scholarly journals In situ reconstruction of an MRSA-infected paravisceral aortic pseudoaneurysm with cryopreserved aortic allograft

2019 ◽  
Vol 11 (2) ◽  
pp. 122-124
Author(s):  
Peter Banga ◽  
Peter Legeza ◽  
Zoltán Szeberin
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Prosthetic Graft ◽  
Celiac Artery ◽  
Medical Documentation ◽  
Surgical Interventions ◽  
Aortic Pseudoaneurysm ◽  
Aortic Allograft ◽  
Aortic Replacement

Objectives Treatment of paravisceral aortic infections poses several challenges because standard therapy with excision of all infected tissues and extraanatomic reconstruction is frequently not possible without jeopardizing visceral perfusion. In situ reconstruction with rifampin-soaked prosthetic graft or endovascular repair with stent grafts runs the risk of reinfection. We present a case of a paravisceral aortic infection, where cryopreserved allograft was used for the reconstruction of the aorta. Methods Medical documentation and CT angiography studies were retrospectively reviewed for a patient in a tertiary care center. Results A 62-year-old male patient presented with an infected pseudoaneurysm of the paravisceral aorta at the level of the celiac artery. He had previously undergone multiple orthopedic surgical interventions and developed methicillin-resistant Staphylococcus aureus infections. We successfully repaired the paravisceral pseudoaneurysm with excision of all infected tissues and in situ aortic replacement with a cryopreserved allograft. Conclusion In case of infected aortic pseudoaneurysm, the use of cryopreserved aortic allograft is a reliable choice for reconstruction of the aorta.

scholarly journals An infant with 49XXXXY syndrome: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
N. P. G. C. R. Naotunna ◽  
C. Liyanage ◽  
N. Atapattu
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Chromosome Analysis ◽  
Dehydroepiandrosterone Sulfate ◽  
Ambiguous Genitalia ◽  
Normal Vaginal Delivery ◽  
Sri Lankan ◽  
Pediatric Endocrinology ◽  
First Child

Abstract Background 49XXXXY syndrome is the rarest X chromosome aneuploidy, with approximate incidence of 1:85,000–100,000 male births. Worldwide, around 100 cases have been reported. In this report, we describe one such case seen in Sri Lanka. Case presentation A 10-day-old Sri Lankan neonate born in a tertiary care center was referred to the pediatric endocrinology unit of Lady Ridgeway Hospital due to detection of ambiguous genitalia at birth. He was the first child born to nonconsanguineous healthy parents following an uncomplicated antenatal period. He was born at term via normal vaginal delivery, with a birth weight of 2.385 kg. The baby was active, and there was no documented hypoglycemia or alteration in basic biochemical investigations. On examination, the child had hypertelorism, upslanting palpebral fissures, flat occiput, and mild webbing of the neck. System examination was normal. Genitalia examination revealed bifid scrotum, perineal urethra, 2 cm phallus, and bilateral testis in situ. Hormonal analysis, including dehydroepiandrosterone sulfate, testosterone, and 17-OH progesterone levels, was normal except for an elevated level of follicle-stimulating hormone, indicating gonadal dysgenesis. Ultrasound of the abdomen detected testis located at bilateral inguinal canal, and no Müllerian structures were visible. Echocardiography showed a small patent foramen ovale with otherwise normal heart. Chromosome analysis revealed 49XXXXY syndrome. Conclusion 49XXXXY syndrome should be entertained as a rare possibility for ambiguous genitalia, and karyotyping is an essential investigation for evaluation of such patients.

Voice and Swallowing Dysfunction in Neurofibromatosis 2

2017 ◽  
Vol 158 (3) ◽  
pp. 505-510 ◽  
Author(s):  
Simon R. Best ◽  
Julie Ahn ◽  
Shannon Langmead ◽  
Vaninder Dhillon ◽  
Alexander T. Hillel ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Care Center ◽  
Tertiary Care ◽  
Surgical Excision ◽  
Velopharyngeal Insufficiency ◽  
Neurofibromatosis 2 ◽  
Cross Sectional ◽  
Surgical Interventions ◽  
Swallowing Dysfunction

