scholarly journals Severe Necrotising Soft Tissue Infections in Orthopaedic Surgery

2002 ◽  
Vol 10 (2) ◽  
pp. 108-113 ◽  
Author(s):  
JC Theis ◽  
J Rietveld ◽  
T Danesh-Clough
Keyword(s):  
Orthopaedic Surgery ◽  
Surgical Intervention ◽  
Treatment Strategies ◽  
Predisposing Factors ◽  
Mortality And Morbidity ◽  
Presenting Symptoms ◽  
Group A ◽  
Inflammatory Drugs ◽  
The Mean ◽  
High Index Of Suspicion

Purpose. To review all cases of necrotising infection managed in the Department of Orthopaedic Surgery of Dunedin Hospital in New Zealand between 1989 and 1998. Methods. Hospital records were analysed for predisposing factors, clinical features, diagnostic results, treatment strategies, and outcomes. Results. 13 cases (9 males and 4 females) of necrotising infection were identified. The mean age was 48 years (range, 8–76 years). Presenting symptoms included painful swelling, erythema, and necrosis. Most patients had predisposing factors and had received non-steroidal anti-inflammatory drugs before presentation. 12 patients underwent surgical debridement including a total of 4 amputations. Septic shock developed in 9 patients who required dialysis for renal failure. Four patients died. The most common organisms identified were group A beta-haemolytic streptococci. Conclusion. Severe necrotising infections require a high index of suspicion and rapid medical and surgical intervention to reduce the mortality and morbidity.

scholarly journals Repeated short cycles of nonsteroidal anti-inflammatory drugs and kidney injury in patients with spinal degenerative-dystrophic diseases

2018 ◽  
Vol 12 (3) ◽  
pp. 94-97
Author(s):  
D. M. Bichurina ◽  
I. Z. Gaydukova ◽  
D. А. Patrikeeva ◽  
A. P. Rebrov
Keyword(s):  
Back Pain ◽  
Kidney Injury ◽  
Control Group ◽  
Study Group ◽  
Creatinine Ratio ◽  
Healthy Individuals ◽  
Group A ◽  
Inflammatory Drugs ◽  
The Mean ◽  
Anti Inflammatory

Objective: to evaluate kidney function in patients with spinal degenerative-dystrophic diseases (SDDDs) who take nonsteroidal anti-inflammatory drugs (NSAIDs) as repeated short cycles of treatment for severe back pain.Patients and methods. The investigation enrolled 97 patients with SDDDs who took NSAIDs for back pain (a study group). A control group consisted of sexand age-matched healthy individuals who had not used NSAIDs within the past year (n=40). Glomerular filtration rate (GFR) was estimated using the CKD-EPI equation and markers of kidney injury (albuminuria and globulinuria) were measured.Results. In the study group, GFR was decreased to <90 ml/min/1.73 m2 in 61 (62.9%) patients, to <60 ml/min/1.73 m2 in 11 (11.3%); the mean GFR was 77.5 [68.0; 89.0] ml/min/1.73 m2; in the control group, a decline in GFR to 89–60 ml/min/1.73 m2 was recorded in 35 (62.5%) cases; this indicator was >90 ml/min/1.73 m2 in the remaining 15 (37.5%) cases; the mean GFR was 82.5 [70.8; 90.0] ml/min/1.73 m2 (p≥0.05 for all pairwise comparisons). A decrease in GFR to <60 ml/min/1.73 m2 was found in 11 (11.3%) patients in the study group and in nobody in the control group (p=0.026). Elevated albuminuria was noted in 74 (76.3%) patients with SDDDs and in 9 (22.5%) healthy individuals (p<0.05). Albumin/creatinine ratio was 57.1 [33.8; 82.4] mg/g in the study group and 25.0 [17.5; 32.9] mg/g in the control group (p<0.0001). Increased globulinuria was established in all the patients with SDDDs and only in 3 (7.5%) healthy examinees. Globulin/creatinine ratio was 134.7 [77.5; 197.7] mg/g in the study group and 12.9 [0.5; 18.1] mg/g in the control group (p<0.0001).Conclusion. A decline in GFR to <60 ml/min/1.73 m2 was more often seen in the patients taking NSAIDs for spine pain caused by SDDDs than in the healthy individuals. In case of comparable GFR, the level of kidney injury markers was significantly higher in the study group than that in the control group, which suggests that patients with SDDDs who take NSAIDs have subclinical tubulointerstitial and glomerular changes.

