Heatwave hyponatraemia: a case series at a single Victorian tertiary centre during January 2014

2015 ◽  
Vol 45 (2) ◽  
pp. 211-214 ◽  
Author(s):  
S. A. Yong ◽  
D. A. Reid ◽  
A. E. Tobin
Keyword(s):  
Case Series ◽  
Tertiary Centre

scholarly journals 63 Chronic Femoral Osteomyelitis Case Series: Outcomes and Economic Impact at A United Kingdom Based Tertiary Centre

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
E Lau ◽  
Z Arshad ◽  
A Aslam ◽  
A Thahir ◽  
M Krkovic
Keyword(s):  
Economic Impact ◽  
Treatment Protocol ◽  
Case Series ◽  
Consecutive Series ◽  
Financial Loss ◽  
Patient Demographics ◽  
Tertiary Centre ◽  
The Mean ◽  
Eq Vas

Abstract Introduction Osteomyelitis refers to an inflammatory process affecting bone and bone marrow. This study reviews chronic femoral osteomyelitis treatment and outcomes, including economic impact. Method We retrospectively collected data from a consecutive series of 14 chronic femoral osteomyelitis patients treated between January 2013 and January 2020. Data collected include patient demographics, comorbidities, pathogens, complications, treatment protocol and costs. Functional outcome was assessed using EuroQOL five-dimensional interview administration questionnaire (EQ-5D-5L™) and EuroQOL Visual Analogue Scale (EQ-VAS™). Results Of these, 92.9% had one or more osteomyelitis risk factor, including smoking and diabetes. Samples from 78.6% grew at least one pathogen. Only 42.9% achieved remission after initial treatment, but 85.7% were in remission at final follow-up, with no signs of recurrence throughout the follow-up period (mean: 21.4 months). The average treatment cost was £39,249.50 with a net mean loss of £19,080.10 when funding was considered. The mean-derived EQ-5D score was 0.360 and the mean EQ-VAS score was 61.7, lower than their values for United Kingdom’s general population, p = 0.0018 and p = 0.013 respectively. Conclusions Chronic femoral osteomyelitis treatment is difficult, resulting in significant economic burden. With previous studies showing cheaper osteomyelitis treatment at specialist centres, our net financial loss incurred suggests the need for management at specialised centres.

Genital tract fistula: a case series from a tertiary centre in South Africa

2017 ◽  
Vol 29 (3) ◽  
pp. 383-389
Author(s):  
Thinagrin Dhasarathun Naidoo ◽  
Jagidesa Moodley ◽  
Saloshni Naidoo
Keyword(s):  
South Africa ◽  
Genital Tract ◽  
Case Series ◽  
Tertiary Centre ◽  
Tract Fistula

Identification and preservation of External Branch of the Superior Laryngeal Nerve during thyroid surgeries at NMCTH

2017 ◽  
Vol 13 (3) ◽  
pp. 306-310 ◽  
Author(s):  
Rupesh Raj Joshi ◽  
Anupama Shah Rijal ◽  
Kundhan Kumar Shrestha ◽  
Anup Dhungana ◽  
Shova Maharjan
Keyword(s):  
Case Series ◽  
Superior Laryngeal Nerve ◽  
Thyroid Neoplasms ◽  
Laryngeal Nerve ◽  
Type I ◽  
Tertiary Centre ◽  
External Branch ◽  
Common Diagnosis ◽  
Recurrent Laryngeal Nerves ◽  
Nerve Identification

Background & Objectives:The most common reason for thyroid surgery is the presence of benign or malignant nodules. Subjective voice disturbance after thyroidectomy is very common, even without injury to the recurrent laryngeal nerves. One possible cause for postoperative dysphonia is injury to the External branch of superior laryngeal nerve (EBSLN). Cernea classification, which we followed in this study, is one of the most popular worldwide classifications of the EBSLN. The study was conducted with objectives to identify and classify EBSLN according to Cernia classification in Nepalese population and help surgeons understand the anatomy of the EBSLN and to preserve the nerve during thyroidectomy. Materials & Methods:A prospective observational case series of seventy-nine patients, who were diagnosed with thyroid neoplasms and underwent thyroid surgeries at the tertiary centre of Kathmandu between 1st January 2015 to 31st December 2016. All procedures were performed by transverse collar incision. We classified the anatomy of the EBSLN using Cernea classification.  Results:There were total of 79 patients. Most common diagnosis and surgery were colloid goitre and hemithyroidectomies respectively. A total of 94 EBSLNs were evaluated.  Cernia Type I was observed in 27.66%, type IIa in 46.80%, and type IIb in 14.89%. Incidences of types IIa and IIb, which put patients at greater risk for intra-operative injury, were observed in 61.69% in our study. The nerve could not be identified in 10.64%. Conclusion:It is possible to increase the rate of nerve identification and avoid the nerve injury even in the absence of sophisticated equipment.

