surgical intervention
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2022 ◽  
Vol 3 (3) ◽  

BACKGROUND Coccydynia refers to debilitating pain in the coccygeal region of the spine. Treatment strategies range from conservative measures (e.g., ergonomic adaptations, physical therapy, nerve block injections) to partial or complete removal of the coccyx (coccygectomy). Because the surgical intervention is situated in a high-pressure location close to the anus, a possible complication is the formation of sacral pressure ulcers and infection at the incision site. OBSERVATIONS In this case report, the authors presented a minimally invasive, fully endoscopic approach to safely perform complete coccygectomy for treatment of refractory posttraumatic coccydynia. LESSONS Although this is a single case report, the authors hope that this novel endoscopic approach may achieve improved wound healing, reduced infection rates, and lower risk of penetration injury to retroperitoneal organs in patients requiring coccygectomy.

Maather Al Abri, MD ◽  
Ghaitha Al Mahruqi, MD ◽  
Hani Al Qadhi, FRCSC

Background: Refractory peptic ulcers are ulcers in the stomach or duodenum that do not heal after eight to twelve weeks of medical/surgical treatment or those that are associated with complications despite medical tssreatment. We herein present a case of a 44 year old man with a recurrent perforated duodenal ulcer requiring emergent surgical intervention.

Peter Hegarty ◽  
Annette Smith

AbstractSurgical interventions on infants with intersex characteristics are considered justified by some on the grounds that they carry a high risk of intolerable stigma. However, public understanding of intersex and its medicalization are under-researched. We review recent qualitative and quantitative studies of the understandings of intersex and its medicalization among people who have no particular professional or public experience of intersex. First, such laypeople reason about clinical dilemmas by drawing on values in similar ways as expert healthcare professionals do. Second, laypeople can over-estimate the utility of current ‘umbrella terms,’ including intersex, for people with direct familial experience of intersex. Third, beliefs about good and bad effects of medical intervention are affected by framing intersex as either a medical condition or the natural basis for a social identity. Fourth, sexual identity is the best evidenced predictor of opinions about early surgical intervention and its legal limitation on human rights grounds. We argue that possible stigmatizing reactions from the public may not be a solid basis on which to justify early surgical intervention on intersex characteristics.

2022 ◽  
Xinyu Jia ◽  
Xiaopeng Guo ◽  
Mingjie Luo ◽  
Yong Yao ◽  
Wei Lian ◽  

Abstract Purpose Although conservative treatment was recommended for pregnant patients with pituitary adenomas (PAs), surgical treatment is occasionally necessary for those with acute symptoms. However, surgical intervention among these patients is poorly studied. Methods Six patients with PAs who underwent surgical treatment during pregnancy at Peking Union Medical College Hospital between January 1990 and June 2021 and another 35 pregnant patients profiled in the literature were included. Results All the 41 enrolled patients (mean age 29.8 ± 5.3 years) had acute symptoms including visual field defects, severe headaches, or vision loss requiring emergency pituitary surgeries. Mean tumor diameter was 2.16 ± 0.9 cm, and 92.6% were macroadenomas. PA apoplexies were found in 23 patients. The average gestation time at surgery was 25.1 ± 7.1 weeks; 55.9% of these patients underwent surgery in the second trimester of pregnancy. Multidisciplinary team was involved from before surgery to after delivery. Except one patient underwent an induced abortion, and one fetus died due to a nuchal cord, thirty-nine patients delivered successfully, and 37 of fetuses were healthy till the last follow-up. One fetus died of congenital diaphragmatic hernia, and another had a low Apgar score after a cesarean section but survived. Conclusion PA surgery for pregnant patients with PAs is effective and safe during the second and third trimesters. Pregnant patients requiring emergency PA surgery need multidisciplinary evaluation and healthcare management. Cooperation of neurosurgery, endocrinology, obstetrics, anesthesiology, and neonatology is necessary for a successful surgical intervention for pregnant patients with PAs.

2022 ◽  
Vol 13 ◽  
pp. 16
Coby Cunningham ◽  
Chiara Flores ◽  
Rocco Dabecco ◽  
Palgun Nisarga ◽  
Janice Ahn ◽  

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.

2022 ◽  
Vishal P. Bhabhor

Appendicitis is one of the most common causes of acute abdomen with life time risk between 6 and 8% and it’s a most common non obstetric surgical emergency during pregnancy. Appendicitis is claimed to be unknown in the villages of India and China in paper by A. M. Spencer. The reason is simply due to the fact that diagnostic facilities do not exist and cases are not recognized. So diagnosing acute appendicitis accurately and efficiently can reduce morbidity and mortality from perforation and other complications. Surgical intervention is the first choice for appendicitis with medical management being reserved for special situations.

