Do All Patients With Left Costal Margin Injuries Require Radiographic Evaluation for Intraabdominal Injury?

Dr. Silverman: I shall present the history of an infant who was admitted to our premature nursery on May 9, 1956. This Puerto Rican male infant was born during the thirty-sixth week of an uneventful pregnancy. An antenatal serologic test for syphilis was negative. Delivery was spontaneous. Birth weight was 1070 gm. Physical examination on admission to the nursery revealed the liver to be 1 cm below the right costal margin and the spleen was firm, 1 cm below the left costal margin. Nothing else worthy of comment was noted and the infant was managed in a routine manner. The immediate newborn period was entirely uneventful, specifically neither petechiae nor unusual degree of icterus were noted. The ocular fundi were examined, as a matter of routine, during the third and fifth weeks of life and they were described as normal. During the sixth week of life, when the infant weighed 2080 gm, it was suddenly noted that the abdomen was quite distended. Examination at this time disclosed marked hepatosplenomegaly, both organs were firm. Again neither icterus nor petechiae were noted. There appeared to be some difficulty in swallowing. Roentgenograms of the chest at this time were normal and of the skull revealed intracranial calcification which was displayed in a pattern that seemed to outline dilated lateral ventricles. Lumbar puncture yielded cerebrospinal fluid which was negative except for protein of 198 mg/100 ml. The urine and cerebrospinal fluid were examined for the cells characteristic of cytomegalic inclusion disease and none were found. Funduscopic examination at this time disclosed an area of chorioretinitis in the right eye. It was presumed at this time that the infant had toxoplasmosis.

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Prognostic significance of early molecular response in chronic myeloid leukemia patients treated with tyrosine kinase inhibitors

Hematology ◽

10.1182/asheducation-2014.1.240 ◽

2014 ◽

Vol 2014 (1) ◽

pp. 240-243 ◽

Cited By ~ 5

Author(s):

David T. Yeung ◽

Michael J. Mauro

Keyword(s):

Chronic Myeloid Leukemia ◽

Myeloid Leukemia ◽

Kinase Inhibitors ◽

Prognostic Significance ◽

Philadelphia Chromosome ◽

Chronic Phase ◽

Molecular Response ◽

Costal Margin ◽

International Scale ◽

Left Costal Margin

Abstract A 55-year-old man presented with splenomegaly (10 cm below left costal margin) and leucocytosis (145 × 109/L). Differential showed neutrophilia with increased basophils (2%), eosinophils (1.5%), and left shift including myeloblasts (3%). A diagnosis of chronic myeloid leukemia in chronic phase was established after marrow cytogenetics demonstrated the Philadelphia chromosome. Molecular studies showed a BCR-ABL1 qPCR result of 65% on the International Scale. Imatinib therapy at 400 mg daily was initiated due to patient preference, with achievement of complete hematological response after 4 weeks of therapy. BCR-ABL1 at 1 and 3 months after starting therapy was 37% and 13%, respectively (all reported on International Scale). Is this considered an adequate molecular response?

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Immuno-Electronmicroscopic Studies of Surface Antigens of Blood Elements

Blood ◽

10.1182/blood.v33.4.648.648 ◽

1969 ◽

Vol 33 (4) ◽

pp. 648-648

Author(s):

Giorgio Tonietti ◽

Giuseppe A. Andres ◽

Lidia Accinni ◽

Maria Purpura ◽

Konrad C. Hsu

Keyword(s):

