scholarly journals Electrochemotherapy and Simultaneous Photodynamic Bone Stabilization of Upper Limbs in Metastatic Renal Cancer Disease: Case Report and Literature Review

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Ugo Albertini ◽  
Andrea Conti ◽  
Nicola Ratto ◽  
Pietro Pellegrino ◽  
Michele Boffano ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Minimally Invasive ◽  
Bone Disease ◽  
Metastatic Bone Disease ◽  
Invasive Technique ◽  
Bone Lesions ◽  
Disease Case ◽  
Lytic Bone Lesions

Introduction. Metastatic bone disease represents a systemic pathology that heavily affects the quality of life of oncologic patients causing pain and functional disability. Methodology. We present the case of a patient with a history of renal cell cancer presenting pathologic fractures of both humeri and proximal right radius. Results. After a careful multidisciplinary approach, an adjuvant anticancer therapy and a photodynamic bone stabilization procedure were performed with a minimally invasive technique aiming to minimize pain and local disease progression, while restoring functional autonomy and improving the patient’s quality of life. Electrochemotherapy was delivered on the lytic bone lesions with extraskeletal involvement of the proximal left humerus and the proximal right radius, and then polymeric bone stabilization was performed on both humeri. At two months of follow-up, the patient presented satisfactory functional scores (MSTS score: 12/30 bilaterally; DASH scores: 46.7/100 for the right side and 48.3/100 for the left one), and pain was well controlled with opioid analgesics. Radiographs showed good results in terms of ossification of lytic bone lesions and durability of polymeric stabilization. At four months of follow-up, the patient reported a stable clinical scenario. Six months after surgery, due to extremely poor prognosis after the progression of primary disease, the patient was referred to palliative care and died shortly thereafter. Conclusion. Over the last decade, the management of metastatic bone disease has changed. Low-toxicity and minimally invasive procedures such as electrochemotherapy and polymeric bone stabilization might be performed concomitantly in selected patients, as an alternative to radiation therapy and to more demanding surgical procedures such as plating and adjuvant cementing.

Long-Term Follow-Up of Minimally Invasive Cardiac Surgery Using an Endoaortic Occlusion System

2014 ◽  
Vol 17 (2) ◽  
pp. 93 ◽  
Author(s):  
Arndt-H. Kiessling ◽  
Philipp Kisker ◽  
Alexandra Miskovic ◽  
Nestoras Papadopoulos ◽  
Andreas Zierer ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Minimally Invasive ◽  
Structural Damage ◽  
Aortic Wall ◽  
Artery Bypass ◽  
Mitral Valve Surgery ◽  
Ascending Aorta ◽  
Invasive Technique

<p><b>Objectives:</b> We reviewed the initial patient series (n=116) of our institution performing minimally invasive coronary artery bypass grafting (CABG) (n=79), mitral valve surgery (n=1), or atrial septal closure (ASD) procedures (n=26) using an endoaortic occlusion system. With this technique relevant intra-aortic pressures are exerted on the aortic wall during the clamping time. This might lead to late aortic degeneration and aneurysm formation. Our study sought to evaluate postoperative aortic complications and the quality of life (modified SF-12).</p><p><b>Methods:</b> One hundred sixteen patients (56% male; 54 years � 14.5; range 19 years to 77 years) underwent a cardiac procedure using an endoaortic clamp. The endoaortic balloon clamp catheter was used to occlude the ascending aorta at pressures >300 mmHg. Patients were rescheduled for echocardiographic examination after a mean follow-up period of 8.8 years.</p><p><b>Results:</b> The analysis performed among 78 patients showed no incidence of any structural damage to the ascending aorta at the intraoperative position of the endoaortic balloon. The physical and mental summary scores are equal to those of comparable patient groups.</p><p><b>Conclusions:</b> The endoaortic occlusion system causes no damage to the aortic wall. If the system causes any problems, they occur immediately during surgery. Patients treated with this minimally invasive technique exhibited the same quality of life as those undergoing conventional surgery.</p>

scholarly journals Prediction of fracture risk and prophylactic intervention in metastatic bone disease: a systematic review

2018 ◽  
Vol 1 (1) ◽  
pp. 44-49
Author(s):  
Bogdan Ştefan Creţu ◽  
Călin Dragosloveanu ◽  
Dragoş Cotor ◽  
Şerban Dragosloveanu ◽  
Cristian Ioan Stoica
Keyword(s):  
Fracture Risk ◽  
Bone Disease ◽  
Meta Analysis ◽  
Metastatic Bone Disease ◽  
Bone Lesions ◽  
Pathological Fractures ◽  
Element Analysis ◽  
Actual Knowledge ◽  
Number Of Patients

