scholarly journals Martorell’s ulcer: a literature review and own clinical observation

2021 ◽  
Vol 18 (1) ◽  
pp. 55-70
Author(s):  
B. V. Boldin ◽  
P. Yu. Golosnitskiy ◽  
V. Yu. Bogachev ◽  
S. V. Rodionov ◽  
I. M. Dizengof
Keyword(s):  
Clinical Observation ◽  
Treatment Options ◽  
Local Treatment ◽  
Local Therapy ◽  
Pain Syndrome ◽  
Definitive Treatment ◽  
Outpatient Basis ◽  
Narcotic Analgesics ◽  
Wide Range ◽  
The Right

Introduction. Martorell’s ulcer is a rather rare pathology that occurs exclusively in patients with long-term and poorly controlled arterial hypertension and continues to be one of the poorly studied areas of modern surgery. There are few reports on the occurrence of this pathology in the medical literature and, as a rule, describe extremely rare clinical cases. The issues of etiology, pathogenesis and differential diagnosis of this disease continue to cause debate. The article provides a review of the literature on this rare surgical pathology, presents its own clinical observation, discusses the issues of diagnosis and treatment options for this disease.Clinical case. A 56-year-old patient was admitted with complaints of a non-healing trophic ulcer on the lateral surface in the lower third of the right leg since one year ago with severe pain syndrome not adequately controlled with non-narcotic analgesics. he received treatment in an outpatient department and in the hospital, underwent courses of rheological therapy to the ulcer region as a local therapy, used a wide range of dressings of domestic and foreign origin. No positive effect was reported on the top of already administered combination therapy, the ulcer continued to increase in size. A Martorell’s ulcer was diagnosed, and a decision was made to provide a course of presurgical conservative rheological therapy with PGE1 (VAP 20 mg), antibiotic therapy, and local therapy aimed at maximal ulcer necrotic tissue clearance before the forthcoming planned surgical treatment. The patient underwent the surgery – autodermatoplasty of the trophic ulcer of the right leg with a mesh graft, continued local treatment of the ulcer using dressings with peruvian balsam and other medications on an outpatient basis without chemical and biological components from the antiseptics and healing stimulants group. Two months after the surgery, the patient had no complaints, the pain syndrome in the ulcer region completely regressed, no edema occurred in the lower operated leg, the right let ulcer completely healed with the formation of a permanent scar.Conclusion. Surgical management is the final and definitive treatment for Martorell’s chronic hypertensive ulcer and should be carried out promptly to minimize the spread of the ulcer and minimize a pain syndrome.

scholarly journals Giant Fibroepithelial Polyp of Vulva: A Case Report and Review of Literature

PRILOZI ◽  
2018 ◽  
Vol 39 (2-3) ◽  
pp. 127-130 ◽  
Author(s):  
Meral Rexhepi ◽  
Elizabeta Trajkovska ◽  
Florin Besimi ◽  
Nagip Rufati
Keyword(s):  
Histopathological Examination ◽  
Treatment Options ◽  
Polypoid Lesion ◽  
Malignant Neoplasm ◽  
Reproductive Period ◽  
Lower Genital Tract ◽  
Wide Range ◽  
Fibroepithelial Polyps ◽  
The Right ◽  
Rule Out

Abstract Fibroepithelial stromal polyps of vulva are the type of mesenchymal lesion that typically occurs in women of reproductive period. They are common, usually small and hystologically benign. Larger lesions are rare and likely arise from proliferation of mesenchymal cells within the hormonally sensitive subepithelial stromal layer of the lower genital tract. We present a case of 16 year old female with a giant polypoid lesion of the vulva localized on the right labium. The mass measure was 18×12×3 cm. Total surgical resection of the lesion was performed. Histopathological examination reported a fibroepithelial stromal polyp of the vulva. The patient showed no evidence of recurrence four years after the resection. Fibroepithelial polyps of the vulvar region are benign lesions that have a wide range of morphologic appearances and may be misinterpreted as malignant. Total excision is the best treatment options and histopathological examination is strongly recommended to rule out a malignant neoplasm.

scholarly journals Intraocular therapy in noninfectious uveitis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Rocco Luigi Modugno ◽  
Ilaria Testi ◽  
Carlos Pavesio
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Growth Factor ◽  
Treatment Options ◽  
Local Treatment ◽  
Local Therapy ◽  
Systemic Administration ◽  
Vascular Endothelial ◽  
Systemic Corticosteroids ◽  
Infectious Uveitis ◽  
Endothelial Growth Factor

AbstractSystemic corticosteroids and immunosuppressant agents are the mainstay of therapy for non-infectious uveitis (NIU). However, the risks associated with systemic administration and the need of delivering an effective and safe anti-inflammatory treatment targeted to the site of inflammation have prompt the use of local therapy in the management of NIU. This review will analyse the different local treatment options available, including corticosteroids, anti-vascular endothelial growth factor (VEGF), methotrexate and the recent biologics.

scholarly journals Comparative evaluation of 5% lignocaine ointment and a combination of 0.2% glyceryl trinitrate and 5% lignocaine in management of acute fissure in ano.