scholarly journals Clinico-radiologic features and therapeutic strategies in tumefactive demyelination: a retrospective analysis of 50 consecutive cases

2021 ◽  
Vol 14 ◽  
pp. 175628642110065
Author(s):  
Aigli G. Vakrakou ◽  
Dimitrios Tzanetakos ◽  
Maria-Eleptheria Evangelopoulos ◽  
Theodore Argyrakos ◽  
John S. Tzartos ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Treatment Strategies ◽  
Poor Response ◽  
Disease Course ◽  
Corticosteroid Administration ◽  
Efficient Treatment ◽  
Relapsing Remitting ◽  
Demyelinating Lesions ◽  
Group A ◽  
The Mean

Aims: Our goal was to expand the spectrum of clinico-radiologic characteristics and the possible therapeutic choices in patients with tumefactive demyelinating lesions (TDLs). Methods: A retrospective analysis of 50 patients with at least one TDL was performed at an academic neurology center (2008–2020). Results: Our cohort comprised mostly women (33/50) with a mean age of 38 years at TDL onset. The mean follow-up time was 76 months. The mean Expanded Disability Status Scale score at TDL onset and at the latest neurological evaluation was 3.7 and 2.3, respectively. We subcategorized the patients into seven groups based mainly on the clinical/radiological findings and disease course. Group A included patients presenting with a Marburg-like TDL ( n = 4). Groups B and C comprised patients presenting with monophasic ( n = 7) and recurrent TDLs ( n = 12), respectively. Multiple sclerosis (MS) patients who subsequently developed TDL ( n = 16) during the disease course were categorized as Group D. Group E comprised patients who initially presented with TDL and subsequently developed a classical relapsing–remitting MS without further evidence of TDL ( n = 5). Groups F ( n = 2) and G ( n = 4) involved MS patients who developed TDL during drug initiation (natalizumab, fingolimod) and cessation (interferon, fingolimod), respectively. Regarding long-term treatments applied after corticosteroid administration in the acute phase, B-cell-directed therapies were shown to be highly effective especially in cases with recurrent TDLs. Cyclophosphamide was spared for more aggressive disease indicated by a poor response to corticosteroids and plasma exchange failure. Conclusion: Tumefactive central nervous system demyelination is an heterogenous disease; its stratification into distinct groups according to different phenotypes can establish more efficient treatment strategies, thus improving clinical outcomes in the future.

scholarly journals Group A Streptococci-Associated Necrotizing Fasciitis following Cat Bite in an Immunocompromised Patient

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Sudheer Nambiar ◽  
Asha Karippot ◽  
Joe Devasahayam ◽  
Tony Oliver
Keyword(s):  
Necrotizing Fasciitis ◽  
Pasteurella Multocida ◽  
Surgical Intervention ◽  
Group A Streptococcus ◽  
Immunocompromised Host ◽  
Tissue Destruction ◽  
Left Hand ◽  
Group A ◽  
Bite Wounds ◽  
High Index Of Suspicion

Necrotizing soft tissue infections are characterized clinically by fulminant tissue destruction, systemic signs of toxicity, and high mortality. Accurate diagnosis and appropriate treatment must include early surgical intervention and antibiotic therapy. Mortality rate is very high and could be even higher in an immunocompromised host. We present a 57-year-old female with history of rheumatoid arthritis on oral corticosteroid and methotrexate therapy with painful swelling of the left hand following a cat bite that was diagnosed as having group A streptococcus pyogenes-associated necrotizing fasciitis. Treatment with ampicillin-sulbactam, Clindamycin, and surgical debridement was performed. In spite of all the adequate therapy she succumbed to death from streptococcal toxic shock and related complications after thirty-two days of treatment in intensive care unit. Necrotizing fasciitis is an uncommon but life-threatening complication in immunocompromised hosts. Tissue infections in cat bite wounds are commonly caused by pathogenic bacterium known as Pasteurella multocida. Group A streptococcal infections are not reported following cat bites. A high index of suspicion must be maintained to suspect group A streptococcal associated necrotizing fasciitis following cat bites and an early medical and surgical intervention should be made for any best possible outcome.

