Simultaneous bilateral distal biceps tendon repair: case report

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Thiago Medeiros Storti

Full Text Available ABSTRACT Simultaneous bilateral rupture of the distal biceps tendon is a rare clinical entity, seldom reported in the literature and with unclear therapeutic setting. The authors report the case of a 39-year-old white man who suffered a simultaneous bilateral rupture while working out. When weightlifting with elbows at 90° of flexion, he suddenly felt pain on the anterior aspect of the arms, coming for evaluation after two days. He presented bulging contour of the biceps muscle belly and ecchymosis in the antecubital fossa, extending distally to the medial aspect of the forearm, as well as a marked decrease of supination strength and pain in active elbow flexion. MRI confirmed the rupture with retraction of the distal biceps bilaterally. The authors opted for performing the tendon repairs simultaneously through the double incision technique and fixation to the bicipital tuberosity with anchors. The patient progressed quite well, with full return to labor and sports activities, being satisfied with the result after two years of surgery. In the literature search, few reports of simultaneous bilateral rupture of the distal biceps were retrieved, with only one treated in the acute phase of injury. Therefore, the authors consider this procedure to be a good option to solve this complex condition.

Simultaneous bilateral distal biceps tendon repair: case report.

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Storti, Thiago Medeiros; Paniago, Alexandre Firmino; Faria, Rafael Salomon Silva

2017-01-01

Simultaneous bilateral rupture of the distal biceps tendon is a rare clinical entity, seldom reported in the literature and with unclear therapeutic setting. The authors report the case of a 39-year-old white man who suffered a simultaneous bilateral rupture while working out. When weightlifting with elbows at 90° of flexion, he suddenly felt pain on the anterior aspect of the arms, coming for evaluation after two days. He presented bulging contour of the biceps muscle belly and ecchymosis in the antecubital fossa, extending distally to the medial aspect of the forearm, as well as a marked decrease of supination strength and pain in active elbow flexion. MRI confirmed the rupture with retraction of the distal biceps bilaterally. The authors opted for performing the tendon repairs simultaneously through the double incision technique and fixation to the bicipital tuberosity with anchors. The patient progressed quite well, with full return to labor and sports activities, being satisfied with the result after two years of surgery. In the literature search, few reports of simultaneous bilateral rupture of the distal biceps were retrieved, with only one treated in the acute phase of injury. Therefore, the authors consider this procedure to be a good option to solve this complex condition.

Simultaneous bilateral patellar tendon rupture.

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Moura, Diogo Lino; Marques, José Pedro; Lucas, Francisco Manuel; Fonseca, Fernando Pereira

2017-01-01

Bilateral patellar tendon rupture is a rare entity, often associated with systemic diseases and patellar tendinopathy. The authors report a rare case of a 34-year-old man with simultaneous bilateral rupture of the patellar tendon caused by minor trauma. The patient is a retired basketball player with no past complaints of chronic knee pain and a history of steroid use. Surgical management consisted in primary end-to-end tendon repair protected temporarily with cerclage wiring, followed by a short immobilization period and intensive rehabilitation program. Five months after surgery, the patient was able to fully participate in sport activities.

Simultaneous bilateral patellar tendon rupture

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Diogo Lino Moura

Full Text Available ABSTRACT Bilateral patellar tendon rupture is a rare entity, often associated with systemic diseases and patellar tendinopathy. The authors report a rare case of a 34-year-old man with simultaneous bilateral rupture of the patellar tendon caused by minor trauma. The patient is a retired basketball player with no past complaints of chronic knee pain and a history of steroid use. Surgical management consisted in primary end-to-end tendon repair protected temporarily with cerclage wiring, followed by a short immobilization period and intensive rehabilitation program. Five months after surgery, the patient was able to fully participate in sport activities.

Simultaneous bilateral elbow dislocation with bilateral medial epicondyle fractures in a 13-year-old female gymnast with hyperlaxity

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Bauer, Stefan; Dunne, Ben; Whitewood, Colin

2012-01-01

Bilateral simultaneous elbow dislocations are extremely rare and have only been described in 12 cases. In the paediatric population unilateral elbow dislocations are rare with 3–6% of all elbow injuries and there are only few studies describing this injury exclusively in children. There is only one case report of a paediatric patient who sustained a simultaneous bilateral elbow dislocation with medial epicondyle fractures. We present a second paediatric case of simultaneous bilateral elbow dislocation with associated displaced bilateral medial epicondyle fractures in a gymnast with joint hyperlaxity (3 of 5 Wynne-Davies criteria) treated with closed reduction and short-term immobilisation (3 weeks). The patient returned to full trampoline gymnastics between 4 and 5 months postinjury and made an uneventful recovery. PMID:23234820

Long-term functional outcome of bilateral spontaneous and simultaneous Achilles tendon ruptures.

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Ellanti, Prasad

2012-10-01

Bilateral simultaneous ruptures are rare comprising less than 1% of all Achilles tendon ruptures. Risk factors for bilateral ruptures include chronic diseases and medications such as corticosteroids and fluoroquinolones. There is little in the literature on the long-term functional outcome of bilateral Achilles tendon ruptures. This article present a series of 3 cases of simultaneous and spontaneous bilateral Achilles tendon ruptures with a minimum of 5-year follow up suggesting a good functional outcome.

Does tranexamic acid increase the risk of thromboembolism after bilateral simultaneous total knee arthroplasties in Asian Population?

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Kim, Young-Hoo; Park, Jang-Won; Kim, Jun-Shik; Seo, Dong-Hyuk

2018-01-01

To ascertain whether tranexamic acid reduces the blood loss and transfusion rate and volumes; increase the prevalence of deep vein thrombosis (DVT); and investigate factors associated with DVT in patients undergoing primary bilateral total knee arthroplasties (TKAs) without use of chemical thromboprophylaxis. There were 874 patients (1748 knees) in the control group who did not receive tranexamic acid and 871 patients (1742 knees) in the study group who received tranexamic acid. Mechanical compression device was applied without any chemical thromboprophylaxis. Transfusion rates and volumes were recorded. DVT was diagnosed using both sonogram and venogram at 7 or 8 day post-operatively. Intra- and post-operative blood loss and transfusion volumes were significantly lower in the tranexamic acid group. The prevalence of DVT was 14% (245 of 1748 knees) in the control group and 18% (314 of 1742 knees) in the tranexamic acid group. Pre- and post-operative perfusion lung scans revealed no evidence of PE in any patients in either group. Coagulation or thrombophilic data or molecular genetic testing was not significantly different between the two groups. The use of tranexamic acid reduces the volume of blood transfusion and does not increase the prevalence of DVT or PE in the patients who did not receive routine chemical thromboprophylaxis after primary bilateral simultaneous sequential TKAs in Asian patients.

Bilateral empyema thoracis treated simultaneously with video ...

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Keywords: bilateral empyema, children, pneumonia, simultaneous ... Department of Pediatric Surgery, J.J. Hospital and Grant Medical College, ... occurrence of an acute inflammatory reaction. ... specific organism has been associated with the patients of ... 8 Santos Jw. Community-acquired staphylococcal pneumonia.

Simultaneous bilateral anterior cruciate ligament reconstruction: Cost comparison and functional results

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Matjaž Sajovic

2014-04-01

Full Text Available Background: The ideal treatment for patients presenting with bilateral anterior cruciate ligament (ACL deficiency remains controversial. The purpose was to evaluate cost and mid-term functional results after one-stage bilateral ACL reconstruction using either hamstring or patella tendon autograft.Methods: We compared the mid-term outcome of 7 patients (14 knees who had one-stage bilateral ACL reconstruction with that of a matched group of patients who had unilateral reconstruction (21 patients.Results: The median duration of hospital stay was 4 nights (range 3 to 5 for the bilateral group and 2 nights (range, 1 to 4 for the control group. The duration of rehabilitation process in patients from the control group with unilateral ACL reconstruction was one week shorter (9 versus 8 weeks. In the bilateral group, the median Lysholm score was 96 (range 85–100 and in the control group, the median score was 93 (range 81–100. The median time to return to full-time work and to full sports was 9 weeks and 7 months for the simultaneous bilateral group and 8 weeks and 6 months for the unilateral group. Six patients (86 % in the bilateral group and 17 patients (81 % in the control group were still performing at their pre-injury level of activity. The Health Insurance Institute of Slovenia saves EUR 2,925 when we perform simultaneous bilateral ACL reconstruction instead of two stage ACL reconstruction.Conclusions: Mid-term clinical results suggested that simultaneous bilateral ACL reconstruction using either hamstring or patella tendon autograft is clinically effective. For patients presenting with symptomatic bilateral ACL deficient knees, one stage bilateral ACL reconstruction is reproducible, cost effective, and does not compromise functional results.

Comparison of ablation centration after bilateral sequential versus simultaneous LASIK.

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Lin, Jane-Ming; Tsai, Yi-Yu

2005-01-01

To compare ablation centration after bilateral sequential and simultaneous myopic LASIK. A retrospective randomized case series was performed of 670 eyes of 335 consecutive patients who had undergone either bilateral sequential (group 1) or simultaneous (group 2) myopic LASIK between July 2000 and July 2001 at the China Medical University Hospital, Taichung, Taiwan. The ablation centrations of the first and second eyes in the two groups were compared 3 months postoperatively. Of 670 eyes, 274 eyes (137 patients) comprised the sequential group and 396 eyes (198 patients) comprised the simultaneous group. Three months post-operatively, 220 eyes of 110 patients (80%) in the sequential group and 236 eyes of 118 patients (60%) in the simultaneous group provided topographic data for centration analysis. For the first eyes, mean decentration was 0.39 +/- 0.26 mm in the sequential group and 0.41 +/- 0.19 mm in the simultaneous group (P = .30). For the second eyes, mean decentration was 0.28 +/- 0.23 mm in the sequential group and 0.30 +/- 0.21 mm in the simultaneous group (P = .36). Decentration in the second eyes significantly improved in both groups (group 1, P = .02; group 2, P sequential group and 0.32 +/- 0.18 mm in the simultaneous group (P = .33). The difference of ablation center angles between the first and second eyes was 43.2 sequential group and 45.1 +/- 50.8 degrees in the simultaneous group (P = .42). Simultaneous bilateral LASIK is comparable to sequential surgery in ablation centration.

A case of simultaneous bilateral spontaneous pneumothorax after the Nuss procedure.

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Matsuoka, Shunichiro; Miyazawa, Masahisa; Kashimoto, Kentaro; Kobayashi, Hiroaki; Mitsui, Fumihiko; Tsunoda, Hajime; Kunitomo, Kazuyoshi; Chisuwa, Hisanao; Haba, Yoshiaki

2016-06-01

We present a case of simultaneous bilateral spontaneous pneumothorax caused by a pleuro-pleural communication formed from Nuss procedure for pectus excavatum. A 17-year-old man with a history of Nuss operation complained chest pain and dyspnea. A chest roentgenogram demonstrated a tiny bilateral pneumothorax and two metallic bars inserted at the Nuss procedure. Computed tomography revealed furthermore a bulla in the apex of the left lung. The bilateral pneumothorax critically deteriorated after 4 days from onset and urgent bilateral chest drainages were performed. Nevertheless the drainages the full expansion of both lungs was not obtained and air leakage only from left side was continued. A video-assisted left bullectomy was performed 9 days after the tube insertion. The two bars penetrating anterior mediastinal pleura were thought to be a cause of the simultaneous bilateral spontaneous pneumothorax.

Simultaneous bilateral cochlear implantation in a five-month-old child with Usher syndrome.

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Alsanosi, A A

2015-09-01

To report a rare case of simultaneous bilateral cochlear implantation in a five-month-old child with Usher syndrome. Case report. A five-month-old boy with Usher syndrome and congenital profound bilateral deafness underwent simultaneous bilateral cochlear implantation. The decision to perform implantation in such a young child was based on his having a supportive family and the desire to foster his audiological development before his vision deteriorated. The subject experienced easily resolvable intra- and post-operative adverse events, and was first fitted with an externally worn audio processor four weeks after implantation. At 14 months of age, his audiological development was age-appropriate. Simultaneous bilateral cochlear implantation is possible, and even advisable, in children as young as five months old when performed by an experienced implantation team.

Better together: reduced compliance after sequential versus simultaneous bilateral hearing aids fitting.

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Lavie, Limor; Banai, Karen; Attias, Joseph; Karni, Avi

2014-03-01

The purpose of this study was to determine the effects of sequential versus simultaneous bilateral hearing aids fitting on patient compliance. Thirty-six older adults with hearing impairment participated in this study. Twelve were fitted with bilateral hearing aids simultaneously. The remaining participants were fitted sequentially: One hearing aid (to the left or to the right ear) was used initially; 1 month later, the other ear was also fitted with a hearing aid for bilateral use. Self-reports on usefulness and compliance were elicited after the first and second months of hearing aid use. In addition, the number of hours the hearing aids were used was extracted from the data loggings of each device. Simultaneous fitting resulted in high levels of compliance and consistent usage throughout the study period. Sequential fitting resulted in abrupt reduction in compliance and hours of use once the second hearing aid was added, both in the clinical scoring and in the data loggings. Simultaneous fitting of bilateral hearing aids results in better compliance compared with sequential fitting. The addition of a second hearing aid after a relatively short period of monaural use may lead to inconsistent use of both hearing aids.

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.

Bilateral acute depigmentation of the iris in two siblings simultaneously

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Rana Amin

2018-06-01

Full Text Available Purpose: To report the first simultaneous onset of bilateral acute depigmentation of the iris (BADI in two siblings. Observations: Two sisters presented with bilateral ocular pain, redness and light sensitivity. Examination revealed bilateral circulating pigment in the anterior chamber with pigment dusting on backs of the corneas, patchy iris depigmentation and heavy pigment deposition in the angle. Both patients had recently suffered from upper respiratory tract infections. Bilateral visual acuities were preserved and no transillumination defects were observed. The patients were diagnosed with BADI. Both cases were successfully controlled with topical corticosteroids and anti-glaucoma drops as well as topical glanciclovir gel. Conclusions and Importance: To date, there had been no published reports of BADI in the Middle East and Africa. This is the first observation of this entity in these regions. Moreover it is the first occurrence of BADI in two immediate siblings simultaneously. We also report the rare asymmetrical presentation with BADI in one of our patients. These observations point to the possibility of genetic factors underlying BADI as well as an infectious cause behind the etiology. Keywords: Acute, Depigmentation, Pigment dispersion, Symmetrical, Krukenberg, Gonioscopy

EFFICACY OF BILATERAL SIMULTANEOUS HALLUX VALGUS CORRECTION COMPARED TO UNILATERAL

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A. V. Boychenko

2014-01-01

Full Text Available The aim - to compare the results of simultaneous bilateral and unilateral surgical correction of hallux valgus and to create recommendations for treatment of the patients with this pathology. Material and methods. The authorse analyzed the data of 40 patients (60 feet who carried out an operative treatment of hallux valgus in SPb multiprofile city hospital N 2 since 2011 to 2013. Functional (AOFAS score and X-ray results were compared between groups with bilateral and unilateral correction. Mean AOFAS score in these 2 groups after 12 months after surgery was 85,6±6,2 and 85,5±6,9 (p>0,05, mean intermetatarsal angle - 8,4±0,5° and 8,8±0,8° (p>0,05 respectively. No statistically significant difference between these two groups was found. Conclusion. A bigger surgical trauma in case of simultaneous bilateral correction neither worsens functional and x-ray results nor increases a complication rate.

Single-staged uniportal VATS in the supine position for simultaneous bilateral primary spontaneous pneumothorax.

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Kim, Kyung Soo

2017-05-15

Simultaneous bilateral primary spontaneous pneumothorax (SBPSP) is rare, but requires surgery on both sides, in patients with definite bilateral bullae to prevent life-threatening conditions. Recently, uniportal video-assisted thoracoscopic surgery (VATS) has been widely accepted as a less invasive technique for the treatment of pneumothorax. Thus, we introduced single-staged uniportal VATS technique in the supine position, for the management of two cases of SBPSP. A 17-year-old boy presented with bilateral spontaneous pneumothorax and he underwent single-staged uniportal VATS in the supine position. Single wide draping in consecutive bilateral approaches removes the needs of changing patients' position. Whole thoracoscopic procedure for wedge resection of bullae lesions was conducted without difficulty. The total operation time took 65 min and the patient discharged 3 days after the operation. The patient was followed for 24 months without recurrence of both sides. Another 18-year-old boy was admitted with bilateral spontaneous pneumothorax and single-staged uniportal VATS was also performed in the supine position. The total operation time took 79 min and the patient discharged on postoperative day 4. He was followed for 19 months without recurrence of both sides. Single-staged uniportal VATS approach yielded satisfactory results from simplicity that not requires position change compared to conventional multi-ports VATS in the lateral position, and with better cosmetics. This technique is thought to be a feasible procedure in selective patients with SBPSP or with contralateral bullae for preventive role.

Adductor canal block for post-operative analgesia after simultaneous bilateral total knee replacement: A randomised controlled trial to study the effect of addition of dexmedetomidine to ropivacaine

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Rakhee Goyal

2017-01-01

Full Text Available Background and Aims: Knee replacement surgery causes tremendous post-operative pain and adductor canal block (ACB is used for post-operative analgesia. This is a randomised, controlled, three-arm parallel group study using different doses of dexmedetomidine added to ropiavcaine for ACB. Methods: A total of 150 patients aged 18–75 years, scheduled for simultaneous bilateral total knee replacement, received ultrasound-guided ACB. They were randomised into three groups -Group A received ACB with plain ropivacaine; Groups B and C received ACB with ropivacaine and addition of dexmedetomidine 0.25 μg/kg and 0.50 μg/kg, respectively, on each side of ACB. The primary outcome was the duration of analgesia. Total opioid consumption, success of early ambulation, and level of patient satisfaction were also assessed. Results: The patient characteristics and block success rates were comparable in all groups. Group C patients had longer duration of analgesia (Group C 18.4 h ± 7.4; Group B 14.6 ± 7.1; Group A 10.8 ± 7; P < 0.001; lesser tramadol consumption (Group C 43.8 mg ± 53.2; Group B 76.4 ± 49.6; Group A 93.9 mg ± 58.3; P < 0.001 and lesser pain on movement (P < 0.001. The patients in Group B and C walked more steps than in Group A (P < 0.002. The level of patient satisfaction was highest in Group C (P < 0.001. Conclusions: The addition of dexmedetomidine to ropivacaine resulted in longer duration of analgesia after adductor canal block for simultaneous bilateral total knee replacement surgery.

Simultaneous bilateral isolated greater trochanter fracture

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Maruti Kambali

2013-01-01

Full Text Available A 48-year-old woman sustained simultaneous isolated bilateral greater trochanteric fracture, following a road traffic accident. The patient presented to us 1 month after the injury. She presented with complaints of pain in the left hip and inability to walk. Roentgenograms revealed displaced comminuted bilateral greater trochanter fractures. The fracture of the left greater trochanter was reduced and fixed internally using the tension band wiring technique. The greater trochanter fracture on the right side was asymptomatic and was managed conservatively. The patient regained full range of motion and use of her hips after a postoperative follow-up of 6 months. Isolated fractures of the greater trochanter are unusual injuries. Because of their relative rarity and the unsettled controversy regarding their etiology and pathogenesis, several methods of treatment have been advocated. Furthermore, the reports of this particular type of injury are not plentiful and the average textbook coverage afforded to this entity is limited. In our study we discuss the mechanism of injury and the various treatment options available.

Bilateral simultaneous anterior cruciate ligament injury: a case report and national survey of orthopedic surgeon management preference

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Ehsan Saadat

2014-12-01

Full Text Available Unilateral anterior cruciate ligament (ACL tear is a common injury seen by sports medicine orthopedic surgeons. However, a bilateral simultaneous ACL injury is extremely rare and has been reported only three times in the literature. We present a young female skier with simultaneous bilateral ACL tears that were managed with staged ACL reconstruction. We then conducted a nationwide survey (United States to determine the prevalence of simultaneous bilateral ACL tear and preferred management strategies by sports medicine orthopedic surgeons. Sports medicine fellowship directors were contacted and asked to send an 8-item survey to colleagues (sports medicine fellowship trained surgeons asking about overall number of ACL reconstructions performed, number of bilateral simultaneous ACL injuries seen and optimal management strategies of such an injury. Out of 43 responses, only 22 (51.2% surgeons had seen a bilateral simultaneous ACL injury. Of these, 16 (76.2% preferred staged reconstruction. Graft choice was mixed between autograft and allograft, but a large majority preferred either patellar tendon autograft (58% or hamstring autograft (41% were the most common choice. Staged reconstruction is the treatment of choice by surgeons surveyed in our study.

Venous thromboembolic prophylaxis after simultaneous bilateral total knee arthroplasty: aspirin versus warfarin.

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Goel, R; Fleischman, A N; Tan, T; Sterbis, E; Huang, R; Higuera, C; Parvizi, J; Rothman, R H

2018-01-01

The aims of this study were to compare the efficacy of two agents, aspirin and warfarin, for the prevention of venous thromboembolism (VTE) after simultaneous bilateral total knee arthroplasty (SBTKA), and to elucidate the risk of VTE conferred by this procedure compared with unilateral TKA (UTKA). A retrospective, multi-institutional study was conducted on 18 951 patients, 3685 who underwent SBTKA and 15 266 who underwent UTKA, using aspirin or warfarin as VTE prophylaxis. Each patient was assigned an individualised baseline VTE risk score based on a system using the Nationwide Inpatient Sample. Symptomatic VTE, including pulmonary embolism (PE) and deep vein thrombosis (DVT), were identified in the first 90 days post-operatively. Statistical analyses were performed with logistic regression accounting for baseline VTE risk. The adjusted incidence of PE following SBTKA was 1.0% (95% confidence interval (CI) 0.86 to 1.2) with aspirin and 2.2% (95% CI 2.0 to 2.4) with warfarin. Similarly, the adjusted incidence of VTE following SBTKA was 1.6% (95% CI 1.1 to 2.3) with aspirin and 2.5% (95% CI 1.9 to 3.3) with warfarin. The risk of PE and VTE were reduced by 66% (odds ratio (OR) 0.44, 95% CI 0.25 to 0.78) and 38% (OR 0.62, 95% CI 0.38 to 1.0), respectively, using aspirin. In addition, the risk of PE was 204% higher for patients undergoing SBTKA relative to those undergoing UTKA. For each ten-point increase in baseline VTE risk, the risk of PE increased by 25.5% for patients undergoing SBTKA compared with 10.5% for those undergoing UTKA. Patients with a history of myocardial infarction or peripheral vascular disease had the greatest increase in risk from undergoing SBTKA instead of UTKA. Aspirin is more effective than warfarin for the prevention of VTE following SBTKA, and serves as the more appropriate agent for VTE prophylaxis for patients in all risk categories. Furthermore, patients undergoing SBTKA are at a substantially increased risk of VTE, even more so for

Simultaneous Bilateral Cochlear Implantation for a 6-Month Child with a History of Meningitis

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Kh. M. Diab

2015-01-01

Full Text Available The article presents the first case of simultaneous bilateral cochlear implantation for a 6-month child with IV degree sensorineural hearing loss after meningocephalitis in Russia. Despite partial ossification of the cochlear basal turns, the early timing of implantation allowed to fully implant active electrodes to both ears. The simultaneous bilateral cochlear implantation in young children, who had meningitis, is a minimally invasive and highly efficient procedure with good long-term results of oral-aural after-care.

Bilateral simultaneous breast reconstruction with SGAP flaps.

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Flores, Jaime I; Magarakis, Michael; Venkat, Raghunandan; Shridharani, Sachin M; Rosson, Gedge D

2012-07-01

Two work-horse approaches to postmastectomy breast reconstruction are the deep inferior epigastric perforator flap and the superior gluteal artery perforator (SGAP) flap [and its variation, the lateral septocutaneous superior gluteal artery perforator flap]. Our purpose was fourfold: 1) to analyze our experience with the SGAP flaps for simultaneous bilateral breast reconstruction; 2) to analyze our experience with lateral septocutaneous superior gluteal artery perforator flaps for that procedure; 3) to compare our results with those in the literature; and 4) to highlight the importance of preoperative three-dimensional computed tomographic angiography. A retrospective chart review was completed for 23 patients who underwent breast reconstruction between December 2005 and January 2010 via an SGAP flap (46 flaps). We reviewed flap weight, ischemia time, length of stay, overall flap survival, fat necrosis development, and emergency re-exploration. Mean weights were 571.2 ± 222.0 g (range 186-1,117 g) and 568.0 ± 237.5 g (range 209-1,115 g) for the left and right buttock flap, respectively. Mean ischemia time was 129.1 ± 15.7 and 177.7 ± 24.7 minutes for the first and second flap, respectively. Mean hospital stay was 5.3 ± 2.5 days. All flaps survived. Fat necrosis developed in five flaps (10.8%), and emergency re-exploration was required in three patients (three flaps). When harvesting abdominal tissue is a poor option, the SGAP flap is an efficacious procedure for patients desiring autologous breast reconstruction, and bilateral procedures can be performed simultaneously. Copyright © 2012 Wiley Periodicals, Inc.

Bilateral Simultaneous Rhegmatogenous Retinal Detachment following Laser in situ Keratomileusis

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Erhan Yumusak

2016-06-01

Full Text Available A 21-year-old woman developed simultaneous rhegmatogenous retinal detachment after laser in situ keratomileusis (LASIK in both eyes. She underwent pars plana vitrectomy surgery combined with endolaser photocoagulation and silicone oil tamponade in the right eye. A week later, pneumatic retinopexy was done in the left eye. As the retinal tear did not seal, 360° scleral buckling surgery was performed and retina was attached. Bilateral simultaneous rhegmatogenous retinal detachment after LASIK for correction of myopia can be a serious complication. Patients should be informed about the possibility of this complication.

Treatment of pediatric moyamoya disease by simultaneous bilateral dual EDASs

International Nuclear Information System (INIS)

Shimoji, Takeyoshi; Nagamine, Tomoaki; Yamashiro, Katumi

2007-01-01

Treatment of moyamoya disease should be considered, especially in children in whom the disease develops rapidly and causes mental retardation. To address these concerns, we have been treating these patients with simultaneous bilateral dual encephaloduro-arterio-synangiosis (EDAS). The patients were 12 children and one adult. Ten of the children developed symptoms under 6 years of age. Their initial symptoms were transient ischemic attack (TIA) in 7, convulsions in 2, hemiparesis secondary to infarction and hemorrhage in 2, TIA and convulsion in 1, and headache in 1. All patients had diagnosis made by the cerebral angiography. All of them underwent EDAS using anterior and posterior branches of superficial temporal artery simultaneously and bilaterally. In this procedure, it is important to dissect both branches more than 10 cm. The mean operation time was 8 hours 25 minutes. Postoperatively, two patients developed hemiparesis secondary to cerebral infarction; both, however, recovered with the aid of rehabilitation. TIAs decreased immediately after surgery and disappeared in a couple of years except in one case. Convulsions ceased immediately. One patient with pre-op TIA developed convulsions 2 years after surgery. Headaches decreased in frequency. One developed cerebral infarction after surgery and mental status deteriorated, but the others maintained stable mental condition post-operatively. Post-operative angiographies were performed 3 and 9 months after surgery. Most patients attained excellent revascularization in the frontal to parietal regions except for three cases. Two of them finally showed good anastomosis 2 and 8 years later. One remained poor because the patient still had early stage of moyamoya disease. It may be postulated that the use of simultaneous bilateral dual EDAS prevents the rapid progression of and the development of mental problems seen in child moyamoya disease. (author)

Bilateral Simultaneous Nonarteritic Anterior Ischemic Optic Neuropathy after Ingestion of Sildenafil for Erectile Dysfunction

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Anna Tarantini

2012-01-01

Full Text Available Purpose. To describe a patient who developed bilateral, simultaneous nonarteritic anterior ischemic optic neuropathy (NAION after ingestion of Sildenafil citrate (Viagra for erectile dysfunction. Methods. Observational case report. Results. A 60-year-old diabetic man noted sudden decrease of vision in both eyes 16 hours after his third consecutive 50 mg daily Sildenafil ingestion. A diagnosis of bilateral NAION was made and he was treated for three days with methylprednisolone 1 g/d intravenously, followed by oral prednisone 75 mg/d. Final visual acuity was 20/50 right eye (OD and 20/20 left eye (OS. He had preexisting diabetes. Conclusion. This is the first reported case of simultaneous bilateral NAION occurred in a diabetic patient early after Sildenafil intake. Patients with predisposing conditions such as diabetes have to be warned against the use of PDE inhibitors.

Bilateral simultaneous quadriceps tendon rupture in a patient with secondary hyperparathyroidism: a case report

International Nuclear Information System (INIS)

Lee, Yeon Soo; Son, Sang Beom; Han, Chang Whan; Kang, Si Won

2001-01-01

Simultaneous bilateral rupture of the quadriceps tendon without a significant history of trauma may occur in association with chronic metabolic disorders such as chronic renal failure and secondary hyperparathyroidism, though has rarely been reported. We describe a case of spontaneous bilateral quadriceps tendon rupture in a 36-year-old female patient with secondary hyperparathyroidism

Neglected simultaneous bilateral femoral neck fractures secondary to narcotic drug abuse treated by bilateral one-staged hemiarthroplasty: a case report

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Vahedi Ehsan

2010-06-01

Full Text Available Abstract Simultaneous bilateral femoral neck fractures are extremely rare and associated with various conditions. Up to now Most cases had correlations with major trauma, repetitive minor trauma, seizure, parathyroid or renal dysfunction, anti-epileptic medications, seizure, etc. A 28-year-old addict man referred to us with a 10-year history of narcotic drug abuse and history of 8 months bilateral groin pain. He admitted with displaced bilateral femoral neck fracture. Because of long duration of this condition and osteonecrosis revealed on bone scan, one-staged bilateral hip hemiarthroplasty was done. A good function was noted after surgery to 4-month follow up. Up to now, have not be founded in the literature that a case of bilateral femoral neck fracture associated with narcotic drug abuse. Because of negative effects of opium or smoking on bone tissues, a simple bone pain should aware us about the risk of stress or fatigue fracture.

SIMULTANEOUS BILATERAL AVULSION FRACTURE OF THE TIBIAL TUBEROSITY IN A TEENAGER: CASE REPORT AND THERAPY USED.

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E Albuquerque, Rodrigo Pires; Giordano, Vincenzo; Carvalho, Antônio Carlos Pires; Puell, Thiago; E Albuquerque, Maria Isabel Pires; do Amaral, Ney Pecegueiro

2012-01-01

Simultaneous bilateral avulsion fracture of the tibial tuberosity in teenagers is a rare lesion. We describe the first case in the literature, in a teenage girl who sustained a fall while jumping during a volleyball match. No predisposing factors were iden tified. The lesions were treated with open surgical reduction and internal fixation. The aim of the present study was to present a case of simultaneous bilateral avulsion fracture of the tibial tuberosity in a teenage girl and the therapy used.

Simultaneous versus Sequential Bilateral Cataract Surgery for Infants with Congenital Cataracts: Visual Outcomes and Economic Costs

Science.gov (United States)

Dave, Hreem; Phoenix, Vidya; Becker, Edmund R.; Lambert, Scott R.

2015-01-01

OBJECTIVES To compare the incidence of adverse events, visual outcomes and economic costs of sequential versus simultaneous bilateral cataract surgery for infants with congenital cataracts. METHODS We retrospectively reviewed the incidence of adverse events, visual outcomes and medical payments associated with simultaneous versus sequential bilateral cataract surgery for infants with congenital cataracts who underwent cataract surgery when 6 months of age or younger at our institution. RESULTS Records were available for 10 children who underwent sequential surgery at a mean age of 49 days for the first eye and 17 children who underwent simultaneous surgery at a mean age of 68 days (p=.25). We found a similar incidence of adverse events between the two treatment groups. Intraoperative or postoperative complications occurred in 14 eyes. The most common postoperative complication was glaucoma. No eyes developed endophthalmitis. The mean absolute interocular difference in logMAR visual acuities between the two treatment groups was 0.47±0.76 for the sequential group and 0.44±0.40 for the simultaneous group (p=.92). Hospital, drugs, supplies and professional payments were on average 21.9% lower per patient in the simultaneous group. CONCLUSIONS Simultaneous bilateral cataract surgery for infants with congenital cataracts was associated with a 21.9% reduction in medical payments and no discernible difference in the incidence of adverse events or visual outcome. PMID:20697007

Simultaneous Bilateral Ureteral Calculi: A New Paradigm for Management.

Science.gov (United States)

Scotland, Kymora B; Hubosky, Scott G; Tanimoto, Ryuta; Cooper, Robert; Healy, Kelly A; Bagley, Demetrius H

2018-05-21

To define the need for emergent intervention between patients with simultaneous bilateral ureteral calculi (SBUC) compared to unilateral ureteral calculi (UUC). Patients with SBUC represent a potential urological emergency due to possible anuria or electrolyte imbalance. While conventional practice mandates immediate intervention in these patients, little data exist to define the rate of these events. Records of all patients with ureteral stones treated ureteroscopically over an 11-year period were reviewed to identify those with SBUC. Patient presenting characteristics, time from diagnosis to intervention, and postoperative outcomes were noted. To determine the need for emergent intervention, we compared metabolic and infectious parameters between SBUC patients and age- and sex-matched patients with UUC. A total of 3800 patients presented with ureteral calculi including 42 (1.1%) with SBUC. Two-thirds of patients with SBUC had an established diagnosis of nephrolithiasis. Among the 42 patients with SBUC, 11 (26.2%) were considered emergent due to metabolic (5 of 11, 45.5%), infectious (1 of 11, 9.1%), or both metabolic and infectious indications (5 of 11, 45.5%). No patients required acute dialysis before surgical intervention. Compared to patients with UUC, those with SBUC were significantly more likely to require emergent management (P = .03, odds ratio 2.3). Univariate and multivariate analyses showed this to be due to anuria (P = .001) and acidosis (P = .003). SBUC is an uncommon condition and, in this series, only the minority of patients presented emergently. Therefore, patients with SBUC can often be managed electively if counseled on clinical signs warranting emergent medical attention. Appropriately selected patients have excellent outcomes following single stage bilateral ureteroscopy. Copyright © 2018. Published by Elsevier Inc.

Simultaneous bilateral Mason type IIb radial head fractures in a young female: Was an increased carrying angle the cause?

LENUS (Irish Health Repository)

2015-01-01

Radial head fracture is the most common type of elbow fracture in adults. It results from a fall on an outstretched hand. However, simultaneous bilateral radial head fractures are extremely rare. We report a case of simultaneous bilateral mason type IIb radial head fractures in a young female, which was treated nonoperatively with excellent results

Mask face: bilateral simultaneous facial palsy in an 11-year-old boy.

Science.gov (United States)

Güngör, Serdal; Güngör Raif, Sabiha; Arslan, Müjgan

2013-04-01

Bilateral facial paralysis is an uncommon clinical entity especially in the pediatric age group and occurs frequently as a manifestation of systemic disease. The most important causes are trauma, infectious diseases, neurological diseases, metabolic, neoplastic, autoimmune diseases and idiopathic disease (Bell's palsy). We report a case of an 11-year-old boy presenting with bilateral simultaneous peripheral facial paralysis. All possible infectious causes were excluded and the patient was diagnosed as having Bell's palsy (idiopathic). The most important approach in these cases is to rule out a life-threatening disease. © 2013 The Authors. Pediatrics International © 2013 Japan Pediatric Society.

Comparison of unilateral and simultaneous bilateral measurement of the globe position, using the Hertel exophthalmometer.

LENUS (Irish Health Repository)

Ameri, Hossein

2012-02-03

PURPOSE: To assess the effect of simultaneous measurement of the two eyes in Hertel exophthalmometry (i.e., when both readings are taken sequentially, without removing the instrument from the orbital rims) and to find out whether simultaneous measurement would influence the final reading of each eye. METHODS: In this prospective, comparative study, Hertel exophthalmometry was performed on 61 patients by two experienced observers. Only patients with no history of orbital disease were included. Three different measurements were performed on each patient by each observer. Initially, the right eye was measured separately, then the left eye was measured separately, and finally, both eyes were measured together. RESULTS: When the eyes were measured separately, in 30% of cases observers obtained equal readings in both eyes; in 47%, the difference between the two eyes was 1 mm; and in 23%, the difference was 2 mm or more. However, in simultaneous bilateral measurements, in 73% of cases, observers obtained equal readings in both eyes; in 24%, the difference between the two eyes was 1 mm; and only in 3% was the difference 2 mm or greater. Paired t tests showed that the mean difference between measurements of the two eyes was significantly smaller in simultaneous bilateral measurements (p <0.001). Interobserver variation was similar for measurements taken separately on each eye and for simultaneous bilateral measurements. CONCLUSIONS: When both eyes were measured simultaneously with the Hertel exophthalmometer, examiners were inclined to obtain similar readings in both eyes of patients with symmetrical-appearing eyes. The possible bias arising this way may reduce the reliability of Hertel exophthalmometer in relative exophthalmometry.

Surgical timing for bilateral simultaneous cochlear implants: When is best?

Science.gov (United States)

Franchella, Sebastiano; Bovo, Roberto; Bandolin, Luigia; Gheller, Flavia; Montino, Silvia; Borsetto, Daniele; Ghiselli, Sara; Martini, Alessandro

2018-06-01

Hearing loss is considered the most common congenital disease and the prevalence of neonatal deafness can be estimated between 1 and 2 cases per 1000 live births. Infant deafness must be diagnosed as early as possible and an effective therapeutic intervention needs to be carried out in order to avoid the serious consequences of hearing deprivation during the evolutionary period: alterations in the development of central auditory pathways and lack of language acquisition. The cochlear implant (CI) has proved to be the best instrument to solve the problem of auditory deprivation. In particular, the bilateral CI gives the patient access to binaural hearing which results in benefits in terms of sound localisation and discrimination. The optimal age of application of the CI is a widely discussed topic in the scientific community and the current guidelines indicate a period between 12 and 24 months of age, even though the supporters of the application before 12 months of age are nowadays increasing. The study is observational, retrospective, monocentric. 49 paediatric patients (<18 years) with simultaneous bilateral CIs were included. The audiometric threshold and speech tests were carried out during the follow-up 3, 6 and 12 months after the CIs activation and when the patient reached 2 years of age. The statistical analysis showed that undergoing bilateral implantation surgery before 2 years of age allows a satisfactory audiometric performance, while there are no particular benefits in performing the surgery before 1 year of age. As far as the speech outcome is concerned, the statistical analysis didn't show significant correlation between the earlier age of implantation and better speech performance if the operation is carried out before 2.5 years of age. The results of the study indicate that the optimal age to perform the simultaneous bilateral CIs surgery is between 12 and 24 months, without demonstrating any particular benefit in carrying out the procedure before

Simultaneous bilateral robotic partial nephrectomy: Case report and critical evaluation of the technique.

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Giberti, Claudio; Gallo, Fabrizio; Schenone, Maurizio; Cortese, Pierluigi

2014-06-16

We report our first simultaneous bilateral robot assisted partial nephrectomy (RAPN) in order to show and critically discuss the feasibility of this procedure. Materials and methods A 69-year-old male patient visited our department due to incidental finding of bilateral mesorenal small masses (2.5 cm on the right and 3.5 cm on the left) suspicious for malignancy. We started from the right side with patient in flank position. Port placement: 12-mm periumbilical camera port, two 8-mm robotic ports in wide ''V''configuration, additional 12 mm assistant port on the midline between the umbilicus and symphysis pubis. A right unclamping RAPN with sliding clip renorrhaphy was performed. The trocars were removed and the robot undocked. Without interrupting the anesthesiological procedures, the patient was reported in supine position and, after 180 degrees rotation of the surgical bed, was newly placed in contralateral flank position. Using both the previous periumbilical and midline ports, two other 8-mm robotic trocars were placed. The robot was then redocked and RAPN was also performed on the left side using the same previously reported technique. Results Total time: 285 min. Estimated blood losses: 150 cc. Postoperative period: uneventful. Pathological examination: bilateral renal cell carcinoma, negative surgical margins. Conclusions Our experience was encouraging and confirmed the feasibility and safety of this procedure. The planning of our technique was time and cost effective with cosmetic benefit for the patient. However, we think that an appropriate selection of the patients and a skill in robotic renal surgery are advisable before approaching this type of surgery.

Simultaneous Versus Sequential Side-by-Side Bilateral Metal Stent Placement for Malignant Hilar Biliary Obstructions.

Science.gov (United States)

Inoue, Tadahisa; Ishii, Norimitsu; Kobayashi, Yuji; Kitano, Rena; Sakamoto, Kazumasa; Ohashi, Tomohiko; Nakade, Yukiomi; Sumida, Yoshio; Ito, Kiyoaki; Nakao, Haruhisa; Yoneda, Masashi

2017-09-01

Endoscopic bilateral self-expandable metallic stent (SEMS) placement for malignant hilar biliary obstructions (MHBOs) is technically demanding, and a second SEMS insertion is particularly challenging. A simultaneous side-by-side (SBS) placement technique using a thinner delivery system may mitigate these issues. We aimed to examine the feasibility and efficacy of simultaneous SBS SEMS placement for treating MHBOs using a novel SEMS that has a 5.7-Fr ultra-thin delivery system. Thirty-four patients with MHBOs underwent SBS SEMS placement between 2010 and 2016. We divided the patient cohort into those who underwent sequential (conventional) SBS placement between 2010 and 2014 (sequential group) and those who underwent simultaneous SBS placement between 2015 and 2016 (simultaneous group), and compared the groups with respect to the clinical outcomes. The technical success rates were 71% (12/17) and 100% (17/17) in the sequential and simultaneous groups, respectively, a difference that was significant (P = .045). The median procedure time was significantly shorter in the simultaneous group (22 min) than in the sequential group (52 min) (P = .017). There were no significant group differences in the time to recurrent biliary obstruction (sequential group: 113 days; simultaneous group: 140 days) or other adverse event rates (sequential group: 12%; simultaneous group: 12%). Simultaneous SBS placement using the novel 5.7-Fr SEMS delivery system may be more straightforward and have a higher success rate compared to that with sequential SBS placement. This new method may be useful for bilateral stenting to treat MHBOs.

Objective and subjective measures of simultaneous vs sequential bilateral cochlear implants in adults : A randomized clinical trial

NARCIS (Netherlands)

Kraaijenga, Véronique J.C.; Ramakers, Geerte G.J.; Smulders, Yvette E.; Van Zon, Alice; Stegeman, Inge; Smit, Adriana L.; Stokroos, Robert J.; Hendrice, Nadia; Free, Rolien H.; Maat, Bert; Frijns, Johan H M; Briaire, Jeroen J; Mylanus, Emmanuel A M; Huinck, Wendy J.; van Zanten, Gijsbert A.; Grolman, Wilko

2017-01-01

IMPORTANCE: To date, no randomized clinical trial on the comparison between simultaneous and sequential bilateral cochlear implants (BiCIs) has been performed.  OBJECTIVE: To investigate the hearing capabilities and the self-reported benefits of simultaneous BiCIs compared with those of sequential

Objective and Subjective Measures of Simultaneous vs Sequential Bilateral Cochlear Implants in Adults: A Randomized Clinical Trial

NARCIS (Netherlands)

Kraaijenga, V.J.; Ramakers, G.G.; Smulders, Y.E.; Zon, A. van; Stegeman, I.; Smit, A.L.; Stokroos, R.J.; Hendrice, N.; Free, R.H.; Maat, B.; Frijns, J.H.; Briaire, J.J.; Mylanus, E.A.M.; Huinck, W.J.; Zanten, G.A.; Grolman, W.

2017-01-01

Importance: To date, no randomized clinical trial on the comparison between simultaneous and sequential bilateral cochlear implants (BiCIs) has been performed. Objective: To investigate the hearing capabilities and the self-reported benefits of simultaneous BiCIs compared with those of sequential

Bilateral Laparoscopic Totally Extraperitoneal Repair Without Mesh Fixation

OpenAIRE

Dehal, Ahmed; Woodward, Brandon; Johna, Samir; Yamanishi, Frank

2014-01-01

Background and Objectives: Mesh fixation during laparoscopic totally extraperitoneal repair is thought to be necessary to prevent recurrence. However, mesh fixation may increase postoperative chronic pain. This study aimed to describe the experience of a single surgeon at our institution performing this operation. Methods: We performed a retrospective review of the medical records of all patients who underwent bilateral laparoscopic totally extraperitoneal repair without mesh fixation for ing...

Simultaneous bilateral laser therapy accelerates recovery after noise-induced hearing loss in a rat model

Directory of Open Access Journals (Sweden)

Jae-Hun Lee

2016-07-01

Full Text Available Noise-induced hearing loss is a common type of hearing loss. The effects of laser therapy have been investigated from various perspectives, including in wound healing, inflammation reduction, and nerve regeneration, as well as in hearing research. A promising feature of the laser is its capability to penetrate soft tissue; depending on the wavelength, laser energy can penetrate into the deepest part of the body without damaging non-target soft tissues. Based on this idea, we developed bilateral transtympanic laser therapy, which uses simultaneous laser irradiation in both ears, and evaluated the effects of bilateral laser therapy on cochlear damage caused by noise overexposure. Thus, the purpose of this research was to assess the benefits of simultaneous bilateral laser therapy compared with unilateral laser therapy and a control. Eighteen Sprague-Dawley rats were exposed to narrow-band noise at 115 dB SPL for 6 h. Multiple auditory brainstem responses were measured after each laser irradiation, and cochlear hair cells were counted after the 15th such irradiation. The penetration depth of the 808 nm laser was also measured after sacrifice. Approximately 5% of the laser energy reached the contralateral cochlea. Both bilateral and unilateral laser therapy decreased the hearing threshold after noise overstimulation in the rat model. The bilateral laser therapy group showed faster functional recovery at all tested frequencies compared with the unilateral laser therapy group. However, there was no difference in the endpoint ABR results or final hair cell survival, which was analyzed histologically.

Simultaneous vs sequential bilateral cataract surgery for infants with congenital cataracts: Visual outcomes, adverse events, and economic costs.

Science.gov (United States)

Dave, Hreem; Phoenix, Vidya; Becker, Edmund R; Lambert, Scott R

2010-08-01

To compare the incidence of adverse events and visual outcomes and to compare the economic costs of sequential vs simultaneous bilateral cataract surgery for infants with congenital cataracts. Retrospective review of simultaneous vs sequential bilateral cataract surgery for infants with congenital cataracts who underwent cataract surgery when 6 months or younger at our institution. Records were available for 10 children who underwent sequential surgery at a mean age of 49 days for the first eye and 17 children who underwent simultaneous surgery at a mean age of 68 days (P = .25). We found a similar incidence of adverse events between the 2 treatment groups. Intraoperative or postoperative complications occurred in 14 eyes. The most common postoperative complication was glaucoma. No eyes developed endophthalmitis. The mean (SD) absolute interocular difference in logMAR visual acuities between the 2 treatment groups was 0.47 (0.76) for the sequential group and 0.44 (0.40) for the simultaneous group (P = .92). Payments for the hospital, drugs, supplies, and professional services were on average 21.9% lower per patient in the simultaneous group. Simultaneous bilateral cataract surgery for infants with congenital cataracts is associated with a 21.9% reduction in medical payments and no discernible difference in the incidence of adverse events or visual outcomes. However, our small sample size limits our ability to make meaningful comparisons of the relative risks and visual benefits of the 2 procedures.

A Clinical Study on 1 Case of Patient with Bilateral Simultaneous Bell's Palsy Treated by Hominis Placenta Herbal-Acupuncture

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Kwon, Kang

2003-06-01

Full Text Available Objective : This study was carried out to investigate the progress of bilateral simultaneous facial palsy and the effect of Hominis Placenta herbal-acupunture and the other oriental medical therapies. Methods : We used two methods to research the progress of disease. 1. Diagnosis - Facial muscle test, Taste test, Hearing test, Photographies, Lab-finding 2. Treatment - Acupuncture, Herbal-acupuncture, Electroacupuncture, Herb-med Results : The onset of Rt. facial palsy was earlier than Lt. facial palsy 3days. The reaction on the treatment of Rt. facial palsy was more dull than Lt. facial palsy. In terms of treatment period, Rt. facial palsy was very longer than Lt. facial palsy. Conclusion : According to the above results, we discoveried that Hominis Placenta herbal-acupunture and the other oriental medical therapies had good influence on the bilateral simultaneous facial palsy. In the future, we should endeavor to know influence between Rt. and Lt. face in case of bilateral simultaneous Bell's palsy.

Simultaneous bilateral tibial tubercle avulsion fracture in a male teenager: case report and literature review.

Science.gov (United States)

Nicolini, Alexandre P; Carvalho, Rogerio T; Ferretti, Mario; Cohen, Moises

2018-01-01

Tibial tuberosity avulsion fractures are injuries accounting for less than 3% of all epiphyseal and 1% of all physeal injuries in adolescents. Bilateral injuries are very rare, with only 19 cases described in the literature. These types of fractures occur commonly in male teenagers during sport activities and are often associated with other orthopaedic disorders. We report the case of a male teenager with simultaneous bilateral tibial tubercle fractures, describe the evolution and treatment of this injury and review the literature on this subject. Case report.

Simultaneous bilateral Achilles tendon ruptures associated with statin medication despite regular rock climbing exercise.

Science.gov (United States)

Carmont, Michael R; Highland, Adrian M; Blundell, Christopher M; Davies, Mark B

2009-11-01

Ruptures of the Achilles tendon are common however simultaneous ruptures occur less frequently. Eccentric loading exercise programmes have been used to successfully treat Achilles tendinopathy. We report a case of simultaneous bilateral Achilles tendon rupture in a patient predisposed to rupture due to longstanding raised serum lipoprotein and recently introduced therapeutic statin medication. The patient was also a keen rock climber and had regularly undertaken loading exercise. This case illustrates that the therapeutic effect of mixed loading exercises for the Achilles tendon may not be adequate to overcome the predisposition to rupture caused by hyperlipidaemia and statin medication.

Total Arterial Off‑pump Coronary Revascularization with a Bilateral ...

African Journals Online (AJOL)

Total Arterial Off‑pump Coronary Revascularization with a Bilateral Internal Mammary Artery Y Graft (208 cases). Jun-Feng Yang, Hong-Chao Zhang1, Cheng-Xiong Gu, Hua Wei. INTRODUCTION. AY graft is a graft formed by the left internal mammary artery (LIMA) connected to the left anterior descending (LAD) artery and ...

Bilateral Simultaneous Macular Infarction with Spontaneous Visual ...

African Journals Online (AJOL)

To report the rare and dramatic event of bilateral macular infarction in a sickle cell hemoglobinopathy (SS genotype) patient, resulting in bilateral severe reduction in visual acuity. Without any intervention, the patient's vision gradually improved over the follow‑up period. Central visual field defects however persisted.

Speech detection in noise and spatial unmasking in children with simultaneous versus sequential bilateral cochlear implants.

Science.gov (United States)

Chadha, Neil K; Papsin, Blake C; Jiwani, Salima; Gordon, Karen A

2011-09-01

To measure speech detection in noise performance for children with bilateral cochlear implants (BiCI), to compare performance in children with simultaneous implant versus those with sequential implant, and to compare performance to normal-hearing children. Prospective cohort study. Tertiary academic pediatric center. Children with early-onset bilateral deafness and 2-year BiCI experience, comprising the "sequential" group (>2 yr interimplantation delay, n = 12) and "simultaneous group" (no interimplantation delay, n = 10) and normal-hearing controls (n = 8). Thresholds to speech detection (at 0-degree azimuth) were measured with noise at 0-degree azimuth or ± 90-degree azimuth. Spatial unmasking (SU) as the noise condition changed from 0-degree azimuth to ± 90-degree azimuth and binaural summation advantage (BSA) of 2 over 1 CI. Speech detection in noise was significantly poorer than controls for both BiCI groups (p simultaneous group approached levels found in normal controls (7.2 ± 0.6 versus 8.6 ± 0.6 dB, p > 0.05) and was significantly better than that in the sequential group (3.9 ± 0.4 dB, p simultaneous group but, in the sequential group, was significantly better when noise was moved to the second rather than the first implanted ear (4.8 ± 0.5 versus 3.0 ± 0.4 dB, p sequential group's second rather than first CI. Children with simultaneously implanted BiCI demonstrated an advantage over children with sequential implant by using spatial cues to improve speech detection in noise.

Bilateral simultaneous femoral neck and shafts fractures - a case report.

Science.gov (United States)

Sadeghifar, Amirreza; Saied, Alireza

2014-10-01

Simultaneous fractures of the femoral neck and shaft are not common injuries, though they cannot be considered rare. Herein, we report our experience with a patient with bilateral occurance of this injury. Up to the best of our knowkedge this is the first case reported in literature in which correct diagnosis was made initially. Both femurs were fixed using broad 4.5 mm dynamic compression plate and both necks were fixed using 6.5 mm cannulated screws. Femur fixation on one side was converted to retrograde nailing because of plate failure. Both neck fractures healed uneventfully. In spite of rarity of concomitant fractures of femoral neck and shaft, this injury must be approached carefully demanding especial attention and careful device selection.

Objective and Subjective Measures of Simultaneous vs Sequential Bilateral Cochlear Implants in Adults A Randomized Clinical Trial : A Randomized Clinical Trial

NARCIS (Netherlands)

Kraaijenga, Véronique J C; Ramakers, Geerte G J; Smulders, Yvette E; van Zon, Alice; Stegeman, Inge; Smit, Adriana L; Stokroos, Robert J; Hendrice, Nadia; Free, Rolien H; Maat, Bert; Frijns, Johan H M; Briaire, Jeroen J; Mylanus, E A M; Huinck, Wendy J; Van Zanten, Gijsbert A; Grolman, Wilko

IMPORTANCE To date, no randomized clinical trial on the comparison between simultaneous and sequential bilateral cochlear implants (BiCIs) has been performed. OBJECTIVE To investigate the hearing capabilities and the self-reported benefits of simultaneous BiCIs compared with those of sequential

Bilateral Simultaneous Femoral Neck Fracture Mimicking Abdominal Pain in a Cerebral Palsy Patient

Directory of Open Access Journals (Sweden)

P. Mariani

2014-01-01

Full Text Available Simultaneous bilateral femoral neck fractures are unusual lesions, generally associated with an underlying condition which causes impaired bone mineralization, triggered by an increased bone stress. We present a 24-year-old cerebral palsy patient, who was previously evaluated in another institution due to inability to walk, interpreted as abdominal pain. No alteration in blood analysis or abdominal X-rays was found. As no response to treatment was observed, a new abdominal X-ray was taken, which incidentally depicted bilateral medial femoral neck fracture. He was referred to our practice after a resection arthroplasty was offered in another institution. After admission, bilateral one-stage THA was performed. Several reports emphasize bone disease as a major precipitating factor, and there is an increased incidence of hip fractures in chronic epilepsy, renal osteodystrophy, and chronic steroid use. Femoral head resection has been proven to be effective in immobilized patients, whereas this was not a reasonable option in this patient who presented walking ability. Despite the treatment election, primary care physicians should be aware of and alert to the possibility of fractures in patients with neurological disorders and calcium metabolism alterations. Late diagnosis of orthopedic injuries in this type of patients may lead to permanent disability.

Simultaneous bilateral contracture of the infraspinatus muscle.

Science.gov (United States)

Franch, J; Bertran, J; Remolins, G; Fontecha, P; Díaz-Bertrana, M C; Durall, I

2009-01-01

A case of bilateral fibrotic contracture of the infraspinatus muscles in a five-year-old Belgian Shepherd dog is described. The dog was presented with progressive forelimb lameness with postural and gait abnormalities three months after an episode of overexertion. When walking, the lower part of both forelimbs swung in a lateral arc causing a circumduction movement and in the standing position, the dog showed elbow adduction with external rotation of the distal part of both front limbs. Orthopaedic examination revealed bilateral atrophy of both infraspinatus and supraspinatus muscles and restriction in the range of motion of both shoulders, especially when attempting abduction and flexion. No specific findings were observed in the shoulder or elbow radiographs but hyperechogenic areas were evident in the ultrasonographic examination of both infraspinatus muscles. A diagnosis of fibrotic contracture of both infraspinatus muscles was established and bilateral tenectomy of the insertion tendons of the infraspinatus muscles was performed. Complete recovery of the animal was achieved after the surgery, which was confirmed in a long-term follow-up (10 months). In conclusion, physical examination and ultrasonography allowed a proper diagnosis of the condition, and tenectomy of the infraspinatus muscles resulted in a complete recovery of the patient even with bilateral involvement.

Incidental findings of intense radioiodine uptake in struma ovarii and bilateral nonlactating breasts simultaneously on postablation {sup 131}I SPECT/CT for papillary thyroid cancer

Energy Technology Data Exchange (ETDEWEB)

Shim, Hye Kyung; Kim, Mi Ra [Haeundae Paik HospitalUniversity of Inje, College of Medicine, Busan (Korea, Republic of)

2016-12-15

A 52-year-old woman diagnosed with papillary thyroid carcinoma was referred for {sup 131}I therapy following total thyroidectomy. She was given 4,810 MBq (130 mCi) of {sup 131}I following 4 weeks of thyroid hormone withdrawal. A post therapy scan showed intense, focal activity in the pelvis and intense, diffuse activity on both sides of the chest, which was localized to the right ovary and both breasts on SPECT/CT examination. She had bilateral nipple pain and a history of antidopaminergic drugs as combination medication for her rheumatoid arthritis and prokinetics during radioiodine therapy. On a {sup 123}I whole-body scan 9 months later after stopping the drugs, bilateral breast uptake was not visible; however, right ovarian focal uptake was still visualized. Bilateral salpingo-oophorectomy was performed, and revealed struma ovarii with substantial internal necrosis due to radioiodine therapy. This case is interesting as two rare entities, {sup 131}I therapy-related struma ovarii and drug-related breast uptake, were simultaneously visualized.

Quadriceps Tendon Rupture and Contralateral Patella Tendon Avulsion Post Primary Bilateral Total Knee Arthroplasty: A Case Report

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Gaurav Sharma

2016-07-01

Full Text Available Background: Extensor mechanism failure secondary to knee replacement could be due to tibial tubercle avulsion, Patellar tendon rupture, patellar fracture or quadriceps tendon rupture. An incidence of Patella tendon rupture of 0.17% and Quadriceps tendon rupture of around 0.1% has been reported after Total knee arthroplasty. These are considered a devastating complication that substantially affects the clinical results and are challenging situations to treat with surgery being the mainstay of the treatment. Case Description: We report here an interesting case of a patellar tendon rupture of one knee and Quadriceps tendon rupture of the contralateral knee following simultaneous bilateral knee replacement in a case of inflammatory arthritis patient. End to end repair for Quadriceps tear and augmentation with Autologous Hamstring tendon graft was done for Patella tendon rupture. OUTCOME: Patient was followed up for a period of 1 year and there was no Extension lag with a flexion of 100 degrees in both the knees. DISCUSSION: The key learning points and important aspects of diagnosing these injuries early and the management techniques are described in this unique case of bilateral extensor mechanism disruption following knee replacements.

EXPERIMENTAL RESEARCH OF REGENERATIVE FEATURES IN BONE TISSUES AROUND IMPLANTS AFTER ONE-STAGE BILATERAL TOTAL HIP REPLACEMENT

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V. M. Mashkov

2012-01-01

Full Text Available Objective: to research the specific features of regenerative processes of bone tissue around implants after one-stage bilateral total hip replacement in experiment. Material and methods: 27 total hip replacement operations have been performed in 18 rabbits of breed "chinchilla" to which bipolar femoral endoprosthesis made of titanic alloy PT-38, one type-size, with friction pair metal-on-metal and neck-shaft angle 165 degrees have been implanted: total unilateral hip replacement operations have been performed in 9 animals (control group, one-stage bilateral total hip replacement operations have been performed in 9 animals (experimental group. During research they have been on radiological and clinical checking-up. After the experiment the animals had histological tests of the tissues around endoprosthesis components. Results and conclusions: After one-stage bilateral total hip replacement in early terms of research more expressed changes of bone tissue in the form of its thinning and decompaction were found around implants. One-stage bilateral total hip replacement did not essentially influence on the speed of osteogenesis around endoprothesis components in comparison with unilateral total hip replacement, so in late terms of observation in both groups the fixing of endoprothesis components did not differ.

Outcome following simultaneous bilateral thyroid lobectomy for treatment of thyroid gland carcinoma in dogs: 15 cases (1994-2010).

Science.gov (United States)

Tuohy, Joanne L; Worley, Deanna R; Withrow, Stephen J

2012-07-01

To evaluate the outcome of resection of simultaneous discrete bilateral mobile thyroid gland carcinomas (TGCs) in dogs. Retrospective case series. 15 dogs with resected simultaneous discrete bilateral mobile TGCs. Medical records (from 1994 to 2010) were searched for dogs with the appropriate diagnosis and treatment. Information collected included signalment, clinical signs, diagnostic test results, tumor mobility (mobile tumor identified by movement ≥ 1 cm in all planes during palpation), complications, adjuvant treatments, and outcome. Mobile, discrete, bilateral TGCs were removed in all dogs. Among the 15 dogs, complete parathyroidectomies were necessary in 9; parathyroid tissue was reimplanted in 4 and preserved in 2. Complications included hemorrhage and laryngeal nerve trauma, but without serious consequences. Thirteen dogs received calcitriol with or without supplemental calcium after surgery. In the immediate postoperative period, hypocalcemia developed and was corrected in 11 dogs. At the end of the study, 7 dogs continued to receive calcitriol with or without supplemental calcium, and 8 dogs required long-term thyroid hormone treatment. Six dogs received adjuvant chemotherapy. Local tumor recurrence or de novo distant metastasis was not detected at each dog's last follow-up examination. Median survival time was 38.3 months. Three dogs were lost to follow-up, 8 survived (4.3 to 77 months after surgery), and 4 died of unrelated causes. In dogs with TGCs undergoing bilateral thyroid lobectomies, a successful outcome can be expected, even when parathyroid gland tissue cannot be preserved. The role of adjuvant chemotherapy in treatment outcome was not clearly defined.

Simultaneous versus sequential bilateral cochlear implants in adults: Cost analysis in a US setting.

Science.gov (United States)

Trinidade, Aaron; Page, Joshua C; Kennett, Sarah W; Cox, Matthew D; Dornhoffer, John L

2017-11-01

From a purely surgical efficiency point of view, simultaneous cochlear implantation (SimCI) is more cost-effective than sequential cochlear implantation (SeqCI) when total direct costs are considered (implant and hospital costs). However, in a setting where only SeqCI is practiced and a proportion of initially unilaterally implanted patients do not progress to a second implant, this may not be the case, especially when audiological costs are factored in. We present a cost analysis of such a scenario as would occur in our institution. Retrospective review and cost analysis. Between 2005 and 2015, 370 patients fulfilled the audiological criteria for bilateral implantation. Of those, 267 (72.1%) underwent unilateral cochlear implantation only, 101 (27.3%) progressed to SeqCI, and two underwent SimCI. The total hospital, surgical, and implant costs, and initial implant stimulation series audiological costs between August 2015 and August 2016 (29 adult patients) were used in this analysis. The total hospital, surgical, and implant costs for this period was $2,731,360.42. Based on previous local trends, if a projected eight (27.3%) of these patients decide to progress to SeqCI, this will cost an additional $750,811.04, resulting in an overall total of $3,482,171.46 for these 29 patients. Had all 29 undergone SimCI, the total projected cost would have been $3,332,991.75, representing a total potential saving of $149,179.67 (4.3%). In institutions where only SeqCI is allowed in adults, overall patient management may cost marginally more than if SimCI were practiced. This will be of interest to CI programs and health insurance companies. 4. Laryngoscope, 127:2615-2618, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

Symptomatic cycling Cushing disease managed by simultaneous bilateral laparoscopic adrenalectomy in a 11-year-old boy

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Khalid M Al-Otaibi

2014-01-01

Full Text Available We report symptomatic cycling Cushing disease in a 11-year-old boy that was managed with simultaneous bilateral laparoscopic adrenalectomy. Positioning and the surgical technique have been fully described. Excellent results were achieved. Recent application of laparoscopic adrenalectomy for various adrenal pathology is highly effective and offers better results than open surgery. Post-operative recovery after laparoscopic technique is significantly shorter than the open technique.

