Hyponatremia is an electrolyte disturbance presenting the potential for morbidity and mortality in patients with neurological complications secondary to brain injury, trauma-related or not. In such patients, hyponatremia is frequently accompanied by the syn- drome of inappropriate secretion of antidiuretic hormone (SIADH). However, in rare cases, hyponatremia can be accompanied by a controversial pathology known as cerebral salt-wasting syndrome (CSWS), which is generally associated with subarachnoid hemorrhage in adults. In this report, we describe the clinical evolution and treatment of a 47-month-old male patient with ventriculo-peritoneal shunt resulting from congenital hydro- cephalus. The patient had developed severe hyponatremia (121 mEq/l) accompanied by signs of dehydration, intracranial hypertension and hypouricemia, as well as elevated urinary sodium and osmolality. In addition to intravenous fluid replacement and infusion of 3% saline, high levels of sodium replacement (up to 25 mEq/kg/day), together with fluorocortisone administration, were required in order to maintain appropriate serum levels of sodium. The diagnosis of CSWS was confirmed on the basis of the high serum level of atrial natriuretic peptide. The patient showed progressive improvement and resolution of the condition after confirmation of intracranial hypertension and clearance of the ventriculo-peritoneal shunt obstruction. We emphasize the importance of recognizing CSWS in patients with hyponatremia accompanied by central nervous system disturbances, as well as the differential diagnosis with SSIADH.
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Neuralgia should first be managed conservatively, with attempts at local anesthetic injection in the affected groin. When local anesthesia is injected along the known course of a nerve, this modality may serve as both a diagnostic and therapeutic maneuver. In some cases, temporary control of the chronic pain with local anesthesia may reduce or altogether eliminate the sequelae of chronic groin pain. When this conservative approach does not succeed, groin re-exploration can be performed to ligate or excise affected nerve branches. This is clearly not the preferred first option, since the groin wound has abundant scar and previously undamaged nerve structures may be placed at additional risk. Occasionally, patients will present with postoperative neuralgia that does not match the distribution of any known inguinal nerve. Groin re-exploration should be avoided in this case since it is unlikely to ameliorate the pain and may damage additional structures.
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The great majority of the cases (70%) did not experience a systemic or another ocular illness preceding the intraocular inflammatory manifestations (Table 2). Antimicrobial treat- ment was efficient in all cases with the exception of the case with neuroretinitis complicated by anterior ischemic optic neuropathy and tubulointerstitial nephritis (case 1). The main antibiotics administered in our cases were rifampicin, doxy- cycline and azithromycin. Ciprofloxacin and ceftriaxone were also used in cases with treatment failure, allergy and early side-effects. Table 3 presents the visual acuities before and after treatment, the antibiotics used to eradicate the microor- ganism, and the complications seen during follow-up.
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Bank at the University of Pittsburgh Medical Center, with the tissue bank rendering the honest broker ser- vices. All specimens were originally obtained with informed consent. Cores from the appropriate case spe- cific paraffin-embedded tissue blocks were assembled into TMAs as described in a previous protocol. The final TMAs consisted of 11 cases of NDP, 37 cases of NAC, 15 cases of BPH, 35 cases of isolated HGPIN (no accompanying cancer diagnosed), 103 cases of PCa, and 36 cases of Mets. No specimens of HGPIN included in this study were diagnosed at the time as containing PCa. All cases were initially prepared so that each one would be represented at least in triplicate. Due to variations in TMA processing, however, some cases were only able to be represented in duplicate. This occurred for three cases of the HGPIN, three cases of the Mets, three cases of the NAC, two cases of the BPH, and eight cases of the PCa. In such instances, these cases were still scored and included as a part of the final analysis.
Among the 11 patients admitted to the emergency department, we deplore 9 inappropriate laparotomies for erroneous diagnoses, followed by 7 incomplete cures of blind hemivagina and 2 unworthy hysterectomies, with 1 concerning the normal contralateral hemiuterus. When managing acute abdomen in an emergency de- partment at this age, appendicitis and adnexal torsion are, indeed, the main causes evoked and diagnosed. Regarding our results, it seems that systematic abdomi- nal and gynecologic examinations completed by radio- logic evaluation with a special focus on renal region should be a part of the management of acute pains in peripubertal girls. Concerning radiologic evaluation, even if statistics in our series are not in favor of an ultrasound scan in an emergency, it allows, if it is spe- cifically asked for by the radiologist, a simple examina- tion of both the lumbar renal region and pelvic region, for arguments for the diagnosis even if hematocolpos of a small size are not easy to display by simple pelvic ultrasound scan. In these cases, and, moreover, if ultra- sound reveals an absent kidney, MRI is the accurate examination for diagnosis, 25 and we must avoid unnec-
Case Report: This is a retrospective case series of patients ( January 2011 to October 2015) in whom cerclage wiring was used as an adjunct to osteosynthesis of primary and periprosthetic fractures of femur. Patient demographics, number of wires used, implant used for osteosynthesis, number of days to union, union rate and complications were recorded and analyzed. The patients were followed up for a minimum of 6 months. 11 patients (7 female and 4 male) with a mean age of 67.10 ± 21.64 years were studied. The number of patients with intertrochanteric, subtrochanteric, diaphyseal, and periprosthetic fractures of the femur was two, five, one, and three, respectively. Internal fixation was done with plates in six and cephalomedullary nails in five patients. Mean total number of wires used was 2.10 ± 0.70. Mean duration of follow-up was 15.91 ± 10.03 months. Union was achieved in all cases with a mean duration of 86.63 ± 22.44 days. There were no complications in our study.
