scholarly journals Massive stone burden in an ileocecal pouch: A preventable condition?

2014 ◽  
Vol 8 (5-6) ◽  
pp. 358
Author(s):  
Anne Sophie Valiquette ◽  
Diego Barrieras ◽  
Michael McCormack
Keyword(s):  
Surgical Complications ◽  
Late Complication ◽  
Bladder Exstrophy ◽  
Stone Burden ◽  
History Of ◽  
Lost To Follow Up ◽  
Efficient Transfer

The challenges of transition from the pediatric to the adult setting have been reported. We describe a case of massive stone burden in the ileocecal pouch of a patient lost to follow-up after his transfer from a pediatric to an adult institution. Although we successfully managed the patient and retrieved the pouch stones without any complications, several surgical complications may occur in a patient with a history of extensive abdominal surgeryand bladder exstrophy. This patient’s late complication might have been prevented with a more efficient transfer from a pediatric to an adult institution.

scholarly journals Right lumbar abscess containing a gallstone—an unexpected late complication of laparoscopic cholecystectomy

2020 ◽  
Vol 2020 (7) ◽  
Author(s):  
André Marçal ◽  
Ricardo Vaz Pereira ◽  
Ana Monteiro ◽  
José Dias ◽  
António Oliveira ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Late Complication ◽  
Late Complications ◽  
Gallbladder Perforation ◽  
Past Medical History ◽  
Symptomatic Gallstones ◽  
History Of ◽  
Gallstone Spillage ◽  
Saline Lavage

Abstract During laparoscopic cholecystectomy, gallbladder perforation may occur leading to gallstone spillage and despite being rare, early or late complications may therefore develop. We report a case of a 79-year-old female, with a past medical history of a laparoscopic cholecystectomy 3 years earlier for symptomatic gallstones, admitted in the emergency department with a subcutaneous right lumbar abscess confirmed by computed tomography. Emergent abscess surgical drainage was performed and a gallstone was identified during saline lavage. Postoperative evolution was unremarkable and follow-up within a year was uneventful. Split gallstones due to gallbladder perforation during laparoscopic cholecystectomy should be retrieved in order to reduce future complications.

Development of new cold antibodies in a patient with a history of warm autoimmune haemolytic anaemia

2020 ◽  
Vol 13 (6) ◽  
pp. e232224 ◽  
Author(s):  
Meghan Anderson ◽  
Megan Winter ◽  
Vinicius Jorge ◽  
Claudia Dourado
Keyword(s):  
Chest Pain ◽  
Haemolytic Anaemia ◽  
Acute Treatment ◽  
Autoimmune Disorder ◽  
Shortness Of Breath ◽  
History Of ◽  
Mixed Pattern ◽  
Lost To Follow Up ◽  
Record Review

A 31-year-old male presented to our facility with complaints of shortness of breath and left-sided chest pain. On record review, it was revealed that he had been seen in 2014 for an almost identical presentation and had been found to have haemolytic anaemia with warm autoantibodies. Following his acute treatment during that hospital admission, he was lost to follow-up. During his subsequent admission, 5 years later, he was found to have a systemic autoimmune disorder with a superimposed acute bacterial infection leading to a second case of haemolytic anaemia and at this time with both cold and warm antibodies present. While his diagnosis was initially difficult to make due to both derangements in expected laboratory values and the mixed pattern of the haemolytic anaemia, he was promptly treated with intravenous immune globulin and steroids and was able to make a full recovery.

scholarly journals Virological and Clinical Outcome of DAA Containing Regimens in a Cohort of Patients in Calabria Region (Southern Italy)

Medicina ◽  
2020 ◽  
Vol 56 (3) ◽  
pp. 101
Author(s):  
Vincenzo Scaglione ◽  
Maria Mazzitelli ◽  
Chiara Costa ◽  
Vincenzo Pisani ◽  
Giuseppe Greco ◽  
...  
Keyword(s):  
Southern Italy ◽  
Liver Stiffness ◽  
Age Group ◽  
Intention To Treat ◽  
Liver Decompensation ◽  
End Of Treatment ◽  
History Of ◽  
Lost To Follow Up ◽  
Treat Analysis

