Project description:Introduction and importancePulmonary artery aneurysms are rare anomalies of the pulmonary vasculature. They are often asymptomatic and frequently an incidental finding on imaging or autopsy. It is imperative to closely monitor pulmonary artery aneurysms as they can result in sudden dissection, rupture, and death. Due to the rarity of this disease, the number of studies on pulmonary artery aneurysm management are limited and debated in the literature.Case presentationWe report a case of an initially symptomatic patient with dyspnea on exertion with an incidental finding of a large 5.0 × 6.4 cm pulmonary artery aneurysm that responded well to conservative management. Her dyspnea self-resolved and the decision was made to closely monitor the patient every three months with serial computed tomography angiography imaging.Clinical discussionIdiopathic aneurysms of the main pulmonary artery are rare with a poorly understood pathogenesis primarily due to the limited number of cases. There are no clear guidelines for management, but the least invasive approach should be used due to the risk of serious adverse events. Pharmacologic treatment of underlying comorbidities and serial computed tomography angiography imaging should be considered as conservative management.ConclusionSix months later, she remains hemodynamically stable and the aneurysm has decreased in size by 15%. This case highlights that conservative management should be considered first line therapy in asymptomatic, hemodynamically stable patients regardless of aneurysm size.
Project description:Acute prolapsed inter-vertebral disc (IVDP) is a painful condition that requires immediate treatment by conservative or surgical management. Though majority of patients show remission in symptoms with conservative treatment, regression of herniated disc with non-surgical management has been rarely reported. A 46 years old female patient with acute and severe low back pain, disability and radiating pain towards right lower extremity came to our hospital. Oswestry Disability Index (ODI) score of the patient was 94% indicating bed-ridden condition. MRI of lumbar spine showed diffuse posterior disc bulge between fourth and fifth lumbar vertebra indenting right traversing nerve root and inferior displacement of extruded disc along the body of fifth lumbar vertebra. She was treated according to treatment explained in Ayurveda. She received oral medications, application of medicated oils, fomentation and medicated enema (Basti). After treatment of seven and half months, the patient showed good remission in pain, stiffness and radiculopathy. ODI score reduced to 9% that indicates minimal disability. Follow up MRI showed non significant compression of the nerve root and gross reduction in the inferior displacement of extruded disc. Acute IVDP can be successfully conserved using Ayurveda treatment. The Panchakarma procedures and medicines used in the treatment need further evaluation.
Project description:IntroductionRetained intraocular graphite foreign bodies are uncommon. Although they are generally inert, they have been reported to cause severe inflammatory reactions and progressive damage to intraocular structures.Case presentationWe report a case of a 7-year-old girl with a retained intraocular graphite pencil lead foreign body in the vitreous treated conservatively for more than 5 years without any consequences.ConclusionGraphite foreign bodies may be retained in the eye posterior segment without causing any inflammation or damage to the intraocular structures.
Project description:Ranula is a rare and benign extravasation mucocele that is clinically characterized by asymptomatic sublingual or submandibular masses. Surgical excision is considered the most effective treatment approach, but it has been associated with high invasiveness and several complications (hemorrhage, damage to Wharton's duct, and lingual nerve injury). Over the past decade, more conservative therapies have been rapidly disseminated into clinical practice to seek a more effective and less traumatic approach for young patients. In this report, an 8-year-old female with an asymptomatic, recurrent sublingual ranula was treated using a conservative approach with marsupialization and an intracystic injection of a plaque remover (Hybenx® gel). After incision of the cystic dome, Hybenx® gel was applied into the cystic lumen for 20 seconds and then aspirated; next, the area was rinsed thoroughly with sterile saline solution before suturing. Ultrasound re-evaluation at 10 months and intraoral clinical examination at 24 months confirmed the absence of relapse. Our results support the hypothesis that marsupialization combined with intracystic injection of Hybenx® gel could be an encouraging conservative treatment alternative for recurrent sublingual ranula in children. Further randomized controlled trials are needed to test this hypothesis.
Project description:IntroductionAnkle arthrodesis is one of the managements for a significantly unstable Charcot ankle. Some of the methods of internal fixation for ankle arthrodesis include the use of intramedullary nails, screws, and plates. Ankle arthrodesis using intramedullary nails has become more popular. However, studies evaluating the use of plate fixation, particularly double posterior lateral plating, are limited. We report the clinical and radiological outcomes of double posterior lateral plating ankle arthrodesis in three diabetic Charcot ankle patients.Presentation of caseThree patients, aged 73, 67, and 65 years old, complained of ankle pain and with a history of type 2 diabetes mellitus. The physical examination revealed swelling and erythema without a sign of active infection. The radiological examination showed ankle deformity, and the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot scores were 5, 10, and 0, respectively. All patients were diagnosed with a diabetic Charcot ankle and underwent ankle arthrodesis using double posterior lateral plating. Four months and six months follow up revealed talus union, improved ankle deformity, and improved AOFAS Ankle-Hindfoot scores to 70, 76, and 73, respectively.DiscussionVarious methods of ankle arthrodesis are retrograde intramedullary nails, screws, and plates. In this report, we opt for plate fixation because it allows for stable internal fixation, adequate compression, high angular stability, and a lower irreversible deformation in osteoporotic bone.ConclusionDouble posterior lateral plating ankle arthrodesis provided satisfactory clinical and radiological outcomes. This method can be an alternative for patients with Charcot ankle requiring ankle arthrodesis.
