scholarly journals Symptomatic intracranial arterial disease: incidence, natural history, diagnosis, and management

2011 ◽  
Vol 30 (6) ◽  
pp. E14 ◽  
Author(s):  
Ananth K. Vellimana ◽  
Andria L. Ford ◽  
Jin-Moo Lee ◽  
Colin P. Derdeyn ◽  
Gregory J. Zipfel
Keyword(s):  
Natural History ◽  
Medical Therapy ◽  
Endovascular Therapy ◽  
Medical Management ◽  
Surgical Intervention ◽  
Disease Incidence ◽  
Arterial Disease ◽  
High Rate ◽  
Diagnosis And Management ◽  
Ischemic Events

Symptomatic intracranial arterial disease is associated with a high rate of recurrent ischemic events. The management of this condition is controversial, with some advocating medical therapy as a sole means of treatment and others recommending endovascular therapy in addition to best medical management. In rare cases, surgical intervention is considered. A thorough review of the available literature was performed, and treatment recommendations based on these data are provided.

scholarly journals Trends in peripheral arterial disease incidence and mortality in EU15+ countries 1990–2017

2020 ◽  
pp. 204748731989962 ◽  
Author(s):  
Richard Goodall ◽  
Justin D Salciccioli ◽  
Alun Huw Davies ◽  
Dominic Marshall ◽  
Joseph Shalhoub
Keyword(s):  
United States ◽  
Peripheral Arterial Disease ◽  
Medical Therapy ◽  
Disease Incidence ◽  
Arterial Disease ◽  
The United States ◽  
Mortality Rates ◽  
Incidence Rates ◽  
Incidence And Mortality ◽  
Peripheral Arterial

Aims The aim was to assess trends in peripheral arterial disease (PAD) incidence and mortality rates in European Union(15+) countries between 1990 and 2017. Methods and Results This observational study used data obtained from the 2017 Global Burden of Disease study. Age-standardised mortality and incidence rates from PAD were extracted from the Global Health Data Exchange for EU15+ countries for the years 1990–2017. Trends were analysed using Joinpoint regression analysis. Between 1990 and 2017, the incidence of PAD decreased in all 19 EU15+ countries for females, and in 18 of 19 countries for males. Increasing PAD incidence was observed only for males in the United States (+1.4%). In 2017, the highest incidence rates were observed in Denmark and the United States for males (213.6 and 202.3 per 100,000, respectively) and in the United States and Canada for females (194.8 and 171.1 per 100,000, respectively). There was a concomitant overall trend for increasing age-standardised mortality rates in all EU15+ countries for females, and in 16 of 19 EU15+ countries for males between 1990 and 2017. Italy (–25.1%), Portugal (–1.9%) and Sweden (–0.6%) were the only countries with reducing PAD mortality rates in males. The largest increases in mortality rates were observed in the United Kingdom (males +140.4%, females +158.0%) and the United States (males +125.7%, females +131.2%). Conclusions We identify shifting burden of PAD in EU15+ countries, with increasing mortality rates despite reducing incidence. Strong evidence supports goal-directed medical therapy in reducing PAD mortality – population-wide strategies to improve compliance to optimal goal-directed medical therapy are warranted.

scholarly journals The role in the decision-making of the surgeon in choledochal cysts during pregnancy

2021 ◽  
Vol 8 (11) ◽  
pp. 3452
Author(s):  
Carlos F. Nicolás-Cruz ◽  
Paola I. Pech-Cervantes ◽  
Juan A. Loyo-Cosme ◽  
Omar M. Herrera-Ortiz De Ora ◽  
Jorge A. Ordoñez-García ◽  
...  
Keyword(s):  
Decision Making ◽  
Bile Duct ◽  
Choledochal Cyst ◽  
Medical Management ◽  
Surgical Intervention ◽  
Well Being ◽  
Choledochal Cysts ◽  
Bile Duct Diseases ◽  
Diagnosis And Management

The diagnosis and management of bile duct diseases during pregnancy are highly controversial because preserving both the fetus and pregnancy often required surgical intervention. In this manuscript we reported three cases of pregnant patients referred to our hospital with choledochal cyst. Medical management was implemented until fetal well-being was compromise with moderate cholangitis and oligohydramnios. A C-section prior induction with lung ripeness was performed, four weeks later cyst resection and biliodigestive derivation was performed prior preoperative parenteral total nutrition was implemented. All patients and products survived without complications.  

scholarly journals Biologic therapy in supra-aortic Takayasu arteritis can improve symptoms of cerebral ischaemia without surgical intervention

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_3) ◽  
pp. iii28-iii32
Author(s):  
Andrew Porter ◽  
Taryn Youngstein ◽  
Enrico Tombetti ◽  
Justin C Mason
Keyword(s):  
Takayasu Arteritis ◽  
Cerebral Ischaemia ◽  
Surgical Intervention ◽  
Biologic Therapy ◽  
Premature Mortality ◽  
Arterial Disease ◽  
Aortic Disease ◽  
Response To Therapy ◽  
High Rate ◽  
Organ Blood Flow

