Native Joint Infections by Aspergillus Species

Background: Septic arthritis due to Aspergillus spp. represents a rare, but severe disease. Nevertheless, clear guidelines regarding most effective medical treatment have not yet been established. The present study is a literature review of all reported cases of fungal septic arthritis due to Aspergillus spp, in order to clarify epidemiology, as well as the medical and operative management and their outcome. Methods: A meticulous review of all published septic arthritis infections due to Aspergillus has been conducted. Information regarding demographics, causative fungus, antifungal treatment (AFT), surgical intervention, as well as the infection’s outcome were recorded and evaluated. Results: A total of 30 Aspergillus spp. strains from 29 hosts have been studied. The patients’ mean age was 45.8 years. The most commonly affected joint was the knee (45.7%), while the predominant symptom was joint pain (62%). Most patients were immunocompromised (72.4%). Diagnosis was established through cultures and/or histopathology. Aspergillus fumigatus was the most common responsible fungi (63.3%), followed by A. flavus (16.6%) and A. terreus (10%). Regarding AFT, the preferred agent proved to be Amphotericin B (14 cases; 48.3%), followed by voriconazole (11; 37.9%), while the mean AFT duration was 5.6 months. In most cases surgical treatment was also performed (in 4 cases no surgery was reported). Treatment was effective in 20 cases (69%). Conclusions: Septic arthritis caused by Aspergillus spp. represents a severe clinical entity. It seems that, with the available data, prolonged AFT along with surgical intervention is the preferred management of this infection, while identification of the responsible fungus is of utmost importance.

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Predictors of Surgical Intervention in Patients with Inflammatory Bowel Disease

QJM ◽

10.1093/qjmed/hcab100.017 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Khaled Hamdy Abd El Megeed ◽

Shereen Abou Bakr Saleh ◽

Christina Alphonse Anwar ◽

Ahmed Elkattary Mohamed Elkattary

Keyword(s):

Inflammatory Bowel Disease ◽

Surgical Treatment ◽

Bowel Disease ◽

Surgical Intervention ◽

High Sensitivity ◽

Medical Patients ◽

Mayo Score ◽

Calprotectin Level ◽

Inflammatory Bowel ◽

The Mean

Abstract Background Inflammatory bowel disease (IBD) is comprised of two major disorders: Ulcerative Colitis and Crohn’s disease. Ulcerative Colitis affects the colon, where as Crohn’s disease can involve any component of the gastrointestinal tract from the mouth to the perianal area. These disorders have somewhat different pathologic and clinical characteristics, but with substantial overlap; their pathogenesis remains poorly understood. Objective To determine & detect different predictors that help us to characterize patients with high probability of undergoing surgical intervention for inflammatory bowel diseases. Patients and Methods The present study was designed to detect & identify possible factors that can be used to predict surgical intervention in patients with IBD. The present study was a case control study that was conducted on 80 patients with inflammatory bowel disease (either controlled by medical treatment or needed surgical intervention as a part of disease control) who were recruited form Ain-Shams university hospitals and El Quabbary general hospital in Alexandria. In the present study, the mean age of the included patients was 36.67 ±8.5 years old and 50% of the patients were males. The mean age at the onset of the disease was 25.81 ±6.8 years old. Results In the present study, there were statistically significant differences between surgical and medical patients in terms of CDAI for CD (p < 0.001) and Mayo score for UC (p < 0.001). Surgical patients were more likely to have higher scores. CDAI and Mayo score were negative predictors of surgical treatment. CDAI score > 287 and Mayo score > 8.5 achieved high sensitivity and specificity for the detection of surgical treatment. In the present study, we found that there was statistically significant differences between surgical and medical patients in terms of Stool Calprotectin level. Surgical patients were more likely to have higher Stool Calprotectin level. Stool Calprotectin level was negative predictor of surgical treatment at a level of > 341.5 microgm/gm with high sensitivity and specificity. Conclusion Surgical treatment is a common outcome in IBD. Certain clinical features and the extent of disease are risk factors for surgical intervention. Our study indicates that smoking, Chron’s disease, perianal disease, granulomas, higher severity scores, higher stool Calprotectin level, CRP, and ESR were associated with higher risks of surgical intervention. In addition, smoking, peri-anal disease, CDAI, Mayo score, Stool Calprotectin level, and CRP level were predictors of surgical treatment. The findings of our analysis have implications for practice, particularly in the promotion of preoperative individualized risk prediction. The ability to predict which patients will need surgery and target more intensive, early treatment to that group would be invaluable. Further research through large prospective cohort studies is needed to confirm our findings and conclusions.

