scholarly journals Intra-discal drain insertion for culture and drainage of pyogenic spondylodiscitis: A one-step diagnostic and therapeutic procedure

2019 ◽  
Vol 26 (1) ◽  
pp. 105-110
Author(s):  
Tal Ackerman ◽  
Jonathan Singer-Jordan ◽  
Adi Shani ◽  
Nimrod Rahamimov
Keyword(s):  
Complete Resolution ◽  
Treatment Guidelines ◽  
Clinical Laboratory ◽  
Case Series ◽  
Retrospective Case ◽  
Disc Space ◽  
Ct Guided ◽  
Pyogenic Spondylodiscitis ◽  
Continuous Drainage ◽  
One Step

Background Pyogenic spondylodiscitis is diagnosed in recent years at higher rates due to the aging population, increased survival of chronic and immune suppressed patients, and the higher rate of invasive procedures leading to bacterial seeding or direct contamination of the disc space. Treatment guidelines encourage bacterial sampling before initiation of antibiotic therapy, and drainage of pus collections. We present our experience with percutaneous CT-guided drain insertion into the disc space itself as a one-step procedure for both culturing and subsequent continuous drainage of the infected disc space. Materials and methods We retrospectively reviewed all cases of pyogenic spondylodiscitis admitted to our spine surgery unit during the past five years and treated with CT-guided percutaneous drain insertion into the infected disc space. All patients were followed until complete resolution of the infection. Results We retrieved electronic records of 12 patients, none presenting with neurological compression symptoms. Cultures taken at the time of drain insertion were positive in 10 patients (83.3%), much higher than the reported yield for needle aspiration (14–48%) and comparable to the yield of open biopsy. In all patients complete resolution of the infection was reached, determined by clinical, laboratory, and imaging parameters. Conclusions Our retrospective case series demonstrates the feasibility and effectiveness of intra-discal CT-guided drainage of an infected disc space. The procedure does not add much burden to current practice as disc-space sampling for culture is commonly performed anyway, and adds the benefit of direct drainage of the pus at its source.

scholarly journals Clinical Characteristics, Treatments and Outcomes of 18 Lung Transplant Recipients with COVID-19

2021 ◽  
Vol 2 (2) ◽  
pp. 229-245
Author(s):  
René Hage ◽  
Carolin Steinack ◽  
Fiorenza Gautschi ◽  
Susan Pfister ◽  
Ilhan Inci ◽  
...  
Keyword(s):  
Lung Transplant ◽  
Clinical Laboratory ◽  
Invasive Mechanical Ventilation ◽  
Case Series ◽  
Outcome Data ◽  
Transplant Recipients ◽  
Retrospective Case ◽  
Laboratory Findings ◽  
Case Series Study ◽  
Lung Transplant Recipients

We report clinical features, treatments and outcomes in 18 lung transplant recipients with laboratory confirmed SARS-CoV-2 infection. We performed a single center, retrospective case series study of lung transplant recipients, who tested positive for SARS-CoV-2 between 1 February 2020 and 1 March 2021. Clinical, laboratory and radiology findingswere obtained. Treatment regimens and patient outcome data were obtained by reviewing the electronic medical record. Mean age was 49.9 (22–68) years, and twelve (67%) patients were male. The most common symptoms were fever (n = 9, 50%), nausea/vomiting (n = 7, 39%), cough (n = 6, 33%), dyspnea (n = 6, 33%) and fatigue (n = 6, 33%). Headache was reported by five patients (28%). The most notable laboratory findings were elevated levels of C-reactive protein (CRP) and lactate dehydrogenase (LDH). Computed Tomography (CT) of the chest was performed in all hospitalized patients (n = 11, 7%), and showed ground-glass opacities (GGO) in 11 patients (100%), of whom nine (82%) had GGO combined with pulmonary consolidations. Six (33%) patients received remdesivir, five (28%) intravenous dexamethasone either alone or in combination with remdesivir, and 15 (83%) were treated with broad spectrum antibiotics including co-amoxicillin, tazobactam-piperacillin and meropenem. Four (22%) patients were transferred to the intensive care unit, two patients (11%) required invasive mechanical ventilation who could not be successfully extubated and died. Eighty-nine percent of our patients survived COVID-19 and were cured. Two patients with severe COVID-19 did not survive.

scholarly journals Lung Ultrasound Patterns and Clinical-Laboratory Correlates during COVID-19 Pneumonia: A Retrospective Study from North East Italy

