scholarly journals Acquired Abdominal Intercostal Hernia: A Case Report and Literature Review

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Salim Abunnaja ◽  
Kevin Chysna ◽  
Inam Shaikh ◽  
Giuseppe Tripodi
Keyword(s):  
Clinical Presentation ◽  
Stab Wound ◽  
Treatment Strategies ◽  
Clinical Suspicion ◽  
Appropriate Treatment ◽  
Obese Female ◽  
High Clinical Suspicion ◽  
Intercostal Hernia ◽  
History Of ◽  
Abdominal Intercostal Hernia

Acquired abdominal intercostal hernia (AAIH) is a rare disease phenomenon where intra-abdominal contents reach the intercostal space directly from the peritoneal cavity through an acquired defect in the abdominal wall musculature and fascia. We discuss a case of a 51-year-old obese female who arrived to the emergency room with a painful swelling between her left 10th rib and 11th rib. She gave a history of a stab wound to the area 15 years earlier. A CT scan revealed a fat containing intercostal hernia with no diaphragmatic defect. An open operative approach with a hernia patch was used to repair this hernia. These hernias are difficult to diagnose, so a high clinical suspicion and thorough history and physical exam are important. This review discusses pathogenesis, clinical presentation, complications, and appropriate treatment strategies of AAIH.

scholarly journals Infections of the hand: an overview

2019 ◽  
Vol 4 (5) ◽  
pp. 183-193 ◽  
Author(s):  
Dimitrios A. Flevas ◽  
Sophia Syngouna ◽  
Emmanouel Fandridis ◽  
Sotirios Tsiodras ◽  
Andreas F. Mavrogenis
Keyword(s):  
Primary Care Physicians ◽  
Clinical Suspicion ◽  
Correct Identification ◽  
Orthopaedic Surgeons ◽  
Appropriate Treatment ◽  
High Clinical Suspicion ◽  
Inappropriate Treatment ◽  
The Social ◽  
History Of ◽  
Common Infections

Infections of the hand are common entities that are frequently encountered by orthopaedic surgeons and primary care physicians. A high clinical suspicion and a thorough medical history with information about the social and working history of the patients, correct identification of the type and cause of the infection, and prompt initiation of appropriate treatment by the infectious diseases physicians and orthopaedic surgeons are required. Late diagnosis and inappropriate treatment may be a significant cause of morbidity for the hand and mortality for the patients. This article reviews the clinical spectrum and microbiology of the most common infections of the hand, and discusses the current concepts for their treatment. The aim is to increase the awareness of the treating physicians of the diagnosis and management of infections in the hand. Cite this article: EFORT Open Rev 2019;4:183-193. DOI: 10.1302/2058-5241.4.180082

Abdominal intercostal hernia and costal arch repair

2021 ◽  
Vol 14 (11) ◽  
pp. e247189
Author(s):  
Jacob Moneim
Keyword(s):  
Case Report ◽  
Hernia Repair ◽  
Total Arthroplasty ◽  
Costal Arch ◽  
Intercostal Hernia ◽  
History Of ◽  
Abdominal Intercostal Hernia ◽  
Fat Herniation ◽  
Diaphragmatic Hernia Repair

A 70-year-old asthmatic man presented with a history of chronic intermittent left-sided chest pains and a bulge-like deformity of his chest which became more prominent with expiration. He sustained a traumatic fall 2 years prior whereby he fractured his right humerus at the surgical neck, requiring total arthroplasty. Examination and CT imaging of the thorax revealed a left costal arch fracture with hemidiaphragm rupture and associated transperitoneal fat herniation. He underwent left thoracolaparotomy with costal arch and diaphragmatic hernia repair. He was discharged 48 hours postoperatively and is satisfied with good outcomes under initial follow-up. This case report highlights the surgical management of a condition that usually presents late after significant trauma and may progress to visceral strangulation if untreated.

scholarly journals Management Considerations in Ruptured Isolated Radiculopial Artery Aneurysms

