scholarly journals Removal of malformation in cerebral proliferative angiopathy: illustrative case

2021 ◽  
Vol 1 (9) ◽  
Author(s):  
Gwang Yoon Choi ◽  
Hyuk Jai Choi ◽  
Jin Pyeong Jeon ◽  
Jin Seo Yang ◽  
Suk-Hyung Kang ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Vascular Malformation ◽  
Surgical Intervention ◽  
Meta Analysis ◽  
Treatment Method ◽  
Surgical Removal ◽  
Illustrative Case ◽  
Vascular Disorder ◽  
Effective Treatment Modality ◽  
Promising Treatment

BACKGROUNDCerebral proliferative angiopathy (CPA) is a rare vascular disorder distinct from arteriovenous malformation. Because of the disorder’s rarity, there is still a controversy on the most promising treatment method for CPA. However, several meta-analysis articles suggest indirect vascularization such as encephalo-duro-arterio-synangiosis as an effective way of treating symptoms that are medically uncontrolled.OBSERVATIONSThe authors describe a case of an 11-year-old boy with this disease, who had epilepsy that was intractable despite conservative management. The patient recovered from his symptoms after the vascular malformation was surgically removed. This is the first reported case of surgical removal in CPA.LESSONSAlthough further investigation on the best treatment for CPA is needed, the authors believe surgical intervention may also be an effective treatment modality when a patient presents with persisting symptoms.

scholarly journals Surgical removal of a compressive thoracic epidural vascular malformation in a patient with Klippel-Trénaunay syndrome: illustrative case

2022 ◽  
Vol 3 (1) ◽  
Keyword(s):  
Vascular Malformation ◽  
Venous Malformation ◽  
Spastic Paraparesis ◽  
High Risk Population ◽  
Surgical Removal ◽  
Illustrative Case ◽  
Surgical Morbidity ◽  
Thoracic Epidural ◽  
Increased Risk ◽  
Klippel Trenaunay Syndrome

BACKGROUND Klippel-Trénaunay syndrome (KTS) is a combined capillary-lymphatic-venous malformation disorder traditionally associated with high surgical morbidity. Although rare, pathologic involvement of the spinal cord has been reported in the literature. However, the safety of surgical intervention remains unclear. We report a case of successful decompression of a thoracic epidural lesion in an individual with KTS who presented with spastic paraparesis. OBSERVATIONS The patient is a 38-year-old male, diagnosed with KTS as an infant, who presented with spastic paraparesis secondary to a thoracic epidural lesion. He underwent laminectomies and resection of the lesion with subsequent improvement of his symptoms and without significant postoperative morbidity. Histopathology confirmed the lesion to be a benign vascular malformation. LESSONS Currently, the literature regarding management of symptomatic vascular lesions in individuals with KTS supports nonoperative management, due to the increased risk of operative morbidity associated with this syndrome. This case presents evidence for safe and appropriate surgical management of a thoracic epidural vascular malformation in a patient with KTS in the setting of progressive neurological decline, establishing a role for neurosurgical intervention in this high-risk population when no conservative management portends further neurological deterioration.

scholarly journals Clinical case of arteriovenous malformation

2021 ◽  
Vol 9 (4) ◽  
pp. 613-618
Author(s):  
Gennadiy A. Leonov ◽  
◽  
Anastasiya S. Solomatinа ◽  
Alexandr O. Burshinov ◽  
Ol’ga N. Krasnorutskaya ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Clinical Case ◽  
Surgical Intervention ◽  
Treatment Effectiveness ◽  
Parietal Lobe ◽  
Practical Interest ◽  
Venous Drainage ◽  
Cerebral Vessels ◽  
Surgical Removal ◽  
Risk Of Death

