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Sample records for rupture complicating acute

  1. Acute pancreatitis complicated with splenic rupture: A case report

    Institute of Scientific and Technical Information of China (English)

    Bruno; L; Hernani; Pedro; C; Silva; Ricardo; T; Nishio; Henrique; C; Mateus; José; C; Assef; Tercio; De; Campos

    2015-01-01

    Atraumatic splenic rupture is an uncommon complication of acute pancreatitis. This report describes the case of a 30-year-old man with acute pancreatitis and splenic vein thrombosis complicated by splenic rupture. The patient was admitted to the emergency department with pain in the upper abdomen that had been present for six hours and was associated with vomiting and sweating. He was diagnosed with acute pancreatitis of alcoholic etiology. Upon computed tomography(CT) of the abdomen, the pancreatitis was scored as Balthazar C grade, and a suspicious area of necrosis affecting 30% of the pancreas with splenic vein thrombosis was revealed. Seventytwo hours after admission, the patient had significant improvement in symptoms. However, he showed clinical worsening on the sixth day of hospitalization, with increasing abdominal distension and reduced hemoglobin levels. A CT angiography showed a large amount of free fluid in the abdominal cavity, along with a large splenic hematoma and contrast extravasation along the spleen artery. The patient subsequently underwent laparotomy, which showed hemoperitoneum due to rupture of the splenic parenchyma. A splenectomy was then performed, followed by ultrasound-guided percutaneous drainage.

  2. Acute pancreatitis complicated with splenic rupture: A case report.

    Science.gov (United States)

    Hernani, Bruno L; Silva, Pedro C; Nishio, Ricardo T; Mateus, Henrique C; Assef, José C; De Campos, Tercio

    2015-09-27

    Atraumatic splenic rupture is an uncommon complication of acute pancreatitis. This report describes the case of a 30-year-old man with acute pancreatitis and splenic vein thrombosis complicated by splenic rupture. The patient was admitted to the emergency department with pain in the upper abdomen that had been present for six hours and was associated with vomiting and sweating. He was diagnosed with acute pancreatitis of alcoholic etiology. Upon computed tomography (CT) of the abdomen, the pancreatitis was scored as Balthazar C grade, and a suspicious area of necrosis affecting 30% of the pancreas with splenic vein thrombosis was revealed. Seventy-two hours after admission, the patient had significant improvement in symptoms. However, he showed clinical worsening on the sixth day of hospitalization, with increasing abdominal distension and reduced hemoglobin levels. A CT angiography showed a large amount of free fluid in the abdominal cavity, along with a large splenic hematoma and contrast extravasation along the spleen artery. The patient subsequently underwent laparotomy, which showed hemoperitoneum due to rupture of the splenic parenchyma. A splenectomy was then performed, followed by ultrasound-guided percutaneous drainage.

  3. Atraumatic splenic rupture as a complication of acute exacerbation of chronic pancreatitis, an unusual disease.

    Science.gov (United States)

    Moya Sánchez, Elena; Medina Benítez, Antonio

    2017-02-27

    We report the case of a patient with acute exacerbation of chronic pancreatitis and he suffered an atraumatic splenic rupture. Splenic rupture not associated with trauma is a rare entity that can occurs in normal spleen (spontaneous) or damaged spleen (pathological). This entity may be associated with local inflammatory processes, such as pancreatitis. Ultrasound is a non-invasive technique which is used in unstable patients. CT is useful for making a diagnosis of extension in patients with hemodynamic stability. Atraumatic splenic rupture as a complication of chronic pancreatitis is an unusual disease that requires a high index of suspicion which allows us an early diagnosis because it is a treatable entity that compromises the patient's life.

  4. Effect of Complications After Minimally Invasive Surgical Repair of Acute Achilles Tendon Ruptures Report on 211 Cases

    NARCIS (Netherlands)

    Metz, Roderik; van der Heijden, Geert J. M. G.; Verleisdonk, Egbert-Jan M. M.; Kolfschoten, Nicky; Verhofstad, Michiel H. J.; van der Werken, Christiaan

    2011-01-01

    Background: Complications of acute Achilles tendon rupture treatment are considered to negatively influence outcome, but the relevance of these effects is largely unknown. Purpose: The Achilles Tendon Total Rupture Score (ATRS) was used to determine level of disability in patients with minimally inv

  5. Effect of Complications After Minimally Invasive Surgical Repair of Acute Achilles Tendon Ruptures Report on 211 Cases

    NARCIS (Netherlands)

    Metz, Roderik; van der Heijden, Geert J. M. G.; Verleisdonk, Egbert-Jan M. M.; Kolfschoten, Nicky; Verhofstad, Michiel H. J.; van der Werken, Christiaan

    2011-01-01

    Background: Complications of acute Achilles tendon rupture treatment are considered to negatively influence outcome, but the relevance of these effects is largely unknown. Purpose: The Achilles Tendon Total Rupture Score (ATRS) was used to determine level of disability in patients with minimally inv

  6. Urgent hybrid approach in treatment of the acute myocardial infarction complicated by the ventricular septal rupture

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    Radosavljević-Radovanović Mina

    2014-01-01

    Full Text Available Introduction. Ventricular septal rupture (VSR in the acute myocardial infarction (AMI is a rare but very serious complication, still associated with high mortality, despite significant improvements in pharmacological and surgical treatment. Therefore, hybrid approaches are introduced as new therapeutical options. Case Outline. We present an urgent hybrid approach, consisting of the initial percutaneous coronary intervention (PCI of the infarct-related artery, followed by immediate surgical closure of the ventricular septal rupture, for treatment of high risk, hemodynamically unstable female patient with AMI caused by one-vessel disease and complicated by VSR and cardiogenic shock. Since the operative risk was also very high (EUROSCORE II 37%, this therapeutic decision was based on the assumption that preoperative PCI could promptly establish blood flow and thereby lessen the risks, duration and complexity of urgent cardiosurgical intervention, performed on the same day. This approach proved to be successful and the patient was discharged from the hospital on the fifteenth postoperative day in stable condition. Conclusion. In selected cases, with high operative risk and unstable hemodynamic state due to AMI complicated by VSR, urgent hybrid approach consisting of the initial PCI followed by surgical closure of VSR may represent an acceptable treatment option and contribute to the treatment of this complex group of patients.

  7. Clinical Outcomes and Complications of Percutaneous Achilles Repair System Versus Open Technique for Acute Achilles Tendon Ruptures.

    Science.gov (United States)

    Hsu, Andrew R; Jones, Carroll P; Cohen, Bruce E; Davis, W Hodges; Ellington, J Kent; Anderson, Robert B

    2015-11-01

    Limited incision techniques for acute Achilles tendon ruptures have been developed in recent years to improve recovery and reduce postoperative complications compared with traditional open repair. The purpose of this retrospective cohort study was to analyze the clinical outcomes and postoperative complications between acute Achilles tendon ruptures treated using a percutaneous Achilles repair system (PARS [Arthrex, Inc, Naples, FL]) versus open repair and evaluate the overall outcomes for operatively treated Achilles ruptures. Between 2005 and 2014, 270 consecutive cases of operatively treated acute Achilles tendon ruptures were reviewed (101 PARS, 169 open). Patients with Achilles tendinopathy, insertional ruptures, chronic tears, or less than 3-month follow-up were excluded. Operative treatment consisted of a percutaneous technique (PARS) using a 2-cm transverse incision with FiberWire (Arthrex, Inc, Naples, FL) sutures or open repair using a 5- to 8-cm posteromedial incision with FiberWire in a Krackow fashion reinforced with absorbable sutures. Patient demographics were recorded along with medical comorbidities, activity at injury, time from injury to surgery, length of follow-up, return to baseline activities by 5 months, and postoperative complications. The most common activity during injury for both groups was basketball (PARS: 39%, open: 47%). A greater number of patients treated with PARS were able to return to baseline physical activities by 5 months compared with the open group (PARS: 98%, open: 82%; P = .0001). There were no significant differences (P > .05) between groups in rates of rerupture (P = 1.0), sural neuritis (P = .16), wound dehiscence (P = .74), superficial (P = .29) and/or deep infection (P = .29), or reoperation (P = .13). There were no deep vein thromboses (DVTs) or reruptures in either group. In the PARS group, there were no cases of sural neuritis, 3 cases (3%) of superficial wound dehiscence, and 2 reoperations (2%) for superficial

  8. Absorbable Polydioxanone (PDS) suture provides fewer wound complications than polyester (ethibond) suture in acute Tendo-Achilles rupture repair

    LENUS (Irish Health Repository)

    Baig, M N

    2017-05-01

    We prospectively studied acute Achilles tendon rupture in patients over a two 2-year period and reviewed the causes, outcome and complications. There were 53 patients included with acute Achilles rupture with minimum follow up period of 6 months. We compared the outcomes including infection rate and Boyden score between the two groups repaired by Polydioxanone and Polyester respectively. All infected cases had a suture repair using the polyester suture. The difference in the infection rate was highly significant between the 2 groups (p=0.001). All 34 patients (100%) in the PDS group had good \\/ excellent results based on the Boyden clinical assessment. Conversely, only 16 patients 9(68.4%) had good or excellent results IN Polyester repair group. Patients treated with a non- absorbable suture (ethibond) material for repair had a higher incidence infection and worse Boyden scores than the absorbable PDS group.

  9. Diagnosis and Management of Papillary Muscle Rupture Complicating Acute Myocardial Infarction: A Case Report and Review of the Literature

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    Suarez

    2015-08-01

    Full Text Available Introduction The incidence of mechanical complications related to myocardial infarction has decreased over the last decades, and revascularization certainly plays a major role in this change. However, mortality still remains elevated. This is a case of acute papillary muscle rupture secondary to myocardial infarction leading to cardiogenic shock. Case Presentation A 71-year-old woman presented to an outside hospital complaining of chest pain and shortness of breath. An electrocardiogram was obtained and revealed depression of the ST segments from leads V1 to V4. Troponin I was elevated at 3.0 ng/mL. She was transferred to our facility for a higher level of care. She was found in cardiogenic shock at arrival. A bedside echocardiogram was ordered, which demonstrated papillary muscle rupture with severe mitral regurgitation. A coronary angiogram followed, which diagnosed severe three-vessel disease. After the insertion of an intra-aortic balloon pump, she was transferred emergently to the surgical suite for mitral valve replacement and revascularization. The operation was uneventful. She was discharged to a rehabilitation center after approximately 1 month of hospital stay. Conclusions Mortality from papillary muscle rupture remains elevated. Survival largely depends on the early surgical repair or the replacement of the mitral valve.

  10. Severe Functional Debilitations After Complications Associated With Acute Achilles Tendon Rupture With 9 Years of Follow-Up

    DEFF Research Database (Denmark)

    Barfod, Kristoffer Weisskirchner; Sveen, Thor Magnus; Ganestam, Ann

    2017-01-01

    The purpose of the present study was to investigate the long-term effect of deep infection, sural nerve injury, and repeat rupture in the treatment of acute Achilles tendon rupture. A total of 324 patients had made a claim to the Danish Patient Insurance Association from 1992 to 2010 for a compli......The purpose of the present study was to investigate the long-term effect of deep infection, sural nerve injury, and repeat rupture in the treatment of acute Achilles tendon rupture. A total of 324 patients had made a claim to the Danish Patient Insurance Association from 1992 to 2010...

  11. Outcomes and complications of percutaneous versus open repair of acute Achilles tendon rupture: A meta-analysis.

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    Yang, Bo; Liu, Yang; Kan, Shunli; Zhang, Di; Xu, Hong; Liu, Feifei; Ning, Guangzhi; Feng, Shiqing

    2017-04-01

    Acute Achilles tendon rupture (AATR) is a frequent injury occurring dominantly in young to middle-aged males. Outcomes and complications between percutaneous and open repair are still controversial. Thus, the purpose of this meta-analysis is to evaluate the outcomes and complications of these two operative methods. We searched multiple databases: PubMed, Web of Science, EMBASE and the Cochrane Library up to October 2016. Two reviewers independently screened the studies for eligibility, evaluated the quality and extracted data from eligible studies, with confirmation by cross-checking. The major results and conclusions were concluded, and the different complication rates and functional outcomes were compared. Meta-analysis was processed by Rev Man 5.3 software. Five randomized controlled trials (RCTs) and seven retrospective cohort studies involving 815 patients met the inclusion criteria. The sural nerve injury rate in the percutaneous group was significantly higher (RR = 3.52, 95%CI 1.45 to 8.57, P = 0.006). However, deep infection rate in the open group was higher (RR = 0.33, 95%CI 0.11 to 0.96, P = 0.04) and subgroup analysis of five RCTs showed no significant difference (RR = 0.42, 95%CI 0.09 to 2.10, P = 0.29). No significant difference was seen regarding the rate of re-rupture. The time of operation in the percutaneous group was shorter (RR = -1.99, 95%CI -3.81 to -0.80, P = 0.001). American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score showed statistically different in the two groups. Other functional outcomes were similar in the two groups. Percutaneous repair has the advantages of operation time, deep infection and AOFAS score. The functional outcomes were similar in two treatment groups except AOFAS score. Despite the higher incidence of sural nerve injury, we still believe that percutaneous repair is superior to open repair for treating AATR. Copyright © 2017. Published by Elsevier Ltd.

  12. The clinical analysis of 11 cases of acute myocardial infarction complicated with cardiac rupture%急性心肌梗死后心脏破裂11例临床分析

    Institute of Scientific and Technical Information of China (English)

    覃秀川

    2012-01-01

    心脏破裂(CR)是急性心肌梗死(AMI)后最严重的并发症,一旦出现,患者可在数分钟内死亡.本文回顾性分析了2008~2011年间我科收治的AMI后11例并发CR的临床资料,对AMI并发CR的危险因素、临床表现、早期诊断进行探讨.%Cardiac rupture is one of the most severe complications of acute myocardial infarction. The retrospective analysis of 11 cases between 2008 and 2011 were admitted from acute myocardial infarction complicated with cardiac rupture to investigate the risk factors, clinical manifestation and early diagnosis in patients acute myocardial infarction complicated with cardiac rupture.

  13. Magnetic resonance imaging in acute tendon ruptures

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    Daffner, R.H.; Lupetin, A.R.; Dash, N.; Riemer, B.L.

    1986-11-01

    The diagnosis of acute tendon ruptures of the extensor mechanism of the knee or the Achilles tendon of the ankle may usually be made by clinical means. Massive soft tissue swelling accompanying these injuries often obscures the findings, however. Magnetic resonance imaging (MRI) can rapidly demonstrate these tendon ruptures. Examples of the use of MRI for quadriceps tendon, and Achilles tendon rupture are presented.

  14. NEONATAL COMPLICATIONS OF PREMATURE RUPTURE OF MEMBRANES

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    F. Nili AA. Shams Ansari

    2003-07-01

    Full Text Available Premature rupture of membranes (PROM is one of the most common complications of pregnancy that has a major impact on neonatal outcomes. With respect to racial, nutritional and cultural differences between developed and developing countries, this study was conducted to detect the prevalence of neonatal complications following PROM and the role of the duration of rupture of membranes in producing morbidities and mortalities in these neonates in our hospital. Among 2357 pregnant women, we found 163 (6.91% cases of premature rupture of the fetal membranes in Tehran Vali-e-Asr Hospital during April 2001 to April 2002. Route of delivery was cesarean section in 65.6% of women. Urinary tract infection occured in 1.8%, maternal leukocytosis and fever in 20.2% and 5.5%, chorioamnionitis in 6.1%, fetal tachycardia in 1.2% and olygohydramnios in 4.9%. Gestational age in 138 (86% of neonates was less than 37 completed weeks. Thirty five infants (21.47% had respiratory distress syndrome and 33 (20.245% had clinical sepsis. Pneumonia in 6 (3.7% and skeletal deformity in 7 (4.294% were seen. Rupture of membrane of more than 24 hours duration occurred in 71 (43.6% of the patients. Comparison of morbidities between two groups of neonates and their mothers according to the duration of PROM (less and more than 24 hours showed significant differences in NICU admission, olygohydramnios, maternal fever, leukocytosis and chorioamnionitis rates (p24 hr of PROM with an odds ratio of 2.68 and 2.73, respectively. Positive blood and eye cultures were detected in 16 cases during 72 hours of age. Staphylococcus species, klebsiella, E.coli and streptococcus were the predominant organisms among positive blood cultures. Mortality was seen in 18 (11% of neonates because of respiratory failure, disseminated intravascular coagulation, septic shock, and a single case of congenital toxoplasmosis. In this study, the prevalence of prematurity, sepsis and prolonged rupture of membrane

  15. Functional rehabilitation of patients with acute Achilles tendon rupture

    DEFF Research Database (Denmark)

    Mark-Christensen, Troels; Troelsen, Anders; Kallemose, Thomas

    2014-01-01

    PURPOSE: The optimal treatment for acute Achilles tendon rupture (ATR) is continuously debated. Recent studies have proposed that the choice of either operative or non-operative treatment may not be as important as rehabilitation, suggesting that functional rehabilitation should be preferred over......, CINAHL, Cochrane Library and PEDro using the search terms: "Achilles tendon," "rupture," "mobilization" and "immobilization". Seven RCTs involving 427 participants were eligible for inclusion, with a total of 211 participants treated with functional rehabilitation and 216 treated with immobilization....... CONCLUSION: Functional rehabilitation after acute Achilles tendon rupture does not increase the rate of re-rupture or other complications. A trend toward earlier return to work and sport, and increased patient satisfaction was found when functional rehabilitation was used. The present literature is of low...

  16. Aortic plaque rupture in the setting of acute lower limb ischemia.

    LENUS (Irish Health Repository)

    O'Donnell, David H

    2012-02-01

    Acute aortic plaque rupture is an uncommon cause of acute lower limb ischemia. The authors report sequence computed tomographic imaging of a distal aortic plaque rupture in a young man with bilateral lower limb complications. Clinical awareness, prompt recognition and imaging, and appropriate treatment of this uncommon condition are necessary to improve patient outcomes.

  17. Traumatic dissection and rupture of the abdominal aorta as a complication of the Heimlich maneuver.

    Science.gov (United States)

    Desai, Shaun C; Chute, Dennis J; Desai, Bharati C; Koloski, Eugene R

    2008-11-01

    Although the Heimlich maneuver is considered the best intervention for relieving acute upper airway obstruction, several complications have been reported in the literature. These complications can occur as a result of an increase in abdominal pressure leading to a variety of well-documented visceral injuries, including the great vessels. Acute abdominal aortic thrombosis after the Heimlich maneuver is a rare but recognized event; however, to date no case of traumatic dissection and rupture of the abdominal aorta has been described. We report the first known case, to our knowledge, of a traumatic dissection and rupture of the abdominal aorta after a forcefully applied Heimlich maneuver.

  18. Augmented repair of acute tendo Achilles ruptures with gastrosoleus turn down flap

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    Murat Demirel

    2011-01-01

    Conclusion: Primary repair of acute tendo Achilles rupture augment with gastrosoleus turn down flip technique in combination of immediate weightbearing ambulation provides a good outcome, but is associated with similar complication rates to the previous literature.

  19. Do diabetes mellitus and systemic hypertension predispose to left ventricular free wall rupture in acute myocardial infarction?

    DEFF Research Database (Denmark)

    Melchior, T; Hildebrant, P; Køber, L

    1997-01-01

    Diabetes and systemic hypertension had no influence on left ventricular free wall rupture complicating acute myocardial infarction. Age <65 years and a history of coronary artery disease offers some protection from protection.......Diabetes and systemic hypertension had no influence on left ventricular free wall rupture complicating acute myocardial infarction. Age

  20. Acute diaphragmatic rupture following open type IV paraesophageal hernia repair.

    Science.gov (United States)

    Reames, Bradley N; Reddy, Rishindra M

    2011-06-01

    Open primary transthoracic repair is a well established treatment for large paraesophageal hernias. The rate of major post-operative complications has been reported to be low, and no cases of acute diaphragmatic injury have previously been reported. Here we present a case of open primary transthoracic repair of a type IV paraesophageal hernia that was complicated by rupture of the left diaphragm in the immediate post-operative period, and was successfully repaired with Gore DualMesh® (W.L Gore and Assoc. Flagstaff, AZ). © JSCR.

  1. An Unusual Case of Colon Perforation Complicating Acute Pancreatitis

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    Anthony A. Aghenta

    2009-08-01

    Full Text Available Colonic complications of severe acute pancreatitis occur rarely. Although there have been several theories on how pancreatic pseudocysts rupture into the colon, the exact pathogenesis remains unknown. We report an unusual case of pseudocysts complicating severe acute pancreatitis presenting with colonic perforation in a 71-year-old man with a history of chronic mesenteric ischemia. Pressure effects from a giant pseudocyst and intravascular volume depletion with acute insult on chronic mesenteric ischemia are highlighted as possible etiologic factors.

  2. Acute Achilles tendon rupture - Minimally invasive surgery versus nonoperative treatment with immediate full weightbearing - Randomized controlled trial

    NARCIS (Netherlands)

    Metz, Roderick; Verleisdonk, Egbert-Jan M. M.; van der Heijden, Geert J. -M. -G.; Clevers, Geert-Jan; Hammacher, Erik R.; Verhofstad, Michiel H. J.; van der Werken, Christiaan

    2008-01-01

    Background: Surgical repair of acute Achilles tendon ruptures is considered superior to nonoperative treatment, but complications other than rerupture range up to 34%. Nonoperative treatment by functional bracing seems a promising alternative. Hypothesis: Nonoperative treatment of acute Achilles ten

  3. [Neurologic complications of subarachnoid hemorrhage due to intracranial aneurysm rupture].

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    Rama-Maceiras, P; Fàbregas Julià, N; Ingelmo Ingelmo, I; Hernández-Palazón, J

    2010-12-01

    The high rates of morbidity and mortality after subarachnoid hemorrhage due to spontaneous rupture of an intracranial aneurysm are mainly the result of neurologic complications. Sixty years after cerebral vasospasm was first described, this problem remains unsolved in spite of its highly adverse effect on prognosis after aneurysmatic rupture. Treatment is somewhat empirical, given that uncertainties remain in our understanding of the pathophysiology of this vascular complication, which involves structural and biochemical changes in the endothelium and smooth muscle of vessels. Vasospasm that is refractory to treatment leads to cerebral infarction. Prophylaxis, early diagnosis, and adequate treatment of neurologic complications are key elements in the management of vasospasm if neurologic damage, lengthy hospital stays, and increased use of health care resources are to be avoided. New approaches to early treatment of cerebral lesions and cortical ischemia in cases of subarachnoid hemorrhage due to aneurysm rupture should lead to more effective, specific management.

  4. Spontaneous bladder rupture in acute alcohol intoxication

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    Bahjat Barakat

    2014-03-01

    Full Text Available Spontaneous bladder rupture is a rare condition that can be followed by an acute alcohol intoxication and can be associated with significant morbidity and mortality. We report a case diagnosed in a alcoholic young male who was admitted to our emergency room for epigastric pain. The case demonstrates the difficulties with diagnosis and the need for physicians who work in an emergency room to be aware of this condition.

  5. Ruptured aortic valve cusp: a complication of the Heimlich maneuver.

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    Chapman, J H; Menapace, F J; Howell, R R

    1983-07-01

    A case of traumatic rupture of the aortic valve as a complication of the Heimlich maneuver is presented. Conformation was made by comparative echocardiographic studies available from three months before and immediately following the incident. The patient refused surgical intervention and died one month later with severe congestive heart failure despite vigorous medical therapy.

  6. Spontaneous liver rupture in pregnancy complicating HELLP syndrome: case report

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    Sariyeh Golmahammadlou

    2014-10-01

    Conclusion: Spontaneous liver rupture associated with HELLP syndrome is a rare and life-threatening complication of pregnancy. Unruptured liver hematoma is also a rare condition during pregnancy with a very difficult diagnosis. Using clinical diagnostic tests such as CT scan or MRI would be helpful to improve clinical outcomes.

  7. Bladder rupture causing pseudo acute renal failure

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    Luciana Andrea Avena Smeili

    2011-09-01

    Full Text Available Bladder rupture is a rare condition associated with significant morbidityand mortality. It is classified into traumatic, nontraumatic or idiopathic andspontaneous. The nonspecific initial clinical presentation is followed bydiscomfort in the lower abdomen, oliguria, hematuria and ascitis. Laboratoryabnormalities simulate the picture of acute renal failure and occurs by amechanism called auto reverse dialysis, with absorption of excreta throughthe peritoneal membrane. The authors describe a case of bladder rupturein morphologically and functionally normal urinary bladder associated withalcohol intake in young healthy man, manifested by abdominal discomfort,pseudo renal failure and massive ascitis. The diagnosis was made by anabdominal multidetector computed tomography confirmed by the finding of7 cm laceration at laparotomy.

  8. Unusual Cause of Acute Abdomen—Ruptured Retroperitoneal Paraganglioma

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    Kwok-Kay Yau

    2008-01-01

    Full Text Available Ruptured retroperitoneal paraganglioma is a rare cause of acute abdomen. Its clinical presentation and laparoscopic features have seldom been reported in the literature. Herein, we report a case of ruptured retroperitoneal paraganglioma that presented as acute abdomen, and its subsequent management.

  9. [Traumatic Testicular Rupture Complicated with Hydrocele: A Case Report].

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    Yamamichi, Gaku; Tsutahara, Koichi; Okusa, Takuya; Taniguchi, Ayumu; Kishimoto, Nozomu; Tanigawa, Go; Takao, Tetsuya; Yamaguchi, Seiji

    2015-10-01

    A 17-year-old man presented with right hydrocele because of an athletic injury. His scrotum was hit with a ball 2 months ago while playing baseball. He was diagnosed with post-traumatic hydrocele and underwent needle puncture at another hospital 1 month after the trauma. However, the hydrocele did not improve. Therefore, he was referred to our hospital for surgical treatment. For diagnosis of the traumatic hydrocele testis, a hydrocelectomy was scheduled. When we opened the tunica vaginalis, we realized that the tunica albuginea had been ruptured and the testicular parenchyma had gushed out. We tried to replace all the escaped testicular parenchyma into the tunica albuginea, but it was impossible. Therefore were moved some of the redundant testicular parenchyma, and replaced the remnants into the tunica albuginea. After the operation, right hydrocele and testicular atrophy did not occur. Traumatic testicular rupture complicated with hydrocele is rare.

  10. Ruptured left ventricular pseudoaneurysm in the mediastinum following acute myocardial infarction: a case report

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    Si Daoyuan

    2013-01-01

    Full Text Available Abstract Left ventricular pseudoaneurysm is an uncommon complication after transmural acute myocardial infarction (AMI. Here we describe the case of a 43-year-old man who presented with AMI and chest distress despite the normal appearance of his coronary artery during coronary angiography. Timely thrombolytic therapy was administered. Echocardiography, and cardiac computed tomography showed a ventricular pseudoaneurysm, and direct visualization at the time of surgery showed that it had ruptured in the mediastinum instead of the pericardium. The survival rate of patients with ventricular pseudoaneurysm rupture is low. The rupture of ventricular pseudoaneurysm in the mediastinum is rare; therefore, this case is noteworthy.

  11. Papillary muscle rupture due to acute myocardial infarction followed by cardiogenic shock, pulmonary edema, and acute renal failure

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    Ilić Radoje

    2005-01-01

    Full Text Available Aim. The case of successful surgical treatment of anterolateral papillary muscle rupture due to acute myocardial infarction with cardiogenic shock, pulmonary edema and acute renal failure. Case report. A 62-year old male from Belgrade with chest pain, hypotension and a new heart murmur refused hospitalization at the Military Medical Academy. On the third day of his illness he was readmitted to MMA as an emergency due to hemoptysis. Examination revealed mitral valve anterolateral papillary muscle rupture. The patient, with signs of cardiogenic shock and acute renal failure, was immediately operated on. The surgery was performed using extracorporeal circulation. An artificial mitral valve was implanted, and myocardial revascularization accomplished with one venous graft of the left anterior descending artery. On the second postoperative day, hemodialysis was carried out due to acute renal failure. On the 28th postoperative day, the patient was discharged from the hospital being hemodynamically stable with normal renal function and balanced anticoagulation. The case is interesting in terms of unrecognized papillary muscle rupture that led to the development of cardiogenic shock, hemoptysis and acute renal failure. Conclusion. Papillary muscle rupture is a fatal complication of acute myocardial infarction. Early recognition and urgent surgical intervention were lifesaving in the case of complete papillary muscle rupture. Surgical treatment, regardless of high risk, is the procedure of choice.

  12. HELLP Syndrome Complicated with Postpartum Subcapsular Ruptured Liver Hematoma and Purtscher-Like Retinopathy

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    Daniela Cernea

    2012-01-01

    Full Text Available Purtscher's retinopathy is usually associated with trauma, acute pancreatitis, vasculitis, lupus, and bone fractures. It was rarely described postpartum in patients with preeclampsia as well as associated with HELLP syndrome. We present a case of a multiparous patient aged 44 with severe preeclampsia and postpartum HELLP syndrome complicated with Purtscher-like retinopathy and large ruptured subcapsular liver hematoma that required emergency abdominal surgery after premature delivery of a dead fetus. Postsurgical outcome was favorable regarding both liver function and visual acuity.

  13. Esophageal rupture: a severe complication of transesophageal echocardiography

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    Fernando Peixoto Ferraz de Campos

    2012-12-01

    Full Text Available Since when the first transesophageal echocardiography (TEE was undertaken in 1975, technological advances have made this diagnostic modality more reliable. TEE indications became widespread in cardiac and non-cardiac surgeries, intensive care units, and ambulatory clinics. The procedure is generally considered a safe diagnostic tool, but occasionally complications do occur. The insertion and manipulation of the ultrasound probe can cause oropharyngeal, esophageal, or gastric trauma. Although rare, these complications may present a mortality rate of up to 56% depending on the treatment approach and the elapsed time to the diagnosis. The authors report a case of a 65-year-old woman submitted to attempt a TEE in order to better study or diagnose an inter-atrial communication. After 3 days of the procedure, the patient was admitted to the hospital with edema, hyperemia of the anterior face of the neck, accompanied by systemic symptoms. The imaging diagnostic work-up evidenced signs of esophageal rupture and upper mediastinal involvement, the former confirmed by upper gastrointestinal endoscopy. The patient was treated with antibiotics and cervical and mediastinal drainage, with a favorable outcome.

  14. Acute Pancreatitis due to Rupture of the Hydatid Cyst into the Biliary Tract: A Case Report

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    Zulfu Bayhan

    2014-02-01

    Full Text Available Hydatid disease is still endemic in our country and in many parts of the world. Liver is the most common site of hydatid disease. Rupture of hydatid cysts of liver into the biliary ducts can be seen as a complication. Obstructive jaundice, acute cholangitis and much more rarely acute pancreatitis may occur due to rupture of hydatid cysts into the biliary ducts. In this case report, a 38-year-old male patient with findings of acute pancreatitis and obstructive jaundice due to rupture of hydatid cyst into the biliary tract were presented . In our case, Endoscopic retrograde cholangiopancreatography (ERCP was performed to the patient with diagnostic and therapeutic purposes. Parts of germinative membrane located within the common bile duct and causing the obstruction of papillary orifice was seen in ERCP. Germinative membrane components were removed during the process. Endoscopic sphincterotomy was performed to the patient. After the procedure, the clinical findings and laboratory findings of the patient returned to normal rapidly. As a result, it should be noted that rupture of hepatic hydatid cysts into the bile ducts might be a rare cause of biliary pancreatitis. It must be kept in mind that endoscopic sphincterotomy and endoscopic removal of cyst membranes is a very important method for the diagnosis and treatment of the acute pancreatitis and obstructive jaundice due to rupture of hydatid cyst into the biliary tract. [Natl J Med Res 2014; 4(1.000: 92-94

  15. Intra-arterial tirofiban infusion for thromboembolic complication during coil embolization of ruptured intracranial aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Young Dae, E-mail: aronnn@naver.com [Department of Radiology, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, 425 Sindaebang-dong, Dongjak-gu, Seoul 156-707 (Korea, Republic of); Lee, Jong Young, E-mail: gen78@naver.com [Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yongon-dong, Jongno-gu, Seoul 110-744 (Korea, Republic of); Seo, Jung Hwa, E-mail: jhseo34@gmail.com [Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yongon-dong, Jongno-gu, Seoul 110-744 (Korea, Republic of); Kang, Hyun-Seung, E-mail: hsk4428@yahoo.com [Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yongon-dong, Jongno-gu, Seoul 110-744 (Korea, Republic of); Kim, Jeong Eun, E-mail: eunkim@snu.ac.kr [Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yongon-dong, Jongno-gu, Seoul 110-744 (Korea, Republic of); Jung, Keun Hwa, E-mail: jungkh@gmail.com [Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yongon-dong, Jongno-gu, Seoul 110-744 (Korea, Republic of); Han, Moon Hee, E-mail: hanmh@snuh.org [Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yongon-dong, Jongno-gu, Seoul 110-744 (Korea, Republic of); Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 28 Yongon-dong, Jongno-gu, Seoul 110-744 (Korea, Republic of)

    2012-10-15

    Introduction: Intra-arterial (IA) thrombolytic intervention for acute thrombosis has been challenged due to the risk of bleeding during the endovascular treatment of ruptured aneurysms. We present the results of IA tirofiban infusion for thromboembolic complications during coil embolization in patients with ruptured intracranial aneurysms. Methods: Thromboembolic events requiring thrombolytic intervention occurred in 39 (10.5%) cases during coil embolization of 372 consecutive ruptured intracranial aneurysms. Maximal aneurysm diameters of 39 patients (mean age, 54.7 ± 13.2 years; 23 female, 16 male) ranged from 2.1 to 13.1 mm (mean, 6.6 ± 3.0 mm). The anterior communicating artery was the most common site (n = 13), followed by the middle cerebral artery (n = 9) and the posterior communicating artery (n = 7). In this series, we used intracranial stents in 10 patients during the procedure. Superselective IA tirofiban infusion through a microcatheter was performed to resolve thrombi and emboli. We assessed the efficacy and safety of IA tirofiban infusion in patients with ruptured aneurysms. Results: Intraarterially administered tirofiban doses ranged from 0.25 to 1.25 mg (mean, 0.71 ± 0.26 mg). Effective thrombolysis or recanalization was achieved in 34 patients (87.2%), and three patients (7.7%) suffered distal migration of clots with partial recanalization. The rest (5.1%) had no recanalization. Nonconsequent intracerebral hemorrhage occurred in two patients (5.1%) after the procedure. Thromboemboli-related cerebral infarction developed in eight patients, and only two patients remained infarction related disabilities. Conclusion: IA tirofiban infusion seems to be efficacious and safe for thrombolysis during coil embolization in patients with ruptured intracranial aneurysms.

  16. Acute acalculous cholecystitis complicating chemotherapy for acute myeloblastic leukemia

    OpenAIRE

    Olfa Kassar; Feten Kallel; Manel Ghorbel; Hatem. Bellaaj; Zeineb Mnif; Moez Elloumi

    2015-01-01

    Acute acalculous cholecystitis is a rare complication in the treatment of acute myeloblastic leukemia. Diagnosis of acute acalculous cholecystitis remains difficult during neutropenic period. We present two acute myeloblastic leukemia patients that developed acute acalculous cholecystitis during chemotherapy-induced neutropenia. They suffered from fever, vomiting and acute pain in the epigastrium. Ultrasound demonstrated an acalculous gallbladder. Surgical management was required in one patie...

  17. Functional rehabilitation of patients with acute Achilles tendon rupture: a meta-analysis of current evidence.

    Science.gov (United States)

    Mark-Christensen, Troels; Troelsen, Anders; Kallemose, Thomas; Barfod, Kristoffer Weisskirchner

    2016-06-01

    The optimal treatment for acute Achilles tendon rupture (ATR) is continuously debated. Recent studies have proposed that the choice of either operative or non-operative treatment may not be as important as rehabilitation, suggesting that functional rehabilitation should be preferred over traditional immobilization. The purpose of this meta-analysis of randomized controlled trials (RCTs) was to compare functional rehabilitation to immobilization in the treatment of ATR. This meta-analysis was conducted using the databases: PubMed, EMBASE, Rehabilitation and Sports Medicine Source, AMED, CINAHL, Cochrane Library and PEDro using the search terms: "Achilles tendon," "rupture," "mobilization" and "immobilization". Seven RCTs involving 427 participants were eligible for inclusion, with a total of 211 participants treated with functional rehabilitation and 216 treated with immobilization. Re-rupture rate, other complications, strength, range of motion, duration of sick leave, return to sport and patient satisfaction were examined. There were no statistically significant differences between groups. A trend favoring functional rehabilitation was seen regarding the examined outcomes. Functional rehabilitation after acute Achilles tendon rupture does not increase the rate of re-rupture or other complications. A trend toward earlier return to work and sport, and increased patient satisfaction was found when functional rehabilitation was used. The present literature is of low-to-average quality, and the basic constructs of the examined treatment and study protocols vary considerably. Larger, randomized controlled trials using validated outcome measures are needed to confirm the findings. II.

  18. Venous rupture complicating hemodialysis access angioplasty: percutaneous treatments and outcomes

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    La, Young Jong; Goo, Dong Erk; Kim, Dae Ho; Lee, Hae Kyoung; Hong, Hyun Suk; Kwon, Gui Hyang; Choi, Duk Lin; Ynag, Sung Boo [College of Medicine, Soonchunhyang Univ., Seoul (Korea, Republic of)

    2002-03-01

    To evaluate the usefulness of percutaneous management and prognosis in venous rupture during angioplasty of hemodialytic arteriovenous fistulas. Among 814 patients who underwent angioplasty on account of inadequate hemodialysis, 63(39 women and 24 men aged 20-78 (mean, 55.8) years) were included in this study. All 63 had peripheral venous stenosis. Venous rupture was diagnosed when contrast leakage was seen at venography after percutaneous angioplasty (PTA). In order to manage venous rupture, the sites at which this occurred were compressed manually for 3-5 minutes or blood flow was blocked with a balloon catheter for the same period. In one case, a stent was inserted at the rupture site. Using the Kaplan-Meier method, we investigated the patency rate of arteriovenous fistula (AVF) in cases of successful PTA. We also compared PTA patency rates in cases with and without peripheral venous rupture. Venous rupture occurred in 38 cephalic, 16 brachial, and 9 basilic veins. In 63 patients, bleeding stopped and in 54 (85.7 %) of thee, PTA was successful. Among the nine failed cases, dilatation was incomplete in five, though bleeding had stopped. In patients with brachial and cephalic vein rupture the venous tract at the rupture site was not located. Two patients underwent surgery: one of these experienced brachial venous rupture, with incontrollable bleeding, and the other had nerve compression symptoms due to hematoma. Among 54 patients in whom PTA was successful, the primary and secondary six-months rates for angioaccess were 47.9% and 81.2%, and the mean patency period was 6.1 and 15.8 months, respectively. In cases of non-venous rupture, the mean patency period was 9.6 months, significantly longer than in cases involving venous rupture (p=0.02). Venous rupture occurring during the PTA of hemodialytic AVF can be managed percutaneously.

  19. Therapeutic approaches to cerebral vasospasm complicating ruptured aneurysm

    Directory of Open Access Journals (Sweden)

    Mohamed Barbarawi

    2009-10-01

    Full Text Available Cerebral vasospasm is a serious complication of ruptured aneurysm. In order to avoid short- and long-term effects of cerebral vasospasm, and as there is no single or optimal treatment modality employed, we have instituted a protocol for the prevention and treatment of vasospasm in patients suffering aneurysmal sub-arachnoid hemorrhage (SAH. We then reviewed the effectiveness of this protocol in reducing the mortality and morbidity rate in our institution. In this study we present a retrospective analysis of 52 cases. Between March 2004 and December 2008 52 patients were admitted to our service with aneurysmal SAH. All patients commenced nimodipine, magnesium sulphate (MgSO4 and triple H therapy. Patients with significant reduction in conscious level were intubated, ventilated and sedated. Intracranial pressure (ICP monitoring was used for intubated patients. Sodium thiopental coma was induced for patients with refractory high ICP; angiography was performed for diagnosis and treatment. Balloon angioplasty was performed if considered necessary. Using this protocol, only 13 patients (25% developed clinical vaso-spasm. Ten of them were given barbiturates to induce coma. Three patients underwent transluminal balloon angioplasty. Four out of 52 patients (7.7% died from severe vasospasm, 3 patients (5.8% became severely disabled, and 39 patients (75% were discharged in a condition considered as either normal or near to their pre-hemorrhage status. Our results confirm that the aforementioned protocol for treatment of cerebral vasospasm is effective and can be used safely.

  20. Acute Achilles tendon rupture Treatment strategies and outcomes

    NARCIS (Netherlands)

    Metz, R.

    2009-01-01

    Based on the results of the studies presented in this thesis it is concluded that minimally invasive surgical treatment of acute AT ruptures with functional after-treatment allows patients to return to their original level of their professional and athletic activities and should be regarded best tre

  1. Acute Achilles tendon rupture Treatment strategies and outcomes

    NARCIS (Netherlands)

    Metz, R.

    2009-01-01

    Based on the results of the studies presented in this thesis it is concluded that minimally invasive surgical treatment of acute AT ruptures with functional after-treatment allows patients to return to their original level of their professional and athletic activities and should be regarded best tre

  2. Complications of plantar fascia rupture associated with corticosteroid injection.

    Science.gov (United States)

    Acevedo, J I; Beskin, J L

    1998-02-01

    From 1992 to 1995, 765 patients with a clinical diagnosis of plantar fasciitis were evaluated by one of the authors. Fifty-one patients were diagnosed with plantar fascia rupture, and 44 of these ruptures were associated with corticosteroid injection. The authors injected 122 of the 765 patients, resulting in 12 of the 44 plantar fascia ruptures. Subjective and objective evaluations were conducted through chart and radiographic review. Thirty-nine of these patients were evaluated at an average 27-month follow-up. Thirty patients (68%) reported a sudden onset of tearing at the heel, and 14 (32%) had a gradual onset of symptoms. In most cases the original heel pain was relieved by rupture. However, these patients subsequently developed new problems including longitudinal arch strain, lateral and dorsal midfoot strain, lateral plantar nerve dysfunction, stress fracture, hammertoe deformity, swelling, and/or antalgia. All patients exhibited diminished tension of the plantar fascia upon examination by the stretch test. Comparison of calcaneal pitch angles in the affected and uninvolved foot showed a statistically significant difference of 3.7 degrees (P = 0.0001). Treatment included NSAIDs, rest or cross-training, stretching, orthotics, and boot-brace immobilization. At an average 27-month follow-up, 50% had good/excellent scores and 50% had fair/poor scores. Recovery time was varied. Ten feet were asymptomatic by 6 months post rupture, four feet by 12 months post rupture, and 26 feet remained symptomatic 1 year post rupture. Our findings demonstrate that plantar fascia rupture after corticosteroid injection may result in long-term sequelae that are difficult to resolve.

  3. Acute acalculous cholecystitis complicating chemotherapy for acute myeloblastic leukemia

    Directory of Open Access Journals (Sweden)

    Olfa Kassar

    2015-01-01

    Full Text Available Acute acalculous cholecystitis is a rare complication in the treatment of acute myeloblastic leukemia. Diagnosis of acute acalculous cholecystitis remains difficult during neutropenic period. We present two acute myeloblastic leukemia patients that developed acute acalculous cholecystitis during chemotherapy-induced neutropenia. They suffered from fever, vomiting and acute pain in the epigastrium. Ultrasound demonstrated an acalculous gallbladder. Surgical management was required in one patient and conservative treatment was attempted in the other patient. None treatment measures were effective and two patients died. Acute acalculous cholecystitis is a serious complication in neutropenic patients. Earlier diagnosis could have expedited the management of these patients.

  4. Nonoperative dynamic treatment of acute achilles tendon rupture

    DEFF Research Database (Denmark)

    Barfod, Kristoffer Weisskirchner; Bencke, Jesper; Bloch Lauridsen, Hanne

    2014-01-01

    BACKGROUND: Dynamic rehabilitation has been suggested to be an important part of nonoperative treatment of acute Achilles tendon rupture that results in functional outcome and rerupture rates comparable with those of operative treatment. However, the optimal role of weight-bearing during early...... rehabilitation remains unclear. The purpose of this study was to compare immediate weight-bearing with non-weight-bearing in a nonoperative dynamic treatment protocol for Achilles tendon rupture. METHODS: The study was conducted as a blinded, randomized, controlled, parallel superiority trial. Patients eighteen...... to sixty years of age were eligible for inclusion. Both groups were treated nonoperatively with controlled early motion. The intervention group was allowed full weight-bearing from day one, and the control group was non-weight-bearing for six weeks. The primary outcome was the Achilles tendon Total Rupture...

  5. Percutaneous Repair Technique for Acute Achilles Tendon Rupture with Assistance of Kirschner Wire.

    Science.gov (United States)

    He, Ze-yang; Chai, Ming-xiang; Liu, Yue-ju; Zhang, Xiao-ran; Zhang, Tao; Song, Lian-xin; Ren, Zhi-xin; Wu, Xi-rui

    2015-11-01

    The aim of this study is to introduce a self-designed, minimally invasive technique for repairing an acute Achilles tendon rupture percutaneously. Comparing with the traditional open repair, the new technique provides obvious advantages of minimized operation-related lesions, fewer wound complications as well as a higher healing rate. However, a percutaneous technique without direct vision may be criticized by its insufficient anastomosis of Achilles tendon and may also lead to the lengthening of the Achilles tendon and a reduction in the strength of the gastrocnemius. To address the potential problems, we have improved our technique using a percutaneous Kirschner wire leverage process before suturing, which can effectively recover the length of the Achilles tendon and ensure the broken ends are in tight contact. With this improvement in technique, we have great confidence that it will become the treatment of choice for acute Achilles tendon ruptures. © 2015 Chinese Orthopaedic Association and Wiley Publishing Asia Pty Ltd.

  6. Acute pancreatitis and acute renal failure complicating doxylamine succinate intoxication.

    Science.gov (United States)

    Lee, Yang Deok; Lee, Soo Teik

    2002-06-01

    Doxylamine succinate is an antihistaminic drugwith additional hypnotic, anticholinergic and local anesthetic effects first described in 1948. In Korea and many other countries, it is a common-over-the counter medication frequently involved in overdoses. Clinical symtomatology of doxylamine succinate overdose includes somnolence, coma, seizures, mydriasis, tachycardia, psychosis, and rhabdomyolysis. A serious complication may be rhabdomyolysis with subsequent impairment of renal function and acute renal failure. We report a case of acute renal failure and acute pancreatitis complicating a doxylamine succinate intoxication.

  7. Augmented Versus Nonaugmented Repair of Acute Achilles Tendon Rupture: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Zhang, Yi-Jun; Zhang, Chi; Wang, Quan; Lin, Xiang-Jin

    2017-04-01

    Although simple end-to-end repair of the Achilles tendon is common, many augmented repair protocols have been implemented for acute Achilles tendon rupture. However, whether augmented repair is better than nonaugmented repair of an acute Achilles tendon rupture is still unknown. To conduct a meta-analysis to determine whether augmented surgical repair of an acute Achilles tendon rupture improved subjective patient satisfaction without an increase in rerupture rates. Secondary outcomes assessed included infections, ankle range of motion, calf muscle strength, and minor complications. Meta-analysis. A systematic literature search of peer-reviewed articles was conducted to identify all randomized controlled trials (RCTs) comparing augmented repair and nonaugmented repair for acute Achilles tendon rupture from January 1980 to August 2016 in the electronic databases of PubMed, Web of Science (SCI-E/SSCI/A&HCI), and EMBASE. The keywords (Achilles tendon rupture) AND (surg* OR operat* OR repair* OR augment* OR non-augment* OR end-to-end OR sutur*) were combined, and results were limited to human RCTs and controlled clinical trials published in the English language. Four RCTs involving 169 participants were eligible for inclusion; 83 participants were treated with augmented repair and 86 were treated with nonaugmented repair. Augmented repair led to similar responses when compared with nonaugmented repair for acute Achilles tendon rupture (93% vs 90%, respectively; P = .53). The rerupture rates showed no significant difference for augmented versus nonaugmented repair (7.2% vs 9.3%, respectively; P = .69). No differences in superficial and deep infections occurred in augmented (7 infections) and nonaugmented (8 infections) repair groups during postoperative follow-up ( P = .89). The average incisional infection rate was 8.4% with augmented repair and 9.3% with nonaugmented repair. No significant differences in other complications were found between augmented (7.2%) and

  8. Myocardial infarction with ventricular septal rupture complicating elective aortic valve replacement.

    Science.gov (United States)

    Milhous, J Gerrit-Jan; Heijmen, Robin H; Ball, Egbert T; Plokker, H W Thijs

    2006-07-01

    Herein is described the case of a 79-year-old woman who underwent elective aortic valve replacement. The procedure was complicated by a particulate embolism into the left anterior descending artery leading to a myocardial infarction, complicated by ventricular septal rupture. Subsequently, the patient was reoperated on and the septal defect closed successfully, with an uneventful recovery.

  9. Acute longitudinal ligament rupture following acute spinal trauma

    Directory of Open Access Journals (Sweden)

    Donald Hansom

    2014-06-01

    Full Text Available The authors present a rare case of anterior longitudinal ligament (ALL rupture in a 47- year-old gentleman following a bicycle accident. The ALL is a continuous band of a variable thickness that acts as a primary spinal stabiliser. Stress, strain or rupture of the ALL usually occurs as a result of hyperextension, with the primary perpetrator being whiplash injuries. Such injuries have been shown to result in cervical spine instability during extension, axial rotation, and lateral bending modes. Spine radiographs of such patients may be routinely assessed as normal, therefore this specific type of injury does not lend itself to identification by traditional imaging methods. This account demonstrates the importance of having a high index of suspicion of a ligamentous neck injury in the setting of normal plain radiographs but abnormal clinical examination.

  10. Pathophysiology of pulmonary complications of acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    George W Browne; CS Pitchurnoni

    2006-01-01

    Acute pancreatitis in its severe form is complicated by multiple organ system dysfunction, most importantly by pulmonary complications which include hypoxia,acute respiratory distress syndrome, atelectasis, and pleural effusion. The pathogenesis of some of the above complications is attributed to the production of noxious cytokines. Clinically significant is the early onset of pleural effusion, which heralds a poor outcome of acute pancreatitis. The role of circulating trypsin, phospholipase A2, platelet activating factor, release of free fatty acids,chemoattractants such as tumor necrsosis factor (TNF)-alpha, interleukin (IL)-1, IL-6, IL-8, fMet-leu-phe (a bacterial wall product), nitric oxide, substance P, and macrophage inhibitor factor is currently studied. The hope is that future management of acute pancreatitis with a better understanding of the pathogenesis of lung injury will be directed against the production of noxious cytokines.

  11. Nonoperative, dynamic treatment of acute achilles tendon rupture

    DEFF Research Database (Denmark)

    Barfod, Kristoffer Weisskirchner; Bencke, Jesper; Lauridsen, Hanne Bloch

    2015-01-01

    Acute Achilles tendon rupture alters the biomechanical properties of the plantar flexor muscle-tendon complex that can affect functional performance and the risk of repeat injury. The purpose of the present study was to compare the biomechanical properties of the plantar flexor muscle-tendon...... complex in patients randomized to early weightbearing or non-weightbearing in the nonoperative treatment of Achilles tendon rupture. A total of 60 patients were randomized to full weightbearing from day 1 of treatment or non-weightbearing for 6 weeks. After 6 and 12 months, the peak passive torque at 20......° dorsiflexion, the stiffness during slow stretching, and the maximal strength were measured in both limbs. The stiffness of the plantar flexor muscle-tendon complex in the terminal part of dorsiflexion was significantly increased (p = .024) in the non-weightbearing group at 12 months. The peak passive torque...

  12. Acute Central Nervous System Complications in Pediatric Acute Lymphoblastic Leukemia.

    Science.gov (United States)

    Baytan, Birol; Evim, Melike Sezgin; Güler, Salih; Güneş, Adalet Meral; Okan, Mehmet

    2015-10-01

    The outcome of childhood acute lymphoblastic leukemia has improved because of intensive chemotherapy and supportive care. The frequency of adverse events has also increased, but the data related to acute central nervous system complications during acute lymphoblastic leukemia treatment are sparse. The purpose of this study is to evaluate these complications and to determine their long term outcome. We retrospectively analyzed the hospital reports of 323 children with de novo acute lymphoblastic leukemia from a 13-year period for acute neurological complications. The central nervous system complications of leukemic involvement, peripheral neuropathy, and post-treatment late-onset encephalopathy, and neurocognitive defects were excluded. Twenty-three of 323 children (7.1%) suffered from central nervous system complications during acute lymphoblastic leukemia treatment. The majority of these complications (n = 13/23; 56.5%) developed during the induction period. The complications included posterior reversible encephalopathy (n = 6), fungal abscess (n = 5), cerebrovascular lesions (n = 5), syndrome of inappropriate secretion of antidiuretic hormone (n = 4), and methotrexate encephalopathy (n = 3). Three of these 23 children (13%) died of central nervous system complications, one from an intracranial fungal abscess and the others from intracranial thrombosis. Seven of the survivors (n = 7/20; 35%) became epileptic and three of them had also developed mental and motor retardation. Acute central neurological complications are varied and require an urgent approach for proper diagnosis and treatment. Collaboration among the hematologist, radiologist, neurologist, microbiologist, and neurosurgeon is essential to prevent fatal outcome and serious morbidity. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Repair of acute Achilles tendon ruptures using Lynn method

    Directory of Open Access Journals (Sweden)

    Tolga Tolunay

    2013-09-01

    Full Text Available Objectives: Efficiency assessment of Lynn method onopen primary repair of acute Achilles tendon ruptures.Methods: Data were evaluated from 19 patients whotreated with the Lynne method due to acute Achilles tendonrupture. Average follow-up length was 12.3 months(range 8-15 months. Dominant side was the right sideby all patients and all patients were males. Plantaris tendonaugmentation was applied after end-to-end repair bymodified Kessler suture technique.Results: The mean postoperative AOFAS score (TheAmerican Orthopaedic Foot and Ankle Society hindfootclinical outcome scores was 93.5 (range 82-100. Theaverage of Achilles tendon postoperative assessmentscore, as developed by Thermann and colleagues, was93.3. Both assessment scores were between 90-100 andwere evaluated as very good. None of the patients developedpost-operative wound infection. The Thompson testwas negative on all patients and bilateral motor strengthwas 5/5.Conclusion: Lynn method, especially in young and activepatients with acute Achilles tendon rupture is a methodthat should be considered in treatment protocols.Key words: Achilles tendon, Lynn method, AOFAS score

  14. Outcomes of acute Achilles tendon rupture repair with bone marrow aspirate concentrate augmentation.

    Science.gov (United States)

    Stein, Benjamin E; Stroh, David Alex; Schon, Lew C

    2015-05-01

    Optimal treatment of acute Achilles tendon ruptures remains controversial. Positive results using stem-cell-bearing concentrates have been reported with other soft-tissue repairs, but no studies exist on outcomes of bone marrow aspirate concentrate (BMAC) augmentation in primary Achilles tendon repair. We reviewed patients with sport-related Achilles tendon ruptures treated via open repair augmented with BMAC injection from 2009 to 2011. Data on operative complications, strength, range of motion, rerupture, calf circumference and functional improvement through progressive return to sport and the Achilles tendon Total Rupture Score (ATRS) were analysed. A total of 27 patients (28 tendons) treated with open repair and BMAC injection were identified (mean age 38.3 ± 9.6 years). At mean follow-up of 29.7 ± 6.1 months, there were no reruptures. Walking without a boot was at 1.8 ± 0.7 months, participation in light activity was at 3.4 ± 1.8 months and 92% (25 of 27) of patients returned to their sport at 5.9 ± 1.8 months. Mean ATRS at final follow-up was 91 (range 72-100) points. One case of superficial wound dehiscence healed with local wound care. No soft-tissue masses, bone formation or tumors were observed in the operative extremity. Excellent results, including no re-ruptures and early mobilisation, were observed in this small cohort with open Achilles tendon repair augmented by BMAC. No adverse outcomes of biologic treatment were observed with this protocol. The efficacy of BMAC in the operative repair of acute Achilles tendon ruptures warrants further study. IV - Therapeutic.

  15. Acute complicated diverticulitis managed by laparoscopic lavage

    DEFF Research Database (Denmark)

    Alamili, Mahdi; Gögenur, Ismail; Rosenberg, Jacob

    2009-01-01

    PURPOSE: The classic surgical treatment of acute complicated sigmoid diverticulitis with peritonitis is often a two-stage operation with colon resection and a temporary stoma. This approach is associated with high mortality and morbidity and the reversal of the stoma is in many cases not performed...... searched. RESULTS: Eight studies met the inclusion criteria and reported 213 patients with acute complicated diverticulitis managed by laparoscopic lavage. None of these studies were randomized. The patients' mean age was 59 years and most patients had Hinchey Grade 3 disease. All patients were treated...

  16. Acute gastrointestinal complications after cardiac surgery.

    Science.gov (United States)

    Halm, M A

    1996-03-01

    Gastrointestinal problems, with an incidence of about 1%, may complicate the postoperative period after cardiovascular surgery, increasing morbidity, length of stay, and mortality. Several risk factors for the development of these complications, including preexisting conditions; advancing age; surgical procedure, especially valve, combined bypass/valve, emergency, reoperative, and aortic dissection repair; iatrogenic conditions; stress; ischemia; and postpump complications, have been identified in multiple research studies. Ischemia is the most significant of these risk factors after cardiovascular surgery. Mechanisms that have been implicated include longer cardiopulmonary bypass and aortic cross-clamp times and hypoperfusion states, especially if inotropic or intra-aortic balloon pump support is required. These risk factors have been linked to upper and lower gastrointestinal bleeding, paralytic ileus, intestinal ischemia, acute diverticulitis, acute cholecystitis, hepatic dysfunction, hyperamylasemia, and acute pancreatitis. Gastrointestinal bleeding accounts for almost half of all complications, followed by hepatic dysfunction, intestinal ischemia, and acute cholecystitis. Identification of these gastrointestinal complications may be difficult because manifestations may be masked by postoperative analgesia or not reported by patients because they are sedated or require prolonged mechanical ventilation. Furthermore, clinical manifestations may be nonspecific and not follow the "classic" clinical picture. Therefore, astute assessment skills are needed to recognize these problems in high-risk patients early in their clinical course. Such early recognition will prompt aggressive medical and/or surgical management and therefore improve patient outcomes for the cardiovascular surgical population.

  17. Severe renal bleeding caused by a ruptured renal sheath: case report of a rare complication of percutaneous nephrolithotomy

    Directory of Open Access Journals (Sweden)

    Gunes Ali

    2002-09-01

    Full Text Available Abstract Background Percutaneous nephrolithotomy is a minimally invasive intervention for renal stone disease. Complications, which are rare and usually presented as case reports, are diversified as the utilization of the procedure is expanded. The procedure causes less blood loss and less morbidity when compared to open surgical procedures. Yet, there are some reports involving severe bleeding and relevant morbidity during surgery. These are usually related with the surgical technique or experience of the surgeon. Renal sheaths are designed to cause minimal trauma inside the kidney and, to our knowledge, there are no reports presenting the rupture of a sheath causing severe bleeding during the procedure. Case report We present an adult patient who had severe bleeding during percutaneous nephrolithotomy due to parenchymal injury caused by a ruptured renal sheath. During retrieval, due probably to rough handling of the equipment, a piece of stone with serrated edges ruptured the tip of the sheath, and this tip caused damage inside the kidney. The operation was terminated and measures were taken to control bleeding. The patient was transfused with a total of 1600 ml of blood, and the stones were cleared in a second look operation. Conclusion Although considered to be a minimally invasive procedure, some unexpected complications may arise during percutaneous nephrolithotomy. After being fragmanted, stone pieces may damage surgical equipment, causing acute and severe harm to the kidney. Surgeons must manipulate the equipment with fine and careful movements in order to prevent this situation.

  18. Acute Compartment Syndrome After Gastrocnemius Rupture (Tennis Leg) in a Nonathlete Without Trauma.

    Science.gov (United States)

    Tao, Li; Jun, Huang; Muliang, Ding; Deye, Song; Jiangdong, Ni

    2016-01-01

    Acute compartment syndrome is a serious emergency that warrants urgent decompression, and tennis leg (i.e., rupture of the medial head of the gastrocnemius) is a known clinical condition that is usually treated symptomatically, with good results overall. In rare cases, acute compartment syndrome is associated with tennis leg after severe direct muscle trauma or severe exercise in athletes or physically active individuals. We present an unusual case of acute compartment syndrome secondary to tennis leg after the patient, a nonathlete, had disembarked from a truck without any trauma. Clinicians should have a high index of suspicion for atraumatic compartment syndrome, and timely surgical fasciotomy must be undertaken to avoid complications resulting from delayed diagnosis and treatment.

  19. Antibiotic Duration After Laparoscopic Appendectomy for Acute Complicated Appendicitis

    NARCIS (Netherlands)

    Rossem, C.C. van; Schreinemacher, M.H.; Geloven, A.A. van; Bemelman, W.A.; Goor, H. van; Knaapen, L.

    2016-01-01

    IMPORTANCE: Optimal duration of antibiotic treatment to reduce infectious complications after an appendectomy for acute complicated appendicitis remains unclear. OBJECTIVE: To investigate the effect of antibiotic duration on infectious complications after laparoscopic appendectomy for acute complica

  20. An unreported complication of acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    G Muthukumarasamy; V Shanmugam; SR Yule; R Ravindran

    2007-01-01

    Acute pancreatitis constitutes 3% of all admissions with abdominal pain. There are reports of osteal fat necrosis leading to periosteal reactions and osteolytic lesions following severe pancreatitis, particularly in long bones.A 54-year-old man was admitted to our hospital with acute pancretitis, who later developed spinal discitis secondary to necrotizing pancreatitis. He was treated conservatively with antibiotics and after a month he recovered completely without any neurological deficit.This case is reported for its unusual and unreported spinal complications after acute pancreatitis.

  1. Spontaneous Spleen Rupture in a Teenager: An Uncommon Cause of Acute Abdomen

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    Verroiotou Maria

    2013-01-01

    Full Text Available Spontaneous spleen rupture is a rare complication of infectious diseases and it can become a potentially life-threatening condition if not diagnosed in time. A 17-year-old Greek female presented to the ER due to acute abdominal pain, mainly of the left upper quadrant. She had no recent report of trauma. The patient was pale, her blood pressure was 90/70 mmHg, and her pulse was 120 b/min. Clinical examination of the abdomen revealed muscle contraction and resistance. The patient was submitted to an ultrasound of the upper abdomen and to a CT scanning of the abdomen that revealed an extended intraperitoneal hemorrhage due to spleen rupture. Due to the patient’s hemodynamic instability, she was taken to the operation room and splenectomy was performed. Following a series of laboratory examinations, the patient was diagnosed to be positive for current cytomegalovirus infection. The postoperative course was uneventful, and in a two year follow-up the patient is symptom-free. Spontaneous spleen rupture due to Cytomegalovirus infection is a rare clinical entity, described in few case reports in the world literature and should always be taken into consideration in differential diagnosis of acute abdomen, especially in adolescents with no recent report of trauma.

  2. Acute Achilles tendon rupture: minimally invasive surgery versus non operative treatment, with immediate full weight bearing. Design of a randomized controlled trial

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    Verleisdonk Egbert-Jan MM

    2007-11-01

    Full Text Available Abstract Background We present the design of an open randomized multi-centre study on surgical versus conservative treatment of acute Achilles tendon ruptures. The study is designed to evaluate the effectiveness of conservative treatment in reducing complications when treating acute Achilles tendon rupture. Methods/Design At least 72 patients with acute Achilles tendon rupture will be randomized to minimally invasive surgical repair followed by functional rehabilitation using tape bandage or conservative treatment followed by functional rehabilitation with use of a functional bracing system. Both treatment arms use a 7 weeks post-rupture rehabilitation protocol. Four hospitals in the Netherlands will participate. Primary end-point will be reduction in complications other than re-rupture. Secondary end-point will be re-rupturing, time off work, sporting activity post rupture, functional outcome by Leppilahti score and patient satisfaction. Patient follow-up will be 12 month. Discussion By making this design study we wish to contribute to more profound research on AT rupture treatment and prevent publication bias for this open-labelled randomized trial. Trial registration ISRCTN50141196

  3. ICAM-1 and Acute Pancreatitis Complicated by Acute Lung Injury

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    XiPing Zhang

    2009-01-01

    Full Text Available One of the most common complications of acute pancreatitis is acute lung injury, during which intercellular adhesion molecule-1 (ICAM-1 plays an important role by participating in leukocyte adhesion and activation as well as by inducing the “cascade effect” of inflammatory mediators, pulmonary microcirculation dysfunction and even acute respiratory distress syndrome, multiple organ failure or death. Although it is generally believed that the modulatory mechanism of ICAM-1 during this process is associated with the activation of nuclear transcription factor kappa B which is mediated by IL-1, IL-6, IL-18 and oxygen free radical, etc., further studies are still required to clarify it. Since the upregulation of ICAM-1 expression in the lung during acute lung injury is one of main pathogeneses, the early detection of the ICAM-1 expression level may contribute to the prevention and treatment of acute lung injury. Moreover, reducing pulmonary ICAM-1 expression levels through treatment with anti-ICAM-1 monoclonal antibody (aICAM-1 and antagonists of the neurokinin 1 receptor, etc., should have a positive effect on protecting the lungs during acute pancreatitis. This review aims to further clarify the relationship between ICAM-1 and acute pancreatitis complicated by acute lung injury, and therefore provides a theoretical basis for the formulation of corresponding therapeutic measures in clinical practice for acute pancreatitis.

  4. Treatment of Acute Achilles Tendon Rupture in Scandinavia Does Not Adhere to Evidence-based Guidelines

    DEFF Research Database (Denmark)

    Barfod, Kristoffer W; Nielsen, Fredrik; Helander, Katarina N;

    2013-01-01

    and that adherence to evidence-based recommendations would not be as good as desired. The purpose of the present study was to investigate how acute Achilles tendon rupture is treated in Scandinavia. A questionnaire was distributed to all orthopedic departments treating acute Achilles tendon ruptures in Denmark...

  5. Biomarkers for the prediction of acute ongoing arterial plaque rupture

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    Guo YL

    2013-07-01

    Full Text Available Yuan-Lin Guo, Jian-Jun Li Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China Abstract: Acute coronary syndrome (ACS is the main cause of mortality for coronary artery disease (CAD. Accordingly, earlier detection and diagnosis might be a key point for reducing the mortality in patients with ACS. One promising strategy is biomarker measurement in patients with ACS. Biomarkers are generally considered to be plasma measurements of molecules, proteins, or enzymes that provide independent diagnostic and prognostic values that can reflect underlying disease state and condition, especially repeated measurements. Nowadays, the most widely used biomarkers to identify or predict ACS are high sensitivity C-reactive protein (hs-CRP and high sensitivity troponin T/I (hs-TnT/I. The aim of the present review was principally to summarize recent evidence regarding some new biomarkers by which we could directly predict acute ongoing arterial plaque rupture, which may help to identify at-risk patients earlier than hs-CRP or hs-TnT/I. Keywords: matrix metalloproteinase-9, lipoprotein associated phospholipase A2, myeloperoxidase, soluble lectin-like oxidized low-density lipoprotein receptor-1, pregnancy-associated plasma protein A, placental growth factor, acute coronary syndrome

  6. Acute pericarditis and renal failure complicating acute hepatitis A infection.

    Science.gov (United States)

    Beyazit, Yavuz; Guven, Gulay Sain; Kekilli, Murat; Koklu, Seyfettin; Yolcu, Omer Faruk; Shorbagi, Ali

    2006-01-01

    Hepatitis A infection may result in acute hepatitis, and rarely, fulminant hepatitis may ensue. Extrahepatic manifestations of hepatitis A are uncommon. The authors present the case of a 77-year-old male who had development of acute renal failure and pericarditis during the clinical course of acute hepatitis A infection. He died as a result of septic shock on the fifth day of hospitalization. To the best of our knowledge, this is the first report of both these rare and serious complications appearing in the same patient.

  7. [Two Cases of Ruptured Cerebral Aneurysm Complicated with Delayed Coil Protrusion after Coil Embolization].

    Science.gov (United States)

    Furukawa, Takashi; Ogata, Atsushi; Ebashi, Ryo; Takase, Yukinori; Masuoka, Jun; Kawashima, Masatou; Abe, Tatsuya

    2016-07-01

    We report two cases of delayed coil protrusion after coil embolization for ruptured cerebral aneurysms. Case 1:An 82-year-old woman with a subarachnoid hemorrhage due to a ruptured small anterior communicating artery aneurysm underwent successful coil embolization. Eighteen days after the procedure, coil protrusion from the aneurysm into the right anterior cerebral artery was observed without any symptoms. Further coil protrusion did not develop after 28 days. Case 2:A 78-year-old woman with a subarachnoid hemorrhage due to a ruptured small left middle cerebral artery aneurysm underwent successful coil embolization. Twenty days after the procedure, coil protrusion from the aneurysm into the left middle cerebral artery was observed, with a transient ischemic attack. Further coil protrusion did not develop. Both patients recovered with antithrombotic treatment. Even though delayed coil protrusion after coil embolization is rare, it should be recognized as a long-term complication of coil embolization for cerebral aneurysms.

  8. Surgical versus conservative treatment following acute rupture of the Achilles tendon: is there a pedobarographic difference?

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    Karaaslan F

    2016-08-01

    Full Text Available Fatih Karaaslan,1 Musa Uğur Mermerkaya,1 Alper Çıraklı,2 Sinan Karaoğlu,3 Fuat Duygulu21Department of Orthopaedics and Traumatology, Faculty of Medicine, Bozok University, Yozgat, Turkey; 2Department of Orthopaedics and Traumatology, Kayseri Training Hospital, Kayseri, Turkey; 3Department of Orthopaedics and Traumatology, Memorial Kayseri Hospital, Kayseri, TurkeyIntroduction: Controversy remains regarding the optimal treatment method and postoperative rehabilitation of acute Achilles tendon ruptures. In this study, pedobarographic assessments of surgical and conservative treatments were compared.Material and methods: A prospective assessment was made of 16 patients (eight surgical, eight conservative and eight healthy controls using a plantar pressure measurement system. Biomechanical gait parameters were obtained using the Footscan dynamic gait analysis system. Kruskal–Wallis and Mann–Whitney U-tests were used for the evaluation of data.Results: Nineteen males and five females were assessed, with an average age of 42.0±11.9 years. Follow-up was completed in 16 patients. No statistically significant difference was determined between the two treatment groups with regard to the gait analysis, but a difference was observed with the control group (P<0.001. All patients were able to resume their prior activities after 6 months and regained normal ranges of motion, with a high rate of satisfaction. Most of the patients (75% were able to return to their pre-injury level of activities.Conclusion: Satisfactory results were obtained through conservative treatment of acute ruptures of the Achilles tendon. No significant differences or complications were observed in the group managed conservatively versus the group treated surgically. Further studies including 3D gait analyses and tendon biomechanical research are required to further investigate this issue.Keywords: Achilles tendon, acute rupture, pedobarographic analysis

  9. Acute complicated pyelonephritis: contrast-enhanced ultrasound.

    Science.gov (United States)

    Fontanilla, Teresa; Minaya, Javier; Cortés, Cristina; Hernando, Concepción González; Arangüena, Rafael Pérez; Arriaga, Jesús; Carmona, Maria Soledad; Alcolado, Ana

    2012-08-01

    Imaging is required if complication is suspected in acute pyelonephritis to assess the nature and extent of the lesions, and to detect underlying causes. The current imaging modality of choice in clinical practice is computed tomography. Because of associated radiation and potential nephrotoxicity, CEUS is an alternative that has been proven to be equally accurate in the detection of acute pyelonephritis renal lesions. The aims of this study of 48 patients are to describe in detail the CEUS findings in acute pyelonephritis, and to determine if abscess and focal pyelonephritis may be distinguished. Very characteristic morphologic and temporal patterns of enhancement are described. These allow differentiation of focal pyelonephritis from renal abscess, and detection of tiny suppurative foci within focal pyelonephritis. The detection of abscesses is important because follow-up in 25 patients revealed a longer clinical course. Typical pyelonephritis CEUS features permit distinction from other renal lesions. As a whole, CEUS is an excellent tool in the work-up of complicated acute pyelonephritis, so it may be considered as the imaging technique of choice in the evaluation and follow-up of these patients who frequently are very young, so as to minimise radiation exposure.

