Total Resolution Research Articles

Splenic abscess – unusual cause of fever in an infant

Splenic abscess in children is a rare entity and it usually oc­curs after local dissemination or hematogenous spread, es­pe­cial­ly in immunocompromised patients. Because of its rarity and nonspecific symptoms and signs, the splenic abs­cess is difficult to diagnose. We report the case of a 14-month-old girl with splenic abscesses. She was admitted to the hospital for persistent high fever, aphthous lesions and an ulcerative malleolar lesion. The laboratory tests showed leukocytosis, anemia, thrombocytosis, elevated C-reactive protein and D-dimers levels, with normal pro­cal­ci­to­nin levels. The blood culture and the culture from the lesion were negative. The abdominal ultrasound showed two hypoechogenic lesions in the spleen. She was suc­ces­sful­ly treated with wide-broad antibiotic therapy for six weeks, with a total resolution of the lesions. The pro­longed antibiotic therapy and hospitalization can lead to complications such as dysbiosis and superficial vein throm­bo­sis. This case illustrates that splenic abscess should be considered in unknown-focus fever, even in infants with no underlying conditions. Conservative therapy should be the first-line therapy for splenic abscesses in children, con­si­de­ring the importance of the immunological functions of the organ.

Late-onset Descemet's membrane detachment secondary to presumed interface fluid syndrome after uneventful deep anterior lamellar keratoplasty for keratoconus

A forty-year-old male underwent an uneventful big-bubble deep anterior lamellar keratoplasty (DALK) for keratoconus in the right eye. Suture removal was attempted 15 months post-surgery and led to temporal graft host dehiscence that required resuturing of the graft. The patient presented 4 months later with increased intraocular pressure (IOP), graft edema, and nasal Descemet membrane detachment (DMD). IOP control with medication led to reduction and total resolution of DMD and a clear graft. We postulate that the DMD, in this case, was caused by a mechanism similar to the interface fluid syndrome (IFS) that occurs in post-laser in situ keratomileusis (LASIK) eyes and should be considered as a differential diagnosis for DMD following DALK.

Ultrasound-guided Tenotomy and Osteectomy for the Treatment of Iliopsoas Impingement Post-total Hip Replacement

Ultrasound-guided Tenotomy and Osteectomy for the Treatment of Iliopsoas Impingement Post-total Hip Replacement

Treatment of left ventricular thrombus by rivaroxaban: An echocardiographic case report

Treatment of left ventricular thrombus is challenging work for the clinician. Current guidelines recommend vitamin K antagonists for thrombus resolution, however there is a growing evidence that rivaroxaban can be used in selected cases. In the paper, we report a 47 year-old-man with a large left ventricular thrombus (60x70mm) which was treated with 10 month 15mg rivaroxaban twice per day. The outcome was total resolution of left ventricular thrombus. During the treatment course, there was an episode of stroke which was completely recovered. The patient was followed up for further recurrence of LV thrombus after stopping rivaroxaban at 10-month.

Syringomyelia From Extramedullary Compression: Resolution After Microsurgical Resection of a High-Cervical Spine Schwannoma: 2-Dimensional Operative Video.

Syringomyelia with compression at the foramen magnum is a well-studied subject with a pathophysiological hypothesis explaining syrinx development and treatment.1,2 However, compression of the cervical cord, as in cervical spondylosis, can also lead to cavitation in the spinal cord.3,4 Although the association of intramedullary spinal cord tumors with syringomyelia is well known,5 the association of extramedullary tumors with syringomyelia is scarcely reported, and it is of unknown mechanism and uncertain outcomes regarding syrinx resolution. Syringomyelia is reported to be associated with intramedullary spinal schwannoma.6 However, spinal schwannomas are by and large extramedullary tumors that produce deficits through compressive radiculopathy or myelopathy. The association of extramedullary schwannomas with syringomyelia is extremely rare. In this article, we present a patient with an extramedullary high-cervical schwannoma causing significant syringomyelia who underwent microsurgical resection of the schwannoma, with subsequent total resolution of the syringomyelia. The patient consented for surgery. Images from Lancet 1969 at 6:36 in video Reprinted from The Lancet, Vol. 294, Bernard Williams, The Distending Force in the Production of "Communicating Syringomyelia," Pages 189-193, Copyright 1969, with permission from Elsevier.

