Salvage of infected craniotomy bone flaps with the wash-in, wash-out indwelling antibiotic irrigation system

2006 ◽  
Vol 105 (4) ◽  
pp. 640-644 ◽  
Author(s):  
Kurtis I. Auguste ◽  
Michael W. McDermott
Keyword(s):  
Radiation Treatment ◽  
Irrigation System ◽  
Bone Flap ◽  
Nasal Sinus ◽  
Additional Surgery ◽  
Treatment Paradigm ◽  
History Of ◽  
The One ◽  
The Cost

Object When complicated by infection, craniotomy bone flaps are commonly removed, discarded, and delayed cranioplasty is performed. This treatment paradigm is costly, carries the risks associated with additional surgery, and may cause cosmetic deformities. The authors present their experience with an indwelling antibiotic irrigation system used for the sterilization and salvage of infected bone flaps as an alternative to their removal and replacement. Methods The authors retrospectively reviewed the medical records for 12 patients with bone flap infections following craniotomy who received treatment with the wash-in, wash-out indwelling antibiotic irrigation system. Infected flaps were removed and scrubbed with povidone–iodine solution and soaked in 1.5% hydrogen peroxide while the wound was debrided. The bone flaps were returned to the skull and the irrigation system was installed. Antibiotic medication was infused through the system for a mean of 5 days. Intravenous antibiotic therapy was continued for 2 weeks and oral antibiotics for 3 months postoperatively. Wound checks were performed at clinic follow-up visits, and there was a mean follow-up period of 13 months. Eleven of the 12 patients who had undergone placement of the bone flap irrigation system experienced complete resolution of the infection. In five patients there was involvement of the nasal sinus cavities, and in four there was a history of radiation treatment. In the one patient whose infection recurred, there was both involvement of the nasal sinuses and a history of extensive radiation treatment. Conclusions Infected bone flaps can be salvaged, thus avoiding the cost, risk, and possible disfigurement associated with flap removal and delayed cranioplasty. Although prior radiation treatment and involvement of the nasal sinuses may interfere with wound healing and clearance of the infection, these factors should not preclude the use of irrigation with antibiotic agents for bone flap salvage.

scholarly journals Impact of atrial fibrillation pattern on outcomes after left atrial appendage closure: lessons from the prospective LAARGE registry

2021 ◽  
Author(s):  
Shinwan Kany ◽  
Johannes Brachmann ◽  
Thorsten Lewalter ◽  
Ibrahim Akin ◽  
Horst Sievert ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial Appendage ◽  
Systemic Embolism ◽  
Long Term Outcomes ◽  
Increased Risk ◽  
History Of ◽  
One Year ◽  
The One

Abstract Background Non-paroxysmal (NPAF) forms of atrial fibrillation (AF) have been reported to be associated with an increased risk for systemic embolism or death. Methods Comparison of procedural details and long-term outcomes in patients (pts) with paroxysmal AF (PAF) against controls with NPAF in the prospective, multicentre observational registry of patients undergoing LAAC (LAARGE). Results A total of 638 pts (PAF 274 pts, NPAF 364 pts) were enrolled. In both groups, a history of PVI was rare (4.0% vs 1.6%, p = 0.066). The total CHA2DS2-VASc score was lower in the PAF group (4.4 ± 1.5 vs 4.6 ± 1.5, p = 0.033), while HAS-BLED score (3.8 ± 1.1 vs 3.9 ± 1.1, p = 0.40) was comparable. The rate of successful implantation was equally high (97.4% vs 97.8%, p = 0.77). In the three-month echo follow-up, LA thrombi (2.1% vs 7.3%, p = 0.12) and peridevice leak > 5 mm (0.0% vs 7.1%, p = 0.53) were numerically higher in the NPAF group. Overall, in-hospital complications occurred in 15.0% of the PAF cohort and 10.7% of the NPAF cohort (p = 0.12). In the one-year follow-up, unadjusted mortality (8.4% vs 14.0%, p = 0.039) and combined outcome of death, stroke and systemic embolism (8.8% vs 15.1%, p = 0.022) were significantly higher in the NPAF cohort. After adjusting for CHA2DS2-VASc and previous bleeding, NPAF was associated with increased death/stroke/systemic embolism (HR 1.67, 95% CI 1.02–2.72, p = 0.041). Conclusion Atrial fibrillation type did not impair periprocedural safety or in-hospital MACE patients undergoing LAAC. However, after one year, NPAF was associated with higher mortality. Graphic abstract

scholarly journals A study of herpes zoster particularly in its relationship to chickenpox