Bilateral custom-fit total knee arthroplasty in a patient with poliomyelitis.

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Tardy, Nicolas; Chambat, Pierre; Murphy, Colin G; Fayard, Jean-Marie

2014-09-01

In limbs affected by poliomyelitis, total knee arthroplasty results in satisfactory pain relief. However, the risk of failure is high, especially if the preoperative quadriceps power is low. Therefore, treating osteoarthritis in the current patient represented a challenging procedure. A 66-year-old man presented with tricompartmental osteoarthritis of both knees, with valgus deformity of 14° on the left knee and 11° on the right knee. He walked with a bilateral knee recurvatum of 30° and a grade 1 quadriceps power. The authors treated both knees with cemented custom-fit hinged total knee arthroplasty with 30° of recurvatum in the tibial keel. Clinical scores showed good results 1 year postoperatively, especially on the subjective data of quality of life and function. At follow-up, radiographs showed good total knee arthroplasty positioning on the right side and a small mechanical loosening at the end of the tibial keel on the left side. Only 5 studies (Patterson and Insall; Moran; Giori and Lewallen; Jordan et al; and Tigani et al) have reported total knee arthroplasty results in patients with poliomyelitis. This study reports an original case of bilateral custom-fit hinged total knee arthroplasty in a patient with poliomyelitis. To the authors' knowledge, this is the first report of this type of procedure in the literature. The key point is the degree of recurvatum that is needed to allow walking, avoiding excessive constraints on the implants that can lead to early mechanical failure. Copyright 2014, SLACK Incorporated.

Incidental findings of intense radioiodine uptake in struma ovarii and bilateral nonlactating breasts simultaneously on postablation "1"3"1I SPECT/CT for papillary thyroid cancer

International Nuclear Information System (INIS)

Shim, Hye Kyung; Kim, Mi Ra

2016-01-01

A 52-year-old woman diagnosed with papillary thyroid carcinoma was referred for "1"3"1I therapy following total thyroidectomy. She was given 4,810 MBq (130 mCi) of "1"3"1I following 4 weeks of thyroid hormone withdrawal. A post therapy scan showed intense, focal activity in the pelvis and intense, diffuse activity on both sides of the chest, which was localized to the right ovary and both breasts on SPECT/CT examination. She had bilateral nipple pain and a history of antidopaminergic drugs as combination medication for her rheumatoid arthritis and prokinetics during radioiodine therapy. On a "1"2"3I whole-body scan 9 months later after stopping the drugs, bilateral breast uptake was not visible; however, right ovarian focal uptake was still visualized. Bilateral salpingo-oophorectomy was performed, and revealed struma ovarii with substantial internal necrosis due to radioiodine therapy. This case is interesting as two rare entities, "1"3"1I therapy-related struma ovarii and drug-related breast uptake, were simultaneously visualized

Clinical and logopaedic results of simultaneous and sequential bilateral implants in children with severe and/or profound bilateral sensorineural hearing loss: A literature review.

Science.gov (United States)

López-Torrijo, Manuel; Mengual-Andrés, Santiago; Estellés-Ferrer, Remedios

2015-06-01

This article carries out a literature review of the advantages and limitations of the simultaneous bilateral cochlear implantation (SCI) compared to those of the sequential bilateral cochlear implantation (SBCI) and the unilateral cochlear implantation (UCI). The variables analysed in said comparison are: safety and surgical technique, SCI incidence, effectiveness, impact of the inter-implant interval, costs and financing, impact on brain plasticity, impact on speech and language development, main benefits, main disadvantages and concerns, and predictive factors of prognosis. Although the results are not conclusive, all variables analysed seem to point towards observable benefits of SCI in comparison with SBCI or UCI. This tendency should be studied in more depth in multicentre studies with higher methodological rigour, more comprehensive samples and periods and other determining variables (age at the time of implantation, duration and degree of the hearing loss, rehabilitation methodologies used, family involvement, etc.). Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

A case of treatment in a patient with synchronous bilateral renal cell carcinoma and simultaneous metastatic involvement of both adrenal glands: Clinical observation

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V. R. Latypov

2014-11-01

Full Text Available Synchronous bilateral renal cell carcinoma occurs in 1.4 % of cases. The probability of bilateral adrenal metastases from renal cell carcinoma is less than 0.5 %. The clinical observation presents a case of synchronous bilateral renal cell carcinoma and simultaneous metastatic involvement of both adrenal glands. A 55‑year-old male patient was adm tted with the signs of hematuria and anemia to the Unit of Urology, Clinic of General Surgery, Siberian State Medical University. He was found to have synchronous bilateral renal cell carcinoma and simultaneous bilateral adrenal involvement. Sequential surgical treatment – radical nephrectomy (with adrenal gland removal on the right side and, after 3 months, adrenalectomy and kidney resection on the left side were performed. All the organs removed displayed tumors that proved to be renal cell carcinomas (a clear cell variant. There were lymph node metastases in the right-sided renal portal. Postoperatively, the investigators performed hormone replacement therapy for adrenal insufficiency, an immunotherapy cycle, three cycles of targeted therapy withsorafenib and sunitinib (at an interval of 0.5–2 years, and insulin therapy for new-onset diabetes mellitus. The duration of a follow-up was 6.2 years. When describing the case, the patient was alive and showed a generalized tumorous process with extensive tumor involvement of the solitary kidney. Sunitinib therapy was used.

A case of treatment in a patient with synchronous bilateral renal cell carcinoma and simultaneous metastatic involvement of both adrenal glands: Clinical observation

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V. R. Latypov

2014-01-01

Full Text Available Synchronous bilateral renal cell carcinoma occurs in 1.4 % of cases. The probability of bilateral adrenal metastases from renal cell carcinoma is less than 0.5 %. The clinical observation presents a case of synchronous bilateral renal cell carcinoma and simultaneous metastatic involvement of both adrenal glands. A 55‑year-old male patient was adm tted with the signs of hematuria and anemia to the Unit of Urology, Clinic of General Surgery, Siberian State Medical University. He was found to have synchronous bilateral renal cell carcinoma and simultaneous bilateral adrenal involvement. Sequential surgical treatment – radical nephrectomy (with adrenal gland removal on the right side and, after 3 months, adrenalectomy and kidney resection on the left side were performed. All the organs removed displayed tumors that proved to be renal cell carcinomas (a clear cell variant. There were lymph node metastases in the right-sided renal portal. Postoperatively, the investigators performed hormone replacement therapy for adrenal insufficiency, an immunotherapy cycle, three cycles of targeted therapy withsorafenib and sunitinib (at an interval of 0.5–2 years, and insulin therapy for new-onset diabetes mellitus. The duration of a follow-up was 6.2 years. When describing the case, the patient was alive and showed a generalized tumorous process with extensive tumor involvement of the solitary kidney. Sunitinib therapy was used.

Silicosis with bilateral spontaneous pneumothorax

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Fotedar Sanjay

2010-01-01

Full Text Available Presentation with simultaneous bilateral pneumothorax is uncommon and usually in the context of secondary spontaneous pneumothorax.The association of pneumothorax and silicosis is infrequent and most cases are unilateral. Bilateral pneumothorax in silicosis is very rare with just a few reports in medical literature.

Simultaneous Bilateral Femur Neck Fracture in A Young Adult with Chronic Renal Failure- A Case Report and Review of Literature.

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V, Sathyanarayana; Patel, Maulik Tulsibhai; S, Raghavan; D, Naresh

2015-01-01

Pathological bilateral femoral neck fracture due to renal osteodystrophy is rare. This is a report of a chronic renal failure patient who had sustained bilateral intra-capsular displaced fracture neck of femur following an episode of convulsion and the difficulties encountered in early diagnosis and treatment. The pathophysiology of renal osteodystrophy and the treatment of hip fractures in patients with renal failure are also discussed. A 23 years old male patient admitted with h/o dysuria, pyuria and loss of appetite since 3 months. He was a known case of chronic renal failure and reflux nephropathy. On investigating, patient's renal parameters were high and he was started with haemodialysis. The next day patient had c/o bilateral hip pain and inability to move bilateral lower limbs following an episode of seizure. Radiograph of pelvis showed vertical sub capital fractures of bilateral neck of femur. In this patient, considering his age, general condition & prognosis, an elective surgery in the form of bilateral uncemented modular bipolar hemiarthroplasty was done. Overall risk of hip fracture among patients with chronic renal failure is considerably higher than in the general population, independent of age and gender. Simultaneous spontaneous bilateral fractures of the femoral neck are rare and a delayed diagnosis is usual. The study of etiological factors of these fractures is essential to guide us in choosing the treatment of choice. Obviously patient's age, life expectancy as well as renal co morbidity has an influence over deciding treatment and outcome.

The Symmetry of Adverse Local Tissue Reactions in Patients with Bilateral Simultaneous and Sequential ASR Hip Replacement.

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Madanat, Rami; Hussey, Daniel K; Donahue, Gabrielle S; Potter, Hollis G; Wallace, Robert; Bragdon, Charles R; Muratoglu, Orhun K; Malchau, Henrik

2015-10-01

The purpose of this study was to evaluate whether patients with bilateral metal-on-metal (MoM) hip replacements have symmetric adverse local tissue reactions (ALTRs) at follow-up. An MRI of both hips was performed at a mean time of six years after surgery in 43 patients. The prevalence and severity of ALTRs were found to be similar in simultaneous hips but differences were observed in sequential hips. The order and timing of sequential hip arthroplasties did not affect the severity of ALTRs. Thus, in addition to metal ion exposure from an earlier MoM implant other factors may also play a role in the progression of ALTRs. Bilateral implants should be given special consideration in risk stratification algorithms for management of patients with MoM hip arthroplasty. Copyright © 2015 Elsevier Inc. All rights reserved.

[Bilateral cochlear implants].

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Müller, J

2017-07-01

Cochlear implants (CI) are standard for the hearing rehabilitation of severe to profound deafness. Nowadays, if bilaterally indicated, bilateral implantation is usually recommended (in accordance with German guidelines). Bilateral implantation enables better speech discrimination in quiet and in noise, and restores directional and spatial hearing. Children with bilateral CI are able to undergo hearing-based hearing and speech development. Within the scope of their individual possibilities, bilaterally implanted children develop faster than children with unilateral CI and attain, e.g., a larger vocabulary within a certain time interval. Only bilateral implantation allows "binaural hearing," with all the benefits that people with normal hearing profit from, namely: better speech discrimination in quiet and in noise, as well as directional and spatial hearing. Naturally, the developments take time. Binaural CI users benefit from the same effects as normal hearing persons: head shadow effect, squelch effect, and summation and redundancy effects. Sequential CI fitting is not necessarily disadvantageous-both simultaneously and sequentially fitted patients benefit in a similar way. For children, earliest possible fitting and shortest possible interval between the two surgeries seems to positively influence the outcome if bilateral CI are indicated.

Modulating Brain Connectivity by Simultaneous Dual-Mode Stimulation over Bilateral Primary Motor Cortices in Subacute Stroke Patients

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Jungsoo Lee

2018-01-01

Full Text Available Repetitive transcranial magnetic stimulation (rTMS or transcranial direct current stimulation (tDCS has been used for the modulation of stroke patients’ motor function. Recently, more challenging approaches have been studied. In this study, simultaneous stimulation using both rTMS and tDCS (dual-mode stimulation over bilateral primary motor cortices (M1s was investigated to compare its modulatory effects with single rTMS stimulation over the ipsilesional M1 in subacute stroke patients. Twenty-four patients participated; 12 participants were assigned to the dual-mode stimulation group while the other 12 participants were assigned to the rTMS-only group. We assessed each patient’s motor function using the Fugl-Meyer assessment score and acquired their resting-state fMRI data at two times: prior to stimulation and 2 months after stimulation. Twelve healthy subjects were also recruited as the control group. The interhemispheric connectivity of the contralesional M1, interhemispheric connectivity between bilateral hemispheres, and global efficiency of the motor network noticeably increased in the dual-mode stimulation group compared to the rTMS-only group. Contrary to the dual-mode stimulation group, there was no significant change in the rTMS-only group. These data suggested that simultaneous dual-mode stimulation contributed to the recovery of interhemispheric interaction than rTMS only in subacute stroke patients. This trial is registered with NCT03279640.

Cerebral fat embolism after bilateral total knee replacement arthroplasty -A case report-

OpenAIRE

Chang, Ri-Na; Kim, Jong-Hak; Lee, Heeseung; Baik, Hee-Jung; Chung, Rack Kyung; Kim, Chi Hyo; Hwang, Tae-Hu

2010-01-01

Fat embolism syndrome is a rare and potentially lethal complication most commonly seen in long bone fractures and intramedullary manipulation. The clinical triad of fat embolism syndrome consists of mental confusion, respiratory distress, and petechiae. This study reports a case of cerebral fat embolism syndrome following elective bilateral total knee replacement. After an uneventful anesthesia and initial recovery, the patient developed neurologic symptoms nine hours postoperatively.

Simultaneous bilateral distal biceps tendon rupture during a preacher curl exercise: a case report.

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Rokito, Andrew S; lofin, Ilya

2008-01-01

Complete rupture of the distal biceps tendon is a rare injury, the overwhelming majority occurring in the dominant arm of males during the fourth to sixth decades of life. Simultaneous bilateral rupture of the distal biceps tendon is an extremely rare occurrence, with only three cases reported in the literature. This unusual injury occurred in a recreational weightlifter during a preacher curl exercise. In this particular case, a 6-week delay in presentation necessitated a staged procedure in which a primary repair was feasible in one elbow, while reconstruction using allograft tissue was required in the contralateral elbow. Satisfactory results for both elbows were achieved, with return to weightlifting by one year following surgery.

Total knee arthroplasty in a pseudoachondroplastic dwarfism patient with bilateral patellar dislocation.

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Oh, Kwang-Jun; Yoon, Jung-Ro; Yang, Jae-Hyuk

2013-01-01

Late presentation of congenital patellar dislocation with advanced osteoarthritis is rare. This article presents a case of a 59-year-old man with underlying pseudoachondroplastic dwarfism. Advanced osteoarthritis due to bilateral neglected congenital patellar dislocation was treated with total knee arthroplasty without patella relocation surgery. Two years later, the patient had an improvement in Knee Society scores, painless function, and stability. Copyright © 2012 Elsevier B.V. All rights reserved.

Bilateral Wilms' tumor

International Nuclear Information System (INIS)

Malcolm, A.W.; Jaffe, N.; Folkman, M.J.; Cassady, J.R.

1980-01-01

Twenty children with bilateral Wilms' tumor were presented to the Children's Hospital Medical Center and Children's Cancer Research Foundation, Sidney Farber Cancer Institute, and Joint Center for Radiation Therapy (CHMC-CCRF, SFCI, JCRT) from January 1, 1956 to December 31, 1976. Of these 20, 16 had simultaneous and 4 had metachronous disease on presentation. All patients were treated with surgery, radiation and chemotherapy. Of the 16 patients with simultaneous disease, 10 (63%) are alive and free of disease 12+ to 175+ months post diagnosis and treatment, with median follow-up of 121 months. There were no long-term survivors in the metachronous group; all were dead of disease within 21 months from initial presentation of original tumor. With these data we relate prognosis to extent of disease and discuss a general approach to the management of bilateral Wilms' tumor

Bilateral simultaneous traumatic upper arm compartment syndromes associated with anabolic steroids.

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Erturan, Gurhan; Davies, Nev; Williams, Huw; Deo, Sunny

2013-01-01

Acute compartment syndrome, a surgical emergency, is defined as increased pressure in an osseofascial space. The resulting reduction of capillary perfusion to that compartment requires prompt fasciotomy. Treatment delay has a poor prognosis, and is associated with muscle and nerve ischemia, resultant infarction, and late-onset contractures. We report a case of traumatic bilateral upper limb acute compartment syndrome associated with anabolic steroids, requiring bilateral emergency fasciotomies. A 25-year-old male bodybuilder taking anabolic steroids, with no past medical history, presented to the Emergency Department 25 min after a road traffic accident. Secondary survey confirmed injuries to both upper limbs with no distal neurovascular deficit. Plain radiographs demonstrated bilateral metaphyseal fractures of the distal humeri. Within 2 h of the accident, the patient developed clinical features that were consistent with bilateral upper arm compartment syndrome. Bilateral fasciotomies of both anterior and posterior compartments were performed, confirming clinical suspicion. We suggest consideration of a history of anabolic steroid use when evaluating patients with extremity trauma. Copyright © 2013 Elsevier Inc. All rights reserved.

Simultaneous total cavopulmonary connection and cardiac re-synchronisation therapy.

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Nakanishi, Keisuke; Kawasaki, Shiori; Amano, Atsushi

2017-08-01

We report the simultaneous use of cardiac re-synchronisation therapy and total cavopulmonary connection in a patient with dyssynchrony, wide QRS, and cardiac failure. To our knowledge, this simultaneous approach has not been reported previously. On follow-up, we noted that QRS width and brain natriuretic peptide levels improved. In addition, speckle tracking revealed improved synchronisation of ventricular wall motion.

Tranexamic acid for control of blood loss in bilateral total knee replacement in a single stage

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Mandeep S Dhillon

2011-01-01

Full Text Available Background: Tranexamic acid (TEA reduces blood loss and red cell transfusions in patients undergoing unilateral total knee arthroplasty (TKA. However, there is not much literature regarding the use of TEA in patients undergoing bilateral TKA in a single stage and the protocols for administration of TEA in such patients are ill-defined. Materials and Methods: We carried out a case control study evaluating the effect of TEA on postoperative hemoglobin (Hb, total drain output, and number of blood units transfused in 52 patients undergoing bilateral TKA in a single stage, and compared it with 56 matched controls who did not receive TEA. Two doses of TEA were administered in doses of 10 mg / kg each (slow intravenous (IV infusion, with the first dose given just before tourniquet release of the first knee and the second dose three hours after the first one. Results: A statistically significant reduction in the total drain output and requirement of allogenic blood transfusion in cases who received TEA, as compared to the controls was observed. The postoperative Hb and Hb at the time of discharge were found to be lower in the control group, and this result was found to be statistically significant. Conclusion: TEA administered in patients undergoing single stage bilateral TKA helped reduce total blood loss and decreased allogenic blood transfusion requirements. This might be particularly relevant, where facilities such as autologous reinfusion might not be available.

Neuropsychological, neurological and functional outcome following pallidotomy for Parkinson's disease. A consecutive series of eight simultaneous bilateral and twelve unilateral procedures.

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Scott, R; Gregory, R; Hines, N; Carroll, C; Hyman, N; Papanasstasiou, V; Leather, C; Rowe, J; Silburn, P; Aziz, T

1998-04-01

Intellectual, psychological and functional outcomes were evaluated in a consecutive series of 20 Parkinsonian patients who had unilateral (UPVP) or simultaneous bilateral posteroventral pallidotomy (BPVP) using Image Fusion and Stereoplan (Radionics Inc., Boston, Mass., USA) with stimulation for lesion localization. Comprehensive baseline and 3-month postoperative neuropsychological and neurological assessment protocols were administered together with questionnaire measures of functional disability, quality of life and psychological symptomatology. Changes in patients' clinical presentation and scores on psychometric tests, questionnaires and observational rating scales were then examined. We observed no new neuropsychiatric sequelae directly related to pallidotomy. Cognitive sequelae were restricted to selective reductions in categorical verbal fluency following UPVP (P improvement on neurological rating scales; following UPVP, Total Unified Parkinson's Disease Rating Scale (UPDRS) scores improved by 27% (P improvement was 53% (P improvements in 'quality of life' also achieved statistical significance on a number of both physical and psychosocial questionnaire subscales.

Bilateral carotid endarterectomy combined with myocardial revascularization during the same surgical act

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Mulinari Leonardo Andrade

2000-01-01

Full Text Available The best surgical approach for the treatment of patients with severe cerebral artery disease and simultaneous serious coronary artery disease still remains controversial. In this report we present a case of a 72-year-old female patient admitted to the hospital with unstable angina. Triple coronary artery obstructive disease and severe bilateral carotid artery stenosis were diagnosed. A combined, simultaneous surgical procedure was performed. After total circulatory by-pass with a membrane oxygenator, the patient's body temperature was lowered to 32°C. During the cool-down period, three proximal anastomoses of segments of autologous saphenous veins were performed in the ascending aorta. Immediately afterwards, bilateral carotid endarterectomy was performed, followed by three distal anastomoses to coronary arteries. The patient showed a satisfactory post-operative outcome. It was concluded that the combination of moderate hypothermia, hemodilution with appropriate hemodynamic control, as used in this patient, was an effective method of cerebral protection. The simultaneous approach of carotid endarterectomy and coronary artery by-pass surgery should be seen as a safe option for the treatment of this type of patient.

Acute simultaneous bilateral avulsion fractures of the tibial tubercles in a 15-year-old male hurler: case report and literature review.

LENUS (Irish Health Repository)

Hanley, C

2012-02-01

BACKGROUND: Avulsion fractures of the tibial tubercle are an unusual injury pattern generally occurring in the adolescent male during sporting activities. Bilateral simultaneous fractures are extremely rare. They are often associated with other underlying orthopaedic pathology. AIMS: We present a case of bilateral tibial tubercle avulsions occurring in a 15 year-old male hurler. We describe the management and necessary investigations required for this type of trauma and present a literature review on this rarely encountered injury. CONCLUSION: Although this type of atypical fracture pattern is associated with high energy trauma and other underlying pathology, we have shown that once treated, the patient can expect to make a prompt return to sporting activities with no significant long-term functional deficit.

Bilateral Video-Assisted Thoracoscopic Surgery Resection for Multiple Mediastinal Myelolipoma: Report of a Case

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Kohno, Tadasu; Mun, Mingyon; Yoshiya, Tomoharu

2014-01-01

Myelolipoma in the mediastinum is an extremely rare entity. In this report, we present the case of a 79-year-old asymptomatic man who had three bilateral paravertebral mediastinal tumors. The three tumors were resected simultaneously using bilateral three-port video-assisted thoracoscopic surgery (VATS). There has been no evidence of recurrence within four years after the operation. Multiple bilateral mediastinal myelolipomas are extremely rare. There are no reports in the English literature of multiple bilateral thoracic myelolipomas that were resected simultaneously using bilateral VATS. We also present characteristic features of myelolipomas, which are helpful for diagnosis. PMID:24782978

Bilateral calcaneal epiphysiolysis in a dog.

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Font, J; Pèlach, M; Font, C; Cairo, J

2013-01-01

A case of bilateral calcaneal epiphysiolysis in a six-month-old female Dobermann Pinscher is described in this report. The absence of a traumatic event and the clinical, radiographic and histopathological abnormalities led us to the diagnosis of simultaneous bilateral epiphysiolysis of the calcaneus. A tension band and a type II transarticular external fixator were placed. The clinical signs were resolved only temporarily because of the gravity of the bone changes.

Bilateral periprosthetic tibial stress fracture after total knee arthroplasty: A case report.

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Ozdemir, Guzelali; Azboy, Ibrahim; Yilmaz, Baris

2016-01-01

Periprosthetic fractures around the knee after total knee arthroplasty can be seen in the femur, tibia and patella. The tibial fractures are rare cases. Our case with bilateral tibial stress fracture developed after total knee arthroplasty (TKA) is the first of its kind in the literature. 75-year-old male patient with bilateral knee osteoarthritis had not benefited from conservative treatment methods previously applied. Left TKA was applied. In the second month postoperatively, periprosthetic tibial fracture was identified and osteosynthesis was implemented with locked tibia proximal plate-screw. Bone union in 12 weeks was observed in his follow-ups. After 15 months of his first operation, TKA was applied to the right knee. Postoperatively in the second month, as in the first operation, periprosthetic tibial fracture was detected. Osteosynthesis with locking plate-screw was applied and union in 12 weeks was observed in his follow-up. He was seen mobilized independently and without support in the last control of the case made in the 24th month after the second operation. The number of TKA applications is expected to increase in the future. The incidence of periprosthetic fractures should also be expected to increase in these cases. Periprosthetic tibial fractures after TKA are rarely seen. The treatment of periprosthetic fractures around the knee after TKA can be difficult. In the case of persistent pain in the upper end of the tibia after the surgery, stress fracture should be considered. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Mirror image extradural hematoma in elderly population: management strategy with surgical bilateral or unilateral evacuation or conservative treatment modality with literature review

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Satyarthee Guru Dutta

2017-12-01

Full Text Available Extradural hematomas (EDH represent one of common imaging findings in cases sustaining traumatic brain injury. Bilateral extradural haematoma is considered rare and even rarer in elder people male. Bilateral extradural hematoma is usually acute, and generally associated with severe traumatic head injury. Mirror-image extradural hematomas (MEDH constitute a special type of bilateral extradural hamatomas, which is placed anatomically symmetrically on both the sides of the intracranial compartment, requires prompt diagnosis and emergent surgical intervention as it carry high mortality if evacuation of hematoma is not carried out expeditely. The mortality rate still remains higher in comparison to unilateral single extradural hematomas. The postoperative outcome depends on preoperative neurological status, total volume of blood, accurate diagnosis and prompt shifting to neurosurgical facility, expatiation of surgical procedure, pre- hospital care. Authors report a case of a - 65-year-old man who presented with acute simultaneous bilateral extradural haematomas following road traffic accident, underwent bilateral trephine craniotomy and simultaneous evacuation on both side led to good recovery.

Bilateral Total Hip Arthroplasty in Femoral Head Avascular Necrosis: Functional Outcomes and Complications

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Afshin Taheriazam

2016-06-01

Full Text Available Total hip arthroplasty (THA is one of the successful and cost-benefit surgical treatments. One-stage bilateral THA (BTHA offers many benefits. However, there are concerns about the safety of the procedure and higher complications. We aimed to evaluate the complications and outcomes of one-stage BTHA with Hardinge approach for femoral head avascular necrosis patients. A total of 60 patients from April 2009 and May 2013, were underwent one-stage bilateral total hip arthroplasty (BTHA in Milad and Erfan hospitals, Tehran, Iran. A prospective analysis of the functional outcomes and complications of one-stage BTHA through Hardinge approach in patients with femoral head avascular necrosis (AVN performed. We evaluated all patients clinically and radiologically with serial follow-ups. A clinical hip score based upon the modified Harris Hip Score (MHHS was performed preoperatively and again postoperatively. During period of study 44 men (73.3% and 16 women (26.6% with a mean age of 31.40±4.08 years (range 25 to 36 years at the time of presentation were entered. The mean surgical time was 2.6±0.38 hrs. The mean hospital stay was 3 .50±0.72 days. Hemoglobin level decreased significa ntly after operation (P= 0.046. There was no reported patient with perioperative death, deep venous thrombosis, pulmonary embolism, infection, dislocation, periprosthetic fracture or heterotrophic ossification. The mean preoperative MHHS score was 47.93±7.33 in patients. MHHS score i mproved to 95.06±3.47 in the last follow-up (P=0.0001.Our results recommend the use of one-stage BTHA through Hardinge approach in femoral head avascular necrosis patients.

Effect of unilateral and simultaneous bilateral cochlear implantation on tinnitus : A Prospective Study

NARCIS (Netherlands)

van Zon, Alice; Smulders, Yvette E.; Ramakers, Geerte G. J.; Stegeman, Inge; Smit, Adriana L.; Van Zanten, Gijsbert A.; Stokroos, Robert J.; Hendrice, Nadia; Free, Rolien H.; Maat, Bert; Frijns, Johan H. M.; Mylanus, Emmanuel A. M.; Huinck, Wendy J.; Topsakal, Vedat; Tange, Rinze A.; Grolman, Wilko

Objectives/HypothesisTo determine the effect of cochlear implantation on tinnitus perception in patients with severe bilateral postlingual sensorineural hearing loss and to demonstrate possible differences between unilateral and bilateral cochlear implantation. Study DesignProspective study.

Acute Bilateral Superior Branch Vestibular Neuropathy

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Dario A. Yacovino

2018-05-01

Full Text Available The rapid onset of a bilateral vestibular hypofunction (BVH is often attributed to vestibular ototoxicity. However, without any prior exposure to ototoxins, the idiopathic form of BVH is most common. Although sequential bilateral vestibular neuritis (VN is described as a cause of BVH, clinical evidence for simultaneous and acute onset bilateral VN is unknown. We describe a patient with an acute onset of severe gait ataxia and oscillopsia with features compatible with acute BVH putatively due to a bilateral VN, which we serially evaluated with clinical and laboratory vestibular function testing over the course of 1 year. Initially, bilateral superior and horizontal semicircular canals and bilateral utricles were impaired, consistent with damage to both superior branches of each vestibular nerve. Hearing was spared. Only modest results were obtained following 6 months of vestibular rehabilitation. At a 1-year follow-up, only the utricular function of one side recovered. This case is the first evidence supporting an acute presentation of bilateral VN as a cause for BVH, which would not have been observed without critical assessment of each of the 10 vestibular end organs.

CT and SPECT in bilateral hypertensive intracerebral hemorrhages of simultaneous onset

International Nuclear Information System (INIS)

Kikuchi, Kenji; Kojima, Hisashi; Kowada, Masayoshi; Ogayama, Hiroyuki; Watanabe, Kazuo.

1988-01-01

A 59-year-old woman was admitted to the hospital on November 6, 1983, after she suddenly lost consciousness. She was semicomatous, and the level of consciousness was evaluated as 100 according to the Japan Coma Scale. There were left hemiparesis and conjugate deviation to the right. CT scans obtained one hour after onset demonstrated bilateral intracerebral hemorrhages involving the right basal ganglia and the left posterior temporal region. Carotid angiograms failed to demonstrate the presence of either cerebral aneurysms or arteriovenous malformations which might be responsible for the intracerebral hemorrhages. A right fronto-temporal craniotomy was performed, and about 50 ml of intracerebral blood clots were evacuated by the transcortical approach. The patient was discharged with left hemiparesis, disorientation, and pseudobulbar palsy. A 57-year-old man was transferred to the hospital on February 22, 1986, with an episode of cerebral stroke. On admission he was free of symptoms except for mild hemiparesis on the right side. CT scan was performed nine days after onset, revealing bilateral intracerebral hemorrhages involving the right putamen and the left thalamus. Bilateral carotid angiograms showed an avascular mass lesion medial to the left insula, displacing both the left lenticulostriate arteries and the insular segment of the left middle cerebral artery laterally. No abnormal vascular lesions, such as cerebral aneurysms and arteriovenous malformations, were demonstrated. SPECT was performed using the continuous inhalation of Xe-133, and a prolonged decrease in the cerebral blood flow was demonstrated in the vicinity of the bilateral intracerebral hematomas, in contrast to the gradual alleviations shown on CT images. (J.P.N.)

Bilateral movements increase sustained extensor force in the paretic arm.

Science.gov (United States)

Kang, Nyeonju; Cauraugh, James H

2018-04-01

Muscle weakness in the extensors poststroke is a common motor impairment. Unfortunately, research is unclear on whether bilateral movements increase extensor force production in the paretic arm. This study investigated sustained force production while stroke individuals maximally extended their wrist and fingers on their paretic arm. Specifically, we determined isometric force production in three conditions: (a) unilateral paretic arm, (b) unilateral nonparetic arm, and (c) bilateral (both arms executing the same movement simultaneously). Seventeen chronic stroke patients produced isometric sustained force by executing wrist and fingers extension in unilateral and bilateral contraction conditions. Mean force, force variability (coefficient of variation), and signal-to-noise ratio were calculated for each contraction condition. Analysis of two-way (Arm × Type of Condition: 2 × 2; Paretic or Nonparetic Arm × Unilateral or Bilateral Conditions) within-subjects ANOVAs revealed that the bilateral condition increased sustained force in the paretic arm, but reduced sustained force in the nonparetic arm. Further, although the paretic arm exhibited more force variability and less signal-to-noise ratio than the nonparetic arm during a unilateral condition, there were no differences when participants simultaneously executed isometric contractions with both arms. Our unique findings indicate that bilateral contractions transiently increased extensor force in the paretic arm. Implications for Rehabilitation Bilateral movements increased isometric wrsit extensor force in paretic arms and redcued force in nonparetic arms versus unilateral movements. Both paretic and nonparetic arms produced similar force variability and signal-to-noise ratio during bilateral movements. Increased sustained force in the paretic arm during the bilateral condition indicates that rehabilitation protocols based on bilateral movements may be beneficial for functional recovery.

Bilateral Neuroretinitis and a Unilateral Superior Hemivein Occlusion with Frosted Branch Angiitis Pattern Presenting Simultaneously in Behçet's Disease

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Roy Schwartz

2016-03-01

Full Text Available Purpose: To report a unique case of Behçet's disease that presented with atypical ocular manifestations. Methods: Case report. Results: A 23-year-old homosexual male presented with bilateral anterior uveitis, vitritis, neuroretinitis and a unilateral superior hemivein occlusion with frosted branch angiitis pattern. These were accompanied by systemic findings of recurrent oral aphthous ulcers, erythema nodosum, and neurological and gastrointestinal involvement. A positive HLA-B51 examination supported the diagnosis of Behçet's disease. Conclusion: Neuroretinitis and frosted branch angiitis may be the clinical manifestations of Behçet's disease and may present simultaneously.

Long-term follow-up of total abdominal wall reconstruction for prune belly syndrome.

Science.gov (United States)

Lesavoy, Malcolm A; Chang, Eric I; Suliman, Ahmed; Taylor, Jason; Taylor, James; Kim, Sara E; Ehrlich, Richard M

2012-01-01

Prune belly syndrome is a rare, congenital condition that consists of a major deficiency or hypoplasia of the abdominal wall musculature, bilateral cryptorchidism, and genitourinary tract malformations. Reconstruction of the abdominal wall in these patients has presented a challenge to plastic surgeons throughout the years. The authors previously described a technique for total abdominal wall reconstruction that permitted simultaneous urinary tract reconstruction and bilateral orchiopexy. This innovative procedure used medial advancement of the fascia in a "double-breasted" fashion with preservation of the umbilicus. The authors reviewed their experience with this particular technique in one of the largest series of patients in the literature and the series with the longest follow-up. Twenty patients underwent total abdominal wall reconstruction with simultaneous urinary tract reconstruction and orchiopexy with a mean follow-up of 20.4 years. There were no major complications noted during this period, and all patients were extremely satisfied with their postoperative result. Total abdominal wall reconstruction using the double-breasted technique in patients with prune belly syndrome is a safe and durable procedure that achieves excellent cosmetic results. Therapeutic, IV.

Bilateral cochlear implantation: current concepts, indications, and results.

Science.gov (United States)

Basura, Gregory J; Eapen, Rose; Buchman, Craig A

2009-12-01

The optimal treatment for bilateral hearing loss continues to evolve as cochlear implant (CI) and hearing aid technologies advance, as does our understanding of the central auditory system. Ongoing discussions continue on the validity and feasibility of bilateral CI in terms of performance, justification of need, medical/surgical safety concerns, and economics. The purpose of this review article is to provide an update on the advantages and disadvantages of bilateral CI and to provide a discussion on timing (simultaneous vs. sequential), technology (bimodal vs. binaural) and feasibility. Binaural advantages are found in both adult and pediatric bilateral CI recipients, the greatest being the head shadow effect and improvements in localization and loudness summation. This theoretically offers an advantage over their unilateral implanted counterparts in terms of improved sound localization and enhanced speech perception under noisy conditions. Most investigators agree that bilateral stimulation during critical periods of development is paramount for optimizing auditory functioning in children. Currently, bilateral CI is widely accepted as a safe and effective means of bilateral auditory stimulation.

United Kingdom national paediatric bilateral cochlear implant audit: preliminary results.

Science.gov (United States)

Cullington, Helen; Bele, Devyanee; Brinton, Julie; Lutman, Mark

2013-11-01

Prior to 2009, United Kingdom (UK) public funding was mainly only available for children to receive unilateral cochlear implants. In 2009, the National Institute for Health and Care Excellence published guidance for cochlear implantation following their review. According to these guidelines, all suitable children are eligible to have simultaneous bilateral cochlear implants or a sequential bilateral cochlear implant if they had received the first before the guidelines were published. Fifteen UK cochlear implant centres formed a consortium to carry out a multi-centre audit. The audit involves collecting data from simultaneously and sequentially implanted children at four intervals: before bilateral cochlear implants or before the sequential implant, 1, 2, and 3 years after bilateral implants. The measures include localization, speech recognition in quiet and background noise, speech production, listening, vocabulary, parental perception, quality of life, and surgical data including complications. The audit has now passed the 2-year point, and data have been received on 850 children. This article provides a first view of some data received up until March 2012.

Endometrioid adenocarcinoma 13 years after total abdominal hysterectomy and bilateral salpingooophorectomy

International Nuclear Information System (INIS)

Al-Talib, A.; Gilbert, L.

2008-01-01

Malignant transformation is an infrequent complication of endometriosis. As endometriosis is an ectopic endometrium, hyperestrogenism may cause hyperplasia or transformation into cancer. We describe a case of a 68-year-old woman who underwent total abdominal hysterectomy and bilateral salpingooophorectomy for endometriosis. She was subsequently placed on estrogen only replacement therapy. She presented with left-sided pelvic mass and shortness of breath. Computed tomography of chest, pelvis and abdomen, demonstrated right-sided pleural effusion and soft tissue mass in the pelvis. Pleural effusion was tapped and biopsy from the peritoneal mass showed metastatic adenocarcinoma. She was treated by 6 cycles of Carboplatin/Paclitexal and responded well. Unopposed estrogen stimulation may lead to malignant transformation in the residual foci of endometriosis. Therefore, the addition of progestins to estrogen replacement therapy should be considered in women who have undergone hysterectomy with oophorectomy due to endometriosis. (author)

Results of a prospective surgical audit of bilateral paediatric cochlear implantation in the UK.

Science.gov (United States)

Broomfield, Stephen J; Murphy, John; Wild, Dominik C; Emmett, Stevan R; O'Donoghue, Gerard M

2014-09-01

Since being approved in 2009, bilateral simultaneous cochlear implantation (CI) has been the standard treatment for children in the UK who meet the criteria for CI. The aim was to report surgical outcomes of bilateral CI in the UK. Between January 2010 and December 2011, 14 UK CI centres collected data prospectively: demographics, aetiology, use of imaging, device type, surgery duration, use of intra-operative electrophysiology, length of stay, and post-operative complications. 1397 CI procedures in 961 CI recipients were included; 436 bilateral simultaneous, 394 bilateral sequential, and 131 unilateral. The majority (85%) were congenitally deaf. The commonest causes of acquired deafness were meningitis and cytomegalovirus infection. The median age for congenitally deaf bilateral simultaneous CI was 2.2 years, mean surgical duration 4.5 hours. 6.3% surgeries were day case procedures. Eight cases (2.0%) of planned bilateral CI had unilateral surgery. The overall major complication rate was 1.6% (0.9% excluding device failures), including explantation due to infection (0.2%), cerebrospinal fluid leak (0.2%), and meningitis (0.1%). There were no permanent facial nerve palsies and no deaths. Sixty-two (6.5%) immediate minor complications included 12 (1.3%) children with significant vestibular impairment. The complication rate was similar following bilateral CI compared to sequential and unilateral CI, and is comparable to other published series. This prospective multi-centre audit provides evidence that bilateral paediatric CI is a safe procedure in the UK, thus endorsing its role as a major therapeutic intervention in childhood deafness.

Simultaneous maxillary distraction osteogenesis using a twin-track distraction device combined with alveolar bone grafting in cleft patients: preliminary report of a technique.

Science.gov (United States)

Suzuki, Eduardo Yugo; Watanabe, Masayo; Buranastidporn, Boonsiva; Baba, Yoshiyuki; Ohyama, Kimie; Ishii, Masatoshi

2006-01-01

The simultaneous use of cleft reduction and maxillary advancement by distraction osteogenesis has not been applied routinely because of the difficulty in three-dimensional control and stabilization of the transported segments. This report describes a new approach of simultaneous bilateral alveolar cleft reduction and maxillary advancement by distraction osteogenesis combined with autogenous bone grafting. A custom-made Twin-Track device was used to allow bilateral alveolar cleft closure combined with simultaneous maxillary advancement, using distraction osteogenesis and a rigid external distraction system in a bilateral cleft lip and palate patient. After a maxillary Le Fort I osteotomy, autogenous iliac bone graft was placed in the cleft spaces before suturing. A latency period of six days was observed before activation. The rate of activation was one mm/d for the maxillary advancement and 0.5 mm/d for the segmental transport. Accordingly, the concave facial appearance was improved with acceptable occlusion, and complete bilateral cleft closure was attained. No adjustments were necessary to the vector of the transported segments during the activation and no complications were observed. The proposed Twin-Track device, based on the concept of track-guided bone transport, permitted three-dimensional control over the distraction processes allowing simultaneous cleft closure, maxillary distraction, and autogenous bone grafting. The combined simultaneous approach is extremely advantageous in correcting severe deformities, reducing the number of surgical interventions and, consequently, the total treatment time.

Coexistence of bilateral first and second branchial arch anomalies

Science.gov (United States)

Thakur, J S; Shekar, Vidya; Saluja, Manika; Mohindroo, N K

2013-01-01

Branchial arch anomalies are one of the most common congenital anomalies that are usually unilateral and bilateral presentation is rare. The simultaneous presence of bilateral second branchial arch anomalies along with bilateral first arch anomalies is extremely rare, with only three such cases reported in the literature. We present two non-syndromic cases of coexisting bilateral first and second arch anomalies. Developmental anomalies of the branchial apparatus account for 17% of all paediatric cervical masses and are the most common type of congenital cervical mass. They usually present in the paediatric age group. About 96–97% of these anomalies are unilateral. Bilateral presentation is seen in 2–3% having a strong familial association. Congenital syndromes also have been associated with first and second branchial arch anomalies. Thorough clinical examination and investigations should be done to rule out these syndromes. PMID:23580675

Early assessment of bilateral inguinal hernia repair: A comparison between the laparoscopic total extraperitoneal and Stoppa approaches

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Edivaldo Massazo Utiyama

2016-01-01

Full Text Available Background: The present clinical trial was designed to compare the results of bilateral inguinal hernia repair between patients who underwent the conventional Stoppa technique and laparoscopic total extraperitoneal repair (LTE with a single mesh and without staple fixation. Patients and Methods: This controlled, randomised clinical trial was conducted at General Surgery and Trauma of the Clinics Hospital, Medical School, the University of São Paulo between September 2010 and February 2011. Totally, 50 male patients, with a bilateral inguinal hernia, older than 25 years were considered eligible for the study. The following parameters were analysed during the early post-operative period: (1 The intensity of surgical trauma, operation time, C-reactive protein (CRP levels, white blood cell count, bleeding and pain intensity; (2 quality of life assessment; and (3 post-operative complications. Results: LTE procedure was longer than the Stoppa procedure (134.6 min ± 38.3 vs. 90.6 min ± 41.3; P 0.05. There was no difference in pain during the 1st and 7th post-operative, physical functioning, physical limitation, the impact of pain on daily activities, and the Carolinas Comfort Scale during the 7th and 15th post-operative (P > 0.05. Complications occurred in 88% of Stoppa group (22 patients and 64% in LTE group (16 patients (P < 0.05. Conclusion: The comparative study between the Stoppa and LTE approaches for the bilateral inguinal hernia repair demonstrated that: (1 The LTE approach showed less surgical trauma despite the longer operation time; (2 Quality of life during the early post-operative period were similar; and (3 Complication rates were higher in the Stoppa group.

Bilateral double level tibial lengthening in dwarfism.

Science.gov (United States)

Burghardt, Rolf D; Yoshino, Koichi; Kashiwagi, Naoya; Yoshino, Shigeo; Bhave, Anil; Paley, Dror; Herzenberg, John E

2015-12-01

Outcome assessment after double level tibial lengthening in patients with dwarfism. Fourteen patients with dwarfism were analyzed after bilateral simultaneous double level tibial lengthening. Average age was 15.1 years. Average lengthening was 13.5 cm. The two levels were lengthened by an average of 7.5 cm proximally and 6.0 cm distally. Concomitant deformities were also addressed during lengthening. External fixation treatment time averaged 8.8 months. Healing index averaged 0.7 months/cm. Bilateral tibial lengthening for dwarfism is difficult, but the results are usually quite gratifying.

Objective and Subjective Measures of Simultaneous vs Sequential Bilateral Cochlear Implants in Adults: A Randomized Clinical Trial.

Science.gov (United States)

Kraaijenga, Véronique J C; Ramakers, Geerte G J; Smulders, Yvette E; van Zon, Alice; Stegeman, Inge; Smit, Adriana L; Stokroos, Robert J; Hendrice, Nadia; Free, Rolien H; Maat, Bert; Frijns, Johan H M; Briaire, Jeroen J; Mylanus, E A M; Huinck, Wendy J; Van Zanten, Gijsbert A; Grolman, Wilko

2017-09-01

To date, no randomized clinical trial on the comparison between simultaneous and sequential bilateral cochlear implants (BiCIs) has been performed. To investigate the hearing capabilities and the self-reported benefits of simultaneous BiCIs compared with those of sequential BiCIs. A multicenter randomized clinical trial was conducted between January 12, 2010, and September 2, 2012, at 5 tertiary referral centers among 40 participants eligible for BiCIs. Main inclusion criteria were postlingual severe to profound hearing loss, age 18 to 70 years, and a maximum duration of 10 years without hearing aid use in both ears. Data analysis was conducted from May 24 to June 12, 2016. The simultaneous BiCI group received 2 cochlear implants during 1 surgical procedure. The sequential BiCI group received 2 cochlear implants with an interval of 2 years between implants. First, the results 1 year after receiving simultaneous BiCIs were compared with the results 1 year after receiving sequential BiCIs. Second, the results of 3 years of follow-up for both groups were compared separately. The primary outcome measure was speech intelligibility in noise from straight ahead. Secondary outcome measures were speech intelligibility in noise from spatially separated sources, speech intelligibility in silence, localization capabilities, and self-reported benefits assessed with various hearing and quality of life questionnaires. Nineteen participants were randomized to receive simultaneous BiCIs (11 women and 8 men; median age, 52 years [interquartile range, 36-63 years]), and another 19 participants were randomized to undergo sequential BiCIs (8 women and 11 men; median age, 54 years [interquartile range, 43-64 years]). Three patients did not receive a second cochlear implant and were unavailable for follow-up. Comparable results were found 1 year after simultaneous or sequential BiCIs for speech intelligibility in noise from straight ahead (difference, 0.9 dB [95% CI, -3.1 to 4.4 dB]) and

A comparison of critical heat flux in tubes and bilaterally heated annuli

Energy Technology Data Exchange (ETDEWEB)

Doerffer, S.; Groeneveld, D.C.; Cheng, S.C. [Univ. of Ottawa (Canada)

1995-09-01

This paper examines the critical heat flux (CHF) behaviour for annular flow in bilaterally heated annuli and compares it to that in tubes and unilaterally heated annuli. It was found that the differences in CHF between bilaterally and unilaterally heated annuli or tubes strongly depend on pressure and quality. the CHF in bilaterally heated annuli can be predicted by tube CHF prediction methods for the simultaneous CHF occurrence at both surfaces, and the following flow conditions: pressure 7-10 MPa, mass flux 0.5-4.0 Mg/m{sup 2}s and critical quality 0.23-0.9. The effect on CHF of the outer-to-inner surface heat flux ratio, was also examined. The prediction of CHF for bilaterally heated annuli was based on the droplet-diffusion model proposed by Kirillov and Smogalev. While their model refers only to CHF occurrence at the inner surface, we extended it to cases where CHF occurs at the outer surface, and simultaneously at both surfaces, thus covering all cases of CHF occurrence in bilaterally heated annuli. From the annuli CHF data of Becker and Letzter, we derived empirical functions required by the model. the proposed equations provide good accuracy for the CHF data used in this study. Moreover, the equations can predict conditions at which CHF occurs simultaneously at both surfaces. Also, this method can be used for cases with only one heated surface.

Bilateral Distal Femoral Flexion Deformity After Total Knee Arthroplasty in a Patient with Rheumatoid Arthritis

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Jimmy Chan Chun-Ming

2013-12-01

Full Text Available Rheumatoid arthritis is an autoimmune systemic disease with predominant peripheral polyarthritis, often leading to severe joint destruction. This is a case report of an 81-year-old woman with long-standing severe rheumatoid arthritis requiring multiple orthopaedic operations for joint destruction since 2000. These operated joints improved her functional mobility until recently, when she found that her knees were fixed at around 70° of flexion with limited motion. There was chronic progressive flexion deformity of bilateral distal femurs, which was an extremely rare complication of total knee arthroplasty.

Adverse Outcomes in Infantile Bilateral Developmental Dysplasia of the Hip.

Science.gov (United States)

Morbi, Abigail H M; Carsi, Belen; Gorianinov, Vitalli; Clarke, Nicholas M P

2015-01-01

It is believed that bilateral developmental dysplasia of the hip (DDH) has poorer outcomes with higher rates of avascular necrosis (AVN) and reintervention, compared with unilateral DDH. However, there is limited evidence in the literature, with few studies looking specifically at bilateral cases. A retrospective review of 36 patients (72 hips) with >4 years of follow-up. Patient population included surgically treated DDH including late presentations and failures of conservative treatment. The dislocated hips underwent either simultaneous closed or 1 open and 1 closed, or sequential open reduction. AVN and secondary procedures were used as endpoints for analysis as well as clinical and radiologic outcomes. At the last follow-up, 33% of hips had radiologic signs of AVN. Those hips that had no ossific nucleus (ON) at the time of surgery had an odds ratio of developing AVN of 3.05 and a statistically significant association between the 2 variables, whereas open/closed or simultaneous/sequential reduction did not increase the risk for AVN. In addition, 45.8% of those hips required further surgery. The estimated odds ratio of needing additional surgery after simultaneous reduction was 4.04. Clinically, 79.2% of the hips were graded as McKay I, whereas radiologically only 38.8% were Severin I. The AVN rate in bilateral DDH treated surgically is greater than the rate noted in unilateral cases from the same institution undergoing identical protocols. There was no difference in AVN rates between simultaneous and sequential or between the first and second hip to be sequentially reduced. Presence of ON decreases the risk for AVN, suggesting that in bilateral cases, awaiting the appearance of the ON is an important tool to reduce the incidence of AVN. IV.

Ultrasound Diagnosis of Bilateral Quadriceps Tendon Rupture After Statin Use

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Nesselroade, Ryan D

2010-09-01

Full Text Available Simultaneous bilateral quadriceps tendon rupture is a rare injury. We report the case of bilateral quadriceps tendon rupture sustained with minimal force while refereeing a football game. The injury was suspected to be associated with statin use as the patient had no other identifiable risk factors.The diagnosis was confirmed using bedside ultrasound. [West J Emerg Med. 2010; 11(4:306-309.

An accelerometry-based methodology for assessment of real-world bilateral upper extremity activity.

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Ryan R Bailey

Full Text Available The use of both upper extremities (UE is necessary for the completion of many everyday tasks. Few clinical assessments measure the abilities of the UEs to work together; rather, they assess unilateral function and compare it between affected and unaffected UEs. Furthermore, clinical assessments are unable to measure function that occurs in the real-world, outside the clinic. This study examines the validity of an innovative approach to assess real-world bilateral UE activity using accelerometry.Seventy-four neurologically intact adults completed ten tasks (donning/doffing shoes, grooming, stacking boxes, cutting playdough, folding towels, writing, unilateral sorting, bilateral sorting, unilateral typing, and bilateral typing while wearing accelerometers on both wrists. Two variables, the Bilateral Magnitude and Magnitude Ratio, were derived from accelerometry data to distinguish between high- and low-intensity tasks, and between bilateral and unilateral tasks. Estimated energy expenditure and time spent in simultaneous UE activity for each task were also calculated.The Bilateral Magnitude distinguished between high- and low-intensity tasks, and the Magnitude Ratio distinguished between unilateral and bilateral UE tasks. The Bilateral Magnitude was strongly correlated with estimated energy expenditure (ρ = 0.74, p<0.02, and the Magnitude Ratio was strongly correlated with time spent in simultaneous UE activity (ρ = 0.93, p<0.01 across tasks.These results demonstrate face validity and construct validity of this methodology to quantify bilateral UE activity during the performance of everyday tasks performed in a laboratory setting, and can now be used to assess bilateral UE activity in real-world environments.

Pros and cons of immediately sequential bilateral cataract surgery (ISBCS).

Science.gov (United States)

Grzybowski, Andrzej; Wasinska-Borowiec, Weronika; Claoué, Charles

2016-01-01

Immediately sequential bilateral cataract surgery (ISBCS) is currently a "hot topic" in ophthalmology. There are well-documented advantages in terms of quicker visual rehabilitation and reduced costs. The risk of bilateral simultaneous endophthalmitis and bilateral blindness is now recognized to be minuscule with the advent of intracameral antibiotics and modern management of endophthalmitis. Refractive surprises are rare for normal eyes and with the use of optical biometry. Where a general anesthetic is indicated for cataract surgery, the risk of death from a second anesthetic is much higher than the risk of blindness. A widely recognized protocol from the International Society of Bilateral Cataract Surgeons needs to be adhered to if surgeons wish to start practicing ISBCS.

Bilateral synchronous rupture of the quadriceps tendon.

LENUS (Irish Health Repository)

Ellanti, P

2012-09-01

Bilateral simultaneous rupture of the quadriceps tendon is a rare entity. They are often associated with degenerative changes of the tendons and predisposing conditions such as diabetes or excessive steroid use. They most commonly tend to occur in patients of 40 years of age or older.

Bilateral Simultaneous Avulsion Fractures of the Proximal Tibia in a 14-Year-Old Athlete with Vitamin-D Deficiency

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Ziad Harb

2015-01-01

Full Text Available Fractures involving the proximal tibial epiphysis are rare and form 0.5% of all epiphyseal injuries. The specific anatomical and developmental features of the proximal tibial epiphysis make it vulnerable to unique patterns of fractures. Vitamin-D plays a vital role in bone homeostasis and its deficiency has an impact on fracture risk and healing. We present the first ever reported case of simultaneous bilateral proximal tibial physeal fractures in an athlete with vitamin-D deficiency. Treatment consisted of plaster immobilisation, and the patient made a full recovery and returned to preinjury level of activities. We report this case for its uniqueness and as an educational review of the importance of the developmental anatomy of the proximal tibia. We review the literature and discuss how the stages of the growing physis determine the type of fracture sustained.

Bilateral avascular necrosis of the femoral head due to the use of heroin: A case report.

Science.gov (United States)

Ozkunt, Okan; Sarıyılmaz, Kerim; Sungur, Mustafa; Ilen, Ferhat; Dikici, Fatih

2015-01-01

Femoral head avascular necrosis is caused by disruption of the blood supply of the femoral head, which finally results in hip dysfunction. Non traumatic osteonecrosis may related with corticosteroid use, alcohol abuse, SLE, hemoglobinopathies or exposure to cytotoxic agents. But avascular necrosis of the femoral head (ANFH) due to heroin use is a rare condition. We report a patient with bilateral ANFH due to heroin use treated by simultaneous bilateral hip arthroplasty. 37 year-old male patient presented with bilateral hip pain that had been occurring for four years. The patient had no history of smoking, excessive drinking, using corticosteroid and the other drugs or trauma but used heroin for 10 years. In clinic and radiologic examination indicated advanced degenerative changes on both hip due to femoral head avascular necrosis. The patient was treated with simultaneous bilateral total hip arthroplasty. After 6 months postoperatively the active hip range of motion was painless. Avascular femoral head necrosis caused by the using of heroin is rare. Ultimately, osteonecrosis of the femoral head occurs through one final common pathway, which is decreased blood flow to the femoral head that leads bone ischemia and death. But it is still unknown that heroin's systemic effects. Intravenous drug use more as a serious problem for today. There is a need for comprehensive studies to demonstrate effects of heroin on bone and vascularity metabolism. Heroin use will be important problem for population. That's why is crucial to understand the effect of heroin. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Invasive lobular carcinoma of the breast: MRI pathological correlation following bilateral total mastectomy

International Nuclear Information System (INIS)

Stivalet, Aude; Pigneur, Frederic; Luciani, Alain

2012-01-01

Background: Invasive lobular carcinoma (ILC) is more often multifocal and bilateral than invasive ductal carcinoma. MRI is usually recommended for detection of all ILC sites. The performance of known diagnostic breast MRI criteria for ILC characterization has not been evaluated to date using bilateral mastectomy specimens as gold standard. Purpose: To determine the value of BI-RADS 2006 MRI criteria for ILC detection and characterization, using pathological examination of bilateral mastectomy specimens as the reference standard. Material and Methods: Between 2004 and 2007, we retrospectively included all patients with pathologically documented ILC referred to our institution for bilateral mastectomy and preoperative bilateral breast MRI. The location, diameter, and characteristics (BI-RADS) of all lesions were compared with pathological findings. The sensitivity and positive predictive value of bilateral breast MRI for the diagnosis of ILC were calculated. Association of MRI BI-RADS categorical variables and characterization of ILC were assessed (Fisher exact test). Results: Among 360 patients treated for ILC in 2004-2007, 15 patients qualified for this study. Thirty-one ILC foci were found on pathological examination (30 ipsilateral and 1 contralateral tumor; mean diameter 23 mm; range 2-60 mm) and all were identified on MRI, with 90% of masses and 10% non-mass-like enhancements; MRI features significantly associated with ILC included absence of smooth margins (P = 0.02) and rim-shaped enhancement (P = 0.039). Enhancement kinetics of the 31 foci were evenly distributed among wash-out, plateau, and persistent profiles. Eleven additional lesions were seen on MRI, mainly corresponding to fibrocystic disease; 91% presented as masses and 9% had a wash-out profile. Conclusion: Based on the 2006 BI-RADS criteria, breast MRI shows a high sensitivity for ILC detection, at the expense of a 26% false-positive rate, suggesting that a pathological proof by US- or MR

Invasive lobular carcinoma of the breast: MRI pathological correlation following bilateral total mastectomy

Energy Technology Data Exchange (ETDEWEB)

Stivalet, Aude; Pigneur, Frederic (AP-HP, Groupe Henri Mondor Albert Chenevier, Imagerie Medicale, Creteil (France)); Luciani, Alain (AP-HP, Groupe Henri Mondor Albert Chenevier, Imagerie Medicale, Creteil (France); INSERM Unite U 955, Equipe 17, Univ. Paris Est Creteil, Creteil (France)), email: alain.luciani@hmn.aphp.fr (and others)

2012-05-15

Background: Invasive lobular carcinoma (ILC) is more often multifocal and bilateral than invasive ductal carcinoma. MRI is usually recommended for detection of all ILC sites. The performance of known diagnostic breast MRI criteria for ILC characterization has not been evaluated to date using bilateral mastectomy specimens as gold standard. Purpose: To determine the value of BI-RADS 2006 MRI criteria for ILC detection and characterization, using pathological examination of bilateral mastectomy specimens as the reference standard. Material and Methods: Between 2004 and 2007, we retrospectively included all patients with pathologically documented ILC referred to our institution for bilateral mastectomy and preoperative bilateral breast MRI. The location, diameter, and characteristics (BI-RADS) of all lesions were compared with pathological findings. The sensitivity and positive predictive value of bilateral breast MRI for the diagnosis of ILC were calculated. Association of MRI BI-RADS categorical variables and characterization of ILC were assessed (Fisher exact test). Results: Among 360 patients treated for ILC in 2004-2007, 15 patients qualified for this study. Thirty-one ILC foci were found on pathological examination (30 ipsilateral and 1 contralateral tumor; mean diameter 23 mm; range 2-60 mm) and all were identified on MRI, with 90% of masses and 10% non-mass-like enhancements; MRI features significantly associated with ILC included absence of smooth margins (P = 0.02) and rim-shaped enhancement (P = 0.039). Enhancement kinetics of the 31 foci were evenly distributed among wash-out, plateau, and persistent profiles. Eleven additional lesions were seen on MRI, mainly corresponding to fibrocystic disease; 91% presented as masses and 9% had a wash-out profile. Conclusion: Based on the 2006 BI-RADS criteria, breast MRI shows a high sensitivity for ILC detection, at the expense of a 26% false-positive rate, suggesting that a pathological proof by US- or MR

Is the cup orientation different in bilateral total hip arthroplasty with right-handed surgeons using posterolateral approach?

Science.gov (United States)

Song, Xinggui; Ni, Ming; Li, Heng; Li, Xin; Li, Xiang; Fu, Jun; Chen, Jiying

2018-05-23

The impact of surgeon handedness on acetabular cup orientation in total hip arthroplasty (THA) is not well studied. The aim of our study is to investigate the difference of cup orientation in bilateral THA performed by right-handed surgeons using posterolateral approach and which cup could be fitter to Lewinneck's safe zone. The study consisted of 498 patients that underwent bilateral THA by three right-handed surgeons in our hospital. Postoperative acetabular cup anteversion and abduction on an anteroposterior pelvic radiograph were measured by Orthoview software (Orthoview LLC, Jacksonville, Florida). Furthermore, the percentage of cup placement within the safe zone was compared. The mean anteversion was 25.28 (25.28° ± 7.16°) in left THA and 22.01 (22.01° ± 6.35°) in right THA (p cup was positioned in Lewinnek's safe zone in 52% for anteversion, 87% for abduction, and 46% for both anteversion and abduction. But the cup placement within Lewinnek's safe zone was 71, 88, and 62% in the right side, respectively. There were significant differences in the percentage of acetabular cup placement within the safe zone for anteversion (p cup inclination and anteversion in bilateral THA and that the placement of cup performed by dominant hands of surgeons is more accurate than that performed by non-dominant sides.

Simultaneous double-side Crile operation in larynx cancer

International Nuclear Information System (INIS)

Szmeja, Z.; Kruk-Zagajewska, A.; Wozniak, S.

1994-01-01

Radical operation of lymphatic system of the neck (Crile'a operation) is a classic operation in the treatment of metastases of head and neck cancer. Bilateral Crile'a operation is indicated only in cases of bilateral metastases which in filtrate the jugular vein. According to new statistics the mortality rate around the operation time does not exceed 2,4%, that is why this operation is justified. Between 1978 and 1992 in the Clinic of Otolaryngology of the Medical Academy 8 patients underwent a simultaneous bilateral Crile'a operation due to large metastases to lymphatic system of the neck (N 3 ). The result of the simultaneous resection of both jugular veins was swelling and cyanosis of the face, the increase of blood pressure and others. They were of temporary character and did not cause any brain complications. (author)

Bilateral recurrent laryngeal nerve injury in total thyroidectomy with or without intraoperative neuromonitoring. Systematic review and meta-analysis.

Science.gov (United States)

Pardal-Refoyo, José Luis; Ochoa-Sangrador, Carlos

2016-01-01

The risk of producing bilateral laryngeal paralysis (BLP) in total thyroidectomy (TT) is low, but it is a concern for the surgeon and a serious safety incident that may compromise the airway, require reintubation or tracheostomy and cause serious sequelae or death. Neuromonitoring (NM), as an early diagnostic tool for the existence of injury to the recurrent laryngeal nerve (RLN), has not been shown to have reduced the risk, even though published series show lower incidences. Our objective was to estimate the risk of bilateral RLN paralysis with and without NM TT by systematic review and meta-analysis. We performed a systematic review of clinical trials, cohort studies and case series with total thyroidectomy without NM published in the period 2000-2014. A database search was performed using PubMed, Scopus (EMBASE) and the Cochrane Library. Heterogeneity between studies was explored and weighted risks grouped according to random effects models were estimated. We selected 40 articles and estimates of risk were identified in 54 case series (without NM, 25; with NM, 29) with 30,922 patients. The prevalence of BLP in the series with NM was lower compared to that without NM (2.43‰, [1.55 to 3.5‰] versus 5.18‰ [2.53 to 8.7‰]). This difference is equivalent to an absolute risk reduction of 2.75‰ with a number needed to treat of 364.13. The NM group was more homogeneous (I2=7.52%) than those without NM (I2=79.32%). The observed differences in the subgroup analysis were very imprecise because the number of observed paralysis was very low. The risk of bilateral paralysis is lower in studies with neuromonitoring. Copyright © 2014 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Patología Cérvico-Facial. All rights reserved.