“Mummy, my eyelids are heavy”: A case series of juvenile myasthenia gravis

2019 ◽  
pp. 112067211986760
Author(s):  
Logeswari Krishna ◽  
Nor Fadzillah Abdul Jalil ◽  
Pooi Wah Lott ◽  
Sujaya Singh ◽  
May May Choo
Keyword(s):  
Myasthenia Gravis ◽  
Case Series ◽  
Tertiary Centre ◽  
Ocular Symptoms ◽  
Ocular Myasthenia Gravis ◽  
Life Threatening ◽  
Receptor Antibodies ◽  
Juvenile Myasthenia Gravis ◽  
Anti Acetylcholine ◽  
Second Twin

Purpose: To report three cases of juvenile myasthenia gravis aged between 18 and 24 months with ocular symptoms as their first presentation. Method: A case series. Results: We present a case series of juvenile myasthenia gravis in a tertiary centre in Malaysia. Two of the three cases consist of a pair of twins who presented with ptosis of bilateral eyes; the first twin presented 4 months later than the second twin. These two cases were positive for anti-acetylcholine receptor antibodies and had generalized myasthenia gravis, whereas the other case was negative for receptor antibodies and was purely ocular myasthenia gravis. Conclusion: Juvenile myasthenia gravis is relatively rare in toddlers. Early diagnosis and commencement of treatment is important to slow the progression of the disease and avoiding life-threatening events.

scholarly journals Vitrectomy for endophthalmitis: 5-year study of outcomes and complications

2020 ◽  
Vol 5 (1) ◽  
pp. e000423 ◽  
Author(s):  
Guy Simon Negretti ◽  
WengOnn Chan ◽  
Carlos Pavesio ◽  
Mahiul Muhammed Khan Muqit
Keyword(s):  
Case Series ◽  
Vitreoretinal Surgery ◽  
Endogenous Endophthalmitis ◽  
Final Visit ◽  
Retrospective Case ◽  
Tertiary Centre ◽  
Early Vitrectomy ◽  
Exogenous Endophthalmitis ◽  
Vitrectomy Surgery

Background/AimsTo analyse the complications and outcomes of vitrectomy surgery for endophthalmitis.MethodsThis was a retrospective case series. All cases that underwent 23-gauge vitrectomy surgery for endophthalmitis at a tertiary centre between 1 February 2013 and 1 February 2018 were included. Main outcome measures were as follows: visual acuity (VA) at final visit and post-vitrectomy complications.Results33 patients were included in the study with 20 men and 13 women, average age 63 years. Main post-surgical causes for endophthalmitis included phacoemulsification (n=9), trabeculectomy (n=5), intravitreal injection (n=5), corneal graft (n=4), vitreoretinal surgery (n=3) and endogenous endophthalmitis (n=6). Average follow-up was 18 months (SD 14). 21/33 (64%) patients had baseline perception of light VA. Analysis of exogenous endophthalmitis cases only demonstrated: mean LogMAR VA improved significantly from 2.68 to 1.66 (p=0.001). At final follow-up, 12% had VA of 6/12 or better, and 28% had VA of 6/36 or better. Vitrectomy within 7 days resulted in improved final VA outcomes (1.49 vs 2.16 LogMAR, p=0.032). Complications included retinal detachment (24.2%), macular hole (3%), hypotony (6%), suprachoroidal haemorrhage (3%) and enucleation/evisceration (6%).ConclusionVitrectomy for endophthalmitis leads to VA gains in some cases. Surgical outcomes may be improved with early vitrectomy performed within 7 days of the initial event for exogenous endophthalmitis. Patients should be advised of the potential risk of severe complications with/and without surgery.

scholarly journals Bullous X linked retinoschisis: clinical features and prognosis

2017 ◽  
Vol 102 (5) ◽  
pp. 622-624 ◽  
Author(s):  
Anne-Marie Hinds ◽  
Abigail Fahim ◽  
Anthony T Moore ◽  
Sui Chien Wong ◽  
Michel Michaelides
Keyword(s):  
Retinal Detachment ◽  
Age Of Onset ◽  
Case Series ◽  
Peripheral Retina ◽  
Exudative Retinal Detachment ◽  
Retrospective Case ◽  
Tertiary Centre ◽  
Unilateral Case ◽  
The Mean

Background/AimsA subset of patients with X linked retinoschisis (XLRS) have bullous schisis cavities in the peripheral retina. This study describes the characteristics and prognosis of the bullous form of XLRS.MethodsA retrospective case series was performed of nine patients with molecularly proven bullous XLRS seen at a single tertiary centre.ResultsAll cases of bullous peripheral schisis were bilateral, with one unilateral case at presentation which developed into bilateral bullous schisis over time. The mean age of onset was 1.9 years (range: 1 month–7 years, SD: 2.1 years) and at clinical diagnosis was 5.9 years (range: 1 month–27 years, SD: 9.0 years). Mean follow-up was 11 years (range: 6 months–36 years, SD: 10.8 years). Strabismus was the most common presentation (n=7). Other presenting complaints included decreased vision, floaters and an irregularly shaped pupil. The most frequently associated ocular features were strabismus (100%), vitreous haemorrhage (4/18 eyes, 22%), nystagmus (2/9, 22%) and persistent fetal vasculature (1/18, 6%). Localised tractional detachment was seen in 2/18 (11%) eyes, total detachment that underwent surgical repair in 1/18 (6%) and pigmented demarcation lines in a further 22% of the eyes. There was one eye with exudative retinal detachment.ConclusionIn XLRS, bullous schisis may be congenital or develop soon after birth and most commonly presents with strabismus. Cases may be complicated by some form of retinal detachment, which may be tractional or a Coats-like exudative detachment.

