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.
We conducted our network meta-analysis to compare the efficacy of the steroid injections to other injectable therapies in partial-thickness rotator cuff tears (PTRCTs).
A systematic literature search ...was performed until October 25, 2021 in three databases (CENTRAL, Embase, MEDLINE). Eligible studies compared the efficacy of steroid, hyaluronic acid (HA), platelet-rich plasma (PRP), the combination of HA and PRP (HA+PRP), and adipose-derived regenerative cells (ADRC) in RC tears. The primary outcomes were the Visual Analogue Scale (VAS), Constant Murley Score (CMS), and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form. Using paired and network meta-analysis, we calculated pooled mean differences (MDs) with 95% confidence intervals (CIs).
We included a total of seven articles in the quantitative synthesis. In shorter periods, the HA+PRP combination was superior to the other substances we investigated (HA+PRP: VAS (0-4 weeks): MD: −0.99 CI = −1.62, −0.36; CMS (0-3 months): 20.56 CI = 16.18, 24.94. This combination was followed by the use of HA or PRP alone, depending on the duration of follow-up and the outcome being studied. In our study, short-term results suggest that saline is superior to steroids for partial tears, but this trend is reversed at six-month follow-up.
Our results suggest the combination of HA and PRP to be a more effective therapeutic option for partial RC ruptures for short terms, but there is no significant difference after 6 months.
II, Included of Level of Evidence studies I-II
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.
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