scholarly journals Endovascular Treatment in a Case of Phelgmasia Cerulean Doleans

2019 ◽  
pp. 1-3
Author(s):  
Yuxin Guo ◽  
Darius Aw Kang Lie ◽  
Jack Kian Chng ◽  
Yuxin Guo
Keyword(s):  
Neuroendocrine Tumour ◽  
Morbidity And Mortality ◽  
Treatment Modalities ◽  
Good Effect ◽  
Mortality Case ◽  
Severe Manifestation ◽  
Venous Gangrene ◽  
Venous Outflow Obstruction ◽  
Massive Fluid ◽  
High Degree

Background: Phlegmasia cerulean dolens (PCD) is an uncommon and severe manifestation of massive proximal venous thrombosis of the lower extremities associated with a high degree of morbidity and mortality. Case: We describe a case of a 67-year-old gentleman with metastatic gastric neuroendocrine tumour, who developed PCD of his left lower limb. He underwent endovascular thrombectomy with thrombolysis and stent placement with good effect. Discussion: Characterised by severe venous outflow obstruction, marked limb swelling, pain and discolouration, PCD can lead to venous gangrene, congestion with massive fluid sequestration and circulatory collapse if left untreated. Various treatment modalities were reported with varying outcomes, morbidity and mortality. Conclusion: A multifaceted approach to PCD may be required for successful limb salvage, taking into account the risks and benefits of each treatment modality.

Narrowing the mindware gap in medicine

Diagnosis ◽  
2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Pat Croskerry
Keyword(s):  
United States ◽  
Cognitive Performance ◽  
Clinical Reasoning ◽  
Medical Errors ◽  
Medical Error ◽  
Causes Of Death ◽  
The United States ◽  
Morbidity And Mortality ◽  
Medical Educators ◽  
High Degree

Abstract Medical error is now recognized as one of the leading causes of death in the United States. Of the medical errors, diagnostic failure appears to be the dominant contributor, failing in a significant number of cases, and associated with a high degree of morbidity and mortality. One of the significant contributors to diagnostic failure is the cognitive performance of the provider, how they think and decide about the process of diagnosis. This thinking deficit in clinical reasoning, referred to as a mindware gap, deserves the attention of medical educators. A variety of specific approaches are outlined here that have the potential to close the gap.

scholarly journals Are morbidity and mortality case review practices in Scottish intensive care units aligned to national standards?

2017 ◽  
Vol 19 (3) ◽  
pp. 264-268
Author(s):  
Mohammed(Mo) Faik Al-Haddad ◽  
Andrew Cadamy ◽  
Euan Black ◽  
Kate Slade
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
National Standards ◽  
Morbidity And Mortality ◽  
Case Review ◽  
Allied Health Professionals ◽  
Telephone Interviews ◽  
Significant Events ◽  
Mortality Case ◽  
Cardiac Intensive Care

Introduction Both Scottish and UK standards guidelines recommend that intensive care units should hold regular, structured, multidisciplinary morbidity and mortality meetings. The aim of this survey was to ascertain the nature of current practice with regards to morbidity and mortality case reviews and meetings in all intensive care units in Scotland. Methods Semi-structured telephone interviews were conducted with a consultant from all Scottish intensive care units. A list of intensive care units in Scotland was obtained from the Scottish Intensive Care Society Audit Group annual report. Results All 24 intensive care units (100%) in Scotland were surveyed. The interviews took an average of 20 min. The three cardiac intensive care units were excluded from analysis. All other intensive care units had morbidity and mortality meetings and 18 units had a morbidity and mortality clinical lead. Nineteen intensive care units held joint morbidity and mortality meetings, eight of which were regular. In all intensive care units, meetings were attended by consultants and trainees. In 14 intensive care units, meetings were attended by nurses, seven by allied health professionals, 1 by a manager and 11 by other professionals. All mortality cases in intensive care unit were discussed in 19 intensive care units, in the other two intensive care units, 10–20% of mortality cases were discussed. Conclusion There is a wide variation in the processes of reviewing mortality cases and significant events in intensive care units across Scotland, and in the way morbidity and mortality meetings are organised and held. Based on this survey, there is scope for improving the consistency of approach to morbidity and mortality case reviews and meetings in order to improve education and facilitate shared learning.

