scholarly journals Catastrophe Disguised as a Complication After Epiduroscopy-A Case Study

2021 ◽  
pp. 1-5
Author(s):  
Eva M. Monzon
Keyword(s):  
Clinical History ◽  
Neurological Complications ◽  
Medical Intervention ◽  
Lower Limbs ◽  
Invasive Technique ◽  
Interventional Treatment ◽  
Key Words Complications ◽  
Surgical Interventions ◽  
Lower Limb Pain ◽  
Left Limb

Background: Epiduroscopy is a minimally invasive technique that enables diagnosis and treatment within the epidural space with direct vision. Previously reported complications of this technique have been mostly mild neurological complications of a transitory nature. In the present case, we describe a serious complication following an epiduroscopy, resulting in death. Case Report: The patient was a 39-year-old woman with lower back and lower limb pain who had undergone 3 surgical interventions previously on the lumbar spine. Only limited results from conservative and interventional treatment had been observed. She underwent an epiduroscopy in the Pain Management Unit. Immediately after the procedure, which was completed without incident, the patient presented neurological symptoms with areflexic paraplegia and a loss of sensation in the lower limbs and the upper left limb. Imaging tests identified signs of craniospinal hypotension that progressed slowly despite medical intervention. Ventricular dilation and cerebral edema without remission occurred, which ultimately caused the patient’s death 2 months after admission to the intensive care unit. Conclusion: Epiduroscopy has the potential to present adverse effects and complications. A thorough evaluation of the clinical history and the imaging tests are advisable Key words: Complications, epiduroscopy, low back pain, spinal cord, spinal endoscopy

scholarly journals Intracardiac EUS-B-Guided FNA for Diagnosing Cardiac Tumors

Respiration ◽  
2021 ◽  
pp. 1-5
Author(s):  
Haizea Alvarez Martinez ◽  
Jolanda C. Kuijvenhoven ◽  
Jouke T. Annema
Keyword(s):  
Left Atrium ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Needle Aspiration ◽  
Invasive Technique ◽  
Cardiac Tumors ◽  
Surgical Interventions ◽  
Tumor Diagnostics ◽  
Specific Tumor ◽  
Primary Cardiac Tumors

Primary cardiac tumors are extremely rare. Obtaining a tissue diagnosis is difficult and commonly requires open-heart surgery with associated morbidity. Esophageal endoscopic ultrasound (EUS) and EUS with the EBUS scope (EUS-B) provide real-time sampling of centrally located lung tumors and mediastinal lymph nodes. They also provide an excellent view of the left atrium, since it is located adjacent to the esophagus. To date, left atrium tumor diagnostics by endosonography is poorly explored. We describe 2 exceptional diagnostic cases of left atrium tumors in which cardiac surgery was hazardous due to the clinical condition or previous surgical interventions. During EUS-B-guided fine-needle aspiration (FNA), the left atrial masses were successfully and safely sampled, revealing a Burkitt lymphoma and a synovial sarcoma. FNA including cell block analysis enabled specific tumor diagnosis and molecular subtyping. Our findings suggest that in selected cases, linear endosonography qualifies as a minimally invasive technique for intracardiac tumor diagnostics.

scholarly journals Subacute Sclerosing Panencephalitis manifesting as Bell’s palsy and bilateral macular necrotizing retinitis: an atypical presenting feature

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Lagan Paul ◽  
Tanya Jain ◽  
Manisha Agarwal ◽  
Shalini Singh
Keyword(s):  
Subacute Sclerosing Panencephalitis ◽  
Clinical History ◽  
Neurological Complications ◽  
Bell’S Palsy ◽  
Ocular Involvement ◽  
Bell's Palsy ◽  
Diagnostic Challenge ◽  
Bladder Control ◽  
Mri Brain ◽  
History Of

Abstract Background Subacute sclerosing panencephalitis (SSPE) is a potentially lethal complication of measles infection. Neurological complications take years to manifest after primary viral infection of brain and can lead to blindness in some individuals. Findings A 13-year-old female patient with history of Bell’s palsy 2 months prior, presented with rapidly progressing necrotizing retinitis in both eyes. Soon after, she was unable to walk, developed myoclonic jerks, altered sensorium and loss of bowel and bladder control. Her clinical history, CSF IgG measles antibody analysis, MRI brain and EEG findings confirmed the diagnosis of SSPE. Conclusion SSPE in our case presented as Bell’s palsy and sudden painless diminution of vision due to ocular involvement, and developed full blown disease within 2 months. SSPE can present as a diagnostic challenge and warrants early identification and referral for timely diagnosis and management.

