scholarly journals Use of Vacuum-suction in Depressed Skull Fractures – Case Report and Technical Nuances of Nonoperative Treatment

2020 ◽  
Author(s):  
Rodrigo Moreira Faleiro ◽  
Sérgio Cavalheiro ◽  
João Tiago Alves Belo ◽  
Vítor Vieira de Souza Moraes ◽  
Aieska Kellen Dantas dos Santos ◽  
...  
Keyword(s):  
Case Report ◽  
Pediatric Patients ◽  
Surgical Repair ◽  
Pediatric Population ◽  
Skull Fracture ◽  
Invasive Procedure ◽  
Nonoperative Treatment ◽  
Skull Fractures ◽  
Vacuum Suction ◽  
Non Invasive

AbstractUp to 20% of victims from skull fractures are represented by the pediatric population, and 50% of these lesions are depressed skull fractures. The treatment is multimodal in nature, ranging from conservative treatment to open surgical repair. The last one is associated, although in a small proportion, to complications, such as infections, hematomas and even death, besides the risks of the anesthetic procedure itself. The authors of the present article present a case report of the successful treatment of a depressed skull fracture in a newborn patient, using the vacuum-suction technique. The use of vacuum-suction may be beneficial for the pediatric patients, as it is a quick, non-invasive procedure, without the need for general anesthesia.

scholarly journals Risks, costs, and outcomes of cerebrospinal fluid leaks after pediatric skull fractures: a MarketScan analysis between 2007 and 2015

2019 ◽  
Vol 47 (5) ◽  
pp. E10
Author(s):  
Kunal Varshneya ◽  
Adrian J. Rodrigues ◽  
Zachary A. Medress ◽  
Martin N. Stienen ◽  
Gerald A. Grant ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Pediatric Population ◽  
Skull Fracture ◽  
Neurological Deficits ◽  
Csf Leak ◽  
Skull Fractures ◽  
Pediatric Head Trauma ◽  
Cerebrospinal Fluid Leaks ◽  
Neurosurgical Intervention ◽  
Csf Leaks

OBJECTIVESkull fractures are common after blunt pediatric head trauma. CSF leaks are a rare but serious complication of skull fractures; however, little evidence exists on the risk of developing a CSF leak following skull fracture in the pediatric population. In this epidemiological study, the authors investigated the risk factors of CSF leaks and their impact on pediatric skull fracture outcomes.METHODSThe authors queried the MarketScan database (2007–2015), identifying pediatric patients (age < 18 years) with a diagnosis of skull fracture and CSF leak. Skull fractures were disaggregated by location (base, vault, facial) and severity (open, closed, multiple, concomitant cerebral or vascular injury). Descriptive statistics and hypothesis testing were used to compare baseline characteristics, complications, quality metrics, and costs.RESULTSThe authors identified 13,861 pediatric patients admitted with a skull fracture, of whom 1.46% (n = 202) developed a CSF leak. Among patients with a skull fracture and a CSF leak, 118 (58.4%) presented with otorrhea and 84 (41.6%) presented with rhinorrhea. Patients who developed CSF leaks were older (10.4 years vs 8.7 years, p < 0.0001) and more commonly had skull base (n = 183) and multiple (n = 22) skull fractures (p < 0.05). These patients also more frequently underwent a neurosurgical intervention (24.8% vs 9.6%, p < 0.0001). Compared with the non–CSF leak population, patients with a CSF leak had longer average hospitalizations (9.6 days vs 3.7 days, p < 0.0001) and higher rates of neurological deficits (5.0% vs 0.7%, p < 0.0001; OR 7.0; 95% CI 3.6–13.6), meningitis (5.5% vs 0.3%, p < 0.0001; OR 22.4; 95% CI 11.2–44.9), nonroutine discharge (6.9% vs 2.5%, p < 0.0001; OR 2.9; 95% CI 1.7–5.0), and readmission (24.7% vs 8.5%, p < 0.0001; OR 3.4; 95% CI 2.5–4.7). Total costs at 90 days for patients with a CSF leak averaged $81,206, compared with $32,831 for patients without a CSF leak (p < 0.0001).CONCLUSIONSThe authors found that CSF leaks occurred in 1.46% of pediatric patients with skull fractures and that skull fractures were associated with significantly increased rates of neurosurgical intervention and risks of meningitis, hospital readmission, and neurological deficits at 90 days. Pediatric patients with skull fractures also experienced longer average hospitalizations and greater healthcare costs at presentation and at 90 days.

