scholarly journals Primary Typical Carcinoid of The Pleura, A Rare Incidental Finding

2019 ◽  
pp. 1-3
Author(s):  
Anupama Sharma ◽  
Diane Strollo ◽  
Ernest G. Chan ◽  
James D. Luketich ◽  
Lawrence Crist ◽  
...  
Keyword(s):  
Multidisciplinary Approach ◽  
Surgical Intervention ◽  
Incidental Finding ◽  
Lung Parenchyma ◽  
Thoracic Cavity ◽  
Imaging Studies ◽  
Talc Pleurodesis ◽  
Typical Carcinoid ◽  
Well Differentiated ◽  
Partial Pleurectomy

Roughly 30% of carcinoids are found in the thoracic cavity, with the overwhelming majority of these being found in the lung parenchyma. We present a case of a rarely found primary pleural carcinoid incidentally diagnosed in a 73 year old male who presented with recalcitrant spontaneous pneumothorax requiring surgical intervention. The patient was taken to the operating room for a right video assisted thoracic surgery, partial pleurectomy, and talc pleurodesis. At the time of the operation, there were no abnormalities noted in the pleura or chest wall, and the patient did well post operatively. Pathologic examination of the pleura revealed a 3mm well differentiated neuroendocrine carcinoid tumor. Laboratory and imaging studies did not indicate another site of tumor. The importance of a multidisciplinary approach to the diagnosis, treatment, and surveillance is emphasized.

scholarly journals Ulna Autograft for Wrist Arthrodesis: A Novel Approach in Failed Wrist Arthoplasty

2017 ◽  
Vol 11 (1) ◽  
pp. 768-776 ◽  
Author(s):  
Nastaran Sargazi ◽  
M. Philpott ◽  
A. Malik ◽  
M. Waseem
Keyword(s):  
Multidisciplinary Approach ◽  
Surgical Intervention ◽  
Salvage Surgery ◽  
Wrist Arthrodesis ◽  
Novel Approach ◽  
Total Wrist Arthroplasty ◽  
Stage Disease ◽  
Wrist Function ◽  
End Stage ◽  
Wrist Arthroplasty

Rheumatoid arthritis is a polyarthropathy affecting approximately 1% of the population worldwide. Wrist involvement is observed around 75% of patients, resulting in substantial disability and morbidity. A multidisciplinary approach to management of such patients is undertaken to prevent disease progression, many go on to develop debilitating disease requiring surgical intervention. Total wrist arthroplasty and arthrodesis are the main options available for those with end-stage disease, with arthroplasty preferred due to its ability to preserve a good degree of wrist function. Where complications occur with total wrist arthroplasty, salvage surgery with arthrodesis can be considered, however this requires satisfactory bone stock to enable stable fusion of the joint following arthroplasty. We report our experience of Ulna strut allografts in wrist arthrodesis in the management of failed total wrist arthroplasty.

(Un) conventional complicated pancreatitis

2021 ◽  
Vol 75 (1) ◽  
pp. 61-67
Author(s):  
Michal Rybár ◽  
Ivo Horný
Keyword(s):  
Acute Pancreatitis ◽  
Multidisciplinary Approach ◽  
Pancreatic Necrosis ◽  
Surgical Intervention ◽  
Secondary Infection ◽  
Abdominal Ultrasound ◽  
Stent Migration ◽  
Endoscopic Extraction ◽  
Threatening Condition ◽  
Life Threatening

