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Current Approach for Diagnosis and Treatment of Adrenal Tuberculosis—Our Experience and Review of Literature 肾上腺结核的诊断和治疗方法——经验与文献复习
IF 0.9 Q4 SURGERY Pub Date : 2022-01-01 DOI: 10.1055/s-0042-1743523
Stuti Gupta, Md. Abu Masud Ansari, Arun Gupta, P. Chaudhary, L. Bansal
Addison's disease was first described by Thomas Addison in 1855. He demonstrated the destruction of bilateral adrenal gland by tuberculosis (TB) in six patients. Since then, the incidence of TB has declined in the Western world, but in developing countries, it is still the most common cause of adrenal insufficiency. Because of the introduction of antituberculous chemotherapy, the incidence of adrenal TB has been declined in the past decades. The most common symptoms are nonspecific; therefore, diagnosis is often delayed, and patients may first present with a life-threatening adrenal crisis. The most commonly identified organism for adrenal failure in adrenal TB is Mycobacterium tuberculosis infection. Adrenal TB involves bilateral adrenal glands more frequently than unilateral glands. Computed tomography (CT) scan and magnetic resonance imaging (MRI) are useful investigations to differentiate between tuberculous Addison's disease and the other causes of adrenal insufficiency. In CT scans or MRI, features of adrenal TB are bilateral adrenal enlargement and peripheral rim enhancement with or without calcifications. Antituberculous drugs, biochemical monitoring of adrenal function, and steroid therapy are essential for the management of adrenal TB and adrenal insufficiency. Here, we describe a case of adrenal TB with abscess formation followed by a review of the current literature of adrenal TB for better diagnosis and management of this condition.
托马斯·艾迪生于1855年首次描述了艾迪生病。他在6名患者中证实了肺结核对双侧肾上腺的破坏。从那时起,结核病的发病率在西方世界有所下降,但在发展中国家,它仍然是肾上腺功能不全的最常见原因。由于抗结核化疗的引入,肾上腺结核的发病率在过去几十年中有所下降。最常见的症状是非特异性的;因此,诊断往往会延迟,患者可能首先出现危及生命的肾上腺危象。肾上腺结核肾上腺功能衰竭最常见的病因是结核分枝杆菌感染。肾上腺结核涉及双侧肾上腺的频率高于单侧肾上腺。计算机断层扫描(CT)和磁共振成像(MRI)是区分结核性艾迪生病和其他肾上腺功能不全原因的有用研究。在CT扫描或MRI中,肾上腺结核的特征是双侧肾上腺增大和外周边缘增强,伴有或不伴有钙化。抗结核药物、肾上腺功能的生化监测和类固醇治疗对治疗肾上腺结核和肾上腺功能不全至关重要。在此,我们描述了一例肾上腺结核伴脓肿形成的病例,然后回顾了目前肾上腺结核的文献,以更好地诊断和治疗这种情况。
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引用次数: 3
Giant Adrenal Pseudocysts: An Enigma for Surgeons 巨大肾上腺假性囊肿:外科医生的谜
IF 0.9 Q4 SURGERY Pub Date : 2022-01-01 DOI: 10.1055/s-0042-1744153
K. Parasar, Shantam Mohan, A. John, J. Nigam, U. Anand, C. Jha
Adrenal pseudocysts are cystic lesions arising within the adrenal gland enclosed by a fibrous connective tissue wall that lacks lining cells. They can attain a huge size and pose a diagnostic challenge with a broad range of differentials including benign and malignant neoplasms. There are only a few small case series and case reports describing these lesions. We report a series of five patients who presented with “indeterminate” abdominal cystic lesions and were later on found to have adrenal pseudocyst. Four out of five patients presented with non-specific abdominal symptoms, and one patient presented with symptoms suggestive of a functional adrenal tumor. The size of these tumors ranged from 6 to 30 cm. They had variable radiological features and in two cases even a percutaneous biopsy could not establish the diagnosis. In four of these “indeterminate” abdominal masses, an adrenal origin was not suspected preoperatively. Surgical excision provided a resolution of symptoms, ruled out malignancy, and clinched the diagnosis.
