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Journal of Clinical Neuroscience :... Aug 2016Dramatic hemodynamic changes occur following resection of brain arteriovenous malformations (AVM). Transcranial Doppler (TCD) records non-invasive velocity and... (Review)
Review
Dramatic hemodynamic changes occur following resection of brain arteriovenous malformations (AVM). Transcranial Doppler (TCD) records non-invasive velocity and pulsatility parameters. We undertook a systematic review to assess AVM hemodynamics including the time course of changes in velocity and pulsatility in patients undergoing AVM resection. The review employed the Embase and Medline databases. A search strategy was designed. An initial title search for clinical series on AVM and TCD was performed followed by a search for reports on AVM and TCD. A total of 283 publications were selected. Full text analysis produced 54 studies with extractable data regarding AVM, velocity and pulsatility. Two TCD techniques were utilized: conventional "blind" TCD (blind TCD); and transcranial color duplex Doppler (TCCD). Of these, 23 publications reported on blind TCD and seven on TCCD. The presence of high velocity and low pulsatility within AVM feeding arteries preoperatively followed by a postoperative decrease in velocity and subsequent increase in pulsatility of feeding arteries is established. The time sequence of hemodynamic changes following AVM resection using TCD remains uncertain, confounded by variations in methodology and timing of perioperative measurements. Of the two techniques, TCCD reported qualitative aspects including improved differentiation of feeding arteries from draining veins. However, there are a limited number of studies supporting this conclusion. Furthermore, none report reproducible changes with time from treatment. TCCD appears to be a useful technique to analyze the hemodynamic changes occurring following treatment of AVM, however little data is available. This is a field of research that is appropriate to pursue.
Topics: Cerebrovascular Circulation; Databases, Factual; Female; Hemodynamics; Humans; Intracranial Arteriovenous Malformations; Male; Neurosurgical Procedures; Ultrasonography, Doppler, Transcranial; Vascular Surgical Procedures
PubMed: 27178113
DOI: 10.1016/j.jocn.2016.01.029 -
Annals of Anatomy = Anatomischer... Dec 2013The normal pattern of the celiac trunk (CT) implies its bifurcation to three branches, the common hepatic, the splenic and the left gastric artery. According to the... (Meta-Analysis)
Meta-Analysis Review
The normal pattern of the celiac trunk (CT) implies its bifurcation to three branches, the common hepatic, the splenic and the left gastric artery. According to the available literature the CT presents several anatomical variations. The purpose of our study is to investigate the different types of these variations, the corresponding incidences and the probable influence of genetic factors, as they are presented in the existing literature. Four databases were searched for eligible articles for the period up to January 2013 and a total of 36 studies were collected. The CT was trifurcated into the three basic branches in the 89.42% (10,906/12,196) of the cases. Bifurcation of the CT occurred in the 7.40% of the pooled samples (903/12,196). Absence of the CT was the rarest variation with a percentage of 0.38% (46/12,196), hepatosplenomesenteric trunk was found in 49 out of the 12,196 cases (0.40%) and the celiacomesenteric trunk presented an incidence of 0.76% (93/12,196). Other variations of the CT were detected in the 1.64% of the pooled cases (199/12,196). The 14.9% of the cases in the cadaveric series (489/3278 specimens), the 10.5% in the imaging series (675/6501 specimens) and the 4.6% (104/2261) in the liver transplantation series presented variations. These differences are statistically significant (p<0.001). The Japanese and Korean populations presented more variations in the CT than Caucasians (p<0.05 and p<0.001). Negro, colored and black populations presented more variations of the CT than Indian ones (p>0.05). Using those data, a novel classification of CT variations is proposed.
