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Neurology India 2020The study was done to review the literature about the intriguing aspects of the aneurysmal bone cyst and to describe our experience with these cases. (Review)
Review
AIMS
The study was done to review the literature about the intriguing aspects of the aneurysmal bone cyst and to describe our experience with these cases.
DESIGN
Retrospective.
MATERIAL AND METHOD
We reviewed the records of all patients with primary spinal tumours whom we managed over last 8 years. We selected the patients with biopsy proven aneurysmal bone cyst (ABC) for our study.
RESULTS
Four patients (two males and two females) were included. The age ranged from 15-18 years. Three of them had neurological deficits and one had only pain. All of them were operated and three required instrumentation for stabilization. Neurological deficits improved in all the cases. However we had to re- operate one of the cases for recurrence and that patient was administered adjuvant radiotherapy.
CONCLUSIONS
ABC is not a tumour in real sense but due to destructive nature that are classified as tumours. The patients have an excellent outcome as the disease is benign and has very low recurrence rates if surgical excision is complete. Best treatment modality is complete excision. Aneurysmal bone cyst is one of the uncommon tumors of the spine, and many of its features continue to be unclear even today. There is ambiguity about the definition, etiopathogenesis, radiological characteristics, histopathology and treatment modalities. They are common in young age and etiology is not clear. The presentation is varied with pain being the common symptom and neurological deficit depends on extent of cord involvement. The best treatment is controversial although surgery is believed to be curative in the majority of cases. We here describe our experience with four such cases who had varied clinical presentation and outcome.
Topics: Adolescent; Bone Cysts, Aneurysmal; Cervical Vertebrae; Female; Humans; Male; Neoplasm Recurrence, Local; Retrospective Studies; Spinal Diseases
PubMed: 32859826
DOI: 10.4103/0028-3886.293465 -
Australian Journal of General Practice Mar 2019Chronic pilonidal disease is a common debilitating condition often seen in general practice. It is a cause of considerable morbidity and social embarrassment, but recent...
BACKGROUND
Chronic pilonidal disease is a common debilitating condition often seen in general practice. It is a cause of considerable morbidity and social embarrassment, but recent developments in treatment options provide promising solutions to this problem. OBJECTIVE: This article recaps pilonidal sinus development and presentation, details methods of treatment in the primary care setting and explores new specialist management options available in Australia.
DISCUSSION
As a chronic condition, the devastation of recurrence with further pain, embarrassment and time off work - added to the prospect of more surgery - is still common for patients with chronic pilonidal disease. This can be avoided with correct management and timely counselling regarding surgical options available.
Topics: Dermatologic Surgical Procedures; Humans; Inflammation; Pain; Pilonidal Sinus; Wound Healing
PubMed: 31256473
DOI: 10.31128/AJGP-07-18-4649 -
Arthritis & Rheumatology (Hoboken, N.J.) Jan 2022To examine whether knee subchondral cysts, measured on magnetic resonance imaging (MRI), are associated with incident knee osteoarthritis (OA) outcomes. (Observational Study)
Observational Study
OBJECTIVE
To examine whether knee subchondral cysts, measured on magnetic resonance imaging (MRI), are associated with incident knee osteoarthritis (OA) outcomes.
METHODS
We used longitudinal data from the Multicenter Osteoarthritis Study, a community-based cohort of subjects with risk factors for knee OA. Participants without a history of knee surgery and/or inflammatory arthritis (i.e., rheumatoid arthritis and gout) were followed up for 84 months for the following incident outcomes: 1) radiographic knee OA (Kellgren/Lawrence grade ≥2), 2) symptomatic radiographic knee OA (radiographic knee OA and frequent knee pain), and 3) frequent knee pain (with or without radiographic knee OA). In a subset of participants, subchondral cysts were scored on baseline MRIs of 1 knee. Multiple logistic regression, with adjustment for participant characteristics and other baseline knee MRI findings, was used to assess whether subchondral cysts were predictive of incident outcomes.
RESULTS
Among the participants with knees eligible for analyses of outcomes over 84 months, incident radiographic knee OA occurred in 22.8% of knees with no baseline radiographic knee OA, symptomatic radiographic knee OA occurred in 17.0% of knees with no baseline symptomatic radiographic knee OA, and frequent knee pain (with or without radiographic knee OA) occurred in 28.8% of knees with no baseline radiographic knee OA and 43.7% of knees with baseline radiographic knee OA. With adjustment for age, sex, and body mass index, the presence of subchondral cysts was not associated with incident radiographic knee OA but was associated with increased odds of incident symptomatic radiographic knee OA (odds ratio 1.92 [95% confidence interval 1.16-3.19]) and increased odds of incident frequent knee pain in those who had radiographic knee OA at baseline (odds ratio 2.11 [95% confidence interval 0.87-5.12]). Stronger and significant associations were observed for outcomes based on consistent reports of frequent knee pain within ~1 month of the study visit.
