scholarly journals Endoscopic ablation of Hunner’s lesions in interstitial cystitis patients

2013 ◽  
Vol 3 (6) ◽  
pp. 473 ◽  
Author(s):  
Ryan A. Payne ◽  
R. Corey O’Connor ◽  
Margarita Kressin ◽  
Michael L. Guralnick
Keyword(s):  
Interstitial Cystitis ◽  
Chart Review ◽  
Prise En Charge ◽  
Cystite Interstitielle ◽  
Symptomatic Recurrence ◽  
Endoscopic Ablation ◽  
Pathology Reports

Introduction: We report our experience with endoscopic ablationof Hunner’s lesions in women with interstitial cystitis (IC).Methods: A chart review was performed on 14 patients with ICsymptoms who were identified to have bladder lesions and underwentendoscopic ablation. A Hunner’s lesion was identified asan area of erythema that reproduced the patients’ pain when touchedby the cystoscope. Pathology reports were reviewed and improvementin pain was used as the main outcome measure.Results: Of the 14 patients, 12 had more than 50% symptomaticimprovement and 8 patients reported 100% improvement. Meanimprovement was 76%. In all patients who improved, the biopsyspecimen showed inflammatory cystitis, often with epithelialdenudation. Four patients had symptomatic recurrence, but allhad improvement after repeat ablation.Conclusion: Endoscopic ablation of Hunner’s lesions improves symptomsin IC patients. Recurrence of symptoms should prompt repeatcystoscopy to identify recurrent lesions, as repeat ablation offerssymptomatic improvement.Introduction : L’article fait état de notre expérience concernantl’ablation endoscopique d’ulcères de Hunner chez des femmesatteintes de cystite interstitielle (CI).Méthodologie : On a mené un examen des dossiers de 14 patientesprésentant des symptômes de CI chez qui des lésions vésicalesavaient été observées et traitées par ablation endoscopique. Unulcère de Hunner était défini comme une zone d’érythème reproduisantla douleur décrite par la patiente lorsque cette zone étaittouchée à l’aide du cystoscope. Les rapports de pathologie ontété examinés et la réduction de la douleur a été utilisée commeprincipal critère d’évaluation.Résultats : Sur les 14 patientes, 12 ont présenté une réduction supérieureà 50 % des symptômes et 8 ont signalé une réduction de 100 %. Letaux moyen de réduction était de 76 %. Chez toutes les patientesayant signalé une réduction des symptômes, l’échantillon de tissuprélevé par biopsie montrait la présence de cystite inflammatoire,souvent accompagnée de dénudation épithéliale. Quatre patientesont signalé une réapparition des symptômes, mais une nouvelle ablationa permis de réduire encore une fois les symptômes.Conclusion : L’ablation endoscopique des ulcères de Hunner entraîneune réduction des symptômes en présence de CI. La réapparitiondes symptômes devrait être prise en charge par une nouvelle cystoscopieafin de repérer les nouvelles lésions; une nouvelle ablationpermet de soulager les symptômes.

Cholecystectomy for Biliary Hyperkinesia

2019 ◽  
Vol 85 (2) ◽  
pp. 219-222 ◽  
Author(s):  
Joshua Gazzetta ◽  
Betty Fan ◽  
Paul Bonner ◽  
John Galante
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Chart Review ◽  
Gallbladder Disease ◽  
Retrospective Chart Review ◽  
Biliary Colic ◽  
Study Cohort ◽  
Final Pathology ◽  
Pathology Reports ◽  
Histologic Changes

