scholarly journals Massive prosthetic aortic abscess: an overarching plight 7 years post-Bentall’s procedure

2019 ◽  
Vol 12 (9) ◽  
pp. e230204
Author(s):  
Michael McCann ◽  
Nikki Stamp ◽  
Robert Larbalestier
Keyword(s):  
Surgical Intervention ◽  
Aortic Surgery ◽  
Surgical Excision ◽  
High Dose ◽  
Rapid Progression ◽  
Redo Surgery ◽  
Aortic Arch Replacement ◽  
Urgent Surgery ◽  
Initial Surgery ◽  
History Of

Infections of proximal aortic vascular grafts are a catastrophic complication of aortic surgery. Despite aggressive antimicrobial and surgical intervention, mortality and reinfection rates remain significant. Here, we describe a man aged 71 years with a medical history of bioprosthetic aortic valve with aortic arch replacement (modified Bentall’s procedure), who developed a large periprosthetic abscess due to Staphylococcus aureus 7 years after his initial surgery. The patient’s preference was to avoid redo surgery, however despite high-dose intravenous flucloxacillin and oral rifampicin therapy, there was rapid progression of the abscess, necessitating urgent surgery. Notwithstanding the burden of infection, the patient underwent successful surgical excision and graft re-implantation and remains independent and well, almost 2 years postoperatively.

Schneiderian-Type Mucosal Papillomas of the Middle Ear and Mastoid

1996 ◽  
Vol 105 (3) ◽  
pp. 226-233 ◽  
Author(s):  
Bruce M. Wenig
Keyword(s):  
Middle Ear ◽  
Conductive Hearing Loss ◽  
Recurrent Disease ◽  
Chronic Otitis Media ◽  
Surgical Excision ◽  
Initial Surgery ◽  
Additional Surgery ◽  
History Of ◽  
Conductive Hearing ◽  
Tympanic Membranes

Five cases of schneiderian-type mucosal papillomas arising in the middle ear space are reported. The patients were all women, ranging in age from 19 to 57 years (median, 31 years). Clinical complaints — unilateral conductive hearing loss, pain, or otorrhea — ranged from those lasting several months to recurrent problems spanning 20 years. All of the patients had a history of chronic otitis media predating the development of the papillomas; none of the patients had a history of sinonasal or nasopharyngeal schneiderian-type papillomas. Clinically, three patients had intact tympanic membranes, while the other two patients had perforated tympanic membranes through which a bulging polypoid mass was identified. Radiographic studies showed opacification of the middle ear space without evidence of osseous destruction. The intraoperative findings were of polypoid lesions filling the middle ear space, including involvement of the eustachian tube orifice. Histologically, the tumors were identical to sinonasal schneiderian papillomas. Immunohistochemical evaluation for human papillomavirus was negative. Surgical excision is the treatment of choice. In four of the patients, recurrent tumor was identified, necessitating additional surgery. In only one patient did the initial surgery result in complete ablation of the tumor. All patients are alive and free of recurrent disease over periods ranging from 6 months to 120 months (median, 84 months).

scholarly journals Under the Radar: A Case Report of a Missed Aortoenteric Fistula

2021 ◽  
Vol 5 (3) ◽  
pp. 312-315
Author(s):  
Blake Briggs ◽  
David Manthey
Keyword(s):  
Case Report ◽  
Surgical Intervention ◽  
Imaging Modality ◽  
Aortic Surgery ◽  
Aortoenteric Fistula ◽  
Prior History ◽  
Gi Bleeding ◽  
Life Threatening ◽  
History Of ◽  
Widespread Availability

