Surgical Curettage Research Articles

Arthroscopic Management of Juxta-Articular Proximal Tibial Chondroblastoma: A Case Report and Literature Review.

Chondroblastoma is a rare bone tumor that originates from the epiphysis, constitutes around 1% of all primary bone tumors and is recognized for its tendency to exhibit local invasiveness, as well as the possibility of metastasis and recurrence in nearby areas. Currently, the main surgical treatment for chondroblastoma is open surgery, involving excision of the lesion. There are relatively few reports on arthroscopic surgery for the treatment of chondroblastoma. However, open surgical curettage is associated with operation-related trauma and potential for damage to the osteoepiphysis resulting in growth disturbances. This case study presents the application of an arthroscopic technique in a 14-year-old male patient with chondroblastoma affecting the proximal tibia and tibial eminence. The procedure involved thorough removal of the lesion using direct visualization with the management of the cavity utilizing a substitute for autologous bone graft. After 1 year of follow-up, the patient remains free from symptoms, exhibits normal knee functionality, and radiographic analysis reveals a good autologous bone graft fusion without any signs of recurrence. Based on the existing cases of arthroscopic treatment for chondroblastoma and the report of this case, arthroscopic treatment for chondroblastoma can be considered as a specific treatment option for certain patients. In some cases, this technique could be an effective alternative to open surgery.

Simple bone cyst of the mandible: A case report with review of literature

Simple bone cyst (SBC) was first described by Lucas in 1929. It is an asymptomatic, intraosseous cyst. It falls under pseudocyst category, as it is devoid of an epithelial lining and mostly discovered accidently on routine radiograph. It commonly affects metaphyses of long bones such as humerus and femur. Other terminologies used for this lesion include Solitary bone cyst, traumatic bone cyst and hemorrhagic bone cyst. The incidence of cyst affecting the jaws is only 1%. About 89% of the lesion occurs in mandible and 11% in maxilla. The purpose of this article is to present rare occurrence of SBC in the mandibular region with review of literature. An 18 year old male patient reported with pain in right lower back teeth region. Clinically 47 was tender. Panoramic radiograph showed a radiolucent unilocular lesion in ascending ramus and mandibular body distal to 47. Diagnosis of apical periodontitis in relation to 47 and simple bone cyst mandible was made by correlating clinical, radiographic and histopathological evaluation. Surgical curettage was performed and follow up after 4 months revealed no evidence of recurrence. Simple bone cyst is rare incidental lesion of the mandible. Thorough clinical, radiological and histopathologic evaluation is helpful for diagnosis and surgical management of the lesion. Conservative management should be approached to prevent noble structure, with follow up to confirm remission of the lesion.

Utilizing fractional lasers and tirbanibulin ointment to treat squamous and basal cell carcinomas

Keratinocyte carcinoma is the most common form of cancer in the United States. Often treated by surgical excision, electrodessication and curettage, or Mohs surgery, treatment can frequently leave patients with a scar and can be time consuming and inconvenient for both patients and healthcare providers. Utilizing non-ablative fractional laser therapy followed by tirbanibulin ointment, we treated 30 basal and/or squamous cell carcinomas on 23 patients over the age of 50 with varying skin types. Multiple areas of the face and body, and carcinomas at differing stages, were treated. We maximized the depth of penetration of the fractional laser by using bulk heating methods while simultaneously optimizing cosmetic results. This is an ongoing study as we continue to track the progress of our participants. Thus far, no clinical or histological recurrence of carcinoma has been found in any of the treated sites.

Evaluating Treatment Modalities for Reducing Recurrence in Central Giant Cell Granuloma: A Narrative Review.

