scholarly journals Coloarticular Fistula: A Rare but Potentially Fatal Complication

2020 ◽  
pp. 1-3
Author(s):  
Valentine Nfonsam ◽  
Agnes Ewongwo ◽  
Nabajit Choudhury ◽  
Pamela Omesiete ◽  
Prakash Matthews ◽  
...  
Keyword(s):  
Hip Joint ◽  
Hip Arthroplasty ◽  
Case Reports ◽  
Rare Complication ◽  
High Morbidity ◽  
Radiologic Evaluation ◽  
Joint Infections ◽  
Negative Findings ◽  
History Of ◽  
Prompt Diagnosis

Introduction: Coloarticular fistula is a very rare entity and is a potential complication after total hip arthroplasty. Discussions surrounding coloarticular fistulas is presented mainly as case reports in the literature. Case: A 66-year-old Caucasian female evaluated at our institution for left hip pain and weakness. Radiologic evaluation showed periprosthetic infection with further discovery of air in the hip joint. Abdominal exploration by general surgery did not show any intraoperative findings concerning for coloarticular fistula. Diagnosis of coloarticular fistula was later made with a gastrograffin enema study following negative findings from MRI of pelvis with contrast. She was treated with distal transverse colostomy. The patient had a difficult post-operative course with sepsis and multi-organ failure that resulted in death. Conclusion: Coloarticular fistula is a rare complication of hip arthroplasty and is associated with high morbidity and mortality rates. This complication should be taken into consideration during evaluation of hip joint infections in patients with history of hip arthroplasty. Despite prompt diagnosis and treatment final outcome may be fatal.

Intraorbital Abscess: A Rare Cause of Orbit Compression

FACE ◽  
2021 ◽  
pp. 273250162110050
Author(s):  
Samuel Ruiz ◽  
Rizal Lim
Keyword(s):  
Pediatric Population ◽  
Rare Complication ◽  
Disease Process ◽  
Rare Condition ◽  
External Drainage ◽  
Direct Extension ◽  
Life Threatening ◽  
History Of ◽  
High Index Of Suspicion ◽  
Prompt Diagnosis

Introduction: Intraorbital abscess is a rare complication of rhinosinusitis that affects most commonly the pediatric population. It is thought to be caused by direct extension or venous spread of infections from contiguous sites and can lead to life-threatening complications, like permanent visual loss and cerebral abscesses. Objectives: Intraorbital abscess is a rare condition that requires prompt diagnosis and treatment to avoid serious complications. Our objectives are to provide an overview of this rare disease process and its management including our successful treatment experience. Case Description: We present a 2 case report of a 13-year-old pediatric male and a 66-year-old male with history of chronic sinusitis who presented with a right intraorbital abscess successfully treated with external drainage with decompression of the orbit. Conclusion: When intraorbital abscess is encountered, a high index of suspicion is needed to allow prompt and accurate diagnosis for this infrequent condition. Timely surgical drainage of the abscess is needed to prevent the development of fatal complications.

scholarly journals Pneumocephalus Following Self-Inflicted Penetrating Brain Injury

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Che-Fang Ho ◽  
Yuan-Yun Tam ◽  
Chia-Chen Wu
Keyword(s):  
Rare Complication ◽  
Bed Rest ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Adequate Treatment ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Intravenous Antibiotics ◽  
Computed Tomography Scans ◽  
Intravenous Hydration ◽  
Prompt Diagnosis

Objective. Pneumocephalus is a rare complication that often occurs after traumatic skull base injury, leading to morbidity and mortality. Material and Method. We present the case of a 42-year-old healthy man who injured himself when he stuck a metal stick into his left nasal cavity to relieve prolonged nasal obstruction. Immediate cerebrospinal fluid rhinorrhea and subsequent meningitis and pneumocephalus occurred later. He was presented at our hospital with fever and meningeal signs. Result. Computed tomography scans revealed left rhinosinusitis and air collection in the subarachnoid space. The patient received the conservative treatment of bed rest, intravenous hydration, head elevation, and broad-spectrum intravenous antibiotics. Pneumocephalus and meningitis resolved without any surgery, and he experienced no other sequela or complication. Conclusion. Pneumocephalus is a rare incidence and can lead to high morbidity and mortality. Prompt diagnosis and adequate treatment of pneumocephalus and meningitis proved beneficial for our patient who recovered without any complication or surgery.

