Vascular malformations – Treatment modalities

Background: Vascular malformation is a general term that includes congenital vascular anomalies of veins, lymph vessels, both veins and lymph vessels, or both arteries and veins vascular malformation, is a blood vessel abnormality. These are all present at birth and become apparent at different ages. Most are known to occur during development of the arteries, veins, and/or lymph vessels, but without specific cause. Most are congenital and few appear late in life. Aim: It was using different treatment modalities to reform, reshape, and reorganize to obtain near normal appearance and function. Materials and methods: An observational study done in VIMS - Visakha Institute of Medical Sciences, a superspeciality hospital, 20 cases of vascular malformations are taken from period January 2017 –August 2019. Consent was taken from all the patients, and counseling was done regarding the procedures we do, about surgical/ non-surgical methods, stages required and follow up. Results: Statistical analysis was done, results were tabulated and displayed in pie diagrams. Satisfaction scale was shown by VAS (visual analogue scale). Conclusion: Vascular malformations are mesenchymal lesions may be congenital/ acquired and may present late in life. Sometimes few congenital hemangiomas spontaneously resolve by growth of child, some if large may require steroids for suppression and to prevent recurrences. They are known for recurrences or residual lesions and surgery may be done in stages to obtain optimal results. Nonsurgical methods are done by intralesional sclerosants.

The survival and prognostic factors of primary testicular lymphoma: two-decade single-center experience / 亚洲男科学杂志(英文版)

This study aims to investigate the effect of different local testicular treatments and validate common prognostic factors on primary testicular lymphoma (PTL) patients. We retrospectively reviewed the clinical records of 32 patients from 1993 to 2017 diagnosed with PTL and included 22 patients for analysis. The Kaplan-Meier method, Log-rank test, and multivariate Cox proportional hazard regression analysis were applied to evaluate progression-free survival (PFS), overall survival (OS), and determine prognosis predictors. The median follow-up time was 30 months. Median OS and PFS were 96 months and 49 months, respectively. In univariate analysis, advanced Ann Arbor stage (III/IV) (P < 0.001), B symptoms (P < 0.001), and extranodal involvement other than testis (P = 0.001) were significantly associated with shorter OS and PFS. In multivariate analysis, Ann Arbor stage was significantly associated with OS (OR = 11.58, P = 0.049), whereas B symptom was significantly associated with PFS (OR = 11.79, P= 0.049). In the 10 patients with the systemic usage of rituximab, bilateral intervention could improve median OS from 16 to 96 months (P = 0.032). The study provides preliminary evidence on bilateral intervention in testes in the rituximab era and validates common prognostic factors for Chinese PTL patients.

The survival and prognostic factors of primary testicular lymphoma: Two-decade single-center experience / 亚洲男科学杂志(英文版)

This study aims to investigate the effect of different local testicular treatments and validate common prognostic factors on primary testicular lymphoma (PTL) patients. We retrospectively reviewed the clinical records of 32 patients from 1993 to 2017 diagnosed with PTL and included 22 patients for analysis. The Kaplan-Meier method, Log-rank test, and multivariate Cox proportional hazard regression analysis were applied to evaluate progression-free survival (PFS), overall survival (OS), and determine prognosis predictors. The median follow-up time was 30 months. Median OS and PFS were 96 months and 49 months, respectively. In univariate analysis, advanced Ann Arbor stage (III/IV) (P < 0.001), B symptoms (P < 0.001), and extranodal involvement other than testis (P = 0.001) were significantly associated with shorter OS and PFS. In multivariate analysis, Ann Arbor stage was significantly associated with OS (OR = 11.58, P = 0.049), whereas B symptom was significantly associated with PFS (OR = 11.79, P= 0.049). In the 10 patients with the systemic usage of rituximab, bilateral intervention could improve median OS from 16 to 96 months (P = 0.032). The study provides preliminary evidence on bilateral intervention in testes in the rituximab era and validates common prognostic factors for Chinese PTL patients.

Therapeutic Management of Recurrent Aphthous Stomatitis: A Review of the Growing Knowledge.

