scholarly journals Salvaging the Digit in Invasive Subungual Malignancies Using a Triple Technique under Awake Local Anesthesia

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Samer Abdel Al ◽  
Mohamad K. Abou Chaar ◽  
Ala’a Aldeen Alkhatib ◽  
Muhamad Al-Qawasmi ◽  
Mohammad Barham ◽  
...  
Keyword(s):  
Local Anesthesia ◽  
High Speed ◽  
Case Reports ◽  
Scientific Evidence ◽  
Ring Finger ◽  
Distant Recurrence ◽  
Advancement Flap ◽  
Radical Excision ◽  
First Case ◽  
High Speed Burr

Introduction. Amputation for subungual malignancy (SUM) was thought to be the gold standard in preventing recurrence and metastasis. The rationale behind this aggressive treatment was never based on scientific evidence. Even though multiple recent studies supported more conservative management by illustrating successful results of the digit salvage technique, especially for “in situ” SUM, this salvage approach is not well supported for the more aggressive type of the “invasive” SUM; herein, we salvaged two cases of “invasive” SUM. Case Presentation. We present two cases of invasive SUM without radiographic evidence of intraosseous involvement, where we avoided digit amputation for both invasive subungual squamous cell carcinoma of the thumb and invasive subungual melanoma of the ring finger. Both were salvaged by using a triple technique under awake local anesthesia which included (I) radical excision of the nail bed unit including both eponychium and periosteum, (II) dorsal cortical bone shaving using a high-speed burr for the distal phalanx, and (III) flap coverage. Brunelli flap was used for the thumb in the first case, and V-Y plasty combined with proximal nail fold advancement flap was used for the ring finger in the second case. There was no evidence of local or distant recurrence, with a good functional outcome after 2.5 years in the first case and 2 years in the second. Conclusion. Ensuring complete resection with negative margins while preserving the functionality of the affected digit is considered to be the optimal challenge in treating “invasive” subungual malignancies. These two case reports contribute by reporting a successful digit salvage. The safety of this procedure could be confirmed by larger series and longer follow-up periods.

Surgical treatment of extensive perianal hidradenitis

2020 ◽  
Vol 99 (9) ◽  
Keyword(s):  
Surgical Treatment ◽  
Hidradenitis Suppurativa ◽  
Soft Tissues ◽  
Case Reports ◽  
Radical Excision ◽  
Skin Flaps ◽  
Perianal Area ◽  
Apocrine Glands ◽  
Patient Preparation ◽  
Two Stages

Introduction: Perianal hidradenitis suppurativa is a chronic recurrent inflammatory, suppurative, and fistulising disease of apocrine glands, adjacent anal canal and soft tissues. Perianal area is the second most common affected area after axilla. There are three grades of the disease. Hidradenitis suppurativa represents a chronic, recurrent, deep-seated folliculitis resulting in abscesses, followed by the formation of sinus tracts and subsequent scarring. Perianal hidradenitis suppurativa is the last and the most serious grade of the disease and a specific access is needed for patient preparation and surgical treatment alone. The currently preferred method of treatment for patients with extensive perianal hidradentitis is excision and closure with combination of skin flaps, primary suture and skin graft in one or two stages. Case reports: There are three case reports of perianal hidradenitis suppurativa in this article. The local and overall initial treatment of patients followed by a radical excision and closure with a rotation skin flaps and skin grafts is described. The final results were satisfactory, with no recurrence or serious complication.

Total uncinectomy of the cervical spine with an osteotome: technical note and intraoperative video

2019 ◽  
Vol 31 (6) ◽  
pp. 831-834 ◽  
Author(s):  
Anand H. Segar ◽  
Alexander Riccio ◽  
Michael Smith ◽  
Themistocles S. Protopsaltis
Keyword(s):  
Vertebral Artery ◽  
High Speed ◽  
Thermal Injury ◽  
Technical Note ◽  
Uncinate Process ◽  
Foraminal Stenosis ◽  
Cervical Kyphosis ◽  
Kyphosis Correction ◽  
Direct Injury ◽  
High Speed Burr