Bilateral Video-Assisted Thoracoscopic Surgery Resection for Multiple Mediastinal Myelolipoma: Report of a Case

OpenAIRE

Nakagawa, Masatoshi; Kohno, Tadasu; Mun, Mingyon; Yoshiya, Tomoharu

2014-01-01

Myelolipoma in the mediastinum is an extremely rare entity. In this report, we present the case of a 79-year-old asymptomatic man who had three bilateral paravertebral mediastinal tumors. The three tumors were resected simultaneously using bilateral three-port video-assisted thoracoscopic surgery (VATS). There has been no evidence of recurrence within four years after the operation. Multiple bilateral mediastinal myelolipomas are extremely rare. There are no reports in the English literature ...

No effect of fibrin sealant on drain output or functional recovery following simultaneous bilateral total knee arthroplasty

DEFF Research Database (Denmark)

Skovgaard, Christian; Holm, Bente; Troelsen, Anders

2013-01-01

Background and purpose Blood loss after total knee arthroplasty (TKA) may lead to anemia, blood transfusions, and increased total costs. Also, bleeding into the periarticular tissue may cause swelling and a reduction in quadriceps strength, thus impairing early functional recovery. In this random...... in TKA showed no benefit in reducing drain output or in facilitating early functional recovery when used with a tourniquet, tranexamic acid, and a femoral bone plug....

Laparoscopic Partial Adrenalectomy for Bilateral Cortisol-secreting Adenomas

Directory of Open Access Journals (Sweden)

Jeffrey P. Domino

2007-04-01

Full Text Available Bilateral cortisol-secreting adenomas are a rare cause of Cushing's syndrome. We report a case of a 35-year-old woman who presented with ACTH-independent Cushing's syndrome and bilateral adrenal adenomas. Adrenal venous sampling confirmed both adenomas to be hyper-secreting cortisol. She underwent bilateral laparoscopic adrenalectomy; total right and partial left adrenalectomies. At 2-year follow-up, she is maintained on low-dose fludrocortisone and hydrocortisone, and without recurrence of hypercorticolism. Laparoscopic partial adrenalectomy is a feasible option for this rare condition; however, long-term follow-up is needed to determine her total independence from steroid usage.

Simultaneous Bilateral Tubal Pregnancy After In Vitro Fertilization and Embryo Transfer

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Sunduz Ozlem Altinkaya

2008-09-01

Conclusion: The diagnosis of ectopic or heterotopic pregnancy should always be considered in patients undergoing IVF-ET because of its increased incidence with this technique compared with natural conception. Although the incidence of bilateral tubal pregnancy is not high, sonographers and surgeons should examine both adnexa when diagnosing an ectopic pregnancy, especially in IVF-ET patients. Early diagnosis is essential for the prevention of significant maternal morbidity and mortality.

Bilateral Rhegmatogenous Retinal Detachment during External Beam Radiotherapy

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Takako Hidaka

2016-06-01

Full Text Available Herein, we report a case of nontraumatic bilateral rhegmatogenous retinal detachment (RRD during external beam radiotherapy for nonocular tumor, presented as an observational case study in conjunction with a review of the relevant literature. A 65-year-old male was referred to our hospital due to bilateral RRD. He underwent a biopsy for a tumor of the left frontal lobe 4 months prior to presentation, and the tumor had been diagnosed as primary central nerve system B-cell type lymphoma. He received chemotherapy and external beam radiotherapy for 1 month. There were no traumatic episodes. Bilateral retinal detachment occurred during a series of radiotherapies. Simultaneous nontraumatic bilateral retinal detachment is rare. The effects of radiotherapy on ocular functionality, particularly in cases involving retinal adhesion and vitreous contraction, may include RRD. Thus, it is necessary to closely monitor the eyes of patients undergoing radiotherapy, particularly those undergoing surgery for retinal detachment and those with a history of photocoagulation for retinal tears, a relevant family history, or risk factors known to be associated with RRD.

Bilateral Diabetic Papillopathy and Metabolic Control

DEFF Research Database (Denmark)

Ostri, Christoffer; Lund-Andersen, Henrik; Sander, Birgit

2010-01-01

OBJECTIVE: The pathogenesis of diabetic papillopathy largely is unknown, but case reports suggest that it may follow rapidly improved metabolic control. The present study was designed to investigate this hypothesis. DESIGN: Retrospective case-control study. PARTICIPANTS: Two thousand sixty......-six patients with type 1 diabetes. METHODS: Review of clinical, photographic, and clinical chemistry records from a large diabetology and ophthalmology unit between 2001 and 2008. MAIN OUTCOME MEASURES: Simultaneous, bilateral diabetic papillopathy. RESULTS: The mean follow-up was 4.9 years. During 10 020...... patient-years of observation, bilateral diabetic papillopathy developed in 5 patients. During the year preceding this incident, all 5 patients had experienced a decrease in glycosylated hemoglobin A(1c) (HbA(1C)) at a maximum rate of -2.5 (mean) percentage points per quarter year, which was significantly...

Combined Partial Penectomy With Bilateral Robotic Inguinal Lymphadenectomy Using Near-infrared Fluorescence Guidance.

Science.gov (United States)

Sávio, Luís Felipe; Panizzutti Barboza, Marcelo; Alameddine, Mahmoud; Ahdoot, Michael; Alonzo, David; Ritch, Chad R

2018-03-01

To describe our novel technique for performing a combined partial penectomy and bilateral robotic inguinal lymphadenectomy using intraoperative near-infrared (NIR) fluorescence guidance with indocyanine green (ICG) and the DaVinci Firefly camera system. A 58-year-old man presented status post recent excisional biopsy of a 2-cm lesion on the left coronal aspect of the glans penis. Pathology revealed "invasive squamous cell carcinoma of the penis with multifocal positive margins." His examination was suspicious for cT2 primary and his inguinal nodes were cN0. He was counseled to undergo partial penectomy with possible combined vs staged bilateral robotic inguinal lymphadenectomy. Preoperative computed tomography scan was negative for pathologic lymphadenopathy. Before incision, 5 mL of ICG was injected subcutaneously beneath the tumor. Bilateral thigh pockets were then developed simultaneously and a right, then left robotic modified inguinal lymphadenectomy was performed using NIR fluorescence guidance via the DaVinci Firefly camera. A partial penectomy was then performed in the standard fashion. The combined procedure was performed successfully without complication. Total operative time was 379 minutes and total robotic console time was 95 minutes for the right and 58 minutes to the left. Estimated blood loss on the right and left were 15 and 25 mL, respectively. A total of 24 lymph nodes were retrieved. This video demonstrates a safe and feasible approach for combined partial penectomy and bilateral inguinal lymphadenectomy with NIR guidance using ICG and the DaVinci Firefly camera system. The combined robotic approach has minimal morbidity and avoids the need for a staged procedure. Furthermore, use of NIR guidance with ICG during robotic inguinal lymphadenectomy is feasible and may help identify sentinel lymph nodes and improve the quality of dissection. Further studies are needed to confirm the utility of NIR guidance for robotic sentinel lymph node

Bilateral internal laryngoceles mimicking asthma

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Elif A Aksoy

2013-01-01

Full Text Available Laryngocele is an air-filled, abnormal dilation of the laryngeal saccule that extends upward within the false vocal fold, in communication with the laryngeal lumen. A case of 43-year-old male with bilateral internal laryngoceles, who has been treated as asthma for 4 years, is presented. The patient had dyspnea, cough, and excessive phlegm for a month and a late onset stridor. Flexible nasopharyngolaryngoscopy showed bilateral cystic enlargements of the false vocal folds and true vocal folds could not be visualized. Laryngeal CT without contrast enhancement showed bilateral internal laryngoceles. Submucosal total excision of bilateral cystic masses including parts of false vocal folds was performed. The symptoms resolved immediately after surgery. Although the incidence of internal laryngocele is rare, it should be remembered in the differential diagnosis of upper airway problems and diagnostic flexible nasopharnygolaryngoscopy is routinely indicated for airway evaluation in at-risk patients.

Total Reconstruction of the Upper Lip Using Bilateral Nasolabial Flaps, Submental Flap, and Mucosa Graft following Complete Resection for Squamous Cell Carcinoma

Directory of Open Access Journals (Sweden)

O. G. Oseni

2015-01-01

Full Text Available Lip reconstruction following resection for tumour or following extensive trauma may pose a challenge. This is more so when the resection is total and a complete lip has to be constructed. We present a case of lip reconstruction following a total resection of the upper lip. The procedure used in this case was a combination of bilateral nasolabial flaps with a submental flap and buccal mucosal graft lining. We believe that this provides an alternative method of total upper lip reconstruction with minimal disruption of the facial aesthesis.

Comparative study between unilateral and bilateral cochlear implantation in children of 1 and 2 years of age.

Science.gov (United States)

Escorihuela García, Vicente; Pitarch Ribas, María Ignacia; Llópez Carratalá, Ignacio; Latorre Monteagudo, Emilia; Morant Ventura, Antonio; Marco Algarra, Jaime

2016-01-01

The studies that have evaluated the effectiveness of bilateral cochlear implantation in children suggest an improvement in hearing about sound localization and speech discrimination. In this paper we show the differences in audio-linguistic achievements with early bilateral cochlear implantation versus unilateral, and differences between simultaneous and sequential bilateral implantation. We present 88 children with bilateral profound sensorineural hearing loss, treated with bilateral cochlear implantation in 32 cases and unilateral in 56 cases, during the first 12 months (27 children) of life and between 12 and 24 months (61 children). We conducted a statistical comparison of both groups in the audiometry, IT-Mais, Nottingham, LittlEars scales and verbal tests. No significant differences in hearing thresholds and questionnaires between unilateral and bilateral implantation were detected in either the first or second year. Verbal tests do show statistically significant differences: children with bilateral cochlear implant obtain 100% recognition of disyllabic and phrases within 2-3 years after implantation whilst children with one implant do not obtain those results at 5 years after surgery. No differences between simultaneous and sequential bilateral implantation were detected. We emphasize the importance of ensuring good early audiological screening, to carry out an early and bilateral cochlear implantation with the consequent development of audio-language skills similar to normal hearing children. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

Bilateral, independent juvenile nasopharyngeal angiofibroma: case report.

Science.gov (United States)

Mørkenborg, M-L; Frendø, M; Stavngaard, T; Von Buchwald, C

2015-10-01

Juvenile nasopharyngeal angiofibroma is a benign, vascular tumour that primarily occurs in adolescent males. Despite its benign nature, aggressive growth patterns can cause potential life-threatening complications. Juvenile nasopharyngeal angiofibroma is normally unilateral, originating from the sphenopalatine artery, but bilateral symptoms can occur if a large tumour extends to the contralateral side of the nasopharynx. This paper presents the first reported case of true bilateral extensive juvenile nasopharyngeal angiofibroma involving clinically challenging pre-surgical planning and surgical strategy. A 21-year-old male presented with increasing bilateral nasal obstruction and discharge. Examination revealed tumours bilaterally and imaging demonstrated non-contiguous tumours. Pre-operative angiography showed strictly ipsilateral vascular supplies requiring bilateral embolisation. Radical removal performed as one-step, computer-assisted functional endoscopic sinus surgery was performed. The follow-up period was uncomplicated. This case illustrates the importance of suspecting bilateral juvenile nasopharyngeal angiofibroma in patients presenting with bilateral symptoms. Our management, including successful pre-operative planning, enabled one-step total removal of both tumours and rapid patient recovery.

Efficacy of total lymphoid irradiation for chronic allograft rejection following bilateral lung transplantation

International Nuclear Information System (INIS)

Diamond, David A.; Michalski, Jeff M.; Lynch, John P.; Trulock, Elbert P.

1998-01-01

Purpose: To assess the safety and efficacy of total lymphoid irradiation (TLI) in patients experiencing chronic rejection following bilateral lung transplantation (BLT). Patients and Materials: Eleven patients received TLI for chronic allograft rejection (bronchiolitis obliterans syndrome) refractory to conventional treatment modalities. Radiation therapy (RT) was prescribed as 8 Gy delivered in 10 0.8-Gy fractions, 2 fractions/week, via mantle, paraaortic, and inverted-Y fields. Serial pre- and post-RT pulmonary function values, complete blood counts, and immunosuppressive augmentation requirements [use of methylprednisolone, murine anti-human mature T-cell monoclonal antibody (OKT3), polyclonal antithymocyte globulin (ATG), and tacrolimus] were monitored. Results: In the 3 months preceding TLI, the average decrease in forced expiratory volume in 1 s (FEV 1 ) was 34% (range 0-75%) and the median number of immunosuppression augmentations was 3 (range 0-5). Only 4 of 11 patients completed all 10 TLI treatment fractions. Reasons for discontinuation included progressive pulmonary decline (four patients), worsening pulmonary infection (two patients), and persistent thrombocytopenia (one patient). Seven of the 11 patients failed within 8 weeks of treatment cessation. One patient had unabated rejection and received bilateral living related-donor transplants; he is alive and well. Six patients died. Two of these deaths were due to pulmonary infection from organisms isolated prior to the start of RT; the other four deaths were from progressive pulmonary decline. The four remaining patients had durable positive responses to TLI (mean follow-up of 47 weeks; range 24-72). Comparing the 3 months preceding RT to the 3 months following treatment, these four patients had improvements in average FEV 1 (40% decline vs. 1% improvement) and fewer median number of immunosuppressive augmentations (3.5 vs. 0). None of these patients has developed lymphoproliferative disease or has died

HPLC for simultaneous quantification of total ceramide, glucosylceramide, and ceramide trihexoside concentrations in plasma

NARCIS (Netherlands)

Groener, Johanna E. M.; Poorthuis, Ben J. H. M.; Kuiper, Sijmen; Helmond, Mariette T. J.; Hollak, Carla E. M.; Aerts, Johannes M. F. G.

2007-01-01

BACKGROUND: Simple, reproducible assays are needed for the quantification of sphingolipids, ceramide (Cer), and sphingoid bases. We developed an HPLC method for simultaneous quantification of total plasma concentrations of Cer, glucosylceramide (GlcCer), and ceramide trihexoside (CTH). METHODS:

Bilateral acute retinal necrosis-A case report

Directory of Open Access Journals (Sweden)

Prasad Palimar

1992-01-01

Full Text Available A 42 year old man presented with acute bilateral uveitis and necrotizing retinitis. Systemic investigations including test for AIDS and CMV retinitis were negative. Despite oral Acyclovir, both eyes progressed rapidly to retinal detachment with loss of vision. Early recognition is necessary to diagnose the bilateral acute retinal necrosis syndrome and initiate treatment. Bilateral acute retinal necrosis (BARN is a term first coined by Young and Bird in 1978 although the syndrome had been originally described by Urayama et al as an unilateral condition. This syndrome is characterized by the triad of acute confluent peripheral necrotizing retinitis, moderate to severe vasculitis and vitritis in an otherwise healthy individual. Rhegmatogenous retinal detachment occurs within two to three months of the onset of the disease and the second eye is involved in 36% of patients, usually within 6 weeks. We herein report a patient who presented with simultaneous BARN leading to retinal detachment in a matter of days. Also, to our knowledge this is the first report of this condition in India.

Bilateral breast carcinoma: results with breast conservation therapy and a comparison with bilateral mastectomy

International Nuclear Information System (INIS)

Kim, David H.; Haffty, Bruce G.

1996-01-01

Purpose: To assess outcome of patients with bilateral breast carcinoma treated with bilateral breast conserving surgery with radiation therapy (CS+RT) and to compare their outcome to (1) patients with unilateral disease treated with CS+RT and (2) patients of comparable stage treated with bilateral mastectomy. Methods and Materials: The charts of all patients with the diagnosis of breast cancer treated with CS+RT at our facilities prior to 1993 were reviewed to identify patients with bilateral disease. A total of 50 patients identified as having bilateral breast cancer conservatively treated(BCT) served as the index population. Out of the 50 patients, 23 presented with synchronous bilateral breast cancer and 27 presented with metachronous bilateral breast cancer. A group of 984 patients with unilateral breast cancer (UCT) treated with CS+RT during the same time interval served as the first control group. A second control group was comprised of 42 patients with early stage bilateral breast cancer presenting during the same time interval treated with bilateral mastectomy (BMAST). Patients who had locally advanced disease in either breast or those patients treated exclusively for lobular carcinoma in situ in either breast were excluded from the analysis. Of the 42 BMAST patients, 33 presented with synchronous disease and nine presented with metachronous disease. Local-regional relapse rates were calculated from the date of treatment of each breast. Overall survival and distant relapse rates were calculated from the date of treatment of the second breast cancer diagnosed. Survival curves were calculated via the life table method and statistical comparisons between curves were performed using the log rank statistic. Chi square analysis was used to detect differences between categorical variables. Results: As of December 1995, the median follow-up of the bilateral conservatively treated patient population was 9.4 years. No statistically significant differences were noted

Pattern of secure bilateral transactions ensuring power economic dispatch in hybrid electricity markets

International Nuclear Information System (INIS)

Kumar, Ashwani; Gao, Wenzhong

2009-01-01

This paper proposes a new method for secure bilateral transactions determination ensuring economic power dispatch of the generators using new AC distribution factors for pool and bilateral coordinated markets. The new optimization problem considers simultaneous minimization of deviations from scheduled transactions and fuel cost of the generators in the network. The fuel cost has been obtained for hybrid market model and impact of different percentage of bilateral demand on fuel cost, generation share, and pattern of transactions has also been determined. The impact of optimally located unified power flow controller (UPFC) on the bilateral transactions, fuel cost and generation pattern has also been studied. The results have also been obtained for pool market model. The proposed technique has been applied on IEEE 24-bus reliability test system (RTS). (author)

Patient–machine interactions of intravenous patient-controlled analgesia in bilateral versus unilateral total knee arthroplasty: A retrospective study

Directory of Open Access Journals (Sweden)

Yu-Chieh Wang

2013-06-01

Conclusion: In this study, we successfully demonstrated that our IVPCA protocol can provide adequate analgesia for patients after both bilateral and unilateral TKA. However, sedation, nausea, and vomiting occurred more frequently during the postoperative 24–48-hour period in patients who underwent bilateral than unilateral TKA. This may due of the increased number of bolus doses administered to the patients in the bilateral TKA group during the postoperative 12–18, 18–24, and 30–36-hour periods. Therefore, the initial infusion rates for patients undergoing bilateral TKA could be set at a lower threshold in order to reduce the incidence of these side effects.

Bilateral Testicular Tumors Resulting in Recurrent Cushing Disease After Bilateral Adrenalectomy.

Science.gov (United States)

Puar, Troy; Engels, Manon; van Herwaarden, Antonius E; Sweep, Fred C G J; Hulsbergen-van de Kaa, Christina; Kamphuis-van Ulzen, Karin; Chortis, Vasileios; Arlt, Wiebke; Stikkelbroeck, Nike; Claahsen-van der Grinten, Hedi L; Hermus, Ad R M M

2017-02-01

Recurrence of hypercortisolism in patients after bilateral adrenalectomy for Cushing disease is extremely rare. We present a 27-year-old man who previously underwent bilateral adrenalectomy for Cushing disease with complete clinical resolution. Cushingoid features recurred 12 years later, with bilateral testicular enlargement. Hormonal tests confirmed adrenocorticotropic hormone (ACTH)-dependent Cushing disease. Surgical resection of the testicular tumors led to clinical and biochemical remission. Gene expression analysis of the tumor tissue by quantitative polymerase chain reaction showed high expression of all key steroidogenic enzymes. Adrenocortical-specific genes were 5.1 × 105 (CYP11B1), 1.8 × 102 (CYP11B2), and 6.3 × 104 (MC2R) times higher than nonsteroidogenic fibroblast control. This correlated with urine steroid metabolome profiling showing 2 fivefold increases in the excretion of the metabolites of 11-deoxycortisol, 21-deoxycortisol, and total glucocorticoids. Leydig-specific genes were 4.3 × 101 (LHCGR) and 9.3 × 100 (HSD17B3) times higher than control, and urinary steroid profiling showed twofold increased excretion of the major androgen metabolites androsterone and etiocholanolone. These distinctly increased steroid metabolites were suppressed by dexamethasone but unresponsive to human chorionic gonadotropin stimulation, supporting the role of ACTH, but not luteinizing hormone, in regulating tumor-specific steroid excess. We report bilateral testicular tumors occurring in a patient with recurrent Cushing disease 12 years after bilateral adrenalectomy. Using mRNA expression analysis and steroid metabolome profiling, the tumors demonstrated both adrenocortical and gonadal steroidogenic properties, similar to testicular adrenal rest tumors found in patients with congenital adrenal hyperplasia, suggesting the presence of pluripotent cells even in patients without congenital adrenal hyperplasia. Copyright © 2017 by the Endocrine Society

Simultaneous determination of total arsenic and total selenium in Chinese medicinal herbs by hydride generation atomic fluorescence spectrometry in tartaric acid medium

International Nuclear Information System (INIS)

Liu Zhanfeng; Sun Hanwen; Shen Shigang; Li Liqing; Shi Hongmei

2005-01-01

By HG-AFS, a new method was proposed for simultaneous determination of total arsenic and total selenium existed in the Chinese medicinal herbs in tartaric acid medium. The effects of analytical conditions and coexisting ions on the fluorescence signal intensity of analytes were investigated. The proposed method was provided with linear response ranges above 22 μg l -1 for As and 44 μg l -1 for Se, and the detection limits of 0.13 and 0.12 μg l -1 were obtained for As and Se respectively. The recoveries of 93.8-96.1% for As and 95.3-99.1% for Se, and the precision of 1.2-3.8% and 2.4-5.3% (R.S.D., n = 8) respectively, were obtained via simultaneous determined four samples of Chinese medicinal herbs and three certified botanic reference materials successfully. The proposed method has the advantages of simple operation, high sensitivity and high efficiency

Bilateral intraocular lens subluxation secondary to haptic angulation.

Science.gov (United States)

Moreno-Montañés, Javier; Fernández-Hortelano, Ana; Caire, Josemaría

2008-04-01

An 82-year-old man had uneventful phacoemulsification with bilateral implantation of a hydrophilic acrylic, single-piece intraocular lens (IOL) (ACR6D SE, Laboratoires Cornéal). Five years later, simultaneous and bilateral IOL subluxations occurred. In both eyes, the subluxation was situated on the side of one haptic that had moved forward (temporal area in the right eye and superior area in the left eye). In the right eye, the haptic-capsular bag was entrapped by the pupil and produced endothelial damage. A transscleral suture was placed over and under the subluxated haptic through the anterior and posterior capsules to capture the haptic. The haptic was then sutured to the sclera. No postoperative complications developed. We hypothesize that 10-degree angulated and broad haptic junctions can lead to zonular damage and IOL subluxation.

Bilateral cochlear implantation in a patient with bilateral temporal bone fractures.

Science.gov (United States)

Chung, Jae Ho; Shin, Myung Chul; Min, Hyun Jung; Park, Chul Won; Lee, Seung Hwan

2011-01-01

With the emphasis on bilateral hearing nowadays, bilateral cochlear implantation has been tried out for bilateral aural rehabilitation. Bilateral sensorineural hearing loss caused by head trauma can get help from cochlear implantation. We present the case of a 44-year-old man with bilateral otic capsule violating temporal bone fractures due to head trauma. The patient demonstrated much improved audiometric and psychoacoustic performance after bilateral cochlear implantation. We believe bilateral cochlear implantation in such patient can be a very effective tool for rehabilitation. Copyright © 2011 Elsevier Inc. All rights reserved.

Bilateral acute depigmentation of the iris (BADI: first reported case in Brazil

Directory of Open Access Journals (Sweden)

Heloisa Andrade Maestrini

2013-02-01

Full Text Available Bilateral acute depigmentation of the iris (BADI is a recently described entity characterized by acute onset of pigment dispersion in the anterior chamber, depigmentation of the iris, and heavy pigment deposition in the anterior chamber angle. Involvement is always bilateral, simultaneous, and symmetrical. We report the case of a 61-year-old man who presented with bilateral ocular pain, red eyes, and severe photophobia. Examination revealed a dense Krukenberg spindle, heavy pigment dispersion in the anterior chamber, extensive transillumination iris defects, and a heavy pigment deposition in the trabecular meshwork bilaterally. Intraocular pressure increased to 48 mmHg in both eyes. The patient received topical steroids, maximum hypotensive treatment and oral valacyclovir. Intraocular pressure gradually decreased throughout the second and third months, and medications were gradually tapered. The time to complete resolution of pigment dispersion was 18 weeks. Visual acuity and visual fields remained normal, but the photophobia was permanent.

Laparoscopic inguinal hernia repair: gold standard in bilateral hernia repair? Results of more than 2800 patients in comparison to literature.

Science.gov (United States)

Wauschkuhn, Constantin Aurel; Schwarz, Jochen; Boekeler, Ulf; Bittner, Reinhard

2010-12-01

Advantages and disadvantages of open and endoscopic hernia surgery are still being discussed. Until now there has been no study that evaluated the advantages and disadvantages of bilateral hernia repair in a large number of patients. Our prospectively collected database was analyzed to compare the results of laparoscopic bilateral with laparoscopic unilateral hernia repair. We then compared these results with the results of a literature review regarding open and laparoscopic bilateral hernia repair. From April 1993 to December 2007 there were 7240 patients with unilateral primary hernia (PH) and 2880 patients with bilateral hernia (5760 hernias) who underwent laparoscopic transabdominal preperitoneal patch plastic (TAPP). Of the 10,120 patients, 28.5% had bilateral hernias. Adjusted for the number of patients operated on, the mean duration of surgery for unilateral hernia repair was shorter than that for bilateral repair (45 vs. 70 min), but period of disability (14 vs. 14 days) was the same. Adjusted for the number of hernias repaired, morbidity (1.9 vs. 1.4%), reoperation (0.5 vs. 0.43%), and recurrence rate (0.63 vs. 0.42%) were similar for unilateral versus bilateral repair, respectively. The review of the literature shows a significantly shorter time out of work after laparoscopic bilateral repair than after the bilateral open approach. Simultaneous laparoscopic repair of bilateral inguinal hernias does not increase the risk for the patient and has an equal length of down time compared with unilateral repair. According to literature, recovery after laparoscopic repair is faster than after open simultaneous repair. Laparoscopic/endoscopic inguinal hernia repair of bilateral hernias should be recommended as the gold standard.

Levobupivacaine vs racemic bupivacaine in spinal anesthesia for sequential bilateral total knee arthroplasty: a retrospective cohort study.

Science.gov (United States)

Chen, Chee Kean; Lau, Francis C S; Lee, Woo Guan; Phui, Vui Eng

2016-09-01

To compare the anesthetic potency and safety of spinal anesthesia with higher dosages of levobupivacaine and bupivacaine in patients for bilateral sequential for total knee arthroplasty (TKA). Retrospective cohort study. Operation theater with postoperative inpatient follow-up. The medical records of 315 patients who underwent sequential bilateral TKA were reviewed. Patients who received intrathecal levobupicavaine 0.5% were compared with patients who received hyperbaric bupivacaine 0.5% with fentanyl 25 μg for spinal anesthesia. The primary outcome was the use of rescue analgesia (systemic opioids, conversion to general anesthesia) during surgery for both groups. Secondary outcomes included adverse effects of local anesthetics (hypotension and bradycardia) during surgery and morbidity related to spinal anesthesia (postoperative nausea, vomiting, and bleeding) during hospital stay. One hundred fifty patients who received intrathecal levobupivacaine 0.5% (group L) were compared with 90 patients given hyperbaric bupivacaine 0.5% with fentanyl 25 μg (group B). The mean volume of levobupivacaine administered was 5.8 mL (range, 5.0-6.0 mL), and that of bupivacaine was 3.8 mL (range, 3.5-4.0 mL). Both groups achieved similar maximal sensory level of block (T6). The time to maximal height of sensory block was significantly shorter in group B than group L, 18.2 ± 4.5 vs 23.9 ± 3.8 minutes (P< .001). The time to motor block of Bromage 3 was also shorter in group B (8.7 ± 4.1 minutes) than group L (16.0 ± 4.5 minutes) (P< .001). Patients in group B required more anesthetic supplement than group L (P< .001). Hypotension and postoperative bleeding were significantly less common in group L than group B. Levobupivacaine at a higher dosage provided longer duration of spinal anesthesia with better safety profile in sequential bilateral TKA. Copyright © 2016 Elsevier Inc. All rights reserved.

True bilateral nasopharyngeal angiofibroma: report and review.

Science.gov (United States)

Mishra, Anupam; Mishra, Subhash Chandra

2016-10-01

This report describes the third case of a true bilateral Juvenile nasopharyngeal angiofibroma (JNA), i.e. two separate JNA arising from both sides simultaneously. The associated multiple recurrences in such a case have not yet been reported. A 21-year-man underwent transpalatal excision and recurred twice. The last 'neo-occurrence' encountered after 2 years was at a different site and was subsequently managed by post-embolization endoscopic resection. A complete report of its clinico-radiological features and management outcome is discussed.

Nelson′s syndrome presenting as bilateral oculomotor palsy

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Abhay Gundgurthi

2013-01-01

Full Text Available Nelson′s syndrome refers to a clinical spectrum arising from progressive enlargement of pituitary adenoma and elevated adrenocorticotrophic hormone after total bilateral adrenalectomy for Cushing′s disease comprising of hyperpigmentation, visual field defects which can be life threatening. We report here a 50-year male presenting with rapid onset of Nelson′s syndrome with an unusual finding of bilateral oculomotor palsy mistakenly treated as ocular myasthenia.

Bilateral theta-burst TMS to influence global gestalt perception.

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Bernd Ritzinger

Full Text Available While early and higher visual areas along the ventral visual pathway in the inferotemporal cortex are critical for the recognition of individual objects, the neural representation of human perception of complex global visual scenes remains under debate. Stroke patients with a selective deficit in the perception of a complex global Gestalt with intact recognition of individual objects - a deficit termed simultanagnosia - greatly helped to study this question. Interestingly, simultanagnosia typically results from bilateral lesions of the temporo-parietal junction (TPJ. The present study aimed to verify the relevance of this area for human global Gestalt perception. We applied continuous theta-burst TMS either unilaterally (left or right or bilateral simultaneously over TPJ. Healthy subjects were presented with hierarchically organized visual stimuli that allowed parametrical degrading of the object at the global level. Identification of the global Gestalt was significantly modulated only for the bilateral TPJ stimulation condition. Our results strengthen the view that global Gestalt perception in the human brain involves TPJ and is co-dependent on both hemispheres.

BILATERAL ANTERIOR DISLOCATION OF SHOULDER WITH GREATER TUBEROSITY FRACTURE DUE TO HYPONATREMIA : A RARE PRESENTATION

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Sivananda

2015-01-01

Full Text Available We here report a rare presentation of bilateral anterior dislocation of shoulder with associated fracture of greater tuberosity in a 38 year old male due to minor trauma which he sustained secondary to hyponatremia induced irritability. There was no associ ated rotator cuff tear which is often associated with BADS which makes this presentation unique. Unilateral dislocation of shoulder is a common condition which is frequently encountered in emergency trauma department. Anterior dislocation is more common th an posterior dislocation. However, simultaneous bilateral shoulder dislocations are usually posterior. Bilateral anterior dislocations with fractures of the greater tuberosity are even rarer and are usually associated with trauma or seizures

Bilateral Ovarian Fibrothecoma Associated with Ascites, Bilateral Pleural Effusion, and Marked Elevated Serum CA-125

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Védi André Serges Loué

2013-01-01

Full Text Available Background. The risk of ovarian cancer is increased in the association of ovarian tumor, ascites, and hydrothorax with the significant elevated tumor marker CA-125. However, this association can be observed in a rare clinical and benign pathological entity, that is Demons-Meigs’ syndrome. Objective. To describe a rare case of Demons-Meigs' syndrome observed in our department. Methods. A black African woman of 35 years old, seventh gravida and fourth parous, underwent a total abdominal hysterectomy with bilateral salpingoophorectomy for large bilateral ovarian masses associated with significant ascites, bilateral pleural effusion, and particular highly elevated tumor marker CA-125 (1835 UI/mL in a pronounced general alteration condition. Results. The postoperative course was uneventful characterized by a complete remission of hydrothorax and ascites with normal level of CA-125 three months after tumor excision. Histology of both masses revealed a bilateral ovarian fibrothecoma, a benign tumor of the ovary, thus confirming the diagnosis of Demons-Meigs’ syndrome. Conclusion. The Demons-Meigs syndrome, although it strongly mimics the clinical picture of malignant metastatic ovarian cancer, remains a disease with benign prognosis after surgical tumor resection. This is a rare condition that must be known and recognized by practitioners to avoid unnecessary practices.

Binaural Pitch Fusion in Bilateral Cochlear Implant Users.

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Reiss, Lina A J; Fowler, Jennifer R; Hartling, Curtis L; Oh, Yonghee

Binaural pitch fusion is the fusion of stimuli that evoke different pitches between the ears into a single auditory image. Individuals who use hearing aids or bimodal cochlear implants (CIs) experience abnormally broad binaural pitch fusion, such that sounds differing in pitch by as much as 3-4 octaves are fused across ears, leading to spectral averaging and speech perception interference. The goal of this study was to determine if adult bilateral CI users also experience broad binaural pitch fusion. Stimuli were pulse trains delivered to individual electrodes. Fusion ranges were measured using simultaneous, dichotic presentation of reference and comparison stimuli in opposite ears, and varying the comparison stimulus to find the range that fused with the reference stimulus. Bilateral CI listeners had binaural pitch fusion ranges varying from 0 to 12 mm (average 6.1 ± 3.9 mm), where 12 mm indicates fusion over all electrodes in the array. No significant correlations of fusion range were observed with any subject factors related to age, hearing loss history, or hearing device history, or with any electrode factors including interaural electrode pitch mismatch, pitch match bandwidth, or within-ear electrode discrimination abilities. Bilateral CI listeners have abnormally broad fusion, similar to hearing aid and bimodal CI listeners. This broad fusion may explain the variability of binaural benefits for speech perception in quiet and in noise in bilateral CI users.

Stereotactic ultrasound for target volume definition in a patient with prostate cancer and bilateral total hip replacement.

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Boda-Heggemann, Judit; Haneder, Stefan; Ehmann, Michael; Sihono, Dwi Seno Kuncoro; Wertz, Hansjörg; Mai, Sabine; Kegel, Stefan; Heitmann, Sigrun; von Swietochowski, Sandra; Lohr, Frank; Wenz, Frederik

2015-01-01

Target-volume definition for prostate cancer in patients with bilateral metal total hip replacements (THRs) is a challenge because of metal artifacts in the planning computed tomography (CT) scans. Magnetic resonance imaging (MRI) can be used for matching and prostate delineation; however, at a spatial and temporal distance from the planning CT, identical rectal and vesical filling is difficult to achieve. In addition, MRI may also be impaired by metal artifacts, even resulting in spatial image distortion. Here, we present a method to define prostate target volumes based on ultrasound images acquired during CT simulation and online-matched to the CT data set directly at the planning CT. A 78-year-old patient with cT2cNxM0 prostate cancer with bilateral metal THRs was referred to external beam radiation therapy. T2-weighted MRI was performed on the day of the planning CT with preparation according to a protocol for reproducible bladder and rectal filling. The planning CT was obtained with the immediate acquisition of a 3-dimensional ultrasound data set with a dedicated stereotactic ultrasound system for online intermodality image matching referenced to the isocenter by ceiling-mounted infrared cameras. MRI (offline) and ultrasound images (online) were thus both matched to the CT images for planning. Daily image guided radiation therapy (IGRT) was performed with transabdominal ultrasound and compared with cone beam CT. Because of variations in bladder and rectal filling and metal-induced image distortion in MRI, soft-tissue-based matching of the MRI to CT was not sufficient for unequivocal prostate target definition. Ultrasound-based images could be matched, and prostate, seminal vesicles, and target volumes were reliably defined. Daily IGRT could be successfully completed with transabdominal ultrasound with good accordance between cone beam CT and ultrasound. For prostate cancer patients with bilateral THRs causing artifacts in planning CTs, ultrasound referenced to

Bilateral pallidotomy for generalized dystonia Palidotomia bilateral para distonias generalizadas

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Hélio A. G. Teive

2001-06-01

Full Text Available OBJECTIVE: To evaluate the efficacy and safety of bilateral pallidotomies in five patients with generalized dystonia. BACKGROUND: Generalized dystonias are frequently a therapeutic challenge, with poor responses to pharmacological treatment. GPi (globus pallidus internus pallidotomies for Parkinson's disease ameliorate all kinds of dyskinesias/dystonia, and recent studies reported a marked improvement of refractory dystonias with this procedure. METHODS: Five patients with generalized dystonias refractory to medical treatment were selected; one posttraumatic and four idiopathic. The decision to perform bilateral procedures was based on the predominant axial involvement in these patients. Dystonia severity was assessed with the Burke-Fahn-Marsden Dystonia Scale (BFM. Simultaneous procedures were performed in all but one patient, who had a staged procedure. They were reevaluated with the same scale (BFM by an unblinded rater at 1, 2, 3, 30, 60, 90, 120 and 180 days post-operatively. RESULTS: The four patients with idiopathic dystonia showed a progressive improvement up to three months; the patient with posttraumatic dystonia relapsed at three months. One patient had a marked improvement, being able to discontinue all the medications. A mean decrease in the BFM scores of 52,58% was noted. One patient had a trans-operative motor seizure followed by a transient hemiparesis secondary to rack hemorrhage; other was lethargic up to three days after the procedure. CONCLUSIONS: Our results show that bilateral GPi pallidotomies may be a safe and effective approach to medically refractory generalized dystonias; it can also be speculated that the posttraumatic subgroup may not benefit with this procedure.As distonias generalizadas são freqüentemente um desafio terapêutico, com pobres respostas aos tratamentos farmacológicos. As cirurgias estereotáxicas, como a palidotomia, têm sido utilizadas com êxito no tratamento da doença de Parkinson e estudos

Multidirectional pseudodynamic studies of the bilateral temporomandibular joint diseases with 0.2-Tesla MR imaging unit

International Nuclear Information System (INIS)

Sasaki, Makoto; Ehara, Shigeru; Nakasato, Tatsuhiko; Tamakawa, Yoshiharu; Sugisawa, Miyoshi; Iwahana, Hideaki; Kuboya, Yasuo.

1996-01-01

Sagittal and coronal images of the bilateral temporomandibular joint (TMJ) simultaneously have been obtained to evaluate displacement of the meniscus in nine patients with TMJ clicking using a 0.2-Tesla permanent magnetic unit. The obtained images were displayed in closed loop cine fashion and recorded on videotapes. Anterior displacement of meniscus was seen on sagittal images in 5 of 9 paients. In the other four patients, no anterior displacement was observed, but in three of them, medial and lateral displacement on coronal images were shown in the closed position. Even using the 0.2-Tesla unit, simultaneous pseudodynamic display of the bilateral TMJ in sagittal and coronal planes was useful for evaluating internal derangement of the TMJ. This technique not only saves time but provides accurate evaluation of meniscal position and motion. (H.O.)

One-stage bilateral anterior cruciate ligament reconstruction with use of hamstring tendon autografts: a case report

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Matjaž Sajovic

2007-12-01

Full Text Available Background: Bilateral ACL rupture is not a common clinical problem, but the incidence of the bilateral knee injuries is increasing especially within highly sports active population. Mechanism of the injury rarely causes simultaneous bilateral ACL tear. Usually unilateral injury of the knee has occurred and later on contralateral injury has taken place.Patient and methods: Case report presented an unusual problem of a patient with chronic bilateral ACL – deficient knees and constitutionally very thin patellar tendons. Author decided to perform onestage bilateral ACL reconstructions using hamstring tendon autographs so as not too weaken his quadriceps muscles by compromising his extensor mechanism.Results: At three years follow-up the patient’s opinion was that both ACL reconstructed knees had normal function, and he had returned to his preinjury activity level. The overall result of the Lysholm knee score for left knee was 100 and for right one 95. Both knees had full range of motion, Lachman and pivot shift signs were negative.Conclusions: Two-stage bilateral ACL reconstruction is much more time consuming for the patient and expensive for health insurance, so one-stage bilateral ACL reconstruction is a logical solution of the problem.

Synchronous bilateral male breast cancer: a case report.

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Sun, Woo-Young; Lee, Ki-Hyeong; Lee, Ho-Chang; Ryu, Dong-Hee; Park, Jin-Woo; Yun, Hyo-Young; Song, Young-Jin

2012-06-01

Synchronous bilateral breast cancer is extremely rare in men and has not, up to date, been reported in Korea. A 54-year-old man presented with a palpable mass in the right breast. The right nipple was retracted and bilateral axillary accessory breasts and nipples were present. On physical examination, a 2 cm-sized mass was palpated directly under the right nipple, and, with squeezing, bloody discharge developed in a single duct of the left nipple. There was no palpable mass in the left breast, and axillary lymph nodes were not palpable. Physical examination of external genitalia revealed a unilateral undescended testis on the left side. Synchronous bilateral breast cancer was diagnosed using mammography, ultrasonography, and core-needle biopsy. Histopathological examination revealed invasive ductal carcinoma in the right breast and ductal carcinoma in situ in the left breast. Bilateral total mastectomy, sentinel lymph node biopsy, and excision of accessory breasts in the axilla were performed.

A Rare Entity: Bilateral First Rib Fractures Accompanying Bilateral Scapular Fractures

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Gulbahar, Gultekin; Kaplan, Tevfik; Turker, Hasan Bozkurt; Gundogdu, Ahmet Gokhan; Han, Serdar

2015-01-01

First rib fractures are scarce due to their well-protected anatomic locations. Bilateral first rib fractures accompanying bilateral scapular fractures are very rare, although they may be together with scapular and clavicular fractures. According to our knowledge, no case of bilateral first rib fractures accompanying bilateral scapular fractures has been reported, so we herein discussed the diagnosis, treatment, and complications of bone fractures due to thoracic trauma in bias of this rare en...

A Rare Entity: Bilateral First Rib Fractures Accompanying Bilateral Scapular Fractures.

Science.gov (United States)

Gulbahar, Gultekin; Kaplan, Tevfik; Turker, Hasan Bozkurt; Gundogdu, Ahmet Gokhan; Han, Serdar

2015-01-01

First rib fractures are scarce due to their well-protected anatomic locations. Bilateral first rib fractures accompanying bilateral scapular fractures are very rare, although they may be together with scapular and clavicular fractures. According to our knowledge, no case of bilateral first rib fractures accompanying bilateral scapular fractures has been reported, so we herein discussed the diagnosis, treatment, and complications of bone fractures due to thoracic trauma in bias of this rare entity.

Live Donor Renal Transplant With Simultaneous Bilateral Nephrectomy for Autosomal Dominant Polycystic Kidney Disease Is Feasible and Satisfactory at Long-term Follow-up.

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Ahmad, Sarwat B; Inouye, Brian; Phelan, Michael S; Kramer, Andrew C; Sulek, Jay; Weir, Matthew R; Barth, Rolf N; LaMattina, John C; Schweitzer, Eugene J; Leeser, David B; Niederhaus, Silke V; Bartlett, Stephen T; Bromberg, Jonathan S

2016-02-01

Timing of bilateral nephrectomy (BN) is controversial in patients with refractory symptoms of autosomal dominant polycystic kidney disease (APKD) in need of a renal transplant. Adults who underwent live donor renal transplant (LRT) + simultaneous BN (SBN) from August 2003 to 2013 at a single transplant center (n = 66) were retrospectively compared to a matched group of APKD patients who underwent LRT alone (n = 52). All patients received general health and polycystic kidney symptom surveys. Simultaneous BN increased operative duration, estimated blood loss, transfusions, intravenous fluid, and hospital length of stay. Most common indications for BN were pain, loss of abdominal domain, and early satiety. There were more intraoperative complications for LRT + SBN (6 vs 0, P = 0.03; 2 vascular, 2 splenic, and 1 liver injury; 1 reexploration to adjust graft positioning). There were no differences in Clavien-Dindo grade I or II (39% vs 25%, P = 0.12) or grade III or IV (7.5% vs 5.7%, P = 1.0) complications during the hospital course. There were no surgery-related mortalities. There were no differences in readmission rates (68% vs 48%, P = 0.19) or readmissions requiring procedures (25% vs. 20%, P = 0.51) over 12 months. One hundred percent of LRT + SBN allografts functioned at longer than 1 year for those available for follow-up. Survey response rate was 40% for LRT-alone and 56% for LRT + SBN. One hundred percent of LRT + SBN survey responders were satisfied with their choice of having BN done simultaneously. Excellent outcomes for graft survival, satisfaction, and morbidity suggest that the combined operative approach be preferred for patients with symptomatic APKD to avoid multiple procedures, dialysis, and costs of staged operations.

Bilateral Elastofibroma Dorsi: A Case Report

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Burçin Çelik

2010-09-01

Full Text Available Elastofibroma dorsi is a rare, slow-growing soſt tissue tumor of the chest wall. The tumor typically located under the lower pole of the scapula. A 57-year-old woman who had retiredas a teacher, presented with a 1-year history of pain on the back and with a 3-month history of swelling located under the leſt scapula. Computed tomography and magnetic resonance imaging showed bilateral, solid soſt tissue tumors under the scapula. She underwent total resection of the tumor on the leſt side. Tumor was diagnosed histopathologically as elastofibroma. Elastofibroma dorsi can be undetermined because of its localization. Radiological examination is important especially on diagnosis of bilateral localization.

A Rare Entity: Bilateral First Rib Fractures Accompanying Bilateral Scapular Fractures

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Gultekin Gulbahar

2015-01-01

Full Text Available First rib fractures are scarce due to their well-protected anatomic locations. Bilateral first rib fractures accompanying bilateral scapular fractures are very rare, although they may be together with scapular and clavicular fractures. According to our knowledge, no case of bilateral first rib fractures accompanying bilateral scapular fractures has been reported, so we herein discussed the diagnosis, treatment, and complications of bone fractures due to thoracic trauma in bias of this rare entity.

Pathogenesis and prognosis of bilateral thalamic infarction

International Nuclear Information System (INIS)

Nakase, Taizen; Ogura, Naoko; Maeda, Tetsuya; Yamazaki, Takashi; Kameda, Tomoaki; Sato, Yuichi; Nagata, Ken

2008-01-01

Only a few reports have discussed the detailed clinical symptoms and pathogenesis of bilateral thalamic infarction. The thalamus is composed of different functional nuclei and supplied by vessels containing several variations from the main arteries, leading to difficulty in the precise evaluation of bilateral thalamic infarction. In the present study, we assessed the prognosis of bilateral thalamic infarction based on the distribution of stroke lesions. From among the consecutive ischemic stroke patients admitted to hospital between April 2001 and March 2005, cases of acute bilateral thalamic infarction were selected for this study (n=9; 65.1±13.6 y.o.). The stroke lesions and vascular abnormalities were investigated by magnetic resonance imaging and magnetic resonance angiography on admission. Outcome was evaluated from the modified Rankin scale (mRS) at discharge. Good outcome patients (mRS 0-2; n=5) showed memory disturbance, cognitive impairment and hypersomnia. On the other hand, quadriplegia, oculomotor disturbance and bulbar palsy were observed in the poor outcome patients (mRS≥4; n=4). The critical features of a poor outcome were the age at onset (72.0±15.3 vs. 58.2±11.9 y.o.), inclusion of brainstem lesions and total occlusion of the basilar artery. In conclusion, older age at onset and/or basilar artery occlusion may be critical factors for predicting a poor outcome in bilateral thalamic infarction cases. (author)

Simultaneous surgeries in a split forward surgical team: a case study.

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Vanfosson, Christopher A; Seery, Jason M

2011-12-01

The 541st Forward Surgical Team performed split-based operations, with one site in the city of Pol-e-Khumri. One evening, the 10-person team received two pediatric patients simultaneously and conducted simultaneous surgeries. The 3-year-old female sustained severe injuries to bilateral lower extremities and a puncture wound to her right forearm. The 13-year-old sustained fragmentary wounds to her left hand, left foot, right medial calf, and evisceration to her left lower quadrant. The patients presented in extremis after being taken to a civilian hospital initially, spending approximately 1.5 hours receiving no resuscitative therapy. The 3-year-old underwent amputations of bilateral lower extremities and a fasciotomy of the right forearm. The 13-year-old survived an exploratory laparotomy and irrigation and debridement of intra-abdominal wounds. The successful completion of simultaneous surgeries, by a split forward surgical team at a remote location, for two critically ill patients is possible. It should not become the standard of care. Prior planning made this occurrence feasible and safer, but such situations put the patients at risk for complications.

A longitudinal study of the bilateral benefit in children with bilateral cochlear implants.

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Asp, Filip; Mäki-Torkko, Elina; Karltorp, Eva; Harder, Henrik; Hergils, Leif; Eskilsson, Gunnar; Stenfelt, Stefan

2015-02-01

To study the development of the bilateral benefit in children using bilateral cochlear implants by measurements of speech recognition and sound localization. Bilateral and unilateral speech recognition in quiet, in multi-source noise, and horizontal sound localization was measured at three occasions during a two-year period, without controlling for age or implant experience. Longitudinal and cross-sectional analyses were performed. Results were compared to cross-sectional data from children with normal hearing. Seventy-eight children aged 5.1-11.9 years, with a mean bilateral cochlear implant experience of 3.3 years and a mean age of 7.8 years, at inclusion in the study. Thirty children with normal hearing aged 4.8-9.0 years provided normative data. For children with cochlear implants, bilateral and unilateral speech recognition in quiet was comparable whereas a bilateral benefit for speech recognition in noise and sound localization was found at all three test occasions. Absolute performance was lower than in children with normal hearing. Early bilateral implantation facilitated sound localization. A bilateral benefit for speech recognition in noise and sound localization continues to exist over time for children with bilateral cochlear implants, but no relative improvement is found after three years of bilateral cochlear implant experience.

Efficacy of breast conservation therapy in early stage bilateral breast cancer

International Nuclear Information System (INIS)

Lee, Misa M.; Chen, Luci M.; Heimann, Ruth; Powers, Claire; Weichselbaum, Ralph R.

1996-01-01

PURPOSE: To evaluate outcome of patients with bilateral breast cancer as compared to unilateral breast cancer treated with breast conservation therapy. This is a complex issue, however, we address this by comparing (1) synchronous bilateral breast cancer patients, (2) metachronous bilateral breast cancer patients from the time of diagnosis of the second breast primary, and (3) unilateral breast cancer patients. The authors recognize that there are inherent biases in these comparisons. MATERIALS AND METHODS: A total of 60 bilateral patients and 1080 unilateral patients treated with breast conservation therapy from 1977-1994 were analyzed for outcome. Of the 60 bilateral patients, 44 were metachronous bilateral breast cancer patients (MBBC) and 16 were synchronous breast cancer patients (SBBC). Patients with bilateral breast cancer had local-regional disease with the following tumor stages: DCIS=8%, T1=80%, T2=12%, pathologic N0=90%, pathologic N+=10%. Unilateral patients had the following tumor stages: DCIS=10%, T1=66%, T2=20%, T3=1.2%, Tx=2%, pathological N0=80%, pathological N+=19%, and NX=1%. The majority of patients received lumpectomy and axillary node dissection followed by radiation therapy. The median size of the lesions were 1.4cm and 1.5cm for bilateral and unilateral patients, respectively. Median total dose to the primary tumor was 60Gy for both unilateral and bilateral patients. Of the 44 metachronous bilateral breast cancer patients, 14 patients received breast conservation for both the first and second lesions while 30 patients had breast conservation for only the second metachronous breast lesion. Thus 58 lesions in the 44 patients were treated with breast conservation therapy in the patients with metachronous bilateral breast cancer. Of the synchronous bilateral breast cancer patients, 13 out of 16 patients had breast conserving therapy for both breasts, and 3 patients received mastectomy for the second synchronous breast tumor. The median follow

Giant Bilateral Juvenile Fibroadenoma of the Breast in Prepubescent Girl.

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Khan, Salma; Khan, Momna; Rafique, Sadia

2015-10-01

Juvenile fibroadenoma accounts for 4% of the total fibroadenomas. Giant juvenile fibroadenoma is found in only 0.5% of all fibroadenomas. The authors report a 10-year girl presenting with progressive enlargement of both breasts for one year. Based on clinical findings and Fine Needle Aspiration Cytology (FNAC), a diagnosis of bilateral giant juvenile fibroadenomas of breast was made. She underwent bilateral lumpectomy with breast conservation and made uneventful postoperative recovery.

IgG4-Related Disease of Bilateral Temporal Bones.

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Li, Lilun; Ward, Bryan; Cocks, Margaret; Kheradmand, Amir; Francis, Howard W

2017-03-01

IgG4-related disease (IgG4-RD) is an idiopathic inflammatory condition that causes pseudotumor formation in single or multiple organs, including those of the head and neck. Temporal bone involvement is rare, with only 3 cases of unilateral temporal bone IgG4-RD described in the literature. We report the first known case of IgG4-RD of bilateral temporal bones and describe its clinical presentation, diagnosis, and treatment. The patient was a 52-year-old man with latent tuberculosis (TB) who presented with a 10-year history of bilateral profound hearing loss and vestibular dysfunction. Computed tomography and magnetic resonance imaging demonstrated bilateral labyrinthine destruction with invasion of the posterior fossa. Immunoglobulin level testing showed elevated total serum IgG levels with normal IgG4 levels. Bilateral mastoidectomies were performed, with biopsy samples demonstrating IgG4 staining with IgG4-positive plasma cells up to 40/HPF (high power field) on the right and 20/HPF on the left, consistent with bilateral IgG4-RD. IgG4-RD of bilateral temporal bones presents with chronic and progressive bilateral hearing loss and vestibular dysfunction. Clinical presentation and radiologic findings are nonspecific, and definitive diagnosis must be made with histopathology and immunostaining. Corticosteroids are therapeutic, but surgical resection may be necessary for temporal bone IgG4-RD to improve long-term remission.

Bilateral tumors of the upper urothelium

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Đokić Milan

2006-01-01

Full Text Available Introduction: The incidence of tumors of the upper urothelium is high in our country, apart from their relation to specific regions (BEN and PBEN and their frequent bilateralism. Bilateral forms are present in significant percentage and are followed, in most cases, by renal failure, which speaks in favor of conservative surgery, if possible. Objective: The aim of the study was to present epidemiological, pathoanatomical and clinical characteristics of bilateral tumors of the upper urothelium and evaluate the Results of their treatment. Method: Our retrospective study analyzed 12 patients with bilateral tumors of the upper urothelium who were treated in the period from 1992 to 1996, according to their epidemiological, clinical, pathoanatomical and pathohistological characteristics, type of surgical treatment and relevant success. Results: In the observed period, bilateral tumors of the upper urothelium were found in 8.2% of our patients. In the group of 12 patients, 5 females and 7 males, 11 cases were from the region of Balkan Endemic Nephropathy (BEN. Renal failure was recorded in high percentage (66%. Radical surgical treatment - total nephroureterectomy was performed in 9 kidney units, and conservative operation in 15 units. Relapse significantly depended on tumor stage and grade, not on type of surgical treatment in the majority of cases. Five-year survival was 58.33%; major cause of death was associated with further evolution of tumor, recurrence and tumor dissemination, respectively, while renal failure complications were the cause of death in one case. Conclusion: The success of treatment mainly depends on tumor stage and grade and not on type of surgical Method in conservative treatment, but renal failure and its complications are an important risk factor in these patients.

Symptomatic versus asymptomatic knees after bilateral total knee arthroplasty: what is the difference in SPECT/CT?

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Awengen, R.; Hirschmann, M.T. [Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Department of Orthopaedic Surgery and Traumatology, Bruderholz (Switzerland); Rasch, H. [Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Institute of Radiology and Nuclear Medicine, Bruderholz (Switzerland); Amsler, F. [Amsler Consulting, Basel (Switzerland)

2016-04-15

The primary purpose of this retrospective study was to evaluate the differences of bone tracer uptake (BTU) in symptomatic and asymptomatic knees after bilateral total knee arthroplasty (TKA) and identify typical BTU patterns with regards to TKA component position and alignment. A consecutive number of 37 patients after bilateral TKA were retrospectively included. The knees were grouped into symptomatic (group A) and asymptomatic (group B) knees. All patients underwent 99m-Tc-HDP-SPECT/CT. Coronal, rotational, and sagittal TKA component position was analysed in 3D reconstructed CT. BTU was anatomically localised and quantified using a validated standardized localization scheme. Maximum BTU values for each area were recorded and normalized values calculated. Signed log-rank test, chi-square test, paired t-tests, and Pearson correlations were used (p <0.05). Symptomatic TKAs were significantly more flexed and had a tendency to be more internally rotated when compared to asymptomatic ones (p < 0.05). In all regions, the mean BTU in asymptomatic knees was lower than in symptomatic knees. In both groups the highest mean BTU was found around the tibial stem (symptomatic 7.30; asymptomatic 6.30, p = 0.061) and at the tip of the tibial stem (symptomatic 5.49; asymptomatic 4.74, p = 0.062). Superior patellar regions showed higher BTU than inferior regions. The highest patellar BTU was found in the superior medial patella (symptomatic 4.99; asymptomatic 3.98, p = 0.048). The lowest BTU was found in the posterior femoral regions (flatsp, flatip, fmedsp, fmedip) (Table 3). Tibial and patellar areas showed twice as high mean BTUs than femoral areas (Fig. 3). A significant correlation of TKA component position and BTU was demonstrated. Distribution and intensity of BTU in SPECT/CT depends on TKA component position and alignment. In addition, typical BTU patterns in symptomatic and asymptomatic knees were identified. A profound knowledge of BTU pattern, TKA component position

Bilateral catheterization of inferior petrosal sinous: Utility in Cushing syndrome

International Nuclear Information System (INIS)

Ferrer, Maria D; Fajardo, Carmen; Esteban Enrique; Cosin Octavio, Valldecabres Carmen; Reig, Marian

2010-01-01

The aim of this study is to present our experience on bilateral and simultaneous inferior petrous sinus catheterization, on those patients with ACTH -dependent Cushing's syndrome. We describe the procedure and our results. Material and Method: A retrospective study was held between January 2003 and September 2009, including nine patients (2 men, 7 women) presenting ACTH - dependent Cushing's syndrome. Simultaneous inferior petrosal sinus catheterization was performed in all of them, sampling basal ACTH and after CRH stimulation. ACTH levels gradient in different pituitary locations and peripheral blood levels was recorded. Diagnosis was suggested when inappropriate and maintained hypercortisolemia. High urinary free cortisol levels and no response to dexamethasone suppression were detected. Eight out of nine patients had a prior negative imaging test result. Results: Inferior petrosal sinus bilateral catheterization was successfully performed in all cases, with no evidence of further complications. The results showed definitive diagnosis in all cases. In four patients ACTH levels gradient was lateralized to the left, leading to a specific surgical approach. One patient presented pituitary ACTH - secreting adenoma. Two other patients showed ectopic ACTH production, one showed suprarenal adenoma secreting ACTH and other one showed response to pituitary stimulation without side lateralisation, presenting a histological diagnosis of pituitary hyperplasia. Conclusion: Petrosal sinus catheterization is shown to be an efficient procedure to manage Cushing's syndrome differential diagnosis and to obtain specific anatomical information.

Bilateral inguinal hernia repair: laparoscopic or open approach?

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Feliu, X; Clavería, R; Besora, P; Camps, J; Fernández-Sallent, E; Viñas, X; Abad, J M

2011-02-01

The aim of this study was to investigate outcomes in the treatment of bilateral inguinal hernia, comparing the laparoscopic totally extraperitoneal (TEP) and open tension-free mesh repair (LICHT) approaches. We performed a prospective controlled non randomized clinical study in 128 patients with bilateral inguinal hernia over a period of 3 years. LICHT was used in 106 cases (53 patients) while TEP was employed in 150 cases (75 patients). The main outcome measurements were: recurrence rate, operating time, hospital stay and postoperative complications. There were three recurrences (2.3%): two in the LICHT group (3.8%) and one (1.3%) in the TEP group P = NS. The TEP procedure was faster than LICHT repair (48.8 ± 10.8 vs. 70.4 ± 11.2 min) P approach is an effective option for the treatment of bilateral inguinal hernia when performed by experienced surgeons.

Quantifying metal artefact reduction using virtual monochromatic dual-layer detector spectral CT imaging in unilateral and bilateral total hip prostheses

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Wellenberg, R.H.H., E-mail: r.h.wellenberg@amc.uva.nl [Department of Radiology, Academic Medical Centre, Amsterdam (Netherlands); Boomsma, M.F., E-mail: m.f.boomsma@isala.nl [Department of Radiology, Isala, Zwolle (Netherlands); Osch, J.A.C. van, E-mail: j.a.c.van.osch@isala.nl [Department of Radiology, Isala, Zwolle (Netherlands); Vlassenbroek, A., E-mail: alain.vlassenbroek@philips.com [Philips Medical Systems, Brussels (Belgium); Milles, J., E-mail: julien.milles@philips.com [Philips Medical Systems, Eindhoven (Netherlands); Edens, M.A., E-mail: m.a.edens@isala.nl [Department of Innovation and Science, Isala, Zwolle (Netherlands); Streekstra, G.J., E-mail: g.j.streekstra@amc.uva.nl [Department of Radiology, Academic Medical Centre, Amsterdam (Netherlands); Slump, C.H., E-mail: c.h.slump@utwente.nl [MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede (Netherlands); Maas, M., E-mail: m.maas@amc.uva.nl [Department of Radiology, Academic Medical Centre, Amsterdam (Netherlands)

2017-03-15

Highlights: • Dual-layer detector CT reduces metal artefacts at high monochromatic energies (keV). • 130 keV images were optimal based on quantitative analysis on CNRs. • Optimal keVs varied from 74 to 150 keV for different hip prostheses configurations. • The Titanium alloy resulted in less severe artefacts compared to the Cobalt alloy. • Severe metal artefacts, caused by extensive photon-starvation, were not reduced. - Abstract: Purpose: To quantify the impact of prosthesis material and design on the reduction of metal artefacts in total hip arthroplasties using virtual monochromatic dual-layer detector Spectral CT imaging. Methods: The water-filled total hip arthroplasty phantom was scanned on a novel 128-slice Philips IQon dual-layer detector Spectral CT scanner at 120-kVp and 140-kVp at a standard computed tomography dose index of 20.0 mGy. Several unilateral and bilateral hip prostheses consisting of different metal alloys were inserted and combined which were surrounded by 18 hydroxyapatite calcium carbonate pellets representing bone. Images were reconstructed with iterative reconstruction and analysed at monochromatic energies ranging from 40 to 200 keV. CT numbers in Hounsfield Units (HU), noise measured as the standard deviation in HU, signal-to-noise-ratios (SNRs) and contrast-to-noise-ratios (CNRs) were analysed within fixed regions-of-interests placed in and around the pellets. Results: In 70 and 74 keV virtual monochromatic images the CT numbers of the pellets were similar to 120-kVp and 140-kVp polychromatic results, therefore serving as reference. A separation into three categories of metal artefacts was made (no, mild/moderate and severe) where pellets were categorized based on HU deviations. At high keV values overall image contrast was reduced. For mild/moderate artefacts, the highest average CNRs were attained with virtual monochromatic 130 keV images, acquired at 140-kVp. Severe metal artefacts were not reduced. In 130 keV images

Bilateral bone conduction devices: improved hearing ability in children with bilateral conductive hearing loss.

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Dun, Catharina A J; Agterberg, Martijn J H; Cremers, Cor W R J; Hol, Myrthe K S; Snik, Ad F M

2013-01-01

The aim of the study was to investigate whether children with bilateral conductive hearing loss benefit from their second device (i.e., the bilateral bone conduction device [BCD]). Speech recognition in noise was assessed in 10 children fitted with bilateral BCDs during childhood. Speech recognition was measured in 2 conditions with both BCDs active. Spatial resolution was tested with the Minimum Audible Angle test in the bilateral and monaural listening conditions. Children demonstrated an improvement in speech recognition when speech was presented from the front and noise was presented from the right-hand side as compared with both speech and noise being presented from the front. The minimum audible angle decreased from 57° in the best monaural condition to 13° in the bilateral condition. The audiological outcomes demonstrate the advantage of bilateral BCD fitting in children with bilateral conductive hearing loss.