  10. ACUTE SYMPTOMS AND COMPLICATIONS OF HEMODIALYSIS

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    Bárbara Paula Magalhães de Deus

    2015-07-01

    Full Text Available Backgound and Objectives: Chronic Kidney Disease and the number of patients on renal replacement therapies have become more frequent in recent decades. Even with new technologies used in hemodialysis, which result in greater patient safety, acute symptoms and complications after the procedure may still occur. Recognizing these complications and knowing how to manage them is crucial to ensure a better quality of life for these patients. Content: This is a literature search on symptoms related to hemodialysis, carried out in electronic databases: Periodicals CAPES (Coordination of Higher Education Personnel Training, Brazil, Scientific Electronic Library Online - SciELO, LILACS and Pubmed, from which 30 articles were selected on the main complications observed and described during the course of hemodialysis. Conclusion: There was a prevalence of symptoms related to fluid and electrolyte imbalance and hemodynamic changes, especially headache. KEYWORDS: Renal Insufficiency Chronic; Symptoms; Renal Dialysis.

  11. The Effectiveness of Open Repair Versus Percutaneous Repair for an Acute Achilles Tendon Rupture.

    Science.gov (United States)

    Krueger, Heidi; David, Shannon

    2016-12-01

    Clinical Scenario: There are 2 approaches available for surgical repair of the Achilles tendon: open or percutaneous. However, there is controversy over which repair is superior. Focused Clinical Question: Which type of surgery is better in providing the best overall patient outcome, open or percutaneous repair, in physically active men and women with acute Achilles tendon ruptures? Summary of Search, "Best Evidence" Appraised, and Key Findings: The literature was searched for studies of level 3 evidence or higher that investigated the effectiveness of open repair versus percutaneous repair on acute Achilles tendon ruptures in physically active men and women. The literature search resulted in 3 studies for possible inclusion. All 3 good-quality studies were included. Clinical Bottom Line: There is supporting evidence to indicate that percutaneous repair is the best option for Achilles tendon surgery when it comes to the physically active population. Percutaneous repair has faster surgery times, less risk of complications, and faster recovery times over having an open repair, although it is acknowledged that every patient has a different situation and best individual option may vary patient to patient.

  12. [Cardiac rupture in acute myocardial infarct. Presentation of 20 postmortem cases].

    Science.gov (United States)

    Cruz, H; Cruz, J C; Badui, E; Galindo, M E; Solorio, S; Bojorges, R

    1997-01-01

    With the advancement of the Coronary Care Units in the past three decades, there had been an important reduction in mortality secondary to arrhythmias in acute myocardial infarction (AMI): been now days, cardiogenic shock and cardiac rupture the first and second causes of in-hospital death in these patients. The purpose of this report is to know the anatomoclinical characteristics in our hospital of cardiac rupture and to look for risk factors that may be considered to diagnose at the precise time this complication that might cause sudden death secondary to hemodynamic and electromechanical changes. From 300 postmortem cases with AMI proved clinical, and by anatomopathological studies, 20 cases with cardiac rupture were obtained, among which: 11 (55%) were males with an average age of 61.7 years and 9 (45%) females, with an average age of 60 years. The following coronary risk factors were detected: systemic hypertension in 15 (75%) cases; cigarette smoking in 13 (65%) cases and diabetes mellitus in 11 (55%) cases. Long lasting or recurrent history of chest pain previous to death was present in 14 (70%) cases. Conduction disturbances were detected in 13 (65%) cases; among them, 7 (35%) had third degree heart block in whom permanent pacemaker was inserted; 4 (20%) had CRBBB and 2 (10%) ASB. The average heart weight was 478 gr. in males and 434 gr. in females. Evidence of an old MI was present in 7 (35%) cases. All patients had transmural MI. Free cardiac wall rupture was seen in 14 (70%) cases and from the ventricular septum, 6 (30%) cases. Hemopericardium was present in all cases (100%) with an average amount of 425 ml of blood. Pericarditis in 3 (15%). The average time of evolution since the beginning of the AMI until death were 4 days and the main causes of death were cardiogenic shock in 17 (85%) and congestive heart failure in 3 (15%).

  13. Intracranial hemorrhage from undetected aneurysmal rupture complicating transphenoidal pituitary adenoma resection.

    Science.gov (United States)

    Rustagi, Tarun; Uy, Edilfavia Mae; Rai, Mridula; Kannan, Subramanian; Senatus, Patrick

    2011-08-01

    We report a case of a 39-year-old man who presented with a nonfunctioning pituitary macroadenoma which extended into the suprasellar region. He underwent a transcranial resection of the tumor followed eight months later by transsphenoidal surgery for the residual tumor. Postoperatively he developed massive subarachnoid and intraventricular hemorrhage. A cerebral angiogram revealed a leaking anterior communicating artery aneurysm which was not seen on the computed tomography angiography and magnetic resonance angiography before the surgery. Complications of transsphenoidal surgery, particularly vascular hemorrhagic complications, and risk of rupture of undetected aneurysms are discussed.

  14. [Complicated acute apendicitis. Open versus laparoscopic surgery].

    Science.gov (United States)

    Gil Piedra, Francisco; Morales García, Dieter; Bernal Marco, José Manuel; Llorca Díaz, Javier; Marton Bedia, Paula; Naranjo Gómez, Angel

    2008-06-01

    Although laparoscopy has become the standard approach in other procedures, this technique is not generally accepted for acute appendicitis, especially if it is complicated due reports on the increase in intra-abdominal abscesses. The purpose of this study was to evaluate the morbidity in a group of patients diagnosed with complicated apendicitis (gangrenous or perforated) who had undergone open or laparoscopic appendectomy. We prospectively studied 107 patients who had undergone appendectomy for complicated appendicitis over a two year period. Mean operation time, mean hospital stay and morbidity, such as wound infection and intra-abdominal abscess were evaluated. In the group with gangrenous appendicitis morbidity was significantly lower in laparoscopic appendectomy group (p = 0.014). Wound infection was significantly higher in the open appendectomy group (p = 0.041), and there were no significant differences in intra-abdominal abscesses (p = 0.471). In the perforated appendicitis group overall morbidity (p = 0.046) and wound infection (p = 0.004) was significantly higher in the open appendectomy group. There were no significant differences in intra-abdominal abscesses (p = 0.612). These results suggest that laparoscopic appendectomy for complicated appendicitis is a safe procedure that may prove to have significant clinical advantages over conventional surgery.

  15. Acute tonsillitis and its complications: an overview.

    Science.gov (United States)

    Bartlett, A; Bola, S; Williams, R

    2015-01-01

    Acute tonsillitis may be defined as inflammation of the tonsils, predominantly due to infection. It is part of the spectrum of pharyngitis, which ranges from localised tonsillar infection to generalised infection of the pharynx and commonly affects young healthy adults. Simple sore throats secondary to viral or bacterial pharyngitis are very common and generally do not require hospital admission or antimicrobial treatment. Supportive management in the form of analgesia and adequate hydration is often sufficient. However, there is potential for life-threatening complications to develop, highlighting the need for basic knowledge in the management of these conditions. This article aims to provide an overview of acute tonsillitis and its complications, including peritonsillar and parapharyngeal abscess formation. Specific attention will be given to the pathogenesis, diagnosis, investigation and management of each condition, in particular advising on emergency pre-shore treatment and indications for referral to an Ear, Nose and Throat Department. We will also summarise important guidelines and evidence from the literature to support these management decisions.

  16. [A case of rupture of the left ventricle free wall with papillary muscle dysfunction following acute myocardial infarction, operated on successfully].

    Science.gov (United States)

    de Lima, R; Perdigão, C; Neves, L; Cravino, J; Dantas, M; Bordalo, A; Pais, F; Diogo, A N; Ferreira, R; Ribeiro, C

    1990-09-01

    The authors present a case of left ventricular free wall rupture post acute myocardial infarction, associated with mitral papillary posterior muscle necrosis, operated by infartectomy and mitral valvular protesis replacement. They refer the various complications occurred during the hospital staying, and discuss its medical and surgical approach. The patient was discharged alive and six months after the infarction keeps a moderate activity.

  17. A Rare Case of Simultaneous Acute Bilateral Quadriceps Tendon Rupture and Unilateral Achilles Tendon Rupture

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    Wei Yee Leong

    2013-07-01

    Full Text Available Introduction: There have been multiple reported cases of bilateral quadriceps tendon ruptures (QTR in the literature. These injuries frequently associated with delayed diagnosis, which results in delayed surgical treatment. In very unusual cases, bilateral QTRs can be associated with other simultaneous tendon ruptures. Case Report: We present a rare case of bilateral QTR with a simultaneous Achilles Tendon Rupture involving a 31 years old Caucasian man who is a semi-professional body builder taking anabolic steroids. To date bilateral QTR with additional TA rupture has only been reported once in the literature and to our knowledge this is the first reported case of bilateral QTR and simultaneous TA rupture in a young, fit and healthy individual. Conclusion: The diagnosis of bilateral QTR alone can sometimes be challenging and the possibility of even further tendon injuries should be carefully assessed. A delay in diagnosis could result in delay in treatment and potentially worse outcome for the patient. Keywords: Quadriceps tendon rupture; Achilles tendon rupture; Bilateral.

  18. Short-term prognosis and risk factors of ventricular septal rupture following acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    胡小莹

    2013-01-01

    Objective To analyze the short-term prognosis and risk factors of ventricular septal rupture(VSR)following acute myocardial infarction(AMI).Methods A total of 70 consecutive VSR patients following AMI hospitalized in

  19. Short-term prognosis and risk factors of ventricular septal rupture following acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    胡小莹

    2013-01-01

    Objective To analyze the short-term prognosis and risk factors of ventricular septal rupture(VSR)following acute myocardial infarction(AMI).Methods A total of 70 consecutive VSR patients following AMI

  20. Surgical Versus Conservative Intervention for Acute Achilles Tendon Rupture: A PRISMA-Compliant Systematic Review of Overlapping Meta-Analyses.

    Science.gov (United States)

    Zhang, Hao; Tang, Hao; He, Qianyun; Wei, Qiang; Tong, Dake; Wang, Chuangfeng; Wu, Dajiang; Wang, Guangchao; Zhang, Xin; Ding, Wenbin; Li, Di; Ding, Chen; Liu, Kang; Ji, Fang

    2015-11-01

    Although many meta-analyses comparing surgical intervention with conservative treatment have been conducted for acute Achilles tendon rupture, discordant conclusions are shown. This study systematically reviewed the overlapping meta-analyses relating to surgical versus conservative intervention of acute Achilles tendon rupture to assist decision makers select among conflicting meta-analyses, and to offer intervention recommendations based on the currently best evidence.Multiple databases were comprehensively searched for meta-analyses comparing surgical with conservative treatment of acute Achilles tendon rupture. Meta-analyses only comprising randomized controlled trials (RCTs) were included. Two authors independently evaluated the meta-analysis quality and extracted data. The Jadad decision algorithm was applied to ascertain which meta-analysis offered the best evidence.A total of 9 meta-analyses were included. Only RCTs were determined as Level-II evidence. The scores of Assessment of Multiple Systematic Reviews (AMSTAR) ranged from 5 to 10 (median 7). A high-quality meta-analysis with more RCTs was selected according to the Jadad decision algorithm. This study found that when functional rehabilitation was used, conservative intervention was equal to surgical treatment regarding the incidence of rerupture, range of motion, calf circumference, and functional outcomes, while reducing the incidence of other complications. Where functional rehabilitation was not performed, conservative intervention could significantly increase rerupture rate.Conservative intervention may be preferred for acute Achilles tendon rupture at centers offering functional rehabilitation, because it shows a similar rerupture rate with a lower risk of other complications when compared with surgical treatment. However, surgical treatment should be considered at centers without functional rehabilitation as this can reduce the incidence of rerupture.

  1. Combined uterine and urinary bladder rupture: an unusual complication of obstructed labor in a primigravida

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    Takai IU

    2016-07-01

    Full Text Available Idris Usman Takai,1 Abdulkadir Abubakar2 1Department of Obstetrics and Gynaecology, 2Department of Surgery, Bayero University/Aminu Kano Teaching Hospital, Kano, Kano State, Nigeria Background: Combined uterine and urinary bladder rupture following prolonged obstructed labor is indeed a momentous uro-obstetric emergency. The urinary bladder involvement is distinctly rare in the absence of factors that predispose the bladder to be adherent to the lower uterine segment and is quite unusual in a primigravida. Objective: To report a rare case of uterine rupture involving urinary bladder secondary to a prolonged obstructed labor in a primigravida from a low resource setting. Case: A 17-year-old married unbooked primigravida who presented with a 3-day history of spontaneous onset of labor at term that was initially managed at home and later in a primary health care center where she had fundal pressure and oxytocin augmentation, respectively. The labor was complicated by combined uterine and urinary bladder rupture with sepsis. She was resuscitated and had exploratory laparotomy with uterine and urinary bladder repair. The postoperative period was uneventful and she was followed-up at the gynecology and family planning clinics. Conclusion: There is a need for community reawakening on the inherent risks of teenage pregnancy, bad obstetric practices, and unsupervised pregnancy, labor, and delivery, particularly in the rural settings as in the index patient. A high index of suspicion and prompt appropriate intervention will reduce the sequel of morbidity and occasional mortality from this predicament. Keywords: uterine rupture, bladder rupture, primigravida, labor

  2. Percutaneous Tenolig(®) repair under intra-operative ultrasonography guidance in acute Achilles tendon rupture.

    Science.gov (United States)

    Lacoste, S; Féron, J M; Cherrier, B

    2014-12-01

    Acute Achilles tendon rupture can be treated conservatively or surgically. Open surgery restores tendon continuity but carries a risk of skin complications. Tenolig(®) is a device designed for the percutaneous biological treatment of acute Achilles tendon rupture. Earlier studies found high rates of recurrent tears and nerve injury after Tenolig(®) repair. We hypothesised that intra-operative ultrasonography during Tenolig(®) repair would decrease the post-operative complication rate and improve functional outcomes. We studied 75 consecutive patients with a mean age of 39.9 years. The injury was sports-related in 82.8% of cases. Mean distance from the calcaneal tendon attachment to the tear was 5cm and mean time from injury to repair was 4.2 days. All patients underwent Tenolig(®) repair under ultrasound guidance followed by early rehabilitation therapy with partial weight bearing started after 3 weeks. Mean follow-up was 20.7 months and no patient was lost to follow-up. A single patient (1.3%) experienced rerupture and none had permanent sural nerve damage. Mean time to sports resumption was 8.6 months, with two-thirds of patients returning to their previous level of sporting activities. The mean AOFAS functional score was 95 and the mean ATRS score was 91.3. Our experience suggests that intra-operative ultrasonography, a non-invasive, widely available, and accurate tool, provided improved control of Tenolig(®) suture position. Ultrasonography provided valuable guidance during this demanding procedure and allowed the very early initiation of rehabilitation therapy. Another crucial factor is patient education about the physical therapy programme. Attention to this point allowed us to obtain robust and reliable functional outcomes in a population predominantly composed of athletes. Level IV. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  3. Repeat acute abdomen and hemoperitoneum during the same pregnancy due to a ruptured ectopic treated by salpingostomy.

    Science.gov (United States)

    Canelas, Caroline M; Shih, Richard D; Clayton, Lisa M; Giroski, Laura J; Alter, Scott M; Feinstein, Stacey; Learman, Lee A

    2017-06-01

    A leading cause of maternal mortality in the first trimester is hemorrhage due to a ruptured ectopic pregnancy. With the advent of tube salvage surgery, ectopic pregnancies can be removed while ensuring hemostasis and preserving the integrity of the fallopian tube. A major drawback of tube salvage surgery is the significant risk of persistent trophoblastic tissue being left behind. We report a case of a 30year old female who presented to the ED with acute abdomen and hemoperitoneum due to a ruptured ectopic pregnancy. She was treated with salpingostomy and the pathologic report confirmed removal of the ectopic pregnancy. After an initially uneventful post-operative recovery, she presented to the ED 27days later with signs of acute abdomen and hemoperitoneum. Surgical intervention confirmed a ruptured ectopic pregnancy in the same site as previous, and salpingectomy was performed, after which the patient recovered without complications. The increased risk of persistent trophoblastic tissue associated with tube salvage surgery can lead to subsequent reoperation for tubal rupture. Patients undergoing these procedures should be closely monitored in the following weeks and undergo serial β-hCG testing in order to confirm successful removal of the ectopic. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Chest radiography in acute traumatic rupture of the thoracic aorta

    Energy Technology Data Exchange (ETDEWEB)

    Heystraten, F.M.; Rosenbusch, G.; Kingma, L.M.; Lacquet, L.K.; Boo, T. de; Lemmens, W.A.

    Of 123 patients who had suffered blunt trauma to the chest traumatic aortic rupture was eventually confirmed in 61 and absent in 62 patients. The chest radiographs of these patients were examined for 15 signs reported in the literature as being associated with traumatic aortic rupture. Although many individual signs were significantly more frequent in the aortic rupture group they were not useful in differentiating between patients with and those without rupture of the aorta. By using discriminant analysis combining 2 or 3 signs, patients were classified as having aortic rupture or not. The best discrimination between the two groups was obtained using the combined signs of a widened paratracheal stripe, and opacified pulmonary window, a widened right paraspinal interface and a displaced nasogastric tube.

  5. Laparoscopic appendectomy for complicated acute appendicitis does not result in increased surgical complications

    Directory of Open Access Journals (Sweden)

    Yueh-Ming Lin

    2012-07-01

    Conclusion: This study demonstrated no increase in surgical complications after LA in patients with complicated acute appendicitis when compared with those who had uncomplicated disease. Therefore, LA may be considered the first-choice treatment option for both uncomplicated and complicated acute appendicitis.

  6. Peritonitis secondary to ruptured splenic abscess:A grave complication of typhoid fever

    Institute of Scientific and Technical Information of China (English)

    Peter George; Ashfaq Ahmed; Roshan Maroli; Leo Francis Tauro

    2012-01-01

    Splenic abscesses are increasingly being identified, possibly due to widespread use of imaging modalities in clinical practice. The commonest clinical features are high grade fever and exclusively localised left upper quadrant abdominal pain. These symptoms are similar to most infectious diseases prevalent in the tropics, making imaging by ultrasonography or computer tomography a necessity in the diagnosis. There are reports from different geographic areas on splenic abscesses associated with typhoid fever. We reported ruptured splenic abscess presenting with peritonitis as a rare and grave complication of typhoid fever.

  7. Peritonitis secondary to ruptured splenic abscess: a grave complication of typhoid fever.

    Science.gov (United States)

    George, Peter; Ahmed, Ashfaq; Maroli, Roshan; Tauro, Leo Francis

    2012-12-01

    Splenic abscesses are increasingly being identified, possibly due to widespread use of imaging modalities in clinical practice. The commonest clinical features are high grade fever and exclusively localised left upper quadrant abdominal pain. These symptoms are similar to most infectious diseases prevalent in the tropics, making imaging by ultrasonography or computer tomography a necessity in the diagnosis. There are reports from different geographic areas on splenic abscesses associated with typhoid fever. We reported ruptured splenic abscess presenting with peritonitis as a rare and grave complication of typhoid fever.

  8. Risk of cardiac rupture after acute myocardial infarction is related to a risk of hemorrhage

    Institute of Scientific and Technical Information of China (English)

    Geng QIAN; Hong-bin LIU; Jin-wen WANG; Chen WU; Yun-dai CHEN

    2013-01-01

    Although cardiac rupture (CR) is a fatal mechanical complication of acute myocardial infarction (AMI),to date no predictive model for CR has been described.CR has common pathological characteristics with major bleeding.We aimed to investigate the relationship between the risk factors of major bleeding and CR.A total of 10202 consecutive AMI patients were recruited,and mechanical complications occurred in 72 patients.AMI patients without CR were chosen as control group.Clinical characteristics including bleeding-related factors were compared between the groups.The incidences of free wall rupture (FWR),ventricular septal rupture (VSR),and papillary muscle rupture (PMR) were 0.39%,0.21%,and 0.09%,respectively,and the hospital mortalities were 92.5%,45.5%,and 10.0%,respectively.Female proportion and average age were significantly higher in the groups of FWR and VSR than in the control group (P<0.01); higher white blood cell count and lower hemoglobin were found in all CR groups (P<0.01).Compared to the control group,patients with CR were more likely to receive an administration of thrombolysis [26.39%vs.13.19%,P<0.05],and were less likely to be treated with primary percutaneous coronary intervention (PCI) [41.67%vs.81.60%,P<0.05].The major bleeding scores (integer scores) of FWR,VSR,and PMR were (17.70±7.24),(21.91±8.33),and (18.60±7.88),respectively,and were significantly higher than that of the control group (11.72±7.71)(P<0.05).A regression analysis identified age,increased heart rate,anemia,higher white blood cell count,and thrombolysis as independent risk factors of CR,most of which were major bleeding-related factors.The patients with CR have a significantly higher risk of hemorrhage compared to the group without CR.Risk of CR after AMI is related to the risk of hemorrhage.

  9. Combined uterine and urinary bladder rupture: an unusual complication of obstructed labor in a primigravida.

    Science.gov (United States)

    Takai, Idris Usman; Abubakar, Abdulkadir

    2016-01-01

    Combined uterine and urinary bladder rupture following prolonged obstructed labor is indeed a momentous uro-obstetric emergency. The urinary bladder involvement is distinctly rare in the absence of factors that predispose the bladder to be adherent to the lower uterine segment and is quite unusual in a primigravida. To report a rare case of uterine rupture involving urinary bladder secondary to a prolonged obstructed labor in a primigravida from a low resource setting. A 17-year-old married unbooked primigravida who presented with a 3-day history of spontaneous onset of labor at term that was initially managed at home and later in a primary health care center where she had fundal pressure and oxytocin augmentation, respectively. The labor was complicated by combined uterine and urinary bladder rupture with sepsis. She was resuscitated and had exploratory laparotomy with uterine and urinary bladder repair. The postoperative period was uneventful and she was followed-up at the gynecology and family planning clinics. There is a need for community reawakening on the inherent risks of teenage pregnancy, bad obstetric practices, and unsupervised pregnancy, labor, and delivery, particularly in the rural settings as in the index patient. A high index of suspicion and prompt appropriate intervention will reduce the sequel of morbidity and occasional mortality from this predicament.

  10. Acute phlegmonous gastritis complicated by delayed perforation.

    Science.gov (United States)

    Min, Sun Young; Kim, Yong Ho; Park, Won Seo

    2014-03-28

    Here, we report on a case of acute phlegmonous gastritis (PG) complicated by delayed perforation. A 51-year-old woman presented with severe abdominal pain and septic shock symptoms. A computed tomography scan showed diffuse thickening of the gastric wall and distention with peritoneal fluid. Although we did not find definite evidence of free air on the computed tomography (CT) scan, the patient's clinical condition suggested diffuse peritonitis requiring surgical intervention. Exploratory laparotomy revealed a thickened gastric wall with suppurative intraperitoneal fluid in which Streptococcus pyogenes grew. There was no evidence of gastric or duodenal perforation. No further operation was performed at that time. The patient was conservatively treated with antibiotics and proton pump inhibitor, and her condition improved. However, she experienced abdominal and flank pain again on postoperative day 10. CT and esophagogastroduodenoscopy showed a large gastric ulcer with perforation. Unfortunately, although the CT showed further improvement in the thickening of the stomach and the mucosal defect, the patient's condition did not recover until a week later, and an esophagogastroduodenoscopy taken on postoperative day 30 showed suspected gastric submucosal dissection. We performed total gastrectomy as a second operation, and the patient recovered without major complications. A pathological examination revealed a multifocal ulceration and necrosis from the mucosa to the serosa with perforation.

  11. Abdominal Pain in the Female Patient: A Case of Concurrent Acute Appendicitis and Ruptured Endometrioma

    Science.gov (United States)

    Louis, Martine A.; Lin, Elizabeth; Baek, Ji Yoon; Andoni, Alda; Wang, Xiao Hui

    2016-01-01

    General surgeons are often asked to evaluate acute abdominal pain which has an expanded differential diagnosis in women of childbearing age. Acute appendicitis accounts for many surgical emergencies as a common cause of nongynecologic pelvic pain. In some rare instances, acute appendicitis has been shown to occur simultaneously with a variety of gynecologic diseases. We report a case of concurrent acute appendicitis and ruptured ovarian endometrioma. PMID:28097032

  12. [Acute abdomen secondary to spontaneous uterine rupture associated with pyometra].

    Science.gov (United States)

    Ortiz-Mendoza, Carlos Manuel

    2006-01-01

    A 71-year-old female with rheumatoid arthritis and chronic use of corticosteroids presented to the emergency room with 2 weeks of urinary symptoms, abdominal pain and a mass located in hypo-mesogastrium and both flanks. An X-ray film of the abdomen showed that bowels were displaced by the mass. Laboratory studies showed thrombocytosis (549,000/mm(3)) and leukocytosis (41,800/mm(3)). Several hours after her arrival the patient developed acute abdomen and surgery was indicated. A urinary catheter drained 2100 ml of urine and the abdominal mass was reduced in size but did not disappear. Surgery demonstrated that the urinary bladder covered the fundus and the anterior face of the uterus, where extensive necrosis and a 3-cm perforation were found; 400 ml of foul-smelling pus was drained from the uterine cavity. Due to necrosis, a hysterectomy was performed. The histopathological report indicated necrosis, atrophic cervicitis and endometritis; pus culture developed Escherichia coli and Proteus vulgaris. Despite administration of broad-spectrum antibiotics, the patient developed severe sepsis and died 11 days postoperatively. During a literature review, only one similar case was found. Acute abdomen due to uterine perforation secondary to pyometra and associated with chronic use of corticosteroids is a rare complication.

  13. Acute distal biceps rupture in an adolescent weightlifter on chronic steroid suppression: a case report.

    Science.gov (United States)

    Ding, David Y; LaMartina, Joey A; Zhang, Alan L; Pandya, Nirav K

    2016-09-01

    Distal biceps tendon ruptures are uncommon events in the adult population and exceedingly rare in the adolescent population. To the best of our knowledge, this is the first and only report of a distal biceps tendon rupture in an adolescent with a history of chronic corticosteroid suppression. We present a case of a 17-year-old male on chronic corticosteroid suppression who underwent a successful distal biceps tendon repair after an acute rupture following weightlifting. At the 1-year follow-up, the patient reports full range of motion and strength, and is able to return to his preinjury activity level with sports and weightlifting. Acute distal biceps ruptures are uncommon injuries in the pediatric population, but may occur in conjunction with chronic corticosteroid use. Anatomic repair, when possible, can restore function and strength. level IV, case report.

  14. Rupture

    CERN Multimedia

    Association du personnel

    2006-01-01

    Our Director-General is indifferent to the tradition of concertation foreseen in our statutes and is "culturally" unable to associate the Staff Association with problem-solving in staff matters. He drags his heels as long as possible before entering into negotiations, presents "often misleading" solutions at the last minute which he only accepts to change once a power struggle has been established. Faced with this rupture and despite its commitment to concertation between gentlemen. The results of the poll in which the staff is invited to participate this week. We therefore need your support to state our claims to the Governing Bodies. The Staff Association proposes a new medium of communication and thus hopes to show that it is ready for future negotiations. The pages devoted to the Staff Association are presented in a more informative, reactive and factual manner and in line with the evolution of the social situation at CERN. We want to establish strong and continuous ties between the members of CERN and ou...

  15. Percutaneous repair followed by accelerated rehabilitation for acute Achilles tendon ruptures.

    Science.gov (United States)

    Al-Mouazzen, Louay; Rajakulendran, Karthig; Najefi, Ali; Ahad, Nurul

    2015-12-01

    To evaluate the outcome after percutaneous repair followed by accelerated rehabilitation for acute Achilles tendon ruptures. 21 men and 9 women (mean age, 41 years) underwent percutaneous repair by a single senior surgeon for acute Achilles tendon ruptures, followed by early weight bearing and accelerated rehabilitation. Outcome measures included the Achilles tendon re-rupture rate, the Achilles tendon total rupture score (ATRS) at 3 and 6 months, the incidence of sural nerve injury, wound infection, wound dehiscence, patient satisfaction, and the time to return to pre-rupture activity. The mean follow-up period was 12.5 months. The mean ATRS score improved from 57.65 at 3 months to 86.95 at 6 months (ptendon re-rupture, sural nerve injury, wound dehiscence, or deep infection. Two patients developed a superficial wound infection, which was resolved with oral flucloxacillin. Two patients had a mass at the transverse incision, but neither had any symptoms or functional restriction. All patients were able to bear full weight comfortably without the walker boot at 8 weeks, and return to their work by 3 months. The mean time to return to pre-rupture activity, including sports, was 10.4 months. The mean satisfaction rate was 87% at 6 months. Percutaneous repair of the Achilles tendon followed by early weight bearing and accelerated rehabilitation achieves good functional outcome.

  16. Acute transverse myelitis: an unusual complication of typhoid fever.

    Science.gov (United States)

    Mishra, Kirtisudha; Kaur, Sharandeep; Basu, Srikanta; Gulati, Praveen; Parakh, Ankit

    2012-08-01

    Typhoid fever is associated with a wide spectrum of neurological complications. Acute transverse myelitis is a rare complication with only a few reports in adults and none in children. A 15-year-old boy with typhoid fever is reported who developed acute transverse myelitis in the 3rd week of illness. He was treated with antibiotics and corticosteroids and made a complete recovery.

  17. Five-year follow-up of knee joint cartilage thickness changes after acute anterior cruciate ligament rupture

    DEFF Research Database (Denmark)

    Eckstein, F; Wirth, W; Lohmander, Stefan

    2015-01-01

    Objective: Anterior cruciate ligament (ACL) rupture involves increased risk of osteoarthritis. We explored cartilage thickness changes over five years after ACL rupture. Methods: 121 young active adults (26% women, age 18-35 years) with acute traumatic ACL rupture were studied (the KANON...

  18. Surgical tip: Repair of acute Achilles rupture with Krackow suture through a 1.5 cm medial wound.

    Science.gov (United States)

    Lui, T H

    2010-03-01

    Acute Achilles tendon ruptures is one of the commonest tendon injury of the foot and ankle. The management of this problem is still controversial. Treatment can be classified into non-surgical and surgical types. Surgical management can be subdivided into open repair, percutaneous with or without adjunct of arthroscopy. In compare with non-surgical management, surgical management will decrease the tendon re-rupture rate. However, the possible surgical complications including wound breakdown and sural nerve injury are still quite significant. Percutaneous repair technique has the advantage of less chance of wound breakdown, but the rate of tendon re-rupture is higher than that after open tendon repair, because the repair is usually weaker than that achieved in open repair. Lui have described an endoscopic assisted repair with the Krackow locking suture. However, the technique is complicated and six portal wounds are needed. A simpler way of applying the Krackow suture through the portal wound has been described for reattachment of Achilles tendon insertion after endoscopic calcaneoplasty. We describe a mini-open approach of Achilles tendon repair with the Krackow locking suture. By means of release of the medial edge of the investing fascia, the Achilles tendon can be mobilized easily and the Krackow locking suture can be applied through a 1.5cm medial wound. Hopefully, this can improve the strength of repair and maintaining the advantage of minimally invasive tendon repair.

  19. Amniotic fluid cathepsin-G in pregnancies complicated by the preterm prelabor rupture of membranes.

    Science.gov (United States)

    Musilova, Ivana; Andrys, Ctirad; Drahosova, Marcela; Soucek, Ondrej; Pliskova, Lenka; Stepan, Martin; Bestvina, Tomas; Maly, Jan; Jacobsson, Bo; Kacerovsky, Marian

    2017-09-01

    The aim of this study was to evaluate the amniotic fluid cathepsin-G concentrations in women with preterm prelabor rupture of membranes (PPROM) based on the presence of the microbial invasion of the amniotic cavity (MIAC) and/or intra-amniotic inflammation (IAI). A total of 154 women with singleton pregnancies complicated by PPROM were included in this study. Amniotic fluid samples were obtained by transabdominal amniocentesis. Amniotic fluid cathepsin-G concentrations were assessed by ELISA. MIAC was determined using a non-cultivation approach. IAI was defined as an amniotic fluid bedside interleukin-6 concentration ≥ 745 pg/mL. Women with MIAC had higher amniotic fluid cathepsin-G concentrations than women without MIAC (with MIAC: median 82.7 ng/mL, versus without MIAC: median 64.7 ng/mL; p = 0.0003). Women with IAI had higher amniotic fluid cathepsin-G concentrations than women without this complication (with IAI: median 103.0 ng/mL, versus without IAI: median 66.2 ng/mL; p G concentrations than women with colonization (MIAC without IAI) and women without both MIAC and IAI (p G concentrations in pregnancies complicated by PPROM. Amniotic fluid cathepsin-G appears to be a potential marker of IAI.

  20. Double valve replacement for acute spontaneous left chordal rupture secondary to chronic aortic incompetence

    Directory of Open Access Journals (Sweden)

    McLenachan Jim

    2006-10-01

    Full Text Available Abstract A 54 years old male with undiagnosed chronic calcific degenerative aortic valve incompetence presented with acute left anterior chordae tendinae rupture resulting in severe left heart failure and cardiogenic shock. He was successfully treated with emergency double valve replacement using mechanical valves. The pathogenesis of acute rupture of the anterior chordae tendinae, without any evidence of infective endocarditis or ischemic heart disease seems to have been attrition of the subvalvular mitral apparatus by the chronic regurgitant jet of aortic incompetence with chronic volume overload. We review the literature with specific focus on the occurrence of this unusual event.

  1. Endometrioid ovarian carcinoma during pregnancy presenting with acute rupture.

    Science.gov (United States)

    Gottheil, Stephanie; McGee, Jacob

    2013-11-01

    Contexte : Le carcinome endométroïde de l’ovaire est rarement diagnostiqué pendant la grossesse et est généralement asymptomatique. Nous faisons état d’un cas de carcinome endométroïde de l’ovaire pendant la grossesse ayant présenté une rupture aiguë et nous discutons des options de prise en charge. Cas : Une primigravide présentait, à 26 semaines de gestation, de graves douleurs abdominales. Au moment de la laparotomie, nous avons constaté la présence d’une masse annexielle ayant connu une rupture. Cette masse a postopératoirement été identifiée comme étant un carcinome endométroïde de l’ovaire. En vue de maximiser les issues maternelles et fœtales, nous avons pris la décision de procéder, à 34 semaines, à une césarienne au moyen d’une prise en charge chirurgicale permettant de sauvegarder la fertilité. Conclusion : À notre connaissance, il s’agit du premier cas signalé de carcinome endométroïde de l’ovaire présentant une rupture pendant la grossesse. En présence de graves douleurs abdominales pendant la grossesse, le diagnostic différentiel devrait inclure la rupture d’une tumeur ovarienne maligne.

  2. Endoscopic Repair of Acute and Chronic Retracted Distal Biceps Ruptures.

    Science.gov (United States)

    Bhatia, Deepak N

    2016-12-01

    Distal biceps tendon (DBT) ruptures are infrequent injuries that result in pain, weakness, and cosmetic deformity. Severe retraction of the ruptured DBT can occur at the time of injury, or in chronic neglected ruptures, and surgical exposure is performed using a single incision or a 2-incision technique. The technique presented here describes an endoscopic approach using 3 portals that provide access to the retracted DBT, biceps sheath, and radial tuberosity. Preoperative sonographic localization of the retracted DBT and neurovascular structures is used to guide portal placement. The parabiceps portal is used for visualization of the biceps sheath remnant, and the midbiceps portal is used to visualize and retrieve the retracted tendon in the arm. The retracted DBT is shuttled through the biceps sheath into the upper forearm, and 2 suture anchors are passed into the radial tuberosity under direct endoscopic vision. The DBT is whipstitched via the distal anterior portal, and nonsliding knots are tied to securely reattach the DBT to the prepared radial tuberosity. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  3. Functional outcomes of conservatively managed acute ruptures of the Achilles tendon.

    Science.gov (United States)

    Lawrence, J E; Nasr, P; Fountain, D M; Berman, L; Robinson, A H N

    2017-01-01

    This prospective cohort study aims to determine if the size of the tendon gap following acute rupture of the Achilles tendon shows an association with the functional outcome following non-operative treatment. All patients presenting within two weeks of an acute unilateral rupture of the Achilles tendon between July 2012 and July 2015 were considered for the study. In total, 38 patients (nine female, 29 male, mean age 52 years; 29 to 78) completed the study. Dynamic ultrasound examination was performed to confirm the diagnosis and measure the gap between ruptured tendon ends. Outcome was assessed using dynamometric testing of plantarflexion and the Achilles tendon Total Rupture score (ATRS) six months after the completion of a rehabilitation programme. Patients with a gap ≥ 10 mm with the ankle in the neutral position had significantly greater peak torque deficit than those with gaps tendon gap and functional outcome in acute rupture of the Achilles tendon. We have identified 10 mm as a gap size at which deficits in plantarflexion strength become significantly greater, however, the precise relationship between gap size and plantarflexion strength remains unclear. Large, multicentre studies will be needed to clarify this relationship and identify population subgroups in whom deficits in peak torque are reflected in patient-reported outcome measures. Cite this article: Bone Joint J 2017;99-B:87-93. ©2017 The British Editorial Society of Bone & Joint Surgery.

  4. Comparison between tenocutaneous suture and Kessler suture techniques in treating acute closed Achilles tendon rupture.

    Science.gov (United States)

    Ding, Wen-Ge; Li, Huan; Zhu, Ya-Ping; Liu, Zhi-wei

    2014-06-01

    To compare the effectiveness of tenocutaneous suture and conventional Kessler suture techniques in treating acute closed Achilles tendon rupture. A total of 33 patients with acute closed Achilles tendon rupture who were admitted to our hospital from February 1998 to December 2008 underwent repair with either a tenocutaneous suture or Kessler suture technique. All patients were followed up for 1-5 years (mean, 3 years). According to the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale, the excellence rate was 91% in the Kessler suture group and 98% in the tenocutaneous suture group, with a significant difference between groups. Our tenocutaneous suture technique is an effective method for treating Achilles tendon rupture. It has certain advantages compared with the conventional incision method and is worthy of wide clinical application. Copyright © 2014 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  5. Pancreaticobronchial Fistula: A Complication of Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    Dorota Overbeck-Zubrzycka

    2011-01-01

    Full Text Available Context Pancreaticobronchial fistula is a rare complication of severe pancreatitis. Various diagnostic methods have been described previously. Case report The presentation, diagnostic methods, management and 5-year follow-up of a 40-year-old woman with severe gallstone induced pancreatitis complicated by a pancreaticobronchial fistula were reviewed. Diagnosis was made on the endotracheal intubation when amylase rich-fluid was drained via the tube and confirmed by CT scanning. Successful management was achieved by an open pancreatic necrosectomy, during which air bubbles were seen emerging from the pancreatic collection which supported the diagnosis of the fistula. Five-year follow-up did not reveal any complications. Conclusions Pancreaticobronchial fistulas have the potential to cause severe respiratory complications and mortality. Awareness of this condition is important in the treatment of complicated cases of pancreatitis.

  6. Ventricular septal rupture and right ventricular intramyocardial dissection secondary to acute inferior myocardial infarction.

    Science.gov (United States)

    Bittencourt, Márcio Sommer; Seltmann, Martin; Muschiol, Gerd; Achenbach, Stephan

    2010-01-01

    A 61-year-old female patient presented with sub acute myocardial infarction with an occluded right coronary artery on invasive evaluation and a ventricular septal rupture on echocardiogram. Cardiac computed tomography (CT) was performed to better define the septal anatomy. As the anatomy on cardiac CT was considered unfavorable for percutaneous intervention, the patient underwent successful surgical repair.

  7. Severe Vascular Complications Of Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    Głuszek Stanisław

    2015-10-01

    Full Text Available Acute pancreatitis (AP develops as a result of the imbalance of the mechanisms inhibiting the activity of enzymes in the pancreatic cells, which causes their autoactivation in the pancreas. The incidence of AP ranges from 10 up to 100 cases per 100,000 population per year in different parts of the world. The overall mortality rate for acute pancreatitis is 10-15%. The mortality rate in patients diagnosed with the severe form of acute pancreatitis is up to 30-40%.

  8. [Acute cholangitis secondary to ascariasis and complicated by liver abscesses].

    Science.gov (United States)

    Rakotonaivo, A; Ranoharison, H D; Razarimahefa, S H; Rakotozafindrabe, R; Rabenjanahary, T H; Ramanampamonjy, R M

    2015-01-01

    Acute cholangitis secondary to ascariasis is rare and occurs mainly in areas of high endemicity. The clinical presentation is non-specific, sometimes complicated by liver abscess. Abdominal ultrasound plays an important role in diagnosis and therapeutic surveillance. We report the case of a 35-year-old Malagasy woman with an acute cholangitis secondary to ascariasis and complicated by liver abscesses and its course to full recovery under medical treatment.

  9. Complications of acute posterior vitreous detachment.

    Science.gov (United States)

    Kanski, J J

    1975-07-01

    Of 201 patients whose presenting symptoms were acute entoptic phenomena or photopsia, or both, 150 patients had posterior vitreous detachment; 69 patients (46%) had retinal breaks; 18 (12%) had a vitreous hemorrhage without detectable retinal breaks; and two (1.3%) had peripheral retinal hemorrhages without retinal breaks or vitreous hemorrhage. Retinal breaks that occur in eyes in conjunction with acute posterior vitreous detachment are potentially dangerous and there is a possibility of delayed break formation.

  10. Surgical repair of acute Achilles tendon rupture with an end-to-end tendon suture and tendon flap.

    Science.gov (United States)

    Corradino, B; Di Lorenzo, S; Calamia, C; Moschella, F

    2015-08-01

    Achilles tendon ruptures are becoming more common. Complications after open or minimally invasive surgery are: recurrent rupture (2-8%), wound breakdown, deep infections, granuloma, and fistulas. The authors expose their experience with a personal technique. In 8 patients with acute rupture of Achilles tendon the surgery was performed at least 25 days after trauma. Clinical exam and MR demonstrated in all case a total lesion of tendon. After a posterolateral skin incision the tendon stumps were debrided and suture in end-to-end fashion. A tendon flap was harvested from the proximal part of the tendon, in order to protect and reinforce the suture itself. A plaster cast was applied for 3 weeks and the patients started the rehabilitation protocol. After 4 months all patients returned to pre-injury daily activities. The mean follow up was 13 months (ranged between 6 and 24 months). No major complications occurred. The posterolateral skin incision, not above the tendon, preserves the vascularity of the soft tissues, allows identifying and not accidentally injuring the sural nerve, and prevents the cutaneous scar is overlapped the tendon. In this way is favoured physiological tendon sliding. The preparation of the flap tendon does not weaken the overall strength of the tendon and protects the tendon suture. The tension on sutured stumps is less than being spread over a larger area. In our sample of 8 patients the absence of short-and long-term complications and the rapid functional recovery after surgery suggest that the technique used is safe and effective. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. Clinical analysis and risk stratification of ventricular septal rupture following acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    HU Xiao-ying; QIU Hong; QIAO Shu-bin; KANG Lian-ming; SONG Lei; ZHANG Jun; TAN Xiao-yan

    2013-01-01

    Background Ventricular septal rupture (VSR) remains an infrequent but devastating complication of acute myocardial infarction (AMI).The best time to undergo surgical repair is controversial and there is currently no risk stratification for patients with VSR to guide treatment.The purpose of this study was to review the clinical outcomes of 70 patients with VSR,to analyze the short-term prognosis factors of VSR following AMI,and to make a risk stratification for patients with VSR.Methods A total of 70 consecutive VSR patients following AMI treated in our hospital from January 2002 to October 2010 were enrolled in this study retrospectively.The difference of clinical characteristics were observed between patients with VSR who survived <30 days and survived >30 days.We analyzed the short-term prognosis factors of VSR and established the short-term prognosis index of VSR (SPIV) based on the Logistic regression analysis to stratify patients with VSR.Results Among 12 354 patients with acute ST-segment elevation myocardial infarction,70 (0.57%) patients (33 males and 37 females) were found to have VSR.The average age was (68.1±8.5) years.Fifty-four (77.1%) patients were diagnosed with an acute anterior infarction.Patients with VSR selected for surgical repair had better outcomes than patients treated conservatively; 1-year mortality 9.5% versus 87.8%,P <0.005.Logistic regression analysis revealed that female (P=-0.013),anterior AMI (P=0.023),non-ventricular aneurysm (P=0.023),non-diabetes (P=0.009),Killip class 3 or 4 (P=0.022) and time from AMI to VSR less than 4 days (P=0.027) were independent risk determinants for shortterm mortality.SPIV >9 indicates a high risk as the 30-day mortality is 77.4%; SPIV <8 indicates a low risk as the 30-day mortality is 28.6%; SPIV between 8 and 9 indicates a moderate risk.Conclusions VSR remains a rare but devastating complication of AMI.The independent risk determinants for short-term mortality of VSR were female

  12. Pathologic rupture of the spleen in a patient with acute myelogenous leukemia and leukostasis

    Directory of Open Access Journals (Sweden)

    Gil Cunha De Santis

    2014-07-01

    Full Text Available Rupture of the spleen can be classified as spontaneous, traumatic, or pathologic. Pathologic rupture has been reported in infectious diseases such as infectious mononucleosis, and hematologic malignancies such as acute and chronic leukemias. Splenomegaly is considered the most relevant factor that predisposes to splenic rupture. A 66-year-old man with acute myeloid leukemia evolved from an unclassified myeloproliferative neoplasm, complaining of fatigue and mild upper left abdominal pain. He was pale and presented fever and tachypnea. Laboratory analyses showed hemoglobin 8.3 g/dL, white blood cell count 278 × 109/L, platelet count 367 × 109/L, activated partial thromboplastin time (aPTT ratio 2.10, and international normalized ratio (INR 1.60. A blood smear showed 62% of myeloblasts. The immunophenotype of the blasts was positive for CD117, HLA-DR, CD13, CD56, CD64, CD11c and CD14. Lactate dehydrogenase was 2384 U/L and creatinine 2.4 mg/dL (normal range: 0.7-1.6 mg/dL. Two sessions of leukapheresis were performed. At the end of the second session, the patient presented hemodynamic instability that culminated in circulatory shock and death. The post-mortem examination revealed infiltration of the vessels of the lungs, heart, and liver, and massive infiltration of the spleen by leukemic blasts. Blood volume in the peritoneal cavity was 500 mL. Acute leukemia is a rare cause of splenic rupture. Male gender, old age and splenomegaly are factors associated with this condition. As the patient had leukostasis, we hypothesize that this, associated with other factors such as lung and heart leukemic infiltration, had a role in inducing splenic rupture. Finally, we do not believe that leukapheresis in itself contributed to splenic rupture, as it is essentially atraumatic.

  13. Acute Compartment Syndrome after Non-Contact Peroneus Longus Muscle Rupture.

    Science.gov (United States)

    Merriman, Jarrad; Villacis, Diego; Kephart, Curtis; Yi, Anthony; Romano, Russ; Hatch, George F Rick

    2015-12-01

    This case demonstrates a rare variation in the pattern of injury and the presentation of acute lateral compartment syndrome of the leg. Although uncommon, lateral compartment syndrome of the leg after an ankle inversion leading to peroneus longus muscle rupture has been previously documented. This case was unusual because there was no overt ankle injury and the patient was able to continue physical activity, in spite of a significant rupture of the peroneus longus muscle that was determined later. This case highlights the necessary vigilance clinicians must maintain when assessing non-contact injuries in patients with possible compartment syndrome.

  14. [Late complication of surgical repair of aortic coarctation: ruptured pseudoaneurysm of the aorta treated by thoracic endovascular aortic repair].

    Science.gov (United States)

    Varejka, P; Lubanda, J C; Prochazka, P; Heller, S; Beran, S; Dostal, O; Charvat, F; Horejs, J; Semrad, M; Linhart, A

    2010-06-01

    Aortic coarctation is a frequent congenital defect requiring early surgical treatment. Late complications of these surgical procedures can be fatal as in the case of a ruptured anastomotic pseudoaneurysm. We present a case of a 49-year-old man presenting with hemorrhagic shock due to this complication who was successfully treated by endovascular techniques with implantation of two stent grafts. This case illustrates the fact that endovascular aortic repair is feasible, certainly less invasive and very efficient for this type of complication when used in an experienced center.

  15. Acute stroke: postprocedural care and management of complications.

    Science.gov (United States)

    de Carvalho, Flávio Augusto; de Figueiredo, Marcelo Marinho; Silva, Gisele Sampaio

    2012-03-01

    Endovascular treatment for acute ischemic stroke is an important alternative to thrombolysis with recombinant tissue plasminogen activator (rt-PA) for patients who present beyond the thrombolysis time window, those who are ineligible for rt-PA, or those who do not improve after intravenous rt-PA. These patients generally require special attention in the postprocedural period because, although not frequent, complications of endovascular procedures in acute ischemic stroke have the potential to be devastating. Neurocritical care is essential to reduce and appropriately treat complications after endovascular procedures. Neurointensivists and neurocritical care nurses are experts in both critical care and neurologic disorders and have special training to recognize early physiological derangements in patients presenting with acute stroke. Close attention to the serial neurological examination, blood pressure control, adequate management of glucose, temperature, and immediate identification of complications such as reocclusion and hemorrhagic transformation are key elements that exemplify the importance of postprocedural neurocritical care in acute ischemic stroke.

  16. Prospective randomized clinical trial of aggressive rehabilitation after acute Achilles tendon ruptures repaired with Dresden technique.

    Science.gov (United States)

    De la Fuente, Carlos; Peña y Lillo, Roberto; Carreño, Gabriel; Marambio, Hugo

    2016-03-01

    Rupture of the Achilles tendon is a common injury during working years. Aggressive rehabilitation may provide better outcomes, but also a greater chance of re-rupture. To determine if aggressive rehabilitation has better clinical outcomes for Achilles tendon function, Triceps surae function, one-leg heel rise capacity and lower complication rate during twelve weeks after percutaneous Achilles tendon repair compared to conventional rehabilitation. Randomized controlled trial. Thirty-nine patients were prospectively randomized. The aggressive group (n=20, 41.4 ± 8.3 years) received rehabilitation from the first day after surgery. The conventional group (n=19, 41.7 ± 10.7 years) rested for 28 days, before rehabilitation started. The statistical parameters were the Achilles tendon rupture score (ATRS), verbal pain scale, time to return to work, pain medication consumption, Achilles tendon strength, dorsiflexion range of motion (RoM), injured-leg calf circumference, calf circumference difference, one-leg heel rise repetition and difference, re-rupture rate, strength deficit rate, and other complication rates. Mixed-ANOVA and Bonferroni's post hoc test were performed for multiple comparisons. Student's t-test was performed for parameters measured on the 12th week. The aggressive group with respect to the conventional group had a higher ATRS; lower verbal pain score; lower pain medication consumption; early return to work; higher Achilles tendon strength; higher one-leg heel rise repetitions; and lower one-leg heel rise difference. The re-rupture rate was 5% and 5%, the strength deficit rate was 42% and 5%, and other complications rate was 11% and 15% in the conventional and aggressive group, respectively. Patients with Dresden repair and aggressive rehabilitation have better clinical outcomes, Achilles tendon function and one-leg heel rise capacity without increasing the postoperative complications rate after 12 weeks compared to rehabilitation with immobilization and

  17. Acute aortic rupture in a dog with spirocercosis following the administration of medetomidine : clinical communication

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    K.E. Joubert

    2005-06-01

    Full Text Available Spirocercosis is an emerging disease in veterinary medicine. A strong suspicion of spirocercosis is usually evident after a thorough clinical examination and radiography of the chest has been performed. Lesions seen on radiography include an oesophageal mass, spondylitis and oesophageal air. Unfortunately, radiography is not diagnostic and additional diagnostic procedures are required to confirm the diagnosis. Endoscopy is commonly performed to diagnose the condition. The dog presented in this study had radiographic and clinical signs consistent with spirocercosis and definitive diagnosis was required. Shortly after sedation with medetomidine, the dog went into cardiac arrest and failed to respond to resuscitative measures. On post mortem, the diagnosis of spirocercosis was confirmed and the cause of death was identified as acute aortic rupture. Aortic aneurysms are not an uncommon finding and cause of acute death in dogs with spirocercosis. The acute rupture of the aorta in this case is most probably the result of cardiovascular changes associated with the administration of medetomidine. Medetomidine causes an acute rise in systemic vascular resistance with hypertension. The increase in shear stress across the weakened aortic wall resulted in rupture. Caution with the use of medetomidine in patients with spirocercosis is advised.

  18. Tracheal rupture post-emergency intubation

    OpenAIRE

    Andrea Billè; Luca Errico; Francesco Ardissone; Luciano Cardinale

    2009-01-01

    Tracheal rupture is an uncommon and potentially lifethreatening complication of endotracheal intubation. We present a case of intrathoracic tracheal rupture in a female patient who required emergent endotracheal intubation for acute respiratory distress related to chronic obstructive pulmonary disease exacerbation. Possible contributing factors to tracheal injury included overinflation of the tube cuff, chronic obstructive pulmonary disease, and chronic steroid use. The patient underwent surg...

  19. Periodontal disease and intra-amniotic complications in women with preterm prelabor rupture of membranes.

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    Radochova, Vladimira; Kacerovska Musilova, Ivana; Stepan, Martin; Vescicik, Peter; Slezak, Radovan; Jacobsson, Bo; Kacerovsky, Marian

    2017-08-04

    Periodontal disease is frequently suggested as a possible causal factor for preterm delivery. The link between periodontal disease and preterm delivery is a possible translocation of periopathogenic bacteria to the placenta and amniotic fluid as well as a systemic response to this chronic inflammatory disease. However, there is a lack of information on whether there is an association between clinical periodontal status in women with preterm prelabor rupture of membranes (PPROM) and the presence of microbial invasion of the amniotic cavity (MIAC) and intra-amniotic inflammation (IAI). Therefore, the main aim of this study was to evaluate the incidence and severity of periodontal disease in women with PPROM. The secondary aim was to characterize an association between periodontal status and the presence of intra-amniotic PPROM complications (MIAC and/or IAI). Seventy-eight women with PPROM at gestational ages between 24 + 0 and 36 + 6 weeks were included in this study. The samples of amniotic fluid were obtained at admission via transabdominal amniocentesis, and amniotic fluid interleukin (IL)-6 concentrations were determined using a point-of-care test. All women had a full-mouth recording to determine the periodontal and oral hygiene status. Probing pocket depth and clinical attachment loss were measured at four sites on each fully erupted tooth. In total, 45% (35/78) of women with PPROM had periodontal disease. Mild, moderate, and severe periodontal disease was present in 19% (15/78), 19% (15/78), and 6% (5/78) of women, respectively. The presence of MIAC and IAI was found in 28% (22/78) and 26% (20/78) of women, respectively. Periopathogenic bacteria (2 × Streptococcus intermedius and 1 × Fusobacterium nucleatum) was found in the amniotic fluid of 4% (3/78) of women. There were no differences in periodontal status between women with MIAC and/or IAI and women without these intra-amniotic complications. The presence of MIAC and IAI was not related

  20. Managing Acute Complications Of Sickle Cell Disease In Pediatric Patients.

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    Subramaniam, Sathyaseelan; Chao, Jennifer H

    2016-11-01

    Sickle cell disease is a chronic hematologic disease with a variety of acute, and often recurring, complications. Vaso-occlusive crisis, a unique but common presentation in sickle cell disease, can be challenging to manage. Acute chest syndrome is the leading cause of death in patients with sickle cell disease, occurring in more than half of patients who are hospitalized with a vaso-occlusive crisis. Uncommon diagnoses in children, such as stroke, priapism, and transient red cell aplasia, occur more frequently in patients with sickle cell disease and necessitate a degree of familiarity with the disease process and its management. Patients with sickle cell trait generally have a benign course, but are also subject to serious complications. This issue provides a current review of evidence-based management of the most common acute complications of sickle cell disease seen in pediatric patients in the emergency department.

  1. Acute tubulointerstitial nephritis complicating Legionnaires' disease: a case report

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    Daumas Aurélie

    2012-04-01

    Full Text Available Abstract Introduction Legionnaires' disease is recognized as a multi-systemic illness. Afflicted patients may have pulmonary, renal, gastrointestinal tract and central nervous system complications. However, renal insufficiency is uncommon. The spectrum of renal involvement may range from a mild and transient elevation of serum creatinine levels to anuric renal failure requiring dialysis and may be linked to several causes. In our present case report, we would like to draw attention to the importance of the pathological documentation of acute renal failure by reporting a case of a patient with acute tubulointerstitial nephritis complicating Legionnaires' disease. Case presentation A 55-year-old Caucasian man was admitted to our hospital for community-acquired pneumonia complicated by acute renal failure. Legionella pneumophila serogroup type 1 was diagnosed. Although the patient's respiratory illness responded to intravenous erythromycin and ofloxacin therapy, his renal failure worsened, he became anuric, and hemodialysis was started. A renal biopsy was performed, which revealed severe tubulointerstitial nephritis. After initiation of steroid therapy, his renal function improved dramatically. Conclusions This case highlights the importance of kidney biopsies in cases where acute renal failure is a complicating factor in Legionnaires' disease. If the presence of acute tubulointerstitial nephritis can be confirmed, it will likely respond favorably to steroidal treatment and thus irreversible renal damage and chronic renal failure will be avoided.

  2. Acute Appendicitis Complicated by Pylephlebitis: A Case Report

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    Ricardo Castro

    2013-01-01

    Full Text Available Pylephlebitis is defined as septic thrombophlebitis of the portal vein. It is a rare but serious complication of an intraabdominal infection, more commonly diverticulitis and appendicitis. It has an unspecific clinical presentation and the diagnosis is difficult. The authors report a case of a 21-year-old man with acute appendicitis complicated by pylephlebitis. The diagnosis was made with contrast enhanced CT.

  3. Hospital cost of pediatric patients with complicated acute sinusitis.

    Science.gov (United States)

    Padia, Reema; Thomas, Andrew; Alt, Jeremiah; Gale, Craig; Meier, Jeremy D

    2016-01-01

    Review costs for pediatric patients with complicated acute sinusitis. A retrospective case series of patients in a pediatric hospital was created to determine hospital costs using a standardized activity-based accounting system for inpatient treatment between November 2010 and December 2014. Children less than 18 years of age who were admitted for complicated acute sinusitis were included in the study. Demographics, length of stay, type of complication and cost of care were determined for these patients. The study included 64 patients with a mean age of 10 years. Orbital cellulitis (orbital/preseptal/postseptal cellulitis) accounted for 32.8% of patients, intracranial complications (epidural/subdural abscess, cavernous sinus thrombosis) for 29.7%, orbital abscesses (subperiosteal/intraorbital abscesses) for 25.0%, potts puffy tumor for 7.8%, and other (including facial abscess and dacryocystitis) for 4.7%. The average length of stay was 5.7 days. The mean cost per patient was $20,748. Inpatient floor costs (31%) and operating room costs (18%) were the two greatest expenditures. The major drivers in variation of cost between types of complications included pediatric intensive care unit stays and pharmacy costs. Although complicated acute sinusitis in the pediatric population is rare, this study demonstrates a significant financial impact on the health care system. Identifying ways to reduce unnecessary costs for these visits would improve the value of care for these patients. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  4. Acute mobilization and migration of bone marrow-derived stem cells following anterior cruciate ligament rupture.

    Science.gov (United States)

    Maerz, T; Fleischer, M; Newton, M D; Davidson, A; Salisbury, M; Altman, P; Kurdziel, M D; Anderson, K; Bedi, A; Baker, K C

    2017-08-01

    Little is known regarding acute local and systemic processes following anterior cruciate ligament (ACL) rupture. No study has elucidated whether bone marrow-derived mesenchymal stem cells (MSCs) are mobilized into circulation and recruited to the injured joint. In Part 1, Lewis rats were randomized to noninvasive ACL rupture (Rupture) or non-injured (Control) (n = 6/group). After 72 h, whole blood MSC concentration was assessed using flow cytometry. Synovial fluid and serum were assayed for stromal cell-derived factor (SDF)-1α and cartilage degeneration biomarkers, respectively. In Part 2, 12 additional rats were randomized and intravenously-injected with fluorescently-labeled allogenic MSCs. Cell tracking was performed using longitudinal, in vivo and ex vivo near-infrared (NIR) imaging and histology. Synovium SDF-1α and interleukin (IL)-17A immunostaining was performed. Serum was assayed for SDF-1α and 29 other cytokines. In Part 1, there was a significant increase in MSC concentration and synovial fluid SDF-1α in Rupture. No differences in cartilage biomarkers were observed. In Part 2, Rupture had significantly higher NIR signal at 24, 48, and 72 h, indicating active recruitment of MSCs to the injured joint. Ex vivo cell tracking demonstrated MSC localization in the synovium and myotendinous junction (MTJ) of the quadriceps. Injured synovia exhibited increased synovitis grade and higher degree of IL-17A and SDF-1α immunostaining. ACL rupture induced peripheral blood mobilization of MSCs and migration of intravenously-injected allogenic MSCs to the injured joint, where they localized in the synovium and quadriceps MTJ. Copyright © 2017 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  5. PROSPECTIVE STUDY OF CT IN ACUTE PANCREATITIS AND ITS COMPLICATIONS

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    Shivanand S .

    2015-09-01

    Full Text Available Visualization of the pancreas was far better by CT than b y ultrasound. Ultrasound had certain limitation. Due to bowel gas the pancreas may not be visualized. Extra pancreatic spread of inflammation and vascular complications was not always picked up by Ultrasonography. These limitations were overcome with the u se of CT which yielded more diagnostic information in the evaluation of acute pancreatitis. CT is a confirmative investigation in diagnosis and staging of acute pancreatitis. MCTSI is a very useful tool for the screening of patients with acute pancreatitis for the classification of severity accurately and to predict the clinical outcome. OBJECTIVES OF STUDY: To determine the value of computed tomography in evaluation of early diagnosis of acute pancreatitis. To evaluate the complications using computed tom ography severity index. MATERIAL AND METHODS: The study was conducted on 100 patients with clinical suspicion of acute pancreatitis, altered biochemical parameters (Serum amylase, Serum lipase in favor of acute pancreatitis, ultrasonography suggestive of acute pancreatitis and complications known case of chronic pancreatitis with features of acute symptoms who were referred to the department of Radiodiagnosis, Basaveshwar teaching & General Hospital, Kalaburagi. Before evaluating a patient by CT imaging, i nformed consent was obtained from the patient or guardian. The patient were informed about the radiation exposure in the examination. CT was carried out using Philips 6 slice scanner. Scan was obtained with both plain and contrast study. RESULT: 100 patien ts were included in the study. 83% patients were males and 17% patients were females. Majority of patients belonged to 31 - 40 yrs. of age group. Alcohol was the most common cause of acute pancreatitis. 73 patients had positive ultrasound finding while CT wa s positive in all cases. According to, MCTSI 63 patients had moderate, 26 patients had mild and 11 patients had severe

  6. A Rare Complication of Acute Otitis Media: Otitic Hydrocephalus

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    Ahmet Mutlu

    2013-06-01

    Full Text Available Acute otitis media is very common disorder in childhood. In this article we present a 6-years old boy who applied with diplopia, dysfunction of lateral eye movements on left eye, nausea, at 10th day of acute otitis media treatment. After the radiological images case was described as an otitic hydrocephalus clinic. Patient underwent medical treatment, lomboperitoneal shunt operation and simple mastoidectomy. We wanted to share the evaluation and the management steps of this very rare complication of acute otitis media.

  7. Right adrenal abscess -- an unusual complication of acute apendicitis.

    Science.gov (United States)

    Dimofte, Gabriel; Dubei, Liviu; Lozneanu, Lili-Gabriela; Ursulescu, Corina; Grigora Scedil, Mihai

    2004-09-01

    Acute appendicitis represents one of the most frequent abdominal emergencies encountered in everyday surgical practice. Local infectious complications are not unusual and retroperitoneal abscesses after acute retrocaecal appendicitis have been previously described. The authors present the case of a 22-years-young female patient, admitted for a right iliac fossa abscess, secondary to gangrenous appendicitis. A right adrenal mass 35/40 mm was revealed during preoperative ultrasound evaluation, which evolved in an adrenal abscess that spontaneously drained 10 days after appendectomy and retrocecal drainage. Adrenal abscesses are exceptionally rare, with only a few cases being reported in the literature, but none of these after acute appendicitis.

  8. Antibiotic Therapy for Acute Infiltrate-Complicated Calculous Cholecystitis

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    Yu. A. Nesterenko

    2007-01-01

    Full Text Available Objective: to summarize the results of treatment in 442 patients of various ages with acute calculous cholecystitis complicated by a compact perivesical infiltrate.Materials and methods. Bile from all the patients was bacteriologically studied. The implication of various antibiotics in limiting perivesical fat inflammation was determined.Results. The importance of decompressive treatments for complicated calculous cholecystitis has been ascertained. The advantages of microcholecystostomy have been revealed. There is evidence that it is expedient to use third-forth-generation cephalosporins, fluoroquinolones, and dioxidine in the combined treatment of destructive calculous cholecystitis complicated by an infiltrate. 

  9. Realtime Achilles Ultrasound Thompson (RAUT) Test for the Evaluation and Diagnosis of Acute Achilles Tendon Ruptures.

    Science.gov (United States)

    Griffin, Matthew J; Olson, Kirstina; Heckmann, Nathanael; Charlton, Timothy P

    2017-01-01

    Acute complete Achilles tendon ruptures are commonly missed injuries. We propose the Realtime Achilles Ultrasound Thompson (RAUT) test, a Thompson test under ultrasound visualization, to aid in the diagnosis of these injuries. We hypothesized that RAUT testing would provide improved diagnostic characteristics compared with static ultrasound. Twenty-two consecutive patients with operatively confirmed acute Achilles tendon ruptures were prospectively evaluated with RAUT testing and static ultrasonography. RAUT video recordings and static ultrasound images from both ruptured and uninjured sides were randomized and graded by a group of novice reviewers and a group of expert attendings. From these observations, sensitivity, specificity, positive predictive value, and negative predictive value for RAUT and static ultrasound were calculated. In addition, κ interobserver coefficients were computed. Forty-seven novice reviewers and 11 foot and ankle attendings made a total of 4136 and 528 observations, respectively. For static ultrasound, sensitivity and specificity were 76.8% and 74.8% for the novice reviewers and 79.6% and 86.4% for the attendings, respectively. For RAUT testing, sensitivity and specificity were 87.2% and 81.1% for the novice group and 86.4% and 91.7% for the attending group, respectively. The κ coefficient was 0.62 and 0.27 for novice and attending RAUT reviewers, indicating substantial and fair agreement, respectively, but only 0.46 and 0.12 for static ultrasonography, representing moderate and slight agreement, respectively. RAUT testing was a sensitive and specific test, providing a cost-effective adjunct to the clinical examination when diagnosing acute Achilles tendon ruptures. This test can be used by surgeons with minimal training in ultrasonography. Level II, diagnostic study.

  10. Coronary Artery Vasospasm Complicating Acute Myocarditis: A Rare Association

    OpenAIRE

    Ferguson, David W.; Farwell, Allan P.; Bradley, William A.; Rollings, Robert C.

    1988-01-01

    A 17-year-old boy had a 2-day prodrome of fever and mild sore throat followed by 2 episodes of severe anginal chest discomfort and substantial transient ST-segment elevations in the anterior leads of the electrocardiogram. A subsequent evaluation showed the 2 episodes were most likely coronary vasospasm complicating acute viral myocarditis.

  11. Acute intracerebral haemorrhage complication after carotid artery stenting

    OpenAIRE

    Chiriac A.; Ion Georgiana; Dobrin N.; Poeata I.

    2015-01-01

    Intracranial hemorrhage following carotid artery stenting is a recognized rare complication but with potentially devastating evolution. Reports of acute cerebral hemorrhage injury following internal carotid artery (ICA) angioplasty are few, and usually were discussed in correlation with hyperperfusion syndrome. In this article we present a patient who experienced a fatal ipsilateral basal ganglia hemorrhage within 10 minutes after carotid angioplasty and stent placement

  12. Acute pancreatitis : a newly recognised potential complication of canine babesiosis

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    A.J. Möhr

    2000-07-01

    Full Text Available This retrospective study describes 4 cases of canine babesiosis with histologically confirmed acute pancreatitis. In addition, 16 dogs with babesiosis are reported with serum amylase (>3500 U/l and/or lipase (>650 U/l activity elevations of a magnitude that would support a diagnosis of probable acute pancreatitis, although extra-pancreatic sources of the enzymes could not be excluded in these cases. Median time of pancreatitis diagnosis was 2.5 days post-admission, with primarily young (median age 3 years, sexually intact dogs affected. The development of pancreatitis was unrelated to the degree of anaemia at time of admission. In addition to pancreatitis, 80 % of cases suffered from other babesial complications, namely icterus (13, acute respiratory distress syndrome (6, immune-mediated haemolytic anaemia (6, renal failure (3, haemoconcentration (2 and cerebral syndrome (2. Acute respiratory distress syndrome, renal failure and cerebral syndrome were associated with a poor prognosis, with 4 of the 5 dogs included in the overall 26 % mortality rate having at least 1 of these complications. Haemolytic anaemia with ischaemia-reperfusion injury to the pancreas is proposed as a possible primary pathophysiological mechanism in babesial pancreatitis. Hypotensive shock, immune-mediated haemolytic anaemia, haemoconcentration and possibly altered lipid metabolism in babesiosis may also be involved. The previously postulated pro-inflammatory cytokine milieu of complicated babesiosis may underlie the progression, if not the primary initiation, of pancreatic pathology. Acute pancreatitis may represent the previously reported 'gut' form of babesiosis.

  13. [Colonic perforation, a rare complication of acute necrotizing pancreatitis].

    Science.gov (United States)

    Calleja Subirán, M C; Urien Blázquez, L M

    2006-05-01

    The inflammatory disease of the pancreas can be classified like us acute or chronic pancreatitis. The pancreatitis incidence vary according to the countries and the causes which originate it; consumption of alcohol, gallotone, metabolic factors, drugs and others. The anatomopathological spectrum of the acute pancreatitis vary from pancreatitis edematosa, which usually is a light disorder with a limited evolution, to the pancreatitis necrosante, in which the grade of pancreas necrosis keeps relation with the importance of the attack and with its general declarations that in his evolution can give place to numerous complications, among which the colonic perforation is not frequent. We present a 75-year-old woman, with acute pancreatitis necrohaemorragic for colelitiasis multiple that evolves favorably at the beginning of the medical treatment, but she presented a later colonic perforation as a rare complication of the pancreatic process.

  14. A rare cause of acute abdomen: tumor rupture of nonpalpable testis

    Science.gov (United States)

    Yıldız, Turan; İlçe, Zekeriya; Gündüz, Yasemin; Çakırsoy, Gözde Çakar

    2016-01-01

    Undescended testicle is the most common congenital anomaly among males. Testicular tumor develops in 3–5% of the boys with a complaint of undescended testicle. The clinical presentation of malignant intra-abdominal testicular tumors ranges from asymptomatic cases to acute abdomen. In this study, we present a child with testicular tumor rupture which is observed very rarely. A 16-year-old boy presented 24 hours after the sudden onset of right lower quadrant pain, nausea, vomiting and fever. On physical examination, extensive tenderness in the abdomen and abdominal guarding were found. The right testicle was not palpable. The serum white blood cell count was elevated. Ultrasonography and abdominal computerized tomography scan demonstrated a perforated, hyperdense mass with free fluid in the abdomen. The preoperative alpha fetoprotein level was found to be increased. We performed surgery with laparoscopy and a perforated right intraabdominal testicle was found in the right iliac fossa. The mass was excised. Histopathological examination revealed a yolk sac tumor. Ruptured nonpalpable testicular tumors are very rare. To our knowledge, this is the first adolescent case reported so far. Testicular tumor rupture should be considered in patients with nonpalpable testicle and acute abdomen. Laparoscopy may be performed in differential diagnosis and treatment of these patients.

