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Singh S, Saini R, Mathur R, Sarkar S, Sagar R. The prevalence of depression in people following limb amputation: A systematic review and meta-analysis. J Psychosom Res 2024; 181:111677. [PMID: 38657566 DOI: 10.1016/j.jpsychores.2024.111677] [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: 09/23/2023] [Revised: 04/10/2024] [Accepted: 04/15/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE To estimate the prevalence of depression in people with limb amputation. Additionally, factors affecting the prevalence or pattern of depression following limb amputation were explored. METHODS Systematic literature search to identify all relevant studies assessing prevalence of depression following limb amputations was conducted through following databases: PubMed/ MEDLINE, Scopus, Embase, and Web of Science. Search period was since inception of database till December 2021. Meta-analyses using random-effects model were conducted to estimate pooled prevalence of depression. RESULTS A total of 61 studies comprising 9852 limb amputees were included. Pooled prevalence of depression following limb amputations was 33.85% (95% CI: 27.15% to 40.54%), with significant heterogeneity (I2 = 98.57%; p < 0.001). Sub-group meta-analysis showed that pooled prevalence of depression was significantly higher in studies conducted from middle-income (45.31%, 95% CI: 28.92% to 61.70%) as compared high income countries (28.31%, 95% CI: 23.97% to 32.64%). Greater activity restriction, amputation-related body image disturbances, social discomfort, perceived vulnerability regarding disability, and avoidant coping style were commonly reported factors associated with greater depression symptomatology. Whereas, good perceived social support, and use of more active coping strategies were commonly reported protective factors. CONCLUSION About one-third of all limb amputees suffered from clinically significant depression. This emphasizes need to sensitize health care professionals involved in providing care to people following limb amputation regarding the importance of periodically screening this vulnerable group of patients for depression and liaising with psychiatrists. Further, addressing risk factors identified in this review could help in reducing the rates of depression post-amputation.
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Affiliation(s)
- Swarndeep Singh
- Assistant Professor, Department of Psychiatry, Vardhman Mahavir Medical College & Safdarjung Hospital, Delhi, India.
| | - Romil Saini
- Department of Psychiatry, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rahul Mathur
- Department of Psychiatry, All India Institute of Medical Sciences, Delhi, India
| | - Siddharth Sarkar
- National Drug Dependence Treatment Centre & Department of Psychiatry, All India Institute of Medical Sciences, Delhi, India
| | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, Delhi, India
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Aljohani OI, Almustafa RN, Almalki BT, Allehaibi MH. Non-traumatic bilateral epidural hematoma in a child with sickle cell anemia: A case report and a review of the literature. Childs Nerv Syst 2024; 40:925-931. [PMID: 38010431 DOI: 10.1007/s00381-023-06235-1] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/16/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE To report a rare case of spontaneous bilateral epidural hematoma (EDH) in a 10-year-old Nigerian child with sickle cell disease (SCD) and review the literature regarding this unusual complication. METHODS We present a case of a pediatric patient with SCD who developed a spontaneous bilateral EDH and discuss the potential underlying mechanisms, management approaches, and outcomes. We also conducted a literature review of existing cases of spontaneous EDH in patients with SCD. RESULTS Our patient initially presented with a subgaleal hematoma and underlying bilateral EDH, but she was sent home without any neurosurgical consultation. Two years later, she returned with altered consciousness and left-sided weakness, revealing an increased size of the EDH with a noticeable mass effect. She underwent a successful emergency bilateral craniotomy, with noticeable improvement in her level of consciousness and left-sided weakness post-operatively. In our literature review, we found 40 reported cases of spontaneous EDH in SCD patients, with a male predominance (82.5%). The average age of patients was 15.282 years. The most common hematoma location was bifrontal (20%) and the most reported symptom was headache (47.5%). Most patients (97.5%) were already known cases of SCD. Among those treated, 77.5% survived. CONCLUSION Spontaneous bilateral EDH in SCD patients is an uncommon complication, with a variety of proposed pathophysiological mechanisms. Prompt recognition and appropriate management, either conservative or surgical, are crucial to improve outcomes. Our case and literature review underscore the importance of considering spontaneous EDH in SCD patients presenting with neurological symptoms, even in the absence of trauma. Further research is needed to elucidate the precise etiology, identify risk factors, and optimize management approaches for this rare complication in SCD patients.
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MESH Headings
- Humans
- Child
- Female
- Male
- Adolescent
- Hematoma, Epidural, Cranial/diagnostic imaging
- Hematoma, Epidural, Cranial/etiology
- Hematoma, Epidural, Cranial/surgery
- Craniotomy/adverse effects
- Hematoma, Epidural, Spinal/complications
- Risk Factors
- Anemia, Sickle Cell/complications
- Anemia, Sickle Cell/surgery
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Affiliation(s)
- Omar I Aljohani
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Reem N Almustafa
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Basim T Almalki
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Barua DS, Roy V, Ahmed J, Pandey D, Shah V, Ashraf S, Karim M. Medial Knee Joint Space in Relation to Joint Function and Early Knee Pain in 20-45-Year Adults: A Cross Sectional Study. Indian J Orthop 2023; 57:1640-1645. [PMID: 37766947 PMCID: PMC10519885 DOI: 10.1007/s43465-023-00980-w] [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: 02/01/2023] [Accepted: 08/18/2023] [Indexed: 09/29/2023]
Abstract
Background Anterior knee pain is very common in the young and active age groups but there are no significant studies on the normal population. Therefore, the objective of the study was to understand the relation between medial knee joint space to the development of knee pain and functional disability with special reference to the 20-45-year age group. Materials and methods 250 cases with mean age of 36.36 years presenting with knee pain for at least 1 month were included in this prospective study (July 2021 and June 2022) and were asked to self-complete questionnaires on knee pain which included KNEST, AKPQ, VAS and IPAQ. Patients underwent X-rays of bilateral knees in AP view with weight bearing and then medial and lateral knee joint spaces were calculated. Results There was a higher incidence of knee pain in women compared to men. The average medial and lateral joint space widths (MJSW and LJSW) of the right knee were 4.22 mm and 4.57 mm, respectively. For the left knee it was 4.19 mm and 4.42 mm, respectively. There is a decrease in MJSW with increasing age, level of pain and BMI. Also, with an increase in physical activity, there was a higher incidence of knee pain. Conclusion Overuse injuries are the main cause of knee pain in this age group. There is a significant association between medial joint space width and age, gender, level of pain, and BMI. Rising BMI patterns at a young age, leads to an increase in physical activity, which in turn leads to early knee pain and also predisposes to osteoarthritis.
