1
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Felix M, Denis R, Chen C, Picaza A, Casadesus D. Myositis Ossificans Traumatica of Bilateral Sternocleidomastoid Muscles After Chiropractor Adjustment: A Case Report. Cureus 2024; 16:e56931. [PMID: 38665716 PMCID: PMC11043790 DOI: 10.7759/cureus.56931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
A woman in her 20s with a past medical history of surgical debulking of a right neck mass presented to the hospital for persistent and worsening right shoulder pain. The shoulder pain was associated with trismus and back and neck pain. A CT scan of the neck with contrast revealed post-surgical changes with increased heterotopic ossification throughout the surgical site extending to the supraclavicular soft tissues and the left sternocleidomastoid muscle, suggesting muscle ossification. A biopsy was performed, and the patient was diagnosed with myositis ossificans (MO). Initial treatment began with the administration of steroids and analgesics. She was scheduled for a follow-up with orthopedics, rheumatology, and genetics, but she was lost for follow-up. MO is a very rare medical condition usually associated with trauma, and in our patient, the symptoms started after a chiropractic adjustment.
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Affiliation(s)
- Martin Felix
- Internal Medicine, St. George's University School of Medicine, St. George, GRD
| | - Ryan Denis
- Internal Medicine, St. George's University School of Medicine, St. George, GRD
| | - Charles Chen
- Internal Medicine, Jackson Memorial Hospital, Miami, USA
| | - Ana Picaza
- Internal Medicine, Jackson Memorial Hospital, Miami, USA
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2
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Aldridge K, Guzman KE, Barry RW, Franklin Christian MA, Ruiz F, Fonarov I, Casadesus D. ECG Changes Post-pericardiocentesis for Cardiac Tamponade Secondary to Non-small Cell Carcinoma of the Lung. Cureus 2024; 16:e54677. [PMID: 38523986 PMCID: PMC10960619 DOI: 10.7759/cureus.54677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 03/26/2024] Open
Abstract
Electrical alternans on electrocardiograph (ECG) is an uncommon but nearly pathognomonic sign of cardiac tamponade. Here, we present a male quadragenarian who came to the emergency department complaining of low back and right upper abdominal pain. Work-up revealed a large pericardial effusion associated with electrical alternans on ECG and clinical findings of cardiac tamponade. Pericardiocentesis drained approximately 1 liter of hemorrhagic fluid with resolution of cardiac tamponade and normalization of the ECG. Further evaluation with right hilar lymph node biopsy confirmed a diagnosis of poorly differentiated non-small cell adenocarcinoma of the lung.
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Affiliation(s)
- Kyle Aldridge
- Medicine, St. George's University, True Blue, GRD
- Internal Medicine, Jackson Memorial Hospital, Miami, USA
| | - Kevin E Guzman
- Medicine, American University of the Caribbean, Cupecoy, SXM
- Internal Medicine, Jackson Memorial Hospital, Miami, USA
| | - Russell W Barry
- Medicine, St. George's University, True Blue, GRD
- Internal Medicine, Jackson Memorial Hospital, Miami, USA
| | | | - Felipe Ruiz
- Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, USA
| | - Ilya Fonarov
- Internal Medicine, Jackson Memorial Hospital, Miami, USA
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3
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Saunders Corea J, Schwartz KB, Fonarov I, Casadesus D. Acute Generalized Exanthematous Pustulosis in a Hemodialysis Patient. Cureus 2023; 15:e50354. [PMID: 38213362 PMCID: PMC10781596 DOI: 10.7759/cureus.50354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2023] [Indexed: 01/13/2024] Open
Abstract
Acute generalized exanthematous pustulosis (AGEP) is an uncommon skin condition that should be considered when evaluating patients with severe skin eruptions accompanied by systemic symptoms. We present a woman in her 70s with end-stage renal disease on hemodialysis who developed a generalized pruritic rash seven days after the administration of pre-procedure vancomycin and acetaminophen. Our patient underwent a biopsy with findings consistent with AGEP. This report highlights the need to consider AGEP in patients with severe cutaneous eruptions and systemic involvement. Prompt biopsy and blood cultures are essential to prevent misdiagnosis and treatment delays.
