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1
Le, Thong Q. "Case report of brachycephalic obstructive airway syndrome in brachycephalic dogs from Veterinary Specialist Service Hospital, Australia." Journal of Agriculture and Development 19, no. 03 (June 30, 2020): 28–38. http://dx.doi.org/10.52997/jad.5.03.2020.
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This report aimed to study symptoms and causes of brachycephalic obstructive airway syndrome (BOAS) in brachycephalic dogs and to determine appropriate surgical procedures for these symptoms by reviewing literatures and examining four case studies conducted at Veterinary Specialist Service Hospital, Underwood, Queensland, Australia. The cases included a 6-year 3-month-old Staffordshire Bull Terrier (case 1), a 1-year 5-month-old French Bulldog (case 2), an 8-month-old French Bulldog (case 3), and an 8-year 8-month Pug (case 4). Those dogs went to the Veterinary Specialist Service in a worsen state of respiratory problems, including the upper respiratory noise (case 1, 2, 3), decrease in exercise tolerance, respiratory struggling (case 1, 3), regurgitation (case 1), coughing, sleeping difficulty, respiratory stridor (case 2), nasal discharge, dyspnea, bloating, and tachypnea (case 4). Examinations revealed the causes including the elongated soft palate (case 1, 2, 3, 4), stenotic nostrils (case 2, 3, 4), tonsils inflammation (case 3) and everted laryngeal saccules (case 4). After surgery, the dogs were recovered in intensive care unit within 2 days, and then discharged. Scheduled re-examination one week later showed improvement in the respiratory health in all cases. Overall, major complications occur in 10% of cases; however, this surgery is vital and can be totally applied in Vietnam where brachycephalic dogs have become a popular companion.
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Hoffberg, Jamie Elizabeth, and Amy Koenigshof. "Evaluation of the Safety of Early Compared to Late Enteral Nutrition in Canine Septic Peritonitis." Journal of the American Animal Hospital Association 53, no. 2 (March 1, 2017): 90–95. http://dx.doi.org/10.5326/jaaha-ms-6513.
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ABSTRACT Septic peritonitis is a relatively common condition in the veterinary intensive care unit, with a classically high mortality rate. Early enteral nutrition (EEN) in critically ill humans can lead to improved outcome. This study was performed to determine the safety of early postoperative feeding in canine septic peritonitis. In this retrospective case series, 56 dogs were identified. Sixteen dogs received EEN, defined as nutrition within 24 hr of surgery; 27 received late enteral nutrition (LEN) defined as nutrition more than 24 hours following surgery; and 13 dogs had no enteral nutrition in hospital (NEN). Signalment, physical examination findings, and occurrence of pre-admission vomiting, regurgitation, and length of anorexia were the same amongst all groups. There was no significant difference in the number of gastrointestinal complications postoperatively between the EEN, LEN, and NEN groups or in the occurrence of vomiting/regurgitation postoperatively compared to preoperatively. There was no difference in the length of hospitalization between any group, although fewer dogs in the NEN group survived compared to the EEN/LEN combined group (46% [6/13] versus 81% [37/40]). This study indicates it is safe to initiate EEN without additional risk of gastrointestinal complications. Prospective studies are needed to evaluate the potential benefits of EEN in dogs with septic peritonitis.
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Kunyuan, Jiang, Li Ao(Ngao), Pan Jin, Zhu Peifang, He Baobin, Chen Faming, Lian Weikun, Wang Tianyi, and Wu Zhengzhong. "Blood gas studies in dogs with severe steam inhalation injury." Burns 13, no. 5 (October 1987): 371–76. http://dx.doi.org/10.1016/0305-4179(87)90126-4.
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Hohenhaus, Ann E., Jennifer L. Kelsey, Jamie Haddad, Lisa Barber, Matthew Palmisano, John Farrelly, and Anita Soucy. "Canine Cutaneous and Subcutaneous Soft Tissue Sarcoma: An Evidence-Based Review of Case Management." Journal of the American Animal Hospital Association 52, no. 2 (March 1, 2016): 77–89. http://dx.doi.org/10.5326/jaaha-ms-6305.
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Canine cutaneous and subcutaneous soft tissue sarcomas (STS) account for 20.3% of malignant neoplasms of the skin. This article makes recommendations for the diagnosis, treatment, and follow-up in dogs with STS, using evidence-based medicine concepts. Although our review of the literature on the management of canine STS found many of the studies to be less than rigorous, board-certified specialists in internal medicine, surgery, pathology, oncology, and radiation oncology were able to make several recommendations based on the literature review: cytology and biopsy are important for presurgical planning; wide (>3 cm margins) surgical excision decreases the likelihood of tumor recurrence; the use of a histologic grading scale is useful in predicting biologic behavior; and, in select cases, chemotherapy and radiation therapy may be beneficial adjunct treatments to surgical excision. More research is necessary to determine minimum size of surgical margins, the impact of radiation therapy on incompletely resected tumors, the ideal chemotherapy protocol for high grade STS, and the optimal methods of monitoring dogs for tumor recurrence and metastasis.
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Yoon, HY, JW Choi, H. Kim Ji, and H. Kim Jung. "Use of a double-wire woven uncovered nitinol stent for the treatment of refractory tracheal collapse in a dog: a case report." Veterinární Medicína 62, No. 2 (February 13, 2017): 98–104. http://dx.doi.org/10.17221/15/2016-vetmed.
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A 2.7 kg, 11-year-old, castrated male Maltese dog was presented for evaluation of a 2-year history of intractable coughing, dyspnoea and cyanosis. A diagnosis of tracheal collapse with myxomatous mitral valve disease was made on the basis of inspiratory and expiratory thoracic radiographs, fluoroscopy and echocardiography. Measurement for stent size selection was performed on thoracic radiographs. A 10 mm (diameter) × 70 mm (length) self-expanding double-wire woven uncovered nitinol stent was used for intratracheal implantation and was deployed under fluoroscopic guidance. On thoracic radiography seven days after surgery, the position of the stent remained unchanged. On presentation six months after surgery, the owner reported that the dog was doing well without medical management. Although studies of various intraluminal stents have been reported in dogs, to the authors’ knowledge, use of a double-wire woven uncovered nitinol stent has not been reported previously for the management of a dog with tracheal collapse. Since this particular type of stent with unfixed individual cells provided proper airway patency without stent fracture in the dog in this report, this stent might be used as an alternative to other commercially available nitinol stents in cases of thoracic inlet collapse.
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Cherrone, Karen L., Christopher S. Eich, and Jennifer J. Bonzynski. "Suspected Paraspinal Abscess and Spinal Epidural Empyema in a Dog." Journal of the American Animal Hospital Association 38, no. 2 (March 1, 2002): 149–51. http://dx.doi.org/10.5326/0380149.
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Epidural spinal cord compression was visualized myelographically in a dog presented for rapid development of paraparesis. A large, fluid-filled pocket in the epaxial musculature was found at surgery and appeared to communicate with the first lumbar vertebra. Unfortunately, cytopathological evaluation of the fluid was not performed. No etiological agents were isolated on aerobic culture. The dog responded well to decompressive surgery and medical therapy consisting of antibiotics, pain medication, and nursing care. In the veterinary literature, only two studies of spinal epidural empyema in the dog have been reported. Of these dogs, one had successful decompressive surgery performed. The other dogs in these two reports were euthanized. The dog presented in this report fully recovered. Spinal epidural empyema should be considered as a differential diagnosis in dogs presenting with a fever and a rapidly progressing myelopathy.
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Elzein, Fatehi Elnour, Abdullah Aljaberi, Abdullah AlFiaar, and Abdullah Alghamdi. "A Large Isolated Hydatid Cyst of the Adrenal Gland: A Case Report and Review of the Literature." Case Reports in Endocrinology 2016 (2016): 1–4. http://dx.doi.org/10.1155/2016/9237903.
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A 44-year-old patient presented with two-year history of (R) lumbar pain. There was a strong history of childhood animals’ contact, including dogs. A brother had multiple hydatid cysts requiring surgery. Initial ultrasound showed a large (R) adrenal mass measuring 10×9×8 cm. Subsequent CT scan confirmed a heavily calcified cyst in the (R) adrenal gland. Hormonal studies were normal. He had an uneventful course following a total adrenalectomy. Isolated adrenal hydatid is extremely rare with an incidence of less than 0.5%; however, the diagnosis should always be suspected in all patients from an endemic area presenting with an adrenal cystic mass.
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Johnson, R. L., S. S. Cassidy, R. Grover, M. Ramanathan, A. Estrera, R. C. Reynolds, R. Epstein, and J. Schutte. "Effect of pneumonectomy on the remaining lung in dogs." Journal of Applied Physiology 70, no. 2 (February 1, 1991): 849–58. http://dx.doi.org/10.1152/jappl.1991.70.2.849.
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To determine the magnitude of functional compensation after pneumonectomy and whether compensation is related to maturity of the animal at the time of resection, we performed left pneumonectomy in either adult or 10-wk-old beagles. Studies were performed in adults 7-9 mo after surgery and in puppies 18-23 mo after surgery when the dogs reached full maturity. Results were compared with those in age- and sex-matched unoperated controls. Measurements included pressure-volume relationships, pulmonary hemodynamics, rebreathing studies of lung volume, diffusing capacity and its components, lung tissue volume, and pulmonary blood flow. Computerized-tomographic scans were performed in the puppy groups to determine changes in thoracic shape and size. Morphometric analysis of the lungs was performed under light microscopy. There was partial compensation for loss of one lung by functional improvement in the remaining lung. Compensation was greater in those pneumonectomized as puppies than as adults. Volume of the remaining lung was larger than predicted for a given transpulmonary pressure in both groups. Diffusing capacity, pulmonary capillary blood volume, and lung tissue volume were larger than expected for the normal right lung. After pneumonectomy, compliance of the rib cage was greater in puppies than in adults. Weight of the costal diaphragm was reduced in pneumonectomized puppies. Pulmonary hypertension at rest did not develop, and pulmonary vascular reactivity to hypoxia was unchanged after pneumonectomy in both groups. Significant correlations were obtained between physiological and morphometric measurements.
