Tubercular Abscess of the Spleen in a Child: Conservative Management and Long-Term Follow-Up

AbstractIsolated involvement of the spleen is a rare manifestation of childhood tuberculosis. The rare occurrence and presence of nonspecific clinical features often pose diagnostic challenges even in countries where tuberculosis is endemic. Splenectomy is often performed for establishing the diagnosis or achieving a cure in combination with antitubercular therapy (ATT). In this report, we describe a boy who presented with nonspecific symptoms and was detected to have a well-defined lesion in the spleen on ultrasonography. The diagnosis of tubercular splenic abscess was made after line probe assay for the detection of Mycobacterium tuberculosis and cytomorphology of the aspirated material. The tubercular abscess showed complete healing after 9 months of four-drug ATT.

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A Long-Term Follow-Up of Post-Operative Periprosthetic Humeral Fracture in Shoulder Arthroplasty

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/21514593211039908 ◽

2021 ◽

Vol 12 ◽

pp. 215145932110399

Author(s):

Michele Novi ◽

Giuseppe Porcellini ◽

Alessandro Donà ◽

Luigi Tarallo ◽

Gianmario Micheloni ◽

...

Keyword(s):

Treatment Protocol ◽

Complete Healing ◽

Fracture Pattern ◽

Periprosthetic Fractures ◽

Level Of Evidence ◽

Cortical Index ◽

Constant Murley Score ◽

Long Term Follow Up

Background During the last decades, the growing number of shoulder replacement has increased the associated complications. Periprosthetic fractures have a low incidence but can be a severe clinical condition, especially in elderly population. There are still no guidelines to define the best treatment protocol for post-operative periprosthetic humeral fractures. Factors associated to these fractures and consequently the decision-making for the best treatment seem to be patient-related but also correlated with the type of implant. The aim of this study is to analyze the patient’s risk factors, fracture pattern, implant type and treatment, evaluating the outcome with a long-term follow-up. Methods A retrospective study was performed on more than 2700 shoulder prostheses implanted over 10 years in two specialized centers, identifying 19 patients who underwent surgery for post-operative periprosthetic fracture. Gender, age, comorbidities, type of prosthetic implant, type of fracture, and cortical index of each patient were evaluated. All patients underwent surgery and were evaluated with a mean follow-up of 5 years with radiographic controls and functional assessment with the Constant–Murley score. Results Complete healing was achieved in 18 of 19 patients. All patients presented a lower Constant–Murley score than the pre-fracture score, there were no significant differences between prosthetic implants, and the cortical index was lower than the threshold level in more than 60% of cases. Conclusion The results of this study showed that a correct preoperative planning is essential to evaluate the type of implant and possible signs of stem mobilization. With a stable stem, it is preferable to maintain it and proceed to a synthesis. The decision process is more complex in periprosthetic fractures with a reduced cortical index, when some radiolucency lines are present in stems with high primary stability, because it is not always indicative of an unstable stem. Level of Evidence Therapeutic III

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Diffuse Leukoplakia of the Bladder Ostium-Sparing in Patient Treated with Leuprorelin for Breast Cancer

Case Reports in Urology ◽

10.1155/2021/9970711 ◽

2021 ◽

Vol 2021 ◽

pp. 1-4

Author(s):

Antonio Nacchia ◽

Ferdinando di Giacomo ◽

Arcangelo Di Cerbo ◽

Massimo Dante Di Somma ◽

Giuseppe Patitucci ◽

...

Keyword(s):

Breast Cancer ◽

Urine Culture ◽

Previous Treatment ◽

Lateral Wall ◽

Rare Occurrence ◽

Left Lateral Wall ◽

Long Term Follow Up

Case. A 55-year-old woman came to our attention in April 2020 referring haematuria, frequency and urgency. The patient referred previous treatment with leuprorelin 3.75 mg/2 ml for breast cancer three years ago. Urine culture was performed and resulted always negative for pathogens. Cystoscopy revealed a whitish plaque lesion on the fundus, dome, trigone, and left lateral wall of the bladder. Histology of the biopsy confirmed the diagnosis of leukoplakia of the bladder. The plan is to follow her up repeating a cystoscopy every three months and biopsy in 6 months. Literature search revealed very little information on pathogenesis and prognosis of this condition due to its rare occurrence. The main objective of our case study was to describe individual situation of a woman affected by diffuse leukoplakia of the bladder ostium-sparing with a previous treatment with leuprorelin 3.75 mg/2 ml for breast cancer and to show safety of follow-up by cystoscopy and biopsy. Conclusions. We showed a case of a woman treated with leuprorelin and with diffuse leukoplakia of the bladder. We support the recommended long-term follow-up and surveillance based on the literature review by cystoscopy with or without biopsy.