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Affiliation(s)
| | - Kaley B Schwartz
- Internal Medicine, St. George's University School of Medicine, True Blue, GRD
| | - Ilya Fonarov
- Primary Care, Orlando College of Osteopathic Medicine, Orlando, USA
- Hospital Medicine, Jackson Memorial Hospital, Miami, USA
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4
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Bury CS, Antwi SO, Fonarov I, Casadesus D. Acute Hemoptysis Caused by Eroding Spinal Fusion Hardware Into the Left Lower Lobe of the Lung. Cureus 2023; 15:e49918. [PMID: 38174174 PMCID: PMC10763981 DOI: 10.7759/cureus.49918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2023] [Indexed: 01/05/2024] Open
Abstract
Hemoptysis can occur in rare cases as a late complication of anterior approach spinal rod surgery in the spine. Our patient presented with hemoptysis. At age 14, he underwent an anterior approach spine surgery for scoliosis. He underwent bronchoscopy, and a round serrated metal object was visible in the left lower lobe. Multiple attempts were unsuccessful in retrieving the metal object. A review of the imaging did not show obvious penetration of the spinal instrumentation into the lung; however, the metallic object was believed to be a round serrated metal object from the fusion spinal hardware. Due to low lung function and the risk of injuring the surrounding tissue, the patient was not deemed a candidate for lobectomy or removal of the hardware. Instead, the patient underwent a left bronchial arterial embolization (BAE) procedure, which successfully stopped the hemoptysis.
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Affiliation(s)
- Christian S Bury
- Internal Medicine, Jackson Memorial Hospital, Miami, USA
- Internal Medicine, St. George's University School of Medicine, Great River, USA
| | - Salomey O Antwi
- Internal Medicine, Jackson Memorial Hospital, Miami, USA
- Internal Medicine, St. George's University School of Medicine, Great River, USA
| | - Ilya Fonarov
- Primary Care, Orlando College of Osteopathic Medicine, Orlando, USA
- Internal Medicine, Jackson Memorial Hospital, Miami, USA
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5
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Navarro Zellek M, Hernandez A, Fonarov I, Casadesus D. A giant mediastinal parathyroid adenoma presenting as a parathyroid crisis. BMJ Case Rep 2023; 16:e257187. [PMID: 38011946 PMCID: PMC10685913 DOI: 10.1136/bcr-2023-257187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Affiliation(s)
- Monica Navarro Zellek
- Hospital Medicine, Jackson Memorial Hospital, Miami, Florida, USA
- Department of Internal Medicine, St George's University, Great River, New York, USA
| | | | - Ilya Fonarov
- Hospital Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - Damian Casadesus
- Hospital Medicine, Jackson Memorial Hospital, Miami, Florida, USA
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6
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Aldridge K, Guzman KE, Machin Y, Fonarov I, Casadesus D. Atypical Dermal Findings in a Patient Following a Lightning Strike Injury. Cureus 2023; 15:e49096. [PMID: 38125222 PMCID: PMC10732266 DOI: 10.7759/cureus.49096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2023] [Indexed: 12/23/2023] Open
Abstract
Lightning is a common atmospheric occurrence. However, lightning strikes are not a frequent environmental cause of human injury. Survivors may present with Lichtenberg figures, a fern-like skin manifestation, and burns of varying severity. After a lightning strike, our patient demonstrated atypical cutaneous manifestations of large, ecchymotic discolorations on the medial upper extremities. After a comprehensive evaluation, the patient fully recovered and was discharged home without limitations. This case highlights lightning strike injury, including common findings, epidemiology, mechanisms, and prevention.
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Affiliation(s)
- Kyle Aldridge
- Medicine, St. George's University, True Blue, GRD
- Internal Medicine, Jackson Memorial Hospital, Miami, USA
| | - Kevin E Guzman
- Medicine, American University of the Caribbean, Cupecoy, SXM
- Internal Medicine, Jackson Memorial Hospital, Miami, USA
| | - Yarelis Machin
- Medicine, American University of the Caribbean, Cupecoy, SXM
- Internal Medicine, Jackson Memorial Hospital, Miami, USA
| | - Ilya Fonarov
- Internal Medicine, Jackson Memorial Hospital, Miami, USA
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7
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Ober C, Esmail R, Casadesus D. Glioblastoma Multiforme in a Patient With Alpha-1-Antitrypsin Deficiency. Cureus 2023; 15:e47371. [PMID: 38021884 PMCID: PMC10657158 DOI: 10.7759/cureus.47371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Alpha-1 antitrypsin (A1AT) is a common genetic disease caused by a mutation in the SERPINA1 gene, predisposing patients to severe premature lung and liver disease. Higher expression of SERPINA1 has been associated with a poor prognosis in patients with high-grade glioblastoma. We present a woman in her 70s with a history of A1AT deficiency treated with weekly plasma-purified A1AT infusions, who presented with metabolic encephalopathy. A CT scan of the brain obtained during admission revealed a left frontal lobe mass measuring 1.1 cm. A craniotomy and resection of the lesion were performed, and the pathology studies revealed a glioblastoma multiforme, WHO grade IV. She is currently healing and awaiting treatment with temozolomide with concomitant radiation and tolerating treatment well.