Recurrent aphthous stomatitis (RAS) is one of the common clinical oral diseases that produces painful ulcerations in the oral cavity .It is also called canker sore or mouth ulcer. Although , the clinical features and characteristics of this disease are easily defined , the etiology and the pathophysiology remain unclear . So as a result, the available treatments still remaining unsatisfactory with the ability to reduce the severity , healing time and the frequency of recurrence of ulceration with no permanent and definitive treatment. The healing time ranges usually from seven to fourteen days. This review discusses the different treatment modalities and updates that are available to the moment and according to the severity of the ulceration, the clinician can decide to go with topical , physical or systemic treatments which give the clinician broad and detailed picture to deal with RAS in an appropriate way.

Técnicas quirúrgicas para las lesiones de menisco / Surgical techniques for meniscal injuries / Techniques chirurgicales pour la correction des lésions méniscales

Los meniscos son estructuras anatómicas que desempeñan importantes funciones en la articulación de la rodilla. Con el propósito de profundizar en las modalidades de tratamiento quirúrgico en pacientes con lesiones de menisco de la rodilla, se realizó una revisión bibliográfica de 300 artículos publicados en Pubmed, Hinari y Medline mediante el localizador de información Endnote; fueron seleccionadas 55 citas, 51 de ellas de los últimos 5 años, donde se incluyeron dos libros. Las modalidades de tratamiento quirúrgico son la meniscectomía, la reparación y la sustitución. Se realizó una breve descripción anatómica y epidemiológica de la entidad, para luego profundizar en los detalles de las técnicas empleadas. En relación con la reparación se plasman las diferentes variantes de tratamiento, sus indicaciones y complicaciones. La sustitución de menisco tiene indicaciones específicas indispensables para obtener resultados satisfactorios. El tratamiento de las lesiones de menisco es, por lo general, quirúrgico, en especial mediante el empleo de la vía artroscópica. Las variedades de tratamiento dependen del tipo de lesión, de las posibilidades materiales y las habilidades del cirujano.

The menisci are anatomic structures that play important roles in the knee joint. In order to deepen the surgical treatment modalities in patients with meniscal injuries of the knee, a literature review of 300 articles was performed. These articles were published in PubMed, Medline by Hinari and information locator Endnote. 55 citations were selected, 51 of them are from the last 5 years. Two books were included. The surgical treatment modalities are meniscectomy, repairing and replacement. A brief anatomical and epidemiological description of the entity was made, and then delves into the details of the techniques used. In connection with repairing of different variants of treatment, indications and complications are reflected. Meniscus replacing has specific indications which are essential for its success. The treatment of meniscus lesions is usually surgery, particularly through the use of arthroscopic approach. The varieties of treatment are depending on the type of injury, material options and skills of the surgeon.

Les ménisques sont des structures anatomiques qui jouent un rôle très important dans l’articulation du genou. Afin d’approfondir les connaissances sur les modalités de traitement chirurgical chez les patients souffrant des lésions au niveau des ménisques du genou, on a fait une analyse bibliographique de 300 articles publiés à Pubmed, Hinari et Medline à l’aide d’EndNote, un outil de gestion bibliographique. Cinquante-cinq citations, dont 51 appartenaient à ces dernières cinq années, ont été sélectionnées, y compris 2 livres. Les modalités de traitement chirurgical comprennent la méniscectomie, la réparation et le remplacement. D’abord, on a fait une brève description anatomique et épidémiologique de cette pathologie, et puis on a révélé en détail les techniques utilisées. En ce qui concerne la réparation, on montre les différents types de traitement, leurs indications et complications. Le remplacement du ménisque a des indications spécifiques nécessaires pour obtenir des résultats satisfaisants. Généralement, le traitement des lésions méniscales est chirurgical, surtout sous arthroscopie. Les différents traitements s’appliquent en dépendance du type de lésion, de la disponibilité matérielle et des habiletés du chirurgien orthopédiste.

