scholarly journals Delayed Tracheal Perforation After Partial Thyroidectomy: A Case Report and Review of the Literature

2021 ◽  
pp. 014556132110197
Author(s):  
Shaghauyegh S. Azar ◽  
Evan Patel ◽  
Lauran K. Evans ◽  
Timothy C. Blood ◽  
Brooke M. Su-Velez ◽  
...  
Keyword(s):  
Primary Closure ◽  
High Dose ◽  
Review Of The Literature ◽  
Muscle Transposition ◽  
Current Case ◽  
Transposition Flap ◽  
Wall Defect ◽  
Steroid Administration ◽  
Thyroid Mass ◽  
Partial Thyroidectomy

Tracheal perforation is an extremely rare and potentially dangerous complication of a partial thyroidectomy. The current case represents a unique presentation of delayed tracheal perforation following an uncomplicated thyroid isthmusectomy for tissue diagnosis of an aggressive appearing thyroid mass in the setting of high-dose steroid administration and recent intubation and self-extubation. While conservative management of tracheal perforation can sometimes be appropriate, our patient was successfully managed via primary closure and infrahyoid muscle transposition flap to cover a 5 mm right lateral tracheal wall defect. We recommend caution be exercised following thyroid surgery in the setting of intubation and high-dose steroids.

scholarly journals A Case of Type 2 Amiodarone-Induced Thyrotoxicosis That Underwent Total Thyroidectomy under High-Dose Steroid Administration

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Koshi Hashimoto ◽  
Masaki Ota ◽  
Tadanobu Irie ◽  
Daisuke Takata ◽  
Tadashi Nakajima ◽  
...  
Keyword(s):  
Total Thyroidectomy ◽  
Withdrawal Syndrome ◽  
Adrenal Crisis ◽  
High Dose ◽  
Steroid Withdrawal ◽  
Current Case ◽  
Steroid Administration ◽  
High Dose Steroid

Amiodarone is used commonly and effectively in the treatment of arrhythmia; however, it may cause thyrotoxicosis categorized into two types: iodine-induced hyperthyroidism (type 1 amiodarone-induced thyrotoxicosis (AIT)) and destructive thyroiditis (type 2 AIT). We experienced a case of type 2 AIT, in which high-dose steroid was administered intravenously, and we finally decided to perform total thyroidectomy, resulting in a complete cure of the AIT. Even though steroid had been administered to the patient (maximum 80 mg of prednisolone), the operation was performed safely and no acute adrenal crisis as steroid withdrawal syndrome was found after the operation. Few cases of type 2 AIT that underwent total thyroidectomy with high-dose steroid administration have been reported. The current case suggests that total thyroidectomy should be taken into consideration for patients with AIT who cannot be controlled by medical treatment and even in those under high-dose steroid administration.

scholarly journals High-dose intravenous methotrexate in the management of breast cancer with leptomeningeal disease: Case series and review of the literature

2019 ◽  
Vol 12 (4) ◽  
pp. 189-193 ◽  
Author(s):  
Jonathan T. Kapke ◽  
Robert J. Schneidewend ◽  
Zeeshan A. Jawa ◽  
Chiang-Ching Huang ◽  
Jennifer M. Connelly ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Case Series ◽  
Leptomeningeal Disease ◽  
High Dose ◽  
Review Of The Literature ◽  
Disease Case

Muscle Transposition Flap for Salvage of Exposed Peripheral Prosthetic Vascular Grafts

1998 ◽  
Vol 41 (6) ◽  
pp. 640-645 ◽  
Author(s):  
Bishara S. Atiyeh ◽  
Maher M. Hussein ◽  
Dany I. Kayle ◽  
Ali A. Nasser ◽  
Hussein A. Hashim
Keyword(s):  
Vascular Grafts ◽  
Muscle Transposition ◽  
Transposition Flap

