Extra-articular Medial Impression Fracture of the Talus: A Previously Undescribed Injury

2018 ◽  
Vol 11 (6) ◽  
pp. 553-558
Author(s):  
Olivier Wijers ◽  
Rosa C. Looijen ◽  
Jens A. Halm ◽  
Tim Schepers
Keyword(s):  
Correct Diagnosis ◽  
Case Series ◽  
Patient Characteristics ◽  
Trauma Mechanism ◽  
Retrospective Case ◽  
Articular Fractures ◽  
First Case ◽  
Impression Fracture ◽  
Talar Fractures ◽  
Almost All

Background: Peripheral fractures of the talus are uncommon. Almost all the literature regarding talar fractures consists of central intra-articular fractures, whereas studies about peripheral talar fractures are lacking. The aim of this study is to increase awareness in diagnosing an unusual peripheral extra-articular medial impression fracture of the talus. Methods: This study includes a retrospective case series of patients with an extra-articular medial impression fracture of the talus. Patient characteristics, trauma mechanism, diagnostics, fracture characteristics, and treatment were reported. Results: Eight consecutive patients with an extra-articular medial impression fracture of the talus were identified. In 80%, the trauma mechanism was a supination or inversion injury of the ankle and foot. An X-ray was obtained in all patients; in 7 (88%) patients, a computed tomography scan was done, and an additional magnetic resonance imaging was done in 3 (38%) patients. In 4 patients (50%), the correct diagnosis was missed at first presentation. The delay between injury and diagnosis was 0 to 180 days (of 36 days on average). Conclusion: This is the first case series to describe patients with a peripheral extra-articular medial impression fracture of the talus. Good clinical examination and judicious use of diagnostic imaging are a necessity to find the talar impression fractures in a timely manner, and treatment can be started immediately. Levels of Evidence: Level V

scholarly journals Medication-Related Osteonecrosis of the Jaw (MRONJ): Are Antiresorptive Drugs the Main Culprits or Only Accomplices? The Triggering Role of Vitamin D Deficiency

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 561
Author(s):  
Luca Dalle Carbonare ◽  
Monica Mottes ◽  
Maria Teresa Valenti
Keyword(s):  
Vitamin D ◽  
Clinical Condition ◽  
Case Series ◽  
Osteonecrosis Of The Jaw ◽  
First Case ◽  
Vitamin D Levels ◽  
Exposed Bone ◽  
Antiresorptive Drugs ◽  
Almost All

Osteonecrosis of the jaw (ONJ) is a severe clinical condition characterized mostly but not exclusively by an area of exposed bone in the mandible and/or maxilla that typically does not heal over a period of 6–8 weeks. The diagnosis is first of all clinical, but an imaging feedback such as Magnetic Resonance is essential to confirm clinical suspicions. In the last few decades, medication-related osteonecrosis of the jaw (MRONJ) has been widely discussed. From the first case reported in 2003, many case series and reviews have appeared in the scientific literature. Almost all papers concerning this topic conclude that bisphosphonates (BPs) can induce this severe clinical condition, particularly in cancer patients. Nevertheless, the exact mechanism by which amino-BPs would be responsible for ONJ is still debatable. Recent findings suggest a possible alternative explanation for BPs role in this pattern. In the present work we discuss how a condition of osteomalacia and low vitamin D levels might be determinant factors.

Approach to dyspnoea in pregnancy in the COVID-19 era

2020 ◽  
Vol 19 (4) ◽  
pp. 230-234
Author(s):  
Anita Banerjee ◽  
◽  
Lindsay A Arrandale ◽  
Srividhya Sankaran ◽  
Guy W Glover ◽  
...  
Keyword(s):  
Decision Making ◽  
Pregnant Women ◽  
Correct Diagnosis ◽  
Case Series ◽  
Differential Diagnoses ◽  
Shared Decision ◽  
First Case ◽  
Compromise Design ◽  
A Current ◽  
In Pregnancy

Importance: Dyspnoea and hypoxia in pregnant women during the COVID-19 pandemic may be due to causes other than SARS Co-V-2 infection which should not be ignored. Shared decision-making regarding early delivery is paramount. Objective: To highlight and discuss the differential diagnoses of dyspnoea and hypoxia in pregnant women and to discuss the risks versus benefit of delivery for maternal compromise. Design, setting and participants: Case series of two pregnant women who presented with dyspnoea and hypoxia during the COVID-19 pandemic. Results: Two pregnant women presented with dyspnoea and hypoxia. The first case had COVID-19 infection in the 3rd trimester. The second case had an exacerbation of asthma without concurrent COVID-19. Only the first case required intubation and delivery. Both recovered and were discharged home. Conclusion and relevance: Our two cases highlight the importance of making the correct diagnosis and timely decision-making to consider if delivery for maternal compromise is warranted. Whilst COVID-19 is a current healthcare concern other differential diagnoses must still be considered when pregnant women present with dyspnoea and hypoxia.

