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Regmi A, Singh V, Bandhu Niraula B, Gowda AKS, Bansal S, Gowda R, Sharma C, Barman S. Outcome of early versus delayed presentation of proximal femur fractures in children: A prospective cohort study. Orthop Traumatol Surg Res 2024:103840. [PMID: 38360173 DOI: 10.1016/j.otsr.2024.103840] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/02/2024] [Accepted: 02/09/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVE We hypothesized that the exact time of fixation of paediatric proximal femur fractures will have an effect on the ultimate clinical and radiological outcome. This article aimed to compare the clinical-radiological outcomes in paediatric proximal femur fractures having early and delayed presentation. METHODOLOGY A prospective cohort study was conducted from January 2019 to November 2022 in patients of age of 5 to 16 years presented with proximal femur fracture and divided into two groups: group A: early presentation, presented <48hours of injury; group B: delayed presentation, presented >48hours of injury. Patients underwent internal fixation treatment modality and followed up to assess clinical outcomes and radiological outcomes, and final outcome was assessed as per Ratliff's criteria. RESULTS In the study of 44 patients, 72.72% were male, and 27.27% were female, with male-to-female ratio to be 2.6:1. The commonest mode of injury was fall from height accounting for 52.27% followed by road traffic accidents (RTA) in 38.63%. The most common fracture type observed was Delbet type II, which was observed in 43.18%. There was significant shorter duration of surgery in group A (p-value=0.013), VAS score (p=0.045), and limb length discrepancy (p=0.022). Also, there was a statistical difference in AVN (p-value=0.0295) and growth disturbance (p-value=0.0394) between two groups. Also, there was statistically significant difference between Ratliff's criteria two groups (p-value=0.030). CONCLUSION Early presentation has shorter duration of surgery, less VAS score at final follow-up, and less limb length discrepancy, less development of complications like avascular necrosis of the femoral head, and growth disturbance. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Anil Regmi
- Department of Orthopaedics, AIIMS, Rishikesh, Uttarakhand, 249203, India
| | - Vivek Singh
- Department of Orthopaedics, AIIMS, Rishikesh, Uttarakhand, 249203, India.
| | | | - Aditya K S Gowda
- Department of Orthopaedics, AIIMS, Rishikesh, Uttarakhand, 249203, India
| | - Shivam Bansal
- Department of Orthopaedics, AIIMS, Rishikesh, Uttarakhand, 249203, India
| | - Rohan Gowda
- Department of Orthopaedics, AIIMS, Rishikesh, Uttarakhand, 249203, India
| | - Cury Sharma
- Department of Orthopaedics, AIIMS, Rishikesh, Uttarakhand, 249203, India
| | - Saptarshi Barman
- Department of Orthopaedics, AIIMS, Rishikesh, Uttarakhand, 249203, India
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Rong C, Zhang Q, Zhu S, Zhang G, Zeng J, Han Q, Guo Y. 3D printed guide-assisted percutaneous screw fixation for minimally displaced scaphoid waist fractures with delayed diagnosis or presentation. BMC Musculoskelet Disord 2024; 25:127. [PMID: 38341564 PMCID: PMC10858476 DOI: 10.1186/s12891-024-07243-1] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
OBJECTIVES To Investigate the value of 3D printed guide-assisted percutaneous management of minimally displaced scaphoid waist fractures(Herbert's B2) with delayed diagnosis or presentation. METHODS From October 2018 to February 2022, 10 patients with established delayed diagnoses and presentation of minimally displaced scaphoid waist fractures were treated with 3D printed guides assisted with percutaneous internal fixation without bone grafting. This technique was based on the patient's preoperative CT and imported into the software. Based on Boolean subtraction, the most centralized screw placement position was identified and a customized guide was produced. Intraoperative percutaneous insertion of the guide wire was assisted by the custom guide. RESULTS All 10 patients were successful in one attempt. The fractures healed at a mean of 7.7 weeks postoperatively (range 6-10 weeks). At a mean follow-up of 7.7 months (6-13 months), patients had excellent recovery of wrist function with minimal pain reduction. There were no major postoperative complications and the patients all returned to their previous activities before the injury. CONCLUSIONS Percutaneous internal fixation based on 3D printed guides is a safe and effective technique for delayed diagnosis or presentation of patients with minimally displaced fractures of the scaphoid waist. This method allows for easy insertion of screws and avoids multiple attempts.
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Affiliation(s)
- Cunmin Rong
- Department of Hand and Foot Surgery, The Affiliated Hospital of Jining Medical University, Jining, 272029, Shandong, China.
| | - Qinglin Zhang
- Department of Hand and Foot Surgery, The Affiliated Hospital of Jining Medical University, Jining, 272029, Shandong, China
| | - Shaobo Zhu
- Department of Hand and Foot Surgery, The Affiliated Hospital of Jining Medical University, Jining, 272029, Shandong, China
| | - Guanghui Zhang
- Department of Hand and Foot Surgery, The Affiliated Hospital of Jining Medical University, Jining, 272029, Shandong, China
| | - Junhao Zeng
- Department of Hand and Foot Surgery, The Affiliated Hospital of Jining Medical University, Jining, 272029, Shandong, China
| | - Qingluan Han
- Department of Hand and Foot Surgery, The Affiliated Hospital of Jining Medical University, Jining, 272029, Shandong, China
| | - Yang Guo
- Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, 100035, China
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Nkurikiyumukiza L, Buteera AM, El-Sharkawi MM. Delayed presentation of lower cervical facet dislocations: What to learn from past reports? SICOT J 2024; 10:4. [PMID: 38240730 PMCID: PMC10798230 DOI: 10.1051/sicotj/2023036] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/08/2023] [Indexed: 01/22/2024] Open
Abstract
Delayed presentation of lower cervical facet dislocations is uncommon, and there is no standardized way to approach these neglected injuries. The literature on neglected lower cervical facet dislocations is limited to case reports and few retrospective studies. This justifies the need for a comprehensive review of this condition. Our purpose was to elaborate a review on the epidemiology, clinical and radiological presentation, and treatment techniques and approach to these neglected injuries. Middle-aged adults from 30 to 50 represent 73.8% of reported cases, and most of them are males (72.0%). The most affected level is C5-C6 (43.0%). While most delays are due to missed injuries (52.1%) and ineffective non-operative treatment (36.2%), the other reason for delay is negligence in seeking medical care (11.7%). Patients present with variable degrees of neurological deficit, persistent neck pain, and neck stiffness. Reported approaches and techniques to reduce and stabilize these injuries are highly variable and depend on the surgeon's judgment, experience, and preference. Fibrotic tissues and bony fusion around the dislocated facet joint contribute to the reduction challenge, and 77.0% of closed reduction attempts fail. Anterior and posterior approaches to the cervical spine are used selectively or in combination for surgical release, reduction, and stabilization. Despite the lack of standardized treatment guidelines and different approaches, most of the authors reported improvement in pain, balance, and neurology post-surgery. Starting with the posterior surgical approach aims to achieve reduction compared to the anterior approach which largely aims at spinal decompression. Given the existing controversies, the need for quality prospective studies to determine the best treatment approach for lower cervical facet dislocations presenting with delay is evident.
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Affiliation(s)
| | - Alex Mathias Buteera
- University of Rwanda College of Medicine and Health Sciences, P.O. Box 3286, Kigali, Rwanda
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Wahhab J, Zwijack A. Beware the ides of Morel-Lavallée: A lesion to consider when diagnosing trauma patients. Trauma Case Rep 2023; 47:100917. [PMID: 37674770 PMCID: PMC10477790 DOI: 10.1016/j.tcr.2023.100917] [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: 08/20/2023] [Indexed: 09/08/2023] Open
Abstract
Morel-Lavallée lesions are post-traumatic, internal degloving injuries associated with substantial patient mortality that are frequently undetected due to often presenting days to weeks after initial injury. Delay of diagnosis can perpetuate complications such as expansion and infection (Mutluoglu et al., 2021 [1]). A 46 year old male presented with a Morel-Lavallée lesion to the left anterior thigh and hip two weeks after receiving emergency care after an accident where he was thrown from his motorcycle. It is paramount that physicians consider this diagnosis when evaluating post-traumatic patients to mitigate lesion expansion, overlying skin necrosis, underlying fracture exposure and subsequent infection.
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Affiliation(s)
- John Wahhab
- Chicago Medical School at Rosalind Franklin University of Medicine and Science, 3333 Green Bay Rd, North Chicago, IL 60064, United States of America
- Mount Sinai Hospital, Chicago, IL, United States of America
| | - Andrew Zwijack
- Chicago Medical School at Rosalind Franklin University of Medicine and Science, 3333 Green Bay Rd, North Chicago, IL 60064, United States of America
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Alimadadi M, Ghanbari R, Yousefi M, Sadani S. Duodenal Web in an Elderly Patient with Abdominal Discomfort and Vomiting: A Rare Case. Arch Iran Med 2023; 26:455-458. [PMID: 38301108 PMCID: PMC10685735 DOI: 10.34172/aim.2023.69] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/25/2023] [Indexed: 02/03/2024]
Abstract
Duodenal web is complete or incomplete obstruction of the duodenum due to a membranous web or intraluminal diverticulum. This abnormality is one of the main causes of intestinal obstruction in children. The symptoms of this disease may rarely appear in older age and cause gastric outlet obstruction in adults. In the present paper, we report a 69-year-old male patient with heartburn, abdominal discomfort, frequent non-bilious, non-bloody vomiting for the past 6 months. Furthermore, the patient had experienced a weight loss of 12 kg during this period. He had been taking aspirin daily for years due to his ischemic heart disease. After performing contrast-enhanced CT imaging, esophagogastroduodenoscopy and barium meal examination, the patient was diagnosed to suffer from duodenal web. Since surgery is currently the mainstay of treatment in the management of this disease, the patient finally underwent a gastrojejunostomy.
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Affiliation(s)
- Mehdi Alimadadi
- Clinical Research Development Unit (CRDU), Sayad Shirazi Hospital, Golestan University of Medical Sciences, Gorgan, Iran
| | - Reza Ghanbari
- Gene Therapy Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohanna Yousefi
- Clinical Research Development Unit (CRDU), Sayad Shirazi Hospital, Golestan University of Medical Sciences, Gorgan, Iran
| | - Somayeh Sadani
- Clinical Research Development Unit (CRDU), Sayad Shirazi Hospital, Golestan University of Medical Sciences, Gorgan, Iran
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Chen KK, Edwards MJ. Delayed presentation of a right congenital diaphragmatic hernia following left congenital diaphragmatic hernia repair in infancy. Int J Surg Case Rep 2023; 105:108020. [PMID: 36963226 PMCID: PMC10053395 DOI: 10.1016/j.ijscr.2023.108020] [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] [Received: 01/03/2023] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 03/26/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Congenital diaphragmatic hernias (CDH) affect variable portions of diaphragm, resulting in herniation of abdominal contents into the chest. CDH typically is diagnosed prenatally or presents soon after birth with respiratory distress and abnormal chest X-ray (CXR) findings. Presentation after infancy is rare but well described. We present a case of delayed presentation of a right CDH following left CDH repair. CASE PRESENTATION An 18-month-old boy with a history of a left CDH repaired in the newborn period presented with a newly elevated right hemidiaphragm presumed to be an eventration. He re-presented 9 months later with abdominal pain and respiratory distress. Xray was concerning for gastric volvulus within the right chest. Surgical exploration revealed a small right sided diaphragmatic hernia with an incarcerated liver and stomach. This was repaired without event. CLINICAL DISCUSSION Normal appearing CXR following L CDH repair led to delayed recognition of this right CDH. Delayed presentation was likely due to the liver covering the small diaphragmatic defect, preventing early migration of the intra-abdominal viscera into the chest. Recurrence of the CDH is the most common cause of respiratory and gastrointestinal symptoms following prior repair, but an unrecognized contralateral defect is a rare possibility. CONCLUSION In a patient with a prior history of a left CDH who presents with respiratory and gastrointestinal symptoms, along with a recurrence of the left sided CDH, the presence of a right sided defect should be considered if the right hemidiaphragm is newly elevated.
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Affiliation(s)
- Kaddie Kwok Chen
- Albany Medical College, 49 New Scotland Avenue, Albany, NY 12208, United States of America.
| | - Mary Jude Edwards
- Pediatric Surgery, Department of Surgery, Albany Medical Center, 50 New Scotland Avenue, Albany, NY 12208, United States of America.
