scholarly journals Successful Limb-Sparing Wide Excision of a Giant Lipofibromatosis in a 5-Year-Old Girl

2018 ◽  
Vol 11 (1) ◽  
pp. 179-184
Author(s):  
Putu Anda Tusta Adiputra
Keyword(s):  
Operating Room ◽  
Distal Femur ◽  
Surgical Decision ◽  
Left Tibia ◽  
Course Of Action ◽  
Left Limb ◽  
Set Up ◽  
Painless Mass ◽  
Bony Erosion

A 5-year-old girl presented with a big painless mass, sized 24 × 37 × 35 cm, in her lower left limb. MRI revealed a huge heterogeneous mass splaying from the left distal femur to the calcaneal region without bony erosion but compressing the arteries and causing bowing of the left tibia and fibula bones. The difficulty was to determine the best course of action taken which would either be limb salvation or amputation. Considering that only a few muscles could be saved, the author initially recommended amputation but still considered a limb-sparing procedure. After a double set-up examination in the operating room, the author ultimately decided to save the affected limb. The salvaged limb was found to be viable after the surgery, and there was no further recurrence over a subsequent 6-month follow-up period. The careful surgical decision is vital in giving the best possible care to the patient.

scholarly journals Utility of intraoperative electromyography in microvascular decompression for hemifacial spasm: a meta-analysis

2009 ◽  
Vol 27 (4) ◽  
pp. E10 ◽  
Author(s):  
Raymond F. Sekula ◽  
Sanjay Bhatia ◽  
Andrew M. Frederickson ◽  
Peter J. Jannetta ◽  
Matthew R. Quigley ◽  
...  
Keyword(s):  
Operating Room ◽  
Hemifacial Spasm ◽  
Microvascular Decompression ◽  
English Language ◽  
Meta Analysis ◽  
Lateral Spread ◽  
Decompression Surgery ◽  
Surgical Decision ◽  
Microvascular Decompression Surgery

Object In this paper, the authors' goal was to determine the utility of monitoring the abnormal muscle response (AMR) or “lateral spread” during microvascular decompression surgery for hemifacial spasm. Methods The authors' experience with AMR as well as the data available in the English-language literature regarding resolution or persistence of AMR and the resolution or persistence of hemifacial spasm at follow-up was pooled and subjected to a meta-analysis. Results The pooled OR revealed by the meta-analysis was 4.2 (95% CI 2.7–6.7). The chance of a cure if the AMR was abolished during surgery was 4.2 times greater than if the lateral spread persisted. Conclusions The AMR should be monitored routinely in the operating room, and surgical decision-making in the operating room should be augmented by the AMR.

Fibroadenoma of Ectopic Breast Tissue in the Groin – A Rare Disease Entity

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S47-S48
Author(s):  
D Emechebe ◽  
M Alshal ◽  
T Rana ◽  
M Agaronov
Keyword(s):  
Breast Tissue ◽  
Tissue Mass ◽  
Ectopic Breast Tissue ◽  
The Common ◽  
Painless Mass ◽  
The Right ◽  
Ectopic Breast ◽  
Urogenital Anomalies ◽  
Superficial Soft Tissue

Abstract Introduction/Objective Ectopic breast tissue (EBT) is a well-documented anomaly of the breast and commonly presents along the embryonic milk line extending between the axilla and groin. Reported incidence of accessory breast is 0.4–6% in females. Pathologies developing in an EBT are reported as a rare entity in the literature. Carcinoma is reported as the common pathology followed by inflammation and fibroadenoma Methods We present a case of 43-year- old female who presented with a painless mass in her right groin for the past year which gradually increased in size. CT abdomen pelvis with contrast showed a 2.2 x 3.0 x 4.4 cm superficial soft tissue mass in the right groin which was suspected to be a lymph node. Further investigation and histopathological report of biopsy showed ectopic breast tissue with admixed chronic inflammation and reactive changes.However, excision of the mass three months later showed showed proloferation of both glandular and stromal elements. Results The tissue from the biopsy was positive for GATA 3, mammoglobin, GCDFP and CD 10 and the histological features on excision was confirmatory of fibroadenoma. Conclusion In conclusion, when tumors or nodules are found along the mammary line, the presence of breast tissue should be considered during the investigation. It is clinically wise to evaluate and screen carefully cases of supernumerary breast for any pathology and for any associated urogenital anomalies such as supernumerary kidneys, polycystic kidneys and renal cell adenocaricnoma. In our case, patient had no associated urogenital anomalies and she is on follow up.

scholarly journals 829 Is There an Ongoing Role For 'Telephone Triage Clinics' Post COVID-19?