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Martin-Suarez, E. M., A. Galan, and J. M. Molleda. "Reincident corneal epithelial inclusion cyst in a dog: a case report." Veterinární Medicína 54, No. 2 (March 9, 2009): 84–88. http://dx.doi.org/10.17221/3003-vetmed.
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An unilateral corneal epithelial inclusion cyst (CEIC) in a 8-years-old female mixed Poodle is reported. The cyst had been observed for 60 days, was unique, not congenital and only one eye was involved. One year prior to the referral the dog was treated with antibiotics due to an ocular trauma caused by a fight with a cat. In the same eye, palpebral melanocytic tumor and corneal dystrophy were also observed. In order to remove the CEIC a superficial keratectomy was performed. Collagen contact lens and topical antibiotics were the medical treatment of choice. Fifteen month after surgery the dog was referred for recurrence of the CEIC. A second keratectomy and similar topical treatment was attempted again. A second recurrence 16 months after surgery has not been observed to the date. Cytology and histology analysis of the cyst confirmed the diagnosis of the CEIC. Microbiologic studies were also realized and <i>Staphylococcus epidermidis</i> was aisled twice in fifteen months. In this case a relapsing CEIC is reported associated to <i>S. epidermidis</i> contamination. Corneal dystrophy and palpebral melanoma were concomitant lesions, although no relations with the CEIC were concluded.
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Bimadi, Muhammad Hilman, Krisna Yuarno Phatama, and Edi Mustamsir. "Does The Peroneus Longus Tendon Autograft Affect The Ankle Function? A Case Series." Hip and Knee Journal 1, no. 1 (August 19, 2020): 57–62. http://dx.doi.org/10.46355/hipknee.v1i1.6.
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Introduction: The peroneus longus (PL) tendon is one of the autograft choices for knee ligament injury because of its safety, length, and strength. However, studies that evaluated donor site morbidity after PL tendon graft are still limited. This case series aims to evaluate the functional outcomes of donor site morbidity after full-thickness PL tendon harvesting for knee ligament reconstruction.Presentation of Case:This study evaluated four patients who had a revision of knee ligament reconstruction surgery using PL tendon autograft from August until September 2018. The functional outcome of the donor site was evaluated before surgery, two weeks, and three months after surgery by using functional scores assessment of foot and ankle.Discussion:There are some donor sites of autograft, but several studies show that the PL tendon autograft has proven to be more favorable methods for knee ligament reconstruction based on the accessibility, safety, and strength of the harvested tendon. The studies also found that using PL tendon as an autograft, has a good result in donor site morbidity evaluation compared to others. This study provides a satisfying result on the functional outcome of the donor site morbidity evaluation.Conclusion:This study showed satisfactory functional outcomes of the foot and ankle after harvesting full-thickness PL tendon. All functional score assessment provides an excellent result in three months after surgery, although lateral ankle bulging has occurred in all patients. However, gait analysis and isokinetic test with a more significant number of patients and longer follow up periods are necessary for further study.
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Berkowitz, Samuel. "Ethical Issues in the Case of Surgical Repair of Cleft Palate." Cleft Palate-Craniofacial Journal 32, no. 4 (July 1995): 271–81. http://dx.doi.org/10.1597/1545-1569_1995_032_0271_eiitco_2.3.co_2.
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There are some advantages to prospective randomized clinical trials (PRCT) to resolve some limited clinical problems. But, when this method is used to determine the best surgical procedure to close the palatal cleft space, there are strong ethical considerations that cannot be overcome. There are two basic problems. The first is having the surgeon perform surgical procedures which he/she does not believe is the treatment of choice or that can be performed as skillfully as others, even after demonstrations. Secondly, this method does not consider the theoretical aspect that many clefts within the same cleft type are different in the relative size of cleft space to size of soft tissue available for closing the cleft space, thereby creating different degrees of scarring. Different outcomes to the same surgery must, therefore, result irrespective of the surgeons’ skills or treatment plans. Retrospective research studies, whether they involve one or more institutions, have been and are still very valuable in improving the knowledge base of all areas of cleft palate habilitation.
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Stehlík, Ladislav, Pavel Proks, Petra Fedorová, and Alois Nečas. "Radiographic changes of the patellar ligament in dogs after tibial tuberosity advancement." Acta Veterinaria Brno 82, no. 2 (2013): 215–18. http://dx.doi.org/10.2754/avb201382020215.
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Patellar desmopathy in dogs after tibial plateau levelling osteotomy has been described in many studies. Tibial tuberosity advancement is a biomechanically different technique. It is assumed that the patellar ligament is loaded with little force similarly as after tibial plateau levelling osteotomy. Various aspects related to secondary patellar desmopathy are not completely understood. This study deals with computed radiography measurement of patellar ligament thickness after tibial tuberosity advancement in dogs with cranial cruciate ligament rupture. The thickness of the patellar ligament in exactly predetermined locations was measured from mediolateral radiographs of stifle joints. A total of 18 dogs (20 knee joints) with cranial cruciate ligament (ligamentum cruciatum craniale) rupture underwent three radiographic examinations of the knee (preoperative examination and control examination 7 and 15 weeks after the surgery). Significant difference was found between the thickness of the patellar ligament in the first and second examinations. Some of the demographic factors possibly related to patellar ligament thickness (age, sex, body weight, type of cranial cruciate ligament rupture, arthrotomy, cage size, meniscal injury, time between surgery and radiographic examination) were analyzed. However, statistical analyses did not show any effect of these factors on the thickness of the patellar ligament, except for the time between surgery and radiographic examination. These findings can extend the surgeons’ knowledge of biomechanical aspects of tibial tuberosity advancement.
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Ito, Mamoru, Jamshid Jamshidi, and Kazunori Yamanaka. "Does Craniopharyngioma Metastasize? Case Report and Review of the Literature." Neurosurgery 48, no. 4 (April 1, 2001): 933–36. http://dx.doi.org/10.1097/00006123-200104000-00050.
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Abstract OBJECTIVE AND IMPORTANCE A rare case of recurrent craniopharyngioma at an ectopic location is described. This recurrence suggested cerebrospinal fluid seeding. CLINICAL PRESENTATION A 65-year-old man presented for follow-up of persisting visual field defect. He had undergone total resection of a suprasellar craniopharyngioma via a subfrontal approach 3 years before presentation. Recent magnetic resonance imaging scans revealed a contrast-enhancing tumor with cystic and solid components at the right temporal lobe. The primary tumor bed was intact. INTERVENTION A temporal craniotomy was performed for total resection of the tumor. Intraoperative findings revealed that the recurrent tumor was anatomically unrelated to the previous surgical track. Histological studies of the tumor specimen demonstrated a benign craniopharyngioma. Cerebrospinal fluid spreading was suspected to be the sole route for the recurrence. CONCLUSION The case presented here and a review of reports on remote recurrence of craniopharyngioma suggest that care is required during intraoperative handling of the tumor and that long-term follow-up should be performed even in patients whose primary tumor was resected completely.
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Mottaghy, K., B. Oedekoven, K. Pöppel, B. Kovacs, M. Kirschfink, K. Bruchmüller, A. Kashefi, and C. Geisen. "Heparin-Coated versus Non-Coated Surfaces for Extracorporeal Circulation." International Journal of Artificial Organs 14, no. 11 (November 1991): 721–28. http://dx.doi.org/10.1177/039139889101401108.
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Studies were made to compare completely heparin-bonded (HBS) and conventional extracorporeal circulation surfaces using capillary membrane oxygenators (CMO) in sheep and dogs for up to five days. The aims were: to investigate the need for systemic heparinization in the case of heparincoated surfaces, to assess blood compatibility and gas exchange performance of both systems and the extent of complement activation, and to find solutions for plasma leakage by the use of CMO. All studies were performed under standardized conditions, such as drugs, surgery, priming, blood flow rate etc. For heparin-coated surface studies all blood interfaces (CMO, catheters, tubes, etc) were coated. It was possible to eliminate systemic heparinization totally when HBS were used. During the five-day non-heparin application period blood coagulation parameters were almost unchanged and in the physiological range, platelets did not drop below 80%, hemolysis was negligible and gas exchange performance was unaffected. Less complement activation occurred with HBS than with non-coated surfaces
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Beck, Edward C., Benedict U. Nwachukwu, Elaine K. Lee, Reagan Chapman, Allston J. Stubbs, Matthew Gitelis, Jonathan Rasio, and Shane J. Nho. "Travel Distance Does Not Affect Outcomes in Hip Preservation Surgery: A Case for Centers of Excellence." Orthopaedic Journal of Sports Medicine 8, no. 3 (March 1, 2020): 232596712090882. http://dx.doi.org/10.1177/2325967120908821.
