scholarly journals Evaluation of Fetuses Diagnosed With Megacystis During Prenatal Period

2019 ◽  
pp. 1
Author(s):  
Kemal Sarsmaz ◽  
Busra Kanyildiz ◽  
Gokcen Orgul ◽  
Gokhan Karakoc ◽  
Hasan Eroglu ◽  
...  
Keyword(s):  
Pulmonary Hypoplasia ◽  
Prognostic Markers ◽  
Chromosomal Abnormalities ◽  
Management Strategies ◽  
Diagnostic Methods ◽  
Invasive Procedures ◽  
Fetal Demise ◽  
Vesicoamniotic Shunt

<p><strong>Objectives:</strong> Fetal megacystis is very rare; however this problem may be associated with other structural or chromosomal abnormalities leading to morbidity and mortality. Due to renal injury and pulmonary hypoplasia, prognosis is poor especially in fetuses with early onset oligohydramnios. In this study, we evaluated the management strategies and outcomes of fetal megacystis in our hospital.</p><p><strong>Study Design:</strong> The data of cases who were prenatally diagnosed with megacystis between 1 January 2017 and 31 December 2019 were analyzed. Ultrasonography findings and antennal interventions were withdrawn from computerized database. Information about postpartum status was also received. The data were analyzed in terms of diagnostic methods, fetal interventions (vesicosynthesis (VS), vesicoamniotic shunt (VAS)), potential prognostic markers and short/long-term prognostic results.</p><p><strong>Results:</strong> A total of 15 megacystis patients were detected. One of the fetuses was female and the remaining cases were male. Six of the patients were isolated. Ten patients underwent invasive procedures for prenatal aneuploidy diagnosis and one of them diagnosed with trisomy 18. Totally, 4 patients underwent VS; however no VAS was recorded. Four fetuses were terminated and intrauterine fetal demise occurred in 2 fetuses. Four patients were lost during follow up. Survival rate was 33.3%.</p><p><strong>Conclusion: </strong>Fetal megacystis is an important ultrasonographic finding which may be a component of chromosomal / genetic anomalies. This problem may also be isolated in some cases. Because of the poor outcome, parents should be well informed and all interventions should be offered to families.</p>

scholarly journals Coronary artery aneurysms: outcomes following medical, percutaneous interventional and surgical management

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001440
Author(s):  
Shameer Khubber ◽  
Rajdeep Chana ◽  
Chandramohan Meenakshisundaram ◽  
Kamal Dhaliwal ◽  
Mohomed Gad ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Surgical Management ◽  
Medical Management ◽  
Cox Regression ◽  
Artery Bypass ◽  
Management Strategies ◽  
Coronary Artery Aneurysms ◽  
Kaplan Meier

BackgroundCoronary artery aneurysms (CAAs) are increasingly diagnosed on coronary angiography; however, controversies persist regarding their optimal management. In the present study, we analysed the long-term outcomes of patients with CAAs following three different management strategies.MethodsWe performed a retrospective review of patient records with documented CAA diagnosis between 2000 and 2005. Patients were divided into three groups: medical management versus percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG). We analysed the rate of major cardiovascular and cerebrovascular events (MACCEs) over a period of 10 years.ResultsWe identified 458 patients with CAAs (mean age 78±10.5 years, 74.5% men) who received medical therapy (N=230) or underwent PCI (N=52) or CABG (N=176). The incidence of CAAs was 0.7% of the total catheterisation reports. The left anterior descending was the most common coronary artery involved (38%). The median follow-up time was 62 months. The total number of MACCE during follow-up was 155 (33.8%); 91 (39.6%) in the medical management group vs 46 (26.1%) in the CABG group vs 18 (34.6%) in the PCI group (p=0.02). Kaplan-Meier survival analysis showed that CABG was associated with better MACCE-free survival (p log-rank=0.03) than medical management. These results were confirmed on univariate Cox regression, but not multivariate regression (OR 0.773 (0.526 to 1.136); p=0.19). Both Kaplan-Meier survival and regression analyses showed that dual antiplatelet therapy (DAPT) and anticoagulation were not associated with significant improvement in MACCE rates.ConclusionOur analysis showed similar long-term MACCE risks in patients with CAA undergoing medical, percutaneous and surgical management. Further, DAPT and anticoagulation were not associated with significant benefits in terms of MACCE rates. These results should be interpreted with caution considering the small size and potential for selection bias and should be confirmed in large, randomised trials.

