scholarly journals Transforaminal Epidural Balloon Adhesiolysis via a Contralateral Interlaminar Retrograde Foraminal Approach: A Retrospective Analysis and Technical Considerations

2020 ◽  
Vol 9 (4) ◽  
pp. 981
Author(s):  
Chan-Sik Kim ◽  
Yeon-Jin Moon ◽  
Jae Won Kim ◽  
Dong-Min Hyun ◽  
Shill Lee Son ◽  
...  
Keyword(s):  
Iliac Crest ◽  
Treatment Options ◽  
Balloon Catheter ◽  
Radicular Pain ◽  
Treatment Modalities ◽  
Foraminal Stenosis ◽  
The Novel ◽  
Lumbar Foraminal Stenosis ◽  
Transforaminal Approach ◽  
Technical Considerations

Several treatment modalities have been proposed for foraminal stenosis, but the treatment options remain unsatisfactory. Previous studies have shown that transforaminal balloon adhesiolysis may be effective in patients with refractory lumbar foraminal stenosis. However, in patients with a high iliac crest, balloon catheter insertion may be difficult via a conventional transforaminal approach (particularly targeting the L5–S1 foramen). It has been reported that an epidural catheter can be placed easily by a contralateral interlaminar retrograde foraminal approach. Therefore, we applied this approach to L5–S1 transforaminal balloon adhesiolysis in patients with a high iliac crest. We retrospectively analyzed data from 22 patients who underwent combined epidural adhesiolysis and balloon decompression (balloon adhesiolysis) using the novel foraminal balloon catheter via a contralateral interlaminar retrograde foraminal approach. The pain intensity significantly decreased over the three-month period after balloon adhesiolysis (p < 0.001). There were no complications associated with the balloon procedure. The present study suggests that balloon adhesiolysis for L5-S1 foramen via a contralateral interlaminar retrograde foraminal approach may be an effective alternative for patients with a high iliac crest and refractory lumbar radicular pain due to lumbar foraminal stenosis. In addition, detailed procedural aspects are described here.

Turning Calamity into Opportunity: COVID-19 & Dental Practice

2020 ◽  
Author(s):  
Arpit Sikri
Keyword(s):  
Treatment Options ◽  
Treatment Modalities ◽  
Effective Vaccine ◽  
Dental Practice ◽  
The Novel ◽  
Global Challenge ◽  
Novel Coronavirus ◽  
The Impact ◽  
Preventive Methods ◽  
Viable Treatment

The novel coronavirus disease (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), remains a global challenge. Even after extensive research going on globally, an effective vaccine and other viable treatment options have eluded investigators. Therefore, guidelines by the higher authorities and following the precautions as well as protocols provide the best approach in controlling the spread of the disease. In this article, various treatment modalities, preventive methods, and transmission routes of COVID-19 are discussed along with the impact of COVID-19 in dental practice and remedial measures to fight against the same.

scholarly journals Factors Associated with Successful Response to Balloon Decompressive Adhesiolysis Neuroplasty in Patients with Chronic Lumbar Foraminal Stenosis

2019 ◽  
Vol 8 (11) ◽  
pp. 1766 ◽  
Author(s):  
Oh ◽  
Kim ◽  
Park ◽  
Ji ◽  
Shin ◽  
...  
Keyword(s):  
Steroid Injection ◽  
Balloon Catheter ◽  
Multivariate Logistic Regression Analysis ◽  
Neurogenic Claudication ◽  
Foraminal Stenosis ◽  
Lumbar Foraminal Stenosis ◽  
Factors Associated ◽  
Refractory Pain ◽  
Epidural Steroid

Epidural neuroplasty, often called percutaneous epidural adhesiolysis, is often performed in refractory patients with chronic lumbar radiculopathy or neurogenic claudication. Recent studies have showed that decompressive adhesiolysis with an inflatable balloon catheter (balloon neuroplasty) is efficient in patients who experience refractory pain from epidural steroid injection or even epidural neuroplasty with a balloon-less catheter. However, exact indications or predictive factors for epidural balloon neuroplasty have not been fully evaluated. Therefore, to assess associated factors that could affect a favorable outcome, we analyzed a prospectively collected multicenter cohort of patients with chronic refractory lumbar foraminal stenosis after balloon neuroplasty. At the 6-month point in follow-up, 92 (44.4%) patients among 207 subjects were classified as successful responders according to a robust combination of outcome measures. Multivariate logistic regression analysis also showed that mild grade lumbar foraminal stenosis may be an independent factor associated with a successful response 6 months after balloon neuroplasty (odds ratio = 2.829; 95% confidence interval = 1.351–5.923; p = 0.006). However, we found that there were 29.4% and 24.6% successful responders with moderate and severe foraminal stenosis, respectively. Attempting balloon neuroplasty in refractory lumbar foraminal stenosis, especially mild grade, may be worthwhile. 

scholarly journals Successful Use of Eltrombopag in a Pediatric Patient With Human Immunodeficiency Virus (HIV)–Associated Thrombocytopenia