Application of DWI combined with MRI in diagnostic staging and decision of treatment method in patients with cervical cancer / 肿瘤

Objective: To explore the value of diffusion-weighted imaging (DWI) combined with conventional magnetic resonance imaging (MRI) in diagnostic staging and the decision of treatment method in patients with cervical cancer. Methods: The data of DWI MRI from 42 patients pathologically confirmed with cervical cancer were retrospectively analyzed. The apparent diffusion coeffcient (ADC) and exponential ADC (eADC) values were measured. The ADC and eADC values were compared according to different pathologic types and stages of cervical cancer, and between the cervical cancer and normal cervix. The diagnostic accuracy of DWI combined with conventional MRI for pathologic staging was examined. The ADC and eADC values were compared between radiochemotherapy group and the surgery group. Results: The cervical cancer demonstrated high signal intensity on DWI, whereas the normal cervix showed no obviously abnormal signal intensity. The mean ADC value of 42 patients with cervical cancer was lower than that of normal cervix (P = 0.000); the mean ADC value of cervical squamous-cell cancer was lower than that of adenocarcinoma (P = 0.036); the mean ADC value of radiochemotherapy group before treatment was lower than that of surgery group (P = 0.000), whereas the eADC value was higher than that of surgery group (P = 0.000). There were no significant differences in mean ADC and eADC values among different pathologic stages of cervival cancer (all P values < 0.05). The diagnostic accuracy of conventional MRI and DWI combined with conventional MRI for pathologic staging were 92.9% (39/42) and 95.2% (40/42), respectively (Kappa = 0.903 5 and 0.935 8, respectively; P < 0.01). Conclusion: DWI combined with MRI exerts a high value in diagnostic staging of cervical cancer. The ADC value can be used as reference in selection of therapeutic methods for stage II B cervical cancer.

Predictors of diabetes distress in patients with type 2 diabetes mellitus.

Background: Diabetes distress is a condition distinct from depression that is related to diabetes outcomes. This study intends to identify the predicting risk factors of diabetes distress in Bangladeshi type 2 diabetes mellitus patients. Methods: A cross sectional study was conducted from January to June, 2012 in Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka. Data were collected through interview and reviewing documents. Results: Among 165 respondents, the proportion of diabetes distress was 48.5% (n=80) which include 22.4% (n=37) high distress and 26.1% (n=43) moderate distress. Glycemic status measured by HbA1c was the best predictor of diabetes distress [Adjusted odds ratio (AOR) 1.56; 95% Confidence Interval (CI) 1.16 to 2.10]. Insulin users were five times more likely to develop distress [Adjusted odds ratio (AOR) 5.05; 95% Confidence Interval (CI) 1.20 to 21.19] than users of oral anti-diabetic agents. Other predictors of diabetes distress were duration of DM [Adjusted odds ratio (AOR) 1.27; 95% Confidence Interval (CI) 1.06 to 1.52], Diabetic complications [Adjusted odds ratio (AOR) 3.92; 95% Confidence Interval (CI) 1.09 to 14.19], Average monthly family income [Adjusted odds ratio (AOR) 1.00; 95% Confidence Interval (CI) 1.00 to 1.00]. Conclusion: HbA1c, treatment modalities, duration of DM, diabetic complications and average monthly family income appeared to be significant predicting factors of diabetes distress among the type 2 diabetes mellitus patients. This should be taken into consideration for effective management of patient.

Multimodal Therapeutic Approach in Anaplastic Thyroid Cancer / 대한내분비외과학회지

PURPOSE: Anaplastic thyroid cancer (ATC) is a rare but highly aggressive neoplasm with a dismal prognosis. However, a few patients survive for a long time after treatment. We tried to identify prognostic factors of this disease and analyzed treatment outcomes in patients with ATC. METHODS: We reviewed the medical records of 15 patients diagnosed with ATC in our institution between 1988 and 2003. The survival was compared by the Kaplan-Meier logrank test using SPSS program. RESULTS: The female-to-male ratio was 1.5:1 (9 women and 6 men), and the mean age at diagnosis was 63.9 years (range, 44~91). The mean tumor size was 6.3 cm (range, 4~10 cm). Extrathyroidal invasion was present in 12 cases and distant metastasis at diagnosis was present in 6 cases. Surgery was performed in 8 cases. Radiotherapy was used for 10 cases and chemotherapy for 5 cases. The mean overall survival time of the 15 patients was 237 days (range, 28~717 days). The 6~, 12~, 18~ and 24~ month survival rates were 33%, 26%, 13% and 0%. No association was found between survival and presenting symptoms, age, gender, tumor size, previous goiter history, extrathyroidal invasion, distant metastasis, surgery, radiotherapy or chemotherapy. A significantly better outcome was observed in patients received triple modality treatment (surgery, radiotherapy and chemotherapy) than in those received single or dual modality treatment (P=0.05). CONCLUSION: Although most patients with ATC had a poor prognosis, a multimodal approach including surgery, radiotherapy and chemotherapy, might improve survival.

