scholarly journals New System for the Classification of Epiphyseal Separation of the Coracoid Process: Evaluation of Nine Cases and Review of the Literature

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Takamitsu Mondori ◽  
Yoshiyuki Nakagawa ◽  
Shimpei Kurata ◽  
Shuhei Fujii ◽  
Takuya Egawa ◽  
...  
Keyword(s):  
Surgical Management ◽  
Case Series ◽  
Shoulder Girdle ◽  
Coracoid Process ◽  
Type I ◽  
Retrospective Case ◽  
Type Iii ◽  
Associated Injury ◽  
Ac Dislocation ◽  
New System

Objectives and Design. Epiphyseal separation of the coracoid process (CP) rarely occurs in adolescents. In this retrospective case series, we reviewed the data of nine patients treated at our center and those of 28 patients reported in the literature. This injury can be classified into three types according to the injured area: Type I, base including the area above the glenoid; Type II, center including the coracoclavicular ligament (CCL); and Type III, tip with the short head of the biceps and coracobrachialis, as well as the pectoralis minor. Patients/Participants. A total of 37 patients were included in the analysis. Data on sex, age, cause and mechanism of injury, separation type, concomitant injury around the shoulder girdle, treatment, and functional outcomes were obtained. Main Outcome Measurements and Results. Type I is the most common type. The cause of injury and associated injury around the shoulder girdle were significantly different between Type I, II, and III fractures. The associated acromioclavicular (AC) dislocation and treatment were significantly different between Type I and III fractures. Our new classification system reflects the clinical features, imaging findings, and surgical management of epiphyseal separation of the CP. Type I and II fractures are mostly associated with AC dislocation and have an associated injury around the shoulder girdle. Type III fractures are typically caused by forceful resisted flexion of the arm and elbow. Although the latter are best managed surgically, whether conservative or surgical management is optimal for Type I and II fractures remains controversial. Conclusions. We noted some differences in the clinical characteristics depending on the location of injury; therefore, we aimed to examine these differences to develop a new system for classifying epiphyseal separation of the CP. This would increase the clinicians’ awareness regarding this injury and lead to the development of an appropriate treatment.

CRPS of Lower Extremity– A Case Report and Review

2016 ◽  
Vol 27 (1) ◽  
pp. 22-28
Author(s):  
Mahima Agrawal
Keyword(s):  
Case Report ◽  
Lower Extremity ◽  
Lower Limb ◽  
Relaxation Training ◽  
Single Case ◽  
Case Series ◽  
Pain Syndrome ◽  
Type I ◽  
Retrospective Case ◽  
Single Case Report

Abstract Complex regional pain syndrome (CRPS) of the lower limb is a relatively uncommon entity as compared to CRPS of the upper extremity. Literature search has revealed only 2 retrospective case series and a single case report of lower extremity CRPS type I from 1975 to 2014 on Pubmed, isolated cases of CRPS type I of lower extremity have also been reported following knee surgeries and arthroscopies. This report presents a case of lower limb CRPS type I following blunt trauma to right foot, treatment of which was directed towards management of allodynia, vasomotor symptoms and surgical correction of deformity which had developed because of the disease, coping mechanisms were also reinforced through counselling and relaxation training. The individual responded well to treatment with a reported 75% reduction in the disabling symptoms and improvement in ambulatory status.

Idiopathic syringomyelia: retrospective case series, comprehensive review, and update on management

2011 ◽  
Vol 31 (6) ◽  
pp. E15 ◽  
Author(s):  
Anil K. Roy ◽  
Nicholas P. Slimack ◽  
Aruna Ganju
Keyword(s):  
Conservative Management ◽  
Incidental Finding ◽  
Imaging Techniques ◽  
Case Series ◽  
Neurological Dysfunction ◽  
Type I ◽  
Retrospective Case ◽  
Chiari Malformation Type I ◽  
Comprehensive Review ◽  
Idiopathic Syringomyelia