Background and objectives: In Italy, Hepatitis C Virus (HCV) infections are most prevalent in people older than 50 years of age, who often experience multi-morbidities, take co-medications, and have a long history of liver disease. These characteristics could potentially affect tolerability of HCV treatments and adherence in this subgroup. After achievement of sustained virological response (SVR), retention into care is very important both to detect the onset of possible complications and prevent further infections. In this study, SVR rates and retention into care of patients treated with directly acting antivirals (DAAs) of a single-center cohort in Southern Italy were evaluated. Materials and Methods: Patients treated with directly acting antivirals from 2014 to 2018 were included. Patients were stratified by age (i.e., <65 vs. ≥65 years) and by cirrhosis presence (i.e., liver stiffness >14.6 KPa or clinical/ultrasound cirrhosis vs. absence of these criteria). Primary outcome was availability of SVR at Weeks 12–24 after the end of treatment. Inter- and intra-group comparisons were performed along the follow-up for significant laboratory parameters. Results: In total, 212 patients were treated; 184 (87%) obtained SVR after the first treatment course and 4 patients after retreatment. Twenty-two (10.4%) patients were lost to follow-up before assessment of SVR, and two patients died before the end of treatment for liver decompensation. Considering only the first treatment episode, per protocol analysis (i.e., excluding patients lost to follow-up) showed the following rates of SVR: 97% (overall), 97% (older age group), 96% (age group <65 years), 94% (cirrhotics), and 100% (non-cirrhotics). By contrast, at the intention to treat analysis (i.e., patients lost were computed as failures), SVR percentages were significantly lower for patients <65 years of age (80%) and for non-cirrhotics (85%). Conclusions: High rates of SVR were obtained. However, younger patients and those without cirrhosis displayed an apparent high risk of being lost to follow-up. This may have important implications: since those who are lost may transmit HCV in case SVR is not achieved, these subpopulations should receive appropriate counselling during treatment.

scholarly journals Incarcerated Lumbar Hernia Complicated by Retroperitoneal Pseudoaneurysm 50 Years after Resection and Radiation Therapy of a Sarcoma

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Oluwatobi Onafowokan ◽  
Dabanjan Bandyopadhyay ◽  
Dale Johnson ◽  
Hugo J. R. Bonatti
Keyword(s):  
Abdominal Pain ◽  
Small Bowel ◽  
Ct Scan ◽  
Late Complication ◽  
Abdominal Hernia ◽  
Emergency Laparotomy ◽  
Incisional Hernias ◽  
History Of ◽  
The Right

Background. Lumbar hernias are rare abdominal hernias. Surgery is the only treatment option but remains challenging. Posterior incisional hernias are even rarer especially with incarceration of intra-abdominal contents.Case Presentation. A 68-year old female presented with a 3-day history of worsening acute abdominal pain and distension, with multiple episodes of emesis. A CT scan indicated a large incarcerated posterolateral abdominal hernia. The patient had a history of resection of a sarcoma on her back as a child and also received chemotherapy and radiation. During emergency laparoscopy, a hemorrhagic small bowel segment incarcerated in the hernia was reduced and resected, and the distended small bowel was decompressed. An elective hernia repair was scheduled. After temporary clinical improvement, the patient again developed abdominal pain, distention, and emesis. During emergency laparotomy, a large hematoma in the right flank was found and partially evacuated. The right colon was mobilized out of the hernia and the duodenum was kocherized. A20×20cm BIO-A mesh was placed on top of the Gerota fascia and cranially tucked under liver segment VI. Anteriorly, the mesh was fixated with absorbable tacks. The duodenum and colon were placed into the mesh pocket. A postoperative CT scan identified a 2 cm pseudoaneurysm of a side branch of a lumbar artery, and the bleeding source was embolized. The postoperative course was complicated byClostridium difficile-associated colitis, but ultimately, the patient recovered fully. At 6-month follow-up, there was no evidence for a recurrent hernia.Discussion. There is a paucity of literature concerning lumbar incisional hernias. Repair with bioabsorbable mesh seems feasible, but longer follow-up is necessary as the mesh was placed in an unusual fashion due to the retroperitoneal hematoma. The exact cause of the hemorrhage is unclear and may have been caused during the initial incarceration, during surgery, or may be a late complication of her previous radiation.