Predictors of Mortality and Outcomes of Liver Transplant in Spur Cell Hemolytic Anemia

BACKGROUND :Spur cell hemolytic anemia (SCHA) is a rare, acquired, non-immune hemolytic anemia of decompensated cirrhosis resulting from abnormal lipid composition of the red cell membrane. Treatment is limited to red cell transfusion. Data describing prognostic impact, outcomes of liver transplant, and clinical hematologic characteristics of SCHA are absent or limited; published data on SCHA are limited to single-patient case reports and small single-center case series. The independent prognostic impact of SCHA on patients with cirrhosis remains unclear, and it is not known if hemolytic anemia severity has a significant impact on survival of these patients. As a result, SCHA is not formally considered during liver transplant evaluation, and patients do not receive MELD exception points for this diagnosis.METHODS :We performed a multicenter, 24-year observational cohort study of patients with SCHA, retrospectively analyzing hepatic and hematologic parameters, independent predictors of mortality, and long-term outcomes of liver transplant. Strict diagnostic criteria for SCHA were applied, requiring all of the following: (1) decompensated cirrhosis; (2) anemia; (3) objective laboratory evidence of hemolysis; (4) no alternate contributing cause of hemolysis or acanthocytosis; and (5) chart documentation of a confirmed diagnosis of SCHA incorporating peripheral blood film examination. The primary outcome was mortality at 3 months after date of SCHA diagnosis. The impact of hemolytic parameters on 3-month mortality was evaluated utilizing multivariable logistic models. Observed mortality vs. expected mortality (per MELD-Na score and Child-Turcotte-Pugh class) was compared using standardized mortality ratios. Given the limited survival of this population, red cell transfusion dependence was defined as 4 or more units of red cells transfused during the 60-day peri-diagnostic period.RESULTS :Patients: 69 patients with SCHA were included (FIGURE 1). The median (interquartile range) age was 53 (42-59) years; 46.4% were female, and 11 (15.9%) received liver transplant. Alcohol contributed to the etiology of cirrhosis in 53 patients (76.8%). The median (IQR) survival from SCHA diagnosis of patients not receiving liver transplant was 58 (23-113) days. 39 patients (56.5%) were red cell transfusion-dependent. Hematologic parameters are described in TABLE 1.Outcomes of Liver Transplant: All 11 patients undergoing transplant had rapid and complete resolution of SCHA, with an improvement in median hematocrit from 22.1% to 34.6% post-transplant (P=0.001) (TABLE 2) and excellent post-transplant outcomes, with 9 patients still alive after 6.1 years median follow-up.Independent Predictors of Mortality in SCHA: In multivariable logistic models adjusting for age, sex, etiology of cirrhosis, active/recent variceal bleeding, and Child-Turcotte-Pugh score, transfusion dependence had an OR for 90-day mortality of 9.14 (95% CI, 2.46-34.00) and reduced pre-transfusion hematocrit had an OR of 4.73 (95% CI, 1.42-15.82) per 6% decrease; increased red cell transfusion requirement, reduced hemoglobin, increased lactate dehydrogenase, and increased indirect bilirubin were also independently predictive of higher 90-day mortality (FIGURE 2).Performance of MELD-Na and Child-Turcotte-Pugh Scores in Estimating 90-Day Mortality: MELD-Na and Child-Turcotte-Pugh scores consistently significantly underestimated 90-day mortality, with standardized mortality ratios (SMRs) >1 across all scores/classes [MELD-Na 20-29, SMR 2.42 (1.18-4.44); Child-Turcotte-Pugh class B, SMR 4.46 (1.64-9.90)], FIGURE 3.CONCLUSIONS :In this largest study of SCHA to date, SCHA was associated with substantial excess mortality than was predicted by MELD-Na or Child-Turcotte-Pugh scores. Several clinical and laboratory parameters of hemolytic anemia severity, including transfusion burden, hemoglobin, and markers of hemolysis were each independent predictors of 90-day mortality in SCHA. Despite its unique morbidity as a complication of decompensated cirrhosis, outcomes of liver transplant were excellent in all 11 patients undergoing this intervention, with total resolution of SCHA and no evidence of recurrence. These findings should promote greater awareness of SCHA as a clinical entity and broader consideration of MELD exception points for afflicted patients when transplant-eligible. [Display omitted] DisclosuresAl-Samkari: Novartis: Consultancy; Amgen: Research Funding; Argenx: Consultancy; Rigel: Consultancy; Dova/Sobi: Consultancy, Research Funding; Agios: Consultancy, Research Funding; Moderna: Consultancy.

