A Novel Approach to Managing a Strangulated De Garengeot’s Hernia

2020 ◽  
pp. 000313482094355
Author(s):  
Francis J. Simpson ◽  
Katherine Fay ◽  
Vivian Wang ◽  
David Elwood
Keyword(s):  
Surgical Technique ◽  
Significant Variation ◽  
Case Reports ◽  
Relevant Literature ◽  
Vermiform Appendix ◽  
Open Approach ◽  
Hernia Defect ◽  
Elderly Female ◽  
Novel Approach ◽  
De Garengeot’S Hernia

De Garengeot’s hernia, the presence of an incarcerated vermiform appendix within a femoral hernia, is a rare general surgery emergency that predominantly affects elderly female patients. Due to its rarity, there is significant variation in surgical technique; however, most case reports favor an open approach. Here we present a case of a De Garengeot’s hernia with a unique hybrid open and laparoscopic repair, utilizing the hernia defect as a port site. We will also review the relevant literature.

Arthroscopic Reduction and Internal Fixation (ARIF) of a Comminuted Posterior Talar Body Fracture: Surgical Technique and Case Report

2017 ◽  
Vol 10 (5) ◽  
pp. 465-469 ◽  
Author(s):  
Rishin Kadakia ◽  
Jeff Konopka ◽  
Tristan Rodik ◽  
Samra Ahmed ◽  
Sameh A Labib
Keyword(s):  
Case Report ◽  
Surgical Technique ◽  
Internal Fixation ◽  
Case Reports ◽  
Wound Complications ◽  
Open Approach ◽  
Arthroscopic Reduction ◽  
Body Fracture ◽  
Anatomic Reduction ◽  
Talar Body Fracture

The talus is the second most common fractured tarsal bone. While their incidence may be low, talus fractures are severe injuries that can lead to long-term disability and pain. Displaced talar body fractures are typically treated through an open approach with the aim of obtaining anatomic reduction and stable fixation. There are several case reports in the literature demonstrating successful management of talus fractures arthroscopically. An arthroscopic approach minimizes soft tissue trauma, which can help decrease postoperative wound complications and infections. In this article, the authors describe a surgical technique of an arthroscopic reduction and internal fixation of a comminuted posterior talar body fracture. Compared with an open posterior approach with or without osteotomies, an arthroscopic technique improved visualization and allowed precise reduction and fixation. Levels of Evidence: Level V: Case report

scholarly journals De Garengeot’s Hernia: Two Case Reports with Correct Preoperative Identification of the Vermiform Appendix in the Hernia

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Zhaosheng Jin ◽  
Muhammad Rafiz Imtiaz ◽  
Henry Nnajiuba ◽  
Suzette Samlalsingh ◽  
Akinyede Ojo
Keyword(s):  
Hernia Repair ◽  
Gold Standard ◽  
Femoral Hernia ◽  
Case Reports ◽  
Vermiform Appendix ◽  
Case Control ◽  
Case Control Studies ◽  
Intravenous Contrast ◽  
De Garengeot’S Hernia

We present two cases of incarcerated de Garengeot’s hernia. This anatomical phenomenon is thought to occur in as few as 0.5% of femoral hernia cases and is a rare cause of acute appendicitis. Risk factors include a long pelvic appendix, abnormal embryological bowel rotation, and a large mobile caecum. In earlier reports operative treatment invariably involves simultaneous appendicectomy and femoral hernia repair. Both patients were correctly diagnosed preoperatively with computed tomography (CT). Both had open femoral hernia repair, one with appendectomy and one with the appendix left in situ. Both patients recovered without complications. Routine diagnostic imaging modalities such as ultrasonography and standard CT have previously shown little success in identifying de Garengeot’s hernia preoperatively. We believe this to be the first documented case of CT with concurrent oral and intravenous contrast being used to confidently and correctly diagnose de Garengeot’s hernia prior to surgery. We hope that this case report adds to the growing literature on this condition, which will ultimately allow for more detailed case-control studies and systematic reviews in order to establish gold-standard diagnostic studies and optimal surgical management in future.

scholarly journals Augmentation of Antipsychotic Medications with Low-Dose Clozapine in Treatment-Resistant Schizophrenia—Case Reports and Discussion

