-
Alimentary Pharmacology & Therapeutics Jun 2020Medical therapy and/or endoscopic balloon dilation with intralesional therapies are options for the treatment of small bowel fibrostenotic Crohn's disease (CD).
BACKGROUND
Medical therapy and/or endoscopic balloon dilation with intralesional therapies are options for the treatment of small bowel fibrostenotic Crohn's disease (CD).
AIM
To perform a systematic review summarising evidence for efficacy of systemic and endoscopic intralesional medical therapy in established small bowel strictures in adult CD patients.
METHODS
A systematic search of MEDLINE, EMBASE, CENTRAL and Scopus was conducted. Primary outcomes were rates of surgical resection and repeat endoscopic dilation. Pooled event rates from random effects models across studies with 95% confidence intervals were reported.
RESULTS
Ten studies describing systemic medical therapy and eight studies of intralesional injection were included. One randomised controlled trial each for systemic therapy and intrastricture injection were identified. Only observational studies were found for systemic biologic therapies, which exclusively included tumour necrosis factor (TNF) antagonists, while intralesional therapies all involved corticosteroids except for one study that evaluated infliximab. Pooled event rates for surgical resection after systemic and intralesional therapy were 28.3% (95% CI: 18.2%-41.3%) and 18.5% (95% CI: 8.3%-36.2%), respectively over a median follow-up of 23 months (range 5.5-105.8), and 21.8 months (range 5-47). Risk of repeat endoscopic balloon dilation in those with intralesional therapy was 58.3% (95% CI: 36.6%-77.3%) over a median follow-up of 21.8 months (range 5-47).
CONCLUSIONS
There are no favoured therapies for patients with stricturing small bowel CD. Data are lacking for ustekinumab and vedolizumab. No endoscopic intralesional medications provided a clear benefit for prevention of repeat EBD or surgery.
Topics: Adrenal Cortex Hormones; Combined Modality Therapy; Constriction, Pathologic; Crohn Disease; Dilatation; Endoscopy, Gastrointestinal; Fibrosis; Humans; Infusions, Intralesional; Intestinal Obstruction; Tumor Necrosis Factor-alpha
PubMed: 32406116
DOI: 10.1111/apt.15750 -
The Journal of Craniofacial Surgery Jun 2021Pneumosinus dilatans (PD) is a rare condition in which one or more paranasal sinuses are pathologically hyperaerated. Patients commonly present with an aesthetic...
BACKGROUND
Pneumosinus dilatans (PD) is a rare condition in which one or more paranasal sinuses are pathologically hyperaerated. Patients commonly present with an aesthetic complaint, however it has been associated with several serious conditions. The etiology is largely theoretical and the management remains unstandardized, potentially leading to missed diagnoses. This article aims to establish a presumptive classification scheme and management algorithm based on a comprehensive review of the literature.
MATERIALS AND METHODS
A systematic review of all available publications on the search term "Pneumosinus dilatans" was conducted in PubMed. Associated conditions were identified and clustered based on the number and anatomic location of the sinuses involved. The resultant data was used to formulate an evidence-based algorithm for the evaluation and management of PD patients.
RESULTS
A total of 145 patients from 103 articles were included. The majority of patients were male (57.2%) with an average age of 32.6 years-old at onset. The frontal sinus was most commonly involved (62.8%) and one pathologic sinus was most common (84.6%). 51% of patients presented with an associated condition; with it least common in frontal sinus PD (29.7% cases) and most common in ethmoid sinus PD (81.5%). To date, no articles to date have proposed a management algorithm for PD based on the number or location of sinus involved.
CONCLUSIONS
A standardized evidence-based management algorithm and classification scheme for patients with PD will not only lead to the highest-quality treatment, but will also be instrumental in elucidating an etiology for this rare, and potentially serious, condition.
Topics: Adult; Algorithms; Dilatation, Pathologic; Esthetics, Dental; Female; Frontal Sinus; Humans; Male; Paranasal Sinus Diseases
PubMed: 33427782
DOI: 10.1097/SCS.0000000000007432 -
European Journal of Cancer (Oxford,... Sep 2015Cervical stenosis is a major and specific postoperative complication following radical trachelectomy. The current article presents a review of studies describing the... (Review)
Review
PURPOSE
Cervical stenosis is a major and specific postoperative complication following radical trachelectomy. The current article presents a review of studies describing the incidence, risk factors and treatment methods of cervical stenosis after this fertility sparing procedure.
