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World Neurosurgery Aug 2021Transorbital neuroendoscopic surgery (TONES) offers a new level of minimally invasive, minimally disfiguring skull base surgery with maximal surgical visualization.
BACKGROUND
Transorbital neuroendoscopic surgery (TONES) offers a new level of minimally invasive, minimally disfiguring skull base surgery with maximal surgical visualization.
METHODS
This review systematically assesses the body of published anatomic (cadaveric) and clinical evidence for the approach. PubMed, Cochrane Library, Ovid MEDLINE, and Embase were systematically searched for articles in which the TONES surgical technique was used in an anatomic, clinical, or combined study. The outcomes of interest included identification of the diseases, operative outcomes, and complication rates.
RESULTS
Twenty-three articles were selected for this systematic review: 10 were purely anatomic, 10 were clinical, and 3 had both clinical and cadaveric components. The articles reported 69 patients undergoing transorbital or combined transorbital and transnasal intervention. A total of 30 cases of cerebrospinal fluid leak were documented; of these, 28 (93%) had successful resolution, 2 (7%) had recurrence, and 5 (15%) experienced complications. A total of 31 tumors were biopsied (n = 1), resected (n = 22), or debulked (n = 8). Meningiomas were the most common lesion managed via TONES, with 5 of 7 patients with meningioma who reported preoperative neurologic deficits experiencing an improvement in extraocular movement impairment, visual acuity, proptosis, and ptosis. Transient postoperative clinical sequelae, including diplopia and ptosis, were increasingly associated with the superior lid crease incision and the sole transorbital approach.
CONCLUSIONS
TONES is a significant development in transorbital skull base surgery. However, comprehensive, robust, comparative analyses and increasing use and generalizability of this technique in skull base surgery are awaited.
Topics: Humans; Neuroendoscopy; Orbit
PubMed: 33940270
DOI: 10.1016/j.wneu.2021.04.104 -
The American Journal of Dermatopathology Jun 2024Histologic differentiation between melanoma in situ in chronically sun-damaged skin (CSDS) [lentigo maligna (LM)] and CSDS without malignancy is difficult because signs...
Histologic differentiation between melanoma in situ in chronically sun-damaged skin (CSDS) [lentigo maligna (LM)] and CSDS without malignancy is difficult because signs of melanocyte activation and proliferation are found in both. A potentially reliable and quantifiable criterion is melanocyte density (MD). Here, we evaluated whether and to what extent MD allows the distinction between LM and CSDS, which is particularly relevant for the evaluation of borderline cases and surgical margins.Articles assessing MD in LM and/or CSDS were evaluated in a systematic review. The results were categorized and compared according to staining. Cutoff values were included whenever stated.Twenty articles matched the selection criteria. Six hundred forty-four samples of CSDS and 227 samples of LM were considered. In each individual study, mean MD scores were higher for LM than for CSDS. However, looking at the overall study situation, it becomes clear that the data are very heterogeneous and show overlaps. Therefore, no reliable orientation value can be derived. Only 1 article defined a cutoff value.The data of MD in LM in contrast to CSDS were sparse, and a defined cutoff value was only mentioned in 1 article for microphthalmia-associated transcription factor, which cannot yet be generalized. Especially regarding the importance for the definition of surgical resection margins, this unsatisfactory data set highlights the need for further studies. More precise diagnostic criteria could spare some patients extensive and possibly disfiguring surgery.
Topics: Humans; Skin Neoplasms; Melanocytes; Melanoma; Cell Count; Hutchinson's Melanotic Freckle; Sunlight; Diagnosis, Differential
PubMed: 38513120
DOI: 10.1097/DAD.0000000000002680 -
Skin Health and Disease Jun 2023Cutaneous vulval Crohn disease (VCD) is an under-recognised extra-intestinal manifestation of Crohn disease (CD) which is challenging to identify and treat. It causes...
BACKGROUND
Cutaneous vulval Crohn disease (VCD) is an under-recognised extra-intestinal manifestation of Crohn disease (CD) which is challenging to identify and treat. It causes significant oedema, painful deep fissures, and has potential to cause permanent disfiguring changes to vulval anatomy. There is no agreement on the best management for VCD.
OBJECTIVES
This systematic review evaluates the use of metronidazole for the treatment of VCD in women and children.
METHODS
We conducted a systematic review (PROSPERO CRD42021285033) of the use of metronidazole in clinically or histologically diagnosed non-contiguous VCD in patients of all ages and ethnicities. We recorded clinical improvement, reduction in flares, relapse and adverse events using a standardised form.