2013 ◽  
Vol 19 (1) ◽  
pp. 60-66 ◽  
Author(s):  
A.C.G.M. Van Es ◽  
P.A. Brouwer ◽  
P.W.A. Willems
Keyword(s):  
Surgical Treatment ◽  
Management Strategy ◽  
Clinical Course ◽  
Treatment Strategies ◽  
The Other ◽  
Posterior Spinal Artery ◽  
Appropriate Treatment ◽  
History Of ◽  
Clinical Paradigm ◽  
Slight Growth

Little is known on the natural history of ruptured isolated aneurysms of the posterior spinal artery (PSA). To date, only a few of such cases have been described in the literature. This paper aims to assess the most appropriate management strategy, based on the available literature and two new cases. In one of these, treatment was postponed until day 33, when angiography showed slight growth of the aneurysm. In the other, conservative treatment, requested by the patient, was successful. From these data, we conclude that treatment strategies for ruptured PSA aneurysms may vary. Aside from the recommendation by others to perform prompt surgical treatment, we suggest an alternative clinical paradigm allowing for the evaluation of the early clinical course. This may preclude the unnecessary treatment of spontaneously regressing lesions and still allows for appropriate treatment for persistent lesions.

Postauricular swelling secondary to salmonella extradural abscess in a toddler: a near miss condition

2021 ◽  
Vol 14 (7) ◽  
pp. e243412
Author(s):  
Chee Chean Lim ◽  
Jeyasakthy Saniasiaya ◽  
Jeyanthi Kulasegarah
Keyword(s):  
Infectious Disease ◽  
Rare Case ◽  
Clinical Suspicion ◽  
Near Miss ◽  
Emergency Setting ◽  
History Taking ◽  
Suppurative Otitis Media ◽  
High Clinical Suspicion ◽  
Life Threatening ◽  
History Of

Postauricular swelling is usually encountered in an emergency setting in otorhinolaryngology, resulting from complication of acute or chronic suppurative otitis media. Besides that, postauricular swelling may occur secondary to various other conditions including infectious disease, tumour, vascular malformation, granulomatous condition and even trauma. Children less than 2 years old are prone to fall and up to 10% sustain traumatic brain injury without any obvious signs of neurological deficit. We describe a rare case of a postauricular swelling in a toddler which turned out to be salmonella extradural abscess from an infected traumatic haematoma. The importance of high clinical suspicion especially in a child with a history of fall cannot be emphasised more because a missed brain abscess could lead to potentially life-threatening problems. We would like to highlight that meticulous history taking along with prompt assessment and intervention is prudent for a better prognosis and recovery.

scholarly journals Laparoscopic IPOM repair of an acquired abdominal intercostal hernia

2018 ◽  
pp. bcr-2018-227158 ◽  
Author(s):  
Muhammad Qais Luqman ◽  
Afzaal Mughal ◽  
Ronan Waldron ◽  
Iqbal Z Khan
Keyword(s):  
Recurrence Risk ◽  
Outpatient Setting ◽  
Minor Trauma ◽  
Open Approach ◽  
Contrast Enhanced ◽  
Intercostal Hernia ◽  
History Of ◽  
Onlay Mesh ◽  
Intraperitoneal Onlay Mesh Technique ◽  
Abdominal Intercostal Hernia

Acquired abdominal intercostal hernia (AAIH) is an infrequent occurrence whereby intra-abdominal contents herniate into intercostal space directly from the peritoneal cavity through an acquired defect in the abdominal wall musculature and fascia. These hernias are difficult to diagnose and should always be suspected when a chest wall swelling occur after major or minor trauma. Surgical repair is warranted in symptomatic patients. The majority of AAIHs are repaired through an open approach using tension-free mesh, with significant recurrence risk. Recently, laparoscopic and robot-assisted repairs have been proposed. We discuss a 49-year-old man presented through outpatient setting with a 5-year history of ongoing left subcostal discomfort and a reducible lump. His history included a workplace accident 5 years ago. Contrast-enhanced abdominal CT confirmed AAIH with omentum herniation into the sac. A successful laparoscopic repair with intraperitoneal onlay mesh technique using composite mesh was performed.

