Congenital Lung Abnormalities: Experience of a Tertiary Care NICU in Delhi, A Case Series

2021 ◽  
pp. 097321792110653
Author(s):  
Bhavya Kukreja ◽  
Deepak Mittal ◽  
Poonam Sidana ◽  
Gurleen Sikka ◽  
Harsh Wardhan ◽  
...  
Keyword(s):  
Imaging Techniques ◽  
Tertiary Care ◽  
Survival Rates ◽  
Case Series ◽  
Expectant Management ◽  
Mass Effect ◽  
In Utero ◽  
Team Approach ◽  
Lung Lesions ◽  
Cystic Lung

Respiratory distress is the most common cause of neonatal admission. Cystic lung lesions are rarer cause of the same. These are heterogeneous lesions with varied antenatal and postnatal manifestations. The outcomes of antenatally diagnosed lung malformations have showed more improvement than previously thought of. With advancement in imaging techniques, more definitive diagnosis and timely intervention, even in-utero interventions, can be planned. Overall, survival rates have also improved over the past 2 decades. A majority of infants are asymptomatic and do not require surgery in neonatal period, and the expectant management is usually followed in most centers, but some may have mass effect and require either in-utero or early neonatal intervention. For asymptomatic lesions, the timing of surgery remains controversial as there are propagators of both early and late intervention. A multidisciplinary team approach is required for its optimal management. We present here a set of 3 babies who were diagnosed as having cystic lung lesions antenatally but later these turned out to be completely different entities.

scholarly journals Placenta Accreta Overlying a Caesarean Section Scar: A 10-Year Experience in a Tertiary-Care Centre in Portugal

2021 ◽  
Vol 34 (4) ◽  
pp. 266
Author(s):  
Margarida Cal ◽  
Carla Nunes ◽  
Nuno Clode ◽  
Diogo Ayres-de-Campos
Keyword(s):  
Cesarean Section ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Tertiary Care ◽  
Case Series ◽  
Morbidity And Mortality ◽  
Team Approach ◽  
Tertiary Center ◽  
Placenta Accreta Spectrum ◽  
Spectrum Disorders

Introduction: Placenta accreta spectrum disorders are among the leading causes of maternal morbidity and mortality and their prevalence is likely to increase in the future. The risk of placenta accreta spectrum disorders is highest in cases of placenta previa overlying a previous cesarean section scar. Few studies have evaluated placenta accreta spectrum disorders in Portugal. The aim of this study was to review the cases of placenta accreta spectrum overlying a cesarean section scar managed in a Portuguese tertiary center over the last decade.Material and Methods: Retrospective, cross-sectional study, with data collected from hospital databases. Only cases with histopathological confirmation of placenta accreta spectrum were included.Results: During the study period, 15 cases of placenta accreta spectrum overlying a cesarean section scar were diagnosed (prevalence 0.6/1000). All cases were diagnosed antenatally. A transverse cesarean section was present in all cases; 13 were managed by a scheduled multidisciplinary approach, while two required emergent management. Total or subtotal hysterectomy was performed in 12 cases. There were no cases of maternal or neonatal death. Histopathological evaluation confirmed nine cases of placenta accreta, three cases of placenta increta and three cases of placenta percreta.Discussion: Early antenatal diagnosis is important for a programmed multidisciplinary management of these cases, which may reduce potential morbidity and mortality and ensure better obstetric outcomes.Conclusion: This case series of placenta accreta spectrum overlying a cesarean section scar reports the reality of a tertiary-care perinatal center in Portugal, in which no maternal or neonatal mortality due to placenta accreta spectrum was registered over the last decade; this may be attributed to prenatal diagnosis and a coordinated multidisciplinary team approach.

scholarly journals Unusual Cases of Pure Malignant Germ Cell Tumors of the Ovary: A Case Series on 10 Years Experience at a Tertiary Care Center