Histologic Features of Zygomycosis

2001 ◽  
Vol 125 (3) ◽  
pp. 375-378 ◽  
Author(s):  
John L. Frater ◽  
Gerri S. Hall ◽  
Gary W. Procop
Keyword(s):  
Perineural Invasion ◽  
Inflammatory Responses ◽  
Fungal Growth ◽  
Positive Culture ◽  
Clinical History ◽  
Invasive Disease ◽  
Medical Intervention ◽  
Common Finding ◽  
Fungus Ball ◽  
Fungal Morphology

Abstract Objective.—Invasive zygomycosis is rapidly progressive and is associated with angioinvasion and infarction. Invasive disease requires emergent surgical and medical intervention. Because it is important for surgical pathologists to recognize these fungi and their preferential sites of growth, the objective of this article is to describe the fungal morphology and histopathologic findings in biopsies from patients with zygomycotic disease, with emphasis on preferential sites of fungal growth. Design.—Medical record and histologic review identified 20 patients with zygomycosis. Inclusion criteria included the presence of typical ribbonlike hyphae and positive culture, a clinical history of invasive zygomycosis, or both. The histologic features of disease and the fungal morphology were assessed. Results.—Fungus ball (15%), rhinocerebral (55%), and pulmonary (30%) disease were the types of disease represented. The inflammatory responses were predominantly neutrophilic (50%), predominantly granulomatous (5%), pyogranulomatous (25%), or absent (20%). Invasive disease was characterized by prominent infarcts (94%), angioinvasion (100%), and, surprisingly, prominent perineural invasion (90%) in biopsies that contained nerves for evaluation. At least rare hyphal septa were always seen (100%), and most branches (95%) varied from 45° to 90°. Conclusions.—As known to mycologists, zygomycetes are pauciseptate, rather than aseptate, molds. Therefore, the presence of an occasional septum is expected. Perineural invasion is a common finding in invasive zygomycosis, as are angioinvasion and infarcts. Therefore, prior to excluding the presence of these fungi in biopsies suspected to contain zygomycetes, the perineural space should be carefully examined.

PREDICTORS OF NEUROLOGICAL COMPLICATIONS AFTER CARDIAC SURGICAL INTERVENTIONS IN OLDERY PATIENTS

2020 ◽  
pp. 319-324
Author(s):  
О. В. Каменская ◽  
А. С. Клинкова ◽  
В. В. Ломиворотов ◽  
В. А. Шмырев ◽  
А. М. Чернявский
Keyword(s):  
Intraoperative Monitoring ◽  
Cerebral Oxygenation ◽  
Artery Bypass ◽  
Neurological Complications ◽  
Myocardial Infarctions ◽  
Bypass Grafting ◽  
Surgical Interventions ◽  
Increased Risk ◽  
History Of ◽  
Left And Right

Для выявления предикторов неврологических осложнений в госпитальный период после коронарного шунтирования (КШ) проанализированы данные 92 больных 70 лет и старше с ИБС. Интраоперационно проведен мониторинг церебральной оксигенации ( rSO , %). На этапе вводной анестезии средний уровень rSO по правому и левому полушариям составлял 64-65% без значительных изменений во время операции. Снижение rSO во время искусственного кровообращения (ИК) связано с увеличением риска развития неврологических осложнений в раннем послеоперационном периоде. При снижении rSO во время ИК на 20% и более относительно исходных значений по левому и правому полушариям риск неблагоприятных неврологических событий возрастает в 7 и 9 раз соответственно. Два и более инфаркта миокарда в анамнезе в 3 раза увеличивают риск неврологических осложнений после КШ. To identify predictors of neurological complications in the hospital period after coronary artery bypass grafting (CABG), 92 patients with coronary heart disease aged 70 years and over were analyzed. Intraoperative monitoring of cerebral oxygenation ( rSO , %) was carried out. At the stage of induction anesthesia, the average level of rSO for left and right hemispheres was 64-65 % without significant changes during the operation. A decrease in rSO during cardiopulmonary bypass (CPB) was associated with increased risk of neurological complications. The risk of neurological complications increase 7-fold and 9-fold with a decrease in rSO by 20 % or more during CPB relative to baseline for left and right hemispheres, respectively. A history of two or more myocardial infarctions increases 3-fold the risk of neurological complications after CABG.