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Background: Previous studies have evaluated the effect of distance to high-volume centers on outcomes after joint replacement. However, there is limited evidence on whether this distance has an effect on outcomes after undergoing hip arthroscopic surgery for femoroacetabular impingement syndrome (FAIS). Purpose: To determine whether increased distance from a patient’s home to his or her primary orthopaedic clinic has an influence on the ability to achieve the minimal clinically important difference (MCID) on outcome measures after surgery for FAIS. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective cohort analysis was performed on patients undergoing surgery for FAIS by a single surgeon from January 2012 through January 2017. A total of 692 patients were identified and split into 2 groups: driving distance of <50 miles from our institution (referral group) and driving distance of <50 miles from our institution (local group). Preoperative and 2-year postoperative scores on patient-reported outcome measures (PROMs), including the Hip Outcome Score Activities of Daily Living and Sport-Specific subscales, International Hip Outcome Tool–12, and modified Harris Hip Score, were assessed. Patients achieving the MCID on any included PROM were analyzed using a chi-square analysis. Logistic regression was performed to determine whether driving distance and other demographic variables of interest had an effect on achieving the MCID. Study data were analyzed using PatientIQ, a cloud-based research and analytics platform for health care. Results: There were 647 patients who completed 2-year follow-up and were included in the analysis. Of these patients, 116 (17.9%) were identified as being ≥50 miles from their orthopaedic provider, and 531 (82.1%) were identified as having a driving distance of <50 miles. A total of 100 patients (86.2%) in the referral group reached the MCID, and 476 patients (89.6%) in the local group reached the MCID. There was no statistically significant difference in reaching the MCID on any of the included PROMs between the 2 groups ( P = .364). The same result held when controlling for a number of factors including age, body mass index, and adjusted gross income with logistic regression. Conclusion: When controlling for a number of factors including age, body mass index, and adjusted gross income, distance to a high-volume hip arthroscopic surgery center did not have an effect on postoperative outcome scores or achieving the MCID 2 years after undergoing surgery for FAIS.
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Gunn, Tyler, Gaetano Paone, Robert W. Emery, and Victor A. Ferraris. "The Case for a Conservative Approach to Blood Transfusion Management in Cardiac Surgery." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 11, no. 3 (May 2016): 157–64. http://dx.doi.org/10.1097/imi.0000000000000280.
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Limiting blood transfusion in cardiac operations is a well-meaning goal of perioperative care. Potential benefits include decreasing morbidity and limiting procedural costs. It is difficult to identify transfusion as the cause of adverse outcomes. The need for transfusion may identify a sicker patient population at greater risk for a worse outcome that may or may not be related to the transfusion. We reviewed the indications for and adverse effects of blood transfusion in patients undergoing cardiac procedures to provide a balanced approach to management of blood resources in this population. We reviewed current literature, including systematic reviews and practice guidelines, to synthesize a practice management plan in patients having cardiac operations. Several prospective randomized studies and large population cohort studies compared a postoperative restrictive transfusion policy to a more liberal policy and found very little difference in outcomes but decreased costs with a restrictive policy. Evidence-based practice guidelines and implementation standards provide robust intervention plans that can limit harmful effects of transfusion and provide safe and effective procedure outcomes. A restrictive transfusion policy seems to be safe and effective but does not necessarily provide better outcome in most patient cohorts. The implications of these findings suggest that many discretionary transfusions could be avoided. A subset of high-risk patients could undoubtedly benefit from a more liberal transfusion policy, but the definition of high risk is ill defined.
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PAVLIDOU, K., and I. SAVVAS. "Trans-diaphragmatic pressure measurement as a prognostic factor in the Intensive Care Unit in dogs." Journal of the Hellenic Veterinary Medical Society 70, no. 4 (January 27, 2020): 1851. http://dx.doi.org/10.12681/jhvms.22235.
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In the last decade, attempts to improve the quality of the services provided to the critically ill patients in the Intensive Care Unit (ICU) are of great interest in human medicine. The aim of the majority of the clinical studies is the correlation of the survival rate of a critically ill patient with specific prognostic factors at the time of admission. The detailed assessment of a patient at admission in the ICU and during hospitalization seems to affect the management and the outcome. The main aim of this study was to evaluate if the trans-diaphragmatic pressure measurement can be a prognostic factor of the outcome in the ICU in dogs. Thirty-one dogs, 21 male and 10 female was included in this prospective, cohort study. Age, breed, sex, body weight and clinical diagnosis were recorded. The type of admission, the mentation status, physiological and biochemical parameters were measured at the admission of the dog in the ICU. All the variables were assessed over the first 24 hours following ICU admission. The animals were allocated into sixgroups: peritonitis/intra-abdominal surgery, intra-thoracic surgery, respiratory disease, neurologic disease, neoplasia, and systematic disease. The trans-diaphragmatic pressure (Pdi) was measured under the same anesthetic level in all animals with two oesophageal balloon catheters. The most frequent problem for admission in ICU was peritonitis (5/31). Seventeen out of 31 were admitted in acute status while 14/31 had a chronic problem. Mean±standard deviation of Pdi was 10.7±5.6 mmHg and of lactate concentration 2.3±1.2 mmol/L. Both, they can predict outcome (p=0.071 and p=0.076, respectively). Seven out of 31 dogs died, 2 were euthanized and 22 were discharged from the ICU after hospitalization. The technique of Pdi measurement with balloon catheters can be successfully applied in dogs in the ICU. Pdi measurement, as well as lactate concentration may be used as prognostic indicators for the outcome, in dogs in the ICU. However, a bigger sample size is need to support these findings.
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Novitsky, V. O. "Features of sacroiliac joint x-ray examination in dogs." Theoretical and Applied Veterinary Medicine 9, no. 1 (2021): 47–51. http://dx.doi.org/10.32819/2021.91008.
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Sacroiliac joint instability is a fairly common pathology of the musculoskeletal system, which is observed in dogs of various breeds, sex, and age. This problem has received little attention in the research field, veterinary literature and clinical practice due to similar symptoms with more studied and treated pathologies of the musculoskeletal system, that are more common in everyday practice. Therefore, it is necessary to conduct a differential diagnosis of pathologies that are similar in clinical manifestation. Radiography remains the main method for examining bones and their joints even today. But examining the sacroiliac joint requires the development of an optimal protocol for radiography of the studied area. The research was conducted on the basis of the Clinical and Diagnostic Center of Veterinary Medicine Faculty of the Dnipro State Agrarian and Economic University for one year on 20 dogs of different age, sex, and breeds. Radiography was performed to diagnose the instability of the sacroiliac joint. A combination of a Triones tw-120 X-ray machine and an Alfa-4600 digital receiver was used for the examination. According to the results of the study, it was found that there was no significant difference between the central positioning method of the animal and the angular one for assessing the state of soft tissues, but the angular method was more suitable for assessing the state of the sacroiliac joint structures since it allowed a more detailed analysis of the state of the articular surfaces and the location of the iliac bones relative to the sacrum. This kind of x-ray examination should be performed only with sedatives. Since the position of the animal’s body on radiography is not physiological and in the case of sacroiliac joint instability there is pain, these factors will negatively affect the accuracy of the study. It was also found that the use of M-shaped pillows significantly improved the quality of the obtained X-ray image. When working with the radiograph, it is necessary to pay attention to the condition of the joint surfaces, as osteoarthritis and osteosclerosis in the future may cause instability of the sacroiliac joint. If there is an X-ray of the joint space, the congruence index should be calculated. It is important to take into account the anamnestic data of the animal, as pregnant females may have abnormalities. Compliance with the proposed protocol of diagnostic actions in case of suspicion of sacroiliac joint instability will make it possible to accurately diagnose, prescribe appropriate treatment, plan the course of the surgery and prevent the development of this pathology in the future.
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Ignjatovic, D., and R. Bergamaschi. "What role, if any, for laparoscopis surgery in Chron's disease of the hindgut?" Acta chirurgica Iugoslavica 49, no. 2 (2002): 9–12. http://dx.doi.org/10.2298/aci0202009i.
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An outsider to the Held of surgery would probably take it for granted that surgeons have a highly developed rationale for choosing a laparoscopic approach to Crohns disease. After all, an increasing number of surgeons are performing laparoscopic surgery for Crohn's disease as witnessed by several articles published in the 1990s (Table)1-19. In fact this is not quite true. Most papers are case reports or series without controls, capable only of suggesting feasibility. Furthermore, comparison studies often feature selection flaws, and therefore beg the question of whether laparoscopic surgery should or not be considered as standard care. An attempt is made herein to give readers a concise insight of the evidence available in the English language literature. It does not pretend to offer a comprehensive review of the topic rather, it highlights some relevant issues, and then outlines what role, if any, laparoscopic surgery should play in Crohn's disease. There are at least 6 categories for discussion.
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Downs, M. O., D. N. Aron, E. A. Mahaffey, and C. W. Dewey. "Acute Traumatic Intracranial Haemorrhage in Dogs and Cats." Veterinary and Comparative Orthopaedics and Traumatology 06, no. 03 (1993): 153–59. http://dx.doi.org/10.1055/s-0038-1633114.
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SummaryTwenty-three records of dogs and cats having experienced severe craniocerebral trauma were reviewed. Case selection was restricted to those patients whose brains were examined at necropsy and/or surgery. Records of 14 dogs and nine cats were evaluated for the presence or absence of intracranial haemorrhage. The majority of patients were victims of automobile trauma (n = 16), the remainder being victims of household accidents (n = 4), malicious human behavior (n = 2), and injury inflicted by another animal (n = 1). Six of the 23 (27%) were conscious upon admission. One patient was unconscious upon admission, but regained consciousness following medical therapy. Evidence of intracranial haemorrhage was found in 100% (14/14) of the canine and 89% (8/9) of the feline cases. Four dogs and four cats exhibited two forms of intracranial haemorrhage. One cat exhibited three forms of intracranial haemorrhage. The distribution of intracranial haemorrhage was as follows: two epidural, 10 subdural, 10 subarachnoid and 10 intraparenchymal. Histopathology was available for 10 of the 23 cases. Surgical confirmation of the subdural haematomas, as typical subdural haematomas (focal intradural mass lesions), was available for four cases. Gross pathology of one other of the 10 subdural hematomas described a focal, 2 × 3 cm mass lesion. The remaining five subdural haematomas were of a more diffuse nature (more typical of subarachnoid haemorrhage), but three of these five were described as massive accumulations of blood. Four patients underwent emergency craniotomy/craniectomy; two of these patients made rapid and full recoveries, one died on the operating table, and one was euthanatized at the operation because of uncontrollable brain swelling. Ninety-three percent of the canine and 75% of the feline cases had haemorrhagic lesions that would have been potentially accessible via a lateral craniotomy/craniectomy. The results of this investigation suggest that acute intracranial haemorrhage may be a relatively frequent occurrence, following severe brain injury in dogs and cats. Prospective studies are needed to better define the incidence, anatomical distribution, and potential clinical significance of acute traumatic intracranial haemorrhage in dogs and cats. Comparative aspects of acute traumatic intracranial haemorrhage in people and small animals (dogs and cats) are discussed.Twenty-three records of dogs (n = 14) and cats (n = 9) with severe craniocerebral trauma were evaluated for the presence or absence of intracranial haemorrhage. Evidence of intracranial haemorrhage was found in 96% (14 dogs, 8 cats) of the cases reviewed. Comparative aspects of acute traumatic intracranial haemorrhage in people and small animals (dogs and cats) are discussed.