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Affiliation(s)
- Curtis Ober
- Internal Medicine, Jackson Memorial Hospital, Miami, USA
| | - Rojin Esmail
- Internal Medicine, Ross University School of Medicine, St. Michael, BRB
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8
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Echevarria V, Echevarria AC, Casadesus D. Cocaine-Induced Four-Extremity Ischemia Caused by a Hypercoagulable State. Cureus 2023; 15:e44862. [PMID: 37809197 PMCID: PMC10560104 DOI: 10.7759/cureus.44862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 10/10/2023] Open
Abstract
The use of cocaine is associated with serious complications including coronary vasospasm and myocardial, renal, intestinal, and neurological ischemia. Among these feared complications lies limb ischemia which is a rare potential side effect of chronic cocaine use. We present the case of a 50-year-old female with an extensive history of cocaine use who developed ischemia in all four limbs. Imaging studies revealed pulmonary emboli, multisystem thromboses, and microhemorrhages in the brain. Laboratory studies were significant for leukocytosis, thrombocytopenia, schistocytes on blood smear, and normal rheumatologic and hematologic studies. The patient was diagnosed with cocaine-induced thrombotic microangiopathy and she was treated symptomatically and with continuous heparin infusion. However, she ultimately requested to be discharged home and was lost to follow-up. Cocaine-induced thrombotic microangiopathy has been reported in only a few other patients to date and although there are some theories describing the possible pathophysiology, a clearly defined explanation has not yet been widely accepted.
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Affiliation(s)
| | - Alexandra C Echevarria
- Internal Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
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9
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Mesa E, Ruprecht V, Nguyen MC, Casadesus D. Vertigo: An Atypical Presentation of Neurocysticercosis Successfully Treated With Albendazole. Cureus 2023; 15:e45722. [PMID: 37868522 PMCID: PMC10590210 DOI: 10.7759/cureus.45722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
A 20-year-old male presented to our facility with a worsening sensation of "the room spinning around" himself for the past three weeks. In the last week, he began to experience daily spells lasting for three hours each without losing consciousness. The patient had recently migrated from Central America six weeks prior to admission. On physical examination, his vital signs were within normal limits, with no focal neurological deficits. Magnetic resonance imaging (MRI) of the brain revealed a cystic-appearing lesion in the fourth ventricle with associated mass effect on the posterior aspect of the brainstem and mild periventricular edema. Laboratory studies were unremarkable except for a positive anti-cysticercus IgG antibody, which confirmed the diagnosis of neurocysticercosis. Initially, surgery was considered, but the neurosurgeons advised medical management due to the small size of the lesion. The patient was started on albendazole 400 mg orally twice daily and dexamethasone 6 mg orally daily for 14 days. The patient responded well; his symptoms resolved by the eighth day. He was discharged home to complete his treatment and remained asymptomatic at the follow-up appointment two weeks later.