METHODS
We searched PubMed, MEDLINE, Embase (January 1994 through November 2014) using the following terms: uterine cervix neoplasms, cervical cancer, radical trachelectomy, fertility sparing and fertility preservation. We included original articles and case series. Case reports, review articles, articles not in English and articles not mentioning cervical stenosis were all excluded.
RESULTS
We identified 1547 patients. The incidence rates of cervical stenosis ranged from 0% to 73.3% with an average rate of 10.5%. Among patients with abdominal, vaginal, laparoscopic and robotic radical trachelectomy, the incidences of cervical stenosis were 11.0%, 8.1%, 9.3% and 0%, respectively. In patients in whom whether cerclage was placed or not, the incidence rates of cervical stenosis were 8.6% and 3.0%, respectively (P=NS). Among those in whom whether anti-stenosis tools were placed or not, the incidences of cervical stenosis were 4.6% and 12.7%, respectively (P<0.001). Cervical stenosis was a potential cause of infertility and increased the use of artificial reproductive technology. Surgical dilatation resolved stenosis in the majority of cases but had to be repeated.
CONCLUSIONS
Cervical stenosis is related to the surgical approach, cerclage and anti-stenosis tools utilised. It affects not only the quality of life but also obstetrical outcomes of patients following radical trachelectomy. Greater attention should be given to the prevention and treatment of this complication.
Topics: Constriction, Pathologic; Female; Fertility Preservation; Gynecologic Surgical Procedures; Humans; Incidence; Laparoscopy; Risk Assessment; Risk Factors; Robotic Surgical Procedures; Treatment Outcome; Uterine Cervical Diseases; Uterine Cervical Neoplasms
PubMed: 26049687
DOI: 10.1016/j.ejca.2015.05.012 -
Annals of Vascular Surgery Nov 2022For arteriovenous fistula (AVF) presence of a venous segment with adequate diameter is essential which is lacking in many patients. To find the optimal augmentation... (Meta-Analysis)
Meta-Analysis Review
Primary Balloon Angioplasty Versus Hydrostatic Dilation for Arteriovenous Fistula Creation in Patients with Small-Caliber Cephalic Veins: A Systematic Review and Meta-Analysis.
BACKGROUND
For arteriovenous fistula (AVF) presence of a venous segment with adequate diameter is essential which is lacking in many patients. To find the optimal augmentation technique in patients with small-caliber cephalic vein (i.e., cephalic vein diameter <3 mm), studies compared primary balloon angioplasty (PBA) versus hydrostatic dilation (HD); however, it remained debatable. This systematic review seeks to determine which technique is preferable.
METHODS
We searched MEDLINE, PubMed, Embase, and Google Scholar. Primary outcomes were 6-month primary patency, reintervention, and working AVF. Secondary outcomes were immediate success, the AVF's maturation time (day), and surgical site infection.
RESULTS
Three randomized controlled trials yielding 180 patients were included, of which 89 patients were in the PBA group. The odds ratio (OR) of primary patency was significantly higher in the PBA group (OR 6.09, 95% confidence interval [CI], 2.36-15.76, P = 0.0002), the OR of reintervention was significantly lower in the PBA group (OR 0.16, 95% CI, 0.06-0.42, P = 0.0002), and the OR of working AVF was greater in PBA group (OR 4.22, 95% CI, 1.31-13.59, P = 0.02). The OR of immediate success was significantly greater in the PBA group (OR 11.42, 95% CI, 2.54-51.42, P = 0.002), and the AVF maturation time was significantly shorter in patients who underwent PBA (mean difference -20.32 days, 95% CI, -30.12 to -10.52, P = 0.0001). The certainty of the evidence was high.
CONCLUSIONS
PBA of small cephalic veins with diameter ≤2.5 cm is a safe, feasible, and efficacious augmentation method for AVF creation. This technique achieves favorable maturation outcomes, and PBA is superior to the standard hydrostatic dilatation technique.
