Pediatric Trauma-Induced Testicular Torsion: A Surgical Emergency

2020 ◽  
pp. 1-4
Author(s):  
Haijun Zhong ◽  
Yunli Bi
Keyword(s):  
Testicular Torsion ◽  
Tertiary Care ◽  
Pediatric Trauma ◽  
Delayed Diagnosis ◽  
Retrospective Chart Review ◽  
Duration Of Symptoms ◽  
Testicular Trauma ◽  
Genital Trauma ◽  
Tertiary Care Institution ◽  
The Mean

<b><i>Objective:</i></b> To evaluate the features of testicular torsion (TT) resulting from minor groin trauma and to raise the awareness of trauma-induced testicular torsion (TITT). <b><i>Methods:</i></b> This is a retrospective chart review of patients presenting with TT resulting from minor genital trauma that was performed from January 2010 to December 2018 at a single tertiary care institution. The demographic, clinical, and perioperative characteristics, as well as data on follow-up and complications, were analyzed. <b><i>Results:</i></b> Of the 155 patients treated for TT, 15 were included in this study. The average age of the patients was 10.3 years (range: 3.2–13.3 years). All patients experienced a direct scrotal trauma and subsequently presented with an ipsilateral scrotal or testicular pain secondary to the twisted testicle. Six patients were misdiagnosed as having scrotal inflammation or hematoma, and all were initially treated at local hospitals. The mean duration of symptoms before hospitalization was 138 h (range: 5–504 h). The mean degree of torsion was 390° (range: 180–720°). The testicular salvation rate, at 33%, was poor. No serious postoperative complications or recurrences of TT was observed. <b><i>Conclusions:</i></b> TITT is a rare entity and still has delayed diagnosis. This may subsequently lead to a low testicular salvation rate. Emergency surgeons, especially in local hospitals, should be aware of the possibility of TT following testicular trauma in pediatric patients. Improving the parents’ awareness regarding TT is also important.

Trend of Hospital Admission and Outcome Study of Patients Admitted in a Neurology Unit at a Tertiary Care Neuroscience Hospital in Bangladesh

2018 ◽  
Vol 4 (2) ◽  
pp. 69-74
Author(s):  
Md Tauhidul Islam Chowdhury ◽  
Mohammad Shah Jahirul Hoque Choudhury ◽  
KM Ahasan Ahmed ◽  
Mohammad Sadekur Rahman Sarkar ◽  
Md Abdullah Yusuf ◽  
...  
Keyword(s):  
Neurological Disorders ◽  
Neurological Diseases ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Total Death ◽  
Neurological Patients ◽  
Study Population ◽  
The Mean ◽  
Day By Day

Background: Neurological disorders is becoming a growing concern both for developed and developing countries. Magnitude of the problem is increasing day by day. Among all neurological disorders, stroke is the leading cause of morbidity and mortality globally.Objectives: The purpose of the study was to see the trend of admission of patients with neurological diseases and to study the outcome of patients at referral neurology hospital in Bangladesh.Methodology: This retrospective chart review was conducted in the blue unit of the Department of Neurology at National Institute of Neurosciences and Hospital, Dhaka, Bangladesh from 1st January to 31st December 2016 for a period of one (01) year. All the admitted patients with both sexes were selected as study population. The outcome was observed among the study population.Result: A total number of 1044 patients were admitted during the study period. Majority of the patients were in the age group of the 41 to 50 years which was 417(39.9%) cases. Both male and female were in highest number in the month of May which was 63 and 48 cases respectively. The total death of the study population was 146(14.0%) cases. The mean length of hospital stay was 8.4±2.31 days.Conclusion: Middle aged male is the main bulk of the neurological patients, admitted in a referral neurology hospital in Bangladesh. Highest admission and mortality was observed in stroke patients.Journal of National Institute of Neurosciences Bangladesh, 2018;4(2): 69-74

scholarly journals P108: Characterizing use of next-day ultrasound from the emergency department

