Mass barium carbonate poisoning with fatal outcome, lessons learned: a case series

Background: REBOA has become an established adjunct to hemorrhage control. Prospective data sets are being collected, primarily from large, high volume trauma centers. There are limited data, and guidelines, to guide implementation and use outside of highly resourced environments. Smaller centers interested in adopting a REBOA program could benefit from closing this knowledge gap. Methods: A clinical series of cases utilizing REBOA from Grand Strand Medical Center, Myrtle Beach, South Carolina were reviewed. This represents early data from a busy community trauma center (ACS Level 2), from January 2017 to May 2018. Seven cases are identified and reported on, including outcomes. Considerations and ‘lessons learned’ from this early institutional experience are commented on. Results: REBOA was performed by trauma and acute care surgeons for hemorrhage and shock (blunt trauma n=3, penetrating trauma n=2, no- trauma n=2). All were placed in Zone 1 (one initially was placed in zone 3 then advanced). Mean (SD) systolic pressure (mmHg) before REBOA was 43 (30); post REBOA pressure was 104 (19). N=4 were placed via an open approach, n=3 percutaneous (n=2 with ultrasound). All with arrest before placement expired (n=3) and all others survived. Complications are described. Conclusions: REBOA can be a feasible adjunct for shock treatment in the community hospital environment, with outcomes comparable to large centers, and can be implemented by acute care and trauma surgeons. A rigorous process improvement program and critical appraisal process are critical in maximizing benefit in these centers.

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Pulmonary Arterial Thrombosis Is a Novel and Underreported Feature in Severe COVID-19 with Fatal Outcome: Results from a Prospective Single-Centre Clinicopathological Case Series

SSRN Electronic Journal ◽

10.2139/ssrn.3586685 ◽

2020 ◽

Cited By ~ 2

Author(s):

Sigurd Lax ◽

Kristijan Skok ◽

Peter Zechner ◽

Harald Kessler ◽

Norbert Kaufmann ◽

...

Keyword(s):

Arterial Thrombosis ◽

Fatal Outcome ◽

Case Series ◽

Single Centre ◽

Pulmonary Arterial

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Lessons learned from volar plate fixation of scaphoid fracture nonunions

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193417743636 ◽

2017 ◽

Vol 43 (1) ◽

pp. 57-65 ◽

Cited By ~ 6

Author(s):

Seth D. Dodds ◽

John B. Williams ◽

Max Seiter ◽

Clark Chen

Keyword(s):

Plate Fixation ◽

Scaphoid Fracture ◽

Case Series ◽

Lessons Learned ◽

Wrist Flexion ◽

Level Of Evidence ◽

Computed Tomographic ◽

Volar Aspect ◽

Fracture Nonunions ◽

New Type

Treating scaphoid nonunions presents difficulties particularly when there is bone loss, significant humpback deformity or avascular necrosis. We describe a new type of fixation with a volar scaphoid plate that adds to the methods of internal fixation that are available for the treatment of recalcitrant scaphoid nonunions. We will also discuss ‘lessons learned’ from a cases series. The case series includes 20 consecutive patients treated with volar buttress plating and a pedicled vascularized bone graft from the ipsilateral volar distal radius. There was clinical and radiographic evidence of union in 18 of 20 patients, 13 of which were verified by computed tomographic scan. The range of motion was improved in all patients post-operatively. Four patients with radiographic union experienced intermittent clicking with maximal wrist flexion, believed to be due to the impingement of the plate on the volar aspect of the radioscaphoid articulation and underwent removal at approximately 1 year after the index procedure. Volar scaphoid plating is a useful alternative to headless scaphoid screw fixation in the treatment of unstable scaphoid waist fractures and nonunions. Level of evidence: IV

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COVID-19 situation in Baden-Württemberg, Germany: Preliminary case series study during the first wave

GMPC Thesis and Opinions Platform ◽

10.51585/gtop.2021.0003 ◽

2021 ◽

Vol 1 (1) ◽

pp. 6-11

Author(s):

Dzmitry Katovich ◽

Claudia Grun ◽

Hanna Katovich ◽

Bastian Hauer ◽

Thomas Iber ◽

...

