scholarly journals Neonatal Atrial Flutter Approach: A Case Series

2020 ◽  
Vol 32 (4) ◽  
pp. 245-251
Author(s):  
Fernanda Pessa Valente ◽  
Gustavo Henrique Belarmino Góes ◽  
Caroline Bernardi Fabro ◽  
Afonso Luiz Tavares Albuquerque ◽  
Dário Celestino Sobral Filho
Keyword(s):  
Atrial Flutter ◽  
Medical Records ◽  
Neonatal Period ◽  
Case Series ◽  
Electrical Cardioversion ◽  
Diagnostic Methods ◽  
Ventricular Rate ◽  
Third Trimester ◽  
Fetal Ultrasound

Objective: This study set out to analyze the therapeutic options of patients with neonatal atrial flutter (AFL), considering the diagnostic methods available and the prognosis of these patients. Methodology: A retrospective study was performed by reviewing the medical records of a series of seven patients with atrial fibrillation (AF) diagnosed during fetal or neonatal period. The follow-up time of these patients ranged from 7 months to 3 years and 8 months (mean: 1 year). The clinical data for the diagnosis included sustained heart rate greater than 180 bpm, which was confirmed in all patients by a 12-lead electrocardiogram. Results: Four (57.1%) of the 7 patients studied were male. Most of the patients revealed cardiac arrhythmia during the intrauterine period when screened by fetal ultrasound in the third trimester of gestation (5 patients, i.e. 71.2%). Only the mother of Patient 2 was administered digoxin before childbirth. The atrial rate of the tachyarrhythmia revealed a mean of 375 bpm, with an increase of up to 500 bpm. Atrioventricular conduction presented a 2:1 ratio in all patients, with variations of 3:1 and 4:1 observed in Patients 1, 3 and 6. The ventricular rate ranged from 188 to 250 bpm. All patients revealed typical and counter-clockwise electrocardiogram characteristics. Synchronized electrical cardioversion was the treatment of choice in 6 patients (85.7%), with a dose of 1 J/kg. Conclusion: Early diagnosis, prior treatment, and synchronized electrical cardioversion indicate an excellent prognosis, and prolonged maintenance treatment may be unnecessary.

scholarly journals Midterm Safety of Carbon Dioxide Insufflation of the Knee During Arthroscopic Cartilage–Based Procedures

2021 ◽  
Vol 9 (10) ◽  
pp. 232596712110354
Author(s):  
Judson L. Penton ◽  
Travis R. Flick ◽  
Felix H. Savoie ◽  
Wendell M. Heard ◽  
William F. Sherman
Keyword(s):  
Carbon Dioxide ◽  
Clinical Outcomes ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Knee Arthroscopy ◽  
Case Series ◽  
Osteochondral Allograft ◽  
Systemic Complications ◽  
Allograft Transplantation

Background: When compared with fluid arthroscopy, carbon dioxide (CO2) insufflation offers an increased scope of view and a more natural-appearing joint cavity, and it eliminates floating debris that may obscure the surgeon’s view. Despite the advantages of CO2 insufflation during knee arthroscopy and no reported cases of air emboli, the technique is not widely used because of concerns of hematogenous gas leakage and a lack of case series demonstrating safety. Purpose/Hypothesis: To investigate the safety profile of CO2 insufflation during arthroscopic osteochondral allograft transplantation of the knee and report the midterm clinical outcomes using this technique. We hypothesized that patients undergoing CO2 insufflation of the knee joint would have minimal systemic complications, allowing arthroscopic cartilage work in a dry field. Study Design: Case series; level of evidence, 4. Methods: A retrospective chart review was performed of electronic medical records for patients who underwent arthroscopic osteochondral allograft transplantation of the knee with the use of CO2 insufflation. Included were patients aged 18 to 65 years who underwent knee arthroscopy with CO2 insufflation from January 1, 2015, to January 1, 2021, and who had a minimum follow-up of 24 months. All procedures were performed by a single, fellowship-trained and board-certified sports medicine surgeon. The patients’ electronic medical records were reviewed in their entirety for relevant demographic and clinical outcomes. Results: We evaluated 27 patients (14 women and 13 men) with a mean age of 38 and a mean follow-up of 39.2 months. CO2 insufflation was used in 100% of cases during the placement of the osteochondral allograft. None of the patients sustained any systemic complications, including signs or symptoms of gas embolism or persistent subcutaneous emphysema. Conclusion: The results of this case series suggest CO2 insufflation during knee arthroscopy can be performed safely with minimal systemic complications and provide an alternative environment for treating osteochondral defects requiring a dry field in the knee.