  15. A rare cause of acute abdomen: tumor rupture of nonpalpable testis.

    Science.gov (United States)

    Yıldız, Turan; İlçe, Zekeriya; Gündüz, Yasemin; Çakırsoy, Gözde Çakar

    2016-09-01

    Undescended testicle is the most common congenital anomaly among males. Testicular tumor develops in 3-5% of the boys with a complaint of undescended testicle. The clinical presentation of malignant intra-abdominal testicular tumors ranges from asymptomatic cases to acute abdomen. In this study, we present a child with testicular tumor rupture which is observed very rarely. A 16-year-old boy presented 24 hours after the sudden onset of right lower quadrant pain, nausea, vomiting and fever. On physical examination, extensive tenderness in the abdomen and abdominal guarding were found. The right testicle was not palpable. The serum white blood cell count was elevated. Ultrasonography and abdominal computerized tomography scan demonstrated a perforated, hyperdense mass with free fluid in the abdomen. The preoperative alpha fetoprotein level was found to be increased. We performed surgery with laparoscopy and a perforated right intraabdominal testicle was found in the right iliac fossa. The mass was excised. Histopathological examination revealed a yolk sac tumor. Ruptured nonpalpable testicular tumors are very rare. To our knowledge, this is the first adolescent case reported so far. Testicular tumor rupture should be considered in patients with nonpalpable testicle and acute abdomen. Laparoscopy may be performed in differential diagnosis and treatment of these patients.

  16. Augmented Repair of Acute Achilles Tendon Rupture Using an Allograft Tendon Weaving Technique.

    Science.gov (United States)

    Huang, Xiaowei; Huang, Gan; Ji, Ying; Ao, Rong guang; Yu, Baoqing; Zhu, Ya Long

    2015-01-01

    Achilles tendon rupture is a common injury, especially in those who are physically active. Although open surgery is a widely used option for the treatment of acute Achilles tendon rupture, the optimal treatment is still disputed. In our study, 59 patients with unilateral, closed, acute rupture of the Achilles tendon were treated by open surgery using an allograft weave to augment the repair. All the surgeries were performed within 1 to 4 days after injury. The mean American Orthopaedic Foot and Ankle Society ankle-hindfoot score was recorded as 91.20 (range 88 to 95), 95.34 (range 92 to 98), and 98.27 (range 97 to 99) at the 3-, 6-, and 12-month follow-up visit, respectively. At the final follow-up visit, the mean difference between the mid-calf circumference of the injured and uninjured legs was 0.19 (range -0.03 to 1.50) cm (p = .43). At the final follow-up visit, the mean difference between the vertical distances from the plantar surface of the heel to the ground for the injured and uninjured lower extremities was 0.44 (range -0.03 to 0.5) cm (p = .17). Augmented repair using the allograft tendon weaving technique provided satisfactory tendon strength and functional outcomes and a timely return to the patients' activities. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  17. Orbital complications of acute sinusitis in infants: a systematic review and report of a case.

    Science.gov (United States)

    Sharma, Saurabh; Josephson, Gary D

    2014-11-01

    Orbital infections from acute sinusitis are rare in neonates and infants and can lead to devastating complications. To our knowledge, no prior dedicated review exists for evaluation, treatment, and outcomes of orbital complications in this age group. To perform a systematic review over the past 50 years on the diagnosis and treatment of orbital complications secondary to acute sinusitis in neonates and infants and report a case. A systematic review of the literature was performed searching PubMed to collect all the pertinent case reports and series in the English language with subperiosteal orbital abscess (SPOA) or orbital abscess in neonates or infants (date range, 1959-2012). Eleven cases of SPOA in infants were identified, including our current case. Ages ranged from 10 to 74 days. There were 6 female and 5 male infants. The right eye was affected in 5 cases, the left in 5, and both in 1. There was 1 mortality in this series for which surgical drainage was not performed. Staphylococcus aureus was the most common organism isolated in 9 of 11 cases. Seven of the cases had open surgical drainage, 2 had endoscopic procedures (including our case), and 1 had spontaneous rupture of the abscess. An orbital complication due to acute sinusitis is rare in infants and neonates. Drainage in this patient population appears to be paramount, since the only infant in this series who did not receive drainage had died. Modern telescopes and equipment have allowed endoscopic drainage to be a safe and effective surgical treatment in this age group.

  18. [Pulmonary contusion and acute respiratory distress syndrome (ARDS) as complications of blunt chest trauma].

    Science.gov (United States)

    Michalska, Agata; Jurczyk, Agnieszka P; Machała, Waldemar; Szram, Stefan; Berent, Jarosław

    2009-01-01

    Blunt chest traumas are common nowadays due to development of motor transport. They are associated with high mortality rates because of serious injuries of internal organs. The mechanisms of injuries are complex and may cause damages ranging from small ones, such as bruises or abrasions, to life-threatening trauma. Among typical injuries there are rib fractures, sternal fractures, pneumothorax, hemothorax, diaphragm lacerations, pulmonary contusions, cardiac tamponade, cardiac rupture and many others. The authors of the article would like to emphasize the pathophysiology and diagnostic difficulties in such blunt chest trauma complications as pulmonary contusions and acute respiratory distress syndrome, for which no causal treatment is available and only early diagnosis and administration of symptomatic treatment may increase the patients' chances to survive. In Forensic Medicine Department, Medical University of Łódź, an opinion was issued on a case which illustrates the clinical problem.

  19. Fatal rupture of a brain arteriovenous malformation flow-related aneurysm during microcatheter removal: a rare complication.

    Science.gov (United States)

    Gabrieli, Joseph; Clarençon, Frédéric; Di Maria, Federico; Fahed, Robert; Boch, Anne-Laure; Degos, Vincent; Chiras, Jacques; Sourour, Nader-Antoine

    2015-04-01

    Intracranial aneurysms are relatively frequently encountered in patients with brain arteriovenous malformations (BAVMs). They may be located on the circle of Willis, on arterial feeders, or even inside the nidus. Because BAVM-associated aneurysms represent a risk factor of bleeding, the question of the timing and modality of their management remains a matter of debate in unruptured BAVMs. The authors present a case of fatal periprocedural rupture of a flow-related aneurysm (FRA) during the removal of the microcatheter after injection of a liquid embolic agent. A 40-year-old man was treated at the authors' institution for the management of a Spetzler-Martin Grade III left unruptured frontal BAVM, revealed by seizures and a focal neurological deficit attributed to flow steal phenomenon. After a multidisciplinary meeting, endovascular treatment was considered to reduce the flow of the BAVM. A proximal FRA located on the feeding internal carotid artery (ICA) was purposely left untreated because it did not meet the criteria of the authors' institution for preventative treatment (i.e., small size [2.5 mm]). During embolization, at the time of microcatheter retrieval, and after glue injection, the aneurysm unexpectedly ruptured. The aneurysm's rupture was attributed to the stress (torsion/flexion) on the ICA caused by the microcatheter removal. Despite the attempts to manage the bleeding, the patient eventually died of the acute increase of intracranial pressure related to the massive subarachnoid hemorrhage. This case highlights a previously unreported mechanism of FRA rupture during BAVM embolization: the stress transmitted to the parent artery during the removal of the microcatheter.

  20. Long-Term Results of Mini-Open Repair Technique in the Treatment of Acute Achilles Tendon Rupture: A Prospective Study.

    Science.gov (United States)

    Taşatan, Ersin; Emre, Tuluhan Yunus; Demircioğlu, Demet Tekdöş; Demiralp, Bahtiyar; Kırdemir, Vecihi

    2016-01-01

    An ideal surgical treatment of acute Achilles tendon rupture includes restoring the original length of the tendon, minimizing possible adhesions with the surrounding tissues, minimizing the risk of repeat rupture, alleviating wound problems, and providing an acceptable cosmetic outcome. In the mini-open repair technique, unlike the percutaneous repair technique, the quality of the tenodesis can be visualized without disturbing the healing potential of the surrounding tissues, thus minimizing wound problems. The purpose of the present study was to assess the long-term results of the mini-open repair technique in patients with acute Achilles tendon rupture. A total of 20 consecutive patients with acute Achilles tendon rupture, admitted to our inpatient clinic from October 2003 to March 2008, were included in the present study. The patients underwent Achilles tenodesis with the mini-open repair technique, and each patient was followed up for 5 years. The study was completed in April 2013. The surgical procedure was performed with the assistance of a device designed in our orthosis laboratories, similarly to that defined by Assal et al. Of the 20 patients, 18 were male and 2 were female. Their mean age was 39.3 (range 21 to 55) years. The Achilles tendon rupture was located on the left side in 15 patients (75%) and on the right side in 5 patients (25%). The mean follow-up duration was 58.5 (range 18 to 60) months and no complications occurred during the follow-up period, including repeat rupture, wound site infection, and sural nerve injury. The mean American Orthopaedic Foot and Ankle Society scale score for the patients was 99.2 (range 94 to 100) points at the final follow-up visit. All our patients were able to return to work and sporting activities. According to the Trillat scores, the outcome was excellent in 19 patients and good in 1 patient at the 18th postoperative month. No complaint, such as pain or loss of function, that might have a negative effect on the

  1. Spontaneous rupture of renal pelvis as a rare complication of ureteral lithiasis.

    Science.gov (United States)

    Porfyris, Orestis; Apostolidi, Elena; Mpampali, Andromachi; Kalomoiris, Paraskevas

    2016-03-01

    Spontaneous rupture of renal pelvis with urine extravasation is a rare condition and usually associated with obstructing ureteric calculus. It poses diagnostic and therapeutic dilemmas, while a stepwise approach for the confirmation of diagnosis, treatment and follow up is needed. We present a case of a 75-year old male patient who had a renal pelvis rupture with perirenal extravasation of urine due to a 4 mm stone located at the right ureterovesical junction. Diagnosis was confirmed by computed tomography, while the patient was treated successfully with the placement of a percutaneous nephrostomy. A week later a CT- nephrostomography showed the healing of renal pelvis with no extravasation and no evidence of the obstructing stone.

  2. An Unusual Complication of Foam Sclerotherapy: Acute Kidney Injury

    Directory of Open Access Journals (Sweden)

    Müge EREK

    2014-09-01

    Full Text Available Sclerotherapy, in which an irritant solution is administered, is a method used to treat venous failure that results in complete venous destruction due to endothelial reaction and fibrosis. In recent years, foam sclerotherapy, in which a sclerosing agent (aethyl sclerole and air are mixed until they turn into foam and the resultant mixture is injected into noticeable veins directly and into other veins under ultrasonography in doses depending on the diameters of the varices, has been introduced. The drugs or gases used in foam sclerotherapy can cause local or systemic complications. Foam affects vessel endothelial cells and causes severe spasm in the vessel. It has been reported that endothelin-1 levels are high after foam sclerotherapy compared to the initial levels and that neurological complications vary with the endothelin levels. In this report, we present a case of acute kidney injury due to acute tubular necrosis probably caused by endothelin release following foam sclerotherapy.

  3. Rupture of Right Ventricular Free Wall Following Ventricular Septal Rupture in Takotsubo Cardiomyopathy with Right Ventricular Involvement.

    Science.gov (United States)

    Sung, June Min; Hong, Sung Jin; Chung, In Hyun; Lee, Hye Young; Lee, Jae Hoon; Kim, Hyun Jung; Byun, Young Sup; Kim, Byung Ok; Rhee, Kun Joo

    2017-01-01

    Most patients diagnosed with takotsubo cardiomyopathies are expected to almost completely recover, and their prognosis is excellent. However, complications can occur in the acute phase. We present a case of a woman with takotsubo cardiomyopathy with right ventricular involvement who developed a rupture of the right ventricular free wall following ventricular septal rupture, as a consequence of an acute increase in right ventricular afterload by left-to-right shunt. Our case report illustrates that takotsubo cardiomyopathy can be life threatening in the acute phase. Ventricular septal rupture in biventricular takotsubo cardiomyopathy may be a harbinger of cardiac tamponade by right ventricular rupture.

  4. Acute hydrothorax complicating peritoneal dialysis: a case report

    OpenAIRE

    2010-01-01

    Abstract Introduction Acute hydrothorax is an uncommon but a well-recognized complication of peritoneal dialysis. No single test is definitive for diagnosis. Although it is not a life-threatening condition, hydrothorax often requires abandonment of peritoneal dialysis. Delay in diagnosis can lead to worsening of the clinical status. Case Presentation A 33-year-old Caucasian woman with lupus, who was successfully treated with temporary peritoneal dialysis 17 years previously, presented with ac...

  5. Acute intracerebral haemorrhage complication after carotid artery stenting

    Directory of Open Access Journals (Sweden)

    Chiriac A.

    2015-06-01

    Full Text Available Intracranial hemorrhage following carotid artery stenting is a recognized rare complication but with potentially devastating evolution. Reports of acute cerebral hemorrhage injury following internal carotid artery (ICA angioplasty are few, and usually were discussed in correlation with hyperperfusion syndrome. In this article we present a patient who experienced a fatal ipsilateral basal ganglia hemorrhage within 10 minutes after carotid angioplasty and stent placement

  6. Minimally invasive flexor hallucis longus transfer in management of acute achilles tendon rupture associated with tendinosis: a case report.

    Science.gov (United States)

    Lui, Tun Hing

    2012-04-01

    Chronic tendinopathy is characterized by pain in the tendon, generally at the start and completion of exercise. However, tendinosis may lead to decreased blood flow, increased stiffness of the tendon and reduced tensile strength, and predispose to rupture. Operative treatment is indicated to restore the function of the Achilles tendon and alleviate the prerupture heel cord pain. A case of acute Achilles tendon rupture with extensive tendinosis that was successfully treated with minimally invasive flexor hallucis longus transfer is reported.

  7. The Achilles tendon total rupture score: a study of responsiveness, internal consistency and convergent validity on patients with acute Achilles tendon ruptures

    Directory of Open Access Journals (Sweden)

    Kearney Rebecca S

    2012-02-01

    Full Text Available Abstract Background The Achilles tendon Total Rupture Score was developed by a research group in 2007 in response to the need for a patient reported outcome measure for this patient population. Beyond this original development paper, no further validation studies have been published. Consequently the purpose of this study was to evaluate internal consistency, convergent validity and responsiveness of this newly developed patient reported outcome measure within patients who have sustained an isolated acute Achilles tendon rupture. Methods Sixty-four eligible patients with an acute rupture of their Achilles tendon completed the Achilles tendon Total Rupture Score alongside two further patient reported outcome measures (Disability Rating Index and EQ 5D. These were completed at baseline, six weeks, three months, six months and nine months post injury. The Achilles tendon Total Rupture Score was evaluated for internal consistency, using Cronbach's alpha, convergent validity, through correlation analysis and responsiveness, by analysing floor and ceiling effects and calculating its relative efficiency in comparison to the Disability Rating Index and EQ 5D scores. Results The Achilles tendon Total Rupture Score demonstrated high internal consistency (Cronbachs alpha > 0.8 and correlated significantly (p Conclusions A universally accepted outcome measure is imperative to allow comparisons to be made across practice. This is the first study to evaluate aspects of validity of this newly developed outcome measure, outside of the developing centre. The ATRS demonstrated high internal consistency and responsiveness, with limited convergent validity. This research provides further support for the use of this outcome measure, however further research is required to advocate its universal use in patients with acute Achilles tendon ruptures. Such areas include inter-rater reliability and research to determine the minimally clinically important difference

  8. The Achilles tendon total rupture score: a study of responsiveness, internal consistency and convergent validity on patients with acute Achilles tendon ruptures.

    Science.gov (United States)

    Kearney, Rebecca S; Achten, Juul; Lamb, Sarah E; Parsons, Nicholas; Costa, Matthew L

    2012-02-29

    The Achilles tendon Total Rupture Score was developed by a research group in 2007 in response to the need for a patient reported outcome measure for this patient population. Beyond this original development paper, no further validation studies have been published.Consequently the purpose of this study was to evaluate internal consistency, convergent validity and responsiveness of this newly developed patient reported outcome measure within patients who have sustained an isolated acute Achilles tendon rupture. Sixty-four eligible patients with an acute rupture of their Achilles tendon completed the Achilles tendon Total Rupture Score alongside two further patient reported outcome measures (Disability Rating Index and EQ 5D). These were completed at baseline, six weeks, three months, six months and nine months post injury. The Achilles tendon Total Rupture Score was evaluated for internal consistency, using Cronbach's alpha, convergent validity, through correlation analysis and responsiveness, by analysing floor and ceiling effects and calculating its relative efficiency in comparison to the Disability Rating Index and EQ 5D scores. The Achilles tendon Total Rupture Score demonstrated high internal consistency (Cronbachs alpha > 0.8) and correlated significantly (p measure is imperative to allow comparisons to be made across practice. This is the first study to evaluate aspects of validity of this newly developed outcome measure, outside of the developing centre. The ATRS demonstrated high internal consistency and responsiveness, with limited convergent validity. This research provides further support for the use of this outcome measure, however further research is required to advocate its universal use in patients with acute Achilles tendon ruptures. Such areas include inter-rater reliability and research to determine the minimally clinically important difference between scores.All authors have read and concur with the content of this manuscript. The material

  9. SURGICAL PERCUTANEOUS TREATMENT OF AN ACUTE RUPTURE OF ACHILLES TENDON IN ATHLETES

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    Zarko Dasic

    2005-01-01

    Full Text Available We have registered that with growing interest of the middle-aged in sport activities in our country the incidence of Achilles tendon ruptures has increased. It was usually preceded by its degenerative changes. Our aim was to examine the results of Achiles tendon rupture treatment in the group treated with our modified percutaneous technique with double - crossed suture.We compared these results with those obtained by the treatment with the nonsurgical method.Our study included 139 patients who gained injuries during their sports activities. They were active professionals or ex-active who continued training sports for recreation, and finally, amateurs who trained sports for the sake of recreation. We also analyzed differences in the results of those three groups after the treatment and checked them statistically.The results have showed superiority of this percutaneous operative treatment because of its simple operative technique, possibility of doing it in the local anaesthesia, continuous ultrasonographic following of the rupture during the process of healing up and shorter immobilisation time, practically without hospitalization and rare complications.

  10. Peritonsillar Abscess: Complication of Acute Tonsillitis or Weber's Glands Infection?

    Science.gov (United States)

    Klug, Tejs Ehlers; Rusan, Maria; Fuursted, Kurt; Ovesen, Therese

    2016-08-01

    To review the literature concerning the 2 primary hypotheses put forth to explain the pathogenesis of peritonsillar abscess: "the acute tonsillitis hypothesis" (peritonsillar abscess is a complication of acute tonsillitis) and "the Weber gland hypothesis" (peritonsillar abscess is an infection of Weber's glands). PubMed, EMBASE. Data supporting or negating one hypothesis or the other were elicited from the literature. Several findings support the acute tonsillitis hypothesis. First, the 2 main pathogens in peritonsillar abscess have been recovered from pus aspirates and bilateral tonsillar tissues with high concordance rates, suggesting that both tonsils are infected in patients with peritonsillar abscess. Second, studies report signs of acute tonsillitis in the days prior to and at the time of peritonsillar abscess. Third, antibiotic treatment reduces the risk of abscess development in patients with acute tonsillitis. However, some findings suggest involvement of the Weber's glands in peritonsillar abscess pathogenesis. First, high amylase levels have been found in peritonsillar pus. Second, the majority of peritonsillar abscesses are located at the superior tonsillar pole in proximity of the Weber's glands. We propose a unified hypothesis whereby bacteria initially infect the tonsillar mucosa and spread via the salivary duct system to the peritonsillar space, where an abscess is formed. Our findings support the rationale for antibiotic treatment of patients with severe acute tonsillitis to reduce the risk of abscess development. Improved understanding of peritonsillar abscess pathogenesis is important for the development of efficient prevention strategies. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

  11. Contrast-enhanced ultrasonography to diagnose complicated acute cholecystitis.

    Science.gov (United States)

    Sagrini, Elisabetta; Pecorelli, Anna; Pettinari, Irene; Cucchetti, Alessandro; Stefanini, Federico; Bolondi, Luigi; Piscaglia, Fabio

    2016-02-01

    Gangrenous cholecystitis and perforation are severe complications of acute cholecystitis, which have a challenging preoperative diagnosis. Early identification allows better surgical management. Contrast-enhanced computed tomography (ceCT) is the current diagnostic gold standard. Contrast-enhanced ultrasonography (CEUS) is a promising tool for the diagnosis of gallbladder perforation, but data from the literature concerning efficacy are sparse. The aim of the study was to evaluate CEUS findings in pathologically proven complicated cholecystitis (gangrenous, perforated gallbladder, pericholecystic abscess). A total of 8 patients submitted to preoperative CEUS, and with subsequent proven acute complicated cholecystitis at surgical inspection and pathological analysis, were retrospectively identified. The final diagnosis was gangrenous/phlegmonous cholecystitis (n. 2), phlegmonous/ulcerative changes plus pericholecystic abscess (n. 2), perforated plus pericholecystic abscess (n. 3), or perforated plus pericholecystic biliary collection (n. 1). Conventional US findings revealed irregularly thickened gallbladder walls in all 8 patients, with vaguely defined walls in 7 patients, four of whom also had striated wall thickening. CEUS revealed irregular enhancing gallbladder walls in all patients. A distinct wall defect was seen in six patients, confirmed as gangrenous/phlegmonous cholecystitis at pathology in all six, and in four as perforation at macroscopic surgical inspection. CEUS is a non-invasive easily repeatable technique that can be performed at the bedside, and is able to accurately diagnose complicated/perforated cholecystitis. Despite the limited sample size in the present case series, CEUS appears as a promising tool for the management of patients with the clinical possibility of having an acute complicated cholecystitis.

  12. Acute concentrated phenol dermal burns: Complications and management

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    Tapan Jayantilal Parikh

    2015-01-01

    Full Text Available Phenol burns can result in multiple organ failure. This is a case report of acute severe phenol dermal burn after accidental splash of 94% phenol on 35-year-old patient′s body who was brought to hospital after 90 min of exposure. Decontamination was done with high-density water and glycerol. Early complications in form of metabolic acidosis and acute renal failure required hemodialysis. Extensive protein denaturation was managed with IV albumin and high protein diet. Patient also developed pleural effusion and acute respiratory distress syndrome, but these were successfully managed by intercostal drain tube insertion and noninvasive ventilation. The patient survived after multiple organ failures and widespread burns despite the fact that it has been observed that outcome of phenol burns with >60 2 inches of skin affected or two or more organs failure involving renal system is nearly fatal.

  13. Application of Computed Tomography Processed by Picture Archiving and Communication Systems in the Diagnosis of Acute Achilles Tendon Rupture

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    Hai-Peng Xue

    2016-01-01

    Full Text Available The applications of CT examination in the diagnosis of the acute Achilles tendon rupture (AATR were investigated. A total of 36 patients with suspected acute Achilles tendon rupture were tested using physical examination, ultrasound, and 3DCT scanning, respectively. Then, surgery was performed for the patients who showed positive result in at least two of the three tests for AATR. 3DVR, MPR, and the other CT scan image processing and diagnosis were conducted in PACS (picture archiving and communication system. PACS was also used to measure the length of distal broken ends of the Achilles tendon (AT to tendon calcaneal insertion. Our study indicated that CT has the highest accuracy in diagnosis of acute Achilles tendon complete rupture. The length measurement is matched between PACS and those actually measured in operation. CT not only demonstrates more details directly in three dimensions especially with the rupture involved calcaneal insertion flap but also locates the rupture region for percutaneous suture by measuring the length of distal stump in PACS without the effect of the position of ankle. The accuracy of CT diagnosis for Achilles tendon partial rupture is yet to be studied.

  14. Application of Computed Tomography Processed by Picture Archiving and Communication Systems in the Diagnosis of Acute Achilles Tendon Rupture.

    Science.gov (United States)

    Xue, Hai-Peng; Liu, Xin-Wei; Tian, Jing; Xie, Bing; Yang, Chao; Zhang, Hao; Zhou, Da-Peng

    2016-01-01

    The applications of CT examination in the diagnosis of the acute Achilles tendon rupture (AATR) were investigated. A total of 36 patients with suspected acute Achilles tendon rupture were tested using physical examination, ultrasound, and 3DCT scanning, respectively. Then, surgery was performed for the patients who showed positive result in at least two of the three tests for AATR. 3DVR, MPR, and the other CT scan image processing and diagnosis were conducted in PACS (picture archiving and communication system). PACS was also used to measure the length of distal broken ends of the Achilles tendon (AT) to tendon calcaneal insertion. Our study indicated that CT has the highest accuracy in diagnosis of acute Achilles tendon complete rupture. The length measurement is matched between PACS and those actually measured in operation. CT not only demonstrates more details directly in three dimensions especially with the rupture involved calcaneal insertion flap but also locates the rupture region for percutaneous suture by measuring the length of distal stump in PACS without the effect of the position of ankle. The accuracy of CT diagnosis for Achilles tendon partial rupture is yet to be studied.

  15. Management of acute Achilles tendon rupture with tendon-bundle technique.

    Science.gov (United States)

    Li, Chun-Guang; Li, Bing; Yang, Yun-Feng

    2017-02-01

    Objective * These authors contributed equally to this work. To explore tendon-bundle technique for treating Achilles tendon rupture with no defects. Methods Patients with full unilateral Achilles tendon rupture with no defects were included. The Achilles tendon medial edge surgical repair approach was used, revealing horsetail-like rupture bundles. Tendon bundles were anatomically realigned and repaired end-to-end using 5-0 sutures. Patients were followed-up for 1 year, and assessed for differences between the repaired versus healthy limb. Results Out of 24 patients (18 male, 6 female; aged 19-56 years) at 1 year following surgery, mean American Orthopaedic Foot and Ankle Society score was 92.4 ± 5.9; mean differences between the surgically repaired versus contralateral side in dorsiflexion and plantarflexion angle were 3.5 ± 2.3° and 5.6 ± 3.2°, respectively; mean difference in calf circumference between the two sides was 0.9 ± 0.5 cm; and mean increase in Achilles tendon width versus the healthy side was 0.8 ± 0.2 cm. By 1 year post-surgery, there were no significant between-side differences in dorsiflexion and plantarflexion angle, or calf circumference. Conclusions Tendon-bundle surgery resulted in good ankle function restoration and low complication rates. Tendon-bundle surgery may reduce blood supply destruction and maximally preserve Achilles tendon length, and may be effective for treating Achilles tendon rupture with no defects.

  16. Ruptured Granulosa Cell Tumor of the Ovary as a Cause of Acute Abdomen in Postmenopausal Woman

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    Tufan Oge

    2012-01-01

    Full Text Available Acute abdomen with hemoperitoneum is a very rare entity in postmenopausal women due to gynecologic conditions. A 54-year-old, postmenopausal woman was brought to emergency department with severe abdominal pain. Physical examination revealed acute abdomen findings with 15 cm pelvic mass on the right adnexal region. Immediate exploratory laparotomy was performed. During laparotomy 1000 cc of bloodstained fluid, ruptured and actively bleeding large mass arising from right ovary was observed. Right salpingo-oopherectomy was performed in emergency conditions, and pathology report revealed an adult type of granulosa cell tumor. After this result, staging surgery was performed and patient was diagnosed as granulosa cell tumor stage 1 c. Cisplatin, etoposide, and bleomycin chemotherapy was given. Clinicians should be aware of granulosa cell tumors which may occur at any age and prone to rupture. Frozen section will be helpful in order to avoid incomplete surgeries especially in postmenopausal women presented with intra-abdominal bleeding.

  17. A Torted Ruptured Intra-abdominal Testicular Seminoma Presenting As An Acute Abdomen.

    Science.gov (United States)

    Nickalls, Oliver James; Tan, Char Loo; Thian, Yee Liang

    2015-12-01

    The susceptibility of the undescended testis to malignant transformation is well documented. The most common location of the undescended testis is within the inguinal canal, with only a minority located within the abdominal cavity. When a testicular mass develops, the risk of torsion increases. We describe a large intra-abdominal testicular seminoma that had undergone torsion, rupture and haemorrhage, presenting as an acute abdomen. A 30 year old man presented to the emergency department with right iliac fossa pain. Computed tomography in the emergency department showed haemoperitoneum and a torted large left testicular mass, likely malignant. The patient underwent laparotomy and excision of the mass. Histologic examination revealed a grossly enlarged seminomatous testis which had torted and ruptured. While pre-operative imaging diagnosis of an intra-abdominal testicular seminoma has been published, reports are few. To the best of the author's knowledge pre-operative imaging diagnosis of a malignant testicular mass with torsion and intra-abdominal haemorrhage presenting as an acute abdomen has not been described before.

  18. A Torted Ruptured Intra-abdominal Testicular Seminoma Presenting As An Acute Abdomen

    Science.gov (United States)

    Nickalls, Oliver James; Tan, Char Loo; Thian, Yee Liang

    2015-01-01

    The susceptibility of the undescended testis to malignant transformation is well documented. The most common location of the undescended testis is within the inguinal canal, with only a minority located within the abdominal cavity. When a testicular mass develops, the risk of torsion increases. We describe a large intra-abdominal testicular seminoma that had undergone torsion, rupture and haemorrhage, presenting as an acute abdomen. A 30 year old man presented to the emergency department with right iliac fossa pain. Computed tomography in the emergency department showed haemoperitoneum and a torted large left testicular mass, likely malignant. The patient underwent laparotomy and excision of the mass. Histologic examination revealed a grossly enlarged seminomatous testis which had torted and ruptured. While pre-operative imaging diagnosis of an intra-abdominal testicular seminoma has been published, reports are few. To the best of the author’s knowledge pre-operative imaging diagnosis of a malignant testicular mass with torsion and intra-abdominal haemorrhage presenting as an acute abdomen has not been described before. PMID:27200173

  19. Unusual balloon rupture during direct stenting with a TaxusExpress stent in a venous graft complicated by vessel rupture: a device-related fatal event

    DEFF Research Database (Denmark)

    Christiansen, Evald H

    2007-01-01

    proximally with a diameter of 4.5 mm, and the balloon ruptured. Angiography showed rupture of the vessel proximal to the implanted stent, and the patient developed severe hypotension. The rupture was treated with a covered stent and pericardiocentesis was performed with evacuation of 600 mL blood. However......, it was not possible to resuscitate the patient, who died due to severe pump failure and incessant ventricular fibrillation. Udgivelsesdato: 2007-Feb...

  20. A Prospective Study of Platelet-Rich Plasma as Biological Augmentation for Acute Achilles Tendon Rupture Repair

    Directory of Open Access Journals (Sweden)

    Jian Zou

    2016-01-01

    Full Text Available Acute Achilles tendon rupture is one of the most common tendon injuries in adults. We hypothesized that Platelet-Rich Plasma (PRP can be used as biological augmentation for surgical treatment of acute Achilles tendon rupture. Our study is a prospective randomized controlled trial. Patients with acute Achilles tendon rupture undergoing surgical repair were randomly assigned into either control group or PRP group. End-to-end modified Krackow suture was performed in both groups. In the PRP group, PRP was injected into the paratenon sheath and around the ruptured tissue after the tendon was repaired. Postoperatively we evaluated isokinetic muscle strength at 3, 6, 12, and 24 months. In addition, ankle ROM, calf circumference, Leppilahti score, and the SF-36 score were evaluated at 6, 12, and 24 months after operation. At 3 months, the PRP group had better isokinetic muscle. The PRP group also achieved higher SF-36 and Leppilahti scores at 6 and 12 months. At 24 months, the PRP group had an improved ankle range of motion compared to the control group. Our study results suggest that PRP can serve as a biological augmentation to acute Achilles tendon rupture repair and improves both short and midterm functional outcomes.

  1. A Prospective Study of Platelet-Rich Plasma as Biological Augmentation for Acute Achilles Tendon Rupture Repair.

    Science.gov (United States)

    Zou, Jian; Mo, Xiaolian; Shi, Zhongmin; Li, Tanzhu; Xue, Jianfeng; Mei, Guohua; Li, Xiaolin

    2016-01-01

    Acute Achilles tendon rupture is one of the most common tendon injuries in adults. We hypothesized that Platelet-Rich Plasma (PRP) can be used as biological augmentation for surgical treatment of acute Achilles tendon rupture. Our study is a prospective randomized controlled trial. Patients with acute Achilles tendon rupture undergoing surgical repair were randomly assigned into either control group or PRP group. End-to-end modified Krackow suture was performed in both groups. In the PRP group, PRP was injected into the paratenon sheath and around the ruptured tissue after the tendon was repaired. Postoperatively we evaluated isokinetic muscle strength at 3, 6, 12, and 24 months. In addition, ankle ROM, calf circumference, Leppilahti score, and the SF-36 score were evaluated at 6, 12, and 24 months after operation. At 3 months, the PRP group had better isokinetic muscle. The PRP group also achieved higher SF-36 and Leppilahti scores at 6 and 12 months. At 24 months, the PRP group had an improved ankle range of motion compared to the control group. Our study results suggest that PRP can serve as a biological augmentation to acute Achilles tendon rupture repair and improves both short and midterm functional outcomes.

  2. A Case of a Chronic Pancreatic Pseudocyst Causing Atraumatic Splenic Rupture without Evidence of Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    P. Moori

    2016-01-01

    Full Text Available Atraumatic splenic rupture is a rare complication of a pancreatic pseudocyst (PP, described in the setting of chronic pancreatitis. There is common understanding, within the literature, that an inflammatory process at the tail of the pancreas may disrupt the spleen and result in such splenic complications. The authors present a case report of a 29-year-old male with a PP, associated with chronic pancreatitis. The patient had a history of excessive alcohol intake and presented to the emergency department with a short history of abdominal pain and vomiting. He denied any significant history of trauma and serum amylase levels were normal. An admission computed tomography (CT scan of the abdomen confirmed the presence of a PP in direct contact with the spleen. The CT also demonstrated a heterogenous hypodense area of the splenic hilum, along with perisplenic fluid. The patient was admitted for observation. His abdominal pain progressed, and he became haemodynamically unstable. An emergency ultrasound scan (USS at this time revealed intra-abdominal haemorrhage. A subsequent CT confirmed splenic rupture, which was managed surgically with a full recovery. Few such cases are documented within the literature and more understanding of preempting such events is needed.

  3. Complication rate of posterior capsule rupture with vitreous loss during phacoemulsification at a Hawaiian cataract surgical center: a clinical audit

    Directory of Open Access Journals (Sweden)

    Chen M

    2014-02-01

    Full Text Available Ming Chen,1 Kara C LaMattina,2 Thomas Patrianakos,2 Surendar Dwarakanathan2 1Department of Surgery, Division of Ophthalmology, University of Hawaii, Honolulu, HI, USA; 2Division of Ophthalmology, John H Stroger, Jr Hospital of Cook County, Chicago, IL, USA Purpose: To compare the complication rate of posterior capsule rupture (PCR with vitreous loss during phacoemulsification at an ambulatory surgical center with published results as a clinical audit for quality control. Methods: A retrospective chart review of 3,339 consecutive patients who underwent routine phacoemulsification by four experienced private practice surgeons from January 1, 2011 to June 30, 2012 at The Surgical Suites, Honolulu, HI, USA. All cases with PCR and vitreous loss were identified and selected for the study. Risk factors of this complication were further examined. Data were sent to John H Stroger Jr Hospital of Cook County, Division of Ophthalmology, for literature review, analysis, and write-up. Results: Twenty-three of the 3,339 cases incurred PCR and vitreous loss during phacoemulsification, for an incidence rate of 0.68%. Miosis, shallow chamber, restlessness, pseudoexfoliation syndrome, floppy iris syndrome, and zonulopathy were the main causes. In addition, surgeon volume (number of cases was inversely correlated with PCR. Conclusion: The rate of PCR with vitreous loss during phacoemulsification in this study may be lower than other published results done at academic centers. However, there was no compatible study available for comparison, as existing studies performed at academic centers included resident cases. This study identified risk factors for PCR/vitreous loss both preoperatively and postoperatively that may assist in application of preventive measures to decrease rates of PCR/vitreous loss. Keywords: phacoemulsification complications, posterior capsule rupture, vitreous loss, vitrectomy, miosis, pseudoexfoliation, floppy iris syndrome, zonulopathy

  4. Systemic sarcoidosis complicated of acute renal failure: about 12 cases.

    Science.gov (United States)

    Mahfoudhi, Madiha; Mamlouk, Habiba; Turki, Sami; Kheder, Adel

    2015-01-01

    The sarcoidosis is a systemic granulomatosis affecting most frequently the lungs and the mediastinum. An acute renal failure reveals exceptionally this disease. It's a retrospective study implicating 12 cases of sarcoidosis complicated of acute renal failure. The aim of this study is to determine epidemiological, clinical, biological and histological profile in these cases and then to indicate the interest to consider the diagnosis of sarcoidosis in cases of unexplained renal failure. Extra-renal complications, therapeutic modalities and the outcome were determined in all patients. Our series involved 12 women with an average age of 40 years. Biological investigations showed an abnormal normocalcemia in 7 cases, a hypercalcemia in 5 cases, a hypercalciuria in 10 cases and polyclonal hypergammaglobulinemia in 7 cases. An acute renal failure was found in all patients with a median creatinin of 520 umol/L. For all patients, the renal echography was normal however, the kidney biopsy showed tubulo-interstitial nephritis. The extra-renal signs highlighting pulmonary interstitial syndrome in 5 cases, a sicca syndrome in 4 cases, mediastinal lymph nodes in 2 cases, a lymphocytic alveolitis in 3 cases, an anterior granulomatous uveitis in 2 cases and a polyarthritis in 5 cases. Five patients benefited of hemodialysis. The treatment consisted of corticosteroid in all cases. The follow up was marked by complete resolution of clinical and biological signs. The diagnosis of renal sarcoidosis must be done quickly to prevent renal failure.

  5. Association of oral flora with orbital complications of acute sinusitis.

    Science.gov (United States)

    Flam, Juliette O; Platt, Michael P; Sobel, Rachel; Devaiah, Anand K; Brook, Christopher D

    2016-07-01

    Acute and chronic sinusitis in children and adults can spread to the orbit. Oral flora has been seen in orbital infections, but the extent of synergy between pathogens in such infections remains unknown. A retrospective case series of patients with complicated sinusitis that involved the orbit from acute sinusitis who were admitted to a tertiary care hospital from January 2000 to December 2014 and who had surgical cultures obtained. Patients were identified by the International Classification of Diseases, Ninth Revision code for periorbital cellulitis, subperiosteal abscess, or orbital abscess. Sixteen patients underwent surgical drainage via external drainage or endoscopic sinus surgery of an orbital infection associated with sinusitis and had cultures obtained. Nine patients (56%) grew organisms that exist in oral flora, whereas seven patients (44%) grew common respiratory pathogens. The most common organisms recovered were viridans group streptococcus (VGS) (50%), Staphylococcus aureus (31%), Eikenella corrodens (25%), and Prevotella species (19%). Oral flora anaerobes were cultured alongside a VGS species in seven of eight patients (88%) as opposed to the respiratory pathogens, which were less frequently associated with concomitant VGS infection (29%) (p = 0.04). There are two main sources for infectious orbital complications from acute sinusitis: respiratory pathogens and oral flora. The high prevalence of concurrent anaerobic oral flora and VGS infection supports a suspected synergy between VGS and other oral organisms.

  6. Scrotal Swelling as a Complication of Hydrochlorothiazide Induced Acute Pancreatitis

    Directory of Open Access Journals (Sweden)

    Ivan Nikiforov

    2015-01-01

    Full Text Available Background. Scrotal swelling is a rare complication of acute pancreatitis with few reported cases in the literature. In this case report, we present a 59-year-old male with hydrochlorothiazide induced pancreatitis who developed scrotal swelling. Case Presentation. A 59-year-old male presented to the emergency department with sharp epigastric abdominal pain that radiated to the back and chest. On physical examination, he had abdominal tenderness and distention with hypoactive bowel sounds. Computed tomography (CT scan of the abdomen showed acute pancreatitis. The patient’s condition deteriorated and he was admitted to the intensive care unit (ICU. After he improved and was transferred out of the ICU, the patient developed swelling of the scrotum and penis. Ultrasound (US of the scrotum showed large hydrocele bilaterally with no varicoceles or testicular masses. Good blood flow was observed for both testicles. The swelling diminished over the next eight days with the addition of Lasix and the patient was discharged home in stable condition. Conclusion. Scrotal swelling is a rare complication of acute pancreatitis. It usually resolves spontaneously with conservative medical management such as diuretics and elevation of the legs.

  7. [Systemic complications of subarachnoid hemorrhage from spontaneous rupture of a cerebral aneurysm].

    Science.gov (United States)

    Rama-Maceiras, P; Fàbregas Julià, N; Ingelmo Ingelmo, I; Hernández-Palazón, J

    2010-12-01

    Systemic complications secondary to subarachnoid hemorrhage from an aneurysm are common (40%) and the mortality attributable to them (23%) is comparable to mortality from the primary lesion, rebleeding, or vasospasm. Although nonneurologic medical complications are avoidable, they worsen the prognosis, lengthen the hospital stay, and generate additional costs. The prevention, early detection, and appropriate treatment of systemic complications will be essential for managing the individual patient's case. Treatment should cover major symptoms (headache, nausea, and dizziness) and ambient noise should be reduced, all with the aim of achieving excellence and improving the patient's perception of quality of care.

  8. Ageing, deep vein thrombosis and male gender predict poor outcome after acute Achilles tendon rupture.

    Science.gov (United States)

    Arverud, E Domeij-; Anundsson, P; Hardell, E; Barreng, G; Edman, G; Latifi, A; Labruto, F; Ackermann, P W

    2016-12-01

    Patients with an acute Achilles tendon rupture (ATR) take a long time to heal, have a high incidence of deep vein thrombosis (DVT) and widely variable functional outcomes. This variation in outcome may be explained by a lack of knowledge of adverse factors, and a subsequent shortage of appropriate interventions. A total of 111 patients (95 men, 16 women; mean age 40.3, standard deviation 8.4) with an acute total ATR were prospectively assessed. At one year post-operatively a uniform outcome score, Achilles Combined Outcome Score (ACOS), was obtained by combining three validated, independent, outcome measures: Achilles tendon Total Rupture Score, heel-rise height test, and limb symmetry heel-rise height. Predictors of ACOS included treatment; gender; age; smoking; body mass index; time to surgery; physical activity level pre- and post-injury; symptoms; quality of life and incidence of DVT. There were three independent variables that correlated significantly with the dichotomised outcome score (ACOS), while there was no correlation with other factors. An age of less than 40 years old was the strongest independent predictor of a good outcome one year after ATR (odds ratio (OR) 0.20, 95% confidence interval (CI) 0.08 to 0.51), followed by female gender (OR) 4.18, 95% CI 1.01 to 17.24). Notably, patients who did not have a DVT while immobilised post-operatively had a better outcome (OR 0.31, 95% CI 0.12 to 0.80). Over the age of 40 years, male gender and having a DVT while immobilised are independent negative predictors of outcome in patients with an acute ATR. Cite this article: Bone Joint J 2016;98-B:1635-41. ©2016 The British Editorial Society of Bone & Joint Surgery.

  9. Acute Achilles tendon rupture: Mini-incision repair with double-Tsuge loop suture vs. open repair with modified Kessler suture.

    Science.gov (United States)

    Fu, Chongyang; Qu, Wei

    2015-08-01

    Achilles tendon rupture is a common injury of the foot and ankle. However, the optimal treatment strategy for Achilles tendon rupture is still not established. This study was conducted to compare the efficacy and complications of mini-incision repair with double-Tsuge loop sutures and open repair with modified Kessler sutures. We evaluated data from 60 patients with acute closed Achilles tendon ruptures who underwent mini-incision repair with double-Tsuge loop sutures (n = 30) or open repair with modified Kessler sutures (n = 30) from 2006 to 2010 in an ongoing prospective study conducted by us and have finished at least 18-month follow-up or finished the study. The AOFAS Ankle-Hindfoot score, ATRS, maximal ankle range of motion and the time to achieve 20 continuous single heel raises after operation were recorded to compare the efficacy. The complications were also evaluated. During a mean follow-up of 25 months after surgery, the time to achieve 20 continuous single heel raises after operation of patients in Group Mini was significantly shorter than patients in Group Open. Moreover, the mini-incision with double-Tsuge repair was associated with a significantly shorter operating time, smaller incision length, and lower rate of complications. The mini-incision with double-Tsuge suture method in our study was shown to provide earlier strength recovery, as well as shorter operation time, less complications and improved cosmetic appearance. Copyright © 2014 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  10. Accounts of severe acute obstetric complications in Rural Bangladesh

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    Sikder Shegufta S

    2011-10-01

    Full Text Available Abstract Background As maternal deaths have decreased worldwide, increasing attention has been placed on the study of severe obstetric complications, such as hemorrhage, eclampsia, and obstructed labor, to identify where improvements can be made in maternal health. Though access to medical care is considered to be life-saving during obstetric emergencies, data on the factors associated with health care decision-making during obstetric emergencies are lacking. We aim to describe the health care decision-making process during severe acute obstetric complications among women and their families in rural Bangladesh. Methods Using the pregnancy surveillance infrastructure from a large community trial in northwest rural Bangladesh, we nested a qualitative study to document barriers to timely receipt of medical care for severe obstetric complications. We conducted 40 semi-structured, in-depth interviews with women reporting severe acute obstetric complications and purposively selected for conditions representing the top five most common obstetric complications. The interviews were transcribed and coded to highlight common themes and to develop an overall conceptual model. Results Women attributed their life-threatening experiences to societal and socioeconomic factors that led to delays in seeking timely medical care by decision makers, usually husbands or other male relatives. Despite the dominance of male relatives and husbands in the decision-making process, women who underwent induced abortions made their own decisions about their health care and relied on female relatives for advice. The study shows that non-certified providers such as village doctors and untrained birth attendants were the first-line providers for women in all categories of severe complications. Coordination of transportation and finances was often arranged through mobile phones, and referrals were likely to be provided by village doctors. Conclusions Strategies to increase timely

  11. Acute Respiratory Distress Syndrome Complicating Strongyloides stercoralis Hyperinfection

    Directory of Open Access Journals (Sweden)

    Ming-Ju Tsai

    2011-03-01

    Full Text Available Strongyloidiasis is endemic in tropic and subtropic areas, but is currently seldom encountered in developed area like Taiwan. We present an elder man with acute respiratory distress syndrome complicating Strongyloides stercoralis hyperinfection. There was no significant clue initially for diagnosing this patient as having S. stercoralis hyperinfection. Neither peripheral eosinophilia nor significant hemoptysis was noted. Bronchoscopy played a critical role to define the unexpected cause of his progressive pulmonary infiltrates. The correct diagnosis was soon made by recognition of the worm in bronchioloalveolar lavage cytology, and specific treatment was initiated promptly. For a septic patient with progressive pulmonary infiltrates, bronchoscopic studies including cytology may be necessary for defining the cause. Hyperinfection strongyloidiasis should be considered as a cause of acute respiratory distress syndrome in immunocompromised patient, especially with the presence of chronic gastrointestinal symptoms.

  12. Management of cardiogenic shock complicating acute myocardial infarction.

    Science.gov (United States)

    Van Herck, Jozef L; Claeys, Marc J; De Paep, Rudi; Van Herck, Paul L; Vrints, Christiaan J; Jorens, Philippe G

    2015-06-01

    Cardiogenic shock complicates approximately 5-10% of cases with acute myocardial infarction and carries a poor prognosis. Early revascularization remains the cornerstone treatment of cardiogenic shock complicating myocardial infarction. Inotropic and/or vasopressor agents can be used for haemodynamic stabilization, although this comes at the expense of increased myocardial oxygen consumption and extended myocardial ischaemia. In recent years, the use of mechanical circulatory support has significantly increased. However, there is only limited data available from randomized trials evaluating the different percutaneous support systems. This review summarizes the available literature concerning the management of cardiogenic shock and gives an overview of the recommendations of the European and German-Austrian guidelines on cardiogenic shock.

  13. Pregnancy Outcomes Complicated by Preterm Premature Rupture of Membranes: Retrospective Review of Cases in Three Institutions in Kazakhstan

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    Balkenzhe Imankulova

    2015-06-01

    Full Text Available Introduction. Pre-term premature rupture of membranes (PPROM is one of the leading causes of perinatal morbidity and mortality. This complication is diagnosed in 3% of pregnant women in Kazakhstan, and it is the leading cause of pre-term deliveries. The aim of this study was to determine the outcomes of pregnancies complicated by PPROM in gestation periods between 24 to 32 weeks among three institutions in Kazakhstan.Methods. This is descriptive analysis of 154 cases with PPROM observed between 24 to 32 weeks of gestation at Perinatal Centers #2 and #3 and the National Research Center for Maternal and Child Health, Astana, Kazakhstan. Cases were selected on the basis of retrospective chart review where PPROM diagnosis occurred in 2013. Descriptive statistics were utilized for data analysis.Results. The most frequent complications associated with PPROM were threat of miscarriage (13.6% of cases and chronic placental insufficiency (7.8%. The mean time between PPROM and onset of spontaneous labor was 12.1 ± 2.3 days.  Spontaneous labor within 3 days after PPROM started in patients with an amniotic fluid index of 3.0 ± 0.2 cm. Complications experienced by PPROM women during delivery and early postpartum period included: precipitous labor (6.4%, weakness of labor activity (16.2%, atonic hemorrhage (1.2%, and chorioamnionitis (3.2%. 37.6% of newborns in this study were admitted to the Intensive Care Unit. Their health complications included pneumonia (7.7%, conjunctivitis (1.3%, omphalitis and infectious-toxic shock (3.8%, intraventricular hemorrhage  (7.8%, and respiratory distress (10.3% .Conclusion. Thus, preterm rupture of membranes is associated with preterm delivery and an increase of neonatal morbidity. Therefore, it is necessary to find ways to effectively manage PPROM, including developing new techniques to restore the amniotic fluid volume in women experiencing PPROM during 24 to 32 weeks of gestation. 

  14. Acute Pulmonary Edema Associated With Propofol: An Unusual Complication

    Science.gov (United States)

    Waheed, Mian Adnan; Oud, Lavi

    2014-01-01

    Propofol is frequently used in the emergency department to provide procedural sedation for patients undergoing various procedures and is considered to be safe when administered by trained personnel. Pulmonary edema after administration of propofol has rarely been reported. We report a case of a 23-year-old healthy male who developed acute cough, hemoptysis and hypoxia following administration of propofol for splinting of a foot fracture. Chest radiography showed bilateral patchy infiltrates. The patient was treated successfully with supportive care. This report emphasizes the importance of this potentially fatal propofol-associated complication and discusses possible underlying mechanisms and related literature. PMID:25493132

  15. Rupture of Renal Transplant

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    Shona Baker

    2015-01-01

    Full Text Available Background. Rupture of renal allograft is a rare and serious complication of transplantation that is usually attributed to acute rejection, acute tubular necrosis, or renal vein thrombosis. Case Presentation. LD, a 26-year-old male with established renal failure, underwent deceased donor transplantation using kidney from a 50-year-old donor with acute kidney injury (Cr 430 mmol/L. LD had a stormy posttransplant recovery and required exploration immediately for significant bleeding. On day three after transplant, he developed pain/graft swelling and another significant haemorrhage with cardiovascular compromise which did not respond to aggressive resuscitation. At reexploration, the renal allograft was found to have a longitudinal rupture and was removed. Histology showed features of type IIa Banff 97 acute vascular rejection, moderate arteriosclerosis, and acute tubular necrosis. Conclusion. Possible ways of avoiding allograft rupture include use of well-matched, good quality kidneys; reducing or managing risk factors that would predispose to delayed graft function; ensuring a technically satisfactory transplant procedure with short cold and warm ischemia times; and avoiding large donor-recipient age gradients.

  16. Percutaneous liver biopsy complicated by hemobilia-associated acute cholecystitis

    Institute of Scientific and Technical Information of China (English)

    Yair Edden; Hugo St Hilaire; Keith Benkov; Michael T Harris

    2006-01-01

    Liver biopsy is generally considered a safe and highly useful procedure. It is frequently performed in an outpatient setting for diagnosis and follow-up in numerous liver disorders. Since its introduction at the end of the 19th century, broad experience, new imaging techniques and special needles have significantly reduced the rate of complications associated with liver biopsy. Known complications of percutaneous biopsy of the liver include hemoperitoneum, subcapsular hematoma, hypotension, pneumothorax and sepsis.Other intra-abdominal complications are less common.Hemobilia due to arterio-biliary duct fistula has been described, which has only rarely been clinically expressed as cholecystitis or pancreatitis. We report a case of a fifteen year-old boy who developed severe acute cholecystitis twelve days after a percutaneous liver biopsy performed in an outpatient setting. The etiology was clearly demonstrated to be hemobilia-associated,and the clinical course required the performance of a laparoscopic cholecystectomy. The post operative course was uneventful and the patient was discharged home. Percutaneous liver biopsy is a safe and commonly performed procedure. However, severe complications can occasionally occur. Both medical and surgical options should be evaluated while dealing with these rare incidents.

  17. Pulmonary Thromboembolism Complicating Acute Pancreatitis With Pancreatic Ascites: A Series of 4 cases

    OpenAIRE

    Ruchir Patel; Nirav Pipaliya; Prateik Poddar; Vikas Pandey; Meghraj Ingle; Prabha Sawant

    2016-01-01

    Acute pancreatitis is an inflammatory disease often associated with local and systemic complications. Portosplenic and splanchnic vascular complications of acute pancreatitis are common, but extrasplanchnic vessel thrombosis is less commonly seen. Among them, pulmonary thromboembolism is a very rare complication to be encountered with. We report four cases of acute pulmonary thromboembolism in patients with acute pancreatitis superimposed on chronic pancreatitis. All the patients had abdomina...

  18. Increasing incidence of acute Achilles tendon rupture and a noticeable decline in surgical treatment from 1994 to 2013

    DEFF Research Database (Denmark)

    Ganestam, Ann; Kallemose, Thomas; Troelsen, Anders

    2016-01-01

    PURPOSE: The purpose of this study is to investigate the incidence of acute Achilles tendon rupture in Denmark from 1994 to 2013 with focus on sex, age, geographical areas, seasonal variation and choice of treatment. METHODS: The National Patient Registry was retrospectively searched to find the ...

  19. [Treatment of extensive acute radiation burn and its complications].

    Science.gov (United States)

    Li, Ye-yang; Wang, Jin-lun; Li, Gang; Lin, Wei-hua; Liang, Min; Huang, Jun; Sun, Jing-en

    2013-06-01

    This article reports the treatment of a patient suffered from acute radiation burn covering 41% TBSA, with deep partial-thickness and full-thickness injury, produced by exposure to a large-scale industrial electron accelerator. An open wound began to appear and enlarged gradually 10 weeks after the exposure. Serious wound infection with methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa, pneumonia, respiratory failure, systemic inflammatory response syndrome, nephropathy and hypoproteinemia developed successively since 3 weeks after the wound formation. Skin grafts failed to survive, resulting in enlargement of the wound. After being treated with proper measures, including parenteral nutrition, respiratory support with a ventilator, appropriate antibiotics, steroid administration for nephropathy, deep debridement for wounds followed by skin grafting, the patient was cured and discharged after undergoing 15 operations in 500 days. The clinical condition of an extensive acute radiation burn is complicated. We should pay close attention to the changes in functions of organs, and strengthen the therapeutic strategies to support the function of organs to reduce the incidence of systemic complications. The control of the infection and the timely and effective repair of the wound are still the key points of the treatment of an extensive local radiation injury.

  20. Surgical treatment of colorectal cancer complicated with acute intestinal obstruction

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    S. N. Schaeva

    2016-01-01

    Full Text Available Background. The main reason for urgent complications of colon cancer is an acute intestinal obstruction (AIO. This is complex pathological condition in 90 % of cases caused by colorectal cancer (CRC.Objective – to evaluate radicality of the performed operations in complicated colorectal cancer in general surgical hospitals. Dependence of the severity of intestinal obstruction by tumor localization, its morphological characteristics, determine dependence of the type of the surgical operation performed on the severity of intestinal obstruction.Materials and methods. We have studied the data on 667 patients with colorectal cancer complicated by acute intestinal obstruction. These patients were treated in the period from 2001 to 2013 in general surgical hospital in the territory of Smolensk and Smolensk region. For the processing of the obtained results we have used software Statistica 6.1. Differences were considered statistically at p ≤ 0.05.Results. All the patients were divided into 3 groups by the expression of intestinal obstruction. Group 1 (n = 279 consisted of patients with the presence of decompensated intestinal obstruction (DIO, group 2 (n = 313 consisted of patients with subcompensated intestinal obstruction (SIO, group 3 (n = 75 included patients with compensated intestinal obstruction (CIO. In case of tumor localization in right halfof the colon we most commonly observed clinical picture of acute development of decompensated intestinal obstruction (p = 0.041. Subcompensated intestinal obstruction prevailed in case of tumor localization in left half of the colon and rectal localization. In general surgical hospitals it is not always possible to speak about radicality of surgical treatment, as in a large number of cases (62.5 % the number of examined lymph nodes was less than 4. When DIO patients are admitted in the clinic, the percentage of singlestage operations is equal to 7.5 % (n = 21. In case of DIO and SIO there was a high

  1. Experience in Diagnosis and Treatment of Bleeding Complications in Severe Acute Pancreatitis by TAE

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    The experience in diagnosis and treatment of bleeding complications in severe acute pancreatitis (SAP) by transcatheter arterial embolization was summarized. The clinical data of 19 SAP patients complicated with intra-abdominal bleeding in our hospital from Jan. 2000 to Jan. 2003 were analyzed retrospectively and the therapeutic outcome of TAE was evaluated statistically. The results showed that the short-term successful rate of hemostasis by TAE was 89.5 % (17/19), the incidence of re-bleeding after TAE was 36.8 % (7/19) and the successful rate of hemostatis by second TAE was 71.4 % (5/7). It was concluded that the intra-abdominal bleeding in SAP was mainly caused by the rupture of erosive/infected pseudoaneurysm. Mostly, the broken vessels were splenic artery and gastroduodenal artery. In terms of emergence hemostatis, TAE is the most effective method. Surgical hemostasis is necessary if hemostasis by TAE is failed or re-bleeding occurs after TAE.

  2. [Management of ocular and orbital complications in acute sinusitis].

    Science.gov (United States)

    Chahed, H; Bachraoui, R; Kedous, S; Ghorbel, H; Houcine, A; Mediouni, A; Marrakchi, J; Zainine, R; Ben Amor, M; Beltaief, N; Besbes, G

    2014-11-01

    Describe the clinical presentations of orbital complications of acute sinusitis and discuss therapeutic approaches. Retrospective study of 29 cases of acute sinusitis with orbital extension hospitalized over a period of 12years (2000 to 2012). There were 23 men and 6 women. The mean age was 15.75years. The average time until consultation was 7.68 days. Sinusitis was ethmoido-maxillary in 20 cases, ethmoidal in 6 cases, and frontal in 3 cases. Orbital extension was grouped according to the Chandler classification: stage I (3 cases), stage II (3 cases), stage III (15 cases), stage IV (8 cases). Antibiotic therapy was prescribed in all cases. Surgery was performed in 22 cases. Bacterial cultures revealed streptococcus (2 cases), aspergillus fumigatus (1 case) and were negative in 8 cases. The outcome was favorable in 27 cases. In two cases, the outcome was unfavorable with associated intracranial complications. Oculoorbital extension of acute sinusitis is a diagnostic and therapeutic emergency. Paranasal sinus CT is essential to confirm orbital extension and identify the causative sinus. Intravenous antibiotic therapy is the main treatment. The roles of corticosteroid and heparin therapy remain controversial. Surgery is indicated in the case of abscess or high visual risk. Endoscopic endonasal surgery appears to have a double role, in diagnosis and treatment. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  3. Acute hydrothorax complicating peritoneal dialysis: a case report

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    Ranganathan Dwarkanathan

    2010-11-01

    Full Text Available Abstract Introduction Acute hydrothorax is an uncommon but a well-recognized complication of peritoneal dialysis. No single test is definitive for diagnosis. Although it is not a life-threatening condition, hydrothorax often requires abandonment of peritoneal dialysis. Delay in diagnosis can lead to worsening of the clinical status. Case Presentation A 33-year-old Caucasian woman with lupus, who was successfully treated with temporary peritoneal dialysis 17 years previously, presented with acute dyspnea and a right pleural effusion after recommencing peritoneal dialysis. Investigations eliminated infective, cardiac, and primary respiratory causes. Peritoneal dialysis-related hydrothorax was suggested by biochemistry, and a pleuroperitoneal leak was definitively confirmed by using a Tc-99 m DTPA (diethylene triamine penta-acetic acid scintigraphy scan. Subsequently, she underwent video-assisted thoracoscopy-guided talc pleurodesis and was able to return successfully to peritoneal dialysis. Conclusion Although our case is not the first report that describes the occurrence of acute hydrothorax in peritoneal dialysis, it is an important condition to recognize for the wider general medical community. Furthermore, this case demonstrates that peritoneal dialysis can be continued with a hydrothorax, provided the underlying cause can be corrected. We review the literature pertaining to the utility and reliability of different diagnostic approaches to hydrothorax.

  4. Subacute left ventricular free-wall rupture in early course of acute myocardial infarction. Clinical report of two cases and review of the literature.

    Science.gov (United States)

    Varbella, F; Bongioanni, S; Sibona Masi, A; Iazzolino, E; Alunni, G; Conte, M R; Brusca, A

    1999-02-01

    Left ventricular free wall rupture (LVFWR) may complicate an acute myocardial infarction (AMI); its frequency ranges from 1 to 6 percent. In the era of coronary care units, LVFWR is the second cause of in-hospital death, after pump failure. The subacute presentation accounts for 2-3 percent of total hospital admissions for AMI. Heart rupture may not be suddenly fatal and sometimes there is enough time for surgical repair. Electromechanical dissociation is neither the only nor the main clinical presentation. More subtle symptoms occurring hours or days before the final event include unexplained hypotension and transient bradycardia and some ECG features such as persistent ST-segment elevation with T-waves failing to invert in the same leads. On echocardiographic subcostal view, pericardial effusion of more than 5-10 mm, with echo-dense masses overlying the heart independently of cardiac tamponade, is highly suggestive of heart rupture. If pericardiocentesis yields hemorrhagic fluid, surgical intervention is mandatory, providing both diagnostic confirmation and definitive treatment. Medical management strategies (prolonged bed rest, beta-blockade therapy) are still experimental but could become suitable for particular subsets of patients (elderly patients and patients at a high surgical risk). We report two cases of subacute LVFWR and review the currently available literature.

  5. Is surgical intervention more effective than non-surgical treatment for acute Achilles tendon rupture? A systematic review of overlapping meta-analyses.

    Science.gov (United States)

    Wu, Yaohong; Lin, Linghan; Li, Hao; Zhao, Yachao; Liu, Longgang; Jia, Zhiwei; Wang, Deli; He, Qing; Ruan, Dike

    2016-12-01

    There is discordance in the results from meta-analyses on surgical versus non-surgical treatment for acute Achilles tendon rupture. We systematically reviewed the overlapping meta-analyses on this topic to provide information that will be helpful to decision makers when selecting treatments based on the current best available evidence. We comprehensively searched multiple databases for systematic reviews that compared surgical and non-surgical treatments for acute Achilles tendon rupture. We only included meta-analyses that comprised randomized controlled trials (RCTs). The methodological quality and extracted data were assessed. The meta-analysis that offered the best evidence was ascertained with the Jadad decision algorithm. Nine meta-analyses were included in our study and all of them included RCTs with Level-II evidence. Assessment of Multiple Systematic Reviews (AMSTAR) scores ranged from 5 to 10 (median 7). The Jadad decision algorithm was used to select a high-quality meta-analysis with more RCTs. The results from this study showed that when functional rehabilitation was used, non-surgical intervention was similar to surgical treatment regarding the incidence of range of motion, rerupture, calf circumference and functional outcomes, and the incidence of other complications was reduced. Non-surgical intervention significantly increased the rerupture rate if functional rehabilitation was not considered. The findings of meta-analyses regarding surgical versus non-surgical treatment for acute Achilles tendon rupture are inconsistent. According to this systematic review of overlapping meta-analyses, the current best available evidence suggests that centers offering functional rehabilitation may prefer non-surgical intervention. Surgical treatment may be preferred at centers that do not have functional rehabilitation. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  6. The role of levosimendan in acute heart failure complicating acute coronary syndrome

    DEFF Research Database (Denmark)

    Nieminen, Markku S; Buerke, Michael; Cohen-Solál, Alain

    2016-01-01

    Acute heart failure and/or cardiogenic shock are frequently triggered by ischemic coronary events. Yet, there is a paucity of randomized data on the management of patients with heart failure complicating acute coronary syndrome, as acute coronary syndrome and cardiogenic shock have frequently been...... defined as exclusion criteria in trials and registries. As a consequence, guideline recommendations are mostly driven by observational studies, even though these patients have a particularly poor prognosis compared to heart failure patients without signs of coronary artery disease. In acute heart failure......, and especially in cardiogenic shock related to ischemic conditions, vasopressors and inotropes are used. However, both pathophysiological considerations and available clinical data suggest that these treatments may have disadvantageous effects. The inodilator levosimendan offers potential benefits due to a range...

  7. Pathogenic aspects of pulmonary complications in acute pancreatitis patients

    Institute of Scientific and Technical Information of China (English)

    Serge Chooklin

    2009-01-01

    BACKGROUND: Experimental and clinical observations show that proinlfammatory cytokines and oxidative stress are involved in the development of local and particularly systemic complications in acute pancreatitis (AP) patients. There are often pulmonary complications in such patients. The mechanisms through which lung injury is induced in AP are not fully clear. METHODS: In order to assess the role of activated neutrophils, pro- and anti-inlfammatory cytokines and adhesion molecules at the onset and development of respiratory complications and respiratory failure, we measured the serum levels of pro-inlfammatory (IL-1β, IL-6, IL-8, IL-18, TNF-α) and anti-inlfammatory (IL-1ra, IL-10) cytokines in 51 AP patients who had been diagnosed with pancreatitis-associated lung injury with and without the development of organ dysfunction. RESULTS: When admitted to the hospital, severe AP patients had increased concentrations of IL-1β, IL-6, IL-8, IL-18, and TNF-α. The concentration of IL-18 alone was considerably increased in the patients who later developed respiratory failure. The onset of acute respiratory distress syndrome in the AP patients was accompanied by an increase in the level of anti-inlfammatory cytokines, especially IL-10. It was noted that in severe lung injury, myeloperoxidase activity in the blood increased signiifcantly, but still relfected the processes taking place in the lung parenchyma. Increase in the concentrations of adhesion molecules preceded the development of pulmonary inifltration with respiratory failure symptoms, which provoked endothelial dysfunction and determined the capillary surface permeability for neutrophils and monocytes.CONCLUSIONS: In the pathogenesis of respiratory complications in AP cytokines, chemokines and adhesion molecules, in particular IL-1β, IL-6, IL-8, IL-18, TNF-α, ICAM-1, and E-selectin play major roles. At IL-18 concentrations >650 pg/ml, AP patients are likely to develop pulmonary dysfunction (sensitivity

  8. Acute obstructive hydrocephalus complicating decompression surgery of the craniovertebral junction

    Science.gov (United States)

    Ohya, Junichi; Chikuda, Hirotaka; Nakatomi, Hirofumi; Sakamoto, Ryuji; Saito, Nobuhito; Tanaka, Sakae

    2016-01-01

    Obstructive hydrocephalus has been described as a rare complication following foramen magnum decompression for Chiari malformation. However, there are few reports of obstructive hydrocephalus after spinal surgery for other pathologies of the craniovertebral junction (CVJ). The authors herein report a 52-year-old female with achondroplasia presenting with an 8-month history of myelopathy due to spinal cord compression at CVJ. She underwent resection of the C1 posterior arch and part of the edge of the occipital bone. A computed tomography (CT) scan obtained 1-week after the surgery revealed bilateral infratentorial fluid collection. The patient was first managed conservatively; however, on the 17th day, her consciousness level showed sudden deterioration. Emergency CT demonstrated marked hydrocephalus due to obstruction of the cerebral aqueduct. Acute obstructive hydrocephalus can occur late after decompression surgery at the CVJ, and thus should be included in the differential diagnosis of a deteriorating mental status. PMID:27366268

  9. Acute onset headache complicating labor epidural caused by intrapartum pneumocephalus.

    Science.gov (United States)

    Smarkusky, Loren; DeCarvalho, Helena; Bermudez, Ady; González-Quintero, Víctor Hugo

    2006-09-01

    Epidural placement for obstetric anesthesia is a common procedure. Pneumocephalus, the introduction of air into the cranial cavity after epidural placement, is a rare complication encountered when air is used for identification of the epidural space. A 42-year-old primipara undergoing epidural placement reported sudden onset of severe headache with associated neurologic symptoms and nuchal rigidity. Emergent CT scan revealed pneumocephalus. With conservative management, her symptoms resolved with interval resumption of the air collection evidenced on interval CT. Acute onset headache after epidural placement can present with impressive neurologic signs and symptoms. Prompt identification of the cause of this pathology is of vital importance to delineate pneumocephalus from potentially treatable or life-threatening disorders.

  10. Study on subsequent neurologic complications in children with acute leukemia

    Energy Technology Data Exchange (ETDEWEB)

    Kobayashi, Naoaki; Shimazaki, Haruyo; Hoshi, Yasutaka; Akatsuka, Jun-ichi (Jikei Univ., Tokyo (Japan). School of Medicine)

    1989-06-01

    Twenty-seven children with acute leukemia were studied in order to detect the subsequent neurologic complications due to chemotherapy and radiation therapy. Twenty-four patients with ALL received central nervous system prophylaxis including cranial irradiation. The methods of evaluation consisted of electroencephalogram (EEG), computed tomography of the head (CT scan), soft neurological sign, intelligence quotient (IQ) and Bender Gestalt test. The patients with relapse showed severe abnormalities in various kinds of examinations. Younger children at diagnosis were associated with a higher abnormality rate of soft neurological signs and Bender Gestalt test. Factors which were found to be closely associated with a lower IQ score included younger children at diagnosis and longer duration of remission time. These results indicate the need for caution for the dosage of cranial irradiation for younger patients in CNS prophylaxis, and improvement of a lower IQ score in long-term survivors requires further investigation as to the appropriate intellectual environment for their development after remission. (author).

  11. Endovascular treatment of acute type B dissection complicating aortic coarctation.

    Science.gov (United States)

    Kassaian, Seyed Ebrahim; Abbasi, Kyomars; Mousavi, Mehdi; Sahebjam, Mohammad

    2013-01-01

    Surgical treatment poses a high risk to patients with concomitant aortic coarctation and dissection, and an interventional approach could be an alternative. We describe the case of a 52-year-old man with a long history of untreated hypertension and aortic coarctation who emergently presented at our institution with an acute Stanford type B dissection. The patient's elevated serum creatinine level, perfusion deficit in the right lower limb, and hypertension did not respond to medical therapy, and he did not consent to surgery. By endovascular means, we used a self-expandable stent-graft to cover the entry point of the dissection; then, we deployed a balloon-expandable bare-metal stent to correct residual stenosis. To our knowledge, this is the first report of the endovascular treatment of aortic coarctation complicated by type B dissection.

  12. STUDY OF COMPLICATIONS OF COLLES FRACTURE TO FIND OUT THE TRUE INCIDENCE OF EXTENSOR POLLICIS LONGUS TENDON RUPTURE AND CARPAL TUNNEL SYNDROME IN INDIAN POPULATION

    Directory of Open Access Journals (Sweden)

    Kulkarni

    2015-02-01

    Full Text Available Colles‟ fracture is confined to adult and usually is seen in women over the age of fifty who have fallen on the outstretched hand. EPL tendon is the most common extensor tendon to rupture after colles‟ fracture. To our belief the incidenc e of median nerve injury and EPL tendon rupture given in literature are much higher than what we see now a days, so with this aim we carried this study to find out the true incidence of CTS and EPL tendon rupture in Indian population. AIMS AND OBJECTIVES: To study 100 patients with colles‟ fracture for true incidence of Extensor Pollicis Longus (EPL Tendon rupture and Carpal Tunnel Syndrome (CTS in Indian Population. MATERIALS AND METHODS: In our study 100 patients with colles fracture were followed up at regural intervals and were evaluated clinically and radiogrphically to rule out complications like EPL tendon rupture and CTS. OBSERVATION AND RESULTS: In our study, we found 0% incidence of CTS and EPL tendon rupture. CONCLUS ION: Proper division of patients into displaced and un displaced fracture and treatment of displaced fracture being closed reduction and internal fixation with „K‟ wires and then cast application in neutral position i.e. supination without flexion at wrist joint and properly advised physiotheraphy after cast removal at one and half month should be advocated

  13. Pictorial essay: Acute neurological complications in children with acute lymphoblastic leukemia

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    Seema A Kembhavi

    2012-01-01

    Full Text Available Acute lymphoblastic leukemia (ALL is the commonest childhood malignancy with high cure rates due to recent advances in central nervous system (CNS prophylaxis. The disease per se, as well as the prophylactic therapy, predisposes the child to complications such as cerebrovascular events, infections, drug toxicities, etc. The purpose of this study is to highlight the pathophysiology and the imaging features (with appropriate examples of these complications and to propose a diagnostic algorithm based on MRI. Interpreting these scans in the light of clinical inputs very often helps the radiologist reach an appropriate diagnosis and help treatment and management.

