scholarly journals Upper limb phlegmasia cerulea dolens treated with single-session suction thrombectomy: a case report

2020 ◽  
Vol 2020 (10) ◽  
Author(s):  
Paul Ghaly ◽  
Glen Schlaphoff ◽  
John Crozier ◽  
Mehtab Ahmad
Keyword(s):  
Upper Limb ◽  
Rare Condition ◽  
Sudden Onset ◽  
Lower Limbs ◽  
Single Session ◽  
Vessel Patency ◽  
Clinical Triad ◽  
Phlegmasia Cerulea Dolens

Abstract Phlegmasia cerulea dolens (PCD) of the lower limbs is a rare condition. PCD of the upper limbs is extremely uncommon, with only a select few cases documented in the literature. A complication of severe deep venous thrombosis, PCD, is characterized by the clinical triad of oedema, pain and limb cyanosis. Delays in treatment are associated with high rates of morbidity and mortality. We present a case of sudden-onset upper limb PCD in a 68-year-old man following haemodialysis through a long-term arteriovenous fistula. Prompt diagnosis and rapid initiation of intravenous anticoagulation followed by urgent single-session suction thrombectomy resulted in the successful restoration of vessel patency without any significant adverse sequelae on 3-month follow-up.

scholarly journals Long-term Follow-up and Muscle Imaging Findings in Brachio-Cervical Inflammatory Myopathy

2021 ◽  
Vol 8 (4) ◽  
pp. e1016
Author(s):  
Matteo Lucchini ◽  
Sara Bortolani ◽  
Mauro Monforte ◽  
Manuela Papacci ◽  
Enzo Ricci ◽  
...  
Keyword(s):  
Upper Limb ◽  
Age At Onset ◽  
Inflammatory Myopathy ◽  
Diagnostic Delay ◽  
Lower Limbs ◽  
Mri Findings ◽  
Limb Muscles ◽  
Long Term Follow Up

ObjectiveTo report on a cohort of patients diagnosed with brachio-cervical inflammatory myopathy (BCIM), with specific focus on muscle MRI and follow-up data.MethodsClinical, histopathologic, serologic, and pre- and post-treatment MRI findings of patients diagnosed with BCIM were retrospectively evaluated.ResultsSix patients, all females with a mean age at onset of 53 years (range 37–62 years), were identified. Mean diagnostic delay was 17 months, and mean follow-up was 35 months. Most common clinical features encompassed predominant involvement of neck and proximal upper limb muscles, followed by distal upper limb, facial, and bulbar muscle weakness with different severity. Lower limb involvement was rare, although present in severe cases. Muscle biopsies showed a heterogeneous degree of perivascular and endomysial inflammatory changes. Myositis-specific antibodies were absent in all patients, whereas all resulted positive for antinuclear antibodies; half of the patients had anti–acetylcholine receptor antibodies without evidence of muscle fatigability. MRI showed disproportionate involvement of upper girdle and neck muscles compared with lower limbs, with frequent hyperintensities on short-tau inversion recovery sequences. Partial clinical and radiologic improvement with steroid and immunosuppressant therapy was obtained in most patients, especially in proximal upper limb muscles, whereas neck weakness persisted.ConclusionBCIM is an inflammatory myopathy with a peculiar clinical and radiologic presentation and a relatively broad spectrum of severity. Long-term follow-up data suggest that appropriate and early treatment can prevent chronic muscle function impairment. MRI characterization can be helpful in reducing diagnostic and treatment delay with positive consequence on clinical outcome.

Persistent Multispecies Actinomyces Mastitis Treated With Repeated Aspiration and Long-Term Oral Antibiotics

2021 ◽  
pp. 000313482110257
Author(s):  
Colin Jenkins ◽  
Anand Ganapathy ◽  
Crystal Fancher ◽  
Kazuhide Matsushima
Keyword(s):  
Antibiotic Therapy ◽  
Rare Condition ◽  
Breast Abscess ◽  
Amoxicillin Clavulanic Acid ◽  
Recurrent Breast ◽  
Causative Bacterium ◽  
Repeated Aspiration ◽  
Prolonged Antibiotic Therapy

