Management and outcomes of caesarean scar pregnancy in medina maternity and children hospital

Undergoing previous cesarean section (CS) can have the possibility for implantation of embryonic sac of any later gestation throughout its scar evolving what was known as a scar pregnancy (SP). The aim of this study to describe the diagnosis, treatment and outcomes of caesarean SP in Medina maternity and children hospital. This a case series study encompassed all patient diagnosed and managed as cesarean SP in Medina maternity and children hospital, Medina (MMCH), Saudi Arabia in the period from January 2020 to January 2021. Demographics, clinical and discharge data were attained from the previous hospital electronic records, nursing notes, anesthesia sheets, operative notes, discharge papers, and outpatient clinic documents. A total of 11 women detected by ultrasound (US) and magnetic resonance imaging (MRI) as SP. The mean age of women was 36±3.8 years. The median number of repeated CS was 2 while the mean gestational age was 50.6±7.8 days. The interval from diagnosis to management ranged from 2 to 9 days with a median of 4 days, and the interval between start treatment and negative Beta human chorionic gonadotropin β-hCG ranged from 21 to 135 days with a median of 62 days. The mean interval from last CS until this pregnancy is 39.7±19.2 months. Systemic methotrexate (MTX) given in a single dose for two patients while nine patients received multiple doses. Local MTX given for six cases. Bleeding as a complication occurred with two out of the eleven patients. MTX was actual treatment for SP, but bigger multicenter randomized-controlled trials involving more cases are essential to validate our conclusions.

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Opioid-free anesthesia for patients with joint hypermobility syndrome undergoing craneo-cervical fixation: a case-series study focused on anti-hyperalgesic approach

Orphanet Journal of Rare Diseases ◽

10.1186/s13023-021-01795-4 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Carlos Ramírez-Paesano ◽

Albert Juanola Galceran ◽

Claudia Rodiera Clarens ◽

Vicenҫ Gilete García ◽

Bartolomé Oliver Abadal ◽

...

Keyword(s):

Side Effects ◽

Postoperative Pain ◽

Hospital Discharge ◽

Case Series ◽

Ehlers Danlos Syndrome ◽

Painful Condition ◽

Discharge Data ◽

Gastrointestinal Complications ◽

Case Series Study ◽

Series Study

Abstract Background Patients with Ehlers-Danlos Syndrome/Hypermobility Type (EDS-HT/JHS) and Craneo-Cervical Instability frequently suffer from severe widespread pain which is difficult to control. Chronic neuroinflammation, opioid-induced hyperalgesia, and central sensitization may explain this painful condition. The aim of this study was to determine if opioid-free anesthesia plus the postoperative administration of lidocaine, ketamine and dexmedetomidine can reduce postoperative pain and the need of methadone rescues in comparison with opioid-based management in these patients undergoing Craneo-Cervical Fixation (CCF). The secondary aim was to assess the needs of opioids at hospital-discharge, incidence of gastrointestinal complications and the requirement of anxiolytic. Methods A retrospective, consecutive case series study was designed. 42 patients with EDS-HT/JHS undergoing CCF were enrolled in two groups: an OFA-plus Group that received opioid-free anesthesia with propofol, lidocaine, ketamine and dexmedetomidine, and OP Group, opioid-based anesthesia-analgesia. The main variables: Preoperative Visual Analogue Score (VAS), postoperative VAS on the 1st, 2nd, 4th and 6th days, sufentanil or morphine requirements, need for methadone rescue, and VAS at hospital-discharge. Data was presented by mean ± SD, percentage, median or interquartile range. Chi-squared or Fisher’s test. 95% C.I and P values < 0.05. Results Nineteen patients in OFA-plus, and 23 patients in OP group. VAS was lower in OFA-plus on the postoperative days evaluated (p < 0.001).VAS at hospital-discharge was lower in OFA-plus: 4.96 (4.54–5.37) vs. OP 6.39 (6.07–6.71) (p < 0.001). Methadone requirement was lower in the OFA-plus (p < 0.001). 78% of patients in OFA-plus didn’t need methadone rescue. 95% in OP group needed methadone rescues at high doses(> 15 mg/day). No differences regarding equivalent doses of sufentanil or morphine consumption on the 2nd, 4th, and 6th postoperative days were found. OFA-plus decreased ileus, nausea and vomiting (p < 0.001). 60.9% in OFA-plus group decreased opioid requirements at hospital-discharge compared with preoperative values. A 77% reduction of anxiolytics requirements was shown. Conclusion OFA-plus management for patients undergoing CCF with EDS-HT/JHS shows significant reduction in postoperative pain and at hospital-discharge compared with opioid-based anesthesia. OFA-plus management decreases the total doses of methadone rescues, reduces anxiolytic requirements and gastrointestinal side-effects, except for constipation. OFA-plus management is a feasible option to improve postoperative pain control, reducing the opioids’ use and their postoperative side-effects in patients undergoing CCF with EDS-HT/JHS.

