1/34. cardiopulmonary bypass on a patient with malaria.There are special considerations when performing cardiopulmonary bypass (CPB) on a patient with malaria. A 70-year-old female with a recent history of severe aortic stenosis was scheduled to undergo elective aortic valve replacement. One week prior to surgery, the patient developed shaking chills and fever, with a positive malaria smear. An extensive literature search was undertaken to determine the effect of CPB on a patient with active malaria, but no prior reference was found. One major concern was the lysis of red blood cells while on bypass. The surgery was performed uneventfully, following 2 weeks of treatment with primaquine phosphate.- - - - - - - - - - ranking = 1keywords = chill (Clic here for more details about this article) |
2/34. Frozen allogeneic human epidermal cultured sheets for the cure of complicated leg ulcers.BACKGROUND: skin ulcers due to venous stasis or diabetes are common among the elderly and are difficult to treat. Repeated applications of cell-based products have been reported to result in cure or improvement of leg ulcers of small size in a fraction of patients. OBJECTIVE: To examine the effects of frozen human allogeneic epidermal cultures for the treatment of acute and chronic ulcers. methods: We treated a series of 10 consecutive patients with leg ulcers of different etiology and duration with frozen human allogeneic epidermal cultures stored frozen and thawed for 5-10 minutes at room temperature before application. Three patients had ulcers with exposed Achilles or extensor tendon. The ulcers treated were as large as 160 cm2 in area and of up to 20-years' duration. After preliminary preparation of the wounds by debridement to remove necrotic tissue and application of silver sulfadiazine to control infection, thawed cultures were applied biweekly from 2 to 15 times depending on the size and complexity of the ulcer. RESULTS: All ulcers healed, including those with tendon exposure. After the first few applications, granulation tissue formed in the ulcer bed and on exposed tendons, and epidermal healing took place through proliferation and migration of cells from the margins of the wound. The time required for complete healing ranged from 1 to 31 weeks after the first application. CONCLUSION: The use of frozen human allogeneic epidermal cultures is a safe and effective treatment for venous or diabetic ulcers, even those with tendon exposure. It seems possible that any leg ulcer will be amenable to successful treatment by this method.- - - - - - - - - - ranking = 1keywords = chill (Clic here for more details about this article) |
3/34. Extensive intracranial xanthoma associated with type II hyperlipidemia.Xanthomas are associated with a spectrum of medical conditions, most commonly disorders of lipid storage and lipid metabolism. They occur primarily in the subcutaneous tissues, especially along the achilles tendon and the extensor tendons of the hands. Intracranial xanthomas are extremely rare. We present a case of an extensive xanthoma of the temporal bone in a patient with hyperlipidemia.- - - - - - - - - - ranking = 1keywords = chill (Clic here for more details about this article) |
4/34. Radial forearm free flap for salvage of Achilles-tendon repair wounds.Achilles-tendon repair wounds are prone to breakdowns and secondary infections, compromising the integrity of the repair and the ultimate function of the repaired tendon. Unlike defects resulting from tumor excision, burns, or trauma, Achilles-tendon repair wounds have their own special considerations. The dissection needed for the repair of the tendon often denudes the tendon of the peritenon blood supply and creates a sub-tendinous dead space. Anatomic topography unique to the Achilles region makes the choice of flap coverage crucial in terms of function and cosmesis. Considering all the flap options utilized in the past, the radial forearm free flap is the most logical choice, offering the advantage of thin, supple, vascularized tissue. The flap can also be elevated easily for secondary reconstructions, when simultaneous tendon reconstruction and coverage are not possible. The authors present their experience utilizing the radial forearm flap as the flap of choice for salvage of the complicated wounds of achilles tendon repair.- - - - - - - - - - ranking = 8keywords = chill (Clic here for more details about this article) |
5/34. The sandwich temporoparietal free fascial flap for tendon gliding.Microsurgical transfer of the superficial and deep temporal fascia based on the superficial temporal vessels has been documented. This article analyzes the functional recovery when each layer of this facial flap is placed on either side of reconstructed or repaired tendons, to recreate a gliding environment. This fascial flap also provided a thin, pliable vascular cover in selected defects of the extremities.Six patients (four male and two female) with tendon loss and skin scarring of the hand (three dorsum, one palmar, and one distal forearm) and posttraumatic scarring of the ankle with tendoachilles shortening (one patient) underwent this procedure. No flap loss was witnessed. Good overall functional recovery and tendon excursion were observed. Complication of partial graft loss was observed in two patients.- - - - - - - - - - ranking = 1keywords = chill (Clic here for more details about this article) |