scholarly journals Device-assisted enteroscopy in the UK: description of a large tertiary case series under conscious sedation

2017 ◽  
Vol 9 (2) ◽  
pp. 122-128
Author(s):  
Vijay Pattni ◽  
David J Tate ◽  
Ana Terlevich ◽  
Peter Marden ◽  
Steve Hughes
Keyword(s):  
Capsule Endoscopy ◽  
Conscious Sedation ◽  
Case Series ◽  
Outpatient Setting ◽  
High Yield ◽  
Completion Rates ◽  
Double Balloon Enteroscopy ◽  
Tertiary Centre ◽  
Spiral Enteroscopy ◽  
The Uk

ObjectiveDevice-assisted enteroscopy (DAE) has developed rapidly, particularly with the advent of double-balloon enteroscopy (DBE). This study reports a case series from a UK tertiary centre for DAE across two modalities—DBE and spiral enteroscopy (SE)—under conscious sedation.DesignRetrospective observational study of 257 enteroscopy procedures from 2008 to 2014. Data were collected on demographics, indications, diagnosis, sedation requirements, duration, complications, tolerance, therapy performed and completion rate. Procedures were performed under conscious sedation using a combination of midazolam, pethidine and fentanyl in a solely outpatient setting.ResultsObscure gastrointestinal bleeding (OGIB) was the commonest indication for DAE (n=164, 63.8%). Overall, yield of DAE was 47.2% and varied significantly across the indications (p=0.003). There was a greater likelihood of positive findings if the indication was polyposis syndrome (75%), abnormal capsule endoscopy (67%) or OGIB (53%) and in older patients (mean age normal exam 60.3 vs abnormal exam 67.9 years, p<0.001). Higher mean doses of midazolam were used for DBE from above (5.4 mg, SD 2.24) and SE (5.6 mg, SD 2.9) to DBE from below (4.4 mg, SD 1.8). No serious complications were recorded. Tolerance of DAE was good with the majority (240/257, 93.4%) of procedures tolerated with comfort scores 0 or 1. Therapy was performed in 121/257 (47.1%) of procedures. The strongest predictor indications for therapy to be performed at DAE were abnormal capsule endoscopy (88.9%) and occult gastrointestinal (GI) bleeding (54.9%). Completion rates were higher in DBEb (91.8%) compared to DBEa (76.5%) and SE (81.6%).ConclusionDAE under conscious sedation is safe and well tolerated. DAE has a high yield if performed for recognised indications and may be safely used to provide therapy where a diagnosis has been made using other modalities.

scholarly journals SP1.1.2Perineal reconstruction following extralevator abdominoperineal excision of rectum - Is IGAP flap a feasible option

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Prem Thambi ◽  
Wafa Abdul Muiz Dzihni ◽  
Trisha Jha ◽  
Haroon Siddiqui ◽  
Madan Jha
Keyword(s):  
Rectal Cancer ◽  
Neoadjuvant Treatment ◽  
Case Series ◽  
Perineal Wound ◽  
Abdominoperineal Excision ◽  
Low Rectal Cancer ◽  
Wound Complications ◽  
Rectal Cancer Surgery ◽  
Tertiary Centre ◽  
The Mean

Abstract Aim Extra-levator abdomino-perineal excision for low rectal cancer has been shown to reduce tumor perfoation rates and incidence of local recurrence when compared to a conventional abdominoperineal excision. This is however associated with increased wound complications. This study was done to evaluate the feasibility of an inferior gluteal artery flap in patients undergoing ELAPE. Methods This was retrospective analysis was done at tertiary centre for all patients who underwent an ELAPE over a period of 7 years (December 2013 to July 2020). Patient demographic, relevant co morbidities and the data regarding chemotherapy and radiotherapy were analysed. Results A Total of 33 patients underwent ELAPE with an IGAP flap wound reconstruction. The mean age was 68 (44-86) with a mean BMI of 27 (25-45). 26 patients out of 33 (82%) received neoadjuvant treatment for cancer. The mean LoS was 11 days (6-31). The perineal wound complications were graded as per Clavein Dindo classification and 56 % had no wound complications recorded. 07/33 had Grade I and 06/33 had Grade II complications. Conclusion IGAP flap closure for perineal defects, does offer the advantage of compatibility with both minimally invasive and open procedures and the avoidance of using irradiated tissue. This case series does demonstrate the feasibility of IGAP flaps as viable option to cover perineal defects following radical low rectal cancer surgery with low morbidity.

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