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Naik P, Nagda T, Patwardhan S. Role of Percutaneous Screw Fixation in Children with Delayed Presentation and Nonunion of Lateral Condyle Humerus Fractures with Elbow Stiffness. Indian J Orthop 2023; 57:245-252. [PMID: 36777115 PMCID: PMC9880091 DOI: 10.1007/s43465-022-00789-z] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022]
Abstract
Introduction Delayed presentations and nonunion of lateral condyle of Humerus (LCH) fractures in children are common. It is recommended to gain elbow movements before placing single screw for late presenting LCH fractures. We examined the efficacy of a percutaneously placed screw in delayed presenting LCH fractures and LCH nonunion in children who presented with varying degree of elbow stiffness without waiting for improvement in elbow movements. Material and Methods Sixteen children with LCH fractures presenting after six weeks of fracture, without signs of union, and with frank nonunion were treated with percutaneous placement of the cancellous screw. There was a delay of 1.5 to18 months before presenting to us. The results were assessed by Dhillon criteria. Results All the patients at presentation had flexion deformity (avg 290) and restricted flexion ((avg 1000). Successful radiological union was achieved in fifteen patients. All the patients had full recovery of extension. Fifteen patient regained full flexion and one patient has only 100 flexion restriction (p value < 0.001). At the final follow-up, fifteen patients had excellent and one had a good overall Dhillon score. There was no clinically evident varus or valgus deformity. Conclusion We could achieve union in a majority of the patients with delayed presentation and established nonunion of LCH fractures with simple percutaneous screw placement, thereby avoiding open surgery, big scar, bone grafting, and AVN of LCH. We did not wait for an improvement in elbow movements before screw fixation and still all our patients regained full elbow movements with improved Dhillon scores.
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Affiliation(s)
- Premal Naik
- Director, Rainbow Superspeciality Hospital and Children’s Orthopaedic Centre, Next to Asia School, Behind HDFC Bank, Opposite Drive In Cinema, Bodakdev, Ahmedabad, Gujarat 380 054 India
- Honorary Pediatric Orthopedic surgeon, Smt S C L Hospital, NHM Municipal Medical College, Ahmedabad, Gujarat India
| | - Taral Nagda
- SRCC NH Children Hospital, Mumbai, Maharashtra India
- Jupiter Hospital, Mumbai, Maharashtra India
| | - Sandeep Patwardhan
- Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra India
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Barka M, Jarrar MS, Sahli J, Abdessalem ZB, Hamila F, Youssef S. Early laparoscopic cholecystectomy for acute cholecystitis: should we operate beyond the first week? Langenbecks Arch Surg 2023; 408:68. [PMID: 36701033 DOI: 10.1007/s00423-023-02816-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 01/18/2023] [Indexed: 01/27/2023]
Abstract
BACKGROUND The deadline for early laparoscopic cholecystectomy (ELC) in patients with acute calculous cholecystitis (ACC) is the subject of much debate. The aim of this study was to assess outcomes of ELC in patients with more than 7 days of symptoms. METHODS It is a retrospective analysis of 564 patients having undergone ELC for ACC between January 2003 and June 2021. Patients were divided into two groups according to the timing between the onset of symptoms and surgery: group 1 (G1), within the first 7 days of symptoms, and group 2 (G2) after day 7 of symptoms. RESULTS Apart from a longer operative time (G1 80 min vs. G2 90 min; p = 0.016), there were no significant differences regarding conversion rate (G1 14.5% vs. G2 13.2%; p = 0.748), both intra- and postoperative complications, mainly bile duct injuries (G1 0.2% vs. G2 0%; p = 1) and bile leakage (G1 1.2% vs. G2 0%; p = 1) and postoperative length of stay (G1 2 days [1-3] vs. G2 2 days [1-4]; p = 0.125). CONCLUSION Early laparoscopic cholecystectomy could be proposed for patients with acute calculous cholecystitis even beyond 7 days of symptoms.
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Affiliation(s)
- Malek Barka
- Department of General and Digestive Surgery, Farhat Hached University Hospital, Faculty of Medicine of Sousse, Sousse, Tunisia.
| | - Mohamed Salah Jarrar
- Department of General and Digestive Surgery, Farhat Hached University Hospital, Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Jihene Sahli
- Department of Family and Community Medicine, Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Zied Ben Abdessalem
- Department of General and Digestive Surgery, Farhat Hached University Hospital, Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Fehmi Hamila
- Department of General and Digestive Surgery, Farhat Hached University Hospital, Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Sabri Youssef
- Department of General and Digestive Surgery, Farhat Hached University Hospital, Faculty of Medicine of Sousse, Sousse, Tunisia
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Agarwal P, Kukrele R, Sharma D. Delayed revascularization of extremities following vascular injuries: Challenges and outcome. J Orthop 2023; 35:31-36. [PMID: 36387761 PMCID: PMC9660842 DOI: 10.1016/j.jor.2022.10.016] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 10/30/2022] [Accepted: 10/31/2022] [Indexed: 11/11/2022] Open
Abstract
Purpose In developing countries delayed presentation following major vascular injury is common due to limited vascular trauma units; delay in diagnosis and time lost in transit which pose a major challenge for limb salvage. Aim of this study was to assess limb survival and complications after delayed revascularization of extremity following major vascular injury. Method 20 patients, (19 males and 1 female, mean age 31.55 years) with major extremity vascular injury who presented >8 h after vascular trauma were included in this study. All patients had road traffic accidents as the cause of extremity injury. These patients were operated by primary vascular repairs, thrombectomy and/or interposition vein graft along with fixation of concomitant skeletal trauma. Results The commonest vessel injured was popliteal artery. The mean time of limb revascularization was 30.8 h. Limb salvage rate was 95% and there was no perioperative mortality. 9 patients developed postoperative complications including sloughing of leg muscles (4), foot drop (3) pseudo aneurysm (1) and reperfusion injury (1). At 6 months follow-up all the patients were able to walk with full weight bearing and there was no chronic ischemia, pain or sinuses. Conclusion Limb salvage can be achieved with good results in patients with delayed revascularization in selected cases. However; delayed revascularization leads to long and protracted postoperative course with high chances of vascular and neurological complications.
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Affiliation(s)
- Pawan Agarwal
- Plastic Surgery Unit, Department of Surgery NSCB Government Medical College, Jabalpur, MP, 482003, India
| | - Rajeev Kukrele
- Plastic Surgery Unit, Department of Surgery NSCB Government Medical College, Jabalpur, MP, 482003, India
| | - Dhananjaya Sharma
- Department of Surgery, NSCB Government Medical College, Jabalpur, MP, 482003, India
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Ovenden CD, Hewitt J, Kovoor J, Gupta A, Edwards S, Abou-Hamden A, Kleinig T. Time to hospital presentation following intracerebral haemorrhage: Proportion of patients presenting within eight hours and factors associated with delayed presentation. J Stroke Cerebrovasc Dis 2022; 31:106758. [PMID: 36137452 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106758] [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] [Received: 12/05/2021] [Revised: 08/21/2022] [Accepted: 09/04/2022] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Prolonged time to diagnosis of primary intracerebral haemorrhage (ICH) can result in delays in obtaining appropriate blood pressure control, reversal of coagulopathy or surgical intervention in select cases. We sought to characterise the time to diagnosis in a cohort of patients with ICH and identify factors associated with delayed diagnosis. METHODOLOGY The stroke database of our hospital was retrospectively reviewed to identify patients presenting to our hospitals emergency department with ICH over two years (January 2017-December 2018.) Data collected included demographics (age and sex), comorbidities, anticoagulation status, clinical scores (NIHSS, GCS, ICH score), and imaging (anatomical site, haematoma size). Time from symptom onset to diagnosis and hospital presentation were recorded. Factors associated with diagnosis >8 h post ictus were assessed using a univariate and then multivariable analysis. RESULTS 235 patients were identified with 125 males (53%) and a median age of 76 (range 40-98). For the 200 patients that initially presented to our hospital, median time to presentation was 179 min (IQR 77-584 min), and median time from ictus to imaging diagnosis was 268 min (IQR 114-717 min). 139 (70%) presented within 8 h of symptom onset, and 129 (65%) patients had imaging of the brain performed within 8 h of symptom onset. Factors associated with presentation >8 h post symptom onset included wake up stroke (OR 5.31, 95% confidence interval (CI) 2.36-11.96, p < 0.0001) and age (OR 1.04, 95% CI 1.01-1.08, p = 0.01). Patients with hemiplegia were less likely to present >8 h following ictus (OR 0.41, 95% CI 0.21-0.84, p = 0.01). CONCLUSIONS The majority of patients with ICH presented within 8 h of ictus. Cases of delayed diagnosis involved patients who had not incurred hemiplegia.
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Affiliation(s)
- Christopher Dillon Ovenden
- Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.
| | - Joseph Hewitt
- Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Joshua Kovoor
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Aashray Gupta
- Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Suzanne Edwards
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Amal Abou-Hamden
- Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Timothy Kleinig
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia; Stroke Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Lodhia J, Goodluck G, Tendai J, Urassa E, Nkya G, Mremi A. Case series of high-grade soft tissue sarcoma of the lower limb with delayed diagnosis: Experience at a tertiary hospital in northern Tanzania. Int J Surg Case Rep 2022; 97:107475. [PMID: 35932713 PMCID: PMC9403340 DOI: 10.1016/j.ijscr.2022.107475] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/30/2022] [Accepted: 07/31/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Soft tissue sarcoma is an uncommon form of cancer with poor prognosis. Early diagnosis and treatment are vital for improving the treatment outcomes. CASE PRESENTATION We report a series of high-grade soft tissue sarcomas of the lower extremity with delayed diagnosis to gain insight into the presentation, treatments and outcomes for this rare disease and to determine whether limb-salvage surgery yields reasonable outcomes. CLINICAL DISCUSSION Timely health seeking has an impact on the outcome of the treatment of any particular disease. Patient delays are usually socio-economic factors. Soft tissues sarcomas are uncommon malignant tumors that even managed adequately have a poor 5-year survival. Limb salvage becomes questionable especially when patients present late with adverse symptoms. CONCLUSION In this series, we found that patients presented late and this led to unfavorable oncological outcomes, also limb salvage was not an option due to delayed presentation. Thus, early diagnosis is recommended so as to improve treatment outcome.
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Affiliation(s)
- Jay Lodhia
- Department of General Surgery, Kilimanjaro Christian Medical Centre, P. O Box 3010, Moshi, Tanzania,Faculty of Medicine, Kilimanjaro Christian Medical University College, P. O Box 2240, Moshi, Tanzania,Corresponding author at: Kilimanjaro Christian Medical Centre, P. O Box 3010, Moshi, Tanzania.
| | - Gregory Goodluck
- Department of General Surgery, Kilimanjaro Christian Medical Centre, P. O Box 3010, Moshi, Tanzania
| | - Joylene Tendai
- Department of General Surgery, Kilimanjaro Christian Medical Centre, P. O Box 3010, Moshi, Tanzania
| | - Ellyagape Urassa
- Department of General Surgery, Kilimanjaro Christian Medical Centre, P. O Box 3010, Moshi, Tanzania
| | - Gilbert Nkya
- Faculty of Medicine, Kilimanjaro Christian Medical University College, P. O Box 2240, Moshi, Tanzania,Department of Pathology, Kilimanjaro Christian Medical Centre, P. O Box 3010, Moshi, Tanzania
| | - Alex Mremi
- Faculty of Medicine, Kilimanjaro Christian Medical University College, P. O Box 2240, Moshi, Tanzania,Department of Pathology, Kilimanjaro Christian Medical Centre, P. O Box 3010, Moshi, Tanzania
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Kumar A, Singla V, Pulle MV, Asaf BB, Puri HV, Bishnoi S. Multidisciplinary, minimally invasive approach for oesophageal perforations with delayed presentation. J Minim Access Surg 2022; 18:353-359. [PMID: 35708379 PMCID: PMC9306118 DOI: 10.4103/jmas.jmas_28_21] [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] [Indexed: 11/04/2022] Open
Abstract
Background The present study aims to report the outcomes of a multidisciplinary, minimally invasive approach to treating patients with delayed presentation of oesophageal perforation. Patients and Methods The present study is a retrospective analysis of prospectively maintained data at a tertiary care centre. All patients with oesophageal perforation presenting over 48 h after the onset of symptoms and without oesophageal obstruction were included in the study. Self-expanding Metallic Stent (SEMS) or endoscopic clip placement was performed in all the patients, followed by video-assisted thoracoscopic surgery (VATS) debridement and decortication of pleural cavity collection. 'Success' was defined as, discharge without the need of oesophageal diversion and complete healing of leak site at 8 weeks with successful removal of the stent. Results Between March 2012 and December 2019, 12 patients (10 males, median age of 55 years- range of 39-71 years) with oesophageal perforation and delayed presentation underwent treatment with this approach. Ten patients had spontaneous perforation (83.3%) and one patient each had upper gastrointestinal endoscopy-induced and post-traumatic perforation. The median duration of symptoms was 8 days (range 3-31 days). SEMS was placed in ten patients and, in two patients, an over-the-scope clip was used. VATS decortication was done in ten patients (83.3%) and the remaining two (16.7%) underwent VATS debridement. One patient required oesophageal diversion and another patient expired due to sepsis. The overall success with this approach was 83.3%. Conclusion This multidisciplinary, minimally invasive approach is feasible in patients with thoracic oesophageal perforation and delayed presentation, with a high success rate.
