scholarly journals Open surgery retrieval of a missing guidewire causing cerebral infarctions after cerebral angiography: a case report

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Chaodi Luo ◽  
Jing Li ◽  
Yang Yan ◽  
Dan Han
Keyword(s):  
Cerebral Angiography ◽  
Open Surgery ◽  
Foreign Bodies ◽  
Treatment Options ◽  
Case Presentation ◽  
Appropriate Treatment ◽  
Long Time ◽  
Multiple Cerebral Infarctions ◽  
Selection Of

Abstract Background Intra-aortic foreign body (IAFB) is uncommon, which is usually caused by a rupture of the catheter or guidewire. IAFB can cause catastrophic complications, including arrhythmia, embolization of guidewire fragments, intravascular clipping of the guidewire and vascular perforation. However, there are still no guidelines on removal and management of IAFB. Here, we present a rare case of fractured cerebral angiographic guidewires in the aorta that resulted in multiple cerebral infarctions. Case presentation A 50-year-old man experienced new cerebral infarction after cerebral angiography. Computed tomography and echocardiography demonstrated foreign bodies in his ascending aorta and aortic arch. Open surgery was successfully performed to retrieve the guidewires. The postoperation and follow-up was uneventful. Conclusion It is very important for interventional radiologists to check the catheter and guidewire after operation and perform ultrasound or radiograph to prevent IAFB. Additionally, the effective management of IAFB requires the early detection and the selection of appropriate treatment options, as well as long-time follow up.

scholarly journals Open Surgery Retrieval Of A Missing Guidewire Causing Cerebral Infarctions After Cerebral Angiography: A Case Report

2021 ◽  
Author(s):  
Chaodi Luo ◽  
Jing Li ◽  
Yang Yan ◽  
Dan Han
Keyword(s):  
Cerebral Angiography ◽  
Open Surgery ◽  
Guide Wire ◽  
Treatment Options ◽  
Case Presentation ◽  
Appropriate Treatment ◽  
Long Time ◽  
Multiple Cerebral Infarctions ◽  
Selection Of

Abstract Background: Intra-aortic foreign body (IAFB) is uncommon, which is usually caused by a rupture of the catheter or guidewire. IAFB can cause catastrophic complications, including arrhythmia, embolization of guide wire fragments, intravascular clipping of the guide wire and vascular perforation. However, there are still no guidelines on removal and management of IAFB. Here, we present a rare case of fractured cerebral angiographic guidewires in the aorta that resulted in multiple cerebral infarctions.Case presentation: A 50-year-old man experienced new cerebral infarction after cerebral angiography. Computed tomography and echocardiography demonstrated foreign bodies in his ascending aorta and aortic arch. Open surgery was successfully performed to retrieve the guidewires. The postoperation and follow-up was uneventful.Conclusion: It is very important for interventional radiologists to check the catheter and guidewire after operation and perform ultrasound or radiograph to prevent IAFB. Additionally, the effective management of IAFB requires the early detection and the selection of appropriate treatment options, as well as long-time follow up.

scholarly journals Selection of treatment for hepatic epithelioid hemangioendothelioma: a single-center experience

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Linping Cao ◽  
Jiawei Hong ◽  
Lingfeng Zhou ◽  
Yufu Ye ◽  
Yuanxing Liu ◽  
...  
Keyword(s):  
Treatment Options ◽  
Needle Aspiration ◽  
Epithelioid Hemangioendothelioma ◽  
Multiple Strategies ◽  
Single Center Experience ◽  
Appropriate Treatment ◽  
Significant Disease ◽  
Selection Of ◽  
Observation Period