scholarly journals Nonunion of the bone fragments during total hip replacement with T. Paavilainen osteotomy — causes of failure

2020 ◽  
Vol 8 (2) ◽  
pp. 119-128
Author(s):  
Alexandr I. Avdeev ◽  
Igor A. Voronkevich ◽  
Dmitrii G. Parfeev ◽  
Anton N. Kovalenko ◽  
David G. Pliev ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Joint ◽  
Hip Arthroplasty ◽  
Hip Dislocation ◽  
Greater Trochanter ◽  
Total Hip ◽  
Shortening Osteotomy ◽  
History Of ◽  
Bone Fragments

Background. Conservative treatment options for hip dysplasia and hip dislocation in early childhood allow for good results in cases of a timely diagnosis. The preferred treatment option for patients with hip dislocation in adulthood is total hip joint replacement. The shortening osteotomy, proposed by T. Paavilainen, allows the surgeon to restore the difference in the lengths of the lower extremities during arthroplasty of the hip joint. However, according to the results of the Paavilainen technique, as presented by Russian orthopedic surgeons, the problem of nonunion of the greater trochanter fragment with the diaphysis of the femur remains unresolved, as evidenced by a massive group of clinical cases. Aim. The aim of this study was to identify factors affecting the consolidation of bone fragments after osteotomy of the greater trochanter, according to T. Paavilainen, during total hip arthroplasty and evaluate their significance after fixation with cerclage screws in comparison with a special trochanteric fork-plate. Materials and methods. The present study includes 208 cases that were treated at the Russian Scientific Research Institute of Traumatology and Orthopedics named after R.R. Vreden from 2003 to 2019 using various fixation techniques of the greater trochanter fragment. Patients were divided into two groups depending on their type of fixation. The quality of consolidation of a greater trochanter fragment with the femur was assessed during a follow-up period of six months or longer. The fragment of the greater trochanter was divided into the part that was not in contact with the diaphysis, or A, and the part that was in contact with the diaphysis, or B. We assessed the effect of the absolute value of the contact between fragments, the B/A ratio, the distance between the points of insertion of the screws into the diaphyseal part of the femur, the quality of the bone by the modified Barnet-Nordin index, and the history of previous surgical interventions on this joint on the consolidation. Results. When the part of the greater trochanter was in contact with the diaphysis of the femur (B) was less than 3.5 cm, the risk ratio of nonunion of the greater trochanter fragment with the diaphysis of the femur increased. Also, a significant factor is the index of the contact of the greater trochanter fragment (B/A less than 1) with the diaphysis of the femur using the T. Paavilainen technique. In addition, the presence of surgical intervention in the hip joint history significantly increases the relative risk (RR) of nonunion of the greater trochanter fragment with the diaphysis of the femur with this method of shortening osteotomy of the femur. Conclusion. In the absence of timely diagnosis and conservative treatment of children with hip dislocation, reconstructive-plastic techniques on the hip joint do not allow the achievement of proper results and increase the complexity of total hip arthroplasty. According to the results of this study, the absolute value of the contact between fragments (B), the index of the greater trochanter contact with the diaphysis of the femur, and the history of previous surgical intervention on this joint are objective tools for the prognostic assessment of the probability of fragment unions during total hip arthroplasty with the T. Paavilainen technique.

scholarly journals Total Hip Arthroplasty for the Paralytic and Non-paralytic Side in Patient with Residual Poliomyelitis

2016 ◽  
Vol 10 (1) ◽  
pp. 105-110 ◽  
Author(s):  
Motoki Sonohata ◽  
Masaru Kitajima ◽  
Shunsuke Kawano ◽  
Masaaki Mawatari
Keyword(s):  
Muscle Strength ◽  
Total Hip Arthroplasty ◽  
Hip Joint ◽  
Hip Arthroplasty ◽  
Muscle Tone ◽  
Hip Osteoarthritis ◽  
Hip Pain ◽  
Total Hip ◽  
Early Results ◽  
History Of