Project description:BackgroundSpontaneous coronary artery dissection (SCAD) is a particular mode of presentation of acute coronary syndrome. It preferentially affects the young woman with little or no classical risk factor for atheromatous disease.Case summaryIn this report, we present a classical non-ST-segment myocardial infarction (NSTEMI) condition in link with a spontaneous coronary artery wall haematoma. A 43-year-old female patient who did not have any risk factors for atheromatous disease presented with NSTEMI. The coronary angiogram (CA) revealed a moderate smooth stenosis of the proximal left anterior descending artery (LAD) that ended just before the take-off of a septal branch. Intracoronary imaging by optical coherence tomography (OCT) visualized a large intramural haematoma reducing the coronary artery lumen. The patient was managed conservatively with antithrombotic regimen, nitrates, and close monitoring with repeated CA. Evolution was favourable despite striking extension of coronary haematoma towards distal LAD. She was then discharged and has been asymptomatic on follow-up visits. Planned repeat CA and OCT at 3 months showed a quite normal coronary artery appearance of the LAD with significant regression of haematoma.DiscussionPrecise data regarding SCAD epidemiology remains to be determined. The angiographic pattern of our case recalls the Type 2 described by Saw team. But OCT was necessary to confirm the diagnosis. We manage our patient conservatively with close monitoring, as largely suggested by current state of the art, regarding the good haemodynamic status, and absence of ongoing ischaemia despite an evolution severe stenosis.
Project description:Sacral colpopexy is one of the standard procedures to treat apical pelvic organ prolapse. In most cases, a synthetic mesh is used to facilitate the colposuspension. Spondylodiscitis is a rare but potentially serious complication that must be promptly diagnosed and treated, despite the lack of consensus in the management of this complication. We report one case of spondylodiscitis after a laparoscopic supracervical hysterectomy and sacral colpopexy treated conservatively. We also present a literature review regarding this rare complication. A conservative approach without mesh removal may be possible in selected patients (stable, with no vaginal lesions, mesh exposure or severe neurologic compromise). Hemocultures and culture of image-guided biopsies should be performed to direct antibiotic therapy. Conservative versus surgical treatment should be regularly weighted depending on clinical and analytical progression. A multidisciplinary team is of paramount importance in the follow-up of these patients.
Project description:IntroductionFoot deformities are frequent complications in Charcot-Marie-Tooth disease (CMT) patients, often requiring orthopedic surgery. However, there are no prospective, randomized studies on surgical management, and there is variation in the approaches among centers both within and between countries.MethodsIn this study we assessed the frequency of foot deformities and surgery among patients recruited into the Inherited Neuropathies Consortium (INC). We also designed a survey addressed to orthopedic surgeons at INC centers to determine whether surgical approaches to orthopedic complications in CMT are variable.ResultsFoot deformities were reported in 71% of CMT patients; 30% of the patients had surgery. Survey questions were answered by 16 surgeons working in different specialized centers. Most of the respondents were foot and ankle surgeons. There was marked variation in surgical management.DiscussionOur findings confirm that the approaches to orthopedic management of CMT are varied. We identify areas that require further research. Muscle Nerve 57: 255-259, 2018.
Project description:BackgroundLeft main (LM) coronary atresia (LMCA) is a rare coronary anomaly where the LM is congenitally absent and a variable clinical spectrum can follow. The diagnosis of LMCA is generally made in youth because of the development of symptoms, but very rarely in adulthood. In symptomatic patients, surgical revascularization is recommended, whereas, in asymptomatic patients with LMCA and without inducible myocardial ischaemia, preventive surgical treatment is controversial.Case summaryA 58-year-old male patient with aortic ectasia detected during an echocardiogram performed to evaluate a hypertension-related preclinical cardiac damage and, due to this finding, an echocardiographic follow-up was suggested. Three years later, he was admitted to undergo coronary angiography (CA) after the computed tomography finding of a suspected occlusion of the LM with collateral circulation from right coronary artery (RCA) to left anterior descending and circumflex arteries. CA confirmed an LMCA and the RCA provided blood supply to the left coronary artery through collaterals whose calibre was similar to that of the target left-sided vessels. No obstructive coronary artery disease was detected. In order to detect potential myocardial ischaemia, a technetium-tetrofosmin cardiac single-photon emission computed tomography during maximal exercise-stress test was performed and it did not show a perfusion defect. Medical management with scheduled follow-up visits was deemed to be the best therapeutic option.DiscussionLMCA is a rare anomaly where LM is absent and the RCA provides collateral circulation for left coronary artery. In asymptomatic patients, preventive surgical treatment is controversial.