Diagnosis and management of urethro-cavernosal fistulas

2020 ◽  
Vol 13 (6) ◽  
pp. 398-401
Author(s):  
Jullet Han ◽  
Saum Ghodoussipour ◽  
Evgeniy I Kreydin ◽  
Leo Doumanian
Keyword(s):  
Case Reports ◽  
Case Series ◽  
Surgical Approaches ◽  
Success Rates ◽  
Long Term Outcomes ◽  
Level Of Evidence ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

Objective: To present a case series of urethro-cavernosal fistulas evaluating their diagnostic work-up and management. Methods: A literature search was performed using key words including “urethro-cavernosal fistula,” “urethral fistula,” and “cavernosal fistula.” Results: In total 10 case reports were identified and reviewed for information regarding clinical diagnosis, management, and long-term outcomes including success rates and complications. Conclusion: Urethro-cavernosal fistula is a rare urological condition. With few cases reported to date, there is considerable variation in diagnostic work-up and management. Both conservative and surgical approaches can be utilized in the management of urethro-cavernosal fistulas with good long-term outcomes. Level of evidence: Not applicable for this multicentre audit.

Long-term Outcomes of Microfracture for Treatment of Osteochondral Lesions of the Talus

2021 ◽  
pp. 107110072199542
Author(s):  
Daniel Corr ◽  
Jared Raikin ◽  
Joseph O’Neil ◽  
Steven Raikin
Keyword(s):  
Survival Rate ◽  
Case Series ◽  
Return To Sport ◽  
Osteochondral Lesions ◽  
Long Term Outcomes ◽  
Level Of Evidence ◽  
Additional Surgery ◽  
Case Series Study

Background: Microfracture is the most common reparative surgery for osteochondral lesions of the talus (OLTs). While shown to be effective in short- to midterm outcomes, the fibrocartilage that microfracture produces is both biomechanically and biologically inferior to that of native hyaline cartilage and is susceptible to possible deterioration over time following repair. With orthobiologics being proposed to augment repair, there exists a clear gap in the study of long-term clinical outcomes of microfracture to determine if this added expense is necessary. Methods: A retrospective review of patients undergoing microfracture of an OLT with a single fellowship-trained orthopedic surgeon from 2007 to 2009 was performed. Patients meeting the inclusion criteria were contacted to complete the Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) and Sports subscales and visual analog scale (VAS) for pain, as well as surveyed regarding their satisfaction with the outcome of the procedure and their likelihood to recommend the procedure to a friend with the same problem using 5-point Likert scales. Patient demographics were reviewed and included for statistical analysis. Results: Of 45 respondents, 3 patients required additional surgery on their ankle for the osteochondral defect, yielding a 10-year survival rate of 93.3%. Of surviving cases, 90.4% (38/42) reported being “extremely satisfied” or “satisfied” with the outcome of the procedure. The VAS score at follow-up averaged 14 out of 100 (range, 0-75), while the FAAM-ADL and FAAM-Sports scores averaged 90.29 out of 100 and 82 out of 100, respectively. Thirty-six patients (85.7%) stated that their ankle did not prevent them from participating in the sports of their choice. Conclusion: The current study represents a minimum 10-year follow-up of patients undergoing isolated arthroscopic microfracture for talar osteochondral defects, with a 93.3% survival rate and 85.7% return to sport. While biological adjuvants may play a role in improving the long-term outcomes of microfracture procedures, larger and longer-term follow-up studies are required for procedures using orthobiologics before their cost can be justified for routine use. Level of Evidence: Level IV, retrospective cohort case series study.

Copeptin; utility in paediatric patients with hyponatraemia

2021 ◽  
Author(s):  
Rachel L Boal ◽  
James Hughes ◽  
Debbie Matthews ◽  
Helen Johnstone ◽  
Christopher Boot ◽  
...  
Keyword(s):  
Reference Range ◽  
Case Reports ◽  
Underlying Mechanism ◽  
Vasopressin Release ◽  
Diuretic Hormone ◽  
Low Sodium ◽  
Paediatric Patients ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

