Bowel Injury in Septic Abortion: The Need for More Aggressive Management

In this paper we argue for the aggressive management of voice disorders. Aggressive management includes early identification, prevention, and treatment of voice disorders. The argument for aggressive management is supported by current incidence trends, laryngologists' expectations, and the benefits of prevention programs.

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Inhibition of Nuclear Factor-κB Ameliorates Bowel Injury and Prolongs Survival in a Neonatal Rat Model of Necrotizing Enterocolitis

Yearbook of Neonatal and Perinatal Medicine ◽

10.1016/s8756-5005(08)79242-4 ◽

2008 ◽

Vol 2008 ◽

pp. 217-219

Author(s):

J. Neu

Keyword(s):

Necrotizing Enterocolitis ◽

Rat Model ◽

Nuclear Factor Κb ◽

Bowel Injury ◽

Neonatal Rat ◽

Nuclear Factor ◽

Neonatal Rat Model

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Cervical Myelopathy as a Complication of Untreated Motor Tics: A Cautionary Tale

Journal of Pediatric Neurology ◽

10.1055/s-0040-1718696 ◽

2020 ◽

Author(s):

Mariam Hull ◽

Mered Parnes

Keyword(s):

Cervical Myelopathy ◽

Management Strategies ◽

Vertebral Artery Dissection ◽

Tic Disorders ◽

Artery Dissection ◽

Cautionary Tale ◽

Eye Injuries ◽

Tic Disorder ◽

Aggressive Management ◽

Motor Tics

AbstractTic disorders are common, affecting approximately 0.5 to 1% of children and adolescents. Treatment is required only when symptoms are bothersome or impairing to the patient, so many do not require intervention. However, on occasion tics may cause significant morbidity and are referred to as “malignant.” These malignant tics have resulted in cervical myelopathy, subdural hematoma secondary to head banging, biting of lips leading to infection of oral muscles, self-inflicted eye injuries leading to blindness, skeletal fractures, compressive neuropathies, and vertebral artery dissection. We describe a case of malignant tic disorder, with accompanying video segment, resulting in cervical myelopathy and quadriparesis in a child. We also discuss aggressive management strategies for neurologists to prevent potential lifelong disability. This case emphasizes that these malignant tics must be treated with all due haste to prevent such complications.

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Gitelman syndrome and ectopic calcification in the retina and joints

Clinical Kidney Journal ◽

10.1093/ckj/sfab034 ◽

2021 ◽

Author(s):

Yeji Ham ◽

Heather Mack ◽

Deb Colville ◽

Philip Harraka ◽

B Biomed ◽

...

Keyword(s):

Calcium Pyrophosphate ◽

Bartter Syndrome ◽

Gitelman Syndrome ◽

Ectopic Calcification ◽

Aggressive Management ◽

Renal Tubular Disorder ◽

Rate Of Progression ◽

Renal Tubular ◽

Retinal Photography

ABSTRACT Gitelman syndrome is a rare inherited renal tubular disorder with features that resemble thiazide use, including a hypokalemic metabolic alkalosis, hypomagnesemia, hypocalciuria, a low or normal blood pressure, and hyperreninemia and hyperaldosteronism. Treatment is primarily correction of the K and Mg levels. The diagnosis is confirmed with genetic testing but Gitelman syndrome is often not suspected. However the association with ectopic calcification in the retina, blood vessels and chondrocalcinosis in the joints is a useful pointer to this diagnosis. Bilateral symmetrical whitish deposits of calcium pyrophosphate are visible superotemporally on ophthalmoscopy and retinal photography but are actually located beneath the retina in the sclerochoroid. Optical coherence tomography is even more sensitive for their detection. These deposits increase in size with time, but the rate of progression slows with long-term correction of the hypomagnesemia. Calcification may be complicated by atrophy of the overlying retina and visual loss. The deposits often correlate with ectopic calcification in the aorta, coronary and cerebral vessels. Chondrocalcinosis occurs in the large joints such as the knees. Ectopic calcification in Gitelman syndrome indicates the need for more aggressive management of Ca and Mg levels. Calcification is much less common in Bartter syndrome which itself is rarer and associated less often with hypomagnesemia.

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Surgical Complications Requiring Intervention in Open versus Minimally Invasive Radical Prostatectomy

Urologia Internationalis ◽

10.1159/000515618 ◽

2021 ◽

pp. 1-5

Author(s):

Lorine Haeuser ◽

Stephen W. Reese ◽

Marco Paciotti ◽

Joachim Noldus ◽

Ethan Y. Brovman ◽

...