Topics: Adult; Cadaver; Celiac Artery; Female; Hepatic Artery; Humans; Liver; Liver Transplantation; Male; Racial Groups; Sex Factors; Tomography, X-Ray Computed; Vascular Diseases
PubMed: 23972701
DOI: 10.1016/j.aanat.2013.06.003 -
Journal of Clinical Medicine Apr 2023Chorangiocarcinoma is a very rare and misdiagnosed placental neoplasm. The unique morphologic features of the lesion distinguish it from other trophoblastic tumors and... (Review)
Review
Chorangiocarcinoma is a very rare and misdiagnosed placental neoplasm. The unique morphologic features of the lesion distinguish it from other trophoblastic tumors and vascular abnormalities. We present a systematic review of the literature to provide clarity on chorangiocarcinoma entity and biology. A literature search was carried out in December 2022 using the keywords "Placental chorangiocarcinoma", "Chorangioma", "Placenta", and "Throphoblast proliferation". Articles published from 1988 to 2022 were obtained from Scopus, Google Scholar, and PUBMED. In our review, we examined maternal age, gestational age at the time of delivery, parity, type of pregnancy, placental weight, ultrasound features of the placenta, macroscopic examination and tumor size, microscopic examination, immunostaining, maternal beta-human chorionic gonadotropin, fetal and maternal outcome. Eight manuscripts were detected. They are all case reports. The macroscopic characteristics of the lesions were represented by the presence of a grey-yellow-white color well-demarcated round nodule. Microscopically, all the authors described typical aspects of malignancy as a high rate of mitosis, nuclear atypia and necrotic areas. In some cases, the presence of AE1/AE3 cytoplasmic positivity, p63 nuclear staining, and beta-human chorionic gonadotropin (BHCG) were reported. A good fetal outcome was reported in all cases of newborns with normal birth weight, except one with fetal growth restriction. Maternal outcome was good in all cases except one with maternal lung metastasis three months after delivery. The clinical course has probably underestimated the real incidence of the pathology. Only greater knowledge of its histology and its clinical course will allow us to evaluate the real prevalence of the disease.
PubMed: 37176506
DOI: 10.3390/jcm12093065 -
Journal of Plastic, Reconstructive &... Mar 2024Implant-based breast augmentations and reconstructions are one of the most common surgical procedures performed by plastic surgeons in the United States, which has... (Review)
Review
INTRODUCTION
Implant-based breast augmentations and reconstructions are one of the most common surgical procedures performed by plastic surgeons in the United States, which has rapidly increased in popularity since the 2000s. Silicone lymphadenopathy (SL) is a complication of breast implants that involves migration of silicone to nearby soft tissue/lymph nodes. Data on its clinical features and management is scarce.
METHODS
SL-related search terms were used to find articles in 3 databases. Of 598 articles, 101 studies met the inclusion criteria. Demographics, clinical presentation, workup, and management data were analyzed.
RESULTS
Of 279 cases of SL and 107 with information on initial diagnosis, 35 (33%) were incidental. The most common symptom was painless lymphadenopathy, followed by painful lymphadenopathy. 251 (95%) and 13 (5%) patients had silicone and saline implants, respectively. 149 (68%) patients had implant rupture. Axillary lymphadenopathy was the most affected region (136 cases, 72%), followed by internal mammary (40 cases, 21%), cervical/supraclavicular (36 cases, 19%), and mediastinal (24 cases, 13%) regions. 25% of patients underwent fine-needle aspiration, 12% core needle biopsy, and 59% excisional biopsy. 32% of cases underwent explantation and/or implant exchange. The most common indication for surgery was implant rupture. Histology showed multinucleated giant cells, large histiocytes, and silicone accumulation.
CONCLUSIONS
SL is a complication associated with breast implants. The majority of patients are asymptomatic, and most cases are managed conservatively. Minority need a biopsy and surgical interventions due to abnormal imaging, persistent symptoms, and/or implant rupture. Workup and management should be tailored to the patient.
Topics: Humans; Silicone Gels; Prevalence; Lymphadenopathy; Breast Implants; Breast Implantation
PubMed: 38364672
DOI: 10.1016/j.bjps.2024.01.011 -
The Journal of Pediatrics Jan 2016To determine the proportion of children aged <2 years who have been asphyxiated presenting with epistaxis in the absence of trauma or medical explanation and to... (Review)
Review
OBJECTIVE
To determine the proportion of children aged <2 years who have been asphyxiated presenting with epistaxis in the absence of trauma or medical explanation and to identify the characteristics of the clinical presentation indicative of asphyxiation.
STUDY DESIGN
An all-language systematic review was conducted by searching 10 databases from 1900 to 2015 and gray literature to identify high-quality studies that included children with epistaxis aged <2 years (alive or dead) with explicit confirmation of intentional or unintentional asphyxiation (upper airway obstruction). Studies of traumatic or pathological epistaxis were excluded. For each comparative study, the proportion of children presenting with epistaxis that were asphyxiated is reported with 95% CI.