2017 ◽  
Vol 4 (9) ◽  
pp. 3113
Author(s):  
Vundavalli Sattibabu ◽  
Satish Dalal ◽  
Mahavir Singh ◽  
Chisel Bhatia
Keyword(s):  
Side Effects ◽  
Glyceryl Trinitrate ◽  
Anal Fissure ◽  
Treatment Options ◽  
Common Symptom ◽  
Outpatient Basis ◽  
Fissure In Ano ◽  
Aged Patients ◽  
Group I ◽  
Wide Range

Background: Anal fissure is one of the most common anorectal problem and presents as a tear in the anoderm distal to the dentate line. It is a common proctologic problem and accounts for 10-15% of proctological consultations and seen frequently in young and middle-aged patients. Presently wide range of medical and surgical treatment options were available. Present study was aimed to evaluate the therapeutic efficacy of 5% lignocaine ointment and a combination of 0.2% glyceryl trinitrate and 5% lignocaine in management of acute fissure in ano.Methods: In the present study, a total of 100 patients diagnosed with acute fissure in ano were randomly allocated into two groups (I, II) of 50 patients each and were managed by local application of 5% Lignocaine (LIG) ointment and a combination of both 0.2% Glyceryl trinitrate (NTG) and 5% Lignocaine (LIG) ointment respectively.Results: In the present study, the incidence of anal fissure was higher in males than in females with mean age of occurrence of 35.12 years. Pain was the most common symptom to present with. After six weeks, complete pain relief was seen in most of the patients and was comparable in both the groups but healing was superior in group II when compared to group I. Headache and dizziness were the side effects only noticed in group II.Conclusions: To conclude the study, we can say that the treatment of anal fissure is becoming increasingly medical as it can be carried out on outpatient basis and is cost effective and there is no loss of man hours. Lignocaine may be preferred as the first line treatment as there are no side effects and if there is failure to heal then we can prescribe the combination of both drugs owing to their risk benefit ratio.

Utilization and survival outcomes between definitive versus conservative treatments among elderly men with high-risk prostate cancer.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 204-204
Author(s):  
Sagar Anil Patel ◽  
Hiram Alberto Gay ◽  
Jeff M. Michalski ◽  
Brian Christopher Baumann ◽  
Randall Brenneman ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Treatment Modality ◽  
Local Treatment ◽  
Local Therapy ◽  
The United States ◽  
Definitive Treatment ◽  
Survival Outcomes ◽  
Elderly Men ◽  
Primary Treatment Modality

204 Background: Prostate cancer (PCa) is the second leading cause of cancer death in men > 80 years old. However, studies have shown that older men are less likely to undergo curative treatment for localized PCa, possibly due to competing comorbidities or inability to accurately estimate life expectancy. Herein, we investigate utilization trends and survival outcomes amongst guideline-supported treatment options in elderly men with high-risk PCa in the United States. Methods: Men ≥ 80 years diagnosed with high-risk PCa (cT3-4 or Gleason 8-10 or PSA > 20) between 2004-2016 were analyzed from the National Cancer Database. Those missing risk-stratification or treatment data were excluded. Eligible patients were grouped based on their primary treatment modality: no treatment (observation), androgen deprivation therapy (ADT) alone, radiation therapy (RT) alone, RT + ADT, or radical prostatectomy (RP). Cochran-Armitage was used to evaluate treatment trends over time, and multivariable logistic regression was used to identify sociodemographic predictors of treatment. Overall survival (OS) between treatments was evaluated using Kaplan-Meier, log-rank, and multivariable Cox proportional hazards. Results: With a median follow up of 42 months, 19,920 men were eligible for analysis. The most utilized treatment modality was RT+ADT (37.2%), followed by ADT alone (29.4%), observation (23.9%), RT alone (7.8%), and RP (1.7%). There was a significant increase in use of RT+ADT and RT alone (p < 0.001) and decrease in use of ADT alone and observation ( p< 0.001); no change was seen in RP use. There was no OS difference between observation versus ADT alone (aHR 1.04, 95% CI 0.99-1.09, p = 0.11). Definitive local treatment was associated with improved OS compared to ADT alone (RT+ADT: aHR 0.48, 95% CI 0.46-0.50, p < 0.0001; RT alone: aHR 0.54, 95% CI 0.50-0.59, p < 0.0001; RP: aHR 0.50, 95% CI 0.42-0.59, p < 0.0001). Black men and uninsured status were independently associated with lower likelihood of undergoing definitive treatment (i.e. RT+ADT, RT, or RP). Conclusions: For men ≥ 80 years old with high-risk PCa in this large US registry, definitive local therapy using RT +/- ADT or RP was associated with a 50% reduction in overall mortality compared to observation or ADT alone. Less than half of men in this time period underwent a definitive treatment, and Black and uninsured men remained at particularly high risk of undertreatment.

