Acute Diplopia Following Rhinoplasty: Clearing the Air

2021 ◽  
pp. 229255032110270
Author(s):  
Ashley N. Boustany ◽  
Carly D. Comer ◽  
Harsha Gopal ◽  
Samuel J. Lin ◽  
Sumner A. Slavin
Keyword(s):  
Rare Complication ◽  
Therapeutic Interventions ◽  
Medical Attention ◽  
Delayed Presentation ◽  
Patient Evaluation ◽  
Acute Stroke Patient ◽  
Dry Eyes ◽  
Orbital Emphysema ◽  
Complete History ◽  
Binocular Diplopia

Diplopia after rhinoplasty is a rare complication that requires immediate medical attention. Workup should include a complete history and physical examination, appropriate imaging, and consultation with ophthalmology. Diagnosis may be challenging due to the wide differential ranging from dry eyes to orbital emphysema to an acute stroke. Patient evaluation should be expedient, though thorough to facilitate time-sensitive therapeutic interventions. Here, we present a case of transient binocular diplopia presenting 2 days after closed septorhinoplasty. The visual symptoms were attributed to either intra-orbital emphysema or a decompensated exophoria. This is the second documented case of orbital emphysema after rhinoplasty presenting with diplopia. It is the only case with a delayed presentation as well as the only case that resolved after positional maneuvers.

Clinical manifestations and diagnosis of keratoconus. Treatment of iatrogenic keratoconus

2020 ◽  
pp. 37-42
Author(s):  
Fedor Ermolyuk
Keyword(s):  
Research Methods ◽  
Contact Lenses ◽  
Correct Diagnosis ◽  
Clinical Manifestations ◽  
Refractive Errors ◽  
Dry Eyes ◽  
Advanced Stages ◽  
Dystrophic Disease ◽  
Iatrogenic Origin ◽  
Binocular Diplopia

Keratoconus is a dystrophic disease of the cornea, when it is thinned with the formation of a conus-like protrusion (protrusion of the cornea). This disease belongs to the group of keratectasia, it has a multifactorial nature and occurs in approximately 25 % of all corneal pathologies. The disease can be either primary, which is based on dystrophic changes in the cornea, or secondary, which develops against the background of prenatal keratitis. Keratoconus of iatrogenic origin, which develops as a result of refractive eye microsurgery, has become widespread during the last 20 years. Most often primary keratoconus manifests during puberty, progresses to 30–40 years, after which its development slows down. An early clinical manifestation of this corneal pathology is a progressive decrease in visual acuity, development of double vision (binocular diplopia) with the development of a strong headache against this background. Monocular polyopia — images and symbols with multiple contours — develops subsequently. Severe dry eyes, itching, photophobia appear in advanced stages. Diagnosis of keratoconus in some cases can be a significant difficulty, since the use of conventional research methods only allow to suspect refractive errors in the form of myopia or astigmatism. It is necessary to take into account the impossibility of correcting visual impairment using conventional methods — glasses or contact lenses — to make correct diagnosis. As a rule, diagnosis of keratoconus requires use of expanded spectrum of instrumental research methods.

scholarly journals Non-Invasive Biomarkers for Earlier Detection of Pancreatic Cancer—A Comprehensive Review

Cancers ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 2722
Author(s):  
Greta Brezgyte ◽  
Vinay Shah ◽  
Daria Jach ◽  
Tatjana Crnogorac-Jurcevic
Keyword(s):  
Clinical Setting ◽  
Selection Index ◽  
Reporting Quality ◽  
Standard Of Care ◽  
Therapeutic Interventions ◽  
Ductal Adenocarcinoma ◽  
Index Test ◽  
Delayed Presentation ◽  
Non Invasive ◽  
Study Selection