Abstract P363: Predictors of Utility of Advanced Cardiac Imaging in Revealing Cryptogenic Stroke Etiology

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Daniel M Schachter ◽  
Micaela Schachter ◽  
Blake Beehler ◽  
Jeffrey Quinn ◽  
Jeremy E Kulacz ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Cardiac Imaging ◽  
Left Atrial ◽  
Cryptogenic Stroke ◽  
Case Series ◽  
Patient Characteristics ◽  
Current Data ◽  
Common Finding ◽  
Retrospective Case ◽  
Patients With Diabetes

Introduction: Advanced cardiac imaging (ACI), including transesophageal echocardiogram (TEE), cardiac CT and cardiac MRI, is widely considered a crucial element in the work-up of cryptogenic and ESUS stroke. Current data on diagnostic yields are variable, though, and selection of patients to undergo such imaging is largely anecdotal. Methodology: We conducted a retrospective case series review of all cryptogenic ischemic strokes who received ACI, admitted to a large urban academic single-center over a 2.5-year period. Patient characteristics and imaging findings were analyzed to determine diagnostic yields and to identify positive and negative predictors that ACI would uncover etiology. Results: Out of 277 total cryptogenic ischemic strokes reviewed, ACI determined etiology in 20 cases (7.2%). Median age was 61 (IQR = 52-73). Patient sex was 49.5% female. Race demographic was 1.8% Asian, 50.9% black, 14.1% latino(a), and 33.2% white. Etiology was found by TEE in 16 of 20 cases, and the most common finding was left atrial thrombus/smoke. Latino(a) race was significantly more likely (15.4%) for ACI to find etiology and white race was significantly less likely (1.1%), p = .03 and .005, respectively. The table included shows other notable findings. Analogous trends were observed in a subgroup analysis of patients greater or equal to 60 years old. Conclusion: Our data indicate that in cryptogenic stroke premorbid non-use of antithrombotic, elevated troponin and left atrial dilatation are each individually associated with increased likelihood that ACI will find an etiology. Meanwhile, patients with diabetes mellitus are significantly less likely to have etiology found by ACI; and, smokers with combined hypertension, hyperlipidemia, and diabetes mellitus trend towards ACI less frequently uncovering etiology. Finally, the data suggest potential racial disparities of finding etiology with ACI, the determinants of which remain to be studied.

scholarly journals Surgical Technique for Management of Severe Calcaneofibular Impingement: Case Series

2020 ◽  
Vol 5 (4) ◽  
pp. 247301142095379
Author(s):  
Jay M. Levin ◽  
James K. DeOrio
Keyword(s):  
Surgical Technique ◽  
Case Series ◽  
Lateral Wall ◽  
Patient Characteristics ◽  
Calcaneal Fracture ◽  
Lateral Approach ◽  
Emergency Department Visits ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Calcaneal Osteotomy

Background: Calcaneofibular impingement is characterized by lateral hindfoot pain and is commonly resulting from calcaneal fracture malunion or severe flatfoot deformity. Lateral calcaneal wall decompression has been used successfully to relieve pain in patients who have calcaneofibular impingement. However, in cases of severe impingement and hindfoot valgus, lateral wall excision may leave only a small remnant of calcaneal bone for weightbearing and can lead to chronic heel pain. We describe a surgical technique using a medial displacement calcaneal osteotomy (MDCO) combined with a lateral wall exostectomy and report on the outcomes from our series of patients. Methods: Retrospective study of a single surgeon’s patients was done from 2010 to 2020 who underwent medial slide calcaneal osteotomy and lateral wall exostectomy for calcaneofibular impingement. Descriptive statistics were used to summarize patient characteristics. Our study included 9 patients, 6 females and 3 males, with a mean age of 59 years (range: 19-77) and a mean follow-up of 62 weeks (range: 6-184). Results: Five had an Achilles split approach, 2 had an oblique lateral approach, and 1 had an extensile lateral approach. Patients achieved radiographic relief of impingement and improvement in pain. Minor skin and soft tissue complications occurred in 3 patients, all of which were associated with laterally based incisions, and all resolved after a 10-day course of oral antibiotics. No major complications, emergency department visits, or readmissions occurred. Conclusions: MDCO and lateral wall exostectomy was a safe and effective treatment for severe calcaneofibular impingement. Level of Evidence: Level IV, retrospective case series.