Objective Neurofibromatosis 2 (NF2) is a neuro-oncologic condition that presents with bilateral vestibular schwannomas of the cerebellopontine angle (CPA). Voice and swallowing impairment can occur from direct involvement or compression of the vagus nerve or as the result of surgical excision of CPA tumors. The objectives in this study are to (1) assess the prevalence of voice and swallowing impairments and (2) analyze the effects of vagal dysfunction in patients with NF2. Study Design Cross-sectional. Setting Academic tertiary care center. Subjects and Methods Patients at a neurofibromatosis center were mailed Voice Handicap Index and Sydney Swallow Questionnaire surveys. Stroboscopic, voice, and swallowing evaluations were performed for patients who elected to participate in screening exams. Results There were high rates of self-assessed and objective voice and swallowing handicaps in this population. Fourteen of 40 (35%) patients had a self-assessed voice handicap, and 20 of 40 (50%) patients had a self-assessed swallow handicap. Vocal fold motion impairment (VFMI) was observed in 22 of 31 (71%) patients examined, with 27 of 62 (44%) possible vocal cords affected. Velopharyngeal insufficiency (45%) and piriform sinus pooling or residue (39%) were seen in a significant percentage of patients. There was a significant relationship between vocal cord motion impairment and CPA surgical intervention ipsilateral to the impairment ( P = .002). The presence of VFMI was strongly associated with voice ( P = .002) and swallowing ( P = .01) impact on quality of life. Conclusion Speech and swallowing impairments are highly prevalent in patients with NF2, cause significant impact on quality of life, and are most commonly related to surgical interventions in the CPA region.

scholarly journals Management of Diabetic Foot Ulcer in a Tertiary Level Hospital-Faridpur

2019 ◽  
Vol 34 (1) ◽  
pp. 52-57
Author(s):  
AL Gaddafi ◽  
DK Das ◽  
G Faruque ◽  
Z Islam ◽  
MA Rahman ◽  
...  
Keyword(s):  
Blood Sugar ◽  
Diabetic Foot ◽  
Care Center ◽  
Tertiary Care ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Diabetic Patients ◽  
Cross Sectional ◽  
Surgical Interventions ◽  
Delay In Diagnosis

A descriptive type of cross sectional study among 210 diabetic patients with foot ulcer was carried out in Diabetic Association Medical College during the period of May 2016 to April 2017 and were categorized based on Meggitt-Wagner system to find out the complications, management, below knee amputation rate and mortality rate. The aim of this study was to practise a profile of diabetic foot ulcer (DFU), complications and its management to assess the outcome of the surgical interventions. Majority of the patients were male 112(53%), and most of them 116 patients (55.23%) presented within Wegner grade - 2 and grade-3 diabetic foot ulcers. The duration of diabetes more than 10 years was 116 (55%). 99 (47%) patients out of 210 patients developed diabetic neuropathy. 76 (36%) patients presented with CKD. Lack of awareness about diabetes mellitus and its lower limb complications, poor compliance to the treatment, poorly controlled blood sugar levels, delay in diagnosis, and late presentation to the tertiary care center, associated habit of smoking are all factors which lead to incidence of DFU at an earlier age than that seen in other studies. After admission of diabetic foot ulcer patients, diabetic foot ulcer is classified according to Wagner grading and treated the diabetic foot ulcer patients as the using protocol ’!1.Assesment whether it was conservative or surgical. 2. Optimal blood sugar control. 3. Systemic antibiotic. 4. Moist wound environment. 5. Offloading such as total contact casting. 6. Improves peripheral arterial circulation due to lack of vascularity. 7. Surgical debridement or minor amputation or major amputation. In case of G-4 or G-5 patients, ischemia was treated before debridement or amputation so that vascular circulation improved in the ulcer area and then healing potential was fastened. Bangladesh Heart Journal 2019; 34(1) : 52-57

scholarly journals Clinical study of post partum haemorrhage from a teaching hospital in Maharashtra, India