2021 ◽  
Vol 10 (6) ◽  
pp. 1288
Author(s):  
Riccardo Senter ◽  
Federico Capone ◽  
Stefano Pasqualin ◽  
Lorenzo Cerruti ◽  
Leonardo Molinari ◽  
...  
Keyword(s):  
Lung Ultrasound ◽  
Clinical Laboratory ◽  
Imaging Modality ◽  
Case Series ◽  
Severity Index ◽  
Disease Stage ◽  
Retrospective Case ◽  
North East ◽  
High Flow Oxygen ◽  
B Lines

Background and Aim. Lung ultrasound (LUS) is a convenient imaging modality in the setting of coronavirus disease-19 (COVID-19) because it is easily available, can be performed bedside and repeated over time. We herein examined LUS patterns in relation to disease severity and disease stage among patients with COVID-19 pneumonia. Methods. We performed a retrospective case series analysis of patients with confirmed SARS-CoV-2 infection who were admitted to the hospital because of pneumonia. We recorded history, clinical parameters and medications. LUS was performed and scored in a standardized fashion by experienced operators, with evaluation of up to 12 lung fields, reporting especially on B-lines and consolidations. Results. We included 96 patients, 58.3% men, with a mean age of 65.9 years. Patients with a high-risk quick COVID-19 severity index (qCSI) were older and had worse outcomes, especially for the need for high-flow oxygen. B-lines and consolidations were located mainly in the lower posterior lung fields. LUS patterns for B-lines and consolidations were significantly worse in all lung fields among patients with high versus low qCSI. B-lines and consolidations were worse in the intermediate disease stage, from day 7 to 13 after onset of symptoms. While consolidations correlated more with inflammatory biomarkers, B-lines correlated more with end-organ damage, including extrapulmonary involvement. Conclusions. LUS patterns provide a comprehensive evaluation of patients with COVID-19 pneumonia that correlated with severity and dynamically reflect disease stage. LUS patterns may reflect different pathophysiological processes related to inflammation or tissue damage; consolidations may represent a more specific sign of localized disease, whereas B-lines seem to be also dependent upon generalized illness due to SARS-CoV-2 infection.

scholarly journals Calcified Thoracic Disc Herniations in the Elderly: Revisiting the Laminectomy for Single Level Disease

2018 ◽  
Vol 9 (5) ◽  
pp. 527-531 ◽  
Author(s):  
Colby Oitment ◽  
Desmond Kwok ◽  
Chris Steyn
Keyword(s):  
Spinal Injury ◽  
Present Report ◽  
Case Series ◽  
The Elderly ◽  
Retrospective Case ◽  
Disc Space ◽  
Disc Herniations ◽  
Asia Score ◽  
Thoracic Disc ◽  
Clinical Conditions

Study Design: Retrospective case series. Objectives: Calcified thoracic disc herniations in the elderly present with a variety of clinical conditions and the treatment is a source of significant debate. Decompression of the disc space is done through anterior, lateral, posterolateral, and posterior approaches. There is significant morbidity of thoracic disc herniation and associated decompression. Methods: The present report is a case series of 8 elderly patients with calcified discopathy who received a simple laminectomy without decompression of the disc space. Results: Postoperatively, 5 patients mobilized independently, 2 with a walker, and 1 patient was nonambulatory. Two patients improved 1 ASIA (American Spinal Injury Association Impairment Scale) score, 1 patient improved 2 ASIA scores, and 3 patients had no change in ASIA score. Conclusion: In our experience, thoracic disc herniations require a technically difficult decompression and overall the complications are significant. We present a series of 8 patients who generally improved from a simple laminectomy and consider this a viable procedure for patients too unwell to undergo direct disc decompression.

Intralesional Methotrexate Treatment for Keratoacanthoma Tumors: A Retrospective Case Series

2012 ◽  
Vol 16 (3) ◽  
pp. 212-217 ◽  
Author(s):  
Nicolas Aubut ◽  
Jimmy Alain ◽  
Joël Claveau
Keyword(s):  
Adverse Events ◽  
Total Dose ◽  
Effective Treatment ◽  
Complete Resolution ◽  
Case Series ◽  
Response Rates ◽  
Initial Diagnosis ◽  
Retrospective Case ◽  
Methotrexate Treatment

Background: Intralesional methotrexate (IL-MTX) is an effective treatment for keratoacanthoma. Objective: We sought to determine the response rates and adverse events in KA treated with intralesional methotrexate. Methods: All cases of KA treated with intralesional methotrexate at our institutions from 2001 to 2009 were systematically reviewed. Results: Forty-six cases of KA treated with IL-MTX were identified. A complete resolution was achieved in 74% of patients, requiring an average of 1.8 injection sessions, for a mean total dose of 10 mg. Adverse events did not occur. Limitations: The follow-up period was short, and there was no histologic confirmation of the initial diagnosis. Conclusion: IL-MTX is an effective and well-tolerated alternative to surgery for the treatment of KA.