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Affiliation(s)
- Arvind Kumar
- Department of Thoracic Surgery, Institute of Chest Surgery and Chest Onco-Surgery, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Vikas Singla
- Department of Gastroenterology, Sir Ganga Ram Hospital, New Delhi, India
| | - Mohan Venkatesh Pulle
- Department of Thoracic Surgery, Institute of Chest Surgery and Chest Onco-Surgery, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Belal Bin Asaf
- Department of Thoracic Surgery, Institute of Chest Surgery and Chest Onco-Surgery, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Harsh Vardhan Puri
- Department of Thoracic Surgery, Institute of Chest Surgery and Chest Onco-Surgery, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Sukhram Bishnoi
- Department of Thoracic Surgery, Institute of Chest Surgery and Chest Onco-Surgery, Medanta - The Medicity, Gurgaon, Haryana, India
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Dreyer H, De Oliveira K, Lalloo V, Engelbrecht A. A qualitative study of COVID-19 related reasons for delayed presentation of patients with chest pain during the COVID-19 pandemic. Afr J Emerg Med 2022; 12:34-8. [PMID: 34777986 DOI: 10.1016/j.afjem.2021.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 09/04/2021] [Accepted: 10/26/2021] [Indexed: 02/06/2023] Open
Abstract
Introduction In previous pandemics such as the Ebola virus outbreak in West Africa, it has been observed that patients with non-pandemic related complaints, delay their presentation to hospital. Similarly, delayed presentation of patients with chest pain during the COVID-19 pandemic has been documented. This qualitative study identified the COVID-19 related reasons which lead to this delay. Methods A qualitative study based on 10 individual patient interviews. Half of these were conducted at a public hospital emergency centre (EC) and the other half at a private EC. Results A variety of psychosocial factors were identified as themes for delayed presentation. Interestingly, the fear of contracting COVID-19 at the hospital was not found to be an important theme in our study. Rather, confusion around hospital protocols during the pandemic was identified as a recurrent theme. Discussion This study found that confusion about COVID-19 hospital protocols was the major pandemic related delaying factor. A number of themes unrelated to COVID-19 were also identified.
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Das R, Borthakur B, Agarwala V, Ghosh S. Evaluation of anterior approach in failed closed reduction and delayed presentation of supracondylar humerus fractures in children. J Orthop 2022; 30:51-58. [PMID: 35241888 PMCID: PMC8857543 DOI: 10.1016/j.jor.2022.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/26/2022] [Accepted: 02/04/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The treatment of displaced paediatric supracondylar fracture is a challenging problem and requires strict vigilance and a proper management protocol. Prospective investigation of the treatment options for fractures that cannot be reduced by closed reduction is recommended in literature. Operative treatment is indicated for the fractures that cannot be reduced satisfactorily by closed methods. It is also considered the best option for late presenting fractures. The aim of this study was to assess and compare the clinical outcome using open reduction through anterior approach in delayed presentation and failed closed reduction of supracondylar fracture humerus in children. MATERIALS AND METHODS 15 patients of failed closed reduction and 11 patients of delayed presentation of supracondylar humerus fractures were operated with anterior approach. The demographic data, time from injury to presentation and from admission to surgery, reasons for delayed presentation, type of fracture, operative findings and time, K-wire configuration, length of hospitalization, post operative complications were noted. The patients were followed up for a period of 12 months and final range of motion, Baumann's angle, and cosmetic, functional and overall outcome by Flynn's criteria were evaluated and analyzed. RESULTS The overall outcome was very satisfactory according to Flynn's criteria. 80.77% patients had excellent, 15.38% patients had good, and 3.85% patient had fair results with no poor results. Our results show distinct advantage of anterior approach which are on a par with or better than the previous studies using anterior approach, adding to their evidence. CONCLUSION Open reduction using anterior approach is a very safe, logical and effective technique of treating failed closed reduction or late presentation of supracondylar fractures humerus in children with excellent cosmetic and functional results, and offers distinctive advantage over other approaches.
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Affiliation(s)
- Rajdeep Das
- Department of Orthopaedics, Silchar Medical College & Hospital, Silchar, Assam, India
- Corresponding author.
| | - Bipul Borthakur
- Department of Orthopaedics, Silchar Medical College & Hospital, Silchar, Assam, India
| | - Vikash Agarwala
- Department of Orthopaedics, Silchar Medical College & Hospital, Silchar, Assam, India
| | - Shantasree Ghosh
- Department of Paediatrics, Silchar Medical College & Hospital, Silchar, Assam, India
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Nandan R, Dhua AK, Yadav DK, Jain V, Goel P. Delayed Presentation of Jejunal Atresia with Multiple Enteric Fistula: A Case Report and Review of Literature. J Indian Assoc Pediatr Surg 2022; 27:345-347. [PMID: 35733595 PMCID: PMC9208680 DOI: 10.4103/jiaps.jiaps_17_21] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/23/2021] [Accepted: 06/15/2021] [Indexed: 11/17/2022] Open
Abstract
A 6-month-old boy presented with features of intestinal obstruction. Laparotomy revealed Type IIIa jejunal atresia. The proximal and distal bowel loops were in continuity through multiple fistulae between the adjoining bowel loops. To the best of our knowledge, it is the first report of congenital Type IIIa intestinal atresia surviving beyond the neonatal age without surgery.
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Affiliation(s)
- Ruchira Nandan
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Anjan Kumar Dhua
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Devendra Kumar Yadav
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India,Address for correspondence: Dr. Devendra Kumar Yadav, Room No-4002, Teaching Block, Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India. E-mail:
| | - Vishesh Jain
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Prabudh Goel
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
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16
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Kolben T, Beyer S, Ghasemi S, Hermelink K, Meister S, Degenhardt T, Himsl I, Edler von Koch F, Kolben TM, Wuerstlein R, Mahner S, Harbeck N, Hester A. Late Presentation at Primary Diagnosis of Breast Cancer: Patients' Personality Characteristics and Attitudes. Breast Care (Basel) 2021; 16:343-349. [PMID: 34602939 DOI: 10.1159/000509597] [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] [Received: 01/07/2020] [Accepted: 06/23/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Breast cancer (BC) is the most common cancer in women worldwide. Despite screening and information efforts, about 10% of patients present with tumor size T3 or T4 at primary diagnosis. Late presentation is associated with more advanced tumor stage and consecutively with worse survival rates. Objective This study aimed to evaluate whether patients with a late presentation at primary BC diagnosis differ in their personality from those with early diagnosis. Methods In this bicentric, observational study, personality traits, positive and negative affectivity, anxiety, spirituality, illness beliefs, and sociodemographic characteristics were assessed in BC patients who presented with T-stages 3 or 4 (late presenters) and T-stages 1 or 2 (controls) at initial diagnosis. Results Forty patients (20 controls, 20 late presenters) were interviewed. "Late presenters" perceived their disease as long lasting and had significantly more "positive affectivity" in the current trait. Although no significant associations were found, there was a trend for late presenters to have higher education levels, less spiritual longing, less accurate explanation of their illness, less anxiety in the trait scale, and more conscientiousness than the controls. Conclusion As patients with late presentation for BC differ in specific psychological and sociodemographic characteristics from patients with early BC, the findings of this pilot project warrant additional investigations to identify further specific characteristics and motivations. Identifying patients at risk for late presentation and encouraging them to accept an earlier diagnosis could help to improve their therapy and, finally, their outcome.
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Affiliation(s)
- Thomas Kolben
- Department of Obstetrics and Gynecology, Breast Center and CCC LMU University Hospital, LMU Munich, Munich, Germany
| | - Susanne Beyer
- Department of Obstetrics and Gynecology, Breast Center and CCC LMU University Hospital, LMU Munich, Munich, Germany
| | - Sanaz Ghasemi
- Department of Obstetrics and Gynecology, Breast Center and CCC LMU University Hospital, LMU Munich, Munich, Germany
| | - Kerstin Hermelink
- Department of Obstetrics and Gynecology, Breast Center and CCC LMU University Hospital, LMU Munich, Munich, Germany
| | - Sarah Meister
- Department of Obstetrics and Gynecology, Breast Center and CCC LMU University Hospital, LMU Munich, Munich, Germany
| | - Tom Degenhardt
- Department of Obstetrics and Gynecology, Breast Center and CCC LMU University Hospital, LMU Munich, Munich, Germany
| | - Isabelle Himsl
- Department of Obstetrics and Gynecology, Klinikum Dritter Orden, Munich, Germany
| | - Franz Edler von Koch
- Department of Obstetrics and Gynecology, Klinikum Dritter Orden, Munich, Germany
| | - Theresa M Kolben
- Department of Obstetrics and Gynecology, Breast Center and CCC LMU University Hospital, LMU Munich, Munich, Germany
| | - Rachel Wuerstlein
- Department of Obstetrics and Gynecology, Breast Center and CCC LMU University Hospital, LMU Munich, Munich, Germany
| | - Sven Mahner
- Department of Obstetrics and Gynecology, Breast Center and CCC LMU University Hospital, LMU Munich, Munich, Germany
| | - Nadia Harbeck
- Department of Obstetrics and Gynecology, Breast Center and CCC LMU University Hospital, LMU Munich, Munich, Germany
| | - Anna Hester
- Department of Obstetrics and Gynecology, Breast Center and CCC LMU University Hospital, LMU Munich, Munich, Germany
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Divya G, Kundal VK, Debnath PR, Addagatla R, Garbhapu AK, Sen A, Saha AK, Meena AK, Shah S, Syal S, Khanna C, Dotikalkar R, Gautam V. Delayed presentation of anorectal malformations in a tertiary care hospital in India. Pediatr Surg Int 2021; 37:451-456. [PMID: 33449157 DOI: 10.1007/s00383-020-04843-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/11/2020] [Indexed: 11/26/2022]
Abstract
AIM To study delayed presentation of ARMs, management and its effect on surgical and functional complications. METHODS It is a retrospective study from March 2015 to March 2020. All the patients satisfying the criteria of delayed ARMs, i.e., presenting 7 days after birth were included. Information regarding type of ARM, mode of presentation, time of presentation, associated anomalies, management strategy, postoperative complications and functional outcome was noted. Minimum follow-up period was 6 months. RESULTS Out of 102 patients with ARM, 44 patients presented late. Among the 44 patients, 9 were males and 35 were females. Associated comorbidities observed are low birth weight (n = 9) and preterm (n = 13). Associated anomalies observed were cardiac (n = 18), renal (n = 8), other gastrointestinal (n = 5) and skeletal (n = 1). (1) Male: rectourethral fistula-2 (staged repair), anal stenosis-3 (anoplasty) and anocutaneous fistula-4 (anoplasty). (2) Female: vestibular fistula: 15 (6 primary definitive surgery + 9 staged repair), ectopic anus: 3 (staged repair), anal stenosis: 2 (anoplasty), urogenital sinus: 4 (staged repair), H-type ARM: 8 (staged repair) and persistent cloaca: 3 (staged repair). Primary repair was done in 15 patients (34%), and staged repair was done in 29 patients (65.9%). Anoplasty was done in 9 patients, ASARP (modified tsuchida's procedure) in 8 patients and PSARP in 27 patients. Postoperative complications observed were constipation (n = 21, 47.7%), fecal incontinence (n = 12, 27.27%) with perianal excoriation in 2 patients, anal stenosis (n = 3, 6.8%) and rectal mucosal prolapse (n = 2, 4.5%) CONCLUSION: Delayed presentation of ARMs is not uncommon and is more common in females. Management is almost similar to those who present early. Those who present with chronic constipation and megarectum require staged repair. Complications were more frequent with delayed presentation. Hence, every newborn should have careful examination of perineum and screened for ARM to avoid possible morbidity and mortality.
