Subdural false twins: concomitant appearance of subdural haematoma and spontaneous subdural empyema

2021 ◽  
Vol 14 (6) ◽  
pp. e240110
Author(s):  
Rúben Santos Cardoso ◽  
Sofia Tavares ◽  
Inácio Reis ◽  
José Luís Alves
Keyword(s):  
Multidisciplinary Approach ◽  
Systemic Infection ◽  
Blood Analysis ◽  
Surgical Drainage ◽  
Subdural Collection ◽  
E Coli ◽  
History Of ◽  
The Right ◽  
Burr Holes ◽  
Dural Opening

A 55-year-old man was taken to the emergency department due to right arm weakness for the past 3 days and fever (39.5°C). There was no impaired consciousness, no history of trauma and meningeal signs were absent on physical examination. Blood analysis and inflammatory markers were not evocative of a systemic infection. A cranial CT scan was requested, revealing hypodense bilateral hemispheric subdural collections, suggestive of chronic subdural haematomas. He was submitted to surgical drainage by burr holes, which confirmed the chronic subdural collection on the left side. Unexpectedly, after dural opening on the right side, a subdural purulent collection was found, which was later confirmed as an empyema due to Escherichia coli infection. A second surgical drainage was performed by craniotomy due to recurrence of the right subdural collection. Spontaneously appearing subdural empyemas due to E. coli are extremely rare and their treatment is not always straightforward. The reported case is an example of an apparently straightforward and frequent pathology that turned out to be a challenging case, requiring a multidisciplinary approach.

scholarly journals Beware of the Anticoagulated Elderly with Minor Head Injury

2005 ◽  
Vol 12 (2) ◽  
pp. 108-111
Author(s):  
CH Chung
Keyword(s):  
Head Injury ◽  
Subdural Haematoma ◽  
The Elderly ◽  
Minor Head Injury ◽  
Loss Of Consciousness ◽  
X Rays ◽  
Acute Subdural Haematoma ◽  
History Of ◽  
The Right ◽  
Burr Holes

A 69-year-old man first presented to the emergency department after a fall. He had no history of loss of consciousness or vomiting. He sustained a 3 cm long laceration over the right occipital region of the head. There was no fracture in the X-rays of the skull. He was on warfarin because of cardiac problem. He was discharged after suturing. He re-attended the next morning because of left sided weakness. Non-contrast brain computed tomogram showed acute subdural haematoma. Burr holes were performed subsequently. Special precautions should be undertaken in managing the elderly with minor head injury, with a lower threshold for computed tomography and coagulation profile studies.

Microsurgical Resection of Thoracic Meningioma: 2-Dimensional Operative Video

2018 ◽  
Vol 16 (4) ◽  
pp. 521-521
Author(s):  
Yutaka Ito ◽  
Kunio Yokoyama ◽  
Hidekazu Tanaka ◽  
Makoto Yamada ◽  
Masashi Yamashita ◽  
...  
Keyword(s):  
Lower Limb ◽  
Cost Effective ◽  
Magnetic Resonance Images ◽  
Surgical Removal ◽  
Spinal Meningioma ◽  
Extramedullary Tumor ◽  
Icg Angiography ◽  
History Of ◽  
The Right ◽  
Dural Opening

Abstract The primary goal of surgery with spinal meningioma is complete safe tumor removal and decompression of the spinal cord. For the surgical removal of spinal meningioma, internal debulking before dissection of the tumor capsule is essential. Intraoperative ultrasonography to localize the tumor is recommended by some authors, but we use indocyanine green (ICG) videography to visualize the localization of tumor before dural incision. ICG videography allows safe and complete delineation of intradural tumors before dural opening. This technique is quick, cost-effective, and simple to use, especially with its integration into the surgical microscope.  Herein, we present a case of a 54-yr-old female patient presenting with a 1-yr history of numbness of the right lower limb. Neurological examinations demonstrated temperature pain disorder of right lower limb and slight dysuria. Magnetic resonance images demonstrated intradural extramedullary tumor at the level of Th6. Preoperative diagnosis was spinal meningioma.  In this surgical video, we show ICG angiography before dural opening, in addition to the basic surgical procedure of the thoracic meningioma. We believe this operative video will be useful for those in training as well as practicing surgeons. We received written informed consent from the patient for this publication.