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Affiliation(s)
- Elvis Mesa
- Internal Medicine, St. George's University School of Medicine, St. George's, GRD
- Internal Medicine, Jackson Memorial Hospital, Miami, USA
| | - Victoria Ruprecht
- Internal Medicine, Ross University School of Medicine, Bridgetown, BRB
| | - My Chau Nguyen
- Internal Medicine, American University of the Caribbean School of Medicine, Cupecoy, SXM
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10
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Marquez-Gil KY, Mesa E, Kouka N, Fonarov I, Casadesus D. Medicinal Leeches to Aid in Post-procedural Hematoma Evacuation. Cureus 2023; 15:e43338. [PMID: 37700963 PMCID: PMC10494989 DOI: 10.7759/cureus.43338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2023] [Indexed: 09/14/2023] Open
Abstract
Patients presenting with a post-invasive procedure hematoma can be treated with medicinal leeches to evacuate the hematoma. Our patient, a postmenopausal woman in her 60s, with a past medical history of hypothyroidism, presented to the outpatient clinic with pain, redness, warmth, and swelling on her right thigh. Ten days prior, the patient had undergone a subcutaneous pellet implant procedure in the right thigh for hormonal replacement therapy. The patient developed post-procedure cellulitis and soft tissue infection and was treated with antibiotics. The patient developed a progressively enlarged hematoma at the implant site. The hematoma was treated with medicinal leeches. Two weeks after treatment, the implant area healed. The patient had a family history of von Willebrand disease and a history of prolonged bleeding during childbirth, menstruation, and dental procedures. A von Willebrand panel was obtained, and the results were consistent with a new diagnosis of von Willebrand disease.
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Affiliation(s)
- Karolina Y Marquez-Gil
- Medicine, St. George's University School of Medicine, New York, USA
- Medicine, Jackson Memorial Hospital, Miami, USA
| | - Elvis Mesa
- Medicine, St. George's University School of Medicine, New York, USA
- Medicine, Jackson Memorial Hospital, Miami, USA
| | - Nabeel Kouka
- Neuromusculoskeletal Medicine, Salus Neuromuscular Institute, Hallandale Beach, USA
| | - Ilya Fonarov
- Hospital Medicine, Jackson Memorial Hospital, Miami, USA
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11
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Mesa E, Miles D, Araguez-Ancares N, Casadesus D. Hemolysis, Elevated Liver Enzymes and Low Platelets (HELLP) Syndrome and Metastatic Breast Cancer: A Rare Overlap in a Postpartum Patient With Disseminated Intravascular Coagulation and Refractory Thrombocytopenia. Cureus 2023; 15:e42225. [PMID: 37605670 PMCID: PMC10439979 DOI: 10.7759/cureus.42225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 08/23/2023] Open
Abstract
A middle-aged female arrived at a tertiary care hospital after a referral from her primary care physician to evaluate a left breast mass found on ultrasound concerning malignancy. The patient was also 27 weeks gestational with monochorionic diamniotic twins. During triage, she was found to have severe hypertension and lab abnormalities concerning HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome and underwent cesarean delivery of the infants. She had a biopsy of the left breast mass post-delivery, later diagnosed as invasive ductal cell carcinoma with spinal metastasis and numerous metastatic pulmonary nodules. Her hospital stay was complicated by a right lower extremity deep vein thrombosis, acute subdural hematoma, and disseminated intravascular coagulation with refractory thrombocytopenia resulting in her death.
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Affiliation(s)
- Elvis Mesa
- Internal Medicine, St. George's University School of Medicine, St. George's, USA
- Internal Medicine, Jackson Memorial Hospital, Miami, USA
| | - Dylan Miles
- Internal Medicine, St. George's University School of Medicine, St. George's, GRD
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12
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Bevilacqua A, Obua A, Fonarov I, Casadesus D. Acute episode of erythrodermic psoriasis following self-administration of expired insulin glargine. BMJ Case Rep 2023; 16:e255472. [PMID: 37336622 DOI: 10.1136/bcr-2023-255472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Affiliation(s)
| | - Andre Obua
- Pathology and Laboratory Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - Ilya Fonarov
- Hospital Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - Damian Casadesus
- Hospital Medicine, Jackson Memorial Hospital, Miami, Florida, USA
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13
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Jarrett O, Heydari H, Elder Z, Casadesus D. Penile calciphylaxis in a patient with concurrent haemodialysis and Coumadin treatment. BMJ Case Rep 2023; 16:16/5/e254925. [PMID: 37130645 PMCID: PMC10163535 DOI: 10.1136/bcr-2023-254925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
A man in his 30s, with a medical history of end-stage renal disease on haemodialysis three times a week after kidney transplant rejection, anaemia of inflammatory disease, hypertension, atrial fibrillation, hyperlipidaemia, subtotal parathyroidectomy and aortic valve replacement on Coumadin treatment, presented to our institution with glans penis pain. Examination of the penis revealed a painful black eschar with ulceration on the glans penis with surrounding erythema. CT scan of the abdomen and pelvis and penile Doppler ultrasound revealed calcifications of the abdominal, pelvic and penile blood vessels. He was diagnosed with penile calciphylaxis, a very rare manifestation of calciphylaxis characterised by penile blood vessel calcification leading to occlusion, ischaemia and necrosis. Treatment with low calcium dialysate and sodium thiosulfate was initiated with haemodialysis. Five days after the treatment started, the patient's symptoms improved.