Morbidity and mortality associated with sequential flow reduction embolization technique of cerebral arteriovenous malformations using n-butyl cyanoacrylate

2020 ◽  
pp. neurintsurg-2020-016223
Author(s):  
Alfred P See ◽  
Mahmoud H Mohammaden ◽  
Mark Rizko ◽  
Christopher J Stapleton ◽  
Sepideh Amin-Hanjani ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Endovascular Embolization ◽  
Morbidity And Mortality ◽  
Treatment Modalities ◽  
Cerebral Arteriovenous Malformations ◽  
Major Morbidity ◽  
Factors Affecting ◽  
Flow Reduction ◽  
Ruptured Avm ◽  
Targeting Strategy

BackgroundEndovascular embolization of cerebral arteriovenous malformations (AVM) with liquid n-butyl cyanoacrylate (n-BCA) serves multiple purposes including AVM occlusion and flow reduction in preparation for other treatment modalities. The objective was to study the clinical, structural, and angiographic factors affecting complications associated with AVM treatment by sequential n-BCA embolizations for nidal occlusion versus quantitative flow reduction in preparation for surgical resection or radiosurgery.MethodsWe performed a retrospective review of all patients who underwent endovascular embolization of cerebral AVM at our institution between 1998 and 2019, during which time the technique of traditional embolization evolved to a strategy of targeted sequential flow reduction guided by serial flow imaging based on quantitative magnetic resonance angiography, in conjunction with a shift away from nidal penetration.ResultsAmong 251 patients, 47.8% of patients presented with ruptured AVM. On average, each patient underwent 2.4 embolizations, for a total of 613 sessions. Major morbidity related to embolization occurred in 18 (7.2%) patients, but this occurred disproportionately in the traditional embolization strategy (n=16, 8%) in contrast with the flow-targeting strategy (n=2, 3.8%). Four patients (1.6%) died in the overall group, and these all occurred with the traditional embolization strategy (2% of 199 patients); no deaths occurred in the flow-targeting strategy (n=52).ConclusionEmbolization with n-BCA targeted to sequential flow reduction and feeder occlusion with limited nidal penetration prior to definitive surgical or radiosurgical treatment can be safely performed with low overall morbidity and mortality.

scholarly journals Delayed Surgical Site Infection by Tuberculosis – A Rising Cause of Concern ?

2015 ◽  
Vol 32 (4) ◽  
pp. 186-189 ◽  
Author(s):  
MA Mazid ◽  
MM Rahim ◽  
MM Rahman ◽  
N Sultana
Keyword(s):  
Foreign Body ◽  
Surgical Site Infection ◽  
Chronic Inflammation ◽  
Surgical Site Infections ◽  
Morbidity And Mortality ◽  
Site Infection ◽  
Significant Morbidity ◽  
Pyogenic Infection ◽  
High Degree ◽  
Wound Tissue

Background: Surgical site infections causes significant morbidity and mortality of patients and causes more difficult to treat if unexpected cause behind the infection like tuberculosis. Delayed surgical site infection after initial healing are uncomfortable for both surgeons and patient.Methods: Wound tissue from 18 patients with delayed surgical site infection not responding to antibiotics used for pyogenic infection were collected and examined histopathologically.Results: Of the 18 patients, 9 revealed histologically tuberculosis, 7 non-specific chronic inflammation and others showed foreign body granulomma. Association between histopathological report and incidence of tuberculosis is significant (p<0.001) and association between onset of infection and incidence of tuberculosis also significant (p<0.05).Conclusion: A high degree of suspicion is required in case of delayed or recurrent surgical site infection to diagnose tuberculosis as a cause.J Bangladesh Coll Phys Surg 2014; 32: 186-189

scholarly journals Skin Cancer Screening

2002 ◽  
Vol 82 (12) ◽  
pp. 1232-1237 ◽  
Author(s):  
Mary Wills
Keyword(s):  
Cancer Screening ◽  
Skin Cancer ◽  
Early Detection ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Care Physician ◽  
Morbidity And Mortality ◽  
Skin Cancer Screening ◽  
Complete Excision ◽  
Mortality Case

Abstract Background. Skin cancer is the most common malignancy occurring in humans, affecting 1 in 5 Americans at some time during their lives. Early detection of cancerous lesions is important for reducing morbidity and mortality. Case Description. The patient was a 79-year-old woman who was receiving physical therapy for cervical stenosis. The physical therapist identified a mole with suspicious characteristics, using the ABCD checklist for skin cancer screening. The patient was referred to her primary care physician, and the lesion was removed and identified as basal cell carcinoma. Outcomes. Early detection of this lesion allowed for complete excision, with no further treatment of the area warranted. Discussion. Physical therapists can aid in detection of suspect lesions with knowledge of the basic screening techniques for skin cancer, which may help reduce the morbidity and mortality caused by these lesions.

scholarly journals Successful application of recombinant activated factor VII in a patient with HELLP syndrome and disseminated intravascular coagulation

2008 ◽  
Vol 136 (Suppl. 3) ◽  
pp. 253-258
Author(s):  
Tatjana Ilic-Mostic ◽  
Rajka Argirovic ◽  
Radmila Sparic ◽  
Aleksandar Ljubic ◽  
Tatjana Bozanovic ◽  
...  
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Hellp Syndrome ◽  
Morbidity And Mortality ◽  
Factor Vii ◽  
Recombinant Activated Factor Vii ◽  
Fetal Demise ◽  
Intravascular Coagulation ◽  
Activated Factor Vii ◽  
Maternal Morbidity And Mortality ◽  
Mortality Case