Leonardo Botallo (1530–1587) and his pioneering contributions to traumatology, cardiology and deontology

2020 ◽  
pp. 096777202094097
Author(s):  
Pamela Tozzo ◽  
Alberto Zanatta ◽  
Gabriella D’Angiolella ◽  
Luciana Caenazzo ◽  
Fabio Zampieri
Keyword(s):  
Scientific Revolution ◽  
Multidisciplinary Approach ◽  
Ductus Arteriosus ◽  
Human Anatomy ◽  
Descending Aorta ◽  
Anatomy And Physiology ◽  
Human Anatomy And Physiology ◽  
History Of ◽  
The Right ◽  
History Of Medical Ethics

Leonardo Botallo (1530–c. 1587) is widely known for the eponymous “foramen Botalli” and “ductus Botalli”. The first, most commonly named “foramen ovale”, allows blood in the fetal heart to enter the left atrium from the right atrium. The second, named “ductus arteriosus”, consists of a blood vessel in the developing fetus connecting the trunk of the pulmonary artery to the proximal descending aorta. However, Botallo was a multifaceted figure who studied many aspects of human anatomy and physiology, also making important contributions to clinical and surgical practices. Moreover, as we will see in the last section of this paper, Botallo wrote a book on medical deontology having significant features in relationship to the history of medical ethics. Botallo’s multidisciplinary approach is a typical characteristic of Renaissance physicians and scientists, who contributed to making this period a fundamental prelude to the scientific revolution of the 17th century.

Pulmonary Aggregatibacter actinomycetemcomitans infection masquerades as malignancy in a patient with periodontitis

2021 ◽  
Vol 14 (2) ◽  
pp. e239636
Author(s):  
Emma Turner ◽  
Thomas Hastie ◽  
Pritam Daniel Sundaresan
Keyword(s):  
Systemic Disease ◽  
Systemic Infection ◽  
Aggregatibacter Actinomycetemcomitans ◽  
Periodontal Pathogen ◽  
Smoking History ◽  
Active Mass ◽  
Source Of Infection ◽  
Positron Emission ◽  
History Of ◽  
The Right

A 49-year-old man with a 37.5 pack-year smoking history presented with a suspected neoplasm of the right lung following the discovery of a metabolically active mass on positron emission tomography-CT imaging. The patient, who demonstrated poor oral hygiene, had a history of irregular problem-oriented dental visitation. Having excluded malignancy through histologic investigations, Aggregatibacter actinomycetemcomitans—a well-established periodontal pathogen—was subsequently cultured from his pulmonary aspirate. The patient was therefore managed with systemic antimicrobials and adjunctive dental extractions to eliminate the likely source of infection, whereafter the mass resolved without complication. This case corroborates previous reports of extraoral isolation of A. actinomycetemcomitans, which may mimic cancer clinically and radiographically. While a definitive causative link between untreated periodontitis and systemic infection remains to be elucidated, such cases present a compelling argument in favour of promoting oral health to prevent systemic disease.

Lemierre’s Syndrome

1970 ◽  
Vol 9 (2) ◽  
Author(s):  
Pearl Behl MD ◽  
Phillip Wattam MD
Keyword(s):  
Blood Count ◽  
Complete Blood Count ◽  
Jugular Vein ◽  
Blood Cultures ◽  
Surgical Drainage ◽  
Computed Tomography Scan ◽  
Intermittent Fever ◽  
History Of ◽  
The Right ◽  
Tomography Scan

A 67-year-old immunocompetent female with a history of recurrent parotiditis developed swelling of the right side of her neck and face, intermittent fever, dyspnea, and dysphagia. Her complete blood count revealed a neutrophilic leukocytosis. Blood cultures grew Staphylococcus aureus. A computed tomography scan showed right-sided facial and neck edema, and a thrombus in the right internal jugular vein (Figure 1). A prolonged course of antibiotic therapy was initiated. In some cases, surgical drainage of any abscesses, ligation of thrombosed vessels, and anticoagulation may be required.

Unusual Clinical and Imaging Presentation of Chronic Subdural Hematoma

2017 ◽  
Vol 14 (02/03) ◽  
pp. 149-151
Author(s):  
Partha Ghosh ◽  
Kaushik Roy ◽  
Suniti Saha
Keyword(s):  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Subdural Collection ◽  
Computed Tomographic ◽  
Mode Of Presentation ◽  
First Case ◽  
Large Head ◽  
History Of ◽  
Operative Findings ◽  
The Right

AbstractVarious clinical and radiologic presentations of chronic subdural hematoma (SDH) are reported in the literature. Therefore, sometimes the presentation of a patient with chronic SDH often creates confusion regarding decision making. Here, the authors present three cases of chronic SDH, in which the clinical presentation, radiology, and operative findings were unusual. In the first case, the patient presented with acute extradural hematoma like clinical as well as radiologic presentation but intraoperatively found to have chronic calcified SDH, whereas another case with history of bilateral ventriculoperitoneal (VP) shunting at childhood presented with large head with discharging sinus at the forehead. Radiologic and operative findings were very much unusual. Intraoperatively, the bilateral subdural collection was found to have fungus-like projections with subdural space communicating with the forehead sinus. In another case, a 10-year-old girl with history of VP shunting at age of 6 months presented with left hemiparesis of subacute onset. Computed tomographic (CT) scan revealed biconvex lesion at the right parietal region intraoperatively. The authors found the shell-like lesion with inner and outer membrane calcified, within which the subdural collection was present. In these three cases, they observed the very unusual mode of presentation of chronic SDH, and in the literature such mode of presentation and operative findings of such type are very rare.