Laparoscopic bilateral transperitoneal adrenalectomy for Cushing syndrome: surgical challenges and lessons learnt.

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Aggarwal, Sandeep; Yadav, Kunal; Sharma, Aditya P; Sethi, Vrishketan

2013-06-01

Laparoscopic adrenalectomy is well established for treatment of adrenal lesions. However, bilateral adrenalectomy for Cushing syndrome is a challenging and time-consuming operation. We report our experience of laparoscopic bilateral adrenalectomy for this disease in 19 patients. From September 2009 to August 2012, we have operated 19 patients with Cushing syndrome and performed bilateral laparoscopic adrenalectomy using the transperitoneal approach; synchronous in 15 patients and staged in 4 patients. In 15 patients, the surgery was carried out sequentially on both the sides in lateral position with intraoperative change in position. Complete adrenalectomy including periadrenal fat was carried out on both the sides. Nineteen patients were referred from Department of Endocrinology for bilateral adrenalectomy for adrenocorticotropin hormone (ACTH)-dependent and ACTH-independent Cushing syndrome. The indications for surgery were Cushing disease in 15 patients, occult/ectopic source of ACTH in 2 patients, and primary adrenal hyperplasia in 2 patients. Fifteen patients underwent bilateral adrenalectomy during the same operation. Four patients underwent staged procedures. All procedures were completed laparoscopically with no conversions. The mean operating time for simultaneous bilateral adrenalectomy was 210 minutes (range, 150 to 240 min). This included the repositioning and reprepping time. There were no major intraoperative complications. The average blood loss was 100 mL (range, 50 to 200 mL). None of the patients required blood transfusions in the postoperative period. The postoperative complications included minor port-site infection in 2 patients. One severely debilitated patient died on the 14th postoperative day because of hospital-acquired pneumonia. The remaining 18 patients have done well in terms of impact on the disease. Laparoscopic bilateral adrenalectomy for Cushing syndrome is feasible and safe. It confers all the advantages of minimally invasive

Epileptogenic developmental venous anomaly: insights from simultaneous EEG/fMRI.

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Scheidegger, Olivier; Wiest, Roland; Jann, Kay; König, Thomas; Meyer, Klaus; Hauf, Martinus

2013-04-01

Developmental venous anomalies (DVAs) are associated with epileptic seizures; however, the role of DVA in the epileptogenesis is still not established. Simultaneous interictal electroencephalogram/functional magnetic resonance imaging (EEG/fMRI) recordings provide supplementary information to electroclinical data about the epileptic generators, and thus aid in the differentiation of clinically equivocal epilepsy syndromes. The main objective of our study was to characterize the epileptic network in a patient with DVA and epilepsy by simultaneous EEG/fMRI recordings. A 17-year-old woman with recently emerging generalized tonic-clonic seizures, and atypical generalized discharges, was investigated using simultaneous EEG/fMRI at the university hospital. Previous high-resolution MRI showed no structural abnormalities, except a DVA in the right frontal operculum. Interictal EEG recordings showed atypical generalized discharges, corresponding to positive focal blood oxygen level dependent (BOLD) correlates in the right frontal operculum, a region drained by the DVA. Additionally, widespread cortical bilateral negative BOLD correlates in the frontal and parietal lobes were delineated, resembling a generalized epileptic network. The EEG/fMRI recordings support a right frontal lobe epilepsy, originating in the vicinity of the DVA, propagating rapidly to both frontal and parietal lobes, as expressed on the scalp EEG by secondary bilateral synchrony. The DVA may be causative of focal epilepsies in cases where no concomitant epileptogenic lesions can be detected. Advanced imaging techniques, such as simultaneous EEG/fMRI, may thus aid in the differentiation of clinically equivocal epilepsy syndromes.

Simultaneous measurement of milk intake and total energy expenditure in mixed-fed infants: Methodological approach and prediction of total body water

International Nuclear Information System (INIS)

Wells, J.C.K.; Davies, P.S.W.; Coward, W.A.

2000-01-01

Evaluation of the energy metabolism that underlies the new WHO breast-fed growth reference requires simultaneous measurements of milk volume intake (MVI) and total energy expenditure (TEE) by stable isotope methodologies. In young infants, such data is collected without difficulty using the dose-to-the-infant method. In older infants, where breast-milk is supplemented with non-milk foods, MVI must be measured by dosing the mother instead of the infant. This procedure would interfere with a simple measurement of infant TEE using the standard dose-to-the-infant method. Theoretically, this difficulty can be resolved by dosing the mother with deuterium and the infant with 18-oxygen, and using curve-peeling methods to calculate the infant deuterium kinetics. We propose to ascertain whether such an approach is viable in practice, such that MVI, TEE and body composition could all be measured simultaneously in mixed-fed infants. Where MVI in older infants is measured on its own, there is a need to predict infant body water in order to estimate the deuterium dilution space. Using a database of 234 infants aged 1.5 to 12 months, we provide new predictive equations by which such values may be obtained. (author)

Bilateral complete ureteral duplication with calculi obstructing both limbs of left double ureter.

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Aiken, William D; Johnson, Peter B; Mayhew, Richard G

2015-01-01

A woman with bilateral complete ureteral duplication with stones simultaneously obstructing both limbs of the left double ureter is presented. A search of the English medical literature suggests that this is the first reported case. Based on the initial difficulty accessing the stones via ureteroscopy we make recommendations regarding how this rare problem should be approached if encountered. A 37-year old woman with left-sided flank pain was discovered on CT scan to have bilateral complete ureteral duplication and three stones obstructing both limbs of the left double ureter. Ureteroscopy was initially unsuccessful due to the very small calibre and unyielding nature of the ureters and both ureteral limbs were stented. Repeat ureteroscopy was easily achieved after pre-stenting and the impacted stones were completely cleared with intracorporeal laser lithotripsy. The smaller calibre of both double ureters and their presence in a common adventitial sheath distally, made initial attempts at ureteroscopy difficult. Stenting both limbs increased ureteral compliance, passively dilated both ureters and allowed for improved manoeuvrability and retrograde passage of the ureteroscope. Based on the experience with this first reported case it is recommended that pre-stenting should be routinely performed prior to any attempt at ureteroscopy in cases of stones complicating completely duplicated ureters. We report the first recorded case of bilateral complete ureteral duplication with stones simultaneously obstructing both limbs of the double ureter and recommend that routine pre-stenting be done prior to ureteroscopy to allow easy uncomplicated retrograde passage of the ureteroscope. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

US findings of bilateral primary breast cancer: Retrospective study

International Nuclear Information System (INIS)

Lou Li; Cong Xinli; Yu Guofang; Li Jichang; Ma Yuxiang

2007-01-01

Background: For women with breast cancer, the contralateral breast is at high risk. The bilateral cancers may be synchronous or metachronous. If the bilateral breast cancers have similar ultrasonography (US) appearances, the US findings of the first breast cancer (index cancer) might lead to early detection of the contralateral cancer. The purpose of this study was to identify the US characteristics of bilateral breast cancer and to determine whether bilateral breast cancers have similar US appearances and whether the US findings for one breast cancer might be predictive of the contralateral breast cancer. Methods: We retrospectively reviewed the US manifestations of 58 patients with surgically proven bilateral primary breast cancer and compared the contralateral cancer with the index cancer by evaluation the margin, shape, inside echoes, posterior attenuation, calcification and color flow signals of 58 lesion pairs to investigate whether the bilateral breast cancers have similar US appearances. Results: Bilateral primary breast cancers were more located in upper outer quadrant, frequently spiculation, taller than wide shape, with irregular margin, heterogeneous internal echo and acoustic shadowing, containing microcalcification and abundant color flow signals. The most common US appearances were taller than wide shape (75.0%, 87/116), irregular margins (79.3%, 92/116) and heterogeneous internal echo (86.2%, 100/116). Of the total 58 lesion pairs, 18 (31.0%) pairs had similar US characteristics, whereas 40 (69.0%) pairs had different US characteristics. Conclusions: US signs of the index cancer do not indicate the most likely appearance of the second cancer in the contralateral breast. Evaluation of the contralateral cancer should be performed without regard for the US findings for the index cancer

Paralisia facial periférica bilateral na leucemia linfóide aguda: relato de caso Bilateral peripheric facial nerve palsy in acute linfoid leukemia: a case report

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Marcos L. Antunes

2004-04-01

Full Text Available A mímica facial é fundamental para a expressão e comunicação humana, que são possíveis apenas através da integridade do nervo facial. Sendo assim, a paralisia facial periférica (PFP pode deixar seqüelas estéticas, funcionais e psicológicas. A causa mais comum é a paralisia de Bell (50 a 80%, onde a maioria dos pacientes apresenta manifestação unilateral. O acometimento bilateral simultâneo é raro, sendo a leucemia a neoplasia que com maior freqüência pode resultar nesse tipo de manifestação. A seguir, relatamos o caso de um paciente de dezoito anos de idade apresentando leucemia linfóide aguda (LLA e PFP simultânea, ambas refratárias ao tratamento quimioterápico, culminando com o óbito cinco meses após o início da PFP. Realizou-se considerações importantes sobre a fisiopatologia da PFP na LLA, além de uma revisão da literatura.The facial mimic is very important to the human expression and communication, which depend on the integrity of the facial nerve. So, the peripheric facial palsy (PFP can leave esthetics, functional and psychological sequelae. The more common etiology is Bell's palsy (50 to 80% and most of the patients show a unilateral manifestation. The simultaneous bilateral PFP is rare, and the leukemia is the neoplasia that can often that kind of manifestation. We present a clinical case of an 18-year-old patient with acute lymphoid leukemia and simultaneous bilateral facial palsy, who did not recover after the chemotherapy treatment, and died five months after the initial manifestation of the facial palsy. Important considerations were accomplished about the physiopathology of PFP in acute lymphoid leukemia, besides literature review.

Reconstruction of bilateral tibial aplasia and split hand-foot syndrome in a father and daughter.

Science.gov (United States)

Al Kaissi, Ali; Ganger, Rudolf; Klaushofer, Klaus; Grill, Franz

2014-01-01

Tibial aplasia is of heterogeneous aetiology, the majority of reports are sporadic. We describe the reconstruction procedures in two subjects - a daughter and father manifested autosomal dominant (AD) inheritance of the bilateral tibial aplasia and split hand-foot syndrome. Reconstruction of these patients required multiple surgical procedures and orthoprosthesis was mandatory. The main goal of treatment was to achieve walking. Stabilization of the ankle joint by fibular-talar-chondrodesis on both sides, followed by bilateral Brown-procedure at the knee joint level has been applied accordingly. The outcome was with improved function of the deformed limbs and walking was achieved with simultaneous designation of orthotic fitting. This is the first study encompassing the diagnosis and management of a father and daughter with bilateral tibial aplasia associated with variable split hand/foot deformity without foot ablation. Our patients showed the typical AD pattern of inheritance of split-hand/foot and tibial aplasia.

Parallel control method for a bilateral master-slave manipulator

International Nuclear Information System (INIS)

Miyazaki, Tomohiro; Hagihara, Shiro

1989-01-01

In this paper, a new control method for a bilateral master-slave manipulator is proposed. The proposed method yields stable and fast response of the control system. These are essential to obtain a precise position control and a sensitive force reflection control. In the conventional position-force control method, each control loop of the master and the slave arms are connected in series to construct a bilateral control loop. Therefore the total phase lag through the bilateral control loop becomes twice as much as that of one arm control. Such phase lag makes the control system unstable and control performance worse. To improve the stability and the control performance, we propose 'parallel control method.' In the proposed method, the control loops of the master and the slave arms are connected in parallel so that the total phase lag is reduced to as much as that of one arm. The stability condition of the proposed method is studied and it is proved that the stability of this method can be guaranteed independent of the rigidness of a reaction surface and the position/force ratio between the master and the slave arms while the stability of the conventional method depends on them. (author)

Bilateral herpes zoster

OpenAIRE

Singh K; Bajaj A; Dwivedi N; Merchery A

1993-01-01

A case of bilateral herpes zoster of lumbosacral region is reported in association with diabetes mellitus in a 55 years old female. The case is of interest due to bilateral distribution which is rare and sacral region involvement which is quite uncommon.

Bilateral Testicular Tumors Resulting in Recurrent Cushing Disease After Bilateral Adrenalectomy

NARCIS (Netherlands)

Puar, T.; Engels, M.; Herwaarden, A.E. van; Sweep, F.C.; Hulsbergen-van de Kaa, C.A.; Kamphuis-van Ulzen, K.; Chortis, V.; Arlt, W.; Stikkelbroeck, N.; Claahsen-van der Grinten, H.L.; Hermus, A.R.M.M.

2017-01-01

Context: Recurrence of hypercortisolism in patients after bilateral adrenalectomy for Cushing disease is extremely rare. Patient: We present a 27-year-old man who previously underwent bilateral adrenalectomy for Cushing disease with complete clinical resolution. Cushingoid features recurred 12 years

Bilateral herpes zoster

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Singh K

1993-01-01

Full Text Available A case of bilateral herpes zoster of lumbosacral region is reported in association with diabetes mellitus in a 55 years old female. The case is of interest due to bilateral distribution which is rare and sacral region involvement which is quite uncommon.

MODEL OF TEACHING PROFESSION SPECIFIC BILATERAL TRANSLATION

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Yana Fabrychna

2017-03-01

Full Text Available The article deals with the author’s interpretation of the process of teaching profession specific bilateral translation to student teacher of English in the Master’s program. The goal of the model of teaching profession specific bilateral translation development is to determine the logical sequence of educational activities of the teacher as the organizer of the educational process and students as its members. English and Ukrainian texts on methods of foreign languages and cultures teaching are defined as the object of study. Learning activities aimed at the development of student teachers of English profession specific competence in bilateral translation and Translation Proficiency Language Portfolio for Student Teachers of English are suggested as teaching tools. The realization of the model of teaching profession specific bilateral translation to student teachers of English in the Master’s program is suggested within the module topics of the academic discipline «Practice of English as the first foreign language»: Globalization; Localization; Education; Work; The role of new communication technologies in personal and professional development. We believe that the amount of time needed for efficient functioning of the model is 48 academic hours, which was determined by calculating the total number of academic hours allotted for the academic discipline «Practice of English as the first foreign language» in Ukrainian universities. Peculiarities of the model realization as well as learning goals and content of class activities and home self-study work of students are outlined.

Bilateral breast carcinoma

International Nuclear Information System (INIS)

Kim, Eung Jo; Oh, Ki Keun

1990-01-01

We evaluate 311 breast cancer patients admitted to Yong Dong Severance Hospital Between October 1st 1985 and July 31th 1989, and were able to obtain the following conclusions. 1) There were 14(4.5%) bilateral breast cancers among the 311 confirmed breast cancers. 2) Among the bilateral breast cancers, 5(31%) were synchronous and 9(69%) metachronous. 3) Average interval between the first and the second breast cancer in metachronous cancers was 3.8 year(1-15 years). 4) Bilateral breast cancer was most prevalent in the fifth decade (6/14) with the mean age of 47 years. 5) Film mammogram and sonomammogram showed findings of typical breast malignancies. There was no additional specific findings for each cancer in bilateral breast cancers which was different from unilateral cancers. Therefor, in the patients with unilateral breast cancer, possibility of the second lesion in the contralateral side must be considered and a close follow up observation should be done for at least 3 years

Reconstruction of bilateral tibial aplasia and split hand-foot syndrome in a father and daughter

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Ali Al Kaissi

2014-01-01

Full Text Available Background: Tibial aplasia is of heterogeneous aetiology, the majority of reports are sporadic. We describe the reconstruction procedures in two subjects - a daughter and father manifested autosomal dominant (AD inheritance of the bilateral tibial aplasia and split hand-foot syndrome. Materials and Methods: Reconstruction of these patients required multiple surgical procedures and orthoprosthesis was mandatory. The main goal of treatment was to achieve walking. Stabilization of the ankle joint by fibular-talar-chondrodesis on both sides, followed by bilateral Brown-procedure at the knee joint level has been applied accordingly. Results: The outcome was with improved function of the deformed limbs and walking was achieved with simultaneous designation of orthotic fitting. Conclusion: This is the first study encompassing the diagnosis and management of a father and daughter with bilateral tibial aplasia associated with variable split hand/foot deformity without foot ablation. Our patients showed the typical AD pattern of inheritance of split-hand/foot and tibial aplasia.

Binaural fusion and listening effort in children who use bilateral cochlear implants: a psychoacoustic and pupillometric study.

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Steel, Morrison M; Papsin, Blake C; Gordon, Karen A

2015-01-01

Bilateral cochlear implants aim to provide hearing to both ears for children who are deaf and promote binaural/spatial hearing. Benefits are limited by mismatched devices and unilaterally-driven development which could compromise the normal integration of left and right ear input. We thus asked whether children hear a fused image (ie. 1 vs 2 sounds) from their bilateral implants and if this "binaural fusion" reduces listening effort. Binaural fusion was assessed by asking 25 deaf children with cochlear implants and 24 peers with normal hearing whether they heard one or two sounds when listening to bilaterally presented acoustic click-trains/electric pulses (250 Hz trains of 36 ms presented at 1 Hz). Reaction times and pupillary changes were recorded simultaneously to measure listening effort. Bilaterally implanted children heard one image of bilateral input less frequently than normal hearing peers, particularly when intensity levels on each side were balanced. Binaural fusion declined as brainstem asymmetries increased and age at implantation decreased. Children implanted later had access to acoustic input prior to implantation due to progressive deterioration of hearing. Increases in both pupil diameter and reaction time occurred as perception of binaural fusion decreased. Results indicate that, without binaural level cues, children have difficulty fusing input from their bilateral implants to perceive one sound which costs them increased listening effort. Brainstem asymmetries exacerbate this issue. By contrast, later implantation, reflecting longer access to bilateral acoustic hearing, may have supported development of auditory pathways underlying binaural fusion. Improved integration of bilateral cochlear implant signals for children is required to improve their binaural hearing.

Unilateral versus bilateral thyroarytenoid Botulinum toxin injections in adductor spasmodic dysphonia: a prospective study

Science.gov (United States)

Upile, Tahwinder; Elmiyeh, Behrad; Jerjes, Waseem; Prasad, Vyas; Kafas, Panagiotis; Abiola, Jesuloba; Youl, Bryan; Epstein, Ruth; Hopper, Colin; Sudhoff, Holger; Rubin, John

2009-01-01

Objectives In this preliminary prospective study, we compared unilateral and bilateral thyroarytenoid muscle injections of Botulinum toxin (Dysport) in 31 patients with adductor spasmodic dysphonia, who had undergone more than 5 consecutive Dysport injections (either unilateral or bilateral) and had completed 5 concomitant self-rated efficacy and complication scores questionnaires related to the previous injections. We also developed a Neurophysiological Scoring (NPS) system which has utility in the treatment administration. Method and materials Data were gathered prospectively on voice improvement (self-rated 6 point scale), length of response and duration of complications (breathiness, cough, dysphagia and total voice loss). Injections were performed under electromyography (EMG) guidance. NPS scale was used to describe the EMG response. Dose and unilateral/bilateral injections were determined by clinical judgment based on previous response. Time intervals between injections were patient driven. Results Low dose unilateral Dysport injection was associated with no significant difference in the patient's outcome in terms of duration of action, voice score (VS) and complication rate when compared to bilateral injections. Unilateral injections were not associated with any post treatment total voice loss unlike the bilateral injections. Conclusion Unilateral low dose Dysport injections are recommended in the treatment of adductor spasmodic dysphonia. PMID:19852852

Unilateral versus bilateral thyroarytenoid Botulinum toxin injections in adductor spasmodic dysphonia: a prospective study

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Abiola Jesuloba

2009-10-01

Full Text Available Abstract Objectives In this preliminary prospective study, we compared unilateral and bilateral thyroarytenoid muscle injections of Botulinum toxin (Dysport in 31 patients with adductor spasmodic dysphonia, who had undergone more than 5 consecutive Dysport injections (either unilateral or bilateral and had completed 5 concomitant self-rated efficacy and complication scores questionnaires related to the previous injections. We also developed a Neurophysiological Scoring (NPS system which has utility in the treatment administration. Method and materials Data were gathered prospectively on voice improvement (self-rated 6 point scale, length of response and duration of complications (breathiness, cough, dysphagia and total voice loss. Injections were performed under electromyography (EMG guidance. NPS scale was used to describe the EMG response. Dose and unilateral/bilateral injections were determined by clinical judgment based on previous response. Time intervals between injections were patient driven. Results Low dose unilateral Dysport injection was associated with no significant difference in the patient's outcome in terms of duration of action, voice score (VS and complication rate when compared to bilateral injections. Unilateral injections were not associated with any post treatment total voice loss unlike the bilateral injections. Conclusion Unilateral low dose Dysport injections are recommended in the treatment of adductor spasmodic dysphonia.

Safety of bilateral same-day intravitreal injections of anti-vascular endothelial growth factor agents

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Ruão M

2017-02-01

Full Text Available Miguel Ruão,1 María Andreu-Fenoll,2 Rosa Dolz-Marco,2 Roberto Gallego-Pinazo2 1Department of Ophthalmology, Centro Hospitalar Entre Douro e Vouga, Santa Maria da Feira, Portugal; 2Unit of Macula, Department of Ophthalmology, University and Polytechnic Hospital La Fe, Valencia, Spain Purpose: The aim was to evaluate the safety of bilateral same-day injections with intravitreal antiangiogenic drugs for macular diseases.Methods: Cross-sectional retrospective review of unilateral and bilateral same-day antiangiogenic injections was conducted between January 2011 and March 2016 in the Unit of Macula, University and Polytechnic Hospital La Fe (Valencia, Spain. A total of 8,172 injections were administered, among which 6,560 were unilateral and 1,612 were bilateral injections. Patients were included in the study regardless of the diagnosis. Ranibizumab and aflibercept were the antiangiogenic drugs used. The presence of endophthalmitis or retinal detachment was evaluated.Results: A total of 1 (0.012% culture-proven endophthalmitis and 19 (0.233% acute intraocular inflammations were registered. In the unilateral injections group, there were 18 (0.274% acute intraocular inflammations and 1 (0.015% culture-proven endophthalmitis. One (0.062% of the 1,612 bilateral same-day injections had a unilateral acute intraocular inflammation, and there were no culture-proven endophthalmitis in this group.Conclusion: Bilateral same-day injections are more convenient for patients and their caregivers than the unilateral injections administered on different days. In our study, the prevalence of culture-proven endophthalmitis and acute intraocular inflammation was lower in the bilateral injections than in the unilateral group. These data support the idea that bilateral same-day injections are a safe and valid treatment to use in our clinical practice. Keywords: bilateral, intravitreal, injections, anti-VEGF, endophthalmitis

Posterior retroperitoneoscopic adrenal surgery for clinical and subclinical Cushing's syndrome in patients with bilateral adrenal disease.

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Lowery, Aoife J; Seeliger, Barbara; Alesina, Pier F; Walz, Martin K

2017-08-01

The treatment of hypercortisolism for patients with bilateral adrenal disease (BAD) is controversial. Bilateral total adrenalectomy results in permanent hypocortisolaemia requiring lifelong steroid replacement. A more conservative surgical approach, with less than bilateral total adrenalectomy (leaving functional adrenal tissue either unilaterally or bilaterally), represents an alternative option; however, long-term outcome or recurrence data are limited. We report our experience with the surgical management of hypercortisolism caused by BAD. Between 2004 and 2016, 42 patients (12 male, 30 female; mean age 58 ± 10 years) with clinical or subclinical Cushing's syndrome (CS/sCS) caused by BAD underwent adrenal surgery via the posterior retroperitoneoscopic approach. Adrenal surgery was defined as "adrenalectomy" when total gland excision was performed or "resection" when a partial or subtotal adrenal resection was performed. Clinical, radiological and biochemical parameters were evaluated preoperatively and postoperatively. Seventy adrenal operations performed in total included unilateral resection (n = 3), unilateral adrenalectomy (n = 15), bilateral resection (n = 9), adrenalectomy and contralateral resection (n = 14) and bilateral total adrenalectomy (n = 3). Median operating time was 47.5 min (30-150) with no difference between unilateral and bilateral (synchronous included) procedures (p = 0.15). Mortality was zero. Clavien-Dindo grade of postoperative complications was I (n = 5) and IV (n = 3). All but one patient with CS and 17/31 patients with sCS received postoperative steroid supplementation for a median duration of 20 (1.5-129) months. After median follow-up of 40 months (3-129), the remission rate was 92%; 11 patients required ongoing steroid supplementation. There were three biochemical recurrences (two underwent contralateral resection); two patients with new/progressive radiological nodularity are biochemically eucortisolaemic. A

Luxatio erecta bilateral: um relato de caso Bilateral luxatio erecta, a case report

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César Augusto Xavier Acosta

2012-02-01

Full Text Available O deslocamento inferior do ombro (luxatio erecta é uma lesão rara, acometendo aproximadamente 0,5% dos deslocamentos dessa articulação. A grande maioria desses casos ocorre unilateralmente. Em setembro de 2004, um homem de 43 anos chegou ao pronto-socorro do Hospital Universitário de Santa Maria (HUSM com queixa de dor bilateral no ombro e incapacidade de abaixar os braços, em consequência de uma queda com os braços abduzidos, enquanto desempenhava sua atividade laboral. Após o exame físico e radiológico constatou- se que o indivíduo apresentava uma luxação inferior bilateral dos ombros. O paciente foi então encaminhado ao bloco cirúrgico onde foi realizada redução incruenta das luxações sob anestesia através da técnica de tração e contra-tração. No dia seguinte recebeu alta com imobilização tipo Velpeau mantendo os ombros totalmente aduzidos e rotados internamente, com orientação de manter a imobilização por três semanas. Foi orientado também a realizar fisioterapia.Inferior shoulder dislocation (luxactio erecta is a rare lesion affecting approximately 0.5% of dislocations of this joint. The vast majority of these cases occur unilaterally. In September 2004, a 43 year old man was brought to the emergency room of the University Hospital of Santa Maria (HUSM complaining of bilateral shoulder pain and inability to lower the arms, as a result of a fall with the arms abducted, while carrying out work activities. After physical examination and radiological exams, it was found that the patient had a bilateral inferior shoulder dislocation. He was referred to the surgical ward and after intravenous sedation, both shoulders were reduced by closed reduction using the traction-countertraction maneuver. The patient was discharged the day after the reduction. Both arms were immobilized with a velpeau sling in total adduction and intrarotation, with instructions to maintain immobilization for three weeks. The patient was

Bilateral acute retinal necrosis associated with bilateral uveal effusion in an immunocompetent patient: A challenging association

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S Bala Murugan

2018-01-01

Full Text Available Bilateral uveal effusion syndrome associated with bilateral acute retinal necrosis is a diagnostic and therapeutic challenge. A 52 year old man presented with bilateral angle closure with choroidal detachment. With restricted fundus view, parenteral steroid was started. During close follow up bilateral discrete areas of peripheral retinitis were noted. Parenteral steroids were promptly stopped and parenteral antivirals with oral steroids were continued. It showed healing response with nil recurrences till last follow up. Aggressive treatment of bilateral uveal effusion with parenteral steroids can cause progression of bilateral acute retinal necrosis leading to phthisis bulbi. However early diagnosis, prompt intervention and close follow up are the key elements to therapeutic success even during diagnostic surprises and avoid costly mistakes.

38 CFR 4.26 - Bilateral factor.

Science.gov (United States)

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Bilateral factor. 4.26... DISABILITIES General Policy in Rating § 4.26 Bilateral factor. When a partial disability results from disease... disability. The bilateral factor will be applied to such bilateral disabilities before other combinations are...

The application of the bilateral collimator to parasternal lymphoscintigraphy: a new method to measure the depth of the lymph node

International Nuclear Information System (INIS)

Ohtake, E.; Toyama, H.; Iio, M.; Noguchi, M.; Kawaguchi, S.; Murata, H.; Chiba, K.; Yamada, H.

1980-01-01

The bilateral collimator has been widely adopted for obtaining two simultaneous views of the heart in nuclear cardiology. As an additional useful clinical application of the bilateral collimator, it has been used for parasternal lymphoscintigraphy. Lymphography with a contrast medium for the parasternal lymphatics is technically very difficult and the radionuclide method is adopted. Lymphoscintigraphy has been used in order to determine the existence of malignant invasion to the lymph nodes, and also to find the depth of the lymph node as a guide to operation and radiation therapy of the nodes. (author)

Delayed fixation of displaced bilateral, atraumatic, femoral neck fractures in a patient with pregnancy related osteomalacia.

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Docker, Charles; Starks, Ian; Wade, Roger; Wynn-Jones, Charles

2011-06-01

We present the case of a woman diagnosed with simultaneous displaced intracapsular femoral neck fractures following the birth of her second child. No traumatic event was identified. Diagnosis was delayed as the cause of her pain was thought to be non-skeletal in origin. Radiological and serological investigations were diagnostic of osteomalacia. Surgical fixation of her fractures was further delayed due to profound hypocalcaemia. Despite the delays, fixation with bilateral dynamic hip screws resulted in union with no evidence of avascular necrosis at 2 years follow-up. We believe this to be the first report of atraumatic bilateral femoral neck fractures and it shows that a good result can be achieved even in the presence of delayed fixation.

Surgical management for early-stage bilateral breast cancer patients in China.

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Jia-jian Chen

Full Text Available The aim of this study was to investigate the current surgical management strategy for bilateral breast cancer (BBC patients and to assess the changes in this strategy in China.This is a retrospective review of all patients with early-stage BBC who underwent surgical treatment at the Fudan University Shanghai Cancer Center between June 2007 and June 2014.A total of 15,337 patients with primary breast cancer were identified. Of these patients, 218 (1.5% suffered from synchronous bilateral breast cancer (sBBC, and 296 (2.0% suffered from metachronous bilateral breast cancer (mBBC. Patients with a lobular carcinoma component, those with estrogen receptor-positive cancer, and those with an accompanying sclerosing adenosis in the affected breast tended to develop BBC. The rates of bilateral mastectomy, breast conserving therapy, reconstruction, and combined surgeries were 86.2%, 6.4%, 3.7%, and 3.7%, respectively, for patients with sBBC and 81.1%, 4.4%, 3.0%, and 11.5%, respectively, for patients with mBBC. The interval between bilateral cancers, age at first diagnosis of breast cancer, histopathological type, and stage have significant impacts on the choice of surgery for patients with BBC.Bilateral mastectomy was the dominant surgical management for patients with BBC in China, despite the increased application of breast reconstruction surgery observed in recent years. Bilateral prosthetic breast reconstruction was the ideal choice for patients with sBBC. Chinese surgeons should take responsibility for patient education and inform their patients about their surgical options.

Binaural Fusion and Listening Effort in Children Who Use Bilateral Cochlear Implants: A Psychoacoustic and Pupillometric Study

Science.gov (United States)

Steel, Morrison M.; Papsin, Blake C.; Gordon, Karen A.

2015-01-01

Bilateral cochlear implants aim to provide hearing to both ears for children who are deaf and promote binaural/spatial hearing. Benefits are limited by mismatched devices and unilaterally-driven development which could compromise the normal integration of left and right ear input. We thus asked whether children hear a fused image (ie. 1 vs 2 sounds) from their bilateral implants and if this “binaural fusion” reduces listening effort. Binaural fusion was assessed by asking 25 deaf children with cochlear implants and 24 peers with normal hearing whether they heard one or two sounds when listening to bilaterally presented acoustic click-trains/electric pulses (250 Hz trains of 36 ms presented at 1 Hz). Reaction times and pupillary changes were recorded simultaneously to measure listening effort. Bilaterally implanted children heard one image of bilateral input less frequently than normal hearing peers, particularly when intensity levels on each side were balanced. Binaural fusion declined as brainstem asymmetries increased and age at implantation decreased. Children implanted later had access to acoustic input prior to implantation due to progressive deterioration of hearing. Increases in both pupil diameter and reaction time occurred as perception of binaural fusion decreased. Results indicate that, without binaural level cues, children have difficulty fusing input from their bilateral implants to perceive one sound which costs them increased listening effort. Brainstem asymmetries exacerbate this issue. By contrast, later implantation, reflecting longer access to bilateral acoustic hearing, may have supported development of auditory pathways underlying binaural fusion. Improved integration of bilateral cochlear implant signals for children is required to improve their binaural hearing. PMID:25668423

Binaural fusion and listening effort in children who use bilateral cochlear implants: a psychoacoustic and pupillometric study.

Directory of Open Access Journals (Sweden)

Morrison M Steel

Full Text Available Bilateral cochlear implants aim to provide hearing to both ears for children who are deaf and promote binaural/spatial hearing. Benefits are limited by mismatched devices and unilaterally-driven development which could compromise the normal integration of left and right ear input. We thus asked whether children hear a fused image (ie. 1 vs 2 sounds from their bilateral implants and if this "binaural fusion" reduces listening effort. Binaural fusion was assessed by asking 25 deaf children with cochlear implants and 24 peers with normal hearing whether they heard one or two sounds when listening to bilaterally presented acoustic click-trains/electric pulses (250 Hz trains of 36 ms presented at 1 Hz. Reaction times and pupillary changes were recorded simultaneously to measure listening effort. Bilaterally implanted children heard one image of bilateral input less frequently than normal hearing peers, particularly when intensity levels on each side were balanced. Binaural fusion declined as brainstem asymmetries increased and age at implantation decreased. Children implanted later had access to acoustic input prior to implantation due to progressive deterioration of hearing. Increases in both pupil diameter and reaction time occurred as perception of binaural fusion decreased. Results indicate that, without binaural level cues, children have difficulty fusing input from their bilateral implants to perceive one sound which costs them increased listening effort. Brainstem asymmetries exacerbate this issue. By contrast, later implantation, reflecting longer access to bilateral acoustic hearing, may have supported development of auditory pathways underlying binaural fusion. Improved integration of bilateral cochlear implant signals for children is required to improve their binaural hearing.

Evaluation of disabilities and activities of daily living of war-related bilateral lower extremity amputees.

Science.gov (United States)

Ebrahimzadeh, Mohammad H; Moradi, Ali; Bozorgnia, Shahram; Hallaj-Moghaddam, Mohammad

2016-02-01

Long-term consequences and the activities of daily living of bilateral lower limb amputation are not well documented. The aims of our study were to identify the long-term effects of bilateral lower extremity amputations on daily activities and understand how these amputees cope with their mobility assistive devices. Cross-sectional study. A total of 291 veterans with war bilateral lower limb amputations accepted to participate in a cross-sectional study. The average of follow-up was 25.4 years. A total of 152 amputees (54%) were involved in sports averagely 6.7 h per week. Bilateral amputees walk 10 m by the average of 15 ± 33 s, and they could walk continuously with their prosthesis 315 ± 295 m. They wore their prosthesis 6.8 ± 1.7 days per week and 7.9 ± 8.1 h per day. Of these, 6.7% of bilateral lower limb amputees needed help to wear their prosthesis; 88.3% of amputees used assistant device for walking. According to this survey, 73 (42%) prostheses in right limb were appropriate, 95 (54.6%) needed to be replaced, and 6 (3.4) needed to be fixed. On the left side, it was 76 (42%), 92 (52.0%), and 9 (5.1%), respectively. A total of 203 (74.9%) amputees reported limitations in at least one domain of the activities of daily living. The most common single item that affected the patients was ascending and descending stairs by the score of 66% of normal population. Veterans with bilateral lower limb amputations suffering from vast categories of daily problems. This study and its results confirm that bilateral lower limb amputees have major progressive disabilities in daily activities and their social performance. This should attract the attention of amputees' administrative organizations, social workers, health-care providers and caregiver providers. © The International Society for Prosthetics and Orthotics 2014.

Pregnancy following bilateral salpingectomy

DEFF Research Database (Denmark)

Oturai, Annette Bang

2008-01-01

This report presents a rare case of spontaneous pregnancy following bilateral salpingectomy. A woman with a history of bilateral salpingectomy was admitted to hospital because of abdominal pain and positive urine HCG. Surprisingly, ultrasound confirmed a live intrauterine fetus. The pregnancy...... was unwanted, and the woman decided to terminate the pregnancy. She was offered diagnostic examination to localise a potential fistula, but she declined. In a MEDLINE search of English literature this is only the second case of spontaneous pregnancy following bilateral salpingectomy Udgivelsesdato: 2008/4/21...

Bilateral male breast cancer with male potential hypogonadism

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Kurokawa Yasushi

2007-06-01

Full Text Available Abstract Background Male breast cancer is a comparatively rare disease, and simultaneous bilateral male breast cancer is considered to be an extremely rare event. Risk factors are said to be genetic factors and hormonal abnormalities due to obesity or testicular diseases. Case presentation The patient was a 47-year-old Japanese male. His family had no history of female breast cancer. This patient also had hypospadias and hormonal examination indicated the presence of primary testicular potential hypogonadism, and these hormonal abnormalities seemed to be present since childhood or the fetal period. The bilateral breast cancer developed in this man at a comparatively young age, and histopathological studies of multiple sections showed that there was almost no normal epithelial cell in the ducts, while the ducts were almost completely filled with breast cancer cells. Conclusion It is thought that male breast cancer is caused by an imbalance between estrogen and testosterone. We cannot rule out the possibility that the breast cancer developed due to the effect of the slight elevation of estrogen over a long period of time, but the actual causative factors in this patient were unable to be definitively identified. In the future, we hope to further elucidate the causes of male breast cancer.

Role of integrated approach of yoga therapy in a failed post-total knee replacement of bilateral knees

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John Ebnezar

2014-01-01

Full Text Available OA Knee is the most common arthritis. Knee replacement Surgeries are being done increasingly in the present times. This has led to the violation of the standard indications and when knees are replaced ignoring other co - musculoskeletal conditions it results in the surgery failing early. This is about a patient who encountered a failed TKR due to improper selection as patient had bilateral OA Hip that was ignored in the initial stages. To overcome the problem she was advised bilateral hip replacement which would leave her with four replacements in the lower limb. She refused surgery and was told there are no alternative treatment options. This patient underwent a 3 week integrated course of IAYT at our center and she made a remarkable recovery. IAYT is a good non-surgical treatment that can be affective both before and after knee replacement and it should be considered as the first choice of treatment before surgery.

Bilateral persistent hyperplastic primary vitreous

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Jain Tarun

2009-01-01

Full Text Available A case of bilateral persistent hyperplastic primary vitreous (PHPV in a 3-month-old male infant, who had bilateral leukokoria, is presented. The child was referred for imaging with a clinical suspicion of retinoblastoma. Gray-scale ultrasound evaluation revealed an echogenic band in the posterior segment of both globes, extending from the posterior surface of the lens capsule to the optic disc. Doppler examination revealed the presence of arterial flow in the band in both globes. Associated echogenic hemorrhage was also seen, which was confirmed by computed tomography. Most cases of PHPV are sporadic and unilateral, and bilateral PHPV is rare. The imaging features in this case suggest the diagnosis of bilateral PHPV and differentiate it from retinoblastoma. This entity, although infrequent, should be considered in the differential diagnosis while evaluating bilateral leukokoria.

Bilateral hip arthroplasty: is 1-week staging the optimum strategy?

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Willis-Owen Charles A

2010-11-01

Full Text Available Abstract Seventy-nine patients underwent bilateral hip arthroplasty staged either at 1 week (Group 1 or after greater intervals (as suggested by the patients, mean 44 weeks, range 16-88 weeks (Group 2, over a five year period at one Institution. Sixty-eight patients (29 bilateral hip resurfacings and 39 total hip replacements completed questionnaires regarding their post-operative recovery, complications and overall satisfaction with the staging of their surgery. There was no significant age or ASA grade difference between the patient groups. Complication rates in the two groups were similar and overall satisfaction rates were 84% in Group 1 (n = 32 and 89% in Group 2 (n = 36. Cumulative hospital lengths of stay were significantly longer in Group 1 patients (11.9 days vs 9.1 days(p The mean time to return to part-time work was 16.4 weeks for Group 1, and a cumulative 17.2 weeks (8.8 and 8.4 weeks for Group 2. The time to return to full-time work was significantly shorter for Group 1 patients (21.0 weeks, compared with a cumulative 29.7 weeks for Group 2(p Hip resurfacing patients in Group 2 had significantly shorter durations of postoperative pain and were able to return to part-time and full time work sooner than total hip arthroplasty patients. There was a general trend towards a faster recovery and resumption of normal activities following the second operation in Group 2 patients, compared with the first operation. Bilateral hip arthroplasty staged at a 1-week interval resulted in an earlier resolution of hip pain, and an earlier return to full-time work (particularly following total hip replacement surgery, with high levels of patient satisfaction and no increased risk in complications; however the hospital length of stay was significantly longer. The decision for the timing of staged bilateral surgery should be made in conjunction with the patient, making adjustments to accommodate their occupational needs and functional demands.

Studies on fission with ALADIN. Precise and simultaneous measurement of fission yields, total kinetic energy and total prompt neutron multiplicity at GSI

International Nuclear Information System (INIS)

Martin, Julie-Fiona; Taieb, Julien; Chatillon, Audrey; Belier, Gilbert; Boutoux, Guillaume; Ebran, Adeline; Gorbinet, Thomas; Grente, Lucie; Laurent, Benoit; Pellereau, Eric; Alvarez-Pol, Hector; Ayyad, Yassid; Benlliure, Jose; Cortina Gil, Dolores; Caamano, Manuel; Fernandez Dominguez, Beatriz; Paradela, Carlos; Ramos, Diego; Rodriguez-Sanchez, Jose-Luis; Vargas, Jossitt; Audouin, Laurent; Tassan-Got, Laurent; Aumann, Thomas; Casarejos, Enrique; Farget, Fanny; Rodriguez-Tajes, Carme; Heinz, Andreas; Jurado, Beatriz; Kelic-Heil, Aleksandra; Kurz, Nikolaus; Nociforo, Chiara; Pietri, Stephane; Rossi, Dominic; Schmidt, Karl-Heinz; Simon, Haik; Voss, Bernd; Weick, Helmut

2015-01-01

A novel technique for fission studies, based on the inverse kinematics approach, is presented. Following pioneering work in the nineties, the SOFIA Collaboration has designed and built an experimental set-up dedicated to the simultaneous measurement of isotopic yields, total kinetic energies and total prompt neutron multiplicities, by fully identifying both fission fragments in coincidence, for the very first time. This experiment, performed at GSI, permits to study the fission of a wide variety of fissioning systems, ranging from mercury to neptunium, possibly far from the valley of stability. A first experiment, performed in 2012, has provided a large array of unprecedented data regarding the nuclear fission process. An excerpt of the results is presented. With this solid starter, further improvements of the experimental set-up are considered, which are consistent with the expected developments at the GSI facility, in order to measure more fission observables in coincidence. The completeness reached in the SOFIA data, permits to scrutinize the correlations between the interesting features of fission, offering a very detailed insight in this still unraveled mechanism. (orig.)

Studies on fission with ALADIN. Precise and simultaneous measurement of fission yields, total kinetic energy and total prompt neutron multiplicity at GSI

Energy Technology Data Exchange (ETDEWEB)

Martin, Julie-Fiona; Taieb, Julien; Chatillon, Audrey; Belier, Gilbert; Boutoux, Guillaume; Ebran, Adeline; Gorbinet, Thomas; Grente, Lucie; Laurent, Benoit; Pellereau, Eric [CEA DAM Bruyeres-le-Chatel, Arpajon (France); Alvarez-Pol, Hector; Ayyad, Yassid; Benlliure, Jose; Cortina Gil, Dolores; Caamano, Manuel; Fernandez Dominguez, Beatriz; Paradela, Carlos; Ramos, Diego; Rodriguez-Sanchez, Jose-Luis; Vargas, Jossitt [Universidad de Santiago de Compostela, Santiago de Compostela (Spain); Audouin, Laurent; Tassan-Got, Laurent [CNRS/IN2P3, IPNO, Orsay (France); Aumann, Thomas [Technische Universitaet Darmstadt, Darmstadt (Germany); Casarejos, Enrique [Universidad de Vigo, Vigo (Spain); Farget, Fanny; Rodriguez-Tajes, Carme [CNRS/IN2P3, GANIL, Caen (France); Heinz, Andreas [Chalmers University of Technology, Gothenburg (Sweden); Jurado, Beatriz [CNRS/IN2P3, CENBG, Gradignan (France); Kelic-Heil, Aleksandra; Kurz, Nikolaus; Nociforo, Chiara; Pietri, Stephane; Rossi, Dominic; Schmidt, Karl-Heinz; Simon, Haik; Voss, Bernd; Weick, Helmut [GSI Helmholtzzentrum fuer Schwerionenforschung GmbH, Darmstadt (Germany)

2015-12-15

A novel technique for fission studies, based on the inverse kinematics approach, is presented. Following pioneering work in the nineties, the SOFIA Collaboration has designed and built an experimental set-up dedicated to the simultaneous measurement of isotopic yields, total kinetic energies and total prompt neutron multiplicities, by fully identifying both fission fragments in coincidence, for the very first time. This experiment, performed at GSI, permits to study the fission of a wide variety of fissioning systems, ranging from mercury to neptunium, possibly far from the valley of stability. A first experiment, performed in 2012, has provided a large array of unprecedented data regarding the nuclear fission process. An excerpt of the results is presented. With this solid starter, further improvements of the experimental set-up are considered, which are consistent with the expected developments at the GSI facility, in order to measure more fission observables in coincidence. The completeness reached in the SOFIA data, permits to scrutinize the correlations between the interesting features of fission, offering a very detailed insight in this still unraveled mechanism. (orig.)

Bilateral Giant Renal Angiomyolipoma in a Patient with Tuberous Sclerosis Complex: A Case Report

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Andika Afriansyah

2018-04-01

Full Text Available Tuberous sclerosis complex (TSC has several renal manifestations including angiomyolipomas (AML and renal epithelial neoplasms. A bilateral giant renal AML is extremely rare. We report a case of giant bilateral AML and discuss the diagnosis and treatment of it. The 22-year-old man was admitted due to bilateral flank pain, gross hematuria, and abdominal fullness. He had history of epilepsy, mental retardation, and delayed development during childhood. He had angiofibroma on his face since 10 years ago. Abdominal CT and MRI revealed large lobulated heterogeneous mass with fatty content. Based on those findings, we diagnosed the patient with bilateral giant renal AML. We gave conservative management for the patient and planned to total nephrectomy on the left kidney if the continued bleeding occurred. AML associated with TSC occur more frequently as multiple lesions and grows to larger size than idiopathic AML. Bilateral giant AML, which is very rare, could be treated with conservative management if no significant hemorrhage occurred.

[The incidence of bilateral multiple primary breast cancer among the female inhabitants of Crimea].

Science.gov (United States)

Tel'kina, G N; Sorkin, V M

1998-08-01

A method is proposed for calculation of PMSO frequency depending on succession of origination of polyneoplasias. The incidence rate of synchronous bilateral breast cancer (BC) was calculated in reference to all primary BC patients and came to 0.75%. The incidence rate of metachronous bilateral BC was calculated depending on the number of those BC patients having been registered every year of observation and it was found to be 5.4%. The total frequency of bilateral BC in a 20-year follow-up in the Crimean region appeared to be 6.15%. The incidence of metachronous bilateral BC was noted to be dependent on the length of follow-up: 1.27 percent and 4.14 percent in the 3- to 10- and 11- to 20-year periods respectively. The risk for the development of bilateral BC is conditioned by the time having elapsed since detection of the first tumor and increases after 10 and 18 years.

Idiopathic bilateral male breast abscess.

Science.gov (United States)

Sinha, Rajan Kumar; Sinha, Mithilesh Kumar; Gaurav, Kumar; Kumar, Amar

2014-03-10

A 38-year-old man presented with bilateral breast swelling, along with pain and redness for 7 days. Bilateral axillary nodes were also palpable; which were multiple and discrete. A provisional diagnosis of bilateral breast abscess was made with suspicion of underlying malignancy. Incision and drainage through subareolar incision was performed and the adjoining tissue was excised and sent for histopathological examination.

Unilateral and bilateral neck SIB for head and neck cancer patients. Intensity-modulated proton therapy, tomotherapy, and RapidArc

Energy Technology Data Exchange (ETDEWEB)

Stromberger, Carmen; Budach, Volker; Ghadjar, Pirus; Wlodarczyk, Waldemar; Marnitz, Simone [Charite - Universitaetsmedizin Berlin, Department of Radiation Oncology and Radiotherapy, Berlin (Germany); Cozzi, Luca; Fogliata, Antonella [Humanitas Cancer Center Milan, Radiotherapy and Radiosurgery Department, Milan (Italy); Jamil, Basil [Klinikum Frankfurt Oder, Praxis fuer Strahlentherapie, Frankfurt Oder (Germany); Raguse, Jan D. [Clinic for Oral and Maxillofacial Surgery, Berlin (Germany); Boettcher, Arne [Charite - Universitaetsmedizin Berlin, Department of Otorhinolaryngology, Berlin (Germany)

2016-04-15

To compare simultaneous integrated boost plans for intensity-modulated proton therapy (IMPT), helical tomotherapy (HT), and RapidArc therapy (RA) for patients with head and neck cancer. A total of 20 patients with squamous cell carcinoma of the head and neck received definitive chemoradiation with bilateral (n = 14) or unilateral (n = 6) neck irradiation and were planned using IMPT, HT, and RA with 54.4, 60.8, and 70.4 GyE/Gy in 32 fractions. Dose distributions, coverage, conformity, homogeneity to planning target volumes (PTV)s and sparing of organs at risk and normal tissue were compared. All unilateral and bilateral plans showed excellent PTV coverage and acceptable dose conformity. For unilateral treatment, IMPT delivered substantially lower mean doses to contralateral salivary glands (< 0.001-1.1 Gy) than both rotational techniques did (parotid gland: 6-10 Gy; submandibular gland: 15-20 Gy). Regarding the sparing of classical organs at risk for bilateral treatment, IMPT and HT were similarly excellent and RA was satisfactory. For unilateral neck irradiation, IMPT may minimize the dry mouth risk in this subgroup but showed no advantage over HT for bilateral neck treatment regarding classical organ-at-risk sparing. All methods satisfied modern standards regarding toxicity and excellent target coverage for unilateral and bilateral treatment of head and neck cancer at the planning level. (orig.) [German] Planvergleich von intensitaetsmodulierter Protonentherapie (IMPT), Tomotherapie (HT) und RapidArc-Therapie (RA) fuer Patienten mit Plattenepithelkarzinomen der Kopf-Hals-Region unter Anwendung des simultan integrierten Boost-Konzepts (SIB). Fuer 20 Patienten mit Plattenepithelkarzinomen der Kopf-Hals-Region und bilateraler (n = 14) oder unilateraler (n = 6) zervikaler primaerer Radiochemotherapie erfolgte eine IMPT-, HT- und RA-Planung mit 54,4, 60,8 und 70,4 GyE/Gy in 32 Fraktionen. Die Dosisverteilung, Abdeckung, Konformitaet und Homogenitaet der PTVs sowie die

The effect of tranexamic acid in unilateral and bilateral total knee arthroplasty in the South Asian population: A retrospective cohort study.

Science.gov (United States)

Mufarrih, Syed Hamza; Malik, Azeem Tariq; Qureshi, Nada Qaisar; Lakdawala, Riaz Hussain; Rabbani, Muhammad Umar; Ali, Arif; Noordin, Shahryar

2018-04-01

Together with evidence of higher bleeding tendencies, the vulnerability of the South-Asian population to anemia secondary to a higher prevalence of hemoglobinopathies and micronutrient deficiencies merits further exploration of the effects of tranexamic acid on this population. Additionally, limited access to self-care facilities and certain sociocultural beliefs and practices may not be conducive to a speedy recovery from surgical complications. The aim of this study is to investigate the effects of intraoperative administration of tranexamic acid during total knee arthroplasty when considering the South-Asian population. Medical record files of 355 patients who underwent total knee arthroplasty (2007-2015) were reviewed to collect data regarding patient characteristics, surgical variables and post-operative complications. Unilateral and Bilateral total knee arthroplasty were studied separately. Analysis was done using t-test, Mann-Whitney U test, chi-square and Fisher's exact square where appropriate. The threshold for significance was p tranexamic acid caused a significant reduction in estimated blood loss (p-value=0.011), total operative time, calculated blood loss, and hemoglobin change (p-valuetranexamic acid only caused a significant reduction in calculated blood loss (p-value tranexamic acid vs. those who did not, there was a significant increase in length of hospital stay (ptranexamic acid effectively reduces intraoperative blood loss, it does not have an effect on the need for post-operative blood transfusions. The increased length of stay and special care unit admissions associated with tranexamic acid use should be explored further to reveal the complete safety profile of tranexamic acid administration in the South-Asian population during total knee arthroplasty. Copyright © 2018 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Bilateral Endoscopic Medial Maxillectomy for Bilateral Inverted Papilloma

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Satoru Kodama

2012-01-01

Full Text Available Inverted papilloma (IP is a benign tumor of the nasal cavity and paranasal sinuses that is unilateral in most cases. Bilateral IP, involving both sides of the nasal cavity and sinuses, is extremely rare. This paper describes a large IP that filled in both sides of the nasal cavity and sinuses, mimicking association with malignancy. The tumor was successfully treated by bilateral endoscopic medial maxillectomy (EMM. The patient is without evidence of the disease 24 months after surgery. If preoperative diagnosis does not confirm the association with malignancy in IP, endoscopic sinus surgery (ESS should be selected, and ESS, including EMM, is a good first choice of the treatment for IP.

Bilateral Endoscopic Medial Maxillectomy for Bilateral Inverted Papilloma

Science.gov (United States)

Kodama, Satoru; Kawano, Toshiaki; Suzuki, Masashi

2012-01-01

Inverted papilloma (IP) is a benign tumor of the nasal cavity and paranasal sinuses that is unilateral in most cases. Bilateral IP, involving both sides of the nasal cavity and sinuses, is extremely rare. This paper describes a large IP that filled in both sides of the nasal cavity and sinuses, mimicking association with malignancy. The tumor was successfully treated by bilateral endoscopic medial maxillectomy (EMM). The patient is without evidence of the disease 24 months after surgery. If preoperative diagnosis does not confirm the association with malignancy in IP, endoscopic sinus surgery (ESS) should be selected, and ESS, including EMM, is a good first choice of the treatment for IP. PMID:22953103

Bilateral, independent juvenile nasopharyngeal angiofibroma

DEFF Research Database (Denmark)

Mørkenborg, Marie-Louise; Frendø, M; Stavngaard, T

2015-01-01

BACKGROUND: Juvenile nasopharyngeal angiofibroma is a benign, vascular tumour that primarily occurs in adolescent males. Despite its benign nature, aggressive growth patterns can cause potential life-threatening complications. Juvenile nasopharyngeal angiofibroma is normally unilateral, originating...... from the sphenopalatine artery, but bilateral symptoms can occur if a large tumour extends to the contralateral side of the nasopharynx. This paper presents the first reported case of true bilateral extensive juvenile nasopharyngeal angiofibroma involving clinically challenging pre-surgical planning...... embolisation. Radical removal performed as one-step, computer-assisted functional endoscopic sinus surgery was performed. The follow-up period was uncomplicated. CONCLUSION: This case illustrates the importance of suspecting bilateral juvenile nasopharyngeal angiofibroma in patients presenting with bilateral...

Attenuated total reflection UV spectroscopy for simultaneous analysis of alkali, sulphide and dissolved lignin in pulping liquors

International Nuclear Information System (INIS)

Chai, X.S.; Zhu, J.Y.; Luo, Q.; Li, J.

2003-01-01

This study experimentally demonstrated attenuated total reflection (ATR) ultraviolet (UV) spectroscopy for rapid and simultaneous determination of the concentrations of hydroxide, sulphide and dissolved lignin in kraft pulping liquors. A multivariate partial least squares fitting procedure (using commercially available software) was employed to obtain the species concentrations from the measured absorption spectra of the pulping liquors. Good agreements between ATR-UV measured species concentrations and those obtained by reference methods (titration for hydroxide and sulphide and conventional UV absorption for dissolved lignin) were achieved. (author)

BILATERAL SINGLE SESSION URETEROSCOPY FOR URETERAL ...

African Journals Online (AJOL)

Objectives: To determine the feasibility, safety and success rate of bilateral single session rigid retrograde ureteroscopy (URS) for bilateral ureteral calculi. Patients and Methods: Thirty-five patients underwent bilateral single session ureteroscopic calculus removal. Results: Out of 70 renal units in 35 patients treated, ...

Morbidity and mortality after bilateral simultaneous total knee arthroplasty in a fast-track setting

DEFF Research Database (Denmark)

Gromov, Kirill; Troelsen, Anders; Otte, Kristian Stahl

2016-01-01

and mortality rates and time until death were recorded. Transfusion rates and numbers of transfusions were also recorded. Logistic regression analysis was used to identify risk factors for re-admission within 90 days, and also for a LOS of more than 5 days. Results - 90-day mortality was 0%. 10% of the patients...

Bilateral non-traumatic acetabular and femoral neck fractures due to pregnancy-associated osteoporosis.

Science.gov (United States)

Aynaci, Osman; Kerimoglu, Servet; Ozturk, Cagatay; Saracoglu, Metehan

2008-03-01

Pregnancy-associated osteoporosis is a rare disorder and its pathophysiology remains unknown. We report a case of pregnancy-associated osteoporosis in a 27-year-old primiparous patient who revealed bilateral hip pain during early postnatal period. The plain radiographs and computerized tomography showed bilateral femoral neck and acetabular fractures. The diagnosis of osteoporosis was established by bone mineral density. Diagnostic work-up excluded a secondary osteoporosis. The case was treated successfully by bilateral cementless total hip arthroplasty. Bone mineral density increased after 2 years of treatment with calcium-vitamin D, calcitriol and alendronate. Diagnosis of pregnancy-associated osteoporosis should be suspected when hip pain occurs during pregnancy or in the post-partum period as it can lead to acetabular and femoral neck fractures.

American-Soviet Track and Field Exchanges as a Tool of Shaping Bilateral Political Relations

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Michał Marcin Kobierecki

2017-04-01

Full Text Available The aim of the research is to investigate the track and field exchanges between the United States and the Soviet Union in the Cold War era, in search of their role in shaping bilateral relations between the two states. Particular attention has been paid to the motivation of respective subjects. The research allowed to test the hypothesis stating that the track and field exchanges were an attempt to bring the two countries closer and to achieve propaganda benefits simultaneously.

NEUROLOGICAL SEQUELAE FOLLOWING ANAESTHETIC RECOVERY AFTER BILATERAL TOTAL KNEE REPLACEMENT – TWO CASE REPORTS

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Harpreet

2016-03-01

Full Text Available BACKGROUND Thromboembolism is a common and serious complication of joint replacement surgery. Cognitive decline occurs in 5-29% of patients, undergoing major orthopaedic surgery. Many studies show that systemic embolism may occur in the absence of venous-arterial shunts leading to cognitive dysfunction and neurological sequelae. METHODS We present two cases of neurological consequences occurring post bilateral TKR. Cases were successfully done under Combined Spinal Epidural Anaesthesia. Steroids were not used intraoperatively. RESULTS Both cases had neurological complications following completion of surgery. First case had posterior circulation TIA while the other had a right upper motor neuron facial palsy. CONCLUSION We suspect both as cases of cerebral fat microembolism in the absence of any venous-arterial shunt.

[Bilateral facial nerve palsy associated with Epstein-Barr virus infection in a 3-year-old boy].

Science.gov (United States)

Grassin, M; Rolland, A; Leboucq, N; Roubertie, A; Rivier, F; Meyer, P

2017-06-01

Bilateral facial nerve palsy is a rare and sometimes difficult diagnosis. We describe a case of bilateral simultaneous facial nerve palsy associated with Epstein-Barr virus (EBV) infection in a 3-year-old boy. Several symptoms led to the diagnosis of EBV infection: the clinical situation (fever, stomachache, and throat infection), white blood cell count (5300/mm 3 with 70% lymphocyte count), seroconversion with EBV-specific antibodies, lymphocytic meningitis, and a positive blood EBV polymerase chain reaction (9.3×10 3 copies of EBV-DNA). An MRI brain scan showed bilateral gadolinium enhancement of the facial nerve. A treatment plan with IV antibiotics (ceftriaxone) and corticosteroids was implemented. Antibiotics were stopped after the diagnosis of Lyme disease was ruled out. The patient's facial weakness improved within a few weeks. Bilateral facial nerve palsy is rare and, unlike unilateral facial palsy, it is idiopathic in only 20% of cases. Therefore, it requires further investigation and examination to search for the underlying etiology. Lyme disease is the first infectious disease that should be considered in children, especially in endemic areas. An antibiotic treatment effective against Borrelia burgdorferi should be set up until the diagnosis is negated or confirmed. Further examination should include a blood test (such as immunologic testing, and serologic testing for viruses and bacterium with neurological tropism), a cerebrospinal fluid test, and an MRI brain scan to exclude any serious or curable underlying etiology. Facial bilateral nerve palsy associated with EBV is rarely described in children. Neurological complications have been reported in 7% of all EBV infections. The facial nerve is the most frequently affected of all cranial nerves. Facial palsy described in EBV infections is bilateral in 35% of all cases. The physiopathology is currently unknown. Prognosis is good most of the time. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Bilateral tension pneumothorax related to acupuncture.

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Tagami, Rumi; Moriya, Takashi; Kinoshita, Kosaku; Tanjoh, Katsuhisa

2013-06-01

We report on a patient with a rare case of bilateral tension pneumothorax that occurred after acupuncture. A 69-year-old large-bodied man, who otherwise had no risk factors for spontaneous pneumothorax, presented with chest pressure, cold sweats and shortness of breath. Immediately after bilateral pneumothorax had been identified on a chest radiograph in the emergency room, his blood pressure and percutaneous oxygen saturation suddenly decreased to 78 mm Hg and 86%, respectively. We confirmed deterioration in his cardiopulmonary status and diagnosed bilateral tension pneumothorax. We punctured his chest bilaterally and inserted chest tubes for drainage. His vital signs promptly recovered. After the bilateral puncture and drainage, we learnt that he had been treated with acupuncture on his upper back. We finally diagnosed a bilateral tension pneumothorax based on the symptoms that appeared 8 h after the acupuncture. Because the patient had no risk factors for spontaneous pneumothorax, no alternative diagnosis was proposed. We recommend that patients receiving acupuncture around the chest wall must be adequately informed of the possibility of complications and expected symptoms, as a definitive diagnosis can be difficult without complete information.

Bilateral non-arteritic ischemic optic neuropathy in a transsexual woman using excessive estrogen dosage.

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Wierckx, Katrien; De Zaeytijd, Julie; Elaut, Els; Heylens, Gunter; T'Sjoen, Guy

2014-02-01

We present a case report on a 53-year-old transsexual woman who developed acute painless vision loss in both eyes during cross-sex hormone treatment. After 10 months of cross-sex hormone treatment, she experienced total vision loss of the right eye and, 6 months later, vision loss to 20/63 in the left eye. After a full ophthalmic exam, bilateral sequential non-arteritic ischemic optic neuropathy (NA-ION) was diagnosed. Extensive etiological work-up revealed no cardiac abnormalities or inherited blood-clotting disorders. A manifest self-administered overdose of transdermal estrogen treatment with serum estradiol levels of 5,765 pg/ml was possibly related to the sequential bilateral NA-ION resulting in nearly total vision loss in this transsexual woman.

Postradiation leiomyosarcoma of the orbit complicating bilateral retinoblastoma

International Nuclear Information System (INIS)

Font, R.L.; Jurco, S.; Brechner, R.J.

1983-01-01

A 31-year-old woman had bilateral retinoblastoma diagnosed in early childhood. The right eye was enucleated at the age of 1 year, and the left eye was treated with radiation therapy (a total dose of 16,000 rad). Twenty-three years later, in 1975, a subcutaneous mass was noted in the left periorbital region. A biopsy specimen of the mass was taken and a diagnosis of pleomorphic postradiation sarcoma was made. Electron microscopic studies of the periorbital mass confirmed the diagnosis of leiomyosarcoma. After additional radiation therapy, the residual mass was surgically excised. Five years later, a right renal mass, which histologically proved to be a renal cell carcinoma, was discovered. She was treated with nephrectomy, radiation, and chemotherapy. A recent follow-up examination disclosed that the patient is alive and apparently without any evidence of metastatic disease, 30 years after the diagnosis of bilateral retinoblastoma was made. The literature is reviewed regarding postradiation sarcomas and the occurrence of second malignant neoplasms in patients with retinoblastoma

Postradiation leiomyosarcoma of the orbit complicating bilateral retinoblastoma.

