Treatment Of Symptoms In Patients Research Articles

Minimally Invasive Fusion of the First Metatarsophalangeal Joint: A Technical Report

Hallux rigidus, a common arthritic condition of the forefoot, affects a significant portion of the population, with ~8% of the population developing it at some point in their lives. Failure of first-line nonoperative treatment options may necessitate surgical treatment in symptomatic patients. Traditional surgical approaches include cheilectomy for milder cases and open arthrodesis for severe cases. The minimally invasive surgery approach to first metatarsophalangeal joint fusion is a novel technique that utilizes small incisions and arthroscopy for joint fusion. Fusion rates of 93% to 97% and low complication rates were reported by several studies on this technique. The technique involves percutaneous portal development, joint preparation and debridement, joint reduction, and fixation using k-wires and compression screws. The proper positioning of the toe is crucial to ensure optimal functional outcomes. Indications for this technique include advanced arthritis, significant scar tissue, and patient concern for cosmetic outcomes. Contraindications include poor bone quality, revision fusion, significant bone loss, active infection, or vascular compromise. Preoperative planning involves a comprehensive physical examination and imaging to assess the extent of the arthritis and any associated deformities. Complications of the procedure may include nonunion, malunion, iatrogenic thermal burns, and asymmetrical joint preparation. Postoperative management includes weight-bearing restrictions, regular follow-up visits, and gradual progression to normal activities. Preliminary results demonstrate promising outcomes for minimally invasive surgery first metatarsophalangeal fusions.

Rebound Acid Hypersecretion after Withdrawal of Long-Term Proton Pump Inhibitor (PPI) Treatment-Are PPIs Addictive?

Proton pump inhibitors (PPIs) are widely used in the long-term treatment of gastroesophageal reflux disease (GERD) and other upper gastrointestinal disorders, such as the healing of peptic ulcers and/or prophylactic treatment of peptic ulcers. PPIs are also widely used as symptomatic treatment in patients with functional dyspepsia. One of the adverse effects of the long-term use of PPI is rebound acid hypersecretion (RAHS), which can occur after the withdrawal of PPI therapy due to a compensatory increase in gastric acid production. Mechanisms of the RAHS have been well established. Studies have shown that pentagastrin-stimulated acid secretion after the discontinuation of PPIs increased significantly compared to that before treatment. In healthy volunteers treated with PPIs, the latter induced gastrointestinal symptoms in 40-50% of subjects after the discontinuation of PPI therapy but after stopping the placebo. It is important for practicing physicians to be aware and understand the underlying mechanisms and inform patients about potential RAHS before discontinuing PPIs in order to avoid continuing unnecessary PPI therapy. This is important because RAHS may lead patients to reuptake PPIs as symptoms are incorrectly thought to originate from the recurrence of underlying conditions, such as GERD. Mechanisms of RAHS have been well established; however, clinical implications and the risk factors for RAHS are not fully understood. Further research is needed to facilitate appropriate management of RAHS in the future.

Validation of resting full-cycle ratio and diastolic pressure ratio with [15O]H2O positron emission tomography myocardial perfusion

Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are invasive techniques used to evaluate the hemodynamic significance of coronary artery stenosis. These methods have been validated through perfusion imaging and clinical trials. New invasive pressure ratios that do not require hyperemia have recently emerged, and it is essential to confirm their diagnostic efficacy. The aim of this study was to validate the resting full-cycle ratio (RFR) and the diastolic pressure ratio (dPR), against [15O]H2O positron emission tomography (PET) imaging. A total of 129 symptomatic patients with an intermediate risk of coronary artery disease (CAD) were included. All patients underwent cardiac [15O]H2O PET with quantitative assessment of resting and hyperemic myocardial perfusion. Within a 2 week period, coronary angiography was performed. Intracoronary pressure measurements were obtained in 320 vessels and RFR, dPR, and FFR were computed. PET derived regional hyperemic myocardial blood flow (hMBF) and myocardial perfusion reserve (MPR) served as reference standards. In coronary arteries with stenoses (43%, 136 of 320), the overall diagnostic accuracies of RFR, dPR, and FFR did not differ when PET hyperemic MBF < 2.3 ml min−1 (69.9%, 70.6%, and 77.1%, respectively) and PET MPR < 2.5 (70.6%, 71.3%, and 66.9%, respectively) were considered as the reference for myocardial ischemia. Non-significant differences between the areas under the receiver operating characteristic (ROC) curve were found between the different indices. Furthermore, the integration of FFR with RFR (or dPR) does not enhance the diagnostic information already achieved by FFR in the characterization of ischemia via PET perfusion. In conclusion, the novel non-hyperemic pressure ratios, RFR and dPR, have a diagnostic performance comparable to FFR in assessing regional myocardial ischemia. These findings suggest that RFR and dPR may be considered as an FFR alternative for invasively guiding revascularization treatment in symptomatic patients with CAD.

