共查询到20条相似文献,搜索用时 31 毫秒
1.
Jaclyn A. Durante 《The Journal of the Canadian Chiropractic Association》2009,53(4):334-338
Objective:
To present the diagnostic and clinical features of a ganglion cyst located on the posterior cruciate ligament and create awareness amongst clinicians of this uncommon diagnosis.Clinical Features:
A 24-year old woman complaining of intermittent left knee pain brought on by an increase in mileage during her training for a half-marathon. A diagnosis of mild chondromalacia patella and a ganglion cyst on the posterior cruciate ligament was made via diagnostic imaging.Intervention and outcome:
Patient was followed up with imaging. The patient chose to withdraw a surgical consult due to patient preference. No conservative treatment was provided.Conclusion:
Although chondromalacia patella is the more probable, a secondary diagnostic consideration in this patient could be a ganglion cyst. A ganglion cyst on the posterior cruciate ligament is an uncommon diagnosis and the clinical manifestations are variable and non-specific. It is important to be aware of its clinical features and to obtain appropriate methods of imaging to generate the diagnosis promptly. 相似文献2.
David Wallace Elizabeth Bright N J M London 《Annals of the Royal College of Surgeons of England》2010,92(1):31-33
INTRODUCTION
Complications of epidural catheterisation can cause significant morbidity. Epidural abscess following epidural catheterisation is rare and the reported incidence is variable. The purpose of this study was to review the incidence of epidural abscess in patients undergoing open abdominal aortic aneurysm (AAA) repair.PATIENTS AND METHODS
A retrospective case note review of all patients having open AAA repair over a 5-year period.RESULTS
A total of 415 patients underwent open AAA repair between January 2003 and March 2008. Of these, 290 were elective procedures and 125 were for ruptured aneurysms. Six patients underwent postoperative magnetic resonance imaging of the spine for clinical suspicion of an epidural abscess. Two of these (0.48%) had confirmed epidural abscess and two superficial infection at the epidural site.CONCLUSIONS
The incidence of epidural abscess following epidural analgesia in patients undergoing open AAA repair within our department was 0.48%. Although a rare complication, epidural abscess can cause significant morbidity. Epidural abscesses rarely develop before the third postoperative day. 相似文献3.
Huseyin Aksoy Sezin Ozyurt Ulku Aksoy Gokhan Acmaz Ozge Idem Karadag Mert Ali Karadag 《International journal of surgery case reports》2014,5(12):1074-1076
INTRODUCTION
Ovarian torsion (OT) is a rare cause of acute abdominal pain that requires prompt recognition and treatment during puerperium. Diagnosis of OT can be challenging due to nonspecific clinical features and uncommon objective findings. The management of OT is often delayed because of diagnostic uncertainty. Early and timely recognition and prompt intervention are crucial to preserve ovarian function and to minimize morbidity.PRESENTATION OF CASE
We report a 29-year-old postpartum woman who presented to the emergency department (ED) with severe right flank pain, nausea and anorexia initially considered as renal colic. After further investigation, OT caused by large mucinous cyst was diagnosed. Right-sided salpingo-oophorectomy was performed due to hemorrhagic ovary and huge cystic mass causing ischemic OT.DISCUSSION
OT is often diagnosed based on the clinical presentation, including severe, sharp, sudden onset of unilateral lower abdominal pain and tenderness with a palpable laterouterine pelvic mass and nausea/vomiting. Emergency surgical intervention should be performed if OT is suspected to confirm the diagnosis and uncoil the twist to prevent ovarian damage.CONCLUSION
In conclusion, emergency physicians should be aware of the possibility of OT in postpartum women. Therefore, early and timely surgical intervention should be undertaken. 相似文献4.