2021 ◽  
Author(s):  
Lajya Devi Goyal ◽  
Balpreet Kaur ◽  
Gitanjali Goyal ◽  
Parveen Rajora
Keyword(s):  
Germ Cell ◽  
Care Center ◽  
Tertiary Care ◽  
Survival Rates ◽  
Germ Cell Tumors ◽  
Case Series ◽  
Immature Teratoma ◽  
Surgical Removal ◽  
Fertility Sparing ◽  
Bep Chemotherapy

Background: Malignant ovarian germ cell tumors (MOGCTs) are rare female cancers, constituting  up to 10% of ovarian cancers. Dysgerminoma is the most common histological variant. Surgical removal of the tumor with optimal debulking is the treatment of choice. Multidrug chemotherapy following surgery offers high remission rates. Considering the prevalence of these tumors in adolescent and young females, fertility-sparing treatment is of paramount importance. Methods: The data of all patients with ovarian malignancy admitted at a tertiary-care-teaching hospital from September 2009-March 2019 were analyzed. Ten patients of MOGCTs were treated in this period. The clinical features, radiological and biochemical findings, and management and treatment outcome were evaluated. Results: The median age of patients was 23 years. Histological subtypes included immature teratoma (n=3), endodermal sinus tumor (n=4), and dysgerminoma (n=3). Tumor markers namely AFP, βHCG, and LDH increased in all except the patients with immature teratoma. Two patients with dysgerminoma were in the second trimester of pregnancy. All patients except one underwent surgery followed by BEP chemotherapy. Two patients had developed metastasis within six months of treatment and died. In seven patients, no evidence of disease was reported till date. Conclusion: Management of antenatal patients with dysgerminoma by surgery followed by BEP chemotherapy has favorable prognosis. Fertility-sparing surgery with adjuvant chemotherapy offers great advantage in young girls. However, risk stratification based on prognostic factors should be implemented in order to individualize the treatment for achieving higher survival rates. The option for oocyte-cryopreser-vation prior to surgery must be discussed with patients desiring future fertlity.

scholarly journals Total Hip Arthroplasty in Failed Hip Fractures: A Case Series

2015 ◽  
Vol 4 (4) ◽  
pp. 33-38
Author(s):  
Syed Shahid Noor ◽  
Mehroze Zamir ◽  
Muhammad Kazim Rahim Najjad
Keyword(s):  
Hip Fractures ◽  
Hip Arthroplasty ◽  
Tertiary Care ◽  
Survival Rates ◽  
Case Series ◽  
Epidemiological Data ◽  
Mineral Density ◽  
Tertiary Care Centre ◽  
Cause Of Failure ◽  
Post Menopausal

Osteoporosis is epidemic in Asian countries. It is a major cause of fractures that orthopaedic surgeons deal in Pakistan, though proper epidemiological data is not available. Habiba U et al found that 75.3% of post menopausal women of Pakistan were predisposed to Osteoporosis; whereas Baig L has described an average T - score of -1.833±0.65 on bone mineral density calculation of post menopausal females of Pakistan. Osteoporotic hip fractures constitute a major cause of elderly mortality worldwide and recent figures supporting the idea that these patients have survival rates comparable to breast and thyroid cancer patients. Pakistan is a developing country with large burden of hip fractures. Patients living in remote areas are the ones which suffer more because of inadequate awareness, fear of surgical treatment and lack of availability of standard treatment. These patients are dealt by surgeons of various expertise and levels of experience. Lack of facilities in hospitals is well known and usage of sub-standard implant is a major cause of failure. Therefore these patients either because of their bone fragility or mal-treatment suffer frequently from failure of hip fracture surgeries. Being in a tertiary care centre we come across these types of cases very frequently. Six to eight such cases present to outpatient department of Liaquat National Hospital every month being referred from every part of the country. These patients may have been operated once, twice or even multiple times. Special attention is required to acquire an informative history from these cases and perform a comprehensive examination. Moreover previous records and radiographs provide invaluable information regarding cause of failure and deciding course of further treatment. We herein discuss few of the cases of failure of hip fractures which were treated by hip arthroplasty. 

scholarly journals Delayed Remission after Transsphenoidal Surgery in Patients with Cushing’s Disease