1949 ◽  
Vol 47 (3) ◽  
pp. 253-262 ◽  
Author(s):  
H. E. Seiler
Keyword(s):  
Herpes Zoster ◽  
Sex Differentiation ◽  
Motor Paralysis ◽  
Recurrent Herpes ◽  
History Of ◽  
The One ◽  
Two Peaks ◽  
Relationship Of ◽  
The Relationship

The results of a field survey of herpes zoster over a period of 18 months are described and the difficulties of such a survey mentioned.A total of 246 patients with herpes zoster, only 16% of whom had attended hospital, is reported. It is calculated that the yearly incidence in the population was approximately 2 per 1000.Full investigation and ‘follow up’ was undertaken in 184 cases. These are classified according to the site of the zoster—the dorsal, supra-orbital and cervical regions being affected in almost 90%, the dorsal region alone accounting for 53·3%.Herpes generalisatus occurred in 7, or 38%, of the cases, recurrent herpes zoster in 6, or 3·3%, while there was one case of motor paralysis affecting lower limb.The majority of patients were apparently well at the onset of the zoster, but 27 had some associated disease; 5 gave a history of trauma prior to the onset and 2 were related to pregnancy.The seasonal and geographical distribution is given and, while the numbers are too small for statistical analysis, the disease in 1947 showed two peaks of higher incidence, the one in May and the other in October. Crowding or density of population did not appear to be important, and the disease occurred sporadically rather than in epidemic form.There was a higher proportion of female cases, but when related to the population as a whole no sex differentiation was observed. Of the patients 60% were over 45 years of age.There was no evidence that housing conditions or occupation were of aetiological significance or that the disease was more common among any particular section of the community.Eleven patients had been associated with other cases of herpes zoster before developing the disease, while 3 gave a suggestive history of prior contact with chickenpox.A condition indistinguishable from chickenpox occurred among the contacts of 10 patients, 12 individuals being affected, and there was one instance of concurrent herpes zoster and chickenpox. Other infections such as mumps, measles and rubella, while as common in association with the onset of herpes zoster, were not so frequently found as the chickenpox condition amongst contacts of the disease.The results of the survey as regards the relationship of chickenpox and herpes zoster are discussed. It is considered that the evidence does not favour a significant association with chickenpox prior to the onset of herpes zoster, but that the facts are consistent with the view that a condition indistinguishable from chickenpox may follow contact with herpes zoster. It is suggested, however, that this may be a generalized manifestation of the virus of zoster rather than true chickenpox.

scholarly journals Spontaneous regression of extradural intraspinal cysts in a dog: a case report

2019 ◽  
Vol 15 (1) ◽  
Author(s):  
Marília de Albuquerque Bonelli ◽  
Ronaldo Casimiro da Costa
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Spontaneous Regression ◽  
Magnetic Resonance Imaging Scan ◽  
Resonance Imaging ◽  
Lumbosacral Region ◽  
History Of ◽  
The One ◽  
Intraspinal Cyst