Management and outcomes of patients with left atrial appendage thrombus prior to percutaneous closure

ObjectiveLeft atrial appendage (LAA) thrombus has heretofore been considered a contraindication to percutaneous LAA closure (LAAC). Data regarding its management are very limited. The aim of this study was to...

“Perrotta Psychotherapeutic Protocol for Disorders of the Neurotic Area” (PPP-DNA): Proposal of protocol, profiles and clinical applications. Research

Purpose: This research addresses the topic of anxiety, phobic and obsessive disorders. In this research, the theme is addressed to the psychopathological investigation of personalities, according to the PICI-2TA model (Perrotta Integrative Clinical Interviews, version 2-TA), the PAD-Q (Perrotta Affective Dependency Questionnaire), the PSM (Perrotta Sexual Matrix), the PDM-Q (Perrotta Defence Mechanisms Questionnaire) and the PHEM model (Perrotta Human Emotions Model), in order to design a direct and functional psychotherapeutic protocol to manage the psychopathological process in the shortest time possible, according to the principles of efficiency, effectiveness and economy, trying to reduce the symptomatology until the total regression by the fifth-tenth session. Methods: Clinical interview and administration of the PICI-2, the PAD-Q, the PSM, and the PDM-Q. Results: In the male group, aged 18-36 years, there were 8 people, of whom 6 (75%) reacted to the total resolution of the neurotic symptomatology described between the fifth and ninth sessions, while only 2 (25%) said they felt their neurotic symptoms had subsided. In the male group, aged 37-54 years, there are 5 people, of whom 4 (80%) reacted to the total resolution of neurotic symptomatology described between the fifth and ninth sessions. In the male group, aged 55-72 years, there were 6 people, of whom 4 (66.6%) reacted to the total resolution of neurotic symptoms described between the ninth and tenth sessions. In the female group, aged 18-36 years, there were 22 people, of whom 18 (82%) reacted to the total resolution of neurotic symptoms described between the fifth and ninth sessions. In the female group, aged 37-54 years, there were 13 people, of whom 9 (69.2%) reacted to the total resolution of neurotic symptoms described between the fifth and ninth session. In the female group, aged 55-72 years, there were 11 people, of whom 8 (72.7%) reacted to the total resolution of neurotic symptoms described between the fifth and ninth sessions. Conclusions: The research showed that the PPP-DNA protocol, for neurotic disorders, was effective in the total population sample for 74.36%, for the fractionated male population sample for 73.86% and for the fractionated female population sample for 74.86%, with resistance to change identified in adverse conditions of family, environmental, socio-cultural and temporal type (of duration of neurotic symptomatology), however able to promote an attenuation of the symptomatology suffered by at least 50%.

Disease Modifying Treatment of Osteoarthritis with Triple Combination Anti-Microbial Therapy

