scholarly journals Sudden perceived absence of foetal movement – a unique presentation of a vertebral haemangioma in pregnancy

2021 ◽  
Author(s):  
Ankitha Devaraj ◽  
Jamaal Raoof ◽  
Osman Janjua ◽  
Kevin Tsang ◽  
Muhammad Zamir
Keyword(s):  
Multidisciplinary Approach ◽  
Surgical Intervention ◽  
Pregnant Patient ◽  
Cord Compression ◽  
Mri Scan ◽  
Posterior Decompression ◽  
Vertebral Haemangioma ◽  
Apparent Loss ◽  
Foetal Movement ◽  
Operative Recovery

Objective: Symptomatic vertebral haemangiomas that present during pregnancy are extremely uncommon with few cases reported in literature. Epidural haemangiomas are rarer still with few documented. Methods: In this report, we describe the case of a 22-year-old pregnant patient who presented with apparent loss of foetal movement at 38 weeks’ gestation. Clinical review demonstrated the foetus was well but neurological examination revealed lower limb paresthesia, paresis, and evident uterine hypoesthesia. An MRI scan illustrated a haemangioma in the T1 vertebral body with an epidural component causing cord compression. Results: The management of spinal haemangiomas that present during pregnancy is a complex clinical scenario which requires careful multidisciplinary consideration to determine if surgical intervention is appropriate. In this case, the patient had an emergency caesarean section followed by posterior decompression and laminectomy of the T1 vertebra with excellent post-operative recovery. Conclusion: Gestational increase in the size of vertebral haemangiomas is well documented. We discuss a rare case in which a young pregnant patient presents with an atypical symptom of a vertebral haemangioma (uterine hypoesthesia). This case highlights the importance of prompt imaging in these scenarios and a cohesive multidisciplinary approach in order to provide optimal treatment for the patient.

Management of prolonged epistaxis in pregnancy: case report

2013 ◽  
Vol 127 (8) ◽  
pp. 811-813 ◽  
Author(s):  
K Cornthwaite ◽  
K Varadharajan ◽  
M Oyarzabal ◽  
H Watson
Keyword(s):  
Case Report ◽  
Multidisciplinary Approach ◽  
Surgical Intervention ◽  
Pregnant Patient ◽  
Evidence Based ◽  
Second Trimester ◽  
Severe Epistaxis ◽  
Life Threatening ◽  
Evidence Based Guidelines ◽  
In Pregnancy

AbstractObjectives:To report a case of life-threatening epistaxis in a pregnant patient, describe the links between pregnancy and epistaxis, and discuss the management of such cases. Life-threatening epistaxis in pregnancy is rare, and there are no specific evidence-based guidelines regarding the management of these patients.Case report:A 31-year-old primigravida presented with severe epistaxis in the second trimester of her pregnancy. Conservative measures failed, thereby necessitating surgical intervention.Conclusion:This case illustrates the importance of a multidisciplinary approach in the management of a pregnant patient presenting with severe epistaxis, and highlights the surgical challenges presented in such a situation.

scholarly journals Ulna Autograft for Wrist Arthrodesis: A Novel Approach in Failed Wrist Arthoplasty

2017 ◽  
Vol 11 (1) ◽  
pp. 768-776 ◽  
Author(s):  
Nastaran Sargazi ◽  
M. Philpott ◽  
A. Malik ◽  
M. Waseem
Keyword(s):  
Multidisciplinary Approach ◽  
Surgical Intervention ◽  
Salvage Surgery ◽  
Wrist Arthrodesis ◽  
Novel Approach ◽  
Total Wrist Arthroplasty ◽  
Stage Disease ◽  
Wrist Function ◽  
End Stage ◽  
Wrist Arthroplasty

Rheumatoid arthritis is a polyarthropathy affecting approximately 1% of the population worldwide. Wrist involvement is observed around 75% of patients, resulting in substantial disability and morbidity. A multidisciplinary approach to management of such patients is undertaken to prevent disease progression, many go on to develop debilitating disease requiring surgical intervention. Total wrist arthroplasty and arthrodesis are the main options available for those with end-stage disease, with arthroplasty preferred due to its ability to preserve a good degree of wrist function. Where complications occur with total wrist arthroplasty, salvage surgery with arthrodesis can be considered, however this requires satisfactory bone stock to enable stable fusion of the joint following arthroplasty. We report our experience of Ulna strut allografts in wrist arthrodesis in the management of failed total wrist arthroplasty.

