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Journal of Oral Rehabilitation Jun 2024Surgical treatment of temporomandibular joint (TMJ) disc displacement (DD) has been established in different forms since over a century. Ther is a consensus to perform... (Review)
Review
BACKGROUND
Surgical treatment of temporomandibular joint (TMJ) disc displacement (DD) has been established in different forms since over a century. Ther is a consensus to perform minimal invasive interventions as first-line surgical treatment since there are no evidence on best surgical practice yet.
OBJECTIVE
The aim was to perform a complex systematic review (SR) on the topic-is there evidence for surgical treatment of TMJ DD?
METHODS
The PICO was defined as DD patients (population), treated with different surgical interventions including arthrocentesis (intervention), compared with other or no treatment (control) regarding the outcome variables mandibular function, mouth opening capacity, TMJ pain, etcetera (outcome). For identification of prospective controlled trials and SRs, a search strategy was developed for application in three databases.
RESULTS
The search yielded 4931 studies of which 56 fulfilled the stipulated PICO. Studies with low or moderate risk of bias were possible to include in meta-analyses. There were evidence suggesting arthrocentesis being more effective compared to conservative management (maximum interincisal opening (MIO): p < .0001, I = 22%; TMJ pain: p = .0003, I = 84%) and arthrocentesis being slightly more effective than arthrocentesis with an adjunctive hyaluronic acid injection (MIO: p = .04, I = 0%; TMJ pain: p = .28, I = 0%). Other treatment comparisons showed nonsignificant differences. The performed meta-analyses only included 2-4 studies each, which might indicate a low grade of evidence.
CONCLUSION
Although arthrocentesis performed better than conservative management the findings should be interpreted cautiously, and non-invasive management considered as primary measure. Still, several knowledge gaps concerning surgical methods of choice remains.
Topics: Humans; Temporomandibular Joint Disorders; Minimally Invasive Surgical Procedures; Joint Dislocations; Temporomandibular Joint Disc; Treatment Outcome; Arthrocentesis; Range of Motion, Articular; Hyaluronic Acid; Injections, Intra-Articular
PubMed: 38400536
DOI: 10.1111/joor.13661 -
Liver International : Official Journal... Sep 2019The incidence and mortality from end-stage liver disease is increasing, with a minority eligible for liver transplantation. Ascites is the commonest complication of...
BACKGROUND & AIMS
The incidence and mortality from end-stage liver disease is increasing, with a minority eligible for liver transplantation. Ascites is the commonest complication of end-stage liver disease and large volume paracentesis (LVP) the accepted management strategy where refractory to medical treatment. In malignant ascites, permanent indwelling peritoneal catheters (PIPC) are an established palliative intervention. The aims are to describe available data using permanent indwelling peritoneal catheters in refractory ascites due to end-stage liver disease.
METHODS
Using systematic review methodology, databases were searched (MEDLINE, EMBASE, CINAHL [The Cumulative Index to Nursing and Allied Health Literature], Google Scholar and Cochrane Database of Systematic Reviews from inception-March 2018), for studies combining ascites and palliative care. Inclusion and exclusion criteria were applied to results.
RESULTS
Following initial and updated searches, 225 studies were identified for full text review, 18 were eligible for final analysis. The studies displayed heterogeneity in design, reported on different indwelling catheters and were overall of low quality. Only one pilot randomised controlled trial was identified, of PIPC versus LVP, recruiting one patient into each arm. Technical insertion success was 100%, with low rates of non-infectious complications (<12%), none life threatening. Rates of bacterial peritonitis were not unacceptably high (12.7%), considering this was an end-stage liver disease population and only a minority utilising long-term prophylactic antibiotics. Only one study attempted quality-of-life assessments; none addressed potential health economic benefits.
CONCLUSIONS
Despite lack of well-designed studies, preliminary data suggests low significant complication rates; however safety and efficacy of permanent indwelling peritoneal catheters in end-stage liver disease remains to be confirmed. Further prospective randomised controlled trials are warranted, potentially translating permanent indwelling peritoneal catheters into improved palliative care in end-stage liver disease.
Topics: Antibiotic Prophylaxis; Ascites; Bacterial Infections; Catheters, Indwelling; Drainage; End Stage Liver Disease; Humans; Palliative Care; Paracentesis; Peritonitis; Quality of Life; Randomized Controlled Trials as Topic
PubMed: 31152623
DOI: 10.1111/liv.14162 -
Cardiovascular Revascularization... Jun 2022Spontaneous hemopericardium, associated with direct oral anticoagulant (DOAC) use, is one of the uncommon complications with high morbidity that has not been extensively...
