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Ng JY, Cramer H, Lee MS, Moher D. Traditional, complementary, and integrative medicine and artificial intelligence: Novel opportunities in healthcare. Integr Med Res 2024; 13:101024. [PMID: 38384497 PMCID: PMC10879672 DOI: 10.1016/j.imr.2024.101024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/02/2024] [Accepted: 02/07/2024] [Indexed: 02/23/2024] Open
Abstract
The convergence of traditional, complementary, and integrative medicine (TCIM) with artificial intelligence (AI) is a promising frontier in healthcare. TCIM is a patient-centric approach that combines conventional medicine with complementary therapies, emphasizing holistic well-being. AI can revolutionize healthcare through data-driven decision-making and personalized treatment plans. This article explores how AI technologies can complement and enhance TCIM, aligning with the shared objectives of researchers from both fields in improving patient outcomes, enhancing care quality, and promoting holistic wellness. This integration of TCIM and AI introduces exciting opportunities but also noteworthy challenges. AI may augment TCIM by assisting in early disease detection, providing personalized treatment plans, predicting health trends, and enhancing patient engagement. Challenges at the intersection of AI and TCIM include data privacy and security, regulatory complexities, maintaining the human touch in patient-provider relationships, and mitigating bias in AI algorithms. Patients' trust, informed consent, and legal accountability are all essential considerations. Future directions in AI-enhanced TCIM include advanced personalized medicine, understanding the efficacy of herbal remedies, and studying patient-provider interactions. Research on bias mitigation, patient acceptance, and trust in AI-driven TCIM healthcare is crucial. In this article, we outlined that the merging of TCIM and AI holds great promise in enhancing healthcare delivery, personalizing treatment plans, preventive care, and patient engagement. Addressing challenges and fostering collaboration between AI experts, TCIM practitioners, and policymakers, however, is vital to harnessing the full potential of this integration.
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Affiliation(s)
- Jeremy Y. Ng
- Centre for Journalology, Ottawa Hospital Research Institute, Ottawa, Canada
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
- Robert Bosch Center for Integrative Medicine and Health, Bosch Health Campus, Stuttgart, Germany
| | - Holger Cramer
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
- Robert Bosch Center for Integrative Medicine and Health, Bosch Health Campus, Stuttgart, Germany
| | - Myeong Soo Lee
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - David Moher
- Centre for Journalology, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
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Morgado ME, Brumfield KD, Mitchell C, Boyle MM, Colwell RR, Sapkota AR. Increased incidence of vibriosis in Maryland, U.S.A., 2006-2019. Environ Res 2024; 244:117940. [PMID: 38101724 PMCID: PMC10922380 DOI: 10.1016/j.envres.2023.117940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/30/2023] [Accepted: 12/11/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Vibrio spp. naturally occur in warm water with moderate salinity. Infections with non-cholera Vibrio (vibriosis) cause an estimated 80,000 illnesses and 100 fatalities each year in the United States. Climate associated changes to environmental parameters in aquatic ecosystems are largely promoting Vibrio growth, and increased incidence of vibriosis is being reported globally. However, vibriosis trends in the northeastern U.S. (e.g., Maryland) have not been evaluated since 2008. METHODS Vibriosis case data for Maryland (2006-2019; n = 611) were obtained from the COVIS database. Incidence rates were calculated using U.S. Census Bureau population estimates for Maryland. A logistic regression model, including region, age group, race, gender, occupation, and exposure type, was used to estimate the likelihood of hospitalization. RESULTS Comparing the 2006-2012 and 2013-2019 periods, there was a 39% (p = 0.01) increase in the average annual incidence rate (per 100,000 population) of vibriosis, with V. vulnificus infections seeing the greatest percentage increase (53%, p = 0.01), followed by V. parahaemolyticus (47%, p = 0.05). The number of hospitalizations increased by 58% (p = 0.01). Since 2010, there were more reported vibriosis cases with a hospital duration ≥10 days. Patients from the upper eastern shore region and those over the age of 65 were more likely (OR = 6.8 and 12.2) to be hospitalized compared to other patients. CONCLUSIONS Long-term increases in Vibrio infections, notably V. vulnificus wound infections, are occurring in Maryland. This trend, along with increased rates in hospitalizations and average hospital durations, underscore the need to improve public awareness, water monitoring, post-harvest seafood interventions, and environmental forecasting ability.
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Affiliation(s)
- Michele E Morgado
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD, USA
| | - Kyle D Brumfield
- Maryland Pathogen Research Institute, University of Maryland, College Park, MD, USA; University of Maryland Institute for Advanced Computer Studies, University of Maryland, College Park, MD, USA
| | - Clifford Mitchell
- Prevention and Health Promotion Administration, Maryland Department of Health, Baltimore, MD, USA
| | - Michelle M Boyle
- Prevention and Health Promotion Administration, Maryland Department of Health, Baltimore, MD, USA
| | - Rita R Colwell
- Maryland Pathogen Research Institute, University of Maryland, College Park, MD, USA; University of Maryland Institute for Advanced Computer Studies, University of Maryland, College Park, MD, USA
| | - Amy R Sapkota
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD, USA.
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Niinikoski I, Himanen S, Tenhunen M, Aromaa M, Lilja‐Maula L, Rajamäki MM. Evaluation of risk factors for sleep-disordered breathing in dogs. J Vet Intern Med 2024; 38:1135-1145. [PMID: 38358051 PMCID: PMC10937515 DOI: 10.1111/jvim.17019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/30/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Brachycephalic dogs display sleep-disordered breathing (SDB). The risk factors for SDB remain unknown. OBJECTIVES To identify risk factors for SDB. We hypothesized that brachycephaly, increasing severity of brachycephalic obstructive airway syndrome (BOAS), excess weight, and aging predispose to SDB. ANIMALS Sixty-three privately owned pet dogs were prospectively recruited: 28 brachycephalic and 35 normocephalic (mesaticephalic or dolicocephalic) dogs. METHODS Prospective observational cross-sectional study with convenience sampling. Recording with the neckband was done over 1 night at each dog's home. The primary outcome measure was the obstructive respiratory event index (OREI). Body condition score (BCS) was assessed, and BOAS severity was graded for brachycephalic dogs. RESULTS Brachycephaly was a significant risk factor for high OREI value (ratio of the geometric means 5.6, 95% confidence interval [CI] 3.2-9.9; P < .001) but aging was not (1.1, 95% CI 1.0-1.2; P = .2). Excess weight, defined as a BCS of over 5/9, (3.5, 95% CI 1.8-6.7; P < .001) was a significant risk factor. In brachycephalic dogs, BOAS-positive class (moderate or severe BOAS signs) was a significant risk factor (2.5, 95% CI 1.1-5.6; P = .03). CONCLUSIONS AND CLINICAL IMPORTANCE Brachycephaly decreases welfare in a multitude of ways, including disrupting sleep. Brachycephaly, increasing severity of BOAS and excess weight are risk factors for obstructive SDB.
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Affiliation(s)
- Iida Niinikoski
- Department of Equine and Small Animal MedicineUniversity of HelsinkiHelsinkiFinland
| | - Sari‐Leena Himanen
- Faculty of Medicine and Health TechnologyTampere UniversityTampereFinland
- Department of Clinical NeurophysiologyTampere University Hospital, Wellbeing Services County of PirkanmaaTampereFinland
| | - Mirja Tenhunen
- Department of Clinical NeurophysiologyTampere University Hospital, Wellbeing Services County of PirkanmaaTampereFinland
- Department of Medical PhysicsTampere University Hospital, Wellbeing Services County of PirkanmaaTampereFinland
| | - Mimma Aromaa
- Department of Equine and Small Animal MedicineUniversity of HelsinkiHelsinkiFinland
| | - Liisa Lilja‐Maula
- Department of Equine and Small Animal MedicineUniversity of HelsinkiHelsinkiFinland
| | - Minna M. Rajamäki
- Department of Equine and Small Animal MedicineUniversity of HelsinkiHelsinkiFinland
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Mraihi F, Basly J, Ghali Z, Azouz E, Ayari A, Chelli D. Diagnostic and therapeutic challenges of a rare large ovarian strumal carcinoid in pregnancy, about a case report. Int J Surg Case Rep 2024; 116:109468. [PMID: 38430900 PMCID: PMC10944124 DOI: 10.1016/j.ijscr.2024.109468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 03/05/2024] Open
Abstract
INTRODUCTION Ovarian strumal carcinoid is a rare type of germ cell tumor. It usually affects perimenopausal and postmenopausal women. Very few cases of stromal carcinoid have been reported in the literature in women of childbearing age, particularly during pregnancy. The clinical presentation of the tumor, and in particular its non-specific clinical and radiological appearance and rarity, explain the difficulties in diagnosis and management. PRESENTATION OF CASE Herein, we describe a rare case of a 36-year-old patient who was followed-up in our outpatient clinic for organic cyst of the ovary. The ultrasound revealed a multilocular regular cystic mass with a modestly thickened wall and fine septations. The MRI indicated a right ovarian cyst with solid tissue. The levels of tumor markers were normal. The patient was lost to follow-up and did not return until six months later. She was admitted in our Department with acute ovarian torsion and underwent emergency surgery at 17 weeks' gestation. A laparoscopic cystectomy of the right ovary was provisionally performed. Pathology revealed an ovarian strumal carcinoid tumor. DISCUSSION Patients with ovarian stromal carcinoid have an excellent prognosis. Ovarian strumal carcinoid 's primary therapy method is operation. The majority of original ovarian carcinoid tumors progress slowly, and practically all thyroid carcinoid tumors are clinical stage I with a positive prognosis. CONCLUSION In the absence of standardized treatment, the association of carcinoid strumal tumor with pregnancy, underlines the need for early diagnosis and appropriate multidisciplinary management, taking into account both the maternal and fetal prognosis.
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Affiliation(s)
- Fathi Mraihi
- D Department at the Maternity and Neonatology Center of Tunis, Tunis, Tunisia.
| | - Jihene Basly
- D Department at the Maternity and Neonatology Center of Tunis, Tunis, Tunisia
| | - Zeineb Ghali
- D Department at the Maternity and Neonatology Center of Tunis, Tunis, Tunisia
| | - Eya Azouz
- Radiology Department at Rabta University Hospital, Tunis, Tunisia
| | - Asma Ayari
- Anatomopathology Department at Rabta University Hospital, Tunis, Tunisia
| | - Dalenda Chelli
- D Department at the Maternity and Neonatology Center of Tunis, Tunis, Tunisia
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Lee SH, Lee S, Jang SW, Shin HK, Kim DH, Kang DH, Jeon SR, Roh SW, Park JH. Unilateral Pediculectomy and Reduction with Short-Segment Pedicle Screw Fixation for Thoracolumbar Burst Fracture: A Case Series. World Neurosurg 2024; 183:e116-e126. [PMID: 38042288 DOI: 10.1016/j.wneu.2023.11.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/26/2023] [Accepted: 11/27/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND This study aimed to evaluate the efficacy of unilateral pediculectomy and reduction with short-segment pedicle screw fixation for thoracolumbar burst fracture. METHODS We retrospectively reviewed patients who underwent a unilateral pediculectomy and reduction with short-segment fixation and interbody fusion for thoracolumbar burst fracture. The unilateral pediculectomy created sufficient space to approach the ventral side of the spinal cord for removing bone fragments and insertion of an interbody cage to correct kyphosis. Lumbar lordosis (LL), pelvic incidence (PI) minus LL, and segmental Cobb angle were measured at 3 time points: preoperatively, postoperatively, and final follow-up. Furthermore, sagittal vertical axis (SVA) was measured to assess global sagittal balance at the final follow-up. RESULTS A total of 10 patients, with a mean age of 39.8 ± 21.0, underwent the surgical procedure. All patients had a thoracolumbar injury classification and severity score > 5. The mean follow-up period was 15.8 ± 13.9 months. The mean postoperative LL (46.0 ± 5.8) was significantly higher (P = 0.008) than the preoperative measurement (32.8 ± 8.2). The mean postoperative PI minus LL (2.2 ± 8.4) was not significantly lower (P = 0.051) than preoperative measurement (15.4 ± 12.6). The mean postoperative segmental Cobb angle (11.4 ± 8.4) was significantly higher (P < 0.001) than the preoperative measurement (-11.6 ± 10.9). At the final follow-up, the mean sagittal vertical axiswas 10.0 ± 28.8 mm. CONCLUSIONS Unilateral pediculectomy and reduction with short-segment fixation and interbody fusion served as an efficient surgical method for thoracolumbar burst fracture.
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Affiliation(s)
- Sang Hyub Lee
- Department of Neurosurgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju-Si, Gyeongsangnam-do, Republic of Korea
| | - Subum Lee
- Department of Neurosurgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sun Woo Jang
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hong Kyung Shin
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong-Hwan Kim
- Department of Neurosurgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju-Si, Gyeongsangnam-do, Republic of Korea
| | - Dong Ho Kang
- Department of Neurosurgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju-Si, Gyeongsangnam-do, Republic of Korea
| | - Sang Ryong Jeon
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung Woo Roh
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin Hoon Park
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Mohsen MA, Abouassi M, Albokai M, Alyousef S, Hamed A. Delayed surgical treatment of asymptomatic severe traumatic C7-T1 spondylolisthesis: a rare case report from Syria. Ann Med Surg (Lond) 2024; 86:1789-1793. [PMID: 38463103 PMCID: PMC10923267 DOI: 10.1097/ms9.0000000000001786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/24/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction Spondylolisthesis is described as the displacement of one vertebra over another, leading to spinal instability and potential nerve compression. When this occurs in the cervicothoracic junction, it can result in unique clinical manifestations. High-grade spondylolisthesis caused by trauma in the cervicothoracic junction of the spine usually results in acute spinal cord injury and quadriparesis. However, a few uncommon cases of the same injury reported minimal or no neurological deficits. Biomechanical evaluation of the underlying pathology can offer insights into the mechanism of injury and the preservation of neurological function. Case presentation This paper explains the case of a 32-year-old white male patient who suffered from a traumatic C7-T1 spondylolisthesis. Despite having radiographic evidence of grade III traumatic spondylolisthesis, cord compression, fracture in the isthmus of the C7 vertebra, and intervertebral disc traumatic change and protrusion, the patient did not exhibit any motor neurological deficits. The patient underwent posterior spine fixation via the posterior approach as the first step of the surgical management, followed by anterior spine fixation via the anterior approach after several days (360° fixation). Fortunately, after 6 months of follow-up, the patient showed good outcomes. The patient was pain-free with an intact neurological clinical examination, the radiographs showed well-maintained fusion and alignment. Discussion The best management approach to cervical spondylolisthesis without neurological injury is complicated and arguable due to the rarity of occurrence of such cases. Conclusion A combined anteroposterior surgical approach, or 360° fixation, is a valuable technique for addressing complex spinal conditions such as the condition seen in our case, offering comprehensive stabilization and improved outcomes.