2019 ◽  
Vol 24 (3) ◽  
pp. 242-246
Author(s):  
Mary Soliman ◽  
Elissa Engel ◽  
Juan Rico ◽  
Carina Rodriguez
Keyword(s):  
Platelet Count ◽  
Pediatric Patient ◽  
Pediatric Population ◽  
Treatment Options ◽  
Retrospective Chart Review ◽  
Treatment Modalities ◽  
The Novel ◽  
Platelet Response ◽  
Thrombopoietin Receptor ◽  
Immunodeficiency Virus

Thrombocytopenia and other hematologic manifestations related to HIV are not uncommon. Treatment of HIV-related thrombocytopenia is challenging: treatment options are not effective in all patients, or less well studied, particularly in the pediatric population. We aim to present and discuss the case of a 13-year-old with HIV and persistent thrombocytopenia who, after failing monthly IVIG infusions, showed normalization of platelet count on the novel thrombopoietin receptor agonist, eltrombopag. A retrospective chart review of the case patient's medical record was conducted. Additionally, a thorough literature review was performed on this topic, including the pathophysiology of underlying HIV-related thrombocytopenia and its treatment modalities. The patient was treated initially with monthly IVIG infusions for about 1 year but did not show a sustained response, particularly in between infusions. After initiation with eltrombopag 50 mg daily, the patient showed a sustained increase in his platelet count. During a brief lapse in eltrombopag treatment, his platelet count dropped, which then increased upon his reinitiation of therapy. He has continued to show a sustained platelet response and has not been symptomatic or required IVIG for more than 1 year. To our knowledge, this is the first report of a pediatric patient with HIV-related thrombocytopenia who has benefited from the use of eltrombopag.

Management of thoracic aortic lesions - the future is endovascular

VASA ◽  
2012 ◽  
Vol 41 (3) ◽  
pp. 163-176 ◽  
Author(s):  
Weidenhagen ◽  
Bombien ◽  
Meimarakis ◽  
Geisler ◽  
A. Koeppel
Keyword(s):  
Thoracic Aorta ◽  
Clinical Decision Making ◽  
Treatment Options ◽  
Clinical Decision ◽  
Clinical Results ◽  
Treatment Modalities ◽  
Traumatic Rupture ◽  
Descending Thoracic Aorta ◽  
New Treatment ◽  
Aneurysm Dissection

Open surgical repair of lesions of the descending thoracic aorta, such as aneurysm, dissection and traumatic rupture, has been the “state-of-the-art” treatment for many decades. However, in specialized cardiovascular centers, thoracic endovascular aortic repair and hybrid aortic procedures have been implemented as novel treatment options. The current clinical results show that these procedures can be performed with low morbidity and mortality rates. However, due to a lack of randomized trials, the level of reliability of these new treatment modalities remains a matter of discussion. Clinical decision-making is generally based on the experience of the vascular center as well as on individual factors, such as life expectancy, comorbidity, aneurysm aetiology, aortic diameter and morphology. This article will review and discuss recent publications of open surgical, hybrid thoracic aortic (in case of aortic arch involvement) and endovascular repair in complex pathologies of the descending thoracic aorta.

Overview of Treatment Options for Critical Limb Ischaemia Patients

2011 ◽  
Vol 7 (1) ◽  
pp. 51 ◽  
Author(s):  
Frederic Baumann ◽  
Nicolas Diehm ◽  
◽  
Keyword(s):  
Treatment Options ◽  
Critical Limb Ischaemia ◽  
Treatment Modalities ◽  
High Morbidity ◽  
Limb Ischaemia ◽  
Arterial Revascularisation ◽  
Planning Treatment ◽  
Treatment Concepts ◽  
Peripheral Arterial ◽  
Renal Origin

Patients with critical limb ischaemia (CLI) constitute a subgroup of patients with particularly severe peripheral arterial occlusive disease (PAD). Treatment modalities for these patients that often exhibit multilevel lesions and severe vascular calcifications are complicated due to multiple comorbidities, i.e. of cardiac and vascular but also of renal origin. These need to be taken into consideration while planning treatment options. Although CLI is associated with considerably high morbidity and mortality rates, the clinical outcome of patients being subjected to revascularisation has improved substantially in recent years. This is mainly due to improved secondary prevention strategies as well as dedicated endovascular innovations for this most challenging patient cohort. The aim of this article is to provide a discussion of the contemporary treatment concepts for CLI patients with a focus on arterial revascularisation.

scholarly journals Molecular Subtypes and Precision Oncology in Intrahepatic Cholangiocarcinoma

2021 ◽  
Vol 10 (13) ◽  
pp. 2803
Author(s):  
Carolin Czauderna ◽  
Martha M. Kirstein ◽  
Hauke C. Tews ◽  
Arndt Vogel ◽  
Jens U. Marquardt
Keyword(s):  
Clinical Care ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Specific Treatment ◽  
Growth Factor Receptor ◽  
Treatment Modalities ◽  
Precision Oncology ◽  
Recurrence Rates ◽  
Isocitrate Dehydrogenase 1 ◽  
Liver Cancers