(Un) conventional complicated pancreatitis

2021 ◽  
Vol 75 (1) ◽  
pp. 61-67
Author(s):  
Michal Rybár ◽  
Ivo Horný
Keyword(s):  
Acute Pancreatitis ◽  
Multidisciplinary Approach ◽  
Pancreatic Necrosis ◽  
Surgical Intervention ◽  
Secondary Infection ◽  
Abdominal Ultrasound ◽  
Stent Migration ◽  
Endoscopic Extraction ◽  
Threatening Condition ◽  
Life Threatening

Acute pancreatitis is sudden inflammatory disease of pancreas, which can vary from a mild form to severe life threatening condition. The management of pancreatitis usually consists of intensive care and multidisciplinary approach, often including surgical intervention or digestive endoscopy. In this article, we present a 68-year-old female with recidivous acute pancreatitis who underwent a series of endoscopic examinations and at the end also an unusual surgical intervention due to numerous complications. At first, it seemed that there was an idiopatic etiology because neither an anamnesis of alcohol consumption nor metabolic risks or CT signs of cholelithiasis were found. The condition was complicated by the development of acute necrotic collection, gastrointestinal bleeding and development of walled-off pancreatic necrosis (WOPN). Later, the biliary etiology was revealed after cholecystolithiasis was found on abdominal ultrasound. The WOPN was endoscopically drained because of the local compression syndrome. After the drainage, we noticed two cases of stent migration and the secondary infection of the WOPN. At the end, the migrated stents caused transient bowel obstruction and were stuck in the distal ileum. After three unsuccessful attempts to endoscopic extraction, the condition was solved by surgical intervention and double enterotomy was performed. The postoperative care was not easy anyway, being complicated by the dehiscence of the surgical wound with the need of opening the wound and use the VAC system to heal it up.

Motor network recovery in patients with chronic spinal cord compression: a longitudinal study following decompression surgery

2018 ◽  
Vol 28 (4) ◽  
pp. 379-388 ◽  
Author(s):  
Kayla Ryan ◽  
Sandy Goncalves ◽  
Robert Bartha ◽  
Neil Duggal
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Surgical Intervention ◽  
Blood Oxygen Level Dependent ◽  
Cord Compression ◽  
Decompression Surgery ◽  
Blood Oxygen Level ◽  
Motor Network ◽  
Dependent Signal

OBJECTIVEThe authors used functional MRI to assess cortical reorganization of the motor network after chronic spinal cord compression and to characterize the plasticity that occurs following surgical intervention.METHODSA 3-T MRI scanner was used to acquire functional images of the brain in 22 patients with reversible cervical spinal cord compression and 10 control subjects. Controls performed a finger-tapping task on 3 different occasions (baseline, 6-week follow-up, and 6-month follow-up), whereas patients performed the identical task before surgery and again 6 weeks and 6 months after spinal decompression surgery.RESULTSAfter surgical intervention, an increased percentage blood oxygen level–dependent signal and volume of activation was observed within the contralateral and ipsilateral motor network. The volume of activation of the contralateral primary motor cortex was associated with functional measures both at baseline (r = 0.55, p < 0.01) and 6 months after surgery (r = 0.55, p < 0.01). The percentage blood oxygen level–dependent signal of the ipsilateral supplementary motor area 6 months after surgery was associated with increased function 6 months after surgery (r = 0.48, p < 0.01).CONCLUSIONSPlasticity of the contralateral and ipsilateral motor network plays complementary roles in maintaining neurological function in patients with spinal cord compression and may be critical in the recovery phase following surgery.

scholarly journals Laparoendoscopic Transgastric Resection of Prepyloric Gastrointestinal Stromal Tumor

2019 ◽  
Vol 14 (1) ◽  
pp. 66-68 ◽  
Author(s):  
Nandita Nettu Mahajan ◽  
Sajan Jiv Singh Nagpal ◽  
Louis M. Wong Kee Song ◽  
Shanda H. Blackmon
Keyword(s):  
Case Report ◽  
Surgical Technique ◽  
Gastrointestinal Stromal Tumor ◽  
Multidisciplinary Approach ◽  
Surgical Intervention ◽  
Optimal Treatment ◽  
Stromal Tumor ◽  
Successful Outcome ◽  
Diagnostic Studies ◽  
Coffee Ground