scholarly journals Combined lenvatinib and pembrolizumab as salvage therapy in advanced adrenal cortical carcinoma

2020 ◽  
Vol 8 (2) ◽  
pp. e001009
Author(s):  
Sara Bedrose ◽  
Kevin Charles Miller ◽  
Lina Altameemi ◽  
Mohamed S Ali ◽  
Sameh Nassar ◽  
...  
Keyword(s):  
Systemic Therapy ◽  
Salvage Therapy ◽  
Checkpoint Inhibitors ◽  
Single Agent ◽  
Case Series ◽  
Progression Free Survival ◽  
Adrenal Cortical Carcinoma ◽  
Retrospective Case ◽  
First Case ◽  
Platinum Based Chemotherapy

BackgroundThere is no effective systemic therapy for metastatic adrenal cortical carcinoma (ACC) after failure of platinum-based chemotherapy. The efficacies of single-agent oral multikinase inhibitors (MKIs) or salvage immune checkpoint inhibitors (CPIs) have been very limited. It is unknown whether combining CPIs, such as pembrolizumab (PEM), with other therapies, such as MKIs, could yield higher response rates in ACC, yet this combination has shown promise in other cancers. Herein, we describe the first case series using PEM in combination with the MKI lenvatinib (LEN) in patients with progressive, metastatic ACC.MethodsA retrospective case series describing the use of LEN/PEM as salvage therapy in patients with progressive/metastatic ACC.ResultsEight patients were treated with the LEN/PEM combination therapy. Half were female, and the median age at time of diagnosis was 38 years (range 21–49). Three (37.5%) patients had hormonally active ACC. The median number of prior lines of systemic therapy was 4 (range 2–9). Six (75%) patients had had disease progression on prior CPIs and five (62.5%) patients had progressed on prior MKI therapy. The median progression-free survival was 5.5 months (95% CI 1.8–not reached) and median duration of therapy was 8.5 months (range 2–22). Two (25%) patients had a partial response, one (12.5%) patient had stable disease, and five (62.5%) patients had progressive disease. None of the eight patients stopped therapy because of adverse events.ConclusionsIn our small cohort of heavily pretreated patients with ACC, the combination of LEN/PEM was associated with objective responses in a subset of patients without significant toxicity. This combination should be formally investigated in phase II clinical trial with robust correlative studies to identify predictors for response.

Peroral endoscopic myotomy (POEM) for dysphagia and esophageal motor disorder after antireflux fundoplication

Endoscopy ◽  
2020 ◽  
Vol 52 (07) ◽  
pp. 583-588
Author(s):  
Jean-Michel Gonzalez ◽  
Laurent Monino ◽  
Philippe Ah-Soune ◽  
Véronique Vitton ◽  
Marc Barthet
Keyword(s):  
Clinical Efficacy ◽  
Laparoscopic Fundoplication ◽  
Therapeutic Option ◽  
Case Series ◽  
Peroral Endoscopic Myotomy ◽  
Efficacy Rate ◽  
Motor Disorder ◽  
Retrospective Case ◽  
First Case ◽  
Endoscopic Myotomy

Abstract Introduction Laparoscopic fundoplication is the treatment of severe and refractory gastroesophageal reflux disease (GERD). It induces dysphagia in 5 % – 10 % owing to a tight valve ± esophageal motility disorders (EMD), with challenging management. We assessed the first case series assessing peroral endoscopic myotomy (POEM) in such a situation. Methods A retrospective case series including eight patients with severe dysphagia after laparoscopic fundoplication who were treated by POEM. They were assessed clinically by Eckardt and Mellow – Pinkas dysphagia scores, and by high resolution manometry (HRM). The procedure was a regular esophageal POEM, mainly posterior, including a myotomy of the wrap. The objectives were to evaluate the clinical efficacy, technical difficulties, and complications of this approach. Results HRM showed aperistalsis in 6 /8 patients and raised lower esophageal sphincter (LES) pressure in 5 /8. The median preoperative Eckardt and dysphagia scores were 5 and 3.5, respectively. The procedure was completed in 7 /8 patients, with a clinical efficacy rate (normalization of both scores) of 75 % (6 /8). Although the submucosa seemed more fibrotic and vascularized, no severe complications occurred. Conclusion POEM is a newly described therapeutic option to consider for managing dysphagia due to EMD after laparoscopic fundoplication.

