Diagnosis and management of neglected foreign body foot in children

Background: Foreign body related extremity trauma is uncommon in children and mostly involves lower limb. Such cases are prone to get neglected or missed and present at a later date with complications. Careful management at the outset can avoid such complications. Clinical suspicion followed by diagnostic imaging and retrieval of foreign bodies in cases with delayed presentation is vital. Methods: A retrospective case series analysis of foreign body foot, diagnosed and managed over a period of 6 years, was carried out at our institute with the aim to highlight clinical presentation and management of cases with a neglected foreign body foot.Results: A total of 23 patients with diagnosis of foreign body foot were studied with 15 acute cases and 8 chronic neglected cases. The neglected cases ranged in age from 15 months to 96 months (Mean 58.87±28.32). Male to female ratio was 7:1. The history of trauma was concealed in 6 out of 8 cases. Three presented as abscess, 2 each as cellulitis and non-healing wound and one as a granuloma. Mean delay in foreign body removal was 57.12±67.94 days. Five patients had radiolucent while three had radiopaque foreign bodies.Conclusions: Clinical suspicion aided by radiography and/or ultrasonography is pivotal in diagnosis. Removal of foreign body can be done by wound exploration under local anaesthesia in most of the cases.

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63. Prognosis of COVID-19 Patients with Diabetic Ketoacidosis with or Without Hyperosmolar Hyperglycemic State

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.373 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S163-S163

Author(s):

Kok Hoe Chan ◽

Divya Thimmareddygari ◽

Amr Ramahi ◽

Liana Atallah ◽

Jihad Slim

Keyword(s):

Diabetes Mellitus ◽

Diabetic Ketoacidosis ◽

Case Series ◽

Plasma Osmolality ◽

Retrospective Case ◽

Female Ratio ◽

Hyperosmolar Hyperglycemic State ◽

History Of ◽

Male To Female

Abstract Background One of the risk factors for poor outcome with SARS-CoV-2 infection is diabetes mellitus; diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are the most serious complications of diabetes mellitus. We aimed to explore the clinical characteristics and outcomes of COVID-19 patients presenting with isolated DKA or combined DKA/HHS to our institution. Methods A retrospective, hospital based observation case series was performed on patients with SARS-CoV-2 admitted to Intensive Care Unit between 03/20/20 and 04/20/20. Inclusion criteria were: 1) Blood Glucose >250mg/dL; 2) Serum bicarbonate < 18 mmol/L; 3) Anion Gap >10; 4) serum pH < 7.3; 4) ketonemia or ketonuria; and 5) positive SARS-CoV-2 RT-PCR. Hyperosmolality, on the other hand, was defined as an effective/calculated plasma osmolality >304 mOsm/kg. Results A total of 87 patients with COVID-19 were admitted to the ICU during the study period, 12 of them had either isolated DKA or DKA/HHS. Baseline demographics, lab values and outcome are summarized in Table 1. Six of the patients had isolated DKA and six had combined DKA and HHS. The median age for the patient was 49.5 years old (range from 19 to 62 years old). The male to female ratio was 5:1. Of the 12 patients, 10 patients (83%) had a history of DM, nine were type 2 and only one type 1; two patients were newly diagnosed DM, presenting as DKA, presumptively precipitated by COVID-19. Five patients (42%) had a BMI >30 kg/m2. As for ethnicity; seven were Hispanic (59%), four African American (33%), and one Caucasian (8%). Patients with combined DKA/HHS, higher BMI, higher HbA1c, severe acidosis tended to have higher mortality. The striking feature was that isolated DKA or combined DKA/HHS was the initial presentation for COVID-19 for most of the cases. Table 1: Demographic characteristic, inflammatory markers and outcome. Conclusion Our observational retrospective case series reinforces the need to watch for new onset DM and monitor blood sugar closely in those with known diabetes mellitus during SARS-CoV-2 infection, in order to avoid such serious complications as DKA and HHS. Disclosures Jihad Slim, MD, Abbvie (Speaker’s Bureau)Gilead (Speaker’s Bureau)Jansen (Speaker’s Bureau)Merck (Speaker’s Bureau)ViiV (Speaker’s Bureau)

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Incidence and Risk Factors of Symptomatic Venous Thromboembolism Following Foot and Ankle Surgery