This case report describes an 83-year-old woman with multiple comorbidities who presented with melena and coffee-ground emesis with diagnostic studies evident for a large prepyloric gastrointestinal stromal tumor. She underwent combined laparoendoscopic transgastric resection surgery for the tumor, performed by a team of gastroenterologist and thoracic surgeon with a successful outcome. The case and videos in this report provide a descriptive demonstration of the steps leading up to the surgical intervention followed by a step-by-step illustration of the combined surgical technique, thus highlighting the importance of multidisciplinary approach for optimal treatment of prepyloric gastrointestinal stromal tumor.

scholarly journals A Clinical Practice Guideline for the Management of Patients With Degenerative Cervical Myelopathy: Recommendations for Patients With Mild, Moderate, and Severe Disease and Nonmyelopathic Patients With Evidence of Cord Compression

2017 ◽  
Vol 7 (3_suppl) ◽  
pp. 70S-83S ◽  
Author(s):  
Michael G. Fehlings ◽  
Lindsay A. Tetreault ◽  
K. Daniel Riew ◽  
James W. Middleton ◽  
Bizhan Aarabi ◽  
...  
Keyword(s):  
Cervical Myelopathy ◽  
Surgical Intervention ◽  
Guideline Development ◽  
Cord Compression ◽  
Operative Intervention ◽  
Prophylactic Surgery ◽  
Cervical Cord ◽  
Duration Of Symptoms ◽  
Degenerative Cervical Myelopathy ◽  
The Impact

Study Design: Guideline development. Objectives: The objective of this study is to develop guidelines that outline how to best manage (1) patients with mild, moderate, and severe myelopathy and (2) nonmyelopathic patients with evidence of cord compression with or without clinical symptoms of radiculopathy. Methods: Five systematic reviews of the literature were conducted to synthesize evidence on disease natural history; risk factors of disease progression; the efficacy, effectiveness, and safety of nonoperative and surgical management; the impact of preoperative duration of symptoms and myelopathy severity on treatment outcomes; and the frequency, timing, and predictors of symptom development. A multidisciplinary guideline development group used this information, and their clinical expertise, to develop recommendations for the management of degenerative cervical myelopathy (DCM). Results: Our recommendations were as follows: (1) “We recommend surgical intervention for patients with moderate and severe DCM.” (2) “We suggest offering surgical intervention or a supervised trial of structured rehabilitation for patients with mild DCM. If initial nonoperative management is pursued, we recommend operative intervention if there is neurological deterioration and suggest operative intervention if the patient fails to improve.” (3) “We suggest not offering prophylactic surgery for non-myelopathic patients with evidence of cervical cord compression without signs or symptoms of radiculopathy. We suggest that these patients be counseled as to potential risks of progression, educated about relevant signs and symptoms of myelopathy, and be followed clinically.” (4) “Non-myelopathic patients with cord compression and clinical evidence of radiculopathy with or without electrophysiological confirmation are at a higher risk of developing myelopathy and should be counselled about this risk. We suggest offering either surgical intervention or nonoperative treatment consisting of close serial follow-up or a supervised trial of structured rehabilitation. In the event of myelopathic development, the patient should be managed according to the recommendations above.” Conclusions: These guidelines will promote standardization of care for patients with DCM, decrease the heterogeneity of management strategies and encourage clinicians to make evidence-informed decisions.

Conservative management of cavernous sinus cavernous hemangioma in pregnancy

2014 ◽  
Vol 120 (6) ◽  
pp. 1309-1312 ◽  
Author(s):  
Jessica S. Haber ◽  
Kartik Kesavabhotla ◽  
Malte Ottenhausen ◽  
Imithri Bodhinayake ◽  
Marc J. Dinkin ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Cavernous Hemangioma ◽  
Surgical Intervention ◽  
Pregnant Patient ◽  
Mass Effect ◽  
Lesion Size ◽  
Nonsurgical Management ◽  
Postpartum Involution ◽  
Cavernous Hemangiomas ◽  
In Pregnancy

