[Horton's disease: ophthalmological and neurological complication].
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We report the case of a 74-year-old women admitted to the hospital because of rapidly developing diplopia. The admission anamnesis revealed fronto-temporal headaches and pain in the maxilla for three days. A cerebral cT scan was normal, and a corticosteroid therapy was initiated. Diagnosis of Horton's syndrome was confirmed by the good response to treatment and by biopsy of the temporal artery. Different ocular and neurologic complications of Horton's disease, their clinical appearances and therapeutic measures are discussed by the authors.Keywords:
Anamnesis
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Pseudoaneurysm
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The aim of the study was to identify influencing factors on the complication rate in pediatric supracondylar humerus fractures (PSHF). 22 male and 19 female patients with an extension type PSHF underwent conservative and operative treatment at a single trauma department and were reviewed retrospectively. The complications were assessed and the groups of patients with and without complications were compared according to patient- and therapy-related factors. The overall complication rate was 19.5%. Two patients had a primary and 4 patients a postoperative neurological deficit. One patient developed a pin infection after open reduction and crossed pin fixation. One patient underwent early revision surgery because of insufficient initial reduction after closed reduction and crossed pin fixation. All complications appeared in the surgical treatment group. The appearance of complications was significantly associated with a higher Gartland stage. The median time between trauma and operation was significantly longer in patients without compared to patients with complications. PSHF are associated with a high rate of neurological complications. The Gartland stage and the necessity of surgical treatment are the major influencing factors on the complication rate.
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To determine the postoperative complications of primary total knee arthroplasty (TKA) within 30 postoperative days, and the different causes for revision surgery during follow-up.Between January 2001 and December 2012, a total of 1 920 patients underwent 2 779 primary TKA with fixed bearing platform in Peking Union Medical College Hospital, with 323 for male and 1 607 for female. The revision surgery at index time and the hemophiliac arthropathy were excluded for this study. The average age was (66 ± 9) years (from 25 to 86 years).Osteoarthritis accounted for 1 720 cases (89.58%), rheumatoid arthritis for 168 cases (8.75%), ankylosing spondylitis for 12 cases (0.63%), secondary arthritis for 20 cases (1.04%). The postoperative complications with 30 postoperative days and revision surgery during follow-up were recorded.Follow-up was concluded at December 2013. Totally, 1 854 patients (2 693 knees) were successfully followed-up.Forty-one patients experienced systemic complication within 30 postoperative days, with the rate of 2.21%. The most common reasons of systemic complication were the respiratory complication and cardiovascular complication in origin, with the rate of 0.49% (9/1 854) and 0.38% (7/1 854) respectively. The average rate of deep venous thrombosis in this group was 3.02% (56/1 854). The local complication rate within 30 days was 1.29% in this group. Totally 59 knees experienced the revision surgeries during average 67 months follow-up. The most common causes for revision surgery in relative values were septic loosening, with the rate of 1.19% (32 in 2 693 knees), followed by postoperative stiffness, with the rate of 0.37% (10 in 2 693 knees).The most common reasons of systemic complication with 30 postoperative days after primary TKA procedure are the respiratory complication and cardiovascular complication in origin. The most common reason for revision surgery during mid-term follow-up for primary TKA is septic loosening.
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Although operative methods and management have been improved, but an appreciable number of cases are still subject to reoperation due to postoperative complication. We examined 92 cases of reoperative gastrointestinal surgery experienced in our department during a 14-years period.The reuslts were as follows: 1) Incidence of reoperation was 3% and there was difference between the previous and latter terms. 2) Although sutural insufficiency was decreased, postoperative bleeding and ileus were increased in the latter term. 3) Reoperation was done more frequently between 1 and 8 days in the previous term and between 14 and 21 days in the latter term. 4) Patients aged between 30 and 80 years accounted for as much as 77% of reoperative cases. 5) The prognosis for reoperation was unfavorable in malignant than in benign primary cases. 6) Of the 92 examined cases, 30 resulted in death, most of which involved reoperation in the early postoperative period. Old persons accounted for 50% of the cases. The prognosis in old patients depends upon the presence of asymptomatic functional disorders of organs.
Ileus
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Radiological detection of pyloroduodenal fistulas in 2 patients with a short history of abdominal pain related to analgesic and anti-inflammatory medication is described. This uncommon complication of peptic ulcer disease is of limited importance provided the patient is asymptomatic.
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We present our experience with the thoracoscopic treatment of congenital diaphragmatic eventration (CDE) in children through 15 years to evaluate the efficiency of the procedure and the potential risk of recurrence. Materials andWe reviewed the medical files of patients treated for CDE through thoracoscopy from 2000 to 2011. Age at surgery, sex, side of the lesion, procedure's details, postoperative course, and complications were analyzed. Mean follow-up was 12 months.In this study, eight patients (five males and three females) aged from 6 months to 7 years underwent thoracoscopic plication for six right and two left eventrations; one conversion was necessary due to a too small operative field. Mean operative time was 60.5 minutes. A chest drainage was placed in six patients. We observed two recurrences from which the first one was treated thoracoscopically by endostapler resection/suturing and the other one by laparotomy. At follow-up, all patients were asymptomatic with a correct level of the diaphragm.Thoracoscopic plication is feasible and safe, and we consider this approach as the gold standard for the treatment of CDE. However, we still need to carefully consider the possibility of introducing certain modifications to reduce the potential risk of recurrence.
Thoracoscopy
Diaphragm (acoustics)
Gold standard (test)
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Sixty-eight patients (7.1% of all cases) underwent bilateral carotid thrombo-endarterectomy, with one peroperative death due to permanent vascular cerebral ischemia. Two patients were re-operated (saphenous vein) for a thrombosis which had given rise to a totally regressive transient ischemia. The usual surgical technique was not modified for bilateral lesions, and the follow-up was similar. The evolutive risk of bilateral lesions was higher than that for isolated lesions as the risk of an accident after unilateral surgery in bilateral cases remained higher. As regards the surgical technique, we did not observe significant differences between the stump pressures according to the side operated. A one-week interval between the two surgical stages seems necessary and sufficient. Operative indications are studied except in cases of bilateral lesions which are asymptomatic or with former TIA, where surgery is considered mandatory.
Endarterectomy
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Abdominal aortic aneurysms are usually atherosclerotic in origin and infrarenal in location. They most commonly occur in patients over 50 and often are entirely asymptomatic. Although not essential for diagnosis, arteriography is necessary for proper planning of the operative procedure. Ultrasound and computerized axial tomography provide equal or superior diagnostic accuracy. The mortality rate from rupture of even small aneurysms is greater than the elective operative mortality. In the absence of absolute contraindications, aneurysms larger than 4.5 cm. should be surgically treated.
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Secondary aorto-enteric fistula (SAFE) is a late but dreaded complication of abdominal aortic surgery with an overall mortality ranging from 30% to 70% in different series. Most commonly the patients with SAFE, present with the massive gastrointestinal bleed or other symptoms such as sepsis, lower extremity ischemia, abdominal pain, septic arthritis, and multicentric osteomyelitis. Treatment requires prompt diagnosis, and surgery. We present a case of para-prosthetic graft to bowel fistula in a patient who was asymptomatic and has presented for treatment of ventral wall incisional hernia.
Bleed
Aortoenteric Fistula
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