  14. Tretinoin in pregnancy complicated with acute promyelocytic leukaemia.

    Science.gov (United States)

    Leong, K W; Teh, A; Bosco, J J

    2000-06-01

    Acute promyelocytic leukemia (APL) in pregnancy poses serious danger to both the mother and fetus. Cytotoxic chemotherapy may cause teratogenicity to the fetus. APL is unique because it is usually associated with a coagulopathy that markedly increases the risk for the mother and fetus. A 21 year old lady with APL in her third trimester of pregnancy was treated with oral tretinoin. Tretinoin reversed the coagulopathy and normalised her blood counts without causing cytotoxic damage associated with cancer chemotherapy. Fetal distress occurred at 37 weeks of gestation and an emergency caesarean section was performed without complications and no blood transfusion support was needed as her coagulopathy and thrombocytopenia had resolved. A remission was achieved with only tretinoin induction. She subsequently had consolidation and maintenance chemotherapy. The mother and baby remain well at 4 years from completion of chemotherapy. A total of 10 pregnancies associated with APL have been reported in the current literature. Premature delivery and a fetal arrhythmia were the only complications. Although retinoin is considered teratogenic, its use so far in second and third trimester has been safe.

  15. AN UNCOMMON COMPLICATION OF A COMMON DISORDER: PNEUMOTHORAX, PNEUMOMEDIASTINUM AND SUBCUTANEOUS EMPHYSEMA COMPLICATING ACUTE SEVERE ASTHMA: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Urvinderpal

    2014-05-01

    Full Text Available Pneumomediastinum (air in the mediastinum was first described as a complication of trauma in 1819 by Laennec. Although subcutaneous emphysema, pneumothorax and pneumomediastinum are relatively uncommon, but are important complications of bronchial asthma. Their sudden and usually unexpected onset may herald an emergency. We are reporting a case of a 72 year old male presenting with pneumothorax, pneumo- mediastinum and subcutaneous emphysema as a complication of acute severe asthma

  16. NIHSS and acute complications after anterior and posterior circulation strokes

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    Godefroy O

    2012-02-01

    Full Text Available Mathieu Boone1, Jean-Marc Chillon2, Pierre-Yves Garcia1, Sandrine Canaple1, Chantal Lamy1, Olivier Godefroy1,3, Jean-Marc Bugnicourt1,2,31Department of Neurology, Amiens University Hospital, Amiens, France, 2INSERM ERI-12, and University of Picardie, 3Laboratory of Functional Neurosciences and Pathology (EA 4559, Amiens, FranceBackground: The purpose of this study was to determine whether the National Institutes of Health Stroke Scale (NIHSS score was associated with inhospital neurological and medical complications (NMC in patients with posterior circulation infarction.Methods: This retrospective study included all patients admitted to our stroke unit during a one-year period (n = 289. NMC included neurological deterioration (ie, worsening by 4 points or more of the NIHSS score during the hospital stay and all other medical complications based on what was recorded in the patients' charts.Results: Seventy-nine patients (27% experienced NMC. In posterior circulation infarction patients (n = 90, patients with NMC had a higher baseline NIHSS score (10.9 versus 2.2, P = 0.004 and a baseline NIHSS score >2 (78% versus 36%, P = 0.003. In stepwise logistic regression, an NIHSS score >2 (odds ratio: 8.2; 95% confidence interval: 1.64–41.0; P = 0.01 was associated with NMC. Similar results were observed for anterior circulation infarction patients but with a higher cutoff value for NIHSS score.Conclusion: In ischemic stroke patients, an increased baseline NIHSS score was associated with an increased risk of NMC. This association applied to anterior-circulation as well as posterior circulation stroke, although zero on the NIHSS for posterior circulation stroke does not mean the absence of NMC during hospitalization. The clinical significance of these findings requires further evaluation in larger prospective studies.Keywords: acute, stroke, rating scales, complications

  17. Cardiovascular Complications of Acute Amphetamine Abuse; Cross-sectional study

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    Elham Bazmi

    2017-03-01

    Full Text Available Objectives: This study aimed to evaluate cardiovascular complications among patients who abuse amphetamines. Methods: This cross-sectional study took place between April 2014 and April 2015 among 3,870 patients referred to the Toxicology Emergency Department of Baharlou Hospital, Tehran University of Medical Sciences, Tehran, Iran. Those with clinical signs of drug abuse and positive urine screening tests were included in the study, while cases of chronic abuse were excluded. Cardiac complications were evaluated via electrocardiography (ECG and transthoracic echocardiography. Results: A total of 230 patients (5.9% had a history of acute amphetamine abuse and positive urine tests. Of these, 32 patients (13.9% were <20 years old and 196 (85.2% were male. In total, 119 (51.7% used amphetamine and methamphetamine compounds while 111 (48.3% used amphetamines with morphine or benzodiazepines. The most common ECG finding was sinus tachycardia (43.0%, followed by sinus tachycardia plus a prolonged QT interval (34.3%. Mean creatine kinase-MB and troponin I levels were 35.9 ± 4.3 U/mL and 0.6 ± 0.2 ng/mL, respectively. A total of 60 patients (26.1% were admitted to the Intensive Care Unit. The majority (83.3% of these patients had normal echocardiography results. The mean aortic root diameter (ARD was 27.2 ± 2.8 mm. Abnormalities related to the ARD were found in 10 patients (16.7%, three of whom subsequently died. Conclusion: According to these findings, cardiac complications were common among Iranian patients who abuse amphetamines, although the majority of patients had normal echocardiography and ECG findings.

  18. Placenta percreta leading to spontaneous complete uterine rupture in the second trimester. Example of a fatal complication of abnormal placentation following uterine scarring.

    Science.gov (United States)

    Fleisch, M C; Lux, J; Schoppe, M; Grieshaber, K; Hampl, M

    2008-01-01

    A 30-year-old gravida 2 para 1 was admitted to hospital 2 years after cesarean section at 20 weeks' gestation with acute onset of abdominal pain and hypovolaemic shock. Emergency laparotomy revealed a uterine rupture located in the anterior uterine wall caused by a placenta percreta and supracervical hysterectomy was performed. This site of invasion and finally rupture was in projection of the previous lower-segment cesarean section. This report illustrates the dramatic consequences of abnormal placentation after prior uterine surgery, which can already occur early during pregnancy and prior to the onset of labour. (c) 2008 S. Karger AG, Basel.

  19. Pulmonary contusion and acute respiratory distress syndrome (ARDS) as complications of blunt chest trauma

    National Research Council Canada - National Science Library

    Michalska, Agata; Jurczyk, Agnieszka P; Machała, Waldemar; Szram, Stefan; Berent, Jarosław

    2009-01-01

    .... The authors of the article would like to emphasize the pathophysiology and diagnostic difficulties in such blunt chest trauma complications as pulmonary contusions and acute respiratory distress...

  20. Hepatic abscess in a pre-existed simple hepatic cyst as a late complication of sigmoid colon ruptured diverticula: a case report

    Directory of Open Access Journals (Sweden)

    Chatzipetrou Maria

    2008-03-01

    Full Text Available Abstract Introduction Hepatic abscesses have been reported as a rare complication of diverticulitis of the bowel. This complication is recognized more commonly at the time of the diagnosis of diverticulitis, or ruptured diverticula, but also can be diagnosed prior to surgery, or postoperatively. Case presentation This report describes a man who developed an hepatic abscess within a simple hepatic cyst, two months after operation for ruptured diverticula of the sigmoid colon. The abscess was drained surgically and the patient made a complete recovery. Conclusion The development of an hepatic abscess in a pre-existing hepatic cyst, secondary to diverticulitis, is a rare complication. A high degree of clinical suspicion is required for immediate diagnosis and treatment.

  1. Acute Achilles Tendon Rupture Treated by Double Side-Locking Loop Suture Technique With Early Rehabilitation.

    Science.gov (United States)

    Miyamoto, Wataru; Imade, Shinji; Innami, Ken; Kawano, Hirotaka; Takao, Masato

    2017-02-01

    Although early accelerated rehabilitation is recommended for the treatment of acute Achilles tendon rupture, most traditional rehabilitation techniques require some type of brace. We retrospectively analyzed 44 feet of 44 patients (25 male and 19 female) with a mean age of 31.8 years who had an acute Achilles tendon rupture related to athletic activity. Patients had been treated by a double side-locking loop suture (SLLS) technique using double antislip knots between stumps and had undergone early accelerated rehabilitation, including active and passive range of motion exercises on the day following the operation and full weight-bearing at 4 weeks. No brace was applied postoperatively. The evaluation criteria included the American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Scale (AOFAS) score; active plantar flexion and dorsiflexion angles; and the intervals between surgery and the time when patients could walk normally without any support, perform double-leg heel raises, and perform 20 continuous single-leg heel raises of the operated foot. Despite postoperative early accelerated rehabilitation, the AOFAS score and active dorsiflexion angles improved over time (6, 12, and 24 weeks and 2 years). A mean of 4.3 ± 0.6 weeks was required for patients to be able to walk normally without any support. The mean period to perform double-leg heel raises and 20 continuous single-leg heel raises of the injured foot was 8.0 ± 1.3 weeks and 10.9 ± 2.1 weeks, respectively. All patients, except one who was engaged in classical ballet, could return to their preinjury level of athletic activities, and the interval between operation and return to athletic activities was 17.1 ± 3.7 weeks. The double SLLS technique with double antislip knots between stumps adjusted the tension of the sutured Achilles tendon at the ideal ankle position and provided good clinical outcomes following accelerated rehabilitation after surgery without the use of a brace. Level IV, retrospective case

  2. Donepezil, anti-Alzheimer's disease drug, prevents cardiac rupture during acute phase of myocardial infarction in mice.

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    Mikihiko Arikawa

    Full Text Available BACKGROUND: We have previously demonstrated that the chronic intervention in the cholinergic system by donepezil, an acetylcholinesterase inhibitor, plays a beneficial role in suppressing long-term cardiac remodeling after myocardial infarction (MI. In comparison with such a chronic effect, however, the acute effect of donepezil during an acute phase of MI remains unclear. Noticing recent findings of a cholinergic mechanism for anti-inflammatory actions, we tested the hypothesis that donepezil attenuates an acute inflammatory tissue injury following MI. METHODS AND RESULTS: In isolated and activated macrophages, donepezil significantly reduced intra- and extracellular matrix metalloproteinase-9 (MMP-9. In mice with MI, despite the comparable values of heart rate and blood pressure, the donepezil-treated group showed a significantly lower incidence of cardiac rupture than the untreated group during the acute phase of MI. Immunohistochemistry revealed that MMP-9 was localized at the infarct area where a large number of inflammatory cells including macrophages infiltrated, and the expression and the enzymatic activity of MMP-9 at the left ventricular infarct area was significantly reduced in the donepezil-treated group. CONCLUSION: The present study suggests that donepezil inhibits the MMP-9-related acute inflammatory tissue injury in the infarcted myocardium, thereby reduces the risk of left ventricular free wall rupture during the acute phase of MI.

  3. A Rare Cause of Acute Abdomen: Urinary Bladder Rupture due to Foley Catheter

    Directory of Open Access Journals (Sweden)

    Ömer Engin

    2013-07-01

    Full Text Available Urinary bladder rupture is usually found due to blunt or penetrating traumas and iatrogenic injuries, and spontaneous intraperitoneal perforation is very rare. 57 years old male patient was consulted to general surgery department due to abdominal pain, nausia-vomiting and fever. He had Diabetes Mellitus, Multiple Sclerosis, Leriche Syndrome and operation for benign prostatic hypertrophy 5 years ago on his medical history which the case catheterised him urinary bladder himself frequently in nonsterile conditions. He did not care about sterility. On physical examination, suprapubic defence and rebound was noted more prominently on right lower quadrant. He was taken to operating room with the diagnosis of acute abdomen. On exploration, infection was seen on all layers of the whole urinary bladder, abscess formation and necrosis causing a microperforation which is detected by methylene blue was also present. Intraabdominal abscess drainage, cystostomy and primary suturing of the urinary bladder was performed. Patient died due to sepsis at the 9.th post operative day.

  4. Anterolateral ligament abnormalities in patients with acute anterior cruciate ligament rupture are associated with lateral meniscal and osseous injuries

    Energy Technology Data Exchange (ETDEWEB)

    Dyck, Pieter van; Smet, Eline de; Gielen, Jan L.; Parizel, Paul M. [Antwerp University Hospital and University of Antwerp, Department of Radiology, Antwerp (Belgium); Clockaerts, Stefan [University College Hospitals, Department of Orthopaedics, London (United Kingdom); Vanhoenacker, Filip M. [Antwerp University Hospital and University of Antwerp, Department of Radiology, Antwerp (Belgium); Ghent University Hospital and University of Ghent, Department of Radiology, Ghent (Belgium); AZ St-Maarten, Department of Radiology, Antwerp (Belgium); Lambrecht, Valerie [Ghent University Hospital and University of Ghent, Department of Radiology, Ghent (Belgium); Wouters, Kristien [Antwerp University Hospital and University of Antwerp, Department of Biostatistics, Antwerp (Belgium)

    2016-10-15

    To determine the frequency of anterolateral ligament (ALL) injury in patients with acute anterior cruciate ligament (ACL) rupture and to analyse its associated injury patterns. Ninety patients with acute ACL rupture for which MRI was obtained within 8 weeks after the initial trauma were retrospectively identified. Two radiologists assessed the status of the ALL on MRI by consensus. The presence or absence of an ALL abnormality was compared with the existence of medial and lateral meniscal tears diagnosed during arthroscopy. Associated collateral ligament and osseous injuries were documented with MRI. Forty-one of 90 knees (46 %) demonstrated ALL abnormalities on MRI. Of 49 knees with intact ALL, 15 (31 %) had a torn lateral meniscus as compared to 25 torn lateral menisci in 41 knees (61 %) with abnormal ALL (p = 0.008). Collateral ligament (p ≤ 0.05) and osseous injuries (p = 0.0037) were more frequent and severe in ALL-injured as compared with ALL-intact knees. ALL injuries are fairly common in patients with acute ACL rupture and are statistically significantly associated with lateral meniscal, collateral ligament and osseous injuries. (orig.)

  5. Two cases of cystic artery pseudoaneurysm rupture due to acute cholecystitis with gallstone impaction in the neck.

    Science.gov (United States)

    Kaida, Shogo; Arahata, Kyouko; Itou, Asako; Takarabe, Sakiko; Kimura, Kayoko; Kishikawa, Hiroshi; Nishida, Jiro; Fujiyama, Yoshiki; Takigawa, Yutaka; Matsui, Junichi

    2016-09-01

    A cystic artery aneurysm is a rare cause of hemobilia. Herein, we report two cases of acute cholecystitis with a ruptured cystic artery pseudoaneurysm. Two patients (a 69-year-old man and an 83-year-old man) were admitted to our hospital because of acute cholecystitis with gallstone impaction in the neck. Percutaneous transhepatic gallbladder drainage (PTGBD) was performed for both patients. After a few days of PTGBD, gallbladder hemorrhage was observed. Abdominal angiography showed cystic artery aneurysm. A transcatheter arterial embolization was therefore performed, followed by an open cholecystectomy.

  6. First Trimester Spontaneous Uterine Rupture in a Young Woman with Uterine Anomaly

    Directory of Open Access Journals (Sweden)

    Esra Nur Tola

    2014-01-01

    Full Text Available Spontaneous uterine rupture is a life-threatening obstetrical emergency carrying a high risk for the mother and the fetus. Spontaneous uterine rupture in early pregnancy is very rare complication and it occurs usually in scarred uterus. Uterine anomalies are one of the reasons for spontaneous unscarred uterine rupture in early pregnancy. Obstetricians must consider this diagnosis when a pregnant patient presented with acute abdomen in early pregnancy. We present a case of spontaneous uterine rupture at 12 weeks of gestation in 24-year-old multigravida who had uterine anomaly presenting as an acute abdomen. Our preoperative diagnosis was ectopic pregnancy. Emergency laparotomy confirmed a spontaneous uterine rupture. Uterine anomaly is a risk factor for spontaneous uterine rupture in the early pregnancy. Clinical signs of uterine rupture in early pregnancy are nonspecific and must be distinguished from acute abdominal emergencies.

  7. Minimally invasive versus open surgery for acute Achilles tendon rupture: a systematic review of overlapping meta-analyses.

    Science.gov (United States)

    Li, Qingbo; Wang, Chuanying; Huo, Yanqing; Jia, Zhiwei; Wang, Xiqian

    2016-06-06

    A number of meta-analyses have been carried out to evaluate the effects of minimally invasive surgery (MIS) versus open surgery (OS) for acute Achilles tendon rupture. However, discordant findings were seen in these meta-analyses. The present study, performing a systematic review of overlapping meta-analyses regarding MIS versus OS of acute Achilles tendon rupture, aimed to assist decision-makers interpret and choose among conflicting meta-analyses, as well as to offer treatment recommendations based on current best evidence. The literature search was performed to identify systematic reviews comparing MIS with OS for Achilles tendon rupture. Meta-analyses only comprising randomized controlled trials (RCTs) were included. Two authors individually evaluated the quality of meta-analysis and extracted data. The Jadad decision algorithm was conducted to ascertain which meta-analysis offered the best evidence. A total of four meta-analyses was included. All these meta-analyses comprised RCTs or quasi-RCTs and were determined as Level-II evidence. The scores of the Assessment of Multiple Systematic Reviews (AMSTAR) ranged from 7 to 10 (median 9.5). The Jadad algorithm indicated that the best meta-analysis should be chosen according to the search strategies and application of selection. A high-quality meta-analysis with more RCTs was chosen, which suggested that there was no statistically significant difference between MIS and OS regarding rerupture rate, tissue adhesion, sural nerve injury, deep infection, and deep vein thrombosis. However, MIS could decrease superficial infection rate, and had a better patient satisfaction for good to excellent outcomes in comparison to OS. Based on the best available evidence, MIS may be superior to OS for treating acute Achilles tendon rupture. However, due to some limitations, this should be cautiously interpreted, and further high-quality studies are needed.

  8. Orbital complications secondary to acute sinusitis– A 10 years retrospective review

    OpenAIRE

    2015-01-01

    Abstract Introduction: Orbital complication may accompany acute sinusitis in all age, commonly preseptal or orbital cellulitis. Aim: To evaluate the clinical presentation, management, and outcome of orbital complications of sinusitis in patients treated at our institution. Methods: A case study of retrospective review of 10 patients with orbital complications secondary to acute sinusitis was conducted in our centre over a 10-years period. The clinical presentation, relevant investigations, m...

  9. Prognosis of patients in coma after acute subdural hematoma due to ruptured intracranial aneurysm.

    Science.gov (United States)

    Torné, Ramon; Rodríguez-Hernández, Ana; Romero-Chala, Fabián; Arikan, Fuat; Vilalta, Jordi; Sahuquillo, Juan

    2016-04-01

    Acute subdural hematomas (aSDH) secondary to intracranial aneurysm rupture are rare. Most patients present with coma and their functional prognosis has been classically considered to be very poor. Previous studies mixed good-grade and poor-grade patients and reported variable outcomes. We reviewed our experience by focusing on patients in coma only and hypothesized that aSDH might worsen initial mortality but not long-term functional outcome. Between 2005 and 2013, 440 subarachnoid hemorrhage (SAH) patients were admitted to our center. Nineteen (4.3%) were found to have an associated aSDH and 13 (2.9%) of these presented with coma. Their prospectively collected clinical and outcome data were reviewed and compared with that of 104 SAH patients without aSDH who presented with coma during the same period. Median aSDH thickness was 10mm. Four patients presented with an associated aneurysmal cortical laceration and only one had good recovery. Overall, we observed good long-term outcomes in both SAH patients in coma with aSDH and those without aSDH (38.5% versus 26.4%). Associated aSDH does not appear to indicate a poorer long-term functional prognosis in SAH patients presenting with coma. Anisocoria and brain herniation are observed in patients with aSDH thicknesses that are smaller than those observed in trauma patients. Despite a high initial mortality, early surgery to remove the aSDH results in a good outcome in over 60% of survivors. Aneurysmal cortical laceration appears to be an independent entity which shows a poorer prognosis than other types of aneurysmal aSDH.

  10. Atmospheric Pressure Changes Are Associated with Type A Acute Aortic Dissections and Spontaneous Abdominal Aortic Aneurysm Rupture in Tuzla Canton

    Science.gov (United States)

    Krdzalic, Alisa; Rifatbegovic, Zijah; Krdzalic, Goran; Jahic, Elmir; Adam, Visnja Nesek; Golic, Darko

    2014-01-01

    Aim: The aim of this study was to investigate a relationship between seasonal variation and incidence of type A acute aortic dissection (AAD) and spontaneous abdominal aneurysm rupture (rAAA) in Canton Tuzla, Bosnia and Herzegovina. Patients and methods: A total of 81 cases, 41 AAD and 40 of ruptured AAA were identified from one center over a 6-year, from 2008 till 2013. In 2012 were admitted (45.6% or 36 patients). Results: Seasonal analysis showed that 19(23.4%) patients were admitted in spring, 15(18.5) in summer, 26(32%) in autumn and 21(25.9) in winter. The most frequent period was autumn/winter with 47 or 58% patients. A causal link between atmospheric pressure (AP) and incidence of rAAA and AAD on seasonal and monthly basis was found. PMID:25568523

  11. Gastric rupture caused by acute gastric distention in non-neonatal children:clinical analysis of 3 cases

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Objective To study gastric rupture, a progressive, rapid and high mortality condition, caused by acute gastric distention (GRAGD) and its appropriate diagnosis and treatment. Methods The etiology, pathology, clinical manifestations and expeniences in 3 children with GRAGD were reviewed. Results Case 1: After diagnosising GRAGD and stabilizing her shock with massive fluid replacement, gastrostomy was performed. Her postoparative course was uneventful because of fasting, suction, fluid infusion, correction of acidosis and supporting natrition. Case 2: After diagnosising gastric distention which subsided With conservative therapy for 9 days, she suddanly had gastric rupture when she had not eaten for 6 days. She died of shock and had no chence for surgery. Case 3: The patient had sudden abdominal pain, distention end vomitting with severe shlock for 4 days. Emergency surgery found gastric rupture and the method was the same as Case 1. The patient survived but has brain impairment. Case 1 and 3 showed multifiocal transmural necrosis. Conclusions Syrnptoms like overeating, bulimia, changes in kind of food, X-ray showing large distended stomach and massive pneumoperitoneum were seen after pastric rupture and can help to diagnose this condition. Clinical course of gastric dislention with toxic shock progresses rapidly, hewever subsequent gastric rupture exacerbates the shock and makes the treatment difficult treatment.It is extremely important that a laparotomy he performed at once after stabilizing shock with massive fluid replacement. Postoperative nutritional support and fluid replacement will increase survival. It is very important that when gastric distenition disappears after conservative therapy,the doctor should assess carefully whether the gastric wall recovery is under way by using effective methods of examination.

  12. Gastric rupture caused by acute gastric distention in non-neonatal children: clinical analysis of 3 cases.

    Science.gov (United States)

    Qin, H; Yao, H; Zhang, J

    2000-12-01

    To study gastric rupture, a progressive, rapid and high mortality condition, caused by acute gastric distention (GRAGD) and its appropriate diagnosis and treatment. The etiology, pathology, clinical manifestations and experiences in 3 children with GRAGD were reviewed. Case 1: After diagnosing GRAGD and stabilizing her shock with massive fluid replacement, gastrostomy was performed. Her postoperative course was uneventful because of fasting, suction, fluid infusion, correction of acidosis and supporting nutrition. Case 2: After diagnosing gastric distention which subsided with conservative therapy for 9 days, she suddenly had gastric rupture when she had not eaten for 6 days. She died of shock and had no chance for surgery. Case 3: The patient had sudden abdominal pain, distention and vomiting with severe shock for 4 days. Emergency surgery found gastric rupture and the method was the same as Case 1. The patient survived but has brain impairment. Case 1 and 3 showed multifocal transmural necrosis. Symptoms like overeating, bulimia, changes in kind of food, X-ray showing large distended stomach and massive pneumoperitoneum were seen after gastric rupture and can help to diagnose this condition. Clinical course of gastric distention with toxic shock progresses rapidly, however subsequent gastric rupture exacerbates the shock and makes the treatment difficult treatment. It is extremely important that a laparotomy be performed at once after stabilizing shock with massive fluid replacement. Postoperative nutritional support and fluid replacement will increase survival. It is very important that when gastric distention disappears after conservative therapy, the doctor should assess carefully whether the gastric wall recovery is under way by using effective methods of examination.

  13. Diffusion and perfusion MRI in patients with ruptured and unruptured intracranial aneurysms treated by endovascular coiling: complications, procedural results, MR findings and clinical outcome

    Energy Technology Data Exchange (ETDEWEB)

    Cronqvist, M.; Ramgren, B.; Holtaas, S.; Larsson, E.-M. [Lund University Hospital, Department of Neuroradiology, Lund (Sweden); Wirestam, R. [Lund University Hospital, Department of Radiation Physics, Lund (Sweden); Brandt, L.; Nilsson, O.; Saeveland, H. [Lund University Hospital, Department of Neurosurgery, Lund (Sweden)

    2005-11-01

    Our purpose was to evaluate treatment safety as well as complications frequency and management in endovascular coiling of intracerebral aneurysms using MR diffusion and perfusion imaging. In this prospective study, 77 MR examinations were performed in conjunction with 43 procedures in 40 patients, 14 patients presented with ruptured and 26 with unruptured aneurysms. Mean time interval between treatment and post-procedure MRI was 29 and 25 h for the ruptured and unruptured aneurysm group, respectively. Peri-procedural complications, including five major events and five minor transient events, occurred in 10/43 procedures (23%), necessitating thrombolytic therapy in two patients and angioplasty in one, all three within the unruptured aneurysm group. Fifty-one new lesions were found on post-treatment DWI and 47 of them were regarded as of ischemic origin. Most lesions were small (<3 mm), ipsilateral to the treated aneurysm and asymptomatic (37/40 patients). Sixty-seven percent of the lesions were found in the ruptured and 33% in the unruptured aneurysm group. The ischemic lesions did occur more frequently in patients treated for aneurysm of large neck size and according to the remodelling technique. The overall morbidity and mortality rates were 14.6 and 7.3% whereas morbidity and mortality rates related to the technique were only 2.6 and 0%, respectively. (orig.)

  14. Post-septal orbital complications of acute bacterial rhinosinusitis: Endoscopic anatomical considerations

    Directory of Open Access Journals (Sweden)

    Ahmed A. Ibrahim

    2015-11-01

    The study was carried out on 240 patients suffering from acute rhino-sinusitis with 90 patients suffering from orbital post-septal complicating acute rhino-sinusitis. Eighty-five cases underwent orbital decompression, except 5 cases with orbital cellulitis; they were improved on medical treatment. Visual monitoring by the ophthalmological team on regular basis was performed, until clinical and radiological improvement of the condition. This study proves that there may be a relationship between anatomic variation and orbital infections complicating acute sinusitis or acute on top of chronic sinusitis.

  15. Frontal sinus mini-trephination for acute sinusitis complicated by intracranial infection.

    Science.gov (United States)

    McIntosh, D L; Mahadevan, M

    2007-10-01

    Acute bacterial sinusitis is common in the pediatric population. Intracranial spread of infection is a rare but life-threatening complication of acute sinusitis. Due to the infrequent presentation of this complication, there are no well-defined management protocols for the acute sinusitis. We present three pediatric cases where children presented with intracranial sepsis, and the underlying source of infection was from the paranasal sinuses. In all cases, endoscopic sinus surgery was performed in the acute setting, with the use of frontal sinus mini-trephines playing a significant role. We describe our experience and review the available literature.

  16. Prognostic importance of complete atrioventricular block complicating acute myocardial infarction

    DEFF Research Database (Denmark)

    Aplin, Mark; Engstrøm, Thomas; Vejlstrup, Niels G

    2003-01-01

    Third-degree atrioventricular block after acute myocardial infarction is considered to have prognostic importance. However, its importance in conjunction with thrombolytic therapy and its relation to left ventricular function remains uncertain. This report also outlines an important distinction...... between atrioventricular block in the setting of anterior and inferior wall acute myocardial infarction, with profound clinical and prognostic implications....

  17. Prognostic importance of complete atrioventricular block complicating acute myocardial infarction

    DEFF Research Database (Denmark)

    Aplin, Mark; Engstrøm, Thomas; Vejlstrup, Niels G

    2003-01-01

    Third-degree atrioventricular block after acute myocardial infarction is considered to have prognostic importance. However, its importance in conjunction with thrombolytic therapy and its relation to left ventricular function remains uncertain. This report also outlines an important distinction...... between atrioventricular block in the setting of anterior and inferior wall acute myocardial infarction, with profound clinical and prognostic implications....

  18. Acute interstitial nephritis, a rare complication of Giardiasis

    Directory of Open Access Journals (Sweden)

    Antonio De Pascalis

    2011-12-01

    Full Text Available Acute interstitial nephritis is a relevant cause of acute renal failure. Drugs are the predominant cause, followed by infections and idiopathic lesions. Acute interstitial nephritis as a form of hypersensitivity reaction is an uncommon manifestation in the setting of human parasitic infections. We present a case of acute interstitial nephritis in association with Giardia infection in a 54-year-old woman who developed an impairment of renal function after a prolonged period of slight fever and diarrhea. After an attempt to recover renal impairment by vigorous rehydratation, because of the unclear origin of the persisting renal failure, a percutaneous renal biopsy was performed and a diagnosis of severe acute interstitial nephritis was made. Steroid therapy was started and after six weeks, renal function had completely recovered. In cases of unexplained renal failure in patients affected by parasitic infections, interstitial nephritis should be considered and it is our opinion that a renal biopsy should be always performed.

  19. Myocardial rupture after myocardial infarction. Detection by multi-gated image-acquisition scintigraphy.

    Science.gov (United States)

    Nicod, P; Corbett, J; Leachman, R; Croyle, P H; Reich, S; Peshock, R; Farkas, R; Rude, R; Buja, L M; Mills, L; Lewis, S E; Willerson, J T

    1982-11-01

    Myocardial rupture following infarction usually is an acute and dramatic event. Rarely, it may take a subacute course, allowing surgical treatment. We report herein a case of subacute rupture of the heart in a 54 year old patient with acute myocardial infarction. The rupture was diagnosed by the appearance of a radiopaque halo around the heart during radionuclide ventriculography. The patient subsequently underwent surgical resection of a large anterolateral aneurysm and a 2 inch long rupture of the myocardium and survived. Clinical suspicion, prompt diagnosis, and surgical intervention are important in the management of this relatively unusual complication of infarction.

  20. Imaging findings of the orbital and intracranial complications of acute bacterial rhinosinusitis

    NARCIS (Netherlands)

    Dankbaar, J W; van Bemmel, A J M; Pameijer, F A

    2015-01-01

    UNLABELLED: In patients with acute bacterial rhinosinusitis severe orbital and intracranial complications can occur. This review will illustrate the anatomic relationship between the paranasal sinuses and the orbital and intracranial compartments. Subsequently, the spectrum of orbital and intracrani

  1. Uterine preservation in placenta percreta complicated by unscarred uterine rupture at second trimester in a patient with repeated molar pregnancies: a case report and brief review of the literature.

    Science.gov (United States)

    Ozdemir, A; Ertas, I E; Gungorduk, K; Kaya, C; Solmaz, U; Yildirim, G

    2014-01-01

    Placenta-percreta causing uterine rupture in unscarred uterus is a rare obstetric surgical emergency that can cause maternal and perinatal morbidity and mortality. A 25-year-old woman presented with abdominal pain for four days. Previously, she had undergone two suction curettages for complete hydatiform moles. Ultrasound revealed a non-viable fetus with an estimated gestational age of 21 weeks and free fluid and coagulum in the abdominal cavity. An emergency laparotomy was performed because of the acute abdomen. At exploration, the placenta had invaded the entire thickness of the myometrium and the non-viable fetus was in the abdominal cavity. The uterus was closed with a double-layer of interrupted sutures and uterine-sparing surgery was performed. The patient was discharged on postoperative day seven. The authors present a case of placenta-percreta in an unscarred uterus complicated with uterine rupture during the second-trimester that was managed successfully with uterine repair. They also review the literature briefly and discuss similar cases managed conservatively in the second-trimester.

  2. Do you need to operate following recovery from complications of pediatric acute sinusitis?

    Science.gov (United States)

    Patel, Ruchin G; Daramola, Opeyemi O; Linn, David; Flanary, Valerie A; Chun, Robert H

    2014-06-01

    There are many studies that evaluate the role of surgery in the treatment of complications of pediatric acute sinusitis; however there are few studies, if any that report the incidence of surgery following recovery from acute complicated sinusitis. The goal of this study was to report the incidence and indications for surgical intervention after recovery from complications of pediatric acute sinusitis. We reviewed the records of all children admitted to a tertiary care children's hospital between January 2005 and September 2010 with a diagnosis of sinusitis and an orbital or intracranial complication. Eighty-six patients met inclusion criteria. Charts were reviewed for type of complication, initial treatment (medical or surgical), type of procedure, secondary procedures, age, and comorbidities. Statistical analysis was completed using independent samples student t-tests and Mann-Whitney tests. A total of 86 patients with a mean age of 6.38 years (2 months to 18 years) were identified. Eighty patients had orbital complications while six presented with intracranial complications. Twenty-seven patients (31%) underwent sinus surgery during the acute phase of their illness whereas 59 patients (69%) were treated medically. After hospitalization and recovery for acute complicated sinusitis, surgery was performed on nine patients (mean age 4.86 years) within 1 month to 2 years post hospitalization. Of the nine patients who required secondary surgery following resolution of the initial complicated sinusitis, four patients were following initial surgical intervention and five patients had initially resolved their complication with medical therapy alone. Indications for subsequent surgery included failure of medical therapy for persistent rhinosinusitis (8 patients) and second complication (1 patient). This study suggests that following resolution of complicated pediatric rhinosinusitis, very few patients may need further surgical intervention. Subsequent intervention is best

  3. Acute complications of tattooing presenting in the ED.

    Science.gov (United States)

    Kluger, Nicolas

    2012-11-01

    Permanent decorative tattooing involves the introduction of exogenous pigments and/or dyes into the dermis to produce the permanent design. Despite improved hygiene in the tattoo parlors of Western countries, this procedure still carries risk. Various complications may occur right after tattooing, from benign complications such as transient limb edema, palpable lymph nodes, and contact eczema, to more severe ones such as the inoculation of virulent microorganisms into the dermis, potentially life-threatening cellulitis, and necrotizing fasciitis or cutaneous vasculitis. This review focuses specifically on the complications that occur within the first month of tattooing that emergency physicians may have to manage.

  4. Increased risk of complications in acute onset intestinal malrotation

    DEFF Research Database (Denmark)

    Wallberg, Sidsel Vang; Qvist, Niels

    2013-01-01

    Intestinal malrotation is a potentially life-threatening illness which presents in many different ways and the symptoms span from acute to chronic. The purpose of this study was to determine the clinical presentation of intestinal malrotation at all ages....

  5. A case of scrub typhus complicated by acute calculous cholecystitis.

    Science.gov (United States)

    Lee, Su Jin; Cho, Young Hye; Lee, Sang Yeoup; Jeong, Dong Wook; Choi, Eun Jung; Kim, Yun Jin; Lee, Jeong Gyu; Lee, Yu Hyun

    2012-07-01

    We report a case of acute calculous cholecystitis through scrub typhus. A 69-year-old woman presented with a history of general myalgia, fever, and right abdominal pain. She referred to our hospital for surgical treatment of clinically suspected acute cholecystitis. Physicians concluded the cause of cholecystitis as gall bladder (GB) stone and proper antibiotics treatment of scrub typhus was started later. The patient developed acute respiratory distress syndrome and multi organ failure through scrub typhus. Five days after admission, the patient was treated with proper antibiotics and discharged on the 13th day after starting doxycycline treatment without any sequelae. In areas endemic for tsutsugamushi disease, even though a patient with GB stone presents with symptoms of acute cholecystitis, careful history and physical examination are required to reveal the existence of eschars or skin eruptions.

  6. Study of Controlling Acute Hemorrhage from Esophageal Varices Rupture with Technique of Traditional Chinese Medicine

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective: To find a method for inducing Chinese drugs to adhere to the esophageal mucosa to control bleeding from ruptured esophageal varices. Methods: The site and time that the Chinese drugs adhere to esophageal mucosa were observed in 30 healthy volunteers under the specific condition of standing and lying posture. Seventy episodes bled with ruptured esophageal varices patients (treated group 36 episodes in 25 patients and control group 34 episodes in 27 patients) suffering from cirrhosis of liver were treated by the technique of drug adhesion. Results: (1) The adhesion of Chinese hemostatic drugs remained in the lower segment of esophagus for more than 15 minutes in lying posture, longer than that in standing posture (P0.05). Conclusion: This drug adhesion technique provides a new approach to control hemorrhage from ruptured esophageal varices.

  7. Risk factors for medical complications of acute hemorrhagic stroke

    Institute of Scientific and Technical Information of China (English)

    Jangala Mohan Sidhartha; Aravinda Reddy Purma; Nagaswaram Krupa Sagar; Marri Prabhu Teja; Meda Venkata subbaiah; Muniswami Purushothaman

    2015-01-01

    Objective: To assess the risk factors leading to medical complications of hemorrhagic stroke. Methods: We conducted an observational study in neurology, emergency and general medicine wards at a tertiary care teaching hospital in Kadapa. We recruited hemorrhagic stroke patients, and excluded the patients have evidence of trauma or brain tumor as the cause of hemorrhage. We observed the subjects throughout their hospital stay to assess the risk factors and complications. Results: During period of 12 months, 288 subjects included in the study, 89% of them identified at least 1 prespecified risk factor for their admission in hospital and 75% of them experienced at least 1 prespecified complication during their stay in hospital. Around 47% of subjects deceased, among which 64% were females. Conclusions: Our study has assessed that hypertension followed by diabetes mellitus are the major risk factors for medical complications of hemorrhagic stroke. Female mortality rate was more when compared to males.

  8. Large B- Cell lymphoma presenting as acute abdominal pain and spontaneous splenic rupture; A case report and review of relevant literature

    Science.gov (United States)

    Biswas, Saptarshi; Keddington, Judith; McClanathan, James

    2006-01-01

    Background Spontaneous rupture of the spleen is an uncommon dramatic abdominal emergency that requires immediate diagnosis and prompt surgical treatment to ensure the patients survival. Infections have been cited in most cases involving splenic rupture but are rare in hematological malignancies despite frequent involvement of the spleen. Methods and Materials We present a case of a splenic rupture caused by infiltration of B-cell lymphoma. A 43 year old gentleman presented with a 1 day h/o left upper quadrant pain; nausea and vomiting for 2 days with associated dizziness and anorexia. The CT showed abnormal spleen 20 × 11 cm with free fluid in the abdomen and enlarged retroperitoneal LNs. The patient underwent a splenectomy after initial resuscitation and the operative finding was that of a massively enlarged spleen with areas of tumor extruding through the splenic capsule. Result and conclusion Although the spleen is often involved in hematological malignancies, splenic rupture is an infrequent occurrence. In a recent literature review 136 cases were of splenic rupture secondary to hematological malignancy were identified. Acute leukemia and non Hodgkin lymphoma were the frequent causes followed by chronic myelogeneous leukemia. Male sex, adulthood, severe splenomegaly and cytoreductive chemotherapy were factors more often associated with splenic rupture. Emergency splenectomy remains the cornerstone treatment for splenic rupture. We present a case report of a "spontaneous splenic rupture" and discuss the presentation, etiology and treatment options along with discussion of relevant literature PMID:17129392

  9. Rapid detection of sepsis complicating acute necrotizing pancreatitis using polymerase chain reaction

    Institute of Scientific and Technical Information of China (English)

    Wei Zhong Zhang; Tian Quan Han; Yao Qing Tang; Sheng Dao Zhang

    2001-01-01

    @@INTRODUCTION Acute narcotizing pancreatitis usually takes a severe clinical course and is associated with multiple organ dysfunction .With the further understanding of pathophysiological events of acute pancreatisis and the therapeutic measuses taken by the clinicians ,the patients can pass through the critical carry stages ,and then the septic complication caused by rtanslocated bacteria, mostly gram-negative microbes from the intestines ensues[1].

  10. Compartment syndrome, rhabdomyolysis and risk of acute renal failure as complications of the lithotomy position.

    NARCIS (Netherlands)

    Bocca, G.; Moorselaar, R.J.A. van; Feitz, W.F.J.; Staak, F.H.J.M. van der; Monnens, L.A.H.

    2002-01-01

    Compartment syndrome, rhabdomyolysis and the risk of acute renal failure are potential complications of the lithotomy position. A six-year-old girl is described who developed a compartment syndrome with rhabdomyolysis after prolonged surgery in the lithotomy position. This complication occurred thre

  11. Imaging of acute cholecystitis and cholecystitis-associated complications in the emergency setting

    OpenAIRE

    Chawla, Ashish; Bosco, Jerome Irai; Lim, Tze Chwan; Srinivasan, Sivasubramanian; Teh, Hui Seong; Shenoy, Jagadish Narayana

    2015-01-01

    Acute cholecystitis is a common cause of right upper quadrant pain in patients presenting at the emergency department. Early diagnosis and recognition of associated complications, though challenging, are essential for timely management. Imaging studies, including ultrasonography, computed tomography and magnetic resonance imaging, are increasingly utilised for the evaluation of suspected cases of cholecystitis. These investigations help in diagnosis, identification of complications and surgic...

  12. Intratemporal and intracranial complications of acute suppurative otitis media in children : renewed interest

    NARCIS (Netherlands)

    Dhooge, IJM; Albers, FWJ; Van Cauwenberge, PB

    1999-01-01

    In recent years, a rise in the incidence of intratemporal and intracranial complications of acute otitis media (AOM) has been mentioned in the literature. Lack of a well-developed immune system and difficulties in diagnosing AOM, can account for part of the rise in the incidence of complications of

  13. Compartment syndrome, rhabdomyolysis and risk of acute renal failure as complications of the lithotomy position.

    NARCIS (Netherlands)

    Bocca, G.; Moorselaar, R.J.A. van; Feitz, W.F.J.; Staak, F.H.J.M. van der; Monnens, L.A.H.

    2002-01-01

    Compartment syndrome, rhabdomyolysis and the risk of acute renal failure are potential complications of the lithotomy position. A six-year-old girl is described who developed a compartment syndrome with rhabdomyolysis after prolonged surgery in the lithotomy position. This complication occurred

  14. [Tumor lysis syndrome in a pregnancy complicated with acute lymphoblastic leukemia].

    Science.gov (United States)

    Álvarez-Goris, M P; Sánchez-Zamora, R; Torres-Aguilar, A A; Briones Garduño, J C

    2016-04-01

    Acute leukemia is rare during pregnancy, affects about 1 in 75,000 pregnancies, of all leukemias diagnosed only 28% are acute lymphoblastic leukemia, this is a risk factor to develop spontaneous tumor lysis syndrome, it's a oncologic complication potentially deadly if the prophylactic treatment its avoided. Cases of acute lymphoblastic leukemia associated with pregnancy has been poorly documented in the literature the association of these two entities to pregnancy is the first report published worldwide, so the information is limited.

  15. Bilateral psoas and bilateral perinephric abscesses complicating acute pyelonephritis in pregnancy

    OpenAIRE

    2013-01-01

    Acute pyelonephritis complicates 1-2% of pregnancies and causes significant maternal and fetal morbidity and mortality. The diagnosis of renal tuberculosis (TB) is often delayed and commonly presents with sterile pyuria or along with other pyogenic organisms. We report a case where the diagnosis of renal TB was missed in a pregnant woman when she presented with acute pyelonephritis, septic shock, and acute renal failure. There was clinical recovery with antibiotics, but bilateral psoas and pe...

  16. Magnetic resonance imaging for local complications of acute pancreatitis: A pictorial review

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    Acute pancreatitis is a common disease characterized by sudden upper abdominal pain and vomiting. Alcoholism and choledocholithiasis are the most common factors for this disease. The choice of treatment for acute pancreatitis might be affected by local complications, such as local hemorrhage in or around the pancreas, and peripancreatic infection or pseudoaneurysm. Diagnostic imaging modalities for acute pancreatitis have a significant role in confirming the diagnosis of the disease, helping detect the exte...

  17. Unrecognised Acute Rupture of the Achilles Tendon in Severe Ankle Sprain

    Directory of Open Access Journals (Sweden)

    Kin Wai Lam

    2015-12-01

    Full Text Available Inversion ankle sprain is a common sport injury. It commonly refers to the injury of lateral collateral ligaments of the ankle. Failure to detect the concomitant injuries would lead to inappropriate treatment and suboptimal result. A case of unrecognised rupture of the Achilles tendon in a patient with severe inversion ankle sprain is reported.

  18. Acute subdural hematoma secondary to distal middle cerebral artery aneurysm rupture in a newborn infant.

    Science.gov (United States)

    Iza-Vallejo, Begoña; Mateo-Sierra, Olga; Fortea-Gil, Fernando; Ruiz-Juretschke, Fernando; Martín, Yolanda Ruiz

    2009-05-01

    The authors present the case of a peripheral aneurysmal lesion that developed in a newborn baby and was successfully treated by endovascular parent artery occlusion. Given the natural history of aneurysms, which are prone to rupture and to cause deleterious intracerebral hemorrhage, with high mortality rates, aggressive and early management (endovascular or surgical) is recommended.

  19. Spontaneous Rupture of Pancreatic Pseudocyst: Report of Two Cases

    Directory of Open Access Journals (Sweden)

    Ricardo Rocha

    2016-01-01

    Full Text Available Introduction. Pancreatic pseudocysts are a common complication of acute pancreatitis. Pancreatic pseudocyst’s natural history ranges between its spontaneous regression and the settlement of serious complications if untreated, such as splenic complications, hemorrhage, infection, biliary complications, portal hypertension, and rupture. The rupture of a pancreatic pseudocyst to the peritoneal cavity is a dangerous complication leading to severe peritonitis and septic conditions. It requires emergent surgical exploration that is often of great technical difficulty and with important morbidity and mortality. Case Study. We present two cases of spontaneous rupture of pancreatic pseudocysts, managed differently according to the local and systemic conditions. Conclusion. The best surgical choice is the internal drainage of the cyst to the GI tract; however, in some conditions, the external drainage is the only choice available.

  20. Acute cytomegalovirus infection complicated by venous thrombosis: a case report

    Directory of Open Access Journals (Sweden)

    Parola Philippe

    2005-08-01

    Full Text Available Abstract Background CMV-induced vasculopathy and thrombosis have been reported, but they are rare conditions usually encountered in immunocompromised patients. However more and more complications of CMV infections are recognized in immunocompetent patients. Case presentation We present a case report of a previously healthy adult with cytomegalovirus infection that was complicated by tibiopopliteal deep venous thrombosis and in whom Factor V Leiden heterozygous mutation was found. Conclusion This new case report emphasizes the involvement of cytomegalovirus in induction of vascular thrombosis in patients with predisposing risk factors for thrombosis. It is necessary to screen for CMV infection in patients with spontaneous thrombosis and an history of fever.

  1. Rare but numerous serious complications of acute otitis media in a young child.

    Science.gov (United States)

    Van Munster, Mariëtte P E; Brus, Frank; Mul, Dick

    2013-03-12

    Acute otitis media is a very common disease in children. Most children recover with symptomatic therapy like potent analgesics, but occasionally serious complications occur. We present a 3-year-old girl who suffered from acute otitis media for already 2 weeks and presented with fever, abducens nerve palsy of her left eye and vomiting. She was finally diagnosed with an acute otitis media complicated by a mastoiditis, sinus thrombosis, meningitis and cerebellar empyema. Fusobacterium necrophorum was cultured from cerebrospinal fluid. The girl recovered following appropriate antibiotic and anticoagulation treatment.

  2. Pott's puffy tumor: a rare complication of acute otitis media in child: a case report.

    Science.gov (United States)

    Urík, Milan; Machač, Josef; Šlapák, Ivo; Hošnová, Dagmar

    2015-09-01

    To describe a rare case of Potts' puffy tumor (PPT) in the zygomatic area, which developed as a complication of acute otitis media in a 6-year-old child. To date, only one case of PPT has been described in the literature as a complication of latent mastoiditis in an adult, and one case of PPT as a complication of acute mastoiditis in a 10-year-old child. Urgent surgical intervention, including evacuation of the purulent lesion, removal of inflamed soft tissue and osteolysis of the involved bone, and antromastoidectomy, intravenous treatment with broad-spectrum antibiotics, including G+, G-, anaerobes and fungi, and local therapy.

  3. Attritional rupture of extensor pollicis longus: a rare complication following elastic stable intramedullary nailing of a paediatric radial fracture.

    LENUS (Irish Health Repository)

    Sproule, James A

    2011-01-01

    Elastic stable intramedullary nail fixation has become established as an acceptable method of treatment for diaphyseal fractures of both forearm bones in the paediatric population. It is considered safe, minimally invasive and does not compromise physeal growth. We report a case of delayed rupture of extensor pollicis longus due to attrition over the sharp edges of a protruding nail end after elastic stable intramedullary nailing of a paediatric radial diaphyseal fracture.

  4. Imaging of acute cholecystitis and cholecystitis-associated complications in the emergency setting.

    Science.gov (United States)

    Chawla, Ashish; Bosco, Jerome Irai; Lim, Tze Chwan; Srinivasan, Sivasubramanian; Teh, Hui Seong; Shenoy, Jagadish Narayana

    2015-08-01

    Acute cholecystitis is a common cause of right upper quadrant pain in patients presenting at the emergency department. Early diagnosis and recognition of associated complications, though challenging, are essential for timely management. Imaging studies, including ultrasonography, computed tomography and magnetic resonance imaging, are increasingly utilised for the evaluation of suspected cases of cholecystitis. These investigations help in diagnosis, identification of complications and surgical planning. Imaging features of acute cholecystitis have been described in the literature and are variable, depending on the stage of inflammation. This article discusses the spectrum of cholecystitis-associated complications and their imaging manifestations. We also suggest a checklist for the prompt and accurate identification of complications in acute cholecystitis.

  5. Imaging of acute cholecystitis and cholecystitis-associated complications in the emergency setting

    Science.gov (United States)

    Chawla, Ashish; Bosco, Jerome Irai; Lim, Tze Chwan; Srinivasan, Sivasubramanian; Teh, Hui Seong; Shenoy, Jagadish Narayana

    2015-01-01

    Acute cholecystitis is a common cause of right upper quadrant pain in patients presenting at the emergency department. Early diagnosis and recognition of associated complications, though challenging, are essential for timely management. Imaging studies, including ultrasonography, computed tomography and magnetic resonance imaging, are increasingly utilised for the evaluation of suspected cases of cholecystitis. These investigations help in diagnosis, identification of complications and surgical planning. Imaging features of acute cholecystitis have been described in the literature and are variable, depending on the stage of inflammation. This article discusses the spectrum of cholecystitis-associated complications and their imaging manifestations. We also suggest a checklist for the prompt and accurate identification of complications in acute cholecystitis. PMID:26311909

  6. Apical ballooning syndrome complicated by acute severe mitral regurgitation with left ventricular outflow obstruction – Case report

    Directory of Open Access Journals (Sweden)

    Celermajer David S

    2007-02-01

    Full Text Available Abstract Background Apical ballooning syndrome (or Takotsubo cardiomyopathy is a syndrome of transient left ventricular apical ballooning. Although first described in Japanese patients, it is now well reported in the Caucasian population. The syndrome mimicks an acute myocardial infarction but is characterised by the absence of obstructive coronary disease. We describe a serious and poorly understood complication of Takotsubo cardiomyopathy. Case Presentation We present the case of a 65 year-old lady referred to us from a rural hospital where she was treated with thrombolytic therapy for a presumed acute anterior myocardial infarction. Four hours after thrombolysis she developed acute pulmonary oedema and a new systolic murmur. It was presumed she had acute mitral regurgitation secondary to a ruptured papillary muscle, ischaemic dysfunction or an acute ventricular septal defect. Echocardiogram revealed severe mitral regurgitation, left ventricular apical ballooning, and systolic anterior motion of the mitral valve with significant left ventricular outflow tract gradient (60–70 mmHg. Coronary angiography revealed no obstructive coronary lesions. She had an intra-aortic balloon pump inserted with no improvement in her parlous haemodynamic state. We elected to replace her mitral valve to correct the outflow tract gradient and mitral regurgitation. Intra-operatively the mitral valve was mildly myxomatous but there were no structural abnormalities. She had a mechanical mitral valve replacement with a 29 mm St Jude valve. Post-operatively, her left ventricular outflow obstruction resolved and ventricular function returned to normal over the subsequent 10 days. She recovered well. Conclusion This case represents a serious and poorly understood association of Takotsubo cardiomyopathy with acute pulmonary oedema, severe mitral regurgitaton and systolic anterior motion of the mitral valve with significant left ventricular outflow tract obstruction. The

  7. Biventricular Mechanical Circulatory Support Does Not Prevent Delayed Myocardial Ventricular Rupture following Myocardial Infarction

    Directory of Open Access Journals (Sweden)

    Yazhini Ravi

    2013-01-01

    Full Text Available Cardiogenic shock and myocardial rupture can complicate an acute myocardial infarction (AMI. A case is reported in which a 58-year-old male with an acute inferior myocardial infarction required placement of biventricular assist device for hemodynamic support eight days after the onset of his AMI; eleven days after his AMI, the patient developed abrupt onset of hemodynamic instability with massive bleeding from his chest tube due to delayed free wall myocardial rupture that was discovered when he was taking emergently to the operating room. Myocardial rupture in patients with a ventricular assist device should be considered in the differential diagnosis in the event of acute hemodynamic compromise. A high level of suspicion for such a complication should prompt aggressive and emergent actions including surgery. We present a case of delayed free wall myocardial rupture following an acute inferior wall myocardial infarction in a patient with biventricular mechanical circulatory support.

  8. A novel repair method for the treatment of acute Achilles tendon rupture with minimally invasive approach using button implant: a biomechanical study.

    Science.gov (United States)

    Huri, Gazi; Biçer, Ömer Sunkar; Ozgözen, Levent; Uçar, Yurdanur; Garbis, Nickolas G; Hyun, Yoon Suk

    2013-12-01

    Minimally invasive Q3 repair has been proposed for acute Achilles tendon rupture with low rate of complications. However there are still controversies about optimal technique. In this study we aimed to describe Endobutton-assisted modified Bunnell configuration as a new Achilles tendon repair technique and evaluate its biomechanical properties comparing with native tendon and Krackow technique. 27 ovine Achilles tendons were obtained and randomly placed into 3 groups with 9 specimens ineach. The Achilles tendons were repaired with Endobutton-assisted modified Bunnell technique in group 1, Krackow suture technique in group 2 and group 3 was defined as the control group including native tendons. Unidirectional tensile loading to failure was performed at 25mm/min. Biomechanicalproperties such as peak force to failure (N), stress at peak (MPa), elongation at failure, and Young'smodulus (GPa) was measured for each group. All groups were compared with each other using one-wayANOVA followed by the Tukey HSD multiple comparison test (a=0.05). The average peak force (N) to failure of group 1 and group 2 and control group was 415.6±57.6, 268.1±65.2 and 704.5±85.8, respectively. There was no statistically significant difference between native tendon and group 1 for the amount elongation at failure (p>0.05). Regarding the results, we concluded that Endobutton-assisted modified Bunnell technique provides stronger fixation than conventional techniques. It may allow early range of motion and can be easily applied in minimally invasive and percutaneous methods particularly for cases with poor quality tendon at the distal part of rupture. Level II, Biomechanical research study. Copyright © 2013 European Foot and Ankle Society. All rights reserved.

  9. Quadriceps tendon rupture - treatment results

    Directory of Open Access Journals (Sweden)

    Popov Iva

    2013-01-01

    Full Text Available Introduction. Quadriceps tendon rupture is a rare but rather serious injury. If this injury is not promptly recognized and early operated, it may lead to disability. This research was aimed at pointing out the results and complications of the quadriceps tendon rupture surgical treatment. Material and Methods. This retrospective multicentric study was conducted in a group of 29 patients (mostly elderly men. Lysholm knee scoring scale was used to evaluate the surgical results. The post-operative results were compared in relation to the type of tendon rupture reconstructions (acute or chronic, various surgical techniques, type of injuries (unilateral or bilateral as well as the presence or absence of comorbid risk factors in the patients. Results. The average value of a Lysholm score was 87.6. Excellent and satisfactory Lysholm score results dominated in our sample of patients. Better post-operative results were recorded in the group of patients without risk factors, in case of a bilateral injury, and in case of an acute injury. The best result was obtained after performing the reconstruction using anchors, and the worst result came after using Codivilla technique. Discussion and Conclusion. Early diagnosis and surgical treatment are an absolute imperative in management of this injury. We have not proven that a certain surgical technique has an advantage over the others. A comorbid risk factor is related to a lower Lysholm score. Despite a few cases of complications, we can conclude that the surgical treatment yields satisfactory results.

  10. Cardiac tamponade, an unusual complication of acute pancreatitis.

    Science.gov (United States)

    Veron Esquivel, Daniel; Aello, Gerardo; Batiz, Fernando; Fernandez Barrera, Alejandro

    2016-03-11

    A 41-year-old Hispanic man was admitted to our hospital with the diagnosis of acute pancreatitis due to hypertriglyceridemia. During his stay, he developed sudden haemodynamic instability and clinical presentation suggestive of cardiac tamponade. A transthoracic echocardiogram confirmed the diagnosis. Echocardiography-guided pericardiocentesis was performed with immediate haemodynamic improvement. The patient's condition underwent favourable evolution. The pancreatitis was resolved and a control transthoracic echocardiography was performed showing no pericardial effusion. The pathophysiology of this rare entity is unknown. Early diagnosis and treatment are crucial. Although pericardiocentesis is the treatment of choice, there have been a few reports of medical treatment with encouraging results. Although the association of acute pancreatitis and tamponade are anecdotal in literature, medics should be aware of this association in order to perform prompt diagnosis.

  11. Acute suppurative parotitis: a dreadful complication in elderly surgical patients.

    Science.gov (United States)

    Lampropoulos, Pavlos; Rizos, Spyros; Marinis, Athanasios

    2012-08-01

    Acute suppurative parotitis (ASP) is a severe infection seen particularly in elderly surgical patients. Factors that increase the risk of ASP include post-operative dehydration, debilitating conditions, and immunosuppressed states. Case report and literature review. An 82-year-old female patient was admitted because of paralytic ileus, dehydration, and poor oral hygiene, and was in distress. After two days of hospitalization, the patient developed a progressive painful swelling of her right parotid gland and fever up to 39.0°C. Computed tomography scanning showed an abscess in the parotid gland. Because of her progressive clinical deterioration, the patient underwent operative drainage of the abscess and removal of the necrotic material. Unfortunately, she suffered multiple organ dysfunction syndrome and died. Acute suppurative parotitis requires prompt aggressive treatment that nevertheless may fail.

  12. A Rare Complication of Acute Appendicitis: Superior Mesenteric Vein Thrombosis

    Directory of Open Access Journals (Sweden)

    Hendra Koncoro

    2016-12-01

    Full Text Available Superior mesenteric vein (SMV thrombosis caused by acute appendicitis is quite rare nowadays. These conditions occurs secondary to infection in the region drained by the portal venous system. In this case, we report a successfully treated case of SMV thrombosis and liver abscess associated with appendicitis with antibiotics and anticoagulant.Early diagnosis and prompt treatment are basic to a favorable clinical course.

  13. Higher rate of compensation after surgical treatment versus conservative treatment for acute Achilles tendon rupture

    DEFF Research Database (Denmark)

    Sveen, Thor-Magnus; Troelsen, Anders; Barfod, Kristoffer Weisskirchner

    2015-01-01

    complications. The aim of this study was to investigate: 1) the socio-economic impact of complications after ATR through the utilisation of the Danish Patient Insurance Association (DPIA) database, 2) correlations between treatment and complications. METHODS: A total of 324 patients with ATR reported...

  14. Surgical management of acute quadriceps tendon rupture (a case report with literature review).

    Science.gov (United States)

    Ennaciri, Badr; Montbarbon, Eric; Beaudouin, Emmanuel

    2015-01-01

    Quadriceps tendon rupture is uncommon and often overlooked in emergency. Tearing affects weakening tendon by systemic diseases or some medications. The mechanism is generally indirect. Inability to actively extend the knee associated to a supra-patellar defect evoke easily the diagnosis without other investigations. Surgical repair is realized in emergency to completely restore the extension. We report a case of a patient who has sustained of complete quadriceps tendon tear after a long period of tendon weakening by statin therapy, hypertension and diabetes. The repair has consisted on end-to-end Krackow sutures associated with bone suture to the proximal pole of the patella. Surgeons and emergency physicians must think to this form of extensor apparatus rupture, because early diagnosis leads to early treatment and to best outcomes.

  15. Surgical management of acute quadriceps tendon rupture (a case report with literature review)

    OpenAIRE

    2015-01-01

    Quadriceps tendon rupture is uncommon and often overlooked in emergency. Tearing affects weakening tendon by systemic diseases or some medications. The mechanism is generally indirect. Inability to actively extend the knee associated to a supra-patellar defect evoke easily the diagnosis without other investigations. Surgical repair is realized in emergency to completely restore the extension. We report a case of a patient who has sustained of complete quadriceps tendon tear after a long perio...

  16. Increasing incidence of acute Achilles tendon rupture and a noticeable decline in surgical treatment from 1994 to 2013. A nationwide registry study of 33,160 patients.

    Science.gov (United States)

    Ganestam, Ann; Kallemose, Thomas; Troelsen, Anders; Barfod, Kristoffer Weisskirchner

    2016-12-01

    The purpose of this study is to investigate the incidence of acute Achilles tendon rupture in Denmark from 1994 to 2013 with focus on sex, age, geographical areas, seasonal variation and choice of treatment. The National Patient Registry was retrospectively searched to find the number of acute Achilles tendon rupture in Denmark during the time period of 1994-2013. Regional population data were retrieved from the services of Statistics Denmark. During the 20-year period, 33,160 ruptures occurred revealing a statistically significant increase in the incidence (p Achilles tendon rupture increased from 1994 to 2013 based on increasing incidence in the older population. There was no difference in incidence of acute Achilles tendon rupture in the rural compared with urban geographical areas. A steady decline in surgical treatment was found over the whole period, with a noticeable decline from 2009 to 2013, possibly reflecting a rapid change in clinical practice following a range of high-quality randomized clinical trials (RCT). IV.

  17. Management and Outcome of Patients With Acute Coronary Syndrome Caused by Plaque Rupture Versus Plaque Erosion: An Intravascular Optical Coherence Tomography Study.

    Science.gov (United States)

    Hu, Sining; Zhu, Yinchun; Zhang, Yingying; Dai, Jiannan; Li, Lulu; Dauerman, Harold; Soeda, Tsunenari; Wang, Zhao; Lee, Hang; Wang, Chao; Zhe, Chunyang; Wang, Yan; Zheng, Gonghui; Zhang, Shaosong; Jia, Haibo; Yu, Bo; Jang, Ik-Kyung

    2017-02-24

    Plaque rupture and erosion are the 2 most common mechanisms for acute coronary syndromes. However, the outcome of these 2 distinct pathologies in patients with acute coronary syndromes has never been studied. We retrospectively studied 141 patients with acute coronary syndromes who underwent optical coherence tomography (OCT) imaging of the culprit lesion prior to stenting from the Massachusetts General Hospital OCT Registry. Management (stent versus no stent), poststent OCT findings, and outcomes were compared. Among the 141 culprit lesions, rupture was found in 79 (56%) patients and erosion in 62 (44%). Stent implantation was performed in 77 (97.5%) patients with rupture versus 49 (79.0%) in those with erosion (Perosion group. Plaque rupture was associated with a higher incidence of no reflow or slow flow and distal embolization. Although cardiac event rates were comparable between the two groups at the 1-year follow-up, none of the erosion patients who were treated conservatively without stenting had adverse cardiac events. Unfavorable poststent OCT findings were more frequent in rupture patients compared with erosion patients. A subset of erosion patients who were treated conservatively without stenting remained free of adverse cardiac events for up to 1 year. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  18. Endoloops or endostapler use in laparoscopic appendectomy for acute uncomplicated and complicated appendicitis : No difference in infectious complications.

    Science.gov (United States)

    van Rossem, Charles C; van Geloven, Anna A W; Schreinemacher, Marc H F; Bemelman, Willem A

    2017-01-01

    The most appropriate closure for the appendicular stump with either endoloops or an endostapler in laparoscopic appendectomy remains unclear and under debate because of limited and conflicting evidence. In a 2-month prospective, observational, resident-led nationwide cohort study, patients undergoing laparoscopic appendectomy for both uncomplicated and complicated appendicitis were analysed. Logistic regression analyses were performed for identifying the possible effect of stump closure type and other risk factors for infectious complications. Laparoscopic appendectomy for acute appendicitis was performed in 1369 patients in 62 hospitals; endoloops were used in 76.7 % and an endostapler in other patients. Median operating time was not different between endoloop and endostapler use (42.0 vs. 44.0 min, P = 0.243). A superficial surgical site infection was seen in 2.0 % after uncomplicated appendicitis and in 0.8 % after complicated appendicitis. The intra-abdominal abscess rate was 1.9 % after uncomplicated and 11.0 % after complicated appendicitis. No significant effect of stump closure type was observed for any infectious complication (OR 1.05; 95 % CI 0.625-1.766, P = 0.853) or an intra-abdominal abscess (OR OR 0.96; 95 % CI 0.523-1.768, P = 0.899). In multivariable analysis, complicated appendicitis was identified as the only independent risk factor for an intra-abdominal abscess (OR 6.26; 95 % CI 3.454-11.341, P < 0.001). The infectious complication rate is not influenced by the type of appendicular stump closure with either endoloops or an endostapler in this study. If technically feasible, closure with endoloops is advised for cost considerations.

  19. Uncomplicated spontaneous rupture of the pancreatic pseudocyst into the duodenum: Case report

    Directory of Open Access Journals (Sweden)

    Ali Emre Atıcı

    2014-06-01

    Full Text Available Pancreatic pseudocyst is one of the common complications of acute and chronic pancreatitis. Although most pseudocysts resolve spontaneously with supportive care, larger pseudocysts are more likely to cause complications. Large pancreatic pseudocysts may rupture spontaneously into the gastrointestinal tract and are usually associated with life-threatening bleeding. Surgical treatment or interventional drainage procedures may be necessary. Uncomplicated rupture of pseudocyst is extremely rare.

  20. Acute esophageal and gastric injury: complication of Lugol's solution.

    Science.gov (United States)

    Park, Jae Myung; Seok Lee, In; Young Kang, Ji; Nyol Paik, Chang; Kyung Cho, Yu; Woo Kim, Sang; Choi, Myung-Gyu; Chung, In-Sik

    2007-01-01

    Several new technologies have been developed to improve the diagnostic capability of conventional endoscopic techniques. One of these most frequently used methods is chromoendoscopy with Lugol's solution in the esophagus to detect malignant lesions. This method has been used for several decades and is generally considered as a safe method, only a few cases of side effects having been reported. We describe a case of acute esophageal and gastric mucosal damage after application of Lugol's solution during endoscopy in an 84-year-old woman. Endoscopists should be aware of the potential for adverse reactions to iodine staining.

  1. Idiopathic cystic ar ter y aneur ysm complicated with hemobilia and acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Subhi J. Al'Aref; Husham Abdel-Rahman; Nasir Hussain

    2008-01-01

    BACKGROUND:  Aneurysm of the cystic artery is not common, and it is a rare cause of hemobilia. Most of reported cases are pseudoaneurysms resulting from either an inlfammatory process in the abdomen or abdominal trauma. METHOD: We report a healthy individual who developed hemobilia and acute pancreatitis associated with cystic artery aneurysm. RESULT: The patient was managed with angio-embolization with an uneventful post-embolization course. CONCLUSIONS: Visceral artery aneurysms are rare and can rupture with potentially grave outcome due to excessive bleeding. Angiographic embolization as a common method of treatment for visceral artery aneurysms was used in our patient with good outcome.

  2. Outcomes after laparoscopic treatment of complicated versus uncomplicated acute appendicitis: a prospective, comparative trial.

    Science.gov (United States)

    Malagon, Antonio M; Arteaga-Gonzalez, Ivan; Rodriguez-Ballester, Lucrecia

    2009-12-01

    Laparoscopic treatment of simple acute appendicitis (AA) is a safe procedure; however, there are doubts about its safety in cases of complicated AA. The aim of this study was to determine the differences in results of laparoscopic treatment between cases of complicated versus simple AA. We prospectively included all patients treated for suspected AA by two surgeons of our service between May 2002 and May 2007. Of 221 patients, 20 were excluded from the study because the laparoscopic approach was not possible; 116 of 201 had uncomplicated AA, 57 complicated AA, 12 gynecologic ethiology, 11 negative appendectomy, and 5 other causes; patients without acute appendicitis were also excluded from the study. In all cases, laparoscopy was the first treatment option. The following variables were considered: mean surgical time, reconversions, emergency readmissions, emergency reinterventions or invasive procedures, mean postoperative hospital stay, and postoperative complications (i.e., infectious or noninfectious). Our results showed statistically significantly worse results, in terms of surgical time, postoperative stay, reconversions, and infectious complications, for patients with complicated versus uncomplicated AA; however, no differences were observed regarding noninfectious complications, emergency readmissions, and emergency reinterventions or invasive procedures. We consider that laparoscopic treatment of complicated AA may be safely used, despite worse results than in cases of simple AA, since the differences in numbers of severe postoperative complications requiring emergency readmission, reintervention, or invasive procedures were not statistically significant.

  3. 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

  4. Hepatitis A complicated with acute renal failure and high hepatocyte growth factor: A case report.

    Science.gov (United States)

    Oe, Shinji; Shibata, Michihiko; Miyagawa, Koichiro; Honma, Yuichi; Hiura, Masaaki; Abe, Shintaro; Harada, Masaru

    2015-08-28

    A 58-year-old man was admitted to our hospital. Laboratory data showed severe liver injury and that the patient was positive for immunoglobulin M anti-hepatitis A virus (HAV) antibodies. He was also complicated with severe renal dysfunction and had an extremely high level of serum hepatocyte growth factor (HGF). Therefore, he was diagnosed with severe acute liver failure with acute renal failure (ARF) caused by HAV infection. Prognosis was expected to be poor because of complications by ARF and high serum HGF. However, liver and renal functions both improved rapidly without intensive treatment, and he was subsequently discharged from our hospital on the 21(st) hospital day. Although complication with ARF and high levels of serum HGF are both important factors predicting poor prognosis in acute liver failure patients, the present case achieved a favorable outcome. Endogenous HGF might play an important role as a regenerative effector in injured livers and kidneys.