Object A syrinx is a fluid-filled cavity within the spinal cord that can be an incidental finding or it can be accompanied by symptoms of pain and temperature insensitivity. Although it is most commonly associated with Chiari malformation Type I, the advancement of imaging techniques has resulted in more incidental idiopathic syringes that are not associated with Chiari, tumor, trauma, or postinfectious causes. The authors present a comprehensive review and management strategies for the idiopathic variant of syringomyelia. Methods The authors retrospectively identified 8 idiopathic cases of syringomyelia at their institution during the last 6 years. A PubMed/Medline literature review yielded an additional 38 articles. Results Two of the authors' patients underwent surgical treatment that included a combination of laminectomy, lysis of adhesions, duraplasty, and syrinx fenestration. The remaining 6 patients were treated conservatively and had neurologically stable outcomes. Review of the literature suggests that an etiology-driven approach is essential in the diagnosis and management of syringomyelia, although conservative management suffices for most cases. In particular, it is important to look at disturbances in CSF flow, as well as structural abnormalities including arachnoid webs, cysts, scars, and a diminutive posterior fossa. Conclusions The precise etiology for idiopathic syringomyelia (IS) is still unclear, although conceptual advances have been made toward the overall understanding of the pathophysiology of IS. Various theories include the cerebellar piston theory, intramedullary pulse pressure theory, and increased spinal subarachnoid pressure. For most patients with IS, conservative management works well. Continued progression of symptoms, however, could be approached using decompressive strategies such as laminectomy, lysis of adhesions, and craniocervical decompression, depending on the level of pathology. Management for patients with progressive neurological dysfunction and the lack of flow disturbance is unclear, although syringosubarachnoid shunting can be considered.

scholarly journals Endoscopic and Surgical Management of a Hayes Type III-G Cystic Duct Anomaly Causing a Mirizzi Type I Syndrome

HPB Surgery ◽  
1998 ◽  
Vol 10 (6) ◽  
pp. 399-402
Author(s):  
Paul G. Anderson ◽  
James Toouli ◽  
Thomas G. Wilson ◽  
Michael Graham
Keyword(s):  
Surgical Management ◽  
Cystic Duct ◽  
Type I ◽  
Type Iii

scholarly journals Attenuated androgen discontinuation in patients with hereditary angioedema: a commented case series

2022 ◽  
Vol 18 (1) ◽  
Author(s):  
Marcus Maurer ◽  
Markus Magerl ◽  
Emel Aygören-Pürsün ◽  
Konrad Bork ◽  
Henriette Farkas ◽  
...  
Keyword(s):  
Side Effects ◽  
Hereditary Angioedema ◽  
Treatment Strategies ◽  
Case Series ◽  
Additional Patient ◽  
Type I ◽  
Retrospective Case ◽  
Androgen Withdrawal ◽  
Life Threatening ◽  
Attenuated Androgen

Abstract Background Hereditary angioedema (HAE) is characterized by potentially severe and life-threatening attacks of localized swelling. Prophylactic therapies are available, including attenuated androgens. Efficacy of attenuated androgens has not been assessed in large, randomized, placebo-controlled trials and can be associated with frequent, and sometimes severe, side effects. As better tolerated targeted therapies become available, attenuated androgen withdrawal is increasingly considered by physicians and their patients with HAE. Attenuated androgens withdrawal has not been systematically studied in HAE, although examination of other disorders indicates that attenuated androgen withdrawal may result in mood disturbances and flu-like symptoms. Standardized protocols for attenuated androgen discontinuation that continue to provide control of attacks while limiting potential attenuated androgen withdrawal symptoms are not established as the outcomes of different withdrawal strategies have not been compared. We aim to describe the challenges of attenuated androgen discontinuation in patients with HAE and how these may continue into the post-androgen period. Case presentation We present a retrospective case series of 10 patients with confirmed type I HAE who have discontinued prophylactic treatment with attenuated androgens. The most common reason for attenuated androgen discontinuation was side effects. Attenuated androgens were either immediately withdrawn, tapered and/or overlapped with another treatment. The major challenge of discontinuation was the management of an increased frequency and severity of HAE attacks in some patients. Conclusions Healthcare teams need to undertake careful planning and monitoring after attenuated androgens discontinuation, and modify treatment strategies if HAE control is destabilized with an increased number of attacks. Discontinuation of attenuated androgens is definitively an option in an evolving HAE treatment landscape, and outcomes can be favourable with additional patient support and education.

scholarly journals Surgical and Protocolized Management of Distal Radius Nonunion

2020 ◽  
Vol 48 (02) ◽  
pp. 79-86
Author(s):  
Juan María Pardo García ◽  
Verónica Jiménez Díaz ◽  
Amaya Barberia Biurrun ◽  
Lorena García Lamas ◽  
Miguel Porras Moreno ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Distal Radius ◽  
Case Series ◽  
Degenerative Changes ◽  
Average Score ◽  
Type I ◽  
Bone Stock ◽  
Type Iii ◽  
Metaphyseal Bone

