scholarly journals Unusual Case of a Missing Vibrator Device in the Pelvis

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Greg J. Marchand ◽  
Katelyn M. Sainz ◽  
Ali Azadi ◽  
Alexa King ◽  
Sienna Anderson ◽  
...  
Keyword(s):  
Emergency Room ◽  
Unusual Case ◽  
Surgical Intervention ◽  
Abdominal Cavity ◽  
Traumatic Injury ◽  
The United States ◽  
X Ray ◽  
Sexual Stimulation ◽  
Emergency Room Setting ◽  
Careful History

Emergency room admissions and surgery secondary to the malfunctioning of devices intended for sexual stimulation are extremely common. Emergency room staff in the United States are commonly skilled in the detection and removal of some of these frequent occurrences. Occasionally, surgical intervention can be warranted if the device enters a cavity that cannot safely be explored in the emergency room setting. We report a case of a vibrator which was lost during sexual activity and appeared on flat plate X-ray to be in the abdominal cavity. A careful history showed that the device was of an unusually narrow diameter, and surgical intervention showed the device ultimately ended up in the bladder without traumatic injury. Following laparoscopic confirmation of the device’s location in the bladder, cystoscopic removal was performed and the patient recovered uneventfully.

Caution on Overdiagnosis

PEDIATRICS ◽  
1977 ◽  
Vol 60 (2) ◽  
pp. 261-261
Author(s):  
John B. Reinhart
Keyword(s):  
Abdominal Pain ◽  
Physical Examination ◽  
Surgical Intervention ◽  
X Ray ◽  
Laboratory Procedures ◽  
Careful Physical Examination ◽  
Careful History ◽  
Rule Out

I am writing to comment on the article by Bugenstein and Phibbs, which appeared in the December 1975 issue of Pediatrics (page 1073). I do not question that such herniations do occur and may need surgical intervention on occasion. Whether they cause generalized abdominal pain or cause confusion in diagnosis to the pediatrician or surgeon who takes a careful history and does a careful physical examination is my question. There is already the tendency to make a diagnosis on a "rule out" basis, and, in my opinion, there is excessive use of gastrointestinal x-ray and other laboratory procedures.

scholarly journals Early diagnostics of acute honestious intestinal incapability with help of X-ray tomography

2018 ◽  
pp. 55-59
Author(s):  
I. F. Sufiyarov ◽  
F. F. Mufazalov ◽  
G. R. Yamalova
Keyword(s):  
Intestinal Obstruction ◽  
Surgical Intervention ◽  
Abdominal Cavity ◽  
Intestinal Wall ◽  
Peritoneal Adhesion ◽  
Peritoneal Disease ◽  
X Ray ◽  
Pearson Criterion ◽  
X Ray Computed ◽  
Adhesive Intestinal Obstruction

The most important problem determining the indications for surgical treatment of peritoneal adhesion is associated with the uncertainty of the criteria for early diagnosis of intestinal obstruction. Of all the most common acute surgical diseases of the abdominal cavity, acute intestinal obstruction gives the highest lethality. The main reason for this is untimely diagnosis. In two groups of patients, we performed a study of chronic peritoneal peritoneal disease using X-ray computed tomography (RCT), with obstruction (58 patients) and absence of this pathology (56 patients). Analyzing nonparametric statistics with the calculation of the Pearson criterion, with the Yates correction. We presented the criteria for the RCT study, differential diagnosis of adhesive intestinal obstruction from exacerbation of peritoneal adhesion. The main indicators of this disease: the fluid content in the lumen of the small intestine is more than 200.0 ml, in two or more regions, the inflated intestinal loops, an extension of 2.1 mm and more of the intestinal wall. The validity of the diagnostic criteria for RCT research leaves no doubt about the need for their use in preoperative access prognosis and the scope of surgical intervention.

Validation of the Surgical Intervention for Traumatic Injury scale in the pediatric population

2020 ◽  
Vol 26 (1) ◽  
pp. 92-97
Author(s):  
David Dornbos ◽  
Christy Monson ◽  
Andrew Look ◽  
Kristin Huntoon ◽  
Luke G. F. Smith ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Pediatric Population ◽  
Traumatic Injury ◽  
Pediatric Trauma ◽  
Current Method ◽  
Clinical Findings ◽  
Surgical Decompression ◽  
Operative Intervention ◽  
Admission Diagnosis ◽  
Communication Tool

