A Retrospective Study of 12 Cases of Pyoderma Gangrenosum: Why We Should Avoid Surgical Intervention and What Therapy to Apply

2011 ◽  
Vol 77 (12) ◽  
pp. 1644-1649 ◽  
Author(s):  
Wioletta Barańska-Rybak ◽  
Monika Kakol ◽  
Matilda Naesstrom ◽  
Olivia Komorowska ◽  
Małgorzata Sokolowska-Wojdyło ◽  
...  
Keyword(s):  
Pyoderma Gangrenosum ◽  
Skin Diseases ◽  
Surgical Intervention ◽  
Histopathological Examination ◽  
Case Series ◽  
Disease Process ◽  
Diagnosis And Treatment ◽  
Surgical Interventions ◽  
Case Series Study ◽  
Proper Diagnosis

Lesions of skin are ubiquitous in the medical field. The varying etiopathologies with similar presentation can pose a misleading picture, especially when faced with less common skin diseases. Furthermore, the misdiagnosis can cause detrimental effects on the patient's morbidity and mortality, which was seen in the case series study we performed on pyoderma gangrenosum. The history of 12 patients were analyzed in reference to the course of the disease, accompanying diseases, clinical picture, histopathological examination, surgical intervention before diagnosis, and treatment. Within this group of 12 patients, five were exposed to surgical interventions before diagnosis of pyoderma gangrenosum. The 5 patients were all exposed to prolonged aggravation of the disease process, followed by remission after proper diagnosis and treatment therapy. This study was done to improve the knowledge of surgeons about pyoderma gangrenosum considering the frequency of skin lesion cases in the surgical practice. Knowledge of the disease is essential to diagnose pyoderma gangrenosum in early stages to avoid interventions that may prolong or worsen the outcome. Surgical interventions in these patients should be avoided before proper diagnosis. The key to a better prognosis of pyoderma gangrenosum patients is often in the hands of surgeons.

scholarly journals ALGORITHM OF TREATMENT AND DIAGNOSIS IN RESISTANT FORMS OF COLONIC CONSTIPATION IN ADULTS

2021 ◽  
Vol 14 (3) ◽  
pp. 38-43
Author(s):  
KIRILL A. SAKULIN ◽  
◽  
OLEG YU. KARPUKHIN ◽  
Keyword(s):  
Functional State ◽  
Chronic Constipation ◽  
Surgical Intervention ◽  
Detailed Examination ◽  
Diagnosis And Treatment ◽  
Positive Outcomes ◽  
Surgical Interventions ◽  
Individual Approach ◽  
Treatment And Diagnosis

The variety of etiological causes of chronic constipation requires an individual approach to diagnosis and treatment. Outdated views do not consider a detailed examination of patients with long-term constipation. Today, surgical interventions for refractory colonic constipation are used more and more often and have begun to demonstrate positive outcomes. The choice of surgical intervention largely depends on the results of the detected abnormality of the structure and location of the colon, as well as on the functional state of its various parts.

scholarly journals Oral health of patients suffering from end-stage solid organ insufficiency prior to solid organ re-transplantation: a retrospective case series study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tobias Moest ◽  
Rainer Lutz ◽  
Arne Eric Jahn ◽  
Katharina Heller ◽  
Mario Schiffer ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Surgical Intervention ◽  
Case Series ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Retrospective Case ◽  
Treatment Need ◽  
Case Series Study ◽  
Series Study ◽  
Radiological Examinations

Abstract Background The oral health of organ transplanted patients before organ re-transplantation is largely unknown. This retrospective clinical study evaluates the necessity for intraoral surgical intervention and/or conservative treatment in candidates awaiting organ re-transplantation, both for graft failure and for reasons of another upcoming solid organ transplantation (renal or non-renal). Methods From January 2015 to March 2020 n = 19 transplant recipients in evaluation on the waiting list for solid organ re-transplantation could be included in the retrospective case series study. Using clinical and radiological examinations, necessity for oral surgical or conservative dental treatment was evaluated. On the basis of anamnesis data, current kidney function, renal replacement treatment (RRT), and medication, a risk profile for several patient subgroups was created. Results The clinical and radiological examinations showed a conservative and/or surgical treatment need in n = 13 cases (68.42%). In n = 7 cases (36.84%) surgical intervention was recommended due to residual root remnants (n = 5), unclear mucosal changes (n = 1), and periimplantitis (n = 1). In n = 16 recipients (84.2%) RRT (n = 15 hemodialysis; n = 1 peritoneal dialysis) had been performed. N = 14 recipients (73.68%) received immunosuppressants. In n = 1 patient (5.3%) displayed intraoral and n = 4 patients (21.1%) extraoral neoplasms due to drug-induced immunosuppression. Conclusions Solid organ transplant recipients with renal failure present a complex treatment profile due to a double burden of uremia plus immunosuppressants. In cases of surgical treatment need a hospitalized setting is recommended, where potentially necessary follow-up care and close cooperation with disciplines of internal medicine is possible in order to avoid surgical and/or internal complications.