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Affiliation(s)
- Omar Jarrett
- Hospital Medicine, Jackson Memorial Hospital, Miami, Florida, USA
- Internal Medicine, St George's University, Great River, New York, USA
| | - Hamed Heydari
- Hospital Medicine, Jackson Memorial Hospital, Miami, Florida, USA
- Internal Medicine, American University of the Caribbean School of Medicine BV, Plantation, Florida, USA
| | - Zachary Elder
- Hospital Medicine, Jackson Memorial Hospital, Miami, Florida, USA
- Internal Medicine, American University of the Caribbean School of Medicine BV, Plantation, Florida, USA
| | - Damian Casadesus
- Hospital Medicine, Jackson Memorial Hospital, Miami, Florida, USA
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14
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Sattar S, Naimzadeh D, Behaeddin BC, Fonarov I, Casadesus D. Uterine Artery Embolization in a Patient With Large Uterine Fibroids. Cureus 2023; 15:e39740. [PMID: 37398722 PMCID: PMC10310461 DOI: 10.7759/cureus.39740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
A woman in her 20s with no past medical history presented to the emergency department with a 4-day history of abdominal pain. Imaging revealed several large uterine fibroids that compressed various intra-abdominal structures. Options of observation, medical management, surgical management with abdominal myomectomy, and uterine artery embolization (UAE) were discussed. The patient was counseled about the associated risks of UAE and myomectomy. Since both procedures have a risk of infertility, the patient elected to proceed with uterine artery embolization due to the less invasive nature of the procedure. She was discharged after one day in the hospital following the procedure and readmitted three days later for suspected endometritis. The patient was treated with antibiotics for five days and discharged home. Eleven months post-procedure, the patient became pregnant. The patient had achieved a full-term delivery at 39 weeks and two days via a cesarean section secondary to a breech presentation.
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Affiliation(s)
- Safura Sattar
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - David Naimzadeh
- Internal Medicine, Henry Ford Health System, Clinton Township, USA
| | - Bita C Behaeddin
- Medicine, St. George's University School of Medicine, Great River, USA
- Internal Medicine, Jackson Memorial Hospital, Miami, USA
| | - Ilya Fonarov
- Internal Medicine, Jackson Memorial Hospital, Miami, USA
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15
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Ortiz C, Wexler R, Drews-Elger K, Fonarov I, Casadesus D. Primary Ovarian Mucinous Adenocarcinoma, Expansile Type, Misperceived As Pregnancy by the Patient. Cureus 2023; 15:e39077. [PMID: 37378092 PMCID: PMC10292007 DOI: 10.7759/cureus.39077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 06/29/2023] Open
Abstract
We present the case of a woman in her 20s with an eight-month history of increasing abdominal distention, dyspnea, and night sweats. The patient believed she was pregnant despite being told at another hospital that the pregnancy tests were negative, and no fetus was seen on an abdominal ultrasound. The patient delayed obtaining follow-up because of a distrust of the healthcare system and presented to our hospital at the behest of her mother. On physical examination, the abdomen was distended with a positive fluid wave, and a large mass was palpated in the abdomen. Gynecological examination was limited because of severe abdominal distension but a mass was palpable in the right adnexa. A pregnancy test and fetal ultrasound were performed, and the patient was not pregnant. A CT scan of the abdomen and pelvis revealed a large mass arising from the right adnexa. She underwent right salpingo-oophorectomy, appendectomy, omentectomy, lymph node dissection, and peritoneal implant resection. The biopsy confirmed intestinal-type IIB primary ovarian mucinous adenocarcinoma, expansile type, with peritoneal spread. Chemotherapy was provided for three cycles. A follow-up CT scan of the abdomen showed no evidence of a tumor six months after surgery.