Abstract Background Hepatic epithelioid hemangioendothelioma (HEHE) is a rare angiogenic tumor with no recognized effective treatment. Treatment options used worldwide include liver transplantation (LT), liver resection (LR), radiofrequency ablation (RFA), chemotherapy, and observation. The aim of this study was to describe the efficacy of different treatment options used for HEHE at our center. Methods The medical charts of 12 patients with HEHE (9 women and 3 men) who were diagnosed and treated at the First Affiliated Hospital of Zhejiang University, China, between January 2011 and December 2017 were retrospectively reviewed. Results The patients were diagnosed by postoperative histopathology or fine needle aspiration biopsy. Two patients with diffuse lesions received LT and were alive without recurrence at the last follow-up. Three patients received LR as the initial treatment, and all of them developed recurrence during the follow-up period. One patient received RFA and remained free of disease, while the remaining six patients opted for simple observation rather than treatment. One of the patients who received LR passed away because of tumor recurrence within 32 months after surgery; the other patients showed no significant disease activity after treatments for their recurrent lesions. As of April 2018, the mean follow-up duration was 39.6 ± 20.1 months (15–82 months). Conclusions There are multiple strategies for HEHE. Considering its indolent course, initial observation for assessment of the lesion behavior may aid in the selection of appropriate treatment. Surgery or LT is suitable for patients with disease progression during the observation period. However, our sample size was small, and further studies are required to gather more information that can aid in optimal treatment selection.

scholarly journals A Rare Case of Urinary Tract Fungal Ball Leading to Fungemia and Bilateral Chorioretinitis

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Christopher Ferari ◽  
Chad Crigger ◽  
Chad Morley ◽  
David Duchene
Keyword(s):  
Urinary Tract ◽  
Type Ii Diabetes ◽  
Rare Complication ◽  
Obstructive Uropathy ◽  
Treatment Options ◽  
Type Ii ◽  
Invasive Treatment ◽  
Case Presentation ◽  
Fungal Ball

Background. Fungemia due to obstructive urinary tract fungal ball is exceedingly rare. These patients often have multiple predisposing conditions, including diabetes or antimicrobial exposure. While candiduria can be relatively common in this population, urinary tract fungal balls are a rare entity. Hospitalists should be aware of this rare complication in patients presenting with funguria. Case Presentation. We present a case of a 44-year-old male with type II diabetes, chronic hepatitis C secondary to injection drug use, and chronic kidney disease who developed a urinary tract fungal ball leading to fungemia and subsequent bilateral chorioretinitis, additionally complicated by emphysematous cystitis and pyelonephritis. Additional invasive treatment options beyond typical antifungals are often required in the case of urinary tract fungal ball, and in this case, bilateral nephrostomy tubes and micafungin were employed. Hospital course was complicated by C. tropicalis fungemia with subsequent bilateral fungal chorioretinitis on dilated fundus exam. This was effectively treated with cyclogyl and prednisolone drops along with bilateral voriconazole injections. Follow-up imaging and cultures showed resolution of fungemia, urinary tract masses, and chorioretinal infiltrates; however, recurrent polymicrobial UTIs continue to be an issue for this patient. Conclusions. Special multidisciplinary management is required in the treatment of urinary tract fungal balls with subsequent fungemia, including nephrostomy tubes, antifungal irrigation, ureterorenoscopy, and more powerful antifungals such as amphotericin B and 5-flucytosine. This management draws from a myriad of specialties, including urology, infectious disease, and interventional radiology. Additionally, the literature has demonstrated that only approximately half of patients with fungemia receive an ophthalmologic evaluation. Ophthalmologic and urologic cooperation is essential in the case of obstructive uropathy leading to fungemia as the obstructive uropathy must be relieved and these patients should receive a dilated fundus exam.

scholarly journals Infection-provoked reversible posterior leukoencephalopathy syndrome in an adult with nephrotic syndrome: a case report

BMC Neurology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Kuan-Ying Li ◽  
Ching-Fang Chien ◽  
Chin-Ling Tsai ◽  
Huang-Chi Chen ◽  
Meng-Ni Wu ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Altered Mental Status ◽  
Reversible Posterior Leukoencephalopathy Syndrome ◽  
Asian Woman ◽  
Case Presentation ◽  
Reversible Posterior Leukoencephalopathy ◽  
Posterior Leukoencephalopathy ◽  
Appropriate Treatment ◽  
Visual Disturbances

Abstract Background Reversible posterior leukoencephalopathy syndrome (RPLS) is a rare and heterogeneous clinico-neuroradiological syndrome characterized by headache, altered mental status, seizures, and visual disturbances. Hypertension and immunosuppression are two of the main factors that predispose an individual to RPLS. However, RPLS can develop when no major risk factors are present. RPLS has been reported in pediatric nephrotic patients, but rarely in adults. Case presentation A 42-year-old Asian woman with nephrotic syndrome presented with seizures, headaches, and nausea. Her blood pressure was controlled, and no immunosuppressants had been prescribed. All symptoms and tests indicated RPLS following infection with pneumonia, which was successfully treated by immediate administration antibiotic and anti-epileptic medications. Seizures did not recur during a 2-year follow-up period. Conclusions When patients with nephrotic syndrome have an infection, RPLS symptoms should be investigated thoroughly. With early diagnosis and appropriate treatment of RPLS, morbidity and mortality can be prevented.

