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Sample records for injuries complicating ankylosing

  1. MRI of cervical spine injuries complicating ankylosing spondylitis

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    Koivikko, Mika P.; Koskinen, Seppo K. [Helsinki Medical Imaging Center, Helsinki University Central Hospital, Toeoeloe Hospital, Department of Radiology, Helsinki (Finland)

    2008-09-15

    The objective was to study characteristic MRI findings in cervical spine fractures complicating ankylosing spondylitis (AS). Technical issues related to MRI are also addressed. A review of 6,774 consecutive cervical spine multidetector CT (MDCT) scans obtained during 6.2 years revealed 33 ankylosed spines studied for suspected acute cervical spine injury complicating AS. Of these, 20 patients also underwent MRI. On MRI, of these 20 patients, 19 had a total of 29 cervical and upper thoracic spine fractures. Of 20 transverse fractures traversing both anterior and posterior columns, 7 were transdiskal and exhibited less bone marrow edema than did those traversing vertebral bodies. One Jefferson's, 1 atlas posterior arch (Jefferson's on MDCT), 2 odontoid process, and 5 non-contiguous spinous process fractures were detectable. MRI showed 2 fractures that were undetected by MDCT, and conversely, MDCT detected 6 fractures not seen on MRI; 16 patients had spinal cord findings ranging from impingement and contusion to complete transection. Magnetic resonance imaging can visualize unstable fractures of the cervical and upper thoracic spine. Paravertebral hemorrhages and any ligamentous injuries should alert radiologists to seek transverse fractures. Multiple fractures are common and often complicated by spinal cord injuries. Diagnostic images can be obtained with a flexible multipurpose coil if the use of standard spine array coil is impossible due to a rigid collar or excessive kyphosis. (orig.)

  2. Pitfalls and complications in the treatment of cervical spine fractures in patients with ankylosing spondylitis

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    Tschoeke Sven K

    2008-06-01

    Full Text Available Abstract Patients with ankylosing spondylitis are at significant risk for sustaining cervical spine injuries following trauma predisposed by kyphosis, stiffness and osteoporotic bone quality of the spine. The risk of sustaining neurological deficits in this patient population is higher than average. The present review article provides an outline on the specific injury patterns in the cervical spine, diagnostic algorithms and specific treatment modalities dictated by the underlying disease in patients with ankylosing spondylitis. An emphasis is placed on the risks and complication patterns in the treatment of these rare, but challenging injuries.

  3. Aortic rupture complicating a fracture of an ankylosed thoracic spine. A case report.

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    Savolaine, E R; Ebraheim, N A; Stitgen, S; Jackson, W T

    1991-11-01

    A 34-year-old man was injured in a motorcycle accident and suffered both aortic rupture and thoracic spinal fracture, complicated by an underlying undetected ankylosing spondylitis. The latter disease can affect the integrity of vascular and spinal structure. Aortography is recommended as a high priority for the patient in an unstable cardiovascular condition requiring a definitive diagnosis. Aortic rupture and thoracic spine fracture may occur from high energy deceleration trauma. Motor vehicle passenger and pedestrian injuries are most commonly involved, although airline accidents and high falls also generate some cases. Mediastinal widening, displacement of esophagus and trachea, apical dissection of blood, and, especially, paravertebral pleural space widening are common to both injuries. Whereas most mediastinal hematomas are nonaortic in origin, a combined injury must be considered because clinical features may also overlap. These include hypotension (hypovolemic or spinal shock), paraplegia, and severe back pain. In light of the high mortality and time constraints associated with aortic rupture, immediate diagnostic resolution is necessary for appropriate management and priority of investigation.

  4. Atlantoaxial instability: An exceptional complication of ankylosing spondylitis

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    Zeineb Alaya

    2018-04-01

    Full Text Available Background: Atlantoaxial instability (AAI and more rarely odontoid pannus formation, similar to the one observed in Rheumatoid Arthritis, are seldom reported in ankylosing spondylitis (AS. We report a new case of a patient with AS with a pannus in the atlanto-axial region and cervical C1-C2 instability. Case presentation: The patient, now aged 41, was diagnosed with AS in 2010. She was put on different non steroidal anti inflammatory treatments with persistent spinal pain. She was referred to our department in 2015 with severe cervical pain and stiffness since 3 months. On examination, the patient had severely limited cervical spine movements. Lumbar spine movements were moderately affected. There was no neurological deficit. Her Bath Ankylosing Spondylitis Disease Activity Index (BASDAI was 4.9/10 and Bath Ankylosing Spondylitis Functional Index (BASFI was 5/10. Plain Radiographs of the pelvis showed bilateral grade 4 sacroilitis and bilateral coxitis. Dorsal and lumbar spine plain radiographs showed squaring of vertebral bodies. Cervical spine radiographs showed an increased atlanto-axial distance. Spinal MRI confirmed the atlantoaxial subluxation with an anterior distance of 8 mm, with marked intraspinal pannus formation and synovitis around the odontoid peg. Synovial thickening exerted an anterior mark on the bulbo-medullary junction with no evidence of oedema signs. Posterior zygapophysial ankylosis involving all cervical levels was also observed. The patient had a cervical collar with anti-tumor necrosis factor-α (cerolizumab-pegol prescription with favorable outcome. Conclusion: Odontoid pannus formation is rare in AS. Clinical and radiological follow-up are important to assess the impact on the cervical spine. Keywords: Ankylosing spondylitis, Atlantoaxial instability, MRI, Cerolizumab-pegol

  5. Total hip arthroplasty in patients with ankylosing spondylitis: Midterm radiologic and functional results

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    Yavuz Saglam

    2016-08-01

    Conclusion: Revision incidence was similar in between ankylosed and non-ankylosed hips. While complication rates are high, significant functional improvement can be achieved after THA in patients with AS.

  6. Cauda equina syndrome complicating ankylosing spondylitis: use of electromyography and computerised tomography in diagnosis.

    Science.gov (United States)

    Young, A; Dixon, A; Getty, J; Renton, P; Vacher, H

    1981-06-01

    A case of the cauda equina syndrome complicating ankylosing spondylitis (AS) is described. An unusual feature of this case was the relapsing and remitting nature of the condition, but there is sufficient evidence to explain the clinical picture on the basis of a recurrent intraspinal inflammatory process. The clinical and radiological features are similar to those of a further 28 reported in the literature. An electromyogram (EMG) proved important in defining the extent of neurological involvement. Computerised tomography (CT) showed marked laminar erosion and no bony exit foramen encroachment. We believe that the clinical diagnosis of this condition can be adequately confirmed with plain radiology, EMG, and CT scan.

  7. Ankylosing Spondylitis Increases Perioperative and Postoperative Complications After Total Hip Arthroplasty.

    Science.gov (United States)

    Blizzard, Daniel J; Penrose, Colin T; Sheets, Charles Z; Seyler, Thorsten M; Bolognesi, Michael P; Brown, Christopher R

    2017-08-01

    Ankylosing spondylitis (AS) is a chronic autoimmune spondyloarthropathy that primarily affects the axial spine and hips. Progressive disease leads to pronounced spinal kyphosis, positive sagittal balance, and altered biomechanics. The purpose of this study is to determine the complication profile of patients with AS undergoing total hip arthroplasty (THA). The Medicare sample was searched from 2005 to 2012 yielding 1006 patients with AS who subsequently underwent THA. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated for 90-day, 2-year, and the final postoperative follow-up for complications including hip dislocation, periprosthetic fracture, wound complication, revision THA, and postoperative infection. Compared to controls, AS patients had an RR of 2.50 (CI, 1.04-5.99) of THA component breakage at 90-days post-operatively and 1.99 (CI, 1.10-3.59) at 2-years. The RR of periprosthetic hip dislocation was elevated at 90 days (1.44; CI, 0.93-2.22) and significantly increased at 2-years (1.67; CI, 1.25-2.23) and overall follow-up (1.49; CI, 1.14-1.93). Similarly, the RR for THA revision was elevated at 90-days (1.46; CI, 0.97-2.18) and significantly increased at 2-years (1.69; CI, 1.33-2.14) and overall follow-up (1.51; CI, 1.23-1.85). Patients with AS are at increased risk for complications after THA. Altered biomechanics from a rigid, kyphotic spine place increased demand on the hip joints. The elevated perioperative and postoperative risks should be discussed preoperatively, and these patients may require increased preoperative medical optimization as well as possible changes in component selection and position to compensate for altered spinopelvic biomechanics. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Clinical Evaluation of Fused/Ankylosed Hip with Severe Flexion Deformity after Conversion to Total Hip Arthroplasty

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    Saroj Kumar Suwal

    2016-06-01

    Conclusions: THA is an effective treatment for ankylosed hip with severe flexion deformity although complications are noted more than routine hip arthroplasties. Keywords: ankylosed hip; fused hip; severe flexion deformity; total hip arthroplasty. | PubMed

  9. The role of biomechanical factors in ankylosing spondylitis: the patient’s perspective

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    R.C. Ansell

    2016-02-01

    Full Text Available Biomechanical factors including occupational joint physical stressing and joint injury have been linked to spondyloarthritis. We explored such factors in ankylosing spondylitis (AS. A retrospective, online survey was developed alongside the UK National Ankylosing Spondylitis Society (NASS. Questions on early entheseal symptoms, potential precipitating trauma, sporting activity, and physiotherapy were asked. A total of 1026 patients responded with 44% recalling an instance of injury or trauma as a potential trigger for their AS. After symptom onset, 55% modified sporting activities and 28% reported that the initial AS recommended exercises exacerbated symptoms. Patients report physical trauma, exercise and physiotherapy as potential triggers for AS symptoms. These findings further support the experimental evidence for the role of biomechanical factors in disease.

  10. Respiratory Disorders in Complicated Cervical Spine Injury

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    S. A. Pervukhin

    2016-01-01

    Full Text Available Objective. Evaluating the results of respiratory therapy in patients with complicated traumatic injury of the cervical spine.Materials and methods. A retrospective comparative analysis of the clinical course was carried out in 52 patients with complicated traumatic injury of the cervical spine: group A: complete spinal cord injury (ASIA A, 37 patients and group B: incomplete injury (ASIA B, 15 patients. The severity of patients' status on integral scales, parameters of the respiratory pattern and thoracopulmonary compliance, gas composition, and acidbase status of the blood were assessed. Data on patients who required prolonged mechanical ventilation, duration of mechanical ventilation, incidence of nosocomial pneumonia, duration of stay in the ICU, time of hospital treatment, and mortality were included in the analysis. Results. The average APACHE II and SOFA scores were higher in group A patients. The development of the acute respiratory failure required longterm mechanical ventilation (more than 48 hours in 91.4% of group A patients and in 53.3% of group B patients. Ventilatorassociated pneumonia complicated the disease in 81.3% of group A patients and 62.5% of group B patients and was accompanied by sepsis in 25% and 12.5% of cases, respectively. Statistically significant deterioration of biomechanical properties and gas exchange function of the lungs was observed in patients complicated with septic pneumonia.Conclusion. Patients with complicated ASIA A and ASIA B cervical spine injuries demonstrate the presence of respiratory failure of neurogenic origin. In addition, the infectious bronchopulmonary complications aggravated respiratory failure in patients with ASIA A injury in 70.3% versus 33.3% in patients with ASIA B. Developmentof pulmonogenic sepsis led to deterioration of the biomechanical and gas exchange functions of the lungs and increased the likelihood of unfavorable outcome of the disease in 77.8% of cases. The high

  11. Spinal pseudo arthrosis in the ankylosing spondylitis: complications with infectious discytis simulation

    International Nuclear Information System (INIS)

    Galant, J.; Marti-Bonmarti, L.; Poyatos, C.; Martinez-Rodrigo, J.; Ferrer, M.D.

    1995-01-01

    A case is presented of radiological signs typical of spinal pseudo arthrosis in a patient with ankylosing spondylitis. The radiological signs (plain radiology, computerized tomography and magnetic resonance) are described, and the recognition of this disorder and its differentiation with respect to infectious spondilodiscitis is discussed. (Author) 11 refs

  12. [Airway management in a man with ankylosing spondylitis].

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    Gil, S; Jamart, V; Borrás, R; Miranda, A

    2007-02-01

    We report a case of difficult airway management in a 41-year-old man with ankylosing spondylitis who was scheduled for total left hip replacement surgery. After several failed attempts to achieve regional anesthesia, we converted to general anesthesia with orotracheal intubation using a fiberoptic bronchoscope. Ankylosing spondylitis leads to fibrosis, ossification, and ankylosis along the spinal column and sacroiliac articulations. Cervical column and atlantooccipital articulation mobility are reduced and in severe cases the cervical vertebrae become fixed in a flexed position. This portion of the spine is also the most susceptible to fracture, particularly in hyperextension, an event that could lead to damage to the cervical spinal cord during maneuvers to manage the airway. Patients with this condition may also have temporomandibular joint involvement, further complicating airway management. We report the case of a patient with ankylosing spondylitis with fixation along the entire spine. The airway was managed by intubation with a fiberoptic bronchoscope. Spontaneous ventilation was maintained during the maneuver, and sedation was achieved with perfusion of remifentanil as the only anesthetic agent following failure of intradural anesthesia.

  13. A case of severe ankylosing spondylitis posted for hip replacement surgery

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    Nalini Kotekar

    2007-01-01

    Full Text Available A 50-year-old male patient with history of ankylosing spondylitis (AS for 30 years presented for hip replacement surgery. Airway management in ankylosing spondylitis patients presents the most serious array of intubation and airway hazards imagin-able, which is secondary to decrease in cervical spine mobility and possible temporo-mandibular joint disease. Literatures support definitive airway management and many authors consider regional anaesthesia to be contraindicated. The reasons cited include inability to gain neuraxial access and the need for urgent airway control in case of complication of regional anaesthesia.

  14. Predictors of clinical complications in patients with spinomedullary injury

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    Dionei Freitas De Morais

    2014-01-01

    Full Text Available Objective: To analyze individuals with spinal cord injury who developed secondary clinical complications, and the variables that can influence the prognosis. Methods: A prospective study of 321 patients with spinal cord injury. The variables were collected: age, sex, cause of the accident, anatomical distribution, neurological status, associated injuries, in-hospital complications, and mortality only in patients who developed complications. Results: A total of 72 patients were analyzed (85% male with a mean age of 44.72±19.19 years. The individuals with spinal cord injury who developed clinical complications were mostly male, over 50 years of age, and the main cause was accidental falls. These patients had longer hospitalization times and a higher risk of progressing to death. Pneumonia was the main clinical complication. With regard to the variables that can influence the prognosis of these patients, it was observed that spinal cord injury to the cervical segment with syndromic quadriplegia, and neurological status ASIA-A, have a higher risk of developing pneumonia, the most common complication, as well as increased mortality. Conclusion: Clinical complications secondary to spinal cord injury are influenced by demographic factors, as well as characteristics of the injury contributing to an increase in mortality.

  15. Ankylosing Spondylitis: Patterns of Spinal Injury and Treatment Outcomes

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    Altun, Idiris; Yuksel, Kas?m Zafer

    2016-01-01

    Study Design Retrospective review. Purpose We retrospectively reviewed our patients with ankylosing spondylitis (AS) to identify their patterns of spinal fractures to help clarify management strategies and the morbidity and mortality rates associated with this group of patients. Overview of Literature Because of the brittleness of bone and long autofused spinal segments in AS, spinal fractures are common even after minor trauma and often associated with overt instability. Methods Between Janu...

  16. Complications of nonoperative management of high-grade blunt hepatic injuries.

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    Kozar, Rosemary A; Moore, John B; Niles, Sarah E; Holcomb, John B; Moore, Ernest E; Cothren, C Clay; Hartwell, Elizabeth; Moore, Frederick A

    2005-11-01

    Nonoperative management of blunt hepatic injuries is highly successful. Complications associated with high-grade injuries, however, have not been well characterized. The purpose of the present study was therefore to define hepatic-related complications and associated treatment modalities in patients undergoing nonoperative management of high-grade blunt hepatic injuries. Three hundred thirty-seven patients from two regional Level I trauma centers with grade 3 to 5 blunt hepatic injuries during a 40-month period were reviewed. Complications and treatment of hepatic-related complications in patients not requiring laparotomy in the first 24 hours were identified. Of 337 patients with a grade 3 to 5 injury, 230 (68%) were managed nonoperatively. There were 37 hepatic-related complications in 25 patients (11%); 63% (5 of 8) of patients with grade 5 injuries developed complications, 21% (19 of 92) of patients with grade 4 injuries, but only 1% (1 of 130) of patients with grade 3 injuries. Complications included bleeding in 13 patients managed by angioembolization (n = 12) and laparotomy (n = 1), liver abscesses in 2 patients managed with computed tomography-guided drainage (n = 2) and subsequent laparotomy (n = 1). In one patient with bleeding, hepatic necrosis followed surgical ligation of the right hepatic artery and required delayed hepatic lobectomy. Sixteen biliary complications were managed with endoscopic retrograde cholangiopancreatography and stenting (n = 7), drainage (n = 5), and laparoscopy (n = 4). Three patients had suspected abdominal sepsis and underwent a negative laparotomy, whereas an additional three patients underwent laparotomy for abdominal compartment syndrome. Nonoperative management of high-grade liver injuries can be safely accomplished. Mortality is low; however, complications in grade 4 and 5 injuries should be anticipated and may require a combination of operative and nonoperative management strategies.

  17. Scintigraphic findings in ankylosing spondylitis.

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    Lentle, B C; Russell, A S; Percy, J S; Jackson, F I

    1977-06-01

    A prospective study of bone scintigraphic findings has been carried out in 63 patients, firmly diagnosed as having ankylosing spondylitis. In addition to abnormal uptake of the radiotracer at the sacroiliac joints, a peripheral arthropathy has been a common finding, particularly in the proximal joints, occurring in up to 50% of patients. Increased uptake of radiotracer in the spine has also been found both diffusely and focally. Focal increases have been noted at the apophyseal joints in 40% of patients and in three patients with a sterile intervertebral diskitis, an unusual complication of this disease only diagnosed in two patients after bone scintigraphy.

  18. X-ray therapy in the treatment of ankylosing spondylitis

    International Nuclear Information System (INIS)

    Windeyer, B.

    1976-01-01

    The results of the treatment of a randomly selected series of 277 patients is presented and some consideration is given to the complications and sequelae of the X-ray therapy here described. There is particular reference to the risk of leukaemogenesis, the decline in the use of X-ray therapy and the present position in Britain of the management of ankylosing spondylitis. (orig./MG) [de

  19. Complications and Causes of Death in Spinal Cord Injury Patients in ...

    African Journals Online (AJOL)

    Conclusion: Most common complication and cause of death following SCI are muscle spasm and respiratory failure respectively. The risk factors associated with mortality are age, GCS<9, cervical spinal injury, and complete neurologic injury and those for complications were cervical spinal injury and Frankel Type A injury.

  20. Retrospective analysis of spinal trauma in patients with ankylosing spondylitis: a descriptive study in Indian population.

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    Mahajan, R; Chhabra, H S; Srivastava, A; Venkatesh, R; Kanagaraju, V; Kaul, R; Tandon, V; Nanda, A; Sangondimath, G; Patel, N

    2015-05-01

    This study aims to understand the demographics, mode of trauma, hospital stay, complications, neurological improvement, mortality and expenditure incurred by Indian patients with spinal trauma and ankylosing spondylitis (AS). Retrospective analysis of the patient data admitted to a tertiary referral hospital from 2008 to 2013 with the diagnosis of AS and spinal trauma was carried out. The variables studied were demographics, mode of trauma, neurological status, neurological improvement, involved vertebral level, duration of hospital stay, comorbid factors, expenditure and complications during the stay. Forty-six patients with diagnosis of AS with spine trauma were admitted over the last 5 years with a total of 52 fractures. All were male patients; 58.6% had injury because of trivial trauma and 78.2% patients presented with neurological injury. C5 C6, C6 C7, C7 D1 and D12 were the most common injured level. Fractures through intervertebral disc were most common in cervical spine. Of the patients, 52.7% had shown neurological improvement of at least grade 1(AIS). Mean expenditure of patient admitted with spinal cord injury (SCI) with AS is 7957 USD (United States dollar), which is around five times the per capita income in India (as per year 2013). Males with AS are much more prone to spinal fractures than females and its incidence may be higher than previously reported. Domestic falls are the most common mechanism of spinal trauma in this population. High velocity injuries are associated with complete SCI. The study reinforces the need for development of subsidized spinal care services for SCI management.

  1. Odontoid pannus formation in a patient with ankylosing spondylitis causing atlanto-axial instability

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    Rajak, Rizwan; Wardle, Phil; Rhys-Dillon, Ceril; Martin, James C

    2012-01-01

    Ankylosing spondylitis is one of the commonest inflammatory diseases of the axial skeleton and can be complicated by atlanto-axial instability. This serious and likely underestimated complication can be easily overlooked. However, there are clear features which can help alert suspicion to initiate the appropriate investigations with imaging that is very effective at diagnosing and assessing this complication. The authors report an unusual case where odontoid pannus formation, akin to that seen in rheumatoid arthritis, was the underlying cause. PMID:22665557

  2. Scintigraphic findings in ankylosing spondylitis

    International Nuclear Information System (INIS)

    Lentle, B.C.; Russell, A.S.; Percy, J.S.; Jackson, F.I.

    1977-01-01

    A prospective study of bone scintigraphic findings has been carried out in 63 patients, firmly diagnosed as having ankylosing spondylitis. In addition to abnormal uptake of the radiotracer at the sacroiliac joints, a peripheral arthropathy has been a common finding, particularly in the proximal joints, occurring in up to 50 percent of patients. Increased uptake of radiotracer in the spine has also been found both diffusely and focally. Focal increases have been noted at the apophyseal joints in 40 percent of patients and in three patients with a sterile intervertebral diskitis, an unusual complication of this disease only diagnosed in two patients after bone scintigraphy

  3. Clinical treatment of traumatic brain injury complicated by cranial nerve injury.

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    Jin, Hai; Wang, Sumin; Hou, Lijun; Pan, Chengguang; Li, Bo; Wang, Hui; Yu, Mingkun; Lu, Yicheng

    2010-09-01

    To discuss the epidemiology, diagnosis and surgical treatment of cranial nerve injury following traumatic brain injury (TBI) for the sake of raising the clinical treatment of this special category of TBI. A retrospective analysis was made of 312 patients with cranial nerve injury among 3417 TBI patients, who were admitted for treatment in this hospital. A total of 312 patients (9.1%) involving either a single nerve or multiple nerves among the 12 pairs of cranial nerves were observed. The extent of nerve injury varied and involved the olfactory nerve (66 cases), optic nerve (78 cases), oculomotor nerve (56 cases), trochlear nerve (8 cases), trigeminal nerve (4 cases), abducent nerve (12 cases), facial nerve (48 cases), acoustic nerve (10 cases), glossopharyngeal nerve (8 cases), vagus nerve (6 cases), accessory nerve (10 cases) and hypoglossal nerve (6 cases). Imaging examination revealed skull fracture in 217 cases, complicated brain contusion in 232 cases, epidural haematoma in 194 cases, subarachnoid haemorrhage in 32 cases, nasal cerebrospinal fluid (CSF) leakage in 76 cases and ear CSF leakage in 8 cases. Of the 312 patients, 46 patients died; the mortality rate associated with low cranial nerve injury was as high as 73.3%. Among the 266 surviving patients, 199 patients received conservative therapy and 67 patients received surgical therapy; the curative rates among these two groups were 61.3% (122 patients) and 86.6% (58 patients), respectively. TBI-complicated cranial nerve injury is subject to a high incidence rate, a high mortality rate and a high disability rate. Our findings suggest that the chance of recovery may be increased in cases where injuries are amenable to surgical decompression. It is necessary to study all 12 pairs of cranial nerves systematically. Clinically, it is necessary to standardise surgical indications, operation timing, surgical approaches and methods for the treatment of TBI-complicated cranial nerve injury. 2010 Elsevier Ltd. All

  4. Disease flare of ankylosing spondylitis presenting as reactive arthritis with seropositivity: a case report

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    Manoj EM

    2012-02-01

    Full Text Available Abstract Introduction Concurrent rheumatoid factor seropositivity is occasionally detected in ankylosing spondylitis and often causes confusion in clinical routine. Overlap between various seronegative arthritides is a known but uncommon association. Differentiation of spondyloarthropathy from rheumatoid arthritis is important, since the natural history, complications, treatments and prognosis of the two diseases differ significantly. Case presentation Here, we report the case of a 47-year-old Sri Lankan man who had a long history of intermittent joint pains worsening following a recent episode of self-resolving non-bloody diarrhea. Subsequently, he developed a skin rash suggestive of keratoderma blenorrhagica and circinate balanitis. He had classical radiological evidence of ankylosing spondylosis (previously undiagnosed associated with human leukocyte antigen B27 antigen, but was positive for rheumatoid factor. Conclusions A disease flare of ankylosing spondylitis prompted by a minor diarrheal illness showing well documented features of reactive arthritis is remarkable. The prognostic implications of seropositivity in spondyloarthritis are discussed.

  5. The management of traumatic ankylosis during orthodontics: a case report.

    LENUS (Irish Health Repository)

    McNamara, T G

    2000-01-01

    Dental ankylosis may be a significant complication in orthodontic clinical practice. This case report describes the management of a malocclusion, complicated by an ankylosed maxillary central incisor, which arose during orthodontic treatment, following an acute traumatic injury. The use of the ankylosed incisor in successfully managing the significant Class II division 1 malocclusion is described.

  6. associated injuries and complications in floating knee management

    African Journals Online (AJOL)

    Materials and Methods: The investigation lasted ten years from 1st January, 2000 to ... hemarthrosis, 2 paralysis of fibular nerve associated to a displaced fracture of neck of ... Keywords: Associated injuries, complications, Floating knee, Management ... Road traffic accidents were responsible for 51 cases ... cerebral injuries.

  7. Traumatic Rib Injury: Patterns, Imaging Pitfalls, Complications, and Treatment.

    Science.gov (United States)

    Talbot, Brett S; Gange, Christopher P; Chaturvedi, Apeksha; Klionsky, Nina; Hobbs, Susan K; Chaturvedi, Abhishek

    2017-01-01

    The ribs are frequently affected by blunt or penetrating injury to the thorax. In the emergency department setting, it is vital for the interpreting radiologist to not only identify the presence of rib injuries but also alert the clinician about organ-specific injury, specific traumatic patterns, and acute rib trauma complications that require emergent attention. Rib injuries can be separated into specific morphologic fracture patterns that include stress, buckle, nondisplaced, displaced, segmental, and pathologic fractures. Specific attention is also required for flail chest and for fractures due to pediatric nonaccidental trauma. Rib fractures are associated with significant morbidity and mortality, both of which increase as the number of fractured ribs increases. Key complications associated with rib fracture include pain, hemothorax, pneumothorax, extrapleural hematoma, pulmonary contusion, pulmonary laceration, acute vascular injury, and abdominal solid-organ injury. Congenital anomalies, including supernumerary or accessory ribs, vestigial anterior ribs, bifid ribs, and synostoses, are common and should not be confused with traumatic pathologic conditions. Nontraumatic mimics of traumatic rib injury, with or without fracture, include metastatic disease, primary osseous neoplasms (osteosarcoma, chondrosarcoma, Ewing sarcoma, Langerhans cell histiocytosis, and osteochondroma), fibrous dysplasia, and Paget disease. Principles of management include supportive and procedural methods of alleviating pain, treating complications, and stabilizing posttraumatic deformity. By recognizing and accurately reporting the imaging findings, the radiologist will add value to the care of patients with thoracic trauma. Online supplemental material is available for this article. © RSNA, 2017.

  8. Traumatic injuries: imaging and intervention in post-traumatic complications (delayed intervention)

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    Goffette, Pierre P. [Department of Medical Imaging, Saint-Luc University Hospital-Louvain Medical School, Brussels (Belgium); Laterre, Pierre-Francois [Department of Emergency and Critical Care, Saint-Luc University Hospital-Louvain Medical School, Brussels (Belgium)

    2002-05-01

    The nonoperative management (NOM) of abdominal trauma has gained increasing acceptance over the past decade. This approach has been extended to severe trauma patients previously considered as candidates for surgery. Consequently, the incidence of delayed and uncommonly encountered complications has increased. Causes of delayed complications are multiple and include: (a) abnormal or insufficient injury healing process; (b) retention of necrotic tissue; (c) secondary infection of initially sterile collections; and (d) underestimation of injury severity. The purpose of this review article is to explain the role of various imaging modalities in detecting post-traumatic delayed complications and to highlight the usefulness of minimally invasive techniques, including laparoscopy, biliary endoscopy, therapeutic angiography and image-guided drainage. Subsequent complications, which do not necessarily negatively influence the final outcome, are often predictable, virtually obligatory consequences of the successful NOM of high-grade or complex abdominal injuries. Between 50 and 60% of those patients with grade-IV or grade-V liver or splenic lacerations require some type of interventional treatment; therefore, indiscriminate discharge of patients with solid organ injury managed conservatively may be potentially harmful. As the incidence of complications is higher for more severe grade-IV or grade-V liver, spleen, or kidney injuries, scheduled follow-up CT scans may be rational in this subset of patients to identify potential complications amenable to early application of interventional techniques. Follow-up CT scans are unnecessary in stable adults or children with low-grade injury. Delayed splenic or hepatic rupture is one of the major concerns because this type of complication remains difficult to predict and historically often requires emergent surgery. (orig.) (orig.)

  9. Fracture-dislocation at C6-C7 level with Quadriplegia after Traditional Massage in a Patient with Ankylosing Spondylitis: A Case Report.

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    Abilash, Kak; Mohd, Qmq; Ahmad, Zah; Towil, Basir

    2017-07-01

    Ankylosing spinal disorders (ASD) tend to result in fractures and/or dislocations after minor trauma because of the altered biomechanical properties. The relative risk of traumatic vertebral fractures in patients with ankylosing spondylitis has been estimated as three times higher than in the general population. These spine traumas, which are located at cervical level in 81% of patients with ankylosing spondylitis, are complicated by neurological lesions in 65% of patients, due to the high inherent instability of these fractures. Traditional massage is an ancient practice in many parts of Asia. It has many benefits that are currently recognized world-wide. However, it can be dangerous and even lethal if practised without adequate knowledge and skill. We report a case of C6-C7 fracture-dislocation with complete neurology and neurogenic shock in a middle aged man with undiagnosed ankylosing spondylitis.

  10. ocular complications among cases of head injury seen in a neurosurgi

    African Journals Online (AJOL)

    EZENWUGO CHIEDOZIE OBIORA

    ocular cranial nerves were the most commonly occurring complication among the cases of head injury seen in Memphys. Hospital for Neurosurgery, Enugu. Key words: Ocular complications, head injury, Nigeria. INTRODUCTION. Road traffic accidents have been on the increase in Nigeria. Some studies have attributed this ...

  11. Postural control is altered in patients with ankylosing spondylitis.

    Science.gov (United States)

    Vergara, Martin E; O'Shea, Finbar D; Inman, Robert D; Gage, William H

    2012-05-01

    Ankylosing spondylitis is a chronic inflammatory disorder that can lead to increased axial and peripheral joint stiffness, impairing joint mobility. Impaired axial mobility due to vertebral ankylosis may result in changes in standing postural control. Little research has addressed changes in standing postural control in the ankylosing spondylitis population, nor how these issues might affect clinical understanding and treatment. Sixteen ankylosing spondylitis patients, and 17 healthy controls participated. Each individual completed two 120-second quiet standing trials with eyes open and eyes closed, while standing upon two force platforms. Net center of pressure displacement and mean power frequency in the frontal and sagittal planes were calculated. A Spearman's rank correlation analysis was performed between net center of pressure measures and several clinical measures of disease activity. Frontal plane net center of pressure displacement and frequency content, and sagittal plane net center of pressure displacement were significantly greater within the ankylosing spondylitis patient group. Ankylosing spondylitis patients demonstrated a significant increase in frontal plane net center of pressure displacement in the eyes-closed condition. Net center of pressure displacement and frequency were significantly correlated to the Bath Ankylosing Spondylitis Functional Index, and individual components of the Bath Ankylosing Spondylitis Metrology Index. Quiet standing postural control was altered particularly so in the frontal plane in patients with ankylosing spondylitis, which may be associated with increased fall risk. Posturographic measures of postural control may serve as valuable clinical tools for the monitoring of disease progression and disease status in ankylosing spondylitis. Copyright © 2011 Elsevier Ltd. All rights reserved.

  12. Symptom modifiers in therapy for ankylosing spondylitis

    Directory of Open Access Journals (Sweden)

    Vladimir Vasilyevich Badokin

    2010-01-01

    Full Text Available Based on the data available in the literature, the author gives information on the prevalence of ankylosing spondyloarthritis. The clinical picture and pathogenesis of this disease and the principles of its diagnosis and treatment are described. Particular emphasis is placed on the use of etoricoxib, a nonsteroidal anti-inflammatory drug, in ankylosing spondyloarthritis. The available data strongly prove that etoricoxib is an alternative in the treatment of inflammatory diseases of the joints and vertebral column, ankylosing spondyloarthritis in particular.

  13. Compartment syndrome and popliteal vascular injury complicating unicompartmental knee arthroplasty

    NARCIS (Netherlands)

    Kort, Nanne Pieter; Van Raay, Jos J. J. A. M.; van Horn, Jim R.

    Popliteal vascular injury and the compartment syndrome of the leg are rare but important complications of knee arthroplasties. Early diagnosis and treatment are of paramount importance in preventing the devastating complications of these conditions. To our knowledge, these complications have not

  14. Fracture-dislocation at C6-C7 level with Quadriplegia after Traditional Massage in a Patient with Ankylosing Spondylitis: A Case Report

    Directory of Open Access Journals (Sweden)

    Abilash KAK

    2017-07-01

    Full Text Available Ankylosing spinal disorders (ASD tend to result in fractures and/or dislocations after minor trauma because of the altered biomechanical properties. The relative risk of traumatic vertebral fractures in patients with ankylosing spondylitis has been estimated as three times higher than in the general population. These spine traumas, which are located at cervical level in 81% of patients with ankylosing spondylitis, are complicated by neurological lesions in 65% of patients, due to the high inherent instability of these fractures. Traditional massage is an ancient practice in many parts of Asia. It has many benefits that are currently recognized world-wide. However, it can be dangerous and even lethal if practised without adequate knowledge and skill. We report a case of C6-C7 fracture-dislocation with complete neurology and neurogenic shock in a middle aged man with undiagnosed ankylosing spondylitis.

  15. Ankylosing spondylitis and cardiovascular risk – case report

    Directory of Open Access Journals (Sweden)

    Daniela Anghel

    2016-12-01

    Full Text Available Introduction: Ankylosing spondylitis (AS is a chronic progressive inflammatory disease of the axial skeleton and peripheral joints associated with HLA B27 antigen and with the predominance of the male gender (with an average between 20 and 30 years old. Case presentation A 48 years old male patient was admitted to our clinic, having a long history regarding this disease since he was 16. This patient has switched 3 therapies with anti TNF alpha agents until now, and we hope to obtain a good response for a long time. During the treatment with Etanercept he presented an acute anterior uveitis which had a good response to therapy. Conclusion: The ankylosing spondylitis management is complicated when we have the possibility to choose only three anti TNF alpha agents. If a patient does not respond to the first or second agent we are constrained to follow the last one. Therefore the principal problem regarding this special case is that the patient is non responder at the last agent. So the question that arises is witch will be the next therapy for this patient?

  16. Computed tomographic study of the complication of head injury

    International Nuclear Information System (INIS)

    Kojima, Tadashi; Waga, Shiro

    1982-01-01

    Computed tomography (CT) is quite effective in the diagnosis of traumatic intracranial hemorrhage and cerebral contusion. Two hundred and nine consecutive patients with head injury were admitted to the hospital and studied by CT in the year from 1977 to 1980. Fourty-sevenof 209 patients had the complications of head injury, including 6 patients with carotidcavernous fistula (CCF), 6 with traumatic aneurysm, 10 with pneumocephalus, 4 with intracranial foreign body, 15 with optic nerve injury, and 14 with other cranial nerve palsy. Five patients with CCF had abnormal finding on CT. Two traumatic aneurysms of the superficial temporal artery were visualized on CT after injection of contrast material, but all traumatic aneurysms of the carotid siphon were not seven on CT. CT in all 10 patients with pneumocephalus and in all 4 patients with intracranial foreign body was of diagnostic value: On CT in two patients even small air bubbles were seen in details. In the CT examination of 29 patients who presented with cranial nerve injury, we could not find out any abnormality on CT. We emphasize that CT is much less effective in the diagnosis of vascular complication of head injury and traumatic cranial nerve injury. (author)

  17. Quantitative metagenomics reveals unique gut microbiome biomarkers in ankylosing spondylitis.

    Science.gov (United States)

    Wen, Chengping; Zheng, Zhijun; Shao, Tiejuan; Liu, Lin; Xie, Zhijun; Le Chatelier, Emmanuelle; He, Zhixing; Zhong, Wendi; Fan, Yongsheng; Zhang, Linshuang; Li, Haichang; Wu, Chunyan; Hu, Changfeng; Xu, Qian; Zhou, Jia; Cai, Shunfeng; Wang, Dawei; Huang, Yun; Breban, Maxime; Qin, Nan; Ehrlich, Stanislav Dusko

    2017-07-27

    The assessment and characterization of the gut microbiome has become a focus of research in the area of human autoimmune diseases. Ankylosing spondylitis is an inflammatory autoimmune disease and evidence showed that ankylosing spondylitis may be a microbiome-driven disease. To investigate the relationship between the gut microbiome and ankylosing spondylitis, a quantitative metagenomics study based on deep shotgun sequencing was performed, using gut microbial DNA from 211 Chinese individuals. A total of 23,709 genes and 12 metagenomic species were shown to be differentially abundant between ankylosing spondylitis patients and healthy controls. Patients were characterized by a form of gut microbial dysbiosis that is more prominent than previously reported cases with inflammatory bowel disease. Specifically, the ankylosing spondylitis patients demonstrated increases in the abundance of Prevotella melaninogenica, Prevotella copri, and Prevotella sp. C561 and decreases in Bacteroides spp. It is noteworthy that the Bifidobacterium genus, which is commonly used in probiotics, accumulated in the ankylosing spondylitis patients. Diagnostic algorithms were established using a subset of these gut microbial biomarkers. Alterations of the gut microbiome are associated with development of ankylosing spondylitis. Our data suggest biomarkers identified in this study might participate in the pathogenesis or development process of ankylosing spondylitis, providing new leads for the development of new diagnostic tools and potential treatments.

  18. Complications of high grade liver injuries: management and outcomewith focus on bile leaks

    Directory of Open Access Journals (Sweden)

    Bala Miklosh

    2012-03-01

    Full Text Available Abstract Background Although liver injury scale does not predict need for surgical intervention, a high-grade complex liver injury should alert the physician to expect an increased risk of hepatic complications following trauma. The aim of the current study was to define hepatic related morbidity in patients sustaining high-grade hepatic injuries that could be safely managed non-operatively. Patients and methods This is a retrospective study of patients with liver injury admitted to Hadassah-Hebrew University Medical Centre over a 10-year period. Grade 3-5 injuries were considered to be high grade. Collected data included the number and types of liver-related complications. Interventions which were required for these complications in patients who survived longer than 24 hours were analysed. Results Of 398 patients with liver trauma, 64 (16% were found to have high-grade liver injuries. Mechanism of injury was blunt trauma in 43 cases, and penetrating in 21. Forty patients (62% required operative treatment. Among survivors 22 patients (47.8% developed liver-related complications which required additional interventional treatment. Bilomas and bile leaks were diagnosed in 16 cases post-injury. The diagnosis of bile leaks was suspected with abdominal CT scan, which revealed intraabdominal collections (n = 6, and ascites (n = 2. Three patients had continuous biliary leak from intraabdominal drains left after laparotomy. Nine patients required ERCP with biliary stent placement, and 2 required percutaneous transhepatic biliary drainage. ERCP failed in one case. Four angioembolizations (AE were performed in 3 patients for rebleeding. Surgical treatment was found to be associated with higher complication rate. AE at admission was associated with a significantly higher rate of biliary complications. There were 24 deaths (37%, the majority from uncontrolled haemorrhage (18 patients. There were only 2 hepatic-related mortalities due to liver failure

  19. Complications of high grade liver injuries: management and outcomewith focus on bile leaks.

    Science.gov (United States)

    Bala, Miklosh; Gazalla, Samir Abu; Faroja, Mohammad; Bloom, Allan I; Zamir, Gideon; Rivkind, Avraham I; Almogy, Gidon

    2012-03-23

    Although liver injury scale does not predict need for surgical intervention, a high-grade complex liver injury should alert the physician to expect an increased risk of hepatic complications following trauma. The aim of the current study was to define hepatic related morbidity in patients sustaining high-grade hepatic injuries that could be safely managed non-operatively. This is a retrospective study of patients with liver injury admitted to Hadassah-Hebrew University Medical Centre over a 10-year period. Grade 3-5 injuries were considered to be high grade. Collected data included the number and types of liver-related complications. Interventions which were required for these complications in patients who survived longer than 24 hours were analysed. Of 398 patients with liver trauma, 64 (16%) were found to have high-grade liver injuries. Mechanism of injury was blunt trauma in 43 cases, and penetrating in 21. Forty patients (62%) required operative treatment. Among survivors 22 patients (47.8%) developed liver-related complications which required additional interventional treatment. Bilomas and bile leaks were diagnosed in 16 cases post-injury. The diagnosis of bile leaks was suspected with abdominal CT scan, which revealed intraabdominal collections (n = 6), and ascites (n = 2). Three patients had continuous biliary leak from intraabdominal drains left after laparotomy. Nine patients required ERCP with biliary stent placement, and 2 required percutaneous transhepatic biliary drainage. ERCP failed in one case. Four angioembolizations (AE) were performed in 3 patients for rebleeding. Surgical treatment was found to be associated with higher complication rate. AE at admission was associated with a significantly higher rate of biliary complications. There were 24 deaths (37%), the majority from uncontrolled haemorrhage (18 patients). There were only 2 hepatic-related mortalities due to liver failure. A high complication rate following high-grade liver injuries should

  20. Complications Associated With High-dose Corticosteroid Administration in Children With Spinal Cord Injury.

    Science.gov (United States)

    Cage, Jason M; Knox, Jeffrey B; Wimberly, Robert L; Shaha, Steve; Jo, ChanHee; Riccio, Anthony I

    2015-01-01

    Complications with high-dose steroid administration for spinal cord injury are documented in adult patients. Our purpose was to determine the incidence of early complications of this therapy in pediatric patients with spinal cord injuries. An IRB-approved retrospective review was performed for patients treated for spinal cord injury at a level 1 pediatric trauma center between 2003 and 2011. Demographic data, injury characteristics, and surgical interventions were documented. Complications were divided into 4 categories: infectious, gastrointestinal (GI), hyperglycemia/endocrine, and wound healing problems. Complication rates were compared using a Student's t test and Fischer's exact test. Thirty-four spinal cord injury patients were identified. Twenty-three patients (mean age 6.6 y) in the treatment group received high-dose steroid treatment and 11 patients (mean age 8.4 y) did not and comprised the control group. No statistical difference was detected between the 2 groups regarding age, mechanism of injury, rate of surgical intervention, level of injury, and injury severity. Hyperglycemia was the most common complication and was present in all patients in both the treatment and control groups. The overall infection rate was 64% in the control group compared with 26% in the treatment (Pspinal trauma in a pediatric population. Hyperglycemia was found in all spinal cord injury patients, regardless of steroid treatment. Paradoxically, infection rates were noted to be higher in the control group. GI and wound problems were not significantly different. Larger, multicenter prospective studies are needed to better understand the risks in pediatric SCI patients.

  1. Risk factors for central bile duct injury complicating partial liver resection

    NARCIS (Netherlands)

    Boonstra, E. A.; de Boer, M. T.; Sieders, E.; Peeters, P. M. J. G.; de Jong, K. P.; Slooff, M. J. H.; Porte, R. J.

    Background: Bile duct injury is a serious complication following liver resection. Few studies have differentiated between leakage from small peripheral bile ducts and central bile duct injury (CBDI), defined as an injury leading to leakage or stenosis of the common bile duct, common hepatic duct,

  2. Dentoalveolar Segmental Osteotomy Combined with Orthodontic Treatment for an Impacted and Ankylosed Upper Canine

    DEFF Research Database (Denmark)

    Aludden, Hanna Cecilia; Jensen, Thomas

    2016-01-01

    Ankylosis is the abnormal adhesion of alveolar bone to dentin or cementum and commonly seen after traumatic dental injuries. Treatment of impacted and ankylosed teeth solely by orthodontics alignment may be challenging. Consequently, several treatment alternatives have been proposed for the manag....... A dentoalveolar segmental osteotomy with immediate repositioning of an upper canine was performed. One year after final orthodontic treatment a satisfying occlusal and esthetic treatment outcome was obtained....

  3. Evolution of Juvenile Ankylosing Spondylitis

    Directory of Open Access Journals (Sweden)

    Ye.V. Prohorov

    2013-02-01

    Full Text Available Evolution of juvenile ankylosing spondylitis tend to follow a more frequent involvement in the pathological process of elbow and ankle joints, development of enthesiopathies, changes of intraarticular meniscal horns, forming of Baker’s cysts, cartilage flaps and systemic osteoporosis, and total value of all these signs 13 times exceeds thereof in patients with with the debut of disease in adulthood, but for juvenile ankylosing spondylitis vertebral lesion is less common. Age dimorphism of the use of certain groups of drugs and physiotherapy facilities is observed.

  4. [Consequence of secondary complications during the rehabilitation of patients with severe brain injury].

    Science.gov (United States)

    Dénes, Zoltán

    2009-01-25

    Recovery from brain injury is not only determined by the primary injury, but a very important element is the development of secondary complications which have a major role in determining the possibility of the achievement of available maximal functional abilities and the quality of life of the patients and their family after rehabilitation. This is why during medical treatment the prevention of secondary complications is at least as important as the prevention of primary injury. Determination of the most important secondary complications after severe brain injury, and observation of these effects on the rehabilitation process. Retrospective study in the Brain Injury Rehabilitation unit of the National Institute for Medical Rehabilitation in Hungary. 166 patients were treated with brain injury; the mean age of the patients was 33 (8-83) years in 2004. The majority of patients suffered traumatic brain injury in traffic accidents (125/166), while the rest of them through falls or acts of violence. Sixty-four patients were admitted directly from an intensive care unit, 18 from a second hospital ward (traumatology, neurosurgery or neurology) and the rest of the patients were treated in several different units before they were admitted for rehabilitation. The time that has elapsed between injury and rehabilitation admission was 50 days (21-177). At the time of admission 27 patients were in a vegetative state, 38 patients in a minimal conscious state, and 101 patients had already regained consciousness. 83 patients were hemiparetic, 54 presented tetraparesis, and 1 paraparesis, but 28 patients were not paretic. The most frequent complications in patients with severe brain injury at admission in our rehabilitation unit were: contractures (47%), pressure sores (35%), respiratory (14%) and urinary (11%) tract infections, malnutrition (20%). The functional outcome was worse in the cases arriving with secondary complications during the same rehabilitation period. The length of

  5. Ocular Complications among Cases of Head Injury Seen in a ...

    African Journals Online (AJOL)

    Background: Head injuries with ocular involvement are of great importance due to the visual morbidity and mortality which may result. Objective: To determine the pattern of ocular complications among cases of head injury seen in Memphys Hospital for Neurosurgery, Enugu, in south-eastern Nigeria. Patients and Methods: ...

  6. Orthodontic treatment of severe anterior open bite and alveolar bone defect complicated by an ankylosed maxillary central incisor: a case report.

    Science.gov (United States)

    Lin, Feiou; Sun, Hao; Yao, Linjie; Chen, Qiushuo; Ni, Zhenyu

    2014-11-21

    Incisor trauma is common in children, and can cause severe complications during adolescent growth and development. This report describes the treatment of a 16-year-old patient with severe anterior open bite due to ankylosis of the maxillary left incisor after dental trauma as an 8-year-old. No examination or active treatment was undertaken until he was 16 years old. Clinical examination revealed that the maxillary left incisor was severely intruded accompanied by a vertical alveolar bone defect. Orthodontic treatment combined with surgical luxation took 3 years and 7 months. During treatment, the intruded incisor was moved to the occlusal level and the alveolar bone defect was restored, achieving normal occlusion. After two years of retention, the maxillary left incisor was retained in a stable normal position with a slightly reduced overbite. This case demonstrates that surgical luxation with orthodontic traction can be an effective approach, especially when the ankylosed tooth has a single root. Long-term monitoring of orthodontic stability and the maintenance of periodontal health are crucial in the post-treatment period.

  7. Serum Adipokines and Adipose Tissue Distribution in Rheumatoid Arthritis and Ankylosing Spondylitis. A Comparative Study

    OpenAIRE

    Toussirot, Éric; Grandclément, Émilie; Gaugler, Béatrice; Michel, Fabrice; Wendling, Daniel; Saas, Philippe; Dumoulin, Gilles

    2013-01-01

    Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are inflammatory rheumatic diseases that may modify body composition. Adipose tissue has the ability to release a wide range of products involved in physiologic functions, but also in various pathological processes, including the inflammatory/immune response. RA and AS are both associated with the development of cardiovascular complications. It is has been established that central/abdominal, and particularly intra-abdominal or visceral...

  8. Serum adipokines and adipose tissue distribution in rheumatoid arthritis and ankylosing spondylitis. A comparative study.

    OpenAIRE

    ERIC eTOUSSIROT; Emilie eGrandclement; Beatrice eGaugler; Fabrice eMichel; daniel eWendling; Philippe eSaas; Gilles eDumoulin; cic ebt

    2013-01-01

    Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are inflammatory rheumatic diseases that may modify body composition. Adipose tissue has the ability to release a wide range of products involved in physiologic functions, but also in various pathological processes, including the inflammatory/immune response. RA and AS are both associated with the development of cardiovascular complications. It is has been established that central/abdominal and particularly intra-abdominal or visceral ...

  9. Higher incidence of major complications after splenic embolization for blunt splenic injuries in elderly patients.

    Science.gov (United States)

    Wu, Shih-Chi; Fu, Chih-Yuan; Chen, Ray-Jade; Chen, Yung-Fang; Wang, Yu-Chun; Chung, Ping-Kuei; Yu, Shu-Fen; Tung, Cheng-Cheng; Lee, Kun-Hua

    2011-02-01

    Nonoperative management (NOM) of blunt splenic injuries has been widely accepted, and the application of splenic artery embolization (SAE) has become an effective adjunct to NOM. However, complications do occur after SAE. In this study, we assess the factors leading to the major complications associated with SAE. Focusing on the major complications after SAE, we retrospectively studied patients who received SAE and were admitted to 2 major referral trauma centers under the same established algorithm for management of blunt splenic injuries. The demographics, angiographic findings, and factors for major complications after SAE were examined. Major complications were considered to be direct adverse effects arising from SAE that were potentially fatal or were capable of causing disability. There were a total of 261 patients with blunt splenic injuries in this study. Of the 261 patients, 53 underwent SAE, 11 (21%) of whom were noted to have 12 major complications: 8 cases of postprocedural bleeding, 2 cases of total infarction, 1 case of splenic abscess, and 1 case of splenic atrophy. Patients older than 65 years were more susceptible to major complications after SAE. Splenic artery embolization is considered an effective adjunct to NOM in patients with blunt splenic injuries. However, risks of major complications do exist, and being elderly is, in part, associated with a higher major complication incidence. Copyright © 2011 Elsevier Inc. All rights reserved.

  10. Ankylosing Spondylitis: a Reflection and a Question

    Directory of Open Access Journals (Sweden)

    Annia Deysi Hernández Martín

    2014-07-01

    Full Text Available Ankylosing spondylitis is a chronic inflammatory disease that affects the synovial membrane, joint entheses and para-articular structures of the spine, including the sacroiliac joints and limbs. We present a case of ankylosing spondylitis that had evolved for 12 years despite the relatively early diagnosis and treatment, showing flexion deformity and limitation of spinal movements. On radiological examination an early evolution to ankylosis was observed, which motivated us to make a reflection and a question.

  11. Acute Kidney Injury Complicated Epstein-Barr Virus Infection in Infancy

    Directory of Open Access Journals (Sweden)

    Gamze Ozgurhan

    2015-01-01

    Full Text Available Infectious mononucleosis is an acute lymphoproliferative disorder caused by the Epstein-Barr virus (EBV and seen most commonly in children and young adults. Clinical presentation of the disease is characterized by fever, tonsillopharyngitis, lymphadenopathy, and hepatosplenomegaly, whereas serological findings of this benign disorder include positive heterophilic antibody formation (transient increase in heterophilic antibodies and prominence of hematological lymphocytosis of more than 10% of atypical lymphocytes. An EBV infection is usually asymptomatic in childhood, but acute kidney injury can be a rare complication during its course. Most cases recover from the disease completely. Early recognition of EBV infection and estimation of its complication are important for its prognosis. In light of previous literature, we discuss the case evaluated as an EBV infection complicated by acute kidney injury in early childhood and results of tubulointerstitial nephritis shown on a renal biopsy that was later diagnosed as an EBV infection by serological examination.

  12. Multidetector Computed Tomography of Cervical Spine Fractures in Ankylosing Spondylitis

    Energy Technology Data Exchange (ETDEWEB)

    Koivikko, M.P.; Kiuru, M.J.; Koskinen, S.K. [Helsinki Univ. Central Hospital, Toeoeloe Trauma Center (Finland). Dept. of Radiology

    2004-11-01

    Purpose: To analyze multidetector computed tomography (MDCT) cervical spine findings in trauma patients with advanced ankylosing spondylitis (AS). Material and Methods: Using PACS, 2282 cervical spine MDCT examinations requested by emergency room physicians were found during a period of 3 years. Of these patients, 18 (16 M, aged 41-87, mean 57 years) had advanced AS. Primary imaging included radiography in 12 and MRI in 11 patients. Results: MDCT detected one facet joint subluxation and 31 fractures in 17 patients: 14 transverse fractures, 8 spinous process fractures, 2 Jefferson's fractures, 1 type I and 2 type II odontoid process fractures, and 1 each: atlanto-occipital joint fracture and C2 laminar fracture plus isolated transverse process and facet joint fractures. Radiographs detected 48% and MRI 60% of the fractures. MRI detected all transverse and odontoid fractures, demonstrating spinal cord abnormalities in 72%. Conclusion: MDCT is superior to plain radiographs or MRI, showing significantly more injuries and yielding more information on fracture morphology. MRI is valuable, however, in evaluating the spinal cord and soft-tissue injuries. Fractures in advanced AS often show an abnormal orientation and are frequently associated with spinal cord injuries. In these patients, for any suspected cervical spine injuries, MDCT is therefore the imaging modality of choice.

  13. Imaging in ankylosing spondylitis

    NARCIS (Netherlands)

    Maksymowych, Walter P.; Landewé, Robert

    2006-01-01

    The introduction of symptomatically highly effective anti-tumour necrosis factor alpha therapies for ankylosing spondylitis (AS) has generated interest in the use of imaging to evaluate the potential structure-modifying properties of these agents. Several approaches have been developed to score the

  14. Mortality in ankylosing spondylitis

    DEFF Research Database (Denmark)

    Exarchou, Sofia; Lie, Elisabeth; Lindström, Ulf

    2016-01-01

    OBJECTIVES: Information on mortality in ankylosing spondylitis (AS) is scarce. Our study therefore aimed to assess: (1) mortality in AS versus the general population, and (2) predictors of death in the AS population. METHODS: Nationwide cohorts of patients with AS diagnosed at rheumatology or int...

  15. Coexistence of Ankylosing Spondylitis and Klinefelter's Syndrome.

    Science.gov (United States)

    Kobak, Senol; Yalçin, Murat; Karadeniz, Muamer; Oncel, Guray

    2013-01-01

    Ankylosing spondylitis is a chronic inflammatory disease characterized by inflammatory lower back pain and morning stiffness and accompanied by spine and sacroiliac joint involvement. Klinefelter's syndrome is a genetic condition that only affects males. Affected males have an extra X chromosome. This paper reports a 30-years-old male on followup with the diagnosis of Klinefelters syndrome. The patient admitted with complaints of inflammatory lower back, and neck pain and morning stiffness and was diagnosed with ankylosing spondylitis. Nonsteroidal anti-inflammatory drug and salazopyrine treatment resulted in significant regression in his complaints.

  16. Coexistence of Ankylosing Spondylitis and Klinefelter's Syndrome

    Directory of Open Access Journals (Sweden)

    Şenol Kobak

    2013-01-01

    Full Text Available Ankylosing spondylitis is a chronic inflammatory disease characterized by inflammatory lower back pain and morning stiffness and accompanied by spine and sacroiliac joint involvement. Klinefelter's syndrome is a genetic condition that only affects males. Affected males have an extra X chromosome. This paper reports a 30-years-old male on followup with the diagnosis of Klinefelters syndrome. The patient admitted with complaints of inflammatory lower back, and neck pain and morning stiffness and was diagnosed with ankylosing spondylitis. Nonsteroidal anti-inflammatory drug and salazopyrine treatment resulted in significant regression in his complaints.

  17. Prevalence of occult inflammatory bowel disease in ankylosing spondylitis.

    Science.gov (United States)

    Costello, P B; Alea, J A; Kennedy, A C; McCluskey, R T; Green, F A

    1980-10-01

    Fifty-five patients with ankylosing spondylitis and 16 control patients matched for sex and age were examined for evidence of occult inflammatory bowel disease. In all patients evaluation included history and physical examination, barium enema, sigmoidoscopy, and rectal biopsy. The results of this study suggest that there is no increased prevalence of occult inflammatory bowel disease in patients with ankylosing spondylitis.

  18. The influence of the risk factor on the abdominal complications in colon injury management.

    Science.gov (United States)

    Torba, M; Gjata, A; Buci, S; Bushi, G; Zenelaj, A; Kajo, I; Koceku, S; Kagjini, K; Subashi, K

    2015-01-01

    The management of colon injuries has distinctly evolved over the last three decades. However, trauma surgeons often find themselves in a dilemma, whether to perform a diversion or to perform a primary repair. The purpose of this study is to evaluate risk factors in colon injury management and their influence on abdominal complications. This is a prospective study conducted at a national level I trauma center in Tirana, Albania from January 2009 to December 2012. The data with respect to demographics, physiological risk factors, intraoperative findings, and surgical procedures were collected. Colonic injury-related morbidity and mortality were analyzed. Multivariate logistic regression analysis was performed by assessing the influence of risk factors on abdominal complications. Of the 157 patients treated with colon injury, was performed a primary repair in 107 (68.15%) of the patients and a diversion in the remaining 50 (31.85%). The mean PATI was 18.6, while 37 (23.6%) of patients had PATI greater than 25. The complications and their frequencies according to the surgical technique used (primay repair vs diversion respectively) includes: wound infections (9.3% vs 50%), anastomotic leak (1.8% vs 8.7%), and intra-abdominal abscess (1.8% vs 6.5%). The multivariate analysis identified two independent risk factors for abdominal complications: transfusions of 4 units of blood within the first 24 hours (OR = 1.2 95% CI (1.03 - 1.57) p =0.02), and diversion (OR = 9.6, 95% CI 4.4 - 21.3, pcolon injuries are both independent risk factors for abdominal complications. The socioeconomic impact and the need for a subsequent operation in colostomy patients are strong reasons to consider primary repair in the management of colon injuries.

  19. Biomechanical assessment of balance and posture in subjects with ankylosing spondylitis

    Directory of Open Access Journals (Sweden)

    Sawacha Zimi

    2012-08-01

    Full Text Available Abstract Background Ankylosing spondylitis is a major chronic rheumatic disease that predominantly affects axial joints, determining a rigid spine from the occiput to the sacrum. The dorsal hyperkyphosis may induce the patients to stand in a stooped position with consequent restriction in patients’ daily living activities. The aim of this study was to develop a method for quantitatively and objectively assessing both balance and posture and their mutual relationship in ankylosing spondylitis subjects. Methods The data of 12 healthy and 12 ankylosing spondylitis subjects (treated with anti-TNF-α stabilized, with a mean age of 51.42 and 49.42 years; mean BMI of 23.08 and 25.44 kg/m2 were collected. Subjects underwent a morphological examination of the spinal mobility by means of a pocket compass needle goniometer, together with an evaluation of both spinal and hip mobility (Bath Ankylosing Spondylitis Metrology Index, and disease activity (Bath Ankylosing Spondylitis Disease Activity Index. Quantitative evaluation of kinematics and balance were performed through a six cameras stereophotogrammetric system and a force plate. Kinematic models together with a test for evaluating balance in different eye level conditions were developed. Head protrusion, trunk flexion-extension, pelvic tilt, hip-knee-ankle flexion-extension were evaluated during Romberg Test, together with centre of pressure parameters. Results Each subject was able to accomplish the required task. Subjects’ were comparable for demographic parameters. A significant increment was observed in ankylosing spondylitis subjects for knee joint angle with the target placed at each eye level on both sides (p  Conclusions Our findings confirm the need to investigate both balance and posture in ankylosing spondylitis subjects. This methodology could help clinicians to plan rehabilitation treatments.

  20. A profile of traumatic spinal cord injury and medical complications in Latvia

    OpenAIRE

    Nulle, Anda; Tjurina, Uljana; Erts, Renars; Vetra, Anita

    2017-01-01

    Study design A single centre retrospective study. Objectives To collect data and analyse the epidemiological profile of traumatic spinal cord injury and its medical complications during the subacute rehabilitation period. Setting Spinal Cord Injury Rehabilitation Programme of the National Rehabilitation Centre, ‘Vaivari’, Jurmala, Latvia. Methods Information was collected in 2015 from the medical records of 134 patients with a traumatic spinal cord injury admitted for primary rehabilitation b...

  1. Arthritis of the middle ear in ankylosing spondylitis.

    OpenAIRE

    Magarò, M; Ceresia, G; Frustaci, A

    1984-01-01

    A case of ankylosing spondylitis with aortic valve disease and hearing loss is described. A series of radiographic and audiometric investigations showed the hearing loss to be of a conductive type. It seemed most likely that the hearing loss was related to an inflammatory involvement of the ossicular joints due to the primary disease. No other case of conductive hearing loss has previously been reported due to otoarthritis in ankylosing spondylitis. This is important both theoretically and pr...

  2. The prevalence of clinically diagnosed ankylosing spondylitis and its clinical manifestations

    DEFF Research Database (Denmark)

    Exarchou, Sofia; Lindström, Ulf; Askling, Johan

    2015-01-01

    -economic factors, and according to subgroups with ankylosing spondylitis-related clinical manifestations and pharmacological treatment. METHODS: All individuals diagnosed with ankylosing spondylitis according to the World Health Organization International Classification of Disease codes, between 1967 and 2009......, were identified from the National Patient Register. Data regarding disease manifestations, patient demographics, level of education, pharmacological treatment, and geographical region were retrieved from the National Patient Register and other national registers. RESULTS: A total of 11,030 cases...... prevalence of ankylosing spondylitis (0.23% versus 0.14%, P uveitis (25.5% versus 20.0%, P 

  3. DIFFICULTIeS OF TOTAL HIP REPLACEMENT IN PATIENTS WITH ANKYLOSING SPONDYLITIS (case report

    Directory of Open Access Journals (Sweden)

    R. M. Tikhilov

    2016-01-01

    Full Text Available A distinctive feature of patients with ankylosing spondylitis is the formation of hip ankylosis in an extremely unfavorable functional position combined with upset of sagittal balance of the body along with a thoracolumbar kyphosis. Treatment of these patients poses considerable technical difficulties and is often associated with complications. The authors report a clinical case of a female 40 years old patient with confirmed rhizomelic spondylitis. The patient mainly complained of fixed malposition of the right lower extremity (hip ankylosis in extreme 1450 flexion and 1500 abduction combined with a severe fixed spine deformity (thoracic kyphosis 920, lumbar lordosis 170. Considering significant sagittal balance disorder it was decided to go for a two-stage procedure. Total hip arthroplasty of the right joint was performed at the first stage. At the second stage the authors corrected thoracolumbar spinal deformity by Th12 (type PSO 4 and L2 (type PSO 3 wedge resections and converging resected vertebral bodies by a multilevel fixation system with transpedicular support elements. The interval between the stages was 11 months. Two-stage treatment of this patient al-lowed to avoid adverse postoperative complications and to achieve a significant functional improvement in one year after treatment started. The sum of points before and after the treat-ment amounted respectively to 46 and 79 on Harris Hip Score, 17 and 38 points on Oxford Hip Score (OHS. To summarize, comprehensive treatment with planning of all subsequent steps prior to hip replacement is the method of choice for avoidance of postoperative complications in patients with ankylosing spondylitis accompanied by a significant upset of sagittal balance.

  4. Coexisting ankylosing spondylitis and rheumatoid arthritis: a case report with literature review.

    Science.gov (United States)

    Guo, Ying-Ying; Yang, Li-Li; Cui, Hua-Dong; Zhao, Shuai; Zhang, Ning

    2011-10-01

    A 30-year-old female patient with coexisting ankylosing spondylitis and rheumatoid arthritis was diagnosed and treated. The human leukocyte antigen (HLA)-B27 is a predisposing factor of ankylosing spondylitis and HLA-DR4 is a predisposing factor of rheumatoid arthritis. This patient was HLA-B27 and HLA-DR4 positive, and ankylosing spondylitis manifested before rheumatoid arthritis. After disease modifying anti-rheumatic drugs successfully arrested ankylosing spondylitis activity the patient conceived and delivered a healthy baby. One year later, she developed peripheral polyarthritis and was diagnosed with rheumatoid arthritis. We hypothesized that pregnancy may be one of the environmental factors that can activate rheumatoid arthritis, and that disease modifying anti-rheumatic drugs play an important role in keeping the disease under control.

  5. MICROBIOLOGICAL METHODS APPLICATION EXPERIENCE IN THE SEVERE INJURIES INFECTIOUS COMPLICATIONS

    Directory of Open Access Journals (Sweden)

    S. A. Svistunov

    2016-01-01

    Full Text Available Modern clinical medicine and surgery problems are associated with infections complications after medical care. In recent years, surgery has made substantial progress related to the new organizational approaches and medical technology specialized medical care to the wounded and injured. However, these gains are offset by a high rate of infectious complications that require finding effective measures emerging infectious complications timely diagnosis and their prevention. Clinical manifestations are often nosocomial in patients with severe injuries and are largely determined by the influence of clinical and pathogenetic risk factors. Such infectious complications require a comprehensive assessment, including microbiological testing. The main causative agents of infectious complications in surgical hospitals are S. aureus, K. pneumoniae, P. aeruginosa, Acinetobacter spp., which can cause bloodstream infections, soft tissue, respiratory and urinary tract infections, especially in debilitated and immunocompromised patients and patients in intensive care units. These micro organisms are dangerous to patients and medical staff, as they can survive for a long time in the hospital environment, as well as to spread from patient to patient in violation of isolation restrictive measures and requirements for hygiene of medical workers hands. Clinical patterns of infection associated with medical care for severe injuries are to the possibility of serial and parallel development, both in different and in the same time frame of local, visceral and generalized infection with prevalence of combined forms of patients surgical hospital with a high risk of nosocomial infection against the background of factors, diagnostic and treatment process and hospital environment, introduction of the agent. Early etiological diagnosis allows timely assign empirical causal treatment and arrange for infection control to prevent the spread of microorganisms in the hospital. The

  6. The Disease of the Italian Poet Giacomo Leopardi (1798-1837): A Case of Juvenile Ankylosing Spondylitis in the 19th Century?

    Science.gov (United States)

    Sganzerla, Erik Pietro; Riva, Michele Augusto

    2017-06-01

    Some authors sustained that the pessimistic thought of the Italian writer and philosopher Giacomo Leopardi (1798-1837) may be attributed to his unhappy life, characterized by several health problems. His philosophical theories appear as the result of depressive and melancholic state, related to his precarious health conditions, so limiting their intrinsic values. Several authors formulated various hypotheses on the diseases that Leopardi suffered from and postulated different theories on the cause of his early death. This article assumed that Leopardi may have been affected by juvenile ankylosing spondylitis, conditioning spinal deformities, relapsing-remitting uveitis, urinary tract and bowel tract problems, and acute arthritis. Chest deformity, as a complication of juvenile ankylosing spondylitis, may have caused progressive cardiorespiratory failure, worsened by recurrent bronchial and pulmonary complications, until his death caused by acute right ventricular heart failure. The acknowledgment of a physical cause of Leopardi's disease contributes to reevaluate his "cosmic pessimism" as an original expression of his thought, so leading a general revaluation of the figure of one of the most important European thinkers of the 19th century.

  7. The relationship between inflammation and new bone formation in patients with ankylosing spondylitis

    OpenAIRE

    Baraliakos, Xenofon; Listing, Joachim; Rudwaleit, Martin; Sieper, Joachim; Braun, Juergen

    2008-01-01

    Introduction Spinal inflammation as detected by magnetic resonance imaging and new bone formation as identified by conventional radiographs are characteristic of ankylosing spondylitis. Whether and how spondylitis and syndesmophyte formation are linked are unclear. Our objective was to investigate whether and how spinal inflammation are associated with new bone formation in ankylosing spondylitis. Methods Spinal magnetic resonance images and conventional radiographs from 39 ankylosing spondyl...

  8. Intrathecal baclofen in multiple sclerosis and spinal cord injury: complications and long-term dosage evolution.

    Science.gov (United States)

    Draulans, Nathalie; Vermeersch, Kristof; Degraeuwe, Bart; Meurrens, Tom; Peers, Koen; Nuttin, Bart; Kiekens, Carlotte

    2013-12-01

    To investigate the long-term dosage evolution and complication rate of intrathecal baclofen use in multiple sclerosis and spinal cord injury patients, based on a large population with a long follow-up. Retrospective data analysis. Academic hospital. Patients with multiple sclerosis (n = 81) or spinal cord injury (n = 49) having an intrathecal baclofen pump implanted at the University Hospitals Leuven between 1988 and 2009. Medical records review of included patients in August 2010. Complications linked to intrathecal baclofen therapy. Daily baclofen dosage after 3 and 6 months, and yearly thereafter. Data on dosage evolution were analysed using a mixed-effect linear model. In 130 patients with a mean follow-up of 63 months, comprising 797 pump years, 104 complications were recorded. This corresponds to a complication rate of 0.011 per month, equally divided among both groups. Seventy-eight of these complications were catheter related. The mean dosage of baclofen stabilizes two years after implantation at 323 µg/day in the multiple sclerosis population. In spinal cord injury patients the daily dose only stabilizes after five years at a significantly higher dosage (504 µg/day). No significant increase in dosage is seen in the long term. In multiple sclerosis and spinal cord injury patients, intrathecal baclofen therapy has a complication rate of 1% per month. Complications are mainly due to catheter-related problems (74%). The intrathecal baclofen dosage stabilizes in the long term, indicating that long-term tolerance, defined as progressive diminution of the susceptibility to the effects of a drug, is not present.

  9. Diagnostic capabilities of quantitative bone scintigraphy in ankylosing spondylitis: A comparison with radiography

    International Nuclear Information System (INIS)

    Mlatschkov, C.; Mlatschkova, D.; Andreev, T.

