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Intractable patients

Min Gyu Choi, Joon Hyung Yeo, Jeong Woo Kang, Yeoun Sook Chun, Jeong Kyu Lee, Jae Chan Kim
PURPOSE: To determine the effects of botulinum toxin type A (BTX-A) injection on dry eye signs, symptoms, and tear cytokine levels in patients with intractable dry eye disease (DED). METHODS: In this prospective study, patients with intractable DED were randomized to a BTX-A (group A) or control group (group B). Patients were injected with BTX-A or normal saline in the medial part of the upper and lower eyelids. Before and at 2 weeks, 1 month, 2 months, and 4 months after injection, dry eye signs; tear film break-up time (TBUT), Schirmer I test, corneal fluorescein staining (CFS), and symptoms; ocular surface disease index (OSDI); and frequency of lubricants were assessed...
December 14, 2018: Graefe's Archive for Clinical and Experimental Ophthalmology
Y Liu, F Yuan
Chronic rhinosinusitis (CRS) is an inflammatory disease of the nasal airways and paranasal sinuses. The condition is defined by more than 12 weeks of nasal obstruction, nasal discharge, facial pain/pressure, and reduced/lost smell. CRS is commonly further classified into 2 subsets based on its clinical phenotype: those with polyps (CRSwNP) and those without (CRSsNP). The incidence of CRS increases year by year. Due to its persistent, intractable and easy to relapse, CRS seriously affects patient's daily work and life...
October 5, 2018: Journal of Clinical Otorhinolaryngology, Head, and Neck Surgery
Brian Poligone, Belen Rubio-Gonzalez, Christiane Querfeld
Cutaneous T-cell lymphomas (CTCL) are a relatively rare and heterogeneous group of non-Hodgkin lymphomas that typically present in the skin. The majority of patients with CTCL experience pruritus, which can interfere with daily activities, significantly impact quality of life, and is typically uncontrolled by standard anti-itch therapies. Several lymphoma treatments have reported anti-pruritic effects including romidepsin, a potent class 1 selective histone deacetylase inhibitor approved for the treatment of patients with CTCL who have had at least 1 prior systemic therapy...
December 14, 2018: Dermatologic Therapy
(no author information available yet)
OBJECTIVEAblative procedures are still useful in the treatment of intractable pain despite the proliferation of neuromodulation techniques. In the paper the authors present the results of Gamma Knife thalamotomy (GKT) in various pain syndromes.METHODSBetween 1996 and 2016, unilateral GKT was performed in 30 patients suffering from various severe pain syndromes in whom conservative treatment had failed. There were 20 women and 10 men in the study population, with a median age of 80 years (range 53-89 years)...
December 1, 2018: Journal of Neurosurgery
Sonja Chiappetta, Christine Stier, Oliver Scheffel, Simone Squillante, Rudolf A Weiner
BACKGROUND: Whether one anastomosis gastric bypass (OAGB) or Roux-en-Y gastric bypass (RYGB) is a better revisional bariatric surgery (RBS) after sleeve gastrectomy (SG) is still under debate. The aim is to compare short-term outcomes of RYGB and OAGB as a RBS after SG, pertaining to their effects on weight loss, resolution of comorbidities, and complications. METHODS: We performed a single-center analysis of 55 patients (n = 34 OAGB, n = 21 RYGB). Indications for revisional surgery included weight regain/loss failure (67%) and intractable gastroesophageal reflux disease (33%)...
December 12, 2018: Obesity Surgery
Leigh N Sepeta, Madison M Berl, William Davis Gaillard
Epilepsy affects 2.2 million adults in the USA, with 1 in 26 people developing epilepsy at some point in their lives. Temporal lobe epilepsy (TLE) is the most common form of focal epilepsy as medial structures, and the hippocampus in particular, are prone to generating seizures. Selective anterior temporal resection (which removes the hippocampus) is the most effective intractable TLE treatment, but given the critical role of the mesial temporal lobe in memory functioning, resection can have negative effects on this crucial cognitive skill...
December 13, 2018: Journal of Neurodevelopmental Disorders
Dominique Vibert, John H J Allum, Martin Kompis, Simona Wiedmer, Christof Stieger, Rudolf Häusler, Marco Caversaccio
The aim of this study was to investigate changes in balance control for stance and gait tasks in patients 2 years before and after vestibular neurectomy (VN) performed to alleviate intractable Meniere's disease. Amplitudes of trunk sway in roll and pitch directions were measured for stance and gait tasks in 19 patients using gyroscopes mounted at the lower-back. Measurements before VN and 2 years later were compared to those of healthy age-matched controls (HC). We also examined if changes in trunk sway amplitudes were correlated with patients' subjective assessment of disability using the AAO-HNS scale...
