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Ntourantonis D, Mousafeiris V, Lianou I. Nontraumatic Triceps Tendon Rupture in a Young Bodybuilder Athlete: A Case Report and Review of the Literature of a Known Injury in an Unknown Setting. J Orthop Case Rep 2023; 13:70-76. [PMID: 37521377 PMCID: PMC10379251 DOI: 10.13107/jocr.2023.v13.i07.3758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/16/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Triceps' tendon rupture is thought to be a relatively rare injury, and its exact incidence is unknown. As a result of the rareness of this injury, very few cases of weightlifters or bodybuilders taking androgenic anabolic steroids have been published in the literature to date. In this article, we report a very rare case of non-traumatic triceps tendon rupture in a professional bodybuilder under androgenic anabolic steroids. Case Report A 32-year-old male patient was admitted to our emergency department, reporting that while trying to maneuver his motorbike to avoid collision with another vehicle, he felt sudden pain at the posterior elbow and heard a popping sound. Active extension of the elbow was found to be reduced, raising suspicion of triceps tendon rupture. Ultrasound and magnetic resonance imaging revealed rupture of the triceps, confirming the clinical diagnosis. Intraoperatively, an almost complete rupture of the triceps was noted at its insertion into the olecranon. After the recognition and preparation of the triceps' footprint, two 3.5 mm titanium bone sutured anchors were placed at the anatomical insertion of the tendon, and the tendon was repaired using a modified double-row technique. Follow-up at 6 months and 1 year postoperatively revealed perfect Mayo Elbow Performance and Oxford Elbow Scores with no residual pain or range of motion deficits; triceps strength had returned to pre-injury levels. Conclusion Triceps tendon rupture is thought to be a relatively rare injury and among the rarest tendon injuries. It usually occurs in patients with systematic diseases, such as renal disease, or on medication, such as androgenic anabolic steroid use. As a result of its rareness, very few cases of weightlifters or bodybuilders taking steroids have been reported in the literature. To our knowledge, this is the first case of non-traumatic triceps tendon rupture in a bodybuilder under oral androgenic anabolic steroids.
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Affiliation(s)
| | | | - Ioanna Lianou
- Department of Orthopaedics and Trauma, General Hospital of Patras, Patras, Greece
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Sood C, Prasad M, Thakur K, Shakya AR, Chhetri P. Atraumatic Reciprocal Scapula Fracture - A Case Report and Review of Literature. J Orthop Case Rep 2023; 13:60-63. [PMID: 37255651 PMCID: PMC10226630 DOI: 10.13107/jocr.2023.v13.i05.3646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/19/2023] [Indexed: 06/01/2023] Open
Abstract
Introduction Scapula fractures are very rare and bilateral reciprocal involvement is rarest of all. Due to the protective nature of surrounding musculature, it is least prone to fracture with reported incidence of 1% of all skeletal fractures. However, synchronized firing of the periscapular muscles could overcome the bone strength resulting into the fracture as in the cases of electrocution and seizure attack. Case Report We present a case of 54-year-old ex-military male patient with a history of acute onset seizure of multiple episodes. Magnetic resonance imaging showed cerebrovascular thrombosis. The patient was admitted in the intensive care and complained pain over bilateral shoulder with restricted movement in the post-ictal phase. X-ray showed bilateral comminuted extra-articular scapular fractures. The severity of the injury and displacement of the fracture pronounced operative intervention. Modified Judet approach was used to approach the fractures. After a successful surgery, rehabilitation protocol constituted of passive range of motion exercises with gradual active exercises of shoulder. One-year follow-up showed good consolidation of both fracture with full recovery of function. Conclusion Periscapular musculature protects the scapula from traumatic events due to the significant bulk that it provides but these can on the other hand be source of deforming force in the patient who has history of simultaneous contraction as in the case of recurrent episodic seizure or electrocution. Scapular fracture should always be suspected in the patient with insidious development of shoulder pain following strong seizure attack. These fractures if indicated should be managed operatively.
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Affiliation(s)
- Chetan Sood
- Department of Orthopaedic, Armed Forces Medical College, Pune, Maharashtra, India
| | - Manish Prasad
- Department of Orthopaedic, Indian Field Hospital Level II Plus, UNMISS, Juba, South Sudan
| | - Kamparsh Thakur
- Department of Orthopaedics, 166 Military Hospital, Jammu, Jammu and Kashmir, India
| | - Amir Ratna Shakya
- Department of Orthopaedics, Shree Birendra Hospital, Chhauni, Kathmandu, Nepal
| | - Prakrit Chhetri
- Department of Orthopaedic, Armed Forces Medical College, Pune, Maharashtra, India
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West N, Butterfield S, Rusbridge C, Fernandez A, Tabanez J, Rudolf NJ, Archer S, Whittaker D. Non-traumatic hemorrhagic myelopathy in dogs. J Vet Intern Med 2023; 37:1129-1138. [PMID: 37095733 DOI: 10.1111/jvim.16694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/17/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Non-traumatic spinal cord hemorrhage (NTSH) is an uncommon cause of myelopathy in dogs. OBJECTIVES Describe the clinical characteristics, concurrent medical conditions and underlying causes, magnetic resonance imaging (MRI) findings and outcome in dogs with NTSH. ANIMALS Dogs diagnosed with NTSH using gradient echo T2-weighted (GRE) sequences with or without histopathological confirmation of hemorrhage were included. Dogs with a traumatic cause were excluded, including those with compressive intervertebral disc extrusion. METHODS Retrospective descriptive study; the databases of 2 referral hospitals were searched between 2013 and 2021. RESULTS Twenty-three dogs met inclusion criteria. The onset of signs was acute and progressive in 70% of cases; spinal hyperesthesia was variable (48%). Hemorrhage was identified in the thoracolumbar spinal segments in 65% of dogs. An underlying cause was identified in 65% of cases. Angiostrongylus vasorum represented 18% of the total cohort, followed by steroid-responsive meningitis arteritis (SRMA; 13%). Overall, 64% of dogs had a good or excellent outcome, regardless of cause; which was increased to 100% for SRMA, 75% for A. vasorum and 75% for idiopathic NTSH. Outcome was not associated with neurological severity. Recovery rate was 67% and 50% for nociception-intact and nociception-negative dogs, respectively. CONCLUSIONS Larger prospective studies would be required to define prognostic factors for dogs with NTSH, but outcome appeared to be most influenced by the underlying cause, as opposed to neurological severity at presentation.