Prognostic markers in lentigo maligna patients treated with imiquimod cream: A long-term follow-up study

2016 ◽  
Vol 74 (1) ◽  
pp. 81-87.e1 ◽  
Author(s):  
Mirja Gautschi ◽  
Patrick A. Oberholzer ◽  
Marc Baumgartner ◽  
Karolina Gadaldi ◽  
Nikhil Yawalkar ◽  
...  
Keyword(s):  
Prognostic Markers ◽  
Lentigo Maligna ◽  
Imiquimod Cream ◽  
Follow Up Study ◽  
Long Term Follow Up

The Evolution of Endovascular Management of Extracranial Carotid Artery Aneurysms and Pseudoaneurysms

2019 ◽  
Vol 53 (8) ◽  
pp. 658-661 ◽  
Author(s):  
James W. Cornwall ◽  
Maximilian C. Y. Png ◽  
Rami O. Tadros ◽  
Daniel K. Han ◽  
Michael L. Marin ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Management Strategies ◽  
Endovascular Management ◽  
Extracranial Carotid Artery ◽  
Standard Management ◽  
Aneurysm Resection ◽  
Arterial Repair ◽  
Open Management

Introduction: Extracranial carotid artery aneurysms and pseudoaneurysms (ECCAs) are rare pathologies with various etiologies, presentations, and management strategies. Historically, open aneurysm resection and arterial repair have been the gold standard management of ECCAs. Our study examines the evolving experience with endovascular management of ECCAs. Methods: We performed a literature review of multiple studies on endovascular and open management of carotid artery aneurysms and pseudoaneurysms. Conclusions: Endovascular stenting is technically feasible and clinically effective for the treatment of carotid artery aneurysms and pseudoaneurysms. Further follow-up is required regarding long-term safety and efficacy.

Central Neurocytoma

Neurosurgery ◽  
2012 ◽  
Vol 72 (3) ◽  
pp. 407-414 ◽  
Author(s):  
Jin Wook Kim ◽  
Dong Gyu Kim ◽  
In Kyeong Kim ◽  
Yong Hwy Kim ◽  
Seung Hong Choi ◽  
...  
Keyword(s):  
Overall Survival ◽  
Clinical Outcomes ◽  
Functional Outcomes ◽  
Management Strategies ◽  
Treatment Strategies ◽  
Central Neurocytoma ◽  
Tumor Control ◽  
Seizure Outcome

Abstract BACKGROUND: A thorough investigation of the long-term outcomes of central neurocytoma (CN) after different treatments is required to establish optimal management strategies. OBJECTIVE We retrospectively reviewed the long-term clinical outcomes of patients with CN according to various treatments and suggest treatment strategies based on 30 years of experience in a single institution. METHODS: Fifty-eight consecutive patients with CN were treated at our institution between 1982 and 2008. Patient demographics, overall survival, local control rates according to multimodal treatments, and functional outcomes were evaluated. The mean clinical and radiological follow-up periods were 119 months (range, 18-304 months) and 98 months (range, 13-245 months), respectively. RESULTS: The initial treatment modality was classified into 4 subgroups: operation only (34 patients), operation followed by radiation therapy (7 patients) or radiosurgery (7 patients), and radiosurgery alone (10 patients). The actuarial overall survival was 91% at 5 years and 88% at 10 years. The actuarial overall survival and local tumor control rate did not differ significantly according to the various treatments and the initial extent of the surgical resection. However, functional outcomes, such as the postoperative seizure outcome at the last follow-up, differed according to the surgical approach. CONCLUSION: The long-term clinical outcomes of CN after multimodal treatment seem to be excellent. Our study suggests that treatment strategies for CN should focus on the patient's quality of life, as well as on tumor control, because of the benign nature of CN.