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Affiliation(s)
- Debanga Sarma Barua
- Department of Orthopaedics, Assam Medical College and Hospital, Dibrugarh, Assam 786002 India
| | - Vishwaroop Roy
- Department of Orthopaedics, Assam Medical College and Hospital, Dibrugarh, Assam 786002 India
| | - Jehirul Ahmed
- Department of Orthopaedics, Assam Medical College and Hospital, Dibrugarh, Assam 786002 India
| | - Devesh Pandey
- Department of Orthopaedics, Assam Medical College and Hospital, Dibrugarh, Assam 786002 India
| | - Vijay Shah
- Department of Orthopaedics, Assam Medical College and Hospital, Dibrugarh, Assam 786002 India
| | - Shuhail Ashraf
- Department of Orthopaedics, Assam Medical College and Hospital, Dibrugarh, Assam 786002 India
| | - Mahmoodul Karim
- Department of Orthopaedics, Assam Medical College and Hospital, Dibrugarh, Assam 786002 India
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Moussa BS, Abd Elatiff ZM, Kamal Eldin Elhadary GM. Survey study of the etiology of non-traumatic altered consciousness in the Emergency Department at Suez Canal University Hospital in Egypt. World J Clin Cases 2023; 11:1310-1317. [PMID: 36926139 PMCID: PMC10013117 DOI: 10.12998/wjcc.v11.i6.1310] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/06/2023] [Accepted: 02/03/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Disorders of consciousness including coma in non-trauma patients can be caused by a wide variety of pathologies affecting the central nervous system. They represent a frequent challenge in emergency medicine and are combined with a very high in-hospital mortality. Hence, early treatment of these patients is vital and increases the likelihood of a good outcome.
AIM To identify the causes of altered consciousness presentation to the Emergency Department at Suez Canal University Hospital.
METHODS This was a descriptive cross-sectional study conducted on 87 patients with acute non-traumatic disturbed level of consciousness (DLOC) at the Emergency Department.
RESULTS The mean age of the studied patients was 60.5 ± 13.6 years. Among them, 60% were males and 40% were females. The most common cause of acute non-traumatic DLOC was systemic infection, such as sepsis and septic shock (25.3%), followed by respiratory causes (24.1%) and neurological causes (18.4%).
CONCLUSION The most common cause of acute non-traumatic DLOC was systemic infections followed by respiratory and neurological causes.
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Affiliation(s)
- Bassant S Moussa
- Emergency Medicine Department, Suez Canal University, Faculty of Medicine, Ismailia 41522, Egypt
| | - Zeinab M Abd Elatiff
- Emergency Medicine Department, Suez Canal University, Faculty of Medicine, Ismailia 41522, Egypt
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Asirdizer M, Besik EZ, Kartal E. Non-traumatic ecchymoses: A literature review from a medico-legal perspective. J Forensic Leg Med 2023; 95:102490. [PMID: 36758310 DOI: 10.1016/j.jflm.2023.102490] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 01/23/2023] [Accepted: 01/27/2023] [Indexed: 02/05/2023]
Abstract
Ecchymosis, as a general term, refers to discoloration of the skin due to the presence of extravasated blood into the dermis and/or subcutaneous tissue. However, it can occasionally be observed without any trauma, as a symptom of disease, a clinical condition, or even during the course of treating a disease. It is extremely important that these non-traumatic lesions are known and recognized and can be distinguished from traumatic ecchymoses by both clinicians and forensic scientists. This review of the literature includes detailed descriptions of non-traumatic periorbital ecchymosis, Slapped Cheek Syndrome, Cullen's Sign, Grey Turner's Sign, Stabler's Sign, Ransohoff Sign, Bryant's Sign, postsacral ecchymosis, perianal ecchymosis, Fox's Sign, other lower leg ecchymosis, and ecchymosis on various body regions. In this article, it is emphasized that failure to correctly identify these findings may subject practitioners to malpractice lawsuits, and failure to correctly identify findings by forensic experts may result in unjust legal judgments against people or loss of rights. It is also this review encourages accurate diagnosis of non-traumatic ecchymoses.
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Kunichika H, Takahama J, Taguchi H, Haga M, Shimoda E, Inoue M, Morimoto K, Marugami N, Tanaka T. The diagnostic challenge of non-traumatic bladder rupture: a pictorial essay. Jpn J Radiol 2023:10.1007/s11604-023-01395-1. [PMID: 36729190 DOI: 10.1007/s11604-023-01395-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 01/13/2023] [Indexed: 02/03/2023]
Abstract
Non-traumatic bladder rupture (NTBR) is relative rare pathology including spontaneous rupture and iatrogenic injury. As increasing the medical intervention for the pelvic malignancy or elderly population, NTBR will be encountered more frequently. There are few previous studies summarizing the imaging features of NTBR. We reviewed imaging characteristics of 18 previous cases of NTBR experienced. In addition, 3 presentative cases that can be a pitfall to differentiate from NTBR. The aim of this article is to clarify the key CT findings of NTBR and its pitfalls.
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Affiliation(s)
- Hideki Kunichika
- Department of Diagnostic and Interventional Radiology, Nara Medical University, 840, Shijo-cho, Kashihara, , Nara, 634-8522, Japan.
| | - Junko Takahama
- Department of Radiology, Higashiosaka City Medical Center, 3-4-5 Nishiiwata, Higashiosaka, Osaka, 578-8588, Japan
| | - Hidehiko Taguchi
- Department of Radiology, Higashiosaka City Medical Center, 3-4-5 Nishiiwata, Higashiosaka, Osaka, 578-8588, Japan
| | - Masayo Haga
- Department of Radiology, Higashiosaka City Medical Center, 3-4-5 Nishiiwata, Higashiosaka, Osaka, 578-8588, Japan
| | - Emiko Shimoda
- Department of Radiology, Higashiosaka City Medical Center, 3-4-5 Nishiiwata, Higashiosaka, Osaka, 578-8588, Japan
| | - Masayoshi Inoue
- Department of Radiology, Higashiosaka City Medical Center, 3-4-5 Nishiiwata, Higashiosaka, Osaka, 578-8588, Japan
| | - Kengo Morimoto
- Department of Radiology, Higashiosaka City Medical Center, 3-4-5 Nishiiwata, Higashiosaka, Osaka, 578-8588, Japan
| | - Nagaaki Marugami
- Department of Diagnostic and Interventional Radiology, Nara Medical University, 840, Shijo-cho, Kashihara, , Nara, 634-8522, Japan
| | - Toshihiro Tanaka
- Department of Diagnostic and Interventional Radiology, Nara Medical University, 840, Shijo-cho, Kashihara, , Nara, 634-8522, Japan
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Sarvari HR, Baigrezaii H, Nazarianpirdosti M, Meysami A, Safari-Faramani R. Comparison of the efficacy of intranasal ketamine versus intravenous ketorolac on acute non-traumatic headaches: a randomized double-blind clinical trial. Head Face Med 2022; 18:1. [PMID: 34980184 PMCID: PMC8722273 DOI: 10.1186/s13005-021-00303-0] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/07/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Non - traumatic headaches are one of the most common causes of referral to hospital emergency. This study aimed to compare the efficacy of intranasal ketamine and intravenous ketorolac on acute non-traumatic headaches. METHODS This randomized and double-blind clinical trial was conducted in 2019. One hundred and forty samples were randomly divided into intranasal ketamine (A) and intravenous ketorolac (B). Group (A) received ketamine intranasal (0.75 mg/kg, max 75 mg), and group B received intravenous ketorolac (30 mg). Headache severity was measured on arrival, 30, 60, and 120 min after intervention with Visual Analogue Scale (VAS). The side effects were recorded an hour after the intervention. RESULT The mean difference of pain intensity 30, 60, and 120 min after the intervention between the two groups was statistically significant (p < 0.001). In the first 30 min, significant changes were observed in the VAS levels of the two groups. These changes were significantly greater in the intranasal ketamine group (p < 0.001). Side effects such as fatigue, dizziness, general discomfort, nausea, increased heart rate, and hypertension were significantly higher in the ketamine group (p < 0.05). CONCLUSION Intranasal ketamine and intravenous ketorolac both effectively reduced headaches. However, more analgesic effects of intranasal ketamine in a short time can be considered as a selective approach to reducing headaches. TRIAL REGISTRATION IRCT20180108038276N3 , Registered 29 September 2019. ETHICS COMMITTEE REFERENCE NUMBER IR.KUMS.REC.1398.068.
