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Retroperitoneoscopic drainage of a retroperitoneal abscess when open surgery is not an option: a novel surgical technique 不能选择开放手术时腹膜后脓肿的后腹腔镜引流:一种新的手术技术
Pub Date : 2019-06-07 DOI: 10.15406/mojcr.2019.09.00305
C. Rivera
Objective: An open cholecystectomy has specific surgical indications, including cirrhosis, vesicular cancer, and severe adherence syndrome. Abscesses resulting from the open surgery corresponds to 1% of complications. When located in the retroperitoneum, these abscesses are life-threatening conditions, having a high mortality from a delayed diagnosis or incomplete drainage. Treatment can be conservative, surgical or endoscopically. Materials and Methods: In the right lateral decubitus position, between the medial and posterior axillary lines, inferior to the twelfth costal space an incision is made for the 12mm trocar. Avulsion and resection of the lateral abdominal muscles and latissimus dorsi muscle until inside the retroperitoneum, where under direct vision, the 5mm and the pneumatic trocar are inserted above and anterior to the iliac crest. Results: Through the retroperitoneum scope, the retroperitoneum space is easily accessed to ensure complete abscess drainage. In the out-patient consults, there were no resulting complications reported. Discussion: Retroperitoneal infections are a surgical and diagnostic challenge. The abscess classification depends on the anatomic location which can direct any of the therapeutic options, between the conservative, surgical, or percutaneous drainage. The conservative approach is reserved for small collections (<3cm), the percutaneous is widely used but not exempt from complications, and more recently the minimally invasive approach, the retroperitoneoscopic drainage, has shown superior benefits, with complete drainage and debridement leading to a decreased recurrence rate. Conclusions: We propose a retroperitoneum scope access as a safe and ideal method to drain retroperitoneal abscesses in patients whom a conservative approach cannot be performed, or those who cannot undergo a percutaneous or open surgical technique.
目的:开放性胆囊切除术具有特殊的手术指征,包括肝硬化、膀胱癌症和严重粘连综合征。开放手术引起的脓肿相当于1%的并发症。当位于腹膜后时,这些脓肿会危及生命,诊断延迟或引流不完全会导致高死亡率。治疗可以是保守治疗、手术治疗或内镜治疗。材料和方法:在右侧卧位,在腋中线和腋后线之间,在第十二肋间隙下方,切开12mm套管针。对腹外侧肌和背阔肌进行剥离和切除,直到腹膜后,在直视下,将5mm和气动套管针插入髂嵴上方和前方。结果:通过腹膜后镜,腹膜后间隙很容易进入,确保脓肿完全引流。在门诊会诊中,没有任何并发症的报告。讨论:腹膜后感染是一个外科和诊断挑战。脓肿的分类取决于解剖位置,解剖位置可以指导保守、手术或经皮引流之间的任何治疗选择。保守的入路是为小的收集(<3cm)保留的,经皮入路被广泛使用,但也不能避免并发症,最近的微创入路,后腹腔镜引流,显示出优越的优势,完全引流和清创可以降低复发率。结论:我们建议腹膜后窥镜入路是一种安全理想的方法,用于引流无法采用保守入路或无法采用经皮或开放手术技术的腹膜后脓肿。
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引用次数: 2
4th ventricular ependymoma with lumbosacralmetastasis surgically removed at one sitting: a case report 第四脑室室管膜瘤合并腰骶部转移一次手术切除1例
Pub Date : 2019-05-20 DOI: 10.15406/MOJCR.2019.09.00303
Neeraj Salhotra
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引用次数: 0
Recurrent lymphoma as a cause of obscure massive small bowel bleeding 复发性淋巴瘤引起不明原因的大量小肠出血
Pub Date : 2019-05-17 DOI: 10.15406/mojcr.2019.09.00302
D. Victor
Diffuse large B-cell lymphoma (DLBCL) is an aggressive malignancy that accounts for the largest proportion of non-Hodgkin lymphoma. The gastrointestinal (GI) tract is the most common site of extra-nodal involvement.1,2 Subsequent gastrointestinal bleeding can be a life-threatening complication. Recurrent lymphoma is unusual to present with gastrointestinal hemorrhage, especially after longstanding remission. Here, we present obscure massive small bowel bleeding as the initial presentation of recurrent DLBCL.