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Triple Procedure for Dense Cataractous Neovascular Glaucoma Patients

Journal of Ophthalmology ◽

10.1155/2020/1251203 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Hossam M. Moharram ◽

Shaaban Abd-Elhamid Mehany Elwan ◽

Mahmoud M. Nassar ◽

Mohamed F. Abdelkader

Keyword(s):

Case Series ◽

Neovascular Glaucoma ◽

Panretinal Photocoagulation ◽

Case Series Study ◽

Triple Procedure ◽

Distant Visual Acuity ◽

Pars Plana ◽

The Mean ◽

Series Study

Purpose. One of the most difficult refractory glaucomas is the neovascular type (NVG), and its association with dense cataract adds to this difficulty. This study aimed to provide results of the triple surgical procedure for such conditions. Methods. 12 eyes of 12 patients with NVG and dense cataract were included in this case series study. The mean age of patients was 57.25 ± 5.9 years. The mean preoperative intraocular pressure (IOP) was 47.25 ± 4.04 mmHg with maximum antiglaucoma therapy. The mean best corrected distant visual acuity (BCDVA) in LogMAR was 2.13 ± 0.38. All patients received intravitreal injection of 1.25 mg (0.05 ml) bevacizumab followed by phacoemulsification, pars plana vitrectomy (PPV) including panretinal photocoagulation (PRP), and trabeculectomy with mitomycin C (MMC). Mean IOP and BCDVA changes were the main outcome results of this study. Results. The follow-up period was 2 years. The mean BCDVA was improved to 1.22 ± 0.35, 1.13 ± 0.34, 1.12 ± 0.37, 1.06 ± 0.38, and 1.01 ± 0.37 at 1, 3, 6, 12, and 24 months, respectively, after this procedure. This improvement was statistically significant when compared with preoperative BCDVA (P<0.0001). The mean postoperative IOP was dropped to 20.08 ± 4.1, 17.08 ± 2.1, 17.17 ± 5, 15.75 ± 4.7, and 16.17 ± 6.1 mmHg, respectively. At the last follow-up, the mean IOP was statistically significantly lower than preoperative IOP (P<0.0001) at the previously mentioned time points. The success rate was complete in 90.9% of eyes and qualified in 100% of eyes. Iris and angle neovascularization had regressed significantly in all patients, and no serious complications occurred during the follow-up period. Conclusions. This triple surgery can safely improve patients with NVG and dense cataract regarding BCDVA and IOP control. This trial is registered with NCT04143620.

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Clinical profile of SUNCT/SUNA in Japan: A clinic-based study

Cephalalgia Reports ◽

10.1177/2515816319829907 ◽

2019 ◽

Vol 2 ◽

pp. 251581631982990 ◽

Cited By ~ 1

Author(s):

Shoji Kikui ◽

Junichi Miyahara ◽

Hanako Sugiyama ◽

Kentaro Yamakawa ◽

Yoshihiro Kashiwaya ◽

...