Keyword(s):

Intensive Care ◽

Clinical Symptoms ◽

Fatal Outcome ◽

Laboratory Data ◽

Case Series ◽

Severe Illness ◽

Case Series Study ◽

Regional Factors ◽

Series Study

The present case series study presents the preliminary data of 347 of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) positively tested patients in the Mittelbaden hospital, Baden-Baden Bühl, Germany, during the period from March to June 2020. Among the 347 patients, 55% were males. The mean age-wise was 52.5±20.2 years in the overall cohort and 78.9±11.1 years in fatal outcome cases. A total of 120/347 patients (34.6%) required hospitalization, but only 36/347 (10.37%) cases required intensive care. The overall fatality rate was 6.6% (23/347), of which 12 patients were from the intensive care unit. The most frequent clinical symptoms observed were cough (62.5%), hyperthermia (47.8%), rhinorrhea (25.1%), sore throat (23.1%), dyspnea (22.8%), and headache (19.3%). Laboratory data analysis showed no specific findings, but severe laboratory disturbances could predict critical illness. A higher risk of severe illness or lethal outcome in elderly patients with several comorbidities was the most frequent. The fight against COVID-19 infection in Germany seems to be more successful during the first wave than in other countries. The improvement of the healthcare system against infectious outbreaks depends directly on the analysis of regional factors.

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Deformity and Clinical Outcomes Following Operative Correction of Charcot Ankle

Foot & Ankle International ◽

10.1177/1071100718805076 ◽

2018 ◽

Vol 40 (2) ◽

pp. 145-151 ◽

Cited By ~ 5

Author(s):

Elizabeth A. Harkin ◽

Andrew M. Schneider ◽

Michael Murphy ◽

Adam P. Schiff ◽

Michael S. Pinzur

Keyword(s):

Clinical Outcome ◽

Clinical Outcomes ◽

Ankle Joint ◽

Chronic Wounds ◽

Surgical Techniques ◽

Case Series ◽

Lessons Learned ◽

Charcot Foot ◽

Operative Correction ◽

Therapeutic Footwear

Background: Deformity associated with Charcot foot arthropathy leads to a poor quality of life in affected individuals. Deformity in the midfoot appears to be predictive of clinical outcomes following operative correction. The goal of this retrospective study was to determine if that same methodology could be applied to patients treated for Charcot foot arthropathy involving the ankle joint. Methods: Fifty-six consecutive patients underwent operative reconstruction of Charcot foot deformity involving the ankle joint by a single surgeon over a 14-year period. Preoperative patient characteristics and tibiotalar alignment, were recorded. Surgical treatment included single-stage debridement of active infection and ankle arthrodesis with application of a circular external fixator when infection was present (39 of 56, 69.6%) or retrograde locked intramedullary nailing in the absence of infection (17 of 56, 30.3%). Clinical outcomes were graded based on limb salvage, resolution of infection and chronic wounds, and the ability to ambulate with therapeutic footwear or accommodative orthoses. The average follow-up was 7.5 (range 1.1-14.0) years. Results: One patient died at 134.3 weeks following surgery of unrelated causes and 8 underwent amputation. Twenty-eight of 56 patients (50.0%) achieved a favorable (excellent or good) clinical outcome. There was no significant association between pre- or postoperative alignment and clinical outcomes. Insulin-dependent diabetics were approximately 3 times more likely to have a poor clinical outcome. Conclusions: Operative correction of Charcot deformity involving the ankle joint was associated with a high complication rate and risk for failure. The lessons learned from this highly comorbid patient population with complex deformities can be used as a benchmark for applying modern surgical techniques. Level of Evidence: Level IV, case series.

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P14.123 Neurological complications related to checkpoints inhibitors

Neuro-Oncology ◽

10.1093/neuonc/noz126.358 ◽

2019 ◽

Vol 21 (Supplement_3) ◽

pp. iii97-iii98

Author(s):

I Esparragosa ◽

R Valenti-Azcarate ◽

D Moreno-Ajona ◽

J Gallego Perez de Larraya

Keyword(s):