Foot & Ankle International ◽

10.1177/1071100718794851 ◽

2018 ◽

Vol 40 (1) ◽

pp. 98-104 ◽

Cited By ~ 5

Author(s):

Johanna Marie Richey ◽

Miranda Lucia Ritterman Weintraub ◽

John M. Schuberth

Keyword(s):

Risk Factors ◽

Hormone Replacement ◽

Case Series ◽

Foot And Ankle ◽

Retrospective Case ◽

Level Of Evidence ◽

Ankle Surgery ◽

History Of ◽

Low Incidence ◽

Predictive Risk

Background: The incidence rate of venous thrombotic events (VTEs) following foot and ankle surgery is low. Currently, there is no consensus regarding postoperative prophylaxis or evidence to support risk stratification. Methods: A 2-part study assessing the incidence and factors for the development of VTE was conducted: (1) a retrospective observational cohort study of 22 486 adults to calculate the overall incidence following foot and/or ankle surgery from January 2008 to May 2011 and (2) a retrospective matched case-control study to identify risk factors for development of VTE postsurgery. One control per VTE case matched on age and sex was randomly selected from the remaining patients. Results: The overall incidence of VTE was 0.9%. Predictive risk factors in bivariate analyses included obesity, history of VTE, history of trauma, use of hormonal replacement or oral contraception therapy, anatomic location of surgery, procedure duration 60 minutes or more, general anesthesia, postoperative nonweightbearing immobilization greater than 2 weeks, and use of anticoagulation. When significant variables from bivariate analyses were placed into the multivariable regression model, 4 remained statistically significant: adjusted odds ratio (aOR) for obesity, 6.1; history of VTE, 15.7; use of hormone replacement therapy, 8.9; and postoperative nonweightbearing immobilization greater than 2 weeks, 9.0. The risk of VTE increased significantly with 3 or more risk factors ( P = .001). Conclusion: The overall low incidence of VTE following foot and ankle surgery does not support routine prophylaxis for all patients. Among patients with 3 or more risk factors, the use of chemoprophylaxis may be warranted. Level of Evidence: Level III, retrospective case series.

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Chronic subdural hematomas: a case series from the medical ward of a north Tanzanian referral hospital

Egyptian Journal of Neurosurgery ◽

10.1186/s41984-019-0054-7 ◽

2019 ◽

Vol 34 (1) ◽

Author(s):

Sakina Mehboob Rashid ◽

Shahrzad Seyedeh Deliran ◽

Marieke Cornelia Johanna Dekker ◽

William Patrick Howlett

Keyword(s):

Mortality Rate ◽

Case Series ◽

Medical Ward ◽

Sub Saharan Africa ◽

Neurological Deficits ◽

Definitive Treatment ◽

Delayed Presentation ◽

General Medical Ward ◽

Subdural Hematomas ◽

History Of

Abstract Background Chronic subdural hematomas (CSDH) initially present as focal neurological deficits with or without signs of increased intracranial pressure, for which admission to the general medical ward may occur if they present with poorly understood neurological deficits and no evident history of trauma. The symptoms may be long standing and mimic stroke upon presentation. Their distribution and specific clinical features in sub-Saharan Africa are largely unknown. Methods We describe a series of subdural hematoma (SDH) inpatients from the medical ward of a tertiary referral center in Northern Tanzania, describing clinical and radiological characteristics and providing clinical outcome where possible. Results Our study population numbered 30, with a male majority (n = 19, 63.3%) and a mean age of 66.8 ± 14.5 years. Mean duration from symptom onset to admission in the medical ward was 20.0 ± 30.8 days. History of head injury was reported in only 43.3% of patients. Improvement in the neurological examination was noted in 68.1% of the 22 patients who underwent surgery. The mortality rate was 20.0%. Conclusion A majority of the patients were elderly males and presented late to the hospital. Delayed presentation and diagnosis due to, amongst other reasons, postponed imaging resulted in a prolonged time to definitive treatment and a high mortality rate compared to other regions of the world.