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Affiliation(s)
| | - Majd Abouassi
- Faculty of Medicine, Damascus University, Damascus, Syria
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Xu J, Chang X, Qin H, Yang W, Cheng H, Wang H. A case series of clinical characteristics and prognosis of congenital hepatoblastoma in a single center. Int J Surg Case Rep 2024; 116:109358. [PMID: 38364752 PMCID: PMC10943666 DOI: 10.1016/j.ijscr.2024.109358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/18/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Congenital hepatoblastoma is an exceedingly rare neoplasm, predominantly documented as isolated instances, with contentious aspects surrounding its therapeutic approaches and prognostic implications. This study aims to comprehensively summarize and evaluate the management experience of congenital hepatoblastoma (CHB). CASE PRESENTATION This cohort comprised five infants diagnosed with hepatoblastoma, confirmed through pathological examination, and with an onset of symptoms before 28 days of age. They were enrolled between November 2019 and May 2022. The treatment course they underwent has been summarized, and their prognosis has been subject to analysis. CLINICAL DISCUSSION Distinguishing congenital hepatoblastoma from other medical conditions is typically necessary. Given the patient's tender age, the approach to treatment demands comprehensive assessment, particularly in cases involving unique tumor locations or substantial tumor sizes. The selection of treatment modalities, encompassing preoperative neoadjuvant chemotherapy and surgical techniques, becomes of paramount importance. Furthermore, determining the treatment's endpoint poses a notable challenge and often necessitates a comprehensive evaluation. CONCLUSION For pediatric patients afflicted with CHB, the application of preoperative neoadjuvant chemotherapy mitigates surgical risks, while the incorporation of surgical procedures followed by postoperative chemotherapy significantly enhances the overall prognosis. Additionally, AFP-L3% levels may serve as a valuable adjunctive marker signifying the conclusion of treatment.
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Affiliation(s)
- Jiatong Xu
- Department of Pathology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China
| | - Xiaofeng Chang
- Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China
| | - Hong Qin
- Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China
| | - Wei Yang
- Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China
| | - Haiyan Cheng
- Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China
| | - Huanmin Wang
- Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China.
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Kong M, Liu W, Bai Y, Jia J, Liu C, Zhang S. Transumbilical single-site laparoscopic treatment of small intestinal cavernous hemangioma in child: a case report. Front Oncol 2024; 14:1360557. [PMID: 38496755 PMCID: PMC10941337 DOI: 10.3389/fonc.2024.1360557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 02/08/2024] [Indexed: 03/19/2024] Open
Abstract
Background While hemangiomas are the most commonly occurring benign vascular tumors, their occurrence in the gastrointestinal system is rare. This case report presents a unique instance of small intestinal hemangioma in a pediatric patient. Case description A 21-month-old girl was admitted to the hospital with a history of "recurrent blood in the stool for one year and anemia for five months." Upon evaluation at our facility, abdominal color ultrasound and enhanced CT scans revealed a protruding mass in the wall of the small intestine, leading to a preliminary diagnosis of small intestinal hemangioma. Subsequent single-site umbilical laparoscopic exploration identified a tumor measuring approximately 6cm×2.5cm×1.2cm on the jejunum wall. Consequently, segmental resection of the intestine was performed, and the postoperative pathological diagnosis confirmed cavernous hemangioma. Conclusion Small intestinal hemangiomas, particularly in pediatric patients, are exceptionally rare and challenging to diagnose as the cause of gastrointestinal bleeding prior to surgery. Hence, small intestinal hemangiomas should be considered in such cases. Laparoscopic surgical resection emerges as the optimal approach for addressing small intestinal hemangiomas.
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Affiliation(s)
- Meng Kong
- Department of Pediatric Surgery, Children’s Hospital Affiliated to Shandong University, Jinan, China
- Department of Pediatric Surgery, Jinan Children’s Hospital, Jinan, China
| | - Weiqiang Liu
- Department of Pediatric Surgery, Zhucheng Women and Children’s Hospital, Weifang, China
| | - Yuexia Bai
- Department of Pathology, Children’s Hospital Affiliated to Shandong University, Jinan, China
| | - Jinhua Jia
- Department of Pediatric Surgery, Children’s Hospital Affiliated to Shandong University, Jinan, China
- Department of Pediatric Surgery, Jinan Children’s Hospital, Jinan, China
| | - Chuanyang Liu
- Department of Pediatric Surgery, Children’s Hospital Affiliated to Shandong University, Jinan, China
- Department of Pediatric Surgery, Jinan Children’s Hospital, Jinan, China
| | - Shisong Zhang
- Department of Pediatric Surgery, Children’s Hospital Affiliated to Shandong University, Jinan, China
- Department of Pediatric Surgery, Jinan Children’s Hospital, Jinan, China
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Campos JK, Zarrin DA, Meyer BM, Khan MW, Laghari FJ, Collard de Beaufort JC, Amin G, Beaty NB, Bender MT, Suzuki S, Colby GP, Lin LM, Coon AL. Use of a large-bore 088 intracranial access support catheter for delivery of large intracranial devices: case series with the TracStar LDP in 125 cases. J Neurointerv Surg 2024:jnis-2023-021054. [PMID: 38418227 DOI: 10.1136/jnis-2023-021054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 02/02/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND The delivery of neuroendovascular devices requires a robust proximal access platform. This demand has previously been met with a 6Fr long sheath (8Fr guide) that is placed in the proximal internal carotid artery (ICA) or vertebral artery segments. We share our experience with the first 0.088 inch 8Fr guide catheter designed for direct intracranial access. METHODS We retrospectively reviewed a prospectively maintained IRB-approved institutional database of the senior authors to identify all cases where the TracStar Large Distal Platform (LDP) was positioned within the intracranial vasculature, defined as within or distal to the petrous ICA, vertebral artery (V3) segments, or transverse sinus. Technical success was defined as safe placement of the TracStar LDP within or distal to the described distal vessel segments with subsequent complication-free device implantation. RESULTS Over the 41-month study period from January 2020 to June 2023, 125 consecutive cases were identified in whom the TracStar LDP was navigated into the intracranial vasculature for triaxial delivery of large devices, 0.027 inch microcatheter and greater, for aneurysm treatment (n=108, 86%), intracranial angioplasty/stenting (n=15, 12%), and venous sinus stenting (n=2, 1.6%). All cases used a direct select catheter technique for initial guide placement (no exchange). Posterior circulation treatments occurred in 14.4% (n=18) of cases. Technical success was achieved in 100% of cases. No vessel dissections occurred in any cases. CONCLUSION The TracStar LDP is an 0.088 inch 8Fr guide catheter that can establish direct intracranial access with an acceptable safety profile. This can be achieved in a wide range of neurointerventional cases with a high rate of technical success.
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Affiliation(s)
- Jessica K Campos
- Department of Neurosurgery, University of California Irvine, Orange, California, USA
| | - David A Zarrin
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Benjamen M Meyer
- College of Medicine Tucson, The University of Arizona, Tucson, Arizona, USA
| | - Muhammad Waqas Khan
- Carondelet Neurological Institute, Carondelet Saint Joseph's Hospital, Tucson, Arizona, USA
| | - Fahad J Laghari
- Carondelet Neurological Institute, Carondelet Saint Joseph's Hospital, Tucson, Arizona, USA
| | | | - Gizal Amin
- Carondelet Neurological Institute, Carondelet Saint Joseph's Hospital, Tucson, Arizona, USA
| | - Narlin B Beaty
- Department of Neurosurgery Tallahassee Memorial Hospital, Tallahassee Memorial Hospital Florida State University, Tallahassee, Florida, USA
| | - Matthew T Bender
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Shuichi Suzuki
- Department of Neurosurgery, University of California Irvine, Orange, California, USA
| | - Geoffrey P Colby
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, USA
| | - Li-Mei Lin
- Carondelet Neurological Institute, Carondelet Saint Joseph's Hospital, Tucson, Arizona, USA
| | - Alexander L Coon
- Carondelet Neurological Institute, Carondelet Saint Joseph's Hospital, Tucson, Arizona, USA
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Markus AF, Rijnbeek PR, Kors JA, Burn E, Duarte-Salles T, Haug M, Kim C, Kolde R, Lee Y, Park HS, Park RW, Prieto-Alhambra D, Reyes C, Krishnan JA, Brusselle GG, Verhamme KM. Real-world treatment trajectories of adults with newly diagnosed asthma or COPD. BMJ Open Respir Res 2024; 11:e002127. [PMID: 38413124 PMCID: PMC10900306 DOI: 10.1136/bmjresp-2023-002127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 02/09/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND There is a lack of knowledge on how patients with asthma or chronic obstructive pulmonary disease (COPD) are globally treated in the real world, especially with regard to the initial pharmacological treatment of newly diagnosed patients and the different treatment trajectories. This knowledge is important to monitor and improve clinical practice. METHODS This retrospective cohort study aims to characterise treatments using data from four claims (drug dispensing) and four electronic health record (EHR; drug prescriptions) databases across six countries and three continents, encompassing 1.3 million patients with asthma or COPD. We analysed treatment trajectories at drug class level from first diagnosis and visualised these in sunburst plots. RESULTS In four countries (USA, UK, Spain and the Netherlands), most adults with asthma initiate treatment with short-acting ß2 agonists monotherapy (20.8%-47.4% of first-line treatments). For COPD, the most frequent first-line treatment varies by country. The largest percentages of untreated patients (for asthma and COPD) were found in claims databases (14.5%-33.2% for asthma and 27.0%-52.2% for COPD) from the USA as compared with EHR databases (6.9%-15.2% for asthma and 4.4%-17.5% for COPD) from European countries. The treatment trajectories showed step-up as well as step-down in treatments. CONCLUSION Real-world data from claims and EHRs indicate that first-line treatments of asthma and COPD vary widely across countries. We found evidence of a stepwise approach in the pharmacological treatment of asthma and COPD, suggesting that treatments may be tailored to patients' needs.
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Affiliation(s)
- Aniek F Markus
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Peter R Rijnbeek
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jan A Kors
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Edward Burn
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Centre for Statistics in Medicine (CSM), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDROMS), University of Oxford, Oxford, UK
| | - Talita Duarte-Salles
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Markus Haug
- Institute of Computer Science, University of Tartu, Tartu, Estonia
| | - Chungsoo Kim
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Republic of Korea
| | - Raivo Kolde
- Institute of Computer Science, University of Tartu, Tartu, Estonia
| | - Youngsoo Lee
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Rae Woong Park
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Republic of Korea
| | - Daniel Prieto-Alhambra
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
- Centre for Statistics in Medicine (CSM), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDROMS), University of Oxford, Oxford, UK
| | - Carlen Reyes
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Jerry A Krishnan
- Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois Chicago, Chicago, Illinois, USA
| | - Guy G Brusselle
- Departments of Clinical Epidemiology and Respiratory Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Katia Mc Verhamme
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Infection Control & Epidemiology, OLV Hospital, Aalst, Belgium
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Kreinest M, Raisch P, Hörnig L, Vetter SY, Grützner PA, Jung MK. Odontoid Fracture with Accompanying Severe Atlantoaxial Instability in Elderly Patients-Analysis of Treatment, Adverse Events, and Outcome. J Clin Med 2024; 13:1326. [PMID: 38592668 PMCID: PMC10932128 DOI: 10.3390/jcm13051326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 02/19/2024] [Accepted: 02/24/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: In elderly patients with type II odontoid fractures, accompanying severe atlantoaxial instability (AAI) is discussed as a marker possibly warranting more aggressive surgical therapy. This study aimed to characterize adverse events as well as the radiological and functional outcomes of surgical vs. conservative therapy in patients with odontoid fracture and AAI. (2) Methods: Patients aged 65 years and older with type II odontoid fracture and AAI treated were included. AAI was assumed if the mean subluxation across both atlantoaxial facet joints in the sagittal plane was greater than 50%. Data on demographics, comorbidities, treatment, adverse events, radiological, and functional outcomes were analyzed. (3) Results: Thirty-nine patients were included. Hospitalization time was significantly shorter in conservatively treated patients compared to patients with ventral or dorsal surgery. Adverse events occurred in 11 patients (28.2%), affecting 10 surgically treated patients (35.7%), and 1 conservatively treated patient (9.1%). Moreover, 25 patients were followed-up (64.1%). One secondary dislocation occurred in the conservative group (11.1%) and three in the surgical group (18.8%). (4) Conclusions: Despite the potential for instability in this injury, conservative treatment does not seem to lead to unfavorable short-term results, less adverse events, and a shorter hospital stay and should thus be considered and discussed with patients as a treatment option, even in the presence of severe AAI.
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Affiliation(s)
| | | | | | | | | | - Matthias K. Jung
- BG Trauma Center Ludwigshafen at the University of Heidelberg, Clinic for Trauma and Orthopedic Surgery, Ludwig-Guttmann-Straße 13, 67071 Ludwigshafen, Germany (L.H.)
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Arefpour H, Rasaei N, Amini MR, Salavatizadeh M, Hashemi M, Makhtoomi M, Hajiaqaei M, Gholizadeh M, Askarpour M, Hekmatdoost A. The effects of astaxanthin supplementation on liver enzymes levels. INT J VITAM NUTR RES 2024. [PMID: 38407143 DOI: 10.1024/0300-9831/a000804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
According to previous studies, astaxanthin exerts various biological effects due to its anti-inflammatory and antioxidant capabilities; however, its effects on liver enzymes have not yet been well elucidated. Therefore, we conducted a meta-analysis to assess astaxanthin's effects on liver enzymes. A systematic literature search was conducted using scientific databases including PubMed, Scopus, Web of Science, the Cochrane databases, and Google Scholar up to February 2023 to find relevant randomized controlled trials (RCTs) examining the effects of astaxanthin supplementation on alanine transaminase (ALT), aspartate transaminase (AST), gamma-glutamyl transferase (GGT), and alkaline phosphatase (ALP). A random-effects model was used for the estimation of the pooled weighted mean difference (WMD). Overall, we included five trials involving 196 subjects. The duration of the intervention was between 4 and 48 weeks, and the dose was between 6 and 12 mg/day. ALT levels increased in the intervention group compared to the control group following astaxanthin supplementation (WMD: 1.92 U/L, 95% CI: 0.16 to 3.68, P=0.03), whereas supplementation with astaxanthin had a non-significant effect on AST (WMD: 0.72 U/L, 95% CI: -0.85 to 2.29, P=0.36), GGT (WMD: 0.48 U/L, 95% CI: -2.71 to 3.67, P=0.76), and ALP levels (WMD: 2.85 U/L, 95% CI: -7.94 to 13.63, P=0.60) compared to the placebo group. Our data showed that astaxanthin supplementation increases ALT concentrations in adults without affecting the levels of other liver enzymes. Further long-term and well-designed RCTs are necessary to assess and confirm these findings.
