Pediatric Neck Trauma

2020 ◽  
pp. 392-404
Author(s):  
Kim Newton
Keyword(s):  
Imaging Study ◽  
Signs And Symptoms ◽  
Clinical Suspicion ◽  
Neck Injury ◽  
Neck Injuries ◽  
High Resolution Computed Tomography ◽  
Unstable Patient ◽  
Plain Films ◽  
Diagnostic Modalities ◽  
Bedside Tests

Pediatric neck injuries have significant potential morbidity. Any hemodynamically unstable patient with hard signs of neck injury should be taken to the operating room immediately. Assurance of airway stability in all other pediatric patients with neck injury should take first priority. Bedside tests, including the extended focused assessment with sonography for trauma examination and plain films of the neck and chest, are readily available and can provide helpful information. High-resolution computed tomography (CT) with angiogram has been shown to be the superior imaging study when evaluating the neck for vascular or aerodigestive injury. Additional diagnostic modalities are based on clinical suspicion, signs and symptoms, injury location, and CT results.

Role of MR venography in the evaluation of deep venous thrombosis

1997 ◽  
Vol 38 (5) ◽  
pp. 907-912 ◽  
Author(s):  
C. Catalano ◽  
P. Pavone ◽  
A. Laghi ◽  
A. Scipioni ◽  
F. Fanelli ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Sensitivity And Specificity ◽  
Filling Defect ◽  
Clinical Suspicion ◽  
Mr Venography ◽  
Diagnostic Modalities ◽  
Positive Results ◽  
Intraluminal Filling Defect

Purpose: MR venography has been recommended for the evaluation of deep venous thrombosis. The purpose of our study was to determine the role of MR venography, in particular at the level of the pelvis where other diagnostic modalities show major limitations. Materials and Methods: Forty-three patients with clinical suspicion of deep venous thrombosis were examined by means of pelvic MR venography. In all cases, a 2D-TOF sequence was used with cranial arterial presaturation. In selected cases, i.e. when a small intraluminal filling defect was present, a cine-PC sequence was used in addition in order to exclude the presence of a pulsatility artifact as causing the filling defect. In all cases, contrast venography was also performed and considered to be the standard of reference. Results: MR venography showed 26 patients to be positive for deep venous thrombosis at the pelvic level. These positive results were correct in 25 cases. The analysis of the results provided values of sensitivity and specificity of respectively 100% and 94%, with an overall accuracy of 97.6%. Conclusion: Our results indicate that MR can provide highly accurate images, similar to those of contrast venography, in a noninvasive fashion. It is particularly useful in the pelvic region where the limitations of other imaging modalities are more evident.

scholarly journals Clinical Trial of Efficacy and Toxicity of Disoproxil Tenofovir Fumarate and Emtricitabine for Mild to Moderate SARS-CoV-2 Infections

2021 ◽  
Author(s):  
Aldo A M Lima ◽  
Erico A G Arruda ◽  
Roberto J Pires-Neto ◽  
Melissa S Medeiros ◽  
J Quirino-Filho ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Vitamin C ◽  
Respiratory Infection ◽  
Clinical Symptoms ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Clinical Suspicion ◽  
Pharmacological Intervention ◽  
Controlled Clinical Trial ◽  
Double Blind

This study aimed to evaluate the efficacy and toxicity of tenofovir (TDF) and TDF combined with emtricitabine (TDF/FTC) in patients with mild to moderate COVID-19 infections. We conducted a randomized, double-blind, placebo-controlled clinical trial in patients with clinical suspicion of mild to moderate respiratory infection caused by SARS-CoV-2 who were treated at an outpatient clinic. Patients were randomly recruited to take 10 days of TDF (300 mg/day), TDF (300 mg/day) combined with FTC (200 mg/day) or placebo Vitamin C (500 mg/day). The primary parameter was the score of symptoms and predictive signs of COVID-19, assessed on the seventh day of patient follow-up. From a total of 309 patients with clinical suspicion of SARS-CoV-2, 227 met the inclusion criteria and were randomly distributed into the following groups: (a) 75 (one did not initiate treatment) in the TDF group; (b) 74 in the TDF combined with FTC group; and (c) 77 in the Vitamin C group (placebo). Of the 226 patients, 139 (62%) were positive for SARS-CoV-2. Fever (37.8oC), ageusia or dysgeusia, anosmia or dysosmia, and two or more clinical symptoms or signs were significantly associated with SARS-CoV-2 infection. There was no significant change in clinical score based on clinical symptoms and signs between treatment groups. Patients with mild to moderate infection by SARS-CoV-2 had higher concentrations of G-CSF, IL-1β, IL-6 and TNF-α compared to patients without infection. Patients with mild to moderate respiratory infection, with fever (37.8oC), loss of smell, loss of taste and two or more symptoms, have a better prediction for the diagnosis of COVID-19. Patients with SARS-CoV-2 showed higher and more persistent proinflammatory cytokines profile compared to patients not infected with SARS-CoV-2. Pharmacological intervention with TDF or TDF combined with FTC did not change the clinical signs and symptoms score in mild to moderate respiratory infection in patients with SARS-CoV-2 compared to the Vitamin C group (placebo).