Epilepsy in patients with glioblastoma: Mechanisms of occurrence and problems of treatment (part 2)

Epilepsy caused by glioblastoma requires careful study of the combination of factors causing it, with an integrated approach to prevention and complete relief when seizures occur against the background of adequate and modern treatment regimens. Control of seizures often requires the administration of antiepileptic drugs concomitantly with other treatments, including surgery, radiation, and chemotherapy. Pharmacological interactions between antiepileptic drugs and antineoplastic agents may alter the activity of both treatments, reducing their effectiveness and increasing the likelihood of side effects associated with both therapies. The presented literature review summarizes novel pathophysiological pathways associated with glioblastoma and involved in epileptogenesis, and also describes the interaction between antiepileptic drugs and oncological treatment. The article focuses on the impact of treatment on survival and presents evidence of the effectiveness of antiepileptic treatment, including the potential usefulness of new third-generation antiepileptic drugs. The second part of the article discusses in detail aspects of both preventive and symptomatic treatment of patients with epilepsy associated with glioblastomas.

Effectiveness and safety of everolimus treatment in patients with tuberous sclerosis complex in real-world clinical practice

BackgroundThe randomised double-blinded placebo-controlled EXIST-1–3 studies have showed everolimus effective with adverse effects reported as acceptable in treatment of symptoms in patients with tuberous sclerosis complex (TSC), although evidence of outcomes in clinical practice remains limited. This study aimed to investigate, in clinical practice, the effectiveness and safety of everolimus for epilepsy, renal angiomyolipoma (rAML), and subependymal giant cell astrocytoma (SEGA) in patients with TSC.ResultsThe study included 64 patients with TSC (median age: 19, range 0.9–54 years) receiving everolimus treatment (Norway: n = 35; Denmark: n = 29). Among 45 patients with epilepsy, 14 (31%) were responders experiencing ≥ 50% reduction in seizure frequency in the last 3 months of treatment compared with the last 3 months before treatment. Nineteen (42%) patients changed their anti-seizure medications (ASMs). Responders were more common among patients < 18 years (46%) than among patients ≥ 18 years (14%, p = 0.03). In 29 patients with rAML, everolimus reduced (≥ 30% decrease) and stabilized (< 20% increase, ≤ 30% decrease) longest diameter of rAML in 38% and 59%, respectively, after a mean treatment duration of 37 months. SEGA volume was reduced in three patients by 71%, 43%, and 48% after 39, 34, and 82 months. Adverse effects were reported in 61 of 64 patients (95%) after a median treatment duration of 31 months (range 0–106), with oral ulceration/stomatitis (63%) and upper respiratory tract infections (38%) being the most common. The most common laboratory abnormalities were increased cholesterol (41%), anaemia (30%), and leucopoenia (25%). Grade 3–4 adverse effects were reported in 36% of cases, and life-threatening conditions were reported in two patients. Nine patients discontinued everolimus treatment.ConclusionsSeizure reduction in this study sample was consistent with results from EXIST, but might be lower than expected, given that changes in concomitant ASMs are part of clinical practice. Seizure reduction was associated with younger age. As with EXIST, everolimus reduced or stabilised rAML size in most patients. SEGA volume was reduced in all three patients. Close follow-up is needed for this group, especially for children and patients who may not be able to report adverse effects.

Same-day CT can reduce delays in treatment for symptomatic patients with colorectal cancer

Same-day CT can reduce delays in treatment for symptomatic patients with colorectal cancer

Hyaline Vascular Variant of Castleman Disease of the Tonsil in an Adolescent: A case Report.