BACKGROUND
Spontaneous hemopericardium, associated with direct oral anticoagulant (DOAC) use, is one of the uncommon complications with high morbidity that has not been extensively studied We aimed to determine demographic characteristics, clinical features, lab evaluation, management, and outcomes of the studies focusing on hemopericardium as a DOAC use.
METHODS
PubMed, Web of Science, Google Scholar, and CINAHL databases were searched for relevant articles using MeSH key-words and imported into referencing/review software. The data regarding demographics, clinical characteristics, cardiac investigations, and management were analyzed in IBM Statistics SPSS 21. t-Test and Chi-square test were used. A P score of <0.05 was considered statistically significant.
RESULTS
After literature search, a total of 41 articles were selected for analysis. The mean age of the patients was 70.09 ± 11.06 years (p < 0.05); the majority of them were males (58.5%). Most of the patients presented with shortness of breath (75.2%) and had more than 3 co-morbid conditions (43.9%). The most frequently used anticoagulant was rivaroxaban (15/41; 36.6%); the common indication being arrhythmia (78.0%). CYP4503A4/P-Gp inhibitors (22.2%) were commonly used by the patients. Majority of the cases had a favorable outcome (95.1%). Pericardial tamponade was noted in 31/41 cases. Pericardiocentesis was performed in 37/41 cases.
CONCLUSIONS
Hemopericardium from DOAC use has a favorable outcome but requires urgent pericardiocentesis. However, long term mortality, monitoring of DOAC activity, and drug-drug interactions have not been widely studied.
Topics: Administration, Oral; Aged; Aged, 80 and over; Anticoagulants; Female; Humans; Male; Middle Aged; Pericardial Effusion; Pericardiocentesis; Rivaroxaban
PubMed: 34607787
DOI: 10.1016/j.carrev.2021.09.010 -
Journal of Stomatology, Oral and... Feb 2023Arthrocentesis is being widely used as an invasive treatment modality for managing temporomandibular joint (TMJ) disorders. The current review aimed to assess if... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Arthrocentesis is being widely used as an invasive treatment modality for managing temporomandibular joint (TMJ) disorders. The current review aimed to assess if arthrocentesis as the first line of therapy leads to better outcomes as compared to conservative management of TMJ disorders.
METHODS
PubMed, Scopus, Embase, Web of Science, and CENTRAL were searched up to 20th June 2022 for randomized controlled trials comparing TMJ arthrocentesis vs conservative management as first-line therapy for TMJ disorders.
RESULTS
Eight trials were included. Our analysis indicated significantly reduced pain scores in patients undergoing TMJ arthrocentesis as compared to conservative therapy at 1 month (MD: -0.82 95% CI: -1.43, -0.20 I=56% p = 0.01) and 6 months (MD: -1.38 95% CI: -2.45, -0.32 I=86% p = 0.01), but not at 3 months of follow-up (MD: -0.66 95% CI: -1.68, 0.37 I=82% p = 0.21). The results were not stable on sensitivity analysis. There was no difference in MMO between the TMJ arthrocentesis and conservative therapy groups at 1 month (MD: -0.06 95% CI: -3.67, 3.54 I=88% p = 0.97), 3 months (MD: -0.35 95% CI: -3.95, 3.25 I=89% p = 0.85) and 6 months (MD: 0.00 95% CI: -3.34, 3.34 I=86% p = 0.10).
CONCLUSION
Analysis of a small number of trials with high inter-study heterogeneity indicates that first line TMJ arthrocentesis may result in a significant but small improvement in pain scores but without any additional improvement in MMO as compared to conservative therapies. Current evidence does not provide strong support for the use of TMJ arthrocentesis as the first line of therapy for TMDs.
Topics: Humans; Arthrocentesis; Conservative Treatment; Treatment Outcome; Temporomandibular Joint Disorders; Pain
PubMed: 36084892
DOI: 10.1016/j.jormas.2022.09.004 -
Alimentary Pharmacology & Therapeutics Nov 2019Few effective treatments are available for patients with cirrhosis and refractory ascites. New treatment modalities are needed for these patients. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Few effective treatments are available for patients with cirrhosis and refractory ascites. New treatment modalities are needed for these patients.
AIM
To synthesise the available evidence on the efficacy and safety of automated low-flow ascites pump therapy in patients with cirrhosis and refractory ascites.
METHODS
Electronic databases were searched for trials evaluating automated low-flow ascites pump therapy in patients with refractory ascites.
