scholarly journals Our experience with Amyand’s hernia

2019 ◽  
Vol 6 (12) ◽  
pp. 4572
Author(s):  
Brajesh Gupta ◽  
Ghanshyam Hatwar ◽  
Charu Tiwari ◽  
Shweta Gupta
Keyword(s):  
Inguinal Hernia ◽  
Clinical Presentation ◽  
Amyand’S Hernia ◽  
Rare Type ◽  
Duration Of Symptoms ◽  
Female Ratio ◽  
Duration Of Hospital Stay ◽  
The Mean ◽  
One Year

Amyand’s hernia is a rare type of inguinal hernia with appendix as its content, which may be normal or pathological. We present our experience with Amyand’s hernia in 6 patients. A retrospective review of 6 cases with Amyand’s hernia that were managed over a 2-year period was done by reviewing the hospital records. The variables assessed and analyzed were demographic details, clinical presentation, management and follow-up. There were 4 children and 2 adults; male and female ratio being 5:1. The mean age of four children was 1.5 years; the two adults were 72 and 54 years of age. The duration of symptoms of inguinal hernia ranged from 1 month to one year; mean duration of irreducibility was 5.33 days (range: 2 days to 15 days). Five patients had symptoms of obstruction. All 5 patients with obstruction underwent emergency surgery. The sixth patient was posted for elective hernioplasty the next day. Appendix was inflamed only in one patient. The post-operative course was uneventful in all patients. The mean duration of hospital stay was 3.33 days. Only one patient had surgical site infection. Amyand’s hernia, thus presents with features of incarcerated right hernia. Pre-operative diagnosis is difficult. Intra-operatively, the surgical procedure needs to be individualized depending upon the pathology.

scholarly journals Spontaneous Intracranial Hypotension – Not Always Benign

2021 ◽  
Vol 7 (2) ◽  
pp. 85-91
Author(s):  
Pavithran Vadakkam Muriyil ◽  
◽  
Rajeev Mandaka Parambil ◽  
Shanavas Cholakkal ◽  
Akhil Mohan ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Patch Repair ◽  
Common Symptom ◽  
Duration Of Symptoms ◽  
Symptom Pattern ◽  
The Mean ◽  
One Year

Background and Aim: Spontaneous Intracranial Hypotension (SIH) is a rare cause of headaches. It commonly presents with newly-developed persistent postural headaches and resolves with conservative treatment but rarely becomes a life-threatening disease. We retrospectively reviewed all cases of SIH patients treated in our institution for over ten years. Their clinical and radiological findings and the treatment given were analyzed. Their outcomes were assessed at a minimum of one year of follow-up. Materials and Methods: We retrospectively reviewed all cases of SIH patients treated in our institution over ten years. Clinicoradiological aspects, as well as the treatment given, were analyzed. The outcome was assessed at a minimum of one year of follow-up. Results: Six cases of SIH were studied. The Mean±SD age of the study population was 41.6±2.87 years. Four cases (66%) were female. The most common symptom was orthostatic headache which was present in all of them. The Mean±SD duration of symptoms before the diagnosis of SIH was 3±1.78 months. Four cases were managed conservatively, while one patient was managed with surgery and the other with epidural patch repair. The exact site of the leak could be delineated in 2 cases (33%). Two patients who were managed invasively for Cerebrospinal Fluid (CSF) the leak had a subdural hematoma. All patients had a favorable outcome at one year of follow-up. Conclusion: Prompt and early identification of changes in symptom pattern and the onset of subdural hematoma are essential markers of shifting to definitive management rather than continuing conservative measures. Subdural hematoma, secondary to SIH, warrants evacuation if it causes clinical deterioration.

scholarly journals Long-term clinical results of autologous Platelet Rich Plasma (PRP) in recalcitrant plantar fasciitis

2021 ◽  
Vol 7 (1) ◽  
pp. 12-16
Author(s):  
Ankit Kumar Garg ◽  
Ranjeet Choudhary ◽  
Alok Chandra Agrawal ◽  
Anupam Pradip Inamdar ◽  
Shilp Verma
Keyword(s):  
Plantar Fasciitis ◽  
Platelet Rich Plasma ◽  
Post Injection ◽  
Duration Of Symptoms ◽  
Low Level ◽  
Autologous Platelet Rich Plasma ◽  
The Mean ◽  
One Year ◽  
Autologous Platelet