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Tracheo-bronchial foreign bodies: our experience at a tertiary care hospital

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20161848 ◽

2016 ◽

Author(s):

Shashidhar S. Suligavi ◽

Mallikarjun N. Patil ◽

S. S. Doddamani ◽

Chandrashekarayya S. Hiremath ◽

Afshan Fathima

Keyword(s):

Foreign Body ◽

Early Diagnosis ◽

Foreign Bodies ◽

Tertiary Care ◽

Case Series ◽

Team Work ◽

Care Hospital ◽

Retrospective Case ◽

Presenting Symptoms ◽

Case Series Study

Background:Tracheo- bronchial foreign bodies have always posed a challenge to the ENT surgeon as they present with varied symptomatology ranging from a simple cough and fever to more grave respiratory distress. It requires a strong suspicion, early diagnosis and timely intervention to reduce the overall morbidity and mortality .This study was undertaken to highlight our experiences in handling cases of tracheo- bronchial foreign bodies (FB) at our setup.Methods:It is a retrospective case series study conducted in S. Nijalingappa Medical College between January 2011 and January 2015. Results:Most commonly affected were children between 1year to 3years of age. Chronic cough and wheeze were the commonest presenting symptoms. Vegetative foreign body was found to be the commonest variety of foreign body. The mortality rate in our study was 4.7% (n=3).Conclusions:A good clinical acumen, team work, early diagnosis and timely intervention are all needed to reduce the overall mortality and morbidity associated with tracheo- bronchial foreign bodies.

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Prognostic Factors in Paranasal Sinus Squamous Cell Carcinoma and Adenocarcinoma: A SEER Database Analysis

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1669420 ◽

2018 ◽

Vol 80 (03) ◽

pp. 258-263 ◽

Cited By ~ 10

Author(s):

Sumit Jain ◽

Yan Li ◽

Edward C. Kuan ◽

Bobby A. Tajudeen ◽

Pete S. Batra

Keyword(s):

Squamous Cell Carcinoma ◽

Multivariate Analysis ◽

Prognostic Factors ◽

Cell Carcinoma ◽

Paranasal Sinus ◽

Squamous Cell ◽

Case Series ◽

Stage Iv ◽

Retrospective Case ◽

Female Ratio

Background Outcome studies on sinonasal malignancy are limited to retrospective case series, often with inclusion of diverse histology and short follow-up. The objective of this study was to identify key predictive variables that independently impact survival for paranasal sinus squamous cell carcinoma (SCC) and adenocarcinoma (AC) and to compare these variables in the context of these two distinct clinicopathologic entities. Methods: Analysis was conducted using the Surveillance, Epidemiology, and End Results database from 1973 to 2012 to identify key variables that impact survival for SCC and AC. Results A total of 3,714 cases were included. There were 2,895 SCC cases and 819 AC cases. The mean age at diagnosis was 64.1 years. The male to female ratio for SCC and AC was 1.85 and 1.04, respectively. Patients with SCC and AC were most often diagnosed with stage IV disease in 61.8 and 63.4% of cases, respectively. The majority of patients received combined surgery and radiation (52% for SCC and 43.1% for AC). For SCC, increased age (p < 0.001) and stage (p < 0.001) were negative predictors, and surgery improved survival (p < 0.001) on multivariate analysis. For AC, prognostic factors associated with worse survival include increased age (p < 0.001) and grade (p < 0.001) on multivariate analysis. Overall survival was significantly higher in AC compared with SCC at 5 years (p = 0.001). Conclusion SCC and AC of the paranasal sinuses are both aggressive malignancies with poor survival. For both histological subtypes, increased age predicts worse survival and grade also closely links to survival in AC. These data have important potential implications for treatment planning and pretreatment counseling.

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The natural history of traumatic femur head necrosis after femoral neck fracture in children and adolescent: a retrospective case series of 64 patients

10.21203/rs.3.rs-17536/v1 ◽

2020 ◽

Author(s):

Fan Yang ◽

Yonggang Tu ◽

Zhinan Hong ◽

Fengxiang Pang ◽

Wei He ◽

...

Keyword(s):

