Case studies in surgery最新文献

Incidental finding of an arteriovenous malformation originating from the diaphragm: Case report and literature review 意外发现源自膈肌的动静脉畸形：病例报告和文献综述

Case studies in surgery Pub Date : 2024-06-11 DOI: 10.5430/css.v10n1p1

Cara Gose, Prakash Patel, Alexander Posch, Adam Bowling

{"title":"Incidental finding of an arteriovenous malformation originating from the diaphragm: Case report and literature review","authors":"Cara Gose, Prakash Patel, Alexander Posch, Adam Bowling","doi":"10.5430/css.v10n1p1","DOIUrl":"https://doi.org/10.5430/css.v10n1p1","url":null,"abstract":"Arteriovenous malformations (AVMs) are defined as aberrant linkages between arteries and veins in the absence of a capillary network. This case report will discuss the incidental finding of an AVM likely originating from the diaphragm. A 65-year-old female presents for an umbilical hernia repair. Her past medical history is significant for HTN, type 2 diabetes mellitus, gastroesophageal reflux disease, and class 1 obesity. She has a past surgical history of hysteroscopy in 2020 and laparoscopy in 1996. She has no history of tobacco use, alcohol use, or recreational drug use. She is allergic to contrast. A computed tomography (CT) scan was ordered and incidentally showed a soft tissue mass in the left upper quadrant adjacent to the stomach and diaphragm, possibly a gastrointestinal stromal tumor (GIST) or splenule, in addition to diastasis of the abdominal wall. Biopsies of the esophagus, stomach, and duodenum from the esophagogastroduodenoscopy (EGD) were all benign. A nuclear medicine scan of the liver and spleen found an estimated 2.3 cm soft tissue nodule located between the fundus of the stomach and the left hemidiaphragm that does not demonstrate sulfa colloid uptake and is therefore not consistent with a splenule. This is the only incidence cited of an AVM originating from the diaphragm. We suspect that the origin of this AVM is the inferior phrenic artery. The decision for management for this case was to get a CT scan of the abdomen and chest to trace the path of the AVM and manage with surveillance.","PeriodicalId":91667,"journal":{"name":"Case studies in surgery","volume":"25 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141357543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Hand surgeon diagnosis and management of cutaneous infection with Purpureocillium lilacinium of the upper extremity: A mimicker of necrotizing fasciitis 手外科医生对上肢紫癜癣菌皮肤感染的诊断和处理：坏死性筋膜炎的模仿者

Case studies in surgery Pub Date : 2023-11-30 DOI: 10.5430/css.v9n1p1

Matthew B. Weber, Brady Ernst, Omar Protzuk, J. Frankenhoff

{"title":"Hand surgeon diagnosis and management of cutaneous infection with Purpureocillium lilacinium of the upper extremity: A mimicker of necrotizing fasciitis","authors":"Matthew B. Weber, Brady Ernst, Omar Protzuk, J. Frankenhoff","doi":"10.5430/css.v9n1p1","DOIUrl":"https://doi.org/10.5430/css.v9n1p1","url":null,"abstract":"Purpureocillium lilacinum is a filamentous fungus commonly found in soil that has been recognized as an opportunistic pathogen. Cutaneous infections with Purpureocillium lilacinum are relatively rare, and they usually occur in individuals with some predisposing factors such as minor trauma or pre-existing skin conditions. Infections in immunocompetent individuals are unexpected due to the fungus’s typically low pathogenicity and the robust immune response of healthy individuals. In immunocompetent hosts, the skin serves as an effective barrier against many fungal infections. While cases of cutaneous infections in immunocompetent hosts have been documented, they are considered rare outliers. Presented is the case of a 93-year-old male who presented to the emergency department with a 10-day history of progressive, painful left upper extremity erythema and swelling. The patient had aggressive progression of hemorrhagic bullae requiring surgical debridement. While the patient’s presentation was originally thought to be consistent with necrotizing fasciitis, only cutaneous necrosis was encountered, and the patient was ultimately diagnosed with a superficial P. lilacinum infection. The failure of treatment leading to death in the described case could be attributed to a combination of factors including intrinsic resistance of the fungus, delayed diagnosis, underlying health conditions, antifungal susceptibility variations, fungal persistence, and immunosuppressive factors.","PeriodicalId":91667,"journal":{"name":"Case studies in surgery","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139200734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Thumb metacarpal dislocation after trapeziectomy with ligamentous reconstruction and tendon interposition: A case report 拇掌骨脱位伴韧带重建及肌腱间置1例