RESULTS
Nine studies were included. Eight were case series, one was a randomised controlled trial. Pooled estimate rates were 0.62 (95% CI = 0.49-0.74) for the absence of requirement of large volume paracentesis (LVP) after pump insertion, 0.30 (95% CI = 0.17-0.47) for acute kidney injury, 0.27 (95% CI = 0.13-0.49) for bacterial peritonitis and 0.20 (95% CI = 0.09-0.37) for urinary tract infection. There was high heterogeneity between studies which was often reduced or eliminated in sensitivity analyses by excluding studies of patients with a mean or median model for end-stage liver disease (MELD) score > 15. Results of sensitivity analyses were similar to those of overall analyses. Mean increase in serum creatinine level after pump insertion was 23 µmol/L (95% CI = 10-35) with no heterogeneity between studies. The pooled estimate rate for pump-related side effects was 0.77 (95% CI = 0.64-0.87) with low heterogeneity between studies.
CONCLUSION
This meta-analysis demonstrates that most patients treated with automated low-flow ascites pump therapy do not require LVP after pump insertion. Acute kidney injury occurs in 30% of patients and creatinine levels increase by a mean of 23 µmol/L after pump insertion. Bacterial peritonitis and urinary tract infection occur in 27% and 20% of patients respectively.
Topics: Ascites; Automation; Bacterial Infections; Humans; Liver Cirrhosis; Liver Function Tests; Paracentesis; Peritonitis; Treatment Failure; Treatment Outcome
PubMed: 31583729
DOI: 10.1111/apt.15502 -
Current Cardiology Reviews 2021Pericardial Decompression Syndrome (PDS) is defined as paradoxical hemodynamic deterioration and/or pulmonary edema, commonly associated with ventricular dysfunction....
BACKGROUND
Pericardial Decompression Syndrome (PDS) is defined as paradoxical hemodynamic deterioration and/or pulmonary edema, commonly associated with ventricular dysfunction. This phenomenon was first described by Vandyke in 1983. PDS is a rare but formidable complication of pericardiocentesis, which, if not managed appropriately, is fatal. PDS, as an entity, has discrete literature; this review is to understand its epidemiology, presentation, and management.
METHODOLOGY
Medline, Science Direct and Google Scholar databases were utilized to do a systemic literature search. PRISMA protocol was employed. Abstracts, case reports, case series and clinical studies were identified from 1983 to 2019. A total of 6508 articles were reviewed, out of which, 210 were short-listed, and after removal of duplicates, 49 manuscripts were included in this review. For statistical analysis, patient data was tabulated in SPSS version 20. Cases were divided into two categories surgical and percutaneous groups. t-test was conducted for continuous variable and chi-square test was conducted for categorical data used for analysis.
RESULTS
A total of 42 full-length case reports, 2 poster abstracts, 3 case series of 2 patients, 1 case series of 4 patients and 1 case series of 5 patients were included in the study. A total of 59 cases were included in this manuscript. Our data had 45.8% (n=27) males and 54.2% (n=32) females. The mean age of patients was 48.04 ± 17 years. Pericardiocentesis was performed in 52.5% (n=31) cases, and pericardiostomy was performed in 45.8% (n=27). The most common identifiable cause of pericardial effusion was found to be malignancy in 35.6% (n=21). Twenty-three 23 cases reported pre-procedural ejection fraction, which ranged from 20%-75% with a mean of 55.8 ± 14.6%, while 26 cases reported post-procedural ejection fraction which ranged from 10%-65% with a mean of 30% ± 15.1%. Data was further divided into two categories, namely, pericardiocentesis and pericardiostomy. The outcome as death was significant in the pericardiostomy arm with a p-value of < 0.00. The use of inotropic agents for the treatment of PDS was more common in needle pericardiocentesis with a p-value of 0.04. Lastly, the computed recovery time did not yield any significance with a p-value of 0.275.
CONCLUSION
Pericardial decompression syndrome is a rare condition with high mortality. Operators performing pericardial drainage should be aware of this complication following drainage of cardiac tamponade, since early recognition and expeditious supportive care are the only therapeutic modalities available for adequate management of this complication.
Topics: Decompression; Female; Humans; Male; Pericardiocentesis; Syndrome
PubMed: 32515313
DOI: 10.2174/1573403X16666200607184501 -
Ultrasound in Obstetrics & Gynecology :... Nov 2020To assess the rate of fetal loss following amniocentesis or chorionic villus sampling (CVS) in twin pregnancy. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To assess the rate of fetal loss following amniocentesis or chorionic villus sampling (CVS) in twin pregnancy.