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S103
Author(s):  
C. Roberts ◽  
T. Oyedokun ◽  
B. Cload ◽  
L. Witt
Keyword(s):  
Emergency Department ◽  
Patient Care ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Improve Patient Care ◽  
Additional Stress ◽  
Start Date ◽  
The Mean ◽  
Tertiary Care Hospitals ◽  
Improve Patient

Introduction: Formal ultrasound imaging, with use of ultrasound technicians and radiologists, provides a valuable diagnostic component to patient care in the Emergency Department (ED). Outside of regular weekday hours, ordering formal ultrasounds can produce logistical difficulties. EDs have developed protocols for next-day ultrasounds, where the patient returns the following day for imaging and reassessment by an ED physician. This creates additional stress on ED resources – personnel, bed space, finances – that are already strained. There is a dearth of literature regarding the use of next-day ultrasounds or guidelines to direct efficient use. This study sought to accumulate data on the use of ED next-day ultrasounds and patient oriented clinical outcomes. Methods: This study was a retrospective chart review of 150 patients, 75 from each of two different tertiary care hospitals in Saskatoon, Saskatchewan. After a predetermined start date, convenience samples were collected of all patients who had undergone a next-day ultrasound ordered from the ED until the quota was satisfied. Patients were identified by an electronic medical record search for specific triage note phrases indicating use of next-day ultrasounds. Different demographic, clinical, and administrative parameters were collected and analyzed. Results: Of the 150 patients, the mean age was 35.9 years and 75.3% were female. Median length of stay for the first visit was 4.1 hours, and 2.2 hours for the return visit. Most common ultrasound scans performed were abdomen and pelvis/gyne (34.7%), complete abdomen (30.0%), duplex extremity venous (10.0%). Most common indications on the ultrasound requisition were nonspecific abdominal pain (18.7%), vaginal bleeding with or without pregnancy (17.3%), and hepatobiliary pathology (15.3%). Ultrasounds results reported a relevant finding 56% of the time, and 34% were completely normal. After the next-day ultrasound 5.3% of patients had a CT scan, 10.7% had specialist consultation, 8.2% were admitted, and 7.3% underwent surgery. Conclusion: Information was gathered to close gaps in knowledge about the use of next-day ultrasounds from the ED. A large proportion of patients are discharged home without further interventions. Additional research and the development of next-day ultrasound guidelines or outpatient pathways may improve patient care and ED resource utilization.

scholarly journals Renal traumas in childhood: a five years experience of tertiary care hospital in Turkey

2018 ◽  
Vol 5 (5) ◽  
pp. 1644
Author(s):  
Ahmet A. Tuncer ◽  
Hülya Gökbaş ◽  
Samet Deniz ◽  
Elif Ozkan ◽  
Hüsne B. Kocataş ◽  
...  
Keyword(s):  
Renal Injury ◽  
Traffic Accident ◽  
Tertiary Care ◽  
Pediatric Trauma ◽  
Spine Injury ◽  
Care Hospital ◽  
Kidney Trauma ◽  
Duration Of Hospitalization ◽  
The Mean ◽  
Renal Injuries

