Outcomes Of Various Treatment Modalities Research Articles

Diagnosis and Treatment of Hepatic Hematoma After Liver Transplantation in a Timely Manner

ObjectiveHematomas of the liver graft, that is, postintervention, subcapsular or intrahepatic are rare yet potentially fatal complications following liver transplantation (LT), necessitating immediate diagnosis and management to avert devastating outcomes. This study was aimed to introduce our approach to manage graft hematoma subsequent to LT. MethodsAmong 131 orthotopic liver transplantations (OLT) conducted at our institution between January 2017 and May 2023, 3 cases of intrahepatic (n = 2) and extrahepatic (n = 1) hematoma were confirmed through computed tomography (CT) within 10 days after LT. The clinical outcomes of various treatment modalities for these three cases were analyzed. ResultsThree out of 131 (2.3%) LT recipients developed graft hematoma. Patient 1 developed a spontaneous intrahepatic hematoma, without evident predisposing factors, while patient 2 developed an intrahepatic hematoma following endoscopic retrograde cholangiopancreatography (ERCP). The third case that is extrahepatic hematoma was speculated to be a result of minor hepatic parenchymal injury stemming from compressive and volume-reducing manipulation of a large graft, or secondary to focal ischemic necrosis of the liver. Our management protocol was summarized as follows: (1). Immediate ultrasound and CT, particularly enhanced CT; (2). Puncture and percutaneous drainage (PD) of the hematoma; (3). Arterial embolization if the origin could be identified as a ruptured vessel; (4). Surgical evacuation of the hematoma in the presence of bile leakage, to avoid a compartment respectably secondary infection. All three patients responded favorably to treatment and remained alive to date. ConclusionPrompt diagnosis and sequential individualized management can successfully deal with intra-/extrahepatic graft hematoma after LT. Our results underscored that an individualized management considering potential future complications into account.

Objective assessment of the factors affecting outcome of immediate management of mandibular fractures – A prospective study in a Level-I trauma care center

Background: Mandibular fractures lead to complications if improperly treated. The management of mandibular fractures includes open reduction and internal fixation (ORIF) or closed reduction. Associated complications include malocclusion, infection, hardware extrusion, and nerve injury. Aims and Objectives: The aims of this study were to evaluate the functional outcome of various treatment modalities of mandibular fracture and to identify the factors affecting the outcome. Materials and Methods:The study included patients admitted in the trauma care center, between 13 and 70 years of age, and having mandibular fracture. Patients underwent ORIF or closed reduction according to the type of fracture. Mandibular injury severity score (MISS), Mandibular functional impairment questionnaire (MFIQ) score, and pain visual analog score were used to assess the functional outcome of treatment and complications. Results: Majority of the patients were male and were in the age group 21–30 years. The most common cause of fracture was road traffic accident (RTA). Majority of the patients underwent ORIF. Patients having higher injury severity scores, severe MFIQ scores and pain visual analog scores had more complications. Overall, complications in open reduction cases were higher than closed reduction ones. However, weight loss and time to functional improvement were more in closed reduction cases. Conclusion:Young males are most commonly affected with fracture of mandibles and mostly due to RTAs. There should be minimal delay from presentation to operative intervention in case of patients who require ORIF. Scoring systems such as MISS, MFIQ, and pain visual analog scale scores may help in the early prognostication of injury and warn against imminent complications.

A study to evaluate functional outcome of various treatment modalities (surgical) of proximal humerus fracture

A study to evaluate functional outcome of various treatment modalities (surgical) of proximal humerus fracture

Laryngotracheal Stenosis: Our Experience in a Tertiary Care Hospital.

