scholarly journals Atlantoaxial subluxation in the pediatric patient: Case series and literature review

2020 ◽  
Vol 4 (2) ◽  
pp. 069-074
Author(s):  
Mazzola Catherine A ◽  
Christie Catherine ◽  
Snee Isabel A ◽  
Iqbal Hamail
Keyword(s):  
Cervical Spine ◽  
Imaging Techniques ◽  
Case Series ◽  
Atlantoaxial Subluxation ◽  
Upper Cervical Spine ◽  
Atlantoaxial Joint ◽  
Retrospective Case ◽  
Ligamentous Laxity ◽  
Halo Traction ◽  
Increased Risk

Objective: Atlantoaxial subluxation (AAS) occurs when there is misalignment of the atlantoaxial joint. Several etiologies confer increased risk of AAS in children, including neck trauma, inflammation, infection, or inherent ligamentous laxity of the cervical spine. Methods: A single-center, retrospective case review was performed. Thirty-four patients with an ICD-10 diagnosis of S13.1 were identified. Demographics and clinical data were reviewed for etiology, imaging techniques, treatment, and clinical outcome. Results: Out of thirty-four patients, twenty-two suffered cervical spine trauma, seven presented with Grisel’s Syndrome, four presented with ligamentous laxity, and one had an unrecognizable etiology. Most diagnoses of cervical spine subluxation and/or instability were detected on computerized tomography (CT), while radiography and magnetic resonance imaging (MRI) were largely performed for follow-up monitoring. Six patients underwent cervical spine fusion, five had halo traction, twelve wore a hard and/or soft collar without having surgery or halo traction, and eight were referred to physical therapy without other interventions. Conclusion: Pediatric patients with atlantoaxial subluxation may benefit from limited 3D CT scans of the upper cervical spine for accurate diagnosis. Conservative treatment with hard cervical collar and immobilization after reduction may be attempted, but halo traction and halo vest immobilization may be necessary. If non-operative treatment fails, cervical spine internal reduction and fixation may be necessary to maintain normal C1-C2 alignment.

scholarly journals Recurrent Torticollis and Cervical Subluxation in a Pediatric Patient

2020 ◽  
pp. 1-3
Author(s):  
Catherine A. Mazzola ◽  
Hamail Iqbal ◽  
Catherine A. Mazzola
Keyword(s):  
Cervical Spine ◽  
Pediatric Patient ◽  
Head Tilt ◽  
Clinical History ◽  
Atlantoaxial Subluxation ◽  
Retrospective Case ◽  
Halo Vest ◽  
Limited Range Of Motion ◽  
Halo Traction ◽  
Cervical Subluxation

Background: Atlantoaxial subluxation (AAS), also referred to as C1-C2 subluxation, is a misalignment of the first two vertebrae of the cervical spine. AAS typically presents with a head tilt (torticollis) with limited range of motion (ROM). Torticollis is quite common in infants, but in older children, torticollis may be an indication of AAS. Method: In this retrospective case study, the clinical history of a female pediatric patient diagnosed with atlantoaxial subluxation presenting with recurrent torticollis is reviewed. Result: The patient was initially diagnosed with torticollis during infancy; torticollis partially resolved. However, after an ear infection, the child again developed torticollis secondary to Grisel’s Syndrome. Despite undergoing physical therapy treatments, torticollis persisted. The patient was referred to neurosurgery at age nine. AAS was diagnosed after a three-dimensional (3D) computed tomography (CT) scan. The child was subsequently placed in halo-traction to reduce the C1-C2 subluxation. Once the alignment was acceptable, the child was placed in a halo vest. However, even after several months of noninvasive cervical spine immobilization with a halo vest and hard cervical collar, the head tilt and cervical subluxation recurred due to bone remodeling. Conclusion: The diagnosis of AAS requires both a comprehensive physical examination and imaging following presentation of torticollis. Understanding the etiology of the torticollis early on is critical in preventing the occurrence of AAS after treatment.