Management of Laparotomy Wound Dehiscence

2007 ◽  
Vol 73 (12) ◽  
pp. 1224-1227 ◽  
Author(s):  
Daniel E. Abbott ◽  
Gregory A. Dumanian ◽  
Amy L. Halverson
Keyword(s):  
Primary Closure ◽  
Abdominal Wall Defect ◽  
Wound Dehiscence ◽  
High Rate ◽  
Fascial Closure ◽  
Wall Defect ◽  
Laparotomy Wound ◽  
Abdominal Wound Dehiscence ◽  
Successful Repair ◽  
Optimal Treatment Strategy

Many studies identify risk factors for dehiscence, but a paucity of data exist suggesting an optimal treatment strategy. This study examines repair of abdominal wound dehiscence, comparing closure and interposition of mesh. We conducted a retrospective review of 37 individuals who suffered a wound dehiscence after laparotomy. Outcomes of repairs with either primary closure or polyglactin mesh interposition were examined. Twenty-seven individuals underwent repair with primary closure. Twelve of these individuals suffered repeat wound dehiscence; 10 were treated with repeat fascial closure, 2 with polyglactin mesh interposition. Seven individuals initially underwent successful repair with polyglactin mesh interposition; all subsequently had their hernias repaired. Three patients had minor fascial separation managed nonoperatively. Primary closure is associated with a relatively high rate of recurrent wound dehiscence. Closure with polyglactin mesh interposition has a higher initial success rate, but necessitates additional surgeries for repair of the abdominal wall defect.

scholarly journals Cytopathological Diagnosis of an Unusual Cause of Malignant Hydrocele

2016 ◽  
Vol 9 ◽  
pp. CPath.S40517 ◽  
Author(s):  
Ankur Jain ◽  
Alka Khadwal ◽  
Gaurav Prakash ◽  
Nalini Gupta ◽  
Subhash Varma ◽  
...  
Keyword(s):  
Residual Disease ◽  
Lymphoblastic Leukemia ◽  
Cervical Lymphadenopathy ◽  
Maintenance Phase ◽  
Bone Marrow Examination ◽  
High Dose ◽  
Current Case ◽  
One Year ◽  
Contiguous Spread

Testicular involvement in a case of acute lymphoblastic leukemia (ALL) is well reported, but occurrence of “isolated” malignant hydrocele is extremely uncommon. We herein report a case of a 22-year-old man who presented to our hematology clinic with fever and easy fatiguability of 2 weeks' duration. Examination revealed pallor, cervical lymphadenopathy, and bilateral scrotal swellings. He was diagnosed as a case of Philadelphia-positive ALL (B-cell type) based on peripheral smear, bone marrow examination, and flow cytometry of the marrow aspirate. Ultrasonography of scrotum revealed bilateral hydrocele with normal testes. Cytopathological analysis of the hydrocele fluid showed the presence of lymphoblasts. The patient was treated with modified BFM-90 protocol along with imatinib mesylate (600 mg/day). He achieved complete remission with a minimal residual disease of <0.001% at the end of induction therapy. However, the hydrocele persisted and a repeat cytological examination of the aspirate did not reveal any lymphoblasts. The patient was treated with consolidation (high-dose methotrexate), bilateral testicular irradiation, and re-induction following which the hydrocele disappeared. The patient is currently on maintenance phase of BFM-90 protocol and is alive at one year of follow-up. Contiguous spread from the subclinical testicular involvement is hypothesized as the mechanism for development of hydrocele in the current case. The role of cytopathology in the early diagnosis of testicular involvement in ALL is emphasized here.

scholarly journals Utility of Botulinum Injections in Stiff-Person Syndrome

2019 ◽  
Vol 2019 ◽  
pp. 1-3 ◽  
Author(s):  
L. M. Conners ◽  
A. Betcher ◽  
A. Shahinian ◽  
P. Janda
Keyword(s):  
Case Report ◽  
Adverse Reactions ◽  
Intravenous Immunoglobulins ◽  
Initial Therapy ◽  
High Dose ◽  
B Cell Depletion ◽  
Stiff Person Syndrome ◽  
Review Of The Literature ◽  
Systemic Treatments ◽  
Muscle Spasms