Science.gov (United States)

Font, R L; Jurco, S; Brechner, R J

1983-10-01

A 31-year-old woman had bilateral retinoblastoma diagnosed in early childhood. The right eye was enucleated at the age of 1 year, and the left eye was treated with radiation therapy (a total dose of 16,000 rad). Twenty-three years later, in 1975, a subcutaneous mass was noted in the left periorbital region. A biopsy specimen of the mass was taken and a diagnosis of pleomorphic postradiation sarcoma was made. Electron microscopic studies of the periorbital mass confirmed the diagnosis of leiomyosarcoma. After additional radiation therapy, the residual mass was surgically excised. Five years later, a right renal mass, which histologically proved to be a renal cell carcinoma, was discovered. She was treated with nephrectomy, radiation, and chemotherapy. A recent follow-up examination disclosed that the patient is alive and apparently without any evidence of metastatic disease, 30 years after the diagnosis of bilateral retinoblastoma was made. The literature is reviewed regarding postradiation sarcomas and the occurrence of second malignant neoplasms in patients with retinoblastoma.

Bilateral spontaneous hemotympanum: Case report

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Economou Nicolas C

2006-10-01

Full Text Available Abstract Background The most common causes of hemotympanum are therapeutic nasal packing, epistaxis, blood disorders and blunt trauma to the head. Hemotympanum is characterized as idiopathic, when it is detected in the presence of chronic otitis media. A rare case of spontaneous bilateral hemotympanum in a patient treated with anticoagulants is presented herein. Case presentation A 72-year-old male presented with acute deterioration of hearing. In the patient's medical history aortic valve replacement 1 year before presentation was reported. Since then he had been administered regularly coumarinic anticoagulants, with INR levels maintained between 3.4 and 4.0. Otoscopy revealed the presence of bilateral hemotympanum. The audiogram showed symmetrical moderately severe mixed hearing loss bilaterally, with the conductive component predominating. Tympanograms were flat bilaterally with absent acoustic reflexes. A computerized tomography scan showed the presence of fluid in the mastoid and middle ear bilaterally. Treatment was conservative and consisted of a 10-day course of antibiotics, anticongestants and temporary interruption of the anticoagulant therapy. After 3 weeks, normal tympanic membranes were found and hearing had returned to previous levels. Conclusion Anticoagulant intake should be included in the differential diagnosis of hemotympanum, because its detection and appropriate treatment may lead to resolution of the disorder.

The direction of bilateral transfer depends on the performance parameter.

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Pan, Zhujun; van Gemmert, Arend W A

2013-10-01

To acquire a more comprehensive understanding of the learning benefits associated with bilateral transfer and to gain knowledge of possible mechanisms behind bilateral transfer, we investigated the transfer direction of several parameters which are assumed to represent important features of movement control in a visuo-motor task. During the study, participants learned a multidirectional point-to-point drawing task in which the visual feedback was rotated 45° and the gain was increased. Performance changes of the untrained hand in movement time, trajectory length, normalized jerk, initial direction error, ratio of the primary sub-movement time to the total movement time, and the accuracy of the aiming movement after the primary sub-movement were investigated as indices of learning from bilateral transfer. The results showed that performance parameters related to the initial production of the movement, such as the initial direction, ratio of primary sub-movement to the total movement time, and movement accuracy after the primary sub-movement, only transferred to the non-dominant, while hand performance variables related to the overall outcome, such as movement duration, movement smoothness, and trajectory length, transferred in both directions. The findings of the current study support the basic principle of the "dynamic dominance model" because it is suggested that overall improvements in the non-dominant system are controlled by trajectory parameters in visuo-motor tasks, which resulted in transference of the afore mentioned production parameters to rather occur to the non-dominant hand as opposed to transference to the dominant hand. Published by Elsevier B.V.

Bilateral Keratectasia 34 Years after Corneal Transplant

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Xavier Valldeperas

2010-07-01

Full Text Available We report the clinical findings of a patient with severe bilateral keratectasia 34 years after a penetrating keratoplasty (PK in both eyes. An otherwise healthy 67-year-old man complained of deterioration of the eyesight in both eyes over the last 6 months. The patient was diagnosed with bilateral keratoconus at the age of 32 years, and he underwent a bilateral PK. At presentation, visual acuity was 20/200 in the right eye and light perception in the left eye. A Pentacam pachymetric map revealed a central pachymetry of 720 µm in the right eye and of 710 µm in the left eye, as well as an average paracentral pachymetry of 436 and 270 µm in the 9-mm zone in the right and the left eye, respectively. Corneal topography revealed bilateral irregular and asymmetric bowing with generalized steepening and high corneal power. We describe a case of bilateral keratectasia 34 years after PK in a patient who was originally diagnosed with bilateral keratoconus.

Bilateral tubercular mastitis

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Kant Surya

2007-01-01

Full Text Available Breast tuberculosis is a rare form of tuberculosis. Moreover the disease is often overlooked and misdiagnosed as carcinoma or pyogenic abscess. Reports on breast tuberculosis from India have been few; reported incidence of breast tuberculosis amongst the total number of mammary conditions varies between 0.64 and 3.59 per cent. Bilateral involvement is still more uncommon (3%. Most accepted view for spread of infection is centripetal lymphatic spread as axillary node involvement was shown to occur in 50 to 75 per cent of cases of tubercular mastitis. Here we re-port a case of a young female who presented with draining sinuses in the breast and no axillary lymphadenopathy. Fine needle aspiration cytology (FNAC of breast lump showed evidence of granulomatous mastitis. She was given therapeutic trial of four drug antitubercular treatment. Both the lump disappeared and sinus healed after six months of antitubercular treatment. Thus a retrospective diagnosis of tu-bercular mastitis was made.

A boy with bilateral SUNA

DEFF Research Database (Denmark)

Vuković Cvetković, Vlasta; Jensen, Rigmor Højland

2017-01-01

secondary causes should be searched for vigorously if there are bilateral symptoms. Despite a number of therapeutic trials, effective management for the majority of SUNA patients is not available at present. Management of SUNA is often difficult. Case We report the case of a young boy with bilateral SUNA...

Bilateral juvenile nasopharyngeal angiofibroma: report of a case.

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Wu, Edward C; Chark, Davin W; Bhandarkar, Naveen D

2014-07-01

Juvenile nasopharyngeal angiofibroma (JNA) is the most common benign neoplasm of the nasopharynx. Almost always unilateral on diagnosis, JNAs are locally invasive and may extend across the midline, giving a false bilateral appearance; as such, true bilateral JNA is exceedingly rare. We present a recent case of true bilateral JNA. Single case report of a patient with bilateral JNA, including clinical presentation, diagnosis, and management. The patient presented with unilateral nasal obstruction and recurrent epistaxis. Computed tomography and magnetic resonance imaging demonstrated bilateral, noncontiguous masses. Angiography revealed independent vascular supplies from each respective side with no bilateral supply noted. The patient underwent preoperative embolization followed by endoscopic surgical removal of the larger mass; no complications were noted. Follow-up at 2 years demonstrated no recurrence or growth. The vast majority of JNAs are unilateral, though invasive growth to the contralateral side may appear "bilateral" in presentation. Proper identification of true bilateral JNA is helpful in guiding management, wherein excision of both tumors may not be necessary. © 2014 ARS-AAOA, LLC.

Genetic susceptibility to bilateral tinnitus in a Swedish twin cohort

DEFF Research Database (Denmark)

Maas, Iris Lianne; Brüggemann, Petra; Requena, Teresa

2017-01-01

PURPOSE: Genetic contributions to tinnitus have been difficult to determine due to the heterogeneity of the condition and its broad etiology. Here, we evaluated the genetic and nongenetic influences on self-reported tinnitus from the Swedish Twin Registry (STR). METHODS: Cross-sectional data from...... the STR was obtained. Casewise concordance rates (the risk of one twin being affected given that his/her twin partner has tinnitus) were compared for monozygotic (MZ) and dizygotic (DZ) twin pairs (N = 10,464 concordant and discordant twin pairs) and heritability coefficients (the proportion of the total...... variance attributable to genetic factors) were calculated using biometrical model fitting procedures. RESULTS: Stratification of tinnitus cases into subtypes according to laterality (unilateral versus bilateral) revealed that heritability of bilateral tinnitus was 0.56; however, it was 0.27 for unilateral...

Bilateral and pseudobilateral tonsilloliths: Three dimensional imaging with cone-beam computed tomography

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Misirlioglu, Melda; Adisen, Mehmet Zahit; Yardimci, Selmi [Dept. of Oral and Maxillofacial Radiology, Faculty of Dentistry, Kirikkale University, Kirikkale (Turkmenistan); Nalcaci, Rana [Dept. of Oral and Maxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara (Turkmenistan)

2013-09-15

Tonsilloliths are calcifications found in the crypts of the palatal tonsils and can be detected on routine panoramic examinations. This study was performed to highlight the benefits of cone-beam computed tomography (CBCT) in the diagnosis of tonsilloliths appearing bilaterally on panoramic radiographs. The sample group consisted of 7 patients who had bilateral radiopaque lesions at the area of the ascending ramus on panoramic radiographs. CBCT images for every patient were obtained from both sides of the jaw to determine the exact locations of the lesions and to rule out other calcifications. The calcifications were evaluated on the CBCT images using Ez3D2009 software. Additionally, the obtained images in DICOM format were transferred to ITK SNAP 2.4.0 pc software for semiautomatic segmentation. Segmentation was performed using contrast differences between the soft tissues and calcifications on grayscale images, and the volume in mm{sup 3} of the segmented three dimensional models were obtained. CBCT scans revealed that what appeared on panoramic radiographs as bilateral images were in fact unilateral lesions in 2 cases. The total volume of the calcifications ranged from 7.92 to 302.5mm{sup 3}. The patients with bilaterally multiple and large calcifications were found to be symptomatic. The cases provided the evidence that tonsilloliths should be considered in the differential diagnosis of radiopaque masses involving the mandibular ramus, and they highlight the need for a CBCT scan to differentiate pseudo- or ghost images from true bilateral pathologies.

Bilateral complex regional pain syndrome following spinal cord injury and bilateral calcaneus fracture

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Ahmet Boyacı

2013-09-01

Full Text Available Complex regional pain syndrome (CRPS is a disease affectingone or more extremities, characterized by spontaneouspain, allodynia, hyperpathia and hyperalgesia.CRPS is separated into Type 1 and Type 2. CRPS whichdevelops after a nociceptive event is labeled as Type 1and when it develops following peripheral nerve damage,Type 2. Although the pathogenesis is not fully understood,peripheral and central sensitivity are held responsible.Bilateral lower extremity involvement is extremely rare.However, it should be borne in mind that it can develop intraumatic injuries which occur in more than one area anddiagnosis and commencement of a rehabilitation programshould be made in the early period. The case is presentedhere of bilateral Type 1 CRPS developing after incompletespinal cord injury and bilateral calcaneus fracture. JClin Exp Invest 2013; 4 (3: 360-363Key words: complex regional pain syndrome, calcaneusfracture, spinal cord injury

An Unusual Case of Neuralgic Amyotrophy Presenting with Bilateral Phrenic Nerve and Vocal Cord Paresis

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F. Holtbernd

2011-02-01

Full Text Available Background: Neuralgic amyotrophy (brachial plexus neuropathy, brachial plexus neuritis, or Parsonage-Turner syndrome is an uncommon inflammatory condition typically characterized by acute and severe shoulder pain followed by paresis with muscle weakness and atrophy of the upper limb or shoulder girdle. We report an unusual clinical manifestation of neuralgic amyotrophy, namely bilateral phrenic nerve palsy with concomitant laryngeal paresis. Case Report: A 55-year-old male presented with orthopnea and aphonia after an episode of bilateral shoulder pain preceded by an upper respiratory tract infection. Spirometry, chest X-ray and videolaryngoscopy revealed bilateral and simultaneous paresis of the diaphragm and the vocal cords. Clinical examination at admission and at the 2-month follow-up did not show upper limb weakness or atrophy, except for a mild atrophy of the right supraspinatus muscle. An electromyography of the upper limb muscles and nerve conduction studies did not reveal signs of denervation. Analysis of the cerebrospinal fluid and an MRI of the neuraxis were unremarkable. After treatment with prednisolone, vocal cord function markedly improved within 8 weeks, whereas paresis of the diaphragm persisted. Conclusion: Shoulder pain followed by diaphragmatic paralysis with dyspnea and hoarseness may be a manifestation of neuralgic amyotrophy even if upper limb or shoulder girdle palsies are absent.

Percutaneous microsphere compression for the treatment of bilateral primary trigeminal neuralgia

International Nuclear Information System (INIS)

Li Yanfeng; Ma Yi; Huang Haitao; Zou Jianjun; Wang Bin; Li Fuyong; Wang Quancai

2010-01-01

Objective: To evaluate the clinical effectiveness of percutaneous microsphere compression (PMC) in treating bilateral primary trigeminal neuralgia and to discuss the optimal contralateral operation time after one side trigeminal neuralgia was treated with PMC. Methods: From Dec.2000 to Aug. 2009 PMC was performed in 74 patients with bilateral primary trigeminal neuralgia. The clinical data were retrospectively analyzed. Based on the pain-relieving degree the therapeutic effect was evaluated. Complete disappearance of pain was regarded as the criteria of a successful procedure. According to the recovery of mastication function of the operated side, the operation time for the contralateral side was decided. Results: A total of 145 PMC procedures were carried out in 74 patients,including three repeated operations in 3 cases due to recurrent pain after initial PMC. The postoperative instant effective rate was 96.5%. The recurrence rate was 2.1% during a mean follow-up period of 2.9 years (ranged 1-7 years). Of the 74 patients, bilateral PMC was accomplished in 68, and among them 57 patients received the contralateral operation within 1-3 months after the initial procedure was finished. Conclusion: Percutaneous microsphere compression is a quite effective treatment for bilateral primary trigeminal neuralgia. Usually, PMC for the contralateral side can be considered to perform in 1-3 months after the initial procedure. (authors)

Simultan bilateral perifer facialisparese er en sjælden præsentationsform af Guillain-Barrés syndrom

DEFF Research Database (Denmark)

Frahm-Falkenberg, Siska; Dornonville de la Cour, Charlotte; Andersen, Preben Borring

2014-01-01

This case report describes a 63-year-old male presenting with five days progressing bilateral peripheral facial paralysis and mild sensory symptoms. Cerebrospinal fluid showed albumin-cytological dissociation. Nerve conduction studies showed slightly reduced conduction velocity, slightly prolonged...... F-wave latency and temporal dispersion. Following treatment with IV immunoglobulin (0.4 g/kg/day for five consecutive days) recovery was prominent, though incomplete. This is believed to be the first described case in Denmark of the very rare variant of Guillain-Barré syndrome termed "facial...

Reducción simultánea del enfisema bulloso bilateral por esternotomía media

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Armando Leal Mursulí

2000-12-01

esternotomía media constituye el procedimiento de elección para esta enfermedad, en virtud de los beneficios que reporta. Este procedimiento se considera actualmente una modalidad de la cirugía de reducción del volumen pulmonar, técnica de punta en la cirugía torácica modernaIt is reported that pulmonary emphysema is a chronic and disabling disease in which the bilateral giant bullae (that occupy more than 50% of each hemithorax may produce a clinical form characterized by dyspnoea and impossibility of a satisfactory quality of life treated by the conventional method (2 thoracotomies, synchronic or not until 1973. The mean sternotomy for bilateral and simultaneous resection of the bilateral emphysema was performed for the first time in Cuba in 1987 by the Multidisciplinary Group of Thoracic Surgery at the "Miguel Enriquez"< Clinical and Surgical Teaching Hospital. Age, sex, personal pathological history, preoperative complementary tests, the time of removal of the pleural tubes, complications, mortality, and postoperative evolution at 6 and 12 months were evaluated as part of a prospective research and the usefulness of this technique was compared with the conventional one. The data obtained were processed by a computerized pogram in order to express them in tables and figures. The fifth decade of life and the male sex were the most affected. The most used preoperative complementary tests were chest X-rays and fluoroscopy, gasometry and the functional ventilatory tests. Dyspnoea was the most frequent syndrome. The average time of removal of the pleural tubes was of 8 days. The airway leak was the commonest complication. There was no operative mortality. Postoperative evolution was excellent and the comparison between both surgical techniques showed the scientific, economic and social superiority of the simultaneous resection of the bilateral bullous emphysema by mean sternotomy. It is concluded that the simultaneous surgical treatment of bilateral bullous emphysema by

Bilateral Facial Paralysis Caused by Bilateral Temporal Bone Fracture: A Case Report and a Literature Review

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Sultan Şevik Eliçora

2015-01-01

Full Text Available Bilateral facial paralysis caused by bilateral temporal bone fracture is a rare clinical entity, with seven cases reported in the literature to date. In this paper, we describe a 40-year-old male patient with bilateral facial paralysis and hearing loss that developed after an occupational accident. On physical examination, House-Brackmann (HB facial paralysis of grade 6 was observed on the right side and HB grade 5 paralysis on the left. Upon temporal bone computed tomography (CT examination, a fracture line exhibiting transverse progression was observed in both petrous temporal bones. Our patient underwent transmastoid facial decompression surgery of the right ear. The patient refused a left-side operation. Such patients require extensive monitoring in intensive care units because the presence of multiple injuries means that facial functions are often very difficult to evaluate. Therefore, delays may ensue in both diagnosis and treatment of bilateral facial paralysis.

Challenges in the reconstruction of bilateral maxillectomy defects.

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Joseph, Shawn T; Thankappan, Krishnakumar; Buggaveeti, Rahul; Sharma, Mohit; Mathew, Jimmy; Iyer, Subramania

2015-02-01

Bilateral maxillectomy defects, if not adequately reconstructed, can result in grave esthetic and functional problems. The purpose of this study was to investigate the outcome of reconstruction of such defects. This is a retrospective case series. The defects were analyzed for their components and the flaps used for reconstruction. Outcomes for flap loss and functional indices, including oral diet, speech, and dental rehabilitation, also were evaluated. Ten consecutive patients who underwent bilateral maxillectomy reconstruction received 14 flaps. Six patients had malignancies of the maxilla, and 4 patients had nonmalignant indications. Ten bony free flaps were used. Four soft tissue flaps were used. The fibula free flap was the most common flap used. Three patients had total flap loss. Seven patients were alive and available for functional evaluation. Of these, 4 were taking an oral diet with altered consistency and 2 were on a regular diet. Speech was intelligible in all patients. Only 2 patients opted for dental rehabilitation with removable dentures. Reconstruction after bilateral maxillectomy is essential to prevent esthetic and functional problems. Bony reconstruction is ideal. The fibula bone free flap is commonly used. The complexity of the defect makes reconstruction difficult and the initial success rate of free flaps is low. Secondary reconstructions after the initial flap failures were successful. A satisfactory functional outcome can be achieved. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Bulectomia bilateral por cirurgia torácica vídeo-assistida uniportal combinada com acesso contralateral ao mediastino anterior Bilateral bullectomy through uniportal video-assisted thoracoscopic surgery combined with contralateral access to the anterior mediastinum

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Nan Song

2013-02-01

Full Text Available OBJETIVO: A cirurgia torácica vídeo-assistida (CTVA tem sido uma intervenção de escolha para o tratamento de pneumotórax espontâneo (PS com bolha pulmonar. Nosso objetivo foi apresentar uma abordagem de CTVA uniportal unilateral para bulectomia bilateral e avaliar sua eficácia terapêutica. MÉTODOS: Entre maio de 2011 e janeiro de 2012, cinco pacientes foram submetidos a bulectomia bilateral por essa abordagem. Todos apresentavam PS bilateral. A TCAR pré-operatória mostrou que todos os pacientes tinham bolhas bilaterais no pulmão apical. As indicações cirúrgicas, os procedimentos de operação e os desfechos foram revisados. RESULTADOS: Todos os pacientes foram submetidos com sucesso a essa abordagem para bulectomia bilateral, sem complicações intraoperatórias. A mediana de tempo para a retirada do dreno torácico foi de 4,2 dias, e a mediana do tempo de hospitalização no pós-operatório foi de 5,2 dias. A mediana de seguimento pós-operatório foi de 11,2 meses. Um paciente teve recidiva de PE do lado esquerdo três semanas após a cirurgia e foi submetido a abrasão pleural. CONCLUSÕES: A bulectomia bilateral utilizando CTVA uniportal combinada com acesso contralateral ao mediastino anterior é tecnicamente confiável e promove desfechos favoráveis para pacientes com PS que desenvolvem bolhas bilaterais no pulmão apical. Entretanto, para a realização desse procedimento cirúrgico, são necessários cirurgiões com experiência em CTVA, instrumentos toracoscópicos longos, entre outras exigências.OBJECTIVE: Video-assisted thoracoscopic surgery (VATS has been a surgical intervention of choice for the treatment of spontaneous pneumothorax (SP with lung bulla. Our objective was to introduce a uniportal VATS approach for simultaneous bilateral bullectomy and to evaluate its therapeutic efficacy. METHODS: Between May of 2011 and January of 2012, five patients underwent bilateral bullectomy conducted using this approach. All

A rare case of bilateral optic nerve sheath meningioma

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Somen Misra

2014-01-01

Full Text Available A 60-year-old female presented with gradual, painless, progressive diminution of vision, and progressive proptosis of left eye since 7 years. Ophthalmological examination revealed mild proptosis and total optic atrophy in the left eye. Magnetic resonance imaging (MRI and computed tomography (CT brain with orbit showed bilateral optic nerve sheath meningioma (ONSM involving the intracranial, intracanalicular, intraorbital part of the optic nerve extending up to optic chiasma and left cavernous sinus.

Bilateral optic neuropathy in acute cryptococcal meningitis

Institute of Scientific and Technical Information of China (English)

Qi Zhe Ngoo; Li Min Evelyn Tai; Wan Hazabbah Wan Hitam; John Tharakan

2016-01-01

We reported a case of cryptococcal meningitis presenting with bilateral optic neuropathy in an immunocompetent patient. A 64-year-old Malay gentleman with no medical comorbidities presented with acute bilateral blurring of vision for a week, which was associated with generalised throbbing headache and low grade fever. He also had som-nolence and altered consciousness. Visual acuity in both eyes was no perception of light with poor pupillary reflexes. Extraocular muscle movements were normal. Anterior segments were unremarkable bilaterally. Fundoscopy revealed bilateral optic disc swelling. CT scan of the brain showed multifocal infarct, but no meningeal enhancement or mass. Cerebrospinal fluid opening pressure was normal, while its culture grew Cryptococcus neoformans. A diagnosis of cryptococcal meningitis with bilateral optic neuropathy was made. Patient was treated with a six-week course of intravenous flu-conazole and started concomitantly on a fortnight's course of intravenous amphotericin B. After that, his general condition improved, but there was still no improvement in his visual acuity. On reviewing at two months post-initiation of treatment, fundi showed bilateral optic atrophy. Bilateral optic neuropathy secondary to cryptococcal meningitis was rare. The prognosis was guarded due to the sequelae of optic atrophy. Anti-fungal medication alone may not be sufficient to manage this condition. However, evidence for other treatment modalities is still lacking and further clinical studies are required.

Proceedings of the 8th Japan-China bilateral symposium on radiation chemistry

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Yamaoka, Hitoshi; Hase, Hirotomo; Makuuchi, Keizou [eds.

2000-03-01

This issue is the collection of papers presented at The 8th Japan-China Bilateral Symposium on Radiation Chemistry held on October 25-29, 1999 at Kyodai Kaikan in Kyoto. The total number of the contributed papers is 69 which consists of 41 and 28 papers for oral and poster presentations, respectively. The papers presented are classified into five categories: A: Radiation Chemistry - Fundament (21 papers), B: Radiation Chemistry - Polymer (10 papers), C: Radiation Chemistry - Biological System (8 papers), D: Radiation Processing (19 papers), and E: Advanced Radiation Chemistry - Ion Beams and Positron (11 papers). The output of the Symposium and the history of the Bilateral Symposium were compiled in the Closing. (J.P.N.)

Bilateral renal calculi

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Sreenevasan, G

1974-01-01

Bilateral renal calculi were present in 114 (10.7%) of 1,070 cases of proved urinary calculus admitted to the Urological Department of the General Hospital, Kuala Lumpur, during the period November 1968—May 1973. The management of bilateral renal calculi is discussed with reference to the first 100 cases in this series. The introduction of renography has greatly facilitated the decision as to which kidney should be operated on first. The management of patients with and without uraemia is discussed and the use of the modified V and V—Y incisions for the removal of staghorn calculi is described. Complications and results are briefly reviewed. ImagesFig. 1Fig. 4Fig. 6Fig. 7 PMID:4845653

FLOWING BILATERAL FILTER: DEFINITION AND IMPLEMENTATIONS

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Maxime Moreaud

2015-06-01

Full Text Available The bilateral filter plays a key role in image processing applications due to its intuitive parameterization and its high quality filter result, smoothing homogeneous regions while preserving the edges of the objects. Considering the image as a topological relief, seeing pixel intensities as peaks and valleys, we introduce a way to control the tonal weighting coefficients, the flowing bilateral filter, reducing "halo" artifacts typically produced by the regular bilateral filter around a large peak surrounded by two valleys of lower values. In this paper we propose to investigate exact and approximated versions of CPU and parallel GPU (Graphical Processing Unit based implementations of the regular and flowing bilateral filter using the NVidia CUDA API. Fast implementations of these filters are important for the processing of large 3D volumes up to several GB acquired by x-ray or electron tomography.

Association between unilateral or bilateral mastectomy and breast cancer death in patients with unilateral ductal carcinoma.

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Agarwal, Shailesh; Pappas, Lisa; Agarwal, Jayant

2017-01-01

Utilization of bilateral mastectomy for unilateral breast cancer is increasing despite cost and surgical risks with conflicting reports of survival benefit. Current studies evaluating death after bilateral mastectomy have included patients treated both with breast conservation therapy and unilateral mastectomy. In this study, we directly compared breast cancer-specific death of patients who underwent bilateral or unilateral mastectomy for unilateral breast cancer using a matched cohort analysis. This was an observational study of women diagnosed with unilateral breast cancer from 1998 through 2002, using the Surveillance, Epidemiology, and End Results (SEER) database. A 4-to-1 matched cohort of patients was selected including 14,075 patients. Mortality of the groups was compared using Cox proportional hazards models for cause-specific death. A total of 41,510 patients diagnosed with unilateral breast cancer were included. Unilateral mastectomy was performed in 93% of patients, while bilateral mastectomy was performed in the remaining 7% of patients. When 4-to-1 matching was performed, 11,260 unilateral mastectomy and 2,815 bilateral mastectomy patients were included. Patients with bilateral mastectomy did not have a significantly lower hazard of breast cancer-specific death when compared with patients with unilateral mastectomy (hazard ratio: 0.92 vs 1.00, p =0.11). Bilateral mastectomy did not provide a clinically or statistically significant breast cancer-specific mortality benefit over unilateral mastectomy based on a matched cohort analysis of a nationwide population database. These findings should be interpreted in the context of patient preference and alternative benefits of bilateral mastectomy.

Achondroplasia Associated with Bilateral Keratoconus

Directory of Open Access Journals (Sweden)

Ammar M. Al Mahmood

2012-01-01

Full Text Available We report a rare case of bilateral keratoconus in association with achondroplasia. A 26-year-old male, with a known case of achondroplasia, complained of bilateral gradual deterioration in vision for the past few years. Slit lamp biomicroscopy showed bilateral central corneal protrusion and stromal thinning at the apex consistent with keratoconus. a trial of hard contact lens fitting failed to improve VA in the left eye (LE. Right eye (RE improved to 20/25. The patient underwent penetrating keratoplasty (PKP in his LE. Twenty-seven months postoperatively, uncorrected visual acuity (UCVA was 20/30. Ophthalmologists should be aware that patients with achondroplasia who complain of poor vision should be suspected of having keratoconus once other more common conditions are ruled out.

Determinants of Iran's BilateralIntra-industry Trade in Pharmaceutical Industry.

Science.gov (United States)

Aghlmand, Siamak; Rahimi, Bahlol; Farrokh-Eslamlou, Hamidreza; Nabilou, Bahram; Yusefzadeh, Hassan

2018-01-01

Among non-oil and in trade arena, drug has always been strategic importance and most government especially industrialized countries pay special attention to its production and trade issues. Thus, having a comprehensive view from economic perspective to this section is essential for suggesting intervention. This was a descriptive-analytical and panel study. In this study, gravity model is used to estimate Iran's bilateral intra-industry trade in pharmaceutical products in the 2001-2012 periods. To illustrate the extent of pharmaceutical's intra-industry trade between Iran and its major trading partners, the explanatory variables of market size, income, factor endowments, distance, cultural contributions, and similarities and also special trade arrangements have been applied. Analysis of factors affecting Iran's bilateral intra-industry trade in pharmaceutical industry showed that the average GDP and cultural similarities had a significant positive impact on Iran's bilateral IIT, while the difference in GDP has a negative and significant effect. Coefficients obtained for the geographical distance and the average ratio of total capital to the labor force is not consistent with theoretical expectations. Special trade arrangements did not have significant impact on the extent of bilateral intra-industry trade between Iran and its trading partners. The knowledge of the intra-industry trade between Iran and its trade partners make integration between the countries. Factors affecting this type of trade pattern underlie its development in trade relationship. Therefore, the findings of this study would be useful in helping to develop and implement policies for the expansion of the pharmaceutical trade.

Bilateral Complex Regional Pain Syndrome after Fracture of Bilateral Tibia and Fibula

Directory of Open Access Journals (Sweden)

Senem Şaş

2017-04-01

Full Text Available Complex regional syndrome type 1 (CRPS-1 is a painful clinical condition. It occurs after a painful event and characterized by allodynia, hyperalgesia, edema, abnormalities in skin blood flow and abnormal sudomotor activity. When CRPS-1 is associated with nerve injury, it is defined as CRPS-2. Central and peripheral theory are responsible in etiopathogenesis of CRPS-1. Generally it occurs in the injured limb. But, it may ocur in the opposite extremities. In this article, we present a case developing bilateral CRPS-1 after bilateral tibia and fibula fracture by reviewing current literatüre.

The simultaneous boost technique

International Nuclear Information System (INIS)

Lebesque, J.V.; Keus, R.B.

1991-01-01

Simultaneous boost technique in radiotherapy consists of delivering the boost treatment (additional doses to reduced volumes) simultaneously with the basic (large-field) treatment for all treatment sessions. Both the dose per fraction delivered by basic-treatment fields and by boost-treatment fields have to be reduced to end up with the same total dose in boost volume as in the original schedule, where basic treatment preceded boost treatment. These dose reductions and corresponding weighting factors have been calculated using the linear-quadratic (LQ) model and the concept of Normalized Total Dose (NTD). Relative NTD distributions were computed to evaluate the dose distributions resulting for the simultaneous boost technique with respect to acute and late normal tissue damage and tumor control. For the example of treatment of prostate cancer the weighting factors were calculated on basis of NTD for late normal tissue damage. For treatment of oropharyngeal cancer NTD for acute and normal tissue damage was used to determine the weighting factors. In this last example a theoretical sparing of late normal tissue damage can be demonstrated. Another advantage of simultaneous boost technique is that megavoltage images of the large basic-treatment fields facilitates the determination of the position of the patient with respect to the small boost-treatment fields. (author). 42 refs., 8 figs

Bilateral tension pneumothorax after acupuncture.

Science.gov (United States)

Mohammad, Nurashikin

2018-04-19

Acupuncture is an ancient complementary medicine which is currently used worldwide. Many serious adverse events have been reported which include a spectrum of mild-to-fatal complications. However, the level of awareness with regard to complications is still low both to physicians and patients. We report a 63-year-old who presented with acute shortness of breath 2 hours after having had acupuncture. On examination, there was absent breath sound heard on the left lung and slightly reduced breath sound on the right lung. She had type 1 respiratory failure. Urgent chest radiograph confirmed bilateral pneumothorax which was more severe on the left with tension pneumothorax and mediastinal shift. Chest tubes were inserted bilaterally after failed needle aspiration attempts. Subsequently, the pneumothoraces resolved, and she was discharged well. The bilateral pneumothoraces caused by acupuncture were curable but could have been potentially fatal if diagnosis was delayed. This case report adds to the limited current literature on the complications of acupuncture leading to bilateral pneumothoraces. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Hydraulic bilateral construction robot; Yuatsushiki bilateral kensetsu robot

Energy Technology Data Exchange (ETDEWEB)

Maehata, K.; Mori, N. [Kayaba Industry Co. Ltd., Tokyo (Japan)

1999-05-15

Concerning a hydraulic bilateral construction robot, its system constitution, structures and functions of important components, and the results of some tests are explained, and the researches conducted at Gifu University are described. The construction robot in this report is a servo controlled system of a version developed from the mini-shovel now available in the market. It is equipped, in addition to an electrohydraulic servo control system, with various sensors for detecting the robot attitude, vibration, and load state, and with a camera for visualizing the surrounding landscape. It is also provided with a bilateral joy stick which is a remote control actuator capable of working sensation feedback and with a rocking unit that creates robot movements of rolling, pitching, and heaving. The construction robot discussed here, with output increased and response faster thanks to the employment of a hydraulic driving system for the aim of building a robot system superior in performance to the conventional model designed primarily for heavy duty, proves after tests to be a highly sophisticated remotely controlled robot control system. (NEDO)

THE EUROPEAN UNION’S BILATERAL APPROACH

Directory of Open Access Journals (Sweden)

Ludmila BORTA

2014-12-01

Full Text Available The EU is a world economic power and a major trading partner for most countries. All the time, this region has been interested and has acted towards a free and fair trade. The decrease and even the elimination of tariff and non-tariff barriers in the world trade are among the main objectives of the EU strategy for international trade. At the moment, the elusive outcome of the WTO Doha Round has led to the proliferation of bilateral trade agreements worldwide. Although the EU remains committed to further development of the multilateral trading system, however, the EU still has appealed also to the development of bilateral trade relations. The aim of this paper is to illustrate the current bilateral dimension of the common commercial policy of the EU. In conclusion, to describe this bilateral approach of the EU we are using one word, namely “diversity”.

A case of bilateral tubal pregnancy

Directory of Open Access Journals (Sweden)

Ayano Funamizu

2017-11-01

Full Text Available Bilateral tubal pregnancy is very rare and occurs in only 1 out of every 200,000 spontaneous pregnancies. In this case, a 29-year-old woman with a history of primary infertility underwent treatment with human menopausal gonadotropin (hMG-human chorionic gonadotropin (hCG, and became pregnant. A gestational sac (GS was not detected in the uterus and transvaginal ultrasonography (USG revealed GS with fetal heartbeat in the left adnexa at 7 weeks and 6 days of gestation. The patient underwent laparoscopic surgery and ultimately, bilateral tubal pregnancy was diagnosed. Consequently, bilateral fallopian tube resection was performed. Afterwards, she conceived by assisted reproductive technology (ART and delivered vaginally. This case suggests that even if a GS is found in one fallopian tube by USG, it is important to evaluate the other fallopian tube carefully. Keywords: bilateral tubal pregnancy, ectopic pregnancy, human menopausal gonadotropin, laparoscopy

Genetic susceptibility to bilateral tinnitus in a Swedish twin cohort.

Science.gov (United States)

Maas, Iris Lianne; Brüggemann, Petra; Requena, Teresa; Bulla, Jan; Edvall, Niklas K; Hjelmborg, Jacob V B; Szczepek, Agnieszka J; Canlon, Barbara; Mazurek, Birgit; Lopez-Escamez, Jose A; Cederroth, Christopher R

2017-09-01

Genetic contributions to tinnitus have been difficult to determine due to the heterogeneity of the condition and its broad etiology. Here, we evaluated the genetic and nongenetic influences on self-reported tinnitus from the Swedish Twin Registry (STR). Cross-sectional data from the STR was obtained. Casewise concordance rates (the risk of one twin being affected given that his/her twin partner has tinnitus) were compared for monozygotic (MZ) and dizygotic (DZ) twin pairs (N = 10,464 concordant and discordant twin pairs) and heritability coefficients (the proportion of the total variance attributable to genetic factors) were calculated using biometrical model fitting procedures. Stratification of tinnitus cases into subtypes according to laterality (unilateral versus bilateral) revealed that heritability of bilateral tinnitus was 0.56; however, it was 0.27 for unilateral tinnitus. Heritability was greater in men (0.68) than in women (0.41). However, when female pairs younger than 40 years of age were selected, heritability of 0.62 was achieved with negligible effects of shared environment. Unlike unilateral tinnitus, bilateral tinnitus is influenced by genetic factors and might constitute a genetic subtype. Overall, our study provides the initial evidence for a tinnitus phenotype with a genetic influence.Genet Med advance online publication 23 March 2017.

Multiscale bilateral filtering for improving image quality in digital breast tomosynthesis

Science.gov (United States)

Lu, Yao; Chan, Heang-Ping; Wei, Jun; Hadjiiski, Lubomir M.; Samala, Ravi K.

2015-01-01

Purpose: Detection of subtle microcalcifications in digital breast tomosynthesis (DBT) is a challenging task because of the large, noisy DBT volume. It is important to enhance the contrast-to-noise ratio (CNR) of microcalcifications in DBT reconstruction. Most regularization methods depend on local gradient and may treat the ill-defined margins or subtle spiculations of masses and subtle microcalcifications as noise because of their small gradient. The authors developed a new multiscale bilateral filtering (MSBF) regularization method for the simultaneous algebraic reconstruction technique (SART) to improve the CNR of microcalcifications without compromising the quality of masses. Methods: The MSBF exploits a multiscale structure of DBT images to suppress noise and selectively enhance high frequency structures. At the end of each SART iteration, every DBT slice is decomposed into several frequency bands via Laplacian pyramid decomposition. No regularization is applied to the low frequency bands so that subtle edges of masses and structured background are preserved. Bilateral filtering is applied to the high frequency bands to enhance microcalcifications while suppressing noise. The regularized DBT images are used for updating in the next SART iteration. The new MSBF method was compared with the nonconvex total p-variation (TpV) method for noise regularization with SART. A GE GEN2 prototype DBT system was used for acquisition of projections at 21 angles in 3° increments over a ±30° range. The reconstruction image quality with no regularization (NR) and that with the two regularization methods were compared using the DBT scans of a heterogeneous breast phantom and several human subjects with masses and microcalcifications. The CNR and the full width at half maximum (FWHM) of the line profiles of microcalcifications and across the spiculations within their in-focus DBT slices were used as image quality measures. Results: The MSBF method reduced contouring artifacts

Bilateral sarkoidose i glandula parotis

DEFF Research Database (Denmark)

Hahn, Pernille; Krogdahl, Annelise; Godballe, Christian

2012-01-01

We describe an unusual case of sarcoidosis in which the patient presented with a bilateral swelling of the parotid salivary glands and no other manifestation of the disease. Sarcoidosis is a multisystem granulomatous disorder of unknown cause in which there may be multiple exocrine involvement......, including the salivary glands. This case emphasises the importance of including sarcoidosis in the differential diagnosis of bilateral parotid swelling....

MODERN VIEWS ON BILATERAL BREAST CANCER

Directory of Open Access Journals (Sweden)

Ye. A. Fesik

2014-01-01

Full Text Available Presented modern literature data on the features of the pathogenesis, course, clinical and morphological expression and tumor characteristics, parameters and nodal metastasis of hematogenous bilateral breast cancer. Highlight the results of domestic and foreign studies in recent years to determine the prognostic factors and recurrence of synchronous and metachronous bilateral breast cancer. It was revealed that the frequency of bilateral breast tumor lesions varies widely, ranging from 0.1 to 20%, with metachronous tumors recorded significantly higher (69.6% than the synchronous (22.7%. The probability of occurrence of metachronous breast cancer is higher in women with a family history, as well as if they have a gene mutation BRCA-1. Found that the most common histological type of breast tumor with bilateral lesions is invasive ductal. However, the incidence of invasive lobular cancer and non-invasive lobular cancer is slightly higher among synchronous bilateral cancer compared with unilateral disease. Studies have shown that in a double-sided synchronous breast cancer tumor, as a rule, has a lower degree of differentiation, and the higher the expression level of estrogen receptors and progesterone receptors. Relevance of the issue because the identification of patterns in the study of lymphatic and hematogenous features bilateral metastasis of mammary tumors provides a basis for speculation about the differences in the progression of neoplastic disease in these groups and is a cause for further detailed research in this area to identify and evaluate the prognosis and also the choice of tactics of such patients.

SU-E-T-522: Investigation of Underdosage of Total Body Irradiation with Bilateral Irradiation Scheme

Energy Technology Data Exchange (ETDEWEB)

Lin, T; Eldib, A; Hossain, M; Price, R; Ma, C [Fox Chase Cancer Center, Philadelphia, PA (United States)

2015-06-15

Purpose: Patient in-vivo measurements report lower readings than those predicted from TMR-based treatment planning on TBI patient knees and ankles where rice was placed to fill the gap between patient’s legs. This study is to understand and correct the under dosage of Total Body Irradiation(TBI) with rice tissue equivalent bolus placement at TBI treatment patient setup. Methods: Bilateral TBI scheme was investigated with rice bags bolus placing between patient’s two legs acting as missing tissue. In-house TMR based treatment planning system was commissioned with measurements under TBI condition at 10MV, i.e. source-to-reference distance 383.4cm with 40×40cm field size with 1cm thickness Lucite. Predictions of patient specific dose points are reported at different sites with 200cGy prescription at patient umbilicus point. Solid water and rice bag phantoms are used at TBI conditions for the attenuation factor verification and CT scanned to verify the CT number and electron density. Results: We found that the rice bag bolus overall density is 11% lower than the water; however, the attenuation factor of rice bags could become 15% lower than that of water at TBI condition. This overestimate of rice bag electron density could cause the lack of lateral scatter and the lack of backscatter. This could Result in an overestimate of dose at in-vivo dosimeter measurement points with TMR-based treatment planning systems. Observations of patient specific optically stimulated luminescent dosimeters(OSLDs) were used to confirm this overestimation. Measurements of setups with increasing the rice bag filled patient leg separation were performed to demonstrate eliminating the overdose issue. Conclusion: Rice bolus has a lower electron density than water does(11%) but results in 15% lower in attenuation factor at TBI condition. This effect was observed in patient delivery with OSLD measurements and can be corrected by increasing the filling rice bolus thickness with 15% longer of

SU-E-T-522: Investigation of Underdosage of Total Body Irradiation with Bilateral Irradiation Scheme

International Nuclear Information System (INIS)

Lin, T; Eldib, A; Hossain, M; Price, R; Ma, C

2015-01-01

Purpose: Patient in-vivo measurements report lower readings than those predicted from TMR-based treatment planning on TBI patient knees and ankles where rice was placed to fill the gap between patient’s legs. This study is to understand and correct the under dosage of Total Body Irradiation(TBI) with rice tissue equivalent bolus placement at TBI treatment patient setup. Methods: Bilateral TBI scheme was investigated with rice bags bolus placing between patient’s two legs acting as missing tissue. In-house TMR based treatment planning system was commissioned with measurements under TBI condition at 10MV, i.e. source-to-reference distance 383.4cm with 40×40cm field size with 1cm thickness Lucite. Predictions of patient specific dose points are reported at different sites with 200cGy prescription at patient umbilicus point. Solid water and rice bag phantoms are used at TBI conditions for the attenuation factor verification and CT scanned to verify the CT number and electron density. Results: We found that the rice bag bolus overall density is 11% lower than the water; however, the attenuation factor of rice bags could become 15% lower than that of water at TBI condition. This overestimate of rice bag electron density could cause the lack of lateral scatter and the lack of backscatter. This could Result in an overestimate of dose at in-vivo dosimeter measurement points with TMR-based treatment planning systems. Observations of patient specific optically stimulated luminescent dosimeters(OSLDs) were used to confirm this overestimation. Measurements of setups with increasing the rice bag filled patient leg separation were performed to demonstrate eliminating the overdose issue. Conclusion: Rice bolus has a lower electron density than water does(11%) but results in 15% lower in attenuation factor at TBI condition. This effect was observed in patient delivery with OSLD measurements and can be corrected by increasing the filling rice bolus thickness with 15% longer of

Towards assessing corticospinal excitability bilaterally: Validation of a double-coil TMS method.

Science.gov (United States)

Grandjean, Julien; Derosiere, Gerard; Vassiliadis, Pierre; Quemener, Louise; Wilde, Ysaline de; Duque, Julie

2018-01-01

For several decades, Transcranial magnetic stimulation (TMS) has been used to monitor corticospinal excitability (CSE) changes in various contexts. Habitually, single-coil TMS is applied over one primary motor cortex (M1), eliciting motor-evoked potentials (MEPs) in a contralateral limb muscle, usually a hand effector. However, in many situations, it would be useful to obtain MEPs in both hands simultaneously, to track CSE bilaterally. Such an approach requires stimulating both M1 concurrently while avoiding interference between the two descending stimuli. We examined MEPs obtained at rest using a double-coil TMS approach where the two M1 are stimulated with a 1ms inter-pulse interval (double-coil 1ms ). MEPs were acquired using double-coil 1ms (MEP double ) or single-coil (MEP single ) TMS, at five different intensities of stimulation (100, 115, 130, 145 or 160% of the resting motor threshold, rMT). Given the 1ms inter-pulse interval in double-coil 1ms trials, MEP double were either evoked by a 1st (MEP double-1 ) or a 2nd (MEP double-2 ) TMS pulse. All MEP TYPE (MEP TYPE =MEP single , MEP double-1 and MEP double-2 ) were equivalent, regardless of the hand within which they were elicited, the intensity of stimulation or the pulse order. This method allows one to observe state-related CSE changes for the two hands simultaneously on a trial-by-trial basis. These results infer the absence of any neural interactions between the two cortico-spinal volleys with double-coil 1ms TMS. Hence, this technique can be reliably used to assess CSE bilaterally, opening new research perspectives for scientists interested in physiological markers of activity in the motor output system. Copyright © 2017 Elsevier B.V. All rights reserved.

Paresia diafragmática bilateral idiopática Idiopathic bilateral diaphragmatic paresis

Directory of Open Access Journals (Sweden)

Mônica Corso Pereira

2006-10-01

Full Text Available Relata-se o caso de um paciente com dispnéia intensa ao se deitar, em que foram excluídas doenças pulmonares, neuromusculares ou cardíacas, cuja investigação revelou paresia diafragmática bilateral. Um sinal chave para o diagnóstico foi a evidência de respiração paradoxal com o doente em decúbito supino. Havia piora da oxigenação e da capacidade vital forçada com a mudança da posição ortostática para supina. A fluoroscopia ortostática foi normal. A pressão inspiratória máxima estava muito reduzida. A estimulação elétrica transcutânea do diafragma foi normal, e a eletroestimulação do nervo frênico mostrou ausência de resposta, permitindo o diagnóstico de paresia bilateral do diafragma.We report the case of a patient with severe dyspnea upon reclining. Lung disease, neuromuscular disorders and heart disease were ruled out. However, during the course of the investigation, bilateral diaphragmatic paresis was discovered. A key sign leading to the diagnosis was evidence of paradoxical respiration in the dorsal decubitus position. When the patient was moved from the orthostatic position to the dorsal decubitus position, oxygenation and forced vital capacity worsened. The orthostatic fluoroscopy was normal. Maximal inspiratory pressure was severely reduced. The responses to transcutaneous electric stimulation of the diaphragm were normal. However, electric stimulation of the phrenic nerve produced no response, leading to the diagnosis of bilateral diaphragmatic paresis.

Bilateral microperc in a severe kyphoscoliosis

OpenAIRE

Dağgülli, Mansur; Penbegül, Necmettin; Dede, Onur; Utanğaç, Mehmet Mazhar

2016-01-01

Percutaneous nephrolithotomy is the standard modality for large renal calculi in normal and abnormal renal anatomic situations. This case report describes a 57-year-old male patient who presented with bilateral kidney stones and severe kyphoscoliosis. He had successfully been treated with a bilateral microperc technique.

A case of bilateral trench foot.

Science.gov (United States)

Parsons, S L; Leach, I H; Charnley, R M

1993-12-01

A case of severe bilateral trench foot is presented in a patient who lived rough for 3 weeks without removing his boots. Non-operative management yielded no clinical improvement and bilateral below-knee amputation was necessary. Histology revealed subcutaneous and muscle necrosis with secondary arterial thrombosis.

Preservation of the External Jugular Vein in Bilateral Radical Neck Dissections: Technique in Two Cases and Review of the Literature

Directory of Open Access Journals (Sweden)

Rodrigo Lima Bastos da Rocha

2015-01-01

Full Text Available Context. The possibility of cephalic venous hypertension with the resultant facial edema and elevated cerebrospinal fluid pressure continues to challenge head and neck surgeons who perform bilateral radical neck dissections during simultaneous or staged procedures. Case Report. The staged procedure in patients who require bilateral neck dissections allows collateral venous drainage to develop, mainly through the internal and external vertebral plexuses, thereby minimizing the risks of deleterious consequences. Nevertheless, this procedure has disadvantages, such as a delay in definitive therapy, the need for a second hospitalization and anesthesia, and the risk of cutting lymphatic vessels and spreading viable cancer cells. In this paper, we discuss the rationale and feasibility of preserving the external jugular vein. Considering the limited number of similar reports in the literature, two cases in which this procedure was accomplished are described. The relevant anatomy and technique are reviewed and the patients’ outcomes are discussed. Conclusion. Preservation of the EJV during bilateral neck dissections is technically feasible, fast, and safe, with clinically and radiologically demonstrated patency.

Bilateral tubal ligation in a rural hospital in the Niger Delta, Nigeria ...

African Journals Online (AJOL)

Background and Objective: To document bilateral tubal ligation (BTL) rate and highlight the need to improve on the rates. Materials and Methods: A retrospective review of BTLs done in a five-year period from January 2000 to December 2004 constituted the study group. Results: There were a total of 103 BTLs, 58 were ...

Ceratite bilateral por Acanthamoeba: relato de caso Bilateral Acanthamoeba keratitis: case report

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Wilson Nahmatallah Obeid

2003-12-01

Full Text Available A ceratite por Acanthamoeba é uma infecção ocular grave que, apesar dos recentes progressos no diagnóstico e tratamento, ainda provoca prolongada morbidade e perda da acuidade visual. Relatamos um caso de ceratite bilateral por Acanthamoeba em usuário de lentes de contato, que é o primeiro caso descrito na literatura brasileira.Acanthamoeba keratitis is a severe ocular infection which even with recent progress in diagnosis and treatment still causes long morbidity and loss of visual acuity. We describe a case of bilateral Acanthamoeba keratitis in a user of contact lenses, which is the first case discussed in Brazilian literature.

Totally extraperitoneal (TEP) bilateral hernioplasty using the Single Site® robotic da Vinci platform (DV-SS TEP): description of the technique and preliminary results.

Science.gov (United States)

Cestari, A; Galli, A C; Sangalli, M N; Zanoni, M; Ferrari, M; Roviaro, G

2017-06-01

Laparoendoscopic single site totally extraperitoneal (TEP) hernia repair showed to be a feasible alternative to conventional laparoscopic hernia repair; nevertheless single site surgery, with the loss of instruments triangulation can be a demanding procedure. To overcome those hurdles, the Single Site® (SS) platform of the da Vinci (DV) Si robotic system enables to perform surgical procedures through a 25-mm skin incision, with a stable 3D vision and restoring an adequate triangulation of the surgical instruments. We present in details the technique and the preliminary results of DV-SS TEP, to our knowledge the first cases reported in literature. In March 2016, three consecutive male patients (mean age 46.6 years-mean BMI 25.3) with bilateral symptomatic inguinal hernia were submitted to DV-SS TEP in our institutions. Feasibility, codification of the technique, operative time and perioperative outcomes were recorded. All the procedures were completed as scheduled, with no conversion to other techniques. Mean operative time was 98.6 min, ranging between 155 and 55 min, reflecting the learning curve of the operating room team on this new procedure. No intraoperative or postoperative complications were experienced and all the patients were discharged within 24 h after surgery. Patients reported satisfactory postoperative course, with no recurrence of inguinal hernia and satisfaction in cosmetic result at 6-month follow-up. DV-SS TEP inguinal hernia repair showed to be feasible and effective surgical option for bilateral groin hernia repair. Patients' outcome was uneventful, with optimal cosmetic results. Further studies comparing this innovative technique to TEP or LESS TEP should be promoted.

Bilateral agenesis of the anterior cruciate ligament: MRI evaluation

Energy Technology Data Exchange (ETDEWEB)

Bedoya, Maria A.; Jaramillo, Diego [The Children' s Hospital of Philadelphia, Radiology Department, Philadelphia, PA (United States); McGraw, Michael H. [Hospitalof theUniversityof Pennsylvania, Divisionof Orthopaedics, Philadelphia, PA (United States); Wells, Lawrence [The Children' s Hospital of Philadelphia, Division of Orthopaedics, Philadelphia, PA (United States)

2014-09-15

Bilateral agenesis of the anterior cruciate ligament (ACL) is extremely rare. We describe a 13-year-old girl who presented with bilateral knee pain without history of trauma; she has two family members with knee instability. Magnetic resonance imaging showed bilateral absence of the ACL, and medial posterior horn meniscal tears. Bilateral arthroscopic partial meniscectomy and anterior cruciate ligament reconstruction was performed. (orig.)

Staged bilateral carotid endarterectomy

DEFF Research Database (Denmark)

Schroeder, T; Sillesen, H; Engell, Hans Christian

1986-01-01

In a series of 56 staged bilateral carotid endarterectomies, new neurologic symptoms developed in 5% and 20% following the first and second procedure, respectively. All complications were transient or minor. The incidence of postendarterectomy hypertension was significantly higher following...... the second procedure, when operations were staged less than 3 weeks apart. A correlation between these hypertensive episodes and the occurrence of new neurologic symptoms could not be shown. However, as this correlation has been proved in several other reports, bilateral carotid endarterectomy is advised...... to be staged at least 3 weeks apart. In addition, a conservative attitude towards contralateral asymptomatic lesions is proposed....

Simultaneous canine distemper encephalitis and canine parvovirus infection with distemper-associated cardiac necrosis in a pup

OpenAIRE

Headley,Selwyn Arlington; Saito,Taís Berelli

2003-01-01

Simultaneous infection of canine distemper virus and canine parvovirus associated with distemper myocardial degeneration and necrosis is described in a pup. The dog demonstrated myoclonus, nystagmus, enamel hypoplasia, abdominal pustules, and bilateral corneal ulceration clinically. Demyelinating encephalitis, myocardial degeneration and necrosis with mineralization, and necrosis, hemorrhage and fusion of intestinal villi were observed. The lesions observed in this dog are characteristic of a...

Impairments of motor-cortex responses to unilateral and bilateral direct current stimulation in schizophrenia

Directory of Open Access Journals (Sweden)

Alkomiet eHasan

2013-10-01

Full Text Available Transcranial direct current stimulation (tDCS is a non-invasive stimulation technique that can be applied to modulate cortical activity through induction of cortical plasticity. Since various neuropsychiatric disorders are characterised by fluctuations in cortical activity levels (e.g. schizophrenia, tDCS is increasingly investigated as a treatment tool. Several studies have shown that the induction of cortical plasticity following classical, unilateral tDCS is reduced or impaired in the stimulated and non-stimulated primary motor cortices (M1 of schizophrenia patients. Moreover, an alternative, bilateral tDCS setup has recently been shown to modulate cortical plasticity in both hemispheres in healthy subjects, highlighting another potential treatment approach. Here we present the first study comparing the efficacy of unilateral tDCS (cathode left M1, anode right supraorbital with simultaneous bilateral tDCS (cathode left M1, anode right M1 in schizophrenia patients. tDCS-induced cortical plasticity was monitored by investigating motor-evoked potentials induced by single-pulse transcranial magnetic stimulation applied to both hemispheres. Healthy subjects showed a reduction of left M1 excitability following unilateral tDCS on the stimulated left hemisphere and an increase in right M1 excitability following bilateral tDCS. In schizophrenia, no plasticity was induced following both stimulation paradigms. The pattern of these results indicates a complex interplay between plasticity and connectivity that is impaired in schizophrenia patients. Further studies are needed to clarify the biological underpinnings and clinical impact of these findings.

Reinnervation of bilateral posterior cricoarytenoid muscles using the left phrenic nerve in patients with bilateral vocal fold paralysis.

Directory of Open Access Journals (Sweden)

Meng Li

Full Text Available OBJECTIVE: To evaluate the feasibility, effectiveness, and safety of reinnervation of the bilateral posterior cricoarytenoid (PCA muscles using the left phrenic nerve in patients with bilateral vocal fold paralysis. METHODS: Forty-four patients with bilateral vocal fold paralysis who underwent reinnervation of the bilateral PCA muscles using the left phrenic nerve were enrolled in this study. Videostroboscopy, perceptual evaluation, acoustic analysis, maximum phonation time, pulmonary function testing, and laryngeal electromyography were performed preoperatively and postoperatively. Patients were followed-up for at least 1 year after surgery. RESULTS: Videostroboscopy showed that within 1 year after reinnervation, abductive movement could be observed in the left vocal folds of 87% of patients and the right vocal folds of 72% of patients. Abductive excursion on the left side was significantly larger than that on the right side (P 0.05. No patients developed immediate dyspnea after surgery, and the pulmonary function parameters recovered to normal reference value levels within 1 year. Postoperative laryngeal electromyography confirmed successful reinnervation of the bilateral PCA muscles. Eighty-seven percent of patients in this series were decannulated and did not show obvious dyspnea after physical activity. Those who were decannulated after subsequent arytenoidectomy were not included in calculating the success rate of decannulation. CONCLUSIONS: Reinnervation of the bilateral PCA muscles using the left phrenic nerve can restore inspiratory vocal fold abduction to a physiologically satisfactory extent while preserving phonatory function at the preoperative level without evident morbidity.

Reinnervation of Bilateral Posterior Cricoarytenoid Muscles Using the Left Phrenic Nerve in Patients with Bilateral Vocal Fold Paralysis

Science.gov (United States)

Zheng, Hongliang; Chen, Donghui; Zhu, Minhui; Wang, Wei; Liu, Fei; Zhang, Caiyun

2013-01-01

Objective To evaluate the feasibility, effectiveness, and safety of reinnervation of the bilateral posterior cricoarytenoid (PCA) muscles using the left phrenic nerve in patients with bilateral vocal fold paralysis. Methods Forty-four patients with bilateral vocal fold paralysis who underwent reinnervation of the bilateral PCA muscles using the left phrenic nerve were enrolled in this study. Videostroboscopy, perceptual evaluation, acoustic analysis, maximum phonation time, pulmonary function testing, and laryngeal electromyography were performed preoperatively and postoperatively. Patients were followed-up for at least 1 year after surgery. Results Videostroboscopy showed that within 1 year after reinnervation, abductive movement could be observed in the left vocal folds of 87% of patients and the right vocal folds of 72% of patients. Abductive excursion on the left side was significantly larger than that on the right side (P 0.05). No patients developed immediate dyspnea after surgery, and the pulmonary function parameters recovered to normal reference value levels within 1 year. Postoperative laryngeal electromyography confirmed successful reinnervation of the bilateral PCA muscles. Eighty-seven percent of patients in this series were decannulated and did not show obvious dyspnea after physical activity. Those who were decannulated after subsequent arytenoidectomy were not included in calculating the success rate of decannulation. Conclusions Reinnervation of the bilateral PCA muscles using the left phrenic nerve can restore inspiratory vocal fold abduction to a physiologically satisfactory extent while preserving phonatory function at the preoperative level without evident morbidity. PMID:24098581

MRI features of bilateral parotid haemangiomas of infancy

International Nuclear Information System (INIS)

Andronikou, Savvas; Jadwat, Saaleeha; McHugh, Kieran; Linward, Jane

2003-01-01

The aim of this article is to report the MRI features of bilateral parotid haemangiomas of infancy and highlight the diagnostic and prognostic value of MRI especially with regard to those lesions that may cause respiratory compromise. Retrospective review of MRI scans in six infants with bilateral parotid haemangiomas. The bilateral haemangiomas were symmetrical in all but one patient. On T1-weighted images the masses were isointense to muscle and on T2 they were hyperintense with numerous small vessels giving a septated appearance. There was vivid enhancement with gadolinium in all cases. In three patients, deep bilateral extensions were demonstrated involving the parapharyngeal spaces resulting in respiratory compromise which required tracheostomy. Bilateral parotid haemangiomas are rare, but when present may have deep extensions, which can result in respiratory compromise requiring tracheostomy. (orig.)

MRI features of bilateral parotid haemangiomas of infancy

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Andronikou, Savvas; Jadwat, Saaleeha [Institute of Child Health, University of Cape Town, Klipfontein Road, Rondebosch, 7700, Cape Town (South Africa); McHugh, Kieran; Linward, Jane [Department of Radiology, Great Ormond Street Hospital for Children, London, WC1N 3JH (United Kingdom)

2003-04-01

The aim of this article is to report the MRI features of bilateral parotid haemangiomas of infancy and highlight the diagnostic and prognostic value of MRI especially with regard to those lesions that may cause respiratory compromise. Retrospective review of MRI scans in six infants with bilateral parotid haemangiomas. The bilateral haemangiomas were symmetrical in all but one patient. On T1-weighted images the masses were isointense to muscle and on T2 they were hyperintense with numerous small vessels giving a septated appearance. There was vivid enhancement with gadolinium in all cases. In three patients, deep bilateral extensions were demonstrated involving the parapharyngeal spaces resulting in respiratory compromise which required tracheostomy. Bilateral parotid haemangiomas are rare, but when present may have deep extensions, which can result in respiratory compromise requiring tracheostomy. (orig.)

Bilateral electric energy contracts: return and risk

Energy Technology Data Exchange (ETDEWEB)

Gunn, Laura K.; Silva, Elisa B.; Correia, Paulo B. [State University of Campinas (UNICAMP), SP (Brazil). College of Mechanical Engineering

2009-07-01

In Brazil electricity is traded through three segments: the spot market that balances offer and demand, with prices calculated by a cost-based computational model; the regulated market , where prices are settled in public auctions, and the free market for bilateral contracts. As spot and regulated market prices are public information, a seller is able to calculate his opportunity price to trade a bilateral contract in the free market by using the non-arbitrage principle. Thus, the seller searches the price of a bilateral contract in the free market that balances his/her revenues with the value expected in case it were negotiated in the regulated and the spot market. Besides the expected revenue, the seller may also consider the CVaR to measure the risk of her/his bilateral contract in the free market. So this paper develops a binomial lattice approach to price bilateral contracts in the free market, considering the seller's opportunity of negotiations in both regulated and spot markets, and measuring the contract risk directly. (author)

Bilateral primary fallopian tube papillary serous carcinoma in postmenopausal woman: Report of two cases

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Dipanwita Nag

2016-01-01

Full Text Available Primary carcinoma of the fallopian tube is rare and accounts for about 0.14-1.8% of all gynecological malignancies. Correct diagnosis is rarely made preoperatively as clinically tubal carcinoma closely resembles ovarian carcinoma. Here, we report two cases of bilateral primary fallopian tube carcinomas. Case 1: A 54-year-old female presented with postmenopausal bleeding, abdominal pain, and pervaginal watery discharge for 10 days. Ultrasonography (USG of pelvis showed endometrial thickening and multiple tiny echogenic foci in omentum suggestive of omental cake. With a provisional diagnosis of endometrial carcinoma, total abdominal hysterectomy with bilateral salpingo-oophorectomy and omentectomy was done. On gross examination, small and rudimentary right ovary was adherent to the fimbrial end of the tube. Left-sided tubo-ovarian mass was present, cut section of which showed yellowish solid area in tubal wall and encroaching on ovarian surface. On histological examination, sections from the fimbrial end of both fallopian tubes showed features of papillary serous adenocarcinoma. Case 2: 70-year-old lady, 15 years postmenopausal presented with gradual onset pain and swelling of abdomen, urinary incontinence since 4 days. USG showed bulky uterus, 5 cm × 2 cm fibroid, bilateral tubes, and ovaries were not visualized. Serum cancer antigen-125 was raised (159.7 U/ml. Total hysterectomy and bilateral salpingo-oophorectomy with infracolic omentectomy was done. On gross examination, ovaries were firmly attached to tubes and no apparent solid area was noted. On microscopy, papillary serous adenocarcinoma arising from tubal wall was seen infiltrating focally into ovarian stroma; tubal epithelium showed dysplastic change. Sections from omentum showed numerous psammoma bodies.