scholarly journals AB0741 PREVALENCE AND ASSOCIATED FACTORS OF ATLANTO-AXIAL INSTABILITY IN PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1399.3-1400
Author(s):  
H. Bettaieb ◽  
H. Ferjani ◽  
K. Maatallah ◽  
H. Boussaa ◽  
D. Kaffel ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Cervical Spine ◽  
Disease Activity ◽  
Disease Onset ◽  
Atlantoaxial Subluxation ◽  
Upper Cervical Spine ◽  
Diagnosis Delay ◽  
Factors Associated ◽  
Increased Risk

Background:Atlanto-axial instability (AAI) is a serious complication during Juvenile Idiopathic Arthritis (JIA). It can lead to severe neurological morbidity or mortality if left untreated (1).Objectives:To determine the prevalence of AAI in patients with JIA and to identify factors associated with an increased risk of its occurrence.Methods:A retrospective monocentric study was carried out on JIA patients (ILAR criteria). Data, including age at disease onset, JIA type, disease activity at AAI diagnosis and treatment were collected. Disease activity at JIA diagnosis was evaluated by JADAS10 (Juvenile Arthritis Disease Activity Score) in poly and oligoarticular subtypes and by BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) in arthritis related enthesitis form. Standard radiographs of the cervical spine were analyzed. The data were analyzed using the SPSS statistical package. A p value < 0.05 was considered significant.Results:We enrolled 48 JIA (31 male and 17 female) with a mean age at disease onset of 11.2 ± 3.8 years. The median disease duration was 84 months [2-408]. The median JIA diagnosis delay was 8 months [1-108]. The JIA subgroups were in decreasing order of frequency: Enthesitis-related Arthritis (n=32), Polyarticular RF- (n=4), Polyarticular RF+ (n=2), Oligoarticular (n=6), Systemic (n=2), Psoriatic Arthritis (n=1) and Undifferentiated (n=1).At diagnosis, median ESR and CRP were 44 mm/hour [2-100] and 24 mg/l [2-86] respectively. Median JADAS10 score was 4 [0-21]. Median BASDAI score was 6.2 [2-9.4].At follow-up, five patients (10.4%) had atlantoaxial subluxation and 17 had coxitis (43.8%).At bone densitometry, 45% of patients had osteroposis and 27.5% had osteopenia.An agreement was assessed between a long diagnosis delay and the following parameters: male gender (p=0.04) and osteoporosis (p=0.018). A Significant positive correlation was found between delay in JIA diagnosis and BASDAI score (p=0.047, r=0.63). No association was found between JIA diagnosis delay and JADAS score (p=0.56). Neither ESR (p=0.19) nor CRP (p=0.42) was associated with JIA diagnosis delay.Finally, no link was observed with the occurrence of hip arthritis (p=0.281) or atlantoaxial subluxation (p=0.137).Conclusion:In our study, the prevalence of AAI was 10.4%. Prolonged corticosteroid use and elevated inflammatory markers were the major factors associated with an increased risk of upper cervical spine involvement. Hence, targeted treatments are required to prevent cervical spine instability.References:[1]Hospach T, Maier J, Müller-Abt P, Patel A, Horneff G, von Kalle T. Cervical spine involvement in patients with juvenile idiopathic arthritis - MRI follow-up study. Pediatr Rheumatol Online J. 2014;12:9.Disclosure of Interests:None declared

Coexistent Malignant Melanoma and Renal Cell Carcinoma

2009 ◽  
Vol 95 (4) ◽  
pp. 518-520 ◽  
Author(s):  
Balaji Venugopal ◽  
TR Jeffry Evans
Keyword(s):  
Renal Cell Carcinoma ◽  
Malignant Melanoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Renal Mass ◽  
Past History ◽  
Imaging Techniques ◽  
Case Series ◽  
Second Primary ◽  
Increased Risk

