Cases reported "Wounds, Penetrating"

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1/48. Perforation of the right ventricular free wall by an active fixation transvenous cardioverter defibrillator lead.

    A 58-year-old patient with dilated cardiomyopathy underwent implantable cardioverter defibrillator (ICD) implantation. The postoperative course was complicated by perforation of the right ventricular free wall by the active fixation transvenous ICD lead. The type of ICD lead and the type of organic heart disease are apparently important risk factors for perforation.
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2/48. Isolation of pantoea agglomerans in two cases of septic monoarthritis after plant thorn and wood sliver injuries.

    arthritis after plant injury is often apparently aseptic. We report two cases due to pantoea agglomerans. In one case, the bacterium was isolated only from the pediatric blood culture media, BACTEC Peds Plus, monitored in BACTEC 9240, and not from the other media inoculated with the joint fluid. This procedure could help improve the diagnosis of septic arthritis.
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3/48. Sea urchin puncture resulting in PIP joint synovial arthritis: case report and MRI study.

    Of the 600 species of sea urchins, approximately 80 may be venomous to humans. The long spined or black sea urchin, Diadema setosum may cause damage by the breaking off of its brittle spines after they penetrate the skin. synovitis followed by arthritis may be an unusual but apparently not a rare sequel to such injury, when implantation occurs near a joint. In this case report, osseous changes were not seen by plain x-rays. magnetic resonance imaging (MRI) was used to expose the more salient features of both soft tissue and bone changes of black sea urchin puncture injury 30 months after penetration. In all likelihood, this type of injury may be more common than the existing literature at present suggests. It is believed to be the first reported case in this part of the world as well as the first MRI study describing this type of joint pathology. Local and systemic reactions to puncture injuries from sea urchin spines have been described previously. These may range from mild, local irritation lasting a few days to granuloma formation, infection and on occasions systemic illness. The sea urchin spines are composed of calcium carbonate with proteinaceous covering. The covering tends to cause immune reactions of variable presentation. There are only a handful of reported cases with sea urchin stings on record, none of them from the Red Sea. However, this condition is probably more common than is thought and can present difficulty in diagnosis. In this case report, the inflammation responded well to heat treatment, mobilization and manipulation of the joint in its post acute and chronic stages. As some subtle changes in soft tissues and the changes in bone were not seen either on plain x-rays or ultrasound scan, gadolinium-enhanced MRI was used to unveil the marked changes in the joint.
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4/48. Laparoscopic nephrectomy for autotransplantation.

    Proximal ureteral injuries often require extensive reconstruction to repair. Management options include nephrectomy, ileal ureter interposition, extensive spiral bladder flaps, or autotransplantation. We report a patient who sustained a proximal ureteral avulsion and underwent a less invasive repair by way of a laparoscopic nephrectomy and subsequent autotransplantation.
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5/48. Left internal mammary artery graft perforation repair using polytetrafluoroethylene-covered stents.

    The increase in the use of the left internal mammary artery (LIMA) as graft of choice to the left anterior descending coronary artery for conventional and minimally invasive coronary artery bypass surgery has led to an increased incidence of LIMA pathologic lesions early after surgery. The lesion, commonly located in the body of the LIMA graft, is usually caused by mechanical injury during harvesting of the vessel. In this context, percutaneous intervention with stent implantation can be complicated by vessel rupture, which usually requires emergency surgical repair. We describe two cases of stent implantation in newly placed LIMA grafts complicated by vessel rupture, which were successfully repaired using polytetrafluoroethylene-covered stents.
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6/48. Cactus thorn arthritis: case report and review of the literature.

    synovitis secondary to penetrating plant thorn injuries is an infrequently reported event. Despite its wide geographic distribution, thorns from the prickly pear cactus (Optunia ficusindica) are a rare source of this type of inflammatory arthritis. We hereby present an unusual case of an individual who developed an acute monoarthritis of the knee shortly after sustaining a penetrating cactus thorn injury. The clinical and pathophysiologic features of cactus thorn arthritis are reviewed and the unusual features present in this individual are highlighted. Treatment options, with an emphasis on rapid diagnosis and therapeutic interventions, are discussed. Increased physician awareness and recognition of this unusual but not rare entity are essential as a means of improving clinical outcome.
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7/48. Laparoscopic ureteral reimplantation for ureteral lesion secondary to transvaginal ultrasonography for oocyte retrieval.

    Transvaginal ultrasound-guided follicular puncture for oocyte retrieval is a highly efficient and minimally invasive method for assisted reproductive techniques. Complications related to this procedure are rare. We report the case of a ureteral stricture secondary to ultrasound-guided follicular puncture for oocyte retrieval that was corrected by a laparoscopic approach. This approach can minimize postoperative pain, the length of hospitalization, and the period of convalescence and should be considered a minimally invasive option in the management of this rare complication of oocyte retrieval.
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8/48. Right atrial perforation secondary to implantable cardioverter defibrillator insertion.

    Implantable cardioverter defibrillator (ICD) placements can be associated with serious complications. This paper reports a patient in whom percutaneous placement of an ICD resulted in a hemopneumothorax. This was due to an active fixation lead that perforated the right atrial wall and injured the adjacent lung parenchyma. The hemothorax was drained thoracoscopically, and the atrial injury was covered with fibrin glue.
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ranking = 2.5
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9/48. Laparoscopic nephrectomy and autotransplantation for severe iatrogenic ureteral injuries.

    OBJECTIVES: To evaluate the efficacy of laparoscopic nephrectomy with autotransplantation in cases of severe proximal ureteral damage. Many patients with complex proximal ureteral injuries have good functional renal parenchyma and wish to salvage their kidney. Autotransplantation is a viable alternative to nephrectomy in these frustrating situations. methods: Two patients, aged 32 and 36 years, underwent laparoscopic nephrectomy and autotransplantation for treatment of severe proximal ureteral injuries. The injuries included a ureteropelvic junction avulsion and a proximal ureteral avulsion, respectively. Both patients had good functional renal parenchyma. A transperitoneal laparoscopic approach was used, and the kidney was removed by way of a Gibson incision. RESULTS: The procedures were successful, with immediate return of renal function in both patients. A pyeloureterostomy to the native distal ipsilateral ureter was required in one and a direct ureterovesical anastomosis was performed in the other. In the 2 patients, the warm ischemia time was 4.5 and 4 minutes, the transplant operative time 175 and 150 minutes, and the estimated blood loss 150 and 75 mL, respectively. No intraoperative complications occurred. At follow-up, the kidneys were functional, and the patients had returned to their normal activity. CONCLUSIONS: Laparoscopic nephrectomy with autotransplantation is an excellent alternative to nephrectomy or bowel interposition in patients with proximal ureteral loss, irrespective of the contralateral renal function. This procedure is associated with acceptable morbidity and preserves the renal function. This approach is desirable in those patients who have had complications from other surgical procedures and are otherwise facing the loss of a normally functioning kidney.
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10/48. Difficult airway management of a child impaled through the neck.

    We report the difficult airway management of a child impaled through the neck by a wooden plant support. The various options are discussed and the involvement of experienced personnel together with a clear preformulated plan of action is stressed.
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