scholarly journals Paediatric oropharyngeal tularaemia requiring surgical intervention

2019 ◽  
Vol 12 (9) ◽  
pp. e229754
Author(s):  
Amina Nemmour ◽  
Adzreil Bakri ◽  
Claude A Fischer ◽  
Yves Brand
Keyword(s):  
Surgical Intervention ◽  
Cervical Lymphadenopathy ◽  
Who Guidelines ◽  
Clinical Progression ◽  
Delay In Diagnosis ◽  
History Of ◽  
Deep Neck Abscess ◽  
Extended Course ◽  
Specific Symptoms

Tularaemia is a rare infectious disease endemic in most European countries caused by the bacterium Francisella tularensis. 1 Patients often show acute non-specific symptoms, which causes a delay in diagnosis and proper treatment, potentially resulting in significant morbidities such as deep neck abscess, meningitis, endocarditis and septic shock. The authors present a case of a 5-year old boy with a 4-day history of fever, sore throat and painful cervical lymphadenopathy, whose clinical progression worsened despite being treated with recommended antibiotics as per WHO guidelines once the diagnosis of Tularaemia was confirmed by serologic tests. He developed a parapharyngeal abscess and a persistent left necrotic cervical lymph node, which both were surgically drained and excised, respectively, and an extended course of antibiotic was given. Subsequently, the patient fully recovered from the illness and the follow-up was negative for relapse.

scholarly journals A case report: spontaneous postpartum rupture of unscarred uterus

2018 ◽  
Vol 7 (8) ◽  
pp. 3420
Author(s):  
Swati Singh ◽  
Ravinder Ahlawat
Keyword(s):  
Risk Factors ◽  
Differential Diagnosis ◽  
Unusual Case ◽  
Surgical Intervention ◽  
Emergency Laparotomy ◽  
Full Thickness ◽  
Uterine Incision ◽  
History Of ◽  
Rupture Of Uterus ◽  
Specific Symptoms

Rupture of uterus is characterized by a breach in the wall of the uterus involving its full thickness. An unscarred uterus rupture is uncommon. It has non-specific symptoms and presentation differs according to site and time of rupture. Authors report an unusual case of spontaneous rupture of unscarred uterus. A 32-year-old, pregnant woman, developed postpartum bleeding with no history of prior uterine incision. She was diagnosed as a case of rupture of uterus and emergency laparotomy was done. Early diagnosis and immediate surgical intervention may significantly improve the prognosis. Differential diagnosis of uterine rupture should always be kept in mind in all patients with or without risk factors.

scholarly journals Non-operative Management of Posterior Shoulder Instability: An Assessment of Survival and Predictors for Conversion to Surgery at 1 to 13 Years After Diagnosis

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0009
Author(s):  
Jarret Murray Woodmass ◽  
Julia Lee ◽  
Nick R. Johnson ◽  
Christopher L. Camp ◽  
Diane L. Dahm ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Radiographic Progression ◽  
Surgical Intervention ◽  
Cox Proportional Hazards ◽  
Posterior Shoulder Instability ◽  
Late Failure ◽  
Posterior Shoulder ◽  
Increased Risk ◽  
History Of

Objectives: Among patients treated non-operatively for 1 year following a diagnosis of posterior shoulder instability (PSI), little is known about the the incidence of surgery between 1-13 years after injury. The purpose of this study is to define the frequency and evaluate the factors predictive for late surgical intervention of symptomatic PSI. Methods: This study included a population-based cohort of 115 patients (14 females, 101 males) diagnosed with PSI between January 1994 and July 2012 with a minimum 5-years follow-up (mean:13.9 years; range: 5-23 years). Landmark survival analysis was performed to evaluate incidence of surgery after 1 year. Survival was estimated using Kaplan Meier method and predictors of late surgical intervention were analyzed using Cox proportional hazards regression. Results: A total of 61/115 (53%) patients were treated non-operatively for 1 year following diagnosis of PSI. Of these, 24/61 (39%) converted to surgery for symptomatic PSI. The overall survival free of surgery at 1 and 5 years was 53.0% (95% CI 434.7-63.0) and 37.1% (95% CI 29.1-47.1), respectively. BMI >35 (p=0.04, HR 3.3) was predictive for late conversion to surgery. Age, gender, occupation, or history of glenohumeral dislocation were not significant. Assessing surgery as a time dependent covariate, a patient undergoing surgery was at an increased risk for radiographic progression of osteoarthritis (p=0.02, HR=4.0, 95% CI 1.2-13.2). Conclusion: Conservative management was performed for at least one year in over half of patients diagnosed with PSI. However, long-term follow-up demonstrates that nearly 40% of these patients eventually require surgery. Increased BMI was predictive for late failure of while age, gender, history of dislocation and occupation did not show an effect. Patients who underwent surgery were at an increased risk of radiographic progression of arthritis.

