-
Journal of Vascular Surgery. Venous and... May 2018Venous aneurysms are uncommon vascular abnormalities that may be identified anywhere in the body. Historically, they were often misdiagnosed as soft tissue lesions, but... (Review)
Review
OBJECTIVE
Venous aneurysms are uncommon vascular abnormalities that may be identified anywhere in the body. Historically, they were often misdiagnosed as soft tissue lesions, but with the advent of readily available noninvasive imaging (such as duplex ultrasound), they can now be easily identified. Our aim was to review the presentation of venous aneurysms, available imaging modalities for defining them, and management.
METHODS
The English-language literature before March 2017 was reviewed, and only reports of primary venous aneurysms of the deep veins were included. Reports were subdivided on the basis of the location of the venous aneurysm, and reports containing sample imaging studies were referenced from Elsevier publications.
RESULTS
In total, our review identified reports of 35 head and neck venous aneurysms, 42 thoracic venous aneurysms, 152 intra-abdominal venous aneurysms, and 279 venous aneurysms of the extremities. Venous aneurysms of the lower extremity deep veins were most likely to be manifested by venous thromboembolic events, with approximately 25% to 50% of popliteal vein aneurysms presenting with pulmonary embolism. Diagnosis can be made by duplex ultrasound, computed tomography venography, magnetic resonance venography, or invasive venography. Management varies by location; most thoracic and head and neck aneurysms are observed, whereas venous aneurysms of the extremities are treated with surgical intervention, given the potential for venous thromboembolism. Few reports describe endovascular management of these lesions, so open surgical intervention remains the standard of care.
CONCLUSIONS
Venous aneurysms are rare vascular malformations that occur throughout the body. Many are identified on routine imaging ordered for other indications, whereas venous aneurysms of the deep veins of the extremities are often manifested with venous thromboembolism. Management of these lesions is determined largely by location and the potential morbidity and mortality of the untreated aneurysms vs surgery; aneurysms of the head and neck and thorax are managed with observation and serial imaging over time, whereas those of the abdomen and extremities are treated with surgical intervention. Endovascular techniques continue to lack a defined role in their management, and the standard of care remains open repair, when indicated.
Topics: Aneurysm; Humans; Jugular Veins; Magnetic Resonance Angiography; Mesenteric Veins; Phlebography; Popliteal Vein; Subclavian Vein; Tomography, X-Ray Computed; Ultrasonography, Doppler, Duplex
PubMed: 29661366
DOI: 10.1016/j.jvsv.2017.11.014 -
Journal of Vascular Surgery Jun 2016Visceral artery aneurysms as a result of arterial degenerative disease are rare (0.1%-2%), and the superior mesenteric artery (SMA) accounts for 3.2% of all reported... (Review)
Review
OBJECTIVE
Visceral artery aneurysms as a result of arterial degenerative disease are rare (0.1%-2%), and the superior mesenteric artery (SMA) accounts for 3.2% of all reported series. The current incidence of inferior mesenteric artery (IMA) aneurysm is unknown. However, infective causes (mycotic) of SMA and IMA aneurysm as a result of primary, secondary, and cryptogenic etiology remain a separate entity and attain fewer cases in the literature. Currently, there is no consensus on their presentation, diagnosis, and overall management.
METHODS
A systematic review and meta-aggregation of literature from 1944 to March 2015 in the English language and of adult subjects in MEDLINE, Ovid, CINAHL, and the Cochrane database was conducted.
RESULTS
The median age of patients with SMA aneurysm was 36 (range, 14-92) years, with a significant male predominance (73% vs 27%). In order of prevalence, abdominal pain (n = 25; 65%), low-grade fever (n = 23; 60%), malaise (n = 10; 26%), weight loss (n = 9; 23%), and nausea and vomiting (n = 8; 20%) were the most common presenting signs and symptoms. The most common microorganism was Streptococcus (n = 18; 47%), followed by Staphylococcus (n = 11; 28%). The investigative modality of choice was computed tomography (n = 22; 57.8%), followed by ultrasonography of the abdomen (n = 9; 23%). Primary etiology was noted in 5.4%, secondary in 71%, and cryptogenic in 13% of all cases. Aneurysmectomy alone was associated with bowel resection in four cases (10.5%), whereas aneurysmectomy with interposition vein grafting required no further intervention. The inpatient mortality after surgery was 7.8%, and the overall mortality was 15%. The median follow-up was 12 months (range, 2-120 months). The median age of patients with IMA aneurysm was 48 (range, 22-64) years, with a male predominance of 2:1 and abdominal pain in all cases (n = 3; 100%). The most common microorganism was Streptococcus (n = 2; 66.6%), and the operation of choice was aneurysmectomy (n = 2; 66.6%) after computed tomography scan (n = 3; 100%) as an investigative modality of choice.
