scholarly journals Transscaphoid Dorsal Lunate Dislocation: A Case Presentation and Review of the Literature

2020 ◽  
Author(s):  
Ahmadreza Afshar ◽  
Ali Tabrizi ◽  
Ali Aidenlou
Keyword(s):  
Daily Living ◽  
Scaphoid Fracture ◽  
Delayed Diagnosis ◽  
Proximal Row Carpectomy ◽  
Huge Amount ◽  
Level Of Evidence ◽  
Rare Injury ◽  
Case Presentation ◽  
Delayed Treatment ◽  
High Prevalence

AbstractThis case report describes a 74-year-old man with the rare injury of transscaphoid dorsal lunate dislocation (LD). He sustained a crushing injury with a huge amount of energy to his right wrist while working with a pressing machine. There were deep abrasions and areas of skin necrosis on the dorsum of the wrist. The patient was treated with closed reduction and a Herbert screw fixation for the scaphoid fracture. Six months postoperatively, avascular necrosis (AVN) of the lunate and scaphoid was apparent on the wrist radiographs. We offered a proximal row carpectomy to the patient, but he declined surgery because he was able to perform his activity of daily living. Dorsal LD as well as its variants has a high prevalence of AVN of the lunate. Delayed diagnosis, delayed treatment, and open reduction increase the risk of AVN development of the lunate. The level of evidence is therapeutic IV.

Comparison of activities of daily living after proximal row carpectomy or wrist four-corner fusion

2016 ◽  
Vol 42 (1) ◽  
pp. 57-62 ◽  
Author(s):  
M.E. Brinkhorst ◽  
H.P. Singh ◽  
J.J. Dias ◽  
R. Feitz ◽  
S.E.R. Hovius
Keyword(s):  
Activities Of Daily Living ◽  
Daily Living ◽  
Hand Function ◽  
Scaphoid Nonunion ◽  
Proximal Row Carpectomy ◽  
Level Of Evidence ◽  
Evidence Level ◽  
Function Test ◽  
Sollerman Hand Function Test ◽  
Therapeutic Study

Proximal row carpectomy and four-corner fusion are commonly used in the patients with scaphoid nonunion advanced collapse or scapholunate advanced collapse. We compared activities of daily living of the 24 patients after proximal row carpectomy with 24 patients with four-corner fusion procedures using the modified Sollerman hand function test and Michigan Hand Questionnaire. Most tasks were performed significantly quicker by the patients after proximal row carpectomy. The patients after proximal row carpectomy reported better function during activities of daily living. Level of Evidence: Level III, Therapeutic Study.

scholarly journals Delayed treatment of bacteremia during the COVID-19 pandemic

Diagnosis ◽  
2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Taiju Miyagami ◽  
Yuki Uehara ◽  
Taku Harada ◽  
Takashi Watari ◽  
Taro Shimizu ◽  
...  
Keyword(s):  
Blood Culture ◽  
Delayed Diagnosis ◽  
Chest Ct ◽  
Blood Cultures ◽  
Emergency Unit ◽  
Medical Providers ◽  
Delayed Treatment ◽  
Clinical Measures ◽  
Primary Measure ◽  
Antimicrobial Administration

Abstract Objectives Coronavirus disease (COVID-19) blindness, that is, the excessive consideration of the disease in diagnosis, has reportedly led to delayed diagnosis of some diseases. We compared several clinical measures between patients admitted for bacteremia during the two months of the COVID-19 pandemic and those admitted during the same period in 2019. We hypothesized that the pandemic has led to delayed treatment of bacteremia. Methods This retrospective observational study compared several measures undertaken for patients who visited the emergency unit in two hospitals between March 1 and May 31, 2020, during the COVID-19 pandemic and whose blood cultures tested positive for bacteremia with those for corresponding patients treated during the same period in 2019. The primary measure was time from consultation to blood culture/antimicrobials. Results We included 29 eligible patients from 2020 and 26 from 2019. In 2020, the time from consultation to antimicrobial administration was significantly longer than in 2019 (mean [range], 222 [145–309] min vs. 139 [102–179] min, p=0.002). The frequency of chest computed tomography (CT) was significantly higher in 2020 (96.6 vs. 73.1%, p=0.021). Significant differences were not observed in the time to blood culture or chest CT preceding the blood culture between the two periods. Conclusions Our findings suggested that due to the COVID-19 epidemic/pandemic, focusing on the exclusion of its infection using CT scans leads to an overall delay in the diagnosis and treatment of bacteremia. Medical providers must be aware of COVID-19 blindness and evaluate patients objectively based on rational criteria and take appropriate action.