The Effect of Treatment Modalities on Survival Rates of Patients with Anaplastic Thyroid Carcinoma / 대한내분비학회지

BACKGROUND: Anaplastic thyroid carcinoma represents 2% to 5% of all thyroid cancers and it is one of the most aggressive human cancers. Local extension at the time of diagnosis and distant metastases are almost always the rule. Its lethality is evidenced by a 5-year survival rate of 3.6% and a median survival time of 4 months. We retrospectively reviewed patients with this disease at 4 tertiary referral centers. METHODS: From 1990 to 2003, 19 cases(9 men and 10 women, mean age: 65.1+/-7.1 years) of anaplastic thyroid carcinoma were reviewed via the medical records. The overall survival rates according to the prognostic factors and the treatment modalities were analyzed. RESULTS: The presenting symptoms included rapidly enlarged neck masses in 16 patients, shortness of breath in 3 patients, hoarseness in 4 patients, dysphagia in 2 patients and chest wall pain in 1 patient. The mean diameter of tumor was 7.2cm. Local extension was seen in all of the cases that had undergone surgery. Distant metastases(lung 6, bone 2, abdominal carcinomatosis 2, brain 1 and mediastinum 1) were seen in 9 patients. Surgical treatment was performed in 10 patients. Radiotherapy was performed in 9 patients and chemotherapy was done in 5 patients; radiotherapy was performed alone in 2 patients, combination chemo-radiotherapy was performed in 3 patients, postoperative radiotherapy was performed in 2 patients and postoperative combination chemo-radiotherapy was performed in 2 patients. 4 patients were treated cons ervatively after the confirmative diagnosis. The overall median survival time was 123 days(range: 23~621 days); the median survival time was 129 days in the treatment group(n=15), and 27 days in the no treatment group (n=4), and significantly higher survival rates were observed for the treated patients(p=0.02). According to the treatment modalities, patients who underwent surgical treatment and postoperative radiotherapy and/or chemotherapy were observed to have significantly higher survival rates than patients in the radiotherapy and/or chemotherapy group(p=0.03), and also than those patients in the surgical treatment only group(p=0.04). CONCLUSION: We found that aggressive surgical treatment and postoperative radiotherapy and/or chemotherapy improved the survival rates of patients with anaplastic thyroid carcinoma even though local invasion and distant metastases was generally observed to occur

Anaplastic Thyroid Carcinoma: A Therapeutic Dilemma

Anaplastic thyroid carcinoma (ATC) is one of the most malignant human neoplasms and has a grave prognosis. This study gives an update on our experience with this unusual neoplasm, with specific focus on the response to various treatment modalities. Forty-seven patients with histologically proven ATCs were enrolled (19 men, 28 women; mean age, 62.8 years). This number represents 1.5% among a total of 3, 088 thyroid cancers treated between 1977 and 2002. The mean tumor diameter was 8.8 cm, and 22 patients had distant metastasis. Extrathyroidal extension was seen in 26 (89.7%) of the cases that underwent surgery. Treatment modalities adopted could be classified into 5 groups: Group 1, biopsy only; Group 2, biopsy and chemoradiotherapy; Group 3, debulking only; Goup 4, debulking and chemoradiotherapy; Group 5, complete excision and chemoradiotherapy. Survival was calculated from the time of diagnosis, and comparisons of survival were done by log-rank analysis. The mean survival was 4.3 months (range, 1.0-21 months). The mean survival based on treatment modalities were as follows: Group 1 (n = 10), 2.1 months, Group 2 (n = 8) ; 3.6 months; Group 3 (n = 7), 3.0 months; Group 4 (n = 14), 3.5 months, Group 5 (n = 8), 9.4 months. There was no significant difference in survival time between the various types of treatment modalities. Even though a small improvement in survival was observed with complete excision and aggressive multimodality therapy, nearly all ATCs remain unresponsive to ongoing treatment modalities and as such, present a therapeutic dilemma. A more effective treatment regimen should be sought in order to improve survival.