Volume of surgical interventions for benign colorectal tumors – an analysis of 3510 surgical and endoscopic resections in the single colorectal center in Poland

2021 ◽  
Vol 93 (6) ◽  
pp. 11-19
Author(s):  
Michał Spychalski ◽  
Marcin Włodarczyk ◽  
Katarzyna Winter ◽  
Jakub Włodarczyk ◽  
Igor Dąbrowski ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Histopathological Examination ◽  
Early Stage ◽  
Benign Lesion ◽  
Screening Colonoscopy ◽  
Colorectal Tumors ◽  
Surgical Interventions ◽  
Endoscopic Techniques ◽  
Abdominal Approach ◽  
Appropriate Treatment

Introduction: Colorectal cancer is the most frequent neoplasm of the whole gastrointestinal track. Due to screening colonoscopy program, colorectal lesions are often diagnosed at early stage. The vast majority of them are possible to remove endoscopically. However, a substantial percentage of benign lesion in Western centers are still operated. The aim of this article was to determine the percentage of surgical resections due to benign adenomas in the reference center of endoscopic submucosal dissection (ESD) and colorectal surgery in Poland. Materials and Methods: Retrospective analysis of 3 510 patients operated from 2015 to 2019 in Center of Bowel Treatment in Brzeziny. Results: We have analyzed 3 510 endoscopic and surgical procedures performed in the colon: 601 ESDs; 1 002 endoscopic mucosal resections (EMRs); and 1,907 surgical resections. Out of 601 ESDs, 57 invaded the submucosa, of which 29 (4.8%) were non-therapeutic ESDs. In 5 patients, due to occurrence of post-ESD perforation, an additional surgical intervention was necessary. Out of the 1,002 EMRs, 22 cases (2.2%) were diagnosed with deeply infiltrating cancers, which required a surgery. The overall percentage of the need for surgery in the endoscopically treated patients (ESD + mucosectomy) was 3.5% (56/1 603). Among resection surgeries, 15 of them (0.8%) ended with the diagnosis of a benign lesion in the postoperative histopathological examination. Conclusions: Inclusion advanced endoscopic techniques such as ESD to routine clinical practice in colorectal centers gives clear benefits for the patients. Well defined and standardized process of qualifying for appropriate treatment allows to significantly reduce the percentage of abdominal approach surgery due to benign colorectal lesions.  

scholarly journals Cranio-vertebral junction tuberculosis

2012 ◽  
Vol 01 (01) ◽  
pp. 061-065 ◽  
Author(s):  
Keyword(s):  
Early Diagnosis ◽  
Surgical Intervention ◽  
Treatment Protocol ◽  
Case Series ◽  
Disease Process ◽  
Rare Condition ◽  
Craniovertebral Junction ◽  
Inflammatory Lesions ◽  
Malignant Lesions ◽  
High Index Of Suspicion

Abstract There are variety of diseases which affect the region of craniovertebral junction, including congenital, malignant lesions, traumatic and infective/inflammatory lesions. CVJ tuberculosis is an extremely rare condition, accounting for 0.3 to 1% of all cases of spinal TB. Few case series have been reported in the literature about this rare condition, but there appears to be lack of consensus even on basic issues like whether to undertake surgical intervention or prefer a conservative approach in cases of CVJ TB. These cases can present with a myriad of symptoms and one needs to have a high index of suspicion for early diagnosis. Early diagnosis and treatment is very important for a favorable outcome. In this article, we have tried to review the available literature and also share our experience about this condition so as to have a better understanding of the disease process and have a more rational treatment protocol.