Introduction: An aortoenteric fistula (AEF) is an abnormal connection between the aorta and the gastrointestinal tract that develops due to a pathologic cause. It is a rare, but life-threatening, cause of gastrointestinal (GI) bleeding. Although no single imaging modality exists that definitively diagnoses AEF, computed tomography angiography (CTA) of the abdomen and pelvis is the preferred initial test due to widespread availability and efficiency. Case Report: Many deaths occur before the diagnosis is made or prior to surgical intervention. We describe a case of a patient with a history of aortic graft repair who presented with active GI bleeding. Conclusion: Although CTA can make the diagnosis of AEF, it cannot adequately rule it out. In patients with significant GI bleeding and prior history of aortic surgery, vascular surgery should be consulted early on, even if CTA is equivocal.

scholarly journals Falx cerebri tuberculoma mimicking en plaque meningioma – case report

2016 ◽  
Vol 30 (2) ◽  
pp. 209-213
Author(s):  
A.I. Cucu ◽  
Dana Mihaela Turliuc ◽  
Anca Sava ◽  
Gabriela Florenţa Dumitrescu ◽  
Ş. Turliuc ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Histopathological Examination ◽  
Surgical Excision ◽  
Antituberculous Therapy ◽  
Falx Cerebri ◽  
Clinical Imaging ◽  
Complete Surgical Excision ◽  
Histopathologic Diagnosis ◽  
History Of ◽  
Cerebral Tuberculosis

Abstract Background: The involvement of falx cerebri in tuberculosis is extremely rare, with only three cases reported so far in the literature. The diagnosis is most often difficult to establish, given the location of the lesion, making surgical intervention necessary for a definite histopathologic diagnosis. Methods: We present the case of a 49-year old female patient who was admitted for a right jacksonian seizure, followed by a right crural monoparesis, without a history of tuberculosis. The lesion mimicked a falx cerebri en plaque meningioma in the imaging tests. Results: A complete surgical excision was performed through a left fronto-parietal parasagittal approach. The histopathological examination revealed a case of cerebral tuberculosis. The surgical treatment was complemented postoperatively with antituberculous therapy. Conclusion: In this article, we emphasize the rarity of the lesion at this level and also presenting similar cases from the literature. Moreover, we also discuss epidemiological, clinical, imaging, therapeutic as well as pathological aspects of en-plaque dural tuberculoma.

scholarly journals Spondylitis Presenting With Cauda Equina Syndrome in a 12 Year Old Boy

2020 ◽  
Vol 28 (1) ◽  
pp. 119-122
Author(s):  
Sukriti Das ◽  
Musannah Ashfaq ◽  
Kaniz Fatema Ishrat Jahan ◽  
Shamsul Islam Khan ◽  
Rakibul Islam ◽  
...  
Keyword(s):  
Cauda Equina Syndrome ◽  
Muscle Power ◽  
Cauda Equina ◽  
Surgical Excision ◽  
Lower Limbs ◽  
High Dose ◽  
Medical College ◽  
Bladder Control ◽  
History Of ◽  
Antibiotic Regime

A 12-year-old boy presented with a 2-week history of low back pain and 10-day history of weakness of the lower limbs,5-day history of inability to pass urine. An MRI scan of the lumbar spine showed dehiscent lamina of L5,S1 and an epidural abscess. He was admitted to hospital and treated with a high dose of IV antibiotics followed by radical surgical excision of the lesion. Histopathology showed features of abscess. He eventually recovered bowel and bladder control and regained muscle power in the lower limbs. Infection is not a common cause of cauda equina syndrome. Aggressive surgical treatment combined with a prolonged antibiotic regime is recommended to achieve a satisfactory result. J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 119-122

Genetic diseases of the aorta: aortic diseases related to Marfan syndrome and other genetic abnormalities

ESC CardioMed ◽  
2018 ◽  
pp. 2611-2613
Author(s):  
Bernard Iung
Keyword(s):  
Aortic Valve ◽  
Aortic Dissection ◽  
Bicuspid Aortic Valve ◽  
Aortic Surgery ◽  
Genetic Diseases ◽  
Rapid Progression ◽  
Aortic Diseases ◽  
Genetic Abnormalities ◽  
History Of ◽  
Associated Risk Factors

Bicuspid aortic valve affects 1–2% of babies at birth and is frequently associated with thoracic aortic aneurysm but the risk of aortic dissection is low. Indications for aortic surgery are based on studies on natural history. Aortic surgery is recommended when the maximum aortic diameter is greater than 55 mm in patients with a bicuspid aortic valve. Intervention is indicated at an earlier stage when there are associated risk factors, in particular familial history of aortic dissection or rapid progression, or if there is an indication for aortic valve replacement. The choice between partial or total replacement of the aorta should be based on anatomy, but also take into account the patient’s age and operative risk.