2017 ◽  
Vol 6 (6) ◽  
pp. 2366 ◽  
Author(s):  
Fasiha Tasneem ◽  
Shyam Sirsam ◽  
Vijayalakshmi Shanbhag
Keyword(s):  
Teaching Hospital ◽  
Postpartum Haemorrhage ◽  
Post Partum ◽  
Care Center ◽  
Tertiary Care ◽  
Morbidity And Mortality ◽  
Active Management ◽  
Surgical Interventions ◽  
Maternal Morbidity And Mortality ◽  
Post Partum Haemorrhage

Background: To study the cases of postpartum haemorrhage, their causes and management in a tertiary care centre.Methods: A retrospective study of cases of postpartum haemorrhage for a period of 3yrs was conducted in Dept. of OBGY at a rural tertiary care center and teaching hospital in Maharashtra. The major causes, management modalities, morbidity and mortality associated with it were discussed.Results: Out of 37515 deliveries over the period of 3 years (2014-2016), there were 1333 cases of PPH out of which accounted for a prevalence of 3.55%. Study showed that 86% of cases were due to atonic PPH, 9.9% due to traumatic PPH, and 0.97% were due to both atonic and traumatic PPH. 2.7% of cases were due to retained placenta, 0.07% were due to bleeding diathesis.Conclusions: In an era with availability of excellent uterotonics and active management of 3rd stage of labour even today postpartum haemorrhage stands first as the cause of maternal morbidity and mortality. Even though with excellent medical and surgical interventions, maternal mortality due to PPH has been significantly reduced, the field still needs extensive research and new modalities to prevent and manage post-partum haemorrhage.

Long-term outcomes of pediatric traumatic cataracts and retinal detachments due to self-inflicted injuries

2020 ◽  
pp. 112067212092645
Author(s):  
Tina Felfeli ◽  
Kamiar Mireskandari ◽  
Asim Ali
Keyword(s):  
Retinal Detachment ◽  
Care Center ◽  
Tertiary Care ◽  
Case Series ◽  
Long Term Outcomes ◽  
Retrospective Case ◽  
Surgical Interventions ◽  
Severe Visual Loss

Purpose To report the characteristics and longitudinal visual outcomes of traumatic cataracts and retinal detachments in children with self-inflicted injury. Methods A retrospective case series of pediatric patients at a tertiary care center who sustained ocular trauma due to self-inflicted injury between 2000 and 2014. Results A total of 11 children, all with an intellectual disability and a mean age of 10 ± 4.8 years (range, 2.8–16.2), were identified with traumatic cataract secondary to ocular self-inflicted injury over the study period. Five eyes had a concurrent unilateral retinal detachment. Over the course of follow-up, one additional eye developed a cataract and five eyes developed a retinal detachment. Patients underwent an average of 2.5 ± 2.3 procedures and 17.1 ± 10.7 eye examinations over 11.7 ± 4.2 years of follow-up; 36% required general anesthesia for examination. Visual acuity was improved or preserved in 77% of the eyes that underwent surgical interventions, but was worse in the remaining cases due to development of traumatic retinal detachment. The use of protective helmets, eye shields, and immobilizing orthoses were essential in management of active self-inflicted injury. Conclusion Traumatic cataracts and retinal detachments due to self-inflicted injury may cause severe visual loss. Visual prognosis although poor in children with severe intellectual disabilities may be optimized with risk awareness for early detection and customized interventions.

scholarly journals Immunohistochemical expression of MGMT in gliomas and its role in ascertaining patient survival

2021 ◽  
Vol 94 (3) ◽  
pp. 318-324
Author(s):  
Shristi Butta ◽  
Manoj Kumar Gupta
Keyword(s):  
Patient Survival ◽  
Care Center ◽  
Tertiary Care ◽  
Immunohistochemical Analysis ◽  
Low Grade ◽  
Common Symptom ◽  
Karnofsky Performance Score ◽  
Focal Neurological Deficit ◽  
Surgical Interventions