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Veloso, Gilson Gabriel Viana, Raul De Almeida Dutra, Letícia De Almeida Dutra, Pedro Teixeira Meireles, Douglas Reis Abdalla, and Luiz Carlos Furtado De Almeida Júnior. "Intracranial Hemangiopericytoma – A Case Report." Asian Pacific Journal of Cancer Care 5, no. 4 (December 26, 2020): 351–54. http://dx.doi.org/10.31557/apjcc.2020.5.4.351-354.
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Hemangiopericytoma is a rare mesenchymal tumor, considered as a subtype of soft tissue sarcomas with an incidence of 3.77/10.000.000 cases. Intracranial hemangiopericytomas account for less than 1% of all primary tumors of the central nervous system. Due to the lack of data available regarding this disease, national and international research provides information derived from retrospective case series and phase I and phase II studies. This is a case report of a young adult diagnosed with intracranial hemangiopericytoma in 2012 with a history of multiple recurrences and therapeutic approaches, assisted in a public health center in southeastern Brazil. Among the treatment options given to the patient, there are surgery, radiotherapy, and systemic chemotherapy (including alkylating and anthracyclines agents). Systemic therapy usually is offered after multiple recurrences or in a metastatic setting; although it increases progression-free survival, there is not enough data on objective response rate and does not yield increased overall survival.
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Filion, C. Mario, Lucas Rodrigues, Chad Johannes, and Aleksandar Masic. "The in Vitro and in Vivo Anti-Cancer Potential of Mycobacterium Cell Wall Fraction (MCWF) Against Canine Transitional Cell Carcinoma of the Urinary Bladder." Acta Veterinaria 67, no. 4 (December 20, 2017): 477–94. http://dx.doi.org/10.1515/acve-2017-0039.
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AbstractTransitional cell carcinoma (TCC), is the most common form of urinary bladder cancer in dogs and represents 2% of all reported canine cancers. Canine TCC is usually a high-grade invasive cancer and problems associated with TCC include urinary tract obstruction and distant metastases in more than 50% of affected dogs. TCC is most commonly located in the trigone region of the bladder precluding complete surgical resection. Current treatment options for TCC in dogs include medical therapy, surgery or radiation. Mycobacterium Cell Wall Fraction (MCWF) is a biological immunomodulator derived from non-pathogenic Mycobacterium phlei. MCWF possesses a potential in multiple veterinary areas such as anticancer therapy, palliative care and treatment of infectious diseases in both small and large animals. MCWF is considered a bifunctional anti-cancer agent that induces apoptosis of cancer cells and stimulates cytokine and chemokines synthesis by cells of the immune system. Here we report the results from in vitro and in vivo studies that could suggest use of MCWF as an additional treatment option for TCC in dogs. Particularly, we demonstrated that MCWF induces a concentration dependent inhibition of proliferation of K9TCC cells which was associated with the induction of apoptosis as measured by the proteolytic activation of caspase-3 and the degradation of PARP. Furthermore, we demonstrated the safety and potential for in vivo MCWF treatment efficacy in dogs bearing stage T2 TCC by reducing clinical signs, and improving the quality of life in dogs with TCC.
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Compagnoni, Riccardo, Roberta Gualtierotti, Francesco Luceri, Fabio Sciancalepore, and Pietro Simone Randelli. "Fibromyalgia and Shoulder Surgery: A Systematic Review and a Critical Appraisal of the Literature." Journal of Clinical Medicine 8, no. 10 (September 21, 2019): 1518. http://dx.doi.org/10.3390/jcm8101518.
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Fibromyalgia is a common musculoskeletal syndrome characterized by chronic widespread pain and other systemic manifestations, which has demonstrated a contribution to higher postoperative analgesic consumption to other surgeries such as hysterectomies and knee and hip replacements. The aim of this review is to search current literature for studies considering the impact of fibromyalgia on clinical outcomes of patients undergoing shoulder surgery. A systematic literature review was conducted in PubMed/Medline, Embase, and ClinicalTrials.gov in February 2019. Studies were selected based on the following participants, interventions, comparisons, outcomes, and study design criteria: adult patients undergoing surgery for shoulder pain (P); diagnosis of fibromyalgia (I); patients without fibromyalgia (C); outcome of surgery in terms of pain or analgesic or non-steroidal anti-inflammatory drugs consumption (O); case series, retrospective studies, observational studies, open-label studies, randomized clinical trials, systematic reviews and meta-analyses were included (S). Authors found 678 articles, of which four were found eligible. One retrospective study showed that patients with fibromyalgia had worse clinical postoperative outcomes; two retrospective studies reported a higher opioid prescription in patients with fibromyalgia and one prospective observational study found that a higher fibromyalgia survey score correlated with lower quality of recovery scores two days after surgery. The scarce and low-quality evidence available does not allow confirming that fibromyalgia has an impact on postoperative outcomes in shoulder surgery. Future studies specifically focusing on shoulder surgery outcomes may help improvement and personalization of the management of patients with fibromyalgia syndrome (PROSPERO 2019, CRD42019121180).
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Smirnov, Alexander V., Vladimir R. Stankevich, Dmitriy N. Panchenkov Panchenkov, Valentin I. Sharobaro, Yuri V. Ivanov, and Yevgeny A. Velichko. "Simultaneous surgeries in bariatric surgery (literature review)." Journal of Clinical Practice 11, no. 4 (December 26, 2020): 55–63. http://dx.doi.org/10.17816/clinpract58047.
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Based on the available publications, the article presents an analysis of the studies on the simultaneous implementation of cholecystectomy, ventral and paraesophageal hernia repair during a bariatric intervention. If there is a clinical picture of chronic calculous cholecystitis, simultaneous cholecystectomy is justified and does not lead to a significant increase in the number of complications. In the case of asymptomatic gallstones, the optimal tactics remains controversial, both a surgical treatment and observation are possible. In the absence of gallstone disease, all patients after the surgical correction of the excess weight are prescribed ursodeoxycholic acid, while performing preventive cholecystectomy is not recommended. A simultaneous ventral hernia repair is justified only for small defects ( 10 cm) of the anterior abdominal wall. If a paraesophageal hernia is detected in patients with morbid obesity, bariatric surgery may be combined with cruroraphy.
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Cabon, Q., C. Deroy, F. X. Ferrand, P. Pillard, T. Cachon, D. Fau, I. Goy-Thollot, E. Viguier, and C. Carozzo. "Thoracic bite trauma in dogs and cats: a retrospective study of 65 cases." Veterinary and Comparative Orthopaedics and Traumatology 28, no. 06 (2015): 448–54. http://dx.doi.org/10.3415/vcot-15-01-0001.
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SummaryObjectives: To report a case series of thoracic bite trauma in dogs and cats and to evaluate risk factors for mortality.Methods: A retrospective study concerning thoracic bite wounds in dogs and cats was performed. Lesions were categorized by depth of penetration: no wound, superficial, deep or penetrating. Thoracic radiographic reports were reviewed. Lesion management was classified as non-surgical, wound exploration, or explorative thoracotomy.Results: Sixty-five cases were collected. Twenty-two percent of patients with normal respiratory patterns showed thoracic radio-graphic lesions. Respiratory distress was not correlated with mortality. Twenty-eight patients were presented with superficial wounds and 13 with deep wounds. Eight patients exhibited penetrating wounds. Radio-graphic lesions were observed in 77% of dogs and 100% of cats. Explorative thoracotomy was performed in 28% of patients, and surgical wound exploration in 17.2%. With the exception of skin wounds, thoracic wall discontinuity was the most frequent lesion. Thoracotomy was associated with increased length of hospitalisation but was not correlated with mortality. The mortality rate was 15.4%. No studied factor correlated with mortality, and the long-term outcomes were excellent.Clinical significance: A penetrating injury, more than three radiographic lesions, or both together seemed to be indicative of the need for a thoracotomy. In the absence of these criteria, systematic bite wound explorative surgery is recommended, with extension to thoracotomy if thoracic body wall disruption is observed.
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Vallarino, Nicolas, Steven Pil, Nausikaa Devriendt, Matan Or, Eva Vandermeulen, Gonçalo Serrano, Dominique Paepe, Tim Bosmans, and Hilde de Rooster. "Diagnostic value of blood variables following attenuation of congenital extrahepatic portosystemic shunt in dogs." Veterinary Record 187, no. 7 (October 29, 2019): e48-e48. http://dx.doi.org/10.1136/vr.105296.
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BackgroundThe aims of this study were to determine if extrahepatic portosystemic shunt (EHPSS) postoperative closure could be predicted based on preoperative blood analyses and to determine the accuracy of blood variables to evaluate persistence of portosystemic shunting postoperatively (multiple acquired portosystemic shunts (MAPSS) or persistent EHPSS).MethodsRetrospectively, 62 dogs treated surgically for congenital EHPSS that underwent postoperative trans-splenic portal scintigraphy or CT angiography three to six months postoperatively were included.ResultsNone of the studied preoperative blood variables could unambiguously predict surgical outcome. Elevated postoperative fasting venous ammonia (FA) concentration always indicated surgical failure (persistent shunting or MAPSS), but normal FA did not provide any information on the postoperative shunting status. Paired serum bile acids (SBA) were not reliable enough to confirm or exclude postoperative shunting. In the presence of low normal postoperative FA levels, elevated preprandial SBA was more likely in dogs with persistent shunting (sensitivity of 0.79, specificity of 0.83), whereas postprandial SBA below reference limit was more often observed in case of surgical success (sensitivity of 0.93, specificity of 0.67).ConclusionBlood variables, and more specifically the combination of FA and SBA, are not a valuable alternative to advanced medical imaging to reliably assess the surgical outcome after EHPSS surgery.
