Background: Epidemiological data on ruptured aortic aneurysms from large-scale studies are scarce. The aims of this study were to: clarify the clinical course of ruptured aortic aneurysms; identify ...aneurysm site-specific therapies and outcomes; and determine the clinical course of patients receiving conservative therapy.Methods and Results: Using the Tokyo Acute Aortic Super Network database, we retrospectively analyzed 544 patients (mean ±SD age 78±10 years; 70% male) with ruptured non-dissecting aortic aneurysms (AAs) after excluding those with impending rupture. Patient characteristics, status on admission, therapeutic strategy, and outcomes were evaluated. Shock or pulselessness on admission were observed in 45% of all patients. Conservative therapy, endovascular therapy (EVT), and open surgery (OS) accounted for 32%, 23%, and 42% of cases, respectively, with corresponding mortality rates of 93%, 30%, and 29%. The overall in-hospital mortality rate was 50%. The prevalence of pulselessness was highest (48%) in the ruptured ascending AA group, and in-hospital mortality was the highest (70%) in the ruptured thoracoabdominal AA group. Multivariable logistic regression analysis indicated in-hospital mortality was positively associated with pulselessness (odds ratio OR 10.12; 95% confidence interval CI 4.09–25.07), and negatively associated with invasive therapy (EVT and OS; OR 0.11; 95% CI 0.06–0.20).Conclusions: The outcomes of ruptured AAs remain poor; emergency invasive therapy is essential to save lives, although it remains challenging to reduce the risk of death.
Dandy-Walker Malformation is a rare congenital malformation which is characterized by the agenesis or hypoplasia of vermis cerebellum, cyst dilation of 4th ventricle and enlargement of posterior ...fossa. The incidence of Dandy-Walker Malformation (DWM) in USA is one case over 25.000-35.000 in every birth rate, with 40% of them are females and 60% are males. Meanwhile, there is still no definite incidence of Dandy-Walker Malformation in Indonesia. There are 11 articles reported asymptomatic DWM.
A 23 years old female presented with moderate and persistent headache, with no aura or hallucination since 1 year before admission. There were no symptoms of increased intrakranial pressure. There is no history head trauma and no history of developmental disorders while childhood. The neurological physical examination, fundus photos, OCT and humphrey from the eye part within normal limits. The EEG shows a normal EEG. The head CT-Scan and head MRI of the contras that revealed agenesis of cerebellar vermis and extensive CSF cysts at the cysterna magna with the enlarged fourth ventricle suggestive of Dandy-Walker malformation without hydrocephalus. In these patients managed conservative therapy and follow-up were carried out without surgical therapy. It seems that in the case of patients with asymptomatic DWS, CSF dynamics compensate for malformations.
There are important aspects should be followed up in asymptomatic Dandy Walker Malformation patients, there are head MRI to determine the present of hydrocephalus, high ICP signs, and cerebellum symptoms examination.
A 76-year-old woman was referred to our department because of high fever and bladder irritative symptoms. Computed tomography revealed the presence of a heterogeneous mass with indistinct borders on ...the left anterior wall of the bladder. The lesion contained a linear hyperdense shadow. We initially suspected malignancy, such as urachal carcinoma or soft-tissue sarcoma. However, upon review of previous computed tomography scans, it was confirmed that the linear hyperdense shadow had migrated from the intestinal tract to the bladder. Considering the possibility of abscess formation caused by a foreign body, we decided to perform a transurethral biopsy. The results of the pathological analysis showed abscess formation. The patient was diagnosed with perivesical abscess caused by accidental ingestion of a fish bone. Following the administration of antibiotics, the lesion markedly shrank. Although it is difficult to distinguish perivesical abscess from malignant disease, invasive treatment can be avoided by appropriate diagnosis based on imaging studies.
Given the increasing prevalence of diabetes and obesity worldwide, the deleterious effects of non-alcoholic fatty liver disease (NAFLD) are becoming a growing challenge for public health. NAFLD is ...the most common chronic liver disease in the Western world. NAFLD is closely associated with metabolic disorders, including central obesity, dyslipidaemia, hypertension, hyperglycaemia and persistent abnormalities of liver function tests.In general NAFLD is a common denominer for a broad spectrum of damage to the liver, which can be due to hepatocyte injury, inflammatory processes and fibrosis. This is normally seen on liver biopsy and can range from milder forms (steatosis) to the more severe forms (non-alcoholic steatohepatitis (NASH), advanced fibrosis, cirrhosis and liver failure). In these patients, advanced fibrosis is the major predictor of morbidity and liver-related mortality, and an accurate diagnosis of NASH and NAFLD is mandatory. Histologic evaluation with liver biopsy remains the gold standard to diagnose NAFLD. Diagnosis of NAFLD is defined as presence of hepatic steatosis, ballooning and lobular inflammation with or without fibrosis. Weight loss, dietary modification, and the treatment of underlying metabolic syndrome remain the mainstays of therapy once the diagnosis is established. Dietary recommendations and lifestyle interventions, weight loss, and the treatment of underlying metabolic syndrome remain the mainstays of therapy once the diagnosis is established with promising results but are difficult to maintain. Pioglitazone and vitamin E are recommended by guidelines in selected patients. This review gives an overview of NAFLD and its treatment options.
