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Hopman LHGA, Bhagirath P, Götte MJW. MRI-Guided Fibrosis Ablation vs Conventional Catheter Ablation for Patients With Persistent Atrial Fibrillation. JAMA 2022; 328:1643-1644. [PMID: 36282264 DOI: 10.1001/jama.2022.16292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Luuk H G A Hopman
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Pranav Bhagirath
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, England
| | - Marco J W Götte
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
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Marrouche NF, Wazni O, McGann C, Greene T, Dean JM, Dagher L, Kholmovski E, Mansour M, Marchlinski F, Wilber D, Hindricks G, Mahnkopf C, Wells D, Jais P, Sanders P, Brachmann J, Bax JJ, Morrison-de Boer L, Deneke T, Calkins H, Sohns C, Akoum N. Effect of MRI-Guided Fibrosis Ablation vs Conventional Catheter Ablation on Atrial Arrhythmia Recurrence in Patients With Persistent Atrial Fibrillation: The DECAAF II Randomized Clinical Trial. JAMA 2022; 327:2296-2305. [PMID: 35727277 PMCID: PMC9214588 DOI: 10.1001/jama.2022.8831] [Citation(s) in RCA: 109] [Impact Index Per Article: 54.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 05/11/2022] [Indexed: 11/14/2022]
Abstract
Importance Ablation of persistent atrial fibrillation (AF) remains a challenge. Left atrial fibrosis plays an important role in the pathophysiology of AF and has been associated with poor procedural outcomes. Objective To investigate the efficacy and adverse events of targeting atrial fibrosis detected on magnetic resonance imaging (MRI) in reducing atrial arrhythmia recurrence in persistent AF. Design, Setting, and Participants The Efficacy of Delayed Enhancement-MRI-Guided Fibrosis Ablation vs Conventional Catheter Ablation of Atrial Fibrillation trial was an investigator-initiated, multicenter, randomized clinical trial involving 44 academic and nonacademic centers in 10 countries. A total of 843 patients with symptomatic or asymptomatic persistent AF and undergoing AF ablation were enrolled from July 2016 to January 2020, with follow-up through February 19, 2021. Interventions Patients with persistent AF were randomly assigned to pulmonary vein isolation (PVI) plus MRI-guided atrial fibrosis ablation (421 patients) or PVI alone (422 patients). Delayed-enhancement MRI was performed in both groups before the ablation procedure to assess baseline atrial fibrosis and at 3 months postablation to assess for ablation scar. Main Outcomes and Measures The primary end point was time to first atrial arrhythmia recurrence after a 90-day blanking period postablation. The primary safety composite outcome was defined by the occurrence of 1 or more of the following events within 30 days postablation: stroke, PV stenosis, bleeding, heart failure, or death. Results Among 843 patients who were randomized (mean age 62.7 years; 178 [21.1%] women), 815 (96.9%) completed the 90-day blanking period and contributed to the efficacy analyses. There was no significant difference in atrial arrhythmia recurrence between groups (fibrosis-guided ablation plus PVI patients, 175 [43.0%] vs PVI-only patients, 188 [46.1%]; hazard ratio [HR], 0.95 [95% CI, 0.77-1.17]; P = .63). Patients in the fibrosis-guided ablation plus PVI group experienced a higher rate of safety outcomes (9 [2.2%] vs 0 in PVI group; P = .001). Six patients (1.5%) in the fibrosis-guided ablation plus PVI group had an ischemic stroke compared with none in PVI-only group. Two deaths occurred in the fibrosis-guided ablation plus PVI group, and the first one was possibly related to the procedure. Conclusions and Relevance Among patients with persistent AF, MRI-guided fibrosis ablation plus PVI, compared with PVI catheter ablation only, resulted in no significant difference in atrial arrhythmia recurrence. Findings do not support the use of MRI-guided fibrosis ablation for the treatment of persistent AF. Trial Registration ClinicalTrials.gov Identifier: NCT02529319.
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Affiliation(s)
- Nassir F. Marrouche
- Cardiology Department, Tulane University School of Medicine, New Orleans, Louisiana
| | | | | | | | | | - Lilas Dagher
- Cardiology Department, Tulane University School of Medicine, New Orleans, Louisiana
| | | | - Moussa Mansour
- Cardiology Department, Massachusetts General Hospital, Boston
| | | | - David Wilber
- Cardiology Department, Loyola University Chicago, Chicago, Illinois
| | | | | | | | - Pierre Jais
- Cardiology Department, Segalen University, Bordeaux, France
| | | | | | - Jeroen J. Bax
- Cardiology Department, Leiden University Medical Center, Leiden, the Netherlands
- Cardiology Department, Turku Heart Center, Turku, Finland
| | | | | | - Hugh Calkins
- Cardiology Department, Johns Hopkins University, Baltimore, Maryland
| | | | - Nazem Akoum
- Cardiology Department, University of Washington Medical Center, Seattle
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Wang L, Li H, Zhang W, Ren M, Shao M, Wang J. AGTR1 blocker attenuates activation of Tenon's capsule fibroblasts after glaucoma filtration surgery via the NF-κB signaling pathway. Exp Cell Res 2021; 407:112786. [PMID: 34411608 DOI: 10.1016/j.yexcr.2021.112786] [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: 05/12/2021] [Revised: 08/12/2021] [Accepted: 08/15/2021] [Indexed: 11/21/2022]
Abstract
Activation of Tenon's capsule fibroblasts limits the success rate of glaucoma filtration surgery (GFS), the most efficacious therapy for patients with glaucoma. Angiotensin type 1 receptor (AGTR1) is involved in tissues remodeling and fibrogenesis. However, whether AGTR1 is involved in the progress of fibrogenesis after GFS is not fully elucidated. The aim of this study was to investigate the role of an AGTR1 in scar formation after GFS and the potential anti-fibrosis effect of AGTR1 blocker. AGTR1 expression level was increased in subconjunctival tissues in a rat model of GFS and transforming growth factor-beta 2 (TGF-β2)-induced human Tenon's capsule fibroblasts (HTFs). AGTR1 blocker treatment suppressed TGF-β2-induced HTF migration and α-smooth muscle actin (α-SMA) and fibronectin (FN) expression. AGTR1 blocker treatment also attenuated collagen deposition and α-SMA and FN expression in subconjunctival tissues of the rat model after GFS. Moreover, AGTR1 blocker decreased TGF-β2-induced P65 phosphorylation, P65 nuclear translocation, and nuclear factor kappa B (NF-κB) luciferase activity. Additionally, BAY 11-7082 (an NF-κB inhibitor) significantly suppressed HTF fibrosis. In conclusion, our results indicate that AGTR1 is involved in scar formation after GFS. The AGTR1 blocker attenuates subconjunctival fibrosis after GFS by inhibiting the NF-κB signaling pathway. These findings indicate that targeting AGTR1 is a potential approach to attenuate fibrosis after GFS.
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Affiliation(s)
- Lijun Wang
- Department of Ophthalmology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 Xiwu Road, Xi'an, 710004, China
| | - Hongsong Li
- Department of Ophthalmology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 Xiwu Road, Xi'an, 710004, China
| | - Wenyi Zhang
- Department of Ophthalmology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 Xiwu Road, Xi'an, 710004, China
| | - Meimei Ren
- Department of Ophthalmology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 Xiwu Road, Xi'an, 710004, China
| | - Meilin Shao
- Department of Ophthalmology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 Xiwu Road, Xi'an, 710004, China
| | - Jianming Wang
- Department of Ophthalmology, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 Xiwu Road, Xi'an, 710004, China.
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Ballester MP, Lluch P, Gómez C, Capilla M, Tosca J, Martí-Aguado D, Guijarro J, Mínguez M. Transjugular intrahepatic portosystemic shunt reduces hospital care burden in patients with decompensated cirrhosis. Intern Emerg Med 2021; 16:1519-1527. [PMID: 33400160 DOI: 10.1007/s11739-020-02602-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND AIMS Patients with decompensated cirrhosis frequently require hospital admissions, which are associated with worse prognosis. The aim of this study was to analyze the effect of TIPS on the need for hospital care. Secondary objectives were to assess the clinical and biological impact of TIPS and to identify predictors of post-TIPS hospital care. METHODS An observational, retrospective study of patients with decompensated cirrhosis treated with TIPS from January 2008 until March 2019. Exclusion criteria were TIPS placed for non-cirrhotic portal hypertension (PH) and patients referred from another hospital without prior or subsequent follow-up at our Unit. Hospital care, PH-related complications, and laboratory data were compared before and after TIPS. RESULTS The final cohort comprised 104 patients (72% male) with a mean age of 60 (± 10) years. Follow-up from first decompensation until TIPS and that from procedure to study completion were 7 (4.2-9.8) and 20 (4.6-35.4) months, respectively. TIPS was indicated mainly for refractory ascites (50%) and variceal bleeding (39%). Hemodynamic and clinical success rates were 97% and 92%, respectively. The number of emergency department visits and hospital admissions decreased after the procedure (p < 0.001). Improvement was seen in MELD and Child-Pugh scores, renal function, hyponatremia, and anemia after TIPS. Variceal bleeding as the indication for TIPS (OR 0.047; 95 CI 0.006-0,39; p < 0.05) together with early creation of the shunt (stage 3 vs 5; p < 0.05) were associated with a reduction in risk of post-TIPS hospital care. CONCLUSION TIPS is a safe and effective procedure that reduces hospital care burden by improving PH-related complications, hepatic, renal function, hyponatremia, and anemia. Variceal bleeding as the indication and early placement of the device were associated with a reduction in post-TIPS hospital care. These findings support a role for this treatment, predominantly in the early stages of cirrhosis.
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Affiliation(s)
- Maria Pilar Ballester
- Digestive Disease Department, Clinic University Hospital of Valencia, Blasco Ibañez 17, 46010, Valencia, Spain.