Surgical Treatment of Childhood Inflammatory Myofibroblastic Tumors

2016 ◽  
Vol 27 (04) ◽  
pp. 319-323 ◽  
Author(s):  
Beril Talim ◽  
İbrahim Karnak ◽  
Saniye Ekinci ◽  
Fatih Andiran ◽  
Arbay Çiftçi ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Lower Lobe ◽  
Diagnostic Methods ◽  
Incomplete Resection ◽  
Total Resection ◽  
Presenting Symptoms ◽  
Inflammatory Myofibroblastic Tumors ◽  
The Mean

Aim A retrospective study was performed to evaluate the clinical features, diagnostic methods, and treatment alternatives of childhood inflammatory myofibroblastic tumors (IMTs). Patients and Methods Patients who underwent surgical treatment for IMT between 2000 and 2015 were evaluated for age, sex, presenting symptoms, physical examination findings, diagnostic methods, treatment modalities, histopathologic findings, and results of surgical treatment during long-term follow-up. Results Eleven patients who underwent surgical treatment were included in the study. Male:female ratio was 7:4 and the mean age of the patients was 6.09 years (1–10 years). Presenting symptoms were respiratory difficulty, cough (n = 7, 63.3%), abdominal pain, vomiting (n = 2, 18.8%), loss of body weight (n = 1, 9.09%), palpable mass (n = 1, 9.09%), and rectal bleeding (n = 1, 9.09%). Ultrasonography (n = 4, 36.3%) and computed tomography (n = 9, 81.1%) were used for diagnosis. Localizations of tumors were lungs (n = 5, 45.4%), mediastinum (n = 2, 18.1%), spleen (n = 1, 9.09%), neck (n = 1, 9.09%), colon (n = 1, 9.09%), and rectum (n = 1, 9.09%). The mean size of mass was 6.6 cm (2–12 cm) and six patients were diagnosed with preoperative biopsy. Lung lobectomy (right lower lobe; n = 3, right middle and lower lobe; n = 2), total resection of mass with adjacent bowel (n = 2), partial splenectomy (n = 1), total resection of neck mass (n = 1), and incomplete resection (n = 2) were the choice of surgical treatment. Incomplete resection was performed in masses closely adjacent to atrium and mediastinal structures. In histopathologic evaluation, surgical margins were free of tumor in four cases, positive in six cases, and were not reported in one case. Anaplastic lymphoma kinase (ALK) positivity was detected in six cases, negative in two cases, and was not evaluated in three cases. Two cases who had residual mass with positive ALK received chemotherapy. Mean follow-up time was 68.2 months (5 months to 12 years). During follow-up, there was no recurrence or distant metastasis. Ten patients survived and one patient was lost to follow-up. Conclusion IMT is a rare tumor of childhood with a spectrum of clinical findings because of variable localization. Surgical treatment is the first choice of treatment. Patients with residual mass and ALK positivity may require medical treatment. In our series, long-term survival of patients was favorable in patients with total resection.

scholarly journals Rosai-Dorfman disease of cranial and spinal origin - A case series

2020 ◽  
Vol 11 ◽  
pp. 298
Author(s):  
Saleh Salah Safi ◽  
Khaled Murshed ◽  
Arshad Ali ◽  
Surjith Vattoth ◽  
Abdulrazzaq Haider ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Inflammatory Diseases ◽  
Management Strategies ◽  
Case Series ◽  
Current Management ◽  
Rosai Dorfman Disease ◽  
Lymph Node Enlargement ◽  
Long Term Follow Up

Background: Rosai-Dorfman disease (RDD) is an idiopathic nonneoplastic lymphadenopathy disorder which is characterized by lymph node enlargement, but it may also presents primarily involving a variety of extranodal sites, including central nerves system and craniospinal axis. This study reports five cases of craniospinal RDD, with review of epidemiology, clinical presentation, imaging, and histopathological features with current management strategies. Case Description: Five cases of RDD are diagnosed at Hamad General Hospital, Qatar, during 2013–2018. Two cases had dural-based cranial lesions with overlying cranial involvement while three cases were having extradural thoracic spine lesions. All cases underwent surgical intervention and confirmed by histopathology. Conclusion: Craniospinal RDD is a rare clinical presentation and poses significant diagnostic challenges preoperatively due to its similarity with other neoplastic or inflammatory diseases. Surgical option to remove compressive neural pathology provides a good clinical outcome with no recurrence in long-term follow-up.

scholarly journals Non-Hodgkin lymphomas in childhood: How to move on?