scholarly journals Telemedicine during the Coronavirus Disease (COVID-19) Pandemic: A Multiple Sclerosis (MS) Outpatients Service Perspective

2021 ◽  
Vol 13 (1) ◽  
pp. 25-31
Author(s):  
Francesco Corea ◽  
Silvia Ciotti ◽  
Antonella Cometa ◽  
Claudia De Carlo ◽  
Giancarlo Martini ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Care Delivery ◽  
Oral Treatment ◽  
Case Series ◽  
Patient Characteristics ◽  
Stroke Care ◽  
Retrospective Case ◽  
Short Disease Duration ◽  
Relapsing Remitting ◽  
Relapsing Remitting Multiple Sclerosis

Background: During the COVID-19 pandemic, the need for a broader implementation of telemedicine for many diseases has become apparent. Televisits are one type of telemedicine in which clinical visits are conducted remotely using an audio-visual connection with the patient at home. The use of televisits is more established in Stroke care but was also recently formally evaluated for Multiple Sclerosis (MS). This retrospective case series describes patient characteristics and reasons for televisits in persons with MS during the COVID-19 pandemic outbreak in Italy, which was declared in February 2020. Methods: Recruitment occurred in a general hospital based MS clinic during Italy’s lockdown months period (9 March–18 May). Each subject completed at least one televisit. The baseline data included were demographics and MS history; reasons for the remote house calls were analyzed focusing on COVID-19 related needs. Results: Forty-six participants completed at least one study visit. The patients enrolled were more often females suffering from Relapsing Remitting Multiple Sclerosis (RRMS). Half of the patients had an intermediate level of education and lived within a 60 min drive from the clinic. These patients predominately had a short disease duration and were mostly involved in oral treatment. The main reasons for the call were drug use and counseling on social distancing. In 5 cases, COVID-19 infection was reported. Conclusions: Televisits during the COVID-19 outbreak demonstrated their utility as a care delivery method for MS. Hence, it is vital to facilitate the implementation of this technology in common practice to both face infectious threats and increase accessibility of the health care system.

scholarly journals Clinical Features and Outcomes of Patients with Elizabethkingia Meningoseptica Infection: An Emerging Pathogen

2020 ◽  
Author(s):  
Abdullah Umair ◽  
Nosheen Nasir
Keyword(s):  
Hospital Stay ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Opportunistic Pathogen ◽  
University Hospital ◽  
Retrospective Case ◽  
First Case ◽  
Elizabethkingia Meningoseptica ◽  
Co Morbidity ◽  
Morbidity Index

Abstract Background:Elizabethkingia meningoseptica, formerly known as Chryseobacterium meningosepticum, is a non-motile, non-fastidious, catalase and oxidase-positive, aerobic, glucose-non-fermentative Gram-negative bacillus first defined by Elizabeth O. King in 1959. It has recently emerged as an opportunistic pathogen infecting people in the the extremes of age and the immunocompromised, especially in nosocomial settings. There has been an increased interest in this pathogen due to its rising occurrence around the world, its ubiquity in nature, and inherent capacity for antimicrobial resistance.Methods: We describe a retrospective case series at the Aga Khan University Hospital in Karachi, Pakistan on patients admitted from January 2013 to December 2018 with Elizabethkingia meningoseptica infections. All patients identified to have any clinical culture specimen positive for Elizabethkingia meningoseptica were included. Data was collected on a structured proforma from the Hospital Information Management Systems (HIMS).Results:Sixteen patients with E. meningoseptica were identified. The mean Charlson’s co-morbidity index was 3.25. Nine patients had bacteremia with E. meningosepticum. Three of the isolates were extensively drug resistant with sensitivity only to minocycline. Nine out of 16 patients required intubation and mechanical ventilation. The median length of hospital stay was 13 days and four out of 16 patients died during hospital stay,Conclusion: This is the first case series from Pakistan reporting Elizabethkingia meningoseptica infections.

scholarly journals Characteristics and risk factors for COVID-19 diagnosis and adverse outcomes in Mexico: an analysis of 89,756 laboratory–confirmed COVID-19 cases

2020 ◽  
Author(s):  
Theodoros V Giannouchos ◽  
Roberto A Sussman ◽  
José Manuel Mier Odriozola ◽  
Konstantinos Poulas ◽  
Konstantinos Farsalinos
Keyword(s):  
Risk Factors ◽  
Adverse Outcome ◽  
Chronic Renal Disease ◽  
Case Series ◽  
Patient Characteristics ◽  
Male Gender ◽  
Adverse Outcomes ◽  
Retrospective Case ◽  
Middle Income ◽  
Clinical Endpoints