Topics: Humans; Arteriovenous Shunt, Surgical; Dilatation; Renal Dialysis; Treatment Outcome; Angioplasty, Balloon; Arteriovenous Fistula; Dilatation, Pathologic; Vascular Patency; Randomized Controlled Trials as Topic
PubMed: 36029949
DOI: 10.1016/j.avsg.2022.07.025 -
Surgical Oncology Sep 2016Hepatic sinusoidal dilatation (SD) is a histopathological entity that occurs in up to 75% of patients undergoing oxaliplatin-based chemotherapy for colorectal liver... (Meta-Analysis)
Meta-Analysis Review
The influence of chemotherapy-associated sinusoidal dilatation on short-term outcome after partial hepatectomy for colorectal liver metastases: A systematic review with meta-analysis.
BACKGROUND DATA
Hepatic sinusoidal dilatation (SD) is a histopathological entity that occurs in up to 75% of patients undergoing oxaliplatin-based chemotherapy for colorectal liver metastases (CRLM).
OBJECTIVE
To study the influence of SD on outcome after partial hepatectomy in patients with CRLM.
METHODS
Medline, Embase, CENTRAL, LILACS and CINAHL were searched for studies published between 01.01.2004 and 09.06.2015 with keywords: "sinusoidal obstruction syndrome", "hepatic veno-occlusive disease", and "Stuart-Bras syndrome". Studies comprising adults who underwent partial hepatectomy for CRLM with grading of SD and registration of postoperative morbidity and/or mortality were included. Risk of bias and quality of studies were evaluated with the Quality In Prognosis Studies Instrument (QUIPS) and modified GRADE framework.
RESULTS
Search strategies produced 2007 hits from which 23 and 13 articles were extracted for qualitative and quantitative analyses, respectively. Meta-analysis on the influence of SD grade 2-3 vs. SD grade 0-1 on postoperative overall morbidity showed an odds ratio (OR) of 1.26 [95% CI 0.74, 2.15](p = 0.40), an OR of 1.03 [0.15, 6.89](p = 0.98) for liver failure, an OR of 1.21 [0.23, 6.35](p = 0.82) for overall mortality, and an OR of 3.52 [0.31, 39.91](p = 0.31) for liver-related morbidity. QUIPS showed a low to high risk of bias for studies, and GRADE showed very low quality of evidence per outcome.
CONCLUSIONS
No significant effect of SD grade 2-3 on short-term outcome after partial hepatectomy was found. However, the data on which this conclusion was based were not very robust and therefore no solid conclusions could be drawn.
Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Chemical and Drug Induced Liver Injury; Colorectal Neoplasms; Dilatation, Pathologic; Hepatectomy; Humans; Liver Neoplasms; Prognosis
PubMed: 27566036
DOI: 10.1016/j.suronc.2016.05.030 -
The Journal of International Medical... Oct 2020A laryngocele is a space that develops as a result of pathological dilatation of the laryngeal saccule. However, the reported management of laryngoceles varies. We... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
A laryngocele is a space that develops as a result of pathological dilatation of the laryngeal saccule. However, the reported management of laryngoceles varies. We conducted a systematic review of the literature regarding the surgical management of laryngoceles and pyolaryngoceles, to understand the evolving nature of treatment for this rare condition.
METHODS
We searched for publications in the PubMed, Cochrane Library, JBI Library of Systematic Reviews, and Ovid databases using the terms "laryngocele", "pyolaryngocele", and "laryngopyocele", and reviewed the identified articles.
RESULTS
After removal of repeated studies and filtering for relevance and studies written in English, a total of 227 studies were included in this review. No meta-analyses or randomized controlled trials have been published. The identified studies have been summarized in 14 reviews conducted since 1946. The meta-analysis determined that endoscopy was the preferred approach for internal laryngoceles, while combined laryngoceles benefited from both internal and external surgical approaches.
CONCLUSIONS
Laryngocele management has progressed since its initial description, from open surgery to an endoscopic approach, and more recently to a robotic-assisted surgical approach. The uptake of robotic surgery as a possible treatment modality over the last decade shows much promise for the treatment of these conditions.
Topics: Humans; Dilatation, Pathologic; Laryngocele; Larynx; Robotic Surgical Procedures
PubMed: 33100073
DOI: 10.1177/0300060520940441 -
The Journal of Sexual Medicine Mar 2021Vaginal stenosis (VS) is a common side effect of pelvic radiotherapy for gynecological cancer in women. It has a high incidence variability, likely due to unstandardized...