- Neurological Impairment Research Unit, INCLIVA Biomedical Research Institute of Clinic University Hospital of Valencia, Valencia, Spain.
| | - Paloma Lluch
- Digestive Disease Department, Clinic University Hospital of Valencia, Blasco Ibañez 17, 46010, Valencia, Spain
- Department of Medicine. Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain
| | - Concepción Gómez
- Digestive Disease Department, Clinic University Hospital of Valencia, Blasco Ibañez 17, 46010, Valencia, Spain
| | - Maria Capilla
- Digestive Disease Department, Clinic University Hospital of Valencia, Blasco Ibañez 17, 46010, Valencia, Spain
| | - Joan Tosca
- Digestive Disease Department, Clinic University Hospital of Valencia, Blasco Ibañez 17, 46010, Valencia, Spain
| | - David Martí-Aguado
- Digestive Disease Department, Clinic University Hospital of Valencia, Blasco Ibañez 17, 46010, Valencia, Spain
- Biomedical Imaging Research Group (GIBI230), La Fe Health Research Institute, Valencia, Spain
| | - Jorge Guijarro
- Interventional Radiology Department, Clinic University Hospital of Valencia, Valencia, Spain
| | - Miguel Mínguez
- Digestive Disease Department, Clinic University Hospital of Valencia, Blasco Ibañez 17, 46010, Valencia, Spain
- Department of Medicine. Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain
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Lu C, Baraty B, Robertson HL, Filyk A, Shen H, Fung T, Novak K, Ma C, Panaccione R, Achkar JP, Ouali SE, Bruining D, Jairath V, Feagan B, Rieder F. Systematic review: medical therapy for fibrostenosing Crohn's disease. Aliment Pharmacol Ther 2020; 51:1233-1246. [PMID: 32406116 PMCID: PMC7777136 DOI: 10.1111/apt.15750] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/16/2020] [Accepted: 04/05/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Medical therapy and/or endoscopic balloon dilation with intralesional therapies are options for the treatment of small bowel fibrostenotic Crohn's disease (CD). AIM To perform a systematic review summarising evidence for efficacy of systemic and endoscopic intralesional medical therapy in established small bowel strictures in adult CD patients. METHODS A systematic search of MEDLINE, EMBASE, CENTRAL and Scopus was conducted. Primary outcomes were rates of surgical resection and repeat endoscopic dilation. Pooled event rates from random effects models across studies with 95% confidence intervals were reported. RESULTS Ten studies describing systemic medical therapy and eight studies of intralesional injection were included. One randomised controlled trial each for systemic therapy and intrastricture injection were identified. Only observational studies were found for systemic biologic therapies, which exclusively included tumour necrosis factor (TNF) antagonists, while intralesional therapies all involved corticosteroids except for one study that evaluated infliximab. Pooled event rates for surgical resection after systemic and intralesional therapy were 28.3% (95% CI: 18.2%-41.3%) and 18.5% (95% CI: 8.3%-36.2%), respectively over a median follow-up of 23 months (range 5.5-105.8), and 21.8 months (range 5-47). Risk of repeat endoscopic balloon dilation in those with intralesional therapy was 58.3% (95% CI: 36.6%-77.3%) over a median follow-up of 21.8 months (range 5-47). CONCLUSIONS There are no favoured therapies for patients with stricturing small bowel CD. Data are lacking for ustekinumab and vedolizumab. No endoscopic intralesional medications provided a clear benefit for prevention of repeat EBD or surgery.
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Affiliation(s)
- Cathy Lu
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - Brandon Baraty
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
- Department of Gastroenterology, University of Sydney, Sydney, Australia
| | | | - Alexis Filyk
- Department of Life Sciences, Queen’s University, Kingston, Ontario, Canada
| | - Hua Shen
- Department of Mathematics and Statistics, University of Calgary, AB, Canada
| | - Tak Fung
- Department of Mathematics and Statistics, University of Calgary, AB, Canada
| | - Kerri Novak
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - Christopher Ma
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
- Robarts Clinical Trials Inc., London, Ontario, Canada; Department of Medicine, University of Western Ontario, London, Ontario, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Remo Panaccione
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - Jean-Paul Achkar
- Department of Gastroenterology, Hepatology & Nutrition; Digestive Diseases and Surgery Institute; Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Sara El Ouali
- Department of Gastroenterology, Hepatology & Nutrition; Digestive Diseases and Surgery Institute; Cleveland Clinic Foundation, Cleveland, OH, USA
| | - David Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Vipul Jairath
- Robarts Clinical Trials Inc., London, Ontario, Canada; Department of Medicine, University of Western Ontario, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London Ontario, Canada
| | - Brian Feagan
- Robarts Clinical Trials Inc., London, Ontario, Canada; Department of Medicine, University of Western Ontario, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London Ontario, Canada
| | - Florian Rieder
- Department of Gastroenterology, Hepatology & Nutrition; Digestive Diseases and Surgery Institute; Cleveland Clinic Foundation, Cleveland, OH, USA
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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Lin N, Li J, Ke Q, Xin F, Zeng Y, Wang L, Liu J. Does the intermittent Pringle maneuver affect the recurrence following surgical resection for hepatocellular carcinoma? A systematic review. PLoS One 2020; 15:e0229870. [PMID: 32160231 PMCID: PMC7065790 DOI: 10.1371/journal.pone.0229870] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 02/15/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND AIM To evaluate the effect of intermittent pringle maneuver (IPM) on the long-term prognosis and recurrence of hepatocellular carcinoma (HCC). METHODS Eligible studies were identified by PubMed and other databases from Jan 1st 1990 to Mar 31st 2019. Hazard ratios (HR) with 95% confidence interval (CI) were calculated to evaluate the effects of IPM on the long-term prognosis and recurrence of patients with HCC. RESULTS Six studies were enrolled in this meta-analysis. Results showed that there were no differences between IPM group and non-IPM group in the pooled HRs for the overall survival (OS) and disease-free survival (DFS) (HR 1.04, 95%CI 0.84~1.28, P = 0.74; HR 0.93, 95%CI 0.81~1.07, P = 0.29; respectively). However, subgroup analysis showed that the pooled Odd ratios (OR) for the 1-year OS and DFS rates of the IPM group when compared with the non-IPM group were 0.65 (95% CI 0.45~0.94, P = 0.02), 0.38 (95% CI 0.20~0.72, P = 0.003), respectively. In addition, there were no significant differences in the proportions of liver cirrhosis, HBsAg (+), Child-Pugh A class, multiple tumor, vascular invasion, and major hepatectomy between groups of IPM and non-IPM. CONCLUSION Since IPM would increase the risk of early-recurrence, it should be used cautiously in the procedure of hepatectomy for resectable HCC. However, the current conclusion needs further validation. TRIAL REGISTRY NUMBER CRD 42019124923.
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Affiliation(s)
- Nanping Lin
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian, China
- The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Jingrong Li
- Department of Laboratory, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Qiao Ke
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian, China
- The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Fuli Xin
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian, China
- The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Yongyi Zeng
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian, China
- The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Lei Wang
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Department of Radiation Oncology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Jingfeng Liu
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, Fujian, China
- The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
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Němec I, Mikolaj M, Hrabal P. EOSINOPHILIC ANGIOCENTRIC FIBROSIS AS A CAUSE OF NASAL OBSTRUCTION. A CASE REPORT. Acta Chir Plast 2020; 60:59-61. [PMID: 32370519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Eosinophilic angiocentric fibrosis (EAF) is a rare benign lesion of unknown aetiology, found predominantly in the upper respiratory tract. The fibrosis must be confirmed by considering other lesions in the differential diagnosis. The typical histological characteristics are the basis for establishing the diagnosis. We present a patient with long-term nasal obstruction caused by EAF. The patient had repeated resections of the lesion for its recurrences. As follows from the literature, radical resection is crucial for the treatment of EAF. This procedure may be difficult at times given the extent and localization of the disease..
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Kawamura T, Iwanaga Y, Nakamura T, Yasuda M, Kurita T, Miyazaki S. Cardiac Magnetic Resonance Identified the Fibrotic Lesion Associated with Syncope Attack Due to Complete Atrioventricular Block in a Patient with Hypertrophic Cardiomyopathy and Aortic Stenosis. Intern Med 2019; 58:2041-2044. [PMID: 30918200 PMCID: PMC6702018 DOI: 10.2169/internalmedicine.2563-18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
An 84-year-old man presented with syncope. Prior to admission, ambulatory electrocardiogram had demonstrated non-sustained ventricular tachycardia. Echocardiography showed severe aortic stenosis. He was also diagnosed with hypertrophic cardiomyopathy (HCM) by cardiac magnetic resonance (CMR) showing remarkable inhomogeneous left ventricular hypertrophy and extensive late gadolinium enhancement (LGE) in the lesions at the upper border and right-ventricular side of the basal-mid septal wall. Finally, he showed complete atrioventricular (AV) block followed by a long pause and syncope several times after admission. In this case with several possible causes of syncope, the CMR findings suggested a clue concerning the etiology of his syncope: complete AV block in HCM.
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Affiliation(s)
- Takayuki Kawamura
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, Japan
| | - Yoshitaka Iwanaga
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, Japan
| | - Takashi Nakamura
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, Japan
| | - Masakazu Yasuda
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, Japan
| | - Takashi Kurita
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, Japan
| | - Shunichi Miyazaki
- Division of Cardiology, Department of Internal Medicine, Kindai University Faculty of Medicine, Japan
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Hanzawa S, Tateishi T, Takemura T, Okada Y, Yamada Y, Noda M, Miyazaki Y, Inase N. The Analysis of Surgical Lung Biopsy and Explanted Lung Specimens Sheds Light on the Pathological Progression of Chronic Bird-related Hypersensitivity Pneumonitis. Intern Med 2019; 58:1145-1150. [PMID: 30568114 PMCID: PMC6522403 DOI: 10.2169/internalmedicine.1142-18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Chronic hypersensitivity pneumonitis is an interstitial pneumonia caused by an immunological reaction to the chronic inhalation of an antigen. Little is known, however, about the pathological change of the pulmonary lesions. A 33-year-old man was diagnosed with chronic bird-related hypersensitivity pneumonitis based on the findings of a surgical lung biopsy and an inhalation provocation test. He underwent lung transplantation at 8 years after the diagnosis because of disease progression. We conclude that the analysis of the explant suggests that the presence of extensive fibrosis in the centrilobular and perilobular area with bridging fibrosis is a form of pathological progression of chronic hypersensitivity pneumonitis.