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Affiliation(s)
- Natalie West
- Fitzpatrick Referrals Ltd, Halfway ln, Godalming, UK
- North Downs Specialist Referrals, part of Linnaeus Veterinary Limited, Bletchingley, UK
| | - Sarah Butterfield
- The Queen Mother Hospital for Small Animals, Royal Veterinary College
| | - Clare Rusbridge
- Fitzpatrick Referrals Ltd, Halfway ln, Godalming, UK
- The University of Surrey, Surrey, UK
- Wear Referrals, County Durham, UK
| | - Ana Fernandez
- Fitzpatrick Referrals Ltd, Halfway ln, Godalming, UK
| | - Joana Tabanez
- Fitzpatrick Referrals Ltd, Halfway ln, Godalming, UK
| | | | | | - Danielle Whittaker
- Fitzpatrick Referrals Ltd, Halfway ln, Godalming, UK
- The Queen Mother Hospital for Small Animals, Royal Veterinary College
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Avon JT, Gerrard AJ, Patel BB. Chylous Ascites Developing Into Bilateral Chylothorax in High-Grade Lymphoma: A Case Report. Cureus 2023; 15:e37344. [PMID: 37182072 PMCID: PMC10169282 DOI: 10.7759/cureus.37344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2023] [Indexed: 05/16/2023] Open
Abstract
Chylothorax and chylous ascites occur when lymphatic fluid accumulates in the pleural space or peritoneum, respectively. They are classified as either traumatic or non-traumatic, and lymphomas are the most common non-traumatic cause. Lymphomas can obstruct the lymphatic architecture causing lipid-rich chyle to leak out below the level of the obstructing mass. Bilateral chylothoraces presenting in the presence of chylous ascites, secondary to Non-Hodgkin Lymphoma, are rare. We describe a case of a 55-year-old man with recurring large-volume chylous ascites secondary to Non-Hodgkin lymphoma who developed bilateral chylothoraces. Initially, he presented with dyspnea and hypoxia and was found to have bilateral pleural effusions, requiring bilateral thoracentesis for diagnostic and therapeutic management. The fluid removed from the pleural space was found to be lymphatic fluid, and the patient was eventually discharged home with instructions to follow up with oncology for further management. The case reveals a temporal relationship where a huge volume of chylous ascites develops into a chylothorax.
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Affiliation(s)
- Jonathan T Avon
- Pulmonary and Critical Care Medicine, Carilion Clinic, Christiansburg, USA
| | - Allison J Gerrard
- Pulmonary and Critical Care Medicine, Carilion Clinic, Christiansburg, USA
| | - Brijesh B Patel
- Pulmonary and Critical Care Medicine, Carilion Clinic, Christiansburg, USA
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5
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Marshall C, Josephson CD, Leonard JC, Wisniewski SR, Leeper CM, Luther JF, Spinella PC. Blood component ratios in children with non-traumatic life-threatening bleeding. Vox Sang 2023; 118:68-75. [PMID: 36427061 DOI: 10.1111/vox.13382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/04/2022] [Accepted: 11/09/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES In paediatric trauma patients, there are limited prospective data regarding blood components and mortality, with some literature suggesting decreased mortality with high ratios of plasma and platelets to red blood cells (RBCs) in massive transfusions; however, most paediatric massive transfusions occur for non-traumatic aetiologies and few studies assess blood product ratios in these children. This study's objective was to evaluate whether high blood product ratios or low deficits conferred a survival benefit in children with non-traumatic life-threatening bleeding. MATERIALS AND METHODS This is a secondary analysis of the five-year, multicentre, prospective, observational massive transfusion epidemiology and outcomes in children study of children with life-threatening bleeding from US, Canadian and Italian medical centres. Primary interventions were plasma:RBC and platelets:RBC (high ratio ≥1:2 ml/kg) and plasma and platelet deficits. The primary outcome was mortality at 6 h, 24 h and 28 days. Multivariate logistic regression models were used to determine independent associations with mortality. RESULTS A total of 222 children were included from 24 medical centres: 145 children (median [interquartile range] age 2.1 years [0.3-11.8]) with operative bleeding and 77 (8.0 years [1.2-14.7]) with medical bleeding. In adjusted analyses, neither blood product ratios nor deficits were associated with mortality at 6 h, 24 h or 28 days. CONCLUSION This paper addresses a lack of prospective data in children regarding optimal empiric massive transfusion strategies in non-traumatic massive haemorrhage and in finding no decrease in mortality with high plasma or platelet to RBC ratios or lower deficits supports an exploratory analysis for mortality.
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Affiliation(s)
- Callie Marshall
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Missouri, USA
| | - Cassandra D Josephson
- Department of Oncology and Cancer and Blood Disorders Institute, Johns Hopkins University School of Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Julie C Leonard
- Department of Critical Care Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | | | - Christine M Leeper
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - James F Luther
- University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | | | - Philip C Spinella
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Missouri, USA.,Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
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6
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Osawa Y, Nakaseko Y, Nakashima K, Suto D, Odaira H, Kohgo Y, Suzuki Y, Ohtake T. Non-traumatic False Cyst of the Spleen: A Case Report and Review of the Literature. Intern Med 2023; 62:1005-1009. [PMID: 37005295 PMCID: PMC10125812 DOI: 10.2169/internalmedicine.0284-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
False cysts have no cellular lining and usually originate from past abdominal trauma. We herein report a 23-year-old woman with an asymptomatic splenic false cyst. She had no history of abdominal trauma. Abdominal computed tomography showed a cystic lesion without internal structure. In contrast, magnetic resonance imaging and ultrasonography revealed an inhomogeneous internal structure without fluid/debris level. Although the images were not typical of a splenic false cyst, the surgically excised mass histologically showed a splenic false cyst (no epithelial element). Non-traumatic splenic false cysts are rare and show nonspecific clinical findings and symptoms. The recommended treatment is splenectomy.
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Affiliation(s)
- Yosuke Osawa
- Departments of Gastroenterology, International University of Health and Welfare Hospital, Japan
| | - Yuichi Nakaseko
- Departments of Surgery, International University of Health and Welfare Hospital, Japan
| | - Keigo Nakashima
- Departments of Surgery, International University of Health and Welfare Hospital, Japan
| | - Daisuke Suto
- Departments of Gastroenterology, International University of Health and Welfare Hospital, Japan
| | - Hironori Odaira
- Departments of Surgery, International University of Health and Welfare Hospital, Japan
| | - Yutaka Kohgo
- Departments of Gastroenterology, International University of Health and Welfare Hospital, Japan
| | - Yutaka Suzuki
- Departments of Surgery, International University of Health and Welfare Hospital, Japan
| | - Takaaki Ohtake
- Departments of Gastroenterology, International University of Health and Welfare Hospital, Japan
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Ichida T, Otsuki Y, Ueda K. Massive non-incisional abdominal wall hernia caused by abdominal wall weakness resulting from childhood radiation therapy: a case report. Case Reports Plast Surg Hand Surg 2022; 9:119-122. [PMID: 35530751 PMCID: PMC9067969 DOI: 10.1080/23320885.2022.2059485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Huge abdominal wall hernias after radiation therapy in the absence of any previous surgical incisions or trauma are rare and, to the best of our knowledge, have not previously been reported. we report a patient with a massive hernia caused by abdominal wall weakness resulting from childhood radiation therapy.