BACKGROUND
Vaginal stenosis (VS) is a common side effect of pelvic radiotherapy for gynecological cancer in women. It has a high incidence variability, likely due to unstandardized and subjective assessment methods. Furthermore, even though the worldwide standard treatment for VS is vaginal dilation, low compliance rates have been noted.
AIM
To evaluate the parameters used to diagnose VS and to assess whether the lack of an objective measure of VS hampers vaginal dilator use.
METHODS
A systematic review in accordance with the PRISMA reporting guidelines was conducted. PubMed, EMBASE, and Web of Science databases were searched. Randomized trials and prospective, retrospective, and cross-sectional studies published from January 2011 to February 2020 were included.
OUTCOMES
The main outcome of this study was a review of the published literature on assessment methods for VS and compliance to vaginal dilator use.
RESULTS
Of the 28 articles obtained, only 7 used objective methods to measure the vaginal volume. 3 studies have demonstrated patient's concern with VS development and showed a high compliance to dilator use, whereas others reported several barriers to dilator use.
CLINICAL IMPLICATIONS
Lack of an objective assessment method can be a predisposing factor for uncertain VS incidence rates and impair compliance to vaginal dilator therapy, leading to long-term VS and sexual dysfunction.
STRENGTHS & LIMITATIONS
This is the first systematic review on the heterogeneity of VS evaluation methods and compliance to vaginal dilator use. All studies were comprehensively evaluated by 2 reviewers. The limitations included the heterogeneity of the study designs and the unstandardized criteria used to classify stenosis or to evaluate compliance to dilator use. Although 3 well-known databases were used, the inclusion of more data sources could have increased the number of publications included in this review.
CONCLUSION
VS is frequently diagnosed using subjective parameters. Few unstandardized objective methods are used to evaluate this condition. Regarding compliance to vaginal dilator use, there was a high dropout rate during follow-up and no consensus on starting time or ideal usage. Haddad NC, Soares Brollo LC, Pinho Oliveira MA, et al. Diagnostic Methods for Vaginal Stenosis and Compliance to Vaginal Dilator Use: A Systematic Review. J Sex Med 2021;18:493-514.
Topics: Constriction, Pathologic; Cross-Sectional Studies; Dilatation; Female; Humans; Prospective Studies; Retrospective Studies; Vaginal Diseases
PubMed: 33526400
DOI: 10.1016/j.jsxm.2020.12.013 -
Pediatric Surgery International Dec 2022Postoperative anastomotic stricture (PAS) is a well-known complication after correcting choledochal cyst (CC). Although the exact cause of PAS is unknown, various risk... (Meta-Analysis)
Meta-Analysis
PURPOSE
Postoperative anastomotic stricture (PAS) is a well-known complication after correcting choledochal cyst (CC). Although the exact cause of PAS is unknown, various risk factors, such as Todani classification type IV-A, hepaticoduodenostomy, and narrow anastomosis have been reported to be associated with PAS. As far as we know, there is no report with a cumulative analysis of such risk factors of PAS. This systematic review and meta-analysis aimed to investigate the risk factors of PAS following surgical correction of CC in children.
METHODS
A systematic literature search for relevant articles was performed in four databases using the combinations of the following terms "Congenital biliary dilatation", "Congenital choledochal cyst", "Choledochal cyst", "Stenosis", "Stricture", and "Complication" for studies published between 1973 and 2022. The relevant cohorts of PAS were systematically searched for clinical presentation and outcomes.
RESULTS
The search strategy identified 795 reports. Seventy studies met the defined inclusion criteria, reporting a total of 206 patients with PAS. There is no prospective study in this search. The incidence of PAS was 2.1%. The proportion of Todani classification of the patient with PAS was higher in type IV-A with significant difference (2.0% in type I and 10.1% in type IV-A (p = 0.001)). Fourteen studies reported a comparison between hepaticojejunostomy and hepaticoduodenostomy. There was no significant difference between the two groups (p = 0.36). Four studies reported the diameter of the anastomosis at the primary surgery. The mean diameter was 12.5 mm. Nine studies reported a comparison between laparoscopic surgery and open surgery. Pooled odds ratio of PAS did not show a statistical difference (p = 0.29).
CONCLUSIONS
This study suggests that close careful follow-up is important in the patients with type IV-A of CC who underwent excision surgery, considering the possibility of PAS.