  5. A clinical study of complications of acute pancreatitis and their outcome

    Directory of Open Access Journals (Sweden)

    Sajjad Hussain

    2015-02-01

    Conclusion: Ascites was the most common local complication, whereas pleural effusion was the most common systemic complication. Shock, acute respiratory distress syndrome, acute renal failure, pancreatic abscess, infection of the pancre- atic necrosis, upper gastrointestinal bleed, hypocalcaemia, portal vein thrombosis, and hepatic encephalopathy were com- plications with the poorest prognosis. It is important to identify patients with acute pancreatitis who have an increased risk of complications and death. The MOSF scoring system is simple to use, has better clinical utility, and helps in directing pre- cious resources to patients who benefit the most from intensive therapy. Patients with severe pancreatitis require intensive monitoring and support of a failing system in intensive care unit, the lack of which resulted in higher mortality in our study. [Arch Clin Exp Surg 2015; 4(1.000: 1-13

  6. 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.

  7. Acute acalculous cholecystitis complicated with peritonitis caused by Lactobacillus plantarum.

    Science.gov (United States)

    Tena, Daniel; Martínez, Nora Mariela; Losa, Cristina; Fernández, Cristina; Medina, María José; Sáez-Nieto, Juan Antonio

    2013-08-01

    Lactobacillus spp. rarely causes human disease. We report a case of a 57-year-old man with non-insulin-dependent diabetes and vascular disease admitted to our hospital with severe abdominal pain and fever. Signs of peritonitis were found upon examination. The patient underwent surgery, and a diagnosis of perforated cholecystitis with purulent peritonitis was made intra-operatively. A cholecystectomy was performed, and therapy with imipenem was initiated. Lactobacillus plantarum was isolated from bile and peritoneal fluid cultures 2 days later. The patient recovered well and was discharged on post-operative day 16 after 14 days of treatment with imipenem. To our knowledge, this is the second case reported of acute cholecystitis caused by Lactobacillus spp. This organism should be considered as a cause of biliary infections, especially in patients with underlying diseases. Correct identification is often difficult, but it is very important because these organisms are usually resistant to vancomycin and other antibiotics.

  8. Acute gingival bleeding as a complication of dengue hemorrhagic fever

    Directory of Open Access Journals (Sweden)

    Saif Khan

    2013-01-01

    Full Text Available Dengue fever is mosquito borne disease caused by dengue virus (DENV of Flaviviridae family. The clinical manifestations range from fever to severe hemorrhage, shock and death. Here, we report a case of 20-year-old male patient undergoing orthodontic treatment presenting with acute gingival bleeding with a history of fever, weakness, backache, retro orbital pain and ecchymosis over his right arm. The hematological investigations revealed anemia, thrombocytopenia and positive dengue non-structural protein-1 antigen and also positive immunoglobulin M and immunoglobulin G antibodies for DENV. Patient was diagnosed as a case of dengue hemorrhagic fever and was immediately referred for appropriate management. This case report emphasizes the importance of taking correct and thorough medical history.

  9. [Content of C-reactive protein in patients in an acute period of a ruptured intracranial aneurysm].

    Science.gov (United States)

    Globa, M V; Lisyanyi, M I; Tsimeyko, A; Litvak, S O

    2015-03-01

    A content of C-reactive protein (CRP) in the blood serum was determined in 36 patients in acute period of a ruptured intracranial arterial aneurysm (AA). It was significantly more, than in a control group, and have exceeded 10 mg/I in 1 - 4th day of the disease. The level of CRP have had differ, depending on severity of cerebral vasospasm (CVS), determined in accordance to the ultrasound investigation data. In a pronounced CVS in majority of patients the level of CRP in the blood serum have had exceed 10 mg/l, and have secured elevated in a spinal liquor on the 7 - 10th day of the disease, differing from this index in patients with moderately pronounced CVS or without it. In patients with severe invalidization or those, who have died, the level of CRP was trust-worthy higher.

  10. Efficacy of early controlled motion of the ankle compared with no motion after non-operative treatment of an acute Achilles tendon rupture

    DEFF Research Database (Denmark)

    Barfod, Kristoffer Weisskirchner; Hansen, Maria Swennergren; Holmich, Per;

    2016-01-01

    BACKGROUND: Early controlled ankle motion is widely used in the non-operative treatment of acute Achilles tendon rupture, though its safety and efficacy have never been investigated in a randomized setup. The objectives of this study are to investigate if early controlled motion of the ankle affe...

  11. Operative versus nonoperative treatment of acute Achilles tendon rupture: An analysis of 12,570 patients in a large healthcare database.

    Science.gov (United States)

    Wang, Dean; Sandlin, M Isiah; Cohen, Jeremiah R; Lord, Elizabeth L; Petrigliano, Frank A; SooHoo, Nelson F

    2015-12-01

    The purpose of this study was to compare the latest patient demographics and rerupture rates of operative versus nonoperative treatment of acute Achilles tendon rupture in the United States. Patients undergoing treatment of an acute Achilles tendon rupture from 2007 to 2011 were identified by cross-referencing ICD-9-CM and CPT codes through the PearlDiver Patient Record Database. In total, 12,570 patients were treated for an acute Achilles tendon rupture. The ratio of operative to nonoperative treatment increased from 1.41 to 1.65. Males were more likely to undergo surgery than females. There were no significant differences in short-term rerupture rate for operative (2.1%) versus nonoperative (2.4%) treatment. The proportion of patients who received operative treatment for an acute Achilles tendon rupture increased slightly during the 5 year period, suggesting that surgeons in the United States have been slower to adopt nonoperative treatment than their European counterparts. Copyright © 2015 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  12. VALIDITY OF CONTRAST ENHANCED CT IN THE ASSESSMENT OF ACUTE PANCREATITIS AND ITS RELATED COMPLICATIONS

    Directory of Open Access Journals (Sweden)

    Mannivanan

    2016-03-01

    Full Text Available BACKGROUND In the earlier days, ultrasonogram was considered as one of the most important investigation for pancreatitis, later the clinicians started using cholangiography in acute pancreatitis, but today CT is considered as a gold standard test in the diagnosis of acute pancreatitis. Though the sensitivity of CT in diagnosing acute pancreatitis was not studied much particularly in a mild case, but a good-quality contrast enhanced CT demonstrates distinct pancreatic and peri-pancreatic abnormalities. AIM To assess the importance of computed tomography in diagnosing acute pancreatitis and its related complications. MATERIALS AND METHODS A prospective study was conducted on 150 patients with clinically suspected pancreatitis. CT was performed on all the patients with Siemens Spiral CT scanner Sensation 16 slice. Oral contrast of was 1000 mL given one hour prior to the scan in the form of taking 250 mL every 15 mins. The CT severity index (CTSI and the necrosis point scoring was used to assess the severity of acute pancreatitis. All the complications related to acute pancreatitis were also assessed. RESULTS The CT analysis in the detection of acute pancreatitis showed the sensitivity of 100% and the positive predictive value of 97.3%. The severity index of acute pancreatitis based on the CT imaging had shown that majority of the patients are with moderate (60.6% level of acute pancreatitis. The necrosis point scoring showed that 54.6% of the patients had necrosis involving less than 30% of the pancreas. Among the various complications detected by CECT the commonest were pleural effusion and ascites. CONCLUSION CECT is the most important gold standard technique both for diagnosis as well as for predicting the prognosis in acute pancreatitis. The clinicians should routinely send the patient for the CT imaging whenever there is a suspicion of pancreatitis clinically.

  13. Achilles tendon rupture; assessment of nonoperative treatment

    National Research Council Canada - National Science Library

    Barfod, Kristoffer Weisskirchner

    2014-01-01

    Acute Achilles tendon rupture is a frequent and potentially disabling injury. Over the past decade a change in treatment of acute Achilles tendon rupture away from operative towards non-operative treatment has taken place...

  14. Accelerated rehabilitation following Achilles tendon repair after acute rupture - Development of an evidence-based treatment protocol.

    Science.gov (United States)

    Brumann, Mareen; Baumbach, Sebastian F; Mutschler, Wolf; Polzer, Hans

    2014-11-01

    The acute rupture of the Achilles tendon is a protracted injury. Surgery is only the beginning of a long rehabilitation period. Therefore, the rehabilitation protocol is an integral aspect to restore the pre-injury activity level. Despite several trials available comparing different treatment regimes, there is still no consensus regarding the optimal protocol. Consequently, the aim of our study was to systematically search the evidence available and define a precise rehabilitation programme after operative repair of acute Achilles tendon rupture based on the trials with the highest level of evidence. We performed a systematic literature search in Medline, Embase and Cochrane library. We identified twelve randomized controlled trials comparing different treatment regimes after operative repair of the Achilles tendon. Five trials compared full to non weight bearing, all applying immobilization in equinus. Immediate full weight bearing led to significant higher patient satisfaction, earlier ambulation and return to pre-injury activity. Four trials compared early ankle mobilization to immobilization. All trials found mobilization to be superior as it shortens time to return to work and sports significantly. Three trials compared the combination of full weight bearing and early ankle mobilization to immobilization. This combination was most beneficial. Patients showed significantly higher satisfaction, less use of rehabilitation resources, earlier return to pre-injury activities and further demonstrated significantly increased calf muscle strength, reduced atrophy and tendon elongation. No study found an increased rerupture rate for the more progressive treatment. In conclusion, the rehabilitation protocol after Achilles tendon repair should allow immediate full weight bearing. After the second postoperative week controlled ankle mobilization by free plantar flexion and limited dorsiflexion at 0° should be applied. Copyright © 2014 Elsevier Ltd. All rights reserved.

  15. [Mathematical analysis of complicated course of acute surgical diseases of abdominal cavity organs].

    Science.gov (United States)

    Vozniuk, S M; Pol'ovyĭ, V P; Sydorchuk, R I; Palianytsia, A S

    2013-03-01

    In this paper we analyze the results of diagnosis and treatment of 130 patients with acute surgical diseases of the abdominal cavity, complicated by peritonitis. We proposed the method of estimating the severity of the patients using a coefficient of status severity (C(SS)), developed a scale for prediction of complicated outcomes of acute surgical pathology of the abdominal cavity and abdominal sepsis, which is adapted to the working conditions of local clinics. Using the C(SS) and the scale prediction, allowed timely identification of patients' risk group with possible complicated course, assign adequate treatment, reduce postoperative complications by 5%, relaparotomies by 4.4%, decrease postoperative mortality by 3.9%.

  16. Survival after profound hypocalcaemia with tetany complicating severe haemorrhagic acute pancreatitis.

    Science.gov (United States)

    Jones, P. A.

    1985-01-01

    A patient is reported who developed severe haemorrhagic pancreatitis, without hyperamylasemia, which was complicated by gross hypocalcaemia presenting as tetany. Tetany is very uncommon in acute pancreatitis and is a grave prognostic indicator, recovery being exceptionally rare. The mechanisms responsible for disordered calcium homeostasis associated with acute pancreatitis are reviewed. CT scanning was an important feature of this patient's management and its role in severe pancreatitis is discussed. Images Figure 1 PMID:3991403

  17. Acute Sinusitis Resulting in a Craniotomy: An Uncommon Complication of a Common Infection

    Directory of Open Access Journals (Sweden)

    Allison Price

    2012-01-01

    Full Text Available Acute bacterial sinusitis is a common infectious condition. Patients may initially present with an uncomplicated infection and later, despite appropriate initial antibiotic therapy, develop a potentially life-threatening complication. Interventions aimed at alleviating such unexpected events need be prompt and adequate. We describe a case of a patient who initially presented with signs and symptoms of acute sinusitis later to be diagnosed with a frontal epidural abscess.

  18. Acute Sinusitis Resulting in a Craniotomy: An Uncommon Complication of a Common Infection

    OpenAIRE

    2012-01-01

    Acute bacterial sinusitis is a common infectious condition. Patients may initially present with an uncomplicated infection and later, despite appropriate initial antibiotic therapy, develop a potentially life-threatening complication. Interventions aimed at alleviating such unexpected events need be prompt and adequate. We describe a case of a patient who initially presented with signs and symptoms of acute sinusitis later to be diagnosed with a frontal epidural abscess.

  19. Surgical repair of subacute left ventricular free wall rupture

    NARCIS (Netherlands)

    Zeebregts, CJ; Noyez, L; Hensens, AG; Skotnicki, SH; Lacquet, LK

    1997-01-01

    Background: The natural course of subacute ventricular free wall rupture (FWR) as a complication of acute myocardial infarction (MI) is usually lethal. The aim of this study was to investigate the curability of this entity and to report on five patients successfully treated by rapid diagnosis, hemod

  20. Acute axonal polyneuropathy with predominant proximal involvement: an uncommon neurological complication of bariatric surgery

    OpenAIRE

    2006-01-01

    Bariatric surgery is frequently indicated in the treatment of morbid obesity. Previously unreported complications have been associated to this surgery; among them, neurological complications have gained attention. We report the case of a 25-year-old man submitted to gastric surgery for treatment of morbid obesity who developed, two months after surgery, acute proximal weakness in lower limbs. The electroneuromyography revealed axonal peripheral polyneuropathy with predominant proximal involve...

  1. Severe crush syndrome complicated with acute pancreatitis: a case report and review of the literatures

    Institute of Scientific and Technical Information of China (English)

    LIU Fang; ZHANG Ling; FU Ping; SU Bai-hai; CHEN Xiao-lei; LIU Ling; CHEN Wei-xia; TAO Ye; HUANG Song-min

    2009-01-01

    @@ Earthquake is one of the most catastrophic natural disasters. As we know, crush syndrome is the second most frequent cause of mortality after the direct impact of trauma.~(1-3) It is a serious clinical case that develops among casualties of earthquakes or other catastrophic events that may also result in a variety of ensuing uncommon complications. Cases of crush syndrome complicated with acute pancreatitis (AP) following the earthquakes are seldom reported.

  2. A case of uterine rupture in mid-trimester spontaneous abortion: a complication of gemeprost vaginal administration.

    Science.gov (United States)

    La Torre, R; Bevilacqua, E; D'Ambrosio, V; Pasquali, G; Aliberti, C; Perrone, G; Giancotti, A

    2014-01-01

    The only prostaglandin analogue licensed in Italy for induction of labour in spontaneous and therapeutic abortion is gemeprost. The authors report a case of spontaneous uterine rupture of a scarred uterus, for previous caesarean sections, in a woman at 20 weeks of gestation with a diagnosis of spontaneous abortion. She received a pessary of gemeprost every three hours. After the fifth pessary, she complained of severe pain. At the ultrasound examination, uterine cavity appeared empty and the dead fetus was dislocated in the abdomen. Emergency laparotomy was performed and uterine tear was repaired. To induce labour for fetal demise or therapeutic abortion in second trimester in women with scarred uterus, the authors decided to lengthen the time between administrations of pessary from four to five hours depending on patient's symptoms. However the appropriate drug regimen has still to be found and more data are necessary.

  3. Delayed rupture of flexor tendons in zone V complicated by neuritis 18 years following Galeazzi fracture-dislocation.

    Science.gov (United States)

    Nagy, Mathias Thomas; Ghosh, Sabyasachi; Shah, Bhavik; Sankar, Thangasamy

    2014-04-16

    We report a rare case of an 84-year-old woman who presented with delayed, complete rupture of superficial (flexor digitorum superficialis) and deep flexor tendons (flexor digitorum profundus) of the third, fourth and fifth digits of the right hand in zone V of the flexor tendons. The patient, who was otherwise healthy, active and independent, incurred a closed fracture of her right wrist 18 years ago, which was treated conservatively. Current X-rays and operative findings confirmed a malunited Galeazzi fracture-dislocation with volar dislocation of the ulna from the distal radioulnar joint. She underwent surgical treatment to improve her hand function and agonising neuritis symptoms, as she was unable to use her middle, ring and little fingers and had developed severe neuritis of the ulnar nerve. Exploration and repair of the flexor tendons, nerve decompressions and Darrach procedure were performed. On follow-up, the patient showed improvement in hand function with the neuritis completely resolved.

  4. Acute Pancreatitis Complicated with Diabetic Ketoacidosis in a Young Adult without Hypertriglyceridemia: A Case Report.

    Science.gov (United States)

    Kim, Jung Hyun; Oh, Myung Jin

    2016-11-25

    Systemic complications related to acute pancreatitis include acute respiratory distress syndrome, multiple organ dysfunction syndrome, disseminated intravascular coagulation, hypocalcemia, hyperglycemia, and insulin dependent diabetes or diabetic ketoacidosis. In practice, the development of diabetic ketoacidosis induced by acute pancreatitis is rare and generally associated with hypertriglyceridemia. However, herein we report a case of a 34-year-old female without hypertriglyceridemia, who was diagnosed with acute pancreatitis complicated with diabetic ketoacidosis. The patient was admitted with complaints of febrile sensation, back pain, and abdominal pain around the epigastric area. Levels of serum amylase and lipase were elevated to 663 U/L and 3,232 U/L. Contrast-enhanced abdominal CT showed pancreatic swelling, peri-pancreatic fat infiltration and fluid collection. The patient was initially diagnosed with simple acute pancreatitis. Though the symptoms were rapidly relieved after initiation of treatment, severe hyperglycemia (575 mg/dL), severe metabolic acidosis (pH 6.9), and ketonuria developed at four days after hospitalization. However, serum triglyceride levels remained within the normal range (134 mg/dL). Finally, the patient was diagnosed with acute pancreatitis complicated with diabetic ketoacidosis unrelated to hypertriglyceridemia. She recovered through insulin and fluid therapy, and receives insulin therapy at the outpatient clinic.

  5. Imaging of acute pancreatitis and its complications. Part 1: acute pancreatitis.

    Science.gov (United States)

    Türkvatan, A; Erden, A; Türkoğlu, M A; Seçil, M; Yener, Ö

    2015-02-01

    Acute pancreatitis is an acute inflammatory disease of the pancreas that may also involve surrounding tissues or remote organs. The Atlanta classification of acute pancreatitis was introduced in 1992 and divides patients into mild and severe groups based on clinical and biochemical criteria. Recently, the terminology and classification scheme proposed at the initial Atlanta Symposium have been reviewed and a new consensus statement has been proposed by the Acute Pancreatitis Classification Working Group. Generally, imaging is recommended to confirm the clinical diagnosis, investigate the etiology, and grade the extend and severity of the acute pancreatitis. Ultrasound is the first-line imaging modality in most centers for the confirmation of the diagnosis of acute pancreatitis and the ruling out of other causes of acute abdomen, but it has limitations in the acute clinical setting. Computed tomography not only establishes the diagnosis of acute pancreatitis, but also enables to stage severity of the disease. Magnetic resonance imaging has earned an ever more important role in the diagnosis of acute pancreatitis. It is especially useful for imaging of patients with iodine allergies, characterizing collections and assessment of an abnormal or disconnected pancreatic duct. The purpose of this review article is to present an overview of the acute pancreatitis, clarify confusing terminology, underline the role of ultrasound, computed tomography and magnetic resonance imaging according to the proper clinical context and compare the advantages and limitations of each modality.

  6. Blunt traumatic diaphragmatic rupture

    Directory of Open Access Journals (Sweden)

    Antonio Carlos Nogueira

    2011-09-01

    Full Text Available Traumatic injury of the diaphragm ranges from 0.6 to 1.2% and rise up to 5%among patients who were victims of blunt trauma and underwent laparotomy.Clinical suspicion associated with radiological assessment contributes to earlydiagnosis. Isolated diaphragmatic injury has a good prognosis. Generallyworse outcomes are associated with other trauma injuries. Bilateral andright diaphragmatic lesions have worse prognosis. Multi detector computed tomography (MDCT scan of the chest and abdomen provides better diagnosticaccuracy using the possibility of image multiplanar reconstruction. Surgicalrepair via laparotomy and/ or thoracotomy in the acute phase of the injury hasa better outcome and avoids chronic complications of diaphragmatic hernia.The authors present the case of a young male patient, victim of blunt abdominaltrauma due to motor vehicle accident with rupture of the diaphragm, spleenand kidney injuries. The diagnosis was made by computed tomography of thethorax and abdomen and was confirmed during laparotomy.

  7. Spontaneous Rupture of Pyometra

    Directory of Open Access Journals (Sweden)

    Fatemeh Mallah

    2013-01-01

    Full Text Available Spontaneous perforation is a very rare complication of pyometra. The clinical findings of perforated pyometra are similar to perforation of the gastrointestinal tract and other causes of acute abdomen. In most cases, a correct and definite diagnosis can be made only by laparotomy. We report two cases of diffuse peritonitis caused by spontaneous perforated pyometra. The first case is a 78-year-old woman with abdominal pain for which laparotomy was performed because of suspected incarcerated hernia. The second case is a 61-year-old woman with abdominal pain for which laparotomy was performed because of symptoms of peritonitis. At laparotomy of both cases, 1 liter of pus with the source of uterine was found in the abdominal cavity. The ruptured uterine is also detected. More investigations revealed no malignancy as the reason of the pyometra.

  8. Spontaneous Rupture of Pyometra

    Science.gov (United States)

    Mallah, Fatemeh; Eftekhar, Tahere; Naghavi-Behzad, Mohammad

    2013-01-01

    Spontaneous perforation is a very rare complication of pyometra. The clinical findings of perforated pyometra are similar to perforation of the gastrointestinal tract and other causes of acute abdomen. In most cases, a correct and definite diagnosis can be made only by laparotomy. We report two cases of diffuse peritonitis caused by spontaneous perforated pyometra. The first case is a 78-year-old woman with abdominal pain for which laparotomy was performed because of suspected incarcerated hernia. The second case is a 61-year-old woman with abdominal pain for which laparotomy was performed because of symptoms of peritonitis. At laparotomy of both cases, 1 liter of pus with the source of uterine was found in the abdominal cavity. The ruptured uterine is also detected. More investigations revealed no malignancy as the reason of the pyometra. PMID:24024054

  9. Viral-bacterial interactions and risk of acute otitis media complicating upper respiratory tract infection.

    Science.gov (United States)

    Pettigrew, Melinda M; Gent, Janneane F; Pyles, Richard B; Miller, Aaron L; Nokso-Koivisto, Johanna; Chonmaitree, Tasnee

    2011-11-01

    Acute otitis media (AOM) is a common complication of upper respiratory tract infection whose pathogenesis involves both viruses and bacteria. We examined risks of acute otitis media associated with specific combinations of respiratory viruses and acute otitis media bacterial pathogens. Data were from a prospective study of children ages 6 to 36 months and included viral and bacterial culture and quantitative PCR for respiratory syncytial virus (RSV), human bocavirus, and human metapneumovirus. Repeated-measure logistic regression was used to assess the relationship between specific viruses, bacteria, and the risk of acute otitis media complicating upper respiratory tract infection. In unadjusted analyses of data from 194 children, adenovirus, bocavirus, Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis were significantly associated with AOM (P virus loads (≥3.16 × 10(7) copies/ml) experienced increased acute otitis media risk. Higher viral loads of bocavirus and metapneumovirus were not significantly associated with acute otitis media. In adjusted models controlling for the presence of key viruses, bacteria, and acute otitis media risk factors, acute otitis media risk was independently associated with high RSV viral load with Streptococcus pneumoniae (odds ratio [OR], 4.40; 95% confidence interval [CI], 1.90 and 10.19) and Haemophilus influenzae (OR, 2.04; 95% CI, 1.38 and 3.02). The risk was higher for the presence of bocavirus and H. influenzae together (OR, 3.61; 95% CI, 1.90 and 6.86). Acute otitis media risk differs by the specific viruses and bacteria involved. Acute otitis media prevention efforts should consider methods for reducing infections caused by respiratory syncytial virus, bocavirus, and adenovirus in addition to acute otitis media bacterial pathogens.

  10. Higher rate of compensation after surgical treatment versus conservative treatment for acute Achilles tendon rupture

    DEFF Research Database (Denmark)

    Sveen, Thor-Magnus; Troelsen, Anders; Barfod, Kristoffer Weisskirchner

    2015-01-01

    complications. The aim of this study was to investigate: 1) the socio-economic impact of complications after ATR through the utilisation of the Danish Patient Insurance Association (DPIA) database, 2) correlations between treatment and complications. METHODS: A total of 324 patients with ATR reported...... in the period from 1992 to 2010 in the DPIA database were identified and patient records were reviewed manually. RESULTS: The compensation awarded for the 18-year period totalled 18,147,202 DKK with 41% of patient claims being recognised. Out of 180 surgically treated patients, 79 received a total compensation...

  11. A case report of acute acalculous cholecystitis due to Salmonella Paratyphi B complicated by biliary peritonitis.

    Science.gov (United States)

    Benjelloun, El Bachir; Chbani, Leila; Toughrai, Iman; Ousadden, Abdelmalek; Mazaz, Khalid; Taleb, Kahlid Ait

    2013-01-01

    Non-typhoidal salmonella are a rare case of acute acalculouscholecystitis (AAC). Salmonella Paratyphi B, which accounts for one of the less invasive NTS serotypes, has rarely been reported to cause cholecystitis. We describe a case of 65-year old previously healthy man, who present with signs of acute abdomen, due to biliary peritonitis as a complication of acute acalculouscholecystitis caused by Salmonella paratyphi B. Our case illustrates the potential severity of infection with Salmonella Paratyphi B especially in older patient. High index of awarenessshould be considered in endemic areas.

  12. Emergency adrenalectomy due to acute heart failure secondary to complicated pheochromocytoma: a case report

    Directory of Open Access Journals (Sweden)

    Padillo Francisco J

    2011-05-01

    Full Text Available Abstract Pheochromocytomas are catecholamine producing tumors arising mostly from chromaffin cells of the adrenal medulla. The most common clinical presentation is hypertension, mainly in the form of paroxymal episodes. Cardiovascular manifestations include malignant arrhythmia and catecholamine cardiomyopathy, mimicking acute coronary syndromes and acute heart failure. There are reports of pheochromocytomas presenting as acute coronary syndrome and rapidly leading to cardiogenic shock; the failure of intensive medical treatment in these cases has prompted the need for emergency adrenalectomy as the only remaining option. We report on a case of complicated pheochromocytoma presenting as cardiogenic shock, in which emergency adrenalectomy was performed following a total lack of response to intensive medical treatment.

  13. A Rare Case of Acute Phlegmonous Esophagogastritis Complicated with Hypopharyngeal Abscess and Esophageal Perforation

    Science.gov (United States)

    Huang, Yuan-Chun; Cheng, Ching-Yuan; Liao, Chiung-Ying; Hsueh, Ching; Tyan, Yeu-Sheng; Ho, Shang-Yun

    2017-01-01

    Patient: Female, 60 Final Diagnosis: Acute phlegmonous esophagogastritis complicated with hypopharyngeal abscess • esophageal perforation Symptoms: Fever • painful swallowing • chest pain Medication: — Clinical Procedure: Drainage • debridement • esophageal reconstruction Specialty: Surgery Objective: Rare disease Background: Acute phlegmonous esophagogastritis is a life-threatening disease that may be combined with serious complications. We present the classical radiological and endoscopic features and treatment strategy of a middle-aged female patient suffering from acute phlegmonous esophagogastritis complicated with hypopharyngeal abscess, esophageal perforation, mediastinitis, and empyema. Case Report: A 60-year-old Taiwanese female presented at our hospital due to fever, fatigue, painful swallowing, and vague chest pain for 5 days. She had a past history of uncontrolled type 2 diabetes mellitus. On physical examination, general weakness, chest pain, odynophagia, and a fever up to 38.9°C were found. Positive laboratory findings included leukocytosis (leukocyte count of 14.58×103/μL, neutrophils 76.8%) and serum glucose 348 mg/dL (HbA1c 11.3%). A diagnosis of acute phlegmonous esophagogastritis with hypopharyngeal abscess was made based on typical computed tomography image features and clinical signs of infection. The patient received empirical antibiotic therapy initially; however, esophageal perforation with mediastinitis and empyema developed after admission. Emergency surgery with drainage and debridement was performed and antibiotics were administered. She was discharged in a stable condition on the 56th day of hospitalization. Six months later, a delayed esophageal reconstruction was performed. The patient has performed well for 9 months to date since the initial diagnosis. Conclusions: Acute phlegmonous esophagogastritis complicated with hypopharyngeal abscess and esophageal perforation is extremely rare, and requires immediate medical

  14. Myocardial infarction following recombinant tissue plasminogen activator treatment for acute ischemic stroke: a dangerous complication

    Institute of Scientific and Technical Information of China (English)

    ZHOU Zhi-gang; WANG Rui-lan; YU Kang-long

    2012-01-01

    Thrombolysis with intravenous tissue plasminogen activator (t-PA) is currently an approved therapy for patients with acute ischemic stroke.Acute myocardial infarction (AMI) immediately following t-PA treatment for stroke is a rare but serious complication.A case of acute myocardial infarction (MI) following IV t-PA infusion for acute stroke was observed.This is a 52-year-old male with a known history of hypertension and chest pain,who subsequently developed MI four hours after IV t-PA was administered for acute ischemic stroke.The disruption of intra-cardiac thrombus and subsequent embolization to the coronary arteries may be an important mechanism.In addition.spontaneous recanalization of infarct-related arteries may be associated with 9reater myocardial salvage and better prognosis.

  15. [Prognostication of malignization and acute complications of gastric ulcer disease, using multiparametric neuronet clasterization].

    Science.gov (United States)

    Dzyubanovskiy, I Ya; Selskiy, P R; Viytovych, L E

    2015-03-01

    Results of examination of 20 gastric ulcer disease patients were analyzed for delineation of a high risk group for an acute complications occurrence, and in whom the conduction of organ preserving preventive operative interventions is expedient. For prognostication such following indices were applied: quantity of cells-producents of various immunoglobulins, mitotic and apoptotic indices, relative volume of damaged epitheliocytes, the patients' age.

  16. Acute Appendicitis as Complication of Colon Transit Time Study; A Case Report.

    Science.gov (United States)

    Ghahramani, Leila; Roshanravan, Reza; Khodaei, Shahin; Rahimi Kazerooni, Salar; Moslemi, Sam

    2015-07-01

    Colon transit time study with radio opaque markers is a simple method for assessment of colon motility disorder in patients with chronic idiopathic constipation. We report a case of acute appendicitis that was induced by impaction of radio opaque markers after colon transit time study. We think that this case report is first significant complication of colon transit time study until now.

  17. Contemporary Review of Risk-Stratified Management in Acute Uncomplicated and Complicated Diverticulitis.

    Science.gov (United States)

    Boermeester, Marja A; Humes, David J; Velmahos, George C; Søreide, Kjetil

    2016-10-01

    Acute colonic diverticulitis is a common clinical condition. Severity of the disease is based on clinical, laboratory, and radiological investigations and dictates the need for medical or surgical intervention. Recent clinical trials have improved the understanding of the natural history of the disease resulting in new approaches to and better evidence for the management of acute diverticulitis. We searched the Cochrane Library (years 2004-2015), MEDLINE (years 2004-2015), and EMBASE (years 2004-2015) databases. We used the search terms "diverticulitis, colonic" or "acute diverticulitis" or "divertic*" in combination with the terms "management," "antibiotics," "non-operative," or "surgery." Registers for clinical trials (such as the WHO registry and the https://clinicaltrials.gov/ ) were searched for ongoing, recruiting, or closed trials not yet published. Antibiotic treatment can be avoided in simple, non-complicated diverticulitis and outpatient management is safe. The management of complicated disease, ranging from a localized abscess to perforation with diffuse peritonitis, has changed towards either percutaneous or minimally invasive approaches in selected cases. The role of laparoscopic lavage without resection in perforated non-fecal diverticulitis is still debated; however, recent evidence from two randomised controlled trials has found a higher re-intervention in this group of patients. A shift in management has occurred towards conservative management in acute uncomplicated disease. Those with uncomplicated acute diverticulitis may be treated without antibiotics. For complicated diverticulitis with purulent peritonitis, the use of peritoneal lavage appears to be non-superior to resection.

  18. Acute angle closure glaucoma secondary to polypoidal choroidal vasculopathy – a devastating complication

    Directory of Open Access Journals (Sweden)

    Baskaran, Prabu

    2017-01-01

    Full Text Available Acute angle closure glaucoma (ACG in the setting of polypoidal choroidal vasculopathy (PCV is a catastrophic complication that has been documented infrequently in literature. Ours is the second only report that describes hemorrhagic choroidal detachment as an event leading to acute angle closure glaucoma in PCV patients and the first one to describe the use of diode cyclophotocoagulation (CPC for this condition. The purpose of this article is to familiarize readers with this entity that has an extremely dismal visual prognosis. Ours is a descriptive case report of two patients with PCV complicated by sudden onset hemorrhagic choroidal detachment (CD and acute ACG. Both patients had severe pain with no perception of light at presentation with an acute angle closure attack. Both underwent diode CPC for pain relief and control of intraocular pressure (IOP. Both our patients did not regain any vision, but their pain was relieved by diode CPC. Both eyes eventually became phthisical. Acute ACG following massive hemorrhagic CD is a rare but grave complication of PCV, not amenable to treatment. Diode CPC is an effective palliative modality of management to achieve pain relief in such cases.

  19. Could an abdominal drainage be avoided in complicated acute appendicitis? Lessons learned after 1300 laparoscopic appendectomies.

    Science.gov (United States)

    Schlottmann, Francisco; Reino, Romina; Sadava, Emmanuel E; Campos Arbulú, Ana; Rotholtz, Nicolás A

    2016-12-01

    Complicated appendicitis (CA) may be a risk factor for postoperative intra-abdominal abscess formation (IAA). In addition, several publications have shown an increased risk of postoperative collection after laparoscopic appendectomy. Most surgeons prefer to place a drain to collect contaminated abdominal fluid to prevent consequent abscess formation. We aimed to evaluate the utility of placing an intra-abdominal drain in laparoscopic appendectomy for complicated acute appendicitis. From January 2005 to June 2015 all charts of consecutive patients who underwent laparoscopic appendectomy for CA were revised. CA was defined as a perforated appendix with associated peritonitis. The sample was divided into two groups, G1: intra-abdominal drain and G2: no drain. Demographics, operative factors and 30-day postoperative complications were analyzed. In the study period 1300 laparoscopic appendectomies were performed. Laparoscopic findings showed that 17.3% of the surgeries were for complicated acute appendicitis (225 patients). Fifty-six patients (25%) were in G1 and 169 patients (75%) in G2. No significant differences in clinical presentation and demographics were found (p: NS). G1 had an increased conversion rate (G1: 19.6% vs. G2: 7.1%; p: 0.007). No differences were found in the overall morbidity (G1: 32.1% vs. G2: 21.3%, p: NS). The rate of postoperative IAA was 14.2% in G1 and 8.9% in G2 (p: NS). Length of stay was higher in G1 (G1: 5.2 days vs. G2 2.9 days, p: 0.001). There was no mortality in either group. The placement of intra-abdominal drain in complicated acute appendicitis may not present benefits and may even lengthen hospital stay. These observations suggest that there is no need of using a drain in laparoscopic appendectomy for complicated acute appendicitis. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  20. Pheochromocytoma presenting as an acute coronary syndrome complicated by acute heart failure: The challenge of a great mimic

    Directory of Open Access Journals (Sweden)

    Giuseppe Damiano Sanna

    2016-10-01

    Full Text Available Pheochromocytoma is a rare neuroendocrine tumor with a highly variable clinical presentation. The serious and potentially lethal cardiovascular complications of these tumors are related to the effects of secreted catecholamines. We describe a case of a 50-year-old woman urgently admitted to our hospital because of symptoms and clinical and instrumental findings consistent with an acute coronary syndrome complicated by acute heart failure. Urgent coronary angiography showed normal coronary arteries. During her hospital stay, the recurrence of episodes characterized by a sudden increase in blood pressure, cold sweating, and nausea allowed us to hypothesize a pheochromocytoma. The diagnosis was confirmed by elevated levels of urinary catecholamines and by the finding of a left adrenal mass on magnetic resonance imaging. The patient underwent left adrenalectomy. Therefore, the initial diagnosis was critically reappraised and reviewed as a cardiac manifestation of a pheochromocytoma during catecholaminergic crisis.

  1. Spontaneous rupture of pyometra manifesting as an acute abdomen: a case report.

    Science.gov (United States)

    Singh, Alpana; Mundhra, Rajlaxmi; Agarwal, Tannavi; Radhakrishnan, Gita

    2015-07-01

    Spontaneous perforation of pyometra is a rare entity with a reported incidence in the range of 0.01-0.05%. The clinical picture is similar to peritonitis arising from intestinal perforation and commonly the correct diagnosis is only made perioperatively. We report a case in an elderly postmenopausal woman presenting with an acute abdomen.

  2. Acute Page kidney following renal allograft biopsy: a complication requiring early recognition and treatment.

    Science.gov (United States)

    Chung, J; Caumartin, Y; Warren, J; Luke, P P W

    2008-06-01

    The acute Page kidney phenomenon occurs as a consequence of external compression of the renal parenchyma leading to renal ischemia and hypertension. Between January 2000 and September 2007, 550 kidney transplants and 518 ultrasound-guided kidney biopsies were performed. During that time, four recipients developed acute oligo-anuria following ultrasound-guided allograft biopsy. Emergent doppler-ultrasounds were performed demonstrating absence of diastolic flow as well as a sub-capsular hematoma of the kidney. Prompt surgical exploration with allograft capsulotomy was performed in all cases. Immediately after capsulotomy, intraoperative Doppler study demonstrated robust return of diastolic flow. Three patients maintained good graft function, and one kidney was lost due to acute antibody-mediated rejection. We conclude that postbiopsy anuria associated with a subcapsular hematoma and acute absence of diastolic flow on doppler ultrasound should be considered pathognomonic of APK. All renal transplant specialists should be able to recognize this complication, because immediate surgical decompression can salvage the allograft.

  3. [Cerebral artery infarction presented as an unusual complication of acute middle otitis].

    Science.gov (United States)

    Moscote-Salazar, Luis Rafael; Alcalá-Cerra, Gabriel; Castellar-Leones, Sandra Milena; Gutiérrez-Paternina, Juan José

    2013-01-01

    acute otitis media is a frequent disease in the pediatric age. About 2 % of all cases develop intracranial complications such as meningitis. The cerebral infarction originates meningitis and usually occurs in the venous system. The presence of a cerebral artery infarction secondary to acute otitis media is a rare cause described in the literature. a girl of 12 months who presented a febrile syndrome due to acute otitis media and mental confusion. On physical examination, she appeared sleepy with anisocoria, mydriasis in the right eye and left hemiparesis. The computed tomography examination showed extensive cerebral artery infarction. The patient's parents refused the proposed surgical treatment and the girl died 48 hours later. regardless of the current technological advances, the clinical prognosis of cerebral infarction associated with acute otitis media is bad. The focused neurological signs and progressive clinical deterioration should raise suspicion that antimicrobial therapy is not effective.

  4. Acute and old ruptures of the extensor apparatus of the knee in adults (excluding knee replacement).

    Science.gov (United States)

    Saragaglia, D; Pison, A; Rubens-Duval, B

    2013-02-01

    Rupture of the extensor apparatus of the knee in adults is infrequent and dominated by patellar fracture, which in our experience is six times as frequent as quadriceps or patellar tendon tear. Patellar fracture poses few diagnostic problems and treatment is now well codified. Tension-band osteosynthesis is generally used, involving two longitudinal K-wires and wire in a figure-of-eight pattern looped over the anterior patella; sometimes, for more complex fractures, cerclage wiring is added to the tension band. Non-union is rare and generally well tolerated. Quadriceps tendon tear mainly affects patients over 40 years of age, in a context of systemic disease. Diagnosis is easily suggested by inability to actively extend the knee, but is unfortunately still often overlooked in emergency. In most cases, early surgical management is needed to reinsert the tendon at the proximal pole of the patella by bone suture. For chronic lesions, it is often necessary to lengthen the quadriceps tendon by V-Y plasty or the Codivilla technique. Patellar tendon tear, on the other hand, typically occurs in patients under 40 years of age, often involved in sports. Diagnosis is again clinically straightforward, but again may be missed in emergency, especially in case of incomplete tear. Surgery is mandatory in all cases. The procedure depends on the type of lesion: either end-to-end suture or transosseous reinsertion. In most cases repair is protected by tendon augmentation. Old lesions often require tendon graft or a tendon-bone-tendon-bone graft taken from the opposite side.

  5. Complications of flow-directed balloon-tipped catheters.

    Science.gov (United States)

    Smart, F W; Husserl, F E

    1990-01-01

    Acute or short-term complications following the use of flow-directed balloon-tipped catheters are well recognized. Long-term sequelae are rarely reported. We report herein an early complication of pulmonary arterial rupture with infarction followed by the delayed development of a pulmonary arterial aneurysm.

  6. Septic thrombophlebitis of the porto-mesenteric veins as a complication of acute appendicitis

    Institute of Scientific and Technical Information of China (English)

    Yeon Soo Chang; Sun Young Min; Sun Hyung Joo; Suk-Hwan Lee

    2008-01-01

    Pylephlebitis, a rare complication of acute appendicitis,is defined as thrombophlebitis of the portal venous system. Pylephlebitis usually occurs due to secondary infection in the region drained into the portal system.We report a case of pylephlebitis caused by acute appendicitis. The patient was transferred from a private clinic 1 wk after appendectomy with the chief complaints of high fever and abdominal pain. He was diagnosed with pylephlebitis of the portal vein and superior mesenteric vein by CT-scan. The patient was treated with antibiotics and anticoagulation therapy,and discharged on the 25th day and follow-up CT scan showed a cavernous transformation of portal thrombosis.

  7. A case of acute acalculous cholecystitis complicated by primary Epstein-Barr virus infection.

    Science.gov (United States)

    Suga, Kenichi; Shono, Miki; Goji, Aya; Matsuura, Sato; Inoue, Miki; Kawahito, Masami; Mori, Kazuhiro

    2014-01-01

    Acute acalculous cholecystitis (AAC) is a rare complication of infectious mononucleosis (IM). An immunocompetent 6-year-old Japanese girl complained of epigastralgia during the course of IM. Ultrasonography (US) revealed a markedly thickened and sonolucent gallbladder wall. No gallstones were apparent. Antibodies against Epstein-Barr virus (EBV) confirmed primary EBV infection. Cytomegalovirus immunoglobulin M showed a false-positive result in the acute phase, probably due to cross-reaction to EBV nuclear antigen. We diagnosed her as AAC related with primary EBV infection. She recovered completely by conservative treatment. US should be performed in consideration of the possibility of AAC when a patient with IM complains of epigastralgia.

  8. Hereditary angioedema type 2 presented as an orbital complication of acute rhinosinusitis.

    Science.gov (United States)

    Somuk, Battal Tahsin; Göktas, Göksel; Özer, Samet; Sapmaz, Emrah; Bas, Yalcın

    2016-03-01

    Hereditary angioedema is an autosomal dominant and life-threatening disorder characterized by recurrent episodes of non-pitting edema affecting the skin, respiratory system and digestive tracts and caused by a congenital deficiency or function defect of the C1 esterase inhibitor. Preseptal cellulitis is defined as an infection of the tissues of the anterior orbital septum. It is generally caused by complications from an upper respiratory tract infection, dacryocystitis, dermal infection, and, rarely, sinusitis. The disease presents with orbital pain, edema on the eyelids, erythema, and fever. In this case, a child with hereditary angioedema type 2 who presented as mimicking a complication of acute sinusitis is discussed.

  9. [Acute renal failure as a complication of transarterial chemoembolization in a patient with hepatocellular carcinoma].

    Science.gov (United States)

    La Spada, Emanuele; La Spada, Monica; Brusca, Tiziana; Campagna, M Elisa; Di Gesaro, Valeria; Terranova, Angela; Sandonato, Luigi; Soresi, Maurizio

    2007-04-01

    Transarterial chemoembolization (TACE) is included among the wide therapeutic tools for the treatment of hepatocellular carcinoma (HCC), tumour with high frequency and malignancy. The approach is invasive and, beyond the discomfort for the patient, it is charged by a number of side effects and complications. In this study we report the case of renal acute failure of hypovolemic origin, as a consequence of a TACE in a patient suffering from HCC, occurred after one week of intervention. The different possible mechanisms involved in the pathogenesis of this complication are discussed.

  10. Review: Study progress on mechanism of severe acute pancreatitis complicated with hepatic injury

    Institute of Scientific and Technical Information of China (English)

    ZHANG Xi-ping; WANG Lei; ZHANG Jie

    2007-01-01

    Study on the action mechanism of inflammatory mediators generated by the severe acute pancreatitis (SAP) in multiple organ injury is a hotspot in the surgical field. In clinical practice, the main complicated organ dysfunctions are shock, respiratory failure, renal failure, encephalopathy, with the rate of hepatic diseases being closely next to them. The hepatic injury caused by SAP cannot only aggravate the state of pancreatitis, but also develop into hepatic failure and cause patient death. Its complicated pathogenic mechanism is an obstacle in clinical treatment. Among many pathogenic factors, the changes ofvasoactive substances, participation of inflammatory mediators as well as OFR (oxygen free radical), endotoxin, etc. may play important roles in its progression.

  11. Acute Pancreatitis with Splenic Infarction as Early Postoperative Complication following Laparoscopic Sleeve Gastrectomy

    Directory of Open Access Journals (Sweden)

    Aleksandr Kalabin

    2017-01-01

    Full Text Available Obesity is becoming a global health burden along with its comorbidities. It imposes tremendous financial burden and health costs worldwide. Surgery has emerged as the definitive treatment option for morbidly obese patients with comorbidities. Laparoscopic sleeve gastrectomy is performed now more than ever making it imperative for physicians and surgeons to recognize both the common and the uncommon risks and complications associated with it. In this report we describe a rare early life-threatening postoperative complication following laparoscopic sleeve gastrectomy. From our extensive review of literature, there is no existing report of acute pancreatitis with splenic infarction postsleeve gastrectomy to this date.

  12. [Aorto-caval fistula as a results of abdominal aortic aneurysm rupture imitating acute renal insufficiency].

    Science.gov (United States)

    Zaniewski, Maciej; Ludyga, Tomasz; Kazibudzki, Marek; Kowalewska-Twardela, Teresa

    2002-01-01

    Aorto-caval fistula (ACF) is a rare complication of abdominal aortic aneurysm. It occurs in 1-6% of cases. The classic diagnostic signs of an ACF (pulsatile abdominal mass with bruit and right ventricular failure) are present only in a half of the patients. The most common diagnostic imaging procedures like ultrasound and computed tomography often are not sufficient enough. This leads to the delay in diagnosis, which has a great impact on the results of operation. We report a case of a patient, who was treated before admission to the Clinic because of azotemia and oliguria suggesting renal failure.

  13. Asymptomatic superior mesenteric vein thrombosis as unusual complication of acute cytomegalovirus infection: a case report

    Directory of Open Access Journals (Sweden)

    Michele Bertoni

    2015-10-01

    Full Text Available We describe a 39-year-old male who presented with a fever of unknown origin, the diagnostic work-up of which disclosed an acute cytomegalovirus (CMV infection complicated by a partial superior mesenteric vein (SMV thrombosis. Further investigations revealed the presence of factor V Leiden mutation. Oral anticoagulant treatment with warfarin led to a complete recanalization of SMV two months after. A literature review on the association between CMV infection and portal system (PS thrombosis in immunocompetent patients was performed. We found that, in agreement with our case, in a minority of case reports patients did not complain of abdominal pain, but presented with a mononucleosis-like syndrome with malaise and prolonged fever and displayed a variable elevation of aminotransferase levels. Interestingly, most of them exhibited a limited extension of portal thrombosis. On the whole, these data suggest that PS thrombosis during acute CMV infection may be an underestimated complication.

  14. Non-Complicated Acute Appendicitis in Adults Treated Successfully by Conservative Treatment without Recurrences.

    Science.gov (United States)

    Charalampopoulos, Anestis; Dimopoulos, Ioannis; Koliakos, Nikolaos; Kopanakis, Konstantinos; And, Theodoros Liakakos

    2017-01-01

    Backround: Surgical treatment of appendicitis remains the standard treatment, but many cases respond conservatively. Our purpose was the clarification of the clinical, laboratory and imaging characteristics of uncomplicated cases undergoing successful conservative treatment without recurrence. Methods: 105 adult patients (66 female, 39 male) with non-complicated acute appendicitis. Symptom duration, clinical abdominal examination, body temperature, inflammatory markers, imaging studies results and in-hospital treatment were recorded. No patient had a previous episode of appendicitis. Results: Duration of symptoms was 2 hours-3 days. Abdominal examination was compatible with appendicitis and findings were localized in the lower right quadrat. The majority (85.7%) had no or low fever ( 37.4 C). All had leukocytosis (range: 10.000-22.900 WBC/L, mean 14.370'+-2.900 WBC/L), 3 patients 20.000 WBC/L. All had CRP 3.36 mg/L (mean 46.8'+-40.5 mg/L), and 3 150 mg/L. U/S was performed on 95 patients (combined with transvaginal U/S in 19 females) with positive findings of acute appendicitis in 91 (91/95, 95.7%). When faced with inconclusive findings, CT was performed (13 patients) and MRI on one pregnant. In-hospital conservative treatment lasted 1-10 days, overstay was 1-2 days following clinic-laboratory regression. Outpatient, antibiotic treatment followed discharge in 27 patients. Conclusions: Young patients with non-complicated acute appendicitis and short symptom duration, without rare etiologic pathologies, are candidates for conservative treatment. Diagnosis of non-complicated acute appendicitis is based on combining clinical signs, positive inflammatory markers and imaging studies, excluding complicated cases, generalized peritonitis and sepsis. The inflammation seems self-limited, while the role of anti-inflammatory drugs remains obscure. AA = Acute Appendicitis, un-AA = Uncomplicated AA, cAA = Complicated Acute Appendicitis, WBC = White Blood Cells, CRP = C

  15. Cardiac CT and MRI guide surgery in impending left ventricular rupture after acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Shah Ashish S

    2009-08-01

    Full Text Available Abstract We report the case of a 67 year-old patient who presented with worsening chest pain and shortness of breath, four days post acute myocardial infarction. Contrast enhanced computed tomography of the chest ruled out a pulmonary embolus but revealed an unexpected small subepicardial aneurysm (SEA in the lateral left ventricular wall which was confirmed on cardiac magnetic resonance imaging. Intraoperative palpation of the left lateral wall was guided by the cardiac MRI and CT findings and confirmed the presence of focally thinned and weakened myocardium, covered by epicardial fat. An aneurysmorrhaphy was subsequently performed in addition to coronary bypass surgery and a mitral valve repair. The patient was discharged home on post operative day eight in good condition and is feeling well 2 years after surgery.

  16. Acute mechanical circulatory support for fulminant myocarditis complicated by cardiogenic shock.

    Science.gov (United States)

    Mody, Kanika P; Takayama, Hiroo; Landes, Elissa; Yuzefpolskaya, Melana; Colombo, Paolo C; Naka, Yoshifumi; Jorde, Ulrich P; Uriel, Nir

    2014-03-01

    In fulminant myocarditis complicated by cardiogenic shock, early mechanical circulatory support (MCS) may prevent cardiomyopathy and death. We sought to examine the outcomes of patients with fulminant myocarditis supported with MCS. A retrospective review of patients with acute cardiogenic shock treated with MCS from 2007 to 2013 was conducted, and patients with a diagnosis of fulminant myocarditis were included in this series. At our center, 260 patients received MCS for acute cardiogenic shock, and 11 were implanted for fulminant myocarditis. Eight received the Centrimag biventricular assist device (BIVAD), and three received veno-arterial extracorporeal membrane oxygenator (VA ECMO), though 1 VA ECMO-supported patient was transitioned to BIVAD due to refractory shock. The mean acute support time was 14.7 ± 4.4 days. Two patients required long-term left ventricular assist devices and were further supported for 55 and 112 days. Eight patients recovered with a mean ejection fraction of 54 ± 7 %, and one was successfully transplanted. Eight patients survived to discharge (73 %) with mean follow-up: 292.6 ± 306.8 days. All three deaths were due to neurologic complications. MCS should be considered in patients with fulminant myocarditis complicated by shock. With aggressive medical therapy, early utilization of MCS carries promising outcomes.

  17. Leptospirosis presenting as ascending progressive leg weakness and complicating with acute pancreatitis

    Directory of Open Access Journals (Sweden)

    Andre Pacheco Silva

    Full Text Available Leptospirosis is a spirochetal bacterial infection of great public health importance. It has a broad spectrum of clinical manifestations which goes from subclinical infection and self-limited anicteric febrile illness (80-90% of all cases to icteric leptospiropirosis known as Weil's disease. This is a severe disease characterized by hemorrhage, acute renal failure and jaundice. It is uncommon for leptospirosis to present itself as a primary neurological disease. Additionally, acute pancreatitis is an unusual gastrointestinal manifestation. We report a case of leptospirosis presenting as ascending progressive leg weakness and complicating with acute pancreatitis in an adult patient treated at Hospital Universitário, Universidade Federal de Santa Catarina. The diagnosis was confirmed through ELISA-IgM antibody testing positive for leptospirosis. After antibiotic therapy and support treatment for a few weeks, total resolution of severe manifestations was achieved. Rare and unusual presentations of leptospirosis should be kept in mind in relevant epidemiological scenario.

  18. Soluble Endothelial Selectin in Acute Lung Injury Complicated by Severe Pneumonia

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    Daisuke Osaka, Yoko Shibata, Kazunori Kanouchi, Michiko Nishiwaki, Tomomi Kimura, Hiroyuki Kishi, Shuichi Abe, Sumito Inoue, Yoshikane Tokairin, Akira Igarashi, Keiko Yamauchi, Yasuko Aida, Takako Nemoto, Keiko Nunomiya, Koji Fukuzaki, Isao Kubota

    2011-01-01

    Full Text Available Background: Pneumonia is still one of the most frequent causes of death in the elderly. Complication of acute lung injury (ALI/acute respiratory distress syndrome (ARDS by pneumonia makes patients very ill due to severe respiratory failure. Biomarkers that can discriminate the presence of complicating ALI/ARDS are required for early detection. The aim of this research was to investigate whether soluble endothelial selectin (sES could be a biomarker for ALI.Methods: Serum sES levels were measured in 27 pneumonia patients, who were enrolled between April 2006 and September 2007. Among these patients, six had ALI or a condition that was clinically comparable to ALI (cALI. All patients who were enrolled were successfully treated and survived.Results: Circulating sES levels were elevated in pneumonia patients with ALI/cALI, and sES levels decreased following treatment of their pneumonia. Univariate and multivariate logistic regression analyses showed that sES was the only significant factor for identifying complicating ALI/cALI, independently of C-reactive protein (CRP and lactate dehydrogenase (LDH. By receiver operating characteristic (ROC curve analysis, the cut-off value for sES was 40.1 ng/mL, with a sensitivity of 0.8 and a specificity of 0.8.Conclusion: sES may be a useful biomarker for discriminating complicating ALI/cALI in patients with severe pneumonia.

  19. Current Concepts and New Trends in the Treatment of Cardiogenic Shock Complicating Acute Myocardial Infarction

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    Benedek Theodora

    2015-03-01

    Full Text Available Cardiogenic shock (CS is a critical condition which often complicates the evolution of an acute myocardial infarction (AMI. At the same time, co-existence of chronic multi-vessel disease can lead to the development of cardiogenic shock in cases with pronounced haemodynamic instability. Different clinical studies have tried to identify the most appropriate treatment for critical cases of CS complicating AMI. This review aims to present the current status of recommended therapeutic strategies for severe cases of CS presenting as a complication of AMI, and try to shed light on the most appropriate therapeutic strategy as outlined in the current literature. The paper will discuss the different current strategies available for use in the treatment of this condition, includig interventional revascularisation, (complete or culprit, the role of new devices for providing mechanical circulatory support, and the potential role of new drug therapies and of hypothermia.

  20. Spontaneous rupture of the liver in a patient with chronic hepatitis B and D

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    Liu, Ching-Jung; Chien, Rong-Nan; Yen, Cho-li; Chang, Jia-Jang

    2007-01-01

    Spontaneous rupture of the liver is a rare condition with serious consequences, if not recognized and treated in time. It has been reported as a complication of several disorders, including benign or malignant liver tumors, connective tissue disease, infiltrating liver disease, preeclampsia, and post anticoagulant therapy. We report a case of spontaneous rupture of liver in a non-cirrhotic, chronic hepatitis B and D patient presenting with acute hemoperitoneum and shock. The subcapsular hemat...

  1. Combined blood purification for treating acute fatty liver of pregnancy complicated by acute kidney injury: a case series.

    Science.gov (United States)

    Tang, Wan Xin; Huang, Zhong Ying; Chen, Ze Jun; Cui, Tian Lei; Zhang, Ling; Fu, Ping

    2012-06-01

    Acute fatty liver of pregnancy (AFLP) complicated by acute kidney injury (AKI) is serious and life-threatening for the mother. The present study aimed to determine the clinical efficacy of combined blood purification treatment (CBPT) in patients with AFLP complicated by AKI. The CBPT involves plasma exchange (PE) combined with continuous venovenous hemofiltration (CVVH). The subjects were 17 patients with AFLP complicated by AKI. The CBPT was implemented based on the timely termination of pregnancy and general treatment. Changes in clinical manifestations, laboratory tests, liver ultrasounds, as well as Sequential Organ Failure Assessment (SOFA) and Glasgow scores were evaluated. The efficacy and adverse reactions of the CBPT were also assessed. The CBPT was smoothly performed without any obvious adverse reaction. After treatment, the clinical manifestations, laboratory examinations, and liver ultrasonography significantly improved. Therefore, the SOFA scores correspondingly decreased 1 week after treatment [9 (range 5-11) vs. 3 (range 0-10), P = 0.002], and the median was close to normal by the second week. The clearance rate of the total bilirubin in PE was significantly higher than that in CVVH (37.2 vs. 7.9%, P = 0.000). The incidence of acute pulmonary edema in CVVH was less than that in PE (0 vs. 41.2%, P = 0.007). Finally, the maternal mortality was 5.88% (95% CI: 0-29%). Overall, we think that CBPT aids in the recovery of liver and kidney function. Different blood purification methods may be combined to integrate and maximize their advantages to improve the prognoses of patients with serious AFLP.

  2. CT in nontraumatic acute thoracic aortic disease: typical and atypical features and complications.

    Science.gov (United States)

    Castañer, Eva; Andreu, Marta; Gallardo, Xavier; Mata, Josep Maria; Cabezuelo, María Angeles; Pallardó, Yolanda

    2003-10-01

    Thoracic aortic dissection is the most frequent cause of aortic emergency, and unless it is rapidly diagnosed and treated, the result is death. Helical computed tomography (CT) permits the diagnosis of acute aortic dissection with a sensitivity and specificity of nearly 100%. This imaging modality also enables differentiation between proximal aortic dissection (type A in the Stanford classification) and distal aortic dissection (Stanford type B), which are treated differently and have different prognoses. In 70% of patients in whom nontraumatic acute thoracic aortic dissection is diagnosed after evaluation with helical CT, scans show the typical signs of aortic dissection, with rupture and displacement of the intima. CT also can depict other pathologic entities with similar clinical manifestations, such as intramural hematoma and penetrating atherosclerotic ulcer. Awareness of the different radiologic appearances of these disease entities is essential for differential diagnosis. More than one-third of patients with aortic dissection show signs and symptoms indicative of systemic involvement. Because branch-vessel involvement may increase morbidity and mortality, in this group of patients it is important to evaluate the entire aorta so as to determine the distal extent of the dissection and detect any systemic involvement.

  3. [Exceptional iatrogenic ureteral rupture].

    Science.gov (United States)

    Martínez-Vieira, Almudena; Valera-Sánchez, Zoraida; Sousa-Vaquero, José María; Palacios-González, Carmen; García-Poley, Antonio; Bernal-Bellido, Carmen; Alamo-Martínez, José María; Millán-López, Ana; Blanco-Domínguez, Manuel; Galindo-Galindo, Antonio

    2005-08-01

    Rupture of the ureter is an infrequent event that can have serious consequences. The most frequent cause is surgical iatrogenic ureter disease. Other possible causes are urological procedures and urographic studies. In our patient, which, to our knowledge, is the first to be reported in the literature, the ureteral rupture was produced by a traumatic urinary catheterism, because the balloon was filled inside the ureter. The normal presentation is nephritic colic, although acute abdomen is also a possibility. The possibility of ureteral rupture in abdominopelvic surgery or in urological techniques should be evaluated when patients present these clinical symptoms. Treatment is surgical, although in some cases conservative measures can be used.

  4. Percutaneous treatment of acute closed Achil es tendon ruptures with the rivet with thread%带线铆钉经皮微创治疗跟腱断裂25例

    Institute of Scientific and Technical Information of China (English)

    王昆; 丁亮华; 何双华

    2014-01-01

    Objective To investigate the clinical effects of the percutaneous treatment of acute closed Achil es tendon ruptures with the rivet with thread. Method The data of twenty-five patients of the acute closed Achil es tendon ruptures receiving percutaneous treatment with the rivet with thread were reviewed, including the healing of skin incision, improvement of heal pain, re-ruptures after operations. The plantar flexion angle was compared before and after operation. Arner Lindholm system was used to evaluate the functional recovery of the sick ankle joint. Results The process of the operation was smooth going without the injury of major vessel and nerve . Al patients were fol owed up. According to Arner Lindholm system the treatment outcome was excellent in twenty-one cases and good in three., with excellence rate of 100%. Conclusions The clinical effects were valid because of its lesser incidence rate of complication such as re-ruptures, lesser invasive treatment,convenient for clinical application.%目的:探讨采用经皮带线铆钉治疗急性闭合性跟腱断裂的临床疗效。方法25例急性闭合性跟腱断裂病例,采用经皮带线铆钉治疗,术后随访伤口愈合、足跟疼痛、跟腱再断裂及患侧踝关节功能恢复情况,采用Arner Lindholm疗效评定标准评估手术前后踝关节功能。结果手术顺利,术中未发生重要血管、神经等组织结构的损伤,所有患者均得到随访,按Arner Lindholm评分标准,本组优21例,良4例,优良率100%。结论经皮带线铆钉治疗急性闭合性跟腱断裂效果良好,可降低跟腱再断裂等并发症的发生率,是治疗急性闭合性跟腱断裂的理想方法。

  5. Primary percutaneous coronary intervention ameliorates complete atrioventricular block complicating acute inferior myocardial infarction

    Directory of Open Access Journals (Sweden)

    Lee SN

    2014-11-01

    Full Text Available Su Nam Lee, You-Mi Hwang, Gee-Hee Kim, Ji-Hoon Kim, Ki-Dong Yoo, Chul-Min Kim, Keon-Woong MoonDepartment of Internal Medicine, St Vincent’s Hospital, The Catholic University of Korea, Suwon, South KoreaObjective: Complete atrioventricular block (CAVB in acute inferior ST-segment elevation myocardial infarction (STEMI is associated with poor clinical outcomes after noninvasive treatment. This study was designed to determine the effect of primary percutaneous coronary intervention (PCI in patients with CAVB complicating acute inferior STEMI, at a single center.Methods: We enrolled 138 consecutive patients diagnosed with STEMI involving the inferior wall; of these, 27 patients had CAVB. All patients received primary PCI. The clinical characteristics, procedural data, and clinical outcomes were compared in patients with versus without CAVB. Results: Baseline clinical characteristics were similar between patients with and without CAVB. Patients with CAVB were more likely to present with cardiogenic shock, and CAVB was caused primarily by right coronary artery occlusion. Door-to-balloon time was similar between those two groups. After primary PCI, CAVB was reversed in all patients. The peak creatinine phosphokinase level, left ventricular ejection fraction and in-hospital mortality rate were similar between the two groups. After a median follow up of 318 days, major adverse cardiac events did not differ between the groups (8.1% in patients without CAVB; 11.1% in patients with CAVB (P=0.702.Conclusion: We conclude that primary PCI can ameliorate CAVB-complicated acute inferior STEMI, with an acceptable rate of major adverse cardiac events, and suggest that primary PCI should be the preferred reperfusion therapy in patients with CAVB complicating acute inferior myocardial infarction. Keywords: major adverse cardiac events, PCI-capable hospital

  6. Orbital complications of acute sinusitis: changes in the post-pneumococcal vaccine era.

    Science.gov (United States)

    Peña, Maria T; Preciado, Diego; Orestes, Michael; Choi, Sukgi

    2013-03-01

    The widespread use of the 7-valent pneumococcal conjugate vaccine (PVC7), developed to combat invasive Streptococcus pneumoniae infections, has the potential to influence the prevalence and antibiotic resistance patterns of pathogens associated with orbital complications from acute sinusitis. Given the significant morbidity that may result from inadequate treatment of orbital infections related to acute sinusitis, determining the impact of PCV7 on the bacteriology and drug resistance of the pathogens associated with these infections may provide critical information needed to accurately guide optimal clinical management. To determine if the characteristics of orbital complications from acute sinusitis in children have changed in the post-PCV7 era. Review of clinical data. Tertiary care children's hospital. Patients with a diagnosis of orbital cellulitis and/or subperiosteal abscess from January 1, 1996, to December 31, 2009. Patients with immune deficiency or orbital trauma were excluded. Patients were divided into pre-PCV7 (before 2003 [n = 128]) and post-PCV7 (2003 and after [n = 145]) groups. Statistical analyses were used to compare the 2 groups. Differences in patient demographics, signs and symptoms, laboratory study results, computed tomography scan findings, and microbiological analyses between the pre-PCV7 and post-PCV7 groups. A total of 273 children met the inclusion criteria. The post-PCV7 group was older (71.4 months vs 88.8 months [P = .007]) than the pre-PCV7 group. A significant decrease in S pneumoniae and Streptococcus viridans -positive sinus or blood cultures were observed (22.4% vs 0% [P sinusitis complications in this series, there has been a parallel and significant increase in S aureus, including an increase in the prevalence of MRSA associated with orbital infections related to acute sinusitis.

  7. Risk comparison of bleeding and ischemic perioperative complications after acute and elective orthopedic surgery in patients with cardiovascular disease.

    Science.gov (United States)

    Džupa, V; Waldauf, P; Moťovská, Z; Widimský, P; Ondráková, M; Bartoška, R; Ježek, M; Lena, T; Popelka, O; Krbec, M

    2016-07-01

    The study objective was to ascertain the incidence of bleeding and ischemic complications related to acute and planned orthopedic surgery in patients with known cardiovascular diseases. The study conducted between 2010 and 2013 enrolled 477 patients (289 women, 188 men) with a diagnosed cardiovascular disease or a history of thromboembolic event. Aside from gender, age, height and weight, the study observed other anamnestic data and perioperative laboratory test results that may impact on a bleeding or ischemic event. Two hundred seventy-two (57 %) patients had acute surgery, and 205 (43 %) patients had elective surgery. Complications arose in 55 (11.6 %) patients, 32 (6.9 %) had bleeding complications, 19 (4.0 %) ischemic complications, and both complications were experienced by 4 (0.8 %) patients. Bleeding developed in 14 (5.1 %) patients who had acute surgery, and in 22 (10.7 %) who had elective surgery. Twenty-two (8.1 %) patients having acute surgery and one (0.1 %) undergoing elective surgery suffered from ischemic complications. The incidence of bleeding complications was significantly higher in elective surgery (p = 0.026, OR 2.22), and when adjusted (general anaesthesia, gender, and use of warfarin), the difference was even higher (p = 0.015, OR 2.44), whereas the occurrence of ischemic complications was significantly higher in acute surgery (p = 0.005, OR 18.0), and when adjusted (age), the difference remained significant (p = 0.044, OR 8.3). The study noted a significantly higher incidence of bleeding complications in elective orthopedic surgery when compared with acute surgery. Conversely, the incidence of ischemic complications was significantly higher in patients having acute orthopedic surgery when compared with those operated on electively.

  8. Chronobiology of acute aortic rupture or dissection: a systematic review and a meta-analysis of the literature.

    Science.gov (United States)

    Vitale, Josè; Manfredini, Roberto; Gallerani, Massimo; Mumoli, Nicola; Eagle, Kim A; Ageno, Walter; Dentali, Francesco

    2015-04-01

    Identification and quantification higher risk incidence of aortic rupture or dissection (AARD) could be of clinical interest and improve preventive strategies. Several studies and subsequent meta-analyses have shown chronobiologic variations in the timing of occurrence of myocardial infarction, stroke, and pulmonary embolism. Conversely, such evidences are currently lacking for AARD despite a number of studies available dealing with periodicity. MEDLINE, EMBASE, and Google Scholar databases were searched up to July 2013. Temporal variation in the incidence of AARD was analyzed including all studies analyzing seasonal, monthly, weekly, and circadian aggregations. Two authors independently reviewed and extracted data. Forty-two studies for a total of more than 80 000 patients were included. Our results showed a significantly increased incidence of AARD in Winter (Chi-square 854.92, p < 0.001), with a relative risk (RR) of 1.171 (99% CI 1.169, 1.172), in December (Chi-square 361.03, p < 0.001), RR of 1.142 (99% CI 1.141, 1.143), on Monday (Chi-square 428.09, p < 0.001), RR of 1.214 (99% CI 1.211, 1.216), and in the hours between 6 am and 12 pm (Chi-square 212.02, p < 0.001), RR of 1.585 (99% CI 1.562, 1.609). Subgroup and sensitivity analyses confirmed the results of principal analyses. Our data strongly support the presence of evident rhythmic patterns in the incidence of acute aortic events, characterized by significantly higher risk in Winter, in December, on Monday and between 6 am and 12 pm. Future studies are needed to better clarify the underlying mechanisms and clinical implications.

  9. Transnasal endoscopic treatment of orbital complications of acute sinusitis: the Graz concept.

    Science.gov (United States)

    Teinzer, Fabian; Stammberger, Heinz; Tomazic, Peter Valentin

    2015-05-01

    Orbital complications of acute sinusitis can be severe. Nowadays, surgical drainage of intraorbital abscess formations is performed endoscopically in the majority of cases. This study aims to illustrate the Graz experience in the endoscopic treatment of orbital complications and to present our treatment algorithm. In a retrospective study, 53 patients were examined who were referred to the Department of General Otorhinolaryngology of the ENT-University Hospital Graz from 2000 to 2011. Of 53 patients, men were affected more frequently than women (n=37, 69.81% vs n=16, 30.19%). The following diagnoses were obtained: 9 preseptal cellulitis, 7 orbital cellulitis, 14 subperiosteal abscesses, and 23 orbital abscesses. In 16 patients, a conservative therapy was administered; 37 patients underwent surgery, most of them purely endoscopically (n=31, 83.78%). Two of the patients who underwent conservative treatment and 7 of those who underwent surgery experienced a recurrence (n=9, 16.98%). Based on analysis of our recurrences, we have tried to create the optimal treatment algorithm as a point of reference in the management of orbital complications of acute sinusitis. In this way, 7 of 9 recurrences could have been avoided, equaling a hypothetical recurrence rate of 3.77% instead of 16.98% (hypothetical success rate 96.23%). © The Author(s) 2014.

  10. Acute pyelonephritis and associated complications during pregnancy in 2006 in US hospitals.

    Science.gov (United States)

    Jolley, Jennifer A; Kim, Soojin; Wing, Deborah A

    2012-12-01

    To describe the occurrence of hospitalization for acute pyelonephritis during pregnancy and associated complications in 2006 in USA. Cases were defined as those with ICD-9-CM codes corresponding to the infections of the genitourinary tract in pregnancy and pyelonephritis in the 2006 Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS). Additional analyses identified those cases also coupled with ICD-9-CM codes corresponding to obstetrical and medical complications. Calculations were weighted to produce national estimates and hospitalization rates were determined. Twenty-eight thousand nine hundred and twenty-three hospitalizations for pyelonephritis in pregnancy were identified. Women aged 8-19 had the highest hospitalization rate (175.06/10 000 cases) compared to other age groupings. Hispanic patients had the highest hospitalization rate of the recorded ethnicities (100.93/10 000 cases). Diabetes was a concomitant diagnosis in 3.7% of patients. Of the pregnant patients hospitalized with pyelonephritis, 3.77% had threatened preterm labor, 1.95% was diagnosed with sepsis, 0.77% had acute respiratory failure, and several deaths also occurred. The mean length of hospital stay was 2.8 days. The estimated annual cost of hospitalization for pyelonephritis in pregnancy was $263 million. Hospitalization for pyelonephritis in pregnancy is associated with recognizable characteristics including age and diabetes. Serious medical complications and even mortality can occur.