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Gamma Knife thalamotomy for treatment of essential tremor: long-term results

Journal of Neurosurgery ◽

10.3171/2009.10.jns09332 ◽

2010 ◽

Vol 112 (6) ◽

pp. 1311-1317 ◽

Cited By ~ 70

Author(s):

Ronald F. Young ◽

Francisco Li ◽

Sandra Vermeulen ◽

Robert Meier

Keyword(s):

Surgical Treatment ◽

Essential Tremor ◽

Gamma Knife ◽

Surgical Intervention ◽

Long Term Results ◽

The Mean ◽

Lost To Follow Up ◽

Deep Brain

Object The goal of this report was to describe the safety and effectiveness of nucleus ventralis intermedius (VIM) thalamotomy performed with the Leksell Gamma Knife (GK) for the treatment of essential tremor (ET). Methods One hundred seventy-two patients underwent a total of 214 VIM thalamotomy procedures with the Leksell GK between February 1994 and March 2007 for treatment of disabling ET. Eleven patients were lost to follow-up less than 1 year after the procedures, so that in this report the authors describe the results in 161 patients who underwent a total of 203 thalamotomies (119 unilateral and 42 bilateral). Results There were statistically significant decreases (p < 0.0001) in tremor scores for both writing and drawing. The mean postoperative follow-up duration for all patients was 44 ± 33 months. Fifty-four patients have been followed for more than 60 months posttreatment. There were 14 patients who suffered neurological side effects that were temporary (6) or permanent (8), which accounted for 6.9% of the 203 treatments. All complications were related to lesions that grew larger than expected. Conclusions A VIM thalamotomy with the Leksell GK offers a safe and effective alternative for surgical treatment of ET. It is particularly applicable to patients who are not ideal candidates for deep brain stimulation but can be offered to all patients who are considering surgical intervention for ET.

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Spondylodiscitis Caused by Aspergillus Species

Diagnostics ◽

10.3390/diagnostics11101899 ◽

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.

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Surgical Treatment of Pancreatic Insulinomas: A Series of 15 Years

10.47363/jcrr/2021(3)145 ◽

2021 ◽

Vol 3 (3) ◽

pp. 1-4

Author(s):

Vanessa Rebelo dos Santos ◽

◽

Carlota Ramos ◽

Rafael Cruz ◽

◽

...

Keyword(s):

Surgical Treatment ◽

Local Recurrence ◽

Surgical Approach ◽

Medical Records ◽

Surgical Intervention ◽

Female Gender ◽

The Body ◽

Head Of The Pancreas ◽

The Mean

Insulinomas, although rare, are the most common pancreatic functioning neuroendocrine tumors. The diagnostic workup is commonly made late in time and surgical treatment is the only curative method. Our aim was to analyze the surgical approach to pancreatic insulinomas, through a 15-year series of patients who underwent surgery for this matter. From January 2006 to December 2020, we performed a retrospective review of the medical records of all the patients who underwent surgical treatment for insulinoma. Fourteen patients with insulinoma performed surgical intervention, 78,6% were of the female gender and the mean age was 48 years (19-86 years). Four (28,6%) of the tumors were located in the head of the pancreas, 5 (35,7%) in the body and 5 (35,7%) in the tail. Complications occurred in 4 patients (28,6%) following surgery. On follow-up, there was one (7,1%) case of local recurrence, thus necessitating a new surgical intervention [1-8].

