Pub Date : 2021-08-31DOI: 10.11648/J.JS.20210904.23
S. Gaudio, F. E. Gaudio
The United States has vaccinated almost 200 million citizens in the first 7 months of 2021. During that period adverse events have been described from minor complaints of redness, pain and swelling at the injection site to more serious events such as Guillain Barre Syndrome and thrombosis. As vaccination distribution continue to move forward, more side effects and complications will become evident. This case report is of a patient presenting in shock 4 days after receiving her second COVID-19 vaccination with altered mental status, dyspnea, and an acute abdomen with a bowel perforation. After resuscitation, the patient was taken to surgery where an additional diagnosis of embolic mesenteric arterial ischemia was made on exploratory laparotomy. While a causal relationship between the vaccine and the findings in this particular patient cannot be proven, there certainly is a temporal relationship between her receiving the Pfizer-BioNTech (BNT162b2) COVID-19 vaccine, the presentation of this patient to our institution, and the findings during emergency surgery. Thromboses are known adverse events from the COVID-19 vaccines however to our knowledge, there has not been a published case report of embolic mesenteric arterial ischemia after receiving a COVID-19 vaccine. Appreciating the association between COVID-19 vaccines and embolic mesenteric arterial ischemia should alert physicians to keep this diagnosis high on their differential in the setting of unusual abdominal pain and recent vaccination.
{"title":"A Case Report of Mesenteric Ischemia After COVID-19 Vaccination","authors":"S. Gaudio, F. E. Gaudio","doi":"10.11648/J.JS.20210904.23","DOIUrl":"https://doi.org/10.11648/J.JS.20210904.23","url":null,"abstract":"The United States has vaccinated almost 200 million citizens in the first 7 months of 2021. During that period adverse events have been described from minor complaints of redness, pain and swelling at the injection site to more serious events such as Guillain Barre Syndrome and thrombosis. As vaccination distribution continue to move forward, more side effects and complications will become evident. This case report is of a patient presenting in shock 4 days after receiving her second COVID-19 vaccination with altered mental status, dyspnea, and an acute abdomen with a bowel perforation. After resuscitation, the patient was taken to surgery where an additional diagnosis of embolic mesenteric arterial ischemia was made on exploratory laparotomy. While a causal relationship between the vaccine and the findings in this particular patient cannot be proven, there certainly is a temporal relationship between her receiving the Pfizer-BioNTech (BNT162b2) COVID-19 vaccine, the presentation of this patient to our institution, and the findings during emergency surgery. Thromboses are known adverse events from the COVID-19 vaccines however to our knowledge, there has not been a published case report of embolic mesenteric arterial ischemia after receiving a COVID-19 vaccine. Appreciating the association between COVID-19 vaccines and embolic mesenteric arterial ischemia should alert physicians to keep this diagnosis high on their differential in the setting of unusual abdominal pain and recent vaccination.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73598779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-08-27DOI: 10.11648/J.JS.20210904.21
A. Rebel, L. Hampton, Zaki-Udin Hassan, M. Shah
The case report discusses a significant discrepancy between the pre-transplant cardiac evaluation and post-induction transesophageal echocardiography, leading to aborting the surgical procedure. The transthoracic echocardiography [TTE] pre-liver transplant indicated only a minor intracardiac shunt, while the post-induction transesophageal echocardiography [TEE] showed a large atrial septal defect with a more significant left to right shunt. The attempt to close the defect with a transcatheter closure device failed and the perioperative care team decided not to proceed with the liver transplantation. Later cardiac evaluation with cardiac magnetic resonance imaging demonstrated a secundum atrial septum defect in the inferior border of the interatrial septum with 43 ml flow difference between systemic and pulmonary circulation. The failure to identify a large atrial septal defect/inferior venosus defect in the preoperative screening process for liver transplantation resulted in failing to optimize the patient pre transplant. Although complications related to large atrial septal defects are rare during liver transplant (paradoxical embolisms, malignant arrhythmias, myocardial infarctions or cerebrovascular complications), they can be potentially fatal. The preoperative cardiac assessment should have included optimization of this congenital defect. The case report discusses implications of atrial septal defects for liver transplant and why the screening process may have missed the defect. The findings of a positive bubble study during the transthoracic echocardiography should not be trivialized and may require further workup.