scholarly journals Disseminated Coccidioidomycosis of the Knee Joint Requiring Synovectomy and Arthrotomy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Farhan Ahmad ◽  
Kavina Patel ◽  
Jorge Clint De Leon ◽  
Frank A Buttacavoli
Keyword(s):  
Infectious Disease ◽  
Fungal Infection ◽  
Orthopedic Surgery ◽  
Surgical Intervention ◽  
History Of ◽  
The Right ◽  
United States Mexico ◽  
Comprehensive History ◽  
Fat Pads

Introduction: Coccidioidomycosis is a fungal infection endemic to the Southwestern United States, Mexico, and South America. While uncommon, inhalation of spores or direct cutaneous contact can lead to disseminated infection in the immunocompetent, with the involvement of the musculoskeletal and integumentary systems. Case Report: A 49-year-old patient with a history of pulmonary coccidioidomycosis presented with the right knee pain and multiple symptomatic abscesses beneath the suprapatellar and infrapatellar fat pads. Arthrocentesis and culture confirmed the infection, and open synovectomy, arthrotomy, and drainage of the infection were performed without complication. Conclusion: Disseminated coccidioidomycosis is an uncommon fungal infection that may involve joints and become refractory to pharmacotherapy. Management may require surgical intervention, along with infectious disease consultation and close follow-up. Patients from endemic regions should be evaluated with a comprehensive history of this disease. Keywords: Coccidioidomycosis, knee, septic arthritis, arthrotomy, synovectomy, orthopedic surgery, fungal infection.

scholarly journals Management of radiation-related supraglottic stenosis with serial in-office steroid injections

2018 ◽  
Vol 5 (1) ◽  
pp. 184
Author(s):  
Christine M. Kim ◽  
Pratik B. Patel ◽  
Aaron J. Feinstein ◽  
Dinesh K. Chhetri
Keyword(s):  
Head And Neck ◽  
Paradigm Shift ◽  
Surgical Intervention ◽  
Outpatient Management ◽  
Clinical Protocol ◽  
Steroid Injections ◽  
Clinical Challenge ◽  
History Of ◽  
Head And Neck Radiation

<p class="abstract">Management of supraglottic stenosis in patients with history of head and neck radiation presents a clinical challenge for otolaryngologists. The cornerstone of treatment has historically been surgical intervention, both endoscopic and open. However, recently described techniques related to outpatient management of subglottic and tracheal stenosis with routine in-office steroid injections may provide a translatable model for supraglottic stenosis management.<strong> </strong>We describe a clinical protocol for in-office steroid injections to the laryngopharynx for patients with supraglottic stenosis secondary to radiation fibrosis.<strong> </strong>Two patient cases are reported, including endoscopic examinations over a follow-up period of 12 to 16 months. Both patients experienced significant improvement in their supraglottic airways. In-office steroid injections may be beneficial to prevent or slow stenosis recurrence in patients treated with radiation for head and neck cancer. With continued refinement of this technique, a paradigm shift may occur in the management of supraglottic stenosis.</p>

Surgical management of radial head luxation in a dog using an external skeletal traction device

2013 ◽  
Vol 26 (02) ◽  
pp. 140-146 ◽  
Author(s):  
R. Yeadon ◽  
M. Farrell ◽  
N. Fitzpatrick
Keyword(s):  
Radial Head ◽  
Surgical Intervention ◽  
Skeletal Traction ◽  
Thoracic Limb ◽  
Consolidation Phase ◽  
Traction Device ◽  
History Of ◽  
Reaction Forces ◽  
The Right

SummaryA five-month-old Airedale Terrier was presented with a history of right thoracic limb lameness. Clinical and radiographic examinations revealed caudolateral luxation of the right radial head. Surgical intervention involved an oblique proximal radial osteotomy and gradual craniomedial traction of the radial head using an external skeletal fixator (ESF) incorporating a traction device. The radial head was gradually reduced over 16 days. After radiographic confirmation of appropriate radial head reduction, a consolidation phase followed, with removal of the traction ESF after 24 days. Follow-up radiographs documented remodelling of the radial head. Clinical follow-up three years postoperatively revealed nearly normal ground reaction forces. Activity was unrestricted and there was no requirement for analgesic medications.

