Severe cochlear dysplasia causing recurrent meningitis: a surgical lesson

1993 ◽  
Vol 107 (8) ◽  
pp. 726-729 ◽  
Author(s):  
D. S. Stevenson ◽  
D. W. Proops ◽  
P. D. Phelps
Keyword(s):  
Operative Management ◽  
Oval Window ◽  
Alternative Procedure ◽  
Prolonged Hospital Stay ◽  
Recurrent Meningitis ◽  
Gram Negative ◽  
Csf Rhinorrhoea ◽  
The Right ◽  
Prolonged Hospital

AbstarctMeningitis may be the sole presenting sign of a cerebrospinal fluid (CSF) fistula of the temporal bone. An eight-year-old boy suffering from recurrent meningits was found to hav ebilateral severe cochlear dysplasia. Bilateral tympanotomies were performed, planning to obliterate each vestibule. In the right ear a stapedectomy was oerfirned, resulting in terrntial ‘CSF gusher’ and difficulty in packing the vestibule. CSF rhinorrhoea requiring revision surgery and twon episodes of gram-negative bacterial meningtis complicated the post-operative management, resulting in a prolonged hospital stay. Subsequently, the left ear was managed in a different fasion, leaving the stapes in situ, with grafts placed to seal the oval window nche. We would recommended this alternative procedure in cases of severe cochlear dysplasia, where abnormalities of the vestibule and basal turn of the cochela mean that performing a stapeddectomy to pack the vestibule may result in a severe ‘CSF gusher’, by opening directly into the subarachnoid space.

scholarly journals Point-of-Care Ultrasound-Directed Evaluation of Elbow Effusion

2019 ◽  
Vol 3 (3) ◽  
pp. 286-288
Author(s):  
Peter Patitsas ◽  
Richard Davis ◽  
Robert Strony
Keyword(s):  
Emergency Department ◽  
Best Practices ◽  
Point Of Care ◽  
Robotic Prostatectomy ◽  
Point Of Care Ultrasound ◽  
Prolonged Hospital Stay ◽  
Ultrasound Guided ◽  
The Right ◽  
Department Evaluation ◽  
Prolonged Hospital

A 53-year-old male presented with pain in the right elbow that was sudden in onset and progressively worsening over approximately eight hours. The pain was exacerbated with any movement of the elbow. Of note, he had been recently admitted for robotic prostatectomy and had a prolonged hospital stay requiring a course of antibiotics. This case report details the emergency department evaluation of septic arthritis of the elbow with a focus on best practices for ultrasound- guided elbow arthrocentesis.

Oval window perilymph fistula in child with recurrent meningitis and unilateral hearing loss

2020 ◽  
Vol 13 (7) ◽  
pp. e234744
Author(s):  
Miane Min Yan Ng ◽  
Felice D'Arco ◽  
Raouf Chorbachi ◽  
Robert Nash
Keyword(s):  
Hearing Loss ◽  
Oval Window ◽  
Fat Grafting ◽  
Csf Leak ◽  
Unilateral Hearing Loss ◽  
Upper Respiratory Tract ◽  
Recurrent Meningitis ◽  
Newborn Hearing ◽  
Blind Sac Closure ◽  
The Right

A 2-year-old boy presented to Ears, Nose and Throat (ENT) surgeons with unilateral hearing loss. Following a prodrome of upper respiratory tract infection (URTI), he developed two episodes of pneumococcal meningitis in quick succession. This case demonstrates an unusual cause of perilymph fistula diagnosed on imaging and confirmed surgically. He had failed the Newborn Hearing Screening Programme and was therefore referred to audiology, who confirmed profound sensorineural hearing loss in the right ear. MRI showed incomplete partitioning (type 1) of the right cochlea, suggesting cerebrospinal fluid (CSF) leak from the region of the stapes. Exploratory tympanotomy confirmed this, and proceeded to CSF leak repair, obliteration of the Eustachian tube, subtotal petrosectomy, abdominal fat grafting and blind sac closure. Although middle ear effusions are common; particularly in children with recent URTI, the possibility of otogenic CSF leak needs to be considered, especially in cases of recurrent meningitis.

