Delayed presentation and conservative management of an intraarterial injection of crushed amphetamine/dextroamphetamine salts

AbstractA case of delayed presentation of spontaneous rupture of the cervical oesophagus, which followed vomitting after a Chinese meal, is reported. Conservative management resulted in full uncomplicated recovery.

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Delayed presentation and conservative management of an odontoid basilar synchondrosis fracture in a child

Journal of Neurosurgery Pediatrics ◽

10.3171/ped/2008/1/5/402 ◽

2008 ◽

Vol 1 (5) ◽

pp. 402-405 ◽

Cited By ~ 4

Author(s):

Kenneth M. Crandall ◽

Esperanza Pacheco-Jacome ◽

David I. Sandberg

Keyword(s):

Computed Tomography ◽

Emergency Department ◽

Neck Pain ◽

Conservative Management ◽

Delayed Presentation ◽

Imaging Studies ◽

Bone Fusion ◽

Cervical Orthosis ◽

Computed Tomography Scans

✓ The authors report the case of a 3-year-old boy who presented with neck pain after falling from a low height and who was discharged from the emergency department after imaging studies were noted to be normal. He presented again 2 months later with continued neck pain, and repeated imaging demonstrated a fracture of the odontoid basilar synchondrosis that had not been shown on the initial studies. Based on the normal alignment of his spine and evidence of early bone fusion at the time of his second presentation, he underwent cervical orthosis therapy only. To the authors' knowledge, this is the first reported case of an odontoid synchondrosis fracture in which computed tomography scans were normal at presentation.

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Factors Affecting Traumatic Brain Injury Outcome Among Patients Treated for Head Injury at Surgical Side, in Nekemte Referral Hospital, Oromia, Ethiopia.

Journal of Spine and Neuroscience ◽

10.14302/issn.2694-1201.jsn-20-3554 ◽

2020 ◽

Vol 1 (2) ◽

pp. 1-13

Author(s):

Mitiku Getachew Kumara ◽

Miresa Banti Dhugasa

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Head Injury ◽

Conservative Management ◽

Referral Hospital ◽

Time Interval ◽

Secondary Brain Injury ◽

Major Public Health Problem ◽

Delayed Presentation ◽

Unfavourable Outcome

Background Traumatic brain injury is an expanding major public health problem and the leading cause of death of the young and productive part of the world’s population. Research is mainly done in high-income countries where only a small proportion of the worldwide fatalities occur. Only few studies have examined prognostic factors of traumatic brain injury outcome in developing countries including Ethiopia. This study was aimed at defining the peculiar demographic and other associated factors of traumatic brain injury (TBI) outcome among patients treated for head injury at Nekemte Referral Hospital. Objective The main purpose of this study was to describe the magnitude of TBI outcome and assess factors associated with unfavourable outcome of TBI among patients treated for head injury at the surgical side in Nekemte Referral Hospital from July 8, 2016 to July 7, 2018. Methods A retrospective cross-sectional document review was conducted among TBI patients treated for head injury from July 8, 2016 to July 7, 2018 at Nekemte Referral Hospital. Data were collected using a pre-tested data collection format. Data analysis was done using SPSS version 20. Descriptive statistics were computed and association between the dependent and independent variables were assessed by using logistic regression. Odds ratios with 95% confidence interval were computed. Significant association was declared when the p value was <0.05. Results In this study, out of 378 cases 95 (25.1%) were discharged with unfavourable outcome of which 37(9.8%) were neurologic deficits and 58 were deaths giving overall mortality rate of 15.3%. Patient age>60years (AOR: 15.13; 95%CI: 3.575-64.028), time interval from injury to treatment (AOR: 16.054; 95%CI: 5.832-44.194), low GCS (AOR: 18.224; 95%CI: 4.167, 79.695), conservative management (AOR: 20.774; 95%CI: 6.106-70.681), pupils abnormality (AOR: 9.078; 95%CI: AOR: 2.996-27.509) were associated with unfavourable outcome. Conclusions A quarter of patients treated for TBI at Nekemte Referral Hospital are discharged with unfavourable outcomes. Old age, delayed presentation to the hospital, low GCS, conservative management, and pupillary abnormality increase the odds of unfavourable outcome. Timely management of TBI before patients develop secondary brain injury and use of surgical intervention based on CT scan diagnosis will reduce the occurrence of unfavourable outcome.

