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Cureus Apr 2024Background The anterior iliac crest is the workhorse for the harvest of cancellous bone in children undergoing cleft alveolar bone grafting. However, the complexity of...
Background The anterior iliac crest is the workhorse for the harvest of cancellous bone in children undergoing cleft alveolar bone grafting. However, the complexity of the anatomy makes the process of harvesting graft technique sensitive. The aim was to describe the outcomes of the medially based trap door method of graft harvest in pediatric patients undergoing cleft alveolar bone grafting. Methods A cohort study was conducted, including all the patients in the age group of 8-12 years. Alveolar bone grafting was performed after harvesting a cancellous graft from the iliac crest bone grafting (ICBG) using a medially based trap door approach. Intraoperative time, average blood loss, and postoperative outcomes, including pain score, paresthesia, and gait disturbances, were recorded. Results A total of 28 patients were included in the study based on the inclusion and exclusion criteria. The volume of cancellous bone harvested was between 4-9 cc. The mean intraoperative time was 42 minutes, with an average blood loss of 36 to 48 ml. The average visual analog scale (VAS) score in the postoperative period was 3.5, 6, and 4 on the first, third, and seventh postoperative days. All the patients were ambulated on the second postoperative day, and none of them reported paresthesia. Long-term evaluation of the anterior illum revealed intact crestal morphology with a bone refill on the posterior-anterior (PA) pelvic X-ray. Conclusion A medially based modified trap door approach is more efficacious and less morbid for the harvest of ICBG in pediatric patients.
PubMed: 38738000
DOI: 10.7759/cureus.58020 -
Radiology Case Reports Aug 2024Bony hemangiomas are benign vascular lesions with an expansive growth; usually they tend to obliterate the entire bony cavity. They are typical lesion of the spinal...
Coexistence of mastoid, frontal and vertebral hemangiomas in a patient with diabetic neuropathy: Possible correlation between diabetic angiopathy and intraosseous neoangiogenesis.
Bony hemangiomas are benign vascular lesions with an expansive growth; usually they tend to obliterate the entire bony cavity. They are typical lesion of the spinal bones, but they can rarely arise within other bones of the neurocranium. Diabetic microangiopathy is a condition characterized by the development of aberrant vessel tangles anastomosed to each other due to dysregulated neoangiogenesis. We report the case of a 56-year-old woman, suffering from type 2 diabetes mellitus, admitted to the neurology department due to a reported worsening of paresthesias and dysesthesias of the upper and lower limbs. She performed a contrast-enhanced brain CT scan that showed the presence, at the level of the right mastoid process, of an hypervascular angioma. A subsequent MRI study of the brain and spine showed the presence of multiple bone angiomas, at the level of the right frontal theca and C7, Th3, and Th7 vertebral bodies. Due to the absence of further symptoms and clinical and radiological signs of intracranial compression, the patient did not perform surgery. A radiological follow-up was advised. Although possible pathophysiological correlations between diabetes and vertebral hemangiomas are mentioned in literature, vascular lesions of this type involving vertebrae and skull base simultaneously can be discovered in a patient with chronic diabetic disease. As long as these lesions remain asymptomatic, surgical treatment is not indicated, and the patient is followed over time with radiological follow-up.
PubMed: 38737173
DOI: 10.1016/j.radcr.2024.03.087 -
The Israel Medical Association Journal... May 2024The recreational use of nitrous oxide (N2O) has increased in recent years with a noticeable surge in the incidence of nitrous oxide-related myeloneuropathy.
BACKGROUND
The recreational use of nitrous oxide (N2O) has increased in recent years with a noticeable surge in the incidence of nitrous oxide-related myeloneuropathy.
OBJECTIVES
To raise awareness of increasing myeloneuropathy due to recreational nitrous oxide misuse in Israel.
METHODS
We conducted a case series documenting the clinical and investigative features of eight patients presenting with nitrous oxide-induced myeloneuropathy who were admitted to our departments.