scholarly journals Central nervous system vasculopathy and Seckel syndrome: case illustration and systematic review

2021 ◽  
Author(s):  
Osama Khojah ◽  
Saeed Alamoudi ◽  
Nouf Aldawsari ◽  
Mohammed Babgi ◽  
Ahmed Lary
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Internal Carotid ◽  
Management Plan ◽  
Management Approach ◽  
Illustrative Case ◽  
Seckel Syndrome ◽  
Presenting Symptoms ◽  
The Mean ◽  
High Index Of Suspicion

Abstract Purpose To systematically review reported cases of Seckel syndrome (SS) and point out cases associated with central nervous system (CNS) vasculopathy and provide a summary of their clinical presentation, management, and outcomes including our illustrative case. Methods We conducted a search on the MEDLINE, PubMed, Google Scholar, and Cochrane databases using the keywords “Seckel + syndrome.” We identified 127 related articles reporting 252 cases of SS apart from our case. Moreover, we searched for SS cases with CNS vasculopathies from the same databases. We identified 7 related articles reporting 7 cases of CNS vasculopathies in SS patients. Results The overall rate of CNS vasculopathy in SS patients is 3.16% (n = 8/253), where moyamoya disease (MMD) accounted for 1.97%. The mean age is 13.5 years (6–19 years), with equal gender distribution (M:F, 1:1). The most common presenting symptoms were headache and seizure followed by weakness or coma. Aneurysms were mostly located in the basilar artery, middle cerebral artery, and internal carotid artery, respectively. Regardless of the management approach, 50% of the cases sustained mild-moderate neurological deficit, 37.5% have died, and 12.5% sustained no deficit. Conclusion A high index of suspicion should be maintained in (SS) patients, and MMD should be part of the differential diagnosis. Prevalence of CNS vasculopathy in SS is 3.16% with a much higher prevalence of MMD compared to the general population. Screening for cerebral vasculopathy in SS is justifiable especially in centers that have good resources. Further data are still needed to identify the most appropriate management plan in these cases.

scholarly journals Small bowel obstruction secondary to obturator hernia in an elderly female

2020 ◽  
Vol 2020 (10) ◽  
Author(s):  
Aneela Devarakonda ◽  
Aarav Gupta-Kaistha ◽  
Nikhil Kulkarni
Keyword(s):  
Bowel Obstruction ◽  
Surgical Intervention ◽  
Delayed Diagnosis ◽  
Obturator Hernia ◽  
Computed Tomography Imaging ◽  
Rare Type ◽  
Midline Laparotomy ◽  
Mortality And Morbidity ◽  
Tomography Imaging ◽  
High Index Of Suspicion

Abstract Obturator hernia is an extremely rare type of pelvic hernia with relatively high mortality and morbidity due to delayed diagnosis. Most cases present with acute intestinal obstruction and typically affect elderly, emaciated females. A high index of suspicion is required for early diagnosis and timely surgical intervention. We present a rare case of an 81-year-old female who was initially discharged from the emergency department due to nonspecific symptoms. She represented with clinical features of bowel obstruction and was diagnosed preoperatively with computed tomography imaging identifying a left-sided obturator hernia with a loop of bowel extending through the obturator canal. She was taken to theater for lower midline laparotomy and repair of obturator hernia. Although many cases are identified intraoperatively, we will discuss preoperative means of diagnosis of obturator hernia from examination findings to imaging diagnosis.

Transverse Maxillary Development in Complete Cleft Patients: Comparison of 2 Treatment Strategies by Longitudinal and Cross-Sectional Model Analysis

2018 ◽  
Vol 56 (5) ◽  
pp. 610-618 ◽  
Author(s):  
Natalie Loomans ◽  
Oona Decombel ◽  
Klara Goethals ◽  
Maurice Y. Mommaerts
Keyword(s):  
Cleft Lip ◽  
Treatment Strategies ◽  
Transverse Dimension ◽  
Scar Tissue ◽  
University Hospital ◽  
Cross Sectional ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Matched Study