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Affiliation(s)
- Hooman Rafiei Sarvari
- Department of Emergency Medicine, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hamidreza Baigrezaii
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Amirhossein Meysami
- Department of Emergency Medicine, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Roya Safari-Faramani
- Department of Epidemiology, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Alito A, Filardi V, Famà F, Bruschetta D, Ruggeri C, Basile G, Stancanelli L, D'Amico C, Bianconi S, Tisano A. Traumatic and non-traumatic spinal cord injury: Demographic characteristics, neurological and functional outcomes. A 7-year single centre experience. J Orthop 2021; 28:62-66. [PMID: 34880567 PMCID: PMC8627899 DOI: 10.1016/j.jor.2021.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 07/02/2021] [Revised: 09/03/2021] [Accepted: 11/17/2021] [Indexed: 01/10/2023] Open
Abstract
Objective The aim of this study is to evaluate demographic and clinical characteristics of a population affected by traumatic and non-traumatic spinal cord injury (SCI) and to analyze functional outcomes after rehabilitation. Methods This study involved 112 SCI patients (75 male and 37 female) admitted at the Neurorehabilitation Unit of the University Hospital of Messina. The neurological outcomes were evaluated according to the American Spinal Injury Association Impairment Scale (AIS) and by using length of stay, Functional Independence Measure (FIM) and Barthel Index (BI). Results NT-SCI patients were significantly older, numerous (75,89%) and affected by greater lesions when admitted, than T-SCI ones. Most of lesions were incomplete (93%) and associated with paraplegia (71%). FIM and BI outcomes are similar in both groups, even if T-SCI patients showed greater improvement when discharged. No significant differences were found in the length of stay. The most common complication in non-traumatic SCI group was urinary tract infection and this was observed in 25 patients (29,41%). Linear regression models explained 26% of the variance of LOS and 38% of the variance of functional outcome. Functional status on admission was the strongest determinant of LOS and completeness of the lesion was the strongest determinant of functional outcome. Etiology (traumatic versus non-traumatic) was a weak independent determinant of LOS but was not an independent determinant of functional outcome. Conclusion SCI patient's rehabilitation should be carried out by taking into account etiology of the injury. It is important to consider this information while developing the targets and planning of the rehabilitation program. In particular, older age negatively influence the degree of disability on admission and the entity of functional recovery in both populations. Non-traumatic lesions could have minor benefits after rehabilitation therapy if compared with traumatic ones.
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Affiliation(s)
- A. Alito
- Unità Operativa Complessa Medicina Fisica e Riabilitativa AOU, Policlinico G. Martino, Italy
| | - V. Filardi
- D.A. Research and Internationalization, University of Messina, Via Consolato Del Mare 41, 98121, Messina, Italy,Corresponding author.
| | - F. Famà
- Unità Operativa Complessa Medicina Fisica e Riabilitativa AOU, University of Messina, Italy
| | - D. Bruschetta
- Unità Operativa Complessa Medicina Fisica e Riabilitativa AOU, University of Messina, Italy
| | - C. Ruggeri
- Unità Operativa Complessa Medicina Fisica e Riabilitativa AOU, Policlinico G. Martino, Italy
| | - G. Basile
- Unità Operativa Complessa Medicina Fisica e Riabilitativa AOU, University of Messina, Italy
| | - L. Stancanelli
- Unità Operativa Complessa Medicina Fisica e Riabilitativa AOU, Policlinico G. Martino, Italy
| | - C. D'Amico
- Unità Operativa Complessa Medicina Fisica e Riabilitativa AOU, Policlinico G. Martino, Italy
| | - S. Bianconi
- Unità Operativa Complessa Medicina Fisica e Riabilitativa AOU, Policlinico G. Martino, Italy
| | - A. Tisano
- Unità Operativa Complessa Medicina Fisica e Riabilitativa AOU, University of Messina, Italy
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Ray STJ, Fuller C, Boubour A, Bonnett LJ, Lalloo DG, Seydel KB, Griffiths MJ. Aetiology and outcome of non-traumatic coma in African children: protocol for a systematic review and meta-analysis. Syst Rev 2021; 10:282. [PMID: 34715918 PMCID: PMC8556005 DOI: 10.1186/s13643-021-01796-1] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 08/20/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Non-traumatic coma is a common acute childhood presentation to healthcare facilities in Africa and is associated with high morbidity and mortality. Historically, the majority of cases were attributed to cerebral malaria (CM). With the recent drastic reduction in malaria incidence, non-malarial coma is becoming a larger proportion of cases and determining the aetiology is diagnostically challenging, particularly in resource-limited settings. The purpose of this study will be to evaluate the aetiology and prognosis of non-traumatic coma in African children. METHODS With no date restrictions, systematic searches of MEDLINE, Embase, and Scopus will identify prospective and retrospective studies (including randomised controlled trials, cluster randomised trials, cohort studies, cross-sectional, and case-control studies) recruiting children (1 month-16 years) with non-traumatic coma (defined by Blantyre Coma Score ≤ 2 or comparable alternative) from any African country. Disease-specific studies will be included if coma is associated and reported. The primary outcome is to determine the aetiology (infectious and non-infectious) of non-traumatic coma in African children, with pooled prevalence estimates of causes (e.g., malaria). Secondary outcomes are to determine overall estimates of morbidity and mortality of all-cause non-traumatic coma and disease-specific states of non-traumatic coma, where available. Random effects meta-analysis will summarise aetiology data and in-hospital and post-discharge mortality. Heterogeneity will be quantified with τ2, I2, and Cochran's Q test. DISCUSSION This systematic review will provide a summary of the best available evidence on the aetiology and outcome of non-traumatic coma in African children. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020141937.