scholarly journals Kala-azar Burden in Bangladesh- An Overview

2021 ◽  
Vol 9 (1) ◽  
pp. 43-50
Author(s):  
Santana Rani Sarkar ◽  
Nitai Chandra Ray ◽  
Md Rashedul Kabir
Keyword(s):  
Signs And Symptoms ◽  
Sand Fly ◽  
Effective Vaccine ◽  
Eradication Programme ◽  
Internal Organs ◽  
Non Invasive ◽  
Kala Azar ◽  
Rapid Tests ◽  
Diagnostic Modalities ◽  
Third Line

Kala-azar is one of the major public health problems in Bangladesh and the disease is endemic for many decades. In SEA Region, VL is reported from 109 contiguous districts bordering Bangladesh, India and Nepal. Approx. 147 million people at risk in these three countries with an estimated 50,000 new cases each year. Kala-azar or Leishmaniasis is a disease caused by protozoan parasites of the Leishmania genus. It is transmitted by the sand fly named Phlebotomus argentipes and affects largely the socially marginalized and the poorest communities. The parasite migrates to the internal organs such as liver, spleen and bone marrow and if left untreated, will almost always result in the death of the host. Signs and symptoms include fever, weight loss, fatigue, anemia, and substantial swelling of the spleen and occasionally liver. In Bangladesh, kala-azar cases were reported from 45 of 64 districts, >90% of cases were reported from just 10 districts. Mymensingh accounted for more than 50% of the total kala-azar cases reported in Bangladesh. Research in recent years has demonstrated the utility of non-invasive diagnostic modalities such as the direct agglutination test and rapid tests based on the immune response to the rK39 antigen. Primary kala-azar now can be easily recognized and effective treatment is available. Clinical trials in Bangladesh have reported encouraging results with amphotericin B (recommended as a third-line drug by the National Malaria Eradication Programme). Until a safe and effective vaccine is developed, a combination of sandfly control, detection and treatment of patients and prevention of drug resistance is the best approach for controlling kala-azar. CBMJ 2020 January: Vol. 09 No. 01 P: 43-50

The injured patient

2018 ◽  
pp. 21-60
Author(s):  
Mike Perry
Keyword(s):  
Head And Neck ◽  
Life Support ◽  
Clinical Signs ◽  
Injured Patient ◽  
Signs And Symptoms ◽  
Advanced Trauma Life Support ◽  
Neck Injuries ◽  
Complex Decision Making ◽  
Clinical Signs And Symptoms ◽  
Multiply Injured Patient

This chapter gives an overview of the assessment of patients presenting to an emergency department with injuries to head or neck (above the collar bones). The Advanced Trauma Life Support® (ATLS®) programme is now widely accepted as the gold standard in trauma management, but its strict application to patients with coexisting facial injuries can result in a number of dilemmas and complex decision-making. These issues are discussed. The approach to head and neck injuries remains the same as for the multiply injured patient but those aspects related specifically to injuries to the head and neck are discussed in detail. Emergency procedures undertaken in head and neck injuries are also discussed. Useful clinical signs and symptoms indicating significant injuries are listed at the end of the chapter.