Diane Isabel Selvido ◽  
Nattharin Wongsirichat ◽  
Pratanporn Arirachakaran ◽  
Dinesh Rokaya ◽  
Natthamet Wongsirichat

AbstractImpacted lower second molars (ILM2) are rarely reported in the literature, but various studies have been done for its treatment. Apart from solely orthodontic approaches, different surgical management techniques were reported to have successful outcomes. Surgical intervention of ILM2 can help expose the tooth for further orthodontic purposes, simplifying complex treatment methods, and reducing treatment time. This review illustrates the comprehensive evaluation and updated methods of surgical uprighting, repositioning, and transplantation of ILM2 with future directions for better understanding and treatment planning in the clinical setting. The successful outcome of surgical intervention depends on case selection, root development of ILM2, careful surgical manipulation, and adherence to sound biological principles.

2022 ◽  
Vol 11 (2) ◽  
pp. 335
Marcin Strzałka ◽  
Marek Winiarski ◽  
Marcin Dembiński ◽  
Michał Pędziwiatr ◽  
Andrzej Matyja ◽  

Upper gastrointestinal bleeding (UGIB) is one of the most common emergencies. Risk stratification is essential in patients with this potentially life-threatening condition. The aim of this prospective study was to evaluate the usefulness of the admission venous lactate level in predicting clinical outcomes in patients with UGIB. All consecutive adult patients hospitalized due to UGIB were included in the study. The clinical data included the demographic characteristics of the observed population, etiology of UGIB, need for surgical intervention and intensive care, bleeding recurrence, and mortality rates. Venous lactate was measured in all patients on admission. Logistic regression analyses were used to calculate the odds ratios (OR) of lactate levels for all outcomes. The receiver operating characteristic (ROC) curve was used to determine the accuracy of lactate levels in measuring clinical outcomes, while Youden index was used to calculate the best cut-off points. A total of 221 patients were included in the study (151M; 70F). There were 24 cases of UGIB recurrence (10.8%), 19 patients (8.6%) required surgery, and 37 individuals (16.7%) required intensive care. Mortality rate was 11.3% (25 cases). The logistic regression analysis showed statistically significant association between admission venous lactate and all clinical outcomes: mortality (OR = 1.39, 95%CI: 1.22–1.58, p < 0.001), recurrence of bleeding (OR = 1.16, 95%CI: 1.06; 1.28, p = 0.002), surgical intervention (OR = 1.17, 95%CI: 1.06–1.3, p = 0.002) and intensive care (OR = 1.33, 95%CI: 1.19–1.5, p < 0.001). The ROC curve analysis showed a high predictive value of lactate levels for all outcomes, especially mortality: cut-off point 4.3 (AUC = 0.82, 95%CI: 0.72–0.92, p < 0.001) and intensive care: cut-off point 4.2 (AUC = 0.76, 95%CI: 0.66–0.85, p < 0.001). Admission venous lactate level may be a useful predictive factor of clinical outcomes in patients with UGIB.

Neonatology ◽  
2022 ◽  
pp. 1-9
Se In Sung ◽  
So Yoon Ahn ◽  
Suk-Joo Choi ◽  
Soo-young Oh ◽  
Cheong-Rae Roh ◽  

<b><i>Introduction:</i></b> We experienced an increased incidence of meconium-related ileus (MRI) in extremely premature infants (EPIs) while adopting the antenatal magnesium sulfate (MgSO<sub>4</sub>) protocol for fetal neuroprotection in our neonatal intensive care unit. This study aimed to test whether antenatal MgSO<sub>4</sub> use was associated with increased risk of MRI in EPIs. <b><i>Methods:</i></b> The incidences of complicated MRI requiring aggressive enema or surgical intervention and other intestinal complications were compared among period 1 (January 2012–December 2013, <i>n</i> = 79), before adoption of the antenatal MgSO<sub>4</sub> protocol for fetal neuroprotection; period 2 (January 2014–March 2016, <i>n</i> = 72), when the protocol was adopted; and period 3 (April 2016–September 2018, <i>n</i> = 75), when the protocol was temporarily withdrawn due to concern regarding intestinal complications in EPIs. <b><i>Results:</i></b> Despite similar baseline clinical characteristics among infants across the study periods, the MRI and MRI with surgical treatment incidences were higher in period 2 than those in periods 1 and 3 (13% vs. 8% and 6%, <i>p</i> = 0.391, and 11% vs. 0% and 1%, <i>p</i> = 0.001, respectively). In multivariable analysis, exposure to antenatal MgSO<sub>4</sub> independently increased the risk of MRI (adjusted odds ratio, 3.8; 95% confidence interval, 1.4, 10.6). <b><i>Conclusion:</i></b> Antenatal MgSO<sub>4</sub> may increase the risk of MRI, frequently requiring surgical intervention, in EPIs with a gestational age of 25 weeks or less.

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