CONCLUSION
Subchondral cysts are likely to be a secondary phenomenon, rather than a primary trigger, of radiographic knee OA, and may predict symptoms in knees with existing disease.
Topics: Aged; Arthralgia; Bone Cysts; Female; Humans; Joint Diseases; Knee Joint; Magnetic Resonance Imaging; Male; Middle Aged; Osteoarthritis, Knee; Prospective Studies
PubMed: 34224660
DOI: 10.1002/art.41917 -
The New England Journal of Medicine Jun 2017
Topics: Adult; Arachnoid Cysts; Brain; Headache; Humans; Magnetic Resonance Imaging; Male; Seizures
PubMed: 28591531
DOI: 10.1056/NEJMicm1610483 -
European Journal of Human Genetics :... Nov 2021Neurofibromatosis type 1 (NF1), neurofibromatosis type 2 (NF2) and schwannomatosis (SWN) are rare conditions with pronounced variability of clinical expression. We aimed...
Neurofibromatosis type 1 (NF1), neurofibromatosis type 2 (NF2) and schwannomatosis (SWN) are rare conditions with pronounced variability of clinical expression. We aimed to reach consensus on the most important manifestations meriting the development of drug trials. The five-staged modified Delphi procedure consisted of two questionnaires and a consensus meeting for 40 NF experts, a survey for 63 patient representatives, and a final workshop. In the questionnaires, manifestations were scored on multiple items on a 4-point Likert scale. The highest average scores for NF experts deciding the 'need for new treatment' were for malignant peripheral nerve sheath tumour (MPNST) (4,0) and high grade glioma (HGG) (3,9) for NF1; meningioma (3,9) for NF2 and pain (3,9) for SWN. The patient representatives assigned high scores to all manifestations, with plexiform neurofibroma being highest in NF1 (4,0), vestibular schwannoma in NF2 (4,0), and pain in SWN (3,9). Twelve experts participated in the consensus meeting and prioritised manifestations. MPNST was ranked the highest for NF1, followed by benign peripheral nerve sheath tumours. Tumour manifestations received highest ranking in NF2, and pain was the most prominent problem for SWN. Patient representative ratings for NF1 were similar to the experts' opinions, except that they ranked HGG as the most important manifestation. For NF2 and SWN, the patient representatives agreed with the experts. We conclude that NF experts and patient representatives consent to prioritise development of drug trials for MPNST, benign peripheral nerve sheath tumours, cutaneous manifestations and HGG for NF1; tumours for NF2; and pain for SWN.
Topics: Attitude; Clinical Trials as Topic; Delphi Technique; Drug Development; Health Personnel; Humans; Neurofibromatoses; Patients; Research Personnel; Stakeholder Participation
PubMed: 33903738
DOI: 10.1038/s41431-021-00892-z -
Medicine Feb 2018Schwannomatosis has been linked to germline mutations in the SMARCB1 and LZTR1 genes, and is frequently associated with pain.In a cohort study, we assessed the mutation...
Schwannomatosis has been linked to germline mutations in the SMARCB1 and LZTR1 genes, and is frequently associated with pain.In a cohort study, we assessed the mutation status of 37 patients with clinically diagnosed schwannomatosis and compared to clinical data, whole body MRI (WBMRI), visual analog pain scale, and Short Form 36 (SF-36) bodily pain subscale.We identified a germline mutation in LZTR1 in 5 patients (13.5%) and SMARCB1 in 15 patients (40.5%), but found no germline mutation in 17 patients (45.9%). Peripheral schwannomas were detected in 3 LZTR1-mutant (60%) and 10 SMARCB1-mutant subjects (66.7%). Among those with peripheral tumors, the median tumor number was 4 in the LZTR1 group (median total body tumor volume 30 cc) and 10 in the SMARCB1 group (median volume 85cc), (P=.2915 for tumor number and P = .2289 for volume). mutation was associated with an increased prevalence of spinal schwannomas (100% vs 41%, P = .0197). The median pain score was 3.9/10 in the LZTR1 group and 0.5/10 in the SMARCB1 group (P = .0414), and SF-36 pain-associated quality of life was significantly worse in the LZTR1 group (P = .0106). Pain scores correlated with total body tumor volume (rho = 0.32471, P = .0499), but not with number of tumors (rho = 0.23065, P = .1696).We found no significant difference in quantitative tumor burden between mutational groups, but spinal schwannomas were more common in LZTR1-mutant patients. Pain was significantly higher in LZTR1-mutant than in SMARCB1-mutant patients, though spinal tumor location did not significantly correlate with pain. This suggests a possible genetic association with schwannomatosis-associated pain.