scholarly journals Cerebellar Infarction — Review of Recent Experiences

1980 ◽  
Vol 7 (2) ◽  
pp. 97-99 ◽  
Author(s):  
W.B. Woodhurst
Keyword(s):  
Clinical Presentation ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Clinical Syndrome ◽  
Clinical Suspicion ◽  
Cerebellar Infarction ◽  
Tissue Mass ◽  
Clinical Signs And Symptoms ◽  
High Level ◽  
Infarcted Tissue

SUMMARY:Six cases of acute cerebellar infarction seen on a neurosurgery service in a general hospital during a twenty-six month period are reviewed. The clinical presentation, course, and treatment are presented and discussed. This is an important clinical syndrome which requires a high level of clinical suspicion for detection. The diagnosis rests primarily upon the clinical signs and symptoms. The C.T. Scan may provide useful confirmatory evidence and clarifies the differential diagnosis. Surgial treatment by resection of the infarcted tissue — mass lesion is urgently required for those patients who deteriorate progressively.

Precurved Cochlear Implants and Tip Foldover: A Cadaveric Imaging Study

2017 ◽  
Vol 158 (2) ◽  
pp. 343-349 ◽  
Author(s):  
Danielle R. Trakimas ◽  
Elliott D. Kozin ◽  
Iman Ghanad ◽  
Sam R. Barber ◽  
Hugh Curtin ◽  
...  
Keyword(s):  
Computed Tomography ◽  
High Resolution ◽  
Cochlear Implants ◽  
Electrode Array ◽  
Imaging Study ◽  
Plain Film ◽  
Plain Radiography ◽  
Electrode Placement ◽  
High Resolution Computed Tomography ◽  
Plain Film Radiography

Objective This study aims to define a reliable protocol for radiographic identification of placement and tip foldover of newly designed precurved and straight electrodes. Study Design Prospective imaging study. Setting Academic institution. Methods Three models of cochlear implants (Cochlear, MED-EL, and Advanced Bionics) were inserted into fresh cadaveric specimens (n = 2) in 3 configurations (normal positioning in the scala tympani, intracochlear tip foldover, and placement into the vestibular system) for a total of 9 implant scenarios. Specimens were imaged with plain radiography in Stenvers projection, as well as by high-resolution computed tomography. Results Electrode placement and presence or absence of electrode tip foldover were easily identified in all 9 scenarios on plain radiography based on the described technique. Each was confirmed with high-resolution computed tomography. Plain film temporal bone images of new electrode designs with proper and improper placement are provided for reference. Conclusion A defined protocol for intraoperative plain film radiography allowed for reliable imaging of 3 newly designed cochlear implant electrodes and immediate identification of extracochlear placement and tip foldover. Findings may be used for intraoperative confirmation of electrode array placement.

Penetrating neck injury: case report and evaluation of management

2000 ◽  
Vol 114 (7) ◽  
pp. 554-556 ◽  
Author(s):  
M. Tariq ◽  
A. Kalan ◽  
S. S. Surenthiran ◽  
A. Bhowmik
Keyword(s):  
Case Report ◽  
Surgical Intervention ◽  
Effective Means ◽  
Neck Injury ◽  
Urban Violence ◽  
Neck Injuries ◽  
Neck Trauma ◽  
Specific Approach ◽  
Penetrating Neck Injury ◽  
Penetrating Neck Trauma

Greater urban violence has resulted in an increased incidence of penetrating neck trauma. Penetrating neck wounds can present difficult diagnostic and therapeutic dilemmas. The evaluation and management of such injuries, however, remains controversial. There is no universally accepted specific approach to the management of patients with penetrating neck injuries, with some surgeons advocating mandatory neck exploration whilst others believe in selective surgical intervention.We believe that an equal willingness for both conservative and surgical intervention as dictated by serial bedside evaluation with adequate radiological and endoscopic support can provide the clinician a safe and effective means of managing a potentially complex and lethal problem.

scholarly journals Occult hemoptysis: a rare case of esthesioneuroblastoma

2020 ◽  
Vol 6 (8) ◽  
pp. 1542
Author(s):  
Shalini Jain ◽  
Kanwer Sen
Keyword(s):  
Clinical Diagnosis ◽  
Rare Case ◽  
Systematic Approach ◽  
Case Reports ◽  
Signs And Symptoms ◽  
Clinical Suspicion ◽  
Unusual Presentation ◽  
Chest Physician ◽  
Chief Complaints ◽  
Nose And Throat