scholarly journals Loss to Followup in HIV-Infected Patients from Asia-Pacific Region: Results from TAHOD

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Jialun Zhou ◽  
Junko Tanuma ◽  
Romanee Chaiwarith ◽  
Christopher K. C. Lee ◽  
Matthew G. Law ◽  
...  
Keyword(s):  
Viral Load ◽  
Drug Regimen ◽  
Clinic Visit ◽  
Asia Pacific ◽  
Pacific Region ◽  
Asia Pacific Region ◽  
Hiv Viral Load ◽  
History Of ◽  
Lost To Follow Up

This study examined characteristics of HIV-infected patients in the TREAT Asia HIV Observational Database who were lost to follow-up (LTFU) from treatment and care. Time from last clinic visit to 31 March 2009 was analysed to determine the interval that best classified LTFU. Patients defined as LTFU were then categorised into permanently LTFU (never returned) and temporary LTFU (re-entered later), and these groups compared. A total of 3626 patients were included (71% male). No clinic visits for 180 days was the best-performing LTFU definition (sensitivity 90.6%, specificity 92.3%). During 7697 person-years of follow-up, 1648 episodes of LFTU were recorded (21.4 per 100-person-years). Patients LFTU were younger (P=0.002), had HIV viral load ≥500 copies/mL or missing (P=0.021), had shorter history of HIV infection (P=0.048), and received no, single- or double-antiretroviral therapy, or a triple-drug regimen containing a protease inhibitor (P<0.001). 48% of patients LTFU never returned. These patients were more likely to have low or missing haemoglobin (P<0.001), missing recent HIV viral load (P<0.001), negative hepatitis C test (P=0.025), and previous temporary LTFU episodes (P<0.001). Our analyses suggest that patients not seen at a clinic for 180 days are at high risk of permanent LTFU, and should be aggressively traced.

scholarly journals Incidentally identified ductus arteriosus aneurysm in eight adults: a case series

2021 ◽  
pp. 20200097
Author(s):  
Mayo Yukimoto ◽  
Tomohisa Okuma ◽  
Etsuji Sohgawa ◽  
Mariko M Nakano ◽  
Taro Shimono ◽  
...  
Keyword(s):  
Ductus Arteriosus ◽  
Three Dimensional ◽  
Case Series ◽  
Risk Of Rupture ◽  
Radiographic Screening ◽  
Dimensional Reconstruction ◽  
History Of ◽  
Ductus Arteriosus Aneurysm ◽  
Lost To Follow Up

Ductus arteriosus aneurysm (DAA) in adulthood is a rare entity. We retrospectively reviewed our medical records from the past ten years and identified eight cases of adult DAA (six males and two females aged between 69 and 89 years; mean, 76 years), using multi planar reconstruction and three-dimensional reconstruction computed tomography (CT) images. The aneurysm was suspected incidentally in all cases based on the results of chest radiographic screening or postoperative follow-up CT for lung or colon cancer. All eight patients were asymptomatic but had a history of or concurrent hypertension (n = 5, 62.5%), diabetes mellitus (n = 3, 37.5%), cerebrovascular disease (n = 3, 37.5%), ischemic heart disease (n = 1, 12.5%), and cardiac failure (n = 1). All patients had no history of trauma (n = 8, 100%). Six had a history of cigarette smoking. The aneurysm size ranged from 2.0 × 4.0 to 6.3 × 5.3 cm (mean, 3 × 5 cm). The surgical procedures used were four cases of total arch replacement and two cases of thoracic endovascular aortic repair. Two patients were not surgically treated. The median follow-up was 14.5 months (range, 2 months to 9 years). In the two patients who were not surgically treated, the aneurysm enlarged in one, and remained unchanged in the other. Of the six cases surgically-managed cases, one was lost to follow-up, and another patient died of an unrelated cause. The remaining four cases had no enlargement of the aneurysm. No ruptures were reported in any of the cases. DAA should be considered when a saccular aneurysm is located in the minor curvature of the aortic arch and extending toward the left pulmonary trunk in adult patients. Differentiating adult DAA is important, because it is associated with a high risk of rupture due to the fragile nature of true aneurysms.

