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Munk Bang M, Schou Andersen MC, Poulsen FR, Bonde Pedersen C, Darling P, Jakobsen J, Bechtold D, Dehghani Molander L, Hedegaard Dahlrot R, Nguyen N, Halle B. Treatment of meningiomas involving the optic canal with endoscopic transnasal decompression of the optic nerve. World Neurosurg 2024:S1878-8750(24)00710-1. [PMID: 38692572 DOI: 10.1016/j.wneu.2024.04.137] [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: 11/02/2023] [Revised: 04/21/2024] [Accepted: 04/22/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Management of patients with optic nerve sheath meningiomas (ONSM) is controversial and the treatment strategy in this patient group is still up for discussion. Transnasal endoscopic orbital and optic nerve decompression aims to reduce the pressure in the orbit and on the optic nerve and thereby prevent vision loss. This article presents material from seven cases of transnasal endoscopic orbital decompressions. METHODS The study design is a retrospective cohort study. The aim was to include all patients with a meningioma residing along the nerve sheath and who were operated using endoscopic transnasal decompression of the orbit and if needed the optic canal at Odense University Hospital. Data from the medical records were collected and pre- and postoperative eye examinations were compared. In addition, it was recorded whether there were complications to the procedure and whether additional treatments were given. RESULTS In total, four women and three men were included in the study. Four out of seven patients experienced improvement in vision after the operation. One patient experienced unchanged vision and two patients experienced deterioration of vision after surgery. CONCLUSIONS The current report of seven patients with ONSM shows promising results for this surgical procedure as four out of seven patients experienced improvement in their vision at follow-up examinations. The two patients, who experienced deterioration of vision, already had severely reduced vision pre-operatively, which indicates that surgery should be considered before the vision becomes significantly reduced.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Nina Nguyen
- Radiology at Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark
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Schuh A, Ayvaz G, Baldeschi L, Baretić M, Bechtold D, Boschi A, Brix TH, Burlacu MC, Ciric J, Covelli D, Currò N, Donati S, Eckstein AK, Fichter N, Führer D, Horn M, Jabłońska-Pawlak A, Juri Mandić J, Kahaly GJ, Konuk O, Langbein A, Lanzolla G, Marcocci C, Marinò M, Miśkiewicz P, Beleslin BN, Pérez-Lázaro A, Pérez-López M, Ponto KA, Quinn A, Rudofsky G, Salvi M, Schittkowski MP, Tanda ML, Toruner F, Vaidya B, Hintschich CR. Presentation of Graves' orbitopathy within European Group On Graves' Orbitopathy (EUGOGO) centres from 2012 to 2019 (PREGO III). Br J Ophthalmol 2024; 108:294-300. [PMID: 36627174 PMCID: PMC10850632 DOI: 10.1136/bjo-2022-322442] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 08/20/2022] [Accepted: 12/22/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Graves' orbitopathy (GO) is subject to epidemiological and care-related changes. Aim of the survey was to identify trends in presentation of GO to the European Group On Graves' Orbitopathy (EUGOGO) tertiary referral centres and initial management over time. METHODS Prospective observational multicentre study. All new referrals with diagnosis of GO within September-December 2019 were included. Clinical and demographic characteristics, referral timelines and initial therapeutic decisions were recorded. Data were compared with a similar EUGOGO survey performed in 2012. RESULTS Besides age (mean age: 50.5±13 years vs 47.7±14 years; p 0.007), demographic characteristics of 432 patients studied in 2019 were similar to those in 2012. In 2019, there was a decrease of severe cases (9.8% vs 14.9; p<0.001), but no significant change in proportion of active cases (41.3% vs 36.6%; p 0.217). After first diagnosis of GO, median referral time to an EUGOGO tertiary centre was shorter (2 (0-350) vs 6 (0-552) months; p<0.001) in 2019. At the time of first visit, more patients were already on antithyroid medications (80.2% vs 45.0%; p<0.001) or selenium (22.3% vs 3.0%; p<0.001). In 2019, the initial management plans for GO were similar to 2012, except for lid surgery (2.4% vs 13.9%; p<0.001) and prescription of selenium (28.5% vs 21.0%; p 0.027). CONCLUSION GO patients are referred to tertiary EUGOGO centres in a less severe stage of the disease than before. We speculate that this might be linked to a broader awareness of the disease and faster and adequate delivered treatment.