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Zoe Harrison ◽  
Owen Haeney ◽  
William Brereton
Keyword(s):  
Case Reports ◽  
Treatment Options ◽  
Relevant Literature ◽  
Treatment Resistance ◽  
Antipsychotic Treatment ◽  
Forensic Mental Health ◽  
Forensic Hospital ◽  
Novel Approach ◽  
Appropriate Therapy ◽  
Schizophrenia Case

Treatment resistance in schizophrenia is often encountered in clinical practice, with clozapine usually recommended as the appropriate therapy. However, where clozapine proves ineffective or cannot be tolerated due to side effects, treatment options are limited. In patients within forensic mental health services, residual symptomatology often presents a barrier to discharge and can have lasting effects on prospects for rehabilitation as well as risk to self and others. This paper presents a review of the relevant literature and three cases of a novel approach, utilising clozapine in doses usually considered subtherapeutic, in combination with the primary antipsychotic treatment. In all three patients, it improved clinical efficacy as well as tolerability, resulting in improvement that allowed discharge from the forensic hospital.

scholarly journals De Garengeot’s hernia with appendicitis—a rare cause of an acutely painful groin swelling

2019 ◽  
Vol 2019 (5) ◽  
Author(s):  
Adam O’Connor ◽  
Peter Asaad
Keyword(s):  
Acute Appendicitis ◽  
Hernia Repair ◽  
Mesh Repair ◽  
Vermiform Appendix ◽  
Short Review ◽  
Review Of The Literature ◽  
Hernia Sac ◽  
De Garengeot’S Hernia ◽  
De Garengeot Hernia ◽  
Groin Swelling

Abstract De Garengeot hernia is a rare subtype of femoral hernia whereby the vermiform appendix is located within the hernial sac. Even rarer is the presence of appendicitis within the hernia sac. De Garengeot’s hernia is difficult to diagnose pre-operatively and can prove technically difficult at operation particularly with regards to mobilization of the caecum and appendix in order to perform appendicectomy. Laparoscopic, open, with and without mesh repair of de Garengeot hernia have all been described in the literature with varying degrees of success. We present a case of an 82 year old lady presenting with an acutely painful right sided groin lump. CT scan revealed the presence of de Garengeot hernia with acute appendicitis. We describe in text and photo format our approach to the hernia repair, appendicectomy and provide a short review of the literature with regards to the different operative approaches to such a patient.

Complication Rate after Radical Cystectomy Depends on the Surgical Technique and Patient’s Clinical Status

2021 ◽  
pp. 1-8
Author(s):  
Przemysław Adamczyk ◽  
Paweł Pobłocki ◽  
Mateusz Kadlubowski ◽  
Adam Ostrowski ◽  
Witold Mikołajczak ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Minimally Invasive ◽  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Complication Rate ◽  
Tnm Stage ◽  
Complication Rates ◽  
Open Approach ◽  
Invasive Approach ◽  
Asa Score

<b><i>Purpose:</i></b> This study aimed to explore the complication rates of radical cystectomy in patients with muscle-invasive bladder cancer and identify potential risk factors. <b><i>Methods:</i></b> A total of 553 patients were included: 131 were operated on via an open approach (ORC), 242 patients via a laparoscopic method (LRC), and 180 by a robot-assisted procedure (RARC). Patient age, gender, American Society of Anesthesiologists (ASA) score, urinary diversion type, preoperative albumin level, body mass index (BMI), pathological (TNM) stage, and surgical times were collected. The severity of complications was classified according to the Clavien-Dindo scale (Grades 1–5). <b><i>Results:</i></b> The surgical technique was significantly related to the number of complications (<i>p</i> &#x3c; 0.00005). Grade 1 complications were observed most frequently following LRC (52.5%) and RARC (51.1%), whereas mostly Grade 2 complications were detected after ORC (78.6%). Those with less severe complications had significantly higher albumin levels than those with more severe complications (<i>p</i> &#x3c; 0.05). Patients with an elevated BMI had fewer complications if a minimally invasive approach was used rather than ORC. The patient’s general condition (ASA score) did not impact the number of complications, and urinary diversion type did not affect the severity of the complications. Mean surgical time differed according to the urinary diversion type in patients with a similar TNM stage (<i>p</i> &#x3c; 0.005); however, no difference was found in those with more locally advanced disease. Longer operation time and lower protein concentration were associated with higher probability of complication rate, that is, Clavien-Dindo score 3–5. <b><i>Conclusions:</i></b> The risk of complications after RC is not related to the type of urinary diversion, and can be reduced by using a minimally invasive surgical technique, especially in patients with high BMI.