December 12, 2018: Audiology & Neuro-otology
Kazuya Koyama, Hisatsugu Goto, Shun Morizumi, Kozo Kagawa, Haruka Nishimura, Seidai Sato, Hiroshi Kawano, Yuko Toyoda, Hirohisa Ogawa, Sakae Homma, Yasuhiko Nishioka
The signaling pathways of growth factors including platelet-derived growth factor (PDGF) can be considered specific targets for overcoming the poor prognosis of idiopathic pulmonary fibrosis (IPF). Nintedanib, the recently approved multiple kinase inhibitor, has shown promising anti-fibrotic effects in IPF patients; however, its efficacy is still limited, and in some cases, treatment discontinuation is necessary due to toxicities such as gastrointestinal disorders. Therefore, more effective agents with less toxicity are still needed...
December 12, 2018: American Journal of Respiratory Cell and Molecular Biology
Shearwood McClelland, Paul H Cooper, Anupama K Acheson, Jeremy N Ciporen, Jerry J Jaboin, Timur Mitin
Introduction: Stereotactic body radiotherapy (SBRT) of the spine has become an increasingly utilized modality in the United States, most commonly for metastatic disease (McClelland et al., 2017). Spinal SBRT in patients with spinal instrumentation has been sparsely examined. We report a patient who developed myelitis following spinal SBRT to a region with existing hardware. Methods: A 55-year-old woman with Stage IV breast cancer developed a T4 vertebral body metastasis and underwent tumor debulking with posteriorly instrumented T3-T5 fusion...
2018: Journal of Radiosurgery and SBRT
Han Gil Seo, Sang Jun Park, Jiah Seo, Seong Jun Byun, Byung-Mo Oh
Objective: Although evidence and guidelines recommend appropriate rehabilitation from the beginning of diagnosis in patients with Parkinson's disease (PD), there is a lack of data addressing the utilization of rehabilitation therapies for these patients in practice. The aim of this study is to investigate the rate of rehabilitation therapy utilization over time in patients with PD using a nationwide cohort in Korea. Methods: Patients were identified using the registration code for PD in the program for rare, intractable disease from the National Health Insurance Service-National Sample Cohort database, which consists of 979,390 Korean residents...
2018: Parkinson's Disease
Hammouda Hamdy Ghoraba, Mahmoud Leila, Sameh Mohamed Elgouhary, Emad Eldin Mohamed Elgemai, Haithem Mamon Abdelfattah, Hashem Hammouda Ghoraba, Mohamed Amin Heikal
Purpose: The purpose of this study was to evaluate the safety of high-dose intravitreal triamcinolone acetonide (IVTA) as affordable low-cost alternative to anti-vascular endothelial growth factor (anti-vascular endothelial growth factor [anti-VEGF] agents) in lower-middle-income countries. Patients and methods: This was a retrospective interventional non-comparative case series. The study recruited patients who received 20 mg IVTA for treating various retinal and optic nerve diseases over the past 5 years...
2018: Clinical Ophthalmology
Wuilker Knoner Campos, Marcelo Neves Linhares, Jamir Sarda, Adair Roberto Soares Santos, Júlio Licinio, João Quevedo, Kátia Lin, Roger Walz
OBJECTIVES: Previous studies demonstrated significant improvement in mean pain scores and quality of life (QOL) scales in patients with chronic pain who underwent spinal cord stimulation (SCS). However, the number of individuals who experience relevant improvements in QOL, termed the meaningful clinical improvement (MCI), is not known. The present study investigated changes in pain measurements based on MCI after SCS. MATERIALS AND METHODS: Thirty-four patients with chronic intractable pain completed scales of pain (visual analogue scale [VAS]), QOL (SF-36), and psychological dimensions during a 22-month follow-up period (mean)...
December 10, 2018: Neuromodulation: Journal of the International Neuromodulation Society
Ming Ma, Nataliya Kovalchuk, Mark K Buyyounouski, Lei Xing, Yong Yang
PURPOSE: Few features characterizing the dosimetric properties of the patients are included in currently available dose-volume histogram (DVH) prediction models, making it intractable to build a correlative relationship between the input and output parameters. Here we use PTV-only treatment plans of the patients (i.e., the achievable dose distribution in the absence of organs-at-risks (OARs) constraints) to estimate the potentially achievable quality of treatment plans and establish a machine learning-based DVH prediction framework with the use of the dosimetric metric as model input parameters...