    1989-01-01

    In 576 patients quantitative scintigraphy of the sacroiliac joints and the spinal cord with 99m Tc-pyrophosphate was performed. 328 were patients with proven ankylosing spondylitis according to the New York criteria. 120 were patients with a clinically and roentgenologically suspected ankylosing spondylitis and 128 persons formed a healthy control group. The count rate in small regions of interest (ROI) in the sacroiliac joints, the spinal cord and the os sacrum were compared on the basis of indexes. The scintigraphic data of patients with ankylosing spondylitis were compared with the healthy control group and with the radiographic findings and radiologic staging of the disease. In a longitudinal follow-up study during 1 to 6 years these investigations were continued together with clinical and roentgenological checks. Quantitative bone scintigraphy provides characteristic indexes for ankylosing spondylitis, indicating the increased mineral metabolism of the sacroiliac joints and the spinal cord. Skeletal scintigraphy is recommended for early detection and monitoring of ankylosing spondylitis. (author)

  10. Etiology of Infectious Complications and Antibiotic-Resistance of Major Causative Agents in Victims with Severe Injury

    Directory of Open Access Journals (Sweden)

    T. A. Vasina

    2007-01-01

    Full Text Available Objective: to analyze the spectrum of major pathogens of infectious complications in patients with concomitant injury.Materials and methods. 560 biological samples taken from 331 patients were bacteriologically studied. A significant reduction in the isolation frequency of Pseudomonas aeruginosa and an increase in etiological role of Staphylococcus aureus were ascertained in victims with severe injury and concomitant infectious complications during long-term 1982—1984 and 2002—2004 follow-ups.Results. The significant pathogens of infectious complications in concomitant injuries are Staphylococcus aureus, Klebsiella and Escherichia coli. Vancomycin, imipenem/cilastatin, and amikacin are shown to be the most effective drugs for early antibiotic therapy. Thus, the findings reflect structural changes in the leading causative agents of infectious complications in victims with severe injury. If their principal pathogen was Pseudomonas aeruginosa in the 1990s, Staphylococcus aureus and representatives in the colibacillus group prevail today. This supports and generates a need for continuous microbiological monitoring of the causative agents of pyoin-flammatory complications in intensive care units wherein patients with immunosuppression are also present. Pathogen monitoring makes it possible to apply of a well-grounded and rational package of preventive and therapeutic measures and to perform early target antibiotic therapy. 

  11. Pre-ankylosing spondylitis. Histopathological report.

    Science.gov (United States)

    Pasion, E G; Goodfellow, J W

    1975-02-01

    A novel explanation for the natural history of joint destruction in the early phase of ankylosing spondylitis is proposed on the basis of the clinical history, x-ray appearance, operative findings, and histopathology of a young patient believed to be suffering from the peripheral form of this disease.

  12. Imaging of postarthroscopic complications after knee injuries; Bildgebung postarthroskopischer Komplikationen nach Knieverletzungen

    Energy Technology Data Exchange (ETDEWEB)

    Schueller-Weidekamm, C. [Medizinische Universitaet Wien, Abteilung fuer Neuroradiologie und muskuloskelettale Radiologie, Klinik fuer Radiodiagnostik, Wien (Austria); Skrbensky, G. von [Medizinische Universitaet Wien, Klinik fuer Orthopaedie, Wien (Austria)

    2012-11-15

    The most common joint injuries in professional and recreational sports participants and also in the total population are knee injuries. Arthroscopy is indicated if this modality will improve the patient outcome and potential long-term complications can be avoided. Although uncommon, complications following arthroscopy are mostly evaluated by magnetic resonance imaging (MRI). For planning further therapy strategies following postarthroscopic complications, e.g. if anterior cruciate ligament (ACL) reconstruction is required, digital radiographs and computed tomography (CT) are helpful. This article provides an overview of the different procedures for surgical treatment which are a prerequisite for the analysis of postarthroscopic images. In addition typical complications after treatment of meniscal and chondral injuries as well as after ACL reconstruction are described and typical signs in MRI, radiography and CT are explained in detail. (orig.) [German] Kniegelenkverletzungen sind nicht nur bei Profisportlern, sondern auch in der Gesamtbevoelkerung die haeufigsten Gelenkverletzungen. Die Indikation zur arthroskopischen Operation wird gestellt, wenn im Vergleich zur konservativen Therapie ein besseres Ergebnis postarthroskopisch zu erwarten ist und potenzielle Spaetkomplikationen verhindert werden koennten. Die selten aber dennoch auftretenden postarthroskopischen Komplikationen werden zumeist mit der Magnetresonanztomographie (MRT) abgeklaert. Zur weiteren Therapieplanung nach Komplikationen, z. B. wenn eine Kreuzbandrevision notwendig ist, sind die digitale Projektionsradiographie und die Computertomographie (CT) hilfreich. Dieser Artikel bietet eine kurze Uebersicht ueber die unterschiedlichen Operationstechniken, die eine Voraussetzung fuer das Verstaendnis der bildgebenden postoperativen Veraenderungen sind. Weiter wird auf die haeufigsten Komplikationen nach Meniskus- und Knorpeloperationen sowie nach vorderer Kreuzbandrekonstruktion und den damit

  13. Sacroiliitis in Ankylosing Spondylitis: Comparison with Multidetector Row CT and Plain Radiography

    Energy Technology Data Exchange (ETDEWEB)

    Yu, Ji Youn; Joo, Kyung Bin; Choi, Byeong Kyoo; Ryu, Jeong Ah; Kim, Tae Hwan; Choi, Woo Jung [Hanyang University Hospital, Seoul (Korea, Republic of)

    2009-03-15

    The objective of our study was to compare multidetector row CT and the plain radiographs for making the diagnosis and grading the sacroiliitis that accompanies ankylosing spondylitis. We wanted to determine the role of multidetector row CT for the evaluation of the sacroilitis in patients with ankylosing spondylitis. One hundred ninety two patients with clinically suspected ankylosing spondylitis were evaluated by conventional radiography and multidetector row CT. Two musculoskeletal radiologists retrospectively analyzed the images, and they graded the sacroiliitis using the modified New York Criteria. Multidetector row CT demonstrated a significantly higher sensitivity (74.5%, 83.3%) than did plain radiography (59.9%, 66.7%) for detecting early sacroiliitis (p<0.05). Multidetector row CT showed a higher grade of sacroiliitis in 114 and 127 of 384 sacroiliac joints. Performing multidetector row CT rather than plain radiography for making the diagnoses of accompanying ankylosing spondylitis allows an early start of treatment with a subsequently improved prognosis

  14. Aerobic capacity and its correlates in patients with ankylosing spondylitis.

    Science.gov (United States)

    Hsieh, Lin-Fen; Wei, James Cheng-Chung; Lee, Hsin-Yi; Chuang, Chih-Cheng; Jiang, Jiunn-Song; Chang, Kae-Chwen

    2016-05-01

    To evaluate aerobic capacity in patients with ankylosing spondylitis (AS) and determine possible relationships between aerobic capacity, pulmonary function, and disease-related variables. Forty-two patients with AS and 42 healthy controls were recruited in the study. Descriptive data, disease-related variables (grip strength, lumbosacral mobility, occiput-to-wall distance, chest expansion, finger-to-floor distance, Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Global Score, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and hemoglobin), and chest and thoracic spine x-rays were collected in each patient with AS. All subjects took standard pulmonary function and exercise tolerance tests, and forced vital capacity (FVC) and aerobic capacity were recorded. Both aerobic capacity and FVC in patients with AS were significantly lower than those in normal subjects (P aerobic capacity. There was significant correlation between aerobic capacity, vital capacity, chest expansion, Schober's test, cervical range of motion, and BASFI in patients with AS. Neither aerobic capacity nor vital capacity correlated with disease duration, ESR, CRP, and hemoglobin. Significantly reduced aerobic capacity and FVC were observed in patients with AS, and there was significant correlation between aerobic capacity, vital capacity, chest expansion, and BASFI. © 2014 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.

  15. The Association of Acromegaly and Ankylosing Spondylitis

    Directory of Open Access Journals (Sweden)

    Alpaslan Tuzcu

    2004-01-01

    Full Text Available Coexistence of acromegaly and anklosing spondylitis had been rarelyreported. Only two case reports were described coexistence of two diseasesin literature. These two diseases have some similar clinical andradiographic features. Calcaneal epin formation, enteshopathy and caudeequina syndrome can be seen both acromegaly and ankylosing spondylitis.Our case had clinical and radiological features of both acromegaly andankylosing spondylitis. Acral enlargement, coarsening of feature,malocclusion, non-suppressed growth hormone levels with oral glucosetolerance test and evidence of pituitary adenoma were support diagnose ofacromegaly. Morning stiffness, positive Schober and Moll test, elevatederythrocyte sedimentation rate and grade 4 sacroiletis of the patient lead usto diagnose ankylosing spondylitis at the same time. In this case report, weaim to discuss interesting coexistence of two disease

  16. Bladder management methods and urological complications in spinal cord injury patients

    Directory of Open Access Journals (Sweden)

    Roop Singh

    2011-01-01

    Full Text Available Background: The optimal bladder management method should preserve renal function and minimize the risk of urinary tract complications. The present study is conducted to assess the overall incidence of urinary tract infections (UTI and other urological complications in spinal cord injury patients (SCI, and to compare the incidence of these complications with different bladder management subgroups. Materials and Methods: 545 patients (386 males and 159 females of traumatic spinal cord injury with the mean age of 35.4±16.2 years (range, 18 - 73 years were included in the study. The data regarding demography, bladder type, method of bladder management, and urological complications, were recorded. Bladder management methods included indwelling catheterization in 224 cases, clean intermittent catheterization (CIC in 180 cases, condom drainage in 45 cases, suprapubic cystostomy in 24 cases, reflex voiding in 32 cases, and normal voiding in 40 cases. We assessed the incidence of UTI and bacteriuria as the number of episodes per hundred person-days, and other urological complications as percentages. Results: The overall incidence of bacteriuria was 1.70 / hundred person-days. The overall incidenceof urinary tract infection was 0.64 / hundered person-days. The incidence of UTI per 100 person-days was 2.68 for indwelling catheterization, 0.34 for CIC, 0.34 for condom drainage, 0.56 for suprapubic cystostomy, 0.34 for reflex voiding, and 0.32 for normal voiding. Other urological complications recorded were urethral stricture (n=66, 12.1%, urethritis (n=78, 14.3%, periurethral abscess (n=45, 8.2%, epididymorchitis (n=44, 8.07%, urethral false passage (n=22, 4.03%, urethral fistula (n=11, 2%, lithiasis (n=23, 4.2%, hematuria (n=44, 8.07%, stress incontinence (n=60, 11%, and pyelonephritis (n=6, 1.1%. Clean intermittent catheterization was associated with lower incidence of urological complications, in comparison to indwelling catheterization. Conclusions

  17. Danish recommendations on treatment of ankylosing spondylitis and spondyloarthritis based on multinational project initiative

    DEFF Research Database (Denmark)

    Pedersen, Susanne Juhl; Madsen, Ole Rintek; Erlendsson, J.

    2008-01-01

    INTRODUCTION: The multinational initiative "3e Initiative in Rheumatology - Multi-national Recommendations for the Management of Ankylosing Spondylitis 2006-7" served the primary purpose of providing specific recommendations for the management of ankylosing spondylitis and spondyloarthritis...

  18. Prevalence of fibromyalgia in patients with ankylosing spondylitis

    Directory of Open Access Journals (Sweden)

    Aref Hosseinian Amiri

    2014-01-01

    Full Text Available Introduction: Ankylosing spondylitis (AS is a chronic inflammatory disease that affects the peripheral and axial skeletal system, causing pain, arthritis, low back pain and functional incapacity. Questionnaires are used to assess disease activity bath ankylosing spondylitis disease activity index (BASDAI to measure the effect of AS on patient′s life quality, functional incapacity bath ankylosing spondylitis functional index (BASFI; and Ankylosing Spondylitis quality of life (ASQoL. Fibromyalgia (FM is one of the most common causes of generalized pain and fatigability and can coexist with other diseases; it can be assessed by the FM impact questionnaire (FIQ. There are few studies that demonstrated correlations between FM and AS. The present study obtained data regarding the epidemiologic profile of patients with AS and FM and evaluated the prevalence of FM in patients with AS. The FM influence on BASDAI, BASFI and ASQoL test scores was assessed. Materials and Methods: A total of 36 patients with AS, diagnosed according to the modified New York criteria, were studied. Clinical and functional assessment was performed and BASDAI, BASFI and ASQoL tests were applied. Patients with a diagnosis of FM were evaluated through the FIQ. Results: Seven patients met the criteria for FM; thus a FM prevalence of 19.4% was observed among patients with AS. FM was more prevalent among women (2.5:1. Age at disease onset (AS was 24.3 years. The human leukocyte antigen-B27 antigen was positive in most of them (83.2%. When comparing BASDAI, BASFI and ASQoL test means, it was observed that values are significantly higher (P < 0.01 among patients with FM. We concluded that the coexistence of FM with AS is associated with disease activity aspects including pain, as well as functional disability and quality of life.

  19. High-dose thalidomide increases the risk of peripheral neuropathy in the treatment of ankylosing spondylitis.

    Science.gov (United States)

    Xue, Hong-Xia; Fu, Wen-Yi; Cui, Hua-Dong; Yang, Li-Li; Zhang, Ning; Zhao, Li-Juan

    2015-05-01

    Thalidomide is an effective drug for the treatment of ankylosing spondylitis but might induce peripheral neuropathy. This major adverse reaction has attracted much concern. The current study aimed to observe the incidence of thalidomide-induced peripheral neuropathy among ankylosing spondylitis patients for 1 year after treatment. In this study, 207 ankylosing spondylitis cases received thalidomide treatment, while 116 ankylosing spondylitis cases received other treatments. Results showed that the incidence of thalidomide-induced peripheral neuropathy in the thalidomide group was higher than that in the non-thalidomide group. There was no significant difference in the incidence of neuropathy between the peripheral neuropathy among patients receiving 25, 50, 75, or 100 mg thalidomide per day was 4.6%, 8.5%, 17.1%, 21.7%, respectively. The incidence was significantly different between the groups receiving 25 mg and 100 mg thalidomide. In conclusion, thalidomide can induce peripheral neuropathy within 1 year after treatment of ankylosing spondylitis; however, age and gender have no obvious impact on the incidence of peripheral neuropathy. The incidence of peripheral neuropathy is associated with increasing daily doses of thalidomide.

  20. Complications following blunt and penetrating injuries in 216 victims of chest trauma requiring tube thoracostomy.

    Science.gov (United States)

    Helling, T S; Gyles, N R; Eisenstein, C L; Soracco, C A

    1989-10-01

    Tube thoracostomy (TT) is required in the treatment of many blunt and penetrating injuries of the chest. In addition to complications from the injuries, TT may contribute to morbidity by introducing microorganisms into the pleural space or by incomplete lung expansion and evacuation of pleural blood. We have attempted to assess the impact of TT following penetrating and blunt thoracic trauma by examining a consecutive series of 216 patients seen at two urban trauma centers with such injuries who required TT over a 30-month period. Ninety-four patients suffered blunt chest trauma; 122 patients were victims of penetrating wounds. Patients with blunt injuries had longer ventilator requirements (12.6 +/- 14 days vs. 3.7 +/- 7.1 days, p = 0.003), longer intensive care stays (12.2 +/- 12.5 days vs. 4.1 +/- 7.5 days, p = 0.001), and longer periods of TT, (6.5 +/- 4.9 days vs. 5.2 +/- 4.5 days, p = 0.018). Empyema occurred in six patients (3%). Residual hemothorax was found in 39 patients (18%), seven of whom required decortication. Recurrent pneumothorax developed in 51 patients (24%) and ten required repeat TT. Complications occurred in 78 patients (36%). Patients with blunt trauma experienced more complications (44%) than those with penetrating wounds (30%) (p = 0.04). However, only seven of 13 patients developing empyema or requiring decortication had blunt trauma. Despite longer requirements for mechanical ventilation, intensive care, and intubation, victims of blunt trauma seemed to have effective drainage of their pleural space by TT without increased risk of infectious complications.

  1. Double Level Extension-Distraction Thoracic Spine Injuries with Concomitant Double Level Sternal Fractures: A Case Report

    Directory of Open Access Journals (Sweden)

    CK Lee

    2011-03-01

    Full Text Available Extension-distraction injury of the spine is rare. A majority of these cases occur in the cervical region and at an isolated level. Rare instances of this injury have been described in an ankylosed or fused spine. This case report describes a rare two level extension-distraction thoracic spine injury in an otherwise healthy adult resulting from a motor vehicle accident.

  2. Idiopathic Hypoparathyroidism Mimicking Ankylosing Spondylitis: A Case Report

    Directory of Open Access Journals (Sweden)

    Ozge Illeez Memetoglu

    2016-01-01

    Full Text Available Idiopathic hypoparathyroidism, inadequate secretion of parathyroid hormone of unknown etiology, may mimic ankylosing spondylitis both clinically and radiologically. Spinal complaints may be the first sign of any endocrinological disorder.

  3. Bony ankylosis following thermal and electrical injury

    Energy Technology Data Exchange (ETDEWEB)

    Balen, P.F.; Helms, C.A. [Dept. of Radiology, Duke University Medical Center, Durham, NC (United States)

    2001-07-01

    Objective. Bony ankylosis has been described following trauma, paralysis, psoriasis, Reiter's syndrome, ankylosing spondylitis, juvenile chronic arthritis and rheumatoid arthritis. Reports of bony ankylosis following thermal and electrical injury are limited.Design and patients. Thirteen cases of burn-related joint ankylosis in four patients are presented.Conclusion. Patients with burns from thermal or electrical injury may develop bony ankylosis among other radiographic manifestations. This bony ankylosis may result either from bridging extra-articular heterotopic ossification with preservation of the underlying joint or from intra-articular fusion due to joint destruction. (orig.)

  4. Ankylosing spondylitis in an athlete with chronic sacroiliac joint pain.

    Science.gov (United States)

    Miller, Timothy L; Cass, Nathan; Siegel, Courtney

    2014-02-01

    Ankylosing spondylitis is a disease in which inflammation of joints, most often in the axial skeleton, can lead to reactive fibrosis and eventual joint fusion with associated immobility and kyphosis. The disease often involves extra-articular features, such as uveitis and aortic regurgitation, as well as associated inflammatory conditions of the intestines. Its etiology is unknown. Ankylosing spondylitis most commonly presents in young males (15-30 years old) as persistent low back pain and stiffness that is worse in the morning and at night and improves with activity. The authors report the case of a young male athlete whose symptoms were initially incorrectly diagnosed as sacroiliac joint instability and dysfunction and later as a sacroiliac stress fracture before further workup revealed a seronegative spondyloarthropathy and the diagnosis of ankylosing spondylitis. The patient was prescribed oral indomethacin daily by the attending rheumatologist and started on a slow progression of return to running, jumping, and weight lifting. Within 4 weeks of beginning this treatment, the patient had complete cessation of pain with the medication. At follow-up 1 year after graduation from his university, the patient was nearly symptom free and working in a non-heavy labor job. The purpose of this case report is to remind sports medicine physicians of the prevalence of rheumatologic diseases in general and ankylosing spondylitis in particular and of the various ways in which spondyloarthropathies may present in athletes. Increased suspicion may lead to earlier diagnosis and treatment, potentially reducing illness severity and duration and improving the performance of athletes with this condition. Copyright 2014, SLACK Incorporated.

  5. Multicenter validation of the value of BASFI and BASDAI in Chinese ankylosing spondylitis and undifferentiated spondyloarthropathy patients

    OpenAIRE

    Lin, Zhiming; Gu, Jieruo; He, Peigen; Gao, Jiesheng; Zuo, Xiaoxia; Ye, Zhizhong; Shao, Fengmin; Zhan, Feng; Lin, Jinying; Li, Li; Wei, Yanlin; Xu, Manlong; Liao, Zetao; Lin, Qu

    2009-01-01

    The objectives of this study were to evaluate the reliability of Bath ankylosing spondylitis functional index (BASFI) and Bath ankylosing spondylitis disease activity index (BASDAI) in Chinese ankylosing spondylitis (AS) and undifferentiated spondyloarthropathy (USpA) patients. 664 AS patients by the revised New York criteria for AS and 252 USpA patients by the European Spondyloarthropathy Study Group criteria were enrolled. BASDAI and BASFI questionnaires were translated into Chinese. Partic...

  6. [Septic complications after multilocal fractures and multiple traumatic injury].

    Science.gov (United States)

    Okapa, Robert; Rak, Stanisław; Wenda, Jarosław; Marczyński, Wojciech; Walczak, Piotr; Macias, Julia

    2011-01-01

    The increase of the number of the multiple traumatic injuries is related to social factors, such as: the development of industry, the change of life style and the conditions of work, the manner and the speed of relocation and the biological factors related with the elongation of life time. According to the World Health Organization data the injuries are one of the main health problems in the world. The clinical analysis of multitrauma patients treated due to the septic complications of the fractures. The material consists of 34 multitrauma patients treated in The Osteomyelitis and Septic Complications Unit in Prof. A. Gruca Orthopedic and Trauma Hospital in Otwock, Poland between 2005 and 2010. The cause of trauma, the timing of arrival to our unit, the number of the days of treatment, the number and the specificity of bone and internal injuries, the bacteriology of bone infections and operative techniques and pharmacologic treatment were analyzed. The causes of the injuries were: road accident (79%), fall from the height (8.8%), others (12.2%). The first stay in our unit was 21 months after the injury on average (1-129 months), the number of stays in the unit was 2,8 on average (1-6), the length of stay was 25.7 days on average (4-108 days). In analyzed group of 34 patients, we found: 12 opened fractures of single bone, 11 opened fractures of more than one bone, 22 closed fractures of single bone, 12 closed fracture of more than one bone. Central nervous system (55.9%), abdominal organs (35.3%) and thorax (29.4%) were the most common internal organs ocuppied with the injury. Osteomyelitis was the most frequently diagnosed in femur (50%) and tibia (41.2%). The main reasons of bone infection were: Methycylin-Sensitive Staphylococcus Aureus (35,3%), Methycylin-Resistant Staphylococcus Aureus (17,3%), Pseudomonas aeruginosa (23,5%), Escherichia coli, Acinetobacter baumani, Enterococcus faecalis. The following treatment was undertaken: the debridement of septic bone

  7. Employment perspectives of patients with ankylosing spondylitis

    NARCIS (Netherlands)

    Chorus, A.M.J.; Boonen, A.; Miedema, H.S.; Linden, S. van der

    2002-01-01

    Objectives: To assess the labour market position of patients with ankylosing spondylitis (AS) in relation to disease duration and to identify potential factors in relation to withdrawal from the labour force. Methods: A cross sectional mail survey was conducted among 658 patients with AS.

  8. Current treatment approaches in patients with ankylosing spondylitis

    Directory of Open Access Journals (Sweden)

    Bilal Elbey

    2015-03-01

    Full Text Available Ankylosing spondylitis (AS is a chronic, inflammatory, rheumatic disease that mainly affects sacroiliac joints and spine. AS predominantly occurs more often in males and typically begins in the second or third decade. The mainstay of therapy in AS are nonsteroidal anti-inflammatory drugs, which reduce inflammation and pain. Disease modifying antirheumatic drugs (DMARD did not have enough evidence to prove their effect in AS treatment. The use of DMARD may not sufficient to improve the treatment and symptoms. Currently, TNF-blockers such as, Golimumab Etanersept Adalimumab İnfliksimab have promising results in the treatment of AS. TNF-blockers improve the clinical signs and symptoms, and improve the patients’ physical function and quality of life. This manuscript is focused that Current pharmacological treatments in patients with ankylosing spondylitis.

  9. Hyperbaric oxygenation therapy for crush injuries reduces the risk of complications: research report.

    Science.gov (United States)

    Yamada, Noriaki; Toyoda, Izumi; Doi, Tomoaki; Kumada, Keisuke; Kato, Hisaaki; Yoshida, Shozo; Shirai, Kunihiro; Kanda, Norihide; Ogura, Shinji

    2014-01-01

    Hyperbaric oxygen (HBO2) therapy has been adopted for crush injuries, but there are few studies supporting its use. We therefore investigated the effects of HBO2 on management of patients with complicated crush injuries. This historic cohort study included patients with crush injuries and open fractures with severities greater than or equal to Gustilo class IIIA. We divided the patients into two groups: Control and HBO2. The control group received conventional treatment, while the HBO2 group received conventional treatment plus HBO2. We compared the groups with respect to the incidence of infection, need for additional surgery, and length of intensive care unit (ICU) and hospital stays. There were 16 patients in the HBO2 group and 13 in the control group. There were no patients with infections in the HBO2 group, whereas in the control group six patients had infections and five needed another drainage procedure. These incidences were significantly lower in the HBO2 group (p = 0.003 and 0.013). However, the durations of ICU and hospital stays were similar across the two groups. HBO2 is effective in the management of crush injuries from the viewpoint of reducing complications and reoperations. These observations should be verified in additional studies with larger sample sizes because the patient number is limited.

  10. Coexistence of Ankylosing Spondylitis and Löfgren’s Syndrome

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    Senol Kobak

    2014-01-01

    Full Text Available A 46-year-old male patient diagnosed with ankylosing spondylitis presented to our polyclinic with complaints of pain, swelling, and limitation in joint mobility in both ankles and erythema nodosum skin lesions in both pretibial sites. The sacroiliac joint graphy and the MRI taken revealed active and chronic sacroiliitis. On the thorax CT, multiple mediastinal and hilar lymphadenopathies were reported. Mediastinoscopic excisional lymph node biopsy was taken and noncalcified granulomatous structures, lymphocytes, and histiocytes were determined on histopathological examination. The patients were diagnosed with ankylosing spondylitis, sarcoidosis, and Löfgren’s syndrome. NSAIDs, sulfasalazine, and low dose corticosteroid were started. Significant regression was seen in the patient’s subjective and laboratory assessments.

  11. Acute fulminant drug induced necrotizing pancreatitis in a patient with ankylosing spondylitis

    Directory of Open Access Journals (Sweden)

    Pablo Miramontes

    2015-03-01

    Full Text Available Drug-induced acute necrotizing pancreatitis is a rare adverse event, although it has been reported in association with different drugs, including non-steroidal anti-inflammatory drugs, disease-modifying antirheumatic drugs, and analgesic agents commonly used in rheumatology. In different reviews of the pancreotoxicity of drugs, infliximab and etanercept are mentioned among all medications implicated in drug-induced pancreatitis, but clinical cases of acute pancreatitis complicating treatment with these anti-TNF-α agents have been exceptionally reported. We describe a patient with ankylosing spondylitis treated with etanercept, who developed an acute fulminant necrotizing pancreatitis that resulted in death. Doctors should pay close attention to patients taking biologic drugs in which a complaint of abdominal pain lasting for several days with no apparent cause may require a prompt referral for medical consultation.

  12. EFFECTIVENESS OF INFLIXIMAB IN PATIENTS WITH JUVENILE ANKYLOSING SPONDYLARTHRITIS

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    A.L. Kozlova

    2009-01-01

    Full Text Available The objective of open-labeled study was estimation of effectiveness and safety of infliximab — monoclonal antibodies to tumor necrosis factor (TNF - in treatment of 48 patients with juvenile ankylosing spondylarthritis. Duration of observation was 6 weeks — 1,5 years. Anticytokine treatment was administrated on the ground of therapy with immunosuppressive agents in 96% of patients. Infliximab was administrated in median dose 7,4 ± 3,7 mg/kg of body weight by standard scheme (0–2–6 — week and further every 8 weeks intravenously. Results of a trial showed that infliximab has evident anti-inflammatory effect. Treatment with infliximab provided development of remission of articular syndrome, decreasing and normalization of laboratory indices of activity of disease, the rate of disability, and increasing of quality of life in 84% of patients. Effect of this medication was registered after first infusion and continued during all period of follow up. Adverse effects included transfusion reactions: fever, head ache, nausea/vomiting in 10% of patients, allergic arthritis — in 2% of patients. Thus, treatment of infliximab is pathogenetically grounded, effective and safe in patients with juvenile ankylosing spondylarthritis.Key words: children, juvenile ankylosing spondylarthritis, infliximab, treatment.(Voprosy sovremennoi pediatrii — Current Pediatrics. 2009;8(2:20-26

  13. Spinal Cord Injury in the Geriatric Population: Risk Factors, Treatment Options, and Long-Term Management.

    Science.gov (United States)

    Ikpeze, Tochukwu C; Mesfin, Addisu

    2017-06-01

    Spinal cord injuries (SCIs) are sustained by more than 12 500 patients per year in the United States and more globally. The SCIs disproportionately affect the elderly, especially men. Approximately 60% of these injuries are sustained traumatically through falls, but nontraumatic causes including infections, tumors, and medication-related epidural bleeding have also been documented. Preexisting conditions such as ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis can render the spine stiff and are risk factors as well as cervical spondylosis and ensuing cervical stenosis. Treatment options vary depending on the severity, location, and complexity of the injury. Surgical management has been growing in popularity over the years and remains an option as it helps reduce spinal cord compression and alleviate pain. Elevating mean arterial pressures to prevent spinal cord ischemia and avoiding the second hit of SCI have become more common as opposed to high dose steroids. Ongoing clinical trials with pharmacological agents such as minocycline and riluzole have shown early, promising results in their ability to reduce cellular damage and facilitate recovery. Though SCI can be life changing, the available treatment options have aimed to reduce pain and minimize complications and maintain quality of life alongside rehabilitative services.

  14. High-dose thalidomide increases the risk of peripheral neuropathy in the treatment of ankylosing spondylitis

    Directory of Open Access Journals (Sweden)

    Hong-xia Xue

    2015-01-01

    Full Text Available Thalidomide is an effective drug for the treatment of ankylosing spondylitis but might induce peripheral neuropathy. This major adverse reaction has attracted much concern. The current study aimed to observe the incidence of thalidomide-induced peripheral neuropathy among ankylosing spondylitis patients for 1 year after treatment. In this study, 207 ankylosing spondylitis cases received thalidomide treatment, while 116 ankylosing spondylitis cases received other treatments. Results showed that the incidence of thalidomide-induced peripheral neuropathy in the thalidomide group was higher than that in the non-thalidomide group. There was no significant difference in the incidence of neuropathy between the < 6 months medication and ≥ 6 months medication groups. There were no differences in the mean age, gender, or daily dose between the two groups. The incidence of peripheral neuropathy among patients receiving 25, 50, 75, or 100 mg thalidomide per day was 4.6%, 8.5%, 17.1%, 21.7%, respectively. The incidence was significantly different between the groups receiving 25 mg and 100 mg thalidomide. In conclusion, thalidomide can induce peripheral neuropathy within 1 year after treatment of ankylosing spondylitis; however, age and gender have no obvious impact on the incidence of peripheral neuropathy. The incidence of peripheral neuropathy is associated with increasing daily doses of thalidomide.

  15. Assessment of subclinical atherosclerosis in ankylosing spondylitis: correlations with disease activity indices

    Directory of Open Access Journals (Sweden)

    F.M. Perrotta

    2013-07-01

    Full Text Available The aim of the study was to evaluate atherosclerosis in ankylosing spondylitis (AS through the assessment of morphological and functional measures of subclinical atherosclerosis. Twenty patients [M/F=12/8, age (median/range 43.5/28-69 years; disease duration (median/range 9.7/1-36 years] with AS classified according to modified New York criteria and twenty age and sex related healthy controls with negative past medical history for cardiovascular events were enrolled in the study. In all patients and controls, the intima-media thickness (IMT of common carotid artery, carotid bulb and internal carotid artery, and the flow-mediated dilatation (FMD of non-dominant arm brachial artery were determined, using a sonographic probe Esaote GPX (Genoa, Italy. Furthermore, we assess the main disease activity and disability indices [bath ankylosing spondylitis disease activity index, ankylosing spondylitis disease activity score-eritrosedimentation rate (ASDAS-ESR, ASDAS-C-reactive protein (CRP, bath ankylosing spondylitis metrology index, bath ankylosing spondylitis functional index and acute phase reactants. Plasmatic values of total cholesterol, low-density lipoprotein, high-density lipoprotein, triglyceride and homocysteine were carried out in all twenty patients. IMT at carotid bulb was significant higher in patients than in controls (0.67 mm vs 0.54 mm; P=0.03. FMD did not statistically differ between patients and controls (12.5% vs 15%; P>0.05. We found a correlation between IMT at carotid bulb and ESR (rho 0.43; P=0.04. No correlation was found between FMD and disease activity and disability indices. This study showed that in AS patients, without risk factors for cardiovascular disease, carotid bulb IMT, morphological index of subclinical atherosclerosis, is higher than in controls.

  16. Imaging in ankylosing spondylitis

    DEFF Research Database (Denmark)

    Østergaard, Mikkel; Lambert, Robert G W

    2012-01-01

    Imaging is an integral part of the management of patients with ankylosing spondylitis and axial spondyloarthritis. Characteristic radiographic and/or magnetic resonance imaging (MRI) findings are key in the diagnosis. Radiography and MRI are also useful in monitoring the disease. Radiography...... in the spine and sacroiliac joints, but its clinical utility is limited due to its use of ionizing radiation and lack of ability to assess the soft tissues. It is exciting that with continued dedicated research and the rapid technical development it is likely that even larger improvements in the use of imaging...

  17. Treatment of ankylosed maxillary central incisors by segmental osteotomy with autogenous bone graft.

    Science.gov (United States)

    You, Kug-Ho; Min, Yon-Sook; Baik, Hyoung-Seon

    2012-04-01

    This case report describes the treatment of a 16-year-old girl with ankylosed maxillary central incisors that were noticeably infraoccluded and labially displaced. We performed a segmental osteotomy with an autogenous bone graft in a single-stage surgery to align and level the ankylosed teeth. The dento-osseous segment was successfully repositioned with satisfactory periodontal results. Copyright © 2012 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

  18. The risk of healing complications in primary teeth with concussion and subluxation injury

    DEFF Research Database (Denmark)

    Lauridsen, Eva; Blanche, Paul; Amaloo, Catherina

    2017-01-01

    BACKGROUND/AIM: Traumatic dental injuries (TDIs) in the primary dentition occur frequently. Long term complications may potentially cause damage to the permanent successor. The aim of this study was to report the risk of pulp necrosis (PN), pulp canal obliteration (PCO), repair related resorption...

  19. Distraction osteogenesis of ankylosed front teeth with subsequent orthodontic fine adjustment.

    Science.gov (United States)

    Huck, Lothar; Korbmacher, Heike; Niemeyer, Karsten; Kahl-Nieke, Bärbel

    2006-07-01

    Conventional therapeutic approaches to correct ankylosed anterior teeth in infraposition require compromises involving esthetics and function. The combined approach of distraction and early orthodontic fine adjustment, not yet established as a routine, promises better results concerning the bone conditions and gingival development. Both female patients had suffered a trauma to the front teeth during early mixed dentition resulting in ankylosed central incisors in infraposition. At the ages of 14 years and 2 months and 15 years and 2 months, respectively, we carried out segment distraction by means of a bone-supported internal distractor followed by orthodontic fine adjustment after having shortened the consolidation phase. Both ankylosed front teeth could be successfully aligned, leading to an increase in bone and harmonization of the gingival margin in the dental arch. At ten and 14 months after the conclusion of treatment, we observed only few deviations in the dental situation compared to posttherapeutic findings. From a functional and esthetic point of view, therapy involving combined orthodontics and surgery is superior to conventional therapy. Orthodontic fine adjustment should be considered as a continuation of the distraction procedure.

  20. Unusual presentations of acute kidney injury and neurologic complications due to snake bite

    Directory of Open Access Journals (Sweden)

    Hamid Noshad

    2015-06-01

    Full Text Available Introduction: Vascularity of kidneys is very high, so these organs are potentially susceptible to be affected with toxins including snake venom. Hypersensitivity to snake venous could cause some neurological problem. Case Report: We present a 14-year-old boy with acute kidney injury (AKI due to snake bite. After a few days, kidney failure with hematuria was developed. His serum creatinine level rose to 3 mg/dl and following 2 weeks gradually and decreased to normal level without any special treatment except for anti-venom, which was not prescribed inappropriate time (this type of AKI is not reported previously. He had seizure attacks, which were according to magnetic resonance imaging due to posterior reversible encephalopathy syndrome (PRES (This neurologic complication has been seen in other kidney injuries but up to now it was not reported in snake bite victims. Conclusion: Sanke venom could cause PRES due to AKI and seizure could be one of the most important complications in snake bite.

  1. Serum beta-2 microglobulin levels for predicting acute kidney injury complicating aortic valve replacement.

    Science.gov (United States)

    Zaleska-Kociecka, Marta; Skrobisz, Anna; Wojtkowska, Izabela; Grabowski, Maciej; Dabrowski, Maciej; Kusmierski, Krzysztof; Piotrowska, Katarzyna; Imiela, Jacek; Stepinska, Janina

    2017-10-01

    Acute kidney injury complicating both transcatheter and surgical aortic valve replacement is associated with high rates of morbidity and mortality. The aim of this study was to investigate the role of serum beta 2 (β2) microglobulin, cystatin C and neutrophil gelatinase-associated lipocalin levels in detecting periprocedural acute kidney injury. Eighty consecutive patients who were 70 years of age or older and who were having surgical (n = 40) or transcatheter (n = 40) aortic valve replacement were recruited in a prospective study. The biomarkers were tested before the procedure, 6 times afterwards, at discharge and at a 6-month follow-up visit. The baseline β2-microglobulin level was the strongest predictor of acute kidney injury as a complication of transcatheter aortic valve replacement [odds ratio (OR) 5.277, P = 0.009]. Its level 24 h after the procedure reached the largest area under the curve (AUC) of 0.880 (P regression analysis, the levels of β2-microglobulin and cystatin C 24 h after the procedure were significantly associated with acute kidney injury after transcatheter valve replacement (OR 38.15, P = 0.044; OR 1782, P = 0.019, respectively). In the surgical aortic valve replacement group, the highest AUCs belonged to β2-microglobulin and cystatin C at 24 h (AUC = 0.808, P = 0.003 and AUC = 0.854, P = 0.001, respectively). Their higher values were also associated with acute kidney injury (OR 17.2, P = 0.018; OR 965.6, P = 0.02, respectively). A persistent increase in the postoperative levels of β2-microglobulin following acute kidney injury was associated with the progression of chronic kidney disease for 6 months after both transcatheter (OR 6.56, P = 0.030) and surgical (OR 7.67, P = 0.03) aortic valve replacements. Serum β2-microglobulin had the potential to predict acute kidney injury complicating transcatheter valve replacement and to diagnose it as early as 24 h after both the

  2. Anxiety and depression correlate with disease and quality-of-life parameters in Chinese patients with ankylosing spondylitis

    Directory of Open Access Journals (Sweden)

    Xu X

    2016-05-01

    Full Text Available Xujuan Xu,1,* Biyu Shen,2,3,* Aixian Zhang,4 Jingwei Liu,3 Zhanyun Da,4 Hong Liu,4 Zhifeng Gu4 1Department of Nursing, Affiliated Hospital of Nantong University, 2School of Nursing, Nantong University, 3Department of Nursing, The Second Affiliated Hospital of Nantong University, 4Department of Rheumatology, Affiliated Hospital of Nantong University, Nantong, People’s Republic of China *These authors contributed equally to this work Aim: To evaluate the relationship between mental and physical health in Chinese patients with ankylosing spondylitis (AS and to identify the predictors of psychological status.Methods: Patients with AS (n=103 and healthy controls (n=121 were surveyed between 2010 and 2011 (cross-sectional study. The Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Metrology Index, pain visual analog scale, Health Assessment Questionnaire, revised Self-Rating Anxiety Scale, revised Self-Rating Depression Scale, and Short-Form 36 questionnaire were administered.Results: The frequency of anxiety and depression in patients with AS was higher than that in healthy controls (P<0.001. Severe disease status and reduced quality of life (QoL were associated with anxiety and depression. Disease activity and somatic pain were more severe in the anxious and depressed subgroups. Impaired physical functioning (assessed by Bath Ankylosing Spondylitis Functional Index was higher in the anxious and depressed subgroups, while measures of spinal mobility (assessed by Bath Ankylosing Spondylitis Metrology Index were not associated with depression. Lower QoL was observed in the depressed subgroup.Conclusion: Low socioeconomic status, lack of health insurance, and fatigue contributed to depression in Chinese patients with AS. These patients may require a psychological care approach that is different from those of other countries. Keywords: ankylosing spondylitis, disease activity

  3. Long-term safety and efficacy of etanercept in the treatment of ankylosing spondylitis

    Directory of Open Access Journals (Sweden)

    Senabre-Gallego JM

    2013-09-01

    Full Text Available José Miguel Senabre-Gallego,1 Carlos Santos-Ramirez,2 Gregorio Santos-Soler,1 Esteban Salas-Heredia,1 Mabel Sánchez-Barrioluengo,3 Xavier Barber,4 José Rosas1 On behalf of the AIRE-MB group 1Rheumatology, Hospital Marina Baixa, Villajoyosa, 2Rheumatology, Hospital Marina Salud, Denia, 3INGENIO (Instituto de Gestión de la Inovación y del Conocimiento (CSIC [Consejo Superior de Investigaciones Científicas]-UPV [Universidad Politécnica de Valencia], Universitat Politècnica de València, Valencia, 4CIO (Centro de Investigación Operativa-UMH (Universidad Miguel Hernández, Universidad Miguel Henández, Elche, Spain Abstract: To date, anti-tumor necrosis factor alfa (anti-TNF-α therapy is the only alternative to nonsteroidal anti-inflammatory drugs for the treatment of ankylosing spondylitis. Etanercept is a soluble TNF receptor, with a mode of action and pharmacokinetics different to those of antibodies and distinctive efficacy and safety. Etanercept has demonstrated efficacy in the treatment of ankylosing spondylitis, with or without radiographic sacroiliitis, and other manifestations of the disease, including peripheral arthritis, enthesitis, and psoriasis. Etanercept is not efficacious in inflammatory bowel disease, and its efficacy in the treatment of uveitis appears to be lower than that of other anti-TNF drugs. Studies of etanercept confirmed regression of bone edema on magnetic resonance imaging of the spine and sacroiliac joint, but failed to reduce radiographic progression, as do the other anti-TNF drugs. It seems that a proportion of patients remain in disease remission when the etanercept dose is reduced or administration intervals are extended. Etanercept is generally well tolerated with an acceptable safety profile in the treatment of ankylosing spondylitis. The most common adverse effect of etanercept treatment is injection site reactions, which are generally self-limiting. Reactivation of tuberculosis, reactivation of

  4. The effect of pre-injury anti-platelet therapy on the development of complications in isolated blunt chest wall trauma: a retrospective study.

    Directory of Open Access Journals (Sweden)

    Ceri Battle

    Full Text Available INTRODUCTION: The difficulties in the management of the blunt chest wall trauma patient in the Emergency Department due to the development of late complications are well recognised in the literature. Pre-injury anti-platelet therapy has been previously investigated as a risk factor for poor outcomes following traumatic head injury, but not in the blunt chest wall trauma patient cohort. The aim of this study was to investigate pre-injury anti-platelet therapy as a risk factor for the development of complications in the recovery phase following blunt chest wall trauma. METHODS: A retrospective study was completed in which the medical notes were analysed of all blunt chest wall trauma patients presenting to a large trauma centre in Wales in 2012 and 2013. Using univariate and multivariable logistic regression analysis, pre-injury platelet therapy was investigated as a risk factor for the development of complications following blunt chest wall trauma. Previously identified risk factors were included in the analysis to address the influence of confounding. RESULTS: A total of 1303 isolated blunt chest wall trauma patients presented to the ED in Morriston Hospital in 2012 and 2013 with complications recorded in 144 patients (11%. On multi-variable analysis, pre-injury anti-platelet therapy was found to be a significant risk factor for the development of complications following isolated blunt chest wall trauma (odds ratio: 16.9; 95% confidence intervals: 8.2-35.2. As in previous studies patient age, number of rib fractures, chronic lung disease and pre-injury anti-coagulant use were also found to be significant risk factors. CONCLUSIONS: Pre-injury anti-platelet therapy is being increasingly used as a first line treatment for a number of conditions and there is a concurrent increase in trauma in the elderly population. Pre-injury anti-platelet therapy should be considered as a risk factor for the development of complications by clinicians managing

  5. [Posttraumatic complications after pediatric ankle injuries].

    Science.gov (United States)

    Schneider, F J; Linhart, W E

    2013-08-01

    Ankle sprains are common injuries in childhood and are generally harmless. However, fractures of the ankle joint are rare, but complications (persistent rotational or axial deformity, alteration of growth of the distal tibia or fibula, or joint deformity) can lead to serious problems during growth. The clinical relevance of growth disturbances at the distal tibia or fibula depends on the age at the time of fracture more than on the fracture type, severity of dislocation, or interponated material in the fracture gap. Both stimulation and inhibition of growth are possible. Inhibition of growth at the distal tibial growth plate regularly leads to varus deformity and shortening. This is of clinical importance as this type of growth disturbance is the most common. Valgus deformity is rare, mostly due to persistent axial deviation of an insufficiently reduced fracture. Transitional fractures always occur at the time of growth plate closure; thus, growth disturbances do not play a role. Transitional fractures could be overlooked or treated insufficiently, leading to a step or gap of the joint surface.

  6. Radon within therapeutic strategies of ankylosing spondylitis

    International Nuclear Information System (INIS)

    Herold, M.; Lind-Albrecht, G.

    2008-01-01

    For more than fifty years patients with rheumatic diseases have been treated in the thermal gallery of Bad Gastein, main indication is ankylosing spondylitis. Experiences of this kind of spa treatment on several hundred patients and randomised controlled clinical trials document the positive treatment effect of spa therapy with Radon which lasts for up to 40 weeks. (author) [de

  7. [Muscular disorders associated with ankylosing spondylitis and their correction with the help of whole body cryotherapy].

    Science.gov (United States)

    Kulikov, A G; Tabiev, V I; Rassulova, M A

    2015-01-01

    The objective of the present study was to evaluate the possibilities for the correction of muscular disorders associated with ankylosing spondylitis and their correction with the help of whole body cryotherapy. The study included 55 patients randomly allocated to two groups. Group 1 was comprised of the patients treated with the use of the common mineral baths, physiotherapy, therapeutic physical exercises, spinal massage, and whole body air-cryotherapy. Group 2 contained the patients who were treated in a similar way with the exception of whole body cryotherapy; they served as controls. Muscular disorders were diagnosed by means of functional muscular testing. The study has demonstrated the high prevalence of muscular disorders in the patients suffering from ankylosing spondylitis. Moreover, it revealed the profile of such disorders associated with ankylosing spondylitis and showed significant correlation between the results of functional muscular testing, BASMI and BASFI indices as well as characteristics of chest excursions (pcryotherapy in comparison with the alternative therapeutic modalities employed in the present study. This therapeutic modality ensured the statistically more pronounced improvement of functional muscular testing parameters (pcryotherapy accounting for its corrective influence on the muscular disorders in the patients presenting with ankylosing spondylitis. It is concluded that the proposed approach can be recommended for the introduction in the combined therapeutic and rehabilitative treatment of muscular disorders associated with ankylosing spondylitis.

  8. Foot Disability in Patients with Ankylosing Spondylitis: A Clinical and Ultrasonographic Assessment

    Directory of Open Access Journals (Sweden)

    Erkan Mesci

    2016-04-01

    Full Text Available Aim: The objective of this study was to perform a clinical and ultrasonographic assessment of foot disability and related factors among patients with ankylosing spondylitis. Material and Method: The study enrolled 40 patients diagnosed with ankylosing spondylitis (AS according to the modified New York criteria and 30 matched healthy controls. In addition to the assessments for Disease activity (BASDAI and functional status (BASFI, foot functioning was evaluated using the Foot Function Index (FFI and quality of life using the Ankylosing Spondylitis Quality of Life (ASQoL questionnaire. Thickness of plantar fascia (PF and Achilles tendon (AT, changes in echogenicity and presence of bone erosions, entesophytes and bursitis were examined using ultrasound. Results: The mean age of patients was 39.9 ± 10.4 years and median disease duration was 48 (1-288 months. Sixteen patients (40% had foot pain. Thirteen patients (32.5% had clinical evidence for enthesitis. Thirty patients (75% showed at least one pathological finding at ultrasonographic examination. Mean FFI score was higher in the AS group versus control group (p

  9. Using peer mentoring for people with spinal cord injury to enhance self-efficacy beliefs and prevent medical complications.

    Science.gov (United States)

    Ljungberg, Inger; Kroll, Thilo; Libin, Alexander; Gordon, Samuel

    2011-02-01

    Individuals with spinal cord injury/disease are faced with a myriad of psychosocial adjustment challenges. This article describes the implementation of a peer-mentoring programme designed to support this adjustment process for people with SCI/disease and the programme's believed impact on self-efficacy and prevention of medical complications. With shorter length of stay in acute inpatient rehabilitation after spinal cord injury/disease, peer mentor programmes are becoming an important component to assist with education and community re-integration. Quasi-experimental non-controlled pretest/post-test. Patients with newly acquired spinal cord injury/disease participated in a one-year spinal cord injury peer-mentoring programme. Peer mentors met with their assigned participants regularly during inpatient care and on discharge to track medical complications and assist with adjusting to life after spinal cord injury/disease. In all, of 37 mentees enrolled, 24 successfully completed the programme. Sixty-seven per cent showed improved self-efficacy score between the two time points. Medical complications and doctor visits all decreased significantly between 0-6 months and 7-12 months. Our findings indicate that the older an individual is, the lower the likelihood of having a urinary tract infection (p = 0.006). The programme was well received by all mentees who felt they could connect well with their peer mentor. Peer mentoring in a rehabilitation setting enhances the understanding of challenges that patients and medical staff deal with on a day-to-day basis. Our findings suggest it is important to monitor and educate individuals with spinal cord injury/disease at the acute stage to improve medical outcomes. Caution is advised in the interpretation of these results as they were obtained in a small non-random sample using self-report data. Peer mentors play an increasingly important role in nurse-delivered education in the spinal cord injury/disease population. © 2011

  10. The Association of Acromegaly and Ankylosing Spondylitis

    OpenAIRE

    Alpaslan Tuzcu; Ayse Dicle Turhanoglu; Mithat Bahçeci; Hatice Öztürkmen Akay; Zülfü Karabulut

    2004-01-01

    Coexistence of acromegaly and anklosing spondylitis had been rarelyreported. Only two case reports were described coexistence of two diseasesin literature. These two diseases have some similar clinical andradiographic features. Calcaneal epin formation, enteshopathy and caudeequina syndrome can be seen both acromegaly and ankylosing spondylitis.Our case had clinical and radiological features of both acromegaly andankylosing spondylitis. Acral enlargement, coarsening of feature,malocclusion, n...

  11. Taylor Approach of Spinal Anaesthesia in a case of Ankylosing Spondylitis for Hip Fracture Surgery

    Directory of Open Access Journals (Sweden)

    Urmila Palaria

    2011-11-01

    Full Text Available Ankylosing Spondylitis (AS is a chronic inflammatory rheumatic disease primarily affecting the axial joints manifesting as stiffnesss of the spine. Patient with ankylosing spondylitis is a challenge to anaesthesiologists in terms of airway management and neuraxial blocks. Modified paramedian approach (Taylor approach of spinal anaesthesia can be used as an alternative to technically difficult cases in patients undergoing lower limb surgeries.

  12. Complications of treating terrible triad injury of the elbow: a systematic review.

    Directory of Open Access Journals (Sweden)

    Hong-wei Chen

    Full Text Available Terrible triad injury of the elbow (TTIE, comprising elbow dislocation with radial head and coronoid process fracture, is notoriously challenging to treat and has typically been associated with complications and poor outcomes. The objective of this systematic review was to summarize the most recent available evidence regarding functional outcomes and complications following surgical management of TTIE.Medline, EMBASE, Cochrane Library, and Google Scholar were searched to identify relevant studies, which were included if they were retrospective or prospective in design, involved participants who had TTIE, and were published in English. Outcomes of interest were functional outcomes and complications.Sixteen studies, involving 312 patients, were included in the systematic review. Mean follow up after surgery was typically 25 to 30 months. Mean Mayo elbow performance scores ranged from 78 to 95. Mean Broberg-Morrey scores ranged from 76 to 90. Mean DASH scores ranged from 9 to 31. The proportion of patients who required reoperation due to complications ranged from 0 to 54.5% (overall  = 70/312 [22.4%]. Most of these complications were related to hardware fixation problems, joint stiffness, joint instability, and ulnar neuropathy. The most common complications that did not require reoperation were heterotopic ossification (39/312 [12.5%] patients and arthrosis (35/312 [11.2%] patients.The results of this systematic review indicate that functional outcomes after surgery for TTIE are generally satisfactory and that complications are common. Further research is warranted to determine which surgical techniques optimize functional outcomes and reduce the risk of complications.

  13. THE BASIC PRINCIPLES OF TREATMENT OF ANKYLOSING SPONDYLITIS (BECHTEREW'S DISEASE

    Directory of Open Access Journals (Sweden)

    Shandor Fedorovich Erdes

    2013-01-01

    Full Text Available The history of treatment of ankylosing spondylitis (AS and the reasons behind the development of modern approaches to its therapy are briefly described. The main tasks and principles of non-pharmacological and drug therapies for ASare briefly reported. The need for therapeutic physical training is emphasized, since its role in maintaining the functional status in this group of patients has been proved. The lecture casts doubt on effectiveness of physiotherapy andother physical techniques because of the poor evidence base. The lecture emphasizes the disease-modifying role of nonsteroidal anti-inflammatory drugs and requirement to receive them constantly for patients with Bechterew's disease. Meanwhile, the basic anti-inflammatory drugs in patients with this disease are reported to play an auxiliary role and to have no effect on disease progression. The pronounced clinical effectiveness of all tumor necrosis factor α inhibitors is emphasized; certain differences in their therapeutical effect are described. The problems of surgical treatment, which deal with correction of disease complications or undesirable effects, are discussed.

  14. Overlap of Ankylosing Spondylitis and Systemic Lupus Erythematosus: A case report

    Directory of Open Access Journals (Sweden)

    Mahmood Akbaryan

    2016-04-01

    Full Text Available Ankylosing spondylitis is a typical, very heritable incendiary joint inflammation, influencing principally the spine and pelvis. Inflammatory arthritis in ankylosing spondylitis causes pain and stiffness and progressively leads to new bone formation and ankylosis (fusion of affected joints. Systemic lupus erythematosus (SLE, lupus is a highly complex and heterogeneous autoimmune disease that most often afflicts women in their child-bearing years. It is characterized by circulating self-reactive antibodies that deposit in tissues, including skin, kidneys, and brain, and the ensuing inflammatory response can lead to irreparable tissue damage. There are few reports of coexistence of Ankylosing spondylitis and Systemic lupus erythematosus which firmly emphasis on an overlap phenomenon between these two disorders. A 30 year old woman was admitted to our hospital due to signs of butterfly-shaped rash on her cheeks, which became prominent after exposure to sunlight and severe inflammatory low-back pain. About ten year earlier, AS had been diagnosed and treatment started with non-steroidal anti-inflammatory drug (NSAID. To the best of our knowledge, the present case is one of 10 reported cases of coexistence of these two disorders in English literature. The coexistence of these two diseases with different genetic backgrounds and clinical symptoms may implicate the importance of shared environmental factors.

  15. Spinal fractures in ankylosing spondylitis: prevalence, prevention and management

    NARCIS (Netherlands)

    Vosse, D.; Lems, W.F.; Geusens, P.P.

    2013-01-01

    In patients with ankylosing spondylitis (AS), the risk of vertebral fractures (VFs) is increased. Case finding and fractures in patients with AS is a clinical challenge for several reasons. First, back pain and hyperkyphosis are mostly attributed to disease-related inflammation and structural damage

  16. Disease activity in longstanding ankylosing spondylitis: a correlation of clinical and magnetic resonance imaging findings.

    Science.gov (United States)

    Goh, L; Suresh, P; Gafoor, A; Hughes, P; Hickling, P

    2008-04-01

    We evaluated magnetic resonance imaging (MRI) changes in ankylosing spondylitis (AS) patients with longstanding disease and investigated whether there is any relationship between MRI findings and validated methods of disease assessment. A total of 34 AS patients with disease duration greater than 10 years were included in this observational cross-sectional study (26 men, 8 women). The main outcome measures were Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Global assessment (BASG), Bath Ankylosing Spondylitis Metrology Index (BASMI), MRI of the thoracic and lumbar spine (AS spi MRI A) and measurement of serum erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), plasma viscosity (PV) and immunoglobulin A (Ig A). The median scores for the acute lesions based on AS spi MRI A scoring system was 2.5 (0-4.12). The respective mean ESR and CRP were 36 (SD, 24.00) mm/h and 14.19 (SD, 24.00) mg/l with the median PV of 1.8 (1.75-1.87). The median BASG, BASFI and BASDAI were 4.55 (2.37-5.55), 4.40(2.31-5.47) and 4.32 (3.07-6.48), respectively. No significant correlations were found between the acute MRI scores and each of the clinical instruments and laboratory markers of inflammation. In this study, majority of AS patients with longstanding disease had very low AS spi MRI A scores or no evidence of spinal inflammatory lesions. Our study would suggest that MRI should be used along with other measures of disease activity in the assessment of symptomatic AS patients with longstanding disease.

  17. Detection of Chlamydia pneumoniae in Ankylosing Spondylitis Patients

    Directory of Open Access Journals (Sweden)

    Dunya Fareed Salloom

    2018-03-01

    Full Text Available Ankylosing spondylitis is a complex debilitating disease because its pathogenesis is not clear. This study aims at detecting some pathogenesis factors that lead to induce the disease. Chlamydia pneumoniae is one of these pathogenesis factors which acts as a triggering factor for the disease. The study groups included forty Iraqi Ankylosing spondylitis patients and forty healthy persons as a control group. Immunological and molecular examinations were done to detect Chlamydia. pneumoniae in AS group. The immunological results were performed by Enzyme-Linked Immunosorbent Assay (ELISA to detect anti-IgG and anti-IgM antibodies of C. pneumoniae revealed that five of forty AS patients' samples (12.5% were positive for anti-IgG and IgM C. pneumoniae antibodies compared to controls which revealed seronegative. Molecular detection included 16srRNA and HSP-70 genes were to ensure the serological examination for detection of bacteria in the five blood samples which were positive; therefore, these results improved that C. pneumoniae played a role in the pathogenesis of the disease.

  18. Efficacy and safety of adalimumab in ankylosing spondylitis

    Directory of Open Access Journals (Sweden)

    Mounach A

    2014-08-01

    Full Text Available Aziza Mounach, Abdellah El MaghraouiRheumatology Department, Military Hospital Mohammed V, Rabat, MoroccoAbstract: Ankylosing spondylitis (AS is the most common and most severe subtype of spondyloarthritis. It also may be an outcome of any of the other spondyloarthritis subtypes. AS preferentially affects the sacroiliac joints and the tip of the column, with a tendency to later ankylosis. Peripheral joints, enthesis, and other extra-articular involvement may be observed. Tumor necrosis factor (TNF inhibitors are now well-established, effective drugs in the treatment of AS symptoms. Adalimumab, which is a fully human monoclonal antibody that binds to and neutralizes TNF, has demonstrated efficacy in treating AS symptoms, including axial involvement, peripheral arthritis, enthesitis, uveitis, gut involvement, and psoriasis. Furthermore, adalimumab has showed an overall acceptable safety profile. In this paper, we review the efficacy and safety profile of adalimumab in the treatment of AS, and discuss its differences from the other anti-TNF drugs reported in the literature.Keywords: ankylosing spondylitis, spondyloarthritis, adalimumab, tumor necrosis factor-α

  19. Intestinal bacteria as triggering agents in murine ankylosing enthesopathy

    Czech Academy of Sciences Publication Activity Database

    Řeháková, Z.; Čapková, Jana; Šinkora, J.; Osterreicher, J.; Ivanyi, P.

    2004-01-01

    Roč. 3, Suppl. 2 (2004), s. 108 ISSN 1568-9972. [International Congress of Autoimmunity /4./. Budapešť, 03.11.2004-07.11.2004] R&D Projects: GA ČR GA305/03/0287 Keywords : ankylosing spondylitis * ANKENT * HLA-B27 Subject RIV: EC - Immunology

  20. Perinatal characteristics, older siblings, and risk of ankylosing spondylitis

    DEFF Research Database (Denmark)

    Lindström, Ulf; Forsblad-d'Elia, Helena; Askling, Johan

    2016-01-01

    BACKGROUND: The effect of circumstances and exposures early in life on the risk of developing ankylosing spondylitis (AS) is largely unknown. The purpose of this study was to determine whether perinatal characteristics predict development of AS. METHODS: AS cases (n = 1960; 59 % men) were defined...

  1. Complications of wrist arthroscopy.

    Science.gov (United States)

    Ahsan, Zahab S; Yao, Jeffrey

    2012-06-01

    The purpose of this systematic review was to address the incidence of complications associated with wrist arthroscopy. Given the paucity of information published on this topic, an all-inclusive review of published wrist arthroscopy complications was sought. Two independent reviewers performed a literature search using PubMed, Google Scholar, EBSCO, and Academic Megasearch using the terms "wrist arthroscopy complications," "complications of wrist arthroscopy," "wrist arthroscopy injury," and "wrist arthroscopy." Inclusion criteria were (1) Levels I to V evidence, (2) "complication" defined as an adverse outcome directly related to the operative procedure, and (3) explicit description of operative complications in the study. Eleven multiple-patient studies addressing complications of wrist arthroscopy from 1994 to 2010 were identified, with 42 complications reported from 895 wrist arthroscopy procedures, a 4.7% complication rate. Four case reports were also found, identifying injury to the dorsal sensory branch of the ulnar nerve, injury to the posterior interosseous nerve, and extensor tendon sheath fistula formation. This systematic review suggests that the previously documented rate of wrist arthroscopy complications may be underestimating the true incidence. The report of various complications provides insight to surgeons for improving future surgical techniques. Level IV, systematic review of Levels I-V studies. Copyright © 2012 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  2. Atlantoaxial Ankylosis Detected on Neck CT Scans in a Patient with Ankylosing Spondylitis: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jeong Ah; Lee, Seung Hun; Joo, Kyung Bin [Dept. of Radiology, Seoul Hospital, Hanyang University College of Medicine, Seoul (Korea, Republic of); Ryu, Jeong Ah [Dept. of Radiology, Guri Hospital, Hanyang University College of Medicine, Guri (Korea, Republic of); Kim, Tae Hwan [Dept. of Rheynmatology, Seoul Hospital, Hanyang University College of Medicine, Seoul (Korea, Republic of)

    2011-07-15

    Ankylosing spondylitis is a chronic inflammatory disorder of unknown cause that principally affects the axial skeleton. The cervical spine is also vulnerable to this disease process and the characteristic feature of cervical involvement is atlantoaxial subluxation. However, only a few cases of atlantoaxial ankylosis have been reported to date. We report a case of atlantoaxial ankylosis in a patient with ankylosing spondylitis with radiologic findings incidentally detected on neck CT scans.

  3. Atlantoaxial Ankylosis Detected on Neck CT Scans in a Patient with Ankylosing Spondylitis: A Case Report

    International Nuclear Information System (INIS)

    Lee, Jeong Ah; Lee, Seung Hun; Joo, Kyung Bin; Ryu, Jeong Ah; Kim, Tae Hwan

    2011-01-01

    Ankylosing spondylitis is a chronic inflammatory disorder of unknown cause that principally affects the axial skeleton. The cervical spine is also vulnerable to this disease process and the characteristic feature of cervical involvement is atlantoaxial subluxation. However, only a few cases of atlantoaxial ankylosis have been reported to date. We report a case of atlantoaxial ankylosis in a patient with ankylosing spondylitis with radiologic findings incidentally detected on neck CT scans.

  4. The relationship between inflammation and new bone formation in patients with ankylosing spondylitis.

    Science.gov (United States)

    Baraliakos, Xenofon; Listing, Joachim; Rudwaleit, Martin; Sieper, Joachim; Braun, Juergen

    2008-01-01

    Spinal inflammation as detected by magnetic resonance imaging and new bone formation as identified by conventional radiographs are characteristic of ankylosing spondylitis. Whether and how spondylitis and syndesmophyte formation are linked are unclear. Our objective was to investigate whether and how spinal inflammation are associated with new bone formation in ankylosing spondylitis. Spinal magnetic resonance images and conventional radiographs from 39 ankylosing spondylitis patients treated with anti-tumour necrosis factor (anti-TNF) agents at baseline and after 2 years were analysed for syndesmophyte formation at vertebral edges with or without inflammatory lesions at baseline. Overall, 922 vertebral edges at the cervical and lumbar spine were analysed. At baseline, the proportion of vertebral edges with and without inflammation (magnetic resonance imaging) that showed structural changes (conventional radiographs) was similar (in total, 16.6% of all vertebral edges in 71.4% of patients). From the perspective of syndesmophyte formation (n = 26, 2.9%) after 2 years, there were more vertebral edges without (62%) than with (38%) inflammation at baseline (P = 0.03). From the perspective of spinal inflammation at baseline (n = 153 vertebral edges), more syndesmophytes developed at vertebral edges with (6.5%) than without (2.1%) inflammation (P = 0.002, odds ratio 3.3, 95% confidence interval 1.5 to 7.4). Inflammation persisted in 31% of the initially inflamed vertebral edges (n = 132), and new lesions developed in 8% of the vertebral edges without inflammation at baseline (n = 410). From the perspective of spinal inflammation after 2 years (n = 72 vertebral edges), 5.6% of the vertebral edges showed syndesmophyte development in contrast to 1.9% of the vertebral edges with new syndesmophytes without inflammation (P = 0.06). These findings obtained in patients treated with anti-TNF agents suggest linkage and some dissociation of inflammation and new bone formation in

  5. [Effects of balneotherapy on the reactants of acute inflammation phase in ankylosing spondylitis].

    Science.gov (United States)

    2009-01-01

    Ankylosing spondylitis (AS) is a chronic inflammatory disease that affects sacroiliac joints, spinal column and peripheral joints. Beside medication therapy, physical and balneotherapy play an important role in its complex treatment. The aim of the research was to establish serum concentrations of C-reactive protein (CRP), alpha 1-acid glycoprotein (alpha 1-AGP), ceruloplasmine (CP) and erythrocyte sedimentation rate (SE) before and after the balneotherapy in ankylosing spondylitis. The research included 50 AS patients according to the revised New York criteria, of mean age 43 years, who were treated for 14 days on the average at the Clinic for Rheumatology of the Institute "Niska Banja". All the patients received medications and balneotherapy (radioactive oligomineral baths, peloid, massage, kinesitherapy); the serum concentrations of CRP, al-AGP, CP and SE were measured before and after balneotherapy. Serum proteins were determined using original Nor Partigen plates Boehringer. Erythrocyte sedimentation rate was measured by Westergreen method. Balneotherapy was applied individually, intensively or mildly, depending on the AS stage and activity phase. After dosed balneotherapy, a significant decrease in the concentrations of CP (p balneotherapy efficiency in the treatment of ankylosing spondylitis.

  6. Long-term clinical investigation of patients with ankylosing spondylitis treated with /sup 224/Ra

    Energy Technology Data Exchange (ETDEWEB)

    Schmitt, E [Universitatsklinik Friedrichsheim, Frankfurt, West Germany; Ruckbeil, C; Wick, R R

    1983-01-01

    Between 1952 and 1980 about 250 patients with ankylosing spondylitis were treated with /sup 224/Ra at the Orthopaedic University Hospital of Frankfurt/M. In 1970, 119 of them were examined and X-rayed as was another group of 40 patients in 1980. The results of those examined could be compared with a group of 40 patients treated without /sup 224/Ra. Patients with /sup 224/Ra demonstrated a long-lasting period of subjective improvement after the treatment, with reduced consumption of antirheumatoid and analgesic drugs, on the average. Blood examinations show inflammatory activities. Nevertheless, the ankylosing spondylitis proceeded. In the final stages of the disease, neither the clinical aspects nor the X-rays showed any specific changes. We observed no case of malignant bone tumor. Of the 169 examined patients, 22 had a total of 32 children after the treatment with /sup 224/Ra. Among these was a set of twins with cerebral palsy and diabetes insipidus renalis. In conclusion, /sup 224/Ra in ankylosing spondylitis is a recommended treatment without higher risk compared to the common therapy with drugs.

  7. Hypoparathyroidism in a patient with systemic lupus erythematosus coexisted with ankylosing spondylitis: a case report and review of literature.

    Science.gov (United States)

    Jiang, Lindi; Dai, Xiaomin; Liu, Jun; Ma, Lili; Yu, Fei

    2010-12-01

    Hypoparathyroidism is rare in patients with systemic lupus erythematosus (SLE). Here we describe a case of SLE coexisted with hypoparathyroidism and ankylosing spondylitis with definite diagnosis, and also give a review of past five cases of SLE with hypoparathyroidism. We find that hypoparathyroidism is easily ignored by subtle manifestations despite of its significant complications. More attention should be paid to clues to hypocalcemia, symptoms of central nervous system and prolonged QT interval on electrocardiogram. The three diseases may be coexistent of genetically determined markers. The cause of hypoparathyroidism in SLE patient is not clear. It may be independent of SLE. Copyright © 2010 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

  8. Critical appraisal of the guidelines for the management of ankylosing spondylitis: disease-modifying antirheumatic drugs.

    Science.gov (United States)

    Soriano, Enrique R; Clegg, Daniel O; Lisse, Jeffrey R

    2012-05-01

    Surprisingly, little data are available for the use of disease-modifying antirheumatic drugs in ankylosing spondylitis. Sulfasalazine has been the best studied. Efficacy data for individual agents (including pamidronate) and combinations of agents are detailed in this review. Intriguingly, these agents continue to be used with some frequency, even in the absence of efficacy data. To answer these questions, additional systematic studies of these agents in ankylosing spondylitis are needed and will likely need to be done by interested collaborative groups such as SPARTAN.

  9. Ankylosing spondylitis: a case report with review of literature ...

    African Journals Online (AJOL)

    Materials and Methods: A case report of a 60 year old Libyan male who has Ankylosing spondylitis and then review the available literature. Results: The patient has been having a chronic low back pain and stiffness for the last 26 years. His symptoms are most severe in morning and improve with movement. He developed ...

  10. Safety of Etoricoxib, Celecoxib, and Nonselective Nonsteroidal Antiinflammatory Drugs in Ankylosing Spondylitis and Other Spondyloarthritis Patients

    DEFF Research Database (Denmark)

    Kristensen, L E; Jakobsen, A K; Askling, J

    2015-01-01

    OBJECTIVE: Safety data regarding the use of etoricoxib and other nonsteroidal antiinflammatory drugs (NSAIDs) in ankylosing spondylitis (AS) and other spondyloarthritis (SpA) patients are rather limited. Our objective was to estimate and compare rates of gastrointestinal, renovascular, and cardio......OBJECTIVE: Safety data regarding the use of etoricoxib and other nonsteroidal antiinflammatory drugs (NSAIDs) in ankylosing spondylitis (AS) and other spondyloarthritis (SpA) patients are rather limited. Our objective was to estimate and compare rates of gastrointestinal, renovascular...

  11. A rare cause of dysphagia: compression of the esophagus by an anterior cervical osteophyte due to ankylosing spondylitis.

    Science.gov (United States)

    Albayrak, Ilknur; Bağcacı, Sinan; Sallı, Ali; Kucuksen, Sami; Uğurlu, Hatice

    2013-09-01

    Ankylosing spondylitis (AS) is a chronic inflammatory rheumatological disease affecting the axial skeleton with various extra-articular complications. Dysphagia due to a giant anterior osteophyte of the cervical spine in AS is extremely rare. We present a 48-year-old male with AS suffering from progressive dysphagia to soft foods and liquids. Esophagography showed an anterior osteophyte at C5-C6 resulting in esophageal compression. The patient refused surgical resection of the osteophyte and received conservative therapy. However, after 6 months there was no improvement in dysphagia. This case illustrates that a large cervical osteophyte may be the cause of dysphagia in patients with AS and should be included in the diagnostic workup in early stages of the disease.

