• Title/Summary/Keyword: University of Rochester

검색결과 93건 처리시간 0.025초

Preoperative embolization and en bloc resection of a metastatic pheochromocytoma of the cervical spine

  • Aman Singh;Gabrielle Santangelo;Nathaniel Ellens;Gurkirat Kohli;Robert Pranaat;Matthew T. Bender
    • Journal of Cerebrovascular and Endovascular Neurosurgery
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    • 제26권3호
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    • pp.331-337
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    • 2024
  • This is a unique case of metastatic pheochromocytoma of the cervical spine treated with preoperative embolization and subsequent en bloc resection. A 65-year-old man with metastatic pheochromocytoma presented with two weeks of worsening neck pain, left arm and leg weakness and paresthesia, and urinary incontinence. Magnetic resonance imaging showed a metastatic osseous lesion at C6 with severe stenosis and spinal cord compression. The patient underwent successful preoperative angiographic embolization with a liquid embolic agent followed by C5-C7 laminectomy, en bloc tumor resection, and C3-T2 posterior spinal fusion. Six weeks postoperatively, the patient reported improving strength and resolving neck pain and paresthesias. While there is no standard paradigm for the treatment of metastatic pheochromocytomas of the cervical spine, preoperative embolization may minimize intraoperative blood loss and hemodynamic instability during subsequent surgical resection.

Safety and efficacy comparison of embolic agents for middle meningeal artery embolization for chronic subdural hematoma

  • Nathaniel R. Ellens;Derrek Schartz;Gurkirat Kohli;Redi Rahmani;Sajal Medha K. Akkipeddi;Thomas K. Mattingly;Tarun Bhalla;Matthew T. Bender
    • Journal of Cerebrovascular and Endovascular Neurosurgery
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    • 제26권1호
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    • pp.11-22
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    • 2024
  • Objective: To perform a systematic review and meta-analysis evaluating the efficacy of middle meningeal artery embolization in terms of both clinical and radiographic outcomes, when performed with different embolic agents. Methods: A systematic literature review and meta-analysis was performed to evaluate the impact of embolic agents on outcomes for middle meningeal artery (MMA) embolization. The use of polyvinyl alcohol (PVA) with or without (±) coils, N-butyl cyanoacrylate (n-BCA) ± coils, and Onyx alone were separately evaluated. Primary outcome measures were recurrence, the need for surgical rescue and in-hospital periprocedural complications. Results: Thirty-one studies were identified with a total of 1,134 patients, with 786 receiving PVA, 167 receiving n-BCA, and 181 patients receiving Onyx. There was no difference in the recurrence rate (5.5% for PVA, 4.5% for n-BCA, and 6.5% for Onyx, with P=0.71) or need for surgical rescue (5.0% for PVA, 4.0% for n-BCA, and 6.9% for Onyx, with P=0.89) based on the embolic agent. Procedural complications also did not differ between embolic agents (1.8% for PVA, 3.6% for n-BCA, and 1.6% for Onyx, with P=0.48). Conclusions: Rates of recurrence, need for surgical rescue, and periprocedural complication following MMA embolization are not impacted by the type of embolic agent utilized. Ongoing clinical trials may be used to further investigate these findings.

Differentiation between Viral and Urinary Tract Infections Using the Modified Rochester Criteria In Febrile Infants Younger than three Months

  • Kim, Tae Hee;Hwang, Ji Hye;Yi, Dae Yong;Yun, Ki Wook;Lim, In Seok
    • Childhood Kidney Diseases
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    • 제19권2호
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    • pp.118-124
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    • 2015
  • Purpose: The symptoms and signs of urinary tract infection (UTI) in early infancy are non-specific. Prompt diagnosis of UTI is important, as untreated UTI results in renal damage. Especially, febrile UTI in young infants coexist with other serious bacterial infections. The purpose this study was to propose modified Rochester criteria to differentiate viral infection from urinary tract infection. Methods: We carried out a retrospective investigation of 168 infants less than three months old with a tympanic temperature $>38^{\circ}C$ who were admitted to Chung-Ang University Hospital between 2011 and 2014. We compared the symptoms, physical examination results, and laboratory data between viral infection and UTI groups. A modified Rochester criterion was composed of statistically significant factors. Results: A total of 76 and 92 infants with UTI and a viral infection, respectively, were included. Statistically significant differences in gender, previous admission history, neutrophil ratio, and urine WBC count were found between the two study groups. Using a cut off value of 3 points, the sensitivity and specificity of the modified Rochester criteria were 71.28% and 78.57%, respectively. Conclusion: The modified Rochester criteria may give an outline for identifying young infants with UTI.