Iliac Venous Obstruction: Surgical Reconstruction

2000 ◽  
Vol 15 (3-4) ◽  
pp. 144-148
Author(s):  
F. Mercier ◽  
F. Cormier ◽  
J. M. Fichelle ◽  
F. Duarte ◽  
J. M. Cormier
Keyword(s):  
Iliac Artery ◽  
Lower Limb ◽  
Iliac Vein ◽  
Lower Limbs ◽  
Surgical Reconstruction ◽  
Invasive Technique ◽  
Venous Obstruction ◽  
Long Term Outcome ◽  
First Choice

Aim: To review the investigation and treatment of iliac vein obstruction. Method: A review of current literature in the field of management of iliac venous obstruction has been conducted. Synthesis: Iliac venous obstruction results in chronic or acute symptoms in the lower limb presenting as pain, swelling, oedema and discomfort of the lower limb. Intrinsic or extrinsic obstruction of the iliac veins may be the cause. Cockett syndrome is the classic aetiology for chronic intermittent or fixed left inferior limb venous obstruction. Other causes include tumours, vascular grafts or lymph node compression and retroperitoneal fibrosis. Duplex ultrasound imaging is now the first-choice investigation. CT scanning is useful where external vein compression is suspected. Phlebography is used when an endovascular procedure is to be done. The surgical treatment of Cockett syndrome described by Cormier is transposition of the common right iliac artery in the left internal iliac artery. This is being replaced by endovascular balloon venoplasty completed by stenting of the left iliac vein. We reviewed the experience of surgical correction of Cockett syndrome with Cormier's technique in 70 patients operated on between 1976 and 1990; 55 patients had a follow-up of 12-177 months. Anatomical and functional results were perfect for all patients except when endoluminal synechiae or iliac venous thrombosis were associated with postural compression. In this case a 50% success rate was achieved. The endovascular revolution offers a less invasive technique for treatment of chronic iliac venous obstruction. Follow-up is short at present in the few publications found in the literature. Conclusions: Iliac vein obstruction results in symptoms of swelling in the lower limbs. These may be managed conservatively. Where there is an indication for venous reconstruction, investigation by duplex ultrasonography is the first step. Endovascular procedures including stenting offer significant benefit. The long-term outcome of these interventions has yet to be established.

scholarly journals Affinity-Enhanced CTC-Capturing Hydrogel Microparticles Fabricated by Degassed Mold Lithography

2020 ◽  
Vol 9 (2) ◽  
pp. 301
Author(s):  
Nak Jun Lee ◽  
Sejung Maeng ◽  
Hyeon Ung Kim ◽  
Yoon Ho Roh ◽  
Changhyun Hwang ◽  
...  
Keyword(s):  
Fluorescence Analysis ◽  
Medical Intervention ◽  
Breast Cancer Cell Lines ◽  
Invasive Technique ◽  
Cell Capture ◽  
Hydrogel Microparticles ◽  
Hydrogel Particles ◽  
Antibody Conjugation ◽  
Cell Affinity ◽  
Novel Method

Technologies for the detection and isolation of circulating tumor cells (CTCs) are essential in liquid biopsy, a minimally invasive technique for early diagnosis and medical intervention in cancer patients. A promising method for CTC capture, using an affinity-based approach, is the use of functionalized hydrogel microparticles (MP), which have the advantages of water-like reactivity, biologically compatible materials, and synergy with various analysis platforms. In this paper, we demonstrate the feasibility of CTC capture by hydrogel particles synthesized using a novel method called degassed mold lithography (DML). This technique increases the porosity and functionality of the MPs for effective conjugation with antibodies. Qualitative fluorescence analysis demonstrates that DML produces superior uniformity, integrity, and functionality of the MPs, as compared to conventional stop flow lithography (SFL). Analysis of the fluorescence intensity from porosity-controlled MPs by each reaction step of antibody conjugation elucidates that more antibodies are loaded when the particles are more porous. The feasibility of selective cell capture is demonstrated using breast cancer cell lines. In conclusion, using DML for the synthesis of porous MPs offers a powerful method for improving the cell affinity of the antibody-conjugated MPs.

scholarly journals Devastating Complications of Metal Strut Migration Following Pectus Excavatum Repair

