Thaís Sumie Nozu Imada
Full Text Available INTRODUCTION: Torus palatinus is a specific name to identify exostoses developed in the hard palate along the median palatine suture. Despite of not being a pathological condition, its presence requires attention and knowledge regarding its management. Surgical removal of exostoses is indicated when the patient frequently traumatizes the area of palatine torus during mastication and speech or when it is necessary for the rehabilitation of the upper arcade with complete dentures. OBJECTIVE: The aim of this article is to present three cases of Torus palatinus and to discuss the management of them. CASE REPORT: In the first case, a 57-year-old Caucasian man sought oral rehabilitation of his edentulous maxilla but presented a hard nodules in the hard palate; in the second case, a 40-year-old Caucasian woman was referred for frequent trauma of palatal mucosa during mastication, aesthetic complaint, and discomfort caused by the trauma of her tongue in this area; and in the third case, a 45-year-old Caucasian woman presented with a lesion on the palate that caused difficulty swallowing. When the Torus palatinus was impairing the basic physiological functions of the patients, all cases were surgically treated, improving the patients' quality of life. FINAL CONSIDERATION: The dentist should be properly prepared to choose the best from among the existing surgical approaches for each individual lesion in order to improve the results and avoid possible complications.
Full Text Available Introduction: For decades, acetabular fractures were treated conservatively. Judet et al. in 1960s established the operative treatment of these fractures by continuous improvement of pre-operative evaluation and classification of fractures. Several studies demonstrated that accurate fracture reduction decreases the incidence of post-traumatic arthritis and improves functional outcome.Case Series: We report 67 consecutive patients who underwent surgical treatment for acetabular fracture; 44 patients were available for follow-up. In 35 (79.5% cases, congruent reductions were achieved. The final mean Harris hip score was 81.8 (53-95. Functional outcomes according to Harris score were excellent and good in 31 patients (70.5%.Conclusions: The results of internal fixation of displaced acetabular fractures in our series were satisfactory.
Full Text Available Background and Objective. Although minimally invasive surgical treatment of acute epidural hematoma attracts increasing attention, no generalized indications for the surgery have been adopted. This study aimed to evaluate the effects of minimally invasive surgery in acute epidural hematoma with various hematoma volumes. Methods. Minimally invasive puncture and aspiration surgery were performed in 59 cases of acute epidural hematoma with various hematoma volumes (13–145 mL; postoperative follow-up was 3 months. Clinical data, including surgical trauma, surgery time, complications, and outcome of hematoma drainage, recovery, and Barthel index scores, were assessed, as well as treatment outcome. Results. Surgical trauma was minimal and surgery time was short (10–20 minutes; no anesthesia accidents or surgical complications occurred. Two patients died. Drainage was completed within 7 days in the remaining 57 cases. Barthel index scores of ADL were ≤40 (n=1, 41–60 (n=1, and >60 (n=55; scores of 100 were obtained in 48 cases, with no dysfunctions. Conclusion. Satisfactory results can be achieved with minimally invasive surgery in treating acute epidural hematoma with hematoma volumes ranging from 13 to 145 mL. For patients with hematoma volume >50 mL and even cerebral herniation, flexible application of minimally invasive surgery would help improve treatment efficacy.
Prifti, Edvin; Bonacchi, Massimo; Baboci, Arben; Giunti, Gabriele; Veshti, Altin; Demiraj, Aurel; Zeka, Merita; Rruci, Edlira; Bejko, Ervin
The left ventricular pseudoaneurysm (LVP) is rare, the surgical experience is limited and its surgical treatment remains still a challenge with an elevated mortality. Herein, it is presented a retrospective analysis of our experience with acquired post infarct LVP over a10-year period. Between January 2006 through August 2016, a total of 13 patients underwent operation for post infarct pseudoaneurysm of the left ventricle. There were 10 men and 3 women and the mean age was 61 ± 7.6 years. 4 patients presented acute LVP. Two patients had preoperative intraortic balloon pump implantation. Various surgical techniques were used to obliterate the pseudoaneurysm such as direct pledgeted sutures buttressed by polytetrafluoroethylene felt, a Gore-Tex or Dacron patch, transatrial closure of LVP neck in submitral pseudoaneurysm, or linear closure in cases presenting associated postinfarct ventricular septal defect. Concomitant coronary artery bypasses were performed for significant stenoses in 12 patients, ventricular septal defect closure in 4 patients, mitral valve replacement in 3 and aortic valve replacement in 1 patient. Operative mortality was 30.8% (4 patients). Three of them were acute LVP. Three patients required the continuous hemodyalisis and 8 patients required intra-aortic balloon pump. At follow-up two deaths occurred at 1 and 3 years after surgery. In conclusion, this study revealed that surgical repair of post infarct left ventricular pseudoaneurysm was associated with an acceptable surgical mortality rate, that cardiac rupture did not occur in surgically treated patients.
Awang Saufi M
Full Text Available Abstract Introduction We report three cases of demyelinating disease with tumor-like presentation. This information is particularly important to both neurosurgeons and neurologists who should be aware that inflammatory demyelinating diseases can present as a mass lesion, which is indistinguishable from a tumor, both clinically and radiologically, especially when there is no evidence of temporal dissemination of this disease. Case presentation The first patient was a 42-year-old Malay woman who developed subacute onset of progressive quadriparesis with urinary incontinence. Magnetic resonance imaging of her spine showed an intramedullary lesion at the C5-C7 level. She was operated on and biopsy was suggestive of a demyelinating disease. Retrospective history discovered two episodes of acute onset of neurological deficits with partial recovery and magnetic resonance imaging of her brain revealed demyelinating plaques in the centrum semiovale. The second patient was a 16-year-old Malay boy who presented with symptoms of raised intracranial pressure. A computed tomography brain scan revealed obstructive hydrocephalus with a lesion adjacent to the fourth ventricle. An external ventricular drainage was inserted. Subsequently, a stereotactic biopsy was taken and histopathology was reported as demyelination. Retrospective history revealed similar episodes with full recovery in between episodes. The third case was a 28-year-old Malay man who presented with acute bilateral visual loss and confusion. Magnetic resonance imaging of his brain showed a large mass lesion in the right temporoparietal region. Biopsy was consistent with demyelinating disease. Reexamination of the patient revealed bilateral papillitis and not papilledema. Visual evoked potential was prolonged bilaterally. In all three cases, lumbar puncture for cerebrospinal fluid study was not carried out due to lack of patient consent. Conclusions These cases illustrate the importance of
Edvin Prifti, MD, PhD
Conclusion: In conclusion, this study revealed that surgical repair of post infarct left ventricular pseudoaneurysm was associated with an acceptable surgical mortality rate, that cardiac rupture did not occur in surgically treated patients.
Babu, Anna Serene; Manju, V; Nair, Vinod P; Thomas, C Tony
The rehabilitation of a patient who has suffered the psychological trauma due to loss of an eye requires a prosthesis that will provide the optimum cosmetic and functional result. The mode of rehabilitation varies based on the type of defect and surgical approach being adopted. A case series of prosthetic rehabilitation of three types of orbital defects - evisceration, enucleation and exenteration have been reported in this article. The clinical relevance of surgical approaches highlights the preservation of remaining anatomic structures creating a negative space or concavity to aid in future prosthetic rehabilitation. A multidisciplinary management and team approach is essential in providing esthetics and to regain the confidence. Follow-up care for the patient is mandatory.
Anna Serene Babu
Full Text Available The rehabilitation of a patient who has suffered the psychological trauma due to loss of an eye requires a prosthesis that will provide the optimum cosmetic and functional result. The mode of rehabilitation varies based on the type of defect and surgical approach being adopted. A case series of prosthetic rehabilitation of three types of orbital defects - evisceration, enucleation and exenteration have been reported in this article. The clinical relevance of surgical approaches highlights the preservation of remaining anatomic structures creating a negative space or concavity to aid in future prosthetic rehabilitation. A multidisciplinary management and team approach is essential in providing esthetics and to regain the confidence. Follow-up care for the patient is mandatory.
Full Text Available Polycystic ovarian syndrome (PCOS is one of the most common causes of infertility in women. Surgical treatment of PCOS, either by the antiquated wedge resection or ovarian drilling, is one of the commonly used lines in developing countries due to its low-cost. Premature ovarian failure and diminished ovarian reserve are serious complications of the surgical treatment but no published reports sufficiently highlighted these hazards. In this case series, we report on twenty one women aged between 19–39 years, presented to Infertility Clinic, Assiut Women Health Hospital with ovarian dysfunction, diagnosed within 6–36 months after surgical management of PCOS. Nineteen of them had laparoscopic bilateral ovarian drilling using electrocauterization, and the last two had bilateral wedge resection of the ovaries through minilaparotomy. Accurate and documented diagnosis of PCOS, appropriate surgical training, adjusted thermal injury and adjusted number of punctures are essential for the avoidance of excessive damage to the ovaries. Under treatment (failure of drilling is much better than premature ovarian failure or diminishing ovarian reserve.
Saulat H.Fatimi; Hashim M. Hanif; Ameera Ahmed; Ghina Shamsi; Marium Muzaffar
Objective: Tracheobronchial injuries are defined as injuries involving the trachea and/or bronchi from the level of the cricoid cartilage extending up to the division of the bronchi. We present a case series with most of the tracheobronchial injuries found to be sustained after penetrating trauma.Methods: A retrospective review was performed at the Aga Khan University, Karachi, Pakistan. From January 2004to December 2009, 168 patients with thoracic trauma were treated, of whom 15 were recognized to have major tracheobronchial and pulmonary injuries.Results: The average age was 31 years with most of the patients being male (14:1). Among them,11 patients had penetrating trauma as the main cause of injury, 3 patients had blunt trauma from road traffic accidents, only 1 patient had combined trauma (blunt and penetrating trauma). Eight patients were diagnosed based on radiological findings. All the patients were treated surgically. Lobectomy was the most common intervention performed in 7 patients. The mortality rate was 7% (1 patient). Most patients survived with no sequelae (10 patients) while 5 survived with disability. We found that penetrating trauma was the leading cause of injury in our series. The severity of injury depends upon the weapon causing the trauma. Patients in our series had multiple injuries and required surgical management.Conclusions: Tracheobronchial injuries are rare but potentially life threatening. They require quick diagnosis and management. Diagnosis tends to be difficult since there are no specialised diagnostic modalities available at present.
Mansilla, Beatriz; Isla, Alberto; Pérez-López, Carlos; Román-de Aragón, María; Zamorano, Jorge; Giner, Javier
A series of 18 patients with symptomatic synovial cysts was analysed from May 2009 to November 2013. Different approaches were performed for their removal. The study included 18 patients, 8 men and 10 women, aged between 50 and 77 years. An analysis was made of the variables including age, gender, symptoms, imaging studies, histopathology, surgery, follow-up, complications, and clinical outcome. An articular synovial cyst was diagnosed in 17 cases, and a ganglion in one cases. The most common symptom was back pain with radiculopathy (94%). Motor deficits occurred in 4 cases (22%), and 1 case (5%) presented with urinary incontinence. The most common level was L4- L5 (67%), with one atypical case observed in the D12 -L1 location. Hemi-laminectomy was performed in 14 cases, with 9 of them having an interspinous spacer (ISP) device inserted. A laminectomy with a fusion procedure was performed in 3 patients and 1 patient had a bilateral decompression using a unilateral approach. The patients were followed-up for between 6 months to 2 years. Synovial cysts are a cause of radiculopathy/neurogenic claudication. Spinal cysts are commonly found at the L4-L5 level. MRI is the tool of choice for diagnosis. The most common symptom was back pain with radiculopathy. Synovial cysts resistant to conservative therapy should be treated surgically. In our series, surgical resection of symptomatic juxtafacet cysts showed a good clinical outcome, but the optimal approach for patients with juxtafacet cysts remains unclear. Copyright © 2016 Sociedad Española de Neurocirugía. Publicado por Elsevier España, S.L.U. All rights reserved.
Haiun, M; Feuvrier, D; Bayti, T; Pluvy, I; Pauchot, J
Retrospective study about pressure ulcers surgical treatments in a series of 61 in 43 patients. To assess the management of pressure ulcers in spinal cord injury patients who had been operated in our institution. On the 61 pressure ulcers, location was ischial in 35 cases, sacral in 15 cases, trochanteric in 7 cases, lateral malleolar in 2 cases, on the heel in 1 case, and 1 was located lateral to the fibular head. Comorbidities were searched pre- and postoperatively. Fifty-five muscular, cutaneous flaps or myocutaneous, 5 fasciocutaneous and 1 excision/suture were realized. The mean follow-up was 8.6 years, and we observed 9 pressure ulcers recurrences (14.8%). We had a total result of 15 (24.6%) complicated pressure ulcers, with 8 early complications (13.1%) and 7 delay (11.5%). Antibiotic therapy was prescribed in 54 (88.5%) surgery cases and 7 were operated without any (11.5%). Pressure ulcers are major public health focus that need to be improved. A multidisciplinary care, mixed with education of patients are mandatory to achieve these goals: reduce complications and recurrences. Thanks to muscle sparring, perforators flap should become the gold standard of pressure ulcers surgery. Copyright Â© 2016 Elsevier Masson SAS. All rights reserved.
Junqueira, Marina Azevedo; Cunha, Nayara Nery Oliveira; Costa e Silva, Lidiane Lucas; Araújo, Leandro Borges; Moretti, Ana Beatriz Silveira; Couto Filho, Carlos Eduardo Gomes; Sakai, Vivien Thiemy
This paper reports a series of clinical cases of ankyloglossia in children, which were approached by different techniques: frenotomy and frenectomy with the use of one hemostat, two hemostats, a groove director or laser. Information on the indications, contraindications, advantages and disadvantages of the techniques was also presented. Children diagnosed with ankyloglossia were subjected to different surgical procedures. The choice of the techniques was based on the age of the patient, length of the frenulum and availability of the instruments and equipment. All the techniques presented are successful for the treatment of ankyloglossia and require a skilled professional. Laser may be considered a simple and safe alternative for children while reducing the amount of local anesthetics needed, the bleeding and the chances of infection, swelling and discomfort.
Marina Azevedo JUNQUEIRA
Full Text Available This paper reports a series of clinical cases of ankyloglossia in children, which were approached by different techniques: frenotomy and frenectomy with the use of one hemostat, two hemostats, a groove director or laser. Information on the indications, contraindications, advantages and disadvantages of the techniques was also presented. Children diagnosed with ankyloglossia were subjected to different surgical procedures. The choice of the techniques was based on the age of the patient, length of the frenulum and availability of the instruments and equipment. All the techniques presented are successful for the treatment of ankyloglossia and require a skilled professional. Laser may be considered a simple and safe alternative for children while reducing the amount of local anesthetics needed, the bleeding and the chances of infection, swelling and discomfort.
Steltzlen, C; Lazennec, J-Y; Catonné, Y; Rousseau, M-A
Surgical treatment of unstable odontoid fracture (type II OBAR or HTAL) has progressed, with a range of techniques, the specificities of which need to be known so as to determine their respective roles in the therapeutic arsenal now available. A retrospective study of 22 patients operated on in our center for odontoid fracture between 2005 and 2010 examined the operative techniques employed and analyzed results in the light of the literature, so as to construct an updated decision tree. Two populations could be distinguished: elderly victims of simple fall (mean age, 82.1 years), and younger victims of high-energy trauma (mean age, 42.6 years). Surgical techniques comprised: anterior odontoid screwing (n=14), transarticular C1-C2 screwing on the posterior Magerl (n=3) or anterior Vaccaro approach (n=1), Harms' posterior C1-C2 arthrodesis (n=3), and occipitocervical arthrodesis (n=3). The overall complications rate for the series was 28%, including one case of non-union, at a mean 11 months' follow-up. The risk/benefit ratio may be hard to assess in elderly patients. However, anterior screwing restores odontoid anatomy and is the technique of choice in first intention for reducible fracture. In second intention, transarticular C1-C2arthrodesis may be performed on an anterior or posterior approach, depending on local vertebral artery anatomy. Harms' posterior C1-C2 arthrodesis allows fixation of non-reduced fractures. Occipitocervical arthrodesis is a last resort, as the associated morbidity rate is higher.
Full Text Available Background: This paper describes the surgical technique of a modified Pirogoff's amputation performed by the senior author and reports the results of this operation in a single surgeon case series for patients with diabetic foot infections. Methods: Six patients with diabetic foot infections were operated on by the National University Hospital (NUH diabetic foot team in Singapore between November 2011 and January 2012. All patients underwent a modified Pirogoff's amputation for diabetic foot infections. Inclusion criteria included the presence of a palpable posterior tibial pulse, ankle brachial index (ABI of more than 0.7, and distal infections not extending proximally beyond the midfoot level. Clinical parameters such as presence of pulses and ABI were recorded. Preoperative blood tests performed included a glycated hemoglobin level, hemoglobin, total white blood cell count, C-reactive protein, erythrocyte sedimentation rate, albumin, and creatinine levels. All patients were subjected to 14 sessions of hyperbaric oxygen therapy postoperatively and were followed up for a minimum of 10 months. Results: All six patients had good wound healing. Tibio-calcaneal arthrodesis of the stump was achieved in all cases by 6 months postoperatively. All patients were able to walk with the prosthesis. Conclusions: The modified Pirogoff's amputation has been found to show good results in carefully selected patients with diabetic foot infections. The selection criteria included a palpable posterior tibial pulse, distal infections not extending proximally beyond the midfoot level, ABI of more than 0.7, hemoglobin level of more than 10 g/dL, and serum albumin level of more than 30 g/L.
Full Text Available Objectives. First branchial cleft anomalies (BCAs constitute a rare entity with variable clinical presentations and anatomic findings. Given the high rate of recurrence with incomplete excision, identification of the entire tract during surgical treatment is of paramount importance. The objectives of this paper were to present five anatomic variations of first BCAs and describe the presentation, evaluation, and surgical approach to each one. Methods. A retrospective case review and literature review were performed. We describe patient characteristics, presentation, evaluation, and surgical approach of five patients with first BCAs. Results. Age at definitive surgical treatment ranged from 8 months to 7 years. Various clinical presentations were encountered, some of which were atypical for first BCAs. All had preoperative imaging demonstrating the tract. Four surgical approaches required a superficial parotidectomy with identification of the facial nerve, one of which revealed an aberrant facial nerve. In one case the tract was found to travel into the angle of the mandible, terminating as a mandibular cyst. This required en bloc excision that included the lateral cortex of the mandible. Conclusions. First BCAs have variable presentations. Complete surgical excision can be challenging. Therefore, careful preoperative planning and the recognition of atypical variants during surgery are essential.
Talacchi, Andrea; Biroli, Antonio; Soda, Christian; Masotto, Barbara; Bricolo, Albino
Foramen magnum meningioma poses a challenge for neurosurgeons. Prognosis has generally improved with diagnostic and surgical advances over the past two decades; however, it may ultimately depend more on the surgeon's ability to tailor the approach and interpret intraoperative risks in single cases. The series comprised 64 patients operated on for ventral and ventrolateral foramen magnum meningioma. All patients underwent preoperative magnetic resonance imaging and received surgery via the dorsolateral route, rendering the series homogeneous in neuroradiological workup and surgical treatment. Particular to this series was that the majority of patients were of advanced age (n = 29; age, >65 years), had serious functional impairment (n = 30, Karnofski score magnum meningiomas behave like clival or spinal tumors depending on their prevalent extension. A dorsolateral approach tailored to tumor position and extension and meticulous surgical technique allow for definitive control of surgical complications. Scrupulous postoperative care may prevent dysphagia, a major persistent complication of surgery. Long-term observation of indolent tumor behavior at follow-up suggests that incomplete resection may be a viable surgical treatment option.
J. Fallah Moses
Conclusion: Peptic ulcer disease and its treatment represent a potentially substantial source of morbidity and mortality in limited-resource settings. In this case series, surgical treatment for perforated peptic ulcer disease carried a high mortality, and the results highlight the potential for public health systems strengthening to prevent poor health outcomes. Peptic ulcer disease in low- and middle-income countries presents unique epidemiology and treatment challenges that may differ significantly from evidence-based guidelines in high-income countries.
Meneses, Murilo S; Rocha, Samanta B; Kowacs, Pedro A; Andrade, Nelson O; Santos, Heraldo L; Narata, Ana Paula; Bacchi, Ana Paula; Silva, Erasmo B; Simão, Cristiane; Hunhevicz, Sonival C
Forty-three patients with epilepsy resistant to drug therapy were submitted to temporal lobe epilepsy surgery at the Instituto de Neurologia de Curitiba, from 1998 to 2003. Thirty-nine patients (90.6%) had mesial temporal sclerosis, and four had brain tumors. According to Engel's rating, 83.7% from 37 patients with complete postoperative evaluation were classified as Class I (free of disabling seizure). Postoperative complications (18.6%) were evaluated, with one case of surgical wound infection, one case of hydrocephalus, one case of cerebrospinal fluid fistula, two cases of transient palsy of the trochlear nerve and one case of transient hemiparesis. No death related to epilepsy surgery was found in our study.
Metaxa, Dafni; Balakrishnan, Anita; Upponi, Sara; Huguet, Emmanuel L; Praseedom, Raaj K
Development of mediastinal pancreatic pseudocysts is a rare complication of pancreatitis. There is currently no consensus on the optimal management of this condition, options for which include conservative management with somatostatin analogues, endoscopic drainage procedures and surgery. Here we present two patients with mediastinal pancreatic pseudocysts which were initially managed endoscopically. However, in both cases, this led to complications secondary to the endoscopic procedures, recurrence or non-resolution of symptoms, requiring surgical cystogastrostomy and/or cystojejunostomy. These cases suggest that surgery may be ultimately necessary for mediastinal pancreatic pseudocysts where endoscopic procedures might have a high likelihood of failure.
Satyarthee Guru Dutta
Full Text Available Combined fracture involving atlas together associated with axis (CAAF accounts for approximately 3 % of traumatic cervical spine injury, CAAF are rarely reported, so modalities of management and outcome are not well understood, due to paucity of literature and only few reports reported in the form of isolated case report. CAFF management possess challenge as it is associated with high incidence non-union with previously conservative method. However, missed diagnosis and subsequent delay may be associated with catastrophic worsening in neurological deficit. So early diagnosis and management remains the key for successful neurological outcome. Such fractures are rare. Authors report five such cases of CAFF, all required surgical management with good outcome with no mortality. Current study, all cases were males (n=5, commonest mode of injury was fall (n=3, time interval since injury was within 24 hours in (n=4, however rest one presented after a gap of eight months. Commonest clinical feature was neck pain (n=3, neurological deficit (n=2, neck tenderness and swelling tenderness (n=3 Neuroimaging including X-ray, CT scan and MRI were carried out for all cases revealed fracture of arches of atlas (n=5, one case had multiple site fracture of both arches, odontoid fracture (n=2, lateral mass of atlas fracture in 1 cases. Astonishingly two cases had disruption of transverse ligament. Surgical procedures performed considering economic consideration included occipito-cervcial fusion (n=3, transarticular C1-C2 fusion and anterior odontoid screw fixation in one cases each. Management options in CAFF and review of literature discussed in present study.
Jun 20, 2013 ... Upper cervical spine injuries: a management of a series of 70 cases. El Fatemi ... women, with traffic accidents being the major traumatic cause. .... osteosynthesis is preferred to respect the biomechanics of the cervical spine ...
Full Text Available Introducation: The long-term outcome and clinical results of gaparthroplasty used for the treatment of condylar ankylosis of the mandible in children with application of postoperative activator appliances and costochondral rib graft are evaluated and compared. The purpose of this study was to compare the effect of gap arthroplasty and costochondral graft methods on reankylosis, a mount of mouth opening and growth. Materials and Methods: A non-randomized, retrospective clinical study of l0 cases (5-12 years old of condylar ankylosis of the mandible, surgically treated during a 10 year period from 2002 to 2012 was performed. Four patients were treated by condylectomy and interpositional flap, whereas six were treated by condylectomy and immediate costachondral rib grafts. The first group underwent long-term postoperative therapy using removable activator appliances. Casts, radiographs, photographs, and computed tomography (CT were used post surgically to evaluate rib graft, condylar growth and function, occlusion, facial, and condylar symmetry. Data were analyzed by SPSS 16 statistical software using Mann-Whitney, Paired T-test and Chi-square tests. Results: Children with long-standing condylar ankylosis of the mandible treated by condylectomy and interpositional flap showed more favorably when activators were used post-surgically. Conclusions: Gaparthroplasty with functional activator post-operatively can be considering for TMJ ankylosis.
Full Text Available Abstract Introduction Contractures, ectropion and scarring, the most common sequelae of skin grafts after eyelid burn injuries, can result in corneal exposure, corneal ulceration and even blindness. Split-thickness or full-thickness skin grafts are commonly used for the treatment of acute eyelid burns. Plasma exudation and infection are common early complications of eyelid burns, which decrease the success rate of grafts. Case presentation We present the cases of eight patients, two Chinese women and six Chinese men. The first Chinese woman was 36 years old, with 70% body surface area second or third degree flame burn injuries involving her eyelids on both sides. The other Chinese woman was 28 years old, with sulfuric acid burns on her face and third degree burn on her eyelids. The six Chinese men were aged 21, 31, 38, 42, 44, and 55 years, respectively. The 38-year-old patient was transferred from the ER with 80% body surface area second or third degree flame burn injuries and third degree burn injuries to his eyelids. The other five men were all patients with flame burn injuries, with 7% to 10% body surface area third degree burns and eyelids involved. All patients were treated with a modified surgical procedure consisting of separation and loosening of the musculus orbicularis oculi between tarsal plate and septum orbital, followed by grafting a large full-thickness skin graft in three days after burn injury. The use of our modified surgical procedure resulted in 100% successful eyelid grafting on first attempt, and all our patients were in good condition at six-month follow-up. Conclusions This new surgical technique is highly successful in treating eyelid burn injuries, especially flame burn injuries of the eyelid.
Wavreille, Vincent; Boston, S E; Souza, C; Ham, K; Chanoit, G; Rossetti, D; Takacs, J; Milner, R
To report the signalment, presenting clinical signs, surgical complications, histologic diagnosis, postoperative complications, and outcome of dogs and cats undergoing pneumonectomy. Retrospective case series; multicenter study. Client-owned dogs (n=17) and cats (n=10). Signalment, clinical signs, side affected, surgical data, preoperative diagnostic tests (including complete blood count, serum biochemistry, cytologic diagnosis, chest radiographs, and computed tomography), histologic diagnosis, surgical complications, adjunctive therapy, and date and cause of death were collected from records of dogs and cats that underwent pneumonectomy. Survival estimates and complication were assessed. Seventeen animals had a left-sided pneumonectomy performed (12 dogs, 5 cats) and 10 animals had a right-sided pneumonectomy (5 dogs, 5 cats). Fourteen animals were diagnosed with neoplasia (52%). The overall incidence of complications for dogs and cats were 76 and 80%, respectively, with major complications in 41 and 50%, respectively. Respiratory complications (persistent pleural effusion, oxygen dependence, persistent increased respiratory rate, or coughing) were the most frequent complications. No animals died or were euthanatized intraoperative or within the first 24 hours postoperative. One dog (6%) and 2 cats (20%) died, or were euthanatized in the first 2 weeks postoperative. Based on this case series, right and left pneumonectomy can be performed with low perioperative mortality in dogs and cats, with some animals experiencing prolonged survival. © Copyright 2016 by The American College of Veterinary Surgeons.
Witt, Bryan L; Hyer, Christopher F
Achilles tendinopathy is a clinical diagnosis characterized as a triad of symptoms including pain, swelling, and impaired performance of the diseased tendon. Achilles tendinopathy is divided into Achilles tendonitis and tendinosis based on histopathological examination. Achilles tendinosis is viewed microscopically as disorganized collagen, abnormal neovascularization, necrosis, and mucoid degeneration. Insertional Achilles tendinosis is a degenerative process of the tendon at the junction of the tendon and calcaneus. This disease is initially treated conservatively with activity modification, custom orthotic devices, heel lifts, and immobilization. After 3 to 6 months of conservative therapy has failed to alleviate symptoms, surgical management is indicated. Surgical management of insertional Achilles tendinosis includes Achilles tendon debridement, calcaneal exostosis ostectomy, and retrocalcaneal bursa excision. In this case series, we present 4 patients who underwent surgical management of insertional Achilles tendinosis with complete tendon detachment. All patients underwent reattachment of the Achilles tendon with the suture bridge technique. The Arthrex SutureBridge(®) (Arthrex, Inc., Naples, FL) device uses a series of 4 suture anchors and FiberWire(®) (Arthrex Inc.) to reattach the Achilles tendon to its calcaneal insertion. This hourglass pattern of FiberWire(®) provides a greater area of tendon compression, consequently allowing greater stability and possible earlier return to weightbearing activities. The patients were followed up for approximately 2 years' duration. There were no intraoperative or postoperative complications. At final follow-up there was no evidence of Achilles tendon ruptures or device failures. All patients were able to return to their activities of daily living without the use of assistive devices. The patients' average visual analog pain scale was 1 (range 0 to 4), and their average foot functional index score was 3.41 (range 0
P Mohan Kumar
The technique presented is an alternative approach to periodontal surgical procedures consisting orthodontic extrusion and osseous recontouring. It does not result in functional or esthetic deformities especially in the anterior esthetic zone.
Hector; Losada; Morales; Luis; Burgos; San; Juan; Jorge; Silva; Abarca; Cesar; Muoz; Castro
AIM: To describe patient characteristics and the results of surgical treatment for hepatic hydatidosis (HH) in the Hospital Hernán Henríquez Aravena from December 2001 to March 2005. METHODS: Subjects older than 16 years with suspected HH were included based on the clinical picture and radiological studies. Variables examined included clinical and laboratory aspects, outcome, features of the parasite and surgical aspects. Descriptive statistics were used, calculating central tendency, dispersion and extreme...
Shahi, N; Bradley, S; Vowden, K; Vowden, P
Bullosis diabeticorum is considered a rare skin manifestation of diabetes mellitus. Tense blisters appear rapidly, mostly on the feet, the cause of which is unclear, with multiple pathophysiologies hypothesised. This is a retrospective review of 4 diabetic patients who presented over six months with diabetic bullae; the condition may therefore not be as rare as commonly believed. All the patients had early surgical debridement followed by topical negative pressure wound dressings. A multidisciplinary team that included vascular surgeons, diabetologists, diabetic foot care team, wound care team, physiotherapists and occupational therapists managed the patients and none of them required amputations. We propose an alternative way of managing these patients with early surgical debridement followed by topical negative pressure wound dressing.
Full Text Available Abstract Background Interspinous distraction devices (IPDD are indicated as stand-alone devices for the treatment of spinal stenosis. The purpose of this study is to evaluate the results of patients undergoing surgery for spinal stenosis with a combination of unilateral microdecompression and interspinous distraction device insertion. Methods This is a prospective clinical and radiological study of minimum 2 years follow-up. Twenty-two patients (average age 64.5 years with low-back pain and unilateral sciatica underwent decompressive surgery for lumbar spinal stenosis. Visual Analogue Scale, Oswestry Disability Index and walking capacity plus radiologic measurements of posterior disc height of the involved level and lumbar lordosis Cobb angle were documented both preoperatively and postoperatively. One-sided posterior subarticular and foraminal decompression was conducted followed by dynamic stabilization of the diseased level with an IPDD (X-STOP. Results The average follow-up time was 27.4 months. Visual Analogue Scale and Oswestry Disability Index improved statistically significantly (p Conclusions The described surgical technique using unilateral microdecompression and IPDD insertion is a clinically effective and radiologically viable treatment method for symptoms of spinal stenosis resistant to non-operative treatment.
Elsawaf, Ahmed; Awad, Tariq Elamam; Fesal, Salem S
Symptomatic sacral perineural cysts are extremely rare. The aim of this retrospective study is to investigate the outcome of 15 consecutive patients treated by microsurgical resection of the cyst and to review the literature. The authors retrospectively reviewed their clinical data archive from 2002 to 2014. Fifteen patients who were operated on due to symptomatic sacral perineural cysts were enrolled in the study. Patients' symptoms, radiographs, intra-operative findings, and clinical results were evaluated. All 15 patients underwent microsurgical excision of the cyst. The literature on this topic available in PubMed was also reviewed. There were 5 men and 10 women included in the study, with a mean age of 31 years (range 7-60 years). Preoperative symptoms include low back pain, coccydynia, buttock pain, perianal pain and radicular pain. All of the patients underwent surgical resection. The mean follow-up was 54 months (range 3-160 months). All the patients experienced complete or substantial resolution of the preoperative local and radicular pain after surgery. Cyst excision is an effective and safe technique for symptomatic sacral perineural (Tarlov) cysts. Careful patient selection is vital to the management and treatment of this difficult and controversial pathology.
30 janv. 2017 ... Clinical symptoms were mainly cough (32.8% of cases), dyspnea (23.7% of ... of cases, sarcomas in 7.8% of cases, renal cancers in 5.2% of cases, bladder ..... Prognosis of osteosarcoma with pulmonary metastases at initial.
Nov 23, 2015 ... The prevalence and characteristics of right heart endocarditis in Africa are not well ... Anaemia was present in 9 patients whilst leukocytosis in 6 patients. The .... three cases of renal impairment, heart failure in two patients and.
Mohammad Irfan Akhtar
Full Text Available Fast-track extubation is an established safe practice in pediatric congenital heart disease (CHD surgical patients. On table extubation (OTE in acyanotic CHD surgical patients is well established with validated safety profile. This practice is not yet reported in tetralogy of Fallot (TOF cardiac surgical repair patients in developing countries. Evidence suggests that TOF total correction patients should be extubated early, as positive pressure ventilation has a negative impact on right ventricular function and the overall increase in post-TOF repair complications such as low cardiac output state and arrhythmias. The objective of the case series was to determine the safety and feasibility of OTE in elective TOF total correction cardiac surgical patients with an integrated team approach. To the best of our knowledge, this is the first reported case series. A total of 8 elective male and female TOF patients were included. Standard anesthetic, surgical and perfusion techniques were used in these procedures. All patients were extubated in the operating room safely without any complications with the exception of one patient who continued to bleed for 3 h of postextubation at 2-3 ml/kg/h which was managed with transfusion of fresh frozen plasma at 15 mL/kg, packed red blood cells 10 mL/kg and bolus of transamine at 20 mg/kg. Apart from better surgical and bypass techniques, the most important factor leading to successful OTE was an excellent analgesia. On the basis of the case series, it is suggested to extubate selected TOF cardiac surgery repair patients on table safely with integrated multidisciplinary approach.
Akhtar, Mohammad Irfan; Hamid, Mohammad; Minai, Fauzia; Rehman, Naveed
Fast-track extubation is an established safe practice in pediatric congenital heart disease (CHD) surgical patients. On table extubation (OTE) in acyanotic CHD surgical patients is well established with validated safety profile. This practice is not yet reported in tetralogy of Fallot (TOF) cardiac surgical repair patients in developing countries. Evidence suggests that TOF total correction patients should be extubated early, as positive pressure ventilation has a negative impact on right ventricular function and the overall increase in post-TOF repair complications such as low cardiac output state and arrhythmias. The objective of the case series was to determine the safety and feasibility of OTE in elective TOF total correction cardiac surgical patients with an integrated team approach. To the best of our knowledge, this is the first reported case series. A total of 8 elective male and female TOF patients were included. Standard anesthetic, surgical and perfusion techniques were used in these procedures. All patients were extubated in the operating room safely without any complications with the exception of one patient who continued to bleed for 3 h of postextubation at 2-3 ml/kg/h which was managed with transfusion of fresh frozen plasma at 15 mL/kg, packed red blood cells 10 mL/kg and bolus of transamine at 20 mg/kg. Apart from better surgical and bypass techniques, the most important factor leading to successful OTE was an excellent analgesia. On the basis of the case series, it is suggested to extubate selected TOF cardiac surgery repair patients on table safely with integrated multidisciplinary approach.
Van der Meer, W. Joerd; Raghoebar, Gerry M.; Gerrits, Peter O.; Noorda, Willem D.; Vissink, Arjan; Visser, Anita
Purpose: Insight into the bone volume and position of natural teeth is essential when placing implants to retain nasal prostheses. This paper describes a series of three cases in which a new method was applied for implant placement in the nasal floor of dentate patients using digital planning techni
Boviatsis, Efstathios J; Stavrinou, Lampis C; Kouyialis, Andreas T; Gavra, Maria M; Stavrinou, Pantelis C; Themistokleous, Marios; Selviaridis, Panayiotis; Sakas, Damianos E
This study is designed based on the retrospective analysis of patients treated in the Neurosurgical Department of two major hospitals and review of the literature. The aim of this study is to evaluate the efficacy of surgery and address controversial issues in the treatment of symptomatic lumbar intraspinal synovial cysts. Spinal juxtafacet cysts (synovial and ganglion cysts) are a rare cause of low back and radicular leg pain. Although the relevant reports in the international literature are increasing, the controversy about conservative versus surgical treatment and the need for concomitant fusion still exists. Data from seven patients (age range 58-69 years, mean age 61 years) with low back and radicular leg pain due to a lumbar facet joint cyst were retrospectively analyzed. Demographic data, cyst level, presence of concomitant local pathology, treatment and results of treatment were recorded. A follow-up of at least 6 months (range 6-48 months) was conducted and results were noted. All patients had back pain, while five also experienced unilateral radicular leg pain and one had bilateral leg pain. One patient had neurogenic claudication. MRI identified the cyst and highlighted underlying pathology in all cases. All patients underwent surgical cyst excision. No fusion was performed. Post-operatively, all patients showed a total resolution of symptoms with sustained benefit at final evaluation. Review of the literature revealed a trend towards surgery, as this is correlated to a more favorable outcome compared with conservative treatment. Fusion should be performed on a case-by-case basis only. Surgery is a safe and effective treatment choice in this increasingly appearing ailment. A prospective, randomized trial should clarify issues under debate.
Abd Elmaksoud, Abd Elmaksoud M; Farahat, Iman G; Kamel, Mahmoud M
Total thyroidectomy is indicated in most cases with postcricoid carcinoma, circumferential hypopharyngeal carcinoma and in advanced laryngeal carcinoma. Persistent hypoparathyroidism is a frequent complication after total thyroidectomy which is difficult to manage unlike hypothyroidism. This study was to assess the feasibility of parathyroid gland autotranplantation after total thyroidectomy in advanced carcinomas and their effectiveness in preventing persistent hypoparathyroidism. This study included 26 patients with hypopharyngeal and laryngeal carcinoma presented to National Cancer Institute, Cairo University. Total thyroidectomy and total parathyroid gland excision were performed as a part of adequate oncologic surgical procedure. The parathyroid glands were identified, resected and stored in iced saline. Histological confirmation was necessary before implantation into separated muscle pockets in the anterior forearm muscles. Regular samples were drawn to assess serum parathormone and calcium levels. All patients experienced hypocalcaemia within 1-5 days after operation. Only one patient experienced parathyroid graft failure while the remaining patients were normocalcemic during follow up after surgery, indicating functioning parathyroid grafts. Parathyroid gland autotranplantation is a simple safe technique with high success rate in preventing persistent hypoparathyroidism after total thyroidectomy in surgical management of advanced hypopharyngeal and laryngeal carcinomas.
Spanyer, Jonathon M; Beaumont, Christopher M; Yerasimides, Jonathan G
Anterior column deficiency of the pelvis may pose a serious threat to the stability of the acetabular component after total hip arthroplasty and, thus, jeopardize the overall success of the procedure. After Institutional Review Board approval, a retrospective review was undertaken to identify all patients undergoing revision total hip arthroplasty with anterior column augmentation through an extended direct anterior approach. Demographics and surgical details were collected, and subjects were followed for a 2-year minimum period to measure patient outcomes and to evaluate for the stability of construct fixation. A novel surgical procedure description was provided and supplemented with an illustrative case example. At 2 years post augmentation, patients had favorable functional outcomes with radiologic evidence of stable fixation. Proximal extension of the direct anterior approach to the hip can facilitate anterior column access and augmentation to improve stability of the hip reconstruction. This treatment may be an alternative to spanning constructs such as cup-cage constructs and custom implants, affording the potential for long-term biologic fixation. Further investigation into this technique is warranted. Copyright © 2016 Elsevier Inc. All rights reserved.
Popescu, I; Ionescu, M; Braşoveanu, V; Hrehoreţ, D; Matei, E; Dorobantu, B; Zamfir, R; Alexandrescu, S; Grigorie, M; Tulbure, D; Popa, L; Ungureanu, M; Tomescu, D; Droc, G; Popescu, H; Cristea, A; Gheorghe, L; Iacob, S; Gheorghe, C; Boroş, M; Lupescu, I; Vlad, L; Herlea, V; Croitoru, M; Platon, P; Alloub, A
Initially considered experimental, liver transplantation (LT) has become the treatment of choice for the patients with end-stage liver diseases. Between April 2000 and October 2009, 200 LTs (10 reLTs) were performed in 190 patients, this study being retrospective. There were transplanted 110 men and 80 women, 159 adults and 31 children with the age between 1 and 64 years old (mean age--39.9). The main indication in the adult group was represented by viral cirrhosis, while the pediatric series the etiology was mainly glycogenosis and biliary atresia. There were performed 143 whole graft LTs, 46 living donor LTs, 6 split LTs, 4 reduced LTs and one domino LT RESULTS: The postoperative survival was 90% (170 patients). The patient and graft one-year and five-year survivals were 76.9%, 73.6% and 71%, 68.2%, respectively. The early complications occurred in 127 patients (67%). The late complications were recorded in 71 patients (37.3%). The intraoperative and early postoperative mortality rate was 9.5% (18 patients). The Romanian liver transplantation program from Fundeni includes all types of current surgical techniques and the results are comparable with those from other international centers.
Philippot, Rémi; Wegrzyn, Julien; Besse, Jean Luc
We report a series of 15 double-hindfoot (subtalar and talonavicular joint) arthrodeses through a single medial approach on 14 patients. Mean age at surgery was 59.3 years. The chosen surgical technique was always identical using a medial approach and performed by a single surgeon. The average follow-up was 20.6 months. The mean Kitaoka score increased from 44 to 75, axis of the hindfoot decreased from 21 degrees to 11 degrees in valgus, arch foot angle decreased from 142 degrees to 134.4 degrees . Two failures have led to a secondary complementary arthrodesis of the talocrural joint. Throughout our study, subtalar and talonavicular arthrodesis in the treatment of painful valgus deformities of the hindfoot reveals to be a valuable and safe alternative. The chosen fixation method combined with a good articular surface avivement through medial approach guarantee a long-term fusion. Moreover, resort to a medial approach significantly reduces wound complications. This medial approach procedure permits the fusion without developing non-union and provides a significant correction of the fixed deformities.
Swol, J; Buchwald, D; Strauch, J; Schildhauer, T A
Extracorporeal life support (ECLS) devices maintain the circulation and oxygenation of organs during acute right ventricular failure and cardiogenic shock, bypassing the lungs. A pulmonary embolism can cause this life-threatening condition. ECLS is a considerably less invasive treatment than surgical embolectomy. Whether to bridge embolectomy or for a therapeutic purpose, ECLS is used almost exclusively following failure of all other therapeutic options. From January 1, 2008 to June 30, 2014, five patients in cardiac arrest and with diagnosed pulmonary embolism (PE) were cannulated with the ECLS system. PE was diagnosed using computer tomography scanning or echocardiography. Cardiac arrest was witnessed in the hospital in all cases and CPR (cardiopulmonary resuscitation) was initiated immediately. Cannulation of the femoral vein and femoral artery was always performed under CPR conditions. Right heart failure regressed during the ECLS therapy, usually under a blood flow of 4-5 L/min after 48 hours. Three patients were weaned from ECLS and one patient became an organ donor. Finally, two of the five PE patients treated with ECLS were discharged from inpatient treatment without neurological dysfunction. The duration of ECLS therapy depends on the patient's condition. Irreversible damage to the organs after hypoxemia limits ECLS treatment and leads to futile multiorgan failure. Hemorrhages after thrombolysis and cerebral dysfunction were further complications. Veno-arterial cannulation for ECLS can be feasibly achieved and should be established during active CPR for cardiac arrest. In the case of PE, the immediate diagnosis and rapid implantation of the system are decisive for therapeutic success. © The Author(s) 2015.
Abd Elmaksoud M. Abd Elmaksoud
Conclusions: Parathyroid gland autotranplantation is a simple safe technique with high success rate in preventing persistent hypoparathyroidism after total thyroidectomy in surgical management of advanced hypopharyngeal and laryngeal carcinomas.
Aris Petros Tripodakis
Full Text Available Aim: The aim of the present case series report is to illustrate a clinical technique and present the application of onepiece transmucosal implants in flapless surgical procedures, supporting full arch immediate prostheses. Materials and methods: A total of 294 implants (Xive TG, Friadent, Germany have been used to support full arch immediate prostheses, over the last six years and have been in function for at least one year. The surgical placement of five or more implants per case involved immediate extraction and intrasocket flapless placement, combined with minimal flap elevation in the areas of healed extraction sites (43 mandibular and 7 maxillary arches. In all cases immediate provisionalization followed. Detailed three-dimensional cone-beam localized volumetric tomography preceeded the surgical procedures. The delivery of the final ceramo-metal prostheses was accomplished within a 20 day period. Materials and methods: Results Six implants failed to osseointegrate. All other implants are still successfully bearing the final prosthesis for the time that they have been followed. Soft tissue reaction was favorable from both the biologic and esthetic point of view. Conclusion: The flapless placement of one piece implants into edentulous healed sites is a predictable procedure in the presence of abundance of supporting bone as confirmed by 3-D imaging. On the other hand, immediate extraction placement of one piece implants allows the engagement of sound bone located deeper into the socket and provides adequate mechanical support of the soft tissue architecture that is preserved predictably. In all cases the prosthetic procedures are accomplished without disturbing the hardsoft tissue interface as the abutment-prosthesis interface is coronally elevated by the virtual design of the implant.
Thierbach, René; Eger, Thomas
The replacement of missing teeth with dental implants has been standard practice in dentistry for many years. The success of dental implants depends on many factors, among which the diagnosis, clinical severity, and treatment of peri-implant diseases play a key role. In this prospective case series, the influence of cumulative treatment modalities on peri-implantitis with and without pus formation on clinical outcome was assessed. During 2010, 28 patients were referred for peri-implantitis treatment. They presented two different types of peri-implant diseases: peri-implantitis with (17 implants) or without pus formation (33 implants). After microbiologic diagnosis, all patients were treated at baseline with full-mouth scaling and root planing. Two months later, further full-mouth scaling and root planing and additional antimicrobial photodynamic therapy (aPDT) was applied. Four months after baseline, patients with pus formation additionally underwent access flap surgery. Active human matrix metalloproteinase-8 (aMMP-8) levels were measured in eluates before and after all treatment modalities and 7 months after baseline. Clinical parameters (probing depth, bleeding on probing) and aMMP-8-levels improved in both groups after treatment and the final examination. In periimplantitis patients without pus formation, all parameters decreased after full-mouth scaling and root planing and the additional aPDT and no surgery was necessary to improve the parameters. In patients with pus formation, the parameters decreased only after access flap surgery. The presence of pus influences the clinical outcome of the treatment of peri-implant diseases. Whereas peri-implantitis cases without pus formation can be successfully managed nonsurgically, peri-implantitis with pus formation can be effectively treated after an additional observation time of 3 months postoperatively only with additional flap surgery.
Visser, Jetze; Verra, Wiebe C.; Kuijlen, Jos M.; Horsting, Philip P.; Journee, Henricus L.
Purpose: This study aimed to illustrate the recovery of transcranial electrical stimulation motor evoked potentials during surgical decompression of the spinal cord in patients with impaired motor function preoperatively. Specific attention was paid to the duration of neurologic symptoms before surg
Mayra Elena Hernández Carrazco
Full Text Available Obesity is a public health challenge that has crossed into the area of reproductive health. An obese pregnant woman has multiple complications before, during, and after pregnancy. Likewise, cesarean section is more difficult and has slower recovery times in this group of patients. This paper proposes a surgical technique adapted to the morbidly obese pregnant patient that aims to reduce cesarean section complications
Chan, Jeffrey C Y
The purpose of this study is to describe our technique of central slip repair using the Mitek bone anchor and to evaluate the treatment outcome. Eight digits in eight patients were reconstructed using the bone anchor: three little fingers, two middle fingers, two index fingers and one ring finger. There were two immediate and six delayed repairs (range from one day to eight months). Four patients had pre-operative intensive splinting and physiotherapy to restore passive extension of the proximal interphalangeal joint prior to central slip reconstruction. All patients have made good progress since surgery. No patient requires a second procedure and none of the bone anchors have dislodged or loosened. We conclude that the Mitek bone anchor is a reliable technique to achieve soft tissue to bone fixation in central slip avulsion injuries. We recommend that this technique be considered as a treatment option for patients requiring surgical repair.
Park, Min Jung; Pappas, Nick; Steinberg, David R; Bozentka, David J
The goal of this study was to investigate whether immobilization in supination is necessary to prevent recurrent distal radioulnar joint (DRUJ) instability in patients older than 18 years with a Galeazzi fracture-dislocation and a stable DRUJ following open reduction and internal fixation of the radius. We performed a retrospective chart review of 10 consecutive patients who were immobilized in either supination or a neutral position following surgical treatment of a Galeazzi fracture-dislocation in which the DRUJ was noted to be stable immediately after fixation of the radius. Group 1 consisted of 5 patients who were immobilized in supination for a period of 4 weeks, and group 2 consisted of 5 patients who were immobilized in neutral for 2 weeks, followed by functional bracing. Patients were followed up for an average of 68 months (range, 26-124 mo) after surgery. No significant difference was noted between the 2 groups with respect to age, medical comorbidities (no noteworthy medical comorbidities in either group), or hand dominance. None of the patients in either group demonstrated DRUJ instability during the follow-up period or required any additional surgery. At the latest follow-up, patients in the 2 groups had comparable forearm motion. The results of the current study suggest that following open reduction and internal fixation of the radius in patients with Galeazzi fracture-dislocations and with stable DRUJs, immobilization in supination for 4 weeks does not have an advantage over immobilization in neutral for a shorter period. Copyright Â© 2012 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
Almeida, A L P F; Esper, L A; Sbrana, M C; Cunha, M J S; Greghi, S L A; Carrilho, G P B; Pegoraro, L F
Maintenance of a healthy periodontium is fundamental for the long term success of prosthetic restorations. Thus, prosthetic procedures with subgingival margins may affect the periodontal health if the distances between the junctional epithelium and supracrestal connective tissue attachment aren't respected, or if there is insufficient space to maintain the health of the interproximal tissues, leading to gingival inflammation, connective tissue attachment loss and bone resorption. The restorative alveolar interface (RAI) technique was described as the portion of the root surface extending from the alveolar crest apically to the restorative margin coronally. RAI consists of modifying the restorative margin position into a healthier environment, respecting the biological width and therefore allowing effective plaque control. This paper describes four clinical cases with indication for the RAI technique for maintenance of periodontal health. The cases were associated with prostheses. All cases were evaluated at 90 days and exhibited a healthy periodontal tissue. Successful outcomes were observed in the different indications for the RAI technique.
Zhong, Zhihong; Sun, Yuhao; Lin, Dong; Sun, Qingfang; Bian, Liuguan
Coexistence of brain tumor and intracranial aneurysm was previously considered as an uncommon phenomenon. Actually it is not rare in neurosurgical procedures, and its incidence rate may be underestimated. Furthermore, there remains a lack of consensus regarding numerous aspects of its clinical management. We performed a retrospective study of 12 cases of coexistent brain tumor and intracranial aneurysm in our database. Then a systematic PubMed search of English-language literature published between 1970 and 2012 was carried out using the keywords: "brain tumor" and "intracranial aneurysm" in combination with "associate" or "coexist." A consensus panel of neurosurgeons, anesthetists, interventional neurologists, and intensivests reviewed this information and proposed a treatment strategy. In the majority of patients, clinical symptoms were caused by tumor growth, whereas aneurysm rupture was seen only in a few cases. Meningioma was the commonest tumor associated with aneurysm. In most patients, both lesions occurred within the adjacent area. Treatment of both pathologies in one session was performed in most patients. All of our patients were alive within the period of follow-up. Coexistence of brain tumor and intracranial aneurysm may be a coincidence. The treatment strategy should be designed according to the conditions of tumor and aneurysm, locations of both lesions, and pathologic nature of tumor.
Perrin, G; Goutelle, A; Fischer, G; Monib, H
66 patients with spondylolisthesis were reviewed after surgical procedure with a follow-up period of more than a year postoperatively. The indication for the operation was disabling sciatica in all patients. 4 patients had undergone prior excision of the herniated disc. All the patients underwent a removal of the loose posterior element as suggested by the Gill procedure and intervertebral body fusion using a posterior surgical approach. The surgical procedures with only one regressive neurological complication are described. The results are considered from a clinical and anatomo-radiological point of view. In this series 86.5 percent of 66 patients became sciatica-free. 62 percent of the total series rated the end result as excellent or good. 92.4 percent of the patients demonstrated bony fusion between the two grafted vertebrae. The benefits of posterior laminectomy with interbody fusion are also attractive for spondylolisthesis with sciatica.
Andrew N. Kornstein, MD, FACS
Full Text Available Summary: Although the popularity of longitudinal brachioplasty has grown tremendously in recent years, dealing with the unpredictable scar remains a challenge for the surgeon and the patient. The scar often heals slowly and widens over time, perpetuated by the effects of gravity, body movements, and the thin nature of the superficial fascial system (SFS of the arm. Scar widening may correlate with recurrence of the soft-tissue deformity as the repaired underlying SFS stretches. Therefore, techniques that support and stabilize the SFS are highly desirable for addressing the problematic scar. In the present case, the author used a silk-derived surgical scaffold (SERI as an adjunct to conventional brachioplasty. SERI provided the requisite support for the patient’s SFS, resulting in a faster maturation process and a better-quality scar. This stands in stark contrast to the majority of longitudinal brachioplasty results reported in the medical literature.
Bodegas, A; Leenhardt, A; Cauchemez, B; Meslindrey, P; Menasche, P; Leclercq, J F; Coumel, P; Piwnica, A; Slama, R
Eighty two patients diagnosed of the Wolff-Parkinson-White syndrome (WPW) underwent operation for the surgical section of the Kent-His bundle. In these cases, posteroseptal localization (PS) occurred in 32, left lateral (LL) in 25, right lateral (RL) in six, anteroseptal (AS) in one, posteroseptal and left lateral in 14, right and left posteroseptal in two, anteroseptal and left lateral in one, and left lateral and right and left posteroseptal in one. All of the patients presented an invalidating clinical of palpitations and/or loss of consciousness, and episodes of atrial fibrillation and/or reciprocal rhythm were registered in all cases. The mean anterograde refractory period in the accessory pathways was 244 +/- 60 msec, and the shortest RR in atrial fibrillation was 190 +/- 36 msec. A mitral commissurotomy was carried out in 3 patients during surgery, mitral prostheses were implanted in two, a double aorto-coronary bypass was made in three and an interventricular communication was closed in one. After a follow-up of 36 +/- 18 months, the surgical section of the Kent bundle was found to be effective in 77 out 82 patients (94%). (In 70 out of 77 cases, both anterograde and retrograde conduction were totally abolished and in seven out of 77 obtunded. All patients were asymptomatic during the follow-up period). In 5 out of 82 patients, surgical treatment was ineffective all five showed a PS Kent-His and two presented a second Kent-His fascicle (LL).(ABSTRACT TRUNCATED AT 250 WORDS)
Discussion and conclusions: Nerve sheath tumors localized within the membrane offer good long-term prognosis even if malignant. Furthermore, long-term survival is possible even if the tumor has invaded neighboring organs, provided it can be completely excised. In cases where complete excision is difficult, a multidisciplinary approach including radiotherapy and anti-cancer drug treatment may contribute to improved prognosis but this is a subject that requires further study.
Full Text Available Aim: Medulloblastoma is one of the most common posterior fossa tumors in childhood. The treatment-related side effects as well as predictive outcome still remain as a major challenge. The improved understanding of the disease and advances in molecular biology is changing the treatment paradigms from Chang′s staging system to molecular risk stratification. However, surgery still remains as an important mainstay of therapy and is formidable. The role of radical surgery has always been a crucial factor in the outcome of these patients, the best survival being reported in patients who had total excision of the tumor and with no metastasis. Patient and Methods: An analysis of 365 patients (age<18 years of medulloblastoma who underwent treatment at the Seth G.S. Medical College and King Edward VII Memorial hospital (KEM, Mumbai over a 25- year period (1985-2000 and 2001-2010 is presented. The clinical profile, radiological features, pathology and surgical nuances are discussed. Results: The most common age group affected was between 3 and 12 years. 75.3% presented with headaches, vomiting and 63.2% with papilledema. Sitting position was used in majority of cases. A total of 8 patients underwent shunting; all of them were in the postoperative period (5.19%. 92.2% (142 cases had classical medulloblastoma, 5.1% (8 cases had desmoplastic variant, 1.9% (3 cases had anaplastic changes and 0.6% (1 case had glial differentiation. The 5-year and 10-year progression free survival rate was 73 and 41% for average risk disease while for high risk disease rate it was 34%. The mortality rate was 2%. The quality of life was enhanced in patients who survived 5-10 years after treatment. Conclusion: Surgery for medulloblastoma is formidable. The option of sitting position for medulloblastoma surgery is still viable. A vigilant neuroanesthesiologist and a safe surgery are necessary to achieve a good postoperative result. Radiological characteristics are helpful
Paolini, Sergio; Ciappetta, Pasquale; Raco, Antonino; Missori, Paolo; Delfini, Roberto
Large lumbosacral disc herniations effacing both the paramedian and the foraminal area often cause double radicular compression. Surgical management of these lesions may be difficult. A traditional interlaminar approach usually brings into view only the paramedian portion of the intervertebral disc, unless the lateral bone removal is considerably increased. Conversely, the numerous far-lateral approaches proposed for removing foraminal or extraforaminal disc herniations would decompress the exiting nerve root only. Overall, these approaches share the drawback of controlling the neuroforamen on one side alone. A combined intra-extraforaminal exposure is a useful yet rarely reported approach. Over a 3-year period, 15 patients with bi-radicular symptoms due to large disc herniations of the lumbar spine underwent surgery through a combined intra-extracanal approach. A standard medial exposure with an almost complete hemilaminectomy of the upper vertebra was combined with an extraforaminal exposure, achieved by minimal drilling of the inferior facet joint, the lateral border of the pars interarticularis and the inferior margin of the superior transverse process. The herniated discs were removed using key maneuvers made feasible by working simultaneously on both operative windows. In all cases the disc herniation could be completely removed, thus decompressing both nerve roots. Radicular pain was fully relieved without procedure-related morbidity. The intra-extraforaminal exposure was particularly useful in identifying the extraforaminal nerve root early. Early identification was especially advantageous when periradicular scar tissue hid the nerve root from view, as it did in patients who had undergone previous surgery at the same site or had long-standing radicular symptoms. Controlling the foramen on both sides also reduced the risk of leaving residual disc fragments. A curved probe was used to push the disc material outside the foramen. In conclusion, specific
Full Text Available Tinea incognito is a dermatophytic infection which has lost its typical clinical appearance because of inappropriate use of topical or systemic corticosteroids. The clinical manifestations of tinea incognito can mimic many dermatoses such as eczema, psoriasis, allergic contact dermatitis, rosacea, seborrheic dermatitis and atopic dermatitis. The diagnosis of tinea incognito is confirmed by direct KOH (potassium hydroxide examination ( native preparation, making the fungal cultures from the lesion and histopathological examination in some cases. Systemic antifungal therapy is recommended in the treatment of tinea incognito. Herein, 10 cases of tinea incognito which mimicking various dermatoses were diagnosed and treated in our clinic in 2014 is presented.
Saluja, Bharat; Chan, Lai Gwen; Dhaval, Dani
Kleptomania is an enigmatic condition and is among the very few psychiatric disorders in which crime is medicalised and used as a legal defence. The scientific literature on kleptomania is scarce. Early literature and recent studies have shown a female preponderance, with an early age of onset of stealing in people with comorbid personality disorder(s). In a retrospective review of the case notes of theft offenders who had forensic psychiatric evaluations performed in a one-year period in 2010 at the Institute of Mental Health, Singapore, we found three patients who were diagnosed with kleptomania. In this report, we describe the pertinent clinical and sociodemographic characteristics, as well as the diagnostic issues of kleptomania in relation to the three cases.
Saluja, Bharat; Chan, Lai Gwen; Dhaval, Dani
Kleptomania is an enigmatic condition and is among the very few psychiatric disorders in which crime is medicalised and used as a legal defence. The scientific literature on kleptomania is scarce. Early literature and recent studies have shown a female preponderance, with an early age of onset of stealing in people with comorbid personality disorder(s). In a retrospective review of the case notes of theft offenders who had forensic psychiatric evaluations performed in a one-year period in 201...
Full Text Available Mucormycosis is a rare opportunistic fungal infection with a rapidly progressive and fulminantcourse with often fatal outcome. A less fulminant variety of this is the Rhino maxillary subtypewhich usually presents with palatal ulceration, facial swelling, turbinate necrosis and purulentsinusitis. We are reporting our experience of 4 such cases seen during the last 10 yrs. A strongsuspicion, prompt diagnosis with pathological confirmation and aggressive surgical treatmentgives a better outcome.