Abstract Background Extradural intraspinal cysts are fluid accumulations that appear to be associated with increased motion at vertebral joints. Case presentation We report the spontaneous regression of lumbar and lumbosacral cysts (presumably synovial cysts) and the unusual occurrence of an S1–2 extradural intraspinal cyst in a dog. The dog presented with lumbosacral pain. Six extradural intraspinal cysts were observed on high-field magnetic resonance imaging from L5–6 to S1-S2. The cysts between L5–6 and L7-S1 ranged from 0.12 to 0.44cm2 at their largest area. The largest cyst was located at S1–2 (left), measuring 0.84 cm2 at its largest view. The dog was medically managed. A follow-up magnetic resonance imaging scan was obtained 3.5 years after the first imaging. All cysts except the one at S1–2 had reduced in size. Mean reduction in size was 59.6% (35–81%). Conclusions In summary, we report a case with multiple extradural intraspinal cysts that underwent spontaneous regression of all but one cyst during a 3.5-year follow-up period. Whether this is a single occurrence, or is part of the natural history of these cysts in the lumbosacral region of dogs, remains to be established. Spontaneous regression of intraspinal cysts had not been described in dogs.

Is the One Ray Normal or Are the Rest Shorter?: Brachymetapody—A Case Report

2020 ◽  
Vol 110 (6) ◽  
Author(s):  
Yakup Ekinci ◽  
Kaan Gürbüz ◽  
Mustafa Arık ◽  
Sabri Batın
Keyword(s):  
Case Report ◽  
Rare Case ◽  
Genetic Disorder ◽  
Proximal Phalanx ◽  
Rare Type ◽  
Double Osteotomy ◽  
History Of ◽  
The One ◽  
Distorted Body Image

In this case report, we present the case of a 20-year-old male patient who suffered from pain in walking clinically, and in whom an extremely rare type of brachymetatarsia was diagnosed. Although distorted body image is the main reason for consulting a specialist, the patient presented because he was unable to find a proper shoe. The patient had no familial history of brachydactyly, trauma, or a genetic disorder. In this extremely rare case, the decision was made to perform shortening of the normal foot ray with a double osteotomy to the metatarsal and proximal phalanx. At the end of the follow-up period, the patient was walking pain-free and had no limitation in shoe choice.

scholarly journals Using the “One Shot” Concept for Immediate Loading Implant Protocol in Edentulous Patient Rehabilitation with a Fixed Prosthesis: A 6-Year Follow-Up

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Philippe Bousquet ◽  
Delphine Carayon ◽  
Jean-Cedric Durand
Keyword(s):  
Healing Process ◽  
Immediate Loading ◽  
Viable Option ◽  
Modified Model ◽  
Cast Model ◽  
Fixed Prosthesis ◽  
Master Model ◽  
The One ◽  
The Cost

Immediate-loaded implants with a fixed prosthesis are a viable option for the restoration of edentulous ridges. Several procedures now allow for the fabrication of immediate-loading provisional and definitive prostheses. However, this complex treatment is not accessible to all patients with budget restrictions. By using a unique master model with a single titanium framework prosthesis can simplify and shorten the treatment, as well as reduce costs. After surgical placement of implant fixtures, an interim prosthesis was fabricated using a laser-welded definitive titanium framework. The prosthesis was fitted intraorally following the immediate loading protocols. The master cast model used to fabricate interim prosthesis was conserved and subsequently used in modifying the final prosthesis. After the healing process and complete soft tissue stability, an impression was made to register the clearance between the gingiva and resin. The light silicone material was directly injected under the prosthesis screwed in the mouth. In the master cast model, the stone was eliminated between the implants and a new plaster was poured to modify the crest profile with the posthealing new shape. With this modified model, it is possible to rehabilitate the denture to the new gingival anatomy in 3 to 4 hours and, if necessary, the tooth rearrangement. This “one shot” concept combines the single definitive titanium welded framework and limited laboratory work with a unique master model thereby decreasing the cost and the time of treatment.