Castleman disease (CD) is a lymphoproliferative disorder classified into two categories as unicentric Castleman disease (UCD) or localized type and multicentric Castleman disease (MCD). A rare case of hyaline vascular variant of tonsil has been presented in which a 14 years old male presented with symptomatic unilateral hypertrophy of right tonsil. A right tonsillectomy was done and surgical pathology report was concluded as hyaline vascular variant of Castleman's disease.Castleman disease (CD) is a rare lymphoproliferative disorder also called as giant lymph node hyperplasia, angiofollicular lymph node hyperplasia (AFH), angiomatous lymphoid hematoma and follicular lymphoreticuloma. The treatment of symptomatic patients with UCD is complete surgical excision (as in present case). In cases with incomplete resection, adjuvant radiotherapy can be given.

Solitary Fibrous Tumor One Year After Posterior Cervical Laminectomy

Background and importance: Cervical laminectomy and fixation (PCF) is a surgery used in the treatment of symptomatic patients who are resistant to medical therapy, though it can have serious complications affecting patient outcomes. Case Presentation: This case report describes a rare occurrence of a solitary fibrous tumor (SFT) at the site of a previous cervical laminectomy in a 45-year-old female patient. Following non-surgical treatment for paresthesia and weakness in the upper limbs due to cervical stenosis, the patient underwent cervical laminectomy from C3-6 without instrumentation. Conclusion: One year after surgery, the patient presented with severe pain and swelling at the surgical site, and radiological evaluation revealed a large mass in the para-vertebral muscular layer. The mass was removed, and microscopic evaluation revealed a typical SFT. The patient underwent an extension of laminectomy and fusion with lateral mass screw, and follow-up at six months showed no recurrence of the tumor.

Киста белочной оболочки яичка больших размеров.

Introduction. A cyst of the tunica albuginea of the testis is a rare benign formation, the prevalence in the male population varies from 0.3 to 0.76%. Cysts of the tunica albuginea are usually small in size from 2 to 5 mm. Clinical case. A case of a large cyst of the tunica albuginea (3.5×2.5×2.9 cm) of the left testicle in a 44-year-old man is presented. In the case presented, the cyst was probably of post-traumatic origin, since the patient had suffered a blunt trauma to the scrotum about 10 years ago. The patient complained of pain in the left half of the scrotum. An operation was performed – microsurgical excision of the cyst of the albuginea of the left testicle. Postoperative period without complications. The pain syndrome was relieved 14 days after the operation. Histological examination – a cystic formation with a connective tissue wall lined with cubic, in places ciliated epithelium. Ultrasound control after 3 months – the size of the left testicle is 4.2 * 2.7 * 1.9 (volume 11.2 cm3), the parenchyma is homogeneous. Conclusion. The presented observation demonstrates that cysts of the albuginea of the testis can reach a significant size, spreading into the testicular parenchyma. Organ-sparing treatment in symptomatic patients with large cysts of the albuginea with intraparenchymal growth allows to eliminate pain symptoms and preserve the residual testicular parenchyma. The use of microsurgical techniques may be useful in minimizing circulatory disturbance and reducing the risk of atrophic changes in the testicular parenchyma.

ID: 205979 Deep Brain Stimulation in Patients With Advanced Parkinson's Disease: 99 Cases From a Tertiary Center

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) or the globus pallidus internus (GPI) has largely replaced ablative surgery as a symptomatic treatment for patients with advanced Parkinson’s disease (PD).

Medical Cannabis in the Treatment of Parkinson's Disease.