Bilateral Traumatic Globe Luxation with Optic Nerve Transection

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Levent Tok

2014-12-01

Full Text Available Purpose: The purpose of this study was to document clinical findings and management of a patient with bilateral globe luxation and optic nerve transection. Materials and Methods: A 25-year-old female patient was admitted to the emergency department with bilateral traumatic globe luxation following a motor vehicle accident. Results: Visual acuity testing showed no light perception. The right pupil was dilated and bilaterally did not react to light. The globes were bilaterally intact. A computed tomography scan revealed Le Fort type II fractures, bilateral optic nerve transection and disruption of all extraocular muscles. The globes of the patient were bilaterally reduced into the orbit. However, the patient developed phthisis bulbi in the right eye at month 3. Conclusion: Globe luxation presents a dramatic clinical picture, and may lead to the development of severe complications due to the concomitance of complete optic nerve dissection and multiple traumas. Even if the luxated globe is repositioned into the orbit, there is still an increased risk of the development of phthisis due to ischemia.

Bilateral Traumatic Globe Luxation with Optic Nerve Transection

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Tok, Levent; Tok, Ozlem Yalcin; Argun, Tugba Cakmak; Yilmaz, Omer; Gunes, Alime; Unlu, Elif Nisa; Sezer, Sezgin; Ibisoglu, Seda; Argun, Mehmet

2014-01-01

Purpose The purpose of this study was to document clinical findings and management of a patient with bilateral globe luxation and optic nerve transection. Materials and Methods A 25-year-old female patient was admitted to the emergency department with bilateral traumatic globe luxation following a motor vehicle accident. Results Visual acuity testing showed no light perception. The right pupil was dilated and bilaterally did not react to light. The globes were bilaterally intact. A computed tomography scan revealed Le Fort type II fractures, bilateral optic nerve transection and disruption of all extraocular muscles. The globes of the patient were bilaterally reduced into the orbit. However, the patient developed phthisis bulbi in the right eye at month 3. Conclusion Globe luxation presents a dramatic clinical picture, and may lead to the development of severe complications due to the concomitance of complete optic nerve dissection and multiple traumas. Even if the luxated globe is repositioned into the orbit, there is still an increased risk of the development of phthisis due to ischemia. PMID:25606034

Bilateral adrenal masses: a single-centre experience

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Nilesh Lomte

2016-05-01

Full Text Available Background Bilateral adrenal masses may have aetiologies like hyperplasia and infiltrative lesions, besides tumours. Hyperplastic and infiltrative lesions may have coexisting hypocortisolism. Bilateral tumours are likely to have hereditary/syndromic associations. The data on clinical profile of bilateral adrenal masses are limited. Aims To analyse clinical, biochemical and radiological features, and management outcomes in patients with bilateral adrenal masses. Methods Retrospective analysis of 70 patients with bilateral adrenal masses presenting to a single tertiary care endocrine centre from western India (2002–2015. Results The most common aetiology was pheochromocytoma (40%, followed by tuberculosis (27.1%, primary adrenal lymphoma (PAL (10%, metastases (5.7%, non-functioning adenomas (4.3%, primary bilateral macronodular adrenal hyperplasia (4.3%, and others (8.6%. Age at presentation was less in patients with pheochromocytoma (33 years and tuberculosis (41 years compared with PAL (48 years and metastases (61 years (P<0.001. The presenting symptoms for pheochromocytoma were hyperadrenergic spells (54% and abdominal pain (29%, whereas tuberculosis presented with adrenal insufficiency (AI (95%. The presenting symptoms for PAL were AI (57% and abdominal pain (43%, whereas all cases of metastasis had abdominal pain. Mean size of adrenal masses was the largest in lymphoma (5.5cm followed by pheochromocytoma (4.8cm, metastasis (4cm and tuberculosis (2.1cm (P<0.001. Biochemically, most patients with pheochromocytoma (92.8% had catecholamine excess. Hypocortisolism was common in tuberculosis (100% and PAL (71.4% and absent with metastases (P<0.001. Conclusion In evaluation of bilateral adrenal masses, age at presentation, presenting symptoms, lesion size, and biochemical features are helpful in delineating varied underlying aetiologies.

Bilateral adrenal masses: a single-centre experience

Science.gov (United States)

Bandgar, Tushar; Khare, Shruti; Jadhav, Swati; Lila, Anurag; Goroshi, Manjunath; Kasaliwal, Rajeev; Khadilkar, Kranti; Shah, Nalini S

2016-01-01

Background Bilateral adrenal masses may have aetiologies like hyperplasia and infiltrative lesions, besides tumours. Hyperplastic and infiltrative lesions may have coexisting hypocortisolism. Bilateral tumours are likely to have hereditary/syndromic associations. The data on clinical profile of bilateral adrenal masses are limited. Aims To analyse clinical, biochemical and radiological features, and management outcomes in patients with bilateral adrenal masses. Methods Retrospective analysis of 70 patients with bilateral adrenal masses presenting to a single tertiary care endocrine centre from western India (2002–2015). Results The most common aetiology was pheochromocytoma (40%), followed by tuberculosis (27.1%), primary adrenal lymphoma (PAL) (10%), metastases (5.7%), non-functioning adenomas (4.3%), primary bilateral macronodular adrenal hyperplasia (4.3%), and others (8.6%). Age at presentation was less in patients with pheochromocytoma (33 years) and tuberculosis (41 years) compared with PAL (48 years) and metastases (61 years) (P<0.001). The presenting symptoms for pheochromocytoma were hyperadrenergic spells (54%) and abdominal pain (29%), whereas tuberculosis presented with adrenal insufficiency (AI) (95%). The presenting symptoms for PAL were AI (57%) and abdominal pain (43%), whereas all cases of metastasis had abdominal pain. Mean size of adrenal masses was the largest in lymphoma (5.5cm) followed by pheochromocytoma (4.8cm), metastasis (4cm) and tuberculosis (2.1cm) (P<0.001). Biochemically, most patients with pheochromocytoma (92.8%) had catecholamine excess. Hypocortisolism was common in tuberculosis (100%) and PAL (71.4%) and absent with metastases (P<0.001). Conclusion In evaluation of bilateral adrenal masses, age at presentation, presenting symptoms, lesion size, and biochemical features are helpful in delineating varied underlying aetiologies. PMID:27037294

Bilateral renal cell carcinoma in a horseshoe kidney: preoperative assessment with MRI and digital subtraction angiography

International Nuclear Information System (INIS)

Schubert, R.A.; Soeldner, J.; Kaiser, W.A.; Steiner, T.; Schubert, J.

1998-01-01

Renal cell carcinoma in a horseshoe kidney is an unusual entity. To our knowledge, only 123 cases have been published to date. We report the first bilateral case of two clear-cell carcinomas in an asymmetrically fused kidney. Optimum preservation of renal function after radical tumor removal requires accurate preoperative imaging. Since the vascular supply in fusion anomalies is extremely variable, angiography is mandatory. Magnetic resonance imaging was most suitable to predict the tumor extent and localization, because it simultaneously gave the most comprehensive anatomical overview of the malformation. (orig.)

Evaluation of the outcome of CT and MR imaging in pediatric patients with bilateral sensorineural hearing loss.

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van Beeck Calkoen, E A; Merkus, P; Goverts, S T; van de Kamp, J M; Mulder, M F; Sanchez Aliaga, E; Hensen, E F

2018-05-01

To evaluate the clinically relevant abnormalities as visualized on CT and MR imaging in children with symmetric and asymmetric bilateral sensorineural hearing loss (SNHL), in relation to age and the severity of hearing loss. Retrospective cohort study. Tertiary referral otology and audiology center. From January 2006 until January 2016, a total of 207 children diagnosed with symmetric and asymmetric bilateral SNHL were included. They underwent CT and/or MR imaging for the evaluation of the etiology of their hearing loss. Radiologic abnormalities associated with SNHL. 302 scans were performed in 207 children (median age of 0.8 years old) with bilateral SNHL. The most frequently identified cause of bilateral SNHL was a malformation of the labyrinth. The combined diagnostic yield of CT and MR imaging was 32%. The diagnostic yield of MR (34%) was considerably higher than that of CT (20%). We found a higher rate of abnormalities in children with profound hearing loss (41%) compared to milder hearing loss (8-29%), and in asymmetric SNHL (52%) compared to symmetric SNHL (30%). Imaging is essential in the etiologic evaluation of children with bilateral SNHL. The highest diagnostic yield is found in children with bilateral asymmetric SNHL or profound SNHL. Based on our findings, MR is the primary imaging modality of choice in the etiological evaluation of children with bilateral SNHL because of its high diagnostic yield. Copyright © 2018. Published by Elsevier B.V.

Bilateral Tubal Pregnancy without Known Risk Factor

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Hyacinthe Zamané

2017-01-01

Full Text Available Spontaneous bilateral ectopic gestation is very rare. The authors report a case diagnosed and taken care of at Yalgado Ouedraogo Teaching Hospital, Ouagadougou. It was a 30-year-old patient with no known pathological history. She had presented at the obstetric emergencies with a state of hypovolemic shock by haemoperitoneum with digestive disorders, pelvic pain, vaginal bleeding, and a mention of delayed menstruation. The ultrasound coupled with the urinary immunological pregnancy test confirmed the diagnosis of ruptured ectopic pregnancy and a bilateral form was suspected. A laparotomy in emergency confirmed the diagnosis of bilateral ectopic gestation with a right ampullary unruptured pregnancy and a left isthmic ruptured gestation. A bilateral salpingectomy was performed and counseling was made for the use of medical help of procreation in case of future need of pregnancy.

Sucessfull management of bilateral presumed Candida endogenous endophtalmitis following pancreatitis

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Ricardo Evangelista Marrocos de Aragão

2016-06-01

Full Text Available ABSTRACT Endogenous endophthalmitis is a rare, and frequently devastating, ophthalmic disease. It occurs mostly in immunocompromised patients, or those with diabetes mellitus, cancer or intravenous drugs users. Candida infection is the most common cause of endogenous endophthalmitis. Ocular candidiasis develops within days to weeks of fungemia. The association of treatment for pancreatitis with endophthalmitis is unusual. Treatment with broad-spectrum antibiotics and total parenteral nutrition may explain endogenous endophthalmitis. We report the case of a patient with pancreatitis treated with broad-spectrum antibiotics and total parenteral nutrition who developed bilateral presumed Candida endogenous endophthalmitis that was successfully treated with vitrectomy and intravitreal amphotericin B.

Determinants of Iran’s Bilateral Intra-industry Trade in Pharmaceutical Industry

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Aghlmand, Siamak; Rahimi, Bahlol; Farrokh-Eslamlou, Hamidreza; Nabilou, Bahram; Yusefzadeh, Hassan

2018-01-01

Among non-oil and in trade arena, drug has always been strategic importance and most government especially industrialized countries pay special attention to its production and trade issues. Thus, having a comprehensive view from economic perspective to this section is essential for suggesting intervention. This was a descriptive-analytical and panel study. In this study, gravity model is used to estimate Iran’s bilateral intra-industry trade in pharmaceutical products in the 2001-2012 periods. To illustrate the extent of pharmaceutical’s intra-industry trade between Iran and its major trading partners, the explanatory variables of market size, income, factor endowments, distance, cultural contributions, and similarities and also special trade arrangements have been applied. Analysis of factors affecting Iran’s bilateral intra-industry trade in pharmaceutical industry showed that the average GDP and cultural similarities had a significant positive impact on Iran’s bilateral IIT, while the difference in GDP has a negative and significant effect. Coefficients obtained for the geographical distance and the average ratio of total capital to the labor force is not consistent with theoretical expectations. Special trade arrangements did not have significant impact on the extent of bilateral intra-industry trade between Iran and its trading partners. The knowledge of the intra-industry trade between Iran and its trade partners make integration between the countries. Factors affecting this type of trade pattern underlie its development in trade relationship. Therefore, the findings of this study would be useful in helping to develop and implement policies for the expansion of the pharmaceutical trade. PMID:29881438

[Bilateral torticollis].

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Kustos, T; Magdics, M

1993-12-19

Bilateral torticollis is a very rare form of a well known deformity i.e. muscular torticollis. This malformation might present a differential diagnostic problem both for orthopaedic surgeons and ophthalmologists, as well as, for neurologists. In agreement with the literature, the role of an injury during labour or defective embriogenesis is suggested to play a part.

Bilateral optic neuropathy in acute cr yptococcal meningitis

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Qi Zhe Ngoo

2016-11-01

Full Text Available We reported a case of cryptococcal meningitis presenting with bilateral optic neuropathy in an immunocompetent patient. A 64-year-old Malay gentleman with no medical comorbidities presented with acute bilateral blurring of vision for a week, which was associated with generalised throbbing headache and low grade fever. He also had somnolence and altered consciousness. Visual acuity in both eyes was no perception of light with poor pupillary reflexes. Extraocular muscle movements were normal. Anterior segments were unremarkable bilaterally. Fundoscopy revealed bilateral optic disc swelling. CT scan of the brain showed multifocal infarct, but no meningeal enhancement or mass. Cerebrospinal fluid opening pressure was normal, while its culture grew Cryptococcus neoformans. A diagnosis of cryptococcal meningitis with bilateral optic neuropathy was made. Patient was treated with a six-week course of intravenous fluconazole and started concomitantly on a fortnight's course of intravenous amphotericin B. After that, his general condition improved, but there was still no improvement in his visual acuity. On reviewing at two months post-initiation of treatment, fundi showed bilateral optic atrophy. Bilateral optic neuropathy secondary to cryptococcal meningitis was rare. The prognosis was guarded due to the sequelae of optic atrophy. Anti-fungal medication alone may not be sufficient to manage this condition. However, evidence for other treatment modalities is still lacking and further clinical studies are required.

[Mechanisms disordering wound healing on the lip after bilateral crossing of the inferior alveolar nerve and experimental validation of correction methods].

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Volozhin, A I; Brusenina, N D; Gemonov, V V; Rybalkina, E A; Druzhinina, R A

2003-01-01

The mechanisms of lip wound healing after bilateral crossing of the inferior alveolar nerve (IAN) were studied on Chinchilla rabbits in 3 experimental series, 6 animals per series. In group 1 bilateral crossing of IAN was carried out, in group 2 bilateral crossing of IAN was paralleled by removal of a mucous flap in the middle of the lower lip, and in group 3 the same wound as in group 2 was created, after which the wounds in this group were daily treated with a special ointment and a single injection of lidocaine (1% solution) under the wound. The nerve crossing led to development of ulcer on the lip with degenerative changes in the vascular walls, destruction of nerve fibers, and fragmentation of some axial cylinders. Crossing of IAN simultaneously with removal of the lower lip flap led to more severe degenerative changes in the tissue. Daily treatment of the lip with the ointment and lidocaine blocking normalized wound healing. A possible mechanism of the changes observed is discussed.

Successful treatment of multiple bilateral impactions - a case report.

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Schubert, Michael; Proff, Peter; Kirschneck, Christian

2016-07-25

Successful treatment of patients with multiple bilateral impactions can be an orthodontic challenge, but few reports on treatment planning and execution exist. In this case report, we describe the successful orthodontic treatment of a 16.3-year old female patient without systemic or genetic disease with initially nine persisting deciduous and nine impacted permanent teeth with complete root formation and closed apices in both jaws. After extraction of the deciduous and surgical exposure of the impacted permanent teeth, the Easy-Way-Coil™ system was used in conjunction with a skeletal anchorage (maxilla, BENEfit™ system) to guide the eruption of all impacted teeth. After a total treatment time of only 22.8 months all impacted teeth could be aligned successfully and a stable and functional class I occlusion was achieved. In addition, there were no adverse treatment effects such as anchorage loss, root resorptions or periodontal problems and an esthetic result could be achieved. The presented treatment approach thus proved to be highly effective in cases with multiple bilateral impactions with minimal side effects and considerably reduced treatment time.

Involuntary masturbation and hemiballismus after bilateral anterior cerebral artery infarction.

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Bejot, Yannick; Caillier, Marie; Osseby, Guy-Victor; Didi, Roy; Ben Salem, Douraied; Moreau, Thibault; Giroud, Maurice

2008-02-01

Ischemia of the areas supplied by the anterior cerebral artery is relatively uncommon. In addition, combined hemiballismus and masturbation have rarely been reported in patients with cerebrovascular disease. We describe herein a 62-year-old right-handed man simultaneously exhibiting right side hemiballismus and involuntary masturbation with the left hand after bilateral infarction of the anterior cerebral artery territory. Right side hemiballismus was related to the disruption of afferent fibers from the left frontal lobe to the left subthalamic nucleus. Involuntary masturbation using the left hand was exclusively linked to a callosal type of alien hand syndrome secondary to infarction of the right side of the anterior corpus callosum. After 2 weeks, these abnormal behaviours were completely extinguished. This report stresses the wide diversity of clinical manifestations observed after infarction of the anterior cerebral artery territory.

Maxillary arch width in unoperated adult bilateral cleft lip and alveolus and complete bilateral cleft lip and palate.

NARCIS (Netherlands)

Latief, B.S.; Lekkas, C.; Kuijpers, M.A.R.

2010-01-01

OBJECTIVES: To study maxillary arch width in adult patients with bilateral cleft lip and alveolus (BCLA) or with complete bilateral cleft lip and palate (BCLP), who have not had any surgery. SETTING AND SAMPLING POPULATION: Eighteen patients with BCLA, 13 patients with BCLP, and 24 controls from

Bilateral Cochlear Implants: Maximizing Expected Outcomes.

Science.gov (United States)

Wallis, Kate E; Blum, Nathan J; Waryasz, Stephanie A; Augustyn, Marilyn

Sonia is a 4 years 1 month-year-old girl with Waardenburg syndrome and bilateral sensorineural hearing loss who had bilateral cochlear implants at 2 years 7 months years of age. She is referred to Developmental-Behavioral Pediatrics by her speech/language pathologist because of concerns that her language skills are not progressing as expected after the cochlear implant. At the time of the implant, she communicated using approximately 20 signs and 1 spoken word (mama). At the time of the evaluation (18 months after the implant) she had approximately 70 spoken words (English and Spanish) and innumerable signs that she used to communicate. She could follow 1-step directions in English but had more difficulty after 2-step directions.Sonia was born in Puerto Rico at 40 weeks gestation after an uncomplicated pregnancy. She failed her newborn hearing test and was given hearing aids that did not seem to help.At age 2 years, Sonia, her mother, and younger sister moved to the United States where she was diagnosed with bilateral severe-to-profound hearing loss. Genetic testing led to a diagnosis of Waardenburg syndrome (group of genetic conditions that can cause hearing loss and changes in coloring [pigmentation] of the hair, skin, and eyes). She received bilateral cochlear implants 6 months later.Sonia's mother is primarily Spanish-speaking and mostly communicates with her in Spanish or with gestures but has recently begun to learn American Sign Language (ASL). In a preschool program at a specialized school for the deaf, Sonia is learning both English and ASL. Sonia seems to prefer to use ASL to communicate.Sonia receives speech and language therapy (SLT) 3 times per week (90 minutes total) individually in school and once per week within a group. She is also receiving outpatient SLT once per week. Therapy sessions are completed in English, with the aid of an ASL interpreter. Sonia's language scores remain low, with her receptive skills in the first percentile, and her

Simultaneus bilateral spontaneus pneumothoraces: A Retrospective Analysis of 11 Cases

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Ufuk Cobanoglu

2011-09-01

Full Text Available Spontaneous pneumothorax (SP is relatively common in clinical practice and occurs more frequently in young, tall thin men, and in smokers. However, simultaneous bilateral spontaneous pneumothorax (SBSP is a rare clinical condition that often presents with significant respiratory distress. It is often dangerous; therefore, the chest drain should be inserted immediately. In this study, simultaneus bilateral spontaneus pneumothoraces cases were divided into two groups and retrospectively evaluated according to age, sex, diagnostic methods, treatments, and results. Material and Methods :Between January 2006 and May 2009, 11 patients with SBSP were enrolled into our study. Age, gender, underlying lung disease, smoking history, symptoms, diagnosis, treatment type, surgical indication, morbidity, recurrence, mortality, duration of chest tube and postoperative hospital stay of the patients were reviewed. Arterial blood gas values (before and after intervention in patiens with primary and secondary spontaneous pneumothorax were evaluated. Results; 7 patients (63.63 % were male and 4 patients (36.37 % were female and their mean age was 34,5±6.81 years. There were 4 (36.37% primary SP and 4 (36.37% secondary SP patients. Chronic obstructive pulmonary disease (COPD was the most common cause in secondary SP patients. In two (18.18% patients recurrency were observed. Eight (72.72% patients had smoking history. The most common symptom in both groups was dyspnea. All patients had immediate bilateral chest tubes on admission. We treated these patients with chest drain insertion, VATS (Video-Assisted Thoracoscopic Surgery, axillary thoracotomy, and chemical pleurodesis. Postoperative morbidity was detected in 3 (27.27% patients (prolonged air leak in 1 case, empyema in 1 case and pneumonia in 1 case. No mortality was observed in alll cases. Recurrence developed in 3 (27.27% patients in this series. Conclusions: An urgent and effective treatment requires in the

Bilateral ovarian tumour in a young girl | Govindarajan | African ...

African Journals Online (AJOL)

Bilateral ovarian tumour in a girl presents the dilemma of conservative versus aggressive approach towards these tumours. When faced with suspicious tumour and complete replacement of the ovaries bilaterally, bilateral oophorectomy is a viable option, though the certain possibility of infertility and lifelong hormonal ...

Bilateral elastofibroma dorsi: A case report

OpenAIRE

Molini, L.; Ciortan, E.; Bianchi, S.

2010-01-01

Elastofibroma dorsi is a rare pseudotumoral lesion located in the periscapular region. Ultrasound can be used to evaluate its dimensions, margins, and internal structure. In the presence of bilateralism, diagnosis can be made on the basis of clinical and sonographic findings. The authors present a case of bilateral elastofibroma dorsi in which the clinical and ultrasound diagnosis was confirmed by magnetic resonance imaging.

Unusual Presentation of Recurrent Pyogenic Bilateral Psoas Abscess Causing Bilateral Pulmonary Embolism by Iliac Vein Compression

OpenAIRE

Ijaz, Mohsin; Sakam, Sailaja; Ashraf, Umair; Marquez, Jose Gomez

2015-01-01

Patient: Male, 47 Final Diagnosis: Bilateral psoas abscess • acute lower extremity deep vein thrombosis • bilateral pulmonary embolism Symptoms: Progressive left leg swelling • productive cough with whitish sputum • right flank pain Medication: Antibiotics and anticoagulation Clinical Procedure: CT-guided percutaneous drain placement Specialty: Internal Medicine/Critical Care Objective: Unusual presentation Background: Psoas abscesses are a known cause of back pain, but they have not been rep...

Bilateral acute iris transillumination: Case report

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Cumali Degirmenci

2016-04-01

Full Text Available Bilateral acute iris transillumination (BAIT is a recently defined disease characterized with bilateral acute, severe pigment dispersion of iris and pupil sphincter paralysis. The etiopathogenesis of the disease is unknown, but antibiotics such as moxifloxacin, clarithromycin, viral infections, and fumigation therapies were considered as probable etiologic factors. A 33-year-old female was referred to our clinic for acute iridocyclitis refractory to azathioprine, colchicum and corticosteroid treatments. Ophthalmic examination revealed bilateral pigment dispersion, significant iris transillumination, heavy pigment deposition in iridocorneal angle, and elevated intraocular pressure. Upon systemic evaluation she was found to have bacterial urinary tract infection. BAIT is an important cause of pigment dispersion and clinicians must be vigilant for this condition to avoid unnecessary diagnostic tests and treatment.

Infectious mononucleosis presenting as bilateral acute dacryocystitis.

Science.gov (United States)

Atkinson, P L; Ansons, A M; Patterson, A

1990-01-01

A case of infectious mononucleosis presenting as bilateral acute dacryocystitis in a 7-year-old girl is reported. Acute dacryocystitis is uncommon in this age group, and an underlying systemic illness should be suspected particularly when it is bilateral. Images PMID:2275940

Similarity in Bilateral Isolated Internal Orbital Fractures.

Science.gov (United States)

Chen, Hung-Chang; Cox, Jacob T; Sanyal, Abanti; Mahoney, Nicholas R

2018-04-13

In evaluating patients sustaining bilateral isolated internal orbital fractures, the authors have observed both similar fracture locations and also similar expansion of orbital volumes. In this study, we aim to investigate if there is a propensity for the 2 orbits to fracture in symmetrically similar patterns when sustaining similar trauma. A retrospective chart review was performed studying all cases at our institution of bilateral isolated internal orbital fractures involving the medial wall and/or the floor at the time of presentation. The similarity of the bilateral fracture locations was evaluated using the Fisher's exact test. The bilateral expanded orbital volumes were analyzed using the Wilcoxon signed-rank test to assess for orbital volume similarity. Twenty-four patients with bilateral internal orbital fractures were analyzed for fracture location similarity. Seventeen patients (70.8%) had 100% concordance in the orbital subregion fractured, and the association between the right and the left orbital fracture subregion locations was statistically significant (P < 0.0001). Fifteen patients were analyzed for orbital volume similarity. The average orbital cavity volume was 31.2 ± 3.8 cm on the right and 32.0 ± 3.7 cm on the left. There was a statistically significant difference between right and left orbital cavity volumes (P = 0.0026). The data from this study suggest that an individual who suffers isolated bilateral internal orbital fractures has a statistically significant similarity in the location of their orbital fractures. However, there does not appear to be statistically significant similarity in the expansion of the orbital volumes in these patients.

Bilateral locked facets in the thoracic spine

NARCIS (Netherlands)

M.H.A. Willems; Braakman, R. (Reinder); B. van Linge (Bert)

1984-01-01

textabstractTwo cases of traumatic bilateral locked facets in the thoracic spine are reported. Both patients had only minor neurological signs. They both made a full neurological recovery after surgical reduction of the locked facets. Bilateral locked facets are very uncommon in the thoracic spine.

Fibromuscular Dysplasia Presenting with Bilateral Renal Infarction

International Nuclear Information System (INIS)

Doody, O.; Adam, W. R.; Foley, P. T.; Lyon, S. M.

2009-01-01

Fibromuscular dysplasia (FMD) describes a group of conditions which cause nonatheromatous arterial stenoses, most commonly of the renal and carotid arteries, typically in young women. We report a rare case of bilateral segmental renal infarction secondary to FMD in a young male patient. His initial presentation with loin pain and pyrexia resulted in a delay in the definitive diagnosis of FMD. He was successfully treated with bilateral balloon angioplasty. The delayed diagnosis in this patient until the condition had progressed to bilateral renal infarcts highlights the need for prompt investigation and diagnosis of suspected cases of FMD.

Recurrent Bilateral Breast Abscesses after Sternotomy

Directory of Open Access Journals (Sweden)

Hamza Cinar

2012-01-01

Full Text Available Median sternotomy is the most commonly used incision in cardiothoracic procedures. Development of breast abscess after sternotomy is a very rare situation. We present a case of sternal wound infection with recurrent bilateral breast abscess after sternotomy. Our case is the first and only case in the literature due to the presence of sternal wound infection with recurrent bilateral breast abscess after sternotomy.

Bilateral agreements

International Nuclear Information System (INIS)

Anon.

2004-01-01

The bilateral agreements concern Brazil with United States relative to the co operation in nuclear energy, Germany with Russian Federation relative to the elimination and disposal of nuclear weapons; The multilateral agreements concerns the signature of the Protocols to amend the Paris and Brussels Conventions, the multilateral nuclear environmental programme in the Russian Federation, the status of Conventions in the field of nuclear energy. (N.C.)

Simultaneous engineering; Simultaneous Engineering bei der Entwicklung der Motorenbaureihen

Energy Technology Data Exchange (ETDEWEB)

Reifenscheid, O. [Entwicklung Kommerzielle Motoren, MTU, Friedrichshafen (Germany)

1997-10-01

At a time when the German industry is faced with world-wide competition and the recent recession has not been fully overcome, the subject of simultaneous engineering is very popular. A series of punch words such as Lean Management, TQM, (Total Quality Management), Lean Production, KVP, Kaizen, Value Management, etc. are considered as synonyms for strategies by which product development is to be made more efficient and production more economical, faster and more flexible. In this respect the co-ordination between market, company the human element, procedure and structure play a major role. The present paper describes Simultaneous Enginering (SE) from the standpoint of the research engineer; provides information regarding the degree of implementation of SE at MTU and presents some of the author`s personal thoughts and experiences for discussion. (orig.)

Noise reduction with complex bilateral filter.

Science.gov (United States)

Matsumoto, Mitsuharu

2017-12-01

This study introduces a noise reduction technique that uses a complex bilateral filter. A bilateral filter is a nonlinear filter originally developed for images that can reduce noise while preserving edge information. It is an attractive filter and has been used in many applications in image processing. When it is applied to an acoustical signal, small-amplitude noise is reduced while the speech signal is preserved. However, a bilateral filter cannot handle noise with relatively large amplitudes owing to its innate characteristics. In this study, the noisy signal is transformed into the time-frequency domain and the filter is improved to handle complex spectra. The high-amplitude noise is reduced in the time-frequency domain via the proposed filter. The features and the potential of the proposed filter are also confirmed through experiments.

Prognosis of synchronous bilateral breast cancer

DEFF Research Database (Denmark)

Holm, Marianne; Tjønneland, Anne; Balslev, Eva

2014-01-01

Currently, no consistent evidence-based guidelines for the management of synchronous bilateral breast cancer (SBBC) exist and it is uncertain how presenting with SBBC affects patients' prognosis. We conducted a review of studies analyzing the association between SBBC and prognosis. The studies...... that reported adjusted effect measures were included in meta-analyses of effect of bilaterality on breast cancer mortality. From 57 initially identified records 17 studies from 11 different countries including 8,050 SBBC patients were included. The quality of the studies varied but was generally low with small...... sample sizes, and lack of consistent, detailed histo-pathological information. When doing meta-analysis on the subgroup of studies that provided adjusted effect estimates on breast cancer mortality (nine studies including 3,631 SBBC cases), we found that bilaterality in itself had a negative impact...

Bilateral Medial Medullary Infarction with Nondominant Vertebral Artery Occlusion.

Science.gov (United States)

Zhang, Lei; Zhang, Gui-lian; Du, Ju-mei; Ma, Zhu-lin

2015-09-01

Bilateral medial medullary infarction (MMI) is a rare stroke subtype. Here, we report a case with bilateral MMI caused by nondominant vertebral artery occlusion confirmed by brain digital subtraction angiography and magnetic resonance imaging basi-parallel-anatomical-scanning. We highlight that anterior spinal arteries could originate from a unilateral vertebral artery (VA). Radiologists and neurologists should pay attention to the nondominant VA as bilateral MMI may be induced by occlusion of nondominant VA that supplies the bilateral anteromedial territories of the medulla. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

EXERTIONAL RHABDOMYOLYSIS OF THE BILATERAL ADDUCTOR MAGNUS

Directory of Open Access Journals (Sweden)

Tolga Saka

2007-12-01

Full Text Available We present a case study of a person (63 year-old man, who has been using statins for 18 years, with rhabdomyolysis of the bilateral adductor muscles associated with strenuous and prolonged eccentric exercises (hiking in a hot environment. Clinical examination showed predominantly on the right side muscle swelling and palpational pain of the bilateral adductor muscle groups and bilateral tibial edema. His serum creatine kinase (CK level was 12218 IU/L. T2-weighted magnetic resonance (MR images showed a high signal intensity in the bilateral adductor muscles of the hip. The patient did not develop complications and returned to his previous performance level in 30 days following adequate hydration and resting of the affected muscles. Strenuous eccentric exercise should be avoided during the course of statin use and clinicians should be aware of present observations when considering the significance of acute CK elevations in patients on statin treatment

Bilateral nasolabial cysts associated with recurrent dacryocystitis.

Science.gov (United States)

Kyrmizakis, Dionysios E; Lachanas, Vassilios A; Benakis, Antonios A; Velegrakis, George A; Aslanides, Ioannis M

2005-05-01

Nasolabial cysts are rare, nonodontogenic, soft-tissue, developmental cysts occurring inferior to the nasal alar region. They are thought to arise from remnants of the nasolacrimal ducts and they are frequently asymptomatic. We report a rare case of bilateral nasolabial cysts accompanied by bilateral chronic dacryocystitis. A 48-year-old woman suffering from bilateral chronic dacryocystitis was referred to our department for endonasal dacryocystorhinostomy. She had undergone external dacryocystorhinostomy on the left side a few years earlier. Physical examination and computed tomography scan revealed nasolabial cysts bilaterally inferior to the nasal alar region. The cysts were removed via a sublabial approach and endoscopic dacryocystorhinostomy was performed on the right side. Ten months after surgery, the patient was asymptomatic. There may be a correlation, due to embryological reasons, between the presence of nasolabial cysts and the presence of chronic dacryocystitis. Both can be corrected surgically, under the same anaesthesia, without visible scar formation.

Hysterectomy and Bilateral Salpingoovariectomy in a Transsexual Subject without Visible Scaring

OpenAIRE

Perrone, Anna Myriam; Scifo, Maria Cristina; Martelli, Valentina; Casadio, Paolo; Morselli, Paolo Giovanni; Pelusi, Giuseppe; Meriggiola, Maria Cristina

2010-01-01

Objective. To report on the use of laparoendoscopic single-site surgery (LESS) for the management of total hysterectomy (TH) with bilateral salpingoovariectomy (BSO) in a subject affected by gender identity disorder. Design. Case report. Setting. University Hospital. Patient(s). A 27-year-old affected by Gender Identity Disorder underwent a hysterectomy and BSO as part of surgical sex reassignment. Intervention(s). Laparoendoscopic single-site surgery access for TH and BSO. Main Outcome ...

The behavioral implications of the bilateral gamma process

Science.gov (United States)

Xie, Haibin; Wang, Shouyang; Lu, Zudi

2018-06-01

Bilateral gamma process is widely used in risk management and asset pricing. However the behavioral implications of this process remain unknown. This paper investigates this problem for the first time within the framework of Tauchen and Pitts (1983). With the assumption that there are two types of traders in the market, the optimistic and the pessimistic, we find the bilateral gamma process can be derived from Walrasian equilibrium. This finding establishes the microstructure foundations for the bilateral gamma process.

[Atypical etiology of rhinorrhea: spontaneous bilateral temporal encephalocele].

Science.gov (United States)

Lorente Muñoz, Asís; Lisbona Alquézar, María Pilar; González Martínez, Luis; Sevil Navarro, Jorge; Llorente Arenas, Eva María

2012-01-01

Spontaneous herniation of brain parenchyma through a dural and osseous defect in the temporal bone is a rare entity and a bilateral form is even more infrequent. It usually presents as an intermittent but persistent otorrhea. Manifestation as nose cerebrospinal fluid (CSF) leak is very uncommon. Our objective is presenting this unusual case report of a spontaneous bilateral encephalocele with a bilateral tegmen tympani defect. Copyright © 2010 Elsevier España, S.L. All rights reserved.

Bilateral cerebellar activation in unilaterally challenged essential tremor

Directory of Open Access Journals (Sweden)

Marja Broersma

2016-01-01

Conclusions: Our results expand on previous findings of bilateral cerebellar involvement in ET. We have identified specific areas in the bilateral somatomotor regions of the cerebellum: lobules V, VI and VIII.

Longer-term functional outcomes and everyday listening performance for young children through to young adults using bilateral implants.

Science.gov (United States)

Galvin, Karyn Louise; Holland, Jennifer Frances; Hughes, Kathryn Clare

2014-01-01

First, to document a broad range of functional outcomes of bilateral implantation for young children through young adults at a postoperative point at which stable outcomes could be expected. Second, to evaluate the relationship between functional outcomes and age at bilateral implantation and time between implants. A study-specific questionnaire was administered to parents in an interview 3.5 years or more after sequential (n = 50) or simultaneous (n = 7) implants were received by their child. Median age at bilateral implantation was 4.1 years (range 0.7 to 19.8) and time between implants was 2.7 years (range 0.0 to 16.7). On the basis of parent report, 72% of the sequentially implanted children and young adults found it easy/only "a bit difficult" to adapt to the second implant, and were "happily wearing both implants together most of the time" by 6 months or before; 26% had not adapted, with both implants not worn most of the time or worn as a parental requirement. Seventy-two percent of sequentially implanted children and young adults had a positive attitude toward the second implant, including 9 whose early postoperative attitude was negative or neutral. The majority of children and young adults preferred bilateral implants (70%) and used the two full time (72%), while around half demonstrated similar performance with each implant alone. The proportion of nonusers or very minimal users of the second implant was just 9%. Eighty-eight percent of parents reported superior performance with bilateral versus a unilateral implant (n = 40), or that only bilateral implants were worn (n = 10) so performance could not be compared. The most commonly identified areas of superiority were localization, less need for repetition, and increased responsiveness. In balancing risks and costs with benefits, most parents (86%) considered the second implant worthwhile. Regarding the relationship between outcomes and demographic factors, the group achieving similar performance with

Bilateral Ramsay Hunt syndrome in a diabetic patient

Directory of Open Access Journals (Sweden)

Goyal Amit

2004-12-01

Full Text Available Abstract Background Herpes zoster oticus accounts for about 10% cases of facial palsy, which is usually unilateral and complete and full recovery occurs in only about 20% of untreated patients. Bilateral herpes zoster oticus can sometime occur in immunocompromised patients, though incidence is very rare. Case presentation Diabetic male, 57 year old presented to us with bilateral facial palsy due to herpes zoster oticus. Patient was having bilateral mild to moderate sensorineural hearing loss. Patient was treated with appropriate metabolic control, anti-inflammatory drugs and intravenous acyclovir. Due to uncontrolled diabetes, glucocorticoids were not used in this patient. Significant improvement in hearing status and facial nerve functions were seen in this patient. Conclusions Herpes zoster causes severe infections in diabetic patients and can be a cause of bilateral facial palsy and bilateral Ramsay Hunt syndrome. Herpes zoster in diabetic patients should be treated with appropriate metabolic control, NSAIDS and intravenous acyclovir, which we feel should be started at the earliest. Glucocorticoids should be avoided in diabetic patients.

Primary and revision efficacy of cross-wired metallic stents for endoscopic bilateral stent-in-stent placement in malignant hilar biliary strictures.

Science.gov (United States)

Lee, T H; Moon, J H; Kim, J H; Park, D H; Lee, S S; Choi, H J; Cho, Y D; Park, S H; Kim, S J

2013-01-01

Endoscopic bilateral drainage for inoperable malignant hilar biliary strictures (HBS) using metal stents is considered to be technically difficult. Furthermore, endoscopic revision of bilateral stenting after occlusion can be challenging. This study was performed to evaluate the long-term efficacy of endoscopic bilateral stent-in-stent placement of cross-wired metallic stents in high-grade malignant HBS and planned endoscopic bilateral revision. A total of 84 patients with inoperable high-grade malignant HBS were enrolled from three academic tertiary referral centers. Two cross-wired metal stents were inserted using a bilateral stent-in-stent placement method. Bilateral endoscopic revision was also performed during follow-up using either identical metal stents or plastic stents. The main outcome measurements were technical and functional success, complications, stent patency, and endoscopic revision efficacy. The technical and clinical success rates of endoscopic bilateral stent-in-stent placement of cross-wired metallic stents were 95.2% (80/84) and 92.9% (78/84), respectively. Median patency (range) and survival were 238 days (10-429) and 256 days (10-1130), respectively. Obstruction of primary bilateral stents occurred in 30.8% (24/78) of patients with functionally successful stent placement. The technical and clinical success rates of planned bilateral endoscopic revision for occluded stents were 83.3% (20/24) and 79.2% (19/24), respectively. For revision, bilateral metallic stents were placed in 11 patients (55.0%); the remaining patients received plastic stents. Palliative endoscopic bilateral stent-in-stent placement of cross-wired metallic stents was effective in patients with inoperable HBS. Revision endoscopic bilateral stenting may be feasible and successful in cases where the primary deployed metal stents are occluded. © Georg Thieme Verlag KG Stuttgart · New York.

Adrenal vein sampling in primary aldosteronism: concordance of simultaneous vs sequential sampling.

Science.gov (United States)

Almarzooqi, Mohamed-Karji; Chagnon, Miguel; Soulez, Gilles; Giroux, Marie-France; Gilbert, Patrick; Oliva, Vincent L; Perreault, Pierre; Bouchard, Louis; Bourdeau, Isabelle; Lacroix, André; Therasse, Eric

2017-02-01

Many investigators believe that basal adrenal venous sampling (AVS) should be done simultaneously, whereas others opt for sequential AVS for simplicity and reduced cost. This study aimed to evaluate the concordance of sequential and simultaneous AVS methods. Between 1989 and 2015, bilateral simultaneous sets of basal AVS were obtained twice within 5 min, in 188 consecutive patients (59 women and 129 men; mean age: 53.4 years). Selectivity was defined by adrenal-to-peripheral cortisol ratio ≥2, and lateralization was defined as an adrenal aldosterone-to-cortisol ratio ≥2, the contralateral side. Sequential AVS was simulated using right sampling at -5 min (t = -5) and left sampling at 0 min (t = 0). There was no significant difference in mean selectivity ratio (P = 0.12 and P = 0.42 for the right and left sides respectively) and in mean lateralization ratio (P = 0.93) between t = -5 and t = 0. Kappa for selectivity between 2 simultaneous AVS was 0.71 (95% CI: 0.60-0.82), whereas it was 0.84 (95% CI: 0.76-0.92) and 0.85 (95% CI: 0.77-0.93) between sequential and simultaneous AVS at respectively -5 min and at 0 min. Kappa for lateralization between 2 simultaneous AVS was 0.84 (95% CI: 0.75-0.93), whereas it was 0.86 (95% CI: 0.78-0.94) and 0.80 (95% CI: 0.71-0.90) between sequential AVS and simultaneous AVS at respectively -5 min at 0 min. Concordance between simultaneous and sequential AVS was not different than that between 2 repeated simultaneous AVS in the same patient. Therefore, a better diagnostic performance is not a good argument to select the AVS method. © 2017 European Society of Endocrinology.

Bilateral Giant Retinal Tear and Sequential Vitrectomy.

Science.gov (United States)

Mustapha, Mushawiahti; Roufail Franzco, Edward

2017-01-01

To describe the excellent outcome of surgery for bilateral giant retinal tears (GRTs) with better options of endotamponade. This is a case report of a 62-year-old man who presented with bilateral GRTs and associated retinal detachment. The tear in the right eye was supero-temporal and silicone oil was used as an endotamponade. The tear in the left eye was infero-temporal and perfluorocarbon liquid was used as an endotamponade. The outcome at 6 months after surgery was excellent with visual acuities of 6/6 in both eyes. Improved availability of endotamponade agents allows repair of bilateral GRTs to be done at the same time, with good surgical outcomes.

Solid State Sensor for Simultaneous Measurement of Total Alkalinity and pH of Seawater.

Science.gov (United States)

Briggs, Ellen M; Sandoval, Sergio; Erten, Ahmet; Takeshita, Yuichiro; Kummel, Andrew C; Martz, Todd R

2017-09-22

A novel design is demonstrated for a solid state, reagent-less sensor capable of rapid and simultaneous measurement of pH and Total Alkalinity (A T ) using ion sensitive field effect transistor (ISFET) technology to provide a simplified means of characterization of the aqueous carbon dioxide system through measurement of two "master variables": pH and A T . ISFET-based pH sensors that achieve 0.001 precision are widely used in various oceanographic applications. A modified ISFET is demonstrated to perform a nanoliter-scale acid-base titration of A T in under 40 s. This method of measuring A T , a Coulometric Diffusion Titration, involves electrolytic generation of titrant, H + , through the electrolysis of water on the surface of the chip via a microfabricated electrode eliminating the requirement of external reagents. Characterization has been performed in seawater as well as titrating individual components (i.e., OH - , HCO 3 - , CO 3 2- , B(OH) 4 - , PO 4 3- ) of seawater A T . The seawater measurements are consistent with the design in reaching the benchmark goal of 0.5% precision in A T over the range of seawater A T of ∼2200-2500 μmol kg -1 which demonstrates great potential for autonomous sensing.

Processing demands upon cognitive, linguistic, and articulatory functions promote grey matter plasticity in the adult multilingual brain: Insights from simultaneous interpreters.

Science.gov (United States)

Elmer, Stefan; Hänggi, Jürgen; Jäncke, Lutz

2014-05-01

Until now, considerable effort has been made to determine structural brain characteristics related to exceptional multilingual skills. However, at least one important question has not yet been satisfactorily addressed in the previous literature, namely whether and to which extent the processing demands upon cognitive, linguistic, and articulatory functions may promote grey matter plasticity in the adult multilingual brain. Based on the premise that simultaneous interpretation is a highly demanding linguistic task that places strong demands on executive and articulatory functions, here we compared grey matter volumes between professional simultaneous interpreters (SI) and multilingual control subjects. Thereby, we focused on a specific set of a-priori defined bilateral brain regions that have previously been shown to support neurocognitional aspects of language control and linguistic functions in the multilingual brain. These regions are the cingulate gyrus, caudate nucleus, frontal operculum (pars triangularis and opercularis), inferior parietal lobe (IPL) (supramarginal and angular gyrus), and the insula. As a main result, we found reduced grey matter volumes in professional SI, compared to multilingual controls, in the left middle-anterior cingulate gyrus, bilateral pars triangularis, left pars opercularis, bilateral middle part of the insula, and in the left supramarginal gyrus (SMG). Interestingly, grey matter volume in left pars triangularis, right pars opercularis, middle-anterior cingulate gyrus, and in the bilateral caudate nucleus was negatively correlated with the cumulative number of interpreting hours. Hence, we provide first evidence for an expertise-related grey matter architecture that may reflect a composite of brain characteristics that were still present before interpreting training and training-related changes. Copyright © 2014 Elsevier Ltd. All rights reserved.

Danish Exports and Danish Bilateral Aid

DEFF Research Database (Denmark)

Hansen, Henrik; Rand, John

higher in the 1980s compared to in particular the most recent decade. This may be related to factors such as untying of aid in the same period. The econometric analysis has two important limitations. First of all, the model can only give information about marginal changes in aid. As a decision to give...... and trade policies. The main result of the study is that Danish bilateral aid has a positive and statistically significant impact on Danish exports to the recipient countries. Bilateral development assistance may affect exports through several channels. Three of the main channels are direct aid tying......; increasing recipient income where higher income leads to higher imports, and decreased trade costs, say due to improved information about cultural and administrative customs and practices. Thus, as for preferential trade arrangements, bilateral aid has two potential economic effects; trade creation working...

Associations of unilateral whisker and olfactory signals induce synapse formation and memory cell recruitment in bilateral barrel cortices: cellular mechanism for unilateral training toward bilateral memory

Directory of Open Access Journals (Sweden)

Zilong Gao

2016-12-01

Full Text Available Somatosensory signals and operative skills learned by unilateral limbs can be retrieved bilaterally. In terms of cellular mechanism underlying this unilateral learning toward bilateral memory, we hypothesized that associative memory cells in bilateral cortices and synapse innervations between them were produced. In the examination of this hypothesis, we have observed that paired unilateral whisker and odor stimulations led to odorant-induced whisker motions in bilateral sides, which were attenuated by inhibiting the activity of barrel cortices. In the mice that showed bilateral cross-modal responses, the neurons in both sides of barrel cortices became to encode this new odor signal alongside the innate whisker signal. Axon projections and synapse formations from the barrel cortex, which was co-activated with the piriform cortex, toward its contralateral barrel cortex were upregulated. Glutamatergic synaptic transmission in bilateral barrel cortices was upregulated and GABAergic synaptic transmission was downregulated. The associative activations of the sensory cortices facilitate new axon projection, glutamatergic synapse formation and GABAergic synapse downregulation, which drive the neurons to be recruited as associative memory cells in the bilateral cortices. Our data reveals the productions of associative memory cells and synapse innervations in bilateral sensory cortices for unilateral training toward bilateral memory.

Spontaneous Unruptured Bilateral Tubal Pregnancy: A Case Report

Directory of Open Access Journals (Sweden)

Nayereh Ghomian

2015-11-01

Full Text Available Bilateral spontaneous tubal ectopic pregnancy is the rarest form of extra uterine pregnancy. The diagnosis is usually made intraoperatively and levels of serum BHCG and ultrasound has not been useful in the diagnosis of bilateral tubal ectopic pregnancy. A 33-year-old woman with 8 weeks amenorrhea and sever lower abdominal pain was admitted. A transvaginal pelvic ultrasound revealed left adnexal mass and massive fluid collection in the pelvis and abdomen. The serum BHCG was 5,700 mIU/ml and in laparotomy bilateral unruptured tubal pregnancy was noted. Left salpingectomy and right salpingostomy were performed. The diagnosis of bilateral spontaneous tubal ectopic pregnancy is usually made intraoperatively. Both tubes at the time of surgery should be closely examined in order to prevent maternal morbidity and mortality.

Delayed-onset bilateral abducens paresis after head trauma

Directory of Open Access Journals (Sweden)

Pravin Salunke

2012-01-01

Full Text Available Bilateral sixth nerve paresis following closed head injury, though rare, is a known entity. However, delayed-onset post-traumatic bilateral abducens paresis is extremely rare. We present two cases. The first patient had onset of bilateral abducens paresis 2 weeks after closed head injury and the second patient after 3 days. The cause in the former was detected to be chronic subdural hematoma and in the latter is speculated to be edema/ischemia due to injury to soft tissue structures housing these nerves. The delayed onset of bilateral abducens paresis following head injury may vary according to the cause. There may be another mechanism of injury apart from direct trauma. Though rare, it needs to be evaluated and may have a treatable cause like elevated intracranial pressure.

Diffusion MR Imaging of Postoperative Bilateral Acute Ischemic Optic Neuropathy

International Nuclear Information System (INIS)

Park, Ju Young; Lee, In Ho; Song, Chang June; Hwang, Hee Youn

2012-01-01

A 57-year-old woman experienced bilateral acute ischemic optic neuropathy after spine surgery. Routine MR imaging sequence, T2-weighted image, showed subtle high signal intensity on bilateral optic nerves. A contrast-enhanced T1 weighted image showed enhancement along the bilateral optic nerve sheath. Moreover, diffusion-weighted image (DWI) and an apparent diffusion coefficient map showed markedly restricted diffusion on bilateral optic nerves. Although MR findings of T2-weighted and contrast enhanced T1-weighted images may be nonspecific, the DWI finding of cytotoxic edema of bilateral optic nerves will be helpful for the diagnosis of acute ischemic optic neuropathy after spine surgery.

Diffusion MR Imaging of Postoperative Bilateral Acute Ischemic Optic Neuropathy

Energy Technology Data Exchange (ETDEWEB)

Park, Ju Young; Lee, In Ho; Song, Chang June [Chungnam National University Hospital, Daejeon (Korea, Republic of); Hwang, Hee Youn [Eulji University Hospital, Daejeon(Korea, Republic of)

2012-03-15

A 57-year-old woman experienced bilateral acute ischemic optic neuropathy after spine surgery. Routine MR imaging sequence, T2-weighted image, showed subtle high signal intensity on bilateral optic nerves. A contrast-enhanced T1 weighted image showed enhancement along the bilateral optic nerve sheath. Moreover, diffusion-weighted image (DWI) and an apparent diffusion coefficient map showed markedly restricted diffusion on bilateral optic nerves. Although MR findings of T2-weighted and contrast enhanced T1-weighted images may be nonspecific, the DWI finding of cytotoxic edema of bilateral optic nerves will be helpful for the diagnosis of acute ischemic optic neuropathy after spine surgery.

Bilateral anophthalmia with septo-optic dysplasia

OpenAIRE

Jana, Manisha; Sharma, Sanjay

2010-01-01

Bilateral anophthalmia is a rare entity and association with septo-optic dysplasia is an even rare condition. The condition is characterized by absent eyeballs in the presence of eyelids, conjunctiva or lacrimal apparatus. Though anophthalmia can be diagnosed clinically, imaging plays a crucial role in delineating the associated anomalies. In addition, often clinical anophthalmia may prove to be severe microphthalmia on imaging. We describe the imaging findings in an infant with bilateral ano...

Bilateral spontaneous adrenal haemorrhage complicating acute pancreatitis

International Nuclear Information System (INIS)

Pianta, M.; Varma, D. K.

2007-01-01

Bilateral adrenal haemorrhage is an event that mandates prompt diagnosis and treatment to prevent primary adrenocortical insufficiency and potential death. Presentation can be non-specific and incidentally diagnosed with imaging alone, primarily CT. We present a case of acute pancreatitis with spontaneous bilateral adrenal haemorrhage and briefly discuss imaging and treatment implications

Topiramate-associated acute, bilateral, angle-closure glaucoma: case report

Directory of Open Access Journals (Sweden)

Lucas Barasnevicius Quagliato

2013-02-01

Full Text Available This paper describes a topiramate induced acute bilateral angle-closure glaucoma. This rare adverse effect is an idiosyncratic reaction characterized by uveal effusion and lens forward displacement, leading to increased intraocular pressure and vision loss. We describe a 55 year-old white woman with migraine, spasmodic torticollis and essential tremor, who developed bilateral acute angle-closure glaucoma, one week after starting topiramate 25 mg/day. She was seen at the Ophthalmology Emergency Department of the Fundação João Penido Burnier (Campinas, SP, Brazil with a 4 hours history of blurry vision, ocular pain and bright flashes vision. Slit lamp examination revealed moderate conjunctival injection and corneal edema, and shallow anterior chambers. Intraocular pressure was 48 mmHg in both eyes. Fundoscopic examination findings were normal. She was treated with timolol, brimonidine, dorzolamide, pilocarpine, prednisone acetate eye drops and acetazolamide. One hour after those measures, as the intraocular pressure was 30 mmHg, she received a manitol intravenous injection and the intraocular pressure normalized. After 24 hours an iridotomy with Yag laser was performed. Topiramate was discontinued and she was totally recovered after one week.

Surgical practices in total knee arthroplasty in Turkey.

Science.gov (United States)

Erduran, Mehmet; Akseki, Devrim; Araç, Sükrü

2012-01-01

The aim of this study was to determine the current practices in the total knee arthroplasty (TKA) and the differences of practice among the orthopedic surgeons in Turkey. Data in this cross-sectional and descriptive study was collected through a questionnaire from 76 orthopaedic surgeons performing TKA. The questionnaire form contained 57 questions under four main headings, covering the professional properties of the surgeon, pre-surgery approach, surgical technique applied for TKA and the surgical details peculiar to the technique with solutions applied for complication scenarios, and finally the postoperative approach. It was determined that 39.7% of the TKA applications were performed in operating theatres without laminar airflow or HEPA filters. Nearly 1/5 of the surgeons used more than one antibiotic for prophylaxis, and more than 85% continued prophylaxis use over 3 days. Low-molecular-weight heparin was the most commonly used method for thromboprophylaxis. 94.67% of the surgeons used only the cemented technique in primary TKA. 44% indicated that they performed simultaneous bilateral arthroplasty, 89% did not use any scoring system and 72.37% preferred fixed-bearing and posterior-cruciate-retaining type prosthesis. Results showed no standardization in TKA surgery among surgeons in Turkey, and important educational deficiencies were noted.

Association between renal cystic lesions and bilateral Wilms' tumours

Energy Technology Data Exchange (ETDEWEB)

Simanovsky, Natalia; Hiller, Nurith [Hadassah-Hebrew University Medical Center at Mt Scopus, Department of Medical Imaging, POB 12000, Jerusalem (Israel); Revel-Vilk, Shoshana; Weintraub, Michael [Hadassah-Hebrew University Medical Center, Department of Pediatric Hematology/ Oncology, Jerusalem (Israel)

2016-06-15

Evaluate a potential association between Wilms' tumour (WT) and renal cystic lesions. Digital records and imaging files of consecutive patients diagnosed with WT between 2004 and 2014 were retrospectively reviewed under an Institutional Review Board waiver of informed consent. The locations of renal cysts seen on US, CT, and/or MRI were recorded and compared with the locations of newly developed WT. A total of 48 patients (mean age 3 years 9 months) presented with newly diagnosed WT in the study period. Mean follow-up was 4.5 (range 1-10) years. WT was unilateral in 40 children, bilateral in 8. Renal cysts were identified in only one of the forty patients (2.5 %) with unilateral disease - in the contralateral kidney. In contrast, renal cysts were found in seven of eight patients with bilateral WT (87.5 %), in two of whom, new tumours developed in the same location where cysts had been seen on previous imaging studies. Renal cystic lesions in patients with Wilms' tumour should be regarded as potential tumour precursors, and followed with frequent imaging. (orig.)

Bilateral same-session ureterorenoscopy: A feasible approach to treat pan-urinary stone disease

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Bora Özveren

2017-12-01

Full Text Available Objectives: To assess treatment effectiveness and safety of bilateral same-session ureterorenoscopy (BSSU for the management of stone disease involving the entire urinary system. Patients and methods: We reviewed the records of 64 patients who underwent BSSU for the treatment of bilateral ureteric and/or kidney stones. Size, number, location per side, and the total burden of stones were recorded. Data on stenting, lithotripsy, and stone retrieval, and details of hospital stay and operation times were investigated. Treatment results were assessed using intraoperative findings and postoperative imaging. The outcome was considered successful in patients who were completely stone-free or who had only residual fragments of ≤2 mm. Results: The outcome was successful in 82.8% of the patients who received BSSU (54.7% stone-free and 28.1% insignificant residual fragments. The success rate per renal unit was 89.8%. There were no adverse events in 73.4% of the patients. The most common intraoperative complication was mucosal injury (36%. The complications were Clavien–Dindo Grade I in 9.4% and Grade II in 7.8%. Grade IIIa and IIIb (9.4% complications required re-treatments. Statistical evaluation showed no association between complication grades and stone, patient, or operation features. Stone burden had no negative impact on BSSU results. The presence of impacted proximal ureteric stones was significantly related to unsuccessful outcomes. Conclusion: BSSU is safe and effective for the management of bilateral urolithiasis. BSSU can prevent recurrent surgeries, reduce overall hospital stay, and achieve a stone-free status and complication rates that are comparable to those of unilateral or staged bilateral procedures. Keywords: Ureteroscopy, Bilateral, Kidney stones, ureter stones, Flexible ureterorenoscopy, Treatment outcomes

Dacrioadenite bilateral causada pelo vírus Epstein-Barr: relato de caso Epstein-Barr virus bilateral dacryoadenitis: case report

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Bernardo Kaplan Moscovici

2009-12-01

Full Text Available Os autores apresentam um caso raro de dacrioadenite aguda bilateral associada à mononucleose. Paciente do sexo feminino, 27 anos, tinha aumento agudo da glândula lacrimal, bilateral, com sinais flogísticos. As alterações tomográficas e laboratoriais confirmaram o diagnóstico e o tratamento com esteróide sistêmico foi introduzido, com resolução completa dos sinais e sintomas. COMENTÁRIOS: A dacrioadenite é uma apresentação incomum da mononucleose infecciosa e pode minimizar outras manifestações desta doença. O diagnóstico de mononucleose deve ser considerado em casos de dacrioadenite aguda bilateral. Os esteróides sistêmicos contribuem para a resolução do quadro inflamatório.The authors present a rare case of acute bilateral dacryoadenitis in association with infectious mononucleosis. A 27 year-old woman had acute bilateral lacrimal gland enlargement with inflammatory signs. The CT scan findings and laboratorial investigations confirmed the diagnosis of infectious mononucleosis. The systemic treatment with intravenous steroids was initiated leading to complete remission of the signs and symptoms. COMMENTS: Dacryoadenitis is an uncommon manifestation of infectious mononucleosis and may minimize other signs of the disease. Mononucleosis has to be considered in acute dacryoadenitis cases. Systemic steroids contribute to the fast regression of inflammatory condition.

Heart rate variability and baroreflex sensitivity in bilateral lung transplant recipients.

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Fontolliet, Timothée; Gianella, Pietro; Pichot, Vincent; Barthélémy, Jean-Claude; Gasche-Soccal, Paola; Ferretti, Guido; Lador, Frédéric

2018-01-09

The effects of lung afferents denervation on cardiovascular regulation can be assessed on bilateral lung transplantation patients. The high-frequency component of heart rate variability is known to be synchronous with breathing frequency. Then, if heart beat is neurally modulated by breathing frequency, we may expect disappearance of high frequency of heart rate variability in bilateral lung transplantation patients. On 11 patients and 11 matching healthy controls, we measured R-R interval (electrocardiography), blood pressure (Portapres ® ) and breathing frequency (ultrasonic device) in supine rest, during 10-min free breathing, 10-min cadenced breathing (0·25 Hz) and 5-min handgrip. We analysed heart rate variability and spontaneous variability of arterial blood pressure, by power spectral analysis, and baroreflex sensitivity, by the sequence method. Concerning heart rate variability, with respect to controls, transplant recipients had lower total power and lower low- and high-frequency power. The low-frequency/high-frequency ratio was higher. Concerning systolic, diastolic and mean arterial pressure variability, transplant recipients had lower total power (only for cadenced breathing), low frequency and low-frequency/high-frequency ratio during free and cadenced breathing. Baroreflex sensitivity was decreased. Denervated lungs induced strong heart rate variability reduction. The higher low-frequency/high-frequency ratio suggested that the total power drop was mostly due to high frequency. These results support the hypothesis that neural modulation from lung afferents contributes to the high frequency of heart rate variability. © 2018 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.

Sarcoidosis Presenting as Bilateral Vocal Fold Immobility.

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Hintze, Justin M; Gnagi, Sharon H; Lott, David G

2018-05-01

Bilateral true vocal fold paralysis is rarely attributable to inflammatory diseases. Sarcoidosis is a rare but important etiology of bilateral true vocal fold paralysis by compressive lymphadenopathy, granulomatous infiltration, and neural involvement. We describe the first reported case of sarcoidosis presenting as bilateral vocal fold immobility caused by direct fixation by granulomatous infiltration severe enough to necessitate tracheostomy insertion. In addition, we discuss the presentation, the pathophysiology, and the treatment of this disease with a review of the literature of previously reported cases of sarcoidosis-related vocal fold immobility. Sarcoidosis should therefore be an important consideration for the otolaryngologist's differential diagnosis of true vocal fold immobility. Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Is unilateral laparoscopic TEP inguinal hernia repair a job half done? The case for bilateral repair.