Juliana Straehl Marin
Full Text Available OBJETIVO: Avaliar os resultados do tratamento da agenesia vaginal pela técnica cirúrgica de McIndoe-Bannister modificada e pela técnica de Frank. MÉTODOS: Este estudo retrospectivo foi conduzido com uma amostra de conveniência de 25 mulheres portadoras de agenesia vaginal em seguimento no Ambulatório de Ginecologia Infanto Puberal. Quinze mulheres foram submetidas à cirúrgica modificada de McIndoe-Bannister Grupo Cirúrgico e 10 fora tratadas com a técnica de Frank Grupo Frank. Para a análise comparativa entre essas duas amostras, foram considerados os seguintes parâmentros: vaginometria final, efeitos adversos e satisfação sexual após o tratamento. Esses dados foram obtidos por meio dos registros nos prontuários médicos. A satisfação sexual foi aferida por questão simples: como está sua vida sexual? RESULTADOS: Houve diferença em relação ao comprimento da vagina tanto naquelas submetidas à técnica de Frank (comprimento inicial 2,4±2,0 cm, após o tratamento 6,9±1,1 cm, pPURPOSE: This study aimed to evaluate the results of neovaginoplasty by a modified McIndoe-Bannister technique and by the non-surgical Frank technique. METHODS: This retrospective study was conducted on a convenience sample of 25 women with vaginal agenesis undergoing surgical or conservative treatment at an Infant-Pubertal Gynecology Outpatient Clinic. Data were obtained from the medical records. Fifteen women underwent the surgical McIndoe-Bannister modified technique Surgical Group, and 10 women underwent the non-surgical Frank technique Frank Group. The following parameters were considered for comparative analysis between the two samples: vaginometry, surgical and non-surgical complications, and sexual satisfaction after treatment. Sexual satisfaction was assessed by a simple question: How is your sex life? RESULTS: There were differences related to vaginal length before and after performing exercises in both Frank Group (initial vaginal length 2
Full Text Available Mucocele is a common salivary gland disorder that can appear in the lacrimal sac, paranasal sinuses, oral cavity, appendix, or gall bladder. These lesions occur due to mucous accumulation resulting from the alteration of minor salivary glands. Lower lip is the most common site of occurrence of these lesions in the oral cavity and most probable cause is trauma or habit of lip biting. Diagnosis is mainly clinical due to its pathognomonic presentation. We report a case series of mucocele in children treated by conventional surgical excision of the lesion.
Full Text Available Ameloblastic carcinoma is a rare odontogenic tumor exhibiting not only features of ameloblastoma but also features of carcinoma in either or both primary and metastatic lesions. Clinical features of this lesion are more aggressive and rapid than those of ameloblastoma. At times, it can metastasize to the lung or regional lymph nodes. Histologically, there is a picture of both ameloblastoma and carcinoma. Treatment is aggressive and has to be designed for each individual patient. English literature is sparse for this condition, as fewer cases have been reported till date. We report a series of four cases with different treatment modalities.
Lahaye, Laura; Grasso, Mario; Green, Jeffrey; Biddle, C J
Demands associated with the Trendelenburg position (TP) are well known yet there is little attention given to regional cerebral tissue O2 saturation (SctO2) in those undergoing robotic surgery in the TP with CO2 insufflation (C-INSF). This is the first study to report on SctO2 in a wide range of patients undergoing lengthy TP and robotic surgery. We measured SctO2 during robotic surgery in patients in the TP with C-INSF, as well as a control robotic thyroid surgery group who were supine with no C-INSF. We recorded relevant variables and periods of cerebral desaturation (CD). We studied 42 patients in 25°-45° of TP for ≥125 min. Management was at the providers' discretion. The INVOS(®) 5100C Cerebral Oximeter (Covidien, Boulder, CO) recorded SctO2. CD was defined as a >20 % decrease from baseline SctO2 or a value ≤55 % for ≥10 min. Patients were assessed for adverse outcome. The sample consisted of 13 males and 29 females aged 22-73, BMI 22-36 had general (N = 3), urological (N = 14) and gynecological (N = 25) surgery; two patients had CD lasting 150 and 190 min and two had episodic CD lasting 10-35 min. The four were female aged 22-60 in 38°-45° of TP. Eleven cases had multiple episodic CD for ≤15 min, 27 TP cases had no CD. Other observations included a consistent fall in SctO2 with phenylephrine; an increased SctO2 with ephedrine; and FiO2 and EtCO2 being generally strong, direct modifiers of SctO2. High MAP was inconsistently associated with high SctO2. BMI had no observed effect on SctO2. Pulse oximetry was ≥97 % in all cases. We observed no adverse cerebral events on follow-up. Additional clinical studies are warranted.
S.L. de Kunder, MD
Conclusion: In this case series, TLIF was associated with shorter surgical time. Other assumed advantages of TLIF could not be verified in this retrospective patient series. Further prospective research is needed to confirm these results.
Schanker, Benjamin D; Walcott, Brian P; Nahed, Brian V; Kahle, Kristopher T; Li, Yan Michael; Coumans, Jean-Valery C E
Chiari malformations (Types I-IV) are abnormalities of the posterior fossa that affect the cerebellum, brainstem, and the spinal cord with prevalence rates of 0.1%-0.5%. Case reports of familial aggregation of Chiari malformation, twin studies, cosegregation of Chiari malformation with known genetic conditions, and recent gene and genome-wide association studies provide strong evidence of the genetic underpinnings of familial Chiari malformation. The authors report on a series of 3 family pairs with Chiari malformation Type I: 2 mother-daughter pairs and 1 father-daughter pair. The specific genetic causes of familial Chiari malformation have yet to be fully elucidated. The authors review the literature and discuss several candidate genes. Recent advances in the understanding of the genetic influences and pathogenesis of familial Chiari malformation are expected to improve management of affected patients and monitoring of at-risk family members.
Full Text Available Coronary artery fistula is an uncommon finding during angiographic exams. We report a case series of five patients with congenital coronary fistulas. The first patient was 56 years old and had a coronary fistula associated with a partial atrio ventricular defect, the second patient was 54 years old and had two fistulas originating from the right coronary artery with a severe atherosclerotic coronary disease, the third patient was 57 years old with a fistula originating from the circumflex artery associated with a rheumatic mitral stenosis, the fourth patient was 50 years old and had a fistulous communication between the right coronary artery and the right bronchial artery, and the last patient was 12 years old who had bilateral coronary fistulas draining into the right ventricle with an aneurismal dilatation of the coronary arteries. Angiographic aspects of coronary fistulas are various; management is controversial and depends on the presence of symptoms.
Sano, T; Horiguchi, H; Xu, B; Li, C; Hino, A; Sakaki, M; Kannuki, S; Yamada, S
While double pituitary adenomas have been found in approximately 1% of autopsy pituitaries, those in surgically resected material have been only rarely reported. We report herein 6 cases of double pituitary adenomas, which consisted of two histologically and/or immunohistochemically different areas among approximately 450 surgical specimens. Five out of 6 patients were men and the age was ranged between 18 and 61 years old. All these 6 patients presented acromegaly or acrogigantism and hyperprolactinemia was noted in 3 patients. In 2 patients (cases 1 and 2) the two adenomas belonged to different adenoma groups (GH-PRL-TSH group and FSH/LH group), while in the remaining 4 patients (cases 3-6) the two adenomas belonged to the same group (GH-PRL-TSH group). Thus, in all patients at least one of the two adenomas was GH-producing adenoma. Reasons for a high incidence of GH-producing adenomas in surgically resected double pituitary adenomas may include the presence of a variety of histologic subtypes among GH-producing adenomas and the advantage of cytokeratin immunostaining to distinguish these subtypes. In regard to pathogenesis of double pituitary adenomas, adenomas in cases 1 and 2 may be of multicentric occurrence, while those in cases 3-6 may occur through different clonal proliferation within originally one adenoma, resulting in diverse phenotypic expressions. Since there were patients with familial MEN 1 (case 2) and familial pituitary adenoma unrelated MEN 1 (case 3), genetic background should be also considered. Double pituitary adenomas in surgically resected material may not be so infrequent. Further molecular analysis will provide new insights into understanding the pathogenesis of pituitary adenomas and their mechanisms of multidirectional phenotypic diffrentiation.
Sanjeev N Deshpande
Full Text Available Introduction: The chin (mentum is vital to the human facial morphology as it contributes to the facial aesthetics and harmony both on frontal and lateral views. Osseous genioplasty, the alteration of the chin through skeletal modification, can lead to significant enhancement of the overall facial profile. Aim and Study Design: A case series was designed to study the long-term results of osseous genioplasty in Indian patients with regard to patient satisfaction, complications, and long-term stability. Materials and Methods: All subjects who underwent osseous genioplasty either alone or as a component of orthognathic surgery between January 1992 and December 2010, with a minimum follow-up of 2 years, were included. The genioplasty was performed using standard protocols of assessment and execution. Post-operative evaluation included patient satisfaction, complications and radiological evidence of long-term stability. A comprehensive score was formulated for the purpose of the study. Results: Thirty-seven subjects underwent osseous genioplasty with at least 2 years of follow-up in the study period. This included 17 male and 20 female subjects, with a mean age of 22.8 years (15-52 years and a mean follow-up of 3 years 4 months (2 years to 4 years and 11 months. Nineteen subjects underwent isolated genioplasty while 18 underwent genioplasty as a part of orthognathic surgery. The procedures included advancement (22, pushback (9, side-to-side (4 and vertical reduction (2 genioplasty.Thirty-six subjects (97.3% were extremely pleased with the results with only one subject expressing reservations, without, however, demanding any further procedure. There were no significant complications. The osteotomised segment was well maintained in its new position with good bony union and minimal resorption. Overall, 35 (94.6% cases had excellent results and 2 (4.4% cases had good results, according to the comprehensive score. Conclusions: Osseous genioplasty is a safe
Jul 26, 2016 ... with hyperaldosteronism or Cushing syndrome. Case series: We ... Pathological examination confirmed the diagnosis of nodular hyperplasia. ... Theirpatients were managed by unilateral adrenalectomy and this management.
Full Text Available Fireworks are used to celebrate a variety of religious, patriotic, and cultural holidays and events around the world. Fireworks are common in the United States, with the most popular holiday for their use being national Independence Day, also known as July Fourth. The use of fireworks within the context of celebrations and holidays presents the ideal environment for accidents that lead to severe and dangerous injuries. Injuries to the face from explosions present a challenging problem in terms of restoring ideal ocular, oral, and facial function. Despite the well documented prevalence of firework use and injury, there is a relatively large deficit in the literature in terms of firework injury that involves the face. We present a unique case series that includes 4 adult male patients all with severe firework injuries to the face that presented at an urban level 1 trauma center. These four patients had an average age of 26.7 years old and presented within 5 hours of each other starting on July Fourth. Two patients died from their injuries and two patients underwent reconstructive surgical management, one of which had two follow up surgeries. We explore in detail their presentation, management, and subsequent outcomes as an attempt to add to the very limited data in the field of facial firework blast injury. In addition, the coincidence of their presentation within the same 5 hours brings into question the availability of the fireworks involved, and the possibility of similar injuries related to this type of firework in the future.
Bhatia M S
Full Text Available A series 25 cases of delusional parasitosis is being reported. There were three cases below 45 years, 12 cases between 46-45 years and 11 cases above 55 years of age, 64% cases were females. A majority of cases (92% had insidious onset. The duration of symptoms in all the cases (except one was 6 months or more. 13 cases presented with infestation with insects over body and 10 cases with insects crawling over scalp. There were three cases each with diabetes mellitus and leprosy. Three cased had dementia, 2 cases had depression and one case presented with trichotillomania. Pimozide was used in22 cases, amitriptyline in 2 cases and fluoxetine in one. 14 cases (52% showed complete remission while receiving drug, 8 cases showed partial improvement and 3 cases did not respond.
treatment options, surgical procedures, and outcomes were collected and detailed. Case Reports Patient 1 Patient 1 is a 22-year-old male soldier injured...were also placed in the temporal bone to support ear prosthesis . Patient 4 currently suffers from microstomia, recurrent ectropion, decreased...injuries ► reconstruction ► surgical complications ► surgical outcomes Abstract This case series describes craniomaxillofacial battle injuries
Ferrari, Bruno; Taliercio, Vanina; Restrepo, Paola; Luna, Paula; Abad, María Eugenia; Larralde, Margarita
Twelve previously unreported cases of nevus comedonicus are presented. Characteristic closely grouped dilated follicular openings with horny plugs that mimic comedones led to the diagnosis. One patient had nevus comedonicus syndrome and there were cases with atypical locations and unusual complications of this condition. We also highlight clinical associations and therapeutic options. © 2014 Wiley Periodicals, Inc.
Ayfle Yeflim Oral
Full Text Available Purpose: To determine horizontal deviation type and to evaluate the correlation between deviation type/etiology and surgical results for sensory strabismus. Patients and Methods: The reports of 29 patients operated for sensory strabismus (12 female, 17 male whose mean age was 22.17±11.52 (range: 4-57 years were evaluated retrospectively. Sixteen cases (55.2% had exotropia (XT and 13 cases (44.8% had esotropia (ET. Etiologies, ages during surgeries, and preoperative/postoperative deviation amounts were noted for the total of the patients as well as for ET and XT groups separately. The results for ET and XT groups were compared statistically using t test. The mean follow-up time was 4.27±3.5 years (range: 4 months-12 years and deviation in ±10 prism diopters (PD in the last visit was considered as success. Results: Etiologies in all cases examined were as follows: anisometropia in 13 (44.8%, trauma in 10 (34.5%, congenital cataracts in 2, and congenital glaucoma, keratoconus, choroidal coloboma, and hypoplastic optic disc in one case each. The visual acuity of the squinting eyes ranged from no light perception to 0.8 logMAR. The mean preoperative deviation was 46.24±19.29 PD, and the mean postoperative deviation decreased to 9.55±11.86 PD in the last visit. When the ET and XT groups were compared, the congenital causes were more common in the ET group (30.75% compared to the XT group (6.25%, otherwise, there was no statistically significant difference in terms of mean age, preoperative and postoperative deviation amounts and follow-up time between the two groups (p>0.05. In contrast, while the surgical success rate was found to be 75.9 % for all cases and 87.5% for the XT group, it was 61.5% for the ET group. Discussion: Despite the deep amblyopia in sensory strabismus, satisfactory surgical results are achieved; nevertheless, the success may be more limited in sensory esotropia particularly due to congenital causes. (Turk J Ophthalmol 2011
Schwartz, Myrna F.; Dell, Gary S.
Case series methodology involves the systematic assessment of a sample of related patients, with the goal of understanding how and why they differ from one another. This method has become increasingly important in cognitive neuropsychology, which has long been identified with single-subject research. We review case series studies dealing with impaired semantic memory, reading, and language production, and draw attention to the affinity of this methodology for testing theories that are expressed as computational models and for addressing questions about neuroanatomy. It is concluded that case series methods usefully complement single-subject techniques. PMID:21714756
Ennaifer, Rym; Ayadi, Shema; Romdhane, Hayfa; Cheikh, Myriam; Nejma, Houda Ben; Bougassas, Wassila; Hadj, Najet Bel
Sarcoidosis is a systemic non caseous granulomas disease. Liver is a common location but usually asymptomatic. Evidence based guidelines for this location treatment is lacking and the effect of corticosteroids may be inadequate. The aim of our study was to describe the clinical, biochemical, radiological and therapeutic features of seven patients with systemic sarcoidosis and liver involvement. A retrospective and descriptive monocentric study, over 3 years, including seven patients with systemic sarcoidosis and liver involvement. We included 5 women and 2 men with an average age of 43 years. Hepatic localization revealed sarcoidosis in 5 cases. Hepatomegaly was observed in all patients as well as abnormal serum liver function test reflected by anicteric cholestasis. Liver biopsy, showed in all granulomatous lesions consistent with sarcoidosis and severe fibrosis in 2 cases. Extra-hepatic manifestations were present in all patients represented mainly by pulmonary location. All patients were treated, five by corticosteroid and two with ursodeoxycholic acid (UDCA). Complete response was observed in one case, partial response in another case and corticosteroid refractoriness in one case. In two cases, corticosteroid therapy was introduced for less than 1 month, not allowing assessment of response. Antimalarials in combination with UDCA were used successfully in a patient with steroid-resistant liver disease. Liver involvement can reveal systemic sarcoidois. Given the risk of progression to severe liver disease, it must be screened in all patients with systemic sarcoidosis. Treatment is not systematic, and still based on corticosteroid therapy. In the absence of prospective randomized controlled trials, the efficacy of UDCA need to be proven.
To ensure optimal results, we must do our utmost to achieve targets based on order, symmetry and precision, our ultimate aim being to strive towards the desired harmony, planned contrast and exact proportions. Orthodontic-surgical treatments require specific finishing procedures, which most often call for multidisciplinary, or even transdisciplinary, collaboration. Finishing will involve the dental arches just as much as the orofacial environment. Above all, treatment of this kind demands a highly targeted approach in combination with well-defined and perfectly executed techniques. To finish a case satisfactorily, reasonable targets should be aimed for to ensure they are achieved. One must be ambitious and yet wise. A tight alliance of surgeon and orthodontist will nurture convincing and achievable projects and good, lifelong outcomes. Following the consolidation phase, roughly 4 to 6 weeks post-surgery, we can initiate the final orthodontic treatment, which, in effect, constitutes a mini-treatment in its own right. "Details make perfection, but perfection is not a detail" (Leonardo Da Vinci). "A lucid mind is the ante-chamber of intelligence" (Léo Ferré). In the order of life, every form of unity is always unique, and if each of us is unique, it is because everyone else is too. Ambition, wisdom, lucidity and efficiency will guarantee a successful result, the successful result. We must not be mere observers of our treatments, but the architect, project manager and site foreman at one and the same time. One could talk ad infinitum about finishing orthodontic-surgical cases because everything else leads up to the case-finishing and even the fullest description could never be exhaustive. Copyright © 2015 CEO. Published by Elsevier Masson SAS. All rights reserved.
Full Text Available Background. Robotic surgery in gynaecological oncology is a rapidly developing field as it offers several technical advantages over conventional laparoscopy. An audit was performed on the outcome of robotic surgery during our learning curve and compared with recent well-established laparoscopic procedure data. Method. Following acquisition of the da Vinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, California, USA, we prospectively analysed all cases performed over the first six months by one experienced gynaecologist who had been appropriately trained and mentored. Data on age, BMI, pathology, surgery type, blood loss, morbidity, return to theatre, hospital stay, and readmission rate were collected and compared with a consecutive series over the preceding 6 months performed laparoscopically by the same team. Results. A comparison of two consecutive series was made. The mean age was somewhat different, 55 years in the robotic versus 69 years in the laparoscopic group, but obesity was a feature of both groups with a mean of BMI 29.3 versus 28.06, respectively. This difference was not statistically significant (P=0.54. Three subgroups of minimal access surgical procedures were performed: total hysterectomy and bilateral salpingooophorectomy (TH + BSO, total hysterectomy and bilateral salpingooophorectomy plus bilateral pelvic lymphadenectomy (TH + BSO + BPLND, and radical hysterectomy plus bilateral pelvic lymphadenectomy (RH + BPLND. The mean time taken to perform surgery for TH + BSO was longer in the robotic group, 151.2 min compared to 126.3 min in the laparoscopic group. TH + BSO + BPLND surgical time was similar to 178.3 min in robotic group and 176.5 min in laparoscopic group. RH + BPLND surgical time was similar, 263.6 min (robotic arm and 264.0 min (laparoscopic arm. However, the numbers in this initial analysis were small especially in the last two subgroups and do not allow for statistical analysis. The rate of
Povolotskaya, Natalia; Woolas, Robert; Brinkmann, Dirk
Robotic surgery in gynaecological oncology is a rapidly developing field as it offers several technical advantages over conventional laparoscopy. An audit was performed on the outcome of robotic surgery during our learning curve and compared with recent well-established laparoscopic procedure data. Following acquisition of the da Vinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, California, USA), we prospectively analysed all cases performed over the first six months by one experienced gynaecologist who had been appropriately trained and mentored. Data on age, BMI, pathology, surgery type, blood loss, morbidity, return to theatre, hospital stay, and readmission rate were collected and compared with a consecutive series over the preceding 6 months performed laparoscopically by the same team. A comparison of two consecutive series was made. The mean age was somewhat different, 55 years in the robotic versus 69 years in the laparoscopic group, but obesity was a feature of both groups with a mean of BMI 29.3 versus 28.06, respectively. This difference was not statistically significant (P = 0.54). Three subgroups of minimal access surgical procedures were performed: total hysterectomy and bilateral salpingooophorectomy (TH + BSO), total hysterectomy and bilateral salpingooophorectomy plus bilateral pelvic lymphadenectomy (TH + BSO + BPLND), and radical hysterectomy plus bilateral pelvic lymphadenectomy (RH + BPLND). The mean time taken to perform surgery for TH + BSO was longer in the robotic group, 151.2 min compared to 126.3 min in the laparoscopic group. TH + BSO + BPLND surgical time was similar to 178.3 min in robotic group and 176.5 min in laparoscopic group. RH + BPLND surgical time was similar, 263.6 min (robotic arm) and 264.0 min (laparoscopic arm). However, the numbers in this initial analysis were small especially in the last two subgroups and do not allow for statistical analysis. The rate of complications necessitating intervention
Raihan AR; Zunaina E; Wan-Hazabbah WH; Adil H; Lakana-Kumar T
Abdul-Rahim Raihan,1 Embong Zunaina,1,2 Wan-Hitam Wan-Hazabbah,1,2 Hussein Adil,1,2 Thavaratnam Lakana-Kumar1 1Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia; 2Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, MalaysiaAbstract: We report a case series of neuroretinitis in ocular bartonellosis and describe the serologic verification for Bartonella henselae. This is a retrospective interventional case series of fo...
Afridi, Shahida Parveen; Memon, Aisha; Memon, Aysha; Shafiq-ur-Rahman; Memon, Asif
To find out the clinical and management profile of granulomatous mastitis (GM). A case. This study was carried out at Civil Hospital and Dow University of Health Sciences, Karachi and Tuberculosis Clinic at Bantwa Hospital, Karachi, from January 1999 to January 2009. Histopathologically diagnosed cases of GM were studied. Data included, detailed history, examination, clinical diagnosis, ultrasound, mammogram and fine needle aspiration cytology (FNAC). All patients were initially given antibiotics and corticosteroid for a period of 10 days. All patients were followed for a period of 6 months. Recurrent cases were managed by wide excision and followed for another period of 6 months. Percentage, mean and range values were determined on SPSS version 10. The mean age of the 22 patients was 37.6 years (range=22-52 years). Right breast was affected in 54.5% and left breast in 45.5% patients. Eighteen (82%) were non-lactating. Patients presented clinically with painful breast lump in 54.5%, painless lump in 45.5% and additional discharging sinuses in 18%. Clinical diagnosis was chronic mastitis in 40.9%, tuberculosis of breast in 36.3% and malignancy in 22.7% patients. Mammography showed an ill-defined mass in 45.5% and asymmetrical density in 31.8%. Diagnosis was confirmed in all patients on histopathology. Recurrence was noted in 2 patients, managed by wide excision, and followed for another period of 6 months without evidence of complications. GM is an uncommon chronic inflammatory disease of the breast. Usually involving a single non-lactating breast in reproductive age group. It clinically mimics tuberculosis and carcinoma. Mammography remains non-conclusive. Excision and wide excision biopsy are both diagnostic and therapeutic in majority of cases. Treatment includes short course of steroids and antibiotic along with close regular surveillance.
Terra, Bernardo Barcellos; Rodrigues, Leandro Marano; Pádua, David Victoria Hoffmann; Martins, Marcelo Giovanini; Teixeira, João Carlos de Medeiros; De Nadai, Anderson
Sternoclavicular dislocations account for less than 5% of all dislocations of the scapular belt. Most cases of anterior dislocation of the sternoclavicular joint do not present symptoms. However, some patients may develop chronic anterior instability and remain symptomatic, and surgical treatment is indicated in these cases. There is a scarcity of reports in the literature relating to reconstruction using the long palmar tendon in cases of traumatic anterior instability. Although rare, these injuries deserve rapid diagnosis and efficient treatment in order to avoid future complications. The aim of this report was to report on a case of a motocross competitor who developed chronic traumatic anterior instability of the sternoclavicular joint and underwent surgical reconstruction using the autogenous long palmar tendon. The patient was a 33-year-old man with a history of anterior dislocation of the sternoclavicular subsequent to a fall during a maneuver in a motocross competition. Conservative treatment was instituted initially, consisting of use of a functional sling to treat the symptoms for 3 weeks, along with physiotherapeutic rehabilitation for 3 months. We chose to use a modification of the “figure of eight” technique based on the studies by Spencer and Kuhn. A longitudinal incision of approximately 10 cm was made at the level of the sternoclavicular joint. The graft from the ipsilateral long palmar tendon was passed through the orifices in the form of a modified “figure of eight” and its ends were sutured together. The patient was immobilized using an American sling for 4 weeks. After 6 months of follow-up, the patient no longer presented pain or instability when movement of the sternoclavicular joint was required. Minor discomfort and slight prominence of the sternoclavicular joint continued to be present but did not affect the patient's activities. Thus, the patient was able to return to racing 6 months after the operation. Our study presented a case
Terra, Bernardo Barcellos; Rodrigues, Leandro Marano; Pádua, David Victoria Hoffmann; Martins, Marcelo Giovanini; Teixeira, João Carlos de Medeiros; De Nadai, Anderson
Sternoclavicular dislocations account for less than 5% of all dislocations of the scapular belt. Most cases of anterior dislocation of the sternoclavicular joint do not present symptoms. However, some patients may develop chronic anterior instability and remain symptomatic, and surgical treatment is indicated in these cases. There is a scarcity of reports in the literature relating to reconstruction using the long palmar tendon in cases of traumatic anterior instability. Although rare, these injuries deserve rapid diagnosis and efficient treatment in order to avoid future complications. The aim of this report was to report on a case of a motocross competitor who developed chronic traumatic anterior instability of the sternoclavicular joint and underwent surgical reconstruction using the autogenous long palmar tendon. The patient was a 33-year-old man with a history of anterior dislocation of the sternoclavicular subsequent to a fall during a maneuver in a motocross competition. Conservative treatment was instituted initially, consisting of use of a functional sling to treat the symptoms for 3 weeks, along with physiotherapeutic rehabilitation for 3 months. We chose to use a modification of the "figure of eight" technique based on the studies by Spencer and Kuhn. A longitudinal incision of approximately 10 cm was made at the level of the sternoclavicular joint. The graft from the ipsilateral long palmar tendon was passed through the orifices in the form of a modified "figure of eight" and its ends were sutured together. The patient was immobilized using an American sling for 4 weeks. After 6 months of follow-up, the patient no longer presented pain or instability when movement of the sternoclavicular joint was required. Minor discomfort and slight prominence of the sternoclavicular joint continued to be present but did not affect the patient's activities. Thus, the patient was able to return to racing 6 months after the operation. Our study presented a case of
Bernardo Barcellos Terra
Full Text Available Abstract Sternoclavicular dislocations account for less than 5% of all dislocations of the scapular belt. Most cases of anterior dislocation of the sternoclavicular joint do not present symptoms. However, some patients may develop chronic anterior instability and remain symptomatic, and surgical treatment is indicated in these cases. There is a scarcity of reports in the literature relating to reconstruction using the long palmar tendon in cases of traumatic anterior instability. Although rare, these injuries deserve rapid diagnosis and efficient treatment in order to avoid future complications. The aim of this report was to report on a case of a motocross competitor who developed chronic traumatic anterior instability of the sternoclavicular joint and underwent surgical reconstruction using the autogenous long palmar tendon. The patient was a 33-year-old man with a history of anterior dislocation of the sternoclavicular subsequent to a fall during a maneuver in a motocross competition. Conservative treatment was instituted initially, consisting of use of a functional sling to treat the symptoms for 3 weeks, along with physiotherapeutic rehabilitation for 3 months. We chose to use a modification of the "figure of eight" technique based on the studies by Spencer and Kuhn. A longitudinal incision of approximately 10 cm was made at the level of the sternoclavicular joint. The graft from the ipsilateral long palmar tendon was passed through the orifices in the form of a modified "figure of eight" and its ends were sutured together. The patient was immobilized using an American sling for 4 weeks. After 6 months of follow-up, the patient no longer presented pain or instability when movement of the sternoclavicular joint was required. Minor discomfort and slight prominence of the sternoclavicular joint continued to be present but did not affect the patient's activities. Thus, the patient was able to return to racing 6 months after the operation. Our
Murilo S. Meneses
Full Text Available Quarenta e três pacientes com epilepsia refratária ao tratamento medicamentoso foram submetidos à cirurgia de epilepsia do lobo temporal no Instituto de Neurologia de Curitiba, entre os anos de 1998 a 2003. Trinta e nove (90,6% pacientes apresentavam esclerose mesial temporal, e quatro (9,4%, tumores cerebrais. Dos trinta e sete pacientes que possuíam avaliação pós-operatória completa, 83,7% apresentaram classificação I, segundo Engel (livres de crises incapacitantes. Complicações pós-operatórias ocorreram em 18,6%: uma infecção da ferida operatória, um caso de hidrocefalia, um de fístula liquórica, dois casos de paralisia transitória do IV nervo craniano e um de hemiparesia transitória. Não houve nenhum óbito relacionado à cirurgia de epilepsia no presente estudo.Forty-three patients with epilepsy resistent to drug therapy were submitted to temporal lobe epilepsy surgery at the Instituto de Neurologia de Curitiba, from 1998 to 2003. Thirty-nine patients (90.6% had mesial temporal sclerosis, and four had brain tumors. According to Engel's rating, 83.7% from 37 patients with complete postoperative evaluation were classified as Class I (free of disabling seizure. Postoperative complications (18.6% were evaluated, with one case of surgical wound infection, one case of hydrocephalus, one case of cerebrospinal fluid fistula, two cases of transient palsy of the trochlear nerve and one case of transient hemiparesis. No death related to epilepsy surgery was found in our study.
Prasad, Gowri Sayi; Bhupali, Ashok; Prasad, Sayi; Patil, Ajit N.; Deka, Yashodhan
Objectives To study the pattern of presentation, course of disease and outcome of pregnancy in Peripartum Cardiomyopathy. Methods A prospective study of sixteen cases of PPCM was conducted at Apple Saraswati Multispecialty Hospital and Dr. D.Y. Patil Medical College and Hospital, Kolhapur, Maharashtra, India from January 2006 to December 2012. Data included age distribution, parity, gestational age, symptoms and risk factors. Medical management and pregnancy outcome were documented. Serial echocardiography data was compiled for a period of one year. Results In our study 9/16 (56%) were primigravidae, 4/16 (25%) had pre-eclamsia and 6/16 (35%) had co-existing hypertension. The difference in Echocardiography parameters observed between recovered and non-recovered patients was significant: Left Ventricular End diastolic dimension (5.6 cm vs 6.06 cm), Left Ventricular Ejection Fraction (28.7% vs 22.4%) and Left Ventricular fractional shortening (17.5% vs 13.4%). Thirteen out of sixteen patients were followed up for a period of one year out of which 61% (8/13) patients recovered completely. There was one mortality. Conclusion PPCM is a diagnosis of exclusion. Majority were young primigravidae presenting postnatally. Pre-eclampsia and hypertension were risk factors. ECHO parameters were reliable predictors of recovery. Future pregnancies are better avoided. PMID:24814122
Nucera, Eleonora; Aruanno, Arianna; Rizzi, Angela; Pecora, Valentina; Patriarca, Giampiero; Buonomo, Alessandro; Mezzacappa, Simona; Schiavino, Domenico
The role of profilin as an allergen has long been questioned. The capacity of profilin to induce respiratory symptoms has recently been demonstrated; moreover, over 50% of patients sensitized to profilin experienced symptoms after the ingestion of plant-derived foods, suggesting that profilin should be considered as a clinically relevant food allergen.We describe the cases of seven allergic patients with oral allergy syndrome and other adverse reactions after eating plant-derived food, that have been undergone to profilin desensitization treatment.The protocol started with a drop of profilin solution (50 µg/mL) diluted 1:10(18) in water until the highest dose of 10 drops of undiluted solution three times a week. At the end of the treatment we observed a decreased mean diameter of profilin wheal in skin prick test (SPT) in five of the seven participants and in profilin specific IgE values in six patients that repeated the test. Regarding basophil activation test (BAT) and the detection of IgG4, we do not have significant results because the tests have to be repeated in some patients. Regarding the double-blind placebo-controlled challenges, after about 10 months of induction phase all the patients showed tolerance to several foods that they previously did not tolerate.Moreover, the immunotherapy with profilin has proved to be safe because no serious adverse events have been reported in our patients.In summary, the results of this exploratory study of sublingual immunotherapy (SLIT) for profilin allergy show that it can be a promising therapeutic option that could modify the clinical reactivity of the patients to the intake of plant-derived food. © The Author(s) 2015.
Ferrari, Bruno; Taliercio, Vanina; Luna, Paula; Abad, María Eugenia; Larralde, Margarita
Kaposi's varicelliform eruption is a rare and potentially fatal viral infection caused mainly by reactivation of herpes simplex virus. It concomitantly occurs with pre-existing skin conditions, mostly atopic dermatitis, so it is predominately found in children. We present a case series that includes four adults, familial cases, and previously healthy patients. We also highlight clinical features, associations and therapeutic options.
Full Text Available Eruption cysts are benign cysts that appear on the mucosa of a tooth shortly before its eruption. They may disappear by themselves but if they hurt, bleed or are infected they may require surgical treatment to expose the tooth and drain the contents. Here we present 2 case reports of eruption cysts presenting with different chief complaint. The treatment included incising the eruption cyst and draining the contents of the cyst.
Valentini, Laura; Visintini, Sergio; Saletti, Veronica; Chiapparini, Luisa; Estienne, Margherita; Solero, Carlo Lazzaro
Children may present a peculiar picture of CIM, as syncopes and acute paraparesis. In a series of 99 children operated for CIM at FINCB there were no major surgical morbidity nor mortality. The preoperative symptoms improved more in this pediatric series than in the adult cases treated at the same institution in the same period; a reason could be the shorter duration of symptoms and another the children plasticity. An untreated nonsyndromic craniosynostosis was present in 10 cases. In our hands, the results of the limited extradural decompression were poor. In some CIM associated with psychiatric symptoms an unexpected improvement was observed after tonsilar resection. The associated Syringomyelia reduced in more than 80% of children and disappeared in a significant number. The rare associated tethered cord (5%) needed a double treatment, detethering by itself being insufficient to treat also tonsillar descent. The clinical symptoms are often more serious in children than in the adults, but the results of surgery, especially on the syrinx, are better.
Full Text Available In the oro-facial region cystic lesions of different etiologies are encountered owing to the presence of the teeth in the jaw bones. A bewildering variety of developmental, odontogenic and non-odontogenic cysts are seen. Epidermoid cyst is a rare developmental cyst of the oro-facial region which results from entrapped epidermal elements without adnexal appendages. Dermoid and epidermoid cysts occur in oro-facial region with an incidence of 6.9-7% and represents less than 0.01% of all oral cavity cysts. Here we report two cases of epidermoid cysts occurring at unusual locations involving upper left maxillary region lateral to the nose and pinna of the ear.
Bibi F. Gurreebun
Full Text Available Moderate induced hypothermia has become standard of care for children with peripartum hypoxic ischaemic encephalopathy. However, children with congenital abnormalities and conditions requiring surgical intervention have been excluded from randomised controlled trials investigating this, in view of concerns regarding the potential side effects of cooling that can affect surgery. We report two cases of children, born with congenital conditions requiring surgery, who were successfully cooled and stabilised medically before undergoing surgery. Our first patient was diagnosed after birth with duodenal atresia after prolonged resuscitation, while the second had an antenatal diagnosis of left-sided congenital diaphragmatic hernia and suffered an episode of hypoxia at birth. They both met the criteria for cooling and after weighing the pros and cons, this was initiated. Both patients were medically stabilised and successfully underwent therapeutic hypothermia. Potential complications were investigated for and treated as required before they both underwent surgery successfully. We review the potential side effects of cooling, especially regarding coagulation defects. We conclude that newborns with conditions requiring surgery need not be excluded from therapeutic hypothermia if they might benefit from it.
Orthognathic surgery is a surgical procedure largely practiced throughout the world for the correction of various maxillofacial deformities. The procedure for correcting a particular deformity will be done after proper evaluation, which includes cephalometric, dental model analysis and photographs. The patient undergoes pre-surgical orthodontic correction for dental compensation, after which surgery is planned. During the last few decades, the profession has witnessed ...
Mackenzie C. Lees
Full Text Available Congenital esophageal stenosis (CES is rare condition found in 1 per 25,000 to 50,000 live births. It is characterized by intrinsic narrowing of the esophagus secondary to congenital malformation of the esophageal wall architecture. Diagnosis is often difficult to definitively establish as the symptoms are often initially attributed to esophageal strictures secondary to reflux, or occur within the context of a tracheo-esophageal fistula (TEF in the newborn. Endoscopic dilation and surgical repair are the mainstays of treatment. We report a series of three cases seen recently at our institution, the University of Alberta/Stollery Children's Hospital.
Anupama, M.; Gangadhar, K. H.; Shetty, Vandana B.; Dip, P. Bhadja
Transvestism, commonly termed as cross-dressing, means to dress in the clothing of opposite sex. We describe a series of three cases with transvestism as one of their primary complaints. The discussion sheds light on the various ways in which transvestism as a symptom can present in Psychiatry. In the first two cases, there was lower intelligence. In first and third case, there were other paraphilia along with transvestism. Second case had co-morbid obsessive-compulsive disorder (OCD) and had good response to selective serotonin reuptake inhibitor (SSRI). PMID:27011411
Full Text Available Transvestism, commonly termed as cross-dressing, means to dress in the clothing of opposite sex. We describe a series of three cases with transvestism as one of their primary complaints. The discussion sheds light on the various ways in which transvestism as a symptom can present in Psychiatry. In the first two cases, there was lower intelligence. In first and third case, there were other paraphilia along with transvestism. Second case had co-morbid obsessive-compulsive disorder (OCD and had good response to selective serotonin reuptake inhibitor (SSRI.
Full Text Available Three cases of rhinocerebral mucormycosis (RCM with different courses of illness following a common standardized treatment protocol are discussed. Seen predominantly in diabetics. Clinical picture is often blurred by overlapping features of chronic rhinosinusitis. CT picture is helpful in assessing extent. Histopathological evidence is diagnostic. We describe three cases of RCM with different presentations but followed same treatment protocol. RCM is not just a disease of chronic uncontrolled diabetics. Its indolent clinical course doesn′t correlate with its aggressive pathology for which strict treatment protocol to be followed. In suspected cases of RCM, improvement of predisposing diseases, radical surgical debridement and effective systemic antifungal therapy must be instituted immediately. Absence of intracranial or orbital extension are indicators of good prognosis. Ketoacidosis is the single most important detrimental factor.
Petrino, Joseph A; Boda, Kendra K; Shambarger, Sandra; Bowles, Walter R; McClanahan, Scott B
An immature tooth with pulpal necrosis and apical periodontitis presents a unique challenge to the endodontist. Endodontic treatment options consist of apexification, apical barriers, or more recently, revascularization. The purpose of this case series is to report three cases that used revascularization protocol as described by Banchs and Trope. Each case presented its own special circumstances and challenges. The lessons learned from each case provided guidance for more predictable outcomes on subsequent cases. Six immature teeth with apical periodontitis (in three patients) were treated via the revascularization protocol using irrigants, a triple antibiotic paste, and a coronal seal of mineral trioxide aggregate and composite. For follow-up, all six teeth showed resolution of periapical radiolucencies, whereas three of six teeth showed continued root development. Two teeth displayed a positive response to vitality testing. Results from this case series show that revascularization is a technically challenging but effective treatment modality for the immature tooth with apical periodontitis. Based on this case series, the following recommendations are made to help with the revascularization technique: (1) clinicians should consider the use of an anesthetic without a vasoconstrictor when trying to induce bleeding, (2) a collagen matrix is useful for the controlled placement of MTA to a desired and optimal level, (3) patients/parents should be informed about the potential for staining, especially in anterior teeth when the paste contains minocycline, and (4) patient/parent compliance with the necessary multiple appointment treatment plan may be significant for case selection. Copyright (c) 2010 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
Ezeani, I U; Edo, A E
Tropical diabetic hand syndrome is a term used to describe diabetes complication of the hand affecting people in the tropics. It consists of localized cellulitis with variable swelling and ulceration of the hands, progressive, fulminant hand sepsis and gangrene in extreme cases. This syndrome is not well-recognized and is therefore less frequently reported. The authors describe three different female patients who were known diabetics of varying duration presenting with this syndrome at our tertiary health center and who were successfully managed by both the surgical and medical units. The need for early diagnosis and aggressive management is emphasized.
Bruder, Markus; Cattani, Adriano; Gessler, Florian; Droste, Christian; Setzer, Matthias; Seifert, Volker; Marquardt, Gerhard
Surgical treatment with resection of the cyst provides favorable results in outcome. Excellent or good outcome persisting for a long-term follow-up period can be achieved in the vast majority of cases. Complication rates are low despite an increased risk of dural injury. With facet-sparing techniques, the stability of the segment can be preserved, and resection of spinal synovial cysts does not necessarily require segmental fusion.
Full Text Available Abdul-Rahim Raihan,1 Embong Zunaina,1,2 Wan-Hitam Wan-Hazabbah,1,2 Hussein Adil,1,2 Thavaratnam Lakana-Kumar1 1Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia; 2Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, MalaysiaAbstract: We report a case series of neuroretinitis in ocular bartonellosis and describe the serologic verification for Bartonella henselae. This is a retrospective interventional case series of four patients who presented in the ophthalmology clinic of Hospital Universiti Sains Malaysia from June 2012 to March 2013. All four patients had a history of contact with cats and had fever prior to ocular symptoms. Each patient presented with neuroretinitis characterized by optic disc swelling with macular star. Serology analysis showed strongly positive for B. henselae in all of the patients. All patients were treated with oral azithromycin (except case 4, who was treated with oral doxycycline, and two patients (case 1 and case 3 had poor vision at initial presentation that warranted the use of oral prednisolone. All patients showed a good visual outcome except case 3. Vision-threatening ocular manifestation of cat scratch disease can be improved with systemic antibiotics and steroids.Keyword: cat scratch disease
Guilherme Machado De Carvalho
Conclusion: Since there is no corrective treatment for this type of injuries, the craniomaxillofacial surgeon and other professionals who carry out interventions of this nature need perfect knowledge of the anatomy of the temporal bone and lateral skull base, taking into account the risk of surgical disasters like the one here reported.
CASE REPORT. Functional magnetic resonance imaging (fMRI) is an MRI technique ... most promising direct clinical application is in pre-surgical planning, where fMRI is ... robust and established, although it is interesting to note that recent.
McGuire, Michael K; Scheyer, E Todd
As part of the paradigm shift toward more minimally invasive surgical procedures, increasing numbers of references to laser-mediated flapless crown lengthening are noted in the published literature. The vast majority of these references are noncontrolled case reports or technique-focused articles. Therefore, prospective, randomized controlled studies that objectively examine the safety and efficacy of flapless crown lengthening are lacking. The current case series represents an initial attempt to examine some of the clinical issues posed by this minimally invasive flapless approach. Ultimately, only well-designed controlled clinical trials can yield the type of evidence-based data necessary to categorize this approach to crown lengthening as standard-of-care treatment.
Full Text Available Orthognathic surgery is a surgical procedure largely practiced throughout the world for the correction of various maxillofacial deformities. The procedure for correcting a particular deformity will be done after proper evaluation, which includes cephalometric, dental model analysis and photographs. The patient undergoes pre-surgical orthodontic correction for dental compensation, after which surgery is planned. During the last few decades, the profession has witnessed intense interest for the treatment of facial deformities, being widely practiced throughout the world. Orthognathic surgery has become an acceptable treatment plan for patients with various maxillofacial deformities, giving pleasing results. The present study reports the successful treatment method of Class II division 1 malocclusion through orthognathic surgery.
Morax, S; Longueville, E; Hurbli, T
Twenty cases of severe progressive ophthalmoplegia (Myopathic ptosis) with significant ptosis were treated by various procedures, including levator resection with blepharoplasty or frontalis suspension using temporalis fascia. Surgical indications were generally limited to cases with poor or absent levator function. The results are analysed after an average follow-up of 6 months. The particular problems concerning surgery of myopathic ptosis are discussed.
Pisipati, Sailaja; Bach, Christian; Daneshwar, Datesh; Rowe, Edward W.; Koupparis, Anthony J.
The da Vinci Surgical System (Intuitive Surgical Inc.) continues to develop as a platform in urological surgery. Synchronous upper and lower urinary tract tumours requiring extirpative surgery are not uncommon. We report the first case robotic series of combined complex upper and lower urinary tract surgery. Six high-risk anaesthetic patients with a median age of 71 years and apparent synchronous upper and lower urinary tract pathologies underwent concurrent robotic surgery. Five underwent ro...
Couturier, A; Aumaître, O; Gilain, L; Jean, B; Mom, T; André, M
Fibrous dysplasia of bone is a rare sporadic benign congenital condition in which normal cancellous bone is replaced by fibro-osseous tissue with immature osteogenesis. Sarcomatous transformation is exceptional. Lesions may involve one bone (monostotic) or several (polyostotic). Fibrous dysplasia may be associated with café-au-lait skin macules and endocrinopathy in McCune-Albright syndrome, or with myxoma in Mazabraud's syndrome. We report ten cases of patients followed up for craniofacial fibrous dysplasia in our center between 2010 and 2015. Mean age was 43 years (range, 10-72 years). Clinical symptoms comprised headache (n=3) and sensorineural disorder: recurrent anterior uveitis (n=1), visual acuity loss, epiphora and vestibular syndrome (n=1), and hearing loss (n=1). All cases were monostotic. The sphenoid bone was most commonly involved (n=5), followed by the ethmoid (n=1), frontal (n=1), fronto-ethmoid (n=1), temporal (n=1) and fronto-ethmoido-sphenoid (n=1) bones. Five patients were treated with intravenous pamidronate, a bisphosphonate: evolution was favorable for 3 of them at 1-6 months after treatment initiation, with resolution of headache or vestibular syndrome; the other 2 patients were stable. Two patients were operated on. Diagnosis of craniofacial fibrous dysplasia should be considered in case of headache, neuralgia, sensory disorder, functional disorder or infectious ENT complications. A medico-surgical approach is useful for these patients. Copyright © 2017 Elsevier Masson SAS. All rights reserved.
Noval, S; Cabrejas, L; Jarrín, E; Ruiz-Guerrero, M; Ciancas, E
Turkana is the largest district in Kenya, situated in the Northwest of the country. It features a semi-nomadic population of 850,000. Around 60% of population lives below the poverty threshold. The ratio of doctors is 1:75,000 inhabitants. Five ophthalmologists took part in the last deployment in November. Local staff had previously selected the patients from the rural areas, as well as in Lodwar, the capital of the district. Of the 371 patients who attended the clinic, 128 required surgery. To describe the pediatric population attended to in the last «Turkana Eye Project» Camp. Description of the ophthalmic pathologies of the children seen in the clinic in this surgical camp, and the diagnostic and therapeutic options according to the limitations of the environment. Of the 371 patients, 54 were younger than 15 years old (14.5%). Four children had surgery (3.25% of the 128 patients). In 2 more cases surgery was the indicated but not performed. Therefore, of the total of 54 cases, 6 could be considered as surgical (11.1%), and 17 suffered ophthalmic problems other than refraction defects, or mild ocular surface pathologies: traumatic cataracts, neuropathies, impetigo, exophthalmos, retinal dystrophies, dermoid cysts, or nyctalopia. The etiology was traumatic in four of the 17 children (23.5%). Surgical camps are increasing in the developing countries. They are usually focused on particular pathologies, such as cataracts or trachoma. Our case series shows the importance of pediatric teams and the need to be prepared to face complex pediatric pathologies. Copyright © 2012 Sociedad Española de Oftalmología. Published by Elsevier Espana. All rights reserved.
Morris, Tim; Otto, Charissa; Zerella, Tanisha; Semmler, John G; Human, Taaibos; Phadnis, Joideep; Bain, Gregory I
Objectives To investigate outcomes after surgical repair of distal biceps tendon rupture and the influence of arm dominance on isokinetic flexion and supination results. Background/Purpose While relatively uncommon, rupture of the distal biceps tendon can result in significant strength deficits, for which surgical repair is recommended. The purpose of this study was to assess patient reported functional outcomes and muscle performance following surgery. Methods A sample of 23 participants (22 males, 1 female), who had previously undergone surgical repair of the distal biceps tendon, were re-examined at a minimum of one year after surgery. Biodex isokinetic elbow flexion and supination testing was performed to assess strength (as measured by peak torque) and endurance (as measured by total work and work fatigue). The Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Mayo Elbow Performance Scale (MEPS) were used to assess participants' subjectively reported functional recovery. Results At a mean of 7.6 years after surgical repair, there were no differences between the repaired and uninvolved elbows in peak torque (p = 0.47) or total work (p = 0.60) for flexion or supination. There was also no difference in elbow flexion work fatigue (p = 0.22). However, there was significantly less work fatigue in supination, which was likely influenced by arm dominance, as most repairs were to the dominant arm, F(1,22)=5.67, p = 0.03. Conclusion The long-term strength of the repaired elbow was similar to the uninvolved elbow after surgery to the distal biceps tendon. Endurance of the repaired elbow was similar in flexion but greater in supination, probably influenced by arm dominance. Study design Retrospective case series Level of Evidence Level 4 PMID:27904798
Cante, Domenico; Franco, Pierfrancesco; Sciacero, Piera; Girelli, Giuseppe; Marra, Anna Maria; Pasquino, Massimo; Russo, Giuliana; Borca, Valeria Casanova; Mondini, Guido; Paino, Ovidio; Barmasse, Roberto; Tofani, Santi; Numico, Gianmauro; La Porta, Maria Rosa; Ricardi, Umberto
Accelerated hypofractionation (HF) using larger dose per fraction, delivered in fewer fractions over a shorter overall treatment time, is presently a consistent possibility for adjuvant whole breast radiation (WBRT) after breast-conserving surgery for early breast cancer (EBC). Between 2005 and 2008, we submitted 375 consecutive patients to accelerated hypofractionated WBRT after breast-conserving surgery for EBC. The basic course of radiation consisted of 45 Gy in 20 fractions over 4 weeks to the whole breast (2.25 Gy daily) with an additional daily concomitant boost of 0.25 Gy up to 50 Gy to the surgical bed. Overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS) and local control (LC) were assessed. Late toxicity was scored according to the CTCAE v3.0; acute toxicity using the RTOG/EORTC toxicity scale. Cosmesis was assessed comparing treated and untreated breast. Quality of life (QoL) was determined using EORTC QLQ-C30/QLQ-BR23 questionnaires. With a median follow-up of 60 months (range 42-88), 5 years OS, CSS, DFS and LC were 97.6, 99.4, 96.6 and 100 %, respectively. Late skin and subcutaneous toxicity was generally mild, with few events > grade 2 observed. Cosmetic results were excellent in 75.7 % of patients, good in 20 % and fair in 4.3 %. QoL, assessed both through QLQ-C30/QLQ-BR23, was generally favorable, within the functioning and symptoms domains. Our study is another proof of principle that HF WBRT with a concurrent boost dose to the surgical cavity represents a safe and effective postoperative treatment modality with excellent local control and survival, consistent cosmetic results and mild toxicity.
Christina Esposito, OD
Full Text Available Background: The use of colored light, filters, and therapeutic tinting dates back to the early years of optometry. It has been used by optometrists and other professionals throughout history for a variety of different reasons, including photophobia, near point stress, migraines, and dyslexia. Case Series: A series of cases are presented where color is used to help patients resolve their visual disturbances. The patients who were identified are those suffering from photophobia, reading difficulties, and visual changes related to a vestibular condition. The colors are chosen using the Intuitive Colorimeter. This instrument is used to investigate the possible preferences for a specific color to reduce the patient’s symptomatology. This is done logically and sequentially to explore color space in order to find the optimal precision tint for the relief of perceptual distortions. Discussion: Tinting contact lenses and/or glasses for therapeutic reasons can be time consuming but can be a rewarding experience for both the clinician and the patient.
Altan Atakan Özcan
Full Text Available Pur po se: To evaluate the etiological factors, diagnosis, follow-up and treatment procedures in cases of orbital cellulitis. Ma te ri al and Met hod: A retrospective review was performed on medical records of patients with orbital cellulitis treated between 2009 and 2011 in our clinic. The patients were studied for age, ophthalmologic examination features, laboratory and radiology results, treatment modalities and the response to these treatments. Re sults: Eleven patients (7 male, 4 female having an average age of 9.7 years (6 months-25 years participated in the study. All patients had eyelid oedema, hyperemia and ocular pain; with chemosis in 3, gaze restriction in 6, relative afferent pupillary defect and proptosis in 4 cases. Orbital cellulitis was observed to occur secondary to paranasal sinusitis in 10 patients (90.9% and 1 patient had only history of superior respiratory tract infection. Sinus infection was localized in ethmoid and maxillary sinuses in all except one case. Laboratory tests showed leukocytosis in 8 patients. Surgical drainage was performed in 7 of 8 patients with abscess formation observed with radiological imaging. The remainder of the patients were followed with sole medical treatment. All patients recovered without any vision loss or life-threatening complication. Dis cus si on: Orbital cellulitis cases must be followed with radiologic imaging for any complication that may occur and patients with abscess should be evaluated for surgical drainage besides antimicrobial treatment.(Turk J Ophthalmol 2012; 42: 284-7
Иван Иванович Кужеливский
Full Text Available Dysplastic coxarthrosis is dominate among children orthopedic cases, and its surgical alignment continues to be peracute. Despite the application of advanced therapies and medical treatment, the patients of surgical state case constitute a significant percentage of the total patient number, i. e. from 19 to 35 %. In this article a detailed literature review of surgical alignment methods for deficiency acetabular roof by applying different implants has been described. The authors have proposed applying titanium nickelide materials in the surgical alignment method, as such materials possess the following properties: high corrosion stability, full compatibility with the body tissues, as well as, sufficient porosis providing radial border structure regeneration of acetabular roof, which in its turn, improves the support ability of extermity. In the event of progression of coxarthrosis iliac segment is reserved for the upcoming replacement.
Kosti, E; Molyvdas, I; Lambrianidis, T
To present the diagnosis and management of an unusual case of root perforation caused by surgical trephination. A root perforation caused by surgical trephination on a maxillary lateral incisor with diagnosis of symptomatic chronic periradicular periodontitis was managed with standard root canal preparation and filling with thermoplasticized gutta-percha. Recall radiographs up to 1 year revealed healing of the periapical lesion. *During surgical trephination, there is risk of damaging anatomical structures surrounding the tooth as well as the tooth itself. *Root perforation caused by trephination was successfully managed by standard canal preparation and filling with thermoplasticized gutta-percha.
Kumari, Pooja; Verma, Mahesh; Sainia, Vikrant; Gupta, Ankur; Gupta, Rekha; Gill, Shubhra
Dental implants have evolved as a standard of care for replacement of missing teeth. Though this treatment modality promises a high level of patient satisfaction and success, it cannot be performed in all cases. Apart from medically compromised patients, implant use is also restricted whenever there is limited available bone volume at the edentulous site. An example includes the mandibular incisor, the maxillary lateral incisor region, and other sites with reduced interdental spacing and atrophic edentulous maxillary and mandibular ridges. Bone volume at some of these sites can be increased by suitable augmentation procedure for placement of a regular diameter implant (3.75 to 4.2 mm). But many a times such procedure cannot be undertaken either due to financial constraint, risk of subjecting the patient to additional surgical procedure, added time factor, or guarded prognosis of the grafted site. In such cases, mini-implants can be used. In this case series, mini-implants (2.5 to 3 mm) were used to replace teeth in all mouth quadrants and to retain a mandibular overdenture in a compromised case. The implants served well at all the sites with minimal bone loss and a high level of patient satisfaction. Mini-implants hold the potential to serve as an alternate to regular diameter implants in certain situations. Preferably they should be used in multiples to retain fixed dental prostheses and might serve as an efficient, low-cost solution for retaining overdentures in selected cases.
Conclusion: This initial series adds to existing data on the feasibility of robotic hepatobiliary cases with inherent advantages of minimal invasive surgery, however with limitation of availability and use of devices like cavitron ultrasonic surgical aspirator (CUSA and higher operative cost.
Secchi, Mario A; Pettinari, Ricardo; Mercapide, Carlos; Bracco, Ricardo; Castilla, Carlos; Cassone, Eduardo; Sisco, Pablo; Andriani, Oscar; Rossi, Leonardo; Grondona, Jorge; Quadrelli, Lisandro; Cabral, Raúl; Rodríguez León, Nicolás; Ledesma, Carlos
The management of hydatid liver disease (HLD) includes various nonsurgical and surgical treatment options. The purpose of the present longitudinal study was to report the changes in surgical management and the consequent outcome of HLD patients in 10 referral surgical centres in Argentina from 1975 to 2007. The study result analysis was divided into two study periods (1975-1990 and 1991-2007). A total of 1412 patients underwent radical (Group 1: 396 patients), conservative (Group 2: 748 patients) or combined (Group 3: 536 interventions in 268 patients) surgical procedures. The overall mortality and complication rate (Clavien I-IV) was 1.8 and 39% respectively. The complication rate was significantly lower in Group 1 (26%) compared with Group 2 (45%) and Group 3 (42%) There was a significant decrease in mortality (2.3 vs. 1%), complication (42 vs. 34%) and early reoperation (12 vs. 6%) rates between the first study part (918 patients) and the second study part (494 patients). During a median follow-up of 7 years, there was a significant decrease in the first part of this study in the late reoperation rate (8.4-3%) and in disease recurrence (9-1.6%). This large national observational multicentre series shows a significant improvement in surgical management of HLD in Argentina, with a decrease in mortality, morbidity, early and late reoperation and recurrence rates. A recent trend was observed in favour of an earlier diagnosis, less complicated clinical presentation and recent use of minimally invasive approaches.
Deguchi, Hisatsugu; Ozawa, Tetsuro; Wada, Toshihiro; Tsugu, Yukio (Toho Univ., Tokyo (Japan). School of Medicine)
Surgical procedures were performed on 25 patients suffering from late-phase intestinal tract disorders induced by irradiation. The primary diseases of these cases were almost exclusively gynecological in nature, such as cancer of the uterine cervix. Symptoms observed in these cases were overwhelming ileus followed by melena, fistulation and free perforation, as well as combination thereof. The most common portion involved was the recto-sigmoidal colon, followed by the ileo-cecum and ileum. As for the relationship of symptoms to the disordered portion, ileus was seen mainly in cases of disorders at the ileocecal portion; melena was observed exclusively in cases of disorders at the rectosigmoidal colon; fistulation was manifested mainly as recto-vaginal fistula or ileo-sigmoidal fistula; free perforation was observed at both the ileum and sigmoidal colon. Colostomy was the most frequent surgical method applied. Only 3 cases were able to undergo enterectomy. Other cases were subjected to enteroanastomosis or enterostomy. In most cases it was nearly in possible to excise the disordered portions. As for the effect of surgical procedures on symptoms, cases of melena or fistulation were all subjected to colostomy; the majority of these cases showed improvement in symptoms. Moreover, a high improvement ratio was obtained in cases of ileus which were subjected to enterectomy and enteroanastomosis. Cases of free perforation showed high improvement ratio irrespective of the surgical procedure given. As for postoperative complications, one case of free perforation at the ileum showed anastomotic leakage after partial resection. For cases suffering from late-phase intestinal tract disorders induced by irradiation, immediate resection of the disordered intestinal tract and anastomosis are ideal. However, conservative operations must be considered, based on the focal condition. (author).
Artrodese lombar minimamente invasiva com acesso intermuscular sem material cirúrgico especial: estudo de série de casos Artrodesis lumbar mínimamente invasiva con acceso intermuscular sin material quirúrgico especial: estudio de serie de casos Minimally invasive lumbar arthrodesis with intermuscular approach without special surgical material: a case series
Bruno de Azevedo Oliveira
por enfermedad degenerativa. El Índice de Discapacidad de Oswestry (ODI versión 2.0 y la escala visual analógica de dolor (VAS fueron analizados antes de la cirugía y 6 meses después. La artrodesis se realizó con el acceso paramediano bilateral entre los músculos multifidus y longisimus utilizando sistemas simples de retractores cervicales, con láminas sustituibles, e implantes convencionales. RESULTADOS: Se observó una mejoría media de 3,6 puntos en la VAS y 27,5 puntos porcentuales en el ODI comparado con las evaluaciones realizadas antes y 6 meses después de la cirugía. La mejora fue mayor en los pacientes con ciática por hernia discal asociada con discopatía. Las preguntas del Índice de Oswestry, que presentaron mejores resultados, fueron la intensidad del dolor y la calidad del sueño. Las que tuvieron peores resultados fueron la capacidad de levantamiento de pesos y el dolor al sentarse. No hubo mayores dificultades relacionadas con la técnica y el material utilizado. CONCLUSIONES: La artrodesis de la columna lumbosacra, con abordaje intermuscular mínimamente invasivo, es posible de ser realizada con retractores quirúrgicos normales e implantes semejantes a los de la técnica tradicional, sin perjuicio técnico y sin comprometer el resultado clínico.OBJECTIVES: To analyze the clinical results of a series of patients with degenerative disease of the lumbar spine treated with circumferential arthrodesis with minimally invasive intermuscular approach without special surgical material. METHODS: Analysis of a prospective series of 12 consecutive non-randomized patients undergoing single level lumbosacral fusion for degenerative disease. Oswestry Disability Index (ODI version 2.0 and visual analogue pain scale (VAS were performed preoperatively and six months after surgery. Arthrodesis was performed with bilateral paramedian approach between the multifidus and longissimus muscles using simple cervical retractor systems and conventional implants
Full Text Available Implantation of the blastocyst anywhere else other than the uterine cavity is ectopic pregnancy. Ovarian Pregnancy is one of the rare forms of an ectopic pregnancy. The incidence of ovarian pregnancy is 0.15 to 3 % 1 of all ectopic pregnancies. Here we present a case of ruptured ovarian pregnancy, which was preoperatively diagnosed as ruptured tubal pregnancy and later found to be an ovarian pregnancy at laparotomy.
