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The Korean Journal of Gastroenterology... Jun 2024This case report presents the successful endoscopic submucosal dissection (ESD) of a well-differentiated esophageal liposarcoma in a 51-year-old male with persistent...
This case report presents the successful endoscopic submucosal dissection (ESD) of a well-differentiated esophageal liposarcoma in a 51-year-old male with persistent dysphagia. The cause was initially diagnosed as a 10 cm pedunculated lesion extending from the upper esophageal sphincter to the mid-esophagus. An ESD was chosen over traditional surgery because it is less invasive. The procedure involved a precise submucosal injection and excision with special techniques to manage bleeding from a central vessel. Despite the extraction challenges owing to the size of the lesion, it was successfully removed orally. A histopathological examination of the 8.3×4.2×2.3 cm specimen revealed the characteristic features of a well-differentiated liposarcoma, including MDM2 and CDK4 positivity. The follow-up revealed no recurrence, and active surveillance has been performed since. This report highlights the versatility of ESD in treating significant esophageal tumors and provides evidence for its efficacy as a minimally invasive alternative.
Topics: Humans; Male; Esophageal Neoplasms; Middle Aged; Endoscopic Mucosal Resection; Liposarcoma; Tomography, X-Ray Computed; Cyclin-Dependent Kinase 4; Proto-Oncogene Proteins c-mdm2; Esophagoscopy
PubMed: 38918037
DOI: 10.4166/kjg.2024.047 -
Frontiers in Neurology 2024This systematic review and meta-analysis aims to systematically evaluate the effectiveness and safety of acupuncture in the treatment of aspiration caused by post-stroke...
OBJECTIVE
This systematic review and meta-analysis aims to systematically evaluate the effectiveness and safety of acupuncture in the treatment of aspiration caused by post-stroke dysphagia.
METHODS
A computer search was conducted in nine databases, including the China National Knowledge Infrastructure (CNKI), China Science and Technology Journal (VIP), Wan-fang Database, China Biomedical Literature Database (CBM), PubMed, Web of Science, Cochrane Library, Embase, and Chinese Clinical Trial Registry (ChiCTR), from their inception until April 2024. Clinical randomized controlled trials comparing acupuncture combined therapy or single therapy with control interventions for the treatment of aspiration caused by post-stroke dysphagia were included. The primary outcome measure was the Penetration Aspiration Scale (PAS), and secondary outcome measures included the overall effective rate, video fluoroscopic swallowing study (VFSS), and hyoid bone displacement. The statistical analysis was performed using RevMan 5.3 and Stata 16.0.
RESULTS
A total of 16 articles involving 1,284 patients were included. The meta-analysis results showed that acupuncture combined therapy or single therapy was more effective in improving PAS scores compared to conventional rehabilitation therapy or balloon dilation of the catheter [WMD = -1.05, 95% CI (-1.30, -0.80), = 0.82, = 0.00 < 0.05]. It was also more effective in improving VFSS scores [WMD = 1.32, 95% CI (0.08, 2.55), = 2.09, = 0.04 < 0.05] and hyoid bone displacement [WMD = 2.02, 95% CI (0.86, 3.18), = 3.41, = 0.00 < 0.05]. Additionally, acupuncture had a higher overall effective rate [WMD = 1.21, 95% CI (1.14, 1.29), = 5.76, = 0.00 < 0.05] and a lower incidence of adverse events. Sensitivity analysis indicated that the literature had minimal impact on the results, and bias tests showed no publication bias.
CONCLUSION
Acupuncture combined therapy and acupuncture single therapy can effectively improve aspiration caused by post-stroke dysphagia with a low incidence of adverse events. However, due to the low quality of the included literature, more high-quality randomized controlled trials are still needed to confirm the effectiveness and safety of acupuncture in the treatment of aspiration caused by post-stroke dysphagia.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023462707, identifier CRD42023462707.