scholarly journals Incidental whole-body MRI evidence of COVID-19 in an asymptomatic patient in a high prevalence region

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Valentina Angelini ◽  
Alberta Villanacci ◽  
Angelo Belotti ◽  
Francesca Castagnoli ◽  
Barbara Frittoli ◽  
...  
Keyword(s):  
Asymptomatic Patient ◽  
Whole Body ◽  
Diagnostic Tools ◽  
Historical Period ◽  
Case Presentation ◽  
Whole Body Mri ◽  
High Prevalence ◽  
Chest X Ray ◽  
Full Knowledge ◽  
Polymerase Chain

Abstract Background The purpose of this case report is to emphasize the importance of curing any clinical radiological elements in this historical period, especially in the area of endemic to coronavirus disease 19 (COVID-19) such as Lombardy and to stress the importance of the management of the asymptomatic patient, their crucial role in the spread of contagion. Case presentation We reported the case of incidental diagnosis of interstitial pneumonia by first finding on whole-body MR (WB-MR) in the patient affected by multiple myeloma (MM), with a negative respiratory symptoms at the time and with previous (1 month before) negative chest X-ray. The patient was promptly subjected to chest CT, which confirmed the suspicion of interstitial COVID-19 pneumonia and, in hospitalization, performed nasopharyngeal swabs for real-time polymerase chain reaction (RNA-PCR), with a doubtful outcome. Once the bacterial nature of the alterations was serologically and radiologically excluded, the patient was definitively diagnosed with COVID-19 and appropriately treated in hospitalization. Conclusion The clinical choices must, therefore, to make use of all the diagnostic tools available and full knowledge of the limitation of each of them.

Thrombosed Urethral Prolapse: a case series and review of the literature

2021 ◽  
pp. 205141582110328
Author(s):  
Abisola Oliyide ◽  
Ijeoma Chibuzo ◽  
Magda Kujawa
Keyword(s):  
Clinical Condition ◽  
Correct Diagnosis ◽  
Age Distribution ◽  
Case Series ◽  
Review Of The Literature ◽  
Level Of Evidence ◽  
Case Presentation ◽  
Urethral Prolapse ◽  
Evidence Level

Thrombosed urethral prolapse is a rare clinical condition. In this context, we describe our experience and compare our findings with the literature, following presentation of five consecutive cases over 2 years. This will hopefully improve awareness and appropriateness of specialty referrals as a correct diagnosis is rarely established prior to the patient being seen by a urologist. We also wish to highlight a case presentation of thrombosed urethral prolapse outside the bimodal age distribution which has been recorded in the literature. Level of Evidence: Level 4

scholarly journals Factors Associated with Scaphoid Nonunion following Early Open Reduction and Internal Fixation

2020 ◽  
Vol 09 (02) ◽  
pp. 141-149
Author(s):  
Pooja Prabhakar ◽  
Lauren Wessel ◽  
Joseph Nguyen ◽  
Jeffrey Stepan ◽  
Michelle Carlson ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Scaphoid Fracture ◽  
Receiver Operating Curve ◽  
Scaphoid Nonunion ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Fracture Location ◽  
Scaphoid Fractures ◽  
Time From Injury

Abstract Background Nonunion after open reduction and internal fixation (ORIF) of scaphoid fractures is reported in 5 to 30% of cases; however, predictors of nonunion are not clearly defined. Objective The purpose of this study is to determine fracture characteristics and surgical factors which may influence progression to nonunion after scaphoid fracture ORIF. Patients and Methods We performed a retrospective case–control study of scaphoid fractures treated by early ORIF between 2003 and 2017. Inclusion criteria were surgical fixation within 6 months from date of injury and postoperative CT with minimum clinical follow-up of 6 months to evaluate healing. Forty-eight patients were included in this study. Nonunion cases were matched by age, sex, and fracture location to patients who progressed to fracture union in the 1:2 ratio. Results This series of 48 patients matched 16 nonunion cases with 32 cases that progressed to union. Fracture location was proximal pole in 15% (7/48) and waist in 85% (41/48). Multivariate regression demonstrated that shorter length of time from injury to initial ORIF and smaller percent of proximal fracture fragment volume were significantly associated with scaphoid nonunion after ORIF (63 vs. 27 days and 34 vs. 40%, respectively). Receiver operating curve analysis revealed that fracture volume below 38% and time from injury to surgery greater than 31 days were associated with nonunion. Conclusion Increased likelihood for nonunion was found when the fracture was treated greater than 31 days from injury and when fracture volume was less than 38% of the entire scaphoid. Level of Evidence This is a Level III, therapeutic study.