2014 ◽  
Vol 142 (7-8) ◽  
pp. 498-504 ◽  
Author(s):  
Lidija Dokmanovic ◽  
Predrag Rodic ◽  
Nada Krstovski ◽  
Jelena Lazic ◽  
Dragana Janic
Keyword(s):  
Prognostic Markers ◽  
Large Cell ◽  
Treatment Regimens ◽  
Diagnosis And Prognosis ◽  
Dismal Prognosis ◽  
Genetic Features ◽  
Short And Long Term ◽  
Refractory Diseases

Non-Hodgkin lymphomas of childhood represent a diverse group of neoplasms with different clinical, pathological, immunophenotypical and genetic features. A vast majority of childhood non-Hodgkin lymphomas could be classified into one of the three major histological subgroups: mature B-cell neoplasms, lymphoblastic lymphomas or anaplastic large cell lymphomas. Modern therapeutic strategies lead to cure in more than 80% of patients. Conversely, refractory diseases, as well as disease relapse convey a dismal prognosis. This fact requires much better stratification based on prognostic markers which would ideally recognize distinct groups of patients requiring different therapeutic regimens. Defining novel diagnostic and prognostic markers should improve diagnosis and prognosis as well as patient follow-up. It should also allow introduction of individually tailored treatment regimens in selected groups of patients with non-Hodgkin lymphomas, with the main goal of improving treatment results and decreasing short- and long-term complications.

scholarly journals Narrative Review: Nutrient Deficiencies in Adults and Children with Treated and Untreated Celiac Disease

Nutrients ◽  
2020 ◽  
Vol 12 (2) ◽  
pp. 500 ◽  
Author(s):  
Johanna M. Kreutz ◽  
Marlou P. M. Adriaanse ◽  
Elisabeth M. C. van der Ploeg ◽  
Anita C. E. Vreugdenhil
Keyword(s):  
Celiac Disease ◽  
Management Strategies ◽  
Term Treatment ◽  
Nutrient Deficiencies ◽  
Nutrient Supplementation ◽  
Long Term Treatment ◽  
Adults And Children ◽  
Untreated Celiac Disease

Nutrient deficiencies are well recognized as secondary consequences of celiac disease (CD) and closely related to the clinical presentation of affected patients. Despite their clinical significance, consensus is lacking on the pattern and frequency of nutrient deficiencies in CD, the usefulness of their assessment at the time of diagnosis and during follow-up. This review aims to provide an overview of nutrient deficiencies among pediatric and adult CD patients at diagnosis and on a gluten-free diet (GFD), and their potential causes in CD. Secondly, we review their impact on CD management strategies including the potential of nutrient supplementation. A search of Medline, Pubmed and Embase until January 2019 was performed. Despite a high variability between the reported deficiencies, we noted that nutrient deficiencies occur frequently in children and adults with CD at diagnosis and during treatment with a GFD. Both inadequate dietary intake and/or diminished uptake due to intestinal dysfunction contribute to nutrient deficiencies. Most deficiencies can be restored with (long-term) treatment with a GFD and/or supplementation. However, some of them persist while others may become even more prominent during GFD. Our results indicate a lack of comprehensive evidence on the clinical efficacy of nutrient supplementation in CD management highlighting the need for further studies.

Perinatal and long-term outcome (up to 24 months) with isolated ventriculomegaly

2019 ◽  
Author(s):  
S.I. Buryakova, R.S. Bataeva
Keyword(s):  
Chromosomal Abnormalities ◽  
Perinatal Outcomes ◽  
Postnatal Period ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Lateral Ventricles ◽  
Retrospective Assessment ◽  
Parent Counseling

A retrospective assessment of the pregnancy outcome, ultrasound data, childbirth outcome and neurological postnatal follow-up was carried out for 62 cases of isolated enlargements of the occipital horns of the lateral ventricles revealed prenatally. It was found that the incidence of unfavourable perinatal outcomes in newborns with isolated pre-ventriculomegaly (3.8 %) and borderline ventriculomegaly (10 %) revealed in the antenatal period (10 %) did not exceed that one in newborns with normal width of the occipital horns of the lateral ventricles (7.9 %). There were no unfavourable outcomes at the age up to 24 months in these groups. Unfavourable perinatal outcomes (neurological disorders, chromosomal abnormalities and pathology revealed postnatally by MRI) occurred in 66.6 % of cases with “apparently” isolated moderate ventriculomegaly and long-term unfavourable outcomes were observed in half of the cases. If isolated moderate ventriculomegaly are revealed, invasive prenatal diagnosis, MRI and parent counseling about the neurological risks in the postnatal period are necessary.

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