Abstract 2439: Visually-Guided Pulmonary Vein Isolation Using a Balloon Ablation Catheter to Treat Patients with Paroxysmal Atrial Fibrillation: One-Year Clincial Outcome Following a Single Ablation Procedure

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Vivek Y Reddy ◽  
Petr Neuzil ◽  
Sakis Themistoclakis ◽  
Aldo Bonso ◽  
Antonio Rossillo ◽  
...  
Keyword(s):  
Treatment Success ◽  
Balloon Catheter ◽  
Visually Guided ◽  
Endoscopic Ablation ◽  
Real Time Visualization ◽  
History Of ◽  
One Year ◽  
The One ◽  
Balloon Ablation

Introduction: During AF catheter ablation, placing contiguous point ablation lesions to electrically isolate the PVs can be technically challenging. A novel balloon catheter (EAS, Endoscopic Ablation System, Cardiofocus, Inc.) which utilizes an endoscope for real-time visualization of the LA-PV junction and adjustable arcs of ablative light energy was used to isolate the PVs. This report details the one-year follow-up results after a single treatment. Methods: In this three-center study, 30 patients with a history of symptomatic drug-resistant paroxysmal AF were studied: Sex: M/F = 26/4 (87%/13%); Age 53 ± 11 years (28 –73); AF duration: 6.0±4.9 years (range 0.4 –24.1); LA diameter: 4.3±0.5 cm (range 3.1– 4.9); LVEF 67.6±8.9% (range 45– 86). PV isolation using the EAS was confirmed using a circular mapping catheter. There were no exclusion criteria related to PV shape/number. Results: Electrical PV isolation was achieved in 91% (105/116) of the targeted PVs. An average of 14 energy deliveries/PV were delivered (range 2– 40). There was no significant PV stenosis. There were three primary adverse events. Following a 90-day blanking period, 70% (21/30) of patients were free from symptomatic AF episodes >1 min at 6-month follow-up, and 67% (20/30) were free from symptomatic AF episodes lasting >1 minute through one-year follow-up. Two treatment success were on AADs for indications other than AF. An examination of the treatment failures was conducted. There were no differences between chronic treatment successes and failures in sex (p=0.56), age (p=0.22), EF (p=1.0), LA diameter (p=0.70), years of AF (p=0.30) and acute PV isolation of all PVs versus less than all PVs (p=0.66). Most treatment ``failures” did not require repeat AF ablation due to minimal symptoms. One underwent subsequent RF ablation for AF in follow-up; PV reconnections were noted. Conclusions: A single treament with the visually-guided EAS ablation system appears feasible, safe and efficacious to treat patients with paroxysmal AF.

‘Intranasal toothache’: case report

2012 ◽  
Vol 127 (3) ◽  
pp. 321-322 ◽  
Author(s):  
T A van Essen ◽  
J B van Rijswijk
Keyword(s):  
Case Report ◽  
Facial Pain ◽  
Surgical Extraction ◽  
History Of ◽  
Nasal Tooth ◽  
Endoscopic Guidance ◽  
Ectopic Tooth ◽  
One Year ◽  
The One

AbstractObjective:This paper describes a patient with recurrent unilateral nasal discomfort and pain due to an intranasal tooth. A short overview of the literature is provided in relation to the aetiology, symptomatology, diagnosis and treatment of intranasal teeth.Case report:A 26-year-old man was referred with a history of recurrent left-sided nasal obstruction, facial pain and discomfort, and chronic purulent rhinorrhoea. Computed tomography revealed a nasal tooth, which was likely to have been the cause of these symptoms. After transnasal surgical extraction under endoscopic guidance, the patient was relieved of his complaints (at the one-year follow up).Conclusion:An ectopic tooth in the nasal cavity is a rare phenomenon, and in most cases the cause of an intranasal tooth remains unclear. The treatment of an intranasal tooth entails surgical extraction even though such teeth may remain asymptomatic; several cases have illustrated the potential significant morbidity associated with their occurrence.

scholarly journals Pathological laughter in a patient with trigeminal neurinoma

2002 ◽  
Vol 60 (4) ◽  
pp. 1000-1002 ◽  
Author(s):  
André G. Machado ◽  
Paulo Henrique Aguiar ◽  
Raul Marino Jr
Keyword(s):  
Nerve Palsy ◽  
Large Tumor ◽  
Pathological Laughter ◽  
History Of ◽  
Significant Compression ◽  
One Year ◽  
The One ◽  
The Right ◽  
The Brain

