Venous pectoralis minor syndrome: a rare subdivision of the thoracic outlet syndrome

Abstract We analysed data of all patients who had received surgery for rare, isolated venous pectoralis minor syndrome at our tertiary institution from January 2015 to December 2018. Venous duplex scan was the preferred mode of diagnosis in all our patients. We operated on patients via a 5–6 cm deltopectoral groove incision. Ten procedures were performed on 6 patients, of whom 5 were female. The median age was 23 years (range 17–33 years). Three patients (2 female, 1 male) with bilateral pectoralis minor syndrome had separate procedures performed over a course of a few weeks. The median operating time was 22 min (range 15–95 min). Median blood loss was 20 ml (range 5–410 ml). The median hospital stay was 2 days (range 1–5 days). There was one complication in the form of a recurrence on the right side in a patient who had bilateral pectoralis minor syndrome. No other morbidities were recorded. Nine of 10 procedures (90%) were classified by patients as being satisfactory, where symptoms had partially or completely resolved. Our experience emphasizes the need for a systematic search and to maintain a high index of suspicion for venous pectoralis minor syndrome in all patients complaining of painful symptoms related to thoracic outlet syndrome. The deltopectoral groove approach is a simple and straightforward incision with a gentle learning curve.

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The value of real-time ultrasound-guidance for definite placement of a right supraclavicular subclavian central venous catheter

The Journal of Vascular Access ◽

10.1177/1129729821998531 ◽

2021 ◽

pp. 112972982199853

Author(s):

Jens M Poth ◽

Stefan F Ehrentraut ◽

Se-Chan Kim

Keyword(s):

Ultrasound Guidance ◽

Venous Catheter ◽

Needle Insertion ◽

Major Surgery ◽

Axillary Vein ◽

Central Venous ◽

Supraclavicular Fossa ◽

The Right ◽

High Index Of Suspicion ◽

Insertion Process

Central venous catheters (CVC) are widely used in critically ill patients and in those undergoing major surgery. Significant adverse events, such as pneumothorax and hemothorax, can be caused by needle insertion during CVC insertion. CVC misplacement is less often described, yet equally important, as it can lead to deleterious complications. Here, we describe a case in which misplacement of a guidewire following infraclavicular puncture of the right axillary vein was detected by continuous ultrasound employing the right supraclavicular fossa view. Utilizing this ultrasound view, the insertion approach to the vessel was changed and correct CVC placement could be achieved. While ultrasound guidance is widely accepted for vessel puncture, this case demonstrates the value of continuous ultrasound guidance for the entire process of CVC insertion: vessel puncture, correct guidewire advancement, catheter placement, and exclusion of complications such as pneumothorax. It also shows that there should be a high index of suspicion for guidewire misplacement, even after successful venipuncture. In conclusion, ultrasound protocols covering the complete CVC insertion process should be implemented into current clinical practice.

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Minilaparotomy a Good Option in Specific Cases: A Case Report of Bilateral Ovarian Germ Cell Tumor

Case Reports in Obstetrics and Gynecology ◽

10.1155/2012/589568 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 3

Author(s):

D. Bolla ◽

N. Deseö ◽

A. Sturm ◽

A. Schöning ◽

C. Leimgruber

Keyword(s):

