Current status of spontaneous isolated celiac artery dissection.

Aim: The purpose of this study is to compare the surgical outcomes of treating recurrent carpal tunnel with recurrent carpal tunnel release only compared to recurrent carpal tunnel release with fat grafting as an adjunct. Methods: Retrospective case-control study was performed of the recurrent carpal tunnels treated, excluding explicit nerve injury such as transections, neuromas in continuity, etc. Patients with recurrent carpal tunnel received re-release of carpal tunnel only or fat grafting as an adjunct. The outcomes of both groups were compared utilizing chi-square analysis. Results: A total number of 81 patients were found to meet the inclusion criteria. Of the recurrences, a total of 16 patients did not receive fat grafting and 65 did. The rate of improvement in symptoms for performing a carpal tunnel release was only 50.0% and for performing carpal tunnel release with fat grafting was 92%, with P-value < 0.00. Conclusion: Adipose-derived stem cells as an adjunct to carpal tunnel release increased the rate of improvement in symptoms of carpal tunnel compression after recurrence compared to carpal tunnel release alone. Further studies need to be performed to confirm the validity of these findings.

Dose Reductions Related to Adverse Effects in Patients with Waldenström Macroglobulinemia Treated with the BTK-Inhibitor Ibrutinib

Management Strategy Based on Disease Stages for Patients with Symptomatic Isolated Mesenteric Artery Dissection

Introduction: Carpal tunnel syndrome (CTS), a common entrapment neuropathy, can cause debilitating symptoms affecting hand function and sleep. While conservative treatments are initially attempted, surgical intervention becomes necessary for severe cases. The study introduces endoscopic carpal tunnel release (ECTR) as a minimally invasive alternative to open procedures to enhance patient outcomes. Methods: A prospective study from January 2019 to January 2022 investigated arthroscope-assisted carpal tunnel release for CTS. Patients with chronic medical conditions were excluded. The surgical procedure involved local anesthesia, a 1.5 cm incision, flexor retinaculum release under arthroscopic guidance, and postoperative care. Outcomes were assessed using the Global Symptom Scoring Scale (GSS). Results: The affected population (n = 60) had a mean age of 47.58 years, with 42 females and 18 males. Common symptoms included numbness (43.3%), paresthesia (35%), and weakness (13%). Most patients (67.1%) had no comorbidities. Complications were minimal (5.0% paresthesia, 1.7% scar tenderness, and 3.3% infection). The mean preoperative GSS was 38.57, reducing significantly (P < 0.001) to 4.6 at 12 months’ follow-up. Conclusion: The study demonstrates the efficacy and safety of ECTR as a minimally invasive alternative for severe cases of CTS. With a low rate of complications and significant improvement in symptoms, including numbness, paresthesia, weakness, and surgeon expertise remains vital for successful outcomes.

To compare ecabet sodium and cimetidine in relieving symptoms of functional dyspepsia. We performed a multi-center, prospective, randomized, double-blinded controlled trial to compare the clinical efficacy of ecabet sodium and cimetidine in patients with functional dyspepsia. Two-hundred and seventy-two patients with dyspeptic symptoms fulfilling the Rome-II criteria were enrolled from 7 centers. In the study group (115 patients), 1.5 g ecabet sodium was given twice a day. In the control group (121 patients), 400 mg cimetidine was given twice a day. Symptoms and parameters of quality of life were analyzed at baseline, 3, 14, and 28 d after initiating the treatment. Two-hundred and thirty-six patients completed the clinical trial. After 4 wk of treatment, the rates of improvement in patients with dyspeptic symptoms were not different between two groups (77.4% in the ecabet group and 79.3% in the cimetidine group, respectively, P > 0.05). Likewise, the rates of symptomatic improvement were not different at 3 d and 14 d. The parameters of quality of life did not change significantly during the study period in both groups. There was no clinically significant adverse event in both groups. In patients with functional dyspepsia, ecabet sodium has similar clinical efficacy with cimetidine.

Body packer syndrome involves the deliberate internal concealment of illicit drug packets for trafficking. Packet rupture or acute drug toxicity can lead to life-threatening complications. Given the variability across reported cases, a systematic review of case-based evidence is essential. Following PRISMA guidelines, this review was registered in PROSPERO (CRD420251028368). A comprehensive search of PubMed, EMBASE, Scopus, and Google Scholar identified case reports and series involving radiologically or surgically confirmed body packers. Extracted data included demographics, drug type, imaging modality, toxicology results, complications, treatment strategy, hospital stay, and outcomes. Risk of bias was assessed using Murad's tool. Descriptive statistics, Chi-square, and Mann-Whitney U tests were used for analysis. Seventy-six cases were included. Cocaine and heroin were the most trafficked substances. Computed tomography (CT) was the most reliable imaging modality, outperforming plain radiography and ultrasonography in packet detection. Conservative management was successful in asymptomatic individuals, while surgical intervention was needed in cases of rupture or obstruction. Mortality was associated with packet rupture, poor packaging, and delayed diagnosis. Surgical cases had significantly longer hospital stays than conservative ones (p = 0.0025), as did ICU-admitted patients (p = 0.0044). Heroin cases showed longer stays compared to cocaine (p = 0.0102). CT is the most sensitive diagnostic tool in body packer syndrome. Conservative treatment is appropriate in stable patients. Early diagnosis, multidisciplinary coordination, and vigilance for novel concealment trends are critical to reduce morbidity and mortality.