Total uncinate process resection or uncinectomy is often required in the setting of severe foraminal stenosis or cervical kyphosis correction. The proximity of the uncus to the vertebral artery, nerve root, and spinal cord makes this a challenging undertaking. Use of a high-speed burr or ultrasonic bone dissector can be associated with direct injury to the vertebral artery and thermal injury to the surrounding structures. The use of an osteotome is a safe and efficient method of uncinectomy. Here the authors describe their technique, which is illustrated with an intraoperative video.

scholarly journals Fetus in fetu: two case reports from North African country

2021 ◽  
Vol 69 (1) ◽  
Author(s):  
Moutaz Ragab ◽  
Omar Nagy Abdelhakeem ◽  
Omar Mansour ◽  
Mai Gad ◽  
Hesham Anwar Hussein
Keyword(s):  
Histopathological Examination ◽  
Case Reports ◽  
Abdominal Mass ◽  
Mature Teratoma ◽  
Surgical Techniques ◽  
Rare Condition ◽  
Mass Effect ◽  
Fetus In Fetu ◽  
Vascular Connection ◽  
First Case

Abstract Background Fetus in fetu is a rare congenital anomaly. The exact etiology is unclear; one of the mostly accepted theories is the occurrence of an embryological insult occurring in a diamniotic monochorionic twin leading to asymmetrical division of the blastocyst mass. Commonly, they present in the infancy with clinical picture related to their mass effect. About 80% of cases are in the abdomen retroperitoneally. Case presentation We present two cases of this rare condition. The first case was for a 10-year-old girl that presented with anemia and abdominal mass, while the second case was for a 4-month-old boy that was diagnosed antenatally by ultrasound. Both cases had vertebrae, recognizable fetal organs, and skin coverage. Both had a distinct sac. The second case had a vascular connection with the host arising from the superior mesenteric artery. Both cases were intra-abdominal and showed normal levels of alpha-fetoprotein. Histopathological examination revealed elements from the three germ layers without any evidence of immature cells ruling out teratoma as a differential diagnosis. Conclusions Owing to its rarity, fetus in fetu requires a high degree of suspicion and meticulous surgical techniques to avoid either injury of the adjacent vital structures or bleeding from the main blood supply connection to the host. It should be differentiated from mature teratoma.

scholarly journals Bittersweet: infective complications of drug-induced glycosuria in patients with diabetes mellitus on SGLT2-inhibitors: two case reports

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Caroline Bartolo ◽  
Victoria Hall ◽  
N. Deborah Friedman ◽  
Chloe Lanyon ◽  
Andrew Fuller ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Fungal Infections ◽  
Case Reports ◽  
Sglt2 Inhibitor ◽  
Sglt2 Inhibitors ◽  
Urogenital Tract ◽  
Hypoglycemic Agents ◽  
Drug Induced ◽  
First Case ◽  
Increased Risk

Abstract Background Sodium-glucose co-transporter 2 (SGLT2) inhibitors are novel hypoglycemic agents which reduce reabsorption of glucose at the renal proximal tubule, resulting in significant glycosuria and increased risk of genital mycotic infections (GMI). These infections are typically not severe as reported in large systematic reviews and meta-analyses of the medications. These reviews have also demonstrated significant cardiovascular benefits through other mechanisms of action, making them attractive options for the management of Type 2 diabetes mellitus (T2DM). We present two cases with underlying abnormalities of the urogenital tract in which the GMI were complicated and necessitated cessation of the SGLT2 inhibitor. Case presentations Both cases are patients with T2DM on empagliflozin, an SGLT2 inhibitor. The first case is a 64 year old man with Candida albicans balanitis and candidemia who was found to have an obstructing renal calculus and prostatic abscess requiring operative management. The second case describes a 72 year old man with Candida glabrata candidemia who was found to have prostatomegaly, balanitis xerotica obliterans with significant urethral stricture and bladder diverticulae. His treatment was more complex due to fluconazole resistance and concerns about urinary tract penetration of other antifungals. Both patients recovered following prolonged courses of antifungal therapy and in both cases the SGLT2 inhibitor was ceased. Conclusions Despite their cardiovascular benefits, SGLT2 inhibitors can be associated with complicated fungal infections including candidemia and patients with anatomical abnormalities of the urogenital tract may be more susceptible to these infections as demonstrated in these cases. Clinicians should be aware of their mechanism of action and associated risk of infection and prior to prescription, assessment of urogenital anatomical abnormalities should be performed to identify patients who may be at risk of complicated infection.