METHODS
MEDLINE, EMBASE and Cochrane databases were searched for studies reporting procedure-related complications following amniocentesis or CVS in twin pregnancy. The primary outcome was the rate of procedure-related fetal loss. The secondary outcomes were fetal loss occurring before 24 weeks of gestation and fetal loss occurring within 4 weeks after the procedure. Head-to-head meta-analyses were used to compare directly each outcome, between women undergoing amniocentesis and those not undergoing amniocentesis and between women undergoing CVS and those not undergoing CVS, and to compute pooled risk differences (RD) between women exposed and those not exposed to each invasive procedure. Additionally, meta-analyses of proportions were used to estimate the pooled rates of each of the three outcomes in women undergoing amniocentesis or CVS and in controls.
RESULTS
Sixteen studies (3419 twin pregnancies undergoing and 2517 not undergoing an invasive procedure) were included. Head-to-head meta-analyses comparing directly twin pregnancies undergoing and those not undergoing amniocentesis showed a higher risk for overall fetal loss in those undergoing amniocentesis (odds ratio (OR), 1.46 (P = 0.04); RD, 0.013 (P = 0.04)), while there was no difference in the risk of either fetal loss before 24 weeks of gestation (OR, 1.59 (P = 0.06); RD, 0.010 (P = 0.11)) or fetal loss within 4 weeks after the procedure (OR, 1.38 (P = 0.3); RD, 0.003 (P = 0.8)). Overall, the pooled rate of fetal loss was 2.4% (95% CI, 1.4-3.6%) in twin pregnancies undergoing amniocentesis compared with 2.4% (95% CI, 0.9-4.6%) in those not undergoing amniocentesis. Head-to-head meta-analyses directly comparing twin pregnancies undergoing and those not undergoing CVS showed no significant difference in either overall fetal loss (OR, 1.61 (P = 0.5); RD, 0.003 (P = 0.8)) or fetal loss before 24 weeks of gestation (OR, 1.61 (P = 0.5); RD, 0.003 (P = 0.8)). Overall, the pooled rate of fetal loss was 2.0% (95% CI, 0.0-6.5%) in twin pregnancies undergoing CVS compared with 1.8% (95% CI, 0.3-4.2%) in those not undergoing CVS.
CONCLUSION
The risk of fetal loss following amniocentesis and CVS in twins is lower than reported previously and the rate of fetal loss before 24 weeks of gestation, or within 4 weeks after the procedure, did not differ from the background risk in twin pregnancy not undergoing invasive prenatal testing. These data can guide prenatal counseling for twin pregnancies undergoing invasive procedures. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
Topics: Abortion, Spontaneous; Adult; Amniocentesis; Chorionic Villi Sampling; Female; Fetal Death; Humans; Odds Ratio; Pregnancy; Pregnancy, Twin; Risk Factors
PubMed: 32632979
DOI: 10.1002/uog.22143 -
International Journal of Oral and... Aug 2021The aim of this study was to assess the best timing to perform arthrocentesis in the management of temporomandibular disorders with regard to conservative treatment. A... (Meta-Analysis)
Meta-Analysis
The aim of this study was to assess the best timing to perform arthrocentesis in the management of temporomandibular disorders with regard to conservative treatment. A systematic search based on PRISMA guidelines, including a computer search with specific keywords, reference list search, and manual search was performed. Relevant articles were selected after three search rounds for final review based on six predefined inclusion criteria, followed by a round of critical appraisal. Eleven publications, including eight randomized controlled trials and three prospective clinical studies, were included in the review. The studies were divided into three groups based on the timing of arthrocentesis: (1) arthrocentesis as the initial treatment; (2) early arthrocentesis; and (3) late arthrocentesis. Meta-analysis was carried out to compare the efficacy of improvement in mouth opening and pain reduction in the three groups. All three groups showed improvement in mouth opening and pain reduction, with forest plots suggesting that arthrocentesis performed within 3 months of conservative treatment might produce beneficial results. We conclude that there is a knowledge gap in the current literature regarding the preferable timing to perform arthrocentesis in the management of temporomandibular disorders, and more high-quality randomized controlled trials are required to shed light on this subject.
Topics: Arthrocentesis; Conservative Treatment; Humans; Pain; Prospective Studies; Range of Motion, Articular; Temporomandibular Joint; Temporomandibular Joint Disorders; Treatment Outcome
PubMed: 33602649
DOI: 10.1016/j.ijom.2021.01.011 -
Surgical Laparoscopy, Endoscopy &... Dec 2020Umbilical hernia is a common abdominal complication in cirrhotic patients. The incidence of umbilical hernias can be up to 20% in the presence of ascites. However, there...