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Affiliation(s)
- Tatsuya Ichida
- Department of Plastic Surgery, Ueyama Hospital, Neyagawa, Osaka, Japan
| | - Yuki Otsuki
- Department of Plastic and Reconstruction Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Koichi Ueda
- Department of Plastic and Reconstruction Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
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Ojha U, Ayathamattam J, Okonkwo K, Ogunmwonyi I. Recent Updates and Technological Developments in Evaluating Cardiac Syncope in the Emergency Department. Curr Cardiol Rev 2022; 18:e210422203887. [PMID: 35593355 PMCID: PMC9893151 DOI: 10.2174/1573403x18666220421110935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/21/2022] [Accepted: 02/24/2022] [Indexed: 11/22/2022] Open
Abstract
Syncope is a commonly encountered problem in the emergency department (ED), accounting for approximately 3% of presenting complaints. Clinical assessment of syncope can be challenging due to the diverse range of conditions that can precipitate the symptom. Annual mortality for patients presenting with syncope ranges from 0-12%, and if the syncope is secondary to a cardiac cause, then this figure rises to 18-33%. In ED, it is paramount to accurately identify those presenting with syncope, especially patients with an underlying cardiac aetiology, initiate appropriate management, and refer them for further investigations. In 2018, the European Society of Cardiology (ESC) updated its guidelines with regard to diagnosing and managing patients with syncope. We highlight recent developments and considerations in various components of the workup, such as history, physical examination, investigations, risk stratification, and novel biomarkers, since the establishment of the 2018 ESC guidelines. We further discuss the emerging role of artificial intelligence in diagnosing cardiac syncope and postulate how wearable technology may transform evaluating cardiac syncope in ED.
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Affiliation(s)
- Utkarsh Ojha
- Department of Cardiology, Royal Brompton & Harefield Hospitals, England, UK
| | - James Ayathamattam
- Department of Medicine, Royal Lancaster Infirmary, Lancaster, United Kingdom
| | - Kenneth Okonkwo
- Department of Medicine, Royal Lancaster Infirmary, Lancaster, United Kingdom
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9
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Eom TY, Choi JW, Yoon KA, Jeong SW, Kim JH. Case Report: Non-traumatic Unilateral Forelimb Arterial Thrombosis Associated With Hyperadrenocorticism in a Dog. Front Vet Sci 2021; 8:795928. [PMID: 34901256 PMCID: PMC8655981 DOI: 10.3389/fvets.2021.795928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/04/2021] [Indexed: 11/24/2022] Open
Abstract
A 16-year-old spayed female Pomeranian dog was presented to the hospital with an acute onset of pain and non-weight-bearing lameness in the right forelimb. On physical examination, knuckling, coolness, pain, and cyanosis were observed in the affected forelimb. Peripheral blood glucose concentration and body surface temperature differed between the right and left forelimbs. Hypercoagulable thromboelastographic results and increased D-dimer levels were suggestive of thrombus. Accordingly, recombinant tissue plasminogen activator (rtPA) was administered intravenously. Prompt clinical improvements (including restored warmth of the affected limb) occurred, and rtPA was discontinued after two shots administered 2 h apart owing to concerns of bleeding side effects. The dog was discharged 6 days after admission, and outpatient treatment with clopidogrel was continued for the prevention of re-thrombosis. Following patient stabilization, further examinations for underlying diseases of hypercoagulability were conducted; hyperadrenocorticism (HAC) was diagnosed, and oral trilostane therapy was thus administered. Eight weeks later, the patient regained normal mobility. Finally, in the present canine patient with arterial thrombosis, thrombolysis with rtPA successfully improved clinical symptoms and the following administration of clopidogrel inhibited the formation of additional thrombus.
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Affiliation(s)
- Tae-Yoon Eom
- Department of Veterinary Surgery, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | - Ju-Won Choi
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | - Kyong-Ah Yoon
- Department of Veterinary Biochemistry, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | - Soon-Wuk Jeong
- Department of Veterinary Surgery, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | - Jung-Hyun Kim
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
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Fukushima Y, Matsuda K, Yoshino S, Hirakawa K, Inoue T. A Pure Acute Subdural Hematoma Presenting with a Diploic Arteriovenous Fistula: Case Report and Literature Review. J Neuroendovasc Ther 2021; 16:123-126. [PMID: 37502645 PMCID: PMC10370970 DOI: 10.5797/jnet.cr.2020-0206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 05/21/2021] [Indexed: 07/29/2023]
Abstract
Objective We report a case of pure acute subdural hematoma (SDH) caused by a diploic arteriovenous fistula (AVF) and it is a first case report as far as we researched it. Case Presentation A 19-year-old man was admitted as an emergency to our hospital with headache and nausea. CT scan on hospital admission showed a right acute SDH. Because there was no history of head trauma, MRI, MRA, and DSA were performed to identify a source of bleeding. DSA disclosed an AVF. The shunt was located between a frontotemporal branch of the middle meningeal artery (MMA) and a diploic vein, and its shunting point formed an aneurysmal sac, which was considered to have ruptured. Endovascular treatment was administered rather than surgical treatment to prevent re-bleeding because the patient was conscious and alert, CT showed a small SDH, and the left MMA near the shunting point was accessible for catheterization. A diluted mixture of 25% n-butyl-2-cyanoacrilate was injected into a left frontoparietal branch just before the shunting point and the shunt, including the aneurysmal sac, was obliterated. The patient's postoperative course was uneventful and he was discharged without neurological deficits. Conclusion We experienced a patient with a pure acute SDH caused by diploic AVF. In patients with non-traumatic acute SDH, DSA is recommended to determine its underlying cause. Our review of published reports yielded few instances of non-traumatic pure acute SDH in young people. Possible causative factors should be investigated promptly and appropriate treatment provided immediately.
