Flaps in adult urethrocutaneous fistula repair: a report of two cases with the review of literature

2021 ◽  
Vol 14 (4) ◽  
pp. e236475
Author(s):  
Sri Harsha Bokka ◽  
Sreerag Kodakkattil Sreenivasan ◽  
Ketan Mehra ◽  
Friji Meethale Thiruvoth

Urethrocutaneous fistula (UCF) poses a challenge to the reconstructive urologist in terms of its location, patient’s expectations, availability of tissues for interposition, wound infection and chances of recurrence. Also, patient-related factors, such as uncontrolled diabetes, local surgery with extensive tissue loss, prior history of radiation, poor nutritional status and presence of any distal obstruction in the urethra severely affect the outcomes of a good repair with vascularised flap. We report two cases of UCF repair in adults using scrotal and gracilis muscle flaps (GMFs), their anatomic basis, technicality and advantages. The scrotal flap was used in the first case where it was freely available and GMF in second case where the patient had already undergone extensive local tissue debridement for Fournier’s gangrene and hence, we had to look for a distant flap for protection of the UCF repair. Both patients had an uneventful recovery, there were no early or late treatment-related complications and follow-up after the third and sixth month of surgery revealed no recurrence and the patients are voiding well.

Author(s):  
Minjung Lee ◽  
Myoungsoon You

Avoidance of healthcare utilization among the general population during pandemic outbreaks has been observed and it can lead to a negative impact on population health. The object of this study is to examine the influence of socio-demographic and health-related factors on the avoidance of healthcare utilization during the global outbreak of a novel coronavirus (COVID-19) in 2020. Data were collected through an online survey four weeks after the Korea Centers for Disease Control and Prevention (KCDC) confirmed the first case in South Korea; 1000 subjects were included in the analysis. The logit model for regression was used to analyze the associations between sociodemographic and health-related factors regarding the avoidance of healthcare utilization. Among the participants, 73.2% avoided healthcare utilization, and there was no significant difference in the prevalence of healthcare avoidance between groups with (72.0%) and without (74.9%) an underlying disease. Sociodemographic characteristics (e.g., gender, age, income level, and residential area) were related to healthcare avoidance. Among the investigated influencing factors, residential areas highly affected by COVID-19 (i.e., Daegu/Gyeoungbuk region) had the most significant effect on healthcare avoidance. This study found a high prevalence of healthcare avoidance among the general population who under-utilized healthcare resources during the COVID-19 outbreak. However, the results reveal that not all societal groups share the burden of healthcare avoidance equally, with it disproportionately affecting those with certain sociodemographic characteristics. This study can inform healthcare under-utilization patterns during emerging infectious disease outbreaks and provide information to public health emergency management for implementing strategies necessary to improve the preparedness of the healthcare system.


2021 ◽  
Author(s):  
Piyush Kumar

Background: – This time last year in 2020 India was under lockdown phase, many theories about India’s surprisingly low rates of Sars-CoV-2 infection included variety of factors including hot weather, natural immunity, heard immunity, robust health system, highly qualified doctors and the country’s high proportion of young people; some also attributed it to the country’s harsh lockdown. India was doing so well that in megacities like Mumbai and Delhi, officials had begun dismantling temporary COVID-19 facilities. Comparing it to current scenario in April 2021, cases and deaths are soaring. The shortage of beds and space is so acute that people are dying in car parks and other places while waiting to be admitted in hospitals. Daily rates are currently over 300,000, the world’s highest-ever daily infection rate. The SARS-CoV-2/ Covid -19 pandemic is still going on and globally as well as in India particularly healthcare system is overstressed with this new burden added with previous NCD(non communicable diseases) & CD(communicable diseases). The First human case of this global pandemic was reported from Wuhan city of China in December 2019. The first case of covid-19 in India was found in January 2020. Today India is having more than 3 lakh cases per day and thousands of deaths daily due to this pandemic. The situation is very worse as compared to previous year and is worsening day by day due to several factors.Objective: – The main objective of this study is to illustrate the key features of Covid -19 virus, host human beings factors, irresponsibility’s and environmental factors responsible for continuation and recurrence of this pandemic as well as worsening of pandemic day by day. Setting and design: – Different aspects of Covid -19 structural variations, mutations, host factors, environmental factors (internal & external) and its effect will be analysed. Brief details about epidemiological triad will be outlined. Methodology: – The explanation will be given to title through analysis of several factors responsible for increase in cases. The cause of perpetuation of Covid -19 can be understood by the way of infections and other related factors. Result: - Several factors are responsible for the continuation and worsening of pandemic situation in India of the pandemic. Of great concern today is a new ‘double mutant’ B1617 variant, identified in India last year, that is spreading across the country as well as triple variants discovered recently and studies are going on to know more. Although scientists are still investigating whether or not the variant is more deadly & more infectious, it does contain the L452R mutation that affects the virus' spike protein. This protein is very significant because through this the virus hooks on to our cells receptor. Early research suggests that this mutation makes the virus more infectious. This doesn’t necessarily mean that the variant will be any more deadly, but it means that more people are at risk. Conclusion: – In the epidemiological triad we have agent/host/environment. The clinical approach is based on individuals & standard treatment guidelines-protocols and public health approach is based on population strategy to control this pandemic. Various strategies and approaches are required to prevent epidemic through assessment of important parameters and indicators (see figure 1) to control the ongoing disaster and hazards of pandemicKeywords: – SARS-Cov-2, Covid-19, Pandemic, Strain, India, increase cases , death