According to Shukla 1988 the incidence of abdominal tuberculosis is high in India. But recent literature indicates that the disease is also prevalent all over the world (Chen ws Taiwan 1992). Shafer RW New York reports those 47 cases in 1983 and 113 cases in 1988. In Government Rajaji Hospital, Madurai, Tamilnadu over 24 months of study, 60 cases are reported in various surgical units and treated as inpatients. In United Kingdom the frequency has recently increased due to arrival of Asian immigrants (VK Kapoor and L.K. Sharma 1988).
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ance of the interhypothalamic adhesion is quite characteristic, always visible in the sagittal plane as an additional small ovoid structure between the fornices and lamina terminalis, centered near the level of the midbrain cranial margin (Fig 6). Anatomically, this location corre- sponds to the anterior and tuberalis re- gions of the periventricular hypothala- mus. Although there are no known cases with histologic correlation, interhypo- thalamic adhesion may represent a cho- ristoma or a focal area of failed hypotha- lamic separation.
11 This study examined dengue cases using time series approach. Time series is a set of historical data arranged sequentially according to time. Past studies showed that time series forecasting has been used to analyse dengue cases in many affected regions [8-10]. In this study, two time series model namely Double Exponential Smoothing and Holt Winters’ method are fitted to the historical data. The performance of these two models are evaluated and compared, and subsequently, the best model is used to make forecasting. Seven years (2010 – 2016) of dengue data in the form of weekly data are obtained from the official Malaysia i-Dengue Data Portal, Ministry of Health Malaysia. Specifically, weekly data from week 8, 2010 to week 46, 2016 (351 weeks) are analysed.
gadolinium enhancement is a variegated internal and nodular peripheral appearance. In addition, some groups reported that AFH shows cystic areas, pseudocapsules, hemosiderin, and fluid–fluid levels on MRI [7–13]. Martinez et al. reported the double rim sign and invasive pattern as novel MRI findings for AFH . The double rim sign refers to the presence of a rim of high signal in- tensity (RHS) and an adjacent rim of low signal intensity (RLS), which can be observed on both T2-weighted and post-contrast images. The invasive pattern presents as ir- regular infiltrating peritumoral strings of high signal in- tensity on T2-weighted and post-contrast images. We believe that these signs were present in the pseudocap- sule, peritumoral edema, and enhancement of our series.
This study involved a series of 127 patients presented with nasal blockage and subsequently undergone septoplasty and/or Septorhinoplasty. Archives related to all patients were retrieved from ENT department, King Khalid hospital in Hail, Northern Saudi Arabia. Only adults over 18 years of age were contained within the study. Patients’ medical records were examined, and patients with a history of cranial and facial trauma or bone deformity (except DNS), and pa- tients with a mass in the nasal cavity were excluded from the study. A number of nasal obstruction clinical presentations were recorded including nasal blockage. Demographical characteristics including; age, gender and residence were also recorded.
This case series describes our experience (albeit limited) with the combined use of three previously reported techniques - aimed at three different aspects of breast reduction: skin reduction, shaping, and NAC- transposing flap. Skin reduction using the classic “inverted T” approach  was ideal for our group of patients, as it closely followed the shape molded by the mobilized deep flap. Furthermore, we left 1 cm of de-epithelia- lized skin along the cut skin edge of the entire inverted T pattern, which limited the risk of skin dehiscence due to moderate suture stretch after compression of the “Ribeiro-Foustanos” inferior flap from behind.
Odontoma is a hamartomatous lesion of odontogenic origin involving both epithelial and mesenchymal tissues. Although it is not an uncommon lesion yet in certain conditions it can lead to complications if left untreated. This is a retrospective review of 30 diag- nosed odontoma cases from the archives of Depart- ment of Oral & Maxillofacial Surgery, Government Dental College & Hospital, Nagpur, India. Out of these 30 cases, 17 were diagnosed as complex odon- toma and 13 cases as compound odontoma. Two of these unusual cases have been described which em- phasize the importance of early & appropriate treat- ment to prevent further morbidity.