肾上腺假性囊肿是肾上腺内的囊性病变,由缺乏衬里细胞的纤维结缔组织壁包围。它们可以达到巨大的体积,并对包括良性和恶性肿瘤在内的广泛差异的诊断提出挑战。只有少数小病例系列和病例报告描述了这些病变。我们报告了一系列五名患者,他们表现出“不确定”的腹部囊性病变,后来被发现患有肾上腺假性囊肿。五分之四的患者出现非特异性腹部症状,一名患者出现提示功能性肾上腺肿瘤的症状。这些肿瘤的大小从6到30不等 他们有不同的放射学特征,在两个病例中,即使是经皮活检也无法确定诊断。在其中四个“不确定”的腹部肿块中,术前未怀疑是肾上腺来源。手术切除提供了症状的解决,排除了恶性肿瘤,并确定了诊断。
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引用次数: 0
Long-Term Outcomes of Digital Nerve Repair Accompanied by Digital Artery Injury in Flexor Zone 2 屈肌2区指神经修复伴指动脉损伤的远期疗效
IF 0.9 Q4 SURGERY Pub Date : 2019-12-02 DOI: 10.1055/s-0039-3400229
G. Yildiran, M. Sutcu, O. Akdağ, Z. Tosun
Abstract Objectives Better healing results of any tissue or area is closely linked with a well-blood supply in reconstructive surgery. Peripheric nerve healing is closely related to blood supply as well. We aimed to assess whether there was any difference between digital nerve healing with and without extrinsic blood supply. Methods We assessed 48 patients with unilateral digital nerve injury at zone 2. Twenty-four of them had unrepairable arterial injury and other 24 had no arterial injury. The 24 patients in the “unrepaired artery group” (UA) and 24 patients in the “intact artery group” (IA) were compared. Results Mean follow-up time was 17.7 months. The mean two-point discrimination (2PD) was 5.29 mm in IA group and 5.37 mm in UA group. One neuroma in IA group and two neuromas in UA group were determined. We found no statistically significant difference between these groups in terms of neuroma, 2PD, and cold intolerance. The results of British Medical Research Council sensory recovery clinical scale were comparable for these two groups. Conclusion Digital nerve healing is related to numerous factors. We hypothesized that blood flow may be one of these factors; however, at this zone digital artery repair is not the foremost determinant for digital nerve healing. Further researches should be done for upper injury levels. Despite this result, we argue not to leave the digital artery without repairment and we propose to repair both artery and nerve to achieve the normal anatomical integrity and to warrant finger blood flow in possible future injuries.
目的在重建手术中,任何组织或区域的良好愈合效果都与良好的血液供应密切相关。外周神经的愈合也与血液供应密切相关。我们的目的是评估在有和没有外源性血液供应的情况下,指神经愈合是否有任何差异。方法对48例单侧指神经2区损伤患者进行临床分析。动脉损伤不可修复者24例,无动脉损伤者24例。将24例“未修复动脉组”(UA)与24例“完整动脉组”(IA)进行比较。结果平均随访时间17.7个月。IA组和UA组的平均两点辨别(2PD)分别为5.29 mm和5.37 mm。IA组1个神经瘤,UA组2个神经瘤。我们发现两组之间在神经瘤、2PD和冷不耐受方面没有统计学上的显著差异。英国医学研究理事会感觉恢复临床量表结果两组具有可比性。结论指神经的愈合与多种因素有关。我们假设血流量可能是这些因素之一;然而,在这个区域,指动脉修复并不是指神经愈合的首要决定因素。上肢损伤程度有待进一步研究。尽管结果如此,我们认为不能不修复就离开指动脉,我们建议修复动脉和神经以达到正常的解剖完整性,并保证手指在可能的未来损伤中血液流动。
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引用次数: 6
Surgical Experience in Management of Para-Pharyngeal Tumors in Tertiary Center 三级中心咽旁肿瘤的外科治疗体会
IF 0.9 Q4 SURGERY Pub Date : 2019-10-31 DOI: 10.36478/sjour.2017.1.4
G. Jamjoum, Sarah Altayyari
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引用次数: 0
Camptodactyly Caused by an Anomalous Origin of the Flexor Digitorum Superficialis Tendon: A Case Report and Review of the Literature 指浅屈肌腱起源异常致强直1例并文献复习
IF 0.9 Q4 SURGERY Pub Date : 2019-10-01 DOI: 10.1055/s-0039-1697631
S. Duci