CONCLUSIONS
The pentad of abdominal pain, pyrexia of unknown origin, malaise, weight loss, and nausea remains the most convincing presentation of mycotic aneurysms of the SMA and IMA. Computed tomography is the investigative modality of choice, and such patients are best served with aneurysmectomy alone in IMA aneurysms and interposition vein grafting in SMA aneurysms after initiation of antimicrobial therapy on suspicion of the diagnosis.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Aneurysm, Infected; Anti-Bacterial Agents; Computed Tomography Angiography; Female; Humans; Male; Mesenteric Artery, Inferior; Mesenteric Artery, Superior; Middle Aged; Predictive Value of Tests; Risk Factors; Treatment Outcome; Vascular Surgical Procedures; Young Adult
PubMed: 26951998
DOI: 10.1016/j.jvs.2016.01.031 -
Sports Health 2017Injury data on hip and groin injuries vary, and these injuries are often misrepresented or overlooked for more commonly seen injuries, such as those to the foot and... (Review)
Review
CONTEXT
Injury data on hip and groin injuries vary, and these injuries are often misrepresented or overlooked for more commonly seen injuries, such as those to the foot and ankle.
OBJECTIVE
To provide a systematic review of the injury rates of hip and groin pathology in dancers and look to establish a better understanding of the occurrence of hip and groin injuries in the dancer population.
DATA SOURCES
A literature search was performed using PubMed and CINAHL databases for articles published between 2000 and 2016.
STUDY SELECTION
Inclusion criteria consisted of (1) documentation of the number of hip and/or groin injuries, (2) study population consisting of dancers whose training included some level of ballet, and (3) studies of levels 1 through 3 evidence.
STUDY DESIGN
Systematic review.
LEVEL OF EVIDENCE
Level 3.
DATA EXTRACTION
A single reviewer identified studies that met the inclusion criteria. The number of overall injuries, hip/groin injuries, study participants, injured participants, training hours per week, mean age of study group, injury definition, injury reporting method, and study time frame were extracted.
RESULTS
Thirteen unique studies were included in the descriptive analysis. Of the 2001 dancers included in this study, 3527 musculoskeletal injuries were seen in 1553 dancers. Of these, 345 injuries were localized to the hip and groin region (overall rate, 17.2%). An incidence rate of 0.09 hip and groin injuries per 1000 dance-hours was seen in the selected cohort studies. Of 462 professional dancers, 128 hip/groin injuries were recorded, for an injury rate of 27.7%. Of the 1539 student dancers, 217 hip/groin injuries were recorded, for an injury rate of 14.1% ( P < 0.01).
CONCLUSION
Data on hip and groin injuries have many limitations. However, these injuries represent an important health issue for dancers of all skill levels, encompassing 17.2% of musculoskeletal injuries seen in dancers. An increasing rate of hip/groin injuries is seen in professional dancers compared with students.