PubMed: 38915795
DOI: 10.3389/fneur.2024.1305056 -
BMJ Neurology Open 2024Dystonia is a genetic or non-genetic movement disorder with typical patterned and twisting movements due to abnormal muscle contractions that may be associated with...
BACKGROUND
Dystonia is a genetic or non-genetic movement disorder with typical patterned and twisting movements due to abnormal muscle contractions that may be associated with tremor. Genetic and phenotypic heterogeneity leads to variable clinical presentation.
METHODOLOGY
Next-generation sequencing technologies are being currently used in the workup of patients with inherited dystonia to determine the specific cause in the individuals with autosomal dominant, recessive, X-linked or mitochondrial inheritance patterns. Calcium voltage-gated channel subunit alpha1 A (CACNA1A) gene variants are rare in dystonias.
RESULTS
We here present a 20-year-old man with a history of delayed milestones, flexor posturing, dysarthria, dysphagia and a negative family history from consanguineous parents. Neurological examination revealed right lateral scoliosis of the neck and generalised dystonic posturing affecting both upper and lower limbs. MRI of the brain was unremarkable. Molecular genetic results revealed a heterozygous variant in the CACNA1A gene (CHR19: NM_023035.2, c. 1602G>A; p. Met534Ile). Segregation analyses in both the parents revealed wild-type CACNA1A gene suggesting de novo nature of the variant with a likely pathogenic classification.
CONCLUSION
Dystonia is one of the clinical phenotypes that can be associated with CACNA1A gene mutations and we recommend that this gene either be included in the dystonia panel offered or tested when the initial primary genetic result is negative.
PubMed: 38912174
DOI: 10.1136/bmjno-2024-000710 -
Clinical Interventions in Aging 2024Stroke-associated pneumonia (SAP) usually complicates stroke and is linked to adverse prognoses. Triglycerides, total cholesterol, and body weight index (TCBI) is a new...
PURPOSE
Stroke-associated pneumonia (SAP) usually complicates stroke and is linked to adverse prognoses. Triglycerides, total cholesterol, and body weight index (TCBI) is a new and simple calculated nutrition index. This study seeks to investigate the association between TCBI and SAP incidence, along with its predictive value.
PATIENTS AND METHODS
Nine hundred and sixty-two patients with acute ischemic stroke were divided into SAP group and Non-SAP group. The TCBI was divided into three layers: T1, TCBI < 948.33; T2, TCBI 948.33-1647.15; T3, TCBI > 1647.15. Binary Logistic regression analysis was used to determine the relationship between TCBI levels and the incidence of SAP. Furthermore, restricted cubic splines (RCS) analysis was utilized to evaluate the influence of TCBI on the risk of SAP.
RESULTS
TCBI in the SAP group was markedly lower compared to that in the Non-SAP group ( < 0.001). The Logistic regression model revealed that, using T3 layer as the reference, T1 layer had the highest risk for SAP prevalence (OR = 2.962, 95% CI: 1.600-5.485, = 0.001), with confounding factors being controlled. The RCS model found that TCBI had a linear relationship with SAP ( for nonlinear = 0.490, for overall = 0.004). Moreover, incorporating TCBI into the ADS (Age, atrial fibrillation, dysphagia, sex, and severity) model substantially enhanced the initial model's predictive accuracy.
CONCLUSION
Low TCBI was associated with a higher risk of SAP. In clinical practice, TCBI has shown predictive value for SAP, contributing to early intervention and treatment of SAP.
Topics: Humans; Male; Female; Aged; Ischemic Stroke; Middle Aged; Pneumonia; Triglycerides; Cholesterol; Logistic Models; Risk Factors; Body Weight; Incidence; Retrospective Studies; Aged, 80 and over; Body Mass Index
PubMed: 38911675
DOI: 10.2147/CIA.S467577 -
Journal of Neuroendovascular Therapy 2024To report the rare case of a patient with a perianeurysmal cyst following stent-assisted coil embolization of an unruptured vertebral artery aneurysm.