2010 ◽  
Vol 95 (2) ◽  
pp. 601-610 ◽  
Author(s):  
Elena Valassi ◽  
Beverly M. K. Biller ◽  
Brooke Swearingen ◽  
Francesca Pecori Giraldi ◽  
Marco Losa ◽  
...  
Keyword(s):  
Cushing’S Disease ◽  
Transsphenoidal Surgery ◽  
Tertiary Care ◽  
Case Series ◽  
Expectant Management ◽  
Pituitary Surgery ◽  
Cushing's Disease ◽  
Optimal Timing ◽  
Retrospective Case

Abstract Background: Transsphenoidal surgery (TSS) is the treatment of choice for Cushing’s disease (CD). Postoperative hypercortisolemia mandates further therapy. Objective: The aim of the study was to characterize patients without immediate postoperative remission who have a delayed decrease to normal or low cortisol levels without further therapy. Design and Setting: A retrospective case series was conducted at three tertiary care centers. Patients and Intervention: We reviewed the records of 620 patients (512 females, 108 males; mean age, 38 ± 13 yr) who underwent transsphenoidal pituitary surgery for CD between 1982 and 2007. Results: Outcomes were classified into the following three groups based upon the postoperative pattern of cortisol testing: group IC (immediate control) included 437 of the 620 patients (70.5%) with hypocortisolism and/or cortisol normalization throughout the postoperative follow-up; group NC (no control) included 148 of 620 patients (23.9%) with persistent hypercortisolism; and group DC (delayed control) included 35 of 620 patients (5.6%) who had early elevated or normal UFC levels and developed a delayed and persistent cortisol decrease after an average of 38 ± 50 postoperative days. The total rate of recurrence was 13% at a median follow-up time of 66 months after TSS; the cumulative rate of recurrence at 4.5 yr was significantly higher in group DC vs. group IC (43 vs. 14%; P = 0.02). Conclusions: Hormonal assessment in the immediate postoperative period after TSS for CD may be misleading because delayed remission can occur in a subset of patients. Expectant management and retesting may spare some patients from unnecessary further treatment. Optimal timing to determine the need for further therapy after TSS remains to be determined.

CONGENITAL CYSTIC LUNG LESIONS: EVOLUTION FROM IN-UTERO TO PATHOLOGY DIAGNOSIS - A MULTIDISCIPLINARY APPROACH

2016 ◽  
Author(s):  
Steven Hardee ◽  
Lea Tuzovic ◽  
Cicero T. Silva ◽  
Robert A. Cowles ◽  
Joshua Copel ◽  
...  
Keyword(s):  
Multidisciplinary Approach ◽  
In Utero ◽  
Lung Lesions ◽  
Cystic Lung

scholarly journals Brain Tuberculoma Management Challenges: A Series of 5 Cases

2019 ◽  
Vol 9 (1) ◽  
pp. 64-68
Author(s):  
Md Rashidoon Nabi Khan ◽  
Mostafa Taufiq Ahmed ◽  
SM Asaduzzaman Juel ◽  
Mesbah Uddin Ahmed
Keyword(s):  
Clinical Presentation ◽  
Tertiary Care ◽  
Case Series ◽  
Mass Effect ◽  
Neurological Deficits ◽  
Care Hospital ◽  
Diagnostic Dilemma ◽  
Common Clinical Presentation ◽  
Almost All ◽  
Management Challenge

Although intracranial tuberculomas are not rare & account for a significant number of ICSOLs; Its clinical presentation &neuro-radiological findings sometimes lead us to a diagnostic dilemma and management challenge. Here, in this case series we are presenting diagnostic as well as management challenges we’ve faced managing patients with tuberculoma at a tertiary care hospital of Bangladesh. Intracranial tuberculomas can be situated in various locations and can mimic any lesion.Extracranial involvement is not always common, clinical presentation &neuroradiological findings sometimes not conclusive. Medical management indicated in almost all cases, as well as surgical intervention indicated in cases with neurological deficits & mass effect. Bang. J Neurosurgery 2019; 9(1): 64-68

scholarly journals Complications of intravascular intrauterine transfusion for Rh alloimmunization