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Affiliation(s)
- Gali Divya
- Department of Pediatric Surgery, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Vijay Kumar Kundal
- Department of Pediatric Surgery, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India.
| | - Pinaki R Debnath
- Department of Pediatric Surgery, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Rajasekhar Addagatla
- Department of Pediatric Surgery, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Anil Kumar Garbhapu
- Department of Pediatric Surgery, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Amita Sen
- Department of Pediatric Surgery, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Arnab Kumar Saha
- Department of Pediatric Surgery, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Atul Kumar Meena
- Department of Pediatric Surgery, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Shalu Shah
- Department of Pediatric Surgery, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Sarita Syal
- Department of Pediatric Surgery, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Chetna Khanna
- Department of Pediatric Surgery, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Rashmi Dotikalkar
- Department of Pediatric Surgery, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
| | - Vasu Gautam
- Department of Pediatric Surgery, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India
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18
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Cruz N, Jiménez R. Morel-Lavallée lesion diagnosed 25 years after blunt trauma. Int J Surg Case Rep 2021; 81:105733. [PMID: 33743247 DOI: 10.1016/j.ijscr.2021.105733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/28/2021] [Accepted: 03/03/2021] [Indexed: 11/29/2022] Open
Abstract
Morel-Lavallée lesions are rare injuries that can be difficult to diagnose acutely after trauma. It is important to distinguish it from other lesions on imaging. Open surgical excision is often required for large, chronic and recurrent lesions.
Introduction Morel-Lavallée lesions are closed degloving injuries in which the skin and subcutaneous tissues separate from the underlying fascia secondary to a shearing force. These injuries are uncommon and can be misdiagnosed in acute settings. If treated incorrectly, they can recur, causing complications requiring multiple surgical interventions. Therefore, it is important to discuss the clinical presentation and imaging characteristics in order to improve their diagnosis and management. Presentation of case This is the case of a 44-year-old male patient with a Morel-Lavallée lesion of the left thigh that presented 25 years after trauma. He was successfully treated with open surgical excision. The patient underwent multiple surgical interventions before the lesion was accurately diagnosed and treated. Discussion Morel-Lavallée injuries can lead to chronic symptoms, such as pain and swelling, affecting the patient’s quality of life. Treatment options include minimally invasive procedures, such as compression bandages or percutaneous drainage. However, if diagnosed late, a fibrotic capsule can form, which may require surgical excision. Our patient was diagnosed more than 20 years after the trauma. Earlier noninvasive treatment options were unsuccessful. Conclusion The patient was treated with open surgical excision of the chronic lesion. There was no report of any recurrence up to 10 months after surgery. Such lesion treatments should be guided based on the chronicity of the injury and the patient’s symptoms. To the best of our knowledge, this is the first case with such delayed presentation.
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Abstract
Blunt abdominal trauma is a rare cause of small bowel obstruction thought to arise from either a sealed perforation of the small bowel or mesenteric injury resulting in adhesions. A 55-year-old gentleman presented with symptoms and signs of small bowel obstruction and a history of blunt abdominal trauma 14 months previously. Abdominal computed tomography showed a transition zone at the terminal ilium with proximal dilatation indicative of obstruction. At surgery, he had adhesions involving the terminal ilium with shortening and fibrosis of the supplying mesentery. Patients with a history of blunt abdominal trauma presenting with abdominal symptoms must be investigated to rule out bowel obstruction, with a low threshold for surgical intervention.
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20
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Chandra NL, Bolt H, Dan-Nwafor C, Ipadeola O, Ilori E, Namara G, Olayinka AT, Ukponu W, Iniobong A, Amedu M, Akano A, Akabike KO, Okhuarobo U, Fagbemi S, Sampson E, Newitt S, Verlander NQ, Bausch DG, le Polain de Waroux O, Ihekweazu C. Factors associated with delayed presentation to healthcare facilities for Lassa fever cases, Nigeria 2019: a retrospective cohort study. BMC Infect Dis 2021; 21:143. [PMID: 33541278 PMCID: PMC7863257 DOI: 10.1186/s12879-021-05822-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/19/2021] [Indexed: 11/18/2022] Open
Abstract
Background Large outbreaks of Lassa fever (LF) occur annually in Nigeria. The case fatality rate among hospitalised cases is ~ 20%. The antiviral drug ribavirin along with supportive care and rehydration are the recommended treatments but must be administered early (within 6 days of symptom onset) for optimal results. We aimed to identify factors associated with late presentation of LF cases to a healthcare facility to inform interventions. Methods We undertook a retrospective cohort study of all laboratory confirmed LF cases reported in Nigeria from December 2018 to April 2019. We performed descriptive epidemiology and a univariate Cox proportional-hazards regression analysis to investigate the effect of clinical (symptom severity), epidemiological (age, sex, education, occupation, residential State) and exposure (travel, attendance at funeral, exposure to rodents or confirmed case) factors on time to presentation. Results Of 389 cases, median presentation time was 6 days (IQR 4–10 days), with 53% attending within 6 days. There were no differences in presentation times by sex but differences were noted by age-group; 60+ year-olds had the longest delays while 13–17 year-olds had the shortest. By sex and age, there were differences seen among the younger ages, with 0–4-year-old females presenting earlier than males (4 days and 73% vs. 10 days and 30%). For 5–12 and 13–17 year-olds, males presented sooner than females (males: 5 days, 65% and 3 days, 85% vs. females: 6 days, 50% and 5 days, 61%, respectively). Presentation times differed across occupations 4.5–9 days and 20–60%, transporters (people who drive informal public transport vehicles) had the longest delays. Other data were limited (41–95% missing). However, the Cox regression showed no factors were statistically associated with longer presentation time. Conclusions Whilst we observed important differences in presentation delays across factors, our sample size was insufficient to show any statistically significant differences that might exist. However, almost half of cases presented after 6 days of onset, highlighting the need for more accurate and complete surveillance data to determine if there is a systemic or specific cause for delays, so to inform, monitor and evaluate public health strategies and improve outcomes.
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Affiliation(s)
- Nastassya L Chandra
- UK Field Epidemiology Training Programme, Public Health England, London, UK. .,UK Public Health Rapid Support Team - Public Health England/London School of Hygiene & Tropical Medicine, London, UK.
| | - Hikaru Bolt
- UK Public Health Rapid Support Team - Public Health England/London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Elsie Ilori
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Geoffrey Namara
- Nigeria Centre for Disease Control, Abuja, Nigeria.,World Health Organization, Abuja, Nigeria
| | - Adebola T Olayinka
- Nigeria Centre for Disease Control, Abuja, Nigeria.,World Health Organization, Abuja, Nigeria
| | - Winifred Ukponu
- Georgetown University, Centre for Global Health Practice and Impact, Abuja, Nigeria
| | | | | | | | | | | | | | | | - Sophie Newitt
- Public Health England, National Infection Service, London, UK
| | | | - Daniel G Bausch
- UK Public Health Rapid Support Team - Public Health England/London School of Hygiene & Tropical Medicine, London, UK
| | - Olivier le Polain de Waroux
- UK Public Health Rapid Support Team - Public Health England/London School of Hygiene & Tropical Medicine, London, UK
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21
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Campioni-Norman D, Faulkner J, Kumar L, Day A. A rare case report of an ilio-psoas abscess due to entero-retroperitoneal fistula from gallstones post cholecystectomy. Int J Surg Case Rep 2021; 79:402-404. [PMID: 33517213 PMCID: PMC7848702 DOI: 10.1016/j.ijscr.2021.01.073] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/15/2021] [Accepted: 01/15/2021] [Indexed: 02/07/2023] Open
Abstract
Ilio-psoas abscess due to gallstone entero-retroperitoneal fistulation post-cholecystectomy has not been reported previously. De-novo stone formation in the CBD can occur post-cholecystectomy and can lead to complications. Surgeons should consider gallstones as a differential in small bowel fistulation.
Introduction and importance This is a novel case of a 50-year-old female presenting with several months of left iliac fossa pain, on a background of a cholecystectomy 5 years prior. The aetiology of her pain was an ilio-psoas abscess secondary to an entero-retroperitoneal gallstone fistula, a condition not previously reported in the literature. Case presentation CT imaging revealed an abscess superior to the left psoas muscle, with a clear fistula to the small bowel and two calcified stones at the site of the fistula. The patient was managed operatively, with the fistula disconnected and a 5 cm section of small bowel disconnected. Clinical discussion This is a novel case whereby a left sided iliopsoas abscess occurred due to entero-retroperitoneal fistulation of gallstones several years after the patient underwent laparoscopic cholecystectomy. Gallstone fistulation from within the small bowel does not appear to have previously been documented and the exact pathogenesis is unknown. Conclusion Gallstones should remain an important, albeit rare, differential diagnosis of small bowel fistulation and abscess formation following cholecystectomy.
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Affiliation(s)
| | - Jack Faulkner
- Ashford and St Peters Hospital, Surgery, United Kingdom
| | - Lalit Kumar
- Ashford and St Peters Hospital, Surgery, United Kingdom
| | - Andrew Day
- Ashford and St Peters Hospital, Surgery, United Kingdom
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Mönkemöller K, Kamrath C, Hammersen J, Biester T, Warncke K, Pappa A, Fink K, Raile K, Rohrer TR, Holl RW; DPV Initiative. [Is it possible to prevent diabetic ketoacidosis at diagnosis of pediatric type 1 diabetes? Lessons from the COVID-19 pandemic]. Monatsschr Kinderheilkd 2021;:1-8. [PMID: 33437098 DOI: 10.1007/s00112-020-01108-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 12/08/2020] [Indexed: 11/11/2022]
Abstract
Hintergrund Die diabetische Ketoacidose (DKA) ist ein lebensbedrohlicher Notfall bei Manifestation eines Diabetes mellitus Typ 1 (DM1) bei Kindern und Jugendlichen, häufig bei verspäteter Diagnosestellung oder vorheriger Fehldiagnose. Während der Zeit des „Coronavirus-disease-2019(COVID-19)-Lockdowns“ in Deutschland stellten sich weniger Patienten in Notfallambulanzen und Arztpraxen vor. Fragestellung Hat sich der Anteil der DKA bei Manifestation eines DM1 in der pädiatrischen Population in diesem Zeitraum verändert, und welche Gruppen sind besonders gefährdet, eine DKA zu erleiden? Material und Methoden Die DKA-Häufigkeit in der Zeit vom 13.03.2020 bis 13.05.2020 wurde bei Patienten <18 Jahren mit DM1-Manifestation in pädiatrischen Diabeteszentren untersucht. Die Diabeteszentren dokumentierten ihre Einschätzung, ob durch COVID-19 die Vorstellung verzögert war. Um den Einfluss von Risikofaktoren auf die DKA-Häufigkeit zu analysieren, erfolgte ein Vergleich der Daten aus dem Jahr 2020 mit denselben Zeiträumen der Jahre 2018 und 2019 mit linearen und logistischen Regressionsmodellen. Ergebnisse Die Daten von 532 Patienten aus 216 Diabeteszentren zeigten, dass das Risiko für eine DKA im Vergleich zu den Jahren 2018/2019 um 84,7 % und für eine schwere DKA um 45,3 % erhöht war. Kinder <6 Jahren waren mit einer Steigerung einer DKA um 141,6 % bzw. einer schweren DKA um 97,0 % besonders betroffen. Migrationshintergrund war ein COVID-19-unabhängiger Risikofaktor. Insgesamt wurden 31 % der Patienten verspätet vorgestellt, oder ihre Diagnose wurde zuvor verkannt. Diskussion In der Zeit des „COVID-19-Lockdowns“ war die Häufigkeit der DKA bei DM1-Manifestation für Kinder und Jugendliche signifikant erhöht. Alter <6 Jahre, Migrationshintergrund und verzögerte Vorstellung waren die Hauptrisikofaktoren.