{"title":"The Intraoperative Finding of a Large Atrial Septum Defect Pre-Liver Transplantation: A Case Report","authors":"A. Rebel, L. Hampton, Zaki-Udin Hassan, M. Shah","doi":"10.11648/J.JS.20210904.21","DOIUrl":"https://doi.org/10.11648/J.JS.20210904.21","url":null,"abstract":"The case report discusses a significant discrepancy between the pre-transplant cardiac evaluation and post-induction transesophageal echocardiography, leading to aborting the surgical procedure. The transthoracic echocardiography [TTE] pre-liver transplant indicated only a minor intracardiac shunt, while the post-induction transesophageal echocardiography [TEE] showed a large atrial septal defect with a more significant left to right shunt. The attempt to close the defect with a transcatheter closure device failed and the perioperative care team decided not to proceed with the liver transplantation. Later cardiac evaluation with cardiac magnetic resonance imaging demonstrated a secundum atrial septum defect in the inferior border of the interatrial septum with 43 ml flow difference between systemic and pulmonary circulation. The failure to identify a large atrial septal defect/inferior venosus defect in the preoperative screening process for liver transplantation resulted in failing to optimize the patient pre transplant. Although complications related to large atrial septal defects are rare during liver transplant (paradoxical embolisms, malignant arrhythmias, myocardial infarctions or cerebrovascular complications), they can be potentially fatal. The preoperative cardiac assessment should have included optimization of this congenital defect. The case report discusses implications of atrial septal defects for liver transplant and why the screening process may have missed the defect. The findings of a positive bubble study during the transthoracic echocardiography should not be trivialized and may require further workup.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87337211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-08-27DOI: 10.11648/J.JS.20210904.22
Mahmoud El Ghoneimy Abd El-Sadek, A. Swelam, H. Abd-Allah, G. Moussa, Osama Helmy El Khadrawy
Background: One anastomosis gastric bypass (OAGB) has several apparent advantages over Roux-En-Y Gastric Bypass (RYGB). However, symptomatic biliary reflux and its potential risks have prevented its widespread adoption. The aim of this study was to assess the short term outcomes of LOAGB in comparison to LRYGB in treatment of patients with super obesity regarding weight loss, resolution/improvement of co-morbidities and impact on patients’ quality of life (QoL). Methods: One hundred adult patients with super obesity were randomly divided into 2 matched groups, 50 patients each; group I underwent LRYGB and group II underwent LOAGB. Results: The operative time was significantly longer in LRYGB (176.4±27.29 vs. 110.5±14.13 minutes, p<0.05). The frequency and severity of the early postoperative complications were comparable between both groups. No mortality or re-admission was reported in both groups. There are no patients lost to follow-up. Although, the mean Excess weight loss percent (EWL%) was 57% vs 64.7% and 69.7% vs 75.5% at one and two years follow-up in group I and II respectively, the differences were statistically insignificant. T2DM remission/improvement rates at 12th month were 88.9% and 94.1% in group I and II respectively without a statistically insignificant difference. In comparison to the preoperative Qol score, the postoperative score showed a statistically significant improvement (from 0.31 to 6 and from 0.41 to 6.32 in group I and II respectively). Conclusions: LOAGB had a shorter operative time and a tendency towards a higher EWL%, a better remission of obesity-related comorbidities and improvement in the patients QoL with comparable short term operative and postoperative complications. Thus, LOAGB can be considered an acceptable alternative to LRYGB in management of super obese patients.