scholarly journals Gelatin sponge (Spongostan®) and N-butyl-2-cyanoacrylate: Utility on percutaneous treatment of persistent urinary leakage after partial nephrectomy. Case report and review of the literature

2020 ◽  
Vol 92 (3) ◽  
Author(s):  
Bernardino De Concilio ◽  
Francesca Vedovo ◽  
Maria Carmen Mir ◽  
Tommaso Silvestri ◽  
Andrea Casarin ◽  
...  
Keyword(s):  
Case Report ◽  
Partial Nephrectomy ◽  
Invasive Procedure ◽  
Percutaneous Treatment ◽  
Urinary Fistula ◽  
Gelatin Sponge ◽  
Review Of The Literature ◽  
Percutaneous Embolization ◽  
Non Invasive ◽  
Urinary Leakage

Introduction: Percutaneous treatment of persistent urinary fistula after partial nephrectomy using N-butyl-2-cyanoacrylate and gelatin sponge (Spongostan®) is an effective and relatively non-invasive procedure that should be considered when a conservative approach fails. Three successful cases of percutaneous embolization by using N-butyl-2-cyanoacrylate have been reported in the literature. To our knowledge, the use of Spongostan for the treatment of urinary fistula after partial nephrectomy has not been previously described. Case report: We present the case of an 82-year old man who underwent percutaneous closure of a urinary fistula following partial nephrectomy by using gelatin sponge (Spongostan®) and N-butyl-2-cyanoacrylate.Conclusions: We encourage the use of this technique in selected cases. Collaboration amongst urologists and skilled interventional radiologist is strongly recommended.

scholarly journals Transfer of children with isolated linear skull fractures: is it worth the cost?

2016 ◽  
Vol 17 (5) ◽  
pp. 602-606 ◽  
Author(s):  
Ian K. White ◽  
Ecaterina Pestereva ◽  
Kashif A. Shaikh ◽  
Daniel H. Fulkerson
Keyword(s):  
Clinical Outcomes ◽  
Trauma Center ◽  
Pediatric Patients ◽  
Skull Fracture ◽  
Pediatric Trauma ◽  
Skull Fractures ◽  
Financial Costs ◽  
Level 1 ◽  
Transfer Fees ◽  
Neurosurgical Intervention

OBJECTIVE Children with skull fractures are often transferred to hospitals with pediatric neurosurgical capabilities. Historical data suggest that a small percentage of patients with an isolated skull fracture will clinically decline. However, recent papers have suggested that the risk of decline in certain patients is low. There are few data regarding the financial costs associated with transporting patients at low risk for requiring specialty care. In this study, the clinical outcomes and financial costs of transferring of a population of children with isolated skull fractures to a Level 1 pediatric trauma center over a 9-year period were analyzed. METHODS A retrospective review of all children treated for head injury at Riley Hospital for Children (Indianapolis, Indiana) between 2005 and 2013 was performed. Patients with a skull fracture were identified based on ICD-9 codes. Patients with intracranial hematoma, brain parenchymal injury, or multisystem trauma were excluded. Children transferred to Riley Hospital from an outside facility were identified. The clinical and radiographic outcomes were recorded. A cost analysis was performed on patients who were transferred with an isolated, linear, nondisplaced skull fracture. RESULTS Between 2005 and 2013, a total of 619 pediatric patients with isolated skull fractures were transferred. Of these, 438 (70.8%) patients had a linear, nondisplaced skull fracture. Of these 438 patients, 399 (91.1%) were transferred by ambulance and 39 (8.9%) by helicopter. Based on the current ambulance and helicopter fees, a total of $1,834,727 (an average of $4188.90 per patient) was spent on transfer fees alone. No patient required neurosurgical intervention. All patients recovered with symptomatic treatment; no patient suffered late decline or epilepsy. CONCLUSIONS This study found that nearly $2 million was spent solely on transfer fees for 438 pediatric patients with isolated linear skull fractures over a 9-year period. All patients in this study had good clinical outcomes, and none required neurosurgical intervention. Based on these findings, the authors suggest that, in the absence of abuse, most children with isolated, linear, nondisplaced skull fractures do not require transfer to a Level 1 pediatric trauma center. The authors suggest ideas for further study to refine the protocols for determining which patients require transport.