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Affiliation(s)
- Yutaka Fukushima
- Department of Neurosurgery, Fukuoka City Hospital, Fukuoka, Fukuoka, Japan
| | - Koudai Matsuda
- Department of Neurosurgery, Fukuoka City Hospital, Fukuoka, Fukuoka, Japan
- Department of Neurosurgery, Faculty of Medicine, University of Fukuoka, Fukuoka, Fukuoka, Japan
| | - Shinichiro Yoshino
- Department of Neurosurgery, Fukuoka City Hospital, Fukuoka, Fukuoka, Japan
| | - Katsuyuki Hirakawa
- Department of Neurosurgery, Fukuoka City Hospital, Fukuoka, Fukuoka, Japan
| | - Tooru Inoue
- Department of Neurosurgery, Faculty of Medicine, University of Fukuoka, Fukuoka, Fukuoka, Japan
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Ahmad S, Ali H, Ikram S, Sarfraz S, Yousaf A. Spontaneous Bilateral Subdural Hematomas in a Patient With Cryptogenic Liver Cirrhosis. Cureus 2021; 13:e16100. [PMID: 34345569 PMCID: PMC8325620 DOI: 10.7759/cureus.16100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 11/20/2022] Open
Abstract
Spontaneous subdural hematoma (SDH) in cirrhotic patients is a rarely described condition in the literature and carries a high mortality rate. Several factors can potentially contribute to SDH development in cirrhosis, including coagulation cascade defects, thrombocytopenia, arteriovenous malformations, and cerebral atrophy. Clinicians should always keep spontaneous development of SDH in the differential diagnosis of acute encephalopathy in patients with end-stage liver disease, and prompt head imaging should be considered. We report a unique case of a 64-year-old patient with cryptogenic liver cirrhosis who was found to have spontaneous, bilateral SDHs while undergoing workup for acute encephalopathy.
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Affiliation(s)
- Soban Ahmad
- Internal Medicine, East Carolina University, Greenville, USA
| | - Hassam Ali
- Internal Medicine, East Carolina University, Greenville, USA
| | - Sundus Ikram
- Internal Medicine, SEGi University, Petaling Jaya, MYS
| | - Shiza Sarfraz
- Anesthesiology, Bahawal Victoria Hospital, Quaid-E-Azam Medical University, Bahawalpur, PAK
| | - Amman Yousaf
- Internal Medicine, McLaren Health Care, Flint, USA
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12
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Śmiłowska K, Sznajder-Stacha K, Kocyłowski D, Popek A, Rozpondek K, Grechuta M, Salari M. Pneumocephalus as a rare complication: a systematic review plus clinical vignette. Neurol Neurochir Pol 2021; 55:253-268. [PMID: 33543469 DOI: 10.5603/pjnns.a2021.0014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 12/09/2020] [Accepted: 12/31/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Pneumocephalus is a clinical entity characterised by the presence of gas in the intracranial space. It can result from many different causes. The most common cause is head or facial trauma. Other causes include neoplasms, infections, and surgical or diagnostic procedures. Spontaneous non-traumatic pneumocephalus is a rare condition caused by bone defects, malformations, infections, tumours, intravenous air injection, and other causes. This review, supplemented with a case presentation, aims to summarise the current state of knowledge regarding non-traumatic pneumocephalus. METHODOLOGY This review involved an electronic search (PubMed, Scopus, Embase, and Web of Science) to identify studies regarding non-traumatic pneumocephalus. In addition, reference lists of identified articles were screened for other potentially relevant papers. RESULTS In total, 1,107 articles were retrieved by searching databases with the selected query. Based on the selection process, 134 articles were included. These articles were then classified into 'otogenic', 'bone defect', 'malformations', 'infectious', 'tumours', 'associated with intravenous air injection', and other categories. CONCLUSION Spontaneous non-traumatic pneumocephalus is a rare condition. Symptoms, clinical courses, and prognoses vary depending on the underlying cause of the disease. To the best of our knowledge, this review's example is the first case report of spontaneous pneumocephalus due to air embolism secondary to lung cancer.
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Affiliation(s)
- Katarzyna Śmiłowska
- Department of Neurology, Regional Specialist Hospital im. Św. Barbary, Sonowiec, Poland.
| | | | - Daniel Kocyłowski
- Department of Neurosurgery, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Aleksandra Popek
- Department of Radiology, City Hospital in Sosnowiec, Sosnowiec, Poland
| | - Kamila Rozpondek
- Department of Neurology, City Hospital in Sosnowiec, Sosnowiec, Poland
| | - Maciej Grechuta
- Department of Neurology, City Hospital in Sosnowiec, Sosnowiec, Poland
| | - Mehri Salari
- Functional Neurosurgery Research Center, Shohada Tajrish Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran., Iran, Islamic Republic Of
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Al-Mousa A, Altarawneh M, Alqatawneh O, Bashir Z, Al-Dwairy S, Shtaya A. Eosinophilic Granuloma of the Skull Presenting as Non-Traumatic Extradural Haematoma in Children. Int J Gen Med 2020; 13:1229-1234. [PMID: 33262638 PMCID: PMC7700074 DOI: 10.2147/ijgm.s288512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 11/13/2020] [Indexed: 01/17/2023] Open
Abstract
Cranial extradural haematoma (EDH) is a neurosurgical emergency that can be caused by traumatic or non-traumatic causes with the former being more prevalent. Non-traumatic causes are variable and can include infection, vascular malformation and haematological disorders. This paper will address an extremely rare non-traumatic cause of EDH. More specifically, eosinophilic granuloma (EG), the localized form of Langerhans histiocytosis, may involve the skull and has rarely been reported to present with EDH. The case that will be presented is that of a three-year-old male patient, who presented with progressive vomiting and drowsiness, associated with left parietal swelling. CT scan of the brain showed an extradural haematoma and an osteolytic parietal lesion. He underwent emergent craniectomy, evacuation of the haematoma and dura resection as the lesion was infiltrating the dura. Histopathological examination of the dura and the bone edges showed eosinophilic granuloma (EG). The mechanism of a haemorrhage in this situation is poorly understood and the literature is extremely scarce. In conducting a thorough literature review, only 11 case reports of EG causing non-traumatic EDH were found. The details of these 11 cases will be reviewed and discussed in this paper, in addition to our illustrative case.