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Nuño, Miriam, Diana Ly, Alicia Ortega, J. Manuel Sarmiento, Debraj Mukherjee, Keith L. Black, and Chirag G. Patil. "Does 30-Day Readmission Affect Long-term Outcome Among Glioblastoma Patients?" Neurosurgery 74, no. 2 (October 30, 2013): 196–205. http://dx.doi.org/10.1227/neu.0000000000000243.
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Abstract BACKGROUND: Research on readmissions has focused mainly on the economic and resource burden it places on hospitals. OBJECTIVE: To evaluate the effect of 30-day readmission on overall survival among newly diagnosed glioblastoma multiforme (GBM) patients. METHODS: A nationwide cohort of GBM patients diagnosed between 1991 and 2007 was studied using the Surveillance, Epidemiology and End Results Medicare database. Multivariate models were used to determine factors associated with readmission and overall survival. Odds ratio, hazard ratio, 95% confidence interval, and P values were reported. Complete case and multiple imputation analyses were performed. RESULTS: Among the 2774 newly diagnosed GBM patients undergoing surgery at 442 hospitals nationwide, 437 (15.8%) were readmitted within 30 days of the index hospitalization. Although 63% of readmitted patients returned to the index hospital where surgery was performed, a significant portion (37%) were readmitted to nonindex hospitals. The median overall survival for readmitted patients (6.0 months) was significantly shorter than for nonreadmitted (7.6 months; P < .001). In a confounder-adjusted imputed model, 30-day readmission increased the hazard of mortality by 30% (hazard ratio, 1.3; P < .001). Neurological symptoms (30.2%), thromboembolic complications (19.7%), and infections (17.6%) were the leading reasons for readmission. CONCLUSION: Prior studies that have reported only the readmissions back to index hospitals are likely underestimating the true 30-day readmission rate. GBM patients who were readmitted within 30 days had significantly shorter survival than nonreadmitted patients. Future studies that attempt to decrease readmissions and evaluate the impact of reducing readmissions on patient outcomes are needed.
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Lin, Jun, Zhaosheng Jin, and Ru Li. "The effect of regional anesthesia on cancer related outcomes after oncological surgeries: A systematic review." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e19099-e19099. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e19099.
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e19099 Background: Surgical resection remains one of the main curative treatment options for most solid-organ malignancies, and oncological surgery caseload has been steadily increasing over the years (1). It has been hypothesized that regional anesthesia may improve cancer related outcome. Both retrospective and prospective studies have been conducted on various cancer types, using different regional anesthesia techniques; and most meta-analyses did not specify the cancer type or regional anesthesia technique as part of their primary outcome (2, 3). In this systematic review, we will review the evidence base of regional anesthesia techniques for each cancer sites. Methods: We systematically reviewed literature from PubMed for studies related to oncological surgery with regional anesthesia, and cancer related outcomes. Main outcomes of interest are recurrence rate or recurrence free survival. The strength of the evidence is reported descriptively. Results: Regional anesthesia techniques most studied in relation to oncological surgery and cancer outcomes are neuraxial (spinal and epidural) anesthesia, and paravertebral block. Neuraxial anesthesia have been shown to improve outcomes in both prostate and ovarian cancer surgeries. On the other hand, current evidence suggest that paravertebral block does not improve breast cancer outcomes, and neuraxial anesthesia does not improve colorectal cancer outcomes. Evidence regarding the use of neuraxial anesthesia in bladder cancer is conflicting. There are also limited evidence suggesting that regional anesthesia may not improve outcomes in lung and upper GI cancers. Conclusions: The protective benefit of regional anesthesia appears to be limited to certain cancer types. More studies are needed in order to determine the effect of regional anesthesia techniques on each cancer types and underlying mechanisms. 1 Vesey SG, McCabe JE, Hounsome L, Fowler S. UK radical prostatectomy outcomes and surgeon case volume: based on an analysis of the British Association of Urological Surgeons Complex Operations Database. BJU Int 2012; 109: 346-54. 2 Sun Y, Li T, Gan TJ. The Effects of Perioperative Regional Anesthesia and Analgesia on Cancer Recurrence and Survival After Oncology Surgery: A Systematic Review and Meta-Analysis. Reg Anesth Pain Med 2015; 40: 589-98. 3 Chen WK, Miao CH. The effect of anesthetic technique on survival in human cancers: a meta-analysis of retrospective and prospective studies. PLoS One 2013; 8: e56540.
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Highsmith, Jason M., Luis M. Tumialán, and Gerald E. Rodts. "Flexible rods and the case for dynamic stabilization." Neurosurgical Focus 22, no. 1 (January 2007): 1–5. http://dx.doi.org/10.3171/foc.2007.22.1.11.
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✓The widespread use of instrumentation in the lumbar spine has led to high rates of fusion. This has been accompanied by a marked rise in adjacent-segment disease, which is considered to be an increasingly common and significant consequence of lumbar or lumbosacral fusion. Numerous biomechanical studies have demonstrated that segments fused with rigid metallic fixation lead to significant amounts of supraphysiological stress on adjacent discs and facets. The resultant disc degeneration and/or stenosis may require further surgical intervention and extension of the fusion to address symptomatic adjacent-segment disease. Recently, dynamic stabilization implants and disc arthroplasty have been introduced as an alternative to rigid fixation. The scope of spinal disease that can be treated with this novel technology, however, remains limited, and these treatments may not apply to patients who still require rigid stabilization and arthrodesis. In the spectrum between rigid metallic fixation and motion-preserving arthroplasty is a semirigid type of stabilization in which a construct is used that more closely mirrors the modulus of elasticity of natural bone. After either inter-body or posterolateral arthrodesis is achieved, the fused segments will not generate the same adjacent-level forces believed to be the cause of adjacent-segment disease. Although this form of arthrodesis does not completely prevent adjacent-segment disease, the dynamic component of this stabilization technique may minimize its occurrence. The authors report their initial experience with the use of posterior dynamic stabilization in which polyetheretherketone rods were used for a posterior construct. The biomechanics of dynamic stabilization are discussed, clinical indications are reviewed, and case studies for its application are presented.
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Pontes, Kelly Cristine de Sousa, Andrea Pacheco Batista Borges, Renato Barros Eleotério, Priscila Soares Ferreira, and Tatiana Schmitz Duarte. "A comparison of the effects of propofol and thiopental on tear production in dogs." Revista Ceres 57, no. 6 (December 2010): 757–61. http://dx.doi.org/10.1590/s0034-737x2010000600009.
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The tear film plays an important role in maintaining the integrity of the ocular suface. During general anesthesia, tear production is considerably reduced, which requires care to prevent adverse effects that result in diseases of these structures. Studies comparing the effects of induction of anaesthesia with thiopental and propofol on tear production have not been carried out yet. Because these drugs are used in veterinary medicine, we decided to evaluate the tear production in 30 dogs undergoing experimental surgery as well as routine procedures at the veterinary hospital of Federal University of Viçosa. Patients were divided into two groups of equal number. All animals were sedated with clorpromazine and maintained with isoflurane in diluted oxygen. Group 1 was induced with thiopental whereas group 2 with propofol. Schirmer tear test 1 was performed before sedation (T0), 15 minutes after sedation (T1) and 10 minutes after induction of anesthesia (T2) with the drug chosen for one of the groups. There was a significant decrease in tear production for both drugs, but no significant statistical differences were found between them. Thus, considering the results and the way in which the study was conducted, we suggest protecting the cornea and conjunctiva of patients during anesthesia using any of the drugs here evaluated.
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Junior, Messias Gonçalves Pacheco, Bruno Lima Pessoa, Jose Alberto Landeiro, Pedro Henrique de Abreu Macedo, and Marco Antônio Araújo Leite. "Spontaneous resolution of chronic subdural hematoma: Does only the size matter?" Surgical Neurology International 10 (October 4, 2019): 194. http://dx.doi.org/10.25259/sni_58_2019.
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Background: Chronic subdural hematomas (CSDHs) usually occur late in adults and older after mild head trauma. Surgical intervention is the first treatment option in CSDH with conservative management being adopted in few cases. Case Description: We report a case of a 71-year-old man who presented a spontaneous resolution of a large CSDH. He presented with a difficulty of speech and an ataxic gait. Head (computed tomography scan) showed a low-density lesion located in the right frontal-temporal-parietal region. Conclusion: In this report, we discuss the spontaneous resolution of a large CSDH in elderly patients, without surgical intervention. Gradually, several successful nonsurgical therapies for the treatment of these hematomas are reported, although further studies are essential to establish the role of these nonsurgical treatments of CSDHs.
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Huson, Henry B., Herbert Phelan, David G’Sell, Sydney Smith, and Jeffrey E. Carter. "539 If Seeing Was Believing - A Retrospective Analysis of Potential Reduced Treatment Delays with a Novel Burn Wound Assessment Device." Journal of Burn Care & Research 42, Supplement_1 (April 1, 2021): S117—S118. http://dx.doi.org/10.1093/jbcr/irab032.189.