Treating central giant cell granuloma (CGCG) is challenging due to high recurrence rates and variable therapy responses. This study examines the efficacy of various treatments in reducing CGCG recurrence. A literature review explored outcomes of surgical excision, curettage, intralesional corticosteroid injection, and adjuvant therapy, considering factors like lesion location, size, and histological features. Aggressive surgical techniques such as en bloc resection were found to potentially lower recurrence rates compared to conservative approaches. However, treatment should be tailored to individual patient needs. Further research is needed to confirm these findings and improve treatment strategies. A concise literature review was conducted using PubMed, MEDLINE, and Google Scholar, focusing on papers published from 1986 to 2024. Search terms included "central giant cell granuloma", "recurrence", "treatment modalities", and "surgical excision". Studies reporting recurrence rates and treatment outcomes for CGCG were analyzed. Twenty-nine studies were reviewed, including six studies on surgical excision and curettage, eight studies on intralesional corticosteroid injections, six studies on calcitonin therapy, five studies on interferon-alpha therapy, and four studies on the therapy with denosumab. Analysis indicated that aggressive surgical treatments like en bloc resection were associated with lower recurrence rates compared to conservative methods. Predictors of recurrence included lesion size (>3 cm), location (mandible), and aggressive histopathological features. Aggressive surgical excision combined with nonsurgical methods may lower recurrence rates, while conservative techniques remain viable in some cases. Further prospective research is needed to validate these findings and enhance CGCG treatment options.

Endometrial pathology in abnormal uterine bleeding (AUB) & role of different techniques of endometrial sampling in evaluation of AUB: A cross-sectional study

: Abnormal uterine bleeding (AUB), traditionally defined as uterine bleeding that is abnormal in volume, regularity, and/or timing. It affects 14–25% of women of reproductive age. AUB has a major impact on quality of life of women. Aetiology of AUB may be structural and functional and varies with the age group. Histology of endometrium remains the mainstay in diagnosis of pathology and management of AUB. Various techniques such as endometrial sampling by pipelle, dilatation and curettage (D & C) and hysteroscopy are used to obtain endometrium for histological diagnosis. A single center prospective cross-sectional study at teaching institute was carried out to include 150 females from 18-70 years presenting with abnormal uterine bleeding. Objective of study was to analyse prevalence of various endometrial pathologies in AUB, symptomatology as well as age wise distribution of various endometrial pathologies in AUB and compare feasibility of different techniques of collecting endometrial sample. Endometrial sample was obtained either by OPD Pipelle brush or Surgical Dilatation and Curettage method or hysteroscopy. Statistical Analysis was done by using Epi-Info-7 software.Commonest age group presenting with AUB was 41-50 (40%) years, 64% were para 3 or more, Proliferative and secretary changes, 53(35.3%) and 24(16%) cases while endometrial hyperplasia without atypia 18 (12%) cases and with atypia 7 cases (4.7%), endometrial carcinoma 5 cases (3.3%) while endometrial polyp was seen in 8 cases (5.3%). Heavy menstrual bleeding with normal duration was the commonest presentation in 64%. Endometrial sampling technical failure was seen in 2 cases with pipelle biopsy while in 7 cases inadequate sample was obtained with pipelle and dilatation and curettage. Uterine perforation was seen in one case which was managed conservatively.Technical failure and inadequate sample needs to be addressed considering background high risk factors, TVS imaging, repeat sample and use of hysteroscopy may be offered case to case basis.

Outcomes and complications of second-trimester induction of labor using laminaria and gemeprost: A single-center experience in Japan.

To document the outcomes of second-trimester induction of labor with laminaria cervical dilation followed by gemeprost vaginal tablets, with a particular emphasis on its complications. This was a single-center retrospective cohort study of women who experienced medical abortions between 12 and 21 weeks of gestation from January 2016 to July 2021. Procedures were performed with three laminaria cervical dilation for 2 days followed by the administration of gemeprost (1 mg, vaginal tablet) every 3 h with a maximum of five tablets per day. Epidural anesthesia was provided upon request. The primary outcome was successful labor induction, which was defined as fetal expulsion without assisted surgical procedures. Other maternal outcomes, complications and related interventions during and after the procedure were assessed. Among 319 women, 313 (98.1%) experienced successful labor induction with a median of one gemeprost tablet. The median blood loss during the abortion was 145 mL, and three women (0.9%) required blood transfusion. Fever was observed in 19 women (6.0%) during hospitalization, although most cases were drug fever. Thirteen women (4.1%) had abnormal uterine bleeding ~24 days after the abortion. Eleven cases (3.4%) were associated with retained products of conception, of which three cases required uterine artery embolization and three needed surgical curettage. Second-trimester induction of labor with laminaria cervical dilation and subsequent gemeprost vaginal tablets is a reliable method for completing medical abortions. Abnormal uterine bleeding several weeks after abortion is suspected to be a retained product of conception that could require invasive treatment.