In recent years, biologic therapies such as platelet-rich plasma (PRP) have gained prominence in multiple orthopedics degenerative tendinopathy and ligamental pathology. This research aimed to assess the clinical effectiveness of autologous platelet-rich plasma injection in cases of recalcitrant plantar fasciitis (RPF) over a long period.A prospective observational study was performed on RPF that did not experience pain relief after three months of conservative therapy. Under sterile conditions, inject approximately 3ml of platelet-rich plasma mixed with 0.5ml lignocaine into the maximum tender point of the heel. Visual Analogue Score for Pain, the American Orthopedics Foot, and Ankle Society (AOFAS) Ankle, and Hind Foot Score at one month, three months, six months, one year, and two years after injection.A total of 60 patients of RPF which 23 (38.33%) were male, and the rest 37 (61.66%) were female. The mean age was 45 ± 7.25 and the mean duration of symptoms was 7.4 ± 2.1months. The mean VAS score was 7.92 ± 1.2 at pre-injection, was progressively reduced post-injection to 5.61 ± 1.56 at one month, 3.1 ± .83 at three months, and 2.4 ± .68 at six months and remained at low level 2.5 ± .92 at one year and 2.7 ± .56 at two years. The mean AOFAS score was 56.92 ± 13.24 at pre-injection, was progressively increased post-injection to 66.41± 10.26 at one month, 78.31 ± 12.64 at three months, and 90.54 ± 10.71 at six months and remained at a low level 89.24 ± 8.92 at one year and 87.54 ±10.56 at two years. Mean VAS and AOFAS scores showed statistically significant pain reduction and functional improvements at successive follow-ups till 6month (p<.05); the improvement remained stable and did not change significantly until the last appointment at 2year follow-up (p > 0.05).The outcomes of autologous PRP injection in recalcitrant plantar fasciitis are reliable, stable, and predictable in both long- and short-term follow-up. PRP injection is safer and not associated with serious complications as in the case of steroid injection.

scholarly journals Clinical profile of retinoblastoma presenting in a tertiary care hospital, eastern Nepal

2017 ◽  
Vol 13 (3) ◽  
pp. 129-136
Author(s):  
Poonam Lavaju ◽  
BP Badhu ◽  
S Shah ◽  
SK Chaudhary ◽  
P Upadhyaya
Keyword(s):  
Optic Nerve ◽  
Tertiary Care ◽  
Clinical Profile ◽  
Care Hospital ◽  
Duration Of Symptoms ◽  
Female Ratio ◽  
Mode Of Presentation ◽  
The Mean ◽  
Clinical Records

Background: Retinoblastoma is the commonest primary intraocular malignancy of childhood. Under-standing the different modes of presentation with timely intervention are associated with prognosis.Objective: To determine the clinical profile of retinoblastoma and its association with optic nerve infiltration by tumor.  Methods: A retrospective analysis of the clinical records and histopathological reports of patients admitted with retinoblastoma in a tertiary heath care center, eastern Nepal (June 2009 to July 2012) was carried out.Results: A total of 27 patients (28 eyes) with retinoblastoma were studied. The mean age at presentation was 2.89 ± 0.93 years. The mean duration of symptoms to presentation was 3.35 month, ranged from 7 days to 2 years. Male to female ratio was 3:2. Thirty-three percent patients were Muslims. Twentyseven patients (96.3%) had unilateral eye involvement. The commonest mode of presentation was leukocoria in 23 eyes (85.2%) followed by redness 9 eyes (33.3%), proptosis in 5 eyes (18.5%) and phthisis bulbi in one eye (3.7%). Histopathological reports of 26 eyes confirmed the diagnosis of retinoblastoma. One patient with distant metastases was referred to oncology center. Infiltration of the optic nerve by tumor cells was seen in five eyes (18.5%); of which two cases had proptosis (p-0.166). At two years follow up, recurrence was seen in one patient with proptosis and optic nerve infiltration (p-0.136). Age at presentation was positively associated with recurrence of tumor (p-0.005).Conclusion: Leucokoria was the most common mode of presentation of retinoblastoma. Larger sample size with longer follow up is required to come to a definite association with optic nerve infiltration by tumor. Health Renaissance 2015;13 (3): 129-136

scholarly journals Implications of the Changing Pattern of Bacterial Infections following Total Joint Replacements

2005 ◽  
Vol 13 (2) ◽  
pp. 125-130 ◽  
Author(s):  
D Ip ◽  
SK Yam ◽  
CK Chen
Keyword(s):  
Positive Culture ◽  
Resistant Bacteria ◽  
Multiple Drug ◽  
Drug Resistant ◽  
Female Ratio ◽  
Total Hip ◽  
Multiple Drug Resistant ◽  
The Mean ◽  
One Year

