scholarly journals Adult-onset presentation of cervicothoracic split cord malformation: illustrative case

2021 ◽  
Vol 2 (13) ◽  
Author(s):  
Huei Ti Soh
Keyword(s):  
Hip Osteoarthritis ◽  
Tertiary Hospital ◽  
Split Cord Malformation ◽  
Illustrative Case ◽  
Excellent Outcome ◽  
Lower Limb Pain ◽  
History Of ◽  
Whole Spine ◽  
Intensive Rehabilitation

BACKGROUND A 60-year-old female presented with a 6-month history of progressive lower limb pain, weakness, and declining mobility. She was initially diagnosed as having possible hip osteoarthritis or ligamental knee injury. She was eventually seen by a neurologist, who admitted her to a tertiary hospital with new-onset upper motor neuron signs and urinary incontinence. Magnetic resonance imaging of the whole spine revealed evidence of C7–T2 type 1 split cord malformation (SCM) necessitating urgent spinal surgery. She had an excellent outcome with intensive rehabilitation and returned to her premorbid level of function and mobility. OBSERVATIONS The patient presented with nonspecific symptoms, which led to multiple referrals and a significant delay in her diagnosis. LESSONS Clinicians should be aware of the importance of a detailed history with thorough neurological and spinal examinations.

Treatment-induced diabetes neuropathy: reminder of an important clinical lesson

2021 ◽  
Vol 14 (5) ◽  
pp. e241849
Author(s):  
Mafalda Ferreira ◽  
Guilherme Camoes ◽  
João Filipe de Ferreira Gomes ◽  
Diana M Ferreira
Keyword(s):  
Rare Complication ◽  
Sudden Onset ◽  
Limb Pain ◽  
Vein Thrombosis ◽  
Lower Limb Pain ◽  
Noticeable Improvement ◽  
Careful Revision ◽  
History Of ◽  
Deep Vein

Treatment-induced neuropathy of diabetes (TIND) is an acute, painful and rare complication of intensive glycaemic control in diabetes. We present a case of a 32-year-old man with sudden onset of severe lower limb pain. It worsened progressively and was refractory to analgesic and muscle relaxant therapies. It became so severe that the patient was impossible to stand, causing a marked impact on his daily life. He had a history of type 1 diabetes, diagnosed 3 years ago, and an episode of deep vein thrombosis of the left leg, 4 years ago. While completing an extensive workup, various analgesic adjustments were made, with no improvement. After careful revision of his medical data, a significant reduction of his A1C 6 months before the appearance of symptoms was noticed. A diagnosis of TIND was made. The patient was treated with amitriptyline and showed noticeable improvement after the first month.

scholarly journals Three level spinal dysraphism: multiple composite Type 1 and Type 2 split cord malformatıon

2014 ◽  
Vol 21 (4) ◽  
pp. 477-479
Author(s):  
I. Alatas ◽  
M. Gundag ◽  
H. Canaz ◽  
E. Emel
Keyword(s):  
Spinal Dysraphism ◽  
Split Cord Malformation ◽  
Dermal Sinus ◽  
Composite Type ◽  
Uncommon Case ◽  
Whole Spine ◽  
Different Levels

Abstract It has reported an uncommon case a 3 year-old girl a composite split cord malformation (SCM) with two different levels of SCM type1 and one level SCM type2, tight filum and sacral dermal sinus. The patient was admitted with a hypertrichosis and hyperpigmented patch. MRI of whole spine and brain was done. SCM type1 at T 7 and L2 levels and SCM typ2 at T11 level were removed then tight filum was cut and dermal sinus was excised at different sites during the same surge

scholarly journals Value of preoperative computed tomography for meso-Rex bypass in children with extrahepatic portal vein obstruction

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Huiying Wu ◽  
Ning Zhou ◽  
Lianwei Lu ◽  
Xiwen Chen ◽  
Tao Liu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Portal Vein ◽  
Predictive Value ◽  
Extrahepatic Portal Vein Obstruction ◽  
Portal Vein Obstruction ◽  
Left Portal Vein ◽  
History Of ◽  
Associated Malformations ◽  
Sensitivity Specificity