Patients with classic biliary colic symptoms and documented gallbladder ejection fractions on the higher end of the spectrum on hepatobiliary iminoacetic acid scans with cholecystokinin stimulation are presently understudied and the benefits of cholecystectomy are unclear. To determine whether patients with biliary-type pain and biliary hyperkinesia (defined as a gallbladder ejection fractions of 80% or greater) benefit from laparoscopic cholecystectomy, a retrospective chart review encompassing five community hospitals was performed. Patients 16 years and older with diagnosed biliary hyperkinesia who underwent laparoscopic cholecystectomy between January 1, 2010 and May 31, 2015 were included. Pathology reports were reviewed for histologic changes indicating cholecystitis. Resolution of biliary colic symptoms was reviewed one to three weeks after surgery in their postoperative follow-up documentation. Within our study cohort, we found 97 patients who underwent laparoscopic cholecystectomy for biliary hyperkinesia. Within this population, 84.5 per cent of patients undergoing laparoscopic cholecystectomy for biliary hyper-kinesia had positive findings for gallbladder disease on final pathology. Of the 77 patients with data available from their first postoperative visit, 70 (90.9%) reported improvement or resolution of symptoms. Our findings suggest that symptomatic biliary hyperkinesia may be treated successfully with surgery.

Therapeutic effects of endoscopic ablation in patients with Hunner type interstitial cystitis

2018 ◽  
Vol 121 (4) ◽  
pp. 659-666 ◽  
Author(s):  
Kwang Jin Ko ◽  
Hyunwoo Chung ◽  
Yoon Seok Suh ◽  
Sin Woo Lee ◽  
Tae Heon Kim ◽  
...  
Keyword(s):  
Interstitial Cystitis ◽  
Therapeutic Effects ◽  
Endoscopic Ablation

scholarly journals The Value of Preoperative Imaging and Intraoperative Histopathology in Morton’s Neuroma

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0035
Author(s):  
Tammer Raouf ◽  
Ryan Rogero ◽  
Elizabeth McDonald ◽  
Daniel Fuchs ◽  
Rachel J. Shakked ◽  
...  
Keyword(s):  
Chart Review ◽  
Histopathological Examination ◽  
Postoperative Treatment ◽  
Preoperative Imaging ◽  
Pathology Report ◽  
Histopathological Diagnosis ◽  
Morton’S Neuroma ◽  
Pathologic Diagnosis ◽  
Morton's Neuroma ◽  
Pathology Reports

Category: Lesser Toes Introduction/Purpose: Morton’s neuroma is an interdigital abnormality of the nerve between the lesser metatarsal heads, most commonly between the third and fourth metatarsals. Recent studies have demonstrated that clinical diagnosis is highly correlated with intraoperative and histopathological diagnosis, and other studies have questioned the cost-effectiveness of intraoperative histopathology of an excised neuroma to confirm the diagnosis or rule out occult malignancy. The purpose of this study is to determine the utility of preoperative imaging and intraoperative histology in making an accurate diagnosis, guiding treatment decisions, and altering clinical outcomes. We also investigate the potential savings of a more streamlined diagnostic algorithm. Methods: A retrospective review was performed on all patients that underwent surgical resection of a suspected Morton’s neuroma with 4 fellowship-trained foot & ankle surgeons from 2007 to 2017. Patients were excluded from the study if the pathology report was not available for review. In all cases, chart review was undertaken to determine the method of initial diagnosis. Diagnoses were made either by the clinical examination of the operating surgeon and/or by the results of preoperative magnetic resonance imaging (MRI) and/or ultrasound. Operative reports were examined to determine if excised specimens were sent for histopathological analysis. All pathology reports were reviewed to determine the final diagnosis, considered the “gold standard”. Postoperative chart notes were reviewed to determine if any treatment regimen was altered based on the pathology report revealing an alternate diagnosis other than Morton’s neuroma. Results: Three-hundred twenty-seven patients with 354 clinically suspected neuromas were identified through retrospective chart review, and 287 patients with 313 clinically suspected neuromas met inclusion criteria. Of the 313 suspected neuromas with accompanying pathology reports, 309 (98.7%) were confirmed Morton’s neuroma upon histopathological examination. For no patient did the results of the pathology report alter the postoperative treatment course. Preoperative imaging results were available for 179/313 (57.2%) suspected neuromas, with MRI and ultrasound being used to preoperatively image 121 and 71 suspected neuromas, respectively, including 13 with both. The total estimated cost of pathological analysis at our institution for the 287 patients in our study was $131,733, and the potential total combined cost savings by eliminating preoperative imaging and intraoperative histopathology in our cohort totals $266,632. Conclusion: Our study demonstrates that the diagnosis of Morton’s neuroma can be made clinically with extreme accuracy and positive predictive value, calling into question the utility and costs of other imaging modalities and intraoperative sampling for histopathologic diagnosis. Furthermore, in only 4 cases did the pathologic diagnosis disagree with the diagnosis based on clinical exam and imaging, and in none did the pathologic diagnosis alter the course of treatment. Without more clear evidence that these modalities increase diagnostic accuracy, change the course of treatment, or improve patient care, we recommend that preoperative advanced imaging and histopathological examination not be routinely performed.