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
B Holmes ◽  
U Mirza ◽  
C Manning ◽  
R Cooke ◽  
R Jugdey
Keyword(s):  
Common Theme ◽  
Telephone Triage ◽  
Telephone Consultation ◽  
Face To Face ◽  
Clinician Satisfaction ◽  
Set Up ◽  
Local Protocol ◽  
Telephone Questionnaire

Abstract Introduction COVID-19 has placed unprecedented demand on services at ELHT and it has become necessary to have telephone clinics to reduce the number of face-to-face clinics. A ‘telephone triage clinic’ was set up for referrals from A&E. Our project evaluated patient and clinician satisfaction on this. Method We carried out a retrospective telephone questionnaire with patients over a one-week period during the pandemic. We focussed on overall satisfaction of the consultation and quality of communication. Consultants were also surveyed for their opinion on the clinics. Results From 30 patients, 77% said they were ‘very satisfied’ with the overall experience. 80% of patients were ‘very satisfied’ with the overall length of the telephone consultation. 50% of patients felt the clinician was only ‘adequately’ able to assess them over the telephone. The consultants were less satisfied with the overall experience of telephone consultation. A common theme was that they felt ED documentation could be improved to help inform ongoing management. Conclusions Overall, patients were satisfied with the consultations. It has been successful in minimising face to face consultations however some presentations necessitate further evaluation. We need to identify those injuries appropriate for virtual follow up and design a local protocol for these.

scholarly journals Can We Extrapolate SINS Score to Evaluate Instability in Spinal Tuberculosis?

2021 ◽  
pp. 219256822110308
Author(s):  
Yogesh Kishorkant Pithwa ◽  
Vikrant Sinha Roy
Keyword(s):  
Prospective Observational Study ◽  
Surgical Intervention ◽  
Spinal Tuberculosis ◽  
Neurological Status ◽  
Structural Instability ◽  
Stable Group ◽  
Surgical Decision ◽  
Helpful Tool ◽  
Surgical Decision Making

Study Design: Prospective Observational Study. Objectives: To assess the feasibility of utilizing SINS score, originally suggested for neoplastic conditions, to assess structural instability in spinal tuberculosis. Methods: Patients with an established diagnosis of spinal tuberculosis were included in the study. Based on SINS scoring, patients classified as those with “indeterminate stability” were managed with or without surgery based on other parameters including neurological status, severity of pain, medical comorbidities, etc. Results: Eighty [39 males, 41 females] patients prospectively evaluated with mean age 46.74 ± 17.3 years. Classification done into stable [n = 7], indeterminate [n = 45] and unstable [n = 28] groups based on SINS scoring. All the patients in unstable group were treated with surgical stabilization whereas none in the stable group required surgical stabilization. In the indeterminate group, 26 patients underwent surgical stabilization, while 19 treated non-operatively. Major determinants predisposing to surgical intervention in “indeterminate group” were pain [14 of 26 patients] and neurological status [11 of 26 patients]. Mean follow-up 38.5 ± 22.61 months with minimum follow-up being 24 months. Preoperative VAS score for pain improved from median of 9/10 to 1/10 following surgery [ P < .0001]. In the non-operative group, the improvement was from median score of 6/10 to 1/10 [ P < .0001]. Preoperative ODI improved in non-operative and operative group from median of 42% and 70%, respectively to 10% and 12%, respectively in the postoperative period [ P < .0001 for both groups]. Conclusions: SINS scoring can be a helpful tool in surgical decision-making even in spinal tuberculosis. Further refinement of the score can be done with a larger, multicenter study.

scholarly journals Promising medium-term results of anterior approach with an anatomical short stem in primary hip arthroplasty

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Fabrizio Rivera ◽  
Alessandro Bardelli ◽  
Andrea Giolitti
Keyword(s):  
Operating Room ◽  
Anterior Approach ◽  
Direct Anterior Approach ◽  
Short Stem ◽  
Medium Term ◽  
Operating Room Table ◽  
Sf 36 ◽  
Standard Operating ◽  
The Mean

