The plasma cell neoplasm may present as Extramedullary Plasmacytoma (EMP) in soft tissues in bone as a Solitary Plasmacytoma of bone (SPB) or as a part of multi focal disseminated disease Multiple Myeloma (MM). The majority of 80% occurs in head and neck region. In our case, a 62-year-old male patient presented with a non tender swelling of short duration. The swelling was noted obliterating the vestibular depth in right lower mandibular region. The radiological features were non specific.
Background:
The correct diagnosis of trigeminal neuralgia (TN) is still a far cry and the patients suffer from unnecessary dental procedures before getting the definite treatment. In this study, we evaluated, if the patients have undergone dental procedures for their misdiagnosed TN before receiving definite treatment for the same.
Methods:
A total of 187 patients received GKRS for their TN (excluding secondary TN) in two institutes from 2010 to 2019. We did a retrospective analysis of these patients’ primary complaints on a standard questionnaire.
Results:
One hundred and seventeen of the 187 patients responded. About 55.5% of patients had a toothache and 65.8% did visit a dentist for the pain. About 41.8% of patients underwent one dental procedure; 18.8% suffered from worsening of the pain while 8.5% received some partial improvement. About 19.6% also underwent root canal treatment while 6.8% had a nerve block. Mean of 1.6 teeth was extracted per person. About 71% of patients were satisfied with their Gamma Knife radiosurgery for TN at a median follow-up of 49 months.
Conclusion:
There is a need for a better understanding of the disease among the dentists and the patients for the timely and correct treatment, without losing their teeth. The onus lies on neurosurgeons/neurologists disseminate knowledge regarding proper diagnosis and treatment modalities.
The authors found that aneurysm rebleeding after subarachnoid hemorrhage (SAH) has specific characteristics in the preoperative, intraoperative, and postoperative periods, involving aneurysm size, heart disease, aneurysm location, family history, clipping, coiling, etc. According to Horie and colleagues, their study is the first to assess the characteristics and predictors of aneurysmal SAH rebleeding in the preoperative, intraoperative, and postoperative periods. We would like to express our respect for their achievements and to share some comments with the authors.Firstly, and most importantly, the data were collected from 1 university hospital and 10 affiliated hospitals. The authors did not consider the role of these medical institutions in their analysis. Depending on the different medical levels of doctors in these hospitals, different degrees of surgical instruments and equipment, and different management methods after operation, these factors could affect the probability of aneurysm rupture during and after surgery. Therefore, it is difficult to control bias in data collected from 11 hospitals.Secondly, their article does not provide inclusion criteria for the study subjects but simply describes exclusion criteria. It only rules out subjects younger than 18 years of age and nonaneurysmal SAH including dissection. However, patients with intracranial hemorrhage and on the verge of death, patients with vital organ diseases, and older patients (> 75 years of age) should also be excluded because the rate of postoperative mortality and disability is probably high in these patients, and it is difficult for surgical intervention to improve the survival rate.Thirdly, the evaluation of aneurysm rebleeding after operation was defined as new SAH on postoperative CT scans. We think there are some flaws in this definition because postoperative hemorrhage on CT can have false-negative results and will affect the clinical outcome of different aneurysm surgeries (clipping vs endovascular coiling) in terms of postoperative rebleeding.
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