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An Option of Conservative Management of a Duodenal Injury Following Laparoscopic Cholecystectomy

Case Reports in Surgery ◽

10.1155/2014/398545 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

MA Modi ◽

SS Deolekar ◽

AK Gvalani

Keyword(s):

Laparoscopic Cholecystectomy ◽

Cystic Duct ◽

Conservative Management ◽

Surgical Intervention ◽

Delayed Presentation ◽

Duodenal Fistula ◽

Duodenal Injury ◽

Thermal Burns

Duodenal injury following laparoscopic cholecystectomy is rare complications with catastrophic sequelae. Most injuries are attributed to thermal burns with electrocautery following adhesiolysis and have a delayed presentation requiring surgical intervention. We present a case of a 47-year-old gentleman operated on for laparoscopic cholecystectomy with a bilious drain postoperatively; for which an ERC was done showing choledocholithiasis with cystic duct stump blow-out and a drain in the duodenum suggestive of an iatrogenic duodenal injury. He was managed conservatively like a duodenal fistula and recovered without undergoing any intervention.

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Intraarterial Injection of Drugs of Abuse into Femoral Artery: Case Report and Review of the Literature

Surgical Case Reports ◽

10.31487/j.scr.2021.02.12 ◽

2021 ◽

pp. 1-3

Author(s):

Nina Kobilica ◽

Vojko Flis

Keyword(s):

Femoral Artery ◽

Drugs Of Abuse ◽

Combined Therapy ◽

Treatment Protocol ◽

Major Amputation ◽

Limb Amputation ◽

Delayed Presentation ◽

Intraarterial Injection ◽

Evidence Based Guidelines ◽

Hospital Days

Accidental intraarterial injection is a serious condition which can compromise the viability of the limb within hours. There are no evidence based guidelines suggesting the proper treatment protocol and there is no consensus about the ideal treatment for these events. We present a case where a mixture of benzodiazepine pills and street heroin was injected in right femoral artery. Patient arrived in hospital days after event. With intraarterial application of thrombolysis, vasodilators and heparin major amputation was avoided. It seems that in selected cases combined therapy with rtPA lysis and PGE1 intra-arterial infusion may prevent major limb amputation even in delayed presentation of acute leg ischaemia caused by inadvertent injection of drugs of abuse.

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Changing paradigms of management of isolated blunt renal trauma

Trauma ◽

10.1177/1460408620965446 ◽

2020 ◽

pp. 146040862096544

Author(s):

Sunirmal Choudhury ◽

Pinaki Ray ◽

Dilip Kumar Pal

Keyword(s):

Conservative Management ◽

Tertiary Care ◽

Haemorrhagic Shock ◽

Renal Trauma ◽

Trauma Patients ◽

Delayed Presentation ◽

Tertiary Care Centre ◽

Surgical Exploration ◽

Time Period ◽

Ureteral Stenting

Introduction The last thirty years has seen a change in management of renal trauma with progression more towards nonoperative management; however there is lack of guidelines of many practical aspects for conservative management of renal trauma. Here we are sharing our experience of managing isolated renal trauma over a period of five years. Materials and methods The study was conducted in a tertiary care centre of eastern part of India from April 2015–March 2020. It was a retro-prospective study and included cases of isolated blunt renal trauma managed in our hospital. Results A total of 61 cases of isolated blunt renal trauma were treated in the mentioned time period. Seventeen (28%) cases were of AAST Grade IV and five (8%) Grade V injury. Blood transfusion was required in eighteen (29%) cases during management. In eight (47%) cases of Grade IV injury and two (40%) cases of Grade V injury angioembolization was done. In two (11.7%) cases of Grade IV injury ureteral stenting was performed. Delayed surgical exploration and nephrectomy was required in one case of Grade V injury because of failed angioembolization and one Grade IV injury due to sepsis. One death was encountered in Grade V injury who had delayed presentation with haemorrhagic shock and underwent immediate surgical exploration. On follow up four patients (23%) of Grade IV injury and one patient of Grade III injury and two patients (40%) of Grade IV injury developed hypertension. The remaining patients were found to be normal. Conclusion Conservative management of renal trauma is the norm nowadays. Angioembolisation was found to be one of the strongest armamentarium when patient needs intervention. Surgery is rarely contemplated, mostly in hemodynamically unstable high grade trauma patients.

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Should All Complicated Appendicitis be Treated the Same? the Answer is No

The American Surgeon ◽

10.1177/000313481908501023 ◽

2019 ◽

Vol 85 (10) ◽

pp. 1179-1183

Author(s):

Victoria Wang ◽

Diego Kriger ◽

Elias Fanous ◽

Alfred Lee ◽

Bishoy Zakhary ◽

...