Topics: Adult; Cancer Pain; Cohort Studies; Female; Genetic Association Studies; Germ-Line Mutation; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neurilemmoma; Neurofibromatoses; Pain Measurement; Quality of Life; SMARCB1 Protein; Skin Neoplasms; Transcription Factors; Tumor Burden; Whole Body Imaging
PubMed: 29384852
DOI: 10.1097/MD.0000000000009717 -
BMJ Open Jul 2022Neurofibromatosis type 1 (NF1) is a genetic disorder in which chronic pain commonly occurs. The study sought to understand the needs of individuals with NF1 and pain...
Perspectives on adapting a mobile application for pain self-management in neurofibromatosis type 1: results of online focus group discussions with individuals living with neurofibromatosis type 1 and pain management experts.
OBJECTIVE
Neurofibromatosis type 1 (NF1) is a genetic disorder in which chronic pain commonly occurs. The study sought to understand the needs of individuals with NF1 and pain management experts when adapting a pain self-management mobile health application (app) for individuals with NF1.
DESIGN
We conducted a series of online, audio-recorded focus groups that were then thematically analysed.
SETTING
Online focus groups with adults currently residing in the USA.
PARTICIPANTS
Two types of participants were included: individuals with NF1 (n=32 across six focus groups) and pain management experts (n=10 across three focus groups).
RESULTS
Six themes across two levels were identified. The individual level included lifestyle, reasons for using the mobile app and concerns regarding its use. The app level included desired content, desired features and format considerations. Findings included recommendations to grant free access to the app and include a community support feature for individuals to relate and validate one another's experience with pain from NF1. In addition, participants noted the importance of providing clear instructions on navigating the app, the use of an upbeat, hopeful tone and appropriate visuals.
CONCLUSIONS
Both participant groups endorsed the use of iCanCope (iCC) as an NF1 pain self-management mobile app. Differences between groups were noted, however. The NF1 group appeared interested in detailed and nuanced pain tracking capabilities; the expert group prioritised tracking information such as mood, nutrition and activity to identify potential associations with pain. In tailoring the existing iCC app for individuals with NF1, attention should be paid to creating a community support group feature and to tailoring content, features and format to potential users' specific needs.
Topics: Adult; Chronic Pain; Focus Groups; Humans; Mobile Applications; Neurofibromatosis 1; Pain Management; Self-Management
PubMed: 35840301
DOI: 10.1136/bmjopen-2021-056692 -
Journal of Neuro-oncology Sep 2022Peripheral and intraspinal schwannomas are common and clinically complex pathologies in patients with Neurofibromatosis Type 2 (NF2) and Schwannomatosis (SWNT).... (Observational Study)
Observational Study
INTRODUCTION
Peripheral and intraspinal schwannomas are common and clinically complex pathologies in patients with Neurofibromatosis Type 2 (NF2) and Schwannomatosis (SWNT). Functional preservation and pain relief are the major goals in treating these tumors.
METHODS
This retrospective observational study investigates the clinical and functional outcome of 205 operated peripheral (n = 148, 72%) and intraspinal (n = 57, 28%) schwannomas in 85 patients (53 NF2, 32 SWNT) treated at our department between 2006 and 2017. Associated factors such as genetics, age, and location were evaluated.
RESULTS
Persisting drug-resistant pain was the most common symptom (84%, n = 173) and indication for surgery (54%, n = 110). Improvement in pain intensity was postoperatively seen in 81%. Peripheral nerve schwannomas exhibited worse pain intensity preoperatively compared to intraspinal lesions (p = 0.017 NF2, p = 0.029 SWNT). More total resections could be achieved in 93% of SWNT vs. 82% of NF2-associated tumors, p = 0.030). NF2 patients with intraspinal lesions were more neurologically affected (p < 0.05). Perioperative comparison of both tumor syndromes showed more neurological deficits (p = 0.027), and less pain (p = 0.024) in NF2-associated tumors. Mosaic NF2 patients had worse pain levels before surgery, and SWNT patients had a worse neurological function and more pain compared to non-mosaic or non-mutated cases.
CONCLUSIONS
Resection of peripheral and intraspinal schwannomas is an effective and low-risk treatment in both NF2 and SWNT. Patients with severe pain have a particular benefit from surgical treatment. Intraspinal lesions are associated with worse neurological function whereas peripheral lesions showed a higher pain intensity. The influence of mutations needs to be further investigated in larger cohorts.