2020 ◽  
Vol 6 (1) ◽  
pp. e30-e32
Author(s):  
Mimi Wong ◽  
Nirjhar Nandi ◽  
Ashim Sinha

Objective: Immunotherapy is a novel treatment that can cause autoimmune diabetes in rare cases. More cases occur following use of the inhibitor to the protein programmed cell death-1 rather than the inhibitor to programmed cell death-ligand 1. Methods: We report a unique case of autoimmune diabetes following atezolizumab use. Results: A 55-year-old, Aboriginal Australian female with no prior history of diabetes was commenced on atezolizumab for recurrent squamous cell lung carcinoma. Two months following its commencement, there was the onset of fatigue, polyuria, polydipsia, and new hyperglycemia. Subsequently she was found to have a borderline-low C peptide level of 0.6 nmol/L (reference range is 0.5 to 1.0 nmol/L), and positive zinc transporter-8 antibodies. Following the diagnosis of autoimmune diabetes, 5 units of glargine insulin was commenced which maintained euglycemia and resolved her symptoms of hyperglycemia. Conclusion: There are few case reports of atezolizumab-induced autoimmune diabetes. We present the first case associated with zinc transporter-8 antibodies, and a unique case of autoimmune diabetes in a patient of Aboriginal Australian background.


2020 ◽  
Vol 33 (6) ◽  
pp. 429 ◽  
Author(s):  
Joana Lyra ◽  
Rita Valente ◽  
Marta Rosário ◽  
Mariana Guimarães

We report the first cesarean delivery in a woman with COVID-19 in a level III hospital in Portugal. It refers to a healthy woman with a term pregnancy that tested positive for COVID-19 on the day of labor induction. Given a Bishop score < 4 and the prior history of a cesarean section, the team decided to perform a surgical delivery. Appropriate personal protective equipment and safety circuits were employed, as described in more detail in the case report. Both the mother and the newborn are well. With this report we aimed to share our concerns, clinical management, maternal and neonatal outcomes, and to present our current circuits and adjustments regarding the COVID-19 pandemic in our maternity hospital.


CytoJournal ◽  
2005 ◽  
Vol 2 ◽  
pp. 8 ◽  
Author(s):  
Sarah M Bean ◽  
Mohamad A Eloubeidi ◽  
Isam A Eltoum ◽  
Robert J Cerfolio ◽  
Darshana N Jhala

We report the first case of a posterior mediastinal granular cell tumor initially diagnosed on cytologic material obtained via endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in a 51-year-old male with a prior history of colon cancer. Aspirates obtained were cellular and composed of polygonal cells with abundant granular cytoplasm and small, round dark nuclei. An immunoperoxidase stain performed on the cell block for antibodies to S-100 protein showed strong, diffuse staining of the cytoplasmic granules. Electron microscopy performed on the cell block revealed numerous cytoplasmic lysosomes. This is the first case report in the English literature of a definitive preoperative diagnosis of a mediastinal granular cell tumor utilizing material obtained via EUS-FNA.


Vascular ◽  
2014 ◽  
Vol 23 (6) ◽  
pp. 653-656
Author(s):  
Christos Argyriou ◽  
George S Georgiadis ◽  
Michael Mantatzis ◽  
Nikolaos G Schoretsanitis ◽  
George A Antoniou ◽  
...  

Aim Hybrid vascular interventions performed in patients with chronic limb ischemia are considered minimally invasive techniques for treating complex multilevel arterial occlusive disease. Methods We report the case of a 42-year-old woman with a critical upper limb ischemia, who underwent angioplasty and secondary stenting of the distal-third of the axillary artery followed by a brachial–brachial bypass using an autologous graft. Results The patient had an uneventful recovery. To our knowledge, this is the first case reported in the literature of hybrid vascular reconstruction in the upper limb due to atherosclerosis. Conclusion Hybrid revascularization procedure in the upper limb is technically feasible, safe for the patient, and should become a part of the armamentarium of the modern vascular surgeon.