OBJECTIVE
To report the rare case of a patient with a perianeurysmal cyst following stent-assisted coil embolization of an unruptured vertebral artery aneurysm.
CASE PRESENTATION
A 63-year-old woman underwent stent-assisted coil embolization for an unruptured vertebral artery aneurysm embedded in the brainstem (pons). Complete occlusion of the aneurysm was successfully achieved. However, subsequent magnetic resonance imaging (MRI) conducted 8 months after the procedure showed perilesional edematous changes surrounding the aneurysm, and at 20 months, cyst formation was observed in the vicinity of the aneurysm. Progressive enlargement of the cyst eventually led to the development of paralysis and dysphagia, necessitating cyst fenestration surgery. Although postoperative reduction in the cyst size was achieved, the patient experienced complications in the form of aspiration pneumonia and bacterial meningitis, which resulted in a life-threatening condition.
CONCLUSION
Aneurysms embedded in the brain parenchyma should be carefully followed up, recognizing the risk of perianeurysmal cyst formation after coil embolization.
PubMed: 38911484
DOI: 10.5797/jnet.cr.2023-0088 -
SAGE Open Medical Case Reports 2024Pancreatitis can produce several complications such as pseudocyst, which can happen in acute and chronic pancreatitides. Pseudocysts are typically found in the abdomen...
Pancreatitis can produce several complications such as pseudocyst, which can happen in acute and chronic pancreatitides. Pseudocysts are typically found in the abdomen but can rarely extend into the mediastinum. Atypical symptoms such as dyspnea, dysphagia, coughing, vomiting, abdominal or chest pain, and hemoptysis are usually the notable complaints. CT scan, MRI, and endoscopic ultrasound are valuable diagnostic modalities. Drainage and surgical removal of the pseudocyst are the treatment options. Herein, we outline the case of a young female with episodic chest and epigastric discomfort, dysphagia, and weight loss. Previously, she was incorrectly diagnosed with gastroesophageal reflux disease and peptic ulcer. A mediastinal pseudocyst secondary to chronic pancreatitis was found to be the cause. The patient underwent surgical removal of the pseudocyst and a pancreaticojejunostomy. Significant improvement was noticed at follow-up. This article highlights the possibility of such unusual conditions and the importance of a proper assessment while treating patients with epigastric pain.
PubMed: 38911178
DOI: 10.1177/2050313X241262139 -
Endoscopy Dec 2024
Topics: Humans; Suture Techniques; Esophageal Achalasia; Myotomy; Natural Orifice Endoscopic Surgery; Male; Female; Gastroscopy
PubMed: 38906173
DOI: 10.1055/a-2334-2750 -
Medicine Jun 2024This study aimed to characterize the risk factors, etiology, clinical manifestations, anatomical characteristics, stroke mechanisms, imaging features, and prognosis of... (Observational Study)
Observational Study
This study aimed to characterize the risk factors, etiology, clinical manifestations, anatomical characteristics, stroke mechanisms, imaging features, and prognosis of bilateral medial medullary infarction (BMMI). A retrospective analysis was conducted on 11 patients with BMMI who met the inclusion criteria at the Affiliated Hospital of Xuzhou Medical University from January 2013 to January 2023. The patients' imaging and clinical features were analyzed and summarized. Eleven patients (7 male, 4 female), aged 46 to 62 years, met the inclusion criteria. Common clinical presentations included dysarthria (90.9%), dysphagia (90.9%), quadriplegia (81.8%), and so on. Within 72 hours of onset, 8 cases presented with quadriplegia, 2 cases with hemiplegia, and 1 case without limb paralysis. The main risk factor for BMMI was hypertension, followed by diabetes. "Heart appearance" infarcts occurred in 4 cases (36.4%), while "Y appearance" infarcts occurred in 7 cases (63.6%). Among the patients, 3 had unilateral vertebral artery stenosis or occlusion, 5 had bilateral vertebral artery stenosis or occlusion, 2 had normal vertebral basilar artery, and 1 did not undergo cerebrovascular examination. All patients received standardized treatment for cerebral infarction. The prognosis was poor, with 81.8% of patients having an unfavorable outcome, including 1 death, 9 cases of disability, and only 1 patient achieving self-care ability after recovery. BMMI is more prevalent in males aged 45 to 60 years. The main risk factors are hypertension and diabetes. Atherosclerosis is the primary etiological subtype. The main clinical manifestations are dyskinesia, dizziness, quadriplegia, and dysarthria. The prognosis of BMMI is poor. The specific imaging features of "heart appearance" or "Y appearance" infarcts aid in the diagnosis of BMMI.