  11. Complications of endovascular treatment of cerebral aneurysms

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    Orrù, Emanuele, E-mail: surgeon.ema@gmail.com [Neuroradiology Department, Padua University Hospital, Via Giustiniani 2, Padua 35128 (Italy); Roccatagliata, Luca, E-mail: lroccatagliata@neurologia.unige.it [Neuroradiology Department, IRCCS San Martino University Hospital and IST, Largo Rosanna Benzi 10, Genoa 16132 (Italy); Department of Health Sciences (DISSAL), University of Genoa (Italy); Cester, Giacomo, E-mail: giacomo.cester@sanita.padova.it [Neuroradiology Department, Padua University Hospital, Via Giustiniani 2, Padua 35128 (Italy); Causin, Francesco, E-mail: francesco.causin@sanita.padova.it [Neuroradiology Department, Padua University Hospital, Via Giustiniani 2, Padua 35128 (Italy); Castellan, Lucio, E-mail: lucio.castellan@hsanmartino.it [Neuroradiology Department, IRCCS San Martino University Hospital and IST, Largo Rosanna Benzi 10, Genoa 16132 (Italy)

    2013-10-01

    The number of neuroendovascular treatments of both ruptured and unruptured aneurysms has increased substantially in the last two decades. Complications of endovascular treatments of cerebral aneurysms are rare but can potentially lead to acute worsening of the neurological status, to new neurological deficits or death. Some of the possible complications, such as vascular access site complications or systemic side effects associated with contrast medium (e.g. contrast medium allergy, contrast induced nephropathy) can also be encountered in diagnostic angiography. The most common complications of endovascular treatment of cerebral aneurysms are related to acute thromboembolic events and perforation of the aneurysm. Overall, the reported rate of thromboembolic complications ranges between 4.7% and 12.5% while the rate of intraprocedural rupture of cerebral aneurysms is about 0.7% in patients with unruptured aneurysms and about 4.1% in patients with previously ruptured aneurysms. Thromboembolic and hemorrhagic complications may occur during different phases of endovascular procedures and are related to different technical, clinical and anatomic reasons. A thorough knowledge of the different aspects of these complications can reduce the risk of their occurrence and minimize their clinical sequelae. A deep understanding of complications and of their management is thus part of the best standard of care.

  12. Complications of endovascular treatment of cerebral aneurysms.

    Science.gov (United States)

    Orrù, Emanuele; Roccatagliata, Luca; Cester, Giacomo; Causin, Francesco; Castellan, Lucio

    2013-10-01

    The number of neuroendovascular treatments of both ruptured and unruptured aneurysms has increased substantially in the last two decades. Complications of endovascular treatments of cerebral aneurysms are rare but can potentially lead to acute worsening of the neurological status, to new neurological deficits or death. Some of the possible complications, such as vascular access site complications or systemic side effects associated with contrast medium (e.g. contrast medium allergy, contrast induced nephropathy) can also be encountered in diagnostic angiography. The most common complications of endovascular treatment of cerebral aneurysms are related to acute thromboembolic events and perforation of the aneurysm. Overall, the reported rate of thromboembolic complications ranges between 4.7% and 12.5% while the rate of intraprocedural rupture of cerebral aneurysms is about 0.7% in patients with unruptured aneurysms and about 4.1% in patients with previously ruptured aneurysms. Thromboembolic and hemorrhagic complications may occur during different phases of endovascular procedures and are related to different technical, clinical and anatomic reasons. A thorough knowledge of the different aspects of these complications can reduce the risk of their occurrence and minimize their clinical sequelae. A deep understanding of complications and of their management is thus part of the best standard of care.

  13. Augmented repair of acute Achilles tendon ruptures with modified Lindholm turndown gastrocnemius fascia flap%改良Lindholm腓肠肌倒转腱膜瓣加强修复急性跟腱断裂

    Institute of Scientific and Technical Information of China (English)

    钮心刚; 鲍宏玮; 严立生

    2012-01-01

    Objective To find an effective operative method for acute rupture of the Achilles tendon and to discuss its treament result. Methods A modified Lindholm turndown gastrocnemius fascia flap technique was designed. 45 cases of acute Achilles ruptures operated upon this modified Lindholm technique were retrospectively included in this study. The achilles tendon stumps was repaired with the Kessler suture. Two 0. 5 cm X 7 cm turndown gastrocnemius fascia flaps were dissected and made into membrane to wrap and repair the Achilles tendon ends, recovering its shape. Results There was no complication of infection, wound necrosis, sural nerve injury and tendon rerupture. All the patients were followed up for 12 to 20 months. At one-year follow-up, the treatment result was evaluated with Amer-Lindholm rating scale as excellent in 43 cases, good in 2 cases. Conclusions This modified Lindholm technique is an effective method to repair and enhance the acute Achilles tendon ruptures.%目的 探讨治疗急性跟腱断裂的手术方法及疗效.方法 对Lindholm腓肠肌倒转腱膜瓣加强修复跟腱断裂术进行改良,修复45例急性跟腱断裂.用Kessler法缝合跟腱断端,改良术中切取大小为0.5 cm×7 cm 2条腓肠肌腱膜瓣,预制成腱膜片后倒转包裹修复跟腱缝合端,恢复外形.结果 术后无感染、切口坏死、腓肠神经损伤及跟腱再断裂等并发症,跟腱修复处外形良好.患者均获随访,时间12~20个月.术后1年根据Arner-Lindholm评定标准评价治疗效果:优43例,良2例.结论 改良Lindholm腓肠肌倒转腱膜瓣是加强修复急性跟腱断裂的有效手术方法.

  14. Quadriceps and patellar tendon ruptures.

    Science.gov (United States)

    Lee, Dennis; Stinner, Daniel; Mir, Hassan

    2013-10-01

    The diagnosis of quadriceps and patellar tendon ruptures requires a high index of suspicion and thorough history-taking to assess for medical comorbidities that may predispose patients to tendon degeneration. Radiographic assessment with plain films supplemented by ultrasound and magnetic resonance imaging when the work-up is equivocal further aids diagnosis; however, advanced imaging is often unnecessary in patients with functional extensor mechanism deficits. Acute repair is preferred, and transpatellar bone tunnels serve as the primary form of fixation when the tendon rupture occurs at the patellar insertion, with or without augmentation depending on surgeon preference. Chronic tears and disruptions following total knee arthroplasty are special cases requiring reconstructions with allograft, synthetic mesh, or autograft. Rehabilitation protocols generally allow immediate weight-bearing with the knee locked in extension and crutch support. Limited arc motion is started early with active flexion and passive extension and then advanced progressively, followed by full active range of motion and strengthening. Complications are few but include quadriceps atrophy, knee stiffness, and rerupture. Outcomes are excellent if repair is done acutely, with poorer outcomes associated with delayed repair.

  15. Atypical radiological and intraoperative findings of acute cerebral hemorrhage caused by ruptured cerebral aneurysm in a patient with severe chronic anemia.

    Science.gov (United States)

    Matano, Fumihiro; Murai, Yasuo; Nakagawa, Shunsuke; Kato, Taisei; Kitamura, Takayuki; Sekine, Tetsuro; Takagi, Ryo; Teramoto, Akira

    2014-01-01

    Acute intracerebral hemorrhage (ICH) associated with mild anemia is commonly observed on radiological examination, and there are several reports of ruptured aneurysms occurring with ICH but without accompanying subarachnoid hemorrhage. However, the relationship among computed tomography (CT), magnetic resonance imaging (MRI), and intraoperative findings of ICH caused by ruptured cerebral aneurysm in patients with severe chronic anemia has been rarely reported and is poorly understood. Here, we report atypical radiological and intraoperative findings of acute ICH caused by ruptured cerebral aneurysm in a patient with severe chronic anemia. A 64-year-old man with anemia was admitted to our hospital after he experienced left hemiparesis and a disturbance of consciousness. At a referring institution, he showed evidence of macrocytic anemia (white blood cell count, 9,000/μL; red blood cell count, 104×10(4)/μL; hemoglobin, 4.0 g/dL; hematocrit, 12.2%; and platelet count, 26.6×10(4)/μL). Both CT and MRI showed a right frontal ICH. The outer ring of the hematoma appeared as low-density area on CT, a low-intensity area on T1-weighted MRI, and a high-intensity area on T2-weighted MRI with a serous component. The patient received a blood transfusion and underwent surgical removal of the hematoma the following day. The white serous effusion visualized with CT and MRI was identified as a blood clot in the hematoma cavity. The blood that leaks from blood vessels appears as a high-intensity area on CT because it undergoes plasma absorption in a solidification shrinkage process, and is, therefore, concentrated. Although we did not examine the white effusion to determine if serous components were present, we speculated that the effusion may have contained serous components. Therefore, we removed the part of the effusion that appeared as a low-density area on CT. The presence of ICH without subarachnoid hemorrhage suggested the possible adhesion and rupture of a previous

  16. Nicardipine-Induced Acute Pulmonary Edema: A Rare but Severe Complication of Tocolysis

    Directory of Open Access Journals (Sweden)

    Claire Serena

    2014-01-01

    Full Text Available We report four cases of acute pulmonary edema that occurred during treatment by intravenous tocolysis using nicardipine in pregnancy patients with no previous heart problems. Clinical severity justified hospitalization in intensive care unit (ICU each time. Acute dyspnea has begun at an average of 63 hours after initiation of treatment. For all patients, the first diagnosis suspected was pulmonary embolism. The patients' condition improved rapidly with appropriate diuretic treatment and by modifying the tocolysis. The use of intravenous nicardipine is widely used for tocolysis in France even if its prescription does not have a marketing authorization. The pathophysiological mechanisms of this complication remain unclear. The main reported risk factors are spontaneous preterm labor, multiple pregnancy, concomitant obstetrical disease, association with beta-agonists, and fetal lung maturation corticotherapy. A better knowledge of this rare but serious adverse event should improve the management of patients. Nifedipine or atosiban, the efficiency of which tocolysis was also studied, could be an alternative.

  17. Nicardipine-induced acute pulmonary edema: a rare but severe complication of tocolysis.

    Science.gov (United States)

    Serena, Claire; Begot, Emmanuelle; Cros, Jérôme; Hodler, Charles; Fedou, Anne Laure; Nathan-Denizot, Nathalie; Clavel, Marc

    2014-01-01

    We report four cases of acute pulmonary edema that occurred during treatment by intravenous tocolysis using nicardipine in pregnancy patients with no previous heart problems. Clinical severity justified hospitalization in intensive care unit (ICU) each time. Acute dyspnea has begun at an average of 63 hours after initiation of treatment. For all patients, the first diagnosis suspected was pulmonary embolism. The patients' condition improved rapidly with appropriate diuretic treatment and by modifying the tocolysis. The use of intravenous nicardipine is widely used for tocolysis in France even if its prescription does not have a marketing authorization. The pathophysiological mechanisms of this complication remain unclear. The main reported risk factors are spontaneous preterm labor, multiple pregnancy, concomitant obstetrical disease, association with beta-agonists, and fetal lung maturation corticotherapy. A better knowledge of this rare but serious adverse event should improve the management of patients. Nifedipine or atosiban, the efficiency of which tocolysis was also studied, could be an alternative.

  18. Nicardipine-Induced Acute Pulmonary Edema: A Rare but Severe Complication of Tocolysis

    Science.gov (United States)

    Serena, Claire; Begot, Emmanuelle; Cros, Jérôme; Hodler, Charles; Fedou, Anne Laure; Nathan-Denizot, Nathalie; Clavel, Marc

    2014-01-01

    We report four cases of acute pulmonary edema that occurred during treatment by intravenous tocolysis using nicardipine in pregnancy patients with no previous heart problems. Clinical severity justified hospitalization in intensive care unit (ICU) each time. Acute dyspnea has begun at an average of 63 hours after initiation of treatment. For all patients, the first diagnosis suspected was pulmonary embolism. The patients' condition improved rapidly with appropriate diuretic treatment and by modifying the tocolysis. The use of intravenous nicardipine is widely used for tocolysis in France even if its prescription does not have a marketing authorization. The pathophysiological mechanisms of this complication remain unclear. The main reported risk factors are spontaneous preterm labor, multiple pregnancy, concomitant obstetrical disease, association with beta-agonists, and fetal lung maturation corticotherapy. A better knowledge of this rare but serious adverse event should improve the management of patients. Nifedipine or atosiban, the efficiency of which tocolysis was also studied, could be an alternative. PMID:25215245

  19. Acute urinary retention as a late complication of subcutaneous liquid silicone injection: a case report

    Directory of Open Access Journals (Sweden)

    Leandro Luongo de Matos

    2009-12-01

    Full Text Available Acute urinary retention is characterized by a sudden interruption of urinary output; urine is retained in the bladder due to either functional or obstructive anatomic factors, and cannot be voided. The main causes of acute urinary obstruction are benign prostatic hyperplasia, constipation, prostate adenocarcinoma, urethral stenosis, clot retention, neurological disorders, following surgery, calculi, drugs, or urinary tract infections. A transvestite patient, aged 55 years, described having had liquid silicone subcutaneously injected in various parts of the body, the last one four years ago. He complained of absent urinary output during the last 14 hours. The physical examination revealed skin deformation due to migration of implants; a hard nodule (characterized as a foreign body was present in the preputium and a diagnosis of acute urinary retention was made; an unsuccessful attempt to exteriorize the glans for urinary catheterization, was followed by therapeutic cystostomy. Acute urinary retention has not been mentioned in the medical literature as a complication of liquid silicone subcutaneous injection.

  20. Post-streptococcal acute glomerulonephritis complicated by gouty arthritis: a case report.

    Science.gov (United States)

    Kuniyoshi, Yasutaka; Kamura, Azusa; Yasuda, Sumie; Tashiro, Makoto

    2015-06-17

    Gouty arthritis is uncommon in childhood and adolescence. On the other hand, there has been no report of cases with development of gouty arthritis with post-streptococcal acute glomerulonephritis (PSAGN) in pediatric patients. Here we report the case of a mildly obese 12-year-old boy with PSAGN complicated by gouty arthritis of the left first metatarsophalangeal joint. On follow-up, it was confirmed that as serum C3 level returned to normal, urinary excretion of uric acid increased and serum uric acid level decreased, thereby resolving the burning pain of the left big toe. In this case, not only did renal insufficiency associate with PSAGN but also mild obesity may have led to hyperuricemia and gouty arthritis. In conclusion, clinicians should be aware that PSAGN may be complicated by gouty arthritis in obese pediatric patients.

  1. Acute axonal polyneuropathy with predominant proximal involvement: an uncommon neurological complication of bariatric surgery

    Directory of Open Access Journals (Sweden)

    Machado Flavia Costa Nunes

    2006-01-01

    Full Text Available Bariatric surgery is frequently indicated in the treatment of morbid obesity. Previously unreported complications have been associated to this surgery; among them, neurological complications have gained attention. We report the case of a 25-year-old man submitted to gastric surgery for treatment of morbid obesity who developed, two months after surgery, acute proximal weakness in lower limbs. The electroneuromyography revealed axonal peripheral polyneuropathy with predominant proximal involvement. After treatment with immunoglobulin and vitamin supplementation, rapid clinical and neurophysiologic recovery was observed. We describe the clinical and electroneuromyographic features of this case, stressing the difficulty of initial diagnosis, particularly in the differential diagnosis with Guillain-Barré syndrome. We discuss the importance of nutritional follow-up and the eventual indication of routine vitamin supplementation in these patients.

  2. Acute axonal polyneuropathy with predominant proximal involvement: an uncommon neurological complication of bariatric surgery.

    Science.gov (United States)

    Machado, Flavia Costa Nunes; Valério, Berenice Cataldo Oliveira; Morgulis, Roberto Naun Franco; Nunes, Karlo Faria; Mazzali-Verst, Sílvia

    2006-09-01

    Bariatric surgery is frequently indicated in the treatment of morbid obesity. Previously unreported complications have been associated to this surgery; among them, neurological complications have gained attention. We report the case of a 25-year-old man submitted to gastric surgery for treatment of morbid obesity who developed, two months after surgery, acute proximal weakness in lower limbs. The electroneuromyography revealed axonal peripheral polyneuropathy with predominant proximal involvement. After treatment with immunoglobulin and vitamin supplementation, rapid clinical and neurophysiologic recovery was observed. We describe the clinical and electroneuromyographic features of this case, stressing the difficulty of initial diagnosis, particularly in the differential diagnosis with Guillain-Barré syndrome. We discuss the importance of nutritional follow-up and the eventual indication of routine vitamin supplementation in these patients.

  3. Acute Pulmonary Reperfusion Hemorrhage: A Rare Complication After Oversized Percutaneous Balloon Valvuloplasty for Pulmonary Valve Stenosis

    Directory of Open Access Journals (Sweden)

    Hao-I Cheng

    2009-11-01

    Full Text Available Balloon valvuloplasty became the treatment of choice for valvular pulmonary stenosis following its first description in 1982 by Kan et al, and has almost replaced surgical pulmonary valvotomy in the present day. It is a safe and effective method for children for relief of right ventricular obstruction. The results of the procedure are excellent, without significant complications. This report describes the case of a 12-year-old boy who received successful balloon valvuloplasty for critical pulmonary valve stenosis complicated by an episode of acute pulmonary hemorrhage. Because of cyanosis, hypotension and bradycardia, he received emergent endotracheal intubation with 100% oxygen supplement and the highest infusion rate of inotropic agents. Venoarterial mode extracorporeal membrane oxygenation was indicated for life support due to the persistent high oxygenation index. Extracorporeal membrane oxygenation played a key role in the survival of this patient during the course of treatment.

  4. Acute abdomen caused by bladder rupture attributable to neurogenic bladder dysfunction following a stroke: a case report

    Directory of Open Access Journals (Sweden)

    Court Fiona

    2011-06-01

    Full Text Available Abstract Introduction Spontaneous bladder rupture is a rare and serious event with high mortality. It is not often considered in the patient presenting with peritonitis. This often leads to delays in diagnosis. There are very few case reports of true spontaneous rupture in the literature. This is the first such reported case in which bladder rupture was attributable to neurogenic bladder dysfunction following a stroke. Case presentation We report the case of a 67-year-old Caucasian man who presented with lower abdominal pain and a peritonitic abdomen. He had a long-term urethral catheter because of urinary retention following a previous stroke. He was treated conservatively with antibiotics before a surgical opinion was sought. Exploratory laparotomy confirmed the diagnosis of spontaneous bladder rupture. After repair of the defect, he eventually made a full recovery. Conclusion In this unusual case report, we describe an example of a serious event in which delays in diagnosis may lead to increased morbidity and mortality. To date, no unifying theory explaining why rupture occurs has been postulated. We conducted a thorough literature search to examine the etiological factors in other published cases. These etiological factors either increase intra-vesical pressure or decrease the strength of the bladder wall. We hope that by increasing awareness of these etiological factors, spontaneous bladder rupture may be diagnosed earlier and appropriate therapy started.

  5. Pulmonary Complications of Azanucleoside Therapy in Patients with Myelodysplastic Syndrome and Acute Myelogenous Leukemia

    Directory of Open Access Journals (Sweden)

    Manuel Molina

    2015-01-01

    Full Text Available Our primary aim was to identify potential risk factors and clinical outcome of azanucleoside induced pulmonary complications in patients with myelodysplastic syndrome (MDS and Acute Myelogenous Leukemia (AML. We present an 89-year-old female with MDS derived AML who developed fatigability, hypoxemia, and bilateral lung infiltrates indicating interstitial lung disease after 11 cycles of azanucleoside. In addition, we describe a cohort of six MDS patients with fever, cough, dyspnea, and pulmonary infiltrates at early time point during azanucleoside treatment. Early and late onset of pulmonary manifestations suggest different pathogenic mechanisms. Brief azanucleoside discontinuation and steroids led to rapid improvement in symptoms.

  6. Multiple small bowel ruptures due to ischemic enteritis: A case report

    Institute of Scientific and Technical Information of China (English)

    Stylianos Delikoukos; Gregorios Christodoulidis; Dimitrios Zacharoulis; Antigoni Poultsidi; Constantine Hatzitheofilou

    2006-01-01

    A rare case of multiple small bowel ruptures due to ischemic enteritis (ISE) is reported. The patient was admitted to the hospital with acute abdominal pain followed by bloody diarrhoeas. Preoperative colonoscopic findings were similar to those presented in Crohn's disease. Tntraoperatively, ischemic lesions and multiple ruptures were localized at the jejunum and the proximal ileum. Histopathological examination of the resected bowel segment established the diagnosis of ISE. Although ISE is not common, concurred multiple ruptures of the small bowel is a rare but actual complication.

  7. Endotracheal Intubation after Acute Drug Overdoses: Incidence, Complications, and Risk Factors.

    Science.gov (United States)

    Hua, Angela; Haight, Stephen; Hoffman, Robert S; Manini, Alex F

    2017-01-01

    Drug overdose is the leading cause of injury-related fatality in the United States, and respiratory failure remains a major source of morbidity and mortality. We aimed to identify the incidence and risk factors for endotracheal intubation after acute drug overdose. This secondary data analysis was performed on a 5-year prospective cohort at two urban tertiary-care hospitals. The present study analyzed adult patients with suspected acute drug overdose to derive independent clinical predictors of endotracheal intubation. We analyzed 2497 patients with acute drug overdose, of whom 87 (3.5%) underwent endotracheal intubation. Independent clinical risk factors for endotracheal intubation were: younger age (odds ratio [OR] 0.97, 95% confidence interval [CI] 0.96-0.98), and history of obstructive lung disease (OR 6.6, 95% CI 3.5-12.3); however, heart failure had no association. Patients with obstructive lung disease had significantly more hypercapnia (mean difference 6.8 mm Hg, 95% CI 2.3-11.3) and a higher degree of acidemia (mean pH difference 0.04, 95% CI 0.01-0.07) than patients without obstructive lung disease. Lack of rapid sequence sedative/paralytic was associated with in-hospital fatality. Early complications of endotracheal intubation itself included desaturation (3.4%) and bradycardia (1%). Endotracheal intubation was infrequently performed on patients with acute drug overdose, and complications were rare when performed. Risk factors associated with endotracheal intubation included younger age and prior obstructive lung disease. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Clinical course and frequency of complications in children hospitalized for acute bronchiolitis

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    Mašić Marina

    2016-01-01

    Full Text Available Introduction: Acute bronchiolitis is the most common disease of the respiratory tract in children, in 75% of cases caused by respiratory syncytial virus (RSV. There is a risk for complicated clinical course in premature infants and the ones with chronic diseases (chronic lung disease, congenital heart disease or neuromuscular disease. Aim: The evaluation of clinical course of acute bronchiolitis and estimation of possible influences of therapeutic interventions or previous chronic diseases on the outcome. Material and methods: This retrospective study included all patients admitted for acute bronchiolitis in the Department of Pulmonology, Mother and Child Health Institute of Serbia 'Dr Vukan Cupic', from September 2014 to March 2015. The enzyme immunoassay membrane test was used for detection of RSV antigen from nasopharyngeal aspirates in all patients. The influence of age, previous chronic diseases, the occurrence of complications on clinical course and length of the hospital stay, were analyzed. Results: Out of186 patients included, 137 were younger than the age of 6 months. Infection with RSV was confirmed in 53.2% of patients, with the highest rate in December (69.2%. The atelectasis was confirmed in 9 patients, and 44.4% of them had some of the chronic diseases (p < 0.05. Flexible bronchoscopy was performed in 27 patients and 44% of them had previous chronic disease (p < 0.001. Multiple regression model showed that presence of atelectasis, RSV infection and chronic disease correlates with the length of hospital stay. Most of the patients were treated with inhalations of bronchodilators and 3% saline. Systemic corticosteroids and supplemental oxygen were used most frequently for those patients with longer hospital stay (p < 0.001. In three patients (1.6% mechanical ventilation was needed, with favorable outcome. Conclusion: The clinical course and the length of stay in patients hospitalized for acute bronchiolitis is influenced mostly by

  9. The role of levosimendan in acute heart failure complicating acute coronary syndrome: A review and expert consensus opinion.

    Science.gov (United States)

    Nieminen, Markku S; Buerke, Michael; Cohen-Solál, Alain; Costa, Susana; Édes, István; Erlikh, Alexey; Franco, Fatima; Gibson, Charles; Gorjup, Vojka; Guarracino, Fabio; Gustafsson, Finn; Harjola, Veli-Pekka; Husebye, Trygve; Karason, Kristjan; Katsytadze, Igor; Kaul, Sundeep; Kivikko, Matti; Marenzi, Giancarlo; Masip, Josep; Matskeplishvili, Simon; Mebazaa, Alexandre; Møller, Jacob E; Nessler, Jadwiga; Nessler, Bohdan; Ntalianis, Argyrios; Oliva, Fabrizio; Pichler-Cetin, Emel; Põder, Pentti; Recio-Mayoral, Alejandro; Rex, Steffen; Rokyta, Richard; Strasser, Ruth H; Zima, Endre; Pollesello, Piero

    2016-09-01

    Acute heart failure and/or cardiogenic shock are frequently triggered by ischemic coronary events. Yet, there is a paucity of randomized data on the management of patients with heart failure complicating acute coronary syndrome, as acute coronary syndrome and cardiogenic shock have frequently been defined as exclusion criteria in trials and registries. As a consequence, guideline recommendations are mostly driven by observational studies, even though these patients have a particularly poor prognosis compared to heart failure patients without signs of coronary artery disease. In acute heart failure, and especially in cardiogenic shock related to ischemic conditions, vasopressors and inotropes are used. However, both pathophysiological considerations and available clinical data suggest that these treatments may have disadvantageous effects. The inodilator levosimendan offers potential benefits due to a range of distinct effects including positive inotropy, restoration of ventriculo-arterial coupling, increases in tissue perfusion, and anti-stunning and anti-inflammatory effects. In clinical trials levosimendan improves symptoms, cardiac function, hemodynamics, and end-organ function. Adverse effects are generally less common than with other inotropic and vasoactive therapies, with the notable exception of hypotension. The decision to use levosimendan, in terms of timing and dosing, is influenced by the presence of pulmonary congestion, and blood pressure measurements. Levosimendan should be preferred over adrenergic inotropes as a first line therapy for all ACS-AHF patients who are under beta-blockade and/or when urinary output is insufficient after diuretics. Levosimendan can be used alone or in combination with other inotropic or vasopressor agents, but requires monitoring due to the risk of hypotension.

  10. STUDY OF COMPLICATIONS OF COLLES FRACTURE TO FIND OUT THE TRUE INCIDENCE OF EXTENSOR POLLICIS LONGUS TENDON RUPTURE AND CARPAL TUNNEL SYNDROME IN INDIAN POPULATION

    OpenAIRE

    Kulkarni; Mangesh Rajput; Kiran Gaonkar; Nitin Patil; Nishant Gaonkar; Ketan Gupta; Nirav Patel; Ayush Lal

    2015-01-01

    Colles‟ fracture is confined to adult and usually is seen in women over the age of fifty who have fallen on the outstretched hand. EPL tendon is the most common extensor tendon to rupture after colles‟ fracture. To our belief the incidenc e of median nerve injury and EPL tendon rupture given in literature are much higher than what we see now a days, so with this aim we carried this study to find out the true incidence of CTS and EPL tendon rupture in Indian population. AI...

  11. Acute Bacterial Sinusitis Complicating Viral Upper Respiratory Tract Infection in Young Children

    Science.gov (United States)

    Marom, Tal; Alvarez-Fernandez, Pedro E.; Jennings, Kristofer; Patel, Janak A.; McCormick, David P.; Chonmaitree, Tasnee

    2014-01-01

    Background Acute bacterial sinusitis (ABS) is a common complication of viral upper respiratory tract infections (URI). Clinical characteristics of URIs complicated by ABS in young children have not been well studied. Methods We identified ABS episodes in a prospective, longitudinal cohort study of 294 children (6 to 35 months of age at enrollment), who were followed-up for one year to capture all URI episodes and complications. At the initial URI visit seen by the study personnel (median day=4 from symptoms onset), nasopharyngeal samples were obtained for bacterial cultures and viral studies. Results Of 1295 documented URI episodes, 103 (8%) episodes (in 73 children) were complicated by ABS, 32 of which were concurrent with acute otitis media. The majority (72%) of ABS episodes were diagnosed based on persistent symptoms or a biphasic course. Average age at ABS diagnosis was 18.8±7.2 months; white children were more likely to have ABS episodes than blacks (p=0.01). Hispanic/Latino ethnicity (p<0.0001) was negatively associated, and adequate PCV-7 immunization status (p=0.001) appeared to increase the risk of ABS. Girls had more ABS episodes than boys (0.5±0.8 vs 0.3±0.6 episodes/year, respectively, p=0.03). Viruses were detected in 63% during the initial URI visit; rhinovirus detection was positively correlated with ABS risk (p=0.01). Bacterial cultures were positive in 82/83 (99%) available samples obtained at the initial URI visit; polymicrobial (56%), Moraxella catarrhalis (20%) and Streptococcus pneumoniae (10%) were the most common cultures. Presence of pathogenic bacteria overall and presence of M. catarrhalis during URI were positively correlated with the risk for ABS (p=0.04 for both). Conclusion ABS complicates 8% of URI in young children. Girls have more frequent ABS episodes than boys. Presence of rhinovirus and M. catarrhalis during URI are positively correlated with the risk for ABS complication. PMID:24717966

  12. A Case of Heel Cord Pain After Repair of Acute Achilles Tendon Rupture: Treated by Endoscopic Adhesiolysis of the Achilles Tendon.

    Science.gov (United States)

    Lui, Tun Hing

    2016-10-01

    The causes of heel cord pain after repair of acute rupture of the Achilles tendon are unclear. The proposed etiologies include nonabsorbable suture granuloma formation, alteration of the pain receptors threshold in the tendon, and distension of the paratenon by the hypertrophied tendon, underlying tendinopathy, postrepair neovascularization, and peritendinous fibrous adhesion. We present an endoscopic technique of adhesiolysis of the Achilles tendon to deal with the various possible causes of postrepair heel cord pain. Therapeutic, Level 4: Case report. © 2015 The Author(s).

  13. Saving the limb in diabetic patients with ischemic foot lesions complicated by acute infection.

    Science.gov (United States)

    Clerici, Giacomo; Faglia, Ezio

    2014-12-01

    Ischemia and infection are the most important factors affecting the prognosis of foot ulcerations in diabetic patients. To improve the outcome of these patients, it is necessary to aggressively treat 2 important pathologies--namely, occlusive arterial disease affecting the tibial and femoral arteries and infection of the ischemic diabetic foot. Each of these 2 conditions may lead to major limb amputation, and the presence of both critical limb ischemia (CLI) and acute deep infection is a major risk factor for lower-extremity amputation. Thus, the management of diabetic foot ulcers requires specific therapeutic approaches that vary significantly depending on whether foot lesions are complicated by infection and/or ischemia. A multidisciplinary team approach is the key to successful treatment of a diabetic foot ulcer: ischemic diabetic foot ulcers complicated by acute deep infection pose serious treatment challenges because high levels of skill, organization, accuracy, and timing of intervention are required to maximize the chances of limb salvage: these complex issues are better managed by a multidisciplinary clinical group.

  14. A case of testicular rupture

    OpenAIRE

    野俣, 浩一郎; 林, 幹男

    1987-01-01

    A case of testicular rupture is reported. A 26-year-old man was referred to our hospital because of testicular trauma. Ultrasound of the testis was performed preoperatively. Ultrasonography revealed a disruption of the tunica albuginea and dense clusters of echoes in the tunica vaginalis. In the case of acute testicular trauma, this echo pattern suggests testicular rupture.

  15. Infections in children admitted with complicated severe acute malnutrition in Niger.

    Directory of Open Access Journals (Sweden)

    Anne-Laure Page

    Full Text Available BACKGROUND: Although malnutrition affects thousands of children throughout the Sahel each year and predisposes them to infections, there is little data on the etiology of infections in these populations. We present a clinical and biological characterization of infections in hospitalized children with complicated severe acute malnutrition (SAM in Maradi, Niger. METHODS: Children with complicated SAM hospitalized in the intensive care unit of a therapeutic feeding center, with no antibiotics in the previous 7 days, were included. A clinical examination, blood, urine and stool cultures, and chest radiography were performed systematically on admission. RESULTS: Among the 311 children included in the study, gastroenteritis was the most frequent clinical diagnosis on admission, followed by respiratory tract infections and malaria. Blood or urine culture was positive in 17% and 16% of cases, respectively, and 36% had abnormal chest radiography. Enterobacteria were sensitive to most antibiotics, except amoxicillin and cotrimoxazole. Twenty-nine (9% children died, most frequently from sepsis. Clinical signs were poor indicators of infection and initial diagnoses correlated poorly with biologically or radiography-confirmed diagnoses. CONCLUSIONS: These data confirm the high level of infections and poor correlation with clinical signs in children with complicated SAM, and provide antibiotic resistance profiles from an area with limited microbiological data. These results contribute unique data to the ongoing debate on the use and choice of broad-spectrum antibiotics as first-line treatment in children with complicated SAM and reinforce the call for an update of international guidelines on management of complicated SAM based on more recent data.

  16. Achilles tendon rupture; assessment of nonoperative treatment

    DEFF Research Database (Denmark)

    Barfod, Kristoffer Weisskirchner

    2014-01-01

    BACKGROUND: Acute Achilles tendon rupture is a frequent and potentially disabling injury. Over the past decade a change in treatment of acute Achilles tendon rupture away from operative towards non-operative treatment has taken place. However, the optimal non-operative treatment protocol remains...... and Sweden. Immediate weight-bearing was found to be safe and recommendable in non-operative treatment of acute Achilles tendon rupture. The novel ultrasound measurement showed excellent reliability and acceptable validity and agreement....

  17. 小切口微创治疗新鲜跟腱断裂%Limited incision for treatment of acute ruptures of achilles tendon

    Institute of Scientific and Technical Information of China (English)

    张丙磊; 余枫; 赵东升; 李爱民; 殷军; 赵玉麟; 张路

    2009-01-01

    [Objective]To evaluate the clinical effect of limited incision with an instrument to repair acute achiles tendon ruptures. [Method] Data on 26 consecutive patients who underwent limited incision with an instrument to repair achiles tendon ruptures and on a rehabilitation programme based on early range of motion exercise after surgery during March 2006 March 2008 were reviewed at an average follow-up of 21 months (range 12 -36 months). There were 24 males and 2 females with an average age of 37.6 (22 - 58) years. The American Orthopaedic Foot and Ankle Society (AOFAS) score was used to evaluate the treatment outcomes. Calf and ankle circumferences of the injured leg and the contralateral side, the return to work and sports activity time were evaluated. [Result]The patients had neither rerupture nor deep or superficial wound infection. Also.no patient had sensory disturbance with the ankle or fool in the sural nerve distribution. The mean AOFAS score at the time of the latest follow-up was 97 (86 - 100).Twenty-three patients returned to work at an average of 10 weeks (range,4-20 weeks) and to normal sports activities at 20 weeks (range, 18 -24 weeks). Calf and ankle circumferences decreased by 0.4 cm(0.2 -0.8cm)and increased by 0.5cm(0.3-0.7cm),respectively in the injured leg as compared with the contralateral leg. [ Conclusion] The limited incision with an instrument to repair acute achiles tendon ruptures and the early rehabilitation programme provide satisfactory result with low complication rates.%[目的]探讨通过小切口应用跟腱缝合引导器微创治疗新鲜跟腱断裂的临床效果.[方法]2006年3月-2008年3月,通过小切口应用跟腱缝合引导器微创治疗连续的26例新鲜跟腱断裂病人,术后早期功能锻练.男24例,女2例.年龄22~58岁,平均37.6岁.24例获得12~36个月(平均21个月)的随访.采用美国足与踝关节协会(AOFAS)踝与后足功能评分标准进行评分,测量双侧小腿最大周径及跟腱

  18. Complications, effects on dialysis dose, and survival of tunneled femoral dialysis catheters in acute renal failure.

    Science.gov (United States)

    Klouche, Kada; Amigues, Laurent; Deleuze, Sebastien; Beraud, Jean-Jacques; Canaud, Bernard

    2007-01-01

    Availability of a functional vascular access is a mandatory prerequisite for extracorporeal renal replacement therapy in patients with acute renal failure. The femoral site of insertion commonly is chosen because it is an easy and convenient access. However, an array of complications may substantially alter the quality of treatment, and it appears that catheter-related morbidity and dysfunction are more frequent with the femoral than internal jugular site. This study is designed to evaluate the potential benefits of using soft silicone tunneled catheters ((ST)Caths) at the femoral site. Thirty patients with acute renal failure treated by intermittent hemodialysis (IHD) and/or continuous venovenous hemodiafiltration (CVVHDF) were assigned to either twin (ST)Caths or twin polyurethane nontunneled femoral catheters. Time necessary for catheter insertion, catheter-related complications, and catheter lifespan were monitored. Catheter performance during IHD and the effect of catheter type on dialysis dose were evaluated. The time necessary for (ST)Cath insertion was significantly longer. The incidence of vein thrombosis and catheter-related infection was lower, and the ratio of venous return pressure to catheter blood flow was better with an (ST)Cath. Recirculation rates were similar for both types of catheters. Whether treated by using IHD or CVVHDF, patients with an (ST)Cath benefited from a greater delivered dialysis dose. Multivariate analysis confirmed that (ST)Cath use was a determinant factor to optimize dialysis dose delivery. (ST)Cath patency was significantly longer. In patients with acute renal failure, use of an (ST)Cath minimizes catheter-related morbidity and improves dialysis efficiency compared with conventional femoral catheters.

  19. Peripancreatic vascular abnormalities complicating acute pancreatitis: contrast-enhanced helical CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Mortele, Koenraad J. E-mail: kmortele@partners.org; Mergo, Patricia J.; Taylor, Helena M.; Wiesner, Walter; Cantisani, Vito; Ernst, Michael D.; Kalantari, Babak N.; Ros, Pablo R

    2004-10-01

    Objective: To determine the prevalence and morphologic helical computed tomography (CT) features of peripancreatic vascular abnormalities in patients with acute pancreatic inflammatory disease in correlation with the severity of the pancreatitis. Materials and methods: One hundred and fifty-nine contrast-enhanced helical CT scans of 100 consecutive patients with acute pancreatitis were retrospectively and independently reviewed by three observers. CT scans were scored using the CT severity index (CTSI): pancreatitis was graded as mild (0-2 points), moderate (3-6 points), and severe (7-10 points). Interobserver agreement for both the CT severity index and the presence of peripancreatic vascular abnormalities was calculated (K-statistic). Correlation between the prevalence of complications and the degree of pancreatitis was estimated using Fisher's exact test. Results: The severity of pancreatitis was graded as mild (n=59 scans), moderate (n=82 scans), and severe (n=18 scans). Venous abnormalities detected included splenic vein (SV) thrombosis (31 scans, 19 patients), superior mesenteric vein (SMV) thrombosis (20 scans, 14 patients), and portal vein (PV) thrombosis (17 scans, 13 patients). Arterial hemorrhage occurred in five patients (6 scans). In our series, no cases of arterial pseudoaneurysm formation were detected. The interobserver agreement range for scoring the degree of pancreatitis and the overall presence of major vascular abnormalities was 75.5-79.2 and 86.2-98.8%, respectively. The presence of the vascular abnormalities in correlation with the severity of pancreatitis was variable. Conclusion: Vascular abnormalities are relatively common CT findings in association with acute pancreatitis. The CT severity index is insufficiently accurate in predicting some of these complications since no statistically significant correlation between their prevalence and the severity of pancreatitis could be established.

  20. Spontaneous rupture of the liver in a patient with chronic hepatitis B and D

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Spontaneous rupture of the liver is a rare condition with serious consequences, if not recognized and treated in time. It has been reported as a complication of several disorders, including benign or malignant liver tumors,connective tissue disease, infiltrating liver disease,preeclampsia, and post anticoagulant therapy. We report a case of spontaneous rupture of liver in a noncirrhotic, chronic hepatitis B and D patient presenting with acute hemoperitoneum and shock. The subcapsular hematoma and rupture of liver were documented by image studies. The patients' condition gradually stabilized after fluid resuscitation. The reported case and literature review suggest that spontaneous rupture of liver must be considered in a differential diagnosis of acute hemoperitoneum. A high index of suspicion and early diagnosis with imaging are critically important.

  1. Coronary flow and hemorrhagic complications after alteplase and streptokinase administration in patients with acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Kostić Tomislav

    2009-01-01

    Full Text Available Background/Aim. Up-to-date treatment of acute myocardial infarction (AIM has been based on as early as possible establishment of circulation in ischemic myocardium whether by the use of fibrinolythic therapy and/or urgent coronary intervention which significantly changes the destiny of patients with AMI, but also increases the risk of bleeding. The aim of this study was to compare coronary flow and bleeding complications in patients with acute myocardial infarction with ST-elevation (STEMI after administration of alteplase or streptokinase. Methods. The study included 254 patients with STEMI. The group I (n = 174 received streptokinase, and the group II (n = 80 received alteplase. We followed frequency of complications such as bleeding and hypotension in the investigated groups of patients, based on the TIMI classification of bleeding, as well as the transience of infarction artery in accordance with TIMI flow. Results. The patients with myocardial infarction after administration of alteplase had statistically significantly higher coronary flow (TIMI- 3, 72.5% as compared to the patients who received streptokinase, 39.2%. Hypotension as complication of fibrynolythic therapy administration occurred in a significantly higher percentage in the group of patients who received streptokinase. There was no statistically significant difference in the appearance of major bleeding in the groups of patients who received streptokinasis and alteplase (6.9% and 7.5%, respectively. Also, there was no difference in the appearance of minor and minimal bleeding among the investigated groups of patients. Conclusion. It was shown that alteplase in a higher number of patients provided TIMI-3 coronary flow as compared to streptokinese. In comparison with streptokinase, a combination of alteplase, enoxaparin and double antiplatelet therapy enabled earlier achievement of coronary flow through previously blocked coronary artery that was more complete (higher frequency of

  2. Achilles tendon rupture: physiotherapy and endoscopy-assisted surgical treatment of a common sports injury.

    Science.gov (United States)

    Doral, Mahmut Nedim; Bozkurt, Murat; Turhan, Egemen; Dönmez, Gürhan; Demirel, Murat; Kaya, Defne; Ateşok, Kıvanç; Atay, Ozgür Ahmet; Maffulli, Nicola

    2010-12-13

    Although the Achilles tendon (AT) is the strongest tendon in the human body, rupture of this tendon is one of the most common sports injuries in the athletic population. Despite numerous nonoperative and operative methods that have been described, there is no universal agreement about the optimal management strategy of acute total AT ruptures. The management of AT ruptures should aim to minimize the morbidity of the injury, optimize rapid return to full function, and prevent complications. Since endoscopy-assisted percutaneous AT repair allows direct visualization of the synovia and protects the paratenon that is important in biological healing of the AT, this technique becomes a reasonable treatment option in AT ruptures. Furthermore, Achilles tendoscopy technique may decrease the complications about the sural nerve. Also, early functional postoperative physiotherapy following surgery may improve the surgical outcomes.

  3. Impact of NOD2 polymorphisms on infectious complications following chemotherapy in patients with acute myeloid leukaemia.

    Science.gov (United States)

    Yomade, Olaposi; Spies-Weisshart, Bärbel; Glaser, Anita; Schnetzke, Ulf; Hochhaus, Andreas; Scholl, Sebastian

    2013-08-01

    We sought to investigate the relationship between polymorphisms of the NOD2 gene and infectious complications following intensive induction chemotherapy in patients with acute myeloid leukaemia (AML). We hypothesised that single nucleotide polymorphisms (SNPs) of the NOD2 gene are associated with a higher rate of infections during the phase of severe neutropenia. In 131 AML patients receiving induction therapy, the presence of the three most frequent polymorphisms of NOD2 (Arg702Trp, Gly908Arg, Leu1007fsinsC) was analysed. SNP analyses by means of genomic PCR incorporating fluorescence-labelled probes with characteristic melting curves were performed using the LightCycler platform. Our data suggest a significantly lower probability of mucositis or enteritis in AML patients lacking any of the three evaluated NOD2 polymorphisms. Furthermore, bloodstream cultures of AML patients carrying either a missense or a frameshift mutation of NOD2 were significantly more frequently tested positive concerning Streptococcus spp. In contrast, the presence of NOD2 polymorphisms had no impact on such important infectious complications as systemic inflammatory response syndrome or sepsis, the rate of central venous catheter infections or the incidence of pneumonia including fungal infections. Our data represent one of the first reports investigating the impact of polymorphisms of the innate immune system on infectious complications in patients with neutropenia following chemotherapy. A correlation between NOD2 polymorphisms and infectious events in AML patients is demonstrated.

  4. Clinical features, acute complications, and outcome of Salmonella meningitis in children under one year of age in Taiwan

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    Lee Meng-Luen

    2011-01-01

    Full Text Available Abstract Background Salmonella meningitis remains a threat to children below two years of age in both developing and developed countries. However, information on such infections has not been well characterized. We analyzed data related to twelve years of experience in order to clarify the comprehensive features of Salmonella meningitis in our patients, including admission characteristics, acute complications, and long-term outcome. Methods The records of patients with spontaneous Salmonella meningitis from 1982 to 1994 were retrospectively reviewed. The long-term outcome was prospectively determined for survivors at school age by the developmental milestones reported by their parents and detailed neurological evaluation along with intelligence, hearing, visual, speech and language assessments. Results Of the twenty-four patients, seizures were noted in fifteen (63% before admission and thirteen (54% during hospitalization. Acute complications mainly included hydrocephalus (50%, subdural collection (42%, cerebral infarction (33%, ventriculitis (25%, empyema (13%, intracranial abscess (8%, and cranial nerve palsy (8%. Three patients (13% died during the acute phase of Salmonella meningitis. The twenty-one survivors, on whom we followed up at school age, have sequelae consisting of language disorder (52%, motor disability (48%, intelligence quotient Conclusion Salmonella meningitis in neonates and infants had a wide spectrum of morbidity and acute complications, leading to a complicated hospital course and subsequently a high prevalence of permanent adverse outcome. Thus, early recognition of acute complications of Salmonella meningitis and a follow-up plan for early developmental assessment of survivors are vital.

  5. Small Gallstone Size and Delayed Cholecystectomy Increase the Risk of Recurrent Pancreatobiliary Complications After Resolved Acute Biliary Pancreatitis.

    Science.gov (United States)

    Kim, Sung Bum; Kim, Tae Nyeun; Chung, Hyun Hee; Kim, Kook Hyun

    2017-03-01

    Acute biliary pancreatitis (ABP) is a severe complication of gallstone disease with considerable mortality, and its recurrence rate is reported as 50-90% for ABP patients who do not undergo cholecystectomy. However, the incidence of and risk factors for recurrent pancreatobiliary complications after the initial improvement of ABP are not well established in the literature. The aims of this study were to determine the risk factors for recurrent pancreatobiliary complications and to compare the outcomes between early (within 2 weeks after onset of pancreatitis) and delayed cholecystectomy in patients with ABP. Patients diagnosed with ABP at Yeungnam University Hospital from January 2004 to July 2016 were retrospectively reviewed. The following risk factors for recurrent pancreatobiliary complications (acute pancreatitis, acute cholecystitis, and acute cholangitis) were analyzed: demographic characteristics, laboratory data, size and number of gallstones, severity of pancreatitis, endoscopic sphincterotomy, and timing of cholecystectomy. Patients were categorized into two groups: patients with recurrent pancreatobiliary complications (Group A) and patients without pancreatobiliary complications (Group B). Of the total 290 patients with ABP (age 66.8 ± 16.0 years, male 47.9%), 56 (19.3%) patients developed recurrent pancreatobiliary complications, of which 35 cases were acute pancreatitis, 11 cases were acute cholecystitis, and 10 cases were acute cholangitis. Endoscopic sphincterotomy and cholecystectomy were performed in 134 (46.2%) patients and 95 (32.8%) patients, respectively. Age, sex, BMI, diabetes, number of stone, severity of pancreatitis, and laboratory data were not significantly correlated with recurrent pancreatobiliary complications. The risk of recurrent pancreatobiliary complications was significantly increased in the delayed cholecystectomy group compared with the early cholecystectomy group (45.5 vs. 5.0%, p gallstone less than or equal to 5

  6. STUDY OF CLINICAL PROFILE OF DENGUE FEVER WITH SPECIAL REFERENCE TO ACUTE COMPLICATIONS

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    Keshava

    2014-02-01

    Full Text Available ABSTRACT: Dengue is the arthropode borne viral infection transmitted by mosquitoes to humans. AIM: To study the various clinical manifestations and acute complications of dengue fever. METHODS: 100 cases of confirmed dengue infection admitted to KIMS, Bangalore between December 2009 and September 2011 were studied. A detailed clinical history and physical examination was done and baseline investigations were performed. The cases were followed-up daily for the clinical and laboratory parameters and were treated according to WHO guidelines. The data related to each of these cases was collected, compiled and analyzed. RESULTS: of the total 100 cases there were 61 male and 39 female. Age group of 21-30 (41 was most commonly affected Maximum number of patients was seen in the September, October, august, July. Commonest presentation was Fever (100% followed by Headache (78%, Myalgia (70%, Arthralgia (66%, low back ache (60%. On examination patients found to have icterus (22%, bleeding spots (26%, rashes (50%, Splenomegaly (18%, Hepatomegaly (15% and Ascites (9%, pleural effusion (16%, crepitations (7%. Platelet count was not very well correlated with the bleeding tendencies. Incidence of DHF was more with secondary Dengue infection than the primary dengue infection. The frequency of complications was high in the patients with secondary dengue infection than the primary infection. CONCLUSION: In our present study classical dengue fever was most common presentation followed by DHF and DSS. Hypotension, hemorrhagic spots, positive tourniquet test, jaundice, pleural effusion, ascites, neck stiffness are the common findings on examination associated with complicated forms of dengue. Bleeding, shock, hepatitis, polyserositis, meningitis, pneumonia are the complications seen in severe forms. On investigation Deranged liver function test, renal function test, secondary dengue infection, thickened gall bladder wall, hepatosplenomegaly on ultrasound abdomen

  7. Acute morbidity and complications of thigh compartment syndrome: A report of 26 cases

    Science.gov (United States)

    2010-01-01

    Background To describe the patient population, etiology, and complications associated with thigh compartment syndrome (TCS). TCS is a rare condition, affecting less than 0.3% of trauma patients, caused by elevated pressure within a constrained fascial space which can result in tissue necrosis, fibrosis, and physical impairment in addition to other complications. Compartment releases performed after irreversible tissue ischemia has developed can lead to severe infection, amputation, and systemic complications including renal insufficiency and death. Methods This study examines the course of treatment of 23 consecutive patients with 26 thigh compartment syndromes sustained during an eight-year period at two Level 1 trauma centers, each admitting more than 2,000 trauma patients yearly. Results Patients developing TCS were young (average 35.4 years) and likely to have a vascular injury on presentation (57.7%). A tense and edematous thigh was the most consistent clinical exam finding leading to compartment release (69.5%). Average time from admission to the operating room was 18 +/- 4.3 hours and 8/23 (34.8%) were noted to have ischemic muscle changes at the time of release. Half of those patients (4/8) developed local complications requiring limb amputations. Conclusion TCS is often associated with high energy trauma and is difficult to diagnose in uncooperative, obtunded and multiply injured patients. Vascular injuries are a common underlying cause and require prompt recognition and a multidisciplinary approach including the trauma and orthopaedic surgeons, intensive care team, vascular surgery and interventional radiology. Prompt recognition and treatment of TCS are paramount to avoid the catastrophic acute and long term morbidities. PMID:20723263

  8. Inter ventional therapy of diabetes mellitus type 2 complicated with acute cerebral hemorrhage by using dexmedetomidine

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    Shan-Shan Zheng

    2016-09-01

    Full Text Available Objective: To study the effects of dexmedetomidine on cerebral injury, inflammation, oxidative stress and renal function of patients with diabetes mellitus type 2 complicated with acute cerebral hemorrhage. Methods: A total of 98 cases who had been diagnosed with diabetes mellitus type 2 complicated with acute cerebral hemorrhage and treated with interventional therapy in Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from September 2014 January 2016 were chosen to be our study subjects. Among them, 50 cases given dexmedetomidine treatment in the process of anesthesia were included in the dexmedetomidine group (Group A, while the other 48 cases treated with equal amount of normal saline were considered as the negative control group. The postoperative cerebral injury indexes and the serum biochemical indexes were detected after 24 h. Results: The contents of serum S100b [(2.1 ± 0.2 mg/L] and neuron-specific enolase (NSE [(14.2 ± 1.3 mg/mL] in Group A were all significantly lower than serum S100b [(2.9 ± 0.3 mg/L] and NSE [(16.6 ± 1.7 mg/mL] of patients in negative control group. The contents of cerebrospinal fluid S100b [(0.9 ± 0.1 mg/L] and NSE [(10.7 ± 1.3 mg/ mL] in Group A were all significantly lower than cerebrospinal fluid S100b [(1.3 ± 0.2 mg/L] and NSE [(15.3 ± 1.7 mg/mL] of patients in negative control group. The contents of erythrocyte sedimentation rate [(11.7 ± 2.5 mm/h], c-reactive protein [(2.3 ± 0.4 mg/L], urea nitrogen [(10.7 ± 1.2 mmol/L] and serum creatinine [(151.6 ± 14.9] mmol/L in Group A were all significantly lower than erythrocyte sedimentation rate [(23.6 ± 3.8 mm/h], c-reactive protein [(6.9 ± 1.1 mg/L], urea nitrogen [(16.7 ± 1.7 mmol/L] and serum creatinine [(192.5 ± 18.3] mmol/L of patients in negative control group. Conclusions: The application of dexmedetomidine in the interventional therapy of diabetes mellitus type 2 complicated with acute cerebral hemorrhage could

  9. Interventional therapy of diabetes mellitus type 2 complicated with acute cerebral hemorrhage by using dexmedetomidine

    Institute of Scientific and Technical Information of China (English)

    Shan-Shan Zheng; Xin-Ye Qian; Si-Yuan Li; Xuan Zhao

    2016-01-01

    Objective: To study the effects of dexmedetomidine on cerebral injury, inflammation, oxidative stress and renal function of patients with diabetes mellitus type 2 complicated with acute cerebral hemorrhage. Methods: A total of 98 cases who had been diagnosed with diabetes mellitus type 2 complicated with acute cerebral hemorrhage and treated with interventional therapy in Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from September 2014 January 2016 were chosen to be our study subjects. Among them, 50 cases given dexmedetomidine treatment in the process of anesthesia were included in the dexmedetomidine group (Group A), while the other 48 cases treated with equal amount of normal saline were considered as the negative control group. The postoperative cerebral injury indexes and the serum biochemical indexes were detected after 24 h. Results: The contents of serum S100b [(2.1 ± 0.2) mg/L] and neuron-specific enolase (NSE) [(14.2 ± 1.3) mg/mL] in Group A were all significantly lower than serum S100b [(2.9 ± 0.3) mg/L] and NSE [(16.6 ± 1.7) mg/mL] of patients in negative control group. The contents of cerebrospinal fluid S100b [(0.9 ± 0.1) mg/L] and NSE [(10.7 ± 1.3) mg/mL] in Group A were all significantly lower than cerebrospinal fluid S100b [(1.3 ± 0.2) mg/L] and NSE [(15.3 ± 1.7) mg/mL] of patients in negative control group. The contents of erythrocyte sedimentation rate [(11.7 ± 2.5) mm/h], c-reactive protein [(2.3 ± 0.4) mg/L], urea nitrogen [(10.7 ± 1.2) mmol/L] and serum creatinine [(151.6 ± 14.9)] mmol/L in Group A were all significantly lower than erythrocyte sedi-mentation rate [(23.6 ± 3.8) mm/h], c-reactive protein [(6.9 ± 1.1) mg/L], urea nitrogen [(16.7 ± 1.7) mmol/L] and serum creatinine [(192.5 ± 18.3)] mmol/L of patients in negative control group. Conclusions: The application of dexmedetomidine in the interventional therapy of diabetes mellitus type 2 complicated with acute cerebral hemorrhage could

  10. Complete rupture of the anterolateral papillary muscle caused by coronary spasm.

    Science.gov (United States)

    Yamazaki, Masataka; Fukui, Toshihiro; Mahara, Keitaro; Takanashi, Shuichiro

    2015-12-01

    Papillary muscle rupture usually occurs as a catastrophic complication of acute myocardial infarction in patients with coronary artery stenosis; it is therefore less common in patients without coronary artery stenosis. We report the case of a 67-year old woman without coronary artery stenosis who suffered an acute anterolateral papillary muscle rupture and was successfully treated with mitral valve replacement. Evidence of coronary spasm was found on a coronary vasomotion test, suggesting that a high sensitivity to coronary spasm may explain a mechanism of isolated papillary muscle infarction.

  11. Ruptur af fri venstre ventrikelvaeg, septum og papillaermuskler ved akut myokardieinfarkt

    DEFF Research Database (Denmark)

    Kjeld, Thomas; Hassager, Christian; Hjortdal, Vibeke E.

    2009-01-01

    The risk of complications to acute myocardial infarction (AMI), such as cardiogenic shock, is 5-10%. The cause is often left heart failure and sometimes right heart failure, but it can be mechanical AMI complications (MCA) in the form of rupture of the left ventricle and papillary muscle rupture....... This risk of MCA can be reduced by sufficient revascularisation, but these rare differential diagnoses to cardiogenic shock remain important. Echocardiography is the diagnostic gold standard. First line treatment is medical and often mechanical stabilization, but this should not delay quick surgical...

  12. Mini-invasive treatmentof acute closed Achilles tendon ruptures with the rivet with thread%微创带线铆钉治疗新鲜闭合性跟腱断裂

    Institute of Scientific and Technical Information of China (English)

    张楠; 丁亮华; 张晨然; 何双华; 张爱梁; 马文明

    2013-01-01

    ObjectiveTo analyze the clinical effects of the mini-invasive treatment of acute closed achilles tendon ruptures with the rivet with thread. MethodsTotally 32 case of acute closed achilles tendon ruptures were treated by the rivet with thread,including 27 males and 5 females. The plantar flexion angle was compared before and after operation. Postoperative follow-up including the healing of skin incision, improvement of heal pain and re-ruptures. AOFAS-AH score was used to evaluate the functional recovery of the sick ankle joint. ResultsThe process of the operation was smooth going without the injury of major vessel and nerve. All patients were followed up for 19-30 months(average 23.6±4.5). Wound heal well without infection and skin necrosis and there was no heel pain and re-ruptures occurred. All patients with good ankle flexion and extension. ConclusionThe clinical effects are valid because of its lesser incidence rate of complication such as re-ruptures, lesser invasive treatment, convenient for clinical application .%目的:探讨采用经皮带线铆钉治疗新鲜闭合性跟腱断裂的临床疗效。方法采用微创带线铆钉治疗新鲜闭合性跟腱断裂32例,其中男27例,女5例,术后随访伤口愈合、足跟疼痛、跟腱再断裂及患侧踝关节功能恢复情况,比较患者手术前后患足跖屈角度差异,采用美国足踝医师协会踝与后足功能评分(AOFAS-AH评分)评估手术前后踝关节功能。结果手术顺利,术中未发生重要血管、神经等组织结构的损伤,所有患者均得到随访,随访时间19~30个月(23.6±4.5)个月,伤口愈合良好未见感染及皮肤坏死,无足跟疼痛和跟腱再断裂发生,踝关节屈伸活动良好。手术前后患足跖屈角度及AOFAS评分差异有统计学意义(P<0.05)。结论经皮带线铆钉治疗急性闭合性跟腱断裂效果良好并可降低跟腱再断裂等并发症的发生率,其具有手术创伤小

  13. [Effectiveness of various dopamine doses in acute myocardial ischemia complicated by cardiogenic shock (an experimental study)].

    Science.gov (United States)

    Kipshidze, N N; Korotkov, A A; Marsagishvili, L A; Prigolashvili, T Sh; Bokhua, M R

    1981-06-01

    The effect of various doses of dopamine on the values of cardiac contractile and hemodynamic function under conditions of acute two-hour ischemia complicated by cardiogenic shock was studied in 27 experiments on dogs. In a dose of 5 microgram/kg/min dopamine caused an optimum increase in cardiac productive capacity, reduction of peripheral resistance, adequate increase in coronary circulation and decrease in ST segment depression on the ECG. Infusion of 10 microgram/kg/min dopamine usually caused myocardial hyperfunction with an increase in total peripheral resistance and cardiac performance. Maximum dopamine doses (10 microgram/kg/min and more) were effective in the areactive form of cardiogenic shock. In longterm dopamine infusion it is necessary to establish continuous control over the hemodynamic parameters and the ECG to prevent aggravation of ischemia and for stage-by-stage reduction of the drug concentration and determination of the minimum maintenance dose.

  14. Preservation of pre-excitation despite acute myocardial infarction complicated by complete heart block.

    Science.gov (United States)

    Boroomand, K.; Armstrong, P. W.

    1978-01-01

    In a 53-year-old man with ventricular pre-excitation (normal PR interval, QRS interval of 0.12 seconds and delta-waves) acute inferior wall myocardial infarction was complicated by, successively, first-degree atrioventricular block, second-degree atrioventricular block (Wenckebach type) and complete heart block. The QRS pattern of pre-excitation was preserved throughout these events. The classification of ventricular pre-excitation is reviewed and the correlation between the various electrocardiographic patterns (the Wolff-Parkinson-White syndrome and its variants and the Lown-Ganong-Levine syndrome) and the anomalous conduction pathways of Kent, James and Mahaim are discussed. In this case the best possible explanation for preservation of pre-excitation during complete heart block was the existence of accessory fibres of Mahaim. Images FIG. 1 FIG. 2 FIG. 3 FIG. 4 FIG. 5 FIG. 6 FIG. 7 PMID:679113

  15. An Unusual Complication of Acute Necrotising Pancreatitis Detected by Endoscopic Ultrasound

    Directory of Open Access Journals (Sweden)

    Surinder Singh Rana

    2014-05-01

    Full Text Available A 32 year old male patient diagnosed as alcohol related acute necrotising pancreatitis (ANP 2 months ago, now presented with abdominal pain and early satiety. Contrast enhanced computerized tomography (CECT showed 12 cm walled off pancreatic necrosis (WOPN (Figure 1. Endoscopic ultrasound (EUS revealed large WOPN and power doppler revealed vascularity in collection with pulsatile flow suggestive of blood leaking into collection (Figure 2. However, no abnormal vessel or pseudoaneurysm could be identified. CT angiography (CTA also showed normal major abdominal arteries (Figure 3. Since patient was symptomatic, after informed consent EUS guided transmural drainage was attempted. Now there was no vascularity in collection and procedure was successfully accomplished. A 7 Fr nasocystic drain (NCD was inserted and it drained purulent material. Patient had marked symptomatic relief but 6 hours later had severe pain and hematemesis with blood coming through NCD also. CTA revealed blood in WOPN but no abnormal bleeding vessel was identified (Figure 4. Digital subtraction angiography (DSA also did not reveal any abnormal or bleeding vessel. The patient was managed with blood transfusion and NCD was kept patent by intermittent flushing. The bleeding subsided and the effluent from NCD cleared in 48 hours. The NCD was replaced with 10 Fr pigtail stents and CT abdomen done 3 weeks later revealed resolution of WOPN (Figure 5. The patient has been asymptomatic over a follow up period of 13 months. Gastrointestinal bleeding is rare but potentially lethal complication of acute pancreatitis as well as of transmural drainage of pancreatic collections [1, 2, 3]. CTA is the most common procedure used to detect pseudoaneurysms but it can miss them if they are small or bleeding is intermittent and slow because of compression by collection [4, 5]. In these situations, EUS can help in detecting this potentially catastrophic complication of pancreatitis.

  16. Hemoperitoneo masivo consecutivo a perforación espontánea de la vesícula biliar: A propósito de un caso de muerte súbita Massive haemoperitoneum as a complication of spontaneous rupture of the gallbladder: Report of a sudden death

    Directory of Open Access Journals (Sweden)

    P.M. Garamendi

    2002-04-01

    Full Text Available Se presenta un caso de hemoperitoneo masivo consecutivo a perforación espontánea de la vesícula biliar asociada con colelitiasis, obstrucción del conducto cístico y colecistitis aguda hemorrágica que produjo como primera manifestación la muerte súbita en un varón adulto. En la literatura médica este tipo de situación clínica y anatomopatológica es excepcional. Los casos descritos de perforaciones espontáneas de la vesícula biliar con hemoperitoneo asociado son menos de 50 desde 1858. Desde 1952 solo existe otra referencia de 1991 de un hallazgo similar, aunque no asociado a colelitiasis, como causa de muerte súbita.We report a case of sudden death due to massive haemoperitoneum as a complication of spontaneous rupture of the gallbladder associated with cholelithiasis, obstruction of the cystic duct and acute haemorrhagic cholecystitis. Death occurred in an adult male previously asymptomatic. This is an unusual circumstance in the medical literature. Since 1858, less than 50 cases of spontaneous rupture of the gallbladder associated with haemoperitoneum have been reported. Since 1952, there is only one other case of sudden death with this clinical condition, reported in 1991, but not associated with cholelithiasis.

  17. 未足月妊娠胎膜早破并发早产108例临床分析%Clinical Analysis of 108 Cases with Preterm Premature Rupture of Mem-brane Complicated by Premature Delivery

    Institute of Scientific and Technical Information of China (English)

    程宝珠

    2016-01-01

    Objective To study the relevant treatment method and application effect of preterm premature rupture of mem-brane complicated by premature delivery. (Pregnant week was between 28 weeks to 34 weeks). Methods The clinical data of 108 cases of patients with preterm premature rupture of membrane complicated by premature delivery admitted and treated in out-patient department of our hospital were retrospectively analyzed, and the pathogenic factors of premature rupture of membranes, delivery method and general conditions of perinatal infants were analyzed. Results Vaginitis was a very com-mon cause of premature rupture of membranes, the incubation period of premature rupture of membranes was 2h-16d, (6.2± 1.3)d on average;and the difference in the A p-g a r score of perinatal infants between two delivery methods had no statis-tical significance by comparison (P>0.05); the differences in the incidence rate of complications of perinatal infants and death rate between the pregnant women whose pregnant weeks were between 28 weeks and 30 weeks and the pregnant women whose pregnant weeks were between 31 weeks and 34 weeks had statistical significance by comparison, (all P0.05);针对孕周处于28周与30周的孕产妇和孕周处于31周与34周的孕产妇,这两组围产儿并发症的发生率和死亡率相比,比较差异有统计学的意义(由于P<0.05)。结论要及时地借助于期待疗法对未足月妊娠胎膜早破并发早产患者进行治疗,在孕产妇破膜后,医务人员要适时给予其适量的宫缩抑制剂、糖皮质激素和抗生素等药物,以使孕产妇的潜伏期能够有效延长到孕30周以上,从而可以有效地降低早产儿的死亡率。

  18. Prediction value of the ratio of serum high-sensitivity C-reactive protein and prealbumin on acute myocardial infarction complicated with acute heart failure

    Institute of Scientific and Technical Information of China (English)

    Su-Yun Zu; Shuang Wang; Feng-Lan Yang; Bao-Gui Chen; Ming-Zhe Ma

    2015-01-01

    Objective:To through counting serum high-sensitivity C-reactive protein (hs-CRP), prealbumin (PAB) and the ratio of the two to analyze its predictive value on acute myocardial infarction complicated with postoperative acute heart failure.Methods: 100 cases of acute myocardial infarction patients treated in our hospital from January 2013 to January 2015 were selected as research objects. Serum PAB and hs-CRP values on the next day of admission as well as after PCI surgery were recorded respectively. Then PAB data change before and after surgery, PAB and hs-CRP change with or without postoperative cardiovascular events (heart failure) as well as the value of the ratio of hs-CRP and PAB on prediction of acute myocardial infarction complicated with acute heart failure was compared.Results:Postoperative PAB in 100 cases of myocardial infarction patients increased from (0.19±0.05) to (0.24±0.06), and the differences had statistical significance; 40 cases had postoperative cardiovascular events (heart failure), incidence being 40%; PAB in patients without postoperative cardiovascular events (heart failure) increased significantly, hs-CRP decreased significantly, and the differences had statistical significance; Logistic regression univariate analysis showed that acute myocardial infarction complicated with heart failure was associated with diabetes, PAB, hs-CRP and In (hs-CRP/PAB), and multivariate analysis showed that it was associated with In (hs-CRP/PAB). Conclusion:hs-CRP in patients with acute myocardial infarction increases, PAB decreases, postoperative PAB increases relatively, hs-CRP and PAB data shows different degrees of change with or without postoperative cardiovascular (heart failure), and In (hs-CRP/PAB) is associated with acute myocardial infarction complicated with heart failure and can be used as its prediction index.

  19. Preoperative assessment and treatment of appendiceal mucocele complicated by acute torsion: a case report.

    Science.gov (United States)

    Stark, Christoffer; Jousi, Mikko; Enholm, Berndt

    2014-01-02

    Mucus-producing tumours of the appendix or mucoceles can, if left untreated, lead to dissemination of its contents into the peritoneal cavity causing substantial morbidity to the patient. Symptoms for complicated mucoceles can mimic those of acute appendicitis and the final diagnosis is most likely made intraoperatively. We here present a case that is, to our knowledge, one of only ten described in the literature and the first to characterize torsion of an appendiceal mucocele with abdominal magnetic resonance imaging. The patient, a 34-year-old Caucasian female presented at the emergency department with acute abdominal pain in the right lower quadrant. Initial diagnostic work-up including ultrasonography and abdominal magnetic resonance imaging showed a large tubular mass at the base of the appendix with indirect signs of torsion. A laparoscopic appendectomy was performed the following day where the finding was confirmed. The patient went on to have an uneventful recovery and was discharged from the hospital on the first postoperative day. Magnetic resonance imaging is a useful tool in identifying unknown lesions of the appendix and should be considered the primary imaging modality in especially younger patients requiring diagnostic imaging. In this case the preoperative imaging findings aided in choosing the correct timing and treatment option for the patient.

  20. Boxing-acute complications and late sequelae: from concussion to dementia.

    Science.gov (United States)

    Förstl, Hans; Haass, Christian; Hemmer, Bernhard; Meyer, Bernhard; Halle, Martin

    2010-11-01

    Boxing has received increased public attention and acceptance in recent years. However, this development has not been accompanied by a critical discussion of the early and late health complications. We selectively review recent studies on the acute, subacute, and chronic neuropsychiatric consequences of boxing. Cerebral concussions ("knock-outs") are the most relevant acute consequence of boxing. The number of reported cases of death in the ring seems to have mildly decreased. Subacute neuropsychological deficits appear to last longer than subjective symptoms. The associated molecular changes demonstrate neuronal and glial injury correlated with the number and severity of blows to the head (altered total tau, beta-amyloid, neurofilament light protein, glial fibrillary acidic protein, and neuron-specific enolase). The risk of a punch-drunk syndrome (boxer's dementia, dementia pugilistica) as a late effect of chronic traumatic brain injury is associated with the duration of a boxer's career and with his earlier stamina. There are similarities (e.g. increased risk with ApoE4-polymorphism, beta-amyloid pathology) and differences (more tau pathology in boxers) compared with Alzheimer's disease. Protective gear has led to a remarkable reduction of risks in amateur boxing. Similar measures can also be used in professional boxing, but may decrease the thrill, which does appeal to many supporters.

  1. [Amebic colitis and liver abscess complicated by high serum procalcitonin in acute myeloid leukemia].

    Science.gov (United States)

    Oku, Eijiro; Nomura, Kei; Nakamura, Takayuki; Morishige, Satoshi; Seki, Ritsuko; Imamura, Rie; Hashiguchi, Michitoshi; Osaki, Kouichi; Mizuno, Shinichi; Nagafuji, Koji; Okamura, Takashi

    2012-11-01

    We present a case of amebic colitis and liver abscess complicated by acute myeloid leukemia (AML) with high serum procalcitonin (PCT). A 61-year-old Japanese man seen at our hospital for severe diarrhea and high fever was found to have multiple ulcers in the transverse and sigmoid colon and rectum by colonoscopy and biopsies were conducted. Immature leukocytes with mild anemia and thrombocytopenia were seen in peripheral blood, necessitating bone marrow aspiration and biopsy that yielded a diagnosis of AML (FAB M4Eo). Serum C-reactive protein and PCT were extremely elevated. Blood cultures for bacteria and fungi were negative. Multiple low-density areas in the liver were found in abdominal computed tomography. Histological colon biopsy findings revealed amebic colitis, strongly suggesting amebic liver abscess. Metronidazole treatment was initiated for amebiasis and subsequent standard chemotherapy for AML was followed after fever was lowered. Hematological and cytogenetic CR was maintained with good clinical condition. Few case reports have been published in Japan to date on amebic colitis and liver abscess complicated by AML and no reports have been made on PCT elevation caused by amebiasis. In conclusion, differential diagnosis of amebiasis is necessary in addition to that of bacterial or fungal infection in serum PCT elevation.