{"title":"Short Term Outcomes of Laparoscopic Roux-En-Y Gastric Bypass Versus Laparoscopic One Anastomosis Gastric Bypass in Super Obese Patients: Randomized Clinical Trial","authors":"Mahmoud El Ghoneimy Abd El-Sadek, A. Swelam, H. Abd-Allah, G. Moussa, Osama Helmy El Khadrawy","doi":"10.11648/J.JS.20210904.22","DOIUrl":"https://doi.org/10.11648/J.JS.20210904.22","url":null,"abstract":"Background: One anastomosis gastric bypass (OAGB) has several apparent advantages over Roux-En-Y Gastric Bypass (RYGB). However, symptomatic biliary reflux and its potential risks have prevented its widespread adoption. The aim of this study was to assess the short term outcomes of LOAGB in comparison to LRYGB in treatment of patients with super obesity regarding weight loss, resolution/improvement of co-morbidities and impact on patients’ quality of life (QoL). Methods: One hundred adult patients with super obesity were randomly divided into 2 matched groups, 50 patients each; group I underwent LRYGB and group II underwent LOAGB. Results: The operative time was significantly longer in LRYGB (176.4±27.29 vs. 110.5±14.13 minutes, p<0.05). The frequency and severity of the early postoperative complications were comparable between both groups. No mortality or re-admission was reported in both groups. There are no patients lost to follow-up. Although, the mean Excess weight loss percent (EWL%) was 57% vs 64.7% and 69.7% vs 75.5% at one and two years follow-up in group I and II respectively, the differences were statistically insignificant. T2DM remission/improvement rates at 12th month were 88.9% and 94.1% in group I and II respectively without a statistically insignificant difference. In comparison to the preoperative Qol score, the postoperative score showed a statistically significant improvement (from 0.31 to 6 and from 0.41 to 6.32 in group I and II respectively). Conclusions: LOAGB had a shorter operative time and a tendency towards a higher EWL%, a better remission of obesity-related comorbidities and improvement in the patients QoL with comparable short term operative and postoperative complications. Thus, LOAGB can be considered an acceptable alternative to LRYGB in management of super obese patients.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81067554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: To investigate the effectiveness, controllability and safety of fresh plasma infusion in preventing ecchymosis after total knee arthroplasty (TKA). Methods: Patients with osteoarthritis of the knee who received the initial TKA were assigned to study group, control group, and blank control group according to APTT and PT results on the first day postoperatively. Patients in the study group received 400ml fresh frozen plasma infusion on the first day after TKA, and patients in the control group and blank control group received conventional postoperative treatment. The incidence of ecchymosis, the circumference of the affected limb and visual analog scale (VAS) were compared and analyzed in the three groups. Results: 20 patients were included into each group, respectively. After the infusion of fresh frozen plasma, the number of peri-knee ecchymosis in the study group was significantly less than that in the control group on the 7th and 14th days after the operation (P 0.05). On the 7th and 14th day after surgery, the pain degree of the three groups was relieved, and the VAS score of the study group and the blank control group showed no statistically significant difference (P>0.05), while the VAS score of the study group was lower than that of the control group, the difference was statistically significant (P<0.05). Conclusion: For patients with abnormal coagulation function after TKA, timely postoperative infusion of fresh frozen plasma can reduce the incidence of postoperative ecchymosis and relieve pain, which has certain clinical reference significance.