Stiff-person syndrome (SPS) is an uncommon neurological disorder characterized by significant rigidity and muscle spasms primarily affecting the truncal and proximal musculature. Furthermore, a wide-based gait with functional impairment is generally seen. High-dose benzodiazepines or baclofen are widely considered the optimal initial therapy; however, major adverse effects often preclude adequate dosing. Refractory cases may be treated with intravenous immunoglobulins (IVIG), plasma exchange, or B-cell depletion with rituximab, although these are also associated with major, sometimes fatal, adverse reactions. Several reports have validated the safety and utility of botulinum injections in this setting, yet botulinum remains markedly underutilized in this cohort. Below, a case report and review of the literature show botulinum can decrease pain and stiffness, improve gait and balance, and decrease dependence on powerful systemic treatments in this group.

scholarly journals Early changes in immune cell subsets with corticosteroids in patients with solid tumors: implications for COVID-19 management

2020 ◽  
Vol 8 (2) ◽  
pp. e001019
Author(s):  
Jennifer L Marté ◽  
Nicole J Toney ◽  
Lisa Cordes ◽  
Jeffrey Schlom ◽  
Renee N Donahue ◽  
...  
Keyword(s):  
Flow Cytometry ◽  
Solid Tumors ◽  
Immune Cell ◽  
Inflammatory Marker ◽  
Antiviral Immunity ◽  
Effector Memory ◽  
Rank Test ◽  
High Dose ◽  
Corticosteroid Administration ◽  
Steroid Administration

BackgroundThe risk–benefit calculation for corticosteroid administration in the management of COVID-19 is complex and urgently requires data to inform the decision. The neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation associated with poor prognosis in both COVID-19 and cancer. Investigating NLR as an inflammatory marker and lymphocyte levels as a critical component of antiviral immunity may inform the dilemma of reducing toxic hyperinflammation while still maintaining effective antiviral responses.MethodsWe performed a retrospective analysis of NLR, absolute neutrophil counts (ANCs) and absolute lymphocyte counts (ALCs) in patients with cancer enrolled in immunotherapy trials who received moderate-dose to high-dose corticosteroids. We compared paired presteroid and available poststeroid initiation values daily during week 1 and again on day 14 using the Wilcoxon signed-rank test. Associated immune subsets by flow cytometry were included where available.ResultsPatients (n=48) with a variety of solid tumors received prednisone, methylprednisolone, or dexamethasone alone or in combination in doses ranging from 20 to 190 mg/24 hours (prednisone equivalent). The median NLR prior to steroid administration was elevated at 5.0 (range: 0.9–61.2). The corresponding median ANC was 5.1 K/µL (range: 2.03–22.31 K/µL) and ALC was 1.03 K/µL (0.15–2.57 K/µL). One day after steroid administration, there was a significant transient drop in median ALC to 0.54 K/µL (p=0.0243), driving an increase in NLR (median 10.8, p=0.0306). Relative lymphopenia persisted through day 14 but was no longer statistically significant. ANC increased steadily over time, becoming significant at day 4 (median: 7.31 K/µL, p=0.0171) and remaining significantly elevated through day 14. NLR was consistently elevated after steroid initiation, significantly at days 1, 7 (median: 8.2, p=0.0272), and 14 (median: 15.0, p=0.0018). Flow cytometry data from 11 patients showed significant decreases in activated CD4 cells and effector memory CD8 cells.ConclusionsThe early drop in ALC with persistent lymphopenia as well as the prolonged ANC elevation seen in response to corticosteroid administration are similar to trends associated with increased mortality in several coronavirus studies to include the current SARS-CoV-2 pandemic. The affected subsets are essential for effective antiviral immunity. This may have implications for glucocorticoid therapy for COVID-19.

Sign in / Sign up

Export Citation Format

Share Document