Keyword(s):

Case Series ◽

Japanese Patients ◽

Preventive Therapy ◽

Short Term ◽

Case Series Study ◽

Clinical Profiles ◽

The Mean ◽

Series Study ◽

Headache Center

Objectives: This study aimed to report the clinical profiles of patients with short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT)/short-lasting unilateral neuralgiform headache attacks with cranial autonomic (SUNA) in a Japanese population by surveying those enrolled at a regional headache center in Japan. Methods: In this consecutive case series study, the clinical characteristics of patients with SUNCT (eight men, three women; mean age: 59.5 ± 20.5 years) and SUNA (five men, four women; mean age: 51.3 ± 18.4 years) who visited Tominaga Hospital from February 2011 to January 2017 were examined. Headaches were diagnosed according to the International Classification of Headache Disorders, Third edition (ICHD-3) guidelines. Results: Brief clusters of separate attacks were reported by all patients. The mean duration of attacks was 91.9 ± 87.9 s. Ipsilateral rhinorrhea was observed in 9 of 20 (45.0%) cases and facial sweating was observed in 1 of 20 (5.0%) cases. An eminent response to lamotrigine was observed in 9 of 9 (100%) patients; however, adverse events were only reported in 2 of 9 (22.2%) cases. An intravenous infusion of lidocaine was demonstrated to be completely successful for short-term prevention in 5 of 6 (83.3%) SUNCT cases. Conclusions: Lamotrigine can successfully treat most patients, and intravenous lidocaine is useful for the short-term preventive therapy of severe recalcitrant attacks in Japanese patients with SUNCT/SUNA.

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Functional and Radiographic Outcomes of Minimally Invasive Intramedullary Nail Device (MIIND) for Moderate to Severe Hallux Valgus

Foot & Ankle International ◽

10.1177/1071100720969676 ◽

2020 ◽

pp. 107110072096967

Author(s):

Carlo Biz ◽

Alberto Crimì ◽

Ilaria Fantoni ◽

Jacopo Tagliapietra ◽

Pietro Ruggieri

Keyword(s):

Hallux Valgus ◽

Case Series ◽

Radiographic Outcomes ◽

Case Series Study ◽

Significant Correction ◽

The Mean ◽

Series Study ◽

Severe Hallux Valgus

Background: This study was aimed at assessing clinical and radiographic outcomes of the Minimally Invasive Intramedullary Nail Device (MIIND) to correct moderate to severe hallux valgus (HV) and the long-term persistence of its effects. Methods: This case series study involved 100 patients, 84 women and 16 men (mean age, 59 years), who underwent the MIIND procedure with a mean follow-up of 97 months. Assessment was performed preoperatively, postoperatively, at 6 and 12 months, and at last follow-up. Clinical outcomes were evaluated with American Orthopaedic Foot & Ankle Society (AOFAS) scores, visual analog scale (VAS), and patient satisfaction. Intermetatarsal angle (IMA), metatarsophalangeal hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), and tibial sesamoid position were assessed. Statistical analysis was performed. Results: The mean AOFAS score improved from 57.9 to 90.5 points, VAS scale was 1.5 ± 2.0, and patients’ satisfaction was 8.7 ± 1.4. The mean correction of the HVA and IMA showed a significant correction; however, the effect of time was not statistically significant on DMAA. Sex ( P = .047), severity ( P = .050), associated procedures ( P = .000), and preoperative angle ( P = .000) showed significant association with HVA correction and its persistence over time. Age was not statistically significant. Complications were 9 cases of superficial wound infection and 6 recurrences. Conclusions: The MIIND technique proved a viable procedure to correct moderate to severe HV with a low rate of complications and recurrence, producing significant correction of most radiographic parameters assessed and their persistence, even at long term. Level of Evidence: Level IV, case series study.

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Partial capitate shortening for Kienböck’s disease

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193414562355 ◽

2014 ◽

Vol 40 (9) ◽

pp. 957-960 ◽

Cited By ~ 18

Author(s):

A. Citlak ◽

U. Akgun ◽

T. Bulut ◽

M. Tahta ◽

B. Dirim Mete ◽

...