Surgical Treatment of Chronic Hand Ischemia: A Systematic Review and Case Series

2019 ◽  
Vol 24 (03) ◽  
pp. 359-370
Author(s):  
David L. Colen ◽  
Oded Ben-Amotz ◽  
Thibaudeau Stephanie ◽  
Arman Serebrakian ◽  
Martin J. Carney ◽  
...  
Keyword(s):  
Systematic Review ◽  
Surgical Treatment ◽  
Surgical Intervention ◽  
Case Series ◽  
Ulnar Artery ◽  
Pharmacologic Therapy ◽  
Cold Intolerance ◽  
Algorithmic Approach ◽  
Surgical Interventions ◽  
Hand Ischemia

Background: Chronic hand ischemia refers to progressive, non-acute ischemic symptoms such as cold intolerance, rest pain, ulceration, tissue necrosis, and digit loss and poses a significant challenge in management. Conservative treatment begins with medical optimization and pharmacologic therapy, but when symptoms persist, surgical intervention may be required. Various operations exist to improve circulation including sympathectomy, arterial bypass, or venous arterialization. The purpose of this study is to systematically review published outcomes and present our experience with each surgical technique. Methods: A systematic review of literature regarding surgical treatment of chronic hand ischemia published between 1990 and 2016 was conducted using PRISMA guidelines. A retrospective-review of surgical interventions for chronic hand ischemia from 2010 to 2016 was then conducted. Primary outcomes included improvement in pain, wound-healing, and development of new ulcerations. Results: The review included 38 eight studies, showing all three techniques were effective in treating chronic hand ischemia. Sympathectomy had the lowest rate of new ulcerations (0.8%); bypass had the highest rate of healing existing ulcerations (89%). Arterialization was associated with consistent pain improvement pain (100%) but more complications (30.8%). Our series included 18 patients with 21 affected hands, 18 sympathectomies, 6 ulnar artery bypasses, and 1 arterialization. Most hands had improvement of wounds (89.5%) and pain (78.9%). No patients developed new ulcerations, but one required secondary amputation. Conclusions: When conservative measures fail to improve chronic hand ischemia, surgical intervention is an effective last line treatment. An algorithmic approach can determine the best operation for patients with chronic hand ischemia.

scholarly journals Case series of acute appendicitis association with SARS-CoV-2 infection

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Charlsea Prichard ◽  
Matthew Canning ◽  
Kindra McWilliam-Ross ◽  
John Birbari ◽  
William Parker ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Retrospective Review ◽  
Surgical Intervention ◽  
Case Series ◽  
Single Institution ◽  
Chi Square ◽  
Surgical Interventions ◽  
Asymptomatic Patients ◽  
High Prevalence ◽  
Chi Square Analysis

Abstract Background Describe the indications for surgical interventions in asymptomatic patients with SARS-CoV-2. We are unaware of previous reports of an association between SARS-CoV-2 and acute appendicitis. Methods We performed a single institution retrospective review of SARS-CoV-2 pre-procedure testing and indications for surgical intervention. Statistical comparisons were performed using Chi Square analysis or two-tailed Student T test. Results We report a high prevalence of SARS-CoV-2 in both all testing and pre-procedure testing during the enrollment period. We observe a high prevalence of acute appendicitis among patients identified to be SARS-CoV-2 positive during pre-procedure testing and without recognized symptoms of COVID19. Conclusion We report a previously unrecognized association between SARS-CoV-2 and acute appendicitis.

scholarly journals MANAGEMENT CHALLENGE IN CHEST WALL NEOPLASMS

2015 ◽  
Vol 22 (09) ◽  
pp. 1176-1180
Author(s):  
Niaz Hussain Soomro ◽  
Aneeqa Ahsan Zafar ◽  
Saifullah Baig ◽  
Guzel Maxood ◽  
Nisar Rao
Keyword(s):  
Chest Wall ◽  
Primary Tumor ◽  
Malignant Tumors ◽  
Histopathological Examination ◽  
Case Series ◽  
Chest Wall Tumor ◽  
Histopathological Diagnosis ◽  
Team Approach ◽  
Tumor Type ◽  
Case Series Study