Abstract Camptodactyly is a flexion contracture of the proximal interphalangeal joints and is known as an isolated malformation that affects 1 in 300 in the population and can be inherited as an autosomal dominant trait with variable expression. A 17-year-old female was referred to the Clinic of Plastic Surgery, University Clinical Center of Kosovo, Prishtina, for the first time with camptodactyly of the little finger in the right hand. She was presented with a progressive flexion contracture of the proximal interphalangeal joint greater than 110 degrees of her right little finger. According to our observations from outpatient consultations, we concluded that the case of camptodactyly in the little finger in the flexible form (>110 degrees), which underwent surgical treatment, presented excellent result. Therefore, we think that the surgical technique used in our case report will contribute to treating this complicated deformity.
摘要Camptodactyly是一种近端指间关节屈曲挛缩症,是一种孤立的畸形,在人群中影响1/300,可以作为一种常染色体显性遗传,具有可变表达。一名17岁女性因右手小指弯曲首次被转诊至普里什蒂纳科索沃大学临床中心整形外科诊所。她表现为右小指近端指间关节进行性屈曲挛缩大于110度。根据我们在门诊会诊中的观察结果,我们得出结论,小手指弯曲灵活(>110度)的病例接受了手术治疗,取得了良好的效果。因此,我们认为在我们的病例报告中使用的手术技术将有助于治疗这种复杂的畸形。
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引用次数: 1
An Unusual Combination of Three Rare Complications: Pleuro-Pancreatic Fistula, Chylous Ascites, and Renal Vein Thrombosis, in a Case of Acute Severe Pancreatitis 急性重症胰腺炎三种罕见并发症的罕见组合:胸膜胰瘘、糜腹水和肾静脉血栓形成
IF 0.9 Q4 SURGERY Pub Date : 2019-10-01 DOI: 10.1055/s-0039-1700807
Tanweerul Huda, A. Mohan, Mohammad Masoom Parwez, B. Pandya
Abstract Background Acute pancreatitis is fraught with a variety of complications, which account for the mortality associated. Our case had a fulminant course, with three rare, near-fatal complications and was successfully managed conservatively. Pleural effusion due to pleuro-pancreatic fistula is uncommon, seen in only 1% cases, of which right-sided effusions are rarer still. Management modalities include conservative, endoscopic, and surgical options. Chylous ascites is an extremely rare complication of pancreatitis and is managed with high protein, low lipid diet, restricted to medium-chain triglycerides (MCTs). Extra-splanchnic venous thrombosis is uncommon in pancreatitis, and isolated renal vein thrombosis is very rare. Case Presentation A 34-year-old, chronic alcoholic male, presented to the outpatient department (OPD) in a state of shock and respiratory distress. Chest radiograph showed massive right-sided pleural effusion. The pleural fluid was hemorrhagic with markedly elevated amylase levels, and contrast-enhanced computed tomography (CECT) confirmed the presence of a right-sided pleuro-pancreatic fistula. Left renal vein thrombosis was also noted. The patient improved with chest drain, intravenous (IV) octreotide, and anticoagulants. Subsequently, he developed hemorrhagic pancreatic ascites, which later turned chylous. This was managed with dietary modifications. The patient had a prolonged recovery but was finally discharged after 45 days. Conclusion It is a challenge managing the various complications of acute severe pancreatitis. We describe this case to emphasize maintaining a high sensitivity for timely diagnosis and appropriate addressal of all the complications for better patient outcomes.