Computed tomography–guided epidural patching of postoperative cerebrospinal fluid leaks

2014 ◽  
Vol 21 (5) ◽  
pp. 805-810 ◽  
Author(s):  
Frank Mihlon ◽  
Peter G. Kranz ◽  
Andreia Roxana Gafton ◽  
Linda Gray
Keyword(s):  
Cerebrospinal Fluid ◽  
Spinal Surgery ◽  
Case Series ◽  
Clinical History ◽  
Percutaneous Intervention ◽  
Dural Defect ◽  
Retrospective Case ◽  
Ct Guided ◽  
Cerebrospinal Fluid Leaks ◽  
Dural Defects

Object Cerebrospinal fluid leaks due to unrecognized durotomy during spinal surgery are often managed with a second surgery for dural closure. CT-guided percutaneous patching targeted to the dural defect offers an alternative to surgery since it can be performed in a minimally invasive fashion without the need for general anesthesia. This case series describes the authors' experience using targeted CT-guided percutaneous patching to repair incidental durotomies incurred during spinal surgery. Methods This investigation is a retrospective case series involving patients who underwent CT-guided percutaneous patching of surgical incidental durotomies and were referred between January 2007 and June 2013. Their presenting clinical history, myelographic findings, and clinical outcomes, including the need for eventual surgical duraplasty, were reviewed. Results Nine cases were identified, including 7 durotomies incurred during lumbar discectomy, one due to a medial transpedicular screw breach, and one incurred during vertebrectomy for spinal osteosarcoma. All patients who had favorable outcomes with percutaneous intervention alone had 2 common features: dural defect of 4 mm or smaller and absence of a pseudomeningocele. Patients with CSF leaks complicated by pseudomeningocele and those with a dural defect of 6 mm or more all required eventual surgical management. Conclusions The authors' results suggest that findings on CT myelography may help predict which patients with postsurgical durotomy can be treated with percutaneous intervention. In particular, CT-guided patching may be more likely to be successful in those patients with dural defects of less than 5 mm and without pseudomeningocele. In patients with larger dural defects or pseudomeningoceles, percutaneous blood patching alone is unlikely to be successful.

Patellar groove replacement in patellar luxation with severe femoro-patellar osteoarthritis

2015 ◽  
Vol 28 (02) ◽  
pp. 124-130 ◽  
Author(s):  
Z. Dokic ◽  
D. Lorinson ◽  
J. P. Weigel ◽  
A. Vezzoni
Keyword(s):  
Complete Resolution ◽  
Patellar Instability ◽  
Case Series ◽  
Retrospective Case ◽  
Radiographic Images ◽  
Surgical Interventions ◽  
The Third ◽  
Novel Method ◽  
Patellar Stability ◽  
Replacement Prosthesis

SummaryObjective: To report a novel method of treating femoro-patellar instability in association with severe femoro-patellar osteoarthritis, by substituting the femoral trochlear with a patellar groove replacement prosthesis.Study design: Retrospective case series.Methods: Preoperative lameness was scored from 0–4, and radiographic studies including standard positions for patellar luxation were obtained for evidence of malalignment and femoro-patellar osteoarthritis. Cases with or without previous surgeries were included. The size of trochlear implant was determined by transparent templates and confirmed intra-operatively with trials. Radiographic images, together with clinical examinations, were reviewed immediately and at three months postoperatively and at longer term when available.Results: Thirty-five cases of patellar luxation ranging from grades II to IV were included. Eleven of these cases had prior surgical interventions which failed to stabilize the patella. Fourteen dogs required additional surgical procedures in conjunction with patellar groove replacement. Complications occurred in six patients, of which three required revision. Complete resolution of subjectively- assessed lameness was evident in 24/35 cases by the third month and in another seven of 35 patients on the longer term re-evaluations.Clinical significance: Use of a patellar groove replacement prosthesis has the potential to decrease the lameness associated with severe femoro-patellar arthritis, to improve patellar stability, and to correct the alignment of the extensor mechanism.