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Affiliation(s)
- Satoshi Hanzawa
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Tomoya Tateishi
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | | | - Yoshinori Okada
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Japan
| | - Yoshihito Yamada
- Department of Respiratory Medicine, Japan Railway Tokyo General Hospital, Japan
| | - Masafumi Noda
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Japan
| | - Yasunari Miyazaki
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
| | - Naohiko Inase
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Japan
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Abstract
AIM To present treatment strategy for large volumes of injectable non-absorbable 'shell-less' soft tissue fillers (vaseline, synthol, silicone etc.). MATERIAL AND METHODS The authors present an experience of surgical treatment of 8 patients who underwent injections of medical vaseline (breast augmentation, n=5) and synthol (muscles enlargement, n=3) and review of the current literature devoted to this problem. RESULTS Injection of large amounts (over 50 ml) of non-absorbable fillers into soft tissues is unacceptable and leads to numerous complications. Oil-based 'shell-less' fillers cannot be removed by minimally invasive techniques (puncture, mini-incisions, etc.) due to multiple diffuse lesions in the form of oleogranulomas (cysts of different size) and surrounding widespread inflammation and fibrosis of tissues. Surgery is the only adequate method. However, this approach is followed by scars and often tissue contour deformation. Migration of these fillers to other anatomical areas (from the neck to the lower extremities) significantly complicates the situation, treatment and results. In case of categorical refusal of patients from surgical treatment and no complaints, they should be properly informed about possible consequences and complications and dynamic medical supervision is necessary. Intraoperative ultrasound examination is useful for the control of radical removal of pathological areas. Timely removal of non-absorbable fillers allows to avoid serious complications and to achieve good aesthetic results.
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Affiliation(s)
- V I Sharobaro
- Federal Research Clinical Center of Specialized Types of Medical Care and Medical Technologies, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
| | - N E Manturova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - Yu V Ivanov
- Federal Research Clinical Center of Specialized Types of Medical Care and Medical Technologies, Moscow, Russia
| | - A E Avdeev
- Institute of Beauty on Arbat, Moscow, Russia
| | - F G Zabozlaev
- Federal Research Clinical Center of Specialized Types of Medical Care and Medical Technologies, Moscow, Russia
| | - A V Telnova
- Federal Research Clinical Center of Specialized Types of Medical Care and Medical Technologies, Moscow, Russia
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Avellanal M, Diaz-Reganon G, Orts A, Gonzalez-Montero L, Riquelme I. Transforaminal Epiduroscopy in Patients with Failed Back Surgery Syndrome. Pain Physician 2019; 22:89-95. [PMID: 30700072] [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: 06/09/2023]
Abstract
BACKGROUND Epiduroscopy is a useful diagnostic and therapeutic tool for managing failed back surgery syndrome (FBSS). The conventional approach is via either the sacral hiatus or the interlaminar. Major causes of FBSS include epidural fibrosis, disc herniation, and stenosis. When these problems are located at the intervertebral foramen level, it can be difficult to reach the lateral recess and the foramen with the epiduroscope. Transforaminal epiduroscopy could be a useful alternative approach in patients with FBSS located at the foraminal level. OBJECTIVE We present a new procedure for lumbar epiduroscopy via a transforaminal approach and its application in patients with FBSS. The technique is described and long-term results are reported. STUDY DESIGN This study used a single-arm prospective observational design. SETTING The research took place at the University Hospital in Spain. METHODS Patients with FBSS suffering severe chronic radicular pain (Numeric Rating Scale [NRS-11] > 7) who had not responded to other treatments were included. Selective root stimulation during a pulsed radiofrequency procedure confirmed the origin of pain by means of an exact reproduction of typical pain. Transforaminal epiduroscopy was performed at the affected level. The severity of fibrosis observed was recorded. The NRS-11 score was reevaluated at 1, 6, and 12 months after the procedure. Any complications related to the treatment were recorded. RESULTS Twenty-four patients were included. The mean number of back surgeries was 1.66 (range, 1-5). The basal NRS-11 score was 7.83 (0.14); at 1 month, 3.66 (0.38) (P < 0.001); at 6 months, 4.46 (0.48) (P < 0.01); and at 1 year after treatment, 4.17 (0.51) (P < 0.01). Most patients (54%; 95% CI, 34%-74%) obtained > 50% pain reduction on the NRS-11, maintained during a 1-year follow-up period. No major complications were registered. LIMITATIONS The research was limited by the lack of a control group. CONCLUSIONS We have described a new procedure for epiduroscopy via the transforaminal approach. It is a useful and safe approach to managing FBSS at the foraminal level and shows better long-term results than other endoscopic procedures. KEY WORDS Epidural, epiduroscopy, chronic pain, spinal cord, back surgery.
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Affiliation(s)
- Martin Avellanal
- Pain Clinic, Hospital Universitario Sanitas La Moraleja, Madrid, Spain; Consultores en Dolor, Madrid, Spain
| | - Gonzalo Diaz-Reganon
- Pain Clinic, Hospital Universitario Sanitas La Moraleja, Madrid, Spain; Consultores en Dolor, Madrid, Spain
| | - Alejandro Orts
- Pain Clinic, Hospital Universitario Sanitas La Moraleja, Madrid, Spain; Consultores en Dolor, Madrid, Spain
| | - Lucio Gonzalez-Montero
- Pain Clinic, Hospital Universitario Sanitas La Moraleja, Madrid, Spain; Consultores en Dolor, Madrid, Spain
| | - Irene Riquelme
- Pain Clinic, Hospital Universitario Sanitas La Moraleja, Madrid, Spain; Consultores en Dolor, Madrid, Spain
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Müller C, Goliasch G, Schachinger S, Kastl S, Neunteufl T, Delle-Karth G, Kastner J, Gyöngyösi M, Lang I, Gottsauner-Wolf M, Pavo N. Transcatheter aortic valve replacement (TAVR) leads to an increase in the subendocardial viability ratio assessed by pulse wave analysis. PLoS One 2018; 13:e0207537. [PMID: 30462701 PMCID: PMC6248990 DOI: 10.1371/journal.pone.0207537] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 10/11/2018] [Indexed: 01/09/2023] Open
Abstract
Background Pulse wave analysis (PWA) is a useful tool for non-invasive assessment of central cardiac measures as subendocardial perfusion (Subendocardial Viability Ratio, SEVR) or contractility (dP/dtmax). The immediate influence of transcatheter aortic valve replacement (TAVR) on these indices has not been investigated yet. Methods We prospectively enrolled 40 patients presenting with severe aortic stenosis receiving TAVR. Central pressure curves were derived from radial and carotid sites using PWA up to 2 days before and 7 days after TAVR. Parameters were compared between peripheral measurement sites. Changes in SEVR, dP/dtmax and in indices of vascular stiffness were assessed. Additionally, association of these variables with clinical outcome was evaluated during a 12-month follow-up. Results Central waveform parameters were comparable between measurement sites. SEVR, but not dP/dtmax, augmentation Index (AIx) or augmentation pressure height (AGPH) correlated significantly with disease severity reflected by peak transvalvular velocity and mean transvalvular pressure gradient over the aortic valve (Vmax, ΔPm) [r = -0.372,p = 0.029 for Vmax and r = -0.371,p = 0.021 for ΔPm]. Vmax decreased from 4.5m/s (IQR:4.1–5.0) to 2.2m/s (IQR:1.9–2.7), (p<0.001). This resulted in a significant increase in SEVR [135.3%(IQR:115.5–150.8) vs. 140.3%(IQR:123.0–172.5),p = 0.039] and dP/dtmax [666mmHg(IQR:489–891) vs. 927mmHg(IQR:693–1092),p<0.001], and a reduction in AIx [154.8%(IQR:138.3–171.0) vs. 133.5%(IQR:128.3–151.8),p<0.001] and AGPH [34.1%(IQR:26.8–39.0) vs. 25.0%(IQR 21.8–33.7),p = 0.002], confirming the beneficial effects of replacing the stenotic valve. No association of these parameters could be revealed with outcome. Conclusions PWA is suitable for assessing coronary microcirculation and contractility mirrored by SEVR and maxdP/dt in the setting of aortic stenosis. PWA parameters attributed to vascular properties should be interpreted with caution.
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Affiliation(s)
- Claudia Müller
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Georg Goliasch
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Stefan Schachinger
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Stefan Kastl
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Thomas Neunteufl
- Department of Internal Medicine I, Medical University Krems, Krems, Austria
| | | | - Johannes Kastner
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Mariann Gyöngyösi
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Irene Lang
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Michael Gottsauner-Wolf
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
- * E-mail:
| | - Noemi Pavo
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
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Acimi S. The use of buccal mucosa graft for correction of severe chordee and urethroplasty in proximal hypospadias repair. World J Urol 2018; 37:2805. [PMID: 30460595 DOI: 10.1007/s00345-018-2571-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 11/15/2018] [Indexed: 11/25/2022] Open
Affiliation(s)
- Smail Acimi
- Department of Visceral Surgery, Children's Hospital Canastel, University of Oran, Oran, Algeria.
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Shaeer O, Shaeer K. Extracorporeal Transseptal Penile Prosthesis Implantation for Extreme Cases of Corporeal Fibrosis: Shaeer Implantation Technique. J Sex Med 2018; 15:1350-1356. [PMID: 30057279 DOI: 10.1016/j.jsxm.2018.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 03/30/2018] [Revised: 06/09/2018] [Accepted: 06/18/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Penile prosthesis implantation into scarred corporeal bodies is one of the most challenging procedures in prosthetic urologic surgery, especially following infection and extrusion of a penile implant. Several instruments and techniques have been used for making dilatation of scarred corporeal bodies easier and safer in expert hands. Nevertheless, in some cases, implantation is not possible. AIM This work presents extracorporeal transseptal implantation as a last resort in such cases. METHODS In 39 patients with extensive corporeal fibrosis, penile prosthesis implantation is attempted. After failure of alternative techniques, extracorporeal implantation is resorted to in 10 patients. The corpus spongiosum is identified and protected. Diathermy knife is used to cut a longitudinal window into 1 corpus cavernosum, through the septum and into the contralateral corpus cavernosum. A single semirigid implant rod is inserted through the window at the base of the penis, halfway through. The 2 limbs of the rod are bent upward toward the glans, to assume a U shape. The limbs of the U are brought together at midshaft by a gathering suture passed through the corpora cavernosa and septum. The tips of the U are anchored under the glans. OUTCOMES Achievement of acceptable coital relationship. RESULTS The procedure allowed acceptable coital relationship and concealment in 9/10 cases. In 1 case, infection occurred. Reimplantation with the same method was performed 6 months later, and the implant survived adequately. Perforation, migration, and urethral injury were not encountered. CLINICAL IMPLICATIONS This technique may help salvage abandoned cases with corporal fibrosis, particularly when the necessary expertise for alternative techniques is unavailable or when such techniques fail. STRENGTHS & LIMITATIONS The technique presented is fairly straightforward and safe. However, the number of cases and duration of follow-up are limited. CONCLUSION Extracorporeal transseptal penile prosthesis implantation can salvage cases with severe corporeal fibrosis when all alternatives fail. Shaeer O, Shaeer K. Extracorporeal Transseptal Penile Prosthesis Implantation for Extreme Cases of Corporeal Fibrosis: Shaeer Implantation Technique. J Sex Med 2018;15:1350-1356.