摘要背景 急性胰腺炎充满了各种并发症,这些并发症导致了相关的死亡率。我们的病例有一个暴发性的过程,有三种罕见的、近乎致命的并发症,并得到了成功的保守治疗。胸膜胰瘘引起的胸腔积液并不常见,只有1%的病例出现,其中右侧胸腔积液更为罕见。管理方式包括保守治疗、内窥镜治疗和手术治疗。Chylous腹水是胰腺炎的一种极为罕见的并发症,可通过高蛋白、低脂饮食进行治疗,仅限于中链甘油三酯(MCTs)。内脏外静脉血栓形成在胰腺炎中并不常见,孤立性肾静脉血栓形成非常罕见。案例介绍 一名34岁的慢性酒精中毒男性,在休克和呼吸窘迫的状态下到门诊部就诊。胸部X线片显示右侧大量胸腔积液。胸膜液出血,淀粉酶水平显著升高,对比增强计算机断层扫描(CECT)证实存在右侧胸膜-胰腺瘘。还发现左肾静脉血栓形成。患者通过胸腔引流、静脉注射奥曲肽和抗凝剂改善。随后,他出现了出血性胰腺腹水,后来变成了乳糜。这是通过改变饮食来控制的。病人恢复时间很长,但在45天后终于出院了。结论 管理急性重症胰腺炎的各种并发症是一项挑战。我们描述这个病例是为了强调保持对及时诊断的高度敏感性,并适当处理所有并发症,以获得更好的患者结果。
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引用次数: 3
A Rare Case of Acquired Transthoracic Littre's Hernia 罕见的获得性经胸利特氏疝1例
IF 0.9 Q4 SURGERY Pub Date : 2019-10-01 DOI: 10.1055/s-0039-1696727
Arthur Curmi, A. Dimech, R. Dalli, A. Mostafa, J. Debono
Abstract Introduction The Littre hernia is a rare complication of Meckel's diverticulum. Meckel's diverticulum is vestigial remnant of the omphalomesenteric duct occurring in approximately 2% of the general population with an estimated 4 to 16% risk of complications. Usual sites of the Littre hernia include inguinal (50%), umbilical (20%), and femoral (20%). We report a case of an acquired transthoracic Littre's hernia occurring through the left part of the diaphragm triggered by a history of traumatic rib fractures associated with alcohol abuse. Case Report A 71-year-old man presented with 4-day history of worsening shortness of breath, colicky lower abdominal pain, and inability to open bowels despite passing flatus, without nausea or vomiting. His past medical history was remarkable for multiple traumatic rib fractures caused by falls which were associated with excessive alcohol consumption. A noncontrast computed tomography (CT) scan of the abdomen and pelvis showed distended jejunal loops containing air/fluid levels likely resulting from herniated jejunum between the left chest wall and left diaphragm. An urgent laparotomy was performed which revealed small bowel and omentum herniating through a small defect in the left posterior hemidiaphragm. The contents of the sac were reduced and a Meckel's diverticulum was found inside the sac, characteristic of Littre's hernia. The diaphragmatic defect was closed and the Meckel diverticulum stapled and excised. Discussion Herniation of Meckel's diverticulum through the diaphragm most commonly occurs in the pediatric population. Acquired transthoracic Littre's hernia is rare and may arise following thoracobdominal trauma caused by surgery, motor vehicle accidents, and falls from height. Left-diaphragmatic tears are characteristically more clinically apparent and symptomatic than the right since the liver often has a protective effect on the right part of the diaphragm. Herniation of abdominal contents in the chest cavity causes respiratory distress and requires urgent surgical correction. Diagnosis is often delayed since diaphragmatic hernia tends to present very late after the initial trauma, subjecting the patient to possible life-threatening complications. While it is easier to reduce the herniated contents and repair the diaphragm via a thoracic approach, laparotomy is often preferred in cases of acute trauma associated with intra-abdominal injuries. Repair of Littre's hernia then consists of resection of the diverticulum and herniorraphy. Conclusion Internal Littre's hernia is usually of congenital origin. This is the first case of a transthoracic Littre's hernia caused by traumatic rib fractures. Hence, it is of utter importance that a clinician is aware of such uncommon pathology.
