scholarly journals Occipital plagiocephaly: a critical review of the literature

1997 ◽  
Vol 2 (2) ◽  
pp. E3 ◽  
Author(s):  
Harold L. Rekate
Keyword(s):  
Key Words ◽  
Diagnostic Criteria ◽  
Group Treatment ◽  
Critical Review ◽  
Treatment Options ◽  
Surgical Techniques ◽  
Class Ii ◽  
Class I ◽  
Review Of The Literature ◽  
Scientific Publications

The objective of this review was to determine what information is available on the incidence, pathophysiology, late complications, and treatment paradigms for occipital plagiocephaly based on a critical review of the literature obtained from recognized databases in peer-reviewed scientific publications. The content of this article is based on a critical review of the literature, and when discussing treatment options, classification of those articles with respect to the strength of the recommendations they contain. Using standard computerized search techniques, databases containing medical literature were queried for key words related to occipital plagiocephaly beginning in 1966. Key words used for this search were: lambdoid, craniosynostosis, cranial sutures, facial asymmetry, torticollis, and plagiocephaly. Titles of all articles were scanned for relevance. Copies of all potentially relevant articles published in the English language were obtained and received at least a cursory review. Several articles not captured by these methods were found to be important when referenced in the articles obtained. Articles discussing treatment were divided into Class I, Class II, and Class III data for the purpose of deciding on their applicability to the development of a potential consensus for the treatment of this controversial condition. Using the aforementioned key words, there were 4308 articles identified with potential relevance: scanning by title excluded all but 89. Of the 89, those with on-line abstracts were scanned, the remainder were obtained via interlibrary loan when needed for scanning of the article itself. The actual incidence of occipital plagiocephaly is unknown and there are no population-based studies of its incidence or prevalence. The reported incidence of lambdoid craniosynostosis ranges from 3 to 20% with the differences primarily due to differences in diagnostic criteria. With the possible exception of a lambdoid suture, which is replaced throughout its entire course by a dense ridge of bone, there are no other diagnostic criteria upon which there is agreement. There are no Class I and only one Class II studies in which a group of patients treated with one form of therapy is compared with another form of therapy or an untreated group. Treatment options that are recommended include observation only, mechanical treatments such as exercises, positioning, remodeling helmets, and a wide variety of surgical techniques. Very few reports accessed through the aforestated methodology report patients suffering any significant late effects of occipital plagiocephaly, although it may be morphometrically evident in as many as 14% of adults. Controlled clinical trials will be needed before any form of intervention can be generally recommended. If surgery, which is expensive and potentially dangerous, is to continue to play a role in the management of this condition, efforts should be made to ascertain from the general population which patients who have not been treated have suffered from this lack of treatment.

Occipital plagiocephaly: a critical review of the literature

1998 ◽  
Vol 89 (1) ◽  
pp. 24-30 ◽  
Author(s):  
Harold L. Rekate
Keyword(s):  
Diagnostic Criteria ◽  
Treatment Options ◽  
Surgical Techniques ◽  
Class Ii ◽  
Population Based ◽  
Class I ◽  
Weight Of Evidence ◽  
Class Iii ◽  
Content Type ◽  
Fine Print

Object. The literature on occipital plagiocephaly (OP) was critically reviewed to determine the feasibility of establishing treatment recommendations. Methods. Using standard computerized search techniques, medical literature databases containing peer-review articles dating from 1966 were queried for key words related to OP. The titles of all articles were scanned for relevance, and copies of potentially relevant articles published in English were reviewed. Articles in which treatment was discussed were categorized according to their weight of evidence as Class I (prospective randomized controlled trials), Class II (clinical studies in which data are collected prospectively or retrospective analyses based on clearly reliable data), and Class III (most studies based on retrospectively collected data) to evaluate their contribution to developing a consensus on the treatment of OP. Of the 4308 articles identified, all but 89 were excluded. Based on the review of these articles, the actual incidence of OP is unknown, and no population-based studies of its incidence or prevalence exist. The reported incidence of lambdoid craniosynostosis ranges from 3 to 20% with differences in diagnostic criteria accounting for the variability. With the possible exception of a lambdoid suture that is replaced by a dense ridge of bone, no other diagnostic criteria have been agreed on. There were no Class I studies and only one Class II study provided comparisons of outcomes in more than one treatment group with outcomes in an untreated group. Recommended treatment options included observation only, mechanical interventions, and a variety of surgical techniques. Conclusions. Controlled clinical trials are needed before any form of intervention can be recommended for the treatment of OP. If surgery, which is expensive and potentially dangerous, is to continue to play a role in the management of this condition, efforts should be made to determine if patients with untreated OP have suffered from lack of treatment.

scholarly journals Treatment of metastatic spinal epidural disease: a review of the literature

2003 ◽  
Vol 15 (5) ◽  
pp. 1-9 ◽  
Author(s):  
Paul Klimo ◽  
John R. W. Kestle ◽  
Meic H. Schmidt
Keyword(s):  
Spinal Cord ◽  
Radiation Therapy ◽  
Metastatic Cancer ◽  
Treatment Options ◽  
Large Body ◽  
Surgical Techniques ◽  
Class Ii ◽  
Class I ◽  
Spinal Disease ◽  
Spinal Epidural