scholarly journals Clinical Features of Patients with Probable 2019 Novel Coronavirus Infected Pneumonia in Rasht, Iran: A Retrospective Case Series

2020 ◽  
Vol 8 (T1) ◽  
pp. 16-22
Author(s):  
Samad Karkhah ◽  
Mohammad Javad Ghazanfari ◽  
Amir Shamshirian ◽  
Latif Panahi ◽  
Meysam Molai ◽  
...  
Keyword(s):  
Clinical Features ◽  
Clinical Laboratory ◽  
Clinical Symptoms ◽  
Case Series ◽  
Symptomatic Treatment ◽  
Retrospective Case ◽  
Laboratory Findings ◽  
Retrospective Case Series ◽  
Case Series Study ◽  
Novel Coronavirus

BACKGROUND: Coronavirus disease-19 (COVID-19) is the first pandemic infectious disease caused by a novel coronavirus. Viral pneumonia is a severe complication of COVID-19. AIM: Due to the high prevalence of this disease globally, especially in Iran, the aim of this study was to determine the clinical features of seven patients with probable COVID-19 infected pneumonia in Rasht, North Iran. MATERIALS AND METHODS: In this retrospective case series study, we described the clinical, laboratory, and radiological features of seven patients with probable COVID-19 infected pneumonia at Razi Hospital, Rasht, north of Iran, from February 27 to March 16, 2020. RESULTS: In this study, the most common clinical symptoms during hospitalization in patients with COVID-19 were poor appetite (seven cases), dehydration (seven cases), cough (six cases), dyspnea (six cases), fatigue (six cases), fever above 38°C (five cases), myalgia (five cases), Chills (five cases), feeling fever (five cases), sore throat (five cases), and nausea (five cases), respectively. The average body temperature in these patients was 39.32°C. In laboratory findings, erythrocyte sedimentation rate was elevated in three patients. Contrary to most of the evidence, C-reactive protein was not elevated in five patients. All patients received antibiotic and antiviral medications and received symptomatic treatment. Finally, four patients responded to the treatments and were discharged from the hospital; two patients were still hospitalized and only one patient died. CONCLUSION: Patients with COVID-19 associated pneumonia can be treated by evaluating and implementing appropriate therapeutic management. However, at the moment the disease progression for patients with COVID-19 cannot be accurately predicted.

scholarly journals Micronized Dehydrated Amnion Chorion Membrane (mdHACM) Injection in the Treatment of Chronic Achilles Tendinitis: A Large Retrospective Case Series

2021 ◽  
Author(s):  
Jay Spector ◽  
Brandon Hubbs ◽  
Kimberly Kot ◽  
Niki Istwan ◽  
David Mason
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Complete Resolution ◽  
Case Series ◽  
Achilles Tendinopathy ◽  
Retrospective Case ◽  
Short Term Treatment ◽  
Achilles Tendinitis ◽  
Retrospective Case Series

Background: Human amniotic membrane contains growth factors and cytokines, which promote epithelial cell migration and proliferation, stimulate metabolic processes leading to collagen synthesis, and attract fibroblasts, while also reducing pain and inflammation. Randomized studies have shown that micronized dehydrated human amnion chorion membrane (mdHACM) allograft injection is an effective treatment for plantar fasciitis. Our objective is to present our experience with using mdHACM injection as a treatment for Achilles tendinopathy and report short term treatment outcomes. Methods: Included in this retrospective case series were patients diagnosed with Achilles tendinopathy treated with mdHACM by a single physician were identified from an electronic medical record system. Included for analysis were those with at least 2 follow up visits within 45 days of mdHACM injection. Outcomes examined included change in reported level of pain during the 45-day observation period and adverse events associated with treatment. Results: Follow-up data were available for 32 mdHACM-treated patients and abstracted from the electronic medical record. At treatment initiation 97% of patients reported severe (66%) or moderate (31%) pain. At first follow-up visit (mean 8.1 {plus minus} 2.7 days after injection), 84% (27/32) had reported improvement in pain levels, although 37% of patients continued to report severe (6%) or moderate (31%) pain. At the second follow-up visit (mean 23.1 {plus minus} 6.2 days after injection), no patients reported severe pain and one reported moderate pain. Within 45 days of mdHACM injection complete resolution of symptoms was reported by 66% of treated patients (n=21) with the remaining 34% reporting improvement but not complete resolution (n=11) of their symptoms. Two patients reported calf or quadricep pain or tightness post-injection. Conclusions: In a single practice mdHACM injection reduced or eliminated pain in all patients where follow-up data was available.

