Observational study of the suspected or confirmed cases of sars COV-2 infection needing emergency surgical intervention during the first months of the pandemic in a third level hospital: Case series

Diagnosis of spontaneous fascicular nerve torsions is difficult and often delayed until surgical exploration is performed. This case series raises awareness of peripheral nerve torsions and will facilitate an earlier diagnosis by using nerve ultrasound (NUS) and magnetic resonance neurography (MRN). Four patients with previously ambiguous upper-extremity mononeuropathies underwent NUS and 3T MRN. Neuroimaging detected proximal torsions of the anterior and posterior interosseous nerve fascicles within median or radial nerve trunks in all patients. In NUS, most cases presented with a thickening of affected nerve fascicles, followed by an abrupt caliber decrease, leading to the pathognomonic sausage-like configuration. MRN showed T2-weighted hyperintense signal alterations of fascicles at and distal to the torsion site, and directly visualized the distorted nerves. Three patients had favorable outcomes after being transferred to emergency surgical intervention, while 1 patient with existing chronic muscle atrophy was no longer eligible for surgery. NUS and MRN are complementary diagnostic methods, and both can detect nerve torsions on a fascicular level. Neuroimaging is indispensable for diagnosing fascicular nerve torsions, and should be applied in all unclear cases of mononeuropathy to determine the diagnosis and if necessary, to guide surgical therapies, as only timely interventions enable favorable outcomes.

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Asymptomatic free gas post Endoscopic Mucosal Resection (EMR) - Is surgical intervention always necessary?

10.36811/ijcgh.2020.110008 ◽

2020 ◽

pp. 19-26

Author(s):

Shafquat Zaman ◽

Hayaka Amada ◽

Pratik Bhattachayra ◽

Stephen Stonelake ◽

Mark Goldstein ◽

...

Keyword(s):

Endoscopic Mucosal Resection ◽

Surgical Intervention ◽

Bowel Perforation ◽

Case Series ◽

Colonic Polyps ◽

Cost Effective ◽

Direct Result ◽

Free Gas ◽

Mucosal Resection ◽

Emergency Surgical Intervention

Background& Objectives Endoscopic mucosal resection (EMR) is an efficient, cost-effective and minimally-invasive mode of treatment of colonic polyps. Colonic perforation post EMR is one of the potential complications associated with this procedure. Some patients may present with asymptomatic free gas on imaging and therefore not necessarily require intervention. Methods We present a case series of patients undergoing EMR who were found to have intra-abdominal free gas or ‘bowel perforation’ on imaging post procedure. They were all asymptomatic and did not warrant emergency surgical intervention. In addition, we aim to provide a review of the existing literature on ‘bowel perforation’ post EMR and discuss its management. Results & Conclusion Through this case series we highlight the importance of assessing patients clinically and not treating the radiological findings alone. Clinicians must be aware of the possibility of patients with asymptomatic free gas post EMR as a direct result of the injectate during the procedure or due to the passage of air or CO2 from the distended colon. As the popularity of this procedure increases, it is crucial that clinicians, surgeons and endoscopists are all aware of its associated complications.

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Pain in hemophilia patients: Assessment and management in a fourth level hospital. Case series☆

Colombian Journal of Anesthesiology ◽

10.1097/01819236-201712002-00005 ◽

2017 ◽

Vol 45 ◽

pp. 24-29

Author(s):

Diana Patricia Pérez-Moreno ◽

Claudia Liliana Buitrago

Keyword(s):

Case Series ◽

Hospital Case ◽

Fourth Level ◽

Level Hospital

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Seatbelt Injury Causing Small Bowel Devascularisation: Case Series and Review of the Literature

Emergency Medicine International ◽

10.1155/2011/675341 ◽

2011 ◽

Vol 2011 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

Vincent O'Dowd ◽

Christine Kiernan ◽

Aoife Lowery ◽

Waqar Khan ◽

Kevin Barry

Keyword(s):

Small Bowel ◽

Traffic Accidents ◽

Surgical Intervention ◽

Road Traffic ◽

Case Series ◽

Adverse Outcomes ◽

Emergency Surgical Intervention ◽

High Index Of Suspicion ◽

Delays In Diagnosis ◽

Public Health Strategies

The use of seatbelts has increased significantly in the last twenty years, leading to a decrease in mortality from road traffic accidents (RTA). However, this increase in seatbelt use has also led to a change in the spectrum of injuries from RTA; abdominal injuries, particularly intestinal injuries have dramatically increased with the routine use of seatbelts. Such intestinal injuries frequently result from improper placement of the “lap belt”. We present 3 cases in which passengers wearing a seatbelt sustained significant devascularisation injuries to the small bowel requiring emergency surgical intervention. A high index of suspicion is crucial in such cases to prevent delays in diagnosis that can lead to severe complications and adverse outcomes. It is evident that while advocating seatbelt use, the importance of education in correct seatbelt placement should also be a focus of public health strategies to reduce RTA morbidity and mortality.