Keyword(s):

Magnetic Resonance ◽

Case Series ◽

Magnetic Resonance Images ◽

Stage Ii ◽

Pinch Strength ◽

Case Series Study ◽

The Mean ◽

Series Study ◽

Carpal Height

The purpose of this study was to report our experience of partial capitate shortening in seven patients with a median 38 months follow-up. Staging was made by the Lichtman classification system and stage II and III-A patients were included in the study. The mean age was 34 years (range 22–52). Patients were assessed for pain, range of motion, grip and pinch strength, and satisfaction was recorded using a scale between 0 and 4. All these parameters showed improvement after surgery. The Lichtman stage, lunate height index and carpal height index were determined radiographically. Magnetic resonance images of the wrist were studied for lunate revascularization at the final follow-up and occurred in all patients. According to our study, partial capitate shortening seems an effective treatment for Lichtman stage II and III-A patients. Level IV case series study.

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Opioid-free Anesthesia for Patients With Joint Hypermobility Syndrome Undergoing Craneo-cervical Fixation: a Case-series Study Focused on Anti-hyperalgesic Approach

10.21203/rs.3.rs-93957/v1 ◽

2020 ◽

Author(s):

Carlos R Ramirez-Paesano ◽

Albert Juanola Galcerán ◽

Claudia Rodiera Clarens ◽

Vicenç Gilete García ◽

Bartolomé Oliver Abadal ◽

...

Keyword(s):

Side Effects ◽

Postoperative Pain ◽

Hospital Discharge ◽

Case Series ◽

Joint Hypermobility Syndrome ◽

Ehlers Danlos Syndrome ◽

Discharge Data ◽

Gastrointestinal Complications ◽

Case Series Study ◽

Series Study

Abstract Background. Patients with Ehlers-Danlos Syndrome/Hypermobility Type (EDS-HT/JHS) and Craneo-Cervical Instability frequently suffer from severe widespread pain which is difficult to control. Chronic neuroinflammation, opioid-induced hyperalgesia, and central sensitization may explain this painful condition.The aim of this study was to determine if opioid-free anesthesia plus the postoperative administration of lidocaine, ketamine and dexmedetomidine can reduce postoperative pain and the need of methadone rescues in comparison with opioid-based management in these patients undergoing Craneo-Cervical Fixation(CCF). The secondary aim was to assess the needs of opioids at hospital-discharge, incidence of gastrointestinal complications and the requirement of anxiolytic.Methods. A retrospective, consecutive case series study was designed. 42 patients with EDS-HT/JHS undergoing CCF were enrolled in two groups: an OFA-plus Group that received opioid-free anesthesia with propofol, lidocaine, ketamine and dexmedetomidine, and OP Group, opioid-based anesthesia-analgesia. The main variables: Preoperative Visual Analogue Score (VAS), postoperative VAS on the 1st, 2nd, 4th and 6th days, sufentanil or morphine requirements, need for methadone rescue, and VAS at hospital-discharge. Data was presented by mean ± SD, percentage, median or interquartile range. Chi-squared or Fisher’s test. 95% C.I and P values <0.05 . Results. Nineteen patients in OFA-plus, and 23 patients in OP group. VAS was lower in OFA-plus on the postoperative days evaluated (p<0.001).VAS at hospital-discharge was lower in OFA-plus: 4.96 (4.54-5.37) vs. OP 6.39 (6.07-6.71) (p<0.001). Methadone requirement was lower in the OFA-plus (p<0.001). 78% of patients in OFA-plus didn’t need methadone rescue. 95% in OP group needed methadone rescues at high doses(>15mg/day). No differences regarding equivalent doses of sufentanil or morphine consumption on the 2nd, 4th, and 6th postoperative days were found. OFA-plus decreased ileus, nausea and vomiting (p<0.001). 60.9% in OFA-plus group decreased opioid requirements at hospital-discharge compared with preoperative values. A 77% reduction of anxiolytics requirements was shown. Conclusion: OFA-plus management for patients undergoing CCF with EDS-HT/JHS shows significant reduction in postoperative pain and at hospital-discharge compared with opioid-based anesthesia. OFA-plus management decreases the total doses of methadone rescues, reduces anxiolytic requirements and gastrointestinal side-effects, except for constipation. OFA-plus management is a feasible option to improve postoperative pain control, reducing the opioids’ use and their postoperative side-effects in patients undergoing CCF with EDS-HT/JHS.

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Subconjunctival injections of triamcinolone acetonide to treat uveitic macular edema

10.21203/rs.2.16180/v1 ◽

2019 ◽

Author(s):

Yi Qu ◽

Xinshu Liu ◽

Anyi Liang ◽

Chan Zhao ◽

Fei Gao ◽

...