scholarly journals Cerebrovascular Complications of COVID-19

Stroke ◽  
2020 ◽  
Vol 51 (9) ◽  
Author(s):  
Jeffrey M. Katz ◽  
Richard B. Libman ◽  
Jason J. Wang ◽  
Pina Sanelli ◽  
Christopher G. Filippi ◽  
...  
Keyword(s):  
New York ◽  
Risk Factor ◽  
Independent Risk Factor ◽  
Clinical Laboratory ◽  
Case Series ◽  
Outcome Data ◽  
Retrospective Case ◽  
Systemic Complications ◽  
Cerebrovascular Complications ◽  
Global Pandemic

Background and Purpose: Coronavirus disease 2019 (COVID-19) evolved quickly into a global pandemic with myriad systemic complications, including stroke. We report the largest case series to date of cerebrovascular complications of COVID-19 and compare with stroke patients without infection. Methods: Retrospective case series of COVID-19 patients with imaging-confirmed stroke, treated at 11 hospitals in New York, between March 14 and April 26, 2020. Demographic, clinical, laboratory, imaging, and outcome data were collected, and cases were compared with date-matched controls without COVID-19 from 1 year prior. Results: Eighty-six COVID-19–positive stroke cases were identified (mean age, 67.4 years; 44.2% women). Ischemic stroke (83.7%) and nonfocal neurological presentations (67.4%) predominated, commonly involving multivascular distributions (45.8%) with associated hemorrhage (20.8%). Compared with controls (n=499), COVID-19 was associated with in-hospital stroke onset (47.7% versus 5.0%; P <0.001), mortality (29.1% versus 9.0%; P <0.001), and Black/multiracial race (58.1% versus 36.9%; P =0.001). COVID-19 was the strongest independent risk factor for in-hospital stroke (odds ratio, 20.9 [95% CI, 10.4–42.2]; P <0.001), whereas COVID-19, older age, and intracranial hemorrhage independently predicted mortality. Conclusions: COVID-19 is an independent risk factor for stroke in hospitalized patients and mortality, and stroke presentations are frequently atypical.

scholarly journals Supraorbital Nerve Radiofrequency for Severe Neuralgia Caused by Herpes Zoster Ophthalmicus

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Huan Zhang ◽  
Huadong Ni ◽  
Songlei Liu ◽  
Keyue Xie
Keyword(s):  
Case Series ◽  
Spontaneous Pain ◽  
Gasserian Ganglion ◽  
Herpes Zoster Ophthalmicus ◽  
Retrospective Case ◽  
Ct Guided ◽  
Supraorbital Nerve ◽  
Radiofrequency Thermocoagulation ◽  
Number Of Patients ◽  
Case Series Study

Background. Radiofrequency of the Gasserian ganglion can be used for ophthalmic herpetic neuralgia (OHN), but it is associated with complications. This study aimed to use the supraorbital nerve for computed tomography- (CT-) guided radiofrequency thermocoagulation to treat refractory OHN. Methods. This was a retrospective case series study of patients with simple or combined OHN treated at our hospital between 06/2012 and 06/2018. The numerical rating score (NRS), spontaneous pain, allodynia, gabapentin dosage, paracetamol/oxycodone dosage, patient global impression of change (PGIC) score, Barrow numbness score, postoperative 360-day recurrence rate, and complications were recorded before the operation and at 1, 30, 90, 180, and 360 days after the operation. Results. Compared with baseline, the NRS was decreased, and PGIC was increased at postoperative 1, 30, 90, 180, and 360 days, and the gabapentin and paracetamol oxycodone doses at postoperative 30, 90, 180, and 360 days were decreased (all P<0.001). Compared with 1 day after the operation, numbness was decreased at 30, 90, 180, and 360 days after the operation (P<0.001). Compared with baseline, the number of patients with allodynia at each time point after the operation was decreased (P<0.001), but without a difference for spontaneous pain (P=0.407). No subjects showed drooping eyelid, corneal ulcers, eyeball damage, decreased vision, and other severe complications. Conclusion. CT-guided supraorbital nerve radiofrequency thermocoagulation for the treatment of OHN can effectively relieve pain and reduce the dose of analgesics, without any serious complication. This study suggests that this technique is feasible and applicable to clinical practice.

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