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Affiliation(s)
- Hoda Arefpour
- Student Research Committee, Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition & Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Niloufar Rasaei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Iran
- Network of Interdisciplinarity in Neonates and Infants (NINI), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Mohammad Reza Amini
- Student Research Committee, Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition & Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Nutrition and Food Security Research Center, Isfahan University of Medical Sciences, Iran
| | - Marieh Salavatizadeh
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Mohtaram Hashemi
- Student Research Committee, Semnan University of Medical Sciences, Iran
| | - Maede Makhtoomi
- Student Research Committee, Shiraz University of Medical Science, Iran
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Science, Iran
| | - Mahdi Hajiaqaei
- Department of Physiology, Faculty of Medicine, Tehran University of Medical Sciences (TUMS), Iran
| | - Mohammad Gholizadeh
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Moein Askarpour
- Student Research Committee, Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Iran
| | - Azita Hekmatdoost
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Science, Tehran, Iran
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Smischney NJ, Seisa MO, Schroeder DR. Association of Shock Indices with Peri-Intubation Hypotension and Other Outcomes: A Sub-Study of the KEEP PACE Trial. J Intensive Care Med 2024:8850666241235591. [PMID: 38403984 DOI: 10.1177/08850666241235591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
BACKGROUND Based on current evidence, there appears to be an association between peri-intubation hypotension and patient morbidity and mortality. Studies have identified shock indices as possible pre-intubation risk factors for peri-intubation hypotension. Thus, we sought to evaluate the association between shock index (SI), modified shock index (MSI), and diastolic shock index (DSI) and peri-intubation hypotension along with other outcomes. METHODS The present study is a sub-study of a randomized controlled trial involving critically ill patients undergoing intubation. We defined peri-intubation hypotension as a decrease in mean arterial pressure <65 mm Hg and/or a reduction of 40% from baseline; or the initiation of, or increase in infusion dosage of, any vasopressor medication (bolus or infusion) during the 30-min period following intubation. SI, MSI, and DSI were analyzed as continuous variables and categorically using pre-established cut-offs. We also explored the effect of age on shock indices. RESULTS A total of 151 patients were included in the analysis. Mean pre-intubation SI was 1.0 ± 0.3, MSI 1.5 ± 0.5, and DSI 1.9 ± 0.7. Increasing SI, MSI, and DSI were significantly associated with peri-intubation hypotension (OR [95% CI] per 0.1 increase = 1.16 [1.04, 1.30], P = .009 for SI; 1.14 [1.05, 1.24], P = .003 for MSI; and 1.11 [1.04, 1.19], P = .003 for DSI). The area under the ROC curves did not differ across shock indices (0.66 vs 0.67 vs 0.69 for SI, MSI, and DSI respectively; P = .586). Increasing SI, MSI, and DSI were significantly associated with worse sequential organ failure assessment (SOFA) score (spearman rank correlation: r = 0.30, r = 0.40, and r = 0.45 for SI, MSI, and DSI, respectively, all P < .001) but not with other outcomes. There was no significant impact when incorporating age. CONCLUSIONS Increasing SI, MSI, and DSI were all significantly associated with peri-intubation hypotension and worse SOFA scores but not with other outcomes. Shock indices remain a useful bedside tool to assess the potential likelihood of peri-intubation hypotension. TRIAL REGISTRATION ClinicalTrials.gov identifier - NCT02105415.
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Affiliation(s)
- Nathan J Smischney
- Department of Anesthesiology and Perioperative Medicine, Division of Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
- Hemodynamic and Airway Management Group (HEMAIR), Mayo Clinic, Rochester, MN, USA
| | - Mohamed O Seisa
- Department of Anesthesiology and Perioperative Medicine, Division of Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
- Hemodynamic and Airway Management Group (HEMAIR), Mayo Clinic, Rochester, MN, USA
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Kudsi M, Tarcha R, Khalayli N. Nintedanib in systemic sclerosis treatment: a case report. J Med Case Rep 2024; 18:110. [PMID: 38388392 PMCID: PMC10885361 DOI: 10.1186/s13256-024-04433-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 01/10/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Nintedanib was approved for the treatment of scleroderma and scleroderma-related interstitial lung disease, as it decrease the forced expiratory volume. CASE PRESENTATION A 48-year-old Asian female patient with systemic scleroderma 6 years ago developed breathlessness, nausea, heart palpation, and sudden severe occipital headache over the preceding week. She was receiving aspirin 81 mg/day and amlodipine 5 mg/day. Her diagnosis was diffuse scleroderma with pulmonary hypertension, interstitial lung involvement, and renal crisis. The modified Rodnan score was 18. We begin captopril at a dose of 12.5 mg, progressively escalating to 200 mg/day, and oral nintedanib was started at 150 mg. A total of 12 months after initiation of treatment, the patient's kidney function was normal. The pulmonary function tests improved. The modified Rodnan score was reduced to 10. We did not encounter any side effects in our case due to nintedanib treatment. CONCLUSION Treatment with nintedanib is crucial for slowing lung function decline. Diarrhea was the most common adverse event. Scleroderma renal crisis occurs in 10% of patients and typically presents with an abrupt onset of hypertension and kidney failure. The optimal antihypertensive agent for scleroderma renal crisis is an ACE inhibitor. The mainstay of therapy in scleroderma renal crisis has been shown to improve or stabilize renal function in approximately 70% of patients and improve survival in nearly 80% at 1 year. Nintedanib may be effective, and fairly safe to use. Further exploration is anticipated to advance a new period of systemic sclerosis treatment.
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Affiliation(s)
- Maysoun Kudsi
- Department of Rheumatology, Faculty of Medicine, Damascus University, Al-Mazzeh, Damascus, Syria
| | - Raghad Tarcha
- Department of Rheumatology, Faculty of Medicine, Damascus University, Al-Mazzeh, Damascus, Syria.
| | - Naram Khalayli
- Faculty of Medicine, Damascus University, Damascus, Syria
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Fukuda Y, Ushigome E, Yamazaki M, Fukui M. Postoperative Insulin Dose for Cardiac Artery Bypass Graft and Other Cardiac Surgeries in Patients with Type 2 Diabetes: A Retrospective Study. Vasc Health Risk Manag 2024; 20:59-68. [PMID: 38414907 PMCID: PMC10898479 DOI: 10.2147/vhrm.s447077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 01/30/2024] [Indexed: 02/29/2024] Open
Abstract
Purpose Recommendations on perioperative glycemic control in cardiac surgery are based on coronary artery bypass graft surgery (CABG), though coronary artery disease and valvular disease are pathologically distinct. We aimed to compare the postoperative insulin requirement between CABG and other cardiac surgeries in type 2 diabetic patients and identify predictive factors for the maximum postoperative insulin dose. Patients and Methods We retrospectively included 60 Japanese patients with diabetes/glucose intolerance (HbA1c > 37 mmol/mol [5.6%]) who were hospitalized for cardiovascular surgery between April 2017 and March 2019. We categorized the subjects into the CABG and non-CABG groups, and performed subgroup analysis on patients who received postoperative insulin therapy. Results The CABG group required a significantly higher insulin dose on postoperative days 2, 5, 6, and 7, and a significantly higher maximum postoperative insulin dose (24.6 U vs 9.7 U, P < 0.001) than the non-CABG group. Multivariate linear regression analyses showed that the independent determinants of the maximum postoperative insulin dose were HbA1c and duration of diabetes in the non-CABG group, and HbA1c in the CABG group. Conclusion CABG had a higher postoperative insulin requirement than other cardiovascular surgeries; early aggressive insulin therapy is indicated, especially for patients with higher HbA1c levels/longer duration of diabetes.
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Affiliation(s)
- Yukiko Fukuda
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Emi Ushigome
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Masahiro Yamazaki
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Michiaki Fukui
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
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Aydin K, Ozel Yesilyurt A, Cetinkaya F, Gok MG, Dogan O, Ozcengiz D. Earthquake victims in focus: a cross-sectional examination of trauma and management in intensive care unit. BMC Emerg Med 2024; 24:30. [PMID: 38378483 PMCID: PMC10880224 DOI: 10.1186/s12873-024-00949-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 02/06/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND After the Kahramanmaras earthquake of February 6, 2023, the disaster of the century, a significant number of victims were admitted to intensive care units (ICUs). In this study, we aimed to share the characteristics and management of critical earthquake victims and shed light on our experiences as intensivists in future earthquakes. METHODS The study included 62 earthquake victims in two tertiary ICUs. Demographic characteristics, laboratory findings, clinical characteristics, trauma and disease severity scores, treatments administered to patients, and the clinical course of the patients were recorded retrospectively. The patients were divided into two groups, survivors and nonsurvivors, according to 7-day mortality and into two groups according to the duration of their stay under the rubble: those who remained under the rubble for 72 hours or less and those who remained under the rubble for more than 72 hours. A receiver operating characteristic (ROC) curve analysis was used to determine the best cutoff value for the 'Circulation, Respiration, Abdomen, Motor, and Speech' (CRAMS) score. RESULTS The median age of the 62 patients included in the study was 35.5 (23-53) years. The median length of stay under the rubble for the patients was 30.5 (12-64.5) hours. The patient was transferred to the ward with a maximum duration of 222 hours under the rubble. The limb (75.8%) was the most common location of trauma in patients admitted to the ICU. Crush syndrome developed in 96.8% of the patients. There was a positive correlation between the development of acute kidney injury (AKI) and myoglobin, serum lactate, and uric acid levels (r = 0.372, p = 0.003; r = 0.307, p = 0.016; r = 0.428, p = 0.001, respectively). The best cutoff of the CRAMS score to predict in-7-day mortality was < 4.5 with 0.94 area under the curve (AUC); application of this threshold resulted in 75% sensitivity and 96.3% specificity. CONCLUSION Search and rescue operations should continue for at least ten days after an earthquake. The CRAMS score can be used to assess trauma severity and predict mortality in critically ill earthquake victims.
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Affiliation(s)
- Kaniye Aydin
- Division of Medical Intensive Care Unit, Department of Internal Medicine, School of Medicine, Cukurova University, Adana, Türkiye.
| | - Aysun Ozel Yesilyurt
- Department of Anesthesiology and Reanimation, School of Medicine, Cukurova University, Adana, Türkiye
| | - Ferhat Cetinkaya
- Department of Anesthesiology and Reanimation, School of Medicine, Cukurova University, Adana, Türkiye
| | - Mehmet Gokhan Gok
- Department of Anesthesiology and Reanimation, School of Medicine, Cukurova University, Adana, Türkiye
| | - Omer Dogan
- Department of Anesthesiology and Reanimation, School of Medicine, Cukurova University, Adana, Türkiye
| | - Dilek Ozcengiz
- Department of Anesthesiology and Reanimation, School of Medicine, Cukurova University, Adana, Türkiye
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Hagstrom R, Nossek E, Rutledge CW, Ponchione E, Suryadevara C, Kremer C, Alcon A, Sharashidze V, Shapiro M, Raz E, Nelson PK, Staffenberg DA, Riina HA. Transpalpebral/Blepharoplasty Incision and Supraorbital Craniotomy for the Treatment of Ethmoidal Dural Arteriovenous Fistulas: A Case Series. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01066. [PMID: 38376155 DOI: 10.1227/ons.0000000000001103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/03/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Inherent complex angioarchitecture associated with ethmoidal dural arteriovenous fistulas (dAVFs) can make endovascular treatment methods challenging. Many surgical approaches are accompanied by unfavorable cosmetic results such as facial scarring. Blepharoplasty incision of the eyelid offers a minimal, well-hidden scar compared with other incision sites while offering the surgeon optimal visualization of pathogenic structures. This case series aims to report an initial assessment of the safety and efficacy of supraorbital craniotomy by blepharoplasty transpalpebral (eyelid) incision for surgical disconnection of ethmoidal dAVFs. METHODS Retrospective chart review was conducted for all patients who underwent blepharoplasty incision and craniotomy for disconnection of ethmoidal dAVFs at our institution between October 2011 and February 2023. Patient charts and follow-up imaging were reviewed to report clinical and angiographic outcomes as well as periprocedural and follow-up complications. RESULTS Complete obliteration and disconnection of ethmoidal dAVF was achieved in all 6 (100%) patients as confirmed by intraoperative angiogram with no resulting morbidity or mortality. Periprocedural complications included one case of transient nasal cerebrospinal fluid leak that was self-limiting and resolved before discharge without intervention. CONCLUSION Surgical treatment for ethmoidal dAVFs, specifically by transpalpebral incision and supraorbital craniotomy, is a safe and effective treatment option and affords the surgeon greater access to the floor of the anterior fossa when necessary. In addition, blepharoplasty incision addressed patient concerns for facial scarring compared with other incision sites by creating a more well-hidden, minimal scar in the natural folds of the eyelid for patients with an eyelid crease.
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Affiliation(s)
- Rory Hagstrom
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
| | - Erez Nossek
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
| | - Caleb W Rutledge
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
| | | | | | - Caroline Kremer
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
| | - Andre Alcon
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, New York, USA
| | - Vera Sharashidze
- Department of Neurology, NYU Langone Health, New York, New York, USA
| | - Maksim Shapiro
- Department of Radiology, NYU Langone Health, New York, New York, USA
| | - Eytan Raz
- Department of Radiology, NYU Langone Health, New York, New York, USA
| | - Peter K Nelson
- Department of Radiology, NYU Langone Health, New York, New York, USA
| | - David A Staffenberg
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, New York, USA
| | - Howard A Riina
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
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Khattak YR, Baig MA, Din SZU, Ahmad I. Autogenous, alloplastic, or hybrid for total mandibular reconstruction; is here an optimal path? Oral Maxillofac Surg 2024:10.1007/s10006-024-01224-3. [PMID: 38366272 DOI: 10.1007/s10006-024-01224-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 02/04/2024] [Indexed: 02/18/2024]
Abstract
For less fit patients, total reconstruction of the mandible (TRM) is an elucidated alternative for severe maxillofacial defects. This study aimed to comprehensively review and analyze the existing evidence, irrespective of the underlying pathologies, to provide a consolidated overview of the current state of TRM. An electronic search was performed on PubMed, Embase, Scopus, and Google Scholar to identify studies reporting TRM without restrictions on patient age, type of pathology underlying the mandibular defect, and study type. Electronic search identified 390 studies; only 21 met the inclusion criteria, documenting 7 (33.3%) autogenous, 6 (28.6%) alloplastic, and 8 (38.1%) hybrid TRMs. All studies reported one clinical case, except for two studies that reported two patients treated with TRM. The mean age of the patients was 39.0 ± 19.4 years, and the mean follow-up was 22.3 ± 14.7 months. Osteomyelitis was the most common pathology. Bilateral condyles were preserved in only two cases. The TRM has been reported in clinical cases only and no large cohort study is available. Functional and aesthetic parameters have either not been reported or have been reported in heterogeneous formats, thus hampering comparisons of autogenous, alloplastic, and hybrid TRMs. Overall, TRM in patients presenting with severe maxillofacial defects achieved promising clinical outcomes endowed with acceptable function and aesthetics. Large cohort studies are needed to validate these results.
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Affiliation(s)
| | - Mirza Albash Baig
- State Key Laboratory of Precision Measurement Technology and Instruments, Tianjin University, Tianjin, 300072, China
| | - Syed Zaheer Ud Din
- International School for Optoelectronic Engineering, Qilu University of Technology (Shandong Academy of Sciences), Jinan, 250353, China
| | - Iftikhar Ahmad
- Institute of Radiotherapy and Nuclear Medicine (IRNUM), Peshawar, Pakistan.
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Cleofas J, Andrada-Poa MRJ, Jabal R. The Influence of COVID-19 Program Innovativeness on Occupational Stress Outcomes of Community Health Workers in a Selected City Health Department in the Philippines. Soc Work Public Health 2024; 39:156-168. [PMID: 38380906 DOI: 10.1080/19371918.2024.2320794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
The COVID-19 pandemic has caused unprecedented strain on the health sector. Thus, public health organizations have been challenged to design innovative programs that address not only their constituents' needs but also their health workers' work conditions. In one City Health Department in the Philippines, a notable public health program innovation, which harmonizes COVID-19 testing and health risk assessments for other diseases in a single program, has been implemented. This study examined the relationship between the perceived innovativeness of said COVID-19 program and the occupational stress outcomes of community health workers in a selected city health unit in the Philippines. This study used a quantitative, cross-sectional descriptive design with comparative and correlational aspects. A total of 128 purposively selected community health workers involved in the said program participated in this online survey. Findings suggest that age, years of service, gender, and employment status were significantly associated with perceived innovativeness. Reported perceived personal stress level was significantly lower during the implementation of the innovative program compared to the pre-implementation period. Moreover, perceived program innovativeness was found to be significantly negatively correlated with personal stress and significantly positively correlated with occupational support.