Background: The study author, while still a medical student, observed microscopic evidence of chronic inflammation in joint tissue of patients suffering with osteoarthritis and hypothesized that osteoarthritis was caused by an infectious process. After graduating from medical school and entering into private practice, the study author had several patients who informed him that when they were on tetracycline therapy, for reasons other than arthritis, their arthritis symptoms diminished to some extent. After reporting improvement of arthritic symptoms with tetracycline, one of these patients subsequently received metronidazole and while taking both tetracycline and metronidazole reported that his arthritic symptoms improved to an even greater extent, as his joint pain further diminished but did not resolve. Subsequent treatment of osteoarthritis in other patients included the combination of tetracycline, metronidazole, other antibiotics and some natural products but only when L-lysine was added to the tetracycline and metronidazole combination therapy did the author observe yet further improvement in arthritic pain. Since L-lysine was reported to inhibit the growth of herpes simplex virus, the author and another colleague concluded that acyclovir might be a beneficial addition to the tetracycline, metronidazole, L-lysine combination. This four-component combination treatment resulted in total resolution or a marked diminution of osteoarthritis joint pain, joint tenderness and joint stiffness in most patients treated. It was further determined that L-lysine could be eliminated; that acyclovir could be replaced with valicyclovir; and that tetracycline could be replaced with minocycline or doxycycline.
 Preliminary studies of patients diagnosed with osteoarthritis and treated with tetracycline alone or the combination of tetracycline and metronidazole demonstrated improvement in their osteoarthritic symptoms. However the triple combination of doxycycline (broad spectrum antibiotic), metronidazole (antiprotozoal and antibacterial imidazole) and acyclovir (antiviral purine nucleoside) administered orally twice daily for eight weeks showed marked success in a group of patients suffering with osteoarthritis by substantially eliminating their joint pain, joint tenderness and joint stiffness while overcoming their fatigue and increasing their energy level. The data in this report substantiate that this triple combination is a disease modifying therapy that eliminates or markedly diminishes the symptomatology of osteoarthritis and further supports the hypothesis that osteoarthritis is an infectious disease. Objective: To evaluate the effect of the triple combination therapy of doxycycline, metronidazole, and acyclovir on the joint pain, joint stiffness and functionality in patients suffering with osteoarthritis. Design: Non-blinded study of treatment of patients suffering with osteoarthritis Setting: Primary care internal medicine practice in Alameda County, California. Sample: Six adult individuals suffering with osteoarthritis. Patients: Six patients, ages 53 through 82 years. Patient 1 was treated for 28 days and Patients 2 through 6 were treated for 56 days. Method: After obtaining informed consent, six patients suffering with osteoarthritis were prescribed a 56 day course of treatment with the triple combination of doxycycline, metronidazole, and acyclovir for treatment of their osteoarthritis. Utilizing the WOMAC index for assessment of the effectiveness of treatment of osteoarthritis, pre-treatment pain, stiffness and functional limitation, were compared to post-treatment pain, stiffness and functional limitations. Results: Three patients demonstrated total resolution of pain and stiffness and greater than 95% improvement in functional limitations. One of the remaining three patients demonstrated a 70% improvement in pain, total resolution of stiffness, and an 85% improvement in functional limitations; another one of the three remaining patients demonstrated an 86% improvement in pain, total resolution of stiffness, and a 79% improvement in functional limitations; while the last of the three remaining patients demonstrated at least an 85% improvement in pain, 67% improvement in stiffness, and a 63% improvement in functional limitations.
 Limitations: No randomization. No placebo. No control group. Small sample size. Conclusion: The results of treatment of these patients suffering the osteoarthritis support the hypothesis that osteoarthritis is an infectious disease. These results further suggest that osteoarthritis is, at a minimum, modifiable with the triple combination therapy of doxycycline, metronidazole, and acyclovir and is even curative of with this breakthrough treatment in many cases. The medical treatment reported in this article represents the first truly Disease Modifying medication therapy developed for osteoarthritis. 
 Keywords: WOMAC index

S2506 Use of the Pediatric Gastroscope for Endoscopic Decompression of a Right Hydronephrosis Caused by a Peripancreatic Fluid Collection in a Patient With Severe Acute Pancreatitis

