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Laser Treatment of Epistaxis and Oral Bleeding in Hereditary Hemorrhagic Telangiectasia

International Journal of Otolaryngology and Head & Neck Surgery 2019年第5期8卷 180-190页

作者： dan yaniv Uri Alkan Eitan yaniv Calin Bumbulut Lea Rath-Wolfson Department of Otorhinolaryngology-Head and Neck Surgery Rabin Medical CenterBeilinson HospitalPetach TikvaIsrael Sackler Faculty of Medicine Tel Aviv UniversityTel AvivIsrael Civil Medical Society Satu MareRomania Department of Pathology Rabin Medical CenterHasharon HospitalPetach TikvaIsrael

Background: Hereditary hemorrhagic telangiectasia (HHT) is a relatively common, albeit under-recognized autosomal-dominant multisystemic vascular disorder. Epistaxis due to telangiectases in the nasal mucosa is the most common and often the earliest symptom of HHT. As many as 90% of affected individuals eventually experience recurrent epistaxis, with a mean frequency of 18 episodes per month. Prompted by the limitations of invasive treatment, researchers have directed attention to laser photocoagulation as an alternative nonsurgical treatment modality with promising results. Purpose: The purpose of the present study was to describe our experience with the state-of-the-art 980 nm diode laser for the treatment of bleeding lesions of the skin, nasal and oral mucosa in patients with HHT. Methodology/Principal: We treated 16 HHT patients with intractable bleeding from telangiectasias using the 980-nm diode laser as an office procedure using local anesthesia. We recorded hemoglobin levels before and after treatment and used disability questionnaires. Results: All patients treated had an improvement in hemoglobin levels and disability scores. In patients with multiple lesions hemoglobin levels improved from a mean of 8.4 to 11.2 (p = 0.008). The disability index in this group improved from a mean of 5.3 to 2.8 (p = 0.007). Follow-up ranged between 4 and 12 months. Conclusions: The 980-nm diode laser is a good office based solution for bleeding in HHT.

关键词： HHT Laser Epistaxis Osler-Weber-Rendu

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Skull base chordomas review of current treatment paradigms

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World Journal of Otorhinolaryngology-Head and Neck Surgery 2020年第2期6卷 125-131页

作者： dan yaniv Ethan Soudry Yulia Strenov Marc A.Cohen Aviram Mizrachi Department of Otolaryngology-Head and Neck Surgery Rabin Medical CenterPetah Tikva and Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael Department of Pathology Rabin Medical CenterPetah Tikva and Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael Head and Neck Service Department of SurgeryMemorial Sloan-Kettering Cancer CenterNew YorkNYUSA

Background:Chordomas are locally invasive neoplasms,arising from notochordal remnants and can appear anywhere along the axial *** recurrences are common,and distant metastases may occur years after the initial ***:Literature review of current treatment strategies for chordomas of the skull ***:Surgery is the mainstay of treatment and complete resection has paramount importance for *** complete resection is not achieved recurrent disease is *** anatomical complexity of the skull base makes resection *** endoscopic approaches to the clivus has become increasingly favored in recent years although addressing reconstruction of the skull base to prevent CSF leak may be *** suggests that radiotherapy should not be considered as a primary single modality when trying to achieve cure of the ***,immediate post-operative radiotherapy improves *** strategies have been suggested to preserve sensitive vital structures in the skull base during treatment but as for survival there is no evidence of advantage when comparing adjuvant therapy with photon radiotherapy,gamma knife surgery,proton beam therapy,and carbon ion radiation *** is no evidence to support cytotoxic chemotherapy in the treatment of chordomas but targeted therapies have started to show *** optional molecular targets *** is overexpressed in 95%of chordomas but not in other mesenchymal ***,its precise role in chordoma pathogenesis is currently unclear,and its cellular location in the nucleus makes it difficult to *** inhibition of brachyury in chordoma cell lines induces growth arrest and *** does not have clinical application to *** are retrospective results with different molecular targeted therapies for advanced chordomas with some ***:Despite improvements made in the past 10 years in our knowledge of chordoma bio

关键词： Skull Base Chordoma Surgery Review Targeted therapy

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When should we give up on expectant management for patients with proximal ureteral stones?