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Affiliation(s)
- Osama Shaeer
- Department of Andrology, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt; Kamal Shaeer Hospital, Cairo, Egypt.
| | - Kamal Shaeer
- Department of Andrology, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt; Kamal Shaeer Hospital, Cairo, Egypt
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Yue-Meng W, Li YH, Wu HM, Yang J, Yang LH, Xu Y. Portal Vein Thrombosis in Patients With Cirrhosis Undergoing Elective Transjugular Intrahepatic Portosystemic Shunt: Risk Factors, Warfarin Efficacy, and Clinical Outcomes. Clin Appl Thromb Hemost 2018; 24:462-470. [PMID: 28110540 PMCID: PMC6714657 DOI: 10.1177/1076029616689593] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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] [Indexed: 12/17/2022] Open
Abstract
Portal vein thrombosis (PVT) is a common complication in cirrhosis. The aim of this study was to determine risk factors for PVT, assess the efficacy of anticoagulant therapy, and evaluate the effects of PVT on patients with cirrhosis undergoing elective transjugular intrahepatic portosystemic shunt (TIPSS). A total of 101 patients with cirrhosis undergoing elective TIPSS were prospectively studied. After TIPSS, all patients received preventive therapy for PVT and were followed up at 3, 6, 12, and 24 months. Clinical outcomes were compared between patients who developed PVT after TIPSS and those who did not. Multivariate analysis showed that white blood cell count (relative risk [RR]: 0.377; 95% confidence interval [CI]: 0.132-0.579; P = .001), Child-Turcotte-Pugh score (RR: 1.547; 95% CI: 1.029-2.365; P = .032), and ascites (RR: 1.264; 95% CI: 1.019-1.742; P = .040) were independent predictors for PVT. Warfarin treatment within 12 months achieved significantly higher rates of complete recanalization than aspirin or clopidogrel in patients with PVT (54.5% vs 31.3%; P = .013), although adverse events were similar between the 2 groups ( P > .05). Patients without PVT had significantly lower 2-year cumulative rates of variceal rebleeding (15.9% vs 36.6%; P = .023), shunt dysfunction (27.0% vs 46.8%; P = .039), hepatic encephalopathy (24.1% vs 42.6%; P = .045), and hepatocellular carcinoma (11.4% vs 31.2%; P = .024) and markedly higher 2-year cumulative survival rates (89.8% vs 72.9%; P = .041) than those with PVT. The PVT is associated with poorer clinical outcomes in TIPSS-treated patients, and warfarin is both safe and more effective in recanalizing PVT than aspirin or clopidogrel.
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Affiliation(s)
- Wan Yue-Meng
- Gastroenterology Department II or Hepatology Center, The Second Affiliated Hospital of Kunming Medical University, Kunming City, Yunnan Province, China
- Graduate Department of Kunming Medical University, Kunming city, Yunnan province, China
| | - Yu-Hua Li
- Gastroenterology Department II or Hepatology Center, The Second Affiliated Hospital of Kunming Medical University, Kunming City, Yunnan Province, China
| | - Hua-Mei Wu
- Gastroenterology Department II or Hepatology Center, The Second Affiliated Hospital of Kunming Medical University, Kunming City, Yunnan Province, China
| | - Jing Yang
- Gastroenterology Department II or Hepatology Center, The Second Affiliated Hospital of Kunming Medical University, Kunming City, Yunnan Province, China
| | - Li-Hong Yang
- Gastroenterology Department II or Hepatology Center, The Second Affiliated Hospital of Kunming Medical University, Kunming City, Yunnan Province, China
| | - Ying Xu
- Gastroenterology Department II or Hepatology Center, The Second Affiliated Hospital of Kunming Medical University, Kunming City, Yunnan Province, China
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Rodríguez Laval V, Pavel M, Steffen IG, Baur AD, Dilz LM, Fischer C, Detjen K, Prasad V, Pascher A, Geisel D, Denecke T. Mesenteric Fibrosis in Midgut Neuroendocrine Tumors: Functionality and Radiological Features. Neuroendocrinology 2018; 106:139-147. [PMID: 28384635 DOI: 10.1159/000474941] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 04/01/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Mesenteric fibrosis (MF) surrounding a lymph node metastasis is a known phenomenon in midgut neuroendocrine tumors (NETs) with characteristic radiological appearance. Its etiology is poorly understood as it affects some but not all midgut NET patients with lymphatic involvement. This study assessed a potential relationship of MF with carcinoid syndrome, urinary 5-hydroxyindoleacetic acid (5-HIAA), and carcinoid heart disease (CHD). METHODS A cohort of 81 patients with pathologically proven NETs with the primary site in the midgut and mesenteric lymphatic metastases on imaging were retrospectively included. Imaging characteristics of lymphatic and hepatic metastases at diagnosis (size, number, burden, and morphologic features, including presence of MF), Ki67 grading, 5-HIAA, functionality, and development of CHD were analyzed. RESULTS Overall, 54% of patients had MF. The presence of MF was more frequently associated with mesenteric vessel encasement (100 vs. 46% without MF; p < 0.001), presence of hepatic metastases (91 vs. 62%; p = 0.002), larger hepatic tumor burden (15 vs. 5%; p = 0.001), and functionality (86 vs. 43%; p < 0.001). Multivariate analysis revealed 5-HIAA ≥395 µmol/day (p = 0.020), age (p = 0.013), and largest lymphatic metastasis ≥24 mm (p = 0.009) as independent predictors of MF, while functionality (p = 0.098) and CHD (p = 0.070) showed a tendency towards significance. MF was associated with decreased time to development of CHD in functional midgut NETs (p = 0.043). CONCLUSIONS We found a significant association of MF with metastatic patterns and with criteria of functionality. The association of MF with elevated 5-HIAA, and consecutively with carcinoid syndrome and potential development of CHD, suggests a linked pathophysiological mechanism, which might be similar to that of endocardial fibrosis.
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Serra C, Rizzello F, Pratico’ C, Felicani C, Fiorini E, Brugnera R, Mazzotta E, Giunchi F, Fiorentino M, D’Errico A, Morselli-Labate AM, Mastroroberto M, Campieri M, Poggioli G, Gionchetti P. Real-time elastography for the detection of fibrotic and inflammatory tissue in patients with stricturing Crohn's disease. J Ultrasound 2017; 20:273-284. [PMID: 29204231 PMCID: PMC5698189 DOI: 10.1007/s40477-017-0265-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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: 07/06/2017] [Accepted: 09/28/2017] [Indexed: 12/21/2022] Open
Abstract
PURPOSE The distinction between active inflammation and fibrosis of the bowel wall is essential for therapeutic decisions in stricturing Crohn's disease. We aimed to assess whether real-time elastography (RTE) with strain ratio measurement could be useful in differentiating fibrotic from inflamed bowel strictures and to evaluate the possible relationship between US techniques and the histology of the stenotic bowel wall. MATERIALS AND METHODS Bowel ultrasonography (including RTE, color-Doppler and CEUS examination) was prospectively evaluated in 26 patients with symptomatic stricturing Crohn's disease, before surgery. RTE was adopted to evaluate bowel stiffness: five loops of 20 RTE frames were recorded for each stenotic segment and the mean strain ratio (MSR) was obtained. Histology scoring systems both for inflammation and fibrosis were established for surgical specimens. RESULTS No significant correlation was found between MSR and fibrosis score (P = 0.877). Color-Doppler score was significantly related to gut wall and submucosal thicknesses (P = 0.006 and P = 0.032, respectively). There was no significant correlation between the number of vessels counted at histology and color-Doppler and CEUS examinations (P = 0.170 and P = 0.302, respectively). CONCLUSION MSR detection was not able to distinguish fibrotic from inflammatory tissue in our selected population. This result could be influenced by the presence of the superimposed inflammation. Larger cohort of patients, further analysis with shear wave elastography, and validated histopathology classification systems for fibrosis and inflammation are necessary to assess if intestinal fibrosis could be reliably detected on the basis of bowel elastic properties.
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Affiliation(s)
- Carla Serra
- Department of Organ Failure and Transplantation, Ultrasound Unit, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Fernando Rizzello
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, Sant’Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy
| | - Chiara Pratico’
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, Sant’Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy
| | - Cristina Felicani
- Department of Organ Failure and Transplantation, Ultrasound Unit, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Erica Fiorini
- Department of Organ Failure and Transplantation, Ultrasound Unit, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Ramona Brugnera
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, Sant’Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy
| | - Elena Mazzotta
- Department of Organ Failure and Transplantation, Ultrasound Unit, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Francesca Giunchi
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), “F. Addarii” Institute of Oncology and Transplant Pathology, Alma Mater Studiorum-University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Michelangelo Fiorentino
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), “F. Addarii” Institute of Oncology and Transplant Pathology, Alma Mater Studiorum-University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Antonietta D’Errico
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), “F. Addarii” Institute of Oncology and Transplant Pathology, Alma Mater Studiorum-University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Antonio Maria Morselli-Labate
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, Sant’Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy
| | - Marianna Mastroroberto
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, Sant’Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy
| | - Massimo Campieri
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, Sant’Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy
| | - Gilberto Poggioli
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, Sant’Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy
| | - Paolo Gionchetti
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, Sant’Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy
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Sarassa C, Sarassa V, Restrepo R, Angarita LÁ, Herrera AM. Limitation of Knee Flexion by a Fibrotic Band of a Fifth Component of the Quadriceps Muscle in a Child: A Case Report. JBJS Case Connect 2017; 7:e87. [PMID: 29286971 DOI: 10.2106/jbjs.cc.16.00276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
CASE We describe the case of a 3-year-old boy who presented with limited flexion in the left knee. High-resolution magnetic resonance imaging allowed visualization of a fibrotic muscle band in the anatomic position of the fifth component of the quadriceps muscle, which was confirmed by surgical findings. After surgical resection, the patient achieved full recovery of range of motion of the knee. CONCLUSION To our knowledge, this is the first reported case of a fibrotic muscle band in the anatomic position of a previously described fifth accessory component of the quadriceps muscle that caused limited knee flexion in a child.