Conservative management of asymptomatic lately embolized amplatzer atrial septal occluder device to the supraceliac abdominal aorta: case report and the literature review

Background and Purpose: Given the benign natural history of intracranial low-grade dural arteriovenous fistulas (dAVFs), their routine treatment remains controversial. The aim of this study is to compare the outcomes of low-grade dAVF treatment to conservative management. Methods: We performed a retrospective review of dAVF patients derived from 12 institutions participating in the Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR). Patients with low-grade (Borden I) dAVFs were included and categorized into treatment and observation cohorts. Primary outcome was defined as modified Rankin Scale (mRS) score at final follow-up. Secondary outcomes were rates of excellent (mRS 0-1) and good (mRS 0-2) functional outcomes, symptomatic improvement, mortality, and obliteration at final follow-up. Results: The treatment and observation cohorts comprised 230 and 112 patients, respectively. At last follow up, no difference in primary or secondary outcomes was observed between the two cohorts, with the exception of obliteration, which was higher in the treatment cohort (79.3% vs. 28.2%, p<0.001; Table 1). The two cohorts were then matched in a 1:1 ratio, resulting in 64 patients in each matched cohort. No difference in primary or secondary outcomes was observed between the matched cohorts, with the exception of obliteration, which was higher in the matched treatment cohort (75.4% vs. 28.6%, p<0.001; Table 2). Subgroup analysis of symptomatic patients demonstrated higher obliteration rate in the treatment cohort, but no difference in primary or other secondary outcomes were found. Conclusions: Low-grade dAVF treatment was not associated with increased functional disability compared to conservative management. Although higher obliteration rates were achieved in the treatment cohort, rates of symptomatic improvement were similar between the two cohorts. This study did not provide evidence to support the routine treatment of low-grade dAVFs.

Moyamoya disease (MMD) is a chronic, progressive steno-occlusive condition of the distal internal carotid arteries of unknown etiology. Collateral arterial networks typically develop in MMD, bypassing the steno-occlusion. Aneurysms arising on the collateral networks are a known source of hemorrhage. The choroidal collateral system is the most common location for collateral pathway aneurysms in MMD and associated hemorrhage. The authors performed data collection and analysis to further elucidate the best treatment approaches for ruptured aneurysms of the choroidal collateral system in MMD, which as yet remain unclear. A comprehensive data collection and analysis of case reports and case series with ruptured choroidal collateral artery aneurysms (CCAAs) was performed. PRISMA guidelines for systematic reviews were followed and the Medline, Embase, and Scopus databases were searched for relevant studies. A database was created including patients with ruptured CCAA in MMD. Original data from case series were included whenever possible. A previously unreported case of a ruptured choroidal artery aneurysm in MMD treated by the authors was also included. The database comprised 72 patients with ruptured CCAA in MMD. The most common clinical symptoms were headache, nausea, and vomiting (39%). Initially, a conservative treatment approach was chosen in 29% of cases but led to rehemorrhage in 40% of cases; 63% of these rehemorrhages occurred during the first 35 days. Endovascular treatment seemed a safe option for aneurysm exclusion, mainly through parent vessel sacrifice, but had a treatment failure rate of 21%, due to inadequate access. Aneurysm treatment with revascularization as the initial treatment strategy led to aneurysm regression in 82% with no reported rehemorrhage. Aneurysm exclusion through open surgery was effective but was associated with a relatively high complication rate (25%). Outcome after rupture of CCAA was poor, with 41% of patients deceased or permanently disabled. Overall, patient outcomes were better in the endovascular and revascularization treatment group than in the conservative treatment group. Rupture of CCAA in MMD is associated with high morbidity and rerupture rate requiring urgent treatment.