We present a 47-year-old woman with a long history of anxiety and a more recent history of shock-like facial pain and episodes of laughter without any motivation. She could not explain the laughing bursts and did not have a sense of mirth preceding it. On neurological examination she presented a VI nerve palsy and trigeminal hypoesthesia (V2 and V3) on the right side. Magnetic resonance imaging exhibited a large cystic lesion on the right middle fossa causing significant compression on the brain stem. A frontoorbitozygomatic and pretemporal combined approach was performed. During intra and extradural exploration a large tumor was found on the trigeminal nerve. The whole lesion was resected, revealing to be a neurinoma on pathological exhamination. She maintained a VI nerve palsy but had complete remission of the unmotivated laughing episodes during the one year follow up.

scholarly journals Multiple Congenital Bilateral Trigger Digits in a 2-Year-Old Child: Case Report

2013 ◽  
Vol 7 (1) ◽  
pp. 75-77 ◽  
Author(s):  
V De Luna ◽  
V Potenza ◽  
L Garro ◽  
P Farsetti ◽  
R Caterini
Keyword(s):  
Bacterial Infections ◽  
Rare Condition ◽  
Trigger Finger ◽  
Left Hand ◽  
Right Hand ◽  
History Of ◽  
One Year ◽  
The One ◽  
The Right

Trigger finger is a rare condition in children. In this paper, we report on a 2-year-old boy with multiple congenital bilateral trigger digits. The patient had no history of perinatal trauma, viral or bacterial infections, or metabolic disorders. The patient was treated with physiotherapy for one year. At the one-year follow-up, the boy presented with six trigger fingers (3 on the right hand, 3 on the left hand). Neither thumb was involved. The six trigger fingers were treated surgically: first, the right-hand trigger fingers and, six months later, those of the left hand. After each operation, a 4-week brace in extension was applied to the operated hand. The symptoms were completely resolved after surgical treatment. Many authors have recommended surgical release for the treatment of trigger finger in children; empirical treatment with physiotherapy may be an option when symptoms present or appear at an older age.

scholarly journals Oligosymptomatic and giant basilar artery dolichoectasia discovered after a stroke: case report

2007 ◽  
Vol 65 (2A) ◽  
pp. 345-347 ◽  
Author(s):  
Cynthia Resende Campos ◽  
Hugo Leonardo Doria-Netto ◽  
Antonio Marcos de Souza-Filho ◽  
Hilton Mariano da Silva Júnior
Keyword(s):  
Hearing Loss ◽  
Functional Recovery ◽  
Basilar Artery ◽  
Cross Sectional ◽  
Vertebrobasilar Dolichoectasia ◽  
Basilar Arteries ◽  
History Of ◽  
One Year ◽  
The One

The most frequently diagnosed complication of vertebrobasilar dolichoectasia (VBD) is the compression of structures adjacent to the vertebral and basilar arteries. A giant VBD with only slight compressive symptoms is unusual. In this setting, the diagnosis of VBD may be casually revealed after the occurrence of a posterior circulation stroke, another potential complication. We report a 48-year-old woman who presented a two-month history of continuous buzz and a slight right-sided hearing loss that was followed by a cerebellar ischemic stroke. Brain CT and MRI revealed a marked compression of the brainstem due to an ectatic, tortuous and partially thrombosed basilar artery (BA). The largest cross-sectional diameter of BA was 18 mm. The patient had a good functional recovery within the two-month follow-up after stroke with modified Rankin scale score (mRSS)=2. At the one-year follow-up, patient still kept the complaints of continuous buzz, slight right-sided hearing loss and the mRSS was the same. We call attention for an unusual giant VBD that caused an impressive brainstem compression with displacement of important structures in an oligosymptomatic patient. Diagnosis was made only after the occurrence of a stroke. Despite of the good functional recovery after stroke, the presence of significant atherosclerotic changes and the large BA diameter may indicate a poor outcome. However, after one year, she remains oligosymptomatic.

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