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Sharma YP, Santosh Vemuri K, Bootla D, Kanabar K, Pruthvi CR, Kaur N, Prasad Nevali K, Panda P, Kasinadhuni G, Uppal L, Mohanty S. Epidemiological profile, management and outcomes of patients with acute coronary syndrome: Single centre experience from a tertiary care hospital in North India. Indian Heart J 2021; 73:174-179. [PMID: 33865514 PMCID: PMC8065348 DOI: 10.1016/j.ihj.2020.11.149] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 11/18/2020] [Accepted: 11/20/2020] [Indexed: 12/31/2022] Open
Abstract
Background Cardiovascular disease is the leading cause of death in India. Our aim is to study the clinical, epidemiological profile and in-hospital outcomes of patients presenting with acute coronary syndrome. Methods We did a prospective single center observational study of the 1203 patients presenting with ACS to a tertiary referral center in North India over a period of one year (July 2018–June 2019). Results The mean age of study population was 58.4 ± 12.5 years. STEMI and NSTE-ACS accounted for 69.9% and 31.1% respectively. 62.1% of our patients were from rural background. The median time to hospital admission was 600 min for STEMI patients, thrombolysis was performed in 52% of cases. Cardiogenic shock at presentation was noted in 18%. Coronary angiography and percutaneous coronary intervention were done in 1062 (88.3%) and 733 (60.9%) patients respectively. The overall in-hospital mortality was 7.6%. STEMI patients had higher mortality than NSTE-ACS (8.9% vs 4.5% p < 0.001). Female gender (OR−3.306 C.I. 1.87–5.845), severe MR (OR−4.65, C.I.−1.187–18.18), acute kidney injury (AKI) at admission (OR-5.15, C.I.−2.5–10.63), higher Killip class (class III/IV) (OR−3.378,C.I.−1.292–8.849), AF (OR−3.25, C.I.−1,18–8.92), complete heart block (CHB) (OR−4.44,C.I.−2.09–9.43) and right bundle branch block (RBBB) (OR−2.86, C.I.−1.2–6.8) were significant predictors of in hospital mortality. Conclusions Our study represents the predominance of STEMI as the initial ACS presentation with a considerable delay in first medical contact and higher prevalence of cardiogenic shock (CS). STEMI patients had higher mortality. Female sex, severe MR, AKI, higher Killips class, AF, CHB, RBBB being predictors of high in-hospital mortality in ACS patients.
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Affiliation(s)
- Yash Paul Sharma
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Krishna Santosh Vemuri
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Dinakar Bootla
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Kewal Kanabar
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - C R Pruthvi
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Navjyot Kaur
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Krishna Prasad Nevali
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Prashant Panda
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - G Kasinadhuni
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Lipi Uppal
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Soumitra Mohanty
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Nimkar S, Kinikar A, Chavan A, Sangle S, Rewari B, Gupta A, Mave V, Marbaniang I. High prevalence of late presentation of ART-naïve perinatally infected children for care in Pune, India. AIDS Care 2020; 32:1415-1420. [PMID: 32070118 PMCID: PMC7431379 DOI: 10.1080/09540121.2020.1727407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 02/03/2020] [Indexed: 10/25/2022]
Abstract
Delayed presentation to care of perinatally infected children in India continues to be a hindrance to achieving the "end pediatric HIV by 2020" goal. In this study, we characterize this issue by describing the prevalence, risk factors and temporal trends of delayed presentation to care of perinatally infected, antiretroviral therapy (ART) - naïve children using programmatic data from a tertiary care center in western India. Delayed presentation was defined as children presenting in moderate or severe WHO immunodeficiency categories. Of 269 children eligible for inclusion in the analysis, the median age at presentation was 4 years (IQR: 3-6 years) and prevalence of delayed presentation was 52%. Multivariable logistic regression identified domicile distance ≥20km from the ART center (OR: 2.2, 95% CI: 1.02-4.7) to be a risk factor for delayed presentation. An inverse association with increasing age (OR: 0.8, 95% CI: 0.7-0.9) was also seen. The proportion of children with delayed presentation between 2006 and 2016 remained unchanged (p = 0.36), although the median age at presentation over the same time period increased significantly (p < 0.001). Our results indicate the urgency of identifying strategies to improve linkage of perinatally infected ART-naïve children to care, earlier than what is currently observed.
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Affiliation(s)
- Smita Nimkar
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Aarti Kinikar
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Amol Chavan
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | | | - Bharatbhushan Rewari
- Former National Programme Officer, National AIDS Control Organization, New Delhi, India
| | - Amita Gupta
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Vidya Mave
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ivan Marbaniang
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune, India
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Sath S. Does surgical decompression alleviate neglected cauda equina syndromes attributed to lumbar disc herniation and/or degenerative canal stenosis? Surg Neurol Int 2020; 11:278. [PMID: 33033640 PMCID: PMC7538965 DOI: 10.25259/sni_512_2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 08/18/2020] [Indexed: 11/21/2022] Open
Abstract
Background: Most studies recommend urgent decompression (e.g., within 48–72 h) of the symptomatic onset of a cauda equina syndrome. As patients in our area typically underwent >3 months delayed surgery for cauda equina syndromes due to disc disease/stenosis, we asked whether surgery was still worthwhile. Methods: This was a retrospective analysis of 12 patients (2012–2018) who underwent delayed surgical decompression for cauda equina syndromes secondary to lumbar disc herniations and/or degenerative lumbar canal stenosis. Results: After a mean postoperative duration of 8.22 months, nine patients experienced the complete restoration of bladder status; two patients required intermittent self-catheterization, while one patient had some residual symptoms (e.g., urgency but able to void with some difficulty). Conclusion: For 12 patients who originally presented with cauda equina syndrome with complete incontinence, nine exhibited delayed full recovery of bladder function with average of 8.22 months postoperatively. We would, therefore, advise that delayed surgical decompression be offered to these patients, irrespective of the preoperative duration of cauda equina syndromes with complete incontinence.
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Affiliation(s)
- Sulaiman Sath
- Department of Spine Services , Indian Spinal Injuries Centre, New Delhi, India
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Jairath N, Commiskey P, Kaplan A, Paulus YM. FLASH: A Novel Tool to Identify Vision-Threating Eye Emergencies. Int J Ophthalmic Res 2020; 6:336-343. [PMID: 34141947 PMCID: PMC8208706] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Two million patients visit emergency departments due to eye complaints annually in the United States, yet nearly one-quarter of these visits are for non-urgent ocular problems. Other patients often present a significant length of time after the onset of their symptoms, which may cause progression to irreversible vision loss. A major reason for this discrepancy is that many patients are unsure what symptoms constitute eye emergencies. The challenge is helping patients understand what constitutes a vision-threatening eye emergency, as well as the risks and complications that are associated with delaying their visit to the ophthalmologist or Emergency Department. OBJECTIVES To describe relevant literature on incidence, prevalence, presentation times, associated prognoses, risks, and complications of individual vision-threating eye emergencies, and present a novel acronym, FLASH (Floaters and flashes, Loss of vision, Aching pain, Second Image, Help), to better educate patients at risk for these conditions, fostering better symptom recognition and timely care. This manuscript is aimed at reaching public health departments, educational institutions, primary care offices and eye care centers as part of a dedicated patient education effort for vision-threatening eye emergencies. DESIGN / METHODS Narrative overview of the available literature on specific eye conditions presenting with the aforementioned symptoms, synthesizing findings retrieved from searches of computerized databases and authoritative texts. CONCLUSIONS In each condition presented in this article, symptom interval significantly impacts treatment prognoses. The cited literature demonstrates that patients often present late in emergent eye conditions resulting in vision loss.
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Affiliation(s)
- Neil Jairath
- Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall Street, Ann Arbor, MI 48105
| | - Patrick Commiskey
- Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall Street, Ann Arbor, MI 48105
| | - Ariane Kaplan
- Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall Street, Ann Arbor, MI 48105
| | - Yannis M. Paulus
- Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall Street, Ann Arbor, MI 48105
- Department of Biomedical Engineering, University of Michigan, 1000 Wall Street, Ann Arbor, MI 48105
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Abstract
Introduction Deliberate self-harm, including intentional self-poisoning, remains a major health concern in South Africa. Increasing number of cases place a significant burden on our Emergency Centres (EC's). Paracetamol remains the most frequent drug ingested in intentional self-poisoning. As an antidote, N-acetylcysteine (NAC) is very effective in the management of acute cases of paracetamol overdose. However, it shows less efficacy in cases of delayed presentation, where both liver transplant and mortality rates are significantly higher. Case report We present a case of delayed presentation paracetamol overdose. The patient presented in fulminant hepatic failure with encephalopathy, but made a full recovery after being treated with NAC. Discussion This case report highlighted NAC's potential effectiveness in delayed presentations of paracetamol overdose, irrespective of associated fulminant hepatic failure. The effectiveness of NAC in delayed presentations of paracetamol overdose should therefore not be underestimated, and warrants further research.
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Dvir K, Fortuna GMG, Schwartz M. Delayed Presentation of Thymoma-Related Aplastic Anemia: An Unusual Presentation of a Rare Complication. J Hematol 2020; 8:160-164. [PMID: 32300464 PMCID: PMC7155810 DOI: 10.14740/jh557] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 10/07/2019] [Indexed: 11/17/2022] Open
Abstract
A 68-year-old Caucasian man presented with gross hematuria and oral mucosal bleeding. The patient was known to have an anterior mediastinal mass, highly suspicious for thymoma, which was incidentally identified on imaging, 8 years prior. The patient then declined treatment and was lost to follow-up. On presentation, imaging re-demonstrated the anterior mediastinal mass and the patient was found to have profound pancytopenia. Bone marrow biopsy confirmed the diagnosis of aplastic anemia (AA). Despite optimal treatment, the patient expired on day 9 of admission. In this case we report an unusual presentation of thymoma-related AA (TR-AA), a rare complication of thymoma, presenting years after initial diagnosis in a patient with long standing thymoma that was left untreated as per the patient’s wishes. To our best knowledge, this is the first published report where TR-AA presented 8 years after initial diagnosis in a patient with unresected and untreated thymoma.
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Affiliation(s)
- Kathrin Dvir
- Department of Internal Medicine at Mount Sinai Medical Center, Miami Beach, FL, USA
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Hoffman S, Leu CS, Ramjee G, Blanchard K, Gandhi AD, O'Sullivan L, Kelvin EA, Exner TM, Mantell JE, Lince-Deroche N. Linkage to Care Following an HIV Diagnosis in Three Public Sector Clinics in eThekwini (Durban), South Africa: Findings from a Prospective Cohort Study. AIDS Behav 2020; 24:1181-1196. [PMID: 31677039 DOI: 10.1007/s10461-019-02688-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Linkage to care following an HIV diagnosis remains an important HIV care continuum milestone, even in the era of universal ART eligibility. In an 8-month prospective cohort study among 459 (309 women, 150 men) newly-diagnosed HIV-positive individuals in three public-sector clinics in Durban metropolitan region, South Africa, from 2010 to 2013, median time to return to clinic for CD4+ results (linkage) was 10.71 weeks (95% CI 8.52-12.91), with 54.1% 3-month cumulative incidence of linkage. At study completion (9.23 months median follow-up), 26.2% had not linked. Holding more positive outcome-beliefs about enrolling in care was associated with more rapid linkage [adjusted hazard ratio (AHR)each additional belief 1.31; 95% CI 1.05-1.64] and lower odds of never linking [adjusted odds ratio (AOR) 0.50; 95% CI 0.33-0.75]. Holding positive ARV beliefs was strongly protective against never linking to care. Age over 30 years (AHR 1.59; 95% CI 1.29-1.97) and disclosing one's HIV-positive status within 30 days of diagnosis (AHR 1.52; 95% CI 1.10-2.10) were associated with higher linkage rates and lower odds of never linking. Gender was not associated with linkage and did not alter the effect of other predictors. Although expanded access to ART has reduced some linkage barriers, these findings demonstrate that people's beliefs and social relations also matter. In addition to structural interventions, consistent ART education and disclosure support, and targeting younger individuals for linkage are high priorities.
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Affiliation(s)
- Susie Hoffman
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr., Unit 15, New York, NY, 10032, USA.
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
| | - Cheng-Shiun Leu
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr., Unit 15, New York, NY, 10032, USA
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Gita Ramjee
- HIV Prevention Research Unit, South African Medical Research Council, Durban, South Africa
| | - Kelly Blanchard
- Ibis Reproductive Health, Cambridge, MA, USA
- Ibis Reproductive Health, Johannesburg, South Africa
| | - Anisha D Gandhi
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr., Unit 15, New York, NY, 10032, USA
| | - Lucia O'Sullivan
- Department of Psychology, University of New Brunswick, Fredericton, Canada
| | - Elizabeth A Kelvin
- Epidemiology & Biostatistics Program, CUNY Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Theresa M Exner
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr., Unit 15, New York, NY, 10032, USA
| | - Joanne E Mantell
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr., Unit 15, New York, NY, 10032, USA
| | - Naomi Lince-Deroche
- Ibis Reproductive Health, Cambridge, MA, USA
- Ibis Reproductive Health, Johannesburg, South Africa
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Sen P, Gupta N, Mohan A, Shah C, Sen A, Jain E. Causes of delayed presentation of pediatric cataract: A questionnaire-based prospective study at a tertiary eye care center in central rural India. Indian J Ophthalmol 2020; 68:603-607. [PMID: 32174578 PMCID: PMC7210835 DOI: 10.4103/ijo.ijo_872_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 08/28/2019] [Accepted: 10/22/2019] [Indexed: 11/04/2022] Open
Abstract
Purpose To find out the sociodemographic, sociocultural, and socioeconomic factors leading to delay in pediatric cataract surgery and its impact on final visual outcome. Methods A prospective interview-based analytical cohort study was conducted on 156 children aged 0-16 years with either unilateral or bilateral congenital/developmental cataracts. Caregivers were interviewed using a pretested validated questionnaire. Time intervals between recognition by a caregiver to consultation were denoted as Delay-1 and between consultations to surgical intervention as Delay-2. Spearman's rank correlation was used to determine the presence of correlation between causes of delay and visual outcome. Results The mean age of presentation was 7.78 ± 4.34 years. Mothers were the first informant of the problem (n = 110, 70.5%). Out of 156 children, only 8 (5.1%) children presented to the hospital within 1 month by caregivers and 26 (16.7%) children underwent surgery within 2 months of advice. About 22 (14.1%) children had total cumulative delay of 1-6 months, 11 (7%) had delay of 6-12 months, and 115 (73.71%) had delay of >12 months. The most common cause identified for Delay-1 was unawareness in 41 cases (26.28%), however, for Delay-2 major factor responsible was cost (n = 38, 24.35%). The median preoperative visual acuity was 1.31 logMAR and median postoperative visual acuity at 4 weeks was 0.61 logMAR. (P < 0.001) Less age at surgery, upper socioeconomic status, less time delay, and better preoperative vision were positively correlated to better visual outcomes. Conclusion Delay in presentation for childhood cataract surgery remains a significant problem in central rural India. Delay in surgery is multifactorial which includes unawareness, cost, misdiagnosis, self-treatment, distance from the hospital, lack of family support, and poor socioeconomic status.