Abstract Background In the last decade, the increase in the use of the direct anterior approach to the hip has contributed to the diffusion of the use of short stems in orthopedic surgery. The aim of the study is to verify the medium-term clinical and radiographic results of a cementless anatomic short stem in the anterior approach to the hip. We also want to verify whether the use of the standard operating room table or the leg positioner can affect the incidence of pre- and postoperative complications. Materials and methods All total hip arthroplasty patients with a 1-year minimum follow-up who were operated using the MiniMAX stem between January 2010 and December 2019 were included in this study. Clinical evaluation included the Harris Hip Score (HHS), Western Ontario and McMaster Universities Hip Outcome Assessment (WOMAC) Score, and Short Form-36 (SF-36) questionnaires. Bone resorption and remodeling, radiolucency, osteolysis, and cortical hypertrophy were analyzed in the postoperative radiograph and were related to the final follow-up radiographic results. Complications due to the use of the standard operating room table or the leg positioner were evaluated. Results A total of 227 patients (238 hips) were included in the study. Average age at time of surgery was 62 years (range 38–77 years). Mean follow-up time was 67.7 months (range 12–120 months). Kaplan–Meier survivorship analysis after 10 years revealed 98.2% survival rate with revision for loosening as endpoint. The mean preoperative and postoperative HHS were 38.35 and 94.2, respectively. The mean preoperative and postoperative WOMAC Scores were 82.4 and 16.8, respectively. SF-36 physical and mental scores averaged 36.8 and 42.4, respectively, before surgery and 72.4 and 76.2, respectively, at final follow-up. The radiographic change around the stem showed bone hypertrophy in 55 cases (23%) at zone 3. In total, 183 surgeries were performed via the direct anterior approach (DAA) on a standard operating room table, and 44 surgeries were performed on the AMIS mobile leg positioner. Comparison between the two patient groups did not reveal significant differences. Conclusion In conclusion, a short, anatomic, cementless femoral stem provided stable metaphyseal fixation in younger patients. Our clinical and radiographic results support the use of this short stem in the direct anterior approach. Level of evidence IV.

scholarly journals Towards Zero Emissions Noosa

2019 ◽  
Vol 11 (17) ◽  
pp. 4679
Author(s):  
Carina Anderson ◽  
Robert Passey ◽  
Jeremy De Valck ◽  
Rakibuzzaman Shah
Keyword(s):  
Community Engagement ◽  
Focal Point ◽  
Contextual Information ◽  
Renewable Electricity ◽  
Community Group ◽  
Course Of Action ◽  
Engagement Process ◽  
Set Up ◽  
External Consultant

This paper reports on a case study of the community group Zero Emissions Noosa, whose goal is for 100% renewable electricity in the Noosa Shire (Queensland, Australia) by 2026. Described within this paper are the processes used by Zero Emissions Noosa to set up their zero emissions plan, involving community engagement and the use of an external consultant. The external consultant was employed to produce a detailed report outlining how to successfully achieve zero emissions from electricity in the Noosa Shire by 2026. This paper explains how and why the community engagement process used to produce the report was just as important as the outcomes of the report itself. Modeling was undertaken, and both detailed and contextual information was provided. Inclusion of the community in developing the scenario parameters for the modeling had a number of benefits including establishing the context within which their actions would occur and focusing their efforts on options that were technically feasible, financially viable and within their capabilities to implement. This provided a focal point for the community in calling meetings and contacting stakeholders. Rather than prescribing a particular course of action, it also resulted in a toolbox of options, a range of possible solutions that is flexible enough to fit into whatever actions are preferred by the community. The approach and outcomes discussed in this paper should, therefore, be useful to other communities with similar carbon emission reduction goals.

scholarly journals Chemotherapy-Induced Oesophageal Stricture in a Child with Osteosarcoma: A Case Report

2010 ◽  
Vol 2010 ◽  
pp. 1-3
Author(s):  
Daichi Ishimaru ◽  
Takatoshi Ohno ◽  
Masato Maeda ◽  
Yutaka Nishimoto ◽  
Katsuji Shimizu
Keyword(s):  
Case Report ◽  
Balloon Dilatation ◽  
Distal Femur ◽  
Rare Complication ◽  
Oesophageal Stricture ◽  
Solid Foods ◽  
Paediatric Case

Treatment with a combination of chemotherapy and radiotherapy is known to be associated with oesophageal stricture in both children and adults with malignancies. However, oesophageal stricture resulting from chemotherapy alone is a rare complication, with few reports on it. We experienced a rare paediatric case of oesophageal stricture caused by chemotherapy for osteosarcoma of the left distal femur. After completion of the chemotherapy course, the patient showed dysphagia caused by the oesophageal stricture and underwent balloon dilatation for the oesophageal stricture. After balloon dilatation, he was able to ingest solid foods, and the oesophagus was normal without any strictures at the last follow-up (20 months after ballooning). Therefore, oesophageal stricture should be considered as a complication of treatment with chemotherapy alone in children with malignancies.