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Non-Candida Fungal Prosthetic Joint Infections

Diagnostics ◽

10.3390/diagnostics11081410 ◽

2021 ◽

Vol 11 (8) ◽

pp. 1410

Author(s):

Christos Koutserimpas ◽

Ifigeneia Chamakioti ◽

Stylianos Zervakis ◽

Konstantinos Raptis ◽

Kalliopi Alpantaki ◽

...

Keyword(s):

Multidisciplinary Approach ◽

Surgical Intervention ◽

Revision Arthroplasty ◽

Standard Of Care ◽

Surgical Interventions ◽

Joint Infections ◽

Prosthetic Joint ◽

Prosthetic Joint Infections ◽

The Mean ◽

Mean Time

Background: Fungal prosthetic joint infections (PJIs) are rare, especially those caused by non-Candida species. Treatment has not been fully elucidated, since a plethora of antifungal and surgical interventions have been proposed. Τhis study represents an effort to clarify the optimal management of non-Candida fungal PJIs, by reviewing all relevant published cases. Methods: A thorough review of all existing non-Candida fungal PJIs in the literature was conducted. Data regarding demographics, responsible organisms, antifungal treatment (AFT), surgical intervention, time between initial arthroplasty and onset of symptoms, and time between onset of symptoms and firm diagnosis, as well as the infection’s outcome, were evaluated. Results: Forty-two PJIs, in patients with mean age of 66.2 years, were found and reviewed. Aspergillus spp. were isolated in most cases (10; 23.8%), followed by Coccidioides spp. (7; 16.7%) and Pichiaanomala (5; 11.9%). Fluconazole was the preferred antifungal regimen (20 cases; 47.6%), followed by amphotericin B (18 cases; 42.9%), while the mean AFT duration was 9.4 months (SD = 7.06). Two-stage revision arthroplasty (TSRA) was performed in 22 cases (52.4%), with the mean time between stages being 5.2 months (SD = 2.9). The mean time between initial joint implantation and onset of symptoms was 42.1 months (SD = 50.7), while the mean time between onset of symptoms and diagnosis was 5.8 months (SD = 14.3). Conclusions: Non-Candida fungal PJIs pose a clinical challenge, demanding a multidisciplinary approach. The present review has shown that combination of TSRA separated by a 3–6-month interval and prolonged AFT has been the standard of care in the studied cases.

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Return to Play Following High-Grade Turf Toe Injuries in National Football League Athletes

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00055 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0005

Author(s):

Benjamin B. Lindsey ◽

Neil K. Bakshi ◽

David M. Walton ◽

James R. Holmes ◽

Paul G. Talusan

Keyword(s):