Actinomycosis is an infection characterized by abscess formation, draining sinuses, and tissue fibrosis. The causative bacterium is a Gram-positive facultative anaerobe from the genus Actinomyces. Infections classically affect the cervicofacial, thoracic, or pelvic region and often require prolonged antibiotic therapy. Actinomycosis of the breast is a rare condition that may present as a recurrent breast abscess. We present a 33-year-old female with a recurrent breast abscess which grew A. radingae and A. israeli on aspirated fluid cultures. Treatment with surgical aspiration and a 6-week course of oral amoxicillin/clavulanic acid 875 mg twice daily resulted in clinical improvement. Our case demonstrates how recurrent breast abscesses caused by Actinomyces can be difficult to manage. Long-term antibiotic therapy with surgical aspiration and regular follow-up offer the best chance of clinical resolution.

Does a Multicomponent Exercise Program Improve Physical Fitness in Older Adults? Findings From a 5-Year Longitudinal Study

2021 ◽  
pp. 1-8
Author(s):  
Andréa Kruger Gonçalves ◽  
Eliane Mattana Griebler ◽  
Wagner Albo da Silva ◽  
Débora Pastoriza Sant´Helena ◽  
Priscilla Cardoso da Silva ◽  
...  
Keyword(s):  
Older Adults ◽  
Physical Fitness ◽  
Cardiorespiratory Fitness ◽  
Upper Limb ◽  
Exercise Program ◽  
Potential Benefits ◽  
Multicomponent Program ◽  
Post Hoc

The objective was to assess the physical fitness of older adults participating in a 5-year multicomponent exercise program. The sample consisted of 138 older adults aged 60–93 years (70.4 ± 7.8 years) evaluated with the Senior Fitness Test (muscle strength, flexibility, balance, and cardiorespiratory fitness). The multicomponent program was carried out between the months of March and November of each year. Data were analyzed using generalized estimating equations (factor year: Year 1, Year 2, Year 3, Year 4, and Year 5; factor time: pretest and posttest) with Bonferroni’s post hoc test. Participation in the multicomponent exercise program for 5 years (baseline pretest Year 1 and follow-up Year 5) improved lower and upper limb strength, lower limb flexibility, and balance and cardiorespiratory fitness, while upper limb flexibility was maintained. Year-by-year analysis revealed variable patterns for each fitness parameter. The results of this study show the potential benefits of implementing a long-term community-based exercise program.

Vagus Nerve Stimulation Paired With Upper-Limb Rehabilitation After Stroke: One-Year Follow-up

2020 ◽  
Vol 34 (7) ◽  
pp. 609-615
Author(s):  
Jesse Dawson ◽  
Navzer D. Engineer ◽  
Cecília N. Prudente ◽  
David Pierce ◽  
Gerard Francisco ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Vagus Nerve ◽  
Upper Limb ◽  
Nerve Stimulation ◽  
Vagus Nerve Stimulation ◽  
Exercise Program ◽  
Home Exercise ◽  
Home Exercise Program

Background. Vagus nerve stimulation (VNS) paired with rehabilitation may improve upper-limb impairment and function after ischemic stroke. Objective. To report 1-year safety, feasibility, adherence, and outcome data from a home exercise program paired with VNS using long-term follow-up data from a randomized double-blind study of rehabilitation therapy paired with Active VNS (n = 8) or Control VNS (n = 9). Methods. All people were implanted with a VNS device and underwent 6 weeks in clinic therapy with Control or Active VNS followed by home exercises through day 90. Thereafter, participants and investigators were unblinded. The Control VNS group then received 6 weeks in-clinic Active VNS (Cross-VNS group). All participants then performed an individualized home exercise program with self-administered Active VNS. Data from this phase are reported here. Outcome measures were Fugl-Meyer Assessment—Upper Extremity (FMA-UE), Wolf Motor Function Test (Functional and Time), Box and Block Test, Nine-Hole Peg Test, Stroke Impact Scale, and Motor Activity Log. Results. There were no VNS treatment–related serious adverse events during the long-term therapy. Two participants discontinued prior to receiving the full crossover VNS. On average, participants performed 200 ± 63 home therapy sessions, representing device use on 57.4% of home exercise days available for each participant. Pooled analysis revealed that 1 year after randomization, the FMA-UE score increased by 9.2 points (95% CI = 4.7 to 13.7; P = .001; n = 15). Other functional measures were also improved at 1 year. Conclusions. VNS combined with rehabilitation is feasible, with good long-term adherence, and may improve arm function after ischemic stroke.