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Affiliation(s)
- Jerome Cleofas
- Department of Sociology and Behavioral Sciences Department, De La Salle University, Manila, Philippines
| | | | - Ronaldo Jabal
- Department of Sociology and Behavioral Sciences Department, De La Salle University, Manila, Philippines
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McCann W, Murphy KR, Zeiger RS, Beuther DA, Wise RA, Reibman J, George M, Gilbert I, Eudicone JM, Gandhi HN, Cutts K, Coyne KS, Chipps B. Assessing meaningful change in the Asthma Impairment and Risk Questionnaire. Ann Allergy Asthma Immunol 2024:S1081-1206(24)00085-1. [PMID: 38369256 DOI: 10.1016/j.anai.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 02/08/2024] [Accepted: 02/08/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND The Asthma Impairment and Risk Questionnaire (AIRQ) is a 10-item, yes/no, equally weighted control tool. Lower scores indicate better control. Moreover, 7 impairment items reflect previous 2-week symptoms, and 3 risk items assess previous 12-month exacerbations. The Follow-up AIRQ for use between annual assessments has a 3-month recall period for exacerbation items. OBJECTIVE To evaluate the responsiveness of the AIRQ over time and identify a minimal important difference (MID). METHODS The AIRQ longitudinal study data were analyzed from patients with asthma aged 12 years and older. Anchor-based methods assessed differences in AIRQ scores relative to Patient Global Impression of Change, the accepted MIDs for St. George's Respiratory Questionnaire and Asthma Control Test, and exacerbation occurrence over 12 months. Baseline and 12-month data reflected 12-month recall AIRQ scores; Follow-up AIRQ scores were used for 3-, 6-, and 9-month analyses. RESULTS A total of 1070 patients were included. The Patient Global Impression of Change rating of "much improved" was associated with AIRQ mean score changes from baseline to months 3, 6, 9, and 12 of -2.0, -1.9, -1.9, and -1.8, respectively. The mean AIRQ score change among patients who met the St. George's Respiratory Questionnaire MID (≥4-point decrease) was -1.8 at 6 and 12 months. The AIRQ mean scores decreased from baseline by -2.2 to -2.5 points at months 3, 6, 9, and 12 for patients who met the Asthma Control Test MID (≥ 3-point increase). A 2-point higher baseline AIRQ score was associated with a 1.7 odds ratio of 12-month exacerbation occurrence (95% CI, 1.53-1.89). CONCLUSION A change score of 2 is recommended as the AIRQ MID.
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Affiliation(s)
| | - Kevin R Murphy
- Division of Allergy, Asthma and Immunology, Boys Town National Research Hospital, Boys Town, Nebraska
| | - Robert S Zeiger
- Departments of Allergy and Research and Evaluation, Kaiser Permanente Southern California, San Diego and Pasadena, California
| | - David A Beuther
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado
| | - Robert A Wise
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joan Reibman
- Department of Medicine, New York University (NYU) Grossman School of Medicine, New York, New York
| | - Maureen George
- Department of Nursing, Columbia University School of Nursing, New York, New York
| | - Ileen Gilbert
- BioPharmaceuticals Medical, AstraZeneca, Wilmington, Delaware
| | | | - Hitesh N Gandhi
- BioPharmaceuticals Medical, AstraZeneca, Wilmington, Delaware
| | - Katelyn Cutts
- Patient-Centered Research, Evidera, Bethesda, Maryland
| | - Karin S Coyne
- Patient-Centered Research, Evidera, Bethesda, Maryland
| | - Bradley Chipps
- Capital Allergy and Respiratory Disease Center, Sacramento, California
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Liang X, Liu J, Di J, Xiao N, Peng Y, Tian Q, Chen L. Toxicity evaluation of processing Evodiae fructus based on intestinal microbiota. Front Microbiol 2024; 15:1336777. [PMID: 38435687 PMCID: PMC10904473 DOI: 10.3389/fmicb.2024.1336777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 02/06/2024] [Indexed: 03/05/2024] Open
Abstract
Background With the development of healthcare services, drug efficacy, and safety have become the focus of drug use, and processing alters drug toxicity and efficacy, exploring the effects of processing on Evodiae fructus (EF) can guide the clinical use of drugs. Methods Fifty male Kunming mice were randomly divided into the control group (CCN), raw small-flowered EF group (CRSEF), raw medium-flowered EF group (CRMEF), processing small-flowered EF group (CPSEF), and processing medium-flowered EF group (CPMEF). The CRSEF, CRMEF, CPSEF, and CPMEF groups were gavaged with aqueous extracts of raw small-flowered EF dry paste (RSEF), medium-flowered EF dry paste (RMEF), processing small-flowered EF dry paste (PSEF) and processing medium-flowered EF dry paste (PMEF), respectively, for 21 days at 5 times the pharmacopeial dosage. Upon concluding the experiment, histopathological sections of liver and kidney tissues were examined. Additionally, levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), serum creatinine (SCr), and blood urea nitrogen (BUN) were determined. DNA from the intestinal contents of the mice was extracted, and 16S rRNA full-length high-throughput sequencing was performed. Results After fed EF 21 days, mice exhibited a decreasing trend in body weight. Comparative analysis with the CCN group revealed an upward trend in SCr, BUN, AST, and ALT levels in both CRSEF and CRMEF groups. The CRMEF group displayed notably elevated BUN and AST levels, with an observed increasing trend in Scr and ALT. Kidney sections unveiled cellular edema and considerable inflammatory cell infiltrates, whereas significant liver damage was not evident. Compared with CRSEF, Bun levels were significantly lower while AST levels were significantly higher in the CPMEF group. Additionally, the intestinal microbiota diversity and the relative abundance of Psychrobacter decreased significantly, and the relative abundance of Staphylococcus, Jeotgalicoccus, and Salinicoccus increased significantly in the CPMEF group. AST, ALT, and SCr were positively correlated with Staphylococcus, Jeotgalicoccus, and Salinicoccus. Conclusion In conclusion, PMEF significantly increased harmful bacteria (Staphylococcus, Jeotgalicoccus, and Salinicoccu) and decreased beneficial bacteria. SEF with 5 times the clinical dose showed nephrotoxicity and SEF nephrotoxicity decreased after processing, but EF hepatotoxicity was not significant, which may be due to insufficient dose concentration and time.
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Affiliation(s)
| | - Jing Liu
- Hunan University of Chinese Medicine, Changsha, China
| | - Jiaxin Di
- Hunan University of Chinese Medicine, Changsha, China
| | - Nenqun Xiao
- Hunan University of Chinese Medicine, Changsha, China
| | - Yanmei Peng
- Hunan Academy of Chinese Medicine, Changsha, China
| | - Qixue Tian
- Hunan Province Hospital of Integrated Traditional Chinese and Western Medicine (The Affiliated Hospital of Hunan Academy of Traditional Chinese Medicine), Changsha, China
- National Traditional Chinese Medicine Processing Technology Inheritance Base of the Affiliated Hospital of Hunan Academy of Traditional Chinese Medicine, Changsha, China
| | - Linglong Chen
- Hunan Academy of Chinese Medicine, Changsha, China
- National Traditional Chinese Medicine Processing Technology Inheritance Base of the Affiliated Hospital of Hunan Academy of Traditional Chinese Medicine, Changsha, China
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Wu TD, Diamant Z, Hanania NA. An Update on Patient-Reported Outcomes in Asthma. Chest 2024:S0012-3692(24)00156-9. [PMID: 38365175 DOI: 10.1016/j.chest.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 02/18/2024] Open
Abstract
TOPIC IMPORTANCE Patient-reported outcomes (PROs) are information provided by patients on their condition, function, well-being, or experience. Instruments to quantify PROs, called patient-reported outcome measures (PROMs), allow standardized assessment of a unique dimension of health that cannot be measured physically. Herein, we discuss how to appraise PROMs critically and provide an update on their use in asthma clinical practice and research. REVIEW FINDINGS Asthma-specific PROMs have been developed to measure a wide array of disease characteristics, including symptoms, medication use, exacerbations, and impairments to emotional and physical function. Some PROMs also include spirometry or expand questions to overlap with rhinitis symptoms. Use of PROMs to understand asthma control is included in management guidelines, yet real-world evidence of their effectiveness in improving asthma care remains limited. These instruments may be less accurate in characterizing patients with poorly controlled asthma and have modest correlation with exacerbation risk. Two new PROMs are highlighted, the Asthma Impairment and Risk Questionnaire as an instrument to assess asthma control that incorporates domains related to exacerbation risk and impairment, and the CompEx as a composite of daily diary reporting combined with exacerbation events as an early efficacy signal for interventional trials. SUMMARY PROMs are fundamental to asthma assessment. Novel instruments may improve the detection of patients at risk for poor outcomes and shorten the drug discovery pipeline. However, urgent research is needed to understand their practical utility in clinical settings.
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Affiliation(s)
- Tianshi David Wu
- Section of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston TX; Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston TX.
| | - Zuzana Diamant
- Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, Groningen, The Netherlands; Department of Respiratory Medicine & Allergology, Skåne University Hospital, Lund, Sweden
| | - Nicola A Hanania
- Section of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston TX
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Singh R, Ha SE, Park HS, Debnath S, Cho H, Baek G, Yu TY, Ro S. Sustained Effectiveness and Safety of Therapeutic miR-10a/b in Alleviating Diabetes and Gastrointestinal Dysmotility without Inducing Cancer or Inflammation in Murine Liver and Colon. Int J Mol Sci 2024; 25:2266. [PMID: 38396943 PMCID: PMC10888952 DOI: 10.3390/ijms25042266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 02/10/2024] [Accepted: 02/11/2024] [Indexed: 02/25/2024] Open
Abstract
microRNAs (miRNAs) are key regulators of both physiological and pathophysiological mechanisms in diabetes and gastrointestinal (GI) dysmotility. Our previous studies have demonstrated the therapeutic potential of miR-10a-5p mimic and miR-10b-5p mimic (miR-10a/b mimics) in rescuing diabetes and GI dysmotility in murine models of diabetes. In this study, we elucidated the safety profile of a long-term treatment with miR-10a/b mimics in diabetic mice. Male C57BL/6 mice were fed a high-fat, high-sucrose diet (HFHSD) to induce diabetes and treated by five subcutaneous injections of miR-10a/b mimics for a 5 month period. We examined the long-term effects of the miRNA mimics on diabetes and GI dysmotility, including an assessment of potential risks for cancer and inflammation in the liver and colon using biomarkers. HFHSD-induced diabetic mice subcutaneously injected with miR-10a/b mimics on a monthly basis for 5 consecutive months exhibited a marked reduction in fasting blood glucose levels with restoration of insulin and significant weight loss, improved glucose and insulin intolerance, and restored GI transit time. In addition, the miR-10a/b mimic-treated diabetic mice showed no indication of risk for cancer development or inflammation induction in the liver, colon, and blood for 5 months post-injections. This longitudinal study demonstrates that miR-10a/b mimics, when subcutaneously administered in diabetic mice, effectively alleviate diabetes and GI dysmotility for 5 months with no discernible risk for cancer or inflammation in the liver and colon. The sustained efficacy and favorable safety profiles position miR-10a/b mimics as promising candidates in miRNA-based therapeutics for diabetes and GI dysmotility.
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Affiliation(s)
- Rajan Singh
- Department of Physiology and Cell Biology, School of Medicine, University of Nevada, Reno, NV 89557, USA; (R.S.); (S.E.H.); (H.S.P.); (S.D.); (H.C.); (G.B.); (T.Y.Y.)
| | - Se Eun Ha
- Department of Physiology and Cell Biology, School of Medicine, University of Nevada, Reno, NV 89557, USA; (R.S.); (S.E.H.); (H.S.P.); (S.D.); (H.C.); (G.B.); (T.Y.Y.)
| | - Han Sung Park
- Department of Physiology and Cell Biology, School of Medicine, University of Nevada, Reno, NV 89557, USA; (R.S.); (S.E.H.); (H.S.P.); (S.D.); (H.C.); (G.B.); (T.Y.Y.)
| | - Sushmita Debnath
- Department of Physiology and Cell Biology, School of Medicine, University of Nevada, Reno, NV 89557, USA; (R.S.); (S.E.H.); (H.S.P.); (S.D.); (H.C.); (G.B.); (T.Y.Y.)
| | - Hayeong Cho
- Department of Physiology and Cell Biology, School of Medicine, University of Nevada, Reno, NV 89557, USA; (R.S.); (S.E.H.); (H.S.P.); (S.D.); (H.C.); (G.B.); (T.Y.Y.)
| | - Gain Baek
- Department of Physiology and Cell Biology, School of Medicine, University of Nevada, Reno, NV 89557, USA; (R.S.); (S.E.H.); (H.S.P.); (S.D.); (H.C.); (G.B.); (T.Y.Y.)
| | - Tae Yang Yu
- Department of Physiology and Cell Biology, School of Medicine, University of Nevada, Reno, NV 89557, USA; (R.S.); (S.E.H.); (H.S.P.); (S.D.); (H.C.); (G.B.); (T.Y.Y.)
| | - Seungil Ro
- Department of Physiology and Cell Biology, School of Medicine, University of Nevada, Reno, NV 89557, USA; (R.S.); (S.E.H.); (H.S.P.); (S.D.); (H.C.); (G.B.); (T.Y.Y.)
- RosVivo Therapeutics, Applied Research Facility, 1664 N. Virginia St., Reno, NV 89557, USA
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Xu J, Lv TF. Rupture of a giant jejunal mesenteric cystic lymphangioma misdiagnosed as ovarian torsion: A case report. World J Clin Cases 2024; 12:847-852. [PMID: 38322678 PMCID: PMC10841141 DOI: 10.12998/wjcc.v12.i4.847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/22/2023] [Accepted: 01/12/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Cystic lymphangioma is a rare benign tumor that affects the lymphatic system. Mesenteric lymphangiomas in the small bowel are extremely uncommon. CASE SUMMARY We present a 21-year-old female patient who complained of abdominal pain. The diagnosis of ovarian torsion was suspected after abdominopelvic unenhanced computed tomography and ultrasound revealed a large cyst in contact with the bladder, ovary, and uterus. The patient underwent emergency laparotomy performed by gynecologists, but it was discovered that the cystic tumor originated from the jejunum. Gastrointestinal surgeons were then called in to perform a cystectomy. Pathological examination confirmed the diagnosis of cystic lymphangioma of the mesentery. The patient had an uneventful postoperative recovery. CONCLUSION Mesenteric lymphangiomas can cause abdominal pain, and imaging techniques can help determine their characteristics, location, and size. Complete surgical excision and pathological examination are considered the standard treatment and diagnostic method.
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Affiliation(s)
- Jing Xu
- Department of Hepatopathy, Hangzhou Xixi Hospital, Hangzhou 310023, Zhejiang Province, China
| | - Tie-Feng Lv
- Department of Hepatopathy, Hangzhou Xixi Hospital, Hangzhou 310023, Zhejiang Province, China
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Velescu DR, Marc MS, Traila D, Pescaru CC, Hogea P, Suppini N, Crisan AF, Wellmann N, Oancea C. A Narrative Review of Self-Reported Scales to Evaluate Depression and Anxiety Symptoms in Adult Obstructive Sleep Apnea Patients. Medicina (Kaunas) 2024; 60:261. [PMID: 38399548 PMCID: PMC10889932 DOI: 10.3390/medicina60020261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 01/14/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Obstructive sleep apnea (OSA) is a prevalent chronic condition that has been associated with mental disorders like depression and anxiety. This study intends to provide a practical overview of the most relevant self-reported and self-rating scales that assess depression and anxiety in OSA patients. Materials and Methods: A search for articles was performed using PubMed, Google Scholar, and Semantic Scholar using a combination of words for obstructive sleep apnea, depression, anxiety, and scales. The tools were ordered by type (screening and rating) and arranged chronologically according to the year of publication. Results: Three scales were identified for assessing depression, which were the Center for Epidemiologic Studies Depression Scale (CES-D), the Hospital Anxiety and Depression Scale (HADS-D), and the Patient Health Questionnaire-9 (PHQ-9). For rating depression, two scales were discussed: the Zung Self-Rating Depression Scale (SDS) and the Beck Depression Inventory (BDI), which has three versions (the BDI, the BDI-II, and the Fast Screen (BDI-FS)). For assessing anxiety, the Generalized Anxiety Disorder-7 (GAD-7) scale was identified. Two scales were reviewed for rating anxiety: the State-Trait Anxiety Inventory (STAI) and the Beck Anxiety Inventory (BAI). Each scale is accompanied by a brief description of its practicality and psychometric qualities and an analysis of its strengths and limitations. Conclusions: The findings of this review will contribute to the understanding of the importance of assessing mental health comorbidities in the context of OSA, ultimately guiding clinical practice and future research in this area.
