Annals of Medicine and Surgery最新文献

Introduction and importance: The inner ear is considered an 'end organ' since its vascular supply comes from one terminal artery, making the labyrinth especially vulnerable to ischemia, causing loss of auditory and vestibular function with variable clinical patterns according to the different arterial distribution in the inner ear and which vascular branches are concerned by the embolism.

Case presentation: We report a misleading case of central vascular vertigo caused by a labyrinthine infarction resulting from an embolic vertebral artery, which manifested in a typical peripheral clinical presentation mimicking a vestibular neuritis.

Clinical discussion: Vertigo is the result of asymmetrical responses from the vestibules of both ears resulting from any disruption along the complex vestibular pathways, whether peripheral or central. The recognition of the origin of an acute isolated vertigo is fundamental since the therapeutic strategy and prognosis differ, but it can be challenging in the absence of neurological signs, especially when the clinical pattern involves only the vestibular part of the labyrinth.

Conclusion: The diagnosis strategy should consider the patient vascular risk factors and the clinical bedside tests with diffusion-weighted magnetic resonance imaging (MRI). Then, the management of these patients requires pluridisciplinary cooperation with early vestibular rehabilitation.

Introduction and importance: Scalp arteriovenous malformations (AVMs) are intricate vascular anomalies with abnormal connections between arteries and veins in the scalp, leading to serious complications and cosmetic concerns. Managing scalp AVMs is particularly complex in young female patients, where both functional and aesthetic outcomes are crucial. This case report highlights the successful treatment of a young woman with a scalp AVM, emphasizing the importance of early diagnosis and a multidisciplinary approach.

Case presentation: A 30-year-old female presented with a pulsatile scalp mass and significant cosmetic concerns. Diagnostic imaging, including ultrasonography, brain CT scan, MRI, and carotid CT angiogram, confirmed a scalp AVM. The patient underwent a comprehensive treatment plan beginning with endovascular embolization to reduce blood flow to the AVM, followed by surgical resection to remove the lesion. Postoperative follow-up showed a marked reduction in symptoms and lesion volume, with no complications observed.

Clinical discussion: Scalp AVMs, though rare, require prompt diagnosis due to the risk of severe complications such as hemorrhage and cosmetic impact. In this case, a combination of ultrasonography, CT, and MRI provided a detailed assessment of the AVM. A multidisciplinary approach, involving interventional radiology and surgical expertise, was crucial for success. Endovascular embolization minimized intraoperative bleeding and simplified surgical resection, leading to significant symptom and cosmetic improvements. Continuous monitoring is essential for long-term success and early detection of recurrences.

Conclusion: This case underscores the effectiveness of a multidisciplinary approach in managing scalp AVMs in young female patients. Early diagnosis through advanced imaging techniques enables timely and targeted intervention. The combined use of endovascular embolization and surgical resection led to significant symptom resolution and aesthetic enhancement. Collaboration among specialists is vital for optimizing outcomes, and ongoing research will further refine treatment strategies, improving the quality of life for patients with scalp AVMs.

This article explores the potential of telemedicine to revolutionize maternal and perinatal healthcare delivery in rural Nepal, where access to medical facilities is limited. By utilizing telemedicine technologies like remote consultations, mobile health applications, and tele-ultrasound, the authors can overcome barriers to healthcare access and improve outcomes for expectant mothers and newborns. The paper assesses the opportunities presented by telemedicine interventions and addresses the challenges that must be addressed for successful integration into rural healthcare systems.

Introduction and importance: Self-inflicted abdominal stab wounds present rare yet critical challenges requiring urgent surgical intervention and comprehensive psychiatric evaluation. Such injuries often correlate with psychiatric disorders like schizophrenia and alcohol dependence, posing significant clinical and psychological management hurdles.

Case presentation: A 36-year-old male with a history of chronic alcohol use and schizophrenia presented with a self-inflicted stab wound to the abdomen following auditory hallucinations. Upon admission, he was hemodynamically unstable, with eviscerated bowel loops and a lacerated greater omentum. Prompt surgical exploration revealed extensive abdominal trauma necessitating meticulous repair and intensive postoperative care.

Clinical discussion: The case highlights the intricate interplay between severe psychiatric illness and self-harm, exacerbated by alcohol intoxication. Integrated psychiatric and surgical care proved pivotal in achieving stabilization and facilitating recovery. The challenges encountered in a resource-limited setting included a lack of advanced imaging modalities, limited access to specialized psychiatric care, and constraints in postoperative monitoring equipment, underscoring the importance of adaptive management strategies.

Conclusion: This report emphasizes the critical need for a multidisciplinary approach in managing self-inflicted abdominal injuries. The successful outcome underscores the efficacy of timely surgical intervention and comprehensive psychiatric support. Integrated care models are essential for addressing the complex needs of patients with psychiatric comorbidities, ensuring holistic management, and reducing the risk of recurrence in similar cases.

Introduction and importance: Transorbital penetrating traumatic brain injury (TPTBI) is a rare cause of penetrating head injury, yet the diagnoses can be overlooked in some cases due to incomplete history, trivial trauma, and the absence of immediate neurologic deficits.