Background: Total hip arthroplasty (THA) for poliomyelitis is a problematic procedure due to difficulty in positioning the cup of the prosthesis in the true acetabulum and the risk of dislocation after THA due to the low muscle tone. Methods: We herein present a case of bilateral hip pain with a history of poliomyelitis. Radiograph showed bilateral hip osteoarthritis caused by hip dysplasia due to residual poliomyelitis in right hip joint or developing dysplasia of the hip joint in left hip joint. THA was performed to bilateral hip joints. Results: Six years after bilateral THA, bilateral hip pain significantly improved. Additionally, the muscle strength on the paralyzed right side partially improved. However, the muscle strength on the non-paralyzed left side did not significantly improve. No complications related to the surgery were observed. Conclusion: Promising early results were obtained for THA in our patient with residual poliomyelitis. However, surgeons should pay attention to the potential development of complications concerning THA that may arise due to the residual poliomyelitis.

scholarly journals Use of Emergency Department Extracorporeal Membrane Oxygenation for Treatment of Acute Necrotizing Myocarditis

2019 ◽  
Vol 3 (1) ◽  
pp. 47-50
Author(s):  
Carly Loner ◽  
Peter Crane
Keyword(s):  
Emergency Department ◽  
Extracorporeal Membrane Oxygenation ◽  
Rare Complication ◽  
High Morbidity ◽  
Membrane Oxygenation ◽  
Acute Necrotizing ◽  
History Of ◽  
Eosinophilic Myocarditis ◽  
Systemic Symptoms

We report a case of acute necrotizing eosinophilic myocarditis (ANEM) secondary to drug rash with eosinophilia and systemic symptoms (DRESS) related to administration of minocycline. Myocarditis is a rare complication of DRESS and can manifest as either a self-limited hypersensitivity myocarditis or as the frequently fatal ANEM. Due to the high morbidity and mortality caused by this disease, emergency physicians should be aware of the potential of ANEM in patients with history of DRESS and new-onset cardiac dysfunction. This case reviews the clinical presentation and management of ANEM and the potential role of extracorporeal membrane oxygenation use in the emergency department.

scholarly journals Unmasking of Neurosarcoidosis

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A618-A618
Author(s):  
Sharini Venugopal ◽  
Binita Neupane ◽  
Mahesh Nepal ◽  
Luis F Chavez
Keyword(s):  
Diabetes Insipidus ◽  
Medical History ◽  
Case Reports ◽  
Rare Complication ◽  
Case Series ◽  
Primary Hypothyroidism ◽  
Past Medical History ◽  
Water Excretion ◽  
History Of ◽  
Glucocorticoid Deficiency

Abstract Introduction: Central diabetes insipidus is a rare complication of neurosarcoidosis. In patients with concomitant adrenal insufficiency (AI), the symptoms of Diabetes Insipidus (DI) can be masked. Case: A 55-year-old female with past medical history of sarcoidosis presented to the hospital with hematemesis, nausea and dizziness. She has a past medical history of cardiac sarcoidosis that was revealed on a PET scan done before 10 years for which she was being treated with methotrexate and prednisone. She was off prednisone for a year prior to hospitalization. She underwent an upper endoscopy that showed diffusely erythematous gastric mucosa in the antrum. She was also hypotensive on admission, and she received packed red blood transfusions after which her sodium increased from 145mmol/L to 165mmol/L (Normal: 135-145mmol/L) in 48 hours. Further workup revealed persistent hypernatremia and urine osmolality was 75mOsm/kg H2O. (Normal: 50-1200mOsm/kg H2O). She was also hypoglycemic and hypotensive requiring multiple fluid boluses throughout her hospitalization. This prompted us to perform a random cortisol that came back at 2.1ug/dl (Normal: 3-23ug/dl) and 1.8ug/dl on two occasions. Cortisol Stimulation test was subsequently ordered, but was done only at 30 minutes, and Cortisol increased from 1.8ug/dl to 6.3ug/dl. Free thyroxine was 0.5 ng/dl (Normal: 0.9-1.8 ng/dl) and her TSH was 7.58uIU/ml (Normal: 0.55-4.78uIU/ml). MRI of the brain revealed extensive areas of extra-axial supra-sellar/infundibular nodular homogeneous intense enhancement that is most consistent with neuro-sarcoid. She was started on prednisone 40 mg daily, Desmopressin 0.05 mg twice daily, and levothyroxine as well. Her sodium level normalized and was 137mmol/L at discharge. She followed up later with outpatient Endocrinology and reported around 90lbs weight gain and no more episodes of nausea or vomiting or epistaxis or lightheadedness. Conclusion: The involvement of the hypothalamic-pituitary axis in sarcoidosis is extremely rare and attributes to < 1% of patients with a sellar mass. Small case series have shown that hypogonadism is the most common endocrine abnormality followed by DI. Our patient had a long-standing history of sarcoidosis with her pituitary dysfunction unmasked only on admission for other causes. She did not manifest any symptoms of DI or AI. There have been case reports where the symptoms of DI are masked due to underlying glucocorticoid deficiency. There have been theories that glucocorticoid deficiency impairs renal water excretion by both ADH (Anti-diuretic hormone) dependent and ADH independent pathways. Another notable feature in our case is that our patient presented with primary hypothyroidism. In fact, sarcoidosis has been commonly implicated in auto-immune polyglandular syndromes type 3, which can present with auto-immune thyroiditis more so in females.