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Affiliation(s)
- Carlos Sarassa
- Universidad Pontificia Bolivariana Medical School, Medellín, Colombia
- Pediatric Orthopedics, Alliance Hospital Santa Ana Clinica Noel, Pediatric Orthopedics CORA Group, Medellín, Colombia
- Pediatric Orthopedics (C.S.) and Epidemiology Unit (A.M.H.), Clìnica del Campestre, Medellín, Colombia
| | - Verónica Sarassa
- Universidad Pontificia Bolivariana Medical School, Medellín, Colombia
| | - Rodrigo Restrepo
- Department of Osteomuscular Radiology and Imaging, CediMed, Medellín, Colombia
| | | | - Ana Milena Herrera
- Pediatric Orthopedics (C.S.) and Epidemiology Unit (A.M.H.), Clìnica del Campestre, Medellín, Colombia
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Fernandez LA, Romaguera R, Viciana AL, Ruiz P, Tzakis AG, Ricordi C. Pulmonary Embolism with Bone Fragments following Vertebral Body Marrow Infusion for Tolerance Induction. Cell Transplant 2017; 5:513-6. [PMID: 8800520 DOI: 10.1177/096368979600500411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Protocols of donor bone marrow infusion for tolerance induction are receiving increasing attention in clinical trials of organ allotransplantation. We report pulmonary embolism with bone fragments following vertebral body marrow infusion in a recipient of a liver and intestinal transplant. Even though pulmonary embolism with bony microfragments has been widely described following bone marrow transplantation, the use of single, high-dose donor bone marrow infusion and/or multiple infusions currently under clinical investigation for induction of donor specific unresponsiveness, may warrant the implementation of additional steps in the vertebral body marrow processing technique to decrease or eliminate the component of bony microfragments in the final preparation.
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Affiliation(s)
- L A Fernandez
- Veterans Administration Medical Center, Division of Surgery, Miami, FL, USA
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Wei S, Li D, Zhang Y, Su L, Zhang Y, Wang Q, Yang D, Li D, Yang Y, Ma S. Perivascular radiofrequency renal denervation lowers blood pressure and ameliorates cardiorenal fibrosis in spontaneously hypertensive rats. PLoS One 2017; 12:e0176888. [PMID: 28453557 PMCID: PMC5409529 DOI: 10.1371/journal.pone.0176888] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 04/19/2017] [Indexed: 12/30/2022] Open
Abstract
Background Catheter-based renal denervation (RDN) is a promising approach to treat hypertension, but innervation patterns limit the response to endovascular RDN and the post-procedural renal artery narrowing or stenosis questions the endovascular ablation strategy. This study was performed to investigate the anti-hypertensive and target organ protective effects of perivascular RDN in spontaneously hypertensive rats (SHR). Methods SHR and normotensive Wistar-Kyoto (WKY) rats were divided into sham group (n = 10), radiofrequency ablation group (n = 20) in which rats received bilateral perivascular ablation with radiofrequency energy (2 watts), and chemical (10% phenol in 95% ethanol) ablation group (n = 12). The tail-cuff blood pressure was measured before the ablation and on day 14 and day 28 after the procedure. The plasma levels of creatinine, urea nitrogen, and catecholamines, urinary excretion of electrolytes and protein, and myocardial and glomerular fibrosis were analyzed and compared among the groups on day 28 after the procedure. Results We identified that 2-watt is the optimal radiofrequency power for perivascular RDN in rats. Perivascular radiofrequency and chemical ablation achieved roughly comparable blood pressure reduction in SHR but not in WKY on day 14 and day 28 following the procedure. Radiofrequency-mediated ablation substantially destroyed the renal nerves surrounding the renal arteries of both SHR and WKY without damaging the renal arteries and diminished the expression of tyrosine hydroxylase, the enzyme marker for postganglionic sympathetic nerves. Additionally, perivascular radiofrequency ablation also decreased the plasma catecholamines of SHR. Interestingly, both radiofrequency and chemical ablation decreased the myocardial and glomerular fibrosis of SHR, while neither increased the plasma creatinine and blood urea nitrogen nor affected the urinary excretion of electrolytes and protein when compared to sham group. Conclusions Radiofrequency-mediated perivascular RDN may become a feasible procedure against hypertension, and provide similar anti-hypertensive and target organ protective effects as does the chemical ablation.
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Affiliation(s)
- Shujie Wei
- Department of Cardiology, Chengdu Military General Hospital, Chengdu, Sichuan, China
| | - Dan Li
- Department of Cardiology, Chengdu Military General Hospital, Chengdu, Sichuan, China
- Department of Internal Medicine, Shapingba People's Hospital, Chongqing, China
| | - Yan Zhang
- Department of Cardiology, Chengdu Military General Hospital, Chengdu, Sichuan, China
| | - Linan Su
- Department of Cardiology, Chengdu Military General Hospital, Chengdu, Sichuan, China
| | - Yunrong Zhang
- Department of Cardiology, Chengdu Military General Hospital, Chengdu, Sichuan, China
| | - Qiang Wang
- Department of Cardiology, Chengdu Military General Hospital, Chengdu, Sichuan, China
| | - Dachun Yang
- Department of Cardiology, Chengdu Military General Hospital, Chengdu, Sichuan, China
| | - De Li
- Department of Cardiology, Chengdu Military General Hospital, Chengdu, Sichuan, China
| | - Yongjian Yang
- Department of Cardiology, Chengdu Military General Hospital, Chengdu, Sichuan, China
- * E-mail: (SM); (YY)
| | - Shuangtao Ma
- Department of Cardiology, Chengdu Military General Hospital, Chengdu, Sichuan, China
- * E-mail: (SM); (YY)
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Abstract
External Iliac Artery Endofibrosis (EIAE) is an uncommon disease usually affecting young, otherwise healthy, patients. It usually involves cyclists but cases have been reported in other groups of endurance athletes. The external iliac artery is the most affected anatomical site but other locations are described too. The precise pathophysiology and long-term evolution of the disease still remain unknown. The diagnosis may be challenging and delayed as the patients usually present symptoms only in extreme conditions and physical and instrumental examinations may be normal at rest. We present two cases of young professional cyclists who suffered of exercise-induced leg pain which led them to reduce running. Both patients were firstly treated with balloon angioplasty that rapidly failed to improve their symptoms. The successive open surgery with endofibrosectomy and autologous saphenous vein closure patch completely resolved physical limitations. EIAE is a rare disease that can induce arterial stenosis, thrombosis, dissection and secondary atheroma. After-exercise ankle-brachial index represents a useful diagnostic criterion. Careful observation of angio-CT may strengthen the suspect. Knowledge of the these features allows a better pre-operative assessment and an early effective treatment. Surgical revascularization remains the gold standard approach.
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Cameli M, Mondillo S, Righini FM, Lisi M, Dokollari A, Lindqvist P, Maccherini M, Henein M. Left Ventricular Deformation and Myocardial Fibrosis in Patients With Advanced Heart Failure Requiring Transplantation. J Card Fail 2016; 22:901-907. [PMID: 26952240 DOI: 10.1016/j.cardfail.2016.02.012] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [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: 08/02/2015] [Revised: 02/23/2016] [Accepted: 02/29/2016] [Indexed: 01/26/2023]
Abstract
PURPOSE To evaluate potential relationships between different components of left ventricular (LV) function and histopathological evidence for myocardial fibrosis in patients undergoing heart transplantation. METHODS The study population included patients with advanced heart failure, referred for an echocardiographic examination before heart transplantation. Traditional LV function measurements and global longitudinal strain (GLS) by speckle tracking echocardiography, averaging all LV segments in 4-, 2-, and 3-chamber views were obtained in all subjects. LV tissue samples were obtained from all patients who underwent heart transplantation. Myocardial fibrosis was assessed using Masson's staining. RESULTS Of 106 patients referred for cardiac transplantation, 47 underwent cardiac transplantation and were enrolled in the study. LV myocardial fibrosis and its grade strongly correlated with GLS (r = 0.75, P = .0001), modestly with global circumferential strain and LV torsion (r = 0.61, P = .001 and r = 0.52, P = .01, respectively) and weakly with mitral S' wave (r = -0.41; P = .01) and mitral annular plane systolic excursion (r = -0.35; P = .05) but did not correlate with LV ejection fraction (r = -0.12; P = NS). GLS had the strongest accuracy for detecting LV fibrosis (area under the curve, 0.92). None of the echo parameters correlated with patient's exercise capacity. CONCLUSION Global longitudinal strain is the most accurate LV global function measure that correlates with the extent of myocardial fibrosis in patients with advanced systolic HF requiring heart transplantation.
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Affiliation(s)
- Matteo Cameli
- Department of Public Health and Clinical Medicine, Heart Centre, Umeå University, Umeå, Sweden; Department of Cardiovascular Diseases, University of Siena, Siena, Italy.
| | - Sergio Mondillo
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | | | - Matteo Lisi
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | | | - Per Lindqvist
- Department of Public Health and Clinical Medicine, Heart Centre, Umeå University, Umeå, Sweden
| | | | - Michael Henein
- Department of Public Health and Clinical Medicine, Heart Centre, Umeå University, Umeå, Sweden
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Lee M, Perry L, Granzow J. Suction Assisted Protein Lipectomy (SAPL) Even for the Treatment of Chronic Fibrotic and Scarified Lower Extremity Lymphedema. Lymphology 2016; 49:36-41. [PMID: 29906063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Chronic lymphedema results from the accumulation of adipose tissue and fibrotic solids and poses a significant challenge for the treating clinician. Despite its many challenges, chronic lymphedema can be safely and effectively treated using a minimally invasive technique known as suction assisted protein lipectomy (SAPL). We present the use of SAPL in a 65-year-old female with a history of chronic, congenital, non-compressible, solid predominant lymphedema for over 40 years. Her lymphedema was complicated by multiple episodes of severe cellulitis that often required hospitalization and treatment with intravenous antibiotics. The patient also had an excisional procedure designed to debulk the lymphedema swelling performed over 35 years prior by an outside provider. The procedure resulted in substantial scarring and fibrosis between the skin and underlying fascia over a significant area of the leg with only minimal improvement in symptoms. Following SAPL, a stable excess volume reduction of 86% was achieved along with a significant improvement in range of motion of the knee. Furthermore, the patient had no further episodes of recurrent cellulitis. We have found SAPL to be effective even in patients with complex, chronic lymphedema presentations with extensive preexisting scarring from prior surgery..