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Affiliation(s)
- Diana Raluca Velescu
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (D.R.V.); (D.T.); (C.C.P.); (P.H.); (N.S.); (A.F.C.); (C.O.)
- Department of Infectious Diseases, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Monica Steluta Marc
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (D.R.V.); (D.T.); (C.C.P.); (P.H.); (N.S.); (A.F.C.); (C.O.)
- Department of Infectious Diseases, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Daniel Traila
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (D.R.V.); (D.T.); (C.C.P.); (P.H.); (N.S.); (A.F.C.); (C.O.)
- Department of Infectious Diseases, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Camelia Corina Pescaru
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (D.R.V.); (D.T.); (C.C.P.); (P.H.); (N.S.); (A.F.C.); (C.O.)
- Department of Infectious Diseases, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Patricia Hogea
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (D.R.V.); (D.T.); (C.C.P.); (P.H.); (N.S.); (A.F.C.); (C.O.)
- Department of Infectious Diseases, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Noemi Suppini
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (D.R.V.); (D.T.); (C.C.P.); (P.H.); (N.S.); (A.F.C.); (C.O.)
- Department of Infectious Diseases, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Alexandru Florian Crisan
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (D.R.V.); (D.T.); (C.C.P.); (P.H.); (N.S.); (A.F.C.); (C.O.)
- Research Center for the Assessment of Human Motion, Functionality and Disability (CEMFD), “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Norbert Wellmann
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Cristian Oancea
- Center for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (D.R.V.); (D.T.); (C.C.P.); (P.H.); (N.S.); (A.F.C.); (C.O.)
- Department of Infectious Diseases, Discipline of Pulmonology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
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Fernández-Jiménez A, García-De-La-Fuente AM, Marichalar-Mendia X, Aguirre-Zorzano LA, Estefanía-Fresco R. Treatment of deep single RT2 and RT3 antero-mandibular gingival recessions with a combination of surgical techniques: A case series study. J ESTHET RESTOR DENT 2024; 36:363-372. [PMID: 37594747 DOI: 10.1111/jerd.13120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/18/2023] [Accepted: 07/29/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVE To evaluate root coverage (RC) in deep single antero-mandibular RT2 and RT3 gingival recessions (GR) and to investigate the influence of several factors in RC. MATERIALS AND METHODS Fifteen single antero-mandibular GR with a minimum depth of 3 mm were consecutively treated with a new one-stage technique (laterally positioned flap with a tunnel access and a connective tissue graft). At baseline and at 12-month follow-up, the percentage of mean root coverage (%MRC), the recession reduction (RecRed), complete root coverage (CRC) and the gain of keratinized tissue width (KTW) were assessed. Descriptive, intergroup comparative and correlation analyses were performed. RESULTS At 12 months, a %MRC of 77.29 ± 21.48% with a mean RecRed of 4.10 ± 1.51 mm was achieved. The %MRC was 84.71 ± 21.08% in RT2, and 62.43 ± 14.17% in RT3. The mean gain of KTW was 2.10 ± 0.89 mm, with a mean gain of 2.0 ± 1.03 mm for RT2 and 2.3 ± 0.57 mm for RT3. CRC was observed in six cases, all of them being RT2. A positive association was found between the %MRC and the initial position of the tooth and of both papillae. CONCLUSIONS This technique might be a valuable approach for the treatment of deep single antero-mandibular RT2 and RT3 recessions, even in malpositioned teeth. CLINICAL SIGNIFICANCE A combination of different surgical techniques could provide greater vascularization to the CTG especially in malpositioned teeth in sextant V with a large avascular area to be covered.
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Affiliation(s)
- A Fernández-Jiménez
- Research Group: GIU21/042, Department of Stomatology II, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - A M García-De-La-Fuente
- Research Group: GIU21/042, Department of Stomatology II, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - X Marichalar-Mendia
- Research Group: GIU21/042, Department of Nursing I, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - L A Aguirre-Zorzano
- Research Group: GIU21/042, Department of Stomatology II, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
- Clínica Dr. Aguirre, Bilbao, Spain
| | - R Estefanía-Fresco
- Research Group: GIU21/042, Department of Stomatology II, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Spain
- Clínica Dr. Aguirre, Bilbao, Spain
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Alibrahim FK, AlMohaisen SM, Almajed WS, Alzughaibi MA, Alasiry A, Alghafees M, Sabbah BN. The double-edged sword of mesh use in pelvic organ prolapse surgery: a case report. Ann Med Surg (Lond) 2024; 86:1072-1075. [PMID: 38333272 PMCID: PMC10849424 DOI: 10.1097/ms9.0000000000001531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/12/2023] [Indexed: 02/10/2024] Open
Abstract
Introduction Pelvic organ prolapse (POP) is a prevalent condition among parous women, often warranting surgical intervention. This case accentuates the complications associated with mesh in POP surgeries, iterating the imperative need for an evidence-based approach towards its utilization and exhaustive patient counselling. Case presentation A 60-year-old female, post-mesh-augmented POP repair, embarked on a 13-year journey characterized by persistent pelvic pain and multiple interventions. Despite undergoing several surgeries across different countries, involving mesh and stone removals, her symptoms, notably pelvic pain and dyspareunia, persisted. Clinical examinations revealed mesh erosion into the perivesical tissue, bladder, and associated stones, which were addressed through multiple interventions, albeit with transient success. Discussion The complex journey of this patient exemplifies the intricate challenges mesh poses in POP surgeries. While mesh application offers a minimally invasive approach and has proven successful in numerous cases, it simultaneously opens a Pandora's box of potential severe complications, necessitating thorough patient counselling and post-surgery management. Conclusion The case delineates the challenging path that clinicians and patients tread when navigating through mesh-associated complications post-POP repair. Although mesh has been heralded as a revolutionary approach in POP surgeries, its potential drawbacks necessitate judicious application, ensuring clinicians are well-versed with its associated risks and are adept in managing ensuing complications.
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Affiliation(s)
| | | | | | | | - Abeer Alasiry
- Department of Urology, King Abdullah bin Abdulaziz University Hospital
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Mesa N, Rodriguez LO, Lacey M, Seetharamaiah R. Unveiling the Enigma of a Colonic Neuroendocrine Tumor Causing Ileocolic Intussusception: A Case Report. Cureus 2024; 16:e54823. [PMID: 38529438 PMCID: PMC10962868 DOI: 10.7759/cureus.54823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 02/22/2024] [Indexed: 03/27/2024] Open
Abstract
Intussusception in adults is rare and is often associated with a pathologic lead point. While colonic adenocarcinoma is a common cause, well-differentiated colonic neuroendocrine tumors are exceedingly rare. We present a unique case of an ileocolic intussusception due to a distal ascending colonic neuroendocrine tumor, emphasizing the diagnostic challenges and importance of prompt intervention. A 60-year-old male with a previous screening colonoscopy in June of 2022 presented to the Emergency Department with two days of cramping, right upper abdominal pain with associated nausea and two episodes of emesis. A Computed Tomography (CT) scan of the abdomen and pelvis revealed an ileocolic intussusception noted at the level of the hepatic flexure with a lead point. Emergent surgical intervention identified a mass in the distal ascending colon, and a right hemicolectomy with successful side-to-side functional end-to-end anastomosis was performed. Final pathology confirmed a well-differentiated stage III colonic neuroendocrine tumor. After a successful postoperative recovery, a full body Positron Emission Tomography (PET) scan was completed and resulted in no evidence of avid metastatic disease. The patient was placed in cancer remission. Intussusceptions in the adult population are uncommon, and the etiology typically involves a pathologic lead point causing intestinal invagination. In this case, prompt diagnosis and management resulted in successful health outcomes with reduced mortality and morbidity, as untreated intussusception can have devastating results. Given this patient's colonoscopy was approximately one year ago, the probability of a colonic neoplasm acting as the lead point was low. However, identification of the intussusception resulted in a timely and lifesaving emergent right hemicolectomy, as this stage III tumor has a five-year median survival rate of only 50% if left untreated. This case report highlights a rare case of adult ileocolic intussusception involving a lead point at the distal ascending colon identified as an uncommon, well-differentiated stage III neuroendocrine tumor. It showcases the importance of considering intussusception as a diagnosis when evaluating adults with abdominal pain for prompt and adequate intervention, especially when malignant lead points and bowel necrosis are suspected.
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Affiliation(s)
- Natalie Mesa
- General Surgery, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | - Lizis O Rodriguez
- General Surgery, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | - Mitchel Lacey
- General Surgery, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | - Rupa Seetharamaiah
- Surgery, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
- Department of Surgery, Baptist Hospital of Miami, Miami, USA
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129
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Khan A, Khan G, Khan S, Khan H, Asfandiyar M. Double Cystic Ducts Encountered During Laparoscopic Cholecystectomy in a Male Patient With Cholelithiasis: A Case Report. Cureus 2024; 16:e54814. [PMID: 38529435 PMCID: PMC10962221 DOI: 10.7759/cureus.54814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2024] [Indexed: 03/27/2024] Open
Abstract
One of the most uncommon cystic duct abnormalities is double cystic ducts exiting a single gallbladder. Adequate knowledge of this anomaly should be kept in mind to avoid any surgical complications. We present a case of a 49-year-old Asian Pakistani male patient who had an elective laparoscopic cholecystectomy and was discovered to have two distinct cystic ducts leaving the gallbladder. On examination, there were no other clinically relevant signs except for mild tenderness in the right hypochondrium. Ultrasound of the abdomen and pelvis confirmed the diagnosis of cholelithiasis. Standard four-port laparoscopic cholecystectomy was done via the open Hasson technique under general anesthesia. After meticulous dissection of the Calot's triangle, double cystic ducts were discovered draining a single gallbladder. The gallbladder was retrieved after clipping and cutting the cystic ducts and cystic artery. To minimize the risk of complications, surgeons must be aware of the numerous anatomical variations that may exist.
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Affiliation(s)
- Aurangzeb Khan
- Department of General Surgery, Mardan Medical Complex, Mardan, PAK
| | - Ghazanfar Khan
- Department of General Surgery, Mardan Medical Complex, Mardan, PAK
| | - Shakeel Khan
- Department of General Surgery, Mardan Medical Complex, Mardan, PAK
| | - Hamza Khan
- Department of Radiology, Mardan Medical Complex, Mardan, PAK
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Fattahzadeh Ardalani G, Samady Khanghah A, Jahanpanah M, Mokhtari D, Samady Khanghah P. Successfully treated anti-GAD limbic encephalitis in a 15-year-old diabetic boy with intravenous immunoglobulin: case report. Ann Med Surg (Lond) 2024; 86:1173-1181. [PMID: 38333287 PMCID: PMC10849452 DOI: 10.1097/ms9.0000000000001653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/13/2023] [Indexed: 02/10/2024] Open
Abstract
Introduction and importance Limbic encephalitides (LE) have symptoms and signs of new-onset seizures accompanied by cognitive impairment and signal changes in the MRI of the limbic system in the brain. Numerous antibodies against the neurons and synapses have been detected so far. Of those, antiglutamic acid decarboxylase antibody (Anti-GAD Ab) impairs the gamma amino butyric acid, one of the primary mediators that naturally prevents abnormal neuronal activity causing seizure. Case presentation The authors have reported a case of anti-GAD Ab LE in a diabetic male adolescent who responded dramatically to intravenous immunoglobulin and reviewed all similar pediatric cases for 15 years now. Clinical discussion The symptoms in children suffering from anti-GAD LE in three categories, systemic, psychiatric, and neurological, are heterogeneous. The most common manifestations were seizures followed by altered mental status and behavioral changes, respectively. The two main clinical scenarios described in GAD65-mediated autoimmune epilepsy are (1) an acute/subacute onset of seizures alone or seizures (including new-onset refractory status epilepticus, NORSE) accompanied by some degrees of cognitive and psychiatric manifestations, including amnesia and mesiotemporal inflammatory involvement consistent with LE and (2) epilepsy without clinical or MRI evidence of active central nervous system inflammation. Conclusion Although rare, the neurologist should consider the potential role of anti-GAD ab-associated encephalitis in the presence of diabetes mellitus.
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Affiliation(s)
| | | | - Mohammad Jahanpanah
- Department of Genetics and Pathology
- Department of Neurology, School of Medicine, Ardabil University of Medical Sciences
| | - Diana Mokhtari
- Department of Genetics and Pathology
- Department of Neurology, School of Medicine, Ardabil University of Medical Sciences
| | - Parisa Samady Khanghah
- Department of Cellular and Molecular Biology, University of Mohaghegh Ardabili, Ardabil, Iran
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131
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Li F, Xie M. Abdominal cocoon syndrome (ACS): a case report of a Chinese male diagnosed idiopathic ACS with inborn short intestine. Ann Med Surg (Lond) 2024; 86:1152-1155. [PMID: 38333290 PMCID: PMC10849369 DOI: 10.1097/ms9.0000000000001639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/10/2023] [Indexed: 02/10/2024] Open
Abstract
Introduction and importance Abdominal cocoon syndrome (ACS), as a rare cause of mechanical intestinal obstruction, can be divided into primary/idiopathic vs. secondary type. The primary ACS is often asymptomatic and only diagnosed in exploratory laparotomy. The major treatment of surgery can be challenging. Since the gut wall and peritoneum are densely adhered, gut perforation might occur during adhesiolysis. Thus, it is important to have an experienced surgeon to perform the surgery. Case presentation The authors present a primary ACS case of a 50-year-old man. The patient demonstrated an unbearable upper abdominal pain upon admission. A computed tomography (CT) scan showed a severe bowel obstruction. An exploratory laparotomy was indicated, leading to the diagnosis of ACS, which was considered idiopathic after ruling out secondary factors. An adhesiolysis was performed successfully. Note that the entire intestine measured was only 2.1 m during the surgery. There was no post-surgical complication. The patient was recovered uneventfully. Clinical discussion The aetiology of primary ACS is unknown. The incidence is comparatively low and considered equal between men and women. As a rare cause of gut obstruction, the suspicion of the diagnosis should be strengthened. Surgery including adhesiolysis and bowel resection remains the major treatment. If adhesiolysis fails, bowel resection will be inevitable. The knowledge and experience of surgeon will be tested. Conclusion The aetiology of primary ACS should be further explored. And the differential diagnosis of bowel obstruction should cover ACS in order for the surgeon to be prepared before surgery.