scholarly journals Granulomatous interstitial nephritis in a patient with SARS-CoV-2 infection

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Katarzyna Szajek ◽  
Marie-Elisabeth Kajdi ◽  
Valerie A. Luyckx ◽  
Thomas Hans Fehr ◽  
Ariana Gaspert ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Interstitial Nephritis ◽  
Kidney Biopsy ◽  
Kidney Diseases ◽  
Case Reports ◽  
Kidney Injury ◽  
Maculopapular Rash ◽  
Tubular Injury ◽  
Granulomatous Interstitial Nephritis ◽  
First Case

Abstract Background Acute kidney injury (AKI) associated with severe coronavirus disease 19 (COVID-19) is common and is a significant predictor of morbidity and mortality, especially when dialysis is required. Case reports and autopsy series have revealed that most patients with COVID-19 – associated acute kidney injury have evidence of acute tubular injury and necrosis - not unexpected in critically ill patients. Others have been found to have collapsing glomerulopathy, thrombotic microangiopathy and diverse underlying kidney diseases. A primary kidney pathology related to COVID-19 has not yet emerged. Thus far direct infection of the kidney, or its impact on clinical disease remains controversial. The management of AKI is currently supportive. Case Presentation The patient presented here was positive for SARS-CoV-2, had severe acute respiratory distress syndrome and multi-organ failure. Within days of admission to the intensive care unit he developed oliguric acute kidney failure requiring dialysis. Acute kidney injury developed in the setting of hemodynamic instability, sepsis and a maculopapular rash. Over the ensuing days the patient also developed transfusion-requiring severe hemolysis which was Coombs negative. Schistocytes were present on the peripheral smear. Given the broad differential diagnoses for acute kidney injury, a kidney biopsy was performed and revealed granulomatous tubulo-interstitial nephritis with some acute tubular injury. Based on the biopsy findings, a decision was taken to adjust medications and initiate corticosteroids for presumed medication-induced interstitial nephritis, hemolysis and maculo-papular rash. The kidney function and hemolysis improved over the subsequent days and the patient was discharged to a rehabilitation facility, no-longer required dialysis. Conclusions Acute kidney injury in patients with severe COVID-19 may have multiple causes. We present the first case of granulomatous interstitial nephritis in a patient with COVID-19. Drug-reactions may be more frequent than currently recognized in COVID-19 and are potentially reversible. The kidney biopsy findings in this case led to a change in therapy, which was associated with subsequent patient improvement. Kidney biopsy may therefore have significant value in pulling together a clinical diagnosis, and may impact outcome if a treatable cause is identified.

scholarly journals Why has COVID-19 not hit the countries like Nepal yet?

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Krishna Prasad Pathak ◽  
Tara Gaire ◽  
Mu-Hsing Ho ◽  
Hui chen (Rita) Chang
Keyword(s):  
Health Services ◽  
Social Distance ◽  
Scientific Evidence ◽  
Local Health ◽  
First Case ◽  
Populations At Risk ◽  
Test Kit ◽  
Health Services Need ◽  
The Government ◽  
Google Search