Rare case of angiofibroma presenting as perineal hernia

2021 ◽  
Vol 14 (1) ◽  
pp. e236661
Author(s):  
Ruchika Kumari ◽  
Cherring Tandup ◽  
Ambuj Agarwal ◽  
Anish Chowdhury
Keyword(s):  
Soft Tissue ◽  
Case Reports ◽  
En Bloc Resection ◽  
Perineal Hernia ◽  
Pathological Examination ◽  
Soft Tissue Tumour ◽  
Open Approach ◽  
En Bloc ◽  
Rare Tumour ◽  
Tissue Tumour

Angiofibroma is a benign soft tissue tumour presenting as a gradually progressive swelling in the vulvovaginal area in women and in the inguinoscrotal region in men. Being a rare tumour, there are only a few case reports in the literature, and among them, presentation as perineal herniation is very rare. En bloc resection of angiofibroma either via laparoscopic or open approach is the choice of treatment to avoid recurrence. Detailed pathological examination and immunohistochemistry workup are imperative to distinguish it from various mesenchymal tumours. Perineal hernia is itself rare and may occur spontaneously or following abdominoperineal resection, sacrectomy or pelvic exenteration. Surgical repair via open transabdominal and transperineal approaches has been described. Here, we report a case of a young woman who presented with spontaneous reducible perineal hernia with a soft tissue tumour as its content, which on histopathological investigation was found to be an angiofibroma.

Axillary pullout syndrome: A novel approach to managing a devastating complication

Vascular ◽  
2021 ◽  
pp. 170853812110489
Author(s):  
Nathan W Kugler ◽  
Brian D Lewis ◽  
Michael Malinowski
Keyword(s):  
Stent Graft ◽  
Effective Means ◽  
Bypass Graft ◽  
Hybrid Approach ◽  
Inpatient Rehabilitation ◽  
Anastomotic Dehiscence ◽  
Open Approach ◽  
Novel Approach ◽  
Life Threatening ◽  
History Of

Objectives Axillary pullout syndrome is a complex, potentially fatal complication following axillary-femoral bypass graft creation. The re-operative nature, in addition to ongoing hemorrhage, makes for a complicated and potentially morbid repair. Methods We present the case of a 57-year-old man with history of a previous left axillary-femoral-femoral bypass who presented with acute limb-threatening ischemia as a result of bypass thrombosis managed with a right axillary-femoral bypass for limb salvage. His postoperative course was complicated by an axillary anastomotic dehiscence while recovering in inpatient rehabilitation resulting in acute, life-threatening hemorrhage. He was managed utilizing a novel hybrid approach in which a retrograde stent graft was initially placed across the anastomotic dehiscence for control of hemorrhage. He then underwent exploration, decompression, and interposition graft repair utilizing the newly placed stent graft to reinforce the redo axillary anastomosis. Results and Conclusion Compared with a traditional operative approach, the hybrid endovascular and open approach limited ongoing hemorrhage while providing a more stable platform for repair and graft revascularization. A hybrid approach to the management of axillary pullout syndrome provides a safe, effective means to the management of axillary anastomotic dehiscence while minimizing the morbidity of ongoing hemorrhage.

scholarly journals Integrating public risk perception into formal natural hazard risk assessment

2006 ◽  
Vol 6 (3) ◽  
pp. 471-483 ◽  
Author(s):  
Th. Plattner ◽  
T. Plapp ◽  
B. Hebel
Keyword(s):  
Risk Assessment ◽  
Risk Perception ◽  
Risk Evaluation ◽  
Formal Model ◽  
Relevant Literature ◽  
Historical Context ◽  
Individual Risk ◽  
Affecting Factors ◽  
Plausibility Check ◽  
Novel Approach