  2. Complicated Cholelithiasis: An Unusual Combination of Acute Pancreatitis and Bouveret Syndrome

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    Ioannis Baloyiannis

    2012-07-01

    Full Text Available Bouveret syndrome is a rare form of gallstone ileus. The purpose of the present study was to present the unusual case of a female patient with complicated cholelithiasis manifested as a combination of acute pancreatitis and concomitant Bouveret syndrome. A 61-year-old female patient was admitted to the emergency department complaining of mid-epigastric and right upper quadrant abdominal pain radiating band-like in the thoracic region of the back as well as repeated episodes of vomiting over the last 24 h. The initial correct diagnosis of pancreatitis was subsequently combined with the diagnosis of Bouveret syndrome as a computed tomography scan revealed the presence of a gallstone within the duodenum causing luminal obstruction. After failure of endoscopic gallstone removal, a surgical approach was undertaken where gallstone removal was followed by cholecystectomy and restoration of the anatomy by eliminating the fistula. The concomitant pancreatitis complicated the postoperative period and prolonged the length of hospital stay. However, the patient was discharge on the 45th postoperative day. Attempts for endoscopic removal of the impacted stone should be the initial therapeutic step. Surgery should be reserved for cases refractory to endoscopic intervention and when definite treatment is the actual challenge.

  3. In-hospital medical complications associated with patient dependency after acute ischemic stroke: data from the China National Stroke Registry

    Institute of Scientific and Technical Information of China (English)

    WANG Peng-lian; ZHAO Xing-quan; DU Wan-liang; WANG An-xin; JI Rui-jun; YANG Zhong-hua; WANG Chun-xue

    2013-01-01

    Background The mortality of stroke patients is strongly affected by medical complications.However,there are limited data investigating the effect of in-hospital medical complications on the dependency of stroke patients worldwide.We prospectively and systematically investigated the effect of medical complications on dependency of patients at 3,6 and 12 months after stroke using the China National Stroke Registry (CNSR).Methods This prospective cohort study collected data of patients age >18 years with acute ischemic stroke in 132 clinical centers distributed across 32 provinces and four municipalities (including Hong Kong region) of China,from September 2007 to August 2008.Data on medical complications,dependency and other information were obtained from paper-based registry forms.Medical complications associated with stroke outcomes were assessed using multivariable Logistic regression.Results Of 11 560 patients with acute ischemic stroke,1826 (15.80%) presented with in-hospital medical complications.In-hospital medical complications were independent risk factors for dependency of patients at 3 months (adjusted odds ratio (OR) 2.367,95% confidence interval (CI) 2.021-2.771),6 months (adjusted OR 2.257,95% CI 1.922-2.650),and 12 months (adjusted OR 1.820,95% CI 1.538-2.154) after acute ischemic stroke.Conclusion The results demonstrated that the short-term and long-term dependency of acute ischemic stroke patients is significantly associated with in-hospital medical complications in China.

  4. Viscosupplementation of the knee: Three cases of acute Pseudoseptic Arthritis with painful and irritating complications and a literature review

    Science.gov (United States)

    Aydın, Murat; Arıkan, Murat; Toğral, Güray; Varış, Onur; Aydın, Güle

    2017-01-01

    Acute pseudoseptic arthritis is a very rare complication that is associated with intra-articular hyaluronic acid injections, which normally involve minimal risk. The most common adverse events that are caused by hyaluronic acid injections are inflammatory reactions or flares at the injection site. In this study, we described three cases of acute pseudoseptic arthritis that was caused by hyaluronic acid; the symptoms in these cases were reminiscent of acute septic arthritis. Moreover, we performed a literature review on pseudoseptic arthritis following hyaluronic acid injections to determine the manner in which this condition can be described, diagnosed, and treated. PMID:28293455

  5. A case of Clostridium difficile infection complicated by acute respiratory distress syndrome treated with fecal microbiota transplantation.

    Science.gov (United States)

    Kim, Ji Eun; Gweon, Tae-Geun; Yeo, Chang Dong; Cho, Young-Seok; Kim, Gi Jun; Kim, Jae Young; Kim, Jong Wook; Kim, Hyunho; Lee, Hye Won; Lim, Taeseok; Ham, Hyoju; Oh, Hyun Jin; Lee, Yeongbok; Byeon, Jaeho; Park, Sung Soo

    2014-09-21

    Acute respiratory distress syndrome is a life-threatening disorder caused mainly by pneumonia. Clostridium difficile infection (CDI) is a common nosocomial diarrheal disease. Disruption of normal intestinal flora by antibiotics is the main risk factor for CDI. The use of broad-spectrum antibiotics for serious medical conditions can make it difficult to treat CDI complicated by acute respiratory distress syndrome. Fecal microbiota transplantation is a highly effective treatment in patients with refractory CDI. Here we report on a patient with refractory CDI and acute respiratory distress syndrome caused by pneumonia who was treated with fecal microbiota transplantation.

  6. Achilles tendon rupture; assessment of nonoperative treatment

    DEFF Research Database (Denmark)

    Barfod, Kristoffer Weisskirchner; Troelsen, Anders

    2014-01-01

    BACKGROUND: Acute Achilles tendon rupture is a frequent and potentially disabling injury. Over the past decade a change in treatment ofacute Achilles tendon rupture away from operative towards non-operative treatment has taken place. However, the optimal non-operative treatment protocol remains...... and Sweden. Immediate weight-bearing was found to be safe and recommendable in non-operative treatment of acute Achilles tendon rupture. The novel ultrasound measurement showed excellent reliability and acceptable validity and agreement....

  7. Early Diagnosis and Treatment of Premature Rupture of Membranes Complicated by Placental Abruption%胎膜早破并发胎盘早剥的早期诊治分析

    Institute of Scientific and Technical Information of China (English)

    朱永宁

    2016-01-01

    Objective The premature rupture of membranes complicated with placental abruption early clinical diagnosis and treatment research.Method 40 cases of premature rupture of membranes in our hospital from June 2011 to June 2014 were abruption as the object of study, of which 15 cases complicated with premature rupture of membranes, 27 cases did not appear placental abruption, the clinical data of all patients were retrospectively analyzed.Results The main cause is the inducement of placental abruption placental abruption, followed by gestational hypertension; patients with placental abruption occurred in 8.02% of premature rupture of membranes.Conclusion In clinical practice, premature rupture of membranes is one of the important factors of placental abruption, therefore, should be closely in patients with clinical manifestations, and strengthen the monitoring of fetal heart rate and B ultrasound examination, for early detection, early treatment, and protect the mother and child health.%目的:对胎膜早破并发胎盘早剥的早期临床诊治进行探究。方法择选我院2011年6月至2014年6月所收治的40例胎膜早剥作为研究的对象,其中有15例并发胎膜早破,27例未出现胎盘早剥,对全部患者的临床资料进行回顾性分析。结果引发胎盘早剥的主要诱因是胎盘早剥,其次是妊娠期高血压;胎膜早破患者发生胎盘早剥的发生率为8.02%。结论在临床上,胎膜早破是诱发胎盘早剥的一个重要因素,因此,应密切患者的临床表现,且加强胎心监护与B超检查,以便及早发现、及早治疗,继而保障母婴的生命健康。

  8. Clinical correlates of complicated grief among individuals with acute coronary syndromes

    Directory of Open Access Journals (Sweden)

    Pini S

    2015-10-01

    Full Text Available Stefano Pini,1 Camilla Gesi,1 Marianna Abelli,1 Alessandra Cardini,1 Lisa Lari,1 Francesca Felice,2 Rossella Di Stefano,2 Gianfranco Mazzotta,3 Francesco Bovenzi,4 Daniele Bertoli,5 Lucia Borelli,4 Paola Michi,1 Claudia Oligeri,3 Alberto Balbarini,2 Vijaya Manicavasagar6 1Department of Clinical and Experimental Medicine, Psychiatry Sector, University of Pisa, Pisa, 2Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, 3Unit of Cardiology, Ospedale Sant’Andrea, La Spezia, 4Cardio-Respiratory Department, Ospedale Campo di Marte, Lucca, 5Unit of Cardiology, Ospedale San Bartolomeo, Sarzana (SP, Italy; 6Black Dog Institute, University of New South Wales, Sydney, NSW, Australia Objective: The study aimed at exploring bereavement and complicated grief (CG symptoms among subjects without a history of coronary heart disease (CHD at the time of a first acute coronary syndrome (ACS and to evaluate the relationship of CG symptoms and ACS. Method: Overall, 149 subjects with ACS (namely, acute myocardial infarct with or without ST-segment elevation or unstable angina, with no previous history of CHD, admitted to three cardiac intensive care units were included and evaluated by the Structured Clinical Interview for Complicated Grief (SCI-CG, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, and the 36-item Short-Form Health Survey (MOS-SF-36. Results: Of the total sample of 149 subjects with ACS, 118 (79.2% met criteria for DSM-5 persistent complex bereavement disorder. Among these, subjects who lost a partner, child, or sibling were older (P=0.008, less likely to be working (P=0.032, and more likely to be suffering from hypertension (P=0.021, returned higher scores on the SCI-CG (P=0.001 and developed the index ACS more frequently between 12 and 48 months after the death than those who lost a parent or another relative (P≤0.0001. The occurrence of ACS 12–48 months (P=0.019 after the loss was

  9. Strike-parallel and strike-normal coordinate system around geometrically complicated rupture traces: use by NGA-West2 and further improvements

    Science.gov (United States)

    Spudich, Paul A.; Chiou, Brian

    2015-01-01

    We present a two-dimensional system of generalized coordinates for use with geometrically complex fault ruptures that are neither straight nor continuous. The coordinates are a generalization of the conventional strike-normal and strike-parallel coordinates of a single straight fault. The presented conventions and formulations are applicable to a single curved trace, as well as multiple traces representing the rupture of branching faults or noncontiguous faults. An early application of our generalized system is in the second round of the Next Generation of Ground-Motion Attenuation Model project for the Western United States (NGA-West2), where they were used in the characterization of the hanging-wall effects. We further improve the NGA-West2 strike-parallel formulation for multiple rupture traces with a more intuitive definition of the nominal strike direction. We also derive an analytical expression for the gradient of the generalized strike-normal coordinate. The direction of this gradient may be used as the strike-normal direction in the study of polarization effects on ground motions.

  10. Postoperative infection in laparoscopic cholecystectomy in treatment of acute cholecystitis complicated by choleperitonitis

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    YANG Yalin

    2017-01-01

    Full Text Available ObjectiveTo investigate the influence of laparoscopic cholecystectomy (LC versus open cholecystectomy (OC on postoperative systemic infection and immune response in patients with acute cholecystitis complicated by choleperitonitis. MethodsA prospective randomized controlled trial was performed for 45 patients who had a definite diagnosis of acute calculous cholecystitis complicated by choleperitonitis in Shanghai Liqun Hospital from January 2014 to June 2016. According to surgical procedures, the patients were randomized into LC group (23 patients and OC group (22 patients. The length of hospital stay, postoperative complications, and deaths were evaluated in both groups. Blood samples were collected from all patients before surgery and at 1, 3, and 6 days after surgery to compare the changes in neutrophil count, serum levels of C-reactive protein (CRP and interleukin-6 (IL-6, and erythrocyte sedimentation rate (ESR, as well as the incidence of endotoxemia.  The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. ResultsThe LC group had a significantly shorter length of hospital stay than the OC group (5.4±2.7 d vs 10.2±3.5 d, t= -5.46, P<0.001. One patient (4.3% in the LC group and 6 (27.3% in the OC group experienced peritoneal abscess after surgery, and there was a significant difference in the incidence rate of complications between the two groups (χ2=4.77, P=0.03. In all patients, the mortality rate was 17.8% (8/45, with 1 (4.3% in the LC group and 7 (31.8% in the OC group, and there was a significant difference between the two groups (χ2= 5.16, P=0.02. Of all patients in the OC group, 4 died of peritoneal abscess, 1 died of pulmonary embolism, and 1 died of myocardial infarction; of all patients in the LC group, 1 died of myocardial infarction. There were no significant differences in inflammatory markers before surgery between the two

  11. Endovascular embolization treatment of ruptured intracranial aneurysms at the acute stage with micro - coils%微弹簧圈血管内栓塞治疗急性期破裂颅内动脉瘤

    Institute of Scientific and Technical Information of China (English)

    夏吉勇; 焦铁鹰; 李志强; 路长宇; 苗林; 郭吉卫

    2015-01-01

    Objective To investigate the efficacy and safety of the microcoil embolization treatment of ruptured intracranial aneurysms at the acute stage. Methods The clinical data of 30 cases(34 aneurysms)were retrospectively analyzed. All the patients were diagnosed as sub-arachnoid hemorrhage by CT. All cases were confirmed by DSA for intracranial aneurysms. And all of them underwent endovascular embolization within 72 hours after aneurysm rupture. Results Complete embolization was achieved in 24 of 34 aneurysms,95% embolization in 6 aneurysms, 90% embolization in 2 aneurysms,80% embolization in 2 aneurysms. The operation associated complications occurred in 6 patients. The last coil extruding into the patent artery was observed in 1 patient. Re - rupture of aneurysm during the operation in 1 patient,severe cerebral angiospasm in 2 patients and cerebral infarction in 2 patients. After operation,25 patients recovered well,4 patients with mild disability or paralysis,1 patient died of postoperative gastrointestinal bleeding. During the follow - up of 1 ~ 6 months,no rebleeding occurred. Conclusion Microcoil emboliza-tion is a safe and effective method to treat acutely ruptured intracranial aneurysms. Early intracranial surgery and timely treatment after operation is important to reduce fatality and disability.%目的:探讨微弹簧圈血管内栓塞治疗急性期破裂颅内动脉瘤的安全性及有效性。方法回顾性分析30例颅内动脉瘤在破裂出血后72小时内行微弹簧圈血管内栓塞治疗的临床资料。30例患者发病后均行 CT 检查,诊断为蛛网膜下腔出血,并经全脑血管造影证实为颅内动脉瘤,共检出34枚动脉瘤,其中单发26例,2枚4例。结果34枚动脉瘤中,100%栓塞24枚,95%栓塞6枚,90%栓塞2枚,80%栓塞2枚。术后发生手术相关并发症6例,包括微弹簧圈脱出至载瘤动脉1例,术中动脉瘤破裂1例,严重脑血管痉挛2例,术后脑梗死2

  12. Autograft versus allograft reconstruction of acute tibial plateau fractures: a comparative study of complications and outcome.

    Science.gov (United States)

    Bagherifard, Abolfazl; Ghandhari, Hassan; Jabalameli, Mahmoud; Rahbar, Mohammad; Hadi, Hosseinali; Moayedfar, Mehdi; Sajadi, Mohammadreza Minatour; Karimpour, Alireza

    2017-07-01

    There is no consensus regarding the use of filling agent in the re-elevation of depressed tibial plateau fracture (TPF). Although autograft is considered as the gold standard approach of such reconstructions, its limitation has led to a recent attraction toward allograft substitution. In this study, we compare the complications and outcome of autograft and allograft in TPF reconstruction, in order to address the existing controversy. A total of 81 patients with acute TPF were included in this study. Allograft and autograft were applied in 58 and 23 cases, respectively. The mean age of the patients was 40.26 years, and the mean follow-up period of patients was 19.1 months. Clinical and radiological assessment of the outcome was conducted, employing the modified Rasmussen clinical criteria. A total of three infections were observed in our patients, from which two infections occurred in allograft received patients. Articular surface collapse was seen in two cases, including one allograft and one autograft receiving patient. The mean clinical score was 18.65 and 18.55 in autograft and allograft received patients, respectively (p = 0.09). The mean radiological score was 15.65 and 15.68 in autograft and allograft received patients (p = 0.3). With respect to the comparable complication rate, clinical and radiological outcome of allogenic versus autologous reconstruction of TPF, freeze-dried allograft could be recommended as an appropriate substitute of autograft in this treatment. Nevertheless, the longer follow-up period of the patients could further extend our understanding of the clinical outcome of each component.

  13. CT Manifestations of Lung Changes and Complications in Patients with Severe Acute Respiratory Syndrome

    Institute of Scientific and Technical Information of China (English)

    张雪哲; 王武; 卢延; 黄振国; 洪闻; 尚燕宁; 任安

    2003-01-01

    Objective:To investigate the role of CT scanning in diagnosing severe acute respiratory syndrome(SARS). Methods: One hundred and twelve times of spiral CT scanning, 106 times on the chest with standard pulmonary and mediastinal window, 5 on the brain and once on the abdomen, were performed in 82 patients (37 males and 45 females) of SARS. Results: Bilateral shadows showed in 66 patients (80.48%) and unilateral shadow in 16 (19.52%). The lung CT findings were sub-pleural focal consolidation in 26 patients (31.70%), flaky cloudy opacity in 53 (64.63%), large area consolidation in 9 (10.97%), ground-glass blurry shadow in 31 (37.80%), alveolar substantive shadow in 14 (17.07%) and interstitial changes in 16 (19.51%). The pulmonary CT signs of SARS were relatively characterized by: (1) The lesions tending to multiply occur, mostly to be bilaterally distributed and commonly involved in the lower lung field. (2) The lung shadows mostly showed as sub-pleural focal consolidation, flaky cloudy shadow, large area consolidation, ground-glass blurry shadow, and often accompanied with signs of broncho-inflation. (3) Having opacified nodular shadows in the alveolar cavities. (4) Rapid progressions or changes on the size, amount, and distribution of the lesions likely to be found in dynamic observation of chest X-ray and CT scanning, i.e., markedly dynamic changes found within 24 to 48 hrs. Lesions with these characteristics may be recognized as pulmonary changes possibly induced by SARS. Complications were found in 6 patients (7.31%), including tuberculosis of lung and brain accompanied with pneumomediastinum in one patient, secondary infection of lung in 2, pneumothorax in 1, pulmonary fungus in 1, and pyothorax in 1.Conclusion: CT scanning is a sensitive method for diagnosis of SARS, by which more accurate assessment of the abnormal changes of lung and occurrence of complications in SARS patients can be made.

  14. Spontaneous Rupture of Uterine Vein in Twin Pregnancy

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    Emek Doger

    2013-01-01

    Full Text Available Objective. Aim of our study is to present a case of a twin pregnancy following invitro fertilization cycle complicated with hemoperitoneum at third trimester. Case. A 26-year-old nulliparous pregnant woman at 32 weeks of gestation with twin pregnancy following invitro fertilization cycle complained of abdominal pain. After 48 hours of admission, laparotomy was performed with indications of aggravated abdominal pain and decreased hemoglobin levels. Utero-ovarian vein branch rupture was detected on the right posterior side of uterus and bleeding was stopped by suturing the vein. Etiopathogenesis of the present case still remains unclear. Conclusion. Spontaneous rupture of the uterine vessels during pregnancy is a rare complication and may lead to maternal and fetal morbidity and mortality. Diagnosis and treatment are based on the clinical symptoms of acute abdominal pain and laboratory tests of hypovolemic shock signs.

  15. Imaging of diaphragmatic rupture after trauma

    Energy Technology Data Exchange (ETDEWEB)

    Eren, S. [Department of Radiology, Faculty of Medicine, Atatuerk University, Erzurum (Turkey)]. E-mail: suateren@atauni.edu.tr; Kantarci, M. [Department of Radiology, Faculty of Medicine, Atatuerk University, Erzurum (Turkey); Okur, A. [Department of Radiology, Faculty of Medicine, Atatuerk University, Erzurum (Turkey)

    2006-06-15

    Traumatic rupture of the diaphragm usually results from blunt or penetrating injuries, or iatrogenic causes. Most cases are initially overlooked in the acute phase because they present with variable clinical and radiological signs. An overlooked diaphragmatic injury presents as a hernia many years later with potentially serious complications, therefore selection of the most appropriate radiological technique and accurate diagnosis of traumatic diaphragmatic hernias (DH) on the first admission is important. Although the diagnosis of diaphragmatic injuries is problematic, various investigations may be used for diagnosis. We describe the imaging findings of 19 traumatic DH cases with various imaging techniques. The patients were acute trauma cases or cases with prior trauma or thoraco-abdominal surgery with clinical suspicion of DH. An evaluation of the imaging techniques used in the diagnosis of DH is presented.

  16. Predictors of in-hospital mortality after mitral valve surgery for post-myocardial infarction papillary muscle rupture

    NARCIS (Netherlands)

    Bouma, Wobbe; Hamer, Inez J. Wijdh-den; Koene, Bart M.; Kuijpers, Michiel; Natour, Ehsan; Erasmus, Michiel E.; van der Horst, Iwan C. C.; Gorman, Joseph H.; Gorman, Robert C.; Mariani, Massimo A.

    2014-01-01

    Background: Papillary muscle rupture (PMR) is a rare, but often life-threatening mechanical complication of myocardial infarction (MI). Immediate surgical intervention is considered the optimal and most rational treatment for acute PMR, but carries high risks. At this point it is not entirely clear

  17. Risk factors for HBV-related liver cirrhosis complicated by acute upper gastrointestinal bleeding

    Directory of Open Access Journals (Sweden)

    YU Zhirui

    2017-05-01

    Full Text Available ObjectiveTo investigate the risk factors for HBV-related liver cirrhosis complicated by acute upper gastrointestinal bleeding (AUGIB. MethodsA total of 58 patients with HBV-related liver cirrhosis complicated by AUGIB who were hospitalized in our hospital from January to December, 2011 were enrolled as study group, and 100 patients with HBV-related liver cirrhosis who did not experience upper gastrointestinal bleeding during the same period of time were enrolled as control group. Their general clinical data were collected. The t-test was used for comparison of continuous data between groups, the chi-square test was used for comparison of categorical data between groups, the multivariate Cox regression model was used to analyze the risk factors, and the life table method was used to analyze 1-, 2-, and 3-year cumulative survival rates and plot survival curves. ResultsThe 1-, 2-, and 3-year cumulative survival rates in the patients with HBV-related liver cirrhosis complicated by AUGIB were 72.2%, 51.9%, and 35.2%, respectively, with a median survival time of 24.7 months. The univariate analysis showed that AUGIB was associated with bleeding history (χ2=7.128, P=0008, course of disease (t=8.283, P<0.001, bad eating habits (χ2=7.612, P=0.006, Child-Pugh class (χ2=6.045, P=0049, degree of esophageal varices (χ2=46.241, P<0.001, gastric varices (χ2=14.211, P<0.001, and portal hypertension (χ2=6.846, P=0009. The multivariate Cox regression analysis revealed that course of disease (RR=0.745, 95%CI: 0.824-0967, P=0.026, bad eating habits (RR=1.426, 95%CI: 1.033-2.582, P=0.032, Child-Pugh class (RR=2.032, 95%CI: 1.05-2.34, P=0036, degree of esophageal varices (RR=0.796, 95%CI: 1.23-3.37, P=0.015, degree of gastric varices (RR=0825, 95%CI: 2.46-392, P=0.043, and portal hypertension (RR=0.983, 95%CI: 1.26-3.75, P=0.007 were independent risk factors for the prognosis of patients with HBV-related liver cirrhosis

  18. 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

  19. Total Hip Arthroplasty Complicated by a Gluteal Hematoma Resulting in Acute Foot Drop.

    Science.gov (United States)

    Khattar, Nicolas K; Parry, Phillip V; Agarwal, Nitin; George, Hope K; Kretz, Eric S; Larkin, Timothy M; Gruen, Gary S; Abla, Adnan A

    2016-01-01

    Total hip arthroplasty is a prevalent orthopedic intervention in the United States. Massive postoperative hematomas are a rare albeit serious complication of the procedure. Sequelae of these hematomas can include lower extremity paralysis from compression of the sciatic nerve. A 66-year-old woman taking aspirin and clopidogrel for coronary stents presented with a complete foot drop, paresthesias, and lower extremity pain 10 days after a total hip arthroplasty. The patient was initially seen by a neurology service at another hospital and thought to have lateral recess stenosis. At the authors' center, magnetic resonance imaging of the lumbar spine failed to show lateral recess stenosis. Urgent pelvic computed tomography showed a large hematoma and raised suspicion of sciatic nerve compression. Hip magnetic resonance imaging showed a right gluteal hematoma compressing the sciatic nerve. The patient was then taken to the operating room for the clot to be evacuated and was later referred for rehabilitation. Massive hematomas after total hip arthroplasty are an important consideration in the differential diagnosis of nontraumatic acute foot drop. Prompt diagnosis may correlate with improved neurological outcome and help reduce overall morbidity.

  20. Acute disseminated encephalomyelitis complicating dengue infection with neuroimaging mimicking multiple sclerosis: A report of two cases.

    Science.gov (United States)

    Viswanathan, S; Botross, N; Rusli, B N; Riad, A

    2016-11-01

    Acute disseminated encephalomyelitis (ADEM) complicating dengue infection is still exceedingly rare even in endemic countries such as Malaysia. Here we report two such cases, the first in an elderly female patient and the second in a young man. Both presented with encephalopathy, brainstem involvement and worsening upper and lower limb weakness. Initial magnetic resonance imaging (MRI) of the brain was normal in the first case. Serum for dengue Ig M and NS-1 was positive in both cases. Cerebrospinal fluid (CSF) showed pleocytosis in both with Dengue IgM and NS-1 positive in the second case but not done in the first. MRI brain showed changes of perpendicular subcortical palisading white matter, callosal and brainstem disease mimicking multiple sclerosis (MS) in both patients though in the former case there was a lag between the onset of clinical symptoms and MRI changes which was only clarified on reimaging. The temporal evolution and duration of the clinical symptoms, CSF changes and neuroimaging were more suggestive of Dengue ADEM rather than an encephalitis though initially the first case began as dengue encephalitis. Furthermore in dengue encephalitis neuroimaging is usually normal or rarely edema, haemorrhage, brainstem, thalamic or focal lesions are seen. Therefore, early recognition of ADEM as a sequelae of dengue infection with neuroimaging mimicking MS and repeat imaging helped in identifying these two cases. Treatment with intravenous steroids followed by maintenance oral steroids produced good outcome in both patients. Copyright © 2016 Elsevier B.V. All rights reserved.

  1. The role of DNA amplification and cultural growth in complicated acute appendicitis

    Directory of Open Access Journals (Sweden)

    Francesca Tocchioni

    2016-09-01

    Full Text Available Bacterial growth of peritoneal fluid specimens obtained during surgical procedures for acute appendicitis may be useful to optimize further antibiotic therapy in complicated cases. DNA amplification represents a fast technique to detect microbial sequences. We aimed to compare the potential of DNA amplification versus traditional bacterial growth culture highlighting advantages and drawbacks in a surgical setting. Peritoneal fluid specimens were collected during surgery from 36 children who underwent appendectomy between May and December 2012. Real-time polymerase chain reaction (RT-PCR and cultures were performed on each sample. RT-PCR showed an amplification of 16S in 18/36 samples, Escherichia coli (in 7 cases, Pseudomonas aeruginosa (3, Fusobacterium necrophorum (3, Adenovirus (2, E.coli (1, Klebsiella pneumoniae (1, Serratia marcescens/Enterobacter cloacae (1. Bacterial growth was instead observed only in four patients (3 E.coli and 1 P.aeruginosa and Bacteroides ovatus. Preoperative C-reactive protein and inflammation degree, the most reliable indicators of bacterial translocation, were elevated as expected. DNA amplification was a quick and useful method to detect pathogens and it was even more valuable in detecting aggressive pathogens such as anaerobes, difficult to preserve in biological cultures; its drawbacks were the lack of biological growths and of antibiograms. In our pilot study RT-PCR and cultures did not influence the way patients were treated.

  2. The Role of DNA Amplification and Cultural Growth in Complicated Acute Appendicitis

    Science.gov (United States)

    Tocchioni, Francesca; Tani, Chiara; Bartolini, Laura; Moriondo, Maria; Nieddu, Francesco; Pecile, Patrizia; Azzari, Chiara; Messineo, Antonio; Ghionzoli, Marco

    2016-01-01

    Bacterial growth of peritoneal fluid specimens obtained during surgical procedures for acute appendicitis may be useful to optimize further antibiotic therapy in complicated cases. DNA amplification represents a fast technique to detect microbial sequences. We aimed to compare the potential of DNA amplification versus traditional bacterial growth culture highlighting advantages and drawbacks in a surgical setting. Peritoneal fluid specimens were collected during surgery from 36 children who underwent appendectomy between May and December 2012. Real-time polymerase chain reaction (RT-PCR) and cultures were performed on each sample. RT-PCR showed an amplification of 16S in 18/36 samples, Escherichia coli (in 7 cases), Pseudomonas aeruginosa (3), Fusobacterium necrophorum (3), Adenovirus (2), E.coli (1), Klebsiella pneumoniae (1), Serratia marcescens/Enterobacter cloacae (1). Bacterial growth was instead observed only in four patients (3 E.coli and 1 P.aeruginosa and Bacteroides ovatus). Preoperative C-reactive protein and inflammation degree, the most reliable indicators of bacterial translocation, were elevated as expected. DNA amplification was a quick and useful method to detect pathogens and it was even more valuable in detecting aggressive pathogens such as anaerobes, difficult to preserve in biological cultures; its drawbacks were the lack of biological growths and of antibiograms. In our pilot study RT-PCR and cultures did not influence the way patients were treated. PMID:27777701

  3. Liver Hemangioma Bleeding Rupture Misdiagnosed as Acute Appendicitis%肝血管瘤破裂出血误诊为急性阑尾炎

    Institute of Scientific and Technical Information of China (English)

    刘壮

    2014-01-01

    Objective To explore the clinical characteristics of liver hemangioma rupture bleeding, and evaluate its differ-ential diagnosis. Methods Retrospectively analysis of the clinical data of a case of multiple liver hemangioma rupture hemorrhage misdiagnosed as acute appendicitis was made. Results A patient with lower abdominal pain for 20 hours before admission was pri-marily diagnosed as having acute appendicitis, and underwent an emergency laparotomy. During the operation, no abnormal appen-dix was found, but a mass in liver with burst bleeding was found and the liver surface was full of millet qualitative hard nodules. Be-cause of impossible determination on the nature of the tumor, the patient was given local hemostasis therapy, and abdominal cavity was washed, then drainage tube was placed at the same time, some tissues surrounding bleeding mass was removed, and no active bleeding before abdominal closing was observed. Postoperative pathologic result of liver mass showed degeneration of liver cells, with cellulose and inflammatory cells, and reinforced CT scanning confirmed liver hemangioma rupture bleeding, but to define the cause of bleeding, a followed enquiry of history and related examinations were made before systemic lupus erythematosus (active phase) was confirmed. Gamma globulin and Methylprednisolone treatment were given and the patient was discharged after improvement. Conclusion Because of the particular position, patients with liver hemangioma (right liver lobe) rupture hemorrhage usually have atypical clinical symptoms and signs, which may be related to systemic lupus erythematosus and mistaken as acute appendicitis.%目的:探讨肝血管瘤破裂出血的临床特点及鉴别诊断要点。方法对肝多发血管瘤破裂出血误诊为急性阑尾炎1例的临床资料进行回顾性分析。结果本例因右下腹痛20 h急诊入院,按急性阑尾炎行剖腹探查术。术中探查示:阑尾未见异常,肝

  4. A Case of Acute Budd-Chiari Syndrome Complicating Primary Antiphospholipid Syndrome Presenting as Acute Abdomen and Responding to Tight Anticoagulant Therapy

    Directory of Open Access Journals (Sweden)

    Naofumi Chinen

    2016-01-01

    Full Text Available A 34-year-old woman with primary antiphospholipid syndrome was admitted to the Gastroenterology Department of our hospital with fever, acute abdomen, watery diarrhea, and extremely high levels of inflammatory parameters. She had a history of left lower limb deep vein thrombosis and pulmonary embolism and was taking warfarin potassium. Acute gastroenteritis was suspected and an antibiotic was administered, but symptoms progressed. Abdominal ultrasonography showed occlusion of the left hepatic vein and the middle hepatic vein and her D-dimer level was high. Accordingly, Budd-Chiari syndrome was diagnosed and high-dose intravenous infusion of heparin was initiated. Her abdominal symptoms improved and the levels of inflammatory parameters and D-dimer decreased rapidly. It is known that antiphospholipid syndrome can be complicated by Budd-Chiari syndrome that usually occurs as subacute or chronic onset, but acute onset is rare. It is difficult to diagnose acute Budd-Chiari syndrome complicating antiphospholipid syndrome and this complication generally has a poor outcome. However, the present case can get early diagnosis and successful treatment with tight anticoagulant therapy.

  5. Spontaneous pnemomedastinum in acute severe asthma

    Directory of Open Access Journals (Sweden)

    Aleemuddin N

    2010-01-01

    Full Text Available Spontaneous medastinal emphysema, as a complication of acute severe asthma, is an uncommon entity. It usually runs a benign course and resolves spontaneously without any surgical intervention. Recognition of this complication is critical, as it has to be differentiated from other life threatening ones including oesophageal rupture, Boerhave′s syndrome, acute coronary syndrome and pulmonary embolism. This case is being presented to emphasize its recognition in the differential diagnosis of complications arising from acute severe asthma and to present its management strategy in detail.

  6. Comparison of clinic and pathology in heart rupture of patient with acute myocardial infarction%急性心肌梗死伴与不伴心脏破裂临床病理分析

    Institute of Scientific and Technical Information of China (English)

    王冬梅; 韩雅玲; 宋福林; 荆全民; 王祖禄; 王守力; 唐宜海

    2000-01-01

    目的:探讨急性心肌梗死(AMI)心脏破裂的原因、好发部位及与冠状动脉狭窄的关系。方法:AMI死亡并行尸体解剖检查63例,其中AMI伴心脏破裂18例,不伴心脏破裂45例。结果:AMI伴心脏破裂组高血压、溶栓治疗及首次心肌梗死发生率明显升高(P0.05)。心脏破裂多发生在AMI后3 d内,第1天占33.3%,多见于前壁、心尖部及下壁。尸体解剖示破裂处心肌变薄伴出血,梗死相关血管多为高度狭窄。结论:高血压、溶栓治疗及首次心肌梗死均为心脏破裂的危险因素。AMI的超急性期是心脏破裂的高发期。前降支及右冠状动脉高度狭窄导致心脏破裂增加。%Objective:To analysis the cause and the site of heart rupture and the relation between coronary arteries narrowed and heart rupture.Method:A total of 63 patients with acute myocardial infarction (AMI) were examined by necropsy.They were 47 men and 16 women with a mean age of (63±15) years.Group Ⅰ was AMI with heart rupture ( n = 18),group Ⅱ was AMI without heart rupture ( n=45). Result:① Hypertension and thromboclastic treatment and a first AMI occurred mostly in group Ⅰ(P0.05).③ Heart rupture occurred mostly within 3 days,33.3% for 18 patients with heart rupture in 1st day after AMI.The sites of AMI were more anterior wall,cardiac apex and inferior wall.④In③ necropsy cases showed thin and hemorrage in rupture wall and the arteries relative to infarction were more narrow.Conclusion: ① Hypertension and thromboclastic treatment and a first AMI were the risk factors of heart rupture.②The heart rupture occurred possibly during the acute phase. ③The severe narrow of LAD and RCA increased incidence of heart rupture.

  7. Spontaneous rupture of pyometra

    National Research Council Canada - National Science Library

    Mallah, Fatemeh; Eftekhar, Tahere; Naghavi-Behzad, Mohammad

    2013-01-01

    Spontaneous perforation is a very rare complication of pyometra. The clinical findings of perforated pyometra are similar to perforation of the gastrointestinal tract and other causes of acute abdomen...

  8. Lactoferrin acute-phase protein and proteinase inhibitors in blood of patients with Q-wave myocardial infraction complicated by acute heart failure

    Directory of Open Access Journals (Sweden)

    K. P. Belokoneva

    2012-01-01

    Full Text Available 153 patients with Q-wave noncomplicated and complicated myocardial infraction have been examined. Blood serum was studied for acute-phase proteins (alfa-2-macroglobulin (MG, alfa-1-antitrypsin (ATr, and lactoferrin (LF in 97 patients ((57.9 ± 1.06 years old. Blood was sampled at the 1st, 7th, and 14th days after myocardial infraction. The decrease of MG in acute phase was observed in patients with cardiogenic shock. Increased concentrations of LF and unchanged MG level at the 1—7 days were observed at pulmonary edema.

  9. A risk factors analysis of acute-on-chronic liver failure complicated by spontaneous bacterial peritonitis

    Directory of Open Access Journals (Sweden)

    LIU Zhengfang

    2017-04-01

    Full Text Available ObjectiveTo investigate the influencing factors for spontaneous bacterial peritonitis (SBP in patients with acute-on-chronic liver failure (ACLF, and to provide a reference for clinical diagnosis and prognosis evaluation. MethodsA retrospective analysis was performed for the clinical data of 667 patients with ACLF who were hospitalized and treated in our hospital from January 2009 to December 2014, and according to the presence or absence of SBP, they were divided into ACLF group(n=232 and ACLF-SBP group(n=435. The general information, laboratory markers, and incidence of complications were compared between the two groups. The t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups, and a logistic regression analysis was used to identify independent risk factors for ACLF complicated by SBP. ResultsThe comparison of laboratory markers and comorbidities showed that there were significant differences between the two groups in albumin (Alb (t=-4.110, P<0.001, alanine aminotransferase (U=-6.653, P<0.001, aspartate aminotransferase (t=-8.045, P<0.001, blood sodium (t=-2.879, P=0006, prothrombin time activity (t=-2.140, P=0.037, international normalized ratio (t=1.453, P=0.042, hemoglobin (t=-3.446, P=0.001, upper gastrointestinal bleeding (χ2=48.252, P=0.002, hepatorenal syndrome (χ2=16.244, P=0.031, and pulmonary infection (χ2=13.564, P<0.001. The multivariate logistic regression analysis showed that there were significant differences in Alb(OR=1.119,95%CI:1.052~1.189, platelet count (PLT(OR=1.035,95%CI:0.755~1.084, upper gastrointestinal bleeding(OR=1.117,95%CI:0.072~1.135, and pulmonary infection(OR=2.275,95%CI:0.978~5.292 (P=0.002,0.038,0.022, and 0.036. ConclusionIn the treatment of ACLF patients, risk factors including low Alb

  10. Loss of reduction and complications of coracoclavicular ligament reconstruction with autogenous tendon graft in acute acromioclavicular dislocations.

    Science.gov (United States)

    Choi, Nam Hong; Lim, Seok Min; Lee, Sang Young; Lim, Tae Kang

    2017-04-01

    This study was conducted to report loss of reduction and complications after single-tunnel coracoclavicular (CC) ligament reconstruction with autogenous semitendinosus tendon graft for acute acromioclavicular (AC) joint dislocations. This retrospective study included patients with acute, unstable AC dislocations (surgery within 6 weeks after trauma). We excluded patients with chronic injury and distal clavicle fractures with CC ligaments disruption. We measured the CC distance on anteroposterior radiographs of both clavicles, preoperatively, immediately postoperatively, and at the final follow-up visit. We evaluated clinical outcomes using the American Shoulder and Elbow Surgeons Shoulder Assessment and the University of California, Los Angeles Shoulder Rating Scale scores and perioperative complications. There were 30 patients (27 men and 3 women) with mean age of 41 years (range, 19-70 years). The mean follow-up period was 31 months (range, 12-186 months). Mean CC distance was 15.5 ± 3.7 mm (84% ± 14% of the contralateral shoulder) preoperatively, 8.9 ± 2.6 mm (9% ± 40%) immediately postoperatively (P 25% increase of CC distance) developed in 14 patients (47%), and complications occurred in 6 patients (20%), including 3 distal clavicle fractures through the tunnel. Final clinical scores were significantly lower in patients with complications (27 vs. 33 of the University of California, Los Angeles assessment [P < .001] and 81 vs. 95 of the American Shoulder and Elbow Surgeons Shoulder assessment [P < .001]). In acute AC joint dislocation, single-tunnel CC ligament reconstruction using autogenous tendon graft resulted in loss of reduction rate of 47% and a complication rate of 20%. The development of complications adversely affected clinical outcomes. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  11. Acute Renal Failure: Unusual Complication of Epstein-Barr Virus-Induced Infectious Mononucleosis

    National Research Council Canada - National Science Library

    Paul S. Lei; Amy Lowichik; Wain Allen; Teri Jo Mauch

    2000-01-01

    A 17-year-old boy with juvenile rheumatoid arthritis presented with jaundice, confusion, hemolytic anemia, thrombocytopenia, and acute renal failure secondary to titer-confirmed acute Epstein-Barr virus (EBV...

  12. Logistic regression analysis of the risk factors of acute renal failure complicating limb war injuries

    Directory of Open Access Journals (Sweden)

    Chang-zhi CHENG

    2011-06-01

    Full Text Available Objective To explore the risk factors of complication of acute renal failure(ARF in war injuries of limbs.Methods The clinical data of 352 patients with limb injuries admitted to 303 Hospital of PLA from 1968 to 2002 were retrospectively analyzed.The patients were divided into ARF group(n=9 and non-ARF group(n=343 according to the occurrence of ARF,and the case-control study was carried out.Ten factors which might lead to death were analyzed by logistic regression to screen the risk factors for ARF,including causes of trauma,shock after injury,time of admission to hospital after injury,injured sites,combined trauma,number of surgical procedures,presence of foreign matters,features of fractures,amputation,and tourniquet time.Results Fifteen of the 352 patients died(4.3%,among them 7 patients(46.7% died of ARF,3(20.0% of pulmonary embolism,3(20.0% of gas gangrene,and 2(13.3% of multiple organ failure.Univariate analysis revealed that the shock,time before admitted to hospital,amputation and tourniquet time were the risk factors for ARF in the wounded with limb injuries,while the logistic regression analysis showed only amputation was the risk factor for ARF(P < 0.05.Conclusion ARF is the primary cause-of-death in the wounded with limb injury.Prompt and accurate treatment and optimal time for amputation may be beneficial to decreasing the incidence and mortality of ARF in the wounded with severe limb injury and ischemic necrosis.

  13. Reparo de rotura de ventrículo esquerdo após uso de tenecteplase no tratamento do infarto agudo do miocárdio Surgical repair of left ventricular rupture after the use of tenecteplase in the treatment of acute myocardium infarction

    Directory of Open Access Journals (Sweden)

    Marco Antonio Vieira Guedes

    2005-06-01

    Full Text Available A utilização do trombolítico no tratamento do infarto agudo do miocárdio apresentou um impacto importante na diminuição da mortalidade geral, porém não alterou a incidência da rotura cardíaca. Esta complicação deve ser reconhecida e tratada rapidamente, necessitando um alto nível de suspeição clínica. Os autores relatam um caso de reparo cirúrgico de rotura precoce de ventrículo esquerdo, após utilização de tenecteplase associado à heparina não fracionada, no tratamento do infarto agudo do miocárdio.The use of thrombolytic agents in the treatment of acute myocardium infaction represented an important impact in the reduction of overall mortality. But this did not alter the cardiac rupture rate. This complication must be recognized and treated quickly.The authors report on a case of surgical repair of an early left ventricle rupture, after the use of tenecteplase in association with non-fractioned heparin for the treatment of acute myocardium infarction

  14. [Peritonitis caused by spontaneous rupture of pyonephrosis in pregnancy. Report of a case].

    Science.gov (United States)

    Rabii, R; Rais, H; Sarf, I; Joual, A; Aboutaieb, R; Bennani, S; el Mrini, M; Benjelloun, S; Hamoudi, D; Idali, B; Harti, A; Barrou, L

    1999-01-01

    Peritonitis after spontaneous rupture of pyonephrosis into the peritoneal cavity is a rare complication, usually diagnosed intraoperatively. We report a case of a woman presenting with left lumbar pain and fever during pregnancy. On admission, ultrasonography showed a pregnancy with fetal activity for 16 weeks, and pyonephrosis in the left kidney, but on a normal right kidney. After antibiotic therapy and upper urinary, tract stenting renal drainage revealed purulent urine, fever persisted with acute abdomen. Clinical and radiological assessment showed features of acute peritonitis with pyonephrosis. Treatment consisted of laparotomy with nephrectomy and abdominal lavage and drainage. The postoperative complication was septic shock requiring resuscitation and artificial ventilation and prolonged convalescence.

  15. Pain and knee function in relation to degree of bone bruise after acute anterior cruciate ligament rupture

    DEFF Research Database (Denmark)

    Szkopek, K; Warming, Torsten; Neergaard, K;

    2012-01-01

    and the bone bruise volume of the lateral femoral condyle. Patients with bone bruise of the medial tibia and patients with meniscal lesions had more pain. It is suggested that pain and decreased function after acute ACL injury most likely is related to soft tissue and cartilage injury and not to bone bruise....

  16. Cervical necrotizing fasciitis as a complication of acute epiglottitis managed with minimally aggressive surgical intervention: Case report.

    Science.gov (United States)

    Gollapalli, Rajesh Babu; Naiman, Ana Nusa; Merry, David

    2015-07-01

    Cervical necrotizing fasciitis secondary to epiglottitis is rare. The standard treatment of this severe condition has long been early and aggressive surgical debridement and adequate antimicrobial therapy. We report the case of an immunocompetent 59-year-old man who developed cervical necrotizing fasciitis as a complication of acute epiglottitis. We were able to successfully manage this patient with conservative surgical treatment (incision and drainage, in addition to antibiotic therapy) that did not involve aggressive debridement.

  17. Early and midterm outcomes of thoracic endovascular aortic repair (TEVAR) for acute and chronic complicated type B aortic dissection

    Science.gov (United States)

    Zhang, Min-Hong; Du, Xin; Guo, Wei; Liu, Xiao-Ping; Jia, Xin; Ge, Yang-Yang

    2017-01-01

    Abstract Thoracic endovascular aortic repair (TEVAR) in the current era has been chosen as a dominant and minimally invasive treatment for complicated aorta dissection. This study aimed to assess safety and feasibility of TEVAR in acute and chronic type B aortic dissection. Between January 2011 and December 2013, 85 patients with complicated type B aortic dissection undergoing TEVAR were divided into acute aortic dissection (AAD) (n = 60) group and chronic aortic dissection (CAD) group (n = 25). Computed tomography was used to evaluate postoperative changes in maximal aortic diameter and true and false lumen diameters at 3 levels during a mean follow-up period of 26.4 ± 15.6 months. The technical success rate was 100%. In-hospital and 30-day rates of death were 3.3% in acute group and 0 in chronic group. Postdischarge rates of type I leak, type II leak, and retrograde type A dissection were 6.7%, 5.2%, and 3.4% (acute) and 0%, 4.0%, and 4.0% (chronic), respectively. The maximal aorta diameter remained stable in all the 3 levels in both acute and chronic group. The cumulative freedom from all-cause mortality at 3 years was similar in acute and chronic groups (89.5% vs 95.5%, P = .308). The cumulative freedom from aortic-related mortality was also not significantly different in the acute and chronic groups (92.8% vs 95.2%, P = .531). In the thoracic aorta, TEVAR treatment resulted in a significant increase in true lumen (TL) diameter and decrease in false lumen (FL). However, in the abdominal aorta, TEVAR did not lead to significant change in TL and FL diameters. The rates of complete thrombosis thoracic false lumens were better than that in the abdominal false lumen. TEVAR was a safe and effect therapy for complicated acute and chronic type B dissection with low early and mid-term mortality and morbidity. PMID:28700467

  18. National complicated acute diverticulitis (CADS) study: a protocol for a prospective observational scoping study for acute diverticulitis

    Science.gov (United States)

    Shaikh, Shafaque

    2016-01-01

    Background Diverticular disease is a widely prevalent disease in western society, and acute diverticulitis is a common acute surgical presentation. However, there is a lack of level 1 evidence addressing the multifaceted presentations associated with acute diverticulitis. There is also a lack of robust epidemiological data that could be used to meaningfully inform randomised controlled trials. The National CADS project aims to generate baseline data for a cohort of patients managed for clinically suspected acute diverticulitis and evaluate the impact of variability in the management approach on patient outcomes in the short (3 months) and long (2 years) term. Method A Unit policy questionnaire will be completed by the principal investigator from all participating centres prior to study initiation. All patients aged above 18 years admitted with clinical suspicion of acute diverticulitis will be included from UK hospitals providing acute surgical care. Demographic, clinical, inpatient stay and outpatient follow-up data will be collected for index admissions between July and September 2014, 3 months follow-up and finally a 2-year follow-up. Results The study attracted participation from 108 centres nationally and has so far generated data on 2500 patients admitted between 1 July 2014 and 30 September 2014. Short-term follow-up data have been obtained for this cohort. Conclusions The National CADS study is currently ongoing with the long-term outcomes data anticipated to be submitted in autumn of 2016. PMID:27957337

  19. [Acute traumatic spinal cord injury and cardiovascular complications due to neurogenic shock: a possible threat for functional recovery].

    Science.gov (United States)

    van de Meent, H; Vos, P E; Schreuder, H W; van der Hoeven, J G

    2004-05-29

    Three men aged 18, 18 and 24 years, developed hypotension and bradycardia following an acute traumatic cervical or thoracic spinal cord injury. After treatment in intensive care and 1-12 months of rehabilitation they still suffered from considerable neurological disorders. Hypotension and bradycardia are common phenomena following acute traumatic cervical and thoracic spinal cord injury. Awareness of cardiovascular complications as a possible threat for functional recovery and adequate insight in the neurological cause of hypotension and bradycardia are important issues in the acute treatment of patients with spinal cord injury. It seems sensible to admit these patients to a medium-care or intensive-care department where they can be monitored and treated by a specialised team in accordance with an adequate protocol.

  20. [Multiple organ failure complicating a severe acute necrotising pancreatitis secondary of a severe hypertriglyceridemia: a case report].

    Science.gov (United States)

    Degardin, J; Pons, B; Ardisson, F; Gallego, J-P; Thiery, G

    2013-09-01

    We report the case of a 42-year-old man admitted for a multi-organ failure with a coma, a hemodynamic instability, a respiratory distress syndrome, an acute renal failure and a thrombocytopenia. The blood samples highlighted a milky serum and allowed to diagnose an acute pancreatitis associated with a major dyslipidemia: hypertriglyceridemia 11,800 mg/dL and hypercholesterolemia 1195 mg/dL. The CT-scans do not reveal any cerebral abnormalities but highlighted pancreatic lesions without biliary obstruction. A multi-organ failure complicating a severe acute pancreatitis secondary of a major hypertriglyceridemia was mentioned. Despite the absence of clear guidelines, a session of plasma exchange was started in emergency. Symptomatic treatment with protective ventilation, vasopressors, continuous heparin and insulin was continued. The clinical and biological course was good in parallel of the normalization of lipid abnormalities. The patient was discharged at day 17 with a lipid-lowering therapy. We discuss the various treatments available for the management of acute pancreatitis complicating a severe hypertriglyceridemia and their actual relevance in the absence of clear recommendations.

  1. Multiple coronary plaque ruptures in a patient with a recent ST-elevation acute myocardial infarction causing recurrent coronary instability.

    Science.gov (United States)

    Dato, Ilaria; Niccoli, Giampaolo; Cataneo, Leonardo; Crea, Filippo

    2013-09-01

    Multiple plaque instability has been reported in about one-third of patients with ST elevation acute myocardial infarction (STEMI) and could be responsible for early recurrent instability after STEMI. Optical coherence tomography (OCT) is a high-resolution imaging technique that may help in detection and characterization of unstable coronary plaques. We present a case of multiple coronary instability in a patient with anterior STEMI where OCT has tailored an optimal diagnosis and treatment.

  2. Spontaneous rupture of vaginal enterocele

    DEFF Research Database (Denmark)

    Svendsen, Jesper Hastrup; Galatius, H; Hansen, P K

    1985-01-01

    Spontaneous rupture of an enterocele is a rare complication. Only 24 cases including the present case have been reported in the literature. The patients were elderly and had had at least one vaginal operation. The patients were remarkably unaffected symptomatically on admission.......Spontaneous rupture of an enterocele is a rare complication. Only 24 cases including the present case have been reported in the literature. The patients were elderly and had had at least one vaginal operation. The patients were remarkably unaffected symptomatically on admission....

  3. Spontaneous rupture of vaginal enterocele

    DEFF Research Database (Denmark)

    Svendsen, Jesper Hastrup; Galatius, H; Hansen, P K

    1985-01-01

    Spontaneous rupture of an enterocele is a rare complication. Only 24 cases including the present case have been reported in the literature. The patients were elderly and had had at least one vaginal operation. The patients were remarkably unaffected symptomatically on admission.......Spontaneous rupture of an enterocele is a rare complication. Only 24 cases including the present case have been reported in the literature. The patients were elderly and had had at least one vaginal operation. The patients were remarkably unaffected symptomatically on admission....

  4. A one-year observational study of all hospitalized acute poisonings in Oslo: complications, treatment and sequelae

    Directory of Open Access Journals (Sweden)

    Lund Cathrine

    2012-07-01

    Full Text Available Abstract Objectives Changes in poisoning trends may affect both complications and outcomes in patients with acute poisoning. This study reports the treatments given and the frequency of complications, also related to treatment, mortality and sequelae related to various toxic agents. Methods All acute poisonings in adults (≥16 years admitted to the five hospitals in Oslo were included consecutively during one year (2008 to 2009 in an observational cross-sectional multicenter study. A standardized form was completed by the treating physician, which covered the study aims. Results There were 1065 admissions in 912 patients. The median length of hospital stay was one day, and 49% were observed in an intensive care unit (ICU. Active treatment was given to 83%, and consisted of supportive therapy (70%, antidote(s (38%, activated charcoal (16% and gastric lavage (9%. The most commonly used antidotes were flumazenil (19%, naloxone (17% and N-acetylcysteine (11%. The rate of treatment-related complications was 2.4% (21/884. Neither flumazenil, naloxone, nor the combination, was associated with convulsions or other complications. Among those receiving N-acetylcysteine, 5% (6/120 developed allergic reactions, one of which mandated discontinuation of treatment. Nineteen percent presented in a coma. Complications developed in 30%, compared with 18% in a 2003 study, mainly respiratory depression (12%, prolonged QTc interval (6% and hypotension (5%. Eight patients died (0.8% and five (0.5% survived with permanent sequelae, mainly anoxic brain damage. Discussion Few patients stayed more than two days. The use of the ICU was liberal, considering that only one out of five presented in a coma. Antidotes were frequently given diagnostically. Although N-acetylcysteine induced allergic reactions, most were mild and treatment discontinuation was only necessary once. The frequency of complications had almost doubled in five years, although the poisoning pattern was

  5. Phyto-inhalation for treatment of complications of acute respiratory viral diseases

    Directory of Open Access Journals (Sweden)

    I.B. Ershova

    2017-07-01

    Full Text Available Inhalations (inhalation of medicinal substances are one of the effective ways to treat upper respiratory tract diseases and colds. Inhalation therapy is used to treat rhinitis, sinusitis, tonsillitis, pharyngitis, laryngitis, bronchitis and pneumonia, which can be complications of acute respiratory viral infections. The main rules of inhalation are as follows to conduct the procedure better after 1.5 hours after eating; clothes should not impede breathing; the procedure can be carried out only while sitting or standing; solution for the inhaler for treatment of bronchitis should be fresh; it is necessary to strictly keep the prescribed dosage; the time of the procedure should also be respected — usually it is from 1 to 4 minutes, sometimes for adults up to 10 minutes, for children the inhalation period is shorter — 1–2 minutes. Contraindications to inhalation are body temperature above 37.5 degrees; propensity to nasal blee­ding in a patient; propensity to increased arterial pressure, with cardiovascular failure; purulent inflammation of the tonsils; respiratory failure. The procedure should be stopped immediately in case of appearance of adverse symptoms such as shortness of breath, dizziness, difficulty in breathing. Therefore, inhalations must be prescribed by a doctor after examination of a patient. During inhalations in rhinitis, you should try to inhale the vapor through the nose. For effective treatment of rhinitis, inhalations from conife­rous plants are very suitable: fir, pine, juniper, larch, from steamed dried chamomile flowers, mint, and blackberry leaves. Honey inhalations can be used for the treatment of acute and chronic diseases of the upper respiratory tract (tonsillitis, pharyngitis, laryngitis and tracheitis. Medical herbal inhalation for children should be carried out from the age of two years. This must be done under the constant supervision of an adult. Leaves of coniferous trees: pine, fir, if or juniper, cedar

  6. Treatment of bronchial ruptures by delayed surgery

    Institute of Scientific and Technical Information of China (English)

    1999-01-01

    Objective:To study the causes that resulted in delayed surgery for bronchial ruptures and the results.Methods:The cases with the bronchial ruptures by the delayed surgery last decade were retrospectively reviewed.The causes and unsatisfactory results were analysed.Results:The severe complications usually occurred after the delayed surgery and the results were not as satisfactory as those by early surgery.Conclusion:The bronchial ruptures ought to be operated in the early stage after being wounded.

  7. Complete Achilles tendon ruptures.

    Science.gov (United States)

    Landvater, S J; Renström, P A

    1992-10-01

    Achilles tendon ruptures can be treated nonsurgically in the nonathletic or low-end recreational athletic patient, particularly those more than 50 years of age, provided the treating physician does not delay in the diagnosis and treatment (preferably less than 48 hrs and possibly less than 1 week). The patient should be advised of the higher incidence of re-rupture of the tendon when treated nonsurgically. Surgical treatment is recommended for patients who are young and athletic. This is particularly true because the major criticism of surgical treatment has been the complication rate, which has decreased to a low level and to a mild degree, usually not significantly affecting the repair over time. Surgical treatment in these individuals seems to be superior not only in regard to re-rupture but also in assuring the correct apposition of the tendon ends and in placing the necessary tension on the tendon to secure appropriate orientation of the collagen fibers. This in turn allows them to regain full strength, power, endurance, and an early return to sports. Surgery is also recommended for late diagnosed ruptures where there is significant lengthening of the tendon. Surgical technique should involve a medial incision to avoid the sural nerve, absorbable suture, and augmentation with fascia or tendon where there is a gap or late rupture. Postoperatively, the immobilization should be 7 to 10 days in a splint. A walking boot with early motion in plantar flexion or a short leg cast with the tendon under slight tension should thereafter be used for 4 to 5 weeks. An early and well-supervised rehabilitation program should be initiated to restore the patient to the preinjury activity level.

  8. Benign multicystic mesothelioma of peritoneum complicating acute appendicitis in a man: a case report.

    Science.gov (United States)

    Occhionorelli, Savino; Tartarini, Daniela; Pascale, Giovanni; Maccatrozzo, Stefano; Stano, Rocco; Vasquez, Giorgio

    2016-02-27

    Benign multicystic mesothelioma is a rare pathology. Few cases are reported in the medical literature and acute presentation is extremely uncommon. We describe an acute clinical presentation of the neoplasm that revealed itself with signs and symptoms attributable to acute appendicitis in a 41-year-old white man. Abdominal echography and computed tomography scans demonstrated the presence of a mass in direct contiguity with cecal fundus, but diagnosis remained unclear. Our patient underwent surgery and complete removal of the neoplasm. Only a definitive histological examination defined the nature of the lesion. No signs of relapse were demonstrated 1 year after the operation. We showed that an acute presentation of a benign neoplasm represents a diagnostic and therapeutic challenge for the surgeon, because of the difficult differential diagnosis that acute presentation can sometimes pose and the trouble that an emergence treatment can imply.

  9. Effect of streptokinase on reperfusion after acute myocardial infarction and its complications: an ex-post facto study.

    Science.gov (United States)

    Taheri, Leila; Boroujeni, Ali Zargham; Kargar Jahromi, Marzieh; Charkhandaz, Maryam; Hojat, Mohsen

    2015-01-01

    Emergency treatment of patients with acute myocardial infarction is very important. Streptokinase in Iran is often as the only clot-busting medication is used. The purpose of using streptokinase medication is to revive the ischemic heart tissue, although has dangerous complications too. Therefore, the present study aimed to determine the effect of streptokinase on reperfusion after acute myocardial infarction and its complications, has been designed and conducted. This is an Ex-post facto study. The study population included patients who suffer from acute myocardial infarction. The sample size was 300 patients, and 2 groups were matched, in variables of age, sex, underlying disease, frequencies and area of MI. Data collection did by researcher making questionnaire, that accept face and content validity by 10 expert researcher, the reliability was conducted with Spearman's test (r=0.85) by Test-retest method. Data analysis did by SPSS software: V 12. Mean of EF in SK group was (46.15±8.11) and in control group was (43.11±12.57). Significant relationship was seen between SK, arrhythmia occurring and improve EF reperfusion by chi-square test (p=0.028), (p=0.020).The most arrhythmia in SK group was Ventricular Tachycardia (20.7%). Significant statistical relation between SK and mortality were found by Chi-square test (p=0.001). But a meaningful statistical relation was not found between SK and pulmonary edema incidence (p=0.071). Nurses of CCU should be aware about SK complications such as hypotension, bleeding and arrhythmias. Proposed compare SK and tissue plasminogen drug in reperfusion and complications effect.

  10. Splenic rupture following colonoscopy

    Institute of Scientific and Technical Information of China (English)

    Juan Francisco Guerra; Ignacio San Francisco; Fernando Pimentel; Luis Ibanez

    2008-01-01

    Colonoscopy is a safe and routinely performed diagnostic and therapeutic procedure for different colorectal diseases. Although the most common complications are bleeding and perforation, extracolonic or visceral injuries have also been described. Splenic rupture is a rare complication following colonoscopy, with few cases reported. We report a 60-year-old female who presented to surgical consultation 8 h after a diagnostic colonoscopy. Clinical, laboratory and imaging findings were suggestive for a massive hemoperitoneum. At surgery, an almost complete splenic disruption was evident, and an urgent splenectomy was performed. After an uneventful postoperative period, she was discharged home. Splenic injury following colonoscopy is considered infrequent. Direct trauma and excessive traction of the splenocolic ligament can explain the occurrence of this complication. Many times the diagnosis is delayed because the symptoms are due to colonic insufflation, so the most frequent treatment is an urgent splenectomy. A high index of suspicion needs an early diagnosis and adequate therapy.

  11. Analysis of complications of prone position in acute respiratory distress syndrome: quality standard, incidence and related factors.

    Science.gov (United States)

    Jové Ponseti, E; Villarrasa Millán, A; Ortiz Chinchilla, D

    The monitoring system based on standards of quality allows clinicians to evaluate and improve the patient's care. According to the quality indicators recommended by Sociedad Española de Medicina Intensiva Crítica y Unidades Coronarias, and due to the importance of prone position (PP) as a treatment in patients with acute respiratory distress syndrome, it is fundamental to keep accurate record of serious adverse events occurring during the prone position procedure and its posterior analysis. To establish fulfilment of the Sociedad Española de Medicina Intensiva Crítica y Unidades Coronarias standards of quality according to the register of serious complications. To identify the incidence of serious complications registered as well as to identify possible factors related to these complications. Retrospective, cross-sectionsl descriptive study, polyvalent ICU (16 beds). Study population Patients with acute respiratory distress syndrome treated with PP (January 2012-December 2013). Study variables PP recording, accidental extubation, removal of catheters, decubitus ulcers (DU), ETT obstruction, urgency of the procedure, hours in PP, nutritional intake, type of feeding tube, food regurgitation/retention and use of prokinetics/muscle relaxant. The study sample comprised 38 cases, with an adequate record of complications in 92.1% of the cases. DU were the only serious complication recorded, with a 25.7% incidence. Possible factors related to DU: more hours in PP in patients developing DU (p= .067). Less incidence of DU in well-nourished patients (p= .577). 82.9% of patients were not appropriately nourished. The percentage of records duly completed is very high. The presence of DU (grade 1-2 mostly) is to be noted. There is no stastistical significance, although a trend is obversed, between DU and hours in PP. Copyright © 2017 Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC). Publicado por Elsevier España, S.L.U. All rights reserved.

  12. Spontaneous rupture of choledochal cyst: case report

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Ho Seob; Nam, Kyung Jin; Lee, Jin Hwa; Kim, Chan Sung; Choi, Jong Cheol; Oh, Jong Young [Dong-a University College of Medicine, Pusan (Korea, Republic of)

    2002-11-01

    Spontaneous rupture of a choledochal cyst leading to biliary peritonitis is a rare complication which can be fatal if not promptly diagnosed. The authors report the ultrasound and CT findings of two cases of spontaneous choledochal cystic rupture and the biliary peritonitis which ensued.

  13. Local heparinization in endovascular embolization of ruptured intracranial aneurysms at acute stage%急性出血期颅内动脉瘤血管内栓塞术中局部肝素化的应用

    Institute of Scientific and Technical Information of China (English)

    刘东; 吕明; 李佑祥; 杨新健; 姜除寒; 吴中学

    2014-01-01

    Objective To evaluate the efficacy of ization in endovascular embolization of the ruptured intracranial aneurysms at acute stage.Methods Between April 2011 and September 2011,127 patients with ruptured intracranial aneurysms treated with endovascular embolization at acute stage (< 14 days) were retrospectively reviewed to evaluate the efficacy of ization (3 IU/ml heparin saline was dropped into the guiding catheter at 3 ml/min.).Results Total 148 aneurysms were observed in 127 patients and 135 aneurysms were treated with endovascular coil embolization under ization at acute stage,aneurysm perforation related to manipulation occurred in 5 patients (3.9%) which caused 4 deaths and 1 disability.The distal part of the parent artery was not filled well in 11 cases (8.7%),vasospasm in 2 cases without any neurological sequelae,over embolization in 7 cases resulted in 1 severe disability.Thromboembolic complication occurred in 2 cases causing 1 neurological deficit.Clinical outcomes at3.5 years were:GOS 5 in 107 cases (84.3%),4 in 7 cases (5.5%),3 in 6 cases (4.7%),2 in 0 cases (0%) and 1 in 7 cases (5.5%).Conclusions Local heparinizqtion may not increase the incidence of thromboernbolic or hemorrhagic complications compared to systemic heparin.ization could be effective for coil embolization of ruptured aneurysm at acute stage.%目的 探讨急性出血期颅内动脉瘤血管内栓塞术中局部肝素化的安全性.方法 收集2011年4月至2011年9月经血管内治疗的127例急性出血期(<14 d)颅内动脉瘤患者(共148个动脉瘤)的临床资料,该组患者在血管内栓塞术中均应用局部肝素化(经导引导管高压灌注浓度为3 IU/ml的肝素生理盐水,灌注速度为4 ml/min),回顾性分析术中血栓栓塞和动脉瘤破裂的发生率及预后.结果 127例患者148个动脉瘤中,行介入栓塞135个,其中5例(3.9%)发生术中动脉瘤破裂,均与操作相关,术后4例死亡,1例重残.11例(8.7%)术中出

  14. An autopsy case of acute pancreatitis with a high serum IgG4 complicated by amyloidosis and rheumatoid arthritis

    Institute of Scientific and Technical Information of China (English)

    Tatsuki Ichikawa; Kazuhiko Nakao; Keisuke Hamasaki; Kazuaki Ohkubo; Kan Toriyama; Katsumi Eguchi

    2005-01-01

    We report an autopsy case of acute pancreatitis with a high serum IgG4 concentration complicated by systemic amyloid A amyloidosis and rheumatoid arthritis (RA). The patient was a 42-year-old Japanese female with a 22-year history of rheumatoid arthritis. She was diagnosed with myasthenia gravis when she was 31-year old. At the onset of pancreatitis, the patient was anti-nuclear antibody-positive,and had high serum gamma globulin and IgG4 levels.Dexamethasone and conventional therapy induced clinical remission and significantly decreased the serum IgG4 and gamma globulin. However, despite the decreased disease parameters, the patient developed a bleeding pseudocyst and died of cardiac failure. In the autopsy examination, it was determined that pancreatitis was probably caused by ischemia due to vascular obstruction caused by amyloid deposition in the pancreas. Even though acute pancreatitis is a rare complication in RA patients, we speculate that an autoimmune pancreatitis-related mechanism and ischemia due to vascular obstruction by amyloid deposition might be attributable to a single source that leads to acute pancreatitis in our particular case.

  15. Influence of renal dysfunction on clinical outcomes in patients with congestive heart failure complicating acute myocardial infarction.

    Science.gov (United States)

    Kim, Chang Seong; Kim, Min Jee; Kang, Yong Un; Choi, Joon Seok; Bae, Eun Hui; Ma, Seong Kwon; Ahn, Young-Keun; Jeong, Myung Ho; Kim, Young Jo; Cho, Myeong Chan; Kim, Chong Jin; Kim, Soo Wan

    2013-01-01

    The clinical course and medical treatment of patients with congestive heart failure (CHF) complicating acute myocardial infarction (AMI) are not well established, especially in patients with concomitant renal dysfunction. We performed a retrospective analysis of the prospective Korean Acute Myocardial Infarction Registry to assess the medical treatments and clinical outcomes of patients with CHF (Killip classes II or III) complicated by AMI, in the presence or absence of renal dysfunction. Of 13,498 patients with AMI, 2769 (20.5%) had CHF on admission. Compared to CHF patients with preserved renal function, in-hospital mortality and major adverse cardiac events were increased both at 1 month and at 1 year after discharge in patients with renal dysfunction (1154; 41.7%). Postdischarge use of aspirin, betablockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, or angiotensin II receptor blockers and statins significantly reduced the 1-year mortality rate for CHF patients with renal dysfunction; such reduction was not observed for those without renal dysfunction, except in the case of aspirin. Patients with CHF complicating AMI, which is accompanied by renal dysfunction, are at higher risk for adverse cardiovascular outcomes than patients without renal dysfunction. However, they receive fewer medications proven to reduce mortality rates.

  16. [Giant appendiceal mucocele during laparotomy for acute abdomen. Report of a case and brief review].

    Science.gov (United States)

    Caiazzo, P; Comentale, A; Rampone, B; Di Lascio, P; Morlino, A; Pastore, M; Del Vecchio, G; Tramutoli, P R

    2010-01-01

    The authors describe a case of giant appendiceal mucocele, secondary to a mucinous neoplasm of the appendix, diagnosed during laparotomy for acute abdomen. By a review of the literature they stress the rarity of this lesion, the particular onset in their case as acute complication of appendiceal neoplasm with rupture of the intestinal wall, the difficulties of diagnosis and management in emergency.

  17. Intussusception: a rare complication in a patient with acute leukaemia after consolidation chemotherapy.

    Science.gov (United States)

    Qasrawi, Ayman; Abu Ghanimeh, Mouhanna; Abughanimeh, Omar; Qasem, Abdulraheem

    2017-02-28

    Intussusception is telescoping of one segment of the gastrointestinal tract into an adjacent one. It is more common in children than adults. When it occurs in adults, it is usually associated with a lead point. Intussusception is very rare in acute leukaemia and has only been reported in few cases. We present a case of an adult woman who presented with intussusception after a cycle of consolidation chemotherapy with high-dose cytarabine for acute myeloid leukaemia. Other causes of acute abdominal pain were excluded, and the diagnosis was established by CT scan of the abdomen and barium enema. No pathological lead points were found intraoperatively. She underwent a right-sided hemicolectomy with complete recovery. To the best of our knowledge, this is only the fourth case of intussusception that has been reported in an adult patient with acute myeloid leukaemia. 2017 BMJ Publishing Group Ltd.

  18. Prevotella intermedia infection causing acute and complicated aortitis—A case report

    Directory of Open Access Journals (Sweden)

    C. Boersma

    2017-01-01

    CONCLUSION: Prevotella intermedia is a rare causative agent for aortitis. Acute aortitis is a challenging clinical entity which should be managed in an equipped medical center by an experienced multidisciplinary team.

  19. Acute aortic occlusion as an unusual embolic complication of cardiac myxoma

    Institute of Scientific and Technical Information of China (English)

    ZHANG Jian; DUAN Zhi-quan; WANG Chuan-jiang; SONG Qing-bin; LUO Ying-wei; XIN Shi-jie

    2006-01-01

    @@ Acute aortic occlusion is an infrequent but dangerous vascular emergency with a mortality rate of 50%,1 resulting from aortic saddle embolus, thrombosis of an atherosclerotic abdominal aorta, or sudden thrombosis of a small abdominal aortic aneurysm.