弥漫性大B细胞淋巴瘤(DLBCL)是一种侵袭性恶性肿瘤,在非霍奇金淋巴瘤中所占比例最大。胃肠道是最常见的淋巴结外受累部位。1,2随后的胃肠道出血可能是危及生命的并发症。复发性淋巴瘤不常见于胃肠道出血,尤其是在长期缓解后。在这里,我们将不明原因的大量小肠出血作为复发性DLBCL的最初表现。
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引用次数: 0
Atypical case of Mayer–Rokitansky–Kuster–Hauser syndrome and amyloidosis: is there a link or association? 迈尔-罗基坦斯基-库斯特-豪泽综合征与淀粉样变的非典型病例:是否有联系或关联?
Pub Date : 2019-05-16 DOI: 10.15406/mojcr.2019.09.00301
M. Behiry
Renal problems such as absence or ectopia of the kidneys is not uncommon which may lead to urinary incontinence, recurrent urinary tract infections or even renal failure,2 however Amyloidosis was incriminated in our case We present this atypical case of Mayer– Rokitansky–Kuster–Hauser syndrome complicated with renal failure due to amyloid kidney to raise an inquiry is there a link between this syndrome and amyloidosis or such an association.
诸如肾脏缺失或异位的肾脏问题并不罕见,其可导致尿失禁、复发性尿路感染或甚至肾衰竭,2然而,淀粉样变性在我们的病例中被定罪。我们提出了一个非典型的Mayer–Rokitansky–Kuster–Hauser综合征病例,该综合征并发淀粉样肾引起的肾衰竭,以提出一个问题,即该综合征与淀粉样变性之间是否存在联系或这种关联。
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引用次数: 0
Numb chin syndrome with sickle cell disease - a report of two cases Numb-chin综合征合并镰状细胞病——附2例报告
Pub Date : 2019-04-22 DOI: 10.15406/mojcr.2019.09.00299
M. Mohapatra
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引用次数: 3
A case of open degloving injury in a pregnant patient 一例孕妇开放性脱套损伤
Pub Date : 2019-04-22 DOI: 10.15406/mojcr.2019.09.00300
M. Afzal
Road traffic accidents are taking lives of approximately 1.25million people in the world annually. Trauma during pregnancy is also quite common in developing countries but it is not frequently reported. Mothers in 3rd trimester are most vulnerable for trauma due to unstable gate and shift of center of gravity.1,2 Degloving injuries are one of very common devastating injury associated with road traffic accident. It is a type of avulsion in which rotational force causes skin and subcutaneous tissue to be torn completely from underlying muscle and fascia3 .It can be open or closed .It is most common in males and main sites are lower limb, trunk, scalp and face. Diagnosing degloving injury is also a challenging decision .most of the time it’s clinical or by ultrasound or CT scanning.3,4–9
道路交通事故每年夺走全世界约125万人的生命。怀孕期间的创伤在发展中国家也很常见,但并不经常报告。妊娠晚期的母亲最容易因闸门不稳和重心偏移而受到创伤。1,2脱水损伤是与道路交通事故相关的非常常见的毁灭性损伤之一。它是一种旋转力导致皮肤和皮下组织从下层肌肉和筋膜上完全撕裂的撕脱伤3。它可以是开放的或闭合的。它在男性中最常见,主要部位是下肢、躯干、头皮和面部。诊断脱套损伤也是一个具有挑战性的决定。大多数时候是通过临床或超声或CT扫描。3,4–9
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引用次数: 0
Duodenal hematoma secondary to acute chronic pancreatitis: case report and literature review 急性慢性胰腺炎继发十二指肠血肿1例报告及文献复习
Pub Date : 2019-02-19 DOI: 10.15406/MOJCR.2019.09.00295
Luiz Carlos Araújo Souza, Rafael Francisco Alves Silva, Carlos Hirokatsu Watanabe Silva, O. Claros
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引用次数: 0
Single intravitreal etamsylate injection for the treatment of choroidal neovascular membrane formation in neovascular age-related macular degeneration 单次玻璃体内注射乙胺酸治疗新生血管性老年性黄斑变性脉络膜新生血管膜形成