Abstract. An urgent need to take perception into account for risk assessment has been pointed out by relevant literature, its impact in terms of risk-related behaviour by individuals is obvious. This study represents an effort to overcome the broadly discussed question of whether risk perception is quantifiable or not by proposing a still simple but applicable methodology. A novel approach is elaborated to obtain a more accurate and comprehensive quantification of risk in comparison to present formal risk evaluation practice. A consideration of relevant factors enables a explicit quantification of individual risk perception and evaluation. The model approach integrates the effective individual risk reff and a weighted mean of relevant perception affecting factors PAF. The relevant PAF cover voluntariness of risk-taking, individual reducibility of risk, knowledge and experience, endangerment, subjective damage rating and subjective recurrence frequency perception. The approach assigns an individual weight to each PAF to represent its impact magnitude. The quantification of these weights is target-group-dependent (e.g. experts, laypersons) and may be effected by psychometric methods. The novel approach is subject to a plausibility check using data from an expert-workshop. A first model application is conducted by means of data of an empirical risk perception study in Western Germany to deduce PAF and weight quantification as well as to confirm and evaluate model applicbility and flexibility. Main fields of application will be a quantification of risk perception by individual persons in a formal and technical way e.g. for the purpose of risk communication issues in illustrating differing perspectives of experts and non-experts. For decision making processes this model will have to be applied with caution, since it is by definition not designed to quantify risk acceptance or risk evaluation. The approach may well explain how risk perception differs, but not why it differs. The formal model generates only "snap shots" and considers neither the socio-cultural nor the historical context of risk perception, since it is a highly individualistic and non-contextual approach.

scholarly journals Teaching Engineering Ethics Through a Psychology Course

2021 ◽  
Vol 11 (1) ◽  
pp. 16
Author(s):  
Nguyen Van Hanh ◽  
Nguyen Tien Long ◽  
Nguyen Thi Duyen ◽  
Phan Thi Thanh Canh ◽  
Nguyen Thanh Long ◽  
...  
Keyword(s):  
Test Scores ◽  
Relevant Literature ◽  
Engineering Ethics ◽  
Engineering Programs ◽  
Ethics Instruction ◽  
Technical Schools ◽  
Novel Approach ◽  
Post Test ◽  
Psychology Courses ◽  
Psychology Course

While ethics instruction is now widespread, studies are still looking for different ways to integrate ethics in engineering programs. In this article, we propose a novel approach by teaching engineering ethics through a psychology course. Starting with the relevant literature studies, we have argued that the phenomeno-logical experience of ethics is a source to explain psychological truths, while en-gineering ethics can be better taught from psychological / behavioral perspectives. A pedagogical approach of experiential learning has been applied to integrate engineering ethics into the psychology course. The empirical study with 400 stu-dents in psychology courses show that teaching engineering ethics through a psychology course has a significant effect on improving the knowledge of engi-neering ethics for students. The relationship between the two pre- and post-test scores was a strong positive linear relationship. A regression equation with a slope of a straight line of 0.57 and a constant of 1.52 has been provided to predict the improvement of post-test scores through pre-test scores. This study proposes the formation of a "psychology and ethics" module in technical schools.

Co-Creation: A Novel Approach to Developing Guidelines for Research Integrity Policy – Lessons Learned from the SOPS4RI Project

2021 ◽  
Vol 66 (Special Issue) ◽  
pp. 113-114
Author(s):  
Krishma Labib ◽  
◽  
Joeri Tijdink ◽  
◽  
Keyword(s):  
Best Practice ◽  
Guideline Development ◽  
Research Integrity ◽  
Lessons Learned ◽  
Open Approach ◽  
Novel Approach ◽  
Qualitative Research Methodology ◽  
Online Setting ◽  
General Guidance ◽  
Guideline Format

"Co-creation is a qualitative research methodology that engages stakeholders in playful activities to produce user-centered outputs. Through an interactive and open approach, co-creation explores stakeholders’ latent values, generates innovative ideas, and captures minority views, allowing for in-depth understanding of how stakeholders are affected by various factors. Therefore, co-creation is a promising methodology for developing guidelines on research integrity (RI), although there is no literature available about co-creation in this context. In our presentation, we share experiences of using co-creation to design institutional guidelines on RI together with research managers, funders and researchers across Europe. We conducted 24 co-creation workshops on topics ranging from RI education, to creating a responsible research environment, resulting in concrete guidelines that research institutions and funders can implement to foster RI. Our experience has provided us with valuable insights on using co-creation for RI guideline development. While motivating research stakeholders – often serious and analytically oriented people – to engage in creative exercises can be a challenge, particularly in the online setting, it is possible to achieve when ‘play’ and ‘work’ are carefully balanced. Additionally, to ensure the concreteness of guidelines while accounting for differences among institutions and countries, best practice examples can be used to show different approaches to implementing more general guidance. We have also learned that it is valuable to explore stakeholders’ preferences regarding the guideline format, since implementability is not only influenced by the content. These insights provide practical considerations that other researchers can use when co-creating RI guidelines. "

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