Giant complete hydatidiform mole: a case report and review of the literature

BackgroundThis case describes the youngest patient documented in the literature who presented with a giant hydatidiform mole, effectively addressed through conservative treatment.Case presentationOur department received a 20-year-old Caucasian patient who was admitted due to significant metrorrhagia in an undisclosed pregnancy. During examination, we identified a massive, highly vascularized hydatidiform mole measuring 22 cm (cm). We performed a surgical dilatation and curettage. The anatomopathological findings confirmed the presence of a complete hydatidiform mole (CHM). Following the established guidelines, we conducted weekly monitoring of human chorionic gonadotropin (hCG). Unfortunately, the patient discontinued the follow-up and became pregnant again before achieving hCG negativation.ConclusionThis case suggests that conservative treatment is a viable option regardless of the size of gestational trophoblastic disease (GTD), especially when the preservation of fertility is a crucial consideration, as effectively demonstrated in our case.

Differential Diagnosis of OKC and SBC on Panoramic Radiographs: Leveraging Deep Learning Algorithms.

This study aims to determine whether it can distinguish odontogenic keratocyst (OKC) and simple bone cyst (SBC) based solely on preoperative panoramic radiographs through a deep learning algorithm. (1) Methods: We conducted a retrospective analysis of patient data from January 2018 to December 2022 at Pusan National University Dental Hospital. This study included 63 cases of OKC confirmed by histological examination after surgical excision and 125 cases of SBC that underwent surgical curettage. All panoramic radiographs were obtained utilizing the Proline XC system (Planmeca Co., Helsinki, Finland), which already had diagnostic data on them. The panoramic images were cut into 299 × 299 cropped sizes and divided into 80% training and 20% validation data sets for 5-fold cross-validation. Inception-ResNet-V2 system was adopted to train for OKC and SBC discrimination. (2) Results: The classification network for diagnostic performance evaluation achieved 0.829 accuracy, 0.800 precision, 0.615 recall, and a 0.695 F1 score. (4) Conclusions: The deep learning algorithm demonstrated notable accuracy in distinguishing OKC from SBC, facilitated by CAM visualization. This progress is expected to become an essential resource for clinicians, improving diagnostic and treatment outcomes.

Xanthoma of the Jaw Bones: Cases Series and Review of Literature

BackgroundIntraosseous xanthomas are rare benign lesions sometimes associated with excess lipid production. Xanthoma of the jaw bones (XJB) was first reported in 1964, and fewer than 50 cases have been reported in the English literature to date. The etiopathogenesis of XJB is highly suggestive of a reactive process or a metabolic condition.MethodSeven cases of XJBs were retrieved from the archives of 4 oral and maxillofacial pathology services. Clinical, radiographic and histopathologic features of all these cases were retrospectively analyzed. Immunohistochemical (IHC) stains for S100 and CD68 were performed.ResultsAll seven cases involved the mandible. Patients’ age ranged between 13 and 69 years with an evenly distributed female to male ratio. One patient had a medical history of hyperlipidemia, but the medical and dental histories of the others were unremarkable. For most cases, XJB was an incidental finding discovered during routine radiographic examination. Swelling and cortical expansion were noted in a few cases. Radiographically, cases typically presented as either well-defined multilocular or unilocular lesions, which were either radiolucent or mixed radiolucent/radiopaque. All the lesions were treated with surgical curettage and no recurrence was observed during subsequent follow-ups. Each of the seven cases exhibited sheets of foamy macrophages. The diagnosis is established by exclusion of entities with overlapping microscopic features and involved correlation with the clinical, histological, radiographic and IHC profiles. Immunohistochemically, all the cases expressed diffuse positivity for CD68 and were negative for S100.ConclusionXJB is a rare lesion of unknown etiology, which may mimic other benign or reactive jaw lesions. Due to its rarity and the potential diagnostic challenges it presents, clinicians must remain vigilant and consider CXJ in their differential when assessing radiolucent jaw anomalies.

Medical treatment for early pregnancy loss following in vitro fertilization compared to spontaneous pregnancies.