Object Spinal cord compression is one of the most dreaded complications of metastatic cancer. It can lead to a number of sequelae, including pain, spinal instability, neurological deficits, and a reduction in the patient's quality of life. Except in selected circumstances, treatment is palliative. Treatment options include surgery, radiation, and chemotherapy. The goal of this study was to summarize the existing data on the outcomes of various treatment methods for metastatic spinal epidural disease and to make appropriate recommendations for their use. Methods The authors used a search strategy that included an electronic database search, a manual search of journals, analysis of bibliographies in relevant review papers, and consultation with the senior author. There is good evidence, including Class I data, that steroid drugs constitute a beneficial adjunctive therapy in patients with myelopathy from epidural compression. Historically, conventional radiation therapy has been viewed as the first-line treatment because it has been shown to be as effective as a decompressive laminectomy, with a lower incidence of complications (Class II data). Nevertheless, in the last 20 years there has been remarkable progress in surgical techniques and technology. Currently, the goals of surgery are to achieve a circumferential decompression of the spinal cord, and to reconstruct and immediately stabilize the spinal column. Results in a large body of literature support the belief that surgery is better at retaining or regaining neurological function than radiation and that surgery is highly effective in relieving pain. Most of the data on the treatment of metastatic spinal disease are Class II or III, but the preliminary results of a well-designed, randomized controlled trial in which surgery is compared with standard radiation therapy represents the first Class I data. Conclusions As the number of treatment options for metastatic spinal disease has grown, it has become clear that effective implementation of these treatments can only be achieved by a multidisciplinary approach.

scholarly journals Treatment of paediatric trigger finger: a systematic review and treatment algorithm

2018 ◽  
Vol 12 (3) ◽  
pp. 209-217 ◽  
Author(s):  
M. E. Womack ◽  
J. C. Ryan ◽  
V. Shillingford-Cole ◽  
S. Speicher ◽  
G. D. Hogue
Keyword(s):  
Systematic Review ◽  
Treatment Options ◽  
Treatment Algorithm ◽  
Surgical Techniques ◽  
Rare Condition ◽  
Small Sample ◽  
Trigger Finger ◽  
Review Of The Literature ◽  
Level Of Evidence ◽  
Number Of Patients

Purpose Paediatric trigger finger (PTF) is a rare condition as seen by the lack of studies published about paediatric populations. Due to this general lack of information, the steps to employ to correct this disorder, whether surgically or non-surgically, have not yet reached consensus status. The objective of this study is to review the published literature regarding treatment options for PTF in order to develop a proposed step-wise treatment algorithm for children presenting with trigger finger. Methods A systematic review of the literature was conducted on PubMed to locate English language studies reporting on treatment interventions of PTF. Data was collected on number of patients/fingers seen in the study, the category of the fingers involved, the number of patients/fingers undergoing each intervention and reported outcomes. Results Seven articles reporting on 118 trigger fingers were identified. In all, 64 fingers were treated non-surgically, with 57.8% (37/64) resolving. In all, 54 fingers were initially surgically treated, with 87% (47/54) resolving. In total, 34 fingers did not have resolution of symptoms following primary treatment, and 27 fingers received follow-up treatment, with 92.6% (25/27) resolving. Overall, 92.4% (109/118) of fingers achieved resolution of symptoms after all treatments were completed. Conclusion Limitations for this study included few prospective studies and small sample sizes. This is likely due to the rarity of PTF. This review of the literature indicated that a step-wise approach, including non-operative and surgical techniques, should be employed in the management of PTF. Level of Evidence III This work meets the requirements of the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses).

Electron microscopy analysis of degenerating pancreatic ß cells in transgenic mice expressing the MHC Class I antigen Dd

1990 ◽  
Vol 48 (3) ◽  
pp. 548-549
Author(s):  
T. A. Stewart ◽  
D. Liggitt ◽  
S. Pitts ◽  
L. Martin ◽  
M. Siegel ◽  
...  
Keyword(s):  
Type I Diabetes ◽  
Disease Process ◽  
Class Ii ◽  
Class I ◽  
Type I ◽  
Aberrant Expression ◽  
Mhc Molecules ◽  
Endogenous Insulin ◽  
Class Ii Mhc ◽  
Ifn Γ

Insulin-dependant (Type I) diabetes mellitus (IDDM) is a metabolic disorder resulting from the lack of endogenous insulin secretion. The disease is thought to result from the autoimmune mediated destruction of the insulin producing ß cells within the islets of Langerhans. The disease process is probably triggered by environmental agents, e.g. virus or chemical toxins on a background of genetic susceptibility associated with particular alleles within the major histocompatiblity complex (MHC). The relation between IDDM and the MHC locus has been reinforced by the demonstration of both class I and class II MHC proteins on the surface of ß cells from newly diagnosed patients as well as mounting evidence that IDDM has an autoimmune pathogenesis. In 1984, a series of observations were used to advance a hypothesis, in which it was suggested that aberrant expression of class II MHC molecules, perhaps induced by gamma-interferon (IFN γ) could present self antigens and initiate an autoimmune disease. We have tested some aspects of this model and demonstrated that expression of IFN γ by pancreatic ß cells can initiate an inflammatory destruction of both the islets and pancreas and does lead to IDDM.

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