Introduction: Peri-pancreatic fluid collections can cause symptoms by compressing adjacent organs. These collections are classified as early (acute peripancreatic fluid collection or acute necrotic collection) or late (walled-off necrosis or pseudocyst). The treatment of such complication requires drainage of the collection with placement of stents between the cavity and the lumen. Case Description/Methods: A middle-aged man developed gallstone pancreatitis complicated by a large peri-pancreatic fluid collection (pancreatic pseudocyst). Four months later, he developed a right hydronephrosis caused by compression of the right ureter by the fluid collection surrounding it. He therefore underwent EUS guided cyst-gastrostomy with placement of a 20x10mm AXIOS stent and two plastic stents in the direction of the ureteral compression. In a second procedure two weeks later the XP190N pediatric gastroscope was passed through the AXIOS stent into the cavity and into the tract leading to the ureteral compression. This allowed for placement of a wire under fluoroscopic and endoscopic guidance with deployment of two plastic biliary stents. Total decompression of the ureter and resolution of the hydronephrosis ensued. Discussion: The majority of pancreatic fluid collections resolve spontaneously and do not require intervention. However, infection, pain, or compression of adjacent organs may require intervention. Treatment may include endoscopic or percutaneous catheter drainage, and later endoscopic or surgical necrosectomy. Endoscopic drainage is now the preferred approach. This case highlights the use of the XP190N pediatric gastroscope to guide deployment of a wire through a narrow fistulous tract inside the peripancreatic cavity; this allows for deployment of stents to decompress the obstruction of the right ureter. Usage of the pediatric gastroscope in this case afforded multiple advantages including enhanced navigation capabilities due to its smaller size and excellent optics; dye was directly flushed trough the channel of the scope, thus affording fluoroscopic guidance. Also, a small snare was used for necrosectomy and removal of debris. Finally, the wire was placed into the desired position for precise stents deployment. The armamentarium of dedicated endoscopic equipment for treatment of peri-pancreatic fluid collections is limited, therefore, the pediatric gastroscope should be kept in mind for use in selected cases.Figure 1.: Upper left: Peripancreatic fluid collection. Upper right: Passage of a pediatric gastroscope through the AXIOS stent with wire placement in the peri-ureteral space. Lower left: Two plastic stent deployed for decompression of the ureteral obstruction. Lower right: Total resolution of the obstruction of the right ureter.

HeCTOr: the 3He Cryogenic Target of Orsay for direct nuclear reactions with radioactive ion beams

Direct nuclear reactions with radioactive ion beams represent an extremely powerful tool to extend the study of fundamental nuclear properties far from stability. These measurements require pure and dense targets to cope with the low beam intensities. The 3He cryogenic target HeCTOr has been designed to perform direct nuclear reactions in inverse kinematics. The high density of 3He scattering centers, of the order of 1020 atoms/cm2, makes it particularly suited for experiments where low-intensity radioactive beams are involved. The target was employed in a first in-beam experiment, where it was coupled to state-of-the-art gamma-ray and particle detectors. It showed excellent stability in gas temperature and density over time. Relevant experimental quantities, such as total target thickness, energy resolution and gamma-ray absorption, were determined through dedicated Geant4 simulations and found to be in good agreement with experimental data.

Common Errors in Single-Session Therapy

Single-session thinking and practice are being increasingly recognized as an important component in the landscape of mental health service delivery. At the same time, however, there are some common misunderstandings that may impede applications and further developments. Inspired by Jay Haley's (1969) ironic “The Art of Being a Failure as a Therapist” and others of his articles, the authors describe some ways to avoid successful single-session therapy (SST), including insisting that therapy be only one session; disbelieving that therapy could be only one session; lowering hopeful expectations; avoiding clarifying a specific goal for the session; disregarding real-life issues; insisting on one model of therapy; ignoring context and working against the client's culture; thinking that the only single-session goal should be total resolution of whatever problems have brought the client to therapy; and neglecting implementation, supervision, and administrative support.

Anticoagulation and Vessel Recanalization in Cirrhotic Patients with Splanchnic Vein Thrombosis: A Multidisciplinary "Real Life" Experience.