Laryngotracheal stenosis is a recalcitrant disease with high morbidity. Laryngotracheal stenosis can be defined as a partial or circumferential narrowing of the airway and may be congenital or acquired. Sites involved are supraglottis, glottis, or sub glottis. The goal of treating the patient with laryngotracheal stenosis is to reconstruct an adequate airway while preserving phonation and airway protection. Furthermore, there is no fixed treatment for laryngotracheal stenosis, the choice of surgical procedure is determined by the individual anatomy, involved site, length and luminal narrowing of stenotic segment and function of the larynx and trachea, together with patient factors and available facilities. To determine the most common aetiology of laryngotracheal stenosis and to study outcome of various treatment modalities and their efficacies according to the site of stenosis and time of presentation. We have prospectively studied 25 cases of laryngotracheal stenosis who presented in Department of ENT, Civil Hospital, Ahmedabad from May 2019 to December 2021. All patients with clinical suspicion of laryngotracheal stenosis underwent CECT Neck and Thorax with virtual bronchoscopy, flexible bronchoscopy and graded according to myer cotton classification and then included in study. In our study of 25 patients 19 patients had history of intubation. Out of 25 patients, 5 Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation patients had supraglottic stenosis, 14 had subglottic stenosis and 6 patients had tracheal stenosis. 20 patients were tracheostomised. Bilateral vocal cord mobility is pre requisite for any surgical intervention and for decannulation of tracheostomy tube. Laser ablation is best modality for supra glottis stenosis patients. Treatment options of subglottic and tracheal stenosis patients depends on vocal cord mobility, % of luminal narrowing and type of stenosis on flexible bronchoscopy and CT scan. Patients of subglottic or tracheal stenosis having Myer cotton grading 1 or 2 were successfully treated by Laser + Balloon dilatation while grade 3 or 4 by resection and end to end anastomosis. Endoscopic CO2 laser ablation with/without balloon dilatation gives promising results in cases of supra glottic stenosis and in soft, mucosal, short segment (< 1.5cm), grade 1 or 2 stenosis patients with subglottic or tracheal stenosis. In patients with subglottic or tracheal stenosis having hard, cartilage framework involvement, > 1.5cm stenotic segment, Grade 3 or 4 needed external open approach like tracheal resection and end to end anastomosis.

Judicious management of pinna keloids: our experience with combination therapy

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Keloids occur as a result of overgrowth of fibrous tissue following healing of a cutaneous injury and they cause aesthetic issues when they appear on the exposed parts of the body, especially the face. Keloids are difficult to treat, with a high recurrence rate. There are several treatment modalities for management of keloids, though no single modality is completely effective. Most commonly used treatment modalities are intra-lesional steroids, surgical excision, pressure application, silicone gel sheets, 5-fluorouracil (5-FU), cryotherapy, radiation therapy, laser therapy or a combination of these modalities. The aim of the study was to analyse the causes of development of keloids on the pinna and evaluated the outcomes of various treatment modalities applied. It focused on assessing the clinical efficacy of combined surgical excision of pinna keloids with serial steroid injections to prevent recurrence, in comparison to monotherapy with intra-lesional steroid injections alone.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A retrospective review based on medical records was done for 18 patients with keloid of pinna, who were treated with either monotherapy or combination therapy. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Satisfactory low recurrence rates were observed with meticulous surgical excision followed by serial steroid injections (18.2%), as compared to monotherapy with serial steroid injections alone (71.4%), and these comparative results were statistically significant at p&amp;lt;0.05 in the cohort.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; A judicious plan for management for pinna keloids is necessary in order to achieve the best functional and cosmetic outcomes, while reducing the recurrence rates to a minimum. Following a combination of interventions has proved safe and effective for managing this challenging entity.&lt;/p&gt;

A Retrospective Observational Study to Compare the Outcome of Various Treatment Modalities of Idiopathic Avascular Necrosis of Hip.

Avascular necrosis (AVN) of hip of the femoral head is increasingly seen in young age, disabling them in their productive years of life. Available treatment options need to be evaluated. The aim was to compare the outcome of various treatments at different stages of AVN hip. A retrospective observational study was done in patients with idiopathic AVN hip, who had undergone different treatment modalities. The data of the included patients at different time intervals were compared. All patients were graded with the help of Harris Hip Score (HHS), and their outcome was evaluated. The age distribution of patients showed that nearly 80% of them were below the age of 50 years. The patients were presenting more often in Ficat and Arlet stage 4 compared to earlier stages. The patients in stage 1 were treated by core decompression alone, which produced good-to-excellent results in 4 of 7 (57.1%) patients. Patients in stage 2 and 3 were treated by core decompression with fibular bone grafting and had good-to-excellent results in 6 of 8 (75%) patients. In stage 4 of disease, cemented total hip replacement (THR) was done, and it produced good-to-excellent results in 13 of 15 (86.6%) patients. In the early stage of disease, core decompression with and without bone grafting produced satisfactory results. In an advanced stage of AVN, THR is an excellent treatment option.