Acute pancreatitis is sudden inflammatory disease of pancreas, which can vary from a mild form to severe life threatening condition. The management of pancreatitis usually consists of intensive care and multidisciplinary approach, often including surgical intervention or digestive endoscopy. In this article, we present a 68-year-old female with recidivous acute pancreatitis who underwent a series of endoscopic examinations and at the end also an unusual surgical intervention due to numerous complications. At first, it seemed that there was an idiopatic etiology because neither an anamnesis of alcohol consumption nor metabolic risks or CT signs of cholelithiasis were found. The condition was complicated by the development of acute necrotic collection, gastrointestinal bleeding and development of walled-off pancreatic necrosis (WOPN). Later, the biliary etiology was revealed after cholecystolithiasis was found on abdominal ultrasound. The WOPN was endoscopically drained because of the local compression syndrome. After the drainage, we noticed two cases of stent migration and the secondary infection of the WOPN. At the end, the migrated stents caused transient bowel obstruction and were stuck in the distal ileum. After three unsuccessful attempts to endoscopic extraction, the condition was solved by surgical intervention and double enterotomy was performed. The postoperative care was not easy anyway, being complicated by the dehiscence of the surgical wound with the need of opening the wound and use the VAC system to heal it up.

scholarly journals Laparoendoscopic Transgastric Resection of Prepyloric Gastrointestinal Stromal Tumor

2019 ◽  
Vol 14 (1) ◽  
pp. 66-68 ◽  
Author(s):  
Nandita Nettu Mahajan ◽  
Sajan Jiv Singh Nagpal ◽  
Louis M. Wong Kee Song ◽  
Shanda H. Blackmon
Keyword(s):  
Case Report ◽  
Surgical Technique ◽  
Gastrointestinal Stromal Tumor ◽  
Multidisciplinary Approach ◽  
Surgical Intervention ◽  
Optimal Treatment ◽  
Stromal Tumor ◽  
Successful Outcome ◽  
Diagnostic Studies ◽  
Coffee Ground

This case report describes an 83-year-old woman with multiple comorbidities who presented with melena and coffee-ground emesis with diagnostic studies evident for a large prepyloric gastrointestinal stromal tumor. She underwent combined laparoendoscopic transgastric resection surgery for the tumor, performed by a team of gastroenterologist and thoracic surgeon with a successful outcome. The case and videos in this report provide a descriptive demonstration of the steps leading up to the surgical intervention followed by a step-by-step illustration of the combined surgical technique, thus highlighting the importance of multidisciplinary approach for optimal treatment of prepyloric gastrointestinal stromal tumor.

Multidisciplinary approach in urology. Current imaging studies in urology

Urologiia ◽  
2019 ◽  
Vol 4-prilojenie_2019 ◽  
pp. 25-27
Author(s):  
S.K. Ternovoy Ternovoy ◽  
Yu.G. Alyaev Alyaev ◽  
A.V. Amosov Amosov ◽  
Keyword(s):  
Multidisciplinary Approach ◽  
Imaging Studies

Management of pneumatosis intestinalis in children over the age of 6 months: a conservative approach

2017 ◽  
Vol 103 (4) ◽  
pp. 352-355 ◽  
Author(s):  
Leel Nellihela ◽  
Mohamed Mutalib ◽  
David Thompson ◽  
Kammermeier Jochen ◽  
Manasvi Upadhyaya
Keyword(s):  
Surgical Intervention ◽  
Incidental Finding ◽  
Pneumatosis Intestinalis ◽  
Abdominal Distension ◽  
Successful Outcome ◽  
Bowel Ischaemia ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Peroxisomal Biogenesis ◽  
Asymptomatic Individuals