Treatment of Anaplastic Thyroid Carcinoma: A Therapeutic Dilemma

PURPOSE: Anaplastic thyroid carcinoma (ATC) is one of the most malignant human neoplasm, with a grave prognosis. This study updates our experience with this unusual neoplasm with specific focus on the response to various treatment modalities. METHODS: Forty-seven patients with histologically proven ATC were enrolled (19 men, 28 women; mean age, 62.8 years). This group represented 1.5% of the 3, 088 thyroid cancers treated between 1977 to 2002. The mean diameter of tumor was 8.8 cm (range, 2.0~20.0 cm), and 22 patients had distant metastasis (10 in the lung, 8 lung and bone, 1 brain, 1 mediastinum, and 2 lung and mediastinum). Extrathyroidal extension was seen in 26 (89.7%) of the cases that underwent surgery. Treatment modalities adopted were classified into 5 groups. Group 1, biopsy only; group 2, biopsy and chemoradiotherapy; group 3, debulking only; group 4 debulking and chemoradiotherapy; and group 5, complete excision and chemoradiotherapy. Survival was calculated from the time of diagnosis, and comparisons of survival were done by log-rank analysis. RESULTS: The mean survival was 4.3 months (range, 1.0~21 months). The mean survival bases of treatment modalities were as follows: group 1 (n=10), 2.1 months (range 1.0~6.0); group 2 (n=8), 3.6 months (range, 2.0~7.0 months); group 3 (n=7), 3.0 months (range, 1.0~11.0 months); group 4 (n=14), 3.5 months (range, 2.0~9.0 months), group 5 (n=8), 9.4 months (range 5.0~21.0 months). CONCLUSION: Even though a small improvement of survival in response was observed with complete excision and aggressive multimodality therapy, nearly all ATC remains ineffective to ongoing treatment modalities and continue to present a therapeutic dilemma. A more effective treatment regimen should be sought for improving the survival rate.

Clinicopathologic Characteristics and Treatment Modalities about Vulvar Vestibulitis Syndrome: A study of 30 Cases / 대한산부인과학회잡지

OBJECTIVE: This study was performed to evaluate and introduce the clinicopathologic characteristics and treatment modalities of vulvar vestibulitis, a subset of vulvodynia, may cause physical disabilities, phycological or emotional distress, sexual dysfunction and limitation of daily activities. But its etiologies and treatments are not defined yet. We want to summarize the diagnostic methods and treatments patients of vulvar vestibulitis syndrome, could be easily overlooked in your offices. METHODS: This retrospective study was based on medical records including pathologic reports of 30 patients who underwent skin biopsy among the patients who were diagnosed as vulvar vestibulitis syndrome from August 1999 to February 2002 at Kyung-Hee University Medical Center. Skin biopsy was taken at a most painful area of vestibule in Dermatology Department to improve the accuracy of diagnosis. We evaluated the clinicopathologic characteristics of patients RESULTS: The mean age of these patients was 53.4+/-10.4 years and the mean parity was 3.13+/-1.4 times. The mean duration from symptom onset to diagnosis was 26.2+/-24.1 months. The skin biopsies showed chronic inflammation in 21 cases (70.0%), chronic inflammation with koilocytosis in 5 cases (16.7%), subacute inflammation in 3 cases (10.0%), and acute inflammation in 1 case (3.3%). The most predominant painful area is right posterior vestibular site and all patients felt pain on that site with swab test. There were 70% improvement among 30 patients with non-surgical modalities. CONCLUSION: Vulvar vestibulitis syndrome is a syndrome of severe pain, burning, stinging, irritative or raw sensation within the vestibular area by vestibular touch or attempted vaginal entry such as tampon use or intercourse. It also has vestibular redness, urge to urinate frequently or suddenly and is confirmed by history, moistened cotton-tipped swab test and gentian violet staining on the lesions. Its prevalence is 15% and it is frequently accompanied by physical disabilities, limitation of daily activities, sexual dysfunction and psychologic distress. Even though it could be seen frequently in our offices and has a tendency to become a chronic disease requiring long-term treatments, it has been being overlooked in offices due to lack of understanding of its etiologies, diagnostic criteria and treatments. Here we need more concerns and studies of vulvar vestibulitis syndrome.