Abstract Background Extrahepatic portal vein obstruction (EHPVO) is the most important cause of hematemesis in children. Intrahepatic left portal vein and superior mesenteric vein anastomosis, also known as meso-Rex bypass (MRB), is becoming the gold standard treatment for EHPVO. We analyzed the value of preoperative computed tomography (CT) in determining whether MRB is feasible in children with EHPVO. Results We retrieved data on 76 children with EHPVO (50 male, 26 female; median age, 5.9 years) who underwent MRB (n = 68) or the Warren procedure (n = 8) from 2013 to 2019 and retrospectively analyzed their clinical and CT characteristics. The Rex recess was categorized into four subtypes (types 1–4) depending on its diameter in CT images. Of all 76 children, 7.9% had a history of umbilical catheterization and 1.3% had leukemia. Sixteen patients (20 lesions) had associated malformations. A total of 72.4% of Rex recesses could be measured by CT, and their mean diameter was 3.5 ± 1.8 mm (range 0.6–10.5 mm). A type 1, 2, 3, and 4 Rex recess was present in 9.2%, 53.9%, 11.8%, and 25.0% of patients, respectively. MRB could be performed in patients with types 1, 2, and 3, but those with type 4 required further evaluation. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of CT were 100%, 83.8%, 42.1%, 100%, and 85.5%, respectively. Conclusions Among the four types of Rex recesses on CT angiography, types 1–3 allow for the performance of MRB.

scholarly journals Occupational Sharp Injury and Splash Exposure among Healthcare Workers in a Tertiary Hospital

2021 ◽  
Author(s):  
Roshan Mathew ◽  
Ritin Mohindra ◽  
Ankit Sahu ◽  
Rachana Bhat ◽  
Akshaya Ramaswami ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hepatitis B ◽  
Healthcare Workers ◽  
Hepatitis B Surface Antigen ◽  
Tertiary Hospital ◽  
Needle Stick Injury ◽  
Medical Procedures ◽  
Immunodeficiency Virus ◽  
History Of ◽  
Hepatitis C Virus Antibody

Abstract Background Occupational hazards like sharp injury and splash exposure (SISE) are frequently encountered in health-care settings. The adoption of standard precautions by healthcare workers (HCWs) has led to significant reduction in the incidence of such injuries, still SISE continues to pose a serious threat to certain groups of HCWs. Materials and Methods This was a retrospective study which examined the available records of all patients from January 2015 to August 2019 who self-reported to our emergency department with history of sharp injury and/or splash exposure. Details of the patients, mechanism of injury, the circumstances leading to the injury, status of the source (hepatitis B surface antigen, human immunodeficiency virus, and hepatitis C virus antibody status), and the postexposure prophylaxis given were recorded and analyzed. Data were represented in frequency and percentages. Results During the defined period, a total of 834 HCWs reported with SISE, out of which 44.6% were doctors. Majority of the patients have SISE while performing medical procedures on patients (49.5%), while 19.2% were exposed during segregation of waste. The frequency of needle stick injury during cannulation, sampling, and recapping of needle were higher in emergency department than in wards. More than 80% of HCWs received hepatitis B vaccine and immunoglobulin postexposure. Conclusion There is need for periodical briefings on practices of sharp handling as well as re-emphasizing the use of personal protective equipment while performing procedures.

scholarly journals EXPRESS: Pulmonary Hypertension Associated With Neurofibromatosis Type 2

2021 ◽  
pp. 204589402110295
Author(s):  
Hirohisa Taniguchi ◽  
Tomoya Takashima ◽  
Ly Tu ◽  
Raphaël Thuillet ◽  
Asuka Furukawa ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Neurofibromatosis Type ◽  
Pulmonary Vascular Remodeling ◽  
Life Threatening ◽  
History Of ◽  
Pulmonary Arterial ◽  
First Time

Although precapillary pulmonary hypertension (PH) is a rare but severe complication of patients with neurofibromatosis type 1 (NF1), its association with NF2 remains unknown. Herein, we report a case of a 44-year-old woman who was initially diagnosed with idiopathic pulmonary arterial hypertension (IPAH) and treated with PAH-specific combination therapy. However, a careful assessment for a relevant family history of the disease and genetic testing reveal that this patient had a mutation in the NF2 gene. Using immunofluorescence and Western blotting, we demonstrated a decrease in endothelial NF2 protein in lungs from IPAH patients compared to control lungs, suggesting a potential role of NF2 in PAH development. To our knowledge, this is the first time that precapillary PH has been described in a patient with NF2. The altered endothelial NF2 expression pattern in PAH lungs should stimulate work to better understand how NF2 is contributing to the pulmonary vascular remodeling associated to these severe life-threatening conditions.

scholarly journals Prevalence of bone fracture and its association with severe hypoglycemia in Japanese patients with type 1 diabetes

2021 ◽  
Vol 9 (1) ◽  
pp. e002099
Author(s):  
Yuji Komorita ◽  
Masae Minami ◽  
Yasutaka Maeda ◽  
Rie Yoshioka ◽  
Toshiaki Ohkuma ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 1 Diabetes ◽  
Fracture Risk ◽  
Bone Fracture ◽  
Severe Hypoglycemia ◽  
Japanese Patients ◽  
Anatomic Site ◽  
Cross Sectional ◽  
History Of

