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INTRODUCTION: Neurocutaneous melanosis (NCM) is a sporadic condition characterised by congenital melanocytic nevi and melanocytic thickening of the leptomeninges. It is believed to result from congenital dysplasia of melanin-producing cells within the skin and leptomeninges. The management of cutaneous manifestations remains controversial; for neurological manifestations, outcome remains poor even with the use of radiotherapy and chemotherapy. PATIENTS AND METHODS: We describe the case of a 5-month-old boy who presented with giant congenital melanocytic nevus and hydrocephalus. MR imaging and CSF immunohistochemistry confirmed leptomeningeal melanosis. We discuss the diagnosis, treatment and prognosis of this rare disorder in the light of recent published literature. RESULTS: Patient required placement of right-sided ventriculoperitoneal shunt to control hydrocephalus. The patient tolerated the procedure well and was discharged home with normal neurological function. A presumptive diagnosis of NCM was made based on the MR characteristics, CSF cytology and clinical presentation. He received trametinib, a MAPK/Erk kinase inhibitor for 7 months. At 30 months of age, he developed left-sided weakness and status epilepticus requiring paediatric intensive care unit admission and ventilator support. The patient eventually succumbed to malignant transformation of leptomeningeal disease. CONCLUSION: Cutaneous manifestations of NCM are usually congenital, and neurological manifestations develop early in life. Patients with large or multiple congenital nevi should therefore be investigated early to facilitate treatment. MR imaging is the investigation of choice which can further assist in performing biopsy. Symptomatic NCM is refractory to radiotherapy and chemotherapy and has a poor prognosis. A multidisciplinary approach is necessary in the management of NCM patients.
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Hidrocefalia/diagnóstico por imagen , Melanosis/diagnóstico por imagen , Neoplasias Meníngeas/diagnóstico por imagen , Síndromes Neurocutáneos/diagnóstico por imagen , Resultado Fatal , Humanos , Hidrocefalia/complicaciones , Hidrocefalia/terapia , Lactante , Masculino , Melanoma/complicaciones , Melanoma/diagnóstico por imagen , Melanoma/terapia , Melanosis/complicaciones , Melanosis/terapia , Neoplasias Meníngeas/complicaciones , Neoplasias Meníngeas/terapia , Síndromes Neurocutáneos/complicaciones , Síndromes Neurocutáneos/terapia , Nevo Pigmentado/complicaciones , Nevo Pigmentado/diagnóstico por imagen , Nevo Pigmentado/terapia , Neoplasias Cutáneas/complicaciones , Neoplasias Cutáneas/diagnóstico por imagen , Neoplasias Cutáneas/terapia , Melanoma Cutáneo MalignoRESUMEN
The objective of this article is to systematically analyse the randomized, controlled trials evaluating the effectiveness of local anaesthetic infiltration prior to the rubber band ligation of early symptomatic haemorrhoids. Published randomized, controlled trials comparing the use of local anaesthetic (LA) versus no-local anaesthetic (NLA) for the rubber band ligation of early symptomatic haemorrhoids were analysed using RevMan®, and the combined outcomes were expressed as odds ratios (OR) and standardized mean difference (SMD). Four randomized, controlled trials evaluating 387 patients were retrieved from the standard electronic databases. The risk of treatment failure (OR 0.44; 95% CI 0.07, 2.79; z = 0.87; p = 0.39) and post-procedure complications (OR 0.48; 95% CI 0.08, 2.76; z = 0.83; p = 0.41) was similar between two techniques. However, the post-procedure pain score (SMD -5.19; 95% CI -9.08, -1.30; z = 2.62; p < 0.009) was significantly lower in the group of patients undergoing rubber band ligation of haemorrhoids under local anaesthetic injection. The use of LA appears to have clinically measurable advantages over NLA in the rubber band ligation of early symptomatic haemorrhoids to lessen post-procedure pain.
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Anestesia Local/métodos , Anestésicos Locales/administración & dosificación , Hemorroides/cirugía , Dolor Postoperatorio/prevención & control , Humanos , Inyecciones , Ligadura/instrumentación , Dimensión del Dolor , Dolor Postoperatorio/diagnóstico , Goma , Resultado del TratamientoRESUMEN
AIM: Conventional air insufflation (AI) may cause prolonged abdominal bloating, excessive abdominal pain and discomfort during colonoscopy. Carbon dioxide may be an acceptable alternative to avoid these complications. The object of this study was to evaluate systematically the effectiveness of carbon dioxide insufflation (CI) for colonoscopy compared with AI. METHOD: Randomized controlled trials (RCTs) comparing the effectiveness of CI with that of AI during colonoscopy were retrieved from medical electronic databases and combined analysis was performed using the RevMan statistical package. The combined outcome of dichotomous and continuous variables was expressed as an odds ratio (OR) and standardized mean difference (SMD). RESULTS: Twenty-one RCTs comprising 3607 patients were included in the study. There was statistically significant heterogeneity among included studies. CI showed a significant trend towards reduced procedural pain [SMD -1.34; 95% confidence interval (95% CI) -2.23 to -0.45; z = 2.96; P < 0.003] and also postprocedural pain at 1 h (SMD -1.11; 95% CI -1.83 to -0.38; z = 2.97; P < 0.003), 6 and 24 h (OR 0.44; 95% CI 0.23-0.85; z = 2.44; P < 0.01). CI was associated with faster caecal intubation (SMD -0.20; 95% CI -0.37 to -0.02; z = 2.23; P < 0.03) but the caecal intubation rate was similar (P = 0.59) in both colonic insufflation techniques . CONCLUSION: CI seems to have clinical advantages over AI for colonoscopy with regard to pain during and after the procedure.
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Dióxido de Carbono/administración & dosificación , Colonoscopía/métodos , Insuflación/métodos , Complicaciones Intraoperatorias/epidemiología , Dolor Postoperatorio/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Aire , Ciego/cirugía , Femenino , Humanos , Insuflación/efectos adversos , Complicaciones Intraoperatorias/etiología , Complicaciones Intraoperatorias/prevención & control , Masculino , Persona de Mediana Edad , Dolor Postoperatorio/etiología , Dolor Postoperatorio/prevención & control , Ensayos Clínicos Controlados Aleatorios como Asunto , Adulto JovenRESUMEN
AIMS & OBJECTIVES: The aim of the study was to look at the infection rate in adults undergoing craniotomies without hair removal and compare the results with the usual practice of pre-operative shaving/clipping. MATERIALS & METHODS: One-hundred consecutive adult patients who had elective supra-tentorial craniotomy for tumour were studied prospectively. A uniform policy of performing surgery without hair removal was adopted. Patients were followed up prospectively to look for surgical site infection. The rate of infection was determined and the results were compared with the published data on similar procedures where hair removal was carried out before surgery. RESULTS: A total of three patients developed surgical-site infection. One infection occurred in the glioma and two in the meningioma subgroup. The rate of infection is comparable to the published figures where pre-operative hair removal was performed routinely. CONCLUSIONS: Cranial surgery with hair left in place does not pre-dispose to an increased infection risk for adults undergoing tumour surgery.