Purpose. To retrospectively review the causative organisms isolated from infected hip and knee replacements requiring revision. Methods. We reviewed a consecutive series of 36 patients who underwent revision hip or knee arthroplasties due to bacterial infection at Pamela Youde Nethersole Eastern Hospital in Hong Kong between 1995 and 2003. The male to female ratio was 1:2, and the mean age of patients was 70 years (range, 54–82 years). The mean duration of follow-up was 3.8 years (range, 1.1–8.3 years). No patient was lost to follow-up. All 14 revision knee patients had previously undergone cemented and patella-resurfacing total knee arthroplasties. Of the 22 revision hip patients, 9 had cementless, 6 had cemented, and 7 had hybrid total hip arthroplasties previously. Results. None of the bacteria isolated from 1995 to 1996 were multiple-drug resistant. Subsequently, however, most of the isolates were multiple-drug resistant, with methicillin-resistant Staphylococcus aureus (MRSA) being the most common. Half of the isolates of Staphylococcus epidermidis and Escherichia coli demonstrated multiple-drug resistance. The incidence of positive culture in revision hip patients was 59%, 46% of which were MRSA. All 13 revision hips with positive cultures showed chronic sepsis: 4 occurred within one year and 10 occurred 2 or more years after the index arthroplasty. The incidence of positive culture in revision knee patients was 57%, 46% of which were MRSA. All 8 revision knees with positive cultures showed chronic sepsis: 3 occurred within one year, 5 occurred 2 or more years after the index arthroplasty. Only one patient, who was infected with gram-negative bacilli, required a second revision for residual sepsis. Harris hip scores for the revision hip patients improved from a mean of 65 (range, 55–75) to 85 (range, 75–90). Knee Society knee scores of the revision knee patients improved from a mean of 68 (range, 55–75) to 80 (range, 70–85). There were no radiological signs suggestive of loosening in the 2 groups at the latest follow-up. Conclusion. This study found a definite increase in multiple-drug–resistant bacteria isolated from periprosthetic infections around total hip and knee prostheses.

Long-term outcomes of lumbar microdiscectomy in the pediatric population: a large single-institution case series

2019 ◽  
Vol 24 (5) ◽  
pp. 549-557
Author(s):  
Malia McAvoy ◽  
Heather J. McCrea ◽  
Vamsidhar Chavakula ◽  
Hoon Choi ◽  
Wenya Linda Bi ◽  
...  
Keyword(s):  
Conservative Management ◽  
Functional Outcomes ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Case Series ◽  
Csf Leak ◽  
Single Institution ◽  
The Mean

OBJECTIVEFew studies describe long-term functional outcomes of pediatric patients who have undergone lumbar microdiscectomy (LMD) because of the rarity of pediatric disc herniation and the short follow-up periods. The authors analyzed risk factors, clinical presentation, complications, and functional outcomes of a single-institution series of LMD patients over a 19-year period.METHODSA retrospective case series was conducted of pediatric LMD patients at a large pediatric academic hospital from 1998 to 2017. The authors examined premorbid risk factors, clinical presentation, physical examination findings, type and duration of conservative management, indications for surgical intervention, complications, and postoperative outcomes.RESULTSOver the 19-year study period, 199 patients underwent LMD at the authors’ institution. The mean age at presentation was 16.0 years (range 12–18 years), and 55.8% were female. Of these patients, 70.9% participated in competitive sports, and among those who did not play sports, 65.0% had a body mass index greater than 25 kg/m2. Prior to surgery, conservative management had failed in 98.0% of the patients. Only 3 patients (1.5%) presented with cauda equina syndrome requiring emergent microdiscectomy. Complications included 4 cases of postoperative CSF leak (2.0%), 1 case of a noted intraoperative CSF leak, and 3 cases of wound infection (1.5%). At the first postoperative follow-up appointment, minimal or no pain was reported by 93.3% of patients. The mean time to return to sports was 9.8 weeks. During a mean follow-up duration of 8.2 years, 72.9% of patients did not present again after routine postoperative appointments. The total risk of reoperation was a rate of 7.5% (3.5% of patients underwent reoperation for the same level; 4.5% underwent adjacent-level decompression, and one patient [0.5%] ultimately underwent a fusion).CONCLUSIONSMicrodiscectomy is a safe and effective treatment for long-term relief of pain and return to daily activities among pediatric patients with symptomatic lumbar disc disease in whom conservative management has failed.