AbstractNoble CORONA Virus (COVID-19) is an infectious disease similar form of pneumonia/ SARS-CoV-2- impacting globally. The fear of coronavirus looks pandemic, but its severity is uncertain. Nepal was one of the first nine countries outside of China to report a COVID-19 case. Also, its unpredictability of mode or range of surface, the lifespan of the virus, objects of transmission (a distance of air/air currents, living duration in air, humidity, duration on objects, surface). The first case was found in Wuhan in December 2019 in China. The purpose is to summarize the current information about COVID-19 and to explore in terms of why Nepal is not hitting severely, while other countries are on death toll? We summarized the published articles form the web sources and news, Academic Journals, Ministry of health and population Nepal, WHO/CDC update reports/guidelines, Google search engine. Thematic analysis is made to explore the situation. Although, Nepal has a lack of health services, testing kits, advance lab and protecting equipment (PPE), why COVID-19 does not hit Nepal than China, Europe and North America, it still tremendous uncertainty. Is lockdown, isolation, social distance and quarantine the best ways of prevention? The hypothesis is floating globally – do BCG vaccinated countries are safer than non-user OR due to not having enough kits to screen populations at risk for the virus – while lack of testing a big cause for missing case OR Nepalese have better immune systems? It has attracted global attention. We believe that the COVID-19 is still evolving and it is too early to predict of an outbreak in Nepal. The government needs to increase funding for local health departments, begin planning for future epidemics and be prepared to bolster the economy by supporting consumer spending the midst of a serious outbreak. COVID-19 is a serious health challenge for Nepal, but so far the number of death has been lower than was foretell. It is, therefore essential to carry out more scientific evidence to explore results. Nepalese health services need to maintain up than today and follow lockdown, isolation, social distance and an advance screening test kit through the country.

Proteus syndrome in pregnancy: A case report

2020 ◽  
pp. 1753495X2097079
Author(s):  
Niccole Ranaei-Zamani ◽  
Mandeep K Kaler ◽  
Rehan Khan
Keyword(s):  
Case Report ◽  
Case Reports ◽  
Proteus Syndrome ◽  
Cutaneous Lesions ◽  
Genetic Syndrome ◽  
Skeletal Tissue ◽  
First Case ◽  
Large Teaching Hospital ◽  
Clinical Presentations ◽  
In Pregnancy

Proteus syndrome is a rare, multi-system, genetic syndrome characterised by atypical and excessive growth of skeletal tissue. Clinical presentations include abnormal musculoskeletal growth and cutaneous lesions. Due to its rarity, there have been a limited number of published case reports of Proteus syndrome. This is the first case report on the management of Proteus syndrome in pregnancy. We present the case of a pregnant woman with Proteus syndrome in her first pregnancy in a large teaching hospital and discuss the considerations and challenges faced in her antenatal, intrapartum and postnatal care.

scholarly journals Intraperitoneal ampicillin treatment for peritoneal dialysis- related peritonitis with Listeria monocytogenes – a case report

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Kristina Boss ◽  
Ina Wiegard-Szramek ◽  
Jan Dziobaka ◽  
Andreas Kribben ◽  
Sebastian Dolff
Keyword(s):  
Peritoneal Dialysis ◽  
Case Report ◽  
Listeria Monocytogenes ◽  
Case Reports ◽  
Chronic Kidney Disease Stage ◽  
Disease Stage ◽  
Serum Concentrations ◽  
Duration Of Treatment ◽  
First Case ◽  
Listeria Infection

Abstract Background Peritoneal dialysis (PD)-related peritonitis is a rare but serious complication and is associated with increased morbidity and mortality rates. It is most commonly caused by Staphylococcus aureus or Staphylococcus epidermidis, but infection with Listeria monocytogenes may also occur. Recommendations for antibiotic treatment of a Listeria infection are currently based on a small number of case reports and suggest the administration of ampicillin. But unlike vancomycin or gentamicin, for ampicillin the route of application, the dosage, and the duration of treatment have not yet been established. We report a case in which PD-associated peritonitis due to Listeria infection was treated with ampicillin administered intravenously and intraperitoneally, separately and in combination. Case presentation A 72-year-old man with chronic kidney disease stage 5 dialysis (CKDG5D) secondary to hypertension and diabetes was hospitalised in April 2020 because of PD-related peritonitis caused by a Listeria infection. In accordance with the results of resistance tests, the patient was treated with intravenous ampicillin at a dosage of 6 g twice daily. After initial treatment the leukocyte count in the PD effluent had decreased substantially, but it was permanently reduced only with the addition of intraperitoneal ampicillin (4 g daily). Efficient serum concentrations of ampicillin were determined for both routes of administration, intravenous and intraperitoneal. Conclusion This is the first case report demonstrating that PD-related peritonitis due to Listeria monocytogenes infection can be treated with intraperitoneal ampicillin and monitored by the determination of peripheral serum concentrations of ampicillin.

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