Effect of Oral Contraceptive Pill and Metformin on Metabolic and Endocrine Parameters in Polycystic Ovarian Syndrome: A Prospective Interventional Study

Introduction: Polycystic Ovarian Syndrome (PCOS) is one of the most common endocrinopathies, affecting women of reproductive age group worldwide. There is no comprehensive data, regarding the outcome of various treatment modalities. Aim: To assess the effect of Oral Contraceptive Pills (OCP) and metformin on metabolic and endocrine parameters in PCOS. Materials and Methods: It was a prospective interventional study, done over a period of 12 months from January 2017 to January 2018 at the Outpatient Department (OPD) of Gynaecology and Obstetrics, Medical College, Kolkata. A total of 162 PCOS patients were recruited. The selected patients were divided into two groups A and B, based on the clinician’s assessment with respect to the patient profile. Group A received lifestyle intervention plus metformin (started at 500 mg / day and according to patient’s response and the clinical judgement titrated upto 2000 mg/day for 6 months) and group B received lifestyle intervention plus oral contraceptive pill. (fixed dose combination of ethinyl estradiol 50 micrograms and cyproterone acetate 2 milligrams per day for 6 months). The patients were assessed for metabolic parameters [Fasting Blood Sugar (FBS), Post-Prandial Blood Sugar (PPBS), Haemoglobin A1C (HbA1C), lipid profile] and endocrine parameters [testosterone, prolactin and Thyroid Stimulating Hormone (TSH)]. The Student t-test, Chisquare test and Analysis of Variance (ANOVA) test were used to compare the data. Results: A total of 162 patients were recruited for the present study with the mean age in group A was 23.75±1.7 and in group B was 22.40±1.6 years. The mean HbA1C levels of group A before the initiation of the treatment was found to be 7.51±0.89% which was reduced to 7.45±0.49% and 6.83±0.34% at the end of two months and six months respectively (p-value=0.001). In group B, serum testosterone was significantly reduced from 2.86±0.48 to 2.18±0.42 (p-value=0.0001), however the glycemic control worsened. Conclusion: OCPs and metformin do not significantly correct metabolic abnormalities associated with PCOS, although, gynecological symptoms are improved significantly. Comparatively, metformin helps in control of blood sugar levels but high BMI and deranged lipid profile remains unaltered by both metformin and OCP.

Gamma Knife Radiosurgery-Based Combination Treatment Strategies Improve Survival in Patients With Central Nervous System Metastases From Epithelial Ovarian Cancer: A Retrospective Analysis of Two Academic Institutions in Korea and Taiwan.

Central nervous system (CNS) metastases from epithelial ovarian cancer (EOC) are rare. We investigated the clinico-pathological prognostic factors of patients with CNS metastases from EOC and compared the outcomes of various treatment modalities. We retrospectively reviewed the records of patients with CNS metastases from EOC between 2000 and 2020. Information on the clinical and pathological characteristics, treatment, and outcomes of these patients was retrieved from Samsung Medical Center and National Taiwan University Hospital. A total of 94 patients with CNS metastases were identified among 6,300 cases of EOC, resulting in an incidence of 1.49%. Serous histological type [hazard ratio (HR): 0.49 (95% confidence interval [CI] 0.25-0.95), p=0.03], progressive disease [HR: 2.29 (95% CI 1.16-4.54), p=0.01], CNS involvement in first disease relapse [HR: 0.36 (95% CI 0.18-0.70), p=0.002], and gamma knife radiosurgery (GKS)-based combination treatment for EOC patients with CNS lesions [HR: 0.59 (95% CI 0.44-0.79), p<0.001] significantly impacted survival after diagnosis of CNS metastases. In a subgroup analysis, superior survival was observed in patients with CNS involvement not in first tumor recurrence who underwent GKS-based combination therapeutic regimens. The survival benefit of GKS-based treatment was not significant in patients with CNS involvement in first disease relapse, but a trend for longer survival was still observed. In conclusion, GKS-based combination treatment can be considered for the treatment of EOC patients with CNS metastases. The patients with CNS involvement not in first disease relapse could significantly benefit from GKS-based combination strategies.