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Wei DY, Yan L, Wang HQ. Analysis on two postmenopausal women with clinical symptoms resulting from completely encapsulated intrauterine device by fibrous tissue. CLIN EXP OBSTET GYN 2016; 43:911-913. [PMID: 29944252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To report two cases of retained intrauterine device (IUD) encapusulated by fibrous tissues. CASES Two cases of post-menopausal women had a history of using IUD for over 30 years with clinical symptoms resulting from completely encapsulated intrauterine device by fibrous tissue and the IUDs were successfully removed through hysteroscopic and open surgery. CONCLUSIONS IUD could be severely encapsulated by fibrous tissue. The removal is possible with a good understanding of the pathogenetic condition and a skilled operation under hysteroscopy.
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Ji ZX, Qi X, Tu SC, Wang G, Li SQ. [Fibrous dysplasia of proximal femur: a case report and review literatures]. Zhongguo Gu Shang 2015; 28:559-561. [PMID: 26255485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Pettersson GB, Hussain ST, Ramankutty RM, Lytle BW, Blackstone EH. Reconstruction of fibrous skeleton: technique, pitfalls and results. Multimed Man Cardiothorac Surg 2014; 2014:mmu004. [PMID: 24947975 DOI: 10.1093/mmcts/mmu004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [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] [Indexed: 06/03/2023]
Abstract
Destruction of the mitral-aortic (or mitroaortic) intervalvular fibrosa (IVF) by infective endocarditis is a marker of advanced pathology. Patients are at high risk, as they are sicker, have more comorbidities and have more advanced pathology, requiring a difficult operation that includes debriding and reconstructing the IVF. The anatomy and surgical techniques for that reconstruction are presented and discussed. Operative risk is high and remains high for the first year, before becoming equivalent to that of conventional operations for endocarditis. Current outcomes are better than in the past, but there is room for further improvement.
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Affiliation(s)
- Gösta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Syed T Hussain
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Rajesh M Ramankutty
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Bruce W Lytle
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
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Havre RF, Leh S, Gilja OH, Ødegaard S, Waage JE, Baatrup G, Nesje LB. Strain assessment in surgically resected inflammatory and neoplastic bowel lesions. Ultraschall Med 2014; 35:149-158. [PMID: 23154869 DOI: 10.1055/s-0032-1325535] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PURPOSE To investigate whether ultrasound-based strain imaging can discriminate between colorectal adenocarcinomas and stenotic Crohn's lesions in newly resected surgical specimens. MATERIALS AND METHODS Resected surgical specimens from 27 patients electively operated for colorectal tumors or stenotic lesions from Crohn's disease were prospectively examined with ultrasonography using a Hitachi HV 900 US scanner with real-time elastography (RTE). Three different methods were applied to assess tissue strain: A four-level categorical visual classification, a continuous visual analog scale (VAS, 0 - 100) and a strain ratio (SR) measurement between the lesion and surrounding reference tissue. The imaged sections were marked and subsequently examined by a pathologist. Results from RTE were evaluated according to diagnosis, degree of fibrosis, inflammatory parameters, tumor stage and grade. RESULTS 16 sections from Crohn's lesions, 18 sections from adenocarcinomas and 4 sections from adenomas were examined. Both adenocarcinomas and Crohn's lesions were found to be harder than the surrounding tissue, but they could not be discriminated from each other by any of the strain imaging evaluation methods. All adenocarcinomas had significantly higher strain ratios than adenomas. The categorical classification differentiated poorly between Crohn's lesions, adenocarcinomas and adenomas. Categorical evaluation and VAS score showed fair interobserver agreement. SR measurements provided semi-quantitative strain data and added improved information about elasticity properties, despite substantial intra-observer variation. CONCLUSION Sonoelastography with SR measurements and visual evaluation of strain differences could not differentiate stenotic Crohn's lesions from adenocarcinomas in resected bowel specimens. A small number of adenomas were found to be significantly softer than adenocarcinomas using the same evaluation methods. The tumor stage or grade did not have a significant impact on the elastography results.
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Affiliation(s)
- R F Havre
- Institute of Medicine, University of Bergen
| | - S Leh
- The Gade Institute, University of Bergen
| | - O H Gilja
- National Centre for Ultrasound in Gastroenterology, Department of Medicine, Haukeland University Hospital, Institute of Medicine, Bergen
| | - S Ødegaard
- Institute of Medicine, University of Bergen
| | - J E Waage
- Department of Surgery, Haukeland University Hospital, Bergen
| | - G Baatrup
- Institute of Surgery, University of Bergen
| | - L B Nesje
- Institute of Medicine, University of Bergen
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Kajmaković BM, Džamić ZM, Dragićević S, Aćimović M, Milojević B, Djokić JH. Diagnostic and therapeutic protocol in the treatment of hypo functional kidney. Acta Chir Iugosl 2014; 61:113-118. [PMID: 25782238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Laparoscopic nephrectomy is indicated in the treatment of many benign conditions of the kidneys. Hydronephrosis caused by obstruction of the ureter, either internal, or external, is one of the main indications for laparoscopic reconstruction. If an obstruction is prolonged, consequently, it leads to chronic inflammatory process accompanied by persistent and recurrent pain with fever, which eventually become resistant to therapy. If not operated sufficiently fast to resolve the causes, as a consequence it leads to hypofunction and ultimately afunction of affected kidney. In such a situation, the only therapeutic option is surgical treatment. By analyzing the case, we will try to illustrate the diagnostic algorithm and therapeutic treatment modality.
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Abstract
BACKGROUND Total knee arthroplasty (TKA) and related interventions such as revision TKA and the treatment of infected TKAs are commonly performed procedures. Hospital readmission rates are used to measure hospital performance, but risk factors (both medical and surgical) for readmission after TKA, revision TKA, and treatment for the infected TKA have not been well characterized. QUESTIONS/PURPOSES We measured (1) the unplanned hospital readmission rate in primary TKA and revision TKA, including antibiotic-spacer staged revision TKA to treat infection. We also evaluated (2) the medical and surgical causes of readmission and (3) risk factors associated with unplanned hospital readmission. METHODS This retrospective cohort study included a total of 1408 patients (1032 primary TKAs, 262 revision TKAs, 113 revision of infected TKAs) from one institution. All hospital readmissions within 90 days of discharge were evaluated for timing and cause. Diagnoses at readmission were categorized as surgical or medical. Readmission risk was assessed using a Cox proportional hazards model that incorporated patient demographics and medical comorbidities. RESULTS The unplanned readmission rate for the entire cohort was 4% at 30 days and 8% at 90 days. At 90 days postoperatively, revision of an infected TKA had the highest readmission rate, followed by revision TKA, with primary TKA having the lowest rate. Approximately three-fourths of readmissions were the result of surgical causes, mostly infection, arthrofibrosis, and cellulitis, whereas the remainder of readmissions were the result of medical causes. Procedure type (primary TKA versus revision TKA or staged treatment for infected TKA), hospital stay more than 5 days, discharge destination, and a fluid/electrolyte abnormality were each associated with risk of unplanned readmission. CONCLUSIONS Patients having revision TKA, whether for infection or other causes, are more likely to have an unplanned readmission to the hospital than are patients having primary TKA. When assessing hospital performance for TKA, it is important to distinguish among these surgical procedures.
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Affiliation(s)
- William W. Schairer
- Department of Orthopaedic Surgery, University of California San Francisco, 500 Parnassus Avenue, MU 320W, San Francisco, CA 94143-0728 USA
| | - Thomas P. Vail
- Department of Orthopaedic Surgery, University of California San Francisco, 500 Parnassus Avenue, MU 320W, San Francisco, CA 94143-0728 USA
| | - Kevin J. Bozic
- Department of Orthopaedic Surgery, University of California San Francisco, 500 Parnassus Avenue, MU 320W, San Francisco, CA 94143-0728 USA
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Fiogbe MA, Gbenou AS, Magnidet ER, Biaou O. Distal quadricepsplasty in children: 88 cases of retractile fibrosis following intramuscular injections treated in Benin. Orthop Traumatol Surg Res 2013; 99:817-22. [PMID: 24094890 DOI: 10.1016/j.otsr.2013.04.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 04/12/2013] [Accepted: 04/19/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Retractile fibrosis of the quadriceps (RFQ) is a physical and social handicap in children, and often results from a past history of quadriceps intramuscular injection. The aim of this study was to evaluate the therapeutic results of RFQ treated by distal quadricepsplasty using a modified Thompson-Payr procedure (DQPMTP). HYPOTHESIS Functional recovery will be good with DQPMTP. PATIENTS AND METHODS This is a descriptive retrospective 10-year study from 2002 to 2011, including 74 children (88 knees) less than 15 years old, admitted for RFQ and treated in Benin. The types of RFQ were: knee flexion loss of motion 16 cases (18.2%), lag of extension 54 cases (61.4%) and associated genu recurvatum, 18 cases (20.5%). Wasting of the thigh was found in all cases. An associated distal femoral osteotomy was performed to correct a bone deformity in 18 cases (20.5%). RESULTS There were 16 cases (18.2%) of poorly looking postoperative scars and 2 cases (2.3%) of fracture during physical therapy. Mean flexion ROM after surgery was 77.7°. Mean flexion increased from 77.7° to 108.5° following postoperative rehabilitation or a mean gain of 30.7°. The quadriceps muscle testing scores were at least 3/5. Results of DQPMTP were good in 80.7% of cases, as shown by mean active knee flexion of 108.5° with normal active extension. The results were satisfactory in 17 cases (19.3%). DISCUSSION DQPMTP has the advantage of cutting a minimum of blood vessels, thus limiting the risk of hematoma. Laterally placed incisions create less tension reducing the risk of skin necrosis. The clinical and radiological results of this series confirm those in the literature. Treatment of RFQ by DQPMTP provides satisfactory functional rehabilitation in patients, which confirms our hypothesis. LEVEL OF EVIDENCE Level IV, retrospective study without comparison.
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Affiliation(s)
- M-A Fiogbe
- Clinique universitaire de chirurgie pédiatrique/CNHU-HKM, 02 BP 8229, Cotonou, Benin.