Arteriovenous malformation (AVM) is a congenital malformation of cerebral vessels, associated with an abnormal connection of arteries and veins. The altered locations of the cerebral vascula-ture form a conglomerate that is a direct arteriovenous shunting without intermediate capillaries. The incidence of the disease is 4 cases per 100 thousand population. Clinically, AVM debuts mainly at the age of 20 to 40, and is accompanied by intracranial hemorrhages in 50% to 60% of patients; mortality is 35%. In 27% to 70% of individuals, AVM are manifested by epileptic seizures of various focal origins. In diagnostics, X-ray computed tomography is used to detect hemorrhage in case of a ruptured malformation; magnetic resonance imaging, including angiography, to assess the AVM node, afferent vessels and venous drainage. Currently, the only radical treatment for AVM is surgical removal of the malformation. This is feasible for small and medium-sized AVMs of cerebral vessels (36% to 50% of patients), since removal of large AVMs and AVMs located in functionally important areas, even microsurgically, is associated with a high risk of death and disability. A clinical case of a 30-year-old young patient with an acute onset of the disease characterized by sudden loss of consciousness and an episode of seizures is presented. Based on the data of clinical and instrumental examination, an AVM of the left parietal lobe with parenchymal-ventricular hemorrhage was revealed. On the day of admission to the hospital in Ryazan, a surgical intervention was performed: external ventriculostomy on the left side. After 4 months the second surgical intervention, removal of AVM of the left parietal region using neurophysiological control was carried out at Burdenko Neurosurgical Hospital in Moscow, Russia. The successful surgical approach has completely eliminated the life-threatening pathology. Subsequently, the patient underwent rehabilitation in a neurological hospital at the place of residence. CONCLUSION: The topic of AVM is of great practical interest not only for neurosurgeons, but also for neurologists and radiologists, since timely diagnosis and treatment effectiveness directly depend on the coordinated work of these specialists.

Surgical treatment of transmissible venereal tumor (sticker sarcoma)

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Bougherara Hithem ◽  
Boukhechem Saïd ◽  
Aguezlane Abdelaziz ◽  
Benelhadj Khouloud ◽  
Aissi Adel
Keyword(s):  
Surgical Treatment ◽  
Cancer Cells ◽  
Treatment Method ◽  
High Rate ◽  
Surgical Removal ◽  
Characteristic Appearance ◽  
Recurrent Tumors ◽  
External Genital Organs

Background: Sticker sarcoma, also called venereal sarcoma or venereal lymphosarcomatosis, is a tumor of the external genital organs in females and males. In male animals the penis and foreskin (prepuce) are affected, in the female, it happens in vagina (vagina) and labia (vulva). The diagnosis of sticker sarcoma is based on the chronic discharge, the typical locations and the characteristic appearance of the tumor. Methods: We have relied on the treatment method on the complete surgical removal of all cancer cells that we can access. Results: After surgery, we notice recurrent tumors about six months after surgical treatment, indicating the need for other treatments in addition to surgery. Conclusion: Although spontaneous regressions of sticker sarcoma are documented (with permanent immunity), chemotherapy is the treatment of choice today. Irradiation should also be effective. If the tumor is only removed surgically, there is a high rate of recurrence, and this is what happened with the case that we treated, as the tumor reappeared after less than six months.

Surgical treatment of alveolar echinococcosis: a single centre experience and systematic review of the literature

2019 ◽  
Vol 98 (4) ◽  
pp. 167-173
Keyword(s):  
Case Report ◽  
Echinococcus Multilocularis ◽  
Alveolar Echinococcosis ◽  
Lymphatic System ◽  
Surgical Intervention ◽  
Clinical Symptoms ◽  
Safety Margin ◽  
Surgical Removal ◽  
Single Centre Experience ◽  
Therapeutic Procedures

Introduction: Alveolar echinococcosis (AE) is a zoonosis caused by Echinococcus multilocularis. AE is primarily localised in the liver. Echinococcus multilocularis imitates tumour-like behaviour. It can metastasise through blood or lymphatic system to distant organs. Echinococcosis often remains asymptomatic due to its long incubation period and indistinct symptoms. Clinical symptoms are determined by the parasite’s location. Diagnosis of echinococcosis is based on medical history, clinical symptoms, laboratory tests, serology results, imaging methods and final histology findings. Surgical removal of the cyst with a safety margin, followed by chemotherapy is the therapeutic method of choice. Case report: We present a case report of alveolar echinococcosis in a thirty-year-old female patient in whom we surgically removed multiple liver foci of alveolar echinococcosis. The disease recurred after two years and required another surgical intervention. Conclusions: Alveolar echinococcosis is a disease with a high potential for a complete cure provided that it is diagnosed early and that the recommended therapeutic procedures are strictly adhered to.