Keyword(s):

Radical Prostatectomy ◽

Minimally Invasive ◽

Surgical Approach ◽

Large Bowel ◽

Bowel Injury ◽

Improvement Program ◽

Significant Difference ◽

American College Of Surgeons ◽

Vascular Structures ◽

Open Versus

Introduction: Injuries to surrounding structures during radical prostatectomy (RP) are rare but serious complications. However, it remains unknown if injuries to intestines, rectum, or vascular structures occur at different rates depending on the surgical approach. Methods: We compared the frequency of these outcomes in open RP (ORP) and minimally invasive RP (MIS-RP) using the national American College of Surgeons National Surgical Quality Improvement Program database (2012–2017). Along with important metrics of clinical and surgical outcomes, patients were identified as undergoing surgical repair of small or large bowel, vascular structures, or hernias based on Current Procedural Terminology codes. Results: In our propensity matched analysis, a total of 13,044 patients were captured. Bowel injury occurred more frequently in ORP than in MIS-RP (0.89 vs. 0.26%, p < 0.01). By intestinal segment, rectal and large bowel injuries were more common in ORP than MIS-RP (0.41 vs. 0.11% and 0.31 vs. 0.05%, both p < 0.01). However, there was no statistically significant difference between the groups for small bowel injury (0.17 vs. 0.11%, p = 0.39). Vascular injury was more common in MIS-RP (0.18 vs. 0.08%, p = 0.08). Hernias requiring repair were only identified in the MIS-RP group (0.12%). Conclusion: When considering surgical approach, rectal and large bowel injuries were more common in ORP, while vascular injuries and hernia repair were more common in MIS-RP. Our findings can be used in counseling patients and identifying risk factors and strategies to reduce these complications.

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Bilateral Nephrectomy in Patients with Autosomal Dominant Polycystic Kidney Disease and End-Stage Chronic Renal Failure

Nephron ◽

10.1159/000513168 ◽

2021 ◽

pp. 1-7

Author(s):

Alexander E. Lubennikov ◽

Nicolay V. Petrovskii ◽

German E. Krupinov ◽

Evgeniy M. Shilov ◽

Roman N. Trushkin ◽

...

Keyword(s):

Kidney Disease ◽

Large Bowel ◽

Elective Surgery ◽

Length Of Hospital Stay ◽

Bowel Injury ◽

Polycystic Kidney ◽

Group I ◽

Group Ii ◽

Autosomal Dominant Polycystic Kidney ◽

End Stage

Background: In patients with autosomal dominant polycystic kidney disease (ADPKD) and end-stage kidney disease, bilateral nephrectomy (BN) is currently performed predominantly via the laparoscopic approach. We analysed the results of BN depending on the approach and preoperative and perioperative factors. Patients and Methods: This was a single-centre retrospective study carried out from April 2010 to March 2020, including a total of 142 patients presenting with ADPKD who were treated by BN. Of these, 108 patients meeting the inclusion criteria were selected to analyse the results. We compared therapeutic outcomes depending on the surgical approach (laparotomy or laparoscopy) and the type of the operation (emergent or elective). Results: Of the 108 eligible patients, 36 (group I) underwent laparoscopic BN and the remaining 72 patients (group II) were subjected to midline laparotomy. Sixty-nine patients underwent elective surgery and 39 endured emergent operations. The most frequent indications (87 patients, 80.6%) for surgical treatment were urinary tract infection and infected cysts. The median length of hospital stay for group I and group II patients amounted to 8 days (IQR: 7.5–9) and 12.5 days (IQR: 9–16.5), respectively (p < 0.001). However, comparing the patients operated on electively, the actual difference in the length of hospital stay was inconsiderable: median 8 days (IQR: 7–9) in group I and 9 days (IQR: 9–11.5) in group II. The median duration of the operation was significantly (p < 0.001) longer in group I amounting to 217.5 min (IQR: 197.5–305) than in group II equalling 115 min (IQR: 107.5–145). The frequency of postoperative complications, lethal outcomes, and blood loss volume did not statistically significantly differ depending on the surgical approach. Only patients operated on emergency underwent releparotomy due to intraoperative large bowel injury. Lethal outcomes (n = 18, 16.7%) after surgery were observed only in emergent patients. Sepsis prior to surgery, systemic inflammation response syndrome (SIRS) with the CRP level above 173 mg/mL, prolonged preoperative antibacterial therapy, and undiagnosed large bowel injury were associated with a lethal outcome after BN. Conclusion: The results of open and laparoscopic BN in elective surgery were comparable. Emergency operations for infected renal cysts and SIRS were associated with increased incidence of large bowel injury and lethal outcomes.

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