{"title":"Study on Preventive Intervention of Peri-knee Ecchymosis After Total Knee Replacement","authors":"Dabiao Hou, Yong-gang Tang, Chun-Hou Huang, Wenrui Wu, Hongyi Zhang, Dong-Lin Luo","doi":"10.11648/J.JS.20210904.20","DOIUrl":"https://doi.org/10.11648/J.JS.20210904.20","url":null,"abstract":"Objective: To investigate the effectiveness, controllability and safety of fresh plasma infusion in preventing ecchymosis after total knee arthroplasty (TKA). Methods: Patients with osteoarthritis of the knee who received the initial TKA were assigned to study group, control group, and blank control group according to APTT and PT results on the first day postoperatively. Patients in the study group received 400ml fresh frozen plasma infusion on the first day after TKA, and patients in the control group and blank control group received conventional postoperative treatment. The incidence of ecchymosis, the circumference of the affected limb and visual analog scale (VAS) were compared and analyzed in the three groups. Results: 20 patients were included into each group, respectively. After the infusion of fresh frozen plasma, the number of peri-knee ecchymosis in the study group was significantly less than that in the control group on the 7th and 14th days after the operation (P 0.05). On the 7th and 14th day after surgery, the pain degree of the three groups was relieved, and the VAS score of the study group and the blank control group showed no statistically significant difference (P>0.05), while the VAS score of the study group was lower than that of the control group, the difference was statistically significant (P<0.05). Conclusion: For patients with abnormal coagulation function after TKA, timely postoperative infusion of fresh frozen plasma can reduce the incidence of postoperative ecchymosis and relieve pain, which has certain clinical reference significance.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75473781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-08-02DOI: 10.11648/J.JS.20210904.19
Isabella Opoku, Linghao Tang, Lidan Jiang, Dan Wang, Xu Yueqiao, Lin Feng, Wang Ning
Background: Primary central nervous system post-transplant lymphoproliferative disorder (PCNS-PTLD) is a serious and uncommon complication which can be developed months or years after a Kidney transplant. Immunosuppressive agents administered before and after transplantation to minimize the chances of allograft rejection has proved to be a double-edged sword that puts the host at risk of infectious, neoplastic and vascular diseases, including PCNS-PTLD. The immunosuppressive therapy leads to decreased innate malignant and viral immune surveillance and this has been shown to play a role in lymphoproliferative diseases after transplantation. In most cases, PCNS-PTLD is Epstein–Barr virus related. Case Description: A 60-year-old female with history of kidney transplant presented to the emergency room with history of low fever, dizziness nausea and vomiting for 1 month. MRI and CT scans showed a mass cerebellar lesion and a biopsy revealed Primary central nervous system post-transplant lymphoproliferative disorder (PCNS-PTLD). Conclusion: This case highlights the need for a careful long-term follow up of patients with kidney transplant. PCNS-PTLD represents a continuing long-term risk after transplantation, although less common. This case report supports observational data that suggests that peripheral blood screening for EBV DNA does not seem helpful for identification of PCNS-PTLD. Suspicion of PCNS PTLD should be considered when patients with long-term history of kidney transplant present neurological complaints.
{"title":"Late Primary B Cell Cerebral Lymphoma After Kidney Transplant: A Case Report and Literature Review","authors":"Isabella Opoku, Linghao Tang, Lidan Jiang, Dan Wang, Xu Yueqiao, Lin Feng, Wang Ning","doi":"10.11648/J.JS.20210904.19","DOIUrl":"https://doi.org/10.11648/J.JS.20210904.19","url":null,"abstract":"Background: Primary central nervous system post-transplant lymphoproliferative disorder (PCNS-PTLD) is a serious and uncommon complication which can be developed months or years after a Kidney transplant. Immunosuppressive agents administered before and after transplantation to minimize the chances of allograft rejection has proved to be a double-edged sword that puts the host at risk of infectious, neoplastic and vascular diseases, including PCNS-PTLD. The immunosuppressive therapy leads to decreased innate malignant and viral immune surveillance and this has been shown to play a role in lymphoproliferative diseases after transplantation. In most cases, PCNS-PTLD is Epstein–Barr virus related. Case Description: A 60-year-old female with history of kidney transplant presented to the emergency room with history of low fever, dizziness nausea and vomiting for 1 month. MRI and CT scans showed a mass cerebellar lesion and a biopsy revealed Primary central nervous system post-transplant lymphoproliferative disorder (PCNS-PTLD). Conclusion: This case highlights the need for a careful long-term follow up of patients with kidney transplant. PCNS-PTLD represents a continuing long-term risk after transplantation, although less common. This case report supports observational data that suggests that peripheral blood screening for EBV DNA does not seem helpful for identification of PCNS-PTLD. Suspicion of PCNS PTLD should be considered when patients with long-term history of kidney transplant present neurological complaints.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86339173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-29DOI: 10.11648/J.JS.20210904.17