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Abstract Introduction Burn care (BC) remains a highly specialized and resource intensive specialty with only 2% of hospitals featuring a burn center and less than 1% of graduating general surgery and plastic surgery residents pursing a burn fellowship each year. Access to specialized care is further complicated by burn wound assessment (BWA) which is commonly performed visually without adjunctive devices. To help clinicians make more accurate assessments and potentially reduce delays in transfer or treatment, a new non-invasive imaging device for BWA is being developed using visible and non-visible wavelengths of light with machine learning algorithms. Our goal was to assess the potential reduced treatment delay (RTD) and associated financial savings by implementing such a device using our burn center’s historical data. Methods The study was an IRB-approved, retrospective review of admissions from 07/01/2018 through 06/30/2019. Inclusion criteria: thermal, chemical, contact, or electrical mechanism of injury, >15 years of age requiring excision, and length of stay >72 hours. Inclusion data included: presence/absence of concomitant trauma, day of surgery, day of admission, day of electronic order entry for case request, and length of stay per percent total body surface area (LOS%TBSA). RTD was defined starting >48 hours after injury daily until electronic order entry for surgical case request. Reduced costs were calculated per day from prior studies ranging $3,000 to $5,100/day. Results A total of 109 patients were included. 29 patients had case requests placed within 48 hours of admission. Of the remaining 80 patients, a potential of 398 days would have been saved had a novel BWA adjunctive imaging devices aided surgeon to requests earlier surgical intervention. Overall savings from reduced length of stay range from $1,194,000 to $2,029,800 dollars. Conclusions Our study demonstrates that should a BWA technology with accuracy 48 hours after injury be developed, even burn centers with 24-hour access to operating rooms can reduce treatment delays. The study does not look at additional cost savings offered by reduced emergent transfers or admissions which offer additional intrigue and promise.
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Vynnychenko, I., M. Kononenko, O. Smorodska, S. Ivanov, Y. Moskalenko, O. Vynnychenko, V. Sikora, M. Lyndin, and A. Romaniuk. "Case Report of Giant Nonmetastatic Gastrointestinal Solid Tumor without Clinical Manifestations in a Middle-Aged Male Patient." Novosti Khirurgii 28, no. 5 (October 28, 2020): 597–602. http://dx.doi.org/10.18484/2305-0047.2020.5.597.
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Gastrointestinal stromal tumors (GIST) are one of the most common mesenchymal tumors that originate from the intestinal cells of Cajal. The most common localization of GIST is the gastrointestinal tract, however, extragastrointestinal forms are sometimes found. Most GISTs are small in size, which most often does not exceed 5 - 8 cm in maximum dimension. This article describes the case of a patient with a non-metastatic giant tumor of the stomach without any clinical manifestations. The tumor was localized in the abdominal cavity, occupying almost all of it, squeezing and displacing the surrounding organs. Due to the cystic-solid structure, its gigantic size and intimate adherence to the surrounding organs, it was not possible to carry out an accurate differential diagnosis before surgery. Intraoperative imaging of the tumor, further histological and immunohistochemical (CD117, CD34, S100, CD45, PanCK; Ki-67) studies made possible to establish the diagnosis of gastric GIST T4N0M0 stage II. Based on the data obtained, despite the gigantic size, the prognosis of the disease was considered favorable (low mitotic index, no metastasis). During the period of clinical observation, within 1.5 years after surgery, no relapse or disease progression was recorded, which indicates a favorable prognosis for the patient.
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Kotamarti, Vasanth S., Eric Shiah, Kristen M. Rezak, Ashit Patel, and Joseph A. Ricci. "Does Anticoagulation Improve Flap Outcomes in Hypercoagulable Patients? A Systematic Review." Journal of Reconstructive Microsurgery 36, no. 03 (November 25, 2019): 204–12. http://dx.doi.org/10.1055/s-0039-3400531.
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Abstract Background Despite improvements in microsurgical techniques, hypercoagulable patients remain a reconstructive challenge. Thrombophilias are a relatively common problem with potentially catastrophic results including free flap loss. The aim of this study was to assess the available literature on free tissue transfer in patients with known hypercoagulability to develop recommendations for management. Methods A systematic review of the PubMed, EBSCO, and Cochrane databases was performed in June 2018. Inclusion criteria were assessment of outcomes of free tissue transfer in patients with established hypercoagulability. Exclusion criteria were review articles, case reports, and studies lacking detailed discussion of anticoagulation regimens and surgical outcomes. Data collected included the number of hypercoagulable patients, anticoagulation regimens, thrombotic complications, flap success, and bleeding complications. Statistical analysis was performed using independent samples t-tests. Results Of 147 total results, four articles were included for analysis. One relevant article published after search completion was included. In total, 185 free tissue transfers were performed in 155 thrombophilic patients. Anticoagulation regimens varied widely but often included intraoperative continuous heparin, with or without additional bolus, followed by postoperative and outpatient anticoagulation. Hypercoagulable patients often developed late postoperative thromboses. Of the intraoperative thromboses, 36.4% were successfully salvaged. No flaps with postoperative thrombosis were salvaged. Preemptive therapeutic anticoagulation improved outcomes but increased the bleeding risk. Conclusion Free tissue transfer may be successful in hypercoagulable patients. High-risk patients identified preoperatively should receive therapeutic anticoagulation initiated intraoperatively unless contraindicated. Salvage after postoperative thrombosis is poor. Ultimately, the benefits of free tissue transfer must be considered with the potential morbidity of bleeding complications on a case-by-case basis when developing a reconstructive plan. Initiating anticoagulation based on the presence of intraoperative risk factors may prevent unnecessary intervention.
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Michalak, Suzanne M., John D. Rolston, and Michael T. Lawton. "Prospective, multidisciplinary recording of perioperative errors in cerebrovascular surgery: is error in the eye of the beholder?" Journal of Neurosurgery 124, no. 6 (June 2016): 1794–804. http://dx.doi.org/10.3171/2015.5.jns142458.
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OBJECT Surgery requires careful coordination of multiple team members, each playing a vital role in mitigating errors. Previous studies have focused on eliciting errors from only the attending surgeon, likely missing events observed by other team members. METHODS Surveys were administered to the attending surgeon, resident surgeon, anesthesiologist, and nursing staff immediately following each of 31 cerebrovascular surgeries; participants were instructed to record any deviation from optimal course (DOC). DOCs were categorized and sorted by reporter and perioperative timing, then correlated with delays and outcome measures. RESULTS Errors were recorded in 93.5% of the 31 cases surveyed. The number of errors recorded per case ranged from 0 to 8, with an average of 3.1 ± 2.1 errors (± SD). Overall, technical errors were most common (24.5%), followed by communication (22.4%), management/judgment (16.0%), and equipment (11.7%). The resident surgeon reported the most errors (52.1%), followed by the circulating nurse (31.9%), the attending surgeon (26.6%), and the anesthesiologist (14.9%). The attending and resident surgeons were most likely to report technical errors (52% and 30.6%, respectively), while anesthesiologists and circulating nurses mostly reported anesthesia errors (36%) and communication errors (50%), respectively. The overlap in reported errors was 20.3%. If this study had used only the surveys completed by the attending surgeon, as in prior studies, 72% of equipment errors, 90% of anesthesia and communication errors, and 100% of nursing errors would have been missed. In addition, it would have been concluded that errors occurred in only 45.2% of cases (rather than 93.5%) and that errors resulting in a delay occurred in 3.2% of cases instead of the 74.2% calculated using data from 4 team members. Compiled results from all team members yielded significant correlations between technical DOCs and prolonged hospital stays and reported and actual delays (p = 0.001 and p = 0.028, respectively). CONCLUSIONS This study is the only of its kind to elicit error reporting from multiple members of the operating team, and it demonstrates error is truly in the eye of the beholder—the types and timing of perioperative errors vary based on whom you ask. The authors estimate that previous studies surveying only the attending physician missed up to 75% of perioperative errors. By finding significant correlations between technical DOCs and prolonged hospital stays and reported and actual delays, this study shows that these surveys provide relevant and useful information for improving clinical practice. Overall, the results of this study emphasize that research on medical error must include input from all members of the operating team; it is only by understanding every perspective that surgical staff can begin to efficiently prevent errors, improve patient care and safety, and decrease delays.
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Kaibuchi, N., T. Iwata, T. Okamoto, Y. Kawase-Koga, and M. Yamato. "Cell therapy for medication-related osteonecrosis of the jaw: update on treatment strategies." European Cells and Materials 41 (January 5, 2021): 31–39. http://dx.doi.org/10.22203/ecm.v041a03.
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Despite extensive research since the first report of medication-related osteonecrosis of the jaw (MRONJ) in 2003, the optimal treatment and preventive modalities for the condition are not clear. Therefore, its management has been a concern in dentistry, oral and maxillofacial surgery, as well as departments involved in the treatment of cancers and/or bone diseases worldwide. Several cases of MRONJ could not be cured by conventional treatment strategies, as per the recommendations in various position papers. Therefore, a number of studies, including randomized controlled trials, have been conducted to examine the efficacy of novel therapies. However, no definite treatment modality has been determined. Several types of cell therapies have been documented. 10 animal studies and 5 case reports have been documented, in which autologous transplantation of cells has been carried out in MRONJ patients. Although these reports showed the efficacy of cell therapy, they were not large-scale, statistically accurate clinical studies; hence, the efficacy of cell therapy for this condition is not certain. However, the efficacy of MRONJ treatment using mesenchymal stromal cell (MSC) sheets has been investigated since 2013. This has been confirmed through various experiments in which MSC sheets were transplanted into model rats and beagle dogs exhibiting MRONJ-like lesions. Based on these results, a clinical study of MRONJ treatment using periodontal ligament-derived MSC sheets is being currently planned.
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Smith, Timothy L., Pete S. Batra, Allen M. Seiden, and Maureen Hannley. "Evidence Supporting Endoscopic Sinus Surgery in the Management of Adult Chronic Rhinosinusitis: A Systematic Review." American Journal of Rhinology 19, no. 6 (November 2005): 537–43. http://dx.doi.org/10.1177/194589240501900601.