RESULTS
49 records (40 case reports and 9 case series) met inclusion criteria, comprising a total of 57 patients with an age range of 5-61 years. The most reported presenting features in VCD were: oedema, erythema, ulcers/fissures and induration/thickening. Gastrointestinal CD was present in 33/57 (58%). Vulval biopsies were undertaken in 47/57 (83%). Daily doses ranged from 250 to 1500 mg with treatment duration 8 days to 18 months. Improvement of any magnitude was observed in 40/57 (70%) cases. Relapse was described in 11/57 (19%) cases. No response/worsening was reported in 17/57 (30%) cases. Adverse events occurred in two patients.
CONCLUSION
Metronidazole appears to be useful in managing VCD, either as a primary treatment or adjunctive therapy. However, the evidence is insufficient for firm conclusions to be drawn. Further studies including randomised controlled trials are recommended.
PubMed: 37275415
DOI: 10.1002/ski2.210 -
Journal of Photochemistry and... Aug 2021Cutaneous leishmaniasis (CL) is a neglected disease that represents a serious global public health concern. We performed a systematic review with meta-analysis targeting... (Meta-Analysis)
Meta-Analysis
Cutaneous leishmaniasis (CL) is a neglected disease that represents a serious global public health concern. We performed a systematic review with meta-analysis targeting the use of light-based therapies on CL in preclinical studies since they are essential to identify the benefits, challenges, and limitations of proposing new technologies to fight CL. We searched Pubmed and Web of Science to include original preclinical researches in English that used light-based technologies to fight CL. Inclusion criteria encompassed any animal model for CL induction, an untreated infected group as the comparator, reliable and consistent methodology to develop and treat CL, focus on an antimicrobial therapeutic approach, and data for lesion size and/or parasite load in the infection site. We identified eight eligible articles, and all of them used photodynamic therapy (PDT). For the meta-analysis, three studies were included regarding the parasite load in the infection site and four comprised the lesion size. No overall statistically significant differences were observed between untreated control and PDT groups for parasite load. Differently, PDT significantly reduced the lesion size regardless of the protocol used to treat CL (in mm, SMD: -1.90; 95% CI: -3.74 to -0.07, p = 0.04). This finding is particularly encouraging since CL promotes disfiguring lesions that profoundly affect the quality of life of patients. We conclude that PDT is a new promising technology able to be topically used against CL if applied in more than one session, making it a promising ally for the management of CL.
Topics: Animals; Databases, Factual; Disease Models, Animal; Leishmaniasis, Cutaneous; Light; Parasite Load; Photochemotherapy; Photosensitizing Agents
PubMed: 34090038
DOI: 10.1016/j.jphotobiol.2021.112236 -
Oral and Maxillofacial Surgery Sep 2019Oral squamous cell carcinoma results in various morbidities like pain, bleeding on provocation, loss of function, facial disfigurement, extra oral fungation, and tissue...
BACKGROUND
Oral squamous cell carcinoma results in various morbidities like pain, bleeding on provocation, loss of function, facial disfigurement, extra oral fungation, and tissue necrosis. Other than these dreadful complications, sometimes in advanced and incurable stage, the wound gets infested with maggots. Oral myiasis in association with OSCC is rare, and a very few reports have been mentioned in the literature.
MATERIAL AND METHODS
A literature search was performed on PubMed, Medline, and Cochrane databases on 1st November 2018 for all the articles focusing on oral myiasis in patients with oral squamous cell carcinoma.
RESULTS
A total number of nine cases with oral myiasis in association with OSCC have been reported till date. Out of these nine cases, five cases have been reported from India and four from Brazil.
CONCLUSION
Oral myiasis is a possible risk for the patient with Oral squamous cell carcinoma. Good hygiene and general cleanliness along with educating the patients must be a practice to avoid this dreadful condition.
Topics: Brazil; Carcinoma, Squamous Cell; Humans; India; Mouth Neoplasms; Myiasis
PubMed: 31119420
DOI: 10.1007/s10006-019-00757-2 -
BMJ Global Health Oct 2021Globally, about 1.7 billion people living in poverty are affected by one or more of a group of disabling, disfiguring and poverty-promoting conditions known as neglected...
BACKGROUND
Globally, about 1.7 billion people living in poverty are affected by one or more of a group of disabling, disfiguring and poverty-promoting conditions known as neglected tropical diseases (NTDs). Major global health actors, like the WHO, have endorsed a shift from vertical to integrated NTD management.
OBJECTIVE
This systematic review aimed to evaluate how integration is being conducted and how we can improve it.
METHODS
PubMed, Medline, Cochrane library, Web of Science, Trip, Embase, Global Health and Google Scholar were searched from 1 April to 22 July 2020.We included peer-reviewed articles published between 1 January 2000 and 22 July 2020 in English.