scholarly journals Corticosteroid Injection Alone or Combined with Surgical Excision of Keloids versus Other Therapies Including Ionising Radiotherapy: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

2021 ◽  
Vol 2 (2) ◽  
pp. 41-54
Author(s):  
Ru Wang ◽  
Patricia L. Danielsen ◽  
Magnus S. Ågren ◽  
Janine Duke ◽  
Fiona Wood ◽  
...  
Keyword(s):  
Systematic Review ◽  
Randomised Controlled Trials ◽  
Corticosteroid Injection ◽  
Meta Analysis ◽  
Interferon Α ◽  
Surgical Removal ◽  
Controlled Trials ◽  
Intralesional Corticosteroid ◽  
Intralesional Injections ◽  
Randomised Controlled

Keloid scars are difficult to manage and remain a therapeutic challenge. Corticosteroid therapy alone or ionising radiation (radiotherapy) alone or combined with surgery are first-line treatments, but the scientific justification for these treatments is unclear. The aim of this systematic review and meta-analysis of randomised controlled trials (RCTs) is to assess the effects of intralesional corticosteroid injection in treating keloids or preventing their recurrence after surgical removal. Searches for RCTs were conducted through the MEDLINE, EMBASE, EBSCO and Cochrane databases from January 1974 to September 2017. Two authors independently reviewed study eligibility, extracted data, analysed the results, and assessed methodological quality. Sixteen RCTs that included more than 814 patients were scrutinised. The quality of evidence for most outcomes was moderate to high. In 10 RCTs, corticosteroid intralesional injections were compared with 5-fluorouracil, etanercept, cryosurgery, botulinum toxin, topical corticosteroid under a silicone dressing, and radiotherapy. Corticosteroid intralesional injections were more effective than radiotherapy (RR 3.3, 95% CI: 1.4–8.1) but equipotent with the other interventions. In conjunction with keloid excision, corticosteroid treatment was compared with radiotherapy, interferon α-2b and verapamil. In two RCTs, there were fewer keloid recurrences (RR 0.43, 95% CI: 0.21–0.89) demonstrated with adjuvant radiotherapy than with corticosteroid injections. More high-quality, large-scale RCTs are required to establish the effectiveness of corticosteroids and other therapies in keloid management.

scholarly journals Safety and effectiveness of surgical fixation versus non-surgical methods for the treatment of flail chest in adult populations: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Ayobobola A. Apampa ◽  
Ayesha Ali ◽  
Bryar Kadir ◽  
Zubair Ahmed
Keyword(s):  
Systematic Review ◽  
Surgical Intervention ◽  
Meta Analysis ◽  
Adult Population ◽  
Flail Chest ◽  
Surgical Interventions ◽  
Surgical Methods ◽  
Surgical Fixation ◽  
Randomised Controlled ◽  
Pulmonary Status

Abstract Purpose The objective of this systematic review is to compare the safety and efficacy of surgical fixation of rib fractures against non-surgical interventions for the treatment of flail chest in the adult population. Methods A search was performed on the 22nd of July 2020 to identify articles comparing surgical fixation versus clinical management for flail chest in adults, with a description of the outcome parameters (resource utility, mortality, adverse effects of the intervention and adverse progression in pulmonary status). Relevant randomised controlled trials were selected, their risk of bias assessed, and the data then extracted and analysed. Results 157 patients were included from four studies in the analyses, with 79 and 78 patients in the surgical and non-surgical groups, respectively. The pooled effects of all outcomes tended towards favouring surgical intervention. Surgical intervention was associated with lower rates of pneumonia (I2 = 46%, Tau2 = 0.16, p = 0.16), significantly lower rates of tracheostomy (I2 = 76%, Tau2 = 0.67, p = 0.02), and a significantly lower duration of mechanical ventilation (I2 = 88%, Tau2 = 33.7, p < 0.01) in comparison to the non-surgical management methods. Conclusion Our results suggest that surgical intervention reduces the need for tracheostomy, reduces the time spent in the intensive care unit following a traumatic flail chest injury and could reduce the risk of acquiring pneumonia after such an event. There is a need for further well-designed studies with sufficient sample sizes to confirm the results of this study and also detect other possible effects of surgical intervention in the treatment of traumatic flail chest in adults.