AbstractPathological fractures occur in an area of bone where either the quantity or quality of bone is modified and the main cause of bone metastases that weaken the structure and will lead to fractures are in high proportion given by visceral tumors or primary hematopoietic tumors like myeloma.This paper’s objective was to review the actual knowledge in the treatment of fractures secondary to metastases. Spinal lesions were not discussed in this paper.Literature search was performed using MEDLINE and Web of Science to find literature relevant to fracture risk and prophylactic intervention in metastatic bone disease. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline was used for this review. As results, we identified 30 papers that were suitable for this review. Most of them concluded that it is difficult to assess the amount of bone involvement on radiographs alone. Using the actual guidelines for prophylactic fixation may result in an under treatment or overtreatment of patients with metastatic bone disease. Their ability to determine which metastatic bone lesions will fracture is altered mainly because of the small number of patients included in the studies. The prediction factors for fracture risk are still to be evaluated. CT, FDG-PET or CT scan-based finite element analysis may be useful tools for the identification of impending pathological fractures requiring prophylactic stabilization.

Minimally Invasive Separation Surgery for Metastases in the Vertebral Column: A Technical Report

2019 ◽  
Vol 18 (6) ◽  
pp. 606-613
Author(s):  
Rafael A Vega ◽  
Jeffrey I Traylor ◽  
Ahmed Habib ◽  
Laurence D Rhines ◽  
Claudio E Tatsui ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Spinal Cord ◽  
Minimally Invasive ◽  
Definitive Treatment ◽  
Invasive Technique ◽  
Thoracic Vertebrae ◽  
Minimally Invasive Techniques ◽  
Invasive Approach ◽  
Invasive Techniques

Abstract BACKGROUND Epidural spinal cord compression (ESCC) is a common and severe cause of morbidity in cancer patients. Minimally invasive surgical techniques may be utilized to preserve neurological function and permit the use of radiation to maximize local control. Minimally invasive techniques are associated with lower morbidity. OBJECTIVE To describe a novel, minimally invasive operative technique for the management of metastatic ESCC. METHODS A minimally invasive approach was used to cannulate the pedicles of the thoracic vertebrae, which were then held in place by Kirschner wires (K-wires). Following open decompression of the spinal cord, cannulated screws were placed percutaneously with stereotactic guidance through the pedicles followed by cement induction. Stereotactic radiosurgery is performed in the postoperative period for residual metastatic disease in the vertebral body. RESULTS The minimally invasive technique used in this case reduced tissue damage and optimized subsequent recovery without compromising the quality of decompression or the extent of metastatic tumor resection. Development of more minimally invasive techniques for the management of metastatic ESCC has the potential to facilitate healing and preserve quality of life in patients with systemic malignancy. CONCLUSION ESCC from vertebral metastases poses a challenge to treat in the context of minimizing potential risks to preserve quality of life. Percutaneous pedicle screw fixation with cement augmentation provides a minimally invasive alternative for definitive treatment of these patients.

Outcomes of Bilateral Internal Thoracic Arteries in Minimally Invasive Coronary Artery Bypass Grafting With Analogy to the SYNTAX Trial

2019 ◽  
Vol 14 (3) ◽  
pp. 227-235
Author(s):  
Pradeep Nambiar ◽  
Sanjay Kumar ◽  
Chander Mohan Mittal ◽  
Ila C. Sarkar
Keyword(s):  
Quality Of Life ◽  
Coronary Artery ◽  
Relative Risk ◽  
Propensity Score ◽  
Minimally Invasive ◽  
Internal Thoracic Artery ◽  
Artery Bypass ◽  
Secondary Outcome