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Affiliation(s)
- Stephen T. J. Ray
- Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, P.O. Box 30096, Chichiri, Blantyre, Malawi
- Blantyre Malaria Project, Blantyre, Malawi
| | - Charlotte Fuller
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, P.O. Box 30096, Chichiri, Blantyre, Malawi
- Blantyre Malaria Project, Blantyre, Malawi
- Leeds Children’s Hospital, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Alexandra Boubour
- Blantyre Malaria Project, Blantyre, Malawi
- Department of Neurology, Columbia University Irving Medical Center, New York, NY USA
| | - Laura J. Bonnett
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | | | - Karl B. Seydel
- Malawi-Liverpool Wellcome Trust Clinical Research Programme, P.O. Box 30096, Chichiri, Blantyre, Malawi
- Blantyre Malaria Project, Blantyre, Malawi
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI USA
| | - Michael J. Griffiths
- Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, Liverpool, UK
- Department of Neurology, Alder Hey Children’s NHS Trust, Liverpool, UK
- National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, UK
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Abstract
INTRODUCTION This report aims to describe the epidemiology, clinical presentation, diagnostic workup, treatment, and rehabilitation, natural course, and possible risk factors of the rare entity spontaneous iliopsoas tendon rupture. METHODS One case of spontaneous iliopsoas tendon rupture was encountered. The patient was followed during the hospital stay, her journal was later reviewed, and one telephone follow-up after 90 days was performed. Structured reviews of the literature in the PudMed and Micromedex databases were performed. RESULTS The patient recovered fully within 6 weeks of conservative treatment with small doses of acetaminophen and opioid. The literature reviews yielded 14 previously reported spontaneous iliopsoas tendon ruptures but no strong evidence regarding possible risk factors. CONCLUSION Spontaneous iliopsoas tendon rupture is a rare event, typically occurring in the elderly female. MRI is generally diagnostic, but signs are also often present on CT scans and sometimes even on plain X-ray. Conservative treatment has an excellent prognosis of full recovery within 6 weeks. The evidence on possible risk factors is scarce and conflicting.
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Affiliation(s)
- Joachim Stark
- Department of Geriatrics, Region Jönköping County, Jönköping, Sweden. .,Department of Health, Medicine and Caring, Linköping University, Linköping, Sweden.
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Scheinfeld MH, Schwartz C, Jain VR, Goldman IA. Non-traumatic hemoperitoneum in the ED setting: causes, characteristics, prevalence and sex differences. Abdom Radiol (NY) 2021; 46:441-448. [PMID: 32766930 DOI: 10.1007/s00261-020-02699-w] [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] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/20/2020] [Accepted: 07/29/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Prevalence and sex differences of non-traumatic hemoperitoneum in the Emergency Department has not been studied in the literature. METHODS Following IRB approval, multiple keyword searches were used to identify all cases of hemoperitoneum over a 55-month period. Cases were reviewed to confirm and quantify the hemoperitoneum. Maximum attenuation was used to grade blood density. Medical records were reviewed to determine cause, interventions and outcomes in each patient. RESULTS Of the 171 verified cases of non-traumatic hemoperitoneum, 76% of cases were in women. CT exams in women were positive for hemoperitoneum 0.25% of the time, while 0.13% were positive in men. Regarding size, 25.7% were large, 24.5% were moderate and 49.7% were small. Contrast-enhanced studies had HU values of 103 ± 19 (range 47-146) which were significantly higher than for non-enhanced studies with values of 82 ± 19 (range 43-121, p < 0.001). The most common cause of non-traumatic hemoperitoneum was ruptured ovarian cyst which was found in 58% of women (76 cases). Of these, 69 patients received observation, 6 patients underwent surgery and 1 patient received Vitamin K. For the 95 non-ovarian cyst cases, 65% patients were admitted and then discharged, 22% were discharged from the ED, 12% expired and 1% were transferred to a different hospital. Post-procedure hemorrhage was the second to most common cause in women (24/130 = 18%) and the most common etiology in men (14/41 = 34%). CONCLUSIONS In women, ovarian cyst rupture was the most common etiology of hemoperitoneum. Post-procedure hemorrhage was second in women and the most common etiology in men. Although unusual causes of hemoperitoneum will be encountered, understanding the most common causes of hemoperitoneum can provide a reasonable starting point when attempting to determine the most likely etiology of hemoperitoneum in any individual patient.
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Affiliation(s)
- Meir H Scheinfeld
- Division of Emergency Radiology, Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210 Street, Bronx, NY, 10467, USA.
| | - Carly Schwartz
- Division of Emergency Radiology, Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210 Street, Bronx, NY, 10467, USA
| | - Vineet R Jain
- Division of Emergency Radiology, Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210 Street, Bronx, NY, 10467, USA
| | - Inessa A Goldman
- Division of Emergency Radiology, Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210 Street, Bronx, NY, 10467, USA
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12
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Nepal P, Ojili V, Tirumani SH, Gunabushanam G, Nagar A. A pictorial review of non-traumatic adrenergic crisis. Emerg Radiol 2020; 27:533-545. [PMID: 32300900 DOI: 10.1007/s10140-020-01777-2] [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: 02/20/2020] [Accepted: 04/01/2020] [Indexed: 10/23/2022]
Abstract
Non-traumatic adrenal crisis is a rare but critical diagnosis to make in emergency settings due to grave consequences. Various pathologies can present as acute crisis, such as spectrum of endocrine imbalance, ranging from catecholamine excess in pheochromocytomas to acute adrenal insufficiency related to glandular dysfunction. Critical manifestations may be due to structural causes related to adrenal hemorrhage, especially when they are bilateral. Oncological complications such as vascular invasion, tumoral bleed, rupture, and hormonal dysfunction can occur. Due to non-specific clinical presentation, these conditions may come as a surprise on imaging performed for other reasons. Recognition of these imaging findings is critical for appropriate patient management. Although there are few articles discussing non-traumatic emergencies in literature, this review is inclusive of all possible etiologies, thus provides a holistic approach and insight into each situation. Specific imaging approach is needed to tailor the diagnosis. This article will also discuss about the advanced imaging techniques that will complement diagnosis.
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Affiliation(s)
- Pankaj Nepal
- St. Vincent's Medical Center, Bridgeport, CT, USA
| | | | - Sree Harsha Tirumani
- University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | | | - Arpit Nagar
- Ohio State University Wexner Medical Center, Columbus, OH, USA
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13
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Lia M, Radosa JC, Younes S, Fiehn A, Buerger T, Mothes A, Aktas B, Radosa MP. Postoperative non-traumatic compartment syndrome (PNCS) in gynecologic surgery. Arch Gynecol Obstet 2020; 301:1013-9. [PMID: 32140808 DOI: 10.1007/s00404-020-05480-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 02/25/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The postoperative non-traumatic compartment syndrome (PNCS) is a rare, but serious postoperative complication. Etiology, risk factors and clinical manifestation of PNCS are not well characterized since data in gynecologic and obstetric patients are limited. METHODS We performed a retrospective monocentric study of patients who underwent surgery for gynecologic or obstetrics conditions and identified five cases of PNCS, which were analyzed and compared to a control cohort in regard of incidence, clinical presentation, risk factors and clinical outcome. RESULTS Five cases of PNCS were identified among 19.432 patients treated between 2008 and 2019 with an incidence rate of 0.026%. The clinical examination was shown to be unreliable, lacking sensitivity in most clinical signs. Young age, obesity and long operation time were risk factors for the development of a PNCS. Fasciotomy for the treatment of a PNCS should not be delayed, since permanent function loss may occur early. CONCLUSION A low threshold of clinical suspicion might be prudent to identify PNCS following gynecologic surgery. In the presence of the described risk factors, any suspicion of a PNCS should be evaluated further and if necessary treated with fasciotomy urgently.
