• Title/Summary/Keyword: Surgical diagnosis

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Calcaneal Osteomyelitis Presenting as a Paradoxical Reaction during Treatment of Multidrug-Resistant Tuberculosis (다제내성 결핵의 치료 중 역설적 반응으로 나타난 종골 골수염)

  • Han, Yong Hyun;Lee, Chang Hwa;Bae, Min Joon;Hwang, Kihun
    • Clinical Pain
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    • v.18 no.2
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    • pp.102-106
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    • 2019
  • Tuberculosis in the foot progresses gradually; thus, diagnosis is usually delayed, and early treatment is rarely provided. If osteomyelitis occurs due to delayed diagnosis and treatment, surgical treatment should be considered. We report the case of a 46-year-old man with osteomyelitis of the calcaneus who was diagnosed with multidrug-resistant pulmonary tuberculosis and he was treated with anti-tuberculosis drugs. Bilateral adrenal masses, abscess of both testes and a small wound in the left plantar heel were observed. Both adrenal masses and abscess were regarded as paradoxical reaction of anti-tuberculosis treatment. After 1 month, he developed a pain in the left plantar heel that was compatible with calcaneal osteomyelitis in radiological features. He underwent right orchiectomy for right scrotal abscess aggravation and surgical treatment for left calcaneal osteomyelitis. Mycobacterium tuberculosis was confirmed by polymerase chain reaction. The patient was immobilized by cast for 8 weeks and the heel pain gradually improved.

Radiologic Imaging of Traumatic Bowel and Mesenteric Injuries: A Comprehensive Up-to-Date Review

  • Rathachai Kaewlai;Jitti Chatpuwaphat;Worapat Maitriwong;Sirote Wongwaisayawan;Cheong-Il Shin;Choong Wook Lee
    • Korean Journal of Radiology
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    • v.24 no.5
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    • pp.406-423
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    • 2023
  • Diagnosing bowel and mesenteric trauma poses a significant challenge to radiologists. Although these injuries are relatively rare, immediate laparotomy may be indicated when they occur. Delayed diagnosis and treatment are associated with increased morbidity and mortality; therefore, timely and accurate management is essential. Additionally, employing strategies to differentiate between major injuries requiring surgical intervention and minor injuries considered manageable via non-operative management is important. Bowel and mesenteric injuries are among the most frequently overlooked injuries on trauma abdominal computed tomography (CT), with up to 40% of confirmed surgical bowel and mesenteric injuries not reported prior to operative treatment. This high percentage of falsely negative preoperative diagnoses may be due to several factors, including the relative rarity of these injuries, subtle and non-specific appearances on CT, and limited awareness of the injuries among radiologists. To improve the awareness and diagnosis of bowel and mesenteric injuries, this article provides an overview of the injuries most often encountered, imaging evaluation, CT appearances, and diagnostic pearls and pitfalls. Enhanced diagnostic imaging awareness will improve the preoperative diagnostic yield, which will save time, money, and lives.

Bilateral Checkrein Deformities of the Hallux Following Intramuscular Sarcoidosis: A Case Report (근육 내 사르코이드증 후 발생한 양측 무지의 체크레인 변형: 증례 보고)

  • Min Gyu Kyung;Sangyun Yun;Dong Yeon Lee
    • Journal of Korean Foot and Ankle Society
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    • v.28 no.2
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    • pp.71-74
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    • 2024
  • This report presents a unique case of checkrein deformities in both halluces following isolated intramuscular sarcoidosis, a rare occurrence given the infrequent musculoskeletal involvement in sarcoidosis. Typically resulting from flexor hallucis longus tendon entrapment by scar tissue post-trauma, the checkrein deformity reported in this paper presented with unusual metatarsophalangeal joint flexion and interphalangeal joint extension during ankle dorsiflexion. A 49-year-old woman with a history of intramuscular sarcoidosis presented with a great toe deformity and discomfort while wearing shoes, leading to a diagnosis of dynamic deformity, possibly attributed to tendon tethering by sarcoidosis. Surgical treatments, including abductor hallucis muscle intratendinous tenotomy, flexor hallucis longus Z-plasty lengthening, Weil osteotomy, and Kirschner wire fixation, significantly improved the functional scores and patient discomfort. This report underscores the importance of recognizing dynamic deformities and the potential for rare diseases, such as sarcoidosis, to cause such conditions, highlighting the need for careful diagnosis and tailored surgical intervention for atypical checkrein deformities.