Topics: Humans; Male; Female; Middle Aged; Retrospective Studies; Medulla Oblongata; Brain Stem Infarctions; Risk Factors; Prognosis; Quadriplegia; Hypertension
PubMed: 38905383
DOI: 10.1097/MD.0000000000038336 -
Case Reports in Surgery 2024An epiphrenic diverticulum (ED) is a rare pseudodiverticulum commonly located at the lower end of the oesophagus. Surgical treatment is only required in patients with...
An epiphrenic diverticulum (ED) is a rare pseudodiverticulum commonly located at the lower end of the oesophagus. Surgical treatment is only required in patients with worsening dysphagia or repeated chest infection due to microaspirations, and most patients are now treated with minimally invasive surgery (MIS) using the laparoscopic or thoracoscopic approach. Laparoscopic surgery is considered difficult in the presence of previous perforation of the diverticula owing to the intraperitoneal and mediastinal adhesions and is associated with an increased incidence of complications. We were able to perform a laparoscopic transhiatal resection safely on a patient who had a large ED with a wide neck and dense abdominal and mediastinal adhesions due to previous localized perforation.
PubMed: 38903609
DOI: 10.1155/2024/3556567 -
Global Advances in Integrative Medicine... 2024Authoritative research demonstrating efficacy of traditional dysphagia therapy for Head & Neck Cancer (HNC) patients is limited. A 2019 survey reported...
BACKGROUND
Authoritative research demonstrating efficacy of traditional dysphagia therapy for Head & Neck Cancer (HNC) patients is limited. A 2019 survey reported speech-language-pathologists (SLPs) have started using Manual Therapy (MT) to prevent or rehabilitate dysphagia in HNC patients. This application of MT is supported theoretically but no research has established efficacy. Further, specific contents of MT protocols employed in this setting remain unknown.
OBJECTIVES
In the absence of HNC dysphagia specific MT protocols, this study aimed to better understand MT protocols employed by SLPs to prevent and treat dysphagia in HNC patients during and after Radiation Therapy (RT).
METHODS
An internet-based questionnaire for SLPs who use MT with HNC patients was developed and tested for face/content validity. It was sent to SLPs practicing in the USA, twice, through three national listservs (ASHA-SIG13, ASHA-SIG3, University of Iowa Voiceserv).
RESULTS
Of 64 respondents, 44 completed the survey. Of the 44, 15(34%) provided proactive MT during RT, 37(84%) provided proactive MT after RT (to prevent dysphagia), and 44(100%) provided reactive MT after RT (to treat dysphagia). 40(91%) were trained in MT through a CE course and 25(57%) had HNC-specific MT training. The most common MT techniques were laryngeal manipulation (LM) and myofascial release (MFR). During RT, MT protocols are gentler and highly tailored, with simple home programs of mild intensity. After RT, protocols are more regimented and aggressive, but still highly customized, with more diverse home programs of at least moderate intensity.
CONCLUSION
MT for HNC patients lacks a standard protocol or approach, but MFR and LM, or components of those techniques, are used most frequently. Given the frequency with which MFR and LM are employed to treat dysphagia during and post-RT, and the lack of empirical evidence supporting or refuting their use, a collaboratively designed RCT is warranted to establish the safety and efficacy of MT for HNC patients.
PubMed: 38903482
DOI: 10.1177/27536130241263349