Misoprostol is a well-studied medical treatment for early pregnancy loss (EPL), with success rates ranging between 70 and 90%. However, treatment failure is associated with major patient discomfort, including the need for surgical intervention to evacuate the uterus. It was previously reported that medical treatment was especially successful among women who conceived after in vitro fertilization (IVF). We aimed to study if there is a difference in rates of medical treatment failures for EPL between pregnancies conceived by IVF and spontaneous pregnancies. In this retrospective cohort study, we included all women who underwent medical treatment for EPL at our institute between 07/2015 and 12/2020. Treatment outcome was compared between IVF and spontaneous pregnancies. Treatment failure was defined as a need for surgical intervention, namely, dilation & curettage (D&C) and/or hysteroscopy, due to retained products of conception, which was defined as a gestational sac or endometrial thickness greater than 15 mm in a TVS scan. Overall, 775 patients were included, of which 195 (169/775 = 25.1%) ultimately required surgical intervention. There was no difference between the study groups in the rate of treatment failure. However, among IVF pregnancies, the rate of emergency D&C was lower (3.6% vs. 9.8%, p = 0.001), compared to spontaneous group. In cases of medical treatment for EPL, IVF pregnancies had no differences in rates of treatment failure compared to spontaneous pregnancies. That being said, IVF pregnancies have lower chances to undergo emergency D&C, compared to spontaneous pregnancies.

Surgical treatment of bovine nasal granuloma and an allergological exploration.

Nasal granuloma in cattle results from inflammation within, and attendant proliferation of, the nasal mucosa possibly in response to an allergic response. However, the relationship between nasal granuloma and allergies remains unclear. Furthermore, severe cases have a poor prognosis because there is currently no effective treatment. Herein, we report three cases of nasal granuloma with severe stertorous breathing that were treated surgically. We also conducted an allergological exploration. Following surgical removal clinical signs did not recur in two of the three cases; however, stertorous breathing persisted in one case, and the cow was sacrificed 4 months later. A histopathological examination revealed that all nasal granulomas featured varying infiltrations of macrophages eosinophils, mast cells, and lymphocytes. The number of mast cells and the proportion of these cells that had degranulated were significantly higher in the granulomas than in normal nasal mucosae. In addition, serum histamine levels were higher in nasal granuloma cases than in normal cows, although serum immunoglobulin E levels were similar, and lymphocyte infiltration in the submucosal layer suggested type I and type IV allergies. Collectively, the results indicate the efficacy of complete surgical curettage for the treatment of allergic nasal granuloma in cattle. Further studies are required to identify the causes and risk factors of allergic nasal granuloma in cows.

Efficacy of Percutaneous Treatment of Primary Aneurysmal Bone Cysts (ABCs): A Systematic Review and Meta-Analysis

Background: Percutaneous treatment for primary aneurysmal bone cysts (ABCs) has been widely accepted. The study aimed to evaluate the efficacy of various sclerotherapy agents on patients with primary ABCs. Methods: A meta-analysis of relevant studies. A systematic search was conducted on five databases, resulting in the inclusion of 25 studies with different percutaneous agents. Results: A total of 729 patients with primary ABCs were included. Patients were administered with Ethibloc, doxycycline, embolization, alcohol, polidocanol, and calcitonin with methylprednisolone, respectively. Overall, 542 (74.3%) patients with ABCs had complete healing, 120 (16.4%) had partial healing, 44 (6%) had no-ossification or failure, and 26 (3.5%) had a recurrence. However, there was a total of 45 (6.1%) patients who had surgical curettage after sclerotherapy. Among the sclerotherapy agents, doxycycline showed highly effective results with minimal complications and recurrence, but it required multiple injections per patient. Ethibloc and embolization also proved to be highly effective with fewer injections required but had a higher rate of complications. Absolute alcohol, polidocanol, and calcitonin with methylprednisolone had similar efficacity and favorable success with fewer complications and fewer injections. Conclusion: Percutaneous treatment showed promising results in treating primary ABCs. However, more robust research is needed to establish the best approach for sclerotherapy in clinical practice and to address the limitations of the current literature.