Long‐Term Follow‐Up after Finger and Upper‐Limb Replantation: Clinical, Angiologic, and Lymphographic Studies

1998 ◽  
Vol 14 (02) ◽  
pp. 131-136 ◽  
Author(s):  
Claudia Meuli-Simmen ◽  
Marco Canova ◽  
Alfred Bollinger ◽  
Viktor Meyer
Keyword(s):  
Upper Limb ◽  
Long Term Follow Up

scholarly journals Hospital Care and Surgical Treatment of Children With Congenital Upper Limb Defects

2019 ◽  
Vol 109 (3) ◽  
pp. 244-249
Author(s):  
E. Koskimies-Virta ◽  
I. Helenius ◽  
N. Pakkasjärvi ◽  
Y. Nietosvaara
Keyword(s):  
Upper Limb ◽  
Hospital Care ◽  
Hospital Admissions ◽  
Lower Limbs ◽  
Orthopedic Procedures ◽  
Limb Defects ◽  
Average Child ◽  
National Hospital Discharge Register ◽  
Nose And Throat

Background and Aims: To evaluate hospital care of children with congenital upper limb defects. Materials and Methods: Three hundred and sixty-two children with an upper limb defect, born 1993–2005, and alive after birth admission were identified in the Finnish Register of Congenital Malformations. The data on hospital care, with focus on operative treatment, were collected from the National Hospital Discharge Register, until 31 December 2009. Mean follow-up was 10.2 years (range: 4–17 years). The results were compared with data on the whole children population (1.1 million) in Finland. Results: Most children (321, 87%) with upper limb defects had hospital admissions: on average, one admission/year (range: 0–36), and they were treated in hospital 5 days/year (range: 0–150), which is 11-fold compared with an average child in Finland. Four surgical procedures/child were done (range: 0–45), including one hand surgical procedure. The most common procedures were orthopedic (513); gastrointestinal (263); ear, nose, and throat (143); dental (118); thoracic (48); and urologic (44). Of the 513 orthopedic procedures, 326 were directed to upper limbs, 107 to the lower limbs, and 10 to the spine. Median operation age was 2 years 7 months. Altogether, 60% of hospital admissions were non-surgical. Leading causes of non-operative hospital admissions were congenital anomalies (32%), gastroenterological problems (20%), respiratory tract conditions (13%), neurological problems (7%), perinatal conditions (5%), and infectious diseases (5%). Conclusion: Treatment of children with upper limb defects is teamwork between pediatric and surgical subspecialties. Burden of hospital care is 11-fold as compared with an average child.

scholarly journals Transcalvarial and Transdural Involvement of Skull Actinomycosis with Recurrence

2019 ◽  
Vol 08 (03) ◽  
pp. 185-187
Author(s):  
Kramadhari Harshith ◽  
Krishnan Nagarajan ◽  
Andi Sadayandi Ramesh ◽  
Debasis Gochhait
Keyword(s):  
Immune System ◽  
Human Body ◽  
Sudden Onset ◽  
Diabetic Woman ◽  
Gram Positive Bacteria ◽  
Malignant Lesions ◽  
Histopathologic Analysis ◽  
Prompt Diagnosis

AbstractActinomycosis is caused by anaerobic gram-positive bacteria of Actinomyces genus, generally found as commensals in the human body and infection occurs when the immune system is compromised. We present the case of a 35-year-old diabetic woman, who presented with headache and sudden onset of left-sided weakness apart from scalp swelling, which on imaging showed transcalvarial transdural involvement, and subsequent surgical debridement and histopathologic analysis confirmed actinomycosis. Follow-up showed recurrence of the lesion at the same site following a period of remission. Calvarial involvement of actinomycosis is rare and can mimic even neoplastic or malignant lesions, hence requiring prompt diagnosis, treatment with surgery, and long-term antibiotic treatment to prevent complications.