Management of a patient with viral conjunctivitis on an outpatient basis: a case of acute viral conjunctivitis in a patient with hay fever

2021 ◽  
Author(s):  
А.В. Захарова
Keyword(s):  
High Efficiency ◽  
Age Groups ◽  
Anterior Segment ◽  
Clinical Manifestations ◽  
Local Therapy ◽  
Eye Diseases ◽  
Outpatient Basis ◽  
Differential Analysis ◽  
Bacterial Conjunctivitis ◽  
Wide Range

На долю конъюнктивита приходится 33% всех случаев заболеваний глаз. Конъюнктивит, или воспаление конъюнктивы, относится к ее наиболее частым заболеваниям. Независимо от этиологии клинические проявления примерно одинаковые. На прием в поликлинику приходят пациенты с жалобами на светобоязнь, ощущение инородного тела, покраснение склер, зуд, боль, слезотечение, отек век. Первой целью офтальмолога является дифференциация между вирусным и бактериальным конъюнктивитом. Вторым этапом необходимо провести детальный дифференциальный анализ между нозологиями. Для решения этих задач врачу необходимо провести детальный сбор жалоб и анамнеза, а также биомикроскопию переднего отрезка глаза. Вирусные заболевания глаз представляют собой серьезную медико-социальную проблему. Вирусы – одна из наиболее частых причин инфекционного поражения наружных структур глаза с широким спектром возможных проявлений – от легкого преходящего конъюнктивита до более серьезных состояний, при которых поражение конъюнктивы и роговицы может приводить к рубцеванию, что в некоторых случаях ведет к слепоте. Такие возбудители, как аденовирус, пикорнавирус, вирусы простого герпеса и герпеса зостер, могут вызывать изолированный конъюнктивит, однако нередко они поражают также роговицу и веки. В последние годы отмечается рост распространенности аденовирусных конъюнктивитов. Заболевание отличается высокой частотой встречаемости и поражает все возрастные группы. Рост заболеваемости приходится на осенне-весенний период, когда вирусная контагиозность повышена. В клинической практике для местной терапии таких заболеваний, как вирусные (аденовирусные и герпетические) конъюнктивиты, кератиты, кератоконъюнктивиты, увеиты, с высокой эффективностью используются препараты интерферона. Conjunctivitis accounts for 33% of all eye diseases. Conjunctivitis, or inflammation of the conjunctiva, is one of its most common diseases. Regardless of the etiology, the clinical manifestations are approximately the same. Patients come to the clinics with complaints of photophobia, a feeling of a foreign body, red eye, itching, pain, lacrimation, hyperemia and swelling of the eyelids. The first goal of an ophthalmologist is to differentiate between viral and bacterial conjunctivitis. The second stage is to conduct a detailed differential analysis between nosologies. To solve these problems, the doctor needs to conduct a detailed collection of complaints and anamnesis, conducting a detailed biomicroscopy of the anterior segment of the eye. Viral eye diseases are a serious medical and social problem. Viruses are one of the most common causes of infection of the outer structures of the eye with a wide range of possible manifestations - from mild transient conjunctivitis to more serious conditions in which damage to the conjunctiva and cornea can lead to scarring, which in some cases leads to blindness. Pathogens such as adenovirus, picornavirus, herpes simplex virus and herpes zoster can cause isolated conjunctivitis, but they often also affect the cornea and eyelids. In recent years, there has been an increase in the prevalence of adenoviral conjunctivitis. The disease has a high frequency of occurrence and affects all age groups The increase in morbidity occurs in the autumn-spring period, when viral contagiousness is increased. In clinical practice, for local therapy of diseases such as viral (adenoviral and herpetic) conjunctivitis, keratitis, keratoconjunctivitis, uveitis, interferon preparations are used with high efficiency.