A study on the design of a wardrobe, for patients bed-ridden with cancer, applying the knowledge of anonymous design

Impact ◽  
2020 ◽  
Vol 2020 (7) ◽  
pp. 45-47
Author(s):  
Naoko Fujii
Keyword(s):  
Hospital Stay ◽  
Nursing Care ◽  
Healthcare Professionals ◽  
The Other ◽  
Human Beings ◽  
Prolonged Hospital Stay ◽  
Hospital Patients ◽  
Hospital Gowns ◽  
Hospital Stays ◽  
Prolonged Hospital

The majority of human beings will be admitted to hospital at some point over the course of their lives. For the more fortunate among us, these hospital stays will be brief and will barely register as a significant experience. However, for others, being admitted for weeks or months at a time will be necessary in order to combat and recover from whatever it was that made admittance to hospital necessary. While it is easy to think of many reasons why a prolonged hospital stay might be undesirable, one that may escape our attention is the clothes that are worn by patients during their stay. Once a patient has been assigned a bed, they are often given a gown which they put on without thought and then lie down. The gowns that are given to patients are generally designed with healthcare professionals in mind. For example, in Japan pyjamas and yukata (bathrobes) are used as hospital gowns because they have a front opening that is easy to use during treatment and nursing care. In addition, the other gowns can be opened from the ankle to the crotch using the zip. Dr Naoko Fujii has focused her career on designing clothes for hospital patients and believes that there is a way to satisfy the practical needs of a hospital and the care it gives at the same time as satisfying the requirements of patients. She is now focusing her attention on this challenge.

scholarly journals Septic shock due to Yersinia pseudotuberculosis infection in an adult immunocompetent patient: a case report and literature review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Takehiro Hashimoto ◽  
Ryuichi Takenaka ◽  
Haruka Fukuda ◽  
Kazuhiko Hashinaga ◽  
Shin-ichi Nureki ◽  
...  
Keyword(s):  
Septic Shock ◽  
Therapeutic Strategy ◽  
Yersinia Pseudotuberculosis ◽  
Immunocompromised Host ◽  
Immunocompetent Patient ◽  
Case Presentation ◽  
Gram Negative ◽  
Old Japanese ◽  
The Right ◽  
Immunocompetent Patients

Abstract Background Yersinia pseudotuberculosis infection can occur in an immunocompromised host. Although rare, bacteremia due to Y. pseudotuberculosis may also occur in immunocompetent hosts. The prognosis and therapeutic strategy, especially for immunocompetent patients with Y. pseudotuberculosis bacteremia, however, remains unknown. Case presentation A 38-year-old Japanese man with a mood disorder presented to our hospital with fever and diarrhea. Chest computed tomography revealed consolidation in the right upper lobe with air bronchograms. He was diagnosed with pneumonia, and treatment with intravenous ceftriaxone and azithromycin was initiated. The ceftriaxone was replaced with doripenem and the azithromycin was discontinued following the detection of Gram-negative rod bacteria in 2 sets of blood culture tests. The isolated Gram-negative rod bacteria were confirmed to be Y. pseudotuberculosis. Thereafter, he developed septic shock. Doripenem was switched to cefmetazole, which was continued for 14 days. He recovered without relapse. Conclusions We herein report a case of septic shock due to Y. pseudotuberculosis infection in an adult immunocompetent patient. The appropriate microorganism tests and antibiotic therapy are necessary to treat patients with Y. pseudotuberculosis bacteremia.

scholarly journals EXPRESS: Chronic thromboembolic pulmonary hypertension following pulmonary embolism with a right ventricular thrombus: A report of two cases

2021 ◽  
pp. 204589402110136
Author(s):  
Tailong Zhang ◽  
Weitao Liang ◽  
Longrong Bian ◽  
Zhong Wu
Keyword(s):  
Pulmonary Hypertension ◽  
Right Ventricular ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Imaging Features ◽  
Pulmonary Endarterectomy ◽  
Right Heart ◽  
Thromboembolic Pulmonary Hypertension ◽  
The Right ◽  
Cardiac Masses

Right heart thrombus (RHT) accompanied by chronic thromboembolic pulmonary hypertension (CTEPH) is a rare entity. RHT may develop in the peripheral veins or in situ within the right heart chambers. The diagnosis of RHT is challenging, since its symptoms are typically non-specific and its imaging features resemble those of cardiac masses. Here, we report two cases of RHT with CTEPH that presented as right ventricular masses initially. Both patients underwent simultaneous pulmonary endarterectomy (PEA) and resection of the ventricular thrombi. Thus, when mass-like features are confirmed by imaging, RHT should be suspected in patients with CTEPH, and simultaneous RHT resection is required along with PEA.