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Background Evidence-based medicine calls for a critical evaluation of the scientific evidence for treatments of disease. This report synthesizes the available evidence on the use of endoscopic sinus surgery (ESS) in the management of adult chronic rhinosinusitis (CRS) examining the clinical question: “In adults with CRS who have failed medical management, does ESS improve symptoms and/or quality of life (QOL)?” Methods The American Rhinologic Society and the American Academy of Otolaryngology–Head and Neck Surgery convened a steering committee composed of the authors. Primary research articles evaluated for this report were identified using appropriate search terms and a Medline search. Two authors independently reviewed each article. Articles were assigned an evidence level based on accepted guidelines (level 1 = randomized trials; level 2 = prospective cohort studies with comparison group; level 3 = case-control studies; level 4 = retrospective case series; level 5 = expert opinion). Results We identified 886 abstracts to review, retrieved 75 articles for full review, and included 45 articles in our report. The vast majority of articles represented level 4 evidence (n = 42) and two articles represented level 5 evidence. One article was identified that qualified for level 2 evidence. All of these articles generally supported the finding that ESS improves symptoms and/or QOL in adult patients with CRS. Conclusion There is substantial level 4 evidence with supporting level 2 evidence that ESS is effective in improving symptoms and/or QOL in adult patients with CRS. Future research efforts should focus on prospective studies that include appropriate comparison groups in their design.
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Lidral, Andrew C., Jeffrey C. Murray, Kenneth H. Buetow, Ann M. Basart, Heidi Schearer, Rita Shiang, Avelina Naval, Eriberto Layda, Kathy Magee, and William Magee. "Studies of the Candidate Genes TGFB2, MSX1,TGFA, and TGFB3 in the Etiology of Cleft Lip and Palate in the Philippines." Cleft Palate-Craniofacial Journal 34, no. 1 (January 1997): 1–6. http://dx.doi.org/10.1597/1545-1569_1997_034_0001_sotcgt_2.3.co_2.
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Population-based candidate-gene studies can be an effective strategy for identifying genes involved in the etiology of disorders where family-based linkage studies are compromised by lack of access to affected members, low penetrance, and/or genetic heterogeneity. We evaluated association data for four candidate genes using a population from the Philippines that Is genetically separate from previously studied Caucasian populations. Case ascertainment was made possible by collaboration with Operation Smile, a volunteer medical organization, which facilitated Identification of a large number of cases for study. A new allelic variant of transforming growth factor-beta3 was identified to use in these studies. After exclusion of syndromic cases of cleft lip and palate, no evidence for association with previously reported allelic variants of transforming growth factor-beta2 (TGFB2), homeobox 7 (MSX1), or transforming growth factor-alpha (TGFA), or with the new TGFB3 variant was detected. Previous association studies using Caucasian populations of nonsyndromic cleft lip and/or palate (CUP) and cleft palate only (CPO) have strongly suggested a role for TGFA in the susceptibility of clefting in humans. Exclusion of significant association in a non-Caucasian population for TGFA suggests that TGFA plays less of a role than it does in Caucasians. This may be due to multiple or different genetic and/or environmental factors contributing to the etiology of this most common craniofacial anomaly in the Philippine population.
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O’Grady, Eva E., Qureish Vanat, Dominic M. Power, and Simon Tan. "A systematic review of medial epicondylectomy as a surgical treatment for cubital tunnel syndrome." Journal of Hand Surgery (European Volume) 42, no. 9 (August 31, 2017): 941–45. http://dx.doi.org/10.1177/1753193417724351.
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The aim of this study was to review the literature of decompression of the cubital tunnel with medial epicondylectomy and to assess outcomes and complications. Twenty-one case series reported on 886 medial epicondylectomies. The mean percentage of patients obtaining improvement of one or more McGowan grade was 79%. The mean percentage obtaining a good/excellent Wilson Krout grade of outcome was 83%. Of six comparative studies, two showed no significant differences in outcomes between medial epicondylectomy and transposition procedures, and three reported better outcomes with medial epicondylectomy. One reported similar outcomes with medial epicondylectomy and simple decompression. The existing literature on medial epicondylectomy is of limited methodological quality and does not allow for firm conclusions to be drawn regarding its efficacy compared with other surgical techniques. Further studies should aim for high methodological quality, randomized comparison with simple decompression or anterior transposition and should utilize standardized outcome measures. Level of evidence: II
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Rouhani, M. J. "In the face of increasing subspecialisation, how does the specialty ensure that the management of ENT emergencies is timely, appropriate and safe?" Journal of Laryngology & Otology 130, no. 6 (May 10, 2016): 516–20. http://dx.doi.org/10.1017/s0022215116007957.
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AbstractBackground:The field of ENT surgery is one of the most varied specialties, with numerous subspecialties and continuing divergence. With this evolution there comes, however, a risk that specialists become de-skilled in certain areas. In the case of ENT emergencies, this can be particularly dangerous.Methods:Current guidance from relevant UK professional membership bodies regarding emergency surgery provision was inspected and a literature search was performed to identify studies relating to management of ENT emergencies in the context of increasing subspecialisation.Results and conclusion:The specialty currently has provisions in place to ensure timely, appropriate and safe management of emergencies, in the form of guidelines and emergency clinics; however, there is scope for improvement of the system.
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Hernandez, Jonathan M., James S. Barthel, and Scott T. Kelley. "Successful Completion of Neoadjuvant Chemoradiation and Surgical Resection for Esophageal Cancer after Perforation: A Case for Endoscopic Stenting." American Surgeon 74, no. 12 (December 2008): 1215–17. http://dx.doi.org/10.1177/000313480807401218.
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Iatrogenic esophageal perforation during endoscopy in the setting of malignancy is an uncommon but often devastating complication and presents a formidable challenge to the surgeon. We sought to determine the efficacy of a self-expanding plastic stent for esophageal perforation before neoadjuvant chemoradiation in a single patient. A 74-year-old woman with a T4N0 adenocarcinoma at the gastroesophageal junction was perforated during upper endoscopy. We elected to manage the perforation with a silicone-covered, self-expanding Polyflex® stent. Subsequent studies revealed good positioning of the stent with exclusion of the perforation from the esophageal lumen. The patient subsequently underwent neoadjuvant chemoradiation therapy with cisplatin, 5-flourouracil, and external beam radiation (2640 Gy) followed by minimally invasive, hand-assisted transhiatal esophagogastrectomy. We describe the first case of endoscopic stenting for locally advanced, perforated esophageal cancer for the purposes of administering neoadjuvant chemoradiation as a bridge to definitive surgery. This patient was able to resume oral nutrition after stenting and during neoadjuvant therapy, experiencing no major complications from chemoradiation. Chemoradiation does not necessarily preclude the use of endoscopically placed covered plastic esophageal stents as a bridge to resection, even in the face of iatrogenic perforation.
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Dordea, M., and SR Aspinall. "Short and long-term cosmesis of cervical thyroidectomy scars." Annals of The Royal College of Surgeons of England 98, no. 1 (January 1, 2016): 11–17. http://dx.doi.org/10.1308/rcsann.2016.0022.
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Introduction Multiple surgical approaches to the thyroid gland have been described via cervical or extracervical routes. Improved cosmesis, patient satisfaction, reduced pain (procedure dependent) and early discharge have all been reported for minimally invasive approaches with similar safety profiles and long-term outcomes to conventional surgery. This review summarises the current evidence base for improved cosmesis with minimally invasive cervical approaches to the thyroid gland compared with conventional surgery. Methods A systematic review was undertaken. The MEDLINE®, Embase™ and Cochrane databases were searched for relevant articles. Results A total of 57 papers thyroid papers were identified. Of those, 20 reported some form of cosmetic outcome assessment. There were 6 randomised controlled trials with 412 patients (evidence level 2B), 7 cohort studies with 3,073 patients (level 3B) and 7 non-comparative case series with 1,575 patients (level 4). There was significant heterogeneity between studies in terms of wound closure technique, timing of scar assessment and scar assessment scales (validated and non-validated). Most studies performed early scar assessments, some using non-validated scar assessment tools. Conclusions Assessment of cosmesis is complex and requires rigorous methodology. Evidence from healing/remodelling studies suggests scar maturation is a long-term process. This calls into question the value of early scar assessment. Current evidence does not support minimally invasive surgical approaches to the thyroid gland if improved long-term cosmesis is the goal.
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Pingarron-Martin, Lorena, Javier Arias-Gallo, Hui Shan Ong, and Manuel Chamorro Pons. "Le Fort I Osteotomy with Bone Grafts in Preprosthetic Surgery: Technical Note." Craniomaxillofacial Trauma & Reconstruction 6, no. 2 (June 2013): 143–46. http://dx.doi.org/10.1055/s-0033-1333876.
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Background Being edentulous causes progressive bony resorption in maxillae, which can lead to altered maxillomandibular relationships. Discussion should consider Le Fort I osteotomy with inlay grafts for a better success rate. Thus, this article introduces a technical note in improving the success rate. Case Report The presented technical note permits transformation of the surgery in a conventional Le Fort I with a simple fixation not only of the grafts but also of the osteotomy. The surgical steps are explained as well as the follow-up results. Discussion Adding additional wire anchorage around bone grafts greatly improved our success rate and reduced our operative time. Bone grafting concurrently with Le Fort I osteotomy immediately improved the facial skeletal profile. Several in vitro studies have shown that galvanic corrosion does not play a significant role when combining stainless steel and titanium. Our novel technique is relatively simple and can be easily picked up by young surgeons.
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Clementino, Wellida Karinne Lacerda, José Gabriel Gonçalves Lins, and Adílio Santos De Azevedo. "Uso da termografia infravermelha como auxílio diagnóstico de neoplasia mamária canina." Revista Principia - Divulgação Científica e Tecnológica do IFPB 1, no. 43 (November 20, 2018): 76. http://dx.doi.org/10.18265/1517-03062015v1n43p76-87.
