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Bilateral Common Peroneal Nerve Entrapment After Excessive Weight Loss: Case Report and Review of the Literature.
Margulis, M, Ben Zvi, L, Bernfeld, B
The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons. 2018;(3):632-634
Abstract
We report a case of excessive weight loss causing bilateral common peroneal nerve entrapment in a 60-year-old patient. The bilateral peroneal involvement suggested a systemic cause. Excessive weight loss during a relatively short period can cause changes in the tissues surrounding the common peroneal nerve and lead to its entrapment in the peroneal tunnel. Our patient underwent successful surgical decompression with significant improvement.
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Chronic Pancreatitis: Diagnosis and Treatment.
Barry, K
American family physician. 2018;(6):385-393
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Abstract
Chronic pancreatitis is an irreversible and progressive disorder of the pancreas characterized by inflammation, fibrosis, and scarring. Exocrine and endocrine functions are lost, often leading to chronic pain. The etiology is multifactorial, although alcoholism is the most significant risk factor in adults. The average age at diagnosis is 35 to 55 years. If chronic pancreatitis is suspected, contrast-enhanced computed tomography is the best imaging modality for diagnosis. Computed tomography may be inconclusive in early stages of the disease, so other modalities such as magnetic resonance imaging, magnetic resonance cholangiopancreatography, or endoscopic ultrasonography with or without biopsy may be used. Recommended lifestyle modifications include cessation of alcohol and tobacco use and eating small, frequent, low-fat meals. Although narcotics and antidepressants provide the most pain relief, one-half of patients eventually require surgery. Therapeutic endoscopy is indicated to treat symptomatic strictures, stones, and pseudocysts. Decompressive surgical procedures, such as lateral pancreaticojejunostomy, are indicated for large duct disease (pancreatic ductal dilation of 7 mm or more). Resection procedures, such as the Whipple procedure, are indicated for small duct disease or pancreatic head enlargement. The risk of pancreatic cancer is increased in patients with chronic pancreatitis, especially hereditary pancreatitis. Although it is not known if screening improves outcomes, clinicians should counsel patients on this increased risk and evaluate patients with weight loss or jaundice for neoplasm.
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Update on Graves disease: advances in treatment of mild, moderate and severe thyroid eye disease.
Strianese, D
Current opinion in ophthalmology. 2017;(5):505-513
Abstract
PURPOSE OF REVIEW To report the most recent therapeutic advances of thyroid eye disease (TED) and offer general recommendations for management of TED. RECENT FINDINGS Treatment of Graves ophthalmopathy is traditionally based on the use of high doses of corticosteroids and/or radiotherapy (RT) to decrease the activity of the disease, with the subsequent proptosis, strabismus and eyelid deformites treated with different surgical procedures. In recent years, the evidence that oxidative stress plays a relevant role in exacerbating TED severity has encouraged the use of antioxydative agents such as selenium, which has shown a capacity in limiting the disease progression. In addition, reports have shown the effectiveness of biological immunosuppressive agents in the management of TED. The main advantage of these medications seems to be the long lasting effects, which may reduce recurrence, and effectiveness in steroid-resistant cases. The reported increased accuracy of imaging techniques in evaluating fat and muscle volumes may provide useful information for surgical management. SUMMARY The use of selenium, in mild TED, seems to limit disease progression without carrying the risk of relevant side-effects. Biological agents may provide an effective and long lasting block of the inflammatory activity of TED, with a possible lower risk of recurrence and reduction in the need for surgical intervention in moderate-to-severe disease. The accurate evaluation of fat and muscle volume, using a recently published algorithm for imaging, gives relevant information for preoperative assessment, allowing the customization of orbital decompression.
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4.
[Graves' ophthalmopathy].
Eckstein, A, Dekowski, D, Führer-Sakel, D, Berchner-Pfannschmidt, U, Esser, J
Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft. 2016;(4):349-64; quiz 465-6
Abstract
Graves' orbitopathy (GO) is the main extrathyroidal manifestation of Graves' disease and the full clinical picture can impair the quality of life of the patients considerably. Active inflammation can often be effectively treated by intravenous steroids/immunosuppression, however does not lead to full remission, since inflammation rather quickly results in irreversible fibrosis and increase of orbital fat. Very important is the control of risk factors (smoking cessation, good control of thyroid function, selenium supplementation) to prevent progression to severe stages. Treatment should rely on a thorough assessment of activity and severity of GO. Rehabilitative surgery (orbital decompression, squint surgery, eyelid surgery) is needed in many patients to restore function and appearance. Anti-thyroid-stimulating hormone (TSH) receptor antibodies do specifically occur in these patients and correlate to the course of thyroid and eye disease. The levels of these antibodies can be used for treatment decisions at certain time points of the disease.
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Is nasogastric or nasojejunal decompression necessary following gastrectomy for gastric cancer? A systematic review and meta-analysis of randomised controlled trials.