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Affiliation(s)
- Fei Li
- Departments of Gastrointestinal Surgery
- Hepatobiliary and Pancreatic Surgery, PUREN Hospital Affiliated to WUHAN University of Science and Technology, Wuhan, China
| | - Miao Xie
- Departments of Gastrointestinal Surgery
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Grassi D, De Monti M, Espeli V, De Pellegrin L. Use of a Dermal Regeneration Template in a two-stage reconstruction after extensive skin surgery for Bowen's disease of the anterior neck - Case report. Int J Surg Case Rep 2024; 115:109208. [PMID: 38199019 PMCID: PMC10824778 DOI: 10.1016/j.ijscr.2023.109208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Dermal Regeneration Templates may be used in the reconstruction of large skin defects after cutaneous malignancy excisions. Bowen's disease (BD; squamous cell carcinoma in situ) is a common and persistent condition that can be related to chronic sun damage, and consequently, is usually located on the head and neck area or on the lower limbs. Literature does not provide clear guidelines on the treatment of BD, limiting itself to describing a wide range of different methods that can be used, including surgery, laser therapy or topical options. However, large lesions tend to scar in the post-operative setting and hence are difficult to treat surgically. PRESENTATION OF CASE In this paper the authors present a case of a male in his 60s, ASA III score, who presented with a history of histopathologically-confirmed squamocellular carcinoma in the neck and supraclavicular region. Due to recurrent carcinomas the patient was treated with an extensive skin excision and a successful reconstruction using a Dermal Regeneration Template. The work has been reported in line with the SCARE criteria. DISCUSSION The main surgical problem caused by BD is reaching complete oncological resection and, consequently, the need for extensive skin excisions. CONCLUSION The use of the skin substitute resulted in a satisfactory functional and aesthetic result, with total clearance and no recurrence observed after 16 months.
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Affiliation(s)
- Davide Grassi
- EOC - Mendrisio Beata Vergine Regional Hospital - Department of General Surgery, Switzerland
| | - Marco De Monti
- EOC - Mendrisio Beata Vergine Regional Hospital - Department of General Surgery, Switzerland.
| | - Vittoria Espeli
- EOC - Mendrisio Beata Vergine Regional Hospital - Oncology Institute of Southern Switzerland, Switzerland
| | - Laura De Pellegrin
- EOC - Mendrisio Beata Vergine Regional Hospital - Department of General Surgery, Switzerland
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Jubran JH, Scherschinski L, Dholaria N, Shaftel KA, Farhadi DS, Oladokun FC, Hendricks BK, Smith KA. Magnetic Resonance-Guided Laser Interstitial Thermal Therapy for Recurrent Glioblastoma and Radiation Necrosis: A Single-Surgeon Case Series. World Neurosurg 2024; 182:e453-e462. [PMID: 38036173 DOI: 10.1016/j.wneu.2023.11.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 11/24/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE To evaluate long-term clinical outcomes among patients treated with laser interstitial thermal therapy (LITT) for predicted recurrent glioblastoma (rGBM). METHODS Patients with rGBM treated by LITT by a single surgeon (2013-2020) were evaluated for progression-free survival (PFS), overall survival (OS), and OS after LITT. RESULTS Forty-nine patients (33 men, 16 women; mean [SD] age at diagnosis, 58.7 [12.5] years) were evaluated. Among patients with genetic data, 6 of 34 (18%) had IDH-1 R132 mutations, and 7 of 21 (33%) had MGMT methylation. Patients underwent LITT at a mean (SD) of 23.8 (23.8) months after original diagnosis. Twenty of 49 (40%) had previously undergone stereotactic radiosurgery, 37 (75%) had undergone intensity-modulated radiation therapy, and 49 (100%) had undergone chemotherapy. Patients had undergone a mean of 1.2 (0.7) previous resections before LITT. Mean preoperative enhancing and T2 FLAIR volumes were 13.1 (12.8) cm3 and 35.0 (32.8) cm3, respectively. Intraoperative biopsies confirmed rGBM in 31 patients (63%) and radiation necrosis in 18 patients (37%). Six perioperative complications occurred: 3 (6%) cases of worsening aphasia, 1 (2%) seizure, 1 (2%) epidural hematoma, and 1 (2%) intraparenchymal hemorrhage. For the rGBM group, median PFS was 2.0 (IQR, 4.0) months, median OS was 20.0 (IQR, 29.5) months, and median OS after LITT was 6.0 (IQR, 10.5) months. For the radiation necrosis group, median PFS was 4.0 (IQR, 4.5) months, median OS was 37.0 (IQR, 58.0) months, and median OS after LITT was 8.0 (IQR, 23.5) months. CONCLUSIONS In a diverse rGBM cohort, LITT was associated with a short duration of posttreatment PFS.
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Affiliation(s)
- Jubran H Jubran
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Lea Scherschinski
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Nikhil Dholaria
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Kelly A Shaftel
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Dara S Farhadi
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Femi C Oladokun
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Benjamin K Hendricks
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Kris A Smith
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
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Irfan B, Yaqoob A. Innovating Online Otolaryngology: The Development of the ENT Content Engagement and Quality Index for Audiovisual Material. Cureus 2024; 16:e55195. [PMID: 38558591 PMCID: PMC10980907 DOI: 10.7759/cureus.55195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction The advent of social media platforms, notably TikTok, has significantly transformed the landscape of health information dissemination, offering both opportunities and challenges for public health communication. This study focuses on TikTok's influence on sinus health information, addressing the dual challenge of widespread engagement and the risk of misinformation in otolaryngology, or ENT (ear-nose-throat), information online. We introduce the ENT Content Engagement and Quality Index (ENT-CEQI), a pioneering tool designed to assess the quality and engagement of ENT-related content on TikTok, aiming to improve public understanding of sinus health. Materials and methods Our methodology involved a systematic analysis of sinus health-related content on TikTok. We collected data on the top 100 most popular videos using the hashtag #sinus at two different points in time, analyzing engagement metrics and content quality. The ENT-CEQI was developed to evaluate content, incorporating both quantitative engagement metrics (views, likes, comments, shares, favorites) and qualitative assessments (accuracy, clarity, relevance, practicality, engagement). The study employed statistical analyses, including trend analysis, correlation analysis, principal component analysis (PCA), KMeans clustering, regression analysis, and the Kruskal-Wallis test, to understand the dynamics of content engagement and quality. Results Initial findings revealed significant disparities in engagement metrics and quality scores among different content creator categories, with physician-generated content showing the highest engagement and quality. The trend analysis indicated shifts in content popularity and quality over time, with a notable increase in views and likes for private company content. The PCA and clustering analyses identified distinct content clusters, offering insights into viewer engagement patterns. Regression analysis and the Kruskal-Wallis test, however, did not find significant predictors (p-value: 0.3916) of content quality or differences in likes across content types, suggesting complex factors influencing content engagement and quality perception. Discussion The study highlights TikTok's potential and pitfalls in disseminating sinus health information. The introduction of the ENT-CEQI represents a major step toward enhancing the evaluation of health content on social media, emphasizing the importance of accuracy, clarity, and relevance in public health communication. The analysis underscores the complexity of social media engagement and the need for robust tools to assess content quality. It also points to the critical role of healthcare professionals in engaging with the public through social media to combat misinformation. Conclusions TikTok serves as a potent platform for sinus health education, capable of reaching wide and diverse audiences. The ENT-CEQI emerges as a vital tool for assessing the quality and engagement of ENT-related content, guiding content creators toward producing more reliable and informative content. This study contributes to the understanding of social media's role in health communication, advocating for the strategic use of innovative tools such as the ENT-CEQI to enhance public health outcomes through improved online health education and misinformation management.
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Affiliation(s)
- Bilal Irfan
- Microbiology and Immunology, University of Michigan, Ann Arbor, USA
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135
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Serrudo VR, Saurral R, Pool R, Kruler A, Sanchez N, Carrio LM. Advanced wound healing in a patient with transmetatarsal amputation caused by severe diabetic foot infection: A case report. Int J Surg Case Rep 2024; 115:109180. [PMID: 38219509 PMCID: PMC10826814 DOI: 10.1016/j.ijscr.2023.109180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction and importance: Diabetic foot accounts for 50% to 95 % of non-traumatic amputations. The healing process of a surgical wound resulting from amputation in the diabetic foot is complex, and it is difficult to achieve an optimal outcome, which should include obtaining a functional stump for the patient. Healing is mainly hindered by infection, vascular disease, and wound size. In turn, biofilm formation significantly delays the healing process, increasing morbidity and impairing the amputee's quality of life. Case presentation: This study analyzes the case of an 80-year-old male patient with diabetes who had failed to respond to previous treatment on an infected wound from a transmetatarsal amputation. The new treatment involved spraying the wound with silver sulfadiazine, lidocaine, and vitamin A aerosol and covering it with gauze dressings soaked in silver sulfadiazine, lidocaine, and vitamin A. The case evolution indicators used were total wound area, percentage of granulation tissue, wound perimeter, and maximum distance between the wound edges. A 3D simulation was also used to assess the wound bed. Clinical Discussion: Biofilm is linked to slower wound healing and wound chronicity, as this community of microorganisms in the wound slows down healing even when there are no apparent signs of infection. Therefore, treatment should be geared toward preventing contamination from leading to biofilm formation. Conclusion: Our results show that silver sulfadiazine, lidocaine, vitamin A gauze dressings, and aerosol have promoted fast and effective healing in a diabetic patient with a wound at high risk of greater amputation.
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Affiliation(s)
- V R Serrudo
- Hospital Municipal de Trauma y Emergencias Dr Federico Abete, Centro Municipal de Diabetes Dr. Alberto Maggio, Hospital de Día de Pie Diabético "Polo Sanitario", República Argentina
| | - R Saurral
- Hospital Municipal de Trauma y Emergencias Dr Federico Abete, Centro Municipal de Diabetes Dr. Alberto Maggio, Hospital de Día de Pie Diabético "Polo Sanitario", República Argentina
| | - R Pool
- Hospital Municipal de Trauma y Emergencias Dr Federico Abete, Centro Municipal de Diabetes Dr. Alberto Maggio, Hospital de Día de Pie Diabético "Polo Sanitario", República Argentina
| | - A Kruler
- Hospital Municipal de Trauma y Emergencias Dr Federico Abete, Centro Municipal de Diabetes Dr. Alberto Maggio, Hospital de Día de Pie Diabético "Polo Sanitario", República Argentina
| | - N Sanchez
- Hospital Municipal de Trauma y Emergencias Dr Federico Abete, Centro Municipal de Diabetes Dr. Alberto Maggio, Hospital de Día de Pie Diabético "Polo Sanitario", República Argentina
| | - L M Carrio
- Hospital Municipal de Trauma y Emergencias Dr Federico Abete, Centro Municipal de Diabetes Dr. Alberto Maggio, Hospital de Día de Pie Diabético "Polo Sanitario", República Argentina.
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Patel A, Wilson CA, Davidson J, Lam JY, Seemann NM. A Social Media Blueprint - Understanding What Makes the Optimal Social Media Account for Paediatric Surgical Families. J Pediatr Surg 2024:S0022-3468(24)00063-0. [PMID: 38368196 DOI: 10.1016/j.jpedsurg.2024.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 01/18/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Social media is one of the most common sources of information for parents seeking information on their child's health. The purpose of this study was to better understand the social media habits of parents of paediatric surgery patients through surveys and focus groups. METHODS An online survey was distributed to parents visiting paediatric surgery clinics at a tertiary care hospital. Surveys were distributed via QR code and social media. Two virtual focus groups were conducted with parents of paediatric patients. Descriptive statistics were used for survey analysis and focus group transcripts were thematically analyzed. RESULTS A total of 107 respondents completed the online survey. Median age of respondents was 36 (interquartile range: 32-41). 81.3% of the respondents were female. Facebook was the preferred social media platform (47.2%), followed by Instagram (41.5%) then other platforms (4.7%). Respondents indicated that their preferred length of video was 30 s (41.2%). When asked which type of video content they prefer, participants indicated animated video as most popular (66.0%) followed by a physician speaking (60.0%), and slides with voiceover (45.0%). The focus groups revealed themes of: (1) functionality and content; (2) branding, aesthetic and legitimacy; (3) unmasking of physicians; (4) peer and community support. CONCLUSION Creating a successful social media account for parents must take into consideration their social media habits. A Facebook account that features brief videos may be most likely to engage parents. Additionally, physicians need to establish credibility and legitimacy of their content to attract their target audience. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Ashaka Patel
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Claire A Wilson
- Division of Paediatric Surgery, London Health Sciences Centre, London, ON, Canada
| | - Jacob Davidson
- Division of Paediatric Surgery, London Health Sciences Centre, London, ON, Canada
| | - Jennifer Y Lam
- Division of Paediatric Surgery, London Health Sciences Centre, London, ON, Canada; Department of Surgery, Western University, London, ON, Canada
| | - Natashia M Seemann
- Division of Paediatric Surgery, London Health Sciences Centre, London, ON, Canada; Department of Surgery, Western University, London, ON, Canada.
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Tseng HS, Lin CF, Yang HC, Chen CJ, Lin SC, Wu HM, Hu YS, Lin CJ, Chung WY, Shiau CY, Guo WY, Hung-Chi Pan D, Lee CC. Natural History and Histopathology of Expanding Cysts and Hematomas After Stereotactic Radiosurgery for Arteriovenous Malformations of the Brain: A Case Series. World Neurosurg 2024; 182:e854-e865. [PMID: 38104931 DOI: 10.1016/j.wneu.2023.12.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/10/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND We reviewed the clinical course and histopathologic findings for cases involving the formation of expanding cysts and/or hematomas after gamma knife surgery (GKS) for arteriovenous malformations (AVMs). METHODS We report a single-center retrospective review of 18 patients who presented with cyst and/or hematoma expansion after GKS for AVMs between 1993 and 2023. Expanding cysts and hematomas were defined as well-demarcated cavities filled with fluid or well-marginated heterogenous hematomas presenting with expansion proximal to or in the location of the original AVM, respectively. Patient demographics, AVM characteristics, history of interventions and surgeries, and imaging and histopathologic features of expanding cysts and hematomas were collected for analysis. RESULTS Among 1072 AVM patients treated using GKS, 18 presented with expanding cysts or hematomas during a total follow-up period of 16,757 patient-years (0.11 case/100 persons/patient-year). The time to cyst or hematoma identification was 4-13 years after initial GKS, with a mean duration of 8.6 years. Among the patients examined, 7 (38.9%) presented mainly with hematoma, 10 (55.6%) presented mainly with cysts, and 1 presented with approximately equal components of both. Among the 18 patients, 13 (72.2%) underwent craniotomy to treat cyst or hematoma expansion. All the specimens had similar histopathologic characteristics, including organizing hematoma with fresh and old hemorrhage, fibrinoid necrosis of the vessels, gliosis of normal brain tissue, infiltration of hemosiderin-laden histiocytes, and extravascular protein leakage. CONCLUSIONS Our findings suggest that the formation of these 2 complications can be attributed to a common mechanism involving radiation-induced vascular damage in brain tissue adjacent to the AVM and subsequent chronic inflammation and capillary dilatation.
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Affiliation(s)
- Han-Song Tseng
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chun-Fu Lin
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Huai-Che Yang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ching-Jen Chen
- Department of Neurosurgery, The University of Texas Health Science Center, Houston, Texas, USA
| | - Shih-Chieh Lin
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsiu-Mei Wu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yong-Sin Hu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chung-Jung Lin
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Yuh Chung
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Cheng-Ying Shiau
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wan-Yuo Guo
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - David Hung-Chi Pan
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Cheng-Chia Lee
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Sghaier A, Jelassi MA, Fradi K, Mraidha MH, Hamila F, Youssef S. Median arcuate ligament syndrome (Dunbar syndrome): A diagnosis not to be underestimated. Radiol Case Rep 2024; 19:636-641. [PMID: 38111544 PMCID: PMC10726322 DOI: 10.1016/j.radcr.2023.10.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 12/20/2023] Open
Abstract
Medial arcuate ligament syndrome (MALS) is an anatomoclinical entity underestimated in most situations due to the lack of specific signs. However, the consequences can be disastrous if the diagnosis is not seriously considered and investigations are not fully undertaken to confirm this hypothesis. We report a case of Median Arcuate Ligament Syndrome in a young woman who presented to the Emergency Department with moderate postprandial pain. All investigations were carried out promptly, with no abnormalities, and the diagnosis was retained on the evidence of a well-performed and appropriately interpreted abdominal CT. This case illustrates a rare cause of epigastralgia simulating a surgical emergency. This condition should be considered when biological and often radiological investigations are inconclusive. The relative youth of the patient is often suggestive, but confirmation is based on a CT scan with injection of a well-technical contrast product, or angiography. Treatment is debatable between a conservative approach and surgery. Surgical approach is discussed depending on the degree of vascular stenosis and the impact on the digestive tract. However, the recurrence of symptoms may be a contributory factor in the therapeutic decision. The impact could be lethal depending on the degree of stenosis and consequently on the repercussions on the digestive tract. A multidisciplinary approach is required for its management.