IntroductionType 1 diabetes (T1D) is associated with higher fracture risk. However, few studies have investigated the relationship between severe hypoglycemia and fracture risk in patients with T1D, and the results are controversial. Besides, none has investigated the risk factors for fracture in Asian patients with T1D. The aim of the present study was to investigate the prevalence of bone fracture and its relationship between severe hypoglycemia and other risk factors in Japanese patients with T1D.Research design and methodsThe single-center cross-sectional study enrolled 388 Japanese patients with T1D (mean age, 45.2 years; women, 60.4%; mean duration of diabetes, 16.6 years) between October 2019 and April 2020. The occurrence and circumstances of any fracture after the diagnosis of T1D were identified using a self-administered questionnaire. The main outcomes were any anatomic site of fracture and fall-related fracture. Severe hypoglycemia was defined as an episode of hypoglycemia that required the assistance of others to achieve recovery.ResultsA total of 92 fractures occurred in 64 patients, and 59 fractures (64%) were fall-related. Only one participant experienced fracture within the 10 years following their diagnosis of diabetes. In logistic regression analysis, the multivariate-adjusted ORs (95% CIs) of a history of severe hypoglycemia were 2.11 (1.11 to 4.09) for any fracture and 1.91 (0.93 to 4.02) for fall-related fracture. Fourteen of 18 participants with multiple episodes of any type of fracture had a history of severe hypoglycemia (p<0.001 vs no fracture).ConclusionsWe have shown that a history of severe hypoglycemia is significantly associated with a higher risk of bone fracture in Japanese patients with T1D.

scholarly journals Primary Occipital Ewing’s Sarcoma with Subsequent Spinal Seeding

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Ali Alqahtani ◽  
Roaa Amer ◽  
Eman Bakhsh
Keyword(s):  
Posterior Fossa ◽  
Ewing’S Sarcoma ◽  
Ewing's Sarcoma ◽  
Bone Cancer ◽  
Surgical Excision ◽  
Good Prognosis ◽  
Bone Lesions ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
Whole Spine

Ewing’s sarcoma is a primary bone cancer that mainly affects the long bones. This malignancy is particularly common in pediatric patients. Primary cranial involvement accounts for 1% of cases, with occipital involvement considered extremely rare. In this case study, primary occipital Ewing’s sarcoma with a posterior fossa mass and subsequent relapse resulting in spinal seeding is reported. A 3-year-old patient presented with a 1-year history of left-sided headaches, localized over the occipital bone with progressive torticollis. Computed tomography (CT) imaging showed a mass in the left posterior fossa compressing the brainstem. The patient then underwent surgical excision followed by adjuvant chemoradiation therapy. Two years later, the patient presented with severe lower back pain and urinary incontinence. Whole-spine magnetic resonance imaging (MRI) showed cerebrospinal fluid (CSF) seeding from the L5 to the S4 vertebrae. Primary cranial Ewing’s sarcoma is considered in the differential diagnosis of children with extra-axial posterior fossa mass associated with destructive permeative bone lesions. Although primary cranial Ewing’s sarcoma typically has good prognosis, our patient developed metastasis in the lower spine. Therefore, with CNS Ewing’s sarcoma, screening of the entire neural axis should be taken into consideration for early detection of CSF seeding metastasis in order to decrease the associated morbidity and mortality.

74 LAPAROSCOPIC MANAGEMENT OF A PULSION EPIPHRENIC OESOPHAGEAL DIVERTICULUM SECONDARY TO ACHALASIA.

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Jeremy Tan ◽  
Baldwin Yeung ◽  
Lester Ong ◽  
Bin Chet Toh ◽  
Wai Keong Wong ◽  
...  
Keyword(s):  
Laparoscopic Resection ◽  
Barium Swallow ◽  
Toupet Fundoplication ◽  
Rare Entity ◽  
Upper Gi ◽  
Operative Complications ◽  
History Of ◽  
Upper Gi Endoscopy

Abstract   This is a video submission of a laparoscopic resection of an epiphrenic oesophageal pulsion diverticulum secondary to achalasia. A Heller’s cardiomyotomy is also performed together with a Toupet fundoplication. Methods The patient is a 40 year old woman with a 12 month history of worsening dysphagia, reflux symptoms, as well as occasional regurgitation of food, worse at night. Barium swallow showed a distal oesophageal diverticulum and oesophageal manometry confirmed type 1 achalasia. Upper GI endoscopy showed no other intra-luminal findings. Results The patient underwent a laparoscopic resection of the diverticulum, together with a Heller’s cardiomyotomy and Toupet fundoplication. There were no post-operative complications. She remains well and asymptomatic at 9 month follow-up. Conclusion Pulsion diverticula secondary to achalasia are a known but rare entity. A few variations exist on how to manage this condition surgically, especially with respect to the type of fundoplication. We present our preferred technique for dealing with this condition. Video https://www.dropbox.com/s/dg4edkamykugupn/Oesophagealdivert.mp4?dl=0

Sign in / Sign up

Export Citation Format

Share Document