Cerebrospinal Fluid ◽

Checkpoint Inhibitors ◽

Early Recognition ◽

Oral Prednisone ◽

Fatal Outcome ◽

Case Series ◽

Neurological Complications ◽

Ovarian Adenocarcinoma ◽

Inflammatory Myositis ◽

Oncological Treatment

Abstract BACKGROUND Currently, immunotherapy is part of the therapeutic arsenal for oncological treatment. Indeed, the need for new medications has led to the development of immune checkpoint inhibitors. Despite favourable oncological outcomes, these treatments have been associated with immune-related adverse events. Although infrequent, neurological toxicities have been reported. Early recognition is crucial for improvement of functional outcome and requires a multidisciplinary approach. OBJECTIVE To describe a case series of patients with neurological complications related to checkpoint inhibitors. PATIENTS AND METHODS We identified six oncological patients who presented immunomediated neurological complications, derived from the use of checkpoints inhibitors. Five cases were men. Ages ranged from 58 to 73 years. Nivolumab, alone or combined, was the most commonly associated drug (4/6). Underlying diseases included lung carcinoma (2/6), melanoma (2/6), renal carcinoma (1/6) and ovarian adenocarcinoma (1/6). An acute demyelinating sensory-motor polyneuropathy and an acute axonal sensory polyneuropathy were documented in two and one case, respectively. In these, the cerebrospinal fluid analysis revealed albuminocytologic dissociation. All three cases improved after treatment with intravenous immunoglobulins (0.4 g/Kg a day for five days). The latter and another case were diagnosed of aseptic meningitis after cerebrospinal fluid lymphocytic pleocytosis was found. High fever was also associated with lower extremities areflexia, weakness and ataxia. Methylprednisolone (1g/day for five days) was administered. One case of necrotizing inflammatory myositis with high levels of creatine kinasa, confirmed by muscular biopsy, involving cervical weakness and ptosis, was effectively treated with Methylprednisolone (1g/day for five days) follow by oral prednisone tapering. An anti-Yo related pancerebellar syndrome was the only case with a fatal outcome despite treatment. CONCLUSION The increasingly frequent use of immunotherapy in the treatment of cancer may lead to an increase in neurological complications. These include a broad spectrum of syndromes with peripheral nervous system predominantly susceptible. Early identification of these and appropriate management of drug-related toxicity are required. Immune-modulating therapies are particularly beneficial.

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Pyogenic sacroiliitis: Lessons learned from an atypical case series

Anales de Pediatría (English Edition) ◽

10.1016/j.anpede.2018.07.006 ◽

2019 ◽

Vol 91 (1) ◽

pp. 42-46

Author(s):

Joana Arcângelo ◽

Susana Norte Ramos ◽

Pedro Alves ◽

Delfin Tavares ◽

Catarina Gouveia

Keyword(s):

Case Series ◽

Lessons Learned ◽

Atypical Case ◽

Pyogenic Sacroiliitis

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Operative Technique and Lessons Learned From Surgical Implantation of the NeuroPace Responsive Neurostimulation® System in 57 Consecutive Patients

Operative Neurosurgery ◽

10.1093/ons/opaa300 ◽

2020 ◽

Author(s):

Max O Krucoff ◽

Thomas A Wozny ◽

Anthony T Lee ◽

Vikram R Rao ◽

Edward F Chang

Keyword(s):

Operative Technique ◽

Focal Epilepsy ◽

Intraoperative Imaging ◽

Case Series ◽

Lessons Learned ◽

Seizure Freedom ◽

Operative Techniques ◽

Surgical Positioning ◽

Intracerebral Hemorrhages

Abstract BACKGROUND The Responsive Neurostimulation (RNS)® System (NeuroPace, Inc) is an implantable device designed to improve seizure control in patients with medically refractory focal epilepsy. Because it is relatively new, surgical pearls and operative techniques optimized from experience beyond a small case series have yet to be described. OBJECTIVE To provide a detailed description of our operative technique and surgical pearls learned from implantation of the RNS System in 57 patients at our institution. We describe our method for frame-based placement of amygdalo-hippocampal depth leads, open implantation of cortical strip leads, and open installation of the neurostimulator. METHODS We outline considerations for patient selection, preoperative planning, surgical positioning, incision planning, stereotactic depth lead implantation, cortical strip lead implantation, craniotomy for neurostimulator implantation, device testing, closure, and intraoperative imaging. RESULTS The median reduction in clinical seizure frequency was 60% (standard deviation 63.1) with 27% of patients achieving seizure freedom at last follow up (median 23.1 mo). No infections, intracerebral hemorrhages, or lead migrations were encountered. Two patients experienced lead fractures, and four lead exchanges have been performed. CONCLUSION The techniques set forth here will help with the safe and efficient implantation of these new devices.

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