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Affiliation(s)
| | - Rachel Wexler
- Hospital Medicine, Jackson Memorial Hospital, Miami, USA
| | | | - Ilya Fonarov
- Hospital Medicine, Jackson Memorial Hospital, Miami, USA
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16
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Loubser J, Pinto Bronislawski L, Fonarov I, Casadesus D. Sine-wave electrocardiogram rhythm in a patient on haemodialysis presenting with severe weakness and hyperkalaemia. BMJ Case Rep 2023; 16:16/3/e255007. [PMID: 36898713 PMCID: PMC10008419 DOI: 10.1136/bcr-2023-255007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Affiliation(s)
- James Loubser
- Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA.,Internal Medicine, St George's University, Great River, New York, USA
| | - Luana Pinto Bronislawski
- Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA.,Internal Medicine, St George's University, Great River, New York, USA
| | - Ilya Fonarov
- Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - Damian Casadesus
- Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA
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17
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Esmail R, Ober C, Dunn C, Casadesus D. A Fatal Case of Staphylococcus capitis Endocarditis in a Patient With Transcatheter Aortic Valve Replacement. Cureus 2023; 15:e35333. [PMID: 36994272 PMCID: PMC10042522 DOI: 10.7759/cureus.35333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 02/25/2023] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has evolved to become a standard management modality for high-risk, moderate, and even low-risk patients with symptomatic aortic stenosis. Infective endocarditis (IE) after a TAVR is rare and difficult to diagnose. Typical sonographic characteristics observed with an echocardiogram in native valve endocarditis may not be present in TAVR-IE cases. Enterococcal species are identified to be the most frequent causative agents. Coagulase-negative staphylococci (CoNS) can infrequently lead to a fatal course of endocarditis in the TAVR population. There are only seven previously reported cases of Staphylococcus capitis (S. capitis) prosthetic valve endocarditis noted in the literature. Here we present a man in his 60s who presented to our facility for evaluation of fever and shortness of breath. He was subsequently diagnosed with S. capitis TAVR-IE. He was not considered a surgical candidate and was treated medically for IE with a fatal outcome.
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18
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Barcena HA, Behaeddin BC, Abdi Z, Casadesus D. Wernicke's encephalopathy in a patient with hyperemesis gravidarum, hepatitis A and pancreatitis. BMJ Case Rep 2022; 15:15/12/e253982. [PMID: 36526285 PMCID: PMC9764603 DOI: 10.1136/bcr-2022-253982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Hunter A Barcena
- Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA.,Internal Medicine, St George's University, Great River, New York, USA
| | - Bita C Behaeddin
- Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA.,Internal Medicine, St George's University, Great River, New York, USA
| | - Zakaria Abdi
- Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA.,Internal Medicine, St George's University, Great River, New York, USA
| | - Damian Casadesus
- Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA
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Carnio LR, Johnson Shaw ME, Schnur J, Casadesus D. Republished: Concurrent terbinafine-induced acute generalised exanthematous pustulosis and hepatitis. Drug Ther Bull 2021; 60:78-79. [PMID: 34887312 DOI: 10.1136/dtb.2021.238930rep] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | | | - Jack Schnur
- Jackson Memorial Hospital, Miami, Florida, USA
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Schnur J, Hawco C, Fonarov I, Casadesus D. Rare cutaneous manifestation of Trichosporon asahii. BMJ Case Rep 2021; 14:14/6/e243659. [PMID: 34140332 DOI: 10.1136/bcr-2021-243659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Jack Schnur
- Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - Colton Hawco
- Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - Ilya Fonarov
- Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - Damian Casadesus
- Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA
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Yoham AL, Sinawe H, Schnur J, Casadesus D. Aggressive progression of a facial super giant basal cell carcinoma. BMJ Case Rep 2021; 14:14/4/e240617. [PMID: 33858891 PMCID: PMC8054050 DOI: 10.1136/bcr-2020-240617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Super giant basal cell carcinoma (BCC) is a rare oncological entity. A 52-year-old man with a history of a left upper facial lesion for 11 years was transferred to our facility seeking an evaluation. He frequented multiple hospitals where he was treated with antibiotics for this condition. He reported having the Mohs procedure 8 months prior to this hospital visit but he did not follow-up with the other institution. The physical examination revealed an ulcer involving the upper left orbito-fronto-parieto-temporal area with bone exposure. Both CT and MRI of the face and the brain demonstrated dehiscence of the left lateral orbital roof and left frontal bone. The biopsy confirmed advanced BCC. He was discharged against medical advice and lost to follow-up. He returned 1 month later with left eye discharge and vision loss. He was diagnosed with cerebral abscess, treated with antibiotics and discharged to hospice.