Background: In this study, the experiences of kidney trauma of a third step hospital in a city at the junction of the road will be discussed with the current literature.Methods: Pediatric trauma patients admitted to Afyon Kocatepe University Hospital between 1 January 2012 and 31 December 2017 were retrospectively examined. Thirty patients with renal injuries were included in the study. Patients with renal injury were examined in terms of age, gender, type of trauma, degree of renal injury, additional organ damage, treatment method, duration of hospitalization, cost and mortality. Statistical analysis was performed with the SPSS program. The p >0.05 was considered as significant.Results: A total of 30 patients (m:23, f:7) were included in the study. The mean age of the patients was 12.10±5.70. The mean duration of hospitalization was 10.23±17.067 days. The reasons of kidney injury were determined as; traffic accident outside of the vehicle (n=9), fall (n=8), traffic accident inside the vehicle (n=6), bicycle-motorcycle accident (n=5), and firearm injury (n=2). Hematuria (n=8), grade 1 (n=12), grade 2 (n=2), grade 4 (n=5), and grade 5 (n=3) kidney injuries were detected in the patients. Isolated renal injuries were found in 7 patients. Additional organ injuries were found as lung injury (n=3), head injury (N=5), pelvic injury (n=5), spleen injury (n=8), spine injury (n=7), liver injury (n=7), intestinal injury (n=7), and extremity injury (n=7). The average cost was 4948.37 ± 10198.51 TL. One patient had nephrectomy and JJ catheter was placed to one patient due to the development of urinoma and hematoma. All other patients were treated conservatively. The cost and duration of hospitalization of patients with shock status at the time of admission to the hospital were statistically higher than those without shock status (p=0.001; p=0.025). Morbidity and cost of patients with high grades (grade 4 or 5) were higher than those with low grades (p=0.008 and p=0.027, respectively). There was no mortality except for a patient who underwent splenectomy and had concomitant brain parenchymal damage.Conclusions: Conservative treatment of kidney injuries for children is effective and safe. Additional injuries, shock status and high-grade cause morbidity, mortality and cost increases.

scholarly journals Epicrania fugax: Report of eight cases with some novel features

2020 ◽  
Vol 3 ◽  
pp. 251581632094649
Author(s):  
Debashish Chowdhury ◽  
Tanushree Chawla ◽  
Ashish Duggal
Keyword(s):  
Age Of Onset ◽  
Delayed Diagnosis ◽  
Case Series ◽  
Visual Analog Scale Score ◽  
Headache Disorder ◽  
Medical Intervention ◽  
Linear Distribution ◽  
Duration Of Symptoms ◽  
Epicrania Fugax ◽  
The Mean

Introduction: Epicrania fugax (EF) is an epicranial headache syndrome characterized by short lasting headache paroxysms which spread in a typical linear/zigzag pattern. The definition of EF has evolved over time, and new phenotypes have been observed in various studies. Aim: We present eight cases diagnosed as EF according to the International Classification of Headaches Disorders, 3rd edition criteria and highlight certain novel characteristics which will help in the further categorization of this disorder. Methods: We prospectively studied eight cases of EF who presented to our headache clinic from January 2016 to September 2020. Demographic and detailed clinical data were collected and analyzed. Results: The mean age of onset of the cohort was 42 ± 10.47 years with a median duration of symptoms being 1 year. There were 5 male and 3 female patients. The mean visual analog scale score was 5.25 ± 1.83. Headache frequency had high intra and interindividual variability. Four patients had a typical spread of pain along the distribution of greater occipital, and supraorbital, nerves. Four patients had an atypical presentation with midline headache, transverse occipital, and bilateral simultaneous hemicranium involvement. Headache paroxysm was followed by a prolonged fixed pain in the same linear distribution in three patients. One patient had ipsilateral redness in the eye. All eight patients required medical intervention with amitriptyline or neuromodulators, five of whom reported a significant reduction in their headache symptoms. Conclusion: Our case series highlights a few interesting features which need further exploration with larger studies. Firstly, the atypical distribution of the pain trajectory forces us to dig deeper into the pathogenesis of the disorder. Secondly, our data also suggest a possibility of EF triggered “linear headaches.” EF is a relatively uncommon headache disorder that can be managed easily with neuromodulators but the lack of awareness of the condition often leads to delayed diagnosis.

scholarly journals Multisite Study to Examine the Amount of Inpatient Physician Continuity Experienced by Hospitalized Patients

2015 ◽  
Vol 7 (4) ◽  
pp. 624-629 ◽  
Author(s):  
Kathlyn E. Fletcher ◽  
Siddhartha Singh ◽  
Jeff Whittle ◽  
Vishal Ratkalkar ◽  
Alexis M. Visotcky ◽  
...  
Keyword(s):  
Continuity Of Care ◽  
Medical Center ◽  
Care Center ◽  
Tertiary Care ◽  
General Medicine ◽  
Retrospective Chart Review ◽  
Hospitalized Patients ◽  
Inpatient Medicine ◽  
The Mean ◽  
Handoff Of Care