Karp, Nolan; Choi, Mihye; Kulber, David A; Downey, Susan; Duda, Gloria; Kind, Gabriel M; Jewell, Mark L; Murphy, Diane K; Lehfeldt, Max R; Fine, Neil
Soft-tissue support devices are used during breast reconstruction. This study investigated long-term clinical data following SERI Surgical Scaffold (SERI) implantation, a bioresorbable, silk-derived scaffold for soft-tissue support. This was a prospective, multicenter study in 103 subjects who received SERI during stage 1 of 2-stage breast reconstruction with subpectoral tissue expander placement (Natrelle Style 133V; Allergan plc, Dublin, Ireland) followed by subpectoral breast implant placement. Investigator satisfaction (11-point scale: 0, very dissatisfied and 10, very satisfied) at 6 months was the primary endpoint. Ease of use, satisfaction, scaffold palpability/visibility, breast anatomy measurements via 3D images, SERI integration, histology, and safety were also assessed through 2 years after stage 1 surgery. Analyses were performed on the per-protocol population (103 subjects; 161 breasts) with no protocol deviations that could affect outcomes. Ease of use and subject and investigator satisfaction with SERI were high throughout 2 years. Breast anatomy measurements with 3D images demonstrated long-term soft-tissue stability of the lower breast mound. Key complication rates per breast were tissue/skin necrosis and wrinkling/rippling (8.1% each) and seroma, wound dehiscence, and breast redness (5.0% each). Over 2 years, 4 breasts in 4 subjects underwent reoperation with explantation of any device; 2 breasts required SERI explantation. SERI was retained in 98.8% of breasts (159/161) at 2 years. SERI was associated with high and consistent levels of investigator and subject satisfaction and demonstrated soft-tissue stability in the lower breast through 2 years. SERI provides a safe, long-term benefit for soft-tissue support in 2-stage breast reconstruction.
Razeghinejad, Mohammad Reza; Masoumpour, Masoumeh; Eghbal, Mohammad Hossein; Myers, Jonathan S.; Moster, Marlene R.
Glaucoma management in pregnant patients is a real challenge, especially when the glaucoma is not controlled with medications. We report the results of 6 incisional glaucoma surgeries for the management of medically uncontrolled glaucoma patients during pregnancy. This retrospective, case series was conducted on the 6 eyes of 3pregnant patients with uncontrolled glaucoma using maximum tolerable medications. Details of the glaucoma surgical management of these patients as well as their postoperative care and pregnancy and clinical outcomes on longitudinal follow-up are discussed. All 3 patients had juvenile open-angle glaucoma and were on various anti-glaucoma medications, including oral acetazolamide. The first case described underwent trabeculectomy without antimetabolites in both eyes because of uncontrolled intraocular pressure with topical medications. The surgery was done with topical lidocaine jelly and subconjunctival lidocaine during the second and third trimesters. The second patient had an Ahmed valve implantation in both eyes during the second and third trimesters because of uncontrolled IOP with topical medications and no response to selective laser trabeculoplasty. Surgery was done with topical tetracaine and subconjunctival and sub-Tenon’s lidocaine. The third case had a Baerveldt valve implantation under general anesthesia in the second trimester. In selected pregnant glaucoma patients with medically uncontrolled intraocular pressure threatening vision, incisional surgery may lead to good outcomes for the patient with no risk for the fetus. PMID:27582594
Hutchison, Katrina; Johnson, Jane; Carter, Drew
Surgical innovation promises improvements in healthcare, but it also raises ethical issues including risks of harm to patients, conflicts of interest and increased injustice in access to health care. In this article, we focus on risks of injustice, and use a case study of robotic prostatectomy to identify features of surgical innovation that risk introducing or exacerbating injustices. Interpreting justice as encompassing matters of both efficiency and equity, we first examine questions relating to government decisions about whether to publicly fund access to innovative treatments. Here the case of robotic prostatectomy exemplifies the difficulty of accommodating healthcare priorities such as improving the health of marginalized groups. It also illustrates challenges with estimating the likely long-term costs and benefits of a new intervention, the difficulty of comparing outcomes of an innovative treatment to those of established treatments, and the further complexity associated with patient and surgeon preferences. Once the decision has been made to fund a new procedure, separate issues of justice arise at the level of providing care to individual patients. Here, the case of robotic prostatectomy exemplifies how features of surgical innovation, such as surgeon learning curves and the need for an adequate volume of cases at a treatment centre, can exacerbate injustices associated with treatment cost and the logistics of travelling for treatment. Drawing on our analysis, we conclude by making a number of recommendations for the just introduction of surgical innovations.
Full Text Available A smile expresses a feeling of joy, success, sensuality, affection and courtesy, and reveals self confidence and kindness. The harmony of the smile is determined not only by the shape, the position and the color of the teeth but also by the gingival tissues. Gingival health and appearance are essential components of an attractive smile. Gingival pigmentation results from melanin granules, which are produced by melanoblasts. The degree of pigmentation depends on melanoblastic activity. Although melanin pigmentation of the gingiva is completely benign and does not present a medical problem, complaints of ′black gums′ are common particularly in patients having a very high smile line (gummy smile. For depigmentation of gingiva different treatment modalities have been reported like- Bur abrasion, scraping, partial thickness flap, cryotherapy, electrosurgery and laser. In the present case series bur abrasion, scraping, partial thickness flap (epithelial excision cryotherapy and electrosurgery have been tried for depigmentation, which are simple, effective and yield good results, along with good patient satisfaction. The problems encountered with some of these techniques have also been discussed.
Deepak, Prasad; Sunil, S; Mishra, R; Sheshadri
A smile expresses a feeling of joy, success, sensuality, affection and courtesy, and reveals self confidence and kindness. The harmony of the smile is determined not only by the shape, the position and the color of the teeth but also by the gingival tissues. Gingival health and appearance are essential components of an attractive smile. Gingival pigmentation results from melanin granules, which are produced by melanoblasts. The degree of pigmentation depends on melanoblastic activity. Although melanin pigmentation of the gingiva is completely benign and does not present a medical problem, complaints of 'black gums' are common particularly in patients having a very high smile line (gummy smile). For depigmentation of gingiva different treatment modalities have been reported like- Bur abrasion, scraping, partial thickness flap, cryotherapy, electrosurgery and laser. In the present case series bur abrasion, scraping, partial thickness flap (epithelial excision) cryotherapy and electrosurgery have been tried for depigmentation, which are simple, effective and yield good results, along with good patient satisfaction. The problems encountered with some of these techniques have also been discussed.
Stein, Cynthia J; Kinney, Susan A; McCrystal, Tara; Carew, Elizabeth A; Bottino, Nicole M; Meehan Iii, William P; Micheli, Lyle J
Sport-related concussion is a topic of increasing public and media attention; the medical literature on this topic is growing rapidly. However, to our knowledge no published papers have described concussion specifically in the dancer. This case series involved a retrospective chart review at a large teaching hospital over a 5.5-year period. Eleven dancers (10 female, 1 male) were identified who experienced concussions while in dance class, rehearsal, or performance: 2 in classical ballet, 2 in modern dance, 2 in acro dance, 1 in hip hop, 1 in musical theater, and 3 were unspecified. Dancers were between 12 and 20 years old at the time of presentation. Three concussions occurred during stunting, diving, or flipping. Three resulted from unintentional drops while partnering. Two followed slips and falls. Two were due to direct blows to the head, and one dancer developed symptoms after repeatedly whipping her head and neck in a choreographed movement. Time to presentation in the sports medicine clinic ranged from the day of injury to 3 months. Duration of symptoms ranged from less than 3 weeks to greater than 2 years at last documented follow-up appointment. It is concluded that dancers do suffer dance-related concussions that can result in severe symptoms, limitations in dance participation, and difficulty with activities of daily living. Future studies are needed to evaluate dancers' recognition of concussion symptoms and care-seeking behaviors. Additional work is also necessary to tailor existing guidelines for gradual, progressive, safe return to dance.
Schröpfer, Engelbert; Meyer, Thomas
Introduction Pneumatosis cystoides intestinalis is a rare disease usually caused by an underlying condition. It is defined as air filled cysts within the wall of the gastrointestinal tract. The purpose of this paper is the development of an algorithm for the surgical therapy of PCI based one two case reports. Case presentations A 17-year-old girl with Down syndrome and leucopenia due to chemotherapy for acute lymphatic leukemia was admitted with acute septic conditions and PCI. Explorative la...
Paulo Gonçalves de Oliveira
Full Text Available OBJECTIVES: To evaluate the results of surgical treatment of patients with anal fistulas in a consecutive series of patients. METHODS: A retrospective analytical study of a consecutive series of cases prospectively collected. The sample comprised 210 patients who underwent surgery; demographic data, signs and symptoms, intraoperative classification of the fistulas and healing time were analyzed. RESULTS: The median age was 38 years and 69.0% of the patients were male. The most frequent symptom was perianal orifice with purulent drainage. The fistulas were classified as transsphincteric in 60.9% and the most used operative treatment was the marsupialization of fistulotomy, in 84.2% of cases. Complete healing occurred in all patients between 2 and 16 weeks. One hundred and seventy-eight patients, 84.8% of the patients who underwent surgery, were evaluated at least one year after surgery and recurrence occurred in 6.4% of cases. CONCLUSIONS: There was male prevalence (2.2/1, and most fistulas were transsphincteric. The marsupialization of fistulotomy was the most used operative treatment, and it presented acceptable low rates of morbidity and recurrence of 6.4%.OBJETIVOS: Avaliar os resultados do tratamento cirúrgico de pacientes portadores de fístulas anais em uma série consecutiva de pacientes. MÉTODOS: Estudo analítico, retrospectivo, de uma série consecutiva de casos que foram coletados de forma prospectiva. A casuística englobou 210 pacientes operados, tendo sido analisados os dados demográficos, os sinais e sintomas, a classificação transoperatória das fístulas e o tempo até a cicatrização completa. RESULTADOS: A mediana de idade foi de 38 anos e 69,0% dos pacientes eram homens. O sintoma mais frequente foi a drenagem de secreção purulenta por orifício perianal. As fístulas foram classificadas como transesfincterianas em 60,9%, e o tratamento operatório mais empregado foi a fistulotomia com marsupialização do trajeto
Full Text Available Abstract Background Clinical trials assessing efficacy and safety of Intramuscular (IM Olanzapine in acute schizophrenia and acute mania have previously been undertaken in studies required for drug registration in patients who were required to give informed consent. These patients may have less severe forms of psychosis than patients treated in routine practice. Data derived from naturalistic practice following the launch of IM olanzapine may be helpful for clinicians in assessing efficacy and safety of IM olanzapine. The PANSS-EC scale used in the clinical studies may represent a tool that could be used in routine clinical practice. Case presentation We report on an early unselected case series of 7 patients who received IM olanzapine in routine clinical practice settings in the UK. In this case series, olanzapine IM was generally effective, and no adverse events were reported. Adjunctive benzodiazepines were given concomitantly in 1 of the 7 subjects. This is relevant as concomitant benzodiazepines are not recommended for a minimum of 1 hour post IM olanzapine administration. PANSS-EC data was collected in 2 of the 7 subjects. Conclusion Although patients had greater severity of psychosis than clinical trial patients there were no unexpected findings. In addition the PANSS-EC scale is a scale that may be useful in assessing the efficacy of IM antipsychotics in routine clinical practice.
Silverton, Natalie A; Bull, David A; Morrissey, Candice K
Aortic root abscess is a complication of aortic valve endocarditis that is associated with a high morbidity and mortality. The diagnosis usually is made with transesophageal echocardiography, which is highly sensitive and specific for the disease. We present a case of suspected aortic root abscess 1 week after mechanical aortic valve replacement for native valve endocarditis. The diagnosis was made by the use of transesophageal echocardiography but surgical inspection revealed that the paravalvular fluid collection was excessive surgical adhesive. We discuss the clinical significance and differential diagnosis of aortic root abscess in the setting of infective endocarditis.
Bi Jin; Yuan Sun; Yi-Qing Li; Yu-Guo Zhao; Chuan-Shan Lai; Xian-Song Feng; Chi-Dan Wan
We report two cases of extrahepatic portal vein aneurysm,and both of them underwent surgical intervention. The first case had a mild pain in right upper quadrant of the abdomen; the second had no obvious symptoms. Physical examination revealed nothing abnormal. Both of them were diagnosed by magnetic resonance imaging angiography (MRA). One of the aneurysms was located at the main portal vein, the other, at the confluence of the superior mesenteric vein and the splenic vein, and these two places are exactly the most common locations of the extrahepatic portal vein aneurysm reported in the literature (30.7% each site). The first case underwent aneurysmorrhaphy and the second case, aneurysm resection with splenectomy. Both of them recovered soon after the operation, and the symptom of the first case was greatly alleviated. During the follow-up of half a year, no complication and adverse effect of surgical intervention was found and the color Doppler ultrasonography revealed no recurrence of the aneurysmal dilation. We suggest that surgical intervention can alleviate the symptom of the extrahepatic portal vein aneurysm and prevent its complications effectively and safely for low risk patients.
Full Text Available INTRODUCTION: Lipoma , the ubiquitous benign tumor , is not very common in the hand and that to involving the palmar space or finger is very rare. This series of case presentation lays emphasis on consideration of lipoma in the differential diagnosis of swellings/ soft tissue tumors of the hand and the use o f imaging studies in their diagnosis. We report a ser ies of six cases of lipoma in different parts and planes of hand , involving palm and fingers . An uncommon site , size , shape , plane and age of occurrence of this common tumor warrants it’s reporting and an effort had been made to highlight the management. CONCLUSION : Hand lipoma is rare entity for a surgeon in the differential diagnosis of soft tissue tumors with radiology being an invaluable tool. Though rare but frequently seen in this pa rt of country , Precise surgical techniques with a sound anatomic knowledge helps in complete excision without damaging the vital structures and abates recurrences Lipoma , subcutaneous , mid - palmar space.
Full Text Available Background/Aim: The present analysis focuses on examining a case series of eight patients diagnosed with a granular cell tumor located in the oral cavity. Case series: The patients’ clinical states were thoroughly studied, along with the histopathological and immunohistochemical examinations findings. Their surgical treatment and postoperative course are also within the scope of this analysis. Numerous histogenesis theories and the appropriate tumor treatment are mentioned within the article being always in accordance with the relative literature. Conclusions: Oral granular cell tumor is a benign oral disease of possible neural origin commonly located on the tongue. Surgical excision is the treatment of choice. In any case, histological and immunohistochemical examination confirm both the clinical diagnosis and the differential diagnosis between oral squamous cell carcinoma.
Makoshi, Ziyad; AlKherayf, Fahad; Da Silva, Vasco; Lesiuk, Howard
An estimated 3700 individuals are seen annually in US emergency departments for nail gun-related injuries. Approximately 45 cases have been reported in the literature concerning nail gun injuries penetrating the cranium. These cases pose a challenge for the neurosurgeon because of the uniqueness of each case, the dynamics of high pressure nail gun injuries, and the surgical planning to remove the foreign body without further vascular injury or uncontrolled intracranial hemorrhage. Here we present four cases of penetrating nail gun injuries with variable presentations. Case 1 is of a 33-year-old white man who sustained 10 nail gunshot injuries to his head. Case 2 is of a 51-year-old white man who sustained bi-temporal nail gun injuries to his head. Cases 3 and 4 are of two white men aged 22 years and 49 years with a single nail gun injury to the head. In the context of these individual cases and a review of similar cases in the literature we present surgical approaches and considerations in the management of nail gun injuries to the cranium. Case 1 presented with cranial nerve deficits, Case 2 required intubation for low Glasgow Coma Scale, while Cases 3 and 4 were neurologically intact on presentation. Three patients underwent angiography for assessment of vascular injury and all patients underwent surgical removal of foreign objects using a vice-grip. No neurological deficits were found in these patients on follow-up. Nail gun injuries can present with variable clinical status; mortality and morbidity is low for surgically managed isolated nail gun-related injuries to the head. The current case series describes the surgical use of a vice-grip for a good grip of the nail head and controlled extraction, and these patients appear to have a good postoperative prognosis with minimal neurological deficits postoperatively and on follow-up.
Johnson Melissa D
Full Text Available Abstract Background Ertapenem is a once-daily broad spectrum carbapenem that is increasingly used to treat polymicrobial osteomyelitis due to diabetic foot and traumatic wound infections. However, limited data exists on ertapenem use for osteomyelitis. This study aimed to characterize outcomes and adverse effects with empiric use of ertapenem for osteomyelitis. Findings A total of 112 patients presenting to Duke, Durham Regional or Durham VA Medical Centers with a suspected diagnosis of osteomyelitis and ertapenem use from 11/2001 to 8/2009 were screened, and 12 subjects met inclusion criteria for the study. Mean age was 60 ± 16 years, 68% were female, 75% were Caucasian, and the most common comorbidities included diabetes (58%, peripheral vascular disease (42%, and history of tobacco use (75%. Over half of the patients presented to a primary care clinic or emergency room greater than six months after the onset of clinical symptoms. Bone culture was obtained for diagnostic guidance in only two cases; and surgical intervention was pursued in three cases. Patients received a mean duration of 34.6 ± 7.8 days of therapy, and in three cases, subsequent suppressive oral antibiotics were given. Six (50% patients met criteria for clinical success, defined as resolution of clinical signs and symptoms of infection such that discontinuation of antibiotics was deemed appropriate at end of ertapenem therapy, without recurrence at one year follow-up. No adverse drug effects were noted. Conclusions In this case series of mostly community-acquired, lower extremity osteomyelitis, bone biopsy was infrequent, and an average six-week course of empiric ertapenem was well-tolerated with curative rates of 50% at one year.
Tuberculose vertebral: análise descritiva de uma série de casos submetidos a tratamento cirúrgico Tuberculosis vertebral: un análisis descriptivo de una serie de casos sometidos al tratamiento quirúrgico Tuberculosis of the spine: descriptive analysis of a series of cases surgically treated
Luiz Cláudio Schettino
de la cifosis angular y regional de 5.7º y 3.1º, respectivamente. No fue observada progresión significativa de la cifosis en ninguno de los pacientes operados. CONCLUSIÓN: el tratamiento quirúrgico de la espondilitis tuberculosa en esta serie de casos fue eficaz en la prevención de la progresión de la cifosis evaluada en un periodo mínimo de 12 meses. El déficit neurológico relacionado a la tuberculosis vertebral fue más grave en los niños.OBJECTIVE: to present our experience on the surgical treatment of spinal tuberculosis and to compare our data to the recent literature. METHODS: a retrospective evaluation of patients who underwent surgical procedure to treat the disease was done. We analyzed the type of surgery, neurological status and angle of kyphosis before the surgery and after twelve months. The neurological status was determined by the Frankel scale modified by ASIA. The kyphotic deformity was measured using the Cobb method. We identified 23 patients with confirmed diagnosis of tuberculosis of the spine. Thirteen individuals in this group were operated. Three patients were excluded and ten participated in the study. RESULTS: most of the patients underwent decompression, anterior and/or posterior fusion by combined or posterior approach. Six patients presented neurological deficit at the time of diagnosis. Two of these six were children and presented with Pott's disease on admission. Three patients presented complete recovery of the motor function of their legs. One patient had neurological status aggravated after the surgery due to bacterial resistance at the administration of four different drugs and to tuberculous meningitis. Regarding to the kyphosis, the mean focal kyphotic angle in the beginning of the follow up was 26,7º (0º to 90º and 21,2º (0º to 50º at the end of the study. The mean regional kyphotic angle was 24,10º (-27º to +60º in the beginning and 21º(-33º to +65º at the end of the follow-up. There was a decrease of the
João Frank Carvalho DANTAS
Full Text Available is indicated for the treatment of transverse maxillary deficiency in patients with skeletal maturity, through the association of orthodontic and surgical procedures. It leads to an increase in the maxillary arch, resulting in better accommodation of the tongue and correcting the black corridors. This procedure can be performed under local anesthesia with low risk of complications, thus being considered a practical alternative treatment. Case report and conclusion: This article reports a case of surgically assisted maxillary expansion performed under local anesthesia in an outpatient setting. The patient had a clinical picture of transverse maxillary deficiency. Performing SARPE under local anesthesia in an outpatient setting is a viable procedure, of low cost, easy implementation and low risk of complications once it is performed according to the appropriate technique.
Haghnegahdar, Ali; Sedighi, Mahsa; Motalebi, Hassan
We report a recurrent Piriformisc muscle syndrome after surgical release. After the primary neurolysis, a second operation was performed to release adhesions. This case shows a different type of sciatic nerve entrapment by an abnormal thin muscle slip. Results of the revision surgery guide us to the point that revision surgery for Piriformis muscle syndrome should be meticulously selected, and after considering medical and interventional therapies.
Full Text Available Gingival enlargement is one of the side effects associated with certain drugs. Amlodipine, a calcium channel blocker, used as antihypertensive drug has been found associated with gingival hyperplasia. This case series presents diagnosis and management of amlodipine-induced gingival hyperplasia. Amlodipine-induced gingival enlargement was diagnosed and managed by thorough scaling and root planning. Drug substitution and surgical intervention was performed in first two cases. The pathogenesis of gingival enlargement is uncertain and the treatment is still largely limited to the maintenance of an improved level of oral hygiene and surgical removal of the overgrown tissue. Several factors may influence the relationship between the drugs and gingival tissues as discussed by Seymour et al. Meticulous oral hygiene maintenance, switchover to alternative drug, professional scaling and root planning and surgical excision of enlarged gingival tissue may help overcome the effect of these drugs.
Drager Luciano Ferreira
Full Text Available Perianal fistula, usually has a criptoglandular etiology, developing from a perianal abscess and communicating the anal mucosa with the perianal skin. The aim of this paper is to study retrospectively 241 cases of perianal fistula (172 men and 69 women; 2,5:1 aging from 7 and 80 years old (average: 37,4 years, operated on at the Hospital da Clínicas - UFMG, from 1977 to 1996. The surgical techniques and post-operative outcome have been analysed. Perianal abscesses with spontaneous drainage were the predominant etiology (132 patients; 54,8%. Eighty percent were submitted to fistulectomy as the first surgical treatment. Among early complications (78; 32,4%, local pain was the most frequent (60; 24,9%. Among the late complications (136; 56,4% fistula recurrence (101; 41,9% was the most frequent. There were 141 reoperations in 80 patients. Fistulectomy was the predominant surgical technique employed for the treatment (101; 71,6%. The average hospitalization time was 6,3 days until 1990 and 1,5 day from 1991 to 1996, after the advent of day-surgery beds in HC-UFMG. The surgical treatment of perianal fístula has a significant rate of post-operative complications and a high recurrence rate, in spite of the short stay in hospital.
J. Harris Ricardo
Full Text Available El odontoma es el tumor odontogénico más frecuente en cavidad oral, compuesto por una mezcla de células odontogénicas formando dentina y esmalte, presenta células y tejidos normales pero de estructura defectuosa, estos tejidos se encuentran en el área del cuerpo donde se presenta su crecimiento, al examen radiográfico se puede presentar imágenes radiopacas como un gran número de dientes rudimentarios llamados dentículos, en este caso se conoce como odontoma compuesto o presentarse imagen radiopaca como conglomeraciones amorfas, recibiendo el nombre de odontoma complejo. Su etiología se le relaciona con restos paradentales de Malassez, procesos inflamatorios, traumatismos, se le asocia en algunos casos con el quiste odontogénico calcificante, son asintomáticos, producen retención dentaria. El tratamiento es quirúrgico y su recurrencia es baja. Se reporta serie de casos que acudieron al servicio de estomatología y cirugía oral de la Universidad de Cartagena con impresión diagnostica de odontoma, se realizaron los procedimientos quirúrgicos confirmando los diagnósticos con los reportes histopatológicos.Odontoma is the most frequent odontogenic tumor in oral cavity, comprising a mixture of odontogenic cells forming dentin and enamel. It shows cells and normal tissues but in abnormal structure. These tissues are located in the area of the body where it presents its growth. Under radiographic examination may be radiopaque images as a large number of rudimentary teeth called denticles, in this case is known as compound odontoma or presented as conglomerates amorphous radiopaque image, receiving the name of complex odontoma. Its etiology is related to remnants of Malassez paradontals, inflammatory processes. Trauma is sometimes associated with calcifying odontogenic cyst. Generally are asymptomatic, produce tooth retention. Treatment is surgical and recurrence is low. Is reported in the present paper a number of cases that went to
Full Text Available Axel Orozco-Hernández,1 Ximena Ortega-Larrocea,1 Gustavo Sánchez-Bermúdez,1 Gerardo García-Aguirre,1 Virgilio Morales Cantón,1 Raul Velez-Montoya2 1Retina Department, Asociación para Evitar la Ceguera en México IAP, Mexico City, Mexico; 2Department of Ophthalmology, University of Colorado School of Medicine, Rocky Mountain Lions Eye Institute, Aurora, CO, USA Background: Since the ophthalmological community adopted the use of intravitreal bevacizumab as an accepted off-label treatment for neovascular diseases, the amount of knowledge regarding its effects and properties has been increasing continually. In the last few years, there have been an increasing number of reports about sterile intraocular inflammation and intraocular pressure elevations after intravitreal bevacizumab. In the following case series, we describe the clinical presentation and outcomes of ten consecutive cases of patients developing mild-to-severe sterile intraocular inflammation after intravitreal bevacizumab and their management. Methods: This report presents a retrospective case series. We reviewed the medical records of ten consecutive patients from a group of 46, in whom repackaged bevacizumab in individual aliquots from two vials from the same batch were used. All surgical procedures were performed using standard sterile techniques in the operating room. At each follow-up visit, patients underwent a complete ophthalmological examination including visual acuity assessment, intraocular pressure, biomicroscopy, and posterior fundus examination. Results: Ten patients presented sterile endophthalmitis with an onset time of 3.5±1.95 days. The clinical characteristics were mild pain, slight visual loss, conjunctival hyperemia, and various degrees of intraocular inflammation with microhypopyon. All cultures were negative. All patients were managed with topical steroids and antibiotics, except two, in whom, due to severe vitreous cells, intravitreal antibiotics were
Ramanojam, Shandilya; Halli, Rajshekhar; Hebbale, Manjula; Bhardwaj, Smita
Ectopic eruption of a tooth within the dentate region of the jaws is often noticed in clinical practice and is well documented in the literature. But the ectopic eruption into the non dentate region is rare and scantly documented. The maxillary sinus is one such a non dentate region, apart from nasal septum, mandibular condyle, coronoid process and the palate, to accommodate such ectopic eruptions of teeth. Due to its rarity and lack of consensus over its management, the incidence deserves to be added to the literature and discussed. Early surgical intervention for removal of ectopic tooth along with enucleation of the associated cyst, if any, is the treatment of choice.
Schwartz and Dell (2010) advocated for a major role for case series investigations in cognitive neuropsychology. They defined the key features of this approach and presented a number of arguments and examples illustrating the benefits of case series studies and their contribution to computational cognitive neuropsychology. In the Special Issue on "Case Series in Cognitive Neuropsychology" there are six commentaries on Schwartz and Dell as well as a response to the six commentaries by Dell and Schwartz (2011 this issue). In this paper, I provide a brief summary of the key points made in Schwartz and Dell, and I review the promise and perils of case series design as revealed by the six commentaries. I conclude by placing the set of papers within a broader perspective, providing some clarification of the historical record on case series and single-case approaches, raising some cautionary notes for case series studies and situating both case series and single-case approaches within the larger context of theory development in the cognitive sciences.
Biglioli, F; Battista, V; Marelli, S; Valassina, D; Colombo, V; Bardazzi, A; Tarabbia, F; Colletti, G; Rabbiosi, D; Autelitano, L
Iatrogenic lingual nerve (LN) injuries are quite common in oral surgery both in maxillo-facial surgery and in oral surgery. LN runs superficially into the lateral mouth floor just beneath the mucous layer and this position enhances damage frequency. This article lists the different aetiologies of iatrogenic LN injuries and it almost focuses on lesions due to surgical treatment of ranulas. In the case report a LN lesion due to oral ranula excision is discussed; the patient experienced anaesthesia and hyperpatia in the corrisponded tongue side. It was treated with a microneurosugical anastomosis of LN, after amputation neuroma excision. The partial and definitive recovery of perception happened in six months and was deemed satisfying with 70% of functionality restored (results compared with the functionality of the contralateral side). An algorithm for diagnosis and therapy indication for iatrogenic injuries to nerves is also proposed. In case of surgical treatment, funcitonal recovery manifests after 4-6 month; a functional recovery of 70% of total nerve function is possible. The variable that most affects nerve functional recovery is surgical treatment timing; it must be performed as soon as possible.
Baugh, Tiffany P; Franzese, Christine B
Objectives The purpose of this study is to examine the effect of minimum case numbers on otolaryngology resident case log data and understand differences in minimum, mean, and maximum among certain procedures as a follow-up to a prior study. Study Design Cross-sectional survey using a national database. Setting Academic otolaryngology residency programs. Subjects and Methods Review of otolaryngology resident national data reports from the Accreditation Council for Graduate Medical Education (ACGME) resident case log system performed from 2004 to 2015. Minimum, mean, standard deviation, and maximum values for total number of supervisor and resident surgeon cases and for specific surgical procedures were compared. Results The mean total number of resident surgeon cases for residents graduating from 2011 to 2015 ranged from 1833.3 ± 484 in 2011 to 2072.3 ± 548 in 2014. The minimum total number of cases ranged from 826 in 2014 to 1004 in 2015. The maximum total number of cases increased from 3545 in 2011 to 4580 in 2015. Multiple key indicator procedures had less than the required minimum reported in 2015. Conclusion Despite the ACGME instituting required minimum numbers for key indicator procedures, residents have graduated without meeting these minimums. Furthermore, there continues to be large variations in the minimum, mean, and maximum numbers for many procedures. Variation among resident case numbers is likely multifactorial. Ensuring proper instruction on coding and case role as well as emphasizing frequent logging by residents will ensure programs have the most accurate data to evaluate their case volume.
Stacchi, Claudio; Chen, Stephen T.; Raghoebar, Gerry M.; Rosen, Daren; Poggio, Carlo E.; Ronda, Marco; Bacchini, Marco; Di Lenarda, Roberto
Purpose: This multicenter case series evaluates retrospectively the clinical outcomes of malpositioned implants surgically relocated in a more convenient position by segmental osteotomies. Materials and Methods: Authors who published, on indexed journals or books, works about malpositioned implant
H.A. Bruining (Hajo)
textabstractIt is generally accepted that for autonomous hyperparathyroidism, whether primary or tertiary, surgery is still the only suitable method of treatment available. Analysis of a series of cases treated in t his way over the past twenty years has shown that there are certain problems associa
Singh, Virendra; Verma, Ajay; Attresh, Gyanander; Batra, Jitender
Condylar hyperplasia of the mandible is a clinical condition of over-development and growth because of excessive cellular growth of one condylar part of the mandible leading to facial asymmetry, mandibular deviation and enlargement of condyle. The elongation of the condylar neck in turn leads to malocclusion and articular dysfunction. In the past the interceptive and corrective procedures of growth and deformity in condylar hyperplasia were either condylectomy or high condylotomy. However, the deformity ceases after growth is completed. Therefore, other surgical procedures have to be undertaken to correct the manifested deformity of condylar hyperplasia. Further it has to be stressed that no single procedure can completely correct the deformity. So in addition to condylectomy, other orthognathic surgical procedures both on body and ramus and also on maxilla can be undertaken to correct the canting of occlusion. Two rare cases of unilateral hyperplasia encountered in our hospital are presented which required different lines of treatment.
Dal Molin, Danilo Canesin; Ribeiro, Fabiano Rebouças; Filho, Rômulo Brasil; Filardi, Cantídio Salvador; Tenor, Antonio Carlos; Stipp, Willian Nandi; Petros, Rodrigo Souto Borges
To evaluate the results from surgical treatment of 84 cases of acute acromioclavicular dislocation, using a posterosuperior access route. Eighty-four cases of acute acromioclavicular dislocation (grade III in the Allman-Tossy classification) operated between November 2002 and May 2010 were evaluated. The patients' mean age was 34 years. The diagnoses were made using clinical and radiographic evaluations. The patients were operated by the same surgical team, within three weeks of the date of the trauma, using a posterosuperior approach to the shoulder to access the top of the base of the coracoid process for placement of two anchors, which were used in reducing the dislocation. The minimum follow-up was 12 months. The postoperative clinical-radiographic evaluation was done using the modified Karlsson criteria and the University of California at Los Angeles (UCLA) score. 92.8% of the 84 patients treated presented good or excellent results, and 7.2% presented fair or poor results, using the UCLA assessment score. According to the modified Karlsson criteria, 76.2% were assessed as grade A, 17.9% as grade B and 5.9% as grade C. The posterosuperior access route to the shoulder is a new option for accessing the coracoid process and treating acromioclavicular dislocation, with clinical and radiographic results equivalent to those in the literature.
Arjona-Amo, Manuel; Torres-Carranza, Eusebio; Batista-Cruzado, Antonio; Serrera-Figallo, Maria-Angeles; Crespo-Torres, Santos; Belmonte-Caro, Rodolfo; Albisu-Andrade, Claudio; Torres-Lagares, Daniel; Gutiérrez-Pérez, José-Luis
Kissing molars are a very rare form of inclusion defined as molars included in the same quadrant, with occlusal surfaces contacting each other within a single dental follicle. We present four cases of this pathology: a 35 year-old male, referred to the Oral and Maxillofacial Surgery Department of the Hospital Virgen del Rocio in Seville, and three females of 24, 26, and 31 years, all of which had kissing molars that were treated by tooth extraction. We have found only 10 cases published in the medical literature in which this type of inclusion is briefly described, none of which elaborate on the surgical technique employed. In these cases, the indication for surgery is established when there is a history of recurring infections or cystic lesions associated with dental inclusions. The extraction of kissing molars requires an exhaustive comprehension of the anatomy of the region involved, sufficiently developed surgical abilities, and an extensive planning process. Impacted molar, kissing molar, surgical extraction.
Full Text Available Pulmonary artery agenesis is a rare congenital abnormality in which atresia was encountered in the short segment of the right or left pulmonary arteries. It can be isolated or associated with cardiac abnormalities such as tetralogy of Fallot, septal defects or pulmonary stenosis.The majority of cases are diagnosed in childhood whereas some cases yield no symptoms until adulthood. We evaluated retrospectively 5 pulmonary artery agenesis cases diagnosed in our clinics between 1998-2010 with respect to the literature.
Syed Abdul Wadud
Full Text Available Stargardt disease is the most common form of juvenile macular degeneration. Clinically, it is characterized by pisciform flecks at lhe level of the retinal pigment epithelium and a bull's-eye maculopathy. Inheritance is usually autosomal recessive, although dominantly inherited case have been described. Both sexes are affected equally. We reported here three cases of Stargardt's macular dystrophy, who are siblings and daughters of non consanguineous parents. In case-1,2 and 3 we found the typical presentation with almost same findings.
Kučera, Tomáš; Šponer, Pavel; Šrot, Jaromír
Our case-based review focuses on limb salvage through operative management of Charcot neuroarthropathy of the diabetic foot. We describe a case, when a below-knee amputation was considered in a patient with chronic Charcot foot with a rocker-bottom deformity and chronic plantar ulceration. Conservative treatment failed. Targeted antibiotic therapy and operative management (Tendo-Achilles lengthening, resectional arthrodesis of Lisfranc and midtarsal joints, fixation with large-diameter axial screws, and plaster cast) were performed. On the basis of this case, we discuss options and drawbacks of surgical management. Our approach led to healing of the ulcer and correction of the deformity. Two years after surgery, we observed a significant improvement in patient's quality of life. Advanced diagnostic and imaging techniques, a better understanding of the biomechanics and biology of Charcot neuroarthropathy, and suitable osteosynthetic material enables diabetic limb salvage.
Hasan Emre Aydın
Full Text Available These days, as a consequence of the improvement in technology and increase in the use of motor vehicles, spine injuries have become common. Spine traumas, which often occur after motor vehicle accidents, are observed mostly in cervical regions, particularly in the subaxial cervical region, which is also known as the subcervical region, and neurological damage occurs in 70% of the patients. Despite still being controversial, the common ranging for neurological evaluation is the American Spinal Injury Association ranging, which includes the motor and sensory loss and accordingly, the impairment rate. In subaxial cervical traumas, acute neurological deterioration is an indication and therefore requires urgent surgical treatment. The choice of anterior or posterior approach substantially depends on the traumatization mechanism, affected tissues, and neurological deterioration occurring after. The state of patient and instability are the most two important factors affecting the treatment decision. Although the anterior approach is accepted as a routinely available and easily applicable surgical technique, it lacks in the burst fractures involving the three colons, which shows a stabilization disorder. The anterior plate screw technique and posterior lateral mass screw application applied in our clinic are reviewed in literature and are discussed in two cases. Although the best clinical results are achieved in cases where only anterior surgery is performed and in cases where instability is excessive, in unstable compression and blow-out fractures, even if neurological deficit and three colon involvement are not observed in the patient, the requirement of posterior fusion is observed.
E. I. Veliev
Full Text Available In spite of its existing standards, the treatment of patients with progressive prostate cancer (PC remains a matter of debate. Ensuring that the patients have good quality of life is also relevant. The paper describes a clinical case of a patient with progressive PC after hormone therapy, brachytherapy, salvage prostatectomy, enucleation of the testicular parenchyma, and salvage lymphadenectomy. A phallic prosthesis and an artificial urinary sphincter have been implanted to improve quality of life. The results of preoperative examination and the technological features of surgical interventions are given.
Foramen magnum meningioma foramen magnum meningioma (FMM) represents 2% all of meningiomas. The clinical symptomatology is usually insidious and consists of headache, neck pain and hypoesthesia in C2 dermatome. Because of their location, the management is challenging. The purpose of this paper is to present our experience in the surgery of FMM. Since 1938, numerous series have been published but they are very heterogeneous with high variability of location and surgical approaches. During two years, we operated 5 patients with FMM. All the patients had magnetic resonance imaging (MRI) with angio-MRI to study the relationship between tumour and vertebral artery (VA). In all the cases, we used prone position. In one case, considering the tumour localization (posterior and pure intradural) the tumour was removed via a midline suboccipital approach with craniotomy and C1-C2 laminectomy. In all other cases, meningiomas were posterolateral (classification of George) with extradural extension in one case. In all cases, VA was surrounded by tumor. So, we opted for a modified postero-lateral approach with inverted L incision, craniotomy and C1-C2 laminectomy without resect occipital condyle. Epidural part of VA was identified and mobilized laterally. Once VA was identified we opened dura mater and began to remove the tumour. In this paper, we present five cases of operated FMM, describe our approaches, the reason of each approach and propose some surgical remarks.
Rout, Manas Ranjan; Mohanty, Diganta; Vijaylaxmi, Y; Bobba, Kamlesh; Metta, Chakradhar
Adenoid hypertrophy is common in children. Size of the adenoid increases up to the age of 6 years, then slowly atrophies and completely disappears at the age of 16 years. Adenoid hypertrophy in adults is rare. Present study shows that adenoid hypertrophy is now increasing in adults because of various causes. Study has been conducted in the Department of ENT and Head & Neck Surgery, Alluri Sitarama Raju Academy of Medical science, Eluru, Andhra Pradesh, India. Study shows that incidence of adenoid hypertrophy is increasing as the cause of nasal obstruction in adults. This study identified the different causes of adenoid hypertrophy in adult patients. The common causes of adenoid hypertrophy in adults are chronic infection and allergy. Pollution and smoking are also important predisposing factors. Sometimes it is also associated with sinonasal malignancy, lymphoma and HIV infection. Study shows that 21 % of adult nasal obstruction is due to adenoid hypertrophy. But in case of the patient with chronic tonsillitis only 9 % were associated with adenoid hypertrophy. Males are more commonly involved (70 %) then female, may be because of out door activities and more commonly exposed to pollutants. And most commonly involved age group is 16-25 years (60 %). Majority of the cases with adenoid hypertrophy are associated with infection and allergy i.e. descending infection in 33.3 % cases, ascending infection in 20 % cases and allergic rhinitis in 30 % cases. Association of malignant sinonasal tumors, non Hodgkin's lymphoma and HIV infections are rare i.e. 3.3 % each. So any cases of adult adenoid hypertrophy should be treated seriously to exclude the dangerous causes.
Full Text Available We describe two cases of spontaneous pneumothorax in young healthy adults with no underlying structural lung disease. The onset of pneumothorax was following physical activity including playing musical instruments and blowing of balloons. There is sparse data evaluating the pathophysiology of primary spontaneous pneumothorax in relation to increased mouth pressures. These cases highlight the possible physical effect of valsalva manoeuvre on transpulmonary pressures, and the potential risk of developing pneumothorax in otherwise healthy individuals. This aspect of pneumothorax development is worthy of further exploration, to better elucidate the mechanism and enhance our understanding of this common respiratory presentation.
Elgallali, N; El Euch, D; Cheikhrouhou, R; Belhadj, S; Chelly, I; Chaker, E; Ben Osman, A
Mycetoma is a chronic infection of cutaneous and subcutaneous tissue that can be caused by fungi or bacteria. It is endemic in tropical and subtropical areas but rare in Tunisia. The purpose of this report is to describe epidemioclinical features, treatment and outcomes in patients presenting mycetoma in Tunisia. The files of all patients treated for mycetoma in the Dermatology Department of La Rabta Hospital in Tunisia from 1982 to 2006 were retrospectively reviewed. A total of 15 cases of mycetoma were recorded during the study period. There were 6 men and 9 women with a mean age of 53.2 years. The most common clinical presentation was infiltrated erythematous plaques with sinus tracts (fistulas). Lesions were located on the foot in 12 cases. Thirteen patients reported the presence of grains in fluid discharging from fistulas. The cause of mycetoma was actinomycetes, i.e., Actinomadura madurae, in 9 cases and fungus in 6 cases including 3 due to Madurella mycetomi and 2 to Pseudallesheria boydii. Treatment was based on oral antibiotics for actinomycetoma and oral antifungals for eumycetoma. Mycetoma in Tunisia is still uncommon with a slight female predominance. The foot is the most frequent location. Diagnosis can be accomplished by direct mycologic examination, culture, and histololgy. There is no consensus on treatment that is often prolonged with numerous relapses.
RS Walmsley; Yuk-Tong Lee; Joseph JY Sung
AIM: Dieulafoy's lesion (DL) accounts for 1-5.8% of cases of acute upper gastrointestinal bleeding (GIB). Its mortality is high, approaching 20%, despite recent advances in endoscopic therapy. We aimed to report our experience in the treatment of DL.METHODS: A retrospective case study of all patients with DL between January 1993 and January 2003 was done. Characteristics, treatment methods, success rates and 30-d mortality of the patients were analyzed. RESULTS: Thirty-six patients were noted to have DL in the study period. Thirty-three records were available for assessment in which 35 DL were identified. The median age of the patients was 67 years with male to female ratio of 5.6:1. Significant comorbidities existed in 69% of the patients. Eighty-nine percent of the DL was found at first endoscopy, three DL at laparotomy. Significant coexistent endoscopic findings existed in 23%. Hemostasis was achieved in 88% by using adrenaline injection, or in combination with heater probe application at first endoscopy. Four cases had re-bleeding, all were successfully treated endoscopically. The 30-d mortality rate was 23%.CONCLUSION: Successful endoscopic hemostasis could be achieved in 100% of cases of DL. The overall mortality may still remain high, mainly due to the comorbidities and age of these patients.
Oct 24, 2013 ... of 96 mg/dl and she was to continue physiotherapy as an out‑patient for ... poor, with amputation, disability and even death occurring in some cases. ... vascular disease nor peripheral neuropathy appears to play a substantial ...
This case series details experience of four paediatric patients with SCD who underwent corrective cardiac surgery at Red ..... Increased LV stroke volume, increased cardiac output & heart rate ... Hydroxyurea treatment may cause bone marrow.
Chuanyu, Sun; Ke, Xu; Jie, Zheng; Guowei, Xia; Zujun, Fang
Penile verrucous carcinoma is a rare, well-differentiated and low-grade tumor. The surgeons are deficiently aware about the biological behavior and the clinicopathological characteristic of this disease, which raises difficulties during the treatment. In our present study, the clinical and pathological data of 11 patients with penile verrucous carcinoma, aged between 49 to 85 years was retrospectively analyzed. The tumors exhibited exophytic, papillary, caulifower-like or verrucose lesions of great dimensions measuring between 2 to 10 cm on the penises. The tumors were located at glans in 6 cases, invaded the coronoid sulcus in 4 cases and invaded the shaft of the penis in 1 case. Eight cases underwent partial penectomy, while the other 3 were treated with local excision. The diagnosis of penile verrucous carcinoma was confirmed by histopathologic examination of the specimens with the negative surgical margins in all the cases. Within the period of 12 to 60 months of follow-up, all the patients were disease-free with no case of recurrence and metastasis. The novel knowledge and experience of the treatment of penile verrucous carcinoma will be a useful clinical guide for surgeons in the future. PMID:22346275
Full Text Available Kartagener′s syndrome is a rare, autosomal recessive genetic ciliary disorder comprising the triad of situs inversus, chronic sinusitis, and bronchiectasis. The basic problem lies in the defective movement of cilia, leading to recurrent chest infections, ear/nose/throat symptoms, and infertility. We hereby report three unusual cases of this rare entity - an infertile male with azoospermia in whom Bochdalek′s diaphragmatic hernia coexisted, another case of an infertile female, and a third of an infertile male with oligospermia. The need for a high index of suspicion to make an early diagnosis cannot be overemphasized in such patients so that wherever possible, options for timely treatment of infertility may be offered and unnecessary evaluation of symptoms is avoided.
Khatib, Nur; Knyazer, Boris; Lifshitz, Tova; Levy, Jaime
We present four young patients with acute severe solar retinopathy after observation of the total eclipse on January 4, 2011 without appropriate eye protection. Funduscopic findings were accompanied by optical coherence tomography (OCT) investigation of the macula. All our patients were young (range 14-29 years). In three of the four patients we have been able to repeat OCT evaluation revealing that the retinal changes were reversible, but delineating mild pathology in the retinal pigment epithelium and photoreceptors. Best-corrected visual acuity in the fourth case was 6/24. In addition, macular edema, which has been previously described in literature, could not be demonstrated by OCT. In the two cases we performed an early fluorescein angiogram, no pathology was seen.
Narvid, Jared; Amans, Matthew R; Cooke, Daniel L; Hetts, Steven W; Dillon, William P; Higashida, Randall T; Dowd, Christopher F; Halbach, Van V
Retroclival hematomas are rare, appearing mostly as posttraumatic phenomena in children. Spontaneous retroclival hematoma (SRH) in the absence of trauma also has few descriptions in the literature. None of the reported clinical cases features the combination of an SRH and intraventricular hemorrhage (IVH). Nevertheless, despite extensive cases of idiopathic or angiographically negative subarachnoid hemorrhage (SAH) of the posterior fossa, only a single case report of a patient with a unique spontaneous retroclival hematoma has been identified. In this study, the authors reviewed the presentation, management, and clinical outcome of this rare entity. The authors performed a retrospective analysis of all patients with diagnosed SRH at their institution over a 3-year period. Collected data included clinical history, laboratory results, treatment, and review of all imaging studies performed. Four patients had SRH. All were appropriately evaluated for coagulopathic and/or traumatic etiologies of hemorrhage, though no etiology could be found. Moreover, all of the patients demonstrated SRH that both clearly crossed the basioccipital synchondrosis and was contained within a nondependent configuration along the retroclival dura mater. Spontaneous retroclival hematoma, often associated with IVH, is a rare subtype of intracranial hemorrhage frequently recognized only when MRI demonstrates compartmentalization of the posterior fossa hemorrhage. When angiography fails to reveal an underlying lesion, SRH patients, like patients with traditional angiographically negative SAH, enjoy a remarkably good prognosis.
Takeuchi, Satoru; Tanikawa, Rokuya; Tsuboi, Toshiyuki; Noda, Kosumo; Miyata, Shiro; Ota, Nakao; Hamada, Fumihiro; Kamiyama, Hiroyasu
Intracranial osteomas completely unrelated to osseous tissues are extremely rare. In the present study, the case of a 40-year-old female who presented with persistent headache is reported. Computed tomography (CT) and bone window CT revealed an ossified lesion in the frontal area. Fast imaging employing steady-state acquisition (FIESTA)/CT venography fusion imaging demonstrated that the mass was located just below the superior sagittal sinus and cortical veins, and had adhered partially to these veins. Surgery achieved complete tumor removal with preservation of the cortical veins and superior sagittal sinus. The histological examination findings were compatible with osteoma. The present postoperative course was uneventful. The present rare case of intracranial osteoma originating from the falx was successfully treated surgically. Preoperative FIESTA/CT venography fusion imaging was very useful to demonstrate adhesion between the tumor mass and the superior sagittal sinus and cortical veins. PMID:27588144
We courried out a retrospective study of 52 surgical cases of temporomandibular joint ankylosis, fibrous types I and II in 19 patients (36.4%) and osseous type III-IV in 33 patients (63.6%). Forty two children and teenagers at the Hospital de Pediatria (1983-1985/1989-1998) and Hospital General La Raza (1985-1989) were included also, 10 adults including those operated on at the Hospital de Especialidades, CMN Siglo XXI (IMSS) from 1998 to 2001 were included. We used Dunn modified method en 37 cases (67%) and 17 patients were with Risdon operated on technique (33%). Etiology of ankylosis were direct trauma to jaw, which affected temporomandibular joint mainly in children, while in adults causes were more varied and included as osteomyelitis, middle ear infection, sequels of hemifacial microsomy, and trauma results were considered as good upon obtaining mouth opening of 35 mm without neo-ankylosis during 1-year postoperative control.
Whitaker, Heather J; Hocine, Mounia N; Farrington, C Paddy
The self-controlled case series method is increasingly being used in pharmacoepidemiology, particularly in vaccine safety studies. This method is typically used to evaluate the association between a transient exposure and an acute event, using only cases. We present both parametric and semiparametric models using a motivating example on MMR vaccine and bleeding disorders. We briefly describe approaches for interferent events and a sequential version of the method for prospective surveillance of drug safety. The efficiency of the self-controlled case series method is compared to the that of cohort and case control studies. Some further extensions, to long or indefinite exposures and to bivariate counts, are described.
Santos-Bueso, Enrique; Serrador-García, Mercedes; Porta-Etessam, Jesús; Rodríguez-Gómez, Octavio; Martínez-de-la-Casa, José M; García-Feijoo, Julián; García-Sánchez, Julián
Introduccion. El sindrome de Charles Bonnet (SCB) es un cuadro clinico que se caracteriza por la presencia de alucinaciones visuales, principalmente complejas, en pacientes con estado cognitivo conservado e importante deterioro de la vision. El incremento del SCB se debe al aumento de la esperanza de vida y al desarrollo de patologias asociadas al envejecimiento, como la degeneracion macular asociada a la edad. Pacientes y metodos. Se estudian las caracteristicas de una serie de 45 pacientes diagnosticados de SCB en la unidad de neurooftalmologia del Hospital Clinico San Carlos. Los pacientes procedian de las unidades de patologia macular, glaucoma, superficie ocular y urgencias, en las que fueron diagnosticados de SCB, que se confirmo en la unidad multidisciplinar formada por oftalmologia, neurologia y psiquiatria del mismo hospital. Resultados. El 66,66% eran mujeres, de mas de 80 anos (68,88%), principalmente con degeneracion macular asociada a la edad (37,77%). Las alucinaciones que los pacientes presentaban con mas frecuencia eran personas y caras (35,55%), en color (66,66%), en movimiento (80%), con un tiempo de evolucion de 6-12 meses (26,66%), frecuencia de tres episodios al dia (35,55%) y de 3-5 minutos de duracion (35,55%). Conclusiones. El SCB es un complejo sindrome cuya incidencia se esta incrementando en nuestras consultas y que precisa un abordaje multidisciplinar entre oftalmologos, neurologos y psiquiatras para evitar diagnosticos erroneos y proporcionar un tratamiento adecuado. Son necesarios nuevos estudios para un conocimiento mas profundo y adecuado del SCB.
Full Text Available Some drugs have been known to damage to esophagusfor a long time. Half of the cases reported are of tetracyclineand its derivatives. The damage caused by thesedrugs is depends on the drug itself and the patient.In this paper we present 5 patients having diagnosedesophageal damage endoscopically after due to doxycyclinuse. The mean age of the patients was 26 years.Three of them for acne and 2 for heir complaints gynecologicalinfection were taking these drugs. Lesions werelocated at the middle in 4 cases and lover part in 1 patient.The common complaint was retrosternal pain and heartburnafter taking the drug with insufficient water or withoutwater. All the patients were relieved by symtomatic teratment.Esophageal damage is to be remembered in patientscomplaning sudden pain and difficult swallowing on doxycyclintreatment and endoscopic procedure should beemployed for definition of diagnosis and evaluation of theseverity of the damage. After treatment, endoscopic controlis not necessary. Physicians must not forget to advicethe patients to take these drugs with splendid amount ofwater.Key words: Doxycycline, esophagus damage, endoscopy
Braun, Karl F; Pohlig, Florian; Lenze, Ulrich; Netter, Clemens; Hadjamu, Miriam; Rechl, Hans; von Eisenhart-Rothe, Rüdiger
Radiation therapy plays an essential part in modern treatment regimes of musculoskeletal tumors. Nevertheless damage to the surrounding tissue does occur inevitably. Postradiogenic changes of bone are associated with decreased stability and an increased fracture rate. The orthopedic surgeon therefore faces a challenging situation with altered bone metabolism, changes in perfusion and soft tissue problems. We present 3 cases of radiation induced fractures during the treatment of soft tissue tumors, all of which received radiation doses of > 58 Gy. All fractures occurred over 1 year after the exposure to radiation in otherwise uneventful follow ups. Postoperative follow up showed fracture healing or in the case of the arthroplasty, osseous integration without further complications. Radiation doses of ≥ 58 Gy are a major risk factor for pathological fractures in long bones. Regardless of their low incidence, fracture rates between 1,2 and 6,4 % prove their importance. Local tumor control has therefore to be weighed against the resulting decrease in bone quality and stability. Treatment options should always take into consideration the increased risk for complications such as infection, pseudarthroses and wound healing disorders. Our results show that substitution of vitamin D and calcium as well as the the use of reamed intramedullary implants benefits the outcome.
Full Text Available Background. Vascular anomalies in the hand do not occur frequently. Their presence in the metacarpal region can cause different functional disorders. The extent of such disorders directly depends on the localization and size of vascular anomalies, duration and the nature of the anomaly growth as well as on eventual secondary complications such as ulceration or bleeding. The aim of this case report was to show the specifics in the clinical picture, pathogenesis and evolution of such anomalies, applied diagnostic procedures (radiography, ultrasound, magnetic resonance, electromyography and surgical treatment as well as postoperative functional results. Case report. In the Clinic for Plastic Surgery and Burns, Military Medical Academy Belgrade, two patients were treated surgically for vascular anomalies of the middle palmar region of the hand. The first patient, a 36-year-old male, a former active sportsman (professional handball player was treated for acute increase in the vascular anomaly of hand in the metacarpal region and proximal phalange of III and IV fingers of his right hand. The anomaly was detected 6 months prior to his hospitalization while two weeks before the hospitalization there was a sudden growth and increase in the change. The second case, a 15-year-old male patient actively pursuing a career in professional basketball was treated for a tumor localized in the metacarpal zone of his left hand. According to the information provided by his parents, the anomaly had been present since his birth. Initially, the anomaly manifested itself as a discoloration of the skin with a marked capillary drawing, gradually increasing throughout the last five years to the present dimension. The growth of the malformation was noticed to coincide in both patients with more active pursuit of their professional sports career. Conclusion. The clinical picture of hand vascular anomalies is dominated by the symptoms of compression of neurovascular
Cavayero, Chase; Kar, Pran; Kar, Sunny
Although originally considered to be uncommon, Takotsubo cardiomyopathy is becoming increasingly visible, annually comprising an increasing portion of suspected diagnoses of acute coronary syndrome. This condition is characterized by reversible left ventricular akinesis without significant coronary artery obstruction. This case study presents five patients diagnosed with Takotsubo cardiomyopathy, as confirmed by echocardiogram and angiography. All of the patients presented with classic myocardial chest pain and elevated troponins. Following diagnosis, they were treated with supportive measures, particularly angiotensin-converting enzyme inhibitors, and beta-blockers. All patients made a full recovery. Though the mechanism of Takotsubo has not been fully elucidated, hypotheses suggest it may be related to excessive catecholamine levels causing either myocardial stunning or coronary vasospasm. Recognition and understanding of this unusual pathology are essential because it can lead to improved clinical management. PMID:27446769
Al-Saran Khalid A
Full Text Available Abstract Fertility is markedly reduced in patients with chronic renal failure. For women with pre-existing renal disease, pregnancy is associated with an increased rate of fetal complications and a considerable risk of renal disease progression. Due to substantial improvements in antenatal and neonatal care, fetal outcome has improved considerably in the last two decade. A Saudi survey which examined the frequency of pregnancy among women in end stage renal disease (ESRD and undergoing regular hemodialysis (HD, showed an incidence of 7% over a five year period (1.4 per year. This may reflect the cultural endorsement of having offspring. We hereby report 2 cases of successful pregnancy managed at the Prince Salman Center for Kidney Diseases (PSCKD.
Stitik, T P; Nadler, S F; Foye, P M
Cervical radiculopathy can be diagnosed on physical examination with the Spurling test, which narrows neural foramina via neck extension along with coupled rotation and side-bending. In the presence of cervical radiculopathy, this test can reproduce radicular symptoms by transmitting compressive forces to affected nerve roots as they traverse the neural foramina. Treatment of cervical radiculopathy includes patient education to avoid obvious postures that exacerbate radicular symptoms and to assume positions that centralize discomfort. A potentially harmful position to which many patients are unwittingly subjected at least several times per year occurs when their hair is being shampooed in a salon sink before a haircut. This posture causes neck extension and is combined with rotation and side-bending as the patient's head is being manipulated during the shampooing. When the stylist then also applies a mild compressive force while shampooing the patient's hair, hyperextension of the neck is produced. We present two patients with cervical radiculopathy that was significantly exacerbated after the patient's hair had been shampooed in a salon sink; subsequently, these patients required oral administration of steroids. These cases illustrate that patients with suspected or known cervical radiculopathy should be forewarned to avoid this otherwise seemingly innocuous activity.
Lee, Jessica M; Graciano, Ana Lia; Dabrowski, Lukasz; Kuzmic, Brenik; Tablizo, Mary Anne
In contrast to adults, coccidioidomycosis is a rare disease in infants and the mechanisms of disease acquisition are not well described in infants. The purpose of this study was to describe the clinical presentation, treatment, and outcome of pulmonary coccidioidomycosis in infants in an endemic area. We performed a retrospective observational study of all patients less than 12 months of age admitted to a tertiary free standing children's hospital from 2003-2012 diagnosed with coccidioidomycosis. Thirteen infants were hospitalized during the study period. The majority of the patients presented with upper and/or lower respiratory tract infection. The most common presenting symptoms included fever (77%), cough (61%), and respiratory distress (38%). Disseminated disease, included pericardial effusion, neck abscess, and lesions in the cerebellum, basal ganglia and left temporoparietal skull. Fluconazole was the initial, antifungal agent used. Amphotericin B was reserved for significant lung disease and disseminated cases. Failed response to fluconazole and amphotericin B were treated with a combination of voriconazole and caspofungin. Average length of treatment was 4 years. All patients survived to hospital discharge. The majority of the patients had resolution of chest radiograph and coccidiodal complement fixing antibody titers. Infant coccidioidomycosis has a non-specific presentation and can mimic common infant respiratory illnesses. In endemic areas, coccidioidomycosis should be considered in the differential diagnosis of infants with pulmonary symptoms unresponsive to conventional treatment. Pediatr Pulmonol. 2016;51:858-862. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.