Objectives Minimally invasive CABG is making positive strides in the evolution of coronary artery bypass surgery. We carried out a retrospective study of the efficacy and outcomes of the usage of bilateral internal thoracic arteries in MICS CABG patients over a 6 year period using primary (MACCE) and secondary outcome measures and also carried out a subgroup analysis of patients with diabetes and methodology of revascularization, and with analogy to the SYNTAX trial of the relative risk. Methods Nine hundred and forty patients underwent multivessel MICS CABG via a left mini-thoracotomy from August 2011 to September 2017 and complete revascularization was done using the left internal thoracic artery–right internal thoracic artery Y (LITA–RITA Y) composite conduit. Efficacy and outcomes were evaluated by primary (MACCE) and secondary outcome measures including total length of stay, return to full physical activity, and quality of life. Propensity score matched analyses were carried out in diabetics, in the methodology of revascularization (MICS OPCABG vs. MICS ONCABG), and by comparison to the SYNTAX trial for relative risk. Mean follow-up was 2.9 years (maximum was 5.6 years). Results Out of the 940 patients, 843 (89.6%) were diabetic and 97 (10.4%) were nondiabetic. Average grafts were 3.2. There were 9 mortalities (0.9%). The average ICU and hospital stay was 40 ± 12 hours and 3.1 days. Ten patients (1.06%) required reintervention by angioplasty. A total of 99.3% patients were free from major adverse cardiac and cerebrovascular events (MACCE) at follow-up. Mean follow-up was 33 months and 846 (90%) of the patients were followed up. Based on propensity score–matched groups, patients who had their surgery done by MICS ONCABG (beating heart technique) had greater mean number of grafts and hospital length of stay and had significantly longer ICU stay, extubation in OR and blood loss in comparison to patients who had their CABG done by the MICS OPCABG technique. The new technique has shown favorable risk reduction in comparison to both the arms of the SYNTAX trial. Conclusions The safety, efficacy and outcomes of minimally invasive CABG evaluated by primary (MACCE) and secondary outcomes and quality-of-life measures have been good in this study, especially in diabetics, and have shown results better than conventional CABG. The learning curve can be safely negotiated by using peripheral cardiopulmonary bypass assistance and comparison with the SYNTAX trial has shown a relative reduction in all-cause risk.

scholarly journals Effectiveness of Sequential Viscosupplementation in Temporomandibular Joint Internal Derangements and Symptomatology: A Case Series

2018 ◽  
Vol 2018 ◽  
pp. 1-9
Author(s):  
Roberta Maria Drumond Furtado Bossi Fonseca ◽  
Eduardo Januzzi ◽  
Luciano Ambrosio Ferreira ◽  
Eduardo Grossmann ◽  
Antonio Carlos Pires Carvalho ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Molecular Weight ◽  
Temporomandibular Joint ◽  
Temporomandibular Disorders ◽  
Case Series ◽  
Conclusive Evidence ◽  
Invasive Technique ◽  
Disc Displacement

Viscosupplementation is a minimally invasive technique that replaces synovial fluid by intra-articular injection of hyaluronic acid (HA). Although effective in some joints, there is not conclusive evidence regarding temporomandibular disorders. This case series described the efficacy of a viscosupplementation protocol in intra-articular temporomandibular disorders. Ten patients with a diagnosis of disc displacement and/or osteoarthritis by Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were submitted to four monthly injections of low or medium molecular weight HA. Pain, mandibular function, image analysis by tomography and magnetic resonance, and quality of life were assessed at baseline and follow-ups (1 and 6 months). Pain, jaw range-of-motion, mandibular function, and quality of life improved at follow-up evaluations. Osteoarthritis changes decreased, and 20% of patients improved mandibular head excursion after treatment. Resolution of effusion and improvement in disc morphology were observed for most patients. This viscosupplementation protocol reduced pain and symptoms associated with internal derangement of temporomandibular joint, improved quality of life, and showed benefits from both low and medium molecular weight HA in alternate cycles.

The diagnosis and management of metastatic bone disease in general practice

2021 ◽  
pp. 175573802110103
Author(s):  
Natalie Cheyne ◽  
David Nichols ◽  
Amit Kumar
Keyword(s):  
Quality Of Life ◽  
General Practice ◽  
Cancer Treatment ◽  
Bone Disease ◽  
Secondary Care ◽  
Early Recognition ◽  
Survival Rates ◽  
Metastatic Bone Disease ◽  
The Uk

As cancer treatment improves and survival rates continue to increase, clinicians are seeing increasing numbers of patients with metastatic bone disease (MBD). This term describes cancer that has originated in another organ and subsequently spread to the bone. It is a condition that can severely impact the quality of life for an individual and the treatment is often not curative. This article aims to cover the management of MBD, from early recognition to secondary care interventions. The care of individuals with MBD is evolving in the UK, with the development of specialist regional referral pathways to facilitate prompt and timely management.

scholarly journals Intra Osseous Arteriovenous Malformations of Hand and Foot: Treatment Outcome after Open Surgical Cementoplasty in 9 Patients

2019 ◽  
Vol 3 (4) ◽  
pp. 1-9
Author(s):  
Claude Laurian
Keyword(s):  
Quality Of Life ◽  
Ct Scan ◽  
Arteriovenous Malformations ◽  
Distal Phalanx ◽  
Bone Lesions ◽  
Middle Phalanx ◽  
Skeletal Changes ◽  
Short Period