Genetic diseases of the aorta: aortic diseases related to Marfan syndrome and other genetic abnormalities

ESC CardioMed ◽  
2018 ◽  
pp. 2611-2613
Author(s):  
Bernard Iung
Keyword(s):  
Aortic Valve ◽  
Aortic Dissection ◽  
Bicuspid Aortic Valve ◽  
Aortic Surgery ◽  
Genetic Diseases ◽  
Rapid Progression ◽  
Aortic Diseases ◽  
Genetic Abnormalities ◽  
History Of ◽  
Associated Risk Factors

Bicuspid aortic valve affects 1–2% of babies at birth and is frequently associated with thoracic aortic aneurysm but the risk of aortic dissection is low. Indications for aortic surgery are based on studies on natural history. Aortic surgery is recommended when the maximum aortic diameter is greater than 55 mm in patients with a bicuspid aortic valve. Intervention is indicated at an earlier stage when there are associated risk factors, in particular familial history of aortic dissection or rapid progression, or if there is an indication for aortic valve replacement. The choice between partial or total replacement of the aorta should be based on anatomy, but also take into account the patient’s age and operative risk.

scholarly journals Small Intestinal Intussusception Due to Complicated Giant Jejunal Diverticulosis

Medicina ◽  
2021 ◽  
Vol 57 (2) ◽  
pp. 116
Author(s):  
Ewa Grudzińska ◽  
Sławomir Mrowiec ◽  
Joanna Pilch-Kowalczyk ◽  
Monika Ciupińska ◽  
Katarzyna Kusnierz
Keyword(s):  
Metabolic Disorders ◽  
Surgical Intervention ◽  
Acute Abdominal Pain ◽  
Case Presentation ◽  
Radical Treatment ◽  
Jejunal Diverticulosis ◽  
Urgent Surgery ◽  
Contrast Enhanced ◽  
History Of ◽  
Small Intestinal

Background: Jejunal diverticulosis and jejunal lipomatosis are uncommon conditions. Usually asymptomatic, they may cause severe complications in some cases. Intussusception is unusual in adults, but when diagnosed swiftly it can be treated surgically, usually with good outcome. Case presentation: We present a 60-year-old female patient with a history of chronic malnutrition and anemia, complaining of acute abdominal pain, vomiting and diarrhea. Contrast-enhanced abdominal computed tomography (CT) showed intussusception, multiple giant jejunal diverticula and multiple lipomas. The patient underwent urgent surgery, but radical treatment was not possible due to the extent of the diseases. One month later, another surgery was needed due to ileostomy obstruction caused by lipomas. The patient’s condition deteriorated due to malnutrition and concomitant metabolic disorders, which eventually led to her demise. Conclusions: Radical treatment is not always possible in an extensive jejunal disease. Prolonged malnutrition impairs postoperative healing, and therefore surgical or nutritional treatment should be considered in jejunal diverticulosis before the onset of severe complications requiring urgent surgical intervention.

scholarly journals Infected Recurrent Thyroglossal Duct Cyst: A Case Report

2020 ◽  
Vol 4 (3) ◽  
pp. 411-413
Author(s):  
Jennifer Foti ◽  
Felipe Grimaldo
Keyword(s):  
Case Report ◽  
Surgical Intervention ◽  
Acute Infection ◽  
Surgical Excision ◽  
Neck Mass ◽  
Thyroglossal Duct Cyst ◽  
Computed Tomography Imaging ◽  
Duct Cyst ◽  
Thyroglossal Duct ◽  
History Of

Introduction: A thyroglossal duct cyst (TGDC) is a congenital malformation in the neck. Surgical management is often recommended due to risk of recurrent infections and rare possibility of malignancy. Case Report: Herein, we describe the case of an adult presenting with tender neck mass and fever. She had a history of previous surgical excision of her TGDC as a child. On evaluation she was found to have a recurrent TGDC complicated by acute infection via computed tomography imaging. Conclusion: In patients who have had previous surgical intervention to remove a TGDC, recurrence with infection should remain a diagnostic consideration.