December 11, 2018: Medical Physics
Vanessa Plantier, Françoise Watrin, Emmanuelle Buhler, Fanny Sandrine Martineau, Surajit Sahu, Jean-Bernard Manent, Ingrid Bureau, Alfonso Represa
Subcortical band heterotopia (SBH), also known as double-cortex syndrome, is a neuronal migration disorder characterized by an accumulation of neurons in a heterotopic band below the normotopic cortex. The majority of patients with SBH have mild to moderate intellectual disability and intractable epilepsy. However, it is still not clear how cortical networks are organized in SBH patients and how this abnormal organization contributes to improper brain function. In this study, cortical networks were investigated in the barrel cortex in an animal model of SBH induced by in utero knockdown of Dcx, main causative gene of this condition in human patients...
December 7, 2018: Cerebral Cortex
Taohua Liu, Yuezhong Zhang, Qiquan Wan
Pseudomonas aeruginosa bacteremia remains as a life-threatening complication after liver transplantation (LT) and is intractable because of the high rate of drug resistance to commonly used antibiotics. To better understand the characteristics of this postoperative complication, PubMed and Embase searches as well as reference mining was done for relevant literature from the start of the databases through August 2018. Among LT recipients, the incidence of P. aeruginosa bacteremia ranged from 0.5% to 14.4% and mortality rates were up to 40%...
2018: Infection and Drug Resistance
Sumitra G Bakshi, Raghuveer Singh P Gehdoo
Background and Aims: Post-dural puncture headache (PDPH) is one of the complications following spinal anaesthesia (SA) and accidental dural puncture (ADP). In our institute, we routinely practice epidural analgesia (EA) for supra-major surgeries. Our previous audit on EA revealed 4% incidence of ADP. This lead us to a clinical initiative to follow-up patients with dural puncture (DP) to note the incidence, presentation, associated symptoms and treatment of PDPH. Herewith, we present the retrospective analysis over a 2-year period...
November 2018: Indian Journal of Anaesthesia
Abhijit Chandra, Brijesh Mishra, Saket Kumar, Nikhil Chopra, Vivek Gupta, Amit Dangi, Pavan Kumar Gorla, Vishal Gupta
BACKGROUND: Severe fecal incontinence has a significant negative impact on patient well-being. Current surgical methods of total anorectal reconstruction to substitute a colostomy have suboptimal results. A composite graft using antropyloric valve transposition and gracilis wrap has been described with good outcomes. However, this procedure requires extensive training of patients. Gluteus maximus, an accessory muscle for continence, may be better suited for this purpose. OBJECTIVE: The purpose of this study was to evaluate the outcomes of composite antropylorus-gluteus graft for intractable fecal incontinence...
January 2019: Diseases of the Colon and Rectum
Kihwan Hwang, Dong Gyu Kim, Sun Ha Paek, Chae-Yong Kim, Chang-Ho Yun, Chang Wan Oh, Rahyeong Juh, Jung Ho Han
OBJECTIVE: We investigated seizure outcomes of patients with supratentorial meningiomas (ST-MNGs) treated with stereotactic radiosurgery (SRS). METHODS: One hundred and thirty-three patients with a total of 144 ST-MNGs, who were treated with SRS between 2009 and 2016, were included in this study. The mean age was 59.0±11.9 (range, 13-87) years. The mean follow-up duration was 49.8±24.5 (range, 9-96) months. The median tumor volume was 2.60 cm3 (range, 0.06-32...
December 5, 2018: World Neurosurgery
M S Gopalakrishnan, Nagesh C Shanbhag, Dhaval P Shukla, Subhas K Konar, Dhananjaya I Bhat, B Indira Devi
Decompressive craniectomy (DC) has become the definitive surgical procedure to manage medically intractable rise in intracranial pressure due to stroke and traumatic brain injury. With incoming evidence from recent multi-centric randomized controlled trials to support its use, we could expect a significant rise in the number of patients who undergo this procedure. Although one would argue that the procedure reduces mortality only at the expense of increasing the proportion of the severely disabled, what is not contested is that patients face the risk of a large number of complications after the operation and that can further compromise the quality of life...
2018: Frontiers in Neurology
Roberta Morace, Sara Casciato, Pier Paolo Quarato, Addolorata Mascia, Alfredo D'Aniello, Liliana G Grammaldo, Marco De Risi, Giancarlo Di Gennaro, Vincenzo Esposito
PURPOSE: The purpose of this study was to report long-term seizure outcome in patients who underwent frontal lobe epilepsy (FLE) surgery. METHOD: This retrospective study included 44 consecutive subjects who underwent resective surgery for intractable FLE at IRCCS NEUROMED (period 2001-2014), followed up for at least 2 years (mean: 8.7 years). All patients underwent noninvasive presurgical evaluation and/or invasive electroencephalography (EEG) monitoring when nonconcordant data were obtained or epileptogenic zone was hypothesized to be close to the eloquent cortex...
December 3, 2018: Epilepsy & Behavior: E&B
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