  12. Delayed treatment with ADAMTS13 ameliorates cerebral ischemic injury without hemorrhagic complication.

    Science.gov (United States)

    Nakano, Takafumi; Irie, Keiichi; Hayakawa, Kazuhide; Sano, Kazunori; Nakamura, Yoshihiko; Tanaka, Masayoshi; Yamashita, Yuta; Satho, Tomomitsu; Fujioka, Masayuki; Muroi, Carl; Matsuo, Koichi; Ishikura, Hiroyasu; Futagami, Kojiro; Mishima, Kenichi

    2015-10-22

    Tissue plasminogen activator (tPA) is the only approved therapy for acute ischemic stroke. However, delayed tPA treatment increases the risk of cerebral hemorrhage and can result in exacerbation of nerve injury. ADAMTS13, a von Willebrand factor (VWF) cleaving protease, has a protective effect against ischemic brain injury and may reduce bleeding risk by cleaving VWF. We examined whether ADAMTS13 has a longer therapeutic time window in ischemic stroke than tPA in mice subjected to middle cerebral artery occlusion (MCAO). ADAMTS13 (0.1mg/kg) or tPA (10mg/kg) was administered i.v., immediately after reperfusion of after 2-h or 4-h MCAO for comparison of the therapeutic time windows in ischemic stroke. Infarct volume, hemorrhagic volume, plasma high-mobility group box1 (HMGB1) levels and cerebral blood flow were measured 24h after MCAO. Both ADAMTS13 and tPA improved the infarct volume without hemorrhagic complications in 2-h MCAO mice. On the other hand, ADAMTS13 reduced the infarct volume and plasma HMGB1 levels, and improved cerebral blood flow without hemorrhagic complications in 4-h MCAO mice, but tPA was not effective and these animals showed massive intracerebral hemorrhage. These results indicated that ADAMTS13 has a longer therapeutic time window in ischemic stroke than tPA, and ADAMTS13 may be useful as a new therapeutic agent for ischemic stroke. Copyright © 2015 Elsevier B.V. All rights reserved.

  13. Quantitative scintigraphy of the sacroiliac joints and spinal column in patients with probable form of ankylosing spondylitis

    International Nuclear Information System (INIS)

    Mlychkov, Kh.; Andreev, T.

    1983-01-01

    Quantitative scintigraphy with sup(99m)Tc-pyrophos--phate was performed in 103 patients with probable form of ankylosing spondylitis and in a control group of 104 healthy individuals. Sacroiliac and spino-sacral indexes were determined in the patients by comparing small zones of interest of the spinal column, sacroiliac joints and the sacrum. A total of 634 indexes were determined: 293 in patients with probable form of ankylosing spondylitis and 341 in the control group of normal individuals. Comparison of the sacroiliac and spino-sacral indexes in the two groups showed that these indexes were raised in patients with probable form of ankylosing spondylitis, in contrast to the control group. The difference was statistically significant with a high level of significance (p 10 /sacrum and L 4 /sacrum. The difference between the C 7 /sacrum indexes in both groups of individuals had low significance level P=0.04. Repeated check up of patients with probable form of ankylosing spondylitis over a period of 2 to 5 years revealed that in the course of time the obligatory criteria for making a reliable diagnosis had been fulfilled in 15 patients. This is a proof of the high diagnostic value of quantitative scintigraphy of the sacroiliac joints and the spinal column. (authors)

  14. Significance of Plain Radiography of the Pelvis for the Diagnosis of Ankylosing Spondylitis in Clinical Practice

    Directory of Open Access Journals (Sweden)

    А.V. Smirnov

    2015-08-01

    Full Text Available Diagnosis of ankylosing spondylitis is based on characteristic clinical picture of the disease and mandatory identification of sacroiliitis on pelvis X-ray. However, case reports of the radiographic stages of sacroiliac joint disorder available in literature are less informative and often lead to misinterpretation of radiographic changes. Based on many years of experience, the authors present the extended explanations of standard radiographic stages of sacroiliitis and other radiological signs that can facilitate diagnostic search in ankylosing spondylitis.

  15. Reproducibility of the Bath Ankylosing Spondylitis Indices of disease activity (BASDAI), functional status (BASFI) and overall well-being (BAS-G) in anti-tumour necrosis factor-treated spondyloarthropathy patients

    DEFF Research Database (Denmark)

    Madsen, Ole R; Rytter, Anne; Hansen, Lonnie B

    2010-01-01

    The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Function Index (BASFI) and the Bath Ankylosing Spondylitis Global Score (BAS-G) (ranges 0-10) have gained widespread in use as self-reported measures of disease activity, functional impairment and ove...

  16. Potential Long-Term Complications of Endovascular Stent Grafting for Blunt Thoracic Aortic Injury

    Directory of Open Access Journals (Sweden)

    Larry E. Miller

    2012-01-01

    Full Text Available Blunt thoracic aortic injury (BTAI is a rare, but lethal, consequence of rapid deceleration events. Most victims of BTAI die at the scene of the accident. Of those who arrive to the hospital alive, expedient aortic intervention significantly improves survival. Thoracic endovascular aortic repair (TEVAR has been accepted as the standard of care for BTAI at many centers, primarily due to the convincing evidence of lower mortality and morbidity in comparison to open surgery. However, less attention has been given to potential long-term complications of TEVAR for BTAI. This paper focuses on these complications, which include progressive aortic expansion with aging, inadequate stent graft characteristics, device durability concerns, long-term radiation exposure concerns from follow-up computed tomography scans, and the potential for (Victims of Modern Imaging Technology VOMIT.

  17. Comparative evaluation of the quantitative bone scintigraphy and the radiography in patients with ankylosing spondylitis

    International Nuclear Information System (INIS)

    Mlychkov, Kh.; Mlychkova, D.

    1989-01-01

    In 620 patients quantitative bone scintigraphy with 99m Tc pyrophosphate of the sacroiliac joints and of the spine was performed: 365 patients with confirmed ankylosing spondylitis, 125 patients with clinical radiological suspicion for ankylosing spondylitis (probable Bechterev) and control group of 130 healthy individuals. By comparison of the activity in zones of interest of the sacroiliac joints, the spine and sacrum, the following indices were determined: sacroiliac (separately for the left and right sacroiliac joints), index D 10 /sacrum, index L 4 /sacrum and index C 7 /sacrum. The scintigraphic finding was compared to the X-ray one and to the radiological stage of the disease. A long-term follow-up of the patients was carried out during 1-6 years with scintigraphic, X-ray and clinical investigations. Emphasis was laid upon the posibilities for quantitative scintigraphy for early diagnostics of ankylosing spondylitis. The combination of scintigraphic with X-ray investigation improved the posibilities for establishment of a more precise diagnosis of the disease and check up of its evolution

  18. PICTORIAL ESSAY Bamboo spine – X-ray findings of ankylosing ...

    African Journals Online (AJOL)

    Pathology and imaging characteris- tics. In this pictorial essay, we focus on the characteristic axial skeleton imaging findings of AS, as it presents on conventional X-ray:1. • florid anterior spondylitis (Romanus lesions). • florid diskitis (Andersson lesions). Ankylosing spondylitis is a debilitating disease that is one of the sero-.

  19. Comparative analysis of inflammatory complications after firearm injuries of the cerebrum in two clinics with different surgical behaviours

    International Nuclear Information System (INIS)

    Panov, Y.; Guergueltchev, N.

    2008-01-01

    Injuries in the cerebrum caused by firearm shots are found to be more and more in our everyday life. The mortality rate is high (40 - 90 %) regardless of the differences in the therapy applied according to the viewpoints of the surgeons. The valuation of the results is contradictory due to the difficulties to set up systematized groups for these appraisals. Some of the severe complications, which aggravate the process of recovery on the days after the trauma, are the suppurations of the wounds and the purulent meningoencephalitis. The aim of this study is to compare the inflammatory complications after injuries caused by firearm shots in the head according to their type and severity in two clinics with different surgical behaviour. The study involved 30 patients in the Clinic of Emergency Neurosurgery at the Military Medical Academy in Sofia, Bulgaria, during a 7-year period, and 11 patients hospitalized at the Clinic of Neurosurgery in the city of Tours, France, during a 3-year period. At the group of the Military Medical Academy suppuration of the wounds was found in 2 patients without development of cerebral infection. At the Neurosurgical Clinic in Tours, France, 4 patients developed meningoencephalitis and three died (p<0.001). The comparative analysis gives grounds to draw a conclusion that the inflammatory complications of the cerebrum after gunshot injuries have a direct relation to the operative procedure. In order to avert these complications, it is necessary to have aggressive surgical behaviour: elimination of devitalized soft tissues, craniectomy around the inlet and outlet openings, revision of the brain wound in depth of 3-4 cm and hermetic closure of the dura. (authors)

  20. Ankylosant spondylitis association and diffuse idiopathic skeletal hyperostosis (DISH)

    International Nuclear Information System (INIS)

    Medina, Yimi; Restrepo Suarez, Jose Felix; Calvo Paramo, Enrique

    2000-01-01

    We are presenting a 66 year-old patient complaining of low back pain for the last 3 months and cervical pain for the last 45 days, Review of systems showed long standing lumbar and cervical stiffness, Radiological studies were compatible with ankylosing spondylitis and DISH (Diffuse idiopathic Skeletal Hyperostosis). Associations of those diseases are uncommon and reported only few times in the literature

  1. The role of MRI in early ankylosing spondylitis: emphasis on the sacroiliac and hip joints

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Chul Min; Kang, Moo Song; Kim, Chang Soo; Chung, Chun Phil [Maryknoll Hospital, Busan (Korea, Republic of)

    1995-05-15

    In clinically suspected ankylosing spondylitis of sacroiliac (SIJ) and hip joints with normal or minimal secondary bone change in simple X-ray films, we evaluated the role of MRI in sacroiliac and hip joints. Authors evaluated 11 cases (36 joints; SIJ 14 hip 22) confirmed as ankylosing spondylitis by clinical, laboratory, and radiologic findings, and compared the detectability of involvement of joints by simple X-ray film and MRI. Authors analysed MR findings for the presence of pannus and its signal intensities (SI), change of articular cartilage, bony erosion and sclerosis, subchondral bone cysts, osteophytosis, bone marrow edema, joint effusion, adjacent soft tissue change, and contrast enhancement of pannus. MRI detected not only 20 joints (SIJ 11, hip 9) detected in simple X-ray, but also additional 7 joints (SIJ 3, hip 4). MRI depicted simultaneous involvement of SIJ and hip joints in 5 of 11 cases (SIJ 10 joints, hip 9 joints), and bilateral involvement of SIJ and hip joints in 4 among the 5 cases. MRI also demonstrated pannus, which were not detected in conventional films, as intermediate SI on T1WI and high SI on T2WI, in all 27 joints (SIJ 14, hip 13). Gd-DTPA enhanced T1WI revealed enhancement of pannus in 7 cases (17 joints). MRI was a valuable modality in evaluation of clinically suspected ankylosing spondylitis of SIJ or hip joints with normal or minimal secondary bone change in simple X-ray. Simultaneous evaluation of SIJ and hip joints is suggested in clinically suspected ankylosing spondylitis or other joint diseases.

  2. Is magnetotherapy applied to bilateral hips effective in ankylosing spondylitis patients? A randomized, double-blind, controlled study.

    Science.gov (United States)

    Turan, Yasemin; Bayraktar, Kevser; Kahvecioglu, Fatih; Tastaban, Engin; Aydin, Elif; Kurt Omurlu, Imran; Berkit, Isil Karatas

    2014-03-01

    This double-blind, randomized controlled study was conducted with the aim to investigate the effect of magnetic field therapy applied to the hip region on clinical and functional status in ankylosing spondylitis (AS) patients. Patients with AS (n = 66) who were diagnosed according to modified New York criteria were enrolled in this study. Patients were randomly divided in two groups. Participants were randomly assigned to receive magnetic field therapy (2 Hz) (n = 35), or placebo magnetic field therapy (n = 31) each hip region for 20 min. Patients in each group were given heat pack and short-wave treatments applied to bilateral hip regions. Both groups had articular range of motion and stretching exercises and strengthening exercises for surrounding muscles for the hip region as well as breathing and postural exercises by the same physical therapist. These treatment protocols were continued for a total of 15 sessions (1 session per day), and patients were examined by the same physician at months 1, 3 and 6. Visual analogue scale (VAS) pain, VAS fatigue, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Metrologic Index (BASMI), DFI, Harris hip assessment index and Ankylosing Spondylitis Quality of Life scale (ASQOL) were obtained at the beginning of therapy and at month 1, month 3 and month 6 for each patient. There were no significant differences between groups in the VAS pain, VAS fatigue, morning stiffness, BASDAI, BASFI, BASMI, DFI, Harris hip assessment index and ASQoL at baseline, month 1, month 3 or month 6 (p > 0.05). Further randomized, double-blind controlled studies are needed in order to establish the evidence level for the efficacy of modalities with known analgesic and anti-inflammatory action such as magnetotherapy, particularly in rheumatic disorders associated with chronic pain.

  3. Bamboo spine – X-ray findings of ankylosing spondylitis revisited ...

    African Journals Online (AJOL)

    Ankylosing spondylitis is a debilitating disease that is one of the seronegative spondylarthropathies, affecting more males than females in the proportion of about 6:1 in the age group 15 - 35 years of age. Early radiographic findings include bilateral sacro-iliitis and early axial (lower lumbar spine) ankylosis. Typical X-ray ...

  4. Clinical factors associated with intracranial complications after pediatric traumatic head injury: an observational study of children submitted to a neurosurgical referral unit

    DEFF Research Database (Denmark)

    Åstrand, Ramona Alice; Undén, Johan; Hesselgard, Karin

    2010-01-01

    Clinically validated guidelines for the management of head injury in children do not exist, and the treatment is often based upon adult management routines. In order to examine the safety of this procedure, an analysis of clinical factors associated with complications after pediatric head injury ...

  5. Clinical factors associated with intracranial complications after pediatric traumatic head injury: an observational study of children submitted to a neurosurgical referral unit

    DEFF Research Database (Denmark)

    Åstrand, Ramona Alice; Undén, Johan; Hesselgard, Karin

    2010-01-01

    Clinically validated guidelines for the management of head injury in children do not exist, and the treatment is often based upon adult management routines. In order to examine the safety of this procedure, an analysis of clinical factors associated with complications after pediatric head injury...

  6. Paroxysmal supraventricular tachycardia and Wolff-Parkinson-White syndrome in ankylosing spondylitis: a large cohort observation study and literature review.

    Science.gov (United States)

    Ho, Huei-Huang; Yeh, San-Jou; Tsai, Wen-Pin; Wang, Chin-Man; Chen, Ji Yih

    2012-12-01

    To investigate the associations of paroxysmal supraventricular tachycardia (PSVT) and Wolff-Parkinson-White (WPW) syndrome with ankylosing spondylitis (AS). We conducted a retrospective cohort study by reviewing the medical records of 1503 consecutive AS patients diagnosed at a tertiary medical center. The clinical and electrocardiographic (ECG) characteristics of 641 AS patients having 12-lead ECG available were further analyzed in a precise manner. Among the 641 AS patients with 12-lead ECG available for detecting cardiac abnormalities, 14 were identified as having PSVT, including 3 with WPW syndrome and 1 having a WPW (ventricular preexcitation) ECG pattern. A higher proportion of AS patients presented with PSVT (21.8/1000) compared with a general population-based study (2.25/1000). Also, AS patients demonstrated a higher prevalence of WPW syndrome or WPW pattern (6.24/1000) than found in general population-based studies (0.9 to 1.5/1000). Ankylosing spondylitis patients with PSVT or WPW syndrome had significantly higher rates of peripheral arthritis (78.6%; P = 0.002), acute anterior uveitis (64.3%; P = 0.003), bamboo spine (64.3%; P = 0.001), and other cardiovascular disorders (85.7%; P syndrome. Detailed ECG and electrophysiological examinations are required for early detection of PSVT and WPW syndrome for prompt resolution of potentially life-threatening complications in all AS patients, especially those presenting with the symptoms of palpitation, dizziness, dyspnea, or syncope. Copyright © 2012 Elsevier Inc. All rights reserved.

  7. Rationale for methods of prevention and treatment of toxic infections complications of combined radiation and thermal injuries

    International Nuclear Information System (INIS)

    Bodugov, R.S.; Nesterenko, V.S.; Makarov, G.F.; Ul'yanova, L.P.; Khlopovskaya, E.I.

    1992-01-01

    Analysis of the results of experimental studies on the pathogenesis of combined radiation and thermal injuries (CRTI) helped single out the factors aggravating the outcomes of such injuries. Potentiation of the hepatotoxic effects of bacterial enteroendotoxicosis and early toxemia associated with burns is the principal factor augmenting the disorders in the reactivity of radiosensitive systems in CRTI. The authors' findings evidence the efficacy of enterosorption, of methods enhancing the gastrointestinal motoricity, and of a number of modifiers of biologic reactions and heterologous immunoglobulins for the prevention and treatment of toxic infectious complications of CRTI

  8. The effect of balneotherapy on patients with ankylosing spondylitis.

    Science.gov (United States)

    Altan, L; Bingöl, U; Aslan, M; Yurtkuran, M

    2006-01-01

    To compare the effect of balneotherapy on physical activity and quality of life as well as the symptoms of pain and stiffness with exercise alone in ankylosing spondylitis (AS) patients. A total of 60 patients who had a diagnosis of AS according to the modified New York criteria were included in the study. The patients were randomly assigned to two groups. In Group I (n = 30) the patients received balneotherapy in a therapeutic pool for 30 min once a day for 3 weeks. All patients received instructions on the exercise programme, which they were requested to repeat once a day for 30 min during the study. The patients in this group continued the same exercise programme after the end of the balneotherapy protocol to complete a course of 6 months. In Group II the patients were given the same exercise protocol but did not receive balneotherapy. Patients were evaluated before the start of the study and at 3 weeks and 24 weeks. Evaluation parameters were daily and night pain, morning stiffness, the patient's global evaluation and the physician's global evaluation (according to a scoring system of 1 to 5), the Bath Ankylosing Spondilitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Dougados Functional Index (DFI), tragus-wall distance, chest expansion, modified Shober test (MST), fingertip-fibula head distance, and Nottingham Health Profile (NHP). Evaluations were completed in 54 patients in the two groups. Comparison of the groups showed significantly superior results for Group I for parameters of BASDAI, NHP total, pain, physical activity, tiredness and sleep score, patient's global evaluation and the physician's global evaluation at 3 weeks, but only for the parameters of patient's global evaluation and MST at 24 weeks. Balneotherapy has a supplementary effect on improvement in disease activity and functional parameters in AS patients immediately after the treatment period. However, in the light of our medium-term evaluation

  9. Tube Thoracostomy: Complications and Its Management

    Directory of Open Access Journals (Sweden)

    Emeka B. Kesieme

    2012-01-01

    Full Text Available Background. Tube thoracostomy is widely used throughout the medical, surgical, and critical care specialities. It is generally used to drain pleural collections either as elective or emergency. Complications resulting from tube thoracostomy can occasionally be life threatening. Aim. To present an update on the complications and management of complications of tube thoracostomy. Methods. A review of the publications obtained from Medline search, medical libraries, and Google on tube thoracostomy and its complications was done. Results. Tube thoracostomy is a common surgical procedure which can be performed by either the blunt dissection technique or the trocar technique. Complication rates are increased by the trocar technique. These complications have been broadly classified as either technical or infective. Technical causes include tube malposition, blocked drain, chest drain dislodgement, reexpansion pulmonary edema, subcutaneous emphysema, nerve injuries, cardiac and vascular injuries, oesophageal injuries, residual/postextubation pneumothorax, fistulae, tumor recurrence at insertion site, herniation through the site of thoracostomy, chylothorax, and cardiac dysrhythmias. Infective complications include empyema and surgical site infection. Conclusion. Tube thoracostomy, though commonly performed is not without risk. Blunt dissection technique has lower risk of complications and is hence recommended.

  10. Tube Thoracostomy: Complications and Its Management

    Science.gov (United States)

    Kesieme, Emeka B.; Dongo, Andrew; Ezemba, Ndubueze; Irekpita, Eshiobo; Jebbin, Nze; Kesieme, Chinenye

    2012-01-01

    Background. Tube thoracostomy is widely used throughout the medical, surgical, and critical care specialities. It is generally used to drain pleural collections either as elective or emergency. Complications resulting from tube thoracostomy can occasionally be life threatening. Aim. To present an update on the complications and management of complications of tube thoracostomy. Methods. A review of the publications obtained from Medline search, medical libraries, and Google on tube thoracostomy and its complications was done. Results. Tube thoracostomy is a common surgical procedure which can be performed by either the blunt dissection technique or the trocar technique. Complication rates are increased by the trocar technique. These complications have been broadly classified as either technical or infective. Technical causes include tube malposition, blocked drain, chest drain dislodgement, reexpansion pulmonary edema, subcutaneous emphysema, nerve injuries, cardiac and vascular injuries, oesophageal injuries, residual/postextubation pneumothorax, fistulae, tumor recurrence at insertion site, herniation through the site of thoracostomy, chylothorax, and cardiac dysrhythmias. Infective complications include empyema and surgical site infection. Conclusion. Tube thoracostomy, though commonly performed is not without risk. Blunt dissection technique has lower risk of complications and is hence recommended. PMID:22028963

  11. Sugammadex use in difficult intubation due to ankylosing spondylitis and severe restrictive respiratory disease

    Directory of Open Access Journals (Sweden)

    Yakup Tomak

    2012-09-01

    Full Text Available We describe anesthesia management of a 50-year-old man scheduled for thoracic spinal reconstruction, presenting with severe restrictive respiratory disease and difficult airway due to ankylosing spondilitis. The patient was unable to extend his head, had difficulty in breathing and sleeping in supine position due to thoracal deformities. The patient was intubated using intubating laryngeal mask airway to overcome the difficulties of limited mouth opening and head extension. He was extubated following administration of sugammadex to obtain optimal conditions in terms of respiratory muscle function and to prevent hypersecretion and bronchospasm. J Clin Exp Invest 2012; 3 (3: 398-400Key words: Restrictive lung disease, airway management, laryngeal masks, sugammadex, ankylosing spondylitis

  12. Ankylosing Spondylitis and Pregnancy: A Literature Review.

    Science.gov (United States)

    Giovannopoulou, Eirini; Gkasdaris, Grigorios; Kapetanakis, Stylianos; Kontomanolis, Emmanuel

    2017-01-01

    Ankylosing Spondylitis (AS) is the prototype of a group of systemic rheumatic diseases collectively referred to as Spondylarthitides (SpA). It has now become clear that AS is not as rare as previously thought and, although it has an early onset in life affecting patients in their reproductive years, it has not been proved to adversely affect fertility in females. The aim of this review is to summarize all the recent data on AS and pregnancy in terms of fertility, disease course and pregnancy outcome from a clinical perspective. A literature research was conducted based on the following medical databases: Pubmed/ Medline and the Cochrane Library. We searched for randomized controlled studies, casecontrol studies, cohort studies, patient and drug registers in relation to pregnancy and AS. The existing data do not support a causal relationship between AS and infertility. The state of pregnancy is not associated with reduced disease activity in patients with AS. Additionally, AS tends to adversely affect health-related quality of life during pregnancy, in comparison with normal population and patients with rheumatoid arthritis. As far as the obstetrical outcome is concerned, there is no consensus on the significant association between AS and specific pregnancy, delivery and fetal complications. Previous studies are highly heterogenous and mainly retrospective and thus, the existing data are controversial and inconclusive. Subsequent studies are required to enlighten our knowledge on the interaction between AS and pregnancy. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  13. Vertical periodontal ligament distraction--a new method for aligning ankylosed and displaced canines.

    Science.gov (United States)

    Wilmes, Benedict; Drescher, Dieter

    2009-05-01

    In the course of a clinical pilot study we tested the vertical periodontal ligament (V-PDL) distraction as a means of aligning ankylosed upper canines. The objective of this study was to analyze the appropriateness und effectiveness of this method. The ankylosed upper canines of five female patients aged between 16 und 19 years were surgically exposed, luxated, and after a latency period of 5 to 7 days, distracted at a rate of 0.5 mm per day. The installed distractors were borne by the periodontal-mucosa, the periodontal-mucosa and the bone, or by the bone exclusively. We evaluated the distraction distance and time and degree of hard and soft tissue generation present in the region surrounding the distracted teeth. All canines were aligned after a mean distraction period of 43.2 days (+/- 3.6 days). The mean distraction distance was 10.8 mm. Three canines had defects at the cemento-enamel junction, and one canine had to be extracted due to a large defect at the root. Vertical PDL distraction is a minimally-invasive therapy to align ankylosed impacted canines. Even if the long-term prognosis of distracted canines with defects is uncertain, the patient benefits from the vertical PDL distraction because both hard and soft tissues are generated in the vicinity of the distracted canine.

  14. Coexistence of Ankylosing Spondylitis and Neurofibromatosis Type 1.

    Science.gov (United States)

    Gundogdu, Baris; Yolbas, Servet; Yildirim, Ahmet; Gonen, Murat; Koca, Suleyman Serdar

    2016-01-01

    Ankylosing spondylitis (AS) is a systemic disease primarily characterized by the inflammation of sacroiliac joints and axial skeleton. Neurofibromatosis type 1 (NF1) is a multisystem genetic disease which is characterized by cutaneous findings, most importantly café-au-lait spots and axillary freckling, by skeletal dysplasia, and by the growth of both benign and malignant nervous system neoplasms, most notably benign neurofibromas. In this case report, we present a 43-year-old male with AS and NF1.

  15. Iatrogenic burns injury complicating neonatal resuscitation ...

    African Journals Online (AJOL)

    A case of iatrogenic thermal injury in a newborn infant during resuscitation for perinatal asphyxia at a secondary health facility is described. The injury, with surface area coverage of about 4%, involved the lower limbs. This report highlights the poor newborn resuscitation skills of traditional medical practice. Un cas d'une ...

  16. [Pressure sores secondary to immobilization with cervical collar: a complication of acute cervical injury].

    Science.gov (United States)

    Molano Alvarez, Esteban; Murillo Pérez, María del Ara; Salobral Villegas, María Teresa; Domínguez Caballero, Mireia; Cuenca Solanas, Manuela; García Fuentes, Carlos

    2004-01-01

    Cervical collars are essential in the treatment of patients with suspicion or verification of acute cervical spine injury (ACSI). One of the complications of these devices is the development of pressure scores (PS). This study aims to determine its incidence in our unit, the characteristics of patients with ACSI who suffer PS due to the collar and to describe aspects related with these injuries. We include 92 patients with ACSI hospitalized more than 24 hours from January 2002 to December 2003. We analyze demographic variables, incidence, risk factors and characteristics of the PS that develop. The incidence of these lesions was 23.9%. Patients with PS presented: a higher injury severity score (ISS) (37.5 9.8 vs. 31.3 14.9), a greater percentage of catheter carriers of intracraneal pressure (ICP) (55.6% vs. 16.2%), longer time of mechanical ventilation (15.4 8.2 vs. 6.1 9) and longer stays (24.6 10.9 vs. 10 10.3), all statistically significant (pACSI, elevated ISS, monitoring of ICP, mechanical ventilation and prolonged stays is required. The occipital zone requires special attention due to the seriousness of the injuries recorded. We suggest a specific multidisciplinary protocol for this problem.

  17. Relationship of work disability between the disease activity, depression and quality of life in patients with ankylosing spondylitis.

    Science.gov (United States)

    Sağ, Sinem; Nas, Kemal; Sağ, Mustafa Serdar; Tekeoğlu, İbrahim; Kamanlı, Ayhan

    2018-02-02

    In this study, our objective was to determine the work productivity and work disability of the patients with ankylosing spondylitis (AS) and to investigate the relation of these parameters with disease activity, anxiety, depression and quality of life. Fifty patients with the diagnosis of AS and 30 healthy control were included in the study. In patients with AS, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was used to evaluate the disease activity; Bath Ankylosing Spondylitis Metrology Index (BASMI) was used to evaluate the spinal mobility and Bath Ankylosing Spondylitis Functional Index (BASFI) was used to determine the functional status. In addition, the Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire and The Short Form (SF-36) Health Survey was used to evaluate the health status, Hospital Anxiety and Depression Scale (HADS) was used for the evaluation of depression and anxiety and Work Productivity and Activity Impairment Questionnaire: Specific Health Problem v2.0 (WPAI:SHP) was used to evaluate the work productivity. In AS patients duration of disease at the diagnosis was 7.24 ± 6.23 years. The time lost at work due to the disease, decrease in the work productivity and impairment in the time off daily activities were worse in the patient group compared with the control group (pwork productivity was correlated with BASDAI and depression; difficulty in time-off activities was correlated with BASFI and anxiety and depression was correlated with BASDAI (pwork productivity was correlated with the subparameter vitality in SF-36, difficulty in time off activities was correlated with general health status, social functions, vitality and mental health (pworking conditions and the factors related to the disease had a significant correlation with work productivity. Factors related to the psychology and the disease were also correlated with the working conditions.

  18. MAGNETIC RESONANCE IMAGING DIAGNOSIS OF INFLAMMATORY CHANGES OF THE AXIAL SKELETON IN ANKYLOSING SPONDYLITIS

    Directory of Open Access Journals (Sweden)

    A. V. Smirnov

    2016-01-01

    Full Text Available As of now, magnetic resonance imaging (MRI ranks high in the early diagnosis of inflammatory changes in the musculoskeletal system. The uniqueness of MRI is that this diagnostic technique can detect the signs of active and inactive inflammation at the pre-radiological stage of the disease, i.e. before the onset of radiological symptoms of sacroiliitis and the formation of spinal syndesmophytes. At the same time there is evidence that there is a temporary association between active inflammation and the development of radiological changes in the joints.The detection of bone marrow edema in the subchondral portions of bone tissue is of great importance not only for diagnosing the disease and verifying inflammatory activity, but also for predicting the development of chronic arthritis, choosing a treatment option, and evaluating the efficiency of performed therapy.Based on their long-term experience, the authors provided explanations of the MRI pattern of active and inactive chronic sacroiliitis and spondylitis, which can considerably facilitate the early diagnosis of injury to the sacroiliac joints and vertebral column in patients with ankylosing spondylitis.

  19. Coexistence of Ankylosing Spondylitis and Neurofibromatosis Type 1

    Directory of Open Access Journals (Sweden)

    Baris Gundogdu

    2016-01-01

    Full Text Available Ankylosing spondylitis (AS is a systemic disease primarily characterized by the inflammation of sacroiliac joints and axial skeleton. Neurofibromatosis type 1 (NF1 is a multisystem genetic disease which is characterized by cutaneous findings, most importantly café-au-lait spots and axillary freckling, by skeletal dysplasia, and by the growth of both benign and malignant nervous system neoplasms, most notably benign neurofibromas. In this case report, we present a 43-year-old male with AS and NF1.

  20. Clinical and statistical analysis of traumatic injuries of the maxillofacial region and its complications on materials of the Department of Maxillofacial Surgery from 2008 till 2012

    Directory of Open Access Journals (Sweden)

    Lepilin A.V. Bakhteeva G.R.

    2013-09-01

    The ratio of male and female patients during the study period did not change (men 89%, women — 11 %. Single fractures that do not require surgical treatment were dominated. Operating activities during the study period of fracture increased. For 5 years, the number of complications of traumatic injuries remained the same. Conclusion. Statistical analysis of traumatic injuries of the maxillofacial region shows that the average age of the patients decreased by almost 5 years, reduced average hospital stay. Most of the patients were admitted to the profile department in the early period (up to 3 days after preparation, but 21.6% of the patients were received only with the development of complications. The article concludes that there is a need to find new methods of diagnosis, treatment and prevention of complications of traumatic injuries.

  1. Golimumab for the treatment of ankylosing spondylitis : a NICE single technology appraisal

    NARCIS (Netherlands)

    Armstrong, Nigel; Joore, Manuela; van Asselt, Thea; Misso, Kate; Manning, Nathan; Tomini, Florian; Kleijnen, Jos; Riemsma, Rob

    As part of the National Institute for Health and Clinical Excellence (NICE) single technology appraisal (STA) process, the Evidence Review Group (ERG) produced a report to comment on the clinical and cost effectiveness of golimumab (Simponi(®), Merck Sharp & Dohme) for the treatment of ankylosing

  2. Lack of association of the G22A polymorphism of the ADA gene in patients with ankylosing spondylitis.

    Science.gov (United States)

    Camargo, U; Toledo, R A; Cintra, J R; Nunes, D P T; Acayaba de Toledo, R; Brandão de Mattos, C C; Mattos, L C

    2012-05-07

    Genes located outside the HLA region (6p21) have been considered as candidates for susceptibility to ankylosing spondylitis. We tested the hypothesis that the G22A polymorphism of the adenosine deaminase gene (ADA; 20q13.11) is associated with ankylosing spondylitis in 166 Brazilian subjects genotyped for the HLA*27 gene (47 patients and 119 controls matched for gender, age and geographic origin). The HLA-B*27 gene and the G22A ADA polymorphism were identified by PCR with sequence-specific oligonucleotide probes and PCR-RFLP, respectively. There were no significant differences in frequencies of ADA genotypes [odds ratio (OR) = 1.200, 95% confidence interval (CI) = 0.3102-4.643, P > 0.8] and ADA*01 and ADA*02 alleles (OR = 1.192, 95%CI = 0.3155-4.505, P > 0.8) in patients versus controls. We conclude that the G22A polymorphism is not associated with ankylosing spondylitis.

  3. Temporo-mandibular joint disease in ankylosing spondylitis.

    Science.gov (United States)

    Davidson, C; Wojtulewski, J A; Bacon, P A; Winstock, D

    1975-01-01

    The occurrence of temporo-mandibular joint (TMJ) disease in ankylosing spondylitis is not widely recognized and its incidence is disputed. Seventy-nine patients attending two routine rheumatology clinics were therefore examined by dental surgeon and nine (11-5 per cent) were considered to have specific TMJ involvement. These patients were older than the remainder, and had more extensive spinal and peripheral joint disease. Symptoms were mild and the predominant clinical feature was restricted mouth opening, which could present considerable difficulties during emergency anaesthesia. Bilateral condylectomy was undertaken in one patient with some benefit. Images PMID:1124959

  4. Sexual dimorphism, but not testosterone itself, is responsible for ankylosing enthesitis of the ankle in B10.BR(H-2k) male mice

    Czech Academy of Sciences Publication Activity Database

    Čapková, Jana; Ivanyi, P.; Řeháková, Z.

    2006-01-01

    Roč. 65, č. 1 (2006), s. 130-132 ISSN 0003-4967 R&D Projects: GA ČR(CZ) GA305/03/0287 Institutional research plan: CEZ:AV0Z50520514 Keywords : ankylosing enthesopathy * ankylosing spondylitis * testosterone Subject RIV: EB - Genetics ; Molecular Biology Impact factor: 5.767, year: 2006

  5. The indirect costs of ankylosing spondylitis: a systematic review and meta-analysis.

    Science.gov (United States)

    Malinowski, Krzysztof Piotr; Kawalec, Paweł

    2015-04-01

    The aim of this systematic review was to collect and summarize all current data on the indirect costs related to absenteeism and presenteeism associated with ankylosing spondylitis. The search was conducted using Medline, Embase and Centre for Reviews and Dissemination databases. All collected costs were recalculated to average annual cost per patient, expressed in 2013 prices USD using the consumer price index and purchasing power parity. Identified studies were then analyzed to assess their possible inclusion in the meta-analysis. We identified 32 records. The average annual indirect cost per patient varies among all the identified results from US$660.95 to 45,953.87. The mean annual indirect per patient equals US$6454.76. This systematic review summarizes current data related to indirect costs generated by ankylosing spondylitis; it revealed the great economic burden of the disease for society. We observed a great variety of the considered components of indirect costs and their definitions.

  6. Understanding Quality of Life in Adults with Spinal Cord Injury Via SCI-Related Needs and Secondary Complications.

    Science.gov (United States)

    Sweet, Shane N; Noreau, Luc; Leblond, Jean; Dumont, Frédéric S

    2014-01-01

    Understanding the factors that can predict greater quality of life (QoL) is important for adults with spinal cord injury (SCI), given that they report lower levels of QoL than the general population. To build a conceptual model linking SCI-related needs, secondary complications, and QoL in adults with SCI. Prior to testing the conceptual model, we aimed to develop and evaluate the factor structure for both SCI-related needs and secondary complications. Individuals with a traumatic SCI (N = 1,137) responded to an online survey measuring 13 SCI-related needs, 13 secondary complications, and the Life Satisfaction Questionnaire to assess QoL. The SCI-related needs and secondary complications were conceptualized into factors, tested with a confirmatory factor analysis, and subsequently evaluated in a structural equation model to predict QoL. The confirmatory factor analysis supported a 2-factor model for SCI related needs, χ(2)(61, N = 1,137) = 250.40, P SCI-related needs (β = -.22 and -.20, P SCI-related needs of individuals with SCI and preventing or managing secondary complications are essential to their QoL.

  7. Spectrum of imaging findings in hyperextension injuries of the neck.

    Science.gov (United States)

    Rao, Sameet K; Wasyliw, Christopher; Nunez, Diego B

    2005-01-01

    Nonphysiologic hyperextension and lateral forces acting on the cervical spine and soft-tissue structures of the neck can result in a wide spectrum of injury patterns. Multiple factors (eg, patient age; the underlying morphologic features of the cervical spine; the magnitude, vector, and maximal focus of the force) all influence the observed patterns and the severity of injury. A review of the 5-year trauma database in two trauma centers revealed various injury patterns that were frequently recognized in patients with clinical evidence or historical documentation of a predominant hyperextension mechanism. Injuries included anterior arch avulsion and posterior arch compression fractures of the atlas, odontoid fractures, traumatic spondylolisthesis and teardrop fracture of C2, laminar and articular pillar fractures, and hyperextension dislocation injuries. More severe injuries were observed in patients with underlying predisposing conditions (eg, degenerative spondylosis, ankylosing spondylitis, diffuse idiopathic skeletal hyperostosis). Knowledge of the involved biomechanical factors provides a framework for understanding these injury patterns. Diagnostic imaging, especially computed tomography and magnetic resonance imaging, plays a fundamental role in the assessment of patients with suspected cervical injury. Furthermore, cross-sectional imaging facilitates the recognition of accompanying injuries to the face, the head, and the vascular structures of the neck. (c) RSNA, 2005.

  8. ANKYLOSING SPONDYLITIS - AN ALARMING RISK OF VENOUS THROMBOEMBOLIC DISEASE

    OpenAIRE

    Dr. Darpanarayan Hazra; Dr. Shahid Mahdi; Dr. Amit Madan; Dr. Neeraj Bhalla

    2017-01-01

    Venous thrombo-embolic disease (VTE) is a potentially life threatening clinical event. Ankylosing spondylitis (AS) is a chronic inflammatory disease with a significantly increased risk of developing VTE. Management of acute proximal deep venous thrombosis (DVT) depends on the clinical status of the affected limb, extent of the thrombus and comorbidities of the patient. Semba and Dake introduced Catheter directed thrombolysis (CDT) to treat 21 patients of DVT in 1994. CDT is a life or limb sav...

  9. Coexistence of multiple sclerosis and ankylosing spondylitis: Report of four cases from Russia and review of the literature.

    Science.gov (United States)

    Fominykh, Vera; Shevtsova, Tatyana; Arzumanian, Narine; Brylev, Lev

    2017-10-01

    Multiple sclerosis is a chronic demyelinating disorder of the central nervous system. There are many cases of multiple sclerosis - like syndrome and demyelinating disorders in systemic lupus erythematosus, Sjogren disease, Behcet disease and other autoimmune conditions. Coexistence of ankylosing spondylitis and multiple sclerosis usually is rare but in this article we report 4 Russian patients with concomitant multiple sclerosis and ankylosing spondylitis diseases. None of these patients received anti-tumor necrosis factor alpha therapy prior to diagnosis of multiple sclerosis. Pathogenesis, diagnostic and treatment challenges are discussed. Copyright © 2017 Elsevier Ltd. All rights reserved.

  10. Effects of balneotherapy on the reactants of acute inflammation phase in Ankylosing spondylitis

    Directory of Open Access Journals (Sweden)

    Stamenković Bojana

    2009-01-01

    Full Text Available Introduction. Ankylosing spondylitis (AS is a chronic inflammatory disease that affects sacroiliac joints, spinal column and peripheral joints. Beside medication therapy, physical and balneotherapy play an important role in its complex treatment. Objective. The aim of the research was to establish serum concentrations of C-reactive protein (CRP, α 1-acid glycoprotein (α 1-AGP, ceruloplasmine (CP and erythrocyte sedimentation rate (SE before and after the balneotherapy in ankylosing spondylitis. Methods. The research included 50 AS patients according to the revised New York criteria, of mean age 43 years, who were treated for 14 days on the average at the Clinic for Rheumatology of the Institute 'Niška Banja'. All the patients received medications and balneotherapy (radioactive oligomineral baths, peloid, massage, kinesitherapy; the serum concentrations of CRP, α1-AGP, CP and SE were measured before and after balneotherapy. Serum proteins were determined using original Nor Partigen plates Boehringer. Erythrocyte sedimentation rate was measured by Westergreen method. Balneotherapy was applied individually, intensively or mildly, depending on the AS stage and activity phase. Results. After dosed balneotherapy, a significant decrease in the concentrations of CP (p<0.05, α1-AGP (p<0.01 and CRP (p<0.05 was registered in the serums of AS patients. ESR was not significantly reduced. Conclusion. The research proved that α 1-acid glycoprotein, ceruloplasmine and C-reactive protein represent more sensitive inflammation markers as compared to erythrocyte sedimentation rate. The identification of acute phase reactants is important in the evaluation of dosed balneotherapy efficiency in the treatment of ankylosing spondylitis.

  11. TNF blockers inhibit spinal radiographic progression in ankylosing spondylitis by reducing disease activity

    DEFF Research Database (Denmark)

    Molnar, Christoph; Scherer, Almut; Baraliakos, Xenofon

    2018-01-01

    OBJECTIVES: To analyse the impact of tumour necrosis factor inhibitors (TNFis) on spinal radiographic progression in ankylosing spondylitis (AS). METHODS: Patients with AS in the Swiss Clinical Quality Management cohort with up to 10 years of follow-up and radiographic assessments every 2 years w...

  12. Complications of shoulder dystocia.

    Science.gov (United States)

    Dajani, Nafisa K; Magann, Everett F

    2014-06-01

    Complications of shoulder dystocia are divided into fetal and maternal. Fetal brachial plexus injury (BPI) is the most common fetal complication occurring in 4-40% of cases. BPI has also been reported in abdominal deliveries and in deliveries not complicated by shoulder dystocia. Fractures of the fetal humerus and clavicle occur in about 10.6% of cases of shoulder dystocia and usually heal with no sequel. Hypoxic ischemic brain injury is reported in 0.5-23% of cases of shoulder dystocia. The risk correlates with the duration of head-to-body delivery and is especially increased when the duration is >5 min. Fetal death is rare and is reported in 0.4% of cases. Maternal complications of shoulder dystocia include post-partum hemorrhage, vaginal lacerations, anal tears, and uterine rupture. The psychological stress impact of shoulder dystocia is under-recognized and deserves counseling prior to home discharge. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. Effect of ginkgo capsules combined with secondary preventive drugs on the endothelial injury and plaque properties of patients with hypertension complicated by carotid atherosclerosis

    Directory of Open Access Journals (Sweden)

    Wei Li

    2017-10-01

    Full Text Available Objective: To study the effect of ginkgo capsules combined with secondary preventive drugs on the endothelial injury and plaque properties of patients with hypertension complicated by carotid atherosclerosis. Methods: A total of 178 patients with hypertension complicated by carotid atherosclerosis who were treated in Chengyue Community Health Service Center of Xisaishan District Huangshi City Hubei Province between February 2015 and January 2017 were collected and randomly divided into two groups. Control group were treated with conventional secondary preventive drugs, and observation group were treated with ginkgo capsules combined with secondary preventive drugs. The differences in serum endothelial injury indexes and lipid metabolism indexes as well as carotid artery ultrasound parameters were compared between the two groups before and after treatment. Results: Before treatment, endothelial injury indexes and lipid metabolism indexes as well as carotid artery ultrasound parameters were not significantly different between two groups. After treatment, serum ET, AngⅡ, TC, LDL-C and LpA contents as well as carotid artery ultrasound parameters DS and AS levels of observation group were lower than those of control group while serum NO and HDL-C contents as well as carotid artery ultrasound parameter MLD level were higher than those of control group. Conclusion: Ginkgo capsule combined with secondary preventive drugs can effectively reduce the endothelial injury and stabilize the plaques in patients with hypertension complicated by carotid atherosclerosis.

  14. Polyarthritis flare in patient with ankylosing spondylitis treated with infliximab

    Directory of Open Access Journals (Sweden)

    E. Filippucci

    2011-06-01

    Full Text Available Over the last ten years, the treatment of seronegative spondyloarthropathies has changed dramatically with the introduction of the anti-tumor necrosis factor alpha (TNFα agents. Nevertheless, there is a growing number of studies describing several adverse reactions in patients treated with biological agents. In the present report we describe the case of a 22-year-old male patient with ankylosing spondylitis who developed a “paradoxic” adverse reaction, while receiving infliximab.

  15. [Neonatal complications related to shoulder dystocia].

    Science.gov (United States)

    Lopez, E; de Courtivron, B; Saliba, E

    2015-12-01

    To describe neonatal complications related to shoulder dystocia. This systematic evidence review is based on PubMed search, Cochrane library and experts' recommendations. The risks of brachial plexus birth injury, clavicle and humeral fracture, perinatal asphyxia, hypoxic-ischemic encephalopathy and perinatal mortality are increased after shoulder dystocia. The medical team should be able to provide neonatal resuscitation in the delivery room in case of perinatal asphyxia following shoulder dystocia, according to national and international guidelines. The initial clinical examination should search for complications such as brachial plexus birth injury or clavicle fracture. The risk of perinatal complications is increased in newborn after shoulder dystocia. The medical team should be able to manage these complications. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  16. Withdrawal from labour force due to work disability in patients with ankylosing spondylitis

    NARCIS (Netherlands)

    Boonen, A.; Chorus, A.; Miedema, H.; van der Heijde, D.; Landewé, R.; Schouten, H.; van der Tempel, H.; van der Linden, S.

    2001-01-01

    To investigate withdrawal from the labour force because of inability to work owing to ankylosing spondylitis (AS) and to determine the characteristics of patients with no job because of work disability attributable to AS. A postal questionnaire was sent to 709 patients with AS aged 16-60 years

  17. Differences in clinical presentation of ankylosing spondylitis in men and women

    Directory of Open Access Journals (Sweden)

    Hossain Soleymani Salehabadi

    2016-10-01

    Full Text Available Background: Ankylosing spondylitis (AS is an inflammatory disease that mainly affects axial skeleton of the body and ankylosing spondylitis ligaments around the spine at the junction of the spine are inflamed, because the disease is progressive and can lead to significantly cause of disability and the studies could provide a mechanism for the early detection of the disease or help determine when to start treatment, the difference in clinical presentations of AS in men and women is indicative of potential effect of gender on severity of the disease. This study was conducted with the aim to investigate the effect of gender on severity of AS. Methods: In a cross-sectional study, one hundred and fifteen patients with ankylosing spondylitis who referred to Yazd Rheumatology Clinic between 2001 and 2013 were evaluated. Sampling was performed using non-random convenient method. The most important variables studied included demographic data, clinical presentation, radiographic stage of sacroiliac involvement, and laboratory data extracted from patients’ files and recorded in questionnaires. Results: Both groups according to age at diagnosis, presence of enteritis, peripheral joint involvement and laboratory data such as C-reactive protein (CRP, erythrocyte sedimentation rate (ESR and hemoglobin were matched. Inflammatory neck pain was more prevalent in men than in women (77.2% against 51.8%; P< 0.05. Sacroiliac radiographic study revealed stage 1 involvement in 11.3% of men and 37% of women (P= 0.009, and stage 4 in 27.2% of men and 3.7% of women (P< 0.001, with a significant difference. Conclusion: According to the results of the study, the time between age of onset and age at diagnosis, inflammatory pain in the neck and advanced stage in men than in women was higher. Although these findings suggest that gender may have an impact on the pattern and severity of AS but the time delay in diagnosis as a disease affecting the intensity and pattern should

  18. Effectiveness of preoperative planning in the restoration of balance and view in ankylosing spondylitis

    NARCIS (Netherlands)

    Pigge, R.R.; Scheerder, F.J.; Smit, T.H.; Mullender, M.G.; van Royen, B.J.

    2008-01-01

    Object. The object of this study was to assess the effectiveness of preoperative planning in the restoration of balance and view angle in patients treated with lumbar osteotomy in ankylosing spondylitis (AS). Methods. The authors prospectively analyzed 8 patients with a thoracolumbar kyphotic

  19. Development of an ASAS-endorsed disease activity score (ASDAS) in patients with ankylosing spondylitis

    NARCIS (Netherlands)

    Lukas, C.; Landewé, R.; Sieper, J.; Dougados, M.; Davis, J.; Braun, J.; van der Linden, S.; van der Heijde, D.

    2009-01-01

    To develop a new index for disease activity in ankylosing spondylitis (ASDAS) that is truthful, discriminative and feasible, and includes domains/items that are considered relevant by patients and doctors. Eleven candidate variables covering six domains of disease activity, selected by ASAS experts

  20. Why golimumab in the treatment of psoriatic arthritis, ankylosing spondylitis and rheumatoid arthritis?

    Directory of Open Access Journals (Sweden)

    M. Rossini

    2015-03-01

    Full Text Available Golimumab is an anti-TNF monoclonal antibody administred subcutaneously once a month and produced with an innovative technology that minimizes immunogenicity. This paper reviews and updates the main studies on the efficacy, safety and pharmacoeconomic aspects of treatment with golimumab of psoriatic arthritis, ankylosing spondylitis and rheumatoid arthritis.

  1. [Clinical observation on nanometer acupoint mounting method for alleviation of myospasm complicated by spinal injury].

    Science.gov (United States)

    Zhang, Su-Jie; Si, Tong; Li, Zhi

    2008-11-01

    To observe clinical effect of nanometer acupoint mounting method for alleviation of myospasm complicated by spinal injury. Sixty cases were randomly divided into an observation group and a control group, 30 cases in each group. The observation group were treated by nanometer mounting at 4 Jiaji (EX-B 2) points each on both sides of the affected spine and Shenshu (BL 23), Shangliao (BL 31), Ciliao (BL 32), Yang-lingquan (GB 34), Xuanzhong (GB 39); and the control group by mounting zinc oxide sticking tablets at the above acupoints. The mounting was replaced once each two days, 7 times constituting one course. One week and one month after the end of 3 courses, their results were recorded, respectively. Before treatment, there was no significant difference between the two groups in grades of the myospasm degree (P > 0.05). One week after the end of treatment, 15 cases were grade I of myospasm, 9 cases were grade II, 5 cases were grade III and 1 case was grade IV in the observation group, and 1 cases grade I, 7 cases grade II, 14 cases grade III, 8 cases grade IV in the control group. Ridit analysis on the data indicated that there were significant differences before and after treatment in the myospasm degree (P mounting method is a new one for alleviation of myospasm complicated by spinal injury, with convenience, safety and no side effect.

  2. Observation and nursing of complications due to high re-perfusion injury occurring after balloon angioplasty for diabetic vascular diseases of lower extremity

    International Nuclear Information System (INIS)

    Zhang Lingling; Zhu Yueqi; Mou Ling

    2011-01-01

    Objective: To evaluate the symptomatic nursing in treating the complications caused by high re-perfusion which develops after balloon angioplasty for the treatment of diabetic vascular diseases of lower extremity. Methods: Eighteen patients with lower limb ischemia caused by diabetes mellitus developed high re-perfusion injury complications after receiving balloon angioplasty. The patients were randomly and equally divided into study group and control group. The special nursing measures designed by the author's department, including raising the diseased lower limb, enforcing the flexion and extension movement of the leg, cold compress, wound exposure, etc. were carried out for patients of study group, while no special nursing measures were adopted for patients of control group. The clinical results, such as limb pain, swelling and subcutaneous petechia after re-perfusion injury, were evaluated and compared between two groups. Results: After the treatment, the limb pain, swelling and subcutaneous petechia due to high re-perfusion injury in study group were relieved more markedly than that in control group, the difference in evaluation score between two groups was statistically significant (P<0.01). Conclusion: The special symptomatic nursing measures are very effective in relieving the high re-perfusion injury after balloon angioplasty for the treatment of diabetic lower limb ischemia. (authors)

  3. [Awake craniotomy: analysis of complicated cases].

    Science.gov (United States)

    Kulikov, A S; Kobyakov, G L; Gavrilov, A G; Lubnin, A Yu

    2015-01-01

    Awake craniotomy is recognized as method that can decrease the frequency of neurological complications after surgery for gliomas located near eloquent brain regions. Unfortunately good neurological outcome can't be ensured even by using of this technique. This paper discusses reasons and possible ways of prevention of such complications. 162 awake craniotomies were performed in our clinic. 152 of patients were discharged from the clinic with good outcome. In 10 (6%) cases sustained severe neurological deficit was noted. These complications were associated with anatomic or ischemic injury of subcortical pathways and internal capsule. Awake craniotomy is effective instrument of brain language mapping and prevention of neurological deterioration. Severe neurological complications of awake craniotomy are associated with underestimate neurosurgical risks, especially in terms of blood vessel injury and depth of resection. The main way of prevention of such complications is meticulous planning of operation and adequate using of mapping facilities.

  4. MMP mediated type V collagen degradation (C5M) is elevated in ankylosing spondylitis

    DEFF Research Database (Denmark)

    Veidal, S S; Larsen, D V; Chen, Xijuan

    2012-01-01

    Type V collagen has been demonstrated to control fibril formation. The aim of this study was to develop an ELISA capable of detecting a fragment of type V collagen generated by MMP-2/9 and to evaluate the assay as biomarker for ankylosing spondylitis (AS)....

  5. Validity of ankylosing spondylitis and undifferentiated spondyloarthritis diagnoses in the Swedish National Patient Register

    DEFF Research Database (Denmark)

    Lindström, U; Exarchou, S; Sigurdardottir, V

    2015-01-01

    OBJECTIVES: Epidemiological studies of spondyloarthritis (SpA), using ICD codes from the Swedish National Patient Register (NPR), offer unique possibilities but hinge upon an understanding of the validity of the codes. The aim of this study was to validate the ICD codes for ankylosing spondylitis...

  6. Ankylosing Spondylitis and Posture Control: The Role of Visual Input

    Science.gov (United States)

    De Nunzio, Alessandro Marco; Iervolino, Salvatore; Zincarelli, Carmela; Di Gioia, Luisa; Rengo, Giuseppe; Multari, Vincenzo; Peluso, Rosario; Di Minno, Matteo Nicola Dario; Pappone, Nicola

    2015-01-01

    Objectives. To assess the motor control during quiet stance in patients with established ankylosing spondylitis (AS) and to evaluate the effect of visual input on the maintenance of a quiet posture. Methods. 12 male AS patients (mean age 50.1 ± 13.2 years) and 12 matched healthy subjects performed 2 sessions of 3 trials in quiet stance, with eyes open (EO) and with eyes closed (EC) on a baropodometric platform. The oscillation of the centre of feet pressure (CoP) was acquired. Indices of stability and balance control were assessed by the sway path (SP) of the CoP, the frequency bandwidth (FB1) that includes the 80% of the area under the amplitude spectrum, the mean amplitude of the peaks (MP) of the sway density curve (SDC), and the mean distance (MD) between 2 peaks of the SDC. Results. In severe AS patients, the MD between two peaks of the SDC and the SP of the center of feet pressure were significantly higher than controls during both EO and EC conditions. The MP was significantly reduced just on EC. Conclusions. Ankylosing spondylitis exerts negative effect on postural stability, not compensable by visual inputs. Our findings may be useful in the rehabilitative management of the increased risk of falling in AS. PMID:25821831

  7. Ankylosing Spondylitis and Posture Control: The Role of Visual Input

    Directory of Open Access Journals (Sweden)

    Alessandro Marco De Nunzio

    2015-01-01

    Full Text Available Objectives. To assess the motor control during quiet stance in patients with established ankylosing spondylitis (AS and to evaluate the effect of visual input on the maintenance of a quiet posture. Methods. 12 male AS patients (mean age 50.1 ± 13.2 years and 12 matched healthy subjects performed 2 sessions of 3 trials in quiet stance, with eyes open (EO and with eyes closed (EC on a baropodometric platform. The oscillation of the centre of feet pressure (CoP was acquired. Indices of stability and balance control were assessed by the sway path (SP of the CoP, the frequency bandwidth (FB1 that includes the 80% of the area under the amplitude spectrum, the mean amplitude of the peaks (MP of the sway density curve (SDC, and the mean distance (MD between 2 peaks of the SDC. Results. In severe AS patients, the MD between two peaks of the SDC and the SP of the center of feet pressure were significantly higher than controls during both EO and EC conditions. The MP was significantly reduced just on EC. Conclusions. Ankylosing spondylitis exerts negative effect on postural stability, not compensable by visual inputs. Our findings may be useful in the rehabilitative management of the increased risk of falling in AS.

  8. Surgical anesthesia with a combination of T12 paravertebral block and lumbar plexus, sacral plexus block for hip replacement in ankylosing spondylitis: CARE-compliant 4 case reports.

    Science.gov (United States)

    Ke, Xijian; Li, Ji; Liu, Yong; Wu, Xi; Mei, Wei

    2017-06-26

    Anesthesia management for patients with severe ankylosing spondylitis scheduled for total hip arthroplasty is challenging due to a potential difficult airway and difficult neuraxial block. We report 4 cases with ankylosing spondylitis successfully managed with a combination of lumbar plexus, sacral plexus and T12 paravertebral block. Four patients were scheduled for total hip arthroplasty. All of them were diagnosed as severe ankylosing spondylitis with rigidity and immobilization of cervical and lumbar spine and hip joints. A combination of T12 paravertebral block, lumbar plexus and sacral plexus block was successfully used for the surgery without any additional intravenous anesthetic or local anesthetics infiltration to the incision, and none of the patients complained of discomfort during the operations. The combination of T12 paravertebral block, lumbar plexus and sacral plexus block, which may block all nerves innervating the articular capsule, surrounding muscles and the skin involved in total hip arthroplasty, might be a promising alternative for total hip arthroplasty in ankylosing spondylitis.

  9. Endopulmonary Bronchoalveolar Lavage Cytogram in the Prediction of Infective Pulmonary Complications in Concomitant Injury

    Directory of Open Access Journals (Sweden)

    V. I. Kartavenko

    2005-01-01

    Full Text Available The purpose of the study was to examine the time course of changes in the cellular composition of bronchoalveolar lavage (BAL fluid to assess the possibilities of using the values of an endopulmonary cytogram (EPC for the prediction of the development of infectious pulmonary complications and death in victims with severe concomitant injury. Sixty-three victims divided into 2 groups by the injury severity scale (ISS (Beaker et al., 1974 were examined. For BAL sampling, a BF-XT40 endoscope (Olympus, Japan was applied to bronchofibroscopy. To study BAL, the authors used the routine cyto-logical techniques and compared the latter’s results with those of EPC. The data were statistically processed, by employing the Statistica 6.0 programs; p Kozlov I. A., Poptsov V. N. Combined Therapy with Nitric Oxide and Surfactant-BL for Acute Respiratory Distress Syndrome After Operations Using Extracorporeal Circulation ….15 Abstract Выбрать Показать The present study was undertaken to comparatively evaluate the efficacy of inhalational nitric oxide alone and in combination with surfactant-BL in the complex therapy for acute respiratory distress syndrome (ARDS after surgery under extracorporeal circulation (EC. The study included 53 patients aged 21 to 76 years. It has revealed that in ARDS that complicates operations under EC, the use of surfactant-BL during therapy with inhalational nitric oxide enhances the latter’s effects on arterial oxygenation, accelerates the regression of pulmonary oxygenizing dysfunction, and reduces the duration of artificial ventilation and the length of stay in an intensive care unit.

  10. Periodontal healing complications following concussion and subluxation injuries in the permanent dentition: a longitudinal cohort study

    DEFF Research Database (Denmark)

    Hermann, Nuno Vibe; Lauridsen, Eva; Ahrensburg, Søren Steno

    2012-01-01

    Purpose The purpose of the study was to analyze the risk of periodontal ligament (PDL) healing complications following concussion and subluxation injuries in the permanent dentition. Material and method A total 469 permanent teeth (358 patients) with concussion and 404 permanent teeth......-related resorption (ankylosis), marginal bone loss, and tooth loss were analyzed with the Kaplan–Meier method. Results Concussion: In teeth with immature root development, no healing complications were observed. For teeth with mature root development, the risk of repair related resorption after 3 years was 3.2% (95...... among teeth with concussion. Subluxation: In teeth with immature root development, the risk of infection-related resorption after 3 years was 1.7% [95% confidence interval (CI): 0–3.8%]. Infection-related resorption occurred significantly more often in teeth with concomitant crown fracture (P = 0...

  11. [Efficacy and Safety Evaluation of Bushen Shuji Granule in Treating Ankylosing Spondylitis Patients: a Clinical Study].

    Science.gov (United States)

    Kong, Wei-ping; Tao, Qing-wen; Zhang, Ying-ze; Yang, Shu; Xu, Yuan; Zhu, Xiao-xia; Jin, Yue; Yang, Wen-xue; Yan, Xiao-ping

    2015-06-01

    To evaluate the short-term efficacy and safety of Bushen Shuji Granule (BSG) in treating ankylosing spondylitis (AS) patients. A prospective randomized controlled clinical trial was carried out in 62 active stage AS patients with Shen deficiency Du-channel cold syndrome (SDDCS), who were randomly assigned to the BSG group (treated with BSG) and the control group (treated with Celecoxib Capsule). Twelve weeks consisted of one therapeutic course. Therapeutic effects were evaluated by ASAS20 and ASAS40 (set by Assessments in Ankylosing Spondylitis working group) , BASDA150, Chinese medical (CM) syndrome efficacy evaluation standards. BASDAI, the Bath Ankylosing Spondylitis Functional Index (BASFI), the Bath AS Metrology Index (BASMI), scores for spine pain, scores for pain at night, patient global assessment (PGA) , erythrocyte sedimentation rate (ESR) , and C reactive protein (CRP) were observed before and after treatment. After three-month treatment by BSG, ASAS20 standard rate was 63. 33% (19/30 cases) in the BSG group and 66.67% (20/30 cases) in the control group with no significant difference between the two groups (χ2 = 0.073, P > 0.05). The efficacy for CM syndromes was 70.00% (21/30 cases) in the BSG group, higher than that in the control group [40.00% (12/30 cases), χ2 = 5.455, P channel strengthening, blood activating, and channels dredging method had good short-term clinical efficacy and safety in treating AS.

  12. Social Role Participation in Patients With Ankylosing Spondylitis: A Cross-Sectional Comparison With Population Controls

    NARCIS (Netherlands)

    van Genderen, Simon; Plasqui, Guy; Landewe, Robert; Lacaille, Diane; Arends, Suzanne; van Gaalen, Floris; van der Heijde, Desiree; Heuft, Liesbeth; Luime, Jolanda; Spoorenberg, Anneke; Gignac, Monique; Boonen, Annelies

    2016-01-01

    Objective. Participation in social roles for persons with chronic disease is important for their quality of life, but interpretation of the data on participation is difficult in the absence of a benchmark. This study aimed to compare social role participation in patients with ankylosing spondylitis

  13. Social role participation in patients with ankylosing spondylitis. A cross-sectional comparison with population controls

    NARCIS (Netherlands)

    van Genderen, Simon; Plasqui, Guy; Landewé, Robert; Lacaille, Diane; Arends, Suzanne; van Gaalen, Floris; van der Heijde, Désirée; Heuft, Liesbeth; Luime, Jolanda; Spoorenberg, Anneke; Gignac, Monique A M; Boonen, Annelies

    2016-01-01

    OBJECTIVE: Social role participation of persons with a chronic disease is important for their lives, but interpretation of data on participation is difficult in the absence of a benchmark. This study aimed to compare social role participation in patients with ankylosing spondylitis (AS) to

  14. Evaluating the reliability of Persian version of ankylosing spondylitis quality of life (ASQoL) questionnaire and related clinical and demographic parameters in patients with ankylosing spondylitis.

    Science.gov (United States)

    Fallahi, Sasan; Jamshidi, Ahmad Reza; Bidad, Katayoon; Qorbani, Mostafa; Mahmoudi, Mahdi

    2014-06-01

    Ankylosing spondylitis quality of life (ASQoL) is an instrument for assessing quality of life (QoL). The aims of this study were to assess the reliability of Persian version of ASQoL questionnaire and evaluation of QoL status and related factors in ankylosing spondylitis (AS). One hundred and sixty-three Iranian patients with AS who fulfilled modified New York criteria were enrolled. Patients were evaluated using questionnaires including demographic and clinical variables, Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), fatigue, Bath AS Metrology Index, pain and ASQoL. Reliability and validity of Persian version of ASQoL were evaluated by test-re-test agreement, internal consistency and correlation with specific scales. Relationship of parameters with ASQoL was analyzed by multiple regression. Age, disease duration and ASQoL score (mean ± SD) were 37.74 ± 9.88, 14.49 ± 8.47 and 8.02 ± 5.28 years, respectively. Test-re-test reproducibility for ASQoL was good as assessed by intra-class correlation coefficient (ICC: 0.97, P educational level, r = -0.37). Persian version of ASQoL is a valid and reliable scale to assess QoL in AS. Function, fatigue, mood, hip mobility and education are the factors which should be noted to achieve the best QoL.

  15. Scoring inflammatory activity of the spine by magnetic resonance imaging in ankylosing spondylitis: a multireader experiment

    DEFF Research Database (Denmark)

    Lukas, C; Braun, J; van der Heijde, D

    2007-01-01

    OBJECTIVE: Magnetic resonance imaging (MRI) of the spine is increasingly important in the assessment of inflammatory activity in clinical trials with patients with ankylosing spondylitis (AS). We investigated feasibility, inter-reader reliability, sensitivity to change, and discriminatory ability...... of 3 different scoring methods for MRI activity and change in activity of the spine in patients with AS. METHODS: Thirty sets of spinal MRI at baseline and after 24 weeks of followup, derived from a randomized clinical trial comparing a tumor necrosis factor (TNF)-blocking drug (n = 20) with placebo (n...... the Ankylosing Spondylitis spine Magnetic Resonance Imaging-activity [ASspiMRI-a, grading activity (0-6) per vertebral unit in 23 units]; the Berlin modification of the ASspiMRI-a; and the Spondyloarthritis Research Consortium of Canada (SPARCC) scoring system, which scores the 6 vertebral units considered...

  16. Dose dependence of complication rates in cervix cancer radiotherapy

    International Nuclear Information System (INIS)

    Orton, C.G.; Wolf-Rosenblum, S.

    1986-01-01

    The population selected for this study was a group of 410 Stage IIB and III squamous cell Ca cervix patients treated at the Radiumhemmet between the years 1958-1966. A total of 48 of these patients developed moderate-to-severe rectal and/or bladder complications. Of these, 33 were evaluable with respect to dose-dependence of complications, that is, complete intracavitary dose measurements and external beam dose calculations, no chemotherapy or electrocautery, and complete clinical radiotherapy records. A group of 57 randomly selected uninjured patients were used as controls. Results show good correlation between dose, expressed in TDF units, and complication rates for both rectal and bladder injuries. Severity of rectal injury was observed to increase with increase in dose, although no such correlation was observed for bladder injuries. Mean delays in the expression of symptoms of injury were 10 months for the rectum and 22 months for the bladder

  17. Dose dependence of complication rates in cervix cancer radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Orton, C.G.; Wolf-Rosenblum, S.

    1986-01-01

    The population selected for this study was a group of 410 Stage IIB and III squamous cell Ca cervix patients treated at the Radiumhemmet between the years 1958-1966. A total of 48 of these patients developed moderate-to-severe rectal and/or bladder complications. Of these, 33 were evaluable with respect to dose-dependence of complications, that is, complete intracavitary dose measurements and external beam dose calculations, no chemotherapy or electrocautery, and complete clinical radiotherapy records. A group of 57 randomly selected uninjured patients were used as controls. Results show good correlation between dose, expressed in TDF units, and complication rates for both rectal and bladder injuries. Severity of rectal injury was observed to increase with increase in dose, although no such correlation was observed for bladder injuries. Mean delays in the expression of symptoms of injury were 10 months for the rectum and 22 months for the bladder.

  18. Duration of remission after halving of the etanercept dose in patients with ankylosing spondylitis: a randomized, prospective, long-term, follow-up study

    Directory of Open Access Journals (Sweden)

    Nannini C

    2013-01-01

    Full Text Available Fabrizio Cantini, Laura Niccoli, Emanuele Cassarà, Olga Kaloudi, Carlotta NanniniDivision of Rheumatology, Misericordia e Dolce Hospital, Prato, ItalyBackground: The aim of this study was to evaluate the proportion of patients with ankylosing spondylitis maintaining clinical remission after reduction of their subcutaneous etanercept dose to 50 mg every other week compared with that in patients receiving etanercept 50 mg weekly.Methods: In the first phase of this randomized, prospective, follow-up study, all biologic-naïve patients identified between January 2005 and December 2009 as satisfying the modified New York clinical criteria for ankylosing spondylitis treated with etanercept 50 mg weekly were evaluated for disease remission in January 2010. In the second phase, patients meeting the criteria for remission were randomized to receive subcutaneous etanercept as either 50 mg weekly or 50 mg every other week. The randomization allocation was 1:1. Remission was defined as Bath Ankylosing Spondylitis Disease Activity Index < 4, no extra-axial manifestations of peripheral arthritis, dactylitis, tenosynovitis, or iridocyclitis, and normal acute-phase reactants. The patients were assessed at baseline, at weeks 4 and 12, and every 12 weeks thereafter. The last visit constituted the end of the follow-up.Results: During the first phase, 78 patients with ankylosing spondylitis (57 males and 21 females, median age 38 years, median disease duration 12 years were recruited. In January 2010, after a mean follow-up of 25 ± 11 months, 43 (55.1% patients achieving clinical remission were randomized to one of the two treatment arms. Twenty-two patients received etanercept 50 mg every other week (group 1 and 21 received etanercept 50 mg weekly (group 2. At the end of follow-up, 19 of 22 (86.3% subjects in group 1 and 19 of 21 (90.4% in group 2 were still in remission, with no significant difference between the two groups. The mean follow-up duration in group

  19. Ankylosing Spondylitis and Posture Control: The Role of Visual Input

    OpenAIRE

    De Nunzio, Alessandro Marco; Iervolino, Salvatore; Zincarelli, Carmela; Di Gioia, Luisa; Rengo, Giuseppe; Multari, Vincenzo; Peluso, Rosario; Di Minno, Matteo Nicola Dario; Pappone, Nicola

    2015-01-01

    Objectives. To assess the motor control during quiet stance in patients with established ankylosing spondylitis (AS) and to evaluate the effect of visual input on the maintenance of a quiet posture. Methods. 12 male AS patients (mean age 50.1 ± 13.2 years) and 12 matched healthy subjects performed 2 sessions of 3 trials in quiet stance, with eyes open (EO) and with eyes closed (EC) on a baropodometric platform. The oscillation of the centre of feet pressure (CoP) was acquired. Indices of stab...