Pancreatic ductal adenocarcinoma (PDAC) carries a deadly diagnosis, due in large part to delayed presentation when the disease is already at an advanced stage. CA19-9 is currently the most commonly utilized biomarker for PDAC; however, it lacks the necessary accuracy to detect precursor lesions or stage I PDAC. Novel biomarkers that could detect this malignancy with improved sensitivity (SN) and specificity (SP) would likely result in more curative resections and more effective therapeutic interventions, changing thus the present dismal survival figures. The aim of this study was to systematically and comprehensively review the scientific literature on non-invasive biomarkers in biofluids such as blood, urine and saliva that were attempting earlier PDAC detection. The search performed covered a period of 10 years (January 2010—August 2020). Data were extracted using keywords search in the three databases: MEDLINE, Web of Science and Embase. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool was applied for study selection based on establishing the risk of bias and applicability concerns in Patient Selection, Index test (biomarker assay) and Reference Standard (standard-of-care diagnostic test). Out of initially over 4000 published reports, 49 relevant studies were selected and reviewed in more detail. In addition, we discuss the present challenges and complexities in the path of translating the discovered biomarkers into the clinical setting. Our systematic review highlighted several promising biomarkers that could, either alone or in combination with CA19-9, potentially improve earlier detection of PDAC. Overall, reviewed biomarker studies should aim to improve methodological and reporting quality, and novel candidate biomarkers should be investigated further in order to demonstrate their clinical usefulness. However, challenges and complexities in the path of translating the discovered biomarkers from the research laboratory to the clinical setting remain and would have to be addressed before a more realistic breakthrough in earlier detection of PDAC is achieved.

Delayed presentation of doxorubicin extravasation into pleural space: Case report and review of literature

2020 ◽  
pp. 107815522097584 ◽  
Author(s):  
Vera Kazakova ◽  
Yenny A Moreno Vanegas ◽  
Tyion A Torres ◽  
Olga Kozyreva
Keyword(s):  
Case Report ◽  
Chest Pain ◽  
Soft Tissues ◽  
Rare Complication ◽  
Delayed Presentation ◽  
Review Of Literature ◽  
Chemotherapy Administration ◽  
Chemotherapy Infusion ◽  
Space Case ◽  
Anthracycline Extravasation

Introduction Intrathoracic extravasation of anthracyclines is a dangerous and very rare complication of chemotherapy administration. While management of extravasation into soft tissues has been established, the data on treatment of mediastinal and intrapleural anthracycline extravasation is limited. Case Report We present a case of a 52-year-old woman with intrapleural doxorubicin extravasation who presented to the hospital 24-hrs after chemotherapy infusion with chest pain and shortness of breath. Management & Outcome The patient underwent urgent surgical intervention and received IV dexrazoxane 36-hrs after the event. Her pain improved, but she continued to have chest soreness and pleural effusion at the site of extravasation even 3 months later. Discussion We conducted review of literature using Medline/PubMed and Google Scholar databases and identified 7 cases of intrapleural and mediastinal anthracycline extravasation. No data is currently available regarding the outcome of delayed management of intrapleural anthracycline extravasation with dexrazoxane. Prevention and confirmation of adequate port catheter placement is the most important step to avoid such cases. Catheter misplacement should be suspected in any patient presenting with post procedural chest pain and should trigger a thorough evaluation prior to any chemotherapy administration.

Orbital Emphysema as a Rare Complication of Septorhinoplasty: A Case Report

2014 ◽  
Vol 2 (2) ◽  
pp. 14-17 ◽  
Author(s):  
Ahmed Alarfaj ◽  
◽  
Abdullah AlJasser ◽  
Yasin Subhan
Keyword(s):  
Case Report ◽  
Rare Complication ◽  
Orbital Emphysema

scholarly journals Presentation of breast cancer, help seeking behaviour and experience of patients in their cancer journey in Singapore: a qualitative study

BMC Cancer ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Celene W. Q. Ng ◽  
Jennifer N. W. Lim ◽  
Jenny Liu ◽  
Mikael Hartman
Keyword(s):  
Breast Cancer ◽  
Help Seeking ◽  
Financial Burden ◽  
Support Network ◽  
Medical Attention ◽  
Time Interval ◽  
Delayed Presentation ◽  
Cancer Symptoms ◽  
Qualitative Interview Study ◽  
Help Seeking Behaviour