scholarly journals Fetal Atrial Flutter and Hydrops Successfully Treated with Transplacental and Direct Fetal Therapy

2016 ◽  
Vol 6 (1) ◽  
pp. 16-21
Author(s):  
Bettina F. Cuneo
Keyword(s):  
Sinus Rhythm ◽  
Atrial Flutter ◽  
Marked Change ◽  
Postnatal Life ◽  
Fetal Therapy ◽  
Fetal Ultrasound ◽  
Fetal Demise ◽  
Antiarrhythmic Medications ◽  
Antiarrhythmic Treatment

AbstractThe hydropic fetus with atrial flutter has high risk of fetal demise. In utero treatment is not as successful as SVT with 1:1 conduction. Even after conversion to sinus rhythm, close follow-up of the pregnancy is required for several reasons..Case Report:A 25 year old primigravida, at 26 wks of gestation had a fetal ultrasound which showed a tachycardic hydropic fetus with AFI 49. The rhythm was atrial flutter: AR 400 bpm and VR 200 bpm. The heart was structurally normal. Transplacental antiarrhythmic treatment with sotalol was started and 24 hours later, the fetus was still primarily in flutter with rare episodes of sinus rhythm and frequent PAC. Sotalol was increased but the mother’s QTc increased to > 500 ms, so the sotalol dose was reduced. On day 4th direct i.m. of digoxin was given and fetus was in sinus rhythm. Pharmacotherapy was continued. On the 16th day of sinus rhythm (at 33 wks), a marked change in FHR variability was seen. An US revealed the fetus was in sinus rhythm with a normal FHR. Because of the decreased FHR variability, the fetus was delivered by CS and the cord pH was 7.19, Apgars 1, 9 and 9. The neonate received no antiarrhythmic medications. On day 6 of postnatal life, an AV re-entrant tachycardia (AVRT) developed and sinus rhythm was successfully restored with sotalol and digoxin. The infant was treated for 18 months with no episodes of SVT or atrial flutter.

Osteochondritis Dissecans of the Humeral Trochlea: Characterization of a Rare Disorder Based on 28 Cases

2019 ◽  
Vol 47 (9) ◽  
pp. 2167-2173 ◽  
Author(s):  
Kemble K. Wang ◽  
Sarah D. Bixby ◽  
Donald S. Bae
Keyword(s):  
Osteochondritis Dissecans ◽  
Medical Records ◽  
Clinical Presentation ◽  
Case Series ◽  
Ossification Center ◽  
Trochlear Groove ◽  
Level Of Evidence ◽  
Elbow Motion

Background: Osteochondritis dissecans (OCD) of the humeral trochlea is very rare. It may cause pain, mechanical symptoms, and loss of elbow motion, typically in the adolescent athlete. However, little published information is available regarding this condition. Purpose: To describe the clinical presentation, radiographic features, and prognosis of trochlear OCD. Study Design: Case series; Level of evidence, 4. Methods: Over a 10-year period, 28 patients presented to a tertiary pediatric hospital with trochlear OCD. Medical records and imaging were analyzed to characterize presentation, lesions appearances, and outcomes. Results: Mean ± SD age at presentation was 13.4 ± 1.6 years, and 13 of the 28 patients were male. The most common presenting symptom was pain (93%), followed by crepitus (54%). Evidence of trochlear OCD could be seen on initial radiographs in 94% of cases but was commonly missed. Coexisting capitellar OCD lesions were the most common associated abnormalities seen on magnetic resonance imaging (21%). Investigators noted 2 predominant patterns: “typical” trochlear OCD lesions (89%) were located on the lateral crista of the trochlea, 3.1 ± 4.4 mm lateral to the apex of the trochlear groove. This location corresponded to the medial tip of the capitellar epiphyseal ossification center and was not actually on the trochlear ossification center. “Atypical” trochlear OCD lesions (11%) were located more posteromedially. Trochlear OCD lesions in 4 elbows were managed surgically, while the remainder were managed nonoperatively. At mean ± SD follow-up of 13 ± 8 months, 12 patients (43%) were asymptomatic. A further 5 patients had ongoing crepitus but no pain (18%), and 4 patients (14%) underwent surgical treatment for their trochlear OCD (osteochondral fixation, n = 1; drilling/curettage, n = 3); 3 of the 4 patients experienced some improvement in pain. Conclusion: Although rare, trochlear OCD can cause considerable elbow problems. Clinicians should be aware of this differential diagnosis. Plain radiographs should be carefully scrutinized for subtle signs of trochlear OCD, particularly in the repetitive or overhead athlete with elbow pain. Although most patients’ symptoms will improve with activity modification, some may require surgery.