ABSTRACT Background Continuity for inpatient medicine has been widely discussed, but methods for measuring it have been lacking. Objective To measure the continuity of care experienced by hospitalized patients and to identify predictors of continuity. Methods This was a multisite prospective cohort study and retrospective chart review that took place at 3 hospitals: an academic tertiary care center, a Veterans Affairs medical center, and a community teaching hospital. Subjects were general medicine patients and internal medicine residents. We measured continuity of care using 3 metrics: (1) the percentage of hospital time covered by the primary intern; (2) the amount of time between admission and the first handoff of care; and (3) admission-discharge continuity. We conducted univariate analyses to identify patient and hospital factors that may be associated with each type of continuity of care. Results Our sample included 869 patients with a mean age of 62.6 years (SD = 17.2) and 34% female patients. The mean percentage of hospital time covered by the primary intern was 39.2% (SD = 16.3%). The mean time between admission and the first handoff of care was 13.3 hours (SD = 7.1). Forty percent of patients experienced admission-discharge continuity. In univariate and multivariable modeling, the site was significantly associated with each type of continuity. Conclusions The amount of continuity varied greatly and was influenced by the site and other factors. No site maximized every aspect of continuity. Programs and institutions should decide which aspects of continuity are most important locally and design schedules accordingly.

scholarly journals Pyomyositis and Infectious Myositis: A Comprehensive, Single-Center Retrospective Study

2021 ◽  
Author(s):  
Christopher Radcliffe ◽  
Savanah Gisriel ◽  
Yu Si Niu ◽  
David Peaper ◽  
Santiago Delgado ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Percutaneous Drainage ◽  
Treatment Success ◽  
Tertiary Care ◽  
Treatment Strategies ◽  
Altered Mental Status ◽  
Gram Positive Bacteria ◽  
Tertiary Care Institution ◽  
The Mean ◽  
Days Open

Abstract Background Pyomyositis is a bacterial infection of skeletal muscle which classically leads to abscess formation. A related, but distinct, entity is infectious myositis. The epidemiology of these infections has changed in recent years. Methods To better characterize both pyomyositis and infectious myositis, we conducted a retrospective study at our tertiary care institution. We identified 43 cases of pyomyositis and 18 cases of infectious myositis treated between January 2012 and May 2020. Results The mean age of patients was 48 years, and 66% were male. Diabetes mellitus affected one-third of patients, and 16% had other immunocompromising comorbidities. Staphylococcal species accounted for 46% of all infections, and common symptoms included muscle pain (95%) and subjective fever (49%). Altered mental status was a presenting symptom in 16% of cases. Roughly half of all patients received &gt;1 class of antibiotic, and the median length of antimicrobial therapy was 18 days. Open and percutaneous drainage procedures figured prominently in the management of these infections, with 28% of patients requiring multiple procedures. Pathology specimens were available for 12 of 61 cases. Overall, the treatment success rate was 84%. Conclusions Gram-positive bacteria accounted for most infections at our institution, and management commonly involved open or percutaneous drainage procedures. Future studies which prospectively evaluate treatment strategies for pyomyositis and infectious myositis are warranted.

scholarly journals Gender Differences in the Clinical Characteristics of Patients with Acute Coronary Syndrome in the Eastern Region of Nepal

2020 ◽  
Vol 9 (2) ◽  
pp. 3-7
Author(s):  
Sahadeb Prasad Dhungana ◽  
Roshna Adhikari ◽  
Sameen Khatiwada
Keyword(s):  
Acute Coronary Syndrome ◽  
Clinical Characteristics ◽  
Care Center ◽  
Tertiary Care ◽  
Treatment Modalities ◽  
Eastern Region ◽  
Duration Of Symptoms ◽  
Coronary Syndrome ◽  
The Mean ◽  
Gender Based