Introduction Copeptin concentrations are a useful component of the diagnostic work-up of paediatric patients with polyuria and polydipsia but the value of measuring copeptin in patients with hyponatraemia is less clear. Case Reports We report 5 children with hyponatraemia in the context of different underlying pathologies. Copeptin concentrations were elevated in 4 cases (13.7, 14.4, 26.1, 233pmol/L; reference range 2.4 – 8.6pmol/L) suggesting that non-osmoregulated vasopressin release (syndrome of inappropriate antidiuretic diuretic hormone or SIADH) was the underlying mechanism for the low sodium levels. In one of the patients there was an underlying diagnosis of Schaaf-Yang syndrome (MAGEL 2 gene mutation) with a clinical picture suggestive of dysregulated vasopressin production with inappropriately high and then low copeptin release. In one hyponatraemic patient, low copeptin concentrations indicated that non-osmoregulated AVP release was not the cause of hyponatraemia and oliguria. Discussion Copeptin measurement did not influence management acutely but helped to clarify the mechanism leading to hyponatraemia when the result was available. Relatively high and low copeptin concentrations in association with hypo and hypernatraemia indicates dysregulated vasopressin production in Schaaf-Yang syndrome. Profound copeptin elevation may be a clue to underlying sepsis.

Urethral Diverticulum in Women with Neurologic Bladder

1998 ◽  
Vol 65 (4) ◽  
pp. 532-535
Author(s):  
P. Menchinelli ◽  
L De Giovanni ◽  
A. Manca ◽  
J.M. Weir ◽  
G. Ronzoni
Keyword(s):  
Multiple Sclerosis ◽  
Urethral Diverticulum ◽  
Therapeutic Strategies ◽  
Long Term Results ◽  
White Population ◽  
Diagnostic Work ◽  
Work Up ◽  
Female Urethral Diverticulum ◽  
Diagnostic Work Up

Female urethral diverticulum is a rather rare pathology, often ignored, which affects from 1 to 4% of the white population. In this study we report our series, limited to a selected population of women affected by neurologic bladder (6 paraplegic patients; 2 patients with multiple sclerosis) who were referred to our Urosurgical Unit within the space of four years. The diagnostic work-up relevant to these patients is discussed, together with the therapeutic strategies carried out and the long-term results obtained.

scholarly journals Transorbital Endoscopic Surgery for Sphenoid Wing Meningioma: Long-Term Outcomes and Surgical Technique

2020 ◽  
Vol 81 (04) ◽  
pp. 357-368
Author(s):  
N. Goncalves ◽  
D.E. Lubbe
Keyword(s):  
Minimally Invasive ◽  
Endoscopic Surgery ◽  
Case Series ◽  
Surgical Approaches ◽  
Benign Tumors ◽  
Long Term Outcomes ◽  
Invasive Approach ◽  
Visual Outcomes ◽  
Presenting Symptoms

AbstractSphenoid wing meningiomas are benign tumors that can result in proptosis, visual impairment, and pain. Traditional open surgical approaches are associated with significant morbidity. Transorbital endoscopic surgery has been developed as a minimally invasive approach to gain access to these tumors and address the main presenting symptoms. Case series reporting transorbital endoscopic resection of sphenoid wing meningiomas using combined endonasal, pre-caruncular, and extended superior eyelid approaches have demonstrated stable and/or improved short- and medium-term visual outcomes. Earlier medial optic nerve decompression appears to result in more favorable long-term visual outcomes. Transorbital endoscopic surgery therefore represents an emerging minimally invasive alternative to deal with these challenging lesions.

The Japanese Operation for Biliary Atresia: Remedy or Mischief?

PEDIATRICS ◽  
1975 ◽  
Vol 55 (1) ◽  
pp. 12-19
Author(s):  
John R. Lilly
Keyword(s):  
Biliary Atresia ◽  
Case Illustration ◽  
Kasai Operation ◽  
Early Results ◽  
Bile Drainage ◽  
Diagnostic Work ◽  
Work Up ◽  
Term Analysis ◽  
Diagnostic Work Up

A case illustration is given of an infant with biliary atresia who had the Kasai operation more than 1½ years ago and is now, by all biochemical and histiological criteria, cured. The early results with this operation in 14 patients are similar to those reported by the Japanese, that is, 25% have had sustained postoperative bile drainage. Success has never been achieved in infants older than 4 months. A long-held notion in this country to withhold operation in infants with jaundice until after 4 months has thus far militated against a critical and impartial evaluation of the Kasai operation. A plea is made to complete diagnostic work-up for jaundice during the first months of life so that the operation, if elected, may have a genuine chance for legitimate long-term analysis.

scholarly journals Cognitive Status Epilepticus: Two Case Reports

Medicina ◽  
2021 ◽  
Vol 57 (8) ◽  
pp. 799
Author(s):  
Eleni Karantali ◽  
Symela Chatzikonstantinou ◽  
Ioannis Mavroudis ◽  
Constantin Trus ◽  
Dimitrios Kazis
Keyword(s):  
Status Epilepticus ◽  
Antiepileptic Drug ◽  
Case Reports ◽  
Cognitive Status ◽  
Epileptic Disorder ◽  
Diagnostic Work ◽  
Focal Status Epilepticus ◽  
Work Up ◽  
Prompt Diagnosis ◽  
Diagnostic Work Up