Topics: Dancing; Groin; Hip Injuries; Humans; Incidence; Musculoskeletal System
PubMed: 28783444
DOI: 10.1177/1941738117724159 -
Danish Medical Journal Mar 2017Incisional hernia is a common long-term complication to abdominal surgery, occurring in more than 20% of all patients. Some of these hernias become giant and affect... (Review)
Review
Incisional hernia is a common long-term complication to abdominal surgery, occurring in more than 20% of all patients. Some of these hernias become giant and affect patients in several ways. This patient group often experiences pain, decreased perceived body image, and loss of physical function, which results in a need for surgical repair of the giant hernia, known as abdominal wall reconstruction. In the current thesis, patients with a giant hernia were examined to achieve a better understanding of their physical and psychological function before and after abdominal wall reconstruction. Study I was a systematic review of the existing standardized methods for assessing quality of life after incisional hernia repair. After a systematic search in the electronic databases Embase and PubMed, a total of 26 studies using standardized measures for assessment of quality of life after incisional hernia repair were found. The most commonly used questionnaire was the generic Short-Form 36, which assesses overall health-related quality of life, addressing both physical and mental health. The second-most common questionnaire was the Carolinas Comfort Scale, which is a disease specific questionnaire addressing pain, movement limitation and mesh sensation in relation to a current or previous hernia. In total, eight different questionnaires were used at varying time points in the 26 studies. In conclusion, standardization of timing and method of quality of life assessment after incisional hernia repair was lacking. Study II was a case-control study of the effects of an enhanced recovery after surgery pathway for patients undergoing abdominal wall reconstruction for a giant hernia. Sixteen consecutive patients were included prospectively after the implementation of a new enhanced recovery after surgery pathway at the Digestive Disease Center, Bispebjerg Hospital, and compared to a control group of 16 patients included retrospectively in the period immediately prior to the implementation of the pathway. The enhanced recovery after surgery pathway included preoperative high-dose steroid, daily assessment of revised discharge criteria and an aggressive approach to restore bowel function (chewing gum and enema on postoperative day two). Patients who followed the enhanced recovery after surgery pathway reported low scores of pain, nausea and fatigue, and were discharged significantly faster than patients in the control group. A non-significant increase in postoperative readmissions and reoperations was observed after the introduction of the enhanced recovery after surgery pathway. Study III and IV were prospective studies of patients undergoing abdominal wall reconstruction for giant incisional hernia, who were compared to a control group of patients with an intact abdominal wall undergoing colorectal resection for benign or low-grade malignant disease. Patients were examined within a week preoperatively and again one year postoperatively. In study III, the respiratory function and respiratory quality of life were assessed, and the results showed that patients with a giant incisional hernia had a decreased expiratory lung function (peak expiratory flow and maximal expiratory pressure) compared to the predicted values and also compared to patients in the control group. Both parameters increased significantly after abdominal wall reconstruction, while no other significant changes were found in objective or subjective measures at one-year follow-up in both groups of patients. Lastly, study IV examined the abdominal wall- and extremity function, as well as overall and disease specific quality of life. We found that patients with a giant hernia had a significantly decreased relative function of the abdominal wall compared to patients with an intact abdominal wall, and that this deficit was offset at one-year follow-up. Patients in the control group showed a postoperative decrease in abdominal wall function, while no changes were found in extremity function in either group. Patients reported improved quality of life after abdominal wall reconstruction. In summary, the studies in this thesis concluded that; standardization of patient-reported outcomes after incisional hernia repair is lacking; enhanced recovery after surgery is feasible: after abdominal wall reconstruction and seems to lower the time to discharge; patients with giant incisional hernia have compromised expiratory lung function and abdominal wall function, both of which are restored one year after abdominal wall reconstruction.
Topics: Abdominal Wall; Age Factors; Clinical Studies as Topic; Hernia, Ventral; Herniorrhaphy; Humans; Incisional Hernia; Length of Stay; Postoperative Care; Postoperative Period; Practice Guidelines as Topic; Quality of Life; Recurrence; Surveys and Questionnaires; Tomography, X-Ray Computed
PubMed: 28260602
DOI: No ID Found -
The Netherlands Journal of Medicine Feb 2014Orthostatic hypotension is common, especially in the elderly, and it is strongly associated with discomfort and falls. Physicians may sometimes prescribe compression... (Review)
Review
AIM
Orthostatic hypotension is common, especially in the elderly, and it is strongly associated with discomfort and falls. Physicians may sometimes prescribe compression therapy, but the beneficial effect of this treatment in orthostatic hypotension is unclear. The aim of this review was to summarise all available evidence on the effect of four different levels of compression therapy in the treatment of orthostatic hypotension: knee-length, thigh-length, full-length and abdominal compression only.
METHODS
A systematic search was performed in PubMed, Embase and Cochrane databases.
RESULTS
A literature search identified 1232 reports; 11 publications were selected for inclusion in this review. The quality of studies was heterogenous and generally poor. Full length compression (lower limbs and abdomen) and compression of solely the abdomen were found to be superior to knee-length and thigh-length compression. Both significantly reduced the fall in systolic blood pressure after postural change. Symptoms of orthostatic hypotension experienced by patients were improved the most by full-length compression.
CONCLUSIONS
When other interventions fail to ameliorate symptoms, compression therapy can be considered. This review demonstrates that compression treatment should include the abdomen as this has the greatest beneficial effect. However, this review also displays the paucity of evidence for compression therapy for patients with orthostatic hypotension, and further investigation is certainly warranted.