Abstract Introduction Nonunion of the distal radius is an extremely rare and serious complication with unpredictable outcomes. The aim of the present study is to analyze the radiological and functional results after a protocolized surgical treatment. Material and Methods A retrospective review of case series of patients with diagnosis of nonunion of the distal radius surgically treated from 2010 to 2016. The diagnosis of nonunion was made at 6 months without signs of consolidation. According to computed tomography (CT) scan images, we propose a classification of this complication as type I: no deformity or mild deformity, with subchondral metaphyseal bone stock beneath lunate facet greater than 10 mm, with no degenerative changes at the distal radioulnar joint (DRUJ); type II: moderate deformity or degenerative changes in the DRUJ, distinguishing between IIA and IIB based on the subchondral metaphyseal bone stock; and type III: degenerative changes at the midcarpal joint. In all cases, a reconstructive technique consisting of volar locking plate osteosynthesis with autologous tailored iliac crest graft was performed, hence none of the cases were classified as type III. Results In total, six cases were included. Mean follow-up: 58 months (range: 30–108 months). Consolidation was achieved in a mean period of 5 months (range: 3–9 months). Average active range of motion: flexion: 54° (range: 10°–80°); extension: 40° (range: 10°–85°); supination: 82.5° (range: 75°–85°); pronation 80° (range: 55–85°); radial deviation: 15° (range: 5°–20°); and ulnar deviation 15° (range: 5–20°). Mean strength: 24.15 Kg (6.9–35 Kg). The average score on the Visual Analog Scale (VAS) at rest was of 0.6 (0–2), and with movement, it was of 1.8 (0–4). The mean postoperative score on the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was of 18.48 (range: 0–50.8). Average radial height: 9.65 mm (range: 7–12 mm); average radial angulation: 17° (10°–20°); volar tilt: 8.36° (range: 0.2°–21°); average ulnar variance: 1.52 mm (range: 0–3.5 mm). Complications: persistent nonunion, superficial wound infection, acquired residual ulnar club hand deformity, radiocarpal arthritis, and midcarpal arthritis. Nevertheless, no salvage techniques were needed or requested during the follow-up, with all patients in an active work situation or living an active life in complete normality. Conclusions The protocolized surgical treatment of pseudoarthrosis of the the distal radius, based on our proposed classification, offers good functional outcomes in the long-term follow-up.

scholarly journals Apple Peel Small Bowel, A Review of Four Cases: Surgical and Radiographic Aspects

2011 ◽  
Vol 31 (3) ◽  
pp. 227-234 ◽  
Author(s):  
RA Akinola ◽  
RL Osuoji
Keyword(s):  
Surgical Management ◽  
Radiographic Finding ◽  
Case Series ◽  
Intestinal Atresia ◽  
Retrospective Case ◽  
Radiographic Findings ◽  
Mortality And Morbidity ◽  
Resource Limited ◽  
Apple Peel ◽  
Operative Findings

Background: Although apple peel intestinal atresia is rare and is associated with a high mortality and morbidity, there is a dearth of its report in African literature. This study reviews four of the cases seen in a state teaching hospital in Lagos, considering the radiographic findings, surgical management and outcome. A brief review of literature is also undertaken. Aims and Objectives: To correle the plain radiographic findings with the surgical findings of neonates gathered over a six year period and to evaluate their surgical management, hoping to further help improve management of such neonates’ in future in resource limited regions such as ours. Methodology: It was a retrospective case series of four neonates who were brought in over a period of six years and operated after an initial plain abdominal X-ray. They were done as emergency cases, consent was obtained from their parents and the study was approved by the research and ethics committee. Operative findings were subsequently correlated with their radiographic findings and the surgical outcomes and follow up were documented. Conclusion: This study revealed that “the triple bubble sign” is a common radiographic finding in Apple Peel deformities, as well as gangrene of the jejunum and ileum at surgery. Key words: Apple peel atresia; Jejunoileal atresia; Plain Abdominal Radiography; Parenteral nutrition; Short Bowel Syndrome. DOI: http://dx.doi.org/10.3126/jnps.v31i3.5037 J Nep Paedtr Soc 2011;31(3): 227-234  

Intravitreal ranibizumab versus laser photocoagulation for retinopathy of prematurity: efficacy, anatomical outcomes and safety

2018 ◽  
Vol 103 (9) ◽  
pp. 1332-1336 ◽  
Author(s):  
Hyun Goo Kang ◽  
Eun Young Choi ◽  
Suk Ho Byeon ◽  
Sung Soo Kim ◽  
Hyoung Jun Koh ◽  
...  
Keyword(s):  
Retinal Detachment ◽  
Retinopathy Of Prematurity ◽  
Laser Photocoagulation ◽  
Case Series ◽  
Therapeutic Effects ◽  
Type I ◽  
Intravitreal Ranibizumab ◽  
Retrospective Case ◽  
Major Complications ◽  
Anatomical Outcomes