Sangram Keshari Panda Byomokesh Patro Manas Ranjan Samantaroy Jagadananda Mishra K.C. Mohapatra R.K. Meher 《International journal of surgery case reports》2014,5(7):408-411
INTRODUCTION
Follicular carcinoma of thyroid usually behaves in an indolent manner with low metastatic potential. Distant metastases as initial presentation is rare in follicular carcinoma; especially in young patients.PRESENTATION OF CASE
We report the clinical, pathological features and the management of three different cases of follicular carcinoma of the thyroid with unusual presentations at the time of diagnosis. First case presented as thyroid abscess, second case with a large skull swelling in a pre-exiting goiter and the third case with a swelling in the sternum.DISCUSSION
Follicular carcinoma of thyroid is the second category of well-differentiated thyroid cancer that constitutes about 10% of all thyroid malignancies. Blood borne metastasis is common with spread to lung, bone and other solid organs. In less than 10% cases of follicular carcinoma, there is evidence of lymphatic involvement. The patients’ presentations above are highly unusual.CONCLUSION
Recognizing these cases has a significant impact on clinical decision-making and prognosis of the patients. Treatment in these patients should be individualized and an alternative therapeutic approach should be considered. 相似文献5.
Watkinson JC 《Annals of the Royal College of Surgeons of England》2010,92(7):541-547
INTRODUCTION
Thyroid disease is common, thyroid cancer is uncommon. Most goitres are investigated using blood tests, fine needle aspiration cytology together with ultrasound. Surgery usually entails either lobectomy or total thyroidectomy, and for malignancy, patients may need a neck dissection. Recently, significant advances have been made regarding mechanisms involved in both thyroid growth and function (goitrogenesis) and carcinogenesis at a molecular level.PATIENTS AND METHODS
In the study cohort, 1113 patients had benign disease and 387 malignancy. For benign disease, 716 patients had lobectomy or isthmusectomy, 44 had near-total thyroidectomy and 318 a total thyroidectomy. For malignancy, patients received initial lobectomy (180) or total thyroidectomy (152). One hundred and eleven had completion surgery. Thirty patients had extensive surgery. Thyroid growth and function was investigated using 500 human thyroid cell primary cultures obtained at surgery, as well as in three animal models. The role of pituitary tumour transforming gene (PTTG), PTTG binding factor (PBF) and sodium iodide symporter (NIS) in thyroid cell function was then evaluated.RESULTS
Temporary and permanent recurrent laryngeal nerve palsy rates were 2.4% and 0.4%. Other complications included temporary (21%) and permanent (3%) hypoparathyroidism, wound infection (1.2%), haematoma (1.2%) and poor scar (0.8%). Six patients have died. Regarding thyroid growth and function, TSH represents (either directly or indirectly) the main factor mediating thyroid follicular cell growth. For carcinogenesis, over-expression of the proto-oncogenes PTTG and PBF induces tumours in nude mice, and PTTG can induce proliferation of human thyroid cells and, in addition, both repress expression and function of NIS. 相似文献6.
Shi-Min Yuan 《Brazilian Journal Of Cardiovascular Surgery》2015,30(4):489-493
Objective
The diagnosis and treatment of sternal wound infections with mycobacteria are challenging. Such an infection is often associated with a delayed diagnosis and improper treatment that may lead to a worsened clinical outcome. The present study is designed to highlight its clinical features so as to facilitate a prompt diagnosis and timely treatment.Methods
MEDLINE, Highwire Press, and Google search engine were searched for publications in the English language, with no time limit, reporting on sternal wound infection caused by tuberculosis after cardiac surgery.Results
A total of 12 articles reporting on 14 patients were included in this study. Coronary artery bypass grafting was the underlying surgical procedure in more than half of the cases. Purulent discharge and cold abscess were the two main presenting symptoms. Diagnosis of sternal wound infection was evidenced in all 14 patients by different investigations, with culture of samples being the most sensitive method of identifying the pathogen. Good response to first-line anti-tuberculous agents was noted. Almost all patients required surgical debridement/resection and, sometimes, sternal reconstruction. A delayed diagnosis of sternal wound infection may lead to repeated recurrences. A comparison between patients with sternal wound infection due to tuberculosis and non-tuberculous mycobacterial infections showed that the former infections took an even longer period of time. Comparisons also revealed patients with sternal tuberculosis infection had a significantly higher mortality than patients with sternal non-tuberculous infection (29.2% vs. 0%, P=0.051).Conclusion
Sternal infection caused by tuberculosis after cardiac surgery has a longer latency, better response to first-line drugs, and better outcomes in comparison with non-tuberculous sternal infection. Early diagnosis and early anti-tuberculous treatment can surely improve the patients'' prognosis. 相似文献7.