Keyword(s):

Adverse Events ◽

Acute Appendicitis ◽

Conservative Management ◽

Perforated Appendicitis ◽

Late Presentation ◽

Complicated Appendicitis ◽

Fecal Fistula ◽

Delayed Presentation ◽

Radiologic Findings ◽

Uncomplicated Appendicitis

Delayed presentation of acute appendicitis is associated with increased complications. We hypothesized that the outcomes of appendectomy in delayed presentations of acute appendicitis (>72 hours of pain) were dependent on radiologic findings rather than late presentation. We reviewed records from 2009 to 2015 and analyzed delayed presentations of acute appendicitis. We divided patients into three groups based on specific CT findings: uncomplicated appendicitis (UA), phlegmon or abscess (PA), and other perforated appendicitis (PERF, signs of perforation without abscess or phlegmon). One hundred thirty-eight patients were included in this study (58 in the UA, 67 in the PA, and 13 in the PERF groups). Overall, 78 (57%) patients underwent early appendectomy (EA) and 60 (43%) underwent initial conservative management. The incidence of adverse events was lower in EA than that in initial conservative management (17% vs 42%, P = 0.005). EA in the UA group was associated with shorter hospitalization (3.2 vs 5.6 days, P < 0.001) and less adverse events (6% vs 29%, P < 0.05). Severe adverse events (two colectomies and one fecal fistula) were observed in the PA group. In conclusion, in these late presentations of appendicitis, complicated appendicitis was common. EA was safe in selected patients, however, and associated with decreased adverse events.

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Basilar artery thrombosis due to hyperhomocysteinemia treated conservatively: a therapeutic success

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20203132 ◽

2020 ◽

Vol 7 (8) ◽

pp. 1293

Author(s):

Deepak Sharma ◽

Virendra Atam ◽

Avirup Majumdar ◽

Mohammed Hashim

Keyword(s):

Basilar Artery ◽

Conservative Management ◽

Altered Mental Status ◽

Posterior Circulation ◽

Delayed Presentation ◽

Therapeutic Success ◽

Basilar Artery Thrombosis ◽

Artery Thrombosis ◽

History Of ◽

Contrast Ct

Basilar artery thrombosis is a rare and potentially fatal cause of posterior circulation stroke. Among the various etiologies, hyperhomocysteinemia is crucial and often under diagnosed, especially in developing countries. Authors describe the case of a 15-year male who presented with 1-day history of headache, vomiting and altered mental status. Non-contrast CT Head revealed multiple acute infarcts in posterior circulation of brain. Laboratory investigations revealed hyperhomocysteinemia. Contrast enhanced MRI Brain showed acute infarcts in bilateral cerebellar hemispheres, pons, midbrain, medulla and vermis. MR venography was suggestive of Basilar Artery thrombosis. Thrombolysis was not done due to delayed presentation; hence authors resorted to conservative management with folic acid and vitamin B supplementation. The patient showed gradual clinical improvement and had complete clinical recovery during follow up visit. A favorable outcome with conservative management of basilar artery thrombosis is rarely reported in literature.

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A National Evaluation of the Conservative Management of Uncomplicated Acute Appendicitis: How Common Is This and What Are the Issues?

Digestive Surgery ◽

10.1159/000434756 ◽

2015 ◽

Vol 32 (5) ◽

pp. 325-330 ◽

Cited By ~ 7

Author(s):

Michael E. Kelly ◽

Asif Khan ◽

Jameel ur Rehman ◽

Ronan M. Waldron ◽

Waqar Khan ◽

...

Keyword(s):

Acute Appendicitis ◽

Conservative Management ◽

Management Practice ◽

Pediatric Population ◽

Management Approach ◽

Complication Rates ◽

Delayed Presentation ◽

Interval Appendicectomy ◽

Uncomplicated Acute Appendicitis

Introduction: The management approach for acute appendicitis has been challenged in recent years, with numerous randomized controlled trials demonstrating that antibiotics/conservative management is an efficacious treatment, with lower complication rates. Methods: A national survey of all consultant general surgeons evaluating their practices was performed. Reasons for changed practices, choice of antibiotics and follow-up investigations were evaluated. In addition, the role of interval appendicectomy and conservative management in the pediatric population was also assessed. Results: The response rate for this survey was 74.7% (n = 74/99). Over one-fifth (n = 17, 22.9%) routinely treat acute appendicitis conservatively, while another 14.8% (n = 11) consider this approach in selected cases. Main reasons for modified practices included the presence of inflammatory phlegmon (75%), delayed presentation (64%), and recent evidence-based medicine developments (46%). Co-amoxiclav/clavulanic acid was the most popular antibiotic for conservative management (53%). Alternatively, combinations of antibiotics were also utilized. One-third felt interval appendicectomy was warranted, while one-fifth supported conservative management in the paediatric setting. The overwhelming majority (>95%) advocate follow-up colonoscopy ± computed tomography in any patient aged >40 years managed conservatively. Conclusion: Considerable variation in management of uncomplicated appendicitis remains in Ireland despite growing evidence suggesting that the non-operative approach is safe. Reasons for adopting a conservative management practice have been identified and reflect the expanding literature on this subject.

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