scholarly journals Extra-Adrenal Myelolipoma Presenting as Efferent Limb Obstruction

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Alexandria Conley ◽  
Elizabeth Klein ◽  
E. Edhayan ◽  
Richard Berri
Keyword(s):  
Surgical Intervention ◽  
Outlet Obstruction ◽  
Mass Effect ◽  
Benign Lesions ◽  
Adrenal Myelolipoma ◽  
Mature Adipose Tissue ◽  
Efferent Limb ◽  
Common Location ◽  
Efferent Limb Obstruction ◽  
Early Surgical Intervention

Myelolipomas are rare benign lesions composed of mature adipose tissue and immature hematopoetic cells. The adrenal gland is the most common location for these lesions, but cases of extra-adrenal myelolipomas have been described. The predominant location for extra-adrenal myelolipomas is the retroperitoneum, and very few reported cases describe these lesions in the peritoneal cavity. Typically these lesions are incidental findings and asymptomatic, but occasionally can present with symptoms secondary to mass effect. We present the case of a 72 year old man presenting with a gastric outlet obstruction secondary to an epigastric mass. The mass was resected and pathology was consistent with myelolipoma. This case illustrates an atypical location and presentation of a myelolipoma. These are rare tumors with only 5 intra-abdominal myelolipomas reported in the literature. This article is a review of the surgical literature and a discussion on myelolipomas. Knowledge of these rare entities can help ensure proper management of these patients, which may include early surgical intervention.

scholarly journals Early surgical intervention for active thoracic spinal tuberculosis patients with paraparesis and paraplegia

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Weiwei Li ◽  
Zheng Liu ◽  
Xiao Xiao ◽  
Zhenchao Xu ◽  
Zhicheng Sun ◽  
...  
Keyword(s):  
Blood Loss ◽  
Surgical Intervention ◽  
Spinal Tuberculosis ◽  
Thoracic Spinal ◽  
Cobb’S Angle ◽  
Perioperative Complication ◽  
The Mean ◽  
Early Surgical Intervention ◽  
Thoracic Spinal Tuberculosis

Abstract Background To explore the therapeutic effect of early surgical intervention for active thoracic spinal tuberculosis (TB) patients with paraparesis and paraplegia. Methods Data on 118 active thoracic spinal TB patients with paraparesis and paraplegia who had undergone surgery at an early stage (within three weeks of paraparesis and paraplegia) from January 2008 to December 2014 were retrospectively analyzed. The operation duration, blood loss, perioperative complication rate, VAS score, ASIA grade and NASCIS score of neurological status rating, Erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP), kyphotic Cobb’s angle, and duration of bone graft fusion were analyzed to evaluate the therapeutic effects of surgery. Results The mean operating time was 194.2 minutes, and the mean blood loss was 871.2 ml. The perioperative complication rate was 5.9 %. The mean preoperative VAS score was 5.3, which significantly decreased to 3.2 after the operation and continued decreasing to 1.1 at follow up (P<0.05). All cases achieved an increase of at least one ASIA grade after operation. The rate of full neurological recovery for paraplegia (ASIA grade A and B) was 18.0 % and was significantly lower than the rate (100 %) for paraparesis (ASIA grade C and D) (P<0.05). On the NASCIS scale, the difference in the neurological improvement rate between paraplegia (22.2 % ± 14.1 % in sensation and 52.2 % ± 25.8 % in movement) and paraparesis (26.7 % ± 7.5 % in sensation and 59.4 % ± 7.3 % in movement) was remarkable (P<0.05). Mean preoperative ESR and CRP were 73.1 mm /h and 82.4 mg/L, respectively, which showed a significant increase after operation (P>0.05), then gradually decreased to 11.5 ± 1.8 mm/h and 2.6 ± 0.82 mg/L, respectively, at final follow up (P<0.05). The mean preoperative kyphotic Cobb’s angle was 21.9º, which significantly decreased to 6.5º after operation (P<0.05) while kyphotic correction was not lost during follow up (P>0.05). The mean duration of bone graft fusion was 8.6 ± 1.3 months. Conclusions Early surgical intervention may be beneficial for active thoracic spinal TB patients with paraparesis and paraplegia, with surgical intervention being more beneficial for recovery from paraparesis than paraplegia.