Osmotic Fragility ◽

Surface Antigens ◽

Costal Margin ◽

Red Cell ◽

Left Costal Margin ◽

History Of ◽

Red Cell Count ◽

The Right ◽

Blood Elements ◽

Antibody Coating

Abstract PART I Immuno-Electronmicroscopic Studies of Surface Antigens of Blood Elements. I. Autoantibody on Erythrocytes in Acute Hemolytic Anemia, by Tonietti et al. Page 179—Methods and Material: The top 6 lines on page 180 should be transposed to page 179 starting as the 3rd line under Source of Erythrocytes, and the section properly reading as follows: Source of Erythrocytes The patient (L.S.), a seven year old male, was studied at the Centro Nazionale Transfusione Sangue, C.R.I., in March 1967. His history of anemia dated back to May 1964. Physical examination showed a deeply jaundiced boy. On palpation of the abdomen, the liver was felt 2 cm. below the right costal margin and the spleen 3 cm. below the left costal margin. The superficial lymph nodes were minimally but definitely enlarged. Examination of the blood revealed a red cell count of 1.8 million, a total white count of 3,600 and a platelet count of 180,000 per cu. mm. Bilirubin was 4.9 mg./100 ml. and the osmotic fragility of the red blood cells was normal. The blood group was O CCDee. Etc. Antiglobulin Tests Direct agglutination tests performed with the patient’s erythrocytes and antiserum to human globulin and antiserum to human IgG were positive. Absorption of the antihuman globulin with pure IgG rendered the serum incapable of agglutinating the erythrocytes of the patient,6 thus showing that the antibody coating the erythrocytes was of the IgG class.

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LUMBOCOSTOVERTEBRAL SYNDROME (LCVS) - A RARE ENTITY

10.36106/gjra/3909330 ◽

2021 ◽

pp. 71-71

Author(s):

Vinaya Ajaykumar Singh ◽

Sushma Malik

Keyword(s):

Small Bowel ◽

Lumbar Hernia ◽

Thoracic Vertebrae ◽

Costal Margin ◽

Lumbar Region ◽

Anthropometric Parameters ◽

Left Costal Margin ◽

Blue Arrow ◽

Systemic Examination

Full term female neonate, weighing 2.7 kg, was born to 37- year-old mother with an uneventful antenatal course. On examination, child was active and anthropometric parameters were normal. Head to toe examination revealed a globular swelling below left costal margin lateral to dorsolumbar spine measuring approximately 6 cm X 6 cm. It was soft, nontender, reducible and used to become prominent on crying. Rest of general and systemic examination was th th normal. X-ray of chest and spine showed dysplastic 9 , 10 , th th th 11 , 12 thoracic vertebrae (Fig 1 red arrow) with absent left 9 , th, th th 10 11 , 12 ribs (Fig 1 blue arrow) and left lumbar hernia (Fig 1 yellow arrow). Ultrasonography abdomen showed a hernial defect in left lumbar region measuring 5 cm X 5 cm containing small bowel loops. Ultrasonography spine showed spina bida occulta. Echocardiography was normal. Lumbar hernia was repaired by pediatric surgeons, operative ndings showed 5 cm X 4 cm hernial sac containing small bowel loops. Child had uneventful post-operative course and discharged successfully. Baby was advised regular follow up.

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A Rare Case Of Graves’ Disease With Splenomegaly And Pancytopenia

International Archives of Medicine ◽

10.3823/2446 ◽

2017 ◽

Vol 10 ◽

Author(s):

Elayne Christinne Marcelino e Silva ◽

Settings Ricardo Parente Garcia Vieira ◽

Maria Misrelma Moura Bessa ◽

Joao Kennedy Teixeira Lima ◽

Thyciara Fontenele Marques

Keyword(s):

Case Report ◽

Graves Disease ◽

Costal Margin ◽

Normal Number ◽

Left Hypochondrium ◽

Immunological Mechanisms ◽

Left Costal Margin ◽

Reference Hospital ◽

Normochromic Anemia ◽

Characteristic Features

Introduction: Splenomegaly and pancytopenia are rare complications of Graves' disease with few reports in the literature about this association. The pathogenesis is unknown and immunological mechanisms seem to be involved. The possibility of hyperthyroidsm should always considered in patients with pancytopenia. Objective: Describe clinical case of association between Grave's disease, splenomegaly and pancytopenia. Method: This is a case report, obtained through data from medical records of a reference hospital located in the city of Juazeiro do Norte, Ceara, Brazil. Case report: Patient, 46 years old, female, sought treatment at a reference hospital with abdominal pain that started two days earlier, prevalent in mesogastric region and left hypochondrium very intense and recurrent, associated with significant consuptive syndrome ( loss of 10 Kg in 4 months), asthenia, dyspnea on minimum exertion, irritability and fine tremor in extremitie. SHe denied fever, palpitations, heat intolerance, skin ou eye changes. A diffuse thyroid enlargement with the presence of thrill and murmur, digital clubbing, fixed and bright look, light exophthalmos and splenomegaly about 6 cm below the left costal margin were abserved after physical examination. Ultrasound examination (USG) of the abdomen and CT scan showed moderate splenomegaly. Laboratory tests showed normocytic and normochromic anemia, leukocytosis and mild thrombocytopenia. Thyroid USG showed characteristic features of Graves' disease, a bone marrow biopsy revealed maturation preserved in all strains and lack of fibrosis and megakaryocytes present in normal number without atypia. treatment was set with propylthiouracil 300 mg a day and after the first revaluation after hospital discharge three weeks later a regression of splenomegaly has been observed. Conclusion: This case ilustrates the rare association between hyperthyroidism and splenomegaly with pancytopenia.