Clinical and Radiological Follow-up of Intraneural Perineuriomas

Neurosurgery ◽  
2018 ◽  
Vol 85 (6) ◽  
pp. 786-792 ◽  
Author(s):  
Thomas J Wilson ◽  
Kimberly K Amrami ◽  
B Matthew Howe ◽  
Robert J Spinner
Keyword(s):  
Resonance Imaging ◽  
Clinical Progression ◽  
Mri Studies ◽  
Intraneural Perineurioma ◽  
History Of ◽  
Absolute Length ◽  
Magnetic Resonance Imaging Mri ◽  
Sequential Images ◽  
Repeat Imaging

ABSTRACT BACKGROUND Management of intraneural perineuriomas remains controversial, largely due to the lack of knowledge regarding the natural history of these lesions. OBJECTIVE To describe the typical radiological growth pattern of intraneural perineuriomas and to determine how the pattern of growth relates to clinical progression. METHODS We performed a retrospective review of the magnetic resonance imaging (MRI) studies and serial clinical examinations of a cohort of patients with biopsy-proven intraneural perineuriomas who had 2 MRI studies at least 2 yr apart. The outcome of interest was radiological growth in length or width of the intraneural perineurioma. Radiological growth was tested for association with clinical progression. RESULTS Twenty patients were included in the study. By width, the lesions were on average larger on repeat imaging (P = .009). By absolute length, the lesions were on average longer on repeat imaging (P = .02). By lesion:landmark ratio, there was no difference in length of the lesions between sequential images (P = .09), with 10 (50%) lesions being shorter and 7 (35%) showing no change. No lesions grew to involve a new nerve or division of a nerve on sequential imaging. None of the variables tested were associated with clinical progression. CONCLUSION We found that intraneural perineuriomas only rarely grow in length, do not grow to involve new nerves or nerve divisions, and growth does not correlate with clinical progression. These findings have significant ramifications for management of these tumors.

scholarly journals Intestinal intussusception and occlusion caused by small bowel polyps in the Peutz-Jeghers syndrome. Management by combined intraoperative enteroscopy and resection through minimal enterostomy: case report

2000 ◽  
Vol 55 (6) ◽  
pp. 219-224 ◽  
Author(s):  
Joaquim J. Gama-Rodrigues ◽  
José Hyppolito da Silva ◽  
Adilson A. Aisaka ◽  
Ricardo Jureidini ◽  
Renato Falci Júnior ◽  
...  
Keyword(s):  
Small Intestine ◽  
Case Report ◽  
Surgical Intervention ◽  
Intestinal Resection ◽  
Hereditary Disease ◽  
Secondary Complications ◽  
Surgical Interventions ◽  
History Of ◽  
Peutz Jeghers Syndrome

The Peutz-Jeghers syndrome is a hereditary disease that requires frequent endoscopic and surgical intervention, leading to secondary complications such as short bowel syndrome. CASE REPORT: This paper reports on a 15-year-old male patient with a family history of the disease, who underwent surgery for treatment of an intestinal occlusion due to a small intestine intussusception. DISCUSSION: An intra-operative fiberscopic procedure was included for the detection and treatment of numerous polyps distributed along the small intestine. Enterotomy was performed to treat only the larger polyps, therefore limiting the intestinal resection to smaller segments. The postoperative follow-up was uneventful. CONCLUSION: We point out the importance of conservative treatment for patients with this syndrome, especially those who will undergo repeated surgical interventions because of clinical manifestation while they are still young.

scholarly journals Subclinical imaging changes in cerebral cavernous angiomas during prospective surveillance

2020 ◽  
pp. 1-8
Author(s):  
Julián Carrión-Penagos ◽  
Hussein A. Zeineddine ◽  
Sean P. Polster ◽  
Romuald Girard ◽  
Seán B. Lyne ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Maximum Diameter ◽  
Prior History ◽  
Study Cohort ◽  
Prospective Surveillance ◽  
Cavernous Angiomas ◽  
Surrogate Outcome ◽  
Institutional Review ◽  
History Of