MODIFIED LIP REPOSITIONING: A BOON FOR GUMMY SMILE: A CASE REPORT

2021 ◽  
pp. 22-24
Author(s):  
Ishita Joshi ◽  
Ayan Saxena ◽  
Nand Lal ◽  
Kopal Goel ◽  
Anjani Kumar Pathak
Keyword(s):  
Case Report ◽  
Invasive Procedure ◽  
Non Invasive ◽  
Gummy Smile

Background: A high lip line often known commonly as gummy smile is seldom a cause for concern for the patient and leads to the desire for its correction. The gummy smile is usually caused by the hyperactive pull of the elevator muscles. Methods: The procedure used in this case is a modied lip repositioning procedure wherein the labial frenum is left intact in order to maintain the midline. Result: The results following the surgery one month followed by ve months were satisfactory as around 4 mm reduction in the amount of gingiva displayed was observed. Conclusion: This modied lip repositioning can be used as a non-invasive procedure can be used to reduce the excessive display of gingiva effectively

scholarly journals Optical Coherence Tomography Imaging After Surgical Closure of Pediatric Traumatic Macular Holes

2018 ◽  
Vol 2 (2) ◽  
pp. 104-106 ◽  
Author(s):  
Nikisha Kothari ◽  
Kimberly D. Tran ◽  
Sarah P. Read ◽  
Audina M. Berrocal
Keyword(s):  
Optical Coherence Tomography ◽  
Visual Acuity ◽  
Macular Hole ◽  
Pediatric Patients ◽  
Surgical Repair ◽  
Pediatric Population ◽  
Case Series ◽  
Optical Coherence ◽  
Ellipsoid Zone ◽  
Surgical Closure

Purpose: To date, little attention has been directed to retinal photoreceptor migration after traumatic macular hole surgical repair in the pediatric population. The purpose of this study was to evaluate optical coherence tomography (OCT) findings in the foveae of pediatric patients with history of traumatic macular hole surgical repair. Methods: Retrospective case series of 3 eyes in 3 pediatric patients with traumatic macular hole surgical repair. Spectral domain OCT images were obtained pre- and postoperatively. Results: We report 3 cases of restoration of the ellipsoid zone with good visual acuity outcomes following macular hole closure. Conclusion: Optical coherence tomography findings of an intact ellipsoid zone may be a predictor of visual acuity and explain better surgical outcomes in the pediatric population.

scholarly journals Evaluation of Non-Invasive Measurement of Haemoglobin using PPG in Clinically Ill Pediatric Patients

2019 ◽  
Vol 8 (12) ◽  
pp. 4618-4621
Keyword(s):  
Pediatric Patients ◽  
Pediatric Population ◽  
Linear Regression Analysis ◽  
Venous Blood ◽  
Primary Objective ◽  
Altman Analysis ◽  
Bland Altman Analysis ◽  
Non Invasive ◽  
Characteristic Features ◽  
Invasive Measurement

Non-invasive haemoglobin (SpHb) estimation using Photoplethysmograph signal has gained enormous attention among researches in order to provide an earlydiagnosis to polycythemia, anaemia, various cardiovascular diseases, etc. The primary objective of this work is to evaluate the performance efficiency of SpHb monitoring using PPG in clinically ill pediatric population. PPG signal was obtained from the pediatric patients, and SpHb was calculated from the characteristic features of PPG. Haemoglobin value obtained through venous blood sample was compared with SpHb. Theabsolute mean difference between the SpHb and Hbref was 0.78g/dL (SD 0.99; 0.1 to 4.1).For a statistical analysis of the correlation between SpHb and Hblab, IBM SPSS statistics software was used. Bland-Altman analysis, T-test and Linear regression analysis were further used for finding the agreeability limits. Overestimation of SpHb value was observed for lower Hblab values, and SpHb failed to detect anaemic subject

The Sodium Pertechnetate Tc 99m Scan: An Aid in the Evaluation of Gastrointestinal Bleeding

PEDIATRICS ◽  
1975 ◽  
Vol 56 (1) ◽  
pp. 34-40
Author(s):  
Judith E. Ho ◽  
Kurt M. Konieczny
Keyword(s):  
Duodenal Ulcer ◽  
Gastric Mucosa ◽  
Gastrointestinal Bleeding ◽  
Barium Enema ◽  
Pediatric Patients ◽  
Meckel’S Diverticulum ◽  
Invasive Procedure ◽  
Surgical Exploration ◽  
Non Invasive ◽  
Sodium Pertechnetate