Lessons learned from volar plate fixation of scaphoid fracture nonunions

2017 ◽  
Vol 43 (1) ◽  
pp. 57-65 ◽  
Author(s):  
Seth D. Dodds ◽  
John B. Williams ◽  
Max Seiter ◽  
Clark Chen
Keyword(s):  
Plate Fixation ◽  
Scaphoid Fracture ◽  
Case Series ◽  
Lessons Learned ◽  
Wrist Flexion ◽  
Level Of Evidence ◽  
Computed Tomographic ◽  
Volar Aspect ◽  
Fracture Nonunions ◽  
New Type

Treating scaphoid nonunions presents difficulties particularly when there is bone loss, significant humpback deformity or avascular necrosis. We describe a new type of fixation with a volar scaphoid plate that adds to the methods of internal fixation that are available for the treatment of recalcitrant scaphoid nonunions. We will also discuss ‘lessons learned’ from a cases series. The case series includes 20 consecutive patients treated with volar buttress plating and a pedicled vascularized bone graft from the ipsilateral volar distal radius. There was clinical and radiographic evidence of union in 18 of 20 patients, 13 of which were verified by computed tomographic scan. The range of motion was improved in all patients post-operatively. Four patients with radiographic union experienced intermittent clicking with maximal wrist flexion, believed to be due to the impingement of the plate on the volar aspect of the radioscaphoid articulation and underwent removal at approximately 1 year after the index procedure. Volar scaphoid plating is a useful alternative to headless scaphoid screw fixation in the treatment of unstable scaphoid waist fractures and nonunions. Level of evidence: IV

scholarly journals Cognitive, functional and behavioral assessment: Alzheimer's disease

2011 ◽  
Vol 5 (3) ◽  
pp. 153-166 ◽  
Author(s):  
Márcia L.F. Chaves ◽  
Claudia C. Godinho ◽  
Claudia S. Porto ◽  
Leticia Mansur ◽  
Maria Teresa Carthery-Goulart ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Neuropsychiatric Symptoms ◽  
Behavioral Assessment ◽  
Cognitive Domain ◽  
Sufficient Evidence ◽  
Level Of Evidence ◽  
Diagnosis Of Dementia

Abstract A review of the evidence on cognitive, functional and behavioral assessment for the diagnosis of dementia due to Alzheimer's disease (AD) is presented with revision and broadening of the recommendations on the use of tests and batteries in Brazil for the diagnosis of dementia due to AD. A systematic review of the literature (MEDLINE, LILACS and SCIELO database) was carried out by a panel of experts. Studies on the validation and/or adaptation of tests, scales and batteries for the Brazilian population were analyzed and classified according to level of evidence. There were sufficient data to recommend the IQCODE, DAFS-R, DAD, ADL-Q and Bayer scale for the evaluation of instrumental activities of daily living, and the Katz scale for the assessment of basic activities of daily living. For the evaluation of neuropsychiatric symptoms, the Neuropsychiatric Inventory (NPI) and the CAMDEX were found to be useful, as was the Cornell scale for depression in dementia. The Mini-Mental State Examination has clinical utility as a screening test, as do the multifunctional batteries (CAMCOG-R, ADAS-COG, CERAD and MDRS) for brief evaluations of several cognitive domains. There was sufficient evidence to recommend the CDR scale for clinical and severity assessment of dementia. Tests for Brazilian Portuguese are recommended by cognitive domain based on available data.

scholarly journals Comparison of Direct Surgical Costs for Proximal Row Carpectomy and Four-Corner Arthrodesis

2018 ◽  
Vol 08 (01) ◽  
pp. 066-071 ◽  
Author(s):  
Andrew Stephens ◽  
Angela Presson ◽  
Yizhe Xu ◽  
Ross Feller ◽  
Andrew Tyser ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Operative Time ◽  
Tertiary Care ◽  
Proximal Row Carpectomy ◽  
Level Of Evidence ◽  
Surgical Costs ◽  
Patient Reported ◽  
Simultaneous Procedures ◽  
Supply Costs ◽  
Staple Fixation