OBJECTIVEThe purpose of this study was to systematically assess asymptomatic changes (ACs), including subclinical hemorrhage, growth, or new lesion formation (NLF) during longitudinal follow-up of cerebral cavernous angiomas (CAs), and to correlate these with symptomatic hemorrhage (SH) during the same period and with clinical features of the disease.METHODSOne hundred ninety-two patients were included in this study, among 327 consecutive patients with CA, prospectively identified between September 2009 and February 2019. Included patients had undergone clinical and MRI follow-up, in conjunction with institutional review board–approved biomarker studies, and harbored ≥ 1 CA with a maximum diameter of ≥ 5 mm on T2-weighted MRI. Rates of AC and SH per lesion-year and patient-year were assessed using prospectively articulated criteria. In multifocal/familial cases, rates of NLF were also assessed.RESULTSThere were no differences in demographic or disease features among cases included or excluded in the study cohort, except for a higher proportion of included patients with CCM3 mutation. Follow-up was 411 patient-years (2503 lesion-years). The rate of AC was higher than the rate of SH (12.9% vs 7.5% per patient-year, and 2.1% vs 1.2% per lesion-year, both p = 0.02). Patients presenting with a prior history of SH had a higher rate of AC than those with other forms of presentation (19.7% and 8.2% per patient-year, respectively; p = 0.003). A higher rate of NLF on T2-weighted MRI (p = 0.03) was observed in patients with prior SH. Three of 6 solitary/sporadic and 2 of 28 multifocal/familial patients underwent resection of the lesion after AC.CONCLUSIONSRates of AC are greater than SH during prospective follow-up of CAs, and greater in cases with prior SH. AC may be a more sensitive biomarker of lesional activity, and a more efficient surrogate outcome in clinical trials than SH. Patients experiencing an AC are more likely to undergo a surgical intervention when CAs are solitary/sporadic than when they are multifocal/familial.

scholarly journals Surgical Treatment of Gallstone Ileus: Less Is More

2021 ◽  
pp. 1-6
Author(s):  
Cristina Vera-Mansilla ◽  
Ana Sanchez-Gollarte ◽  
Belen Matias ◽  
Fernando Mendoza-Moreno ◽  
Manuel Díez-Alonso ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Gallstone Ileus ◽  
Clinical History ◽  
Less Is More ◽  
Delayed Cholecystectomy ◽  
Female Predominance ◽  
Biliary Pathology ◽  
History Of ◽  
The Mean

Introduction: The objective of this study was to evaluate the need for cholecystectomy in patients who underwent surgery for gallstone ileus. Methods: This was a retrospective review of the clinical history of patients who underwent surgery for gallstone ileus between December 1992 and December 2018 and follow-up until October 2020. Data regarding the surgical intervention, location of the obstruction, and surgical procedure performed were collected, as well as complications in relation to biliary pathology in the postoperative period. Results: Twenty-five patients underwent surgery for gallstone ileus. In all patients, except one, the site of the obstruction was identified. The mean age of the patients was 72 (standard deviation [SD] 13.3) years, with a female predominance (18: 7). The patients presented symptoms, on average, 2.9 (1–7) days before going to the emergency room; the primary symptoms were vomiting associated with abdominal pain and constipation (56%). Fifty-six percent of patients were diagnosed preoperatively by imaging tests. In 72% of patients, an enterolithotomy was performed alone without any other intervention on the gallbladder or bile duct. Eighty-three percent of the patients did not present any cholecystobiliary complications during the entire follow-up period, and urgent or delayed cholecystectomy was not performed after the acute episode. Conclusions: Gallstone ileus is a rare entity, and there are no randomized studies that support a preferred treatment. If surgical intervention is required, enterotomy for stone extraction is a safe and effective technique, and in our experience, urgent or delayed cholecystectomy is not necessary.

scholarly journals Disseminated Coccidioidomycosis of the Knee Joint Requiring Synovectomy and Arthrotomy

2020 ◽  
Author(s):  
Kavina Patel ◽  
Farhan Ahmad ◽  
J.C. De Leon ◽  
Frank Buttacavoli
Keyword(s):  
Knee Joint ◽  
Endemic Area ◽  
Surgical Intervention ◽  
Operative Management ◽  
Immunocompetent Patient ◽  
Case Presentation ◽  
History Of ◽  
Comprehensive History ◽  
Fat Pads

Abstract BackgroundThis article presents a case of an immunocompetent patient from an endemic area diagnosed with disseminated coccidioidomycosis of the knee joint, which was unusually severe and required operative management.Case presentationA 49-year-old patient with a history of pulmonary coccidiomyocosis presented with right knee pain and multiple symptomatic abscesses beneath the suprapatellar and infrapatellar fat pads. Arthocentesis and culture confirmed the infection, and open synovectomy, arthrotomy and drainage of the infection was performed without complication.ConclusionsDisseminated coccidioidomycosis is an uncommon fungal infection that may involve joints and become refractory to pharmacotherapy. Management may require surgical intervention along with infectious disease consultation and close follow-up. Patients from endemic regions should be evaluated with a comprehensive history for this disease.

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