scholarly journals Seizure following the Use of the COX-2 Inhibitor Etoricoxib

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Valentina Arnao ◽  
Marianna Riolo ◽  
Brigida Fierro ◽  
Paolo Aridon
Keyword(s):  
Clinical Presentation ◽  
Clinical Symptoms ◽  
Epileptic Seizures ◽  
Clonic Seizure ◽  
Tonic Clonic Seizure ◽  
Generalized Seizures ◽  
Appropriate Treatment ◽  
History Of ◽  
Cox 2 ◽  
Cox 2 Inhibitors

We describe a case of epileptic seizures occurring after the use of a COX-2 inhibitor. A 61-year-old man was admitted to our department because of a generalized tonic-clonic seizure. EEG showed generalized slowdown of the activity. Neuroimaging and blood samples studies did not evidence alterations, but a careful pharmacological history revealed that the patient had taken the COX-2 inhibitor etoricoxib to treat lumbago few days before the onset of clinical symptoms. No seizures were reported after etoricoxib discontinuation and an EEG resulted to be normal two months after this. Conclusion. Knowing the pharmacological history of a patient is important for understanding the clinical presentation and selecting appropriate treatment. This is, to the best of our knowledge, the first reported case of generalized seizures associated with the use of COX-2 inhibitors.

S138 – Treatment Controversy Incidental Micro-Medullary Carcinoma

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P123-P123
Author(s):  
Jamie M. Swartz ◽  
Thomas Peyton Nowlin
Keyword(s):  
Surgical Treatment ◽  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Previous History ◽  
Treatment Strategies ◽  
Medullary Carcinoma ◽  
Medullary Thyroid ◽  
Appropriate Treatment ◽  
Microscopic Evaluation ◽  
History Of

Objectives 1) Investigate the controversial management dilemma of microscopic foci of medullary thyroid carcinoma found incidentally. 2) Describe appropriate treatment strategies for this rare scenario after critically reviewing the literature. Methods This case is a 33-year-old Caucasian female with a history of a multinodular goiter seen as a referral from an endocrinologist. She had no previous history of parathyroid disease, pheochromocytoma or MEN syndrome. She also had no family history of medullary thyroid carcinoma. The patient underwent total thyroidectomy for multiple nodules with an uneventful operative course and recovery. Results The thyroid was sent for permanent section and evaluated microscopically with an H&E stain. Final microscopic evaluation revealed multiple adenomatous nodules, a 2mm focus of papillary thyroid carcinoma, and a 2 mm focus of medullary thyroid carcinoma. The patient underwent no further surgical treatment. She has undergone chromosomal analysis, evaluation for possible multiple endocrine neoplasia, and serial calcitonin measurements. She is currently disease-free. Conclusions Medullary thyroid carcinoma is a well-described form of thyroid malignancy that typically mandates aggressive surgical treatment; however, there is a paucity of information in the literature concerning sporadic, microscopic foci of medullary thyroid carcinoma. We review the literature and describe appropriate treatment strategies for this rare scenario.

scholarly journals Schizophrenia and delusional disorders with onset in later life

2002 ◽  
Vol 24 (suppl 1) ◽  
pp. 81-86 ◽  
Author(s):  
Anne Hassett
Keyword(s):  
Clinical Presentation ◽  
Late Onset ◽  
Early Adulthood ◽  
Treatment Strategies ◽  
Later Life ◽  
Psychotic Symptoms ◽  
Sensory Impairment ◽  
Schizophrenia Spectrum ◽  
History Of ◽  
First Time