Complex regional pain syndrome: An updated comprehensive review

2020 ◽  
Vol 47 (3) ◽  
pp. 253-264
Author(s):  
Allison Kessler ◽  
Min Yoo ◽  
Randy Calisoff
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Treatment Options ◽  
Interdisciplinary Approach ◽  
Clinical Information ◽  
Pain Syndrome ◽  
Definitive Treatment ◽  
Confirmatory Test ◽  
Exact Etiology ◽  
Behavioral Therapies ◽  
Budapest Criteria

Complex regional pain syndrome (CRPS) is a complex disorder that can have a significant impact on the quality of life of a person with this syndrome. The diagnosis and treatment of CRPS are often difficult as there is no one confirmatory test and no one definitive treatment. Currently, the most widely accepted clinical diagnostic criteria are the Budapest criteria, which were developed by expert consensus. Though no one single treatment has been found to be universally effective, early detection and an interdisciplinary approach to treatment appear to be key in treating CRPS. This review aims to present up-to-date clinical information regarding the diagnosis and management of CRPS and highlight the potential issues with diagnosis in the neurological population. Ultimately, more research is needed to identify the exact etiology of CRPS in order to help target appropriate therapies. In addition, more randomized controlled trials need to be performed in order to test new therapies or combinations of therapies, including pharmacological, interventional, and behavioral therapies, to determine the best treatment options for this potentially debilitating disorder.

FEATURES OF THERAPY FOR ACUTE POISONING WITH JELLYFISH POISON (CLINICAL OBSERVATION)

2020 ◽  
pp. 38-42
Author(s):  
V. V. Shilov ◽  
V. A. Lukin ◽  
L. P. Pivovarova ◽  
M. I. Gromov
Keyword(s):  
Clinical Observation ◽  
Health And Safety ◽  
Pain Syndrome ◽  
Antiplatelet Agents ◽  
Acute Poisoning ◽  
Marine Fauna ◽  
Soft Tissue Necrosis ◽  
Therapeutic Measures ◽  
The Right ◽  
Therapeutic Doses

Jellyfish, as representatives of marine fauna, contain toxic chemicals in their bodies and, if they come into contact with humans, can pose a threat to their health and safety. The article describes a clinical observation of a patient who received a chemical injury as a result of contact of the right upper limb with a venomous jellyfish (Medusa kornerot) and was hospitalized for 35 days with acute poisoning with animal toxin, chemical burns, toxic-allergic dermatitis, epidermolysis, soft tissue necrosis and compression-ischemic neuropathy. Laboratory results confirmed the presence of an inflammatory process, but without allergic and autoimmune components (leukocytosis 16,7 x 109/l, acceleration of ESR to 21 mm/h), revealed an increase in the level of transaminases upon admission: alanine aminotransferase 138.3 u/l (norm 0-31 u/l), aspartate aminotransferase 94,8 u/l (norm 0-31 u/l), gamma-glutamyltransferase 97 u/l (norm 0-32 units/l). Previous drug therapy, including the introduction of tetanus serum (once), antihistamines (chloropyramine), hormonal (prednisone), anticoagulants (heparin sodium), antispasmodics (Metamizole sodium, pitofenone hydrochloride, fenpiverinium bromide), antiplatelet agents (pentoxifylline, nicotinic acid), calcium gluconate, multivitamins in therapeutic doses, the application of bandages «gelonet», «fibrotul Argentum», was not effective enough. Complex therapy with cellular metabolism regulators, antihypoxants, cholinesterase inhibitors using hyperbaric oxygenation and membrane plasmapheresis allowed to achieve a lasting effect: to stop the pain syndrome, normalize the disturbed functions of internal organs and the affected limb, avoid surgery, and fully restore working capacity. This complex of therapeutic measures should be used in the treatment of patients with this pathology

scholarly journals A Series of Patients with Kaposi Sarcoma (Mediterranean/Classical Type): Case Presentations and Short Update on Pathogenesis and Treatment

2018 ◽  
Vol 6 (9) ◽  
pp. 1688-1693
Author(s):  
Ivanka Temelkova ◽  
Michael Tronnier ◽  
Ivan Terziev ◽  
Uwe Wollina ◽  
Ilia Lozev ◽  
...  
Keyword(s):  
Kaposi's Sarcoma ◽  
Histopathological Examination ◽  
Treatment Options ◽  
Correct Diagnosis ◽  
Local Treatment ◽  
Kaposi Sarcoma ◽  
Kaposi’S Sarcoma ◽  
Classical Type ◽  
Wide Range ◽  
Two Samples