BACKGROUND
Umbilical hernia is a common abdominal complication in cirrhotic patients. The incidence of umbilical hernias can be up to 20% in the presence of ascites. However, there is no consensus regarding the optimal management of umbilical hernias in cirrhotic patients. The purpose of this study is to review the management of umbilical hernias in cirrhotic patients with ascites.
METHODS
A search of the available literature in English since 1980 was performed using PubMed, the Cochrane Library, and a search of relevant journals and reference lists. The search terms included "umbilical hernia," "ascites," "cirrhosis," and any derivatives of these terms, and the literature search identified all the relevant publications.
RESULTS
Thirty-three relevant articles published in the language of English were identified. Fourteen studies involved the management of refractory ascites in cirrhotic patients. Twenty-four studies included cirrhotic patients receiving elective or emergency surgery. Because of much lower morbidity and mortality in elective surgery than in emergency surgery, many authors advocated early elective repair of uncomplicated umbilical hernias in cirrhotic patients. Of these, 2 studies described laparoscopic umbilical hernioplasty, with a significant lower morbidity and hernia recurrence than open repair. Fifteen studies described the use of prosthetic mesh umbilical hernia repair in cirrhotic patients, which was associated with minimal wound-related morbidity and markedly lower recurrences.
CONCLUSIONS
Our results indicate that early elective repair of uncomplicated umbilical hernias is recommended in cirrhotic patients with tolerable hepatic functional reserve or when the expected time for liver transplantation is >3 months. Umbilical hernias are supposed to be corrected in the process of liver transplantation, provided that patients could have a better prospect to be transplanted within 3 months. Control of ascites is a crucial part to successful outcomes of umbilical hernia repair. Large volume paracentesis, concomitant peritoneovenous shunting with herniorrhaphy and transjugular intrahepatic portosystemic shunting can be applied to control refractory ascites. Emergency repair of umbilical hernias is indicated in cirrhotic patients with ascites when complications develop.
Topics: Humans; Ascites; Hernia, Umbilical; Herniorrhaphy; Liver Cirrhosis; Liver Transplantation
PubMed: 33347087
DOI: 10.1097/SLE.0000000000000891 -
Journal of Oral Rehabilitation Jan 2021Intra-articular analgesics are increasingly being used after temporomandibular joint (TMJ) arthrocentesis but without clear evidence on its efficacy. The aim of this... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Intra-articular analgesics are increasingly being used after temporomandibular joint (TMJ) arthrocentesis but without clear evidence on its efficacy. The aim of this study was to review the role of intra-articular analgesic injected after TMJ arthrocentesis in improving post-operative outcomes.
METHODS
PubMed, Embase, Scopus, BioMed Central, CENTRAL and Google Scholar databases were searched from inception up to 15th April 2020. Randomised controlled trials (RCTs) on adult patients with temporomandibular joint disorders (TMDs) comparing any intra-articular analgesic with control after arthrocentesis were included. Risk of bias was assessed by Cochrane Collaboration's Risk of Bias-2 tool.
RESULTS
Nine RCTs were included. Four studies used non-steroidal anti-inflammatory drugs (NSAIDs) and five used opioids after arthrocentesis. Descriptive analysis of NSAID studies indicated that intra-articular NSAIDs may not improve pain and maximal mouth opening (MMO) after TMJ arthrocentesis. Meta-analysis indicated a statistically significant reduction of pain with the use of opioids at 1 week, 1, 3, and 6 months. Similarly, MMO was significantly improved with intra-articular opioids at 1 week, 1 and 6 months. Data were analysed from a limited number of studies with a small sample size. The quality of the included studies was low.
CONCLUSIONS
Low-quality evidence suggests that intra-articular NSAIDs may have no effect on pain and MMO after TMJ arthrocentesis. Intra-articular opioids may improve pain and MMO at short-term follow-up. Results are to be interpreted with caution considering several limitations of the review. Further high-quality trials with large sample size are needed to provide better evidence.
Topics: Adult; Analgesics; Anti-Inflammatory Agents, Non-Steroidal; Arthrocentesis; Humans; Injections, Intra-Articular; Range of Motion, Articular; Temporomandibular Joint; Temporomandibular Joint Disorders; Treatment Outcome
PubMed: 33002200
DOI: 10.1111/joor.13105