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Affiliation(s)
- Asma Sghaier
- Hospital Farhat Hached of Sousse, Rue Ibn El Jazzar, 4002 Sousse, Tunisia
- Department of Surgery at Hospital of Farhat Hached of Sousse, Rue Ibn El Jazzar, 4002 Sousse, Tunisia
- Faculty of Medicine of Sousse, Rue Mohamed Karoui, 4002 Sousse, Tunisia
| | - Mohamed Amine Jelassi
- Hospital Farhat Hached of Sousse, Rue Ibn El Jazzar, 4002 Sousse, Tunisia
- Faculty of Medicine of Sousse, Rue Mohamed Karoui, 4002 Sousse, Tunisia
| | - Khalil Fradi
- Hospital Farhat Hached of Sousse, Rue Ibn El Jazzar, 4002 Sousse, Tunisia
- Department of Surgery at Hospital of Farhat Hached of Sousse, Rue Ibn El Jazzar, 4002 Sousse, Tunisia
- Faculty of Medicine of Sousse, Rue Mohamed Karoui, 4002 Sousse, Tunisia
| | - Mohamed Hédi Mraidha
- Hospital Farhat Hached of Sousse, Rue Ibn El Jazzar, 4002 Sousse, Tunisia
- Department of Surgery at Hospital of Farhat Hached of Sousse, Rue Ibn El Jazzar, 4002 Sousse, Tunisia
- Faculty of Medicine of Sousse, Rue Mohamed Karoui, 4002 Sousse, Tunisia
| | - Fehmi Hamila
- Hospital Farhat Hached of Sousse, Rue Ibn El Jazzar, 4002 Sousse, Tunisia
- Department of Surgery at Hospital of Farhat Hached of Sousse, Rue Ibn El Jazzar, 4002 Sousse, Tunisia
- Faculty of Medicine of Sousse, Rue Mohamed Karoui, 4002 Sousse, Tunisia
| | - Sabri Youssef
- Hospital Farhat Hached of Sousse, Rue Ibn El Jazzar, 4002 Sousse, Tunisia
- Department of Surgery at Hospital of Farhat Hached of Sousse, Rue Ibn El Jazzar, 4002 Sousse, Tunisia
- Faculty of Medicine of Sousse, Rue Mohamed Karoui, 4002 Sousse, Tunisia
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Mashlah Q, Al Laham O, Odah Bashi H, Sharaf Aldeen R, Alashi S, Abdulkader M. Thoracoabdominal duplication accompanied by intestinal malrotation: a case report and literature review of a rare congenital anomaly in an infant. Ann Med Surg (Lond) 2024; 86:1166-1172. [PMID: 38333278 PMCID: PMC10849408 DOI: 10.1097/ms9.0000000000001654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/13/2023] [Indexed: 02/10/2024] Open
Abstract
Introduction and importance Thoracoabdominal duplication and intestinal malrotation are extremely rare congenital alimentary tract anomalies that can manifest in any segment of the gastrointestinal tract. Still, tubular duplications are an even rarer subset of alimentary tract duplications. Misdiagnosis could occur and this will yield devastating ramifications. Therefore, consideration in the clinical settings is warranted to aid in conducting timely therapeutic interventions. Case presentation In this article, we illustrate the overwhelmingly rare occurrence of thoracoabdominal duplication coexistent with intestinal malrotation in a 7-month-old male whose primary complaint was chronic dyspnoea since birth that progressed to involve cough and fever. Imaging analysis revealed a significant intrathoracic fluid-filled cyst. Clinical discussion The intestinal malrotation was treated through Ladd's procedure, and surgical excision of the duplicated segments was accomplished. The subsequent analysis of the resected specimens via means of histopathology utilizing Hematoxylin and Eosin dyes established the definitive diagnosis of a foregut duplication cyst. Conclusion Thoracoabdominal duplication is one of the most crucial topics in the field of Paediatric Surgery. It is exceptionally rare in occurrence, and the scarcity of available resources that document and describe this topic is evident in the published literature. The authors must opt to document, study, and broaden awareness regarding this life-threatening pathology so that they can circumvent the resultant complications by means of early detection and the performance of apt surgical interventions. Upon careful review of the available literature, we can state that ours is the first-ever case documented from their country regarding this topic and this co-incidence.
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Affiliation(s)
- Qusai Mashlah
- Faculty of Medicine
- Department of Pediatric Surgery, Children’s University Hospital
| | | | - Hajar Odah Bashi
- Faculty of Medicine
- Department of Pediatric Surgery, Children’s University Hospital
| | - Rahaf Sharaf Aldeen
- Faculty of Medicine
- Department of Surgery, Al-Mouwasat University Hospital
- Department of Surgery, Al Assad University Hospital, Damascus University, Damascus, (The) Syrian Arab Republic
| | | | - Mohammd Abdulkader
- Faculty of Medicine
- Department of Pediatric Surgery, Children’s University Hospital
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AlTarayra M, Abuzaina KNM, Hassouneh AWM, Aljabarein OYA. Spondylodiscitis following perforated acute appendicitis in a 14-year-old female: A case report. Int J Surg Case Rep 2024; 115:109184. [PMID: 38211554 PMCID: PMC10788785 DOI: 10.1016/j.ijscr.2023.109184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/13/2023] [Accepted: 12/16/2023] [Indexed: 01/13/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Acute appendicitis is a common surgical emergency, often resulting in perforation and increased morbidity. Up to 55 % of children with complicated appendicitis may experience a complication such as infection, bowel obstruction, or unplanned hospital re-admission (Blakely et al., 2011 [23]). However, the development of infectious spondylodiscitis following appendectomy is an extremely rare complication, particularly in pediatric patients. We present the first reported case of lumbar spondylodiscitis occurring post-perforated appendicitis in a 14-year-old female, highlighting the importance of recognizing and managing uncommon complications. CASE PRESENTATION A previously healthy 14-year-old female underwent urgent appendectomy for perforated appendicitis. Postoperatively, she developed severe back pain and immobility. Imaging revealed early lumbar discitis, and Pseudomonas aeruginosa was isolated from the surgical site. The patient received multiple antibiotic regimens, including vancomycin, ceftazidime, and meropenem, resulting in clinical improvement. CLINICAL DISCUSSION Infectious spondylodiscitis is typically hematogenously spread or due to direct inoculation. In this case, the spread from a contiguous focus of infection without vascular insufficiency is suspected. The coexistence of appendicitis and spondylodiscitis poses diagnostic challenges, requiring a multidisciplinary approach for accurate diagnosis and appropriate treatment. CONCLUSION This unique case highlights the need for vigilance in recognizing rare complications of appendicitis, such as infectious spondylodiscitis. Early diagnosis and tailored antibiotic therapy are crucial for optimal outcomes. Further research is needed to explore the underlying mechanisms and risk factors associated with this rare complication.
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Robertson J, Muszta A, Lindgren M, af Geijerstam A, Nyberg J, Lissner L, Börjesson M, Gisslén M, Rosengren A, Adiels M, Åberg M. Body mass index and fitness in late adolescence and risk of cardiovascular disease, respiratory disease, and overall death after COVID-19. Obes Sci Pract 2024; 10:e709. [PMID: 38263996 PMCID: PMC10804340 DOI: 10.1002/osp4.709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/24/2023] [Accepted: 08/26/2023] [Indexed: 01/25/2024] Open
Abstract
Objective Since obesity and poor fitness appear to be unfavorable for both cardiovascular health and coping with viral infections such as COVID-19, they are of specific interest in light of the increased risk of cardiovascular and respiratory events now seen after infection with SARS-CoV-2. Therefore, the aim of the present study was to investigate how body mass index (BMI) and cardiorespiratory fitness (CRF) in late adolescence are associated with the risk of cardiovascular disease (CVD), respiratory disease, and mortality after COVID-19. Methods In this study, 1.5 million 18-year-old Swedish men with BMI and CRF measured during enlistment for military service 1968-2005 were included. Hospitalized and non-hospitalized COVID-19 cases were identified through the Patient Register or positive polymerase chain reaction tests, and age-matched with non-infected controls. CVD, respiratory disease, and mortality after COVID-19 were divided into <60days, 60-180days, >180days post-infection. Cox regression models were used. Results Hospitalized COVID-19 cases (n = 9839), compared to controls, had >10-fold, 50 to 70-fold, and >70-fold hazards of CVD, respiratory disease, and mortality over the initial 60 days post-infection with little variation across BMI or CRF categories. The elevated risks persisted at declining levels >180 days. For non-hospitalized COVID-19 cases (n = 181,822), there was a 4- to 7-fold increased acute mortality risk, and high CRF was associated with lower risk of post-infectious respiratory disease. Conclusions The high hazards of adverse outcomes during the first two months after COVID-19 hospitalization, and across BMI and CRF categories, declined rapidly but were still elevated after six months. Adolescent CRF was associated with respiratory disease after COVID-19 without hospitalization, which gives further support to the health benefits of physical activity.
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Affiliation(s)
- Josefina Robertson
- Department of Infectious DiseasesInstitute of BiomedicineSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- School of Public Health and Community MedicineInstitute of MedicineSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Department of Infectious DiseasesSahlgrenska University HospitalRegion Västra GötalandGothenburgSweden
| | - Anders Muszta
- School of Public Health and Community MedicineInstitute of MedicineSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Martin Lindgren
- Department of Molecular and Clinical MedicineInstitute of MedicineSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Department of MedicineGeriatrics and Emergency MedicineSahlgrenska University HospitalÖstra HospitalRegion Västra GötalandGothenburgSweden
| | - Agnes af Geijerstam
- School of Public Health and Community MedicineInstitute of MedicineSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Jenny Nyberg
- Section for Clinical NeuroscienceInstitute of Neuroscience and PhysiologySahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Lauren Lissner
- School of Public Health and Community MedicineInstitute of MedicineSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Mats Börjesson
- Department of MedicineGeriatrics and Emergency MedicineSahlgrenska University HospitalÖstra HospitalRegion Västra GötalandGothenburgSweden
- Center for Health and PerformanceInstitute of MedicineSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Magnus Gisslén
- Department of Infectious DiseasesInstitute of BiomedicineSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Department of Infectious DiseasesSahlgrenska University HospitalRegion Västra GötalandGothenburgSweden
| | - Annika Rosengren
- Department of Molecular and Clinical MedicineInstitute of MedicineSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Department of MedicineGeriatrics and Emergency MedicineSahlgrenska University HospitalÖstra HospitalRegion Västra GötalandGothenburgSweden
| | - Martin Adiels
- School of Public Health and Community MedicineInstitute of MedicineSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Department of Molecular and Clinical MedicineInstitute of MedicineSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Maria Åberg
- School of Public Health and Community MedicineInstitute of MedicineSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Region Västra GötalandGothenburgSweden
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Strahm R, Pratsinis A, Jochum AK, De Lorenzi D. Idiopathic Pneumatosis cystoides intestinalis of the small bowel with pneumoperitoneum and consecutive small bowel mesenteric torsion. A case report. Int J Surg Case Rep 2024; 115:109220. [PMID: 38194864 PMCID: PMC10819719 DOI: 10.1016/j.ijscr.2024.109220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 12/30/2023] [Indexed: 01/11/2024] Open
Abstract
INTRODUCTION Pneumatosis cystoides intestinalis (PCI) is a condition characterized by the presence of gas-filled cyst-like structures in the submucosa and subserosa of the small or large intestine and in some cases accompanied by pneumoperitoneum. PCI is commonly considered a benign condition as opposed to pneumatosis intestinalis in life-threatening conditions such as mesenteric ischemia. Only a minority of cases of PCI are assumed to be primary or idiopathic with the majority being caused by a variety of underlying conditions. Symptoms of PCI are non-specific or may be absent altogether. Provided that there is no suspicion of an underlying life-threatening disease, PCI can be treated non-operatively. CASE PRESENTATION We present the case of a 71-year-old patient with pneumatosis intestinalis with free intraperitoneal gas known for three years. Due to self-limiting symptoms and lack of evidence of a life-threatening underlying disease, no specific therapy had been carried out so far. No underlying diseases could be found. Because of recurrent worsening abdominal pain and newly diagnosed partial small bowel obstruction with radiological signs of mesenteric torsion, resection of the affected small bowel was successfully performed. DISCUSSION Non-surgical management of PCI is possible provided that life-threatening causes of pneumatosis have been ruled out. Bowel obstruction is a rare complication of PCI which requires surgical treatment. CONCLUSION Our case report illustrates that symptoms of PCI may worsen over time, and that complications requiring surgical intervention may occur. We recommend regular monitoring of patients who are primarily treated non-operatively.
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Affiliation(s)
- Raphael Strahm
- Department of General and Visceral Surgery, Cantonal Hospital Grabs, Grabs, Switzerland.
| | - Antonia Pratsinis
- Department of General and Visceral Surgery, Cantonal Hospital Grabs, Grabs, Switzerland
| | - Ann-Kristin Jochum
- Institute for Pathology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Diego De Lorenzi
- Department of General and Visceral Surgery, Cantonal Hospital Grabs, Grabs, Switzerland
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Kang JK, Lee EH, Lee JN, Kim TH, Kwon TG, Chung JW. Pathologic fractures of the humerus during adjuvant pembrolizumab in patients with renal cell carcinoma after radical nephrectomy: A case report. Int J Surg Case Rep 2024; 115:109290. [PMID: 38245944 PMCID: PMC10831885 DOI: 10.1016/j.ijscr.2024.109290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 01/23/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Immune checkpoint inhibitors (ICIs) have noticeably enhanced oncologic outcomes associated with patient survival in different subtypes of metastatic cancer by enhancing cytotoxic T-cell activity. ICI-associated toxicities are often referred to as immune-related adverse events (irAEs) and occur in nearly every organ system. However, the effect of ICIs on the skeleton is poorly examined, and only a few case series have been published. CASE PRESENTATION A 37-year-old man who presented with pathologic fractures of the right proximal humerus during adjuvant pembrolizumab therapy following laparoscopic radical nephrectomy for right renal cell carcinoma. CLINICAL DISCUSSION ICIs are associated with various irAEs virtually affecting all host tissues, most of which have been described well by pharmacovigilance analyses. However, to date, very few studies have examined the effects of ICI on the skeleton. CONCLUSION Urologic oncologists and urologists should be aware of the rare but potentially fatal bone side effects of ICIs.
