Hypopharyngeal perforation caused by blunt trauma during consensual fellatio: an expectant management approach

2021 ◽  
Vol 14 (8) ◽  
pp. e242846
Author(s):  
Edward Noon ◽  
Emma Stapleton
Keyword(s):  
Expectant Management ◽  
Management Approach ◽  
Nasogastric Feeding ◽  
Hypopharyngeal Perforation ◽  
Swallowing Problems ◽  
Pharyngeal Perforation ◽  
Empirical Antibiotics ◽  
Contrast Swallow ◽  
Short Time

Perforation of the pharynx is a rare occurrence but has the potential to cause mediastinitis and has an attendant mortality risk. Though numerous mechanisms have been described, we report a unique case of a young woman who presented with a sore throat, odynophagia and subcutaneous emphysema, a short time after performing fellatio. A contrast swallow confirmed hypopharyngeal perforation. She was managed expectantly with nasogastric feeding and empirical antibiotics. The perforation took 4 weeks to heal, but there were no residual swallowing problems at 3-month follow-up. We will explore the incidence and causes of pharyngeal perforation and discuss the options for and risks of surgical repair. This case highlights that non-surgical management of such injuries can be both safe and feasible, and reinforces the importance of ensuring confidentiality and the need for vigilance regarding potential non-consensual injury.

scholarly journals Evaluation and management of congenital esophageal stenosis: a rare entity

2016 ◽  
Vol 4 (1) ◽  
pp. 408
Author(s):  
Jiledar Rawat ◽  
Anand Pandey ◽  
Sudhir Singh ◽  
Sarita Singh
Keyword(s):  
Esophageal Stenosis ◽  
Antireflux Procedure ◽  
Upper Gastrointestinal Endoscopy ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Swallowing Problems ◽  
Swallow Study ◽  
Treat All ◽  
Contrast Swallow

Background:Congenital esophageal stenosis (CES) is an uncommon condition presenting with swallowing problems. It has been classified into three types. Clinically, the condition is manifested as dysphagia. This is more common after introduction of semisolid to solid foods. We present the management strategy of this uncommon entity.Methods: This study ranged from January 2009 to January 2015. Six patients of CES were included in the study. The patients were diagnosed by contrast swallow study and upper gastrointestinal endoscopy. The initial management included esophageal dilation under fluoroscopy guidance. In case of failed dilation, thoracotomy, resection of the stenotic segment and primary esophageal anastomosis was performed. If required, antireflux procedure was added.Results:In 4 patients, the stenosis was in middle esophagus.  Of these, one had associated esophageal diverticulum. In 2 patients, the stenosis was in the lower esophagus. These patients also underwent antireflux surgery. After the surgery, all patients were able to swallow properly. There was no problem in the follow up except in one patient, who needed dilation in the follow up. He responded to the dilation.Conclusions:High index of suspicion is needed to diagnoses this condition. Dilation may not be successful to treat all type all type of CES, for whom surgery will be needed. Long term outcome may be satisfactory.

scholarly journals A 20-Year Follow-Up Study of Objectively Measured Physical Activity

2021 ◽  
Vol 18 (6) ◽  
pp. 3076
Author(s):  
Anders Raustorp ◽  
Andreas Fröberg
Keyword(s):  
Physical Activity ◽  
Early Adolescence ◽  
Total Sample ◽  
Short Time Span ◽  
Steps Per Day ◽  
Objectively Measured ◽  
Short Time ◽  
Objectively Measured Physical Activity

Background: The objectives of this study were to explore the effect of time, long-term tracking, and the proportion of objectively measured physical activity (PA) from early adolescence to the mid-thirties. Methods: PA was measured as mean steps per day (SPD) with pedometers during 2000 (T1), 2003 (T2), 2005 (T3), 2010 (T4), 2016 (T5) and 2020 (T6). Data from 64 participants (n = 32 males) were analysed from their early adolescence (T1) to their mid-thirties (T6). Results: SPD decreased in the total sample and among males and females (all, p < 0.001). Males took more mean SPD than females during T1 (p = 0.002), whereas females took more mean SPD during T2 (p = 0.009) and T6 (p = 0.008). Males’ mean SPD tracked between T1 and T2 (p = 0.021), T2 and T3 (p = 0.030), T3 and T4 (p = 0.015) and T4 and T5 (p = 0.003). Females’ mean SPD tracked between T3 and T4 (p = 0.024) and T5 and T6 (p < 0.001). In the total sample, more mean SPD were found on weekdays compared to weekend days at T3 (p = 0.017) and T5 (p < 0.001). Conclusions: SPD decreased between T1 and T6. Mean SPD tracked low-to-moderate in the short time span. From late adolescence to the mid-thirties, more mean SPD was observed during weekdays compared to weekend days.