A Case of Neurosarcoid Presenting as Multiple Intraparenchymal Hemorrhages

2021 ◽  
pp. 194187442110294
Author(s):  
Amit Mehta ◽  
Fahad Khan ◽  
Chris Wagner ◽  
Taymour Hashemzadeh ◽  
Andrew Stemer ◽  
...  
Keyword(s):  
African American Male ◽  
Early Recognition ◽  
Medical Center ◽  
Delayed Diagnosis ◽  
Brain Biopsy ◽  
Neurological Deficits ◽  
High Dose ◽  
Rapid Progression ◽  
History Of ◽  
Possible Cause

This report explores the case of a 49-year-old African American male with a six-month history of multifocal neurological deficits who presented to an outside hospital after a generalized seizure. Patient was transferred to our tertiary medical center after brain imaging showed multiple bilateral supratentorial intraparenchymal hemorrhages (IPH). A brain biopsy confirmed parenchymal and perivascular non-caseating granulomas with vasculitis. The patient was definitively diagnosed with neurosarcoidosis (NS) and his condition improved with high dose corticosteroids and additional immunosuppressive therapies. Intracranial hemorrhage in the setting of NS is extremely rare, with fewer than thirty documented cases; however, this is likely an underestimation of its true prevalence. This case illustrates the difficulty in diagnosis as many other etiologies of IPH must be considered. Additionally, the clinical course and manifestations of NS is often quite variable. The uniqueness of this case lies in the rapid progression from seemingly incidental microhemorrhages to multiple large IPHs over two months. While the cause of this progression is not immediately apparent, a possible cause may be inadequate initial treatment due to delayed diagnosis. Our case demonstrates the importance of early recognition and initiation of immunosuppressive therapy, potentially leading to dramatic clinical improvement, as seen in this patient.

ITI with high-dose FIX and combined immunosuppressive therapy in a patient with severe haemophilia B and inhibitor

2009 ◽  
Vol 29 (02) ◽  
pp. 155-157 ◽  
Author(s):  
H. Hauch ◽  
J. Rischewski ◽  
U. Kordes ◽  
J. Schneppenheim ◽  
R. Schneppenheim ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Immunosuppressive Agents ◽  
Tolerance Induction ◽  
Intravenous Immunoglobulins ◽  
Factor Ix ◽  
High Dose ◽  
Allergic Reactions ◽  
Success Rates ◽  
Serious Infections ◽  
History Of

SummaryInhibitor development is a rare but serious event in hemophilia B patients. Management is hampered by the frequent occurrence of allergic reactions to factor IX, low success rates of current inhibitor elimination protocols and the risk of development of nephrotic syndrome. Single cases of immune tolerance induction (ITI) including immunosuppressive agents like mycophenolat mofetil (MMF) or rituximab have been reported. We present a case of successful inhibitor elimination with a combined immune-modulating therapy and high-dose factor IX (FIX). This boy had developed a FIX inhibitor at the age of 5 years and had a history of allergic reactions to FIX and to FEIBA→. Under on-demand treatment with recombinant activated FVII the inhibitor became undetectable but the boy suffered from multiple joint and muscle bleeds. At the age of 11.5 years ITI was attempted with a combination of rituximab, MMF, dexamethasone, intravenous immunoglobulins and high-dose FIX. The inhibitor did not reappear and FIX half-life normalized. No allergic reaction, no signs of nephrotic syndrome and no serious infections were observed.

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