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<p>This paper aimed to evaluate the use of thermography as an aid method for the early diagnosis of breast cancer in female dogs assisted at the Veterinary Hospital of IFPB Campus Sousa. Five female dogs diagnosed clinically with mammary neoplasia were selected for this study. The protocol was listed in the chronological order of medical care: anamnesis, physical examination of the tumours, thermography, surgery and collection of material for histopathological examination. Patients underwent thermographic examination with the Flir® Thermovisor equipment, model T420. The examination took place in an acclimatized room and upon permission of the animal’s tutor. 60% were pure breed female dogs. Tumours were observed in three non-castrated female dogs and two castrated ones. The masses exhibited three macroscopic presentation patterns. The majority of them were nodular, followed by pendular and flat. Masses in animal 1 showed no increase in volume and there was no difference in temperature between the breast affected by neoplasia and healthy one, whereas for animals 2, 3, 4 and 5 there was an increase in temperature of 0.6ºC, 1.0°C, 1.2°C and 2.3°C, respectively. Three different types of carcinoma were found according to histopathological examination: complex carcinoma, tubular and tubulo-papillary carcinoma. In 100% of the animals the lesions were malignant, reporting high frequency of malignant epithelial tumours in the canine species. Based on these results, it was concluded that no direct relationship was found between the thermographic imaging pattern among the types of malignant mammary tumours in female dogs. Therefore, the conception of new studies on the matter is necessary due to the small number of animals on this research, where it was not possible to affirm the capacity of the thermography in the early differentiation of the malignancy of the masses. Future researches in oncology will promote a better understanding of the pathological aspects related to mammary tumours.</p>
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Tepper, Jeffrey, Juergen Pfeiffer, Kim Bujold, James B. Fink, Richard Malcolmson, Dennis Sullivan, Simon Authier, Plamena Entcheva-Dimitrov, and Andrew Clark. "Novel Toxicology Program to Support the Development of Inhaled VentaProst." International Journal of Toxicology 39, no. 5 (August 13, 2020): 433–42. http://dx.doi.org/10.1177/1091581820945985.
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Currently, off-label continuous administration of inhaled epoprostenol is used to manage hemodynamics during mitral valve surgery. A toxicology program was developed to support the use of inhaled epoprostenol during mechanical ventilation as well as pre- and postsurgery via nasal prongs. To support use in patients using nasal prongs, a Good Laboratory Practice (GLP), 14-day rat, nose-only inhalation study was performed. No adverse findings were observed at ∼50× the dose rate received by patient during off-label use. To simulate up to 48 hours continuous aerosol exposure during mechanical ventilation, a GLP toxicology study was performed using anesthetized, intubated, mechanically ventilated dogs. Dogs inhaled epoprostenol at approximately 6× and 13× the dose rate reported in off-label human studies. This novel animal model required establishment of a dog intensive care unit providing sedation, multisystem support, partial parenteral nutrition, and management of the intubated mechanically ventilated dogs for the 48-hour duration of study. Aerosol was generated by a vibrating mesh nebulizer with novel methods required to determine dose and particle size in-vitro. Continuous pH 10.5 epoprostenol was anticipated to be associated with lung injury; however, no adverse findings were observed. As no toxicity at pH 10.5 was observed with a formulation that required refrigeration, a room temperature stable formulation at pH 12 was evaluated in the same ventilated dog model. Again, there were no adverse findings. In conclusion, current toxicology findings support the evaluation of inhaled epoprostenol at pH 12 in surgical patients with pulmonary hypertension for up to 48 hours continuous exposure.
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Shaw, W. C., N. A. Mandall, and C. R. Mattick. "Ethical and Scientific Decision Making in Distraction Osteogenesis." Cleft Palate-Craniofacial Journal 39, no. 6 (November 2002): 641–45. http://dx.doi.org/10.1597/1545-1569_2002_039_0641_easdmi_2.0.co_2.
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Objective To propose a prospective registry for distraction osteogenesis research. Results The search strategy identified 82 reports, of which 11 were review articles, 17 were animal studies, 5 were theoretical models, and 49 were case reports/series. Conclusions So far, the literature concerning distraction osteogenesis does not allow reliable choices to be made on the most appropriate form of distraction osteogenesis in different clinical decisions or whether it is superior to osteotomy or nontreatment. A prospective registry is proposed to hasten critical appraisal of distraction osteogenesis.
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Tsumura, H., N. Kaku, and T. Torisu. "Does the Self-Centering Mechanism of Bipolar Hip Endoprosthesis Really Work in vivo?" Journal of Orthopaedic Surgery 13, no. 1 (April 2005): 46–51. http://dx.doi.org/10.1177/230949900501300108.
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Purposes. To examine radiographically the component motion in a bipolar prosthesis and to determine whether the self-centering mechanism really works in vivo. Methods. 38 patients with 41 bipolar hip endoprostheses (30 for coxarthrosis and 11 for osteonecrosis of femoral head) were included in this study. Two radiographs of each case were taken to evaluate the self-centering mechanism. The first anteroposterior radiograph of both hip joints was taken at the maximum abduction while the patient standing on the endoprosthetic leg. The second radiograph was taken after the patient returned to neutral position while standing on 2 legs. In the present study, the order in which the radiographs were taken differed from previously reported studies. The radiographs were analysed using the method similar to that of Drinker and Murray. The adductive motion from abduction to a neutral position is within the range of inner bearing oscillation. Results. The outer head alignment changed from 23 degrees to 12 degrees in the patients with osteonecrosis. However, the valgus position of the outer head (36 degrees) remained unchanged in the patients with coxarthrosis standing on 2 legs in the neutral position. Conclusion. The self-centering mechanism of the bipolar endoprosthesis functioned in the patients with osteonecrosis, but did not work in the coxarthrosis group.
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Verma, Jaya, and Vipin Ahuja. "Apicoectomy – A review." Journal of Dental Panacea 3, no. 1 (June 15, 2021): 15–19. http://dx.doi.org/10.18231/j.jdp.2021.004.
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This review article throws a light on the background of theoretical and clinical aspects of apicoectomy procedure. Apicoectomy is also known as root resection, which means amputation of the apex of the root and is considered as a part of peiradicular surgery. The periradicular surgery is a standard oral surgical procedure which includes surgical treatment of area surrounding root and is done when conventional root canal treatment does not suffice the infection. This procedure includes three important steps to eliminate persistent endodontic pathogens: surgical debridement of pathological periradicular tissue, root-end resection (apicoectomy), and retrograde root canal obturation (root-end filling). There is a plethora of literature on the clinical studies and case reports on apicoectomy procedure; our review adds an imperative segment to this standard protocol used in pediatric endodontics and the objective is to give the reader an acquaintance about apical surgery with latest updates.
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Lin, Nancy U., Jennifer R. Bellon, and Eric P. Winer. "CNS Metastases in Breast Cancer." Journal of Clinical Oncology 22, no. 17 (September 1, 2004): 3608–17. http://dx.doi.org/10.1200/jco.2004.01.175.
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As systemic therapy of metastatic breast cancer improves, CNS involvement is becoming a more widespread problem. This article summarizes the current knowledge regarding the incidence, clinical presentation, diagnosis, prognosis, and treatment of CNS metastases in patients with breast cancer. When available, studies specific to breast cancer are presented; in studies in which many solid tumors were evaluated together, the proportion of patients with breast cancer is noted. On the basis of data from randomized trials and retrospective series, neurosurgery and stereotactic radiosurgery (SRS) may prolong survival in patients with single brain metastases. The treatment of multiple metastases remains controversial, as does the routine use of whole-brain radiotherapy (WBRT) after either surgery or SRS. Although it is widely assumed that chemotherapy is of limited benefit, data from case series and case reports suggest otherwise. WBRT, neurosurgery, SRS, and medical therapy each have a role in the treatment of CNS metastases; however, neurologic symptoms frequently are not fully reversible, even with appropriate therapy. Studies specifically targeted toward this group of patients are needed.
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Kusak, Artur, Oskar Rosiak, Marcin Durko, Piotr Grzelak, and Wioletta Pietruszewska. "Diagnostic imaging in chronic otitis media: does CT and MRI fusion aid therapeutic decision making? – a pilot study." Otolaryngologia Polska 72, no. 5 (October 1, 2018): 1–5. http://dx.doi.org/10.5604/01.3001.0012.5423.
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Introduction: Despite the recent advances in otosurgery diagnosis of cholesteatoma and qualification for surgery remains an issue in contemporary laryngology. In cases of cholesteatoma recidivism, it is of utmost importance to properly locate the pathology in the middle ear to plan surgical approach. Magnetic Resonance imaging in diffusion weighted non-echoplanar sequences (non-EPI DWI) enables cholesteatoma detection as small as 2 mm and could potentially prevent unnecessary second-look surgery. Computed Tomography of the temporal bone allows precise visualization of bony structures and topographical landmarks of the middle ear. A fusion of both imaging modalities combines the advantages of these techniques. Material and methods: Five patients treated in the Department of Otolaryngology, Medical University of Lodz for probable cholesteatoma recidivism were included in this study. A high-resolution CT scan of the temporal bone and an MRI scan including non-EPI sequences was obtained in all patients. A fusion of CT and MRI studies was conducted using OsirixMD software. Fist, CT studies were fused with MRI BFFE sequences, then non-EPI sequences were added. Finally, if the patient qualified for surgical treatment histopathological diagnosis was compared with MRI results. Results: CT scans were analyzed to establish the extent of previous surgical interventions and anatomical landmarks preservation. In all cases MRI results were suspicious of cholesteatoma recidivism. Four cases were confirmed in postoperative histopathological evaluation, there was one false positive case when intraoperatively scar tissue was identified, which was later confirmed as connective tissue upon histopathological evaluation. Conclusions: CT and MRI fusion provides a helpful diagnostic tool in preparation for surgery in patients with suspected cholesteatoma recidivism. Key words: magnetic resonance, computed tomography, cholesteatoma, canal wall-up surgery