Background and AimSplanchnic vein thrombosis (SVT) is a potentially life-threatening complication of liver cirrhosis. This study aimed to evaluate the impact of a multi-disciplinary approach and early anticoagulation therapy (AT) on bleeding/thrombotic events, recanalization rates and outcome of cirrhotic patients with SVT.MethodsThis is a single-center, registry-based cohort study. Over 17 years, 149 SVT patients were enrolled and prospectively evaluated. Regarding cirrhotic-SVT, a pre-specified algorithm, guiding initial posology of AT and follow-up visits schedule, was performed. Major bleeding (MB), thrombotic events, functional liver scores and all cause-mortality were investigated. Efficacy of AT was evaluated by radiological imaging.ResultsIn cirrhotic-SVT, the incidence rate of MB was 8.4 per 100 patient-year (95% CI, 3.83–15.97), while the incidence rate of thrombosis was 5.6 per 100 patient-year (95% CI, 2.05–12.2). In incidental SVT treated with AT, MB incidence was 6.5 per 100 patient-year (95% CI: 2.8–12.82), while in symptomatic SVT was 2.2 per 100 patient-year (95% CI: 0.25–8.02). All thrombotic recurrences occurred in incidental SVT (7.7 per 100 patient-years; 95% CI, 3.71–14.26). Overall survival was significantly higher in patients who had at least a partial recanalization (p < 0.01) and partial/total recanalization was independently associated with improved MELD score at multivariate analysis (HR 2.62, 95% CI 1.1–6.47, p = 0.03).ConclusionIn cirrhotic SVT patients, partial or total resolution of thrombosis ameliorates liver function and is associated with higher overall survival. A multidisciplinary approach together with radiological follow-up at pre-fixed time improves patient selection and monitoring.

The Treatment of Medication-Related Osteonecrosis of the Jaw (MRONJ): A Systematic Review with a Pooled Analysis of Only Surgery versus Combined Protocols.

Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse reaction of antiresorptive and antiangiogenic agents, and it is also a potentially painful and debilitating condition. To date, no specific studies have prospectively evaluated the efficacy of its treatment and no robust standard of care has been established. Therefore, a systematic review (2007–2020) with a pooled analysis was performed in order to compare MRONJ surgical techniques (conservative or aggressive) versus combined surgical procedures (surgery plus a non-invasive procedure), where 1137 patients were included in the pooled analysis. A statistically significant difference in the 6-month improvement rate, comparing combined conservative surgery versus only aggressive (91% versus 72%, p = 0.05), was observed. No significant difference regarding any group with respect to the 6-month total resolution rate (82% versus 72%) was demonstrated. Of note, conservative surgery combined with various, adjuvant, non-invasive procedures (ozone, LLLT or blood component + Nd:YAG) was found to achieve partial or full healing in all stages, with improved results and the amelioration of many variables. In conclusion, specific adjuvant treatments associated with minimally conservative surgery can be considered effective and safe in the treatment of MRONJ, although well-controlled studies are a requisite in arriving at definitive statements

Is teriparatide therapy effective for medication-related osteonecrosis of the jaw? A systematic review and meta-analysis.

To integrate the data published on the effect of teriparatide (TPTD) therapy on cases of medication-related osteonecrosis of the jaws (MRONJ) into a comprehensive analysis of clinical features. An electronic search was undertaken in six databases. Descriptive analyses of clinicodemographic data of MRONJ were carried out. Poisson regression was also run to evaluate predictors of total resolution of MRONJ treated with TPTD. Twenty-six publications comprising 111 cases were included. Most reported cases affected female individuals (82.0%) with a mean age of 76.54years. Osteoporosis (76.5%) represented the main reason for using antiresorptive drugs, with bisphosphonates (98.1%) as the most frequently reported. Comorbidities were commonly present. The most related trigger factor of MRONJ was dental extraction (61.7%). Mandible (75.8%) was the most commonly affected site, with a mean evolution time of 5months. MRONJ stage 2 (61.3%) was the most prevalent. Regarding TPTD treatment, in 45.1% cases, TPTD was used alone, with the total resolution being observed in 59.5% of the individuals. Associated therapy (54.9%) included surgery, antibiotic therapy, and laser therapy. Mean follow-up was 8.7months. Poisson regression demonstrated that individuals with MRONJ stage 1 were 1.21 times more likely to present total resolution of osteonecrosis than individuals with MRONJ stage 3 (CI = 1.02-1.43; p < 0.023). Individuals who had undergone treatment with TPTD in association with another therapeutic modality were 1.21 times more likely to present total resolution of osteonecrosis than those who had undergone treatment with TPTD alone (CI = 1.40-1.39; p < 0.010). TPTD in combination with another therapy, especially antibiotic therapy, should be considered an effective therapeutic modality for MRONJ.