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Affiliation(s)
- Pradhnya Sen
- Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalaya and Post Graduate Institute of a Ophthalmology, Chitrakoot, Madhya Pradesh, India
| | - Namrata Gupta
- Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalaya and Post Graduate Institute of a Ophthalmology, Chitrakoot, Madhya Pradesh, India
| | - Amit Mohan
- Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalaya and Post Graduate Institute of a Ophthalmology, Chitrakoot, Madhya Pradesh, India
| | - Chintan Shah
- Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalaya and Post Graduate Institute of a Ophthalmology, Chitrakoot, Madhya Pradesh, India
| | - Alok Sen
- Vitreoretina and Uvea, Sadguru Netra Chikitsalaya and Post Graduate Institute of Ophthalmology, Chitrakoot, Madhya Pradesh, India
| | - Elesh Jain
- Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalaya and Post Graduate Institute of a Ophthalmology, Chitrakoot, Madhya Pradesh, India
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Padma M, Kumar N, Nesargi PS, Aruna Kumari BS, Appaji L, Viswanathan A. Epidemiology and clinical features of retinoblastoma: A tertiary care center's experience in India. South Asian J Cancer 2020; 9:56-58. [PMID: 31956625 PMCID: PMC6956589 DOI: 10.4103/sajc.sajc_89_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Retinoblastoma (RB) is a prototype of heritable cancers. It is more common in the lower socioeconomic strata. Delayed presentation significantly reduces the overall outcome. We have analyzed the epidemiological and clinical data of children who were diagnosed with RB between the years 2009 and 2014. Aim: RB being a disease of the poor, delayed presentation is common due to lack of awareness. We have analyzed the epidemiological profile of our patients and tried to establish the link between delayed presentation and the presence of high-risk features. High-risk features are associated with higher chance of metastasis and poor rates of vision salvage in RB. Methodology: Data were collected in a retrospective manner from the patient case files retrieved from the Medical Records Department, Kidwai cancer Institute. The data were analyzed using Excel and SPSS software (IBM Corp. released 2016, IBM SPSS statistics software for Mac OS, version 24, IBM Corp., Armonk, NY). Results: A total of 53 patients were diagnosed with RB in the years 2009–2014. There was a male predominance with 1.2:1 incidence. Bilateral RB was present in 21 cases. The mean age of children with bilateral RB was 2.1 years, against 1.5 years in unilateral cases. High-risk features such as optic nerve invasion, choroidal invasion, intracranial extension, and orbital involvement were found in 12, 6, 5, and 5 eyes, respectively. Bone marrow involvement was detected in 5% and lung metastasis in 2%. Intracranial involvement was found in 10.4% and cerebrospinal fluid positivity in 15%. Children with high-risk features had a significant delay in presentation in comparison to those without high-risk features (P = 0.035). Conclusion: Incidence of metastatic disease and delayed presentation is still high in developing countries. Routine eye examination during vaccination visits can ensure early diagnosis and appropriate referral in many of these children.
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Affiliation(s)
- Maneya Padma
- Department of Pediatric Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Nuthan Kumar
- Department of Pediatric Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Prerana S Nesargi
- Department of Pediatric Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - B S Aruna Kumari
- Department of Pediatric Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - L Appaji
- Department of Pediatric Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Aarthi Viswanathan
- Department of Pediatric Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
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Shivaprasad C, Aiswarya Y, Sridevi A, Anupam B, Amit G, Rakesh B, Annie PA, Anish K. Delayed hypopituitarism following Russell's viper envenomation: a case series and literature review. Pituitary 2019; 22:4-12. [PMID: 30317419 DOI: 10.1007/s11102-018-0915-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE Hypopituitarism (HP) is an uncommon consequence of Russell's viper envenomation (RVE). Delayed hypopituitarism (DHP) presents months to years after recovering from snake bites (SB). The clinical presentation, manifestations, and outcomes of DHP following RVE have not been systematically studied. Here, we present a case series of HP following RVE with delayed diagnosis and conduct a literature review. METHODS We retrospectively reviewed data of eight DHP cases and literature to outline the presentation, manifestations, hormonal profiles, and radiological features of DHP following RVE. RESULTS Three men and five women, with a mean age at diagnosis of 39.5 ± 11.6 years, were included. The mean duration between snake bite (SB) and HP diagnosis was 8.1 ± 3.6 years. Secondary hypothyroidism and hypogonadotropic hypogonadism were present in all patients. Growth hormone deficiency (GHD) and secondary hypocortisolism were present in 6 (75%) patients. Magnetic resonance imaging (MRI) revealed empty sella and partially empty sella in three patients each (75%). The literature review revealed additional 20 DHP cases (mean age at diagnosis 32.4 ± 10.8 years), with 65% of patients being men. Fatigue, reduced libido, and loss of weight were the commonest symptoms among men. Secondary amenorrhea, fatigue, and loss of appetite were common manifestations among women. Acute kidney injury, GHD, secondary hypothyroidism, hypogonadism, and adrenal insufficiency were reported in 75%, 79%, 95%, 100%, and 85% of patients, respectively. CONCLUSIONS DHP is an important complication of RVE, and a delay in its diagnosis is associated with significant morbidity. Patients with RVE should be followed up for a long term to identify DHP.
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Affiliation(s)
- Channabasappa Shivaprasad
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, #82, EPIP Area, Whitefield, Bangalore, Karnataka, 560066, India.
| | - Yalamanchi Aiswarya
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, #82, EPIP Area, Whitefield, Bangalore, Karnataka, 560066, India
| | - Atluri Sridevi
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, #82, EPIP Area, Whitefield, Bangalore, Karnataka, 560066, India
| | - Biswas Anupam
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, #82, EPIP Area, Whitefield, Bangalore, Karnataka, 560066, India
| | - Goel Amit
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, #82, EPIP Area, Whitefield, Bangalore, Karnataka, 560066, India
| | - Boppana Rakesh
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, #82, EPIP Area, Whitefield, Bangalore, Karnataka, 560066, India
| | - Pulikkal A Annie
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, #82, EPIP Area, Whitefield, Bangalore, Karnataka, 560066, India
| | - Kolly Anish
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, #82, EPIP Area, Whitefield, Bangalore, Karnataka, 560066, India
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Martei YM, Vanderpuye V, Jones BA. Fear of Mastectomy Associated with Delayed Breast Cancer Presentation Among Ghanaian Women. Oncologist 2018; 23:1446-1452. [PMID: 29959283 DOI: 10.1634/theoncologist.2017-0409] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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] [Received: 08/21/2017] [Accepted: 04/17/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Breast cancer is the leading cause of cancer mortality among women globally. Most women in Ghana present with advanced stage disease. The aim of this study is to characterize sociocultural factors associated with delayed presentation. MATERIALS AND METHODS Qualitative study (grounded theory, constant comparative method) using individual in-depth interviews with breast cancer patients seen at the Korle Bu Teaching Hospital in Accra, Ghana. Interviews were conducted in English and three local languages. We achieved theoretical saturation with 31 participants. RESULTS The mean length of delay reported by patients was approximately 1 year. Five recurrent themes were related to delayed presentation: (a) Women with a confirmed breast cancer diagnosis delay treatment because of the fear of mastectomy due to self and societal stigma; (b) role of the church as a social support system given the societal stigma associated with breast cancer; (c) study participants expressed some awareness of breast cancer, but with varying depths of breast cancer knowledge encompassing both myths and misconceptions about breast cancer; (d) most patients present late because they do not associate a "painless" breast lump with possible breast malignancy; and (e) delayed presentation linked to significant financial burden associated with breast cancer treatment. CONCLUSION Despite current efforts to increase breast cancer awareness, the fear of mastectomy remains one of the main reasons for delayed presentation. Successful breast cancer education programs will need to be framed within the broader sociocultural dimensions of femininity that address some of the stigma associated with mastectomy reported in the Ghanaian context. IMPLICATIONS FOR PRACTICE Most women in Ghana present with advanced-stage disease. The aim of this study was to characterize sociocultural factors associated with delayed presentation. Although several quantitative studies have been conducted on delays in presentation in sub-Saharan Africa (SSA), this study is one of the few to identify fear of mastectomy as a reason for delayed presentation. Anecdotal data from current clinical experiences in SSA suggest that this is still an issue that has not been adequately reported and addressed in most SSA countries. The research results presented here will hopefully guide health providers and national organizations in designing breast cancer education programs in Ghana and other parts of SSA.
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Affiliation(s)
- Yehoda M Martei
- Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Verna Vanderpuye
- National Center for Radiotherapy and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | - Beth A Jones
- Yale School of Public Health, Yale Comprehensive Cancer Center, New Haven, Connecticut, USA
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Kawano O, Maeda T, Mori E, Yugue I, Ueta T, Shiba K. A Safe Surgical Procedure for Old Distractive Flexion Injuries of the Subaxial Cervical Spine. Asian Spine J 2017; 11:935-42. [PMID: 29279749 DOI: 10.4184/asj.2017.11.6.935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/30/2016] [Accepted: 12/26/2016] [Indexed: 11/08/2022] Open
Abstract
Study Design Retrospective review. Purpose To describe a safe and effective surgical procedure for old distractive flexion (DF) injuries of the subaxial cervical spine. Overview of Literature Surgical treatment is required in old cases when a progression of the kyphotic deformity and/or persistent neck pain and/or the appearance of new neurological symptoms are observed. Since surgical treatment is more complicated and dangerous in old cases than in acute distractive-flexion cases, the indications for surgery and the selection of the surgical procedure must be carefully conducted. Methods To identify a safe and effective surgical procedure, the procedure selected, reason(s) for its selection, and associated neurological complications were investigated in 13 patients with old cervical DF injuries. Results No neurological complications were observed in nine patients (DF stage 2 or 3) who underwent the anterior-posterior-anterior (A-P-A) method and two patients (DF stage 1) who underwent the posterior method. It was initially planned that two patients (DF stage 2) who underwent the P-A method would be treated using the Posterior method alone; however, anterior discectomy was added to the procedure after the development of a severe spinal cord disorder. Conclusions The A-P-A method (anterior discectomy, posterior release and/or partial facetectomy, reduction and instrumentation, anterior bone grafting) is considered to be a suitable surgical procedure for old cervical DF injuries.
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Espina C, McKenzie F, Dos-Santos-Silva I. Delayed presentation and diagnosis of breast cancer in African women: a systematic review. Ann Epidemiol 2017; 27:659-671.e7. [PMID: 29128086 PMCID: PMC5697496 DOI: 10.1016/j.annepidem.2017.09.007] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 08/24/2017] [Accepted: 09/01/2017] [Indexed: 01/07/2023]
Abstract
PURPOSE Africa has low breast cancer incidence rates but high mortality rates from this disease due to poor survival. Delays in presentation and diagnosis are major determinants of breast cancer survival, but these have not been comprehensively investigated in Africa. METHODS MEDLINE, Embase, and Global Health were searched to identify studies reporting on delays in presentation and/or diagnosis of breast cancer published between January 1, 2000 and May 31, 2016. Data were synthesized in narrative, tabular, and graphical forms. Meta-analyses were not possible due to between-study differences in the way delays were reported. RESULTS Twenty-one studies were included in the review. Study-specific average times between symptom recognition and presentation to a health care provider ranged from less than 1 to 4 months in North Africa and from less than 3 to greater than 6 months in sub-Saharan Africa. Study-specific average times from presentation to diagnosis were less than 1 month in North Africa but ranged from less than 3 to greater than 6 months in sub-Saharan Africa. Reported reasons for these delays included patient-mediated (e.g., socioeconomic factors) and health system-mediated factors (e.g., referral pathways). CONCLUSIONS This systematic review revealed marked delays in presentation and diagnosis of breast cancer in Africa. Identification of their drivers is crucial to the development of appropriate control strategies in the continent.