English

BACKGROUND Peripheral ulcerative keratitis (PUK) is a destructive inflammatory disease of the juxta-limbal corneal stroma that is caused by various infectious and non-infectious ocular and systemic diseases. Certain morphologic and immunologic characteristics of peripheral cornea make it more vulnerable to inflammatory reactions and necrosis. Early diagnosis and prompt treatment prevent blindness due to this devastating inflammatory condition. We wanted to study the aetiology, clinical features and outcome of various treatment modalities of peripheral ulcerative keratitis of non-infective aetiology. METHODS 54 eyes of 40 patients with peripheral ulcerative keratitis of non-infective aetiology were evaluated and treated with either medical or surgical therapy or both in a tertiary care centre and were followed up. The total study duration was 12 months. RESULTS 60 percent of cases were males (24 / 40). The most common age group affected was 60 - 70 years (32.5 %) and the mean age in our study group was 57.7 ± 18.33 years. 65 % were unilateral (26 / 40). In our study 15 eyes (27.77 %) had meibomitis. 13 % of eyes had mild involvement, 40.8 % eyes had moderate involvement, 46.2 % eyes had severe involvement. Severe involvement was the most common presentation. The incidence of perforated PUK in the study group was 20.37 % (11 / 54 eyes). 45 % were found to have unknown aetiology. Of the remaining, the most common aetiology was Mooren's ulcer (32.5 %) followed by rheumatoid arthritis (20 %) and Systemic Lupus Erythematosus (2.5 %). Among 54 eyes, the resolution of signs of active PUK was seen in 50 eyes (92.59 %) after treatment. Visual acuity improvement noted on comparison of mean of pretreatment visual acuity 0.90 with standard deviation 0.39 and the mean of post treatment visual acuity 0.62 with standard deviation 0.37 logarithm of minimum angle of resolution units with P value is &lt; 0.001 which is significant. For perforated peripheral ulcerative keratitis eyes, patch graft was found to be successful in 87.5 %. Peritomy was successful in 100 % and peritomy with amniotic membrane graft was successful in 70 %. CONCLUSIONS In our study, male patients were more than female and the commonest presentation was unilateral. Most common aetiology was idiopathic followed by Mooren's ulcer, rheumatoid arthritis and systemic lupus erythematosus. Mild to moderate cases respond well to medical management. Severe cases need immunosuppressants. Perforated cases needs surgical intervention especially patch graft which is better in achieving good anatomical integrity and enhanced visual acuity. Early referral of patients with peripheral ulcerative keratitis to a tertiary care centre helps in early treatment which is beneficial in avoiding blindness. KEYWORDS Peripheral Ulcerative Keratitis, Non Infective, Immunosuppressants, Patch Graft

Retrospective study of proliferative urethritis in dogs: Clinical presentation and outcome using various treatment modalities in 11 dogs.

BackgroundProliferative urethritis (PU) is an uncommon inflammatory and infiltrative disease of the urethra in female dogs, often associated with urinary tract infection (UTI). It typically presents with evidence of urethral obstruction (UO).ObjectivesIdentify clinical features in dogs with PU and determine outcome after different treatment modalities.AnimalsEleven client‐owned dogs.MethodsMedical records of dogs with histopathologic diagnosis of PU from 2011 to 2020 were retrospectively evaluated, including information on clinical pathology, imaging, and histopathology. Outcomes of various treatment modalities were recorded and compared. Long‐term urethral patency (>6 months) was considered treatment success.ResultsAll dogs were female and presented with UO. Eight (73%) had a history of UTI. Ten of 11 survived to discharge and were used for long‐term data collection. Seven of 10 (70%) were treated using an effacement procedure (balloon dilatation [BD], stent, or both) and 6/7 (86%) achieved long‐term urethral patency (>6 months). Seven of 10 had UO recurrence after their first procedure, including 3/3 (100%) that did not have effacement and 4/7 that did (57%), at a median of 101 days and 687 days, respectively. After effacement, the duration of patency was longer for those treated using a stent than BD alone (median, 843 days and 452 days, respectively).Conclusions and Clinical ImportanceProliferative urethritis is a recurrent disease often associated with UTI. The best outcome of long‐term urethral patency occurred after lesion effacement, either by BD or stenting. Future prospective studies should determine the impact of immunosuppressive treatment.