Alexander Bech Rasmussen, B. N. Jepsen, F. hvid-Jensen, N. Katballe, D. Kjaer
Background: The mainstay of intended curative treatment for esophagus cancer is surgery. Symptoms of gastric outlet obstruction can occur in some patients postoperatively. Some of these patients require alleviating treatment which may include balloon dilatation of the pylorus. The aim of this study was to investigate the use for balloon dilatation of the pylorus following esophagectomy in patients treated for carcinoma of the esophagus with intent to cure. Methods: A retrospective study of 120 patients who underwent esophagectomy with gastric pull-up at Aarhus University Hospital, Denmark, between January 2017 and December 2018 and were followed until December 2020. Primary outcome was number of postoperative balloon dilatations of the pylorus. Results: A total of 63 patients (53%) went through at least 1 balloon dilatation of the pylorus, 40 (63%) needed more than 1 dilatation. The median time between esophagectomy and first dilatation was two months. There was a strong association between squamous cell carcinoma and postoperative dilatation compared to adenocarcinoma (OR=4.13). An association was also seen between ex-smokers and postoperative dilatation compared to non-smokers (OR=3.95). Conclusions: More than fifty percent of the patients needed postoperative balloon dilatation. The need for dilatations was strongest between the second and the ninth postoperative month. A nationwide multicentre study of gastric pull-up patients is needed in the future to develop clinical tools to assess the need for pyloric dilatation.
{"title":"Balloon Dilatation of the Pylorus After Gastric Pull-up in a Single Centre","authors":"Alexander Bech Rasmussen, B. N. Jepsen, F. hvid-Jensen, N. Katballe, D. Kjaer","doi":"10.11648/J.JS.20210904.17","DOIUrl":"https://doi.org/10.11648/J.JS.20210904.17","url":null,"abstract":"Background: The mainstay of intended curative treatment for esophagus cancer is surgery. Symptoms of gastric outlet obstruction can occur in some patients postoperatively. Some of these patients require alleviating treatment which may include balloon dilatation of the pylorus. The aim of this study was to investigate the use for balloon dilatation of the pylorus following esophagectomy in patients treated for carcinoma of the esophagus with intent to cure. Methods: A retrospective study of 120 patients who underwent esophagectomy with gastric pull-up at Aarhus University Hospital, Denmark, between January 2017 and December 2018 and were followed until December 2020. Primary outcome was number of postoperative balloon dilatations of the pylorus. Results: A total of 63 patients (53%) went through at least 1 balloon dilatation of the pylorus, 40 (63%) needed more than 1 dilatation. The median time between esophagectomy and first dilatation was two months. There was a strong association between squamous cell carcinoma and postoperative dilatation compared to adenocarcinoma (OR=4.13). An association was also seen between ex-smokers and postoperative dilatation compared to non-smokers (OR=3.95). Conclusions: More than fifty percent of the patients needed postoperative balloon dilatation. The need for dilatations was strongest between the second and the ninth postoperative month. A nationwide multicentre study of gastric pull-up patients is needed in the future to develop clinical tools to assess the need for pyloric dilatation.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86973049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-29DOI: 10.11648/J.JS.20210904.18
Elisa Mareddu, J. Corbaz, R. Desmarchelier, A. Traverso
The avulsion fracture of the patellar tendon from its proximal and distal attachment is extremely rare. Only a few cases have been described in the English literature and many aspects are still poorly understood. During our practice we came across the case of a 13 year old boy with the above mentioned lesion that we present hereby. Other than describing our experience we tried to tackle the different questions surrounding this lesion, with a careful analysis of the previous reports. A “weaker bone” was considered the main risk factor without any connection with a particular disease or condition. We found out that it is a mainly a pediatric problem, due to the particular bone structure of this population, with many of the subjects being affected by Osgood–Schlatter disease. Different authors have reported their experiences and hypothesis concerning the mechanism behind this injury that has yet to be clearly defined. However most of them mentioned an eccentric load over a knee in forced flexion, leading us to believe that this could be the main source of this unique type of disruption of the extensor apparatus of the knee. Moreover the diagnosis can be quite challenging with many authors advocating for the use of advanced imaging. Treatment options are multiples and the choice relies for the most part on the practitioner preference. From what emerged from the available data it is almost exclusively surgical. Independently from the selected technique, the outcomes are generally favorable.