Two patients (patient 1 and 5) had received neoadjuvant therapy (chemotherapy with etoposide, vincristine, adri- amycin, ifosfamide and isolated limb perfusion with mel- phalan and TNF-alpha) prior to surgery because of a large tumor mass adjacent to crucial structures, leaving 70% and 30% of the tumor mass viable in the resection speci- men. These two patients were alive with no evidence of disease at follow-up. Incisional biopsy was performed in six cases; fine needle biopsy in one case. Four patients were primarily resected with microscopically positive margins at other institutions and referred to BG-Univer- sity Hospital Bergmannsheil for curative surgery after his- tological diagnosis. In all but one case (patient 8), who died of disseminated disease subsequently, free surgical margins were achieved by definite surgery.
SUMMARY: RCVS is a clinical condition of recurrent severe headaches that may be associated with ischemic or hemorrhagic stroke and that is defined by the presence of segmental vasoconstriction in multiple cerebral arteries. The angiographic appearance resembles vasculitis, except that the abnor- malities resolve during the course of several months. Because the treatment of RCVS differs from that for vasculitis, radiologists must understand the clinical and radiologic features so as to better guide imaging algorithms and facilitate diagnosis. We present a series of 6 cases of RCVS that highlight the imaging features across multiple modalities.
principles of Ilizarov was applied using a free hand tech- nique in all cases. The wires were applied in the safe zones in each segment. Intra operative correction of de- formity was attempted and if not possible, hinges were applied at the appropriate level to facilitate gradual post operative correction. Corticotomy was done in all cases. The pin sites were dressed with povidone iodine soaked gauze pieces and a rubber stopper was applied. The cor- ticotomy, fibulectomy and debridement wounds were dressed using sterile gauze.
It is interesting that all cases were in lower-middle or low- er classes in term of income. This might suggest us of problems related to inappropriate self-care, for example, malnutrition. Therefore, we also reviewed the patients' ge- ographic distribution. This is because some regions have unique culture and are at risk of some nutritional deficien- cies. However, we could not demonstrate any predilection to a particular region because the distribution of enceph- alocele patients was almost identical to one of general pa- tients admitted to the hospital except a slight increase toward encephalocele patients in the northern region. However, the number of cases is insufficient to achieve a strong conclusion.
Background: Despite a re-increase in the incidence of tuberculosis, extra- nodal location on head and neck remains rare. Clinical symptomatology is non-specific and even data from paraclinical explorations often pose the problem of differential diagnosis with tumor pathology. Methods: We report a series of 29 cases of extranodal tuberculosis collected over a period of 32 years [1986-2018] in ENT department of the military hospital of Tunis. Re- sults: Rhinosinusopharyngeal involvement was predominant (45%) followed by glandular involvement (14%). Diagnosis was histopathological in most cases. Concomitant pulmonary tuberculosis was detected in two cases and spinal lumbar in one case. Treatment was medical in all cases. Conclusion: Clinical presentation of extranodal tuberculosis is various and non-specific. Neoplastic pathology is the main differential diagnosis. However, diagnosis should be systematically raised in endemic countries. Treatment is essentially medical.
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could be encountered in the first surgery without prior chemotherapy. At last, the management of these two terms is quite different. An optimal cytoreduction is rec- ommended for GTS to avoid complications such as bowel obstruction and perforation . Because the le- sions in GP are extensive, complete resection of GP is usually difficult. Luckily residual peritoneal disease in GP can be asymptomatic and quiescent over a long period . Thus, residual implants can be ignored and the therapy is mainly depended on the stage and grade of the primary ovarian teratoma. Seven cases in our series presented macroscopic residual disease at postoperatively, and all of these patients remained alive and asymptomatic during the median follow-up of 60.5 months.
Oral rehabilitation is more difficult in children with ED which requires a multidisciplinary approach (17). Prosthetic rehabilitation of patients with ED can include over denture, complete or partial moving prosthesis and fixed prosthesis supported by teeth or implants. In growth and development stage, using moving prosthesis is recommended over implant or fixed prosthesis. In patients with ED below18 years of age there are some ideas which support application of implants. In addition, at the age of 6, transverse growth of front section of mandible is accepted as stable. Transverse growth in maxilla can continue up to 20 years of age; thus, it is recommended that implant application should be postponed until growth and development period is completed. Implant can be opted for in planning of treatment of ED patients. However, taking skeletal and dental development into consideration, implant can be applied by choosing a proper site (10). In our cases, as skeletal and dental development continued, fixed prosthetic and implant treatment was not applied.
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