Background/AimsTo compare the efficacy, anatomical outcomes and complications of intravitreal ranibizumab with those of laser photocoagulation for retinopathy of prematurity (ROP).MethodsThis is a retrospective case series of 314 eyes from 165 infants diagnosed with type I ROP and treated with either laser photocoagulation (161 eyes) or intravitreal ranibizumab (0.25 mg/0.025 mL) injection (153 eyes) between January 2006 and December 2016 in a tertiary referral-based hospital. The main outcome was the rate of recurrence requiring additional treatment. Secondary outcomes included the incidence of major complications and final refractive error.ResultsThe mean follow-up was 36.3±31.9 months. Recurrences requiring further intervention were noted in 22 (13.7%) laser-treated and 15 (9.8%) ranibizumab-treated eyes (p=0.196). Retinal detachment (8 vs 1, p=0.037) and macular dragging (7 vs 1, p=0.039) were observed in the laser-treated and injection-treated groups, respectively, but no systemic or neurodevelopmental adverse events were reported. In the ranibizumab group, 95.6% showed fully vascularised retinas. Multivariate analyses revealed that birth weight (OR 0.993, p=0.023) and higher ROP stage (OR 11.222, p=0.008) influenced the incidence of major complications.ConclusionIntravitreal ranibizumab for ROP appears to achieve similar therapeutic effects than did laser photocoagulation, but with fewer surgical complications such as retinal detachment or macular dragging.

scholarly journals Gene expression analysis in scars treated with silicone cream: a case series

2019 ◽  
Vol 5 ◽  
pp. 205951311986834 ◽  
Author(s):  
Robin Kikuchi ◽  
Abdullah J Khalil ◽  
Christopher I Zoumalan
Keyword(s):  
Gene Expression ◽  
Wound Healing ◽  
Matrix Protein ◽  
Collagen Type ◽  
Case Series ◽  
Human Growth ◽  
Scar Tissue ◽  
Type I ◽  
Genetic Expression ◽  
Type Iii

Background: In contrast to fetal scar tissue, adult scar tissue presents with visible scarring. Topical silicone creams have been shown to improve the appearance of scars. This case series compares the genetic expression of post-surgical scar tissues that received topical scar treatment with silicone cream, SKN2017B, or no treatment. SKN2017B is a recently formulated silicone-based scar cream that contains selective synthetic recombinant human growth factors, hyaluronic acid, and vitamin C. We hypothesise that scars treated with silicone-based scar creams have a more favourable genetic expression resembling a well-healing scar. Methods: Women who had undergone an abdominoplasty were included in this investigation and randomly assigned to treat part of the scar with topical silicone, another part with SKN2017B, and to leave a third part untreated. After four weeks, punch biopsies were taken and the RNA sequenced. Healthy abdominal skin was biopsied as baseline data. Genes of interest were identified and median values were calculated for the samples. Results: SKN2107B-treated scars demonstrated the lowest collagen type I to collagen type III ratio. Other key genes of interest in wound healing showed the lowest (favourable) expression of fibroblast activation protein alpha, lysyl oxidase and cartilage oligomeric matrix protein; the highest (favourable) expression of fibronectin type III domain containing 1 and matrix metallopeptidase 9 were found in scars treated with SKN2017B. Conclusion: The results of this small case series demonstrate a trend that those scars treated with topical silicone cream, notably SKN2017B, display the most favourable gene expression for wound healing.

Routine Hysterectomy in the Surgical Management of Ovarian Cancer: A Retrospective Case Series, Physician Opinion Survey, and Review of the Literature

2011 ◽  
Vol 21 (9) ◽  
pp. 1579-1584 ◽  
Author(s):  
Michael W. Bunting ◽  
Ken S. Jaaback ◽  
Orla M. McNally
Keyword(s):  
Ovarian Cancer ◽  
Surgical Management ◽  
Residual Disease ◽  
Case Series ◽  
Review Of The Literature ◽  
Opinion Survey ◽  
Limited Evidence ◽  
Retrospective Case ◽  
Endometrial Cancers

AbstractCurrent international guidelines recommend routine hysterectomy in the initial surgical management of epithelial ovarian cancer. However, there seems to be limited evidence to support these recommendations. We examined the data for a series of women undergoing hysterectomy as part of surgical management of ovarian cancer. Most of the women who underwent hysterectomy had no macroscopic uterine involvement in the ovarian cancer. However, almost half of them had macroscopic residual disease at completion of cytoreductive surgery. The incidence of synchronous primary endometrial cancers was 5%, and preoperative ultrasound had a sensitivity of 82% for predicting endometrial pathology. We also surveyed the members of the Australian Society of Gynaecological Oncologists (ASGO) regarding the role of hysterectomy in the management of ovarian cancer. Most of the respondents indicated that they believe hysterectomy should be routinely performed in the management of ovarian cancer but acknowledge that there is a lack of evidence to support the practice.

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