Primary reverse shoulder arthroplasty in patients older than 80 years of age

2019 ◽  
Vol 101-B (12) ◽  
pp. 1520-1525 ◽  
Author(s):  
Nicholas J. Clark ◽  
Brian T. Samuelsen ◽  
Eduard Alentorn-Geli ◽  
Andrew T. Assenmacher ◽  
Robert H. Cofield ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Shoulder Arthroplasty ◽  
Surgical Complications ◽  
Reverse Shoulder Arthroplasty ◽  
Medical Complications ◽  
Time To Death ◽  
One Year ◽  
And Function ◽  
Lost To Follow Up

Aims Reverse shoulder arthroplasty (RSA) reliably improves shoulder pain and function for a variety of indications. However, the safety and efficacy of RSA in elderly patients is largely unknown. The purpose of this study was to report the mortality, morbidity, complications, reoperations, and outcomes of primary RSA in patients aged > 80 years. Patients and Methods Between 2004 and 2013, 242 consecutive primary RSAs were performed in patients aged > 80 years (mean 83.3 years (sd 3.1)). Of these, 53 were lost to follow-up before two years and ten had died within two years of surgery, leaving 179 for analysis of survivorship, pain, motion, and strength at a minimum of two years or until revision surgery. All 242 patients were considered for the analysis of 90-day, one-year, and overall mortality, medical complications (90-day and overall), surgical complications, and reoperations. The indications for surgery included rotator cuff arthropathy, osteoarthritis, fracture, the sequela of trauma, avascular necrosis, and rheumatoid arthritis. A retrospective review of the medical records was performed to collect all variables. Survivorship free of revision surgery was calculated at two and five years. Results One patient (0.4%) died within the first 90 days. A total of 45 patients (19%) were known to have died at the time of the final follow-up, with a median time to death of 67.7 months (interquartile range 40.4 to 94.7) postoperatively. Medical complications occurred in six patients (3%) and surgical complications occurred in 21/179 patients (12%). Survivorship free from revision was 98.9% at two years and 98.3% at five years; survivorship free from loosening was 99.5% at final follow-up. The presence of peripheral vascular disease correlated with a higher complication rate. Conclusion Primary RSA was safe and effective in patients aged > 80 years, with a relatively low rate of medical and surgical complications. Thus, age alone should not be a contraindication to primary RSA in patients aged > 80 years. However, a careful evaluation of comorbidities is required in this age group when considering primary RSA. Cite this article: Bone Joint J 2019;101-B:1520–1525

Prevalence, characteristics and natural history of cold intolerance after the reverse digital artery flap

2015 ◽  
Vol 41 (2) ◽  
pp. 171-176 ◽  
Author(s):  
Y. C. Sun ◽  
Q. Z. Chen ◽  
J. Chen ◽  
Z. W. Qian ◽  
J. Kong ◽  
...  
Keyword(s):  
Natural History ◽  
Lower Incidence ◽  
Ring Finger ◽  
Digital Artery ◽  
Level Of Evidence ◽  
Cold Intolerance ◽  
Symptom Severity Score ◽  
History Of ◽  
Lost To Follow Up

This retrospective study was designed to investigate the prevalence, characteristics and natural history of cold intolerance after the use of the reverse digital artery flap. A total of 123 patients were treated between 2010 and 2013. After excluding patients who were lost to follow-up, 87 patients were studied. The mean follow-up time was 34 months (range 14–61). Cold intolerance occurred in 60% (52) of patients after the reverse digital artery flap procedure. The condition improved in only 15% (8) of the patients. Significant differences were observed in the age and the specific digit involved between the groups with and without cold intolerance. There was a lower incidence in younger patients, and the ring finger group showed a lower incidence than in other fingers. Furthermore, the Cold Intolerance Symptom Severity score was positively correlated with the temperature at which cold intolerance was triggered. Level of evidence: IV