RESULTS
Of 2706 studies identified, 100 underwent full review, resulting in 6 included studies representing 30 children with asphyxiation-related epistaxis and 74 children with non-asphyxiation-related epistaxis. The proportion of children presenting with epistaxis that had been asphyxiated, reported by 3 studies, was between 7% and 24%. Features associated with asphyxiation in live children included malaise, altered skin color, respiratory difficulty, and chest radiograph abnormalities. There were no explicit associated features described among those children who were dead on arrival.
CONCLUSION
There is an association between epistaxis and asphyxiation in young children; however, epistaxis does not constitute a diagnosis of asphyxia in itself. In any infant presenting with unexplained epistaxis, a thorough investigation of etiology is always warranted, which must include active exploration of asphyxia as a possible explanation.
Topics: Asphyxia; Epistaxis; Humans; Infant; Probability
PubMed: 26507155
DOI: 10.1016/j.jpeds.2015.09.043 -
Acta Ophthalmologica May 2021To review studies focusing on cilioretinal arteries (CLRA) in order to assess the overall prevalence and establish the prevalence of CLRA in a Hungarian Caucasian...
PURPOSE
To review studies focusing on cilioretinal arteries (CLRA) in order to assess the overall prevalence and establish the prevalence of CLRA in a Hungarian Caucasian population. METHODS #1: Systematic literature review of published studies with at least 100 participants. METHODS #2: Non-mydriatic digital colour photographs were taken of 1000 consecutively enrolled healthy Caucasian young adult volunteers. Images were graded by two trained independent observers. Number and location of identified cilioretinal arteries were recorded and statistically analysed. RESULTS #1: Prevalence of CLRA ranges from 6.9% to 49.5%. Detection with fluorescein angiography yields the highest values followed by fundus photography and ophthalmoscopy. Unilateral presence of CLRA is between 70.30% and 93.65%, and temporal location is between 80.77% and 100%. RESULTS #2: We found at least one CLRA in 36.5% of the participants and in 22.75% of all the examined eyes. Cilioretinal arteries (CLRA) were unilateral in 75.34% and bilateral in 24.66%. Of all the identified CLRA, 96.16% were originating from the temporal rim of the optic disc. We identified at least one temporal CLRA supplying the macula in 28% of the participants and 16.95% of the examined eyes.
CONCLUSION
Prevalence of CLRA varies depending on identification method. Unilateral presence is unequivocally more frequent similarly to temporal location. From a risk of bias standpoint, high-quality studies are rare. Our data on the distribution pattern of CLRA are similar to that in the international literature. Based on our findings, we assume that slightly more than one-third of the Hungarian Caucasian population has a CLRA.
Topics: Ciliary Arteries; Cross-Sectional Studies; Female; Humans; Male; Prevalence; Prospective Studies; Retinal Artery; Retinal Diseases
PubMed: 32833328
DOI: 10.1111/aos.14592 -
Journal of the American Academy of... Mar 2017Hair collar sign (HCS) and hair tuft of the scalp (HTS) are cutaneous signs of an underlying neuroectodermal defect, but most available data are based on case reports. (Review)
Review
BACKGROUND
Hair collar sign (HCS) and hair tuft of the scalp (HTS) are cutaneous signs of an underlying neuroectodermal defect, but most available data are based on case reports.
OBJECTIVE
We sought to define the clinical spectrum of HCS and HTS, clarify the risk for underlying neurovascular anomalies, and provide imaging recommendations.
METHODS
A 10-year multicenter retrospective and prospective analysis of clinical, radiologic, and histopathologic features of HCS and HTS in pediatric patients was performed.
RESULTS
Of the 78 patients included in the study, 56 underwent cranial and brain imaging. Twenty-three of the 56 patients (41%) had abnormal findings, including the following: (1) cranial/bone defect (30.4%), with direct communication with the central nervous system in 28.6%; (2) venous malformations (25%); or (3) central nervous system abnormalities (12.5%). Meningeal heterotopia in 34.6% (9/26) was the most common neuroectodermal association. Sinus pericranii, paraganglioma, and combined nevus were also identified.
LIMITATIONS
The partial retrospective design and predominant recruitment from the dermatology department are limitations of this study.