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Pain in hemophilia patients: Assessment and management in a fourth level hospital. Case series

Colombian Journal of Anesthesiology ◽

10.1016/j.rcae.2017.10.003 ◽

2017 ◽

Vol 45 ◽

pp. 24-29

Author(s):

Diana Patricia Pérez-Moreno ◽

Claudia Liliana Buitrago

Keyword(s):

Case Series ◽

Hospital Case ◽

Fourth Level ◽

Level Hospital

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Button battery foreign body among children: a case series

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20201699 ◽

2020 ◽

Vol 6 (5) ◽

pp. 978

Author(s):

Gerald P. Sebastian ◽

Rajinidevi Kaliyan ◽

Pethuru Devadason

Keyword(s):

Foreign Body ◽

Foreign Bodies ◽

Surgical Intervention ◽

Case Series ◽

Mucosal Surface ◽

Common Occurrence ◽

Button Battery ◽

Emergency Surgical Intervention ◽

Button Batteries ◽

Nose And Throat

<p>In children the foreign bodies are a common occurrence which may be either accidental or self-induced as a matter of habit. Various materials like metal, plastic toy parts, food matters, etc have been reported as foreign bodies. Button batteries have been reported as foreign bodies in the ear, nose and throat are very relevant and practical, due to their early chemical disintegration in contact with mucosal surface; hence, need emergency surgical intervention to avoid complications. Here, we report five cases of button batteries in the ear nose and throat at various stages of presentation with their sequelae.</p>

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Neurological Recovery in Traumatic Spinal Cord Injury Patient with Delayed Surgical Intervention

Neurologico Spinale Medico Chirurgico ◽

10.15562/nsmc.v1i2.112 ◽

2018 ◽

Vol 1 (2) ◽

pp. 34

Author(s):

Mochamad Targib Alatas

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Surgical Intervention ◽

Case Series ◽

Spinal Cord Injury Patient ◽

Traumatic Spinal Cord Injury ◽

Best Interest ◽

Score Improvement ◽

Cord Injury ◽

Injury Patient

Early surgical treatment for traumatic spinal cord injury (SCI) patients has been proven to yield better improvement on neurological state, and widely practiced among surgeons in this field. However, it is not always affordable in every clinical setting. It is undeniable that surgery for chronic SCI has more challenges as the malunion of vertebral bones might have initiated, thus requires more complex operating techniques. In this case series, we report 7 patients with traumatic SCI whose surgical intervention is delayed due to several reasons. Initial motoric scores vary from 0 to 3, all have their interval periods supervised between outpatient clinic visits. On follow up they demonstrate significant neurological development defined by at least 2 grades motoric score improvement. Physical rehabilitation also began before surgery was conducted. These results should encourage surgeons to keep striving for the patient’s best interest, even when the injury has taken place weeks or even months before surgery is feasible because clinical improvement for these patients is not impossible.

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IgG4-related intracranial disease

The Neuroradiology Journal ◽

10.1177/1971400918806323 ◽

2018 ◽

Vol 32 (1) ◽

pp. 29-35 ◽

Cited By ~ 6

Author(s):

Shahine Goulam-Houssein ◽

Jeffrey L Grenville ◽

Katerina Mastrocostas ◽

David G Munoz ◽

Amy Lin ◽

...

Keyword(s):