Aranzazu Calero-Lillo Enric Caubet 《International journal of surgery case reports》2014,5(12):893-895
INTRODUCTION
Ischiorrectal tumoral masses mimicking perianal abscess and abscess from uncommon microbiological origins have previously been reported.PRESENTATION OF CASE
Unusual perianal abscess arising from an hematoma in an elderly woman with myelodysplastic syndrome: the patient presented on the emergency with gluteal pain and fever after intramuscular injection of analgesic drug. Physical examination revealed subcutaneous thickening on gluteus and perianal region, without skin changes. Magnetic resonance reported an heterogeneous mass sized 5 cm × 12 cm × 20 cm from gluteus maximus to ischioanal fat under levator ani muscle, through sciatic notch. Debridement of an staphylococceal infected hematoma through a single left lateral gluteus incision, and primary closure was performed. Proctologic examination was normal, so any perianal incision was done. The site infection progressed, so the patient required new surgery with wet cure. The patient contracted nosocomial pneumonia and died due to sepsis.DISCUSSION
Hematological diseases can yield infectious and bleeding disorders. Intramuscular injections often cause haematomas that can lead to pyomyositis. Pyomyositis requires early debridement and continue cure.CONCLUSION
Intramuscular administration of drugs should be avoided in patients with thrombocytopenia. Gluteal region is connected to perianal area through the sciatic notch. Usually perianal abscess in immunocompromised patients arise from proctologic origin, but other causes may be taken into account. 相似文献8.
Devipriya Rathnasabapathi Liene Elsone Anita Krishnan Carolyn Young Andrew Larner Anu Jacob 《The journal of spinal cord medicine》2015,38(4):551-555
Context
Progressive myelopathy can be a manifestation of a variety of disorders including progressive multiple sclerosis. However it is extremely uncommon for a single lesion to cause a progressive myelopathy in MS. Such a myelopathy, i.e. a progressive neurological deficit from a solitary demyelinating lesion, not fulfilling the International diagnostic criteria for MS or Neuromyelitis Optica was first reported in 2012 and termed ‘solitary sclerosis’.Method
We report 3 further cases of progressive myelopathy fulfilling the diagnostic criteria for solitary sclerosis.Findings
Two patients had a single demyelinating lesion in the cervical cord and the third patient had it in the brain stem. All patients had serial MRI scans showing no dissemination or progression of lesions. Extensive diagnostic tests including aquaporin 4 antibodies were negative in all. At last follow-up at a median of 3.8 years, all patients continued to clinically progress despite immunosuppressive treatment.Conclusion/Clinical Relevance
Solitary demyelinating lesions can cause a progressive myelopathy without clinical or radiological evidence of dissemination. Importantly, clinicians, both surgical and medical should be aware of such a diagnosis, to avoid invasive and often harmful tests particularly biopsies. 相似文献9.
Objective
To present the diagnostic and clinical features including management of acute compartment syndrome (ACS) of the foot and to create a sense of emergency amongst clinicians of this rare and dangerous condition.Clinical Features
A 28-year old male soccer player on acetylsalicylic acid (ASA) and verapamil presented with severe swelling, paresthesia, and pain in the left ankle after an acute grade three-inversion ankle sprain. A diagnosis of foot compartment syndrome was made.Intervention and Outcome
A fasciotomy was not performed and subsequent neurological sequelae occurred. We hypothesize that the edema caused by the ankle sprain was excessive due to the use of ASA and verapamil, resulting in increased compartmental pressure and neurological signs in the foot.Summary
Although rare, it is extremely important to be aware of the clinical features of ACS of the foot to obtain an appropriate diagnosis and manage this medical emergency promptly. 相似文献10.