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14
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Bosco A, Uvaraj NR, Ramakrishnan E. Delayed unrelated presentation of a lumbar burst fracture consequent to a remote episode of a single convulsive seizure: A diagnostic challenge. J Clin Orthop Trauma 2020; 11:952-5. [PMID: 32879586 DOI: 10.1016/j.jcot.2020.06.043] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/23/2020] [Accepted: 06/27/2020] [Indexed: 11/27/2022] Open
Abstract
UNLABELLED Non-traumatic vertebral fractures occurring as a sole consequence of the violent muscle forces generated during the first episode of a GTCS(generalized tonic clonic seizure) in a previously healthy non-epileptic individual are very rare. Being clinically asymptomatic they are easily overseen at the time of initial presentation due to their rarity of occurrence and the presence of potentially distracting factors in the post-ictal phase. We present a 52-year-old healthy non-epileptic male who presented with unrelenting back pain and neurodeficit secondary to a four-month-old unstable burst fracture of the first lumbar vertebra sustained during an isolated single episode of a witnessed GTCS. A detailed inquiry revealed no history of a significant traumatic event either during the convulsive episode or thereafter. A meticulous history taking, a thorough clinical and neurological examination combined with a comprehensive radiological evaluation established the unusual etiology of the fracture and the presence of a thoracolumbar kyphotic deformity with compression of conus medullaris. A detailed neurological, and laboratory work-up, confirmed no attributable organic or metabolic cause for the seizure. His BMD(Bone Mineral Density) was normal. Patient was managed with posterior instrumented deformity correction by a posterior column shortening osteotomy, neural decompression and fusion of D12-L1 facets. Patient had complete neurological recovery with good clinical and functional outcomes at 28-months follow-up. A few cases of seizure-induced non-traumatic spinal fractures have been published in literature. A majority of these fractures occurred in individuals with either seizure-provoking risk factors (epileptics with recurrent seizures, brain tumors, drug overdose/withdrawal, metabolic disorders, or electrolyte imbalance) or in those with an increased susceptibility to fracture due to decreased BMD. This case demonstrates the rare occurrence of a non-traumatic vertebral fracture during the first episode of a GTCS in an otherwise healthy non-epileptic individual with normal BMD and no seizure-provoking risk factors. This is the first case report of a delayed unrelated presentation of a non-traumatic lumbar vertebral fracture with complications (spinal deformity and neurodeficit) consequent to a remote episode of a single convulsive seizure. It emphasizes the need for a high index of clinical suspicion,a meticulous history taking, thorough musculoskeletal and neurological examination in any individual presenting with a seemingly benign back pain following a remote isolated episode of seizure, even in the absence of overt trauma. A detailed radiological evaluation guided by a meticulous history taking and detailed clinical examination is essential to rule out a fracture unless proven otherwise. It also shows that a single convulsive seizure can result in a potentially unstable fracture that when neglected, can result in devastating complications like spinal deformity and neurodeficit. LEVEL OF EVIDENCE Level IV.
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15
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Samuk I, Seguier-Lipszyc E, Baazov A, Tamary H, Nahum E, Steinberg R, Freud E. Emergency or urgent splenectomy in children for non-traumatic reasons. Eur J Pediatr 2019; 178:1363-7. [PMID: 31312939 DOI: 10.1007/s00431-019-03424-6] [Citation(s) in RCA: 5] [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: 04/08/2019] [Revised: 06/09/2019] [Accepted: 07/02/2019] [Indexed: 12/22/2022]
Abstract
Emergency splenectomy is rarely performed since a widespread consensus exists towards conservative management of splenic injury. However, in selected conditions, mainly hematological, there is a role for emergency or urgent splenectomy. This study aims to retrospectively review these cases and discuss outcome in relation to the pre-existing splenic pathologies. Between 2000 and 2015, 12 patients, five girls, and seven boys, with a median age of six years (3 months-13.11 years), underwent emergency or urgent splenectomy for non-traumatic conditions. All patients had major associated disorders; mainly hematological (11 cases) including hemolytic anemia with pancytopenia (1), sickle cell anemia (1), AML (1), ALL (2), CML (1), T cell lymphoma (1), Burkitt lymphoma (1), and ITP (3). One patient had a microvillous inclusion disease. Indications for splenectomy included diffuse resistant splenic abscesses (4), intracranial hemorrhage (4) or hypersplenism (3) with refractory thrombocytopenia, and spontaneous splenic rapture (1). Nine patients improved following surgery but three died, owing to massive intracranial hemorrhage (1) and severe respiratory failure (2) despite aggressive management.Conclusions: Rarely, an emergency splenectomy is required in complex settings, mostly refractory hematological conditions, in a deteriorating patient when all other measurements have failed. A multidisciplinary team approach is mandatory in the treatment of these complex cases. What is known • Conservative treatment is advised for splenic injury. • Many hematological disorders are responsible of splenic pathology. What is new • Emergency splenectomy in children for reasons other than trauma is a treatment of last resort that should be performed in a multidisciplinary context. • The outcome of emergency splenectomy in children for reasons other than trauma depends on the underlying medical condition.
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16
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Nepal P, Ojili V, Sapire JM, Katkar A, Baxi A, Nagar A. Imaging of non-traumatic urinary bladder emergencies. Emerg Radiol 2019; 26:675-682. [PMID: 31280426 DOI: 10.1007/s10140-019-01703-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 05/24/2019] [Accepted: 06/28/2019] [Indexed: 12/17/2022]
Abstract
Non-traumatic urinary bladder emergencies are rare but critical diagnoses to make in an emergency setting. Acute urinary bladder pathologies require an accurate and timely diagnosis to ensure a favorable clinical outcome. Multidetector computed tomography (CT) is the imaging modality of choice for acute and emergent conditions affecting the urinary bladder. MRI is helpful as a problem-solving modality due to better soft tissue characterization and higher in-plane resolution. The purpose of this article is to illustrate the spectrum of urinary bladder emergencies, review the imaging findings, and briefly describe the role of imaging in the evaluation of such patients. Although there are a few cases of bladder emergencies been reported separately, the literature summarizing the spectrum is lacking. The objective of this article is to review the imaging of acute emergencies involving urinary bladder that will help us to think beyond non-specific conclusion in an emergency setting. For the sake of focused discussion, traumatic bladder emergencies will be excluded in this review. In the era of highly image reliant clinical practice, radiologists must be familiar with the diagnostic strategy to approach these entities.
