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Primary Management (primary + management)
Selected AbstractsHereditary Hemorrhagic Telangiectasia: A Review of 76 Cases,THE LARYNGOSCOPE, Issue 5 2002Rahul K. Shah MD Abstract Objectives/Hypothesis Hereditary hemorrhagic telangiectasia has long been viewed as a rare condition. Recent evidence indicates that the disorder is more frequent than previously thought. Recalcitrant epistaxis is a salient feature of this disease, and the otolaryngologist is often called on to make the diagnosis and guide the primary management of patients with hereditary hemorrhagic telangiectasia. Wider recognition of this condition, awareness of the natural history and associated findings, appropriate workup and screening for arteriovenous malformations (lungs, brain, liver), and knowledge of appropriate interventions can help avoid the considerable morbidity associated with hereditary hemorrhagic telangiectasia. Study Design Retrospectivereview. Methods Records of patients treated by the senior author (s.m.s.) for hereditary hemorrhagic teleangiectasia from 1993 to 2000 were reviewed. Results Seventy-six patients were identified, 98% of whom had epistaxis as their presenting complaint, with 75% having a family history of hereditary hemorrhagic telangiectasia. The severity of epistaxis varied in the patients: 66% had mild, 21% moderate, and 13% severe epistaxis. Sixty-four percent of patients had no transfusions, 25% had 1 to 10 transfusions, and 11% of patients had more than 10 transfusions. Complications of hereditary hemorrhagic telangiectasia were documented in 30% of patients. Screening for arteriovenous malformations was performed in only 34% of patients. Eighty-two percent of patients received a variable number of Nd:YAG laser treatments. Conclusions The study presents the largest retrospective review of patients treated for hereditary hemorrhagic telangiectasia by a single otolaryngologist. The importance of a multidisciplinary approach facilitated by the otolaryngologist for evaluation of concomitant complications and morbidity (arteriovenous malformations) from hereditary hemorrhagic telangiectasia is demonstrated. An algorithm for controlling the epistaxis is presented. [source] Review of the genetics of thyroid tumours: diagnostic and prognostic implicationsANZ JOURNAL OF SURGERY, Issue 1-2 2010Christopher P. Gilfillan Abstract Background:, Thyroid nodules are common, but only a small proportion harbour malignancy. Despite this, the frequency of thyroid cancer is on the increase and thyroid malignancy is the most common endocrine malignancy. Preoperative diagnosis is based on ultrasound and radionucleotide imaging as well as the fine-needle aspiration biopsy (FNAB). These biopsies yield a large proportion of indeterminate results due to inadequate material for cytological diagnosis, or due to the cytological similarity of FAs and follicular carcinomas. Recent advances in the understanding of the molecular pathogenesis of thyroid malignancy have led to the detection of characteristic genetic alterations in FNABs. This technology has the potential to increase the specificity of this test, combining cytological with genetic testing to reduce the number of indeterminate results, thereby reducing the number of thyroidectomies performed for benign disease. Methods:, This review examines the evidence for the presence of the common genetic alterations in thyroid cancer and outlines the pathological and clinical correlations of these mutations. The practicality and utility of measuring these genetic alterations in FNAB specimens is also outlined as well as the potential for these tests to alter primary management and follow-up of patients with nodular thyroid disease. Conclusion:, It is likely that a combination of molecular testing and cytological examination of FNAB specimens will prove to be the most efficient and specific method of diagnosing thyroid cancer preoperatively. [source] Injectable polydimethylsiloxane for treating incontinence in children with the exstrophy-epispadias complex: long-term resultsBJU INTERNATIONAL, Issue 4 2006Tariq Burki In this section authors from the UK describe their experience with plastic injections for treating incontinence in children with the exstrophy-epispadias complex, finding that in the long term the success rate was reasonable, although the injections often needed to be repeated. Authors from Brazil present an analysis of anomalies of the epididymis and processus vaginalis in human fetuses, and in patients with cryptorchidism treated and untreated with hCG. OBJECTIVE To present our experience with the use of injectable polydimethylsiloxane (MacroplastiqueTM, Uroplasty, Minneapolis, MI, USA) for treating incontinence in children with the exstrophy-epispadias complex (EEC), as incontinence continues to be a challenging problem in such children, and although the primary management of EEC has developed over the last few decades, with early closure and reconstruction of the penis, achieving satisfactory continence status remains elusive. PATIENTS AND METHODS We retrospectively reviewed the hospital records of 52 patients (41 boys and 11 girls, mean age at first injection 6.6 years, range 3.6,16.7) with EEC who had injections with Macroplastique between January 1991 and February 2004; 34 had bladder exstrophy and 18 primary epispadias. For this study we defined success as complete dryness with no use of pads or nappies. Improvement was defined as being occasionally wet but with dry intervals lasting ,,4 h. RESULTS The mean (range) follow-up was 4.6 (0.5,9) years. Twenty patients had one injection, 10 had two, 13 had three, six had four, two had six and one had seven injections. In most patients a maximum of three injections predicted the outcome. The injection of Macroplastique was successful in nine patients (17%; with an annual follow-up, two at 1,2 years, three at 2,5 years and four at >5 years), whilst 17 (33%) improved significantly (one at <1 year, two at 1,2 years, eight at 2,5 years and six at >5 years). Those patients comprised five of 18 (27%) with epispadias and four of 34 (12%) with exstrophy. A history of previous surgery and gender had no significant effect on the outcome. Overall half the patients benefited from the procedure. CONCLUSIONS This series confirms that injection with Macroplastique is minimally invasive, durable in significantly many patients and has a reasonable success rate. A history of previous surgery and gender had no significant effect on the outcome. Patients with epispadias are more likely to benefit from an injection with Macroplastique than those with bladder exstrophy. A maximum of three injections is predictive with reasonable certainty of any benefit from the procedure. [source] Initial management of cerebrovascular disease by general practitionersBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 4 2000R. G. J. Gibbs Background: The aim of this study was to determine the primary management of patients presenting with a new diagnosis of transient ischaemic attack (TIA) or stroke by general practitioners and to establish whether practice was uniform across the UK, and to determine whether initial management influenced the performance of carotid endarterectomy (CEA) across the health regions of the UK. Methods: Information on regional reporting of new cases of TIA and stroke between 1992 and 1996 was obtained from the General Practice Research Database, a database of six million patients from 450 practices. Analysis of data from the primary care database and routine data sources was undertaken. Main outcome measures were incidence of TIA and stroke, rates of referral for specialist opinion, prescription of antiplatelet agents and rates of CEA. Results: There were twofold differences (P < 0·00005, ,2 test) in the incidence of cerebrovascular disease between Regional Health Authorities (RHAs) between the years 1992 and 1996 and also for each year. Mean stroke incidence per annum was 143 per 100 000 and TIA incidence 183 per 100 000. Yorkshire had the highest incidence at 170 (stroke) and 206 (TIA) per 100 000 of the population compared with 95 and 98 per 100 000 for Oxford. Some 37 per cent of new patients with stroke and 19 per cent of patients with TIA were referred for specialist opinion following initial diagnosis. These rates did not change over time. There was no positive correlation between disease incidence and referral rate; Yorkshire referred the least (14 per cent) and Oxford the most (26 per cent). The majority of referrals for TIA were made to general medicine (39 per cent); 6 per cent of patients were referred directly for surgical opinion. Mean prescription rate of antiplatelet medication over the time period was 17 per cent for patients with stroke and 35 per cent for those with TIA. Mean CEA rate for English RHAs for the time interval was 15·5 per 100 000. There was a positive correlation between the incidence of disease and rate of CEA, with the regions with the highest incidence of disease tending to perform the most CEAs. Conclusion: The incidence of cerebrovascular disease varies significantly across health regions in the UK. There was no correlation between the regional incidence of disease and the number of patients referred for specialist opinion, but CEA rates were generally correlated with the regional difference in incidence of disease. The low referral rate may be a factor in the perceived underperformance of CEA in the UK and the low usage of antiplatelet medication is surprising. © 2000 British Journal of Surgery Society Ltd [source] | ||||||||||