Topics: Child; Humans; Anastomosis, Surgical; Postoperative Period; Choledochal Cyst; Biliary Tract Surgical Procedures; Neurosurgical Procedures; Constriction, Pathologic
PubMed: 36454303
DOI: 10.1007/s00383-022-05293-x -
VASA. Zeitschrift Fur Gefasskrankheiten 2016Diabetes, a state of relative insulin resistance, is negatively associated with both the presence and growth abdominal aortic aneurysms (AAA), which could suggest a... (Review)
Review
Diabetes, a state of relative insulin resistance, is negatively associated with both the presence and growth abdominal aortic aneurysms (AAA), which could suggest a protective role of obesity against AAA presence or growth. A recent meta-analysis demonstrated a trend toward a positive, though statistically non-significant, association between body mass index (BMI) and the presence of AAA. With respect to the association between obesity and AAA growth, however, the evidence had been very limited. To determine whether obesity (or BMI) is associated with AAA growth, we reviewed currently available studies with a systematic literature search. Our comprehensive search identified seven eligible studies reporting the association of BMI and AAA growth rates, which included data on a total of 3,768 AAA patients. All seven identified studies demonstrated no association between BMI and AAA growth. Despite a trend toward a positive association between BMI and AAA presence, the reason why BMI is not associated with AAA growth (suggested in the present review) is unclear. A discrepancy between associated comorbidities (coronary artery disease, peripheral artery disease, and chronic obstructive pulmonary disease) and AAA presence and between the same comorbidities and AAA growth, however, could be identified. Further investigations are required to elucidate why BMI is not associated with AAA growth despite the trend for a positive association with AAA presence.
Topics: Aorta, Abdominal; Aortic Aneurysm, Abdominal; Body Mass Index; Dilatation, Pathologic; Disease Progression; Humans; Obesity; Risk Assessment; Risk Factors
PubMed: 27058797
DOI: 10.1024/0301-1526/a000505 -
Archives of Disease in Childhood. Fetal... Jul 2022We sought to perform a meta-analysis of the predictive value of antenatal ultrasonographic markers of bowel dilation, gastric dilation, polyhydramnios and abdominal... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
We sought to perform a meta-analysis of the predictive value of antenatal ultrasonographic markers of bowel dilation, gastric dilation, polyhydramnios and abdominal circumference that predict complex gastroschisis and adverse perinatal outcomes DATA SOURCES: PubMed, Web of Science, Scopus and Embase were searched for relevant articles up to December 2020. Studies reporting prenatal ultrasonographic markers including intra-abdominal bowel dilation (IABD), extra-abdominal bowel dilation (EABD), bowel wall thickness, polyhydramnios, abdominal circumference <5th percentile, gastric dilation (GD) and bowel dilation not otherwise specified (BD-NOS) were included. The primary outcome was prediction of complex gastroschisis; secondary outcomes were length of hospital stay for newborn, time to full enteral feeding, postnatal mortality rate, incidence of necrotising enterocolitis and short bowel syndrome.
RESULTS
Thirty-six studies were included in this meta-analysis. We found significant associations between complex gastroschisis and IABD (OR=5.42; 95% CI 3.24 to 9.06), EABD (OR=2.27; 95% CI 1.40 to 3.66), BD-NOS (OR=6.27; 95% CI 1.97 to 19.97), GD (OR=1.88; 95% CI 1.22 to 2.92) and polyhydramnios (OR=6.93; 95% CI 3.39 to 14.18). Second trimester IABD and EABD have greater specificity for the prediction of complex gastroschisis than third trimester values with specificity of 95.6% (95% CI 58.1 to 99.7) and 94.6% (95% CI 86.7 to 97.9) for the second trimester IABD and EABD, respectively.
CONCLUSION
Prenatal ultrasonographic markers, especially the second trimester IABD and EABD, can identify fetuses that develop complex gastroschisis. Furthermore, these specific ultrasonographic markers can identify those babies at the highest risk for severe complications of this congenital anomaly and hence selected for future antenatal interventions.
Topics: Dilatation, Pathologic; Female; Gastroschisis; Humans; Infant, Newborn; Polyhydramnios; Predictive Value of Tests; Pregnancy; Retrospective Studies; Ultrasonography, Prenatal
PubMed: 34607856
DOI: 10.1136/archdischild-2021-322612