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Transperitoneal Subcostal Access for Urologic Laparoscopy: Experience of a Large Chinese Center

BioMed Research International ◽

10.1155/2016/4062390 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Lei Zhang ◽

Dong Fang ◽

Xuesong Li ◽

Lin Yao ◽

Gengyan Xiong ◽

...

Keyword(s):

Success Rate ◽

Complication Rate ◽

Costal Margin ◽

Left Costal Margin ◽

Midclavicular Line ◽

The Right

Objective. To present our experience of using transperitoneal subcostal access, Palmer’s point (3 cm below the left costal margin in the midclavicular line), and its right corresponding site, in urologic laparoscopy. Methods. We used Palmer’s point and the right corresponding site for initial access in 302 urologic surgeries (62 cases with prior surgeries). The record of these cases was reviewed. Results. Success rate of initial access is 99.4%, and complication rate of puncturing is only 3.4% with no serious complication. In the cases with prior surgeries, there were only two cases with access complication on the right side (minor laceration of liver). For people with BMI more than 30 kg/m2 (12, 3.9%), the success rate was also 100 percent. Conclusions. Palmer’s point and the corresponding right location are feasible, effective, and safe for initial access in urologic laparoscopic surgeries. This entry technique should be used routinely in urologic laparoscopic surgeries.

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Motion Analysis of the Cervical Spine

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2004.sepoct01 ◽

2004 ◽

Vol 9 (5) ◽

pp. 1-11

Author(s):

Patrick R. Luers

Keyword(s):

Cervical Spine ◽

Intervertebral Disk ◽

Radiographic Evaluation ◽

Ligamentous Injury ◽

Pattern Of Injury ◽

Motion Segment ◽

Single Pattern ◽

Compensatory Motion ◽

Loss Of Motion ◽

Flexion And Extension

Abstract The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, defines a motion segment as “two adjacent vertebrae, the intervertebral disk, the apophyseal or facet joints, and ligamentous structures between the vertebrae.” The range of motion from segment to segment varies, and loss of motion segment integrity is defined as “an anteroposterior motion of one vertebra over another that is greater than 3.5 mm in the cervical spine, greater than 2.5 mm in the thoracic spine, and greater than 4.5 mm in the lumbar spine.” Multiple etiologies are associated with increased motion in the cervical spine; some are physiologic or compensatory and others are pathologic. The standard radiographic evaluation of instability and ligamentous injury in the cervical spine consists of lateral flexion and extension x-ray views, but no single pattern of injury is identified in whiplash injuries. Fluoroscopy or cineradiographic techniques may be more sensitive than other methods for evaluating subtle abnormal motion in the cervical spine. The increased motion thus detected then must be evaluated to determine whether it represents normal physiologic motion, normal compensatory motion, motion related to underlying degenerative disk and/or facet disease, or increased motion related to ligamentous injury. Imaging studies should be performed and interpreted as instructed in the AMA Guides.

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Dynamic Proximal Ulnar Osteotomy for the Treatment of Ununited Anconeal Process in 17 Dogs

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1632614 ◽

1998 ◽

Vol 11 (02) ◽

pp. 76-79 ◽

Cited By ~ 14

Author(s):

B. M. Turner ◽

R. H. Abercromby ◽

J. Innes ◽

W. M. McKee ◽

M. G. Ness

Keyword(s):

Clinical Outcome ◽

Prospective Study ◽

Patient Population ◽

Clinical Results ◽

Radiographic Evaluation ◽

Proximal Ulna ◽

Ulnar Osteotomy ◽

A Prospective Study

SummaryA prospective study was made of 17 dogs with ununited anconeal process treated by osteotomy of the proximal ulna. The effect of the surgery on lameness was evaluated subjectively and the elbows were assessed radiographically for evidence of anconeal fusion and healing of the osteotomy. Whilst clinical outcome was generally good and complications infrequent, relatively few cases achieved anconeal fusion. These results do not compare well with the results of a previous study but this disparity may be due in part to differences in patient population and radiographic evaluation.Further work is required to establish how best to achieve predictable anconeal fusion.Proximal ulnar osteotomy was used to treat 17 dogs with ununited anconeal process. Clinical results were good but anconeal fusion was not achieved consistently. Further work is needed to determine how best to achieve predictable anconeal fusion.