Pub Date : 2019-01-01 DOI: 10.15406/mojcr.2019.09.00289
P. Cuevas
Submacular haemorrhage (SMH) is an accumulation of blood between the neurosensory retina and retinal pigment epithelium (RPE), arising from the choroidal circulation within the macula. It is considered that it usually occurs in the context of neovascular (wet) age-related macular degeneration (ARMD).1 Owing to iron toxicity, SMH damages the RPE and the photoreceptors, affects the fibrin network contraction and causes a subsequent reduced nutrient flux from choriocapillaris ensued of scarring development.2–4 While SMH is not common, wet ARMD patients with coagulopathies to which anticoagulant medication is administered are, nevertheless, particularly susceptible to developing this disease.5 The visual outcome of wet ARMD patients with SMH is typically poor, particularly in eyes with thick blood clots or involving large areas of the macula, and which develop a choroidal neovascular membrane (CNVM).6 Average time for disappearance of the SMH is 6 months.4 Experimental studies support prompt treatment of SMH, as tissue damage occurs within 24hours. Without treatment the natural history of SMH is poor. Search for a safe and effective treatment for removing the blood beneath the macula to hasten visual recovery and prevent irreversible damage to the outer retina is a medical need. There is no standard treatment for acute SMH. Etamsylate is a newly identified therapeutically relevant molecule that could be used in pathological conditions involving aberrant fibroblast growth factor (FGF) signalling7,8 (NOSOTROS). Immunoreactivity for FGF has been reported in CNVM removed surgically from humans with ARMD, which suggests a role of this growth factor in the origin and progression of the disease.9 Furthermore, damage of RPE as it occurs in ARMD, causes the release of FGF which, in turn, could contribute to formation of CNVM by itself.10 Thus, local inhibition of FGF would sum an adequate strategy for resolving CNVM. We describe here the efficacy of intravitreal etamsylate administration in a patient with SMH and CNVM associated with wet ARMD.
黄斑下出血(SMH)是由黄斑内脉络膜循环引起的神经感觉视网膜和视网膜色素上皮(RPE)之间的血液积聚。人们认为它通常发生在新生血管性(湿性)年龄相关性黄斑变性(ARMD)的背景下由于铁毒性,SMH损害RPE和光感受器,影响纤维蛋白网络收缩,导致绒毛膜毛细血管的营养通量减少,从而导致瘢痕形成。2-4虽然SMH并不常见,但有抗凝药物治疗的凝血功能障碍的湿性ARMD患者特别容易发生这种疾病湿性ARMD合并SMH患者的视力通常较差,特别是有厚血块或累及大片黄斑的眼睛,并形成脉络膜新生血管膜(CNVM)SMH消失的平均时间为6个月实验研究支持及时治疗SMH,因为组织损伤发生在24小时内。未经治疗,SMH的自然史很差。寻找一种安全有效的治疗方法来清除黄斑下的血液,以加速视力恢复,防止对外层视网膜造成不可逆转的损害,这是医学上的需要。急性SMH没有标准的治疗方法。Etamsylate是一种新发现的治疗相关分子,可用于异常成纤维细胞生长因子(FGF)信号传导的病理状态7,8 (NOSOTROS)。据报道,在ARMD患者手术切除的CNVM中,FGF具有免疫反应性,这表明该生长因子在疾病的起源和进展中发挥了作用此外,在ARMD中发生的RPE损伤会导致FGF的释放,而FGF又会促进CNVM自身的形成因此,局部抑制FGF将是解决CNVM的适当策略。我们在这里描述了玻璃体内给药乙胺酸对一例伴有湿性ARMD的SMH和CNVM患者的疗效。
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引用次数: 1