Early Surgical Intervention for Infective Endocarditis

2002 ◽  
Vol 10 (4) ◽  
pp. 298-301 ◽  
Author(s):  
Hong Sheng Zhu ◽  
Pei Yan Yao ◽  
Jia Hao Zheng ◽  
A Thomas Pezzella
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Heart Disease ◽  
Infective Endocarditis ◽  
Complex Disease ◽  
Surgical Intervention ◽  
Elective Surgery ◽  
Postoperative Bleeding ◽  
Arterial Embolization ◽  
Early Surgical Intervention

Infective endocarditis remains a serious and complex disease with significant morbidity and mortality. Sixty cases of infective endocarditis were retrospectively reviewed, consisting of 41 males and 19 females aged 7 to 50 years (mean, 30 years). Congenital heart disease was diagnosed in 19 of the patients and rheumatic heart disease in 41. Congestive heart failure occurred in 36 and systemic embolism in 8 cases. Blood cultures were positive in only 21.7% of the cases, while vegetations were detected by 2-dimensional echocardiography in 70%. Elective surgery was performed in 57 patients and emergent operation for systemic arterial embolization and/or intractable congestive heart failure in 3 patients. Two patients required reoperation for postoperative bleeding. All but 2 patients had been followed up for 6 to 160 months with no evidence of reinfection. Three patients with mechanical valve implantation later died of intracranial bleeding due to over-anticoagulation. The remaining 55 resumed normal activity. The encouraging outcomes were the result of an aggressive diagnostic approach and early surgical intervention.

scholarly journals When the Blood Hits Your Brain: The Neurotoxicity of Extravasated Blood

2021 ◽  
Vol 22 (10) ◽  
pp. 5132
Author(s):  
Jesse A. Stokum ◽  
Gregory J. Cannarsa ◽  
Aaron P. Wessell ◽  
Phelan Shea ◽  
Nicole Wenger ◽  
...  
Keyword(s):  
Molecular Mechanisms ◽  
Surgical Intervention ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Critical Factor ◽  
Mass Effect ◽  
Direct Role ◽  
Scientific Curiosity ◽  
Clot Removal ◽  
Clinical Literature ◽  
The Central Nervous System

Hemorrhage in the central nervous system (CNS), including intracerebral hemorrhage (ICH), intraventricular hemorrhage (IVH), and aneurysmal subarachnoid hemorrhage (aSAH), remains highly morbid. Trials of medical management for these conditions over recent decades have been largely unsuccessful in improving outcome and reducing mortality. Beyond its role in creating mass effect, the presence of extravasated blood in patients with CNS hemorrhage is generally overlooked. Since trials of surgical intervention to remove CNS hemorrhage have been generally unsuccessful, the potent neurotoxicity of blood is generally viewed as a basic scientific curiosity rather than a clinically meaningful factor. In this review, we evaluate the direct role of blood as a neurotoxin and its subsequent clinical relevance. We first describe the molecular mechanisms of blood neurotoxicity. We then evaluate the clinical literature that directly relates to the evacuation of CNS hemorrhage. We posit that the efficacy of clot removal is a critical factor in outcome following surgical intervention. Future interventions for CNS hemorrhage should be guided by the principle that blood is exquisitely toxic to the brain.

scholarly journals Correction to: Early surgical intervention for structural infantile spasms in two patients under 6 months old: a case report

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Haiyan Yang ◽  
Zhiquan Yang ◽  
Jing Peng ◽  
Yehong Huang ◽  
Zhuanyi Yang ◽  
...  
Keyword(s):  
Case Report ◽  
Surgical Intervention ◽  
Infantile Spasms ◽  
Early Surgical Intervention

Mycobacterium mageritense infection following mastectomy and breast reconstruction requiring triple antibiotic therapy and surgical debridement

2021 ◽  
Vol 14 (2) ◽  
pp. e237618 ◽  
Author(s):  
Christie Alyce Joya ◽  
Cara Deegan ◽  
Todd D Gleeson
Keyword(s):  
Antibiotic Therapy ◽  
Surgical Intervention ◽  
Treatment Guidelines ◽  
Perforator Flap ◽  
Published Data ◽  
Gastrointestinal Distress ◽  
Deep Inferior Epigastric Perforator ◽  
Infectious Disease Specialists ◽  
Systemic Symptoms ◽  
Early Surgical Intervention