MANUAL VACUUM ASPIRATOR (MVA)- A SAFE AND EFFECTIVE ALTERNATIVE TO CONVENTIONAL CURETTAGE IN THE SURGICAL MANAGEMENT OF 1ST TRIMESTER MISCARRIAGES

Objective: To compare the efficacy of manual vacuum aspiration and conventional evacuation & curettage (ENC) for first-trimester miscarriage management. Materials and Methods: This quasi-experimental study was carried out at the Department of Gynecology and Obstetrics, Khyber Teaching Hospital, Peshawar, Pakistan from October 2022 to March 2023 including 150 patients with first trimester miscarriage dividing them into two groups (MVA and ENC) having equal number of patients. Efficacy in both groups was compared. Results: The mean age in the MVA group (group A) was 27.81±6.31years while in the ENC group (group B) it was 26.50±6.27 years. The mean gestational age in group A was 5.82±2.82 weeks while in group B it was 5.95±2.9 weeks. MVA was effective in 88% of participants while ENC was effective in 93.33% of participants (p-value, 261), which is not statistically significant. Conclusion: Surgical uterine evacuation utilizing MVA under local anesthetic is safe and successful, and it should be considered to minimize a lengthy hospital stay. MVA can be a viable alternative to surgical curettage like ENC. It is safe, cost-effective, and simple to conduct, eliminating general anesthetic, the requirement for theatre access, and an unnecessary hospital stay. Keywords: Manual Vacuum Aspiration, Evacuation, Curettage, miscarriage, efficacy.

Management of advanced metacarpal aneurysmal cysts: Surgical technique

The hand is a rare site for aneurysmal bone cysts (ABCs). Depending on their degree of invasiveness, treatment of ABCs ranges from medical therapy to surgical curettage and bone filling. In the most advanced cases, bone resection and reconstruction, with or without adjuvant or neoadjuvant treatment, are indicated.We describe a technique involving segmental bone resection and structural iliac graft reconstruction with carpo-metacarpal plate arthrodesis, for the management of advanced ABC involving the base of the metacarpals. The radio-clinical results of two patients operated on using this technique are presented, at 18 and 36 months.At the last follow-up, the results showed a QDASH of 15 and 10, and a PRWE of 9 and 11. Satisfaction was 10/10 in both cases. Grasp strength was 25 kg and 42 kg versus 28 kg and 40 kg on the opposite side. Pinch strength was 6 kg and 11 kg versus 7 kg and 10 kg. Metacarpophalangeal flexion was 80° and 90°. Extension was complete in both cases. Radiographs showed good graft fusion, with no lysis or signs of ABC recurrence at the last follow-up.Segmental bone resection and iliac autograft reconstruction with carpo-metacarpal plate arthrodesis represents a therapeutic option in the management of advanced ABCs of the metacarpal base.

Schwannoma of Foot, Case Report and Literature Review

Schwannomas are benign and rare nerve tumors, slow growing neoplasms originating from the peripheral nerve sheath. Its location in region of the head of the first metatarsal is a very rare presentation. A 43-year old patient reported a history of multiple pains over a year, with no sensorimotor deficit. MRI revealed presence of an isolated Schwannoma in the 1st intermetatarsal area, growing on the first metatarsal space with no associated fracture complication. The diagnosis was confirmed through preoperative biopsy. The patient benefited from surgical excision, bone curettage and adjuvant treatment with liquid nitrogen without bone filling. The final analysis of the surgical specimen confirmed the diagnosis of schwannoma. At the last follow-up, no recurrence was detected either clinically or imaging. This case is only the fourth schwannoma of the first metatarsal space reported in the literature.

A minimally invasive approach on central giant cell granuloma: A case report

A rare, benign, and prying intrabony lesion that affects both the maxilla and the mandible, the central giant cell granuloma, is brought on by reactive or developmental defects. The most popular form of treatment is surgical curettage or, in cases of aggressive lesions, resection, but it is frequently impossible to avoid causing adverse impairment to the teeth or jaws, and recurrences seem more common. As a result, several subcutaneous administration methods using interferon alpha or calcitonin are documented in a number of case studies with varying degrees of efficacy. In this article, intra-lesional corticosteroid is used with no recurrence over a 2-year follow-up period to emphasize the value of a minimally invasive first line treatment.