Cavernous sinus cavernous hemangiomas in pregnancy are extremely rare lesions. The precise management of these lesions remains unknown. The authors present a case of a cavernous hemangioma in pregnancy, centered within the cavernous sinus that underwent postpartum involution without surgical intervention. A 34-year-old pregnant patient (gravida 1, para 0) presented to an otolaryngologist with persistent headache and left-sided facial pain and numbness in the V1 distribution. While being treated for sinusitis, her symptoms progressed to include a left-sided oculomotor palsy and abducens palsy. Magnetic resonance imaging without contrast revealed an expansile mass within the left cavernous sinus consistent with a cavernous hemangioma. The patient was evaluated by a neurosurgeon who recommended close follow-up and postpartum imaging without surgical intervention. Although the lesion enlarged during pregnancy, the patient was able to undergo an uncomplicated cesarean section at 37 weeks. All facial and ocular symptoms resolved by 9 months postpartum, and MRI showed a decrease in lesion size and reduced mass effect. The authors conclude that nonsurgical management may be a viable approach in patients who have an onset or exacerbation of symptoms associated with cavernous sinus cavernous hemangiomas during pregnancy because postpartum involution may negate the need for surgical intervention.

scholarly journals Spondylodiscitis Caused by Aspergillus Species

Diagnostics ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. 1899
Author(s):  
Christos Koutserimpas ◽  
Ifigeneia Chamakioti ◽  
Symeon Naoum ◽  
Konstantinos Raptis ◽  
Kalliopi Alpantaki ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Multidisciplinary Approach ◽  
Surgical Intervention ◽  
Treatment Options ◽  
Standard Of Care ◽  
Clinical Challenge ◽  
Life Threatening ◽  
The Mean ◽  
Magnetic Resonance Imaging Mri ◽  
Mean Time

Background: Spondylodiscitis caused by Aspergillus spp. is a rare but life-threatening clinical entity. However, a consensus on diagnostic criteria and most effective medical management is still missing. The present study is a review of all published cases of spondylodiscitis caused by Aspergillus spp., in an effort to elucidate epidemiology, patients’ characteristics, andand the medical and surgical treatment options and their effectiveness. Methods: A thorough review of all existing spondylodiscitis cases caused by Aspergillus was performed. Data regarding demographics, responsible fungus, time between symptoms’ onset and firm diagnosis, antifungal treatment (AFT), surgical intervention, andand the infection’s outcome were investigated. Results: A total of 118 Aspergillus spondylodiscitis cases, yielding 119 Aspergillus spp. isolates, were identified in the literature. The patients’ mean age was 40.6 years. Magnetic resonance imaging (MRI) (after its introduction) indicated the diagnosis in most cases (66.7%), while definite diagnosis was established through cultures in the majority of cases (73.7%). Aspergillus fumigatus was isolated in most cases (73; 61.3%), followed by Aspergillus flavus (15; 12.6%) andand Aspergillus nidulans and terreus (7; 5.9%, each). The mean time between symptoms’ onset and diagnosis was 5.7 months. Amphotericin B was the preferred antifungal regiment (84 cases; 71.2%), followed by voriconazole (31; 26.3%), and the mean AFT duration was 6.1 months. The final outcome was successful in 93 cases (78.8%). Furthermore, 77 patients (65.3%) underwent surgery. Conclusions: Spondylodiscitis caused by Aspergillus spp. represents a clinical challenge, requiring a multidisciplinary approach. The present review has shown that prolonged AFT has been the standard of care of the studied cases, while surgical treatment seems to play an important role in selected patents.

scholarly journals Primary Typical Carcinoid of The Pleura, A Rare Incidental Finding

2019 ◽  
pp. 1-3
Author(s):  
Anupama Sharma ◽  
Diane Strollo ◽  
Ernest G. Chan ◽  
James D. Luketich ◽  
Lawrence Crist ◽  
...  
Keyword(s):  
Multidisciplinary Approach ◽  
Surgical Intervention ◽  
Incidental Finding ◽  
Lung Parenchyma ◽  
Thoracic Cavity ◽  
Imaging Studies ◽  
Talc Pleurodesis ◽  
Typical Carcinoid ◽  
Well Differentiated ◽  
Partial Pleurectomy

Roughly 30% of carcinoids are found in the thoracic cavity, with the overwhelming majority of these being found in the lung parenchyma. We present a case of a rarely found primary pleural carcinoid incidentally diagnosed in a 73 year old male who presented with recalcitrant spontaneous pneumothorax requiring surgical intervention. The patient was taken to the operating room for a right video assisted thoracic surgery, partial pleurectomy, and talc pleurodesis. At the time of the operation, there were no abnormalities noted in the pleura or chest wall, and the patient did well post operatively. Pathologic examination of the pleura revealed a 3mm well differentiated neuroendocrine carcinoid tumor. Laboratory and imaging studies did not indicate another site of tumor. The importance of a multidisciplinary approach to the diagnosis, treatment, and surveillance is emphasized.

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