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Affiliation(s)
- Pankaj Nepal
- Department of Radiology, St. Vincent's Medical Center, Bridgeport, CT, USA
| | - Vijayanadh Ojili
- Department of Radiology, University of Texas Health, San Antonio, TX, USA.
| | - Joshua M Sapire
- Department of Radiology, St. Vincent's Medical Center, Bridgeport, CT, USA
| | - Amol Katkar
- Department of Radiology, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - Ameya Baxi
- Department of Radiology, University of Texas Health, San Antonio, TX, USA
| | - Arpit Nagar
- Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH, USA
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17
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Rai S, Zhang Q, Tamang N, Jin S, Wang H, Meng C. Arthroscopic arthrolysis of posttraumatic and non-traumatic elbow stiffness offers comparable clinical outcomes. BMC Musculoskelet Disord 2019; 20:285. [PMID: 31200682 PMCID: PMC6570887 DOI: 10.1186/s12891-019-2666-1] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 06/05/2019] [Indexed: 12/16/2022] Open
Abstract
Background Primary purpose of this study is to compare the clinical outcomes of patients undergoing arthroscopic arthrolysis in posttraumatic and non-traumatic elbow stiffness. Secondary aims are to compare the level of satisfaction and complications. Methods We retrospectively evaluated the patients undergoing arthroscopic elbow arthrolysis between January 2008 and September 2015 and have completed a minimum 2-year follow-up. Total of 141 patients (male = 90; female = 51) with 143 elbows (posttraumatic, n = 75; non-traumatic, n = 68) with an average age of 33 years were available for final evaluation. The average follow-up period was 44 months. We used the Mayo Elbow Performance Index (MEPI) score, range of motion (ROM), Visual Analogue Scale (VAS) to measure clinical outcomes. The level of satisfaction was measured by a self-constructed questionnaire. Results All parameters were significantly improved postoperatively (P < 0.01). However, statistically significant differences were not present in the rate of postoperative improvement of elbow ROM (P = 0.08) and MEPI (P = 0.21) in both groups. According to MEPI, 72(96%) elbows in posttraumatic and 60(88%) elbows in non-traumatic group were rated as good to excellent. No statistically significant differences were observed in the level of satisfaction (P = 0.76) and rate of complications (P = 0.91). Conclusions Arthroscopic arthrolysis is an effective tool and a good option for the treatment of patients with posttraumatic and non-traumatic elbow stiffness. The rate of elbow ROM and MEPI score improvements were significant and comparable postoperatively with a high level of patient’s satisfaction. However, postoperative rehabilitation is equally essential to maintain intraoperative elbow ROM, to attain optimal outcome and to prevent complications.
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Affiliation(s)
- Saroj Rai
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Department of Orthopaedics, National Trauma Center, National Academy of Medical Sciences, Kathmandu, Nepal
| | - Qimin Zhang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Nira Tamang
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Norvic International Hospital, Kathmandu, Nepal
| | - Shengyang Jin
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Hong Wang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Chunqing Meng
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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18
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Christian RA, Hartwell MJ, Lee KY, Nicolay RW, Johnson DJ, Selley RS, Terry MA, Tjong VK. Risk factors for complications following decompression of non-traumatic compartment syndrome. J Orthop 2019; 16:386-389. [PMID: 31110399 DOI: 10.1016/j.jor.2019.04.017] [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: 02/17/2019] [Accepted: 04/15/2019] [Indexed: 10/26/2022] Open
Abstract
Purpose To investigate the rate of and risk factors for complications following non-traumatic compartment syndrome decompression. Methods The National Surgical Quality Improvement Program database was queried from 2006 to 2016 for non-traumatic compartment syndrome diagnosis codes. Multivariate analysis was performed to identify risk factors for 30-day complications and hospital readmissions. Results Overall complication, major complication, minor complication, and hospital readmission rates were 4.5%, 2.5%, 2.3%, and 2.0%, respectively. Active smoking was identified as a risk factor for post-operative complication (95%CI 1.19-9.24). Conclusion The complication profile of non-traumatic compartment syndrome decompression is higher than that of traditional elective orthopaedic surgery. Level of evidence IV.
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Affiliation(s)
- Robert A Christian
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Matthew J Hartwell
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kenneth Y Lee
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Richard W Nicolay
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Daniel J Johnson
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ryan S Selley
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael A Terry
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Vehniah K Tjong
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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19
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Ben Yehuda A, Nyska A, Szold A. Mesh fixation using novel bio-adhesive coating compared to tack fixation for IPOM hernia repair: in vivo evaluation in a porcine model. Surg Endosc 2019; 33:2364-75. [PMID: 31069501 DOI: 10.1007/s00464-019-06806-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 04/29/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Mesh fixation in hernia repair is currently based on penetrating sutures or anchors, with proven early and late complications such as pain, adhesions, erosions, and anchor migration. In an attempt to reduce these complications, a bio-adhesive-based self-fixation system was developed. The purpose of this study was to assess the performance and safety of this novel self-adhesive mesh (LifeMesh™) by comparing it with standard tack fixation. METHODS A full-thickness abdominal wall defect was created bilaterally in 24 pigs. The defects were measured 14 days later, and laparoscopic intraperitoneal onlay mesh (IPOM) repairs were performed. In each animal, both LifeMesh and a titanium tack-fixed control, either uncoated polypropylene mesh (PP) or composite mesh (Symbotex™), were used. After 28 and 90 days, we performed macroscopic evaluation and analyzed the fixation strength, shrinkage, adhesion scores, and histopathology in all samples. RESULTS Measurements at both time points revealed that LifeMesh had fully conformed to the abdominal wall, and that its fixation strength was superior to that of the tack-fixated Symbotex and comparable to that of the tack-fixated PP. Shrinkage in all groups was similar. Adhesion scores with LifeMesh were lower than with PP and comparable with Symbotex at both time points. Histology demonstrated similar tissue responses in LifeMesh and Symbotex. Lack of necrosis, mineralization, or exuberant inflammatory reaction in all three groups pointed to their good progressive integration of the mesh to the abdominal wall. By 28 days the bio-adhesive layer in LifeMesh was substantially degraded, allowing a gradual tissue ingrowth that became the main fixation mode of this mesh to the abdominal wall. CONCLUSIONS The excellent incorporation of LifeMesh to the abdominal wall and its superior fixation strength, together with its low adhesion score, suggest that LifeMesh may become a preferred alternative for abdominal wall repair.
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20
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Dyson K, Palan J, Mangwani J. Bilateral non-traumatic lower leg fascial defects causing peroneal muscle herniation and novel use of a GraftJacket to repair the fascial defect. J Clin Orthop Trauma 2019; 10:879-883. [PMID: 31528061 PMCID: PMC6739491 DOI: 10.1016/j.jcot.2018.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 06/22/2018] [Revised: 08/20/2018] [Accepted: 09/19/2018] [Indexed: 11/30/2022] Open
Abstract
Constitutional bilateral defects in the peroneal fascial compartment leading to muscle herniation are extremely rare. We present the case of a twenty-nine year old male carpenter with non-traumatic bilateral peroneal fascial defects, in which the symptomatic right side was successfully repaired using a GraftJacket®. This case report highlights the need for clinicians to remain aware of the diagnosis of muscle herniation as a cause of a painful mass in the lower limbs, especially when related to exercise. The judicious use of further imaging such as ultrasound in combination with MRI can be useful in differentiating a muscle hernia from other more sinister causes, such as malignancy.