scholarly journals Pathology Slide Review in Vulvar Cancer Does Not Change Patient Management

ISRN Surgery ◽  
2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Maaike Beugeling ◽  
Patricia C. Ewing-Graham ◽  
Zineb Mzallassi ◽  
Helena C. van Doorn
Keyword(s):  
Patient Management ◽  
Linear Extension ◽  
Chart Review ◽  
Vulvar Cancer ◽  
Retrospective Chart Review ◽  
Residual Tumor ◽  
Tumor Type ◽  
Tertiary Centre ◽  
Pathology Reports ◽  
Depth Of Infiltration

Hypothesis. Pathology slide review in vulvar cancer is only necessary in a restricted number of cases. Methods. A retrospective chart review of all cases of vulvar cancer treated in a tertiary centre between January 1, 2000, and April 1, 2006. Histopathology reports from the referring and tertiary centre were compared. Results. 121 pathology reports from 112 patients were reviewed. Of the original reports, 56% were deemed adequate, commenting on tumor type and depth of infiltration; of the reviews, 83% were adequate. Conclusion. There were no discrepancies that influenced patient management. We suggest that vulvar cancer biopsies need to be reviewed only when the tumor is less than 10 mm in linear extension, when the infiltration is 1 mm or less, when there is no residual tumor on inspection, and in any nonsquamous cancer.

Relationship Between the Neutrophil to Lymphocyte Ratio and Parathyroid Adenoma Size in Patients With Primary Hyperparathyroidism

2015 ◽  
Vol 100 (7-8) ◽  
pp. 1185-1189 ◽  
Author(s):  
Sezgin Zeren ◽  
Faik Yaylak ◽  
Isa Ozbay ◽  
Zulfu Bayhan
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Neutrophil To Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Calcium Phosphorus ◽  
Pathology Reports ◽  
The Relationship ◽  
Phosphorus Levels

The aim of our study was to evaluate the relationship between neutrophil to lymphocyte ratio (NLR) and adenoma size in parathyroidectomized patients who underwent a parathyroidectomy. The neutrophil to lymphocyte ratio has recently become popular as a biomarker for malignant diseases or for estimating tumor size preoperatively. This study aimed to estimate the relationship between adenoma size and NLR. Furthermore, we assessed whether a higher level of NLR is correlated with the presence of parathyroid carcinoma. A retrospective chart review was performed for patients with parathyroid adenoma who underwent parathyroidectomy between January 2012 and August 2014. Data related to age, sex, NLR, parathyroid hormone level (PTH), preoperative calcium, phosphorus, adenoma size, and pathology reports were collected. The neutrophil to lymphocyte ratio was significantly correlated with calcium levels, PTH levels, parathyroid adenoma size, and the presence of cancer. However, there was no correlation between NLR and age, sex, and phosphorus levels. This study is the first to document a positive correlation between NLR and parathyroid adenoma size, as well as the presence of cancer, in patients who underwent surgery as a result of primary hyperparathyroidism.

Prise en charge des extrêmes prématurés et questionnement éthique

2018 ◽  
Vol 17 (132) ◽  
pp. 16-19
Author(s):  
Laurence Foix-L’hélias ◽  
Pascal Boileau
Keyword(s):  
Prise En Charge
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