LAPAROSCOPIC TRANS-ABDOMINAL PRE-PERITONEAL (TAPP) REPAIR FOR TREATMENT INGUINAL HERNIA DISEASE

2018 ◽  
Vol 8 (4) ◽  
pp. 76-80
Author(s):  
Thao Nguyen Minh ◽  
Vu Pham Anh ◽  
Tri Nguyen Huu ◽  
Phu Nguyen Doan Van ◽  
Phuc Nguyen Thanh ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Operative Time ◽  
Bilateral Hernia ◽  
Repair Method ◽  
Tapp Repair ◽  
Post Operation ◽  
Average Operative Time ◽  
The Mean

Background: Inguinal hernia is one of the commonest surgical diseases and there are many different techniques applied. The laparoscopic trans-abdominal pre-peritoneal (TAPP) repair allows a better view of the inguinal anatomy, evaluation of opposite side and resolve combined peritoneal diseases as well. Patient and method: The study included 60 cases with inguinal hernia that have been treated by laparoscopic transabdominal pre-peritoneal (TAPP) repair. Method: Description, prospective follow-up. Result: The mean age was 58±18.2. 96.7% were males. The average operative time was 45.6±15.1 minutes for one side hernia, 73±25.2 minutes for bilateral hernia. 02 cases have been post-operation inguinal seroma complication (3.3%), 02 cases with hydrocele (3.3%), 01 case with abdominal seroma (1.7%). 04 cases (6.7%) opposite inguinal hernia were detected and 05 cases (8.3%) with combined diseases were resolved. Duration of post-operative stay was 3.9±1.1 days. Conclusion: TAPP is a safe and feasible procedure, allows evaluation of opposite side and resolve combined peritoneal diseases.

EVALUATION OF LONGO’S HEMORRHOIDECTOMY AT HUE UNIVERSITY HOSPITAL

2012 ◽  
pp. 79-85
Author(s):  
Van Lieu Nguyen ◽  
Doan Van Phu Nguyen ◽  
Thanh Phuc Nguyen
Keyword(s):  
Hospital Stay ◽  
Perioperative Complications ◽  
University Hospital ◽  
Anal Pain ◽  
Stapled Hemorrhoidectomy ◽  
Fourth Degree ◽  
Duration Of Hospital Stay ◽  
The Mean ◽  
Good For

Introduction: Since Longo First described it in 1998, Stapled Hemorrhoidectomy has been emerging as the procedure of choice for symtomatic hemorrhoid. Several studies have shown it to be a safe, effective and relative complication free procedure. The aim of this study was to determine the suitability of (SH) as a day cas procedure at Hue University Hospital. Methods: From Decembre 2009 to April 2012, 384 patients with third- degree and fourth-degree hemorrhoids who underwent Stapled Hemorrhoidectomy were included in this study. Parameters recorded included postoperative complications, analegic requirements, duration of hospital stay and patient satisfaction. Follow-up was performed at 1 month and 3 months post-operative. Results: Of the 384 patients that underwent a Stapled Hemorrhoidectomy 252 (65,7%) were male and 132 (34,3%) were female. The mean age was 47,5 years (range 17-76 years. Duration of hospital stay: The mean day was 2,82 ± 1,15 days (range 1-6 days). There were no perioperative complications. There was one case postoperative complication: hemorrhage; Follow-up after surgery: 286 (74,4%) patients had less anal pain, 78 (20,3%) patients had moderate anal pain, 3 (0,8%) patients had urinary retention; Follow-up after one month: good for 325 (84,6%) patients, average for 59 (15,4%) patients; Follow-up after three months: good for 362 (94,3%) patients, average for 22 (5,7%) patients. Conclusion: Our present study shows that Stapled Hemorrhoidectomy is a safe, reduced postoperative pain, shorter hospital stay and a faster return to unrestricted daily activity

scholarly journals Incomplete Kawasaki disease - a diagnostic and therapeutic challenge

2014 ◽  
Vol 9 (4) ◽  
pp. 30-35
Author(s):  
S Datta ◽  
S Maiti ◽  
G Das ◽  
A Chatterjee ◽  
P Ghosh
Keyword(s):  
Kawasaki Disease ◽  
Intravenous Immunoglobulin ◽  
Incomplete Kawasaki Disease ◽  
Duration Of Symptoms ◽  
Clinical Criteria ◽  
Echocardiographic Finding ◽  
2D Echocardiography ◽  
Acquired Heart Disease ◽  
The Mean ◽  
One Year