Acute Abdominal Pain ◽

Adnexal Mass ◽

Past History ◽

Ovarian Tissue ◽

Abdominal Cavity ◽

Operating Time ◽

Expectant Management ◽

Small Incision ◽

Risk Of Rupture ◽

The Right

Mature cystic teratomas (MCTs) of the ovary represent 44% of ovarian neoplasmas. The surgical approach is important in young women especially for the cosmetic results. Nowadays most of the ovarian surgeries can be performed laparoscopically. An alternative between laparoscopy and laparotomy is the minilaparotomy (ML) which can be an interesting option, thanks to the small incision. We report a 39-year-old woman who was referred to our hospital with acute abdominal pain. In her past history the patient had an uncomplicated delivery. During pregnancy a 6 cm bilateral MCT was diagnosed and expectant management was followed. A left-sided ovarial torsion was postulated, and laparoscopic detorsion was performed. To avoid a rupture of the left MCT, the operation was interrupted. To remove the cyst, a ML was done two weeks later. A left-sided salpingo-oophorectomy was performed due to a large cyst including the entire ovary. On the other side, the right dermoid cyst was entirely removed. The advantage of a ML is not only shorter operating time with less learning curve compared to laparoscopy but also the possibility to extract the adnexal mass from the abdominal cavity with lower risk of rupture and in addition the possibility to preserve more ovarian tissue.

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Obstructed right Duari hernia

Ghana Medical Journal ◽

10.4314/gmj.v55i3.9 ◽

2021 ◽

Vol 55 (3) ◽

pp. 229-231

Author(s):

Ugochukwu U Nnadozie, ◽

Otuu Onyeyirichi ◽

Charles C Maduba ◽

Andrew C Ekwesianya

Keyword(s):

Femoral Hernia ◽

Uneventful Recovery ◽

Transverse Incision ◽

Midline Laparotomy ◽

Accident And Emergency ◽

Accident And Emergency Department ◽

The Right ◽

High Index Of Suspicion ◽

Groin Swelling ◽

Laparotomy Incision

The caecum and appendix are uncommon contents of femoral hernia (Duari hernia). Diagnosis is usually intraoperative. We report a rare case of obstructed right femoral hernia in a 65-year-old woman. She was admitted into the accident and emergency department because of sudden irreducibility of a previously reducible right groin swelling of 5 years duration. She had obstructive symptoms with an irreducible right groin mass clinically diagnosed as obstructed right femoral hernia. A combination of infra-inguinal transverse incision and a lower midline laparotomy incision was used. The intraoperative findings included the herniation of the caecum and appendix into the right femoral canal. Patient had an uneventful recovery. Duari hernia is uncommon. A high index of suspicion and an experiencedsurgeon, who can handle uncommon findings should be involved in the management of obstructed femoral hernias.

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Pulmonary Tuberculosis mimicking a right Eventration on Radiography: The falsity of single view radiograph in the diagnosis of a precursor of pulmonary disease: A Case Report

Babcock University Medical Journal (BUMJ) ◽

10.38029/bumj.v4i1.65 ◽

2021 ◽

Vol 4 (1) ◽

pp. 33-37

Author(s):

John Ogunkoya ◽

Oluwatosin Yetunde Adesuyi

Keyword(s):

Pulmonary Tuberculosis ◽

Lower Lobe ◽

Middle Lobe ◽

The Body ◽

Single View ◽

Lymph Node Enlargement ◽

History Of ◽

Chest X Ray ◽

The Right ◽

High Index Of Suspicion

Background: The diaphragm is one of the most important muscles of respiration in the body separating the abdomen from the thorax. Abnormalities of the diaphragm could be congenital or acquired, morphological or functional while pulmonary infection e.g. pulmonary tuberculosis, is implicated in its etiology. Case presentation: A 63-year- old man with six weeks history of cough productive of yellowish sputum. Chest X-ray showed a uniform well-circumscribed opacity in the right lower lobe abutting on or in continuum with the right diaphragm consistent with a diaphragmatic hump. Sputum Gene Xpert was positive for Mycobacterium tuberculosis. Chest CT scan revealed bilateral lymph node enlargement with hyperdense lesions in the anterior basal segment of the right lower lobe and medial bronchopulmonary segments of the right middle lobe. He was treated for 6 months with first-line anti-tuberculosis drugs. Discussion: The incidence of the diaphragmatic hump on chest radiograph worldwide and among Nigerians is unknown. The association of diaphragmatic hump with chest infection has been well document. The association of diaphragmatic hump with pulmonary tuberculosis is uncommon. Conclusion: A high index of suspicion is needed to diagnose pulmonary tuberculosis with atypical clinical and radiological presentations. Such prompt diagnosis will aid the treatment of the disease.