2021 ◽  
Vol 41 (6) ◽  
pp. 313-317
Author(s):  
Asma Alkhaibary ◽  
Mohannad Ali ◽  
Maha Tulbah ◽  
Maha Al-Nemer ◽  
Rubina M. Khan ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Survival Rates ◽  
Case Series ◽  
Intrauterine Fetal Death ◽  
High Survival ◽  
Safe Procedure ◽  
Fetal Bradycardia ◽  
Intrauterine Transfusion ◽  
Record Review

BACKGROUND: Intravascular intrauterine transfusion (IUT) is considered a safe procedure, but complications still occur, including fatalities. OBJECTIVE: Review the outcomes of Rh alloimmunization, including indications and possible complications. DESIGN: Retrospective cohort (medical record review). SETTING: Tertiary care center. PATIENTS AND METHODS: We retrieved the records for all mothers who had an IUT for Rh alloimmunization between January 2009 and August 2019. We collected data on complications, post-transfusion hemoglobin and antibody combinations. MAIN OUTCOME MEASURE: Complications of IUT. SAMPLE SIZE: 119 mothers with 154 fetuses (154 different pregnancies). RESULTS: The 154 fetuses had 560 intrauterine transfusions. The median pre-IUT hemoglobin was a median of 8.0 g/dL while the median post-IUT hemoglobin 16 g/dL. Immediate procedure-related complications included fetal bradycardia in 2.7%, significant bleeding from the cord puncture site (for more than 2 minutes in 0.9%), and contractions in 0.9%. Eight (5.2%) were delivered by cesarean delivery due to IUT-specific complications such as post-procedure fetal bradycardia. Intrauterine fetal death complicated 8.4% of the pregnancies (13 fetuses). Phototherapy was required in 76 (49.4%), postnatal blood transfusions in 17 (11%), and exchange transfusion in 11 (7.1%). Neonatal death occurred 8 (5.2%). Data were insufficient to assess associations of complications with antibody combinations. CONCLUSIONS: Intrauterine transfusion is an effective treatment with high survival rates (around 90% for cases of Rh alloimmunization). LIMITATIONS: Case series. CONFLICT OF INTEREST: None.

Left Pulmonary Artery Sling: Postoperative Outcomes for Patients at a Single Center

2021 ◽  
Vol 12 (6) ◽  
pp. 715-727
Author(s):  
Laura Carlson ◽  
Mahwish Haider ◽  
Hua Liu ◽  
Christopher Baird ◽  
John E. Mayer ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Care Center ◽  
Tertiary Care ◽  
Survival Rates ◽  
Left Lung ◽  
Case Series ◽  
Left Pulmonary Artery ◽  
Retrospective Case ◽  
Tracheal Surgery ◽  
Intracardiac Repair

Background Left pulmonary artery (LPA) sling is a rare anomaly characterized by the origin of the LPA from the right pulmonary artery with a course between the trachea and esophagus. It is often associated with airway and cardiac anomalies. Methods This is a retrospective case series of consecutive patients who underwent LPA sling repair (LPASR) at a tertiary care center over a 35-year period with a focus on tracheal and/or LPA reinterventions and survival. Results Between June 1983 and July 2018, 42 patients were identified: isolated LPASR was performed in 16 (38%), LPASR/intracardiac repair in 10 (24%), and LPASR/tracheal repair in 16 (38%). There were 5 (12%) in-hospital and 4 (10%) late deaths. Survival rates (15 years) were as follows: 100% (isolated LPASR), 65% (concomitant intracardiac repair), and 52% (concomitant tracheal surgery). Preoperative intensive care unit (ICU) hospitalization was associated with future intervention on the LPA/trachea (61%, 11/18). The median distribution of blood flow to the left lung post-index surgery was 38%. Freedom from isolated LPA intervention was 100% after isolated LPASR, 93% after LPASR/tracheal surgery, and 69% after LPASR/intracardiac repair. Freedom from isolated tracheal intervention was 92% after isolated LPASR, 73% after LPASR/tracheal surgery, and 78% after LPASR/intracardiac repair. Conclusions ICU hospitalization prior to index surgery may indicate the severity of associated cardiac/tracheal abnormalities as this is associated with increased morbidity and mortality. Patients who underwent LPASR/intracardiac surgery were more likely to undergo isolated LPA intervention and those who underwent LPASR/tracheal surgery were more likely to undergo isolated tracheal intervention.

