Decompressive craniectomy is employed as treatment for traumatic brain swelling in selected patients. We discussed the effect of temporal muscle resection in patients with intractable intracranial hypertension and temporal muscle swelling after craniectomy.Records of 280 craniectomies performed on 258 patients who were admitted with severe head injury were retrospectively reviewed. Eight patients developed intractable increased intracranial pressure with temporal muscle swelling within 24 h after craniectomy and were treated by muscle resection.The initial Glasgow Coma Scale score was 7 ± 1. The mean intracranial pressure was 41.7 ± 8.59 mmHg before muscle resection and 14.81 ± 8.07 mmHg immediately after surgery. Five patients had skull fracture and epidural hematoma at the craniectomy site. The mean intensive care unit stay was 11.25 ± 5.99 days. Glasgow Outcome Scale-Extended scoring performed during the 12-month follow-up visit showed that 6 patients (75%) had a favorable outcome.Our study findings indicate that a direct impact on the temporal region during trauma may lead to subsequent temporal muscle swelling. Under certain circumstances, muscle resection can effectively control intracranial pressure.
Although numerous reconstruction protocols have been reported for lower leg trauma, those for distal leg trauma remain few. We present the case of a woman with an implant exposure wound, who was successfully treated through fat grafting, without major flap surgery.An 83-year-old woman with an exposed implant in lower extremity received reconstruction surgery once and the surgery failed. She refused additional major surgery and negative pressure wound therapy.The diagnosis of a tibia and fibula shaft open fracture (type IIIA) complicated with an exposed implant was made.The procedure was performed by deploying purified and emulsified fat with a Micro-Autologous Fat Transplantation gun. The required lipoaspirate amount was grossly estimated using a standard formula: 0.5 cc of a lipoaspirate per square centimeter of wound. We prepared the lipoaspirate simply through centrifugation followed by physical emulsification. The endpoint of fat grafting was when lipoaspirate began to flow out of the wound. The initial dressing after the procedure included the topical usage of biomycin ointment with AQUACEL Foam (ConvaTec Inc., NC, USA) coverage, which was later changed to INTRASITE gel (Smith & Nephew, London, UK) with a gauze dressing for 4 weeks. After 4 weeks, dressing components were changed to Mepilex (Mölnlycke Health Care, Gothenburg, Sweden) alone.The wound healed completely without requiring major flap surgery by 18 weeks after surgery.Fat grafting is one kind of cell therapy and potentially has regenerative effects during wound healing. Fat grafting is critical in the healing processes of complicated wounds and might be considered a step in reconstruction surgery.
Abstract Purpose Multidrug-resistant (MDR) bacteria impose a considerable health-care burden and are associated with bronchiectasis exacerbation. This study investigated the clinical outcomes of adult patients with bronchiectasis following MDR bacterial infection. Methods From the Chang Gung Research Database, we identified patients with bronchiectasis and MDR bacterial infection from 2008 to 2017. The control group comprised patients with bronchiectasis who did not have MDR bacterial infection and were propensity-score matched at a 1:2 ratio. The main outcomes were in-hospital and 3-year mortality. Results In total, 554 patients with both bronchiectasis and MDR bacterial infection were identified. The types of MDR bacteria that most commonly affected the patients were MDR- Acinetobacter baumannii (38.6%) and methicillin-resistant Staphylococcus aureus (18.4%), Extended-spectrum-beta-lactamases (ESBL)- Klebsiella pneumoniae (17.8%), MDR- Pseudomonas (14.8%), and ESBL- E. coli (7.5%). Compared with the control group, the MDR group exhibited lower body mass index scores, higher rate of chronic bacterial colonization, a higher rate of previous exacerbations, and an increased use of antibiotics. Furthermore, the MDR group exhibited a higher rate of respiratory failure during hospitalization (MDR vs. control, 41.3% vs. 12.4%; p < 0.001). The MDR and control groups exhibited in-hospital mortality rates of 26.7% and 7.6%, respectively ( p < 0.001); 3-year respiratory failure rates of 33.5% and 13.5%, respectively ( p < 0.001); and 3-year mortality rates of 73.3% and 41.5%, respectively ( p < 0.001). After adjustments were made for confounding factors, the infection with MDR and MDR bacteria species were determined to be independent risk factors affecting in-hospital and 3-year mortality. Conclusions MDR bacteria were discovered in patients with more severe bronchiectasis and were independently associated with an increased risk of in-hospital and 3-year mortality. Given our findings, we recommend that clinicians identify patients at risk of MDR bacterial infection and follow the principle of antimicrobial stewardship to prevent the emergence of resistant bacteria among patients with bronchiectasis.
Penetrating brain injury (PBI), a relatively uncommon injury, is associated with remarkable secondary complications such as vascular injury, intracranial haemorrhage, infection, and mortality. Non-missile PBI (NMPBI) due to sharp or blunt objects is usually treated surgically by removing the penetrating object, evacuating the associated haemorrhage, identifying possible bleeders along with haemostasis, and performing debridement. Various approaches are used for different scenarios of non-missile PBI according to the object's characteristics, penetrating site, depth, associated intracerebral haemorrhage (ICH), and presence of vascular injury along the penetrating tract. NMPBI cases are rarely reported among civilians. We herein describe a patient who was successfully treated for NMPBI, as well as frontal ICH, by simultaneously removing the heavy, metallic penetrating foreign body.
An uncommon case of spinal gouty tophus was diagnosed in a 74-year-old man who presented in the emergency department with sudden onset of acute paraplegia. The patient underwent laminectomy and nodule removal for neurodecompression. After surgery, the patient demonstrated good functional recovery and returned to baseline performance status. Intraspinal tophi are rare. Image study may show irrelevant findings. In patients with gout, the differential diagnosis should include tophi. In the present case, imaging did not reveal much inflammatory change, but severe symptoms were observed, and a definite preoperative diagnosis was difficult. In cases with neurological compromise, timely neurosurgical decompression leads to good outcomes, as in the present case.
Background: Tracheal tumors are rare. The majority of the tumors in adults are malignant, with about 1/2 to 2/3 being squamous cell carcinomas (SCC). Adenoid cystic carcinomas (ACC) were the second most common of all and the most common for primary tracheal malignancy. Because of the rarity of tracheal tumors and the lack of clarity about their clinical outcome, we retrieved patient information from our cancer registration center and database for analysis. Objective: To investigate the clinical manifestations, management and outcome of tracheal tumors. Patients and Methods: Using tumor location in the trachea as the search term, data on 45 patients with tracheal malignant tumors from July 2002 to December 2013 were retrieved from the database of our cancer center. Histology, primary or metastatic, initial clinical manifestations, therapy and outcome were analyzed. Results: Twenty-three patients (51%) had a primary tumor and 22 (49%) had a metastatic tumor. Among the primary tumors, 12 (52%) were ACC, 6 (26%) were SCC, and 3 (13%) were mucoepidermoid carcinoma. Of those patients with metastatic tumors, 13 (59%) had SCC, and 3 (13%) had adenocarcinoma. The most common manifestation was cough and the second most common was dyspnea. Nineteen patients (42%) underwent surgery, 23 (51%) radiation therapy, and 16 (35%) chemotherapy. Sixteen patients received a single modality of therapy, 17 patients, 2 modalities, and 14 patients, 3 modalities. The median survival of patients with primary tracheal tumor was 2674 days, and for those with metastatic cancer, 125 days. Among the primary tumors, the median survival of those with ACC was 3773 days. Conclusions: Primary ACC patients had a better outcome than those with the other tracheal malignancies, and patients with metastatic tracheal malignancy had a poor survival outcome.
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