Treatment of refractory Aspergillus otomycosis with voriconazole: case series and review

2014 ◽  
Vol 128 (6) ◽  
pp. 547-551 ◽  
Author(s):  
Hsu-Chueh Ho ◽  
Shih-Hsuan Hsiao ◽  
Cheng-Yung Lee ◽  
Chen-Chi Tsai
Keyword(s):  
Medical Records ◽  
Therapeutic Option ◽  
Demographic Data ◽  
Local Treatment ◽  
Case Series ◽  
Surgical Debridement ◽  
Underlying Diseases ◽  
Lost To Follow Up

AbstractBackground:Voriconazole is a broad-spectrum azole exhibiting strong anti-Aspergillus activity and good long-term tolerance. However, the evidence for voriconazole efficacy against refractory Aspergillus otomycosis is weak.Method:We reviewed the medical records of patients with Aspergillus otomycosis treated with voriconazole from January 2008 to June 2012 in a Taiwanese regional hospital. Demographic data and information regarding underlying diseases, clinical features, treatment and outcome were assessed.Results:In total, 14 cases of Aspergillus otomycosis were treated with voriconazole, including 5 patients with Aspergillus invasive otitis externa. All patients had failed to respond to local treatment, antibiotics or topical agents. One case was lost to follow up. The symptoms of two patients recurred after voriconazole treatment: one patient received a second 12-week course of voriconazole and was cured; and symptoms of the other patient recurred after a second 12-week course of voriconazole, leading to surgical debridement. The remaining 11 patients were cured by voriconazole treatment without extensive surgical debridement.Conclusion:This study demonstrates that voriconazole can be a very effective and convenient therapeutic option for the management of refractory Aspergillus otomycosis.

Human Amniotic Membrane for the Prevention of Intradural Spinal Cord Adhesions: Retrospective Review of its Novel Use in a Case Series of 14 Patients

Neurosurgery ◽  
2018 ◽  
Vol 83 (5) ◽  
pp. 989-996 ◽  
Author(s):  
Corey T Walker ◽  
Jakub Godzik ◽  
U Kumar Kakarla ◽  
Jay D Turner ◽  
Alexander C Whiting ◽  
...  
Keyword(s):  
Amniotic Membrane ◽  
Medical Records ◽  
Spinal Surgery ◽  
Case Series ◽  
Human Amniotic Membrane ◽  
Potential Efficacy ◽  
Tissue Manipulation ◽  
Human Use ◽  
Dural Patch

Abstract BACKGROUND Tethering after spinal surgery is caused by adhesions that arise from intradural tissue manipulation. Microsurgical detethering is the only treatment for symptomatic patients, but retethering occurs commonly and no treatment is widely available to prevent this complication. OBJECTIVE To apply human amniotic membrane (HAM) grafts, which are immune-privileged and known to possess antifibrogenic properties, in patients requiring microsurgical detethering. For this first-in-human use, we evaluated the safety and potential efficacy of these grafts for preventing retethering. METHODS We retrospectively reviewed the medical records of all patients who required detethering surgery and received an HAM graft between 2013 and 2016 at our institution after various previous intradural spinal surgeries. In all 14 cases, intradural lysis of adhesions was achieved, an HAM graft was sewn in place intradurally, and a dural patch was closed in a watertight fashion over the graft. RESULTS Fourteen patients had received HAM grafts to prevent retethering. All patients had at least 6 mo of follow-up (mean follow-up, 14 mo). Retethering was noted in only 1 patient. Surgical re-exploration showed that the retethering occurred caudal to the edge of the HAM graft, with no tethering underneath the original graft. No complications were attributed specifically to the HAM graft placement. CONCLUSION This first-in-human series provides evidence that HAM grafts are a safe and potentially efficacious method for preventing retethering after microsurgical intradural lysis of adhesions. These results lay the groundwork for further prospective controlled trials in patients with this difficult-to-treat pathology.