scholarly journals Effects of open-label placebos in clinical trials: a systematic review and meta-analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Melina von Wernsdorff ◽  
Martin Loef ◽  
Brunna Tuschen-Caffier ◽  
Stefan Schmidt
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Medical Condition ◽  
Data Extraction ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Open Label ◽  
Cancer Related Fatigue ◽  
Promising Treatment ◽  
Irritable Bowel

AbstractOpen-label placebos (OLPs) are placebos without deception in the sense that patients know that they are receiving a placebo. The objective of our study is to systematically review and analyze the effect of OLPs in comparison to no treatment in clinical trials. A systematic literature search was carried out in February 2020. Randomized controlled trials of any medical condition or mental disorder comparing OLPs to no treatment were included. Data extraction and risk of bias rating were independently assessed. 1246 records were screened and thirteen studies were included into the systematic review. Eleven trials were eligible for meta-analysis. These trials assessed effects of OLPs on back pain, cancer-related fatigue, attention deficit hyperactivity disorder, allergic rhinitis, major depression, irritable bowel syndrome and menopausal hot flushes. Risk of bias was moderate among all studies. We found a significant overall effect (standardized mean difference = 0.72, 95% Cl 0.39–1.05, p < 0.0001, I2 = 76%) of OLP. Thus, OLPs appear to be a promising treatment in different conditions but the respective research is in its infancy. More research is needed, especially with respect to different medical and mental disorders and instructions accompanying the OLP administration as well as the role of expectations and mindsets.

scholarly journals Gunshot Wounds to the Lumbosacral Spine: Systematic Review and Meta-Analysis

2021 ◽  
pp. 219256822110308
Author(s):  
Andrew Platt ◽  
Mostafa H. El Dafrawy ◽  
Michael J. Lee ◽  
Martin H. Herman ◽  
Edwin Ramos
Keyword(s):  
Systematic Review ◽  
Random Effects ◽  
Surgical Intervention ◽  
Meta Analysis ◽  
Gunshot Wounds ◽  
Operative Management ◽  
Operative Intervention ◽  
Lumbosacral Spine ◽  
Random Effects Model ◽  
Significant Difference

Study Design: Systematic review and meta-analysis. Objectives: Indications for surgical decompression of gunshot wounds to the lumbosacral spine are controversial and based on limited data. Methods: A systematic review of literature was conducted to identify studies that directly compare neurologic outcomes following operative and non-operative management of gunshot wounds to the lumbosacral spine. Studies were evaluated for degree of neurologic improvement, complications, and antibiotic usage. An odds ratio and 95% confidence interval were calculated for dichotomous outcomes which were then pooled by random-effects model meta-analysis. Results: Five studies were included that met inclusion criteria. The total rate of neurologic improvement was 72.3% following surgical intervention and 61.7% following non-operative intervention. A random-effects model meta-analysis was carried out which failed to show a statistically significant difference in the rate of neurologic improvement between surgical and non-operative intervention (OR 1.07; 95% CI 0.45, 2.53; P = 0.88). In civilian only studies, a random-effects model meta-analysis failed to show a statistically significant difference in the rate of neurologic improvement between surgical and non-operative intervention (OR 0.75; 95% CI 0.21, 2.72; P = 0.66). Meta-analysis further failed to show a statistically significant difference in the rate of neurologic improvement between patients with either complete (OR 4.13; 95% CI 0.55, 30.80; P = 0.17) or incomplete (OR 0.38; 95% CI 0.10, 1.52; P = 0.17) neurologic injuries who underwent surgical and non-operative intervention. There were no significant differences in the number of infections and other complications between patients who underwent surgical and non-operative intervention. Conclusions: There were no statistically significant differences in the rate of neurologic improvement between those who underwent surgical or non-operative intervention. Further research is necessary to determine if surgical intervention for gunshot wounds to the lumbosacral spine, including in the case of retained bullet within the spinal canal, is efficacious.

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