Pyolaryngocoele: Management of an Unusual Cause of Odynophagia and Neck Swelling

2008 ◽  
Vol 1 ◽  
pp. CMENT.S746 ◽  
Author(s):  
NA Khan ◽  
G Watson ◽  
E Sivayoham ◽  
DJ Willatt
Keyword(s):  
Surgical Management ◽  
Treatment Option ◽  
Rare Complication ◽  
High Dose ◽  
External Approach ◽  
Neck Swelling ◽  
Respiratory Compromise ◽  
Nasogastric Feeding ◽  
History Of ◽  
Prompt Diagnosis

We present a case of 82 years old female with two-week history of neck swelling, odynophagia, hoarseness and cough. There was a tender, fluctuant swelling below the mandible on right side. An urgent C.T scan showed it to be a pyolaryngocele. High dose intra venous antibiotic, analgesia and nasogastric feeding resolved the acute infective episode. The residual laryngocele was treated by an excision via an external approach. A pyolaryngocele is a rare complication of laryngocele that becomes secondarily infected. It can cause feeding and respiratory compromise because of its compression symptoms. A CT is helpful for prompt diagnosis and for planning definitive surgical management. The aim of this paper is to highlight the need to recognise and then treat these cases aggressively. The best treatment option is to remove the laryngocele in-toto to prevent recurrence.

scholarly journals Complications associated with total hip arthroplasty in four large nondomestic felids

2021 ◽  
pp. 1-8
Author(s):  
Lauren P. Kane ◽  
James L. Cook ◽  
Kate E. Archibald ◽  
W. Kirk Suedmeyer ◽  
Jennifer N. Langan ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Joint ◽  
Hip Arthroplasty ◽  
Clinical Findings ◽  
Snow Leopard ◽  
Panthera Tigris ◽  
Intact Male ◽  
Total Hip ◽  
History Of ◽  
Excision Arthroplasty

Abstract CASE DESCRIPTION A 9-year-old 37-kg sexually intact male snow leopard (Panthera uncia) with no history of lameness but radiographic evidence of right femoral subluxation and flattening of both femoral heads, 2 juvenile (< 1 year old) 25-kg sexually intact male cheetahs (Acinoynx jubatus) with unilateral hind limb lameness resulting from trauma, and an 11-year-old 110-kg sexually intact female Amur tiger (Panthera tigris altaica) with a 2-year history of left hip joint osteoarthritis were examined. CLINICAL FINDINGS No clinically relevant clinical findings other than hip joint problems were identified. All 4 felids underwent staged bilateral (snow leopard) or unilateral (cheetahs and tiger [Panthera tigris]) total hip arthroplasty (THA). TREATMENT AND OUTCOME In the snow leopard, both femoral THA components were found to be luxated 1 year after surgery. Treatment consisted of autogenous corticocancellous rib graft augmentation of the dorsal acetabular rims and synthetic suture capsulorrhaphies. The snow leopard lived for an additional 4 years with no additional THA-related complications. In the other 3 animals, catastrophic complications (luxation in the cheetahs and femoral fracture in the tiger) occurred shortly after THA. The THA implants were removed, and excision arthroplasty was performed. Long-term outcomes were good in all 3. CLINICAL RELEVANCE Findings underscore the challenges associated with THA in large nondomestic felids. Given the high risk for early catastrophic failure as a result of luxation or fracture, plans must be made and resources must be available in case revision surgery or implant removal with excision arthroplasty becomes necessary.