摘要简介 Littre疝是Meckel憩室的一种罕见并发症。Meckel’s憩室是脐肠系膜管的残余,约2%的普通人群中存在,估计有4%至16%的并发症风险。利特尔疝的常见部位包括腹股沟疝(50%)、脐疝(20%)和股疝(20%)。我们报告了一例通过膈肌左侧发生的后天性经胸Littre疝,该疝由与酗酒相关的创伤性肋骨骨折史引发。案例报告 一名71岁的男性,有4天的呼吸急促、绞痛性下腹疼痛恶化史,尽管排便但无法排便,没有恶心或呕吐。他过去的病史是由过度饮酒引起的跌倒导致的多处创伤性肋骨骨折。腹部和骨盆的非光栅计算机断层扫描(CT)显示,膨胀的空肠环含有空气/液体水平,这可能是由于左胸壁和左膈之间的空肠突出引起的。进行了紧急剖腹手术,发现小肠和网膜通过左后半横膈膜的一个小缺陷突出。囊内内容物减少,囊内发现Meckel憩室,这是Littre疝的特征。膈肌缺损被闭合,Meckel憩室被缝合并切除。讨论 通过膈肌的Meckel憩室疝最常见于儿科人群。后天性经胸Littre疝是罕见的,可能发生在手术、机动车事故和高处坠落造成的胸腹创伤之后。左侧膈肌撕裂在临床上比右侧更明显,症状也更明显,因为肝脏通常对膈肌的右侧有保护作用。胸腔内腹部内容物疝引起呼吸窘迫,需要紧急手术矫正。诊断往往被推迟,因为膈疝往往在最初的创伤后很晚才出现,使患者可能出现危及生命的并发症。虽然通过胸部入路更容易减少疝出物并修复横膈膜,但在与腹腔内损伤相关的急性创伤病例中,剖腹手术通常是首选。利特尔疝的修复包括切除憩室和疝修补术。结论 利特尔内疝通常是先天性的。这是第一例由创伤性肋骨骨折引起的经胸利特尔疝。因此,临床医生了解这种罕见的病理学是非常重要的。
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引用次数: 3
Association of Hemorrhoid Vascular Injuries with Cigarette Smoking—An Evaluation with Interesting Prospects 痔疮血管损伤与吸烟的关系——一项具有有趣前景的评估
IF 0.9 Q4 SURGERY Pub Date : 2019-10-01 DOI: 10.1055/s-0039-1700497
S. Nagaraj, Amit Mori, M. Reddy
Abstract Background Hemorrhoids are vascular structures in the anal canal which are seldom used to evaluate vascular diseases. Cigarette smoking is well-known to cause both arterial and venous vascular injuries. However, the impact of smoking on hemorrhoid vasculature is unknown. Objective Considering that vasculature in the hemorrhoids has the same anatomy and pathophysiology of vascular damage as other systemic vasculatures, we conducted this study to evaluate the relation between smoking and incidence of hemorrhoidal vascular injury. Design and Data Analysis Retrospective review of all the screening colonoscopies performed at our Department of Gastroenterology (predominantly serving urban minority population) over 3 years was conducted and patients with recorded smoking history were included in the study (n = 242). Fisher's exact test with two-tailed p-value and odds ratio were used to evaluate for the association between smoking and incidence of hemorrhoids. Results We studied 242 subjects and found statistically significant association between smoking and hemorrhoids (p < 0.05) with the risk of developing hemorrhoids among smokers being 2.4 times that of a nonsmoker. We further noted no significant difference in the incidence of hemorrhoidal vascular injuries between the past versus current smokers and male versus female smokers. Conclusion This is one of the first studies to establish an association between smoking and hemorrhoids. Our study shows that the hemorrhoidal vasculature is impacted by smoking similar to other vascular systems. This study sheds light on the possibility of evaluating hemorrhoids for clues of other systemic and gastrointestinal vascular damage. This correlation can add clinical value especially given the flexibility of assessing hemorrhoids as an outpatient in a cost effective and comfortable manner.
