Techniques for overcoming a missing clip during pre-operative needle localization for lumpectomy: case report

Abstract BACKGROUND AND IMPORTANCE In cases of severe nerve trauma with significant local soft tissue damage, identification and subsequent repair of nerve stumps can pose a technical challenge. Ultrasound (US) localization in peripheral nerve surgery has recently become popular. We present a case report illustrating the use of needle-wire localization systems to identify proximal and several distal branches of an injured femoral nerve with a large segmental defect in order to illustrate how such techniques can be used to make surgical repair more efficient, particularly with identifying the distal stump(s). CLINICAL PRESENTATION We illustrate a case of a 16-yr-old female involved in a traumatic accident that lead to a severe injury of the femoral nerve and artery. The patient presented with a 7.3-cm defect between the proximal and distal aspect of the femoral nerve and its branches, respectively. High-resolution US was used to identify the proximal, large femoral nerve, and 3 distal stumps. By enlisting our musculoskeletal radiology team, we were able to trace distal branches of the femoral nerve and see their target muscles. Three separate US flexible needles were used to locate small muscular branches of the femoral nerve and 1 to locate the proximal stump. Intraoperatively, the localization wires allowed for safe and efficient dissection of proximal and distal nerve stumps in a significantly scarred and edematous plane. CONCLUSION US-guided needle-wire localization has shown promise in identifying the distal stumps and minimizing tissue dissection. Preoperative US guidance significantly aided in nerve repair for this severe injury without increasing morbidity.

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Misophonia: An Evidence-Based Case Report

American Journal of Audiology ◽

10.1044/2020_aja-19-00111 ◽

2020 ◽

Vol 29 (4) ◽

pp. 685-690

Author(s):

C. S. Vanaja ◽

Miriam Soni Abigail

Keyword(s):

Quality Of Life ◽

Case Report ◽

Case History ◽

Pure Tone ◽

Physiological Responses ◽

Evidence Based ◽

Management Option ◽

Pure Tone Audiogram

Purpose Misophonia is a sound tolerance disorder condition in certain sounds that trigger intense emotional or physiological responses. While some persons may experience misophonia, a few patients suffer from misophonia. However, there is a dearth of literature on audiological assessment and management of persons with misophonia. The purpose of this report is to discuss the assessment of misophonia and highlight the management option that helped a patient with misophonia. Method A case study of a 26-year-old woman with the complaint of decreased tolerance to specific sounds affecting quality of life is reported. Audiological assessment differentiated misophonia from hyperacusis. Management included retraining counseling as well as desensitization and habituation therapy based on the principles described by P. J. Jastreboff and Jastreboff (2014). A misophonia questionnaire was administered at regular intervals to monitor the effectiveness of therapy. Results A detailed case history and audiological evaluations including pure-tone audiogram and Johnson Hyperacusis Index revealed the presence of misophonia. The patient benefitted from intervention, and the scores of the misophonia questionnaire indicated a decrease in the severity of the problem. Conclusions It is important to differentially diagnose misophonia and hyperacusis in persons with sound tolerance disorders. Retraining counseling as well as desensitization and habituation therapy can help patients who suffer from misophonia.

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Intensive Stuttering Therapy With Telepractice Follow-up: A Case Study

Perspectives on Fluency and Fluency Disorders ◽

10.1044/ffd21.1.11 ◽

2011 ◽

Vol 21 (1) ◽

pp. 11-21 ◽

Cited By ~ 2

Author(s):

Farzan Irani ◽

Rodney Gabel

Keyword(s):

Case Report ◽

Therapeutic Intervention ◽

Intensive Therapy ◽

Positive Outcome ◽

Eclectic Approach

This case report describes the positive outcome of a therapeutic intervention that integrated an intensive, residential component with follow-up telepractice for a 21 year old male who stutters. This therapy utilized an eclectic approach to intensive therapy in conjunction with a 12-month follow-up via video telepractice. The results indicated that the client benefited from the program as demonstrated by a reduction in percent stuttered syllables, a reduction in stuttering severity, and a change in attitudes and feelings related to stuttering and speaking.

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A Tape-Recorded Therapy Method for Stutterers: A Case Report

Journal of Speech and Hearing Disorders ◽

10.1044/jshd.3502.188 ◽

1970 ◽

Vol 35 (2) ◽

pp. 188-193 ◽

Cited By ~ 4

Author(s):

Maryann Peins ◽

Bernard S. Lee ◽

W. Edward McGough

Keyword(s):

Case Report

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The Use of Real-Time Visual Displays of Speech in the Training of a Profoundly Deaf, Nonspeaking Child: A Case Report

Journal of Speech and Hearing Disorders ◽

10.1044/jshd.3603.397 ◽

1971 ◽

Vol 36 (3) ◽

pp. 397-409 ◽

Cited By ~ 10

Author(s):

Rachel E. Stark

Keyword(s):

Case Report ◽

Real Time ◽

Speech Production ◽

Behavior Problem ◽

Deaf Children ◽

Developmental Sequence ◽

Visual Displays ◽

Individual Instruction ◽

Academic Record ◽

Extract Information

Real-time amplitude contour and spectral displays were used in teaching speech production skills to a profoundly deaf, nonspeaking boy. This child had a visual attention problem, a behavior problem, and a poor academic record. In individual instruction, he was first taught to produce features of speech, for example, friction, nasal, and stop, which are present in vocalizations of 6- to 9-month-old infants, and then to combine these features in syllables and words. He made progress in speech, although sign language and finger spelling were taught at the same time. Speech production skills were retained after instruction was terminated. The results suggest that deaf children are able to extract information about the features of speech from visual displays, and that a developmental sequence should be followed as far as possible in teaching speech production skills to them.

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Erratum: Recurrent Laryngeal Nerve Dissection

Journal of Speech and Hearing Disorders ◽

10.1044/jshd.4503.427b ◽

1980 ◽

Vol 45 (3) ◽

Author(s):

Frank B. Wilson ◽

D. J. Oldring ◽

Kathleen Mueller

Keyword(s):

Case Report ◽

Recurrent Laryngeal Nerve ◽

Laryngeal Nerve ◽

Long Period ◽

Initial Surgery

On page 112 of the report by Wilson, Oldring, and Mueller ("Recurrent Laryngeal Nerve Dissection: A Case Report Involving Return of Spastic Dysphonia after Initial Surgery," pp. 112-118), the paraphrase from Cooper (1971), "if the patients are carefully selected and are willing to remain in therapy for a long period of time," was inadvertantly put in quotation marks.

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