Topics: Humans; Neurilemmoma; Neurofibromatoses; Neurofibromatosis 2; Pain; Skin Neoplasms
PubMed: 35771312
DOI: 10.1007/s11060-022-04061-0 -
BioMed Research International 2022Comparing the clinical effect of flexible ureteroscope and laparoscope in the treatment of parapelvic cyst. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
Comparing the clinical effect of flexible ureteroscope and laparoscope in the treatment of parapelvic cyst.
METHOD
A total of 82 patients with parapelvic cyst who underwent surgical treatment in our hospital from May 2019 to May 2020 were selected. Patients were randomly divided into a control group and an observation group; the control group underwent laparoscopic parapelvic cyst topical decompression; the observation group underwent transurethral flexible ureteroscope holmium laser incision and drainage of parapelvic cyst. The intraoperative (operative time, intraoperative blood loss, and ventilation time), postoperative (time of getting out of bed, pain score, and length of hospital stay), and recurrence were compared between the two groups.
RESULTS
(1) The operative time and intraoperative blood loss in the observation group were significantly better than those in the control group ( < 0.05), while the ventilation time had no significant difference ( > 0.05). (2) The pain score and length of hospital stay in the observation group were better than those in the control group ( < 0.05). There was no significant difference in the time of getting out of bed ( > 0.05). (3) There was no serious infection or bleeding in either group. The observation group had no recurrence, and the postoperative recurrence rate was 0. There were 11 cases of recurrence in the control group, and the postoperative recurrence rate was 26.83%. The postoperative recurrence rate of the observation group was significantly lower than that of the control group, with statistical significance ( = 4.604, < 0.05).
CONCLUSION
Flexible ureteroscope for the treatment of parapelvic cyst could effectively reduce the operative time, intraoperative blood loss, and pain; in addition, the postoperative recovery was fast and the recurrence is rare, which was worth popularizing.
Topics: Blood Loss, Surgical; Cysts; Humans; Kidney Diseases, Cystic; Laparoscopes; Pain; Retrospective Studies; Treatment Outcome; Ureteroscopes
PubMed: 36246976
DOI: 10.1155/2022/5718923 -
International Journal of Surgery... Apr 2023Various treatment options have been introduced for the management of primary tumors of the brachial plexus (BP), ranging from conservative therapy to wide local excision...
BACKGROUND
Various treatment options have been introduced for the management of primary tumors of the brachial plexus (BP), ranging from conservative therapy to wide local excision with/without postoperative chemoradiotherapy. However, no consensus exists regarding optimal treatment strategies based on collated and published data.
OBJECTIVE
The aim of this study was to investigate the clinicopathological characteristics and outcome of patients with primary tumors of the BP who underwent surgical treatment.
DATA SOURCES
A systematic search of the four main online databases, including Web of Science (WOS), PubMed, Scopus, and Google Scholar, was conducted.
STUDY SELECTION
All related articles addressing the clinical outcome and role of surgical interventions for management of primary tumors of the BP.
INTERVENTION
Optimal surgical and radiotherapeutic interventions for benign and malignant lesions based on the pathologic characteristics and location of primary BP tumors.
RESULTS
A total of 687 patients (693 tumors) with a mean age of 41.7±8.7 years old were evaluated. In total, 629 (90.8%) tumors were benign, and 64 (9.2%) were malignant, with a mean tumor size of 5.4±3.1 cm. The location of the tumor was reported for 639 patients. For these tumors, 444 (69.5%) originated from the supraclavicular region, and 195 (30.5%) were infraclavicular. The trunks were the most common location for tumor involvement, followed by the roots, cords, and terminal branches. Gross total resection was achieved in 432 patients and subtotal resection (STR) was performed in 109 patients. With neurofibromas, STR still resulted in good outcomes. The outcomes following treatment of malignant peripheral nerve sheath tumors were poor regardless of the type of resection. In general, symptoms related to pain and sensory issues resolved rapidly postoperatively. However, the resolution of motor deficits was often incomplete. Local tumor recurrence occurred in 15 (2.2%), patients and distant metastasis was observed in only eight (1.2%) cases. The overall mortality was 21 (3.1%) patients among the study population.
LIMITATIONS
The main limitation was the lack of level I and II evidence.
CONCLUSIONS
The ideal management strategy for primary BP tumors is complete surgical resection. However, in some cases, particularly for neurofibromas, STR may be preferable to preserve maximal neurological function. The degree of surgical excision (total or subtotal) mainly depends on the pathological characteristics and primary location of the tumor.
Topics: Humans; Adult; Middle Aged; Nerve Sheath Neoplasms; Treatment Outcome; Neurofibroma; Brachial Plexus; Demography; Retrospective Studies
PubMed: 37097618
DOI: 10.1097/JS9.0000000000000309