{"title":"Bifocal Patellar Tendon Avulsion Fracture in a Child","authors":"Elisa Mareddu, J. Corbaz, R. Desmarchelier, A. Traverso","doi":"10.11648/J.JS.20210904.18","DOIUrl":"https://doi.org/10.11648/J.JS.20210904.18","url":null,"abstract":"The avulsion fracture of the patellar tendon from its proximal and distal attachment is extremely rare. Only a few cases have been described in the English literature and many aspects are still poorly understood. During our practice we came across the case of a 13 year old boy with the above mentioned lesion that we present hereby. Other than describing our experience we tried to tackle the different questions surrounding this lesion, with a careful analysis of the previous reports. A “weaker bone” was considered the main risk factor without any connection with a particular disease or condition. We found out that it is a mainly a pediatric problem, due to the particular bone structure of this population, with many of the subjects being affected by Osgood–Schlatter disease. Different authors have reported their experiences and hypothesis concerning the mechanism behind this injury that has yet to be clearly defined. However most of them mentioned an eccentric load over a knee in forced flexion, leading us to believe that this could be the main source of this unique type of disruption of the extensor apparatus of the knee. Moreover the diagnosis can be quite challenging with many authors advocating for the use of advanced imaging. Treatment options are multiples and the choice relies for the most part on the practitioner preference. From what emerged from the available data it is almost exclusively surgical. Independently from the selected technique, the outcomes are generally favorable.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77495231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 45-year-old female with medical background significant for bronchial asthma, hypothyroidism, polycystic kidney disease and obesity presented to the emergency department in December 2020 with one week history of severe headache, unilateral rhinorrhea and metallic taste. Her symptoms started two days after she had nasopharyngeal swab as post travel screening routine. Radiological investigations revealed features of increased intracranial pressure and a suspicious skull base defect for which patient undergone endoscopic transnasal skull base repair. Intraoperative findings were positive for CSF leak from a skull base defect and an incidental finding of Meningiocle. Patient was seen after three weeks with no more CSF rhinorrhea, but was complaining of persistent mild headache, for which she was referred to neurology for further management. Conclusion: CSF leak is one of the rare, yet serious complications of nasopharyngeal swab especially in patients with previous skull base surgery, trauma, patients with pre-existing skull base defects or with elevated intracranial pressure. Meningocele found in this case report was presumed to be a predisposing factor for CSF leak post nasopharyngeal swab. Education about safe administration of nasopharyngeal swabs as well as understanding the nose anatomy is important to reduce the overall risk profile of nasopharyngeal sampling. Moreover, an alternative method of testing such as oropharyngeal specimen should be considered in populations with increased risk of CSF leak.