  20. Carbohydrate metabolism disorders in patients with rheumatoid arthritis and ankylosing spondylitis – impact of treatment

    Directory of Open Access Journals (Sweden)

    Piotr Dąbrowski

    2014-06-01

    Full Text Available Chronic inflammation – the crucial pathogenic mechanism of rheumatoid arthritis and ankylosing spondylitis – is the main cause of accelerated atherosclerosis, insulin resistance and well-known consequences related to it. The conservative treatment of rheumatoid arthritis and ankylosing spondylitis may provide a significant influence on glucose metabolism. The paper is a literature overview concerning insulin resistance and impaired glucose metabolism during treatment with disease-modifying drugs including biologic DMARDs (disease-modifying antirheumatic drugs, corticosteroids and commonly used non-steroidal anti-inflammatory drugs (NSAID. It has been found that the risk of carbohydrate disorders among those patients is much lower after therapy with hydroxychloroquine, methotrexate and TNF blockers – particularly with infliximab. The NSAID may play an important protective role in reducing risk of diabetes. The recent data show, contrary to general opinion, the advantageous outcome for glucose metabolism after treatment with corticosteroids, especially in the early active stage of rheumatoid arthritis.

  1. Decreased Oxidative Stress in Male Patients with Active Phase Ankylosing Spondylitis Who Underwent Whole-Body Cryotherapy in Closed Cryochamber

    Directory of Open Access Journals (Sweden)

    Agata Stanek

    2018-01-01

    Full Text Available Objective. The aim of the study was to estimate the impact of whole body cryotherapy (WBC on oxidative stress when performed in a closed cryochamber on patients with ankylosing spondylitis (AS. Material and methods. The effect of ten WBC procedures lasting 3 minutes a day with a subsequent 60-minute session kinesiotherapy on oxidative stress in male AS patients (WBC group n=16 was investigated. To assess the disease activity, the Bath Ankylosing Spondylitis Diseases Activity Index (BASDAI and Bath Ankylosing Spondylitis Functional Index (BASFI were calculated. The WBC group was compared to the kinesiotherapy only (KT; n=16 group. The routine parameters of oxidative stress (antioxidant enzymatic and nonenzymatic antioxidant status, lipid peroxidation products, total oxidative status (TOS, and oxidative stress index (OSI were estimated one day before the beginning and one day after the completion of the research program. Results. After the completion of the treatment in the WBC group, a significant decrease of oxidative stress markers (TOS and OSI and a significant increase of total antioxidant status were observed. The erythrocyte activity of glutathione peroxidase, glutathione reductase decreased significantly in both groups, but the differences of activity of that enzymes prior to post treatment values (Δ in the KT group were significantly higher as compared to the WBC group. The activity of erythrocyte catalase and plasma ZnCu isoenzyme of superoxide dismutase showed a decreased tendency; erythrocyte total superoxide dismutase activity showed an increased tendency in the WBC group after the completion of the treatment. The BASDAI and BASFI decreased significantly in both groups, but the differences of value indexes prior to post treatment (Δ were significantly higher in the WBC than KT group. Conclusion. WBC performed in a closed cryochamber decreases oxidative stress and improves BASDAI and BASFI indexes in male patients during the active

  2. Temporal bone trauma and complications: computed tomography findings

    Energy Technology Data Exchange (ETDEWEB)

    Costa, Ana Maria Doffemond; Gaiotti, Juliana Oggioni; Couto, Caroline Laurita Batista; Gomes, Natalia Delage; Diniz, Renata Lopes Furletti Caldeira; Motta, Emilia Guerra Pinto Coelho, E-mail: anadoffemond@yahoo.com.br [Hospital Mater Dei, Belo Horizonte, MG (Brazil). Unit of Radiology and Imaging Diagnosis

    2013-03-15

    Most temporal bone fractures result from high-energy blunt head trauma, and are frequently related to other skull fractures or to polytrauma. Fractures and displacements of ossicular chain in the middle ear represent some of the main complications of temporal bone injury, and hence they will be more deeply approached in the present article. Other types of injuries include labyrinthine fractures, dural fistula, facial nerve paralysis and extension into the carotid canal. Computed tomography plays a fundamental role in the initial evaluation of polytrauma patients, as it can help to identify important structural injuries that may lead to severe complications such as sensorineural hearing loss, conductive hearing loss, dizziness and balance dysfunction, perilymphatic fistulas, facial nerve paralysis, vascular injury and others. (author)

  3. Temporal bone trauma and complications: computed tomography findings

    International Nuclear Information System (INIS)

    Costa, Ana Maria Doffemond; Gaiotti, Juliana Oggioni; Couto, Caroline Laurita Batista; Gomes, Natalia Delage; Diniz, Renata Lopes Furletti Caldeira; Motta, Emilia Guerra Pinto Coelho

    2013-01-01

    Most temporal bone fractures result from high-energy blunt head trauma, and are frequently related to other skull fractures or to polytrauma. Fractures and displacements of ossicular chain in the middle ear represent some of the main complications of temporal bone injury, and hence they will be more deeply approached in the present article. Other types of injuries include labyrinthine fractures, dural fistula, facial nerve paralysis and extension into the carotid canal. Computed tomography plays a fundamental role in the initial evaluation of polytrauma patients, as it can help to identify important structural injuries that may lead to severe complications such as sensorineural hearing loss, conductive hearing loss, dizziness and balance dysfunction, perilymphatic fistulas, facial nerve paralysis, vascular injury and others. (author)

  4. Interrelation between Neuroendocrine Disturbances and Medical Complications Encountered during Rehabilitation after TBI

    Directory of Open Access Journals (Sweden)

    Caroline I. E. Renner

    2015-09-01

    Full Text Available Traumatic brain injury is not a discrete event but an unfolding sequence of damage to the central nervous system. Not only the acute phase but also the subacute and chronic period after injury, i.e., during inpatient rehabilitation, is characterized by multiple neurotransmitter alterations, cellular dysfunction, and medical complications causing additional secondary injury. Neuroendocrine disturbances also influence neurological outcome and are easily overlooked as they often present with diffuse symptoms such as fatigue, depression, poor concentration, or a decline in overall cognitive function; these are also typical sequelae of traumatic brain injury. Furthermore, neurological complications such as hydrocephalus, epilepsy, fatigue, disorders of consciousness, paroxysmal sympathetic hyperactivity, or psychiatric-behavioural symptoms may mask and/or complicate the diagnosis of neuroendocrine disturbances, delay appropriate treatment and impede neurorehabilitation. The present review seeks to examine the interrelation between neuroendocrine disturbances with neurological complications frequently encountered after moderate to severe TBI during rehabilitation. Common neuroendocrine disturbances and medical complications and their clinical implications are discussed.

  5. Combined spa-exercise therapy is effective in patients with ankylosing spondylitis: a randomized controlled trial

    NARCIS (Netherlands)

    van Tubergen, A.; Landewé, R.; van der Heijde, D.; Hidding, A.; Wolter, N.; Asscher, M.; Falkenbach, A.; Genth, E.; Thè, H. G.; van der Linden, S.

    2001-01-01

    To determine the efficacy of combined spa-exercise therapy in addition to standard treatment with drugs and weekly group physical therapy in patients with ankylosing spondylitis (AS). A total of 120 Dutch outpatients with AS were randomly allocated into 3 groups of 40 patients each. Group 1 (mean

  6. Baseline factors that influence ASAS 20 response in patients with ankylosing spondylitis treated with etanercept.

    Science.gov (United States)

    Davis, John C; Van der Heijde, Désirée M F M; Dougados, Maxime; Braun, Jurgen; Cush, John J; Clegg, Daniel O; Inman, Robert D; de Vries, Todd; Tsuji, Wayne H

    2005-09-01

    To examine the baseline demographic and disease characteristics that might influence improvement as measured by the Assessment in Ankylosing Spondylitis Response Criteria (ASAS 20) in patients with ankylosing spondylitis (AS). A multicenter Phase 3 study was performed to compare the safety and efficacy of 24 weeks of etanercept 25 mg subcutaneous injection twice weekly (n = 138) and placebo (n = 139) in patients with AS. The ASAS 20 was measured at multiple time points. Using a significance level of 0.05, a repeated measures logistic regression model was used to determine which baseline factors influenced response in the etanercept-treated patients during the 24-week double blind portion of the trial. The following baseline factors were used in the model: demographic and disease severity variables, concomitant medications, extra-articular manifestations, and HLA-B27 status. The predictive capability of the model was then tested on the patients receiving placebo after they had received open-label etanercept treatment. Baseline factors that were significant predictors of an ASAS 20 response in etanercept-treated patients were C-reactive protein (CRP), back pain score, and Bath Ankylosing Spondylitis Functional Index (BASFI) score. Although clinical response to etanercept was seen at all levels of baseline disease activity, responses were consistently more likely with higher CRP levels or back pain scores and less likely with increased BASFI scores at baseline. Higher CRP values and back pain scores and lower BASFI scores at baseline were significant predictors of a higher ASAS 20 response in patients with AS receiving etanercept but predictive value was of insufficient magnitude to determine treatment in individual patients.

  7. Marginal erosive discovertebral ''Romanus'' lesions in ankylosing spondylitis demonstrated by contrast enhanced Gd-DTPA magnetic resonance imaging

    International Nuclear Information System (INIS)

    Jevtic, V.; Kos-Golja, M.; Rozman, B.; McCall, I.

    2000-01-01

    Objective. To assess the value of Gd-DTPA magnetic resonance (MR) imaging in the demonstration of marginal destructive discovertebral Romanus lesions in ankylosing spondylitis.Design and patients. A prospective study of Gd-DTPA MR imaging was performed in 39 patients with a clinical diagnosis of ankylosing spondylitis and typical Romanus lesions seen on radiographs of the thoracolumbar spine. MR morphological appearances and signal intensity changes at the discovertebral junctions were analysed and compared with the radiographic findings.Results. Ninety-nine discovertebral junctions with Romanus lesions showed low signal intensity on T1-weighted and high signal on T2-weighted and T1-weighted postcontrast images at the vertebral corners consistent with oedematous hyperaemic inflammatory tissue. There were nine discovertebral junctions with similar MR findings but normal radiographs. Fifty-three discovertebral junctions showed syndesmophyte formation with increased signal intensity on both T1- and T2-weighted images with no contrast enhancement. Sixty-five discovertebral junctions showed a mixture of radiographic features and varied high and low signal changes at the vertebral rim on MR imaging with rims of enhancement in the vertebral body following contrast administration.Conclusion. Gd-DTPA MR imaging demonstrates a variable signal pattern and degree of contrast enhancement which may reflect the evolutionary stages of discovertebral enthesitis in ankylosing spondylitis. MR imaging may identify early erosive changes in radiographically normal vertebra. The role of MR imaging needs further investigation. (orig.)

  8. Translation to Brazilian Portuguese, cultural adaptation and reproducibility of the questionnaire "Ankylosing Spondylitis: What do you know?"

    Science.gov (United States)

    Orlandi, Aline; Brumini, Christine; Jones, Anamaria; Natour, Jamil

    2016-09-26

    Ankylosing spondylitis (AS) generates inflammation and pain in entheses, peripheral joints and the spine. Education regarding AS can improve patients' disability. Thus, it is important to assess patients' knowledge. There is no instrument in the literature for assessing knowledge of AS in Portuguese. The aim here was to translate to the Brazilian Portuguese language, culturally adapt and test the reliability of the questionnaire "Ankylosing Spondylitis: What do you know?" and to correlate the findings with other factors. Original article regarding validation of questionnaire, produced at the Federal University of Sao Paulo (Unifesp). For translation and cultural adaptation, Guilleman methodology was used. After the first phase, the reliability was tested on 30 patients. Correlations between these scores and other factors were examined. In the interobserver assessment, the Pearson correlation coefficient and Cronbach's alpha were 0.831 and 0.895, respectively. In the intraobserver evaluation, the intraclass correlation coefficient and Cronbach's alpha were 0.79 and 0.883, respectively. At this stage, the score for area of knowledge A showed correlations with ethnicity and education; the score for area D, with age; the total score and scores for areas A and B with "social aspects" of SF-36; and the score for area D with "pain", "vitality" and "emotional aspects" of SF-36. The Brazilian version of the questionnaire "Ankylosing Spondylitis: What do you know?" was created. It is reproducible and correlates with education level, ethnicity and the SF-36 domains "social aspects" and "emotional aspects".

  9. Non-steroidal anti-inflammatory drugs (NSAIDs) for axial spondyloarthritis (ankylosing spondylitis and non-radiographic axial spondyloarthritis)

    NARCIS (Netherlands)

    Kroon, Feline P. B.; van der Burg, Lennart R. A.; Ramiro, Sofia; Landewé, Robert B. M.; Buchbinder, Rachelle; Falzon, Louise; van der Heijde, Désirée

    2015-01-01

    Axial spondyloarthritis (axSpA) comprises ankylosing spondylitis (radiographic axSpA) and non-radiographic (nr-)axSpA and is associated with psoriasis, uveitis and inflammatory bowel disease. Non-steroidal anti-inflammatory drugs (NSAIDs) are recommended as first-line drug treatment. To determine

  10. [APPLICATION OF PHOTOSHOP CS16.0 SOFTWARE IN PREOPERATIVE OSTEOTOMY DESIGN OF ANKYLOSING SPONDYLITIS KYPHOSIS].

    Science.gov (United States)

    Wang, Fei; Tao, Huiren; Liu, Zhibin; Zhang, Jianhua; Han, Fangmin

    2015-02-01

    To introduce the application of Photoshop CS16.0 (PS) software in preoperative osteotomy design of ankylosing spondylitis kyphosis (ASK), and to investigate applied values of the preoperative design. Between March 2009 and March 2013, 21 cases of ASK were treated through preoperative osteotomy design by using PS software. There were 16 males and 5 females, aged from 23 to 50 years (mean, 34.2 years). The deformity included thoracolumbar kyphosis in 14 cases, thoracic kyphosis in 2 cases, and lumbar kyphosis in 5 cases. The ultimate osteotomy angle of preoperative plans and the location and extent of osteotomy were determined by the osteotomy design, which guided operation procedures of the surgeon. The actual osteotomy angle was obtained by measuring Cobb angle of osteotomy segment before and after operation. The sagittal parameters of spine and pelvis including global kyphosis (GK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), and chin brow-vertical angle (CBVA) were measured at preoperation, at 1 week after operation, and last follow-up. The clinical outcomes were assessed by simplified Chinese Scoliosis Research Society-22 (SRS-22) questionnaire and Oswestry disability index (ODI). No complications occurred in the other cases except 1 case of dural tear during operation and 1 case of nerve injury after operation, and primary healing of incision was obtained. All patients were followed up 14 to 45 months (mean, 26.3 months). The SRS-22 and ODI scores at 1 week after operation and last follow-up were significantly improved when compared with preoperative scores (P 0.05). The preoperative planned osteotomy angle and the postoperative actual osteotomy angle were (34.2 ± 10.5) degrees and (33.7 ± 9.7) degrees respectively, showing no significant difference (t = 0.84, P = 0.42). The CBVA, GK, SVA, PT, and LL were significantly improved when compared with the preoperative values (P 0.05). At last follow-up, no failures

  11. Complications of laparoscopic hysterectomy: the Monash experience.

    Science.gov (United States)

    Tsaltas, J; Lawrence, A; Michael, M; Pearce, S

    2002-08-01

    A retrospective review of medical records was performed to assess the incidence and type of significant complications encountered during laparoscopic hysterectomy Two hundred and sixty-five consecutive patients were reviewed between the years 1994 and August 2001. Two hundred and thirty-two laparoscopic vaginal hysterectomies and 33 total laparoscopic hysterectomies were performed. The operations were performed at Monash Medical Centre, a Melbourne tertiary public hospital, and two Melbourne private hospitals, by three surgeons. Ten significant complications occurred. There were two cases of ureteric fistula, two bladder injuries, two bowel obstructions, two postoperative haematomas, one case of a bladder fistula and one superficial epigastric artery injury. In-patient stay ranged from two to six days. Our complication and in-patient stay rates are consistent with previously reported rates.

  12. Impact of ankylosing spondylitis on sick leave, presenteeism and unpaid productivity, and estimation of the societal cost

    NARCIS (Netherlands)

    Boonen, Annelies; Brinkhuizen, Tjinta; Landewé, Robert; van der Heijde, Désirée; Severens, Johan L.

    2010-01-01

    To describe the influence of ankylosing apondylitis (AS) on sick leave, presenteeism and unpaid work restrictions and to estimate related productivity costs. 142 consecutive and unselected patients with AS under the care of rheumatologists participated in a longitudinal observational study and

  13. Acute electrical injury: A systematic review

    Directory of Open Access Journals (Sweden)

    Noor-Ahmad Latifi

    2017-01-01

    >Conclusions: High-voltage injury leads to greater morbidity and mortality than low-voltage one. Lightening has mortality of about 32%, higher rates of complications and specialty long-term complications. Strict multi-specialty treatment and rehabilitations are required for proper treatment of electrical injuries.

  14. Complications of cancer therapy

    International Nuclear Information System (INIS)

    Moskowitz, P.S.; Parker, B.R.

    1985-01-01

    The purpose of this chapter is to review systematically the toxicity of contemporary chemotherapy and irradiation on normal tissues of growing children. Whenever possible, the separate toxicity of chemotherapy, irradiation, and combination therapy is addressed. However, it is not always possible to quantitate specifically such reactions in the face of multiple drug therapy, which may enhance radiation injury or reactivate prior radiation injury. Prior detailed reviews have provided important sources of information concerning radiation injury for this more general discussion. The information provided will assist both the clinician and the radiologist in the recognition of early and late complications of therapy in pediatric oncology

  15. Resolution of inflammation following treatment of ankylosing spondylitis is associated with new bone formation

    DEFF Research Database (Denmark)

    Pedersen, Susanne J; Chiowchanwisawakit, Praveena; Lambert, Robert G W

    2011-01-01

    To test the hypothesis that in patients with ankylosing spondylitis (AS) a vertebral corner inflammatory lesion (CIL) visible on magnetic resonance imaging (MRI) that completely resolves following treatment with anti-tumor necrosis factor-a (TNF-a) agents is more likely to develop into a de novo...... syndesmophyte visible on a radiograph as compared to a vertebral corner with no CIL....

  16. Resolution of inflammation following treatment of ankylosing spondylitis is associated with new bone formation

    DEFF Research Database (Denmark)

    Pedersen, Susanne J; Chiowchanwisawakit, Praveena; Lambert, Robert G W

    2011-01-01

    To test the hypothesis that in patients with ankylosing spondylitis (AS) a vertebral corner inflammatory lesion (CIL) visible on magnetic resonance imaging (MRI) that completely resolves following treatment with anti-tumor necrosis factor-α (TNF-α) agents is more likely to develop into a de novo...... syndesmophyte visible on a radiograph as compared to a vertebral corner with no CIL....

  17. A Rare Complication of Spinal Anesthesia: Subdural Hematoma

    Directory of Open Access Journals (Sweden)

    Fuldem Yıldırım Dönmez

    2014-03-01

    Full Text Available The most common complication of spinal anesthesia is postdural puncture headache. Any injury of the dura may cause headache. After the injury of the dura, CSF leakage may occur and due to the tension of the veins between the cortex and the dural sinuses, subdural hematoma may be seen. Herein, we present a patient with persistent headache after the spinal anesthesia given during delivery of her baby, and emphasize a rare complication of spinal anesthesia which is subdural hematoma

  18. Traumatic brain injury in England and Wales: prospective audit of epidemiology, complications and standardised mortality

    Science.gov (United States)

    Lawrence, T; Bouamra, O; Woodford, M; Lecky, F; Hutchinson, P J

    2016-01-01

    Objectives To provide a comprehensive assessment of the management of traumatic brain injury (TBI) relating to epidemiology, complications and standardised mortality across specialist units. Design The Trauma Audit and Research Network collects data prospectively on patients suffering trauma across England and Wales. We analysed all data collected on patients with TBI between April 2014 and June 2015. Setting Data were collected on patients presenting to emergency departments across 187 hospitals including 26 with specialist neurosurgical services, incorporating factors previously identified in the Ps14 multivariate logistic regression (Ps14n) model multivariate TBI outcome prediction model. The frequency and timing of secondary transfer to neurosurgical centres was assessed. Results We identified 15 820 patients with TBI presenting to neurosurgical centres directly (6258), transferred from a district hospital to a neurosurgical centre (3682) and remaining in a district general hospital (5880). The commonest mechanisms of injury were falls in the elderly and road traffic collisions in the young, which were more likely to present in coma. In severe TBI (Glasgow Coma Score (GCS) ≤8), the median time from admission to imaging with CT scan is 0.5 hours. Median time to craniotomy from admission is 2.6 hours and median time to intracranial pressure monitoring is 3 hours. The most frequently documented complication of severe TBI is bronchopneumonia in 5% of patients. Risk-adjusted W scores derived from the Ps14n model indicate that no neurosurgical unit fell outside the 3 SD limits on a funnel plot. Conclusions We provide the first comprehensive report of the management of TBI in England and Wales, including data from all neurosurgical units. These data provide transparency and suggests equity of access to high-quality TBI management provided in England and Wales. PMID:27884843

  19. Oral complications of cancer therapies. Description and incidence of oral complications

    International Nuclear Information System (INIS)

    Dreizen, S.

    1990-01-01

    No part of the body reflects the complications of cancer chemotherapy as visibly and as vividly as the mouth. The infectious, hemorrhagic, cytotoxic, nutritional, and neurologic signs of drug toxicity are reflected in the mouth by changes in the color, character, comfort, and continuity of the mucosa. The stomatologic complications of radiotherapy for oral cancer are physical and physiological in nature, transient or lasting in duration, and reversible or irreversible in type. Some linger as permanent mementos long after the cancer has been destroyed. They stem from radiation injury to the salivary glands, oral mucosa, oral musculature, alveolar bone, and developing teeth. They are expressed clinically by xerostomia, trismus, radiation dermatitis, nutritional stomatitis, and dentofacial malformation. In both cancer chemotherapy and cancer radiotherapy, the oral complications vary in pattern, duration, intensity, and number, with not every patient developing every complication. 21 references

  20. Evaluation of functional outcomes of physical rehabilitation and medical complications in spinal cord injury victims of the Sichuan earthquake.

    Science.gov (United States)

    Li, Yongqiang; Reinhardt, Jan D; Gosney, James E; Zhang, Xia; Hu, Xiaorong; Chen, Sijing; Ding, Mingpu; Li, Jianan

    2012-06-01

    To characterize a spinal cord injury (SCI) population from the 2008 Sichuan earthquake in China; to evaluate functional outcomes of physical rehabilitation interventions; to assess potential determinants of rehabilitation effectiveness; and to assess medical complications and management outcomes. A total of 51 earthquake victims with SCI were enrolled and underwent rehabilitation programming. Functional rehabilitation outcomes included ambulation ability, wheelchair mobility and activities of daily living (ADL) assessed with the Modified Barthel Index at the beginning and end of rehabilitation. Effectiveness of rehabilitation and the effect of other predictors were evaluated by mixed effects regression. Outcomes of medical complication management were determined by comparison of the incidence of respective complications at the beginning and end of rehabilitation. Ambulation, wheelchair mobility and ADL were significantly improved with rehabilitation programming. Both earlier rescue and earlier onset of rehabilitation were significant positive predictors of rehabilitation effectiveness, whereas delayed onset of rehabilitation combined with prolonged time to rescue resulted in a lesser positive effect. Medical complications were managed effectively in 63% (pressure ulcers) to 85% (deep vein thrombosis) of patients during rehabilitation. Earthquake victims with SCI may achieve significantly improved functional rehabilitation functional outcomes on a formal, institutional-based physical rehabilitation programme.

  1. Real money: complications and hospital costs in trauma patients.

    Science.gov (United States)

    Hemmila, Mark R; Jakubus, Jill L; Maggio, Paul M; Wahl, Wendy L; Dimick, Justin B; Campbell, Darrell A; Taheri, Paul A

    2008-08-01

    Major postoperative complications are associated with a substantial increase in hospital costs. Trauma patients are known to have a higher rate of complications than the general surgery population. We used the National Surgical Quality Improvement Program (NSQIP) methodology to evaluate hospital costs, duration of stay, and payment associated with complications in trauma patients. Using NSQIP principles, patient data were collected for 512 adult patients admitted to the trauma service for > 24 hours at a Level 1 trauma center (2004-2005). Patients were placed in 1 of 3 groups: no complications (none), >or=1 minor complication (minor, eg, urinary tract infection), or >or=1 major complication (major, eg, pneumonia). Total hospital charges, costs, payment, and duration of stay associated with each complication group were determined from a cost-accounting database. Multiple regression was used to determine the costs of each type of complication after adjusting for differences in age, sex, new injury severity score, Glasgow coma scale score, maximum head abbreviated injury scale, and first emergency department systolic blood pressure. A total of 330 (64%) patients had no complications, 53 (10%) had >or= 1 minor complication, and 129 (25%) had >or= 1 major complication. Median hospital charges increased from $33,833 (none) to $81,936 (minor) and $150,885 (major). The mean contribution to margin per day was similar for the no complication and minor complication groups ($994 vs $1,115, P = .7). Despite higher costs, the patients in the major complication group generated a higher mean contribution to margin per day compared to the no complication group ($2,168, P costs when adjusted for confounding variables was $19,915 for the minor complication group (P costs associated with traumatic injury provides a window for assessing the potential cost reductions associated with improved quality care. To optimize system benefits, payers and providers should develop integrated

  2. Clinical course and signs in patients with uveitis associated with ankylosing spondylitis

    Directory of Open Access Journals (Sweden)

    Refik Oltulu

    2013-09-01

    Full Text Available Aim: To evaluate clinical course and signs in patients withuveitis associated ankylosing spondylitis (AS.Methods: In this retrospective study we evaluated thepatients who were diagnosed as uveitis related to AS andfollowed up at the Ophthalmology Department of NecmettinErbakan University Hospital between May 2009 andJune 2012. Demographical features and clinical courseswere assessed.Results: Seventeen eyes of 13 patients were includedin the study. Nine patients (69.2% were male and four(30.8% were female. The mean age at presentation was38.54±9.61 years (range 28-63. Bilateral involvementwas observed in four (30.8% patients. The mean followuptime was 17.46±11.86 months (range 3-36. The meannumber of attacks was 1.15±0.37 (range 1-2. Posteriorsegment manifestation accompanied anterior uveitis inthree eyes (17.6%. Posterior synechia developed in one(7.7% and cataract in one patient (7.7%, cystoid macularedema in two patients (15.4%, and epiretinal membranein one patient (%7.7. The mean final visual acuitywas 0.975±0.07 (range 0.2-1.0.Conclusion: The prognosis of anterior uveitis associatedwith AS is good if the treatment is administered at theappropriate time. However, the posterior segment complicationsmay develop in these patients, treatment andfollow-up should be done in co-operation with the departmentof rheumatology.Key words: Ankylosing spondylitis, uveitis, rheumatology,clinical course

  3. LATERAL ANKLE INJURY

    OpenAIRE

    Pollard, Henry; Sim, Patrick; McHardy, Andrew

    2002-01-01

    Background: Injury to the ankle joint is the most common peripheral joint injury. The sports that most commonly produce high ankle injury rates in their participating athletes include: basketball, netball, and the various codes of football. Objective: To provide an up to date understanding of manual therapy relevant to lateral ligament injury of the ankle. A discussion of the types of ligament injury and common complicating factors that present with lateral ankle pain is presented along with ...

  4. Management of colonic injuries in the combat theater.

    Science.gov (United States)

    Cho, S David; Kiraly, Laszlo N; Flaherty, Stephen F; Herzig, Daniel O; Lu, Kim C; Schreiber, Martin A

    2010-05-01

    Combat injuries are more often associated with blast, penetrating, and high-energy mechanisms than civilian trauma, generating controversy about the management of combat colonic injury. Despite implementation of mandatory colostomy in World War II, recent civilian data suggest that primary repair without diversion is safe and feasible. This study describes the modern management of battle-related colonic injuries and seeks to determine whether management strategy affects early complications. Records from the combat theater (downrange) and tertiary referral center in Germany were retrospectively reviewed from 2005 to 2006. Patient characteristics, management strategy, treatment course, and early complications were recorded. Comparison groups by management strategy were as follows: primary repair, diversion, and damage control. A total of 133 (97% male) patients sustained colonic injuries from penetrating (71%), blunt (5%), and blast (23%) mechanisms. Average injury severity score was 21 and length of stay in the referral center was 7.1 days. Injury distribution was 21% ascending, 21% descending, 15% transverse, 27% sigmoid, and 25% rectum. Downrange complications for primary repair, initial ostomy, and damage control groups were 14%, 15%, and 30%, respectively. On discharge from the center, 62% of patients had undergone a diversion. The complication rate was 18% overall and was unrelated to management strategy (P = .16). Multivariate analysis did not identify independent predictors of complications. Early complications were similar by mechanism, anatomic location, severity of injury, and management strategy. More diversions were performed for rectosigmoid injury. Good surgical judgment allows for low morbidity and supports primary repair in selected cases. Damage control surgery is effective in a multinational theater of operations.

  5. Oral Anaerobic Bacteria in the Etiology of Ankylosing Spondylitis

    Directory of Open Access Journals (Sweden)

    Mesut Öğrendik

    2017-06-01

    Full Text Available Ankylosing spondylitis (AS is associated with periodontitis. Anti– Porphyromonas gingivalis and anti– Prevotella intermedia antibody titers were higher in patients with spondyloarthritis than in healthy people. Sulfasalazine is an effective antibiotic treatment for AS. Moxifloxacin and rifamycin were also found to be significantly effective. The etiology hypothesis suggests that oral anaerobic bacteria such as Porphyromonas spp and Prevotella spp contribute to the disease. These bacteria have been identified in AS, and we will discuss their pathogenic properties with respect to our knowledge of the disease. Periodontal pathogens are likely to be responsible for the development of AS in genetically susceptible individuals. This finding should guide the development of more comprehensive and efficacious treatment strategies for AS.

  6. Translation to Brazilian Portuguese, cultural adaptation and reproducibility of the questionnaire "Ankylosing Spondylitis: What do you know?"

    Directory of Open Access Journals (Sweden)

    Aline Orlandi

    Full Text Available ABSTRACT CONTEXT AND OBJECTIVE: Ankylosing spondylitis (AS generates inflammation and pain in entheses, peripheral joints and the spine. Education regarding AS can improve patients' disability. Thus, it is important to assess patients' knowledge. There is no instrument in the literature for assessing knowledge of AS in Portuguese. The aim here was to translate to the Brazilian Portuguese language, culturally adapt and test the reliability of the questionnaire "Ankylosing Spondylitis: What do you know?" and to correlate the findings with other factors. DESIGN AND SETTING: Original article regarding validation of questionnaire, produced at the Federal University of Sao Paulo (Unifesp. METHODS: For translation and cultural adaptation, Guilleman methodology was used. After the first phase, the reliability was tested on 30 patients. Correlations between these scores and other factors were examined. RESULTS: In the interobserver assessment, the Pearson correlation coefficient and Cronbach's alpha were 0.831 and 0.895, respectively. In the intraobserver evaluation, the intraclass correlation coefficient and Cronbach's alpha were 0.79 and 0.883, respectively. At this stage, the score for area of knowledge A showed correlations with ethnicity and education; the score for area D, with age; the total score and scores for areas A and B with "social aspects" of SF-36; and the score for area D with "pain", "vitality" and "emotional aspects" of SF-36. CONCLUSION: The Brazilian version of the questionnaire "Ankylosing Spondylitis: What do you know?" was created. It is reproducible and correlates with education level, ethnicity and the SF-36 domains "social aspects" and "emotional aspects".

  7. [Injuries of the duodenum].

    Science.gov (United States)

    Korolev, M P; Urakcheev, Sh K; Shlosser, K V

    2012-01-01

    Results of surgical treatment of 69 patients with injuries of the duodenum were analyzed. The most frequent causes of the injury were stab-incised wound of the abdomen (43 patients), gunshot wounds (2 patients), closed injury of the abdomen. Postoperative complications developed in 18 (26%) cases. Lethality was 20.3% (14 patients died). Injuries caused by the closed trauma were considerably more severe than those caused by wounds of the duodenum; lethality was 37.5% and 11.1% respectively. The authors discuss questions of the special diagnostics and surgical strategy for open and closed injuries of the duodenum. Causes of the development of unfavorable outcomes were pyo-septic complications associated with progressing retroperitoneal phlegmons, peritonitis, development of traumatic pancreatitis, incompetent sutures of the duodenum with a formed duodenal fistula. Therefore, the effective prophylactics of incompetent sutures of the duodenum is its decompression with aspiration of the duodenal contents as well as decreased secretion by means of drainage of the bile excreting ducts and medicamental suppression of synthesis of the digestion enzymes of the pancreas and duodenum using Octreatid which allowed considerable decrease of the number of postoperative complications.

  8. Application of the Andersen's health care utilization framework to secondary complications of spinal cord injury: a scoping review.

    Science.gov (United States)

    Guilcher, Sara J T; Craven, B Cathy; McColl, Mary Ann; Lemieux-Charles, Louise; Casciaro, Tiziana; Jaglal, Susan B

    2012-01-01

    The purpose of this scoping review was to identify research priority areas related to secondary complications and associated health care use for individuals with spinal cord injury (SCI). Peer-reviewed journals were identified using CINAHL, MEDLINE, PubMed, Embase, Social Sciences Abstracts, Social Works Abstract and PsycInfo search engines. Key references were hand searched. A total of 289 abstracts were identified from the initial search strategy. We removed studies that did not measure health care and those that did not involve analytical investigation. The selected 31 studies were reviewed in detail using a coding template based on the domains and sub-components of the Andersen model (i.e. environmental, population characteristics, health behavior and outcome). Most studies measured predisposing characteristics (e.g., age, gender) and need characteristics (e.g., level of injury). There was a notable absence of environmental characteristics (e.g., health system, neighborhood variables), enabling characteristics and health behaviors (beyond diet and nutrition). We identified a gap in the SCI literature. Future research should focus on longitudinal study designs with more representation of non-traumatic spinal cord injury, as well as utilizing more advanced statistical analyses (i.e., multivariate level) to adjust for confounding variables.

  9. [Amyloidosis complicating spondyloarthropathies: Study of 15 cases].

    Science.gov (United States)

    Rodríguez-Muguruza, Samantha; Martínez-Morillo, Melania; Holgado, Susana; Saenz-Sarda, Xavier; Mateo, Lourdes; Tena, Xavier; Olivé, Alejandro

    2015-10-21

    Secondary amyloidosis (AA) is a rare complication of rheumatic diseases. The aim of this study was to determine the frequency of symptomatic amyloidosis AA in patients with spondyloarthropathy. Retrospective study (1984-2013). We reviewed the medical records of patients with spondyloarthropathy who had a histological diagnosis of amyloidosis AA (15 patients). We identified 1.125 patients with spondyloarthropathies. Fifteen (1.3%) patients with amyloidosis AA were recruited. It was suspected in 14 patients (93.3%) because of nephrotic syndrome in most of them: 14 were symptomatic (93.3%): 5 (33.3%) ankylosing spondylitis (AS), 5 (33.3%) spondylitis associated with inflammatory bowel diseases (IBD), 4 (26.7%) psoriatic arthritis, and one (6.7%) reactive arthritis. The mean disease duration was 23.9 years. Mortality after one and 5 years of follow-up was 30 and 50% respectively. The frequency of clinical amyloidosis AA in our patients was 1.3%. There was a marked male predominance, with AS or IBD. Clinical amyloidosis was diagnosed at a relatively late stage in spondyloarthropathy. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  10. A discrete event modelling framework for simulation of long-term outcomes of sequential treatment strategies for ankylosing spondylitis

    NARCIS (Netherlands)

    A. Tran-Duy (An); A. Boonen (Annelies); M.A.F.J. van de Laar (Mart); A. Franke (Andre); J.L. Severens (Hans)

    2011-01-01

    textabstractObjective: To develop a modelling framework which can simulate long-term quality of life, societal costs and cost-effectiveness as affected by sequential drug treatment strategies for ankylosing spondylitis (AS). Methods: Discrete event simulation paradigm was selected for model

  11. A discrete event modelling framework for simulation of long-term outcomes of sequential treatment strategies for ankylosing spondylitis

    NARCIS (Netherlands)

    Tran-Duy, A.; Boonen, A.; Laar, M.A.F.J.; Franke, A.C.; Severens, J.L.

    2011-01-01

    Objective To develop a modelling framework which can simulate long-term quality of life, societal costs and cost-effectiveness as affected by sequential drug treatment strategies for ankylosing spondylitis (AS). Methods Discrete event simulation paradigm was selected for model development. Drug

  12. Postmortem changes in lungs in severe closed traumatic brain injury complicated by acute respiratory failure

    Directory of Open Access Journals (Sweden)

    V. A. Tumanskiy

    2013-08-01

    Full Text Available V.А. Tumanskіy, S.І. Ternishniy, L.M. Tumanskaya Pathological changes in the lungs were studied in the work of 42 patiens who died from severe closed intracranial injury (SCII. It was complicated with acute respiratory insufficient (ARI. The most modified subpleural areas were selected from every lobe of the lungs for pathological studies. Prepared histological sections were stained by means of hemotoxylin and eosin and by Van Giеson for light microscopy. The results of the investigation have shown absence of the significant difference of pathological changes in the lungs of patients who died from ARI because of severe brain injury and traumatic intracranial hemorrhage. Pathognomic pathological changes in the lungs as a result of acute lung injury syndrome (ALIS were found in deceased patients on the third day since the SCII (n=8. There was a significant bilateral interstitial edema and mild alveolar edema with the presence of red and blood cells in the alveoli, vascular plethora of the septum interalveolar and stasis of blood in the capillaries, the slight pericapillary leukocyte infiltration, subpleural hemorrhage and laminar pulmonary atelectasis. In deceased patients on 4-6 days after SCII that was complicated with ARI (n=14, morphological changes had been detected in the lungs. It was pathognomic for acute respiratory distress syndrome (ARDS with local pneumonic to be layered. A significant interstitial pulmonary edema was observed in the respiratory part of the lungs. The edema has spread from the walls of the alveoli into the interstitial spaces of the bronchioles and blood vessels, and also less marked serous-hemorrhagic alveolar edema with presence of the fibrin in the alveoli and macrophages. The ways of intrapleural lymphatic drainage were dilatated. Histopathological changes in the lungs of those who died on the 7-15th days after severe closed craniocerebral injury with ARI to be complicated (n=12 have been indicative of two

  13. Diagnosis and treatment of traumatic pancreatic injury

    International Nuclear Information System (INIS)

    Hirakawa, Akihiko; Isayama, Kenji; Nakatani, Toshio

    2011-01-01

    The diagnosis of traumatic pancreatic injury in the acute stage is difficult to establish blood tests and abdominal findings alone. Moreover, to determine treatment strategies, it is important not only that a pancreatic injury is diagnosed but also whether a pancreatic ductal injury can be found. At our center, to diagnose isolated pancreatic injuries, we actively perform endoscopic retrograde pancreatography (ERP) in addition to abdominal CT at the time of admission. For cases with complications such as abdominal and other organ injuries, we perform a laparotomy to ascertain whether a pancreatic duct injury is present. In regard to treatment options, for grade III injuries to the pancreatic body and tail, we basically choose distal pancreatectomy, but we also consider the Bracy method depending on the case. As for grade III injuries to the pancreatic head, we primarily choose pancreaticoduodenectomy, but also apply drainage if the situation calls for it. However, pancreatic injuries are often complicated by injuries of other regions of the body. Thus, diagnosis and treatment of pancreatic injury should be based on a comprehensive decision regarding early prioritization of treatment, taking hemodynamics into consideration after admission, and how to minimize complications such as anastomotic leak and pancreatic fistulas. (author)

  14. Complications of operative treatment of injuries of peripheral arteries.

    Science.gov (United States)

    Velinovic, M M; Davidovic, B L; Lotina, I S; Vranes, R M; Djukic, L P; Arsov, J V; Ristic, V M; Kocica, J M; Petrovic, L P

    2000-06-01

    In 1991 and 1992, a total of 97 patients with 106 peripherial arterial injuries underwent surgery at the Institute for Cardiovascular Diseases, Clinical Centre of Serbia. Civilian injuries accounted for 53 (54.6%) patients (94.3% males, age range: 16-63 yr, mean: 35.2), and 44 patients had war injuries (93.2% males, age range: 19-61 yr, mean: 34.8). The injuries affected the superfitial femoral artery in 31 (29.24%); the popliteal artery in 28 (26.41%); the brachial artery in 17 (16.04%); the posterior tibial artery in 6 (5.66%); the axillary artery in 5 (4.72%); the anterior tibial artery in 5 (4.72%); the tibioperoneal trunk in 4 (3. 77%); the common femoral artery in 4 (3.77%); the external iliac artery in 2 (1.89%); the profound femoral artery in 2 (1.89%); the radial artery in 1 (0.94%); and ulnar artery in 1 (0.94%).A total of 98 reconstructive procedures were used to treat these patients. Graft interposition carried out in 50 (51.02%); by pass in 25 (25. 51%); end-to-end anastomosis in 9 (9.18%); suture in 8 (8.16%); ligation in 4 (4.08%); and patch-angioplasty in 2 (2.04%). Primary reconstruction of injured arteries was performed in 72.2% and secondary repair in 27.8% cases. Infection developed in 51 (52.57%) patients, and it was significantly (P<0.05) more common in the war injuries (70.45%) and in secondary repairs (88.89%). The presence of associated lesions (69.56%) was also correlated with a greater rate of infection. Amputation was necessary in 21 (21.65%) of our patients, and was significantly (P<0.05) more often performed after secondary (44.44%) than primary operations (12.86%) and in the presence of associated injuries (32.61%).

  15. The effect of bisphosphonates on bone mineral density in patients with ankylosing spondylitis in daily clinical practice

    NARCIS (Netherlands)

    Arends, S.; Veneberg, J.G.; Wink, F.R.; Bos, R.; Brouwer, E.; Van Der Veer, E.; Bootsma, H.; Van Roon, E.N.; Maas, F.; Spoorenberg, A.

    2016-01-01

    Background: Ankylosing spondylitis (AS) is not only characterized by excessive bone formation, but also by excessive bone loss which may lead to low bone mineral density (BMD). So far, little is known about the effect of treatment with bisphosphonates on BMD in patients with AS. Objectives: To

  16. [Chronic complications of diabetes mellitus. Recommendations from the American Diabetes Association 2011. Prevention and management].

    Science.gov (United States)

    Isla Pera, Pilar

    2012-09-01

    Diabetes mellitus (DM) is one of the diseases with greater impact public health, not only because of its high prevalence, but, above all, by the consequences of the chronic complications arising from this disease. Hyperglycemia generates damage both in the field of microcirculation and the great vessels causing injury, macroangiopathies and microangiopathies. Macroangiopathies complications are generated from alterations or injury in the great vessels of the arterial to the most important, being from the clinical point of view, ischemic heart disease, disease stroke and peripheral arterial disease. Microangiopathies complications are due to alterations or injury of small vessels being the most important, from a clinical point of view, nephropathy, retinopathy and diabetic neuropathy. Macroangiopathies complications are generated from alterations or injury in the great vessels of the arterial to the most important, being from the clinical point of view, ischemic heart disease, disease stroke and peripheral arterial disease. Microangiopathies complications are due to alterations or injury of small vessels being the most important, from a clinical point of view, nephropathy, retinopathy and diabetic neuropathy.

  17. [Clinical characteristic of patients with acute kidney injury complicated severe cardio-vascular diseases].

    Science.gov (United States)

    Wróbel, Paweł; Wyrwicz-Zielińska, Grażyna; Krzysztonek-Weber, Izabela; Sułowicz, Władysław

    2016-01-01

    Patients with cardiovascular diseases are a group of increased risk of acute kidney injury (AKI). Mortality in this group of patients with AKI, especially treated in intensive care units, is very high. The aim of this study was to evaluate the clinical characteristic of patients with AKI complicated severe cardiovascular diseases. Retrospective evaluation of 246 questionnaire of patients with AKI in the course of severe cardiovascular diseases treated in the wards of nephrological profile from the malopolska and podkarpackie voivodships in the years 2000-2011 was performed. The group of patients consisted of 157 men and 89 women, with mean age 67.9 ± 14.8 years. The most common cause of AKI were: acute decompensated heart failure--24 (9.8%), chronic decompensated heart failure--94 (38.2%), cardiac arrest--29 (11.8%), myocardial infarction--48 (19.5%), CABG--12 (4.9%), cardiac valve implantation--14 (5.7), heart transplantation--4 (1.6%) and aortic aneurysm--21 (8.5%). Age distribution of patients with AKI revealed that most numerous group had 71-80 years. The most of patients (95.9%) with AKI were treated with hemodialysis. The mortality rate in the study group was very high (69.5%). Recovery of renal function was observed in 39 (27.3%) of patients. Signs of kidney disease before AKI was noted in 116 (47.2%) of patients. Patients with severe cardiovascular complications and AKI had high mortality rate instead of performed hemodialysis treatment.

  18. Nerve injuries do occur in elbow arthroscopy

    NARCIS (Netherlands)

    Hilgersom, Nick F. J.; van Deurzen, Derek F. P.; Gerritsma, Carina L. E.; van der Heide, Huub J. L.; Malessy, Martijn J. A.; Eygendaal, Denise; van den Bekerom, Michel P. J.

    2018-01-01

    The purpose is to create more awareness as well as emphasize the risk of permanent nerve injury as a complication of elbow arthroscopy. Patients who underwent elbow arthroscopy complicated by permanent nerve injury were retrospectively collected. Patients were collected using two strategies: (1) by

  19. Special examinations in neuroradiology diagnostic of the neurological complications in atlanto axial dislocations

    International Nuclear Information System (INIS)

    Mihale, J.

    1998-01-01

    We report about contribution myelography, CT myelography, vertebral angiography and angio-cinematography, CT and MRI in diagnostic of the neurological complications of the ventral atlanto axial dislocation in 126 patients with progressive polyarthritis and ankylosing spondylarthritis. On the myelogram, and CT myelogram we visualized narrowing of the spinal channel in ventral atlanto axial dislocation. In patients with unreponibile dislocation up to the stop contrast medium between C1 and C2 vertebrae. With vertebral angiography and angio-cinematography we visualized changes in course of the arteries until with stop of the contrast medium in ante-flexion of the head in patients with unreponibile atlanto axial dislocation. On the MRI studies we visualized pathological changes in the front and back of the atlanto odontoidal joints and compression of the spinal cord. (author)

  20. Ankylosing Spondylitis Associated With Bilateral TMJ Ankylosis

    Energy Technology Data Exchange (ETDEWEB)

    Song, Ju Seop; Koh, Kwang Joon [Dept. of Oral and Maxillofacial Radiology, School of Dentistry, Chonbuk National University, Iksan (Korea, Republic of)

    2000-09-15

    A 31-year-old male with severe limitation of mouth opening was referred to our department of Chonbuk National University Hospital. The physical status of the patient was hyposthenic. Extraoral examination showed no condylar movement of the both temporomandibular joints, no pain, no faical swelling or paresthesia. Intraoral examination showed several cervical caries on the upper anterior teeth, and gingival swelling on the whole dentition. Transcranial view showed no condylar movement, and narrowing of joint spaces. Chest P-A view showed straightening of thoracic, lumbar spine, and squaring of vertebrae of the same spines. Conventional lateral radiograph of cervical spine showed calcification of the intervertebral ligament. Computed tomograph showed extensive bone formation between temporal bone and the both condylar heads. Labortory findings showed positive reaction on HLA-B27 histocompatibility antigen and increased level of IgA, IgG, ESR. Based on the clinical, radiographic, and the labortary findings, final diagnosis was made as bony ankylosis of the both temporomandibular joints secondary to ankylosing spondylitis.

  1. Eckert and Davis Grade 3 Superior Peroneal Retinaculum Injury: Treated by Endoscopic Peroneal Retinaculum Reconstruction and Complicated by Malposition of the Suture Anchors.

    Science.gov (United States)

    Lui, T H

    2015-01-01

    Eckert and Davis grade 3 superior peroneal retinaculum injury is rare and the optimal treatment is not yet determined. A 57 year-old lady sprained her left ankle resulting in grade 3 injury of the superior peroneal retinaculum and was treated by endoscopic retinaculum reconstruction. The fracture healed and the peroneal tendons were stabilized. However, it was complicated by protusion of the suture anchors into the posterolateral ankle gutter. The implants were successfully removed endoscopically. Proper selection of the size and dimension of the suture anchor and preoperative planning with computed tomogram is important for usage of suture anchors in the lateral malleolus.

  2. A discrete event modelling framework for simulation of long-term outcomes of sequential treatment strategies for ankylosing spondylitis.

    Science.gov (United States)

    Tran-Duy, An; Boonen, Annelies; van de Laar, Mart A F J; Franke, Angelinus C; Severens, Johan L

    2011-12-01

    To develop a modelling framework which can simulate long-term quality of life, societal costs and cost-effectiveness as affected by sequential drug treatment strategies for ankylosing spondylitis (AS). Discrete event simulation paradigm was selected for model development. Drug efficacy was modelled as changes in disease activity (Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)) and functional status (Bath Ankylosing Spondylitis Functional Index (BASFI)), which were linked to costs and health utility using statistical models fitted based on an observational AS cohort. Published clinical data were used to estimate drug efficacy and time to events. Two strategies were compared: (1) five available non-steroidal anti-inflammatory drugs (strategy 1) and (2) same as strategy 1 plus two tumour necrosis factor α inhibitors (strategy 2). 13,000 patients were followed up individually until death. For probability sensitivity analysis, Monte Carlo simulations were performed with 1000 sets of parameters sampled from the appropriate probability distributions. The models successfully generated valid data on treatments, BASDAI, BASFI, utility, quality-adjusted life years (QALYs) and costs at time points with intervals of 1-3 months during the simulation length of 70 years. Incremental cost per QALY gained in strategy 2 compared with strategy 1 was €35,186. At a willingness-to-pay threshold of €80,000, it was 99.9% certain that strategy 2 was cost-effective. The modelling framework provides great flexibility to implement complex algorithms representing treatment selection, disease progression and changes in costs and utilities over time of patients with AS. Results obtained from the simulation are plausible.

  3. Efficacy of golimumab in treating uveitis in patients with ankylosing spondylitis

    Directory of Open Access Journals (Sweden)

    T. V. Dubinina

    2016-01-01

    Full Text Available The paper presents the results of recent studies of the efficacy of golimumab (GLM in the treatment of uveitis in patients with ankylosing spondylitis (AS. The data obtained in these studies suggest that GLM is highly effective in relieving and preventing uveitis attacks. However, all the given studies have a number of disadvantages; primarily they have included a limited number of patients. Further prospective randomized clinical trials with large sample sizes are required to evaluate the efficacy and safety of GLM for the treatment of uveitis in patients with spondyloarthritis.

  4. Phrenic Arterial Injury Presenting as Delayed Hemothorax Complicating Simple Rib Fracture

    OpenAIRE

    Ahn, Hong Joon; Lee, Jun Wan; Kim, Kun Dong; You, In Sool

    2016-01-01

    Delayed hemothorax after blunt torso injury is rare, but might be associated with significant morbidity and mortality. We present a case of delayed hemothorax bleeding from phrenic artery injury in a 24-year-old woman. The patient suffered from multiple rib fractures on the right side, a right hemopneumothorax, thoracic vertebral injury and a pelvic bone fracture after a fall from a fourth floor window. Delayed hemothorax associated with phrenic artery bleeding, caused by a stab injury from a...

  5. STEM CELL TRANSPLANTATION AS A POSSIBLE STRATEGY FOR TREATING STANDARD THERAPY-RESISTANT ANKYLOSING SPONDYLITIS

    Directory of Open Access Journals (Sweden)

    I. Z. Gaidukova

    2016-01-01

    Full Text Available The authors have analyzed the literature dealing with studies of the efficiency and safety of stem cell transplantation (SCT in patients with ankylosing spondylitis (AS through the electronic resources Pubmed and Medline by using the keywords «bone marrow transplantation», «hematopoietic stem cell transplantation», «ankylosing spondylitis», «autoimmune diseases», and «sacroiliac joint biopsy». The paper describes four cases of SCT in AS patients, including transplantation that was carried out in one patient with lymphoma concurrent with AS, in two AS patients without blood cancers, and in one patient with AS concurrent with myeloid leukemia. Drug-free remission was achieved in 3 cases: lymphoma concurrent with AS (n=1, AS concurrent with myeloid leukemia (n=1, and AS without comorbidities (n=1. In addition to an improvement in the course of AS, there were also two cases with clinical presentations of AS after SCT. The given cases show that SCT can be basically used to induce drug-free remission in patients with severe forms of standard therapy-resistant AS. However, the introduction of SCT in clinical practice needs to adjust the technique to the specific features of AS patients. 

  6. Lower etanercept levels are associated with high disease activity in ankylosing spondylitis patients at 24 weeks of follow-up

    NARCIS (Netherlands)

    Kneepkens, E. L.; Krieckaert, C. L. M.; van der Kleij, D.; Nurmohamed, M. T.; van der Horst-Bruinsma, I. E.; Rispens, T.; Wolbink, G. J.

    2015-01-01

    Previous data have shown that etanercept levels are associated with clinical response in rheumatoid arthritis. However, for ankylosing spondylitis (AS), data regarding this topic are inconclusive. To investigate the relationship between etanercept levels and clinical response in patients with AS.

  7. Is there a preferred method for scoring activity of the spine by magnetic resonance imaging in ankylosing spondylitis?

    NARCIS (Netherlands)

    van der Heijde, Désirée; Landewé, Robert; Hermann, Kay-Geert; Rudwaleit, Martin; Østergaard, Mikkel; Oostveen, Ans; O'Connor, Phil; Maksymowych, Walter P.; Lambert, Robert G.; Lukas, Cédric; Jurik, Anne Grethe; Boers, Maarten; Baraliakos, Xenofon; Braun, Jürgen

    2007-01-01

    This report summarizes the discussion during a module update at OMERACT 8 on scoring methods for activity in the spine on magnetic resonance imaging. The conclusion was that the 3 available scoring methods are all very good with respect to discrimination and feasibility: the Ankylosing Spondylitis

  8. Traumatic brain injury in England and Wales: prospective audit of epidemiology, complications and standardised mortality.

    Science.gov (United States)

    Lawrence, T; Helmy, A; Bouamra, O; Woodford, M; Lecky, F; Hutchinson, P J

    2016-11-24

    To provide a comprehensive assessment of the management of traumatic brain injury (TBI) relating to epidemiology, complications and standardised mortality across specialist units. The Trauma Audit and Research Network collects data prospectively on patients suffering trauma across England and Wales. We analysed all data collected on patients with TBI between April 2014 and June 2015. Data were collected on patients presenting to emergency departments across 187 hospitals including 26 with specialist neurosurgical services, incorporating factors previously identified in the Ps14 multivariate logistic regression (Ps14 n ) model multivariate TBI outcome prediction model. The frequency and timing of secondary transfer to neurosurgical centres was assessed. We identified 15 820 patients with TBI presenting to neurosurgical centres directly (6258), transferred from a district hospital to a neurosurgical centre (3682) and remaining in a district general hospital (5880). The commonest mechanisms of injury were falls in the elderly and road traffic collisions in the young, which were more likely to present in coma. In severe TBI (Glasgow Coma Score (GCS) ≤8), the median time from admission to imaging with CT scan is 0.5 hours. Median time to craniotomy from admission is 2.6 hours and median time to intracranial pressure monitoring is 3 hours. The most frequently documented complication of severe TBI is bronchopneumonia in 5% of patients. Risk-adjusted W scores derived from the Ps14 n model indicate that no neurosurgical unit fell outside the 3 SD limits on a funnel plot. We provide the first comprehensive report of the management of TBI in England and Wales, including data from all neurosurgical units. These data provide transparency and suggests equity of access to high-quality TBI management provided in England and Wales. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  9. Posterior Cruciate Ligament Injury

    Science.gov (United States)

    ... your knee is bent also can cause this injury. Risk factors Being in a motor vehicle accident and participating in sports such as football and soccer are the most common risk factors for a PCL injury. Complications In ...

  10. Responsiveness of the Ankylosing Spondylitis Disease Activity Score (ASDAS) and clinical and MRI measures of disease activity in a 1-year follow-up study of patients with axial spondyloarthritis treated with tumour necrosis factor alpha inhibitors

    DEFF Research Database (Denmark)

    Pedersen, Susanne Juhl; Sørensen, Inge Juul; Hermann, Kay-Geert A

    2010-01-01

    To investigate construct validity and responsiveness of the novel ankylosing spondylitis (AS) disease activity score (ASDAS) in patients with spondyloarthritis (SpA).......To investigate construct validity and responsiveness of the novel ankylosing spondylitis (AS) disease activity score (ASDAS) in patients with spondyloarthritis (SpA)....

  11. Complications after orthognathic surgery: our experience on 423 cases.

    Science.gov (United States)

    Friscia, Marco; Sbordone, Carolina; Petrocelli, Marzia; Vaira, Luigi Angelo; Attanasi, Federica; Cassandro, Francesco Maria; Paternoster, Mariano; Iaconetta, Giorgio; Califano, Luigi

    2017-06-01

    Orthognathic surgery is widely used to correct dentofacial discrepancies. However, this procedure presents numerous possible complications. The aim of our study is to review intraoperative and postoperative complications related to orthognathic surgery based upon a 10-year period in the Maxillofacial Surgery Department of Federico II University of Naples. Medical records of 423 patients who undergone orthognathic surgery in a 10-year period were retrospectively analyzed and complications was noted. Statistical analysis was conduced in order to understand if the type of surgical procedure influenced complications rate. One hundred eighty-five complications in 143 (33.8%) of the 423 treated patients were reported. Complications detected were nerve injury (49 cases, 11.9%), infections (10 cases, 2.4%), complications related to fixation plates or screws (30 cases, 7.1%), bad split osteotomy (8 cases, 1.9%), secondary temporo-mandibular joint disorders (36 cases, 8.5%), dental injuries (21 cases, 5%), condilar resorption (2 cases, 0.5%), and necessity of a second-time surgery (24 cases, 5.7%). Serious complications seem to be quite rare in orthognathic surgery. Some of the surgical complications found are related to the surgeon experience and not strictly to the risks of the operation itself. Understanding potential complications allows the surgeon to guarantee safe care through early intervention and correctly inform the patient in the preoperative colloquy.

  12. Multicenter validation of the value of BASFI and BASDAI in Chinese ankylosing spondylitis and undifferentiated spondyloarthropathy patients

    Science.gov (United States)

    Lin, Zhiming; He, Peigen; Gao, Jiesheng; Zuo, Xiaoxia; Ye, Zhizhong; Shao, Fengmin; Zhan, Feng; Lin, Jinying; Li, Li; Wei, Yanlin; Xu, Manlong; Liao, Zetao; Lin, Qu

    2009-01-01

    The objectives of this study were to evaluate the reliability of Bath ankylosing spondylitis functional index (BASFI) and Bath ankylosing spondylitis disease activity index (BASDAI) in Chinese ankylosing spondylitis (AS) and undifferentiated spondyloarthropathy (USpA) patients. 664 AS patients by the revised New York criteria for AS and 252 USpA patients by the European Spondyloarthropathy Study Group criteria were enrolled. BASDAI and BASFI questionnaires were translated into Chinese. Participants were required to fill in BASFI and BASDAI questionnaires again after 24 h. Moreover, BASDAI and BASFI were compared in AS patients receiving Enbrel or infliximab before and after treatment. For AS group, BASDAI ICC: 0.9502 (95% CI: 0.9330–0.9502, α = 0.9702), BASFI ICC: 0.9587 (95% CI: 0.9521–0.9645, α = 0.9789). For USpA group, BASDAI ICC: 0.9530 (95% CI: 0.9402–0.9632, α = 0.9760), BASFI ICC: 0.9900 (95% CI: 0.9871–0.9922, α = 0.9950). In the AS group, disease duration, occipital wall distance, modified Schober test, chest expansion, ESR, and CRP showed significant correlation with BASDAI and BASFI (all P < 0.01). In the USpA group, onset age, ESR, and CRP were significantly correlated with BASDAI (all P < 0.05), while modified Schober test, ESR, and CRP were significantly associated with BASFI (all P < 0.05). The change in BASDAI and BASFI via Enbrel or infliximab treatment showed a significant positive correlation (P < 0.01). The two instruments have good reliability and reference value regarding the evaluation of patient’s condition and anti-TNF-α treatment response. PMID:20012866

  13. [Late respiratory function complications following burns].

    Science.gov (United States)

    Ernesto, S; Marduel, Y; Freymond, N; Pacheco, Y; Devouassoux, G

    2008-03-01

    Twenty five per cent of thermal injuries are associated with secondary respiratory events linked to several mechanisms. In the acute phase of the accident oedema of the airways, the fume inhalation syndrome and ARDS are the most common causes responsible for death in 60% of cases. Late respiratory complications are little known and neglected. They comprise obstructive ventilatory defects due to the inhalation syndrome and restrictive defects secondary to ARDS or to dermal injury. We report the case of a female patient, extensively burnt 2 years previously, admitted to hospital with severe acute respiratory failure complicating COPD. The presence of both restrictive and obstructive defects led to the suggestion of alternative underlying mechanisms such as the pulmonary consequences of ARDS and extensive dermal scars. The latter were responsible for an armour like thickening of the skin of the thorax compatible with the restrictive defect. These functional abnormalities and the potential severity of acute respiratory failure are indications for regular pulmonary follow-up of patients with severe circumferential scarring of the thorax who are at high risk for respiratory complications.

  14. Pregabalin for Opioid-Refractory Pain in a Patient with Ankylosing Spondylitis

    Directory of Open Access Journals (Sweden)

    Konstantinos A. Kontoangelos

    2013-01-01

    Full Text Available Background. Ankylosing spondylitis (AS is a systemic inflammatory disease with chronic back pain as the most common presenting symptom. We present a case of a male patient with AS reporting symptoms of severe low back pain, buttock pain, and limited spinal mobility. After chronic treatment with opioids, we administered pregabalin at a dose of 300 mg as an analgesic agent while opioids were discontinued. Findings. Pain symptoms improved progressively, and opioids were gradually discontinued without any withdrawal symptoms reported. Conclusions. Pregabalin is potentially useful in the management of pain in patients with AS while effectively managing the discontinuation of opioid treatment.

  15. Temporomandibular joint ankylosis in ankylosing spondylitis: A case report and review of literature

    Directory of Open Access Journals (Sweden)

    Nishtha Gupta

    2016-01-01

    Full Text Available Ankylosing spondylitis (AS is a chronic systemic inflammatory disorder. It primarily affects the axial skeleton through involvement of the peripheral joint scan occurs. Temporomandibular joint (TMJ involvement in AS varies from 4% to 35%. Here, we present a case of a 35-year-old male, follow-up of AS from last 8 years on nonsteroidal anti-inflammatory drugs, presented with fresh complaints of painfully restricted movements of jaw during swallowing. Computer tomography of patient demonstrates articular cartilage changes with disc and joint abnormalities.

  16. Complications of shoulder arthroscopy.

    Science.gov (United States)

    Moen, Todd C; Rudolph, Glen H; Caswell, Kyle; Espinoza, Christopher; Burkhead, Wayne Z; Krishnan, Sumant G

    2014-07-01

    Over the past 20 to 30 years, arthroscopic shoulder techniques have become increasingly popular. Although these techniques have several advantages over open surgery, surgical complications are no less prevalent or devastating than those associated with open techniques. Some of the complications associated with arthroscopic shoulder surgery include recurrent instability, soft-tissue injury, and neurapraxia. These complications can be minimized with thoughtful consideration of the surgical indications, careful patient selection and positioning, and a thorough knowledge of the shoulder anatomy. Deep infection following arthroscopic shoulder surgery is rare; however, the shoulder is particularly susceptible to Propionibacterium acnes infection, which is mildly virulent and has a benign presentation. The surgeon must maintain a high index of suspicion for this infection. Thromboemoblic complications associated with arthroscopic shoulder techniques are also rare, and studies have shown that pharmacologic prophylaxis has minimal efficacy in preventing these complications. Because high-quality studies on the subject are lacking, minimal evidence is available to suggest strategies for prevention. Copyright 2014 by the American Academy of Orthopaedic Surgeons.

  17. Nerve injuries do occur in elbow arthroscopy.

    Science.gov (United States)

    Hilgersom, Nick F J; van Deurzen, Derek F P; Gerritsma, Carina L E; van der Heide, Huub J L; Malessy, Martijn J A; Eygendaal, Denise; van den Bekerom, Michel P J

    2018-01-01

    The purpose is to create more awareness as well as emphasize the risk of permanent nerve injury as a complication of elbow arthroscopy. Patients who underwent elbow arthroscopy complicated by permanent nerve injury were retrospectively collected. Patients were collected using two strategies: (1) by word-of-mouth throughout the Dutch Society of Shoulder and Elbow Surgery, and the Leiden University Nerve Centre, and (2) approaching two medical liability insurance companies. Medical records were reviewed to determine patient characteristics, disease history and postoperative course. Surgical records were reviewed to determine surgical details. A total of eight patients were collected, four men and four women, ageing 21-54 years. In five out of eight patients (62.5%), the ulnar nerve was affected; in the remaining three patients (37.5%), the radial nerve was involved. Possible causes for nerve injury varied among patients, such as portal placement and the use of motorized instruments. A case series on permanent nerve injury as a complication of elbow arthroscopy is presented. Reporting on this sequel in the literature is little, however, its risk is not to be underestimated. This study emphasizes that permanent nerve injury is a complication of elbow arthroscopy, concurrently increasing awareness and thereby possibly aiding to prevention. IV, case series.

  18. Costs and quality of life of patients with ankylosing spondylitis in Hong Kong.

    Science.gov (United States)

    Zhu, T Y; Tam, L-S; Lee, V W-Y; Hwang, W W; Li, T K; Lee, K K; Li, E K

    2008-09-01

    To assess the annual direct, indirect and total societal costs, quality of life (QoL) of AS in a Chinese population in Hong Kong and determine the cost determinants. A retrospective, non-randomized, cross-sectional study was performed in a cohort of 145 patients with AS in Hong Kong. Participants completed questionnaires on sociodemographics, work status and out-of-pocket expenses. Health resources consumption was recorded by chart review. Functional impairment and disease activity were measured using the Bath Ankylosing Spondylitis Functional Index (BASFI) and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), respectively. Patients' QoL was assessed using the Short Form-36 (SF-36). The mean age of the patients was 40 yrs with mean disease duration of 10 yrs. The mean BASDAI score was 4.7 and BASFI score was 3.3. Annual total costs averaged USD 9120. Direct costs accounted for 38% of the total costs while indirect costs accounted for 62%. Costs of technical examinations represented the largest proportion of total cost. Patients with AS reported significantly impaired QoL. Functional impairment became the major cost driver of direct costs and total costs. There is a substantial societal cost related to the treatment of AS in Hong Kong. Functional impairment is the most important cost driver. Treatments that reduce functional impairment may be effective to decrease the costs of AS and improve the patient's QoL, and ease the pressure on the healthcare system.

  19. Conservative treatment of an ankylosed tooth after delayed replantation: a case report.

    Science.gov (United States)

    Díaz, Jaime Andrés; Sandoval, Hector Paulo; Pineda, Patricia Irene; Junod, Pablo Antonio

    2007-10-01

    An 8-year-old boy sustained avulsion of his upper right maxillary central incisor and lateral luxation of his upper left maxillary incisors. Subsequently, the upper right maxillary central incisor developed replacement resorption, and both upper left maxillary incisors developed pulpal canal obliteration. In the ankylosed tooth, decoronation procedure was performed, and in the 44-month follow-up period the involved alveolar site showed vertical apposition of bone and continuing replacement resorption. Decoronation is a surgical procedure that allows preservation of the bone volume for the future, avoiding aesthetic disturbances and more aggressive treatments in cases where other therapeutic alternatives are not feasible.

  20. Role of Adipokines in Atherosclerosis: Interferences with Cardiovascular Complications in Rheumatic Diseases

    Science.gov (United States)

    Scotece, Morena; Conde, Javier; Gómez, Rodolfo; López, Verónica; Pino, Jesús; González, Antonio; Lago, Francisca; Gómez-Reino, Juan J.; Gualillo, Oreste

    2012-01-01

    Patients with rheumatic diseases have an increased risk of mortality by cardiovascular events. In fact, several rheumatic diseases such as rheumatoid arthritis, osteoarthritis, systemic lupus erythematosus, and ankylosing spondylitis are associated with a higher prevalence of cardiovascular diseases (CVDs). Although traditional cardiovascular risk factors have been involved in the pathogenesis of cardiovascular diseases in rheumatic patients, these alterations do not completely explain the enhanced cardiovascular risk in this population. Obesity and its pathologic alteration of fat mass and dysfunction, due to an altered pattern of secretion of proinflammatory adipokines, could be one of the links between cardiovascular and rheumatic diseases. Indeed, the incidence of CVDs is augmented in obese individuals with rheumatic disorders. Thus, in this paper we explore in detail the relationships among adipokines, rheumatic diseases, and cardiovascular complications by giving to the reader a holistic vision and several suggestions for future perspectives and potential clinical implications. PMID:22910888

  1. Construction and analysis of protein-protein interaction network correlated with ankylosing spondylitis.

    Science.gov (United States)

    Kanwal, Attiya; Fazal, Sahar

    2018-01-05

    Ankylosing spondylitis, a systemic illness is a foundation of progressing joint swelling that for the most part influences the spine. However, it frequently causes aggravation in different joints far from the spine, and in addition organs, for example, the eyes, heart, lungs, and kidneys. It's an immune system ailment that may be activated by specific sorts of bacterial or viral diseases that initiate an invulnerable reaction that don't close off after the contamination is recuperated. The particular reason for ankylosing spondylitis is obscure, yet hereditary qualities assume a huge part in this condition. The rising apparatuses of network medicine offer a stage to investigate an unpredictable illness at framework level. In this study, we meant to recognize the key proteins and the biological regulator pathways including in AS and further investigating the molecular connectivity between these pathways by the topological examination of the Protein-protein communication (PPI) system. The extended network including of 93 nodes and have 199 interactions respectively scanned from STRING database and some separated small networks. 24 proteins with high BC at the threshold of 0.01 and 55 proteins with large degree at the threshold of 1 have been identified. CD4 with highest BC and Closeness centrality located in the centre of the network. The backbone network derived from high BC proteins presents a clear and visual overview which shows all important regulatory pathways for AS and the crosstalk between them. The finding of this research suggests that AS variation is orchestrated by an integrated PPI network centered on CD4 out of 93 nodes. Ankylosing spondylitis, a systemic disease is an establishment of advancing joint swelling that generally impacts the spine. Be that as it may, it as often as possible causes disturbance in various joints a long way from the spine, and what's more organs. It's a resistant framework affliction that might be actuated by particular sorts

  2. Surfing-related ocular injuries.

    Science.gov (United States)

    Kim, J W; McDonald, H R; Rubsamen, P E; Luttrull, J K; Drouilhet, J H; Frambach, D A; Boyer, D S; Lambrou, F H; Hendrick, A; Weiss, J N; Engstrom, R E; Ing, M

    1998-01-01

    This report evaluates the clinical characteristics of surfing-related ocular trauma to learn the nature of such injuries and propose possible preventive measures. The authors reviewed 11 cases of surfing-related eye injuries caused by direct trauma from the surfboard, studying their mechanism of injury, the associated ocular complications, and the anatomic and visual outcomes of surgical repair. Surfing-related ocular injuries occurred exclusively in young males (mean age, 24.8 years; range, 14-37 years). The mechanism of injury most frequently responsible was impact with the sharp nose of the surfboard following a fall. Serious posterior segment complications were observed in all 11 patients, with nine patients suffering ruptured globes. Despite immediate medical attention, five patients did not recover ambulatory levels of visual acuity (>5/200). Surfing-related ocular trauma presenting to the retinal specialist typically leaves the patient with a permanent visual disability. Important factors contributing to these high-velocity injuries include the sharply pointed nose of the surfboard and the leash keeping the surfer in close proximity to the board following a fall. A simple modification in surfboard design such as blunting the sharp nose of the surfboard, or appropriate protective guards fitted over the surfboard nose, should lessen the severity of such injuries.