National Football League ◽

Surgical Intervention ◽

Operative Management ◽

Return To Play ◽

High Grade ◽

Turf Toe ◽

The Mean ◽

And Performance ◽

Non Operative Management ◽

Mean Time

Category: Sports; Midfoot/Forefoot; Trauma Introduction/Purpose: Return-to-play (RTP) rates of National Football League (NFL) athletes following surgical intervention for numerous foot and ankle injuries has been reported. To our knowledge, no studies have reported on RTP rates of NFL athletes after non-operative and operative treatment of high-grade turf toe injuries. The purpose of this study was to evaluate the RTP rates in NFL athletes who sustained high-grade turf to injuries. We hypothesized that NFL athletes requiring operative intervention for high-grade turf toe injuries would have lower RTP rates and longer recoveries than athletes treated non- operatively. Additionally, we hypothesized that regardless of treatment, NFL athletes would demonstrate equal productivity following RTP. Methods: Publicly available NFL injury data was reviewed to identify athletes who sustained high-grade turf toe injuries, as indicated by surgical intervention or missed playing time of 2 weeks or more. Athletes were excluded if RTP was prevented for reasons unrelated to the injury. Demographic and performance data was obtained including a player’s injury, date of injury, date of surgery, RTP, time to RTP, number and percentage of games played, and performance. Results: 53 NFL athletes were identified with high-grade turf toe injuries that met inclusion criteria. 28 of these athletes were treated non-operatively and 25 were treated with surgery. The overall RTP rate was 91%. Athletes who were treated non- operatively had a RTP rate of 100% while athletes who underwent surgery had a RTP rate of 80% (P = 0.011). The mean time to RTP for all athletes was 140.9+-111.9 days. The mean time to RTP for non-operatively treated patients was 75.8+-99.0 days, compared with 221.4+-81.6 days for operatively treated athletes (P = 0.002). In skill position athletes who achieved RTP, 78% treated non-operatively were able to return to their prior level of performance compared to only 27% for athletes treated surgically (P = 0.032). Conclusion: There is a significant difference in return to play following surgical versus non-operative management of high-grade turf toe injuries, with only 80% of athletes achieving return to play after surgery. No athletes were able to return the same season as surgery and the mean time to RTP following initiation of treatment was significantly shorter for players who underwent non- operative management. Postoperative performance was also significantly worse in players who underwent surgical intervention compared to non-operative management. This study provides important prognostic information to high level athletes in regards to recovery following high-grade turf toe injuries

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Surgical intervention in middle-ear cholesterol granuloma

The Journal of Laryngology & Otology ◽

10.1258/002221503321626366 ◽

2003 ◽

Vol 117 (5) ◽

pp. 344-348 ◽

Cited By ~ 9

Author(s):

Manabu Maeta ◽

Ryusuke Saito ◽

Fumio Nakagawa ◽

Takakazu Miyahara

Keyword(s):

Surgical Treatment ◽

Middle Ear ◽

Surgical Intervention ◽

Hearing Level ◽

Cholesterol Granuloma ◽

Ventilation Tube ◽

Tube Insertion ◽

Mastoid Obliteration ◽

The Mean ◽

Perforated Tympanic Membrane

Eleven patients who had been surgically treated from 1988 to 1999 were retrospectively reviewed in order to evaluate the efficacy of ventilation tube insertion and mastoidectomy with, or without, mastoid obliteration for intractable middle-ear cholesterol granuloma. The mean age registered was 17.2 years at the time of surgical treatment. All cases were unilaterally affected. Five ears were treated with simple mastoidectomy coupled with the insertion of a ventilation tube, while six others had additional mastoid obliteration. The hearing prognosis was excellent with an improved post-operative hearing level of 16.5 dB (cf. pre-operative 37.7 dB). However, morphological prognosis revealed two ears had a residual perforated tympanic membrane without otorrhoea after displacement of the ventilation tube. Of the remaining nine ears with intact placement of the ventilation tube, five had dry ears while four had occasional otorrhoea. Although the morphological prognosis was incomplete, treatments involving at least aninsertion of a ventilation tube with thorough mastoidectomy were thought to be necessary.

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The Challenge of Enterocutaneous Fistulae

ARS Medica Tomitana ◽

10.2478/arsm-2014-0022 ◽

2015 ◽

Vol 20 (3) ◽

pp. 123-128

Author(s):

Berro A. ◽

Savin Silvia ◽

Costea D. ◽

Tomita Maria ◽

Nichifor Ana Maria ◽

...

Keyword(s):

Small Intestine ◽

Surgical Treatment ◽

Nutritional Support ◽

Surgical Intervention ◽

Intestinal Fistula ◽

Male Patients ◽

The Mean ◽

Small Intestinal ◽

And Control ◽

Stoma Care

Abstract During a period of three years (01.01.2009-31.12.2011), 17 cases of enterocutaneous fistulas arising from the small intestine were managed. The majority of the fistulas (76%) resulted from surgical complications. There were 6 females and 11 male patients. The mean age of the patients was 40 years. For 9 out of 17 patients (52%) the fistulae arose from the proximal small gut (duodenum and jejunum) and in the remaining 48%, from the ileum. Octreotide was used for 11/17 patients (64%). Enteral nutrition was used for 9/17 patients (52%), while re-feed from the proximal gut fistulae was used in 4/9 patients (44%) in order to maintain the nutrition of the above mentioned subjects. Only one fistula (6%) closed spontaneously. There were 2 deaths (12%) in this study. For 14 out of 17 patients (82%) the surgical intervention at some stage was required for successful closure of intestinal fistula. Aggressive surgical treatment with judicious use of octreotide, nutritional support, stoma care and control of sepsis significantly improves the outcome of small intestinal fistulae.