CONCLUSIONS
Infants with HCS or HTS are at high risk for underlying neurovascular anomalies. Magnetic resonance imaging scans should be performed in order to refer the infant to the appropriate specialist for management.
Topics: Abnormalities, Multiple; Brain; Choristoma; False Negative Reactions; False Positive Reactions; Female; Hair; Humans; Infant; Infant, Newborn; Magnetic Resonance Imaging; Male; Meninges; Multimodal Imaging; Neural Plate; Neuroimaging; Prospective Studies; Retrospective Studies; Scalp; Skull; Tomography, X-Ray Computed; Ultrasonography, Doppler, Color; Veins
PubMed: 27742172
DOI: 10.1016/j.jaad.2016.08.046 -
World Neurosurgery Aug 2022Indocyanine green videoangiography (ICG-VA) with FLOW 800 (Carl Zeiss AG) has been used as a visualization tool to guide arteriovenous malformation (AVM) surgery since...
OBJECTIVE
Indocyanine green videoangiography (ICG-VA) with FLOW 800 (Carl Zeiss AG) has been used as a visualization tool to guide arteriovenous malformation (AVM) surgery since 2011. We performed a systematic review and evaluated the quality of evidence available on this topic. In addition, we present a series of our own cases demonstrating the unique use of ICG-VA in the localization and removal of deeper seated AVMs.
METHODS
Using the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines for systematic reviews, we identified studies related to ICG-VA with FLOW 800 in AVM surgeries using search terms. The studies were screened and reviewed, and the quality of evidence was analyzed using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria. We performed a retrospective review of our own cases of AVM removal with ICG-VA and FLOW 800.
RESULTS
Our search revealed 27 relevant studies, 17 of which met our inclusion criteria. The quality of the body of evidence was determined to be "very low" using the GRADE criteria. We used ICG-VA with FLOW 800 analysis for 14 cases of microsurgical AVM removal. This technique provided unique insights into the localization of deep seated AVMs in 8 cases (57%). No residual AVM was found when assessed by the 6-month follow-up angiogram.
CONCLUSIONS
We present cases highlighting the usefulness of this technique for the localization of certain AVMs. We believe the use of ICG-VA can guide the removal of deeper seated AVMs, because it can reveal surface feeders and draining veins that can be followed to a hidden nidus. Larger, registry-based studies are needed to confirm these findings and improve the overall quality of evidence.
Topics: Arteriovenous Malformations; Cerebral Angiography; Coloring Agents; Humans; Indocyanine Green; Intracranial Arteriovenous Malformations; Neurosurgical Procedures; Retrospective Studies
PubMed: 35483570
DOI: 10.1016/j.wneu.2022.04.082 -
Health Technology Assessment... Dec 2018Endovascular abdominal aortic aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA) is less invasive than open surgery, but may be associated with important...
Contrast-enhanced ultrasound and/or colour duplex ultrasound for surveillance after endovascular abdominal aortic aneurysm repair: a systematic review and economic evaluation.
BACKGROUND
Endovascular abdominal aortic aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA) is less invasive than open surgery, but may be associated with important complications. Patients receiving EVAR require long-term surveillance to detect abnormalities and direct treatments. Computed tomography angiography (CTA) has been the most common imaging modality adopted for EVAR surveillance, but it is associated with repeated radiation exposure and the risk of contrast-related nephropathy. Colour duplex ultrasound (CDU) and, more recently, contrast-enhanced ultrasound (CEU) have been suggested as possible, safer, alternatives to CTA.
OBJECTIVES
To assess the clinical effectiveness and cost-effectiveness of imaging strategies, using either CDU or CEU alone or in conjunction with plain radiography, compared with CTA for EVAR surveillance.
DATA SOURCES
Major electronic databases were searched, including MEDLINE, EMBASE, Science Citation Index, Scopus' Articles-in-Press, Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE) and NHS Economic Evaluation Database from 1996 onwards. We also searched for relevant ongoing studies and conference proceedings. The final searches were undertaken in September 2016.
METHODS
We conducted a systematic review of randomised controlled trials and cohort studies of patients with AAAs who were receiving surveillance using CTA, CDU and CEU with or without plain radiography. Three reviewers were involved in the study selection, data extraction and risk-of-bias assessment. We developed a Markov model based on five surveillance strategies: (1) annual CTA; (2) annual CDU; (3) annual CEU; (4) CDU together with CTA at 1 year, followed by CDU on an annual basis; and (5) CEU together with CTA at 1 year, followed by CEU on an annual basis. All of these strategies also considered plain radiography on an annual basis.
