Similarities between interstitial cystitis/bladder pain syndrome and vulvodynia: implications for patient management

Interstitial cystitis/bladder pain syndrome (IC/BPS) and vulvodynia are chronic pain syndromes that appear to be intertwined from the perspectives of embryology, pathology and epidemiology. These associations may account for similar responses to various therapies.     

Efficacy of Oral Anticoagulation in Stroke Prevention among Sinus-Rhythm Patients Who Lack Left Atrial Mechanical Contraction after Cryoablation

The customary recommendation is that oral anticoagulation be withdrawn a few months after cryoablation for atrial fibrillation, independently of left atrial mechanical contraction in patients in sinus rhythm. Recently, a 5-fold increase in stroke has been described in sinus-rhythm patients who lack atrial mechanical contraction. One aim of this study was to evaluate the efficacy of oral anticoagulation in preventing postoperative stroke in such patients.This prospective study divided 154 sinus-rhythm patients into 2 groups, depending on the presence (108 patients) or absence (46 patients) of left atrial mechanical contraction at 6 months after surgery, and monitored them annually for 5 years. Those without left atrial contraction were maintained on acenocumarol. The primary endpoint was the occurrence of ischemic stroke.The median follow-up period was 29 ± 16 months; 4 patients (2.5%), all belonging to the group with preserved atrial contraction, had ischemic stroke; the group of patients without left atrial contraction had no episodes of stroke during follow-up. Logistic binary regression analyses showed no evidence of factors independently predictive of stroke.Among anticoagulated patients in sinus rhythm without left atrial contraction, we found the incidence of stroke to be zero. In a small, nonrandomized group such as this, we cannot discount the element of chance, yet we suggest that maintaining anticoagulation might lower the incidence of stroke in this population.     

上矢状窦旁中后1/3脑膜瘤术中回流静脉的保护研究

目的探讨上矢状窦中后1/3脑膜瘤术中保护回流静脉的方法及意义,为确保手术成功提供参考依据。方法回顾性分析本院神经外科2011年8月至2013年8月收治的50例上矢状窦旁中后1/3脑膜瘤患者的临床资料,按照是否保护回流静脉分为观察组(36例)和对照组(14例)。观察组患者行静脉磁共振血管成像(MRV)检查,明确上矢状窦通畅程度与脑膜瘤周边静脉回流代偿情况,术中尽量保护回流静脉及正常脑组织,妥善处理受累矢状窦。对照组患者采用传统手术方式治疗,未评价矢状窦通畅情况,未保护回流静脉。依据Simpson标准评价肿瘤切除程度,比较两组患者肿瘤全切率、死亡率、对症治疗及随访情况。结果两组患者均顺利完成手术,观察组患者肿瘤全切除34例(94.44%),对照组患者肿瘤全切除10例(71.43%),两组均未出现死亡病例,观察组患者手术效果明显优于对照组,差异具有显著性(P<0.05)。结论上矢状窦中后1/3脑膜瘤术前行MRV检查,术中保护回流静脉可提高肿瘤全切除率,改善患者的生存质量。     

Editor's choice: New concepts in the management of diffuse low-grade glioma: Proposal of a multistage and individualized therapeutic approach

Diffuse low-grade glioma grows, migrates along white matter tracts, and progresses to high-grade glioma. Rather than a “wait and see” policy, an aggressive attitude is now recommended, with early surgery as the first therapy. Intraoperative mapping, with maximal resection according to functional boundaries, is associated with a longer overall survival (OS) while minimizing morbidity. However, most studies have investigated the role of only one specific treatment (surgery, radiotherapy, chemotherapy) without taking a global view of managing the cumulative time while preserving quality of life (QoL) versus time to anaplastic transformation. Our aim is to switch towards a more holistic concept based upon the anticipation of a personalized and long-term multistage therapeutic approach, with online adaptation of the strategy over the years using feedback from clinical, radiological, and histomolecular monitoring. This dynamic strategy challenges the traditional approach by proposing earlier therapy, by repeating treatments, and by reversing the classical order of therapies (eg, neoadjuvant chemotherapy when maximal resection is impossible, no early radiotherapy) to improve OS and QoL. New individualized management strategies should deal with the interactions between the course of this chronic disease, reaction brain remapping, and oncofunctional modulation elicited by serial treatments. This philosophy supports a personalized, functional, and preventive neuro-oncology.     

Laparoscopic anatomic segmentectomy 8 using the outer-Laennec approach

BackgroundLaparoscopic anatomic segmentectomy 8 is a difficult and technically demanding procedure owing to exposure of two major hepatic veins. To safely and accurately perform this procedure, the outer-Laennec approach was developed (Kiguchi et al., 2019) [1], which is based on the structure of Laennec's capsule (Sugioka et al., 2017; Laennec, 1802; Hayashi et al., 2008) [2,3,4]. The capsule comprises two layers: the hepatic and cardiac Laennec's capsules surrounding the major hepatic vein (Kiguchi et al., 2019) [1]. The outer-Laennec approach maintains the strength of the hepatic vein wall, preserving the two layers of Laennec's capsule. We describe a laparoscopic anatomic segmentectomy 8 using the outer-Laennec approach for hepatocellular carcinoma (HCC).MethodsParenchymal transection was initiated to expose the root of the middle hepatic vein and right hepatic vein with the cranio-caudal view. The space between the hepatic Laennec's capsule and liver parenchyma was invaded using the outer-Laennec approach. The cavitron ultrasonic surgical aspirator was used from the root side toward the peripheral side to retain the hepatic Laennec's capsule on the vein wall and avoid splitting the bifurcation of the hepatic vein. The parenchymal dissection process was completed by an S8 Glissonean pedicle dissection.ResultsThe operative time was 296 min, and the estimated blood loss was 10 mL. The postoperative course was uneventful, and the patient was discharged on postoperative day 5. A pathological examination confirmed that the 2.0-cm mass was HCC with negative margins.ConclusionThe outer-Laennec approach is feasible and useful to standardize the safe laparoscopic anatomic segmentectomy 8.