Sinusitus with Subdural Empyema

2019 ◽  
pp. 267-273
Author(s):  
Christina Sayama
Keyword(s):  
Infectious Disease ◽  
Decision Making ◽  
Surgical Treatment ◽  
Intracranial Pressure ◽  
Broad Spectrum ◽  
Clinical Care ◽  
Subdural Empyema ◽  
Neurologic Examination ◽  
Infectious Disease Specialists

Subdural empyema is considered a neurosurgical emergency and, if found on neuroimaging, should prompt craniotomy for evacuation followed by broad spectrum antibiotics. In the setting of a patient with severe parenchymal swelling, a craniectomy may be indicated, as well as other modalities to lower intracranial pressure. Clinical care and decision making occurs with a multidisciplinary team of pediatric intensivists, infectious disease specialists, otolaryngologists, and neurosurgeons. Detection of recurrent subdural empyema is critical to prevent further morbidity and mortality, and surveillance of fever, neurologic examination, and follow-up imaging is critical. Timely surgical treatment of these infections can lead to good clinical outcomes.

scholarly journals Visceral Mycotic Aneurysm: Superior Mesenteric Artery Aneurysm Caused by K. pneumoniae

2021 ◽  
pp. 1-4
Author(s):  
Reham Almasoud ◽  
Alaaeddin Nwilati ◽  
Saeb Bayazid ◽  
Mamoun Shafaamri
Keyword(s):  
Infectious Disease ◽  
Antibiotic Therapy ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Mycotic Aneurysm ◽  
Artery Aneurysm ◽  
Management Plan ◽  
Resected Tissue ◽  
Infectious Disease Specialists

We herein report a rare case of mycotic aneurysm of the superior mesenteric artery caused by <i>Klebsiella pneumoniae</i>. A 66-year-old man, a known case of hypertension and aorto-oesophageal fistula with stented aorta in 2010 and 2018, presented to the emergency department multiple times over 2 months with severe postprandial abdominal pain associated with vomiting and fever. On his last presentation, the obtained blood cultures grew ESBL positive <i>K. pneumoniae</i> and a repeated computed tomography (CT) showed a growing aneurysm at the origin of the ileocecal branch of the superior mesenteric artery measuring 17 × 10 mm (the aneurysm was 8 × 7.5 mm in the CT angiography on the previous admission). Extensive workup did not reveal the underlying cause of the mycotic aneurysm, thus we believe the cause to be the infected aortic stent, leading to bacteraemia and vegetations to the mesenteric artery causing the aneurysm. The management plan was placed by a multidisciplinary team consisting of vascular surgeons and infectious disease specialists along with review from a dietician to evaluate the patient’s nutritional status. The patient was started on total parenteral nutrition due to his postprandial pain and on antibiotic therapy according to the infectious disease team’s recommendation. He underwent surgical resection of the mycotic aneurysm, which showed a thrombosed aneurysm in the jejunoileal mesenteric area. The histopathology of the resected tissue demonstrated inflammatory aneurysm of the mesenteric artery. Following the surgery, the patient continued his antibiotic therapy and was discharged on the 13th post-operative day with follow-up appointments in the vascular surgery and infectious disease clinic.

scholarly journals Neuroendoscopic treatment of idiopathic occlusion of unilateral foramen of Monro presenting as chronic headache

2016 ◽  
Vol 7 (01) ◽  
pp. 128-130 ◽  
Author(s):  
Dhaval Shukla
Keyword(s):  
Surgical Treatment ◽  
Intracranial Pressure ◽  
Clinical Features ◽  
Chronic Headache ◽  
Primary Headache ◽  
Raised Intracranial Pressure ◽  
Foramen Of Monro ◽  
Clinical Dilemma

ABSTRACTAsymmetric ventriculomegly due to idiopathic occlusion of the foramen of Monro is rare. Such patients present with clinical features of raised intracranial pressure (ICP). Presentation as chronic headache has not been previously described. In the absence of raised ICP, pursuing surgical treatment raises a clinical dilemma as the headache may be a primary headache with no improvement after surgery. A 21-year-old woman presented with chronic headache. She was found to have asymmetric ventriculomegaly due to the occlusion of the foramen of Monro. She underwent endoscopic septostomy and widening of the foramen of Monro. Her headache subsided after surgery. At 15 months of follow-up, she was free from headache without medications. Unilateral occlusion of the foramen of Monro can present with asymmetric ventriculomegaly resulting in chronic headache. Though the symptoms of raised ICP may not be present, still endoscopic relief of ventriculomegaly leads to cure of headache.