RESULTS
We identified two non-randomised comparative studies and 25 cohort studies of interventions, and nine systematic reviews of diagnostic accuracy. Overall, the proportion of patients who required reintervention ranged from 1.1% (mean follow-up of 24 months) to 23.8% (mean follow-up of 32 months). Reintervention was mainly required for patients with thrombosis and types I-III endoleaks. All-cause mortality ranged from 2.7% (mean follow-up of 24 months) to 42% (mean follow-up of 54.8 months). Aneurysm-related mortality occurred in < 1% of the participants. Strategies based on early and mid-term CTA and/or CDU and long-term CDU surveillance were broadly comparable with those based on a combination of CTA and CDU throughout the follow-up period in terms of clinical complications, reinterventions and mortality. The economic evaluation showed that a CDU-based strategy generated lower expected costs and higher quality-adjusted life-year (QALYs) than a CTA-based strategy and has a 63% probability of being cost-effective at a £30,000 willingness-to-pay-per-QALY threshold. A CEU-based strategy generated more QALYs, but at higher costs, and became cost-effective only for high-risk patient groups.
LIMITATIONS
Most studies were rated as being at a high or moderate risk of bias. No studies compared CDU with CEU. Substantial clinical heterogeneity precluded a formal synthesis of results. The economic model was hindered by a lack of suitable data.
CONCLUSIONS
Current surveillance practice is very heterogeneous. CDU may be a safe and cost-effective alternative to CTA, with CTA being reserved for abnormal/inconclusive CDU cases.
FUTURE WORK
Research is needed to validate the safety of modified, more-targeted surveillance protocols based on the use of CDU and CEU. The role of radiography for surveillance after EVAR requires clarification.
STUDY REGISTRATION
This study is registered as PROSPERO CRD42016036475.
FUNDING
The National Institute for Health Research Health Technology Assessment programme.
Topics: Aortic Aneurysm, Abdominal; Contrast Media; Cost-Benefit Analysis; Endovascular Procedures; Humans; Quality-Adjusted Life Years; Technology Assessment, Biomedical; Treatment Outcome; Ultrasonography
PubMed: 30543179
DOI: 10.3310/hta22720 -
Journal of Assisted Reproduction and... Jan 2022Does existing scientific literature suggest an impact of oocyte dysmorphisms on biological or clinical outcomes of assisted reproduction treatments?
PURPOSE
Does existing scientific literature suggest an impact of oocyte dysmorphisms on biological or clinical outcomes of assisted reproduction treatments?
METHODS
Studies of interest were selected from an initial cohort of 6651 potentially relevant records retrieved. PubMed was systematically searched for peer-reviewed original papers and reviews identified by keywords and medical subject heading (MeSH) terms. The most relevant publications were critically evaluated to identify criteria for oocyte morphological evaluation and IVF outcomes. For each morphological abnormality, we generated an oocyte literature score (OLS) through the following procedure: (a) papers showing a negative, absence of, or positive correlation between a given abnormality and IVF outcome were scored 1, 0, and - 1, respectively; (b) the sum of these scores was expressed as a fraction of all analyzed papers; (c) the obtained fraction was multiplied by 10 and converted into decimal number.
RESULT
We identified eleven different dysmorphisms, of which six were extracytoplasmic (COC, zona pellucida, perivitelline space, polar body 1, shape, giant size) and five intracytoplasmic (vacuoles, refractile bodies, SER clusters, granularity, color). Among the extracytoplasmic dysmorphisms, abnormal morphology of the COC generated an OLS of 8.33, indicating a large prevalence (5/6) of studies associated with a negative outcome. Three intracytoplasmic dysmorphisms (vacuoles, SER clusters, and granularity) produced OLS of 7.14, 7.78, and 6.25, respectively, suggestive of a majority of studies reporting a negative outcome.
CONCLUSION
COC morphology, vacuoles, SER clusters, and granularity produced OLS suggestive of a prevalence of studies reporting a negative outcome.
Topics: Humans; Oocytes; Oogenesis; Zona Pellucida
PubMed: 34993709
DOI: 10.1007/s10815-021-02370-3