A Neo-Assyrian statue from Til Barsib

Iraq ◽  
1996 ◽  
Vol 58 ◽  
pp. 79-87
Author(s):  
Arlette Roobaert
Keyword(s):  
Iron Age ◽  
Lower Portion ◽  
Maximum Height ◽  
Clear Indication ◽  
Large Hole ◽  
Relative Placement ◽  
The Right ◽  
As If ◽  
Medium Texture

During the 1993 season of excavations at Tell Ahmar, three pieces of a life-size basalt statue were found in a pit dug into one of the large walls surrounding an Iron Age vaulted tomb (Fig. 1). The head, the tors o and the lower part fitted together perfectly. When correctly assembled, these three pieces formed the figure of a standing beardless man with clasped hands (Fig. 2a−b). Only the feet were missing. The maximum height of the reconstructed statue is 1.45m. It was clear from the damage to portions of its body that the statue had been deliberately broken in antiquity. Details, such as a large hole on the right side of the chest, a smaller one on the top of the head and, above all, the defacement of the head suggest that the statue may have actually been “killed”.All three pieces of the statue, which was carved out of a blue greyish basalt of medium texture, were found lying on their backs (Fig. 4). The head lay next to the lower part of the statue, but was buried in a slightly deeper position. The relative placement of these fragments seems to be a clear indication that the statue was not knocked down at this particular spot, but was brought to this location in separate pieces, perhaps with the deliberate intention of burying them.The head was cut off as if the statue had been decapitated. The torso was separated from the lower portion of the statue by an oblique cut that divided the figure just below the waist. The cut runs downwards from the back and continues underneath the clasped hands at the front, leaving the hands almost completely undamaged. The lower part of the statue seems to have been separated from the missing feet by a horizontal cut. This may indicate that the base of the statue was left in situ, probably because it was solidly set in the ground.

The Evolution of Asymmetries in the Tropical Cyclone Boundary Layer Wind Field during Landfall

2021 ◽  
Keyword(s):  
Boundary Layer ◽  
Tropical Cyclone ◽  
Wind Field ◽  
Surface Wind ◽  
Frictional Stress ◽  
Homogeneous Surface ◽  
Sudden Decrease ◽  
The Right ◽  
Tropical Cyclone Boundary Layer

Abstract The evolution of the tropical cyclone boundary layer (TCBL) wind field before landfall is examined in this study. As noted in previous studies, a typical TCBL wind structure over the ocean features a supergradient boundary layer jet to the left of motion and Earth-relative maximum winds to the right. However, the detailed response of the wind field to frictional convergence at the coastline is less well known. Here, idealized numerical simulations reveal an increase in the offshore radial and vertical velocities beginning once the TC is roughly 200 km offshore. This increase in the radial velocity is attributed to the sudden decrease in frictional stress once the highly agradient flow crosses the offshore coastline. Enhanced advection of angular momentum by the secondary circulation forces a strengthening of the supergradient jet near the top of the TCBL. Sensitivity experiments reveal that the coastal roughness discontinuity dominates the friction asymmetry due to motion. Additionally, increasing the inland roughness through increasing the aerodynamic roughness length enhances the observed asymmetries. Lastly, a brief analysis of in-situ surface wind data collected during the landfall of three Gulf of Mexico hurricanes is provided and compared to the idealized simulations. Despite the limited in-situ data, the observations generally support the simulations. The results here imply that assumptions about the TCBL wind field based on observations from over horizontally-homogeneous surface types - which have been well-documented by previous studies - are inappropriate for use near strong frictional heterogeneity.

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