“FUNCTIONAL OUTCOME OF RETROGRADE NAILING IN THE MANAGEMENT OF SUPRACONDYLAR AND DISTAL FEMORAL FRACTURE”

2021 ◽  
pp. 107-109
Author(s):  
Avinash Kumar Choudhary ◽  
M.K Aseri ◽  
Sumit Machra ◽  
Devendra Singh
Keyword(s):  
Femoral Fracture ◽  
Distal Femur ◽  
Femoral Fractures ◽  
High Energy ◽  
Valgus Deformity ◽  
Minor Trauma ◽  
Rating Score ◽  
Joint Congruency ◽  
Distal Femoral Fractures

INTRODUCTION: Fractures of the Distal femur are complex injuries that pose a challenge to the orthopaedic surgeon. It constitutes about 6 % of all femoral fractures. It usually occurs during high energy trauma in younger patients and frequently are associated with concomitant injuries. In contrast, elderly patients with severe osteopenia might sustain solitary distal femoral fractures from minor trauma such as a simple fall. Proper diagnosis and treatment leads to early mobilization and rehabilitation of patients. MATERIAL AND METHODS :This prospective study was conducted in Department of Orthopedics at Dr. S. N. Medical College and Associated group of Hospital, Jodhpur ,Rajasthan ,India on 30 patients who underwent the surgery with retrograde intramedullary interlocking nail in the management of extra-articular supracondylar femoral fracture from August 2019 to November 2020. On follow up axial alignment was assessed and functional analysis was quantied using NEERS RATING SYSTEM, Radiographs was analyzed for correction, maintenance of position or loss of reduction. function around knee was accessed according to Schatzker and Lambert Criteria, measures the exion/extension , varus/valgus deformity , joint congruency and pain in operated patients. RESULTS: In our study 30 patients with supracondylar & distal femoral fractures based on AO Classication on MULLER ET AL underwent retrograde supracondylar nail, long term nal result were rated using NEER'S RATING SCORE , which gives point for pain, function, working, joint movement ,gross and radiological appearance. NEER'S RATING SCORE assigned for each patient after 24 weeks of follow up. After accessing this score out of total 30 patients, 10 have excellent score, 10 have good score, 8 have fair score and next 2 have poor score. Function around knee was accessed according to Schatzker and Lambert Criteria, measures the exion/extension , varus/valgus deformity , joint congruency and pain in operated patients,out of 30 patients 9 patients have an excellent result , 8 have good ,12 have fair and only 1 patient have poor result CONCLUSION:The retrograde intramedullary locked nail provides the surgeon with a different option in treatment of specic supracondylar fracture patterns. It offers a practical advantages of simple and efcient technique for patients with polytrauma, oating knee injuries and in elderly. this technique is very useful in distal femur fracture where antegrade nailing does not provide stability and also where plate xation is not suitable due to soft tissue condition.

scholarly journals MAGIC electromagnetic follow-up of gravitational wave alerts

2016 ◽  
Vol 12 (S324) ◽  
pp. 287-290
Author(s):  
Barbara De Lotto ◽  
Stefano Ansoldi ◽  
Angelo Antonelli ◽  
Alessio Berti ◽  
Alessandro Carosi ◽  
...  
Keyword(s):  
Black Hole ◽  
Data Analysis ◽  
Gravitational Wave ◽  
Laser Interferometer ◽  
Cherenkov Telescopes ◽  
Direct Observations ◽  
Binary Black Hole ◽  
Set Up

AbstractThe year 2015 witnessed the first direct observations of a transient gravitational-wave (GW) signal from binary black hole mergers by the Advanced Laser Interferometer Gravitational-wave Observatory (aLIGO) Collaboration with the Virgo Collaboration. The MAGIC two 17m diameter Cherenkov telescopes system joined since 2014 the vast collaboration of electromagnetic facilities for follow-up of gravitational wave alerts. During the 2015 LIGO-Virgo science run we set up the procedure for GW alerts follow-up and took data following the last GW alert. MAGIC results on the data analysis and prospects for the forthcoming run are presented.

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