Z-line degradation and phagocytosis of sarcomeric fragments in myonecrosis

1983 ◽  
Vol 41 ◽  
pp. 790-791
Author(s):  
Melinda L. Estes ◽  
Samuel M. Chou
Keyword(s):  
Vastus Lateralis ◽  
Inflammatory Myopathy ◽  
Muscle Disease ◽  
White Female ◽  
Inflammatory Cell Infiltrate ◽  
Limb Weakness ◽  
Muscle Diseases ◽  
History Of ◽  
The Right ◽  
Mononuclear Inflammatory Cell

Many muscle diseases show common pathological features although their etiology is different. In primary muscle diseases a characteristic finding is myofiber necrosis. The mechanism of myonecrosis is unknown. Polymyositis is a primary muscle disease characterized by acute and subacute degeneration as well as regeneration of muscle fibers coupled with an inflammatory infiltrate. We present a case of polymyositis with unusual ultrastructural features indicative of the basic pathogenetic process involved in myonecrosis.The patient is a 63-year-old white female with a one history of proximal limb weakness, weight loss and fatigue. Examination revealed mild proximal weakness and diminished deep tendon reflexes. Her creatine kinase was 1800 mU/ml (normal < 140 mU/ml) and electromyography was consistent with an inflammatory myopathy which was verified by light microscopy on biopsy muscle. Ultrastructural study of necrotizing myofiber, from the right vastus lateralis, showed: (1) degradation of the Z-lines with preservation of the adjacent Abands including M-lines and H-bands, (Fig. 1), (2) fracture of the sarcomeres at the I-bands with disappearance of the Z-lines, (Fig. 2), (3) fragmented sarcomeres without I-bands, engulfed by invading phagocytes, (Fig. 3, a & b ), and (4) mononuclear inflammatory cell infiltrate in the endomysium.

Popliteal artery thrombosis secondary to a tibial osteochondroma

VASA ◽  
2011 ◽  
Vol 40 (3) ◽  
pp. 251-255 ◽  
Author(s):  
Gruber-Szydlo ◽  
Poreba ◽  
Belowska-Bien ◽  
Derkacz ◽  
Badowski ◽  
...  
Keyword(s):  
Case Report ◽  
Magnetic Resonance Angiography ◽  
Popliteal Artery ◽  
Doppler Ultrasonography ◽  
Histopathological Examination ◽  
Previous History ◽  
Plain Radiography ◽  
Artery Thrombosis ◽  
History Of ◽  
The Right

Popliteal artery thrombosis may present as a complication of an osteochondroma located in the vicinity of the knee joint. This is a case report of a 26-year-old man with symptoms of the right lower extremity ischaemia without a previous history of vascular disease or trauma. Plain radiography, magnetic resonance angiography and Doppler ultrasonography documented the presence of an osteochondrous structure of the proximal tibial metaphysis, which displaced and compressed the popliteal artery, causing its occlusion due to intraluminal thrombosis..The patient was operated and histopathological examination confirmed the diagnosis of osteochondroma.

COMMONWEALTH Forum: The Politics of Science or the Science of Politics

Commonwealth ◽  
2017 ◽  
Vol 19 (1) ◽  
Author(s):  
John Arway
Keyword(s):  
Public Policy ◽  
Natural Resource ◽  
Factual Information ◽  
The Past ◽  
Difference Of Opinion ◽  
History Of ◽  
The Right ◽  
Scientific Facts ◽  
Environmental Agency ◽  
Laws And Regulations

The challenges of including factual information in public policy and political discussions are many. The difficulties of including scientific facts in these debates can often be frustrating for scientists, politicians and policymakers alike. At times it seems that discussions involve different languages or dialects such that it becomes a challenge to even understand one another’s position. Oftentimes difference of opinion leads to laws and regulations that are tilted to the left or the right. The collaborative balancing to insure public and natural resource interests are protected ends up being accomplished through extensive litigation in the courts. In this article, the author discusses the history of environmental balancing during the past three decades from the perspective of a field biologist who has used the strength of our policies, laws and regulations to fight for the protection of our Commonwealth’s aquatic resources. For the past 7 years, the author has taken over the reins of “the most powerful environmental agency in Pennsylvania” and charted a course using science to properly represent natural resource interests in public policy and political deliberations.

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