RESULTS
Paresthesia was the chief complaint in all patients, with sensory gait ataxia being a common feature, which was often accompanied by Romberg's sign and mild lower limb weakness. Vitamin B12 levels were below the normal range in seven patients, accompanied by elevated homocysteine and methylmalonic acid levels. Magnetic resonance imaging scans revealed hyperintense signals in the dorsal columns of the cervical spine. All patients improved following vitamin B12 injections.
CONCLUSIONS
Enhancing awareness, prompting the use of appropriate investigations, and advocating for timely treatment are needed to overcome the risks associated with nitrous oxide misuse.
Topics: Humans; Nitrous Oxide; Male; Adult; Vitamin B 12; Female; Israel; Magnetic Resonance Imaging; Spinal Cord Diseases; Paresthesia; Middle Aged; Recreational Drug Use; Gait Ataxia; Young Adult; Substance-Related Disorders; Vitamin B 12 Deficiency
PubMed: 38736344
DOI: No ID Found -
International Journal of Surgery Case... Jun 2024Odontogenic keratocysts (OKC) are benign intraosseous cysts with expansive growth. They account for approximately 7.8 % of all jaw cysts and have a high recurrence...
Clinical and radiological documentation of complete remodeling of the mandibular bone after the enucleation of a large odontogenic keratocyst: 15 years follow-up of a unique case - A case report.
INTRODUCTION AND IMPORTANCE
Odontogenic keratocysts (OKC) are benign intraosseous cysts with expansive growth. They account for approximately 7.8 % of all jaw cysts and have a high recurrence rate. Herein, we present a minimally invasive approach for the surgical treatment of a remarkable variation of OKC with a 15-year radiological and clinical follow-up.
PRESENTATION OF THE CASE
We present the case of a 42-year-old female patient with a large cyst in the mandible between teeth 35 and 45, who reported spontaneous swelling and paresthesia of the lower lip. Radiological imaging is crucial for treatment planning. The cyst was surgically treated with a single enucleation combined with adjuvant therapy to minimise recurrence. A titanium plate was inserted because of the size of the defect. Recurrence was observed one year later and treated with single enucleation and adjuvant therapy. After 15 years, complete healing, no signs of recurrence, and complete remodeling of the mandible were observed.
CLINICAL DISCUSSION
The treatment of OKC remains the subject of varying approaches in the literature due to the lack of established general guidelines. One treatment option is single enucleation combined with adjuvant therapy to minimise recurrence, which can result in complete clinical and radiological remodeling of the bone.
CONCLUSION
Direct enucleation combined with adjuvant therapy is a practical approach for treating large OKCs. It is associated with less morbidity and burden on the patient than enucleation with prior decompression or radical resection. Additionally, it shows no deficits in bone defect healing.
PubMed: 38735217
DOI: 10.1016/j.ijscr.2024.109752 -
BMC Psychiatry May 2024Restless arms syndrome (RAS) is the most common variant of restless legs syndrome (RLS), which is easy to be ignored in clinical practice due to the lack of specific...
BACKGROUND
Restless arms syndrome (RAS) is the most common variant of restless legs syndrome (RLS), which is easy to be ignored in clinical practice due to the lack of specific diagnostic criteria. When effective therapeutic agents induced RAS and symptoms persisted after briefly observation, clinicians will face the challenge of weighing efficacy against side effects.
CASE PRESENTATION
A 67-year-old woman was admitted to a geriatric psychiatric ward with depression. Upon admission, the escitalopram dose was reduced from 15 mg to 10 mg per day, and the duloxetine dose was increased from 60 mg to 80 mg per day. The next night before bedtime, she developed itching and creeping sensations deep inside bilateral shoulders and arms, with the urge to move, worsening at rest, and alleviation after hammering. The symptoms persisted when escitalopram was discontinued. A history of RLS was confirmed. Treatment with 40 mg of duloxetine and 0.125 mg of pramipexole significantly improved depression, and the paresthesia disappeared, with no recurrence occurring 6 months after discharge.
DISCUSSION AND CONCLUSIONS
This case suggests that psychiatrists should pay attention to RLS variants when increasing doses of duloxetine. Long-term improvement can be achieved through dosage reduction combined with dopaminergic drugs instead of immediate discontinuation.