Intraplacental Choriocarcinoma Associated with Viable Pregnancy: Pathologic Features and Implications for the Mother and Infant

1998 ◽  
Vol 1 (5) ◽  
pp. 380-387 ◽  
Author(s):  
Suzanne M. Jacques ◽  
Faisal Qureshi ◽  
Barbara J. Doss ◽  
Adnan Munkarah
Keyword(s):  
Blood Clot ◽  
Normal Pregnancy ◽  
Gestational Trophoblastic Disease ◽  
Small Lesion ◽  
Chorionic Villi ◽  
Pathologic Features ◽  
History Of ◽  
Clinicopathologic Findings ◽  
Lost To Follow Up

Choriocarcinoma arising in the placenta, or intraplacental choriocarcinoma, has seldom been reported, particularly in the absence of maternal metastases. Reluctance to diagnose choriocarcinoma in the presence of chorionic villi can delay diagnosis; however, timely diagnosis of choriocarcinoma is prognostically important, both for the mother and infant. We report the clinicopathologic findings in five mothers and infants in whom choriocarcinoma was identified in the placenta. None of the mothers had a history of gestational trophoblastic disease in previous pregnancies. Three placentas were similar with a single small lesion grossly suggesting a small infarct; microscopically these consisted of infarcted areas surrounded by choriocarcinoma. These three mothers were unusual in that none had metastatic choriocarcinoma; two were treated with chemotherapy and remained disease-free; the third was lost to follow-up shortly following delivery. The remaining two mothers had known pulmonary metastases at time of delivery. One of these latter two placentas contained a large marginal lesion microscopically identified as choriocarcinoma. The fifth placenta had rare microscopic foci of choriocarcinoma, and sheets of necrotic choriocarcinoma were identified in “blood clot” submitted with the placenta. In four of the five cases the choriocarcinoma appeared to be arising from otherwise normal chorionic villi, and in no case was there invasion of the villous stroma. All of the infants survived, and none had evidence of choriocarcinoma. These cases support the concept that choriocarcinoma associated with otherwise normal pregnancy arises in the placenta and may be more common than reported.

scholarly journals Severe Symptomatic Hypocalcemia from HIV Related Hypoparathyroidism

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Sartaj Sandhu ◽  
Akshata Desai ◽  
Manav Batra ◽  
Robin Girdhar ◽  
Kaushik Chatterjee ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Vital Signs ◽  
Neck Surgery ◽  
Normal Range ◽  
Calcium Sensing ◽  
Symptomatic Hypocalcemia ◽  
History Of ◽  
Inhaled Budesonide ◽  
Lost To Follow Up

We report the case of a 54-year-old Caucasian female who presented with a two-year history of persistent hypocalcemia requiring multiple hospitalizations. Her medical history was significant for HIV diagnosed four years ago. She denied any history of prior neck surgery or radiation. Her vital signs were stable with an unremarkable physical exam. Pertinent medications included calcium carbonate, vitamin D3, calcitriol, efavirenz, emtricitabine, tenofovir disoproxil, hydrochlorothiazide, and inhaled budesonide/formoterol. Laboratory testing showed total calcium of 5.7 mg/dL (normal range: 8.4-10.2 mg/dL), ionized calcium of 2.7 mg/dL (normal range: 4.5-5.5 mg/dL), serum phosphate of 6.3 mg/dL (normal range: 2.7-4.5 mg/dL), and intact PTH of 7.6 pg/mL (normal range: 15-65 pg/mL). She was diagnosed with primary hypoparathyroidism. Anti-calcium-sensing receptor antibodies and NALP5 antibodies were tested and found to be negative. During subsequent clinic visits, doses of calcium supplements and calcitriol were titrated. Last corrected serum calcium level was 9.18 mg/dL. She was subsequently lost to follow-up. This case gives insight into severe symptomatic hypocalcemia from primary hypoparathyroidism attributed to HIV infection. We suggest that calcium levels should be closely monitored in patients with HIV infection.

Sign in / Sign up

Export Citation Format

Share Document