  3. Complications of the use of trans-osseous wire osteosynthesis in the ...

    African Journals Online (AJOL)

    variables were age, gender, aetiology, time lag between injury and treatment, and concomitant mandibular and ... The outcome variable was the development of complication(s) after treatment. .... mandibular right angle and left body fractures.

  4. Can erosions on MRI of the sacroiliac joints be reliably detected in patients with ankylosing spondylitis? - A cross-sectional study

    DEFF Research Database (Denmark)

    Weber, Ulrich; Pedersen, Susanne J; Østergaard, Mikkel

    2012-01-01

    Erosions of the sacroiliac joints (SIJ) on pelvic radiographs of patients with ankylosing spondylitis (AS) are an important feature of the modified New York classification criteria. However, radiographic SIJ erosions are often difficult to identify. Recent studies have shown that erosions can...

  5. Effect of remote cesarean delivery on complications during hysterectomy: a cohort study.

    Science.gov (United States)

    Hesselman, Susanne; Högberg, Ulf; Jonsson, Maria

    2017-11-01

    Cesarean delivery is performed frequently worldwide, and follow-up studies that report complications at subsequent surgery are warranted. The aim of the study was to investigate the association between a previous abdominal delivery and complications during a subsequent hysterectomy and to estimate the fraction of complications that are driven by the presence of adhesions. This was a longitudinal population-based register study of 25354 women who underwent a benign hysterectomy at 46 hospital units in Sweden 2000-2014. Adhesions were found in 45% of the women with a history of cesarean delivery. Organ injury affected 2.2% of the women. The risk of organ injury (adjusted odds ratio, 1.74; 95% confidence interval, 1.41-2.15) and postoperative infection (adjusted odds ratio, 1.26; 95% confidence interval, 1.15-1.39) was increased with previous cesarean delivery, irrespective of whether adhesions were present or not. The direct effect on organ injury by a personal history of cesarean delivery was estimated to 73%, and only 27% was mediated by the presence of adhesions. Previous cesarean delivery was a predictor of bladder injury (adjusted odds ratio, 1.86; 95% confidence interval, 1.40-2.47) and bowel injury (adjusted odds ratio, 1.83; 95% confidence interval, 1.10-3.03), but not ureter injury. A personal history of other abdominal surgeries was associated with bowel injury (adjusted odds ratio, 2.27; 95% confidence interval, 1.37-3.78), and the presence of endometriosis increased the risk of ureter injury (adjusted odds ratio, 2.15; 95% confidence interval, 1.34-3.44). Previous cesarean delivery is associated with an increased risk of complications during a subsequent hysterectomy, but the risk is only partly attributable to the presence of adhesions. Previous cesarean delivery and presence of endometriosis were major predisposing factors of organ injury at the time of the hysterectomy, whereas background and perioperative characteristics were of minor importance

  6. Leukocytoclastic Vasculitis in a Patient with Ankylosing Spondylitis

    Directory of Open Access Journals (Sweden)

    Senol Kobak

    2014-01-01

    Full Text Available A 26-year-old male patient presented to our rheumatology clinic with pain, swelling and limitation of movement in his right ankle, and also purpuric skin lesions in the lower extremity pretibial region. He was asked questions, and he said that he had been having chronic low back pain and morning stiffness for the last few years. His physical examination revealed that he had arthritis in his right ankle, purpuric skin lesions in pretibial regions of both legs, and bilateral FABERE/FADIR positivity. The sacroiliac joint imaging and MRI revealed bilateral sacroiliitis findings, and the lateral heel imaging revealed enthesitis. HLA-B27 was positive. Skin biopsy from lower skin lesions was reported to be consistent with leukocytoclastic vasculitis. Based on clinical, laboratory, radiological, and pathological examinations, the patient was diagnosed with ankylosing spondylitis and leukocytoclastic vasculitis. Administration of corticosteroid, salazopyrin, and nonsteroid anti-inflammatory medications was started. Notable clinical and laboratory regression was observed during his checks 3 months later.

  7. Phrenic Arterial Injury Presenting as Delayed Hemothorax Complicating Simple Rib Fracture.

    Science.gov (United States)

    Ahn, Hong Joon; Lee, Jun Wan; Kim, Kun Dong; You, In Sool

    2016-04-01

    Delayed hemothorax after blunt torso injury is rare, but might be associated with significant morbidity and mortality. We present a case of delayed hemothorax bleeding from phrenic artery injury in a 24-year-old woman. The patient suffered from multiple rib fractures on the right side, a right hemopneumothorax, thoracic vertebral injury and a pelvic bone fracture after a fall from a fourth floor window. Delayed hemothorax associated with phrenic artery bleeding, caused by a stab injury from a fractured rib segment, was treated successfully by a minimally invasive thoracoscopic surgery. Here, we have shown that fracture of a lower rib or ribs might be accompanied by delayed massive hemothorax that can be rapidly identified and promptly managed by thoracoscopic means.

  8. A successful therapy for severe malaria accompanied by malaria-related acute kidney injury (MAKI) complications: a case report

    Science.gov (United States)

    Syahputra, A.; Siregar, M. L.; Jamil, K. F.

    2018-03-01

    Indonesia is an endemic malaria country with high levels of morbidity and mortality. In Aceh, by the end of 2016, based on the data from Annual Parasite Incidence, the incidence rate was 0.1 per 1.000 population at risk of malaria. One of severe malaria complications is malaria-related acute kidney injury(MAKI). The death increasesthreefold by the presence of MAKI. A 56 years old male farmer was a resident in Buketmeuh village, Meukek, South Aceh, Indonesia, which was an endemic malaria area. He hadfever for seven days, chills, sweating, joint pain, headache, nausea, vomit, yellow eyes and raved. Concentrated tea-colored urineduring four days before hospital admission with a small amount of urine of 200 cc in 24 hours. The diagnosis established based on the Plasmodium vivax trophozoite finding in the blood smear examination, and the severe malaria clinical descriptions such as black water fever (BWF)with MAKI complications. Artemether injection therapy followed by oral primaquine, dihydroartemisinin and piperaquine phosphate (DHP) and hemodialysis provide a good outcome.

  9. Is there a relation between pre-sarcopenia, sarcopenia, cachexia and osteoporosis in patients with ankylosing spondylitis?

    Science.gov (United States)

    El Maghraoui, Abdellah; Ebo'o, François Bertin; Sadni, Siham; Majjad, Abderrahim; Hamza, Toufik; Mounach, Aziza

    2016-07-11

    Osteoporosis is a well-known complication of ankylosing spondylitis (AS). However, data about body composition modifications and muscle performance showed conflicting results. The aim of the study was to determine the prevalence and risk factors of pre-sarcopenia, sarcopenia and cachexia in patients with AS and analyze its relationship with bone loss and symptomatic and severity parameters of the disease. Sixty-seven consecutive male patients with AS (mean age of 40.9 ± 11.0 years) and 67 healthy controls were studied. Body composition and bone mineral density (BMD) scans were obtained using DXA. The fat-free mass index (FFMI; fat-free mass divided by height squared) and the percent of fat mass (%FM) were calculated. Pre-sarcopenia was defined by low skeletal muscle mass (SMI 10 s) and cachexia by a BMI 5 mg/l, SMI cachexia, and osteoporosis prevalences were (50.4, 34.3, 11.9, and 16.0) respectively. Patients had a mean 3 kg significant decrease in FFM and a 1 kg/m(2) decrease in appendicular mass vs. healthy controls. Pre-sarcopenia, sarcopenia and cachexia were significantly associated to higher BASDAI levels and low BMD. Our study showed that men with AS had a statistically significant reduction in total and appendicular lean mass that is related to higher disease activity and significantly associated to bone loss.

  10. Infectious complications after vehicular trauma in the United States.

    Science.gov (United States)

    Fraser, Douglas R; Dombrovskiy, Viktor Y; Vogel, Todd R

    2011-08-01

    The purpose of this analysis was to evaluate and define the rates of infectious complications (IC) after vehicular trauma. Secondary goals were to identify the injuries associated with the greatest risk of nosocomial infection and to measure the utilization of hospital resources associated with IC and vehicular trauma. A secondary analysis of the Nationwide Inpatient Sample (2003-2007) was performed to classify major vehicular trauma injuries utilizing International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Emergency (E) codes. The post-traumatic IC evaluated were pneumonia, urinary tract infection (UTI), sepsis, and surgical site infection (SSI). All data were analyzed by χ(2) analysis, multivariable logistic regression, and the Cochran-Armitage test for trends. A total of 784,037 vehicular trauma patients were identified (462,543 [59.0%] motor vehicle drivers, 142,283 [18.2%] motor vehicle passengers, 98,767 [12.6%] motorcyclists; 6,568 [colon injuries. After adjustment by age, sex, and co-morbidities, patients with SCI were 4.4 times as likely (95% confidence interval [CI] 4.20-4.63) and those with cranial injuries were 2.1 times as likely (95% CI 2.06-2.19) to develop IC as patients without these injuries. Secondary infection increased significantly the length of stay and hospital charges in all groups. Patients sustaining vehicular trauma in combination with SCI had the highest rate of IC. Infectious complications increased hospital resource utilization significantly after vehicular trauma. Future root-cause analysis of high-risk groups may decrease complications and hospital utilization.

  11. Chronic low backache and stiffness may not be due ankylosing spondylitis.

    Science.gov (United States)

    Ahmed, Shahid; Shah, Zahir; Ali, Nadir

    2010-08-01

    A 38 years old man presented with 2 years history of low backache and progressively increasing stiffness of the spine. Movements were restricted at lumbar spine due to stiffness especially forward flexion was markedly reduced. He was suspected to be suffering from ankylosing spondylitis. There was no tenderness over sacroiliac joints or lumbar spine. Yellowish green Ochronotic pigmentation of cartilage of ears was noted. Radiographs of lumbar and thoracic spine revealed narrowing of inter-vertebral spaces with calcification of intervertebral discs. Homogentisic acid was present in the patient's urine sample, suggesting him to be suffering from Alkaptonuria. Patient is being managed with non steroidal anti-inflammatory drugs and vitamin C, 1g daily.

  12. Complications of mechanical ventilation

    Directory of Open Access Journals (Sweden)

    Drašković Biljana

    2011-01-01

    Full Text Available Mechanical ventilation of the lungs, as an important therapeutic measure, cannot be avoided in critically ill patients. However, when machines take over some of vital functions there is always a risk of complications and accidents. Complications associated with mechanical ventilation can be divided into: 1 airway-associated complications; 2 complications in the response of patients to mechanical ventilation; and 3 complications related to the patient’s response to the device for mechanical ventilation. Complications of artificial airway may be related to intubation and extubation or the endotracheal tube. Complications of mechanical ventilation, which arise because of the patient’s response to mechanical ventilation, may primarily cause significant side effects to the lungs. During the last two decades it was concluded that mechanical ventilation can worsen or cause acute lung injury. Mechanical ventilation may increase the alveolar/capillary permeability by overdistension of the lungs (volutrauma, it can exacerbate lung damage due to the recruitment/derecruitment of collapsed alveoli (atelectrauma and may cause subtle damages due to the activation of inflammatory processes (biotrauma. Complications caused by mechanical ventilation, beside those involving the lungs, can also have significant effects on other organs and organic systems, and can be a significant factor contributing to the increase of morbidity and mortality in critically ill of mechanically ventilated patients. Complications are fortunately rare and do not occur in every patient, but due to their seriousness and severity they require extensive knowledge, experience and responsibility by health-care workers.

  13. Lumbosacral Plexus Injury and Brachial Plexus Injury Following Prolonged Compression

    Directory of Open Access Journals (Sweden)

    Chung-Lan Kao

    2006-11-01

    Full Text Available We report the case of a 36-year-old woman who developed right upper and lower limb paralysis with sensory deficit after sedative drug overdose with prolonged immobilization. Due to the initial motor and sensory deficit pattern, brachial plexus injury or C8/T1 radiculopathy was suspected. Subsequent nerve conduction study/electromyography proved the lesion level to be brachial plexus. Painful swelling of the right buttock was suggestive of gluteal compartment syndrome. Elevation of serum creatine phosphokinase and urinary occult blood indicated rhabdomyolysis. The patient received medical treatment and rehabilitation; 2 years after the injury, her right upper and lower limb function had recovered nearly completely. As it is easy to develop complications such as muscle atrophy and joint contracture during the paralytic period of brachial plexopathy and lumbosacral plexopathy, early intervention with rehabilitation is necessary to ensure that the future limb function of the patient can be recovered. Our patient had suspected gluteal compartment syndrome that developed after prolonged compression, with the complication of concomitant lumbosacral plexus injury and brachial plexus injury, which is rarely reported in the literature. A satisfactory outcome was achieved with nonsurgical management.

  14. Surgical orodental implications in ankylosing spondylitis

    Directory of Open Access Journals (Sweden)

    Mohammad Mehdizadeh

    2012-01-01

    Full Text Available Temporomandibular joint and the pelvic complex are bidirectionally related. Ankylosing spondylitis (AS is a seronegative arthropathy with the key feature of bony fusion of lumbar vertebrae. A 39 year old known case of AS was presented to private office for left lower impacted third molar surgical removal. Previously, he was rejected to receive oral care for pulpectomy and extraction due to limited mouth opening. Prior to the surgery, lateral neck radiography was obtained to exclude any subluxation of fracture of cervical vertebrae. Neck was supported to insure neck stability during surgical forces. In addition, considering consumption of immunosuppressive medications including corticosteroids, procedure was performed with a great care, with attention to higher possibility of infection and fracture. Access to the surgical site was not desirable, though surgery accomplished without any significant event and the patient discharged with routine analgesic and antibiotics recommendation. Sometimes, impaired access to the oral cavity in patients with AS leads to receive suboptimal or minimal orodental care. Long list of dental implications in these patients may be simplified by considering of careful neck and jaw support, applying at least possible forces and great attention to the infection control rules. It is wised to be performed under patient and skilled hands.

  15. Correlation of serum MMP3 and other biomarkers with clinical outcomes in patients with ankylosing spondylitis: A pilot study

    Science.gov (United States)

    The studies aimed to assess a set of biomarkers for their correlations with disease activity/severity of patients with ankylosing spondylitis (AS). A total of 24 AS patients were treated with etanercept and prospectively followed for 12 weeks. Serum levels of TNF-alpha, IFN-gamma, TGF-beta, IL6, IL1...

  16. Trauma: Spinal Cord Injury.

    Science.gov (United States)

    Eckert, Matthew J; Martin, Matthew J

    2017-10-01

    Injuries to the spinal column and spinal cord frequently occur after high-energy mechanisms of injury, or with lower-energy mechanisms, in select patient populations like the elderly. A focused yet complete neurologic examination during the initial evaluation will guide subsequent diagnostic procedures and early supportive measures to help prevent further injury. For patients with injury to bone and/or ligaments, the initial focus should be spinal immobilization and prevention of inducing injury to the spinal cord. Spinal cord injury is associated with numerous life-threatening complications during the acute and long-term phases of care that all acute care surgeons must recognize. Published by Elsevier Inc.

  17. Rate of perioperative neurological complications after surgery for cervical spinal cord stimulation.

    Science.gov (United States)

    Chan, Andrew K; Winkler, Ethan A; Jacques, Line

    2016-07-01

    OBJECTIVE Cervical spinal cord stimulation (cSCS) is used to treat pain of the cervical region and upper extremities. Case reports and small series have shown a relatively low risk of complication after cSCS, with only a single reported case of perioperative spinal cord injury in the literature. Catastrophic cSCS-associated spinal cord injury remains a concern as a result of underreporting. To aid in preoperative counseling, it is necessary to establish a minimum rate of spinal cord injury and surgical complication following cSCS. METHODS The Nationwide Inpatient Sample (NIS) is a stratified sample of 20% of all patient discharges from nonfederal hospitals in the United States. The authors identified discharges with a primary procedure code for spinal cord stimulation (ICD-9 03.93) associated with a primary diagnosis of cervical pathology from 2002 to 2011. They then analyzed short-term safety outcomes including the presence of spinal cord injury and neurological, medical, and general perioperative complications and compared outcomes using univariate analysis. RESULTS Between 2002 and 2011, there were 2053 discharges for cSCS. The spinal cord injury rate was 0.5%. The rates of any neurological, medical, and general perioperative complications were 1.1%, 1.4%, and 11.7%, respectively. There were no deaths. CONCLUSIONS In the largest series of cSCS, the risk of spinal cord injury was higher than previously reported (0.5%). Nonetheless, this procedure remains relatively safe, and physicians may use these data to corroborate the safety of cSCS in an appropriately selected patient population. This may become a key treatment option in an increasingly opioid-dependent, aging population.

  18. [Juvenile-onset ankylosing spondylitis].

    Science.gov (United States)

    Menkes, C J; Job-Deslandre, C; Feldmann, J L

    1984-02-16

    Ankylosing spondylitis (AS) with juvenile onset (under 17 years of age) is not infrequent. Thirty-six cases were studied, amounting to 18% of patients hospitalized between 1977 and 1981. The following criteria were used for diagnosis: radiologic sacroiliitis (typical AS), presence of HLA B27 and/or pelvic or vertebral clinical manifestations (possible AS). 31 patients (85%) were boys. Mean age at onset was 12.3 +/- 2.8 years. In three cases, AS was found in a member of the family of the propositus and in one case there was cutaneous psoriasis. Usually (29 cases) onset was in the lower limbs: arthritis of the knee (14 cases), hip (9 cases), ankle (7 cases) or painful heel (4 cases). During the course (with a mean follow-up of 11.2 +/- 7 years), 35 patients exhibited peripheral joint diseases and 25 had axial involvement. Ocular involvement was present in 5 cases. 10 patients had a modification of respiratory function. Radiologic sacroiliitis was found in 31 patients but with a delay of 5.3 +/- 2.6 years. Vertebral radiologic lesions were only seen in 11 patients. Radiologic hip involvement was frequent (20 cases) with complete destruction in 6 patients. Erosion and ossification of the calcaneum were observed in 15 cases. The ESR was above 20 mm/first hour in 26 cases (72%). 81% of these patients were HLA B27 positive. Functional prognosis was good: 16 patients (51.6%) led an almost normal life, 6 were bedridden (Steinbrocker's grade IV), 3 had severe impairment (grade III) and 6 had slight impairment (grade II).(ABSTRACT TRUNCATED AT 250 WORDS)

  19. Expression of uncarboxylated matrix Gla protein in ankylosing spondylitis and its significance

    Directory of Open Access Journals (Sweden)

    Han-qing HUANG

    2013-07-01

    Full Text Available Objective To investigate the serum level of uncarboxylated matrix Gla protein (ucMGP in ankylosing spondylitis (AS patients, and to evaluate its diagnostic value and the relation of ucMGP to inflammation and ossification process in AS. Methods Eight-two AS patients and 76 healthy controls were enrolled in this randomized controlled study. The clinical indices (age, gender, course of disease, disease activity, changes in radiographic studies, and indices of bone metabolism or inflammation, including erythrocyte sedimentation rate (ESR, C-reactive protein (CRP, osteocalcin (OC, and bone-specific alkaline phosphatase (BALP were evaluated or measured. The disease activity was assessed by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI, and changes in radiographic pictures were evaluated according to the modified Stoke AS Spine Score (mSASSS, and serum level of ucMGP was measured by a competitive ELISA. The relationship between ucMGP and clinical indexes, radiographic scoring, indices in bone metabolism or inflammation was estimated by SPSS software, and the diagnostic value of ucMGP was analyzed by receiver operator characteristic (ROC curve. Results The levels of ESR and CRP in AS patients were higher than those in healthy controls, but the serum ucMGP was lower (2958±654nmol/L compared with healthy controls (4551±1036nmol/L, P0, r=-0.715, P1, r=-0.741, P10, r=-0.776, P<0.01; mSASSS <10, r=-0.297, P=0.028. Conclusion Serum ucMGP may serve as a diagnostic biomarker of AS and progression index of ossification, especially in late stage of AS.

  20. [Vitamin D levels in ankylosing spondylitis: does deficiency correspond to disease activity?].

    Science.gov (United States)

    Pokhai, Gabriel G; Bandagi, Sabiha; Abrudescu, Adriana

    2014-01-01

    Ankylosing spondylitis (AS) is an inflammatory disorder that presents with arthritis of the axial skeleton, including sacroiliac joints. Vitamin D is a secosteroid hormone with a long-established role in calcium and phosphate homeostasis, and in the regulation of bone formation and resorption. It is now known that vitamin D plays an immunosuppressive role in the body, and there is interest of late in the role of vitamin D in autoimmune diseases. Inflammation may be responsible for some of the loss of bone mineral density seen in AS. We reviewed the literature for studies assessing vitamin D level as a marker of AS disease activity and those examining vitamin D levels in AS in comparison to healthy controls. Four of 7 studies found a significant negative correlation between vitamin D levels and Bath Ankylosing Spondylitis Index (BASDAI), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). In a review of 8 case-control studies, the mean level of 25-hydroxyvitamin D3 was 22.8 ± 14.1 ng/mL in 555 AS patients versus 26.6 ± 12.5 ng/mL in 557 healthy controls. When compared with a 2-sample t test, vitamin D levels were significantly higher in healthy controls (p < 0.01). We conclude that patients with AS appear to have lower vitamin D levels versus healthy controls; however, the cause is unclear. Existing studies do not demonstrate a consistent link between vitamin D levels and disease activity in AS. Further studies are in need to determine if a causative link exists between vitamin D deficiency and AS. Copyright © 2014 Elsevier Editora Ltda. All rights reserved.

  1. Bone formation rather than inflammation reflects Ankylosing Spondylitis activity on PET-CT: a pilot study

    OpenAIRE

    Bruijnen, Stefan TG; van der Weijden, Mignon AC; Klein, Joannes P; Hoekstra, Otto S; Boellaard, Ronald; van Denderen, J Christiaan; Dijkmans, Ben AC; Voskuyl, Alexandre E; van der Horst-Bruinsma, Irene E; van der Laken, Conny J

    2012-01-01

    Introduction Positron Emission Tomography - Computer Tomography (PET-CT) is an interesting imaging technique to visualize Ankylosing Spondylitis (AS) activity using specific PET tracers. Previous studies have shown that the PET tracers [18F]FDG and [11C](R)PK11195 can target inflammation (synovitis) in rheumatoid arthritis (RA) and may therefore be useful in AS. Another interesting tracer for AS is [18F]Fluoride, which targets bone formation. In a pilot setting, the potential of PET-CT in ima...

  2. A relationship between spinal new bone formation in ankylosing spondylitis and the sonographically determined Achilles tendon enthesophytes.

    Science.gov (United States)

    Aydin, Sibel Zehra; Can, Meryem; Alibaz-Oner, Fatma; Keser, Gokhan; Kurum, Esra; Inal, Vedat; Yazisiz, Veli; Birlik, Merih; Emmungil, Hakan; Atagunduz, Pamir; Direskeneli, Haner; McGonagle, Dennis; Pay, Salih

    2016-03-01

    Spinal new bone formation is a major but incompletely understood manifestation of ankylosing spondylitis (AS). We explored the relationship between spinal new bone formation and ultrasound (US)-determined Achilles enthesophytes to test the hypothesis that spinal new bone formation is part of a generalized enthesis bone-forming phenotype. A multicenter, case control study of 225 consecutive AS patients and 95 age/body mass index (BMI) matched healthy controls (HC) was performed. US scans of Achilles tendons and cervical and lumbar spine radiographs were obtained. All images were centrally scored by one investigator for US and one for radiographs, blinded to medical data. The relation between syndesmophytes (by modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) and the number of syndesmophytes) and enthesophytes (with a semi-quantitative scoring of the US findings) was investigated. AS patients had significantly higher US enthesophyte scores than HCs (2.1(1.6) vs. 1.6(1.6); p = 0.004). The difference was significant in males (p = 0.001) but not in females (p = 0.5). The enthesophyte scores significantly correlated with mSASSS scores (ρ = 0.274, p gender-specific phenotype that could be a useful marker predicting of new bone formation.

  3. A Rare Case of Morel-Lavallee Syndrome Complicating an Anterior Dislocation of Hip Joint.

    Science.gov (United States)

    Nekkanti, Supreeth; Vijay, C; Theja, Sujana; Shankar, R Ravi; Verma, Anubhav

    2016-01-01

    Hip dislocations are serious injuries as hip joint is an extremely stable joint. It requires a significant amount of force to produce such an injury. Anterior dislocations are uncommon. Potential complications of anterior hip dislocations are a neurovascular injury to femoral vessels or acetabular fractures. We report a rare late complication of Morel-Lavallee syndrome occurring 3 weeks after an anterior dislocation of the hip in a 43-year-old male. The patient presented to us with history. Morel-Lavallee syndrome is a rare complication. However if diagnosed early can be successfully treated with minimal burden to the patient. The authors recommend surgeons to have a high index of suspicion for this syndrome and a stringent follow-up examination of the patient.

  4. Surgical Apgar Score Predicts Post- Laparatomy Complications

    African Journals Online (AJOL)

    calculated Surgical Apgar Scores for 152 patients during a 6-month study ... major postoperative complications and/or death within. 30 days of ... respond to and control hemodynamic changes during a ... abdominal injury (18.42%). Intestinal ...

  5. [Management of war orthopaedic injuries in recent armed conflicts].

    Science.gov (United States)

    Frank, M; Mathieu, L

    2013-01-01

    The extremities continue to be the most frequent sites of wounding during armed conflicts despite the change of combat tactics, soldier armour and battlefield medical support. Due to the advances in prehospital care and timely transport to the hospital, orthopaedic surgeons deal with severe and challenging injuries of the limbs. In contrast to civilian extremity trauma, the most combat-related injuries are open wounds that often have infection-related complications. Data from two recent large armed conflicts (Iraq, Afghanistan) show that extremity injuries are associated with a high complication rate, morbidity and healthcare utilization. A systematic approach that consists of sequential surgical care and good transport capabilities can reduce the complication rate of these injuries. New medical technologies have been implemented in the treatment strategy during the last decade. This article reviews the published scientific data and current opinions on combat-related extremity injuries. Key words: extremity, combat, trauma, medical support system.

  6. Renal complications of anaesthesia.

    Science.gov (United States)

    McKinlay, J; Tyson, E; Forni, L G

    2018-01-01

    Peri-operative acute kidney injury is common, accounting for 30-40% of all in-hospital cases of acute kidney injury. It is associated with clinically significant morbidity and mortality even with what was hitherto regarded as relatively trivial increases in serum creatinine, and carries over a 12-fold relative risk of death following major abdominal surgery. Comorbid conditions such as diabetes, hypertension, liver disease and particularly pre-existing chronic kidney disease, as well as the type and urgency of surgery, are major risk factors for the development of postoperative acute kidney injury. As yet, there are no specific treatment options for the injured kidney, although there are several modifiable risk factors of which the anaesthetist should be aware. As well as the avoidance of potential nephrotoxins and appropriate volume balance, optimal anaesthetic management should aim to reduce the risk of postoperative renal complications. This may include careful ventilatory management and blood pressure control, as well as appropriate analgesic strategies. The choice of anaesthetic agent may also influence renal outcomes. Rather than concentrate on the classical management of acute kidney injury, this review focuses on the potential development of acute kidney injury peri-operatively, and the means by which this may be ameliorated. © 2018 The Association of Anaesthetists of Great Britain and Ireland.

  7. Axillary artery injury secondary to inferior shoulder dislocation.

    Science.gov (United States)

    Plaga, Brad R; Looby, Peter; Feldhaus, Steven J; Kreutzmann, Karl; Babb, Aaron

    2010-11-01

    Dislocation injuries of the glenohumeral joint are common in the general public and generally are corrected without complication. One serious complication with shoulder dislocations, or the subsequent reduction, is a lesion to the axillary artery. This specific complication is most frequently seen in the elderly population, where vascular structures have become less flexible. Also, these injuries are most common in association with anterior dislocations of the shoulder. To bring awareness to the possibility of axillary artery injury with inferior dislocation of the shoulder, the treatment options, and a review. We report a 15-year-old male athlete who inferiorly dislocated his shoulder during wrestling practice. The injury was reduced at the scene with manual traction and the patient was transferred to our clinic for evaluation. The patient was determined to have a pseudoaneurysm of the axillary artery, and the history and treatment of the illness are presented. Axillary artery injuries secondary to shoulder dislocations are rare, especially in the young athlete, and proper recognition and treatment offer patients a full recovery. Copyright © 2010. Published by Elsevier Inc.

  8. Ultrasound diagnosis of postoperative complications of nerve repair.

    Science.gov (United States)

    Fantoni, Caterina; Erra, Carmen; Fernandez Marquez, Eduardo Marcos; Ortensi, Andrea; Faiola, Andrea; Coraci, Daniele; Piccinini, Giulia; Padua, Luca

    2018-05-03

    Peripheral nerve injuries often undergo surgical repair, but poor postoperative functional recovery is frequently observed. We describe four cases of traumatic nerve lesions in whom postoperative recovery was prevented by complications such as detachment of nerve sutures or neuroma growth. To the best of our knowledge no similar cases have been reported in literature so far. It is important an early diagnosis of such condition because it prevents recovery and delays re-intervention, which should be performed before complete muscle denervation and atrophy. Nerve ultrasound is a valuable tool in traumatic nerve injury and has proven to be useful in postoperative follow-up, especially in diagnosing surgical complications such as detachment of nerve direct sutures. Copyright © 2018 Elsevier Inc. All rights reserved.

  9. Assessment of Quality of Life, Psychological and Functional Status and Disease Activity in Patients with Ankylosing Spondylitis and Fibromyalgia

    Directory of Open Access Journals (Sweden)

    Mehmet Caglayan

    2016-03-01

    Full Text Available Objective: Anxiety and depression are psychological dis­orders which frequently accompany and affect the course of rheumatic diseases. Quality of life is also affected by psychological status. In this study, we aimed to assess psychological status and quality of life in patients with an­kylosing spondylitis (AS and fibromyalgia (FM and in­vestigate their association with functional status, disease activity and physical limitation. Method: Thirty-seven patients with AS and thirty-four patients with FM were included in this study. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI and Bath Ankylosing Spondylitis Functional Index (BAS­FI were used for assessment of disease activity and physical functions respectively. The Ankylosing Spondy­litis Quality of Life (ASQoL questionnaire was used for disease-related quality of life in AS patients. Fibromyalgia Impact Questionnaire (FIQ was used for assessment of functional status in FM patients. Nottingham Health Pro­file (NHP and the Hospital Anxiety and Depression Scale (HADS were, respectively, used for assessment of qual­ity of life and psychological status in groups. Results: There was no significant difference between the groups in HADS-total, HADS-depression and HADS-anxiety scores (p>0.05. However, patients with FM had significantly higher NHP-total and NHP-pain scores com­pared to patients with AS (p<0.05. Conclusion: There was no significant difference be­tween the two groups in psychological distress. Higher NHP-pain scores in patients with FM might have been caused by lower pain threshold in these patients. The generalizability of our findings is also limited because of the relatively small sample size. J Clin Exp Invest 2016; 7 (1: 41-46

  10. Mortality among patients with ankylosing spondylitis after a single treatment course with x-rays

    International Nuclear Information System (INIS)

    Darby, S.C.; Doll, R.; Smith, P.G.

    1985-01-01

    Court Brown and Doll identified over 14,000 patients with ankylosing spondylitis who had been treated with one or more courses of x-irradiation from 1935 to 1954 at one of 87 radiotherapy centers in Great Britain and Northern Ireland. The first reports from this study analyzed mortality among these patients from leukemia and other causes, particularly cancer, but these analyses included many patients who had been treated with x-rays for their spondylitis more than once. This complicated the interpretation of the late effects of the treatment on mortality, as it was not clear to what extent the subsequent treatments contributed to the excess of deaths that persisted for many years after the first treatment. Smith and Doll (1982) avoided this difficulty by examining the death rate from leukemia and other radiation-induced cancers at different times after a single course of treatment. A comparison of the mortality of this group with the mortality of Japanese atomic bomb survivors revealed good agreement between the two studies, thus increasing confidence in the belief that both studies are giving sensible estimates of the risk of cancer from high doses of radiation. The follow-up of those spondylitic patients who received a single course of treatment only has recently been extended until the end of 1982, that is, for an additional 13 years. A further 1406 patients are now known to have died, including an additional 335 deaths for which the certified cause is cancer. Detailed results of this further follow-up will be presented

  11. Commensal intestinal bacterial strains trigger ankylosing enthesopathy of the ankle in inbred B10.BR (H-2k) male mice

    Czech Academy of Sciences Publication Activity Database

    Šinkorová, Z.; Čapková, Jana; Niederlová, J.; Štěpánková, Renata; Šinkora, Jiří

    2008-01-01

    Roč. 69, č. 12 (2008), s. 845-850 ISSN 0198-8859 R&D Projects: GA ČR GA305/03/0287 Institutional research plan: CEZ:AV0Z50520701; CEZ:AV0Z5020903 Keywords : Spondyloarthropathies * Ankylosing enthesopathy * Intestinal microflora Subject RIV: EC - Immunology Impact factor: 3.061, year: 2008

  12. A rare complication after renal transplantation: Forgotten stent

    Directory of Open Access Journals (Sweden)

    Mustafa Karabıcak

    2015-07-01

    Full Text Available In renal transplantation surgery, double J stents (DJS are often used to reduce complications, protect the anastomosis between ureter and bladder, provide drainage in ureteral obstructions and enhance healing if there is an ureter injury. Urinary tract infections, hematuria and irritative voiding symptoms are the early complications of DJS. Migration, fragmantation, encrustation and rarely sepsis are among the late complications of DJS. In this report we describe a renal transplantation case whose DJS stent was forgotten because the patient did not attend the regular follow-up and noticed 5 years after surgery.

  13. CT and MRI diagnosis of acute hepatic injury

    International Nuclear Information System (INIS)

    Wang Rengui; Fumio Yamamoto; Pu Yonglin; Gao Yujie.

    1997-01-01

    To evaluate and compare MR and CT in diagnosis of acute traumatic hepatic laceration, ten patients with acute hepatic rupture underwent CT scan and/or MRI in the first 24 hours after injury. The injury was graded as mild ( 50% of one lobe). In the first 24 hours after injury, 33.3% (3/9) and 28.6%(2/7) of the hepatic injury demonstrated isodensity and isointensity on plain CT scan and T 1 -weighted images. All the lesions (100%) were clearly identified as marked hyperintensity on T 2 -weighted images. On T 2 WI, T 1 WI and non-contrast CT, 100%, 57.1% and 55.6% of the acute hepatic injuries could be graded respectively. Delayed complications occurred in four patients with deep hepatic injury about 1 to 3 weeks after injury. T 2 -weighted MR imaging is more sensitive and useful for detection of the type and severity of acute hepatic rupture. Follow-up MRI or CT within the first few weeks after injury is needed in patients with deep hepatic injury for detection of delayed complications

  14. Colon injury after blunt abdominal trauma: results of the EAST Multi-Institutional Hollow Viscus Injury Study.

    Science.gov (United States)

    Williams, Michael D; Watts, Dorraine; Fakhry, Samir

    2003-11-01

    Blunt injury to the colon is rare. Few studies of adequate size and design exist to allow clinically useful conclusions. The Eastern Association for the Surgery of Trauma Multi-institutional Hollow Viscus Injury (HVI) Study presents a unique opportunity to definitively study these injuries. Patients with blunt HVI were identified from the registries of 95 trauma centers over 2 years (1998-1999). Patients with colon injuries (cases) were compared with blunt trauma patient undergoing a negative laparotomy (controls). Data were abstracted by chart review. Of the 227,972 patients represented, 2,632 (1.0%) had an HVI and 798 had a colonic/rectal injury (0.3%). Of patients diagnosed with HVI, 30.2% had a colon injury. No physical findings or imaging modalities were able to discriminate colonic injury. Logistic regression modeling yielded no clinically useful combination of findings that would reliably predict colonic injury. In patients undergoing laparotomy, presence of colon injury was associated with a higher risk of some complications but not mortality. Colon injury was associated with increased hospital (17.4 vs. 13.1, p colon patients (92.0%) underwent laparotomy within 24 hours of injury. Colonic injury after blunt trauma is rare and difficult to diagnose. No diagnostic test or combination of findings reliably excluded blunt colonic injury. Despite the inadequacy of current diagnostic tests, almost all patients with colonic injury were taken to the operating room within 24 hours. Even with relatively prompt surgery, patients with colon injury were at significantly higher risk for serious complications and increased length of stay. In contrast to small bowel perforation, delay in operative intervention appears to be less common but is still associated with serious morbidity.

  15. Diagnosis and management of colonic injuries following blunt trauma.

    Science.gov (United States)

    Zheng, Yi-Xiong; Chen, Li; Tao, Si-Feng; Song, Ping; Xu, Shao-Ming

    2007-01-28

    To retrospectively evaluate the preoperative diagnostic approaches and management of colonic injuries following blunt abdominal trauma. A total of 82 patients with colonic injuries caused by blunt trauma between January 1992 and December 2005 were enrolled. Data were collected on clinical presentation, investigations, diagnostic methods, associated injuries, and operative management. Colonic injury-related mortality and abdominal complications were analyzed. Colonic injuries were caused mainly by motor vehicle accidents. Of the 82 patients, 58 (70.3%) had other associated injuries. Laparotomy was performed within 6 h after injury in 69 cases (84.1%), laparoscopy in 3 because of haemodynamic instability. The most commonly injured site was located in the transverse colon. The mean colon injury scale score was 2.8. The degree of faecal contamination was classified as mild in 18 (22.0%), moderate in 42 (51.2%), severe in 14 (17.1%), and unknown in 8 (9.8%) cases. Sixty-seven patients (81.7%) were treated with primary repair or resection and anastomosis. Faecal stream diversion was performed in 15 cases (18.3%). The overall mortality rate was 6.1%. The incidence of colonic injury-related abdominal complications was 20.7%. The only independent predictor of complications was the degree of peritoneal faecal contamination (P = 0.02). Colonic injuries following blunt trauma are especially important because of the severity and complexity of associated injuries. A thorough physical examination and a combination of tests can be used to evaluate the indications for laparotomy. One stage management at the time of initial exploration is most often used for colonic injuries.

  16. The impact of coagulopathy on traumatic splenic injuries.

    Science.gov (United States)

    Smalls, Norma; Obirieze, Augustine; Ehanire, Imudia

    2015-10-01

    Patients with pre-injury coagulopathy have worse outcomes than those without coagulopathy. This article investigated the risk-adjusted effect of pre-injury coagulopathy on outcomes after splenic injuries. Review of the National Trauma Data Bank from 2007 to 2010 comparing mortality and complications between splenic injury patients with and without a pre-injury bleeding disorder. Of 58,896 patients, 2% had a bleeding disorder. Coagulopathic patients had higher odds of mortality (odds ratio, 1.3), sepsis (odds ratio, 2.0), acute respiratory distress syndrome (odds ratio, 2.6), acute renal failure (odds ratio, 1.5), cardiac arrest (odds ratio, 1.5), and overall complications (odds ratio, 2.4). The higher odds of myocardial infarction did not achieve statistical significance (odds ratio, 1.6). Pre-injury coagulopathy in patients with splenic injury has a negative impact on cardiac arrest, sepsis, acute respiratory distress syndrome, acute renal failure, and mortality. The higher likelihood of myocardial infarction did not reach statistical significance. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. Anxiety, Depression, Problem Solving and Stress Management in Patients with Ankylosing Spondylitis

    Directory of Open Access Journals (Sweden)

    Yasemin Özkan

    2018-04-01

    Full Text Available Objective: This study aims to determine anxiety, depression, self-esteem, stress management and problem solving skills in ankylosing spondylitis (AS patients compared to healthy subjects. Materials and Methods: The study involves 33 patients with AS according to the Modified New York Criteria and 31 healthy subjects as control group. A socio-demographic data form, the Hospital Anxiety and Depression Scale (HADS, the Rosenberg Self-Esteem Scale (RSES, the Problem Solving Inventory (PSI and the Coping Orientation to Problems Experienced (COPE scale were used to evaluate participants. Results: The mean ages of the patients and the control were 36.3±10.9 and 33.6±6.2 years respectively with no significant difference between the two groups (p>0.05. On the HADS scale, AS patients showed significantly higher anxiety and depression scores (p<0.05. AS patients had significantly lower self-esteem as determined by the RSES scores (p<0.05. When the study groups were compared using the PSI, a significant difference was observed only in the “approach-avoidance style” subscale. A positive correlation between Bath Ankylosing Spondylitis Disease Activity Index (BASDAI and RSES was reported and there was a very strong negative correlation between BASDAI and overall PSI scores. A negative correlation was found between humor, mental disengagement and behavioral disengagement and BASDAI scores (p<0.05. Conclusion: Being a chronic rheumatic disease, AS not only limits daily living activities due to its physical manifestations but also causes psychological problems such as depression ve anxiety. However, it does not seem to impair problem solving skills and the ability to cope with stress significantly. It might be helpful to evaluate AS patients using a holistic approach and to be aware of the factors that are associated with difficulties in their social interactions.

  18. Acute Right Ventricular Dysfunction Complicating Prolonged ...

    African Journals Online (AJOL)

    We report a case of transient right ventricular dysfunction associated with prolonged cardiac tamponade, an unusual complication of uncertain etiology. We believe that in this case dynamic coronary flow restriction resulted in ischemic injury and stunning of the right ventricle. Other possible causes are briefly reviewed. Right ...

  19. Primary repair of penetrating colon injuries: a systematic review.

    Science.gov (United States)

    Singer, Marc A; Nelson, Richard L

    2002-12-01

    Primary repair of penetrating colon injuries is an appealing management option; however, uncertainty about its safety persists. This study was conducted to compare the morbidity and mortality of primary repair with fecal diversion in the management of penetrating colon injuries by use of a meta-analysis of randomized, prospective trials. We searched for prospective, randomized trials in MEDLINE (1966 to November 2001), the Cochrane Library, and EMBase using the terms colon, penetrating, injury, colostomy, prospective, and randomized. Studies were included if they were randomized, controlled trials that compared the outcomes of primary repair with fecal diversion in the management of penetrating colon injuries. Five studies were included. Reviewers performed data extraction independently. Outcomes evaluated from each trial included mortality, total complications, infectious complications, intra-abdominal infections, wound complications, penetrating abdominal trauma index, and length of stay. Peto odds ratios for combined effect were calculated with a 95 percent confidence interval for each outcome. Heterogeneity was also assessed for each outcome. The penetrating abdominal trauma index of included subjects did not differ significantly between studies. Mortality was not significantly different between groups (odds ratio, 1.70; 95 percent confidence interval, 0.51-5.66). However, total complications (odds ratio, 0.28; 95 percent confidence interval, 0.18-0.42), total infectious complications (odds ratio, 0.41; 95 percent confidence interval, 0.27-0.63), abdominal infections including dehiscence (odds ratio, 0.59; 95 percent confidence interval, 0.38-0.94), abdominal infections excluding dehiscence (odds ratio, 0.52; 95 percent confidence interval, 0.31-0.86), wound complications including dehiscence (odds ratio, 0.55; 95 percent confidence interval, 0.34-0.89), and wound complications excluding dehiscence (odds ratio, 0.43; 95 percent confidence interval, 0

  20. Complications in the management of bladder trauma in a third level hospital.

    Science.gov (United States)

    Echeverría-García, Fernando Enrique; García-Perdomo, Herney Andrés; Barney, Erika

    2014-05-01

    To determine the frecuency of complications during the management of bladder trauma and its associated factors in a third level reference Hospital. A cross-sectional study of adult patients admitted in a reference Hospital from January 2006 to June 2011 with the diagnosis of bladder trauma. We identified demographic variables, type of trauma (blunt, penetrating), diagnostic method, associated traumatisms, management of bladder traumatism, frequency of complications and mortality. Univariate analysis was performed with frequency tables, measures of central tendency and dispersion. Similarly, bivariate analysis was performed to explore the association between variables. We used chi-square test for categorical variables and Student's t test to compare quantitative variables. We reviewed 40 medical records, which met the eligibility criteria. The median age was 27 years (range 16-;67) and 85% (34 patients) were male. Twenty-nine patients (72.5%) had penetrating injuries, being mainly firearm projectile (96.55%) and 11 patients (27.5%) blunt injuries. Most patients had intraoperative diagnosis (67.5%), while 25%, 5% and 2% were diagnosed by CT-cystography, cystoscopy and voiding cystography respectively. 70% (28 patients) had intraperitoneal bladder injuries. Of the forty patients enrolled, thirty six (90%) underwent surgery, while only four (10%) received conservative management. A total of ten patients (25%) had some type of complication. The most frequent was persistent hematuria (40%) followed by surgical site infection (30%), orchitis (20%), urinary tract infection (10%), urine leakage through the operative site, or to the peritoneal cavity (10%). No mortality was detected. On the bivariate logistic regression model type of trauma, number of injuries, performance of cystostomy, use of perivesical drainage tube, chest trauma and small bowel trauma, no association was found with the presence of complications. The frequency of complications was 25%. The presence of

  1. Anterior dural ectasia mimicking a lytic lesion in the posterior vertebral body in ankylosing spondylitis.

    Science.gov (United States)

    Bele, Keerthiraj; Pendharkar, Hima Shriniwas; Venkat, Easwer; Gupta, Arun Kumar

    2011-12-01

    Anterior dural ectasia is an extremely rare finding in ankylosing spondylitis (AS). The authors describe a unique case of AS in which the patient presented with cauda equina syndrome as well as an unusual imaging finding of erosion of the posterior aspect of the L-1 (predominantly) and L-2 vertebral bodies due to anterior dural ectasia. Symptomatic patients with long-standing AS should be monitored for the presence of dural ectasia, which can be anterior in location, as is demonstrated in the present case.

  2. Rheumatic patients at work : a study of labour force participations and its determinants in rheumatoid arthritis, ankylosing spondylitis, and juvenile chronic arthritis

    NARCIS (Netherlands)

    Chorus, A.M.J.

    2004-01-01

    This thesis at the University of Maastricht, defended at May 7, 2004, yields several important and new findings with regard to work related quality of life, participation in the labour force and its determinants of patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and juvenile

  3. Lawn mower injuries to the lower extremity: a 10-year retrospective review.

    Science.gov (United States)

    Greenhagen, Robert M; Raspovic, Katherine M; Crim, Brandon E; Ryan, Michael T; Gruen, Gary G

    2013-04-01

    Lawn mower injuries occur frequently in the United States and oftentimes result in extensive trauma to the lower extremities. These injuries can be quite devastating and cause there to be loss of function and amputation. The purpose of this study was to determine if there are specific factors that would help determine the best treatment protocol, patient outcomes, and prognosis after lawn mower injury to the foot and ankle. A retrospective review of medical records was performed on all patients treated at a university level 1 trauma center from 2000 to 2010. Only subjects 18 years or older who sustained an injury below the level of the knee were included for review. Seventy-three patients were included in this review. The results revealed that patients who developed a complication were significantly older than the group of patients without complications (P = .03). Digits were found to be injured most often but the odds of developing a complication were much higher if these injuries involved the plantar foot, dorsal foot, or ankle. Interestingly, patients on prolonged antibiotic therapy had a significantly higher risk of developing complications. The presence of comorbidities significantly increased the risk of complication (P = .008); the greatest risk factors were cardiovascular disease (P = .001) and diabetes (P = .06). The authors present the largest cohort of lawn mower injuries in the medical literature, which demonstrates that factors such as age, location of injury, and the presence of comorbidities influence the outcome and increase the risk of injury to the foot and ankle. These results may be useful in determining the best treatment plan possible for patients with these severe injuries. Therapeutic, Level IV, Retrospective case series.

  4. Physical functioning in patients with ankylosing spondylitis: comparing approaches of experienced ability with self-reported and objectively measured physical activity.

    Science.gov (United States)

    van Genderen, Simon; van den Borne, Carlie; Geusens, Piet; van der Linden, Sjef; Boonen, Annelies; Plasqui, Guy

    2014-04-01

    Physical functioning can be assessed by different approaches that are characterized by increasing levels of individual appraisal. There is insufficient insight into which approach is the most informative in patients with ankylosing spondylitis (AS) compared with control subjects. The objective of this study was to compare patients with AS and control subjects regarding 3 approaches of functioning: experienced ability to perform activities (Bath Ankylosing Spondylitis Functional Index [BASFI]), self-reported amount of physical activity (PA) (Baecke questionnaire), and the objectively measured amount of PA (triaxial accelerometer). This case-control study included 24 AS patients and 24 control subjects (matched for age, gender, and body mass index). Subjects completed the BASFI and Baecke questionnaire and wore a triaxial accelerometer. Subjects also completed other self-reported measures on disease activity (Bath AS Disease Activity Index), fatigue (Multidimensional Fatigue Inventory), and overall health (EuroQol visual analog scale). Both groups included 14 men (58%), and the mean age was 48 years. Patients scored significantly worse on the BASFI (3.9 vs 0.2) than their healthy peers, whereas PA assessed by Baecke and the accelerometer did not differ between groups. Correlations between approaches of physical functioning were low to moderate. Bath Ankylosing Spondylitis Functional Index was associated with disease activity (r = 0.49) and physical fatigue (0.73) and Baecke with physical and activity related fatigue (r = 0.54 and r = 0.54), but total PA assessed by accelerometer was not associated with any of these experience-based health outcomes. Different approaches of the concept physical functioning in patients with AS provide different information. Compared with matched control subjects, patients with AS report more difficulties but report and objectively perform the same amount of PA.

  5. Selective Nonoperative Management of Penetrating Abdominal Solid Organ Injuries

    Science.gov (United States)

    Demetriades, Demetrios; Hadjizacharia, Pantelis; Constantinou, Costas; Brown, Carlos; Inaba, Kenji; Rhee, Peter; Salim, Ali

    2006-01-01

    Objective: To assess the feasibility and safety of selective nonoperative management in penetrating abdominal solid organ injuries. Background: Nonoperative management of blunt abdominal solid organ injuries has become the standard of care. However, routine surgical exploration remains the standard practice for all penetrating solid organ injuries. The present study examines the role of nonoperative management in selected patients with penetrating injuries to abdominal solid organs. Patients and Methods: Prospective, protocol-driven study, which included all penetrating abdominal solid organ (liver, spleen, kidney) injuries admitted to a level I trauma center, over a 20-month period. Patients with hemodynamic instability, peritonitis, or an unevaluable abdomen underwent an immediate laparotomy. Patients who were hemodynamically stable and had no signs of peritonitis were selected for further CT scan evaluation. In the absence of CT scan findings suggestive of hollow viscus injury, the patients were observed with serial clinical examinations, hemoglobin levels, and white cell counts. Patients with left thoracoabdominal injuries underwent elective laparoscopy to rule out diaphragmatic injury. Outcome parameters included survival, complications, need for delayed laparotomy in observed patients, and length of hospital stay. Results: During the study period, there were 152 patients with 185 penetrating solid organ injuries. Gunshot wounds accounted for 70.4% and stab wounds for 29.6% of injuries. Ninety-one patients (59.9%) met the criteria for immediate operation. The remaining 61 (40.1%) patients were selected for CT scan evaluation. Forty-three patients (28.3% of all patients) with 47 solid organ injuries who had no CT scan findings suspicious of hollow viscus injury were selected for clinical observation and additional laparoscopy in 2. Four patients with a “blush” on CT scan underwent angiographic embolization of the liver. Overall, 41 patients (27

  6. Analysis of periinterventional complications of intracranial angioplasty and stenting: A single center experience

    International Nuclear Information System (INIS)

    Silber, Toni; Ziemann, Ulf; Ernemann, Ulrike; Bischof, Felix

    2014-01-01

    Highlights: • Periinterventional complications in 7.5% of patients with intracranial artery stenting. • 2.5% of periinterventional complications were perforator strokes. • 3.8% of patients developed a hemorrhagic stroke due to reperfusion injury. • Complications could be reduced by individualized measures to prevent perforator stroke or reperfusion injury. - Abstract: Background and purpose: Treatment of symptomatic intracranial atherosclerotic disease by angioplasty and stenting (PTAS) is limited by a high rate of periinterventional strokes. We performed a detailed analysis of these strokes at our center in order to identify strategies to reduce the risk of periinterventional complications. Methods: Case records and imaging data of 80 patients with a symptomatic 70–99% stenosis of a major intracranial artery treated with PTAS between July 2007 and December 2013 were reviewed. All patients had a sufficient response to aspirin and clopidogrel. Periinterventional strokes were categorized as either ischemic (perforator territory, distal embolic or delayed stent thrombosis) or hemorrhagic (intraparenchymal, subarachnoid). Results: Periinterventional complications occurred in 6/80 (7.5%) patients, consisting of 2 ischemic strokes (2.5%, both perforator territory), 3 hemorrhagic strokes (3.8%, 2 intraparenchymal due to reperfusion injury, 1 subarachnoid due to vessel rupture) and one death (1.3%) unrelated to stroke. All strokes occurred within 24 h after PTAS. Conclusion: Our retrospective data analysis suggests that the risk of periinterventional stroke after PTAS of symptomatic intracranial atherosclerotic disease might be reduced by sufficient antiplatelet therapy and optimized management of patients with high risk for reperfusion injury or perforator strokes, including selection of a stenting device adapted to individual vessel morphology

  7. Analysis of periinterventional complications of intracranial angioplasty and stenting: A single center experience

    Energy Technology Data Exchange (ETDEWEB)

    Silber, Toni; Ziemann, Ulf [Center of Neurology, Hertie-Institute for Clinical Brain Research, University of Tübingen (Germany); Ernemann, Ulrike [Department of Diagnostic and Interventional Neuroradiology, University of Tübingen (Germany); Bischof, Felix, E-mail: felix.bischof@uni-tuebingen.de [Center of Neurology, Hertie-Institute for Clinical Brain Research, University of Tübingen (Germany)

    2014-12-15

    Highlights: • Periinterventional complications in 7.5% of patients with intracranial artery stenting. • 2.5% of periinterventional complications were perforator strokes. • 3.8% of patients developed a hemorrhagic stroke due to reperfusion injury. • Complications could be reduced by individualized measures to prevent perforator stroke or reperfusion injury. - Abstract: Background and purpose: Treatment of symptomatic intracranial atherosclerotic disease by angioplasty and stenting (PTAS) is limited by a high rate of periinterventional strokes. We performed a detailed analysis of these strokes at our center in order to identify strategies to reduce the risk of periinterventional complications. Methods: Case records and imaging data of 80 patients with a symptomatic 70–99% stenosis of a major intracranial artery treated with PTAS between July 2007 and December 2013 were reviewed. All patients had a sufficient response to aspirin and clopidogrel. Periinterventional strokes were categorized as either ischemic (perforator territory, distal embolic or delayed stent thrombosis) or hemorrhagic (intraparenchymal, subarachnoid). Results: Periinterventional complications occurred in 6/80 (7.5%) patients, consisting of 2 ischemic strokes (2.5%, both perforator territory), 3 hemorrhagic strokes (3.8%, 2 intraparenchymal due to reperfusion injury, 1 subarachnoid due to vessel rupture) and one death (1.3%) unrelated to stroke. All strokes occurred within 24 h after PTAS. Conclusion: Our retrospective data analysis suggests that the risk of periinterventional stroke after PTAS of symptomatic intracranial atherosclerotic disease might be reduced by sufficient antiplatelet therapy and optimized management of patients with high risk for reperfusion injury or perforator strokes, including selection of a stenting device adapted to individual vessel morphology.

  8. Wound and Sural Nerve Complications of the Sinus Tarsi Approach for Calcaneus Fractures.

    Science.gov (United States)

    Li, Shaoliang

    2018-05-01

    Background The purpose of this study was to evaluate the optimal timing and measures of the sinus tarsi approach for calcaneus fractures to avoid iatrogenic injury of the sural nerve and to assess for wound complications. A case series of 53 patients with calcaneus fractures treated by a single surgeon with the sinus tarsi approach was retrospectively analyzed. On the basis of the delay time from injury to surgery, patients were classified into 4 groups: immediate (0-3 days), early (4-6 days), intermediate (7-14 days), and late (14-18 days). All patients were followed for at least 1 year to observe wound conditions. The rate of wound complications and iatrogenic sural nerve injury was described. Incisions were classified into 2 groups: group A included patients with incisions extending posterior to the lateral malleolus, and group B included patients with incisions confined anterior to the lateral malleolus. The rates of nerve injury were compared between both groups. Forty-three patients with 52 Sanders type II fractures were included. The average time to surgery from injury was 8.8 days (range, 0-18 days). The overall postoperative rate of wound complications was 5.8% (3 of 52). In the immediate group, deep infections and wound necrosis were found in 2 of 8 fractures (25%). In the early group, 1 of 15 fractures developed superficial infection (6.7%). In the intermediate and late groups, no wound complication was identified. Iatrogenic sural nerve injury was recorded in 5 of 52 patients (9.6%). Group A had 33% (4 of 12) nerve injuries and group B had 2.5% (1 of 40) ( P = .009). In 70% of cases, a main branch of the sural nerve was directly under the incision. The sinus tarsi approach was generally effective and safe for calcaneus fractures. However, it was relatively risky to perform open reduction and internal fixation by the sinus tarsi approach within 6 days of injury. Because the sural nerve is in the vicinity of the approach, iatrogenic injury should be

  9. CT imaging of complications of catheter ablation for atrial fibrillation

    International Nuclear Information System (INIS)

    Shroff, G.S.; Guirguis, M.S.; Ferguson, E.C.; Oldham, S.A.A.; Kantharia, B.K.

    2014-01-01

    The complication rate following radiofrequency catheter ablation for atrial fibrillation is low (<5%). Complications include pericardial effusion, cardiac tamponade, pulmonary vein stenosis, oesophageal ulceration or perforation, atrio-oesophageal fistula formation, stroke/transient ischaemic attack, phrenic nerve injury, haematoma at the puncture site, and femoral arteriovenous fistula. Among available imaging tools, computed tomography (CT) can be very useful in diagnosing complications of the procedure, particularly in the subacute and delayed stages after ablation. This review illustrates CT imaging of several of the common and uncommon complications of radiofrequency catheter ablation

  10. [The relevance of ADC value, T₁intensive rate and the clinical activities in ankylosing spondylitis sacroiliitis].

    Science.gov (United States)

    Zhao, Yinghua; Han, Xinai; Hu, Shaoyong; Shi, Xingliang; Zhao, Jing; Sun, Erwei; Li, Shaolin

    2014-09-23

    To evaluate the value of judging for the activity in AS by diffusion-weighted sequences (DWI) and enhance sequences MRI(DCE-MRI), to explore the correlation of Apparent diffusion coefficient(ADC) values, intensive rate and the clinical activity index in sacroiliitis (SIJ) of ankylosing spondylitis (AS). 56 patients prospectively choiced and diagnosed were divided into two groupsas, active group (n = 32) and chronic group (n = 24) by rheumatologist according to BASDAI and laboratory parameters. Twenty healthy adults were as control group. The values of ADC and intensive rate of all sacroiliac joints (SIJs) were measured on MRI. BASDAI score were got by Bath ankylosing spondylitis disease activity index. ESR, CPR and were got by laboratory. Statisticaly to analysis whether the parameters were significantly different amang AS active, chronic, and the control group. To assess the correlation of the values of ADC, intensive rate and BASDAI score, ESR, CPR and in SIJ. the values of ADC and intensive rate were significantly different among AS active, chronic and the control group. There were the significant correlation between the values of ADC, intensive rate and BASDAI score. Diffusion-weighted sequences and Contrast-enhanced sequences is superior to other methods in judging the activity in AS.combined with clinical activity index, the accuracy can significantly be improved to explore whether the activities of AS are.

  11. Tumour necrosis factor inhibitor treatment and occurrence of anterior uveitis in ankylosing spondylitis

    DEFF Research Database (Denmark)

    Lie, Elisabeth; Lindström, Ulf; Zverkova-Sandström, Tatiana

    2017-01-01

    OBJECTIVES: Tumour necrosis factor-α inhibitor (TNFi) treatment has been shown to reduce the rates of anterior uveitis (AU) in patients with ankylosing spondylitis (AS). Our objective was to compare the effect of adalimumab (ADA), etanercept (ETN) and infliximab (IFX) on AU occurrence in AS, using...... obtained by linkage to the Swedish National Patient Register. For each TNFi, AU rates 2 years before TNFi start and for the first 2 years on TNFi treatment were compared. In the subgroup of patients who were AU-free during the 2 years before TNFi start, we also compared the risk of a first AU event...

  12. Complicated distal femoral epiphyseolysis treated by Ilizarov method: Case report

    Directory of Open Access Journals (Sweden)

    Jovanović Vesna

    2010-01-01

    Full Text Available Introduction Injuries of the distal femur are rare in children; however, they are frequently associated with complications. They are almost always physeal, most frequently Salter-Harris type II epiphyseolysis. The treatment of such injuries is similar in all physeal injuries. It is intended to provide growth plate recovery by gentle reduction and stable fixation thus preventing secondary complications, and also to provide decompression of the segment to solve the compartment syndrome and recover the neurovascular structures. Case Outline A seven-year old boy presented with a right knee injury while sleigh riding. He was admitted three weeks following the injury with distal femoral epiphysiolysis associated with peroneal palsy. A day after admission to our Institute the reduction was performed using the Ilizarov device. Physical therapy was started immediately after surgery, as well as walking with weight bearing on the operated leg. Five months after surgery the patient was anatomically and functionally recovered. Conclusion The presented method is recommended in the treatment of such injuries because of several reasons; reposition is simple and complete, there is no need to open the fracture site, fixation is stable, the growth plate is preserved, there is no need for additional external immobilisation, and physical therapy involving walking with weight bearing on the operated leg may be started immediately after surgery. .

  13. Traumatic Pancreatitis: A Rare Complication of Cardiopulmonary Resuscitation.

    Science.gov (United States)

    Aziz, Muhammad

    2017-08-17

    An elderly gentleman was successfully revived after undergoing cardiopulmonary resuscitation (CPR) for cardiac arrest. Post CPR, the patient developed acute pancreatitis which was likely complication of inappropriately delivered chest compressions which caused further complications and resulted in the death of the patient. This case underlines the importance of quality chest compressions that includes correct placement of hands by the operator giving chest compressions to avoid lethal injuries to the receiver.

  14. Infectious complications following duodenal and/or pancreatic trauma.

    Science.gov (United States)

    Tyburski, J G; Dente, C J; Wilson, R F; Shanti, C; Steffes, C P; Carlin, A

    2001-03-01

    Patients with pancreatic and/or duodenal trauma often have a high incidence of infectious complications. In this study we attempted to find the most important risk factors for these infections. A retrospective review of the records of 167 patients seen over 7 years (1989 through 1996) at an urban Level I trauma center for injury to the duodenum and/or pancreas was performed. Fifty-nine patients (35%) had isolated injury to the duodenum (13 blunt, 46 penetrating), 81 (49%) had isolated pancreatic trauma (18 blunt, 63 penetrating), and 27 (16%) had combined injuries (two blunt, 25 penetrating). The overall mortality rate was 21 per cent and the infectious morbidity rate was 40 per cent. The majority of patients had primary repair and/or drainage as treatment of their injuries. Patients with pancreatic injuries (alone or combined with a duodenal injury) had a much higher infection rate than duodenal injuries. The patients with duodenal injuries had significantly lower penetrating abdominal trauma indices, number of intra-abdominal organ injuries, and incidence of hypothermia. On multivariate analysis independent factors associated with infections included hypothermia and the presence of a pancreatic injury. Although injuries to the pancreas and duodenum often coexist it is the pancreatic injury that contributes most to the infectious morbidity.

  15. Willingness of patients with ankylosing spondylitis to pay for inpatient treatment is influenced by the treatment environment and expectations of improvement

    NARCIS (Netherlands)

    Boonen, A.; Severens, J. L.; van Tubergen, A.; Landewé, R.; Bonsel, G.; van der Heijde, D.; van der Linden, Sj

    2005-01-01

    Objective: To assess the willingness to pay (WTP) for treatment in a spa resort of patients with ankylosing spondylitis ( AS) and to assess if the experience of a spa influences the WTP. Methods: 120 patients participating in a randomised trial comparing 3 weeks' treatment in a spa resort in Austria

  16. A STUDY OF POST-SURGICAL COMPLICATIONS IN ACUTE ABDOMEN CONDITIONS

    Directory of Open Access Journals (Sweden)

    Bhooma Reddy Muthyala

    2016-09-01

    Full Text Available BACKGROUND The most common causes of the acute abdomen are acute appendicitis which may be perforated, typhoid ileal perforation, acute intestinal obstruction, gastroduodenal perforations, nonspecific abdominal pain, abdominal injuries, and acute cholecystitis. A summary of all the acute complications taken together will be the fact that all are associated with post-surgical complications. A sincere effort has been made to study the post-operative complications that a surgeon encounters while treating the acute abdomen cases. This study is intended to help the practising surgeons who deal with such complications. It also is intended to help the doctors who practice to identify such complications and thus refer the patients for immediate intervention. METHODS This study was conducted in the Department of General Surgery, Government Medical College, Nizamabad, Telangana. This study was done from June 2013 to May 2016. One hundred sixty patients who were admitted in the hospital after surgery for acute abdominal conditions were considered for the study. Thorough clinical examination was conducted and the complications that were encountered were noted and the complications were treated as per the need of the hour. The complications faced by the treating surgeon in each and every entity that was discussed earlier was duly noted and statistical analysis was conducted. All the statistical analysis was done using the latest SPSS software 2015 (California. RESULT In our study, the mean age of the study population was found to be 29.8 years. That means the majority of the patients who turn up in the Department of Emergency is young and generally in the third decade of life. In Acute Intestinal Obstruction and blunt abdominal injuries, significance of mortality is high (p<0.05. CONCLUSION The study was successful in proving that abdominal injuries are the main factors of causing morbidity and mortality in the younger generation. The surgical mode of

  17. The natural history of ankylosing spondylitis in the 21st century

    Directory of Open Access Journals (Sweden)

    C. Campana

    2011-06-01

    Full Text Available Ankylosing spondylitis (AS is a chronic inflammatory disease that affects the axial skeleton and evolves in stiffnes followed by ankylosis and disability. However, it may be difficult to exactly establish the natural history of the disease and the influence of risk factors of progression, since most patients are treated with various pharmacologic or non-pharmacologic agents, which may potentially influence the natural progression of the disease. In this context, we report here a very interesting case of a 40 year old man, presented to our outpatient clinic, 28 years after the onset of AS. Previously for personal reasons, did not choose not to undergo any treatment. This case allows us to evaluate the natural radiological progression of the disease and the influence of predictive risk factors.

  18. Endovascular Management of Vascular Injury during Transsphenoidal Surgery

    OpenAIRE

    Çinar, C.; Bozkaya, H.; Parildar, M.; Oran, I.

    2013-01-01

    Vascular injury is an unusual and serious complication of transsphenoidal surgery. We aimed to define the role of angiography and endovascular treatment in patients with vascular injuries occurring during transsphenoidal surgery.

  19. Integrative Structural Biomechanical Concepts of Ankylosing Spondylitis

    Directory of Open Access Journals (Sweden)

    Alfonse T. Masi

    2011-01-01

    Full Text Available Ankylosing spondylitis (AS is not fully explained by inflammatory processes. Clinical, epidemiological, genetic, and course of disease features indicate additional host-related risk processes and predispositions. Collectively, the pattern of predisposition to onset in adolescent and young adult ages, male preponderance, and widely varied severity of AS is unique among rheumatic diseases. However, this pattern could reflect biomechanical and structural differences between the sexes, naturally occurring musculoskeletal changes over life cycles, and a population polymorphism. During juvenile development, the body is more flexible and weaker than during adolescent maturation and young adulthood, when strengthening and stiffening considerably increase. During middle and later ages, the musculoskeletal system again weakens. The novel concept of an innate axial myofascial hypertonicity reflects basic mechanobiological principles in human function, tissue reactivity, and pathology. However, these processes have been little studied and require critical testing. The proposed physical mechanisms likely interact with recognized immunobiological pathways. The structural biomechanical processes and tissue reactions might possibly precede initiation of other AS-related pathways. Research in the combined structural mechanobiology and immunobiology processes promises to improve understanding of the initiation and perpetuation of AS than prevailing concepts. The combined processes might better explain characteristic enthesopathic and inflammatory processes in AS.

  20. Imaging findings of liposuction with an emphasis on postsurgical complications

    Energy Technology Data Exchange (ETDEWEB)

    You, Je Sung; Chung, Sung Phil; Kim, Myeong Jin [Dept. of mergency Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Chung, Yong Eun; Baek, Song Ee [Dept. of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2015-12-15

    Liposuction is one of the most frequently performed cosmetic surgeries worldwide for reshaping the body contour. Although liposuction is minimally invasive and relatively safe, it is a surgical procedure, and it carries the risk of major and minor complications. These complications vary from postoperative nausea to life-threatening events. Common complications include infection, abdominal wall injury, bowel herniation, bleeding, haematoma, seroma, and lymphoedema. Life-threatening complications such as necrotizing fasciitis, deep vein thrombosis, and pulmonary embolism have also been reported. In this paper, we provide a brief introduction to liposuction with the related anatomy and present computed tomography and ultrasonography findings of a wide spectrum of postoperative complications associated with liposuction.

  1. Ocular fishhook injuries.

    Science.gov (United States)

    Ang, C S

    2001-06-01

    Ocular fishhook injuries are rare, yet potentially vision threatening as complications such as corneal scarring, retinal detachment and endophthalmitis may result. The surgical management of these cases is challenging due to the construction of barbed fishhooks.

  2. Major intestinal complications of radiotherapy. Management and nutrition

    Energy Technology Data Exchange (ETDEWEB)

    Deitel, M.; To, T.B.

    1987-12-01

    Hospitalization was required in 57 patients for intestinal injuries following radiotherapy for carcinoma of the cervix, endometrium, ovary, bladder, rectum, and other primary sites. Intestinal complications included stenosis, perforation, rectal ulcer, and rectovaginal, ileovaginal, and ileovesical fistula; 27 patients had multiple intestinal complications. Operation was necessary in 33 patients, as follows: bowel resections, 18; colostomy alone, five; adhesiolysis, five; ileocolic bypass, three; and Hartmann's procedure for sigmoid perforation, two. Five anastomotic leaks and six postoperative deaths occurred. Causes of death among the remaining patients included residual cancer (ten), de novo bowel cancer (two), radiation injury (four), and unrelated causes (six). Resection to uninvolved bowel, omental wrap of anterior resection anastomosis, avoidance of unnecessary adhesiolysis, and long-tube orientation seemed to contribute to successful operations. Nutritional support was used for repletion, post-operative fistulas, and short-gut syndrome.

  3. Major intestinal complications of radiotherapy. Management and nutrition

    International Nuclear Information System (INIS)

    Deitel, M.; To, T.B.