Topics: Aged; Female; Humans; Antidepressive Agents; Duloxetine Hydrochloride; Phenotype; Pramipexole; Restless Legs Syndrome; Serotonin and Noradrenaline Reuptake Inhibitors
PubMed: 38730422
DOI: 10.1186/s12888-024-05763-7 -
Cureus Apr 2024The worldwide mass vaccination campaign against COVID-19 has been the largest one ever undertaken. Although the short-term safety profile of the different vaccines has...
The worldwide mass vaccination campaign against COVID-19 has been the largest one ever undertaken. Although the short-term safety profile of the different vaccines has been well established, neuroinflammatory complications have been described, including rare cases of acute demyelinating inflammatory polyneuropathy. We report a 63-year-old man who presented to the emergency department with proximal muscle weakness and paresthesia. He had received the first dose of the AZD1222 SARS-CoV-2 vaccine (Oxford, AstraZeneca) two weeks before presentation. The diagnosis of Guillain-Barré syndrome (GBS) was confirmed by clinical features, cerebrospinal fluid analysis, and electromyography. On the second hospital day, progression to flaccid tetraplegia, cranial nerve involvement, and respiratory failure, requiring invasive mechanical ventilation, were noted, and he was admitted to the intensive care unit. Despite the prompt diagnosis and immunosuppressive treatment initiation, the patient was left with severe disability. Although the COVID-19 vaccination was generally safe and socially beneficial, individual adverse reactions, including neuroinflammatory severe complications, may occur.
PubMed: 38711707
DOI: 10.7759/cureus.57705 -
Medicine May 2024To illustrate the clinical characteristics and prognostic factors of adult patients pathologically confirmed with brainstem gliomas (BSGs). Clinical data of 40 adult... (Observational Study)
Observational Study
To illustrate the clinical characteristics and prognostic factors of adult patients pathologically confirmed with brainstem gliomas (BSGs). Clinical data of 40 adult patients pathologically diagnosed with BSGs admitted to Beijing Shijitan Hospital from 2009 to 2022 were recorded and retrospectively analyzed. The primary parameters included relevant symptoms, duration of symptoms, Karnofsky performance status (KPS), tumor location, type of surgical resection, diagnosis, treatment, and survival. Univariate and multivariate analyses were evaluated by Cox regression models. The gliomas were located in the midbrain of 9 patients, in the pons of 14 cases, in the medulla of 5 cases, in the midbrain and pons of 6 cases and invading the medulla and pons of 6 cases, respectively. The proportion of patients with low-grade BSGs was 42.5%. Relevant symptoms consisted of visual disturbance, facial paralysis, dizziness, extremity weakness, ataxia, paresthesia, headache, bucking, dysphagia, dysacousia, nausea, dysphasia, dysosmia, hypomnesia and nystagmus. 23 (57.5%) patients accepted stereotactic biopsy, 17 (42.5%) patients underwent surgical resection. 39 patients received radiotherapy and 34 cases were treated with temozolomide. The median overall survival (OS) of all patients was 26.2 months and 21.5 months for the median progression-free survival (PFS). Both duration of symptoms (P = .007) and tumor grading (P = .002) were the influencing factors for OS, and tumor grading was significantly associated with PFS (P = .001). Duration of symptoms for more than 2 months and low-grade are favorable prognostic factors for adult patients with BSGs.
Topics: Humans; Male; Female; Retrospective Studies; Adult; Brain Stem Neoplasms; Middle Aged; Glioma; Prognosis; Young Adult; Karnofsky Performance Status; Aged
PubMed: 38701282
DOI: 10.1097/MD.0000000000037910 -
Monaldi Archives For Chest Disease =... May 2024We describe the case of a 45-year-old female affected by asthma and nasal polyposis who presented to the emergency department because of worsening dyspnea and...
