Since there are now several ways to treat symptomatic gallstone disease, one is able to select treatment on the basis of the patient's comfort, the practicability, effectiveness, and side effects of the technique, and the relative costs. In order to assess the present status of contact dissolution with methyl tert-butyl ether with regard to these aspects, the present enquiry reports the data of 21 European hospitals. Eight hundred three patients were selected for contact litholysis of cholesterol gallbladder stones using methyl tert-butyl ether. Percutaneous transhepatic puncture of the gallbladder was performed under x-ray or ultrasound guidance. Dissolution rate, side effects, and treatment times of 268 patients from one single center were compared to those of 535 patients from the other 20 centers. Two hundred sixty-four patients were followed for five years to assess stone recurrence. Physicians were asked how they assessed the expenditure of the method, the discomfort to the patients, and the staffing situation. Patients were asked to indicate their acceptance on an analog scale. Puncture was successful in 761 (94.8%) patients. Prophylactic administration of antibiotics was not necessary. Stones were dissolved in 724 (95.1%) patients. In 315 (43.5%) sludge remained in the gallbladder. The most severe complication was bile leakage, which led 12 (1.6%) patients to have elective cholecystectomy. Toxic injuries due to the ether were not reported. Method-related lethality amounted to 0%, 30-day-lethality to 0.4%. Stone recurrence rate was about 40% in solitary stones and about 70% in multiple stones over five years. Patients with multiple stones developed recurrent stones almost twice as often as those with solitary stones. The probability of stone recurrence in patients with sludge in the gallbladder after catheter removal was not statistically significantly different from those without sludge. Seventy to 90% of the centers found the puncture to be simple and not distressing for patients and the relation between expenditure and therapeutic success to be acceptable. The acceptance of contact litholysis by the patients was excellent. Contact litholysis when applied by an experienced team provides real advantages in the treatment of gallstone disease. The method is technically simple, well accepted by the patients, and can be easily applied in community hospitals. Contact litholysis may be of particular value in patients who are not suitable for anesthesia or surgery.
Objective Rhombencephalosynapsis (RES) is a rare cerebellar malformation resulting in agenisis/hypogenesis of the vermis. The main clinical features include truncal and/or limb ataxia, neuro-ophthalmological abnormalities, hydrocephalus, and dysmorphic signs, as well as difficulties with attention and emotional/behavioral regulation. This case contributes to the RES literature by providing a pediatric neuropsychological profile of RES with features of Gomez-Lopez-Hernandez syndrome (GLHS) alongside imaging and comparison with related syndromes (e.g. GLHS, Autism, Cerebellar Cognitive Affective Syndrome (CCAS), ADHD). Method The patient is a 12-year-old male with a complex medical history including hydrocephalus, strabismus, gross/fine motor delays, and bilateral alopecia. Psychiatric history includes anxiety, depression, mood lability, and social difficulties. Incidental imaging findings of rhombencephalosynapsis were found during Neurology consult. Imaging showed stable ventriculomegaly, aqueductal stenosis, and low lying cerebellar tonsils. A comprehensive neuropsychological evaluation was completed to assist with treatment recommendations. Results Neuropsychological testing demonstrated above average intellectual/reasoning abilities, with relative weaknesses (base rate difference < 5%) in attention, working memory, and processing speed. Primary deficits in shifting/flexibility within executive functioning tasks and social/emotional functioning, including rigidity of expectations, poor perspective taking, and all-or-nothing characterization of people and events. Fine motor deficits were also observed. Conclusions The RES literature is sparse, particularly for pediatric cases with average or better intellectual functioning. This case study provides concurrent neurological and neuropsychological findings which have been implicated in related conditions with cerebellar abnormalities, particularly the a) absence of the vermis and associated emotional lability and b) executive deficits of shifting/flexibility affecting cognitive, social, and emotional functioning.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.