Role of endoscopy in gastroesophageal reflux disease

  • Daniel Martin Simadibrata;Elvira Lesmana;Ronnie Fass
    • Clinical Endoscopy
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    • v.56 no.6
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    • pp.681-692
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    • 2023
  • In general, gastroesophageal reflux disease (GERD) is diagnosed clinically based on typical symptoms and/or response to proton pump inhibitor treatment. Upper gastrointestinal endoscopy is reserved for patients presenting with alarm symptoms, such as dysphagia, odynophagia, significant weight loss, gastrointestinal bleeding, or anorexia; those who meet the criteria for Barrett's esophagus screening; those who report a lack or partial response to proton pump inhibitor treatment; and those with prior endoscopic or surgical anti-reflux interventions. Newer endoscopic techniques are primarily used to increase diagnostic yield and provide an alternative to medical or surgical treatment for GERD. The available endoscopic modalities for the diagnosis of GERD include conventional endoscopy with white-light imaging, high-resolution and high-magnification endoscopy, chromoendoscopy, image-enhanced endoscopy (narrow-band imaging, I- SCAN, flexible spectral imaging color enhancement, blue laser imaging, and linked color imaging), and confocal laser endomicroscopy. Endoscopic techniques for treating GERD include esophageal radiofrequency energy delivery/Stretta procedure, transoral incisionless fundoplication, and endoscopic full-thickness plication. Other novel techniques include anti-reflux mucosectomy, peroral endoscopic cardiac constriction, endoscopic submucosal dissection, and endoscopic band ligation. Currently, many of the new endoscopic techniques are not widely available, and their use is limited to centers of excellence.

Concomitant Avulsion Injury of the Subclavian Vessels and the Main Bronchus Caused by Blunt Trauma

  • Noh, Dongsub;Lee, Chan-kyu;Hwang, Jung Joo;Cho, Hyun Min
    • Journal of Chest Surgery
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    • v.51 no.2
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    • pp.153-155
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    • 2018
  • Concomitant rupture of the subclavian vessels and the left main bronchus caused by blunt trauma is a serious condition. Moreover, the diagnosis of a tracheobronchial injury with rupture of the subclavian vessels can be difficult. This report describes the case of a 33-year-old man who suffered from blunt trauma that resulted in the rupture of the left subclavian artery and vein. The patient underwent an operation for vascular control. O n postoperative day 3, the left main bronchus was found to be transected on a computed tomography scan and bronchoscopy. The transected bronchus was anastomosed in an end-to-end fashion. He recovered without any notable problems. Although the bronchial injury was not detected early, this case of concomitant rupture of the great vessels and the airway was successfully treated after applying extracorporeal membrane oxygenation.

Management of Carotid Body Paraganglioma: Review of the literature with report of three cases (경동맥체 부신경절종)

  • Park Cheong-Soo;Kim Jun-Sik;Hong Won-Pyo;Choi Eun-Chang;Kim Dong-Ik
    • Korean Journal of Head & Neck Oncology
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    • v.5 no.1
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    • pp.5-13
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    • 1989
  • Carotid body paraganglioma is uncommon, with appoximately 900 reports of it in the world literature, and with only 7 documented cases in the Korean literature. The classic carotid body paraganglioma develops in the bifurcation of common carotid artery and involves both the internal and external carotid arteries at it expands. The diagnosis may almost always be established preoperatively by selective angiography which shows a widening of the carotid bifurcation with a well defined vascular mass. Differential consideration of a single, lateral cervical mass in this location include branchial cleft cyst, neurogenic tumor, metastatic thyroid cancer, carotid body aneurysm and salivary gland tumor. Surgical therapy is the preferred method of treatment as these tumors are regarded as radioresistant. Because of their high vascularity and anatomical location, surgical removal of these tumors reguires a considerable degree of caution and a high degree of surgical expertise. With improved diagnostic and surgical technique, the morbidity and mortality has been reduced lately. This report details the management of 3 patients with carotid body paraganglioma who underwent safe resection by subadventitial dissection or using an internal vascular shunt.

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Surgical Treatment of Acute Traumatic Peroneal Tendon Dislocation (급성 외상성 비골근 탈구의 수술적 치료)

  • Choi, Eun-Seok;Park, Hong-Ki
    • Journal of Korean Foot and Ankle Society
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    • v.9 no.2
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    • pp.179-183
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    • 2005
  • Purpose: Acute traumatic peroneal tendon dislocation is relatively rare disease and their methods of treatment is controversial, that we want to assess the characters and outcomes of 8 patients with early surgical treatments. Materials and Methods: We evaluated the results of 8 patients who can follow up more than 28 months using sex, age, side, injury sports, concomitant injuries, Eckert and Davis classifications, anatomic variants, results and complications. Results: All of 8 patients was male, average age was 27, Right side was dominant (5/8), causal sports was variable. Concomitant injuries were distal tibiofibular ligament syndesmosis injury, Peroneus longus injury, lateral collateral ligament injury. On behalf of Eckert and Davis classifications 5 patients were Grade 1 and other 3 patients were Grade 2. 1 case of low lying peroneus brevis belly was found as an anatomic variants. 6 of patients shown excellent results, 2 patients were good. Post operative complications were discomfort of operation site and mild limited dorsiflexion on ankle joint. Conclusion: Careful history and physical exam is important for diagnosis. And surgical treatments can expect good results.