BACKGROUND: Kaposi’s sarcoma was first described in 1872 by Moritz Kaposi. To date, it is considered a malignant disease is originating from the endothelial cells of the lymphatic vessels believed to be infected with HHV-8. The current classification defines four major epidemiological forms of Kaposi’s sarcoma: classical, endemic, AIDS-associated, and iatrogenic. CASE REPORT: A 90-year-old male is presented with multiple plaques- and tumour-shaped brown-violet formations located on an erythematous-livid base in the area of both feet and both shanks. Two samples were taken from the lesions on the skin of the shanks, with histopathological examination and the subsequent immunohistochemistry showing Kaposi’s sarcoma. CONCLUSIONS: Kaposi sarcoma is a disease that causes difficulties both in diagnostic and therapeutic respect. The only sure way to determine the correct diagnosis is immunohistochemical staining with the anti-HHV8 antibody. Despite the wide range of systematic and local treatment options, there is still no unified algorithm and a unified strategy for the treatment of Kaposi’s sarcoma.

scholarly journals Dysphagia Aortica: A Case Report and Review of Treatment Options

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Komeil Mirzaei Baboli ◽  
Sumeet K. Mittal ◽  
◽  
Keyword(s):  
Treatment Options ◽  
Definitive Treatment ◽  
Barium Swallow ◽  
Upper Gastrointestinal Endoscopy ◽  
Feeding Jejunostomy ◽  
High Resolution Manometry ◽  
History Of ◽  
Chest X Ray ◽  
The Right ◽  
Calcified Aorta

A 64-year-old, cachectic man with body mass index (BMI) <19 visited in clinic with the chief complaint of dysphagia for 6 months. He reported a 2-year history of reflux and heartburn, for which he has been taking pantoprazole but reported only 40% relief of reflux symptoms. He reported progressive solid food mid-chest dysphagia. Additional comorbidities included severe pulmonary bronchiectasis and bullous emphysema and a history of treated pulmonary tuberculosis 40 years prior and two previous episodes of spontaneous pneumothorax in the right-sided lung treated with a chest tube. A chest X-ray showed a calcified aorta crossing the midline (Figure 1). A CT scan done for assessment of pneumothorax showed a torturous descending thoracic aorta and a dilated mid-/proximal esophagus. The diameter of the descending aorta was 41 mm, and it crossed the midline. For evaluation of dysphagia, a barium swallow was performed, which showed a narrowing in the mid-esophagus with proximal dilation and lack of peristalsis (Figure 2). Upper gastrointestinal endoscopy showed a dilated esophagus with eccentric extraluminal compression. High-resolution manometry (HRM) showed an absence of peristalsis and a vascular pressure artifact around the mid-esophagus correlating with the external aortic compression (Figure 3). Due to alarming weight loss and a BMI <19, we recommended a feeding jejunostomy to maintain nutrition before scheduling definitive treatment.

Evaluation of 99mTc-Label led Vitamin K4 as an Agent for Testicular Imaging

1991 ◽  
Vol 30 (01) ◽  
pp. 35-39 ◽  
Author(s):  
H. S. Durak ◽  
M. Kitapgi ◽  
B. E. Caner ◽  
R. Senekowitsch ◽  
M. T. Ercan
Keyword(s):  
Soft Tissue ◽  
Room Temperature ◽  
Normal Subjects ◽  
Left Testis ◽  
Wide Range ◽  
Activity Ratios ◽  
The Right ◽  
Radioactivity Levels

Vitamin K4 was labelled with 99mTc with an efficiency higher than 97%. The compound was stable up to 24 h at room temperature, and its biodistribution in NMRI mice indicated its in vivo stability. Blood radioactivity levels were high over a wide range. 10% of the injected activity remained in blood after 24 h. Excretion was mostly via kidneys. Only the liver and kidneys concentrated appreciable amounts of radioactivity. Testis/soft tissue ratios were 1.4 and 1.57 at 6 and 24 h, respectively. Testis/blood ratios were lower than 1. In vitro studies with mouse blood indicated that 33.9 ±9.6% of the radioactivity was associated with RBCs; it was washed out almost completely with saline. Protein binding was 28.7 ±6.3% as determined by TCA precipitation. Blood clearance of 99mTc-l<4 in normal subjects showed a slow decrease of radioactivity, reaching a plateau after 16 h at 20% of the injected activity. In scintigraphic images in men the testes could be well visualized. The right/left testis ratio was 1.08 ±0.13. Testis/soft tissue and testis/blood activity ratios were highest at 3 h. These ratios were higher than those obtained with pertechnetate at 20 min post injection.99mTc-l<4 appears to be a promising radiopharmaceutical for the scintigraphic visualization of testes.

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