6/34. Delayed-onset mycobacterial keratitis after LASIK.PURPOSE: To describe the time course, diagnosis, clinical features, and treatment of seven patients with mycobacterium szulgai keratitis that developed from 7 to 24 weeks after laser in situ keratomileusis (LASIK). methods: Seven of 30 eyes of 18 patients were identified with keratitis after LASIK. The first two patients presented 12 to 14 weeks after LASIK; nontuberculous mycobacteria were identified 1 month after the flaps were cultured. Patient recall identified three additional cases by culture and two cases by clinical features alone. Pulsed-field gel electrophoresis (PFGE) was used to type the isolates, and treatment was modified based on susceptibilities. RESULTS: M. szulgai was identified in five patients for whom cultures were performed, but response to empiric therapy based on cultures proved unsatisfactory. The keratitis resolved in all patients with treatment including clarithromycin based on susceptibilities. Medical therapy was sufficient, although one patient required flap amputation. Six of seven patients recovered best-corrected visual acuity (BCVA), while one patient lost one line of BCVA. Two patients lost one line of postoperative uncorrected visual acuity (UCVA), two patients gained one line of UCVA, and three patients recovered postoperative UCVA. PFGE analysis revealed that the M. szulgai strains were identical, and the infection source was contaminated ice used to chill syringes for saline lavage. CONCLUSIONS: Nontuberculous mycobacterial keratitis after LASIK is a diagnostic and management challenge, but outcomes can be preserved with treatment based on susceptibilities. This cluster underscores the importance of adherence to sterile protocol during LASIK.- - - - - - - - - - ranking = 1keywords = chill (Clic here for more details about this article) |
7/34. endoleak: the achilles heel of endovascular abdominal aortic aneurysm exclusion--a case report.Endovascular exclusion of abdominal aortic aneurysms (EAAA) is an alternative treatment to open surgical repair in patients with suitable anatomy. The development of endoluminal vascular procedures has allowed aneurysm exclusion via remote arterial access techniques. Aneurysm exclusion by these methods revealed the phenomenon of endoleak, a unique complication characterized by an extravasation of blood into the aneurysm sac after stent-graft deployment. We present a patient treated for an endoleak following EAAA repair and review the endoleak classification system and management.- - - - - - - - - - ranking = 4keywords = chill (Clic here for more details about this article) |
8/34. Late sequelae of secondary Haglund's deformity after malunion of tongue type calcaneal fracture: report of two cases.We are reporting two cases of calcaneal fractures with posterior heel pain due to a prominent superior calcaneal tuberosity impinging on the achilles tendon after a tongue type fracture. Malunion of the tongue fracture fragment resulted in the symptomatic bony prominence, which we defined as the secondary Haglund's deformity. Both cases were treated with resection of the superior calcaneal tuberosity when symptoms continued after non-surgical treatment. Clinical results after operations were both satisfactory with complete pain relief.- - - - - - - - - - ranking = 1keywords = chill (Clic here for more details about this article) |
9/34. serratia spondylodiscitis after elective lumbar spine surgery: a report of two cases.STUDY DESIGN: This report describes two cases of acute spondylodiscitis, caused by, complicating two different conditions: microdiscectomy for herniated nucleus pulposus and decompressing laminotomy for spinal stenosis. OBJECTIVE: To describe a rare and life-threatening spinal infection and discuss its successful management. SUMMARY OF BACKGROUND DATA: To our knowledge, no published reports in the English language have described this potentially devastating infection as a complication of elective noninstrumented discectomy or decompressive laminotomy. methods: Two cases of a very early onset of acute spondylodiscitis, caused by, after minimally invasive lumbar spine surgeries are presented. The elapsed time between these two complications was 1 week. The clinical presentation was characteristically stormy in both cases. On postoperative day 2, the patients developed high fever with intense chills and concomitant acute low back pain rapidly increasing in severity. The overall clinical appearance was alarming. The patients were carefully investigated immediately and scrutinized for possible origin of the infection. Treatment consisted of prompt intravenous antibiotics and surgical debridement. RESULTS: The history and clinical manifestations of postoperative spondylodiscitis were corroborated with magnetic resonance imaging findings and bacteriologic and hematologic laboratory examination. Blood cultures revealed as the responsible pathogenic microorganism. The source of the pathogens was contaminated normal saline used for surgical lavage. Both patients were able to completely resume their previous occupations after aggressive surgical debridement/irrigation and 3 months of antibiotic treatment. CONCLUSIONS: may become a potential pathogen, causing severe spinal infection after elective surgery. For prompt diagnosis and effective treatment of this life-threatening infection, one should maintain high index of suspicion and should not procrastinate in initiating treatment, which should consist of appropriate intravenous antibiotics and surgical debridement.- - - - - - - - - - ranking = 1keywords = chill (Clic here for more details about this article) |
10/34. A case of 'circling seizures' and an intratumoral abscess.We describe a case of a 38-year-old woman who presented with 'circling' seizures and was found to have an intracranial mass with features consistent with a meningioma. Three weeks prior to her presentation she underwent an uncomplicated vaginal hysterectomy. However, after discharge to home she developed a 4-day history of fever, chills and night sweats that eventually resolved. She underwent surgical removal of her intracranial mass without difficulty but intra-operative pathology showed features of acute cerebritis at the margins of the tumor. Further sectioning of the mass revealed evidence of an intratumoral abscess. culture of the meningioma revealed heavy growth of bacteroides fragilis. The patient was treated with intravenous antibiotics, discharged home in excellent health and has had no recurrence of seizures. In our case report we will review the historical literature on the incidence and features of intratumoral abscess. Although it is considered a rare event, our case demonstrates both common and unique features about this occurrence and highlights an unusual chain of events in the natural history of the patient's meningioma and the way in which it became clinically apparent.- - - - - - - - - - ranking = 1keywords = chill (Clic here for more details about this article) |
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