BackgroundPneumatosis intestinalis (PI) is an uncommon and poorly understood condition. Although it can be an incidental finding in asymptomatic individuals, it can also be secondary to life-threatening bowel ischaemia and sepsis. In premature infants, it is a pathognomonic sign of necrotising enterocolitis. There is no consensus regarding management and long-term outcome of children with PI.AimReview of our experience of PI in children beyond the early infantile period.MethodsRetrospective review of patient’s records and radiological images from 2013 to 2015.ResultsEighteen patients (three girls) had radiologically confirmed PI. The median age was 4.5 years (range 8 months–13 years). Background medical conditions (number): short bowel syndrome (one), congenital heart disease (two), sickle cell disease (one), epilepsy (three), cerebral palsy (six), myotonic dystrophy (four) and peroxisomal biogenesis defect (one).Six children (33%) presented with abdominal distension, four (22%) with abdominal pain, three (17%) with bilious vomiting, two (11%) with diarrhoea and one (6%) with rectal bleeding. Two (11%) were asymptomatic. One had air in portal vein and two had pneumoperitoneum.All patients with symptomatic PI were treated conservatively with successful outcome and complete resolution of PI. None required surgical intervention.ConclusionPI in children who are not on chemotherapy or immunosuppressant appears to follow a benign course and is responsive to conservative management. In contrast to adults, portal venous gas and pneumoperitoneum do not predict the need for surgical intervention.

scholarly journals Spondylodiscitis Caused by Aspergillus Species

Diagnostics ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. 1899
Author(s):  
Christos Koutserimpas ◽  
Ifigeneia Chamakioti ◽  
Symeon Naoum ◽  
Konstantinos Raptis ◽  
Kalliopi Alpantaki ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Multidisciplinary Approach ◽  
Surgical Intervention ◽  
Treatment Options ◽  
Standard Of Care ◽  
Clinical Challenge ◽  
Life Threatening ◽  
The Mean ◽  
Magnetic Resonance Imaging Mri ◽  
Mean Time

Background: Spondylodiscitis caused by Aspergillus spp. is a rare but life-threatening clinical entity. However, a consensus on diagnostic criteria and most effective medical management is still missing. The present study is a review of all published cases of spondylodiscitis caused by Aspergillus spp., in an effort to elucidate epidemiology, patients’ characteristics, andand the medical and surgical treatment options and their effectiveness. Methods: A thorough review of all existing spondylodiscitis cases caused by Aspergillus was performed. Data regarding demographics, responsible fungus, time between symptoms’ onset and firm diagnosis, antifungal treatment (AFT), surgical intervention, andand the infection’s outcome were investigated. Results: A total of 118 Aspergillus spondylodiscitis cases, yielding 119 Aspergillus spp. isolates, were identified in the literature. The patients’ mean age was 40.6 years. Magnetic resonance imaging (MRI) (after its introduction) indicated the diagnosis in most cases (66.7%), while definite diagnosis was established through cultures in the majority of cases (73.7%). Aspergillus fumigatus was isolated in most cases (73; 61.3%), followed by Aspergillus flavus (15; 12.6%) andand Aspergillus nidulans and terreus (7; 5.9%, each). The mean time between symptoms’ onset and diagnosis was 5.7 months. Amphotericin B was the preferred antifungal regiment (84 cases; 71.2%), followed by voriconazole (31; 26.3%), and the mean AFT duration was 6.1 months. The final outcome was successful in 93 cases (78.8%). Furthermore, 77 patients (65.3%) underwent surgery. Conclusions: Spondylodiscitis caused by Aspergillus spp. represents a clinical challenge, requiring a multidisciplinary approach. The present review has shown that prolonged AFT has been the standard of care of the studied cases, while surgical treatment seems to play an important role in selected patents.

scholarly journals CLINICAL COURSE OF FETAL PELVI-CALYCEAL DILATATION DIAGNOSED ON EARLY SECOND TRIMESTER ULTRASOUND.

2020 ◽  
Vol 4 (2) ◽  
Author(s):  
Sanjay Punjaji Dhawane
Keyword(s):  
Renal Pelvis ◽  
Surgical Intervention ◽  
Clinical Course ◽  
Incidental Finding ◽  
Common Finding ◽  
Parental Anxiety ◽  
Second Trimester ◽  
Second Year ◽  
Single Kidney