Background: Studies from other regions show gender-based differences in the clinical characteristics of patients with the acute coronary syndrome (ACS) with conflicting results. There is a lack of definite data from our population. Materials and Methods: This is a hospital-based cross-sectional study in patients with ACS admitted to the tertiary care center from January 2019 to June 2020. Risk factors, co-morbidities, clinical symptoms, duration of symptoms onset, modalities of treatment offered, complications, and in-hospital outcome were noted in the pre-structured questionnaire by convenient sampling. Data were analyzed by using Microsoft excel 2007 and SPSS 20. Results: Among 384 participants, 65.9% were male and 34.1% were female. The mean age of males was 60.6 ± 12.1 and females 62.3 ± 11.1 years (P=0.21). Females had a higher prevalence of dyslipidemia (p<0.001). The prevalence of hypertension, diabetes, and smoking was similar. The mean hemoglobin level was higher in males (11.8 ± 2.2 gm/dl vs. 11.1 ± 4.57 gm/dl, P = 0.01). The majority presented with chest pain (94.9%) in males and 87.8% in females, P=0.44), and sweating (76.7% in males and 80.2% in females, P=0.43). Non-anginal symptoms were almost similar in both the genders except nausea which was more common in males (P=0.03). The timing of presentation, treatment with reperfusion therapy, and arterial territory involved were not significantly different. Prevalence of mechanical and arrhythmic complications as well as mortality was similar. Conclusion: Our study did not show significant gender-based differences in clinical profile, treatment modalities, in-hospital complications, and mortality.

scholarly journals Testicular Torsion in Patients With Intellectual and Developmental Disabilities

2021 ◽  
Vol 8 ◽  
pp. 2333794X2110591
Author(s):  
Lisa B. E. Shields ◽  
Michael W. Daniels ◽  
Dennis S. Peppas ◽  
Eran Rosenberg
Keyword(s):  
At Risk ◽  
Developmental Disabilities ◽  
Testicular Torsion ◽  
Delayed Diagnosis ◽  
Signs And Symptoms ◽  
Intellectual And Developmental Disabilities ◽  
Scrotal Pain ◽  
Duration Of Symptoms

Patients with intellectual/developmental disabilities are at risk of delayed diagnosis of testicular torsion due to their inability to effectively communicate their symptoms. We identified males ages 1 to 18 years with testicular torsion between January 1, 2015 and December 31, 2020, focusing on patients with intellectual and/or developmental disabilities. Of the 140 patients with testicular torsion, 5 (3.6%) patients exhibited intellectual/developmental disabilities with an inability to effectively verbalize testicular/groin/scrotal pain. The patients with intellectual/developmental disabilities underwent more orchiectomies (5/5, 100%, P = .009) and had a longer duration of symptoms (median = 48 hours, P = .047) compared to those without intellectual/developmental disabilities (51/135, 38% and median = 9 hours, respectively) (51/134, 38%) ( P = .038). Parents and other caregivers of males with intellectual/developmental disabilities who are unable to adequately verbalize their testicular/groin/scrotal pain should be cognizant of the signs and symptoms associated with testicular torsion, perform a genitalia examination, and seek an immediate evaluation to diagnose and treat this urgent condition.

RETROSPECTIVE ANALYSIS OF TYPHOID ILEAL PERFORATION IN CHILDREN

1969 ◽  
Vol 4 (2) ◽  
pp. 492-496
Author(s):  
ARSHAD KAMAL ◽  
KIFAYAT KHAN ◽  
MOHAMMAD AYUB ◽  
MOHAMMAD UZAIR ◽  
MOHAMMAD FAYYAZ
Keyword(s):  
Surgical Procedure ◽  
Pediatric Surgery ◽  
Tertiary Care ◽  
Care Hospital ◽  
Duration Of Symptoms ◽  
Early Presentation ◽  
Ileal Perforation ◽  
Surgical Options ◽  
The Mean ◽  
Operative Findings