Delineating the Mosaic Trisomy 15 Phenotype Using a Serendipitous Mechanism as a Clue

2015 ◽  
Vol 146 (1) ◽  
pp. 44-50 ◽  
Author(s):  
Federica Natacci ◽  
Giulia Melloni ◽  
Francesca Motta ◽  
Rosamaria Silipigni ◽  
Fabio Doniselli ◽  
...  
Keyword(s):  
Rare Condition ◽  
Diagnostic Process ◽  
Caucasian Woman ◽  
Balanced Translocation ◽  
Fetal Autopsy ◽  
Chorionic Villi ◽  
Short And Long Term ◽  
Mosaic Trisomy

Parental balanced translocation is one of the traditional indications for invasive prenatal diagnosis. Usually, the diagnostic process is straightforward. Sometimes, however, results are not entirely clear and may reveal unexpected biological processes. We performed chorionic villi sampling for a paternal 8;15 reciprocal translocation in the sixth pregnancy of a Caucasian woman. Cytogenetic analysis of chorionic villi, after both short- and long-term cultures, revealed the presence of the same rearrangement found in the father as well as a trisomy 15. Surprisingly, the trisomy, which was initially expected to derive from aberrant segregation during paternal meiosis, resulted instead from maternal nondisjunction. Although a sonogram of the fetus appeared to be normal, follow-up amniocentesis demonstrated a low-level mosaic trisomy 15 in cells extracted from the amniotic fluid, while 10% of cells from fetal tissues sampled after termination of the pregnancy were also found to be trisomic. Fetal autopsy showed dysmorphic features, confirming the diagnosis of mosaic trisomy 15 and enabled deeper insight into the prenatal phenotype of this rare condition.

Gamma Knife radiosurgery for glossopharyngeal neuralgia: A study of 21 patients with long-term follow-up

Cephalalgia ◽  
2017 ◽  
Vol 38 (3) ◽  
pp. 543-550 ◽  
Author(s):  
Pierre-Yves Borius ◽  
Constantin Tuleasca ◽  
Xavier Muraciole ◽  
Laura Negretti ◽  
Luis Schiappacasse ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Rare Condition ◽  
Glossopharyngeal Neuralgia ◽  
University Hospitals ◽  
Minimally Invasive Surgical ◽  
Long Term Follow Up ◽  
The Mean

Objective Glossopharyngeal neuralgia (GPN) is a very rare condition, affecting the patient’s quality of life. We report our experience in drug-resistant, idiopathic GPN, treated with Gamma Knife radiosurgery (GKRS), in terms of safety and efficiency, on a very long-term basis. Methods The study was opened, self-controlled, non-comparative and bicentric (Marseille and Lausanne University Hospitals). Patients treated with GKRS between 2003 and 2015 (models C, 4C and Perfexion) were included. A single 4-mm isocentre was positioned in the cisternal portion of the glossopharyngeal nerve, with a targeting based both on magnetic resonance imaging (MRI) and computed tomography (CT). The mean maximal dose delivered was 81.4 ± 6.7 Gy (median = 85 Gy, range = 60–90 Gy at the 100% isodose line). Results Twenty-one patients (11 women, 10 men) benefited from 25 procedures. The mean follow-up period was 5.2 ± 3 years (range = 0.9–12.1 years). Seventeen (81%) were initially pain-free after GKRS. At three months, six months and one year after radiosurgery, the percentage of patients with good outcome (BNI classes I to IIIA) was 87.6%, 100% and 81.8%, respectively. Ten cases (58.8%) from the initial pain-free ones had a recurrence, after a mean period of 13.6 ± 10.4 months (range = 3.1–36.6 months). Only three patients (14.2%) had recurrences (two for each one of them) requiring further surgeries. Three patients underwent a second GKRS procedure; one case needed a third GKRS. The former procedures were performed at 7, 17, 19 and 30 months after the first one, respectively. Furthermore, two patients needed additional interventions. At last follow-up, 17 cases (80.9%) were still pain-free without medication. The actuarial pain relief without new surgery was 83%. A transient complication (paraesthesia of the edge of the tongue) was seen in one case (4.8%). Conclusion GKRS is a valuable, minimally invasive, surgical alternative for idiopathic GPN, with a very high short- and long-term efficacy and without permanent complications. A quality imaging, including T2 CISS/Fiesta MRI and bone CT acquisitions for good visualisation of the nerve and the other bony anatomic landmarks, is essential for targeting accuracy and successful therapy.

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