Case presentation: A 4-year-old male child was admitted with a diagnosis of TPTBI by a wooden object. Noncontrast enhanced CT scan revealed a linear hypodense structure extending from the superior wall of the right orbit into the frontal lobe with displaced fragments into the brain. Additionally, cerebral contusion, pneumocephalus, and hematoma with surrounding edema were seen in the frontal lobe. Early extraction of the foreign body was performed by a multidisciplinary team of neurosurgeons and ophthalmologists. The wooden fragment of size 10 cm×1 cm×1 cm was removed by a small mini-craniotomy of the right frontal supraorbital bone with the gentle pulling of it through the dura mater and frontal cortex. The postoperative course was uncomplicated, vision was restored, and there were no neurologic deficits at the time of discharge on the seventh postoperative day with good postoperative outcomes.

Clinical discussion: Delayed removal of TPTBI may be complicated by misidentification of entry points, extensive scarring around the foreign body, adherence to the intracranial vessels, and increasing mortality due to infectious complications. Therefore, early exploration with the help of a multidisciplinary team will most likely result in successful debridement, good neurologic outcomes, and lower morbidity and mortality.

Conclusion: Accurate diagnosis and early intervention for TPTBI may prevent possible infectious and neurologic complications.

Introduction and importance: Esophageal perforation from endoscopic dilation is rare (0.53-0.6% incidence) but serious, with mortality rates of 12.5-20%. Optimal treatment is debated and depends on the medical facility's capabilities, the patient's symptoms, the extent of perforation, and the severity of associated lesions. Treatment options include medical management (fasting, antibiotics), esophageal stenting, surgical closure, or emergency esophagectomy. Early diagnosis and treatment are crucial to reduce mortality and hospital stay.

Case presentation: A 49-year-old male with lower third esophageal cancer (stage cT1aN0M0) underwent endoscopic submucosal dissection (ESD) and developed esophageal stenosis. Dilation attempts led to esophageal perforation, necessitating emergency esophagectomy with gastric conduit reconstruction. The patient improved and was discharged on day 10 post-operation without complications.

Clinical discussion: Managing esophageal perforation post-endoscopic dilation is complex. This case highlights the importance of rapid recognition and intervention. Esophageal dilation, while effective for stenosis, carries a perforation risk. Treatment decisions must be tailored to individual patients, considering perforation severity, patient's health, and facility resources. Here, severe perforation and clinical condition warranted emergency esophagectomy. The successful outcome underscores the efficacy of this surgical intervention when performed timely at specialized centers.

Conclusion: Emergency esophagectomy with gastric conduit reconstruction for treating esophageal perforation due to stenosis post-endoscopic submucosal dissection for esophageal cancer is considered a safe procedure and can be performed at an experienced esophageal surgery center.

Malaria remains a significant global health challenge, particularly in regions with limited resources and tropical climates. Despite extensive efforts, the disease continues to cause significant morbidity and mortality, with ~229 million cases and 409 000 deaths reported in 2020. However, recent years have seen promising advancements in public health strategies aimed at malaria control and elimination. Technological advancements have played a crucial role in improving malaria control efforts. Genomic surveillance techniques enable the monitoring of malaria parasite populations, aiding in the detection of drug resistance and informing targeted interventions. Additionally, innovative diagnostic technologies, such as rapid diagnostic tests (RDTs) and molecular assays, have enhanced the speed and accuracy of malaria diagnosis, facilitated prompt treatment and reduced transmission. These tools are instrumental in achieving the WHO goals of reducing malaria cases and deaths by at least 90% by 2030. Novel vector control methods offer innovative approaches to reduce malaria transmission. Insecticide-treated nets (ITNs) and indoor residual spraying (IRS) remain foundational strategies, with advancements including the development of next-generation insecticides and long-lasting insecticidal nets (LLINs). Furthermore, genetic modification of mosquitoes, such as gene drive technology, holds promise for reducing mosquito populations and interrupting malaria transmission. These vector control innovations complement other strategies, contributing to comprehensive malaria control efforts aimed at achieving sustainable disease reduction and eventual elimination.

Background: This study was designed to investigate the effectiveness and outcome of a new modification of the sphincter pharyngoplasty technique in the treatment of velopharyngeal insufficiency patients, with the determination of a specific dimension of velopharyngeal port and velum length of no hypernasality, snoring, and nasal regurgitation potential.

Materials and methods: The study included 10 patients, who were suffering from consistent hypernasal speech after failure of conservative speech therapy. Clinical and radiographic measurements of the velopharyngeal port and velum length before and after surgery were done, with clinical patient follow-up to assess snoring and nasal regurgitation after surgery for 1, 6, and 12 months.

Results: Before surgery, the mean clinical anteroposterior distance/velopharyngeal depth was 16.40±1.7 mm, and the mediolateral distance was 20.20±3.4 mm. After surgery, the mean anteroposterior distance decreased to 8±0.9 mm, and the mean mediolateral distance decreased to 12.60±2.06 mm. Both measurements showed statistically significant (P=0.0001). After 12 months postoperatively, the radiographic CT axial anteroposterior distance was 12.09±1.4 mm, and the mean mediolateral distance was 19.82±5.6 mm, compared to the mean CT anterioposterior before surgery 15.60±2 mm and mediolaterally 21.28±2.7 mm. The anteroposterior measurement showed a statistically significant (P=0.002), while the mediolateral measurement did not (P=0.3). The mean velum length before surgery was 25.80±1.5 mm and 27.03±0.6 mm after 12 months postoperatively. Snoring and nasal regurgitation occurrence were assessed at 1, 6, and 12 months postoperatively, with all reports being negative.

Conclusion: Sphincter pharyngoplasty using posterior tonsillar pillars for treating VPI patients results in improved speech outcomes without snoring or nasal regurgitation.