Plasma Cells ◽

Surgical Intervention ◽

Case Series ◽

Hypertrophic Pachymeningitis ◽

Diagnostic Challenge ◽

Perineural Spread ◽

Related Disease ◽

The Third ◽

Igg4 Related Disease ◽

Intracranial Involvement

IgG4-related disease (IgG4-RD) is a multi-organ chronic inflammatory process caused by infiltration of IgG4-positive plasma cells in one or more organs. Intracranial involvement has only recently become better recognized. Our case series adds to the growing literature on the varying presentations of intracranial IgG4 by describing the clinical and imaging findings of three patients who presented to our institution with intracranial involvement. Our first patient presented with a mass-forming IgG4 pachymeningitis mimicking a sphenoid wing meningioma, which is to our knowledge the largest mass-forming pachymeningitis published in the literature. Our second case depicts another presentation of extensive IgG4 pachymeningitis involving both cavernous sinuses and surrounding Meckel’s caves. The third case describes a patient with presumed lymphocytic hypophysitis, which was later determined to be IgG4-related hypophysitis with concomitant pachymeningitis and perineural spread along the optic nerves. The delayed diagnoses in our cases illustrates the diagnostic challenge that clinicians face in differentiating intracranial IgG4-RD from other infiltrative diseases such as sarcoidosis, granulomatous disease, tuberculosis and lymphoma. Earlier consideration of IgG4-related hypophysitis and hypertrophic pachymeningitis in the differential diagnosis can prevent significant morbidity including unnecessary surgical intervention and organ failure secondary to extensive fibrosis.

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Repairing the injured bronchus in blunt chest trauma – A case series

Trauma ◽

10.1177/1460408620988116 ◽

2021 ◽

pp. 146040862098811

Author(s):

Anith Nadzira Riduan ◽

Narasimman Sathiamurthy ◽

Benedict Dharmaraj ◽

Diong Nguk Chai ◽

Narendran Balasubbiah

Keyword(s):

Blunt Trauma ◽

Chest Trauma ◽

Surgical Intervention ◽

Case Series ◽

Trauma Patients ◽

Lung Collapse ◽

Comprehensive Management ◽

Lung Capacity ◽

Management Algorithm ◽

Operative Outcomes

Introduction Traumatic bronchial injury (TBI) is uncommon, difficult to diagnose and often missed. The incidence of TBI among blunt trauma patients is estimated to be around 0.5–2%. Bronchoplastic surgery is indicated in most cases to repair the tracheobronchial airway and preserve lung capacity. There is limited existing literature addressing the management of this condition in view of its rarity. The comprehensive management and outcomes of these patients are discussed. Methods The case notes of all patients who presented with persistent lung collapse due to trauma since July 2017 were reviewed retrospectively. Those patients requiring surgical intervention were included in the review. The mode of injury, clinical, radiological and bronchoscopy findings, concurrent injuries, type of surgery, length of stay (LOS) and operative outcomes were reviewed. Results Out of 11 patients who presented with persistent lung collapse post-blunt trauma, four (36%) were found to have structural bronchial disruption. All of them underwent successful repair of the injured bronchus, without the need of a pneumonectomy. The other seven patients were successfully treated conservatively. Conclusion The repair of the injured bronchus is essential in improving respiratory function and to prevent a pneumonectomy. Routine bronchoscopic evaluation should be performed for all suspected airway injuries as recommended in our management algorithm. Delayed presentations should not hinder urgent referral to thoracic centers for tracheobronchial reconstruction.

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Heterotopic caval valve implantation for the management of severe tricuspid regurgitation: a case series

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa428 ◽

2020 ◽

Author(s):

Aidan Sharkey ◽

Ronny Munoz Acuna ◽

Kiran Belani ◽

Ravi K Sharma ◽

Omar Chaudhary ◽

...

Keyword(s):

Medical Therapy ◽

Tricuspid Regurgitation ◽

Surgical Intervention ◽

Symptom Relief ◽

Vena Cava ◽

Case Series ◽

High Morbidity ◽

Severe Tricuspid Regurgitation ◽

Maximal Medical Therapy ◽

Valve Implantation

Abstract Background Severe tricuspid regurgitation (TR) is a complex condition that can be difficult to treat medically, and often surgical intervention is prohibited due to the high morbidity and mortality associated with this intervention. In patients who have failed maximal medical therapy and have progressive symptoms related to their severe TR, heterotopic caval valve implantation (CAVI) offers potential for symptom relief for these patients. Case summary We present two cases of patients with severe TR with symptoms of heart failure that were refractory to medical therapy. Due to extensive comorbidities in these patient’s surgical intervention was deemed unsuitable and the decision was made to proceed with heterotopic CAVI in order to try and control their symptoms. Both patients successfully underwent the procedure and had an Edwards SAPIEN 3 valve (Edwards Lifesciences, Irvine, CA, USA) implanted in the inferior vena cava/right atrium junction. In both patients, there was improvement in the postoperative haemodynamics as measured by invasive and non-invasive methods. Successful discharge was achieved in both patients with improvement in their symptoms. Discussion Selective use of heterotopic CAVI to treat symptomatic severe TR that is refractory to medical therapy may be a viable option to improve symptoms in those patients that are unsuitable for surgical intervention.

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