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Complex case management

Oluwaseun O Akinduro, Eric W Nottmeier
We describe the operative approach and management for thoracic metastatic disease in a 78-yr-old man with worsening mechanical lower back and left-sided thoracic radicular pain. Imaging of the thoracic spine revealed an osteolytic T11 mass with destruction of the left T11 pedicle and transverse process. Biopsy confirmed spinal metastasis from the liver. Preoperative angiogram was completed for localization of the artery of Adamkewicz and microparticle embolization of the left T11 intercostal artery. Surgical resection was supplemented with electrophysiological monitoring and neuronavigation...
December 14, 2018: Operative Neurosurgery (Hagerstown, Md.)
E Sanchis-Sales, P J Rodríguez-Cervantes, J L Sancho-Bru
BACKGROUND: Kinematic analysis could help to study how variations in the static foot posture affect lower limb biomechanical function. The analysis of foot kinematics is complex because it involves managing the time-dependent joint angles in different joints and in all three planes of motion. But it could be simplified if joint angles are coordinated. METHODS: The kinematics of the ankle, midtarsal and metatarsophalangeal joints were registered in 20 highly-pronated, 30 normal and 20 highly-supinated subjects (assessed by the Foot Posture Index - FPI) as they walked barefoot...
December 6, 2018: Gait & Posture
Bettoni Jérémie, Matthieu Olivetto, Jérôme Duisit, Alexandre Caula, Ghassan Bitar, Benoit Lengele, Sylvie Testelin, Stéphanie Dakpé, Bernard Devauchelle
Experiment based on the conviction of a biological dimension of reconstructive surgery where the contribution of a vascularized transplant within irradiated tissue constitutes a physiological response to hypoxia, hypocellularity and hypovascularization characteristic of osteoradionecrotic injury. Between 1992 and 2013, 119 osteoradionecrotic lesions were treated requiring 125 free flaps. Revascularization surgery efficiency rate during the study period of 94%. Complex surgery: 49% complications including 38% vascular complications (total or partial flap necrosis) and 37% intolerance to osteosynthesis material...
December 14, 2018: Clinical Otolaryngology
Fernando López, Carlos Suárez, Vincent Vander Poorten, Antti Mäkitie, Iain J Nixon, Primož Strojan, Ehab Y Hanna, Juan Pablo Rodrigo, Remco de Bree, Miquel Quer, Robert P Takes, Carol R Bradford, Ashok R Shaha, Alvaro Sanabria, Alessandra Rinaldo, Alfio Ferlito
The parapharyngeal space is a complex anatomical area. Primary parapharyngeal tumors are rare tumors and 80% of them are benign. A variety of tumor types can develop in this location; most common are salivary gland neoplasm and neurogenic tumors. The management of these tumors has improved greatly owing to the developments in imaging techniques, surgery, and radiotherapy. Most tumors can be removed with a low rate of complications and recurrence. The transcervical approach is the most frequently used. In some cases, minimally invasive approaches may be used alone or in combination with a limited transcervical route, allowing large tumors to be removed by reducing morbidity of expanded approaches...
December 14, 2018: Head & Neck
Daniele Di Mascio, Filomena Giulia Sileo, Asma Khalil, Giuseppe Rizzo, Nicola Persico, Roberto Brunelli, Antonella Giancotti, Pierluigi Benedetti Panici, Ganesh Acharya, Francesco D'Antonio
OBJECTIVES: To report the rate of additional anomalies detected exclusively on prenatal MRI in fetuses affected by isolated mild or moderate ventriculomegaly (VM) according to the type of ultrasound protocol adopted (dedicated neurosonography vs standard assessment of fetal brain) and to explore whether the diagnostic performance of fetal MRI in detecting such anomalies is affected by gestational age at scan and laterality of ventricular dilatation. METHODS: The primary aim was to report the rate of additional anomalies detected exclusively on prenatal MRI in fetuses affected by isolated mild and moderate VM (ventricular dilatation between 10-15 mm) undergoing compared to those not undergoing dedicated neurosonography, defined as a detail assessment of fetal brain according to the International Society of Ultrasound in Obstetrics and Gynecology guidelines...
December 14, 2018: Ultrasound in Obstetrics & Gynecology
Lorenzo Garavaglia, Emanuela Pagliano, Giovanni Baranello, Simone Pittaccio
BACKGROUND: Movement Disorders (MD) are a class of disease that impair the daily activities of patients, conditioning their sensorimotor, cognitive and behavioural capabilities. Nowadays, the general management of patients with MD is based on rehabilitation, pharmacological treatments, surgery, and traditional splints. Although some attempts have been made to devise specific orthoses for the rehabilitation of patients affected by MD, especially the younger ones, those devices have received limited attention...