INTRODUCTION. HELLP syndrome represents the form of preeclampsia characterized by moderate hypertension, often with absence of proteinuria and oedema. The frequency of HELLP syndrome in pregnant women with preeclampsia is 10-20%. The clinical course of the disease is characterized by the progressive worsening of mother and fetus condition, which can be stopped only by delivery. Disseminated intravascular coagulation is present in 8% of patients with HELLP syndrome and causes significant morbidity and mortality. CASE OUTLINE. We present a case of HELLP syndrome complicated by intrauterine fetal demise and disseminated intravascular coagulation in trigemelar pregnancy. After all surgical and medicamentous methods to establish haemostasis were exhausted, the patient was treated by recombinant activated factor VII (rFVIIa) in intravenous bolus dose of 90 ?g/kg twice, which resulted in satisfactory haemostasis. Side effects of the drug were not registered. CONCLUSION. The application of rFVIIa reduced haemorrhage in our patient, both after the Caesarean section and after hysterectomy, contributing to the patient?s full recovery, without neurological sequelae and with preserved renal function. RFVIIa is not an alternative to surgical haemostasis, but its administration should surely be considered before deciding to perform hysterectomy, especially in patients who want to preserve fertility. In cases of postpartum haemorrhage, when bleeding persists even after adequate surgical haemostasis, the administration of rFVIIa is to be considered not only as an alternative to hysterectomy, but also an effort to prevent significant maternal morbidity and mortality.

scholarly journals Septic arthritis of the temporomandibular joint in an infant

2015 ◽  
Vol 5 (2) ◽  
Author(s):  
Raymond Chuk ◽  
John Arvier ◽  
Barbara Laing ◽  
David Coman
Keyword(s):  
Early Diagnosis ◽  
Septic Arthritis ◽  
Temporomandibular Joint ◽  
Clinical Features ◽  
Surgical Management ◽  
Relevant Literature ◽  
Clinical Suspicion ◽  
Morbidity And Mortality ◽  
Severe Morbidity ◽  
High Degree

Infantile temporomandibular joint septic arthritis is an uncommon paediatric infection, but one which carries the potential for severe morbidity and mortality. Early diagnosis and aggressive medical and possibly surgical management is indicated for the best outcomes. The presenting clinical features are non-specific in a neonate and an infant; as such a high degree of clinical suspicion is required. We present the case of an eleven-month-old boy who has made a full recovery from an acute temporomandibular joint septic arthritis and review the relevant literature.

Vagal paraganglioma clinically presenting as a persistent dry cough

2021 ◽  
Vol 14 (7) ◽  
pp. e241913
Author(s):  
Caio Heleno ◽  
Katharine Lasley ◽  
Michelle Low ◽  
Pranav Singh
Keyword(s):  
Radiation Treatment ◽  
Neuroendocrine Tumour ◽  
Primary Treatment ◽  
Neck Mass ◽  
Treatment Modalities ◽  
Pulsatile Tinnitus ◽  
Significant Morbidity ◽  
Unique Case ◽  
Clinical Presentations ◽  
Head Neck

Vagal paragangliomas (VPs) are a rare subset of neuroendocrine tumour derived from paraganglia located in the head/neck that are usually indolent in nature. Typical clinical presentations include pulsatile tinnitus or hoarseness associated with a neck mass. Surgery and radiation therapy remain the primary treatment modalities but come with significant morbidity including cranial nerve damage. We describe a unique case of VP in which cough was the only presenting symptom, that was exacerbated by enlargement of the tumour. Symptoms improved following radiation treatment.

Predicts Based on Multi Modality Support Vector of the Settlement of Composite Foundation

2014 ◽  
Vol 919-921 ◽  
pp. 716-722
Author(s):  
Li Hua Zhang ◽  
Hai Bo Liu ◽  
Feng Ping An
Keyword(s):  
Support Vector Machine ◽  
Composite Foundation ◽  
Good Effect ◽  
Support Vector ◽  
Foundation Settlement ◽  
Modal Synthesis ◽  
Mode Decomposition ◽  
Calculation Results ◽  
The Stability ◽  
High Degree

Composite foundation settlement is affected by many factors, and settlement data is a non-linear changing process with complexity, suddenness and progressive nature and so on. So we must analyze and predict the stability of the foundation settlement. Because empirical mode decomposition (EMD) provides a new way for foundation settlement prediction, we can extract modal signals associated with the foundation settlement mechanisms by decomposing the monitoring data of settlement by EMD and use the support vector machine ( Support Vector Machine, SVM) modal to predict the obtained signal, Calculation results of the modal synthesis and accumulation of foundation settlement, get the evolution of Change with the time of foundation settlement. Combined with the engineering example for the application ,shows that the prediction model has good effect in multi modality support vector, a high degree of agreement with the monitoring values, indicating that this method has a promotional value.

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