The Definition, Diagnosis, and Management of Growth-Discordant Twins: An International Census Survey

1991 ◽  
Vol 40 (3-4) ◽  
pp. 345-351 ◽  
Author(s):  
I. Blickstein
Keyword(s):  
Stress Testing ◽  
Expectant Management ◽  
Doppler Velocimetry ◽  
Diagnosis And Management ◽  
Clear Cut ◽  
Biophysical Profile ◽  
Per Se ◽  
Discordant Twins ◽  
Discordant Twin

AbstractIn order to establish a protocol considering the definition, diagnosis, and management of growth-discordant twin gestations, a questionnaire was sent to 96 authors of twin-related obstetric articles. The views of the 61 responders comprise this international census survey. The data suggest that a clear cut-off value for discordancy is still needed; however, the data indirectly supported a two-grade definition, namely, mild (> 15% and < 25% birth-weight disparity) and severe (> 25%) growth discordants. Expectant management was advocated by the majority of participants with out-patient follow-up for mild discordants, while severe discordants may preferably be hospitalized. Follow-up should be done by non-stress testing (daily - 2/wk), biophysical profile (1-2/wk), Doppler velocimetry (1/wk - bi-weekly) and sonographic biometry (bi-weekly). The opinions considering termination of pregnancy because of intertwin growth discordancy were divided; however, discordancy per se, was not considered an indication for cesarean delivery. An adapted management flowchart that summarizes the survey's data is presented and may be used as a standard for future investigations.

scholarly journals Cross‐Sex Hormone Therapy in Trans Persons Is Safe and Effective at Short‐Time Follow‐Up: Results from the European Network for the Investigation of Gender Incongruence

2014 ◽  
Vol 11 (8) ◽  
pp. 1999-2011 ◽  
Author(s):  
Katrien Wierckx ◽  
Eva Van Caenegem ◽  
Thomas Schreiner ◽  
Ira Haraldsen ◽  
Alessandra Fisher ◽  
...  
Keyword(s):  
Hormone Therapy ◽  
Sex Hormone ◽  
European Network ◽  
In Trans ◽  
Short Time

Idiopathic juvenile osteoporosis in a child: a four-year follow-up with review of literature

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Aashima Dabas ◽  
Rakhi Malhotra ◽  
Ravindra Kumar ◽  
Rajesh Khadgawat
Keyword(s):  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Underlying Disease ◽  
Bone Fragility ◽  
Management Approach ◽  
Primary Osteoporosis ◽  
Disease States ◽  
Idiopathic Juvenile Osteoporosis ◽  
Density Lipoprotein Receptor

Abstract Objectives Childhood osteoporosis is an uncommon condition that usually develops secondary to underlying disease states. Idiopathic juvenile osteoporosis or early onset osteoporosis is a rare cause of primary osteoporosis in childhood associated with mutations in “bone fragility” genes. Case presentation The index case presented with upper back pain and was detected to have multiple vertebral fractures. Further workup for the cause revealed a homozygous benign mutation in low-density lipoprotein receptor-related protein 5, which was also detected in the mother who remained asymptomatic till presentation. The child was successfully treated with intravenous zoledronate. Conclusions The case report describes the management approach and four-year follow-up of the child.

scholarly journals The impact of method of distal ureter management during radical nephroureterectomy on tumour recurrence

2014 ◽  
Vol 8 (11-12) ◽  
pp. 845 ◽  
Author(s):  
Anil Kapoor ◽  
Shawn Dason ◽  
Christopher B. Allard ◽  
Bobby Shayegan ◽  
Louis Lacombe ◽  
...  
Keyword(s):  
Cox Regression ◽  
Tumour Recurrence ◽  
Management Approach ◽  
Management Technique ◽  
Recurrence Free Survival ◽  
Radical Nephroureterectomy ◽  
Distal Ureter ◽  
Free Survival ◽  
Cox Regression Analysis

Introduction: Radical nephroureterectomy for upper tract urothelial carcinoma (UTUC) must include some form of distal ureter management to avoid high rates of tumour recurrence. It is uncertain which distal ureter management technique has the best oncologic outcomes. To determine which distal ureter management technique resulted in the lowest tumour recurrence rate, we analyzed a multiinstitutional Canadian radical nephroureterectomy database.Methods: We retrospectively analyzed patients who underwent radical nephroureterectomy with distal ureter management for UTUC between January 1990 and June 2010 at 10 Canadian tertiary hospitals. Distal ureter management approaches were divided into 3 categories: (1) extravesical tenting for ureteric excision without cystotomy (EXTRAVESICAL); (2) open cystotomy with intravesical bladder cuff excision (INTRAVESICAL); and (3) extravesical excision with endoscopic management of ureteric orifice (ENDOSCOPIC). Data available for each patient included demographic details, distal ureter management approach, pathology and operative details, as well as the presence and location of local or distant recurrence. Clinical outcomes included overall recurrence-free survival and intravesical recurrence-free survival. Survival analysis was performed with the Kaplan-Meier method. Multivariable Cox regression analysis was also performed.Results: A total of 820 patients underwent radical nephroureterectomy with a specified distal ureter management approach at 10 Canadian academic institutions. The mean patient age was 69.6 years and the median follow-up was 24.6 months. Of the 820 patients, 406 (49.5%) underwent INTRAVESICAL, 316 (38.5%) underwent EXTRAVESICAL, and 98 (11.9%) underwent ENDOSOPIC distal ureter management. Groups differed significantly in their proportion of females, proportion of laparoscopic cases, presence of carcinoma in situ and pathological tumour stage (p < 0.05). Recurrence-free survival at 5 years was 46.3%, 35.6%, and 30.1% for INTRAVESICAL, EXTRAVESICAL and ENDOSCOPIC, respectively (p < 0.05). Multivariable Cox regression analysis confirmed that INTRAVESICAL resulted in a lower hazard of recurrence compared to EXTRAVESICAL and ENDOSCOPIC. When looking only at intravesical recurrence-free survival (iRFS), a similar trend held up with INTRAVESICAL having the highest iRFS, followed by ENDOSCOPIC and then EXTRAVESICAL management (p < 0.05). At last follow-up, 406 (49.5%) patients were alive and free of disease.Conclusion: Open intravesical excision of the distal ureter (INTRAVESICAL) during radical nephroureterectomy was associated with improved overall and intravesical recurrence-free survival compared with extravesical and endoscopic approaches. These findings suggest that INTRAVESICAL should be considered the gold standard oncologic approach to distal ureter management during radical nephroureterectomy. Limitations of this study include its retrospective design, heterogeneous cohort, and limited follow-up.