Cognitive status epilepticus is an uncommon form of focal status epilepticus presenting with a dysfunction of language, thinking or associated higher cortical functions. The absence of ictal manifestations can be misleading and delay a prompt diagnosis. Here we present two patients; one with amnesic and one with aphasic status epilepticus. Through these cases, we aim to highlight the value of EEG performance early in the diagnostic work-up and early antiepileptic drug initiation in cases where an epileptic disorder cannot be excluded.

scholarly journals Current surgical approach in cleft palate treatment

2015 ◽  
Vol 10 (3) ◽  
pp. 234-239
Author(s):  
Sorin TALĂ ◽  
◽  
Dan Mircea ENESCU ◽  
Mircea ANDRIESCU ◽  
◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Cleft Palate ◽  
Retrospective Studies ◽  
Case Reports ◽  
Case Series ◽  
Long Term Outcomes ◽  
Exclusion Criteria ◽  
Pubmed Database ◽  
Made In

Objective. To evaluate the present state of cleft palate surgical treatment based on clinical studies after an extensive research of medical literature. Methods. The research was made in PubMed database between 2007-2014 taking in consideration surgical treatment of cleft palate and eliminating case reports, case series and reviews. Results. There was 1,677 articles with relevance for cleft palate surgical treatment and after applying exclusion criteria were retained 43 – 29 retrospective studies and 14 prospective. Conclusion. There isn’t a protocol treatment recognized by all the cleft palate centers, existing a variety of ways to manage this malformation. There are few studies that adress treatment of cleft palate and in particular the surgical treatment of this disease and of these many are retrospective studies. This review reinforces the importance of performing prospective studies with long-term outcomes to elucidate the effect of each protocol for obtaining optimal results.

scholarly journals Cannabinoid Hyperemesis Syndrome: The Missed Diagnosis

2020 ◽  
Vol 6 (3) ◽  
pp. 127-130
Author(s):  
João B. Fonseca ◽  
Daniela Vilaverde ◽  
Rosa Rodrigues ◽  
Pedro Morgado
Keyword(s):  
Illicit Drug ◽  
Cannabis User ◽  
Cannabinoid Hyperemesis Syndrome ◽  
History Of ◽  
Missed Diagnosis ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up ◽  
Cyclic Vomiting

Cannabis is the most cultivated and abused illicit drug worldwide. Paradoxically to the antiemetic properties attributed to cannabis, a relatively new cannabinoid hyperemesis syndrome (CHS) started to be recognized and is characterized by cyclic vomiting that are interspaced by asymptomatic phases. We present a case of a 36‑year‑old woman who repeatedly presented to the emergency room with cyclic vomiting that alleviated with hot showers. She was a long‑term cannabis user and the diagnosis was only established several years later after the onset of symptoms. The diagnostic work up was unremarkable, and the only effective treatment was cannabis cessation. Hot bathing behavior is a key characteristic of this syndrome. CHS is a new clinical condition that should be considered in a setting of recurrent and intractable vomiting in patients with a history of cannabis use.

scholarly journals An Overview of Hypoglycemia in Children Including a Comprehensive Practical Diagnostic Flowchart for Clinical Use

2021 ◽  
Vol 12 ◽  
Author(s):  
Alberto Casertano ◽  
Alessandro Rossi ◽  
Simona Fecarotta ◽  
Francesco Maria Rosanio ◽  
Cristina Moracas ◽  
...  
Keyword(s):  
Neurological Complications ◽  
Clinical Use ◽  
Pediatric Age ◽  
Therapeutic Approaches ◽  
Age Related ◽  
Diagnostic Flowchart ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

Hypoglycemia is the result of defects/impairment in glucose homeostasis. The main etiological causes are metabolic and/or endocrine and/or other congenital disorders. Despite hypoglycemia is one of the most common emergencies in neonatal age and childhood, no consensus on the definition and diagnostic work-up exists yet. Aims of this review are to present the current age-related definitions of hypoglycemia in neonatal-pediatric age, to offer a concise and practical overview of its main causes and management and to discuss the current diagnostic-therapeutic approaches. Since a systematic and prompt approach to diagnosis and therapy is essential to prevent hypoglycemic brain injury and long-term neurological complications in children, a comprehensive diagnostic flowchart is also proposed.

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