Cholangiocarcinomas (CCAs) are the second-most common primary liver cancers. CCAs represent a group of highly heterogeneous tumors classified based on anatomical localization into intra- (iCCA) and extrahepatic CCA (eCCA). In contrast to eCCA, the incidence of iCCA is increasing worldwide. Curative treatment strategies for all CCAs involve oncological resection followed by adjuvant chemotherapy in early stages, whereas chemotherapy is administered at advanced stages of disease. Due to late diagnosis, high recurrence rates, and limited treatment options, the prognosis of patients remains poor. Comprehensive molecular characterization has further revealed considerable heterogeneity and distinct prognostic and therapeutic traits for iCCA and eCCA, indicating that specific treatment modalities are required for different subclasses. Several druggable alterations and oncogenic drivers such as fibroblast growth factor receptor 2 gene fusions and hotspot mutations in isocitrate dehydrogenase 1 and 2 mutations have been identified. Specific inhibitors have demonstrated striking antitumor activity in affected subgroups of patients in phase II and III clinical trials. Thus, improved understanding of the molecular complexity has paved the way for precision oncological approaches. Here, we outline current advances in targeted treatments and immunotherapeutic approaches. In addition, we delineate future perspectives for different molecular subclasses that will improve the clinical care of iCCA patients.

Management of necrotic immature permanent maxillary incisors using a modified technique of revascularisation

2021 ◽  
Vol 14 (3) ◽  
pp. e240203
Author(s):  
Arun Mayya ◽  
Shruti Bhandary ◽  
Advith Kolakemar ◽  
Ann Mary George
Keyword(s):  
Platelet Rich Plasma ◽  
Blood Clot ◽  
Treatment Options ◽  
Permanent Teeth ◽  
Treatment Modalities ◽  
Successful Outcome ◽  
Modified Technique ◽  
Platelet Rich Fibrin ◽  
Periapical Lesions ◽  
Over Time

The management of necrotic immature permanent teeth has always been a challenge to endodontists. Various treatment modalities have been tried and tested for achieving a successful outcome. Revascularisation is one among these treatment options, which is gaining widespread attention among endodontists. The growing body of evidence demonstrating the success of revascularisation has led to different variations of this treatment option. Clinicians have over time used different scaffolds such as blood clot, collagen, platelet-rich fibrin (PRF) and platelet-rich plasma for revascularisation. This case report outlines the management of immature maxillary central incisors with pulp necrosis and large periapical lesions in a 19-year-old female patient with a modified technique of revascularisation by combining PRF and blood clot. At the end of 12 months, the patient was completely asymptomatic along with regression of the periapical lesions.

New Therapeutics for Ulcerative Colitis

2021 ◽  
Vol 72 (1) ◽  
pp. 199-213
Author(s):  
Robert P. Hirten ◽  
Bruce E. Sands
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Disease ◽  
Clinical Remission ◽  
Treatment Options ◽  
Treatment Modalities ◽  
Therapeutic Approaches ◽  
Stages Of Development ◽  
The Future ◽  
New Treatment ◽  
Novel Therapeutic

Ulcerative colitis (UC) is a relapsing and remitting inflammatory disease of the colon with a variable course. Despite advances in treatment, only approximately 40% of patients achieve clinical remission at the end of a year, prompting the exploration of new treatment modalities. This review explores novel therapeutic approaches to UC, including promising drugs in various stages of development, efforts to maximize the efficacy of currently available treatment options, and non-medication-based modalities. Treatment approaches which show promise in impacting the future of UC management are highlighted.

Zosteriform Nevus Comedonicus

2020 ◽  
Vol 11 (SPL4) ◽  
pp. 2609-2612
Author(s):  
Babbita S ◽  
Thillaikkarasi A ◽  
Sathyanarayanana R ◽  
Narasimhalu CRV ◽  
Sulochana Sonti
Keyword(s):  
Topical Therapy ◽  
Treatment Options ◽  
Neck Region ◽  
Surgical Excision ◽  
Hair Follicles ◽  
Treatment Modalities ◽  
Developmental Defect ◽  
Linear Distribution ◽  
Head And Neck Region ◽  
Typical Morphology

Nevus comedonicus is an uncommon cutaneous developmental defect of follicular apparatus characterized by unilateral and linear distribution of bundles of dilated hair follicles filled with keratin plugs. It is usually seen on the head and neck region, trunk and upper arm. This condition may be present at birth or can occur later in life. The term nevus comedonicus is a misnomer as there are no true comedones and is better termed as follicular keratotic nevus. It is also known as nevus zoniforme or nevus acneiformis unilateralis. There are two types of nevus comedonicus, namely inflammatory and non-inflammatory (non-pyogenic). When nevus comedonicus is manifested with other extracutaneous symptoms, it is termed as nevus comedonicus syndrome. Diagnosis is mainly clinical, based on history and typical morphology. As the disease runs a benign course, no aggressive treatment is required. Patients seek treatment, especially for cosmetic purposes and inflammatory type of lesions. Various treatment modalities like topical therapy, surgical excision, lasers are available and treatment options are individualized based on the size and extent of the lesion. We herein present a case of unilateral nevus comedonicus with no systemic associations in a 30-year-old female on her lower limb which is not a common site of occurrence.

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