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Cerebellar Ataxia Followed by Stiff Person Syndrome in a Patient with Anti-GAD Antibodies

Case Reports in Immunology ◽

10.1155/2020/8454532 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Sinali O. Seneviratne ◽

Katherine A. Buzzard ◽

Belinda Cruse ◽

Mastura Monif

Keyword(s):

Cerebellar Ataxia ◽

Acid Decarboxylase ◽

Stiff Person Syndrome ◽

Gamma Aminobutyric Acid ◽

Neurological Manifestations ◽

Rare Occurrence ◽

Gad Antibodies ◽

Long Term Follow Up

Anti-GAD antibody syndrome is a result of the production of antibodies against glutamic acid decarboxylase (GAD), the main enzyme responsible for the production of gamma-aminobutyric acid (GABA). Several neurological manifestations including cerebellar ataxia and stiff person syndrome have been reported in association with anti-GAD antibodies. In this paper, we present a case of a young woman with anti-GAD antibodies who initially presented with cerebellar ataxia followed by stiff person syndrome three and a half years later. Having both cerebellar ataxia and stiff person syndrome is a rare occurrence in anti-GAD antibody syndrome. We emphasise the importance of long-term follow-up of patients with anti-GAD antibody syndrome, as delayed neurological manifestations can occur.

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Endovascular management of giant visceral artery aneurysms

Scientific Reports ◽

10.1038/s41598-020-80150-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Marcello Andrea Tipaldi ◽

Miltiadis Krokidis ◽

Gianluigi Orgera ◽

Matteo Pignatelli ◽

Edoardo Ronconi ◽

...

Keyword(s):

Clinical Symptoms ◽

Clinical Success ◽

Splenic Abscess ◽

Visceral Artery ◽

Complete Relief ◽

Endovascular Management ◽

Visceral Artery Aneurysms ◽

Long Term Follow Up

AbstractEndovascular management of small visceral artery aneurysms is an established treatment with satisfactory outcomes. However, when size exceeds 5 cm visceral aneurysms are considered as “giant” (giant visceral artery aneurysms or GVAAs) and management is significantly more complex. Between August 2007 and June 2019 eleven cases of GVAAs that were endovascularly treated were retrospectively reviewed and included in this single center study. Mean size was 80 mm (± 26.3 mm) x 46 mm (+ \-11.8 mm). Nine of the lesions were true aneurysms, and two were pseudoaneurysms. In 8 patients, the lesion was causing compression symptoms in the surrounding organs, one patient developed a contained rupture while 2 patients were completely asymptomatic. However, all patients were hemodynamically stable at the time of treatment. Technical success was defined as immediate complete exclusion of the aneurysmal sac, and clinical success as complete relief from clinical symptoms. Follow-up was performed with CT angiography, ultrasound and clinical examination. Mean follow-up was 45 months (range 6–84). Technical and clinical success were both 91%. Complications were one lack of control of contained rupture that was subsequently operated, one case of self-limiting non-target spleen embolization and one case of splenic abscess. Three patients died, one due to the contained rupture 15 days after procedure, the other two for other causes and occurred during the long-term follow-up. This series suggests that endovascular treatment of giant visceral artery aneurysms and pseudoaneuryms is a valid minimally invasive solution with very satisfactory immediate and long-term outcomes unless the aneurysm is already ruptured. A variety of endovascular tools may be required for successful treatment.

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Therapy and prevention for mental health: What if mental diseases are mostly not brain disorders?

Behavioral and Brain Sciences ◽

10.1017/s0140525x1800105x ◽

2019 ◽

Vol 42 ◽

Cited By ~ 2

Author(s):

John P. A. Ioannidis

Keyword(s):

Mental Health ◽

Mental Disease ◽

Brain Disorders ◽

Social Stressors ◽

Labor Education ◽

Mental Diseases ◽

Long Term Follow Up ◽

Political Decisions

AbstractNeurobiology-based interventions for mental diseases and searches for useful biomarkers of treatment response have largely failed. Clinical trials should assess interventions related to environmental and social stressors, with long-term follow-up; social rather than biological endpoints; personalized outcomes; and suitable cluster, adaptive, and n-of-1 designs. Labor, education, financial, and other social/political decisions should be evaluated for their impacts on mental disease.

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