Patients with malignant melanoma are at an increased risk of developing subsequent primary melanomas and also nonmelanoma cutaneous cancers. Several studies have reported an association between malignant melanoma and breast cancer, bladder cancer, colorectal cancer, neuroectodermal tumours, non-Hodgkin's lymphoma, leukaemia and renal cell carcinoma. We report a case series of patients with a diagnosis of malignant melanoma who also developed a renal mass. In two of these cases, the renal mass became apparent on diagnostic imaging as part of the staging investigations at the time of initial diagnosis of the malignant melanoma. In both of these cases, biopsy of the renal mass confirmed the presence of a separate primary renal cell carcinoma which had presented concurrently with the malignant melanoma. A third case presented with bone metastases ten years after excision of a thin melanoma. Further imaging revealed pulmonary metastases and a renal mass, biopsy of which confirmed renal cell carcinoma. In contrast, a fourth patient underwent a right nephrectomy for a renal mass having presented with abdominal discomfort. The histology of this lesion was in keeping with metastatic melanoma, and the patient's past history included a diagnosis of ocular melanoma eight years prior to the development of metastatic disease in the right kidney. Survival rates for patients with many types of malignant disease are improving, and there have been significant advances in clinical imaging techniques. Consequently the development and detection of a second primary cancer, either presenting concurrently or on subsequent follow-up, is likely to be increasingly observed. The series of patients reported here highlights the importance of a diagnostic biopsy in patients with malignant melanoma who develop a renal mass in order to establish a diagnosis and to plan optimal treatment.

Short-term effects of an upper cervical spine traction-manipulation program in patients with cervicogenic dizziness: A case series study

2020 ◽  
Vol 33 (6) ◽  
pp. 961-967
Author(s):  
Andoni Carrasco-Uribarren ◽  
Jacobo Rodríguez-Sanz ◽  
Miguel Malo-Urriés ◽  
César Hidalgo-García ◽  
José Miguel Tricás-Moreno ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Case Series ◽  
Upper Cervical Spine ◽  
Cervical Pain ◽  
Case Series Study ◽  
Spine Mobility ◽  
Upper Cervical ◽  
Cervical Spine Manipulation ◽  
Cervicogenic Dizziness ◽  
Series Study

BACKGROUND: Damage on the somatosensory system could cause sensation of dizziness, a condition known as cervicogenic dizziness (CD). Manual physical therapy has shown beneficial effects, relieving the symptoms of cervicogenic dizziness. However, the effect of upper cervical spine manipulation is unknown, as this is a technique that respects the International Federation of Orthopedic Manipulative Physical Therapists (IFOMPT) safety criteria. OBJECTIVE: To assess the effects of upper cervical spine traction-manipulation in subjects with cervicogenic dizziness. METHODS: This was a descriptive case series study. Treatment focused on the upper cervical spine manipulation procedure. Evaluation was performed before and after the treatment. Variables recorded include upper and lower cervical range of motion, Cervical Flexion-Rotation Test (CFRT), dizziness intensity and cervical pain (VAS), self-perceived dizziness measured with Dizziness Handicap Inventory (DHI) and subjective perception of outcome (GROC-scale). RESULTS: Ten subjects were recruited. After the treatment protocol, there was an increased range of movement towards the most restricted side, as measured by the CFRT (p< 0.001), decreased intensity of dizziness (p< 0.001) and intensity of pain (p< 0.001). Functional capacity also improved after the intervention (p< 0.011). CONCLUSION: Upper cervical spine manipulation may decrease dizziness intensity and cervical pain and improve functional ability and upper cervical spine mobility in patients with cervicogenic dizziness.

Idiopathic syringomyelia: retrospective case series, comprehensive review, and update on management

2011 ◽  
Vol 31 (6) ◽  
pp. E15 ◽  
Author(s):  
Anil K. Roy ◽  
Nicholas P. Slimack ◽  
Aruna Ganju
Keyword(s):  
Conservative Management ◽  
Incidental Finding ◽  
Imaging Techniques ◽  
Case Series ◽  
Neurological Dysfunction ◽  
Type I ◽  
Retrospective Case ◽  
Chiari Malformation Type I ◽  
Comprehensive Review ◽  
Idiopathic Syringomyelia