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Affiliation(s)
- Anna Schuh
- Department of Ophthalmology, Ludwig Maximilians University Munich, Munich, Germany
| | - Goksun Ayvaz
- Department of Endocrinology and Metabolism, Koru Hospital, Ankara, Turkey
| | - Lelio Baldeschi
- Service d'Ophtalmologie, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Maja Baretić
- Department of Endocrinology and Diabetes, University Hospital Center Zagreb, Croatia, School of medicine University of Zagreb, Zagreb, Croatia
| | - Dorte Bechtold
- Department of Ophthalmology, Odense University Hospital, Odense C, Denmark
| | - Antonella Boschi
- Service d'Ophtalmologie, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | - Maria-Cristina Burlacu
- Department of Endocrinology, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Jasmina Ciric
- Clinic of Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Danila Covelli
- Department of Endocrinology, Graves' Orbitopathy Center, La Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano Policlinico, Milano, Italy
| | - Nicola Currò
- Department of Ophthalmology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Simone Donati
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Anja K Eckstein
- Department of Ophthalmology, University of Duisburg-Essen, Essen, Germany
| | - Nicole Fichter
- Department of Ophthalmology, ADMEDICO orbital centre/University Basel, Olten, Switzerland
| | - Dagmar Führer
- Department of Endocrinology, Diabetes and Metabolism, University of Duisburg-Essen, Essen, Germany
| | - Maren Horn
- Department of Ophthalmology, University Medicine Goettingen, Goettingen, Germany
| | | | - Jelena Juri Mandić
- Department of Ophthalmology, Medical School, Kišpatićeva 12, University Clinical Hospital Center Zagreb, Zagreb, Croatia
| | - George J Kahaly
- Department of Medicine I, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Onur Konuk
- Department of Ophthalmology, Gazi University Medical School, Ankara, Turkey
| | - Amelie Langbein
- Department of Medicine I, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Giulia Lanzolla
- Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa, Pisa, Italy
| | - Claudio Marcocci
- Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa, Pisa, Italy
| | - Michele Marinò
- Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa, Pisa, Italy
| | - Piotr Miśkiewicz
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Biljana Nedeljkovic Beleslin
- Clinic of Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Antonia Pérez-Lázaro
- Department of Endocrinology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Marta Pérez-López
- Department of Ophthalmology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Katharina A Ponto
- Department of Ophthalmology, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Anthony Quinn
- Department of Ophthalmology, Royal Devon University Hospital, Exeter, UK
| | | | - Mario Salvi
- Department of Endocrinology, Graves' Orbitopathy Center, La Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano Policlinico, Milano, Italy
| | | | - Maria Laura Tanda
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Fusun Toruner
- Department of Endocrinology and Metabolism, Gazi University Medical School, Ankara, Turkey
| | - Bijay Vaidya
- Department of Endocrinology, Royal Devon University Hospital, University of Exeter Medical School, Exeter, UK
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Sharma MB, Jensen K, Urbak SF, Funding M, Johansen J, Bechtold D, Amidi A, Eskildsen SF, Jørgensen JOL, Grau C. A multidimensional cohort study of late toxicity after intensity modulated radiotherapy for sinonasal cancer. Radiother Oncol 2020; 151:58-65. [PMID: 32697945 DOI: 10.1016/j.radonc.2020.07.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 02/23/2020] [Revised: 07/12/2020] [Accepted: 07/15/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE To evaluate the occurrence of late toxicity after curatively intended intensity modulated radiotherapy (IMRT) for sinonasal cancer and assess dose-response associations. METHODS Patients treated with IMRT in 2008-2016 were included. Cross sectional examinations of toxicity from the optic pathway, the brain, the pituitary gland and the nose were performed along with quality of life - (QoL) and dose-response analyses. RESULTS Twenty-seven patients were enrolled; median age was 67 years (range 47-83). Five patients (19%) had radiation-related ocular toxicity. The risk of visual acuity impairment increased with increasing dose (grade 2 odds ration (OR) 1.12, p = 0.01; grade 3 OR 1.14, p = 0.02) and dose constraint violations (grade 2, OR = 21, p < 0.01; grade 3, OR = 41, p < 0.01). Six patients (22%) exhibited evidence of radiation-related hypopituitarism, but no dose-response association was detected. Seventeen patients (63%) had impaired olfactory function. The risk of olfactory impairment increased with higher stage (OR = 3.32, p = 0.03). Three patients (11%) had structural abnormalities in irradiated areas of the brain, and impaired cognitive function was present in 17 patients (63%). Cognitive, physical, role functioning as well as fatigue and insomnia were affected the most in QOL analyses. Fifteen patients (56%) had grade 2 radiation-related impairment in at least one organ. Grade 3 toxicity was only present in patients with toxicities in >3 organs and in patients initially treated for T4 tumours. Three patients (11%) had radiation-related impaired function in all examined OARs. CONCLUSION Late toxicity after radiotherapy was substantial in all examined organs, with dose-response associations between visual acuity impairment and the optic nerve. The results have led to changed praxis for follow-up examinations in Denmark.