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Affiliation(s)
- Carolina Espina
- International Agency for Research on Cancer (IARC), Lyon, France.
| | - Fiona McKenzie
- International Agency for Research on Cancer (IARC), Lyon, France
| | - Isabel Dos-Santos-Silva
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Abstract
BACKGROUND Delayed presentation of injury cases is common in developing countries like India. It is prudent to study reasons for delayed presentations to focus preventive measures towards responsible factors. Since foot and ankle orthopaedics is in its infancy in India, it was deemed to be worthwhile to study reasons for delayed presentations of foot and ankle injuries. METHODS Retrospective analysis of prospectively collected data from 482 foot and ankle injuries treated at our three foot and ankle centres over past three years was undertaken. Delayed presentation was defined as cases presenting to us at or after 3 weeks of injury, but with complete records. Reasons for delayed presentations were analysed. RESULTS There were ninety eight such cases who fulfilled the delayed presentation criteria and within this group there were twenty different varieties of foot and ankle injuries. Of these twenty six cases were never treated by qualified orthopaedic surgeons and were labelled as direct delayed presentations, and the remaining 72 cases who were treated by qualified orthopaedic surgeons, but could not be diagnosed and presented late, were labelled as indirect delayed presentations. Failure to suspect injury (5 cases) or failure to diagnose injury (67 cases) were reasons for indirect delayed presentations. Failure to diagnose injury on part of clinicians was either due to failure of clinical and radiological analysis (analytical failure - 15 cases) or due to failure to investigate case with further radiological investigations (investigative failure - 10 cases). Forty-two cases had combined failures. CONCLUSIONS In developing countries like India, patients did neglect their foot and ankle injuries and presented late. In fact, by way of delayed diagnosis, clinicians were more responsible for indirect delayed presentations of foot and ankle injuries. This is contrary to the common belief that in developing countries like India, only patients would be solely responsible for delayed presentations after injury. Because delayed diagnosis by clinicians seemed more alarming than delayed presentation by patients, focus of prevention of foot and ankle injuries in developing countries should shift more towards educating clinicians than patients.
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Affiliation(s)
- Rajiv Shah
- Sunshine Global Hospital, Manjalpur unit, Near ICICI bank and Shreyas School, Manjalpur, Vadodara, 390015 India.
| | - Shivam Shah
- Department of Orthopaedics, SSG hospital, Vadodara, 390001 India
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Hajong R, Khongwar D, Komut O, Naku N, Baru K. Spontaneous Enterocutaneous Fistula Resulting from Richter's Hernia. J Clin Diagn Res 2017; 11:PD05-PD06. [PMID: 28969198 DOI: 10.7860/jcdr/2017/27789.10370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 05/30/2017] [Indexed: 11/24/2022]
Abstract
Richter's hernia is due to the entrapment of a part of circumference of the bowel wall. As the bowel continuity is maintained, the patients usually do not have intestinal obstruction. Some patients with Richter's hernia may present with enterocutaneous fistula either spontaneous or due to surgical intervention mistaking the obstructed hernia to be inguinal abscess. This is more so in developing countries due to lack of awareness among the masses or due to the delay in seeking medical attention. Presenting here is a case of a 53-year-old male patient with enterocutaneous fistula which occurred spontaneously and sought medical attention only after about three years of repeated discharge of yellowish fluid from the left inguinal region. Magnetic resonance fistulogram confirmed the diagnosis of enterocutaneous fistula. Laparotomy with resection and primary anastomosis of the fistulous bowel was done. Patient recovered uneventfully without any complications or recurrence.
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Affiliation(s)
- Ranendra Hajong
- Associate Professor, Department of General Surgery, NEIGRIHMS, Shillong, Meghalaya, India
| | - Donkupar Khongwar
- Assistant Professor, Department of General Surgery, NEIGRIHMS, Shillong, Meghalaya, India
| | - Ojing Komut
- Assistant Professor, Department of General Surgery, NEIGRIHMS, Shillong, Meghalaya, India
| | - Narang Naku
- Senior Resident, Department of General Surgery, NEIGRIHMS, Shillong, Meghalaya, India
| | - Kappa Baru
- Senior Resident, Department of General Surgery, NEIGRIHMS, Shillong, Meghalaya, India
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Tan JKH, Goh JCI, Lim JWL, Shridhar IG, Madhavan K, Kow AWC. Delayed Presentation of Acute Cholecystitis: Comparative Outcomes of Same-Admission Versus Delayed Laparoscopic Cholecystectomy. J Gastrointest Surg 2017; 21:840-845. [PMID: 28243979 DOI: 10.1007/s11605-017-3378-1] [Citation(s) in RCA: 7] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 01/23/2017] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Studies have shown that same-admission laparoscopic cholecystectomy (SALC) is superior to delayed laparoscopic cholecystectomy (DLC) for acute cholecystitis (AC). However, no studies have compared both modalities in patients with delayed presentation. The aim of the study was to compare outcomes between SALC and DLC in AC patients with more than 7-day symptom duration. METHODS A retrospective analysis of 83 AC patients who underwent LC after presenting with >7 days of symptoms from June 2010 to June 2015 was performed. Patients were divided into L-SALC and L-DLC, defined as LC performed within the same admission and between 4 and 24 weeks after discharge, respectively. Peri-operative outcomes were evaluated. RESULTS In L-SALC patients, the intra-operative severity was higher (p < 0.001) and median operative time was longer (L-SALC, 107 min (46-220) vs L-DLC, 95 mins (25-186)) (p = 0.048). Conversion rates were also higher in L-SALC than that in L-DLC (L-SALC, 21.4% vs L-DLC, 4.9%) (p = 0.048). While post-operative morbidity was similar, L-SALC was associated with a longer post-operative length of stay as compared to L-DLC (L-SALC, 2 (1-17) vs L-DLC, 1 (1-6)) (p < 0.001). CONCLUSION DLC provides lower conversion rates and shorter length of stay in AC patients presenting beyond 7 days of symptoms. This group of patients should be offered DLC.
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Affiliation(s)
- Jarrod K H Tan
- Division of Hepatopancreaticobiliary Surgery and Liver Transplantation, Department of Surgery, National University Health System Singapore, Singapore, Singapore
| | - Joel C I Goh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Janice W L Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Iyer G Shridhar
- Division of Hepatopancreaticobiliary Surgery and Liver Transplantation, Department of Surgery, National University Health System Singapore, Singapore, Singapore
| | - Krishnakumar Madhavan
- Division of Hepatopancreaticobiliary Surgery and Liver Transplantation, Department of Surgery, National University Health System Singapore, Singapore, Singapore
| | - Alfred W C Kow
- Division of Hepatopancreaticobiliary Surgery and Liver Transplantation, Department of Surgery, National University Health System Singapore, Singapore, Singapore.
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Sellin JN, Moreno A, Ryan SL, Lam SK, Donaruma-Kwoh M, Luerssen TG, Jea A. Children presenting in delayed fashion after minor head trauma with scalp swelling: do they require further workup? Childs Nerv Syst 2017; 33:647-52. [PMID: 28050641 DOI: 10.1007/s00381-016-3332-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 12/20/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE It is common to evaluate children who have sustained minor head trauma with computed tomography (CT) of the head. Scalp swelling, in particular, has been associated with intracranial injury. A subset of patients, however, present in delayed fashion, often days after the head trauma, as soft tissue edema progresses and their caregiver notices scalp swelling. We explore the value of further workup in this setting. METHODS We conducted a retrospective review of a prospectively collected cohort of children ≤24 months of age presenting to the Texas Children's Hospital with scalp swelling more than 24 h following a head trauma. Cases were collected over a 2-year study period from June 1, 2014 to May 31, 2016. RESULTS Seventy-six patients comprising 78 patient encounters were included in our study. The mean age at presentation was 8.8 months (range 3 days-24 months). All patients had noncontrast CT of the head as part of their evaluation by emergency medicine, as well as screening for nonaccidental trauma (NAT) by the Child Protection Team. The most common finding on CT head was a linear/nondisplaced skull fracture (SF) with associated extra-axial hemorrhage (epidural or subdural hematoma), which was found in 31/78 patient encounters (40%). Of all 78 patient encounters, 43 patients (55%) were discharged from the emergency room (ER), 17 patients (22%) were admitted for neurologic monitoring, and 18 patients (23%) were admitted solely to allow further NAT evaluation. Of those patients admitted, none experienced a neurologic decline and all had nonfocal neurologic exams on discharge. No patient returned to the ER in delayed fashion for a neurologic decline. Of all the patient encounters, no patient required surgery. CONCLUSIONS Pediatric patients ≤24 months of age presenting to the ER in delayed fashion with scalp swelling after minor head trauma-who were otherwise nonfocal on examination-did not require surgical intervention and did not experience any neurologic decline. Further radiographic investigation did not alter neurosurgical management in these patients; however, it should be noted that workup for child abuse and social care may have been influenced by CT findings, suggesting the need for the future development of a clinical decision-making tool to help safely avoid CT imaging in this setting.
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Gesesew H, Tsehaineh B, Massa D, Tesfay A, Kahsay H, Mwanri L. The prevalence and associated factors for delayed presentation for HIV care among tuberculosis/HIV co-infected patients in Southwest Ethiopia: a retrospective observational cohort. Infect Dis Poverty 2016; 5:96. [PMID: 27802839 DOI: 10.1186/s40249-016-0193-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 08/31/2016] [Indexed: 01/29/2023] Open
Abstract
Background A delay presentation for human immunodeficiency virus (HIV) patient’s care (that is late engagement to HIV care due to delayed HIV testing or delayed linkage for HIV care after the diagnosis of HIV positive) is a critical step in the series of HIV patient care continuum. In Ethiopia, delayed presentation (DP) for HIV care among vulnerable groups such as tuberculosis (Tb) /HIV co-infected patients has not been assessed. We aimed to assess the prevalence of and factors associated with DP (CD4 < 200 cells/μl at first visit) among Tb/HIV co-infected patients in southwest Ethiopia. Methods A retrospective observational cohort study collated Tb/HIV data from Jimma University Teaching Hospital for the period of September 2010 and August 2012. The data analysis used logistic regression model at P value of ≤ 0.05 in the final model. Results The prevalence of DP among Tb/HIV co-infected patients was 59.9 %. Tb/HIV co-infected patients who had a house with at least two rooms were less likely (AOR, 0.5; 95 % CI: 0.3–1.0) to present late than those having only single room. Tobacco non-users of Tb/HIV co-infected participants were also 50 % less likely (AOR, 0.5; 95 % CI: 0.3–0.8) to present late for HIV care compared to tobacco users. The relative odds of DP among Tb/HIV co-infected patients with ambulatory (AOR, 1.8; 95 % CI, 1.0–3.1) and bedridden (AOR, 8.3; 95 % CI, 2.8–25.1) functional status was higher than with working status. Conclusions Three out of five Tb/HIV co-infected patients presented late for HIV care. Higher proportions of DP were observed in bedridden patients, tobacco smokers, and those who had a single room residence. These findings have intervention implications and call for effective management strategies for Tb/HIV co-infection including early HIV diagnosis and early linkage to HIV care services. Electronic supplementary material The online version of this article (doi:10.1186/s40249-016-0193-y) contains supplementary material, which is available to authorized users.
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Wolf LL, Nijagal A, Flores A, Buchmiller TL. Late-onset hypertrophic pyloric stenosis with gastric outlet obstruction: case report and review of the literature. Pediatr Surg Int 2016; 32:1013-6. [PMID: 27506212 DOI: 10.1007/s00383-016-3955-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2016] [Indexed: 10/21/2022]
Abstract
We report late-onset hypertrophic pyloric stenosis in a 17-year-old female. She presented with abdominal pain and an episode of upper gastrointestinal hemorrhage and subsequently developed gastric outlet obstruction. Work-up revealed circumferential pyloric thickening, delayed gastric emptying, and a stenotic, elongated pyloric channel. Biopsies showed benign gastropathy, negative for Helicobacter pylori, without eosinophilic infiltrates. Botulinum toxin injection provided limited relief. Diagnostic laparoscopy confirmed the hypertrophic pylorus and we performed laparoscopic pyloromyotomy. The patient tolerated the procedure well and had complete symptom resolution at 1-year follow-up. Hypertrophic pyloric stenosis is a rare cause of gastric outlet obstruction in adolescents and may be managed successfully with laparoscopic pyloromyotomy.