Feline corneal sequestra: outcome of corneoconjunctival transposition in 97 cats (109 eyes)

2016 ◽  
Vol 19 (6) ◽  
pp. 710-716 ◽  
Author(s):  
Kathleen L Graham ◽  
Joanna D White ◽  
Francis M Billson
Keyword(s):  
Medical Records ◽  
Full Range ◽  
Corneal Thickness ◽  
Case Series ◽  
Postoperative Outcome ◽  
Telephone Contact ◽  
Risk Factors For Recurrence ◽  
Contralateral Eye

Case series summary A retrospective study was undertaken to review outcomes of keratectomy and corneoconjunctival transposition in cats with superficial and deep corneal sequestra. Information including pertinent history, signalment, ophthalmological findings and postoperative outcome was collected from medical records. Follow-up was obtained by clinical examination, contact with the referring veterinarians and review of medical records or telephone contact with owners. Ninety-seven cats (109 eyes) were included from 2005–2015. The most commonly affected breeds included Persian, Burmese and Himalayan. The mean age at the time of surgery was 6.8 years (median 6.5 years; range 8.0 months–18.0 years). A corneal sequestrum in the contralateral eye was diagnosed in 28 cats (28.9%). Recurrent corneal sequestration was diagnosed in eight cats (nine eyes), with recurrence occurring a mean of 703 days after surgery (range 29–1750 days). Age, sex, breed, depth of sequestration and concurrent ocular disease in the contralateral eye were compared between cats with and without recurrence, with no risk factors for recurrence identified. Relevance and novel information Excellent surgical outcomes have previously been described in a series of 17 cats with superficial and mid-stromal corneal sequestra. This paper adds further information to the literature by describing a larger series of cats, with corneal sequestra affecting the full range of corneal thickness, and good long-term postoperative outcomes.

Surgical Management of Esophageal Achalasia in Pediatrics: A Systematic Review

2019 ◽  
Vol 30 (01) ◽  
pp. 013-020
Author(s):  
Ayman Goneidy ◽  
James Cory-Wright ◽  
Limeng Zhu ◽  
Georgina Malakounides
Keyword(s):  
Systematic Review ◽  
Outcome Measures ◽  
Surgical Management ◽  
Case Series ◽  
Esophageal Achalasia ◽  
Treatment Method ◽  
Diagnostic Methods ◽  
Success Rates ◽  
Esophageal Myotomy

Abstract Introduction There are no evidence-based guidelines on the surgical management of esophageal achalasia (OA) in children. This can be a challenging condition with significant physical and psychological morbidity. Our aim was to identify the most common management modalities and their outcomes. Materials and Methods A systematic review was performed through a literature search of health care databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, aiming at identifying pediatric series discussing the diagnosis and management of OA. Duplicates, case series with < 9 patients, and follow-up of < 1 year were excluded. The included papers were analyzed for diagnostic methods, primary treatment method, complications, follow-up duration, outcome measures recorded, and outcome. Results Data from 33 papers for 742 children treated for OA was analyzed. Eleven mentioned multiple management modalities. In summary, 25 described Heller's esophagomyotomy (HM), 13 esophageal dilatation (EOD), and 6 peroral esophageal myotomy (POEM). Mean follow-up was 43.7 months (12–180). Outcome measures were heterogeneous. However, analysis of reported success showed a mean success of 78% for HM (p = 1.79 × 10–7), 44.9% for EOD (p = 0.24), and 99.3% for POEM (p = 0.001). Reported complications were 12.8% for HM, 5% for EOD, and 24.4% for POEM. Further interventions were required for 10.9% of HM, 62.3% of EOD, and 0.01% of POEM patient groups. Conclusion Methods of diagnosis and measures of successful outcomes were heterogeneous, limiting the strength of evidence. HM showed superior short-term success rates to EOD. POEM is a promising modality but requires investment in equipment and training. Information about sustainability of response and long-term outcomes is lacking.

Intermediate-Term Outcomes of a Third-Generation, 2-Component Total Ankle Prosthesis

2021 ◽  
pp. 107110072098611
Author(s):  
Calvin J. Rushing ◽  
Bryon J. Mckenna ◽  
Emily A. Zulauf ◽  
Christopher F. Hyer ◽  
Gregory C. Berlet
Keyword(s):  
Medical Records ◽  
Case Series ◽  
Third Generation ◽  
Single Institution ◽  
Short Term ◽  
Level Of Evidence ◽  
Ankle Prosthesis ◽  
Low Incidence ◽  
Component Revision