Exacerbated mini-puberty of infancy in an ex-extreme preterm girl

2020 ◽  
Vol 13 (9) ◽  
pp. e235492
Author(s):  
Mafalda Casinhas Santos ◽  
Sara Limão ◽  
Patrícia Ferreira
Keyword(s):  
Ovarian Cyst ◽  
Luteinising Hormone ◽  
Vaginal Bleeding ◽  
Expectant Management ◽  
Central Precocious Puberty ◽  
Spontaneous Resolution ◽  
Breast Development ◽  
Long Term Follow Up

Vaginal bleeding can occur shortly after delivery in 3%–5% of newborns as a consequence of placental hormone withdrawal . Although usually benign, its differential diagnosis includes central precocious puberty, tumours and other pathological conditions. A girl born at 26 weeks of gestation presented with five episodes of vaginal bleeding, each lasting less than a week, initiated at 4 months of age. Luteinising hormone and oestradiol levels were in the pubertal range. Later, she exhibited breast development, with no other pubertal signs. An ultrasonography test revealed an impregnated endometrium and a right ovarian cyst with 43 mm of diameter. A cranioencephalic MRI was unremarkable. Clinicians adopted expectant management and there was clinical, hormonal and radiological resolution in 3 months. The spontaneous resolution suggested mini-puberty of infancy. This is usually an asymptomatic condition, but to date, four cases of an exacerbated form in extremepremature infants have been reported. Long-term follow-up data are missing.A girl born at 26 weeks of gestation presented with five episodes of vaginal bleeding, each lasting less than a week, initiated at 4 months of age. Luteinising hormone and oestradiol levels were in the pubertal range. Later, she exhibited breast development, with no other pubertal signs. An ultrasonography test revealed an impregnated endometrium and a right ovarian cyst with 43 mm of diameter. A cranioencephalic MRI was unremarkable. Clinicians adopted expectant management and there was clinical, hormonal and radiological resolution in 3 months. The spontaneous resolution suggested mini-puberty of infancy. This is usually an asymptomatic condition, but to date, four cases of an exacerbated form in extremepremature infants have been reported. Long-term follow-up data are missing.

scholarly journals Pancreatic Neuroendocrine Tumor with Benign Serous Cystadenoma: A Rare Entity

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Randhir Sagar Yadav ◽  
Ashik Pokharel ◽  
Shumneva Shrestha ◽  
Ashbita Pokharel ◽  
Deepshikha Gaire ◽  
...  
Keyword(s):  
Neuroendocrine Tumor ◽  
Histopathological Examination ◽  
Epigastric Pain ◽  
Pancreatic Neuroendocrine Tumor ◽  
Serous Cystadenoma ◽  
Neuroendocrine Neoplasm ◽  
Management Approach ◽  
Cystic Neoplasms ◽  
Distal Pancreas

Mixed serous-neuroendocrine neoplasm constitutes pancreatic serous cystic neoplasms and pancreatic neuroendocrine tumor, two tumor components with different underlying pathologies. The differentiation of these tumors is important as the management and prognosis depend on the pancreatic neuroendocrine tumor component. We report a case of mixed serous-neuroendocrine neoplasm in a 47-year-old female who presented with epigastric pain abdomen for two years. Imaging studies, tumor markers, thorough systemic evaluation, surgical resection, histopathological examination, and timely follow-up constituted our management approach. A 4 cm × 4 cm mass in the distal pancreas with multiple cysts in the pancreatic parenchyma containing serous fluid on distal pancreatectomy and splenectomy was found. The histopathological examination revealed combined benign serous cystadenoma and neuroendocrine tumor. She did not have any recurrence or metastasis by four years of follow-up.

Sign in / Sign up

Export Citation Format

Share Document