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Affiliation(s)
- Jun-Koo Kang
- Department of Urology, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Eun Hye Lee
- Biomedical Research Institute, Kyungpook National University, Daegu, Republic of Korea
| | - Jun Nyung Lee
- Department of Urology, Kyungpook National University Hospital, Daegu, Republic of Korea; Biomedical Research Institute, Kyungpook National University, Daegu, Republic of Korea; Department of Urology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea; Joint Institute for Regenerative Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Tae-Hwan Kim
- Department of Urology, Kyungpook National University Hospital, Daegu, Republic of Korea; Biomedical Research Institute, Kyungpook National University, Daegu, Republic of Korea; Department of Urology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea; Joint Institute for Regenerative Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Tae Gyun Kwon
- Department of Urology, Kyungpook National University Hospital, Daegu, Republic of Korea; Biomedical Research Institute, Kyungpook National University, Daegu, Republic of Korea; Department of Urology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea; Joint Institute for Regenerative Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jae-Wook Chung
- Department of Urology, Kyungpook National University Hospital, Daegu, Republic of Korea; Biomedical Research Institute, Kyungpook National University, Daegu, Republic of Korea; Department of Urology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea; Joint Institute for Regenerative Medicine, Kyungpook National University, Daegu, Republic of Korea.
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Fauvet N, Dobelle E, Le Baron M, Jacquet C, Argenson JN, Lami D. Massive traumatic articular bone loss of the capitulum humeri treated by costal osteochondral autograft reconstruction: A case report. Int J Surg Case Rep 2024; 115:109190. [PMID: 38219510 PMCID: PMC10826819 DOI: 10.1016/j.ijscr.2023.109190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/18/2023] [Accepted: 12/01/2023] [Indexed: 01/16/2024] Open
Abstract
INTRODUCTION Articular traumatic bone loss is a severe condition with heterogeneous outcomes, often necessitating complex technical solutions and posing challenges in managing both bone and cartilage loss. Thus, some surgeons have used a technique of osteochondral autograft using a rib to fix an articular bone loss to manage both of these tissue losses. PRESENTATION OF CASE We present the case of a 25-years-old patient, who had a complex open elbow injury. He presented an association of a terrible triad of the elbow injury with an open traumatic bone loss of the capitulum humeri and unfixable lesion of the lateral collateral ligament complex of the elbow. We initially managed these lesions with an external fixator for 2 months followed by a reconstruction of the capitulum humeri using a costal osteochondral autograft. Unfortunately, the patient was lost to follow-up after the 1 month post-operative consultation but he had some encouraging results. DISCUSSION In this case report, we describe our technique using an osteochondral autograft to address complex bone and cartilaginous losses, thereby expanding the treatment options available to trauma surgeons. CONCLUSION This case report shows that a reconstruction of the capitellum humeri for a traumatic bone loss with an osteochondral autograft using the eighth rib can be easily performed. More generally, this technique could even help to manage complex traumatic substance loss of both bone and cartilage in other locations.
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Affiliation(s)
- Nicolas Fauvet
- Department of Orthopaedic Surgery, APHM, Institute for Locomotion, Sainte-Marguerite University Hospital, Marseille, France.
| | - Emile Dobelle
- Department of Orthopaedic Surgery, APHM, Institute for Locomotion, Sainte-Marguerite University Hospital, Marseille, France
| | - Marie Le Baron
- Department of Orthopaedic Surgery, APHM, Institute for Locomotion, Hôpital Nord University Hospital, Marseille, France
| | - Christophe Jacquet
- Department of Orthopaedic Surgery, APHM, Institute for Locomotion, Sainte-Marguerite University Hospital, Marseille, France
| | - Jean-Noël Argenson
- Department of Orthopaedic Surgery, APHM, Institute for Locomotion, Sainte-Marguerite University Hospital, Marseille, France
| | - Damien Lami
- Department of Orthopaedic Surgery, APHM, Institute for Locomotion, Sainte-Marguerite University Hospital, Marseille, France
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Bouhaddoune Y, Bouchlarhem A, Bazid Z, Ismaili N, El Ouafi N. Right ventricular infarction: epidemiological, clinical, and angiographic characteristics and the outcomes through the experience of a Moroccan cardiology department. Ann Med Surg (Lond) 2024; 86:660-665. [PMID: 38333299 PMCID: PMC10849376 DOI: 10.1097/ms9.0000000000001528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 11/09/2023] [Indexed: 02/10/2024] Open
Abstract
Background Acute myocardial infarction (MI) is a major cause of cardiovascular mortality, which is the leading cause of death in the world. Our objective in this study was to evaluate the epidemiological, clinical, and angiographic features of right ventricular infarction (RVI), as well as its complications and its therapeutic approaches. Patients and methods It is a single-centered retrospective descriptive study conducted over a period of 2 years from November 2018 to October 2020. The authors included 82 patients with RVI hospitalized in the cardiovascular ICU during the initial phase of acute coronary syndrome with persistent ST segment elevation. Patients who were diagnosed with RVI at electrocardiogram and echocardiography were recruited. Results The authors included 500 patients hospitalized for STEMI, 82 had MI extended to the RV, reflecting a rate of 16.4%. The mean age in our study was 64±12.3 years. Dyslipidemia, diabetes mellitus, and hypertension were the most common cardiovascular risk factors among these patients. RVI co-existed with inferior MI in 62.2 of cases and in 37.8% of anterior MI, while isolated RVI was seen in only one patient. Transthoracic echocardiography showed right ventricular (RV) systolic dysfunction in 24.39% of cases, while RV dilatation was seen in only 10.9% of patients. Therapeutic approach was based essentially on revascularization with thrombolysis and coronary angiography +/- PCI. The percentage of mortality was 2.4%. Conclusion RVI is relatively rare and is mostly related to an extension of an inferior MI. Early diagnosis, prompt treatment, and appropriate are the keys to improve prognosis, and reduce complications.
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Affiliation(s)
| | | | - Zakaria Bazid
- Department of Cardiology, Mohammed VI University Hospital of Oujda
- Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Morocco
| | - Nabila Ismaili
- Department of Cardiology, Mohammed VI University Hospital of Oujda
- Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Morocco
| | - Noha El Ouafi
- Department of Cardiology, Mohammed VI University Hospital of Oujda
- Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Morocco
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Thuerlimann AC, Morel J, Martin PY, Kalbermatten DF. Successful Treatment of SIADH after Removal of Ruptured Breast Implants. Plast Reconstr Surg Glob Open 2024; 12:e5591. [PMID: 38379779 PMCID: PMC10878540 DOI: 10.1097/gox.0000000000005591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 11/27/2023] [Indexed: 02/22/2024]
Abstract
Local adverse reactions to breast implants and systemic reactions, mostly autoinflammatory, are numerously described in the literature. A patient presented at our institution with severe neurologic symptoms, including confusion and phasic troubles due to severe hyponatremia as part of syndrome of inappropriate antidiuretic hormone secretion (SIADH). Common etiologies for SIADH, primarily malignancy and central nervous system disturbances, have been ruled out by imaging. On the computed tomography scan of the thorax and abdomen, several masses were found in the pectoral region, inferior to the sternum and in the left axilla that were biopsied and verified as silicone. While evaluating the patient's medical history, the patient remembered having undergone breast augmentation with silicone implants several decades ago. The only explanation left for the persisting SIADH was her ruptured silicone implants, causing an inflammatory systemic reaction. Literature was searched, and one abstract was found, in which a woman presenting with SIADH was treated successfully after removal of her silicone breast implants. We offered the same treatment to our patient, and siliconomas were removed through a bilateral inframammary approach as well as axillary on the left. There were no complications encountered. Postoperatively, the patient's hyponatremia improved and normalized 1 month later even without hydric restriction. This potential form of etiology and treatment of SIADH is a novelty in the medical literature. Surgical removal of dispersed silicone is presumed to be the cure for this syndrome. It represents a diagnosis of exclusion after more life-threatening causes, such as central nervous system disturbances and malignancies, have been ruled out.
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Affiliation(s)
- Alice C. Thuerlimann
- From Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Geneva, Geneva, Switzerland
| | - Jeremy Morel
- Internal Medicine, Private Practice in Geneva, Geneva, Switzerland
| | - Pierre-Yves Martin
- Nephrology and Hypertension, University Hospital of Geneva, Geneva, Switzerland
| | - Daniel F. Kalbermatten
- From Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Geneva, Geneva, Switzerland
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Staudt MD. Spinal Cord Stimulation Paddle-to-Percutaneous Revision: Case Series and Technical Description. World Neurosurg 2024; 182:e891-e898. [PMID: 38128757 DOI: 10.1016/j.wneu.2023.12.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Spinal cord stimulators (SCSs) can be implanted via a percutaneous or paddle approach, the latter technique requiring a laminotomy or laminectomy. Revision surgery may be necessary in instances of migrated, misplaced, or failed stimulators. When revision of a percutaneous system is necessary, it is common to replace the electrodes with a paddle SCS. This study aims to describe a case series of patients with failed paddle SCS electrodes who underwent revision with percutaneous SCS hardware. METHODS A series of 5 patients were retrospectively analyzed. Medical records were reviewed for demographic data, operative technique, postoperative follow-up, and complications. RESULTS Five patients were included in this series. The median age was 63 (range 51-84), and the median duration from initial implantation to revision surgery was 19 months (range 5-60). The median operative duration was 92 minutes (mean 99 ± 19.6 minutes). The median length of follow-up after surgery was 24 months (mean 21.8 ± 6.0 months). All patients had improved pain relief and therapeutic coverage with no complications. CONCLUSIONS Paddle-to-percutaneous SCS surgery is a feasible and durable revision option in appropriately selected patients.
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Affiliation(s)
- Michael D Staudt
- Departments of Neurosurgery, Beaumont Neuroscience Center, Royal Oak, Michigan, USA; Departments of Neurosurgery, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA.
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Zafarghandi MR, Samimiat A, Nikraftar P, Sadeghi A, Pourazari P, Shokri A. Aortic reimplantation of the superior mesenteric artery (SMA) for SMA stenosis in a previously stented patient: New technique and a case report. Int J Surg Case Rep 2024; 115:109170. [PMID: 38181654 PMCID: PMC10809098 DOI: 10.1016/j.ijscr.2023.109170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/09/2023] [Accepted: 12/11/2023] [Indexed: 01/07/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Mesenteric artery stenosis leads to inadequate blood flow toward various parts of the gastrointestinal tract. Revascularization is the primary aim of treatment regardless of its approach. During the last decades, open revascularization has been replaced by endovascular-first approach. Mesenteric artery in-stent restenosis occurs in a considerable number of patients that need reintervention in up to half of them using redo endovascular revascularization or open surgery. Here, we reported a case of SMA and celiac artery stenoses treated by aortic reimplantation of the SMA. CASE PRESENTATION A 62-year-old man with history of previous stenting of CA and SMA was referred due to chronic intermittent abdominal. CT angiography of the abdomen showed restenosis of both arteries. A transection distal part of the occlusions SMA and reimplantation of it into the SMA on the anterolateral face of the infrarenal aorta as the end-to-side anastomosis were performed resulting in resolving the patient problem. CLINICAL DISCUSSION Chronic mesenteric ischemia can result from various medical conditions. Mesenteric vascular surgical revascularization through open laparotomy had been considered the standard of care. However, minimally invasive surgery such as endovascular therapy has attracted attention in the recent decades. There are some concerns about the difficulties of further surgery in case of re-occlusion. The end-to-side anastomosis and aortic reimplantation can be considered in patients with appropriate runoff in the remaining parts of corresponding vessels. CONCLUSION Aortic reimplantation of the superior mesenteric artery in patients with restenosis of stents is a viable option especially in case of inappropriate iliac artery to perform retrograde mesenteric bypass.
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Affiliation(s)
- Mohammad Reza Zafarghandi
- Vascular Surgery, Department of Vascular Surgery, Sina Hospital, Tehran University of Medical Science, Tehran, Iran.
| | - Alireza Samimiat
- Department of General Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Parham Nikraftar
- Department of Vascular Surgery, Sina Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Afrooz Sadeghi
- Department of Vascular Surgery, Sina Hospital, Tehran University of Medical Science, Tehran, Iran.
| | - Pejman Pourazari
- Surgery Department of Surgery, School of Medicine Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amir Shokri
- Vascular & Trauma Surgery, Department of General Surgery, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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149
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Shrestha AL, Mishra A, Khadka S, Dhakhwa R. Retroperitoneal Castleman's disease in a young Nepalese girl: A rare cause of childhood abdominal mass. Ann Med Surg (Lond) 2024; 86:1080-1084. [PMID: 38333308 PMCID: PMC10849377 DOI: 10.1097/ms9.0000000000001579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/22/2023] [Indexed: 02/10/2024] Open
Abstract
Introduction Castleman's disease (CD), or benign angio-follicular lymph node hyperplasia, is an uncommon condition in childhood. When a child presents with a huge retroperitoneal mass and inconclusive findings on clinico-radiological evaluation or tissue sampling, management becomes exceedingly difficult. CD herein becomes an uncommon presentation of an uncommon diagnosis. Case presentation A six-year-old girl with no past medical problems presented to the office with a slowly progressive, painless mass over the right lumbar region for a year. Abdominal ultrasound showed a well-defined oval mass in the right periumbilical region, further evaluation of which with a computed tomography scan suggested lymphoma. A preoperative core-cut biopsy could not confirm the findings and suggested a neoplastic lesion, probably an inflammatory myofibroblastic tumour or small round cell tumour. She underwent an exploratory laparotomy with in-toto excision of the mass. Intraoperatively, a solid retroperitoneal tumour measuring 8×8×6 cm was found. Histopathology and immunohistochemistry confirmed a unicentric CD of the hyaline-vascular type. At two years of follow-up, she remained asymptomatic and disease-free. Conclusion While CD in children is rare, retroperitoneal localization of the same can further add to the diagnostic conundrum. However, if carefully considered, an en-bloc surgical resection offers complete treatment.
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Affiliation(s)
| | - Aakash Mishra
- Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal
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Borni M, Abdelmouleh S, Tallah M, Blibeche H, Elouni E, Boudawara MZ. Extra-axial desmoplastic/nodular medulloblastoma in adult mimicking cerebellar metastasis: reappraisal of this rare presentation with literature review. Ann Med Surg (Lond) 2024; 86:1124-1130. [PMID: 38333306 PMCID: PMC10849342 DOI: 10.1097/ms9.0000000000001617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/04/2023] [Indexed: 02/10/2024] Open
Abstract
Introduction and importance Medulloblastomas are the most common malignant intra-axial brain tumour in paediatric patients and represent 35-40% of posterior fossa tumour types in children between 3 and 9 years of age. Medulloblastomas may also be found in adulthood. These tumours are classified into two groups according to its molecular characteristics and histological type. The desmoplastic/nodular subtype is the second common subtype after the classic one. Only three cases of desmoplastic/nodular extra-axial medelloblastoma have been previously reported in the literature originating from to the cerebellopontine angle. Case presentation The authors report a new case of an extra-axial desmoplastic/nodular cerebellar medulloblastoma originating outside the cerebellopontine angle and mimicking a solitary cerebellar metastasis in a 49-year-old female patient who presented for a raised intracranial pressure and cerebellar syndrome. Clinical discussion Medulloblastoma is a malignant embryonal intra-axial tumour of the cerebellum or posterior brain stem that occurs mainly in children. Medulloblastomas may also be found in adulthood. Desmoplastic/nodular medulloblastoma is the second most common type of all medulloblastomas. The intra-axial form is always predominant. Only three cases of extra-axial desmoplastic/nodular medulloblastoma have been reported in the literature. The authors will go through the literature to dissect this rare entity. Conclusion Although considered a common paediatric intra-axial tumour, there are increasing numbers of solitary cases reporting an extra-axial presentation in different locations of the posterior cerebral fossa even in adulthood. These rare and unusual presentations and locations may mislead the correct diagnosis and delay treatment.
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Affiliation(s)
- Mehdi Borni
- Department of Neurosurgery, UHC Habib Bourguiba
| | | | | | | | - Emna Elouni
- Department of Neurosurgery, UHC Habib Bourguiba, Sfax (Tunisia)
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