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Surgical Treatment of Pulmonary Aspergillosis (폐 Aspergillosis의 외과적 치료)

  • Go, Yeong-Sang;Kim, Min-Ho;Kim, Gong-Su
    • Journal of Chest Surgery
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    • v.26 no.9
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    • pp.696-700
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    • 1993
  • Pulmonary aspergillosis is relatively rare disease, most commonly presenting pre-existing cavitary disease. This investigation is designed to illustrate the clinical features, preoperative diagnosis and surgical role in the management of this disease. In retrospective review of opeative cases since Jan. 1988, total 16 cases were analysis. Peak incidence of age lies in the 3rd & 5th decade[81.3%].The common presenting symptoms were hemoptysis & blood tinged sputum[90.9%] & all cases had a history of treatment with antituberculous drugs, but the tuberculosis was revealed in only 3 cases in the pathologic studies on specimen after resection. The locations of lesion were upper lobes in 13 cases, lower lobe in 2 cases, and left whole lobe in 1 case. The operative procedures for treatment of aspergillosis were performed. The lobectomy was performed in 7 cases, lobectomy & segmentectomy in 2 cases, lobectomy & decortication in 2 cases, segmentectomy in 3 cases, bilobectomy & segmentectomy in 1 case and pneumonectomy in 1 case. There was one death due to respiratory insufficiency 21 days later,postoperatively, and empyemas & residual space problems were developed in 2 & 3 cases,respectively. The empyemas were treated with open thoracostomy and the dead spaces was filled with granulation tissues within 6 months. During follow up, there was no recurrence. In conclusion, surgical resection is the treatment of choice for symptomatic aspergillosis and needed in asymptomatic patient to prevent possible fatal sequelae in the future.

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Aortopulmonary Fistula after Surgical Intervention of Acute Aortic Dissection (급성 대동맥류 수술후 원위부에 발생한 Aortopulmonary Fistula 치험 1례)

  • Cho, Gwang-Jo;No, Jae-Ook;Woo, Jong-Soo
    • Journal of Chest Surgery
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    • v.31 no.2
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    • pp.178-181
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    • 1998
  • Among the late postoperative complications of the acute dissection of aorta, the fistula between dilated distal aorta and pulmonary parenchym is so rare that only few case have been reported sporadically. Although the aortopulmonary fistula is one of a fatal condition that needs prompt surgical intervention, with an appropriate management it is well controllable condition. Early diagnosis and urgent surgical intervention is the only way to prevent catastrophic hemorrhage. We experienced a surgical management of aortoplumonary fistula which occurred between upper lobe of the left lung and distal aortic dilatation of previous aortic bypass graft which was performed for Debakey type I acute aortic dissection.

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Parotid Gland Tumours in Turkish Population: Analysis of 165 Patients

  • Derin, Serhan;Erdogan, Selvet;Almac, Ahmet;Ulubil, Arif;Iseri, Mete;Aydin, Omer;Keskin, I Gurkan;Oran, Abdulkadir;Kuru, Fatma Demir
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.8
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    • pp.3539-3542
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    • 2015
  • Background: Retrospective data on 165 patients who presented with a parotid mass and underwent surgery in our clinics during 2000-2009 were examined. The obtained data (demographic data, surgical procedures, histopathological diagnoses) were compared to similar studies to make contributions to the literature. Materials and Methods: Patients were classified according to their histopathological diagnosis. Surgical procedures and patient follow-up were clarified. The results are presented as means and standard deviations. Results: Of the 165 masses, 134 (81.3%) were benign and 31 (18.7%) were malignant. Pleomorphic adenoma was the most common benign tumour (79 patients, 59%). Lymphoma and adenoid cystic carcinoma were equally common and were the most common malignant parotid gland tumours (both 6 patients, 19.3%). The most frequent surgical procedure was superficial parotidectomy (92 patients, 55.7%), and the most commonly encountered surgical complication was facial paralysis (12 patients, 7.2%). Conclusions: Our data are generally in line with the literature but lymphoma was more common than in most previous reports. Although the number of cases was low, the high incidence of parotid gland lymphoma was remarkable.