Femoral Head ◽

Natural History ◽

Case Series ◽

Retrospective Case ◽

Children And Adolescent ◽

Femoral Head Collapse ◽

Lateral Subluxation ◽

Hip Deformity ◽

Neck Fracture ◽

History Of

Abstract Background: The natural history of traumatic femur head necrosis (TFHN) after femoral neck fracture (FNF) in children and adolescent is relatively unknown and has never been specifically characterized. As we speculated, the natural history in such population would be poor and characterized as the high risk of femoral head collapse, hip deformity and degeneration in a short term. Methods: This retrospective case series enrolled 64 children and adolescent with TFHN who treated with observational treatment from 2000.1 to 2018.1. The primary outcomes, such as the progression of femoral head collapse, hip deformity (Stulberg classification) and hip degeneration (Tönnis grade), and their prognostic factors were analysed. Results: 42 males and 22 females with a mean age of 13 years (6-16 years), were included. A total of 28 hips (44%) showed unsatisfactory outcome and Twenty-five (39%) hips collapsed progressively during a mean follow-up of 48 months (24-203 months). Finally, 38 hips (59%) experienced hip deformity, 20 of them were class IV/V. 34 hips (53%) generally progressed to osteoarthritis, 14 of them were classified as grades II/III. The location of the lesion and the presence of lateral subluxation were found to be independently related to progression of femoral head collapse; however, the presence of lateral subluxation was the only independent risk factor of severe hip deformity and degeneration. Conclusion: TFHN in children and adolescent is a rapidly progressing disease with a poor natural history characterized by a high risk of femoral head collapse progression. If the lateral subluxation emerged, collapsed cases showed increasingly tendency towards severe hip deformity and degeneration.

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Increase of foreign body and harmful substance ingestion and associated complications in children: a retrospective study of 1199 cases from 2005 to 2017

10.21203/rs.3.rs-45920/v1 ◽

2020 ◽

Author(s):

Arne Speidel ◽

Lena Woelfle ◽

Benjamin Mayer ◽

Carsten Posovszky

Keyword(s):

Foreign Body ◽

Linear Regression Analysis ◽

Harmful Substance ◽

Female Ratio ◽

Retrospective Data Analysis ◽

Asymptomatic Children ◽

Classification Of Diseases ◽

International Statistical Classification ◽

History Of ◽

The University

Abstract Background Children with a history of caustic or foreign body ingestions (FBI) are frequently presented at the emergency department. An uncertain case history, the different objects and diverse clinical presentation may complicate or delay a proper management and cause serious complications. Methods A structured retrospective data analysis of patients presented in between January 2005 and December 2017 at the University Medical Centre Ulm was performed. All patients up to 17 years of age with food impaction, foreign body or harmful substance ingestion were included by selection of the corresponding International Statistical Classification of Diseases and Related Health Problems (ICD10-GM) codes. Descriptive statistics, parametric or non-parametric tests, and linear regression analysis were performed. Result In total, 1199 cases were analysed; mean age 3.3 years (SD 3.12; range 7 days to 16 years), male to female ratio 1.15:1, thereof 194 (16.2%) were hospitalized. The majority (n = 619) had no symptoms, 244 out of 580 symptomatic patients complained retching or vomiting. The annually recorded cases increased from 66 in 2005 to 119 in 2017 with a rise of the percentage of all emergency cases by 0.52% since 2010 to 1.34% in 2017. Most frequently, coins were ingested (18,8%). Radiopaque objects accounted for 47.6%, and sharp objects for 10.5% of the FBI, which were significantly more often ingested by girls (p < 0.000015 and p < 0.000024, respectively). Button battery ingestion was recorded in 63 cases with a significant annual increase (R2 = 0.57; beta = 0,753; p < 0.003). The annual rate of complications raised significantly (R2 = 0.42; beta = 0,647; p < 0.017). Conclusion Children with FBI are increasingly presented at emergency departments. Special attention is necessary to prevent serious complications, especially in asymptomatic children. Further preventive measures within the home environment are needed to stop this trend.

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Orbital cholesterol granuloma: a retrospective case series

10.21203/rs.3.rs-1011890/v1 ◽

2021 ◽

Author(s):

Yun Zhao ◽

Jingwen Hui ◽

Shasha Yu ◽

Jinyong Lin ◽

Hong Zhao

Keyword(s):