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Affiliation(s)
- Alaa Al-Mousa
- Department of General and Special Surgery, Faculty of Medicine, The Hashemite University, Zarqa 13133, Jordan.,Department of Surgery, Prince Hamza Hospital, Amman 11732, Jordan
| | | | - Omar Alqatawneh
- Department of Surgery, Prince Hamza Hospital, Amman 11732, Jordan
| | - Zalina Bashir
- Department of Pathology, Prince Hamza Hospital, Amman 11732, Jordan
| | - Salem Al-Dwairy
- Department of General and Special Surgery, Faculty of Medicine, The Hashemite University, Zarqa 13133, Jordan.,Department of Surgery, Prince Hamza Hospital, Amman 11732, Jordan
| | - Anan Shtaya
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK.,Atkinson Morley Neurosurgery Centre, St George's University Hospital NHS Trust, London, UK
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14
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Ennis G, Venade G, Silva Marques J, Batista P, Abreu Nunes A, Constantino J, Costa Matos L. Intrathoracic Acute Cholecystitis. Eur J Case Rep Intern Med 2020; 7:001764. [PMID: 32908838 DOI: 10.12890/2020_001764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/02/2020] [Indexed: 11/05/2022] Open
Abstract
The authors present the case of a 51-year-old woman with no history of surgical or traumatic injury or accident, who presented with right hypochondrium and epigastric discomfort, malaise, nausea, loss of appetite and episodes of dark urine and greenish stools. Initial laboratory work-up revealed elevated inflammatory markers including leucocytosis with left shift and C-reactive protein, and a slight elevation of gamma-glutamyltransferase and alkaline phosphatase, with no other significant alterations. Computed tomography (CT) showed intrathoracic acute cholecystitis with a large diaphragmatic hernia. A literature search revealed only one other case of acute cholecystitis complicated by intrathoracic gallbladder due to a non-traumatic diaphragmatic hernia. Symptoms are uncharacteristic and the absence of pain or fever, explained by the altered location of the gallbladder, makes the diagnosis a challenge. LEARNING POINTS Only one other case of acute cholecystitis complicated by intrathoracic gallbladder due to a non-traumatic diaphragmatic hernia has been reported.Uncharacteristic symptoms make the diagnosis of intrathoracic acute cholecystitis a challenge.
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Affiliation(s)
- Giovana Ennis
- Department of Internal Medicine, Hospital CUF Viseu, Portugal
| | - Gabriela Venade
- Department of Internal Medicine, Hospital CUF Viseu, Portugal
| | | | - Paulo Batista
- Department of Internal Medicine, Hospital CUF Viseu, Portugal
| | - Ana Abreu Nunes
- Department of Internal Medicine, Hospital CUF Viseu, Portugal
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15
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Gao X, Yue F, Zhang F, Sun Y, Zhang Y, Zhu X, Wang W. Acute non-traumatic subdural hematoma induced by intracranial aneurysm rupture: A case report and systematic review of the literature. Medicine (Baltimore) 2020; 99:e21434. [PMID: 32756153 PMCID: PMC7402739 DOI: 10.1097/md.0000000000021434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Intracranial aneurysm with the first manifestation of acute subdural hematoma (aSDH) is rare in the field of neurosurgery. Usually subarachnoid hemorrhage or intracranial hematoma happens after the rupture of an intracranial aneurysm, whereas trauma is the primary cause of aSDH. PATIENT CONCERNS Here, we present the case of a 71-year-old woman who presented with spontaneous aSDH with progressive headache and vomiting. DIAGNOSIS Urgent head computed tomography (CT) identified an aSHD, but the patient had no history of trauma. CT angiography (CTA) identified the cause of the aSDH as rupture of an intracranial aneurysm in the left middle cerebral artery. INTERVENTIONS Emergent craniotomy with hematoma evacuation was performed. OUTCOMES Due to prompt diagnosis and appropriate intervention, the patient recovered fully with no disability. LESSONS This unique case demonstrates that aSDH caused by intracranial aneurysm rupture requires timely identification and appropriate action to prevent adverse outcomes. We performed a comprehensive systematic literature review to examine the etiology and pathogenesis of non-traumatic aSDH. Furthermore, digital subtraction angiography should be considered in patients diagnosed with an aSDH with no known cause.
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Affiliation(s)
| | - Fagui Yue
- Center for Reproductive Medicine and Center for Prenatal Diagnosis
| | - Fenglei Zhang
- Department of Imaging, First Hospital, Jilin University, Changchun, China
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16
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Roelandt K, Van Ruyssevelt L, Bosschaert P. Orbital Subperiosteal Hematoma Arising in the Context of Chronic Sinusitis: Suspicion of Association. J Belg Soc Radiol 2019; 103:44. [PMID: 31304456 DOI: 10.5334/jbsr.1829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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17
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Sonne A, Andersen JB, Rasmussen LS. The positive predictive value of spontaneous subarachnoid hemorrhage diagnoses in the Danish National Patient Register. Clin Epidemiol 2019; 11:323-331. [PMID: 31118820 PMCID: PMC6503197 DOI: 10.2147/clep.s197251] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 02/13/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction: Spontaneous (non-traumatic) subarachnoid hemorrhage (ntSAH) is frequently suspected in the emergency department, but the incidence rate is low. Diagnosis registers can provide valuable data for research in uncommon conditions like ntSAH. Unfortunately, validity vary in the registers. We aimed to assess the validity of the ntSAH diagnosis in the Danish National Patient Register (DNPR) and secondly to describe patients misclassified as ntSAH and to calculate the incidence rate of ntSAH. Methods: From the DNPR we extracted information on patients at least 18 years of age on admission registered with a diagnosis of ntSAH and admitted to a hospital in the Capital Region of Denmark between January 1, 2008 and December 31, 2014. Two independent investigators reviewed the medical records to assess if the diagnosis could be confirmed. Those not confirmed were categorized according to a predeveloped case report form. Results: We identified 1101 patients with a diagnosis of ntSAH; medical records were accessible for 1069 (97.7%) and 842 (78.8%) met the inclusion criteria. The diagnosis was confirmed in 537 patients (63.8% (95% confidence interval: 60.5-67.0%)). Among patients where ntSAH was not confirmed, 122 (40.0%) had a traumatic subarachnoid hemorrhage (tSAH), ntSAH had been suspected in 57 (18.9%) patients but was not substantiated during admission, while parenchymal hemorrhages were identified in 45 (14.5%) patients. The incidence rate was 5.5 (95% CI: 4.9-6.1) per 100,000 persons per year. Conclusion: We found a positive predictive value (PPV) of 63.8% for the diagnosis of non-traumatic subarachnoid hemorrhage in the Danish National Patient Register. The low PPV suggests that care should be taken if unvalidated data are used for research and that results of previous studies should be interpreted with caution.
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Affiliation(s)
- Asger Sonne
- Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jesper B Andersen
- Department of Neurosurgery, The Neuroscience Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lars S Rasmussen
- Department of Anaesthesia, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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18
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Abstract
Background For decades, tuberculosis (TB) has posed a great threat to people worldwide. Bone and joint TB is one of the most common types of extrapulmonary TB, with elbow TB comprising a small proportion of these cases. The treatment for elbow stiffness associated with TB has been rarely reported. Patients and methods We retrospectively analyzed six patients (four females and two males) with tubercular elbow stiffness during a 7-year period. All of them received open arthrolysis and hinged external fixation to restore functional extension, flexion, supination and pronation. Mayo Elbow Performance Score (MEPS) and range of motion (ROM) were evaluated preoperatively and at final follow-up. Results At final follow-up after surgery, we evaluated the average active ROM, which was 111.7° (90°–135°). The average extension was 11.7° (0°–30°), while the average flexion was 123.3° (115°–135°). At the same time, the average supination was increased to 70° (40°–90°) and the average pronation was increased to 68.3° (45°–80°). The MEPS was elevated to 92.5 (85–100). Three patients displayed complications and were treated and cured with dressing changes and antibiotics. Conclusion Open arthrolysis and hinged external fixation are useful for the treatment of non-traumatic elbow stiffness with TB.