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Affiliation(s)
| | - Hadeer Sinawe
- Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - Jack Schnur
- Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - Damian Casadesus
- Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA
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Schnur J, Sinawe H, Yoham AL, Casadesus D. Vascular calcifications and calciphylaxis in a patient on concurrent haemodialysis and Coumadin therapy. BMJ Case Rep 2021; 14:14/3/e240310. [PMID: 33762282 PMCID: PMC7993223 DOI: 10.1136/bcr-2020-240310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Calciphylaxis is a rare life-threatening condition, with calcification of small and medium-sized vessels leading to skin necrosis. It has a high morbidity and mortality, and most of the patients die from wound superinfection and sepsis. A 48-year-old man with a history of end-stage renal disease on haemodialysis and Coumadin therapy for venous thromboembolism presented with pulmonary oedema after missing two haemodialysis treatment. At examination, he had bilateral lower extremity dark brown, possibly necrotic, painful ulcers. He was diagnosed with calciphylaxis and treated with sevelamer hydrochloride, low calcium dialysate and sodium thiosulfate with haemodialysis. He received daily wound care with topical collagenase. After daily wound care treatment for 4 months, the patient's ulcers completely healed. The patient had been followed for 8 months, which included 29 additional readmissions, 3 admissions related to bacteraemia and 26 admissions with the diagnosis of pulmonary oedema and hyperkalaemia requiring haemodialysis.
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Affiliation(s)
- Jack Schnur
- Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - Hadeer Sinawe
- Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | | | - Damian Casadesus
- Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA
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Affiliation(s)
- Jack Schnur
- Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - Hadeer Sinawe
- Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | | | - Damian Casadesus
- Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA
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Carnio LR, Johnson Shaw ME, Schnur J, Casadesus D. Concurrent terbinafine-induced acute generalised exanthematous pustulosis and hepatitis. BMJ Case Rep 2021; 14:14/1/e238930. [PMID: 33462036 PMCID: PMC7813382 DOI: 10.1136/bcr-2020-238930] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Terbinafine is a commonly used antifungal medication. Its side effects, while widely known, are rarely described and can be missed by the medical community. We present a 55-year-old woman who visited her primary care physician with onychomycosis. She started treatment with terbinafine, and 1 week later developed a rash in the left flank that extended to the chest, back, and upper part of lower extremities. Laboratory results showed elevated liver enzymes. A treatment with steroids did not improve the rash and she was admitted to our institution. She was started with intravenous dexamethasone, topical hydrocortisone and triamcinolone. Seven days later the liver enzymes normalised, and the rash resolved on the chest and back. Our patient had concurrent acute generalised exanthematous pustulosis and hepatitis that together has been very rarely associated with terbinafine.
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Affiliation(s)
| | | | - Jack Schnur
- Jackson Memorial Hospital, Miami, Florida, USA
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Abstract
Squamous cell carcinoma (SCC) of the lip typically has a good prognosis when diagnosed at an early stage and treated properly. We present a 65-year-old man with a 3-month history of an ulcerative lesion of the lower lip. On physical examination, he had an ulceration of approximately 5×5 cm in the mucosa of the lower lip, extending through 50% of the lip, and multiple mandibular and neck lymph nodes. The biopsy confirmed SCC of the lip. Surgical treatment was recommended, but the patient was lost to follow-up. The patient eventually returned to the hospital for medical treatment. However, the physical examination, and the images obtained showed progression of the disease. Chemotherapy was started with improvement in the primary site, but he then developed a large submental mass compatible with SCC. The tumour was considered incurable at that time. Palliative radiation therapy was offered; however, he refused any further procedures or treatment.