Schizophrenia-spectrum illness is most commonly associated with an onset in early adulthood. When non-affective psychotic symptoms emerge for the first time in later life, the clinical presentation has both similarities and differences with earlier-onset syndromes. This situation has resulted in continuing debate about the nosological status of late-onset psychosis, and whether there are particular risk factors associated with this late-life peak in incidence. Although early cognitive decline is frequently identified in these patients, studies, to date, have not established if there is a relationship with the dementing illnesses of old age. Sensory impairment, social isolation, and a family history of schizophrenia have been associated with late-onset psychosis, but appear to exert a nonspecific influence on vulnerability. While diagnostic issues remain unresolved, clinicians need to formulate treatment strategies that most appropriately address the constellation of symptoms in the clinical presentation of their psychotic elderly patients.

scholarly journals 974 Paget-Schroetter Syndrome in A Young Fitness Enthusiast with A Negative D-Dimer. Highlighting the Balance Between Clinical Suspicion and Diagnostic Modalities

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A Gani ◽  
G Lucas ◽  
C Ellis ◽  
A El-Karim ◽  
J Refson
Keyword(s):  
Great Saphenous Vein ◽  
Clinical Suspicion ◽  
Venous Obstruction ◽  
Risk Profiling ◽  
High Clinical Suspicion ◽  
Rare Manifestation ◽  
History Of ◽  
Diagnostic Modalities ◽  
D Dimer ◽  
Collateral Formation

Abstract This case illustrates an athletic 22-year-old, who presented to the hospital with a 3-week history of spontaneous right arm ache, discolouration and swelling. His blood tests were normal, with a negative D-dimer (<150ng/ml). He underwent a CT venogram for suspicion of venous obstruction which was unremarkable. However due to a high clinical suspicion, an ultrasound doppler was performed. This identified the presence of axillary-subclavian thrombosis which in conjunction with other clinical and radiological parameters confirmed the diagnosis of Paget-Schroetter Syndrome (PSS). Our patient was commenced on anticoagulation as the venous obstruction was suspected to be sub-acute with clinical suggestion of collateral formation. Unfortunately, his symptoms failed to resolve over a 6-month period, and he underwent an elective right rib resection with right subclavian bypass using the great saphenous vein with good outcome post-operatively. PSS is a rare manifestation of venous thoracic outlet syndrome (TOS) commonly seen in young, healthy, athletic individuals. Despite the high effectiveness of D-Dimers in ruling out acute thrombotic process and the accuracy of dedicated CT angiography in excluding vascular thrombotic events, both tests proved inconclusive in this particular case. This latter observation highlights the importance of the clinical context, and risk profiling in guiding results interpretation.

scholarly journals Hemorragia Maciça na Via Aérea Superior: Um Caso Raro de Fístula Aorto-Brônquica

2016 ◽  
Vol 29 (6) ◽  
pp. 409
Author(s):  
Paola Gudiel Arriaza ◽  
Amparo Sánchez Serrano ◽  
Jorge Marques do Vale ◽  
Isabel Gil Pereira ◽  
António Simões Torres ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Clinical Presentation ◽  
Upper Airway ◽  
Treatment Delay ◽  
Massive Bleeding ◽  
Clinical Suspicion ◽  
Rare Entity ◽  
Aortobronchial Fistula ◽  
High Clinical Suspicion ◽  
Previous Diagnosis

<p>Clinical presentation of haemoptysis and haematemesis often generates confusion, becoming a difficult task to determine the source of upper airway bleeding. Aortobronchial fistula is a rare entity, but has been a reported complication in patients that have undergone aortic vascular surgery. A high clinical suspicion is fundamental to making this diagnosis. A 69 year old male, with a previous diagnosis of chronic gastritis, is admitted to the emergency room for vomiting blood. In the first 24 hours after admission, the patient develops respiratory insufficiency after an episode of massive bleeding from his mouth. A computed tomography is performed, which shows a descending thoracic aortic aneurism and signs of aortobronchial fistula. Urgent thoracic endovascular repair was performed. Early symptoms of aortobronchial fistulae are nonspecific which complicates the diagnosis and can lead to treatment delay. The use of bronchoscopy in these cases is controversial.</p>

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