The aim of this study was to investigate to what extent psychological factors are related to pain levels prior to non-invasive treatment in patients with osteoarthritis of the first carpometacarpal ...joint.
We included patients (n = 255) at the start of non-invasive treatment for osteoarthritis of the first carpometacarpal joint who completed the Michigan Hand Outcome Questionnaire. Psychological distress, pain catastrophizing behavior and illness perception was measured. X-rays were scored on presence of scaphotrapeziotrapezoid osteoarthritis. We used hierarchical linear regression analysis to determine to what extent pain levels could be explained by patient characteristics, X-ray scores, and psychological factors.
Patient characteristics and X-ray scores accounted for only 6% of the variation in pre-treatment pain levels. After adding the psychological factors to our model, 47% of the variance could be explained.
Our results show that psychological factors are more strongly related to pain levels prior to non-invasive treatment in patients with osteoarthritis of the first carpometacarpal joint than patient characteristics and X-ray scores, which implies the important role of these factors in the reporting of symptoms. More research is needed to determine whether psychological factors will also affect treatment outcomes for patients treated non-invasively for osteoarthritis of the first carpometacarpal joint.
IMPLICATIONS FOR REHABILITATION
Pain is the most important complaint for patients with osteoarthritis of the first carpometacarpal joint.
Psychological factors are strongly associated with pain levels prior to treatment.
Pain catastrophizing behavior appears to be a promising target for complementary treatment in patients with osteoarthritis of the first carpometacarpal joint.
In Case 1, a 70-year-old male patient had been on chemotherapy for advanced small cell lung cancer in our hospital. He was referred to our department because of pneumoperitoneum revealed on a chest ...X-ray. We started conservative therapy based on lack of any signs of peritonitis. As a result, the amount of pneumoperitoneum decreased, and he was discharged on the 9th hospital day. In Case 2, a 74-year-old female patient with multiple pulmonary nodules was referred to our department because of pneumoperitoneum detected on a chest computed tomography to follow the pulmonary nodules. She did not have any symptoms and the laboratory data were approximately normal. Therefore, we started follow-up at our outpatient clinic and terminated on the 46th hospital day when CT confirmed decreased pneumoperitoneum. Commonly, pneumoperitoneum is a sign of a viscus perforation, therefore emergent laparotomy is usually required. But spontaneous pneumoperitoneum, which is a rare condition defined intraperitoneal gas without obvious etiology, does not need laparotomy depending on the situation.
To compare the therapeutic approach of surgical specialists, sports medicine and rehabilitation specialists, and veterinarians with rehabilitation certification when treating bicipital tendon disease ...or tenosynovitis in dogs and to combine this information with existing research to develop a treatment algorithm that provides a framework for treating bicipital tenosynovitis.
223 respondents to an internet survey of board-certified veterinary surgeons, board-certified sports medicine and rehabilitation therapists, and veterinarians with rehabilitation certification.
The survey was promoted via multiple listservs, specialist college newsletters, and private relevant social media sites. Answers were compiled and submitted for statistical analysis.
Compared to rehabilitation therapists (RTh), surgeons placed less value on the stabilizing function of the biceps tendon and its role in preventing other shoulder morbidities. Similarly, compared to RTh, surgeons were more inclined to select surgery as the primary therapeutic approach and attributed a less optimistic prognosis to conservative therapy outcomes. There were multiple differences between surgeons and RTh in executing a conservative therapy program, with RTh more likely to recommend therapeutic exercise, extracorporeal shockwave, regenerative medicine, therapeutic ultrasound, exercise restriction, photobiomodulation, and pulsed electromagnetic field therapy. RTh were less likely to prescribe NSAIDS or inject corticosteroids. Despite the above noted differences, there were also multiple areas of agreement.
Consensus agreement, combined with existing research, was used to create a treatment algorithm suggesting how to best address multiple manifestations of bicipital tendinopathy. Such guidelines can be considered to direct therapeutic strategies for this common condition.