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Evaluation of Positive Contrast Arthrography in Canine Cranial Cruciate Ligament Disease

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1632495 ◽

1996 ◽

Vol 09 (01) ◽

pp. 10-3 ◽

Cited By ~ 2

Author(s):

D.N. Aron ◽

R. Roberts ◽

J. Stallings ◽

J. Brown ◽

C.W. Hay

Keyword(s):

Articular Surface ◽

Cruciate Ligament ◽

Positive Contrast ◽

Joint Effusion ◽

Radiographic Evaluation ◽

Cranial Cruciate Ligament ◽

Joint Pathology ◽

Meniscal Pathology ◽

Cranial Cruciate Ligament Disease ◽

Better Than

SummaryArthrographic and intraoperative evaluations of stifles affected with cranial cruciate disease were compared. Arthrography did not appear to be helpful in predicting cranial cruciate ligament pathology. The caudal cruciate ligament was consistently not visualized in the arthrograms and was normal at surgery. The menisci were visualized consistently in the arthrograms, but conclusions could not be made as to the benefit of arthrography in predicting meniscal pathology. Arthrography was not helpful in predicting joint capsule and femoral articular surface pathology. Survey radiographic evaluation was better than arthrography in evaluating joint pathology. When cruciate injury is suspected, after history and physical examination, survey radiographs are better than positive contrast arthrograms at supporting the diagnosis.Positive contrast arthrography was evaluated as a diagnostic aid in canine cranial cruciate ligament disease. It did not appear to be useful in predicting joint pathology. With arthrography, both menisci could be visualized and evaluated for abnormalities. Joint effusion and presence of osteophytes evaluated on survey radiographs was better than arthrography in evaluating joint pathology.

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PEID (Percutaneous Endoscopic Interlaminar Discectomy): Cautionary Points Based on the Evidence

Neurologico Spinale Medico Chirurgico ◽

10.15562/nsmc.v1i2.85 ◽

2018 ◽

Vol 1 (2) ◽

pp. 7

Author(s):

Jun Ho Lee

Keyword(s):

Lumbar Disc ◽

Lumbar Discectomy ◽

Radiographic Evaluation ◽

Operative Indication ◽

Endoscopic Techniques ◽

Bone Removal ◽

Iatrogenic Trauma ◽

Minimal Damage ◽

Surgical Modality ◽

Endoscopic Lumbar Discectomy

Background: Percutaneous endoscopic lumbar discectomy (PELD) is one of the most sophisticated operative procedures for the treatment of lumbar disc herniation (LDH). Endoscopic techniques are now becoming standard in many areas due to expanded technical possibilities of full-endoscopic transforaminal or interlaminar resection of herniated lumbar discs as well as stenosis. However conventional percutaneous endoscopic interlaminar discectomy (PEID) disc operations may sometimes result in subsequent untoward complications due to unnoticed iatrogenic trauma to neural structures, which is mostly related to an anatomical limitation during endoscope insertion.Methods: An appropriate operative indication of the PEID without bone removal or laminectomy can be used to treat LDH cases with an enough interlaminar space (at least ≥ 20 mm by bi-facetal distance) from the reported evidences. Otherwise, there might be several indications for requirement of bone removal; a narrow interlaminar space, disappearance of the concave shape of the upper vertebral laminae, high-grade migration of LDH, recurrent LDH, obesity, or an immobile nerve root.Conclusion: The significance of PEID lies also in its minimal damage to surrounding structures such as muscle, bone, and ligaments. A discrete radiographic evaluation from the patient preoperatively is mandatory before choosing a proper endoscopic surgical modality for the sake of optimal clinical outcome after PEID.

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