Stevens–Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) is a rare, life-threatening mucocutaneous adverse reaction. Limited clinical trials have been undertaken, and clinicians are reliant on case reports and series to guide clinical care. However, these case report and series have never been summarized. Our objective was to scrutinize the clinical characteristics (patient metrics, aetiology, management and complications) reported in case reports and series of SJS/TEN. The OVID MEDLINE and Embase databases were searched from inception to 2023 (updated in 2024). Case reports and series of patients with SJS/TEN of all ages were included. Articles had to be published in English, with keyword data that could be extracted from the abstract or title. Screening and data extraction were conducted by paired researchers independently. Clinical characteristics were categorized thematically; patients could be in more than one category. Patient and clinical characteristics were described using percentages. From 1847 articles identified, 1591 were included, of which 1166 (73%) abstracts were available; 204 (13%) were case series. In total, 1684 patients were included; 56% (484 of 869) were female; age 0–18 years was the commonest age group (18%, 143 of 814); and 1% (17 of 1684) were pregnant. The most common medical histories reported were HIV (17%, 61 of 364), neurological conditions (16%, 59 of 364) and mental health conditions (8%, 30 of 364). The most frequent cancer histories were haematological (28%, 54 of 196), lung (21%, 42 of 196), gastrointestinal/colorectal, and neurological (both 12%, 24 of 196). Erythema multiforme major (24%, 16 of 67) was the most common differential diagnosis. Overall, 137 causative drug classes were reported; the three most common were anticonvulsants (20%, 247 of 1262), nonsteroidal anti-inflammatories (7%, 83 of 1262) and immune checkpoint inhibitors (6%, 71 of 1262). The most common causative individual drugs were lamotrigine (n = 76), carbamazepine (n = 71), phenytoin (n = 45), co-trimoxazole (n = 36) and pembrolizumab (n = 28). The most prevalent causative infections were mycoplasma (31%, 33 of 108), COVID-19 (19%, 21 of 108) and herpes simplex virus (6%, 6 of 108). Investigations undertaken included human leucocyte antigen testing (15%, 34 of 232), lymphocyte transformation test (11%, 26 of 232) and drug patch testing (7%, 17 of 232). The most common treatments were steroid (any route; 53%, 382 of 718), intravenous immunoglobulins (26%, 184 of 718), antibiotics (14%, 98 of 718) and ciclosporin (10%, 70 of 718). The most frequent complications were ocular (other than conjunctivitis, symblepharon, corneal ulcer; 25%, 100 of 405), gastrointestinal (other than dysphagia, liver failure, vanishing bile duct syndrome; 14%, 55 of 405) and skin (13%, 54 of 405). Overall, 7% (111 of 1684) died. This is the first scoping review summarizing all case reports and series of SJS/TEN. We have highlighted reported medication and infection triggers, which may help healthcare professionals to identify a cause and be aware of those at risk. Regarding treatments, steroids are the mainstay, alongside intravenous immunoglobulin and ciclosporin. The range of complications emphasizes the need for a multidisciplinary management approach both in the short- and longer-term care of patients.

Previous studies found that Jinlida granules could significantly reduce blood glucose levels and enhance the low-glucose action of metformin. However, the role of Jinlida in the standard-reaching rate of blood glucose and improving clinical symptoms has yet to be studied. We aimed to elaborate on the efficacy of Jinlida in type 2 diabetes (T2D) patients who experience clinical symptoms based on secondary analysis of a randomized controlled trial. Data were analyzed from a 12-week, randomized, placebo-controlled study of Jinlida. The standard-reaching rate of blood glucose, the symptom disappearance rate, the symptom improvement rate, the efficacy of single symptoms, and the total symptom score were evaluated. The correlation between HbA1c and the improvement of clinical symptoms was analyzed. For 12 weeks straight, 192 T2D patients were randomly assigned to receive either Jinlida or a placebo. The treatment group showed statistically significant differences in the standard-reaching rate of HbA1c < 6.5% (p = 0.046) and 2hPG (< 10 mmol/L, 11.1 mmol/L) (p < 0.001), compared with the control group. The standard-reaching rate of HbA1c < 7% (p = 0.06) and FBG < 7.0 mmol/L (p = 0.079) were not significantly different between the treatment and control groups. Five symptoms exhibited a statistical difference in symptom disappearance rate (p < 0.05). All the symptoms exhibited a significant difference in symptom improvement rate (p < 0.05). The mean change in total symptom score from baseline to week 12 was -5.45 ± 3.98 in the treatment group and -2.38 ± 3.11 in the control group, with statistically significant differences (p < 0.001). No significant correlations were noted between symptom improvement and HbA1c after 12 weeks of continuous intervention with Jinlida granules or placebo. Jinlida granules can effectively improve the standard-reaching rate of blood glucose and clinical symptoms of T2D patients, including thirst, fatigue, increased eating with rapid hungering, polyuria, dry mouth, spontaneous sweating, night sweat, vexing heat in the chest, palms, and soles, and constipation. Jinlida granules can be used as an effective adjuvant treatment for T2D patients who experience those symptoms.