Medical cannabis (MC) has recently garnered interest as a potential treatment for neurologic diseases, including Parkinson's disease (PD). A retrospective chart review was conducted to explore the impact of MC on the symptomatic treatment of patients with PD. Patients with PD treated with MC in the normal course of clinical practice were included (n = 69). Data collected from patient charts included MC ratio/formulation changes, PD symptom changes after initiation of MC, and adverse events (AEs) from MC use. Information regarding changes in concomitant medications after MC initiation, including opioids, benzodiazepines, muscle relaxants, and PD medications, was also collected. Most patients were initially certified for a 1:1 (∆9-tetrahydrocannabinol:cannabidiol) tincture. Eight-seven percent of patients (n = 60) were noted to exhibit an improvement in any PD symptom after starting MC. Symptoms with the highest incidence of improvement included cramping/dystonia, pain, spasticity, lack of appetite, dyskinesia, and tremor. After starting MC, 56% of opioid users (n = 14) were able to decrease or discontinue opioid use with an average daily morphine milligram equivalent change from 31 at baseline to 22 at the last follow-up visit. The MC was well-tolerated with no severe AEs reported and low rate of MC discontinuation due to AEs (n = 4). The MC may improve motor and nonmotor symptoms in patients with PD and may allow for reduction of concomitant opioid medication use. Large, placebo-controlled, randomized studies of MC use in patients with PD are required.

Symptomatic Popliteal Artery Aneurysms in Recently SARS-CoV-2-Infected Patients: The Microangiopathic Thrombosis That Undermines Treatment

Arterial and venous thrombosis are complications in SARS-CoV-2-infected patients. The microangiopathic thrombosis in affected patients can compromise results in urgent limb revascularizations. Aim of our study is to report on the incidence of symptoms development in patients affected by popliteal artery aneurysm (PAA) and to analyze the effect of COVID-19 infection on outcomes. Data on patients surgically treated for PAA from the massive widespread of COVID-19 vaccine (March 2021) to March 2022 were prospectively collected. Factors considered for analysis were: presence of symptoms, aneurysm diameter and length, time from symptom onset and hospital referral, ongoing or recently COVID-19 infection. Outcomes measures were: death, amputation, and neurological deficit. Between March 2021 and March 2022, 35 patients were surgically treated for PAA. Among them 15 referred to our hospital for symptomatic PAA and were urgently treated. Urgent treatments included both endovascular procedures and open surgeries. Nine out of 15 symptomatic patients had an ongoing or recently recovered COVID-19 infection. COVID-19 infection was strongly associated to symptoms development in patients affected by PAA and to surgical failure in those patients (OR 40, 95% CI 2.01-794.31, p = 0.005). In our series, presence of COVID-19 infection was strongly associated to ischemic symptoms onset and to complications after urgent treatment in symptomatic patients.

경추거대세포종에 대한 전척추제거술 후 발생한 경요추부 통증 및 사지부 감각저하에 대한 추나요법을 포함한 한방치료 증례보고 1례

Objectives This study aimed to report the effects of giant cell tumor treatment to a patient who had cervical and lumbar pain and hypoesthesia of the limbs after total spondylectomy with Korean medicine. Methods A 67-year-old female patient with cervical and lumbar pain and hypoesthesia of the limbs after total spondylectomy was treated with herbal medicine (Cheongpa-jeon, Yukkongbaro-hwa), acupuncture, pharmacopuncture, and physical therapy for 36 days. The effects were evaluated using a numerical rating scale (NRS), Neck Disability Index (NDI), Oswestry Disability Index (ODI), and EuroQoL-5D (EQ-5D). Results After treatment, changes were observed in the patient’s pain and hypoesthesia. NRS, NDI, ODI, and EQ-5D scores decreased. Conclusions This case study suggests that Korean medicine treatment may be effective for symptomatic treatment in patients with giant cell tumor following total spondylectomy.

Aneurisma de la arteria comunicante posterior y parálisis del III nervio craneal. Caso clínico y revisión de la literatura

Objective: Case report of posterior communicating artery aneurysm (ACoP) related unilateral oculomotor nerve palsy (ONP). Introduction: The ACoP aneurysms represents the 25% of all aneurysms. It could cause ONP because of his close relation of the aneurysm and the oculomotor nerve. The treatment in symptomatic patients should be the exclusion of the aneurysm. Case report: 38-year-old woman with headache of 15 days of evolution and acute ONP. CT angiography shows a 3x7 mm ACoP aneurysm. Microsurgery and clipping were considered the best treatment and were realized without complications. The patient evolves with complete recovery of his ONP with complete exclusion of the aneurysm. Discussion: ACoP aneurysm should be considered in ONP working diagnosis. The treatment is exclusion of the aneurism either by endovascular or microsurgical techniques. Microsurgical clipping has shown better functional outcomes than endovascular therapy.