Primary Non-Hodgkin's Gastric Lymphoma

PURPOSE: The aim of the study was to obtain data on the anatomic and histologic distributions, the clinical features, and the treatment results for patients with primary gastric non-Hodgkin's lymphoma. MATENRIALS AND METHODS: One hundred thirty-two patients who were treated at 8 university hospitals and 2 general hospitals between January 1991 and December 2000 were enrolled to evaluate clinico-pathologic features. RESULTS: The lower one-third of the stomach was the most frequent site (42%), and the most frequent chief complaint was epigastric pain (54%). Gastric resection was performed in 114 cases. Pathologic findings of preoperative endoscopic biopsy specimens from the 114 patients that underwent surgery were a gastric lymphoma in 94 cases (82%), a carcinoma in 15 cases (13%), an ulcer in 4 cases (4%), and a gastrointestinal stromal tumor in 1 case (1%). The stage distributions by Musshoff's criteria were 71 cases (54%) of stage IE, 36 cases (27%) of stage II1E, 8 cases (6%) of stage II2E, 2 cases (2%) of stage IIIE, and 15 cases (11%) of stage IVE. Histologic gradings by the Working Formulation in were 31 cases (23%) of low grade, 96 cases (73%) of intermediate grade, and 5 cases (4%) of high grade. Chemotherapy-related complications occurred in 25 cases (22%) while operation-related complications occurred in 6 cases (5%). Seventeen patients (13%) only underwent surgery, 19 (14%) had chemotherapy (CTx) and/or radiotherapy (RTx) only, and 96 patients (73%) received surgery and CTx and/or RTx. No substantial differences in survival were found in relation to the different histologic grades and different treatments. The five-year survival was 85% in stage I or II and 47% in stage III or IV (P=0.0000). CONCLUSION: Pathologic stage appears to be the single most important prognostic indicator. Survival differences according to treatment modalities were not statistically significant. However, the low number of patients treated with various approaches over a long period precludes a firm conclusion.

Clinical Evaluations of Prosthetic Vascular Graft Infection

Infection of a prosthetic vascular graft is a perilous complication, difficult to eradicate, and if not recognized or adequately treated eventually caused the prosthesis to malfunction, often with life- threatening hemorrhage. Authors retrospectively evaluated the 17 cases of prosthetic vascular graft infection to determine treatment modalities of graft infection from May 1983 to April 1997 at department of surgery, Yeungnam University Hospital. Aortic and peripheral vascular graft infection were 2 and 15 cases, and mortality rate were 50% and 13.3%, respectively. Amputation rate was 13.3% in peripheral vascular graft infection. Most of the patients had experienced symptoms and signs of infection, such as fever, leukocytosis, pus discharge, wound disruption and/or bleeding due to anastomotic disruption. The Most common pathogen was Staphylococcus aureus(12 cases) and others were Staphylococcus epidermidis(4 cases), Escherichia coli(1 cases). The most common site of infection was inguinal area(7 cases) that associated with repeated operation for thromboembolectomy. The diagnosis was made with Duplex ultrasonography, computed tomography and sinography. In one case of aorto-iliac bypass, graft-cutaneous fistula was found by sinography. Treament modalities were local antibiotic soaking dressing only (4 cases), rotational muscle flap(1 case), graft excision with revascularization(4 cases), and graft excision without revascularization(6 cases) in peripheral graft infection and aortic graft excision with extra-anatomic bypass graft(2 cases) in aortic graft infection with systemic antibiotic administration. In conclusion, prevention of vascular graft infection and early diagnosis of infection are very important. The time to infection after operation, infection sites, bacteological pathogens and general condition of patients are also important to select treatment modalities, such as local care only, muscle flap application, interposition graft, and removal of graft with or without revascularization.