We describe the case of a 45-year-old female affected by asthma and nasal polyposis who presented to the emergency department because of worsening dyspnea and paresthesia of the left lower limb. Comprehensive instrumental examinations revealed the presence of severe left ventricle dysfunction, intra-cardiac thrombus, deep vein thrombosis, pulmonary embolism, lung infiltrates, polyserositis, and neurological involvements. Finally, the patient was diagnosed with eosinophilic granulomatosis with polyangiitis (EGPA), formerly Churg-Strauss syndrome, a rare vasculitis of small-medium blood vessels with several organ involvements. Treatment with anticoagulants, corticosteroids, and cyclophosphamide led to a significant clinical improvement. However, a subcutaneous cardiac defibrillator was implanted because of the persistence of severe left ventricular dysfunction and the high cardiovascular risk phenotype. Indeed, several cardiac manifestations may occur in EGPA, particularly in patients with anti-neutrophil cytoplasmic antibody-negative disease. Therefore, clinicians should have high clinical suspicion because cardiac involvement in EGPA results in a poor prognosis if not diagnosed and adequately treated.
PubMed: 38700128
DOI: 10.4081/monaldi.2024.2882 -
Skin Research and Technology : Official... May 2024Notalgia paresthetica (NP) is a rare condition characterized by localized pain and pruritus of the upper back, associated with a distinct area of hyperpigmentation....
BACKGROUND
Notalgia paresthetica (NP) is a rare condition characterized by localized pain and pruritus of the upper back, associated with a distinct area of hyperpigmentation. Given the lack of standardized treatment and the uncertain efficacy of available options, applying procedural methods is of growing interest in treating NP.
AIMS
We sought to comprehensively evaluate the role of procedural treatments for NP.
METHODS
We systematically searched PubMed/Medline, Ovid Embase, and Web of Science until November 14th, 2023. We also performed a citation search to detect all relevant studies. Original clinical studies published in the English language were included.
RESULTS
Out of 243 articles, sixteen studies have reported various procedural modalities, with or without pharmacological components, in treating NP. Pharmacological procedures, including injections of botulinum toxin, lidocaine, and corticosteroids, led to a level of improvement in case reports and case series. However, botulinum toxin did not show acceptable results in a clinical trial. Moreover, non-pharmacological procedures were as follows: physical therapy, exercise therapy, kinesiotherapy, acupuncture and dry needling, electrical muscle stimulation, surgical decompression, and phototherapy. These treatments result in significant symptom control in refractory cases. Physical therapy can be considered a first-line choice or an alternative in refractory cases.
CONCLUSION
Procedural modalities are critical in the multidisciplinary approach to NP, especially for patients who are refractory to topical and oral treatments. Procedural modalities include a spectrum of options that can be applied based on the disease's symptoms and severity.
Topics: Humans; Pruritus; Lidocaine; Paresthesia; Hyperpigmentation; Physical Therapy Modalities; Acupuncture Therapy; Botulinum Toxins; Anesthetics, Local; Exercise Therapy; Adrenal Cortex Hormones; Dry Needling
PubMed: 38696233
DOI: 10.1111/srt.13723 -
National Journal of Maxillofacial... 2024Condylar osteomyelitis is a long-standing infection of the condylar head of the mandible. The chronic progression of this disease can lead to the destruction of...
Condylar osteomyelitis is a long-standing infection of the condylar head of the mandible. The chronic progression of this disease can lead to the destruction of surrounding bony structures and can ultimately affect function. Currently, in English Literature, there have been few cases published on condylar osteomyelitis. Interestingly, regardless of proximity, there have only been two other reported cases of condylar osteomyelitis subsequent to extractions of the upper maxillary third molar. We report a case of a 27-year-old female who presented with an acute episode of condylar osteomyelitis after a simple extraction of an upper left third molar. Several courses of antibiotics did not alleviate her severe trismus, paresthesia, or extensive preauricular collection. Three surgical interventions showed negative growth on numerous swabs. However, CT scans and an MRI confirmed extensive osteomyelitis along the left head, neck, and the angle of the mandible. Following inpatient IV antibiotics, the patient was discharged with a PICC line to allow for long-term treatment. An improvement in function, pain, and swelling was seen on discharge. However, due to the nature of this disease she was monitored for 2 years and due to joint collapse has been listed for alloplastic replacement.
PubMed: 38690240
DOI: 10.4103/njms.njms_189_22