{"title":"CSF Leak Post COVID-19 Swab in a Patient with Preexisting Meningiocele","authors":"Alzuwayed Abdullah, Algouhi Amani, Alshafi Mohammad, Alhedaithy Riyadh","doi":"10.11648/J.JS.20210904.16","DOIUrl":"https://doi.org/10.11648/J.JS.20210904.16","url":null,"abstract":"A 45-year-old female with medical background significant for bronchial asthma, hypothyroidism, polycystic kidney disease and obesity presented to the emergency department in December 2020 with one week history of severe headache, unilateral rhinorrhea and metallic taste. Her symptoms started two days after she had nasopharyngeal swab as post travel screening routine. Radiological investigations revealed features of increased intracranial pressure and a suspicious skull base defect for which patient undergone endoscopic transnasal skull base repair. Intraoperative findings were positive for CSF leak from a skull base defect and an incidental finding of Meningiocle. Patient was seen after three weeks with no more CSF rhinorrhea, but was complaining of persistent mild headache, for which she was referred to neurology for further management. Conclusion: CSF leak is one of the rare, yet serious complications of nasopharyngeal swab especially in patients with previous skull base surgery, trauma, patients with pre-existing skull base defects or with elevated intracranial pressure. Meningocele found in this case report was presumed to be a predisposing factor for CSF leak post nasopharyngeal swab. Education about safe administration of nasopharyngeal swabs as well as understanding the nose anatomy is important to reduce the overall risk profile of nasopharyngeal sampling. Moreover, an alternative method of testing such as oropharyngeal specimen should be considered in populations with increased risk of CSF leak.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77388597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-23DOI: 10.11648/J.JS.20210904.14
M. Kuwahara, T. Goto, Shintaro Yamamoto, Takanobu Sugase, N. Inadome, H. Hojo, K. Ibusuki, S. Taniguchi, H. Kawano, Hiroshi Tai, Keiko Umekita, Hiroyuki Tanaka, Rintaro Koga
Background: Recently, double cancer is no longer uncommon. It is Particularly difficult to determine whether swollen lymph nodes (LNs) indicate malignant lymphoma or metastasis of other carcinoma. We experienced a case of rectal carcinoma complicated with adult T-cell leukemia/lymphoma (ATLL). Case presentation: We encountered a 77-year-old woman who had visited a previous hospital due to bloody stool. Colonoscopy revealed a 10-cm tumor in the lower rectum. Given its pit pattern and surface and vessel pattern, she was suspected of having adenocarcinoma in situ. However, enhanced computed tomography (CT) showed LN swelling around the rectum, and her bilateral inguinal LNs were palpable. Colonoscopy and a biopsy performed at our hospital showed adenoma (Group 3) with no malignant findings. We performed an inguinal LN biopsy and diagnosed her with ATLL. We suspected the rectal mass either be rectal carcinoma or ATLL invasion. We performed chemotherapy for ATLL. The inguinal LNs became no longer palpable, but the rectal mass did not shrink, so we performed operative resection for diagnostic treatment. Thereafter, we diagnosed her with double cancer of rectal adenocarcinoma and ATLL. Conclusion: It is difficult to determine whether swollen LNs indicate malignant lymphoma or metastasis of other carcinoma without performing an LN biopsy. However, a diagnosis of metastasis or non-metastasis does not influence either the staging of the carcinoma or the treatment plan.
{"title":"A Case of Rectal Carcinoma Complicated with Adult T-cell Leukemia/Lymphoma Diagnosed by an Inguinal Lymph Node Biopsy","authors":"M. Kuwahara, T. Goto, Shintaro Yamamoto, Takanobu Sugase, N. Inadome, H. Hojo, K. Ibusuki, S. Taniguchi, H. Kawano, Hiroshi Tai, Keiko Umekita, Hiroyuki Tanaka, Rintaro Koga","doi":"10.11648/J.JS.20210904.14","DOIUrl":"https://doi.org/10.11648/J.JS.20210904.14","url":null,"abstract":"Background: Recently, double cancer is no longer uncommon. It is Particularly difficult to determine whether swollen lymph nodes (LNs) indicate malignant lymphoma or metastasis of other carcinoma. We experienced a case of rectal carcinoma complicated with adult T-cell leukemia/lymphoma (ATLL). Case presentation: We encountered a 77-year-old woman who had visited a previous hospital due to bloody stool. Colonoscopy revealed a 10-cm tumor in the lower rectum. Given its pit pattern and surface and vessel pattern, she was suspected of having adenocarcinoma in situ. However, enhanced computed tomography (CT) showed LN swelling around the rectum, and her bilateral inguinal LNs were palpable. Colonoscopy and a biopsy performed at our hospital showed adenoma (Group 3) with no malignant findings. We performed an inguinal LN biopsy and diagnosed her with ATLL. We suspected the rectal mass either be rectal carcinoma or ATLL invasion. We performed chemotherapy for ATLL. The inguinal LNs became no longer palpable, but the rectal mass did not shrink, so we performed operative resection for diagnostic treatment. Thereafter, we diagnosed her with double cancer of rectal adenocarcinoma and ATLL. Conclusion: It is difficult to determine whether swollen LNs indicate malignant lymphoma or metastasis of other carcinoma without performing an LN biopsy. However, a diagnosis of metastasis or non-metastasis does not influence either the staging of the carcinoma or the treatment plan.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75794513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-22DOI: 10.11648/J.JS.20210904.15