Objective: This study aimed to compare differences in the maxillary transverse dimension following cleft repair using 2 protocols involving a 2-staged palatal closure with similar timing but different techniques. Design: Retrospective study. Two matched study samples, each containing 10 patients. Setting: Cleft center A is a university hospital. Cleft Center B is a general teaching hospital. Patients: Patients with cleft lip alveolus and palate (CLAP) were matched by cleft type, gender, age, and palatal morphology at the age of 1 month. Differences in the transverse dimension were measured at 4 ages in 2 matched groups (A and B from center A and B), each including 5 patients with unilateral CLAP (UCLAP) and 5 patients with bilateral CLAP (BCLAP). Interventions: Orthodontic/orthopedic expansion treatment began at 8 and 5 years of age at centers A and B, respectively. Results: The mean intercanine distance decreased by 8 mm (standard deviation [SD] = 1.6; P = .030) in group A patients with UCLAP between 1 and 5 years (SD = 1.6; P = .030) and by 6.3 mm (SD = 3.2; P = .016) in group B patients with BCLAP. The mean intermolar distance increased by 4 mm (SD = 3.4; P = .076) in patients with BCLAP. A trend toward improved canine positioning was observed in patients with BCLAP by 12 years of age, with improvement occurring between 4 and 12 years. Conclusion: The type of palatal closure (inducing scar tissue at the bony level) and the late installment of orthodontic/orthopedic expansion probably reduced the intercanine width in bilateral complete clefts.

scholarly journals Fasciitis Necroticans after Elective Hernia Inguinal Surgery

2014 ◽  
Vol 2014 ◽  
pp. 1-3
Author(s):  
T. A. Sigterman ◽  
Kim J. Gorissen ◽  
Dennis E. J. G. J. Dolmans
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Surgical Intervention ◽  
Elective Surgery ◽  
Necrotising Fasciitis ◽  
Time Interval ◽  
Mortality And Morbidity ◽  
Hernia Inguinal ◽  
High Index Of Suspicion ◽  
Inguinal Surgery

Necrotising fasciitis is a rare but disastrous complication after elective surgery. We present two patients (both male, 58 and 18 years old) who developed necrotising fasciitis following elective inguinal hernia repair according to Lichtenstein. The importance of both recognition and time interval between symptom occurrence and surgical intervention is illustrated, emphasising the need for immediate action when necrotising fasciitis is suspected. A high index of suspicion of necrotising fasciitis should be maintained when a wound infection is accompanied by disproportional pain, lethargy, or sepsis. Epidermolysis and subcutaneous emphysema are often very late symptoms. Recognition and immediate intervention decrease mortality and morbidity.

COMPARATIVE STUDY OF FLUCTUATIONS IN HEMODYNAMIC PARAMETERS USING DIFFERENT INTRA-ABDOMINAL PRESSURES IN LAPAROSCOPIC CHOLECYSTECTOMY

2021 ◽  
pp. 27-29
Author(s):  
Challa Karunasree ◽  
Devashri Chilke ◽  
Arunima Dutta ◽  
Debarshi Jana
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Surgical Intervention ◽  
Open Cholecystectomy ◽  
Hemodynamic Changes ◽  
Time Intervals ◽  
Vas Score ◽  
Group A ◽  
Vas Scores ◽  
The Mean ◽  
Group B

INTRODUCTION: Laparoscopic cholecystectomy decreases postoperative pain, decreases the need for postoperative analgesia, returns the patient to full activity within 1 week (compared with 1 month after open cholecystectomy), discharged the day after surgery. This study was conducted to compare the uctuations in hemodynamic changes using different intra- abdominal pressures with CO2 in laparoscopic cholecystectomy. MATERIALS AND METHODS: Thisrandomised, prospective, interventional study was conducted in Durgapur Steel Plant Hospital, Durgapur, West Bengal from November 2018 to January 2020. In our study, we attempted to compare the uctuations in hemodynamic changes using different intra- abdominal pressures. Present study included 90 cases undergoing laparoscopic cholecystectomy who were randomly divided into 3 groups with different intra-abdominal pressures, maintained during surgical intervention by CO2 insufation. RESULT: Mean VAS score was 2.83 in group Aafter 6 hours of laparoscopic cholecystectomy which decreased to 2.13 and 0.07 by the end of 12 and 24 hours respectively. The mean VAS scores for group B and C were 5.87; 8.03, 4.33; 7.10 and 2.40; 5.93 at 6, 12 and 24 hours post laparoscopic cholecystectomy respectively. Mean VAS score was signicantly lower in group A as compared to group B and lower in group B as compared to group C respectively at all time intervals (p<0.01). CONCLUSION: Low intra-abdominal pressures during surgical intervention by CO2 insufation leads to better hemodynamic control, better pain management and decreased hospital stay. Present study thus recommends use of low pressure pneumoperitoneum in all cases undergoing laparoscopic cholecystectomy.