Background
The purpose of this study was to determine the test characteristics of formal ultrasound when used to diagnose upper extremity soft tissue abscess in the setting of suspected infection.Methods
We completed a retrospective chart review of all patients who had formal ultrasounds at our institution for the indication of diagnosing upper extremity abscess between July 2010 and July 2013. Using presence of purulence as the gold standard for diagnosis of abscess, we calculated the test characteristics of ultrasound. We then performed a series of logistic regression models with ultrasound being the independent variable of interest.Results
Using search criteria consistent with upper extremity abscess, we identified 512 patients who underwent ultrasound examinations during our study period. Of these, 178 met the enrollment criteria. Ultrasound reports revealed 110 negative findings, 37 definitively positive findings, and 31 ambiguous findings. Forty-four patients had a final diagnosis of abscess, and 15 of these patients had negative or ambiguous ultrasounds. The sensitivity of definitively positive ultrasound was 65.9 %. The specificity was 94.0 %. Positive predictive value (PPV) of a definitively positive ultrasound result was 78.4 %, and negative predictive value (NPV) of a definitively negative result was 90 %. Logistic regression demonstrated a statistically significant association between definitively positive ultrasound and abscess, but no association between ambiguous ultrasound and abscess after adjustment for significant covariates.Conclusions
Ultrasound is not a sensitive method to detect the presence of abscess in the setting of upper extremity infection. However, in this population of patients with suspected abscess, the negative predictive value was high with and without the inclusion of ambiguous results, suggesting reasonable utility of ultrasound as a rule-out test.Level of Evidence
Diagnostic study, Level II 相似文献11.
Afshin Mohammadi Seyed Babak Mosavi Toomatari Mohammad Ghasemi-Rad 《International journal of surgery case reports》2014,5(12):1110-1112
INTRODUCTION
Renal cell carcinoma (RCC) is commonly known as the “internist''s tumor” because of its unpredictable behavior. Metastasis to the thyroid gland is rarely found in clinical practice.PRESENTATION OF CASE
We report a rare case of non-thyroid malignancies NTM from renal cell carcinoma 1.5 years after radical nephrectomy in a 58-year-old man with a rapidly growing neck mass.DISCUSSION
Malignant melanoma, breast carcinoma, lung, and skin cancer are the most common sources of non-thyroid malignancies (NTM). Although metastases of NTMs to the thyroid gland are uncommon in clinical practice, it should be considered in patients with a history of prior malignancy and a new thyroid mass.CONCLUSION
Isolated thyroid metastasis should be considered in patients with a previous history of cancer and newly developing thyroid mass. 相似文献12.
13.
Aim
To review current data available on use of prostate specific antigen for screening healthy men for prostate cancer.Methods
Literature was reviewed and the guidelines from, American cancer Society, American Urologic Association was reviewed.Results
Current screening protocols lead to over diagnosis of prostate cancer. This often results in unnecessary biopsy procedures and treatments.Conclusion
We must consider the benefit of screening and treatment with the harms of over diagnosis and over treatment. Newer imaging modalities like magnetic resonance imaging have to be evaluated further.Key Words: Prostate cancer, Prostate-specific antigen, Screening 相似文献14.
INTRODUCTION
Anorectal abscess and fistula are quite commonly encountered diseases. Both of these are the acute and chronic manifestations of the same entity. While abscess are thought to begin as an infection in the anal glands, their spreading into adjacent spaces results in a fistula formation. At many times this spread occurs in a complex pattern which is difficult to map and treat.PRESENTATION OF CASE
This paper describes a complex perianal fistula that presented as a painless benign lump in the upper outer quadrant of the right buttock. The lump initially thought to be a soft tissue swelling was later diagnosed to be a chronic abscess cavity extending medially toward the anal canal in the form of a complex fistulous tract.DISCUSSION
Complex perianal fistulas are difficult to treat and are prone to recurrences. Correct diagnosis and characterization of the fistula is essential to optimize the treatment. Clinical examination alone may not give a correct picture of the actual disease, thereby requiring radiological investigations like MRI.CONCLUSION
Although rare, sometimes common clinical conditions like fistula-in-ano may also present in complex manner. It is important to establish the diagnosis firmly and map the fistula properly before going in for surgery. Complexity of fistulas and improper mapping often leads to recurrences and other complications like incontinence. 相似文献15.