RESULTS
Database searches produced 24 565 studies, of which 35 articles met the inclusion criteria. Twenty of these articles were conducted in sub-Saharan Africa. Twenty articles were also published between 2015 and 2020. Literature revealed that NTDs have been integrated-among themselves; with water, sanitation and hygiene programmes; with vector control; with primary healthcare; with immunisation programmes; and with malaria management. Integrated mass drug administration for multiple NTDs was the most common method of integration. The three complex, yet common characteristics of successful integration were good governance, adequate financing and total community engagement.
CONCLUSION
The dataset identified integrated management of NTDs to be cost effective and potentially to increase treatment coverage. However, the identified modes of integration are not exclusive and are limited by the available literature. Nonetheless, integration should urgently be implemented, while considering the programmatic and sociopolitical context.
PROSPERO REGISTRATION NUMBER
The study protocol was registered with PROSPERO number, CRD42020167358.
Topics: Global Health; Humans; Hygiene; Neglected Diseases; Sanitation; Tropical Medicine
PubMed: 34663634
DOI: 10.1136/bmjgh-2021-006968 -
Clinical & Translational Oncology :... May 2024Treating aggressive superficial squamous cell carcinoma (SCC) poses challenges due to invasiveness. Palliative care is recommended for inoperable cases with extensive...
OBJECTIVE
Treating aggressive superficial squamous cell carcinoma (SCC) poses challenges due to invasiveness. Palliative care is recommended for inoperable cases with extensive tumors near vital organs, risking disfigurement or functional impairment. Electrochemotherapy (ECT) is an emerging cutaneous tumor treatment, but its efficacy against superficial SCC remains uncertain. This study conducts a systematic review and single-arm meta-analysis to evaluate ECT's effectiveness against superficial SCC and provide current evidence for clinical practice.
METHODS
Embase, PubMed and Cochrane Library were searched for studies up to May 2023. The random effects model analyzed complete response (CR) and partial response (PR), with subgroup assessment based on drug dosage, treatment response evaluation, tumor size, primary/recurrent status, and tumor location.
RESULTS
Ten studies involving 162 patients and 208 tumors were included. Pooled CR and PR rates for ECT-treated superficial SCC were 66.5% (95% CI 48.4%-82.5%; I = 84%) and 20.3% (95% CI 10.5%-32.3%; I = 70%), respectively. Subgroup analysis indicated ECT's superiority in treating primary tumors (PR: 70%, CR: 30%) and tumors ≤ 3 cm (PR: 81.3%, CR: 10.1%) compared to recurrent tumors (PR: 56.7%, CR: 36.5%) and tumors > 3 cm (PR: 45.2%, CR: 34.4%).
CONCLUSION
This single-arm meta-analysis confirms ECT's efficacy against superficial SCC, especially in primary tumors and those ≤ 3 cm in diameter. The study highlights the impact of tumor location and response evaluation on ECT's benefits, warranting further investigation through additional research.
PubMed: 38758386
DOI: 10.1007/s12094-024-03522-4 -
Annals of Plastic Surgery Apr 2021Patients with factitious disorder (FD) or "Munchausen syndrome" intentionally fabricate or induce medical problems for psychological gratification. They may deceive...
INTRODUCTION
Patients with factitious disorder (FD) or "Munchausen syndrome" intentionally fabricate or induce medical problems for psychological gratification. They may deceive plastic surgeons into performing multiple unnecessary procedures. We undertook the first systematic review of FD case reports in plastic surgery. Our aims were 2-fold: (1) describe the adverse outcomes associated with these cases and (2) identify strategies for their prevention by surgeons.
METHODS
MEDLINE, EMBASE, and SCOPUS databases were searched. We included cases in which an adult with FD presented to a plastic surgeon. Our search returned a total of 42 eligible cases reported from North America (43%), Europe (37%), and Asia (20%).
RESULTS
Seventy-six percent of patients were women, and 62% worked in health care. Sixty percent had a comorbid psychiatric disorder, the most common (50%) being depression. Ninety-three percent of our sample presented with self-induced lesions. The average delay in diagnosis of FD was 54 months, with 46% of patients receiving multiple surgical procedures in this time, including debridement (36%) and skin grafts (39%). Surgical wounds were frequently exploited by patients to remain in, or return to, hospital: 50% contaminated or manipulated their wounds to prevent healing. Thirty-six percent of cases resulted in significant long-term disability (24%) or disfigurement (12%). Ten percent of patients received an amputation. Outcomes were improved when patients were confronted by surgeons, however, and 62% were willing to see a psychiatrist. Surgeons were able to support recovery in 33% of cases-for example, by using occlusive wound dressings.
