Prevalence of Tinnitus in Patients Diagnosed with Cerebral Arteriovenous Fistula Treated with Endovascular Technique

Introduction Tinnitus is characterized as the conscious and involuntary perception of sound, and it affects ∼ 30% of the population. Despite careful physical examination, the etiology of tinnitus can be established for only 30% of patients. Tinnitus is a common symptom of cerebral arteriovenous fistulas and results from increased blood flow through the dural venous sinuses, leading to turbulent arterial flow, mainly related to sigmoid and transverse sinus lesions. Objectives To analyze the frequency of tinnitus, patient profile, and endovascular treatment characteristics in individuals diagnosed with cerebral arteriovenous fistulas. Methods A retrospective and observational study based on reviewed data from medical records on the PHILIPS Tasy system (Philips Healthcare, Cambridge, MA, USA) at the neurosurgery and interventional neuroradiology service of Hospital Santa Isabel in Blumenau–state of Santa Catarina, Brazil. Results The profile of 68 individuals diagnosed with cerebral arteriovenous fistula who underwent endovascular treatment were analyzed. Most patients were female, aged 31 to 60. Tinnitus affected 18 individuals. Dural fistulas were the most prevalent in the sample, and computed tomography alone was the most used diagnostic method for initial investigation. Conclusion The prevalence of this symptom in patients diagnosed with cerebral arteriovenous fistula was found in 26.5% of this sample, mainly in women with associated comorbidities. Tinnitus remission was observed in all patients who underwent endovascular treatment to correct cerebral fistula.

Peripheral Nerve Sheath Tumors

Nerve sheath tumors involve the connective tissue surrounding a peripheral nerve. They may be found incidentally or may be symptomatic. In most cases, nerve sheath tumors are benign. A detailed personal and family history and careful physical examination should be performed to assess for association with neurofibromatosis 1 or 2 or schwannomatosis. This chapter reviews the genetics, clinical features, diagnosis, and management of the common types of peripheral nerve sheath tumors.

A cross preseptal and postseptal gonococcal orbital cellulitis in a 3-year-old male

Gonococcal orbital cellulitis is an infrequent presentation within the pediatric age group, with very few cases reported in literature. Even rarer, is the nonvenereal transmission via fomites. Careful physical examination with detailed social evaluation must always be obtained in any child with a gonococcal infection to look for signs or evidence of sexual abuse. This paper reports a 3-year-old male who developed a left preseptal and postseptal gonococcal orbital cellulitis via a nonsexual mode of transmission.

Fingertip pulse oximetry prevented premature declaration of death

ObjectiveWe describe a case of persisting readings from a fingertip pulse oximeter (FPO) in an elderly cachectic woman with pancreatic cancer, who fulfilled all classical criteria of death.MethodsIt is an instructive example of a home hospice patient who died during the physician’s intervention. Although all classical signs of death had been confirmed several times, a portable FPO continued to indicate satisfactory saturation and pulse readings for the following 30 min.ResultsOur case report confirms that the classical criteria of death might sometimes be faulty. The application of a portable FPO prevented a premature declaration of death.ConclusionIn exceptional cases, even the most careful physical examination may erroneously indicate that a person is dead. A residual cardiac output and gas exchange may be preserved and revealed by FPO readings. In doubtful situations, FPO can provide additional information and prevent a premature declaration of death.

Total Joint Arthroplasty during Coronavirus Disease-2019 COVID-19 Pandemic

Background: Since the outbreak of the novel coronavirus disease-2019 (COVID-19) pandemics many orthopedic elective surgeries have been postponed all over the world. There are several guidelines for resuming elective surgeries during this crisis. In our center (Imam Khomeini hospital, Tehran, Iran), we resumed total joint arthroplasty (TJAs) surgeries using preoperative history taking and physical examination. Here, we report our experience. Methods: From February 2020 to August 2020, we included 165 patients who underwent TJA [70 total hip arthroplasty (THA) and 95 total knee arthroplasty (TKA)] in Imam Khomeini hospital, a referral center for COVID-19. We followed each patient from the day of hospitalization to two weeks after discharge by telephone for clinical symptoms of COVID-19. Results: Only one patient became infected with COVID-19 a week after discharge from the hospital, and other patients did not show any sign or symptoms within two weeks after the discharge. Conclusion: We recommend resuming the elective surgeries using a careful physical examination and medical history for all patients, and in suspicious cases, referring to a specialized COVID-19 clinic for further investigation.

Clinical characteristics and treatment of mixed-pesticide poisoning in a patient: reflections on a particular case

Patients who commit suicide often deliberately hide their medical history. Given that taking pesticides is one of the most common methods of suicide, other forms of poisoning may be neglected in clinical practice. We report here a case of mixed-pesticide poisoning. The patient was poisoned by oral administration of a coumarin rodenticide in combination with an intramuscular injection of organophosphorus (OP) pesticide. The patient was treated with vitamin K1, cholinesterase reactivators, atropine, ventilator-assisted ventilation, and bedside debridement. Her condition gradually stabilized and she eventually recovered and was discharged. Assessment of the causes of delayed diagnosis and treatment suggests that we need to improve early detection and treatment of acute poisoning. It is especially important to ask about the patient’s medical history, conduct a careful physical examination, and track the clinical symptoms and differential diagnosis of common poisoning. In addition to the three common routes of poisoning—oral, inhalation, and cutaneous mucosal contact—intramuscular injection of OP can also lead to severe poisoning, which manifests as respiratory failure.

Reinforced conservative management of post-dural puncture headache in a patient with a rare case of tethered cord syndrome using an abdominal binder: a case report

Careful physical examination of the site of procedure before the caudal pain procedure should be performed because it could show the patient’s abnormal anatomical conditions. An abdominal binder could be used effectively in a patient showing CSF leakage in the coccygeal area, which is not controlled by conventional compressive dressing.

Chest Wall Pain after Minor Trauma

Case Presentation: A 30-year-old healthy male presented with a complaint of chest pain after mild thoracic trauma sustained while rescuing stranded flood victims during Hurricane Harvey. Careful physical examination revealed a tender palpable cord along the lateral aspect of his chest consistent with a superficial thrombophlebitis. Discussion: Mondor’s disease is a superficial thrombophlebitis with myriad underlying causes that can involve the thoracic wall. Although Mondor’s disease has been well described in the literature, this case describes a unique presentation in an austere environment with blunt trauma as the underlying cause.

Scapholunate Dissociation: Current Concepts of the Treatments

Scapholunate dissociation is the most common cause of the wrist pain and instability and typically results from scapholunate interosseous ligament (SLIL) injury. It is difficult for surgeons to diagnose the SLIL injury due to its complex anatomy and biomechanics. The natural history of the SLIL injury is still not fully understood as most of the SLIL injuries are not detected in their acute stage. Careful physical examination and radiologic evaluation are essential aspects of SLIL injury diagnosis. We should consider five conditions to evaluate SLIL injuries: the integrity of the dorsal SLIL, the healing potential of the disrupted ligament, the alignment of the scaphoid, the reducibility of the carpal malalignment, and the cartilage condition. In this review, the stages classified based on these conditions and the current treatments according to each stage will be described in detail.