WU Qing-yu; XU Zhong-hua
Background Myocardial bridging (MB) is usually considered a benign condition but may result in myocardial ischemia,myocardial infarction (MI), exercise-induced tachycardia, atrioventricular conduction block or even sudden cardiac death.This retrospective study summarizes our operative methods and outcomes for treatment of 31 cases of MB.Methods From January 1997 to December 2006, 31 consecutive patients (24 men and 7 women; aged 35-67 years;mean 52.3 years) with MB underwent surgical treatment. Thirteen patients had MB only and 18 patients had MB associated with other heart diseases. In preoperative cardiac function grading, 5 patients were in NYHA class Ⅰ and 18 in NYHA class Ⅱ and 8 in NYHA class Ⅲ. Among them, 15 underwent myotomy and 16 underwent coronary artery bypass grafting (CABG).Results All patients survived and recovered uneventfully. Neither hospital or late death nor major complications occurred. Postoperative exercise testing in all patients failed to reveal any persistent ischemia. Follow-up time was 3-115 months (mean 31 months). Follow-up angiographic studies in 21 patients (68%) demonstrated restoration of coronary blood flow and myocardial perfusion without significant residual compression of the artery. All patients were symptom-free and currently in NYHA class Ⅰ-Ⅱ.Conclusion The patients who are refractory to medication should actively undergo the surgical procedures such as myotomy and CABG. Myotomy should be advocated as the first choice because of its safety and satisfactory results.
Full Text Available BACKGROUND: Granulomatous lobular mastitis (GLM is an inflammatory disease of the breast, which can mimic breast cancer in clinical and radiological findings. We conducted the present study in order to determine the diagnostic and other important aspects of this disease. METHODS: In this study, we reviewed the records of 38 patients with granulomatous lobular mastitis in order to describe the clinical, imaging, laboratory, pathologic, and treatment aspects of this disease. RESULTS: All of the patients’ ages were in the range of 22-62 years (mean age: 42 years. All of them had children, history of oral contraceptive pill (OCP usage, antibiotic therapy and mammoplasty. In physical examination, dimpling, edema, inflammation, ulcer, abscess, and firm mass were detected. Size of masses was in the range of 2 × 2 to 8 × 6 cm and their location, in most cases, was in the superior lateral quadrant or central region. In Ultrasonography, a hypoechoic fibroglandular mass and collection, and in pathologic findings, granulomatous reaction was reported. These patients were treated by antibiotics, corticosteroids, and surgery. CONCLUSIONS: GLM is a chronic inflammatory lesion of the breast which can mimic breast cancer. A history of child bearing, lactation, and OCP drug usage have suspicious roles in the formation of GLM. The most common clinical sign in these patients is a painful mass in the breast. We uncovered that clinical and radiological findings are not specific and sufficient for diagnosis of GLM. Therefore, for better diagnosis of this disease, usage of core, incisional, or excisional biopsy are recommended.
Full Text Available Abstract Introduction Pica is an unusual condition where patients develop cravings for non-nutritive substances that can cause significant health risks. We report three patients with pica, two of them showing evolutionary changes associated with pica and the third demonstrating a peculiar nature of pica, which has yet to be reported. Case presentation We describe three patients who presented with symptoms of pica. The first patient is a 36-year-old Caucasian woman who had dysfunctional uterine bleeding associated with daily ingestion of two super-sized cups of ice as iced tea. The second patient is a 62-year-old Caucasian man who presented with bleeding from colonic polyps associated with drinking partially frozen bottled water. Lastly, the third patient, a 37-year-old Hispanic woman, presented with dysfunctional uterine bleeding and habitually chewed rubber bands. All three patients presented with hematological parameters diagnostic for iron deficiency anemia. Conclusion Pica has been practiced for centuries without a clear etiology. We have noticed that the younger community of academic and community physicians are not aware of the importance of complaints related to pica. None of our patients we describe here, as well as their primary care physicians, were aware of the importance of their pica related symptoms. Pica symptoms abated in one of our patients upon iron supplementation, while the other two are currently under treatment as of this writing. We believe pica is an important sign of iron deficiency that should never be ignored, and the craving for any unusual substance should compel clinicians to search for occult blood loss with secondary iron deficiency.
Gosau, Martin; Vogel, Corinna; Moralis, Antonios; Proff, Peter; Kleinheinz, Johannes; Driemel, Oliver
A 22-year-old man presented for orthodontic surgery because of mandibular prognathism. Clinical symptoms suggested acromegaly, and diagnosis was verified by an endocrinologist as well as by radiograph. Bilateral mandibular prognathism often represents the first and most striking physical characteristic of acromegaly; usually, it is also the main reason why patients seek help from orthodontists or maxillo-facial surgeons. This case report recapitulates the clinical and histopathological findings in pituitary growth hormone (GH) adenomas and emphasises their importance in surgical orthodontic planning. Mandibular prognatism, macroglossia and abnormal growth of hands and feet represent strong indicators for the diagnosis of acromegaly. This disease and its complications not only affect the entire body but increase mortality if the pituitary gland tumour remains untreated.
Bernaldo Canto Vidal
Full Text Available Rhinophyma is a nose skin disease consisting on a hypertrophy of the local sebaceous glands which leads to a characteristic deformation. It presents with skin hypertrophy, chronic inflammation and increase of the vascular tissue, with multiple telangiectasias y comedones, all of which causes a deformed tip of the nose. It more often affects the male sex and can get to a malignancy. Two patients affected by rhinophyma are presented who were assisted at the maxillofacial service of the General Teaching Hospital Dr Gustavo Aldereguía Lima, Cienfuegos. The surgical technique used in both cases is described. It is a rare disease therefore it is considered of interest for study and dissemination.
Full Text Available Abstract A 22-year-old man presented for orthodontic surgery because of mandibular prognathism. Clinical symptoms suggested acromegaly, and diagnosis was verified by an endocrinologist as well as by radiograph. Bilateral mandibular prognathism often represents the first and most striking physical characteristic of acromegaly; usually, it is also the main reason why patients seek help from orthodontists or maxillo-facial surgeons. This case report recapitulates the clinical and histopathological findings in pituitary growth hormone (GH adenomas and emphasises their importance in surgical orthodontic planning. Mandibular prognatism, macroglossia and abnormal growth of hands and feet represent strong indicators for the diagnosis of acromegaly. This disease and its complications not only affect the entire body but increase mortality if the pituitary gland tumour remains untreated.
刘锦纷; 朱宏斌; 朱德明; 陈玲; 苏肇伉; 丁文祥
Objective A surgical team has performed total correction of Tetralogy of Fallot ( TF) consecutively in 115 patients without surgical death. This paper presents an investigation of how to improve the surgical outcome. Methods This group included 115 children, the ages of these children at operation were from 9 months to 13 years(4.6 ± 2.7 years), 47.8% of whom were younger than 3 years old. Associated anomalies included atresia of main pulmonary artery or unilateral pulmonary artery in 4 cases, atrial septal defect ( ASD ) and patent ductus arteriosus ( PDA ) in 11 cases. All patients have undergone total correction. Ventricular septal defects were closed with Dacron patches. Autologous-pericardial patches were used to enlarge the right ventricular outflow tract and pulmonary arteries. 102 cases (89%) needed transannular patches. Results There was no surgical death and the patients have been followed up for 2 months to 4 years. One child died of cardiac arrhythmia 3 months after operation. The remaining patients recovered well. Conclusion The key points in improving the surgical outcome in TF patients lie in the improvement of surgical technique, total elimination of obstruction of right ventricular outflow tract and distal pulmonary arteries. Attention should be paid to the cardiopulmonary bypass and the postoperative care should also be emphasized.
Hostiuc, Sorin; Rentea, Irina; Drima, Eduard; Negoi, Ionut
Placebo is a form of simulated medical treatment intended to deceive the patient/subject who believes that he/she received an active therapy. In clinical medicine, the use of placebo is allowed in particular circumstances to assure a patient that he is taken care of and that he/she receives an active drug, even if this is not the case. In clinical research placebo is widely used, as it allows a baseline comparison for the active intervention. If the use of placebo is highly regulated in pharmacological trials, surgery studies have a series of particularities that make its use extremely problematic and regarded less favorably. The purpose of this paper is to present three famous cases of placebo use in surgical trials and to perform an ethical analysis of their acceptability using the Declaration of Helsinki as a main regulatory source.
Kolte, Abhay P; Kolte, Rajshri A; Shrirao, Tushar S
Intraoral fibrous overgrowths of the soft tissues are relatively common and may be benign reactive or neoplastic lesions. A series of 10 lesions is presented which included pyogenic granuloma, fibroma and peripheral ossifying fibroma. Almost all the lesions occurred in the second and third decades and were present in the anterior segment of the jaws, with a distinct female predilection. Majority of these lesions were asymptomatic and the patients reported for treatment only due to the discomfort during function. Histopathologic examinations were done for diagnosis of these lesions. Surgical excision along with removal of causative irritants remains the treatment of choice. The extent of excision should depend on the severity of the lesion, as some of these lesions have a tendency for recurrence. All the patients in this series were closely followed up for a period of 2 years and showed no signs of recurrence.
Abhay P Kolte
Full Text Available Intraoral fibrous overgrowths of the soft tissues are relatively common and may be benign reactive or neoplastic lesions. A series of 10 lesions is presented which included pyogenic granuloma, fibroma and peripheral ossifying fibroma. Almost all the lesions occurred in the second and third decades and were present in the anterior segment of the jaws, with a distinct female predilection. Majority of these lesions were asymptomatic and the patients reported for treatment only due to the discomfort during function. Histopathologic examinations were done for diagnosis of these lesions. Surgical excision along with removal of causative irritants remains the treatment of choice. The extent of excision should depend on the severity of the lesion, as some of these lesions have a tendency for recurrence. All the patients in this series were closely followed up for a period of 2 years and showed no signs of recurrence.
Kumar Ravi; Puttanna Manohar; Sriprakash K; Sujatha Rathod B; Prabhakaran Venkatesh
We report a large series of ocular injuries caused by fire-crackers. This study was a hospital-based, singlecenter, retrospective case series in which the records of 51 patients with ocular injuries were analyzed. Injuries were classified according to Birmingham eye trauma terminology system (BETTS). Visual outcomes before and after the intervention were recorded. Ten patients were admitted for further management. As ocular firecracker injuries result in significant morbidity, public educatio...
Illuminati, G; Caliò, F G; D'Urso, A; Papaspiropoulos, V; Mancini, P; Ceccanei, G
Due to the rarity of the condition, large and prospective series defining the optimal method of digestive arteries revascularization, for the treatment of chronic intestinal ischemia, are lacking. The aim of this consecutive sample clinical study was to test the hypothesis that flexible application of different revascularization methods, according to individual cases, will yield the best results in the management of chronic intestinal ischemia. Eleven patients, of a mean age of 56 years, underwent revascularization of 11 digestive arteries for symptomatic chronic mesenteric occlusive disease. Eleven superior mesenteric arteries and one celiac axis were revascularized. The revascularization techniques included retrograde bypass grafting in 7 cases, antegrade bypass grafting in 2, percutaneous arterial angioplasty in 1, and arterial reimplantation in one case. The donor axis for either reimplantation or bypass grafting was the infrarenal aorta in 4 cases, an infrarenal Dacron graft in 4, and the celiac aorta in one case. Grafting materials included 5 polytetrafluoroethylene (PTFE) and 3 Dacron grafts. Concomitant procedures included 3 aorto-ilio-femoral grafts and one renal artery revascularization. Mean follow-up duration was 31 months. There was no operative mortality. Cumulative survival rate was 88.9% at 36 months (SE 12.1%). Primary patency rate was 90% at 36 months (SE 11.6%). The symptom free rate was 90% at 36 months (SE 11.6%). Direct reimplantation, antegrade and retrograde bypass grafting, all allow good mid-term results: the choice of the optimal method depends on the anatomic and general patient's status. Associated infrarenal and renal arterial lesions can be safely treated in the same time of digestive revascularization. Angioplasty alone yields poor results and should be limited to patients at poor risk for surgery.
Vennila, Vijayasree; Madhu, Vasapalli; Rajesh, R; Ealla, Kranti Kiran Reddy; Velidandla, Surekha Reddy; Santoshi, S
Tetracycline was the choice of antibiotic in some of the life-threatening bacterial infections. Due to its adverse effects and ability to cross-placental barrier, its use is contraindicated in pregnancy and in children. This is a case series of four patients with tetracycline-induced discoloration in primary teeth. How to cite the article: Vennila V, Madhu V, Rajesh R, Ealla KKR, Velidandla SR, Santoshi S. Tetracycline induced discoloration of deciduous teeth: Case series. J Int Oral Health 2014;6(3):115-9.
Lambon Ralph, Matthew A; Patterson, Karalyn; Plaut, David C
In this commentary, though acknowledging that a case-series approach in neuropsychology is not always possible, we set out a series of considerations that in our view make this approach generally superior to single-case study. We argue that case-series designs are crucial for theory-testing, assessment of computational models, evaluation of inter-patient variation (including selection criteria, patient homogeneity/heterogeneity, premorbid individual differences, etc.) and to establish solid foundations for the interpretation of behavioural dissociations and associations. We conclude by suggesting that, alongside other neuroscience techniques, case-series cognitive neuropsychology provides a crucial contribution to the future of clinical and cognitive neuroscience.
Ichiki, Yoshinobu; Nagashima, Akira; Yasuda, Manabu; Takenoyama, Mitsuhiro; Toyoshima, Satoshi
Catamenial pneumothorax (CP) is a rare entity of spontaneous, recurring pneumothorax in females. Although it has been known to be associated with thoracic endometriosis, varying clinical course and the lack of consistent intraoperative findings have led to conflicting etiological theories. We herein discuss the etiology, clinical course, and surgical treatment of three patients with CP. Three females (aged 40 years, 28 years, and 34 years) had recurrent right-sided spontaneous pneumothoraces that coincided with their menses. They had undergone video-assisted thoracoscopic surgery (VATS) previously. Blueberry spots in the right diaphragm were detected in all three cases. Two patients had recurrence, postoperatively. The other patient, who received luteinizing hormone-releasing hormone analog therapy for an abdominal endometriosis in the perioperative period and postoperative chemical pleurodesis to prevent recurrence, has been free of recurrence for 15 months, postoperatively. However, pelvic endometriosis was detected in this patient only. Therefore, CP should be suspected in ovulating females with spontaneous pneumothorax, even in the absence of any symptoms associated with pelvic endometriosis. In addition, while performing VATS, careful inspection of the diaphragmatic surface is important. In complicated cases, hormonal suppression therapy and chemical pleurodesis might also be helpful adjunct modalities.
Full Text Available Catamenial pneumothorax (CP is a rare entity of spontaneous, recurring pneumothorax in females. Although it has been known to be associated with thoracic endometriosis, varying clinical course and the lack of consistent intraoperative findings have led to conflicting etiological theories. We herein discuss the etiology, clinical course, and surgical treatment of three patients with CP. Three females (aged 40 years, 28 years, and 34 years had recurrent right-sided spontaneous pneumothoraces that coincided with their menses. They had undergone video-assisted thoracoscopic surgery (VATS previously. Blueberry spots in the right diaphragm were detected in all three cases. Two patients had recurrence, postoperatively. The other patient, who received luteinizing hormone-releasing hormone analog therapy for an abdominal endometriosis in the perioperative period and postoperative chemical pleurodesis to prevent recurrence, has been free of recurrence for 15 months, postoperatively. However, pelvic endometriosis was detected in this patient only. Therefore, CP should be suspected in ovulating females with spontaneous pneumothorax, even in the absence of any symptoms associated with pelvic endometriosis. In addition, while performing VATS, careful inspection of the diaphragmatic surface is important. In complicated cases, hormonal suppression therapy and chemical pleurodesis might also be helpful adjunct modalities.
Namdeoraoji Bahadure, Rakesh; Surendraji Jain, Eesha; P Badole, Gautam
Gorlin and Goltz syndrome are a very complex syndrome and a multisystemic process that is characterized by the presence of multiple pigmented basocellular carcinomas, keratocysts in the jaws, palmar and/or plantar pits and calcification of the falx cerebri. Along with these major features a great number minor features have also been described which involves numerous skeletical, dermatology related, neurological, ophthalmological and reproductive anomalies. It exhibits high penetrance and variable expressivity. Presented here is the case of Gorlin-Goltz in a 12 years old male patient which was diagnosed through its oral and maxillofacial manifestations. Treatment of odontogenic keratocyst was done by enucleation without primary suturing. Iodoform dressing was kept to enhance the healing and to reduce the recurrence of the lesion. It is important to provide the early diagnosis for detection of clinical and radiological manifestations in young patients and for provision of advice concerning preventive treatment like protection of the skin from the sunlight and genetic sensitivity testing so that possible complications associated with this syndrome can be prevented. How to cite this article: Bahadure RN, Jain ES, Badole GP. Gorlin and Goltz Syndrome: A Case Report with Surgical Review. Int J Clin Pediatr Dent 2013;6(2):104-108.
This syndrome, which involves nerve compression, is probably often overlooked and is, therefore, more frequent than supposed. It is characterized by pain of the forefoot, especially the 3rd and 4th toe, and is induced by pressure of the intermetatarsal space, or extension of the metatarsophalangeal joints. Results of the present study suggest that it can be successfully treated by surgery. Fifty-four patients--mostly women in midlife--had undergone operation by dorsal excision of the "neuroma" which had been performed under local anaesthesia in a bloodless field. Forty of the patients (74.1%) had recovered completely within an observation period of 1-6 years. Four (7.4%) demonstrated significant, and another 4, only slight improvement. In 6 cases (11.1%), surgery failed. The 6 unsuccessful cases had not exhibited any preoperative disturbance to the sensibility of the 4th toe. They showed, rather, symptoms of conversion disorder with depressive features, e.g. increased nocturnal suffering which is atypical for Morton's metatarsalgia. It is concluded that the accuracy of diagnosis according to strict criteria is decisive for surgical outcome.
Kar, Sushil; Tripathi, Arvind; Madhok, Riti
There are various indications that may necessitate partial or complete resection of the mandible, from trauma to congenital deformities. However, the most prevalent indication that requires surgical resection of the mandible along with the involved adjacent oral structures is the presence of a locally aggressive neoplastic growth. The resultant continuity defect leads to an alteration in the range and direction of mandibular movement, impedes clear articulation of syllables and cosmetic disfigurement. The role of a prosthodontist is paramount in bringing about the restoration of the esthetic and functional dysfunction. This article discusses a series of hemimandibulectomy cases wherein mandibular deviation was successfully corrected using guide-flange prosthesis. PMID:26981486
Yadlapati, Ajay; Sweis, Ranya; Schimmel, Daniel
We describe a case series of 3 patients presenting with intracardiac thrombi treated with standard anticoagulation therapy and intervention with ultrasound-accelerated thrombolysis therapy. Right-sided intracardiac thrombi portend significant mortality due to their susceptibility for embolization and pulmonary embolus despite the continuation of current standard of therapy of parenteral anticoagulation and surgical embolectomy if warranted. We demonstrate the safety and clinical efficacy of ultrasound-accelerated thrombolysis therapy with the EkoSonic Endovascular System infusion catheter system (EKOS Corporation) and highlight its use in resolving intracardiac thrombi and impeding the propagation of pulmonary emboli.
Full Text Available The main objective of presenting the case series is that despite dramatic symptomatic response by intra venous lorazepam or electro convulsive therapy irrespective of primary diagnosis in catatonia cases some cases remain difficult to treat by conventional treatment. Here, we present five catatonia cases who did not respond to conventional treatment even when treated for primary psychiatric diagnosis along with treatment for catatonia. They ultimately responded partially or completely to clozapine only, which explains the multi-factorial causation of catatonia syndrome as postulated by different scientific research.
Singh, Kern; Park, Daniel K
Circumferential arthrodesis and reconstruction is necessary after a lumbar corpectomy in the setting of malignancy and infection. The advent of expandable cage technology now allows for safe anterior column reconstruction via a posterior approach with no transection and minimal retraction of the lumbar spinal nerve roots. Fifteen patients underwent a single-stage, circumferential corpectomy and anterior spinal reconstruction with an expandable cage via a midline, posterior, lateral lumbar extracavitary approach. Posterior segmental pedicle screw fixation and iliac crest bone graft was used in all cases. Fifteen lumbar extracavitary corpectomy nerve root-sparing procedures have been performed to date, with at least 1-year follow-up (12 tumors/3 infections). No patient suffered any neurological complications. One patient suffered from a postoperative myocardial infarction 10 days after the procedure. Two patients had medical complications that were treated without sequelae. We present a technical description and case series of patients undergoing a single-stage, circumferential corpectomy and anterior spinal reconstruction with an expandable cage via a midline, posterior, lateral lumbar extracavitary approach with at least 1-year follow-up. The technique is safe, technically feasible, and obviates an anterior approach in this oftentimes critically ill patient population.
Full Text Available Fahr′s disease is characterized by basal ganglia calcification with clinical manifestations in the form of neuropsychiatric disorders, neurological symptoms, and cognitive symptoms. In this case series, we describe two cases of basal ganglia calcification, one of whom presented with psychotic symptoms and the other with mood symptoms, and discuss the literature with regard to psychiatric manifestations of basal ganglia calcification.
Larralde, Margarita; Solé, Juan Javier; Luna, Paula Carolina; Mosquera, Tomás; Abad, María Eugenia
Rapidly involuting congenital hemangiomas are very rare vascular tumours, that are characterized for being completely developed at birth and for involuting in a short period of time after birth. We describe a case series of 25 patients with rapidly involuting congenital hemangiomas. Twelve patients were male and 13 female; they were all born at term. Lesions were small in 17 cases and big in 8. No patient needed active intervention and all lesions showed a rapid initial involution.
Full Text Available Kaposi's varicelliform eruption is a rare and potentially fatal viral infection caused mainly by reactivation of herpes simplex virus. It concomitantly occurs with pre-existing skin conditions, mostly atopic dermatitis, so it is predominately found in children. We present a case series that includes four adults, familial cases, and previously healthy patients. We also highlight clinical features, associations and therapeutic options.
The case series approach in cognitive neuropsychology provides a means to test theories that make quantitative predictions about associations between different components of the cognitive system [Schwartz, M. F., & Dell, G. S. (2010). Case series investigations in cognitive neuropsychology. Cognitive Neuropsychology, 27, 477-494]. However, even when the predicted association is borne out the study may include outliers-observations that deviate significantly from the rest of the data. These outliers may reveal individual cases whose cognitive impairments dissociate from other cases included in the study. These dissociating cases can pose a significant challenge to the theory being tested. Using a recent case series that investigated the underlying causes of letter perseveration in spelling [Fischer-Baum, S., & Rapp, B. (2012). Underlying cause(s) of letter perseveration errors. Neuropsychologia, 50, 305-318], I discuss statistical and theoretical issues that arise when using outlier detection techniques to identify dissociating cases in a case series study.
Cauvin, E R; Munroe, G A
Eighteen cases of septic osteitis of the distal phalanx were diagnosed clinically and confirmed at surgery over a 6 year period (1990-1996). Focal bone lysis was the most common radiographic finding. Sequestra were identified in 4 horses, one of which was associated with a fractured plantar process. All the horses were treated surgically with open debridement. The septic process recurred in 4 horses: one was subjected to euthanasia due to navicular bursa infection, secondary to a pathological fracture, the other 3 horses responded to further debridement. A pathological fracture occurred in another horse. All the survivors were not lame 3 months post operatively, although complete healing took 1-12 months. Long term follow up was available in 14 cases. One was retired, all the other horses were back in work at a similar level of performance. This series indicates that surgical treatment of septic pedal osteitis carries a fair to good prognosis despite a high rate of post operative complications and convalescence period of up to 12 months.
case series of five patient's along with the review of literature is presented here. Keywords: ... underwent a renal transplant biopsy to ascertain the cause of ... A 16-year-old male presented in March 2002 with a fever of unknown origin and splenomegaly. ... There was no evidence of tuft necrosis/crescent formation or.
Hampton, Rachael L; Scully, Crispian; Gandhi, Shan; Raber-Durlacher, Judith
This is a retrospective case series of 6 patients complaining of a bad taste (cacogeusia) specifically metallogeusia, following the ingestion of pine nuts.(1) The taste arose always within 48h of ingestion, and in all but one patient spontaneously resolved within 14 days. Pine nuts also have a potential for triggering anaphylaxis.(2).
Gustavo Pereira Fraga
Full Text Available CONTEXT AND OBJECTIVES: Significant controversy exists regarding the best surgical treatment for complex duodenal injuries. The aims of this study were to report on a series of eight cases of duodenal repairs using pyloric exclusion and to describe reported complications or improvements in clinical outcomes among patients with complex duodenal trauma. DESIGN AND SETTING: Cross-sectional study followed by a case series in a university hospital. METHODS: Data on eight patients with duodenal trauma who underwent pyloric exclusion over a 17.5 year period were collected and analyzed. RESULTS: The causes of the injuries included penetrating gunshot wounds (GSW in five patients and motor vehicle accidents (blunt trauma in three patients. The time elapsed until surgery was longer in the blunt trauma group, while in one patient, the gunshot injury was initially missed and thus the procedure was carried out 36 hours after the original injury. The injuries were grade III (50% or IV (50% and the morbidity rate was 87.5%. Four patients (50% died during the postoperative period from complications, including hypovolemic shock (one patient, sepsis (peritonitis following the missed injury and pancreatitis with an anastomotic fistula (two patients. CONCLUSIONS: Pyloric exclusion was associated with multiple complications and a high mortality rate. This surgical technique is indicated for rare cases of complex injury to the duodenum and the surgeon should be aware that treatment with a minimalistic approach, with only primary repair, may be ideal.
TANG Yang-feng; XU Ji-bin; HAN Lin; LU Fang-lin; LANG Xi-long; SONG Zhi-gang; XU Zhi-yun
Background Congenital quadricuspid aortic valve is rarely seen during aortic valve replacement (AVR).The diagnosis and treatment of the disease were reported in 11 cases.Methods Eleven patients (nine men and two women,mean age 33.4 years) with quadricuspid aortic valve were retrospectively evaluated.Medical records,echocardiograms and surgical treatment were reviewed.Results In accordance with the Hurwitz and Roberts classification,the patients were classified as type A (n=2),type B (n=7),type F (n=1) and type G (n=1).Three patients were associated with other heart diseases,including infective endocarditis and mitral prolaps,left superior vena cava,aortic aneurysm.All had aortic regurgitation (AR) except two with aortic stenosis (AS),detected by color-flow Doppler echocardiography.The congenital quadricuspid aortic valve deformity in seven patients was diagnosed by echocardiography.All patients underwent successful aortic valve replacement.Conclusion Quadricuspid aortic valve is a rare cause of aortic insufficiency,while echocardiography plays an important role in diagnosing the disease.Aortic valve replacement is the major therapy for the disease.
Phuwapraisirisan, Samart; Lim, Meechai; Suwanthanma, Weerapat
A 27-year-old Thai male was admitted with left groin pain and he felt that he lost his left testis three weeks after his motorcycle accident-car collision. He had not been diagnosed after four days of admission at the previous hospital. Surgical reduction was performed without acute and delayed complications after three months of follow-up. Traumatic testicular dislocation is an uncommon sequel of trauma usually related to straddle injury from motorcycle accidents. Diagnosis depends on the awareness of the physician of its possibility of occurrence. Physical examination is the most helpful in diagnosis. CT scan or Doppler ultrasound, if available, may be helpful in diagnosis, particularly locating the extrascrotal testicle and detecting testicular viability. Manual reduction is the treatment of choice for acute traumatic dislocation of testis. Open reduction is indicated for the delayed case, or if there are (1) difficulty in determining the integrity of dislocated testis, (2) possibility of torsion, (3) failure of close reduction, or (4) the minimal morbidity of an inguinal exploration.
Javier Fernando Rivas Guerrero
Full Text Available Hemivertebra is a congenital malformation, that affects small and brachicephalic breeds particularly those with short and twisted tail. Its origin is hereditary. It becomes from an inappropriate or incomplete embryo development of a vertebrae or due to its vascularization or ossification. Hemivertebras are cuneiform vertebrae and its vertex may be lead dorsally, ventrally or medianly through the mean line. It happens mostly in thoracic vertebras. Symptomatology is varied; the most important is pain, showed by young animals, three or four months of age with weakness of posterior limbs. It could be found pain at back when palpations near the hemivertebra. In puppies with those symptoms, the paralysis in posterior limbs gets worse; they can show muscular atrophy, and no control of bladder and intestines. Final diagnostic of hemivertebra must be done with radiological studies of spinal column and the treatment consists in decompress the vertebral body involved and a stabilization of the spinal column. This study presents the case of a male Bulldog, six months old, which is taken to the clinic because of pain, and neurological symptomatology and after many clinical exams a hemivertebra was confirmed. The patient had a surgery for its treatment and all steps of the surgical process are shown.
Doyle Ronan S
Full Text Available Over a seven-year period, chronic otitis externa was surgically managed in 43 dogs at the University Veterinary Hospital of University College Dublin. Lateral ear canal resection (LECR was undertaken in nine of the 43 dogs: results were unsatisfactory, with a failure of the surgery in five of eight dogs and one dog lost to follow-up. Once end-stage otitis externa, with or without otitis media, is diagnosed, total ear canal ablation and lateral bulla osteotomy (TECA/LBO is the best treatment option. In this series, 37 of 43 dogs underwent TECA/LBO and of the 29 dogs for which follow-up results were obtained 27 (93% had an excellent or improved outcome to surgery. Complications following all procedures were most common in cases with a concurrent dermatopathy; therefore, definitive diagnosis and medical treatment for skin and ear disease is essential.
Sakaura, Hironobu; Matsuoka, Takashi; Iwasaki, Motoki; Yonenobu, Kazuo; Yoshikawa, Hideki
A retrospective case series. To review the surgical results for midcervical kyphosis in 3 cases with Larsen syndrome, and to discuss the choice of surgical treatments. Cervical kyphosis is the most hazardous and serious manifestation of Larsen syndrome due to the risk of life-threatening paralysis, and thus usually requires surgical treatment. However, little information has been reported concerning surgical treatments for this challenging condition. Three patients with Larsen syndrome were surgically treated for midcervical kyphosis at our institution. An infant with mild cervical kyphosis was successfully treated with posterior arthrodesis using a halo immobilization, and anterior vertebral growth with a mature posterior fusion mass resulted in spontaneous correction of the kyphosis. In the remaining 2 infants with myelopathic symptoms due to severe and structural kyphosis, anterior decompression and fusion via a lateral approach followed by posterior fusion with segmental spinal instrumentation and halo immobilization resulted in improved neurologic symptoms and solid fusion. Posterior spinal fusion is only indicated for patients with mild and flexible cervical kyphosis, and anterior decompression and circumferential arthrodesis is required for patients with severe kyphotic deformity, who usually develop myelopathic symptoms. Anterior surgery for such a small patient with severe kyphosis involves much higher risk of spinal cord injury during decompression maneuvers and difficulty in stabilization of the reconstructed cervical spine. Therefore, all patients with Larsen syndrome should be screened with radiographs at the first visit to detect cervical kyphosis early so that posterior alone fusion is possible.
Taga, Arens; Russo, Marco; Genovese, Antonio; Paglia, Maria Vittoria; Manzoni, Gian Camillo; Torelli, Paola
The aim of the present study was to describe the characteristics of migraine with aura (MwA) in a case series of patients with headache onset before 12 years of age. We considered all consecutive patients referred to the Parma Headache Centre between 1975 and 2015 affected by MwA, diagnosed by our team of trained neurologists; the cases were subsequently reviewed applying the ICHD3-beta criteria. We then identified those cases with headache age-of-onset aura was the most common type of aura, followed by sensory and speech disturbances; however, these two latter aura symptoms were significantly more common among pediatric cases. In this group of patients, aura without headache was significantly less frequent (1.8 vs 5.3%); furthermore, headache had migraine characteristics in a higher proportion of cases (90.1 vs 82.6%). A family history of MwA was significantly more frequent among cases with pediatric onset (31.1 vs 16.9%). Males but not females with pediatric MwA had more frequently a comorbid migraine without aura (27.6 vs 16.8%). Among cases with pediatric onset, we did not find any significant differences between males and females. In conclusion, in our very large case series of MwA, patients with headache onset before 12 years of age seem to have a specific clinical phenotype, without significant gender differences.
Fraturas de odontoide tipo III com necessidade de tratamento cirúrgico: estudo de série de casos e revisão de literatura Fracturas de odontoides tipo III con necesidad de tratamiento quirúrgico: estudio de série de casos y revisión de la literatura Type III odontoid fractures requiring surgical treatment: a case series study and literature review
Alan Robert Wieczorek
graves, cuatro pacientes evolucionaron como asintomáticos y solamente uno paciente desarrolló dolor cervical no incapacitante. La Tomografía Computadorizada (TC mostró consolidación de la fractura en 2 casos y los otros 3 no realizaron TC de control. El seguimiento promedio fue de 1,9 años. CONCLUSIONES: Las fracturas de odontoide del tipo III no siempre son lesiones benignas, siendo importante que se individualice su tratamiento siempre que se identifique alguna característica inusual. Existen criterios de inestabilidad e indicación de tratamiento quirúrgico para pacientes con este tipo de la lesión.OBJECTIVES: To analyze a series of patients with unstable type III odontoid fractures surgically treated. METHODS: Retrospective analysis of a series of 5 consecutive cases of patients with type III odontoid fractures, who underwent surgical treatment. RESULTS: Three patients were initially treated with halo vest, and underwent surgical fixation in face of pseudarthrosis or failure of the orthosis in maintaining reduction. Two patients underwent primary surgical treatment, one had marked radiological instability in flexion and spinal cord compression and other had neurological compromise. The surgical technique was individualized for each case. There were no major complications. Four patients became asymptomatic and only one patient developed non-disabling neck pain. Computed tomography (CT showed fracture healing in two cases, the other 3 patients did not undergo CT scan. The mean follow-up was 1.9 years. CONCLUSIONS: As type III fractures of odontoid are not always benign, it is important to individualize their treatment whenever any unusual feature is identified. There are some criteria of instability and indications for surgical treatment for patients with this type of injury.
Omer A. Raheem, MD
Conclusion: We review the literature and case reports on penile amputation and its etiology, surgical management, variables effecting outcomes, and its complications. Raheem OA, Mirheydar HS, Patel ND, Patel SH, Suliman A, and Buckley JC. Surgical management of traumatic penile amputation: A case report and review of the world literature. Sex Med 2015;3:49–53.
Full Text Available Objectives: To investigate the results of different surgical techniques for treating cases of dissociated vertical deviation (DVD. Materials and Methods: A retrospective review of medical records was performed, including 94 eyes of 47 patients who had undergone bilateral superior rectus (SR recessions (Group 1, bilateral SR recession with posterior fixation sutures (Group 2, or bilateral inferior oblique (IO anterior transposition surgery (Group 3 for treatment of DVD. Nineteen patients underwent secondary procedures (SR weakening or IO anterior transposition because of unsatisfactory results. The amount of the DVD in primary position before and after surgery, postoperative success ratios, and probable complications were evaluated. The Wilcoxon signed ranks test and chi-squared test were used for statistical evaluations. Results: In 69% of the 32 eyes in group 1, 65% of the 20 eyes in group 2, and 79% of the 42 eyes in group 3, satisfactory control of the DVD in primary position was achieved. All eyes undergoing both SR weakening and IO anterior transposition had a residual DVD of less than 5 prism diopters (pd. Of the total of 94 eyes, in 26 (89.6% of 29 eyes that had a preoperative DVD angle of more than 15 pd [ten eyes from group 1, seven eyes from group 2, and nine eyes from group 3], the residual DVD angle after surgery was more than 5 pd. However, in the 65 eyes with preoperative DVD of 15 pd or less (21from Group 1, 12 from Group 2, and 32 from Group 3, the residual DVD angle after the operation was less than 5 pd. Two eyes of 2 patients had -1 limitation to elevation after surgery. Conclusion: Only IO anterior transposition or SR weakening surgery appear to be a successful surgical approaches in the management of patients with mild- and moderate-angle (≤15 pd DVD. Weakening both the SR and IO muscles yield a greater success in the management of patients with large-angle (>15 pd DVD. (Turk J Ophthalmol 2014; 44: 132-7
Kumar, Ravi; Puttanna, Manohar; Sriprakash, K S; Sujatha Rathod, B L; Prabhakaran, Venkatesh C
We report a large series of ocular injuries caused by fire-crackers. This study was a hospital-based, singlecenter, retrospective case series in which the records of 51 patients with ocular injuries were analyzed. Injuries were classified according to Birmingham eye trauma terminology system (BETTS). Visual outcomes before and after the intervention were recorded. Ten patients were admitted for further management. As ocular firecracker injuries result in significant morbidity, public education regarding proper use of firecrackers may help in reducing the incidence of ocular injuries.
Full Text Available We report a large series of ocular injuries caused by fire-crackers. This study was a hospital-based, singlecenter, retrospective case series in which the records of 51 patients with ocular injuries were analyzed. Injuries were classified according to Birmingham eye trauma terminology system (BETTS. Visual outcomes before and after the intervention were recorded. Ten patients were admitted for further management. As ocular firecracker injuries result in significant morbidity, public education regarding proper use of firecrackers may help in reducing the incidence of ocular injuries.
Full Text Available Background: Hemifacial microsomia (HM is a syndrome characterized by the presence of structural alterations of the skeletal, nervous, vascular, and muscular structures derived from the first and second branchial arch. Goldenhar syndrome (Gs consistisof the triad of craniofacial microsomia, ocular dermoid cysts, and spinal anomalies. When the patient has hypoplasia of the mandible, orthognatic surgery or distraction osteogenesis (DO can be used to correct the asymmetry. Mandibular DO has been applied for many years, but long-term reports showed controversial results. The aim of this paper is to describe three cases of patients affected by Gs in which DO was performed to correct the mandibular asymmetry. Case series: The cases reported show an increasing degree of dismorphism which required a increasing complexity of the surgical approach: a single mandibular DO in the first patient, and a mandibular DO associated with a Le Fort I osteotomy in the second one, a double mandibular DO associated with Le Fort I and surgical disjunction of the middle palatal suture in the third case. Discussion: The effects of DO involve not only the skeletal segment but also all the surrounding soft tissues. DO leads to rapid and remarkable improvement in facial symmetry due to emimandible hypoplasia. When correct spatial repositioning of the maxilla cann ot be expected, mandibular DO can be carried out by associating a Le Fort I osteotomy. In this way DO minimize the need for major osteotomies and allows an earlier treatment in selected cases.
Scarano, Antonio; Cholakis, Anastasia Kelekis; Piattelli, Adriano
This human case series presents the clinical and histologic results of five cases of peri-implantitis with subsequent sinus graft infections. Complications may follow maxillary sinus augmentation procedures. It is possible to have an inflammatory reaction, movement of the implant inside the sinus, formation of an insufficient quantity of osseous tissue, and the production of an oroantral fistula. Complications following maxillary subantral augmentation procedures are relatively rare; however, the risks and benefits of any surgery must be carefully evaluated at the onset. In this case series, bacterial proliferation from infected implants into the grafted biomaterial in sinus cavities was examined. In five cases, removal of infected implants from augmented sinuses did not result in resolution of the infection, but rather in persistence of the infection in the area of the sinus augmentation procedure. Intraoral examination revealed edema/redness in two cases and edema and sinus tract formation in another case. In all cases, surgical curettage of the affected maxillary sinuses was performed. The inserted biomaterials and the accompanying inflammatory tissue infiltrate were totally removed with curettes. The sample was sent for a histopathologic examination. The maxillary sinuses were filled with an autologous platelet gel. Necrotic bone was found lining the different biomaterial grafts. Macrophages were observed around the grafted particles. No blood vessels were observed. This case series is the first to document the spread of infection from an implant surface to the entirety of the graft in the maxillary antrum. Complete removal of all infected bone graft material is the treatment of choice in such cases.
Full Text Available Background. Mobius Syndrome is a rare disease defined by bilateral congenital 7th nerve palsy. We focus on reporting the prevalence of orthopedic disease in this population. Methods. Twenty-three individuals with Mobius Syndrome underwent orthopedic physical examination, and additional 96 patients filled out a survey for self-reported orthopedic diagnoses. Results. Clubfoot was present in 60% of individuals in the physical exam series and 42% of those in the survey. Scoliosis was present in 26% and 28%, respectively. Poland’s Syndrome was present in 17% and 30%. In addition to these findings, 27% of patients reported having difficulty with anesthesia, including difficulty in intubation and airway problems. Conclusion. An increased prevalence of scoliosis, clubfoot, transverse limb deficiencies, and Poland’s Syndrome is identified in the setting of Mobius Syndrome. In the setting of several deformities often requiring surgical correction, a high incidence of anesthetic difficulty is noted and should be discussed with patients and other providers during surgical planning.
Kasagani, Suresh Kumar; Nutalapati, Rajasekhar; Mutthineni, Ramesh Babu
Gingival melanin pigmentation occurs in people of all races. Although clinical melanin pigmentation does not present a medical problem, demand for cosmetic therapy is commonly made by fair-skinned people with gingival melanin pigmentation. This problem is aggravated in patients with a "gummy smile" or excessive gingival display while smiling. Esthetic periodontal plastic surgery is especially successful in individuals with compromised esthetics. Three cases are reported here where gingival depigmentation was done using three different techniques: electrosurgery; scalpel surgery; and surgical abrasion. The clinical results of the three methods have been compared.
Fiona J. Stewart
Full Text Available The mucopolysaccharidoses (MPS disorders are rare inherited diseases associated with multi-organ accumulation of glycosaminoglycans, leading to musculoskeletal, respiratory, cardiac, neurological, ophthalmological, otolaryngological, and gastrointestinal abnormalities. As a result of improvements in diagnosis, multi-disciplinary care, and therapies such as enzyme replacement therapy and hematopoietic stem cell transplantation, an increasing number of patients with MPS are reaching adulthood and are involved in family planning. Data on fertility and pregnancy outcome in MPS is sparse and comprises primarily isolated case reports. To address this evidence gap, we present a case series on fertility and pregnancy in eight mothers and five fathers with MPS. This case series demonstrates that women with MPS have high-risk pregnancies and deliveries secondary to their underlying disease. However, with appropriate pre-conceptual multi-disciplinary evaluation, optimization and discussion regarding potential risks, combined with regular multi-disciplinary maternal and fetal surveillance in a tertiary center, the outcome of most pregnancies in this case series seems to be favorable with all babies developing normally. Partners of fathers with MPS had uncomplicated pregnancies and deliveries. All children were healthy, with normal growth and development.
Morax, S; Mimoun, G
Fifteen cases of jaw-winking blepharoptosis treated, are reported, to suggest the management of the surgical methods. The degree of the ptosis, the eyelid retraction, the surgical procedures are reviewed. Patients with a wild retraction required a levator muscle resection. Patients with a moderate or severe retraction required an unilateral levator denervation with frontalis suspension. In this case, the most satisfactory surgical results were obtained with unilateral levator denervation on the affected side compared with a bilateral frontalis suspension with fresh autogenous fascia. Then, the surgical procedure seems to depend especially on the eyelid retraction.
Illuminati, Giulio; Ricco, Jean-Baptiste; Caliò, Francesco G; D'Urso, Antonio; Ceccanei, Gianluca; Vietri, Francesco
Although there is a growing body of evidence to document the safety and efficacy of operative treatment of carotid stenosis, surgical indications for elongation and kinking of the internal carotid artery remain controversial. The goal of this study was to evaluate the efficacy of surgical correction of internal carotid artery kinking in patients with persistent hemispheric symptoms despite antiplatelet therapy. A consecutive series of 81 patients (mean age, 64 years) underwent 83 surgical procedures to correct kinking of the internal carotid artery either by shortening and reimplanting the vessel on the common carotid artery, inserting a bypass graft, or transposing the vessel onto the external carotid artery. Mean follow-up was 56 months (range, 15-135 months). Study endpoints were 30-day mortality and any stroke occurring during follow-up. No postoperative death was observed. The postoperative stroke rate was 1%. Primary patency, freedom from neurologic symptoms, and late survival at 5 years (x +/- standard deviation) were 89 +/- 4.1%, 92 +/- 4%, and 71 +/- 6%, respectively. The findings of this study indicate that surgical correction for symptomatic stenotic kinking of the internal carotid artery is safe and effective in relieving symptoms and preventing stroke. Operative correction should be considered as the standard treatment for patients with symptomatic carotid kinking that does not respond to antiplatelet therapy.
Atesalp, A. Sabri; Demiralp, Bahtiyar; Erler, Kaan; Gur, Ethem
Haglund’s disease is the posterior heel pain resulted from the retrocalceneal bursitis and chronic inflammation on the prominence of posterior calcaneus. It becomes prominent following excessive functional stresses. Surgery is an alternative choice of treatment. In the paper, we present the result of surgical procedure of 25 year old male with bilateral Haglund’s disease and surgical treatment principles of Haglund’s disease.
Full Text Available Background and aim of this clinical case presentation is to reveal the importance of early nerve injury diagnosis and surgical treatment in war wounded patients. Methods. The author treated patients in Amman Charity Hospital were among different plastic surgery cases where limb nerve injuries with nerve grafting indication. The presented case was treated with autologus sural nerve graft. Results were evaluated at 3 months after the surgery and revealed detectable nerve conductibility at the Electromiography test. In conclusion, in cases with delayed nerve repair surgical treatment in war wounded patients, the vascularised nerve graft can be a better solution for nerve defect surgical treatment.
Full Text Available Osteoid osteoma is a unique benign primary bone tumor that may present in the metaphyseal diaphyseal areas of the short tubular bones and has also been reported in the carpal bones. It occurs in the first two decades of life. The classic history is bone pain, often relieved by aspirin. The clinical appearance is local swelling and tenderness. The typical radiographic appearance is very characteristic: an eccentric area of cortical sclerosis, frequently with a radiolucent nidus. The lesion does not exceed 1 cm in diameter. The use of a bone scan may be helpful diagnostically, as are the CAT scan and tomography. Doyle et al described seven cases of osteoid osteoma with a prolonged delay in diagnosis, but reported an excellent cure rate following excision. The carpus is not unusual as a site for this tumor, especially the scaphoid. Treatment is windowing with curettage of the tumor nidus. The use of a dental drill to window the phalanx and expose the nidus is very helpful. Removal of the entire nidus is permanently curative, but if a portion of the tumor is missed, prompt recurrence of the symptoms is the rule.
Balasundram, Sathesh; Cotrufo, Stefano; Liew, Colin
An abnormal vascular course of the superior cerebellar artery is often cited as the cause for trigeminal neuralgia. However, among patients with TN-like symptoms, 6% to 16% are variously reported to have intracranial tumours. Aneurysms, tumours, or other lesions may impinge or irritate the trigeminal nerve along its course. Uncommonly, an area of demyelination from multiple sclerosis may be the precipitant. We would like to present a series of unusual lesions, all of which initially presented with neuralgic-like symptoms and were refractory to treatment. Collated case series with photographs and imaging are reviewed in this paper. Discussion of case presentation and management are done for evaluation. A wide range of other compressive lesions can cause trigeminal neuralgia. This paper illustrates the clinical presentation of atypical trigeminal neuralgia and emphasises the value of diagnostic imaging in trigeminal neuralgia patient. Suggested algorithm for management of trigeminal neuralgia.
Syed Wali Peeran
Full Text Available Hereditary gingival fibromatosis (HGF is a rare, benign disorder with slowly progressive enlargement of maxillary and mandibular gingiva. Herewith, we report the first case series of HGF presenting among mother and all of her 3 children. Their complaints included unaesthetic appearance due to gingival growth, malocclusion, and difficulty in mastication. Conventional gingivectomy with oral hygiene measures and regular followup is the treatment of choice for such presentation.
Guida, Maurizio; Maurizio, Guida; Altieri, Roberto; Roberto, Altieri; Palatucci, Valeria; Valeria, Palatucci; Visconti, Federica; Federica, Visconti; Pascale, Renato; Renato, Pascale; Marra, Marialuisa; Marialuisa, Marra; Locatelli, Giampiero; Giampiero, Locatelli; Saponiero, Renato; Renato, Saponiero; Tufano, Rosalba; Rosalba, Tufano; Bifulco, Francesca; Francesca, Bifulco; Piazza, Ornella
Pregnancy is a recognized risk factor for aneurysmal subarachnoid hemorrhage (SAH). Headache is very frequent in normal pregnancy and it is a common sign shared between several intracranial diseases. We present a case series of 10 women in the third trimester of pregnancy admitted to our intensive care unit (ICU) with neurological signs and symptoms. 4 of these patients were diagnosed with SAH. Data in this study suggest that a timely diagnosis and an appropriate treatment is crucial for mother and baby.
Guida, Maurizio; Altieri, Roberto; Palatucci, Valeria; Visconti, Federica; Pascale, Renato; Marra, Marialuisa; Locatelli, Giampiero; Saponiero, Renato; Tufano, Rosalba; Bifulco, Francesca; Piazza, Ornella
Pregnancy is a recognized risk factor for aneurysmal subarachnoid hemorrhage (SAH). Headache is very frequent in normal pregnancy and it is a common sign shared between several intracranial diseases. We present a case series of 10 women in the third trimester of pregnancy admitted to our intensive care unit (ICU) with neurological signs and symptoms. 4 of these patients were diagnosed with SAH. Data in this study suggest that a timely diagnosis and an appropriate treatment is crucial for moth...
Ko, Su Jin; Hwang, Ji Young; Kim, Yong Jin; Hong, Seong Sook [Soonchunhyang University College of Medicine, Seoul Hospital, Seoul (Korea, Republic of)
We report a rare case of barium peritonitis following an upper gastrointestinal (GI) series and its imaging findings in a 74-year-old female. Barium peritonitis is a rare but life-threatening complication of GI contrast investigation. Therefore, clinical awareness of barium peritonitis as a complication of GI tract contrast investigation would help to prevent such a complication and manage the patients properly.
Vela D Desai
Full Text Available Double lip is a rare dental anomaly affecting either upper or lower lip or concurrently. It may be congenital or acquired. This deformity can affect the facial esthetics as it gets exaggerated while speaking, smiling, or chewing food. When it interferes with speech, double lip may cause potential functional problems. The purpose of this article is to review the literature on double lip and present a case series of maxillary double lip.
Full Text Available Kartagener’s Syndrome is a rare Autosomal recessive disorder presents as a triad of Sinusitis, Bronchiectasis and Situs inversus. Chronic Rhino sinusitis is a common condition seen is ENT OPD routinely. Of the several causes of Sinusitis, Kartagener’s is rare entity and can remain undetected. This case series is to emphasize the diagnosis of the disease and alert the patient about it.
Human immunodeficiency virus (HIV) infection in a patient with end-stage renal disease was considered a contraindication for renal transplantation till now despite the advent of highly active antiretroviral therapy with the apprehension that immunosuppression would further jeopardize the already compromised immune status of the patients. Renal transplantation in HIV patients is rare in developing countries including ours. Here we report a series of four cases of renal transplantation in HIV p...
Surender, Kumar; Kochar, I P S; Ahmad, Ayesha; Kapoor, Meenal
Hereditary vitamin D-resistant rickets (HVDRR) is an autosomal recessive disorder characterized by end-organ resistance to 1α,25-dihydroxyvitamin D3 (1,25D3). Clinically, the syndrome is recognized by severe early onset rickets with bowing of the lower extremities, short stature, and often alopecia. Here, we report a case series on three siblings who had HVDRR with varied clinical findings.
Full Text Available Pressure related complications such as abdominal wall hernias occur with relative frequency in patients on peritoneal dialysis. Less frequently, a transudative pleural effusion containing dialysate can develop. This phenomenon appears to be due to increased intra-abdominal pressure in the setting of congenital or acquired diaphragmatic defects. We report three cases of pleuroperitoneal leak that occurred within a nine-month period at our institution. We review the literature on this topic, and discuss management options. The pleural effusion resolved in one patient following drainage of the peritoneum and a switch to haemodialysis. One patient required emergency thoracocentesis. The third patient developed a complex effusion requiring surgical intervention. The three cases highlight the variability of this condition in terms of timing, symptoms and management. The diagnosis of a pleuroperitoneal leak is an important one as it is managed very differently to most transudative pleural effusions seen in this patient population. Surgical repair may be necessary in those patients who wish to resume peritoneal dialysis, or in those patients with complex effusions. Pleuroperitoneal leak should be considered in the differential diagnosis of a pleural effusion, particularly a right-sided effusion, in a patient on peritoneal dialysis.
Şen-Tunç, Emine; Şaroğlu-Sönmez, Işıl; Bayrak, Şule; Tüloğlu, Nuray
Background An eruption cyst (EC) is a benign, developmental cyst associated with a primary or permanent tooth. This paper presents 66 ECs in 53 patients who reported to 3 different centers in Turkey between 2014-2015. Material and Methods 53 patients (31 male, 22 female) with 66 ECs were diagnosed and treated over a 1-year period. The mean age of patients was 5.4 years (minimum 5 months, maximum 11 years). Clinical examination and periapical radiographs were used to establish diagnosis. Age, gender, site, history of trauma and type of treatment were recorded. Results Of the 66 ECs diagnosed in 53 patients, more than half (56.6%) were located in the maxilla, with the maxillary first primary molars the teeth most commonly associated with ECs (30.3%). Multiple ECs were diagnosed in 13 of the 53 patients. ECs had previously diagnosed in the primary dentition of 2 patients, 3 patients reported a history of trauma to primary teeth. In the majority of patients (46 cases, 86.8%), no treatment was provided, whereas surgical treatment was provided in the remaining 7 cases (13.2%). Conclusions Eruption cysts are usually asymptomatic and do not require treatment;. however, if the cyst is symptomatic, it should be treated with simple surgical excision. Key words:Odontogenic cyst, children, eruption cyst, oral pathology. PMID:28160586
Pressure related complications such as abdominal wall hernias occur with relative frequency in patients on peritoneal dialysis. Less frequently, a transudative pleural effusion containing dialysate can develop. This phenomenon appears to be due to increased intra-abdominal pressure in the setting of congenital or acquired diaphragmatic defects. We report three cases of pleuroperitoneal leak that occurred within a nine-month period at our institution. We review the literature on this topic, and discuss management options. The pleural effusion resolved in one patient following drainage of the peritoneum and a switch to haemodialysis. One patient required emergency thoracocentesis. The third patient developed a complex effusion requiring surgical intervention. The three cases highlight the variability of this condition in terms of timing, symptoms and management. The diagnosis of a pleuroperitoneal leak is an important one as it is managed very differently to most transudative pleural effusions seen in this patient population. Surgical repair may be necessary in those patients who wish to resume peritoneal dialysis, or in those patients with complex effusions. Pleuroperitoneal leak should be considered in the differential diagnosis of a pleural effusion, particularly a right-sided effusion, in a patient on peritoneal dialysis.
郑月宏; 刘暴; 李拥军; 刘昌伟; 管珩
Objective. To describe the effects of surgical treatment and complications in 46 patients with carotid body tumor (CBT). Method. Retrospective study on surgical treatment and complications was carried out in 46 cases of CBT which were surgically treated with different kind of procedures. Result. All procedures performed successfully except that the CBT was not excised in 4 cases. No operative mortality was observed. There were 2 postoperative hemiplegia, 4 hypoglossal nerve impairment,2 glossopharyngeal nerve impairment, 1 vagus nerve impairment, and 1 accessory nerve impairment. One patient presented postoperative cranial nerve impairment in glossopharyngeal, vagus and hypoglossal nerves. Two patients developed local recurrence during the long-term follow-up. Conclusion. Complete surgical excision was possible in each patient if the diagnosis had been correctly made through selective preoperative angiography, vessel ultrasound Doppler and other examinations.Reasonable surgical procedure and Matas training were necessary to the successful surgical treatment and thus decrease the complicative incidence rate of carotid chemodectomas.
Cieri, Patricio; Udaquiola, Julia E; Calello, Santiago E; Libero, Daniel H
The thyroglossal duct cyst pathology represents the second cause of bening cervical anomalies in childhood. Diagnosis is mainly clinical. Sistrunk (1920) proposed a surgical technique that is still considered the gold standard for definitive treatment of this condition. A retrospective study was made including patients who underwent surgery for thyroglossal duct cyst pathology in our department between June 2008 and August 2015. In this period, we performed 54 procedures in 45 patients (39 primary cases). Median age was 4.7 years; 14/39 patients (31.1%) had pre-operative infection. All patients were studied with neck ultrasound. A Sistrunk's procedure was performed in all cases. The global recurrence rate was 17.8% (8/45).
Full Text Available Clinicians are often intrigued by the varied manifestations of the gingival tissue. Gingival overgrowth is a common clinical finding and most of them represent a reactive hyperplasia as a direct result of plaque-related inflammatory gingival disease. These types of growth generally respond to good plaque control, removal of the causative irritants, and conservative tissue management. This case series highlights three different cases of localized gingival overgrowth and its management with emphasis on the importance of patient awareness and motivation.
Sunny, Sunil; Mathew, Neethu; Parambath, Anvar Kizhakke; Madhusudanan, Amla
Certain malocclusions have to be treated at an early age to avoid surgeries for the correction in the future. Introduction of functional appliances has reduced the elimination and correction of skeletal as well as dental discrepancies. Proper case selection taking into consideration skeletal and dental age with the use of various diagnostic aids helps us to identify and treat the malocclusions before it is too late. In this case series, we report three patients with skeletal jaw malrelationship treated with functional and orthopaedic appliances. PMID:27656599
Abrons, Ron O; Vansickle, Ryan A; Ouanes, Jean-Pierre P
Nasotracheal intubation can be both challenging and traumatic, especially in cases of atypical anatomy. We present a series of 3 such cases in which an endotracheal tube introducer (bougie) was used to facilitate successful, atraumatic, nasotracheal intubation via Seldinger technique. The technique described can guide a nasotracheal tube through narrow nasal passages, small pharyngeal spaces, and past acute laryngeal approach angles, all without transoral manipulation of the tube. The technique is easy to perform, uses a routine skill set, and can be advantageous in numerous clinical scenarios.
Mcevenue, Giancarlo; Brichacek, Michael; Logsetty, Sarvesh; Shahrokhi, Shar
Levamisole is an increasingly common cocaine adulterant that can cause severe and rapid onset cutaneous vasculitis in humans. While most cases may be managed conservatively, we describe a series of patients in whom the extent of skin and soft tissue necrosis mandated surgical intervention. A retrospective review of all patients admitted to one of two regional burn centers between 2006 and 2016 for soft tissue necrosis after exposure to levamisole-adulterated cocaine was included in our study. Ten patients, majority female (9/10) with an average age of 43.4 years (range 31-57), were included. Cocaine usage before presentation averaged 6 days (range 1-14). Presenting complaints consisted of arthralgia (5/10), fever (7/10), and purpuric lesions (10/10). Average TBSA involvement was 23.5% (range 4-70). Immunological testing revealed pANCA+ in 8 of 10 and cANCA+ in 4 of 8 patients. Operative intervention occurred by postadmission day 11.6 (range 3-30). The mean number of operations required was 3 (range 2-6); length of stay averaged 46.8 days (range 14-120); and survival to discharge was 100% (10/10). To our knowledge, this is the largest case study detailing the surgical management of levamisole-associated skin necrosis. Additionally, we describe the most extensive case of this disease process at 70% TBSA involvement. Based on our experience, we recommend waiting for purpuric rash resolution and soft tissue necrosis to be fully demarcated before fascial debridement and then staged skin grafting with allograft followed by autograft.
Sawant, Neena Sanjiv; Vispute, Chetan Dilip
Delusional parasitosis (DP) is characterized by single hypochondriacal delusion in which patient feels he/she is infested with insects. The authors present a case series of three cases of DP with shared psychotic disorder (folie à deux) in which one individual developed a delusional belief in the context of a close relationship with another person or people who already had an established delusional idea. All patients of DP were assessed in the outpatient department of Psychiatry of a tertiary care hospital. Diagnosis of DP was made on detail clinical history and supporting clinical findings. All our primary cases had DP and the accompanying relatives of our patients had folie à deux as they shared the belief of parasite infestation which was firm and persisted despite evidence to the contrary. The primary cases of delusional parasitosis responded well to oral risperidone. The intensity of the belief in the secondary person also reduced with improvement in the symptoms of the patients. PMID:26257494
Sawant, Neena Sanjiv; Vispute, Chetan Dilip
Delusional parasitosis (DP) is characterized by single hypochondriacal delusion in which patient feels he/she is infested with insects. The authors present a case series of three cases of DP with shared psychotic disorder (folie à deux) in which one individual developed a delusional belief in the context of a close relationship with another person or people who already had an established delusional idea. All patients of DP were assessed in the outpatient department of Psychiatry of a tertiary care hospital. Diagnosis of DP was made on detail clinical history and supporting clinical findings. All our primary cases had DP and the accompanying relatives of our patients had folie à deux as they shared the belief of parasite infestation which was firm and persisted despite evidence to the contrary. The primary cases of delusional parasitosis responded well to oral risperidone. The intensity of the belief in the secondary person also reduced with improvement in the symptoms of the patients.
Lyons, Mark K; Birch, Barry D; Krauss, William E; Patel, Naresh P; Nottmeier, Eric W; Boucher, Orland K
Retrospective study The authors' aim of the present study is to report their experience with subaxial cervical synovial cysts hoping to provide further insight into these lesions including the presenting symptoms, possible mechanisms of cyst development associated with cervical level, surgical treatments and clinical outcomes. Synovial cysts are relatively common in the lumbar spine and very uncommonly identified in the subaxial cervical spine. Several case reports and a few small series have been reported in the literature over the past four decades. The authors retrospectively reviewed the cases of 35 patients who underwent surgical treatment for histologically confirmed symptomatic subaxial cervical synovial cysts between 1993 and 2009. The presenting symptoms, age, sex, cervical level, operation, complications and outcomes were analyzed in this cohort. Preoperative and postoperative neurologic assessments were done by staff neurologists independent of the operating surgeon. This study was approved by the Mayo Clinic institutional review board. Thirty-five patients underwent surgical treatment for their synovial cysts and follow-up for at least 12 months postoperatively. The mean follow-up time was 49 months (range, 12-134). There were no deaths associated with the surgery. There was one postoperative infection in a patient undergoing a decompressive laminectomy and posterior instrumented fusion. Patient outcomes were assessed using the Modified Rankin Score for 12 patients was 0, 17 patients was 1, 4 patients was 2, and 2 patients was 3. This series of 35 patients with subaxial cervical synovial cysts surgically treated over a period of 17 years illustrates the relative rarity of these lesions. Magnetic resonance imaging is currently the optimal radiographic study to identify these lesions. Surgical resection can be an effective treatment.