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Diaphragmatic flutter

Practical Neurology ◽

10.1136/practneurol-2017-001830 ◽

2018 ◽

Vol 18 (3) ◽

pp. 224-226 ◽

Cited By ~ 4

Author(s):

Dean Walton ◽

Michael Bonello ◽

Malcolm Steiger

Keyword(s):

Respiratory Distress ◽

Medical Treatment ◽

Abdominal Wall ◽

Phrenic Nerve ◽

High Frequency ◽

Rare Disorder ◽

Nerve Crush ◽

Irregular Variable ◽

The Right ◽

High Index Of Suspicion

A 78-year-old woman presented with involuntary movements of her abdomen, which started after a right hemispheric stroke. She had irregular, variable, hyperkinetic predominantly right-sided abdominal wall movements. MR scan of brain confirmed a recent infarct in the right occipitotemporal lobe and the right cerebellum. Diaphragmatic fluoroscopy confirmed high-frequency flutter as the cause of her abdominal movements and confirmed the diagnosis of van Leeuwenhoek’s disease. Anthonie van Leeuwenhoek first described this condition in 1723 and had the condition himself. He was a Dutch businessman who is often acknowledged as the first microscopist and microbiologist. He disagreed with his physician who attributed his ailment as being of cardiac origin. Diaphragmatic flutter is a rare disorder that requires a high index of suspicion with symptoms including abnormal abdominal wall movements, dyspnoea and respiratory distress. Despite medical treatment, the patient was still highly symptomatic, so she is currently being considered for a phrenic nerve crush.

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Comparison of laparoscopic pyelolithotomy and retrograde intrarenal surgery in the management of large renal pelvic stone

10.21203/rs.3.rs-69253/v1 ◽

2020 ◽

Author(s):

Mehmet Cagatay Cicek ◽

Tariq Asi ◽

Kadir Omur Gunseren ◽

Hakan Kilicarslan

Keyword(s):

Operation Time ◽

Retrograde Intrarenal Surgery ◽

Median Hospital Stay ◽

Efficient Procedure ◽

Laparoscopic Pyelolithotomy ◽

Stone Free Rate ◽

Lower Complication ◽

Lower Complication Rate ◽

Median Hospital ◽

Free Rate

Abstract Background To compare the clinical outcomes of laparoscopic pyelolithotomy (LP) and retrograde intrarenal surgery (RIRS) in the management of large renal pelvic stones. Methods This study included patients who presented with a single renal pelvic stone sized ≥20 mm and who were treated primarily by laparoscopic pyelolithotomy or retrograde intrarenal surgery. The patients were grouped based on the surgical procedure they underwent. We retrospectively examined and compared the age, the longest axis and the surface area of the stone, operation time, hospitalization time, complications and stone-free rates of the two groups. Results Of the 156 patients included in the study, 44 had laparoscopic pyelolithotomy, and 112 had retrograde intrarenal surgery. Patients who received laparoscopic pyelolithotomy (13 males, 31 females) had a median age of 54 (18-79) years, while those who underwent retrograde intrarenal surgery (46 males, 66 females) had a median age of 54.5 (18-79). Patients who received laparoscopic pyelolithotomy were found to have larger median stone size (30 mm vs 24 mm, p=0.003), longer operation time (100 minutes vs 70 minutes, p=0.007), lower complication rate (2% vs 8.9%, p=0.063), longer median hospital stay (3 days vs 1 day, p<0.001) and better stone-free rate at the third month (90.9% vs 67.9%, p<0.001). Conclusion LP is a safe and efficient procedure that could be used as an alternative to retrograde intrarenal surgery in managing large renal pelvic stones.