2019 ◽  
Vol 07 (01) ◽  
pp. e51-e54
Author(s):  
Mila Stajevic ◽  
Milorad Bijelovic ◽  
Jovan Kosutic ◽  
Radoje Simic
Keyword(s):  
Lower Limb ◽  
Pectus Excavatum ◽  
Rare Complication ◽  
Neurological Complications ◽  
Left Ventricular ◽  
Left Ventricular Cavity ◽  
Cardiac Procedure ◽  
Lower Limb Pain ◽  
Ravitch Procedure

AbstractThe modified Ravitch technique with metal struts and the Nuss operation have been the dominant operative techniques for treatment of pectus excavatum in the previous decades. We present devastating postoperative complications of a 16-year-old boy after the modified Ravitch procedure for a severe deformity utilizing two metal bars. Four months following surgery, one strut was removed after the displacement noted on a regular postoperative examination. Ten days after the strut removal, the patient complained of lower limb pain but the sensations were attributed to physical inactivity. Two months later, after pain intensification, the boy was diagnosed with bilateral arterial and venous lower limb thromboses and subsequently, the migration of the remaining metal strut intracardially with the free end in the left ventricular cavity embedded in massive thrombi. An urgent cardiac procedure was performed and the bar removed. Postoperatively, the boy made a full cardiac recovery but with severe neurological complications and subsequent death. Migration of metal struts is a rare complication and, except in our case, had been dealt with successfully. This case should emphasize more attention to the postoperative follow-up management of such patients.

Causes of recurrent lower limb varicose veins after surgical interventions in 141 limbs – Five-year retrospective analysis of two centers

Vascular ◽  
2013 ◽  
Vol 22 (4) ◽  
pp. 267-273 ◽  
Author(s):  
Wang Rui Hua ◽  
Meng Qing Yi ◽  
Wu Xue Jun ◽  
Jin Xing ◽  
Liu Zhao Xuan ◽  
...  
Keyword(s):  
Lower Limb ◽  
Varicose Veins ◽  
Color Doppler ◽  
Color Doppler Ultrasound ◽  
Lower Limbs ◽  
Venous Reflux ◽  
Surgical Interventions ◽  
Venous Valves ◽  
Second Surgery ◽  
Clinical Changes

Aim The purpose of this study was to explore the causes of recurrent lower limb varicose veins after surgical interventions. Methods A retrospective five-year survey was conducted on patients who underwent second surgery due to recurrent lower limb varicose veins after surgical interventions. A total of 141 limbs (112 cases), including 72 cases of left lower limbs, 47 of right lower limbs and 22 of both limbs, were involved in the study. All patients underwent lower limb venography (141 limbs were anterograde and 28 cases were retrograde), and then examined with color-Doppler ultrasound. Results The major causes that urged patients to undergo second surgery are clinical changes graded above CEAP IV (93.6%), limb edema without changes on skin (5%), and single varicosity (1.4%). Up to 127 (83%) limbs exhibited perforating venous reflux, 67 (47.5%) limbs had varied degrees of deep venous insufficiency and 68 (48.2%) limbs had through or above-the-knee great saphenous vein trunk residual. Conclusions Preoperative venography before operation is indispensible in confirming the diagnosis and operation strategies. Patients with severe primary deep venous reflux and symptoms up to C3 may need simultaneous repair of the deep venous valves.

scholarly journals MON-366 X Linked Hypophosphatemic Rachitism: Case Report in Adult Patient

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Adriana Medina ◽  
Juan José Vargas ◽  
Andres Florez Romero ◽  
Andres Coy
Keyword(s):  
Adult Patient ◽  
Genetic Disorder ◽  
Fibroblast Growth Factor 23 ◽  
Functional Limitation ◽  
Serum Phosphate ◽  
Lower Limbs ◽  
Genu Varum ◽  
Mineral Density ◽  
Surgical Interventions ◽  
Normal Bone Mineral Density