Keyword(s):

Macular Edema ◽

Triamcinolone Acetonide ◽

Case Series ◽

Subconjunctival Injection ◽

Retrospective Case ◽

Case Series Study ◽

Uveitic Macular Edema ◽

The Mean ◽

Series Study

Abstract Background: To evaluate the efficacy and safety of subconjunctival triamcinolone acetonide (TA) injections for treating uveitic macular edema (UME). Methods: This retrospective case series study included patients with UME who received subconjunctival TA injections with a minimum follow-up period of 6 months. The main outcome was central macular thickness. The secondary outcomes included the best corrected visual acuity, recurrence rate and intraocular pressure. Results: In total, 68 patients (83 eyes) were enrolled in this study. The mean CMT decreased from 456.9 ± 171.1 μm at baseline to 324 ± 175.9 μm, 305.6 μm ± 147.7 μm, 331.8 ± 154.3 μm and 281.1 ± 147.6 μm at 1, 2, 3 and 6 months postinjection, respectively (all P < 0.01). A total of 21/83 eyes exhibited elevated IOPs, which was controlled with topical IOP-lowering agents in 14 eyes, whereas 7 eyes got subconjunctival TA deposit surgically removed. Conclusion: subconjunctival TA injections appear to be safe and effective for UME.Key Words: Triamcinolone acetonide; subconjunctival injection; uveitis; macular edema

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Pediatrics Infected with COVID-19: A Case Series Study on Pediatrics Hospitalized in a Referral Pediatric Hospital

International Journal of Pediatrics ◽

10.1155/2021/1135503 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Houman Hashemian ◽

Saeid Sadat Mansouri ◽

Hamid Reza Badeli ◽

Ebrahim Esmaili ◽

Majid Asgharzadeh ◽

...

Keyword(s):

Ct Scan ◽

Clinical Laboratory ◽

Treatment Strategies ◽

Case Series ◽

Pediatric Hospital ◽

Laboratory Findings ◽

Case Series Study ◽

The Mean ◽

Underlying Diseases ◽

Series Study

Introduction. COVID-19 infection which is a novel pneumonia associated with coronavirus suddenly broke out in the world. The aim of this study is to analyze and summarize the clinical characteristics of pediatric patients who were hospitalized in a referral pediatric hospital because of COVID-19 infection. Materials and Methods. Twenty-one COVID-19 infection cases confirmed by clinical and laboratory findings who were hospitalized in our center from 20 February to 19 April 2020 were included. Demography information, clinical, laboratory, and radiological findings, and treatment strategies of patients were evaluated. Results. The mean age was 91.5 ± 68.38 months (1-225), and there were 12 (57.1%) boys and 9 (42.9%) girls. Fever ≥ 38 ° C was detected in 11 (52.4%) patients. Eleven (52.3%) patients had tachypnea, and 4 (19%) of them developed tachycardia. Nine CT scans (42.85%) demonstrated a halo sign, and patchy infiltration was seen in CT scan of 7 patients (33.33%). Furthermore, bilateral crazy-paving pattern was seen in CT scan of nine (42.85%) patients. We prescribed chloroquine in 8 (38.1%), oseltamivir in 8 (38.1%), Kaletra in 6 (28.6%), and Ribavirin in 1 (4.8%) of patients. Finally, four (19.04%) patients expired which one of them suffered from ARDS. Conclusions. We found out that boys might develop more severe cases of COVID-19, and this could be more common in school age. Manifestations might be milder than adults, and the most severe cases might be associated with underlying diseases. Also, the effectiveness of drugs in the treatment of this disease needs further study.

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Volar Scaphoid Plating for Nonunion: A Multicenter Case Series Study

Journal of Wrist Surgery ◽

10.1055/s-0040-1702199 ◽

2020 ◽

Vol 09 (03) ◽

pp. 225-229

Author(s):

Kevin Eng ◽

Stephen Gill ◽

Simon Hoy ◽

Vivek Shridar ◽

Natasha Van Zyl ◽

...