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Forearm Compartment Syndrome following Thrombolytic Therapy for Massive Pulmonary Embolism: A Case Report and Review of Literature

Case Reports in Orthopedics ◽

10.1155/2011/678525 ◽

2011 ◽

Vol 2011 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Ravi Badge ◽

Mukesh Hemmady

Keyword(s):

Pulmonary Embolism ◽

Thrombolytic Therapy ◽

Compartment Syndrome ◽

Signs And Symptoms ◽

Massive Pulmonary Embolism ◽

Heparin Therapy ◽

Arterial Line ◽

The Right ◽

High Index Of Suspicion ◽

Passive Stretch

Use of thrombolytic therapy in pulmonary embolism is restricted in cases of massive embolism. It achieves faster lysis of the thrombus than the conventional heparin therapy thus reducing the morbidity and mortality associated with PE. The compartment syndrome is a well-documented, potentially lethal complication of thrombolytic therapy and known to occur in the limbs involved for vascular lines or venepunctures. The compartment syndrome in a conscious and well-oriented patient is mainly diagnosed on clinical ground with its classical signs and symptoms like disproportionate pain, tense swollen limb and pain on passive stretch. However these findings may not be appropriately assessed in an unconscious patient and therefore the clinicians should have high index of suspicion in a patient with an acutely swollen tense limb. In such scenarios a prompt orthopaedic opinion should be considered. In this report, we present a case of acute compartment syndrome of the right forearm in a 78 years old male patient following repeated attempts to secure an arterial line for initiating the thrombolytic therapy for the management of massive pulmonary embolism. The patient underwent urgent surgical decompression of the forearm compartments and thus managed to save his limb.

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Omental Infarction: a Reappraisal of Conservative Management in Children

Acta Médica Portuguesa ◽

10.20344/amp.4996 ◽

2014 ◽

Vol 27 (4) ◽

pp. 433 ◽

Cited By ~ 3

Author(s):

José Estevão-Costa ◽

Ana Sofia Alvarenga ◽

Ana Catarina Fragoso ◽

Maria Garcia ◽

Miguel Campos

Keyword(s):

Conservative Management ◽

Imaging Techniques ◽

Operative Management ◽

Single Institution ◽

Laboratory Findings ◽

Median Hospital Stay ◽

Course Of Disease ◽

Omental Infarction ◽

Non Operative Management ◽

Median Hospital

Introduction: Accurate recognition of omental infarction has resulted in increasing supporters of non-operative approach. In order to assess the efficacy and safety of conservative management, we surveyed the cases of omental infarction treated at a single institution. Material and Methods: Primary omental infarction treated between 2004 and 2011 were reviewed. Cases recognized by imaging studies were submitted to conservative treatment that consisted of intravenous analgesics and antibiotics. Demographics, clinical presentation, laboratory findings, imaging diagnosis and outcome were analyzed. Results: There were 9 cases of omental infarction. Eight patients (4 males; median age, 8.5 years) presented at initial course of disease; all had right-sided abdominal pain and a normal or lightly increased leukocyte count. Six cases, diagnosed by CT scan after US suspicion in four, were managed conservatively, recovered uneventfully, and were discharged after a median hospital stay of 3 days. Two patients were only recognized at surgery. An additional case presented with intestinal obstruction due to an internal hernia and was successfully resolved by laparoscopy. Discussion: Imaging techniques were diagnostic of omental infarction in the majority of cases, enabling a conservative approach to be adopted. Non-operative management was successful with no complications in all patients presenting at the initial course of disease. One patient presented with a harmful complication that required operative treatment. Conclusion: In the absence of a standard approach for omental infarction, conservative management is an effective noninvasive alternative but it claims for active surveillance. Keywords: Infarction; Omentum.

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A Laparoscopic Splenectomy Allows the Induction of Antiviral Therapy for Patients with Cirrhosis Associated with Hepatitis C Virus

The American Surgeon ◽

10.1177/000313481107700216 ◽

2011 ◽

Vol 77 (2) ◽

pp. 174-179

Author(s):

Yoshinobu Shigekawa ◽

Kazuhisa Uchiyama ◽

Katsunari Takifuji ◽

Masaki Ueno ◽

Takashi Hama ◽

...