Author(s):  
Ravindra Chari M ◽  
Manju Rajaram ◽  
Madhusmita M ◽  
Pampa ChToi ◽  
Sneha L

Co-infections or consecutive infections of mucormycosis and aspergillosis are very rare. Additionally, distinguishing between these two infections is also difficult as both these conditions have similar clinical features. We report two similar cases from Tamilnadu, who presented to a tertiary care centre in Puducherry, India in 2017 (first case) and 2019 (second case).The first case was a 70-year-old, non-diabetic male patient who presented with haemoptysis with a prior history of pulmonary tuberculosis. Computed tomography bronchial angiography revealed an air-crescent sign and the histopathological examination showed a fungal ball (aspergillus and mucor) in the upper lobe and foci of fungal infection in the middle lobe. The second case was a 65-year-old diabetic male patient who presented with blackish expectoration and haemoptysis. A high-resolution computed tomography scan showed a reverse-halo sign in the right upper lobe. The results of the bronchoscopy-guided biopsy were consistent with a diagnosis of mixed mucormycosis and aspergillosis with angioinvasion. Both patients responded to amphotericin B with surgical excision of the affected lobe in the first case.A high degree of clinical suspicion, early surgical intervention and antifungal therapy are essential in the treatment of this rare co-infection. Keywords:Aspergillosis; Mucormycosis; Bronchoscopy; Coinfection; Amphotericin B; Case Report; India.


2020 ◽  
Vol 6 (3) ◽  
pp. 63-72
Author(s):  
Max Mifsud ◽  
Jamie Y. Ferguson ◽  
David A. Stubbs ◽  
Alex J. Ramsden ◽  
Martin A. McNally

Abstract. Chronic bone infections often present with complex bone and soft tissue loss. Management is difficult and commonly delivered in multiple stages over many months. This study investigated the feasibility and clinical outcomes of reconstruction in one stage. Fifty-seven consecutive patients with chronic osteomyelitis (n=27) or infected non-union (n=30) were treated with simultaneous debridement, Ilizarov method and free muscle flap transfer. 41 patients (71.9 %) had systemic co-morbidities (Cierny-Mader group Bs hosts). Infection was confirmed with strict criteria. 48 patients (84.2 %) had segmental defects. The primary outcome was eradication of infection at final follow-up. Secondary outcomes included bone union, flap survival and complications or re-operation related to the reconstruction. Infection was eradicated in 55∕57 cases (96.5 %) at a mean follow-up of 36 months (range 12–146). No flap failures occurred during distraction but 6 required early anastomotic revision and 3 were not salvageable (flap failure rate 5.3 %). Bony union was achieved in 52∕57 (91.2 %) with the initial surgery alone. After treatment of the five un-united docking sites, all cases achieved bony union at final follow-up. Simultaneous reconstruction with Ilizarov method and free tissue transfer is safe but requires careful planning and logistic considerations. The outcomes from this study are equivalent or better than those reported after staged surgery.


2020 ◽  
Vol 54 (5) ◽  
pp. 731-737
Author(s):  
Omid Liaghat ◽  
Zohre Shabbooie

Abstract Background Ectopic banking includes techniques and indications used to bank amputated body parts for later replantation when a body part is amputated in its entirety. Immediate replantation is sometimes impossible due to hemodynamic instability, soft tissue loss, and extensive contamination of the amputated part. The first case of temporary ectopic banking of hand implantation was reported in 2015 by Xu Zhang in China which was not completely successful. The first replantation was reported almost 54 years ago, followed by a limited number of similar cases that were not successful. Xu could not restore the useful function of the replanted hand. Purpose In this study, we reported a case of hand replantation by the banking technique. Method We carried out a hand replantation by the banking technique using the right ankle as the recipient site. Result We restored the useful function of the amputated part and evaluated the function with standard tests. Conclusion Using right ankle as recipient site in ectopic banking can be a useful approach which helps and ensures the researchers and surgeons to decide if they intend to use this method.


2019 ◽  
Vol 2019 (10) ◽  
Author(s):  
Rathin Gosavi ◽  
George Balalis ◽  
Andrew Packiyanathan

Abstract Bowel perforation is a rare and unusual complication of laparoscopic adjustable gastric band (LAGB) insertion, which if left undiagnosed can have potentially fatal consequences. We present the first case ever published of a delayed presentation of small-bowel perforation secondary to a laparoscopic port insertion. A young woman presented to Emergency Department with intermittent vague abdominal pain for 5 months, on the background of having a LAGB inserted 4 years prior. She was subsequently found to have a small-bowel perforation with mesenteric adhesions to a laparoscopic port site. The patient underwent a successful small-bowel resection with primary anastomosis and made an uneventful recovery.


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