Treatment outcomes of photodynamic therapy and findings predicting treatment success in pachychoroid-associated neovascularization.

To investigate the treatment outcomes and predictive factors affecting treatment success of half-fluence photodynamic therapy (hf-PDT) in pachychoroid-associated neovascularization (PNV). Twenty-four eyes of 23 PNV patients who underwent hf-PDT were included in this study. The results of optical coherence tomography (OCT) and OCT-angiography imaging were analyzed. The total choroidal area (CA), luminal area (LA), and stromal area (SA) were measured using ImageJ software. Baseline characteristics of the eyes showing complete response (group 1) and the eyes with partial response or unresponsive to hf-PDT (group 2) were compared. The mean age of the patients was 54.2±9.6 years. The mean follow-up time after hf-PDT was 20.7 ± 13.6 months. Three months after hf-PDT, the subretinal fluid had completely regressed in 18 eyes (75.0%), partial resolution was observed in 3 eyes (12.5%), and 3 eyes (12.5%) were unresponsive to hf-PDT. When the baseline characteristics before hf-PDT were evaluated between the groups, the mean central choroidal thickness (411.5 ± 115.1 µm vs 284.8 ± 69.4 µm), the mean CA (1.082 ± 0.315 mm2 vs 0.795 ± 0.242 mm2) and the mean LA (0.795 ± 0.234 mm2 vs 0.578 ± 0.200 mm2) was significantly higher in group 1 compared to group 2 (p = 0.019, p = 0.018, p = 0.018, respectively). Hf-PDT is an effective treatment method usually providing total resolution of subretinal fluid in PNV cases. A high baseline central choroidal thickness and large luminal area may be positive predictive factors in terms of full anatomical response to hf-PDT. It may be possible to plan a more effective treatment strategy by keeping these factors in mind.

Treatment of juvenile recurrent parotitis with irrigation therapy without anesthesia

PurposeNo standardized treatment regimen exists for juvenile recurrent parotitis (JRP). The investigators hypothesized that irrigation with saline only without local anesthesia will be an effective and beneficial option.MethodsUsing a retrospective study design, a series of children with typical symptoms of JRP who were treated with at least one irrigation therapy were evaluated. This treatment consisted of irrigation of the affected gland with 3–10 ml saline solution without any type of anesthesia. The outcome variables were patient/parent satisfaction, frequency and duration of acute JRP episodes, and the need for antibiotics before and after irrigation therapy.ResultsThe case series was composed of six boys aged 3.3–7.7 years who experienced one to eight sessions of irrigation therapy. The period of follow-up was 9–64 months. We observed a total resolution of symptoms in two children and an improvement in the other four. No relevant side effects were seen.ConclusionOur results suggest that irrigation therapy is a reasonable, simple, and minimally invasive treatment alternative for JRP. In contrast to sialendoscopy or sialography, there is no need for general anesthesia or radiation exposure.

Acute exudative polymorphous vitelliform maculopathy during pembrolizumab treatment for metastatic melanoma: a case report