Reconstruction of Pharyngolaryngeal Defects with the Ileocolon Free Flap: A Comprehensive Review and How to Optimize Outcomes

  • Escandon, Joseph M.;Santamaria, Eric;Prieto, Peter A.;Duarte-Bateman, Daniela;Ciudad, Pedro;Pencek, Megan;Langstein, Howard N.;Chen, Hung-Chi;Manrique, Oscar J.
    • Archives of Plastic Surgery
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    • 제49권3호
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    • pp.378-396
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    • 2022
  • Several reconstructive methods have been reported to restore the continuity of the aerodigestive tract following resection of pharyngeal and hypopharyngeal cancers. However, high complication rates have been reported after voice prosthesis insertion. In this setting, the ileocolon free flap (ICFF) offers a tubularized flap for reconstruction of the hypopharynx while providing a natural phonation tube. Herein, we systematically reviewed the current evidence on the use of the ICFF for reconstruction of the aerodigestive tract. A systematic literature search was conducted across PubMed MEDLINE, Web of Science, ScienceDirect, Scopus, and Ovid MEDLINE(R). Data on the technical considerations and surgical and functional outcomes were extracted. Twenty-one studies were included. The mean age and follow-up were 54.65 years and 24.72 months, respectively. An isoperistaltic or antiperistaltic standard ICFF, patch flap, or chimeric seromuscular-ICFF can be used depending on the patients' needs. The seromuscular chimeric flap is useful to augment the closure of the distal anastomotic site. The maximum phonation time, frequency, and sound pressure level (dB) were higher with ileal segments of 7 to 15 cm. The incidence of postoperative leakage ranged from 0 to 13.3%, and the majority was occurring at the coloesophageal junction. The revision rate of the microanastomosis ranged from 0 to 16.6%. The ICFF provides a reliable and versatile alternative for reconstruction of middle-size defects of the aerodigestive tract. Its three-dimensional configuration and functional anatomy encourage early speech and deglutition without a prosthetic valve and minimal donor-site morbidity.

HINT 검사를 이용한 양이의 어음이해에 있어서 노화와 고주파수 청력의 효과 (Effects of Age and High Frequency Hearing Loss on Binaural Speech Understanding Using HINT Study)

  • 김성희
    • The Journal of the Acoustical Society of Korea
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    • 제26권1E호
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    • pp.8-13
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    • 2007
  • It has long been known that high-frequency sensorineural hearing loss (HFHL) can contribute to difficulty in speech understanding by elderly listeners. This study evaluated the relative contribution of HFHL and age to speech understanding. Subjects included adult middle-aged and old groups with normal hearing or with limited HFHL. The Hearing-in-Noise-Test (HINT) was used to measure speech perception performance in quiet and in noise. The middle-aged groups showed significant effects of HFHL for speech intelligibility in quiet and in noise, but the old groups showed the difference in quiet only due to high frequency hearing. The results suggest that HFHL may affect speech intelligibility differently with age and therefore hearing aid selection needs to take into account the influence of age.

The efficacy of photobiomodulation on dental injection pain: a systematic review of randomized clinical trials

  • Maryam Altuhafy;Virda Baig;Luay Jabr;Junad Khan
    • Journal of Dental Anesthesia and Pain Medicine
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    • 제24권3호
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    • pp.145-159
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    • 2024
  • Dental injections are routinely performed and can result in pain and anxiety in patients. This systematic review aimed to evaluate the efficacy of photobiomodulation therapy (PBMT) in dental injections for pain management in patients undergoing dental treatment. Indexed databases, including PubMed, EMBASE, Scopus, ISI Web of Knowledge, and Cochrane Library, were electronically searched without a time limit up to February 2024. A risk of bias evaluation was performed using the Cochrane tool. A preliminary investigation using electronic and manual methods yielded 4,920,881 manuscripts. Based on the eligibility requirements, 13 randomized control trials (RCTs) were included. Self-assessed pain was determined using the visual analog scale, Face, Legs, Activity, Cry, Controllability scale, or Wong-Baker face pain scale. Eight RCTs demonstrated a notable decrease in needle pain in patients undergoing dental needle injections using PBMT. Based on current evidence, PBMT may help reduce needle pain related to dental anesthesia. Further standardized studies are needed to assess the significance of PBMT for postoperative pain in patients undergoing dental injections.