Tonsillectomy complicated by jugular vein thrombosis and pulmonary embolism

Abstract

To report an unusual and life-threatening complication of routine tonsillectomy, and review the relevant medical literature. A Medline database search was performed to identify reports of thromboembolic complications of tonsillectomy. Thromboembolic complications following tonsillectomy are rare, and no previously reported cases of post-operative jugular vein thrombosis and pulmonary embolism are described. We report a case of an 18-year old previously healthy woman who presented with a sub-massive pulmonary embolus following tonsillectomy. It is believed that the embolus originated from a post-operative jugular vein thrombosis. This is the first report of jugular vein thrombosis and pulmonary embolism following tonsillectomy. Knowledge of this potentially life-threatening complication is vital for otolaryngologists routinely performing this procedure.

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Left ventricular assist device for ventricular recovery of anabolic steroid-induced cardiomyopathy

Abstract

Herein we report a case of a 26-year-old gentleman with severe cardiomyopathy likely secondary to anabolic-androgenic steroid (AAS) abuse who received a HeartMate II (Abbott Laboratories, Abbott Park, IL) left ventricular assist device (LVAD) for rapidly deteriorating heart failure with hemodynamic compromise. Following 18 months on LVAD support, excellent recovery of ventricular function was achieved to allow for LVAD discontinuation. Given that active substance abuse is a contraindication to heart transplantation, few options remain for patients with AAS induced heart failure. Our case demonstrates that LVAD therapy can be an important intervention for bridging to candidacy, recovery or destination therapy.

https://ift.tt/2P88vI5

Anterior and posterior cruciate ligament agenesis

Abstract

Congenital absence of the cruciate ligament is a rare condition with a prevalence of 0.017 per 1000 live births. This study reports a case of congenital absence of the anterior and posterior cruciate ligaments of the left knee associated to a type 1A fibular hemimelia, and a contribution to the existing hypotheses on knee ligaments development. According to medical literature the anomaly begins to develop around the seventh–eighth week of pregnancy. Patients with a cruciate ligament agenesis will often need a knee replacement at one point in their lives.

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Middle colic vein draining to splenic vein: a rare anatomic variation encountered during a right hemicolectomy

Abstract

Right or subtotal colectomy either open or laparoscopic may be a challenging operation owing to technical difficulties. One of these, is to identify a safe and adequate dissection plane, ligating and dissecting lymph nodes around middle colic vessels. The purpose of this study was to depict a rare anatomic variation of middle colic vein (MCV) draining to splenic vein. We report the case of a 55-year-old male patient, who was subjected to a right hemicolectomy for an adenocarcinoma in the ascending colon. During dissecting the transverse mesocolon from the greater omentum, for complete mesocolic excision (CME), we encountered that the MCV drained in the splenic vein. With respect of this rare anatomic variability, CME was completed without hemorrhage. Our aim is to depict that deep knowledge of MCV anatomy and its variations is of paramount importance to achieve CME and to avoid dangerous or massive bleeding.

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Toward a sensible single antigen bead cut-off based on kidney graft survival

Background There is no consensus in the literature on the interpretation of single antigen bead (SAB) positive for a specific HLA antibody. Methods To inform the debate, we studied the relationship between various SAB positivity algorithms and the impact of resulting donor-specific HLA antibody (DSA) positivity on long-term kidney graft survival in 3237 deceased-donor transplants. Results First, we showed that the interassay variability can be greatly reduced when working with signal-to-background ratios instead of absolute MFIs. Next, we determined pretransplant DSA using various MFI cut-offs, signal-to-background ratios (STBR) and combinations thereof. The impact of the various cut-offs was studied by comparing the graft survival between the DSA-positive and DSA-negative groups. We did not observe a strong impact of various cut-off levels on 10-year graft survival. A stronger relationship between the cut-off level and 1-year graft survival for DSA-positive transplants was found when using STBR, most pronounced for the bead of the same HLA-locus with lowest MFI taken as background. Conclusions With respect to pretransplant risk stratification, we propose a SBTR-6 (using the bead of the same HLA-locus with lowest MFI as background) cut-off of 15 combined with an MFI cut-off of 500, resulting in 8% and 21% lower 1- and 10-years graft survival, respectively, for 8% DSA positive transplants. Corresponding author: E-mail address: H.G.Otten@umcutrecht.nl. Corresponding author permanent address: Laboratory of Translational Immunology, University Medical Center Utrecht, F.03.821, P.O. Box 85500, 3508 GA Utrecht, The Netherlands. Tel.: +31 88 75 57680 Disclosure The authors of this manuscript have no conflicts of interest to disclose. Authorship Participated in research design: BW, EK, AD, LP, HO Participated in writing of the paper: BW, EK, IJ, WA, LH, AvZ, MV, MLB, BH, AL, LB, CR, CV, ItB, AH, SH, DR, FC, HO Participated in the performance of the research: BW, EK, AD, LP Contributed new reagents or analytic tools: BW, EK, IJ, WA, AvdM, LH, MCB, ES, CH, FvR, AvZ, MV, MLB, AD, LP, MS, JS, BH, AL, LB, CR, MT, CV, LW, EvD, MG, MC, FvI, AN, NL, WS, KvdP, NvdW, ItB, FB, AH, PvdB, JdF, MB, SH, DR, FC, HO Participated in data analysis: BW, EK, HO Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Comparison of long-pulsed Nd: YAG laser with cryotherapy in treatment of acral warts

Abstract

Acral warts are considered as prevalent reasons for dermatologic consultations and remain an important continuing challenge until now because there is no consensus about optimal therapeutic modality. This study investigated the efficacy of long-pulsed Nd: YAG laser therapy and cryotherapy in treatment of acral warts. Patients who underwent treatment with cryotherapy or long-pulsed Nd: YAG laser therapy for symmetrical and bilateral warts on the extremities (hand and foot) that is confirmed by an expert dermatologist from May 2016 until March 2018 were assessed for enrollment in our study. Laser and cryotherapy sessions were applied every 2 weeks for a maximum of six sessions. Patients followed up and evaluated 3 months after the last treatment. Data were analyzed by SPSS (v.21. IBM Inc. IL). The P value less than 0.05 was considered significant. From 60 enrolled patients, 134 lesions were treated using cryotherapy and 114 other lesions treated with laser beam. Thirty-four males (average age 26.85 ± 7.528 years) and 26 females (average age 26.73 ± 5.640 years) participated. Finally, it was a significant reduction in both lesion width (P = 0.000) and length (P = 0.000) after the sessions of cryotherapy. The width and length of lesions is reduced significantly after each session of laser therapy similarly (P = 0.000). Cryotherapy and long-pulsed Nd: YAG laser are effective on the reduction of both width and length of lesions. Clinically, the methods are not different in their ultimate effects.

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The Metabolic Syndrome and Health Behaviors in School Children Aged 13–16 Years in Ubon Ratchathani: UMeSIA Project

Metabolic Syndrome and Related Disorders, Ahead of Print.


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