A 40-year-old woman was referred to infectious disease specialists for a Mycobacterium mageritense skin infection following mastectomy and bilateral reconstruction with deep inferior epigastric perforator flap. Her case demonstrates the difficulty in treating non-tuberculosis mycobacterial infections, especially the rarely seen species. She failed to respond to dual antibiotic therapy containing imipenem-cilastin despite reported sensitivity. Additionally, her course was complicated by intolerance to various regimens, including gastrointestinal distress, a drug rash with eosinophilia and systemic symptoms, and tendinopathy. With few published data, no treatment guidelines, and limited medications from which to choose for M. mageritense, her treatment posed a challenge. She ultimately required aggressive surgical intervention and a triple therapy antibiotic regimen. The duration of our patient’s treatment and the extent of her complications suggest a potential need for early surgical intervention in postsurgical wounds infected with M. mageritense that do not respond to conventional treatment.

scholarly journals Intestinal Perforation during the Stabilization Period in a Preterm Infant with Congenital Diaphragmatic Hernia

2017 ◽  
Vol 05 (01) ◽  
pp. e51-e54
Author(s):  
Zbyněk Straňák ◽  
Karel Pýcha ◽  
Simona Feyereislova ◽  
Jaroslav Feyereisl ◽  
Michal Rygl
Keyword(s):  
Birth Weight ◽  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Intestinal Perforation ◽  
Surgical Repair ◽  
Very Low Birth Weight ◽  
Surgical Intervention ◽  
Multiple Organ ◽  
Stabilization Period ◽  
Early Surgical Intervention

Background Delayed surgery after stabilization of infants with congenital diaphragmatic hernia (CDH) is an accepted strategy. However, the evidence favoring delayed versus immediate surgical repair is limited. We present an extremely rare case of a very low-birth-weight infant with prenatally diagnosed left-sided CDH and unexpected transmural bowel perforations developing within the postnatal stabilization period. Case Report A neonate born at 31st week of gestation with a birth weight of 1,470 g with antenatally diagnosed left-sided CDH presented with bowel dilation leading to transmural bowel perforations on the 2nd day of life. Meconium pleuroperitonitis resulted in severe systemic inflammatory response syndrome, pulmonary hypertension, multiple organ failure, and death. Conclusion In neonates with CDH deteriorating under standard postnatal management, intestinal perforation, and early surgical intervention should be considered.

scholarly journals Intraparenchymal and Intraventricular Hemorrhage without Mass Effect in Traumatic Coma

1991 ◽  
Vol 18 (4) ◽  
pp. 458-462 ◽  
Author(s):  
Jen-Pei Lee
Keyword(s):  
Brain Stem ◽  
Intraventricular Hemorrhage ◽  
Diffuse Axonal Injury ◽  
Mass Effect ◽  
Intraparenchymal Hemorrhage ◽  
Focal Lesions ◽  
Diffuse Brain Injury ◽  
Common Location ◽  
Head Injured ◽  
Injured Patients

ABSTRACT:A group of 57-head injured patients showing computerized tomographic (CT) findings compatible with “diffuse brain injury” or of the so called “diffuse axonal injury” is analyzed. Thirty-four patients showed intraparenchymal hemorrhage in the CT scan study, 8 intraventricular hemorrhage and 15 patients had both intraparenchymal and intraventricular hemorrhage. Forty percent (23/57) of those with these findings had associated intracranial focal lesions. The deep nuclei are the most common location of intraparenchymal hemorrhage. Signs of brain stem hemorrhage were seen in 9 patients. Forty-nine percent of patients in this series had a good outcome. Old age (>60), abnormal motor response, abnormal eye signs, associated with focal lesions, and evidence of brain stem hemorrhage are reliable prognostic parameters for a grave outcome.

scholarly journals Early Surgical Intervention for Acute Ulcerative Colitis Is Associated with Improved Postoperative Outcomes

2017 ◽  
Vol 21 (10) ◽  
pp. 1675-1682 ◽  
Author(s):  
Ira L. Leeds ◽  
Brindusa Truta ◽  
Alyssa M. Parian ◽  
Sophia Y. Chen ◽  
Jonathan E. Efron ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Surgical Intervention ◽  
Postoperative Outcomes ◽  
Early Surgical Intervention

scholarly journals EUS-IR-Guided Revision of Whipple Anatomy for Concomitant Afferent and Efferent Limb Obstruction

2018 ◽  
Vol 113 (12) ◽  
pp. 1747
Author(s):  
Yen-I. Chen ◽  
Corey S. Miller ◽  
Ahmad Hashim ◽  
David Valenti ◽  
Peter Metrakos ◽  
...  
Keyword(s):  
Efferent Limb ◽  
Efferent Limb Obstruction
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