  20. Preterm Delivery in the Setting of Left Calyceal Rupture

    Directory of Open Access Journals (Sweden)

    Brent Hanson

    2015-01-01

    Full Text Available Spontaneous rupture of the renal collecting system is a rare but serious complication of pregnancy. We report a case of nontraumatic left renal calyceal rupture in a pregnancy which ultimately progressed to preterm delivery. A 29-year-old primigravida with a remote history of urolithiasis presented with left flank pain, suprapubic pain, and signs of preterm labor at 33 weeks of gestation. The patient was believed to have urolithiasis, although initial renal ultrasound failed to demonstrate definitive calculi. After a temporary improvement in flank pain with medication, the patient experienced acute worsening of her left flank pain. Urology was consulted and further imaging was obtained. Magnetic resonance imaging (MRI was consistent with bilateral hydronephrosis and rupture of the left renal calyx. Given the patient’s worsening pain in the setting of left calyceal rupture, the urology team planned for placement of a left ureteral stent. However, before the patient could receive her stent, she progressed to active labor and delivered a viable female infant vaginally. Following delivery, the patient’s flank pain resolved rapidly and spontaneously, so no surgical intervention was performed. A summary of the literature and the details of this specific clinical situation are provided.

  1. Preterm Delivery in the Setting of Left Calyceal Rupture

    Science.gov (United States)

    Hanson, Brent; Tabbarah, Rami

    2015-01-01

    Spontaneous rupture of the renal collecting system is a rare but serious complication of pregnancy. We report a case of nontraumatic left renal calyceal rupture in a pregnancy which ultimately progressed to preterm delivery. A 29-year-old primigravida with a remote history of urolithiasis presented with left flank pain, suprapubic pain, and signs of preterm labor at 33 weeks of gestation. The patient was believed to have urolithiasis, although initial renal ultrasound failed to demonstrate definitive calculi. After a temporary improvement in flank pain with medication, the patient experienced acute worsening of her left flank pain. Urology was consulted and further imaging was obtained. Magnetic resonance imaging (MRI) was consistent with bilateral hydronephrosis and rupture of the left renal calyx. Given the patient's worsening pain in the setting of left calyceal rupture, the urology team planned for placement of a left ureteral stent. However, before the patient could receive her stent, she progressed to active labor and delivered a viable female infant vaginally. Following delivery, the patient's flank pain resolved rapidly and spontaneously, so no surgical intervention was performed. A summary of the literature and the details of this specific clinical situation are provided. PMID:26483981

  2. Rupture of the distal biceps brachii tendon: isokinetic power analysis and complications after anatomic reinsertion compared with fixation to the brachialis muscle.

    Science.gov (United States)

    Klonz, Andreas; Loitz, Dietmar; Wöhler, Peter; Reilmann, Heinrich

    2003-01-01

    Anatomic reattachment of the distal biceps tendon is well established but bears the risk of complications including loss of motion and nerve damage. We questioned whether nonanatomic repair by tenodesis to the brachialis muscle is able to accomplish similar results with less risk. We compared the results of anatomic repair with suture anchors (n = 6) with the results of nonanatomic repair (n = 8). Anatomic reattachment of the biceps tendon can restore full power of flexion in most cases as determined by isokinetic muscle tests (mean, 96.8% compared with the contralateral side). Nonanatomic repair also restores flexion strength to a mean of 96%. Supination power averaged 91% after anatomic repair. Supination strength after nonanatomic repair did not improve in 4 of 8 patients (42%-56% of the uninjured arm). The other 4 patients were able to produce 80% to 150% of the strength of the contralateral side. Major complications such as radioulnar synostosis or motor nerve damage were not encountered in either group. Heterotopic ossification was seen in 4 cases after reinsertion to the tuberosity. One of these patients was not satisfied with the procedure because of anterior elbow pain, even at rest. After tenodesis to the brachialis, one patient was unsatisfied because of considerable weakness. We concluded that major complications after anatomic repair are rare but must not be ignored. Tenodesis of the distal biceps tendon is a safe alternative procedure. We inform our patients about the benefits and risks of anatomic and nonanatomic repair as well as those of nonoperative treatment. The decision concerning the type of therapy best suited for an individual patient should be made on an informed consent basis.

  3. Mechanical model of vulnerable atherosclerotic plaque rupture

    Institute of Scientific and Technical Information of China (English)

    SU; Haijun; ZHANG; Mei; ZHANG; Yun

    2004-01-01

    Rupture of atherosclerotic plaque is the main trigger of acute cardiovascular events, but the mechanism of plaque rupture is still unknown. We have constructed a model describing the motion of the fibrous cap of the plaque using the theory of elastic mechanics and studied the stability of the plaque theoretically. It has shown that plaque rupture is the result of a dynamic interplay between factors intrinsic to the plaque itself and extrinsic factors. We have proposed a new mechanism of plaque rupture, given a new explanation about the nonlinear dynamic progress of atherosclerosis and suggested a method to identify the vulnerable plaques to manage atherosclerosis.

  4. Subcutaneous Emphysema, Pneumomediastinum, Pneumoretroperitoneum, and Pneumoscrotum: Unusual Complications of Acute Perforated Diverticulitis

    Directory of Open Access Journals (Sweden)

    S. Fosi

    2014-01-01

    Full Text Available Pneumomediastinum, and subcutaneous emphysema usually result from spontaneous alveolar wall rupture and, far less commonly, from disruption of the upper airways or gastrointestinal tract. Subcutaneous neck emphysema, pneumomediastinum, and retropneumoperitoneum caused by nontraumatic perforations of the colon have been infrequently reported. The main symptoms of spontaneous subcutaneous emphysema are swelling and crepitus over the involved site; further clinical findings in case of subcutaneous cervical and mediastinal emphysema can be neck and chest pain and dyspnea. Radiological imaging plays an important role to achieve the correct diagnosis and extension of the disease. We present a quite rare case of spontaneous subcutaneous cervical emphysema, pneumomediastinum, and pneumoretroperitoneum due to perforation of an occult sigmoid diverticulum. Abdomen ultrasound, chest X-rays, and computer tomography (CT were performed to evaluate the free gas extension and to identify potential sources of extravasating gas. Radiological diagnosis was confirmed by the subsequent surgical exploration.

  5. Subcutaneous Emphysema, Pneumomediastinum, Pneumoretroperitoneum, and Pneumoscrotum: Unusual Complications of Acute Perforated Diverticulitis

    Science.gov (United States)

    Fosi, S.; Giuricin, V.; Girardi, V.; Di Caprera, E.; Costanzo, E.; Di Trapano, R.; Simonetti, G.

    2014-01-01

    Pneumomediastinum, and subcutaneous emphysema usually result from spontaneous alveolar wall rupture and, far less commonly, from disruption of the upper airways or gastrointestinal tract. Subcutaneous neck emphysema, pneumomediastinum, and retropneumoperitoneum caused by nontraumatic perforations of the colon have been infrequently reported. The main symptoms of spontaneous subcutaneous emphysema are swelling and crepitus over the involved site; further clinical findings in case of subcutaneous cervical and mediastinal emphysema can be neck and chest pain and dyspnea. Radiological imaging plays an important role to achieve the correct diagnosis and extension of the disease. We present a quite rare case of spontaneous subcutaneous cervical emphysema, pneumomediastinum, and pneumoretroperitoneum due to perforation of an occult sigmoid diverticulum. Abdomen ultrasound, chest X-rays, and computer tomography (CT) were performed to evaluate the free gas extension and to identify potential sources of extravasating gas. Radiological diagnosis was confirmed by the subsequent surgical exploration. PMID:25136471

  6. How to reduce avoidable admissions due to acute diabetes complications?: Interrelation between primary and specialized attention in a diabetes unit

    Directory of Open Access Journals (Sweden)

    N. V. García-Talavera Espín

    2012-12-01

    Full Text Available Introduction: Type 2 Diabetes Mellitus is a serious health problem. In the year 2030 it will affect 366 million people around the world. Objective: Evaluate the effectiveness of a mixed intervention and reducing the amount and seriousness of acute complications in diabetics from our Health Area. Materials and method: Protocols of action as well as information documents were produced. Diabetes Unit coordinated educational activities in the different support levels of the Area VII of Murcia. Information talks were provided for the people in charge of the Diabetes Unit in every Care Center and Service of the Health Area. Personalized training was provided for patients treated in the differet Care levels. The study comprised three stages. Information leaflets were spread and talks offered to the patient regarding in house handling of hypo and hyper glycemia. Results: A reduction of 39% of the emergencies due to acute non complicated diabetes was achieved, as well as a reduction of 47.6% of hospital admissions. There was a reduction of 67.8% of the amount of total hospital stays for the group of patients under 35 years who were admitted into the hospital due to type 1 or 2 diabetes mellitus that didn't show any complications (GRD295. Conclusions: There was a reduction of more than thirty percent in the emergencies due to acute decompensations in the disease and a significant reduction in the avoidable hospital stays in the young adult, thus improving the patients' life quality and reducing the social cost of the diabetic patient.

  7. Statin-associated rhabdomyolysis with acute renal failure complicated by intradialytic NSTEMI: a review of lipid management considerations.

    Science.gov (United States)

    Kar, Subrata; Chockalingam, Anand

    2013-01-01

    Statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) are associated with myopathy, myalgias, myositis, and rhabdomyolysis. Rhabdoymyolysis is a rare complication and may cause acute renal failure, which may be fatal. In such cases, alternative therapies should be considered. In this review, we attempted to elucidate the lipid management options in patients with rhabdomyolysis and coronary artery disease. We also describe a case report of a patient who developed rhabdomyolysis from dual antilipid therapy followed by acute renal failure and non-ST elevation myocardial infarction. Such a complex case has not been reported in the literature, and lipid management options may include niacin, omega 3-fatty acids, or bile acid sequestrants. Once alternative therapies are initiated, monitoring a patient closely with evaluation for associated adverse events should be performed.

  8. [Comparative study on animal model of acute Achilles tendon rupture with surgical treatment using platelet-rich plasma].

    Science.gov (United States)

    Hernández-Martínez, J C; Vásquez, C R; Ceja, C B; Fuentes, C C E; Sesma, J F; Benítez, A G

    2012-01-01

    To compare the functional and histologicalal course of two animal model groups with acute Achilles tendon tears using platelet rich plasma. An open clinical trial was conducted with dogs donated by the animal facility of the Autonomous University of Puebla (BUAP, for its acronym in Spanish). Dogs were divided into 2 groups: a control group and a problem group. Intentional surgical Achilles tendon tear was performed to them. The Krackow technique was used to repair the tendon and the control group received platelet rich plasma (PRP) as a clot; the other group did not receive PRP. The dogs were seen at 4 weeks to check functionality using the Farell and Schwarz scale to assess the degree of limping. They were sacrificed at week 5; the tendons were removed and sent to the histopathology lab. Functionality results according to the Farell and Schwarz scale showed grades I and II in the problem group, and grades IV and V in the control group. Histologically, the problem group showed moderate vascular proliferation and abundant fibroblastic proliferation. The control group had mild to moderate vascular proliferation and moderate fibroblastic proliferation. PRP improves tendon healing and this has repercussions on functional recovery.

  9. Impact of Acute Coronary Syndrome Complicated by Ventricular Fibrillation on Long-term Incidence of Sudden Cardiac Death.

    Science.gov (United States)

    Álvarez-Álvarez, Belén; Bouzas-Cruz, Noelia; Abu-Assi, Emad; Raposeiras-Roubin, Sergio; López-López, Andrea; González Cambeiro, María Cristina; Peña-Gil, Carlos; García-Acuña, José María; González-Juanatey, José Ramón

    2015-10-01

    There is little information on the effect of acute coronary syndrome complicated by ventricular fibrillation on the long-term incidence of sudden cardiac death. We analyzed this effect in a contemporary cohort of patients with acute coronary syndrome. We studied 5302 consecutive patients with acute coronary syndrome between December 2003 and December 2012. We compared mortality during and after hospitalization according to the presence or absence of ventricular fibrillation. Ventricular fibrillation was observed in 163 (3.1%) patients, and was early onset in 72.4% of these patients. In-hospital mortality was 36.2% in the group with ventricular fibrillation and 4.7% in the group without (p<.001). After a mean follow-up of 4.7 years (standard deviation, 2.6 years), mortality was 30.7% in the ventricular fibrillation group and 24.7% in the other group (P=.23). After adjusting for confounding variables, the presence of ventricular fibrillation was not associated with an increased risk of death in the follow-up period (hazard ratio=1.29; 95% confidence interval, 0.90-1.87). The cause of death was established in 72% of patients. The incidence of sudden death was 12.9% in the ventricular fibrillation group and 11.9% in the other group (P=.71). Cardiovascular-cause mortality was also similar between the 2 groups (35.5% and 34.4%, respectively. Patients with acute coronary syndrome complicated by ventricular fibrillation who survive the in-hospital phase do not appear to be at an increased risk of sudden cardiac death or other cardiovascular-cause death. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  10. Challenging Friesian horse diseases : aortic rupture and megaesophagus

    NARCIS (Netherlands)

    Ploeg, M.

    2015-01-01

    Aortic rupture is quite rare in Warmblood horses and is best known as an acute and fatal rupture of the aortic root in older breeding stallions. It has now become clear that aortic rupture, which is diagnosed around an age of 4 years, is more frequent in the Friesian breed than in others. The high p

  11. Effect of coumarins started before coronary angioplasty on acute complications and long-term follow-up: a randomized trial.

    Science.gov (United States)

    ten Berg, J M; Kelder, J C; Suttorp, M J; Mast, E G; Bal, E; Ernst, S M; Verheugt, F W; Plokker, H W

    2000-07-25

    Coronary angioplasty frequently creates a thrombogenic surface, with subsequent mural thrombosis that may lead to acute complications and possibly stimulates the development of restenosis. Whether coumarins can prevent these complications is unclear. The objective of this open, randomized trial was to assess the clinical effect of coumarins started before coronary angioplasty and continued for 6 months. Before coronary angioplasty, 530 patients were randomly assigned to aspirin plus coumarins and 528 patients to aspirin alone. At the start of the angioplasty, the mean international normalized ratio was 2.7+/-1.1; during follow-up, it was 3.0+/-1.1. At 30 days, the composite end point of death, myocardial infarction, target-lesion revascularization, and stroke was observed in 18 patients (3.4%) treated with aspirin plus coumarin compared with 34 patients (6.4%) treated with aspirin alone (relative risk, 0.53; 95% CI, 0.30 to 0.92). At 1 year, these figures were 14.3% and 20.3%, respectively (relative risk, 0.71; 95% CI, 0.54 to 0.93). The incidence of major bleeding and false aneurysm during hospitalization was 3.2% and 1.0%, respectively (relative risk, 3.39; 95% CI, 1.26 to 9.11). The benefit of coumarins was observed in both stented and nonstented patients. Coumarins in addition to aspirin started before PTCA and continued for 6 months was more effective than aspirin alone in the prevention of acute and late complications after coronary angioplasty. This benefit was accompanied by a small but significant increase in bleeding complications.

  12. ROTURA DEL SEPTO INTERVENTRICULAR DESPUÉS DE INFARTO AGUDO DE MIOCARDIO CON APERTURA Y CIERRE INTERMITENTES / Interventricular septal rupture after acute myocardial infarction with intermittent opening and closing

    Directory of Open Access Journals (Sweden)

    Jorge L. Alonso Freire

    2013-01-01

    Full Text Available Resumen La rotura del septo interventricular es una grave complicación en pacientes que sufren infarto agudo de miocardio. Se presenta aproximadamente en el 1 % de los pacientes infartados, su mortalidad es elevada y el tratamiento de elección es la reparación quirúrgica. Se presenta un paciente anciano que ingresó en la Unidad de Cuidados Intensivos por infarto agudo de miocardio de cara anterior, que recibió tratamiento trombolítico con estreptokinasa recombinante cubana y 24 horas más tarde, presentó deterioro hemodinámico con cambios electrocardiográficos y aparición de soplo sistólico en la punta. Se realizó una ecocardiografía que mostró un defecto del septo interventricular con apertura y cierre intermitentes. Horas más tarde el paciente falleció por insuficiencia cardiocirculatoria, a pesar del tratamiento. Se presentan las imágenes ecocardiográficas y la pieza anatómica. Lo inusual del presente caso fue la apertura y el cierre intermitentes del defecto interventricular. No se encontró ningún informe similar a en las bases de datos bibliográficas consultadas. / Abstract Ventricular septum rupture is a serious complication in patients with acute myocardial infarction. It occurs in approximately 1% of heart attack patients; its mortality rate is high and surgical repair is the treatment of choice. The case of an elderly male patient who was admitted to the Intensive Care Unit for acute anterior myocardial infarction is reported. This patient received thrombolytic therapy with Cuban recombinant streptokinase and 24 hours later presented hemodynamic deterioration with electrocardiographic changes and appearance of systolic murmur at the apex. Echocardiography was performed which showed a ventricular septal defect with intermittent opening and closing. Despite treatment, the patient died of circulatory failure hours later. Echocardiographic images and the anatomical specimen are shown. What was unusual in this case was

  13. Computed Tomography Appearances of Various Complications Associated with Pancreatic Pseudocysts

    Energy Technology Data Exchange (ETDEWEB)

    Cheol Kim, Hyun; Mo Yang, Dal; Jung Kim, Hyoung; Ho Lee, Dong; Tae Ko, Young; Won Lim, Joo (Dept. of Radiology, East-West Neo Medical Center, Kyung-Hee Univ., Seoul (Korea))

    2008-09-15

    Most pancreatic pseudocysts are common complications of acute or chronic pancreatitis. They usually occur within the pancreas or in peripancreatic tissues, and are visualized as round or oval fluid collections with thin or thick walls on computed tomography (CT) scans. However, pancreatic pseudocysts are often combined with various complications, e.g., various organ involvements, infection, hemorrhage with pseudoaneurysm formation, rupture with fistula formation, or gastrointestinal or biliary obstruction, which may necessitate prompt intervention or surgery. This review illustrates the CT appearances of various complications associated with pancreatic pseudocysts

  14. Percutaneous suturing of the ruptured Achilles tendon with endoscopic control.

    Science.gov (United States)

    Doral, Mahmut Nedim; Bozkurt, Murat; Turhan, Egemen; Ayvaz, Mehmet; Atay, Ozgür Ahmet; Uzümcügil, Akin; Leblebicioğlu, Gürsel; Kaya, Defne; Aydoğ, Tolga

    2009-08-01

    A prospective study of modified percutaneous Achilles tendon repair performed between 1999 and 2005 under local infiltration anesthesia is presented; the study evaluated the results of percutaneous repair technique by visualization of the synovia under endoscopic control, followed by early functional postoperative treatment for surgical intervention of acute Achilles tendon ruptures. Sixty-two patients (58 males, 4 females, mean age 32) were treated by percutaneous suturing with modified Bunnel technique under endoscopic control within 10 days after acute total rupture. Physiotherapy was initiated immediately after the operation and patients were encouraged to weight-bearing ambulation with a walking brace-moon boot as tolerated. Full weight-bearing was allowed minimum after 3 weeks postoperatively without brace. The procedure was tolerated in all patients. There were no significant ROM limitation was observed. Two patients experienced transient hypoesthesia in the region of sural nerve that spontaneously resolved in 6 months. Fifty-nine patients (95%) including professional athletes returned to their previous sportive activities, while 18 of them (29%) had some minor complaints. The interval from injury to return to regular work and rehabilitation training was 11.7 weeks (10-13 weeks). At the latest follow-up (mean: 46 months; range: 12-78 months), all the patients had satisfactory results with a mean American Orthopedic Foot and Ankle Society's ankle-hindfoot score of 94.6. No re-ruptures, deep venous thrombosis or wound problems occurred. The proposed method offers a reasonable treatment option for acute total Achilles tendon rupture with a low number of complications. The rerupture rate and return to preinjury activities are comparable to open and percutaneous without endoscopic control procedures.

  15. Early functional rehabilitation versus postoperative immobilization for acute achilles tendon ruptures:a systematic review%急性跟腱断裂术后早期功能锻炼与制动的Meta分析

    Institute of Scientific and Technical Information of China (English)

    陈江涛; 荀传辉; 宋兴华; 加莎热特·杰力勒; 霍建军

    2012-01-01

    tendon ruptures were identified from MEDLINE (from 1966 to 2011.1),EMBASE (from 1966 to 2011.1),Cochrane Library (Issue 1,2011),Cochrane Musculoskeletal Injuries Group Database (2011.1) and CBM disc (from 1979 to 2011.1).We hand-searched Chinese Journal of Orthopaedics (from the llrst issue to January issue,2011 ) and Chinese Journal of Orthopaedic Trauma (from the first issue to January issue,2011 ) for RCTs and CCTs of our interest.Data were extracted by 2 reviewers with designed extraction form.RevMan 4.2.8 software was used for data analysis.Results Four RCTs and 3 CCTs were included for the present meta analysis.Compared with postoperative immobilization,early functional rehabilitation significantly improved patients' subjective satisfaction [ RR =1.27,95% CI (1.01,1.61),P =0.04]and reduced the complication rate [ RR =0.43,95% CI (0.22,0.83),P =0.01 ]but did not significantly increase the rerupture rate [ RR =0.59,95% CI (0.20,1.80),P =0.92],the infection rate [ RR =0.70,95% CI (0.26,1.86),P =0.48],or the achilles elongation at either 6 weeks [SMD=1.50,95% CI(-3.40,6.40)]or at 12 weeks[SMD=-0.25,95% CI(-5.64,5.14)].Conclusions Compared with postoperative immobilization for acute achilles tendon ruptures,early functional rehabilitation can obviously increase patients' subjective satisfaction and reduce complications without increasing risks of rerupture and infection.There is no significant difference in achilles elongation,calf strength and range of motion of the ankle between the 2 treatments.

  16. Endoscopic endonasal approach for the treatment of a large clival giant cell tumor complicated by an intraoperative internal carotid artery rupture.

    Science.gov (United States)

    Iacoangeli, Maurizio; Di Rienzo, Alessandro; Re, Massimo; Alvaro, Lorenzo; Nocchi, Niccolò; Gladi, Maurizio; De Nicola, Maurizio; Scerrati, Massimo

    2013-01-01

    Giant cell tumors (GCTs) are primary bone neoplasms that rarely involve the skull base. These lesions are usually locally aggressive and require complete removal, including the surrounding apparently healthy bone, to provide the best chance of cure. GCTs, as well as other lesions located in the clivus, can nowadays be treated by a minimally invasive fully endoscopic extended endonasal approach. This approach ensures a more direct route to the craniovertebral junction than other possible approaches (transfacial, extended lateral, and posterolateral approaches). The case reported is a clival GCT operated on by an extended endonasal approach that provides another contribution on how to address one of the most feared complications attributed to this approach: a massive bleed due to an internal carotid artery injury.

  17. Diagnosis and treatment of melamine-associated urinary calculus complicated with acute renal failure in infants and young children

    Institute of Scientific and Technical Information of China (English)

    SUN Ning; JIANG Ye-ping; FENG Dong-chuan; ZHANG Rui-feng; ZHU Xiao-yu; XIAO Hong-zhan; SHEN Ying; SUN Qiang; LI Xu-ran; JIA Li-qun; ZHANG Gui-ju; ZHANG Wei-ping; CHEN Zhi; FAN Jian-feng

    2009-01-01

    Background Infants in some areas of China developed urinary lithiasis after being fed with powdered milk that was tainted with melamine in 2008 and very small proportion of the infants developed acute renal failure caused by urinary tract calculus obstruction. The aim of this article was to summarize clinical characteristics, diagnosis and treatment of infants with urinary calculus and acute renal failure developed after being fed with melamine tainted formula milk.Methods Data of infant patients with urinary calculus and acute renal failure due to melamine tainted formula milk admitted to the Beijing Children's Hospital Affiliated to the Capital Medical University and the Xuzhou Children's Hospital in 2008 were used to analyze the epidemiological characteristics, clinical manifestations, imaging features as well as effects of 4 types of therapies.Results All the 34 infants with urinary calculus were complicated with acute renal failure, their blood urea nitrogen (BUN) was (24.1±8.2) mmol/L and creatinine (CO was (384.2±901.2) μmol/L. The chemical analysis on the urinary calculus sampled from 15 of the infants showed that the calculus contained melamine and acidum uricum. The time needed for the four types of therapies for returning Cr to normal was (3.5±1.9) days for cystoscopy group, (2.7±1.1) days for lithotomy group, (3.8±2.3) days for dialysis group, and (2.7±1.6) days for medical treatment group, which had no statistically significant difference (P=0.508). Renal failure of all the 34 infants was relieved within 1 to 7 days, averaging (3.00±1.78) days.Conclusions Melamine tainted formula milk may cause urinary calculus and obstructive acute renal failure. It is suggested that firstly the patients with urinary calculus complicated with acute renal failure should be treated with dialysis or medication to correct electrolyte disturbance, in particular hyperkalemia, and then relieve the obstruction with available medical and surgical methods as soon as

  18. Diagnosis and treatment of melamine-associated urinary calculus complicated with acute renal failure in infants and young children.

    Science.gov (United States)

    Sun, Ning; Shen, Ying; Sun, Qiang; Li, Xu-ran; Jia, Li-qun; Zhang, Gui-ju; Zhang, Wei-ping; Chen, Zhi; Fan, Jian-feng; Jiang, Ye-ping; Feng, Dong-chuan; Zhang, Rui-feng; Zhu, Xiao-yu; Xiao, Hong-zhan

    2009-02-05

    Infants in some areas of China developed urinary lithiasis after being fed with powdered milk that was tainted with melamine in 2008 and very small proportion of the infants developed acute renal failure caused by urinary tract calculus obstruction. The aim of this article was to summarize clinical characteristics, diagnosis and treatment of infants with urinary calculus and acute renal failure developed after being fed with melamine tainted formula milk. Data of infant patients with urinary calculus and acute renal failure due to melamine tainted formula milk admitted to the Beijing Children's Hospital Affiliated to the Capital Medical University and the Xuzhou Children's Hospital in 2008 were used to analyze the epidemiological characteristics, clinical manifestations, imaging features as well as effects of 4 types of therapies. All the 34 infants with urinary calculus were complicated with acute renal failure, their blood urea nitrogen (BUN) was (24.1+/-8.2) mmol/L and creatinine (Cr) was (384.2+/-201.2) micromol/L. The chemical analysis on the urinary calculus sampled from 15 of the infants showed that the calculus contained melamine and acidum uricum. The time needed for the four types of therapies for returning Cr to normal was (3.5+/-1.9) days for cystoscopy group, (2.7+/-1.1) days for lithotomy group, (3.8+/-2.3) days for dialysis group, and (2.7+/-1.6) days for medical treatment group, which had no statistically significant difference (P=0.508). Renal failure of all the 34 infants was relieved within 1 to 7 days, averaging (3.00+/-1.78) days. Melamine tainted formula milk may cause urinary calculus and obstructive acute renal failure. It is suggested that firstly the patients with urinary calculus complicated with acute renal failure should be treated with dialysis or medication to correct electrolyte disturbance, in particular hyperkalemia, and then relieve the obstruction with available medical and surgical methods as soon as possible. It was observed

  19. Plantar fascia rupture: diagnosis and treatment.

    Science.gov (United States)

    Rolf, C; Guntner, P; Ericsäter, J; Turan, I

    1997-01-01

    Two patients with spontaneous medial plantar fascia rupture due to a definite injury with no prior symptoms, were referred to our institution. Clinically, there was a tender lump in the sole, and magnetic resonance imaging confirmed the diagnosis. Nonoperative treatment was sufficient in curing the acute total rupture. Endoscopic release was used on the partially ruptured plantar fascia, but it is probably more optimal in the acute phase. The literature provides no comparative data on operative or nonoperative treatment efficacy for this rare condition.

  20. Second trimester hepatic rupture in a 35 year old nulliparous woman with HELLP syndrome: a case report.

    LENUS (Irish Health Repository)

    Kelly, J

    2009-01-01

    The HELLP syndrome (haemolysis, elevated liver blood tests and low platelets) is a serious complication in pregnancy characterized by haemolysis, elevated liver enzymes and low platelet count occurring in 0.5 to 0.9% of all pregnancies and in 10-20% of cases with severe preeclampsia. Hepatic capsular rupture is a rare yet dramatic complication of HELLP syndrome. The majority of cases occur in multiparous women over the age of 30. Classically it presents with acute onset right upper quadrant pain in the presence of constitutional symptoms such as vomiting and pyrexia. However, symptoms and signs are usually non specific. Spontaneous hepatic rupture can be preceded by signs of hypovolaemic shock; yet the diagnosis is infrequently made prior to emergent laparotomy. We present the case of a 35 year old nulliparous woman with a second trimester gestational hepatic rupture associated with HELLP syndrome. We briefly discuss the aetiology, diagnostic difficulties and treatment options associated with this rare presentation.

  1. [Quadriceps tendon insufficiency and rupture : Treatment options in total knee arthroplasty].

    Science.gov (United States)

    Thiele, K; von Roth, P; Pfitzner, T; Preininger, B; Perka, C

    2016-05-01

    Quadriceps tendon injuries and insufficiencies in total knee arthroplasty are rare, but are followed by a devastating complication that left untreated leads to a complete loss of function of the knee. This review article summarizes the functional anatomy, risk factors, and the prevalence and diagnosis of quadriceps tendon injuries, in addition to the possible management options for partial and complete ruptures. The treatment options are adapted according to the extent of the loss of function (partial, complete) and the duration of the injury (acute vs chronic). Furthermore, the choice of treatment should take into account the quality and availability of primary tissue, the patient's general health, along with their likely functional requirements. Conservative treatment is often justified in partial ruptures with good results. Complete ruptures require surgical intervention and multiple operative techniques are described. Treatment options for acute ruptures include direct primary repair with autogenous or synthetic tissue augmentation. In the case of chronic insufficiency and a lack of soft-tissue surroundings, reconstruction with the aid of a muscle flap or allograft tissue can be considered. All surgical intervention techniques used so far have been fraught with complications and rarely lead to satisfactory results. A new surgical approach to the reconstruction and augmentation of the extensor mechanism consists of the use of a synthetic mesh. The technique is described here in detail.

  2. Treatment of patients with acute colonic diverticulitis complicated by abscess formation

    DEFF Research Database (Denmark)

    Gregersen, Rasmus; Mortensen, Laura Quitzau; Burcharth, Jakob

    2016-01-01

    PURPOSE: This study aimed to systematically review the literature and present the evidence on outcomes after treatment for acute diverticulitis with abscess formation. Secondly, the paper aimed to compare different treatment options. METHODS: PubMed, EMBASE and the Cochrane Library were searched...

  3. Impaired microcirculation predicts poor outcome of patients with acute myocardial infarction complicated by cardiogenic shock

    NARCIS (Netherlands)

    C.A. den Uil; W.K. Lagrand; M. van der Ent; L.S.D. Jewbali; J.M. Cheng; P.E. Spronk; M.L. Simoons

    2010-01-01

    We investigated the relationship between sublingual perfused capillary density (PCD) as a measure of tissue perfusion and outcome (i.e. occurrence of organ failure and mortality) in patients with cardiogenic shock from acute myocardial infarction. We performed a prospective study in 68 patients. Usi

  4. Hyperglycemia during induction therapy is associated with increased infectious complications in childhood acute lymphocytic leukemia

    Science.gov (United States)

    Children with acute lymphocytic leukemia (ALL) are at high risk for developing hyperglycemia. Hyperglycemic adult ALL patients have shorter remissions, more infections, and increased mortality. No corresponding data are available in children. We hypothesized that children with ALL who become hypergl...

  5. Boxing sparring complicated by an acute subdural haematoma and brainstem haemorrhage.

    Science.gov (United States)

    Hart, Michael G; Trivedi, Rikin A; Hutchinson, Peter J

    2012-10-01

    A professional boxer developed an acute subdural haematoma after boxing sparring. Despite timely surgical decompression, he had a poor overall outcome predominantly from a delayed brainstem haematoma. Magnetic resonance imaging (MRI) was used to elucidate the pathophysiology of the patients' injury and clinical condition.

  6. Complicated septic shock caused by Achromobacter xylosoxidans bacteremia in a patient with acute lymphoblastic leukemia

    Directory of Open Access Journals (Sweden)

    Al-Jasser A M

    2007-01-01

    Full Text Available Infections caused by Achromobacter xylosoxidans cause significant morbidity and mortality in debilitated individuals. Eradication of these infections requires prolonged therapy with antimicrobial agents and removal of any infected central venous catheter. The outcome is usually poor in patients with high risk malignancy, septic complications, and/or multi-organ dysfunction

  7. Cardiac MRI documented left ventricular thrombus complicating acute Takotsubo syndrome: an uncommon dilemma.

    Science.gov (United States)

    Singh, Veerpal; Mayer, Tom; Salanitri, John; Salinger, Michael H

    2007-10-01

    Transient left ventricular apical hypokinesis results in a typical ampullary shape and has been described as Takotsubo cardiomyopathy (TCM). We report a case of TCM with the rare complication of left ventricular thrombus formation. Cardiac magnetic resonance imaging aided the diagnosis by characterizing the non-enhancing mass and evaluating the surrounding myocardium for scarring.

  8. [Hepatosplenic and kidneys candidasis complicating an acute myeloblastic leukemia. A case treated with voriconazole and caspofungin].

    Science.gov (United States)

    Elouennass, M; Doghmi, K; Fagot, T; Soler, C; Mac Nab, C; Foissaud, V; De Revel, T; Hervé, V

    2005-01-01

    We report the observation of hepato-splenic and kidneys candidiasis complicating the chemotherapy of a myeloblastic leukemia (LAM5b). Following the lack of effectiveness of a first line treatement, using amphotericine B liposomale and 5-fluorocytosine, implementation of an association of new molecules, a triazole of second generation (voriconazole) and an echinocandine (caspofungine) has allowed a successful result.

  9. A case of minimal change nephrotic syndrome with acute renal failure complicating Hashimotoâs disease.

    Science.gov (United States)

    Iwazu, Y; Nemoto, J; Okuda, K; Nakazawa, E; Hashimoto, A; Fujio, Y; Sakamoto, M; Ando, Y; Muto, S; Kusano, E

    2008-01-01

    A 63-year-old man was admitted to our hospital for evaluation of generalized edema. Coexistence of severe hypothyroidism and nephrotic syndrome was detected by laboratory examination. High titer of both antimicrosomal antibody and antithyroid peroxidase antibody indicated Hashimotoâs disease. Renal biopsy showed minimal change glomerular abnormality, but no findings of membranous nephropathy. A series of medical treatments, including steroid therapy, thyroid hormone and human albumin replacement therapy, were administered. However, acute renal failure accompanied by hypotension, was not sufficiently prevented. After 9 sessions of plasmapheresis therapy, the severe proteinuria and low serum albumin levels were improved. Even after resting hypotension was normalized, neither renal function nor thyroid function were fully recovered. After discharge, renal function gradually returned to normal, and the blood pressure developed into a hypertensive state concomitant with the normalization of thyroid function. This report is a rare case of autoimmune thyroid disease complicated with minimal change nephrotic syndrome. In most cases of nephritic syndrome, acute renal failure (ARF) has been reported to coexist with hypertension. Although pseudohypothyroidism is well-known in nephrotic pathophysiology, complications of actual hypothyroidism are uncommon. It is suggested that the development of hypotension and ARF could be enhanced not only by hypoproteinemia, but also by severe hypothyroidism.

  10. Successful management of a patient with Marfan syndrome complicated with acute aortic dissection using landiolol during Cesarean section.

    Science.gov (United States)

    Saeki, Noboru; Taguchi, Shima; Kawamoto, Masashi

    2010-04-01

    Aortic dissection is a lethal complication in pregnant women with Marfan syndrome. To decrease arterial wall stress, beta-blockers have been used as standard treatment, although uterine contractions caused by beta-2-adrenergic receptor antagonism may result. Herein, we report a patient with Marfan syndrome who was given landiolol, a selective beta-1-adrenergic receptor antagonist with a short half-life, for management during a Cesarean section procedure following development of acute aortic dissection. A 30-year-old pregnant woman with Marfan syndrome in the 38th week of gestation was referred to our department for an emergency Cesarean section because of development of acute aortic dissection. Blood pressure (BP) decreased from 157/70 to 128/64 mmHg after giving nicardipine and nitroglycerin. However, heartrate (HR) increased from 112 to 145 bpm, which was reduced to 105 bpm with landiolol, while BP was maintained. A Cesarean section was performed without complications under combined spinal-epidural anesthesia. Hemodynamic state, uterine contraction, and the extent of aortic dissection remained stable. The postoperative course was uneventful, and the patient and her baby were discharged safely. Landiolol was useful for reduction of HR without affecting BP or uterine contractions during a Cesarean section procedure in our patient with aortic dissection.

  11. Timing, setting and incidence of cardiovascular complications in patients with acute myocardial infarction submitted to primary percutaneous coronary intervention

    Science.gov (United States)

    Giglioli, Cristina; Margheri, Massimo; Valente, Serafina; Comeglio, Marco; Lazzeri, Chiara; Chechi, Tania; Armentano, Corinna; Romano, Salvatore Mario; Falai, Massimiliano; Gensini, Gian Franco

    2006-01-01

    BACKGROUND At the Istituto di Clinica Medica Generale e Cardiologia (Florence, Italy), the widespread use of percutaneous coronary intervention (PCI) has markedly changed the hospital course of patients with acute myocardial infarction (AMI). These patients are typically transferred to the coronary care unit (CCU) only after primary PCI, whereas during the thrombolytic era, patients were first admitted to CCU before reperfusion. OBJECTIVES AND METHODS The incidence, timing and setting of complications from symptom onset to hospital discharge in 689 consecutive AMI patients undergoing PCI were evaluated. RESULTS Ventricular fibrillation occurred in 11% of patients, and most episodes (94.7%) occurred before or during PCI. Of all patients, 6.3% developed complete atrioventricular block (CAVB), and in 86.3% of these cases, the CAVB occurred before or during PCI; in 94.5%, a CAVB resolution occurred in the catheterization laboratory (CL). Thirty-one patients (4.5%) had impending shock on admission to the CL. Cardiogenic shock developed in 29 patients (4.2%), mostly in the prehospital phase or in the CL. Only four patients (less than 1%) developed cardiogenic shock later during their hospital course. Similarly, circulatory and ventilatory support, as well as temporary pacing and cardiac defibrillation, were used mostly in the prehospital phase or in the CL. During the CCU stay, 45 patients (6.5%) had hemorrhagic or vascular complications, and the incidence of post-PCI ischemia and early reocclusion of the culprit vessel were low (2.1% and 0.6%, respectively). Thus, cardiac complications usually associated with AMI were observed mainly before hospital admission or in the CL during the reopening of the target vessel. These complications were rarely observed after a successful PCI. CONCLUSIONS For AMI patients, the CL is not only the site of PCI, it is also where most life-threatening cardiac complications are observed and treated. PMID:17036099

  12. Endoscopic endonasal approach for the treatment of a large clival giant cell tumor complicated by an intraoperative internal carotid artery rupture

    Directory of Open Access Journals (Sweden)

    Iacoangeli M

    2013-01-01

    Full Text Available Maurizio Iacoangeli,1 Alessandro Di Rienzo,1 Massimo Re,2 Lorenzo Alvaro,1 Niccolò Nocchi,1 Maurizio Gladi,1 Maurizio De Nicola,3 Massimo Scerrati11Department of Neurosurgery, Università Politecnica delle Marche, Umberto I General Hospital, Ancona, Italy; 2Department of Ear, Nose, and Throat Surgery, Università Politecnica delle Marche, Umberto I General Hospital, Ancona, Italy; 3Department of Radiology, Interventional Radiology Section, Università Politecnica delle Marche, Umberto I General Hospital, Ancona, ItalyAbstract: Giant cell tumors (GCTs are primary bone neoplasms that rarely involve the skull base. These lesions are usually locally aggressive and require complete removal, including the surrounding apparently healthy bone, to provide the best chance of cure. GCTs, as well as other lesions located in the clivus, can nowadays be treated by a minimally invasive fully endoscopic extended endonasal approach. This approach ensures a more direct route to the craniovertebral junction than other possible approaches (transfacial, extended lateral, and posterolateral approaches. The case reported is a clival GCT operated on by an extended endonasal approach that provides another contribution on how to address one of the most feared complications attributed to this approach: a massive bleed due to an internal carotid artery injury.Keywords: clival giant cell tumor, endoscopic endonasal approach, internal carotid artery injury, minimally invasive surgery

  13. Complications after arthroscopic coracoclavicular reconstruction using a single adjustable-loop-length suspensory fixation device in acute acromioclavicular joint dislocation.

    Science.gov (United States)

    Shin, Sang-Jin; Kim, Nam-Ki

    2015-05-01

    The purpose of this study was to evaluate clinical and radiological outcomes after arthroscopically assisted coracoclavicular (CC) fixation using a single adjustable-loop-length suspensory fixation device for acute acromioclavicular dislocation and to report intraoperative and postoperative complications. Eighteen consecutive patients with acute acromioclavicular dislocation underwent arthroscopically assisted CC fixation using a single TightRope (Arthrex, Naples, FL). Using the Rockwood classification, 3 patients had grade III dislocations, one patient had a grade IV dislocation, and 14 patients had grade V dislocations. The preoperative CC distance of the injured shoulder was 16.1 ± 2.7 mm (range, 11.2 to 21.0 mm), and it increased by 99% ± 36% (range, 17% to 153%) on average compared with the contralateral shoulder. The average CC distance was 10.5 ± 2.5 mm (range, 7.7 to 15.5 mm), and it increased by 30% ± 30% (range, -9.4% to 90%) at the final follow-up. Compared with immediate postoperative radiographs, the CC distance was maintained in 12 patients, increased between 50% and 100% in 4 patients, and increased more than 100% in 2 patients at final follow-up. However, there was no statistical difference in Constant scores between 6 patients with reduction loss (95.6 ± 4.5) and 12 patients with reduction maintenance (98.4 ± 2.5; P = .17). Perioperative complications occurred in 8 patients, including one case of acromioclavicular arthritis, one case of delayed distal clavicular fracture at the clavicular hole of the device, 3 cases of clavicular or coracoid button failures, and 3 cases of clavicular bony erosion. Satisfactory clinical outcomes were obtained after CC fixation using the single adjustable-loop-length suspensory fixation device for acute acromioclavicular joint dislocation. However, CC fixation failure of greater than 50% of the unaffected side in radiological examinations occurred in 33% of the patients within 3 months after the operation

  14. Complicaciones de la apendicectomía por apendicitis aguda Complications of the appendicectomy due to acute appendicitis

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    Zenén Rodríguez Fernández

    2010-06-01

    Full Text Available INTRODUCCIÓN. La apendicectomía por apendicitis aguda es la operación de urgencia más común en los servicios quirúrgicos, pero no está exenta de complicaciones condicionadas por factores poco conocidos, cuya determinación podría disminuir la morbilidad y mortalidad por esta causa. Fue objetivo de esta investigación identificar algunos factores relacionados con la aparición de complicaciones en los pacientes apendicectomizados por apendicitis aguda. MÉTODOS. Se realizó un estudio descriptivo, observacional y prospectivo de 560 pacientes apendicectomizados, con diagnóstico histopatológico de apendicitis aguda, egresados del Servicio de Cirugía General del Hospital Provincial Docente «Saturnino Lora» de Santiago de Cuba durante el 2006. RESULTADOS. El 21,6 % de la serie sufrió algún tipo de complicación, principalmente la infección del sitio operatorio. Las complicaciones aumentaron en relación con la edad y se presentaron más frecuentemente en los pacientes con enfermedades asociadas, estado físico más precario, mayor tiempo de evolución preoperatoria, así como en las formas histopatológicas más avanzadas de la afección (en las que se incluyen los 4 pacientes fallecidos. La aparición de tales complicaciones puede ser causa de reintervenciones y de aumento de la estadía hospitalaria. CONCLUSIONES. El diagnóstico precoz de la enfermedad y la apendicectomía inmediata con una técnica quirúrgica adecuada previenen la aparición de complicaciones posquirúrgicas y determinan el éxito del único tratamiento eficaz contra la afección más común que causa el abdomen agudo, cuyo pronóstico depende en gran medida y entre otros factores, del tiempo de evolución preoperatoria y de la fase en que se encuentre el proceso morboso al realizar la intervención.INTRODUCTION. Appendicectomy due to acute appendicitis is the commonest urgency operation in surgical services but it is not exempt from complications conditions by

  15. Clinical study of critical patients with hemorrhagic fever with renal syndrome complicated by acute respiratory distress syndrome.

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    Hong Du

    Full Text Available OBJECTIVES: The aim of this study was to investigate the clinical characteristics and outcomes of critical patients with hemorrhagic fever with renal syndrome (HFRS complicated by acute respiratory distress syndrome (ARDS. MATERIALS AND METHODS: To observe the demographic, epidemiological and clinical characteristics, and to explore the predictive effects for prognosis in laboratory findings, we conducted a detailed retrospective analysis of clinical records for critical patients with HFRS complicated by ARDS, treated at the center for infectious diseases, Tangdu Hospital, between January 2008 and December 2012. RESULTS: A total of 48 critical patients with laboratory confirmed HFRS accompanied by ARDS were enrolled in the study, including 27 survivors and 21 non-survivors, with a fatality rate of 43.75%. Thirty-one individuals (64.6% contracted HFRS between the months of September and December. The non-survivors tended to have lower incidence of overlapping phase (P = 0.025. There were no obvious differences in the needs for mechanical ventilation (MV and renal replacement therapy (RRT, except for the need for vasoactive drugs between the survivors and non-survivors (P = 0.001. The non-survivors were found to have higher frequencies of encephalopathy, refractory shock and multiple organ dysfunction syndrome (MODS, lower incidences of acute renal failure (ARF and secondary hypertension (P<0.05. The non-survivors tended to have lower levels of serum creatinine (Scr (P<0.001 and fibrinogen (Fib (P = 0.003, higher incidences of prolonged prothrombin time (PT (P = 0.006 and activated partial thromboplastin time (APTT (P = 0.020 and higher levels of aspartate aminotransferase (AST (P = 0.015, and the laboratory parameters mentioned above reached statistical significance for predicting prognosis (P<0.05. CONCLUSION: The high mortality rate of critical patients with HFRS complicated by ARDS emphasizes the importance of

  16. Mechanism of acute pancreatitis complicated with injury of intestinal mucosa barrier

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Acute pancreatitis (AP) is a common acute abdomen in clinic with a rapid onset and dangerous pathogenetic condition.AP can cause an injury of intestinal mucosa barrier, leading to translocation of bacteria or endotoxin through multiple routes,bacterial translocation (BT), gutorigin endotoxaemia, and secondary infection of pancreatic tissue, and then cause systemic inflammatory response syndrome (SIRS) or multiple organ dysfunction syndrome (MODS), which are important factors influencing AP's severity and mortality. Meanwhile, the injury of intestinal mucosa barrier plays a key role in AP's process. Therefore, it is clinically important to study the relationship between the injury of intestinal mucosa barrier and AP. In addition, many factors such as microcirculation disturbance, ischemical reperfusion injury, excessive release of inflammatory mediators and apoptosis may also play important roles in the damage of intestinal mucosa barrier. In this review, we summarize studies on mechanisms of AP.

  17. Cardiogenic shock complicating acute myocardial infarction; prognostic impact of early and late shock development

    DEFF Research Database (Denmark)

    Lindholm, M G; Køber, L; Boesgaard, S

    2003-01-01

    AIMS: Cardiogenic shock accounts for the majority of deaths following acute myocardial infarction. The majority of outcome data on this issue are, however, derived from single hospitals, referral centers or selected patients in randomized studies. The purpose of this study was to investigate...... incidence, outcome and prognostic significance of cardiogenic shock in 6676 consecutive patients with acute myocardial infarction. METHODS AND RESULTS: Demographic and clinical data including the presence of cardiogenic shock were prospectively collected in 6676 non-invasively managed patients...... with myocardial infarction consecutively admitted to 27 different hospitals during a 2-year period. Six-year mortality data were collected in 99.9% of the population. Cardiogenic shock developed in 444 patients (6.7%). In 59% of these patients cardiogenic shock developed within 48 h, 11% developed shock during...

  18. [Neuroimmunocorrection therapy for the prophylaxis of infectious complications in acute stroke patients].

    Science.gov (United States)

    Kul'chikov, A E; Makarenko, A N

    2008-01-01

    Neuroimmunocorrection therapy with cerebrolysin has been used for the prophylaxis of clinical pneumonia development in the early stage of acute stroke in a group of 140 patients with heavy clinical course of acute ischemic stroke (AIS). All patients in the test and control groups received the basal anti-AIS therapy and antibacterial drugs (IV-generation cephalosporins) in case of pneumonia development. The efficacy of cerebrolysin administration was evaluated both on the clinical scale (NIH-NINDS, CPIS, SIRS immonograms) and using laboratory indices. It is established that the proposed neuroimmunocorrection therapy with cerebrolysin decreases the frequency of the clinical pneumonia development. A relationship between the pneumonia onset rate and the focus localization in limbico-diencephalic part of the brain is established. The use of cerebrolysin decreases lethality, normalizes the impaired immunity indices, accelerates the restoration of violated neural functions, suppresses pneumonia development, restores the level of albumin, and normalizes the laboratory indices of inflammatory syndrome.

  19. Preventive central nervous system irradiation in children with acute nonlymphocytic leukemia. [Complications of. gamma. radiation

    Energy Technology Data Exchange (ETDEWEB)

    Dahl, G.V.; Simone, J.V.; Hustu, H.O.; Mason, C.

    1978-11-01

    In this study of children with acute nonlymphocytic leukemia an attempt was made to prevent central nervous system relapse and to determine whether this therapy, coupled with multiagent chemotherapy, would be successful in prolonging durations of complete remission. Central nervous system relapses were prevented by irradiation, although patients who received this therapy did no better than those who did not receive irradiation. A small group of patients received irradiation to the liver and spleen, but this modality also failed to improve the duration of remission. Control of extramedullary leukemia, in this study, failed to improve remission duration because bone marrow relapse was not prevented or delayed. It is unlikely that focal therapy will have a significant impact in acute nonlymphocytic leukemia until longer marrow remissions are achieved.

  20. Effect of in-hospital medical complications on case fatality post-acute ischemic stroke: data from the China National Stroke Registry

    Institute of Scientific and Technical Information of China (English)

    WANG Peng-lian; CHEN Sheng-yun; CHEN Qi-dong; QU Hui; LU Jing-jing; ZHANG Jing; MA Rui-hua; ZHANG Yu-mei; WANG Yong-jun; ZHAO Xing-quan; YANG Zhong-hua; WANG An-xin; WANG Chun-xue; LIU Li-ping; WANG Yi-long; WANG Xin-gao; JU Yi

    2012-01-01

    Background In-hospital medical complications are associated with poorer clinical outcomes for stroke patients after disease onset.However,few studies from China have reported the effect of these complications on the mortality of patients with acute ischemic stroke.In this prospective work,the China National Stroke Registry Study,we investigated the effect of medical complications on the case fatality of patients with acute ischemic stroke.Methods From September 2007 to August 2008,we prospectively obtained the data of patients with acute stroke from 132 clinical centers in China.Medical complications,case fatality and other information recorded at baseline,during hospitalisation,and at 3,6,and 12 months after stroke onset.Multivariable Logistic regression was performed to analyze the effect of medical complications on the case fatality of patients with acute ischemic stroke.Results There were 39741 patients screened,14526 patients with acute ischemic stroke recruited,and 11560 ischemic stroke patients without missing data identified during the 12-month follow-up.Of the 11560 ischemic patients,15.8% (1826)had in-hospital medical complications.The most common complication was pneumonia (1373;11.9% of patients),followed by urinary tract infection and gastrointestinal bleeding.In comparison with patients without complications,stroke patients with complications had a significantly higher risk of death during their hospitalization,and at 3,6 and 12 months post-stroke.Having any one in-hospital medical complication was an independent risk factor for death in patients with acute ischemic stroke during hospital period (adjusted OR=6.946;95% CI 5.181 to 9.314),at 3 months (adjusted OR=3.843;95% Cl 3.221 to 4.584),6 months (adjusted OR=3.492;95% CI 2.970 to 4.106),and 12 months (adjusted OR=3.511;95% Cl 3.021 to 4.080).Having multiple complications strongly increased the death risk of patients.Conclusion Short-term and long-term outcomes of acute stroke patients

  1. Diagnosis and Management of Severe Acute Pancreatitis Complicated with Abdominal Compartment Syndrome

    Institute of Scientific and Technical Information of China (English)

    陶京; 王春友; 陈立波; 杨智勇; 许逸卿; 熊炯炘; 周峰

    2003-01-01

    Presented in this paper is our experience in the diagnosis and management of abdominal compartment syndrome during severe acute pancreatitis. On the basis of the history of severe acute pancreatitis, after effective fluid resuscitation, if patients developed renal, pulmonary and cardiac insufficiency after abdominal expansion and abdominal wall tension, ACS should be considered.Cystometry could be performed to confirm the diagnosis. Emergency decompressive celiotomy and temporary abdominal closure with a 3 liter sterile plastic bag must be performed. It is also critical to prevent reperfusion syndrome. In 23 cases of ACS, 18 cases received emergency decompressive celiotomy and 5 cases did not. In the former, 3 patients died (16.7 %) while in the later, 4 (80%)died. Total mortality rate was 33.3% (7/21). In 7 death cases, 4 patients developed acute obstructive suppurative cholangitis (AOSC). All the patients who received emergency decompressive celiotomy 5 h after confirmation of ACS survived. The definitive abdominal closure took place mostly 3 to 5 days after emergency decompressive celiotomy, with longest time being 8 days. 6 cases of ACS at infection stage were all attributed to infected necrosis in abdominal cavity and retroperitoneum. ACS could occur in SIRS stage and infection stage during SAP, and has different pathophysiological basis. Early diagnosis, emergency decompressive celiotomy and temporary abdominal closure with a 3L sterile plastic bag are the keys to the management of the condition.

  2. Coexistence of Major Complications in Pancreatic Pseudocyst: Case report

    Directory of Open Access Journals (Sweden)

    Ömer Fatih Nas

    2016-06-01

    Full Text Available Pancreatic pseudocyst is the most common cystic lesion of the pancreas seen following acute and chronic pancreatitis in 2-10% and 10-30%, respectively. Imaging findings vary depending on the age and severity of the attack. Infection, hemorrhage and rupture are the most frightening complications. The possibility of spontaneous recovery is consider­ably low. A 63-year old male patient who has history of longstanding alcohol consumption presented to the emer­gency department with complaints of abdominal pain. On computerized tomography (CT, an encapsulated and round peripancreatic collection with a size of approximately 8.5x7.5 cm was detected in pancreatic head. In the literature, no article is published mentioning coexistence of complication such as infection, hemorrhage and rupture. We present the association of these three complications observed in our case. J Clin Exp Invest 2016; 7 (2: 203-206

  3. Acute pancreatitis and cholangitis: A complication caused by a migrated gastrostomy tube

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Percutaneous endoscopic gastrostomy (PEG) is generally considered safe with a low rate of serious complications. However, dislocation of the PEG-tube into the duodenum can lead to serious complications.An 86-year old Japanese woman with PEG-tube feeding sometimes vomited after her family doctor replaced the PEG-tube without radiologic confirmation. At her hospitalization, she complained of severe tenderness at the epigastric region and the PEG-tube was drawn into the stomach. Imaging studies showed that the tip of PEG-tube with the inflated balloon was migrated into the second portion of the duodenum, suggesting that it might have obstructed the bile and pancreatic ducts,inducing cholangitis and pancreatitis. After the PEG-tube was replaced at the appropriate position, vomiting and abdominal tenderness improved dramatically and laboratory studies became normal immediately. Our case suggests that it is important to secure PEG-tube at the level of skin, especially after replacement.

  4. Acute Abdominal Compartment Syndrome as a Complication of Percutaneous Nephrolithotomy: Two Cases Reports and Literature Review

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    Jing Tao

    2016-09-01

    Full Text Available Percutaneous nephrolithotomy (PCNL is a technique commonly used to remove large or multiple kidney stones and stones in the inferior calyx, with the advantages of lower morbidity rates, decrease in post-operative pain with faster recovery. Intra-abdominal irrigation fluid extravasation which leads to abdominal hypertension is a rare complication of PCNL with little reports. Early detection of intra-abdominal extravagation is very important to prevent morbidity and mortality. We present two cases and review the literature.

  5. Acute Pancreatitis with Splenic Infarction as Early Postoperative Complication following Laparoscopic Sleeve Gastrectomy

    OpenAIRE

    Aleksandr Kalabin; Mani, Vishnu R.; Ankita Mishra; Hector Depaz; Leaque Ahmed

    2017-01-01

    Obesity is becoming a global health burden along with its comorbidities. It imposes tremendous financial burden and health costs worldwide. Surgery has emerged as the definitive treatment option for morbidly obese patients with comorbidities. Laparoscopic sleeve gastrectomy is performed now more than ever making it imperative for physicians and surgeons to recognize both the common and the uncommon risks and complications associated with it. In this report we describe a rare early life-threat...

  6. Acute Pancreatitis in the Postoperative Course after Esophagectomy: A Major Complication Described in 4 Patients

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    R.L.G.M. Blom

    2009-11-01

    Full Text Available Background: Postoperative pancreatitis is a rare but devastating complication after esophageal surgery. It has been described in connection with abdominal surgery but the etiology in connection with esophageal surgery has never been evaluated. The present study describes 4 cases of postoperative pancreatitis, and a hypothesis about the etiology is formed. Methods: We performed a search for patients with postoperative pancreatitis after esophagectomy using our prospective database including all patients that underwent esophageal resection at our institution between 1993 and 2008. Pancreatitis was described as abdominal pain, hyperamylasemia, signs of pancreatitis on CT scan or findings during laparotomy or autopsy. Results: A total of 950 patients underwent esophagectomy at our institution, 4 patients developed postoperative pancreatitis (incidence 0.4%. Two out of four patients died. Discussion: Pancreatitis following esophageal surgery is a serious, potentially lethal complication. Diagnosis can be difficult as clear clinical or laboratory findings might be lacking. Peroperative manipulation of the pancreas, mobilization of the duodenum or compromized vascularization have been suggested as etiological factors; although in the described patients, none of these factors were identified as the cause of pancreatitis. In conclusion, pancreatitis following esophageal surgery is a serious but rare complication that should always be considered in patients who deteriorate postoperatively.

  7. Acute gastric dilatation complicating the use of mydriatics in a preterm newborn

    Energy Technology Data Exchange (ETDEWEB)

    Sarici, S.Ue.; Yurdakoek, M.; Uenal, S. [Div. of Neonatology, Hacettepe University School of Medicine, Ankara (Turkey)

    2001-08-01

    A 2-month-old girl who had been born at 27-weeks' gestation was admitted for her screening examination for retinopathy of prematurity and given two drops each of cyclopentolate 0.5 % and phenylephrine 2.5 %. Approximately 2 h after completion of the examination, the infant had episodes of apnoea and vomiting. She was noted to be distended, and an abdominal radiograph demonstrated acute gastric dilatation. Apnoea, vomiting and distension resolved after 18 h and a repeat abdominal radiograph demonstrated resolution of the gastric dilatation. (orig.)

  8. Untreated silicone breast implant rupture

    DEFF Research Database (Denmark)

    Hölmich, Lisbet R; Vejborg, Ilse M; Conrad, Carsten

    2004-01-01

    Implant rupture is a well-known complication of breast implant surgery that can pass unnoticed by both patient and physician. To date, no prospective study has addressed the possible health implications of silicone breast implant rupture. The aim of the present study was to evaluate whether...... untreated ruptures are associated with changes over time in magnetic resonance imaging findings, serologic markers, or self-reported breast symptoms. A baseline magnetic resonance imaging examination was performed in 1999 on 271 women who were randomly chosen from a larger cohort of women having cosmetic...... breast implants for a median period of 12 years (range, 3 to 25 years). A follow-up magnetic resonance imaging examination was carried out in 2001, excluding women who underwent explantation in the period between the two magnetic resonance imaging examinations (n = 44). On the basis of these examinations...

  9. Amyand's hernia complicated with acute appendicitis: A case report and literature review

    Directory of Open Access Journals (Sweden)

    Mehmet Hanifi Okur

    2015-06-01

    Full Text Available Amyand's hernia is the presence of the appendix within an inguinal hernia sac. It is a rare condition, occurring in 1% of inguinal hernia patients. The clinical presentation varies depending on the extent of appendix inflammation. Amyand's hernia is difficult to diagnose clinically. However, imaging studies are valuable for both its diagnosis and detection of the associated complications. Here, we report a case of Amyand's hernia in a 3-year-old male child who presented with a history of right inguinal tenderness, pain, and swelling. An operation revealed a hernia sac containing the inflamed appendix; hence, an appendectomy was performed along with a right inguinal herniotomy.

  10. Intracranial Hypertension as an Acute Complication of Aseptic Meningoencephalitis with Leptomeningeal Contrast Enhancement on FLAIR MRI

    Directory of Open Access Journals (Sweden)

    Marc E. Wolf

    2016-01-01

    Full Text Available We report a case of a 19-year-old woman who developed intracranial hypertension as an unusual clinical complication of severe aseptic meningoencephalitis probably due to a diminished cerebrospinal fluid reabsorption capacity or leptomeningeal transudation as a consequence of blood-brain barrier dysfunction. These severe inflammatory changes were accompanied by prominent leptomeningeal contrast enhancement best visualized on fluid-attenuated inversion recovery magnetic resonance imaging. In such a prolonged course, a continuous lumbar drainage might be a temporary option to provide rapid symptom relief to the patient.

  11. MRI in flexor tendon rupture after collagenase injection

    Energy Technology Data Exchange (ETDEWEB)

    Khurana, Shruti [Lady Hardinge Medical College, New Delhi (India); Wadhwa, Vibhor [University of Arkansas for Medical Sciences, Little Rock, AR (United States); Chhabra, Avneesh [UT Southwestern Medical Center, Dallas, TX (United States); Johns Hopkins University, Baltimore, MD (United States); Amirlak, Bardia [UT Southwestern Medical Center, Dallas, TX (United States)

    2017-02-15

    Flexor tendon rupture is an unusual complication following collagenase injection to relieve contractures. These patients require a close follow-up and in the event of tendon rupture, a decision has to be made whether to repair the tendon or manage the complication conservatively. The authors report the utility of MRI in the prognostication and management of a patient with Dupuytren's contracture, who underwent collagenase injection and subsequently developed flexor digitorum profundus tendon rupture. (orig.)

  12. A Complicated Case of Acute Promyelocytic Leukemia in the Second Trimester of Pregnancy Successfully Treated with All-trans-Retinoic Acid.

    Science.gov (United States)

    Agarwal, Kanika; Patel, Megha; Agarwal, Vandana

    2015-01-01

    A 40-year-old female at 26-week gestation was diagnosed with acute promyelocytic leukemia (APL) after an abnormal prenatal lab workup showed pancytopenia. She was treated with all-trans-retinoic acid (ATRA), idarubicin, and dexamethasone. After day one of treatment, she developed differentiation syndrome, which was treated with dexamethasone. At 30-week gestation, she had preterm premature rupture of membranes and delivered by cesarean section because of the fetus' breech presentation. Despite ATRA's potential for teratogenicity, a viable infant was born without apparent anomalies. Postpartum, she underwent consolidation treatment with ATRA and arsenic trioxide (ATO). The patient continued ATRA therapy after delivery and is currently in remission.

  13. CYTOMORPHOLOGICAL EVALUATION AND PROGNOSIS OF BRONCHOPULMONARY COMPLICATIONS IN ACUTE AND EARLY PERIODS OF SPINAL CORD TRAUMA

    Directory of Open Access Journals (Sweden)

    I.A. Norkin

    2009-09-01

    Full Text Available There were investigated 50 cytological preparations after fibro-optic bronchoscopy of 10 patients with cervical spinal cord injuries. The dynamics of broncho-pulmonary complications of spinal cord injuries was estimated on the basis of cytological broncho-alveolar lavage fluid investigations. In the work there were used clinico-neurologic methods, radiological (computer tomography and magnetic resonance imaging, endoscopic (fibro-optic bronchoscopy and cytomorphological investigations. Cytomorphological investigations of broncho-alveolar lavage fluid were carried out on the 3-4, 7, 14, 30th days. Cellular composition of the broncho-alveolar wash-out (endopulmonary cytogramme was estimated by calculation of more than 100 cells in 3 fields of the immersion microscope coverage. Quantitative changes of cellular elements were taken into account with respect to normal cell amount. The results were analyzed according to the average out method. Quantitative changes of inflammatory elements in endopulmonary cytogramme were determined by the degree of endobronchitic manifestations and were corresponding to clinico-radiological picture of development of broncho-pulmonary complications in different periods of spinal cord injury

  14. Parietal subdural empyema as complication of acute odontogenic sinusitis: a case report

    Science.gov (United States)

    2014-01-01

    Introduction To date intracranial complication caused by tooth extractions are extremely rare. In particular parietal subdural empyema of odontogenic origin has not been described. A literature review is presented here to emphasize the extreme rarity of this clinical entity. Case presentation An 18-year-old Caucasian man with a history of dental extraction developed dysarthria, lethargy, purulent rhinorrhea, and fever. A computed tomography scan demonstrated extensive sinusitis involving maxillary sinus, anterior ethmoid and frontal sinus on the left side and a subdural fluid collection in the temporal-parietal site on the same side. He underwent vancomycin, metronidazole and meropenem therapy, and subsequently left maxillary antrostomy, and frontal and maxillary sinuses toilette by an open approach. The last clinical control done after 3 months showed a regression of all symptoms. Conclusions The occurrence of subdural empyema is an uncommon but possible sequela of a complicated tooth extraction. A multidisciplinary approach involving otolaryngologist, neurosurgeons, clinical microbiologist, and neuroradiologist is essential. Antibiotic therapy with surgical approach is the gold standard treatment. PMID:25146384

  15. The clinical and imaging presentation of acute "non complicated" pyelonephritis: A new profile for an ancient disease

    Directory of Open Access Journals (Sweden)

    Piccoli Giorgina

    2011-12-01

    Full Text Available Abstract Background Acute pyelonephritis (APN is differently defined according to imaging or clinical criteria. In adults information on the relationship between imaging and clinical data is lacking. Our study was aimed at analysing the relationship between the clinical and imaging presentation of APN, defined according to imaging criteria (parenchymal involvement at MR or CT scan. Methods All consecutive patients hospitalized for "non-complicated" APN were considered (June 2005-December 2009. Clinical, biochemical and imaging data at hospitalization were analyzed by univariate and logistic regression analysis. Results There were 119 patients, all females, median age 32 years (15-72. At hospitalization, inflammatory markers were elevated (CRP median: 12.1 mg/dL, normal Conclusions APN is a protean disease. In the absence of strict correlation with clinical or biochemical markers, imaging studies are required to assess the severity of kidney involvement.

  16. Aortocaval fistula (ACF) in patients operated for ruptured aortic aneurysm (rAAA)

    DEFF Research Database (Denmark)

    Warning, Karina; Houlind, Kim Christian; Ravn, Hans

    Aortocaval fistula (ACF) in patients operated for Ruptured Acute Aorta Aneurysm (rAAA): A surgical challenge. Introduction Aortocaval fistula is a rare complication of abdominal aortic aneurysm (AAA). It been reported to be present in less than 1% of all AAAs. ACF arise in patients with large...... aneurysms and is typically discovered peroperatively in patients with rAAA. Open surgical treatment is associated with high mortality and morbidity. ACF is a result of spontaneously rupture of large atherosclerotic aneurysms into the inferior vena cava in 80%, 15% arise after trauma and 5% are iatrogenic....... Patients During the last 9 month, we have operated three cases with rAAA and ACF. All patients had an open, acute operation. All ACFs detected during operation. Common for all operations was that the patients had large aneurysms (>10 cm) and extensive bleeding (3-4 l) immediately when the aneurysm...

  17. Spontaneous Splenic Rupture in Melanoma

    Directory of Open Access Journals (Sweden)

    Hadi Mirfazaelian

    2014-01-01

    Full Text Available Spontaneous rupture of spleen due to malignant melanoma is a rare situation, with only a few case reports in the literature. This study reports a previously healthy, 30-year-old man who came with chief complaint of acute abdominal pain to emergency room. On physical examination, abdominal tenderness and guarding were detected to be coincident with hypotension. Ultrasonography revealed mild splenomegaly with moderate free fluid in abdominopelvic cavity. Considering acute abdominal pain and hemodynamic instability, he underwent splenectomy with splenic rupture as the source of bleeding. Histologic examination showed diffuse infiltration by tumor. Immunohistochemical study (positive for S100, HMB45, and vimentin and negative for CK, CD10, CK20, CK7, CD30, LCA, EMA, and chromogranin confirmed metastatic malignant melanoma. On further questioning, there was a past history of a nasal dark skin lesion which was removed two years ago with no pathologic examination. Spontaneous (nontraumatic rupture of spleen is an uncommon situation and it happens very rarely due to neoplastic metastasis. Metastasis of malignant melanoma is one of the rare causes of the spontaneous rupture of spleen.

  18. Delayed diagnosis of post-traumatic acute myocardial infarction complicated by congestive heart failure.

    Science.gov (United States)

    Tsai, Tsung-Neng; Yang, Shih-Ping; Tsao, Tien-Ping; Huang, Kuo-An; Cheng, Shu-Meng

    2005-11-01

    A 53-year-old man experienced persistent chest pain followed by slight shortness of breath after being hit in the chest by a stranger. Chest X-ray study showed no rib fractures but electrocardiography indicated acute anterior wall myocardial infarction. Echocardiography revealed akinesia in both the interventricular septum and anterior left ventricular wall. Emergency cardiac catheterization demonstrated total occlusion of the proximal left anterior descending coronary artery, 9 h after the event. He was successfully treated with coronary angioplasty and stenting procedures. However, poor left ventricular function was observed 3 months after the event despite medications. We conclude that evaluation for possible myocardial injury should be considered soon after blunt chest trauma for early treatment to improve prognosis.

  19. A Complicated Course of Acute Viral Induced Pharyngitis, Icteric Hepatitis, Acalculous Cholecystitis, and Skin Rash

    Directory of Open Access Journals (Sweden)

    Fereshte Sheybani

    2016-01-01

    Full Text Available This case reveals the complexities and challenges in the diagnosis of acute Epstein-Barr virus (EBV infection, indicating the potential relationship between EBV infection and severe icteric hepatitis, acalculous cholecystitis, and lymphocytic vasculitis. We suggest including EBV infectious mononucleosis in the list of differential diagnoses when any of these clinical syndromes (or a combination thereof occurs without apparent cause, especially in the presence of lymphocytosis. To our knowledge, this is the first report to suggest the possible role of EBV in the pathogenesis of cutaneous lymphocytic vasculitis. Also it is possible that EBV infection triggered the flare-up of the underlying rheumatologic disease. Therefore, it could be assumed that a part of the clinical syndrome (e.g., dermatologic manifestations might be related to the flare-up of the underlying rheumatologic disease.

  20. Acute exacerbation of Hashimoto thyroiditis mimicking anaplastic carcinoma of the thyroid: A complicated case.

    Science.gov (United States)

    Kanaya, Hiroaki; Konno, Wataru; Fukami, Satoru; Hirabayashi, Hideki; Haruna, Shin-ichi

    2014-12-01

    The fibrous variant of Hashimoto thyroiditis is uncommon, accounting for approximately 10% of all cases of Hashimoto thyroiditis. We report a case of this variant that behaved like a malignant neoplasm. The patient was a 69-year-old man who presented with a right-sided anterior neck mass that had been rapidly growing for 2 weeks. Fine-needle aspiration cytology revealed clusters of large multinucleated cells suggestive of an anaplastic carcinoma. A week after presentation, we ruled out that possibility when the mass had shrunk slightly. Instead, we diagnosed the patient with an acute exacerbation of Hashimoto thyroiditis on the basis of laboratory findings. We performed a right thyroid lobectomy, including removal of the isthmus, to clarify the pathology and alleviate pressure symptoms. The final diagnosis was the fibrous variant of Hashimoto thyroiditis, with no evidence of malignant changes. Physicians should keep in mind that on rare occasions, Hashimoto thyroiditis mimics a malignant neoplasm.