December 14, 2018: Journal of Neuroengineering and Rehabilitation
Konstantinos N Paterakis, Alexandros G Brotis, Athanasios Paschalis, Alkiviadis Tzannis, Konstantinos N Fountas
Background: Surgical treatment of adult degenerative scoliosis (DS) always remains a challenge and often necessitates complex multilevel surgery via traditional open approaches. However, the severity of the procedure, in association with the fact that many of these patients are at an advanced age with several comorbidities, results in high rate of complications. Therefore, during the last decade, minimally invasive procedures have gained a place in the treatment of this pathology. Our aim is to determine the safety and efficacy of extra lateral lumbar interbody fusion (XLIF) with or without supplemented instrumentation in the treatment of DS...
September 2018: Journal of Spine Surgery (Hong Kong)
Alessandro Villanucci, Ketty Tavella, Laura Vannini, Virginia Rossi, Stefania Nobili, Gianni Amunni, Teresita Mazzei, Enrico Mini
The majority of patients with ovarian cancer will experience relapse and thus require second-line therapy. While platinum-based therapies are the primary treatments for refractory disease other options are required, particularly for those with partially platinum-sensitive disease as their response rates are lower. Agents that can resensitize relapsed ovarian cancers to platinum, including trabectedin, are therefore of increasing interest. Trabectedin is a multitarget agent that has a complex, novel mechanism of action and has exhibited promising results in platinum-sensitive ovarian cancer when in combination with pegylated liposomal doxorubicin (PLD)...
December 2018: Molecular and Clinical Oncology
(no author information available yet)
OBJECTIVESpinal meningiomas (sMNGs) are relatively rare in comparison to intracranial MNGs. sMNGs localized anterior to the denticulate ligament (aMNGs) represent a surgically challenging subgroup. A high perioperative complication rate due to the need for complex surgical approaches has been described. In the present study, the authors report on their surgical experience that involves two institutions in which 207 patients underwent surgery for sMNGs. Special focus was placed on patients with aMNGs that were treated via a unilateral posterior approach (ULPA)...
December 1, 2018: Journal of Neurosurgery. Spine
Elisena Franzese, Sara Centonze, Anna Diana, Francesca Carlino, Luigi Pio Guerrera, Marilena Di Napoli, Ferdinando De Vita, Sandro Pignata, Fortunato Ciardiello, Michele Orditura
Poly-ADP-ribosepolymerase inhibitors (PARPis) are the most active and interesting therapies approved for the treatment of epithelial ovarian cancer. They have changed the clinical management of a disease characterized, in almost half of cases, by extreme genetic complexity and alteration of DNA damage repair pathways, particularly homologous recombination (HR) deficiency. In this review, we provide an updated overview of the available results of recent clinical trials on the three Food and Drug Administrationand European Medicines Agency approved PARPis in ovarian cancer: olaparib, niraparib, and rucaparib...
December 4, 2018: Cancer Treatment Reviews
Sudeshna Maya Sen, Aprajita Singh, Navarun Varma, Divya Sharma, Arun Kansal
The governance of natural resources now attracts greater participation of different stakeholders, ushering in a shift from conventional governance by the state to that by a network of stakeholders-a form of governance marked by a growing role of non-state and local actors. These changing dynamics are highlighted through a study of the governance network for springsheds in the Indian Himalayas by empirically mapping the changes in the Dhara Vikas Yojna, a plan or scheme (yojana) by the state for the development (vikas) of springs (dhara) in Sikkim, India, from policy planning to policy implementation...
December 12, 2018: Environmental Management
Vinaya Manchaiah, Monica L Bellon-Harn, Ashley L Dockens, Jamie H Azios, William E Harn
BACKGROUND: Communication during clinical consultations is an important factor that facilitates decision-making by patients and family members. For clinicians, these interactions are opportunities to build rapport and to facilitate appropriate decision-making. PURPOSE: This article presents the literature review of studies focusing on communication between audiologist, patients, and their family members during initial audiology consultations and rehabilitation planning sessions...
November 29, 2018: Journal of the American Academy of Audiology
Uhliarová Barbora, Navrátilová Marcela, Čalkovský Vladimír, Hajtman Andrej
INTRODUCTION: Carcinoma of unknown primary (CUP) in head and neck region is diagnosed in 5% of patients with malignant tumour of head and neck. In the management of patients with CUP, complex investigation to diagnose the occult tumour is always necessary. Detection of origin allows targeted specific treatment that significantly improves the prognosis of the disease. MATERIAL AND METHODS: Retrospective analysis of patients treated at the Department of Otorhinolaryngology and Head and Neck Surgery of the UK JLF and UNM in Martin between January 2012 until September 2017 for CUP in head and neck region...