Background: To evaluate the benefit of open surgical cementoplasty on the intra osseous nidus in the treatment of arteriovenous malformations (AVMs) on hand and forefoot. Methods: Over the period 2014 - 2017, 9 consecutive patients underwent open cementoplasty of bone f or AVMs of hand and foot. Investigations included digital radiography, Doppler ultrasound, and CT scan with bone and vascular reconstructions. The main outcome end points of this study were: pain, residual AVMs identified by CT scan, and quality of life. R esults: Over a period of 4 years, 65 patients with AVM on hand (38 pts.) or foot (27 pts.) were observed in our institution, 10 pts. (15%) of the cohort had bone involvement. Nine patients (4 F, 5 M) with a mean age of 30 years (range 10 - 50) were included in this study. On their hand (n=5), skeletal changes were at first metacarpal (2pts), in the proximal and middle phalanx (3 pts.). On their foot (n=4), changes were in the metatarsal (3 pts.), in proximal and distal phalanx (3 pts.). Nine patients had a ta rgeted cementoplasty of the involved bone. On control CT scan, 9 patients had no residual intraosseous AV shunts, 4 had minor shunt around bone. Mean follow - up was 29 months (range 10 - 55 m). No morbidity, no delays of healing were observed. Disappearance o f pain was the dominant impact in all the patients. Conclusion: Open surgical cementoplasty is a new option for AVMs bone lesions located in the digits and forefoot. The conclusions are restricted by the short period of follow - up.

scholarly journals MON-LB81 Ultrasound-Guided Radiofrequency Ablation RFA of Benign Symptomatic Thyroid Nodules - Initial Colombian Experience

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Eric Hernandez-Triana ◽  
Oscar Mauricio Forero-Cuellar ◽  
Dimas F Herrrera-Rendon ◽  
Valentina Hernandez-Santamaria
Keyword(s):  
Quality Of Life ◽  
Radiofrequency Ablation ◽  
Thyroid Nodules ◽  
Case Series ◽  
Invasive Technique ◽  
Efficacy And Safety ◽  
Serious Adverse Events ◽  
Ambulatory Procedure

Abstract Introduction: Radiofrequency ablation (RF) is a minimally invasive technique probed as effective and safe treatment alternative for the manage, We describe the results of efficacy and safety up to 12 months following the first thyroid nodules with ablative radiofrequency in Colombia.Objective: Evaluate the efficacy and safety of RF thyroid radiofrequency ablation for benign thyroid nodules in a protocol in our center in Bogotá Colombia, case series. Methodology: Prospective, observational and descriptive Trial Patients and procedure: From May/2017 to Nov/2019 we Treated 38 patients with 59 mainly solid nodules were treated with a Radiofrequency Ablation system with cooling 2 standard techniques (Trans-isthmic approach and moving Shut technique). Starmed system with cool type antenna of 16 G. and 10 mm active tip (3 cases) and Cosman RF cooled with 15 cm long active tips 5 to 15 mm 18 G electro Teflon. (35 cases). Here the first 59 nodules who completed a clinical and ultrasound follow-up to 12 months. Outcomes: initial volume was 15.4 +/-28 cc (0.03 a 203 cc) After radiofrequency ablation, the volume decreased significantly, in VRR%**. 40%, 55%, 62% y 68% at 1,3,6 & 12 months. final volume was 4.46 cc P= 0.000*. Compressive Symptoms drop from 5.84 to 1.19, 0.17, 1.76 at 1,3 & 6 moths p &lt;0.001, Cosmetic Symptoms from 2.02/4 to 0.73, 0.58, 0.41 at 1,3 & 6 moths p &lt;0.01. and Quality of Life symptoms from 0 to 10 drop from 5.6 to 2.4, 1.27 & 1.53 at 1,3 & 6 moths p&lt;0.001. Not even one serious adverse event happened. Non-serious adverse events that did happened include minimal skin ecchymosis and transitory pain during less than 3 days, average 4/10 VAS (Visual Analog Scale). None developed hypothyroidism or required hospitalization. one patient presents transitory Horner syndrome and other nodule rupture. Two patients present a transitory dysphonia. Conclusions Radiofrequency ablation performed in our institution is effective and safe for the treatment of thyroid nodules. With patient satisfaction, improve the compressive, cosmetic symptoms and quality of life and without severe complications. It is necessary to continue to enrich this experience, because reducing volume and solving compressive and cosmetic problems, is ambulatory procedure.

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