Vasquez, Javier A Jacobo; Fonnegra, Julio R; Diez, Juan C; Fonnegra, Andres
Epidermoid tumors (ETs) are benign lesions that are treated mainly by means of surgical resection, with overall good results. External beam radiotherapy is an alternative treatment for those recurrent tumors, in which a second surgery might not be the best choice for the patient. A little information exists about the effectiveness of gamma knife radiosurgery for the treatment of newly diagnosed and recurrent ETs. We present three cases of ETs treated with gamma knife radiosurgery. Case 1 is a 21-year-old female with an ET located in the left cerebellopontine angle (CPA) with symptoms related to VIII cranial nerve dysfunction. Symptom control was achieved and maintained after single session radiosurgery with gamma knife. Case 2 is a 59-year-old female patient with the history of trigeminal neuralgia secondary to a recurrent ET located in the left CPA. Significant pain improvement was achieved after treatment with gamma knife radiosurgery. Case 3 is a 29-year-old male patient with a CPA ET causing long lasting trigeminal neuralgia, pain relief was achieved in this patient after gamma knife radiosurgery. Long-term symptom relief was achieved in all three cases proving that gamma knife radiosurgery is a good and safe alternative for patients with recurrent or nonsurgically treated ETs.
Lakhanpal, R Ross; Hariprasad, Seenu M
For this Practical Retina column, Dr. Ross Lakhanpal from Baltimore was asked to comment on the current state of thinking and management options for proliferative vitreoretinopathy (PVR) after retinal detachment (RD) surgery.We are all aware that PVR continues to be an important cause of recurrent RD after successful repair. This feared complication has been reported to occur in up to 8% of patients after undergoing RD repair. Despite the historic progress made in managing various vitreoretinal diseases over the past decade, most retina specialists will agree that an unmet need remains in this landscape. Fortunately, advances in various surgical technologies such as instrumentation, lighting, and visualization have improved the outcomes after PVR management.Dr. Lakhanpal discusses causes of PVR, management goals, surgical techniques, and pearls to avoid complications after managing PVR. His experience working in an urban tertiary surgical retina practice enables him to offer insights that will be highly valued by our community.
Popa, G; Nistorescu, A; Gorgan, M; Macovei, M; Alaicescu, M
A 48-year-old male patient, a surgeon, displayed a right temporo-occipital cerebral haematoma (5 x 7 cm). He had a history of chronic left occipital migraine-like cephalalgia from the age of 16 and hypertension was diagnosed when he was 42 years old. As therapy, he used ACE inhibitors, nifedipine and clonidine for hypertension and for cephalalgia a combination of aspirin, phenacetin and caffeine. During the last 2-3 months before the detection of cerebral haematoma, injections with piritramide were made when severe headaches were unbearable. The patient was operated on the 7th day since the onset of cerebral haematoma after a "wait and see" period of repeated clinical and CT-scan assessment. The initial option of the patient was surgical. We consider that the patient's profession (medical/surgical profile) may have played a positive motivation for the surgical option.
Zonta, Sandro; De Martino, Michela; Podetta, Michele; Viganò, Jacopo; Dominioni, Tommaso; Picheo, Roberto; Cobianchi, Lorenzo; Alessiani, Mario; Dionigi, Paolo
Acute generalized peritonitis secondary to complicated diverticulitis is a life-threatening condition; the standard treatment is surgery. Despite advances in peri-operative care, this condition is accompanied by a high peri-operative complication rate (22%-25%). No definitive evidence is available to recommend a preferred surgical technique in patients with Hinchey stage III/IV disease. A matched case-control study enrolling patients from four surgical units at Italian university hospital was planned to assess the most appropriate surgical treatment on the basis of patient performance status and peritonitis exposure, with the aim of minimizing the surgical site infection (SSI). A series of 1,175 patients undergoing surgery for Hinchey III/IV peritonitis in 2003-2013 were analyzed. Cases (n=145) were selected from among those patients who developed an SSI. control ratio was 1:3. Cases and control groups were matched by age, gender, body mass index, and Hinchey grade. We considered three surgical techniques: T1=Hartman's procedure; T2=sigmoid resection, anastomosis, and ileostomy; and T3=sigmoid resection and anastomosis. Six scoring systems were analyzed to assess performance status; subsequently, patients were divided into low, mild, and high risk (LR, MR, HR) according to the system producing the highest area under the curve. We classified peritonitis exposition as P1=24 h. Univariable and multivariable analyses were performed. The Apgar scoring system defined the risk groups according to performance status. Lowest SSI risk was expected when applying T3 in P1 (OR=0.22), P2 (OR=0.5) for LR and in P1 (OR=0.63) for MR; T2 in P2 (OR=0.5) in LR and in P1 (OR=0.61) in MR; T1 in P3 (OR=0.56) in LR; in P2 (OR=0.63) and P3 (OR=0.54) in MR patients, and in each P subgroup (OR=0.93;0.97;1.01) in HR. Pre-operative assessment based on Apgar scoring system integrated with peritonitis exposure in complicated diverticulitis may offer a ready-to-use tool for reducing SSI
Full Text Available Grant M Comer, Maxwell S Stem, Stephen J SaxeUniversity of Michigan, Department of Ophthalmology and Visual Sciences, Ann Arbor, MI, USAPurpose: To describe a combination of treatment modalities used for the successful eradication of Fusarium endophthalmitis.Design: Interventional case series.Participants: Three consecutive patients with keratitis-associated Fusarium endophthalmitis.Methods: After failure of traditional management options, a combination of intravitreal and long-term, high-dose systemic voriconazole, topical antifungal medications, and surgical intervention, with penetrating keratoplasty, lensectomy, and endoscopic-guided pars plana vitrectomy, was administered to each patient.Results: All three cases achieved full resolution of the infection, with a final Snellen visual acuity score of 20/50 to 20/70.Conclusions: An aggressive combination of therapeutic modalities, including the removal of subiris abscesses, might be needed for the successful resolution of Fusarium endophthalmitis.Keywords: endophthalmitis, fungal, Fusarium, keratitis, keratoplasty, voriconazole
Moura, Eduardo Guimarães Hourneaux de; Franzini, Tomazo; Moura, Renata Nobre; Carneiro, Fred Olavo Aragão Andrade; Artifon, Everson Luiz de Almeida; Sakai, Paulo
Direct endoscopic visualization of biliopancreatic duct is certainly one of the greatest advances of therapeutic endoscopy. The use of a single-operator cholangioscopy platform (SpyGlass) is a promising technique in the evaluation of diseases such as indeterminate biliary stricture and giant choledocholitiasis. This is the first Brazilian case series using this technology. We report a case series of 20 patients in whom SpyGlass was used with diagnostic and therapeutic intention. Most patients were female (60%) and the median age was 48 years (ranging from 14 to 94). Choledocholitiasis was the most common indication (12/20), and electrohydraulic lithotripsy was applied in eight (66%). Electrohydraulic lithotripsy was successful in seven (87.5%) patients. Partial stone fragmentation occurred in one patient with large stone causing stone-choledochal disproportion, which was conducted with biliary plastic stent placement and a second scheduled endoscopic approach in 3 months. In cases of undefined etiology of biliary strictures, it was possible to exclude malignancy due to direct visualization (7/8) or biopsy (1/8). One complication occurred (duodenal perforation) after papillary balloon dilation. The use of SpyGlass demonstrated the benefits, especially in cases of large bile duct stones and indeterminate biliary strictures. Other potencial improvements such as reduction on radiation exposure should be confirmed in prospective studies.
Kim, Sung Gyu; Yang, Sang Kyu; Chi, Jung Ik; Lee, Chang Jun [National Medical Center, Seoul (Korea, Republic of)
Patent ductus arteriosus (PDA) is one of the most common congenital heart diseases. A rare complication occurring after its surgical treatment is the development of an aneurysm, and we report the radiologic findings in a case in which this occurred after surgical ligation.
Safal Khanal, BOptom
Full Text Available Background: Waardenburg syndrome is a rare autosomally-inherited developmental disorder characterized by sensorineural deafness in association with pigmentary anomalies comprising various ocular features including dystopia canthorum, iris heterochromia, eyebrow flare, and fundus alterations. It is a congenital non-progressive genetic disorder that has been found to result in hearing loss, reduced vision, reduced self esteem, problems related to appearance, and decreased intellectual functioning.Case Reports: We report two familial case series that presented with the characteristic ocular findings and the systemic features of Waardenburg syndrome. The first series comprised a 32-year-old father with his two sons aged nine and six years. Two female siblings, aged 10 and eight years, both with cochlear implants, were included in the second series.Conclusion: Waardenburg syndrome manifests differently with dissimilar genetic penetration even within the same family. Some individuals will require no treatment, while others may need treatment or surgery for other abnormalities. Appropriate measures can be undertaken to negotiate the disabilities resulting from the ocular conditions associated with this syndrome.
Full Text Available Background: Balloon atrial septostomy is an emergent procedure in pediatric cardiology. Nowadays, most patients in need of the procedure have acceptable outcomes after surgical repair. Thus, it is important to perform this procedure as safe as possible. By performing early arterial switch operation and prostaglandin infusion, the rate of balloon atrial septostomy has markedly decreased. However, not all centers performing early arterial switch repairs have abandoned atrial septostomy, even in patients who respond favorably to prostaglandin infusion.Case presentation: In total, eight 1- to 15-day old term neonates admitted in Shahid Rajaee Heart Center in Tehran, Iran from October 2009 to February 2011, with congenital heart diseases were scheduled for balloon atrial septostomy. In six cases the procedure was done exclusively under echocardiographic guidance and in two cases with the help of fluoroscopy. Success was defined as the creation of an atrial septal defect with a diameter equal to or more than 5 mm and ample mobility of its margins.Results: Male sex was predominant (87% and the mean age of the neonates was six days. The diagnosis in all cases was simple transposition of great arteries. The procedure was successful in all patients with any cardiovascular complication.Conclusion: Balloon atrial septostomy is an emergent procedure that can be done safely and effectively under echocardiographic guidance. According to the feasibility of this technique it could be performed fast, safe and effective at bedside, avoiding patient transportation to hemodynamic laboratory or referral center.
von Hallern, Bernd
Following treatment with antibiotics and surgical incision, which resulted in the release of putrid exudate, the wound was rinsed thoroughly with octenisept and covered with an antimicrobial dressing. This regimen successfully eradicated the infection, with full healing occurring in 6 weeks.
WU Ming-bai; ZHANG Li-wei; ZHU Hui; QIAN Zhong-xi
@@ Hydatid disease, a serious health problem, is endemic in many sheep and cattle raising areas. Though many kinds of medicines were used experimentally, operation is the only effective treatment for thoracic hydatidosis. The surgical treatments of 1230 patients with the disease in our division between June 1957 and December 2002 are discussed below.
ZHANG Xi; ZHONG Fo-tian; XU Zhe; XU Ying-qi; WANG Zhi-ping; WU Zhong-kai; TANG Bai-yun; XIONG Mai; YAO Jian-ping; SUN Pei-wu
Background Although the results of surgical treatment in cardiac valve disease continue to improve, the postoperative mortality rate and the rate of complications in patients with advanced valvular heart disease (AVHD) are still very high. We did this retrospective study to summarize the surgical experience of heart valve replacement for patients with AVHD and discuss effective ways to improve the surgical outcome.Results The operative mortality rate was 13.2% (30/227). The main causes of death included multiple organ dysfunction syndrome (MODS), low cardiac output syndrome and ventricular fibrillation. From the results of the binary noncounterpart multivariate logistic regression, the following statistically significant factors were found to influence the operative mortality rate: redo operation, age ≥55 years, preoperative NYHA cardiac function grading, extracorporeal circulation time ≥120 minutes and postoperative usage of GIK (glucose, insulin and potassium) solution. All factors were risk ones except postoperative application of GIK. The Hosmer-Lemeshow goodness of fit coefficient of this model was 0.976.Conclusions The risk factors associated with postoperative mortality rate in the patients with AVHD were redo operation, age ≥55 years, preoperative NYHA cardiac function grading and extracorporeal circulation time ≥120 minutes. Postoperative usage of GIK acted as a kind of metabolic therapy and will improve the recovery for patients with AVHD. Active perioperative management and care will play a very important role in reducing the operative risk and improving the short term outcome of surgical treatment for the patients with AVHD.
Full Text Available Objective To summarize the experiences in surgical treatment of abdominal tuberculosis and intestinal obstruction. Methods The clinical data were retrospectively analyzed of surgically treated 112 cases of abdominal tuberculosis and intestinal obstruction from Jan. 2010 to Dec. 2015. Results Of the 112 cases, 96 were diagnosed with complete intestinal obstruction, including 29 cases of ileocecal tuberculosis (12 cases of ileum perforation, 39 cases of severe adhesions, and 28 cases of strangulated ileus caused by adhesive band; 16 cases were incomplete ileus, including 6 cases of ileocecal tuberculosis, 6 cases of part adhesions caused by mesenteric lymph node tuberculosis, and 4 cases of angulation adhesion. A hundred and six cases were cured surgically. Six cases were obstructed again and cured after antituberculotic treatment. Five cases were with intestinal fistula after surgery, of whom 2 cases died of MODS induced by aggravation of infection, and 3 cases were cured and recovered after antituberculotic and nutritional support treatment through thorough drainage. Conclusions The surgical treatment as early as possible is recommended for the patients with abdominal tuberculosis and intestinal obstruction. Preoperative formulation through full multidisciplinary team (MDT consultation of reasonable anti-tuberculosis treatment and nutritional support scheme is the key to complete recovery and reduce of postoperative complications. DOI: 10.11855/j.issn.0577-7402.2016.12.16
Full Text Available Fine needle aspiration (FNA cytology is a well-established diagnostic method based on the microscopic interpretation of often scant cytological material; therefore, experience, good technique and smear quality are equally important in obtaining satisfactory results.We studied the use of fresh surgical pathology specimens for making so-called mock-FNA smears with the potential of cytohistological correlation. Additionally, we studied how this process aids the improvement of preparation technique and smear quality.Cytological aspirates from 32 fresh biopsy specimens from various sites: lung (20, lymph nodes (6, and breast (6 were obtained, all with a clinical diagnosis of tumor. Aspiration was performed from grossly palpable tumors. 25 G needle and Cameco-type syringe holder was used with minimal or no suction.Unfixed surgical specimens provided sufficient cytological material that resulted in good quality smears. After standard processing of specimens into microscopic sections from paraffin embedded tissues, cytohistological case-series were created. No significant alteration was reported in tissue architecture on hematoxylin-eosin stained sections after the aspiration procedure. A gradual, but steady improvement was observed in smear quality just after a few preparations.Our study proved that surgical specimens may be used as a source of cytological material to create cytohistological correlation studies and also to improve FNA cytology skills. The use of very fine gauge needle (25 G, 0,6 mm diameter during the sampling process does not alter tissue architecture therefore the final histopathological diagnosis is not compromised. We conclude that by using fresh surgical specimens useful cytohistological collections can be created both as a teaching resource and as improving experience.
Browning Louise E
Full Text Available Abstract Introduction Gallstone ileus is an uncommon complication of cholelithiasis but an established cause of mechanical bowel obstruction in the elderly. Perforation of the small intestine proximal to the obstructing gallstone is rare, and only a handful of cases have been reported. We present two cases of perforation of the jejunum in gallstone ileus, and remarkably in one case, the gallstone ileus caused perforation of a jejunal diverticulum and is to the best of our knowledge the first such case to be described. Case presentations Case 1 A 69 year old man presented with two days of vomiting and central abdominal pain. He underwent laparotomy for small bowel obstruction and was found to have a gallstone obstructing the mid-ileum. There was a 2 mm perforation in the anti-mesenteric border of the dilated proximal jejunum. The gallstone was removed and the perforated segment of jejunum was resected. Case 2 A 68 year old man presented with a four day history of vomiting and central abdominal pain. Chest and abdominal radiography were unremarkable however a subsequent CT scan of the abdomen showed aerobilia. At laparotomy his distal ileum was found to be obstructed by an impacted gallstone and there was a perforated diverticulum on the mesenteric surface of the mid-jejunum. An enterolithotomy and resection of the perforated small bowel was performed. Conclusion Gallstone ileus remains a diagnostic challenge despite advances in imaging techniques, and pre-operative diagnosis is often delayed. Partly due to the elderly population it affects, gallstone ileus continues to have both high morbidity and mortality rates. On reviewing the literature, the most appropriate surgical intervention remains unclear. Jejunal perforation in gallstone ileus is extremely rare. The cases described illustrate two quite different causes of perforation complicating gallstone ileus. In the first case, perforation was probably due to pressure necrosis caused by the
Pai, B S Jagadish; Rajan, Smitha Anitha; Padma, R; Suragimath, Girish; Annaji, Shridhar; Kamath, K Vinesh
Dentists traditionally think of periodontal treatment as a means of saving the teeth while leaving the patient with an esthetic problem. The goal of gingival esthetics is to maintain normal healthy gingival appearance around teeth that must be restored. Gingival recession represents a significant concern for patients and a therapeutic problem for the clinician. Root coverage is the goal of periodontal plastic surgery when treating gingival recessions in the esthetic zone. Correction of mucogingival recession deformities with a variety of periodontal plastic surgical procedures have been described each demonstrating a variable degree of success. This case report presents to you the treatment outcomes and predictability of modified semilunar coronally advanced flap (Kamran Haghighat) techniques described for the treatment of recession defects on single and multiple adjacent teeth, respectively.
Full Text Available Cutaneous involvement in renal disease is due to a host of factors ranging from metabolic disturbances to immunosuppressive drugs. Herein we report a series of six cases of renal failure with varied cutaneous manifestations ranging from infections to neoplasms due to prolonged immunosuppression. Our first case had cutaneous cryptococcosis where skin lesions gave a clue to the diagnosis of altered sensorium and underlying meningitis. The second case initially presented with florid warts and was treated successfully but later presented with an explosive recurrence of skin lesions due to malignant transformation. Our third case had basal cell carcinoma over the presternal region that was successfully treated with liquid nitrogen cryotherapy. Our fourth case had diabetic nephropathy that presented with septicemia and purpura fulminans. The last case had cutaneous manifestations of drug therapy because of heparin infusion. To conclude, cutaneous manifestations in patients with renal failure are varied and a high degree of suspicion is needed for early diagnosis and aggressive treatment to effectively combat mortality and morbidity.
Functional MRI in pre-surgical planning: case study and cautionary notes. ... Since its inception almost 20 years ago, functional magnetic resonance imaging ... Although the clinical applications of fMRI are still limited, there have recently been ...
Combs, Stephanie A; Diehl, M Dyer; Staples, William H; Conn, Lindsay; Davis, Kendra; Lewis, Nicole; Schaneman, Katie
A nontraditional form of exercise recently applied for patients with Parkinson disease (PD) is boxing training. The primary purpose of this case series is to describe the effects of disease severity and duration of boxing training (short term and long term) on changes in balance, mobility, and quality of life for patients with mild or moderate to severe PD. The feasibility and safety of the boxing training program also were assessed. Six patients with idiopathic PD attended 24 to 36 boxing training sessions for 12 weeks, with the option of continuing the training for an additional 24 weeks (a seventh patient attended sessions for only 4 weeks). The 90-minute sessions included boxing drills and traditional stretching, strengthening, and endurance exercises. Outcomes were tested at the baseline and after 12, 24, and 36 weeks of boxing sessions (12-, 24-, and 36-week tests). The outcome measures were the Functional Reach Test, Berg Balance Scale, Activities-specific Balance Confidence Scale, Timed "Up & Go" Test, Six-Minute Walk Test, gait speed, cadence, stride length, step width, activities of daily living and motor examination subscales of the Unified Parkinson Disease Rating Scale, and Parkinson Disease Quality of Life Scale. Six patients completed all phases of the case series, showed improvements on at least 5 of the 12 outcome measures over the baseline at the 12-week test, and showed continued improvements at the 24- and 36-week tests. Patients with mild PD typically showed improvements earlier than those with moderate to severe PD. Despite the progressive nature of PD, the patients in this case series showed short-term and long-term improvements in balance, gait, activities of daily living, and quality of life after the boxing training program. A longer duration of training was necessary for patients with moderate to severe PD to show maximal training outcomes. The boxing training program was feasible and safe for these patients with PD.
Karam, Matthew D; Thomas, Geb W; Taylor, Leah; Liu, Xiaoxing; Anthony, Chris A; Anderson, Donald D
Orthopedic surgical education is evolving as educators search for new ways to enhance surgical skills training. Orthopedic educators should seek new methods and technologies to augment and add value to real-time orthopedic surgical experience. This paper describes a protocol whereby we have started to capture and evaluate specific orthopedic milestone procedures with a GoPro® point-of-view video camera and a dedicated video reviewing website as a way of supplementing the current paradigm in surgical skills training. We report our experience regarding the details and feasibility of this protocol. Upon identification of a patient undergoing surgical fixation of a hip or ankle fracture, an orthopedic resident places a GoPro® point-of-view camera on his or her forehead. All fluoroscopic images acquired during the case are saved and later incorporated into a video on the reviewing website. Surgical videos are uploaded to a secure server and are accessible for later review and assessment via a custom-built website. An electronic survey of resident participants was performed utilizing Qualtrics software. Results are reported using descriptive statistics. A total of 51 surgical videos involving 23 different residents have been captured to date. This includes 20 intertrochanteric hip fracture cases and 31 ankle fracture cases. The average duration of each surgical video was 1 hour and 16 minutes (range 40 minutes to 2 hours and 19 minutes). Of 24 orthopedic resident surgeons surveyed, 88% thought capturing a video portfolio of orthopedic milestones would benefit their education. There is a growing demand in orthopedic surgical education to extract more value from each surgical experience. While further work in development and refinement of such assessments is necessary, we feel that intraoperative video, particularly when captured and presented in a non-threatening, user friendly manner, can add significant value to the present and future paradigm of orthopedic surgical
Alexander M Aiken
Full Text Available INTRODUCTION: In low-income countries, Surgical Site Infection (SSI is a common form of hospital-acquired infection. Antibiotic prophylaxis is an effective method of preventing these infections, if given immediately before the start of surgery. Although several studies in Africa have compared pre-operative versus post-operative prophylaxis, there are no studies describing the implementation of policies to improve prescribing of surgical antibiotic prophylaxis in African hospitals. METHODS: We conducted SSI surveillance at a typical Government hospital in Kenya over a 16 month period between August 2010 and December 2011, using standard definitions of SSI and the extent of contamination of surgical wounds. As an intervention, we developed a hospital policy that advised pre-operative antibiotic prophylaxis and discouraged extended post-operative antibiotics use. We measured process, outcome and balancing effects of this intervention in using an interrupted time series design. RESULTS: From a starting point of near-exclusive post-operative antibiotic use, after policy introduction in February 2011 there was rapid adoption of the use of pre-operative antibiotic prophylaxis (60% of operations at 1 week; 98% at 6 weeks and a substantial decrease in the use of post-operative antibiotics (40% of operations at 1 week; 10% at 6 weeks in Clean and Clean-Contaminated surgery. There was no immediate step-change in risk of SSI, but overall, there appeared to be a moderate reduction in the risk of superficial SSI across all levels of wound contamination. There were marked reductions in the costs associated with antibiotic use, the number of intravenous injections performed and nursing time spent administering these. CONCLUSION: Implementation of a locally developed policy regarding surgical antibiotic prophylaxis is an achievable quality improvement target for hospitals in low-income countries, and can lead to substantial benefits for individual patients and
LUCKY OBUKOWHO ONOTAI
Full Text Available Foreign body (FB ingestion is common in clinical practice especially in children. Its impaction in the esophagus constitutes an important cause of morbidity and mortality in our environment. Due to technological advancement and increase use of disk batteries to power children toys and remote control gadgets, ingestion of disk batteries is now commonplace. In our environment there is paucity of information on disk batteries hence we decided to present case series of disk batteries in the esophagus of children highlighting the peculiarities of disk batteries, the dangers posed by them, the mode of retrieval, complications encountered, and possible recommendations to curtail the increasing occurrence.
Kenneth D. Katz
Full Text Available Synthetic cannabinoid use has risen at alarming rates. This case series describes 11 patients exposed to the synthetic cannabinoid, MAB-CHMINACA who presented to an emergency department with life-threatening toxicity including obtundation, severe agitation, seizures and death. All patients required sedatives for agitation, nine required endotracheal intubation, three experienced seizures, and one developed hyperthermia. One developed anoxic brain injury, rhabdomyolysis and died. A significant number were pediatric patients. The mainstay of treatment was aggressive sedation and respiratory support. Synthetic cannabinoids pose a major public health risk. Emergency physicians must be aware of their clinical presentation, diagnosis and treatment.
Raju, I. Tammi; Solanki, Rachana; Patnaik, A.N.; Barik, R.C.; Kumari, N.R.; Gulati, A.S.
Endocarditis due to brucellosis is considered a rare occurrence involving native, congenital and prosthetic valves. The diagnosis needs high degree of suspicion in culture negative endocarditis especially in those with history of exposure to farm animals. A positive culture in a susceptible patient confirms the diagnosis with 91% sensitivity. An early diagnosis and prompt treatment with appropriate antibiotics can restore the valve structural integrity with minimal damage. Here we present a series of five cases of culture proven Brucella endocarditis (four native valves, one prosthetic valve) and this report discusses the diagnostic and management issues involved. PMID:23438616
Rubino, Pierangela; Mora, Paolo; Ungaro, Nicola; Gandolfi, Stefano A.; Orsoni, Jelka G.
Vitamin A deficiency is a rare but vision threatening disorder in the developed world, which can lead to blindness for severe keratomalacia with cornea scarring and perforation or night blindness due to impaired dark adaptation. Conversely, the disease is quite common in developing countries, as a consequence of chronic malnutrition. The correct diagnosis and therapy with prompt vitamin A supplementation avoid blindness. We report a series of 3 local cases with different age and causes for vitamin A deficiency. The diagnostic workup, therapy, and prognosis are discussed. PMID:26509090
Alcoverro, Emili; Tabar, Maria Dolores; Lloret, Albert; Roura, Xavier; Pastor, Josep; Planellas, Marta
Phenobarbital-responsive sialadenosis (PRS) is a rare idiopathic disease in dogs. Vomiting, retching, and gulping with bilateral enlargement of the submandibular salivary glands are the more frequent clinical signs. A thorough diagnostic examination must be performed to rule out the most important systemic etiologies involved with chronic vomiting, as there is no specific test to diagnose PRS. Diagnosis is confirmed clinically by a rapid and dramatic improvement of clinical signs after instauration of phenobarbital treatment. The aim of this article is to describe the clinical presentation, diagnostic findings, and outcome of a case series of 4 dogs with presumptive PRS. Copyright © 2015 Elsevier Inc. All rights reserved.
Patankar, Amod P; Kshirsagar, Rajesh A; Dugal, Arun; Mishra, Akshay; Ram, Hari
The Gorlin-Goltz syndrome (GGS) is also known as nevoid basal cell carcinoma syndrome. It is characterized by multiple keratocystic odontogenic tumors (KCOTs) in the jaw, multiple basal cell nevi carcinomas and skeletal abnormities. The syndrome may be diagnosed early by a dentist during the routine radiographic exams in the first decade of life, since the KCOTs are usually one of the first manifestations of the syndrome. This article reports the series of 3 cases, emphasizing its clinical and radiographic manifestations of GGS.
Shubhangi Nigwekar P, Chaitanya Gupte P, Prajakta Kharche M, Akshay Beedkar U, Neeta Misra S, ParagTupe N
Full Text Available ABSTRACT Dermoids are congenital lesions representing normal tissue in abnormal location. Orbital dermoid cysts are divided into superficial and deep dermoids. Depending on type and location, superficial ocular dermoid cysts are divided into limbal, dermoid cyst and epibulbar dermoid cyst or dermolipoma. The most common location for the epibulbar dermoid cyst is inferotemporal region of eye. They are usually asymptomatic or may present with inflammatory response due to leakage of cyst contents or may cause local irritation due to protruding hair and do cause cosmetic blemish to a school going child. For local irritation and cosmetic reasons, complete surgical excision with intact capsule of epibulbar dermoid cyst is mandatory to prevent acute inflammatory response and its recurrence. In this article we are presenting the clinical features and surgical management of an inferotemporal epibulbar dermoid in a male patient.
Raslan, M.; Hiew, K.; Hoyle, A.; Ross, D.G.; Betts, C.D.; Maddineni, S.B.
Stuttering priapism is an extremely rare and poorly understood entity. We present a rare case of a 47-year-old Afro-Caribbean gentleman who required proximal shunt procedure to treat his ischemic stuttering priapism after he had failed medical management. We provided a concise review of the literature on the surgical management of ischemic priapism. This case highlighted the importance of prompt surgical intervention in prolonged stuttering priapism to avoid serious psychological and functional complications. PMID:26977408
Fernex Lucie; Coeytaux Alessandra; Rochat Thierry; Karaca Saziye; Perrig Stephen; Burri Haran; Nendaz Mathieu R
Abstract Introduction We report a case of postural tachycardia syndrome occurring after the surgical correction of an aortic coarctation, and coexisting with upper airway resistance syndrome. Case presentation A 29-year-old Caucasian man complained of extreme fatigue, daytime sleepiness, shortness of breath on exertion, light-headedness and general weakness on standing. These symptoms began shortly after the surgical correction of an aortic coarctation and became progressively more debilitati...
Illuminati, Giulio; LaMuraglia, Glenn; Nigri, Giuseppe; Vietri, Francesco
Aneurysms of the splenic artery are the most common splanchnic aneurysms. Aneurysms of a splenic artery with an anomalous origin from the superior mesenteric artery are however rare, with eight previously reported cases. Their indications for treatment are superposable to those of aneurysms affecting an orthotopic artery. Methods of treatment of this condition include endovascular, minimally invasive techniques and surgical resection. We report one more case of aneurysm of an aberrant splenic artery, treated with surgical resection, and preservation of the spleen.
Marenzi, G; Urciuolo, V; Cimmino, P; Cirillo, A; Sammartino, G
The frenula of the oral cavity represent the insertion of perioral muscles in jaws, consisting of a fold of the triangular fibro-connective tissue covered with mucous membrane and usually inserted at the mucogingival line. The purpose of this work, after a review of literature, was to provide the clinical signs above the median frenum removal order for the orthodontic closure of a interincisor diastema and to present a new surgical technique.
Kolerman, R; Barnea, E
Sinus floor augmentation is the most common surgical procedure for gaining bone volume in the posterior maxilla. The purpose of this procedure is to enable implant placement un edentulous ridges. The most common techniques for sinus augmentation are: 1. Bone added osteotome sinus floor elevation (BAOSFE). 2. Crestal core elevation (CCE). 3. Lateral window technique (LWT). Since the early 80's many articles describing the successful use of different augmentation materials for sinus elevation have been published. Although many articles have been published on the lateral window technique and the osteotome technique as described by Summers, few articles have been published on the crestsal core sinus elevation technique. This technique, first described by Summers, includes the use of wide diameter osteotomes and trephine bur with a diameter of 6 m"m. This technique is implemented in situations when the available bone for implant placement is less than 6 m"m , which impairs the possibility of achieving primary stability of the implant. In those cases crestal core elevation is performed and implant placement is postponed 3-8 months later. Modification of the technique described by Summers was published by Fugazzoto, this technique is implemented concomitant with the extraction of the upper molars. The crestal core elevation technique (CCE), which is based on the BAOSFE (Bone Added Osteotome Sinus Floor Elevation), is based on the principle of hydraulic force acting on fluids and particles which transfer the vector of force to all direction, in this case the sinus membrane. The detached core of interradicular bone prior to osteotome placement and malleting significantly reduces surgical trauma to the patient especially in cases where a significant portion of the pre-disease interradicular bone remains. The concomitant placement of particulate material and a membrane at the time of tooth extraction offers the advantage of minimizing if not eliminating significant 3
Verma, Pushpendra Kumar; Srivastava, Ruchi; Gupta, K K; Chaturvedi, T P
Periodontal regeneration is a main aspect in the treatment of teeth affected by periodontitis. Periodontal regeneration in furcation areas is quite challenging, especially when it is in interproximal region. There are several techniques used alone or in combination considered to achieve periodontal regeneration, including the bone grafts or substitutes, guided tissue regeneration (GTR), root surface modification, and biological mediators. Many factors may account for variability in response to regenerative therapy in class II furcation. This case series describes the management of class II furcation defect in a mesial interproximal region of a maxillary tooth and other with a buccal class II furcation of mandibular tooth, with the help of surgical intervention including the GTR membrane and bone graft materials. This combined treatment resulted in healthy periodontium with a radiographic evidence of alveolar bone gain in both cases. This case series demonstrates that proper diagnosis, followed by removal of etiological factors and utilizing the combined treatment modalities will restore health and function of the tooth with the severe attachment loss.
Kathariya, Rahul; Pradeep, A R
Gingival melanin pigmentation occurs in all races of mankind. Although clinical melanin pigmentation does neither present itself as a medical problem nor a disease entity, it is a major esthetic concern for many people, especially Asians. Esthetic gingival depigmentation procedures can be performed in such patients with excellent results. This case series presents a split mouth de-epithelization procedure using popular surgical techniques such as scalpel, bur abrasion or electrosurgery. These techniques were successfully used to treat gingival hyperpigmentation. Although we found that electrosurgery increased the efficacy of our work, giving a cleaner and neater work field, it required a lot of precision. In contrast, scalpel de-epithelization was easy and technique-friendly, giving excellent results and patient satisfaction. However, the cases are being followed-up to study the factors affecting the rate and length of time required for repigmentation and to study the repigmentation patterns. This case series also reviews the advantages and disadvantages of various techniques available for depigmentation, and reiterates that the scalpel technique still serves as a gold standard for depigmentation.
Full Text Available Abstract Background In November 2008, a surgical team from the Red Cross Hospital Beverwijk, the Netherlands, was deployed in Afghanistan for three months to attend in the army hospital of Kandahar. During their stay, four incidents of armored personnel carriers encountering an improvised explosive device were assessed. In each incident, two soldiers were involved, whose injuries were strikingly similar. Case presentation The described cases comprise paired thoracic vertebral fractures, radial neck fractures, calcaneal fractures and talar fractures. Moreover, the different types of blast injury are mentioned and related to the injuries described in our series. Acknowledging the different blast mechanisms is important for understanding possible injury patterns. Conclusion From this case series, as well as the existing literature on injury patterns caused by blast injuries, it seems appropriate to pay extra attention to bodily areas that were injured in other occupants of the same vehicle. Obviously, the additional surveillance for specific injuries should be complementary to the regular trauma work-up (e.g., ATLS.
Pushpendra Kumar Verma
Full Text Available Periodontal regeneration is a main aspect in the treatment of teeth affected by periodontitis. Periodontal regeneration in furcation areas is quite challenging, especially when it is in interproximal region. There are several techniques used alone or in combination considered to achieve periodontal regeneration, including the bone grafts or substitutes, guided tissue regeneration (GTR, root surface modification, and biological mediators. Many factors may account for variability in response to regenerative therapy in class II furcation. This case series describes the management of class II furcation defect in a mesial interproximal region of a maxillary tooth and other with a buccal class II furcation of mandibular tooth, with the help of surgical intervention including the GTR membrane and bone graft materials. This combined treatment resulted in healthy periodontium with a radiographic evidence of alveolar bone gain in both cases. This case series demonstrates that proper diagnosis, followed by removal of etiological factors and utilizing the combined treatment modalities will restore health and function of the tooth with the severe attachment loss.
Harrell, Travis; Hammes, John S
Meningitis is a common admission diagnosis. No case series or descriptive studies on meningitis have recently been published. Additionally, no recent data exist on meningitis in the U.S. Military Health System. We reviewed charts of adult patients admitted to Naval Medical Center San Diego between January 2004 and December 2008 with an admission diagnosis of meningitis. Charts were excluded if they did not meet our case definition of meningitis, if missing data, or if meningitis was nosocomial or iatrogenic. We reviewed results of cerebrospinal fluid cultures during this period. We compared rates and characteristics, and outcomes of bacterial and aseptic meningitis. Two hundred twenty-one cases met our criteria. Of these, 208 were aseptic. Cerebrospinal fluid polymerase chain reaction testing was positive for enteroviruses and herpes simplex viruses in 42 (20.2%) and 17 (8.2%) cases, respectively. Of culture/polymerase chain reaction/serologically positive cases, the pathogens were Neisseria meningitidis (3), Streptococcus pneumoniae (3), viridans streptococci (2), Cryptococcus neoformans (2), Coccidioides immitis (2), and Mycobacterium tuberculosis (1). Three patients had poor outcomes: one died from S. pneumoniae and two had long-term neurologic deficits. Meningitis is a common admission diagnosis, but serious virulent pathogens are uncommon and adverse outcomes are rare.
Full Text Available Background: Cutaneous leiomyomas are benign smooth muscle tumors that comprise three distinct types such as piloleimyoma, angioleiomyoma, and genital leiomyoma. Aim: The objective of this study was to report a series of cases seen in last 8 years in a tertiary care hospital in north India and to discuss their clinicopathologic findings. Material and Methods: Paraffin-embedded blocks of cases reported as cutaneous leiomyoma from 1999 to 2007 were retrieved from the Institute of Pathology, New Delhi, and their clinical parameters were noted. Their histopathological features were reviewed on hematoxylin-eosin stained slides. Immunohistochemistry was performed where necessary. Results: Twenty-seven cases of piloleiomyoma, three cases of angioleiomyoma, five breast leiomyomas, and two scrotal leiomyomas were seen in patients ranging from 21 to 65 years of age, with an average of 38.2 years at presentation. There was a male predominance with 26 males and 11 females (M:F = 2.2:1. Solitary lesions (n = 21 were more common than multiple ( n = 16. The trunk and upper limbs were involved most commonly, comprising 23 of 37 (62.2% cases. This was followed by lower limb, face, breast, and scrotum. Conclusion: Cutaneous leiomyomas are rare lesions and form an important clinical differential diagnosis of painful papulonodules. These must be biopsied in order to differentiate them from other spindle cell lesions.
Villamil-Gómez, Wilmer; Alba-Silvera, Luz; Menco-Ramos, Antonio; Gonzalez-Vergara, Alfonso; Molinares-Palacios, Tatiana; Barrios-Corrales, María; Rodríguez-Morales, Alfonso J
Congenital chikungunya virus (CHIK) infection has been infrequently reported, even more so during the current 2013-15 outbreak in Latin America. In this study, the consequences of CHIK on pregnancy outcomes and particularly consequences in infants born to infected women were assessed in a case series from a single private institution in the north of Colombia. During September 2014 to February 2015, seven pregnant women with serological and reverse transcription-polymerase chain reaction-positive test for CHIK delivered eight infants with CHIK. These newborns required admission to pediatric intensive care, and related support, owing to severe clinical manifestations, which included respiratory distress, sepsis, necrotizing enterocolitis, meningoencephalitis, myocarditis, edema, bullous dermatitis and pericarditis. There were three deaths (case fatality rate of 37.5%). Pregnant women and newborns with CHIK long term should be followed up, given the implications of chronic sequelae (e.g. chronic inflammatory rheumatism in women) as well as recently described neurocognitive impairment in infants.
Full Text Available Masturbation is common in all societies. Despite being common, it is admonished culturally and almost all religions prohibit masturbation and consider it an act of immorality. The prohibition for masturbation leads to a lot of cultural beliefs, including certain myths, which influence sexual behavior of the person. The impact of these common cultural myths associated with masturbation, are clinically understood as Dhat syndrome and masturbatory guilt. Although there is a reasonable literature on Dhat syndrome, there is limited literature with regard to masturbatory guilt especially linking the same with axis-I psychopathology. In this case series, three cases of masturbatory guilt are presented in whom masturbatory guilt was associated with manifestation of severe psychopathology. This report suggests that masturbatory guilt must be enquired for in patients presenting with severe mental disorder.
Full Text Available Ovarian ectopic pregnancy (OEP is one of the rarest forms of nontubal ectopic pregnancies. Less than 1% of ectopic pregnancies are primary OEP. Exact etio-pathogenesis and predisposing factors for OEP are not yet well understood. Review of literature suggests its possible association with conditions like tubal sterilization, intrauterine contraceptive device (IUCD, IVF-ET in patients with bilateral salpingectomy etc. Clinical and radiological presentation often mimics like tubal ectopic pregnancy, making preoperative diagnosis difficult for clinicians. Thus, correct diagnosis can be made only intraoperatively using Speigelberg's criteria followed by histopathological confirmation. Treatment includes wedge resection of affected ovarian tissue or salpingo-oophorectomy in selected cases. We present a case series of primary ruptured ovarian ectopic pregnancy with no identifiable risk factors with inconclusive radiological diagnosis. [Int J Reprod Contracept Obstet Gynecol 2016; 5(10.000: 3641-3644
Full Text Available Childhood-onset epilepsy has a varied presentation and may have different etiological factors. A multiaxial diagnostic approach should be used before making treatment and management decisions for any individual patient. It is widely accepted that distinction among primary psychiatric disorders, epilepsy, and nonepileptic seizures is a challenge for physicians. This case series demonstrated the identification of three atypical presentations of seizures in children on the basis of detailed history taking and electroencephalogram findings, despite having normal findings in neurological examination and magnetic resonance imaging. We report three rare cases of atypical presentation in epilepsy in patients with symptoms of episodic hallucinations, rage attacks, and secondary enuresis. Clinically, the diagnosis of epilepsy can be strengthened by paying sufficient attention to detailed history and symptom spectrum of partial epilepsy.
If one has to attain high accuracy over long timescales during the numerical computation of the N-body problem, the method called Lie-integration is one of the most effective algorithms. In this paper we present a set of recurrence relations with which the coefficients needed by the Lie-integration of the orbital elements related to the spatial N-body problem can be derived up to arbitrary order. Similarly to the planar case, these formulae yields identically zero series in the case of no perturbations. In addition, the derivation of the formulae has two stages, analogously to the planar problem. Namely, the formulae are obtained to the first order, and then, higher order relations are expanded by involving directly the multilinear and fractional properties of the Lie-operator.
Laštovková, Andrea; Klusáčková, Pavlina; Fenclová, Zdenka; Bonneterre, Vincent; Pelclová, Daniela
The objective of this study is to describe a case-series of potassium aluminium tetrafluoride (KAlF(4))-induced occupational asthma (OA) and/or occupational rhinitis (OR). The study involves five patients from a heat-exchanger production line who were examined (including specific inhalation challenge tests) for suspected OA and/or OR caused by a flux containing almost 100% KAlF(4) - with fluorides' workplace air concentrations ranging between 1.7 and 2.8 mg/m(3). No subject had a previous history of asthma. All five patients had a positive specific challenge test (three patients were diagnosed with OA alone, one with OR and one with both OR and OA). At the follow-up visit, after three years on average, all patients needed permanent corticosteroid therapy (four topical, one oral). After elimination from the exposure, only one of the observed subjects gave an indication of an improvement, two subjects stabilized and two worsened. Our case series focuses on the correlation between patients' exposure to fluorides in air-conditioner production and the subsequent occurrence of OR/OA. Currently, it is uncertain whether these OR/OA were caused by hypersensitivity or irritation.
Hieger, M A; Maskell, K F; Moss, M J; Powell, S W; Cumpston, K L
Dofetilide is a class III antiarrhythmic used for treating atrial dysrhythmias. Though its adverse effects are well described in routine use, very little is known about dofetilide toxicity in overdose. This is a retrospective case series of consecutive patients reported to our poison center after dofetilide overdose. Twenty-seven cases were included. Seventeen patients were treated at a healthcare facility, and of these, eight were admitted. Twenty-one patients took one extra capsule, four took someone else's medication, one took three extra capsules, and one had a large intentional overdose. Ten patients had co-ingestants reported, including three QT-prolonging agents. No one required cardioversion, defibrillation, CPR, or overdrive pacing. The patient who reported taking 90 times his usual dose in suicide attempt was the only patient to have significant clinical effects. He experienced an 8-beat run of non-sustained ventricular tachycardia, frequent multifocal PVCs, and ventricular bigeminy. He received magnesium sulfate and potassium chloride supplementation. In this series, unintentional small overdoses did not result in significant clinical effects and were often managed successfully at home, despite the fact that information showing a single capsule can cause torsades. This study is limited by its small sample size, retrospective design, and reliance on incomplete information.
Full Text Available Abstract Introduction Spontaneous osteonecrosis of the navicular bone in adults is a rare entity, known as Müller-Weiss syndrome. We report here on our experience with six patients with Müller-Weiss syndrome accompanied by flatfoot deformity, but on a literature search found no reports on this phenomenon. Because the natural history and treatment are controversial, an understanding of how to manage this deformity may be helpful for surgeons when choosing the most appropriate operative procedure. Case presentation Six patients (five women, one man; average age, 54 years with flatfoot caused by osteonecrosis of the navicular bone were followed up between January 2005 and December 2008 (mean follow-up period, 23.2 months. Conservative treatment, such as physical therapy, and non-steroidal anti-inflammatory drugs were used, but failed. Physical examinations revealed flattening of the medial arch of the involved foot and mild tenderness at the mid-tarsal joint. Weight-bearing X-rays (anterior-posterior and lateral views, computed tomography, and MRI scans were performed for each case. Talonavicular joint arthrodesis was performed in cases of single talonavicular joint arthritis. Triple arthrodesis was performed in cases of triple joint arthritis to reconstruct the medial arch. Clinical outcomes were assessed using the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale; the scores were 63.0 pre-operatively and 89.8 post-operatively. All patients developed bony fusion. Conclusions The reason for the development of flatfoot in patients with Müller-Weiss syndrome is unknown. Surgical treatment may achieve favorable outcomes in terms of deformity correction, pain relief, and functional restoration. The choice of operative procedure may differ in patients with both flatfoot and posterior tibial tendon dysfunction.
Syed Shahid Noor
Full Text Available Osteoporosis is epidemic in Asian countries. It is a major cause of fractures that orthopaedic surgeons deal in Pakistan, though proper epidemiological data is not available. Habiba U et al found that 75.3% of post menopausal women of Pakistan were predisposed to Osteoporosis; whereas Baig L has described an average T - score of -1.833±0.65 on bone mineral density calculation of post menopausal females of Pakistan. Osteoporotic hip fractures constitute a major cause of elderly mortality worldwide and recent figures supporting the idea that these patients have survival rates comparable to breast and thyroid cancer patients. Pakistan is a developing country with large burden of hip fractures. Patients living in remote areas are the ones which suffer more because of inadequate awareness, fear of surgical treatment and lack of availability of standard treatment. These patients are dealt by surgeons of various expertise and levels of experience. Lack of facilities in hospitals is well known and usage of sub-standard implant is a major cause of failure. Therefore these patients either because of their bone fragility or mal-treatment suffer frequently from failure of hip fracture surgeries. Being in a tertiary care centre we come across these types of cases very frequently. Six to eight such cases present to outpatient department of Liaquat National Hospital every month being referred from every part of the country. These patients may have been operated once, twice or even multiple times. Special attention is required to acquire an informative history from these cases and perform a comprehensive examination. Moreover previous records and radiographs provide invaluable information regarding cause of failure and deciding course of further treatment. We herein discuss few of the cases of failure of hip fractures which were treated by hip arthroplasty.
Full Text Available Purpose: To increase the awareness of longus colli tendinitis (LCT among spine specialists and to present a practical overview of diagnostic and treatment options, so that unnecessary interventions are avoided. Five sample cases from a German spine center will also be presented. Methods: Literature review and case series. A PubMed search was performed in May 2015, and the articles found were reviewed for clinical presentation, investigations, and treatment. The frequency of publication of LCT cases and the specialty of journals were also noted. Recent cases treated in our institution were also reviewed. The clinical findings, investigations, and therapeutic interventions were summarized. Results: The PubMed search from May 2015 found 104 articles, published over 51 years, on the topic of LCT. Only four were published in spine journals. A review of this literature yielded a total of 242 cases. The classic clinical triad included neck pain, limitation of movements, and swallowing complaints. C-reactive Protein (CRP values were available in 21 cases (mean 23.66 mg/dL. A contrast-enhanced computed tomography (CT scan was the best diagnostic modality. LCT is usually a self-limiting condition, but non-steroidal anti-inflammatory drugs (NSAIDs may help alleviate discomfort. Five cases of LCT were diagnosed and treated in our center over the past three years. Conclusions: LCT, which is uncommon and has non-specific symptoms, is often referred to spine centers. Spine specialists should be aware of its clinical presentation and radiographic findings in order to avoid unnecessary interventions. The condition is self-limiting and can be treated conservatively.
Full Text Available Hirayama disease also known as monomelic amyotrophy, primarily involves distal upper limb extremities. It differs from the known types of motor neuron diseases because of its nonprogressive behavior and pathologic findings of focal ischemic changes in the anterior horn of the lower cervical cord. We present a young male with Hirayama disease who had a left upper extremity involvement which was progressive in nature. He didn't respond with initial treatment of cervical collar. Consequently surgical intervention improves muscle weakness and decrease the neurological deficit. [Int J Res Med Sci 2014; 2(3.000: 1232-1235
Full Text Available Abstract Background Rapidly destructive arthrosis of the hip is a rare and incompletely understood disorder with scarce literature about variations in natural history within a population. Methods A series of cases from North Wales with rapid progressive joint destruction and extensive subchondral bone loss in the femoral head and acetabulum are presented. Radiographic findings mimicked those of other disorders such as septic arthritis, rheumatoid and seronegative arthritis, primary osteonecrosis with secondary osteoarthritis, or neuropathic osteoarthropathy, but none of the patients had clinical, pathologic, or laboratory evidence of these entities. Results Rapid progression of hip pain and disability was a consistent clinical feature. The average duration of symptoms was 1.4 years. Radiographs obtained at various intervals before surgery (average 14 months in 18 patients documented rapid hip destruction, involvement being unilateral in 13 cases. All patients underwent total hip arthroplasty, and osteoarthritis was confirmed at pathologic examination. Conclusion The authors postulate that these cases represent an uncommon subset of osteoarthritis and regular review, both clinically and radiologically, are required to assess speed of progression and prevent rapid loss of bone stock without the surgeon being aware. These cases are unsuitable for being placed on long waiting list due to technical difficulties in delayed surgery and compromised outcome following surgery.
Murthy, M Bhanu; Kaur, Jasjit; Das, Rupali
Melanin pigmentation often occurs in the gingiva as a result of an abnormal deposition of melanin, due to which the gums may appear black, but the principles, techniques, and management of the problems associated with gingival melanin pigmentation are still not fully established. Depigmentation procedures such as scalpel surgery, gingivectomy with free gingival autografting, electrosurgery, cryosurgery, chemical agents such as 90% phenol and 95% alcohol, abrasion with diamond bur, Nd: YAG laser, semiconductor diode laser, and CO2 laser have been employed for removal of melanin hyper pigmentation. The following case series describes three different surgical depigmentation techniques: scalpel surgery, abrasion with rotary abrasive, and a diode laser. Better results of depigmentation were achieved with diode laser than conventional scalpel and with rotary abrasion with respect to esthetics. The results point out that lasers are an effective and a safe means to removal of hyperpigmentation from the gingiva. Healing was uneventful and no repigmentation occurred.
Oh, Jae Keun; Yang, Moon Sool; Yoon, Do Heum; Rha, Koon Ho; Kim, Keung Nyun; Yi, Seong; Ha, Yoon
Clinical case series and analysis. The purpose of the present study is to evaluate the advantages and disadvantages of robotic presacral tumor resection compared with conventional open approach. Conventional open approach for huge presacral tumors in the retroperitoneal space often demands excessive hospitalization and poor cosmesis. Furthermore, narrow surgical field sometimes interrupt delicate procedures. Nine patients with huge (diameter >10 cm) presacral tumors underwent surgery. Five patients among them had robotic procedure and the others had open transperitoneal tumor resection. Operation time, blood loss, hospitalization, and complications were analyzed. Robotic presacral tumor resection showed shorter operation time, less bleeding, and shorter hospitalization. Moreover, there was no complication related to abdominal adhesion. Although robotic resection for presacral tumor still has limitations technically and economically, robotic resection for huge presacral tumors demonstrated advantages over open resection specifically for benign neurogenic tumors.
Full Text Available Epiphyseal extension of benign pathology is regarded as an infrequent occurrence. This observation has been attributed to anatomical and biochemical phenomenon unique to physeal cartilage. We report a retrospective series of six patients over a period of 4 years, diagnosed with benign pathologies that showed crossing of an open physeal plate by the disease. Four of these cases were infections and two were benign tumors. The patients were aged between 5 and 11 years, all of them were treated at a tertiary referral centre and followed up for a minimum period of 6 months to evaluate the progress of disease. The findings are more than just a pathological curiosity as they alter the management and surgical procedure that needs to be performed for these conditions. The recognition of the fact that benign tumors may occasionally present with transphyseal spread will prevent unjustified radical procedures that are best reserved for aggressive malignant conditions.
Giuseppe Piccinni; Anna Angrisano; Mario Testini; G. Martino Bonomo
Acute colonic obstruction due to malignancies is an emergency that requires surgical treatment. Elderly patients or inoperable tumors require intestinal decompression that is a simple colostomy in almost all cases. This "manoeuvre"leads the patient to a percentage of mortality/morbidity and to a bad quality of life due to acceptance of stoma. The introduction of enteral metal stent inserted endoscopically has, in our opinion, provided a new way to obtaining the definitive palliation of inoperable colo-rectal cancer with a simple method. We reported our case-series and we analyzed the current literature and costs of treatments.
Ferrari, Ettore; Bandello, Francesco; Roman-Pognuz, Derri; Menchini, Francesca
To evaluate the efficacy and safety of a novel surgical approach, ab interno trabeculectomy, in a combined procedure (clear corneal phacoemulsification + ab interno trabeculectomy) for the management of concurrent cataract and glaucoma with prognostic factors for filtration failure. Department of Ophthalmology, Palmanova Hospital, Udine, Italy. A prospective noncomparative case series of 11 eyes of 11 consecutive cataract patients with medically uncontrolled primary open-angle glaucoma or pseudoexfoliation glaucoma was performed. Each patient had phacoemulsification + intraocular lens implantation + ab interno trabeculectomy, which consisted of a gonioscopically controlled ab interno removal of a quadrant (3 clock hours) of the trabecular meshwork. The main outcome measures were intraocular pressure (IOP), the number of antiglaucomatous medications used, and complications. Ten patients completed a 3-year follow-up. One patient had further surgery because of poor IOP control; in this case, the last valid observation was carried forward for IOP calculation. Mean preoperative IOP and IOPs measured 1, 3, 6, 12, 24, and 36 months after surgery were 25.0, 15.8, 15.4, 15.4, 15.2, 15.0, and 15.3 (-38.56%) mm Hg respectively. The number of medications averaged 2.4 before surgery and dropped to 0.8 at the end of follow-up. No major complications occurred during the follow-up period. The new surgical procedure combining phacoemulsification with ab interno trabeculectomy can induce a clinically relevant decrease in IOP in eyes with cataract and glaucoma with poor prognosis for filtering surgery. However, a randomized controlled clinical trial with a more extended follow-up and a larger series of patients is needed to ascertain the actual effectiveness and safety of this procedure.
Opara Peace I
Full Text Available Abstract Introduction Tongue-tie or ankyloglossia is an anatomic variation in which the lingual frenulum is thick, short or tight. It may be asymptomatic, or present with complications like breast feeding difficulties or speech, dental and cosmetic problems. The treatment of this condition, where indicated, is frenotomy. This procedure usually has few or no complications. However, when it is done by untrained personnel, it may lead to life-threatening complications. This paper highlights complications that could arise from improper treatment of ankyloglossia. Case presentation Case 1 was a one-day-old male neonate, a Nigerian of Igbo ethnicity, who was admitted with bleeding from the mouth and passage of dark stools after clipping of the frenulum by a traditional birth attendant. He was severely pale and in hypovolemic shock, with a severed frenulum which was bleeding actively. His packed cell volume was 15%. He was resuscitated with intravenous fluids and a blood transfusion. The bleeding was controlled using an adrenaline pack. He also received antibiotics. He was discharged five days later. Case 2 was a three-day-old male neonate, a Nigerian of Ikwerre ethnicity, who was admitted with profuse bleeding from a soft tissue injury under the tongue, after clipping of the frenulum by a community health worker. He was severely pale and lethargic. He was resuscitated with intravenous fluids and a blood transfusion. The bleeding vessel was ligated with repair of the soft tissue. He also received antibiotics and was discharged home one week later. Conclusion Treatment of tongue-tie, a benign condition, when done by untrained personnel may result in life-threatening complications. Clinicians should pay more attention to parents' worries about this condition and give adequate counseling or refer them to trained personnel for surgical intervention where clinically indicated.
Knafo, Steven; Page, Philippe; Pallud, Johan; Roux, François-Xavier; Abi-Lahoud, Georges
Retrospective cohort and review of the literature. To compare surgical strategies for the management of spinal synovial cysts. The recent multiplication of retrospective series of patients with spinal synovial cysts has led to a reappraisal of their incidence and clinical significance. Although surgery is considered the treatment of choice, there is still no agreement over which surgical technique should be used. We retrospectively reviewed 23 consecutive patients undergoing surgery for a spinal synovial cyst in our department between 2004 and 2010. Surgical procedures were classified into the following 4 categories: cystectomy by an interlaminar approach, hemilaminectomy, laminectomy, or associated with instrumented spinal fusion. Clinical outcome, cyst recurrence, need for subsequent fusion, and perioperative complications were compared between these groups. Of the patients included in the present cohort, 11 underwent cyst excision by an interlaminar approach, 8 had a hemilaminectomy, 2 had a laminectomy, and 2 underwent instrumented fusion. "Excellent" or "good" clinical outcome on the Macnab modified scale were achieved for 16 patients (69.6%), and there were 2 perioperative complications, 2 cyst recurrences, and 1 secondary fusion. Of the 519 patients reported in the literature, overall clinical outcome was either "excellent" or "good" for 83% of all patients. However, unfavorable outcome was more likely in patients treated with decompression alone (80/396) than decompression with fusion (10/123) (20.2% vs. 8.1%; P=0.003) and cyst recurrence (13/396 vs. 0/123; P=0.028). In contrast, the rate of perioperative complications was significantly higher in the fusion group (23/123) compared with decompression alone (11/396) (18.7% vs. 2.8%; Psynovial cyst, spinal fusion seems to decrease the risk of unfavorable clinical outcome and cyst recurrence and associated with a considerably higher rate of perioperative complications.
Dorman, M L; Wilson, K; Stone, K; Stassen, L F A
The aim of this case review was to describe the use of local anaesthesia (LA) and intravenous conscious sedation (IVCS) as a safe and effective means of managing patients requiring surgical orthodontic procedures as an alternative to general anaesthesia (GA) in children between the age of 11 and 15 years. 1) Whether treatment was completed, partially completed or not completed; 2) assessment of physiological parameters to verify safety profile of the technique. Records were reviewed retrospectively for all patients included in the series undergoing planned surgical orthodontic procedures between January 2001 and January 2004 under IVCS. All patients had been pre-assessed and deemed to be of sufficient mental and physical maturity to be treated with IVCS. Written informed consent was gained from patients and their parents/guardians with full discussion of the alternative pain and anxiety control methods available including GA. All cases were undertaken by experienced SAS grade surgeons assisted by two dental nurses holding the certificate in dental sedation nursing and their recovery was supervised by registered general nurses. Patients were clinically monitored throughout together with continuous pulse oximetry and intermittent recording of non invasive blood pressure and pulse at 10-15 minute intervals. Patients were reviewed post operatively and any complications or comments noted. Over a three year period a total of 107 patients underwent surgical procedures to aid orthodontic treatment, 28 (26%) under IVCS and 79 (74%) under GA. Twenty-five out of 28 patients in the IVCS group successfully completed all of their planned treatment. Based on this case series, IVCS would appear to offer a safe and effective alternative to GA for this group of patients providing they are selected and managed by an appropriately trained team in a suitable setting. Further prospective evidence is needed if IVCS is to be recommended for general dental treatment in patients under the
Full Text Available Objective: Neonatal pneumothoraces are associated with high mortality. Prompt recognition to minimize its complications is paramount for ultimate outcome of these babies.Methods: A retrospective case series study was carried out at Aga khan University Hospital, from January 2010 to December 2010 to determine the etiology and outcome of neonates with pneumothorax in a neonatal tertiary care unit.Results: Ten neonates diagnosed radiologically with pneumothoraces were included. M: F ratio was 1:2.3. Birth weight ranged from 1750-3600 grams with a mean of 2100 grams. The occurrence of pneumothoraces was 50% on the left side, 20% on right, and 30% were bilateral. Primary etiology included pneumonia and sepsis (30%, hyaline membrane disease (20%, meconium aspiration syndrome (20% and congenital diaphragmatic hernia (10%. Spontaneous pneumothoraces were present in 20% of cases. In our study, the incidence of neonatal pneumothoraces was 2.5/1000 births compared to 10-15/1000 in Denmark, 10-20/1000 in Turkey and 6.3/1000 from Vermont Oxford Group. Despite the small number of cases, one incidental finding was the occurrence of pneumothorax, which declined in elective cesarean section after 37 weeks gestation i.e., 1.3 of 1000 births. Mortality was 60% determined mainly by the primary etiology and other co-morbid conditions.Conclusion: The study showed a higher number of mortality cases (60%. Although, it was difficult to draw a conclusion from the limited number of cases, there may be a benefit on neonatal respiratory outcome to be obtained by better selection of mothers and by waiting until 37 weeks before performing elective cesarean section. Adequate clinician training in soft ventilation strategies will reduce the occurrence of pneumothoraces.