BACKGROUND: Objective of the study is to find out the most suitable procedure for surgicaltreatment of typhoid ileal perforation in children. It is a Descriptive retrospective study, conducted atDepartment of Pediatric surgery Lady Reading Hospital Peshawar from January 2012 to June 2014.MATERIALS AND METHODS: This study included all patients who had operative findings oftyphoid ileal perforation. All the patients were admitted at Pediatric Surgery Unit Lady ReadingHospital Peshawar, as emergency. A total of 78 patients were managed during the study period. Patientswere admitted, nasogastric tube was inserted, intravenous fluids and antibiotics in the form ofquinolones, metronidazole and gentamycin were administered. Informed consent from the parents wastaken in all cases. Surgical Procedure was tailored according to the peroperative findings. Data wasanalyzed using SPSS version 16.RESULTS: Out of 78 patients, 49(62.8%) were male and 29(37.1%) were female. The mean age ofpresentation was 10.4 years. Duration of symptoms ranged from 7 to 20 days. The commonestsymptoms observed were fever in 78(100%),pain abdomen 78(100%),abdominal distension28(35.89%)and vomiting in 51(65.38%).The choice of surgical procedure was done peroperativelydepending on the extent of contamination of peritoneal cavity and the general condition of the patient.Mean hospital stay was 8 days.CONCLUSION: Early presentation and referral to tertiary care hospital can improve the mortality andmorbidity in children with typhoid ileal perforation. All patients who underwent ileostomy recoveredwell and is the procedure of choice in patients who present late.KEY WORDS: Typhoid ileal perforation, surgical options, ileostomy.

Spontaneous regression of presumed ocular surface squamous neoplasia: A report of 8 cases

2021 ◽  
pp. 112067212110573
Author(s):  
Vijitha S Vempuluru ◽  
Neha Ghose ◽  
Nidhi Mahendra Vithalani ◽  
Shahenaz Sultana ◽  
Swathi Kaliki
Keyword(s):  
Ocular Surface ◽  
Spontaneous Regression ◽  
Tumor Regression ◽  
Anterior Segment ◽  
Retrospective Chart Review ◽  
Tumor Diameter ◽  
Ocular Surface Squamous Neoplasia ◽  
Duration Of Symptoms ◽  
The Mean

Purpose To report the phenomenon of spontaneous regression in presumed ocular surface squamous neoplasia (OSSN) Methods Retrospective chart review of clinically diagnosed cases of OSSN during 2016 to 2019 Results Of the 449 OSSN lesions, spontaneous regression was seen in 8 lesions (2%). The mean age at diagnosis of OSSN was 37 years (median, 36 years; range, 21 to 59 years). All were males with unilateral, treatment-naïve tumors. Mean duration of symptoms was 3 months (median, 2 months; range, 1 to 12 months). All tumors arose within the interpalpebral region, located in the nasal quadrant in 88% (n = 7) and in temporal quadrant in 12% (n = 1). The mean tumor diameter was 4 mm (median, 4 mm; range, 3 to 5 mm). Lesions showed nodular (n = 4; 50%) or placoid (n = 4; 50%) morphology. The other features included keratin production and intrinsic vascularity (n = 8; 100%), feeder vessels (n = 4; 50%), and intratumoral pigmentation (n = 4; 50%). The diagnosis of OSSN was confirmed by classic anterior segment optical coherence tomography (AS-OCT) features. Tumors regressed after a mean period of 5 months (median, 4 months; range, <1 to 17 months) from presumed onset and a mean period of 2 months (median, 1 month; range, <1 to 6 months) from presentation to the clinic. No recurrences were noted at a mean follow up of 37 months (median, 35 months; range, 17 to 52 months) after spontaneous regression of tumors. Conclusion OSSN can spontaneously regress in 2% of cases. Immune-mediated reversal of dysplastic changes may explain this phenomenon. Précis In this study, spontaneous regression of presumed ocular surface squamous neoplasia was noted in 2% patients. Tumor regression resulted in restoration of normal epithelial architecture and no recurrences were observed during the follow-up period.

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