Peter L. Deptula, Youna K. Choi, Nhung Tran, D. Rochlin, D. Nguyen
We determined the aesthetic outcomes of autologous breast reconstruction in comparison to cosmetically altered or natural breasts. We also examined the effect of perceptions on aesthetic outcomes of breast reconstruction. Images of 10 patients (autologous breast reconstruction following bilateral nipple sparing mastectomy (NSM) (n=5), bilateral breast reduction (n=1), bilateral mastopexy (n=1), bilateral augmentation (n=1), unoperated natural breasts (n=2)), were compiled into a blind three-part survey. Part one asked participants to determine whether the presented breasts are reconstructed after mastectomy and measure aesthetic outcomes (1=poor and 4=excellent). Part two ranks breasts from most desirable to least desirable. Part three presents side-by-side unlabeled pre and postoperative images of patients who have undergone autologous breast reconstruction and asks to select the more aesthetically pleasing breasts. Two thousand images were quantified from 100 surveys (83.3% response rate). Age range of participants was 18-80. Response was not statistically different based on demographics. The rate of correctly identifying breasts as reconstruction after NSM was 62.8% and as natural was 64%. Mean aesthetic scores between the reconstructed and natural breasts were equivalent. Breasts perceived as reconstruction scored significantly lower in five aesthetic factors. The top 3 most desired breasts were augmentation, reconstruction after NSM, and unoperated natural breasts. In paired pre- and postoperative photo comparison, all responses favored postoperative breasts. Aesthetic outcomes after autologous breast reconstruction can be equivalent to natural breasts. Breasts perceived as reconstruction are ranked poorer in aesthetic factors compared to those perceived as natural breasts.
{"title":"Autologous Reconstruction Following Nipple Sparing Mastectomy Achieves Equivalent Aesthetic Outcome as Natural Breasts","authors":"Peter L. Deptula, Youna K. Choi, Nhung Tran, D. Rochlin, D. Nguyen","doi":"10.11648/J.JS.20210904.15","DOIUrl":"https://doi.org/10.11648/J.JS.20210904.15","url":null,"abstract":"We determined the aesthetic outcomes of autologous breast reconstruction in comparison to cosmetically altered or natural breasts. We also examined the effect of perceptions on aesthetic outcomes of breast reconstruction. Images of 10 patients (autologous breast reconstruction following bilateral nipple sparing mastectomy (NSM) (n=5), bilateral breast reduction (n=1), bilateral mastopexy (n=1), bilateral augmentation (n=1), unoperated natural breasts (n=2)), were compiled into a blind three-part survey. Part one asked participants to determine whether the presented breasts are reconstructed after mastectomy and measure aesthetic outcomes (1=poor and 4=excellent). Part two ranks breasts from most desirable to least desirable. Part three presents side-by-side unlabeled pre and postoperative images of patients who have undergone autologous breast reconstruction and asks to select the more aesthetically pleasing breasts. Two thousand images were quantified from 100 surveys (83.3% response rate). Age range of participants was 18-80. Response was not statistically different based on demographics. The rate of correctly identifying breasts as reconstruction after NSM was 62.8% and as natural was 64%. Mean aesthetic scores between the reconstructed and natural breasts were equivalent. Breasts perceived as reconstruction scored significantly lower in five aesthetic factors. The top 3 most desired breasts were augmentation, reconstruction after NSM, and unoperated natural breasts. In paired pre- and postoperative photo comparison, all responses favored postoperative breasts. Aesthetic outcomes after autologous breast reconstruction can be equivalent to natural breasts. Breasts perceived as reconstruction are ranked poorer in aesthetic factors compared to those perceived as natural breasts.","PeriodicalId":101237,"journal":{"name":"The Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83681859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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