摘要背景痔疮是肛管内的血管结构,很少用于血管疾病的评价。众所周知,吸烟会导致动脉和静脉血管损伤。然而,吸烟对痔疮血管的影响尚不清楚。目的考虑到痔疮血管与其他全身血管具有相同的血管损伤解剖和病理生理,我们进行了本研究,以评估吸烟与痔疮血管损伤发生率的关系。设计与数据分析回顾性分析我院消化内科(主要为城市少数民族人群服务)3年来所有结肠镜筛查病例,并纳入有吸烟史的患者(n = 242)。采用双尾p值和优势比的Fisher精确检验来评价吸烟与痔疮发病率之间的关系。结果我们对242名受试者进行了研究,发现吸烟与痔疮有统计学意义(p < 0.05),吸烟者患痔疮的风险是不吸烟者的2.4倍。我们进一步注意到,过去吸烟者与现在吸烟者、男性吸烟者与女性吸烟者之间痔疮血管损伤的发生率无显著差异。结论:这是首次建立吸烟与痔疮之间联系的研究之一。我们的研究表明,与其他血管系统一样,痔疮血管系统也受到吸烟的影响。这项研究揭示了评估痔疮的其他系统性和胃肠道血管损伤的线索的可能性。这种相关性可以增加临床价值,特别是考虑到门诊评估痔疮的灵活性,成本效益和舒适的方式。
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引用次数: 3
Thoracoscopic Esophagectomy for a Huge Leiomyosarcoma 胸腔镜食管切除术治疗巨大平滑肌肉瘤
IF 0.9 Q4 SURGERY Pub Date : 2019-10-01 DOI: 10.1055/s-0039-1696729
J. Manipadam, S. Bains, S. Mahesh, Ami Emmanuel, H. Ramesh
Abstract Esophageal leiomyosarcoma is the commonest of all esophageal sarcomas but yet has a very low incidence. These tumors have been resected by the open approach so far. We describe the steps and challenges involved in the thoracoscopic excision of a huge leiomyosarcoma of the esophagus.
摘要食管平滑肌肉瘤是所有食管肉瘤中最常见的,但发病率很低。到目前为止,这些肿瘤已经通过开放式手术切除。我们描述了胸腔镜切除巨大食管平滑肌肉瘤的步骤和挑战。
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引用次数: 2
A Case Report Describing Three Cases of Challenging or Failed Intubation after Cervical Spine Surgery: A Peril of Early Extubation 描述三例颈椎手术后插管困难或失败的病例报告:早期拔管的危险
IF 0.9 Q4 SURGERY Pub Date : 2019-10-01 DOI: 10.1055/s-0039-1700806
P. Mishra, K. Mishra, C. Palmer, A. Robertson
Abstract Postoperative airway complications can be a common, yet perhaps underappreciated, complication in patients undergoing cervical spine surgery. Presented here are three cases in which patients experienced postoperative airway compromise, resulting in difficulty establishing a secure airway following cervical spine operations. Establishing factors that contribute to airway complications after cervical spine surgery can aid in early identification of high-risk patients to create an appropriate airway management strategy. Ultimately, the frequency of airway difficulty after removal of the endotracheal tube in patients undergoing cervical spine surgery should not be taken lightly.
摘要:在接受颈椎手术的患者中,术后呼吸道并发症可能是一种常见的,但可能被低估的并发症。本文介绍了三例患者术后气道受损,导致颈椎手术后难以建立安全的气道。确定导致颈椎手术后气道并发症的因素有助于早期识别高危患者,以制定适当的气道管理策略。最终,在接受颈椎手术的患者中,拔出气管导管后出现气道困难的频率不应掉以轻心。
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引用次数: 3
期刊
Surgery Journal
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