Introduction
We report a case of IEA false aneurysm following a mesh repair of a large incisional hernia. We emphasize the importance to consider the diagnosis to help avoid inappropriate interventions which could increase patient morbidity.Case report
A 68-year-old male patient, who 4 weeks previously had had a mesh repair of a large incisional hernia, presented with a painful left iliac fossa swelling. This was found to be an IEA false aneurysm. This was treated successfully with percutaneous thrombin injection.Conclusions
We feel an inferior epigastric artery false aneurysm must be included in the differential diagnosis when investigating the cause of any lateral swelling following incisional hernia repair. This would help reduce the chance of a missed diagnosis and avoid any inappropriate interventions which may cause increased patient morbidity. 相似文献16.
INTRODUCTION
Investigation of the anterior midiine neck lump has been debated over the years with little agreement on best practice. Thyrogiossai duct cysts (TDCs) are the most common aetiology. A TDC may contain ectopic thyroid tissue, which may affect the decision to excise.METHODS
A computerised survey was sent to a representative sample of UK-based ENT surgeons to determine current practice in investigation of presumed TDCs and the incidence of ectopic thyroid tissue.RESULTS
Overall, 95% of those surveyed use ultrasonography, with 32% also arranging thyroid function tests. Fifteen per cent had encountered absent normal thyroid tissue in the presence of a midiine neck swelling. In 64% of cases this represented the only functioning thyroid tissue. Thyroid function tests were normal in all but two cases.CONCLUSIONS
The results show a significant change in practice over the last decade. All surgeons would arrange some form of investigation of a presumed TDC, with the vast majority using ultrasonography. Radioisotope scanning should only be used if the ultrasonography or thyroid function tests are abnormal. The incidence of ectopic thyroid tissue in this survey was higher than previously calculated, with a 0.17% prevalence of midiine neck lumps representing the only functioning thyroid tissue. 相似文献17.
Vyacheslav Bard Natalie Goldberg Hanoch Kashtan 《International journal of surgery case reports》2014,5(2):67-69
INTRODUCTION
Accessory spleen is a rare condition. Torsion of accessory spleen can lead to acute abdomen.PRESENTATION OF CASE
We describe a young woman with an acute abdomen caused by torsion of accessory spleen. Abdominal computed tomography angiography (CTA) demonstrated an ischemic giant accessory spleen with a twisted vascular pedicle. An emergency laparotomy was performed with resection of the infarcted accessory spleen.DISCUSSION
Accessory spleen is a rare and asymptomatic condition. Torsion of accessory spleen is also uncommon. Abdominal pain is the main symptom. CTA is effective in reaching a diagnosis. Definitive treatment of an acute abdomen due to accessory splenic torsion is emergency accessory splenectomy.CONCLUSION
Elective accessory splenectomy should be recommended for known giant accessory spleen to prevent complications in future. 相似文献18.
Sara Imboden Amal al-Fana Annette Kuhn Michael D. Mueller 《International journal of surgery case reports》2014,5(10):706-709
INTRODUCTION
Retrorectal tumors are uncommon and the etiology diverse. Literature to define the preoperative diagnosis and plan the intraoperative management are uncommon.PRESENTATION OF CASE
We describe a case of a 44 year old patient with a laparoscopic approach for the removal of a retrorectal tumor and emphasize on the preoperative diagnostics and the intraoperative, minimal invasive approach.DISCUSSION
Especially because these tumors are rare and often an incidental finding in gynecologic surgery, it is important to know the various differential diagnoses and its consequences with the laparoscopic approach.CONCLUSION
We suggest the laparoscopic approach in cases of retroperitoneal cysts of unknown origin is ideal also because anatomic structures, mostly nerves, can be easily spared. 相似文献19.
20.
Mitchell S Jackson CR Wilson-Storey D 《Annals of the Royal College of Surgeons of England》2011,93(2):99-102