Late seizures and morbidity after subdural empyema

1983 ◽  
Vol 58 (4) ◽  
pp. 569-573 ◽  
Author(s):  
Richard Cowie ◽  
Bernard Williams
Keyword(s):  
Surgical Treatment ◽  
Visual Field ◽  
Speech Disorders ◽  
Acute Stage ◽  
Subdural Empyema ◽  
Content Type ◽  
Neurological Morbidity ◽  
Early Seizures ◽  
Fine Print

✓ A survey of 89 patients with subdural empyema was conducted to assess the incidence of late seizures and morbidity in this disease. Twenty-four patients died during the acute stage of the illness and, of the 65 survivors, 13 were lost or had incomplete follow-up review. Hemiparesis occurred in 48 of the survivors during the acute stage, and all but nine recovered completely. Thirteen patients had a visual field deficit and all recovered; in three of these 13 who had speech disorders the deficits persisted. Recovery from neurological morbidity was not related to the type of surgical treatment; however, the mortality rate was improved by craniotomy. The same incidence of early seizures occurred in those who died (62%) as in those who survived (63%). Of those who had no early seizures, 42% had late seizures, the majority appearing within 16 months. Of those who had early seizures, 71% did not have subsequent attacks. The highest incidence of seizures occurred in patients who had their empyema in the second and third decades of life. The incidence of late seizures was not influenced by the method of surgical treatment, the degree of deterioration of consciousness during the acute stage of the illness, nor by occurrence of early seizures. A significantly increased incidence of early seizures was associated with paranasal sepsis, but not with late seizures.

SURGICAL TREATMENT OF CEREBELLAR SCHISTOSOMIASIS

Neurosurgery ◽  
2009 ◽  
Vol 64 (5) ◽  
pp. 941-944 ◽  
Author(s):  
Kai Shu ◽  
Suojun Zhang ◽  
Lin Han ◽  
Ting Lei
Keyword(s):  
Surgical Treatment ◽  
Intracranial Pressure ◽  
Mass Effect ◽  
Posterior Cranial Fossa ◽  
Increased Intracranial Pressure ◽  
Therapeutic Measures ◽  
Cranial Fossa ◽  
Pathological Focus

Abstract OBJECTIVE To explore the surgical treatment of cerebellar schistosomiasis. METHODS Twelve cases of cerebellar schistosomiasis treated in our department were analyzed retrospectively. RESULTS All cases were cured. At the 2-year follow-up examination, all patients could perform physical tasks normally. CONCLUSION Cerebellar schistosomiasis tends to cause mass effect of the posterior cranial fossa and increased intracranial pressure. Microresection of the pathological focus and decompression of the posterior cranial fossa should be effective therapeutic measures.

scholarly journals CTNI-71. TTFIELDS IN ROUTINE CLINICAL CARE OF NEWLY DIAGNOSED GBM PATIENTS IN GERMANY – FIRST REPORT ON THE FULLY ENROLLED TIGER STUDY POPULATION

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii59-ii59
Author(s):  
Oliver Bähr ◽  
Ghazaleh Tabatabai ◽  
Rainer Fietkau ◽  
Roland Goldbrunner ◽  
Martin Glas
Keyword(s):  
Decision Making ◽  
Patient Population ◽  
Clinical Care ◽  
Demographic Data ◽  
Methylation Status ◽  
Treatment Compliance ◽  
Newly Diagnosed ◽  
Routine Clinical Care ◽  
Therapy Decision

Abstract OBJECTIVE Glioblastoma (GBM) is widely treated with surgery, chemoradiation and TTFields in combination with chemotherapy. Since the introduction of TTFields to first-line GBM treatment, prescribing physicians in Germany are interested to gain additional knowledge on the use in clinical practice. The TIGER study was designed to assess the therapy decision making process, safety and efficacy of TTFields in clinical routine, as well as evaluating quality of life (QoL) within 4 months after start of therapy, treatment compliance and duration. METHODS This multi-center prospective non-interventional study in Germany (NCT03258021) included newly diagnosed GBM patients eligible for TTFields therapy. Within the study, after receiving introduction to TTFields therapy, patients could decide for or against receiving TTFields. The study was designed to recruit 500 patients for each group, with and without TTFields. Demographic data, QoL and reasons for therapy decision 2–4 months after treatment start are assessed using the EORTC-QLQ-C30/BN-20 and a TTFields questionnaire, respectively, with 18 months follow-up. RESULTS At the last data cut-off (31st March, 2020), the median follow-up was 11 months (range: 0–28 months) and 581 (82%) of the 710 recruited patients in the trial had decided for TTFields therapy. According to preliminary analysis, this patient population represents a typical GBM population regarding median age (59 years, range: 19.0–85.0), gender (37 % female), median KPS (90, range: 40–100) and MGMT promoter methylation status (44% methylated). In this population 49 % received complete resection, 33 % partial resection and 19 % biopsy. CONCLUSION The TIGER study allows prospective and systematic analysis of TTFields treatment decision making and use of typical GBM patient population in routine clinical care. In addition, the study allows the evaluation of compliance and treatment duration. Here, we will present an updated analysis of the TIGER study.