Background The diagnosis of classical Kawasaki Disease was based on clinical criteria. The conventional criteria is particularly useful in preventing over diagnosis, but at the same time it may result in failure to recognize the incomplete form of Kawasaki Disease. Objective To suspect incomplete Kawasaki Disease, because early diagnosis and proper treatment may reduce substantial risk of developing coronary artery abnormality which is one of the leading causes of acquired heart disease in children. Method Nine cases of incomplete Kawasaki Disease were diagnosed over a period of one year. The diagnosis of incomplete Kawasaki Disease was based on fever for five days with less than four classical clinical features and cardiac abnormality detected by 2D- echocardiography. A repeat echocardiography was done after 6 weeks of onset of illness. The patients were treated with Intravenous Immunoglobulin and/or aspirin. Result The mean age of the patients was 3.83 years and the mean duration of symptoms before diagnosis was 12.1 days. Apart from other criteria all of our patients had edema and extreme irritability. All the patients had abnormal echocardiographic finding. Five patients received only aspirin due to nonaffordability of Intravenous Immunoglobulin and four patients received both aspirin and Intravenous Immunoglobulin, but the outcome was excellent in all the cases. Conclusion Incomplete Kawasaki Disease can be diagnosed with more awareness and aspirin alone may be used as a second line therapy in case of non affordability of Intravenous Immunoglobulin. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-4, 30-35 DOI: http://dx.doi.org/10.3126/jcmsn.v9i4.10234

Diagnostic Utility of Lower Extremity Radiographs of Young Children With Gait Disturbance

PEDIATRICS ◽  
1991 ◽  
Vol 87 (2) ◽  
pp. 138-140
Author(s):  
Steven D. Blatt ◽  
Bruce M. Rosenthal ◽  
Douglas C. Barnhart
Keyword(s):  
Lower Extremity ◽  
Failure To Thrive ◽  
Gait Disturbance ◽  
Diagnostic Utility ◽  
Duration Of Symptoms ◽  
Soft Tissue Swelling ◽  
Chief Complaints ◽  
The Mean ◽  
Limiting Condition

The diagnostic utility of lower extremity radiographs was evaluated using 84 outpatients 1 to 5 years of age with gait disturbance whose lower extremities appeared physically normal. Chief complaints included limp (65 children [77%]), refusal to walk or stand (37 children [44%]), and frequent falling (6 children [7%]). A total of 43 children (51%) had more than one complaint. The mean age of patients was 26 months and the median duration of symptoms was 1 day. Trauma was reported in 43 (51%) cases and fever in 14 (17%). Results of radiographical studies appeared normal in 81 children (96%), demonstrated soft tissue swelling in 2 children, and revealed a bony island in 1 child. In 1 patient admitted to the hospital for failure to thrive and irritability, and whose radiographic results appeared normal, findings consistent with osteomyelitis later developed. Of the remaining children, 68 (81%) were available for follow-up observation 4 to 28 months after the initial visit and all reported spontaneous resolution of the initial complaint. It was concluded that in a well-appearing child with an otherwise normal physical examination results, an acute gait disturbance is likely to be a self-limiting condition and radiographs are unlikely to contribute to the diagnosis.

scholarly journals Meningiomas of pineal region in children

2007 ◽  
Vol 65 (4a) ◽  
pp. 1000-1006 ◽  
Author(s):  
Hamilton Matushita ◽  
Fernando Campos Pinto ◽  
José Píndaro Pereira Plese
Keyword(s):  
Clinical Presentation ◽  
Complete Removal ◽  
Pineal Region ◽  
Total Resection ◽  
Long Term Follow Up ◽  
One Year ◽  
Velum Interpositum ◽  
Transtentorial Approach

Meningiomas are uncommon tumors in children and either more rarely encountered in the pineal region. We report two cases of meningioma of the pineal region in children. One of these cases was a five years-old girl and the other a one year-old boy. No specific clinical presentation or tomographic examinations findings was identified before treatment, suggestive of a diagnosis of menigioma. The clinical and laboratory features were very similar to the most common tumors of the pineal region. Prior to the surgery, the histology of these tumors was not suspected. Both patients underwent direct surgery and complete removal was achieved by a suboccipital transtentorial approach. The tumors originated from velum interpositum in both cases. At the follow up, one case presented with recurrence six years later, and she underwent a reoperation with total resection without morbidity. Long-term follow up presented no other recurrences.

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