Object A syrinx is a fluid-filled cavity within the spinal cord that can be an incidental finding or it can be accompanied by symptoms of pain and temperature insensitivity. Although it is most commonly associated with Chiari malformation Type I, the advancement of imaging techniques has resulted in more incidental idiopathic syringes that are not associated with Chiari, tumor, trauma, or postinfectious causes. The authors present a comprehensive review and management strategies for the idiopathic variant of syringomyelia. Methods The authors retrospectively identified 8 idiopathic cases of syringomyelia at their institution during the last 6 years. A PubMed/Medline literature review yielded an additional 38 articles. Results Two of the authors' patients underwent surgical treatment that included a combination of laminectomy, lysis of adhesions, duraplasty, and syrinx fenestration. The remaining 6 patients were treated conservatively and had neurologically stable outcomes. Review of the literature suggests that an etiology-driven approach is essential in the diagnosis and management of syringomyelia, although conservative management suffices for most cases. In particular, it is important to look at disturbances in CSF flow, as well as structural abnormalities including arachnoid webs, cysts, scars, and a diminutive posterior fossa. Conclusions The precise etiology for idiopathic syringomyelia (IS) is still unclear, although conceptual advances have been made toward the overall understanding of the pathophysiology of IS. Various theories include the cerebellar piston theory, intramedullary pulse pressure theory, and increased spinal subarachnoid pressure. For most patients with IS, conservative management works well. Continued progression of symptoms, however, could be approached using decompressive strategies such as laminectomy, lysis of adhesions, and craniocervical decompression, depending on the level of pathology. Management for patients with progressive neurological dysfunction and the lack of flow disturbance is unclear, although syringosubarachnoid shunting can be considered.

scholarly journals COVID-19 hospitalizations in five California hospitals: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Miriam Nuño ◽  
Yury García ◽  
Ganesh Rajasekar ◽  
Diego Pinheiro ◽  
Alec J. Schmidt
Keyword(s):  
Mortality Rate ◽  
Hospital Admissions ◽  
Large Population ◽  
Case Series ◽  
The United States ◽  
Composite Outcome ◽  
Retrospective Case ◽  
Hospital System ◽  
Icu Admission ◽  
Increased Risk

Abstract Background The novel coronavirus pandemic has had a differential impact on communities of color across the US. The University of California hospital system serves a large population of people who are often underrepresented elsewhere. Data from hospital stays can provide much-needed localized information on risk factors for severe cases and/or death. Methods Patient-level retrospective case series of laboratory-confirmed COVID-19 hospital admissions at five UC hospitals (N = 4730). Odds ratios of ICU admission, death, and a composite of both outcomes were calculated with univariate and multivariate logistic regression based on patient characteristics, including sex, race/ethnicity, and select comorbidities. Associations between comorbidities were quantified and visualized with a correlation network. Results Overall mortality rate was 7.0% (329/4,730). ICU mortality rate was 18.8% (225/1,194). The rate of the composite outcome (ICU admission and/or death) was 27.4% (1298/4730). Comorbidity-controlled odds of a composite outcome were increased for age 75–84 (OR 1.47, 95% CI 1.11–1.93) and 85–59 (OR 1.39, 95% CI 1.04–1.87) compared to 18–34 year-olds, males (OR 1.39, 95% CI 1.21–1.59) vs. females, and patients identifying as Hispanic/Latino (OR 1.35, 95% CI 1.14–1.61) or Asian (OR 1.43, 95% CI 1.23–1.82) compared to White. Patients with 5 or more comorbidities were exceedingly likely to experience a composite outcome (OR 2.74, 95% CI 2.32–3.25). Conclusions Males, older patients, those with multiple pre-existing comorbidities, and those identifying as Hispanic/Latino or Asian experienced an increased risk of ICU admission and/or death. These results are consistent with reported risks among the Hispanic/Latino population elsewhere in the United States, and confirm multiple concerns about heightened risk among the Asian population in California.