Topics: Blood Pressure; Compression Bandages; Humans; Hypotension, Orthostatic; Treatment Outcome
PubMed: 24659590
DOI: No ID Found -
Medical Acupuncture Aug 2022Nocturnal enuresis (NE), often known as bedwetting, is a common condition in children and, as a result, they may have subsequent social impairments. The aim of this... (Review)
Review
INTRODUCTION
Nocturnal enuresis (NE), often known as bedwetting, is a common condition in children and, as a result, they may have subsequent social impairments. The aim of this study was to evaluate the efficacy of low-level laser therapy (LLLT) in children with NE.
METHODS
International databases with laser- and NE-related keywords were searched, and only randomized controlled trials (RCTs) that used any type of LLLT to treat NE and compared it with any type of control intervention were included. Eleven studies using laser acupuncture therapy (LAT), involving 927 participants, were included for a systematic review. A meta-analysis was conducted using full and partial response-rate variables. The analysis was performed using referred eporting tems for ystematic reviews and eta-nalyses guidelines, and the Cochrane risk-of-bias tool and rading of ecommendations ssessment evelopment and valuation recommendations for quality of evidence were used to rate all included publications.
RESULTS
The LAT groups showed significant improvement, compared with control groups when full response rates were analyzed. There was no significant difference between the groups treated with LAT and the groups who underwent medication therapy alone when full response rates were analyzed. Red and infrared wavelengths and continuous waves were the most commonly used LAT modalities, and lower abdomen and back acupoints were the most-common sites.
CONCLUSIONS
LAT seems to be an effective and safe treatment for NE; however, the quality of evidence available in the literature was relatively low. More-rigorous and higher-quality trials are needed to investigate this treatment modality further.
PubMed: 36046465
DOI: 10.1089/acu.2022.0002 -
Sensors (Basel, Switzerland) Jul 2021Intra-abdominal pressure (IAP) is defined as the steady-state pressure within the abdominal cavity. Elevated IAP has been implicated in many medical complications. This... (Review)
Review
Intra-abdominal pressure (IAP) is defined as the steady-state pressure within the abdominal cavity. Elevated IAP has been implicated in many medical complications. This article reviews the current state-of-the-art in innovative sensors for the measurement of IAP. A systematic review was conducted on studies on the development and application of IAP sensors. Publications from 2010 to 2021 were identified by performing structured searches in databases, review articles, and major textbooks. Sixteen studies were eligible for the final systematic review. Of the 16 articles that describe the measurement of IAP, there were 5 in vitro studies (31.3%), 7 in vivo studies (43.7%), and 4 human trials (25.0%). In addition, with the advancement of wireless communication technology, an increasing number of wireless sensing systems have been developed. Among the studies in this review, five presented wireless sensing systems (31.3%) to monitor IAP. In this systematic review, we present recent developments in different types of intra-abdominal pressure sensors and discuss their inherent advantages due to their small size, remote monitoring, and multiplexing.
Topics: Abdominal Cavity; Humans; Monitoring, Physiologic; Wireless Technology
PubMed: 34300564
DOI: 10.3390/s21144824 -
SAGE Open Medicine 2022This systematic review was aimed to address the prevalence and causes of intestinal obstruction in Ethiopia.
OBJECTIVE
This systematic review was aimed to address the prevalence and causes of intestinal obstruction in Ethiopia.
METHODS
Systematic searches were conducted on PubMed, EMBASE, CINAHL, Scopus, African Journals Online, HINARI, and other supplementary sources, including Google Scholar. We conducted methodological quality assessments for the articles by employing a critical appraisal checklist of Joanna Briggs Institute.
RESULTS
The reported prevalence of intestinal obstruction in Ethiopia ranges from 18.6% to 50.7% among patients with acute abdomen. However, the prevalence varies from 4.3% to 34.6% among total surgical admissions. The leading causes of small intestinal obstruction were small bowel volvulus, intussusception, and adhesion. Sigmoid volvulus was the most commonly reported cause of large intestine obstruction, followed by colonic cancer.
CONCLUSION
The highest reported prevalence of intestinal obstruction in Ethiopia was 50.7% among patients with acute abdomen and 34.6% among surgical admissions. Small intestine volvulus and sigmoid volvulus were the common causes of small and large bowel obstructions, respectively. Therefore, clinicians have to consider the common causes during the diagnosis and management of intestinal obstruction.