AbstractBackgroundThere is insufficient information about risk factors for COVID-19 diagnosis and adverse outcomes from low and middle-income countries (LMICs).ObjectivesWe estimated the association between patients’ characteristics and COVID-19 diagnosis, hospitalization and adverse outcome in Mexico.MethodsThis retrospective case series used a publicly available nation-level dataset released on May 31, 2020 by the Mexican Ministry of Health, with patients classified as suspected cases of viral respiratory disease. Patients with COVID-19 were laboratory-confirmed. Their profile was stratified by COVID-19 diagnosis or not. Differences among COVID-19 patients based on two separate clinical endpoints, hospitalization and adverse outcome, were examined. Multivariate logistic regressions examined the associations between patient characteristics and hospitalization and adverse outcome.ResultsOverall, 236,439 patients were included, with 89,756 (38.0%) being diagnosed with COVID-19. COVID-19 patients were disproportionately older, males and with increased prevalence of one or more comorbidities, particularly diabetes, obesity, and hypertension. Age, male gender, diabetes, obesity and having one or more comorbidities were independently associated with laboratory-confirmed COVID-19. Current smokers were 23% less likely to be diagnosed with COVID-19 compared to non-smokers. Of all COVID-19 patients, 34.8% were hospitalized and 13.0% experienced an adverse outcome. Male gender, older age, having one or more comorbidities, and chronic renal disease, diabetes, obesity, COPD, immunosuppression and hypertension were associated with hospitalization and adverse outcome. Current smoking was not associated with adverse outcome.ConclusionThis largest ever case series of COVID-19 patients identified risk factors for COVID-19 diagnosis, hospitalization and adverse outcome. The findings could provide insight for the priorities the need to be set, especially by LMICs, to tackle the pandemic.

Characterising DSCATT: A case series of Australian patients with debilitating symptom complexes attributed to ticks

2021 ◽  
pp. 000486742110437
Author(s):  
Jesse Schnall ◽  
Georgina Oliver ◽  
Sabine Braat ◽  
Richard Macdonell ◽  
Katherine B Gibney ◽  
...  
Keyword(s):  
Chronic Fatigue Syndrome ◽  
Lyme Disease ◽  
Case Series ◽  
Disease Process ◽  
Chronic Fatigue ◽  
Retrospective Case ◽  
Medical Diagnoses ◽  
Fatigue Syndrome ◽  
First Case ◽  
Medically Unexplained

Objectives(s): To characterise the clinical profile, aetiology and treatment responsiveness of ‘Australian Lyme’, or Debilitating Symptom Complexes Attributed to Ticks. Methods: Single-centre retrospective case analysis of patients referred to the Infectious Diseases Unit at Austin Health – a tertiary health service in Heidelberg, Australia – between 2014 and 2020 for investigation and treatment of suspected Debilitating Symptom Complexes Attributed to Ticks. Patients were included if they had debilitating symptoms suggested by either themselves or the referring clinician as being attributed to ticks. Results: Twenty-nine Debilitating Symptom Complexes Attributed to Ticks cases were included in the analysis. Other than Lyme disease (83%), the most common prior medical diagnoses were Epstein–Barr virus (38%), chronic fatigue syndrome (28%) and fibromyalgia (24%). Prior histories of anxiety (48%) and depression (41%) were common. The most frequently reported symptoms included fatigue (83%), headache (72%) and arthralgia (69%). National Association of Testing Authorities/Royal College of Pathologists of Australasia–accredited serology was not diagnostic of acute infective causes, including Lyme disease, in any patient. Of 25 cases with available data, 23 (92%) had previously been prescribed antimicrobials, with 53% reporting benefit from them. The most common diagnoses made by our hospital were chronic fatigue syndrome (31%), migraines (28%) and fibromyalgia (21%). Only one patient’s symptoms were not accounted for by other diagnoses. Conclusion: This is the first case series of patients with Debilitating Symptom Complexes Attributed to Ticks. They had high rates of other medically unexplained syndromes, and no evidence of acute Lyme disease, or any common organic disease process. Debilitating Symptom Complexes Attributed to Ticks remains medically unexplained, and may therefore be due to an as yet unidentified cause, or may be considered a medically unexplained syndrome similar to conditions such as chronic fatigue syndrome.

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