Glandular Odontogenic Cyst in the Anterior Mandible: A Case Report of a Conservative Approach and a Recurrence Detection

The glandular odontogenic cyst (GOC) is considered a rare developmental cyst, with an odontogenic origin and both epithelial and glandular characteristics, with less than 200 reported cases in the literature. In the present case, a 29-year-old man was referred for evaluation of an asymptomatic slow-growing swelling in the anterior region of the mandible, with one-year history. The patient's medical history did not reveal any systemic alteration. The extraoral examination did not show enlargement of the facial contour and the intraoral examination showed vestibular and lingual swelling. Panoramic radiography and CT scan revealed a well-defined unilocular radiolucent lesion involving the inferior incisors and canines bilaterally. Histopathological analysis revealed multiple cysts lined by stratified epithelium with varying thickness and characteristics, in addition to duct-like structures filled with PAS-positive amorphous material, suggestive of GOC. Conservative treatment was performed through surgical curettage, peripheral ostectomy of the surgical site and apicectomy of the teeth involved in the lesion. There was one recurrence, which was detected in postoperative follow-up, leading to a new surgical approach. Fifteen months after the second procedure, no signs of recurrence were identified, and bone neoformation within the surgical site occurred, supporting that a conservative approach for the treatment of GOC is viable.

HAMARTOMATOUS GROWTH IN A CHILD, AMELOBLASTIC FIBRO-ODONTOME: A CASE REPORT

Introduction: Ameloblastic fibro-odontoma is a rare, mixed, benign, odontogenic tumor with significant prevalence in the mandible. It is characterized by histologic features of ameloblastic fibroma with the formation of enamel and dentine. It usually affects pediatric patients and is associated with teeth, leading to delay in eruption or a deviation in the dental eruption pathway. This is a case report of Ameloblastic fibro-odontoma and its management in a 11 y Case Report: ear old boy. Intra-oral examination revealed an edema in the buccal area of the mandible's posterior right region. Radiographic examination showed an expansile, mixed radiolucent-radiopaque lesion with well-defined corticated border. Surgical enucleation and curettage was performed under general anesthesia. Histopathologic findings led to diagnosis of Ameloblastic fibro-odontoma. Although Ameloblastic fibro-odontoma is a rare tumor, its Conclusion: prevalence is more in children’s jaw. Conservative surgical treatment allowed the normal development with no sign of recurrence observed during the 6-month follow-up period.

Previous therapy and the recurrence rate of basal cell carcinoma after Mohs surgery: a meta-analysis.

Mohs micrographic surgery (MMS) for basal cell carcinoma (BCC) is indicated for patients at high risk of recurrence; other therapies, including standard surgical excision, cryotherapy, electrodesiccation and curettage, and radiotherapy, are used in low-risk BCC and in patients who cannot undergo surgery. However, in the case of recurrence following treatment with any of these methods, MMS is indicated. This study aimed to examine how preoperative treatment before MMS affects the recurrence rate after surgery. We conducted a meta-analysis to compare the recurrence rates of primary BCC and previously treated BCC in patients undergoing MMS, with a 5-year follow-up. The secondary outcomes were the recurrence rate after MMS based on previous radiation therapy status, mean time to recurrence, and number of cases undergoing more than one stage of MMS. The recurrence rate in the previously treated group was 2.44 times greater than that of the primary BCC group. In the previous treatment group, the patients who underwent previous radiation showed a 2.52-fold higher recurrence rate than those with no previous radiation therapy. However, there was no significant difference in the mean time to recurrence and the number of cases requiring MMS > 1 stage between the previously treated and non-treated groups. Patients with previously treated BCC, especially those treated using radiation, had a higher likelihood of recurrence.

Extensive humeral hydatid cyst with extraosseous involvement: a case report

Hydatid cysts caused by Echinococcus species mainly involve visceral organs. Rarely skeletal involvement occurs. The spine and pelvis account for half of the cases of osseous hydatidosis, making humeral hydatid cysts one of the rarest conditions. We report a case of humeral hydatidosis in a 42-year male who presented to us with pain and swelling over the left upper arm, radiological investigations suggestive of osseous cystic lesions were inconclusive and diagnosis of hydatidosis was confirmed with a biopsy subsequently. Surgical excision and curettage of bone and surrounding soft tissue were done, and the void was filled using PMMA cement followed by antihelminthic chemotherapy. No complication or recurrence has been found postoperatively at the end of 6 months of follow-up, with preservation of limb function. To keep orthopedic surgeons aware of this morbid condition, due to its low prevalence, and advanced presentation which is likely misdiagnosed, and even after the early intervention, there is a high recurrence rate which makes this one of the rare cases of humeral hydatidosis notifiable.