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Current Urology 2022年第1期16卷 9-14页

作者： Igal Shpunt Etay Elbaz Yuval Avda Jonathan Modai dan Leibovici Brian Berkowitz yaniv Shilo Department of Urology Kaplan Medical CenterRehovot7661041Israel Department of Earth and Planetary Sciences Weizmann Institute of ScienceRehovotIsrael

Background:Proximal ureteral stones(PUS)have relatively low rates of spontaneous ***,some patients do on expectant *** aim was to compare risk factors for surgical intervention in patients with PUS who underwent primary intervention to those subjected to expectant *** and methods:We retrospectively reviewed the medical charts of patients presented to the emergency room with symptoms of renal colic and underwent computerized tomography between August 2016 and August 2017.A total of 97 consecutive patients were identified with up to 10 mm *** collected patient demographics,clinical,and imaging data,and performed binary regression analysis for risk of ***:The average age was 49years(range 17-97)and average stone size was 7.1 mm(range 3-10).Forty-one patients underwent immediate intervention while the remaining 56 patients were treated *** the 56 patients treated conservatively,26 underwent delayed intervention while 30 reported spontaneous stone *** univariate analysis of all 97 patients,statistically significant risk factors for intervention were found based on stone size,age,serum lymphocyte,platelet counts,and stone *** these risk factors,stone size≥7mm(p=0.012,odds ratio=5.4)and platelet count?230K/mL(p=0.027,odds ratio=4.9)remained statistically significant on multivariate ***:Stone size and platelet count were found to be risk factors for surgical intervention in patients with up to 10 mm *** findings may assist in identifying patients who are more suitable for conservative approach.

关键词： Nephrolithiasis Renal colic Ureteral calculi Ureterolithiasis Urolithiasis

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Adjuvant chemotherapy after radical cystectomy:Do all patients who need chemotherapy after surgery actually receive it?

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Current Urology 2023年第2期17卷 109-112页

作者： Roy Croock Jonathan Modai Yuval Avda Igal Shpunt Morad Jaber Yamit Peretz yaniv Shilo dan Leibovici Department of Urology Kaplan Medical CenterRehovotIsrael

Background:Compliance with the guideline recommendations for neoadjuvant chemotherapyin patients with muscle-invasive bladder cancer is *** adjuvant chemotherapy approach has the advantage of pathology-based decision-making,allowing for patient *** addition,radical surgery is not delayed and treatment-related toxicity does not impair surgical *** proportion of patients who completed chemotherapy after cystectomy among those who were fit and in need of treatment were *** reasons for not completing adjuvant chemotherapy were *** and methods:We retrospectively evaluated all patients who had undergone radical cystectomy at our center over thelast 7 *** for adjuvant chemotherapy included pathological T>2,any node+,or surgical margin *** patients who were fit for chemotherapy before surgery were included in the ***:Of the 52 patients with muscle-invasive bladder cancer,14 received neoadjuvant chemotherapy or unfit for chemotherapy were *** the remaining 38 patients,14(37%)had bladder-confined cancers and did not require additional *** the 24 patients who needed chemotherapy and were fit to receive it,8 patients completed treatment(33%),and 3 discontinued treatment due to *** patients(50%)declined chemotherapy,whereas 1 patient became unfit for chemotherapy after ***:While the adjuvant chemotherapy approach could save unnecessary treatment in 37%of patients,two-thirds of those who needed chemotherapy did not complete *** refusal was the primary reason for not receiving treatment.

关键词： Adjuvant chemotherapy Muscle-invasive bladder cancer Neoadjuvant chemotherapy

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