    1987-01-01

    Hospitalization was required in 57 patients for intestinal injuries following radiotherapy for carcinoma of the cervix, endometrium, ovary, bladder, rectum, and other primary sites. Intestinal complications included stenosis, perforation, rectal ulcer, and rectovaginal, ileovaginal, and ileovesical fistula; 27 patients had multiple intestinal complications. Operation was necessary in 33 patients, as follows: bowel resections, 18; colostomy alone, five; adhesiolysis, five; ileocolic bypass, three; and Hartmann's procedure for sigmoid perforation, two. Five anastomotic leaks and six postoperative deaths occurred. Causes of death among the remaining patients included residual cancer (ten), de novo bowel cancer (two), radiation injury (four), and unrelated causes (six). Resection to uninvolved bowel, omental wrap of anterior resection anastomosis, avoidance of unnecessary adhesiolysis, and long-tube orientation seemed to contribute to successful operations. Nutritional support was used for repletion, post-operative fistulas, and short-gut syndrome

  4. Complications to evaluate adult trauma care: An expert consensus study.

    Science.gov (United States)

    Moore, Lynne; Lauzier, François; Stelfox, Henry Thomas; Le Sage, Natalie; Bourgeois, Gilles; Clément, Julien; Shemilt, Michèle; Turgeon, Alexis F

    2014-08-01

    Complications affect up to 37% of patients hospitalized for injury and increase mortality, morbidity, and costs. One of the keys to controlling complications for injury admissions is to monitor in-hospital complication rates. However, there is no consensus on which complications should be used to evaluate the quality of trauma care. The objective of this study was to develop a consensus-based list of complications that can be used to assess the acute phase of adult trauma care. We used a three-round Web-based Delphi survey among experts in the field of trauma care quality with a broad range of clinical expertise and geographic diversity. The main outcome measure was median importance rating on a 5-point Likert scale (very low to very high); complications with a median of 4 or greater and no disagreement were retained. A secondary measure was the perceived quality of information on each complication available in patient files. Of 19 experts invited to participate, 17 completed the first (brainstorming) round and 16 (84%) completed all rounds. Of 73 complications generated in Round 1, a total of 25 were retained including adult respiratory distress syndrome, hospital-acquired pneumonia, sepsis, acute renal failure, deep vein thrombosis, pulmonary embolism, wound infection, decubitus ulcers, and delirium. Of these, 19 (76%) were perceived to have high-quality or very high-quality information in patient files by more than 50% of the panel members. This study proposes a consensus-based list of 25 complications that can be used to evaluate the quality of acute adult trauma care. These complications can be used to develop an informative and actionable quality indicator to evaluate trauma care with the goal of decreasing rates of hospital complications and thus improving patient outcomes and resource use. DRG International Classification of Diseases codes are provided.

  5. Huge hydrocephalus: definition, management, and complications.

    Science.gov (United States)

    Faghih Jouibari, Morteza; Baradaran, Nazanin; Shams Amiri, Rouzbeh; Nejat, Farideh; El Khashab, Mostafa

    2011-01-01

    Lack of comprehensive knowledge and numerous socioeconomic problems may make the parents leave hydrocephalic children untreated, leading to progressive hydrocephalus and eventual unordinary big head. Management of huge hydrocephalus (HH) differs from common hydrocephalus. We present our experience in the management of these children. HH is defined as head circumference larger than the height of the infant. Nine infants with HH have been shunted in Children's Hospital Medical Center and followed up for 0.5 to 7 years. The most common cause of hydrocephalus was aqueductal stenosis. The mean age of patients during shunting was 3 months. The head circumference ranged from 56 to 94 cm with the average of 67 cm. Cognitive statuses were appropriate based on their age in five patients. Motor development was normal only in one patient. Complications were found in most cases which included subdural effusion (six patients), shunt infection (four patients), skin injury (three patients), proximal catheter coming out of ventricle to the subdural space (two patients), and shunt exposure (one patient). Three patients died due to shunt infection and sepsis. Numerous complications may occur in patients with HH after shunt operation such as subdural effusion, ventricular collapse, electrolyte disturbance, skull deformity, scalp injury, and shunt infection. Mental and motor disabilities are very common in patients with HH. Many of these complications can be related to overdrainage; therefore, drainage control using programmable shunts is advisable.

  6. Difficult Decision on Tyroid Surgery of Expert Witness: Complication or Malpractice

    Directory of Open Access Journals (Sweden)

    Ali Rıza Tümer

    2017-10-01

    Full Text Available Introduction: Recurrent laryngeal nerve (RLN paralysis and hypocalcemia following thyroid surgery have been designated as complication or malpractice. In this study, it was aimed to evaluate surgeons’ opinions towards RLN injury and hypocalcemia after bilateral subtotal thyroidectomy (BST and total thyroidectomy (TT in nodular goiter and thyroid carcinoma.  Materials and Methods: We prepared a questionnaire to determine approaches of surgeons in such cases. We grouped the   the respondents according their thyroid surgery experiments and  asked them to determine whether it is malpractice or complication in cases with unilateral or bilateral RLN paralysis and hypocalcemia after “bilateral subtotal thyroidectomy” and in cases with unilateral or bilateral RLN paralysis after “total thyroidectomy”. Results: In all groups describing bilateral RNL injury was more common. Problems which are defined as "complication" in cancer patiens, were more likely defined as "malpractice" in benign cases. However these differences were generally not  statistically significant.  Conclusions: There is no consensus about malpractice and complication discrimination among physicians. Every physician should evaluate every specific case in its own nature and conditions when asked to determine whether the case should be determined as complication or malpractice.

  7. [Knee and shoulder arthroscopy. Positioning and thermal injuries].

    Science.gov (United States)

    Meyer, S; Lobenhoffer, P

    2008-11-01

    Intraoperative positioning injuries during shoulder- and knee arthroscopy are rare complications and affect mainly nerves and soft tissue. Although the majority of these complications are reversible, in some cases serious negative consequences for the patient persist. This article describes the frequency of several positioning injuries including their prevention and the appropriate treatment. The legal responsibilities are illustrated as well as the importance of an intense preoperative investigation of preexisting diseases and possible risk factors. Furthermore, a review of possible thermal injuries of the patient during arthroscopy caused by e.g. electrosurgical instruments or the cold light source, is given as well as prevention strategies.

  8. Lipopolysaccharide treatment suppresses spontaneously developing ankylosing enthesopathy in B10.BR male mice: The potential role of interleukin-10

    Czech Academy of Sciences Publication Activity Database

    Čapková, Jana; Hrnčíř, Tomáš; Kubátová, Alena; Tlaskalová-Hogenová, Helena

    2012-01-01

    Roč. 13, č. 6 (2012) E-ISSN 1471-2474 R&D Projects: GA ČR(CZ) GAP304/11/1252; GA ČR GP310/09/P182; GA MŠk(CZ) 7E09091 Institutional research plan: CEZ:AV0Z50520701 Institutional support: RVO:61388971 Keywords : Ankylosing enthesopathy * Interleukin-10 * Lipopolysacharid * Cytokines Subject RIV: EC - Immunology Impact factor: 1.875, year: 2012

  9. Assessment and outcome of 496 penetrating gastrointestinal warfare injuries.

    Science.gov (United States)

    Saghafinia, M; Nafissi, N; Motamedi, M R K; Motamedi, M H K; Hashemzade, M; Hayati, Z; Panahi, F

    2010-03-01

    The abdominal viscera are among the most vulnerable organs of the body to penetrating trauma. Proper management of such trauma in war victims at the first-line hospital where these victims are first seen is of paramount importance. We reviewed medical records of war victims suffering small bowel and colorectal injuries treated at first, second and third-line hospitals during the Iraq-Iran War (1980-88) to assess surgical outcomes. The medical records of 496 Iranian war victims suffering penetrating gastrointestinal (GI) injuries treated at first, second and third-line (tertiary) hospitals, a total of 19 centres, were reviewed. Laparotomy had been performed at the 1st line hospitals for all patients who had an acute abdomen, whose wounds violated the peritoneum or whose abdominal radiographs showed air or shrapnel in the abdominal cavity. Stable patients were transferred from first-line to second-line or from second line to tertiary hospitals postoperatively. The treatments, complications and patient outcomes were documented and analyzed. There were 496 patients; 145, 220 and 131 victims underwent laparotomy for GI injuries at first, second and third-line hospitals respectively. The small intestine and colon respectively were the most prevalent abdominal organs damaged. Those first treated for GI injuries at front-line hospitals (145 victims) had more serious conditions and could not be transferred prior to surgery and presented a higher prevalence of complications and mortality. Overall mortality from GI surgery was 3.6% (18 patients). Eleven patients (7.5%) whose first GI operation was performed at frontline hospitals and 7 patients (3.2%) who underwent their first surgical operation at second-line hospitals died. The most common reason for these deaths was complications relating to the gastrointestinal operation such as anastomotic leak. Six missed injuries were seen at the frontline and one at second line hospitals. There were no deaths at the 3rd line hospitals

  10. PATTERNS OF SEVEN AND COMPLICATED MALARIA IN CHILDREN

    African Journals Online (AJOL)

    GB

    neurological tuberculosis and includes cases of arachnoiditis, intradural spinal tuberculoma or granuloma, and spinal cord complications of ... Spinal Injury Association (ASIA). Cerebrospinal fluid analysis showed xanthochromic fluid that ... countries, it affects elderly people due to reactivated disease. However patients from.

  11. Delayed diaphragmatic herniation masquerading as a complicated parapneumonic effusion.

    Science.gov (United States)

    Tsang, J; Ryan, F

    1999-01-01

    Injury to the diaphragm following blunt or penetrating thoracoabdominal trauma is not uncommon. Recognition of this important complication of trauma continues to be a challenge because of the lack of specific clinical and plain radiographic features, the frequent presence of other serious injuries and the potential for delayed presentation. Delayed diaphragmatic herniation often presents with catastrophic bowel obstruction or strangulation. Early recognition of diaphragmatic injury is required to avoid this potentially lethal complication. The case of a 35-year-old man with a history of a knife wound to the left flank 15 years previously, who presented with unexplained acute hypoxemic respiratory failure and a unilateral exudative pleural effusion that was refractory to tube thoracostomy drainage, is reported. After admission to hospital, he developed gross dilation of his colon; emergency laparotomy revealed an incarcerated colonic herniation into the left hemithorax. Interesting clinical features of this patient's case included the patient's hobby of weightlifting, a persistently deviated mediastinum despite drainage of the pleural effusion and deceptive pleural fluid biochemical indices.

  12. Delayed Diaphragmatic Herniation Masquerading as a Complicated Parapneumonic Effusion

    Directory of Open Access Journals (Sweden)

    John Tsang

    1999-01-01

    Full Text Available Injury to the diaphragm following blunt or penetrating thoraco-abdominal trauma is not uncommon. Recognition of this important complication of trauma continues to be a challenge because of the lack of specific clinical and plain radiographic features, the frequent presence of other serious injuries and the potential for delayed presentation. Delayed diaphragmatic herniation often presents with catastrophic bowel obstruction or strangulation. Early recognition of diaphragmatic injury is required to avoid this potentially lethal complication. The case of a 35-year-old man with a history of a knife wound to the left flank 15 years previously, who presented with unexplained acute hypoxemic respiratory failure and a unilateral exudative pleural effusion that was refractory to tube thoracostomy drainage, is reported. After admission to hospital, he developed gross dilation of his colon; emergency laparotomy revealed an incarcerated colonic herniation into the left hemithorax. Interesting clinical features of this patient's case included the patient's hobby of weightlifting, a persistently deviated mediastinum despite drainage of the pleural effusion and deceptive pleural fluid biochemical indices.

  13. Vascular complications following therapeutic and diagnostic cardiac catheterisation by the femoral artery

    DEFF Research Database (Denmark)

    Bitsch, M; Liisberg-Larsen, Ole Christian; Schroeder, T V

    1994-01-01

    Twenty-one of 6327 (0.33%) patients undergoing cardiac catheterisation via the femoral artery had an acute vascular complication requiring surgical intervention. The complication rate was 0.1% after coronary angiography, 2% after PTCA and 6% after aortic ballon dilatation. The size of the cathete...... and evaluation of vascular injuries following diagnostic and therapeutic invasive interventions could have a self limitating effect on the complication rate....

  14. TNF blockers inhibit spinal radiographic progression in ankylosing spondylitis by reducing disease activity: results from the Swiss Clinical Quality Management cohort.

    Science.gov (United States)

    Molnar, Christoph; Scherer, Almut; Baraliakos, Xenofon; de Hooge, Manouk; Micheroli, Raphael; Exer, Pascale; Kissling, Rudolf O; Tamborrini, Giorgio; Wildi, Lukas M; Nissen, Michael J; Zufferey, Pascal; Bernhard, Jürg; Weber, Ulrich; Landewé, Robert B M; van der Heijde, Désirée; Ciurea, Adrian

    2018-01-01

    To analyse the impact of tumour necrosis factor inhibitors (TNFis) on spinal radiographic progression in ankylosing spondylitis (AS). Patients with AS in the Swiss Clinical Quality Management cohort with up to 10 years of follow-up and radiographic assessments every 2 years were included. Radiographs were scored by two readers according to the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) with known chronology. The relationship between TNFi use before a 2-year radiographic interval and progression within the interval was investigated using binomial generalised estimating equation models with adjustment for potential confounding and multiple imputation of missing values. Ankylosing Spondylitis Disease Activity Score (ASDAS) was regarded as mediating the effect of TNFi on progression and added to the model in a sensitivity analysis. A total of 432 patients with AS contributed to data for 616 radiographic intervals. Radiographic progression was defined as an increase in ≥2 mSASSS units in 2 years. Mean (SD) mSASSS increase was 0.9 (2.6) units in 2 years. Prior use of TNFi reduced the odds of progression by 50% (OR 0.50, 95% CI 0.28 to 0.88) in the multivariable analysis. While no direct effect of TNFi on progression was present in an analysis including time-varying ASDAS (OR 0.61, 95% CI 0.34 to 1.08), the indirect effect, via a reduction in ASDAS, was statistically significant (OR 0.75, 95% CI 0.59 to 0.97). TNFis are associated with a reduction of spinal radiographic progression in patients with AS. This effect seems mediated through the inhibiting effect of TNFi on disease activity. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  15. Improved CT imaging in diagnosis of ankylosing spondylitis

    International Nuclear Information System (INIS)

    Mai Yuanfeng; Sun Haixing; Ling Jian; Kuang Jianyi; Pan Ximin

    2006-01-01

    Objective: To evaluate the improved CT imaging of sacroiliac joint in diagnosis of ankylosing spondylitis (AS). Methods: 22 patients, diagnosed as AS by clinical and radiography, undertook both conventional and improved CT imaging. All images were comparatively studied. Results: With conventional CT imaging, in the 44 joints of 22 cases, unremarkable images were obtained in 3 cases; early stage AS was found in 15 joints of 9 cases; AS in progressive stage was revealed in 8 cases/16 joints, stabled AS was presented in 2 cases/4 joints. There were 23 joints in 12 cases diagnosed as early term by improved imaging, progressive staged AS was shown in 8 cases/16 joints as, stable AS was demonstrated in 2 cases/4 joints. Conclusion: The improved imaging is sensitive in the diagnosis of early staged AS, for the application of thin slice scan, which helps to reduce partial volume effect. Scanning along the longitudinal axis of the sacroiliac joint extends the observation of erosion of the joint surface. For progressive or stable staged AS, the alterations of bone and joint space are prominent, improved CT imaging is not superior to the conventional. (authors)

  16. Brain-Heart Interaction: Cardiac Complications After Stroke.

    Science.gov (United States)

    Chen, Zhili; Venkat, Poornima; Seyfried, Don; Chopp, Michael; Yan, Tao; Chen, Jieli

    2017-08-04

    Neurocardiology is an emerging specialty that addresses the interaction between the brain and the heart, that is, the effects of cardiac injury on the brain and the effects of brain injury on the heart. This review article focuses on cardiac dysfunction in the setting of stroke such as ischemic stroke, brain hemorrhage, and subarachnoid hemorrhage. The majority of post-stroke deaths are attributed to neurological damage, and cardiovascular complications are the second leading cause of post-stroke mortality. Accumulating clinical and experimental evidence suggests a causal relationship between brain damage and heart dysfunction. Thus, it is important to determine whether cardiac dysfunction is triggered by stroke, is an unrelated complication, or is the underlying cause of stroke. Stroke-induced cardiac damage may lead to fatality or potentially lifelong cardiac problems (such as heart failure), or to mild and recoverable damage such as neurogenic stress cardiomyopathy and Takotsubo cardiomyopathy. The role of location and lateralization of brain lesions after stroke in brain-heart interaction; clinical biomarkers and manifestations of cardiac complications; and underlying mechanisms of brain-heart interaction after stroke, such as the hypothalamic-pituitary-adrenal axis; catecholamine surge; sympathetic and parasympathetic regulation; microvesicles; microRNAs; gut microbiome, immunoresponse, and systemic inflammation, are discussed. © 2017 American Heart Association, Inc.

  17. Oral verrucous carcinoma complicating a repetitive injury by the ...

    African Journals Online (AJOL)

    Here we reported a case of VC of oral cavity a particularly very aggressive, arising from prosthesis injury. Regardless of the treatment modality, given new insights into the possible aggressivity of this tumor, radiotherapy associated to chemotherapy may be a more appropriate primary treatment compared with the significant ...

  18. Reconstructive surgery for the complications of pelvic irradiation

    International Nuclear Information System (INIS)

    Bricker, E.M.; Johnston, W.D.; Kraybill, W.G.; Lopez, M.J.

    1984-01-01

    Severe damage to the pelvic viscera is a complication of irradiation therapy that, unfortunately, cannot always be avoided. Resulting rectal and rectocolonic strictures, rectovaginal fistulas, and shortening and stenosis of the vagina present very difficult problems that frequently require a colostomy for relief and may permanently impair sexual function. The authors present a new approach to correction of these unfortunate lesions based on the use of proximal nonirradiated colon which serves as a vascular pedicle graft to correct the defect without a complicated and massive resection. Twenty-two such operations have been done with 19 satisfactory to excellent results and two total failures (one death from small bowel complications). All patterns and combinations of irradiation injury have been found amenable to this technique of repair. These have included both web and linear strictures with and without fistulas. In half of the patients, it was possible to make use of normal colon bypassed by a prior colostomy. Normal nonirradiated colon with good blood supply will heal satisfactorily to irradiated colon or rectum, thus making excision of all the irradiated tissue unnecessary. The results of this surgical approach have thus far been gratifying and warrant further trials for these distressing injuries

  19. TRAUMATIC BRAIN INJURY CHILDREN: A LITERATURE REVIEW

    Directory of Open Access Journals (Sweden)

    Denismar Borges de Miranda

    2013-09-01

    Full Text Available Objective: to know the scientific literature on head injury in children. Method: this study is an integrative review of published articles in the database SciELO the period 2000-2010. Results: 10 articles were analyzed, from which emerged four categories: causes of traumatic brain child infant prognosis of traumatic brain child, treating children victims of child head injury and complications of therapy used for child victims of traumatic brain injury in children. Conclusions: there is consensus among the authors investigated the factors associated with better prognosis of traumatic brain child, remain vague and uncertain. They add that the success of this customer service related to the control of complications arising from cerebral trauma and mostly are treatable and / or preventable.

  20. Virtual reality: towards a novel treatment environment for ankylosing spondylitis.

    Science.gov (United States)

    Li, Shijuan; Kay, Stephen; Hardicker, Nicholas R

    2007-01-01

    The objective of this paper is to outline the project that eventually seeks to visualize clinical knowledge found within the record; the immediate task being to create a model that can be deployed for therapeutic purposes. How therapies for a certain type of chronically ill patient can benefit from Virtual Reality (VR) tools is investigated. Ankylosing Spondylitis (AS) is selected as a test condition. VR is expected to provide a novel treatment environment for AS sufferers, in which they can relax, manage their pain and take part in the routine exercise more effectively and efficiently by using the VR tools. An integral part of this model's construction will be to elicit evaluative detail from the literature and the patients' perspective. The purpose is to understand the inevitable challenges facing this proposed intervention if the design prototype is to successfully move from the research domain and become an integral part of established therapeutic practice.

  1. Innominate artery injury: a catastrophic complication of tracheostomy, operative procedure revisited.

    Science.gov (United States)

    Maruti Pol, Manjunath; Gupta, Amit; Kumar, Subodh; Mishra, Biplab

    2014-04-03

    A patient presented with profuse bleeding from the oronasal cavity following orofaciomaxillary trauma associated with tracheolaryngeal injury and suspected cervical-spine injury due to collapse of a wall on the face, neck and upper chest. The patient was gasping, coughing blood and was unable to speak. Threatened airway was diagnosed. Inability to maintain oxygenation on cricothyroidotomy, forced emergency department surgeons to shift the patient to the operating room for definitive airway. During tracheostomy a major vessel was injured. Application of vascular clamp in the event of achieving haemostasis resulted in disappearance of saturation and pulse in the right upper limb, thus we suspected innominate artery (IA) injury. High tracheostomy performed and endotracheal tube passed into the trachea after removing clot and overcoming compromised narrow tracheal lumen. The injured IA was repaired and the patient survived for 14 days. On postoperative day 14 he died following profound bleeding into the tracheobronchial tree and asphyxia/apnoea. Tracheoinnominate artery fistula was detected at autopsy.

  2. Phrenic nerve injury: An underrecognized and potentially preventable complication of pulmonary vein isolation using a wide-area circumferential ablation approach.

    Science.gov (United States)

    Yong Ji, Sang; Dewire, Jane; Barcelon, Bernadette; Philips, Binu; Catanzaro, John; Nazarian, Saman; Cheng, Alan; Spragg, David; Tandri, Harikrishna; Bansal, Sandeep; Ashikaga, Hiroshi; Rickard, Jack; Kolandaivelu, Aravindan; Sinha, Sunil; Marine, Joseph E; Calkins, Hugh; Berger, Ronald

    2013-10-01

    Phrenic nerve injury (PNI) is a well-known, although uncommon, complication of pulmonary vein isolation (PVI) using radiofrequency energy. Currently, there is no consensus about how to avoid or minimize this injury. The purpose of this study was to determine how often the phrenic nerve, as identified using a high-output pacing, lies along the ablation trajectory of a wide-area circumferential lesion set. We also sought to determine if PVI can be achieved without phrenic nerve injury by modifying the ablation lesion set so as to avoid those areas where phrenic nerve capture (PNC) is observed. We prospectively enrolled 100 consecutive patients (age 61.7 ± 9.2 years old, 75 men) who underwent RF PVI using a wide-area circumferential ablation approach. A high-output (20 mA at 2 milliseconds) endocardial pacing protocol was performed around the right pulmonary veins and the carina where a usual ablation lesion set would be made. A total of 30% of patients had PNC and required modification of ablation lines. In the group of patients with PNC, the carina was the most common site of capture (85%) followed by anterior right superior pulmonary vein (RSPV) (70%) and anterior right inferior pulmonary vein (RIPV) (30%). A total of 25% of PNC group had capture in all 3 (RSPV, RIPV, and carina) regions. There was no difference in the clinical characteristics between the groups with and without PNC. RF PVI caused no PNI in either group. High output pacing around the right pulmonary veins and the carina reveals that the phrenic nerve lies along a wide-area circumferential ablation trajectory in 30% of patients. Modification of ablation lines to avoid these sites may prevent phrenic nerve injury during RF PVI. © 2013 Wiley Periodicals, Inc.

  3. The reliability and validity of a Venezuelan version of the Bath Ankylosing Spondylitis Functional Index (BASFI) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI).

    Science.gov (United States)

    Rauseo Vera, Mayra; Gutiérrez-González, Luis Arturo; Maldonado, Irama; Al Snih, Soham

    2017-09-21

    Spondyloarthropathies (SpA) are disabling diseases with a prevalence of 1.9% in the general population. The indices designed for monitoring the disease should be valid, reliable and cross-culturally adapted for decision-making concerning the appropriate treatment. Changing an adjective or pronoun in a self-administered questionnaire could be the big difference in condensing an idea in a few words and transmitting that concept to all those who share the same language. To develop a Venezuelan version of the original English version of the BASDAI/BASFI and to evaluate its reliability and validity in Venezuelan patients with SpA. Certified linguists were needed for the translation of a Venezuelan version of the BASDAI/BASFI. The evaluation of reliability and validity was performed by calculating correlation coefficients in addition to Cronbach's alpha correlation between the BASDAI score and the clinical parameters (for example: erythrocyte sedimentation rate, C-reactive protein, modified Schöber test, occiput-to-wall distance and enthesis count). We studied 40 patients including 31 men (77.5%) and 9 women (22.5%). The mean age was 35.9 years ± standard deviation (SD) 12.01 and the disease duration was 11.5 years (± SD 9.5). The most common diagnoses were undifferentiated spondyloarthritis (45%), ankylosing spondylitis (27.5%) and psoriatic arthritis (20%). The incidences of reactive arthritis, ankylosing spondylitis and juvenile Reiter's syndrome were 2.5% each. The test-retest reliability of the BASDAI and BASFI was high (R = 0.99 and 0.99, respectively; P<.0001). The internal consistency for the BASDAI was high (Cronbach's alpha = 0.88; P=.002) and the intraclass correlation coefficient for internal consistency: 0.9867 (P=.001). Internal consistency for the BASFI: Cronbach's alpha = 0.7985 (P=.002), intraclass correlation coefficient for internal consistency: 0.9055 (P=.001). Construct validity of the BASDAI was high for general well-being of the patient (R = 0

  4. Acute kidney injury complicating bee stings - a review.

    Science.gov (United States)

    Silva, Geraldo Bezerra da; Vasconcelos, Adolfo Gomes; Rocha, Amanda Maria Timbó; Vasconcelos, Vanessa Ribeiro de; Barros, João de; Fujishima, Julye Sampaio; Ferreira, Nathália Barros; Barros, Elvino José Guardão; Daher, Elizabeth De Francesco

    2017-06-01

    Bee stings can cause severe reactions and have caused many victims in the last years. Allergic reactions can be triggered by a single sting and the greater the number of stings, the worse the prognosis. The poisoning effects can be systemic and can eventually cause death. The poison components are melitin, apamin, peptide 401, phospholipase A2, hyaluronidase, histamine, dopamine, and norepinephrine, with melitin being the main lethal component. Acute kidney injury (AKI) can be observed in patients suffering from bee stings and this is due to multiple factors, such as intravascular hemolysis, rhabdomyolysis, hypotension and direct toxicity of the venom components to the renal tubules. Arterial hypotension plays an important role in this type of AKI, leading to ischemic renal lesion. The most commonly identified biopsy finding in these cases is acute tubular necrosis, which can occur due to both, ischemic injury and the nephrotoxicity of venom components. Hemolysis and rhabdomyolysis reported in many cases in the literature, were demonstrated by elevated serum levels of indirect bilirubin and creatine kinase. The severity of AKI seems to be associated with the number of stings, since creatinine levels were higher, in most cases, when there were more than 1,000 stings. The aim of this study is to present an updated review of AKI associated with bee stings, including the currently advised clinical approach.

  5. Intestine immune homeostasis after alcohol and burn injury.

    Science.gov (United States)

    Li, Xiaoling; Hammer, Adam M; Rendon, Juan L; Choudhry, Mashkoor A

    2015-06-01

    Traumatic injury remains one of the most prevalent reasons for patients to be hospitalized. Burn injury accounts for 40,000 hospitalizations in the United States annually, resulting in a large burden on both the health and economic system and costing millions of dollars every year. The complications associated with postburn care can quickly cause life-threatening conditions including sepsis and multiple organ dysfunction and failure. In addition, alcohol intoxication at the time of burn injury has been shown to exacerbate these problems. One of the biggest reasons for the onset of these complications is the global suppression of the host immune system and increased susceptibility to infection. It has been hypothesized that infections after burn and other traumatic injury may stem from pathogenic bacteria from within the host's gastrointestinal tract. The intestine is the major reservoir of bacteria within the host, and many studies have demonstrated perturbations of the intestinal barrier after burn injury. This article reviews the findings of these studies as they pertain to changes in the intestinal immune system after alcohol and burn injury.

  6. Post thyroidectomy complications: the Hyderabad experience

    International Nuclear Information System (INIS)

    Khanzada, T.W.; Samad, A.; Memonb, W.; Kumar, B.

    2010-01-01

    Objective: Thyroidectomy is a very common surgical procedure worldwide and is performed by surgeons with varied training. The outcome and complication rates are largely dependent on surgeon's skill and experience, the extent of surgery, indication of surgery and number of thyroid surgeries performed at that particular centre. The objective of this study was to determine the frequency of postoperative complications after thyroid surgery in Hyderabad, Pakistan. Study Design: It was a descriptive study and was carried out at 2 private hospitals including a teaching University Hospital over a period of 3 years from April 2005 to March 2008. Patients and Methods: All patients with goitre, who underwent any sort of thyroid surgery, were included in this study. Patients' bio-data including name, age sex, clinical status of thyroid, thyroid function tests, ultrasound, fine needle aspiration cytology and operative procedure, findings, post operative complications and histopathology reports were recorded. Data were analysed using SPSS 16.0. Results: The overall postoperative complication rate was 10.7%. Postoperative hypocalcaemia was the most frequent complication observed in 3.5% of all patients followed by recurrent laryngeal nerve (RLN) injury noted in 2.8% patients. The less common complications were bleeding, seroma formation and wound infection. Majority of these complications were associated with total thyroidectomy, male gender, and in patients with age more than 30 years. Conclusion: The commonest post thyroidectomy complication was hypocalcaemia. Male gender, old age, and extensive thyroid surgery were associated with increased complication rate. (author)

  7. Are Indian patients with juvenile-onset ankylosing spondylitis taller than reference population ?

    Directory of Open Access Journals (Sweden)

    Pulukool Sandhya

    2015-01-01

    Full Text Available Background & objectives: Paucity of growth retardation has been observed by us in patients with juvenile-onset ankylosing spondylitis (JAS in a tertiary care health centre in south India. We, therefore, undertook this pilot study to assess and compare anthropometry of patients with JAS who were 15 yr and older with that of adult onset ankylosing spondylitis (AAS and matching Indian reference population. Methods: Consecutive male patients (December 2009- October 2012 with JAS and AAS fulfilling Modified New York Criteria were selected after applying inclusion and exclusion criteria. Demography and anthropometry were noted. Height of both patient groups as well as their parents and siblings were compared with that of the reference population. Mid-parental height and delta height were derived. Those with delta height of >8.5 cm were compared with the remaining. Multivariate logistic regression was done for variables that were found to be significant by chi-square in bivariate analysis. Similar analysis was done for BMI also. Results: There was no significant difference in anthropometric variables between JAS and AAS groups. Twenty eight of the 30 (93.33% JAS patients were taller as compared to the reference population. Twenty six (86.67% AAS patients were taller than the reference population. The mean heights of JAS (170.67 ± 6.94 cm and AAS (168.2 ± 5.94 cm patients were significantly higher than the reference value of 163.11 cm; both p0 <0.001. Logistic regression revealed that tallness in JAS was associated positively with hypermobility (OR=23.46,95%CI 1.2-447.2, p0 =0.036. No significant association was detected for height in AAS and for BMI in both JAS and AAS groups. Interpretation & conclusions: No growth retardation was seen in patients with JAS in our study. Majority of patients with JAS and AAS were taller than reference population. The difference between mean height of JAS and AAS was not significant. Larger studies involving different

  8. Delayed pneumothorax complicating minor rib fracture after chest trauma.

    Science.gov (United States)

    Lu, Ming-Shian; Huang, Yao-Kuang; Liu, Yun-Hen; Liu, Hui-Ping; Kao, Chiung-Lun

    2008-06-01

    Pneumothorax (PTX) after trauma is a preventable cause of death. Drainage procedures such as chest tube insertion have been traditionally advocated to prevent fatal tension PTX. We evaluated the safety of close observation in patients with delayed PTX complicating rib fracture after minor chest trauma. Adult patients (>18 years) with a diagnosis of chest trauma and 3 or fewer fractured ribs were reviewed. Case patients were divided according to age, location and number of fractured ribs, mechanism of trauma, and initial pulmonary complication after thoracic trauma for comparative analysis. There were 207 male (70.2%) and 88 female (29.8%) patients whose ages ranged from 18 to 93 years (median, 55 years). The mechanisms of trauma were a motor vehicle accident in 207 patients, falls in 66, pedestrian injury in 10, and assaults in 14. Ninety-five patients sustained 1 rib fracture, 95 had 2 rib fractures, and 105 suffered 3 rib fractures. Right-sided injury occurred in 164 cases, left-sided injury did in 127, and bilateral injury did in 4. The most frequent location of rib fractures was from the fourth rib to the ninth rib. The initial pulmonary complications after trauma were PTX in 16 patients, hemothorax in 43, pneumohemothorax in 14, lung contusion in 75, and isolated subcutaneous emphysema (SubcEmph) in 33. Thirty percent of the patients (n = 5/16) who presented with traumatic PTX were observed safely without drainage. Delayed PTX was recorded in 16 patients, occurring mostly during the first 2 days of their admission. Associated extrathoracic injury was recorded in 189 patients. The mean hospital stay of the patients was 7.66 days. Longer hospital stay was related to increasing number of fractured ribs, need for thoracic drainage, and the presence of associated extrathoracic injury. The mortality rate for the entire group was 2%. The presence of SubcEmph was the only risk factor associated with the development of delayed PTX. Patients sustaining blunt chest

  9. CT of peroneal tendon injury in patients with calcaneal fractures

    International Nuclear Information System (INIS)

    Rosenberg, Z.S.; Feldman, F.; Singson, R.D.

    1986-01-01

    Injury to the peroneal tendons is a major complication of intraarticular calcaneal fractures. Heretofore, the injury has been difficult to diagnose by routine imaging modalities. However, CT studies of 24 intraarticular calcaneal fractures revealed evidence of peroneal tendon injury in 22 cases. The pathologic conditions included lateral displacement, subluxation, dislocation, and impingement on the tendons by bony fragments, hematomas, and scar tissue. Patients studied 6-12 months after injury had CT evidence consistent with clinical symptoms of peroneal tenosynovitis. Since peroneal tendon injury is surgically correctable, it should be differentiated from other known and more obvious complications, of calcaneal fractures. CT therefore serves as a valuable, noninvasive tool in evaluating these otherwise nonvisualized soft tissue structures in the immediate posttraumatic period as well as during long-term follow up

  10. Anaphylaxis due to head injury.

    Science.gov (United States)

    Bruner, Heather C; Bruner, David I

    2015-05-01

    Both anaphylaxis and head injury are often seen in the emergency department, but they are rarely seen in combination. We present a case of a 30-year-old woman who presented with anaphylaxis with urticaria and angioedema following a minor head injury. The patient responded well to intramuscular epinephrine without further complications or airway compromise. Prior case reports have reported angioedema from hereditary angioedema during dental procedures and maxillofacial surgery, but there have not been any cases of first-time angioedema or anaphylaxis due to head injury.

  11. Calculation of complication probability of pion treatment at PSI using dose-volume histograms

    International Nuclear Information System (INIS)

    Nakagawa, Keiichi; Akanuma, Atsuo; Aoki, Yukimasa

    1991-01-01

    In the conformation technique a target volume is irradiated uniformly as in conventional radiations, whereas surrounding tissue and organs are nonuniformly irradiated. Clinical data on radiation injuries that accumulate with conventional radiation are not applicable without appropriate compensation. Recently a putative solution of this problem was proposed by Lyman using dose-volume histograms. This histogram reduction method reduces a given dose-volume histogram of an organ to a single step which corresponds to the equivalent complication probability by interpolation. As a result it converts nonuniform radiation into a unique dose to the whole organ which has the equivalent likelihood of radiation injury. This method is based on low LET radiation with conventional fractionation schedules. When it is applied to high LET radiation such as negative pion treatment, a high LET dose should be converted to an equivalent photon dose using an appropriate value of RBE. In the present study the histogram reduction method was applied to actual patients treated by the negative pion conformation technique at the Paul Scherrer Institute. Out of evaluable 90 cases of pelvic tumors, 16 developed grade III-IV bladder injury, and 7 developed grade III-IV rectal injury. The 90 cases were divided into roughly equal groups according to the equivalent doses to the entire bladder and rectum. Complication rates and equivalent doses to the full organs in these groups could be represented by a sigmoid dose-effect relation. When RBE from a pion dose to a photon dose is assumed to be 2.1 for bladder injury, the rates of bladder complications fit best to the theoretical complication curve. When the RBE value was 2.3, the rates of rectal injury fit the theoretical curve best. These values are close to the conversion factor of 2.0 that is used in clinical practice at PSI. This agreement suggests the clinical feasibility of the histogram reduction method in conformation radiotherapy. (author)

  12. Blunt renal trauma in children: healing of renal injuries and recommendations for imaging follow-up

    International Nuclear Information System (INIS)

    Abdalati, H.; Bulas, D.I.; Sivit, C.J.; Majd, M.; Rushton, H.G.; Eichelberger, M.R.

    1994-01-01

    Initial CT grading of renal injury was correlated with the frequency of complications and the time course of healing in 35 children. All renal contusions (grade 1, 8) and small parenchymal lacerations (grade 2, 8) healed without complications. All lacerations extending to the collecting system (grade 3, 9) resulted in mild to severe loss of renal function with progressive healing over 4 months. One of four segmental infarcts (grade 4 A), and five of six vascular pedicle injuries (grade 4 B) resulted in severe loss of renal function. Complications, including urinoma (2), sepsis (1), hydronephrosis (1), and persistent hypertension (2), were limited to grade 3 and 4 injuries. Our results suggest that mild renal injuries do not require follow-up imaging. Major renal lacerations and vascular pedicle injuries, however, often result in loss of renal function and should be followed up closely due to the risk of delayed complications. Follow-up examinations should continue for 3-4 months until healing is documented. (orig.)

  13. Indicators of complicated mild TBI predict MMPI-2 scores after 23 years.

    Science.gov (United States)

    Hessen, Erik; Nestvold, Knut

    2009-03-01

    Research suggests that post-concussive syndrome may become persistent after mild traumatic brain injury (mTBI). The aim of this study was to investigate determinants of subjective complaints, characteristic for post-concussive syndrome, 23 years after mTBI. The study was a follow-up after a prospective head injury study at a general hospital in Norway. Ninety-seven patients were assessed with the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) 23 years after sustaining primarily mTBI. A good overall outcome was found with scores close to the normative mean, average length of education and normal employment rate. However, the patients that sustained complicated mTBI showed somewhat more pathological scores, well-matched with mild post-concussive syndrome. The most important predictors of poor outcome were a combination of post-traumatic amnesia >30 minutes and EEG pathology within 24 hours after TBI. No influence of pre- and post-injury risk factors on current MMPI-2 profiles was found. The results are in line with previous research findings and support the notion of potentially differential impact of uncomplicated vs. complicated mTBI. The findings suggest that complicated mTBI may cause subtle chronic symptoms typical of post-concussive syndrome.

  14. Prediction of complications following unintentional caustic ingestion in children. Is endoscopy always necessary?

    DEFF Research Database (Denmark)

    Christesen, H B

    1995-01-01

    The records of 115 children hospitalized following caustic ingestion over an 18.5-year period from 1976 to 1994 were reviewed. The relationship between types of product ingested, signs and symptoms, degree of esophageal injury and complications was analyzed. All complications were the result...... of strong alkali ingestion (sensitivity = 1.0). Among the 102 incident patients, 36.8% of lye ingestions resulted in complications, whereas only 2.7% (one) of automatic dishwasher detergent (ADD) ingestions caused any complications (p

  15. Improvement of Lipid Profile Is Accompanied by Atheroprotective Alterations in High-Density Lipoprotein Composition Upon Tumor Necrosis Factor Blockade A Prospective Cohort Study in Ankylosing Spondylitis

    NARCIS (Netherlands)

    Eijk, van I.C.; Vries, de M.K.; Levels, J.H.M.; Peters, M.J.L.; Huizer, E.E.; Dijkmans, B.A.C.; Horst - Bruinsma, van der I.E.; Hazenberg, B.P.C.; Stadt, van de R.J.; Wolbink, G.; Nurmohamed, M.T.

    2009-01-01

    Objective. Cardiovascular mortality is increased in ankylosing spondylitis (AS), and inflammation plays an important role. Inflammation deteriorates the lipid profile and alters high-density lipoprotein cholesterol (HDL-c) composition, reflected by increased concentrations of serum amyloid A (SAA)

  16. LABORATORY BIOMARKERS FOR ANKYLOSING SPONDYLITIS

    Directory of Open Access Journals (Sweden)

    E. N. Aleksandrova

    2017-01-01

    Full Text Available Ankylosing spondylitis (AS is a chronic inflammatory disease from a group of spondyloarthritis (SpA, which is characterized by lesions of the sacroiliac joints and spine with the common involvement of entheses and peripheral joints in the pathological process. Advances in modern laboratory medicine have contributed to a substantial expansion of the range of pathogenetic, diagnostic, and prognostic biomarkers of AS. As of now, there are key pathogenetic biomarkers of AS (therapeutic targets, which include tumor necrosis factor-α (TNF-α, interleukin 17 (IL-17, and IL-23. Among the laboratory diagnostic and prognostic biomarkers, HLA-B27 and C-reactive protein are of the greatest value in clinical practice; the former for the early diagnosis of the disease and the latter for the assessment of disease activity, the risk of radiographic progression and the efficiency of therapy. Anti-CD74 antibodies are a new biomarker that has high sensitivity and specificity values in diagnosing axial SpA at an early stage. A number of laboratory biomarkers, including calprotectin, matrix metalloproteinase-3 (MMP-3, vascular endothelial growth factor, Dickkopf-1 (Dkk-1, and C-terminal telopeptide of type II collagen (CTX II do not well reflect disease activity, but may predict progressive structural changes in the spine and sacroiliac joints in AS. Blood calprotectin level monitoring allows the effective prediction of a response to therapy with TNF inhibitors and anti-IL-17А monoclonal antibodies. The prospects for the laboratory diagnosis of AS are associated with the clinical validation of candidate biomarkers during large-scale prospective cohort studies and with a search for new proteomic, transcriptomic and genomic markers, by using innovative molecular and cellular technologies.

  17. [Crossed renal ectopia in a patient with a complicated sigma neoplasia].

    Science.gov (United States)

    Pérez-Sánchez, Luis Eduardo; Burneo-Esteves, Mauricio; Rosat-Rodrigo, Adriá; Baz-Figueroa, Caleb; Pérez-Álvarez, Antonio Dámaso; Barrera-Gómez, Manuel Ángel

    2017-12-01

    Crossed renal ectopia is a rare pathology that is often asymptomatic. Intraoperative detection with a sigma complicated neoplasia is more infrequent and requires correct management to avoid a renal ureteral injury. To present a case report of a patient with a sigma complicated neoplasia and a crossed renal ectopia detected incidentally. We present the case of a 62-year-old man that was submitted for emergency surgery for a sigma perforated neoplasm, and who presented with a previously undiagnosed left-side CRE. During surgery there was a need to insert 2-double-J stents as a guide to both ureters and to avoid any injury to them. Crossed renal ectopia is a rare, often asymptomatic entity, the diagnosis of which is usually incidental. In our case, the detection of a concomitant complicated neoplasm, required identification of both ureters due the anatomic doubt of its localization and to avoid them being injured. In conclusion, upon finding a casual crossed renal ectopia during an emergency surgery of sigma, we recommend the identification of the ureters to facilitate its location and to avoid any injury to the ureters. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  18. Intraabdominal contamination after gallbladder perforation during laparoscopic cholecystectomy and its complications.

    Science.gov (United States)

    Kimura, T; Goto, H; Takeuchi, Y; Yoshida, M; Kobayashi, T; Sakuramachi, S; Harada, Y

    1996-09-01

    Gallbladder perforation often occurs during laparoscopic cholecystectomy. The frequency and causes of gallbladder perforation as well as the relevant clinical background factors were investigated in 110 patients undergoing laparoscopic cholecystectomy. We also evaluated intraperitoneal contamination by bacteria and gallstones at the time of gallbladder perforation and investigated whether perforation caused early or late postoperative complications. Intraoperative gallbladder perforation occurred in 29 of the 110 patients (26.3%). It was caused by injury with an electric knife during dissection of the gallbladder bed, injury during gallbladder retraction with grasping forceps, injury during gallbladder extraction from the abdomen, and slippage of cystic duct clips (potentially causing bile and stone spillage). Perforation was more frequent in patients with positive bile cultures and in those with pigment stones (p gallbladder perforation is sometimes unavoidable during laparoscopic cholecystectomy, the risk of severe complications appears to be minimized by early closure of perforation, retrieval of as many of the spilled stones as possible, and intraperitoneal lavage.

  19. Disease activity, quality of life and indirect costs of reduced productivity at work, generated by Polish patients with ankylosing spondylitis

    Directory of Open Access Journals (Sweden)

    Paweł Kawalec

    2016-02-01

    Full Text Available Objectives: The aim of the study was to investigate the association between activity of ankylosing spondylitis (AS and decrease in quality of life as well as productivity loss of affected patients in a specified group of patients in the Polish setting. Material and methods : An questionnaire survey was conducted using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI to assess disease activity, as well as the Work Productivity and Activity Impairment Questionnaires to assess productivity loss; quality of life was presented as utility calculated using the EuroQol 5 questionnaire and also measured on a visual analogue scale (VAS. Indirect costs were assessed with the human capital approach implying gross domestic product per capita or gross value added per worker in Poland in 2014 and were expressed in Polish zlotys (PLN as well as in euros. Correlation was presented using Spearman’s rank correlation coefficient. Results : We performed our analysis based on 78 full questionnaires collected. A mean BASDAI score of 5.91 in the analysed group of patients was detected and mean utility of 0.5135 was observed. Average quality of life measured on the visual analogue scale was 46.55. Mean number of days off work was 45.26 days per year and mean on-the-job productivity loss was 49.29%. Average annual indirect costs per patient were €4241 (17 686 PLN calculated using gross domestic product and €10 172 (42 417 PLN estimated using gross value added. Total productivity loss was significantly correlated with disease activity (strong correlation of 0.6005 and utility (moderate correlation of –0.3698. Conclusions : Ankylosing spondylitis causes a great decrease in quality of life as well as patients’ productivity loss associated with both absenteeism and presenteeism. The greater the disease activity is, the lower is the utility, the lower is the quality of life measured on the VAS, and the greater are the total annual indirect costs. Total

  20. Vital capacity helps predict pulmonary complications after rib fractures.

    Science.gov (United States)

    Carver, Thomas W; Milia, David J; Somberg, Chloe; Brasel, Karen; Paul, Jasmeet

    2015-09-01

    Traumatic rib fractures are associated with significant morbidity. Vital capacity (VC) assesses pulmonary function; however, limited data link VC to patient outcomes. Our objective was to determine if VC predicted complications and disposition in patients with rib fractures. This is a retrospective chart review of all patients with fractured ribs admitted to a Level 1 trauma center during a 4-year period. Patients were excluded if no VC was performed within 48 hours of admission. Data collected included demographics, hospital/intensive care unit length of stay, epidural, discharge to home versus extended care facility, mortality, chest Abbreviated Injury Scale (AIS) score, Injury Severity Score (ISS), number of rib fractures, hemothorax/pneumothorax, presence of pulmonary contusion, presence of chest tube, chronic obstructive pulmonary disease, and average daily VC (percentage of predicted). Pulmonary complication was defined as pneumonia, need for intubation, new home O2 requirement, readmission for pulmonary issue, or intensive care unit transfer. Statistical analysis was performed using χ and multivariate logistic regression. Of 801 patients with rib fractures, 683 had VC performed within 48 hours. Average age was 53 years, median ISS was 13 (interquartile range, 9-18), and median length of stay was 5 days. Most (72%) were discharged home, and 26% went to extended care facility. Ten percent developed a pulmonary complication, and there were nine deaths. Every 10% increase in VC was associated with 36% decrease in likelihood of pulmonary complication. Patients with a VC greater than 50% had a significantly lower association of pulmonary complication (p = 0.017), and a VC of less than 30% was independently associated with pulmonary complication (odds ratio, 2.36). Patients with fractured ribs and VC of less than 30% have significant association for pulmonary complication. Higher VC is associated with lower likelihood of pulmonary complication. VC may help

  1. Serum adipokines and adipose tissue distribution in rheumatoid arthritis and ankylosing spondylitis. A comparative study.

    Directory of Open Access Journals (Sweden)

    ERIC eTOUSSIROT

    2013-12-01

    Full Text Available Rheumatoid arthritis (RA and ankylosing spondylitis (AS are inflammatory rheumatic diseases that may modify body composition. Adipose tissue has the ability to release a wide range of products involved in physiologic functions, but also in various pathological processes, including the inflammatory/immune response. RA and AS are both associated with the development of cardiovascular complications. It is has been established that central/abdominal and particularly intra-abdominal or visceral adiposity is closely linked to cardiovascular events. Thus, in this study, we aimed to evaluate the body composition of patients with RA or AS compared to healthy controls (HC with a special emphasis on the visceral region. In parallel, we measured adipose products or adipokines, namely leptin, adiponectin and its high molecular weight (HMW isoform, resistin, and ghrelin, a gastric peptide that plays a role in energetic balance. The homeostasis model assessment for insulin resistance (HOMA-IR and atherogenic index were used to evaluate cardiovascular risk. One hundred and twelve subjects were enrolled (30 patients with RA, 31 with AS and 51 HC. Body composition was measured using dual-energy X-ray absorptiometry (DXA to determine total fat mass and lean mass, adiposity, fat in the android and gynoid regions, and visceral fat. Patients and HC did not differ in terms of body mass index. On the contrary, adiposity was increased in RA (p= 0.01 while visceral fat was also increased, but only in women (p=0.01. Patients with AS tended to have lower total fat mass (p=0.07 and higher lean mass compared to HC (p = 0.07. Leptin and leptin/fat mass were decreased in male patients with AS (p

  2. LAPAROSCOPIC MANAGEMENT OF RETROPERITONEAL INJURIES IN PENETRATING ABDOMINAL INJURIES.

    Science.gov (United States)

    Mosai, F

    2017-09-01

    Laparoscopy in penetrating abdominal injuries is now accepted and practiced in many modern trauma centres. However its role in evaluating and managing retroperitoneal injuries is not yet well established. The aim of this study was to document our experience in using laparoscopy in a setting of penetrating abdominal injuries with suspected retroperitoneal injury in haemodynamically stable patients. A retrospective descriptive study of prospectively collected data from a trauma unit at Dr George Mukhari Academic Hospital (DGMAH) was done. All haemodynamically stable patients with penetrating abdominal injury who were offered laparoscopy from January 2012 to December 2015 were reviewed and those who met the inclusion criteria were analysed. A total of 284 patients with penetrating abdominal injuries were reviewed and 56 met the inclusion criteria and were analysed. The median age was 30.8 years (15-60 years) and males constituted 87.5% of the study population. The most common mechanism of injury was penetrating stab wounds (62.5%). Forty-five patients (80.3%) were managed laparoscopically, of these n=16 (28.5%) had retroperitoneal injuries that required surgical intervention. The most commonly injured organ was the colon (19.6%). The conversion rate was 19.6% with most common indication for conversion been active bleeding (14%). The complication rate was 7.14% (N=4) and were all Clavien-Dindo grade 3. There were no recorded missed injuries and no mortality. The positive outcomes documented in this study with no missed injuries and absence of mortality suggests that laparoscopy is a feasible option in managing stable patients with suspected retroperitoneal injuries.

  3. Hydronephrosis and renal failure following inadequate management of neuropathic bladder in a patient with spinal cord injury: Case report of a preventable complication

    Directory of Open Access Journals (Sweden)

    Vaidyanathan Subramanian

    2012-09-01

    Full Text Available Abstract Background Condom catheters are indicated in spinal cord injury patients in whom intravesical pressures during storage and voiding are safe. Unmonitored use of penile sheath drainage can lead to serious complications. Case report A 32-year old, male person, sustained complete paraplegia at T-11 level in 1985. He had been using condom catheter. Eleven years after sustaining spinal injury, intravenous urography showed no radio-opaque calculus, normal appearances of kidneys, ureters and bladder. Blood urea and Creatinine were within reference range. A year later, urodynamics revealed detrusor pressure of 100 cm water when detrusor contraction was initiated by suprapubic tapping. This patient was advised intermittent catheterisation and take anti-cholinergic drug orally; but, he wished to continue penile sheath drainage. Nine years later, this patient developed bilateral hydronephrosis and renal failure. Indwelling urethral catheter drainage was established. Five months later, ultrasound examination of urinary tract revealed normal kidneys with no evidence of hydronephrosis. Conclusion Spinal cord injury patients with high intravesical pressure should not have penile sheath drainage as these patients are at risk for developing hydronephrosis and renal failure. Intermittent catheterisation along with antimuscarinic drug should be the preferred option for managing neuropathic bladder.

  4. Efficacy of a clinical stroke score in monitoring complications in ...

    African Journals Online (AJOL)

    Background: Presence of medical complications in stroke patients has been established. The efficacy of ... inpatient stroke rehabilitation have been reported .... Lancet. 1975;1:480-44. 12. Langfitt TW. Measuring outcomes from head injuries. J.

  5. THE POSSIBILITIES AND RESULTS OF INDIRECT COMPARISON OF BIOLOGICAL AGENTS IN ANKYLOSING SPONDYLITIS

    Directory of Open Access Journals (Sweden)

    Sh. F. Erdes

    2016-01-01

    Full Text Available The paper analyzes two matching-adjusted indirect comparison-based investigations of the efficacy of adalimumab (ADA and secukinumab (SCM in active ankylosing spondylitis, which have been recently reported at the EULAR Congress (London, 2016. One study sponsored by AbbVie was conducted to determine the short-term (16-week comparative clinical and economic efficacy of the test drugs and the other was supported by Novartis to reveal long-term (52-week, only clinical efficacy. Both studies have shown that the short-term efficacy ofADAand SCM is practically similar; however, the latter has a better long-term clinical efficacy. A pharmacoeconomic analysis of both drugs used during the first 12 weeks has demonstrated some advantage ofADA. 

  6. Cost-Effectiveness Evaluation of Etoricoxib versus Celecoxib and Nonselective NSAIDs in the Treatment of Ankylosing Spondylitis in Norway

    Directory of Open Access Journals (Sweden)

    Jeroen P. Jansen

    2011-01-01

    Full Text Available Objectives. To evaluate the cost-effectiveness of etoricoxib (90 mg relative to celecoxib (200/400 mg, and the nonselective NSAIDs naproxen (1000 mg and diclofenac (150 mg in the initial treatment of ankylosing spondylitis in Norway. Methods. A previously developed Markov state-transition model was used to estimate costs and benefits associated with initiating treatment with the different competing NSAIDs. Efficacy, gastrointestinal and cardiovascular safety, and resource use data were obtained from the literature. Data from different studies were synthesized and translated into direct costs and quality adjusted life years by means of a Bayesian comprehensive decision modeling approach. Results. Over a 30-year time horizon, etoricoxib is associated with about 0.4 more quality adjusted life years than the other interventions. At 1 year, naproxen is the most cost-saving strategy. However, etoricoxib is cost and quality adjusted life year saving relative to celecoxib, as well as diclofenac and naproxen after 5 years of follow-up. For a willingness-to-pay ceiling ratio of 200,000 Norwegian krones per quality adjusted life year, there is a >95% probability that etoricoxib is the most-cost-effective treatment when a time horizon of 5 or more years is considered. Conclusions. Etoricoxib is the most cost-effective NSAID for initiating treatment of ankylosing spondylitis in Norway.

  7. Association of IL1R polymorphism with HLA-B27 positive in Iranian patients with ankylosing spondylitis.

    Science.gov (United States)

    Mahmoudi, M; Amirzargar, A A; Jamshidi, A R; Farhadi, E; Noori, S; Avraee, M; Nazari, B; Nicknam, M H

    2011-12-01

    Ankylosing spondylitis (AS) is one of the most common causes of inflammatory arthritis, with an estimated prevalence of 0.1-0.9%. Genetic factors have been strongly implicated in its aetiology, and heritability as assessed by twin studies has been estimated to be >90%. HLA- B27 is almost essential for inheritance of AS; it is not merely sufficient for explaining the pattern of familial recurrence of the disease. This study's purpose is to investigate the association of ankylosing spondylitis with single-nucleotide polymorphisms (SNPs) in the IL-1 family: IL-1a (-889C/T) rs1800587, IL-1b (-511C/T) rs16944, IL-1b (+3962C/T) rs1143634, IL-1R (Pst-1 1970C/T) rs2234650 and IL-1RA (Mspa-1 11100C/T) rs315952. 99 unrelated Iranian AS patients and 217 healthy control subjects were selected. Cytokine typing was performed by the polymerase chain reaction with sequence-specific primers assay. The allele and genotype frequencies of the polymorphisms were determined: The IL1α rs1800587, IL1β rs16944 and IL1β rs1143634 were not significantly associated with AS. Genotype frequencies at IL1R rs2234650 differed between cases and controls (χ(2)=8.85; p=0.01); the IL1R rs2234650 C/T and T/T genotypes were less common in AS patients than controls. The IL1R rs2234650 C/T genotype was inversely associated with AS comparing with the IL1R rs2234650 C/C genotype (OR=0.48; p=0.005). IL1R rs2234650 C/T genotype was less common in patients than controls (OR=0.37; p=0.02).Furthermore IL1R rs2234650 T allele was strongly associated with HLA-B2702 patients rather than HLA-B2705 but was not associated with HLA-B27 negative patients (OR=0.33; p=0.01). Polymorphisms of IL1α rs1800587, IL1β rs16944 and IL1β rs1143634 were not significantly associated with ankylosing spondylitis but inversely in this study IL1R rs2234650 was significantly associated and carriage of T allele in IL1R rs2234650 seems to be protective, while carriage of C allele result in two fold higher risk of developing AS.

  8. Evolving colon injury management: a review.

    Science.gov (United States)

    Greer, Lauren T; Gillern, Suzanne M; Vertrees, Amy E

    2013-02-01

    The colon is the second most commonly injured intra-abdominal organ in penetrating trauma. Management of traumatic colon injuries has evolved significantly over the past 200 years. Traumatic colon injuries can have a wide spectrum of severity, presentation, and management options. There is strong evidence that most non-destructive colon injuries can be successfully managed with primary repair or primary anastomosis. The management of destructive colon injuries remains controversial with most favoring resection with primary anastomosis and others favor colonic diversion in specific circumstances. The historical management of traumatic colon injuries, common mechanisms of injury, demographics, presentation, assessment, diagnosis, management, and complications of traumatic colon injuries both in civilian and military practice are reviewed. The damage control revolution has added another layer of complexity to management with continued controversy.

  9. Intestinal complications following accelerated fractionated X-irradiation

    International Nuclear Information System (INIS)

    Hauer-Jensen, M.; Poulakos, L.; Osborne, J.W.

    1990-01-01

    Due to paucity of suitable animal models, it has been difficult to study the development of long-term intestinal complications following fractionated irradiation. We recently developed a model which allows multiple radiation exposures of a short segment of rat ileum without the need for repeated surgery. In the present series, this model was used to study the influence of shortening the total treatment time (accelerated fractionation) on development of radiation enteropathy. Male rats were orchiectomized and a short segment of distal ileum was transposed to the scrotum. Starting 3 weeks after surgery, the scrotum containing the intestinal segment was X-irradiated with 20 fractions of 2.8 Gy (total dose 56 Gy). Two fractionation schedules were compared: one fraction per day (total treatment time 26 days) and 3 fractions per day (total treatment time 7 days). Actuarial survival curves were obtained, and the degree of radiation injury was assessed 2, 8 and 26 weeks after the last radiation exposure using a semiquantitative histopathologic scoring system. There was no mortality from acute radiation injury in either treatment group. All animals of the 1-fraction/day group survived the observation period (26 weeks). In the 3-fraction/day group, there was significant mortality due to intestinal obstruction, and cumulative mortality at 26 weeks was 100%. Radiation injury, as assessed by the histopathologic scoring system, was also more pronounced in this group than in the 1-fraction/day group. We conclude that shortening the total treatment time significantly increases the severity of late intestinal complications. Our data are suggestive of an association between acute mucosal damage and chronic radiation injury of the small intestine. (orig.)

  10. Risk of leukaemia following intravenous treatment with 224Ra - results of a long term follow-up study of ankylosing spondylitis patients

    International Nuclear Information System (INIS)

    Wick, R.R.; Chmelevsky, D.; Goessner, W.

    1993-01-01

    In an epidemiological study of the somatic late effects risk following incorporation of a short lived α-emitter, 1473 ankylosing spondylitis patients treated with repeated intravenous injections of 224 Ra in the years 1948 - 75, have been observed in the GSF. The usual therapeutic plan consisted of a total of 10 - 12 injections of 1.036 MBq (28 μCi) of 224 Ra each, given at weekly intervals; this would result in an cumulative α-dose of 0.56 - 0.67 Gy to the marrow-free skeleton of a 70-kg-man (standard man). These patients have been followed together with a control group of ankylosing spondylitis patients not treated with radioactive drugs and/or X-rays. Until May 1993 (mean follow-up time 19.9 yr), 595 patients of the exposure group and 722 patients of the control group have died, causes of death have been ascertained for 578, resp. 668 patients. Among others we observed in the exposure group 10 cases of leukaemia (vs. 2.7 - 2.8 cases expected, p 239 Pu, an α-emitter which like 224 Ra deposits preferentially on the bone surface. (orig.) [de

  11. Hypothyroidism causing paralytic ileus and acute kidney injury - case report

    Directory of Open Access Journals (Sweden)

    Rodrigo Chaturaka

    2011-02-01

    Full Text Available Abstract We present a patient with severe hypothyroidism complicated by paralytic ileus and acute kidney injury. A 65 year old male patient, diagnosed with hypothyroidism one year ago was transferred to our unit in a state of drowsiness and confusion. He was severely hypothyroid and had paralytic ileus and impaired renal function at the time of transfer. Hypokalaemia was present, and was likely to have contributed to the paralytic ileus and this together with dehydration was likely to have contributed to renal injury. Nonetheless, hypothyroidism is very likely to have been the principal precipitant of both these complications, and both paralytic ileus and acute kidney injury improved with thyroxine replacement. Unfortunately, the patient died unexpectedly eight days after admission to the unit. Hypothyroidism may induce de novo acute kidney injury or it may exacerbate ongoing chronic kidney disease. This rare complication is assumed to be due to the hypodynamic circulatory state created by thyroid hormone deficiency. Paralytic ileus is an even rarer fatal manifestation of hypothyroidism and is thought to be due to an autonomic neuropathy affecting the intestines that is reversible with thyroxine replacement. To our knowledge, both these complications have not been observed in a single patient so far. It is important that clinicians are aware of these rare manifestations of hypothyroidism as in most occasions, thyroxine deficiency may be missed, and treatment can reverse the complications.

  12. Pattern and outcome of chest injuries at Bugando Medical Centre in Northwestern Tanzania

    Science.gov (United States)

    2011-01-01

    Background Chest injuries constitute a continuing challenge to the trauma or general surgeon practicing in developing countries. This study was conducted to outline the etiological spectrum, injury patterns and short term outcome of these injuries in our setting. Patients and methods This was a prospective study involving chest injury patients admitted to Bugando Medical Centre over a six-month period from November 2009 to April 2010 inclusive. Results A total of 150 chest injury patients were studied. Males outnumbered females by a ratio of 3.8:1. Their ages ranged from 1 to 80 years (mean = 32.17 years). The majority of patients (72.7%) sustained blunt injuries. Road traffic crush was the most common cause of injuries affecting 50.7% of patients. Chest wall wounds, hemothorax and rib fractures were the most common type of injuries accounting for 30.0%, 21.3% and 20.7% respectively. Associated injuries were noted in 56.0% of patients and head/neck (33.3%) and musculoskeletal regions (26.7%) were commonly affected. The majority of patients (55.3%) were treated successfully with non-operative approach. Underwater seal drainage was performed in 39 patients (19.3%). One patient (0.7%) underwent thoracotomy due to hemopericardium. Thirty nine patients (26.0%) had complications of which wound sepsis (14.7%) and complications of long bone fractures (12.0%) were the most common complications. The mean LOS was 13.17 days and mortality rate was 3.3%. Using multivariate logistic regression analysis, associated injuries, the type of injury, trauma scores (ISS, RTS and PTS) were found to be significant predictors of the LOS (P trauma scores (ISS, RTS and PTS), the need for ICU admission and the presence of complications (P Chest injuries resulting from RTCs remain a major public health problem in this part of Tanzania. Urgent preventive measures targeting at reducing the occurrence of RTCs is necessary to reduce the incidence of chest injuries in this region. PMID:21244706

  13. Use of cervical collar after whiplash injuries.

    Science.gov (United States)

    Józefiak-Wójtowicz, Anna; Stolarczyk, Artur; Deszczyński, Jarosław Michał; Materek, Magdalena; Pietras, Marta; Bażant, Katarzyna

    2014-08-08

    Whiplash injuries, also known as neck sprains and strains, are currently some of the most common injuries of the cervical spine. Mechanism of injury is still controversial and current treatment methods do not provide satisfactory results. In this article we present QTF classification of related disorders, epidemiological data and treatment methods. We described basic principles of using a soft collar, goals and effects of collar use and potential complications ensuing from immobilization. Authors reviewed publications comparing the effects of collar use with other methods of treatment and physiotherapy following whiplash injury.

  14. PATTERNS OF SEVEN AND COMPLICATED MALARIA IN CHILDREN

    African Journals Online (AJOL)

    GB

    report signifies the importance of early management of dental problems and awareness creation about self-injurious habits to prevent any long term complications. REFERENCES. 1. Kalyan SR, Sajjan G. Endodontic management of a foreign body. Contemp Clin. Dent, 2010; 1:180-2. 2. Balto H. A radiopaque object in the.

  15. Injuries of the upper cervical spine: A series of 28 cases

    Directory of Open Access Journals (Sweden)

    Basu Saumyajit

    2007-01-01

    Full Text Available Background: There are very few published reports of upper cervical spine injuries from our country and there is a heavy bias towards operative treatment of these injuries. We present below our experience of upper cervical injuries over the last four years. Materials and Methods: Twenty eight patients (20 males, 8 females with upper cervical spine injury (including Occiput, Atlas and Axis were treated and were followed-up for an average of 11.2 months. The data was analyzed retrospectively with regards to the location and type of injury, the treatment offered (conservative or operative as well as the final clinical and radiological outcome. Results: The clinico-radiological outcome of treatment of these injuries is mostly very good with few complications. Other than a single case of mortality due to associated head injury there were no major complications. Conclusion: Management of these patients needs a proper evaluation to arrive at the type of injury and prompt conservative or operative treatment. Treatment is usually safe and effective with good clinical and radiological outcome.

  16. Clinical feature and imaging findings of juvenile ankylosing spondylitis

    International Nuclear Information System (INIS)

    Zeng Hui; Liang Hongchang; Wang Weigang; Liu Hui; Huang Meiping; Zheng Junhui

    2003-01-01

    Objective: To analyze the clinical features and imaging findings of juvenile ankylosing spondylitis (JAS) in order to improve the diagnosis and the prognosis of JAS. Methods: Twelve cases were analyzed retrospectively and 14 cases, who were followed-up averagely for 2.3 years, were analyzed prospectively. Initially 10 were diagnosed as Still's disease and four were diagnosed as rheumatoid arthritis. Photography was performed in all cases, CT scan was done in 18 cases, and MRI in 8 cases. Lower extremity big joint disorders were observed in all cases and the small joints were reserved. The abnormalities of the sacroiliac joint were revealed in the early stage in 12 cases. The results were analyzed statistically. Results: The age of preliminary diagnosis was 9.3 years in average. There were statistical correlation between the age of the first episode and severity of the disease. And there were statistical correlation between the course of the illness and severity of the disease. The large joints of the lower extremities were most commonly involved. Conclusion: There were characteristic clinical features and imaging findings in the JAS. Early diagnosis and treatment improve the prognosis

  17. Shoulder Acromioclavicular and Coracoclavicular Ligament Injuries: Common Problems and Solutions.

    Science.gov (United States)

    Wylie, James D; Johnson, Jeremiah D; DiVenere, Jessica; Mazzocca, Augustus D

    2018-04-01

    Injuries to the acromioclavicular joint and coracoclavicular ligaments are common. Many of these injuries heal with nonoperative management. However, more severe injuries may lead to continued pain and shoulder dysfunction. In these patients, surgical techniques have been described to reconstruct the function of the coracoclavicular ligaments to provide stable relationship between the clavicle and scapula. These surgeries have been fraught with high complication rates including clavicle and coracoid fractures, infection, loss of reduction and fixation, hardware migration, and osteolysis. This article reviews common acromioclavicular and coracoclavicular repair and reconstruction techniques and associated complications, and provides recommendations for prevention and management. Copyright © 2018 Elsevier Inc. All rights reserved.

  18. Surgical Tip for Prevention of Lip Injury During Orthognathic and Facial Bone Contouring Surgery.

    Science.gov (United States)

    Lee, Tae Sung; Park, Sanghoon

    2017-10-01

    Iatrogenic lip injury is a rather common complication after facial bone surgery, but is usually treated lightly by the surgeon compared with other more severe functional complications. However, these injuries can have permanent sequelae and can therefore be a reason for patient dissatisfaction, especially after cosmetic surgery. Intraoperative lip injuries during facial bone surgery are usually caused by heat-generating surgical instruments or forced traction on the operative fields. The authors have applied a special technical strategy using a hydrocolloid dressing material to avoid these intraoperative lip injuries. This method does not disturb the operative procedure itself, but efficiently prevents lip injuries and decreases surgical morbidities and postoperative swelling.

  19. Penile constriction injury: An experience of four cases

    Directory of Open Access Journals (Sweden)

    Ajit Somaji Sawant

    2016-01-01

    Full Text Available Penile injury due to constriction by a foreign object is a rare known complication, commonly seen in pediatric age group. We report four cases of penile constriction injury in adults due to various foreign objects and different indications. Between October 2014 and March 2016, four patients (mean age 42.5 years presented with penile constriction injury with duration at presentation ranging from 18 h to 2 months. One patient had complete transection of the corpus and penile urethra. Three patients were managed successfully with daily dressings followed by split-skin grafting in one patient. One patient required delayed primary suturing after the resolution of local edema. The outcome was satisfactory in all patients with retained erectile function. Early medical attention and management is the key to success in penile constriction injury cases and to avoid complications and morbidity. Prompt removal can be challenging in cases of metal foreign bodies.

  20. Indications for and outcome of primary repair compared with faecal diversion in the management of traumatic colon injury.

    Science.gov (United States)

    Fouda, E; Emile, S; Elfeki, H; Youssef, M; Ghanem, A; Fikry, A A; Elshobaky, A; Omar, W; Khafagy, W; Morshed, M

    2016-08-01

    Injuries of the colon are a serious sequel of abdominal trauma owing to the associated morbidity and mortality. This study aims to assess postoperative outcome and complications of faecal diversion and primary repair of colon injuries when applied according to established guidelines for the management of colon injuries. This retrospective study was conducted on 110 patients with colon injuries. Guided by estimation of risk factors, patients were managed either by primary repair alone, repair with proximal diversion or diversion alone. There were 102 (92.7%) male patients and 8 (7.3%) female patients of median age 38 years. Thirty-seven were managed by primary repair and 73 by faecal diversion. Colon injuries were caused by penetrating abdominal trauma in 65 and blunt trauma in 45 patients. Forty-three patients were in shock on admission, and were all managed by faecal diversion. Forty patients developed 84 complications after surgery. Primary repair had a significantly lower complication rate than faecal diversion (P = 0.037). Wound infection was the commonest complication. The overall mortality rate was 3.6%. Primary repair, when employed properly, resulted in a significantly lower complication rate than faecal diversion. Significant predictive factors associated with a higher complication rate were faecal diversion, severe faecal contamination, multiple colon injuries, an interval of more than 12 h after colon injury and shock. Colorectal Disease © 2016 The Association of Coloproctology of Great Britain and Ireland.

  1. Radiography of the spine and sacro-iliac joints in ankylosing spondylitis and psoriasis

    International Nuclear Information System (INIS)

    Dale, K.; Vinje, O.