Full Text Available Background: Genital tuberculosis is a chorionic disease and mostly occurs by haematogenous spread from extra genital source like lungs, peritoneum, lymph nodes and bones. Transmission through a sexual intercourse is also possible. Since the majority of patients are in reproductive ages, involvement of fallopian tubes and endometrium cause infertility in patients. Cases: Reviewing 4 cases of female genital tuberculosis, which referred to an infertility treatment center with various symptoms, we encountered various appearances on hysterosalpingography (HSG. Conclusion: The genitourinary tract is the most common site of extra pulmonary TB. The primary focus of genital tuberculosis is fallopian tubes, which are almost always affected bilaterally but not symmetrically. Because of common involvement of fallopian tubes and endometrial cavity, disease causes infertility. Diagnosis is not easy because genital tuberculosis has a wide range of clinical and radiological manifestations with slow growing symptoms. Detailed hysterosalpingography finding may be helpful in better diagnosis of the disease. This case series aims to depict the various hystrosalpingographic appearances and pathology produced by tuberculosis and related literatures are reviewed in order to establish a better diagnostic evaluation of genital tuberculosis
Full Text Available Gingival fibromatosis with hypertrichosis syndrome is an extremely rare genetic condition characterized by profound overgrowth of hair and gums, as well as other variable features. Gingival fibromatosis is characterized by a large increase in the gingival dimension which extends above the dental crowns, covering them partially or completely. They were found to have a genetic origin, may also occur in isolation or be part of a syndrome, or acquired origin, due to specific drugs administered systemically. Congenital generalized hypertrichosis is a heterogeneous group of diseases with continuing excessive growth of terminal hair without androgenic stimulation. It has informally been called werewolf syndrome because the appearance is similar to that of a werewolf. Various syndromes have been associated with these features such as epilepsy, mental retardation, cardiomegaly, or osteochondrodysplasia. As so far very few cases have been reported in literature, we are reporting a series of three cases with management of the same. The excess gingival tissues, in these cases, were removed by conventional gingivectomy under general anesthesia. The postoperative result was uneventful and the patient's appearance improved significantly. Good esthetic result was achieved to allow patient to practice oral hygiene measures. Though this is not a serious condition clinically, psychosocial trauma cannot be neglected owing to the cosmetic disfigurement it produces.
Alexander, Rosemary E
Meralgia paraesthetica is a fairly common condition resulting from entrapment of the lateral femoral cutaneous nerve. I have found that acupuncture produces a rapid improvement, sometimes effecting a cure, after only one or two treatments. I therefore invited referrals in order to collect a case series. A series of 10 patients, which included two who had refused surgery, but excluded those with significant lumbar spine problems, were treated. Visual Analogue Scale pain scores and analgesic intake were recorded weekly, starting before treatment. Four patients were receiving high doses of analgesics and the average period of symptoms was 3-4 years. Acupuncture points used were BL25, GB30, GB34, GB31, GB32, Huatuojiaji and ah shi points of the buttock and thigh, up to a depth of 7.5 cm. Electroacupuncture was normally given from the second treatment. Without exception, patients were specifically tender over GB31 before they started treatment. Most were also tender over the upper lumbar spine. An average of four to five sessions of acupuncture was given. The pain scores for all 10 patients improved by at least 50%, including that of a patient with a 20-year history. At follow-up (varying from 3 to 36 months), improvement was nearly 100%. Most patients were able to stop their analgesics. Meralgia paraesthetica appears to respond rapidly to electroacupuncture. A significant trigger point at GB31 was universally present, which may aid diagnosis, although the reason for this is unclear. Further controlled studies are justified.
Thiago Cardoso Vale
Full Text Available Objective To report the clinical and neuroimaging findings in a case series of vascular parkinsonism (VP. Methods Seventeen patients with VP were evaluated with motor, cognitive, and neuroimaging standardized tests and scales. Results All patients had arterial hypertension. Ten patients were male and the mean age of the whole sample was 75.8±10.1 years. The mean age of parkinsonism onset was 72.2±10.0 years. Common clinical features were urinary incontinence (88.2%, lower limb parkinsonism with freezing of gait and falls (82.3%, and pyramidal signs (76.4%. The mean Unified Parkinson’s Disease Rating Scale (UPDRS and Hoehn-Yahr scores were 72.5±21.6 points and 3.3±0.9 points, respectively. Sixteen (94.1% patients had freezing of gait and executive dysfunction. Twelve (70.5% patients had probable vascular dementia. The mean dose of levodopa was 530.9 mg/day. Unresponsiveness to the drug was confirmed by a 6.9 mean point reduction in the UPDRS score after the “practically defined off” test. Conclusion This series provides a profile of VP with predominant lower-limb involvement, freezing of gait and falls, pyramidal signs, executive dysfunction, concomitant vascular dementia, and poor levodopa response.
Shek, Karen Mei-Yan; Chau, Janita Pak-Chun
Many of the ophthalmic surgical instruments are extremely fine and sharp. Due to the dim light environment required for ophthalmic surgical procedures, the passing of sharp instruments among surgeons and scrub nurses also poses a risk for glove perforations. A case-control study was performed to determine the number and site of perforations in the surgical gloves used by a group of scrub nurses during ophthalmic surgery. All six nurses working in an eye and refractive surgery centre in Hong Kong participated in the study. A total of 100 (50 pairs) used surgical gloves were collected following 50 ophthalmic surgeries. Fifty pairs of new surgical gloves were also collected. Every collected surgical glove underwent the water leak test. The surgical procedure perforation rate was 8%, and none of the perforations were detected by the scrub nurses. No perforations were found in any unused gloves. The findings indicate that glove perforations for scrub nurses during ophthalmic surgery do occur and mostly go unnoticed. Future studies should continue to explore factors contributing to surgical glove perforation.
Full Text Available Smile expresses a feeling of joy, success, sensuality, affection, and courtesy, and reveals self-confidence and kindness. The harmony of the smile is determined not only by the shape, the position, and the color of the teeth, but also by the gingival tissues. Although melanin pigmentation of the gingiva is completely benign and does not present a medical problem, complaints of "black gums" are common, particularly in patients having a very high smile line. Thus, perio-esthetic treatment modalities strive to achieve a harmonious inter-relationship of the pink with white, which is imperative of all treatment procedures. For depigmentation of gingival, different treatment modalities have been reported, such as bur abrasion, scraping, partial thickness flap, cryotherapy, electrosurgery, and laser. In the present case series, scraping, electrosurgery, and diode laser have been tried for depigmentation, which are simple, effective, and yield good results, along with good patient satisfaction.
Sangani, Indiya; Watt, Eileen; Cross, David
Necrotizing ulcerative gingivitis (NUG) can be a painful periodontal disease that can lead to loss of the interdental papillae. It is usually accompanied by systemic signs of fever, malaise and cervical and submandibular lymphadenopathy. It is caused by the profileration of anaerobic bacteria and has been linked to smoking and immunosuppression. This case series reports the occurrence of NUG in orthodontic patients and demonstrates that there is a varying scale of severity of the condition. Orthodontists should be aware of the clinical signs of NUG to ensure early detection and treatment of their patients in order to prevent irreversible loss of the interdental papillae and reduce the likelihood of recurrence. A treatment regime is suggested.
Verma, Esha; Chakki, Arunkumar Bhimashankar; Nagaral, Sharanbasappa Chandrashekar; Ganji, Kiran Kumar
THE CONCEPT OF FIBROOSSEOUS LESIONS OF BONE HAS EVOLVED OVER THE LAST SEVERAL DECADES AND NOW INCLUDES TWO MAJOR ENTITIES: fibrous dysplasia and ossifying fibroma. Peripheral cemento-ossifying fibroma is a relatively rare tumour classified between fibroosseous lesions. It predominantly affects adolescents and young adults, with peak prevalence between 10 and 19 yrs. The cemento-ossifying fibroma is a central neoplasm of bone as well as periodontium which has caused considerable controversy because of confusion regarding terminology and the criteria for its diagnosis. The cemento-ossifying fibroma is odontogenic in origin, whereas ossifying fibroma is of bony origin. Lesions histologically similar to peripheral ossifying fibroma have been given various names in existing literature. Therefore, we present and discuss in this paper a series of cases of peripheral cemento-ossifying fibroma emphasizing the differential diagnosis.
Harish Kumar S, Ujjawal Kumar, Raghavendra Prasad B N, Kiran BJ, Anil Kumar M
Full Text Available Nitrobenzene is a nitrite compound; its toxic effects are due to its ability to convert hemoglobin to methaemoglobin by oxidizing iron. The clinical features of nitrobenzene poisoning vary based on the concentration of methaemoglobin in blood. Immediate identification based on clinical features, odour of the compound with supporting evidence of increased methaemoglobin levels will help in a timely intervention thus preventing fatal outcome. Early haemodynamic and ventilator support along with administration of methylene blue as an antidote has been proved crucial in saving some lives. An acute nitrobenzene poisoning presenting with methaemoglobinemia is becoming quite common in this part of the country. Here authorsreport a series of cases of nitrobenzene poisoning where immediate clinical evaluation, with repeated intravenous methylene blue saved three patients, but two patients presenting late and with heavy exposure could not be saved
Chang, Christopher Y; Thrasher, Richard
We introduce a novel and potentially effective approach in the treatment of tonsil stones using Coblation technology. A retrospective pilot case series was performed demonstrating the effectiveness of a technique that we call Coblation tonsil cryptolysis. This technique is unique in that it can be performed in adult patients without sedation using only local anesthesia, much like laser tonsil cryptolysis. As with laser cryptolysis, pain is significant for only a few days and most adults can resume normal diet and activity within 1 week. In contrast, tonsillectomy entails significant morbidity for several weeks. However, Coblation avoids the significant disadvantages of laser use, including the potential for airway fire, retinal damage from reflected scatter, dealing with plume from vaporized tissues, oral/facial burns, and the high cost of purchasing and maintaining laser equipment. After a single session of Coblation tonsil cryptolysis, a significant decrease and even elimination of tonsil stones can potentially be achieved.
Maryam Alsadat Hashemipour
Full Text Available Snus (nass is a form of snuff used in a similar manner to American dipping tobacco, but it does not typically result in a need for spitting. Possible hazards associated with this material include malignant and premalignant lesions in the oral cavity and gastrointestinal tract. The use of smokeless tobacco has increased in the Middle East in recent decades, particularly among teenagers and young adults. Therefore, practitioners must be able to recognize malignant and premalignant lesions. Although, an estimated 10-25% of the world′s population uses smokeless tobacco, this practice is virtually unknown in Iran. The aim of this study is to report a series of cases of squamous cell carcinoma and verrucous carcinoma occurring in the users of snus, who referred to the Department of Oral Medicine in Kerman Dental School.
Thangavelu, Arthiie; Elavarasu, Sugumari; Jayapalan, Piranitha
Smile expresses a feeling of joy, success, sensuality, affection, and courtesy, and reveals self-confidence and kindness. The harmony of the smile is determined not only by the shape, the position, and the color of the teeth, but also by the gingival tissues. Although melanin pigmentation of the gingiva is completely benign and does not present a medical problem, complaints of "black gums" are common, particularly in patients having a very high smile line. Thus, perio-esthetic treatment modalities strive to achieve a harmonious inter-relationship of the pink with white, which is imperative of all treatment procedures. For depigmentation of gingival, different treatment modalities have been reported, such as bur abrasion, scraping, partial thickness flap, cryotherapy, electrosurgery, and laser. In the present case series, scraping, electrosurgery, and diode laser have been tried for depigmentation, which are simple, effective, and yield good results, along with good patient satisfaction.
Kumar, Sharath; Nair, Sathyajith; Rajam, Lalitha
To determine the clinical and laboratory characteristics of patients diagnosed with pediatric systemic lupus erythematosus (pSLE) in the general pediatrics department of a tertiary level hospital in southern India and compare them to data of case series from other parts of the country. Retrospective chart review by two independent reviewers. All patients diagnosed with SLE in the pediatrics department of the Amrita Institute of Medical Sciences hospital between 1 January 2004 and 31 September 2008, were included in the study. Twenty children were diagnosed with pSLE in the above-mentioned period (female : male ratio 2.3 : 1.0). Fever (75% of patients) and arthralgia (65%) were the most common clinical presenting features. Many patients who were referred as 'Fever of unknown origin' (37.5%) or 'idiopathic thrombocytopenic purpura' (15%) fulfilled the diagnosis of SLE on detailed evaluation. Renal manifestations were present in 11 patients, seven of whom underwent a biopsy. Class IV lupus nephritis was the most common finding (4/7). A very high percentage of our patients had hypocomplementemia (85%). The statistical significance of the differences between our cohort and previously reported cohorts could not be determined. pSLE patients in our series, compared to previous literature from India had a much higher incidence of fever, thrombocytopenia and hypocomplementemia at presentation and much lower incidence of arthritis. It is unclear whether these differences represent unique characteristics of ethnically dissimilar subsets of the Indian population. A high index of suspicion should be maintained in order to make an early diagnosis of pSLE, since the most common presenting features in our cohort were arthralgia and fever.
Karimi, Mohsen; Hulsebus, Elise; Murdison, Kenneth; Wiles, Henry
Complex muscular ventricular septal defect poses difficult surgical management and is associated with high morbidity and mortality despite advancements in surgical therapy. Device closure of muscular ventricular septal defect has been encouraging and has been used in hybrid approach at a few centres. However, device closure has some limitations in patients with complex muscular ventricular septal defect. We report a case of perventricular device closure of a complex muscular ventricular septal defect in a beating heart with entrapped right ventricular disc and its surgical management.
Full Text Available Surgical ciliated cyst happens as a delayed complication in the maxillary sinus, and is more frequent in Asia in comparison with Western countries. We report a case of surgical ciliated cyst in maxillary sinus in a male patient after 30 years of surgery for sinusitis treatment. The patient had swelling and pain in the region, and his radiographic views showed a cystic lesion. Incisional biopsy was performed and surgical ciliated cyst was reported as diagnosis. Then, Enucleation with curettage was performed for him as treatment.
Dongo, Andrew E; Kesieme, Emeka B; Iyamu, Christopher E; Okokhere, Peter O; Akhuemokhan, Odigie C; Akpede, George O
Lassa fever, an endemic zoonotic viral infection in West Africa, presents with varied symptoms including fever, vomiting, retrosternal pain, abdominal pain, sore-throat, mucosal bleeding, seizures and coma. When fever and abdominal pain are the main presenting symptoms, and a diagnosis of acute abdomen is entertained, Lassa fever is rarely considered in the differential diagnosis, even in endemic areas. Rather the diagnosis of Lassa fever is suspected only after surgical intervention. Therefore, such patients often undergo unnecessary surgery with resultant delay in the commencement of ribavirin therapy. This increases morbidity and mortality and the risk of nosocomial transmission to hospital staff. We report 7 patients aged between 17 months and 40 years who had operative intervention for suspected appendicitis, perforated typhoid ileitis, intussuception and ruptured ectopic pregnancy after routine investigations. All seven were post-operatively confirmed as Lassa fever cases. Four patients died postoperatively, most before commencement of ribavirin, while the other three patients eventually recovered with appropriate antibiotic treatment including intravenous ribavirin. Surgeons working in West Africa should include Lassa fever in the differential diagnosis of acute abdomen, especially appendicitis. The presence of high grade fever, proteinuria and thrombocytopenia in patients with acute abdomen should heighten the suspicion of Lassa fever. Prolonged intra-operative bleeding should not only raise suspicion of the disease but also serve to initiate precautions to prevent nosocomial transmission.
Murray B. Gordon
Full Text Available Introduction. Frequent colonoscopy screenings are critical for early diagnosis of colon cancer in patients with acromegaly. Case Presentations. We performed a retrospective analysis of the incidental diagnoses of colon cancer from the ACCESS trial (ClinicalTrials.gov identifier: NCT01995734. Colon cancer was identified in 2 patients (4.5%. Case 1 patient was a 36-year-old male with acromegaly who underwent transsphenoidal surgery to remove the pituitary adenoma. After surgery, the patient underwent routine colonoscopy screening, which revealed a 40 mm tubular adenoma in the descending colon. A T1N1a carcinoma was surgically removed, and 1 of 22 lymph nodes was positive for metastatic disease, leading to a diagnosis of stage 3 colon cancer. Case 2 patient was a 50-year-old male with acromegaly who underwent transsphenoidal surgery to remove a 2 cm pituitary adenoma. The patient reported severe cramping and lower abdominal pain, and an invasive 8.1 cm3 grade 2 adenocarcinoma with signet rings was identified in the ascending colon and removed. Of the 37 lymph nodes, 34 were positive for the presence of tumor cells, and stage 3c colon cancer was confirmed. Conclusion. Current guidelines for colonoscopy screening at the time of diagnosis of acromegaly and at appropriate follow-up intervals should be followed.
Nakhle, Samer; Ludlam, William H.
Introduction. Frequent colonoscopy screenings are critical for early diagnosis of colon cancer in patients with acromegaly. Case Presentations. We performed a retrospective analysis of the incidental diagnoses of colon cancer from the ACCESS trial (ClinicalTrials.gov identifier: NCT01995734). Colon cancer was identified in 2 patients (4.5%). Case 1 patient was a 36-year-old male with acromegaly who underwent transsphenoidal surgery to remove the pituitary adenoma. After surgery, the patient underwent routine colonoscopy screening, which revealed a 40 mm tubular adenoma in the descending colon. A T1N1a carcinoma was surgically removed, and 1 of 22 lymph nodes was positive for metastatic disease, leading to a diagnosis of stage 3 colon cancer. Case 2 patient was a 50-year-old male with acromegaly who underwent transsphenoidal surgery to remove a 2 cm pituitary adenoma. The patient reported severe cramping and lower abdominal pain, and an invasive 8.1 cm3 grade 2 adenocarcinoma with signet rings was identified in the ascending colon and removed. Of the 37 lymph nodes, 34 were positive for the presence of tumor cells, and stage 3c colon cancer was confirmed. Conclusion. Current guidelines for colonoscopy screening at the time of diagnosis of acromegaly and at appropriate follow-up intervals should be followed. PMID:28025627
Full Text Available Abstract Background Gastroparesis has a number of etiologies. The main ones are secondary to a complication from diabetes mellitus, related to post vagotomy or post gastric surgical resections, or idiopathic when the etiology is unclear. Gastroparesis secondary to a demyelinating disease of the brain is unusual. Case presentation A 22-year-old woman was referred for acute onset of intractable nausea and vomiting. She also had cerebellar deficits, dysphagia and paresthesias. Magnetic resonance imaging (MRI of the brain revealed an isolated area of demyelination in the medullary region. Another 24-year-old woman had a similar presentation with right hemiplegia and MRI of the brain revealed a distal medullary region. Both these patients had an abnormal gastric emptying test. Gastroparesis and neurological deficits improved with intravenous corticosteroids. While the former patient has had no further recurrences, the latter patient developed multiple sclerosis within three months of presentation. Conclusion A demyelinating disease is a rare cause gastropareis, but should be suspected when symptoms of gastroparesis are associated with neurological deficits. MRI might help in the diagnosis and intravenous coriticosteroids can address the underlying disease process and improve gastric emptying, especially when used early during the course of the disease.
Reddymasu, Savio C; Bonino, John; McCallum, Richard W
Background Gastroparesis has a number of etiologies. The main ones are secondary to a complication from diabetes mellitus, related to post vagotomy or post gastric surgical resections, or idiopathic when the etiology is unclear. Gastroparesis secondary to a demyelinating disease of the brain is unusual. Case presentation A 22-year-old woman was referred for acute onset of intractable nausea and vomiting. She also had cerebellar deficits, dysphagia and paresthesias. Magnetic resonance imaging (MRI) of the brain revealed an isolated area of demyelination in the medullary region. Another 24-year-old woman had a similar presentation with right hemiplegia and MRI of the brain revealed a distal medullary region. Both these patients had an abnormal gastric emptying test. Gastroparesis and neurological deficits improved with intravenous corticosteroids. While the former patient has had no further recurrences, the latter patient developed multiple sclerosis within three months of presentation. Conclusion A demyelinating disease is a rare cause gastropareis, but should be suspected when symptoms of gastroparesis are associated with neurological deficits. MRI might help in the diagnosis and intravenous coriticosteroids can address the underlying disease process and improve gastric emptying, especially when used early during the course of the disease. PMID:17266755
Samaha, E; Rizk, T; Nohra, G; Mohasseb, G; Okais, N
Temporary arterial occlusion (TAO) is commonly used in the surgery of intracranial giant aneurysms. Its usefulness and safety in the surgical management of all cases of aneurysms remains to be proved. We report a series of 54 patients operated on for an intracranial aneurysm with the use of TAO. Among the 27 patients, admitted before the 4th day following post subarachnoid hemorrhage with I or II on WFNS score clinically, 24 had early aneurysm surgery. The size of the aneurysm was small in 16 cases, medium in 22, large in 13 and giant in 3 cases. The protocol proposed by Batjer in 1988 for large and giant aneurysms (etomidate, normotention and hypervolemia) was used without any electrophysiological monitoring. All patients underwent a post-operative cerebral CT scan to evaluate the incidence of a cerebral ischemia. Serial transcranial doppler was used to evaluate the severity of vasospasm. Clinical results were assessed using the GOS. TAO was elective in 51 patients and done after peroperative aneurysm rupture in 3 patients. The duration of TAO was less than 5 mn in 25 patients, between 5 and 10 min in 12, between 10 and 15 in 11, between 15 and 20 in 5 and more than 20 min in one patient. The last one developed a reversible neurological deficit secondary to ischemia attribuated to TAO. Intracranial aneurysm peroperative rupture was noted in 3 patients, clinical vasospam in 13 patients. These results allow us to recommend the routine use of TAO in the surgery of intracranial aneurysm. When application time is limited and cerebral protection used, TAO is safe. It decreases the risk of intraoperative rupture from a 18% rate in literature to 4.2% in our present experience and the risk of symptomatic vasospasm is not increased.
Cramer, Holger; Krucoff, Carol; Dobos, Gustav
While yoga is gaining increased popularity in North America and Europe, its safety has been questioned in the lay press. The aim of this systematic review was to assess published case reports and case series on adverse events associated with yoga. Medline/Pubmed, Scopus, CAMBase, IndMed and the Cases Database were screened through February 2013; and 35 case reports and 2 case series reporting a total of 76 cases were included. Ten cases had medical preconditions, mainly glaucoma and osteopenia. Pranayama, hatha yoga, and Bikram yoga were the most common yoga practices; headstand, shoulder stand, lotus position, and forceful breathing were the most common yoga postures and breathing techniques cited. Twenty-seven adverse events (35.5%) affected the musculoskeletal system; 14 (18.4%) the nervous system; and 9 (11.8%) the eyes. Fifteen cases (19.7%) reached full recovery; 9 cases (11.3%) partial recovery; 1 case (1.3%) no recovery; and 1 case (1.3%) died. As any other physical or mental practice, yoga should be practiced carefully under the guidance of a qualified instructor. Beginners should avoid extreme practices such as headstand, lotus position and forceful breathing. Individuals with medical preconditions should work with their physician and yoga teacher to appropriately adapt postures; patients with glaucoma should avoid inversions and patients with compromised bone should avoid forceful yoga practices.
Full Text Available Abstract Introduction We report a case of postural tachycardia syndrome occurring after the surgical correction of an aortic coarctation, and coexisting with upper airway resistance syndrome. Case presentation A 29-year-old Caucasian man complained of extreme fatigue, daytime sleepiness, shortness of breath on exertion, light-headedness and general weakness on standing. These symptoms began shortly after the surgical correction of an aortic coarctation and became progressively more debilitating, impairing any daily activity. An extensive work-up revealed postural tachycardia syndrome and a coexisting sleep-related breathing disorder, characterized as upper airway resistance syndrome. Conclusion This is the first reported case describing the occurrence of postural tachycardia syndrome after the surgical correction of an aortic coarctation. This case also provides evidence for the suggestion that this syndrome may coexist with upper airway resistance syndrome, although the exact nature of their relationship must still be better established.
Nogueira, A S; Gonçales, E S; Gonçales, A G B; Thiegui-Neto, V; Nogueira, C B P; Nogueira, A; Medeiros, R
Odontomas represent the most prevalent odontogenic tumors in the jaw. The treatment of choice is surgical removal, usually performed by conventional techniques involving ostectomies to expose the tumor. In this paper, the authors describe, through the report of a case of complex odontoma located in the mandibular angle, a more conservative surgical technique called corticotomy, in which the bone removed for access to the tumor (buccal cortical) is repositioned and fixed by titanium plates of 1.5 mm.
Smith, Joseph R; Sillay, Karl; Winkler, Peter; King, Don W; Loring, David W
Clinical and electrographic data were reviewed on 2 of our patients with orbitofrontal epilepsy who were seizure free at 5-year follow-up, and on 2 similar patients from the literature. One of our patients was lesional, and the other was nonlesional. Interictal EEG discharges were lateralized to the side of invasively recorded orbitofrontal seizures in the nonlesional case. In this case, no clinical manifestations occurred until the orbitofrontal discharge had spread to the opposite orbitofrontal and both mesial temporal areas. Unresponsiveness or arrest of activity were the initial manifestations of complex partial seizures in both cases. The 2 cases from the literature with long-term seizure-free follow-up had little impairment of awareness and displayed vigorous motor automatisms. Interictal epileptiform activity was bifrontally synchronous in 1 case. Ipsilateral frontotemporal discharges were seen in both. Invasive ictal epileptiform activity appeared maximal in the ipsilateral orbitofrontal region in both patients. No consistent electrographic or clinical pattern characterized these 4 cases. Seizures of orbitofrontal origin may be characterized by either unresponsiveness associated with oroalimentary automatisms or limited alteration of awareness and associated with vigorous motor automatisms. Invasive monitoring of the orbitofrontal cortex should be considered in nonlesional cases with complex partial seizures that show nonlocalizing ictal patterns and interictal frontal or frontotemporal epileptiform discharges.
Full Text Available Purpose. The purpose of this retrospective case series is to describe and compare different surgical techniques that can be utilized to augment the keratinized soft tissue around implant-supported overdentures. Materials and Methods. The data set was extracted as deidentified information from the routine treatment of patients at the Ashman Department of Periodontology and Implant Dentistry at New York University College of Dentistry. Eight edentulous patients were selected to be included in this study. Patients were treated for lack of keratinized tissue prior to implant placement, during the second stage surgery, and after delivery of the final prosthesis. Results. All 8 patients in this study were wearing a complete maxillary and/or mandibular denture for at least a year before the time of the surgery. One of the following surgical techniques was utilized to increase the amount of keratinized tissue: apically positioned flap (APF, pedicle graft (PG, connective tissue graft (CTG, or free gingival graft (FGG. Conclusions. The amount of keratinized tissue should be taken into consideration when planning for implant-supported overdentures. The apical repositioning flap is an effective approach to increase the width of keratinized tissue prior to the implant placement.
Gao, Bo; Jiang, Yan; Zhang, Shu; Guo, Lingji; Tian, Wuguo; Wen, Yayuan; He, Yujun; Luo, Donglin
This study was to discuss the surgical diagnosis and treatment experience of primary hyperparathyroidism. Clinical data of 19 primary hyperparathyroidism patients who were treated surgically in our department from Jan. 2005 to Jul. 2014 were retrospectively analyzed. Besides, general data, clinical manifestations, laboratory and imaging test results, surgical procedures and postoperative follow-up information were comprehensively analyzed. 15 of 19 patients had adenoma, among whom 1 case was complicated with goiter, 3 cases with parathyroid hyperplasia, and 1 case with parathyroid carcinoma. One case of bilateral parathyroid adenoma was explored bilaterally, and the bilateral parathyroid adenoma was excised. 14 cases of unilateral parathyroid adenoma were explored unilaterally and the unilateral parathyroid adenoma was excised. 3 cases of parathyroid hyperplasia were explored bilaterally, and parathyroid glands were removed subtotally, and only half gland was reserved. 1 case of parathyroid carcinoma experienced excision of thyroid gland and parathyroid at the affected side and isthmus excision, subtotal excision of thyroid gland at the healthy side and functional cervical lymphonode dissection at the affected side. All the 19 cases recovered well after operation, and symptoms of hyperparathyroidism were controlled. No relapse was found after follow-up of 3 months to 5 years. In conclusion, local parathyroid excision with small wounds after pre-operative locative image test and qualitative laboratory test is effective. Timely surgical treatment could reduce joint and urinary damage. Post-operative follow-up should be emphasized for early detection of the patients with hypoparathyroidism and recurrence.
De Moor, N.G.; Berry, A.V.; Nissenbaum, M.M. (University of the Witwatersrand, Johannesburg (South Africa))
These 2 case reports serve to emphasize two important points concerning carcinoma of the cervix: (i) blood-borne metastases are now frequently encountered in this disease; and (ii) in selected cases surgical excision of a secondary deposit in the lung is the treatment of choice and may even result in cure.
de Moor, N G; Berry, A V; Nissenbaum, M M
These 2 case reports serve to emphasize two important points concerning carcinoma of the cervix: (i) blood-borne metastases are now frequently encountered in this disease; and (ii) in selected cases surgical excision of a secondary deposit in the lung is the treatment of choice and may even result in cure.
John E. Gross, MD, FACS
Full Text Available Summary: Patients with a history of massive weight loss have compromised and poor-quality skin and fascia. Various body contouring surgeries aim to improve appearance and shape of the trunk and restore fascial integrity. These patients may be at increased risk of recurrent fascial laxity or bulges after conventional techniques. Here, the author presents a case where a silk-based bioresorbable scaffold was used prophylactically in a massive weight loss patient undergoing a circumferential body lift.
Smith, Joseph R.; Sillay, Karl; Winkler, Peter; King, Don W.; Loring, David W.
Clinical and electrographic data were reviewed on 2 of our patients with orbitofrontal epilepsy who were seizure free at 5-year follow-up, and on 2 similar patients from the literature. One of our patients was lesional, and the other was nonlesional. Interictal EEG discharges were lateralized to the side of invasively recorded orbitofrontal seizures in the nonlesional case. In this case, no clinical manifestations occurred until the orbitofrontal discharge had spread to the opposite orbitofro...
Full Text Available Objectives. The primary objective for this study is to evaluate the advantages, disadvantages, surgical applicability, and outcome of the pulsed electron avalanche knife (PEAK PlasmaBlade in transoral adenoidectomy under direct visualization using video nasoendoscopy. Patients and Methods. In this series, six cases of adenoid hypertrophy showing varying clinical presentations in relation to its clinical course were surgically treated using a PEAK PlasmaBlade. Before and after surgery, all patients underwent nasal endoscopy to define the grading of hypertrophic adenoids and postoperative outcome. Pure tone audiometry and tympanometry tests were carried out to investigate the change in middle and inner ear functions. Results. The mean follow-up period was 23.8 months. Postoperatively, symptoms of otitis media with effusion were all relieved with closure of the air-bone gap (6/6. Other relevant ear complaints like tinnitus were resolved (1/1 and aural fullness disappeared in 87.5% of ears (7/8. Nasal obstruction (2/2 and postnasal drip (2/2 were improved after surgery. Conclusions. Based on this preliminary report of a case series in a limited sample size, we suggest that using the transoral PEAK PlasmaBlade for adenoidectomy guided by video nasoendoscopy is a safe and feasible surgical technique, allowing remarkable outcomes by providing precise tissue removal, effective hemostasis, and painless postoperative recovery.
Tree, Jeremy J; Wilkie, Jaimie
It has been reported that congenital prosopagnosics may have a general imagery deficit or an imagery deficit specific to faces. However, much of this evidence is based on self-report questionnaires, rather than experimentally based testing (Grüter et al., 2007, 2009). This study tested face and non-face based imagery in a case series of congenital prosopagnosics, utilising both questionnaire based and forced choice accuracy measures. Our findings indicate that all the prosopagnosics showed impaired face based imagery, which contrasted with normal performance on imagery of objects and colours - a pattern that is consistent with reports of acquired prosopagnosia (Barton, 2008; Michelon and Biederman, 2003). Given all our experimentally based testing indicated face imagery impairments, despite no such problems being seen on self-report questionnaires, we would argue that testing based only on the latter must be interpreted with some caution. Overall, we would advocate that our findings demonstrate a category specific visual imagery impairment in congenital prosopagnosia, such that general imagery skill can be intact in such cases.
Lee, Ko-Chao; Lu, Chien-Chang; Hu, Wan-Hsiang; Lin, Shung-Eing; Chen, Hong-Hwa
Nonspecific gastrointestinal symptoms make diagnosis of amebiasis difficult. Certain colonoscopic findings predict amebic colitis while others suggest different diagnoses. We aimed to evaluate the diagnostic capability of colonic evaluation of amebiasis. We retrospectively reviewed data of all amebiasis cases admitted to our institution between 2003 and 2012. Cases were diagnosed by clinical presentation, laboratory examinations, and colonoscopy with biopsy and microscopic examination. Patients were stratified as right-sided colitis and proctosigmoiditis. A systematic review was conducted by searching Medline, Cochrane, EMBASE, and Google Scholar using key words amebiasis, amebic colitis, amebic proctosigmoiditis, colonoscopy, and Entamoeba histolytica. Data were extracted from articles meeting the inclusion criteria. Colonoscopic findings were described and studies were assessed for quality. The current series included 20 patients (5 male, 15 female, median age 51), 7 with amebic liver abscess and 13 with amebic colitis. Colonoscopic findings of right-sided colitis included aphthae or erosions, ulcers, exudates, or edematous swollen mucosa in cecum, and findings for proctosigmoiditis were edematous swollen mucosa with bloody exudate. In 25 studies, colonoscopic findings of 41 patients (36 male, 5 female, median age 43.39 years) included mainly ulcers in the cecum and rectum, ulcerated mass, and edematous mucosa; and in fewer patients, submucosal invasion suggestive of colon cancer, bleeding ulcers, proctitis, and ulcers with aphthae in rectum. Colonic evaluation of suspected amebiasis is of diagnostic value when accompanied by biopsy and microscopic identification of Entamoeba species. Colonoscopic manifestations vary between right-sided colitis and proctosigmoiditis.
Full Text Available Abstract Active myofascial trigger points (MTrPs have been found to contribute to chronic tension-type headache and migraine. The purpose of this case series was to examine if active trigger points (TrPs provoking cluster-type referred pain could be found in cluster headache patients and, if so, to evaluate the effectiveness of active TrPs anaesthetic injections both in the acute and preventive headache's treatment. Twelve patients, 4 experiencing episodic and 8 chronic cluster headache, were studied. TrPs were found in all of them. Abortive infiltrations could be done in 2 episodic and 4 chronic patients, and preemptive infiltrations could be done in 2 episodic and 5 chronic patients, both kind of interventions being successful in 5 (83.3% and in 6 (85.7% of the cases respectively. When combined with prophylactic drug therapy, injections were associated with significant improvement in 7 of the 8 chronic cluster patients. Our data suggest that peripheral sensitization may play a role in cluster headache pathophysiology and that first neuron afferent blockade can be useful in cluster headache management.
Full Text Available Background. Pyogenic granuloma is a reactive tumor-like lesion commonly affecting the oral cavity. These lesions usually appear as localized solitary nodule with a sessile or pedunculated base and colour varying from red, purplish, or pink, depending on the vascularity of the lesion. Pyogenic granuloma shows predilection for gingiva and is usually slow growing, but at times it shows rapid growth. The natural course of this lesion can be categorized into three distinct phases, namely, (i cellular phase, (ii capillary phase/vascular phase, and (iii involutionary phase. Histopathologically, pyogenic granuloma is classified into lobular capillary hemangioma (LCH and non-lobular capillary hemangioma (non-LCH. Case Presentation. In this series, four cases (varied age groups and both genders of pyogenic granuloma showing varying histopathological presentation in relation to its clinical course have been described. The lesion in its early phase reveals diffuse endothelial cells, with few budding into capillaries. Among the capillary phase, the LCH type shows numerous blood vessels organized into lobular aggregates whereas the non-LCH type does not show any such organization and resembles granulation tissue. The involutionary phase shows healing of the lesion and is characterized by extensive fibrosis in the connective tissue. Conclusion. In conclusion, knowledge of the various histopathological presentation of this lesion is necessary for proper identification.
Scarone, Pietro; Leclerq, Delphine; Héran, Françoise; Robert, Gilles
The authors analyzed the long-term results and radiological aspects of sphenoorbital meningioma (with emphasis on exophthalmos) in a series of 30 patients who underwent resection. Data obtained in all 30 patients who underwent surgery for typical sphenoorbital meningioma at the authors' institution between June 1994 and September 2005 were analyzed retrospectively. The exophthalmos index (EI) was measured on preoperative MR images and/or CT scans and compared between the early and last follow-up examinations. All patients were women 35-74 years of age (median 51 years). Exophthalmos was the presenting symptom in 28 patients (93%), and was observed on preoperative MR images in all patients. The median duration of symptoms before surgery was 10 months (2-120 months). Total resection (Simpson Grade I) was not achieved in these patients because of the impossibility of resecting the dura mater in the superior orbital fissure without causing significant complications. Subtotal resection (Simpson Grade II) was obtained in 90% of patients, and in 3 patients (10%) a portion of the tumor was deliberately left in place because of extensive macroscopic infiltration of the cavernous sinus and/or extraocular muscles (Simpson Grade III). No patient died. Radiological evaluation at a median follow-up of 61 months (range 17-136 months) showed no contrast enhancement in 14 patients (47%), residual contrast enhancement without evolution in 13 (43%), and recurrence (new contrast enhancement) in 3 (10%). The EI was improved at the first radiological follow-up (median 12 months) in 27 patients (90%), and at the last radiological follow-up (median 61 months) in 28 patients (93%). In the interval between the first and final imaging follow-up, the EI improved in only 8 patients (20%), worsened in 15 patients (50%), and showed no variation in 7 patients (30%). Sphenoorbital meningiomas are insidious tumors with slow progression. Even when exophthalmos is not clinically evident, it is always
Schauer, Steven G; Pfaff, James A
Combat medics are an integral part of their unit helping to conserve the fighting strength. Minor wounds are a common problem in the deployed settings that affect a soldier's ability to partake in operations. While the medics often manage wound care, there is very little data on the outcomes. Cases were acquired as part of a quality assurance project providing training feedback to medics on wound management. Laceration management is delegated to the medic at the direction of the provider. Follow-up included a series of short questions regarding wound outcomes: infection, revision, and cosmetic outcome (extremely satisfied = 1, unsatisfied = 5). Chart review was used when direct follow-up with the patient was not available for the remainder of the wounds. The project period was from May 2014 to June 2015. During this time there were 30 wound repairs documented. Direct contact follow-up was available for 57% of the encounters, the remainder was via chart review. The location of the wounds were as follows: facial 5, head/neck 0, upper extremity (excluding hand) 3, hand 16, lower extremity 5, and trunk 1. The average wound length was 2.98 cm (range, 0.8-8.0 cm). No wounds became infected. No wounds required revision. The average cosmetic rating was 1.8 (95% confidence interval = 1.48-2.12). In this series of wounds closed by medics in the emergency department no complications or revisions were necessary. Further research is needed to determine if this can be extrapolated to other military settings. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.
Posso, C M Z; Wolff, G A; Suarez, L D
Congenital web neck is a deformity hardly ever reported in the English literature. It is usually associated to Ulrrich-Turner syndrome. There are several options to correct this deformity, but in severe cases complete correction of the web and the abnormal back hair is not always possible. We present our experience with a secondary case where previous butterfly method was employed, a combined procedure was used achieving a satisfactory result. We considered that this technique is useful and offers an important improvement of the contour.
Fernex, Lucie; Coeytaux, Alessandra; Rochat, Thierry; Karaca, Saziye; Perrig, Stephen; Burri, Haran; Nendaz, Mathieu R
We report a case of postural tachycardia syndrome occurring after the surgical correction of an aortic coarctation, and coexisting with upper airway resistance syndrome. A 29-year-old Caucasian man complained of extreme fatigue, daytime sleepiness, shortness of breath on exertion, light-headedness and general weakness on standing. These symptoms began shortly after the surgical correction of an aortic coarctation and became progressively more debilitating, impairing any daily activity. An extensive work-up revealed postural tachycardia syndrome and a coexisting sleep-related breathing disorder, characterized as upper airway resistance syndrome. This is the first reported case describing the occurrence of postural tachycardia syndrome after the surgical correction of an aortic coarctation. This case also provides evidence for the suggestion that this syndrome may coexist with upper airway resistance syndrome, although the exact nature of their relationship must still be better established.
Kuhbier, Jörn W.
Full Text Available Cobra bites are quite rare in European countries as these snakes are not native there. Toxins are devastating for tissue resulting in massive necrosis, thus plastic surgery might play a role in reconstruction of the lost tissue. A case of a male patient bitten by a thai cobra in the left index finger is presented. Antitoxin administration was delayed due to secondary patient admission. Progressive tissue necrosis made radical debridement necessary, resulting in the need for plastic surgical defect coverage with a flap. While a radical debridement to prevent toxic necrosis due to lytic enzymes in cobra venom has been favoured beforehand, large case studies led to a more restrained initial surgical intervention. However, antitoxin administration should be first line therapy in management of these cases. If severe necrosis is present as it might occur in delayed admission, a plastic surgical management of the patient might be advantageous.
Zampieri, P; Scanarini, M; Sicolo, N; Andrioli, G; Mingrino, S
Four cases of growth-hormone-secreting pituitary adenoma, with associated aspects of acromegaly and gigantism, are reported in patients aged 12-26. All of the patients had macroadenomas and were treated surgically, three by the transsphenoidal approach and one with a transfrontal craniotomy. Histologic examination revealed eosinophilic adenomas in three of the cases and a mixed eosinophilic--chromophobe adenoma in one, all with cellular irregularities (mitosis and cellular and nuclear polymorphism), local invasivity, or both. Because surgical treatment did not produce complete normalization of growth hormone levels, radiotherapy followed the operations in all four cases. In our opinion, the treatment of acromegalic gigantism poses more therapeutic problems than that of simple acromegaly, with combined treatment (surgical, radiation, and medical) often being necessary.
Arai, Nobuhiko; Takahashi, Satoshi; Mami, Hatano; Tokuda, Yukina; Yoshida, Kazunari
Hemangiopericytoma (HPC) is a highly vascularized mesenchymal tumor known for its high rates of recurrence and metastasis. The extent of tumor removal is known to be the most trustful prognostic factor. Skull base HPCs are challenging to treat because of the difficulty of the surgical approach and proximity to vital vascular and neuronal structures. We successfully treated a case of HPC at the ventral foramen magnum through surgical gross tumor removal via a far-lateral transcondylar approach. A 38-year-old male complained of neck pain and bilateral paresthesia of his shoulders for 2 months, for which he was referred to our hospital. A magnetic resonance image (MRI) showed a 20 mm diameter mass at the ventral foramen magnum, which compressed his medulla oblongata. The tumor was gross totally removed via a far-lateral transcondylar approach. During the surgery, marked bleeding disturbed the surgical field until the main feeding artery from the direction of the dura mater was coagulated and cut. A relatively wide surgical field and a transcondylar approach were helpful to control the bleeding. The pathological examination revealed the tumor to be a HPC. After an uneventful recovery period of 9 days, the patient was discharged without neurological sequelae. We successfully and completely removed an HPC near the foramen magnum, employing a wide surgical field and a transcondylar approach to help control bleeding. When the tumor is suspected preoperatively to be a hemangiocytoma or vascular-rich tumor, a surgical approach that can secure a wide surgical field should be selected.
Dec 2, 2013 ... Subjects: Twelve patients with HIV infection and pyomyositis. ... Antibiotic therapy with surgical drainage/aspiration is usually .... Marked elevation in serum immunoglobulin G ... immunodeficiency virus: an un–usual form of.
Doornbusch, H.; Broersma, L.; Boering, G.; Wesselink, P.R.
Aim The aim of this study is to test the hypothesis that more patients with failed root-canal treatment or other endodontic problems are referred for periradicular surgery rather than nonsurgical re-treatment. Methodology Three sets of 100 periapical radiographs representing typical cases referred
Full Text Available Introduction and objective: Rhinologic headache caused by mucosal contact is a difficult definition condition with good response to surgical approach. Description: We present a case of a 31 year-old male with rhinologic headache criteria. We decided to offer a surgical approach, successfully. Discussion: Rhinologic headache is included in the group of “Headache caused by disorders of the nasal mucosa, turbinates or septum”. There is no agreement about its cause because the prevalence of mucosal nasal contact is similar in patients with and without facial pain. There is evidence in the resolution of facial pain with a surgical approach. Conclusions: Despite the evidence of success in the surgical approach, some doubts still persist about the causes of this entity.
Andrew Kornstein, MD, FACS
Full Text Available Summary: Patients who have undergone massive weight loss typically have poor-quality skin and fascia and thus are prone to experiencing recurrent skin laxity, bulges, and poor scarring after body contouring efforts, even in the hands of experienced surgeons. Moreover, this challenging patient population often has nutritional deficiencies and concomitant medical problems, which may lead to delayed or suboptimal wound healing. A silk-derived biological scaffold (SBS and its facilitation of autogenous tissue generation may be viewed as a qualitative reinforcement of the superficial fascial system. Therefore, it may help support and stabilize a superficial fascial system that has been weakened by obesity and other factors. When employed in body lifting for patients with massive weight loss who desire long-lasting aesthetic results, it may represent a paradigm shift that has the potential to solve at least some issues that plague this patient population. In the present case of circumferential abdominoplasty and lower body lift, this silk-based bioresorbable scaffold was implanted in one side of the patient’s body but not the other. Throughout the 7-month follow-up period, the patient and her husband (who were blinded as to which side received the SBS and the author consistently observed more favorable results for the SBS side, which included greater postoperative comfort, better shape, higher buttock position, less recurrent laxity, and less descent of the scar.
Polat, Ahmet Veysel; Belet, Umit; Aydin, Ramazan; Akan, Huseyin
Although a number of cases of retained surgical sponge (RSS) after thoracic and abdominal surgery have been reported in the literature, the occurrence of RSS after thyroidectomy is very rare. We report the imaging findings of three cases of RSS after thyroidectomy. Sonography of the three patients revealed a hyperechoic mass with marked acoustic shadow. Computed tomography showed a well-defined, circumscribed heterogeneous mass that had gas bubbles inside in two patients, whereas the mass in the third patient was hyperdense and homogenous with smooth margins. All three RSSs were surgically removed. Copyright © 2012 Wiley Periodicals, Inc., A Wiley Company.
Full Text Available Hideaki Yokogawa, Akira Kobayashi, Natsuko Yamazaki, Toshinori Masaki, Kazuhisa Sugiyama Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, JapanPurpose: To report surgical therapies for corneal perforations in a tertiary referral hospital.Methods: Thirty-one eyes of 31 patients (aged 62.4±18.3 years with surgically treated corneal perforations from January 2002 to July 2013 were included in this study. Demographic data such as cause of corneal perforation, surgical procedures, and visual outcomes were retrospectively analyzed.Results: The causes of corneal perforation (n=31 were divided into infectious (n=8, 26% and noninfectious (n=23, 74% categories. Infectious causes included fungal ulcer, herpetic stromal necrotizing keratitis, and bacterial ulcer. The causes of noninfectious keratopathy included corneal melting after removal of a metal foreign body, severe dry eye, lagophthalmos, canaliculitis, the oral anticancer drug S-1, keratoconus, rheumatoid arthritis, neurotrophic ulcer, atopic keratoconjunctivitis, and unknown causes. Initial surgical procedures included central large corneal graft (n=17, small corneal graft (n=7, and amniotic membrane transplantation (n=7. In two cases the perforation could not be sealed during the first surgical treatment and required subsequent procedures. All infectious keratitis required central large penetrating keratoplasty to obtain anatomical cure. In contrast, several surgical options were used for the treatment of noninfectious keratitis. After surgical treatment, anatomical cure was obtained in all cases. Mean postoperative best corrected visual acuity was better at 6 months (logMAR 1.3 than preoperatively (logMAR 1.8.Conclusion: Surgical therapies for corneal perforations in our hospital included central large lamellar/penetrating keratoplasty, small peripheral patch graft, and amniotic membrane transplantation. All treatments were effective. Corneal
Full Text Available Abstract Introduction Branding refers to a process whereby third degree burns are inflicted on the skin with a hot iron rod or metallic object. Branding employs the phenomenon of "counter irritation," and is widely used by faith healers in developing countries for therapeutic purposes. Some methods, which are very crude and inhuman, carry a large risk of complications. The purpose of this study is to present a series of complications and to familiarize clinicians with this dangerous method of treatment. Case presentation Four Pakistani patients, three male and one female, ranging from 25 to 60 years of age "branded" with a red hot iron rod for various medical reasons presented with severe medical complications to our tertiary care hospital. The mean duration between the procedure and presentation to the hospital was 6 days. At the time of admission, two patients had septic shock, one patient had cavernous sinus thrombosis and one patient had multiple splenic abscesses. All patients received standard care for wound management and systemic infections. Two patients eventually died during the course of treatment. Conclusion Severe complications from branding are troublesome and the potential risks of this treatment outweigh its benefits. Globally, there is a great need for heightened awareness about the dangers of branding among patients and physicians, as this will have an important effect on patients who seek branding for various medical conditions.
Ronda, Marco; Stacchi, Claudio
One of the crucial factors in the success of guided bone regeneration procedures is the correct management of the soft tissues. This allows for stable primary wound closure without tension, which can result in premature exposure of the augmentation area, jeopardizing the final outcome. The use of vertical and periosteal incisions to passivate buccal and lingual flaps in the posterior mandible is often limited by anatomical factors. This paper reports on a series of 69 consecutive cases introducing a novel surgical technique to release and advance the lingual flap coronally in a safe and predictable manner.
Full Text Available Abstract Introduction Quadratus femoris tear is an uncommon injury, which is only rarely reported in the literature. In the majority of cases the correct diagnosis is delayed due to non-specific symptoms and signs. A magnetic resonance imaging scan is crucial in the differential diagnosis since injuries to contiguous soft tissues may present with similar symptoms. Presentation with sciatica is not reported in the few cases existing in the English literature and the reported treatment has always been conservative. Case presentation We report here on a case of quadratus femoris tear in a 22-year-old Greek woman who presented with persistent sciatica. She was unresponsive to conservative measures and so was treated with surgical decompression. Conclusion The correct diagnosis of quadratus muscle tear is a challenge for physicians. The treatment is usually conservative, but in cases of persistent sciatica surgical decompression is an alternative option.
Sugimoto, Dai; Christino, Melissa A; Micheli, Lyle J
Patella instability is often encountered among physically active pediatric athletes, and surgical intervention is useful in cases with recurrent patella dislocations, chronic instability, and abnormal alignment. Several surgical procedures have been used for patella-realignment and stabilization, but the effects of surgical intervention on bony trochlear remodeling in skeletally immature patients have not been well studied. We thus present two cases of pediatric recurrent patella dislocations that showed trochlear remodeling following patella-realignment surgery. The first case describes an 11-year-old female treated with a Roux-Golthwait procedure and the second case highlights a 12-year-old male treated with lateral release and medial capsular reefing. The Merchant technique, a radiographic criterion that was designed to evaluate patella alignment in relation to the femoral trochlea groove, including sulcus and congruence angles was used to measure postoperative bony development. Both pediatric patients showed successful outcomes following surgical interventions for chronic patella instability. Using the Merchant technique, both patients showed improved congruence and sulcus angles postoperatively. Patella realignment in skeletally immature patients may be beneficial for promoting trochlear remodeling and deepening of the trochlear groove, which may help protect against future dislocation or subluxation events. Level IV, case report.
Full Text Available Abstract Thyrotoxic hypokalemic periodic paralysis (THPP is a rare, potentially life-threatening endocrine emergency. It is characterized by recurrent muscle weakness and hypokalemia. Because many THPP patients do not have obvious symptoms and signs of hyperthyroidism, misdiagnosis may occur. The published studies revealed that definitive therapy for THPP is control of hyperthyroidism by medical therapy, radioactive iodine or surgery, but the long-term post-operative follow-up result was not observed. We reported two cases of medically refractory THPP with recurrent paralysis of extremities and hypokalemia, and both were combined with thyroid nodules. Both patients were treated with total thyroidectomy; the pathology revealed that one is Graves' disease with thyroid papillary carcinoma, and the other is adenomatous goiter with papillary hyperplasia. No episode of periodic paralysis was noted and laboratory evaluation revealed normal potassium level during the post-operative follow up. Our experience suggests that total thyroidectomy by experienced surgeon is an appropriate and definite treatment for medically refractory THPP, especially in cases combined with thyroid nodules.
Full Text Available The operative management of giant pituitary prolactinoma represents a significant challenge for neurosurgeons, due to the degree of local tumor infiltration into adjacent structures such as cavernous sinus. The degree of parasellar tumor extension can be classified according to the Knosp grading system’ while suprasellar extension is qualified in accordance with the modified Hardys classification system. This report describes the case of a male patient with a giant pituitary prolactinoma in which a partial tumor resection via a subfrontal approach was achieved. Typically, resection rates of less than 50% have been reported following surgery on giant pituitary adenomas. Prolactin levels were very high, consistent with invasive giant prolactinoma. Our patient was treated with Cabergoline which eventually normalized the prolactin level and significantly reduced the size of the residual tumor. This case serves to illustrate that in the presence of significant suprasellar and parasellar extension, multi-modal treatment strategies with surgery and dopamine agonist, is the gold standard in the management of locally aggressive pituitary prolactinomas.
Lin, Yi-Chu; Wu, Che-Wei; Chen, Hui-Chun; Chen, Hsiu-Ya; Lu, I-Cheng; Tsai, Cheng-Jing; Kuo, Wen-Rei; Chiang, Feng-Yu
Thyrotoxic hypokalemic periodic paralysis (THPP) is a rare, potentially life-threatening endocrine emergency. It is characterized by recurrent muscle weakness and hypokalemia. Because many THPP patients do not have obvious symptoms and signs of hyperthyroidism, misdiagnosis may occur. The published studies revealed that definitive therapy for THPP is control of hyperthyroidism by medical therapy, radioactive iodine or surgery, but the long-term post-operative follow-up result was not observed. We reported two cases of medically refractory THPP with recurrent paralysis of extremities and hypokalemia, and both were combined with thyroid nodules. Both patients were treated with total thyroidectomy; the pathology revealed that one is Graves' disease with thyroid papillary carcinoma, and the other is adenomatous goiter with papillary hyperplasia. No episode of periodic paralysis was noted and laboratory evaluation revealed normal potassium level during the post-operative follow up. Our experience suggests that total thyroidectomy by experienced surgeon is an appropriate and definite treatment for medically refractory THPP, especially in cases combined with thyroid nodules.
Yamamoto, Hiromichi; Kurimoto, Masanori; Hayashi, Nakamasa; Ohmori, Tomoaki; Hirashima, Yutaka; Endo, Shunro
Most cases of atlas burst fracture do not require surgical stabilization, because they can be successfully treated with external immobilization. The authors present two cases of atlas burst fracture in which surgical stabilization was required after external immobilization. The first patient was a 50-year-old male and the second patient was a 34-year-old male. Both presented with neck pain without neurological symptoms after a traffic accident. Neuroradiological examinations revealed atlas burst fracture in both patients. They were initially treated with conservative treatment; one with a rigid collar and the other with a halo vest. However, lateral offset of the atlas on the axis increased and atlanto-axial instability became evident three months later in both patients. They underwent upper cervical arthrodesis with satisfactory results. The authors review surgical indication and its timing in patients with atlas burst fracture.
Filho, Epitacio Leite Rolim; Lins, Otavio Gomes; Aragão, Maria de Fátima Viana Vasco; Brainer-Lima, Alessandra Mertens; Cruz, Danielle Di Cavalcanti Sousa; Rocha, Maria Angela Wanderley; Sobral da Silva, Paula Fabiana; Carvalho, Maria Durce Costa Gomes; do Amaral, Fernando José; Gomes, Joelma Arruda; Ribeiro de Medeiros, Igor Colaço; Ventura, Camila V; Ramos, Regina Coeli
Objective To describe the clinical, radiological, and electromyographic features in a series of children with joint contractures (arthrogryposis) associated with congenital infection presumably caused by Zika virus. Design Retrospective case series study. Setting Association for Assistance of Disabled Children, Pernambuco state, Brazil. Participants Seven children with arthrogryposis and a diagnosis of congenital infection presumably caused by Zika virus during the Brazilian microcephaly epidemic. Main outcome measures Main clinical, radiological, and electromyographic findings, and likely correlation between clinical and primary neurological abnormalities. Results The brain images of all seven children were characteristic of congenital infection and arthrogryposis. Two children tested positive for IgM to Zika virus in the cerebrospinal fluid. Arthrogryposis was present in the arms and legs of six children (86%) and the legs of one child (14%). Hip radiographs showed bilateral dislocation in seven children, subluxation of the knee associated with genu valgus in three children (43%), which was bilateral in two (29%). All the children underwent high definition ultrasonography of the joints, and there was no evidence of abnormalities. Moderate signs of remodeling of the motor units and a reduced recruitment pattern were found on needle electromyography (monopolar). Five of the children underwent brain computed tomography (CT) and magnetic resonance imaging (MRI) and the remaining two CT only. All presented malformations of cortical development, calcifications predominantly in the cortex and subcortical white matter (especially in the junction between the cortex and white matter), reduction in brain volume, ventriculomegaly, and hypoplasia of the brainstem and cerebellum. MRI of the spine in four children showed apparent thinning of the cord and reduced ventral roots. Conclusions Congenital Zika syndrome should be added to the differential diagnosis of congenital
Full Text Available Brain metastases (BM are one of the most common intracranial tumors and surgical treatment can improve both the functional outcomes and patient survival, particularly when systemic disease is controlled. Image-guided BM resection using intraoperative exams, such as intraoperative ultrasound (IOUS, can lead to better surgical results. METHODS: To evaluate the use of IOUS for BM resection, 20 consecutives patients were operated using IOUS to locate tumors, identify their anatomical relationships and surgical cavity after resection. Technical difficulties, complications, recurrence and survival rates were noted. RESULTS: IOUS proved effective for locating, determining borders and defining the anatomical relationships of BM, as well as to identify incomplete tumor resection. No complications related to IOUS were seen. CONCLUSION: IOUS is a practical supporting method for the resection of BM, but further studies comparing this method with other intraoperative exams are needed to evaluate its actual contribution and reliability.
Li, Bob T.; Pearson, Antonia; Pavlakis, Nick; Bell, David; Lee, Adrian; Chan, David; Harden, Michael; Mathur, Manu; Marshman, David; Brady, Peter; Clarke, Stephen
Cardiac tamponade complicating malignant pericardial effusion from non-small cell lung cancer (NSCLC) is generally associated with extremely poor prognosis. With improved systemic chemotherapy and molecular targeted therapy for NSCLC in recent years, the prognosis of such patients and the value of invasive cardiothoracic surgery in this setting have not been adequately examined. We report outcomes from a contemporary case series of eight patients who presented with malignant cardiac tamponade due to NSCLC to an Australian academic medical institution over an 18 months period. Two cases of cardiac tamponade were de novo presentations of NSCLC and six cases were presentations following previous therapy for NSCLC. The median survival was 4.5 months with a range between 9 days to alive beyond 17 months. The two longest survivors are still receiving active therapy at 17 and 15 months after invasive surgical pericardial window respectively. One survivor had a histological subtype of large cell neuroendocrine carcinoma and the other received targeted therapy for epidermal growth factor receptor mutation. These results support the consideration of active surgical palliation to treating this oncological emergency complicating NSCLC, including the use of urgent drainage, surgical creation of pericardial window followed by appropriate systemic therapy in suitably fit patients. PMID:26237019
Bob T. Li
Full Text Available Cardiac tamponade complicating malignant pericardial effusion from non-small cell lung cancer (NSCLC is generally associated with extremely poor prognosis. With improved systemic chemotherapy and molecular targeted therapy for NSCLC in recent years, the prognosis of such patients and the value of invasive cardiothoracic surgery in this setting have not been adequately examined. We report outcomes from a contemporary case series of eight patients who presented with malignant cardiac tamponade due to NSCLC to an Australian academic medical institution over an 18 months period. Two cases of cardiac tamponade were de novo presentations of NSCLC and six cases were presentations following previous therapy for NSCLC. The median survival was 4.5 months with a range between 9 days to alive beyond 17 months. The two longest survivors are still receiving active therapy at 17 and 15 months after invasive surgical pericardial window respectively. One survivor had a histological subtype of large cell neuroendocrine carcinoma and the other received targeted therapy for epidermal growth factor receptor mutation. These results support the consideration of active surgical palliation to treating this oncological emergency complicating NSCLC, including the use of urgent drainage, surgical creation of pericardial window followed by appropriate systemic therapy in suitably fit patients.