OBJECTIVEWhile the Glasgow Coma Scale (GCS) has been effective in describing severity in traumatic brain injury (TBI), there is no current method for communicating the possible need for surgical intervention. This study utilizes a recently developed scoring system, the Surgical Intervention for Traumatic Injury (SITI) scale, which was developed to efficiently communicate the potential need for surgical decompression in adult patients with TBI. The objective of this study was to apply the SITI scale to a pediatric population to provide a tool to increase communication of possible surgical urgency.METHODSThe SITI scale uses both radiographic and clinical findings, including the GCS score on presentation, pupillary examination, and CT findings. To examine the scale in pediatric TBI, a neurotrauma database at a level 1 pediatric trauma center was retrospectively evaluated, and the SITI score for all patients with an admission diagnosis of TBI between 2010 and 2015 was calculated. The primary endpoint was operative intervention, defined as a craniotomy or craniectomy for decompression, performed within the first 24 hours of admission.RESULTSA total of 1524 patients met inclusion criteria for the study during the 5-year span: 1469 (96.4%) were managed nonoperatively and 55 (3.6%) patients underwent emergent operative intervention. The mean SITI score was 4.98 ± 0.31 for patients undergoing surgical intervention and 0.41 ± 0.02 for patients treated nonoperatively (p < 0.0001). The area under the receiver operating characteristic (AUROC) curve was used to examine the diagnostic accuracy of the SITI scale in this pediatric population and was found to be 0.98. Further evaluation of patients presenting with moderate to severe TBI revealed a mean SITI score of 5.51 ± 0.31 in 40 (15.3%) operative patients and 1.55 ± 0.02 in 221 (84.7%) nonoperative patients, with an AUROC curve of 0.95.CONCLUSIONSThe SITI scale was designed to be a simple, objective communication tool regarding the potential need for surgical decompression after TBI. Application of this scale to a pediatric population reveals that the score correlated with the perceived need for emergent surgical intervention, further suggesting its potential utility in clinical practice.

scholarly journals Lawsuits against plastic surgeons: Does locale affect incidence of claims?

2007 ◽  
Vol 15 (3) ◽  
pp. 155-157 ◽  
Author(s):  
Jonathan L Kaplan ◽  
Warren C Hammert ◽  
James E Zin
Keyword(s):  
United States ◽  
Emergency Room ◽  
Plastic Surgery ◽  
Medical Malpractice ◽  
The United States ◽  
Absolute Number ◽  
Malpractice Claims ◽  
High Incidence ◽  
Medical Malpractice Claims ◽  
Geographical Locations

Background Physicians continue to practice in a very litigious environment. Some physicians try to mitigate their exposure to lawsuits by avoiding geographical locations known for their high incidence of medical malpractice claims. Not only are certain areas of the United States known to have a higher incidence of litigation, but it is also assumed that certain areas of the hospital incur a greater liability. There seems to be a medicolegal dogma suggesting a higher percentage of malpractice claims coming from patients seen in the emergency room (ER), as well as higher settlements for ER claims. Objective To determine if there is any validity to the dogma that a higher percentage of malpractice claims arise from the ER. Methods An analysis of common plastic surgery consults that result in malpractice claims was performed. The location where the basis for the lawsuit arose – the ER, office (clinic) or the operating room (OR) – was evaluated. The value of the indemnity paid and whether its value increased or decreased based on the location of the misadventure was evaluated. Results According to the data, which represented 60% of American physicians, there was a larger absolute number of malpractice claims arising from the OR, not the ER. However, the highest average indemnity was paid for cases involving amputations when the misadventure originated in the ER. Conclusions The dogma that a greater percentage of lawsuits come from incidents arising in the ER is not supported. However, depending on the patient's injury and diagnosis, a lawsuit from the ER can be more costly than one from the OR.

scholarly journals A case of pleuroperitoneal communication in which establishing a laparoscopic pneumoperitoneum was useful for the detection of a fistula

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Takehiko Manabe ◽  
Kenji Ono ◽  
Soichi Oka ◽  
Yuichiro Kawamura ◽  
Toshihiro Osaki
Keyword(s):  
Thoracic Surgery ◽  
Surgical Repair ◽  
Abdominal Cavity ◽  
Case Presentation ◽  
X Ray ◽  
Video Assisted Thoracic Surgery ◽  
Video Assisted ◽  
Pleuroperitoneal Communication ◽  
Small Pore ◽  
Chest X Ray