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Affiliation(s)
- Kathryn Dyson
- Corresponding author. Academic Team of Musculoskeletal Surgery, Leicester General Hospital, Gwendolin Road, Leicester, LE5 4PW, England, UK.
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21
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Gransjøen AM, Wiig S, Lysdahl KB, Hofmann BM. Development and conduction of an active re-implementation of the Norwegian musculoskeletal guidelines. BMC Res Notes 2018; 11:785. [PMID: 30390703 PMCID: PMC6215611 DOI: 10.1186/s13104-018-3894-4] [Citation(s) in RCA: 2] [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: 08/24/2018] [Accepted: 10/27/2018] [Indexed: 11/10/2022] Open
Abstract
Objective Significant geographical variations in the use of diagnostic imaging have been demonstrated in Norway and elsewhere. Non-traumatic musculoskeletal conditions is one area where this has been demonstrated. A national musculoskeletal guideline was implemented in response by online publishing and postal dissemination in Norway in 2014 by national policy makers. The objective of our study was to develop and conduct an intervention as an active re-implementation of this guideline in one Norwegian county to investigate and facilitate guideline adherence. The development and implementation process is reported here, to facilitate understanding of the future evaluation results of this study. Results The consolidated framework for implementation research guided the intervention development and implementation. The implementation development was also based on earlier reported success factors in combination with interviews with general practitioners and radiologists regarding facilitators and barriers to guideline adherence. A combined implementation strategy was developed, including educational meetings, shortening of the guideline and easier access. All the aspects of the implementation strategy were adapted towards general practitioners, radiological personnel and the Norwegian Labor and Welfare Administration. Sixteen educational meetings were held, and six educational videos were made for those unable to attend, or where meetings could not be held. Electronic supplementary material The online version of this article (10.1186/s13104-018-3894-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ann Mari Gransjøen
- Department of Health Sciences in Gjøvik, Norwegian University of Science and Technology in Gjøvik (NTNU), Teknologiveien 22, 2815, Gjøvik, Norway.
| | - Siri Wiig
- Faculty of Health Sciences, SHARE-Centre for Resilience in Healthcare, University of Stavanger, Kjell Arholmsgate 41, 4036, Stavanger, Norway
| | - Kristin Bakke Lysdahl
- Department of Optometry, Radiography and Lighting Design, Faculty of Health Sciences, University of South-Eastern Norway, PO Box 235, 3603, Kongsberg, Norway
| | - Bjørn Morten Hofmann
- Department of Health Sciences in Gjøvik, Norwegian University of Science and Technology in Gjøvik (NTNU), Teknologiveien 22, 2815, Gjøvik, Norway.,Center for Medical Ethics, University of Oslo, PO Box 1130, Blindern, 0318, Oslo, Norway
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22
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van Egmond PW, Vermeulen MC, van Dijke CF, Graat HCA. Superior dislocation of the patella: a pathognomonic finding and review of literature. Skeletal Radiol 2017; 46:259-264. [PMID: 27915446 DOI: 10.1007/s00256-016-2540-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 01/13/2016] [Revised: 08/13/2016] [Accepted: 08/21/2016] [Indexed: 02/02/2023]
Abstract
A 59-year-old woman with a painful right knee that became locked in extension after a trivial trauma was seen at the emergency room. This was caused by unloaded hyperextension in bed. She was diagnosed with a superior dislocation of the patella. A closed reduction was performed, but a recurrent episode was seen within a week. An arthroscopy was performed, in which the causative osteophytes were removed. In the 12-month follow-up after treatment, no recurrence was seen. A superior dislocation of the patella is caused by patellofemoral osteophytes that interlock. This can cause a degenerative knee to become locked in extension. Beside interlocking osteophytes of the patella and the distal femur, the superior part of the patella is tilted away from the femur. This is caused by the pull of the patella tendon and the simultaneous relaxation of the quadriceps tendon. This is a pathognomonic finding on radiographs that, to the best of our knowledge, has been identified but not been appreciated as such in previous reports. As illustrated in this report, a superior dislocation of the patella can easily be recognized on physical examination and radiographic imaging alone when familiar with the specific abnormalities. This will reduce unnecessary diagnostic imaging studies and delay in treatment. This case report illustrates a recurrent case of superior dislocation of the patella. We summarize and evaluate previous reports, discuss trauma mechanisms, physical examination, classification, and treatment including recurrent cases. After reading this case report the reader will be able to diagnose a superior dislocation of the patella with near certainty on physical examination and radiographic imaging of the knee alone.
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Affiliation(s)
- P W van Egmond
- Department of Orthopedic Surgery, VU Medical Centre Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - M C Vermeulen
- Department of Radiology, Medical Centre Alkmaar, Alkmaar, The Netherlands
| | - C F van Dijke
- Department of Radiology, Medical Centre Alkmaar, Alkmaar, The Netherlands
| | - H C A Graat
- Department of Orthopedic Surgery, Medical Centre Alkmaar, Alkmaar, The Netherlands
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Iorio-Morin C, Blanchard J, Richer M, Mathieu D. Tranexamic Acid in Chronic Subdural Hematomas (TRACS): study protocol for a randomized controlled trial. Trials 2016; 17:235. [PMID: 27150916 PMCID: PMC4857422 DOI: 10.1186/s13063-016-1358-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [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: 11/11/2015] [Accepted: 04/13/2016] [Indexed: 01/20/2023] Open
Abstract
Background Chronic subdural hematoma (CSDH) is one of the most frequent reason for cranial neurosurgical consultation. There is no widely accepted medical treatment for this condition. Herein, we present the protocol for the Tranexamic Acid (TXA) in Chronic Subdural Hematomas (TRACS) trial aiming at determining whether TXA can increase the rate of CSDH resolution following conservative management, lower the number of required surgical procedures and decrease the rate of CSDH recurrence following surgical evacuation. Methods TRACS is a multicenter, double-blind, randomized, parallel-design, placebo-controlled, phase IIB study designed to provide preliminary efficacy data as well as feasibility, safety and incidence data required to plan a larger definitive phase III trial. Consecutive patients presenting with a diagnosis of chronic subdural hematoma will be screened for eligibility. Exclusion criteria include: specific risk factors for thromboembolic disease, anticoagulant use or contraindication to TXA. A total of 130 patients will be randomized to receive either 750 mg of TXA daily or placebo until complete radiological resolution of the CSDH or for a maximum of 20 weeks. CSDH volume will be measured on serial computed tomography (CT) scanning. Cognitive function tests, quality of life questionnaires as well as functional autonomy assessments will be performed at enrollment, at 10 weeks following randomization and at 3 months following treatment cessation. During the treatment period, patients will undergo standard CSDH management with surgery being performed at the discretion of the treating physician. If surgery is performed, the CSDH and its outer membrane will be sampled for in vitro analysis. The primary outcome is the rate of CSDH resolution by 20 weeks without intervening unplanned surgical procedure. Secondary outcomes include: CSDH volume, incidence of surgical evacuation procedures, CSDH recurrence, cognitive functions, functional autonomy, quality of life, incidence of complications and length of hospital stay. Planned subgroup analyses will be performed for conservatively versus surgically managed subjects and highly versus poorly vascularized CSDH. Discussion CSDH is a frequent morbidity for which an effective medical treatment has yet to be discovered. The TRACS trial will be the first prospective study of TXA for CSDH. Trial registration NCT ID: NCT02568124. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1358-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christian Iorio-Morin
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier Universitaire de Sherbrooke, 3001, 12e avenue Nord, Sherbrooke, QC, J1H 5N4, Canada.