Conclusion: Surgical treatment of CD is a valid alternative in selected cases, contributing to the resolution of acute complications and maintenance of remission, allowing disease-free interval and nutritional recovery.
Minas D. Leventis
Full Text Available Ridge preservation measures, which include the filling of extraction sockets with bone substitutes, have been shown to reduce ridge resorption, while methods that do not require primary soft tissue closure minimize patient morbidity and decrease surgical time and cost. In a case series of 10 patients requiring single extraction, in situ hardening beta-tricalcium phosphate (β-TCP granules coated with poly(lactic-co-glycolic acid (PLGA were utilized as a grafting material that does not necessitate primary wound closure. After 4 months, clinical observations revealed excellent soft tissue healing without loss of attached gingiva in all cases. At reentry for implant placement, bone core biopsies were obtained and primary implant stability was measured by final seating torque and resonance frequency analysis. Histological and histomorphometrical analysis revealed pronounced bone regeneration (24.4 ± 7.9% new bone in parallel to the resorption of the grafting material (12.9 ± 7.7% graft material while high levels of primary implant stability were recorded. Within the limits of this case series, the results suggest that β-TCP coated with polylactide can support new bone formation at postextraction sockets, while the properties of the material improve the handling and produce a stable and porous bone substitute scaffold in situ, facilitating the application of noninvasive surgical techniques.
Leventis, Minas D.; Fairbairn, Peter; Kakar, Ashish; Leventis, Angelos D.; Margaritis, Vasileios; Lückerath, Walter; Horowitz, Robert A.; Rao, Bappanadu H.; Lindner, Annette; Nagursky, Heiner
Ridge preservation measures, which include the filling of extraction sockets with bone substitutes, have been shown to reduce ridge resorption, while methods that do not require primary soft tissue closure minimize patient morbidity and decrease surgical time and cost. In a case series of 10 patients requiring single extraction, in situ hardening beta-tricalcium phosphate (β-TCP) granules coated with poly(lactic-co-glycolic acid) (PLGA) were utilized as a grafting material that does not necessitate primary wound closure. After 4 months, clinical observations revealed excellent soft tissue healing without loss of attached gingiva in all cases. At reentry for implant placement, bone core biopsies were obtained and primary implant stability was measured by final seating torque and resonance frequency analysis. Histological and histomorphometrical analysis revealed pronounced bone regeneration (24.4 ± 7.9% new bone) in parallel to the resorption of the grafting material (12.9 ± 7.7% graft material) while high levels of primary implant stability were recorded. Within the limits of this case series, the results suggest that β-TCP coated with polylactide can support new bone formation at postextraction sockets, while the properties of the material improve the handling and produce a stable and porous bone substitute scaffold in situ, facilitating the application of noninvasive surgical techniques. PMID:27190516
MacDonald, C.W.; Whitman, J.M.; Cleland, J.A.; Smith, M.; Hoeksma, H.L.
Study Design: Case series describing the outcomes of individual patients with hip osteoarthritis treated with manual physical therapy and exercise. Case Description: Seven patients referred to physical therapy with hip osteoarthritis and/or hip pain were included in this case series. All patients we
MacDonald, C.W.; Whitman, J.M.; Cleland, J.A.; Smith, M.; Hoeksma, H.L.
Study Design: Case series describing the outcomes of individual patients with hip osteoarthritis treated with manual physical therapy and exercise. Case Description: Seven patients referred to physical therapy with hip osteoarthritis and/or hip pain were included in this case series. All patients we
YANG Jin-fu; HU Dong-xu; HU Jian-guo; YIN Bang-liang; ZHOU Xin-min; ZHOU Wen-wu; TAN Si-chuang; YIN Ni
@@ Double outlet ventricle (DOV) is defined as a congenital heart disease with: (1) both great arteries arising completely, or almost completely (≥90%), from a single ventricle (usually, right ventricle); (2) an aortic valve having no fibre connection with mitral valve; and (3) the only outlet of the other ventricle is a ventricular septal defect (VSD). The incidence of DOV accounts for 1% of all congenital heart disease.1 Clinically there are three common types: Fallot type or double outlet right ventricle (DORV) with subaortic VSD with pulmonary stenosis; Eisenmenger type or DORV with subaortic VSD without pulmonary stenosis and Taussig-Bing type or DORV with subpulmonary VSD. Operative techniques are different according to the position of the VSD and great arteries and the presence or absence of ventricular outflow tract obstruction. The operative difficulty increases in the presence of coronary artery malformation. Recently, our research centre has treated 72 cases of patients suffering from double outlet ventricle. This article is the report of the operative methods and the outcomes.
Hao Jia; Xiao Yinbing
This ten-year retrospective study was designed to examine the morbidity and mortality of three cases of Cantrell's syndrome between 1998 and 2008. The three patients showed different degrees of Cantrell's pentalogy including abdominal ectopia cordis, thoracic-abdominal ectopia cordis and left ventrieular diverticulum. Of the three, the 5-month-old boy suffering from complicated congenital heart disease with abdominal ectopia cordis received a successful single stage repair and reconstruction of the abdominal wall. The 33-week-old premature girl with thoracic-abdominal ectopia cordis underwent two stage correction of tetraology of Fallot. The 4-year-old girl underwent ectomy of left ventricular diverticulum and thoracoabdominal wall repair. Twenty-four to thirty-five months follow-up were satisfactory. We hold that two-stage repair are technically feasible for Cantrell's syndrome, especially for those with complex congenital heart diseases. Post-operative ventilatory support and multiple post-operative care should be prolonged. Malnutrition, infection and arrhythmia are central problems in medical care and surgery should be considered if there was progressive heart failure or hemodynamic instability.
Mathieu, J; Allard, P; Gobeil, G; Girard, M; De Braekeleer, M; Bégin, P
The objective of this study was to assess the frequency, type, and severity of perioperative complications after a first surgery under general anesthesia in patients with myotonic dystrophy (DM) and to measure the association with suspected risk factors. Numerous cases of perioperative complications in DM patients have been reported. Hazards have been associated with the use of thiopentone, suxamethonium, neostigmine, and halothane. A retrospective study of perioperative complications was conducted for 219 DM patients who had their first surgery under general anesthesia at the Chicoutimi Hospital. The overall frequency of complications was 8.2% (18 of 219). Most complications (16 of 18) were pulmonary, including five patients with acute ventilatory failure necessitating ventilatory support, four patients with atelectasis, and three patients with pneumonia. Using multivariate analysis, we found that the risk of perioperative pulmonary complications (PPC) was significantly higher after an upper abdominal surgery (odds ratio (OR), 24.4; 95% CI, 4.0 to 149.3) and for patients with a severe muscular disability, as assessed by the presence of proximal limb weakness (OR, 14.1; 95% CI, 1.5 to 134.4). The likelihood of PPC was not related to any specific anesthetic drug. Because of the increased risk of PPC, careful monitoring during the early postoperative period, protection of upper airways, chest physiotherapy, and incentive spirometry are mandatory in all symptomatic DM patients, particularly those with a severe muscular disability or those who have undergone an upper abdominal surgery.
Dénes Márton István
Full Text Available Bouveret's syndrome is a high mechanical obstruction due to impaction of a gallstone into the duodenum, through a cholecystoduodenal fistula. It belongs to a larger group of gallstone ileus, a disease which occurs after developing a fistula between the gallbladder and the gastrointestinal tract. This is a rare complication of gallstones but because it appears in elderly people, it has a high morbidity and mortality. Patients have various symptoms and the treatment is individualized. We present here a case of a 67 years old patient, admitted in emergency, presenting symptoms of high bowel obstruction, with onset 5 days before admission. Abdominal ultrasound reveals a 5 cm stone that seems to be in the gallbladder, gastric stasis and at gastroscopy appears a foreign body impacted in the duodenum. After a short preparation the patient underwent surgery. We found a dilated stomach and a large cholecystoduodenal fistula with an impacted gallstone in the duodenum. We performed one stage surgery: cholecystectomy, extraction of the stone and suturing of the fistula. We reestablished the continuity of the intestinal tract. We performed also an ileostomy for feeding the patient and protecting the anastomoses. The postoperative evolution was favorable.
Curtis, Stuart H; Miller, Robert H; Weng, Cindy; Gurgel, Richard K
Evaluate the effect of duty hour regulation on graduating otolaryngology resident surgical case volume and analyze trends in surgical case volume for Accreditation Council for Graduate Medical Education (ACGME) key indicator cases from 1996 to 2011. Time-trend analysis of surgical case volume. Nationwide sample of otolaryngology residency programs. Operative logs from the American Board of Otolaryngology and ACGME for otolaryngology residents graduating in the years 1996 to 2011. Key indicator volumes and grouped domain volumes before and after resident duty hour regulations (2003) were calculated and compared. Independent t test was performed to evaluate overall difference in operative volume. Wilcoxon rank sum test evaluated differences between procedures per time period. Linear regression evaluated trend. The average total number of key indicator cases per graduating resident was 440.8 in 1996-2003 compared to 500.4 cases in 2004-2011, and overall average per number of key indicators was 31.5 and 36.2, respectively (P = .067). Four key indicator cases showed statistically significant (P otolaryngology residents. The overall trend in operative volume is increasing for several specific key indicators. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.
Francischetto, Oslan; da Silva, Luciana Almenara Pereira; Senna, Katia Marie Simões e; Vasques, Marcia Regina; Barbosa, Giovanna Ferraiuoli; Weksler, Clara; Ramos, Rosana Grandelle; Golebiovski, Wilma Felix; Lamas, Cristiane da Cruz
Background Healthcare-associated infective endocarditis (HCA-IE), a severe complication of medical care, shows a growing incidence in literature. Objective To evaluate epidemiology, etiology, risk factors for acquisition, complications, surgical treatment, and outcome of HCA-IE. Methods Observational prospective case series study (2006-2011) in a public hospital in Rio de Janeiro. Results Fifty-three patients with HCA-IE from a total of 151 cases of infective endocarditis (IE) were included. There were 26 (49%) males (mean age of 47 ± 18.7 years), 27 (51%) females (mean age of 42 ± 20.1 years). IE was acute in 37 (70%) cases and subacute in 16 (30%) cases. The mitral valve was affected in 19 (36%) patients and the aortic valve in 12 (36%); prosthetic valves were affected in 23 (43%) patients and native valves in 30 (57%). Deep intravenous access was used in 43 (81%) cases. Negative blood cultures were observed in 11 (21%) patients, Enterococcus faecalis in 10 (19%), Staphylococcus aureus in 9 (17%), and Candida sp. in 7 (13%). Fever was present in 49 (92%) patients, splenomegaly in 12 (23%), new regurgitation murmur in 31 (58%), and elevated C-reactive protein in 44/53 (83%). Echocardiograms showed major criteria in 46 (87%) patients, and 34 (64%) patients were submitted to cardiac surgery. Overall mortality was 17/53 (32%). Conclusion In Brazil HCA-IE affected young subjects. Patients with prosthetic and native valves were affected in a similar proportion, and non-cardiac surgery was an infrequent predisposing factor, whereas intravenous access was a common one. S. aureus was significantly frequent in native valve HCA-IE, and overall mortality was high. PMID:25352503
Full Text Available Background: Healthcare-associated infective endocarditis (HCA-IE, a severe complication of medical care, shows a growing incidence in literature. Objective: To evaluate epidemiology, etiology, risk factors for acquisition, complications, surgical treatment, and outcome of HCA-IE. Methods: Observational prospective case series study (2006-2011 in a public hospital in Rio de Janeiro. Results: Fifty-three patients with HCA-IE from a total of 151 cases of infective endocarditis (IE were included. There were 26 (49% males (mean age of 47 ± 18.7 years, 27 (51% females (mean age of 42 ± 20.1 years. IE was acute in 37 (70% cases and subacute in 16 (30% cases. The mitral valve was affected in 19 (36% patients and the aortic valve in 12 (36%; prosthetic valves were affected in 23 (43% patients and native valves in 30 (57%. Deep intravenous access was used in 43 (81% cases. Negative blood cultures were observed in 11 (21% patients, Enterococcus faecalis in 10 (19%, Staphylococcus aureus in 9 (17%, and Candida sp. in 7 (13%. Fever was present in 49 (92% patients, splenomegaly in 12 (23%, new regurgitation murmur in 31 (58%, and elevated C-reactive protein in 44/53 (83%. Echocardiograms showed major criteria in 46 (87% patients, and 34 (64% patients were submitted to cardiac surgery. Overall mortality was 17/53 (32%. Conclusion: In Brazil HCA-IE affected young subjects. Patients with prosthetic and native valves were affected in a similar proportion, and non-cardiac surgery was an infrequent predisposing factor, whereas intravenous access was a common one. S. aureus was significantly frequent in native valve HCA-IE, and overall mortality was high.
anesthesiologists, and registered nurses. The research was qualitative in nature, primarily employing comprehensive nonprobability sampling . Primary data...Community Hospital (MACH), Fort Benning, Georgia. The case study employed the nominal group technique to garner job factors specific to the...group technique to garner job factors specific to the professionals involved in surgical services at MACH. Job satisfaction was structured under the
Abbas, F; Wennstrom, J; Van der Weijden, F; Schneiders, T; Van der Velden, U
This article describes the clinical procedure and outcome of surgical treatment of gingival recessions with the adjunctive use of Emdogain gel, an enamel matrix derivative bioactive material for periodontal reconstructive surgery. Six cases with gingival recession on maxillary canines are presented
Rosa, Guillermo M.; Elizondo, Maria L. [CORE Dental Clinic, Resistencia (Argentina)
The purposes of this study were to develop a workstation computer that allowed intraoperative touchless control of diagnostic and surgical images by a surgeon, and to report the preliminary experience with the use of the system in a series of cases in which dental surgery was performed. A custom workstation with a new motion sensing input device (Leap Motion) was set up in order to use a natural user interface (NUI) to manipulate the imaging software by hand gestures. The system allowed intraoperative touchless control of the surgical images. For the first time in the literature, an NUI system was used for a pilot study during 11 dental surgery procedures including tooth extractions, dental implant placements, and guided bone regeneration. No complications were reported. The system performed very well and was very useful. The proposed system fulfilled the objective of providing touchless access and control of the system of images and a three-dimensional surgical plan, thus allowing the maintenance of sterile conditions. The interaction between surgical staff, under sterile conditions, and computer equipment has been a key issue. The solution with an NUI with touchless control of the images seems to be closer to an ideal. The cost of the sensor system is quite low; this could facilitate its incorporation into the practice of routine dental surgery. This technology has enormous potential in dental surgery and other healthcare specialties.
Rosa, Guillermo M; Elizondo, María L
The purposes of this study were to develop a workstation computer that allowed intraoperative touchless control of diagnostic and surgical images by a surgeon, and to report the preliminary experience with the use of the system in a series of cases in which dental surgery was performed. A custom workstation with a new motion sensing input device (Leap Motion) was set up in order to use a natural user interface (NUI) to manipulate the imaging software by hand gestures. The system allowed intraoperative touchless control of the surgical images. For the first time in the literature, an NUI system was used for a pilot study during 11 dental surgery procedures including tooth extractions, dental implant placements, and guided bone regeneration. No complications were reported. The system performed very well and was very useful. The proposed system fulfilled the objective of providing touchless access and control of the system of images and a three-dimensional surgical plan, thus allowing the maintenance of sterile conditions. The interaction between surgical staff, under sterile conditions, and computer equipment has been a key issue. The solution with an NUI with touchless control of the images seems to be closer to an ideal. The cost of the sensor system is quite low; this could facilitate its incorporation into the practice of routine dental surgery. This technology has enormous potential in dental surgery and other healthcare specialties.
Song, Yi-Jun; Chen, Mei-Ting; Lian, Wei; Xing, Bing; Yao, Yong; Feng, Ming; Wang, Ren-Zhi
A total of 184 cases of surgically treated male prolactinoma were analyzed retrospectively to summarize the outcome of this surgical intervention. We analyzed the general characteristics, clinical manifestations, hormone levels, imaging features, preoperative treatments, surgical outcomes, pathology results, and follow-up records for all included patients. The most common clinical manifestations included sexual dysfunction (47.4%), headache (55.9%), and visual disturbance (46.7%). Serum prolactin levels ranged from 150 to 204,952 ng/mL. Tumor size varied from 6 to 70 mm. Pituitary adenomas grew in a parasellar pattern with visual deficits occurring 40.7% of the time. After surgical therapy, 88.6% of patients achieved symptom relief, and 98.4% experienced an immediate postoperative decline in prolactin level. Fifty-seven patients (31.0%) achieved initial remission, and 26 patients (45.6%) experienced recurrence. Hence, our results suggest that in male prolactinoma characterized by a large pituitary diameter and high serum prolactin level, tumor size predicts the degree of gross resection. The prognostic predictors included preoperative tumor growth pattern and Ki-67 index.Citation: Yi-jun S, Mei-ting C, Wei L, Bing X, Yong Y, Ming F, Ren-zhi W. (2016) Surgical treatment for male prolactinoma: a retrospective study of 184 cases.
Khalife, Sarah; Marchica, Cinzia; Zawawi, Faisal; Daniel, Sam J.; Manoukian, John J.
Background: Concha bullosa mucocele is a rare diagnosis that presents as a nasal mass. It impinges on surrounding structures and can easily be mistaken for a neoplasm. Objective: The objective of this study was to shed light on this rare entity and report its diagnostic features and treatment outcomes. Methods: A case series conducted in a tertiary health care center. Demographic data, clinical presentation, imaging, cultures, and treatments were recorded. Operative video illustration and key images were obtained. A review of the literature was also performed. Results: A total of five cases were reviewed, four of which were concha bullosa mucoceles and one was a mucopyocele. Three of the patients had some form of previous nasal trauma. Headache and nasal obstruction were the most common symptoms with a nasal mass finding on physical examination. Computed tomography was used in all the patients, and magnetic resonance imaging was used in four of the five patients. Four patients had coexistent chronic rhinosinusitis, and three had positive bacterial cultures. All these patients were treated endoscopically either with middle turbinate marsupialization or subtotal resection. No recurrence has been noted thus far. Conclusion: Concha bullosa mucocele is a rare diagnosis. Imaging characteristics are helpful in considering the diagnosis, although surgical intervention is often necessary to confirm the diagnosis and treat concha bullosa mucocele.
Dumitrascu, Traian; Ionescu, Mihnea; Ciurea, Silviu; Herlea, Vlad; Lupescu, Ioana; Popescu, Irinel
Obstruction of the hepatic hilum in patients without prior surgery is generally due to hilar adenocarcinoma (Klatskin tumor). However, not all the hilar strictures are malignant. Although uncommon, benign strictures of the proximal bile duct should be taken into consideration in differential diagnosis of Klatskin tumors, since the incidence could reach up to 25% of patients with presumed Klatskin tumor diagnosis. This group of benign proximal bile duct strictures (Klatskin-mimicking lesions) is usually represented by segmental fibrosis and non-specific chronic inflammation. The clinical and imaging features can not differentiate between benign and malignant strictures. Herein, we present a case series of three patients with benign proximal bile duct strictures (representing 4.1% of 73 patients resected with presumptive preoperative diagnosis of Klatskin tumor) and literature review. There are presented the clinical and biochemical features, imaging preoperative workup, surgical treatment and histological analysis of the specimen, along with postoperative outcome. For benign strictures of the hilum limited resections are curative. However, despite new diagnosis tools developed in the last years, patients with hilar obstructions still require unnecessary extensive resections due to impossibility of excluding the malignancy. In all cases of proximal bile duct obstruction presumed malignant, they should be managed accordingly, even with the risk of over-treatment for some benign lesions.
Adam T. Marler
Full Text Available Background. Congenital anomalies of the coronary arteries are a cause of sudden cardiac death. Of the known anatomic variants, anomalous origination of a coronary artery from an opposite sinus of Valsalva (ACAOS remains the main focus of debate. Case Series. We present three cases, all presenting to our facility within one week’s time, of patients with newly discovered anomalous origination of the left coronary artery from the right sinus of Valsalva (L-ACAOS. All patients underwent cardiac computed tomography for evaluation of coronary anatomy along with other forms of functional testing. Despite the high risk nature of two of the anomalies, the patients are being treated medically without recurrence of symptoms. Summary. After review of the literature, we have found that the risk of sudden cardiac death in patients with congenital coronary anomalies, even among variants considered the highest risk, may be overestimated. In addition, the exact prevalence of coronary anomalies in the general population is currently underestimated. A national coronary artery anomaly registry based on cardiac computed tomography and invasive coronary angiography data would be helpful in advancing our understanding of these cardiac peculiarities. The true prevalence of congenital coronary anomalies and overall risk of sudden cardiac death in this population are not well known. Surgical intervention remains the mainstay of therapy in certain patients though recent investigations into the pathophysiology of these abnormalities have shown that the risk of surgery may outweigh the minimal reduction in risk of sudden cardiac death.
Osama Shukir Muhammed Amin
Full Text Available Fahrs disease is a rare idiopathic bilateral and symmetrical calcification of the basal ganglia, thalami, subcortical hemispheric white matter, and deep cerebellar nuclei that usually presents between the 4nd and 6th decade of life with a variable combination of involuntary movements, Parkinsonism, presenile subcortical dementia, seizures, and ataxia. This longitudinal observational case series was conducted at the neurology outpatients department of Sulaimaniya general teaching hospital, Iraq. Three patients were diagnosed with Fahrs disease. Their chief presenting complaint and other coexistent clinical features were noted and followed-up for at least one year. The ages of those consecutive patients were 25, 34, and 21 years, respectively. Two were females and the other patient was a male. The chief presenting complaint among the 3 patients was heterogeneous; cognitive impairment, seizures, and chorea, respectively. At the time of diagnosis, Parkinsonism and cognitive decline were present in all patients. The 3 patients never developed dystonia, dyskinesia, or athetosis and one patient only had mild cerebellar ataxia. Seizures were the presenting feature in one patient and they never developed in the other 2 patients. All patients had a variable degree of intracerebral calcification. Fahrs disease has heterogeneous phenotypes and the brain radiological findings do not predict the clinical presentation and course. Although Parkinsonism was not the presenting feature, it was found in all patients at the time of diagnosis. Involuntary movements and cerebellar dysfunction were uncommon and the cognitive impairment was of the frontal lobe subcortical dysfunction. [Cukurova Med J 2013; 38(4.000: 823-831
Surbone, Anna; Cottier, Olivier; Vial, Yvan; Francini, Katyuska; Hohlfeld, Patrick; Achtari, Chahin
Interstitial pregnancy represents 2% of ectopic pregnancies, but it is a highly morbid condition with a 2.5% of maternal mortality. Its diagnostic and therapeutic management remains controversial. The aim of this review is to describe the management of interstitial pregnancy in our institution between 2001 and 2011 and to define some general rules for the clinical practice. Single institution retrospective study. Eleven women were treated for interstitial pregnancy. The median age was 33 years and the median gestity was 4. Seven patients had a history of gynaecological surgery and four interstitial pregnancies followed in vitro fertilisation. The diagnosis was made at a median gestational age of seven weeks with a median beta-HCG level of 5,838 U/l. Six of the eleven patients received an initial treatment with intracornual methotrexate, three with intramuscular methotrexate and two with surgery. The median time to beta-HCG resolution was 58 days. Three of the eleven patients needed a second line treatment: two after intramuscular methotrexate and one after intracornual methotrexate. Six patients had further pregnancies and delivered by caesarean section. A high prevalence of previous ectopic pregnancies, gynaecological surgery and of pregnancies resulting from in vitro fertilisation was observed. The earliness of the diagnosis was the factor that allowed a conservative treatment in most cases. Beta-HCG level follow up was fundamental in allowing a second line therapy but beta-HCG can persist over a long period of time and this must be taken into account due to its possible psychological impact. Intracornual methotrexate seems to be more efficacious than intramuscular methotrexate in our series.
Full Text Available Abstract Background Achilles tendinopathy is understood to be a failed healing response. Operative management is utilised following the failure of non-operative methods. Case Presentation We present a case of Achilles tendon rupture, sustained whilst isometrically loading the Achilles tendon during an eccentric loading exercise programme. Conclusion: Bilateral surgical exploration and debridement had previously been performed after conservative management of bilateral Achilles tendinopathy had been unsuccessful.
P. C. Johnston
Full Text Available Phaeochromocytoma is a catecholamine producing tumour and an uncommon cause of hypertension. We present two cases of relatively asymptomatic individuals, in which previously undiagnosed phaeochromocytoma was unmasked by elective nonadrenal surgical procedures, manifesting as postoperative hypertensive crisis and subsequent cardiogenic shock. The initial management in intensive care is discussed, in addition to the clinical and biochemical diagnostic challenges present. Successful adrenalectomy was performed in each case.
Feiyue Feng; Dechao Zhang; Xiangyang Liu; Yonggang Wang; Yousheng Mao
OBJECTIVE The concept of double primary lung cancer (DPLC) has been generally accepted. Recently, an increasing incidence of synchronous DPLC has been reported, while the diagnostic standard and treatment strategies remain to be improved. This study was conducted to investigate effective surgical treatment and prognosis of synchronous DPLC.METHODS From January 1983 to April 2004, 31 patients with synchronous DPLC were operated in our department. Clinical data, such as surgical pattern, postoperative complications, and survival status, of all these patients were reviewed retrospectively.RESULTS The 31 patients with synchronous DPLC accounted for 0.67% of all the 4,649 patients operated for primary lung cancer in our department during the same period. Both tumors of the synchronous DPLC were resected with Iobectomy or pneumonectomy in 12 patients, while among the other 19 patients at least 1 tumor was treated with partial pulmonary resection. The postoperative morbidity was 29%(9/31), including 1 case of respiratory insufficiency, 3 cases of atelectasis, 2 cases of atrial fibrillation, 1 case of haemoptysis, 1 case of pleural effusion, and 1 case of wound fat necrosis.No deaths occurred during the operations or within 30 days postoperatively.The postoperative 1 -, 3-, and 5-year survival rates were 52%, 29%, and 20%, respectively.CONCLUSION The incidence of synchronous DPLC is low. An aggressive and reasonable surgical approach can achieve a satisfactory outcome in patients with synchronous DPLC. The postoperative morbidity is low. Some patients might achieve long-term survival.
Norat, Federica; Dreant, Nicolas; Riah, Younes; Lebreton, Elisa
Phyllode tumors of the breast are fibroepithelial tumors similar to fibroadenomas but with a predominant conjunctive tissue component. They are rare with an incidence of less than 1% of all breast neoplasms. They can be divided in three categories: benign, borderline, malignant. The Authors report the case of a 53 years old woman who presented an exceptional 6.5 kg phylloid tumor of the left mamma. The diagnostic strategies, the surgical total mastectomy procedure with anterior thoracic parietectomy and the surgical reconstructive treatment are described.
Fresno-García, Carmen; Alconero-Camarero, Ana Rosa; Fernández-Carro, Belén
Topical negative pressure therapy is an alternative treatment for complex wounds that consists of the direct application of sub-atmospheric pressure, obtaining a number of effects that are beneficial for tissues, promoting the healing of both acute and chronic wounds and complementing surgical procedures. We report the case of a 75 year old man diagnosed with surgical wound dehiscence after a femorotibial bypass graft, who was hospitalized again with the aim to perform the implantation of a topical negative pressure therapy in the infected wound. We designed a care plan for this patient following the steps of the scientific method and basing ourselves on the NANDA, NIC, and NOC taxonomies.
Silverton, Natalie A; Bull, David A; Morrissey, Candice K
Aortic root abscess is a complication of aortic valve endocarditis that is associated with a high morbidity and mortality. The diagnosis usually is made with transesophageal echocardiography, which is highly sensitive and specific for the disease. We present a case of suspected aortic root abscess 1 week after mechanical aortic valve replacement for native valve endocarditis. The diagnosis was made by the use of transesophageal echocardiography but surgical inspection revealed that the paravalvular fluid collection was excessive surgical adhesive. We discuss the clinical significance and differential diagnosis of aortic root abscess in the setting of infective endocarditis.
Frank, Arthur W
Three cases of pediatric surgical body modification--limb lengthening, normalization of genitalia, and craniofacial surgery--are considered through the moral language used by those who experience these surgeries. This language has been described as altruistic individualism. Decision making remains individualist, but it also shows considerable concern for others; egoism is complementary with altruism. The altruistic individualist is one of many incompatible identities that are predicted and described by the figure of the cyborg. Cyborgs suggest both ethics and qualitative methods appropriate to surgically shaped children.
Full Text Available Marie Jaeger,1,* Moti Harats,1,* Rachel Kornhaber,2 Uri Aviv,1 Amir Zerach,1 Josef Haik1,3 1Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Tel Hashomer, Israel; 2School of Health Sciences, Faculty of Health, University of Tasmania, Sydney, NSW, Australia; 3Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel *These authors contributed equally to this work. Abstract: Hypergranulation tissue (or also known as overgranulation may negatively influence burn wound healing time and contribute to recurrence of contractures in burn wounds and grafts. Subsequently, the treatment of hypergranulation tissue remains controversial and problematic. In this case series, we aimed to examine the feasibility and document the use of topical hydrocortisone in the treatment of hypergranulation tissue formation resulting from burn wounds. We report five cases where hypergranulation tissue developed following deep dermal/full-thickness burns. Initial burn wound treatment included necrotic tissue debridement, wound cleansing, and Flaminal®. All five cases underwent surgical debridement and split-skin grafting. Upon identification of hypergranulation tissue, hydrocortisone acetate 0.25% was applied topically as usual care for the treatment of hypergranulation tissue. All five patients had deep dermal/full-thickness burns with a total body surface area ranging from 22% to 61% and were aged from 3–41 years. All five cases developed hypergranulation tissue during their admission after debridement and split-thickness skin grafts. All patients showed an improvement in the treated areas with a complete regression of hypergranulation tissue and closure of the burn wounds. No clinically apparent local or systemic side effects of the treatment were observed. Topical hydrocortisone can be utilized as an effective, inexpensive, and noninvasive practical option in the treatment of hypergranulation tissue resulting from burn wounds
Rajesh S Mane
Full Text Available Background: Laparoscopy is one of the most common surgical procedures and is the procedure of choice for most of the elective abdominal surgeries performed preferably under endotracheal general anesthesia. Technical advances in the field of laparoscopy have helped to reduce surgical trauma and discomfort, reduce anesthetic requirement resulting in shortened hospital stay. Recently, regional anaesthetic techniques have been found beneficial, especially in patients at a high risk to receive general anesthesia. Herewith we present a case series of laparoscopic appendectomy in eight American Society of Anaesthesiologists (ASA I and II patients performed under spinal-epidural anaesthesia. Methods: Eight ASA Grade I and II adult patients undergoing elective Laparoscopic appendectomy received Combined Spinal Epidural Anaesthesia. Spinal Anaesthesia was performed at L 2 -L 3 interspace using 2 ml of 0.5% (10 mg hyperbaric Bupivacaine mixed with 0.5ml (25 micrograms of Fentanyl. Epidural catheter was inserted at T 10 -T 11 interspace for inadequate spinal anaesthesia and postoperative pain relief. Perioperative events and operative difficulty were studied. Systemic drugs were administered if patients complained of shoulder pain, abdominal discomfort, nausea or hypotension. Results: Spinal anaesthesia was adequate for surgery with no operative difficulty in all the patients. Intraoperatively, two patients experienced right shoulder pain and received Fentanyl, one patient was given Midazolam for anxiety and two were given Ephedrine for hypotension. The postoperative period was uneventful. Conclusion: Spinal anaesthesia with Hyperbaric Bupivacaine and Fentanyl is adequate and safe for elective laparoscopic appendectomy in healthy patients but careful evaluation of the method is needed particularly in compromised cardio respiratory conditions.
Full Text Available Abstract Introduction Smith-Magenis syndrome is a rare genetic condition associated with scoliosis in approximately 30% of cases. There is limited information in the literature on the treatment of scoliosis and the surgical outcome in patients with this condition. Characteristic features of the syndrome, such as the presence of congenital heart and renal disease, inherent immunodeficiency, as well as severe behavioural disorders may complicate the surgical treatment of patients. Case presentation We present the case of an 11-year-old British Caucasian girl with Smith-Magenis syndrome who developed a severe, progressive thoracic and lumbar scoliosis measuring 85° and 80°, respectively. She had no cardiac or renal anomalies. Brace treatment was unsuccessful to prevent deterioration of the scoliosis. Both curves were rigid on supine maximum side-bending and traction radiographs. Our patient underwent a posterior spinal arthrodesis with pedicle screw/hook and rod instrumentation and autologous iliac crest graft, supplemented by allograft bone. She had an uneventful postoperative course other than the development of a small wound dehiscence which required resuturing with no signs of a wound infection. A good correction of both scoliotic curvatures to 45° and 40° and a balanced spine in both the coronal and sagittal planes was achieved. Follow-up to skeletal maturity (4 years post-surgery showed no loss of deformity correction, no detected pseudarthrosis and a good clinical outcome. Conclusion Patients with Smith-Magenis syndrome can develop a severe scoliosis that may require surgical treatment. Congenital cardiac and renal disease, immunodeficiency and severe behavioural problems can affect the surgical outcome following spinal arthrodesis and need to be taken into consideration. Our case demonstrates that surgical correction of the deformity can be performed safely on this group of patients, with a good outcome and an uncomplicated
Batstone, M D; Macleod, A W G
Hutchinson-Guilford progeria is a rare genetic condition showing the stigmata of accelerated ageing combined with severe growth retardation. Patients with this condition show a classical facies and clinical features with an average age of death of 13, usually due to atherosclerotic changes. Craniofacial and dental manifestations include mandibular and maxillary hypoplasia, both vertically and horizontally. Delayed and abnormal tooth eruption and morphology are commonly present. The long-term medical prognosis and eruption potential of individual teeth is important when considering treatment. In addition to this, surgical planning and surgical technique must be modified by the abnormal facial morphology, dermal inelasticity, potential anaesthetic difficulties, and ongoing deterioration in the medical condition. These factors mandate early and definitive intervention for oral surgical conditions. We report the case of a 13-year-old male treated for pericoronitis and oral pain relating to delayed eruption of first permanent molars.
Dongo, Andrew E.; Kesieme, Emeka B.; Iyamu, Christopher E; Okokhere, Peter O.; Akhuemokhan, Odigie C.; Akpede, George O.
Lassa fever, an endemic zoonotic viral infection in West Africa, presents with varied symptoms including fever, vomiting, retrosternal pain, abdominal pain, sore-throat, mucosal bleeding, seizures and coma. When fever and abdominal pain are the main presenting symptoms, and a diagnosis of acute abdomen is entertained, Lassa fever is rarely considered in the differential diagnosis, even in endemic areas. Rather the diagnosis of Lassa fever is suspected only after surgical intervention. Therefo...
Full Text Available Context - Uterine scar defects or scar niche are relatively common after cesarean delivery. An association has been observed between the severity of scar defect, also known as isthmocele, some gynecologic symptoms, and the risk of uterine scar dehiscence at the next delivery. It has been suggested that surgical repair of scar defect could improve the gynecological symptoms, but it remains unclear whether such surgery mends the uterine scar itself. Case Report - We report the case of a woman with uterine scar defect in whom laparoscopic repair significantly improved the gynecological symptoms without affecting the uterine scar, evaluated by hysterosonography. Conclusion - This case highlights the significant dearth of knowledge surrounding the diagnosis, consequences, and benefits of surgical repair of uterine scar defect after cesarean.
Aymard, P-A; Langlois, B; Putterman, M; Jacomet, P-V; Morax, S; Galatoire, O
Cavernous hemangioma is the most frequent benign orbital tumor in adults. The purpose of this study was to examine its clinical features, to define surgical indications, and to determine the roles of the various surgical approaches praticed in ophthalmology: transconjunctival (increasingly utilized), anterior transcutaneous, and lateral orbitotomy. The records of all patients treated for orbital cavernous hemangioma (OCH) since 2004 at the Fondation Rothschild (Paris, France) were retrospectively reviewed. Forty-three patients were treated for orbital cavernous hemangioma. Fifty-eight percent were women, mean age 50.2; 79 % of the tumors were intraconal. Among those patients, 36 underwent surgical removal, 5 were followed periodically, and 2 were lost to follow-up. The main surgical indications were: optic nerve compression (26 patients), proptosis (24 patients) and diplopia (3 patients). Transconjunctival, anterior transcutaneous and Kronlein approaches were used in 16, 12 and 4 patients respectively. Four patients had intrapalpebral hemangiomas easily reached transcutaneously. Two patients demonstrated transient partial 3rd nerve palsy (one with the lateral orbitotomy approach and one with the transconjunctival approach), one patient with the lateral orbitotomy approach developed a palsy of the superior branch of the 3rd nerve, and one patient with the transcutaneous anterior approach developed mydriasis. Surgical excision of OCH's is required in the presence of clinical complications. The transconjunctival approach is a safe technique which can lead to complete resection of the tumor in most cases.
Mills, Anne M; Gradecki, Sarah E; Horton, Bethany J; Blackwell, Rebecca; Moskaluk, Christopher A; Mandell, James W; Mills, Stacey E; Cathro, Helen P
Prior work has shown that digital images and microscopic slides can be interpreted with comparable diagnostic accuracy. Although accuracy has been well-validated, the interpretative time for digital images has scarcely been studied and concerns about efficiency remain a major barrier to adoption. We investigated the efficiency of digital pathology when compared with glass slide interpretation in the diagnosis of surgical pathology biopsy and resection specimens. Slides were pulled from 510 surgical pathology cases from 5 organ systems (gastrointestinal, gynecologic, liver, bladder, and brain). Original diagnoses were independently confirmed by 2 validating pathologists. Diagnostic slides were scanned using the Philips IntelliSite Pathology Solution. Each case was assessed independently on digital and optical by 3 reading pathologists, with a ≥6 week washout period between modalities. Reading pathologists recorded assessment times for each modality; digital times included time to load the case. Diagnostic accuracy was determined based on whether a rendered diagnosis differed significantly from the original diagnosis. Statistical analysis was performed to assess for differences in interpretative times across modalities. All 3 reading pathologists showed comparable diagnostic accuracy across optical and digital modalities (mean major discordance rates with original diagnosis: 4.8% vs. 4.4%, respectively). Mean assessment times ranged from 1.2 to 9.1 seconds slower on digital versus optical. The slowest reader showed a significant learning effect during the course of the study so that digital assessment times decreased over time and were comparable with optical times by the end of the series. Organ site and specimen type did not significantly influence differences in interpretative times. In summary, digital image reading times compare favorably relative to glass slides across a variety of organ systems and specimen types. Mean increase in assessment time is 4
Begum, Jasmina; Samal, Sunita; Ghose, Seetesh
Unsafe abortion is one of the causes of maternal mortality and morbidity in developing countries. The complications mostly results following unsafe abortion procedure done by unskilled provider with or without minimal medical knowledge in rural part of developing countries. These complications can endanger the life of mother if proper medical or surgical interventions are not offered in time. A majority of these complications remains confidential. The uterine perforation is one of the serious but preventable complications of surgical abortion. A 21-year-old woman G4P2L2A1, presented in the emergency ward with complaints of lower abdominal pain for four days after attempting twice surgical termination of pregnancy at 19 weeks of gestation for an unwanted pregnancy. Transabdominal sonography and MRI revealed uterine rent with pelvic extrusion of fetal head. Emergency laparotomy with removal of fetal head and uterine rent repair was done. This case illustrates the importance of maintaining a high index of suspicion by the gynaecologist for uterine perforation in patient presenting with abdominal pain a few days after undergoing surgical abortion, also shows the complementary role of sonography and MRI in evaluation of the similar patient and this case also highlights the rampant illegal unsafe abortion procedure in rural India despite of legalization of abortion act.
Cazan, I; Strobescu, Cristina; Baroi, Genoveva; Cazan, Simona; Lefter, G; Popa, R F
The writing committee for Antithrombotic Therapy for Venous Thromboembolic Disease of the 2008 ACCP guidelines made the following recommendations for thrombus removal strategies in patients with deep vein thrombosis (DVT): open surgical thrombectomy is recommended in patients with acute iliofemoral DVT to reduce symptoms and post-thrombotic morbidity; whenever available, catheter-directed thrombolysis is preferred to surgical venous thrombectomy, the risk of hemorrhage being diminished; surgical venous thrombectomy is recognized to be efficient in cases where catheter-directed thrombolysis is unavailable or the patients are not suitable candidates for such a procedure. Randomized studies comparing surgical thrombectomy and anticoagulant therapy in patients with iliofemoral DVT (IFDVT) showed that at 6 months, 5 years, and 10 years the patients in the thrombectomy group presented increased permeability, lower venous pressure, less edema, and fewer postthrombotic symptoms compared to the patients receiving anticoagulant therapy. In this article we present 3 cases of IFDVT in postpartum patients diagnosed by Doppler ultrasound of the deep venous system. The 3 patients received anticoagulant therapy prior to surgery. Surgery consisted in thrombectomy of the common, superficial and deep femoral veins, external and internal iliac veins, and femoral-saphenous arteriovenous fistula. The patients received postoperative antithrombotic therapy and were followed-up at 3, 6 and 9 months by Doppler ultrasound of the deep venous system.
Nurse educators are continually challenged to develop teaching strategies that enhance students' critical thinking, problem-solving, and decision-making skills. Case studies are a creative learning strategy that fosters these skills through the use of in-depth descriptions of realistic clinical situations. Conceptual models of nursing provide a unique body of knowledge that can be used to guide construction of case studies and enhance application of didactic course content to nursing practice. In this column, the author discusses the use of case studies constructed within the context of the Roy adaptation model for a senior level medical-surgical nursing course.
Chopra, Seema; Suri, Vanita; Sikka, Pooja; Aggarwal, Neelam
Retained surgical sponges in the peritoneal cavities are an infrequent operative/surgical complication and an error which is avoidable. The unfortunate situation of forgotten or missed foreign bodies after any surgical procedure may lead to medico legal problems. Though gossypiboma can be found at any operative site but intraperitoneal cavity is the most frequent site reported in literature. Over a period of three years, June 2009-2012, we conducted retrospective analysis of case summaries of eight patients who underwent re-laparotomy for retained surgical sponge at our institute. Pre operative diagnosis was made in 7out of 8 patients, 5 of whom underwent re-laparotomy and one had sponge removed through the caesarean incision, while in another it was removed per-vaginum through the open vault (post hysterectomy). In one patient, gossypiboma was an incidental finding on laparotomy done for adnexal mass. There was no mortality in any of the cases.
Jabbour, Jad; Bakeman, Anna; Robey, Thomas; Jabbour, Noel
To characterize the nature of surgical preparation among otolaryngology residents nationwide, determine the self-rated effectiveness and efficiency of case preparation practices, and identify potential means for educational improvement. A survey examining the study objectives was developed and distributed to otolaryngology residents nationwide. Survey response data were submitted to descriptive analysis and comparative analyses between junior and senior residents. Literature regarding case preparation among otolaryngology residents was reviewed. Among 108 resident respondents, the most commonly used resources included textbooks (86.1%), surgical education websites (74.1%), and surgical atlases (66.7%). Time was the primary limitation (cited by 84.3%) and convenience the predominant factor influencing resource selection (92.5%). On a 5-point Likert scale, mean scores regarding effectiveness and efficiency of case preparation were 3.53 ± 0.68 and 3.19 ± 0.88, respectively. Senior residents compared to junior residents were more likely to rate their preparation as effective (3.75 ± 0.54 vs 3.40 ± 0.72, P = .008) and efficient (3.45 ± 0.85 vs 3.03 ± 0.86, P = .02). Otolaryngology residents do not consistently rate their case preparation as effective or efficient. While there appears to be progress in self-directed learning throughout residency, room for improvement remains, with potential avenues for such improvement explored here.
林进; 仉建国; 叶启彬; 沈健雄; 邱贵兴
Complications occur frequently after surgical treatment of scoliosis. In order to prevent from them effectively, 101 cases with failure and po6toperatlve-compllcations were analysed. They included rod fracture in 22 cases(15 Harrington reds,4 Zielke rods,and 3 Luque rods);recurrence of curve severity in 12 cases;broken or loossened luque wires in 15 eases;loss of thoracic kyphosis(flat hack) in 6 cases ;progressive kyphosis with or without paraplegia following incorrect posterior decompression in 5 cases;and increased unbalance of shoulders after instrumentatioa in 2 cases due to neglect of the tilting of the first thoracic vertebra. Infection cocurred in 8 cases(incision infection 7 cases,deep wound infection in 1 case);and pneumothorax in 1 case. They were induced by hiomechanical factors in 23 cases(22. 8% ) ,incorrect selection of indications in 29 cases(28. 7%),operational mistakes in 37 cases(36. 6%),internal fixation factors in 15 cases(14. 9%). The authors hold that there are quite a lot of factors leading to occurrencee of complications and the effective way tor prevention from them is to undezstand the factors and main technical points related to internal fixation.
Debbagh, A; Dahami, Z; Fekak, H; Joual, A; Bennani, S; Elmrini, M; Benjelloun, S
In our daily practice, the reliability of ultrasonography (US) and digital rectal examination (DRE) is limited by many factors. The aim of our study is to correlate between the prostatic volume assessed by the DRE, the pre operative US results and the actual weight of the enucleated or endoscopic resection benign prostatic hyperplasia (BPH). We report a serie of 220 patients with BPH treated by endoscopic resection or by open surgery. The mean age is 65 years (40-90 years old). Ultrasonography was performed in 92% of the cases, and transrectal ultrasound only in 8%. All our patients either underwent endoscopic resection (49.6%) or adenomectomy (50.4%). We found a high correlation between the prostatic volume assessed by DRE and by ultrasonography (r = 0.79; P < 0.0001) and the weight of the piece of surgical adenomectomy (r = 0.701, P < 0.0001). However, the volume of benign prostatic hyperplasia assessed by US did not correlate with the piece of endoscopic resection (r = 0.214, P < 0.05). This study and a review of recent literature enabled us to notice the various anatomical and radiological factors implicated in this correlation.
Maxwel Capsy Boga Ribeiro
Full Text Available There is a clear association between chagasic megaesophagus and the esophageal cancer. On the other hand, the association between chagasic megacolon and intestinal neoplasm is uncommon. There are only a few cases described in literature. We selected two cases of colorectal adenocarcinoma associated with adenoma from 2000 to 2011, which are added to the four patients already described by this group. The mean age of the patients, was 68.5 years. Both had been submitted to surgical resection of the neoplasm. Survival rates ranged and were directly related to tumor staging at the time of diagnosis. In this context, we report our case series and reviwed the corresponding literature, especially the clinical and epidemiological aspects of this rare association.Há uma clara associação entre megaesôfago por doença de Chagas e o câncer esofágico. Ao contrário, tal relação, entre megacólon chagásico e neoplasias do intestino grosso é, reconhecidamente, incomum. Existem poucos casos relatados na literatura. Destacamos, entre 2000 e 2011, dois casos, sendo ambos adenocarcinomas colorretais e associados a adenomas, que se somam aos outros quatro já descritos por este grupo. A média de idade dos pacientes, foi de 68,5 anos. Todos foram submetidos à ressecção cirúrgica da neoplasia. A sobrevida foi variável e diretamente relacionada ao estádio do tumor no momento do diagnóstico. Dentro desse contexto, relatamos essa série de casos e revisamos a literatura correlata, com relação aos aspectos clínicos e epidemiológicos dessa rara associação.
Guru Dayal Singh Kalra
Full Text Available Background: The facial asymmetry correction in complex craniofacial malformations presents a challenging problem for reconstructive surgeons. Progressive hemifacial atrophy (HFA and hemifacial microsomia (HFM can manifest in different grades of severity. Most patients require only soft-tissue augmentation. Free flaps are the best option for correction of severe facial soft-tissue deficiency. Materials and Methods: Twenty-two patients of HFM and HFA were included in this study from January 2006 to March 2009 in the Department of Plastic and Reconstructive Surgery, SMS Medical College and Hospital. In all cases, atrophy correction was done using de-epithelialised parascapular free flap with the de-epithelialised surface was placed under the skin. A small skin paddle was taken for monitoring. Results: All cases were reconstructed with de-epithelialised parascapular free flap. There was no flap loss in this series. Hematoma was noted in five cases. Debulking and removal of skin paddle were done in all cases after 6 months. Atrophy recurrence was not observed in any of the cases on follow-up. Conclusion: Contouring of face in cases of HMF and HFA is satisfactorily done with the parascapular free flap. It gives better cosmetic results with minimal donor site morbidity. Facial vessels are better recipient vessels for anastomosis. Keeping de-epithelialised surface of flap under the skin helped in preventing sagging.
Narayan H Gandedkar
Full Text Available Thorough planning and execution is the key for successful treatment of dentofacial deformity involving surgical orthodontics. Presurgical planning (paper surgery and model surgery are the most essential prerequisites of orthognathic surgery, and orthodontist is the one who carries out this procedure by evaluating diagnostic aids such as crucial clinical findings and radiographic assessments. However, literature pertaining to step-by-step orthognathic surgical guidelines is limited. Hence, this article makes an attempt to provide an insight and nuances involved in the planning and execution. The diagnostic information revealed from clinical findings and radiographic assessments is integrated in the "paper surgery" to establish "surgical-plan." Furthermore, the "paper surgery" is emulated in "model surgery" such that surgical bite-wafers are created, which aid surgeon to preview the final outcome and make surgical movements that are deemed essential for the desired skeletal and dental outcomes. Skeletal complexities are corrected by performing "paper surgery" and an occlusion is set up during "model surgery" for the fabrication of surgical bite-wafers. Further, orthodontics is carried out for the proper settling and finishing of occlusion. Article describes the nuances involved in the treatment of Class III skeletal deformity individuals treated with orthognathic surgical approach and illustrates orthodontic-orthognathic step-by-step procedures from "treatment planning" to "execution" for successful management of aforementioned dentofacial deformity.
Gandedkar, Narayan H; Chng, Chai Kiat; Yeow, Vincent Kok Leng
Thorough planning and execution is the key for successful treatment of dentofacial deformity involving surgical orthodontics. Presurgical planning (paper surgery and model surgery) are the most essential prerequisites of orthognathic surgery, and orthodontist is the one who carries out this procedure by evaluating diagnostic aids such as crucial clinical findings and radiographic assessments. However, literature pertaining to step-by-step orthognathic surgical guidelines is limited. Hence, this article makes an attempt to provide an insight and nuances involved in the planning and execution. The diagnostic information revealed from clinical findings and radiographic assessments is integrated in the "paper surgery" to establish "surgical-plan." Furthermore, the "paper surgery" is emulated in "model surgery" such that surgical bite-wafers are created, which aid surgeon to preview the final outcome and make surgical movements that are deemed essential for the desired skeletal and dental outcomes. Skeletal complexities are corrected by performing "paper surgery" and an occlusion is set up during "model surgery" for the fabrication of surgical bite-wafers. Further, orthodontics is carried out for the proper settling and finishing of occlusion. Article describes the nuances involved in the treatment of Class III skeletal deformity individuals treated with orthognathic surgical approach and illustrates orthodontic-orthognathic step-by-step procedures from "treatment planning" to "execution" for successful management of aforementioned dentofacial deformity.
Al-Sebeih, Khalid H; Bu-Abbas, Mohd H
Concha bullosa is an aerated turbinate in the nose. It is a common anatomic variant that can develop a mucocele if obstructed, which can further progress to become a mucopyocele if infected. A mucopyocele can expand and cause destruction of neighboring tissues. A review of the literature revealed only 10 cases previously reported. We describe 2 cases of mucocele and 2 cases of mucopyocele.
Full Text Available Carbamazepine is an iminostilbene derivative that was initially used as an antiepileptic but has been used with increased frequency for different indications including chronic pain, trigeminal neuralgia, and herpetic neuralgias. This has resulted in increased incidence of carbamazepine related adverse effects such as nausea, vomiting, and serious hematological toxicities such as aplastic anemia, agranulocytosis, eosinophilia, lymphadenopathy, and splenomegaly. Life-threatening hypersensitivity reactions such as Steven Johnson syndrome (SJS and toxic epidermal necrolysis can also occur. We hereby present a series of three cases that were prescribed carbamazepine for different indications and presented with SJS. [Int J Basic Clin Pharmacol 2015; 4(4.000: 797-801
Machón, Lourdes; Universidad Evangélica de El Salvador; Hernández, Morena; Universidad Evangélica de El Salvador; Espinoza, Manuel Antonio; Universidad Evangélica de El Salvador; Hidalgo de Andrade, Laura Elena; Universidad Evangélica de El Salvador; Andrade Acevedo, Roberto Antonio; Universidad Evangélica de El Salvador
Background: The decision to rehabilitate or extract a tooth is determined by the knowledge of the causes of dental destruction affecting treatment plan and prognosis. Aim: Describe indications, surgical periodontal therapy prior to dental restoration, most affected teeth and age of the patients with invasion of biological space (IBS) and/or pre-prosthetic surgery. Methods: This is a case series report of 162 patients, male and female, who were treated at the predoctoral dental program of Univ...
Baglaj, Maciej; King, Juliette; Carachi, Robert
Pallister-Killian syndrome (PKS) is a rare mosaic genetic disorder defined by the presence of isochromosome for the short arm of chromosome 12. The authors report 2 new cases of PKS with prenatal diagnosis of tetrasomy 12p made by cytogenetic study of amniocytes. Typical dysmorphic craniofacial features were noted postnatally. Both newborns were referred to a surgical department because of congenital anomalies requiring operative management. One had an imperforate anus with an anocutaneous fistula and underwent minor anorectoplasty on day 2 of life. The second newborn required emergency laparotomy because of malrotation with midgut volvulus. This is the first report of clinical manifestation of malrotation in a patient with PKS. The authors undertook a detailed review of reported to date cases of PKS with special emphasis on its surgical aspects.
Murata, Tomohiro; Koshiishi, Haruya; Imaizumi, Ken; Okuno, Keisuke; Nakata, Takuya; Hirano, Takayuki; Tokura, Michiyo; Matsuyama, Takatoshi; Hoshino, Mayumi; Kakimoto, Masaki; Goto, Hiroshi; Yoshimura, Tetsunori
We report a rare case of surgical resection for pulmonary metastasis from gastric cancer. A 71-year-old man underwent total gastrectomy for gastric cancer in October 2012. After the operation, he received S-1 chemotherapy for 1 year. In January 2014, computed tomography of the chest showed a nodule shadow with a cavity at S3 in the right lung. Because it showed a tendency to gradually enlarge, we performed an operation in September 2014. The nodule was diagnosed as metastatic adenocarcinoma from gastric cancer on pathology. The patient is being treated with S-1 chemotherapy during follow-up. The pulmonary metastases of gastric cancer often develop along with carcinomatous lymphangiosis or carcinomatous pleurisy, and isolated pulmonary metastasis is rare. A consensus has not been reached about the usefulness of surgical resection, and the accumulation of further cases is required.
Souza, Bruno Gonçalves Schröder E; de Souza Júnior, Gilberto Zaquine; Rodrigues, Raíssa Mansilla Cabrera; Dias, Diogo Stelito Rezende; de Oliveira, Valdeci Manoel
Plantar fibromatosis, Ledderhose's disease, or Morbus Ledderhose is an uncommon benign nodular hyperplasia of the plantar aponeurosis. The aim of this paper was to report the case of a 47-year-old male patient who had concomitant Dupuytren's disease and failed all conservative measures. He was treated surgically with prompt and complete relief of symptoms postoperatively, and he has had no recurrence at the 2-year follow-up. In this richly documented case, we discuss details of the surgical technique and anatomy, which was important for a successful outcome and preventing complications. The technique for subtotal fasciectomy is reviewed and the relevance of the adequate choice of skin incision to prevent painful scarring, skin necrosis, and difficulties with shoe wearing is highlighted.
Full Text Available Objective. Endolymphatic sac tumor (ELST is a rare neoplasm arising from the intrapetrous portion of the endolymphatic sac, either isolated or in association with the von Hippel-Lindau disease. We report a sporadic case of ELST with an overview of the literature and a discussion of clinic-radiological, histopathologic, and surgical findings. Case Report. A young woman presented with a progressive hearing loss in the left ear. Otoscopy showed a reddish, bleeding hypotympanic mass. CT demonstrated an expansile lytic mastoid lesion extending to the middle ear, with bone erosion. MRI confirmed a lesion of increased signal on T1-weighted sequences. The patient underwent a canal wall-down tympanoplasty with complete removal of the tumor. Histopathology was consistent with a papillary ELST. Immunohistochemistry was positive for cytokeratin and chromogranin A. Conclusion. This paper highlights the rarity of ELST, the need for an accurate neuroradiological and immunohistochemical study at the early stages, and the timeliness of surgical treatment.
Full Text Available Eosinophilic Gastroenteritis is a rare disease characterized by infiltration of the gastrointestinal tract by an increased number of eosinophils as compared to the normal. The anatomic location and intensity of the infiltrate decides the varied clinical symptomatology with which these patients present. The present report deals with four cases, all presenting with clinical signs of intestinal obstruction A laparotomy performed revealed a stricture in the first case, superficial ulcers and adhesions in the second case, an ileocaecal mass in the third case and volvulus formation in the fourth case. Eosinophilic gastroenteritis was confirmed on histopathology in all the four cases. All the four patients experienced relief of symptoms after resection. It is essential to diagnose the disease to differentiate it from other conditions presenting as intestinal obstruction. The cases are presented because of the rarity of occurrence and presentation. Relevant literature has been reviewed.
Alexandru Nistor; Olivier Giè; Paul Biegger; Cesare Fusetti; Stefano Lucchina
Skin necrosis of the foot, oedema and lymphangitis from stonefish (Synanceia verrucosa) sting are complications well known for a long time and with potential long-term sequelae. Literature reports of stonefish envenomation give no specific reference on soft tissue management and surgical reconstruction. This is the first report describing a case of foot stonefish envenomation treated by vacuum-assisted closure therapy as an easy to use,accessible and simple adjuvant tool for management of large soft tissue necrosis.
Quadriceps tendon rupture is uncommon and often overlooked in emergency. Tearing affects weakening tendon by systemic diseases or some medications. The mechanism is generally indirect. Inability to actively extend the knee associated to a supra-patellar defect evoke easily the diagnosis without other investigations. Surgical repair is realized in emergency to completely restore the extension. We report a case of a patient who has sustained of complete quadriceps tendon tear after a long perio...
Goursand, Daniela; Ramos-Jorge, Maria Leticia; de Oliveria, Gomes Carlos; Drummond, Alexandre Fortes; de Araujo, Zarzar Patricia Maria Pereira; Paiva, Saul Martins
This article reports a clinical case involving an 8-year-old boy with two mesiodentes. The supernumerary teeth caused both a functional alteration (malocclusion) and an esthetic one (interincisal diastema), both of which affected his quality of living. Surgical removal of the supernumerary teeth and orthodontic follow-up was proposed, in agreement with the treatment established in the literature. This treatment produced satisfactory results in terms of both esthetics and functionality.
Mohammed, Sandra M; Dalrymple, Lorien S; Sentürk, Damla; Nguyen, Danh V
The case series model allows for estimation of the relative incidence of events, such as cardiovascular events, within a pre-specified time window after an exposure, such as an infection. The method requires only cases (individuals with events) and controls for all fixed/time-invariant confounders. The measurement error case series model extends the original case series model to handle imperfect data, where the timing of an infection (exposure) is not known precisely. In this work, we propose a method for power/sample size determination for the measurement error case series model. Extensive simulation studies are used to assess the accuracy of the proposed sample size formulas. We also examine the magnitude of the relative loss of power due to exposure onset measurement error, compared with the ideal situation where the time of exposure is measured precisely. To facilitate the design of case series studies, we provide publicly available web-based tools for determining power/sample size for both the measurement error case series model as well as the standard case series model.
Michele, Danzi; Luciano, Grimaldi; Massimiliano, Fabozzi; Stefano, Reggio; Roberta, Danzi; Ernesto, Soscia; Bruno, Amato
Background Gallstone ileus is a rare cause of gastrointestinal obstruction, more frequent in elderly patients, whose treatment is essentially surgical, although some para-surgical and mini-invasive possibilities exist, allowing the solution of such obstructive condition in a completely non-invasive way. Description In our study, after reporting two cases of biliary ileus managed by our surgical division, we will analyze the most suitable diagnostic procedures and the therapeutic approaches to...
Philip McClure; David Booy; Julia Katarincic; Craig Eberson
Background. Mobius Syndrome is a rare disease defined by bilateral congenital 7th nerve palsy. We focus on reporting the prevalence of orthopedic disease in this population. Methods. Twenty-three individuals with Mobius Syndrome underwent orthopedic physical examination, and additional 96 patients filled out a survey for self-reported orthopedic diagnoses. Results. Clubfoot was present in 60% of individuals in the physical exam series and 42% of those in the survey. Scoliosis was present in 2...
Kolte, Abhay P.; Rajshri A Kolte; Shrirao, Tushar S.
Intraoral fibrous overgrowths of the soft tissues are relatively common and may be benign reactive or neoplastic lesions. A series of 10 lesions is presented which included pyogenic granuloma, fibroma and peripheral ossifying fibroma. Almost all the lesions occurred in the second and third decades and were present in the anterior segment of the jaws, with a distinct female predilection. Majority of these lesions were asymptomatic and the patients reported for treatment only due to the discomf...
