Intravascular leiomyomatosis with intracardiac expansion: a toraco-abdominal method.

Background Hidradenitis suppurativa (HS) can cause considerable impact on several aspects of quality of life. Sexuality is a central aspect of quality of life. In recent years there has been an increase in the number of articles on HS and sexuality. read more Objectives To synthesize the available scientific evidence on HS and sexual health. Methods A systematic review was conducted in February 2020. The clinical databases used included Medline and Embase. All types of epidemiological articles were included; reviews, guidelines, protocols, conference abstracts and case report articles were excluded. Results Eleven studies were included for review, representing 42729 patients with HS. The most common study design was cross-sectional with or without comparison group(s), conducted in an outpatient setting or through surveys. Prevalence of sexual dysfunction ranged between 51%-62%, and in the case of erectile dysfunction, a specific kind of sexual dysfunction affecting penile erection, it ranged from between 52%-60% of patients studied using validated questionnaires. Potential risk factors for sexual dysfunction among men and women were identified, mainly related to disease activity, symptoms and partners. Mood disorders like depression and anxiety appear to be associated with sexual dysfunction. Women were more affected by sexual distress. HS patients with sexual dysfunction had a decreased overall quality of life. With respect to treatment, surgery did not improve sexual function and there is no scientific evidence regarding medical treatments. Patients stated that they would like to treat their sexual problems with healthcare professionals. Conclusions Sexual and erectile dysfunction are common in HS patients, and negatively affect their quality of life. There are clinical factors potentially associated with this which should be identified and treated by dermatologists in the comprehensive care of HS patients. Prospective studies are needed to provide more scientific evidence on this unmet need.Trichotillomania (TTM) is a condition in which affected individuals pull out their hair resulting in hair loss. This disorder affects roughly 0.5% to 2.0% of the population and can have significant psychological morbidity. Behavioral therapy has been used with success in the treatment of TTM, but not all patients are willing or able to comply with this treatment strategy. There is a need for effective pharmacological treatment options. Historically, pharmacotherapy for trichotillomania has been inadequate in most cases, but recent advances have been made in this regard. Fluoxetine, clomipramine, olanzapine, and naltrexone have all been used in the treatment of TTM, but evidence of benefit has varied, and side effect profiles can limit practical utility. Recent advances in the understanding of the pathophysiology of TTM, as well as evidence of benefit seen with some glutamate modulating agents such as N-acetylcysteine and dronabinol have provided newer potential pharmacotherapy options. This article is protected by copyright. All rights reserved.Background Pain is a common symptom of head and neck cancers. In some instances, pain may not resolve with conventional modalities and become refractory. Chemical neurolysis is a technique that utilizes chemical neurolytic agents to temporarily denervate a targeted nerve and provide relief in pain-related symptoms. The aim of this investigation was to determine the effectiveness, safety, and predictors of chemical neurolysis procedures for management of refractory head and neck cancer-related pain. Methods A retrospective chart review of patients who underwent chemical neurolysis procedure in the regions of head and neck for management of head and neck cancer-related pain was conducted between November 2017 and November 2018. All adult male and female patients who had undergone chemical neurolysis procedure in the head and neck region for management of refractory head and neck related pain, in Orofacial Pain Clinic, Shaukat Khanum Memorial Cancer Hospital and Research Center were included in the investigation. Results Among 33 participants enrolled, 72.7% of participants experienced 75% or greater relief in pain at the 1-month follow-up. However, 9.1% reported experiencing an adverse effect following neurolysis. A statistically significant association was found between neurolysis effectiveness and chronicity of pain. Conclusions Chemical neurolysis can provide significant relief to patients with refractory head and neck cancer-related pain as an adjunctive therapy. However, it was found to be associated with mild risk of manageable adverse effects. Shorter chronicity of pain was found to be associated with successful outcome.Background Hidradenitis suppurativa (HS) has been associated with auto-inflammatory conditions, yet the risk of developing connective tissue disease (CTD), morphea, and systemic vasculitis has not been well-characterized. Objectives We sought to evaluate the risk of developing CTD, morphea and systemic vasculitis in patients with HS. Methods Using claims data we identified patients with HS and used 21 risk-set sampling to identify patients without HS. Patients with existing CTD were excluded. Patient follow-up lasted until first occurrence of the following events the occurrence of outcome (i.e., systemic lupus erythematosus, morphea, systemic sclerosis, Sjogren's Syndrome, and systemic vasculitis), death, disenrollment, or end of data stream. Hazard ratios (HR) of developing CTD, morphea, and systemic vasculitis were computed after 11 propensity score (PS)-matching. Results After 21 risk-set sampling, we identified 78,122 HS patients and 156,247 non-HS comparators. The mean follow-up was 540 days. After PS-matching, HS patients had an increased risk of systemic lupus erythematosus HR=1.63 (1.31-2.03) and morphea HR=2.02 (1.32-3.11), compared to non-HS patients. We did not observe an increased risk for systemic sclerosis HR=0.90 (0.59-1.44), Sjogren's Syndrome HR=0.91 (0.73-1.14), or systemic vasculitis HR=0.87 (0.64-1.20). Conclusion In this population-based study we observed an increased risk of developing systemic lupus erythematous and morphea subsequent to a first recorded diagnosis of hidradenitis suppurativa.read more