Abstract Background Little is known about the presentation, help seeking behaviour for breast cancer in Singapore. Nor was there a study exploring the experience of patients in their breast cancer journey. Methods A qualitative interview study with thematic analysis, conducted with 36 patients. Results There is no clear pattern of presentation for breast cancer by cancer stage at diagnosis, age and ethnicity in the cancer journey of this group of patients. Patients were diagnosed with early to advanced stages cancer regardless of when they presented or took up treatment in their cancer journey. The reasons patients sought medical attention also did not appear to differ between the stages of cancer diagnosed, ethnic and age. Without setting a measure to define early and late presentation, we found that women shared similar experience in their breast cancer journey, regardless of age, ethnicity and stage of cancer at diagnosis. Poor knowledge of breast cancer (symptoms and causes); few practised regular BSE; denial of symptom; fear of hospitalisation, diagnosis and treatment; worries and stress over financial burden of treatment; misinformation in magazine and online sources; diet; stress; caring responsibility; support network; and use of alternative medicine before and after diagnosis were identified in patients’ narratives. Strong social support; fear of being an emotional and financial burden for the family; and financial worries during treatment were also the recurring themes after diagnosis. Conclusion A measure of breast cancer presentation - that accounts for the patient’s experience in the cancer journey, the time interval and tumour biology – that is meaningful to patients, clinicians and researchers is needed. For research on late and delayed presentation, details on BSE practice – how often, when and was it done correctly – will improve the accuracy of time delay interval. For the public, concerted efforts to improve knowledge of breast cancer, survival and prognosis for early-diagnosed cancer, and the importance of regular and correct technique to perform BSE, are critical and urgent to address the rising breast cancer incidence in the country.

Microwave Ablation for Twin-Reversed Arterial Perfusion Sequence: A Novel Application of Technology

2015 ◽  
Vol 38 (1) ◽  
pp. 35-40 ◽  
Author(s):  
Courtney D. Stephenson ◽  
Lorene A. Temming ◽  
Rebecca Pollack ◽  
David A. Iannitti
Keyword(s):  
Energy Source ◽  
Microwave Ablation ◽  
Rare Complication ◽  
Therapeutic Interventions ◽  
Vascular Connection ◽  
Arterial Perfusion ◽  
Risk Of Death ◽  
Microwave System ◽  
Twin Reversed Arterial Perfusion ◽  
Pump Twin

Introduction: Twin-reversed arterial perfusion sequence is a rare complication of monochorionic pregnancies that is characterized by the presence of an acardiac mass perfused by an apparently normal pump twin. The risk of death to the pump twin has led to a range of therapeutic interventions aimed at separating their vascular connection. We report a novel application of microwave ablation for vessel coagulation in the treatment of twin-reversed arterial perfusion sequence. Material and Methods: Microwave ablation has been adopted by surgical subspecialties as a superior energy source for vessel and tissue ablation as it creates heat without a circuit and has less thermal spread. We describe the use of a 2.45-GHz microwave system using a 1.8-mm antenna to coagulate the intra-abdominal portion of umbilical vessels of the acardiac mass. Results: We report 6 cases of twin-reversed arterial perfusion sequence treated by microwave ablation. All patients were treated with microwave ablation with successful coagulation of intra-abdominal umbilical cord vessels of the acardiac mass with cessation of flow. Discussion: Microwave ablation is an excellent energy source for vessel coagulation due to its thermal properties and can be used effectively in the treatment of twin-reversed arterial perfusion sequence.