Twenty pediatric patients presenting primarily with unexplained gastrointestinal bleeding were evaluated with sodium pertechnetate Tc 99m imaging. Three patients had normal barium enemas and scans consistent with Meckel's diverticulum. These three patients and three additional patients with normal scans underwent surgical exploration. Meckel's diverticula containing gastric mucosa were found in all three patients with positive scans. No diverticula were found in the three patients with normal scans. Four other patients had scans that were considered abnormal but not felt to represent Meckel's diverticula. In one of these patients a radiographic gastrointestinal study performed after the scan demonstrated a large duodenal ulcer. In another patient, a nonspecific terminal ilial ulcer without gastric mucosa was found at surgery. The two other patients had normal radiographic gastrointestinal studies and no further evaluation was carried out. The etiology of gastrointestinal bleeding in pediatric patients is frequently unexplained even after thorough evaluation including celiotomy. The sodium pertechnetate Tc 99m scan is a safe, simple, non-invasive procedure that can demonstrate Meckel's diverticula with greater certainty than the barium enema and can suggest suspicious areas that can then be evaluated by more definitive procedures.

scholarly journals Skull fracture and epidural hematoma caused by use of a Mayfield skull clamp in an adult patient with chronic hemodialysis: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Takeo Furuya ◽  
Masashi Yamazaki ◽  
Tetsuharu Nemoto ◽  
Akihiko Okawa ◽  
Seiji Ohtori
Keyword(s):  
Adult Patient ◽  
Epidural Hematoma ◽  
Pediatric Population ◽  
Skull Fracture ◽  
Chronic Hemodialysis ◽  
Decompression Surgery ◽  
Skull Fractures ◽  
Mask Type ◽  
Patient Consent ◽  
Neurosurgical Patients

Abstract Background Mayfield skull clamps are widely used and indispensable in current neurosurgery. Complications such as skull fractures or intracranial hematoma from using a Mayfield skull clamp have largely been reported in the pediatric population, are likely related to the relative thinness of the skull, such as in patients with hydrocephalus, and are extremely rare in adults. Here, we report a case of skull fracture and epidural hematoma caused by a Mayfield skull clamp used for posterior decompression surgery in an adult patient with chronic hemodialysis. Case presentation A 67-year-old Asian male patient with a history of dialysis-dependent chronic renal failure over 36 years suffered from severe cervical myelopathy. Neurological examination and radiographic images revealed cervical spondylotic myelopathy due to dialysis-related spondyloarthropathy. Laminoplasty was planned on patient consent. A Mayfield skull clamp was applied with the patient supine. Torque was applied to the screws with gentle care, but there was no resistance and it was not easy to reach the standard 60 lb (267 N) to 80 lb (356 N). Because a skull fracture was suspected, we canceled the surgery. Emergency head computed tomography showed depressed skull fractures underlying the single-pin sites with an associated epidural hematoma. The fractures and epidural hematoma were treated conservatively, and spontaneous resolution of the hematoma was confirmed. Cervical laminoplasty was performed successfully using a mask-type head holder on the subsequent day. Conclusions As a precaution for fractures and epidural hematoma in neurosurgical patients with bone fragility or a thin skull, use of a mask-type fixing device or halo ring is recommended.

scholarly journals A Three-year-old Boy With an Epinephrine Ampoule in the Stomach: A Case Report

2020 ◽  
Author(s):  
Armen Malekiantaghi ◽  
Behzad Mohammadpour Ahranjan ◽  
Kambiz Eftekhari
Keyword(s):  
Case Report ◽  
Emergency Room ◽  
Foreign Bodies ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Upper Endoscopy ◽  
Asymptomatic Patients

Ingested Foreign Bodies (FB) frequently occur in pediatric patients. The most commonly ingested foreign bodies are coins, magnets, batteries, small toys, jewelry, buttons, and bonesin decreasing order of frequency. A three-year-old boy referred to the emergency room with incidental ingestion of an ampoule of epinephrine. The radiography data demonstrated thelocation of the ingested ampoule in the stomach. The upper endoscopy was performed; however, the object had already passed through the pylorus. The following day, he passed theampoule without complications. Our case was pretty unique because the most commonly ingested FBs in the pediatric population include coins followed by magnets, batteries, and soon. Asymptomatic patients having no dangerous FB could be observed until either presenting something abnormal or uneventfully passing the FB.

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