Subarachnoid hemorrhage is a severe neurological condition that requires prompt and appropriate treatment to prevent complications. Aneurysms are the most common cause of spontaneous subarachnoid hemorrhage. Conversely, basilar artery perforator aneurysms (BAPAs) are a rare etiology. There is no consensus on the optimal management of ruptured BAPAs in the acute setting. We present a case series of 3 patients with ruptured BAPAs who were treated at our institution. Two patients had a modified Fisher grade of I, and one had a grade of IV on initial presentation. The aneurysms were detected by computed tomography angiography in two cases and conventional angiography in one case. The 3 patients underwent endovascular treatment with Guglielmi detachable coils. Post-treatment, the patients had good clinical outcomes, and follow-up brain computed tomography scans showed reduced subarachnoid hemorrhage without any new hemorrhage. However, one patient experienced a cerebral infarction 2 months later and eventually succumbed to the condition. The other 2 patients showed progressive recovery, and no aneurysm recurrence was observed at the 2-year follow-up. Endovascular treatment may be a preferable approach for managing ruptured BAPAs compared with surgical intervention or conservative management. Early detection and prompt treatment is important to achieve favorable patient outcomes.

Temporal bone osteoradionecrosis (TBORN) is a rare, chronic complication of head and neck radiation. Initial treatment consists of conservative management, with surgical resection of necrotic bone indicated for cases of severe, symptomatic, or progressive disease. Pentoxifylline-tocopherol (PENTO) has demonstrated usefulness for osteoradionecrosis of other head and neck subsites. Herein, we report five TBORN cases utilizing this protocol. Retrospective case series. Tertiary referral center. This case series describes five TBORN cases in which the PENTO protocol was used in conjunction with conservative management. All patients were women and average age was 61 ± 8 years. All patients received a daily dose of 800 mg of pentoxifylline and 1 g of tocopherol. Four of the five patients received systemic and/or ototopical antibiotics as an antimicrobial regimen before and/or during the PENTO protocol. Details regarding the total duration of protocol, improvement in symptoms, exposed bone and radiographic changes, and duration until first improvement of exposed bone were collected retrospectively. The average duration of PENTO protocol was 302 ± 166 days. Four of the five (80%) patients demonstrated a decrease in exposed ear canal bone. Three of the five (60%) patients had stable or improvement in otologic symptoms of TBORN. One patient progressed to diffuse TBORN. The average duration until first improvement in exposed bone was 193 ± 137 days. The PENTO protocol may be a useful adjunct to conservative measures in the management of localized TBORN. We recommend trialing the protocol for at least 12 months.

The authors examined the cumulative effects of work on symptoms, quality of life, and self-esteem for 149 unemployed clients with severe mental illness receiving vocational rehabilitation. Nonvocational measures were assessed at 6-month intervals throughout the 18-month study period, and vocational activity was tracked continuously. On the basis of their predominant work activity over the study period, participants were classified into 4 groups: competitive work, sheltered work, minimal work, and no work. The groups did not differ at baseline on any of the nonvocational measures. Using mixed effects regression analysis to examine rates of change over time, the authors found that the competitive work group showed higher rates of improvement in symptoms; in satisfaction with vocational services, leisure, and finances; and in self-esteem than did participants in a combined minimal work-no work group. The sheltered work group showed no such advantage.

Catatonia is a neuropsychiatric disorder characterised by altered movement, speech, and behaviour. Clozapine is an established therapy for treatment-resistant schizophrenia, but its role in catatonia has not been systematically examined. In this systematic review, we aimed to assess the evidence for clozapine as a treatment for catatonia.Full text original research articles in English where at least one patient with catatonia was treated with clozapine were included, provided catatonia did not occur solely in the context of neuroleptic malignant syndrome. Results were tabulated with calculations of summary statistics presented. Risk of bias was assessed with the Tool for Evaluating the Methodological Quality of Case Reports and Case Series.182 patients were included, 81 from cohort studies and 101 from case reports or case series. 119/182 patients (65 %) had a specified underlying diagnosis of schizophrenia. Over 80 % of reported patients with catatonia had at least partial remission following treatment with clozapine across both cohort studies and case reports and case series. Among the case reports and series, 24/101 patients (23.8 %) followed clozapine withdrawal. Overall, 25 studies were of low quality, 60 of moderate quality and 8 of high quality.Our findings should be interpreted with caution, as the reliance on case reports, case series and small cohort studies is susceptible to reporting biases, regression to the mean and confounding by other treatments. Future research could use large healthcare databases to ascertain outcomes in those on clozapine with a history of catatonia given the difficulty and expense of conducting randomised controlled trials.