Wang, D, Li, T, Yu, J, Hu, Y, Liu, H, Li, G
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 2015;(1):195-204
Abstract
Whether nasogastric or nasojejunal decompression (ND) prevents anastomotic leakage, hastens the return of bowel function, and shortens hospital stay after gastrectomy for gastric cancer has long been controversial. We evaluated the necessity of routine ND after radical gastrectomy for gastric cancer with a systematic review and meta-analysis. We searched literature published prior to January 2014 in PubMed, Embase, Cochrane Library, Web of Science, and BIOSIS Previews for relevant randomized controlled trials (RCTs). Only prospective RCTs comparing individuals with and without ND after gastrectomy for gastric cancer were included. Outcome measures included time to first flatus, time to starting oral diet, anastomotic leakage, pulmonary complications, wound dehiscence, length of hospital stay, morbidity, and mortality. Cochrane Collaboration RevMan 5.2 software was used for the meta-analysis. Eight RCT studies fulfilled our inclusion criteria. Of the 1,141 patients in those RCTs, 570 received nasogastric or nasojejunal decompression and 571 did not. Anastomotic leakage, pulmonary complications, wound dehiscence, morbidity, and mortality were comparable between the groups. Stratified by the type of gastrectomy or gastrojejunostomy, no significant differences in above mentioned outcomes were observed in subgroup analyses. The no ND group displayed a significantly shorter time to oral diet (weighted mean difference [WMD] = 0.45, 95% confidence interval [CI] = 0.29 to 0.61, p < 0.001) and a marginally shorter end of hospital stay (WMD = 0.48, 95% CI = -0.01 to 0.98, p = 0.05). The ND group significantly shortened time to first flatus (WMD = -0.7, 95% CI = -1.13 to -0.27, p = 0.001), especially with Roux-en-Y reconstruction (WMD = -1.0, 95 % CI = -1.52 to -0.48, p = 0.0002) and prolonged time to starting oral diet (WMD = 0.52, 95% CI = 0.13 to 0.90, p = 0.009) in the patients with subtotal gastrectomy. Routine ND appears to be unnecessary after gastrectomy for gastric cancer, irrespective of the extent of resection, and the type of digestive reconstruction.
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[Spinal epidural lipomatosis].
Artner, J, Leucht, F, Cakir, B, Reichel, H, Lattig, F
Der Orthopade. 2012;(11):889-93
Abstract
Spinal epidural lipomatosis (SEL) is a rare condition affecting the thoracic and lumbar spine, characterized by a hypertrophy and hyperplasia of the rich vascularized fat tissue inside the spinal canal. The etiology of SEL is unknown. A high number of cases are associated with obesity, corticosteroid intake and a dysbalance in adrenocorticotropic hormone (ACTH)-cortisone metabolism. It can be an incidental radiographic finding or present with symptoms, such as low back pain, weakness of the lower limbs, dysesthesia, radiculopathy, claudication or even cauda equina syndrome. The interdisciplinary treatment consists of weight reduction, weaning from corticosteroids and in persisting cases or neurologic alterations in surgical decompression of the spinal canal. The following article presents a current review and a case report of this rare entity.
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Update on open abdomen management: achievements and challenges.
Ivatury, RR
World journal of surgery. 2009;(6):1150-3
Abstract
The open abdomen technique is one of the greatest advances in recent times and has enormous application in the daily management of the critically ill or injured patient. It results in tremendous benefits to the initial resuscitation of these patients but also brings on many challenges beyond those that might be expected from the primary illness or injury. Recent advances in the management of the open abdomen have provided the means to overcome the challenges and reap the benefits.
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8.
[Updates on ossification of posterior longitudinal ligament. Clinical results and problems of posterior decompression for OPLL of the cervical spine].
Ogawa, Y
Clinical calcium. 2009;(10):1493-8
Abstract
Clinical results of expansive laminoplasty (ELAP) for ossification of the posterior longitudinal ligament (OPLL) of the cervical spine are satisfactory and are preserved for long period. ELAP is also thought to be easier and safer procedure than anterior fusion for OPLL of the cervical spine. However, appropriate decompression can not be achieved by ELAP without sufficient dorsal shift of the spinal cord, because pathological lesion exists ventral to the spinal cord in patients with OPLL. Kyphotic alignment, high OPLL occupying ratio, hill-shaped ossification are considered to be risk factors contributing to inappropriate decompression. To acquire satisfactory operative results, careful consideration for the indication of ELAP should be necessary for each patient.
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[Updates of ossification of posterior longitudinal ligament. Clinical results and complication of surgery for thoracic myelopathy due to ossification of posterior longitudinal ligament].
Yamazaki, M
Clinical calcium. 2009;(10):1499-504
Abstract
We performed 3 types of surgical procedures for thoracic myelopathy due to OPLL posterior decompression, OPLL-extirpation, and posterior decompression with instrumented fusion (PDF) . A considerable degree of neurological recovery was obtained in all patients who underwent PDF, despite the anterior impingement of the spinal cord by OPLL remaining. In addition, the rate of post-operative complications was extremely low with PDF, when compared with posterior decompression and OPLL-extirpation groups. We recommend that one stage posterior decompression with instrumented fusion be selected for cases in whom the spinal cord is severely damaged pre-operatively.
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10.
Meta-analysis of the need for nasogastric or nasojejunal decompression after gastrectomy for gastric cancer.
Yang, Z, Zheng, Q, Wang, Z
The British journal of surgery. 2008;(7):809-16
Abstract
BACKGROUND Nasogastric or nasojejunal decompression has been used routinely to prevent anastomotic leakage, hasten the return of bowel function and shorten hospital stay after gastrectomy for gastric cancer. This meta-analysis evaluates the necessity for such routine decompression. METHODS Medline, Embase and The Cochrane Library were searched. Only prospective randomized controlled trials (RCTs) that compared individuals with and without nasogastric or nasojejunal decompression after gastrectomy for gastric cancer were included. Outcomes evaluated were time to flatus, time to starting oral diet, anastomotic leakage, pulmonary complications, length of hospital stay, and morbidity and mortality. RESULTS Of 717 patients in five RCTs, 361 were allocated to nasogastric or nasojejunal decompression and 356 to no decompression. Time to oral diet was significantly shorter in the latter group (weighted mean difference 0.43 (95 per cent confidence interval 0.23 to 0.62) days; P < 0.001). Time to flatus, anastomotic leakage, pulmonary complications, length of hospital stay, morbidity and mortality were similar in both groups. CONCLUSION Routine nasogastric or nasojejunal decompression is unnecessary after gastrectomy for gastric cancer.