Introduction: Chest wall neoplasms are rare and represent only about 5% ofall thoracic neoplasm. We present our 2 years analysis of the clinical features, presentation,diagnosis and treatment of chest wall neoplasms. Study design: Case series study. Place andduration of study: Ojha Institute of Chest Diseases, Dow University of Health Sciences, Karachi,Pakistan from Nov 2012- Oct 2014. Methodology: Between 2012 and 2014, 39 patients with solidchest wall masses were enrolled in the study. Tumors were categorized as benign and malignant,including primary and secondary, after histopathological diagnosis with tissue biopsy. Data onpatients’ characteristics, symptoms, tumor type and management was recorded and analysed.Results: The study included 39 patients (20 males and 19 females) with age range 18-71years(mean 36.3). 21(53.8%) patients had benign chest wall tumors while 18(46.1%) patients hadmalignant tumors. Among malignant tumors, 14(77%) patients had primary malignancy whereas 4(22%) patients had chest wall tumor secondary to primary tumor elsewhere. Among these4, the primary tumor remained unknown in 1 patient. The most common benign solid lesionwas chest wal lesion lipoma in 8/21 patients (38%). Among malignant tumors, chondrosarcoma(4/14, 29%) was the most common. Conclusion: Preoperative needs careful assessment of thepatient, radiological imaging and histopathological examination for diagnosis of the tumor inthe chest wall. Using a multidisciplinary team approach, excellent results can be available withcomplete surgical resection, reconstruction of the chest wall and appropriate or neo adjuvanttreatment where necessary.

scholarly journals CHOLESTEATOMA PRESENTATION TRENDS IN KOHAT DIVISION

2021 ◽  
Vol 71 (Suppl-3) ◽  
pp. S462-66
Author(s):  
Muhammad Waqas Ayub ◽  
Sheikh Saadat Ullah Waleem ◽  
Mahrukh Afzal ◽  
Shahzad Maqbool ◽  
Maqbool Raza ◽  
...  
Keyword(s):  
National Level ◽  
Case Series ◽  
Disease Process ◽  
Stage Iv ◽  
Stage Ii ◽  
Disease Spread ◽  
Stage Iii ◽  
Military Hospital ◽  
Suppurative Otitis Media ◽  
Case Series Study

Objective: To discuss the presentation stages of Cholesteatoma in patients of various areas of Kohat division. Study Design: Case series study. Place and Duration of Study: Combined Military Hospital Kohat, from Nov 2015 to Nov 2017. Methodology: A total of 60 patients having Chronic Suppurative otitis media with Cholesteatoma were selected from outpatient department. Disease process was evaluated by otomicroscopy as well as radiologically. Perioperative disease spread pattern was also assessed and documented. Results: Out of 28 patients with pars tensa cholesteatoma 28.5% were in stage II and 53.5% were in stage III disease. Out of 32 patients with pars flaccid cholesteatoma, 3.1% presented with stage 1 disease, 37.5% with stage II disease, 50% with stage III disease and 9.3% with stage IV disease. Conclusion: Appropriate measures should be taken for training of general physicians as well as otologists at National level to help early diagnosis and better outcome.

scholarly journals Non-surgical management of Boerhaave’s syndrome: a case series study and review of the literature

2018 ◽  
Vol 06 (01) ◽  
pp. E92-E97 ◽  
Author(s):  
Khalil Aloreidi ◽  
Bhavesh Patel ◽  
Tim Ridgway ◽  
Terry Yeager ◽  
Muslim Atiq
Keyword(s):  
Interventional Radiology ◽  
Endoscopic Treatment ◽  
Case Series ◽  
Therapeutic Endoscopy ◽  
Boerhaave’S Syndrome ◽  
Surgical Interventions ◽  
Boerhaave's Syndrome ◽  
Case Series Study ◽  
Threatening Condition ◽  
Esophageal Stenting

Abstract Background and study aims Boerhaave’s syndrome (BS) is a life-threatening condition with morbidity and mortality rates as high as 50 % in some reports. Until recently, surgical intervention has been the mainstay of management plans. With advances in therapeutic endoscopy, however, there has been increasing interest in non-surgical options including endoscopic esophageal stenting. Patients and methods We reviewed the medical records of all patients diagnosed with BS and managed with endoscopic interventions between November 2011 and November 2016. The following variables were collected: patient demographics, clinical presentations, locations of esophageal perforation, primary interventions, complications, and outcomes. Results Six patients were found to be diagnosed with BS during the study period. The median age at presentation was 55. There were 4 males and 2 females. The most common site of perforation was in the distal esophagus. The most common presenting symptom was chest pain (67 %) following an episode of vomiting or retching. Four patients (66.7 %) developed septic shock. Endoscopic treatment with a fully covered esophageal stent was the primary intervention in all patients (100 %). Interventional radiology was consulted in all cases for fluid drainage and chest tube placements. Clinical resolution of the BS was achieved in all patients (100 %) without any subsequent surgical interventions. There were no deaths within the study group, and the average follow-up duration was 2 years. Conclusion Endoscopic treatment seems to be an effective management strategy in patients with BS. We also noted satisfactory results in patients presenting with sepsis, presumably due to urgent, interventional radiology-guided fluid drainage.

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