Wide excision and reconstruction surgery using NVFG for giant cell tumor of the right proximal radius campanacci 3 应用NVFG广泛切除和重建手术治疗右桡骨近端巨细胞瘤3
Pub Date : 2019-01-01 DOI: 10.15406/mojcr.2019.09.00321
Irsan Abubakar
Giant Cell tumors, also widely abbreviated as GCT, is a type of benign, potentially aggressive tumor. It is a fairly common occurrence, representing around 5% of all primary bone tumors.1,2 GCT is often linked with significant disruption of bone structure, which could be severely damaging in peri-articular locations.2 For tumor that is considered benign, GCT is highly recurrent and have a high potential for metastasis; 1-9% of GCT patients are presented with metastasis, and some studies have correlated this with local recurrence and the aggressive tumor type.3 GCT most commonly occurs due into the 3rd decade of life, with around 80% of GCT cases being found in patients of 20 to 50 years of age. Less than 3% of GCT cases are found on patient less than 14 years old, and 13% of cases occurring in patients over the age of 50.4
巨细胞瘤,也被广泛缩写为GCT,是一种良性的、具有潜在侵袭性的肿瘤。这是一种相当常见的情况,约占所有原发性骨肿瘤的5%。1,2 GCT通常与骨结构的严重破坏有关,这可能对关节周围部位造成严重损害对于被认为是良性的肿瘤,GCT是高度复发的,并且有很高的转移潜力;1-9%的GCT患者出现转移,一些研究将其与局部复发和侵袭性肿瘤类型相关联GCT最常发生在生命的第三个十年,约80%的GCT病例发生在20至50岁的患者中。不到3%的GCT病例发生在14岁以下的患者身上,13%的病例发生在50.4岁以上的患者身上
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引用次数: 1
A simple method of unclogging enteral feeding tubes: even when traditional methods have failed 一个简单的方法疏通肠内喂食管:即使传统的方法已经失败
Pub Date : 2019-01-01 DOI: 10.15406/mojcr.2018.08.00290
A. Levy, Sandor J. Kovacs
Enteral feeding tubes are commonly placed as a means for providing patients with nutrition and hydration when they are unable to meet their daily caloric and hydration requirements by mouth. They may also be placed in patients who are at a significant aspiration risk. This may be secondary to malignancy, neurological or mechanical dysphagia, as well as critical illness.1 Many neurological diseases cause dysphagia, but patients with traumatic brain injury (TBI), cerebrovascular disease, degenerative central nervous system disease, and hypoxic brain injury comprise the majority of referrals in this subset of patients.2 These patients not only require enteral nutrition, but they also require medications through these tubes. Medications are preferably administered in liquid form. However, there are several medications that are only manufactured in solid form. These medications require being crushed and dissolved in water prior to administration through feeding tubes.
肠内喂食管通常被放置作为一种手段,为患者提供营养和水合作用,当他们无法满足他们的日常热量和水合作用的口。它们也可能被放置在有严重误吸风险的患者身上。这可能继发于恶性肿瘤、神经性或机械性吞咽困难以及危重疾病许多神经系统疾病引起吞咽困难,但外伤性脑损伤(TBI)、脑血管疾病、退行性中枢神经系统疾病和缺氧性脑损伤患者在这类患者中占多数这些病人不仅需要肠内营养,还需要通过这些管道给药。药物最好以液体形式施用。然而,有几种药物仅以固体形式生产。这些药物需要在通过喂食管给药之前被压碎并溶解在水中。
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引用次数: 0
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MOJ clinical & medical case reports
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