Abstract Objectives Takayasu arteritis commonly results in severe arterial injury with stenoses, occlusions and occasionally aneurysms. Arterial disease may compromise organ blood flow and result in significant cardiovascular morbidity and premature mortality. Involvement of the supra-aortic arteries is common, and in its most severe form may compromise cerebral blood supply, resulting in signs of cerebral ischaemia including visual impairment, dysphasia, transient hemiparesis, loss of consciousness and stroke. In addition to combination immunosuppression, the management paradigm for symptomatic cerebral ischaemia includes revascularization. The invasive nature of this surgery, the risk of complications and the relatively high rate of re-stenosis is of concern to patients and their physicians alike. The aim of this study was to determine whether combined immunosuppression with early escalation to biologic therapy improved outcomes and reduced the need for high risk surgical intervention. Methods A retrospective review of 145 Takayasu arteritis patients attending Imperial College Healthcare between 2010–2018 was conducted to identify those with cerebral ischaemia secondary to supra-aortic disease and to analyse their treatment and outcomes. Results Eight patients (5.5%) were identified. Seven patients received long-term combined immunosuppressive therapy and six were prescribed biologics. The data revealed a higher than expected comprehensive response to therapy, with significant falls in disease activity, the cerebral ischaemia score and the prednisolone dose required, over a median follow-up of 37 months. Serial imaging analysis detected no arterial disease progression after the initiation of optimal therapy. Only one patient required surgical intervention for persistent neurological symptoms. Conclusion Early use of biologic therapy in those with supra-aortic Takayasu arteritis presenting with cerebral ischaemia may reduce the numbers of patients requiring surgical intervention and improve outcomes.

scholarly journals Medical management of a unilateral obstructive ureterolith in a pet rabbit (Oryctolagus cuniculus)

2020 ◽  
Vol 8 (2) ◽  
pp. e000973
Author(s):  
Emma Keeble ◽  
Kevin Eatwell ◽  
Maurizio Longo ◽  
Tobias Schwarz
Keyword(s):  
Medical Therapy ◽  
Medical Management ◽  
Nutritional Support ◽  
Oryctolagus Cuniculus ◽  
Surgical Intervention ◽  
Clinical Signs ◽  
Serum Biochemistry ◽  
History Of ◽  
Systemic Antibiotics ◽  
Repeat Imaging

A 5-year-old neutered male French lop rabbit presented with a 6-hour history of stranguria and reduced faecal output. Routine haematology, serum biochemistry, urinalysis and diagnostic imaging were performed. Ultrasonography revealed left renal pelvis and ureter distension due to the presence of a proximal and distal calculus and marked heterogenous bladder sediment. A diagnosis of left hydronephrosis due to ureteral obstruction with a suspected underlying pyelonephritis and hypercalciuria was made. The rabbit was treated medically with intravenous fluid therapy, prokinetic drugs, analgesia, systemic antibiotics and nutritional support, as well as closely monitored by ultrasonographic examination. Three days later, clinical signs and urinary tract findings had resolved. Repeat imaging at 7 days post-treatment was normal. This is the first report of successful medical management of obstructive ureterolithiasis in a pet rabbit. The small ureteral diameter in rabbits and consequent surgical limitations make medical therapy with close serial ultrasonographic monitoring an alternative option to surgical intervention in select cases that are evaluated as stable. Surgical intervention, however, should always be considered in cases that do not respond to medical therapy.

scholarly journals The Changing Prognosis of Ulcerative Colitis and Crohn’s Disease by Decades

2021 ◽  
Author(s):  
Burton I Korelitz ◽  
Judy Schneider
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Medical Therapy ◽  
Bowel Disease ◽  
Surgical Intervention ◽  
Inflammatory Bowel

Abstract We present a bird’s eye view of the prognosis for both ulcerative colitis and Crohn’s disease as contained in the database of an Inflammatory Bowel Disease gastroenterologist covering the period from 1950 until the present utilizing the variables of medical therapy, surgical intervention, complications and deaths by decades.

scholarly journals COVID-19 pandemic: the implications of the natural history, challenges of diagnosis and management for care in sub-Saharan Africa

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Lawrence Omo-Aghoja ◽  
Emuesiri Goodies Moke ◽  
Kenneth Kelechi Anachuna ◽  
Adrian Itivere Omogbiya ◽  
Emuesiri Kohworho Umukoro ◽  
...  
Keyword(s):  
Public Health ◽  
Natural History ◽  
Low Income ◽  
Sub Saharan Africa ◽  
Low Income Countries ◽  
Diagnosis And Management ◽  
Severe Acute Respiratory Infection ◽  
Identification Technique ◽  
Sub Saharan ◽  
Policies And Programs

Abstract Background Coronavirus disease (COVID-19) is a severe acute respiratory infection which has afflicted virtually almost all nations of the earth. It is highly transmissible and represents one of the most serious pandemics in recent times, with the capacity to overwhelm any healthcare system and cause morbidity and fatality. Main content The diagnosis of this disease is daunting and challenging as it is dependent on emerging clinical symptomatology that continues to increase and change very rapidly. The definitive test is the very expensive and scarce polymerase chain reaction (PCR) viral identification technique. The management has remained largely supportive and empirical, as there are no officially approved therapeutic agents, vaccines or antiviral medications for the management of the disease. Severe cases often require intensive care facilities and personnel. Yet there is paucity of facilities including the personnel required for diagnosis and treatment of COVID-19 in sub-Saharan Africa (SSA). It is against this backdrop that a review of key published reports on the pandemic in SSA and globally is made, as understanding the natural history of a disease and the documented responses to diagnosis and management is usually a key public health strategy for designing and improving as appropriate, relevant interventions. Lead findings were that responses by most nations of SSA were adhoc, paucity of public health awareness strategies and absence of legislations that would help enforce preventive measures, as well as limited facilities (including personal protective equipment) and institutional capacities to deliver needed interventions. Conclusion COVID-19 is real and has overwhelmed global health care system especially low-income countries of the sub-Sahara such as Nigeria. Suggestions for improvement of healthcare policies and programs to contain the current pandemic and to respond more optimally in case of future pandemics are made herein.

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