Introduction: Acute flaccid myelitis (AFM) is a condition causing acute onset flaccid limb weakness primarily in children. Correlations with specific viral illnesses have been found, however, specific pathogenesis remains unknown. Case Report: A 21-year-old female individual presented with progressive weakness provoking multiple falls, severe fatigue, headaches, and body aches after an upper respiratory illness. Deep tendon reflexes were absent, and cerebrospinal fluid analysis was remarkable for lymphocytic pleocytosis and elevated protein. Magnetic resonance imaging revealed T2 hyperintensity extending from C1-T2 predominantly involving the anterior horns. Weakness continued to increase before subtly improving over the course of a 10-day hospital stay. Functional improvements had been achieved by the patient at 1-year follow-up with intensive physical therapy. Conclusions: AFM should be included in the differential for the presentation of acute weakness in adults and pediatric patients. As the incidence of AFM continues to rise, awareness of the condition and prompt obtainment of specimens in suspected patients is crucial to aid in the investigation.
Pneumatosis cystoides intestinalis (PCI) is defined by the presence of gas within the bowel wall. It is often asymptomatic and usually benign but may be associated with significant morbidity and mortality. In this patient, PCI was found incidentally on screening colonoscopy, and biopsy of the affected mucosa resulted in deflation of a cyst. Pneumoperitoneum was then identified on subsequent CT. Because pneumoperitoneum is associated with bowel perforation in most cases, it is often treated as an indication for operation. This case of benign and asymptomatic pneumoperitoneum was managed conservatively without complications. Clinicians should be able to identify PCI as a potentially benign finding on colonoscopy as well as a potentially benign cause of pneumoperitoneum. This understanding presents an opportunity to avoid the unnecessary morbidity and costs associated with surgical exploration or additional endoscopic procedures.
Background:The purpose of this study was to examine the incidence of acute kidney injury and chronic renal impairment following branched endovascular aneurysm repair (BEVAR) of complex thoracoabdominal aortic aneurysms (TAAA) using the Medtronic Valiant Thoracoabdominal Aortic Aneurysm stent graft system (MVM), the physician-modified Visceral Manifold, and Unitary Manifold stent graft systems. The objective was to report the acute and chronic renal function changes in patients following complex TAAA aneurysm repair. Methods: This is an analysis of 139 patients undergoing branched endovascular repair for complex TAAAs between 2012 and 2020. Patient renal function was evaluated using serum creatinine and estimated glomerular filtration rate at baseline, 48 hr, discharge, 1 month, 6 months, and annually to 2 years. Patients on dialysis prior to the procedure were excluded from data analysis. Results: A total of 139 patients (mean age 71.13; 64.7% male) treated for TAAA with BEVAR met inclusion cr iter ia and were evaluated. A total of 530 visceral vessels were stented. A majority of patients ( n = 131, 94.2%) underwent a single procedure while 8 required staged procedures. Thirty-day, 1-year and 2-year all-cause mortality rates were 5.8%, 25.2%, and 32.4%, respectively. Primary and secondary patency rates at a median follow-up of 26.9 months (95% CI; 21.1 -32.7) were 96.2% and 97.5% for all vessels and 95.4% and 96.9% for renal arteries, respectively. Postoperative acute kidney injury (AKI) was identified in 22 (15.8%) patients. At discharge, 16 patients (11.6%) had an increase in CKD stage with 3 requiring permanent dialysis. Five additional patients required permanent dialysis over the 2-year follow-up period for a total Conflicts of Interest: PK has received payments related to license and royalty interest with Medtronic; KP has received payments related to license and royalty interest with Medtronic; AV has received payments related to license and royalty interest with Medtronic; GA is a paid consultant for Medtronic; MS is on advisory boards and is a speaker for Medtronic and Gore and is a speaker for Cook; ML, JV, VB, TM and TN have no competing interests.
e24156 Background: Osseous metastases (OMs), a common cause of cancer pain, are only partially palliated by analgesics. Stereotactic body radiotherapy (SBRT) and radiofrequency ablation (RFA) are increasingly used, but the comparative effectiveness of SBRT vs. RFA for OMs has not been adequately evaluated. Herein we analyzed palliative benefits of SBRT and RFA in terms of pain relief from OMs. Methods: A systematic review was performed for all studies reporting palliative outcomes of SBRT (defined as five or fewer fractions of radiation) or RFA for palliation of OMs. Studies not reporting pain palliation were excluded. Random effects model determined the net Pearson correlation (R2) for post-SBRT and post-RFA pain reduction over time. The pooled correlation coefficient and 95% confidence interval were calculated using Fisher r-to- z transformation. Risk of bias was assessed using sunset plots; heterogeneity was assessed using I2 and meta-regression. Results: Seven full-text articles assessed a total of 1100 SBRT patients and 22 full-text articles assessed a total of 557 RFA patients. No studies directly compared SBRT to RFA. All included studies collected data on pain related to OM disease pre- and post-therapy. The scales used included the visual analog scale (2 SBRT, 15 RFA), brief pain inventory (4 SBRT, 4 RFA), numeric rating scale (0 SBRT, 2 RFA), QLQ-15 (1 SBRT, 0 RFA), or the memorial pain index card (0 SBRT, 1 RFA). Mean SBRT dose and fractions were 17.3 gy and 2.6. Median follow-up was 24 weeks for SBRT and 18 weeks for RFA, with median pain reduction of 59% (R2=0.83, 95%CI:0.80-0.87, I2=58.63%) and 64% (R2=0.52, 95%CI:0.41-0.62, I2=48.16%) respectively. Meta-regression by number of fractions and reporting metric fully accounted for heterogeneity in the SBRT and RFA data respectively. Sunset plots did not indicate significant publication bias. Conclusions: The published literature is predominately non-randomized, limiting the evidence level. Pain reduction and durability post-SBRT or post-RFA are comparable. Pre-SBRT or RFA therapies may obscure the full effect of either treatment modality. SBRT and RFA for painful OMs are associated with pain relief in a majority of patients, but the durability of this relief and the comparative efficacy of SBRT vs. RFA for this purpose has been inadequately reported in the literature. Future, combinatorial therapies as opposed to single-modality approaches may help to increase overall pain relief and durability as well as efficaciously palliating treatment-resistant patients.
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