| | - Jocelyn Blanchard
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier Universitaire de Sherbrooke, 3001, 12e avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Maxime Richer
- Department of Pathology, Centre Hospitalier Universitaire de Sherbrooke, 3001, 12e avenue Nord, Sherbrooke, QC, J1H 5N4, Canada
| | - David Mathieu
- Division of Neurosurgery, Department of Surgery, Centre Hospitalier Universitaire de Sherbrooke, 3001, 12e avenue Nord, Sherbrooke, QC, J1H 5N4, Canada.,Centre de recherche du CHUS, Sherbrooke, QC, Canada
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Hettige S, Sofela A, Bassi S, Chandler C. A review of spontaneous intracranial extradural hematoma in sickle-cell disease. Acta Neurochir (Wien) 2015; 157:2025-9; discussion 2029. [PMID: 26374442 DOI: 10.1007/s00701-015-2582-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 09/03/2015] [Indexed: 10/23/2022]
Abstract
Sickle-cell disease is common among patients of Afro-Caribbean origin. Though it can precipitate neurological conditions, it only rarely causes neurosurgical problems, with very few reported cases. We describe the case of a 7-year-old girl with a background of sickle-cell disease (SCD) brought into an acute neurosurgical unit in extremis, signs of a raised ICP, and with no history of recent trauma. Following further investigations, an acute drop in the hemoglobin and hematocrit levels were noted, with the cause of her presentation being attributed to a sickling crisis causing skull convexity infarction and resulting in spontaneous bilateral extradural hematomas requiring emergency evacuation. We review the current literature and propose the pathophysiological mechanism behind this phenomenon.
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Reimer P, Vosshenrich R, Storck M. [Acute aortic diseases. Diagnostic imaging and therapy]. Radiologe 2015; 55:803-15, quiz 816. [PMID: 26336960 DOI: 10.1007/s00117-015-0010-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Diagnostic imaging is crucial in the work-up of acute aortic diseases. Current imaging algorithms enable radiologists differentiating the various entities with subsequent clinically relevant treatment options. Within this educational overview we focus on non-traumatic acute aortic disease. Recent developments of cross sectional imaging are summarized. As for acute aortic disease, we discuss dissections, intramural hematoma, penetrating aortic ulcer, and aortitis. Current treatment options are presented.
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Affiliation(s)
- P Reimer
- Institut für diagnostische und interventionelle Radiologie, Klinikum Karlsruhe, Moltkestraße 90, 79133, Karlsruhe, Deutschland.
| | - R Vosshenrich
- Praxis für moderne Schnittbild-Diagnostik, Bahnhofsallee 1d, 37081, Göttingen, Deutschland
| | - M Storck
- Klinik für Gefäß- und Thoraxchirurgie, Klinikum Karlsruhe, Moltkestraße 90, 79133, Karlsruhe, Deutschland
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El Bardouni A, Boufettal M, Zouaidia F, Kharmaz M, Berrada MS, Mahassini N, El Yaacoubi M. Non-traumatic myositis ossificans circumscripta: A diagnosis trap. J Clin Orthop Trauma 2014; 5:261-5. [PMID: 25983509 PMCID: PMC4264036 DOI: 10.1016/j.jcot.2014.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [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: 06/05/2014] [Accepted: 09/19/2014] [Indexed: 11/24/2022] Open
Abstract
Myositis ossificans circumscripta (MOC) is a benign condition of non-neoplastic heterotopic bone formation in the muscle or soft tissue. Trauma plays a role in the development of MOC, thus, non-traumatic MOC is very rare. Although MOC may occur anywhere in the body, the lesions are localized predominantly in the high-risk sites of injury, such as the thigh, buttock, and elbow. MOC can easily be mistaken for osteomyelitis or a malignant tumor, specifically osteosarcoma or soft-tissue sarcoma. We report a rare case of non-traumatic myositis ossificans circumscripta of thigh which appear clinically and radiologically as a malignant neoplasm. Despite its rarity, MOC should be contemplated in the differential diagnosis of malignant tumors.
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Affiliation(s)
- Ahmed El Bardouni
- Department of Orthopedic Surgery, Ibn Sina Hospital, University Mohamed V, Rabat, Morocco
| | - Monsef Boufettal
- Department of Orthopedic Surgery, Ibn Sina Hospital, University Mohamed V, Rabat, Morocco
| | - Fouad Zouaidia
- Department of Pathological Anatomy, Ibn Sina Hospital, University Mohamed V, Rabat, Morocco
| | - Mohamed Kharmaz
- Department of Orthopedic Surgery, Ibn Sina Hospital, University Mohamed V, Rabat, Morocco
| | - Mohamed S. Berrada
- Department of Orthopedic Surgery, Ibn Sina Hospital, University Mohamed V, Rabat, Morocco
| | - Najat Mahassini
- Department of Pathological Anatomy, Ibn Sina Hospital, University Mohamed V, Rabat, Morocco
| | - Moradh El Yaacoubi
- Department of Orthopedic Surgery, Ibn Sina Hospital, University Mohamed V, Rabat, Morocco
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Kornhall DK, Dolven T. Resuscitative thoracotomies and open chest cardiac compressions in non-traumatic cardiac arrest. World J Emerg Surg 2014; 9:54. [PMID: 25352911 PMCID: PMC4210589 DOI: 10.1186/1749-7922-9-54] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 03/25/2014] [Accepted: 10/02/2014] [Indexed: 11/10/2022] Open
Abstract
Since the popularisation of closed chest cardiac compressions in the 1960s, open chest compressions in non-traumatic cardiac arrest have become a largely forgotten art. Today, open chest compressions are only rarely performed outside operating theatres. Early defibrillation and high quality closed chest compressions is the dominating gold standard for the layman on the street as well as for the resuscitation specialist. In this paper we argue that the concept of open chest direct cardiac compressions in non-traumatic cardiac arrest should be revisited and that it might be due for a revival. Numerous studies demonstrate how open chest cardiac compressions are superior to closed chest compressions in regards to physiological parameters and outcomes. Thus, by incorporating resuscitative thoracotomies and open chest compressions in our algorithms for non-traumatic cardiac arrest we may improve outcomes.
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Affiliation(s)
- Daniel Kristoffer Kornhall
- Department of Anaesthesiology, University Hospital of North Norway, Sykehusveien 38, Tromsoe, 9038 Norway
| | - Thomas Dolven
- Department of Anaesthesiology, Haukeland University Hospital, Bergen, Norway
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