scholarly journals Progression, recovery and fatality in patients with SARS-CoV-2 related pneumonia in Wuhan, China: a single-centered, retrospective, observational study

2020 ◽  
Author(s):  
Hua Wang ◽  
Yirong Lu ◽  
Qingquan Lv ◽  
Xiping Wu ◽  
Tian Hu ◽  
...  
Keyword(s):  
Critical Illness ◽  
False Negative ◽  
Case Series ◽  
Case Fatality ◽  
Detection Methods ◽  
Close Monitoring ◽  
Diagnostic Efficiency ◽  
Rt Pcr ◽  
Retrospective Case ◽  
Increased Risk

Objectives To determine the case fatality rates and death risk factors. Design Retrospective case series. Setting A COVID-19 ward of a secondary Hospital in Wuhan, China. Participants Consecutively hospitalized COVID-19 patients between Jan 3, 2020 and Feb 27, 2020. Outcomes were followed up to discharge or death. Results Of 121 patients included, 66 (54.6%) were males. The median age was 59 (IQR: 46 to 67) years, and hypertension (33 patients; 27.3%) the leading comorbidity. Lymphopenia (83 of 115 patients; 72.2%) frequently occurred and then normalized on day 4 (IQR: 3 to 6) after admission in the survivors, with lung lesion absorbed gradually on day 8 (IQR: 6 to10) after onset (33 of 57 patients; 57.9%). The real-time polymerase chain reaction (RT-PCR) assays for SARS-CoV-2 were positive in 78 (78/108; 72.2%) patients, and a false-negative RT-PCR occurred in 15 (13.9%) patients. Hypoxemia occurred in 94 (94/117; 80.3%) patients, and supplemental oxygen was given in 88 (72.7%) patients, and mon-invasive or invasive ventilation in 20 (16.5%) cases. Corticosteroid use might link to death. The case fatality rates were 4.4% (one of 23 patients), 29.3% (12/41), 22.8% (13/57) or 45% (9/20) for patients with moderate, severe, critical illness or on ventilator. The length of hospital stay was 14 (IQR: 10 to 20) days, and selfcare ability worsened in 21 patients (21/66; 31.8%) cases. Patients over 60 years were most likely to have poorer outcomes, and increasing in age by one-year increased risk for death by 18% (CI: 1.04-1.32). Conclusions In management of patients with SARS-CoV-2 pneumonia, especially the elderly with hypertension, close monitoring and appropriate supportive treatment should be taken earlier and aggressively to prevent from developing severe or critical illness. Corticosteroid use might link to death. Repeated RT-PCR tests or novel detection methods for SARS-CoV-2 should be adopted to improve diagnostic efficiency.

Association between Cervical Spine Degeneration and the Presence of Dens Fractures

2019 ◽  
Vol 158 (01) ◽  
pp. 46-50
Author(s):  
Marcel Betsch ◽  
Sabina Blizzard ◽  
Bala Krishnamoorthy ◽  
Jung Yoo
Keyword(s):  
Cervical Spine ◽  
Retrospective Cohort ◽  
Odontoid Process ◽  
Case Series ◽  
Facet Joints ◽  
Relative Risks ◽  
Increased Risk ◽  
Dens Fracture ◽  
Spine Degeneration ◽  
Dens Fractures

Abstract Purpose Results of a small case series indicate an increased risk of dens fractures in patients with osteoarthritis. The purpose of this retrospective cohort study was to analyze the relative risks associated with degeneration of the cervical spine in the occurrence of dens fractures in older patients. Methods We performed a retrospective CT study of 1,794 patients > 55 years of age with and without dens fractures for signs of osteoarthritis (OA). Results OA of the atlanto-dens interval (AdI) was present in 75.9% of fracture patients, whereas 63.5% of non-fracture patients had OA of the AdI (p = 0.04). In cases of osteoarthritis of the facet joints, we did find a significant increase (p < 0.05) in the dens fracture risk in patients with OA. Conclusions This study indicates an association between OA of the cervical spine and the risk of sustaining a dens fracture. OA can lead to a reduction in the range of motion of the cervical spine. As a consequence, a relatively low-energy trauma can induce a forced sagittal motion, which will produce a torque at the base of the odontoid process resulting in a fracture.