<p>Esthesioneuroblastoma forms a part of the spectrum of rare malignancies of the olfactory neuroepitheliem. The rarity of the tumour precludes systematic approach to clinical diagnosis and management. This study involves a case of 68 years old female who presents with chief complaints of hemoptysis for 3 months in the medical outpatient department with no nasal signs and symptoms. After referral to chest physician she is referred for ear nose and throat opinion. Esthesioneuroblastoma presentation is very varied and the case reports published have been very few. In view of the rarity of the tumour, clinical suspicion is essential in unusual presentation of hemoptysis.</p>

scholarly journals X-linked agammaglobulinemia rare disease with a rarer presentation

2021 ◽  
Vol 8 (12) ◽  
pp. 1980
Author(s):  
Ramakrishna Myathari ◽  
Anand Gupta
Keyword(s):  
B Cells ◽  
Signs And Symptoms ◽  
Absolute Lymphocyte Count ◽  
Healthcare Facility ◽  
Intravenous Immunoglobulins ◽  
Clinical Suspicion ◽  
Recurrent Fever ◽  
Age Group ◽  
Work Up ◽  
Low Serum

X-linked agammaglobulinemia (XLA) is a rare disorder, characterized by absence of mature B cells leading to severe antibodies deficiency. This translates to recurrent sinopulmonary infections in affected children. The most common age group of presentation is 6 months to 2 years. Being an X-linked recessive disorder males are affected, females are carriers. Intravenous immunoglobulins and antibiotics remains the corner stone of treatment. Here in, we report a case of 11-year-old male having recurrent episodes of fever with one episode of hospitalization 3 years back. Child was treated at healthcare facility elsewhere for recurrent fever. He presented to our institute with signs and symptoms suggestive of meningitis, investigated, had culture proven Staphylococcus aureus meningitis with a low Absolute Lymphocyte Count (ALC). On further work up found to have low serum immunoglobulins (IgG, IgM, IgA) and Flowcytometry showing absence of B cells (CD19/CD20). Child was diagnosed to have XLA. This case highlights the importance of having strong clinical suspicion of XLA, despite not having recurrent sinopulmonary infections.

scholarly journals Osteogenesis imperfecta and cerebrospinal fluid leak: a unique presentation and treatment challenge

2019 ◽  
Vol 59 (4) ◽  
pp. 74-78
Author(s):  
Clara Mota Randal Pompeu ◽  
Anna Caroline Rodrigues de Souza Matos ◽  
Mirian Mota Randal Pompeu ◽  
Luis Fernando Falcão de Castro Meireles ◽  
Daniel Aguiar Dias ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Osteogenesis Imperfecta ◽  
Bone Fractures ◽  
Clinical Status ◽  
Sella Turcica ◽  
Imaging Study ◽  
Cerebrospinal Fluid Leak ◽  
Signs And Symptoms ◽  
Bone Fragility ◽  
Csf Leak

Introduction: Osteogenesis imperfecta (OI) is a heritable disorder of the connective tissue that mainly manifests as bone fragility. Other signs and symptoms may be present, such as sensorineural hearing loss, cardiac malformations, and teeth alterations. Case description: 72-year-old female patient presented with left abundant spontaneous hyaline rhinorrhea, history of several bone fractures since early childhood, and a blue grayish sclera was noted. Cerebrospinal fluid (CSF) leak was diagnosed. Neuroimaging revealed lowering of the sella turcica floor, platybasia, basilar impression, left middle fossa calcified meningioma, syringobulbia, ventricular dilatation, and left ethmoidal fistula. Due to the patient’s age and clinical status, a medical approach was chosen, and treatment with acetazolamide and furosemide in low dosages, which resulted in a decrease of the rhinorrhea. Discussion: Clinical features and imaging study are often sufficient for diagnosis of OI. The neurological and cranial features in OI are varied. CSF leak is not commonly reported and might have been a consequence of bone softening and hydrocephalus. Conclusions: This case represents a treatment challenge, as the surgical results were uncertain, once bone fragility could result in the development of new leaks. Clinical treatment was chosen and resulted in a significant improvement of the symptoms.

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