Meckel's diverticulum management and treatment of symptomatic patient

Meckel's diverticulum management and treatment of symptomatic patient

Surgical approaches to intramedullary spinal cord astrocytomas in the age of genomics.

Intramedullary astrocytomas represent approximately 30%–40% of all intramedullary tumors and are the most common intramedullary tumor in children. Surgical resection is considered the mainstay of treatment in symptomatic patients with neurological deficits. Gross total resection (GTR) can be difficult to achieve as astrocytomas frequently present as diffuse lesions that infiltrate the cord. Therefore, GTR carries a substantial risk of new post-operative deficits. Consequently, subtotal resection and biopsy are often the only surgical options attempted. A midline or paramedian sulcal myelotomy is frequently used for surgical resection, although a dorsal root entry zone myelotomy can be used for lateral tumors. Intra-operative neuromonitoring using D-wave integrity, somatosensory, and motor evoked potentials is critical to facilitating a safe resection. Adjuvant radiation and chemotherapy, such as temozolomide, are often administered for high-grade recurrent or progressive lesions; however, consensus is lacking on their efficacy. Biopsied tumors can be analyzed for molecular markers that inform clinicians about the tumor’s prognosis and response to conventional as well as targeted therapeutic treatments. Stratification of intramedullary tumors is increasingly based on molecular features and mutational status. The landscape of genetic and epigenetic mutations in intramedullary astrocytomas is not equivalent to their intracranial counterparts, with important difference in frequency and type of mutations. Therefore, dedicated attention is needed to cohorts of patients with intramedullary tumors. Targeted therapeutic agents can be designed and administered to patients based on their mutational status, which may be used in coordination with traditional surgical resection to improve overall survival and functional status.

The Efficacy and Cost-Effectiveness of Umeclidinium/Vilanterol versus Tiotropium in Symptomatic Patients with Chronic Obstructive Pulmonary Disease.

Both long-acting muscarinic antagonists (LAMAs) and long-acting β2-agonists (LABAs) are widely used in the treatment of chronic obstructive pulmonary disease (COPD). A novel LAMA/LABA combination of umeclidinium/vilanterol (UMEC/VI; 62.5 μg/25 μg) is approved for chronic obstructive pulmonary disease (COPD) treatment. This study aimed to assess the efficacy and cost-effectiveness of UMEC/VI versus tiotropium (TIO) 18 μg in symptomatic patients with COPD from the perspective of the Chinese National Healthcare System. A simple analysis included three studies in the meta-analysis that compared UMEC/VI with TIO. A Markov model was developed to estimate the cost-effectiveness of UMEC/VI compared with TIO treatment in symptomatic patients with COPD. First, utilities, clinical efficacy, and adverse events obtained from the literature were utilized as model inputs. Costs were from Chinese average data, including local data. Costs were expressed in dollars based on 2020 prices. Then, the model outputs including drug costs, other medical costs, and total costs, and quality-adjusted life years (QALYs) were estimated. Costs and outcomes were discounted at a 5% annual rate. Furthermore, incremental cost-effective ratios (ICERs) were analyzed. Finally, the influences of changing parameters on the uncertainty of the results were assessed by means of one-way and probabilistic sensitivity analyses. This study revealed that UMEC/VI treatment had a higher rate of clinical efficacy in comparison with TIO, and the differences in the rate of adverse events between the two treatments were not significant. The results indicated that UMEC/VI was superior to TIO, which provided an increase in QALYs (0.002) and a total cost savings of $765.67 per patient over 3 years. In the base case, the ICER of UMEC/VI is -$397468.04/QALY compared with TIO, suggesting that UMEC/VI may be considered a dominant option over TIO. According to the Chinese medical system, the probability of UMEC/VI being cost-effective was 61.6% at a willingness-to-pay (WTP) of $31554/QALY. Sensitivity analyses confirmed that the results were robust. UMEC/VI could be considered a cost-effective treatment compared with TIO in symptomatic COPD patients from the Chinese National Healthcare System perspective. These results may help decision-makers in China when making judgements on which treatments to administer.