BackgroundThe use of immunomodulating therapy to treat various cancers has been on the rise and these immune checkpoint inhibitors are known to cause ocular side effects. In this article a case of acute exudative polymorphous vitelliform maculopathy (AEPVM) is reported which developed during a first line treatment with pembrolizumab.Case presentationA 54-year-old woman was referred because of blurry vision in both eyes with a yellow spot in the central visual field of the left eye. These symptoms started after four treatments with pembrolizumab (a monoclonal antibody against the programmed cell death receptor-1) for a metastatic recurrent vaginal mucosal melanoma. Her best corrected visual acuity was 10/10 in both eyes with a correction of + 2.00 bilaterally. There were no inflammatory findings in the anterior segment or the vitreous. Fundoscopy revealed an attenuation of the foveal reflex with subtle yellow-white subretinal macular deposits (vitelliform lesions) in both eyes. Fluorescein angiography did not show staining or leakage in the mid-phase, neither a late staining. Spectral-domain optical coherence tomography of the macula illustrated bilateral neurosensory retinal detachment with a thick, highly reflective band at the outer photoreceptor segment. En face structural OCT at the level of the photoreceptors showed focal areas of increased signal corresponding to hyperreflective vitelliform material. The treatment with pembrolizumab was ceased immediately. During the following visits we slowly saw an improvement of the neurosensory retinal detachment. After almost four months a total resolution of the subretinal fluid was visualized in both eyes without the use of additional treatment, though the vitelliform deposits persisted.ConclusionsThe development of AEPVM in melanoma patients could be triggered by treatment with Pembrolizumab. Pembrolizumab has the potential to disturb indirectly the retinal pigment epithelium homeostasis with accumulation of lipofuscin deposits and subretinal fluid, both signs of AEPVM.

What are the chances of improvement or cure from overactive bladder? A pooled responder analysis of efficacy and treatment emergent adverse events following treatment with fesoterodine.

AimThis study describes patients with different degrees and combinations of symptom resolution in response to fesoterodine exposure to aid physicians in counselling patients with overactive bladder (OAB) on the likelihood of treatment success.MethodsData came from 12‐week fixed‐dose studies of fesoterodine. The proportions of patients experiencing symptom resolution and change in patient‐reported outcome measures (PROM) at 4, 8, and 12 weeks were calculated. Treatment‐emergent adverse events (TEAE) were reported according to response in urinary urgency episodes (UUE). The relationship between PROM and response was examined.ResultsOut of 6689 patients, 81.6% female, urgency urinary incontinence (UUI) episodes/24 h were more responsive to fesoterodine than UUE; with roughly 50% of patients reporting a 50% reduction and fewer than 10% reporting absence of UUE at 12 weeks compared to approximately 40%–50% reporting absence of UUI. TEAE was numerically lower in patients with greater response. There was a statistically significant relationship between improvement in urinary urgency and associated change in OAB‐q symptom bother scores, r = 0.54, p < 0.001. At Week 4, 64.0%–76.7% of patients who had achieved a significant change in Patient Perception of Bladder Condition (PPBC) had a 50% reduction in UUI. At Week 12 this proportion was between 80% and 87.9%, with those being exposed to fesoterodine treatment reporting response in PPBC at numerically higher rates.ConclusionThese data provide clinicians with information from which they may usefully communicate the likelihood of symptom resolution in response to pharmacotherapy for OAB and answer a key clinical question posed by many care providers. Roughly ⅓ of fesoterodine treated patients reported a 50% reduction urgency and ¾ reported 50% resolution of incontinence at 12 weeks. Total resolution of all symptoms was seldom achieved.

Minimally Invasive Dentistry for Pre-Eruptive Enamel Lesions—A Case Series

Pre-eruptive enamel lesions occur during tooth formation and include fluorosis, traumatic hypomineralization, and molar incisor hypomineralization. Minimally invasive treatment approaches, such as microabrasion, should be considered for these cases. This article presents a case series of three patients with pre-eruptive enamel defects in esthetically compromised tooth regions which were treated with the microabrasion technique: two fluorosis cases, moderate and advanced, and one hypomineralization case of traumatic etiology. In Cases 1 and 3, there was a significant improvement in esthetics with a total resolution of the enamel defects. However, a slight yellowish coloration may be detected at close observation. In Case 2 (advanced fluorosis), although there was no full resolution of the white spots, there was a clear improvement in esthetics. Microabrasion is a safe and effective, minimally invasive treatment for pre-eruptive enamel lesions. It does not require local anesthesia, it is less destructive than restorative interventions, and allows good esthetic outcomes with no significant postoperative sensitivity. Its efficacy is directly related to the lesions’ severity and depth. Although there are some limitations, further improvement can be achieved with dental bleaching. More invasive treatments might be considered if results are still unsatisfactory.