Full Text Available Background/Aim. The mastoid is the rarest site for the onset of congenital cholesteatoma (CC. The symptoms are atypical and minimal. The aim of this multicenter retrospective descriptive study was to define this extremely rare condition and its clinical presentation, diagnosis and management. Methods. We analyzed data files for a 15- year period in 4 tertiary otology centers and discovered 6 patients with the diagnosis of CC of the mastoid. Results. The clinical presentation of CC varied from incidental findings in patient to patient with otogenic meningitis. The most common findings during surgical procedures were mastoid cortex erosion, sigmoid plate dehiscence, dural exposure and external canal wall destruction. Conclusion. CC of mastoid origin tends to occur in adult patients probably because of minimal symptoms and the delayed diagnosis. It can exist for years in a nonaggressive state and develop to giant sizes. In children it is almost incidentally diagnosed. Early imaging is necessary in order to prevent serious complication.
Wright, Robert F; Zemnick, Candice; Wazen, Jack J; Asher, Eric
The objective of this study was to report on the survival rate of 16 patients treated with extraoral implants in the auricular region, analyze treatment outcomes, and discuss important clinical variables encountered during treatment. Sixteen patients who received extraoral dental implants to retain auricular prostheses between 1987 and 2003 were followed retrospectively. The variables recorded were gender, initial diagnosis, number and size of implants, implant placement date, age at implant placement, history of radiation to the treated field, abutment size, design of initial prosthesis, age of initial prosthesis (when a remake was indicated), date of prosthesis delivery, soft tissue response, grafting procedure, date of last follow-up, and complications. All patients were thoroughly evaluated presurgically by the reconstruction team, which consisted of prosthodontists, a facial prosthetist, and an otolaryngologist. Surgical templates were used for all patients. The criteria for success of the prostheses included marginal accuracy, overall stability and function, symmetry/position, texture, color stability, and patient acceptance. Thirty-nine implants were placed in 16 patients. All 16 patients were completely satisfied with their reconstructions. No surgical complications, implant failures, or prosthetic failures were encountered. Therefore, the survival rate was 100%. Three patients (18.75%) had grade 0, seven (43.75%) had grade 1, five (31.25%) had grade 2, and one (6.25%) had grade 3 soft tissue inflammation. The inflammation completely resolved in 7 of the 13 patients (54%) with hygiene reinforcement or soft tissue reduction. The survival rate for bone-anchored titanium implants and prostheses was 100%. Bone-anchored titanium implants provided the 16 patients in this study with a safe, reliable, adhesive-free method to anchor auricular prostheses with recovery of normal appearance. Under the guidance of an appropriate implant team, proper positioning of
George I. Mataliotakis
Full Text Available Spinal deformity in patients with cystic fibrosis (CF is usually mild requiring no treatment. These patients are rarely considered as surgical candidates for scoliosis correction, as the pulmonary condition and other comorbidities increase the risk of general anaesthesia and recovery. This paper reviews all the literature up to date with regard to scoliosis in patients with CF and reports this unique case of a 14-year-old Caucasian girl with progressive scoliosis, who was treated surgically at the age of 17. She underwent a posterior spinal fusion T2-L3 with the use of unilateral segmental instrumentation. Preoperative workup included respiratory, cardiac, anaesthetic, endocrine, and dietician reviews, as well as bone density optimisation with zoledronic acid and prophylactic antibiotics. Surgical time was 150 minutes and intraoperative blood loss was 47% of total blood volume. Postoperative intensive care included noninvasive ventilation, antibiotic cover, pain management, chest physiotherapy, pancreatic enzyme supplementation, and nutritional support. She was discharged on day 9. At follow-up she had a good cosmetic outcome, no complaints of her back, and stable respiratory function. Multidisciplinary perioperative care and meticulous surgical technique may reduce the associated risks of major surgery in CF patients, while achieving adequate deformity correction and a good functional outcome.
Spinal deformity in patients with cystic fibrosis (CF) is usually mild requiring no treatment. These patients are rarely considered as surgical candidates for scoliosis correction, as the pulmonary condition and other comorbidities increase the risk of general anaesthesia and recovery. This paper reviews all the literature up to date with regard to scoliosis in patients with CF and reports this unique case of a 14-year-old Caucasian girl with progressive scoliosis, who was treated surgically at the age of 17. She underwent a posterior spinal fusion T2-L3 with the use of unilateral segmental instrumentation. Preoperative workup included respiratory, cardiac, anaesthetic, endocrine, and dietician reviews, as well as bone density optimisation with zoledronic acid and prophylactic antibiotics. Surgical time was 150 minutes and intraoperative blood loss was 47% of total blood volume. Postoperative intensive care included noninvasive ventilation, antibiotic cover, pain management, chest physiotherapy, pancreatic enzyme supplementation, and nutritional support. She was discharged on day 9. At follow-up she had a good cosmetic outcome, no complaints of her back, and stable respiratory function. Multidisciplinary perioperative care and meticulous surgical technique may reduce the associated risks of major surgery in CF patients, while achieving adequate deformity correction and a good functional outcome. PMID:27413564
Mataliotakis, George I; Tsirikos, Athanasios I; Pearson, Karen; Urquhart, Don S; Smith, Carolyn; Fall, Andrew
Spinal deformity in patients with cystic fibrosis (CF) is usually mild requiring no treatment. These patients are rarely considered as surgical candidates for scoliosis correction, as the pulmonary condition and other comorbidities increase the risk of general anaesthesia and recovery. This paper reviews all the literature up to date with regard to scoliosis in patients with CF and reports this unique case of a 14-year-old Caucasian girl with progressive scoliosis, who was treated surgically at the age of 17. She underwent a posterior spinal fusion T2-L3 with the use of unilateral segmental instrumentation. Preoperative workup included respiratory, cardiac, anaesthetic, endocrine, and dietician reviews, as well as bone density optimisation with zoledronic acid and prophylactic antibiotics. Surgical time was 150 minutes and intraoperative blood loss was 47% of total blood volume. Postoperative intensive care included noninvasive ventilation, antibiotic cover, pain management, chest physiotherapy, pancreatic enzyme supplementation, and nutritional support. She was discharged on day 9. At follow-up she had a good cosmetic outcome, no complaints of her back, and stable respiratory function. Multidisciplinary perioperative care and meticulous surgical technique may reduce the associated risks of major surgery in CF patients, while achieving adequate deformity correction and a good functional outcome.
Mariana Fexina Tomé
Full Text Available OBJECTIVE Identify the direct cost of reprocessing double and single cotton-woven drapes of the surgical LAP package. METHOD A quantitative, exploratory and descriptive case study, performed at a teaching hospital. The direct cost of reprocessing cotton-woven surgical drapes was calculated by multiplying the time spent by professionals involved in reprocessing the unit with the direct cost of labor, adding to the cost of materials. The Brazilian currency (R$ originally used for the calculations was converted to US currency at the rate of US$0.42/R$. RESULTS The average total cost for surgical LAP package was US$9.72, with the predominance being in the cost of materials (US$8.70 or 89.65%. It is noteworthy that the average total cost of materials was mostly impacted by the cost of the cotton-woven drapes (US$7.99 or 91.90%. CONCLUSION The knowledge gained will subsidize discussions about replacing reusable cotton-woven surgical drapes for disposable ones, favoring arguments regarding the advantages and disadvantages of this possibility considering human resources, materials, as well as structural, environmental and financial resources.
We did a retrospective study to summarize the surgical experience of anomalous pulmonary venous drainage (APVD) correction and discuss effective way of improving the surgical outcome. Methods From January 1985 to May 2008, 127 patients [56 men and 71 women, aged 14-55 years with an average of (26.79 ± 10.62)years ] with APVD underwent surgical treatments. Among them, 13 patients had simple partial APVD with intact atrial septum, 104 patients had partial APVD with atrial septal defect and 10 patients had total APVD. Seventy-one patients of them accompanied with other cardiac anomalies which were also corrected in their operations. Results One early operative death due to severe low cardiac output syndrome (LCOS) developed postoperatively, which resulted in a mortality rate of 0.78%. Among other patients, 10 patients complicated with LCOS, 11 patients with arrhythmia, 7 patients with acute renal failure and 4 patients with poor wound healing, all discharged from hospital after treatment.Postoperative echocardiography reexamination revealed 1 case of mild residual shunt in atrial septum but without pulmonary vein stenosis. Conclusion For right atrial and ventricle enlarged patients with or without pulmonary hypertension, surgeons should be vigilance of accompanied APVD whether atrial septal defects exist or not. As long as no contraindications are found, surgical treatment should be performed once accurate diagnosis is obtained.
Akins, Paul T.; Axelrod, Yekaterina K; Ji, Cheng; Ciporen, Jeremy N.; Arshad, Syed T.; Hawk, Mark W.; Guppy, Kern H.
Background: Cerebral venous sinus thrombosis (CVST) can cause elevated intracranial pressure, hemorrhagic venous infarct, and cortical subarachnoid hemorrhage. We present a case series and literature review to illustrate that CVST can also present with subdural hematoma (SDH). Case Description: Chart review was completed on a retrospective case series of CVST with spontaneous SDH. We also conducted a literature search. Over a 6 year interval, three patients with CVST and SDH were admitted to ...
Hariri, A; Lebailly, F; Zemirline, A; Hendriks, S; Facca, S; Liverneaux, P
Septic arthritis of the wrist is a diagnostic and therapeutic emergency. Synovectomy and lavage by arthrotomy is often followed by stiffness. The purpose of this study was to evaluate the diagnostic and therapeutic contribution of emergency arthroscopic synovectomy with intraarticular lavage. Nine patients were operated on for wrist pathology with septic appearance. All had signs of local inflammation, three showed locoregional inflammation, three were febrile. In one patient several joints were involved. Seven patients presented with inflammatory or degenerative arthritis. All patients underwent emergency surgery using radiocarpal joint puncture, arthroscopic exploration, intraarticular lavage and synovectomy at both the radiocarpal and midcarpal joints. The results were evaluated by pain, Quick DASH, grip strength, and wrist range of motion. In three cases, joint fluid appeared clear, in three it was turbid, and in three purulent. Gram stain and culture revealed bacteria in four cases. Synovitis was radiocarpal four times, radiocarpal and midcarpal once. In one case, there was radiocarpal and midcarpal chondritis. Average pain was 5.3/10 preoperatively and 2/10 at the last clinical follow-up visit. Mean grip strength was 23.3 kg on the involved side vs. 33.5 kg on the opposite one. Mean flexion was 55° for the involved wrist vs. 68°; mean extension was 52° for the affected wrist vs. 59°. No patient was reoperated on. In all cases, there was no sign of local inflammation, regional lymphadenopathy or systemic infection at the last follow-up. One patient died of colon metastatic cancer. Another patient developed a severe Complex Regional Pain Syndrome type I (CRPS1). Our results suggest three principles of management of wrist arthritis with septic appearance: extended surgical indication, emergency operation and arthroscopic procedure.
Yaris, Fusun; Kadioglu, Mine; Kesim, Murat; Ulku, Cunay; Yaris, Ersin; Kalyoncu, Nuri Ihsan; Unsal, Mesut
Antidepressant drug choice in pregnancy is a complex problem especially for new drugs. Among 590 cases exposed to drugs during pregnancy who were followed by our center, 21 cases used newer antidepressants, i.e., venlafaxine, mirtazapine, nefazodone. We present the gestational findings and fetal outcomes of these cases. Ten cases had used venlafaxine, one case had used both venlafaxine and mirtazapine, eight had used mirtazapine alone or with some other drugs and two had used nefazodone, in the first trimester. Of the 21 cases, 17 (80.9%) had healthy babies, 3 (14.3%) decided to terminate the pregnancy, and 1 (4.8%) spontaneous abortion was observed in a case exposed to mirtazapine, alprazolam, diazepam and trifluoperazine. All obstetrical findings were normal during the pregnancy of each case. No congenital abnormality and developmental problem was observed in the babies followed up for 12 months. The aim of the present study is to contribute the data to the limited knowledge available in the literature regarding human pregnancy.
Cassady, Joslyn D.; Kirschke, David L.; Jones, Timothy F.; Craig, Allen S.; Bermudez, Ovidio B.; Schaffner, William
Objective: Outbreak investigations are challenging in a cross-cultural context, and outbreaks of psychiatric disease are rare in any community. We investigated a cluster of unexplained debilitating illness among Amish girls. Method: We reviewed the medical records of cases, consulted with health care providers, performed active case finding,…
Cassady, Joslyn D.; Kirschke, David L.; Jones, Timothy F.; Craig, Allen S.; Bermudez, Ovidio B.; Schaffner, William
Objective: Outbreak investigations are challenging in a cross-cultural context, and outbreaks of psychiatric disease are rare in any community. We investigated a cluster of unexplained debilitating illness among Amish girls. Method: We reviewed the medical records of cases, consulted with health care providers, performed active case finding,…
Setia, Maninder Singh
Case-Control study design is a type of observational study. In this design, participants are selected for the study based on their outcome status. Thus, some participants have the outcome of interest (referred to as cases), whereas others do not have the outcome of interest (referred to as controls). The investigator then assesses the exposure in both these groups. The investigator should define the cases as specifically as possible. Sometimes, definition of a disease may be based on multiple criteria; thus, all these points should be explicitly stated in case definition. An important aspect of selecting a control is that they should be from the same 'study base' as that of the cases. We can select controls from a variety of groups. Some of them are: General population; relatives or friends; and hospital patients. Matching is often used in case-control control studies to ensure that the cases and controls are similar in certain characteristics, and it is a useful technique to increase the efficiency of the study. Case-Control studies can usually be conducted relatively faster and are inexpensive - particularly when compared with cohort studies (prospective). It is useful to study rare outcomes and outcomes with long latent periods. This design is not very useful to study rare exposures. Furthermore, they may also be prone to certain biases - selection bias and recall bias.
Full Text Available : BACKGROUND: Phyllodes tumor of breast is one of the rare neoplasms comprising less than 1% of all breast tumours.aim of the study is to evaluate the clinical charecteristics, treatment regimens and complications of phyllodes tumor in our institution. PATIENTS AND METHODS: We have retrospectively reviewed the medical records of 2 years from 2013 to 2015 of patients who presented to our department, government general hospital, Kakinada. RESULTS: 342 patients presented with breast tumors of which 126 are malignant and 216 are benign. Phyllodes tumor constituted 8 cases of the total breastlump cases presented in our institution from 2013 to 2015. 3 out of 8 cases are recurrent. CONCLUSION: In benign cases wide local excision with clear margins is sufficient to prevent recurrence. In recurrent and malignant cases simple mastectomy has to be done.
Shields, Lisa B E; Rolf, Cristin M; Goolsby, Mary E; Hunsaker, John C
Homicide-suicides or "dyadic deaths" refer to a homicide followed by the suicide of the perpetrator within 1 week of the homicide. A unique subset is filicide-suicide: a parent kills his/her child before committing suicide. Shooting is the preferred method for both the homicide and suicide. The perpetrator has depression in most cases.We present 3 cases of filicide-suicide. In case 1, a divorced mother with schizophrenia and bipolar disorder shot her son and herself. In case 2, a father shot his son and himself while involved in a child-custody dispute. In case 3, a father, experiencing a divorce and financial difficulties, and his daughter with Angelman syndrome succumbed to carbon monoxide poisoning.The forensic pathologist should be aware of the psychosocial dynamics that interplay in filicide-suicide. Diligent attention to a parent's life stressors may aid in determining risk factors for filicide-suicide.
Das, Kuntal Kanti; Kumar, Rajan; Ashish, Kumar; Bettaswamy, Guruprasad; Mehrotra, Anant; Jaiswal, Sushila; Sahu, Rabi Narayan; Jaiswal, Awadhesh Kumar; Behari, Sanjay
Surgical management of foramen magnum (FM) tumors is challenging by virtue of their location and vital neurovascular relationships. The ideal approach to anterior/anterolateral tumors continue to evoke controversy even in the modern era. In this article, we present and discuss our experience in the surgical management of these tumors. This retrospective study includes 29 consecutive patients (mean age 36.6 years, M: F = 2.63:1) of extramedullary tumors at the surgical foramen magnum, operated at our center, between 2007 and 2012. Their mean duration of symptoms was 14. 6 months. A majority of the patients presented with motor symptoms (quadri/paraparesis, n = 21, 72.4%), neck pain with/without suboccipital radiation (n = 16, 55.2%) and sensory symptoms like tingling/numbness (n = 16, 55.2%). There were nine extradural (31%) and 20 intradural tumors (69%). Most of the tumors were located posterolateral to the neuraxis (n = 13, 44.8%). Nerve sheath tumors (n = 11, 38%) and meningiomas (n = 5, 17.2%) were the most commonly encountered histologies in our series. The standard posterior approach was the most frequently employed surgical approach (n = 20, 69%). Operative mortality and morbidity were 3.4 and 18.9%, respectively. At a mean follow-up of 27.3 months, 13 out of the 18 available patients improved. A majority of the foramen magnum tumors are amenable to excision via the standard posterior approach. Small anterior dural-based meningiomas/recurrent tumors may require a lateral approach like the far lateral approach.
Hegyi, Márta; Siegler, Zsuzsa; Barsi, Péter; Rudas, Gábor; Lengyel, Zsolt; Szakáll, Szabolcs; Bognar, László; Kozak, Lajos Rudolf; Neuwirth, Magdolna; Fogarasi, András
A part of patients with the therapy resistant epilepsy can be cured by surgical interventions. The more concordant the presurgical evaluation data, the better prognosis the patient has postoperatively. In case of discordant examination data, multimodal evaluation or case-specific decision might be successful. We report on a five-year-old boy with bilateral (left-dominated) cortical dysplasia and therapy resistant epilepsy. The ictal EEG did not help to localize the seizure onset zone, semiology had little lateralization value; however, FDG-PET showed left hemispheric hypermetabolism. The child became almost seizure-free and showed improved development after left-sided hemispherotomy.
Abdul Hamid Alsaeed
Full Text Available Background: Umbilical hernia repair, a common day-case surgery procedure in children, is associated with a significant postoperative pain. The most popular peripheral nerve blocks used in umbilical hernia repair are rectus sheath infiltration and caudal block. The rectus sheath block may offer improved pain relief following umbilical hernia repair with no undesired effects such as lower limb motor weakness or urinary retention seen with caudal block which might delay discharge from the hospital. Ultrasound guidance of peripheral nerve blocks has reduced the number of complications and improved the quality of blocks.The aim of this case series is to assess the post rectus sheath block pain relief in pediatric patients coming for umbilical surgery. Methods: Twenty two (22 children (age range: 1.5-8 years scheduled for umbilical hernia repair were included in the study. Following the induction of general anesthesia, the ultrasonographic anatomy of the umbilical region was studied with a 5-16 MHz 50 mm linear probe. An ultrasound-guided posterior rectus sheath block of both rectus abdominis muscles (RMs was performed (total of 44 punctures. An in-plain technique using Stimuplex A insulated facet tip needle 22G 50mm. Surgical conditions, intraoperative hemodynamic parameters, and postoperative analgesia by means of the modified CHEOPS scale were evaluated. Results: ultrasonograghic visualization of the posterior sheath was possible in all patients. The ultrasound guided rectus sheath blockade provided sufficient analgesia in all children with no need for additional analgesia except for one patient who postoperatively required morphine 0.1 mg/kg intravenously. There were no complications. Conclusions: Ultrasound guidance enables performances of an effective rectus sheath block for umbilical hernia. Use of the Stimuplex A insulated facet tip needle 22G 50mm provides easy, less traumatic skin and rectus muscle penetration and satisfactory needle
Alsaeed, Abdul Hamid; Thallaj, Ahmed; Khalil, Nancy; Almutaq, Nada; Aljazaeri, Ayman
Umbilical hernia repair, a common day-case surgery procedure in children, is associated with a significant postoperative pain. The most popular peripheral nerve blocks used in umbilical hernia repair are rectus sheath infiltration and caudal block. The rectus sheath block may offer improved pain relief following umbilical hernia repair with no undesired effects such as lower limb motor weakness or urinary retention seen with caudal block which might delay discharge from the hospital. Ultrasound guidance of peripheral nerve blocks has reduced the number of complications and improved the quality of blocks. The aim of this case series is to assess the post rectus sheath block pain relief in pediatric patients coming for umbilical surgery. Twenty two (22) children (age range: 1.5-8 years) scheduled for umbilical hernia repair were included in the study. Following the induction of general anesthesia, the ultrasonographic anatomy of the umbilical region was studied with a 5-16 MHz 50 mm linear probe. An ultrasound-guided posterior rectus sheath block of both rectus abdominis muscles (RMs) was performed (total of 44 punctures). An in-plain technique using Stimuplex A insulated facet tip needle 22G 50mm. Surgical conditions, intraoperative hemodynamic parameters, and postoperative analgesia by means of the modified CHEOPS scale were evaluated. ultrasonograghic visualization of the posterior sheath was possible in all patients. The ultrasound guided rectus sheath blockade provided sufficient analgesia in all children with no need for additional analgesia except for one patient who postoperatively required morphine 0.1 mg/kg intravenously. There were no complications. Ultrasound guidance enables performances of an effective rectus sheath block for umbilical hernia. Use of the Stimuplex A insulated facet tip needle 22G 50mm provides easy, less traumatic skin and rectus muscle penetration and satisfactory needle visualiza.
Yamada, E.; Sudo, H.; Aoyama, Y. [Fuji Electric Co. Ltd., Tokyo (Japan)
Fuji Electric has developed the open refrigerating display case 'MAX Series' for supermarkets which has further pursued 'articles easy to see, select, and take out' on the concept of 'friendliness' as well as friendliness to customers and installation workers. Its main advantages are (1) The dimensions were determined based on human engineering and improved the display effect of articles. This enables the exhibits to strongly appeal to customers. (2) The air curtain optimized through simulation realizes uniform temperature in the case, reduction in energy consumption, and high freshness control. (author)
Yan Xu; Lin Lou; TianHua Wang; YuanYuan Zhao; XueXiang Cai; Jie Ma; Gang Lu
Background:Although primary hypophysitis is not uncommon,a granulomatous etiology of hypophysitis is relatively rare.Radiological and diagnostic characteristics of several isolated cases have been described to date.However,to the best of our knowledge,surgical treatment of eight cases of granulomatous hypophysitis confirmed by histopathology has not yet been reported.Methods:A retrospective study was performed to review cases of granulomatous hypophysitis from November 2003 to November 2013 in our neurosurgical department.Only eight out of 1345 operations were diagnosed with granulomatous hypophysitis.Results:The cohort included two men and six women.The most common manifestations reported were headache,fatigue and polyuria.All six female patients presented with either menstrual disorders or amenorrhea.Seven of eight patients suffered polyuria.Two patients suffered bitemporal hemianopsia.One was accompanied with eosinophilic granuloma of the skull.Prolactin levels were increased in six patients,four of them were noted to have thyroid axis imbalances,one was noted to be deficient in the gonadotropin axis and two were deficient in the adrenal axis.The lesion demonstrated homogenous enhancement and an abnormally thickened pituitary stalk.A histological diagnosis of granulomatous hypophysitis was established in all eight patients,who were treated surgically.Characteristic granulomas formed by epithelioid histiocytes and multinucleated giant cells were observed.Conclusions:Pure glucocorticoid therapy is less effective than surgical intervention and has not been recommended for the treatment of granulomatous hypophysitis.Although replacement therapy can relieve associated symptoms,we conclude surgical intervention,particularly minimally invasive surgery via a transsphenoidal approach,to be mandatory in establishing a diagnosis and reducing the size of the inflammatory mass.Adjuvant corticosteroids therapy is recommended.
Nandikolla, Amara G; Venugopal, Sangeetha; Anampa, Jesus
Background Li–Fraumeni Syndrome (LFS) is a rare disease with autosomal dominant inheritance linked to germline mutations of tumor suppressor gene TP53. These patients are predisposed to malignancies such as sarcoma, breast cancer, leukemia, and other malignancies. Breast cancer, the most common malignancy in adult patients with LFS, has an early-onset presentation and is usually treated as per the guidelines for the general population due to the limited literature about breast cancer in LFS. We aimed to describe our institutional experience treating patients with breast cancer and LFS to contribute to literature about this entity. Design Retrospective single-institution case-series study. We searched for cases with LFS and breast cancer from 01/01/2000 to 12/31/2015 with treatment received at our institution. Results We identified 4 cases (2 African Americans, 1 Indian, and 1 Hispanic) in 4 different families, who were diagnosed with LFS after presenting with breast cancer. Three cases were triple-negative disease and 1 case was ER+, HER2 positive disease. They were treated with mastectomy and a third-generation breast chemotherapy regimen and/or trastuzumab-containing regimen. Radiation therapy was used in 2 patients. Breast cancer recurrence was seen in 1 patient, while three other malignancies were identified after breast cancer treatment (1 breast sarcoma, 1 leiomyosarcoma, and 1 myelodysplastic syndrome). A patient, who underwent surveillance with a positron emission tomography-computed tomography scan, was found to have a stage I leiomyosarcoma and was treated with surgical resection, but then developed metastatic disease requiring cytotoxic chemotherapy. Conclusion Breast cancer among patients with LFS needs a multidisciplinary treatment approach. Surgical management follows the guidelines for the general population. Risk–benefit assessment of chemotherapy and radiotherapy needs to be performed carefully in a case-by-case approach. Patients should
Şule Çağlayan Sözmen
Full Text Available Introduction: Lymphadenopathy is a common clinical problem in pediatric age group. Tuberculous lymphadenopathy is a prominent cause of peripheral adenopathy amongst children in the developing countries. Tuberculous lymphadenitis is among the most frequent presentations of extrapulmonary tuberculosis. In this article, we presented five pediatric cases with mycobacterial infection detected in cervical lymph nodes.Case Presentation: First case admitted with a painless swelling in cervical and axillar regions and pathologic examination of the extirpated lymph node showed necrotizing granulomatous lymphadenitis. Second case presented with two months history of abdominal pain and painless swelling of right cervical region and Mycobacterium tuberculosis (MTB was grown in culture from the lymph node. Third case admitted with a painless cervical mass, her sputum was found positive for MTB. Fourth case was admitted with one year history of swelling that became fistulized in 6 months and lymph node culture was found positive for MTB. Fifth case, admitted with a painful swelling in left upper gingival mucosa and extirpated lymph node showed chronic granulomatous inflammation.Conclusion: Pathological and microbiological examination of tissues such as cervical enlarged lymph nodes should be evaluated for diagnosis of tuberculous infections.
Full Text Available In the context of medical professional liability, obstetrics is one of the most involved medical specialties because the unfavorable outcome of a pregnancy is difficult to accept for parents, who tend to reduce it to inappropriate care that occurred during pregnancy or birth. 32 cases of perinatal asphyxia were evaluated by the Institute of Forensic Medicine in Brescia during the period between 1999 and 2014 (13 in Civil Court and 19 in Penal Court. 9 out of the 32 pregnancies were twins, so the considerations were carried out on a total of 41 fetuses/newborns. Profiles of inadequacy were identified in 66% of cases (85% of the cases evaluated in Civil Court; 53% of the cases evaluated in Penal Court. The existence of a causal relationship between the medical conduct and the onset of asphyxia was recognized in 79% of civil cases and in 38% of penal cases. There is a “greater rigor” in the verification of causal relationship and malpractice profiles in penal cases compared to civil ones: this is in harmony with the most recent Italian Court decisions, characterized by compelling suspect’s protection in the presence of a reasonable doubt in criminal matters and by victim’s protection in civil ones.
Bouznad, Naima; El Mghari, Ghizlane; El Ansari, Nawal
Arterial hypertensions (HTA) of endocrine origin are a rare cause of hypertension; HTA overall prevalence don't exceed 4% of hypertensive patients. Research interest in endocrine HTA is due to the severity of some life-threatening, potentially curable and reversible forms of HTA. The aim of our study was to determine the clinical, paraclinical, etiological and therapeutic profile of secondary HTA of endocrine origin in patients treated in endocrinology department at the University Hospital Mohamed VI in Marrakech. We conducted a prospective, descriptive study spanned 4 years, enrolling 45 patients with endocrine HTA. The average age was 44.89 years, with a clear predominance of women (sex ratio 0.49). Etiology of endocrine HTA was dominated by pheochromocytoma (17 cases), hypercorticism (11 cases) and acromegaly (8 cases). HTA were paroxysmal in 24.4%. HTA were immediately classified as grade 3 severe in 40% of cases. HTA were complicated by heart disease in 24% of cases and by renal disease in 20% of cases. Curative treatment cleared up HTA in 60% of cases (27 cases). The diagnosis of secondary endocrine HTA is sometimes difficult because of the lack of clinical specificity. It is not unusual for HTA to be the only manifestation of the disease. In our study we noted the paroxysmal and severe nature of HTA. The potentially curable nature of HTA in more than two thirds of cases, demostrates the importance of early diagnosis of each severe HTA resistant to treatment or in the presence of suggestive clinical, biological or radiological signs.
Lopez, Joseph; Soni, Ashwin; Calva, Daniel; Susarla, Srinivas M; Jallo, George I; Redett, Richard
Cutaneous burns associated with microscope-use are perceived to be uncommon adverse events in microsurgery. Currently, it is unknown what factors are associated with these iatrogenic events. In this report, we describe the case of a 1-year-old patient who suffered a full thickness skin burn from a surgical microscope after a L4-S1 laminectomy. Additionally, we present a systematic review of the literature that assessed the preoperative risk, outcome, and management of iatrogenic microscope skin burns. Lastly, a summary of the Food and Drug Administration's (FDA) Manufacturer and User Facility Device Experience (MAUDE) database of voluntary adverse events was reviewed and analyzed for clinical cases of microscope thermal injuries. The systematic literature review identified only seven articles related to microsurgery-related cutaneous burns. From these seven studies, 15 clinical cases of iatrogenic skin burns were extracted for analysis. The systematic review of the FDA MAUDE database revealed only 60 cases of cutaneous burns associated with surgical microscopes since 2004. Few cases of microscope burns have been described in the literature; this report is, to our knowledge, one of the first comprehensive reports of this iatrogenic event in the literature. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.
Cardinale, Francesco; Rizzi, Michele; d'Orio, Piergiorgio; Casaceli, Giuseppe; Arnulfo, Gabriele; Narizzano, Massimo; Scorza, Davide; De Momi, Elena; Nichelatti, Michele; Redaelli, Daniela; Sberna, Maurizio; Moscato, Alessio; Castana, Laura
OBJECTIVE The purpose of this study was to compare the accuracy of Neurolocate frameless registration system and frame-based registration for robotic stereoelectroencephalography (SEEG). METHODS The authors performed a 40-trajectory phantom laboratory study and a 127-trajectory retrospective analysis of a surgical series. The laboratory study was aimed at testing the noninferiority of the Neurolocate system. The analysis of the surgical series compared Neurolocate-based SEEG implantations with a frame-based historical control group. RESULTS The mean localization errors (LE) ± standard deviations (SD) for Neurolocate-based and frame-based trajectories were 0.67 ± 0.29 mm and 0.76 ± 0.34 mm, respectively, in the phantom study (p = 0.35). The median entry point LE was 0.59 mm (interquartile range [IQR] 0.25-0.88 mm) for Neurolocate-registration-based trajectories and 0.78 mm (IQR 0.49-1.08 mm) for frame-registration-based trajectories (p = 0.00002) in the clinical study. The median target point LE was 1.49 mm (IQR 1.06-2.4 mm) for Neurolocate-registration-based trajectories and 1.77 mm (IQR 1.25-2.5 mm) for frame-registration-based trajectories in the clinical study. All the surgical procedures were successful and uneventful. CONCLUSIONS The results of the phantom study demonstrate the noninferiority of Neurolocate frameless registration. The results of the retrospective surgical series analysis suggest that Neurolocate-based procedures can be more accurate than the frame-based ones. The safety profile of Neurolocate-based registration should be similar to that of frame-based registration. The Neurolocate system is comfortable, noninvasive, easy to use, and potentially faster than other registration devices.
known pathogen or trigger, or may occur in the absence of an obvious identifiable ... Case reports. Small-vessel disease in HIV-infected children is seen fairly ... precise mechanisms of vascular injury in HIV require further study. SAJCH MAY ...
Full Text Available Foot ulceration is a major cause of morbidity amongst patients with diabetes. In severe cases of ulceration, osteomyelitis and amputation can ensue. A distinct lack of agreement exists on the most appropriate level of amputation in cases of severe foot ulceration/infection to provide predictable healing rates. This paper provides an overview of the transmetatarsal amputation (TMA as a limb salvage procedure and is written with the perspective and experiences of the Department of Podiatric Surgery at West Middlesex University Hospital (WMUH. We have reflected on the cases of 11 patients (12 feet and have found the TMA to be an effective procedure in the management of cases of severe forefoot ulceration and infection.
Sánchez Aguilar, M; Álvarez Pérez, R M; García Gómez, F J; Fernández Ortega, P; Borrego Dorado, I
The incidence of melanoma in children is uncommon, being particularly rare in children under 10 years-old. However, this disease is increasing by a mean of 2% per year. As in adults, the lymph node status is the most important prognostic factor, crucial to performing the selective sentinel lymph node biopsy (SLNB). We report 3 cases of paediatric patients of 3, 4 and 8 years-old, in which SLNB was performed for malignant melanoma. Paediatric age implies greater technical difficulty to the scintigraphy scan due to poor patient cooperation, with mild sedation required in some cases, and only being able to acquire planar images in other cases. SPECT/CT was only performed in the oldest patient. In our cases, SLNB was useful for selecting the least invasive surgery in order to reduce morbidity. Copyright © 2014 Elsevier España, S.L.U. y SEMNIM. All rights reserved.
Brown, George R
All known cases of breast cancer in patients with a diagnosis consistent with transgender identification were identified in the Veterans Health Administration (1996-2013). Ten cases were confirmed: seven birth sex females and three birth sex males. Of the three birth sex males, two identified as gender dysphoric male-to-female and one identified as transgender with transvestic fetishism. The birth sex males all presented with late-stage disease that proved fatal, whereas most of the birth sex female transgender veterans presented with earlier stage disease that could be treated. These cases support the importance of screening for breast cancer using standard guidelines in birth sex males and females. Family history of breast cancer should be obtained from transgender people as part of routine care. This report expands the known cases of breast cancer in transgender persons from 5 to 12 (female-to-male) and from 10 to 13 (male-to-female).
Nocerino, E.; Remondino, F.; Uccheddu, F.; Gallo, M.; Gerosa, G.
In the last years, cardiovascular diagnosis, surgical planning and intervention have taken advantages from 3D modelling and rapid prototyping techniques. The starting data for the whole process is represented by medical imagery, in particular, but not exclusively, computed tomography (CT) or multi-slice CT (MCT) and magnetic resonance imaging (MRI). On the medical imagery, regions of interest, i.e. heart chambers, valves, aorta, coronary vessels, etc., are segmented and converted into 3D models, which can be finally converted in physical replicas through 3D printing procedure. In this work, an overview on modern approaches for automatic and semiautomatic segmentation of medical imagery for 3D surface model generation is provided. The issue of accuracy check of surface models is also addressed, together with the critical aspects of converting digital models into physical replicas through 3D printing techniques. A patient-specific 3D modelling and printing procedure (Figure 1), for surgical planning in case of complex heart diseases was developed. The procedure was applied to two case studies, for which MCT scans of the chest are available. In the article, a detailed description on the implemented patient-specific modelling procedure is provided, along with a general discussion on the potentiality and future developments of personalized 3D modelling and printing for surgical planning and surgeons practice.
Full Text Available Purpose: To study the clinical presentation and treatment outcome of patients with ocular cysticercosis in southern India. Methods: This study included 10 patients who were diagnosed to have ocular or adnexal cysticercosis over a period of one year in Pondicherry, India. The clinical presentation, results of investigation and treatment outcome of the cases were analysed retrospectively. Results: Age of these patients ranged from 12 to 55 years. Four presented with loss of vision, two with a swelling in the eyelid, one with proptosis, one with diplopia and two with conjunctival involvement. ELISA for cysticercus antibodies in serum was positive in all cases. Albendazole and prednisolone were given for the treatment of these cases. Two patients responded well to treatment and were completely cured of the disease. There was partial improvement in 6 cases. Surgery in the form of excision was performed in two cases following a course of medical therapy. There was no significant change in visual acuity in eyes with intraocular cysticercosis following treatment. Conclusion: Ultrasonography B scan and ELISA for anticysticercal antibodies help to establish the diagnosis of ocular cysticercosis. A combination of oral albendazole and corticosteroids is found to be effective in confirmed cases. Intraocular cysticercosis is associated with a poor prognosis for vision.
Full Text Available ABSTRACT: Glial heterotopias are rare, benign, congenital, mi dline, non- teratomatous extra cranial glial tissues. They may masquerade as encep halocoele or dermoid cyst and mostly present in and around the nose. Clinically, these masses are firm and incompressibl e. Histologically, they are made up of astrocytes and neuroglial cells, emb edded in fibrous and vascular connective tissue. Here in, we present 4 cases of nasal glial heteroto pias. The first case was an 8 month old boy who presented with broadening of nose since birth. The second case was of 6 months old girl who presented with a soft tissue swelling over the root of the nose. The third case was of a 2 months old boy who presented with a soft tissue swelling over the nasolabial fold. The fourth case was a 5 month old boy with mass in left nostril. The radiol ogical and histological features along with differential diagnosis are discussed. These cases a re presented because of their rarity.
McCarty, James M; Demetral, Lindsey C; Dabrowski, Lukasz; Kahal, Amandeep K; Bowser, Anna M; Hahn, Julianne E
Coccidioidomycosis, an endemic fungal infection seen throughout the southwestern United States, is not well described in children. We performed a retrospective observational study of all children admitted to Children's Hospital Central California with coccidioidomycosis from 1 January 2010 to 1 September 2011. Thirty-three children, aged 6 months to 17 years, were hospitalized during the study period. These included patients with pneumonia (n = 28), pleural effusion (n = 13), pleural empyema (n = 4), lung abscess (n = 7), pericarditis (n = 2), osteomyelitis (n = 5), meningitis/cerebritis (n = 2), and vocal cord infection (n = 1). Mediastinitis, with radiographic evidence of purulence and necrotic/abscessed lymph nodes in the mediastinum, was present in 7 patients (21%) and tended to occur more often in younger children (median age, 3 years [range, 0.5-11 years] vs 7 years [range, 0.6-17 years] for non-mediastinitis patients; P = .10). Seven patients were admitted to the intensive care unit and 10 required surgical intervention. One patient died of meningitis. Hospitalizations were longer for patients with mediastinitis (median, 130 days [range, 58-200 days] vs 43 days [range, 3-273 days for non-mediastinitis patients]; P Coccidioidomycosis causes a substantial disease burden in the children of central California. Mediastinitis is common and tends to occur in younger children. Patients with mediastinitis or elevated coccidioidal complement fixation titers require longer hospitalizations. Further research is needed on the prevention and treatment of this disease.
Kim, Chang-Sung; Choi, Seong-Ho; Chai, Jung-Kiu; Kim, Chong-Kwan; Cho, Kyoo-Sung
Although a number of techniques have been proposed for clinical crown lengthening procedures, all have some limitation in terms of function and esthetics. This report presents the clinical and radiographic results of a surgical extrusion technique for clinical crown lengthening. Atraumatic surgical extrusion using a specially designed instrument (Periotome) was performed in three cases in which it was expected that extensive resective osseous surgery would have to be used for crown lengthening. Full-thickness mucoperiosteal flaps were raised both labially and palatally. The tooth was carefully luxated and extruded to the desired position without damaging the marginal bone area or root apex. No rigid splint was applied. Clinical examinations performed for more than 1 year after surgery revealed probing depths crown lengthening; it does not induce functional or esthetic deformities, especially in the anterior region.
Marinoni, B; Minelli, C M; Franzina, B; Martellosio, V; Scafa, F; Giorgi, I; Mazzacane, F; Stancanelli, M; Mennoia, N V; Candura, S M
Mobbing represents nowadays a major challenge for Occupational Medicine. We examined, during the last seven years, 253 patients who asked medical assistance for psychopathological problems by them ascribed to mobbing in the working environment. All patients underwent occupational health visit, psychological counselling (including personality tests administration), and psychiatric evaluation. A clinical picture probably due to mobbing was diagnosed in 37 workers: 2 cases of Post-Traumatic Stress Disorder (PTSD), 33 of Adjustment Disorder (AD), and 2 of anxiety disorder. Regarding mobbing typology, we found 19 cases of vertical mobbing (by an employer/manager to employees), 14 cases of strategic mobbing, 3 cases of horizontal mobbing (among colleagues), and one non intentional mobbing. In conclusion, a pure mobbing syndrome was diagnosed in a lower proportion than that reported by other investigators. The described interdisciplinary approach appears useful for the diagnostic assessment of suspect mobbing cases, that in turn is crucial for prognosis and treatment, as well as in relation to medico-legal issues and work-related compensation claims.
Full Text Available Background: The nevus of Ota is a dermal nevus characterized by bluish pigmentation in the distribution of the first and the second division of the trigeminal nerve. Aim: Our aim was to study the cutaneous and extracutaneous manifestations of the nevus of Ota. Methods: A total of 15 cases were included in our study. A detailed history, clinical examination along with direct ophthalmoscopy and otoscopy were done for all the cases. Results: Most of the patients (60% had lesions at birth and the majority (86.7 % were females. Five (33.3% patients belonged to Tanino class II. Combined dermal and ocular involvement was observed in 60% of the cases. Conclusion: Tanino class II was the most common type observed in our studies. A few rarer associations such as nevus of Ito and hemangioma were also noted in our patients.
Aripiprazole, a dopamine stabilizing atypical antipsychotic is used in treatment of tardive dyskinesia caused by other neuroleptics. Tardive dyskinesia is rarely caused by Aripiprazole and has only been documented in high risk patients i.e., female gender, advanced age, affective illness, coexisting neurological disorders. Here the author describes two atypical cases of tardive dyskinesia associated with Aripiprazole. First case of tardive dyskinesia was observed in a neuroleptic naïve young adult male with paranoid illness after six months of treatment with Aripiprazole upon addition of Fluoxetine and the second case was a middle aged female with affective illness where dyskinetic movements appeared after stopping Aripiprazole. The role of Fluoxetine in causing tardive dyskinesia with Aripiprazole and covert dyskinesia due to Aripiprazole with appropriate management is discussed.
Taylor, Lauren J; Nabozny, Michael J; Steffens, Nicole M; Tucholka, Jennifer L; Brasel, Karen J; Johnson, Sara K; Zelenski, Amy; Rathouz, Paul J; Zhao, Qianqian; Kwekkeboom, Kristine L; Campbell, Toby C; Schwarze, Margaret L
Although many older adults prefer to avoid burdensome interventions with limited ability to preserve their functional status, aggressive treatments, including surgery, are common near the end of life. Shared decision making is critical to achieve value-concordant treatment decisions and minimize unwanted care. However, communication in the acute inpatient setting is challenging. To evaluate the proof of concept of an intervention to teach surgeons to use the Best Case/Worst Case framework as a strategy to change surgeon communication and promote shared decision making during high-stakes surgical decisions. Our prospective pre-post study was conducted from June 2014 to August 2015, and data were analyzed using a mixed methods approach. The data were drawn from decision-making conversations between 32 older inpatients with an acute nonemergent surgical problem, 30 family members, and 25 surgeons at 1 tertiary care hospital in Madison, Wisconsin. A 2-hour training session to teach each study-enrolled surgeon to use the Best Case/Worst Case communication framework. We scored conversation transcripts using OPTION 5, an observer measure of shared decision making, and used qualitative content analysis to characterize patterns in conversation structure, description of outcomes, and deliberation over treatment alternatives. The study participants were patients aged 68 to 95 years (n = 32), 44% of whom had 5 or more comorbid conditions; family members of patients (n = 30); and surgeons (n = 17). The median OPTION 5 score improved from 41 preintervention (interquartile range, 26-66) to 74 after Best Case/Worst Case training (interquartile range, 60-81). Before training, surgeons described the patient's problem in conjunction with an operative solution, directed deliberation over options, listed discrete procedural risks, and did not integrate preferences into a treatment recommendation. After training, surgeons using Best Case/Worst Case clearly presented a choice between
Full Text Available Introduction: Accomodative esotropia is secondary to inappropriate convergence during accomodative effort in an uncorrected hyperope and is often familial. Case presentation: we report the case of 20 year old Caucasian patient with congenital esotropia alternating, of 30 prism diopters distance (5 m and 40 prism diopters of esotropia at near, in both eyes. Measures: Was performed strabismus, in peribulbar anesthesia, the right medial rectus was cashed 3.0mm, the left medial rectus was collected 3.5 mm. Results: Immediately after surgery, the patient complained of intermittent diplopia, resolved with orthotic exercise which stimulated binocular vision, Conclusion: This case report suggests that the surgical correction strabismus, should be considered with due caution in the treatment of congenital esotropia alternating and branches, and in some clinical scenarios selected to avoid the complication of postoperative diplopia, that in the case report resolved so benign. After three months surgical treatmen, remains a small angle strabismus aesthetically acceptable, has not given double vision and remains abnormal retinal correspondence with orthotic exercise.
Speranza, V; Simi, M; Leardi, S; Prantera, C
Of 200 cases of CD observed in the course of twenty years, 141 (70.5%) have been treated by surgery. At the time of surgery, 6 patients had duodenitis, 87 ileitis, 35 ileocolitis, 9 colitis and 8 proctocolitis. In 4 cases the duodenum and ileum were simultaneously involved. Complications of the disease and failure of medical treatment represented the indications for surgery. Elective surgery was possible in 74.5% of cases. Intestinal resection was performed in all cases except for 6 by-passes (4 for duodenal obstruction) and 3 external derivations (1 ileostomy for perforation, and 2 colostomies: one for colovesical fistula and another for a rectovaginal fistula). Surgical strategy mainly depended on the site, number and extent of lesions, together with complications arising from them. Data from preoperative absorption tests and intraoperative measurements of the small bowel were useful aids in determining whether a resection was to be "radical" or "limited". Overall p.o. mortality was 4.2%. The follow-up (from 2 to 21 years) showed a long-term mortality rate of 5.7%. The rate of recurrences was 55.2%. However surgical management undeniably improved the quality of life, that was in fact good, or fairly good, even in the great majority (81.2%) of patients with recurrences.
Full Text Available Introduction. The diagnosis of lung cancer may still be difficult due to the fact that the first symptoms very often mimic symptoms of other diseases. Case Presentation. In this paper we present two cases, in which initial diagnosis of neuroinfection delayed proper diagnosis. Conclusion. Based on our experience we concluded that neurological symptoms in the area endemic for tick-borne diseases suggesting neuroinfection require careful differential diagnosis. Moreover, neurological symptoms in heavy smokers may be associated with metastases of lung cancer.
Kuklińska, Beata; Moniuszko-Malinowska, Anna; Mróz, Robert; Pancewicz, Sławomir; Zajkowska, Joanna
Introduction. The diagnosis of lung cancer may still be difficult due to the fact that the first symptoms very often mimic symptoms of other diseases. Case Presentation. In this paper we present two cases, in which initial diagnosis of neuroinfection delayed proper diagnosis. Conclusion. Based on our experience we concluded that neurological symptoms in the area endemic for tick-borne diseases suggesting neuroinfection require careful differential diagnosis. Moreover, neurological symptoms in heavy smokers may be associated with metastases of lung cancer. PMID:27239354
Ab hameed Raina, Ghulam Nabi Yattoo, Feroz Ahmad Wani, Reyaz Ahmad Para, Khaild Hamid Changal, Arshed Hussain Parry
Full Text Available Ascaris lumbricoides infestations are endemic in tropical countries. Ascaris lumbricoides is the second most common intestinal parasite world-wide and, although the infection can be asymptomatic, in some cases it can present with complications, such as acute pancreatitis. Pancreatitis secondary to ascaris is more common in females. We describe three cases who presented with Ascaris lumbricoides-induced acute pancreatitis and all of them were females and were diagnosed on ultrasonography. In two patients the sphicterotomy was done while in third patient the worm came out after two days of conservative management.
Nain, Prabhdeep Singh; Matta, Harish; Singh, Kuldip; Chhina, Deepinder; Trehan, Munish; Batta, Nishant
Mucormycosis is caused by saprophtytic fungi which cause acute invasive zygomycosis. It clinically presents with necrosis, and on histopathology, acute and chronic infiltrates are seen. It rarely infects a healthy host, but is devastating in an immunocompromised host. We studied five cases with post-operative abdominal wall mucormycosis, three females and two males. Three patients were post-operative while the other two had mucormycosis following trauma and infection was found in sutured wound. All were initially diagnosed as cases of necrotizing fasciitis. Two patients eventually survived after intensive medical therapy and extensive debridements.
To describe three cases of delayed development of intracranial hypertension (IH) after surgical treatment of intracranial arachnoid cyst, including the pathogenesis of IH and a review of the literature.
Sané, A-D; Ndaw, M; Diémé, C; Coulibaly-Ndiaye, N F; Ndiaye, A; Sy, M H; Mbaye, B; Sèye, S I L
"Traffic elbow" is a condition occurring when high energy trauma involves a patient's elbow resting on the window of the car or completely outside it. This is a prospective study over 30 months of 9 patients with "traffic elbow" and therefore sufferring complex open trauma to the elbow. There were 8 men and 1 woman with a median delay of 4 hours before arrival in hospital. The dominant member was affected in 3 cases. The severity of the lesions, using the Mangled Extremity Severity Score (MESS), was more than 7, comprising lesions corresponding to type 1 of the complex trauma of the superior member (TCMS) in 2 patients and a MESS score of between 3 and 6 corresponding to types 2 or 3 of the TCMS for the other 7 patients. The therapeutic possibilities are limited considering the frequent context of polytrauma. In 4 cases we performed a debridement and external humero-ulnar fixation, in 3 cases a debridement and stabilization with Kirschner's wires completed by a fenestrated cast, and in 2 cases a lifesaving amputation. All patients, except those that had had amputation, developed deep sepsis that resolved after adequate treatment. Assessment of the non-amputee patients according to the Mayo Performance Score, yielded more than 70% of bad results. The authors stress the gravity of these lesions whose prognosis is guarded both concerning mobility of the elbow and the frequent neurovascular complications.
Full Text Available Abstract Introduction Traumatic hernia of the abdominal wall is a rare entity. A large proportion of reported cases are in children with a particular type of injury, i.e. from a handlebar injury. In adults, the presentation can vary substantially and the diagnosis is difficult. We present two cases in adults, with widely varying presentations and management. Case presentations A 40-year-old woman from rural north India presented with a low-velocity blunt injury to the lower abdomen. She was attacked by a bull. She had a clinically evident abdominal fascial disruption with intact skin, and was hemodynamically stable. An emergency mesh repair of the defect was performed, and she recovered well. A 38-year-old man from rural north India presented with blunt trauma to the abdomen following a motor vehicle accident. He was stable, with a central abdominal parietal wall swelling and bruising. A computed tomography scan revealed herniation of bowel loops in the area with minor intra-abdominal injuries. A laparotomy, resection-anastomosis of the ischemic bowel, and primary repair of the defect was performed and he recovered well. Conclusion Following blunt abdominal trauma, particularly high-velocity injuries, a high index of suspicion must be reserved for parietal wall swellings, as missed hernias in this setting have a high risk of strangulation. Computed tomography is the best aid to diagnosis. Management of each case needs to be individualized.
Agaba Emmanuel I
Full Text Available Abstract Introduction Parkinsonism puts a high direct cost burden on both patient and caregiver. Several reports of drug-induced parkinsonism have been published, but to the best of our knowledge, there has not been any report of quinine or halothane inducing parkinsonism. Case presentation We describe two cases of parkinsonism possibly caused by adverse drug reaction to quinine in a 29-year-old black Nigerian woman and to halothane in a 36-year-old black Hausa (Nigerian man who received it as general anaesthesia for appendicectomy in our teaching hospital. Conclusion These are two unusual cases of parkinsonism caused by adverse drug reactions to high-dose quinine and to halothane as general anaesthesia. We consider that these two cases are important in bringing this potential side-effect to the attention of both pharmacologists and primary care physicians as these are two of the most commonly used medications in our clinics. We conclude that parkinsonism should be included among the adverse drug reactions to high-dose quinine and halothane general anaesthetic.
L K Makhija
Full Text Available Introduction: Transverse facial cleft (Tessier type 7 or congenital macrostomia is a rare congenital anomaly seldom occurring alone and is frequently associated with deformities of the structures developing from the first and second branchial arches. The reported incidence of No. 7 cleft varies from 1 in 60,000 to 1 in 300,000 live births. Material and Methods: Seventeen patients of transeverse facial cleft who presented to us in last 5 years were included in the study. Their history regarding familial and environmental predispositions was recorded. The cases were analysed on basis of sex, laterality, severity, associated anomalies and were graded according to severity. They were operated by z plasty technique and were followed up for 2 years to look for effectiveness of the technique and its complications. Result: Out of the seventeen patients of transverse cleft, none had familial predilection or any environmental etiology like antenatal radiological exposure or intake of drugs of teratogenic potential. Most of the patients (9/17 were associated with hemifacial microsomia and 1 patient was associated with Treacher Colin′s Syndrome. Out of the 6 cases of Grade I clefts, 4 were isolated transverse clefts and of the 10 patients of Grade II clefts, 7 were associated with hemifacial microsomia. We encountered only one case of Grade III Transverse Cleft which was not only associated with hemifacial microsomia but also had cardiac anomaly. Out of the17 cases, 15 were operated and in most of them the outcome was satisfactory.
Appasamy, Malathy; De Witt, Michelle E; Patel, Nisha; Yeh, Nancy; Bloom, Ona; Oreste, Anthony
To report our clinical experience and propose a biomechanical factor-based treatment strategy for improvement of genu recurvatum (GR) to reduce the need for knee-ankle-foot orthosis (KAFO) or surgical treatment. Case series. Outpatient clinic of a Department of Physical Medicine and Rehabilitation in an academic medical center. Adult subjects (n = 22) with hemiparesis and GR who received botulinum injections alone or in combination with multiple types of orthotic interventions that included solid ankle-foot orthosis (AFO) ± heel lift, hinged AFO with an adjustable posterior stop ± heel lift, AFO with dual-channel ankle joint ± heel lift, or KAFO with offset knee joint. Biomechanical factors reviewed included muscle strength, modified Ashworth score for spasticity, presence of clonus, posterior capsule laxity, sensory deficits, and proprioception. Outcome factors were improvement or elimination of GR based on subjective assessment before and after the interventions by the same experienced clinician. More than one biomechanical factor contributed to GR in all patients. Botulinum toxin A injection was used in patients who had significant plantar flexor spasticity and/or clonus. Four types of orthotic interventions were used based on the biomechanical factor: solid AFO in patients with severe ankle dorsiflexion and plantar flexion weakness or clonus; hinged ankle joint with adjustable posterior stop in patients with less severe ankle dorsiflexion weakness in the absence of clonus; AFO with a dual-channel ankle joint for quadriceps weakness or severe proprioceptive deficits; and KAFO with offset knee joints in patients with Achilles tendon contracture or severe proprioceptive deficits. Adjunctive options included the addition of heel lifts and toeplate modifications. Combinatorial interventions of botulinum injection, modified AFOs, and heel lifts improved or eliminated GR and avoided the need for cumbersome orthotics or surgical interventions. GR in hemiparesis is
Potter, Lucas; Arikatla, Sreekanth; Bray, Aaron; Webb, Jeff; Enquobahrie, Andinet
Stenosis of the upper airway affects approximately 1 in 200,000 adults per year1 , and occurs in neonates as well2 . Its treatment is often dictated by institutional factors and clinicians' experience or preferences 3 . Objective and quantitative methods of evaluating treatment options hold the potential to improve care in stenosis patients. Virtual surgical planning software tools are critically important for this. The Virtual Pediatric Airway Workbench (VPAW) is a software platform designed and evaluated for upper airway stenosis treatment planning. It incorporates CFD simulation and geometric authoring with objective metrics from both that help in informed evaluation and planning. However, this planner currently lacks physiological information which could impact the surgical planning outcomes. In this work, we integrated a lumped parameter, model based human physiological engine called BioGears with VPAW. We demonstrated the use of physiology informed virtual surgical planning platform for patient-specific stenosis treatment planning. The preliminary results show that incorporating patient-specific physiology in the pretreatment plan would play important role in patient-specific surgical trainers and planners in airway surgery and other types of surgery that are significantly impacted by physiological conditions during surgery.
Diabetes Mellitus/HIV Interphase: A Series of 10 Cases. ... transaminase (ALT), aspartate transaminase (AST), serum lipase and amylase levels. ... early enough, escpecially where a family history of diabetes and other risk factors occur.
Full Text Available The sulphonamide group of drugs is implicated in bilateral acute angle closure (AAC due to an idiosyncratic response. We report a series of three cases with bilateral AAC caused by different sulphonamide derivatives, their presentation and management.
Senthil Sirisha; Garudadri Chandrasekhar; Rao Harsha; Maheshwari Rajat
The sulphonamide group of drugs is implicated in bilateral acute angle closure (AAC) due to an idiosyncratic response. We report a series of three cases with bilateral AAC caused by different sulphonamide derivatives, their presentation and management.
Senthil, Sirisha; Garudadri, Chandrasekhar; Rao, Harsha B L; Maheshwari, Rajat
The sulphonamide group of drugs is implicated in bilateral acute angle closure (AAC) due to an idiosyncratic response. We report a series of three cases with bilateral AAC caused by different sulphonamide derivatives, their presentation and management.
Souza, Bruno Gonçalves Schröder e; Gilberto Zaquine de Souza Júnior; Raíssa Mansilla Cabrera Rodrigues; Diogo Stelito Rezende Dias; Valdeci Manoel de Oliveira
Plantar fibromatosis, Ledderhose's disease, or Morbus Ledderhose is an uncommon benign nodular hyperplasia of the plantar aponeurosis. The aim of this paper was to report the case of a 47-year-old male patient who had concomitant Dupuytren's disease and failed all conservative measures. He was treated surgically with prompt and complete relief of symptoms postoperatively, and he has had no recurrence at the 2-year follow-up. In this richly documented case, we discuss details of the surgical t...
Gallego, A; Rogel, R; Luján, S; Plaza, B; Delgado, F; Boronat, F
Aproximately 10% of patients with non-obstructive azoospermia and 5% with non-obstructive severe oligozoospermia carry AZF region microdeletions (AZoospermic Factor) in the Y chromosome. The aim of this study is to analize the clinical and pathological findings in this group of patients and compare them with the previous evidence. Retrospective study of 11 patients with diagnosis of azoospermia or oligozoospermia and the presence of AZFa, AZFb, AZFc microdeletions or any combination of them. Microdeletions of AZFc region were found in 45% of cases, AZFa in 33% and a 10% showed a deletion of the three regions (a,b and c). 91% of them demonstrated azoospermia with low testicular volume in 62,5% cases. Microdeletions of AZF regions are associated with azoospermia and a low expectation of sperm retrieval in testicular biopsy. On the other hand, they seem not related with significative modifications on the hormone profile. Copyright © 2014 AEU. Published by Elsevier Espana. All rights reserved.
Hidradenitis Suppurativa (HS) is characterized by chronic recurrent abscesses, nodules and draining sinus tracts with scar formation. Cutaneous Crohn’s Disease (CD) may also present similarly. We wished to identify and describe an Irish cohort with combined HS and CD, with a view to a better recognition of clinical manifestations and understanding of the pathophysiology underlying these two overlapping conditions. Cases were identified using the HIPE Code at Tallaght Hospital from 1990-2014 and retrospective review was performed. Seven patients with both HS and CD were identified, 5(71%) female. The median age of diagnosis with both conditions was 37 years. In all cases, CD had preceded the diagnosis of HS. All patients smoked. Six had an increased BMI and 43% had additional autoimmune conditions. All patients required treatment with a TNF-alpha inhibitor for HS with 5 of 6 subjects having reduced frequency of flare ups and clinically less active HS on follow up
Gola, Mateusz; Potenza, Marc N
Background How best to conceptualize problematic pornography use (PPU) and intervene most effectively remain debated, with obsessive-compulsive disorder (OCD) and addiction frameworks. We investigated the efficacy of the serotonin-reuptake inhibitor paroxetine in combination with cognitive-behavioral therapy in the treatment of problematic pornography use (PPU). Case presentation Three heterosexual males with PPU were treated with cognitive-behavioral therapy and paroxetine. Frequency of pornography use, other sexual behaviors, and anxiety were assessed during treatment. Discussion Paroxetine treatment, although seemingly initially effective in reducing pornography use and anxiety, appeared related to new compulsive sexual behaviors after 3 months. Conclusions Paroxetine may hold promise for short-term reduction of PPU and related anxiety, but new potentially distressing sexual behaviors may emerge. The cases suggest that PPU may arise from multiple domains. We propose an explanation of the effects based on recent neuroscientific research on sexual behaviors and alcohol use.
Chang; Geun; Lee; Yun; Jeong; Lim; Jong; Sun; Choi; Jin; Ho; Lee
Filiform polyposis is a rare condition of uncertain patho-genesis that is usually found in association with Crohn’s disease, ulcerative colitis, intestinal tuberculosis or histiocytosis X. We report seven interesting cases of polyposis with various pathologic components, mainly located in the left side of the colon with no associated inflammatory bowel disease, intestinal tuberculosis or histiocytosis X. Multiple finger-like polypoid lesions with the appearance of stalactites were noted on the left side of ...