Aims and Objectives: Incidental finding of fetal pelvi-calyceal dilatation is common finding on early second trimester anomaly scan. [18 to 23 weeks] It causes significant parental anxiety. The present study aims to apply stringent criteria for accurate assessment.  It also studies the natural course of such findings, pathological cause for such findings and its postnatal outcomes. Study Design: This study includes 9500 cases that underwent anomaly at 18 to 23 weeks gestation period. The fetal pelvi-calyceal dilatation [PCD] was diagnosed and categorized according to criteria set by European Society for Pediatric Radiology [ 1]. PCD 0 – renal calyces and pelvis not or hardly visible. PCD 1 – renal calyces not visible and axial renal pelvis diameter is less than 7 mm. PCD 2 – some calices are visible but with normal forniceal and papillary shape, axial renal pelvis less than 10 mm. PCD 3 - marked dilatation of calices and pelvis. Pelvic axial width usually more than 10 mm with flattened papilla and rounded fornices but without parenchymal thinning. PCD 4- gross dilatation of entire collecting system and thinning of renal parenchyma. PCD 5- Only thin membrane like residual renal parenchymal rim. Result: Among 9500 women who underwent routine anomaly scan at 18 to 23 weeks gestation, total 390 had PCD findings [4.1 %] Single kidney taken as one case while bilateral findings were taken  as 2 cases. 98 [25.1 %] pregnancies had bilateral PCD findings and rest 292[74.9%] had unilateral PCD changes. These findings correlate well with as shown by S Sairam et al, Livera et al, Gunn et al [2, 3, 4]    PCD 1 findings were noted in 317 cases, PCD2 findings were noted in 38 cases, PCD3 findings in 23 cases and PCD4 findings in 12 cases. All these fetuses were followed till either PCD findings resolved naturally or till 2 years of their life. These findings also compare well with S Sairam et al, and Persutte et al [ 2, 5] About 00 cases of PCD1, 3 cases of PCD2 and 2 cases of PCD3 were lost for follow up for various reasons. Two cases of PCD1 were lost due to additional diagnosis of Down syndrome in one case and multiple anomalies in other cases. Both were excluded from the present study. Rest of them [383] were studied and analyzed for this paper. Out of 315 PCD1 cases, all turned out to be normal Out of 35 PCD2 cases,   19 were resolved, 12 remain unchanged at second year of child age rest were 4 worsened Out of 21 PCD 3, 2 cases resolved spontaneously, 5 remain unchanged and 14 cases worsened Out of 12 PCD 4 cases, all needed and underwent surgical intervention. 04 kidneys were saved and rest 8 had nephrectomies.

scholarly journals Symptomatic mature teratoma of the lumbar spine: A case report

2022 ◽  
Vol 13 ◽  
pp. 16
Author(s):  
Coby Cunningham ◽  
Chiara Flores ◽  
Rocco Dabecco ◽  
Palgun Nisarga ◽  
Janice Ahn ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Surgical Intervention ◽  
Mature Teratoma ◽  
Cauda Equina ◽  
Case Description ◽  
Acute Setting ◽  
The Central Nervous System ◽  
Well Differentiated ◽  
Ct Brain ◽  
Mr Brain

Background: Teratomas are a unique family of tumors derived from two or more of the three embryonic layers: endoderm, mesoderm, and ectoderm. Mature teratomas are comprised the most well-differentiated tissue types and may contain skin, hair, teeth, smooth muscle, respiratory tissues, etc. Infrequently, mature teratomas may be found within the central nervous system and, in exceedingly rare cases, may be occur within the spinal cord itself (i.e., intramedullary/intradural). Case Description: A 78-year-old female presented with a subacute progressive lower extremity paraparesis. The MR revealed a cystic 81 × 30 × 25 mm intradural/intramedullary spinal mass involving the distal conus with exophytic extension into the L1-L4 spinal canal. Following surgical intervention consisting of a L1-L4 laminectomy, the lesion was largely removed. Pathology of the mass confirmed a large mature teratoma containing a multilobulated cyst that intraoperatively compressed the conus and cauda equina. Immediately postoperatively, the patient significantly improved neurologically. However, on postoperative day 2, she acutely developed a change in mental status with the left gaze preference and hemiparesis. CT brain in the acute setting showed no evidence of causative pathology and subsequent MR brain was unremarkable. The patient’s neurologic deficits progressively improved leading to eventual discharge. Conclusion: Intrathecal intramedullary/extramedullary mature teratomas of the conus that results in subacute cauda equina syndromes are rare. The differential diagnosis for such lesions exophytic to the conus must include mature teratomas which, though rare, may be readily resected resulting in generally favorable outcomes.