    1985-01-01

    A grading system involving six stages of arthritis from grade O=normal joints to grade V=extensive bony ankylosis in the sacro-iliac joints and a scheme applicable for quantitative registration of the radiographic findings of the spine in ankylosing spondylitis (AS) are detailed. These radiographic grading systems were used in a study comprising 48 patients with psoriasis (group A), 19 patients with AS and psoriasis (group B), 103 patients with AS (group C) and 231 first-degree relatives of the patients belonging to groups B and C (group D). Radiographic abnormalities of the spine were found totally in 80 per cent of the patients belonging to groups B and C. In these groups sclerotic anterior borders of vertebrae (SABS) and/or straightened anterior surfaces of vertebrae were seen totally in 66 per cent. SABS were earlier findings than syndesmophyte formation which was found in 60 per cent of the patients belonging to groups B and C. Except for ankylosis of the apophyseal joints and ossified interspinous ligament most frequently found in the lower lumbar region in patients with duration of disease more than 20 years, all abnormalities of the spine were most frequent in the dorsolumbar junction. Grade V sacro-iliitis was associated with ankylosis of two or more segments of the spine. Such spinal changes were infrequently seen in patients with grade IV sacro-iliitis. This finding supports the previous notion that among patients fulfilling the criteria for AS, there is a group with a non-ankylosing disease. Thus two different subgroups of AS could be identified. Except for frequent unilateral sacro-iliitis and slight changes of the spine in group A no radiographic differences were found between the groups A, B and C. Sacro-iliitis was found in 22(9%) in group D, and 11 of those with sacro-iliitis had abnormalities of the spine compatible with AS. (orig.)

  2. Physical Activity in Ankylosing Spondylitis: evaluation and analysis of an eHealth tool

    Directory of Open Access Journals (Sweden)

    Jess Shelagh Tyrrell

    2016-07-01

    Full Text Available Background Ankylosing spondylitis (AS is a chronic inflammatory condition characterised by spinal arthritis and exercise is often recommended to reduce the symptoms and improve mobility. However, very little evidence exists for the value of exercise in AS. Objectives Firstly, this pilot study aimed to evaluate an eHealth tool, the AS Observer, specifically designed to monitor symptoms, quality of life and physical activity in AS, in terms of patient experience and suitability in generating data for epidemiological studies. Secondly, it also investigated the collected data to determine if physical activity benefited individuals with AS. Methods The AS Observer was designed to enable weekly monitoring of AS symptoms and exercise using a web based platform. Participants with AS (n = 223 were recruited to use the AS observer. They provided baseline data and completed online weekly data entry for 12 weeks (e.g. Bath Ankylosing Spondylitis Activity Index (BASDAI, howRu, International Physical Activity Questionnaire (IPAQ. Panel data analysis with fixed effects models investigated associations between variables. Activity type data and exit questionnaires were subjected to qualitative thematic analysis. Results In general, the AS Observer was well received and considered useful by participants, with 66% providing a positive response. The collected data suggested that IPAQ is inversely associated with total BASDAI, stiffness, tenderness and pain, but not fatigue. Stratified analysis demonstrated differential associations between BASDAI, IPAQ and howRU based on sex, HLA-B27 status and disease duration. Approximately half of the participants frequently did therapy and three-quarters undertook at least some vigorous activity ranging from formal exercise to recreation and (house work. Despite some technical challenges, tool evaluation suggested that the AS Observer was a useful self-monitoring tool for participants. Conclusions This pilot study demonstrated

  3. BILE DUCT INJURIES FOLLOWING LAPAROSCOPIC CHOLECYSTECTOMY- A RETROSPECTIVE STUDY AT GOVERNMENT GENERAL HOSPITAL, KAKINADA

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    Ravichandra Matcha

    2017-11-01

    Full Text Available BACKGROUND This study aimed at assessing the outcome of laparoscopic cholecystectomy (LC by determining the frequency of complications, especially of bile duct injuries. MATERIALS AND METHODS The case files of all patients undergoing laparoscopic cholecystectomy between January 2008 and December 2016 at Government General Hospital, Kakinada were retrospectively analysed. We evaluated the data according to outcome measures, such as bile duct injury, morbidity, mortality and numbers of patients whose resections had to be converted from laparoscopic to open. RESULTS During the eight years (January 2008 and December 2016, 336 patients underwent LC for chronic cholecystitis (CC, of whom 22 (6.5% developed complications. Among those who developed complications, two patients had major bile duct injuries (0.4%; 43 other patients (12.8% had planned laparoscopic operations converted to open cholecystectomy intra-operatively. None of the patients in this study died as a result of LC. CONCLUSION Bile duct injury is a major complication of LC. Anatomical anomalies, local pathology, and poor surgical techniques are the main factors responsible. The two patients who had severe common bile duct injury in this study had major anatomical anomalies that were only recognized during surgery.

  4. MRI appearances of inflammatory vertebral osteitis in early ankylosing spondylitis

    Energy Technology Data Exchange (ETDEWEB)

    Kurugoglu, Sebuh; Kanberoglu, Kaya; Mihmanli, Ismail; Cokyuksel, Oktay [Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University (Turkey); Kanberoglu, Ayfer [Department of Physical Medicine, SSK Istanbul Hospital, Istanbul (Turkey)

    2002-03-01

    Background: Undiagnosed and early ankylosing spondylitis (AS), especially in adolescent patients suffering from back pain, may present with the finding of vertebral osteitis on MRI. Aims: To identify the early MRI changes of vertebral osteitis in AS. Patients and methods: Five patients (three boys, two girls) aged 11-20 years (mean 15.4 years) suffering from back pain underwent MRI of the thoracolumbar spine. There was no initial diagnosis of AS. After clinical and radiological suspicion of AS, MRI of the sacroiliac (SI) joints was performed. Results: During the course of AS, destructive and reactive changes affect the discovertebral junctions that are initially seen in the thoracolumbar area. At this stage plain radiography of the spinal column may be normal. On MR images, inflammatory osteitis of the vertebrae is seen as hypointense areas on T1-weighted images and hyperintense areas on T2-W images. The lesions enhance homogenously with contrast material. Conclusions: Awareness of the MRI appearances of vertebral osteitis is helpful in suspecting AS. Radiological examination of the SI facilitates the diagnosis and unnecessary further imaging can be avoided. (orig.)

  5. Anaphylaxis Due to Head Injury

    Directory of Open Access Journals (Sweden)

    Bruner, Heather C.

    2015-05-01

    Full Text Available Both anaphylaxis and head injury are often seen in the emergency department, but they are rarely seen in combination. We present a case of a 30-year-old woman who presented with anaphylaxis with urticaria and angioedema following a minor head injury. The patient responded well to intramuscular epinephrine without further complications or airway compromise. Prior case reports have reported angioedema from hereditary angioedema during dental procedures and maxillofacial surgery, but there have not been any cases of first-time angioedema or anaphylaxis due to head injury. [West J Emerg Med. 2015;16(3:435–437.

  6. Sectional Fixed Orthodontic Extrusion Technique in Management of Teeth with Complicated Crown-Root Fractures: Report of Two Cases

    Directory of Open Access Journals (Sweden)

    S. Nagarajan M. P. Sockalingam

    2018-01-01

    Full Text Available Complicated crown-root fractures account for a small percentage of traumatic dental injuries seen in children; however, management of these injuries can be very challenging to clinicians. Factors such as complexity of the injury, patient’s age and dentition stage, patient’s cooperation, and parental demands may have some bearing on the type of treatment undertaken and its outcomes. In some children, these injuries may have significant impact on their quality of life. The purpose of this article is to describe two cases of complicated crown-root fracture which were successfully managed through orthodontic extrusion using a sectional fixed orthodontic technique. The basis for the treatment technique and its favourable outcomes were highlighted with its advantages and drawbacks.

  7. Complication during Postacute Rehabilitation: Patients with Posttraumatic Hydrocephalus

    Science.gov (United States)

    Denes, Zoltan; Barsi, Peter; Szel, Istvan; Boros, Erzsebet; Fazekas, Gabor

    2011-01-01

    The objective of this study was to determine the incidence of posttraumatic hydrocephalus (PTH) among patients in our rehabilitation unit for traumatic brain injury. Furthermore, we aimed to assess the effect of shunt implantation and to identify the postoperative complication rate. This is a retrospective cohort study, in which between 2000 and…

  8. Magnetic resonance imaging for ankylosing spondylitis

    International Nuclear Information System (INIS)

    Bollow, M.

    2002-01-01

    Ankylosing spondylitis (AS) is the prototypical form of the spondyloarthropathies, which at a prevalence of 2% is among the most frequent rheumatic diseases. Spondyloarthropathy comprises the following five disorders: AS, reactive arthritis, psoriatic arthritis, enteropathic arthritis in Crohn's disease, and ulcerosing colitis as well as undifferentiated spondyloarthropathy. In 99% of the patients with AS initial abnormal findings affect the sacroiliac joints. The radiographic changes required for diagnosing AS occur as late as 5-9 years after the onset of clinical symptoms. MRI of the sacroiliac joints reliably demonstrates both chronic inflammatory changes (erosions, sclerotic changes, bone bridges) and acute inflammatory changes (synovitis, capsulitis, osteitis) and allows for grading the chronicity and acuity of such changes. Enthesitis of the interosseous ligaments of the retroarticular space is a manifestation of AS. Spondylodiscitis (Andersson 1937) may occur as an inflammatory or non-inflammatory process (transdiscal fatigue fracture). Inflammations of the facet and costospinal joints developing into ankylosis are typical of AS. Changes of the vertebral bodies occur as anterior (Romanus 1952), posterior, and marginal spondylitis. All forms of spondyloarthropathies are furthermore characterized by asymmetrical synovitis of the large joints, particularly of the legs (gonarthritis, coxitis, tarsitis, peripheral oligoarthritis), rheumatic fibroosteitis (pelvic enthesitis, rheumatic calcaneopathy), and peri- and synchrondritis of the public symphisis and sternal synchondrosis. Since early inflammatory changes of the spinal column and of the extravertebral localizations in AS are demonstrated by MRI before they become apparent on radiographs, and thereby the diagnostic gap could be closed, the early use of MRI for diagnostic and follow-up is commendable, when new therapeutical options like the so-called 'biologicals' are employed. (orig.) [de

  9. Genetic variants of STAT4 are associated with ankylosing spondylitis susceptibility and severity in a Chinese Han population

    OpenAIRE

    Liu, Zhixiang; Zhang, Peisen; Dong, Jie

    2014-01-01

    Objective: Genetic factors play an important role in ankylosing spondylitis (AS) etiology and signal transducer and activator of transcription 4 (STAT4) gene polymorphisms may be involved. The aim of this study was to test whether STAT4 variants were associated with susceptibility to AS in a Chinese population. Methods: A total of 175 subjects who were diagnosed as AS and 249 healthy age-matched controls were enrolled in the present study. The rs7574865 G/T SNP in STAT4 gene was genotyped in ...

  10. Symptomatic hemorrhagic complications associated with dural substitutes

    Directory of Open Access Journals (Sweden)

    Po-Yuan Chen

    2018-01-01

    Conclusion: The increased risk of hemorrhagic complications associated with craniotomy is modified by choice of dural replacement. Our results could assist clinicians in their decision-making with respect to the optimal timing for synthetic dural substitutes in patients with tumor infiltration of the patient's dura, severe brain swelling in traumatic brain injury, or a result of shrinkage from exposure and electrocautery.

  11. Complications encountered in contrast roentgenography of the colon

    International Nuclear Information System (INIS)

    Vogel, H.; Steinkamp, U.

    1983-01-01

    The following problems are analysed referring to the literature and to practical experience of the authors: - Types of complications encountered in contrast roentgenography or in endoscopy of the colon, and their frequency. - Risk factors and secondary injuries. Intestinal perforation is the most frequent complication experienced as a consequence of contrast barium enema. The main risk factors are to be seen in the use of balloon-tipped catheters, or of intestinal tubes with hard tips, in a rise of hydrostatic pressure above 80 cm water column, and in an excessively strong air insufflation. Frequency of complications for contrast barium enema is stated to be 0.002 p.c. (Welin and Welin, 1980) or 0.08 p.c. (Clark et al. 1961). The frequency of perforations in rectoscopy is shown to be in the same order of magnitude. For diagnostic colonoscopy, the frequency of complications is about one per mil. Existing diseases such as carcinoma, diverticulosis, diverticulitis, colitis ulcerosa, or morbus Crohn are factors enhancing the risk. Also, patients of advanced age are running a higher risk due to decreasing intestine wall elasticity with age. Previous biopsy or excision forbids contrast barium enema for the next two weeks. Injuries and sequelae to be expected after perforation are abscesses, phlegmon, peritonitis including formation of adhesion and bands, retroperitoneal fibrosis with formation of hydronephrosis, and anus praeter, the latter being temporary or permanent. An extensive literature survey covering 200 publications has been prepared and is available from the authors upon request. (orig.) [de

  12. [Metacarpal osteoarticular injuries in children].

    Science.gov (United States)

    Jehanno, P; Mas, V; Fitoussi, F; Frajman, J-M; Valenti, P; Mazda, K

    2013-09-01

    Metacarpal fractures and dislocations in the fingers are common injuries in children's hands. Most of these can be treated successfully non-operatively, although a subset requires more aggressive treatment. Results following appropriate care in children are generally good. Twenty percent of them need a reduction, need for surgical stabilization is rare. Each injury is presented, including diagnostic, therapeutic principles, pitfalls to prevent and potential complications. Copyright © 2013. Published by Elsevier SAS.

  13. Assessment and management of patients with ankle injuries.

    Science.gov (United States)

    Walker, Jennie

    2014-08-19

    Foot and ankle injuries are common and can have a significant effect on an individual's daily activities. Nurses have an important role in the assessment, management, ongoing care and support of patients with ankle injuries. An understanding of the anatomy and physiology of the ankle enables nurses to identify significant injuries, which may result in serious complications, and communicate effectively with the multidisciplinary team to improve patient care and outcomes.

  14. Splenic injury after colonoscopy

    DEFF Research Database (Denmark)

    Petersen, C.R.; Adamsen, S.; Gocht-Jensen, P.

    2008-01-01

    the colonoscopy, ranging from 4 hours to 7 days, before presenting with signs of splenic injury. In all cases the spleen was torn, and the amount of blood in the peritoneal cavity ranged from 1500 mL to 5000 mL. Two patients died postoperatively. The number of cases reported after 2000 indicates......Splenic injury is a rare and serious complication of colonoscopy. The most likely mechanism is tension on the splenocolic ligament and adhesions. Eight cases were identified among claims for compensation submitted to the Danish Patient Insurance Association during the period 1992-2006, seven...... that this potentially lethal complication might be more common than was previously assumed, and it is possibly under-reported. Preventive measures include good colonoscopic technique to avoid loop formation and the use of excessive force; and it is possible that emerging endoscopic technologies will lead to a reduced...

  15. Complications of aesthetic medicine procedures: five case studies.

    Science.gov (United States)

    Smędra, A; Szustowski, S; Klemm, J; Jurczyk, A; Zalewska-Janowska, A; Berent, J

    2015-01-01

    The paper presents the cases of five patients who developed complications after aesthetic medicine procedures. Four of the cases involved women who reported to the Department of Forensic Medicine, Medical University of Lodz, for a description and legal qualification of bodily injuries suffered as a result of aesthetic medicine procedures, whereas one was related to the assessment of accuracy of medical management at the request of the prosecutor handling the case. The reported cases concerned acid exfoliation treatments, photoepilation and cryotherapy. The authors attempt to discuss the most common complications that may occur after aesthetic medicine procedures, and measures to avoid them.

  16. Review of sport-induced groin injuries.

    Science.gov (United States)

    Sedaghati, Parisa; Alizadeh, Mohammad-Hossein; Shirzad, Elham; Ardjmand, Abolfazl

    2013-12-01

    Groin injuries are among the most common injuries co-existing with sports. The aim of this review was to outline the epidemiology and identify risk factors, as well as examine preventative and interventional measures for reducing the occurrence of this form of injury among athletes. An electronic, systematic search for relevant keywords, either separately or in combination was sought in the academic scientific databases. Groin injuries, acute or chronic, consist of a high percentage of injuries that manifest with pain. Despite the specific tendency for injury among some sports, such injuries make up 2-5% of sport-induced injuries. There are few available reports on lower limb injuries, especially groin injuries, in Iran. Numerous factors predispose to groin injuries. A lengthy list of preventive/ treatment measures, from preliminary to sophisticated, have been proposed. Although using a programmed strategy designed to decrease the risk of groin injuries by taking a strategic approach to exercise may alleviate complications, in some cases the chronic nature of the injury may threaten the professional life of the athlete. More research is required to plan suitable programs for reducing the risk of this type of injury in athletes.

  17. Temporal Bone Fractures and its Classification: Retrospective Study of Incidence, Causes, Clinical Features, Complications and Outcome

    Directory of Open Access Journals (Sweden)

    Umamaheshwari Basavaraju

    2017-10-01

    Full Text Available Introduction: Temporal bone fracture is usually associated with high energy head injury and can cause potentially severe complications. Immediate detection of temporal bone fracture and its complications helps in providing early and effective treatment, which if left untreated can have drastic consequences. Aim: The main objective of the study is to document the frequency and most prevalent type of temporal bone fracture, co-existing complications and to establish association between them. Materials and Methods: One year (2015-2016 retrospective study of head injured patients presented to the Emergency Department, Mysore Medical College And Research Institute was conducted. Age and gender distribution, cause of injury, radiological findings, otorhinolaryngological clinical presentations and treatment given were analyzed. The results were tabulated and were evaluated by Microsoft Excel 2013. Results: Out of 1450 patients evaluated for head injury 154 patients were positive for temporal bone fracture. Incidence of the study was 10.6%. Majority of the patients were male (66.2% and were between 30 to 40 years (50.1%. The major cause of injury was motor vehicle accidents (84.48%. Right side was involved (58.4% more than the left side (41.5%. Most common clinical presentation was otorrhea 68.8%, followed by otalgia (35.04% and otorhinorrhea (24.67%. Longitudinal type fracture was most frequent 56.25%. Otic capsule involvement was present in 35.93%. Most of the fractures were managed conservatively whereas surgery was required in 12 patients (7.7%. Conclusion: Temporal bone fractures were frequently associated with severe traumatic brain injury leading to serious long term morbidity and sequelae. CT-scan is of utmost importance in detection of fractures and its complications.

  18. Low-dose CT detects more progression of bone formation in comparison to conventional radiography in patients with ankylosing spondylitis: results from the SIAS cohort.

    Science.gov (United States)

    de Koning, Anoek; de Bruin, Freek; van den Berg, Rosaline; Ramiro, Sofia; Baraliakos, Xenofon; Braun, Juergen; van Gaalen, Floris A; Reijnierse, Monique; van der Heijde, Désirée

    2018-02-01

    To compare the CT Syndesmophyte Score (CTSS) for low-dose CT (ldCT) with the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) for conventional radiographs (CR) in patients with ankylosing spondylitis (AS). Patients with AS in the Sensitive Imaging in Ankylosing Spondylitis cohort had lateral cervical and lumbar spine CR and whole spine ldCT at baseline and 2 years. CR and ldCT images were scored by two readers, paired by patient, blinded to time order, per imaging modality. For the total score analysis, we used average scores of readers per corner on CR or quadrant on ldCT. For the syndesmophyte analysis we used individual reader and consensus scores, regarding new or growing syndesmophyte at the same corner/quadrant. 50 patients were included in the syndesmophyte analysis and 37 in the total score analysis. Mean (SD) status scores for mSASSS (range 0-72) and CTSS (range 0-552) at baseline were 17.9 (13.8) and 161.6 (126.6), and mean progression was 2.4 (3.8) and 17.9 (22.1). Three times as many patients showed new or growing syndesmophytes at ≥3 quadrants on ldCT compared with ≥3 corners on CR for individual readers; for consensus this increased to five times. In 50 patients, 36 new or growing syndesmophytes are seen on CR compared with 151 on ldCT, most being found in the thoracic spine. ldCT, covering the whole spine, detects more progression in the form of new and growing syndesmophytes in patients with AS compared with CR, which is limited to the cervical and lumbar spine. Most progression occurred in the thoracic spine. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  19. [Obstetric hysterectomy. Incidence, indications and complications].

    Science.gov (United States)

    Vázquez, Juan A Reveles; Rivera, Geannyne Villegas; Higareda, Salvador Hernández; Páez, Fernando Grover; Vega, Carmen C Hernández; Segura, Agustin Patiño

    2008-03-01

    Obstetric hysterectomy is indicated when patient's life is at risk, and it is a procedure that requires a highly experienced and skilled medical team to solve any complication. To identify incidence, indications, and complications of obstetric hysterectomy within a high-risk population. Transversal, retrospective study from July 1st 2004 to June 30 2006 at Unidad Medica de Alta Especialidad, Hospital de Ginecoobstetricia, Centro Medico Nacional de Occidente, IMSS. There were reviewed 103 patient' files with obstetric hysterectomy. Incidence was calculated, and clinical and socio-demographic characteristics, indications, and complications of obstetric hysterectomy identified and expressed in frequency, percentages, and central tendency measurements. Incidence of obstetric hysterectomy was 8 cases within every 1,000 obstetric consultation. Age average was 31.1 +/- 5.1 years. 72.8% had cesarean surgery history. Main indication was placenta previa associated with placenta accreta (33%), followed by uterine hypotony (22.3%). Complications were hypovolemic shock (56.3%), and vesical injuries (5.8%). There were no maternal deaths. Cesarean history induces higher obstetric hysterectomy incidence in women with high-risk pregnancy, due to its relation to placentation disorders, as placenta previa that increases hemorrhage possibility, and thus, maternal morbidity and mortality.

  20. Management of pancreatic and duodenal injuries in pediatric patients.

    Science.gov (United States)

    Plancq, M C; Villamizar, J; Ricard, J; Canarelli, J P

    2000-01-01

    Diagnosis of duodenal and pancreatic injuries is frequently delayed, and optimal treatment is often controversial. Fourteen children with duodenal and/or pancreatic injuries secondary to blunt trauma were treated between 1980 and 1997. The pancreas was injured in all but 1 child. An associated duodenal injury was present in 4. The preoperative diagnosis was suspected in only 6 patients based on clinical signs and ultrasonography. One patient was treated successfully conservatively; all the others required surgical management. At operation, three procedures were used: peripancreatic drainage, suture of the gland or duodenum with drainage, and primary distal pancreatic resection without splenectomy. A duodenal resection with reconstruction by duodeno-duodenostomy was performed in 1 case. The overall complication rate was 14%: 1 fistula and 1 pseudocyst. Pancreatic ductal transection was recognized 3 days after the initial laparotomy by endoscopic retrograde cholangiopancreatography (ERCP). The mortality was 7%; 1 patient died from septic and neurologic complications. When the diagnosis of pancreatic ductal injuries is a major problem, ERCP may be a useful diagnostic procedure. Pancreatic injuries without a transected duct may often be treated conservatively. The surgical or conservative management of duodenal hematomas is still controversial; other duodenal injuries often need surgical treatment.

  1. Prevention and treatment of complications for thyroid-arterial embolization

    International Nuclear Information System (INIS)

    Yang Jijin; Yuan Min; Tian Jianming; Chen Wei; Yang Chaoai; Hao Qiang; Zou Dajing; Wang Yongchun

    2003-01-01

    Objective: To investigate the complications of thyroid-arterial embolization and their prevention and treatment. Methods: 61 cases of thyroid disorders received the therapy of thyroid-arterial embolization were retrospectively studied. The complications of arterial embolization during or after the procedure were analyzed. How to prevent and deal with these complications were discussed. Results: Sensitivity to contrast media occurred in 1 case and surgical arterial injury in 2. After embolization thyroid storm occurred in 1 patient and all other complications including headache (23 cases), toothache (11 cases), neckache (13 cases), hoarseness (37 cases) were caused by non-target arterial embolization with the most serious one of cerebral infarction (1 case) and another eyelid ptosis (1 case). The cerebral infarct one was treated with some vasodilating drugs and anti-coagulant, all others were given anti-symptomatics or no special treatment. Conclusions: Proper treatment should be ready during thyroid arterial embolization and given in time with occurrence of complications

  2. Diffusion-weighted Imaging Is a Sensitive and Specific Magnetic Resonance Sequence in the Diagnosis of Ankylosing Spondylitis.

    Science.gov (United States)

    Bradbury, Linda A; Hollis, Kelly A; Gautier, Benoît; Shankaranarayana, Sateesh; Robinson, Philip C; Saad, Nivene; Lê Cao, Kim-Anh; Brown, Matthew A

    2018-06-01

    We tested the discriminatory capacity of diffusion-weighted magnetic resonance imaging (DWI) and its potential as an objective measure of treatment response to tumor necrosis factor inhibition in ankylosing spondylitis (AS). Three cohorts were studied prospectively: (1) 18 AS patients with Bath Ankylosing Spondylitis Disease Activity Index > 4, and erythrocyte sedimentation rate > 25 and/or C-reactive protein > 10 meeting the modified New York criteria for AS; (2) 20 cases of nonradiographic axial spondyloarthritis (nr-axSpA) as defined by the Assessment of Spondyloarthritis international Society (ASAS) criteria; and (3) 20 non-AS patients with chronic low back pain, aged between 18 and 45 years, who did not meet the imaging arm of the ASAS criteria for axSpA. Group 1 patients were studied prior to and following adalimumab treatment. Patients were assessed by DWI and conventional magnetic resonance imaging (MRI), and standard nonimaging measures. At baseline, in contrast to standard nonimaging measures, DWI apparent diffusion coefficient (ADC) values showed good discriminatory performance [area under the curve (AUC) > 80% for Group 1 or 2 compared with Group 3]. DWI ADC values were significantly lower posttreatment (0.45 ± 0.433 before, 0.154 ± 0.23 after, p = 0.0017), but had modest discriminating capacity comparing pre- and posttreatment measures (AUC = 68%). This performance was similar to the manual Spondyloarthritis Research Consortium of Canada (SPARCC) scoring system. DWI is informative for diagnosis of AS and nr-axSpA, and has moderate utility in assessment of disease activity or treatment response, with performance similar to that of the SPARCC MRI score.

  3. Clinical characteristics and therapeutic effect of open globe injury

    Directory of Open Access Journals (Sweden)

    Mei-Lin Liu

    2016-06-01

    Full Text Available AIM: To analyze clinical characteristics and postoperative outcomes after open globe injury. METHODS: Demographic characteristics(age, gender, eye trauma, profession, cause of injury and injured part, as well as complications and prognosis were analyzed in 152 cases(152 eyesof open globe injury. RESULTS: Patients with open globe injury had an average age of 40.45±38.32 years old with a 5.9:1 male-to-female gender ratio. The left-to-right eye ratio was 1.27:1. Most patients were workers, farmers, or retired. The most common etiologies were scratches, boxing, and falls. Zone Ⅲ was the most commonly injured part. Iridoptosis or iris incarceration, retinal detachment, vitreal prolapse, hyphema or hypopyon, and vitreous hemorrhage were the most common complications. Visual acuity improved in 86 cases postoperatively but ophthalmectomy was still required in 25 eyes. CONCLUSION: Vision can be improved after surgery in open globe injury. However, patients are usually seriously injured and improvement is minimal, thereby resulting in a great loss to patients and society.

  4. Neurological Complications Related to Elective Orthopedic Surgery: Part 1: Common Shoulder and Elbow Procedures.

    Science.gov (United States)

    Dwyer, Tim; Henry, Patrick D G; Cholvisudhi, Phantila; Chan, Vincent W S; Theodoropoulos, John S; Brull, Richard

    2015-01-01

    Many anesthesiologists are unfamiliar with the rate of surgical neurological complications of the shoulder and elbow procedures for which they provide local anesthetic-based anesthesia and/or analgesia. Part 1 of this narrative review series on neurological complications of elective orthopedic surgery describes the mechanisms and likelihood of peripheral nerve injury associated with some of the most common shoulder and elbow procedures, including open and arthroscopic shoulder procedures, elbow arthroscopy, and total shoulder and elbow replacement. Despite the many articles available, the overall number of studied patients is relatively low. Large prospective trials are required to establish the true incidence of neurological complications following elective shoulder and elbow surgery. As the popularity of regional anesthesia increases with the development of ultrasound guidance, anesthesiologists should have a thoughtful understanding of the nerves at risk of surgical injury during elective shoulder and elbow procedures.

  5. Characteristics and clinical aspects of patients with spinal cord injury undergoing surgery

    Directory of Open Access Journals (Sweden)

    João Simão de Melo-Neto

    Full Text Available ABSTRACT OBJECTIVE: To identify the characteristics of patients with spinal cord injury (SCI undergoing surgery. METHODS: Previously, 321 patients with SCI were selected. Clinical and socio-demographic variables were collected. RESULTS: A total of 211 patients were submitted to surgery. Fall and injuries in the upper cervical and lumbosacral regions were associated with conservative treatment. Patients with lesions in the lower cervical spine, worse neurological status, and unstable injuries were associated with surgery. Individuals undergoing surgery were associated with complications after treatment. The authors assessed whether age influenced the characteristics of patients submitted to surgery. Subjects with <60 years of age were associated with motorcycle accidents and the morphologies of injury were fracture-dislocation. Elderly individuals were associated to fall, SCI in the lower cervical spine and the morphology of injury was listhesis. Subsequently, the authors analyzed the gender characteristics in these patients. Women who suffered car accidents were associated to surgery. Women were associated with paraparesis and the morphologic diagnosis was fracture-explosion, especially in the thoracolumbar transition and lumbosacral regions. Men who presented traumatic brain injury and thoracic trauma were related to surgery. These individuals had a worse neurological status and were associated to complications. Men and the cervical region were most affected, thereby, these subjects were analyzed separately (n= 92. The presence of complications increased the length of hospital stay. The simultaneous presence of morphological diagnosis, worst neurological status, tetraplegia, sensory, and motor alterations were associated with complications. Pneumonia and chest trauma were associated with mortality. CONCLUSION: These factors enable investments in prevention, rehabilitation, and treatment.

  6. Acute kidney injury complicating bee stings – a review

    Science.gov (United States)

    da Silva, Geraldo Bezerra; Vasconcelos, Adolfo Gomes; Rocha, Amanda Maria Timbó; de Vasconcelos, Vanessa Ribeiro; de Barros, João; Fujishima, Julye Sampaio; Ferreira, Nathália Barros; Barros, Elvino José Guardão; Daher, Elizabeth De Francesco

    2017-01-01

    ABSTRACT Bee stings can cause severe reactions and have caused many victims in the last years. Allergic reactions can be triggered by a single sting and the greater the number of stings, the worse the prognosis. The poisoning effects can be systemic and can eventually cause death. The poison components are melitin, apamin, peptide 401, phospholipase A2, hyaluronidase, histamine, dopamine, and norepinephrine, with melitin being the main lethal component. Acute kidney injury (AKI) can be observed in patients suffering from bee stings and this is due to multiple factors, such as intravascular hemolysis, rhabdomyolysis, hypotension and direct toxicity of the venom components to the renal tubules. Arterial hypotension plays an important role in this type of AKI, leading to ischemic renal lesion. The most commonly identified biopsy finding in these cases is acute tubular necrosis, which can occur due to both, ischemic injury and the nephrotoxicity of venom components. Hemolysis and rhabdomyolysis reported in many cases in the literature, were demonstrated by elevated serum levels of indirect bilirubin and creatine kinase. The severity of AKI seems to be associated with the number of stings, since creatinine levels were higher, in most cases, when there were more than 1,000 stings. The aim of this study is to present an updated review of AKI associated with bee stings, including the currently advised clinical approach. PMID:28591253

  7. Evolution of the complications of laparoscopic hysterectomy after a decade: a follow up of the Monash experience.

    Science.gov (United States)

    Tan, Jason J; Tsaltas, Jim; Hengrasmee, Pattaya; Lawrence, Anthony; Najjar, Haider

    2009-04-01

    A retrospective review of medical records was performed to assess the incidence and types of significant complications encountered during laparoscopic hysterectomy which would affect the use of a laparoscopic approach versus other routes of hysterectomy. A total of 526 consecutive patients' medical data between January 1994 and August 2007 were reviewed. Two hundred and thirty-two laparoscopic-assisted vaginal hysterectomies and 294 total laparoscopic hysterectomies were performed at Monash Medical Centre, a Melbourne tertiary public hospital, and three Melbourne private hospitals, by or under the supervision of three surgeons. Sixteen significant complications occurred. There were two cases of ureteric fistula, two bladder injuries, two bowel obstructions, four postoperative haematomas, one case of a bladder fistula, four conversions to laparotomy and one superficial epigastric artery injury. Inpatient stay ranged from two to six days. Our complication and inpatient stay rates are consistent with the previously reported rates, although there has been a reduction of incidence of visceral injuries with experience and introduction of new equipment.

  8. Natural history of nonoperative management for grade 4 and 5 liver and spleen injuries in children.

    Science.gov (United States)

    Yang, Jeannie C; Sharp, Susan W; Ostlie, Daniel J; Holcomb, George W; St Peter, Shawn D

    2008-12-01

    Nonoperative management is standard treatment of blunt liver or spleen injuries. However, there are few reports outlining the natural history and outcomes of severe blunt hepatic and splenic trauma. Therefore, we reviewed our experience with nonoperative management of grade 4 or 5 liver and spleen injuries. A retrospective analysis was performed on patients with grade 4 or 5 (high-grade) blunt liver and/or spleen injuries from April 1997 to July 2007 at our children's hospital. Demographics, hospital course data, and follow-up data were analyzed. There were 74 high-grade injuries in 72 patients. There were 30 high-grade liver and 44 high-grade spleen injuries. Two patients had both a liver and splenic injury. High-grade liver injuries had a significantly longer length of intensive care and hospital stay compared to high-grade spleen injuries. There were also a significantly higher number of transfusions, radiographs, and total charges in the high-grade liver injuries when compared to the high-grade splenic injuries. The only mortality from solid organ injury was a grade 4 liver injury with portal vein disruption. In contrast, there was only one complication from a high-grade splenic injury-a pleural effusion treated with thoracentesis. There were 5 patients with complications from their liver injury requiring 18 therapeutic procedures. Three patients (10%) with liver injury required readmission as follows: one 5 times, one 3 times, and another one time. Patients with high-grade liver injuries have a longer recovery, more complications, and greater use of resources than in patients with similar injuries to the spleen.

  9. Major complications of central neuraxial block: report on the Third National Audit Project of the Royal College of Anaesthetists.

    Science.gov (United States)

    Cook, T M; Counsell, D; Wildsmith, J A W

    2009-02-01

    Serious complications of central neuraxial block (CNB) are rare. Limited information on their incidence and impact impedes clinical decision-making and patient consent. The Royal College of Anaesthetists Third National Audit Project was designed to inform this situation. A 2 week national census estimated the number of CNB procedures performed annually in the UK National Health Service. All major complications of CNBs performed over 1 yr (vertebral canal abscess or haematoma, meningitis, nerve injury, spinal cord ischaemia, fatal cardiovascular collapse, and wrong route errors) were reported. Each case was reviewed by an expert panel to assess causation, severity, and outcome. 'Permanent' injury was defined as symptoms persisting for more than 6 months. Efforts were made to validate denominator (procedures performed) and numerator (complications) data through national databases. The census phase produced a denominator of 707,455 CNB. Eighty-four major complications were reported, of which 52 met the inclusion criteria at the time they were reported. Data were interpreted 'pessimistically' and 'optimistically'. 'Pessimistically' there were 30 permanent injuries and 'optimistically' 14. The incidence of permanent injury due to CNB (expressed per 100,000 cases) was 'pessimistically' 4.2 (95% confidence interval 2.9-6.1) and 'optimistically' 2.0 (1.1-3.3). 'Pessimistically' there were 13 deaths or paraplegias, 'optimistically' five. The incidence of paraplegia or death was 'pessimistically' 1.8 per 100,000 (1.0-3.1) and 'optimistically' 0.7 (0-1.6). Two-thirds of initially disabling injuries resolved fully. The data are reassuring and suggest that CNB has a low incidence of major complications, many of which resolve within 6 months.

  10. Muscle impingement: MR imaging of a painful complication of osteochondromas

    Energy Technology Data Exchange (ETDEWEB)

    Uri, D.S. [Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104 (United States); Dalinka, M.K. [Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104 (United States); Kneeland, J.B. [Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104 (United States)

    1996-10-01

    The purpose of this study was to describe the magnetic resonance (MR) appearance of a newly recognized complication of osteochondromas. Two patients presented with pain and swelling over known osteochondromas. Plain radiographic studies were unrevealing. MR examinations were obtained to characterize the exostoses further and evaluate areas of palpable fullness. Increased signal was present in the muscles on T2-weighted images, which correlated with physical findings and was believed to represent muscle injury due to the osteochondroma. Pain and fullness may result from a number of osteochondroma-related complications, the most worrisome of which is malignant degeneration. Muscular impingement and injury should be considered in the differential diagnosis of pain and swelling in the region of an exostosis. MR imaging allows distinction of this entity, which may be radiographically occult and confused clinically with fracture, bursitis, or malignant degeneration. (orig.). With 2 figs.

  11. Muscle impingement: MR imaging of a painful complication of osteochondromas

    International Nuclear Information System (INIS)

    Uri, D.S.; Dalinka, M.K.; Kneeland, J.B.

    1996-01-01

    The purpose of this study was to describe the magnetic resonance (MR) appearance of a newly recognized complication of osteochondromas. Two patients presented with pain and swelling over known osteochondromas. Plain radiographic studies were unrevealing. MR examinations were obtained to characterize the exostoses further and evaluate areas of palpable fullness. Increased signal was present in the muscles on T2-weighted images, which correlated with physical findings and was believed to represent muscle injury due to the osteochondroma. Pain and fullness may result from a number of osteochondroma-related complications, the most worrisome of which is malignant degeneration. Muscular impingement and injury should be considered in the differential diagnosis of pain and swelling in the region of an exostosis. MR imaging allows distinction of this entity, which may be radiographically occult and confused clinically with fracture, bursitis, or malignant degeneration. (orig.). With 2 figs

  12. Iatrogenic splenic injury: review of the literature and medico-legal issues

    Directory of Open Access Journals (Sweden)

    Feola Alessandro

    2016-01-01

    Full Text Available Iatrogenic splenic injury is a recognized complication in abdominal surgery. The aim of this paper is to understand the medico-legal issues of iatrogenic splenic injuries. We performed a literature review on PubMed and Scopus using iatrogenic splenic or spleen injury and iatrogenic splenic rupture as keywords. Iatrogenic splenic injury cases were identified. Most cases were related to colonoscopy, but we also identified cases related to upper gastrointestinal procedures, colonic surgery, ERCP, left nephrectomy and/or adrenalectomy, percutaneous nephrolithotomy, vascular operations involving the abdominal aorta, gynecological operation, left lung biopsy, chest drain, very rarely spinal surgery and even cardiopulmonary resuscitation. There are several surgical procedures that can lead to a splenic injury. However, from a medico-legal point of view, it is important to assess whether the cause can be attributed to a technical error of the operator rather than being an unpredictable and unpreventable complication. It is important for the medico-legal expert to have great knowledge on iatrogenic splenic injuries because it is important to evaluate every step of the first procedure performed, how a splenic injury is produced, and whether the correct treatment for the splenic injury was administered in a judgment.

  13. Complications in Endovascular Neurosurgery: Critical Analysis and Classification.

    Science.gov (United States)

    Ravindra, Vijay M; Mazur, Marcus D; Park, Min S; Kilburg, Craig; Moran, Christopher J; Hardman, Rulon L; Couldwell, William T; Taussky, Philipp

    2016-11-01

    Precisely defining complications, which are used to measure overall quality, is necessary for critical review of delivery of care and quality improvement in endovascular neurosurgery, which lacks common definitions for complications. Furthermore, in endovascular interventions, events that may be labeled complications may not always negatively affect outcome. Our objective is to provide precise definitions for quality evaluation within endovascular neurosurgery. Thus, we propose an endovascular-specific classification system of complications based on our own patient series. This single-center review included all patients who had endovascular interventions from September 2013 to August 2015. Complication types were analyzed, and a descriptive analysis was undertaken to calculate the incidence of complications overall and in each category. Two hundred and seventy-five endovascular interventions were performed in 245 patients (65% female; mean age, 55 years). Forty complications occurred in 39 patients (15%), most commonly during treatment of intracranial aneurysms (24/40). Mechanical complications (eg, device deployment, catheter, or closure device failure) occurred in 8/40, technical complications (eg, failure to deploy flow diverter, unintended embolization, air emboli, retroperitoneal hemorrhage, dissection) in 11/40, judgment errors (eg, patient or equipment selection) in 9/40, and critical events (eg, groin hematoma, hemorrhagic or thromboembolic complications) in 12/40 patients. Only 12/40 complications (30%) resulted in new neurologic deficits, vessel injury requiring surgery, or blood transfusion. We propose an endovascular-specific classification system of complications with 4 categories: mechanical, technical, judgment errors, and critical events. This system provides a framework for future studies and quality control in endovascular neurosurgery. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Sunburn, Thermal, and Chemical Injuries to the Skin.

    Science.gov (United States)

    Monseau, Aaron J; Reed, Zebula M; Langley, Katherine Jane; Onks, Cayce

    2015-12-01

    Sunburn, thermal, and chemical injuries to the skin are common in the United States and worldwide. Initial management is determined by type and extent of injury with special care to early management of airway, breathing, and circulation. Fluid management has typically been guided by the Parkland formula, whereas some experts now question this. Each type of skin injury has its own pathophysiology and resultant complications. All primary care physicians should have at least a basic knowledge of management of acute and chronic skin injuries. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. A CLINICAL STUDY ON BLUNT INJURY ABDOMEN

    Directory of Open Access Journals (Sweden)

    G. Kishore Babu

    2016-10-01

    Full Text Available BACKGROUND Abdominal trauma continues to account for a large number of trauma-related injuries and deaths. Motor vehicle accidents and urban violence, respectively, are the leading causes of blunt and penetrating trauma to this area of the body. Unnecessary deaths and complications can be minimized by improved resuscitation, evaluation and treatment. The new techniques and diagnostic tools available are important in the management of abdominal trauma. These improved methods, however, still depend on experience and clinical judgment for application and determination of the best care for the injured patient. The aim of the study is to 1. Analyse the incidence, clinical characteristics, diagnosis, indications for laparotomy, therapeutic methods and morbidity & mortality rates. 2. To study nature of blunt abdominal trauma. 3. To assess patient for surgical intervention and to avoid negative laparotomy. 4. To assess morbidity rate in different organs injury. 5. To evaluate modalities of treatment, complications and prognosis. MATERIALS AND METHODS This study is a prospective study on 97 patients with Blunt injuries to the abdomen admitted in S.V.R.R.G.G. Hospital, Tirupati during October 2013-15. Inclusion Criteria Patients > 13 years, with Blunt injury to abdomen either by RTA, fall, object contact, assault giving written informed consent. Exclusion Criteria Patients <13 yrs. Blunt injuries due to blasts, patients with severe cardiothoracic and head injuries who are hemodynamically unstable. CONCLUSION Blunt Trauma to abdomen is on rise due to excessive use of motor vehicles. It poses a therapeutic and diagnostic dilemma for the attending surgeon due to wide range of clinical manifestations ranging from no early physical findings to progression to shock. So, the Trauma surgeon should rely on his physical findings in association with use of modalities like x-ray abdomen, USG abdomen and abdominal paracentesis. Hollow viscus perforations are

  16. Complications of transvaginal natural orifice transluminal endoscopic surgery: a series of 102 patients.

    Science.gov (United States)

    Wood, Stephanie G; Panait, Lucian; Duffy, Andrew J; Bell, Robert L; Roberts, Kurt E

    2014-04-01

    To review the complications encountered in our facility and in previously published studies of transvaginal (TV) natural orifice transluminal endoscopic surgery (NOTES) to date. TV NOTES is currently observed with critical eyes from the surgical community, despite encouraging data to suggest improved short-term recovery and pain. All TV NOTES procedures performed in female patients between 18 and 65 years of age were included. The median follow-up was 90 days. The TV appendectomies and ventral hernia repairs were pure NOTES, through a SILS port in the vagina, whereas TV cholecystectomies were hybrid procedures with the addition of a 5-mm port in the umbilicus. A total of 102 TV NOTES procedures, including 72 TV cholecystectomies, 24 TV appendectomies, and 6 TV ventral hernia repairs, were performed. The average age was 37 years old and body mass index was 29 kg/m. Three major and 7 minor complications occurred. The first major complication was a rectal injury during a TV access port insertion. The second major complication was an omental vessel bleed after a TV cholecystectomy. The third complication was an intra-abdominal abscess after a TV appendectomy. Seven minor complications were urinary retention (4), transient brachial plexus injury, dislodgement of an intrauterine device, and vaginal granulation tissue. As techniques in TV surgery are adopted, inevitably, complications may occur due to the inherent learning curve. Laparoscopic instruments, although adaptable to TV approaches, have yet to be optimized. A high index of suspicion is necessary to identify complications and optimize outcomes for patients.

  17. [Vascular and neurological complications of supracondylar humeral fractures in children].

    Science.gov (United States)

    Masár, J

    2007-10-01

    The author reports two cases of pediatric patients with supracondylar humeral fractures complicated by concomitant vascular injury. One of the patients also presented with neurological symptoms from compression of the ulnar and median nerves. In the case of vascular injury only, it was necessary to resect a 1-cm segment of the brachial artery which was thrombosed due to intimal disruption. In the other case, surgery was not indicated immediately; however, liberation of the nervus ulnaris and nervus medianus was later required because of nerve compression by the scar and bone. The author considers the exact diagnosis, precise reduction and stable fixation of a fracture to be most important for a good outcome of treatment. Any associated vascular injury is indicated for surgery only after a thorough diagnostic consideration, and may not be needed in every case. The most decisive factor is the clinical presentation. Injury to the nerve system is indicated for surgical treatment at a later period, at 3 months post-injury at the earliest.

  18. Maggot therapy in treatment of a complex hand injury complicated by mycotic infection.

    Science.gov (United States)

    Bohac, M; Cambal, M; Zamborsky, R; Takac, P; Fedeles, J

    2015-01-01

    Complex injuries of the hand remain a therapeutic challenge for surgeons. We present the case of a male who suffered a devastating injury of the hand caused by a conveyor belt. The patient developed a progressive Absidia corymbifera infection of the affected soft tissues. Initial treatments with serial surgical debridement and topical and intravenous itraconazole were unsuccessful in eliminating the infection. We decided to use maggot debridement therapy in a new special design to debride all necrotic, devitalized tissue and preserve only healthy tissue and functioning structures. This maneuverer followed by negative pressure therapy allowed progressive healing. In such complex hand injuries, maggot debridement combined with negative pressure therapy could be considered to achieve effective and considerable results, although future functional morbidity may occur (Fig. 4, Ref. 18).

  19. War-related penile injuries in Libya: Single-institution experience.

    Science.gov (United States)

    Etabbal, Abdalla M; Hussain, Fathi F; Benkhadoura, Mohamed O; Banni, Abdalla M

    2018-06-01

    To report on our initial experience in the management of war-related penile injuries; proper diagnosis and immediate treatment of penile injuries is essential to gain satisfactory results. Besides treating primary wounds and restoring penile function, the cosmetic result is also an important issue for the surgeon. The study was conducted in the Department of Urology at Benghazi Medical Center and comprised all patients who presented with a shotgun, gunshot or explosive penile injury between February 2011 and August 2017. The patient's age, cause of injury, site and severity of injuries, management, postoperative complications, and hospital stay, were recorded. In all, 29 males with war-related penile injuries were enrolled in the study. The mean (SD) age of these patients was 31.3 (10.5) years. The glans, urethra, and corporal bodies were involved in four (13.7%), 10 (34.4%), and 20 (68.9%) of the patients, respectively. According to the American Association for the Surgery of Trauma Penis Injury Scale, Grade III penile injuries were the most common (11 patients, 37.9%). The most common post-intervention complications were urethral stricture with or without proximal urethrocutaneous fistula (eight patients, 27.5%), followed by permanent erectile dysfunction (five patients, 17.2%). In patients who sustain war-related penile injuries the surgeon's efforts should not only be directed to restoring normal voiding and erectile function but also on the cosmetic appearance of the penis.

  20. Imaging findings of biliary and nonbiliary complications following laparoscopic surgery

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Jin-Young; Kim, Joo Hee; Lim, Joon Seok; Oh, Young Taik; Kim, Ki Whang [Yonsei University College of Medicine, Department of Diagnostic Radiology, Seoul (Korea); Yonsei University College of Medicine, Research Institute of Radiological Science, Seoul (Korea); Kim, Myeong-Jin [Yonsei University College of Medicine, Department of Diagnostic Radiology, Seoul (Korea); Yonsei University College of Medicine, Brain Korea 21 Project for Medical Science, Seoul (Korea); Yonsei University College of Medicine, Research Institute of Radiological Science, Seoul (Korea); Yonsei University College of Medicine, Institute of Gastroenterology, Seoul (Korea); Park, Mi-Suk [Yonsei University College of Medicine, Department of Diagnostic Radiology, Seoul (Korea)

    2006-09-15

    Laparoscopic techniques are evolving for a wide range of surgical procedures although they were initially confined to cholecystectomy and exploratory laparoscopy. Recently, surgical procedures performed with a laparoscope include splenectomy, adrenalectomy, gastrectomy, and myomectomy. In this article, we review the spectrum of complications and illustrate imaging features of biliary and nonbiliary complications after various laparoscopic surgeries. Biliary complications following laparoscopic cholecystectomy include bile ductal obstruction, bile leak with bile duct injury, dropped stones in the peritoneal cavity, retained CBD stone, and port-site metastasis. Nonbiliary complications are anastomotic leakage after partial gastrectomy, gangrenous cholecystitis after gastrectomy, hematoma at the anastomotic site following gastrectomy, gastric infarction after gastrectomy, port-site metastasis after gastrectomy, hematoma after splenectomy, renal infarction after adrenalectomy, and active bleeding after myomectomy of the uterus. (orig.)

  1. Cervical spine fracture in a boxer a rare but important sporting injury ...

    African Journals Online (AJOL)

    Cervical vertebral injuries are rare in boxing. The case of an adult boxer with an isolated vertical fracture of the anterior arch of the atlas is described. The mechanism of injury, clinical presentation, complications and treatment are discussed. Measures to prevent head and neck injury in boxing are discussed.

  2. Vascular Complications of Pancreatitis: Role of Interventional Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Barge, Jaideep U.; Lopera, Jorge E. [University of Texas Health Science Center, San Antonio (United States)

    2012-02-15

    Major vascular complications related to pancreatitis can cause life-threatening hemorrhage and have to be dealt with as an emergency, utilizing a multidisciplinary approach of angiography, endoscopy or surgery. These may occur secondary to direct vascular injuries, which result in the formation of splanchnic pseudoaneurysms, gastrointestinal etiologies such as peptic ulcer disease and gastroesophageal varices, and post-operative bleeding related to pancreatic surgery. In this review article, we discuss the pathophysiologic mechanisms, diagnostic modalities, and treatment of pancreatic vascular complications, with a focus on the role of minimally-invasive interventional therapies such as angioembolization, endovascular stenting, and ultrasound-guided percutaneous thrombin injection in their management.

  3. Complications associated with prone positioning in elective spinal surgery.

    Science.gov (United States)

    DePasse, J Mason; Palumbo, Mark A; Haque, Maahir; Eberson, Craig P; Daniels, Alan H

    2015-04-18

    Complications associated with prone surgical positioning during elective spine surgery have the potential to cause serious patient morbidity. Although many of these complications remain uncommon, the range of possible morbidities is wide and includes multiple organ systems. Perioperative visual loss (POVL) is a well described, but uncommon complication that may occur due to ischemia to the optic nerve, retina, or cerebral cortex. Closed-angle glaucoma and amaurosis have been reported as additional etiologies for vision loss following spinal surgery. Peripheral nerve injuries, such as those caused by prolonged traction to the brachial plexus, are more commonly encountered postoperative events. Myocutaneous complications including pressure ulcers and compartment syndrome may also occur after prone positioning, albeit rarely. Other uncommon positioning complications such as tongue swelling resulting in airway compromise, femoral artery ischemia, and avascular necrosis of the femoral head have also been reported. Many of these are well-understood and largely avoidable through thoughtful attention to detail. Other complications, such as POVL, remain incompletely understood and thus more difficult to predict or prevent. Here, the current literature on the complications of prone positioning for spine surgery is reviewed to increase awareness of the spectrum of potential complications and to inform spine surgeons of strategies to minimize the risk of prone patient morbidity.

  4. Effect of Obesity on Complication Rate After Elbow Arthroscopy in a Medicare Population.

    Science.gov (United States)

    Werner, Brian C; Fashandi, Ahmad H; Chhabra, A Bobby; Deal, D Nicole

    2016-03-01

    To use a national insurance database to explore the association of obesity with the incidence of complications after elbow arthroscopy in a Medicare population. Using Current Procedural Terminology (CPT) and International Classification of Diseases, 9th Revision (ICD-9) procedure codes, we queried the PearlDiver database for patients undergoing elbow arthroscopy. Patients were divided into obese (body mass index [BMI] >30) and nonobese (BMI arthroscopy were identified from 2005 to 2012; 628 patients (22.5%) were coded as obese or morbidly obese, and 628 matched nonobese patients formed the control group. There were no differences between the obese patients and matched control nonobese patients regarding type of elbow arthroscopy, previous elbow fracture or previous elbow arthroscopy. Obese patients had greater rates of all assessed complications, including infection (odds ratio [OR] 2.8, P = .037), nerve injury (OR 5.4, P = .001), stiffness (OR 1.9, P = .016) and medical complications (OR 6.9, P arthroscopy in a Medicare population, including infection, nerve injury, stiffness, and medical complications. Therapeutic Level III, case-control study. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  5. Muscle injuries in athletes. The value of magnetic resonance imaging

    International Nuclear Information System (INIS)

    Lueckerath, C.; Rehnitz, C.

    2017-01-01

    Competitive sports yield high demands on the musculoskeletal system, accordingly muscle injuries are a common complication. Early imaging clarification of the muscles in cases of a trauma is essential in order to define the exact location of the lesion, the affected muscles, the extent and the degree of the injury as well as to define possible concomitant complications. In the case of a professional athlete, the assessment made by MRI is important for defining the individually required resting period for a riskless resumption of the sporting activities. (orig.) [de

  6. Ankylosing spondylitis in women: A comparison of scintigraphic, clinical, and radiological findings

    International Nuclear Information System (INIS)

    Schoerner, W.; Savaser, A.; Krueger, H.H.; Botsch, H.

    1982-01-01

    Since ankylosing spondylits (S.a.) tends to be milder and less progressive in women than in men, there are great difficulties in diagnosing S.a. in fermale patients. The role of scintiscanning for investigation of S.a. in women is discussed by few examiners only especially there are no investigations of quantitative sacroiliac scintigraphy in large groups of female patients. Quantitative sacroiliac scintigraphy was performed in 19 female patients with S.a. and in 30 control subjects. The sacroiliac/sacrum ratio (Index ISG/sacrum) was calculated. Significantly increased uptakes were found in the patient group compared with the controls. Especially in the early periods of S.a. the activity index was highest. When history and physical examination lead to a suspicion of S.a. and there is not verification by roentgenographic studies, sacroiliac joint scintigraphy is indicated. If clinical and laboratory findings are respected in each patient, quantitative sacroiliac scintigraphy is useful for the early diagnosis of S.a. in female patients. (orig.)

  7. A Possible Role of Intestinal Microbiota in the Pathogenesis of Ankylosing Spondylitis

    Directory of Open Access Journals (Sweden)

    Lianjun Yang

    2016-12-01

    Full Text Available Ankylosing spondylitis (AS is a chronic inflammatory disease primarily affecting the sacroiliac joints and the spine, for which the pathogenesis is thought to be a result of the combination of host genetic factors and environmental triggers. However, the precise factors that determine one’s susceptibility to AS remain to be unraveled. With 100 trillion bacteria residing in the mammalian gut having established a symbiotic relation with their host influencing many aspects of host metabolism, physiology, and immunity, a growing body of evidence suggests that intestinal microbiota may play an important role in AS. Several mechanisms have been suggested to explain the potential role of the microbiome in the etiology of AS, such as alterations of intestinal permeability, stimulation of immune responses, and molecular mimicry. In this review, the existing evidence for the involvement of the microbiome in AS pathogenesis was discussed and the potential of intestinal microbiome-targeting strategies in the prevention and treatment of AS was evaluated.

  8. Inhibition of Klebsiella pneumoniae growth by selected Australian plants: natural approaches for the prevention and management of ankylosing spondylitis.

    Science.gov (United States)

    Winnett, V; Sirdaarta, J; White, A; Clarke, F M; Cock, I E

    2017-04-01

    A wide variety of herbal remedies are used in traditional Australian medicine to treat inflammatory disorders, including autoimmune inflammatory diseases. One hundred and six extracts from 40 native Australian plant species traditionally used for the treatment of inflammation and/or to inhibit bacterial growth were investigated for their ability to inhibit the growth of a microbial trigger for ankylosing spondylitis (K. pneumoniae). Eighty-six of the extracts (81.1%) inhibited the growth of K. pneumoniae. The D. leichardtii, Eucalyptus spp., K. flavescens, Leptospermum spp., M. quinquenervia, Petalostigma spp., P. angustifolium, S. spinescens, S. australe, S. forte and Tasmannia spp. extracts were effective K. pneumoniae growth inhibitors, with MIC values generally <1000 µg/mL. The T. lanceolata peppercorn extracts were the most potent growth inhibitors, with MIC values as low as 16 µg/mL. These extracts were examined by non-biased GC-MS headspace analysis and comparison with a compound database. A notable feature was the high relative abundance of the sesquiterpenoids polygodial, guaiol and caryophyllene oxide, and the monoterpenoids linalool, cineole and α-terpineol in the T. lanceolata peppercorn methanolic and aqueous extracts. The extracts with the most potent K. pneumoniae inhibitory activity (including the T. lanceolata peppercorn extracts) were nontoxic in the Artemia nauplii bioassay. The lack of toxicity and the growth inhibitory activity of these extracts against K. pneumoniae indicate their potential for both preventing the onset of ankylosing spondylitis and minimising its symptoms once the disease is established.

  9. BONE METABOLISM AND ITS REGULATION IN PATIENTS WITH ANKYLOSING SPONDYLITIS

    Directory of Open Access Journals (Sweden)

    O. V. Bugrova

    2016-01-01

    Full Text Available Osteoporosis in ankylosing spondylitis (AS may exacerbate pain and functional disorders and increases the risk of fractures. The mechanisms  of its development in AS have not been adequately studied.Objective: to study bone mineral density (BMD  and its regulation in patients with AS.Subjects and methods. 70 patients (mean age, 43.2±9.2 years with a documented diagnosis of AS (mean disease duration, 17.1±7.8 years and a control group of 30 healthy individuals were examined. All the patients underwent estimation of BMD and the serum concentrations of osteocalcin,  CrossLaps, and key regulators of osteoclastogenesis, such as osteoprotegerin (OPG  and a receptor activator of nuclear factor kappa-B ligand (RANKL by an enzyme immunoassay. Results and discussion. In patients with AS, bone metabolism was characterized  by a decrease in bone formation and by some increase in bone tissue degradation especially in high AS activity. These patients showed the elevated levels of the major blocker of osteoclastogenesis OPG and the OPG/RANKL ratio, which can cause the process of ossification characteristic  of AS.

  10. Preventable long-term complications of suprapubic cystostomy after spinal cord injury: Root cause analysis in a representative case report

    Directory of Open Access Journals (Sweden)

    Singh Gurpreet

    2011-10-01

    Full Text Available Abstract Background Although complications related to suprapubic cystostomies are well documented, there is scarcity of literature on safety issues involved in long-term care of suprapubic cystostomy in spinal cord injury patients. Case Presentation A 23-year-old female patient with tetraplegia underwent suprapubic cystostomy. During the next decade, this patient developed several catheter-related complications, as listed below: (1 Suprapubic catheter came out requiring reoperation. (2 The suprapubic catheter migrated to urethra through a patulous bladder neck, which led to leakage of urine per urethra. (3 Following change of catheter, the balloon of suprapubic catheter was found to be lying under the skin on two separate occasions. (4 Subsequently, this patient developed persistent, seropurulent discharge from suprapubic cystostomy site as well as from under-surface of pubis. (5 Repeated misplacement of catheter outside the bladder led to chronic leakage of urine along suprapubic tract, which in turn predisposed to inflammation and infection of suprapubic tract, abdominal wall fat, osteomyelitis of pubis, and abscess at the insertion of adductor longus muscle Conclusion Suprapubic catheter should be anchored securely to prevent migration of the tip of catheter into urethra and accidental dislodgment of catheter. While changing the suprapubic catheter, correct placement of Foley catheter inside the urinary bladder must be ensured. In case of difficulty, it is advisable to perform exchange of catheter over a guide wire. Ultrasound examination of urinary bladder is useful to check the position of the balloon of Foley catheter.

  11. Mandible Fracture Complications and Infection: The Influence of Demographics and Modifiable Factors.

    Science.gov (United States)

    Odom, Elizabeth B; Snyder-Warwick, Alison K

    2016-08-01

    Mandible fractures account for 36 to 70 percent of all facial fractures. Despite their high prevalence, the literature lacks a comprehensive review of demographics, fracture patterns, timing of management, antibiotic selection, and outcomes, particularly when evaluating pediatric versus adult patients. The authors aim to determine the complication and infection rates after surgical treatment of mandibular fractures and the bacterial isolates and antibiotic sensitivities from mandible infections after open reduction and internal fixation at their institution. Data were collected retrospectively for all mandible fractures treated at the authors' institution between 2003 and 2013. Patients were divided into pediatric (younger than 16 years) and adult (16 years or older) subgroups. Demographics, fracture location, fracture cause, comorbidities, antibiotic choice, and subsequent complications and infections were analyzed. Data were evaluated using appropriate statistical tests for each variable. Three hundred ninety-five patients were evaluated. Demographics and fracture cause were similar to those reported in current literature. Of the 56 pediatric patients, complications occurred in 5.6 percent. Time from injury to operative intervention did not affect outcome. The complication rate was 17.5 percent and the infection rate was 9.4 percent in the adult subgroup. Time from injury to operative intervention, sex, and edentulism were not significant predictors of complication or infection. Tobacco use, number of fractures, number of fractures fixated, and surgical approach were predictors of complication and infection. Perioperative ampicillin-sulbactam had a significantly lower risk of infection. Certain demographic and operative factors lead to significantly higher risks of complications after surgical management of mandibular fractures. Ampicillin-sulbactam provides effective antibiotic prophylaxis. Risk factor modification may improve outcomes. Risk, IV.

  12. Arterial Injury Associated with Tension-Free Vaginal Tapes-SECUR Procedure Successfully Treated by Radiological Embolization

    Directory of Open Access Journals (Sweden)

    Yun Seok Jung

    2010-12-01

    Full Text Available Various postoperative complications have been reported after the use of tension-free vaginal tapes (TVT. The transobturator approach was introduced to minimize the potential complications. The next generation of recently introduced TVT-SECUR is intended to minimize the incidence of complications. Herein we report a case of internal pudendal artery injury sustained during this procedure that was successfully treated by radiological embolization. Angiography with vessel embolization, when available, should be considered when the arterial injury is suspected.

  13. Reconstruction of fingertip injuries: surgical tips and avoiding complications.

    Science.gov (United States)

    Panattoni, Joao B; De Ona, Ignacio Roger; Ahmed, Mohammed M

    2015-05-01

    The fingertip is the most commonly injured part of the hand. When replantation of a fingertip amputation is not possible, flap reconstruction may be necessary for a functional and aesthetically pleasing outcome. This paper reviews commonly utilized reconstruction techniques with a focus on technical tricks and potential complications and how to avoid them, with illustrative cases. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  14. Complications after 1000 lung radiofrequency ablation sessions in 420 patients: a single center's experiences.

    Science.gov (United States)

    Kashima, Masataka; Yamakado, Koichiro; Takaki, Haruyuki; Kodama, Hiroshi; Yamada, Tomomi; Uraki, Junji; Nakatsuka, Atsuhiro

    2011-10-01

    This study retrospectively evaluates complications after lung radiofrequency ablation (RFA). Complications were assessed for each RFA session in 420 consecutive patients with 1403 lung tumors who underwent 1000 RFA sessions with a cool-tip RFA system. A major complication was defined as a grade 3 or 4 adverse event. Risk factors affecting frequent major complications that occurred with an incidence of 1% or more were detected using multivariate analysis. Four deaths (0.4% [4/1000]) related to RFA procedures occurred. Three patients died of interstitial pneumonia. The other patient died of hemothorax. The major complication rate was 9.8% (98/1000). Frequent major complications were aseptic pleuritis (2.3% [23/1000]), pneumonia (1.8% [18/1000]), lung abscess (1.6% [16/1000]), bleeding requiring blood transfusion (1.6% [16/1000]), pneumothorax requiring pleural sclerosis (1.6% [16/1000]), followed by bronchopleural fistula (0.4% [4/1000]), brachial nerve injury (0.3% [3/1000]), tumor seeding (0.1% [1/1000]), and diaphragm injury (0.1% [1/1000]). Puncture number (p risk factors for aseptic pleuritis. Previous external beam radiotherapy (p risk factors for pneumonia, as were emphysema (p lung abscess, and serum platelet count (p risk factor for pneumothorax requiring pleural sclerosis. Lung RFA is a relatively safe procedure, but it can be fatal. Risk factors found in this study will help to stratify high-risk patients.

  15. Increased occurrence of spinal fractures related to ankylosing spondylitis: a prospective 22-year cohort study in 17,764 patients from a national registry in Sweden

    Directory of Open Access Journals (Sweden)

    Robinson Yohan

    2013-01-01

    Full Text Available Abstract Background Ankylosing spondylitis (AS is a rheumatoid disease leading to progressive ossification of the spinal column. Patients suffering from AS are highly susceptible to unstable vertebral fractures and often require surgical stabilisation due to long lever arms. Medical treatment of these patients improved during the last decades, but until now it is unknown whether the annual number of spinal fractures changed during the last years. Since the annual count of fracture is an effective measure for efficacy of injury prevention and patient safety in AS patients, the current recommendations of activity have to be revised accordingly. Methods Data for all patients with AS treated as inpatients between 01/01/1987 and 31/12/2008 were extracted from the Swedish National Hospital Discharge Registry (SNHDR. The data in the registry are collected prospectively, recording all inpatient admissions throughout Sweden. The SNHDR uses the codes for diagnoses at discharge according to the Swedish versions of the International Classification of Diseases (ICD-9 and ICD-10. Results During the years from 1987 to 2008 17,764 patients with AS were treated as inpatients; of these 724 patients were treated due to spinal fractures. The annual number of cervical, thoracic and lumbar fractures in the registry increased until 2008 (r = 0.94. Conclusions Despite the improved treatment of AS the annual number of vertebral fractures requiring inpatient care increased during the last two decades. Possible explanations are population growth, greater awareness of fractures, improved diagnostics, improved emergency care reducing fatalities, and a higher activity level of patients receiving modern medical therapy. Obviously the improvement of medical treatment did not reduce the susceptibility of these patients to unstable fractures. Thus the restrictive injury prevention recommendations for patients with AS cannot be defused, but must be critically revised to

  16. Acute toxoplasmosis infection in a patient with ankylosing spondylitis treated with adalimumab: a case report

    Directory of Open Access Journals (Sweden)

    M. de Almeida Santos Jr

    2011-06-01

    Full Text Available Ankylosing spondylitis (AS is a chronic inflammatory disease that affects the axial skeleton, often beginning in the sacroiliac joints, but accompanied also by other signs, including enthesitis, lung fibrosis and eye involvement. AS generally occurs in the second or third decade of life with inflammatory low back pain and has a strong relation with HLA-B27. The objective of the treatment until the end of the 90’s was to ameliorate pain and stiffness and preserve function (1. Nonselective nonsteroidal antiinflammatory drugs (NSAIDs, cyclooxygenase-2 selective inhibitors, and nonpharmalogic interventions, such as physiotherapy, exercise, education, and lifestyle modifications were the basis of the management. Therapy with agents like sulphasalazine was administered for peripheral arthritis (1, 2...

  17. Corrosive injuries of the upper gastrointestinal tract

    Directory of Open Access Journals (Sweden)

    Babu Lal Meena

    2017-01-01

    Full Text Available Corrosive injury of the upper gastrointestinal tract is a worldwide clinical problem, mostly occurring in children. Alkaline agents produce deeper injuries whereas acidic agents produce superficial injuries usually. Hoarseness, stridor, and respiratory distress indicate airway injury. Dysphagia, odynophagia, and drooling of saliva suggest esophageal injury whereas abdominal pain, nausea, and vomiting are indicative of stomach injury. X-rays should be done to rule out perforation. Endoscopy is usually recommended in the first 12–48 h although it is safe up to 96 h after caustic ingestion. Endoscopy should be performed with caution and gentle insufflation. Initial management includes getting intravenous access and replacement of fluids. Hyperemia and superficial ulcerations have excellent recovery while deeper injuries require total parenteral nutrition or feeding jejunostomy. Patients suspected of perforation should be subjected to laparotomy. Common complications after corrosive injury are esophageal stricture, gastric outlet obstruction, and development of esophageal and gastric carcinoma.

  18. Combat ocular trauma and systemic injury.

    Science.gov (United States)

    Weichel, Eric D; Colyer, Marcus H

    2008-11-01

    To review the recent literature regarding combat ocular trauma during hostilities in Operations Iraqi Freedom and Enduring Freedom, describe the classification of combat ocular trauma, and offer strategies that may assist in the management of eye injuries. Several recent publications have highlighted features of combat ocular trauma from Operation Iraqi Freedom. The most common cause of today's combat ocular injuries is unconventional fragmentary munitions causing significant blast injuries. These explosive munitions cause high rates of concomitant nonocular injuries such as traumatic brain injury, amputation, and other organ injuries. The most frequent ocular injuries include open-globe and adnexal lacerations. The extreme severity of combat-related open-globe injuries leads to high rates of primary enucleation and retained intraocular foreign bodies. Visual outcomes of intraocular foreign body injuries are similar to other series despite delayed removal, and no cases of endophthalmitis have occurred. Despite these advances, however, significant vision loss persists in cases of perforating globe injuries as well as open and closed-globe trauma involving the posterior segment. This review summarizes the recent literature describing ocular and systemic injuries sustained during Operations Iraqi and Enduring Freedom. An emphasis on classification of ocular injuries as well as a discussion of main outcome measures and complications is discussed.

  19. Major intraoperative complications during video-assisted thoracoscopic anatomical lung resections

    DEFF Research Database (Denmark)

    Decaluwe, Herbert; Petersen, René Horsleben; Hansen, Henrik

    2015-01-01

    OBJECTIVES: A multicentre evaluation of the frequency and nature of major intraoperative complications during video-assisted thoracoscopic (VATS) anatomical resections. METHODS: Six European centres submitted their series of consecutive anatomical lung resections with the intention to treat by VATS...... for technical reasons. In-hospital mortality was 1.4% (n = 43). Conversion to open thoracotomy was observed in 5.5% (n = 170), of whom 21.8% (n = 37) were for oncological reasons, 29.4% (n = 50) for technical reasons and 48.8% (n = 83) for complications. Vascular injuries were reported in 2.9% (n = 88) patients...... major surgery (n = 9) or immediate life-threatening complications (n = 17). Twenty-three percent of the in-hospital mortalities (n = 10/43) were related to major intraoperative complications. Eight pneumonectomies (five intraoperative and three postoperative at 0.3%) were a consequence of a major...