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Affiliation(s)
- Yun Qian
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital.,Department of Orthopedics, Shanghai University of Medicine and Health, Shanghai Sixth People's Hospital East Campus
| | | | - Wei Wang
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital.,Department of Orthopedics, Shanghai University of Medicine and Health, Shanghai Sixth People's Hospital East Campus
| | - Yuanming Ouyang
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital.,Department of Orthopedics, Shanghai University of Medicine and Health, Shanghai Sixth People's Hospital East Campus
| | - Weien Yuan
- School of Pharmacy, Shanghai Jiao Tong University, Shanghai, China
| | - Cunyi Fan
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital
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19
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Musubire AK, Meya DB, Bohjanen PR, Katabira ET, Barasukana P, Boulware DR, Meyer AC. A Systematic Review of Non-Traumatic Spinal Cord Injuries in Sub-Saharan Africa and a Proposed Diagnostic Algorithm for Resource-Limited Settings. Front Neurol 2017; 8:618. [PMID: 29375458 PMCID: PMC5770645 DOI: 10.3389/fneur.2017.00618] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 11/06/2017] [Indexed: 11/13/2022] Open
Abstract
Background Non-traumatic myelopathy is common in Africa and there are geographic differences in etiology. Clinical management is challenging due to the broad differential diagnosis and the lack of diagnostics. The objective of this systematic review is to determine the most common etiologies of non-traumatic myelopathy in sub-Saharan Africa to inform a regionally appropriate diagnostic algorithm. Methods We conducted a systemic review searching Medline and Embase databases using the following search terms: “Non traumatic spinal cord injury” or “myelopathy” with limitations to epidemiology or etiologies and Sub-Saharan Africa. We described the frequencies of the different etiologies and proposed a diagnostic algorithm based on the most common diagnoses. Results We identified 19 studies all performed at tertiary institutions; 15 were retrospective and 13 were published in the era of the HIV epidemic. Compressive bone lesions accounted for more than 48% of the cases; a majority were Pott’s disease and metastatic disease. No diagnosis was identified in up to 30% of cases in most studies; in particular, definitive diagnoses of non-compressive lesions were rare and a majority were clinical diagnoses of transverse myelitis and HIV myelopathy. Age and HIV were major determinants of etiology. Conclusion Compressive myelopathies represent a majority of non-traumatic myelopathies in sub-Saharan Africa, and most were due to Pott’s disease. Non-compressive myelopathies have not been well defined and need further research in Africa. We recommend a standardized approach to management of non-traumatic myelopathy focused on identifying treatable conditions with tests widely available in low-resource settings.
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Affiliation(s)
- Abdu Kisekka Musubire
- College of Health Sciences, Infectious Disease Institute, Makerere University, Mulago Hospital Complex, Kampala, Uganda.,Medicine, Mulago National Referral Hospital, Mulago Hospital Complex, Kampala, Uganda
| | - David B Meya
- College of Health Sciences, Infectious Disease Institute, Makerere University, Mulago Hospital Complex, Kampala, Uganda.,Medicine, College of Health Sciences, Makerere University, Mulago Hospital Complex, Kampala, Uganda
| | - Paul R Bohjanen
- Division of Infectious Diseases and International Medicine, Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Elly Tebasooke Katabira
- Medicine, College of Health Sciences, Makerere University, Mulago Hospital Complex, Kampala, Uganda
| | | | - David R Boulware
- Division of Infectious Diseases and International Medicine, Medicine, University of Minnesota, Minneapolis, MN, United States
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20
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Abstract
Ce travail rapporte le cas d’un hématome sous capsulaire spontané rompu de la rate (avec hémopéritoine) et fait le point sur cette pathologie rare. Les ruptures non traumatiques peuvent être mortelles, le diagnostic est parfois difficile. Elles révèlent souvent une pathologie sous-jacente, notamment infectieuse, tumorale ou hématologique. La symptomatologie est habituellement aiguë, mais des formes progressives sont possibles. La majorité des patientssont splénectomisés.
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Affiliation(s)
- Safae El Abbadi
- Service de Radiologie des Urgences, CHU-Ibn Sina, Université Med V, Rabat, Maroc
| | - Fatima Zahra Rhouni
- Service de Radiologie des Urgences, CHU-Ibn Sina, Université Med V, Rabat, Maroc
| | - Laila Jroundi
- Service de Radiologie des Urgences, CHU-Ibn Sina, Université Med V, Rabat, Maroc
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21
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Mimata Y, Sato K, Oikawa R, Doita M. Non-traumatic Thoracic Vertebral Compression Fractures Occurred in a Young Epileptic Patient: A Case Report. J Orthop Case Rep 2017; 6:85-87. [PMID: 28116280 PMCID: PMC5245951 DOI: 10.13107/jocr.2250-0685.526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The occurrence of non-traumatic vertebral compression fractures (VCFs) in a healthy young male is very rare. We present a rare case of non-traumatic thoracic VCFs in a young epileptic patient. CASE REPORT A 19-year-old healthy male experienced severe back pain. There had been no significant traumatic event. A radiograph of the spine showed collapsed vertebra at Th6 and Th7 and magnetic resonance image of the spine showed intensity changes at Th6, Th7 and Th8. Bone mineral density (BMD) at the radius was low and urine N-terminal telopeptide (NTx) was very high. The patient was diagnosed with VCFs caused by low BMD. The patient had a medical history of epilepsy and had taken valproate for thirteen years. We instructed the patient to stop taking valproate and to begin taking bisphosphonate. As a result, urine NTx became normal. CONCLUSION It was previously reported that valproate reduced BMD in epileptic children and reduction in BMD increased with the duration of valproate therapy. We propose that regular BMD screening and measurement of bone metabolic markers should be conducted for all patients taking long-term antiepileptic drugs to prevent BMD loss and associated fractures.