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Pawanindra Lal; Philips, Prejesh; Chander, Jagdish; Ramteke, Vinod K

2010-07-01

Bilateral laparoscopic totally extraperitoneal (TEP) repair of unilateral hernia is conspicuous in published literature by its absence. There are no studies or data on the feasibility, advantages or disadvantages of bilateral repair in all cases or in any subset of patients with unilateral primary inguinal hernia. The objective of this study is to investigate the feasibility of bilateral laparoscopic exploration for all unilateral cases followed by laparoscopic TEP in all cases and to compare complications, recurrence rates, postoperative pain, patient satisfaction, and return to work retrospectively with a similar number of age-matched retrospective controls. One hundred fifty TEP operations were performed in 75 patients (group A) prospectively and were compared with 75 unilateral TEP operations (group B) in age-matched controls done previously by the same surgeon. All cases were performed under general anesthesia, and TEP repair was performed using three midline ports. All uncomplicated patients were discharged at 24 h, in keeping with departmental policy. Of 75 patients (group A), 25 (33.3%) were clinically diagnosed with bilateral hernia and the rest (50, 66.66%) with unilateral hernia. The distribution of the 25 bilateral cases was 11 bilateral direct and 14 bilateral indirect inguinal hernias. The distribution of the 75 age-matched controls (group B) was all unilateral hernia, of which 47 were right-sided and 28 were left-sided. There were 23 direct hernias and 52 indirect hernias among the control group. The mean operative time for all 150 cases was 76.66 +/- 15.92 min. The operative time in the control group (unilateral hernias) was 66.16 +/- 12.44 min, whereas the operative time in the test group (bilateral repair) was 87.2 +/- 11.32 min. The operative time in the bilateral group was significantly higher, by 21.04 min or 31.88% (p = 0.000). The operative time in the true unilateral group was 82.45 +/- 9.38 min, whereas the operative time in the former

Bilateral chronic subdural hematoma

DEFF Research Database (Denmark)

Andersen-Ranberg, Nina Christine; Rom Poulsen, Frantz; Bergholt, Bo

2017-01-01

OBJECTIVE Bilateral chronic subdural hematoma (bCSDH) is a common neurosurgical condition frequently associated with the need for retreatment. The reason for the high rate of retreatment has not been thoroughly investigated. Thus, the authors focused on determining which independent predictors...... are associated with the retreatment of bCSDH with a focus on surgical laterality. METHODS In a national database of CSDHs (Danish Chronic Subdural Hematoma Study) the authors retrospectively identified all bCSDHs treated in the 4 Danish neurosurgical departments over the 3-year period from 2010 to 2012...... that a separated hematoma density and the absence of postoperative drainage were independent predictors of retreatment. CONCLUSIONS In bCSDHs bilateral surgical intervention significantly lowers the risk of retreatment compared with unilateral intervention and should be considered when choosing a surgical...

The effects of virtual reality-based bilateral arm training on hemiplegic children's upper limb motor skills.

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Do, Ji-Hye; Yoo, Eun-Young; Jung, Min-Ye; Park, Hae Yean

2016-01-01

Hemiplegic cerebral palsy is a neurological symptom appearing on the unilateral arm and leg of the body that causes affected upper/lower limb muscle weakening and dysesthesia and accompanies tetany and difficulties in postural control due to abnormal muscle tone, and difficulties in body coordination. The purpose of this study was to examine the impact of virtual reality-based bilateral arm training on the motor skills of children with hemiplegic cerebral palsy, in terms of their upper limb motor skills on the affected side, as well as their bilateral coordination ability. The research subjects were three children who were diagnosed with hemiplegic cerebral palsy. The research followed an ABA design, which was a single-subject experimental design. The procedure consisted of a total of 20 sessions, including four during the baseline period (A1), 12 during the intervention period (B), and four during the baseline regression period (A2), For the independent variable bilateral arm training based on virtual reality, Nintendo Wii game was played for 30 minutes in each of the 12 sessions. For the dependent variables of upper limb motor skills on the affected side and bilateral coordination ability, a Wolf Motor Function Test (WMFT) was carried out for each session and the Pediatric Motor Activity Log (PMAL) was measured before and after the intervention, as well as after the baseline regression period. To test bilateral coordination ability, shooting baskets in basketball with both hands and moving large light boxes were carried out under operational definitions, with the number of shots and time needed to move boxes measured. The results were presented using visual graphs and bar graphs. The study's results indicated that after virtual reality-based bilateral arm training, improvement occurred in upper limb motor skills on the affected sides, and in bilateral coordination ability, for all of the research subjects. Measurements of the effects of sustained therapy after

A Case of Synchronous Bilateral Upper Urinary System Urothelial Carcinoma

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Ibrahim Buldu

2014-12-01

Full Text Available Synchronous bilateral upper urinary tract urothelial cancer (UTUC is a very rare form of urothelial cancer. In patients with high-risk unilateral UTUC, radical nephroureterectomy (RNU is the gold standard treatment. However, there is no consensus on the treatment for synchronous bilateral UTUC. Evaluation of the patient and the tumor is recommended. Bilateral nephron-sparing surgery (NSS was performed on a 53-year-old patient who presented with high-risk synchronous bilateral UTUC, and the outcome was reported.

Bilateral hand/wrist heat and cold hyperalgesia, but not hypoesthesia, in unilateral carpal tunnel syndrome.

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de la Llave-Rincón, Ana Isabel; Fernández-de-las-Peñas, César; Fernández-Carnero, Josué; Padua, Luca; Arendt-Nielsen, Lars; Pareja, Juan A

2009-10-01

The aim of the current study was to evaluate bilaterally warm/cold detection and heat/cold pain thresholds over the hand/wrist in patients with carpal tunnel syndrome (CTS). A total of 25 women with strictly unilateral CTS (mean 42 +/- 10 years), and 20 healthy matched women (mean 41 +/- 8 years) were recruited. Warm/cold detection and heat/cold pain thresholds were assessed bilaterally over the carpal tunnel and the thenar eminence in a blinded design. Self-reported measures included both clinical pain history (intensity, location and area) and Boston Carpal Tunnel Questionnaire. No significant differences between groups for both warm and cold detection thresholds in either carpal tunnel or thenar eminence (P > 0.5) were found. Further, significant differences between groups, but not between sides, for both heat and cold pain thresholds in both the carpal tunnel and thenar eminence were found (all P < 0.001). Heat pain thresholds (P < 0.01) were negatively correlated, whereas cold pain thresholds (P < 0.001) were positively correlated with hand pain intensity and duration of symptoms. Our findings revealed bilateral thermal hyperalgesia (lower heat pain and reduced cold pain thresholds) but not hypoesthesia (normal warm/cold detection thresholds) in patients with strictly unilateral CTS when compared to controls. We suggest that bilateral heat and cold hyperalgesia may reflect impairments in central nociceptive processing in patients with unilateral CTS. The bilateral thermal hyperalgesia associated with pain intensity and duration of pain history supports a role of generalized sensitization mechanisms in the initiation, maintenance and spread of pain in CTS.

Outcome of bilateral ureteroscopic retrieval of stones in a single session

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Majid Mushtaque

2012-01-01

Conclusion: Bilateral same-session ureteroscopy is a safe and effective procedure in the management of bilateral ureteral stones. The results are comparable to unilateral or staged bilateral procedures.

Bilateral implant reconstruction does not affect the quality of postmastectomy radiation therapy

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Ho, Alice Y., E-mail: hoa1234@mskcc.org [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Patel, Nisha [Drexel University College of Medicine, Philadelphia, PA (United States); Ohri, Nisha [Department of Radiation Oncology, Mount Sinai School of Medicine, New York, NY (United States); Morrow, Monica [Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Mehrara, Babak J.; Disa, Joseph J.; Cordeiro, Peter G. [Department of Plastic Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Shi, Weiji; Zhang, Zhigang [Department of Biostatistics and Epidemiology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Gelblum, Daphna [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Nerbun, Claire T.; Woch, Katherine M.; Ballangrud, Ase [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); McCormick, Beryl; Powell, Simon N. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)

2014-04-01

To determine if the presence of bilateral implants, in addition to other anatomic and treatment-related variables, affects coverage of the target volume and dose to the heart and lung in patients receiving postmastectomy radiation therapy (PMRT). A total of 197 consecutive women with breast cancer underwent mastectomy and immediate tissue expander (TE) placement, with or without exchange for a permanent implant (PI) before radiation therapy at our center. PMRT was delivered with 2 tangential beams + supraclavicular lymph node field (50 Gy). Patients were grouped by implant number: 51% unilateral (100) and 49% bilateral (97). The planning target volume (PTV) (defined as implant + chest wall + nodes), heart, and ipsilateral lung were contoured and the following parameters were abstracted from dose-volume histogram (DVH) data: PTV D{sub 95%} > 98%, Lung V{sub 20}Gy > 30%, and Heart V{sub 25}Gy > 5%. Univariate (UVA) and multivariate analyses (MVA) were performed to determine the association of variables with these parameters. The 2 groups were well balanced for implant type and volume, internal mammary node (IMN) treatment, and laterality. In the entire cohort, 90% had PTV D{sub 95%} > 98%, indicating excellent coverage of the chest wall. Of the patients, 27% had high lung doses (V{sub 20}Gy > 30%) and 16% had high heart doses (V{sub 25}Gy > 5%). No significant factors were associated with suboptimal PTV coverage. On MVA, IMN treatment was found to be highly associated with high lung and heart doses (both p < 0.0001), but implant number was not (p = 0.54). In patients with bilateral implants, IMN treatment was the only predictor of dose to the contralateral implant (p = 0.001). In conclusion, bilateral implants do not compromise coverage of the target volume or increase lung and heart dose in patients receiving PMRT. The most important predictor of high lung and heart doses in patients with implant-based reconstruction, whether unilateral or bilateral, is treatment of

Interictal Electroencephalography (EEG) Findings in Children with Epilepsy and Bilateral Brain Lesions on Magnetic Resonance Imaging (MRI).

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Zubcevic, Smail; Milos, Maja; Catibusic, Feriha; Uzicanin, Sajra; Krdzalic, Belma

2015-12-01

Neuroimaging procedures and electroencephalography (EEG) are basic parts of investigation of patients with epilepsies. The aim is to try to assess relationship between bilaterally localized brain lesions found in routine management of children with newly diagnosed epilepsy and their interictal EEG findings. Total amount of 68 patients filled criteria for inclusion in the study that was performed at Neuropediatrics Department, Pediatric Hospital, University Clinical Center Sarajevo, or its outpatient clinic. There were 33 girls (48,5%) and 35 boys (51,5%). Average age at diagnosis of epilepsy was 3,5 years. Both neurological and neuropsychological examination in the moment of making diagnosis of epilepsy was normal in 27 (39,7%) patients, and showed some kind of delay or other neurological finding in 41 (60,3%). Brain MRI showed lesions that can be related to antenatal or perinatal events in most of the patients (ventricular dilation in 30,9%, delayed myelination and post-hypoxic changes in 27,9%). More than half of patients (55,9%) showed bilateral interictal epileptiform discharges on their EEGs, and further 14,7% had other kinds of bilateral abnormalities. Frequency of bilateral epileptic discharges showed statistically significant predominance on level of pEEG finding did not reveal significant type of EEG for assessed brain lesions. We conclude that there exists relationship between bilaterally localized brain MRI lesions and interictal bilateral epileptiform or nonspecific EEG findings in children with newly diagnosed epilepsies. These data are suggesting that in cases when they do not correlate there is a need for further investigation of seizure etiology.

Essure insert expulsion after 3-month hysterosalpingogram confirmation of bilateral tubal occlusion and bilateral correct placement: case report.

Science.gov (United States)

Garcia, Amy L; Lewis, Rae M; Sloan, Anita Lee

2013-01-01

Essure hysteroscopic sterilization is an effective permanent contraception option for women, with a 99.83% effectiveness rate. To date, more than 600,000 Essure procedures have been performed worldwide. This case report describes bilateral Essure insert placement, after which the left insert was subsequently expelled after hysterosalpingogram (HSG)-confirmed correct bilateral insert placement and bilateral tubal occlusion. Although insert expulsion has been reported before a 3-month post-procedure HSG, this is the first published report of expulsion after a confirmatory 3-month post-procedure HSG. Because there now exists documentation of Essure insert expulsion after a 3-month confirmatory HSG, physicians and patients should be informed of this rare occurrence. Further investigation into the causes of such an event is warranted. Copyright © 2013 AAGL. Published by Elsevier Inc. All rights reserved.

Bilateral anophthalmia with septo-optic dysplasia

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Manisha Jana

2010-01-01

Full Text Available Bilateral anophthalmia is a rare entity and association with septo-optic dysplasia is an even rare condition. The condition is characterized by absent eyeballs in the presence of eyelids, conjunctiva or lacrimal apparatus. Though anophthalmia can be diagnosed clinically, imaging plays a crucial role in delineating the associated anomalies. In addition, often clinical anophthalmia may prove to be severe microphthalmia on imaging. We describe the imaging findings in an infant with bilateral anophthalmia and septo-optic dysplasia.

Electricity market risk management using forward contracts with bilateral options

International Nuclear Information System (INIS)

Chung, T.S.; Yu, C.W.; Wong, K.P.; Zhang, S.H.

2003-01-01

Extreme short-term price volatility in competitive electricity markets creates the need for risk management arrangements. A new electricity forward contract with bilateral financial options is introduced, which allows both seller and buyer to take advantage of flexibility in generation and consumption to obtain monetary benefits while simultaneously removing the risk of market price fluctuations. The option theory is incorporated to formulate the contract price. The strike prices of options are derived from solving an equilibrium model in which both the buyer and the seller aim to maximise their own profit. Theoretical analysis shows that the proposed optional forward contract presents a more equitable and reasonable payoff structure that allows the buyer and seller to earn a larger overall expected benefit, and the contractual arrangement supports efficiency in economic dispatch of electricity production and consumption. The insights obtained from these results will be helpful to participants in the contractual decision-making process. (Author)

Bilateral acute retinal necrosis after herpetic meningitis

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Katsura T

2012-04-01

Full Text Available Keisho Hirota1,2, Masayuki Akimoto1,3, Toshiaki Katsura21Department of Ophthalmology, Kyoto Medical Center, National Hospital Organization, 2Internal Medicine, Kyoto Medical Center, 3Clinical Research Center, Kyoto Medical Center, Kyoto, JapanPurpose: The report of a case of bilateral acute retinal necrosis after herpetic meningitis.Case report: A 47-year-old man was admitted with the chief complaint of persistent high fever and transient loss of consciousness. Although his general condition improved after intravenous acyclovir administration, the patient presented with visual loss in both eyes 4 days after admission. Visual acuity in his right eye was 20/200 and his left eye had light perception alone. Both eyes showed panretinal arteritis diagnosed as acute retinal necrosis. Panretinal photocoagulation was performed for both eyes. Progression of retinal detachment was prevented in both eyes; however, visual acuity of the left eye was totally lost because of neovascular glaucoma. Visual acuity of the right eye recovered to 20/20.Conclusion: Although cases of bilateral acute retinal necrosis have been reported after herpetic encephalitis, this condition is rare after herpetic meningitis. Prophylactic acyclovir therapy and early panretinal photocoagulation may prevent retinal detachment and improve the prognosis. Neurologists and ophthalmologists should be aware that not only herpetic encephalitis but also herpetic meningitis can lead to acute retinal necrosis within a very short interval.Keywords: acute retinal necrosis, herpetic meningitis, herpes simplex, varicella zoster virus

Congenital bilateral neuroblastoma (stage IV-S): case report

International Nuclear Information System (INIS)

Lee, Jeong Hee; Lee, Hee Jung; Woo, Seong Ku; Lee, Sang Rak; Kim, Heung Sik

2002-01-01

Congenital neonatal neuroblastoma is not uncommon but bilateral adrenal neuroblastoma is rare, accounting for about ten percent of neuroblastomas in children. We report the US the MR findings of a stage IV-S congenital bilateral neuroblastoma occurring in a one-day-old neonate

A case of bilateral vocal fold mucosal bridges, bilateral trans-vocal fold type III sulci vocales, and an intracordal polyp.

Science.gov (United States)

Tan, Melin; Pitman, Michael J

2011-07-01

We present a patient with a novel finding of bilateral mucosal bridges, bilateral type III trans-vocal fold sulci vocales, and a vocal fold polyp. Although sulci and mucosal bridges occur in the vocal folds, it is rare to find multiples of these lesions in a single patient, and it is even more uncommon when they occur in conjunction with a vocal fold polyp. To our knowledge, this is the first description of a vocal fold polyp in combination with multiple vocal fold bridges and multiple type III sulci vocales in a single patient. To describe and visually present the diagnosis and treatment of a patient with an intracordal polyp, bilateral mucosal bridges, as well as bilateral type III trans-vocal fold sulci vocales. Presentation of a set of high definition intraoperative photos displaying the extent of the vocal fold lesions and the resection of the intracordal polyp. This patient presented with only 6 months of significant dysphonia. It was felt that the recent change in voice was because of the polyp and not the bridges or sulci vocales. Considering the patient's presentation and the possible morbidity of resection of mucosal bridges and sulci, only the polyp was excised. Postoperatively, the patient's voice returned to his acceptable mild baseline dysphonia, and the benefit has persisted 6 months postoperatively. The combination of bilateral mucosal bridges, bilateral type III sulcus vocalis, and an intracordal polyp in one patient is rare if not novel. Treatment of the polyp alone returned the patient's voice to his lifelong baseline of mild dysphonia. Copyright © 2011 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Fibrovascular tissue in bilateral juxtafoveal telangiectasis.

Science.gov (United States)

Park, D; Schatz, H; McDonald, H R; Johnson, R N

1996-09-01

To study the natural history and retinal findings associated with the intraretinal and subretinal fibrovascular tissues that develop in the late phases of bilateral juxtafoveal telangiectasis. The records of 10 patients (11 eyes) with bilateral juxtafoveal telangiectasis who developed these fibrovascular tissues were examined. Throughout the follow-up period (average 44 months), only 2 eyes (18%) lost 2 or more lines of vision; the final visual acuities were similar for the eyes both with and without fibrovascular tissues. Sixty-four percent of fibrovascular tissues showed little to no growth. Eyes with fibrovascular tissue commonly had retinal pigment epithelial hyperplasia (72%), draining retinal venules (82%), and retinal vascular distortion (64%). Fibrovascular tissues of bilateral juxtafoveal telangiectasis have little proliferative potential and minimal effects on visual acuity. Nevertheless, these fibrovascular tissues do remodel over time, leading to retinal vascular distortion. Given these benign findings, the role of laser photocoagulation treatment of these tissues is questionable.

Effect of single-limb inertial loading on bilateral reaching: interlimb interactions.

Science.gov (United States)

Hatzitaki, V; McKinley, P

2001-09-01

This study employed the paradigm of asymmetric limb loading during bilateral arm reaching to examine the motor system's ability to independently organize the discrete movement of both upper limbs to equidistant targets when one of the limbs is loaded under specific timing constraints. The loading procedure involved attaching two different Velcro strapped weights to the right wrist, thus increasing the right arm's mass by 25% (1 kg) and 50% (2 kg). Movements were captured by a high-speed digital camera (240 Hz), while electromyographic (EMG) activity of selected elbow and shoulder muscles of both limbs was recorded (1,000 Hz) simultaneously. The results revealed that the mechanisms used by the system to compensate for unilateral limb loading were as follows: First, addition of an inertial load resulted in an increased movement time and concomitant decrease in peak velocity of both the upper arm and forearm of only the loaded limb and was scaled to the added weight. Second, for the EMG parameters, adjustments to the inertial load were primarily characterized by an increase in burst duration of all muscles, with load-specific changes in activity and onset time: the elbow antagonist (biceps) demonstrated a decrease in activity with the 50% load, and the elbow agonist (triceps) had an earlier onset with the 25% load. Concomitant adjustments on the unloaded limb consisted primarily of an increase in burst duration of the shoulder and elbow agonists (pectoralis and triceps), an earlier triceps onset solely with the 25% load, and a decrease in activity of the biceps solely with the 50% load. Third, with the exception of biceps activity, the amplitude of EMG activity was invariant across changes in load for both the loaded and unloaded limb. This lack of modulation in activity may have been related to the inability of performers to meet the time constraint of simultaneous bilateral limb arrival to the end targets. This inability can be the result of an active strategy

Multilateral and bilateral agreements

International Nuclear Information System (INIS)

Koponen, H.

1993-01-01

Finland has made both multilateral and bilateral agreements on the exchange of information related to radiation safety. The first arrangements for international agreements and exchange of information were made after the Chernobyl accident. In 1987, Finland joined the convention on early notification of a nuclear power accident coordinated by International Atomic Energy Agency. The convention is applied to accidents that cause of may cause emissions of radioactive substances that might affect the radiation safety of another country. Besides the convention on early notification, some other individual agreements have also been made. These include the International Nuclear Event Scale (INES) system and power companies own information exchange systems. Finland has conducted bilateral agreements with the Nordic countries and the Soviet Union on the notification of accidents and exchange of nuclear power plant information. Today, Russia answers for the Soviet Union's contractual obligations. (orig.)

Severe Bilateral Breast Mucinous Carcinoma with Bilateral Lungs and Cutaneous Metastasis: A Case Report and Literature Review

Directory of Open Access Journals (Sweden)

Rong Pu

2018-01-01

Full Text Available The case of a female who had severe, rare, terminal breast mucinous carcinoma (BMC and failed to receive surgery and chemotherapy was reported. The patient was diagnosed with pure BMC (ER++, PR++, CerbB-2−, and Ki-67 10% accompanied with bilateral lungs, bilateral chest walls with skin ulcer (D = 14 cm, lymph nodes of bilateral armpits, and right supraclavicular metastases. ECOG (Eastern Cooperative Oncology Group and NRS (Numeric Rating Scale pain scores were 4 and 6, respectively. Because the patient refused traditional chemotherapy and radiotherapy on religious grounds, an herbal medicine containing Panax ginseng, Agrimonia pilosa, and white flower Patrinia herb was administered; extensive nursing for tumor debridement was also provided. Quality of Life (QOL improved and pain reduced. Tumor-bearing survival time was prolonged. The present case dictates that herbal extract medicines and supportive treatment can be helpful for uncommon severe BMC as an appropriate alternative treatment.

Integer batch scheduling problems for a single-machine with simultaneous effect of learning and forgetting to minimize total actual flow time

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Rinto Yusriski

2015-09-01

Full Text Available This research discusses an integer batch scheduling problems for a single-machine with position-dependent batch processing time due to the simultaneous effect of learning and forgetting. The decision variables are the number of batches, batch sizes, and the sequence of the resulting batches. The objective is to minimize total actual flow time, defined as total interval time between the arrival times of parts in all respective batches and their common due date. There are two proposed algorithms to solve the problems. The first is developed by using the Integer Composition method, and it produces an optimal solution. Since the problems can be solved by the first algorithm in a worst-case time complexity O(n2n-1, this research proposes the second algorithm. It is a heuristic algorithm based on the Lagrange Relaxation method. Numerical experiments show that the heuristic algorithm gives outstanding results.

SU-F-T-289: MLC Fluence Sonogram Based Delivery Quality Assurance for Bilateral Breast Irradiation

Energy Technology Data Exchange (ETDEWEB)

Thiyagarajan, Rajesh; Karrthick, KP; Kataria, Tejinder; Mahendran, Ramu; Selvan, Tamil; Duraikannu, Palani [Division of Radiation Oncology, Medanta The Medicity, Gurgaon, Haryana (India); Raj, Nambi [Department of Physics, School of Advanced sciences, VIT University, Vellore (India); Arunai, N

2016-06-15

Purpose: Performing DQA for Bilateral (B-L) breast tomotherapy is a challenging task due to the limitation of any commercially available detector array or film. Aim of this study is to perform DQA for B-L breast tomotherapy plan using MLC fluence sinogram. Methods: Treatment plan was generated on Tomotherapy system for B-L breast tumour. B-L breast targets were given 50.4 Gy prescribed over 28 fractions. Plan is generated with 6 MV photon beam & pitch was set to 0.3. As the width of the total target is 39 cm (left & right) length is 20 cm. DQA plan delivered without any phantom on the mega voltage computed tomography (MCVT) detector system. The pulses recorded by MVCT system were exported to the delivery analysis software (Tomotherapy Inc.) for reconstruction. The detector signals are reconstructed to a sonogram and converted to MLC fluence sonogram. The MLC fluence sinogram compared with the planned fluence sinogram. Also point dose measured with cheese phantom and ionization chamber to verify the absolute dose component Results: Planned fluence sinogram and reconstructed MLC fluence sinogram were compared using Gamma metric. MLC positional difference and intensity of the beamlet were used as parameters to evaluate gamma. 3 mm positional difference and 3% beamlet intensity difference were used set for gamma calculation. A total of 26784 non-zero beamlets were included in the analysis out of which 161 beamlets had gamma more than 1. The gamma passing rate found to be 99.4%. Point dose measurements were within 1.3% of the calculated dose. Conclusion: MLC fluence sinogram based delivery quality assurance performed for bilateral breast irradiation. This would be a suitable alternate for large volume targets like bilateral breast, Total body irradiation etc. However conventional method of DQA should be used to validate this method periodically.

Bilateral cerebellopontine arachnoid cyst: A rare entity.

Science.gov (United States)

Sharma, Anand; Sharma, Achal; Mittal, Radhey S; Gandhi, Ashok

2015-01-01

Bilateral cerebellopontine angle (CPA) arachnoid cysts (ACs) are very rare: only one case is reported in literature. Pathogenesis of those cysts is unknown; they are thought to be congenital. The presenting symptoms of CPA AC are frequently nonspecific or otological. The management of ACs of the CPA is controversial. We are reporting two cases of bilateral CPA AC with their pathophysiology and review of literature.

Bilateral teleoperation for force sensorless 1-dof robots

NARCIS (Netherlands)

Lichiardopol, S.; Wouw, van de N.; Nijmeijer, H.; Filipe, J.; Cetto, J.A.; Ferrier, J.-L.

2010-01-01

It is well known that for bilateral teleoperation, force feedback information is needed. In this paper, we propose a control approach for bilateral teleoperation with uncertainties in the model of the slave robot and which does not use force sensors for haptic feedback. The controller design is

Bilateral nanophthalmos and pigmentary retinal dystrophy--an unusual syndrome.

Science.gov (United States)

Proença, Helena; Castanheira-Dinis, A; Monteiro-Grillo, M

2006-09-01

To report the clinical picture of the rare association of nanophthalmos and pigmentary retinal dystrophy and its cataract surgery outcome. We report a case of a 60-year-old female who presented with bilateral slowly progressive visual loss. The patient presented with bilateral light perception visual acuity, exotropia, brunescent cataract hindering fundus examination and hypodontia. Ultrasonography revealed bilateral nanophthalmos. A visual-evoked potential was also performed preoperatively. Cataract surgery with +40D IOL implantation was uneventful. Postoperative fundus examination revealed pigmentary retinal dystrophy, confirmed by electrophysiologic tests. Glycosaminoglycan urinary excretion was normal. Congenital bilateral nanophthalmos may rarely be associated with pigmentary retinal dystrophy. We suggest thorough preoperative evaluation in nanophthalmic eyes for the exclusion of significant features concerning visual prognosis.

COMPARATIVE STUDY ON BILATERAL SINGLE SITTING ENDOSCOPIC MYRINGOPLASTY CONCHAL CARTILAGE VERSUS TEMPORALIS FASCIA GRAFT

Directory of Open Access Journals (Sweden)

Indra Thirugnanam

2017-10-01

Full Text Available BACKGROUND Though single sitting myringoplasty using temporalis fascia under general anaesthesia has been documented in many studies, but ours is the first center to have started using tragal cartilage and temporalis fascia harvested from one ear to do bilateral myringoplasty in one sitting using local anaesthesia with excellent results including very good graft uptake rate and audiological improvement without significant complications. The aim of the study is to compare the outcome of bilateral myringoplasty in dry central perforation in one sitting using cartilage on one side and temporalis fascia on the other ear in an urban tertiary care centre. MATERIALS AND METHODS A total of 50 patients above the age of 15 years were included in the study who had dried bilateral perforated ear drum involving pars tensa both sides size of perforation and hearing loss were more or less-matched patients who had persistently discharging ear or had evidence of middle ear infection, granulation tissues, aural polypi, cholesteatoma, ossicular erosion or evidence of sensorineural hearing loss were excluded from the study. In the cases, temporalis fascia graft through postaural incision right side and conchal cartilage was harvested from the right side and endoscopic myringoplasty was performed. Temporalis fascia graft placed by underlay technique and conchal cartilage was used as graft on the left side for all the patients. Patients were followed up after 3 and 6 months to assess closure of tympanic membrane perforation and hearing improvement as depicted by closure of air above gap on pure tone audiometry at 6 months. Study Design- Interventional, descriptive. Place and Duration of Study- Department of ENT, UIORL, Madras Medical College and Rajiv Gandhi Government General Hospital, June 2012 to July 2013. RESULTS A total of 100 myringoplasties were performed on 50 patients included in the study. Majority of the patients included were having medium to large size

Bilateral patellar tuberculosis masquerading as infected infrapatellar bursitis.

Science.gov (United States)

Sreenivasan, Ravi; Haq, Rehan Ul

2017-04-01

A 30-year-old woman presented to our outpatient department with complaints of pain and swelling in bilateral infrapatellar regions and a discharging sinus in the right knee over the duration of one year. Radiographs showed lytic regions in bilateral patellae. Samples sent from material curetted from sinus yielded no organism but histopathology reported granulomatous inflammation. Following a fresh magnetic resonance imaging (MRI) scan that revealed the infrapatellar pad of fat communicating with the patellar lesions, an exploration and evacuation was done. Material sent revealed epithelioid cell granulomas with caseous necrosis consistent with tuberculosis (TB). The patient was put on first line anti-tubercular treatment (ATT) and has responded favourably with healing of sinus and patellar lesions. Bilateral infrapatellar bursitis is not rare. However patellar TB as a cause for OMIT is not a common diagnosis. A bilateral patellar involvement has not been reported in literature to the best of our knowledge.

Surgery for bilateral large intracranial traumatic hematomas: evacuation in a single session.

Science.gov (United States)

Kompheak, Heng; Hwang, Sun-Chul; Kim, Dong-Sung; Shin, Dong-Sung; Kim, Bum-Tae

2014-06-01

Management guidelines for single intracranial hematomas have been established, but the optimal management of multiple hematomas has little known. We present bilateral traumatic supratentorial hematomas that each has enough volume to be evacuated and discuss how to operate effectively it in a single anesthesia. In total, 203 patients underwent evacuation and/or decompressive craniectomies for acute intracranial hematomas over 5 years. Among them, only eight cases (3.9%) underwent operations for bilateral intracranial hematomas in a single session. Injury mechanism, initial Glasgow Coma Scale score, types of intracranial lesions, surgical methods, and Glasgow outcome scale were evaluated. The most common injury mechanism was a fall (four cases). The types of intracranial lesions were epidural hematoma (EDH)/intracerebral hematoma (ICH) in five, EDH/EDH in one, EDH/subdural hematoma (SDH) in one, and ICH/SDH in one. All cases except one had an EDH. The EDH was addressed first in all cases. Then, the evacuation of the ICH was performed through a small craniotomy or burr hole. All patients except one survived. Bilateral intracranial hematomas that should be removed in a single-session operation are rare. Epidural hematomas almost always occur in these cases and should be removed first to prevent the hematoma from growing during the surgery. Then, the other hematoma, contralateral to the EDH, can be evacuated with a small craniotomy.

Primary Multiple Simultaneous Intracerebral Hemorrhages between 1950 and 2013: Analysis of Data on Age, Sex and Outcome

Directory of Open Access Journals (Sweden)

Denchai Laiwattana

2014-05-01

Full Text Available Background: Primary multiple simultaneous intracerebral hemorrhages (MSICHs are quite rare. Although occasional reports have been found, there have been no systematic reviews. The published case reports and case series contain overlapping data, leading to erroneous information about MSICHs. This is the first extensive review of accessible studies published in English on MSICHs. Our primary objective was to analyze the demographic data on age, sex, outcome and prognosis with regard to primary MSICHs. Summary: A PubMed search without language restriction for articles with results from human studies and registered between January 1950 and September 2013 yielded 677 articles. The following inclusion criteria were applied: (1 reported case(s or case series on primary MSICHs; (2 text partly or fully in English, and (3 text contains identifiable data on age, sex and outcome of patients. A total of 24 articles met all the inclusion criteria. The reference lists of these 24 articles were inspected for additional relevant articles, which yielded another 20 articles. In all, 248 cases were identified; 143 cases were excluded for various reasons: 52 duplicate cases, 18 cases of multiple nonsimultaneous intracerebral hemorrhages, 25 cases of secondary MSICHs, and 48 cases with incomplete data on age, sex and outcome. The remaining 105 cases were analyzed. MSICHs were found to be more common in bilateral cases (53.33%: there were bilateral basal ganglia hemorrhages (33.33%, bilateral thalamic hemorrhages (18.10%, bilateral lobar hemorrhages (0.95% and bilateral cerebellar hemorrhages (0.95%. Nonbilateral MSICHs were found in 46.67% of the cases. The hematomas were commonly distributed in the basal ganglia (45.83%, thalamus (30.56% and cerebellum (10.19%. MSICHs were more frequently encountered in males (60.95%; average age: 59.13 ± 12.49 years. The average age of the female patients was higher (63.89 ± 13.11 years. Patients with primary MSICHs had a

Primary Multiple Simultaneous Intracerebral Hemorrhages between 1950 and 2013: Analysis of Data on Age, Sex and Outcome.

Science.gov (United States)

Laiwattana, Denchai; Sangsawang, Bussara; Sangsawang, Nucharee

2014-01-01

Primary multiple simultaneous intracerebral hemorrhages (MSICHs) are quite rare. Although occasional reports have been found, there have been no systematic reviews. The published case reports and case series contain overlapping data, leading to erroneous information about MSICHs. This is the first extensive review of accessible studies published in English on MSICHs. Our primary objective was to analyze the demographic data on age, sex, outcome and prognosis with regard to primary MSICHs. A PubMed search without language restriction for articles with results from human studies and registered between January 1950 and September 2013 yielded 677 articles. The following inclusion criteria were applied: (1) reported case(s) or case series on primary MSICHs; (2) text partly or fully in English, and (3) text contains identifiable data on age, sex and outcome of patients. A total of 24 articles met all the inclusion criteria. The reference lists of these 24 articles were inspected for additional relevant articles, which yielded another 20 articles. In all, 248 cases were identified; 143 cases were excluded for various reasons: 52 duplicate cases, 18 cases of multiple nonsimultaneous intracerebral hemorrhages, 25 cases of secondary MSICHs, and 48 cases with incomplete data on age, sex and outcome. The remaining 105 cases were analyzed. MSICHs were found to be more common in bilateral cases (53.33%): there were bilateral basal ganglia hemorrhages (33.33%), bilateral thalamic hemorrhages (18.10%), bilateral lobar hemorrhages (0.95%) and bilateral cerebellar hemorrhages (0.95%). Nonbilateral MSICHs were found in 46.67% of the cases. The hematomas were commonly distributed in the basal ganglia (45.83%), thalamus (30.56%) and cerebellum (10.19%). MSICHs were more frequently encountered in males (60.95%; average age: 59.13 ± 12.49 years). The average age of the female patients was higher (63.89 ± 13.11 years). Patients with primary MSICHs had a survival rate of 56.20%. There

[Efficacy and safety of ultrasound-guided or neurostimulator-guided bilateral axillary brachial plexus block].

Science.gov (United States)

Xu, C S; Zhao, X L; Zhou, H B; Qu, Z J; Yang, Q G; Wang, H J; Wang, G

2017-10-17

Objective: To explore the efficacy and safety of bilateral axillary brachial plexus block under the guidance of ultrasound or neurostimulator. Methods: From February 2012 to April 2014, 120 patients undergoing bilateral hand/forearm surgery in Beijing Jishuitan Hospital were enrolled and anaesthetized with bilateral axillary brachial plexus block. All patients were divided into two groups randomly using random number table: the ultrasound-guided group (group U, n =60) and the neurostimulator-guidedgroup (group N, n =60). The block was performed with 0.5% ropivacaine. Patients' age, sex and operation duration were recorded. Moreover, success rate, performance time, onset of sensor and motor block, performance pain, patient satisfaction degree and the incidence of related complications were also documented. Venous samples were collected at selected time points and the total and the plasma concentrations of ropivacaine were analyzed with HPLC. Results: The performance time, the onset of sensor block and the onset of motor block of group U were (8.2±1.5), (14.2± 2.2)and (24.0±3.5)min respectively, which were markedly shorter than those in group N( (14.6±3.9), (19.9±3.8), (28.8±4.2)min, respectively), and the differences were statistically significant( t =11.74, 10.09, 6.73, respectively, all P 0.05). No analgesic was superadded and no other anesthesia methods were applied. No complications were detected perioperatively. Conclusions: The bilateral axillary brachial plexus block under the guidance of ultrasound or neurostimulator are both effective and safe for bilateral hand/forearm surgery. However, the ultrasound-guided block may be more clinically beneficial because of its shorter performance time, rapid onset and higher patient satisfaction degree.

Bilateral Supernumerary Kidney: A Very Rare Presentation

International Nuclear Information System (INIS)

Keskin, Suat; Batur, Abdussamet; Keskin, Zeynep; Koc, Abdulkadir; Firat Ozcan, Irfan

2014-01-01

To our knowledge, bilateral supernumerary kidney is a very rare renal abnormality and there are five cases presented in the literature. It is difficult to diagnose supernumerary kidney and clinicians have not detected most cases preoperatively. Laboratory and imaging studies were acquired and carefully examined. The normal laboratory tests were found. Emergency ultrasonography was performed and they revealed no signs of parenchymal abnormality in both kidneys. Serial imaging study including enhanced computed tomography (CT) was performed. An imaging study identified bilateral supernumerary kidney with expanded collecting systems. On each side, significant rotation anomaly was found. In addition, there were two different renal arteries originating from the aorta. This report presents radiological determinations of supernumerary kidney bilaterally in a young man. We think that CT commonly appears to be enough for the diagnosis of supernumerary kidneys

Bilateral cerebral hemispheric infarction associated with sildenafil citrate (Viagra) use.

Science.gov (United States)

Kim, K-K; Kim, D G; Ku, Y H; Lee, Y J; Kim, W-C; Kim, O J; Kim, H S

2008-03-01

Sildenafil citrate (Viagra) is one of the frequently prescribed drugs for men with erectile dysfunction. We describe a 52-year-old man with bilateral middle cerebral artery (MCA) territory infarction after sildenafil use. He ingested 100 mg of sildenafil and about 1 h later, he complained of chest discomfort, palpitation and dizziness followed by mental obtundation, global aphasia and left hemiparesis. Brain magnetic resonance imaging documented acute bilateral hemispheric infarction, and cerebral angiography showed occluded bilateral MCA. Despite significant bilateral MCA stenosis and cerebral infarction, systemic hypotension persisted for a day. We presume that cerebral infarction was caused by cardioembolism with sildenafil use.

Homogeneous bilateral block shifts

Indian Academy of Sciences (India)

Douglas class were classified in [3]; they are unilateral block shifts of arbitrary block size (i.e. dim H(n) can be anything). However, no examples of irreducible homogeneous bilateral block shifts of block size larger than 1 were known until now.

The effect of enhanced trunk control on balance and falls through bilateral upper extremity exercises among chronic stroke patients in a standing position

OpenAIRE

Shin, Ji Won; Don Kim, Kyoung

2016-01-01

[Purpose] This study examined the effects of bilateral upper extremity exercises on trunk control, balance, and risk of falls in stroke patients. [Subjects and Methods] A total of 30 study subjects were selected and randomly divided into experimental and control groups containing 15 subjects each, who received bilateral upper extremity activities and conventional rehabilitation treatment, respectively. [Results] There were statistically significant differences between groups in all sub-items ...

Dental anomalies associated with unilateral and bilateral cleft lip and palate.

Science.gov (United States)

Qureshi, Wafa A; Beiraghi, Soraya; Leon-Salazar, Vladimir

2012-01-01

The purpose of this study was to compare the prevalence of dental anomalies in the primary and permanent dentition of patients with unilateral (UCLP) and bilateral (BCLP) cleft lip with or without palate. One hundred two complete clinical records were randomly selected for review from a university-based cleft palate clinic. Only nonsyndromic UCLP and BCLP cases were further selected for analysis of dental anomalies. The prevalence of 9 dental categories, including anomalies in number, crown structure, position, and maxillary-mandibular relationship, was assessed and compared between UCLP and BCLP cases using Fisher's exact test. Of the 102 charts evaluated, there were 67 cases of UCLP and 29 cases of BCLP for a total of 96 cases. There was a high prevalence of dental anomalies in primary and permanent teeth; 93% of UCLP cases and 96% of BCLP cases presented with at least 1 dental anomaly. Significant differences ( P dental anomalies associated with orofacial clefts regardless of whether they are unilateral or bilateral cleft lip with or without palate.

Bilateral lateral ventricular subependymoma with extensive multiplicity presenting with hemorrhage.

Science.gov (United States)

Moinuddin, F M; Ikbar Khairunnisa, Novita; Hirano, Hirofumi; Hanada, Tomoko; Hiraki, Tsubasa; Kirishima, Mari; Kamimura, Kiyohisa; Arita, Kazunori

2018-02-01

This 48-year-old-man who had undergone right thyroid lobectomy for undifferentiated thyroid carcinoma nine years earlier developed generalized seizures. His cerebrospinal fluid was xanthochromic with elevation of total protein. Computed tomography (CT) showed mixed-density bilateral ventricular masses. Magnetic resonance imaging (MRI) revealed multiple nodules in both lateral ventricles; they were heterogeneously enhanced by gadolinium. Diffuse hyperintensity in the right medial temporal lobe and bilateral subependymal area was noted on fluid-attenuated inversion recovery images. Susceptibility-weighted imaging showed low intensity in the masses and cerebellar sulci suggesting hemorrhage and hemosiderin deposition. The preoperative diagnosis was disseminated malignant tumor with recurring hemorrhage. Histological examination of biopsy specimens showed clusters of cells with small uniform nuclei embedded in a dense fibrillary matrix of glial cells and microcystic degeneration. Pseudo-rosettes indicating ependymoma were absent. Microhemorrhages and hemosiderin deposits were noted. Immunohistochemically, the background fibrillary matrix and neoplastic cells were positive for glial fibrillary acidic protein. Mutated isocitrate dehydrogenase-1 was negative. The MIB-1 index was 1.5%. The tumor was pathologically diagnosed as subependymoma containing microhemorrhages and hemosiderin deposits. The extensive multiplicity and hemorrhage encountered in this case have rarely been reported in patients with subependymoma.

Prevalence of dental anomalies in children with cleft lip and unilateral and bilateral cleft lip and palate.

Science.gov (United States)

Rullo, R; Festa, V M; Rullo, R; Addabbo, F; Chiodini, P; Vitale, M; Perillo, L

2015-09-01

To examine the prevalence of different types of dental anomalies in children with nonsyndromic cleft lip, unilateral cleft lip-palate, and bilateral cleft lip-palate. A sample of 90 patients (aged 4-20 years) affected by isolated cleft lip, unilateral and bilateral cleft lip and palate was examined. Cleft patients were classified into one of three groups according to cleft type: (1) Unilateral Cleft Lip-Palate, (2) Bilateral Cleft Lip-Palate, and (3) Cleft Lip. Intraoral exams, panoramic radiographs and dental casts, were used to analyse the prevalence of the various dental anomalies included in this study. There were no statistically significant differences between patients with cleft lip, unilateral cleft lip and palate and bilateral cleft lip and palate. The congenital absence of the cleft-side lateral incisor was observed in 40% of the sample, and a total of 30% patients showed supernumerary teeth at the incisors region. Second premolar agenesis was found in 4.4% of patients, whereas in 18.9% of the sample there was an ectopic dental eruption. Lateral or central incisors rotation was noted in 31.1% of the sample, while shape anomaly, lateral incisor microdontia, and enamel hypoplasia were detected respectively in 25.6%, 5.6% and 18.9% of cleft patients. High prevalence of different dental anomalies in children with cleft lip and unilateral and bilateral cleft lip and palate has been confirmed. This study, in particular, shows the presence of ectopic and rotated teeth in the cleft area.

Stabilization of Bilateral Progressive Rheumatoid Corneal Melt with Infliximab

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Sheelah F. Antao

2012-01-01

Results. A patient with rheumatoid arthritis presented with bilateral PUK following a 2-month history of ocular discomfort and redness. His systemic prednisolone (PDN and methotrexate (MTX were increased and, despite an initial favorable response, bilateral recurrent corneal perforations ensued. Both eyes underwent cyanoacrylate glue repair, amniotic membrane transplantation (AMT, and penetrating keratoplasty (PKP. Recurrence of the disease and bilateral perforations of the second PKP in both eyes prompted administration of intravenous infliximab immediately after the fourth PKP. The disease activity rapidly settled in both eyes, and at eighteen-month followup, after 12 infliximab infusions, the PUK remains quiescent with no further graft thinning or perforation. Conclusion. Infliximab can be used to arrest the progression of severe bilateral rheumatoid PUK in cases that are refractory to conventional treatment.

Cryptogenic organising pneumonia presenting with bilateral hilar and mediastinal lymphadenopathy.

Science.gov (United States)

Kahraman, Hasan; Tokur, Mahmut; Sayar, Hamide; Inci, Mehmet Fatih

2013-06-10

Cryptogenic organising pneumonia is not considered in the differential diagnosis of bilateral hilar and mediastinal lymphadenopathy. We submitted a patient presenting with bilateral hilar and mediastinal lymphadenopathy. We suspected diagnosis of sarcoidosis, but the patient was diagnosed as cryptogenic organising pneumonia with the histological result. This is the second case report of cryptogenic organising pneumonia presenting with bilateral hilar and mediastinal lymphadenopathy.

Measuring arrangement for simultaneous and continuous determination of the total and radioactive amounts of reactive matters in flowing inert gases. Pt. 1

International Nuclear Information System (INIS)

Figge, K.; Martinen, H.; Schulz, W.

1976-01-01

In order to investigate the metabolism behaviour of radiocarbon-labelled substances, a special apparatus has been designed which enables a fully automatic as well as continuous and simultaneous determination of the total and the 14 C-labelled carbon dioxide (CO 2 ) in the respiratory air of small animals. The CO 2 which is exhaled by the experimental animals is absorbed quantitatively in a novel absorber-scintillator cocktail. The quantity of combined total CO 2 is then determined by measuring the specific conductivity whereas the amount of radioactive CO 2 is assessed via scintillation measurement. The measuring accuracy achieved is around 10 N cm 3 or about 5 nCi, whereas the CO 2 recovery is above 98%. In addition to the recording in a linear recorder, the data are transferred to punching tapes and can be evaluated in an EDP unit. (orig.) [de

An evaluation of surgical outcome of bilateral cleft lip surgery using a modified Millard′s (Fork Flap technique

Directory of Open Access Journals (Sweden)

W L Adeyemo

2013-01-01

Full Text Available Background: The central third of the face is distorted by the bilateral cleft of the lip and palate and restoring the normal facial form is one of the primary goals for the reconstructive surgeons. The history of bilateral cleft lip repair has evolved from discarding the premaxilla and prolabium and approximating the lateral lip elements to a definitive lip and primary cleft nasal repair utilising the underlying musculature. The aim of this study was to review surgical outcome of bilateral cleft lip surgery (BCLS done at the Lagos University Teaching Hospital. Materials and Methods: A review of all cases of BCLS done between January 2007 and December 2012 at the Lagos University Teaching Hospital was done. Data analysis included age and sex of patients, type of cleft deformity and type of surgery (primary or secondary and whether the cleft deformity was syndromic and non-syndromic. Techniques of repair, surgical outcome and complications were also recorded. Results: A total of 39 cases of BCLS involving 21 males and 18 females were done during the period. This constituted 10% (39/390 of all cases of cleft surgery done during the period. There were 5 syndromic and 34 non-syndromic cases. Age of patients at time of surgery ranged between 3 months and 32 years. There were 24 bilateral cleft lip and palate deformities and 15 bilateral cleft lip deformities. Thirty-one of the cases were primary surgery, while 8 were secondary (revision surgery. The most common surgical technique employed was modified Fork flap (Millard technique, which was employed in 37 (95% cases. Conclusion: Bilateral cleft lip deformity is a common cleft deformity seen in clinical practice, surgical repair of which can be a challenge to an experienced surgeon. A modified Fork flap technique for repair of bilateral cleft lip is a reliable and versatile technique associated with excellent surgical outcome.

Bilateral Herpes Simplex Uveitis: Review of the Literature and Own Reports‏.

Science.gov (United States)

de-la-Torre, Alejandra; Valdes-Camacho, Juanita; Foster, C Stephen

2017-08-01

Herpes simplex-associated uveitis is usually considered a unilateral eye disease, and rarely included in the differential diagnosis whenever there is bilateral involvement. We report three cases of bilateral herpetic anterior uveitis. We evaluated three patients who presented with clinical manifestations of bilateral uveitis suggestive of viral origin. We found intraocular hypertension, cells in the anterior chamber, paralytic mydriasis, iris atrophy with transillumination defects, and variable anterior vitreous cellularity. According to the clinical findings, supported with herpes-specific antibody titers and aqueous humor PCR results in two of them, they were diagnosed with bilateral anterior herpetic uveitis. Our patients were initially misdiagnosed as having non-infectious uveitis and were treated with immunomodulatory medications, which could have favored the extension of infection bilaterally. Although uncommon, bilateral herpetic uveitis should always be considered in the differential diagnoses, when patients present with hypertensive uveitis in both eyes.

Synchronous, bilateral tonsillar carcinomas

DEFF Research Database (Denmark)

Nami Saber, Camelia; Grønhøj, Christian; Jensen, David Hebbelstrup

2017-01-01

INTRODUCTION: The incidence of oropharyngeal squamous cell carcinoma (OPSCC) is increasing, but data on the incidence of synchronous, bilateral tonsillar squamous cell carcinomas (BiTSCCs) is sparse. In this study, we report the incidence and tumour characteristics of BiTSCCs in a population-base...

Bilateral acoustic neuromas.

Science.gov (United States)

Anand, V T; Byrnes, D P; Walby, A P; Kerr, A G

1993-10-01

This article reviews 12 patients with bilateral acoustic neuromas. The sex incidence was equal and the mean age at diagnosis was 26.2 years. The family history was positive in nine of the patients. Five patients have had incomplete surgical removal of acoustic neuromas on both sides. Two of them are completely deaf and the other three have severe sensorineural hearing loss in one ear and no hearing in the other ear. In five patients the tumour on one side has been operated on and the other side is being observed with at least short-term preservation of good hearing. The remaining two patients died of intra-cranial complications, one of them post-operatively. Four patients developed facial palsy immediately following surgery and one developed facial weakness 6 months after surgery. Guidelines are discussed for the care of these patients including the timing of surgery and alternative treatment options (observation, radio-surgery and chemotherapy). This is essentially a group of young individuals who have had multiple operations for bilateral acoustic tumours and associated manifestations and for whom the disease and the sequelae of treatment can be tragic.

High Performance, Three-Dimensional Bilateral Filtering

International Nuclear Information System (INIS)

Bethel, E. Wes

2008-01-01

Image smoothing is a fundamental operation in computer vision and image processing. This work has two main thrusts: (1) implementation of a bilateral filter suitable for use in smoothing, or denoising, 3D volumetric data; (2) implementation of the 3D bilateral filter in three different parallelization models, along with parallel performance studies on two modern HPC architectures. Our bilateral filter formulation is based upon the work of Tomasi [11], but extended to 3D for use on volumetric data. Our three parallel implementations use POSIX threads, the Message Passing Interface (MPI), and Unified Parallel C (UPC), a Partitioned Global Address Space (PGAS) language. Our parallel performance studies, which were conducted on a Cray XT4 supercomputer and aquad-socket, quad-core Opteron workstation, show our algorithm to have near-perfect scalability up to 120 processors. Parallel algorithms, such as the one we present here, will have an increasingly important role for use in production visual analysis systems as the underlying computational platforms transition from single- to multi-core architectures in the future.

High Performance, Three-Dimensional Bilateral Filtering

Energy Technology Data Exchange (ETDEWEB)

Bethel, E. Wes

2008-06-05

Image smoothing is a fundamental operation in computer vision and image processing. This work has two main thrusts: (1) implementation of a bilateral filter suitable for use in smoothing, or denoising, 3D volumetric data; (2) implementation of the 3D bilateral filter in three different parallelization models, along with parallel performance studies on two modern HPC architectures. Our bilateral filter formulation is based upon the work of Tomasi [11], but extended to 3D for use on volumetric data. Our three parallel implementations use POSIX threads, the Message Passing Interface (MPI), and Unified Parallel C (UPC), a Partitioned Global Address Space (PGAS) language. Our parallel performance studies, which were conducted on a Cray XT4 supercomputer and aquad-socket, quad-core Opteron workstation, show our algorithm to have near-perfect scalability up to 120 processors. Parallel algorithms, such as the one we present here, will have an increasingly important role for use in production visual analysis systems as the underlying computational platforms transition from single- to multi-core architectures in the future.

Bilateral Supernumerary Kidney: A Very Rare Presentation

Science.gov (United States)

Keskin, Suat; Batur, Abdussamet; Keskin, Zeynep; Koc, Abdulkadir; Firat Ozcan, Irfan

2014-01-01

To our knowledge, bilateral supernumerary kidney is a very rare renal abnormality and there are five cases presented in the literature. It is difficult to diagnose supernumerary kidney and clinicians have not detected most cases preoperatively. Laboratory and imaging studies were acquired and carefully examined. The normal laboratory tests were found. Emergency ultrasonography was performed and they revealed no signs of parenchymal abnormality in both kidneys. Serial imaging study including enhanced computed tomography (CT) was performed. An imaging study identified bilateral supernumerary kidney with expanded collecting systems. On each side, significant rotation anomaly was found. In addition, there were two different renal arteries originating from the aorta. This report presents radiological determinations of supernumerary kidney bilaterally in a young man. We think that CT commonly appears to be enough for the diagnosis of supernumerary kidneys. PMID:25780543

Bilateral ureteropelvic junction obstruction presenting with hypertension and cerebral vascular accident.

Science.gov (United States)

Tourchi, Ali; Kajbafzadeh, Abdolmohammad; Nejat, Farideh; Golmohammadi, Abolfazl; Alizadeh, Farshid; Mahboobi, Amir Hassan

2010-11-01

Cerebrovascular accident and renal hypertension secondary to ureteropelvic junction obstruction (UPJO) are extremely rare. A 6-year-old girl presented with intracranial hemorrhage because of hypertension secondary to the bilateral UPJO. This was successfully treated with craniotomy and subsequent percutaneous nephrostomy placement and bilateral pyeloplasty. Brain computerized tomography revealed right-sided intracranial hemorrhage, and renal ultrasonography confirmed bilateral severe hydronephrosis. Craniotomy with evacuation of intracerebral hematoma and bilateral nephrostomy under ultrasound guidance were performed. One week later, she underwent bilateral pyeloplasty in 2 stages. The patient has been well with normalized renal function and is completely cured of her hypertension in long-term follow-up. Copyright © 2010 Elsevier Inc. All rights reserved.

Bilateral Tubal Gestation Associated with Schistosomiasis in an African Woman

Directory of Open Access Journals (Sweden)

K. H. Odubamowo

2014-01-01

Full Text Available Background. The incidence of tubal ectopic gestation caused by schistosomiasis induced tubal pathology is undocumented in this environment, which may be due to rarity of this pathology. Bilateral tubal gestation is common in patients that have undergone in vitro fertilization. We report a hitherto undocumented case of spontaneous bilateral ectopic gestation following tubal schistosomiasis. Case Report. Mrs. OB was a 32-year-old G4P3+0 (3 alive woman who complained of abdominal pain and bleeding per vaginam of 4 and 2 days’ duration respectively following 8 weeks of amenorrhea. A clinical impression of ruptured ectopic gestation was confirmed by ultrasound scanning. She had bilateral salpingectomy with histology of specimens showing bilateral ectopic gestation with Schistosoma haematobium induced salpingitis (findings of Schistosoma haematobium ova noted on slide. Conclusion. Schistosoma induced salpingitis is a rare but possible cause of bilateral tubal gestation.

Bilateral and unilateral ECT: effects on verbal and nonverbal memory.

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Squire, S R; Slater, P C

1978-11-01

The memory loss associated with bilateral and nondominant unilateral ECT was assessed with verbal memory tests known to be sensitive to left temporal lobe dysfunction and with nonverbal memory tests known to be sensitive to right temporal lobe dysfunction. Bilateral ECT markedly impaired delayed retention of verbal and nonverbal material. Right unilateral ECT impaired delayed retention of nonverbal material without measurably affecting retention of verbal material. Nonverbal memory was affected less by right unilateral ECT than by bilateral ECT. These findings, taken together with a consideration of the clinical efficacy of the two types of treatment, make what appears to be a conclusive case for unilateral over bilateral ECT.

Parálisis diafragmática bilateral. Presentación de un caso Bilateral diaphragmatic paralysis

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Jorge Carnot Pereira

2012-04-01

Full Text Available La parálisis diafragmática bilateral es una entidad muy infrecuente en la clínica, debido a diferentes entidades con capacidad de lesionar el nervio frénico. El compromiso respiratorio que produce requiere cuidado especializado. Este es el primer caso reportado en nuestra literatura a consecuencia de hernias cervicales múltiples. Se presenta un caso de un paciente de 43 años, con antecedentes de salud, exatleta de alto rendimiento, que ingresó en nuestro servicio, con disnea de 5 meses de evolución, que aumentó progresivamente en intensidad hasta mantenerlo en ortopnea constante, fue estudiado exhaustivamente hasta llegar a diagnostico definido y derivarlo al servicio de Neurocirugía para su solución definitiva. La importancia del tema que se presenta es que se describe una presentación rara de parálisis diafragmática bilateral, a consecuencia de hernias discales cervicales múltiples.Bilateral diaphragmatic paralysis is a rare condition in clinical practice due to different entities that can damage phrenic nerve. The resulting respiratory compromise requires medical special care. This is the first case reported in our medical literature caused by multiple cervical hernias. A 43 year-old patient having health history, high performance ex-athlete, admitted in the service with 5-month evolution of dyspnea which progressively increased in intensity up to maintain him in permanent orthopnea, thorough studies were conducted to the definite diagnosis and he was transferred to Neurosurgery Service to a definite solution. A rare presentation of a bilateral diaphragmatic paralysis resulting from multiple cervical hernias gives importance to the topic.

Comparison between Subjective Sensations during First and Second Phacoemulsification Eye Surgeries in Patients with Bilateral Cataract

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Ji-guo Yu

2016-01-01

Full Text Available Purpose. To evaluate and compare the subjective sensations reported by patients during first and second cataract extractions. Methods. Consecutive patients undergoing bilateral sequential cataract extraction using phacoemulsification were recruited. Following cataract surgery, patients completed questionnaires designed to evaluate subjective sensations, including anxiety, eye bulges, pain, and light sensitivity. Changes in painful sensations experienced by patients between the two surgeries were also recorded. Comparisons were also performed for each subjective sensation between different age groups (79 years. Results. A total of 127 patients were included in the final evaluation. Statistical comparison of the results showed that there were significant differences in perception of anxiety, eye bulges, and pain scores between the first and second cataract surgeries (P0.05 for all. Conclusions. Our research confirms the common observation that patients with bilateral cataracts often report more ocular discomfort during the second surgery. There are, therefore, additional factors that should be considered upon treating patients with bilateral cataracts, and the provision of preoperative counseling could play an important role in providing adequate patient care.

Functional sequelae following bilateral mastectomy and immediate reconstruction with latissimus dorsi flap: medium-term follow-up.

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Paolini, Guido; Amoroso, Matteo; Pugliese, Pierfrancesco; Longo, Benedetto; Santanelli, Fabio

2014-04-01

Arm morbidity following unilateral Latissimus Dorsi (LD) flap harvest is controversial and bilateral harvest is considered potentially disabling. Arm and shoulder disability was investigated in patients undergoing bilateral mastectomy and immediate LD flap reconstruction. Thirty consecutive bilateral immediate reconstructions with denervated LD flaps, performed between 2005-2009, were retrospectively analyzed. Patients were assessed for arm function by conducting the Disability of Arm, Shoulder and Hand (DASH) test, between 12-51 months after surgery (mean 23 months). Disability scores ranged from 1-100%, with 1-25% being regarded as mild dysfunction, 26-50% as moderate dysfunction, 51-75% as severe dysfunction, and 76-100% as total dysfunction. A statistical analysis was performed using the Fisher exact test and the multivariate linear regression model for variables. The Global Mean Dash score was 14.8%. Twenty-four patients presented a mild functional deficit (50%). Five of them presented a score LD flaps (p test is a useful tool in terms of informing patients and helping the surgeon to choose the best surgical option.

Delayed diagnosis of homocystinuria presenting as bilateral congenital lens subluxation

OpenAIRE

Jelić-Vuković Marija; Matić Suzana; Barać Josip; Novinščak Tomislav; Belovari Mirna; Barić Hrvoje

2017-01-01

Introduction. Homocystinuria is an autosomal recessively inherited defect leading to hyperhomocysteinemia and associated with ocular manifestations, mainly myopia and ectopia lentis. Case outline. A 26-year-old male with secondary glaucoma due to bilateral lens subluxation was admitted to the Department of vitreoretinal surgery. Horizontal nystagmus, bilateral lens subluxation, and bilateral amblyopia were first discovered at the age of three years. Preoperative laboratory workup revealed ele...

Biomechanics of unilateral and bilateral sacroiliac joint stabilization: laboratory investigation.

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Lindsey, Derek P; Parrish, Robin; Gundanna, Mukund; Leasure, Jeremi; Yerby, Scott A; Kondrashov, Dimitriy

2018-03-01

OBJECTIVE Bilateral symptoms have been reported in 8%-35% of patients with sacroiliac (SI) joint dysfunction. Stabilization of a single SI joint may significantly alter the stresses on the contralateral SI joint. If the contralateral SI joint stresses are significantly increased, degeneration may occur; alternatively, if the stresses are significantly reduced, bilateral stabilization may be unnecessary for patients with bilateral symptoms. The biomechanical effects of 1) unilateral stabilization on the contralateral SI joint and 2) bilateral stabilization on both SI joints are currently unknown. The objectives of this study were to characterize bilateral SI joint range of motion (ROM) and evaluate and compare the biomechanical effects of unilateral and bilateral implant placement for SI joint fusion. METHODS A lumbopelvic model (L5-pelvis) was used to test the ROM of both SI joints in 8 cadavers. A single-leg stance setup was used to load the lumbar spine and measure the ROM of each SI joint in flexion-extension, lateral bending, and axial rotation. Both joints were tested 1) while intact, 2) after unilateral stabilization, and 3) after bilateral stabilization. Stabilization consisted of lateral transiliac placement of 3 triangular titanium plasma-sprayed (TPS) implants. RESULTS Intact testing showed that during single-leg stance the contralateral SI joint had less ROM in flexion-extension (27%), lateral bending (32%), and axial rotation (69%) than the loaded joint. Unilateral stabilization resulted in significant reduction of flexion-extension ROM (46%) on the treated side; no significant ROM changes were observed for the nontreated side. Bilateral stabilization resulted in significant reduction of flexion-extension ROM of the primary (45%) and secondary (75%) SI joints. CONCLUSIONS This study demonstrated that during single-leg loading the ROMs for the stance (loaded) and swing (unloaded) SI joints are significantly different. Unilateral stabilization for SI

Hardware Implementation of a Bilateral Subtraction Filter

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Huertas, Andres; Watson, Robert; Villalpando, Carlos; Goldberg, Steven

2009-01-01

A bilateral subtraction filter has been implemented as a hardware module in the form of a field-programmable gate array (FPGA). In general, a bilateral subtraction filter is a key subsystem of a high-quality stereoscopic machine vision system that utilizes images that are large and/or dense. Bilateral subtraction filters have been implemented in software on general-purpose computers, but the processing speeds attainable in this way even on computers containing the fastest processors are insufficient for real-time applications. The present FPGA bilateral subtraction filter is intended to accelerate processing to real-time speed and to be a prototype of a link in a stereoscopic-machine- vision processing chain, now under development, that would process large and/or dense images in real time and would be implemented in an FPGA. In terms that are necessarily oversimplified for the sake of brevity, a bilateral subtraction filter is a smoothing, edge-preserving filter for suppressing low-frequency noise. The filter operation amounts to replacing the value for each pixel with a weighted average of the values of that pixel and the neighboring pixels in a predefined neighborhood or window (e.g., a 9 9 window). The filter weights depend partly on pixel values and partly on the window size. The present FPGA implementation of a bilateral subtraction filter utilizes a 9 9 window. This implementation was designed to take advantage of the ability to do many of the component computations in parallel pipelines to enable processing of image data at the rate at which they are generated. The filter can be considered to be divided into the following parts (see figure): a) An image pixel pipeline with a 9 9- pixel window generator, b) An array of processing elements; c) An adder tree; d) A smoothing-and-delaying unit; and e) A subtraction unit. After each 9 9 window is created, the affected pixel data are fed to the processing elements. Each processing element is fed the pixel value for

Simultaneous determination of free and total glycerol in biodiesel by capillary electrophoresis using multiple short-end injection.