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Antiviral Therapy ◽

Laparoscopic Splenectomy ◽

Antiviral Treatment ◽

Pegylated Interferon ◽

Virologic Response ◽

Median Hospital Stay ◽

Postoperative Death ◽

Median Hospital

It is difficult to treat patients with cirrhosis-associated hepatitis C with pegylated interferon (PEG-IFN) and ribavirin because of thrombocytopenia-related hypersplenism. Both safety and clinical efficacy were retrospectively analyzed for patients who underwent a laparoscopic splenectomy (LS) from January 2003 to December 2007. A total of 35 patients with cirrhosis associated with hepatitis C virus had LS for thrombocytopenia before PEG-IFN and ribavirin therapy, and all patients had thrombocytopenia, which was a contraindication for antiviral therapy. The hepatopathy was Child A in 24 patients, Child B in 10 patients, and Child C in one patient. All 35 patients increased platelet count from 48,000 ± 15,000 to 155,000 ± 55,000/μl ( P < 0.0001) after LS. The median hospital stay and blood loss were 13.0 days (range, 8 to 57 days) and 342.0 mL (range, 5 to 2350 mL). There was no postoperative death. Twenty-nine (83%) patients had PEG-IFN and ribavirin therapy after LS; 18 had complete therapy and 11 had partial therapy. Of these, nine had a sustained virologic response. A laparoscopic splenectomy for patients with cirrhosis associated with hepatitis C virus can be performed safely and allows induction of antiviral treatment.

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Is simultaneous surgery for nodes and primary in carcinoma penis safe?

Asian Journal of Oncology ◽

10.4103/2454-6798.209329 ◽

2017 ◽

Vol 03 (01) ◽

pp. 050-053

Author(s):

Senthil Chandrasekhar ◽

Kathiresan Narayanswamy

Keyword(s):

Hospital Stay ◽

Median Hospital Stay ◽

Staged Surgery ◽

Surgery Group ◽

Simultaneous Surgery ◽

Simultaneous Group ◽

The Mean ◽

Carcinoma Penis ◽

Median Hospital

Abstract Introduction: Historically, the combination of primary and nodal surgeries for carcinoma penis is thought to increase the morbidity and hospital stay. Despite the modifications in surgery including modified inguinal lymphadenectomies, morbidity of the procedure is high. Methods: A prospective, nonrandomized study to analyze a total of 56 consecutive patients from 2006 to 2009, who were evaluated and underwent surgery for primary and nodes for carcinoma penis at our center, was done. The median follow-up was 34 months (range from 12 to 48 months). The procedures included both prophylactic and therapeutic groin dissections. Various parameters were tested using SPSS version 17 statistics software. Results: Duration of drains, hospital stay, wound morbidity, and long-term complications were found to be similar in the simultaneous and staged surgery groups. The mean duration of drains for the simultaneous group of 18 patients was 12.56 days and the corresponding duration of drains for the staged surgery group of 36 patients was 12.83 days. The minor morbidity and major morbidity for the simultaneous group were 27.8% and 38.9% and the corresponding figures for the staged group were 22.2% and 44.4%, respectively. The mean and median hospital stay for the simultaneous surgery group were 21.5 and 27.5 days, respectively. The mean and median hospital stay for the staged surgery group were 17.5 and 21.36 days, respectively. The study revealed no statistically significant difference between the two groups with regard to all the above parameters. Conclusions: Simultaneous surgery for the primary and nodes in carcinoma penis is very much feasible. Simultaneous and early-staged lymphadenectomy have no difference in results with respect to drain duration, hospital stay, wound morbidity, and long-term complications. Simultaneous lymphadenectomy can be combined with penectomy both in the prophylactic and therapeutic settings.

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