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Affiliation(s)
- Yoshikuni Mimata
- Department of Orthopaedic Surgery, Iwate Medical University, Morioka, Japan
| | - Kotaro Sato
- Department of Orthopaedic Surgery, Iwate Medical University, Morioka, Japan
| | - Ryunosuke Oikawa
- Department of Orthopaedic Surgery, Iwate Medical University, Morioka, Japan
| | - Minoru Doita
- Department of Orthopaedic Surgery, Iwate Medical University, Morioka, Japan
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22
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van der Mieren G, Mertens T, Somville FJ. Non-traumatic vertebral artery dissection presenting with unilateral cervical pain, hemilateral vision problems and headache. Acta Chir Belg 2016; 116:319-321. [PMID: 27378520 DOI: 10.1080/00015458.2016.1171076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Spontaneous vertebral artery dissection is a rare condition, mainly affecting young adults with non-specific symptoms, which are often considered not severe. We report a case of a non-traumatic vertebral artery dissection in a 30-year-old woman. Our patient presented with unilateral right-sided neck pain and frontal headache during 3 weeks and recently developed right-sided vision problems. History and clinical findings were non-specific. Neurovascular imaging showed a right-sided vertebral artery dissection from C2 to C6 with an intima flap at C5-C6. The patient was observed in the stroke unit for 1 week and antithrombotics were given during 3 months. There was a complete revascularization of the vertebral artery after 3 months. A review of literature is given concerning predisposing factors, clinical symptoms, neurovascular imaging and treatment options.
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Affiliation(s)
| | - Tom Mertens
- a Department of Emergency and Traumatology , AZ St Dimpna , Geel , Belgium
| | - Francis J Somville
- a Department of Emergency and Traumatology , AZ St Dimpna , Geel , Belgium
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Abstract
Non-traumatic shoulder instability is frequently associated with chronic disabling pain, altered patterns of motion, dysfunctional muscle strategies and hyperlaxity. Identifying the relationship between potential aetiologies can be challenging. An expanded assessment may be useful to estimate the contribution of each component and offer a framework for targeted rehabilitation.
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Affiliation(s)
- Catherine Barrett
- Catherine Barrett, Specialist Physiotherapist Shoulder Academy, Central Health Physiotherapy, Central Health Ltd, 53–64 Chancery Lane, London WC2A 1QS, UK. Tel: +44 (0)20 7404 6343. Fax: +(44) (0) 207 404 6345.
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Mefire AC, Fokou M, Dika LD. Indications and morbidity of tube thoracostomy performed for traumatic and non-traumatic free pleural effusions in a low-income setting. Pan Afr Med J 2014; 18:256. [PMID: 25489361 PMCID: PMC4258205 DOI: 10.11604/pamj.2014.18.256.3963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 07/15/2014] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Tube thoracostomy (TT) is widely used to resolve a number of pleural conditions. Few data are available on the complications of TT performed for non-traumatic conditions, especially in low income setting. The aim of this study is to analyse the indications and complications of TT performed for both traumatic and non-traumatic conditions of the chest in a low-income environment. METHODS This retrospective study conducted over a four years period in a the Regional Hospital, Limbe in South-West Cameroon analyses the rate and nature of complications after TT performed for both traumatic and non-traumatic conditions. Different factors related to complications are analysed. RESULTS We analysed 134 patients who had 186 chest tubes inserted. After placement, tubes were either connected to a water seal system (40%) or submitted to suction (60%). Most (91%) procedures were performed for a non-traumatic condition. Non-infectious pleural effusion in patients with HIV infection or pulmonary tuberculosis was the most common indication. Sixty six per-cents of procedures were carried out by a general surgeon. The complication rate was 19.35%. The most common complications included tube dislocation and pneumothorax. Most complications were solved by replacement of the tube. The nature of operator (general surgeon vs general practitioner) was a significant predictor of outcome (p < 0.01). No procedure related death was recorded. CONCLUSION TT is a safe and efficient procedure to drain pleural collections of both traumatic and non-traumatic origins, even in low-income settings. The incidence of complications could be reduced by a better training of general practitioners on this procedure.
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Affiliation(s)
- Alain Chichom Mefire
- Regional Hospital Limbé and Faculty of Health Sciences, University of Buea, Yaoundé, Cameroon
| | - Marcus Fokou
- General and Reference Hospital, Yaoundé, Cameroon
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Abstract
Introduction: Non-traumatic fracture of pedunculated osteochondroma is a known, but rare complication. Treatment protocols for such complication are debatable, however, surgical intervene have been advocated. Case Report: 14 years old male presented with pain and redness around the knee with no history of injury. Radiograph showed fracture of solitary osteochondroma of femur. Excision was done through posterolateral approach and confirmed with histopathology. Patient returned to activities at 2 weeks post surgery Conclusion: Atraumatic fractures may occur due to strong muscular contractions in cases of pedunculated osteochondroma. Surgical excision gives prompt relief from symtoms
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Affiliation(s)
| | - Anuj Gupta
- Department of Orthopedic Surgery, Priti Nursing Home, Allahabad U.P. India
| | - Suresh Chandra Gaur
- Department of Orthopedic Surgery, M.L.N Medical College Allahabad U.P. India
| | - Rishi Dwivedi
- Department of Orthopedic, M.L.N MEDICAL COLLEGE ALLAHABAD U.P
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Marinho AR, Flett HM, Craven C, Andrea Ottensmeyer C, Parsons D, Verrier MC. Walking-related outcomes for individuals with traumatic and non-traumatic spinal cord injury inform physical therapy practice. J Spinal Cord Med 2012; 35:371-81. [PMID: 23031174 PMCID: PMC3459566 DOI: 10.1179/2045772312y.0000000038] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVES To describe and compare patient demographics, inpatient lengths of stay (LOS), and walking-related functional outcomes of individuals with spinal cord injuries (SCIs) of traumatic (TSCI) and non-traumatic (NTSCI) etiologies. To contrast these features between individuals who walked from those who did not walk at discharge from inpatient rehabilitation. DESIGN Prospective observational study; comparisons between TSCI and NTSCI, walkers and non-walkers. Information collected as a pilot project within a provincial SCI informatics strategy. SETTING Rehabilitation hospital specialized for SCIs. PARTICIPANTS Adults with NTSCI (n = 31) or TSCI (n = 59) admitted to inpatient rehabilitation, 2007-2009. OUTCOME MEASURES Lower-extremity motor scores (LEMS), spinal cord independence measure version III (SCIM-III) total and mobility subscores, functional independence measure (FIM), Length of Stay (LOS) at inpatient facilities. RESULTS Groups (NTSCI vs. TSCI) did not differ in the proportion of individuals that achieved "walker" status (SCIM-III mobility indoors (MI) score ≥ 3 at rehab discharge) (P = 0.41, 48.9% overall). Inpatient LOS at both acute care and rehabilitation facilities did not differ between groups; however, TSCI non-walkers had longer inpatient rehabilitation LOS than TSCI walkers. Among walkers, improvement was shown on all three mobility subscores of the SCIM-III between admission and discharge from rehabilitation; highest significance was shown on the SCIM-III MI. Walking status at discharge (SCIM-III MI) was most strongly correlated with LEMS at rehab admission (r = 0.71, P < 0.001). CONCLUSION Walking outcomes are comparable among individuals with NTSCI vs. TSCI admitted for specialized SCI rehabilitation. Routine use of SCIM-III mobility items for assessment of walking outcome is recommended for inpatient rehabilitation.