Background Proximal row carpectomy (PRC) and four-corner arthrodesis (FCA) are common treatments for stage II scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) wrists, with similar functional and patient-reported outcomes reported in the peer-reviewed literature. Questions Study questions included (1) whether surgical encounter total direct costs (SETDCs) differ between PRC and FCA, and (2) whether SETDC differs by method of fixation for FCA. Patients and Methods Consecutive adult patients (≥ 18 years) undergoing PRC and FCA between July 2011 and May 2017 at a single tertiary care academic institution were identified. Patients undergoing additional simultaneous procedures were excluded. Using our institution's information technology value tools, we extracted prospectively collected cost data for each surgical encounter. SETDCs were compared between PRC and FCA, and between FCA subgroups (screws, plating, or staples). Results Of 42 included patients, mean age was similar between the 23 PRC and 19 FCA patients (51.2 vs. 54.5 years, respectively). SETDCs were significantly greater for FCA than PRC by 425%. FCA involved significantly greater facility costs (2.3-fold), supply costs (10-fold), and operative time (121 vs. 57 minutes). Implant costs were absent for PRC, which were responsible for 55% of the SETDC for FCA. Compared with compression screws, plating and staple fixation were significantly more costly (70% and 240% greater, respectively). Conclusion SETDCs were 425% greater for FCA than PRC. Implant costs for FCA alone were 130% greater than the entire surgical encounter for PRC. For FCA, SETDC varied depending on the method of fixation. Level of Evidence This is a level III, cost analysis study.

scholarly journals Chilaiditi Syndrome: A Case Report Highlighting the Intermittent Nature of the Disease

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Esha M. Kapania ◽  
Christina Link ◽  
Joshua M. Eberhardt
Keyword(s):  
Case Report ◽  
Complete Resolution ◽  
Clinical Symptoms ◽  
Case Reports ◽  
Delayed Diagnosis ◽  
Spontaneous Resolution ◽  
Radiographic Evidence ◽  
Case Presentation ◽  
Chilaiditi Syndrome

Background. Chilaiditi syndrome is a phenomenon where there is an interposition of the colon between the liver and the abdominal wall leading to clinical symptoms. This is distinct from Chilaiditi sign for which there is radiographic evidence of the interposition, but is asymptomatic. Case Presentation. Here, we present the case of a patient who, despite having clinical symptoms for a decade, had a delayed diagnosis presumably due to the interposition being intermittent and episodic. Conclusions. This case highlights the fact that Chilaiditi syndrome may be intermittent and episodic in nature. This raises an interesting question of whether previous case reports, which describe complete resolution of the syndrome after nonsurgical intervention, are perhaps just capturing periods of resolution that may have occurred spontaneously. Because the syndrome may be intermittent with spontaneous resolution and then recurrence, patients should have episodic follow-up after nonsurgical intervention.

scholarly journals Delayed Diagnosis of Unilateral Mandibular Condylar Fracture in a Posterior Edentulous Patient

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Sahani Anupama ◽  
Pilana Vithanage Kalani Shihanika Hettiarachchi
Keyword(s):  
Early Diagnosis ◽  
Clinical Case ◽  
Delayed Diagnosis ◽  
Mandibular Fractures ◽  
Edentulous Patient ◽  
Condylar Fracture ◽  
Physical Finding ◽  
Case Presentation ◽  
Edentulous Patients ◽  
Condylar Fractures

Background. Fractures of the mandible are common in elderly patients, and among them, condylar fractures are the most frequent type. A change in occlusion is the most common physical finding in patients with fractures of the mandible. Therefore, it is challenging to identify mandibular fractures in posterior edentulous patients due to the lack of posterior occlusal contacts. It is crucial to do radiological investigations in such patients to exclude fractures. Case Presentation. This article describes a case of delayed diagnosis of a unilateral mandibular condylar fracture for a week’s duration and treating the condition as temporomandibular pathology in a posterior edentulous, 52-year-old patient. Conclusion. This clinical case highlights the importance of radiological investigations and occlusal analysis for early diagnosis of condylar fractures, particularly in posterior edentulous patients, lacking posterior occlusal contacts.

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