scholarly journals Cutaneous leishmaniasis in a 65-year-old North Texas male, treated with cryotherapy: A case report

2020 ◽  
Vol 8 ◽  
pp. 2050313X2090459
Author(s):  
Daniel A Nguyen ◽  
Jean Elizze M Charles ◽  
J Trace Worrell ◽  
Dustin V Wilkes
Keyword(s):  
Infectious Disease ◽  
Case Report ◽  
Disease Control ◽  
Granulomatous Inflammation ◽  
North Texas ◽  
Dermatology Clinic ◽  
Control And Prevention ◽  
Infectious Disease Specialists ◽  
Central Ulceration

We report a case of a 65-year-old male seen in a North Texas dermatology clinic with three erythematous nodules possessing central ulceration and scaling on the left lateral shoulder, present for months. Head, ears, lips, oral mucosa, and other body surfaces did not reveal similar lesions, and review of systems was negative. Shave biopsy was performed and histopathological findings demonstrated granulomatous inflammation in the dermis and parasitized histiocytes containing peripherally located amastigotes. Leishmaniasis was diagnosed and patient was educated on the disease while communication with the Centers for Disease Control and Prevention was initiated. The patient declined systemic medications from infectious disease specialists and, 3 weeks later, returned for follow-up treatment with cryotherapy.

scholarly journals Randomized Noninferiority Trial of Telephone Delivery of BRCA1/2 Genetic Counseling Compared With In-Person Counseling: 1-Year Follow-Up

2016 ◽  
Vol 34 (24) ◽  
pp. 2914-2924 ◽  
Author(s):  
Anita Y. Kinney ◽  
Laurie E. Steffen ◽  
Barbara H. Brumbach ◽  
Wendy Kohlmann ◽  
Ruofei Du ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Decision Making ◽  
Genetic Counseling ◽  
Upper Bound ◽  
Clinical Care ◽  
Personal Control ◽  
Telephone Counseling ◽  
Increased Risk

Purpose The ongoing integration of cancer genomic testing into routine clinical care has led to increased demand for cancer genetic services. To meet this demand, there is an urgent need to enhance the accessibility and reach of such services, while ensuring comparable care delivery outcomes. This randomized trial compared 1-year outcomes for telephone genetic counseling with in-person counseling among women at risk of hereditary breast and/or ovarian cancer living in geographically diverse areas. Patients and Methods Using population-based sampling, women at increased risk of hereditary breast and/or ovarian cancer were randomly assigned to in-person (n = 495) or telephone genetic counseling (n = 493). One-sided 97.5% CIs were used to estimate the noninferiority effects of telephone counseling on 1-year psychosocial, decision-making, and quality-of-life outcomes. Differences in test-uptake proportions for determining equivalency of a 10% prespecified margin were evaluated by 95% CIs. Results At the 1-year follow-up, telephone counseling was noninferior to in-person counseling for all psychosocial and informed decision-making outcomes: anxiety (difference [d], 0.08; upper bound 97.5% CI, 0.45), cancer-specific distress (d, 0.66; upper bound 97.5% CI, 2.28), perceived personal control (d, −0.01; lower bound 97.5% CI, −0.06), and decisional conflict (d, −0.12; upper bound 97.5% CI, 2.03). Test uptake was lower for telephone counseling (27.9%) than in-person counseling (37.3%), with the difference of 9.4% (95% CI, 2.2% to 16.8%). Uptake was appreciably higher for rural compared with urban dwellers in both counseling arms. Conclusion Although telephone counseling led to lower testing uptake, our findings suggest that telephone counseling can be effectively used to increase reach and access without long-term adverse psychosocial consequences. Further work is needed to determine long-term adherence to risk management guidelines and effective strategies to boost utilization of primary and secondary preventive strategies.

Novel biomarkers in cardiovascular surgery

2021 ◽  
Vol 15 (4) ◽  
pp. 307-318
Author(s):  
Raffaele Serra ◽  
Federica Jiritano ◽  
Umberto M Bracale ◽  
Nicola Ielapi ◽  
Noemi Licastro ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Decision Making ◽  
Surgical Treatment ◽  
High Risk ◽  
Cardiovascular Surgery ◽  
Health Problems ◽  
Point Of View ◽  
Novel Biomarkers ◽  
Arteries And Veins

Cardiovascular disease includes health problems related to the heart, arteries and veins and is a significant healthcare problem worldwide. Cardiovascular disease may be acute or chronic and relapses are frequent. Biomarkers involved in this field may help clinicians and surgeons in diagnosis and adequate decision making. Relevant articles searched in the following databases Medline, Scopus, ScienceDirect, were retrieved and analysed. Several biomarkers have been identified and we analyzed those of most importance from a clinical and surgical point of view. Biomarkers can better identify high-risk individuals, facilitate follow-up process, provide information regarding prognosis and better tailor the most appropriate surgical treatment.

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