Endovascular Embolization in the Treatment of Epistaxis

2019 ◽  
Vol 160 (5) ◽  
pp. 822-828 ◽  
Author(s):  
Phillip Huyett ◽  
Brian T. Jankowitz ◽  
Eric W. Wang ◽  
Carl H. Snyderman
Keyword(s):  
Tertiary Care ◽  
Surgical Techniques ◽  
Case Series ◽  
Major Complication ◽  
Endovascular Embolization ◽  
High Risk Group ◽  
Care Hospital ◽  
Retrospective Case ◽  
Increased Risk ◽  
Operative Control

Objective The cost-effectiveness of endovascular embolization (EE) for intractable epistaxis has been questioned, especially as endoscopic surgical techniques have become standard of care at many institutions. Our objectives were to review the safety profile and effectiveness of EE for epistaxis. Study Design Retrospective case series. Setting Tertiary care hospital. Subjects There were 54 patients and 64 unique encounters. Patients were 66.7% male, with a mean age of 64.5 years. Bleeding disorders were present in 18.8%, hypertension was present in 71.7%, and 61.1% were on anticoagulant/platelet drugs. Methods Charts of patients undergoing EE for epistaxis between 2005 and 2015 were retrospectively reviewed. Results The immediate bleeding control rate was 92.6%. Three patients died within 1 week of EE and were excluded from further analysis. Overall, 64.7% of the remaining patients had no further episodes of epistaxis. Thirteen patients (25.4%) rebled within 1 week, 11 of whom required repeat EE or operative control. Five patients (9.8%) rebled more than 1 week following the procedure with 4 requiring repeat EE or operative control. The major complication rate was 7.4% and included transient stroke, diplopia, facial skin necrosis, and extraperitoneal hemorrhage. Conclusion While the immediate success rate of EE for epistaxis was comparable to the literature, the overall short- and long-term rebleed rate was high in this selected population. The results suggest that patients who are referred for EE represent a high-risk group with increased risk of repeat hemorrhage and morbidity. Patients who undergo EE for epistaxis should be carefully monitored for complications, including repeat hemorrhage.

Sclerotherapy in an undetected pregnancy - a catastrophe?

VASA ◽  
2012 ◽  
Vol 41 (4) ◽  
pp. 243-247 ◽  
Author(s):  
Reich-Schupke ◽  
Leiste ◽  
Moritz ◽  
Altmeyer ◽  
Stücker
Keyword(s):  
High Probability ◽  
Spontaneous Regression ◽  
Current Knowledge ◽  
Varicose Veins ◽  
Case Reports ◽  
Case Series ◽  
Current Data ◽  
Unborn Child ◽  
Retrospective Case ◽  
Increased Risk

According to the guidelines and the manufacturer‘s information, pregnancy is a contraindication for sclerotherapy with Polidocanol. However, in some cases sclerotherapy has been conducted in a period when the pregnancy is not known by the patient. When pregnancy is diagnosed, patients and gynecologists often ask the phlebologist if there is an indication for the interruption of pregnancy. Up to now, there is only rare information on sclerotherapy, polidocanol and pregnancy. Current knowledge is summed up in this article together with case reports. The existing case reports and mainly retrospective case series on intended or accidentally conducted sclerotherapy with common sclerosants and doses show no increased risk for the mother and the unborn child. However, in view of the limited literature data available and the high probability for spontaneous regression of varicose veins postpartum, sclerotherapy should be avoided in pregnancy, if possible. Conservative measures during pregnancy or an elimination of varicose veins before pregnancy should be preferred. In single cases e.g. painful genitoanal varices, the use of sclerotherapy can be helpful even during pregnancy. Thereby, a very thorough clarification of the mother with a final written consent and an implementation according to the guidelines are especially important. According to the current data, there is no reason for an interruption after a sclerotherapy that has been conducted during undetected pregnancy.

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