Case studies in surgery Pub Date : 2022-11-28 DOI: 10.5430/css.v8n1p1

Matthew Weber, J. Frankenhoff

{"title":"Thumb metacarpal dislocation after trapeziectomy with ligamentous reconstruction and tendon interposition: A case report","authors":"Matthew Weber, J. Frankenhoff","doi":"10.5430/css.v8n1p1","DOIUrl":"https://doi.org/10.5430/css.v8n1p1","url":null,"abstract":"Thumb carpometacarpal (CMC) arthritis is one of the most common and debilitating pathologies evaluated by the hand surgeon, affecting up to 35% of individuals over 55 years of age. Though multifactorial in etiology, dorsal and radial subluxation of the thumb CMC due to incompetency of the volar beak ligament is thought to be among the most important factors contribution to the arthritis. Multiple operative interventions have been proposed to best address this pathology. In the United States, trapeziectomy with ligament reconstruction and tendon interposition (LRTI) as described by Burton and Pellegrini remains the most widely used technique. As an isolated trauma, dislocation of the thumb CMC joint is a rare injury, only comprising approximately 1% of injuries evaluated by hand surgeons. Typically, thumb CMC dislocations occur due to axial load with the thumb in a flexed position. They are most commonly dorsal dislocations, and are thought to occur due to failure of the dorsoradial ligament. To date, no cases of CMC dislocation after LRTI have yet been described in the literature. Here we present a patient with volar thumb CMC dislocation as a rare complication after LRTI. After percutaneous pinning and immobilization followed by hand therapy, the patient has had a successful return to work with improved pain, restored function, and no further instability.","PeriodicalId":91667,"journal":{"name":"Case studies in surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43412623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Significance of vesicles in flap monitoring in oral cancer surgery: Report of two cases 囊泡在口腔癌手术皮瓣监测中的意义:附2例报告

Case studies in surgery Pub Date : 2021-07-29 DOI: 10.5430/css.v7n1p5

Y. Sakamoto, S. Yanamoto, M. Umeda

引用次数: 0

Trapeziometacarpal joint arthritis: A retrospective study of the natural history of symptomatic thumb arthritis 梯形腕关节关节炎:对症状性拇指关节炎自然史的回顾性研究

Case studies in surgery Pub Date : 2019-11-06 DOI: 10.5430/css.v5n2p11

J. Frankenhoff, Jeffrey A. Stromberg, A. Riley, Jun He, Prem Madesh, J. Isaacs

引用次数: 0

Brief report: De Garengeot’s hernia 简要报告：De Garengeot疝

Case studies in surgery Pub Date : 2019-09-16 DOI: 10.5430/css.v5n2p9

M. Witt, Adam R Eppler, A. Mahmoud

引用次数: 0

Thoracic epidural analgesia vs. intravenous analgesia after lung transplant 肺移植术后胸外硬膜外镇痛与静脉镇痛