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Harvey Cushing and pediatric brain tumors at Johns Hopkins: the early stages of development

Journal of Neurosurgery Pediatrics ◽

10.3171/2011.3.peds10323 ◽

2011 ◽

Vol 7 (6) ◽

pp. 575-588 ◽

Cited By ~ 3

Author(s):

Courtney Pendleton ◽

Edward S. Ahn ◽

Alfredo Quiñones-Hinojosa

Keyword(s):

Surgical Treatment ◽

Brain Tumors ◽

Surgical Intervention ◽

Pediatric Brain Tumors ◽

Johns Hopkins Hospital ◽

Intracranial Neoplasms ◽

Harvey Cushing ◽

The Mean ◽

Mean Time ◽

Pediatric Brain

Object Harvey Cushing, credited with pioneering the field of neurosurgery as a distinct surgical subspecialty in the US, was at the forefront of neurooncology, publishing seminal papers on the diagnosis and treatment of pediatric brain tumors during the latter part of his career. However, his contributions to the surgical treatment of these lesions during the early stages of his tenure at the Johns Hopkins Hospital, from 1896 to 1912, remain largely unknown. Methods After obtaining institutional review board approval, and through the courtesy of the Alan Mason Chesney Archives, the authors reviewed the Johns Hopkins Hospital surgical files from the years 1896 to 1912. Patients younger than 18 years of age, presenting with symptoms suspicious for an intracranial tumor, and undergoing surgical intervention by Cushing were selected for further analysis. Results Of the 40 pediatric patients undergoing surgery for suspected intracranial neoplasms, 26 were male. The mean age among the entire sample was 10.1 years. Cushing used three main operative approaches in the surgical treatment of pediatric intracranial neoplasms: infratentorial/suboccipital, subtemporal, and hemisphere flap. Twenty-three patients had negative findings following both the primary and subsequent surgical interventions conducted by Cushing. Postoperative conditions following the primary surgical intervention were improved in 24 patients. Twelve patients (30%) died during their inpatient stay for the primary intervention. The mean time to the last follow-up was 24.9 months; the mean time to death was 10.0 months. Conclusions Cushing strove to maximize exposure while minimizing blood loss in an attempt to increase his ability to successfully treat pediatric brain tumors. His early contributions to the field of pediatric neurooncology demonstrate his commitment to advancing the field of neurosurgery.

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Síndrome da Anca de Ressalto

Revista de Medicina Desportiva ◽

10.23911/rmd.vol9.iss1.pp8-11 ◽

2018 ◽

Vol 9 (1) ◽

pp. 8

Author(s):

Bernardo Almeida

Keyword(s):

Surgical Treatment ◽

Hip Joint ◽

Scientific Literature ◽

Therapeutic Targets ◽

Clinical History ◽

Disease Diagnosis ◽

Diagnosis And Treatment ◽

Snapping Hip ◽

Predominant Symptom ◽

Snapping Hip Syndrome

Snapping hip syndrome is a condition in which the predominant symptom is the snapping feelingaround the hip joint caused by a dynamic impingement between muscles or tendons and boneprominences. The etiology of the snapping hip types and consequently the therapeutic targets havebeen subjects of discussion and controversy along the years. A careful clinical history and physicalexamination is frequently enough for this disease diagnosis. Treatment is typically conservative,however when it is not successful surgical treatment is indicated, consisting on the snapping muscleor tendons lengthening. The authors review in this paper the current scientific literature about functionalanatomy, physiopathology, symptoms, diagnosis and treatment of snapping hip.

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