scholarly journals Metal Foreign Bodies Have Been in the Lungs for Five Years: a Case Report

2021 ◽  
Author(s):  
Yuan Li ◽  
Zhong Li ◽  
Jun-Cai Liu
Keyword(s):  
Foreign Body ◽  
Pulmonary Artery ◽  
Foreign Bodies ◽  
Treatment Plan ◽  
High Density ◽  
Surgical Removal ◽  
Metallic Foreign Body ◽  
Case Presentation ◽  
Appropriate Treatment ◽  
Limb Trauma

Abstract Background: Metallic foreign body migration into the pulmonary artery after limb trauma is extremely rare. If not treated in time, the patient may die. The metallic foreign body was implanted from the thigh into the pulmonary artery and remained for 5 years. It has never been reported in limb trauma.Case Presentation: The patient was a 51-year-old male who had a small metal foreign body embedded in the middle and lower left thigh due to trauma. The foreign body was not found during emergency debridement operation. During the operation, a full-body X-ray was used to reveal a high-density shadow in the left upper lung. The 3D-CT of the chest immediately confirmed that the high-density shadow was a small iron foreign body, and the iron fragment foreign body was present in the pulmonary artery branch, but no abnormal symptoms were observed. He was hospitalized for observation for 3 days without obvious discomfort and refused to open his chest. The patient then decided to leave the hospital voluntarily.Conclusion: Surgical removal of all foreign bodies traveling to the pulmonary artery is not necessary, and the most appropriate treatment plan should be made considering the location of the foreign body, the patient's wishes and the general condition.

scholarly journals A Case of Brachial Artery Thrombosis Caused by Massage of an Occluded Arteriovenous Graft

2021 ◽  
Vol 1 (1) ◽  
pp. 74-78
Author(s):  
Taisuke Matsue ◽  
Yoshikazu Kuroki ◽  
Toshihide Naganuma ◽  
Yoshiaki Takemoto ◽  
Junji Uchida
Keyword(s):  
Vascular Access ◽  
Brachial Artery ◽  
Surgical Intervention ◽  
Treatment Options ◽  
Limb Ischemia ◽  
Vascular Wall ◽  
Arteriovenous Graft ◽  
Case Presentation ◽  
Artery Thrombosis ◽  
Appropriate Treatment

Background: Acute upper limb ischemia (AULI) is a potential complication associated with massages of occluded vascular accesses in patients undergoing hemodialysis. Pharmacological thrombolysis, endovascular intervention and surgical intervention are possible treatment options. Deciding the appropriate treatment strategy is still a controversial issue. Case Presentation: The patient was a 43-year-old woman with renal failure who underwent hemodialysis and peritoneal dialysis. She was found to have an arteriovenous graft (AVG) thrombosis at the start of a hemodialysis session. She underwent massage of the vascular access, and immediately after the massage, she reported pain and cyanosis in her right-hand fingers and was referred to our hospital. Duplex ultrasonography revealed a large number of thrombi in the brachial, radial and ulnar arteries. AULI due to brachial artery thrombosis was diagnosed and surgical intervention was performed on the same day. The vascular wall of the forearm artery was incised vertically against the running vessel and thrombi around the bifurcation of the radial and ulnar arteries were removed. Angiography guided-surgical intervention was performed and improvement in blood flow was achieved. The patient was discharged on the second day after the operation. Conclusion: Surgical intervention has been reported as an effective treatment of AULI due to brachial artery thrombosis after massage of an occluded vascular access.

scholarly journals A Solitary Giant Neurofibroma of Inguinal Region—A Case Report

2020 ◽  
Author(s):  
Haiying Zhou ◽  
Hui Lu
Keyword(s):  
Tumor Resection ◽  
Clinical Manifestations ◽  
Inguinal Region ◽  
Case Presentation ◽  
Neurogenic Tumors ◽  
Long Time ◽  
Giant Neurofibroma ◽  
History Of ◽  
Recurrence Tendency