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Affiliation(s)
- Andresa R. Marinho
- University of Toronto, Toronto, ON, Canada; and Toronto Rehabilitation Institute – UHN, Toronto, ON, Canada
| | - Heather M. Flett
- University of Toronto, Toronto, ON, Canada; and Toronto Rehabilitation Institute – UHN, Toronto, ON, Canada
| | - Catharine Craven
- University of Toronto, Toronto, ON, Canada; and Toronto Rehabilitation Institute – UHN, Toronto, ON, Canada
| | | | - Daria Parsons
- University of Toronto, Toronto, ON, Canada; and Toronto Rehabilitation Institute – UHN, Toronto, ON, Canada
| | - Molly C. Verrier
- University of Toronto, Toronto, ON, Canada; and Toronto Rehabilitation Institute – UHN, Toronto, ON, Canada,Correspondence to: Molly C. Verrier, Centre for Function and Well-Being, University of Toronto, 160-500 University Avenue, Toronto, ON, Canada M5G 1V7.
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27
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Patel V, Raval G, Gavadia K. Pneumothorax, pneumomediastinum, subcutaneous emphysema and pneumorrhachis as complications of common flu. Am J Case Rep 2012; 13:198-201. [PMID: 23569528 PMCID: PMC3615911 DOI: 10.12659/ajcr.883332] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 05/10/2012] [Indexed: 11/09/2022]
Abstract
Background: Spontaneous pneumomediastinum is an uncommon benign condition that is occasionally associated with subcutaneous emphysema and occasionally with pneumothorax, but is rarely associated with pneumorrhachis (air within the spinal epidural space). Case Report: We describe the case of a 20-year-old man and discuss a classification system of pneumorrhachis and its pathoanatomy, clinical and radiological presentation and management based on a detailed review of the previous literature. The pathophysiology is multifocal and diagnosis is state-of–the-art, as free intra-spinal air collection and coexistence of it both should be differentiated. Computed tomography with reconstruction of imaging is the method of choice for investigation. Symptoms associated with pneumorrhachis are due to its cause and origin and rarely due to pneumorrhachis, itself. Neurological symptoms and signs due to pressure effect are rarely found, but were present in our case. The management requires a multidisciplinary regimen and has to be individualized. The case was successfully managed conservatively, except for intercostal drainage for symptomatic pneumothorax. The patient stayed at rest and his symptoms improved within a few days. Seven days later the intraspinal air and pneumomediastinum were spontaneously resolved on follow-up chest computed tomography. In spontaneous pneumomediastinum, pneumorrhachis is self-limiting and benign. Conclusions: The same management is advised in spontaneous pneumomediastinum with or without pneumorrhachis in non-complicated, asymptomatic cases.
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Affiliation(s)
- Varun Patel
- Department of Pulmonary Medicine, Sterling Hospital, Memnagar, Ahmedabad, Gujarat, India
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28
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Abstract
OBJECTIVE To define the epidemiological trends and identify populations at risk of traumatic and non-traumatic spinal cord injury (NTSCI) for the province of Manitoba, Canada. METHODS We reviewed records retrospectively for subjects in three cohorts (1981-1985, 1998-2002, and 2003-2007). A total of 553 individuals with spinal cord injury (SCI) were studied for variables such as age, level of injury, severity of injury, First Nations (FN) status, and etiology of injury. RESULTS Incidence of overall SCi has increased from 22.0 to 46.5 per million (P< 0.001). Incidence of NTSCI increased from 3.12 per million to 16.7 per million (P < 0.001). Incidence of traumatic spinal cord injury (TSCI) has increased from the 17.1 per million to 25.6 per million (P<0.001). There was a significant increase in the mean age at injury from 30.23 to 45.768 years of age (P < 0.0001). Female and NTSCI have a higher mean and median age at injury. There was a significant (P = 0.0008) increase in the proportion of females with a most recent male/female ratio of 3.4:1. A temporal increase in incomplete injuries was observed (P < 0.0001). Incomplete and thoracic level injuries are more common with NTSCI. CONCLUSION The results demonstrate that there are significant differences between NTSCI and TSCI in Manitoba, and that Manitoba trends in SCI are in keeping with those seen on a national and an international level. There is a high risk of SCI in Manitoba FN, for which preventive strategies need to be put in place, and higher resource structure geared towards. Additionally, the trend of older age at injury has significant implications for structuring acute care and rehabilitation programs for these individuals, enhancing the need for treating older and more medically complicated individuals with SCI.
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Affiliation(s)
- James R McCammon
- Physical Medicine and Rehab, University of Manitoba, Winnipeg, Canada.
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29
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Abstract
BACKGROUND Ruptured renal neoplasms can be a catastrophic clinical presentation. Angiomyolipoma is the commonest renal tumor which presents in this fashion. Renal sarcomas are rare renal neoplasms. Renal leiomyosarcomas are the most common histological subtype of renal sarcomas, accounting for approximately 50-60% of the reported cases. These tumors are usually peripherally located and appear to arise from either the renal capsule or smooth muscle tissue in the renal pelvic wall. CASE PRESENTATION A 70 years old male, with hypertension and ischemic disease, developed acute left flank pain. The general physician evaluated this using ultrasound, which showed a solid left renal mass. Two weeks later, he presented in the emergency room in a state of shock with a palpable flank mass. CT scan of the abdomen showed a large heterogeneous mass lesion in the left perinephric space with minimal post contrast enhancement. Per-operatively, large retroperitoneal hematoma was found within Gerota's fascia along with spleen plastered to the upper limit of hematoma. Nephrectomy and splenectomy were performed. Postoperative course was uneventful and patient was discharged on the 10th post-operative day. Histopathological evaluation of the specimen showed high-grade leiomyosarcoma CONCLUSIONS Spontaneous rupture of renal neoplasm is a rare clinical presentation. Angiomyolipoma is the commonest cause of spontaneous rupture of the kidney. Presentation of a leimyosarcoma as a ruptured renal neoplasm has not been previously reported in the English literature.
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Affiliation(s)
- Mohammad Moazzam
- Department of Surgery and Pathology, The Aga Khan University, Karachi, 74800
| | - M Hammad Ather
- Department of Surgery and Pathology, The Aga Khan University, Karachi, 74800
| | - Akber S Hussainy
- Department of Surgery and Pathology, The Aga Khan University, Karachi, 74800
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