scholarly journals Full medical treatment of COVID-19 associated large pneumothorax - A case report

2021 ◽  
Author(s):  
Alberto Fantin ◽  
Nadia Castaldo ◽  
Paolo Vailati ◽  
Giuseppe Morana ◽  
Vincenzo Patruno
Keyword(s):  
Lung Parenchyma ◽  
Air Leakage ◽  
Talc Pleurodesis ◽  
Thoracoscopic Approach ◽  
Recurrent Pneumothorax ◽  
Medical Thoracoscopy ◽  
Blood Patch ◽  
Lung Condition ◽  
History Of ◽  
Multi Phase

A 52-year-old man was re-admitted two weeks after recovering from severe COVD-19 following a 3-days history of cough and worsening shortness of breath. The chest radiograph showed a large right-sided pneumothorax. The first attempt at drainage, performed through a large bored tube, failed. Due to the large dimension of the pneumothorax, and the lung condition (extensive consolidation and diffuse bullous dystrophies), the only thoracic surgical approach prospected was a pneumonectomy. Willing to preserve the lung, the pulmonology team attempted a multi-phase medical-oriented strategy based on medical thoracoscopy. Therefore, the patient underwent 5 chest tube insertions, 2 talc pleurodesis, and an intrapleural blood patch. Air leakage resolution was progressively achieved, and the patient became asymptomatic.             We strongly encourage a medical thoracoscopic approach for the patient presenting with recurrent pneumothorax in order to ensure complete lung re-expansion and preserve lung parenchyma.

scholarly journals Well-Differentiated Papillary Mesothelioma of the Peritoneum is Genetically Distinct from Malignant Mesothelioma

2019 ◽  
Author(s):  
Raunak Shrestha ◽  
Noushin Nabavi ◽  
Stanislav Volik ◽  
Shawn Anderson ◽  
Anne Haegert ◽  
...  
Keyword(s):  
Exome Sequencing ◽  
Whole Exome Sequencing ◽  
Malignant Mesothelioma ◽  
Peritoneal Cavity ◽  
Incidental Finding ◽  
Reactive Process ◽  
Whole Exome ◽  
Substitution Mutations ◽  
Well Differentiated

AbstractWell-differentiated papillary mesothelioma (WDPM) is an uncommon mesothelial proliferation that is most commonly encountered as an incidental finding in the peritoneal cavity. There is controversy in the literature about whether WDPM is a neoplasm or a reactive process, and if neoplastic, whether it is a variant or precursor of epithelial malignant mesothelioma or is a different entity. Using whole exome sequencing of five WDPM of the peritoneum, we have identified distinct mutations in EHD1, ATM, FBXO10, SH2D2A, CDH5, MAGED1, and TP73 shared by WDPM cases but not reported in malignant mesotheliomas. Furthermore, we show that WDPM is strongly enriched with C>A transversion substitution mutations, a pattern that is also not found in malignant mesotheliomas. The WDPMs lacked alterations involving BAP1, SETD2, NF2, CDKN2A/B, LASTS1/2, PBRM1, and SMARCC1 that are frequently altered in malignant mesotheliomas. We conclude that WDPMs are neoplasms that are genetically distinct from malignant mesotheliomas, and based on observed mutations do not appear to be precursors of malignant mesotheliomas.

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