  20. Acute kidney injury from herbal vaginal remedy in Ilorin: a case report

    African Journals Online (AJOL)

    Acute kidney injury from herbal vaginal remedy in Ilorin: a case report. TO Olanrewaju, A Chijioke, IQ Ameh, AA Adewale. Abstract. The use of traditional herbal remedy is very common worldwide, and it is associated with complications such as acute kidney injury. Herbal remedy accounts for 35% of acute kidney injury in ...

  1. Surgical Treatment Results of Acute Acromioclavicular Injuries

    Directory of Open Access Journals (Sweden)

    Mahmoud Jabalameli

    2010-02-01

    Full Text Available Background Different methods of surgical treatment for acromioclavicular(ACjoint injury were considered in the literature. The purpose of the study was to compare intra- articular AC repair technique with the extra-articular coracoclavicular repair technique for the patients with Rockwood type III and VAC joint injury when indicated.Methods: Nineteen consecutive patients with Rockwood type III and VAC joint injury  were treated with intra-articular (Group I - 12 cases and extra-articular (Group II - 7cases repair technique between 1380 - 1386, and the results reviewed. When the diagnosis was established, the mean age of the patients was 32.5 years (Range, 18 - 60; group I and II 31.8 years (Range, 18 - 60 and 34 years (Range, 22 - 58 respectively. The mean duration of postoperative follow - up was 24 months. The Constant shoulder scoring system was applied to obtain clinical results.   Results: Only in group I, the post-surgical complication was associated with fiber allergy, wound infection and pin site infection in two patients respectively. No pain was detected in fourteen cases. Four patients in group I had occasional mild pain during sport activity, while one case in this group reported severe pain during resting which prevented the patient from activity. Also, there was an ossification in thirteen patients particularly in group I. Clinical results showed the mean constant shoulder score was 93.4 in group I and 97.1 in group II.Conclusion: At the time of the follow - up, there was a clear difference between both groups regarding to postoperative pain and discomfort.Therefore, it seemed that potential cause of pain was due to postoperative complications. An interesting postoperative complication without interfere in the functional outcome was coracoclavicular space ossification in most cases. This was probably because of soft tissue injury during the operation.It seemed that surgical treatment of Rockwood type III and VAC joint injuries

  2. Hepatic arterial pseudoaneurysm: a rare complication of blunt abdominal trauma in children

    International Nuclear Information System (INIS)

    Basile, K.E.; Sivit, C.J.; Sachs, P.B.; Stallion, A.

    1999-01-01

    We report a child who developed a hepatic artery pseudoaneurysm following blunt hepatic injury. This is a rare complication of hepatic trauma in children. The imaging evaluation and clinical management of hepatic artery pseudoaneurysms are presented. (orig.)

  3. Handlebar Hernia With Jejunal and Duodenal Injuries: A Case Report

    Directory of Open Access Journals (Sweden)

    Ching-Wen Huang

    2004-09-01

    Full Text Available Traumatic abdominal wall hernia is an uncommon complication of abdominal blunt trauma. Handlebar hernia is even more infrequent. To the best of our knowledge, there are fewer than 30 cases of handlebar hernia reported in the English literature. Associated intra-abdominal injuries are infrequent. We present a case of handlebar hernia with jejunal and duodenal injuries. Emergency surgical intervention included primary repair of the disrupted musculofascial defect and injuries of the duodenum and jejunum. Bile- stained discharge from the drain tube was noted, so a second operation was performed about 7 days after the first. Leakage from the sutured jejunal perforation and another irregular perforation in the posterior wall of the fourth portion of the duodenum were noted. The two perforations were debrided and repaired. The muscular and fascial defects were debrided and closed with interrupted sutures. The patient recovered smoothly and was discharged 30 days after the blunt injury. No other major complication was noted 11 months after surgery.

  4. Severe falciparum malaria with dengue coinfection complicated by rhabdomyolysis and acute kidney injury: an unusual case with myoglobinemia, myoglobinuria but normal serum creatine kinase

    Directory of Open Access Journals (Sweden)

    Yong Kok Pin

    2012-12-01

    Full Text Available Abstract Background Acute kidney injury (AKI is a complication of severe malaria, and rhabdomyolysis with myoglobinuria is an uncommon cause. We report an unusual case of severe falciparum malaria with dengue coinfection complicated by AKI due to myoglobinemia and myoglobinuria while maintaining a normal creatine kinase (CK. Case presentation A 49-year old Indonesian man presented with fever, chills, and rigors with generalized myalgia and was diagnosed with falciparum malaria based on a positive blood smear. This was complicated by rhabdomyolysis with raised serum and urine myoglobin but normal CK. Despite rapid clearance of the parasitemia with intravenous artesunate and aggressive hydration maintaining good urine output, his myoglobinuria and acidosis worsened, progressing to uremia requiring renal replacement therapy. High-flux hemodiafiltration effectively cleared his serum and urine myoglobin with recovery of renal function. Further evaluation revealed evidence of dengue coinfection and past infection with murine typhus. Conclusion In patients with severe falciparum malaria, the absence of raised CK alone does not exclude a diagnosis of rhabdomyolysis. Raised serum and urine myoglobin levels could lead to AKI and should be monitored. In the event of myoglobin-induced AKI requiring dialysis, clinicians may consider using high-flux hemodiafiltration instead of conventional hemodialysis for more effective myoglobin removal. In Southeast Asia, potential endemic coinfections that can also cause or worsen rhabdomyolysis, such as dengue, rickettsiosis and leptospirosis, should be considered.

  5. Chemical and radiation injuries

    International Nuclear Information System (INIS)

    Hugo, M.J.

    1981-01-01

    The paper is a discussion of radiation injuries and the treatment thereof. Radiation injuries are mainly caused as a result of nuclear leaks or nuclear bomb explosions. Such an explosion is usually accompanied by a light flash, noise, heat radiation and nuclear radiation which can all caurse various types of injuries. The general effect of radioactive radiation is discussed. The seriousness of the situation where the whole body was exposed to nuclear radiation, depends on the total radiation dose received and varies from person to person. The progress of radiation sickness is described. Mention is also made of long term radiation effects. The emergency treatment of the injured before specialised aid is available, is discussed. The primary aim of treatment is to save life and to prevent further injuries and complications. Injured people must be removed as far as possible from the point of maximum radiation. Attention must also be given to decontamination

  6. Injuries of the chestFNx01

    Directory of Open Access Journals (Sweden)

    Deodhar S

    1979-01-01

    Full Text Available Thirty cases of chest injuries were admitted in the Department of Surgery, K.E.M. Hospital, Bombay. These injuries seem to be fairly common. Detailed examination at the time of admission is necessary to assess the clinical presentation and the presence of major complications. Institution of intra-peritoneal drainage, restoration of negative intra-pleural pressure and active respiratory physiotherapy constitute an important part of the treatment. The literature on this subject is briefly reviewed

  7. Incidence of vascular complications during lateral lumbar interbody fusion: an examination of the mini-open access technique.

    Science.gov (United States)

    Kueper, Janina; Fantini, Gary A; Walker, Brendon R; Aichmair, Alexander; Hughes, Alexander P

    2015-04-01

    This article examines the incidence and management of vascular injury during Lateral Lumbar Interbody Fusion (LLIF). The details of the mini-open access technique are presented. A total of 900 patients who underwent a LLIF at an average 1.94 levels (range: 1-5 levels) by one of six fellowship trained surgeons on 1,754 levels from 2006 to 2013 were identified. The incidence of intraoperative vascular injury was retrospectively determined from the Operative Records. The management of vascular injury was evaluated. The mini-open access adapted by our institution for LLIF is described. The incidence of major vascular complication in our series was 1/900. The incidence of minor vascular injury was 4/900. The overall incidence of vascular injury was calculated to be 0.056 % per case and 0.029 % per level. All minor vascular injuries were identified to be segmental vessel lacerations, which were readily ligated under direct visualization without further extension of the incision with no clinical sequelae. The laceration of the abdominal aorta, the major vascular complication of this series, was emergently repaired through an exploratory laparotomy. None of the patients suffered long-term sequelae from their intraoperative vascular injuries. The mini-open lateral access technique for LLIF provides for minimal risk of vascular injury to the lumbar spine. In the rare event of minor vascular injury, the mini-open access approach allows for immediate visualization, confirmation and repair of the vessel with no long-term sequelae.

  8. Application of the Mandible Injury Severity Score to Pediatric Mandibular Fractures.

    Science.gov (United States)

    Swanson, Edward W; Susarla, Srinivas M; Ghasemzadeh, Ali; Mundinger, Gerhard S; Redett, Richard J; Tufaro, Anthony P; Manson, Paul N; Dorafshar, Amir H

    2015-07-01

    The Mandible Injury Severity Score (MISS) has been used to evaluate adult mandibular fractures. The purpose of this study was to evaluate the MISS in a cohort of pediatric patients. This was a retrospective study of pediatric patients treated for mandibular fractures over a 20-year period. Patients were included if they had computed tomographic imaging available for review and had at least 1 post-treatment visit. The primary predictor variable was the MISS. Secondary predictors were demographic and injury-associated factors. The outcome was treatment-associated complications. Descriptive, bivariate, and multiple logistic regression statistics were computed. One hundred sixteen patients with mandibular fractures were identified; 73 (62.9%) met the inclusion criteria. The sample's mean age was 8.5 ± 4.1 years; 44% were girls. Motor vehicle collisions (60%) and falls (15.1%) were the most common mechanisms. More than 50% of patients had an extra-mandibular injury. The mean MISS was 13.5 ± 7.8. Forty-five percent of the sample underwent open reduction and internal fixation. Complications were noted in 20.5% of patients, of which malocclusion was the most common (8.2%). Increasing MISS was associated with complications (P pediatric patients with mandibular fractures, increased severity of injury is associated with complications, even after controlling for the effects of multiple confounders, including open treatment. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  9. Indications and risk factors for complications of lower third molar ...

    African Journals Online (AJOL)

    The mesioangular (176/330 [53.4%]) and distoangular (73/330 [22.1%]) impactions were the commonest types. Recurrent pericoronitis (154/330 [46.7%]) was the most common indication for extraction. The complications were delayed healing (19/330 [5.8%]), alveolar, osteitis (9/330 [2.7%]) and injury to alveolar nerve ...

  10. Life expectancy in elderly patients following burns injury.

    Science.gov (United States)

    Sepehripour, Sarvnaz; Duggineni, Sirisha; Shahsavari, Somaya; Dheansa, Baljit

    2018-05-18

    Burn injuries commonly occur in vulnerable age and social groups. Previous research has shown that frailty may represent a more important marker of adverse outcome in healthcare rather than chronological age (Roberts et al., 2012). In this paper we determined the relationship between burn injury, frailty, co-morbidities and long-term survival. Retrospective data collection from patients aged 75 with burns injuries, treated and discharged at Queen Victoria Hospital. The Clinical Frailty Scale (Rockwood et al., 2005) was used to calculate frailty at the time of admission. The expected mortality age (life expectancy) of deceased patients was obtained from two survival predictors. The data shows a statistically significant correlation between frailty score and complications and a statistically significant correlation between total body surface area percentage and complications. No significant difference was found between expected and observed age of death or life expectancy amongst the deceased (p value of 0.109). Based on the data from our unit, sustaining a burn as an elderly person does not reduce life expectancy. Medical and surgical complications, immediate, early and late, although higher with greater frailty and TBSA of burn, but do not adversely affect survival in this population. Copyright © 2018 Elsevier Ltd. All rights reserved.

  11. Suprapubic cystostomy for the management of urethral injuries during penile prosthesis implantation.

    Science.gov (United States)

    Anele, Uzoma A; Le, Brian V; Burnett, Arthur L

    2014-12-01

    Urethral injury is an uncommon surgical complication of penile prosthesis (PP) surgery. Conventional dogma requires abortion of the procedure if the adjacent corporal body is involved or delayed implantation to avert device infection associated with urinary extravasation. Besides the setback of the aborted surgery, this management approach also presents the possible difficulty of encountering corporal fibrosis at the time of reoperation. We report an approach using primary urethral repair and temporary suprapubic cystostomy for the management of incidental urethral injuries in a cohort of patients allowing for successful completion of unaborted PP implantation. We performed a retrospective analysis of all patients receiving PPs from 1990 to 2014 in which incidental urethral injuries were repaired and PP implantation was completed with suprapubic cystostomy (suprapubic tube [SPT] insertion). After allowing for urethral healing and urinary diversion via SPT for 4-8 weeks, the PP was activated. Successful management was determined by the absence of perioperative complications within 6 months of implantation. We identified four cases, all receiving inflatable PPs, managed with temporary suprapubic cystostomy. These patients sustained urethral injuries during corporal dissection (one patient), corporal dilation (one patient), and penile straightening (two patients). All patients were managed safely and successfully. Primary urethral repair followed by temporary suprapubic cystostomy offers a surgical approach to complete PP implantation successfully in patients who sustain urethral injury complications, particularly for complex PP surgeries. Anele UA, Le BV, and Burnett AL. Suprapubic cystostomy for the management of urethral injuries during penile prosthesis implantation.

  12. Tracheobronchial injuries in blunt chest trauma

    Directory of Open Access Journals (Sweden)

    vahid Montazeri

    2004-01-01

    Full Text Available Introduction: Tracheobronchial injuries are uncommon but potentially fatal complication of blunt thoracic trauma harboring a high morbidity and mortality if not diagnosed early . A recent series gleaning cases from four major Trauma Center in Los Angeles nine cases in a seven- year period , but the incidence of these injuries has been increasing recently. This has been attributed to improvement in hospital care and advanced Trauma Centers and earlier diagnosis of such injuries. Disruption of tight main bronchus is more common, such injuries are often associated with rib or clavicular fractures. Findings: Clinical and paraclinical data gathered from records of three patients referred with tracheobronchial injuries during the recent ten years have been reviewed .These include clinical manifestations, diagnostic findings, treatment modality and clinical course. The outcome has been satisfactory in all three patients who have undergone operation 2-5 hours after sustaining the injury. We have not had any mortality. Conclusion: These results are similar to those of other series emphasizing over early diagnosis and treatment of such injuries .

  13. Splenectomy exacerbates lung injury after ischemic acute kidney injury in mice

    Science.gov (United States)

    Andrés-Hernando, Ana; Altmann, Christopher; Ahuja, Nilesh; Lanaspa, Miguel A.; Nemenoff, Raphael; He, Zhibin; Ishimoto, Takuji; Simpson, Pete A.; Weiser-Evans, Mary C.; Bacalja, Jasna

    2011-01-01

    Patients with acute kidney injury (AKI) have increased serum proinflammatory cytokines and an increased occurrence of respiratory complications. The aim of the present study was to examine the effect of renal and extrarenal cytokine production on AKI-mediated lung injury in mice. C57Bl/6 mice underwent sham surgery, splenectomy, ischemic AKI, or ischemic AKI with splenectomy and kidney, spleen, and liver cytokine mRNA, serum cytokines, and lung injury were examined. The proinflammatory cytokines IL-6, CXCL1, IL-1β, and TNF-α were increased in the kidney, spleen, and liver within 6 h of ischemic AKI. Since splenic proinflammatory cytokines were increased, we hypothesized that splenectomy would protect against AKI-mediated lung injury. On the contrary, splenectomy with AKI resulted in increased serum IL-6 and worse lung injury as judged by increased lung capillary leak, higher lung myeloperoxidase activity, and higher lung CXCL1 vs. AKI alone. Splenectomy itself was not associated with increased serum IL-6 or lung injury vs. sham. To investigate the mechanism of the increased proinflammatory response, splenic production of the anti-inflammatory cytokine IL-10 was determined and was markedly upregulated. To confirm that splenic IL-10 downregulates the proinflammatory response of AKI, IL-10 was administered to splenectomized mice with AKI, which reduced serum IL-6 and improved lung injury. Our data demonstrate that AKI in the absence of a counter anti-inflammatory response by splenic IL-10 production results in an exuberant proinflammatory response and lung injury. PMID:21677145

  14. TREATMENT OF BLUNT LIVER INJURIES IN CHILDREN

    Directory of Open Access Journals (Sweden)

    Ana Kostić

    2003-04-01

    Full Text Available Liver is the largest parenchymatous organ, well vascularized, weighing approximately 1.8-3.0% of the whole body weight. Among all abdominal traumas liver injuries account for 25%. For more serious liver injuries the mortality is around 40% in children below 10 years of age. For lesions of the juxtahepatic veins (three major hepatic veins or the retrohepatic portion of v. cava or for complex, combined intraabdominal injuries, the mortality is even up to 70%.This work analyzed the period 1988-2000 during which there were 19 children admitted and treated for blunt liver injuries at the Clinic of Pediatric Surgery and Orthopedics in Nis; I, II and III scale injuries prevailed (17 cases; 89.4%. These injuries were surgically treated for the most part (17 cases; 89.4%. In 7 children (36.8% there were combined injuries. The lethality was 26.3%-5 cases, with three major complications: two intrahepatic hematomas and one biliary fistula associated with biliary peritonitis and biloma formation.

  15. Skull traction for cervical spinal injury in Enugu: A 5‑year ...

    African Journals Online (AJOL)

    2015-11-05

    Nov 5, 2015 ... Background: Treatment of cervical spine injury is the most challenging of all the injuries of the spine, and there is yet no agreement on the best method of care. Objective: We studied the complications and outcome of two skull traction devices used to treat cases of cervical spine injury in three centers in ...

  16. 20-year experience with iatrogenic penile injury.

    Science.gov (United States)

    Amukele, Samuel A; Lee, Gene W; Stock, Jeffrey A; Hanna, Moneer K

    2003-10-01

    We review our experience with the management of iatrogenic penile injuries. Apart from circumcision, serious damage to the penis can occur following hypospadias repair, surgery for priapism or total loss of the penis following surgical repair of bladder exstrophy. A retrospective analysis of patients with iatrogenic penile amputation referred to us between 1980 and 2000 was undertaken. Causes of injury and choice of management were reviewed. Of the 13 cases treated during the 20-year period mechanism of primary injury was circumcision in 4, hypospadias repair in 6, priapism in 1, bladder exstrophy repair in 1 and penile carcinoma in 1. A variety of techniques were used for phallic reconstruction. Penile degloving, division of suspensory ligament and rotational skin flaps achieved penile augmentation and enhancement. Reasonable cosmesis and penile length were achieved in all cases. In indicated cases microsurgical phalloplasty was technically feasible. However long-term followup showed various complications including erosions from the use of a penile stiffener. The ultimate goal of reconstructive surgery is to have a penis with normal function and appearance. The management of penile injury requires a wide variety of surgical techniques that are tailored to the individual patient. Expedient penile reconstruction is successful and therapeutic delay is associated with complications.

  17. Epidemiology of worldwide spinal cord injury: a literature review

    Directory of Open Access Journals (Sweden)

    Kang Y

    2017-12-01

    Full Text Available Yi Kang,1,2,* Han Ding,1,2,* Hengxing Zhou,1,2 Zhijian Wei,1,2 Lu Liu,1,2 Dayu Pan,1,2 Shiqing Feng1,2 1Department of Orthopaedics, Tianjin Medical University General Hospital, 2Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, People’s Republic of China *These authors contributed equally to this work Study design: A literature review of worldwide epidemiology of spinal cord injury (SCI. Objectives: To review the epidemiological indicators of SCI, such as incidence, prevalence, demographic characteristics, etiology, level and severity of injury, complications and mortality. Setting: The Department of Orthopaedics, Tianjin Medical University General Hospital, ­Heping District, Tianjin, People’s Republic of China. Methods: We searched articles published in PubMed, Medline, EMBASE and the Web of ­Science between January 1993 and June 2017 using the key words “spinal cord injury”, “­traumatic spinal cord injury”, “non-traumatic spinal cord injury” and “epidemiology”. The incidence, etiology, prevalence, patient demographics, level and severity of injury, complications and mortality were reviewed from the articles. Results: The epidemiology of SCI has changed. Motor vehicle accidents and falls have become the most common reasons of injury gradually. Incidence of SCI varies by regions or countries, and it has gradually increased with the expansion of human activities. The number of male patients were significantly more than female, the average age of patients with SCI had a tendency to increase gradually. The cervical level of spine was the most common part of injury; there were more number of patients with tetraplegia than patients with paraplegia. Electrolyte disturbances, pulmonary infections, urinary tract infections and bedsores were the four most common complications. Conclusion: We must have a greater

  18. The effects of balneotherapy on disease activity, functional status, pulmonary function and quality of life in patients with ankylosing spondylitis.

    Science.gov (United States)

    Aydemir, Koray; Tok, Fatih; Peker, Fatma; Safaz, Ismail; Taskaynatan, Mehmet Ali; Ozgul, Ahmet

    2010-01-01

    This study aimed to determine the effects of balneotherapy on disease activity, functional status, metrology index, pulmonary function and quality of life in patients with ankylosing spondylitis (AS). The study included 28 patients (27 male and 1 female) diagnosed with AS according to modified New York criteria. The patients were treated with balneotherapy for 3 weeks (30 min/day, 5 days/week). The patients were evaluated using the global index, Bath ankylosing spondylitis disease activity index (BASDAI), disease functional index (BASFI), metrology index (BASMI), chest expansion measures, pulmonary function testing, and the medical outcomes study-short form-36 Health Survey (SF-36) (measure of quality of life) before balneotherapy and 1 month after treatment. Post balneotherapy BASDAI and global index decreased, BASMI parameters improved, chest expansion increased, and some SF-36 parameters improved; however, none of these changes were statistically significant (P > 0.05), except for the decrease in BASMI total score (P balneotherapy 6 patients had restrictive pulmonary disorder, according to pulmonary function test results. Pulmonary function test results in 3 (50%) patients were normalized following balneotherapy; however, as for the other index, balneotherapy did not significantly affect pulmonary function test results. The AS patients' symptoms, clinical findings, pulmonary function test results, and quality of life showed a trend to improve following balneotherapy, although without reaching significant differences. Comprehensive randomized controlled spa intervention studies with longer follow-up periods may be helpful in further delineating the therapeutic efficacy of balneotherapy in AS patients.

  19. Rehabilitation of muscle after injury - the role of anti-inflammatory drugs

    DEFF Research Database (Denmark)

    Mackey, Abigail; Mikkelsen, U R; Magnusson, S P

    2012-01-01

    junction, whereas contusion or overload injury can damage both myofibers and intramuscular connective tissue. The role of NSAIDs in muscle repair is complicated by differences in injury models used, variables evaluated, and time point(s) selected for evaluations. While the temporal pattern of the influence...

  20. Purely transvaginal/perineal management of complications from commercial prolapse kits using a new prostheses/grafts complication classification system.

    Science.gov (United States)

    Firoozi, Farzeen; Ingber, Michael S; Moore, Courtenay K; Vasavada, Sandip P; Rackley, Raymond R; Goldman, Howard B

    2012-05-01

    Commercial prolapse mesh kits are increasingly used in the management of pelvic organ prolapse. We present our experience with the transvaginal/perineal management of synthetic mesh related complications from prolapse kits. In addition, we used the new ICS/IUGA (International Continence Society/International Urogynecological Association) prostheses/grafts complication classification system to report on our contemporary series. A retrospective chart review of all patients who underwent surgical removal of transvaginal mesh for mesh related complications after prolapse kit use from November 2006 to April 2010 at 1 institution was performed. We report our contemporary series of mesh complications using the new ICS/IUGA prostheses/grafts complication classification system. Postoperative pain, degree of improvement and presence of continued symptoms were reported by patients at last followup. A total of 23 patients underwent transvaginal removal of mesh during the study period. Mean patient age was 61 years. Median period of latency to mesh related complication was 10 months (range 1 to 27). Indications for mesh removal included vaginal/pelvic pain (39%), dyspareunia (39%), vaginal mesh extrusion/exposure (26%), urinary incontinence (35%), recurrent pelvic organ prolapse (22%), bladder mesh perforation with recurrent urinary tract infection (22%), rectal mesh perforation (4%), ureteral perforation injury (4%), retained foreign body (surgical sponge) in the bladder (4%) and vesicovaginal fistula (9%), with most patients citing more than 1 reason. Although technically difficult in some cases, purely transvaginal mesh excision appears to be safe with resolution of almost all presenting symptoms. Although slightly cumbersome, the new ICS/IUGA prostheses/graft complication classification system can be used to report and more accurately characterize mesh complications. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc

  1. Acute respiratory distress syndrome assessment after traumatic brain injury

    Directory of Open Access Journals (Sweden)

    Shahrooz Kazemi

    2016-01-01

    Full Text Available Background: Acute respiratory distress syndrome (ARDS is one of the most important complications associated with traumatic brain injury (TBI. ARDS is caused by inflammation of the lungs and hypoxic damage with lung physiology abnormalities associated with acute respiratory distress syndrome. Aim of this study is to determine the epidemiology of ARDS and the prevalence of risk factors. Methods: This prospective study performed on patients with acute traumatic head injury hospitalization in the intensive care unit of the Shohaday-e Haftom-e-Tir Hospital (September 2012 to September 2013 done. About 12 months, the data were evaluated. Information including age, sex, education, employment, drug and alcohol addiction, were collected and analyzed. The inclusion criteria were head traumatic patients and exclusion was the patients with chest trauma. Questionnaire was designed with doctors supervision of neurosurgery. Then the collected data were analysis. Results: In this study, the incidence of ARDS was 23.8% and prevalence of metabolic acidosis was 31.4%. Most injury with metabolic acidosis was Subarachnoid hemorrhage (SAH 48 (60% and Subdural hemorrhage (SDH was Next Level with 39 (48% Correlation between Glasgow Coma Scale (GCS and Respiratory Distress Syndrome (ARDS were significantly decreased (P< 0.0001. The level of consciousness in patients with skull fractures significantly lower than those without fractures (P= 0.009 [(2.3±4.6 vs (4.02±7.07]. Prevalence of metabolic acidosis during hospitalization was 80 patients (31.4%. Conclusion: Acute respiratory distress syndrome is a common complication of traumatic brain injury. Management and treatment is essential to reduce the mortality. In this study it was found the age of patients with ARDS was higher than patients without complications. ARDS risk factor for high blood pressure was higher in men. Most victims were pedestrians. The most common injury associated with ARDS was SDH. Our analysis

  2. A ten-year study of penetrating injuries of the colon.

    Science.gov (United States)

    Adesanya, Adedoyin A; Ekanem, Ekanem E

    2004-12-01

    Colon injury has been associated with a high risk of septic complications and mortality. We prospectively studied the pattern, management, outcome, and prognostic factors in patients who sustained penetrating colon injuries. Sixty patients who presented to our hospital with penetrating colon injuries over a ten-year period (1992 to 2001) were studied. Colon wounds were caused by gunshots in 55 (91.7 percent) patients and knife stabs in 5 (8.3 percent). There was a delay of more than 12 hours before laparotomy in 30 (50 percent) patients. Moderate or major fecal contamination of the peritoneal cavity occurred in 58 (96.7 percent) patients. The average penetrating abdominal trauma index score was 25.9 and 20 (33.3 percent) patients sustained Flint Grade 3 colon injury. Associated intra-abdominal injuries occurred in the small bowel (73.3 percent), liver (25 percent), stomach (23.3 percent), and mesentery (16.7 percent). Right colon wounds (35) were managed by primary repair in 24 (68.6 percent) patients and proximal diverting colostomy in 11 (31.4 percent), whereas left colon wounds (25) were managed by diverting colostomy in 22 (88.0 percent) patients and primary repair in 3 (12.0 percent) patients. Common complications included wound infection (56.7 percent), septicemia (31.7 percent), and enterocutaneous fistula (16.7 percent). The overall mortality rate was 33.3 percent and colon injury-related mortality was 21.7 percent. Presence of destructive colon injury was associated with a greater than fourfold increased incidence of death. Other significant risk factors included shock on admission, major fecal contamination, duration of operation more than four hours, penetrating abdominal trauma index score >25, and more than two postoperative complications. There was no difference in outcome between patients who had primary repair and those undergoing diverting colostomy. Colostomy closure-related morbidity was 21 percent and mortality was 5.3 percent. A more liberal

  3. Influence of early neurological complications on clinical outcome following lung transplant.

    Science.gov (United States)

    Gamez, Josep; Salvado, Maria; Martinez-de La Ossa, Alejandro; Deu, Maria; Romero, Laura; Roman, Antonio; Sacanell, Judith; Laborda, Cesar; Rochera, Isabel; Nadal, Miriam; Carmona, Francesc; Santamarina, Estevo; Raguer, Nuria; Canela, Merce; Solé, Joan

    2017-01-01

    Neurological complications after lung transplantation are common. The full spectrum of neurological complications and their impact on clinical outcomes has not been extensively studied. We investigated the neurological incidence of complications, categorized according to whether they affected the central, peripheral or autonomic nervous systems, in a series of 109 patients undergoing lung transplantation at our center between January 1 2013 and December 31 2014. Fifty-one patients (46.8%) presented at least one neurological complication. Critical illness polyneuropathy-myopathy (31 cases) and phrenic nerve injury (26 cases) were the two most prevalent complications. These two neuromuscular complications lengthened hospital stays by a median period of 35.5 and 32.5 days respectively. However, neurological complications did not affect patients' survival. The real incidence of neurological complications among lung transplant recipients is probably underestimated. They usually appear in the first two months after surgery. Despite not affecting mortality, they do affect the mean length of hospital stay, and especially the time spent in the Intensive Care Unit. We found no risk factor for neurological complications except for long operating times, ischemic time and need for transfusion. It is necessary to develop programs for the prevention and early recognition of these complications, and the prevention of their precipitant and risk factors.

  4. Complications after pinning of supracondylar distal humerus fractures.

    Science.gov (United States)

    Bashyal, Ravi K; Chu, Jennifer Y; Schoenecker, Perry L; Dobbs, Matthew B; Luhmann, Scott J; Gordon, J Eric

    2009-01-01

    Supracondylar distal humerus fractures are one of the most common skeletal injuries in children. The current treatment of choice in North America is closed reduction and percutaneous pin fixation. Often surgeons leave the pins exposed beneath a cast but outside the skin. Great variation exists with respect to preoperative skin preparation, and perioperative antibiotic administration. Few data exist regarding the rate of infection and other complications. The purpose of this study is to review a large series of children to evaluate the rate of infection and other complications. A retrospective review was carried out of all patients treated at our institution over an 11-year period. A total of 622 patients were identified that were followed for a minimum of 2 weeks after pin removal. Seventeen patients had flexion-type fractures, 294 had type II fractures, and 311 had type III fractures. Seventy-four fractures (11.9%) had preoperative nerve deficits with anterior interosseous palsies being the most common (33 fractures, 5.3%). Preoperative antibiotics were given to 163 patients (26.2%). Spray and towel draping were used in 362 patients, paint and towel draping were used in 65 patients, alcohol paint and towel draping were used in 146 patients, and a full preparation and draping were used in 13 patients. The pins were left exposed under the cast in 591 fractures (95%), and buried beneath the skin in 31 fractures (5.0%). A medial pin was placed in 311 fractures with a small incision made to aid placement in 18 of these cases. The most common complication was pin migration necessitating unexpected return to the operating room for pin removal in 11 patients (1.8%). One patient developed a deep infection with septic arthritis and osteomyelitis (0.2%). Five additional patients had superficial skin infections and were treated with oral antibiotics for a total infection rate of 6 of 622 patients (1.0%). One patient ultimately had a malunion and 4 others returned to the

  5. Understanding limitations in at-work productivity in patients with active ankylosing spondylitis: the role of work-related contextual factors.

    Science.gov (United States)

    Boonen, Annelies; Boone, Caroline; Albert, Adelin; Mielants, Herman

    2015-01-01

    To explore the effect of health-related and contextual factors on presenteeism, absenteeism, and overall work productivity loss in patients with active ankylosing spondylitis (AS). Consecutive patients with AS starting their first tumor necrosis factor inhibitor and in paid employment were eligible. Patients completed the Work Productivity and Activity Impairment (WPAI) questionnaire for AS to assess presenteeism, absenteeism, and overall work productivity loss in the previous 7 days. In addition, they answered questions about work characteristics (type, characteristics of workplace, satisfaction of contacts with colleagues, and importance of work in life) and health status [Bath AS Functional Index (BASFI), AS Disease Activity Score-C-reactive protein (ASDAS-CRP)]. Physicians assessed the Bath Ankylosing Spondylitis Metrology Index, presence of articular and extraarticular manifestations, comorbidities, and laboratory indicators of inflammation. Stepwise regression models were computed to determine which work-related and health-related factors contributed to WPAI outcomes. The study included 80 patients. The WPAI presenteeism, absenteeism, and overall work productivity loss scores were 49.1%, 30.2%, and 53.1%, respectively. Presenteeism was associated with higher BASFI, female sex, and poor quality of contact with colleagues. Absenteeism was associated with increasing age, current smoking status, higher ASDAS-CRP, and low importance of work for life. Overall work productivity loss was associated with female sex, higher BASFI, past adaptation of job because of illness, number of working hours, and manual profession. Both health-related and contextual factors contribute to work limitations in patients with AS and suggest additional opportunities for improvement by addressing the working environment.

  6. Neurological complications following liver transplant: a pictorial review of radiological and clinical findings

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Young Kyung; Shin, Ji Hoon; Kim, Sang Joon; Lee, Deok Hee; Lee, Ho Kyu; Choi, Choong Gon; Suh, Dae Chul [University of Ulsan College of Medicine, Seoul (Korea, Republic of)

    2005-07-15

    Neurological complications are a rare but important and significant source of information about morbidity and mortality in liver transplant patients. Based on the clinical and radiological findings of 21 patients, neurological complications were categorized into five main groups; focal hemorrhagic or occlusive complications (n=11); diffuse hypoxic-ischemic injury (n=3); hypertensive encephalopathy (n=1); central pontine or extra-pontine myelinolysis (n=4); and infection (n=2). Neurological manifestations varied according to the location of the lesion, although seizures were the most common manifestation. In this pictorial review, we illustrate the radiological findings, focusing on MR and CT images, of a spectrum of neurological complications following liver transplants, as well as their clinical correlations.

  7. Neurological complications following liver transplant: a pictorial review of radiological and clinical findings

    International Nuclear Information System (INIS)

    Lee, Young Kyung; Shin, Ji Hoon; Kim, Sang Joon; Lee, Deok Hee; Lee, Ho Kyu; Choi, Choong Gon; Suh, Dae Chul

    2005-01-01

    Neurological complications are a rare but important and significant source of information about morbidity and mortality in liver transplant patients. Based on the clinical and radiological findings of 21 patients, neurological complications were categorized into five main groups; focal hemorrhagic or occlusive complications (n=11); diffuse hypoxic-ischemic injury (n=3); hypertensive encephalopathy (n=1); central pontine or extra-pontine myelinolysis (n=4); and infection (n=2). Neurological manifestations varied according to the location of the lesion, although seizures were the most common manifestation. In this pictorial review, we illustrate the radiological findings, focusing on MR and CT images, of a spectrum of neurological complications following liver transplants, as well as their clinical correlations

  8. Tightrope fixation of ankle syndesmosis injuries: clinical outcome, complications and technique modification.

    LENUS (Irish Health Repository)

    Naqvi, Gohar A

    2012-06-01

    Ankle syndesmotic injuries are complex and require anatomic reduction and fixation. Tightrope fixation is a relatively new technique and we present the largest series of syndesmosis fixation using Arthrex Tightrope™ (Naples, FL, USA).

  9. The relationship between disease activity, quality of life, and personality types in rheumatoid arthritis and ankylosing spondylitis patients.

    Science.gov (United States)

    Donisan, T; Bojincă, V C; Dobrin, M A; Bălănescu, D V; Predețeanu, D; Bojincă, M; Berghea, F; Opriș, D; Groșeanu, L; Borangiu, A; Constantinescu, C L; Ionescu, R; Bălănescu, A R

    2017-07-01

    We hypothesized that clinical outcomes might be influenced by personality type (A, B, C, D) in rheumatoid arthritis (RA) and ankylosing spondylitis (AS). One hundred ninety-four patients (104 with RA, 90 with AS) participated in a questionnaire study. We evaluated health-related quality of life (HRQoL) using the Medical Outcome Study Short-Form 36 (SF-36), personality type A/B with the Jenkins Activity Survey, type C with the State-Trait Anger Expression Inventory Anger-in Scale, type D with the Type D Personality Scale, and disease activity with Disease Activity Score with 28 joints for RA and Bath Ankylosing Spondylitis Disease Activity Index for AS. We used Pearson's correlation coefficient, independent samples t tests, and multivariate analyses of variance. In the RA group, type D personality was significantly correlated with 7/12 SF-36 components. AS patients with type D personality had deficits in all SF-36 subscales. Type D was related with higher disease activity in RA and AS. Both RA and AS type C patients had more active disease forms and negatively affected HRQoL subscales. In the RA group, type A personality did not correlate with HRQoL, but it positively influenced pain visual analog scale scores. In AS patients, type A personality was linked with higher HRQoL and with less active disease. Type C and type D personality types were correlated with decreased HRQoL and higher disease activity in RA and AS patients. Type A personality was associated with less active disease and higher HRQoL in AS patients and with less pain in RA patients.

  10. Concomitant injuries are an important determinant of outcome of high-grade blunt hepatic trauma.

    Science.gov (United States)

    Schnüriger, B; Inderbitzin, D; Schafer, M; Kickuth, R; Exadaktylos, A; Candinas, D

    2009-01-01

    Little is known about the clinical importance of concomitant injuries in polytraumatized patients with high-grade blunt liver injury. A retrospective single-centre study was performed to investigate the safety of non-operative management of liver injury and the impact of concomitant intra- and extra-abdominal injuries on clinical outcome. Some 183 patients with blunt liver injury were admitted to Berne University Hospital, Switzerland, between January 2000 and December 2006. Grade 3-5 injuries were considered to be high grade. Immediate laparotomy was required by 35 patients (19.1 per cent), owing to extrahepatic intra-abdominal injury (splenic and vascular injuries, perforations) in 21 cases. The mortality rate was 16.9 per cent; 22 of the 31 deaths were due to concomitant lesions. Of 81 patients with high-grade liver injury, 63 (78 per cent) were managed without surgery; liver-related and extra-abdominal complication rates in these patients were 11 and 17 per cent respectively. Grades 4 and 5 liver injury were associated with hepatic-related and extra-abdominal complications. Concomitant injuries are a major determinant of outcome in patients with blunt hepatic injury and should be given high priority by trauma surgeons. An algorithm for the management of blunt liver injury is proposed. Copyright (c) 2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

  11. What factors determine patients' preference for tumour necrosis factor inhibitors in ankylosing spondylitis?

    Science.gov (United States)

    Fajri, Dessy W; Brand, Caroline A; Dharmage, Shyamali C; Martin, Belinda J; Buchanan, Russell R C; Schachna, Lionel

    2009-05-01

    Tumour necrosis factor inhibitor (TNFi) therapy, either intravenous (IV) or subcutaneous (SQ), demonstrates similar efficacy in ankylosing spondylitis (AS). The objective of this study was to examine factors influencing patient preference of TNFi. Fifty-nine (79.7%) participants were male with mean age 43.9 years and disease duration of 22.0 years. Fifty-nine patients (79.7%) agreed with the statement 'My doctor gave me a choice and I made a decision based on my personal preference'. Patients commenced first on IV TNFi most commonly cited reduced frequency of injections (96.6%), administration by a trained professional (89.7%) and use of infusion time for leisure activities (86.2%). Patients commenced on SQ TNFi cited flexibility with timing of treatment (80%), shortened administration time (73.3%) and the convenience of home therapy (73.3%). Shared clinical decision-making between clinicians and patients may be desirable for AS patients commencing TNFi therapy.

  12. Intravitreal Triamcinolone Acetonide for Macular Edema in HLA-B27 Negative Ankylosing Spondylitis

    Directory of Open Access Journals (Sweden)

    M.M. Moschos

    2010-12-01

    Full Text Available We report a case of a human leukocyte antigen B27 (HLA-B27-negative patient with cystoid macular edema (CME and ankylosing spondylitis (AS after treatment with triamcinolone acetonide. The patient complained of deterioration of visual acuity of the right eye during the last 10 days. At presentation visual acuity of the right eye was 0.2, and the ophthalmic examination did not reveal any sign of active uveitis. Fluorescein angiography (FA and ocular coherent tomography (OCT showed CME. The left eye was normal with a visual acuity of 0.9. Eight weeks after intravitreal injection of triamcinolone acetonide, visual acuity improved to 0.8 and OCT revealed regression of macular edema. Six months later no recurrence was observed. Our case report indicates for the first time that CME may occur in AS independently of the presence of HLA-B27 and intraocular inflammation. Intravitreal use of triamcinolone acetonide can reduce macular edema and restore visual acuity.

  13. Hepatic arterial pseudoaneurysm: a rare complication of blunt abdominal trauma in children

    Energy Technology Data Exchange (ETDEWEB)

    Basile, K.E.; Sivit, C.J.; Sachs, P.B. [Department of Radiology, Rainbow Babies and Children`s Hospital of the University Hospitals of Cleveland, OH (United States); Stallion, A. [Department of Surgery, Rainbow Babies` and Children`s Hospital of the University Hospitals of Cleveland, OH (United States)

    1999-05-01

    We report a child who developed a hepatic artery pseudoaneurysm following blunt hepatic injury. This is a rare complication of hepatic trauma in children. The imaging evaluation and clinical management of hepatic artery pseudoaneurysms are presented. (orig.) With 3 figs., 8 refs.

  14. Physical Activity and Exercise: Perspectives of Adults With Ankylosing Spondylitis.

    Science.gov (United States)

    O'Dwyer, Tom; McGowan, Emer; O'Shea, Finbar; Wilson, Fiona

    2016-05-01

    Exercise is a key component of the management of ankylosing spondylitis (AS). Despite numerous benefits, compliance with exercise programs is low. Little attention has been accorded to the experiences of individuals with AS toward physical activity (PA). This study aimed to explore the attitudes toward PA and exercise of adults with AS. A qualitative descriptive design using thematic analysis was used. Seventeen adults with AS participated in individual, semistructured interviews. Interviews were recorded, transcribed, coded and analyzed for themes and subthemes. Four themes emerged from the analysis: (1) benefits, (2) barriers, (3) motivation, and (4) strategies and enablers. Benefits included amelioration of symptoms, improvements in general health, and enhancement of quality of life. Subthemes of barriers to PA included lack of resources, negative attitudes to exercise, misinformation, and condition-related factors. Motivation to exercise was influenced by intrinsic and extrinsic factors. Participants proposed strategies to enhance PA participation and exercise engagement. Awareness of the benefits of PA appears insufficient to motivate individuals with AS to exercise; a number of factors influence individual motivation to exercise. Many perceived barriers to PA may be considered modifiable. Individually-tailored interventions, collaboratively developed by the individual and the healthcare professionals, were proposed as strategies for effective PA and exercise prescription.

  15. Effects of Glossopharyngeal Insufflation in Ankylosing Spondylitis: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Nina Brodin

    2014-01-01

    Full Text Available In Ankylosing Spondylitis (AS, thoracic range of motion is often greatly limited. The objective of the study was to describe the effects of 12 weeks of Glossopharyngeal Insufflation (GI training in patients with AS. Dynamic spirometry included vital capacity, forced expiratory volume, and peak expiratory flow. Thoracic and lumbar range of motion was assessed by tragus-to-wall distance, modified Schober test, and tape measure. Disease activity, activity limitation, and health perception were assessed using the BAS-Indices, and tension in the thoracic region during GI was assessed using the Borg CR-10 scale. Adherence to training was recorded in an activity log, along with any remarks on the training. Ten patients were recruited and six male patients fulfilled the study protocol. Three patients were able to learn GI by exceeding their maximal vital capacity with 5% using GI. A significant increase in thoracic range of motion both on costae IV (P=0.04 and at the level of the xiphoid process (P=0.04 was seen. Thus, patients with AS can practice GI, it is safe if maximal exertion is avoided, and patients with some mobility in the chest can increase their lung function substantially by performing GI during 12 weeks.

  16. Pleural puncture with thoracic epidural: A rare complication?

    Directory of Open Access Journals (Sweden)

    Rachna Wadhwa

    2011-01-01

    Full Text Available Freedom from pain has almost developed to be a fundamental human right. Providing pain relief via epidural catheters in thoracic and upper abdominal surgeries is widely accepted. Pain relief through this technique not only provides continuous analgesia but also reduces post-operative pulmonary complications and also hastens recovery. But being a blind procedure it is accompanied by certain complications. Hypotension, dura puncture, high epidural, total spinal, epidural haematoma, spinal cord injury and infection are some of the documented side effects of epidural block. There are case reports eliciting neurological complications, catheter site infections, paresthesias, radicular symptoms and worsening of previous neurological conditions. Few technical problems related to breakage of epidural catheter are also mentioned in the literature. The patient had no sequelae on long term follow up even when a portion of catheter was retained. We present a case report where epidural catheter punctured pleura in a patient undergoing thoracotomy for carcinoma oesophagus.

  17. A Four-Year Monocentric Study of the Complications of Third Molars Extractions under General Anesthesia: About 2112 Patients

    Directory of Open Access Journals (Sweden)

    A. Guerrouani

    2013-01-01

    Full Text Available Introduction. The aim of this study was to assess the complications resulting from third molar extraction under general anesthesia. Material and Methods. The retrospective study included all patients who underwent impacted third molars extraction from January 2008 until December 2011. 7659 third molars were extracted for 2112 patients. Postoperative complications were retrieved from medical files. Results. No complications were related to general anesthesia. The most frequent postoperative complication was infection (7.15%. Lingual nerve injuries affected 1.8% of the patients. All of them were transient and were not related to tooth section. Inferior alveolar nerve injuries were reported in 0.4% of the cases. 95.8% of these patients were admitted for one-day ambulatory care, and only two patients were readmitted after discharge from hospital. Discussion. This surgical technique offers comfort for both surgeons and patients. Risks are only linked to the surgical procedure as we observed no complication resulting from general anesthesia. One-day hospitalization offers a good balance between comfort, security, and cost. The incidence of complications is in agreement with the literature data, especially regarding pain, edema, and infectious and nervous complications. It is of utmost importance to discuss indications with patients, and to provide them with clear information.

  18. Vascular complications of prosthetic inter-vertebral discs.

    Science.gov (United States)

    Daly, Kevin J; Ross, E Raymond S; Norris, Heather; McCollum, Charles N

    2006-10-01

    Five consecutive cases of prosthetic inter-vertebral disc displacement with severe vascular complications on revisional surgery are described. The objective of this case report is to warn spinal surgeons that major vascular complications are likely with anterior displacement of inter-vertebral discs. We have not been able to find a previous report on vascular complications associated with anterior displacement of prosthetic inter-vertebral discs. In all five patients the prosthetic disc had eroded into the bifurcation of the inferior vena cava and the left common iliac vein. In three cases the aortic bifurcation was also involved. The fibrosis was so severe that dissecting out the arteries and veins to provide access to the relevant disc proved impossible. Formal division of the left common iliac vein and artery with subsequent repair was our solution. Anterior inter-vertebral disc displacement was associated with severe vascular injury. Preventing anterior disc displacement is essential in disc design. In the event of anterior displacement, disc removal should be planned with a Vascular Surgeon.

  19. Acute kidney injury in symptomatic primary Epstein-Barr virus infectious mononucleosis: Systematic review.

    Science.gov (United States)

    Moretti, Milena; Lava, Sebastiano A G; Zgraggen, Lorenzo; Simonetti, Giacomo D; Kottanattu, Lisa; Bianchetti, Mario G; Milani, Gregorio P

    2017-06-01

    Textbooks and reviews do not mention the association of symptomatic primary Epstein-Barr virus infectious mononucleosis with acute kidney injury in subjects without immunodeficiency or autoimmunity. Stimulated by our experience with two cases, we performed a review of the literature. The literature documents 38 cases (26 male and 12 female individuals ranging in age from 0.3 to 51, median 18 years) of symptomatic primary Epstein-Barr virus infectious mononucleosis complicated by acute kidney injury: 27 acute interstitial nephritides, 1 jaundice-associated nephropathy, 7 myositides and 3 hemolytic uremic syndromes. Acute kidney injury requiring renal replacement therapy was observed in 18 (47%) cases. Acute kidney injury did not resolve in one patient with acute interstitial nephritis. Two patients died because of systemic complications. The remaining 35 cases fully recovered. In individuals with acute symptomatic Epstein-Barr virus infectious mononucleosis, a relevant kidney injury is rare but the outcome potentially fatal. It results from interstitial nephritis, myositis-associated acute kidney injury, hemolytic uremic syndrome or jaundice-associated nephropathy. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. ATTEMPT OF OVERCOMING SECONDARY INEFFECTIVENESS OF INFLIXIMAB IN A PATIENT WITH ANKYLOSING SPONDYLITIS USING PLASMAPHERESIS (A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Oksana Alekseyevna Rumyantseva

    2013-01-01

    Full Text Available The article focuses on the problem of secondary ineffectiveness of tumor necrosis factor α infliximab (INF and describes an attempt of using plasmapheresis (PF to eliminate this problem in a patient with ankylosing spondylitis who had received INF treatment at a dose of 5 mg/kg for a long time (over 4 years. After PF, the IFF therapy ensured a long-term clinical and laboratory improvement of patient's condition. One can assume that PF made it possible to overcome secondary ineffectiveness of INF and can be used in some patients in cases when INF cannot be replaced with another TNFα inhibitor.

  1. Radionuclide assessment of heterotopic ossification in spinal cord injury patients

    International Nuclear Information System (INIS)

    Prakash, V.

    1983-01-01

    Whole body /sup 99m/T-pyrophosphate bone scans were obtained and correlated with skeletal radiographs for detection of heterotopic ossification in 135 spinal injury patients. There were 40 patients with recent injury (less than 6 months) and 95 with injury of over 6 months duration. Heterotopic new bone was detected on the bone scan in 33.7% of 95 patients with spinal cord injuries of more than 6 months duration and 30% of 40 patients with injuries of less than 6 months. The radionuclide scan was found to be useful in detection of heterotopic ossification at its early stage and in its differentiation from other complications in spinal cord injury patients

  2. Hepatic arterial embolization in the management of blunt hepatic trauma: indications and complications.

    Science.gov (United States)

    Letoublon, Christian; Morra, Irene; Chen, Yao; Monnin, Valerie; Voirin, David; Arvieux, Catherine

    2011-05-01

    The objective was to clarify the role of hepatic arterial embolization (AE) in the management of blunt hepatic trauma. Retrospective observational study of 183 patients with blunt hepatic trauma admitted to a trauma referral center over a 9-year period. The charts of 29 patients (16%) who underwent hepatic angiography were reviewed for demographics, injury specific data, management strategy, angiographic indication, efficacy and complications of embolization, and outcome. AE was performed in 23 (79%) of the patients requiring angiography. Thirteen patients managed conservatively underwent emergency embolization after preliminary computed tomography scan. Six had postoperative embolization after damage control laparotomy and four had delayed embolization. Arterial bleeding was controlled in all the cases. Sixteen patients (70%) had one or more liver-related complications; temporary biliary leak (n=11), intra-abdominal hypertension (n=14), inflammatory peritonitis (n=3), hepatic necrosis (n=3), gallbladder infarction (n=2), and compressive subcapsular hematoma (n=1). Unrecognized hepatic necrosis could have contributed to the late posttraumatic death of one patient. AE is a key element in modern management of high-grade liver injuries. Two principal indications exist in the acute postinjury phase: primary hemostatic control in hemodynamically stable or stabilized patients with radiologic computed tomography evidence of active arterial bleeding and adjunctive hemostatic control in patients with uncontrolled suspected arterial bleeding despite emergency laparotomy. Successful management of injuries of grade III upward often entails a combined angiographic and surgical approach. Awareness of the ischemic complications due to angioembolization is important.

  3. Missile injuries of the brain

    International Nuclear Information System (INIS)

    Kazmi, S.A.M.; Ashraf, A.T.; Qureshi, N.A.

    2001-01-01

    Data was analyzed relating to a consecutive series of 16 patients of penetrating brain injuries received at forward defense lines. Characteristics studied were the cause of injury, level of consciousness and various neurological deficits presented on initial examination, CT scan findings, the surgical procedures performed and the final outcome after one year of follow-up. One out of 16 patients, died due to severe associated injuries to abdominal viscera and major vessels. Meningitis occurred in one patient during the immediate postoperative period. All patients with motor weakness speech deficits and incontinence showed significant improvement. Hearing loss of one ear persisted in one patient. Two patients developed delayed onset seizures. It is concluded that, patients with penetrating brain injuries should be evacuated to the tertiary care neurosurgical centres as soon as possible. In operation only obviously necrotic brain and easily accessible metal and bone pieces should be removed. There is no need to explore the normal brain as it would only result in increased neurological deficits. The patients with such injuries should receive broad-spectrum antibiotics to prevent the infective complications. (author)

  4. The Link between Ankylosing Spondylitis, Crohn’s Disease, Klebsiella, and Starch Consumption

    Directory of Open Access Journals (Sweden)

    Taha Rashid

    2013-01-01

    Full Text Available Both ankylosing spondylitis (AS and Crohn’s disease (CD are chronic and potentially disabling interrelated conditions, which have been included under the group of spondyloarthropathies. The results of a large number of studies support the idea that an enteropathic pathogen, Klebsiella pneumoniae, is the most likely triggering factor involved in the initiation and development of these diseases. Increased starch consumptions by genetically susceptible individuals such as those possessing HLA-B27 allelotypes could trigger the disease in both AS and CD by enhancing the growth and perpetuation of the Klebsiella microbes in the bowel. Exposure to increased levels of these microbes will lead to the production of elevated levels of anti-Klebsiella antibodies as well as autoantibodies against cross-reactive self-antigens with resultant pathological lesions in the bowel and joints. Hence, a decrease of starch-containing products in the daily dietary intake could have a beneficial therapeutic effect on the disease especially when used in conjunction with the currently available medical therapies in the treatment of patients with AS and CD.

  5. Chronic Periodontitis Is Associated With Spinal Dysmobility in Patients With Ankylosing Spondylitis.

    Science.gov (United States)

    Kang, Eun Ha; Lee, Jung Tae; Lee, Hyo-Jung; Lee, Joo Youn; Chang, Sung Hae; Cho, Hyon Joung; Choi, Byoong Yong; Ha, You-Jung; Park, Kyoung Un; Song, Yeong Wook; Van Dyke, Thomas E; Lee, Yun Jong

    2015-12-01

    Although microbes have been suggested to play a role in the pathogenesis of ankylosing spondylitis (AS), several studies present contradictory results regarding the association between AS and chronic periodontitis (CP). Clinical, laboratory, and medication data were collected from 84 patients with AS and 84 age- and sex-matched controls. Periodontal measurements, including probing depths (PDs), clinical attachment loss (AL), serum anti-Porphyromonas gingivalis titers, and the detection of P. gingivalis DNA in gingival crevicular fluid, were recorded. All participants with periodontitis with PD ≥4 to periodontitis with PD of ≥4 to periodontal treatment, PD and AL levels were improved in both groups, but the change was significantly greater in patients with AS than in controls. Patients with AS receiving anti-TNF-α agents exhibited a greater improvement in PD and AL than those who did not. Although AS was not associated with the presence of CP, CP was associated positively with the severity of spinal dysmobility in Korean patients with AS. These results suggest that periodontitis can have a negative effect on axial movement in AS.

  6. Surgical intervention for paediatric liver injuries is almost history - a 12-year cohort from a major Scandinavian trauma centre.

    Science.gov (United States)

    Koyama, Tomohide; Skattum, Jorunn; Engelsen, Peder; Eken, Torsten; Gaarder, Christine; Naess, Pål Aksel

    2016-11-29

    Although nonoperative management (NOM) has become standard care, optimal treatment of liver injuries in children is still challenging since many of these patients have multiple injuries. Moreover, the role of angiography remains poorly defined, and a high index of suspicion of complications is warranted. This study reviews treatment and outcomes in children with liver injuries at a major Scandinavian trauma centre over a 12-year period. Patients trauma registry and medical records. A total of 66 children were included. The majority was severely injured as reflected by a median injury severity score of 20.5 (mean 22.2). NOM was attempted in 60 (90.9%) patients and was successful in 57, resulting in a NOM success rate of 95.0% [95% CI 89.3 to 100]. Only one of the three NOM failures was liver related, occurred in the early part of the study period, and consisted in operative placement of drains for bile leak. Two (3.0%) patients underwent angiographic embolization (AE). Complications occurred in 18 (27.3% [95 % CI 16.2 to 38.3]) patients. Only 2 (3.0%) patients had liver related complications, in both cases bile leak. Six (9.1%) patients underwent therapeutic laparotomy for non-liver related injuries. Two (3.0%) patients died secondary to traumatic brain injury. This single institution paediatric liver injury cohort confirms high attempted NOM and NOM success rates even in patients with high grade injuries and multiple accompanying injuries. AE can be a useful NOM adjunct in the treatment of paediatric liver injuries, but is seldom indicated. Moreover, bile leak is the most common liver-related complication and the need for liver-related surgery is very infrequent. NOM is the treatment of choice in almost all liver injuries in children, with operative management and interventional radiology very infrequently indicated.

  7. Thoracostomy tubes: A comprehensive review of complications and related topics

    Science.gov (United States)

    Kwiatt, Michael; Tarbox, Abigail; Seamon, Mark J.; Swaroop, Mamta; Cipolla, James; Allen, Charles; Hallenbeck, Stacinoel; Davido, H. Tracy; Lindsey, David E.; Doraiswamy, Vijay A.; Galwankar, Sagar; Tulman, David; Latchana, Nicholas; Papadimos, Thomas J.; Cook, Charles H.; Stawicki, Stanislaw P.

    2014-01-01

    Tube thoracostomy (TT) placement belongs among the most commonly performed procedures. Despite many benefits of TT drainage, potential for significant morbidity and mortality exists. Abdominal or thoracic injury, fistula formation and vascular trauma are among the most serious, but more common complications such as recurrent pneumothorax, insertion site infection and nonfunctioning or malpositioned TT also represent a significant source of morbidity and treatment cost. Awareness of potential complications and familiarity with associated preventive, diagnostic and treatment strategies are fundamental to satisfactory patient outcomes. This review focuses on chest tube complications and related topics, with emphasis on prevention and problem-oriented approaches to diagnosis and treatment. The authors hope that this manuscript will serve as a valuable foundation for those who wish to become adept at the management of chest tubes. PMID:25024942

  8. Work Productivity and Costs Related to Patients with Ankylosing Spondylitis, Rheumatoid Arthritis, and Psoriasis.

    Science.gov (United States)

    Kruntorádová, Klára; Klimeš, Jiří; Šedová, Liliana; Štolfa, Jiří; Doležal, Tomáš; Petříková, Alena

    2014-09-01

    To determine and compare the impact of rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriasis on work productivity, to calculate the productivity costs (PC), and to map out factors that influence (functional status and disease activity) work productivity. The Work Productivity and Activity Impairment questionnaire was used to evaluate productivity losses of patients with RA (n = 77), AS (n = 230), and psoriasis (n = 93). Demographic data, patient-reported outcomes (PROs) (Health Assessment Questionnaire [HAQ] and Bath Ankylosing Spondylitis Disease Activity Index [BASDAI]), and clinical parameters (Disease Activity Score in 28 joints [DAS28], body surface area [BSA], and Psoriasis Area and Severity Index [PASI]) were collected. The correlations among PROs, clinical parameters, and overall productivity loss were examined, and multiple regression models were used to examine relationships among parameters and productivity loss. PC were calculated using the friction cost approach. Mean patient age and disease duration were 47.1 and 15.7 years, respectively. The mean HAQ and DAS28 in patients with RA were 1.22 and 5.6, respectively. The mean BASDAI score in patients with AS was 4.43. The mean BSA and PASI score in patients with psoriasis were 21.1% and 12.9, respectively. The percentage of patients with psoriatic arthritis (in those with psoriasis) was 24.7%. We did not find significant differences in Work Productivity and Activity Impairment domains among various diagnoses. Patients with AS, RA, and psoriasis reported overall work productivity losses of 40.9%, 42.9%, and 42.8%, respectively. Daily activity impairments were approximately 50.0%. Overall work productivity loss strongly correlated with PROs, whereas correlations with clinical parameters were weak. The HAQ and BASDAI were identified as major predictors of productivity impairment. The greatest loss in productivity was in those with psoriatic arthritis; however, it was not significant. In

  9. Complications after radiation therapy for cervical carcinoma

    International Nuclear Information System (INIS)

    Saitoh, Masataka

    1981-01-01

    From 1966 to 1973, 215 patients with cervical cancer were treated at the Department of Obstetrics and Gynecology, School of Medicine, Iwate Medical University. The patients were divided into two groups. In the first group, 123 patients were treated by external radiation with Tele- 60 Co plus radium insertions (1966-1970). In the second group, 83 patients were treated with linear accelerator plus cesium insertions (1970-1973). The results on both of 5-year survival rate and appearance of radiation injuries were compared with two groups. There was no significant difference in the cure rate between those of groups. The incidence of pigmentation, edema and diarrhea (early complications) was higher and the diarrhea continued significantly longer in the second group. The incidence of rectal ulcer and rectostenosis (later complications) was significantly higher than former group. A study was made to lean the reason for the significant higher occurrence of rectal ulcer and rectostenosis. As a result, it was determined that later complication was more emphasized especially by ret dose given intracavitary radiation. In addition, it is thought that the dose rate, the dose volume and natural history such as the patients' age are also related to the severity of the complication. (J.P.N.)

  10. Complications after radiation therapy for cervical carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Saitoh, M. (Iwate Medical Coll., Morioka (Japan). School of Medicine)

    1981-04-01

    From 1966 to 1973, 215 patients with cervical cancer were treated at the Department of Obstetrics and Gynecology, School of Medicine, Iwate Medical University. The patients were divided into two groups. In the first group, 123 patients were treated by external radiation with Tele-/sup 60/Co plus radium insertions (1966-1970). In the second group, 83 patients were treated with linear accelerator plus cesium insertions (1970-1973). The results on both of 5-year survival rate and appearance of radiation injuries were compared with in the two groups. There was no significant difference in the cure rate between those groups. The incidence of pigmentation, edema and diarrhea (early complications) was higher and the diarrhea continued significantly longer in the second group. The incidence of rectal ulcer and rectostenosis (later complications) was significantly higher than former group. A study was made to learn the reason for the significantly higher occurrence of rectal ulcer and rectostenosis. As a result, it was determined that later complication was more emphasized especially by dose rate of intracavitary irradiation. In addition, it is thought that the dose rate, the dose volume and natural history such as the patients' age are also related to the severity of the complications.

  11. Popliteal artery injury during posterior cruciate ligament reconstruction

    Directory of Open Access Journals (Sweden)

    Marcos Henrique Frauendorf Cenni

    2015-06-01

    Full Text Available This study reports a case of popliteal artery injury during arthroscopic reconstruction of the posterior cruciate ligament. The evolution of the injury is described and comments are made regarding the anatomy of this artery and potential risks of this surgical technique. This study had the aims of alerting the medical community, especially knee surgeons, regarding a severe surgical complication and discussing the ways of preventing it.

  12. Posterior sternoclavicular dislocation: an American football injury

    DEFF Research Database (Denmark)

    Marker, L B; Klareskov, B

    1996-01-01

    Posterior dislocation of the sternoclavicular joint is uncommon, accounting for less than 0.1% of all dislocations. Since 1824 a little more than 100 cases have been reported, and the majority in the past 20 years. A review of published reports suggests that this injury is seen particularly in co...... in connection with American football. A typical case is described. The importance of this injury is that there is often a delay in diagnosis with potentially serious complications....

  13. Bleeding complication with the TVT-Exact procedure: a report of two cases.

    Science.gov (United States)

    Masata, Jaromir; Svabik, Kamil; Martan, Alois

    2015-02-01

    Midurethral tension-free vaginal tapes (TVT), placed through the retropubic space or through the obturator foramina, are widely used for the surgical treatment of female stress urinary incontinence. Some complications are associated with retropubic tapes owing to the passage of the tape through the space of Retzius. One of the most frequent complications is bleeding, and if injury to major vessels is involved, this may be life-threatening. In 2010, the Gynecare TVT-Exact® Continence System was introduced onto the market, with a rigid trocar shaft measuring 3.0 mm in diameter. We have no clinical data regarding the complication rate, especially concerning bleeding, connected with this device; all data are related to the original size of the TVT inserter. The cases presented demonstrate that bleeding complications can occur with the TVT-Exact procedure.

  14. Surgical management of radiation injury to the small intestine

    Energy Technology Data Exchange (ETDEWEB)

    Swan, R.W.; Fowler, W.C. Jr., Boronow, R.C.

    1976-01-01

    Severe injury of the small intestine represents one of the most tragic complications of radiation of the pelvis and abdomen. Not uncommonly, patients die from the radiation or the treatment of its intestinal complications. More commonly, patients become intestinal cripples, secondary to chronic partial obstruction of the small intestine and malnutrition associated with the stagnant loop syndrome, as previously reported by one of us. Management results have been discouraging, usually because of a general lack of clinical recognition and understanding of radiation injury to the intestine. Medical management has not been satisfactory. It may provide temporary relief from symptoms, but not long-lasting. Surgical management, although frequently curative, has been associated with high death and morbidity rates. Many surgical procedures have been used in treating radiation injury to the small intestine. Generally, these fall into two categories: first, intestinal resection with primary anastomosis; and second, enteroenteric or enterocolic bypass. In the literature are reflected advocates for each method of surgical management.

  15. Fingertip injuries: an update on management.

    Science.gov (United States)

    Lee, Donald H; Mignemi, Megan E; Crosby, Samuel N

    2013-12-01

    Injuries to the fingertip are common. The goal of treatment is restoration of a painless, functional digit with protective sensation. The amount of soft-tissue loss, the integrity of the nail bed, and the age and physical demands of the patient should be considered when selecting a treatment method. Some new products are effective for management of injuries to the fingertip. The use of 2-octylcyanoacrylate for nail bed repair is faster than suture repair, with equivalent results reported. Dermal regeneration template is effective for coverage of digital injuries with exposed tendons or bones that lack peritenon or periosteum. Although fingertip replantation offers better functional results than does revision amputation, replantation is more technically demanding and requires longer recovery time. Complications associated with management of injuries to the fingertip include nail deformities, insensate digits, and painful neuromas.

  16. Increased Intracranial Pressure during Hemodialysis in a Patient with Anoxic Brain Injury

    DEFF Research Database (Denmark)

    Lund, Anton; Damholt, Mette B; Strange, Ditte G

    2017-01-01

    Dialysis disequilibrium syndrome (DDS) is a serious neurological complication of hemodialysis, and patients with acute brain injury are at increased risk. We report a case of DDS leading to intracranial hypertension in a patient with anoxic brain injury and discuss the subsequent dialysis strateg...

  17. Intention tremor after head injury

    International Nuclear Information System (INIS)

    Iwadate, Yasuo; Saeki, Naokatsu; Namba, Hiroki; Odaki, Masaru; Oka, Nobuo.

    1989-01-01

    Eight cases of intention tremor as a late complication of head injury were investigated. The patients ranged in age from 3 to 24 years. All received severe head injuries and lapsed into coma immediately afterward (Glasgow Coma Scale scores ≤8). Six patients exhibited decerebration or decortication. Hemiparesis was present in six cases and oculomotor nerve palsy in four. In the chronic stage, all patients displayed some degree of impairment of higher cortical function and five had dysarthria and/or ataxia. Initial computed tomography (CT) scans within 3 hours after the injury were obtained in five cases, of which four showed a hemorrhagic lesion in the midbrain or its surroundings. Other CT findings were diffuse cerebral swelling (four cases), intraventricular hemorrhage (three), and multiple hemorrhagic lesions (two). In the chronic stage, generalized cortical atrophy or ventricular enlargement was noted in five cases. These clinical features and CT findings indicate diffuse brain damage as well as midbrain damage and may reflect shearing injury. (author)

  18. Injury rates and profiles of elite competitive weightlifters.

    Science.gov (United States)

    Calhoon, G; Fry, A C

    1999-07-01

    To determine injury types, natures, anatomical locations, recommended amount of time missed, and injury rates during weightlifting training. We collected and analyzed medical injury records of resident athletes and during numerous training camps to generate an injury profile. Elite US male weightlifters who were injured during training at the United States Olympic Training Centers. United States Olympic Training Center weightlifting injury reports from a 6-year period were analyzed. Data were expressed as percentages and were analyzed via x(2) tests. The back (primarily low back), knees, and shoulders accounted for the most significant number of injuries (64.8%). The types of injuries most prevalent in this study were strains and tendinitis (68.9%). Injuries of acute (59.6%) or chronic (30.4%) nature were significantly more common than recurrent injuries and complications. The recommended number of training days missed for most injuries was 1 day or fewer (90.5%). Injuries to the back primarily consisted of strains (74.6%). Most knee injuries were tendinitis (85.0%). The majority of shoulder injuries were classified as strains (54.6%). Rates of acute and recurring injuries were calculated to be 3.3 injuries/1000 hours of weightlifting exposure. The injuries typical of elite weightlifters are primarily overuse injuries, not traumatic injuries compromising joint integrity. These injury pattems and rates are similar to those reported for other sports and activities.

  19. Laparoscopic hernia repair and bladder injury.

    Science.gov (United States)

    Dalessandri, K M; Bhoyrul, S; Mulvihill, S J

    2001-01-01

    Bladder injury is a complication of laparoscopic surgery with a reported incidence in the general surgery literature of 0.5% and in the gynecology literature of 2%. We describe how to recognize and treat the injury and how to avoid the problem. We report two cases of bladder injury repaired with a General Surgical Interventions (GSI) trocar and a balloon device used for laparoscopic extraperitoneal inguinal hernia repair. One patient had a prior appendectomy; the other had a prior midline incision from a suprapubic prostatectomy. We repaired the bladder injury, and the patients made a good recovery. When using the obturator and balloon device, it is important to stay anterior to the preperitoneal space and bladder. Prior lower abdominal surgery can be considered a relative contraindication to extraperitoneal laparoscopic hernia repair. Signs of gas in the Foley bag or hematuria should alert the surgeon to a bladder injury. A one- or two-layer repair of the bladder injury can be performed either laparoscopically or openly and is recommended for a visible injury. Mesh repair of the hernia can be completed provided no evidence exists of urinary tract infection. A Foley catheter is placed until healing occurs.

  20. Magnetic FB injuries: an old yet unresolved hazard.

    Science.gov (United States)

    Gregori, Dario; Morra, Bruno; Gulati, Achal

    2012-05-14

    Among foreign bodies causing injuries in children, magnets have been reported to cause serious complications and being life-threatening. The aim of this study is to design a risk profile and an epidemiological figure of such injuries, for being used for prevention. Data on 366 injuries have been collected from public surveillance databases and from published scientific literature, and compared with the data of the Susy Safe registry, which is a pan-European registry of foreign bodies injuries co-funded by the European Commission. A median age of 48 months was observed, with a 63% prevalence of males is characterizing the injuries. Magnets have a median volume of 87.9 mm(3) vs the median volume of 41.86 mm(3) of the overall foreign bodies of the Susy Safe registry). Only 43% of the magnets were involving only on piece or objects, with a median number of two objects per injury, up to a maximum of 32 objects. Children are referred to the medical care system with a median delay of 3 days after onset of symptoms. Median length of stay in the hospital was 7 days with respect to 1 day as in the Susy Safe registry. Most of complications, and event the death of a child can be eventually re-conducted to either or both a delay in patient referral or appropriate diagnosis. Thus, it is an absolute priority that an information initiative is taken toward families and emergency doctors to avoid unnecessarily delays respectively in patient referral and in diagnosis. Copyright © 2012. Published by Elsevier Ireland Ltd.