Introduction. MGMT (O-6-methylguanine-DNA methyl transferase) is a DNA repair enzyme with implications on chemoresistance and subsequent patient prognosis. This study investigated the association of MGMT with the various grades and subtypes of gliomas and evaluated the associated clinical outcome of these patients. Methods. This observational longitudinal follow up study spun over a period of 36 months and included 33 patients with primary glioma who underwent surgical interventions and chemoradiotherapy at a tertiary care center in Kolkata.  The surgical samples were processed and histopathologically typed. Immunohistochemical analysis was done using anti- MGMT antibody and MGMT status was determined. Patients were followed up for 3 years. Results. Males were 1.3 times more commonly affected by gliomas. Mean age was 42.9 years for females and 47.2 years for males. Frontal lobe was the most commonly involved site whereas focal neurological deficit was the most common symptom. Karnofsky performance score was higher for low grade gliomas and lower for high grade gliomas (p=0.04). Significant association was found between histopathological grade and MGMT immunoexpression (p=0.0001) as well as histopathological subtype and MGMT status (p=0.0036). On follow up, mean survival of the patients was 25.4 months. Significant association was found between MGMT status and survival of the patients (p=0.0437). Conclusion. MGMT immunoexpression is significantly associated with different grades and subtypes of gliomas. In addition, MGMT has significant implications on chemoresistance and patient survival. Hence, MGMT expression should be mandatorily checked before starting the chemotherapy. 

scholarly journals A Missed Celiac Artery Aneurysm Leading to Rupture: A Case Report

2020 ◽  
Vol 4 (3) ◽  
pp. 440-442
Author(s):  
Jason Vecchia ◽  
Eric Blazar
Keyword(s):  
Abdominal Pain ◽  
Case Report ◽  
Care Center ◽  
Tertiary Care ◽  
Artery Aneurysm ◽  
Operative Management ◽  
Celiac Artery ◽  
Repeat Visit ◽  
Celiac Artery Aneurysm ◽  
Laboratory Investigations

Introduction: Abdominal pain is a common complaint seen in the emergency department (ED). We report a case of celiac artery aneurysm (CAA) in a male patient presenting with abdominal pain to the ED on two separate occasions, approximately 24 hours apart. Case Report: On the initial visit the patient was discharged with undifferentiated abdominal pain after computed tomography imaging and laboratory investigations. On the repeat visit he was found to have a rapidly expanding CAA with rupture. He became unstable requiring intubation, blood transfusions, and emergent transfer to a tertiary care center for surgical management where, unfortunately, he died hours after failed operative management. Conclusion: Although rare, abdominal pain caused by CAAs can rapidly progress to rupture and have a high mortality.

scholarly journals Outcomes Associated With Fibrin Sealant Use in Lateral Neck Dissections

OTO Open ◽  
2020 ◽  
Vol 4 (4) ◽  
pp. 2473974X2098102
Author(s):  
Luke Stanisce ◽  
Michael Lai ◽  
Nadir Ahmad ◽  
Thomas C. Spalla ◽  
Lisa M. Reid ◽  
...  
Keyword(s):  
Fibrin Sealant ◽  
Intraoperative Complications ◽  
Care Center ◽  
Tertiary Care ◽  
Secondary Analysis ◽  
Lateral Neck ◽  
Tissue Adhesives ◽  
Chyle Leak ◽  
Surgical Data

Objective To determine whether the use of fibrin sealant tissue adhesives during lateral neck dissections is associated with a change in postoperative outcomes. Study Design Retrospective cohort. Setting Institutionally affiliated tertiary care center. Methods Various demographic, disease, and surgical data were collected for patients who underwent lateral neck dissections. Univariate regression analysis was performed with the following outcomes: total drain output and duration of drain placement, as well as incidence of postoperative infection, hematoma, seroma, chyle leak, and salivary leak. Results A total of 133 patients underwent lateral neck dissections. Fibrin sealant was used in 35% of cases (n = 46). Its use was not associated with differences in total drain output ( P = .77) or the number of days that the drains were in place ( P = .83). On secondary analysis, the use of fibrin sealant was not associated with a difference in postoperative incidence of hematoma ( P = .65), seroma ( P = .68), chyle leak ( P = .42), or salivary leak ( P = .73). These results were consistent when stratified by the presence of intraoperative complications. Its use accompanied an average cost of $674 per case. Conclusions Fibrin sealant use during lateral neck dissections was not associated with a reduction in drain output or days that the drains remained in situ. Although the current study was limited by sample size, fibrin sealant use was not associated with a decreased risk of postoperative adverse events. The evidence in this report suggests that the routine use of these products adds cost without clear benefit.

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