A Study of Clinical Profile and Factors Associated with Cerebrospinal Fluid Rhinorrhea with Outcomes of Various Treatment Modalities at Tertiary Healthcare Center

A Study of Clinical Profile and Factors Associated with Cerebrospinal Fluid Rhinorrhea with Outcomes of Various Treatment Modalities at Tertiary Healthcare Center

Intracranial Abscesses: An Institutional Study

Background: Brain abscess is defined as a focal intracranial infection that is initiated as an area of cerebritis and evolves into a collection of pus surrounded by a vascularized capsule. These are complications of head trauma, neurosurgical operations, meningitis, and otogenic, mastoid, and paranasal air sinus infections. Management involves both medical and surgical treatment. Surgical management includes either aspiration or excision of lesions larger than 2.5 cm in diameter, depending on brain location. However, literature on surgical treatment is replete with several procedures which, on their own, may not determine outcome. Aim: Aim is to study the epidemiology, management and outcome of various treatment modalities of brain abscess in our institute. Material and Methods: We conducted a retrospective study of demographic data as well as indications, treatment modalities, and outcomes of various surgical procedures for evacuation of intracranial abscesses in patients admitted to our Neuro-intensive care unit at R.N.T. Medical College, Udaipur, Rajasthan, India from January 2013 to June 2019. Results: We carried out 53 procedures in 43 (30 male and 13 female) patients with various intracranial abscesses. Most abscesses [16, i.e. 37%] occurred in the second decade and second most common in the first decade [15, i.e. 34%]. In infants 4 (9%) cases of intracranial abscesses were present. None of the infants had features of congenital heart disease. The predisposing factors were mostly otolaryngologic (15) or posttraumatic (8). Most commonly abscesses were located in frontal 13 (30%) followed by cerebellar 9 (21%). Burr hole evacuation was done in 74% of cases. 3 patients (7% of cases) died. Prognosis appears to worsen with ventriculitis, multiple abscesses especially in infants, and immunosuppression. Conclusion: In conclusion, brain abscess still continues to be a formidable challenge, with prognosis that dramatically improved over the last decades due to advances in brain imaging, neurosurgical techniques and better use of old and more recent antibacterial agents. Mortality is improved compared with historical series; however, long-term morbidity is significant particularly in the infant population. Further researches must be conducted to clarify specific aspects, such as anticonvulsant prophylaxis/therapy, and also for the improvement of microbiological diagnosis.

The Canadian Biomarker Integration Network in Depression (CAN-BIND): magnetic resonance imaging protocols

Studies of clinical populations that combine MRI data generated at multiple sites are increasingly common. The Canadian Biomarker Integration Network in Depression (CAN-BIND; www.canbind.ca) is a national depression research program that includes multimodal neuroimaging collected at several sites across Canada. The purpose of the current paper is to provide detailed information on the imaging protocols used in a number of CAN-BIND studies. The CAN-BIND program implemented a series of platform-specific MRI protocols, including a suite of prescribed structural and functional MRI sequences supported by real-time monitoring for adherence and quality control. The imaging data are retained in an established informatics and databasing platform. Approximately 1300 participants are being recruited, including almost 1000 with depression. These include participants treated with antidepressant medications, transcranial magnetic stimulation, cognitive behavioural therapy and cognitive remediation therapy. Our ability to analyze the large number of imaging variables available may be limited by the sample size of the substudies. The CAN-BIND program includes a multimodal imaging database supported by extensive clinical, demographic, neuropsychological and biological data from people with major depression. It is a resource for Canadian investigators who are interested in understanding whether aspects of neuroimaging — alone or in combination with other variables — can predict the outcomes of various treatment modalities.

Proximal femur nail vs cemented bipolar prosthesis in unstable intertrochanteric femur fractures in elderly: A prospective study