Abstract Background:Neurofibroma is a rare nerve sheath tumorofneuroectodermal origin, especially the huge and isolated neurofibroma located in the inguinal region. To our knowledge, no such case has previously been reported.Case presentation:We report a case of 34-year-old male patient with a 4-year history of progressive enlargement of the medial root mass in his left thigh with sitting and standing disorders along with pain. The tumor was completely removed by operation, and pathological diagnosisshowed neurofibroma. There was no obvious neurologic defect after surgery, and no recurrence tendency was found in the follow-up of 2years.Conclusions:For a large solitary mass with slow growth and no malignant clinical manifestations for a long time, clinicians can not rule out the hypothetical diagnosis of neurofibroma, even though its growth site is very rare, such as this case of a huge tumor located in the groin. For neurogenic tumors, early operation should be performed, and the prognosis of patients after tumor resection isexcellent.

scholarly journals Pyogenic brain abscess

2008 ◽  
Vol 24 (6) ◽  
pp. E2 ◽  
Author(s):  
Ersin Erdoğan ◽  
Tufan Cansever
Keyword(s):  
Treatment Options ◽  
Neurological Status ◽  
Diagnostic Techniques ◽  
Diagnosis And Treatment ◽  
Appropriate Treatment ◽  
Significant Difference ◽  
Immunodeficiency Virus ◽  
Brain Abscesses ◽  
Lower Morbidity

✓ Brain abscesses have been one of the most challenging lesions, both for surgeons and internists. From the beginning of the computed tomography (CT) era, the diagnosis and treatment of these entities have become easier and less invasive. The outcomes have become better with the improvement of diagnostic techniques, neurosurgery, and broad-spectrum antibiotics. Atypical bacterial abscesses are more often due to chemotherapy usage in oncology, long life expectancy in patients with human immunodeficiency virus (HIV) infection, and immunosuppression in conjunction with organ transplantation. Surgical treatment options showed no significant difference with respect to mortality levels, but lower morbidity rates were achieved with stereotactically guided aspiration. Decompression with stereotactically guided aspiration, antibiotic therapy based on results of pus culture, and repeated aspirations if indicated from results of periodic CT follow-up scans seem to be the most appropriate treatment modality for brain abscesses. Immunosuppression and comorbidities, initial neurological status, and intraventricular rupture were significant factors influencing the outcomes of patients. The pitfalls and evolution in the diagnosis and treatment of brain abscesses are discussed in this study.

After the Dance is over: Some Issues and Suggestions for Follow-up Assessment in Behavior Therapy

1977 ◽  
Vol 41 (3_suppl) ◽  
pp. 1287-1308 ◽  
Author(s):  
Eric J. Mash ◽  
Leif G. Terdal
Keyword(s):  
Behavior Therapy ◽  
Intervention Programs ◽  
Long Term Effects ◽  
Long Time ◽  
Time Periods ◽  
Research Recommendations ◽  
Selection Of

Behavioral intervention programs have thus far failed to provide sufficient follow-up information for the evaluation of long-term effects. This omission is believed to be related to an inadequate conceptualization of follow-up assessment, as well as to the methodological and practical difficulties inherent in assessing behavior over long time periods. A framework for follow-up assessment that is consistent with current behavioral efforts to program generalization is described and is contrasted with traditional views of follow-up that look for effects following the termination of treatment. Several methodological features of follow-up assessment are discussed, along with research recommendations, including the determination of length of appropriate follow-up intervals, the frequency of follow-up assessments, the need for standardization of measures both within and between studies, reactivity of follow-up assessment, the selection of follow-up measures and attrition of subjects.

Selective Carpus Denervation – One of Treatment Options of Madelung Deformity

2019 ◽  
Vol 158 (05) ◽  
pp. 497-500
Author(s):  
Jaroslav Pilny ◽  
Roman Slodicka ◽  
Petr Hajek ◽  
Katerina Horackova
Keyword(s):  
Female Patient ◽  
Treatment Options ◽  
Pain Reduction ◽  
Case Presentation ◽  
Madelung Deformity ◽  
Causal Treatment ◽  
Wrist Denervation

AbstractCase presentation of 7 years follow up of female patient with wrist arthritis caused by Madelung deformity. As causal treatment remains unknown, the pain reduction by means of selective wrist denervation is one possible option.

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