Abstract BACKGROUND: X linked hypophosphatemia (XLH) is a rare genetic disorder, with an estimated prevalence of 1: 20,000 live births resulting from a mutation in the PHEX gene (phosphate regulatory endopeptidase), which causes increased levels of circulating fibroblast growth factor 23 (FGF23), reducing both renal reabsorption of phosphate and serum levels of 1,25-dihydroxyvitamin D3, causing chronic hypophosphatemia, rickets and osteomalacy. CLINICAL CASE: a 34 year old female with a height of 1.34 meters whose past medical history began at the age of three years old with a diagnosis of short stature, associated with genu varum and low serum phosphate levels. She received treatment with phosphate salts and calcitriol until eleven years old. During childhood, she underwent several surgical procedures to correct the genu varum. After stopping the treatment, she has presented four fractures in the lower extremities: bilateral femur, tibia and fibula that have required six surgical interventions (osteotomy, osteosynthesis and external fixation); the last surgery was performed in June of 2019; in addition, she has had multiple dental abscesses that required several oral surgeries. Current laboratory tests report: calcium 8.89 mg/dL (8.6-10), 24-hour urine calcium 72.17 mg (100-300) with urinary volume 1470 ml/24 h, serum creatinine 0.44 mg/dL (0.51-0.95), urine creatinine 43.72 mg/dL (29-226), serum phosphate 1.78 mg/dL (2.5-4.5), urine phosphate 17.75 mg/dL (40-136) PTH 86 pg/mL (15-65), alkaline phosphatase 134 ug/ dL (35-104), 25OH vitamin D 23 ng/mL (30-40). Tubular resorption of phosphate corrected for glomerular filtration rate (TmP/GFR:) 1.6 mg/dL (<2.8), Tubular Reabsorption of Phosphate (TRP) 89.96% (>80). Densitometry revealed a normal bone mineral density (BMD) in lumbar spine and hip. Radiographs of the lower limbs showed a difference of 19 mm of the right lower limb in anatomical length and 13 mm in functional length. A HLX genetic panel was performed, with a result of a definitely pathogenic Gene PHEX linked to chromosome X, with a pathological mutation 22 151 705 G> A p Trp456. The patient started treatment with calcitriol and dibasic phosphorus one month ago because of bone and muscle pain, stiffness, functional limitation, periodontal disease, recent hip fracture and indication of left hip replacement. She is candidate for burosumab (Anti-FGF23 Monoclonal Antibody) treatment.CONCLUSIONS: We present the case of adult patient with X-linked hypophosphatemia. Early treatment with phosphate is essential to avoid bone deformities. In adult patients, identifying pain, fractures or requirement of bone surgery, are indications for continuing treatment to improve quality of life, either with phosphate and calcitriol or with the new option, burosumab for pain control, improving functionality and stiffness.

scholarly journals Treatment of critical limb ischemia in patients with multilevel arterial lesions

2018 ◽  
Vol 22 (3) ◽  
pp. 474-478
Author(s):  
V. Shaprynskyi ◽  
Y. Gupalo ◽  
O. Shved ◽  
O. Nabolotnyi ◽  
D. Shapovalov
Keyword(s):  
Atherosclerotic Lesion ◽  
Lower Extremities ◽  
Main Group ◽  
Lower Limbs ◽  
Control Group ◽  
Critical Ischemia ◽  
Optimal Method ◽  
Surgical Interventions ◽  
Limb Preservation ◽  
Arterial Lesions

The extreme manifestation of atherosclerotic lesion of the arteries of the lower extremities is the critical ischemia of the lower extremities. The number of high amputations in such patients ranges from 120 to 500 per 1 million population in the general population annually. In order to achieve the best results in the patency of the arterial bed in the near and distant periods, revascularization of the arteries of the proximal and distal blood flow is necessary. The aim of the work was to evaluate the possibilities and effectiveness of endovascular, open and hybrid arterial interventions on the lower extremities, particularly in patients with multilevel arterial disease, by conducting a retrospective analysis of treatment of critical ischemia. The results of the preoperative ultrasound duplex scan (UDS) of the arteries of 212 patients with critical ischemia of the lower limbs (CILL) shoved, that in 78 (36.8%) were multilevel arterial lesions (MLAL). Patients were divided into two groups. The first (main group) consisted of 50 patients (64%), who have been restored to the open-end and endovascular methods of MLAL, or only endovascular. The second (control) group included 28 patients (36%) — with restoration of permeability of the proximal segment without intervention on the arteries of the distal. Installed, during the period of 16 months, postoperative observation of 78 patients with MLAL, the primary frontal area of the femoral reconstruction in the main group was 92%, and limb preservation - 96%. In the control group, the permeability of the reconstruction zone was 75%, limb preservation — 82%. Thus, it has been established that the most optimal method of recovery of inflow and outflow pathways is one-time hybrid surgical interventions performed in 88% of these patients, which allow to achieve more effectively the recurrence of ischemia and maintain limb.

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