scholarly journals Peripartum hysterectomy: a five year review at a tertiary care centre

2017 ◽  
Vol 6 (8) ◽  
pp. 3590
Author(s):  
Deepak A. V. ◽  
K. J. Jacob ◽  
Sumi P. Maria
Keyword(s):  
Tertiary Care ◽  
Case Series ◽  
Case Fatality ◽  
Tertiary Care Centre ◽  
Retrospective Case ◽  
College Hospital ◽  
Peripartum Hysterectomy ◽  
Medical College ◽  
Obstetric Haemorrhage ◽  
Suboptimal Care

Background: Peripartum hysterectomy is a life-saving procedure resorted to when conservative measures fail to control obstetric haemorrhage. Several predisposing factors, suboptimal care and lack of infrastructure may lead to this emergency procedure. We wanted to find out factors associated with peripartum hysterectomy and the adverse maternal outcomes at our centre.Methods: A retrospective case series analysis of 40 cases of peripartum hysterectomy performed over a period of 5 years from January 2010 to December 2014 at Government Medical College Hospital, Thrissur, Kerala was done.Results: The incidence of peripartum hysterectomy was 0.29%. The most common indication for peripartum hysterectomy was hysterectomy was uterine atony (50%). Thirty-five women (88%) were between 20 and 35 years. Most of the subjects were unbooked. There were two maternal deaths (case fatality rate of 5%) following peripartum hysterectomy during this period. All the subjects required blood transfusion.Conclusions: Prompt performance hysterectomy before the patient’s clinical condition deteriorates is the key to success. The incidence of adherent placenta is increasing, so every effort should be taken to reduce the caesarean section rates globally. 

S153 – Radiological Balloon Dilatation of Neo-Pharyngeal Strictures

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P127-P128
Author(s):  
Robert L Harris ◽  
Grundy Alan ◽  
Tunde A Odutoye
Keyword(s):  
Total Laryngectomy ◽  
Balloon Dilatation ◽  
Malignant Disease ◽  
Outcome Measure ◽  
Tertiary Care ◽  
Case Series ◽  
Stent Insertion ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Main Outcome Measure

Objectives Radiological balloon dilatation of lower oesophageal strictures is common practice. Other than some early reports from our own centre, there is little published regarding radiological dilatation of pharyngeal and upper oesophageal strictures and less still on radiological balloon dilatation of post-total laryngectomy and pharyngolaryngectomy neo-pharyngeal strictures. Standard practise is bouginage under general anaesthaesia. The objective of this study is to assess the efficacy of radiological balloon dilatation for the treatment of dysphagia secondary to neopharyngeal strictures in patients who have undergone laryngectomy. Methods A tertiary care centre case series of 20 consecutive patients (17 males and 3 females aged 40 to 84) with pharyngeal stricture and dysphagia post-total laryngectomy or pharyngolaryngectomy who underwent balloon dilatation of the stricture under radiological guidance. Maintenance of swallowing was the main outcome measure. Results 5 patients gained relief of their dysphagia with 1 balloon dilatation only. 9 patients required more than 1 dilatation to maintain swallowing. 2 patients had balloon dilatation procedures and stent insertion for palliative relief of dysphagia from known recurrent malignant disease. 3 patients failed to maintain swallowing with repeat dilatations. No patients suffered any significant complications such as perforation. Conclusions Balloon dilatation is minimally invasive and less traumatic than rigid pharyngoscopy with bouginage dilatation. It is well tolerated. It may be repeated frequently and can successfully relieve strictures of the pharynx in patients who have undergone total laryngectomy or pharyngolaryngectomy.

Sign in / Sign up

Export Citation Format

Share Document