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Affiliation(s)
- Lindsey L Wolf
- Department of Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, 1620 Tremont Street, 4th Floor, Suite 4-020, Boston, MA, 02120, USA.
| | - Amar Nijagal
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Alejandro Flores
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, MA, USA
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Kao MJ, Nunez H, Monaghan SF, Heffernan DS, Adams CA, Lueckel SN, Stephen AH. Trauma patients who present in a delayed fashion: a unique and challenging population. J Surg Res 2016; 208:204-210. [PMID: 27993211 DOI: 10.1016/j.jss.2016.09.037] [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] [Received: 04/08/2016] [Revised: 09/13/2016] [Accepted: 09/21/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND A proportion of trauma patients present for evaluation in a delayed fashion after injury, likely due to a variety of medical and nonmedical reasons. There has been little investigation into the characteristics and outcomes of trauma patients who present delayed. We hypothesize that trauma patients who present in a delayed fashion are a unique population at risk of increased trauma-related complications. MATERIALS AND METHODS This was a retrospective review from 2010-2015 at a Level I trauma center. Patients were termed delayed if they presented >24 hours after injury. Patients admitted within 24 hours of their injury were the comparison group. Charts were reviewed for demographics, mechanism, comorbidities, complications and outcomes. A subgroup analysis was done on patients who suffered falls. RESULTS During the 5-y period, 11,705 patients were admitted. A total of 588 patients (5%) presented >24 h after their injury. Patients in the delayed group were older (65 versus 55 y, P < 0.001) and more likely to have psychiatric comorbidities (33% vs. 24%, P = 0.0001) than the control group. They were also more likely to suffer substance withdrawal (8.9% vs. 4.1%, P < 0.001) but had toxicology testing for drugs and alcohol done at significantly lower rates. Patients that presented delayed after falls were similar in age and injury severity score (ISS) but more likely to suffer substance withdrawal when compared to those with falls that presented within 24 hours. Patients with falls that presented delayed had toxicology testing at significantly lower rates than the comparison group. CONCLUSIONS Trauma patients that present to the hospital in a delayed fashion have unique characteristics and are more likely to suffer negative outcomes including substance withdrawal. Future goals will include exploring strategies for early intervention, such as automatic withdrawal monitoring and social work referral for all patients who present in a delayed fashion.
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Affiliation(s)
- Mary J Kao
- Division of Trauma and Surgical Critical Care, Department of Surgery, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Hector Nunez
- Division of Trauma and Surgical Critical Care, Department of Surgery, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Sean F Monaghan
- Division of Trauma and Surgical Critical Care, Department of Surgery, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Daithi S Heffernan
- Division of Trauma and Surgical Critical Care, Department of Surgery, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Charles A Adams
- Division of Trauma and Surgical Critical Care, Department of Surgery, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Stephanie N Lueckel
- Division of Trauma and Surgical Critical Care, Department of Surgery, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Andrew H Stephen
- Division of Trauma and Surgical Critical Care, Department of Surgery, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island.
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Singh V, Bhakta P, Zietak E, Hussain A. Bone cement implantation syndrome: a delayed postoperative presentation. J Clin Anesth 2016; 31:274-7. [PMID: 27185726 DOI: 10.1016/j.jclinane.2016.01.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 01/21/2016] [Accepted: 01/26/2016] [Indexed: 12/17/2022]
Abstract
Bone cement implantation syndrome (BCIS) is a well-known entity but is poorly understood and rarely reported. It is an important cause of perioperative morbidity and mortality in the patient undergoing cemented hip arthroplasty. BCIS is characterized by hypotension, hypoxia, cardiac arrhythmias, and increased pulmonary vascular resistance and can lead to eventual cardiac arrest if not managed properly. We hereby report a case of delayed presentation of BCIS following cemented right hip arthroplasty.
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Affiliation(s)
- Vikash Singh
- Department of Anaesthesia and Intensive care, Beaumont Hospital, Dublin, Ireland.
| | - Pradipta Bhakta
- Department of Anaesthesia and Intensive care, Our Lady of Lourdes Hospital, Drogheda, Ireland.
| | - Edyta Zietak
- Department of Physical Medicine, Wiszia, Zamosc, Poland.
| | - Ashfaq Hussain
- Department of Anaesthesia and Intensive care, Our Lady of Lourdes Hospital, Drogheda, Ireland.
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Ryu B, Kim SB, Choi MK, Kim KD. Radiculopathy as Delayed Presentations of Retained Spinal Bullet. J Korean Neurosurg Soc 2015; 58:393-6. [PMID: 26587197 PMCID: PMC4652004 DOI: 10.3340/jkns.2015.58.4.393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 09/01/2015] [Accepted: 09/03/2015] [Indexed: 11/27/2022] Open
Abstract
Bullet injuries to the spine may cause injury to the anatomical structures with or without neurologic deterioration. Most bullet injuries are acute, resulting from direct injury. However, in rare cases, delayed injury may occur, resulting in claudication. We report a case of intradural bullet at the L3-4 level with radiculopathy in a 30-year-old male. After surgical removal, radicular and claudicating pain were improved significantly, and motor power of the right leg also improved. We report the case of intradural bullet, which resulted in delayed radiculopathy.
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Affiliation(s)
- Bang Ryu
- Department of Neurosurgery, Kyung Hee University Hospital, Seoul, Korea
| | - Sung Bum Kim
- Department of Neurosurgery, Kyung Hee University Hospital, Seoul, Korea
| | - Man Kyu Choi
- Department of Neurosurgery, Kyung Hee University Hospital, Seoul, Korea
| | - Kee D Kim
- Department of Neurosurgery, University of California Davis, CA, USA
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Abstract
Degloving injuries of the male perineum are an uncommon urological emergency often requiring reconstruction. They are usually related to industrial and/or agricultural machinery and tend to involve both the penile shaft and the scrotal skin. Adolescents and young adults are the usual victims. The treatment options commonly employed include the use of the degloved skin either as a flap or more often as a free skin graft, yielding variable results. Other modalities include the use of free split skin grafts or free full thickness skin grafts (FTSG) (Wolfe grafts). We report a case of degloving injury in a 10-year-old child, with injury exclusively affecting the skin of the penile shaft, who presented in the sub-acute phase. Optimization of the wound and subsequent cover of the defect with an FTSG yielded a good outcome and patient satisfaction.
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Affiliation(s)
- O O Onumaegbu
- Department of Surgery, Plastic Surgery Unit, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - O C Okechukwu
- Department of Psychology, University of Nigeria, Nsukka, Nigeria
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Fasunla AJ, Ogunkeyede SA. Factors contributing to poor management outcome of sinonasal malignancies in South-west Nigeria. Ghana Med J 2013; 47:10-15. [PMID: 23661850 PMCID: PMC3645191] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
OBJECTIVE To describe the clinico-pathologic manifestations of sinonasal malignancies, identify the contributing factors to delay in presentation and recommend ways of preventing them in a resource challenged environment. DESIGN A questionnaire based cross sectional descriptive study of patients with sinonasal malignancies between 2006 and 2011. SETTING Hospital based study at the Otorhinolaryngology Department, University College Hospital, Ibadan. PARTICIPANTS 61 patients diagnosed with sinonasal malignancies. MAIN OUTCOME MEASURES Patients demographic and essential medical data were collected with a structured, interviewer assisted questionnaire and results analysed using descriptive statistics. RESULTS There were 28(45.9%) males and 33(54.I %) females; mean age 37years. The common presentations were epistaxis, nasal obstruction and facial asymmetry and 96.7% patients with squamous cell carcinoma presented in advanced disease stage (Stage 3 & 4). Over 47% patients presented a year after onset of symptoms. Factors which included self-medication, wrong advice from relations/friends to consult traditional herbalist or quacks for treatment and traditional & religious beliefs contributed to delay in presentation to hospitals. High cost of medical treatment, unwelcoming attitudes of some hospital staff, lack of confidence in orthodox medicine and proximity to health facilities were reasons given for not considering hospital as the first place to seek medical treatment. CONCLUSION Health education to create awareness of sinonasal malignancies and provision of affordable and accessible health facilities especially in rural areas are recommended ways to encourage patients to present early in hospitals. This will improve the management outcome and quality of life of patients with sinonasal malignancies.
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Affiliation(s)
- A J Fasunla
- Department of Otorhinolaryngology, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria.
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Diven C, Latifi R. Partial liver herniation into the right chest following trauma: a delayed presentation as acute injury managed by laparoscopically assisted mini-thoracotomy. Eur J Trauma Emerg Surg 2011; 37:665-8. [PMID: 26815480 DOI: 10.1007/s00068-011-0153-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Accepted: 08/25/2011] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Traumatic diaphragmatic rupture is a relatively uncommon occurrence, with an incidence of 0.8-5% reported in the literature. The reported percentage of missed diaphragmatic injuries that were discovered later ranges from 12 to 66%. Herniation of the liver through the right diaphragm has been reported in the literature after liver transplantation, and in trauma populations. MATERIALS AND METHODS Here, we report a case of late identification of partial liver herniation into the right chest (8 years post initial injury), due to a recent motor vehicle crash. Thought to be suffering from an acute injury, the patient was taken to the operating room and a laparoscopically assisted mini-thoracotomy was performed. An old diaphragmatic injury was found intraoperatively; laparoscopically assisted mini-thoracotomy was used to repair the diaphragm, and the liver was returned into the abdomen. CONCLUSION Right-sided diaphragmatic laceration, if diagnosed at the time of injury, may be repaired with the minimally invasive technique we describe here.
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Lin MT, Tai WC, Chiu KW, Chou YP, Tsai MC, Hu TH, Lee CM, Changchien CS, Chuah SK. Delayed presentation of intrathoracic esophageal perforation after pneumatic dilation for achalasia. World J Gastroenterol 2009; 15:4461-3. [PMID: 19764103 PMCID: PMC2747072 DOI: 10.3748/wjg.15.4461] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Pneumatic dilation (PD) is considered to be a safe and effective first line therapy for achalasia. The major adverse event caused by PD is esophageal perforation but an immediate gastrografin test may not always detect a perforation. It has been reported that delayed management of perforation for more than 24 h is associated with high mortality. Surgery is the treatment of choice within 24 h, but the management of delayed perforation remains controversial. Hereby, we report a delayed presentation of intrathoracic esophageal perforation following PD in a 48-year-old woman who suffered from achalasia. She completely recovered after intensive medical care. A review of the literature is also discussed.
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Clegg-Lamptey J, Dakubo J, Attobra YN. Why do breast cancer patients report late or abscond during treatment in ghana? A pilot study. Ghana Med J 2009; 43:127-131. [PMID: 20126325 PMCID: PMC2810246] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVES To determine the causes of delayed presentation in breast cancer patients at Korle Bu Teaching Hospital (KBTH), and reasons for patients absconding before and during treatment. DESIGN Questionnaire survey. SETTING Out patient departments and surgical wards of KBTH. PARTICIPANTS Women newly diagnosed with breast cancer and breast cancer patients who previously absconded and were returning for treatment. RESULTS Sixty six newly-diagnosed patients aged between 20 and 84 (mean 44.8, median 43) years and 35 previous absconders aged 20 to 74 (mean 44.5, median 44) years were interviewed. The causes of delayed presentation were: previous medical consultations 26(29.4%), ignorance 19(28.8%), fear of mastectomy 16(24.2%), herbal treatment 13(19.7%), prayer/prayer camps 13(19.7%) and financial incapability 12(18.2%). Fear of mastectomy 20(57.1%), herbal treatment 13(37.1%), financial incapability 11(31.4%) and prayers/prayer camps 10(28.6%) which were prominent causes of late presentation, were the main reasons for absconding. Newly diagnosed patients had duration of symptoms one week to five years (mean 46, median 34 weeks). Those whose lumps were found by clinical breast examination in the community presented to hospital between six weeks to two years (mean 47, median 39 weeks). Married women were more likely to abscond (p=0.001). CONCLUSIONS There are similar reasons for delayed presentation and absconding among Ghanaian patients. These must be addressed in outreach programmes, and patients must be counselled at time of diagnosis. Dealing with the causes of delayed presentation appears more important than attempts to screen for breast cancer, since patients identified through community screening still present late to hospital.
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Affiliation(s)
- J Clegg-Lamptey
- Department of Surgery, University of Ghana Medical School, PO Box 4236, Accra, Ghana
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