilar obstruction, cholangitis were significantly more frequent in cases where endoscopic retrograde cholangiopancreatography had also been performed prior to PTD compared to PTD alone, with 39 (18.2%) and 15 (10.5%) occurrences, respectively. Discussion The results and especially the excellent success rates demonstrate that PTD is safe and effective, and it is appropriate for first choice in the treatment algorithm of perihilar stenosis. Ultimately, we concluded that PTD should be performed in experienced centers to achieve low mortality, morbidity, and high success rates.

scholarly journals Epileptic seizures in patients with COVID-19: A systematic review of early evidences

2021 ◽  
Vol 8 (1) ◽  
pp. 33-44
Author(s):  
B Roy ◽  
I Banerjee
Keyword(s):  
Systematic Review ◽  
Epileptic Seizure ◽  
Case Reports ◽  
Neurological Complication ◽  
Epileptic Seizures ◽  
Neurological Complications ◽  
Cross Sectional Study ◽  
Cerebrovascular Diseases ◽  
Cross Sectional ◽  
Demyelinating Lesions

Background: Global emergence of SARS-CoV-2 surfaced neurological complications amongst the patients. COVID-19 resembles with other coronavirus strains follows a trend of neurological complication, damage and encephalopathy, which entails considerable risks, requires attention for the neurologists. This is, to our knowledge, the first systematic review of the literature to investigate solely to elucidate the seizure spectrum by unfolding epileptogenicity of the SARS CoV-2 and potential pathways of neuroinvasion. Methods: A systematic literature search was performed in PubMed and Embase database following standard guidelines, using specific keywords based on epileptic seizure onset described from December 01, 2019, to July 17, 2020 Results: A total of 17 studies were included ranging from case reports, series of cases, multicentre cross-sectional study with the first-time onset of seizure associated with an epileptic origin. We excavated causes of complex COVID-19 related neurological manifestations, e.g., cerebrovascular diseases, encephalitis, demyelinating lesions, cytokine storm and proposed routes of SARS-CoV-2 entry into the nervous system to understand the mechanism of an epileptic seizure. Conclusion: COVID-19 is a potent neuropathogen which causes the new onset of epileptic seizures should get diagnostic recognition to evade possible deterioration of neurological conditions. However, more shreds of evidence from the future will further elucidate the epileptogenic potential of the pandemic.

scholarly journals Imaging findings of neurologic complications in lung transplantation: Review of a 9-year cohort

2021 ◽  
Vol 10 (8) ◽  
pp. 205846012110387
Author(s):  
Elena Marín-Díez ◽  
Marta Drake-Pérez ◽  
Natalia Valle-San Román ◽  
Víctor Manuel Mora Cuesta ◽  
Miguel Ángel Hernández-Hernández ◽  
...  
Keyword(s):  
Lung Transplantation ◽  
Therapeutic Option ◽  
Neurological Complication ◽  
Underlying Disease ◽  
Neurological Complications ◽  
Critical Illness Polyneuropathy ◽  
Imaging Findings ◽  
Post Transplant ◽  
Elevated Rate ◽  
Lung Transplant Recipients

Background Lung transplantation (LT) requires complex multidisciplinary organization and constitutes a therapeutic option and a life-saving procedure. Although the number of lung recipients continues to increase, neurological complications and death rates following lung transplantation are still higher than desirable. Purpose This study aims to analyse the neuroimaging findings in a cohort of adult patients with LT. Material and Methods A retrospective cohort study of all lung transplant recipients (344 patients: 205 men and 139 women) at a single institution from January 2011 to January 2020. The collected data included demographic features, clinical data and evaluation of the imaging findings. We also recorded the date of neurological complication(s) and the underlying disease motivating lung transplantation. Results We found an elevated rate of neuroimaging findings in patients following LT with 32.6% of positive studies. In our cohort, the average time after LT to a neurological complication was 4.9 months post-transplant. Encephalopathy, critical illness polyneuropathy and stroke, in that order, were the most frequent neurological complications. Structural abnormalities in brain imaging were more often detected using MRI than CT for indications of encephalopathy and seizures. Conclusions LT recipients constitute an especially vulnerable group that needs close surveillance, mainly during the early post-transplant period.

scholarly journals Association of Functional Dyspepsia with Depression and Anxiety: A Systematic Review

2021 ◽  
Author(s):  
Tasia Esterita ◽  
Sheilla Dewi ◽  
Felicia Grizelda Suryatenggara ◽  
Glenardi Glenardi
Keyword(s):  
Systematic Review ◽  
Functional Dyspepsia ◽  
Assessment Tools ◽  
Depression And Anxiety ◽  
Questionnaire Assessment ◽  
Prevalence Of Depression ◽  
Choice Of Treatment ◽  
Meta Analyses ◽  
Almost All

Background and Aims: Functional dyspepsia (FD) symptoms may lead to depression or anxiety in affected individuals and vice versa. These individuals often have more serious somatic symptoms, longer disease recovery time, and tend to consume more medical resources and health care costs. Therefore, recognition of depression and anxiety is crucial to improve clinical outcome in FD patients. The aim of this study is to systematically review the association of functional dyspepsia with depression and anxiety. Methods: This systematic review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. A Literature search was carried out with PubMed and ProQuest databases from 1 January 2010 to 5 October 2020. The outcomes of interest were association of functional dyspepsia with depression and anxiety. The quality of each study was assessed using the Joanna Briggs Institute (JBI) tool. Results: A total of 13 studies involving 14,076 subjects were included in this review. Almost all of the studies showed that prevalence of depression or anxiety is higher in patients with FD compared to controls. This is implied by a higher mean score on the depression and anxiety questionnaire assessment tools or a positive correlation in the odds ratio. FD is known to affect more females than males, but psychological links were stronger in males. Moreover, prevalence of depression and anxiety symptoms in patients with refractory FD (63.3% and 61.5%) was higher compared to non-refractory FD (20.9% and 23.3%) and healthy patients (10% and 10%). Conclusion: There is a significant association of FD with depression and anxiety. Thus, identifying psychological factors in FD patients is essential to help clinicians determine the best choice of treatment and improve the prognosis and quality of life of the patients.

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