Background: Surgical stabilization of Intertrochanteric fracture femur is one of the most commonly performed orthopaedic procedures. Present study was done to analyse the outcome of various treatment modalities for unstable Intertrochanteric fracture femur in elderly. Methods: The present clinical study was carried out at our tertiary care hospital. Study duration was from Jan 2015 to June 2016. 70 patients over the age of 60 years with unstable Intertrochanteric fracture were selected. Outcome of management of unstable Intertrochanteric fracture femur was analysed using Harris Hip Score in Proximal femoral nail (PFN) and Cemented Bipolar prosthesis (CBP). Results: Most of the patients were between 60-70 years of age. The average age of study group was 68.9 years. 35 patients treated with PFN and 35 patients treated with CBP. Superficial infection was seen in 4 patients and was the most common complication found in cemented bipolar prosthesis. External rotation deformity was second most common complication seen in 5 patients. Out of them, 2 patients were of CBP and 3 patients of PFN. Deep wound infection occurred in 1 case of CBP. Average blood loss in patients operated with PFN and CBP were 205 ml and 311ml in CBP. It was noted that shorter time was required for P.F.N (55 min) and then for CBP (84min). Average Harris score for PFN and CBP at 3 months, at 1 year and at 2 years were 70.1:74.9, 86.4:78.2 and 84.4:76.6. Conclusion: Considering the amount of blood loss, duration of the surgery and Harris Hip Score, PFN is better for unstable inter trochanteric fracture femur than CBP. The only advantage of Hemiarthroplasty was early weight bearing. But at the end of 1 year and 2 years, the outcome of PFN was better than Cemented Bipolar prostheses. Statistical method: Data were reported as mean, median (range) or number. t-test was used to assess significant difference among all numerical parameters of the study within the two surgical groups. P–values < 0.05 were considered statistically significant.

Effects of Topical Mandelic Acid Treatment on Facial Skin Viscoelasticity.

Mandelic acid is an α-hydroxy acid with reported benefit in treating acne and hyperpigmentation. The authors have developed a topical mandelic acid formulation that subjectively improves the quality of aged skin. Although the gold standard for assessing outcomes, photographic documentation is limited by subjective interpretation. Tools for measuring physical skin properties allow for an objective assessment of changes in skin quality. The authors sought to objectively study the viscoelastic changes to the skin following treatment with topical mandelic acid, using the Cutometer MPA 580. Twenty-four patients, twenty females and four males, aged 42 to 68 years, were studied over a four-week period. Mandelic acid was applied topically to the face twice a day for four weeks. The lower eyelid skin viscoelastic properties were assessed weekly using the Cutometer. After four weeks of topical mandelic acid treatment, the elasticity of lower eyelid skin increased 25.4% (P = .003). Skin firmness increased 23.8% (P = .029). Improvement in photographic appearance correlated with these findings. Mandelic acid is another topical treatment option for improving skin quality, and is well tolerated by patients. The authors feel that the Cutometer or similar device should be used routinely in facial plastic surgery to objectively assess outcomes of various treatment modalities.

Outcomes of Various Treatment Modalities for Lumbar Spinal Ailments in Elite Athletes: A Literature Review.

Lumbar spinal injuries are common in elite athletes, who can present with a spectrum of ailments ranging from lumbar strain to prolapsed intervertebral discs. Sequelae can include neurological impairment and lumbar instability among other possible outcomes. This group of patients is unique in terms of their clinicoradiological presentation and treatment modalities. The primary goals of treatment are a rapid return to play and prevention of recurrence, thus prolonging the athlete’s professional career. Treatment modalities can range from activity restriction to nerve root blocks and surgery. A successful treatment outcome is based on timely diagnosis, treatment suiting the demands of the particular sport, and early rehabilitation. A multidisciplinary team approach involving the coach, rehabilitation specialist, pain management specialist, and spine surgeon helps in planning appropriate treatment. In this article, we review special considerations in the elite athletic population with lumbar spinal ailments as well as the outcomes of various treatment modalities.

Therapeutic outcome of various treatment modalities for the management of 34 cases of mandibular unicystic ameloblastoma