2018: Klinická Onkologie: Casopis Ceské a Slovenské Onkologické Spolecnosti
Sai Liang, Shen Qu, Qiaoting Zhao, Xilin Zhang, Glen Daigger, Joshua Newell, Shelie A Miller, Jeremiah X Johnson, Nancy G Love, Lixiao Zhang, Zhifeng Yang, Ming Xu
The efficient provision of food, energy, and water (FEW) resources to cities is challenging around the world. Because of the complex interdependence of urban FEW systems, changing components of one system may lead to ripple effects on other systems. However, the inputs, intersectoral flows, stocks, and outputs of these FEW resources from the perspective of an integrated urban FEW system have not been synthetically characterized. Therefore, a standardized and specific accounting method to describe this system is needed to sustainably manage these FEW resources...
December 12, 2018: Environmental Science & Technology
Sona Uramova, Peter Kubatka, Zuzana Dankova, Andrea Kapinova, Barbora Zolakova, Marek Samec, Pavol Zubor, Anthony Zulli, Vanda Valentova, Taeg Kyu Kwon, Peter Solar, Martin Kello, Karol Kajo, Dietrich Busselberg, Martin Pec, Jan Danko
In contrast to the genetic component in mammary carcinogenesis, epigenetic alterations are particularly important for the development of sporadic breast cancer (BC) comprising over 90% of all BC cases worldwide. Most of the DNA methylation processes are physiological and essential for human cellular and tissue homeostasis, playing an important role in a number of key mechanisms. However, if dysregulated, DNA methylation contributes to pathological processes such as cancer development and progression. A global hypomethylation of oncogenes and hypermethylation of tumor-suppressor genes are characteristic of most cancer types...
December 2018: EPMA Journal
Kate Beckett, Michelle Farr, Anita Kothari, Lesley Wye, Andrée le May
The potential use, influence and impact of health research is seldom fully realised. This stubborn problem has caused burgeoning global interest in research aiming to address the implementation 'gap' and factors inhibiting the uptake of scientific evidence. Scholars and practitioners have questioned the nature of evidence used and required for healthcare, highlighting the complex ways in which knowledge is formed, shared and modified in practice and policy. This has led to rapid expansion, expertise and innovation in the field of knowledge mobilisation and funding for experimentation into the effectiveness of different knowledge mobilisation models...
December 11, 2018: Health Research Policy and Systems
Kristine Ravina, Ben A Strickland, Ian A Buchanan, Robert C Rennert, Paul E Kim, Vance L Fredrickson, Jonathan J Russin
Large, broad-based basilar artery (BA) apex aneurysms involving multiple arterial origins are complex lesions commonly not amenable to direct clipping or endovascular management. BA proximal (Hunterian) occlusion with extracranial-to-intracranial bypass is a supported strategy if one or both posterior communicating arteries are small. Hunterian ligation risks sudden aneurysm thrombosis and thromboembolism in the perforator rich BA apex. There currently exists no guidelines for antiplatelet and anticoagulant therapy following Hunterian ligation for complex BA apex aneurysm treatment...
December 8, 2018: World Neurosurgery
Joanna Osmanska, Pardeep S Jhund
The foundation of the treatment of heart failure with reduced ejection fraction is a number of pharmacotherapies shown to reduce morbidity and mortality in large randomised multinational clinical trials. These include angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, mineralocorticoid receptor antagonists, and more recently, a combined angiotensin receptor blocker neprilysin inhibitor, sacubitril/valsartan. In select cases, digoxin, ivabradine and hydralazine with isosorbide dinitrate have a role to play in the treatment of heart failure with reduced ejection fraction...
December 11, 2018: Drugs & Aging
Andreas Goebel, Austen Peter Moore, Anu Jacob
Introduction: Autoantibody-mediated autoimmunity directed against targets within the voltage-gated potassium channel complex (VGKCC autoantibodies) has been implicated in causing neuropathic pain. Methods: We report the case of a 76-year-old, United Kingdom male who was diagnosed with contactin-associated protein 2 (CASPR2) autoantibody-associated Morvan syndrome, a rare neurological condition. Results: He had previously worked in a swine abattoir; exposure to aerosol within swine abattoirs has been reported to elicit an immune response resulting in the production of these autoantibodies; however, unusually, his manifestations emerged with several years' latency...
September 2018: Pain Reports (Baltimore, Md.)
Ravina Kullar, Julia Frisenda, Paul S Nassif
Background: With antimicrobial resistance a global threat, optimizing antibiotic usage across the surgical continuum is vital. The American Academy of Otolaryngology-Head and Neck Surgery Foundation recently published the first guidelines addressing management in rhinoplasty. The authors reviewed pertinent literature on the role of systemic antibiotics in rhinoplasty and septorhinoplasty. Methods: The authors performed a MEDLINE search through PubMed using the key terms rhinoplasty, septorhinoplasty, infection, antimicrobials, and antibiotics...
October 2018: Plastic and Reconstructive Surgery. Global Open
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