Ventricular Septal Defect Post-Myocardial Infarction: About 5 Cases.

Post-myocardial infarction (MI) ventricular septal defect (VSD) is a rare but potentially catastrophic mechanical complication that occurs in less than 1% of patients following a myocardial infarction and it is associated with a high morbidity and mortality despite improvements in medical and surgical therapies of revascularization. Our article is based on the study of the occurrence of the VSD after a myocardial infarction in 5 patients. With an average age of 60 years, the prognosis was good if the rupture was small and the patient was hemodynamically stable. VSD tends to occur within the first week after acute myocardial infarction. In most cases, there is an immediate decline in hemodynamics which can lead to cardiogenic shock. VSD is a surgical emergency needing immediate treatment in symptomatic patients. The procedure requires the closure of the VSD and coronary artery bypass grafting.

Why Is There an Increased Risk for Sudden Cardiac Death in Patients With Early Repolarization Syndrome?

The last two decades have changed the viewpoint on early repolarization syndrome (ERS). The prevalence of the early repolarization pattern is variable and ranges between 3-24% depending upon age, gender, and criteria used for J-point upliftment from baseline (0.05mV vs. 1 mV). While this pattern was previously linked with a benign result, multiple recent investigations have found a link between early repolarization and Sudden Cardiac Death (SCD) by causing life-threatening arrhythmias like Ventricular tachycardia/Ventricular fibrillation, a condition known as early repolarization syndrome. The syndrome falls under a broader bracket of J wave syndromes, which can be caused by early repolarization or depolarization abnormalities. The characteristics of early repolarization that are considered high risk for Sudden Cardiac Death include the amplitude of J-point upliftment from baseline ( > 0.2 mV), Inferior-lateral location of Early Repolarization pattern, and horizontal and downsloping ST-segment. Patients with symptomatic early repolarisation patterns on ECG are more likely to have repeated cardiac episodes. Implantable Cardioverter-Defibrillator (ICD) implantation and isoproterenol are the recommended treatments in symptomatic patients. On the other hand, asymptomatic patients with early repolarization patterns are prevalent and have a better outcome. Risk categorization is still obscure in asymptomatic early repolarization patterns. This traditional review outlines the known knowledge of pathophysiology behind the increased risk of sudden cardiac death, risk stratification of patients with ERS, and the treatment guidelines for patients with ERS. Further prospective studies are recommended to elucidate the exact mechanism for ventricular arrhythmogenesis in ERS patients and to risk stratifying asymptomatic patients with ERS.

Submucosal Clustered Brownish Microvessels Based on NBI Endoscopy: A Characteristic of LPR.

This study aimed to analyze the characteristics of laryngopharyngeal reflux (LPR) by using narrow band imaging (NBI) endoscopy. A prospective study. A large-volume practice with tertiary care providers. A total of 67 patients with suspected LPR who underwent 24-hour multichannel intraluminal impedance-pH monitoring were included from June 2020 to March 2022. Manifestations of NBI endoscopy included submucosal clustered brownish microvessels (CBMs), spotted brownish microvessels, and no special microvessels; the latter 2 formed the non-CBM group. The manifestations of all patients and their changes were observed after 8 weeks of proton pump inhibitor and symptomatic treatment for patients with LPR, and symptomatic treatment for patients without LPR. According to the results of 24-hour multichannel intraluminal impedance-pH monitoring, the incidence of submucosal CBMs was significantly higher in patients with LPR (30 cases) than in those without LPR (37 cases, P < .001), particularly in the posterior cricoid area (P < .001). Besides Reflux Finding Score, the incidence of signs such as subglottic edema and vocal fold edema was significantly higher in the CBM group than the non-CBM group (P < .05). Finally, 22 patients with LPR (91.7%) and only 2 patients without LPR (28.6%) underwent a transformation from CBMs to spotted brownish microvessels after continuous medication for 8 weeks in the CBM group (χ2 = 15.916, P < .001), while no significant change was observed in patients with or without LPR in the non-CBM group (P > .05). Submucosal CBMs in the posterior cricoid area under NBI endoscopy may be a characteristic of LPR.