Case studies in surgery Pub Date : 2019-08-20 DOI: 10.5430/CSS.V5N2P4

G. Enten, Suvikram Puri, K. Patel, Z. Stachura, E. Schwaiger, Pratik K. Patel, G. Melloni, E. Camporesi

{"title":"Thoracic epidural analgesia vs. intravenous analgesia after lung transplant","authors":"G. Enten, Suvikram Puri, K. Patel, Z. Stachura, E. Schwaiger, Pratik K. Patel, G. Melloni, E. Camporesi","doi":"10.5430/CSS.V5N2P4","DOIUrl":"https://doi.org/10.5430/CSS.V5N2P4","url":null,"abstract":"Objective: Few reports have evaluated postoperative continuous thoracic epidural analgesia on patients who received a lung transplant. This analgesic modality may facilitate extubation, early ambulation, and achieve adequate pain control with minimization of opioid use. An opioid sparing technique could minimize the side effects of opioids such as ileus, constipation, and somnolence.Methods: A retrospective chart review following local IRB approval was performed. A total of 97 patients’ charts were collected, from April 2015 to March 2017. Forty-eight patients received T6-7 epidural, and forty-nine patients received standard intravenous (IV) analgesia. Outcome measures collected included length of intensive care unit stay, total duration of hospitalization, need for reintubation or noninvasive intermittent positive pressure ventilation (NIPPV), need for IV lidocaine gtt, and total narcotics consumption during hospitalization in milligrams of morphine equivalents (MME).Results: Both groups were comparable in age, BMI, and race/gender distribution. Additionally, patient pain requirements were comparable between groups. However, a significantly smaller proportion of thoracic epidural patients required NIPPV post-operatively, (20.4%, 53.2%: p = .0015). Further, the number of patients requiring reintubation was almost halved, (12.5%, 21.3%: NS). Patients receiving thoracic epidural also experienced shorter ICU times (p = .0335) and on average, an overall reduced length of stay by six days.Conclusions: For patients undergoing lung transplant, epidural analgesia is a viable alternative to IV pain control. Further, it significantly reduced respiratory depression and length of stay in the ICU. More refined comparisons can be made by conducting a precise prospective study with a more structured protocol in place.","PeriodicalId":91667,"journal":{"name":"Case studies in surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5430/CSS.V5N2P4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46512298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Distinguishing duodenal duplication cyst from choledochocele: A case report 十二指肠重复囊肿与胆总管膨出的鉴别诊断1例报告

Case studies in surgery Pub Date : 2019-08-01 DOI: 10.5430/CSS.V5N1P34

O. Okiemy, H. Meunier, A. Goldstein

引用次数: 0

Sugammadex administration shortens reversal times but not operating room turnover times Sugammadex给药可缩短逆转时间，但不会缩短手术室周转时间

Case studies in surgery Pub Date : 2019-07-16 DOI: 10.5430/CSS.V5N1P27

Garrett Enten, M. Albrink, Jin Deng, G. Melloni, E. Camporesi, D. Mangar

{"title":"Sugammadex administration shortens reversal times but not operating room turnover times","authors":"Garrett Enten, M. Albrink, Jin Deng, G. Melloni, E. Camporesi, D. Mangar","doi":"10.5430/CSS.V5N1P27","DOIUrl":"https://doi.org/10.5430/CSS.V5N1P27","url":null,"abstract":"Objective: Current literature debates whether administration of sugammadex translates into a higher operating room (OR) efficiency when compared to neostigmine. This study is a blinded assessment of the effects of sugammadex versus neostigmine on OR efficiency as determined by time of reversal to time of the next case.Methods: 50 patients undergoing abdominal surgery were randomized and evenly distributed into two groups, one receiving sugammadex (4 mg/kg) and the other, neostigmine (0.06 mg/kg) plus glycopyrrolate (0.004 mg/kg). Muscle paralysis was induced with intravenous rocuronium (0.6 mg/kg). Train of four (TOF) was monitored using acceleromyography every 10 minutes until reversal. Reversal agents were blindly prepared and administered during closing. TOF was then recorded every minute until a T4/T1 ratio ≥ 0.9 was achieved. This was designated as time of complete reversal. Subsequently, post-reversal outcome measures were collected.Results: Patients receiving sugammadex experienced a significantly shorter reversal time compared to those receiving neostigmine and glycopyrrolate (2.92 ± 1.71 minutes vs. 7.68 ± 5.63 minutes; p = .0002). No other outcome measures were significantly different between groups: time of OR ready for next case was 55.4 min vs. 56.1 min respectively; not significant.Conclusions: While sugammadex was significantly faster at reversing patient neuromuscular blockade the time from reversal to patient extubation after Sugammadex was prolonged. . This could be due to blinding, as blinded providers are unable to anticipate time of reversal and must compensate by making decisions at safe fixed intervals. This is reflected in that the time gained by administration of sugammadex is approximately equal to the delay experienced across all endpoints collected to the patients’ actual discharge.","PeriodicalId":91667,"journal":{"name":"Case studies in surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5430/CSS.V5N1P27","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46436278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2

Colorectal anastomotic perforation secondary to acute ruptured appendicitis presenting as septic arthritis 结直肠吻合口穿孔继发于急性破裂性阑尾炎，表现为感染性关节炎

Case studies in surgery Pub Date : 2019-07-01 DOI: 10.5430/CSS.V5N2P1

H. Zhoba, B. Fleischer, Wesley B. Vanderlan

引用次数: 1