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Affiliation(s)
| | - Kenneth Jensen
- Danish Center for Particle Therapy, Aarhus University Hospital, Denmark
| | - Steen Fiil Urbak
- Department of Ophthalmology, Aarhus University Hospital, Denmark
| | - Mikkel Funding
- Department of Ophthalmology, Aarhus University Hospital, Denmark
| | | | - Dorte Bechtold
- Department of Ophthalmology, Odense University Hospital, Denmark
| | - Ali Amidi
- Unit for Psychooncology and Health Psychology, Department of Psychology, Aarhus University, Denmark
| | | | | | - Cai Grau
- Department of Oncology, Aarhus University Hospital, Denmark; Danish Center for Particle Therapy, Aarhus University Hospital, Denmark
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Wang H, Lane J, Jones S, Dashti H, Ollila H, Wood A, van Hees V, Brumpton B, Winsvold B, Kantojärvi K, Palviainen T, Cade B, Sofer T, Song Y, Patel K, Anderson S, Bechtold D, Bowden J, Emsley R, Kyle S, Little M, Loudon A, Scheer F, Purcell S, Richmond R, Spiegelhalder K, Tyrrell J, Zhu X, Hublin C, Kaprio J, Kristiansson K, Sulkava S, Paunio T, Hveem K, Nielsen J, Willer C, Zwart JA, Strand L, Frayling T, Ray D, Lawlor D, Rutter M, Weedon M, Redline S, Saxena R. Genome-wide association analysis of self-reported daytime sleepiness identifies 42 loci that suggest biological subtypes. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.1140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Wallace SS, Bechtold D, Sassoon A. Periprosthetic fractures of the distal femur after total knee arthroplasty : Plate versus nail fixation. Orthop Traumatol Surg Res 2017; 103:257-262. [PMID: 28089667 DOI: 10.1016/j.otsr.2016.11.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 04/19/2016] [Revised: 11/15/2016] [Accepted: 11/24/2016] [Indexed: 02/02/2023]
Abstract
UNLABELLED The incidence of periprosthetic fractures about a TKA is increasing. Traditionally, these fractures are classified by their location and prosthesis integrity. In the setting of a supracondyar fracture about a well-fixed prosthesis, both plate and nail fixation of the fracture present themselves as options, each with unique benefits and pitfalls. Through review and discussion of the literature, we aim to describe some of the patient, fracture, and implant related factors that should be considered when planning fixation of periprosthetic fractures about a TKA. Additionally, we present several technical pearls that may be useful in the successful treatment of these difficult injuries. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- S S Wallace
- University of Washington medical center, department of orthopaedics and sports medicine, 98195 Seattle, Washington, USA
| | - D Bechtold
- University of Washington, school of medicine, 1959, NE Pacific St., 98195 Seattle, Washington, USA
| | - A Sassoon
- University of Washington medical center, department of orthopaedics and sports medicine, 98195 Seattle, Washington, USA.
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Petrasch S, Wacker HH, Zou P, Bechtold D, Brittinger G. Enhancement in number and function of antigen-presenting cells in the lymphatic tissue of rats after in vivo administration of diphenylhydantoin (DPH). Clin Exp Immunol 1989; 78:133-7. [PMID: 2805417 PMCID: PMC1534602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
We present a monoclonal IgG1 antibody, KiMy1R, which is specific for macrophages and their derivatives in the lymphatic tissue of the rat, and evaluate the distribution of subsets of mononuclear cells in popliteal and para-aortal lymph nodes of Wistar rats after injection of 50 mg DPH into the hindpads. Compared with resting lymphatic tissue and lymph nodes of animals treated with phenobarbital, DPH induced a significant increase (P less than 0.01) of the proportion of phagocytic cells. Furthermore, the soluble antigen alkaline phosphatase was traced after inoculation into the footpads of rats: in locoregional lymph nodes the percentage (mean 12.8/10(3] and the total number (mean 476 x 10(3) cells/lymph node) of cells with membrane-bound or intracytoplasmic alkaline phosphatase, as detected by a monoclonal anti-alkaline phosphatase antibody, were significantly higher (P less than 0.001) in animals pretreated with DPH than in rats pretreated with phenobarbital (mean 2.1/10(3); 31.2 x 10(3) cells/lymph node) and in untreated animals (mean 1.9/10(3); 4.1 x 10(3) cells/lymph node). If verified in humans, the effect of DPH in enhancing the number and function of macrophages and other antigen-presenting cells may exert favourable effects in patients with impairment of the mononuclear phagocytic system.
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Affiliation(s)
- S Petrasch
- Department of Medicine, University of Essen, West Germany
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