Abstract Background Pleuroperitoneal communication (PPC) is rarely observed, accounting for 1.6% of all patients who undergo continuous ambulatory peritoneal dialysis (CAPD). Although there have been several reports concerning the management of this condition, we have encountered several cases in which control failed. We herein report a valuable case of PPC in which laparoscopic pneumoperitoneum with video-assisted thoracic surgery (VATS) was useful for supporting the diagnosis and treatment. Case presentation The patient was a 58-year-old woman with chronic renal failure due to chronic renal inflammation who was referred to a nephrologist in our hospital to undergo an operation for the induction of CAPD. Post-operatively, she had respiratory failure, and chest X-ray and computed tomography (CT) showed right-sided hydrothorax that decreased when the injection of peritoneal dialysate was interrupted. Therefore, PPC was suspected, and she was referred to our department for surgical repair. We planned surgical treatment via video-assisted thoracic surgery. During the surgery, we failed to detect any lesions with thoracoscopy alone; we therefore added a laparoscopic port at her right-sided abdomen near the navel and infused CO2 gas into the abdominal cavity. On thoracoscopy, bubbles were observed emanating from a small pore at the central tendon of the diaphragm, which was considered to be the lesion responsible for the PPC. We closed it by suturing directly. Conclusions VATS with laparoscopic pneumoperitoneum should be considered as an effective method for inspecting tiny pores of the diaphragm, especially when the lesions responsible for PPC are difficult to detect.

Nursing the uroabdomen patient

2021 ◽  
Vol 12 (3) ◽  
pp. 131-138
Author(s):  
Sam McGaw
Keyword(s):  
Metabolic Acidosis ◽  
Urinary Tract ◽  
Diagnostic Imaging ◽  
Urinary Diversion ◽  
Nursing Care ◽  
Postoperative Care ◽  
Surgical Intervention ◽  
Urinary Catheter ◽  
Abdominal Cavity ◽  
Patient Presentation

Uroabdomen, the presence of urine in the abdominal cavity, commonly occurs in dogs and cats, particularly following a trauma. Initial stabilisation of the patient is essential to treat the multisystemic effects of electrolyte and metabolic derangements, including hyperkalaemia, azotaemia and metabolic acidosis. Diagnosis is confirmed by comparing laboratory analysis of abdominal fluid and serum. Urinary diversion is required, often via placement of a urinary catheter, to prevent continuing urine accumulation. Once haemodynamically stable, diagnostic imaging may be performed to confirm the location of the urinary tract rupture, with several modes of imaging available. Surgical intervention may be necessary to repair the urinary leak, this is dependent on the location and severity of the trauma to the urinary tract. Registered veterinary nurses play an important role in the management of the uroabdomen patient, from initial triage and stabilisation, to assisting with imaging, anaesthetic monitoring and postoperative care. This article will discuss the aetiology of the uroabdomen, patient presentation and how to effectively treat the critical patient. Nursing care is vital for ensuring patient welfare and identifying complications that may arise.

scholarly journals How Can a Deep Learning Algorithm Improve Fracture Detection on X-rays in the Emergency Room?

2021 ◽  
Vol 7 (7) ◽  
pp. 105
Author(s):  
Guillaume Reichert ◽  
Ali Bellamine ◽  
Matthieu Fontaine ◽  
Beatrice Naipeanu ◽  
Adrien Altar ◽  
...  
Keyword(s):  
Deep Learning ◽  
Emergency Room ◽  
Learning Algorithm ◽  
Traumatic Injury ◽  
Diagnostic Tools ◽  
Appendicular Skeleton ◽  
Trauma Patients ◽  
X Rays ◽  
Fracture Detection ◽  
Local Data

The growing need for emergency imaging has greatly increased the number of conventional X-rays, particularly for traumatic injury. Deep learning (DL) algorithms could improve fracture screening by radiologists and emergency room (ER) physicians. We used an algorithm developed for the detection of appendicular skeleton fractures and evaluated its performance for detecting traumatic fractures on conventional X-rays in the ER, without the need for training on local data. This algorithm was tested on all patients (N = 125) consulting at the Louis Mourier ER in May 2019 for limb trauma. Patients were selected by two emergency physicians from the clinical database used in the ER. Their X-rays were exported and analyzed by a radiologist. The prediction made by the algorithm and the annotation made by the radiologist were compared. For the 125 patients included, 25 patients with a fracture were identified by the clinicians, 24 of whom were identified by the algorithm (sensitivity of 96%). The algorithm incorrectly predicted a fracture in 14 of the 100 patients without fractures (specificity of 86%). The negative predictive value was 98.85%. This study shows that DL algorithms are potentially valuable diagnostic tools for detecting fractures in the ER and could be used in the training of junior radiologists.

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