Science.gov (United States)

Spudeit, Daniel Alfonso; Piovezan, Marcel; Dolzan, Maressa D; Vistuba, Jacqueline Pereira; Azevedo, Mônia Stremel; Vitali, Luciano; Leal Oliveira, Marcone Augusto; Oliveira Costa, Ana Carolina; Micke, Gustavo Amadeu

2013-12-01

A rapid method for the simultaneous determination of free glycerol (FG) and total glycerol (TG) in biodiesel by CE using a short-end multiple injection (SE/MI) configuration system is described. The sample preparation for FG involves the extraction of glycerol with water and for TG a saponification reaction is carried out followed by extraction as in the case of FG. The glycerol extracted in both cases is submitted to periodate oxidation and the iodate ions formed are measured on a CE-SE/MI system. The relevance of this study lies in the fact that no analytical procedure has been previously reported for the determination of TG (or of FG and TG simultaneously) by CE. The optimum conditions for the saponification/extraction process were 1.25% KOH and 25°C, with a time of only 5 min, and biodiesel mass in the range of 50.0-200.0 mg can be used. Multiple injections were performed hydrodynamically with negative pressure as follows: 50 mbar/3s (FG sample); 50 mbar/6s (electrolyte spacer); 50 mbar/3s (TG sample). The linear range obtained was 1.55-46.5 mg/L with R(2) > 0.99. The LOD and LOQ were 0.16 mg/L and 0.47 mg/L, respectively for TG. The method provides acceptable throughput for application in quality control and monitoring biodiesel synthesis process. In addition, it offers simple sample preparation (saponification process), it can be applied to a variety biodiesel samples (soybean, castor, and waste cooking oils) and it can be used for the determination of two key parameters related to the biodiesel quality with a fast separation (less than 30 s) using an optimized CE-SE/MI system. © 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Bilateral Moyamoya Disease in a 2-Year-Old Pakistani Male Treated with Bilateral Encephaloduroarteriosynangiosis: A Positive Outcome

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Shahvaiz Magsi

2016-01-01

Full Text Available Background. We present a rare case of bilateral moyamoya disease presenting as multiple strokes and neurological deficits, treated with the neurosurgical procedure, encephaloduroarteriosynangiosis (EDAS, in a 2-year-old male Pakistani minor. A positive outcome was achieved and the patient recovered fully. Case Summary. Our patient presented with a history of seizures and multiple episodes of hemiparesis (on and off weakness at the age of 2 years. He had a delayed speech development and could not speak more than a few words. He had a slight slurring of speech too. He was diagnosed with bilateral moyamoya disease on Computed Tomography Angiography (CTA. Bilateral EDAS was done in the same year, after which his symptoms improved and patient had moderate functional recovery. Conclusion. A rare disease, moyamoya has been left unexplored in Pakistan; physicians and surgeons when dealing with cases in the pediatric population presenting with symptoms of stroke, signs of generalized weakness, and seizures should consider moyamoya disease as a possibility. Furthermore, this case demonstrates the effectiveness of EDAS procedure for the treatment of moyamoya disease.

Bilateral pulmonary infiltrates in association with disseminated actinomycosis.

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Dontfraid, F; Ramphal, R

1994-07-01

The most common infectious cause of bilateral upper-lobe pulmonary disease is tuberculosis. However, we recently encountered a patient with bilateral apical infiltrates and multiple soft-tissue abscesses caused by Actinomyces odontolyticus. Other findings included fever, weight loss, and leukocytosis, and the patient's only known source of immunosuppression was a long history of alcoholism. There was no history of diabetes, steroid use, or other chronic underlying disease. The diagnosis was made by culture of drainage fluid from one abscess. Therapy with intravenous penicillin G led to rapid clinical improvement and reduction in the infiltrates. To our knowledge, the presentation of pulmonary infection, with bilateral apical infiltrates due to A. odontolyticus has not been previously reported in the medical literature.

Allograft tolerance in pigs after fractionated lymphoid irradiation. II. Kidney graft after conventional total lymphoid irradiation and bone marrow cell grafting

International Nuclear Information System (INIS)

Fradelizi, D.; Mahouy, G.; de Riberolles, C.; Lecompte, Y.; Alhomme, P.; Douard, M.C.; Chotin, G.; Martelli, H.; Daburon, F.; Vaiman, M.

1981-01-01

Experiments with pigs have been performed in order to establish bone marrow chimerism and kidney graft tolerance between SLA genotyped semi-incompatible animals. Recipients were conditioned by means of conventional fractionated total lymphoid irradiation (TLI) delivered by a vertical cobalt source. The principal lymphoid regions of the pig, including thymus and spleen, were submitted to irradiation. Two protocols were tested: A = 250 cGy four times a week x 13 times (TLI) (two animals) and B = 350 cGy three times a week x 8 times (TLI) (four animals). Bone marrow cells were injected 24 h after the last irradiation. One day later, bilateral nephrectomy and the graft of one kidney from the bone marrow cell donor were performed simultaneously. Results convinced us that application of the TLI protocol to humans is not yet practicable and that further experimental work is needed

High-volume infiltration analgesia in bilateral hip arthroplasty

DEFF Research Database (Denmark)

Andersen, Lasse Ø; Otte, Niels Kristian Stahl; Husted, Henrik

2011-01-01

Background and purpose High-volume infiltration analgesia may be effective in postoperative pain management after hip arthroplasty but methodological problems prevent exact interpretation of previous studies. Methods In a randomized, double-blind placebo-controlled trial in 12 patients undergoing...... bilateral total hip arthroplasty (THA) in a fast-track setting, saline or high-volume (170 mL) ropivacaine (0.2%) with epinephrine (1:100,000) was administered to the wound intraoperatively along with supplementary postoperative injections via an intraarticular epidural catheter. Oral analgesia...... was instituted preoperatively with a multimodal regimen (gabapentin, celecoxib, and acetaminophen). Pain was assessed repeatedly for 48 hours postoperatively, at rest and with 45° hip flexion. Results Pain scores were low and similar between ropivacaine and saline administration. Median hospital stay was 4...

High-volume infiltration analgesia in bilateral hip arthroplasty

DEFF Research Database (Denmark)

Andersen, Lasse Ø; Otte, Niels Kristian Stahl; Husted, Henrik

2011-01-01

bilateral total hip arthroplasty (THA) in a fast-track setting, saline or high-volume (170 mL) ropivacaine (0.2%) with epinephrine (1:100,000) was administered to the wound intraoperatively along with supplementary postoperative injections via an intraarticular epidural catheter. Oral analgesia...... was instituted preoperatively with a multimodal regimen (gabapentin, celecoxib, and acetaminophen). Pain was assessed repeatedly for 48 hours postoperatively, at rest and with 45° hip flexion. Results Pain scores were low and similar between ropivacaine and saline administration. Median hospital stay was 4...... (range 2-7) days. Interpretation Intraoperative high-volume infiltration with 0.2% ropivacaine with repeated intraarticular injections postoperatively may not give a clinically relevant analgesic effect in THA when combined with a multimodal oral analgesic regimen with gabapentin, celecoxib...

Bilateral widespread mechanical pain sensitivity in carpal tunnel syndrome: evidence of central processing in unilateral neuropathy.

Science.gov (United States)

Fernández-de-las-Peñas, César; de la Llave-Rincón, Ana Isabel; Fernández-Carnero, Josué; Cuadrado, María Luz; Arendt-Nielsen, Lars; Pareja, Juan A

2009-06-01

The aim of this study was to investigate whether bilateral widespread pressure hypersensitivity exists in patients with unilateral carpal tunnel syndrome. A total of 20 females with carpal tunnel syndrome (aged 22-60 years), and 20 healthy matched females (aged 21-60 years old) were recruited. Pressure pain thresholds were assessed bilaterally over median, ulnar, and radial nerve trunks, the C5-C6 zygapophyseal joint, the carpal tunnel and the tibialis anterior muscle in a blinded design. The results showed that pressure pain threshold levels were significantly decreased bilaterally over the median, ulnar, and radial nerve trunks, the carpal tunnel, the C5-C6 zygapophyseal joint, and the tibialis anterior muscle in patients with unilateral carpal tunnel syndrome as compared to healthy controls (all, P < 0.001). Pressure pain threshold was negatively correlated to both hand pain intensity and duration of symptoms (all, P < 0.001). Our findings revealed bilateral widespread pressure hypersensitivity in subjects with carpal tunnel syndrome, which suggest that widespread central sensitization is involved in patients with unilateral carpal tunnel syndrome. The generalized decrease in pressure pain thresholds associated with pain intensity and duration of symptoms supports a role of the peripheral drive to initiate and maintain central sensitization. Nevertheless, both central and peripheral sensitization mechanisms are probably involved at the same time in carpal tunnel syndrome.

Phacoemulsification of bilateral cataracts in two pet rabbits | Gomes ...

African Journals Online (AJOL)

Two 3 year-old, healthy, client-owned Lop rabbits presented with bilateral cataracts. After performing a physical examination, bloodwork, ocular ultrasonography and electroretinography, both animals were deemed good surgical candidates for phacoemulsification. Bilateral cataract surgery was performed and both rabbits ...

Bilateral spontaneous pneumothorax with pulmonary metastases of synovial sarcoma

International Nuclear Information System (INIS)

Matushita, J.P.K.; Azevedo, C.M. de

1989-01-01

The association of bilateral spontaneous pneumothorax with pulmonary tumor is uncommon and with pulmonary metastases is rare. The clinical and radiological features of bilateral spontaneous pneumothorax from a synovial sarcoma in a 14 years old boy are described. (author) [pt

Bilateral nasolabial cysts - case report and review of literature

International Nuclear Information System (INIS)

Patil, Aruna R; Singh, Abhinav Pratap; Nandikoor, Shrivalli; Meganathan, Prabhu

2016-01-01

Nasolabial cyst is a non-odontogenic, extraosseous, soft tissue cyst, commonly unilateral, located in the nasolabial fold. Bilateral nasolabial cysts are of rare occurrence. This case report describes the multimodality imaging appearance of bilateral nasolabial cysts with a review of literature

UNITED STATES/GERMAN TECHNICAL BILATERAL AGREEMENT: PAST, PRESENT & FUTURE

Science.gov (United States)

The U.S. Environmental Protection Agency (EPA) and the German Federal Ministry of Education and Research (BMBF) entered into a Bilateral Agreement in 1990 to study each country's efforts in developing and demonstrating remedial technologies. The bilateral agreement is being impl...

Impact of radiation technique, radiation fraction dose, and total cisplatin dose on hearing. Retrospective analysis of 29 medulloblastoma patients

International Nuclear Information System (INIS)

Scobioala, Sergiu; Kittel, Christopher; Ebrahimi, Fatemeh; Wolters, Heidi; Eich, Hans Theodor; Parfitt, Ross; Matulat, Peter; Am Zehnhoff-Dinnesen, Antoinette

2017-01-01

To analyze the incidence and degree of sensorineural hearing loss (SNHL) resulting from different radiation techniques, fractionation dose, mean cochlear radiation dose (D mean ), and total cisplatin dose. In all, 29 children with medulloblastoma (58 ears) with subclinical pretreatment hearing thresholds participated. Radiotherapy (RT) and cisplatin had been applied sequentially according to the HIT MED Guidance. Audiological outcomes up to the latest follow-up (median 2.6 years) were compared. Bilateral high-frequency SNHL was observed in 26 patients (90%). No significant differences were found in mean hearing threshold between left and right ears at any frequency. A significantly better audiological outcome (p < 0.05) was found after tomotherapy at the 6 kHz bone-conduction threshold (BCT) and left-sided 8 kHz air-conduction threshold (ACT) than after a combined radiotherapy technique (CT). Fraction dose was not found to have any impact on the incidence, degree, and time-to-onset of SNHL. Patients treated with CT had a greater risk of SNHL at high frequencies than tomotherapy patients even though D mean was similar. Increase in severity of SNHL was seen when the total cisplatin dose reached above 210 mg/m 2 , with the highest abnormal level found 8-12 months after RT regardless of radiation technique or fraction dose. The cochlear radiation dose should be kept as low as possible in patients who receive simultaneous cisplatin-based chemotherapy. The risk of clinically relevant HL was shown when D mean exceeds 45 Gy independent of radiation technique or radiation regime. Cisplatin ototoxicity was shown to have a dose-dependent effect on bilateral SNHL, which was more pronounced in higher frequencies. (orig.) [de

A Comparison of Y-Type and T-Type Metallic Bilateral Biliary Stents in Patients with Malignant Hilar Biliary Obstruction

International Nuclear Information System (INIS)

Koh, Esther; Jin, Gong Yong; Hwang, Seung Bae; Choi, Eun Jung; Song, Ji Soo; Han, Young Min; Kwon, Keun Sang

2013-01-01

To compare the Y type (side-by-side) and T type (stent-in-stent) bilateral biliary metal stenting in malignant hilar obstruction in terms of treatment outcomes, including post-stenting serum bilirubin level and stent patency. 41 consecutive patients with advanced hilar malignancies who underwent percutaneous placement of bilateral metallic stents - Y (n = 23) and T types (n = 18) - were retrospectively reviewed. We evaluated stent patency after the procedure by cholangiogram and abdominal CT. Pre- and post-stenting serum bilirubin level (total, direct bilirubin) at 1 week and at 1 month were compared. Student t-test and Kaplan-Meier method were used in the statistical analysis. After comparing the median stent patency according to both types, they did not differ significantly (Y: 38 days, T: 61 days; p 0.141). There was a more decrease in the total and direct bilirubin of the T type compared to the Y type after 1 week (p = 0.013, 0.025). However, no significant difference existed between the decreasing bilirubin rates of both types after 1 month (p = 0.923, 0.742). In patients with malignant hilar obstruction, both Y and T type bilateral metallic biliary stents are effective methods. Stent patency and bilirubin decrease rates were not significantly different.

A Comparison of Y-Type and T-Type Metallic Bilateral Biliary Stents in Patients with Malignant Hilar Biliary Obstruction

Energy Technology Data Exchange (ETDEWEB)

Koh, Esther; Jin, Gong Yong; Hwang, Seung Bae; Choi, Eun Jung; Song, Ji Soo; Han, Young Min; Kwon, Keun Sang [Dept. of Chonbuk National University Hospital and Medical School, Jeonju (Korea, Republic of)

2013-04-15

To compare the Y type (side-by-side) and T type (stent-in-stent) bilateral biliary metal stenting in malignant hilar obstruction in terms of treatment outcomes, including post-stenting serum bilirubin level and stent patency. 41 consecutive patients with advanced hilar malignancies who underwent percutaneous placement of bilateral metallic stents - Y (n = 23) and T types (n = 18) - were retrospectively reviewed. We evaluated stent patency after the procedure by cholangiogram and abdominal CT. Pre- and post-stenting serum bilirubin level (total, direct bilirubin) at 1 week and at 1 month were compared. Student t-test and Kaplan-Meier method were used in the statistical analysis. After comparing the median stent patency according to both types, they did not differ significantly (Y: 38 days, T: 61 days; p 0.141). There was a more decrease in the total and direct bilirubin of the T type compared to the Y type after 1 week (p = 0.013, 0.025). However, no significant difference existed between the decreasing bilirubin rates of both types after 1 month (p = 0.923, 0.742). In patients with malignant hilar obstruction, both Y and T type bilateral metallic biliary stents are effective methods. Stent patency and bilirubin decrease rates were not significantly different.

Bilateral papillary renal cell carcinoma

International Nuclear Information System (INIS)

Gossios, K.; Vazakas, P.; Argyropoulou, M.; Stefanaki, S.; Stavropoulos, N.E.

2001-01-01

Papillary renal cell carcinoma is a subgroup of malignant renal epithelial neoplasms. We report the clinical and imaging findings of a case with multifocal and bilateral renal cell carcinoma which are nonspecific. (orig.)

Bilateral en-masse distalization of maxillary posterior teeth with skeletal anchorage: a case report

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Saeed Noorollahian

Full Text Available ABSTRACT Objective: The aim of this study was to introduce a new method for bilateral distal movement of the entire maxillary posterior segment. Case report: A 17-year-old girl with Class I skeletal malocclusion (end-to-end molar relationships, deviated midline and space deficiency for left maxillary canine was referred for orthodontic treatment. She did not accept maxillary first premolars extraction. A modified Hyrax appliance (Dentaurum Ispringen, Germany was used for bilateral distalization of maxillary posterior teeth simultaneously. Expansion vector was set anteroposteriorly. Posterior legs of Hyrax were welded to first maxillary molar bands. All posterior teeth on each side consolidated with a segment of 0.017 × 0.025-in stainless steel wire from the buccal side. Anterior legs of Hyrax were bent into eyelet form and attached to the anterior palate with two mini-screws (2 × 10 mm (Jeil Medical Corporation Seoul, South Korea. Hyrax opening rate was 0.8 mm per month. Lateral cephalometric radiographs were used to evaluate the extent of distal movement. 3.5-mm distalization of posterior maxillary teeth was achieved in five months. Results: A nearly bodily distal movement without anchorage loss was obtained. Conclusion: The mini-screw-supported modified Hyrax appliance was found to be helpful for achieving en-masse distal movement of maxillary posterior teeth.

Use of Tranexamic acid is a cost effective method in preventing blood loss during and after total knee replacement

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Umer Chaudhry Muhammad

2011-05-01

Full Text Available Abstract Background & Purpose Allogenic blood transfusion in elective orthopaedic surgery is best avoided owing to its associated risks. Total knee replacement often requires blood transfusion, more so when bilateral surgery is performed. Many strategies are currently being employed to reduce the amount of peri-operative allogenic transfusions. Anti-fibrinolytic compounds such as aminocaproic acid and tranexamic acid have been used systemically in perioperative settings with promising results. This study aimed to evaluate the effectiveness of tranexamic acid in reducing allogenic blood transfusion in total knee replacement surgery. Methodology This was a retrospective cohort study conducted on patients undergoing total knee replacement during the time period November 2005 to November 2008. Study population was 99 patients, of which 70 underwent unilateral and 29 bilateral knee replacement. Forty-seven patients with 62 (49.5% knees (group-I had received tranexamic acid (by surgeon preference while the remaining fifty-two patients with 66 (51.5% knees (group-II had did not received any tranexamic acid either pre- or post-operatively. Results The mean drop in the post-operative haemoglobin concentration in Group-II for unilateral and bilateral cases was 1.79 gm/dl and 2.21 gm/dl, with a mean post-operative drainage of 1828 ml (unilateral and 2695 ml (bilateral. In comparison, the mean drop in the post-op haemoglobin in Group-I was 1.49 gm/dl (unilateral and 1.94 gm/dl (bilateral, with a mean drainage of 826 ml (unilateral and 1288 ml (bilateral (p-value Interpretation Tranexamic acid is effective in reducing post-operative drainage and requirement of blood transfusion after knee replacement.

Bilateral cheiloschisis in bovine - A case report

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Saulo Andrade Caldas

2014-01-01

Full Text Available ABSTRACT. Caldas S.A., Nogueira V.A., Lima A.E.S., Aragão A.P., d’Avila M.S., Santos A.M., Miranda I.C., Costa S.Z.R. & Peixoto T.C. [Bilateral cheiloschisis in bovine - A case report.] Queilosquise bilateral em bovino - Relato de caso. Revista Brasileira de Medicina Veterinária, 36(1:55-59, 2014. Departamento de Medicina e Cirurgia Veterinária, Instituto de Veterinária, Universidade Federal Rural do Rio de Janeiro, BR 465 Km 7, Seropédica RJ 23890-000, Brasil. E-mail: saulocaldas@hotmail.com A case of bilateral queilosquise in a cattle two years old was reported. Clinically, there was cachexia, difficulty in grasping food and water intake. The clinical examination revealed that the nasal orifices were discontinuous with the upper lip, which allowed communication between the nostrils and mouth in its rostral portion, crowding of incisors (tweezers, as well as exposure of medium and the 2nd corner and of the tongue. In this case, the bilateral queilosquise was the result of flaws in fusion of the maxillary process and the medial nasal process and its surroundings, probably due to mineral deficiencies of pregnant cow. This pathogenesis was suggested by excluding other possible causes, the knowledge of the existence of mineral deficiencies in the region where the event occurred and bad nutritional status of pregnant female.

Unilateral versus bilateral stent insertion for malignant hilar biliary obstruction.

Science.gov (United States)

Chang, Gang; Xia, Feng-Fei; Li, Hong-Fu; Niu, Su; Xu, Yuan-Shun

2017-11-01

To determine the clinical efficiency and long-term outcomes between unilateral and bilateral stent insertion in patients with malignant hilar biliary obstruction. From August 2012 to February 2016, 63 consecutive patients with malignant hilar biliary obstruction were treated with unilateral or bilateral stent insertion at our center. The bilateral stents were inserted using the side-by-side technique. The clinical efficiency and long-term outcomes were compared between the two groups. Unilateral and bilateral stent insertions were successfully performed in 31 of 33 and 27 of 30 patients, respectively (P = 0.912). No procedure-related complication occurred. Clinical success was achieved in 29 of 31 patients in the unilateral stent group and in 26 of 27 patients in the bilateral stent group (P = 0.637). During the follow-up, re-obstruction of stent occurred in five patients in the unilateral stent group and in three patients in the bilateral stent group (P = 0.58). The significant differences were not observed in the stent patency time (368 vs. 387 days, P = 0.685) and survival (200 vs. 198 days, P = 0.751) between two groups. Based on the univariate and multivariate analyses, the independent risk factors for decreasing the survival time included higher Eastern Cooperative Oncology Group performance status (P = 0.018), higher alanine aminotransferase level (P = 0.009), and absence of anticancer treatment after stent insertion (P = 0.002). Compared to bilateral stent insertion for malignant hilar biliary obstruction, unilateral stent insertion can provide comparable clinical efficiency and long-term outcomes.

Immediate Sequential Bilateral Cataract Surgery

DEFF Research Database (Denmark)

Kessel, Line; Andresen, Jens; Erngaard, Ditte

2015-01-01

The aim of the present systematic review was to examine the benefits and harms associated with immediate sequential bilateral cataract surgery (ISBCS) with specific emphasis on the rate of complications, postoperative anisometropia, and subjective visual function in order to formulate evidence......-based national Danish guidelines for cataract surgery. A systematic literature review in PubMed, Embase, and Cochrane central databases identified three randomized controlled trials that compared outcome in patients randomized to ISBCS or bilateral cataract surgery on two different dates. Meta-analyses were...... performed using the Cochrane Review Manager software. The quality of the evidence was assessed using the GRADE method (Grading of Recommendation, Assessment, Development, and Evaluation). We did not find any difference in the risk of complications or visual outcome in patients randomized to ISBCS or surgery...

International bilateral and multilateral arrangements in energy technologies

International Nuclear Information System (INIS)

1978-07-01

This document, the second report in the series, outlines current DOE international commitments under bilateral and multilateral arrangements, as of January 1, 1978. Included are bilateral agreements for cooperation in the civil uses of atomic energy with countries and international organizations, bilateral and multilateral technical exchanges in all energy technology areas, and multilateral agreements under the auspices of the International Energy Agency (IEA). In addition to outlining the terms, scope, and status of these agreements, this document describes DOE's participation in the work of the major international energy organizations. IEA, the International Atomic Energy Agency (IAEA), and the Nuclear Energy Agency (NEA). Future reports will update the status of ongoing cooperative projects and provide information on new energy R and D activities

Prolapso de gordura orbitária bilateral associado a pterígio: relato de caso Bilateral orbital fat prolapse associated with pterygium: case report

Directory of Open Access Journals (Sweden)

Vanderson Glerian Dias

2006-06-01

Full Text Available O prolapso de gordura orbitária é entidade benigna incomum que pode causar defeitos estéticos. Os autores apresentam uma paciente de 63 anos com prolapso de gordura orbitária temporal bilateral associado a pterígio medial bilateral, ressaltando aspectos clínicos e cirúrgicos. Discute-se a importância do diagnóstico clínico e de imagem, além da comprovação histopatológica da lesão.Orbital fat prolapse is an uncommon benign entity that can cause esthetic defects. The authors present a 63-year-old patient with bilateral temporal orbital fat prolapse associated with a bilateral nasal pterygium. Clinical and surgical features are described. The clinical, imaging and histopathological diagnoses are discussed.

Cutaneous metastasis of bilateral renal cell carcinoma.

Science.gov (United States)

Abbasi, Fariba; Alizadeh, Mansur; Noroozinia, Farahnaz; Moradi, Amin

2013-01-01

Renal cell carcinoma (RCC) is a malignant lethal tumour with high potential of metastasis. However, metastasis from RCC to the skin is much less common. It is virtually a sign of poor prognosis. We represent a 42 years old man with bilateral RCC of clear cell type followed by metastasis to the scalp one month later. In this case the relatively young age of the patient, bilaterality of RCC and occurance of skin metastasis in the absence of recurrent kidney tumour are interesting.

BILATERAL CHOROIDAL EXCAVATION IN JUVENILE LOCALIZED SCLERODERMA.

Science.gov (United States)

Franklin, Mackenzie L; Day, Shelley

2018-01-01

To describe a case of bilateral choroidal excavation in a patient with juvenile localized scleroderma. Case report. An asymptomatic 12-year-old boy with localized scleroderma presented for examination and was found to have bilateral areas of choroidal excavation temporal to the fovea. Previous reports of ocular complications of localized scleroderma have primarily described adnexal and anterior segment changes. This is the second report of choroidal changes in a patient with localized scleroderma, and the first in a pediatric patient.

A case misdiagnosed as bilateral abducens palsy

International Nuclear Information System (INIS)

Takeda, Naoya; Kuwamura, Keiichi; Shirataki, Kunio; Tamaki, Norihiko; Matsumoto, Satoshi

1984-01-01

A 66-year-old male was admitted to our neurosurgical floor because of double vision and gait disturbance. Neurological examinations revealed bilateral 6th nerve palsy with both eyes pointing toward the midline. Initially, using a tentative diagnosis of intracranial mass lesions, especially localized at the base of the skull, computerized tomography of the head, cerebral angiography, orbital venography, and metrizamide CT cisternography were performed; the findings were normal. An orbital CT scan showed an enlargement of the bilateral medial rectus muscles, and the thyroid functions of T 3 and T 4 and the T 3 uptake were all elevated, which was compatible with the diagnosis of Graves' disease. The limitations of both eyeballs were considered to be due not to the 6th nerve palsy, but to the hypertrophy of the bilateral medial rectus muscles. We neurosurgeons should recall Graves' disease as well as intracranial lesions, cerebrovascular disease, and post-traumatic sequelae when examining a patient who presents limitations of external ocular movement. (author)

Bilateral clear cell sarcoma of the kidney

International Nuclear Information System (INIS)

Zekri, W.; Yehia, D.; Alfaar, A.S.; Elshafie, M.M.; Younes, A.A.; Zaghloul, M.S.; El-Kinaai, N.; Taha, H.; Refaat, A.; Zekri, W.; Elshafie, M.M.; Zaghloul, M.S.; Taha, H.; Refaat, A.; Younes, A.A.; Alfaar, A.S.; Yehia, D.

2015-01-01

Clear cell sarcoma of the kidney (CCSK) accounts for 2-5% of all pediatric renal malignancies, and is known for its propensity to metastasize to bone and other sites. We are reporting two cases with bilateral CCSK that were diagnosed at our institution. One patient initially presented with bilateral renal masses, as well as pulmonary, hepatic and bone metastasis; while other present only with bilateral masses with no evident distant metastasis. Both patients received aggressive neo-adjuvant chemotherapy to decrease tumor size. One patient completed his designated treatment and initially showed complete remission (CR); eventually suffering from relapse. The other patient’s tumor progressed during the course of chemotherapy. Both cases manifested brain dissemination at the time of relapse or progression. This emphasizes the importance of staging stratification in CCSK. This also illustrates CCSK’s ability to metastasize to bone and other sites including the brain (a primary relapse site in our cases)

Post appendectomy acalculus bilateral ureteric obstruction: A rare entity in children

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Vipul Gupta

2013-01-01

Full Text Available Bilateral acalculus ureteric obstruction is described as rare sequelae of acute appendicitis in two paediatric patients aged 6 and 11 years presented with features of anuria. Imaging and endoscopic evaluation confirmed bilateral ureteric obstruction secondary to bladder wall oedema as an inflammatory reaction to appendix. Both cases recovered following bilateral ureteric stenting and are doing well.

Simultaneous Spinal and Intracranial Chronic Subdural Hematoma Cured by Craniotomy and Laminectomy: A Video Case Report

Directory of Open Access Journals (Sweden)

Hideki Kanamaru

2016-04-01

Full Text Available Simultaneous spinal and intracranial chronic subdural hematoma (CSDH is a rare entity. A 67-year-old man visited our hospital due to headache after diving into a river 2 weeks before. Non-enhanced computed tomography (CT and magnetic resonance imaging (MRI revealed bilateral intracranial CSDH. The bilateral CSDH was evacuated and his symptoms improved. Three days after craniotomy, he complained of sensory disturbance on his buttocks. Lumbar MRI showed a space-occupying lesion behind the thecal sac at L5. CT with myelography showed a subdural mass lesion; there was no communication with the subarachnoid space. Fourteen days after craniotomy, L5 laminectomy was performed and the dura mater was incised carefully. The video shows that a liquid hematoma similar to the intracranial CSDH flowed out, followed by cerebrospinal fluid. His symptoms improved after the operation and the hematoma did not recur. This is a rare condition of spinal CSDH demonstrated by neuroimaging and intraoperative video.

Bilateral leukocoria in a patient with homozygous protein C deficiency

International Nuclear Information System (INIS)

Khan, Nasrat M.; Al-Dohayan, Noura D.; Al-Batiniji, Fatima S.

2007-01-01

We describe a bilateral leukocoria and neonatal purpura fulminans in a male infant, born at full term after an unremarkable pregnancy to a healthy consanguineous married couple. Multiple hemorrhagic skin bullae were found at birth on various parts of the body with bilateral leukocoria, organized vitreous hemorrhage, retinal detachment, and intracranial hemorrhage with undetectable levels of protein C activity. We report a clinical case of homozygous protein-C deficiency with severe purpura fulminans and bilateral leukocoria. (author)

Bilateral Periventricular Nodular Heterotopia

OpenAIRE

J Gordon Millichap

1998-01-01

Two unrelated boys, ages 8 and 5 years, with a syndrome of bilateral periventricular nodular heterotopia (BPNH), regional cortical dysplasia, mild mental retardation, and frontonasal malformation (FNM) are reported from the Instituto di Neuropsychiatria Infantile, University of Pisa, Italy, and the Institute of Human Genetics, University of Minnesota Medical School, Minneapolis, MN.

Bilateral teleoperation for linear force sensorless 3D robots

NARCIS (Netherlands)

Lichiardopol, S.; Wouw, van de N.; Nijmeijer, H.; Andrade Cetto, J.; Ferrier, J.; Filipe, J.

2011-01-01

It is well known that for bilateral teleoperation, force feedback information is needed. In this paper, we propose a control approach for bilateral teleoperation with uncertainties in the model of the slave robot and which does not use force sensors for haptic feedback. The controller design is

Frontal lobe syndrome from bilateral globus pallidus lesions a complication of Wernicke's encephalopathy

OpenAIRE

Arruda, Walter Oleschko

1991-01-01

A 38 year-old man developed the classical clinical picture of Wernicke's encephalopathy as a consequence of prolonged total parenteral nutrition. As a late complication he developed a frontal lobe syndrome. Bilateral globus pallidus lesions were observed in the CT-scan examination. Some aspects related to the cortical syndromes caused by subcortical lesions are discussed. Relata-se um caso de encefalopatia de Wernicke que ocorreu em paciente masculino de 38 anos, como complicação de alimen...

Bilateral hip arthroscopy under the same anesthetic for patients with symptomatic bilateral femoroacetabular impingement: 1-year outcomes.

Science.gov (United States)

Mei-Dan, Omer; McConkey, Mark O; Knudsen, Joshua S; Brick, Matthew J

2014-01-01

The purpose of this study was to investigate whether, in patients with bilateral symptomatic femoroacetabular impingement, bilateral surgery under 1 anesthetic is safe and efficacious and allows a rapid return of function compared with staged procedures. Three groups were evaluated: in group 1 both hips were treated simultaneously, in group 2 both hips were treated in a staged fashion, and in group 3 a single hip was addressed. The outcome measures were anesthesia and surgical times; time in the hospital; visual analog scale score for pain on postoperative days 1, 3, 7, and 30; analgesic use; and time until the patient could bike, drive, perform office work, perform gym activities, run, and return to play. Midterm evaluation was performed with the Non-Arthritic Hip Score and Western Ontario and McMaster Universities Osteoarthritis Index score at 6 and 12 months postoperatively. We enrolled 76 patients (122 hips) in this study. There were 42 male and 34 female patients. The mean age was 33 years (range, 14 to 50 years), and the mean body mass index was 24 (range, 18 to 35). Group 1 comprised 26 patients (52 hips, 16 male and 10 female patients). Group 2 comprised 20 patients (40 hips, 13 male and 7 female patients), with a mean time between surgeries of 14.56 weeks. Group 3 comprised 33 patients (30 hips, 13 male and 17 female patients). No preoperative differences were found between the groups. The surgical and anesthesia times in group 1 were significantly longer than those in groups 2 and 3. We found no significant differences in postoperative visual analog scale scores, analgesic use, or length of hospital stay. Group 1 required more time before patients were able to ride a stationary bicycle (14.7 days in group 1, 7.8 days in group 2, and 8.5 days in group 3; P returned to driving, performing office work, or reporting a normal gait. Each group had significant improvements in the Western Ontario and McMaster Universities Osteoarthritis Index and Non

An anatomical subunit-based outcome assessment scale for bilateral cleft lip and palate.

Science.gov (United States)

Bonanthaya, K; Shetty, P N; Fudalej, P S; Rao, D D; Bitra, S; Pabari, M; Rachwalski, M

2017-08-01

As there is currently no internationally accepted outcome measurement tool available for complete bilateral cleft lip and palate (CBCLP), the goal of this prospective study was to develop a numerical evaluation scale that allows reliable scoring of this cleft deformity. Our cohort comprised 121 Indian subjects with CBCLP who underwent surgical repair (mean age at time of surgery 6.53 months) using a modified Millard technique. A panel of three professionals evaluated each subject's outcome of bilateral cleft lip repair 6 months postoperatively on two-dimensional (2D) full-face photographs in the frontal view and worm's eye view. A simple two-point rating system was applied to separately analyse a total of 12 components of lip, nose, and scar. The results and mean scores for the analysed anatomical areas were 2.2±1.01 (max=3) for nose, 5.4±1.54 (max=8) for lip, and 1.9±1.3 (max=3) for scar, with a total score 7.7±2.21 (max=12) indicating a good surgical outcome. The inter-examiner ICC for nose, lip, scar, and total score was calculated at 0.836, 0.889, 0.723, and 0.927 respectively and indicated a strong level of repeatability and reliability that was highly significant (P<0.001). In conclusion, we were able to develop and test a scoring system for measuring outcomes in CBCLP that warrants simplicity of use, reliability and reproducibility. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Bilateral parotitis as the initial presentation of childhood sarcoidosis.

Science.gov (United States)

Banks, Gretchen C; Kirse, Daniel J; Anthony, Evelyn; Bergman, Simon; Shetty, Avinash K

2013-01-01

The differential diagnosis of bilateral parotid gland enlargement in children includes infectious, inflammatory, and neoplastic disorders. We present the case of a 13-year-old male who presented with a 5-week history of bilateral parotid swelling. On exam, both parotid glands were nontender, smooth, and diffusely enlarged. He had slightly elevated inflammatory markers, but other lab results were normal. A neck CT revealed symmetric enlargement of the parotid, submandibular, and sublingual glands. A chest CT revealed scattered peripheral pulmonary nodules and bilateral hilar adenopathy. A parotid gland biopsy showed multiple noncaseating granulomas with multinucleated giant cells surrounded by lymphocytes, consistent with the diagnosis of sarcoidosis. Special stains for acid-fast and fungal organisms were negative. Using this illustrative case, we discuss the differential diagnosis of bilateral salivary gland enlargement in children and review the etiology, diagnosis, clinical manifestations, and treatment of pediatric sarcoidosis. Copyright © 2013 Elsevier Inc. All rights reserved.

Delayed diagnosis of homocystinuria presenting as bilateral congenital lens subluxation

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Jelić-Vuković Marija

2017-01-01

Full Text Available Introduction. Homocystinuria is an autosomal recessively inherited defect leading to hyperhomocysteinemia and associated with ocular manifestations, mainly myopia and ectopia lentis. Case outline. A 26-year-old male with secondary glaucoma due to bilateral lens subluxation was admitted to the Department of vitreoretinal surgery. Horizontal nystagmus, bilateral lens subluxation, and bilateral amblyopia were first discovered at the age of three years. Preoperative laboratory workup revealed elevated levels of homocysteine. Bilateral pars plana lensectomy and vitrectomy followed by a sulcus fixation of the intraocular lens (ALCON MA60 Acrysof IOL were performed. The patient was prescribed folic acid, methionine, and pyridoxine, and was urged to maintain a methionine-low diet. After a bilateral lensectomy and sulcus fixation of the intraocular lens and a methionine restriction therapy combined with vitamin B6, B9, and B12 supplementation, his condition improved greatly. Conclusion. In this report of a rare case we emphasize the importance of examining differential diagnoses of lens subluxation, since early intervention can prevent serious complications.

Bilateral Hallux Valgus: A Utility Outcome Score Assessment.

Science.gov (United States)

Makhdom, Asim M; Sinno, Hani; Aldebeyan, Sultan; Cota, Adam; Hamdy, Reggie Charles; Alzahrani, Mohammad; Janelle, Chantal

2016-01-01

Hallux valgus is the most common forefoot problem in adults. Although it can cause considerable disability and affect the quality of life of those affected, many patients seek medical attention because of cosmetic concerns. Our aim was to objectively measure the perceived health burden of living with bilateral hallux valgus. Previously validated utility outcome measures, including the visual analog scale, time trade-off, and standard gamble tests, were used to quantify the health burden for single-eye blindness, double-eye blindness, and bilateral hallux valgus in 103 healthy subjects using an online survey. The Student t test and linear regression analysis were used for statistical analysis. The mean visual analog scale, time trade-off, and standard gamble scores for bilateral hallux valgus were 0.86 ± 1.6, 0.95 ± 0.5, and 0.95 ± 0.14, respectively. These were significantly greater than the utility scores for single-eye and double-eye blindness (p hallux valgus. In conclusion, we have objectively demonstrated the effect of living with bilateral hallux valgus deformities. Our sample population reported being willing to undergo a procedure with a 5% mortality rate and sacrifice 1.8 years of life to attain perfect health and avoid the bilateral hallux valgus health state. Our findings will guide us in counseling our patients and understanding how they perceive their foot deformity. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Binaural Speech Understanding With Bilateral Cochlear Implants in Reverberation.

Science.gov (United States)

Kokkinakis, Kostas

2018-03-08

The purpose of this study was to investigate whether bilateral cochlear implant (CI) listeners who are fitted with clinical processors are able to benefit from binaural advantages under reverberant conditions. Another aim of this contribution was to determine whether the magnitude of each binaural advantage observed inside a highly reverberant environment differs significantly from the magnitude measured in a near-anechoic environment. Ten adults with postlingual deafness who are bilateral CI users fitted with either Nucleus 5 or Nucleus 6 clinical sound processors (Cochlear Corporation) participated in this study. Speech reception thresholds were measured in sound field and 2 different reverberation conditions (0.06 and 0.6 s) as a function of the listening condition (left, right, both) and the noise spatial location (left, front, right). The presence of the binaural effects of head-shadow, squelch, summation, and spatial release from masking in the 2 different reverberation conditions tested was determined using nonparametric statistical analysis. In the bilateral population tested, when the ambient reverberation time was equal to 0.6 s, results indicated strong positive effects of head-shadow and a weaker spatial release from masking advantage, whereas binaural squelch and summation contributed no statistically significant benefit to bilateral performance under this acoustic condition. These findings are consistent with those of previous studies, which have demonstrated that head-shadow yields the most pronounced advantage in noise. The finding that spatial release from masking produced little to almost no benefit in bilateral listeners is consistent with the hypothesis that additive reverberation degrades spatial cues and negatively affects binaural performance. The magnitude of 4 different binaural advantages was measured on the same group of bilateral CI subjects fitted with clinical processors in 2 different reverberation conditions. The results of this work

Prolapsed bilateral ureteroceles leading to intermittent outflow obstruction.

LENUS (Irish Health Repository)

Stunell, H

2012-02-01

A ureterocele refers to a cystic dilatation of the distal ureter. It may be unilateral or bilateral and may be associated with a duplex system in some cases. We present an unusual case where a young patient was found to have large bilateral ureteroceles which prolapsed into the urethra, causing intermittent incontinence and obstruction. We discuss the case and review the literature concerning this rare anomaly.

Amyad's hernia while reparing the bilateral inguinal hernia

OpenAIRE

Arif Aslaner; Tuğrul Çakır; Umut Rıza Gündüz; Burhan Mayir; Nurullah Bülbüller

2015-01-01

Amyand's hernia is the term used for inguinal hernia containing appendix. It is a rare condition and found in 1% of inguinal hernia repairs. Here we report a case of Amyand's hernia in a 61 years old male who was diagnosed with bilateral inguinal hernia. He underwent surgery and bilateral inguinal hernia repair with prosthetic meshes and without appendectomy. The patient was discharged uneventfully. 

A Case of Bilateral Pigment Dispersion Syndrome Following Many Years of Uninterrupted Treatment With Atropine 1% for Bilateral Congenital Cataracts.

Science.gov (United States)

Gizzi, Corrado; Mohamed-Noriega, Jibran; Murdoch, Ian

2017-10-01

Describe an unusual case of bilateral pigment dispersion syndrome (PDS) following years of uninterrupted treatment with atropine 1% for bilateral congenital cataracts, speculate on potential mechanisms leading to this condition. This is a case report. A 45-year-old white patient on long-term treatment with atropine 1% ointment since his infancy for bilateral congenital cataracts developed PDS with secondary ocular hypertension. The patient showed all the hallmarks of PDS with secondary ocular hypertension. An anterior segment Swept-Source optical coherence tomography was obtained to review the iris profile. The patient showed good pressure response to topical prostaglandin therapy. This is the second case report of PDS in a patient with chronic use of topical atropine. The proposed mechanisms for pigment dispersion are discussed and the possibility raised of dispersion being a potential side effect of the drug.

Bilateral Free Flap Breast Reconstruction Outcomes: Do Abdominal Scars Affect Bilateral Flaps?

Directory of Open Access Journals (Sweden)

Dmytro Unukovych, MD, PhD

2017-09-01

Conclusion:. Surgical outcomes of bilateral reconstructions in patients with abdominal scars are generally comparable with ones in patients without prior surgery; however, some problems have been identified. These procedures might have some intraoperative considerations and often require increased operative times. Apart from the traditional preoperative computed tomography angiography, intraoperative imaging (e.g., fluorescence angiography may be advocated in patients with abdominal scars.

Bilateral femoral head dysplasia and osteochondritis. Multiple epiphyseal dysplasia tarda, spondylo-epiphyseal dysplasia tarda, and bilateral Legg-Perthes disease

Energy Technology Data Exchange (ETDEWEB)

Andersen, P.E. Jr.; Schantz, K.; Bollerslev, J.; Justesen, P.

Multiple epiphyseal dysplasia tarda (MEDT) and spondylo-epiphyseal dysplasisa tarda (SEDT) are genetically transmitted conditions affecting the hips, which may resemble bilateral Legg-Perthes disease (LPD). Misdiagnoses are not uncommon, with serious implications for treatment, prognosis and genetic counseling. An epidemiologic study of MEDT and SEDT in a well-defined population of 453 921 persons in Denmark was performed. A population prevalence of 0.7 per 100 000 inhabitants with SEDT and 4.0 per 100 000 inhabitants with MEDT was found. Distinguishing features between MEDT, SEDT and bilateral LPD based on radiologic findings in the hips, other joints, and spine were ascertained. Bilateral LPD is always asymmetric, exhibits patches of increased density in the epiphyses and often metaphyseal cyst-like changes. No spinal lesion or affection of other joints is present, and the acetabula are normal. In MEDT and SEDT the capital femoral epiphyses are symmetrically flattened, fragmented and uniformly slightly sclerotic. Generalised platyspondyly is a constant finding in SEDT.

Method of bilateral pleural drainage by single Blake drain after esophagectomy.

Science.gov (United States)

Niwa, Yukiko; Koike, Masahiko; Oya, Hisaharu; Iwata, Naoki; Kobayashi, Daisuke; Kanda, Mitsuro; Tanaka, Chie; Yamada, Suguru; Fujii, Tsutomu; Nakayama, Goro; Sugimoto, Hiroyuki; Nomoto, Shuji; Fujiwara, Michitaka; Kodera, Yasuhiro

2015-03-01

Clinicians often encounter left pleural effusion after esophagectomy, which sometimes necessitates thoracentesis. We have introduced a new drainage method, bilateral pleural drainage by single Blake drain (BDSD), which we have been using since April 2013. This study aims to evaluate the performance of the BDSD. The BDSD method employs a 15-F Blake drain inserted from the right thoracic cavity to the left thoracic cavity across the posterior mediastinum. The conventional drain (CD) group consisted of 50 patients with a 19-F Blake drain placed in the right thoracic cavity during the period from April 2012 to March 2013. The BDSD group consisted of 54 patients treated from April 2013 to June 2014. The amount of total drainage in the BDSD group was significantly higher than that in the CD group (P pleural effusion and left lower lobe atelectasis in the BDSD group were significantly lower than those in the CD group (P pleural effusion necessitating thoracentesis drainage in the BDSD group. Compared with the conventional method, BDSD was able to evacuate bilateral pleural effusion more effectively, and the incidences of left pleural effusion and left atelectasis were lower. This method is therefore clinically useful after esophagectomy.

Feocromocitoma bilateral: la importancia de los estudios de diagnóstico por imagen Bilateral pheochromocytoma: the importance of imaging studies

Directory of Open Access Journals (Sweden)

Igor I Bonnet

2011-10-01

Full Text Available Se presenta un caso clínico poco frecuente de feocromocitoma bilateral, en el cual los estudios de diagnóstico por imagen, tanto de información estructural como funcional, constituyeron una fuente fundamental para su detección y seguimiento.We report a rare case of bilateral pheochromocytoma, in which imaging studies, both of structural and functional information, were a major source for its detection and follow-up.

Blunt bilateral diaphragmatic rupture—A right side can be easily missed

Directory of Open Access Journals (Sweden)

Maria Michailidou

2015-12-01

Full Text Available Blunt diaphragmatic rupture (BDR is uncommon with a reported incidence range of 1%–2%. The true incidence is not known. Bilateral BDR is particularly rare. We presented a case of bilateral BDR and we think that the incidence is under-recognised thanks to an easily missed and difficult to diagnose right sided injury. Keywords: Blunt, Diaphragm, Bilateral, Injury

Introduction of a Case of Bilateral Pheochromocytoma Tumor

Directory of Open Access Journals (Sweden)

M Zare

2009-01-01

Full Text Available Summary: Pheochromocytoma is an adrenal tumor characterized by symptoms of hypertension, headache, increased sweating, and tachycardia .In one third of patients, the tumor is discovered incidentally during radiological evaluation of the abdomen. In this article a case of bilateral pheochromocytoma is reported. The patient, a twelve years old boy, referred with complaints of headache, flushing, palpitation and blurring of vision. He had a blood pressure of 200/120 mmHg and after investigation, coarctation of aorta was excluded. On abdominal ultrasound, bilateral adrenal mass was diagnosed, followed by serial measurements of urinary vanillyl mandellic acid (VMA which was found to be elevated. Meta- Iodio benzyl glunidin (MIBG scan showed increased uptake in both adrenals. Patient underwent laparotomy and bilateral adrenalectomy with the diagnosis of pheochromocytoma. Pathologic report confirmed the diagnosis

Bilateral Olecranon Tophaceous Gout Bursitis

Directory of Open Access Journals (Sweden)

Güzelali Özdemir

2017-01-01

Full Text Available In this case, we present a patient with the diagnosis of bilateral olecranon tophaceous gout. After the surgical treatment, there was no limitation of range of motion or wound problem at 6th month control.

Tratamiento conservador en pacientes con retinoblastoma bilateral

Directory of Open Access Journals (Sweden)

Juan C. Suárez

2008-11-01

Full Text Available OBJETIVO: comparar el tratamiento convencional del retinoblastoma bilateral, usado hasta hace algunos años, consistente en radioterapia o enucleación bilateral, con el tratamiento conservador actual que incluye termoterapia transpupilar (TTT o TTT/quimioterapia al menos en un ojo, en niños con diagnóstico de retinoblastoma bilateral. DISEÑO: estudio retrospectivo descriptivo. MUESTRA: 20 pacientes con diagnóstico de retinoblastoma bilateral que consultaron al Hospital Universitario San Vicente de Paúl, de Medellín, Colombia, entre 1997 y 2007. MÉTODO: se hizo enucleación del ojo con el tumor de mayor tamaño. En el otro ojo se hizo tratamiento con TTT, con el láser diodo (810 nm, spot amplio, solo o combinado con otras terapias. RESULTADOS: se dividió a los pacientes en dos grupos: 16 pacientes (32 ojos en el grupo 1 tratados conservadoramente y 4 pacientes (8 ojos en el grupo 2 con tratamiento convencional. El rango de edad fue de 1-72 meses en el grupo 1 y de 1-12 meses en el grupo 2. El tiempo de seguimiento fue de 7-67 meses para el grupo 1 y de 13-73 meses para el grupo 2. En el grupo 1 se hizo enucleación de 16 ojos (50%, radioterapia externa de uno (3,1%, quimioterapia más termoterapia de 5 (15,6% y quimioterapia más termoterapia más crioterapia de 10 (31,3%. En todos los pacientes se logró preservar al menos un ojo. En el grupo 2, se enuclearon 7 ojos (87,5% y se hizo radioterapia externa más enucleación en un paciente (12.5%. Además, todos los pacientes recibieron quimioterapia. CONCLUSIÓN: la terapia conservadora actual consistente en tratamiento local (termoterapia, crioterapia o braquiterapia y quimiorreducción permite preservar al menos un ojo y en algunos casos de los dos, muchas veces con buena agudeza visual, en niños con retinoblastoma bilateral; se evitan así la enucleación bilateral y la radioterapia externa usada en el tratamiento convencional con todos sus efectos secundarios. La enucleación contin

BILATERAL PATHOLOGICAL HIP DISLOCATION IN CHILDREN

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Yuriy E. Garkavenko

2017-03-01

Full Text Available Introduction. Pathological dislocation of the hip is one of the most severe complications of acute hematogenous osteomyelitis. The program of treatment for children with pathological hip dislocation is complex, but it has been sufficiently developed and implemented very successfully. At the same time, the available literature provides no cases of treating children with bilateral pathological hip dislocations after hematogenous osteomyelitis. There is no information on the incidence of such cases or in regards to remote functional results. Materials and methods. The results of the treatment of 18 children with bilateral pathological dislocation of the hip after hematogenous osteomyelitis are presented, which constituted 23.1% of the total number of patients (78 who underwent surgery in 2000–2016 for the diagnosis of pathological hip dislocation. Both hip joints were surgically operated on in 12 patients, while one hip joint was operated on in 6 patients. To assess the anatomical and functional state of hip joints, the clinical and roentgenological diagnostic techniques were used. Results and discussion. To stabilize and restore the function of the hip joints, 18 children underwent 30 surgical interventions: simple open hip reduction (19 and open hip reduction with hip arthroplasty with one (6 or two (5 demineralized osteochondral allogeneic grafts. The decision regarding the possibility of performing surgical intervention on the second hip joint was made only after a child's check-up examination was complete and after positive information about the anatomical and functional state of the operated hip joint was obtained. According to these criteria, 14 (77.8% children underwent surgical treatment of the second hip joint 1–1.5 years after the course of conservative measures to restore the range of motion in the previously operated hip joint. Over a period of 1–12 years, 17 patients were examined, 10 of which underwent an operation on both

Bilateral breast cancer : mammographic and clinical findings

International Nuclear Information System (INIS)

Kim, Eun Kyung; Oh, Ki Keun; Jun, Hwang Yoon; Lee, Byung Chan; Lee, Kyong Sik; Lee, Yong Hee

1997-01-01

To evaluate the mammographic and clinical features of bilateral breast cancer. We retrospectively reviewed clinical records(n=23) and mammograms (n=15) of 23 patients with bilateral breast cancer. Patients' age, location of the tumor and pathologic staging were determined from clinical records. Mammographic features were classified as spiculated mass, nonspiculated mass, mass with microcalcification, microcalcification only, asymmetric density, and normal. Of the 23 cases of bilateral breast cancer, 8(34.8%) were synchronous and 15(65.2%) were metachronous. Age at diagnosis of cancer in the first breast was between 27 and 59(mean 43) years ; there was no statistically significant difference in mean age between patients with synchronous and metachronous cancer. The mean interval between the diagnosis of each lesion of the metachronous pairs was 9.1 years. In 11 of 23 cases(48%), tumors were locaated in the same quadrant, and in the other 12 cases(52%), they were in different quadrant. At mammography, five of 15 metachronous cancers(33%) were similar in appearance and 10 pairs(67%) were different. In 4 of 23 cases(17%), cancer in the first breast was at stage 0 and stage 1, and in 13 of 23(57%), cancer in the second breast was at this same stage. In bilateral breast cancer, the two breasts frequently show different mammographic features. Cancer of the second breast was at an early stage; this suggest that regular examination and mammography are important and can allow early detection of contralateral breast cancer

A 72-year-old patient with bilateral Maisonneuve fractures

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Thomas Dienstknecht

2012-07-01

Full Text Available Maisonneuve fractures result from a disruption of the medial ankle structures and a proximal fibular fracture. Patient complaints can be misleading and there is a significant rate of delayed diagnosed injuries. We present a case of bilateral Maisonneuve fractures after a fall due to a syncopal collapse. A precise clinical examination led to this rare diagnosis. The injuries were treated with syndesmotic screw fixation, removal of hardware followed after 6 weeks. The patient was asymptomatic at threemonths follow up. Patients with bilateral injuries undergoing standard surgical treatment can gain full recovery, but high suspicion in clinical examination is needed to detect this uncommon bilateral injury.

Anton's Syndrome due to Bilateral Ischemic Occipital Lobe Strokes.

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Zukić, Sanela; Sinanović, Osman; Zonić, Lejla; Hodžić, Renata; Mujagić, Svjetlana; Smajlović, Edina

2014-01-01

We present a case of a patient with Anton's syndrome (i.e., visual anosognosia with confabulations), who developed bilateral occipital lobe infarct. Bilateral occipital brain damage results in blindness, and patients start to confabulate to fill in the missing sensory input. In addition, the patient occasionally becomes agitated and talks to himself, which indicates that, besides Anton's syndrome, he might have had Charles Bonnet syndrome, characterized by both visual loss and hallucinations. Anton syndrome, is not so frequent condition and is most commonly caused by ischemic stroke. In this particular case, the patient had successive bilateral occipital ischemia as a result of massive stenoses of head and neck arteries.

Bilateral fusion of permanent mandibular incisors: A case report

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Saxena A

2008-05-01

Full Text Available This case report showing a classical presentation of bilateral fusion of permanent mandibular incisors in a child patient for dental attention. Fusion defined as the merger of two adjacent tooth germs producing one tooth. These teeth may be fused by enamel, dentin, or both. The fused crown is broader than non fused adjacent teeth and thus resembles gemination. However, tooth counting reveals decreased numbers. Fused teeth are rare in the permanent dentition. The incisors are reported to be fused in primary and permanent dentition, but bilateral fusion is a rare occurrence. Hence the case report of bilateral fusion in an 11-year-old boy is presented.

Comparison between Unilateral and Bilateral Plyometric Training on Single and Double Leg Jumping Performance and Strength.

Science.gov (United States)

Bogdanis, Gregory C; Tsoukos, Athanasios; Kaloheri, Olga; Terzis, Gerasimos; Veligekas, Panagiotis; Brown, Lee E

2017-04-18

This study compared the effects of unilateral and bilateral plyometric training on single and double-leg jumping performance, maximal strength and rate of force development (RFD). Fifteen moderately trained subjects were randomly assigned to either a unilateral (U, n=7) or bilateral group (B, n=8). Both groups performed maximal effort plyometric leg exercises two times per week for 6 weeks. The B group performed all exercises with both legs, while the U group performed half the repetitions with each leg, so that total exercise volume was the same. Jumping performance was assessed by countermovement jumps (CMJ) and drop jumps (DJ), while maximal isometric leg press strength and RFD were measured before and after training for each leg separately and both legs together. CMJ improvement with both legs was not significantly different between U (12.1±7.2%) and B (11.0±5.5%) groups. However, the sum of right and left leg CMJ only improved in the U group (19.0±7.1%, pplyometric training was more effective at increasing both single and double-leg jumping performance, isometric leg press maximal force and RFD when compared to bilateral training.

Amyad's hernia while reparing the bilateral inguinal hernia

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Arif Aslaner

2015-01-01

Full Text Available Amyand's hernia is the term used for inguinal hernia containing appendix. It is a rare condition and found in 1% of inguinal hernia repairs. Here we report a case of Amyand's hernia in a 61 years old male who was diagnosed with bilateral inguinal hernia. He underwent surgery and bilateral inguinal hernia repair with prosthetic meshes and without appendectomy. The patient was discharged uneventfully. 

Bilateral meandering pulmonary veins

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Thupili, Chakradhar R.; Udayasankar, Unni [Pediatric Imaging, Imaging Institute Cleveland Clinic, Cleveland, OH (United States); Renapurkar, Rahul [Imaging Institute Cleveland Clinic, Thoracic Imaging, L10, Cleveland, OH (United States)

2015-06-15

Meandering pulmonary veins is a rare clinical entity that can be mistaken for more complex congenital syndromes such as hypogenetic lung syndrome. We report imaging findings in a rare incidentally detected case of bilateral meandering pulmonary veins. We briefly discuss the role of imaging in diagnosing this condition, with particular emphasis on contrast-enhanced CT. (orig.)

Bilateral iatrogenic maxillary fractures after dental treatment in two aged horses

OpenAIRE

Widmer, A; Fürst, A; Bettschart-Wolfensberger, R; Makara, M; Geyer, H; Kummer, M

2010-01-01

This clinical report describes two horses with bilateral maxillary fractures following dental treatment. The fractures occurred during dental treatment by a veterinarian, and both had rostral, transverse, and complete bilateral maxillary fractures with instability and minimal displacement. The fractures were repaired using bilateral intraoral wiring with the patients under general anesthesia. The postoperative period was without complications and the fractures healed as expected. Maxillary fr...

Bilateral cerebrovascular accidents in incontinentia pigmenti.

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Fiorillo, Loretta; Sinclair, D Barry; O'Byrne, Mary L; Krol, Alfons L

2003-07-01

Incontinentia Pigmenti is an X-linked dominant neurocutaneous disorder with central nervous system manifestations in 30% of cases, including seizures and mental retardation. Ischemic or hemorrhagic cerebrovascular accidents have been reported rarely in incontinentia pigmenti. Chart review and literature search was performed following identification of the index case. We describe a patient with incontinentia pigmenti who developed bilateral cerebrovascular accidents in the neonatal period, with resultant severe neurologic sequelae. This is the second reported case of bilateral cerebrovascular accidents in a patient with incontinentia pigmenti. This finding may be secondary to cerebrovascular anomalies, similar to those observed in the retina. Recognition of cerebrovascular accidents as a complication of incontinentia pigmenti will hopefully lead to earlier recognition and treatment.

Luxação lateral bilateral isolada do cotovelo Elbow bilateral lateral dislocation

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Leandro José Reckers

2006-01-01

Full Text Available Os autores apresentam um caso de luxação lateral bilateral isolada de cotovelo em uma paciente do sexo feminino de 48 anos. Optou-se pelo tratamento conservador através de redução fechada sob anestesia geral. Ambos os cotovelos foram imobilizados com gesso axilo-palmar e mantidos a 90º de flexão por três semanas, quando se iniciou a reabilitação. No seguimento de dezoito meses observou-se boa estabilidade e recuperação do arco de movimento de ambos os cotovelos.The authors present an isolated case of bilateral lateral dislocation of the elbow joint in a 48-year old female patient. The conservative treatment was chosen, through closed reduction under general anesthesia. Both elbows were placed in an axillopalmar splint cast and held at a 90 degree angle of flexion for three weeks when rehabilitation began. In the eighteen-month follow-up period, good stability as well as the recovery of the range of motion was observed in both elbows

Debilitamiento bilateral de los músculos rectos medios en esotropías parcialmente acomodativas Bilateral attenuation of medial rectus muscles in partially accommodative esotropia

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María Emilia Fernández González

2009-12-01

Full Text Available Se realizó una investigación descriptiva, transversal y prospectiva de 13 pacientes con isotropía parcialmente acomodativa, después de una corrección total de la hipermetropía, tratados en el Servicio de Oftalmología del Policlínico Pediátrico Sur de Santiago de Cuba desde mayo del 2006 hasta septiembre del 2008. La ejecución de este estudio se justificó por el insuficiente conocimiento existente sobre el alineamiento ocular en las endotropías parcialmente acomodativas, luego de aplicar la técnica de debilitamiento bilateral de los músculos rectos medios. En la serie estudiada, la edad media fue de 6,3 años y el alineamiento ocular logrado en el período posoperatorio resultó exitoso, además de que no estuvo relacionado con la ametropía. La ambliopía encontrada contribuyó al pronóstico de la afección.A descriptive, cross-sectional and prospective investigation of 13 patients with partially accommodative esotropia was carried out, after a total correction of the hypermetropy, treated in the Ophthalmology Service of the Southern Pediatric Polyclinic of Santiago de Cuba from May, 2006 to September, 2008. The implementation of this study was justified for the insufficient existent knowledge on the ocular alignment in the partially accommodative endotropia, after applying the technique of bilateral attenuation of medial rectus muscles. In the studied series, the mean age was of 6,3 years and the ocular alignment achieved in the posoperative period was successful besides that was not related with the ametropia. The amblyopia found contributed to the prognosis of the disorder.

Totally optimal decision trees for Boolean functions

KAUST Repository

Chikalov, Igor; Hussain, Shahid; Moshkov, Mikhail

2016-01-01

We study decision trees which are totally optimal relative to different sets of complexity parameters for Boolean functions. A totally optimal tree is an optimal tree relative to each parameter from the set simultaneously. We consider the parameters

Beyond dizziness: virtual navigation, spatial anxiety and hippocampal volume in bilateral vestibulopathy

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Olympia eKremmyda

2016-03-01

Full Text Available Bilateral vestibulopathy (BVP is defined as the impairment or loss of function of either the labyrinths or the eighth nerves. Patients with total BVP due to bilateral vestibular nerve section exhibit difficulties in spatial memory and navigation and show a loss of hippocampal volume. In clinical practice, most patients do not have a complete loss of function but rather an asymmetrical residual functioning of the vestibular system. The purpose of the current study was to investigate navigational ability and hippocampal atrophy in BVP patients with residual vestibular function. Fifteen patients with BVP and a group of age- and gender- matched healthy controls were examined. Self-reported questionnaires on spatial anxiety and wayfinding were used to assess the applied strategy of wayfinding and quality of life. Spatial memory and navigation were tested directly using a virtual Morris Water Maze Task. The hippocampal volume of these two groups was evaluated by voxel-based morphometry. In the patients, the questionnaire showed a higher spatial anxiety and the Morris Water Maze Task a delayed spatial learning performance. MRI revealed a significant decrease in the gray matter mid-hippocampal volume (Left: p = 0.006, Z = 4.58, Right: p < 0.001, Z = 3.63 and posterior parahippocampal volume (Right: p = 0.005, Z = 4.65, Left: p < 0.001, Z = 3.87 compared to those of healthy controls. In addition, a decrease in hippocampal formation volume correlated with a more dominant route-finding strategy. Our current findings demonstrate that even partial bilateral vestibular loss leads to anatomical and functional

Variability of gait, bilateral coordination, and asymmetry in women with fibromyalgia.