Keyword(s):

Case Series ◽

Visual Analogue Score ◽

Rotational Stability ◽

Volar Aspect ◽

Number Of Patients ◽

Case Series Study ◽

Structural Graft ◽

The Mean ◽

Series Study

Abstract Background The volar scaphoid plate from Medartis (Medartis AG, Austrasse, Basel, Switzerland) is a variable angle titanium locking plate, preformed for the volar aspect of the scaphoid. It does not have compressive capability, and may act as a bridging device. It may provide an advantage over a compression screw where the pathoanatomy is less favorable to such a device with increased rotational stability. It may act as a buttress plate for correction of humpback deformity for example. It has been used in nonunions and with vascularized grafts. Questions Our study aims to assess the results of our patients with scaphoid nonunion treated with scaphoid volar plating over a larger number of patients. We aim to identify techniques to increase the success of plating. Methods Patients from our cohort were retrospectively reviewed. Operations were performed by three hand fellowship trained surgeons and in two centers. Inclusion involved a scaphoid plate procedure for a nonunion of the scaphoid with a minimum of 6 months of follow-up. Exclusions were those who had less than 6 months of follow-up. Data included demographics, patient-rated wrist evaluation (PRWE), a quick disabilities of the arm, shoulder, and hand (qDASH), visual analogue score, and range and grip. Radiology was reviewed. Results Thirty-two eligible patients were assessed. The mean age was 25 years (range 13–46), 2 were female and 15 were smokers. Mean follow-up postsurgery was 18 months. Twenty-nine of 32 patients united (90.6%) on computed tomography scan. Clinical assessment was performed in the 25 patients. The mean qDASH score was 12.5 (range 0–42) and mean PRWE was 11 (range 0–54). The mean arc of motion was 115 degrees. The mean grip strength was 39 kg compared with 41 kg on the nonoperated side. Conclusion We postulate that the plate acts like an internal bridging device, acting over a small distance, and inherent stability of the construct with structural graft and accurate reduction prior to plating is advantageous. Potential problems include plate impingement on the volar lip of the radius, particularly when trying to plate more proximal fractures. Ideally, it is utilized for mid to distal waist fractures.

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Safety and Efficacy of Pterygium Extended Removal Followed by Extended Conjunctival Transplant for Recurrent Pterygia

10.21203/rs.3.rs-303034/v1 ◽

2021 ◽

Author(s):

Walid Allam ◽

Ahmed Roshdy Alagorie ◽

Mohammed Nasef ◽

Molham El-Bakary

Keyword(s):

Donor Site ◽

Case Series ◽

Surgical Excision ◽

Safety And Efficacy ◽

Case Series Study ◽

Corrected Distance Visual Acuity ◽

The Mean ◽

Prospective Case Series ◽

Series Study

Abstract Purpose To study the safety and efficacy of pterygium extended removal followed by extended conjunctival transplant for recurrent pterygia. Methods Thirty-three eyes of 33 subjects with recurrent pterygia were enrolled in this prospective case series study. Pterygium extended removal followed by extended conjunctival transplantation was done for all subjects. One surgeon (WA) performed all surgeries. All subjects completed follow-up for at least 12 months and were evaluated for recurrence and complications. Results The mean age of the participants was 41.2 ± 10.3 years (range 22–60), 7 females (21.2%). The mean duration of follow-up was 25.64 ± 9.24 months (range 12–43). Corrected distance visual acuity (decimal notation) improved from 0.69 ± 0.22 (range 0.2–1.0) at presentation to a 1-year postoperative value of 0.83 ± 0.2 (range 0.3–1.0). No recurrence was reported in all subjects throughout the follow-up period. Transient graft swelling was recorded in 14 cases (42.4%) and resolved in all cases by the first week. All patients developed variable degrees of transient postoperative diplopia that resolved completely by the first 6 weeks. Donor site granuloma developed in 4 cases (12.1%). Spontaneous resolution was observed in 3 cases, while in one case, surgical excision was performed 2 months after the procedure. Conclusions In this study of eyes with recurrent pterygia, pterygium extended removal followed by extended conjunctival transplant was found safe and effective with no recurrence and minimal postoperative complications.

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