Background &amp; Objectives: Unicystic ameloblastoma is a challenge, as conservative modalities have high recurrence chances whereas radical modalities have high morbidity for defects and deformity. Enucleation with peripheral ostectomy and Carnoy’s solution is an intermediate treatment with less risk of recurrence and good outcome. The objectives of the study was to determine the therapeutic outcome for various treatment modalities for the management of mandibular unicystic ameloblastoma.Materials &amp; Methods:Retrospective analysis of 34 cases from 2005 to 2014 was done and were analysed in terms of demographic profiles, treatment modalities and its efficacy (recurrence) in 6 years’ follow up time.Results: The total number of patients was 34. The age ranged from 12 years to 28 years with a mean age of 18.82 years. Gender distribution was 21 males (61.8%) and 13 females (38.2%). The location found was 26 (76.5%) cases in posterior mandibular region and 8 (23.5%) cases in the anterior mandibular region. Size of the lesions was small in 10 (29.4%) cases, medium in 18 (52.9%) cases and large in 6 (17.6%) cases. Perforation of buccal or lingual cortex was present in 6 (17.6%) and no preforation in 28 (82.4%). Treatment modalities done was marsupilisation in 6 (17.6%) cases, enucleation with peripheral ostectomy with caroney solution in 22 (64.7%) cases and resection with safe margin in 6 (17.6%) cases. Recurrence occurred in 8 (23.5%) cases and no recurrence in 26 (76.5%) cases.Conclusion:Enucleation with peripheral ostectomy and Carnoy’s solution is one of the good treatment modality for unicystic ameloblastoma of the mandible whereas complete resection of the mandible with safe margin has low risk of recurrence in long term follow up.

Pediatric blepharokeratoconjunctivitis: is there a 'right' treatment?

This article highlights the importance of recognizing blepharokeratoconjunctivitis (BKC) in children and reviews the clinical characteristics and current therapeutic modalities. The mainstay of BKC treatment remains controlling the meibomian gland inflammation and treating cobormid conditions. BKC can occur in the setting of ocular rosacea and Demodex infestation. Small studies have shown treatment benefits of topical cyclosporine A as well as oral azithromycin in pediatric BKC. BKC is a cause for visual loss in children, and therefore pediatric ophthalmologists should be more vigilant about early diagnosis and long-term treatment. There is a lack of randomized controlled trials on this topic and no standardized outcome measures. Better ways to measure the clinical outcome of various treatment modalities need to be developed.

Brain Metastasis from Colorectal Cancer: Predictors and Treatment Outcomes

Objective: Difficulties are associated with the management of brain metastasis (BM), which portends a poor prognosis in the treatment of colorectal cancer (CRC). The aim of the present study was to identify risk factors for BM in CRC and evaluate the outcomes of various treatment modalities. Methods: We retrospectively reviewed data on a total of 2,238 patients with primary CRC who underwent surgical resection at our hospital between 1999 and 2014. Predictive factors for BM and prognostic factors after the diagnosis of BM were examined by univariate and multivariate analyses using Cox proportional hazards models. Results: Three patients (0.1%) had BM at the initial diagnosis, and 23 patients (1.2%) developed metachronous BM during the median follow-up period of 44.6 months. Lung and bone metastases were identified as independent predictive factors for BM. Median survival after the diagnosis of BM was 7.4 months. Stereotactic radiosurgery, administered to 41% of the patients with BM, was associated with a better postdiagnostic survival. Conclusion: CRC patients with metastasis to the lung or bone were at a higher risk of BM. Because the survival is still limited, it is crucial to determine the treatment strategy in consideration of the characteristics of each therapy and quality of life in CRC patients with BM.

Prognostic factors for profound sudden idiopathic sensorineural hearing loss: a multicenter retrospective study.

The aim of this study was to assess the outcomes of various treatment modalities for profound idiopathic sudden sensorineural hearing loss (ISSNHL) and confirm the prognostic factors. In total, 191 patients were enrolled after a thorough medical chart review of patients diagnosed with unilateral, profound ISSNHL (≥90dB). Epidemiological profiles, therapeutic regimens, and the results of pure tone audiometry tests were recorded for all patients. Final recovery was assessed according to Siegel's criteria and by comparing the final hearing level of the affected ear with that of the unaffected ear. The mean follow-up duration and the final hearing level were 75±54days and 77±24dB, respectively. None of the evaluated prognostic factors were significantly associated with complete recovery (<25dB). However, improved hearing in both ears, the absence of dizziness, the use of lipo-prostaglandin E1 (lipo-PGE1), and the use of plasma volume expanders were independently associated with a final hearing level of up to 45dB (p<0.05). Steroid dose reduction, worse initial hearing, and non-use of lipo-PGE1 increased the possibility of no recovery. Although the efficacy of oral steroid treatment for profound ISSNHL has been questioned, steroid dose reduction was significantly associated with no recovery. Therefore, adequate oral corticosteroid doses should be considered in the absence of contraindications. In addition, the use of lipo-PGE1 and/or a plasma volume expander seems preferable for better recovery, and their use for the management of profound ISSNHL should be considered.