scholarly journals Review of the literature on de novo formation of cavernous malformations of the central nervous system after radiation therapy

2006 ◽  
Vol 21 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Shahid M. Nimjee ◽  
Ciaran J. Powers ◽  
Ketan R. Bulsara
Keyword(s):  
Central Nervous System ◽  
Surgical Intervention ◽  
De Novo ◽  
Radiation Treatment ◽  
Latency Period ◽  
Review Of The Literature ◽  
Cavernous Malformations ◽  
Presenting Symptoms ◽  
The Central Nervous System ◽  
The Mean

✓In this paper the authors review the literature concerning de novo cavernoma formation after radiation treatment. PubMed and MEDLINE database searches were performed. Data were compiled on all patients in whom de novo cavernomas formed after radiation treatment and whose cases were reported in the literature. The authors found reports in the literature of 76 patients in whom cavernomas formed de novo after radiation treatment. The mean age of the patients was 11.7 years, and the majority of these lesions occurred in males. The patients received a mean radiation dose of 60.45 Gy. The mean latency period before detection of the cavernoma was 8.9 years, and most of these lesions were detected incidentally. In symptomatic patients, the most common presenting symptoms were seizures. Thirty-seven of the patients had evidence of hemorrhage, and 54% of these required surgical intervention. De novo formation of cavernomas after radiation treatment is a relatively rare phenomenon. Patients in whom these cavernomas develop need to be followed closely because there is a propensity for the lesions to hemorrhage. Surgical intervention to treat symptomatic lesions has a favorable outcome.

Discriminant Validation of the Test of Reading Performance (TORP) for Identifying Children at Risk of Reading Difficulties

2000 ◽  
Vol 16 (2) ◽  
pp. 139-146 ◽  
Author(s):  
Padeliadu Susana ◽  
Georgios D. Sideridis
Keyword(s):  
At Risk ◽  
Elementary School Students ◽  
Reading Difficulties ◽  
Reading Performance ◽  
Low Achievers ◽  
Children At Risk ◽  
School Students ◽  
Students At Risk ◽  
Group A ◽  
The Mean

Abstract This study investigated the discriminant validation of the Test of Reading Performance (TORP), a new scale designed to evaluate the reading performance of elementary-school students. The sample consisted of 181 elementary-school students drawn from public elementary schools in northern Greece using stratified random procedures. The TORP was hypothesized to measure six constructs, namely: “letter knowledge,” “phoneme blending,” “word identification,” “syntax,” “morphology,” and “passage comprehension.” Using standard deviations (SD) from the mean, three groups of students were formed as follows: A group of low achievers in reading (N = 9) including students who scored between -1 and -1.5 SD from the mean of the group. A group of students at risk of reading difficulties (N = 6) including students who scored between -1.5 and -2 SDs below the mean of the group. A group of students at risk of serious reading difficulties (N = 6) including students who scored -2 or more SDs below the mean of the group. The rest of the students (no risk, N = 122) comprised the fourth group. Using discriminant analyses it was evaluated how well the linear combination of the 15 variables that comprised the TORP could discriminate students of different reading ability. Results indicated that correct classification rates for low achievers, those at risk for reading problems, those at risk of serious reading problems, and the no-risk group were 89%, 100%, 83%, and 97%, respectively. Evidence for partial validation of the TORP was provided through the use of confirmatory factor analysis and indices of sensitivity and specificity. It is concluded that the TORP can be ut ilized for the identification of children at risk for low achievement in reading. Analysis of the misclassified cases indicated that increased variability might have been responsible for the existing misclassification. More research is needed to determine the discriminant validation of TORP with samples of children with specific reading disabilities.

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