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Affiliation(s)
- Jack Schnur
- Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | | | - Lorenzo R Carnio
- Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA
| | - Damian Casadesus
- Internal Medicine, Jackson Memorial Hospital, Miami, Florida, USA
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Shillingford K, Melendez F, Villania C, Zeleznak W, Gerasim S, Casadesus D. The Rare Etiologies of Altered Mental Status That Make Thorough Investigations Paramount. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Casadesus D, Araguez-Ancares N, Cotorruelo-Martinez A, Gerasim S. Macroglosia: amyloidosis misdiagnosed as angio-oedema. BMJ Case Rep 2015; 2015:bcr-2015-210656. [PMID: 26404547 DOI: 10.1136/bcr-2015-210656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Abstract
Transanal excision (TE), endoscopic transanal resection (ETAR) and transanal endoscopic microsurgery (TEM) can be used to remove adenomatous polyps. However, their use is limited by the size or location of the tumor. TE is limited to the lower rectum, TEM offers better access to lesions in the middle and upper rectum, and ETAR is used less frequently than it deserves for resection of rectal lesions.
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Abstract
BACKGROUND Benign anal stenosis is an uncommon, disabling and incapacitating disease, occurring mainly after anorectal surgery. Both non-surgical and surgical treatments have been devised in the treatment of anal stenosis with good results. We described the results of the treatment of this disease in the Coloproctology Department of our institution. METHODS A retrospective clinical study was undertaken over a 5-year period for consecutive patients operated on for anal stenosis. RESULTS Twenty-three patients with benign anal stenosis were treated in our department. Haemorrhoidectomy was the most common cause of anal stenosis (74%). Nineteen patients with moderate to severe symptoms of anal stenosis underwent surgical treatment. Lateral mucosal advancement flap was the most frequently carried out operation (63.1%). Four patients were treated with anal dilatation (17.3%). All patients had remission of the preoperative symptoms. There was no re-operation and only minor complications were present in four patients: three patients with anal pruritus and one patient with temporary incontinence. CONCLUSION The easy performance, the absence of major complications and the good results obtained confirm that these methods are effective and safe in the treatment of anal stenosis.
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Affiliation(s)
- Damian Casadesus
- Department of Coloproctology, Calixto Garcia University Hospital, J and University, Plaza, Havana, Cuba.
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Casadesus D, Tani T, Wakai T, Maruyama S, Iiai T, Okamoto H, Hatakeyama K. Possible role of human cytomegalovirus in pouchitis after proctocolectomy with ileal pouch-anal anastomosis in patients with ulcerative colitis. World J Gastroenterol 2007; 13:1085-9. [PMID: 17373744 PMCID: PMC4146872 DOI: 10.3748/wjg.v13.i7.1085] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To detect the presence of human cytomegalovirus (HCMV) proteins and genes on the ileal pouch of patients with ulcerative colitis who have undergone proctocolectomy with ileal pouch-anal anastomosis (IPAA).
METHODS: Immunohistochemistry, polymerase chain reaction (PCR) and PCR sequencing methods were utilized to test the presence of HCMV in pouch specimens taken from 34 patients in 86 endoscopies.
RESULTS: HCMV genes and proteins were detected in samples from 12 (35.2%) patients. The rate of detection was significant in the endoscopies from patients diagnosed with pouchitis (5 of 12, 41.6%), according to the Japanese classification of pouchitis, in comparison to patients with normal pouch (7 of 62, 11.2%; P = 0.021). In all patients with pouchitis in which the HCMV was detected, it was the first episode of pouchitis. The virus was not detected in previous biopsies taken in normal endoscopies of these patients. During the follow-up, HCMV was detected in one patient with recurrent pouchitis and in 3 patients whose pouchitis episodes improved but whose positive endoscopic findings persisted.
CONCLUSION: HCMV can take part in the inflammatory process of the pouch in some patients with ulcerative colitis who have undergone proctocolectomy with IPAA.
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Affiliation(s)
- Damian Casadesus
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata City 951-8510, Japan
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Affiliation(s)
- D Casadesus
- Coloproctology Department, Calixto Garcia University Hospital, Cerro, Havana, Cuba.
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Abstract
This paper presents a chart review of 17 patients who had been treated for rectovaginal fistula (RVF) from 1996 to 2000. In most cases (13; 76.5%), the fistula was the result of post-surgical complications. Following vaginal mucosa advancement flap repair or repair after conversion to a fourth-degree perineal laceration, 16 (94%) of the rectovaginal fistulae (during the first attempted repair or after failed treatment) were successfully treated. In all patients but one, faecal diversion was avoided. In two patients, fistulography was both a diagnostic procedure and the method of treatment.
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Affiliation(s)
- Damian Casadesus
- Coloproctology Department, Calixto Garcia University Hospital, J y Universidad, Vedado, Havana, Cuba.
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