Case Series ◽

Recurrence Time ◽

Cholesterol Granuloma ◽

Pathological Features ◽

Retrospective Case ◽

Orbital Trauma ◽

Retrospective Case Series ◽

Lateral Orbitotomy ◽

Case Series Study ◽

History Of

Abstract Background To review the clinical features, radiographic features, therapy, pathological features and prognosis of orbital cholesterol granuloma(CG). Methods Twelve patients with orbital CG who were referred to Tianjin Eye Hospital between January 2002 and December 2020 were include in this retrospective case series study. Data collected included patient ophthalmic manifestations, imaging finding, treatment strategies, pathological features and prognosis were retrospectively reviewed. Results The patients comprised 10 males and 2 females. The mean age was 34.5±8.9 years(range 16 to 45 years). Four patients had a history of orbital trauma. The clinical manifestations at first visit were proptosis ( 7/12, 58.3%), periorbital or eyelids swelling (6/12,50%), limitation of eye displacement (4/12,33.3%), ptosis(2/12,16.7%), decreased visual acuity (1/12,8.3%).CT showed a non-enhancing,well-circumscribed lesion in the orbit with extensive erosion of the adjacent frontal bone and temporal bone.MRI showed a non-enhancing mass with intermediate to high signal intensity on T1- and T2-weighted imaging. Ten patients underwent lateral orbitotomy, and two patient underwent supraorbital orbitotomy,.All patients had aggressive bone erosion. Histopathologic evaluation of the cyst contents and wall revealed cholesterol clefts,multinucleated giant cells,histiocytes, foamy macrophages,and altered blood pigments. The median recurrence time of 79.6±49.8 months (range 19 month to 193 months). Three patients were lost to follow-up. No postoperative diminution of vision was noted,and no recurrence was observed. Conclusions Cholesterol granulomas can present as superiotemporal or temporal orbital lesions. The diagnosis can be established based on CT and MRI. Most of patients can have no history of orbital trauma.

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Massive ear keloids: Natural history, evaluation of risk factors and recommendation for preventive measures – A retrospective case series

F1000Research ◽

10.12688/f1000research.9504.1 ◽

2016 ◽

Vol 5 ◽

pp. 2517 ◽

Cited By ~ 2

Author(s):

Michael Tirgan

Keyword(s):

Risk Factors ◽

Natural History ◽

Medical Literature ◽

Preventive Measures ◽

Case Series ◽

Retrospective Case ◽

Ear Piercing ◽

Keloid Formation ◽

History Of ◽

Triggering Factor

Keloid disorder (KD) is an inherited wound healing ailment, frequently seen among Africans /African Americans and Asians. Genetics of this disorder continues to be obscure and poorly understood. Clinical manifestation of KD is quite variable and very diverse, spanning from individuals with one or very few small keloidal lesions, to those with numerous and very large lesions covering large portion of their skin. Ears are common locations for development of keloids. Ear piercing is by far the leading triggering factor for ear keloid formation in genetically predisposed individuals. Although there are numerous publications about ear and earlobe keloids, there is a void in medical literature about massive ear keloids. This paper focuses on the natural history of massive ear keloids and risk factors that lead to formation of these life-changing and debilitating tumors and recommendations for prevention.

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Oesophageal ulceration in adult patients treated with doxycycline for acne vulgaris

Journal of International Medical Research ◽

10.1177/0300060519881272 ◽

2019 ◽

Vol 47 (12) ◽

pp. 6404-6409

Author(s):

Yan Guo ◽

Hua-Ming Li ◽

Chun-Xia Li ◽

Wei-Qin Zhu ◽

Yu-Fang Wang ◽

...

Keyword(s):

Acne Vulgaris ◽

Case Series ◽

Adult Patients ◽

Retrospective Case ◽

Drug Induced ◽

Endoscopic Findings ◽

The Third ◽

Oesophageal Ulceration ◽

History Of ◽

Lying Down

Objective To report drug-induced oesophageal ulceration in adult patients treated with doxycycline for acne vulgaris. Methods This retrospective case series included data from adult patients treated with oral doxycycline therapy for acne vulgaris, who had presented with oesophageal ulceration at the Third People’s Hospital of Hangzhou between June 2016 and December 2017, and whose diagnosis was confirmed by gastroscopy. Clinicodemographic data were analysed, including symptom onset, endoscopy results, that were assessed for classic features of oesophageal ulceration. Patients were questioned regarding medication intake. Results A total of 12 patients were included (mean age, 23.50 ± 3.20 years), eight (66.67%) of whom were female. Based on history of medication and endoscopic findings, these patients were diagnosed with doxycycline-induced oesophageal ulceration. Most patients were found to have taken the medication at bedtime, just before lying down, and/or with insufficient water. Conclusion Doxycycline may cause oesophageal irritation when not taken with sufficient water, or taken just before lying down to sleep. Prescribing physicians should be aware of these issues, and instruct patients as to the correct method for intake of doxycycline.

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