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Scanzello CR, Albert AS, DiCarlo E, Rajan KB, Kanda V, Asomugha EU, Swaim BH, Katz JN, Goldring SR, Richmond JC, McKeon B. The influence of synovial inflammation and hyperplasia on symptomatic outcomes up to 2 years post-operatively in patients undergoing partial meniscectomy. Osteoarthritis Cartilage 2013; 21:1392-9. [PMID: 23973154 PMCID: PMC3753697 DOI: 10.1016/j.joca.2013.05.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 04/24/2013] [Accepted: 05/13/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Synovitis is associated with pain and other symptoms in patients with knee osteoarthritis (OA), and in patients with meniscal tears even in the absence of radiographic OA. Patients undergoing arthroscopic partial meniscectomy were followed for 2 years to determine whether synovitis predicts post-operative symptoms. DESIGN Thirty-three patients scheduled for arthroscopy were recruited for this pilot study. Symptoms were assessed using a knee pain scale, the Lysholm score, and the short form-12 (SF-12(®)) pre-operatively and at 16 weeks, 1 year and 2 years post-operatively. Synovial inflammation and hyperplasia were graded on surgical biopsies. Linear mixed effects models were tested to determine whether inflammation or hyperplasia is associated with outcome scores over time. RESULTS Lysholm scores and SF-12(®) physical component sub-scores were worse pre-operatively in patients with inflammation (Lysholm: 52.42 [95% confidence interval (CI) 42.37, 62.47] vs 72.38 [66.03, 78.72], P < 0.001; SF-12: 36.81 [28.26, 45.37] vs 46.23 [40.14, 52.32], P < 0.05). Up to 2-years post-operatively, patients with inflammation achieved mean scores similar to those without inflammation. As a result, the mean improvement in Lysholm scores was 13.01 [1.48-24.53] points higher than patients without inflammation, P = 0.03. 33% (4/12) of patients with inflammation still had fair to poor Lysholm scores 2 years after surgery compared to 7% (1/15, P=0.14) without inflammation. No association between hyperplasia and symptoms was noted. CONCLUSIONS In this pilot study of patients undergoing partial meniscectomy, synovial inflammation was associated with worse pre-operative symptoms, but not with poorer outcomes in the first 2 years post-arthroscopy. Larger cohorts and longer follow-up should be pursued to confirm this relationship, and determine if the initial response is sustained.
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Affiliation(s)
- C R Scanzello
- Section of Rheumatology, Rush University Medical Center, Chicago, IL 60612, USA.
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Albanopoulos K, Tsamis D, Leandros E. Reactive inflammatory mass in the greater omentum: an unusual complication after a bariatric operation. Surg Obes Relat Dis 2013; 9:e72-3. [PMID: 23602494 DOI: 10.1016/j.soard.2013.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Revised: 03/07/2013] [Accepted: 03/07/2013] [Indexed: 11/18/2022]
Affiliation(s)
- Konstantinos Albanopoulos
- First Department of Propaedeutic Surgery, Hippokrateion General Hospital, Athens Medical School, University of Athens, Greece
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Huang LY, Zhang B, Cui J, Liu YX, Wu CR, Lin SJ. Sequential therapy for patients with cirrhosis complicated by common bile duct stones and moderate to severe gastroesophageal varices. Chin Med J (Engl) 2012; 125:4312-4314. [PMID: 23217406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Affiliation(s)
- Liu-Ye Huang
- Department of Gastroenterology, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, China
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Mishra PK, Goel N, Saluja SS, Durga G, Nag HH, Narang P. Management of giant fibrovascular polyp of esophagus. Am Surg 2012; 78:E538-E540. [PMID: 23265116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Pramod Kumar Mishra
- Department of Gastrointestinal Surgery, Gobind Ballabh Pant Hospital & Maulana Azad, Medical College, New Delhi, India
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Abraham GP, Das K, Ramaswami K, Siddaiah AT, George DP, Abraham JJ, Thampan OS. Transperitoneal laparoscopic dismembered pyeloplasty in unusual circumstances--is the outcome comparable to that achieved in familiar pathologies? Urology 2012; 79:1057-62. [PMID: 22546383 DOI: 10.1016/j.urology.2012.01.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Revised: 01/23/2012] [Accepted: 01/27/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare the operative outcome, morbidity profile, and functional outcome after transperitoneal laparoscopic dismembered pyeloplasty for ureteropelvic junction obstruction in unusual circumstances (intrinsic pathology in anomalous kidneys or unusual extrinsic pathologies; group 1) to the outcome after this procedure in familiar pathologies (normally located kidneys with intrinsic dysfunctional segment or extrinsic compression due to a crossing vessel; group 2). METHODS The patients were evaluated in detail. All patients underwent transperitoneal laparoscopic dismembered pyeloplasty. The operative and postoperative parameters were recorded. Patients were followed up after the procedure on a 3-month protocol. Imaging was repeated at 1 year. No intervention during the follow-up period (ie, nephrostomy, ureteral stenting, or redo pyeloplasty) and improvement in the hydronephrosis grade and diuretic renogram parameters was interpreted as procedural success. The operative, postoperative, and follow-up parameters in the 2 groups were compared. RESULTS Group 1 included 17 patients with intrinsic pathologic features and renal anomalies with ureteropelvic junction obstruction due to unusual extrinsic pathology. All procedures were successfully completed with the laparoscopic approach. A significant difference was noted in the mean operative duration (group 1, 196.9 ± 10.3 minutes; group 2, 125.44 minutes, P = .00). The other operative and postoperative parameters were comparable. No significant operative or postoperative events were noted. A total of 14 patients (group 1) completed the 1-year follow-up protocol. The success rate was 92.9% (13 of 14) in group 1 and 97.9% (44 of 45) in group 2 (P = .42). CONCLUSION The procedural duration for laparoscopic dismembered pyeloplasty in unusual circumstances is longer than in familiar pathologies. However, the morbidity profile and functional outcome in these 2 scenarios were comparable.
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Choi SR, Baek SH, Kim US. Dissociated vertical deviation in congenital fibrosis of the extraocular muscles. Graefes Arch Clin Exp Ophthalmol 2012; 251:1007-8. [PMID: 22415008 DOI: 10.1007/s00417-012-1984-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 02/20/2012] [Accepted: 02/22/2012] [Indexed: 11/24/2022] Open
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Salemis NS, Gemenetzis G, Lagoudianakis E. Gossypiboma of the breast. Am Surg 2012; 78:E125-E126. [PMID: 22524733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Yiu KH, Marsan NA, Delgado V, Biermasz NR, Holman ER, Smit JWA, Feelders RA, Bax JJ, Pereira AM. Increased myocardial fibrosis and left ventricular dysfunction in Cushing's syndrome. Eur J Endocrinol 2012; 166:27-34. [PMID: 22004909 DOI: 10.1530/eje-11-0601] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Active Cushing's syndrome (CS) is associated with cardiomyopathy, characterized by myocardial structural, and ultrastructural abnormalities. The extent of myocardial fibrosis in patients with CS has not been previously evaluated. Therefore, the objective of this study was to assess myocardial fibrosis in CS patients, its relationship with left ventricular (LV) hypertrophy and function, and its reversibility after surgical treatment. DESIGN AND METHODS Fifteen consecutive CS patients (41±12 years) were studied together with 30 hypertensive (HT) patients (matched for LV hypertrophy) and 30 healthy subjects. Echocardiography was performed in all patients including i) LV systolic function assessment by conventional measures and by speckle tracking-derived global longitudinal strain, ii) LV diastolic function assessment using E/E', and iii) myocardial fibrosis assessment using calibrated integrated backscatter (IBS). Echocardiography was repeated after normalization of cortisol secretion (14±3 months). RESULTS CS patients showed the highest value of calibrated IBS (-15.1±2.5 dB) compared with HT patients (-20.0±2.6 dB, P<0.01) and controls (-23.8±2.4 dB, P<0.01), indicating increased myocardial fibrosis independent of LV hypertrophy. Moreover, calibrated IBS in CS patients was significantly related to both diastolic function (E/E', r=0.79, P<0.01) and systolic function (global longitudinal strain, r=0.60, P=0.02). After successful surgical treatment, calibrated IBS normalized (-21.0±3.8 vs -15.1±2.5 dB, P<0.01), suggestive of regression of myocardial fibrosis. CONCLUSIONS Patients with CS have increased myocardial fibrosis, which is related to LV systolic and diastolic dysfunction. Successful treatment of CS normalizes the extent of myocardial fibrosis. Therefore, myocardial fibrosis appears to be an important factor in the development and potential regression of CS cardiomyopathy.
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Affiliation(s)
- Kai Hang Yiu
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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Almonte C, Gupta JD, Serou M, Neitzschman HR. Radiology case of the month. Progressive loss of knee extension post anterior cruciate ligament reconstruction. Localized anterior arthrofibrosis. J La State Med Soc 2011; 163:168-171. [PMID: 21827067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Zhu HH. [Calcifying fibrous pseudotumor of the chest: report of a case]. Zhonghua Bing Li Xue Za Zhi 2010; 39:716. [PMID: 21176547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Shah D. The role of MRI-detected left atrial delayed enhancement in selecting the right patient and choosing the optimal strategy for catheter ablation of atrial fibrillation. J Cardiovasc Electrophysiol 2010; 22:23-4. [PMID: 20840463 DOI: 10.1111/j.1540-8167.2010.01904.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Sahajanandhan R, Saravanan PA, Ponniah M, Jacob JI, Gupta AK, Nambi GI. Post-burn contracture neck with extreme microstomia and fibrosed obliterated nose: a unique airway challenge. Natl Med J India 2010; 23:281-282. [PMID: 21250583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- R Sahajanandhan
- Department of Plastic Surgery, Christian Medical College and Hospital, Vellore 632002, Tamil Nadu, India.