CONCLUSIONS
Patients with FD who present to plastic surgeons are high risk: the majority require surgical intervention for severe self-injury, and many engage in harmful behaviors, such as "doctor-shopping." Early recognition of FD in plastic surgery is, therefore, crucial and may be achieved via careful examination of lesions for unusual morphology. Medical records may reveal extensive health care service use and negative investigations. Finally, plastic surgeons may play an important role in managing such patients. Management strategies include direct observation by nursing staff in the postoperative period and use of strict occlusive dressings to prevent access to surgical wounds.
Topics: Adult; Asia; Europe; Female; Humans; Male; Munchausen Syndrome; Plastic Surgery Procedures; Surgery, Plastic
PubMed: 32804718
DOI: 10.1097/SAP.0000000000002526 -
PLoS Neglected Tropical Diseases Apr 2024Cutaneous leishmaniasis (CL) is characterized by potentially disfiguring skin ulcers carrying significant social stigma. To mitigate systemic drug exposure and reduce...
BACKGROUND
Cutaneous leishmaniasis (CL) is characterized by potentially disfiguring skin ulcers carrying significant social stigma. To mitigate systemic drug exposure and reduce the toxicity from available treatments, studies addressing new local therapeutic strategies using available medications are coming up. This review systematically compiles preclinical and clinical data on the efficacy of amphotericin B (AmB) administered locally for cutaneous leishmaniasis.
METHODOLOGY
Structured searches were conducted in major databases. Clinical studies reporting cure rates and preclinical studies presenting any efficacy outcome were included. Exclusion criteria comprised nonoriginal studies, in vitro investigations, studies with fewer than 10 treated patients, and those evaluating AmB in combination with other antileishmanial drug components.
PRINCIPAL FINDINGS
A total of 21 studies were identified, encompassing 16 preclinical and five clinical studies. Preclinical assessments generally involved the topical use of commercial AmB formulations, often in conjunction with carriers or controlled release systems. However, the variation in the treatment schedules hindered direct comparisons. In clinical studies, topical AmB achieved a pooled cure rate of 45.6% [CI: 27.5-64.8%; I2 = 79.7; p = 0.002), while intralesional (IL) administration resulted in a 69.8% cure rate [CI: 52.3-82.9%; I2 = 63.9; p = 0.06). In the direct comparison available, no significant difference was noted between AmB-IL and meglumine antimoniate-IL administration (OR:1.7; CI:0.34-9.15, I2 = 79.1; p = 0.00), however a very low certainty of evidence was verified.
CONCLUSIONS
Different AmB formulations and administration routes have been explored in preclinical and clinical studies. Developing therapeutic technologies is evident. Current findings might be interpreted as a favorable proof of concept for the local AmB administration which makes this intervention eligible to be explored in future well-designed studies towards less toxic treatments for leishmaniasis.
Topics: Leishmaniasis, Cutaneous; Amphotericin B; Humans; Antiprotozoal Agents; Administration, Topical; Treatment Outcome
PubMed: 38626196
DOI: 10.1371/journal.pntd.0012127 -
The British Journal of Oral &... Dec 2019Our aim was to establish the recurrence rate of odontogenic myxoma after different treatments. Our search covered papers from 1972-2017 from different sources. The...
Our aim was to establish the recurrence rate of odontogenic myxoma after different treatments. Our search covered papers from 1972-2017 from different sources. The papers were evaluated and critically appraised by two independent investigators. The recurrence rate and 95% CI were calculated in relation to each specific treatment, and the chi squared test was calculated to find out if there was any significant difference in the recurrence rate between conservative treatment and resection. The overall recurrence rate was 5 of 39 patients (13%) during a mean follow up period of 10 years. With conservative treatment the recurrence rate was 4/22 (19%) (mean follow up 11 years) and after resection it was 1/17 (6%) (mean follow up nine years). Maxillary lesions were more likely to recur than mandibular ones. Quality of life variables such as disfigurement and neural deficit were more common after resection than with conservative treatment. The frequency of recurrence was relatively low over 10 years' follow up, irrespective of whether resection or a more conservative approach was used, despite being slightly lower (as might be expected) after resection. Conservative treatment should be considered first to avoid resection-associated morbidity and the effect on the quality of life. Maxillary lesions have more room to spread before they are clinically evident, making them difficult to treat optimally and contributing to the recurrence rate.
Topics: Humans; Maxilla; Myxoma; Neoplasm Recurrence, Local; Odontogenic Tumors; Quality of Life
PubMed: 31551163
DOI: 10.1016/j.bjoms.2019.09.005