PubMed: 35371487
DOI: 10.1177/20503121221083207 -
Annals of Palliative Medicine Apr 2017The aim of this article was to systematically review the efficacy and safety of various antiemetics in prophylaxis of radiation-induced nausea and vomiting (RINV). (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The aim of this article was to systematically review the efficacy and safety of various antiemetics in prophylaxis of radiation-induced nausea and vomiting (RINV).
METHODS
A literature search of Ovid MEDLINE, EMBASE and Cochrane CENTRAL was performed to identify randomized controlled trials (RCTs) that evaluated the efficacy of prophylaxis for RINV in patients receiving radiotherapy to abdomen/pelvis, including total body irradiation (TBI). Primary endpoints were complete control of nausea and complete control of vomiting during acute and delayed phases. Secondary endpoints included use of rescue medication, quality of life (QoL) and incidence of adverse events.
RESULTS
Seventeen RCTs were identified. Among patients receiving radiotherapy to abdomen/pelvis, our meta-analysis showed that prophylaxis with a 5-hydroxytryptamine-3 receptor antagonist (5HT3 RA) was significantly more efficacious than placebo and dopamine receptor antagonists in both complete control of vomiting [OR 0.49; 95% confidence interval (CI): 0.33-0.72 and OR 0.17; 95% CI: 0.05-0.58 respectively] and complete control of nausea (OR 0.43; 95% CI: 0.26-0.70 and OR 0.46; 95% CI: 0.24-0.88 respectively). 5HT3 RAs were also more efficacious than rescue therapy and dopamine receptor antagonists plus dexamethasone. The addition of dexamethasone to 5HT3 RA compared to 5HT3 RA alone provides a modest improvement in prophylaxis of RINV. Among patients receiving TBI, 5HT3 RA was more effective than other agents (placebo, combination of metoclopramide, dexamethasone and lorazepam).
CONCLUSIONS
5HT3 RAs are more effective than other antiemetics for prophylaxis of RINV in patients receiving radiotherapy to abdomen/pelvis and TBI. Future RCTs should investigate the efficacy of newer agents such as substance P neurokinin 1 receptor antagonists in addition to 5HT3 RAs in prophylaxis of RINV during both acute and delayed phases.
Topics: Antiemetics; Humans; Nausea; Radiotherapy; Randomized Controlled Trials as Topic; Vomiting
PubMed: 28249542
DOI: 10.21037/apm.2016.12.01 -
Annals of Surgical Oncology Mar 2022Almost half of all colorectal cancer (CRC) patients will experience metastases at some point, and in the majority of cases, multiple organs will be involved. If the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Almost half of all colorectal cancer (CRC) patients will experience metastases at some point, and in the majority of cases, multiple organs will be involved. If the peritoneum is involved in addition to the liver, the current guideline-driven treatment options are limited. The reported overall survival ranges from 6 to 13 months for the current standard of care (systemic treatment). This study aimed to evaluate morbidity and clinical long-term outcomes from a combined local treatment of hepatic metastases with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) used to treat peritoneal metastases.
METHODS
A systematic search was performed in PubMed, Embase.com, Web of Science, and Cochrane. Studies evaluating the clinicopathologic data of patients who had both peritoneal and hepatic metastases treated with CRS-HIPEC were included provided sufficient data on the primary outcomes (overall and disease-free survival) were presented. The quality of included studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS).
RESULTS
Patients treated for peritoneal and liver metastases (PMLM group) had a pooled mean survival of 26.4 months (95% confidence interval [CI] 22.4-30.4 months), with a 3-year survival rate of 34% (95% CI 26.7-42.0%) and a 5-year survival rate of 25% (95% CI 17.3-33.8%). Surgical complications occurred more frequently for these patients than for those with peritoneal metastasis only (40% vs 22%; p = 0.0014), but the mortality and reoperation rates did not differ significantly.
CONCLUSION
This systematic review showed that CRS and HIPEC combined with local treatment of limited liver metastasis for selected patients is feasible, although with increased morbidity and an association with a long-term survival rate of 25%, which is unlikely to be achievable with systemic treatment only.
Topics: Antineoplastic Combined Chemotherapy Protocols; Colorectal Neoplasms; Combined Modality Therapy; Cytoreduction Surgical Procedures; Humans; Hyperthermia, Induced; Liver Neoplasms; Peritoneal Neoplasms; Peritoneum; Survival Rate
PubMed: 34686925
DOI: 10.1245/s10434-021-10925-y