Abstract TP173: Delay In Presentation To The Hospital For Young Adults With Ischemic Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Lester Y Leung ◽  
Louis R Caplan
Keyword(s):  
Young Adults ◽  
Ischemic Stroke ◽  
Time Window ◽  
Medical Center ◽  
Academic Medical Center ◽  
Medical Attention ◽  
Psychiatric Disease ◽  
Stroke Severity ◽  
Delayed Presentation ◽  
Medical Conditions

Introduction: Young adults with ischemic stroke may present late to medical care, and the reasons for these delays are unknown. Hypothesis: We hypothesized that some medical conditions, social factors, and low stroke severity would be associated with delayed presentations to medical attention. Methods: We performed a retrospective cohort study of adults ages 18 to 50 admitted to a single academic medical center between 2007-2012. Results: 61% of 141 young adults with ischemic stroke presented more than 4.5 hours after stroke onset. Diabetes was associated with delays in presentation (p = 0.03), whereas systemic cancer was associated with early presentations (p = 0.03). Individuals who were single were more likely to present late than those who were married or living with a partner (p = 0.005). Age (dichotomized by 18-35 and 36-50), race, employment or schooling status, home medications, other medical conditions (including common stroke mimics such as migraine, seizure, and psychiatric disease), and stroke subtype were not determinants of delay in presentation, although there was a non-significant trend towards delayed presentations in women (p = 0.08) and with low stroke severity (dichotomized by NIHSS ≤ 5 and NIHSS > 5, p = 0.06). Conclusions: A majority of young adults with ischemic stroke presented outside the time window for intravenous fibrinolysis. Diabetes and single status were associated with a greater risk of delayed presentation.

scholarly journals A delayed presentation of splenic laceration and hemoperitoneum following an elective colonoscopy: A rare complication with uncertain risk factors

2018 ◽  
Vol 6 ◽  
pp. 2050313X1879106 ◽  
Author(s):  
Allison N Zhang ◽  
Jagannath M Sherigar ◽  
Debra Guss ◽  
Smruti R Mohanty
Keyword(s):  
Risk Factors ◽  
Perceived Risk ◽  
Splenic Injury ◽  
Clinical Presentation ◽  
Rare Complication ◽  
Consent Process ◽  
Delayed Presentation ◽  
Abdominal Adhesions

Splenic laceration is a rare yet often underreported complication of colonoscopy that is infrequently discussed with the patient during the consent process. Most cases present within 48 h after the inciting colonoscopy; a delayed presentation is rare. We present a case of splenic laceration with hemoperitoneum that manifested 5 days after the initial colonoscopy. The patient was treated conservatively. Traditionally perceived risk factors such as intra-abdominal adhesions, splenomegaly, anticoagulation use, biopsy, polypectomy, a technically challenging procedure, and anesthesia assistance have not been clearly shown to increase the incidence of splenic injury following a colonoscopy. Since the risk factors of splenic injury remain unclear, the clinical presentation is nonspecific, and the consequences can be serious, the endoscopist should make an effort to inform the patient of this rare complication before the procedure.

scholarly journals Spontaneous Hepaticoduodenal and Choledochoduodenal Fistula Mimicking Duodenal Ulcer Perforation, a Very Rare Complication of Transarterial Chemoembolization

2015 ◽  
Vol 9 (1) ◽  
pp. 68-73
Author(s):  
Varayu Prachayakul ◽  
Pitulak Aswakul
Keyword(s):  
Transarterial Chemoembolization ◽  
Anastomotic Stricture ◽  
Rare Complication ◽  
Therapeutic Interventions ◽  
Endoscopic Retrograde ◽  
Clinical Sepsis ◽  
Endoscopic View ◽  
Choledochoduodenal Fistula ◽  
Duodenal Ulcer Perforation ◽  
Tace Procedure

Spontaneous bilo-enteric fistula is a rare complication following surgery or some therapeutic interventions such as transarterial chemoembolization (TACE). The present case was a young man, a known case of chronic hepatitis B with multiple recurrent hepatocellular carcinoma, who presented with clinical sepsis and jaundice. Computed tomography showed dilated proximal left intrahepatic ducts which suspected anastomotic stricture. He underwent endoscopic retrograde cholangiopancreatography, but the endoscopic view showed a deep ulcer covered by yellowish debris tissue. After re-evaluation it was found to be hepaticoduodenostomy and choledochoduodenostomy tracts. In the present case the fistula was suspected to be related to a previous TACE procedure.

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