Paradoxical Bronchoconstriction with Albuterol Administered by Metered-Dose Inhaler and Nebulizer Solution

2005 ◽  
Vol 39 (11) ◽  
pp. 1924-1927 ◽  
Author(s):  
Linda M Spooner ◽  
Jacqueline L Olin
Keyword(s):  
Case Reports ◽  
Rare Complication ◽  
Dose Inhaler ◽  
Chronic Obstructive ◽  
Metered Dose Inhaler ◽  
Obstructive Pulmonary Disease ◽  
Initial Event ◽  
Metered Dose ◽  
Causative Agents ◽  
History Of

OBJECTIVE To report a case of a patient who experienced bronchoconstriction following both a single dose of albuterol via metered-dose inhaler and a subsequent rechallenge with nebulized albuterol and review previously published case reports of albuterol-induced paradoxical bronchoconstriction. CASE SUMMARY A 92-year-old white man with a history of chronic obstructive pulmonary disease was prescribed an albuterol inhaler for treatment of cold symptoms. Within 30 minutes of his first inhalation, he became short of breath and had difficulty speaking. During emergency department examination for the initial event, the bronchospasm improved with administration of oxygen 15 L/min via a non-rebreather mask. Two hours later, the patient received albuterol via nebulizer and experienced stridor, shortness of breath, and severe bronchospasm. He was admitted, treated with methylprednisolone, and discharged the following day. DISCUSSION Paradoxical bronchoconstriction is a rare complication of bronchodilator therapy. Although theories have been proposed about components of albuterol solutions and preservatives as causative agents, the true mechanism of the phenomenon remains unknown. Several previous case reports described bronchospasm with albuterol given via tablet, inhaler, and nebulizer. In 2 of these cases, symptoms recurred upon rechallenge; however, none of these cases demonstrates rechallenge using albuterol as both the index and challenge agent. In our patient, paradoxical bronchoconstriction was considered to be probable according to the Naranjo probability scale. CONCLUSIONS β2-Agonists are generally well-tolerated medications. However, clinicians should remain vigilant in their monitoring of adverse effects so they will be able to provide immediate care and minimize the chance of an unfavorable outcome.

scholarly journals Pelvic and Bladder Catecholamine-Producing Tumors A Review of the Literature

2019 ◽  
Author(s):  
Luigi Petramala ◽  
Valeria Bisogni ◽  
Federica Olmati ◽  
Antonio Concistrè ◽  
Monia Celi ◽  
...  
Keyword(s):  
Case Reports ◽  
Bladder Neoplasms ◽  
Signs And Symptoms ◽  
Review Of The Literature ◽  
Current Management ◽  
Prisma Statement ◽  
History Of ◽  
Biochemical Remission ◽  
Prompt Diagnosis ◽  
Chromaffin Tissue

Abstract Purpose . Starting from the description of two interesting cases, we wondered to review the literature on pelvic and bladder paragangliomas (PGLs) in order to illustrate clinical characteristics and current management, lightening the needed of a prompt diagnosis to avoid the onset of several complications. Although PGLs may arise at any site where physiologically chromaffin tissue exists, pelvic origins are not frequent (less than 2%), and the most common localization is the retroperitoneal space, whereas bladder PGLs account for less than 0.06% of all bladder neoplasms and less than 1% of all PGLs. Methods . We herein performed a brief review of the literature about pelvic PGLs in the PubMed library, conducted according to the PRISMA statement, including studies published from 1954 to 2019. We also discuss clinical presentation, morphologic appearance, and management of two cases of pelvic PGL, both of them characterized by an history of paroxysmal high blood pressure episodes uncontrolled by antihypertensive therapy associated with disabling symptoms, not clearly understood for many years. Results . Overall, we evaluated 108 case reports. The majority were females, presenting typical signs and symptoms, such as arterial hypertension (54.2%), hematuria (35.1%), and headache (33.6%). After treatment, the clinical and biochemical remission was evident in only 55% of analyzed cases. Conclusions . For their singular localization, pelvic and bladder PGLs often might be misdiagnosed. The significant delay in the proper treatment could be responsible for the relative low percentage of complete clinical and biochemical remission.

Sign in / Sign up

Export Citation Format

Share Document