Background: Short-term outcomes for the INBONE I and INBONE II tibial stems have been favorable. The INBONE-II talus has been shown to have lower reoperation and failure rates compared to its predecessor at short term follow-up. The purpose of the present study was to assess mid-term outcomes for the third generation, two component total ankle prosthesis at 5 to 9 years follow-up, evaluating both the tibial and talar components. Methods: All patients who underwent primary total ankle arthroplasty (TAA) with INBONE-II between July 2010 and July 2014 at a single institution and who were at least 5 years postoperative were included. A total of 15 ankles with a mean follow-up of 85 months (range, 61-113 months) met the criteria. Radiographs were assessed using coronal and sagittal alignment parameters preoperatively, at 6 weeks postoperatively, and at the most recent follow-up. Medical records were reviewed and revisions, reoperations, and complications were classified according to the criteria established by Vander Griend et al and Glazebrook et al, respectively. Results: The survivorship of the prosthesis at a mean of 85 months was 93.7%. The coronal and sagittal tibiotalar alignments 6 weeks after surgery were 2.1 degrees ( P = .081) and 36% ( P = .15), respectively. Maintenance of this alignment was observed during the latest follow-up ( P = .684 and P = .837, respectively). One ankle (6.7%) required early component revision, while 4 (26.7%) required a non–implant-related revision. Six complications (2 high grade, 1 intermediate, and 3 low) in 5 ankles (33.3%) were recorded according to the Glazebrook classification system. Conclusion: The present study is the first to report midterm follow-up after TAA with this third-generation, 2-component prothesis. High survivorship, maintenance of correction, and a low incidence of major complications were observed in this small case series. The most common complication overall was lateral gutter impingement, which accounted for the majority of the nonrevisional reoperations. Level of Evidence: Level IV, case series.

Feline ophthalmomyiasis externa caused by Cuterebra larvae: four cases (2005–2020)

2021 ◽  
pp. 1098612X2110130
Author(s):  
Brittany N Schlesener ◽  
Elizabeth A Peck ◽  
Eric M Teplitz ◽  
Filipe Espinheira Gomes ◽  
Dwight D Bowman ◽  
...  
Keyword(s):  
Medical Records ◽  
Clinical Signs ◽  
Case Series ◽  
University Hospital ◽  
Nictitating Membrane ◽  
Cornell University ◽  
Unilateral Disease ◽  
The Right ◽  
Lost To Follow Up

Case series summary Described are four cats diagnosed with ophthalmomyiasis externa caused by Cuterebra larvae. Medical records were retrospectively reviewed to identify cats with ophthalmomyiasis externa between 2005 and 2020 at Cornell University Hospital for Animals. Signalment, history, clinical and diagnostic findings, treatment and outcome were recorded. All cats were young (< 3 years of age), had outdoor access and were initially examined during the summer months. All cases had unilateral disease with the right eye affected. Two cases had nictitating membrane lesions and two had orbital disease. Concurrent superficial corneal ulceration was present in three cats. Two cats suffered from pyrexia, suspected secondary to inflammation from the larval infestation. Successful larval removal was performed in all cats, which resulted in improvement of discomfort and clinical signs. A corneal ulcer persisted in one cat, which was lost to follow-up prior to ulcer resolution. Parasite identification confirmed Cuterebra species infestation in all cases. Relevance and novel information To the authors’ knowledge, this is the first report of feline ophthalmomyiasis externa caused by Cuterebra species. Parasite removal was successful in restoring comfort and resolving clinical signs in all cats with adequate follow-up information.

Evaluation of postoperative complication rates in cats undergoing perineal urethrostomy performed in dorsal recumbency

2019 ◽  
Vol 22 (4) ◽  
pp. 399-403 ◽  
Author(s):  
Mallory T Watson ◽  
Rodrigo Y Roca ◽  
Adam H Breiteneicher ◽  
Russell H Kalis
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Postoperative Complication ◽  
Medical Records ◽  
Case Series ◽  
Urethral Obstruction ◽  
Complication Rates

Case series summary Medical records were reviewed for cats that underwent a perineal urethrostomy performed in dorsal recumbency for the treatment of urethral obstruction. Information, including signalment, reason for presentation, number of previous obstructions, surgery time, and perioperative and postoperative complications, were collected through a review of medical records and owner follow-up. The objective was to evaluate short- and long-term complications in cats that underwent perineal urethrostomy performed in dorsal recumbency for treatment of urethral obstruction. Relevance and novel information No major or life-threatening complications, such as urethral stricture, re-obstruction, euthanasia due to lower urinary signs or chronic urinary tract infection, were reported. Short-term complications were limited to dysuria in 2/12 (16.7%) cats. Long-term follow-up was available for nine cats. The most common long-term complication seen in this population of cats was a single recurrence of urinary tract infection in 3/9 (33.3%) cats that resolved after a short course of empirical antibiotic therapy. Performing perineal urethrostomy in dorsal recumbency is safe and may have advantages to ventral recumbency due to improved visualization, allowing for more efficient dissection and improved accuracy in tissue apposition during closure. We believe this has been a major contributor to our reported reduced major postoperative complication rate.

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