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Abstract
BACKGROUND Multiple modalities have been used to treat the stiff TKA, including manipulation under anesthesia (MUA), arthroscopy, and open arthrolysis. QUESTIONS/PURPOSES We reviewed the literature to address three questions: (1) How many degrees of ROM will a stiff TKA gain after MUA, arthroscopy, and open arthrolysis? (2) Does the timing of each procedure influence this gain in ROM? (3) What is the number of clinically important complications for each procedure? METHODS We performed a PubMed search of English language articles from 1966 to 2008 and identified 20 articles, mostly Level IV studies. RESULTS For patients who have arthrofibrosis after TKA, the gains in ROM after MUA and arthroscopy (with or without MUA) are similar. Open arthrolysis seems to have inferior gains in ROM. MUA is more successful in increasing ROM when performed early but still may be effective when performed late. Arthroscopy combined with MUA still is useful 1 year after the index TKA. The numbers of clinically important complications after MUA and arthroscopy (with or without MUA) are similar. CONCLUSIONS Stiffness after TKA is a common problem that can be improved with MUA and/or arthroscopic lysis of adhesions with few complications. The low quality of available literature makes it difficult to develop treatment protocols. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Sean E. Fitzsimmons
- Department of Orthopaedics, The Mount Sinai Hospital, New York, NY 10029 USA
| | | | - Michael J. Bronson
- Department of Orthopaedics, The Mount Sinai Hospital, New York, NY 10029 USA
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Iacob S, Gheorghe L, Iacob R, Gheorghe C, Hrehoreţ D, Popescu I. MELD exceptions and new predictive score of death on long waiting lists for liver transplantation. Chirurgia (Bucur) 2009; 104:267-273. [PMID: 19601457] [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: 05/28/2023]
Abstract
BACKGROUND Cirrhosis related complications, considered MELD exceptions, proved to add prognostic value to the MELD score in predicting waiting list mortality. AIM To identify the predictive value for death on a long waiting list (WL) for the complications of liver disease. METHODS During 2004-2007, 372 consecutive adult patients were listed for liver transplantation (LT). To identify the potential predictors of patient death, univariate and multivariate Cox's proportional hazards regression model was used. RESULTS In the univariate survival analysis the following variables were significant: spontaneous bacterial peritonitis, refractory ascites, hyponatremia, hepatic encephalopathy, hepatorenal syndrome, initial and current MELD score, initial and current Child-Pugh score. The independent predictors of death on our WL were: refractory ascites (p=0.002) and hepatorenal syndrome (p=0.002). Based on a logistic regression analysis a new score has been developed: Score = 1/(1+ exp(-(-4.38 + 1.34 x Refractory ascites + 0.9 x Hepatorenal syndrome + 0.15 x Current MELD). The c-statistic for the new score for prediction of death on the WL was 0.85 compared to 0.80 for current MELD score. CONCLUSION Refractory ascites and hepatorenal syndrome should add valuable points to the current MELD in order to better prioritize for LT patients included on long WL. ABBREVIATIONS Liver transplantation (LT), Model for End-Stage Liver Disease (MELD), waiting list (WL), United Network for Organ Sharing (UNOS), standard deviation (SD), receiver operating characteristic (ROC), hepatitis B virus (HBV), hepatocellular carcinoma (HCC), positive predictive value (PPV), negative predictive value (NPV), Child-Turcotte-Pugh (CTP), hepatic venous pressure gradient (HVPG).
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Affiliation(s)
- S Iacob
- Center of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest, Romania.
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Eren Dağli C, Cetinkaya A, Gelen ME, Atilla N, Kantarçeken B, Köksal N, Tanrikulu C. Oddi sphincter fibrosis due to chemotherapy agents in small cell lung cancer: case report. Tuberk Toraks 2009; 57:431-434. [PMID: 20037861] [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: 05/28/2023] Open
Abstract
A 62-year-old, man patient was diagnosed as small cell lung cancer. Cisplatin (80 mg/m(2), first day) and etoposide (100 mg/m(2), three days) chemotherapy was started for once 21 days. As the patient received third course of chemotherapy, jaundice and hyperbilirubinemia were detected. Hepatic ultrasonography showed dilated choledochus and intrahepatic biliary tract. Hepatic markers and serologic tests for viral hepatitis were found as normal. Finally endoscopic retrograde cholangiopancreatography (ERCP) was performed. Endoscopic sphincterotomy was performed in the first ERCP and two days later, second ERCP was performed and oddi sphincter was seen as fibrotic and stenotic and stent was placed. One day after the stent placement, direct bilirubin was found as 6.2 mg/dL and 10 days later laboratory parameters were detected as normal. Oddi sphincter fibrosis occurred due to lung cancer chemotherapy treatment is an interesting case for fibrosis not having been reported due to cisplatin or etoposide before.
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Affiliation(s)
- Canan Eren Dağli
- Department of Chest Diseases, Faculty of Medicine, Kahramanmaraş Sütçü Imam University, Kahramanmaraş, Turkey.
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Kumar A, Ramakrishnan TS, Sahu S, Mishra KB. Idiopathic sclerosing encapsulating peritonitis--is a preoperative diagnosis possible? Report of three cases. Surg Today 2009; 39:610-4. [PMID: 19562451 DOI: 10.1007/s00595-008-3890-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Accepted: 09/25/2008] [Indexed: 02/07/2023]
Abstract
Sclerosing encapsulating peritonitis (SEP) is a rare cause of intestinal obstruction that is usually diagnosed during a laparotomy; however, a preoperative diagnosis is possible. Sclerosing encapsulating peritonitis can be classified as primary or idiopathic and secondary types and only about 70 cases of idiopathic type have been reported since it was first described. It is characterized by a total or partial encasement of the small bowel by a thick fibrotic membrane. This report presents a series of three cases in which a diagnosis of idiopathic SEP was made preoperatively based on the clinical features and radiological findings, which were confirmed by a laparotomy and histopathology. All of the cases were successfully managed by the excision of the membrane. This report demonstrates that based on the clinical features and radiological investigations, in the absence of other plausible etiologies for intestinal obstruction, it is possible to suspect a preoperative diagnosis of SEP, thereby preventing a "surprise" finding during a laparotomy and allowing for better management.
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Affiliation(s)
- Ameet Kumar
- Department of Surgery, Air Force Hospital, Nathu Singh Road, Kanpur Cantt, UP 208004, India
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Sulewski A, Nowakowski A, Nawrot P, Szczepański P. [Forearm tumor of the soft tissue inflammatory-like etiology]. Chir Narzadow Ruchu Ortop Pol 2008; 73:313-315. [PMID: 19133431] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We write about case of 60-year-old man with a forearm tumor about 7 cm large. The change revealed to have inflammatory-like etiology. The surgery made a good result for the health and quality of life for the patient. The histopatlogy excluded the neoplastic etiology. We observed phenomenas big tumor and no pathological indication in function of medial and ulnar nerve.
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Affiliation(s)
- Adam Sulewski
- Klinika Chirurgii Kregosłupa Ortopedii Onkologicznej i Traumatologii, Uniwersytet Medyczny im. Karola Marcinkowskiego w Poznaniu.
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Cai J, Wang Y, Xuan Z, Hering J, Helton S, Espat NJ. The abdominal cocoon: a rare cause of intestinal obstruction in two patients. Am Surg 2007; 73:1133-1135. [PMID: 18092648] [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: 05/25/2023]
Abstract
The abdominal cocoon is a rare disease that is characterized by total or partial encasement of the small bowel by a thick and fibrotic membrane. After an increased number of case reports, the characteristic age group and sex distribution of abdominal cocoon have changed. Although the etiology is unknown, congenital malformation is implicated as the causative factor in the two patients in this report. Although preoperative diagnosis is a matter of challenge and usually made at laparotomy, our experience suggests that computed tomographic evidence of clustered small bowel loops encased by a thin membrane-like sac is a characteristic preoperative finding in patients with abdominal cocoon. Surgical removal of the membrane and adhesions is the most appropriate choice of therapy.
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Affiliation(s)
- Jun Cai
- Department of General Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People Republic of China
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Abstract
To evaluate the clinical and functional results of surgical treatment for fibrous deltoid muscle in children, a retrospective study has been undertaken. The data were analysed on 105 patients with age over 5 years (182 shoulders) from August 1994 to December 2004. Surgical techniques performed by the author were divided into four types: (i) type I, proximal release of intermediate portion of deltoid muscle; (ii) type II, distal release of intermediate portion of deltoid muscle; (iii) type III, lengthening of intermediate portion of deltoid muscle; and (iv) type IV, distal release of intermediate portion of deltoid muscle and transfer of posterior portion of deltoid muscle to fill the gap. Accordingly, clinical and functional results were compared among four groups. The average duration of follow-up was 3 years and 2 months (range, 2-9 years and 5 months). Overall, in 174 shoulders (95.6%, 99 patients), we had a good clinical result; in two shoulders (1.1%, two patients) a fair result; and poor result in only six shoulders (3.3%, four patients). Postoperative formation of stairstep deformity or loss of roundness of the lateral aspect of shoulder in type I: 46.2%; type II: 30.3%; type III: 16.7%; type IV: 4.3%. Generally, surgical treatment gave good results. Technique type IV had reduced rate of stairstep deformity or loss of the natural roundness of the lateral aspect of the shoulder muscle. Sixty-eight patients (98.6%) in this group achieved a satisfactory outcome.
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Affiliation(s)
- Hung Nguyen Ngoc
- Pediatric Orthopaedic Department, National Hospital of Pediatrics of Vietnam, Vietnam.
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Cross TJS, Berry PA, Akbar N, Wendon J, Thein SL, Harrison PM. Sickle liver disease--an unusual presentation in a compound heterozygote for HbS and a novel beta-thalassemia mutation. Am J Hematol 2007; 82:852-4. [PMID: 17565724 DOI: 10.1002/ajh.20971] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
A 38-year-old Ghanaian man presented with a 6-month history of worsening pruritus, jaundice, and ascites. He was previously fit and well and rarely drank alcohol. Screening tests for chronic liver disease including viral, autoimmune, and other metabolic causes including iron overload were unremarkable. A liver biopsy performed at the referring hospital demonstrated intralobular cholestasis and cirrhosis. He was listed for liver transplantation but subsequently developed sepsis with multiple organ failure and died. The sickle solubility test was positive. Blood smear showed cells consistent with liver failure and no sickle cells. Hemoglobin electrophoresis revealed HbA2 2.8%, HbF 0.5%, and HbS greater than HbA (49.6% vs. 41.3%) in the absence of blood transfusion. Sequence analysis of the beta-globin genes showed he was a compound heterozygote for the Hbs mutation at codon 6 (CAG --> GTG) and a novel mutation at position 844 of intron 2 (betaIVS2-844 C --> A). A diagnosis of sickle hepatopathy causing decompensated cirrhosis was made. This case is unusual insomuch as this patient was asymptomatic for over 35 years and represents a novel presentation of sickle cell disease. Sickle cell disease should be considered in appropriate patients when unusual presentations of liver disease arise.
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Affiliation(s)
- Timothy J S Cross
- Institute of Liver Studies, King's College Hospital, London SE5 9RS, United Kingdom.
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