1/100. Iatrogenic Mycobacterium infection after an epidural injection.STUDY DESIGN: Case report. OBJECTIVES: Successful excision of the mass and identification of the causative agent by histologic and microbiologic studies. SUMMARY OF BACKGROUND DATA: Spinal pain, caused by an infective mass, developed in a 39-year-old man 3 months after an epidural injection for low back pain. methods: Exploratory surgery was performed to remove the mass, and histologic and microbiologic studies were conducted. RESULTS: The inflammatory mass was excised successfully, and several specimens were examined for bacteriologic presence. Histologic examination of the excised specimen showed chronic granulomatous inflammation, and subsequent microbiologic studies cultured an acid- and alcohol-fast bacillus that was later identified as mycobacterium fortuitum. CONCLUSION: A review of the literature shows that this is a particularly uncommon micro-organism.- - - - - - - - - - ranking = 1keywords = back pain (Clic here for more details about this article) |
2/100. Iatrogenic drug dependence--a problem in intensive care? Case study and literature review.Use of sedative and analgesic pharmacological agents is a widespread practice in intensive care units (ICUs). Mainly, this involves opioid and benzodiazepine analogues, both known to induce dependence/tolerance states. This paper is based on a clinical scenario in which a patient treated with these agents developed problems when they had been discontinued, and exploration of the extent of such problems generally. The problems range across a wide range of domains and may include physical discomfort, difficulty weaning from respiratory assistance and the drugs, and the problems of short- and long-term psychological distress. Although there may be a recognition that these drugs can typically cause dependence problems, little emphasis has traditionally been given to assessing these problems in ICUs. Yet the ICU may be an area where these drugs are used in high volumes. The recognition, physiology, management and prevention of iatrogenic drug dependence/tolerance in critical care environments is elucidated, with reference to relevant literature.- - - - - - - - - - ranking = 0.34707901798969keywords = discomfort (Clic here for more details about this article) |
3/100. gangrene following intra-arterial injection of procaine penicillin.Irreversible ischaemic gangrene of the upper limb developed in a one-year-old child after an unintentional intra-arterial injection of procaine penicillin. The hand needed amputation. Arterial embolization phenomenon along with intense vasospasm appears to have been responsible for this rare complication. Unintentional intra-arterial injection of penicillin intended for intra-muscular use may lead to disastrous consequences. Regional tissue necrosis has been described previously but ischaemia leading to gangrene of an extremity has not been reported. The following is a case report of a child who developed such a gangrene in his hand which had to be amputated.- - - - - - - - - - ranking = 0.08435763091156keywords = upper (Clic here for more details about this article) |
4/100. Iatrogenic spondylolysis leading to contralateral pedicular stress fracture and unstable spondylolisthesis: a case report.STUDY DESIGN: A case report of iatrogenic spondylolysis as a complication of microdiscectomy leading to contralateral pedicular stress fracture and unstable spondylolisthesis. OBJECTIVE: To improve understanding of this condition by presenting a case history and roentgenographic findings of a patient that differ from those already reported and to propose an effective method of surgical management. methods: A 67-year-old woman with no history of spondylolysis or spondylolisthesis underwent an L4-L5 microdiscectomy for a left herniated nucleus pulposus 1 year before the current consultation. For the preceding 8 months, she had been experiencing low back and bilateral leg pain. Imaging studies revealed a left L4 spondylolytic defect and a right L4 pedicular stress fracture with an unstable Grade I spondylolisthesis. RESULTS: The patient was treated with posterior spinal fusion, which resulted in complete resolution of her clinical and neurologic symptoms. CONCLUSIONS: Iatrogenic spondylolysis after microdiscectomy is an uncommon entity. However, it can lead to contralateral pedicular stress fracture and spondylolisthesis, and thus can be a source of persistent back pain after disc surgery. Surgeons caring for these patients should be aware of this potential complication.- - - - - - - - - - ranking = 1keywords = back pain (Clic here for more details about this article) |
5/100. Laparoscopic repair of a chronic diaphragmatic hernia.Diaphragmatic injuries that remain undetected after an acute traumatic event may lead to the formation of a diaphragmatic hernia. Symptoms of a chronic diaphragmatic hernia are related to the incarceration of abdominal contents in the defect or to impingement of the lung, heart, or thoracic esophagus by abdominal viscera. A 49-year-old woman with a symptomatic chronic diaphragmatic hernia from an unrecognized iatrogenic injury to the left hemidiaphragm sought treatment. The diaphragmatic injury occurred 2 years earlier when a low, left-sided chest tube was placed for a persistent pleural effusion 2 weeks after a lower lobectomy for an aspergilloma. The patient's diaphragmatic hernia was diagnosed after an upper gastrointestinal series and an esophagogastroduodenoscopy. Approximately 75% of her stomach was incarcerated in the diaphragmatic defect. The diaphragmatic hernia was repaired laparoscopically using a 9 cm x 10-cm polytetrafluoroethylene patch sewn with nonabsorbable, interrupted, horizontal mattress sutures. Improvement of video technology, laparoscopic instruments, and surgical skills has allowed surgeons to expand the boundaries of advanced therapeutic laparoscopy. These factors facilitated the authors' standard tension-free prosthetic repair of a chronic diaphragmatic hernia using minimally invasive techniques.- - - - - - - - - - ranking = 0.36623801431238keywords = chest, upper (Clic here for more details about this article) |
6/100. Percutaneous stenting of an latrogenic superior mesenteric artery dissection complicating suprarenal aortic aneurysm repair.PURPOSE: To report endovascular repair of an iatrogenic superior mesenteric artery (SMA) dissection caused by a balloon occlusion catheter. CASE REPORT: A 68-year-old man with a suprarenal aortic aneurysm underwent conventional prosthetic replacement, during which visceral artery back bleeding was controlled with balloon occlusion catheters. Six hours postoperatively, the patient experienced an episode of bloody diarrhea with abdominal pain and tenderness and mild metabolic acidosis. colonoscopy revealed colitis (grade I) without necrosis of the right and left colon. An emergent abdominal computed tomographic scan showed signs of mesenteric ischemia with bowel dilatation and SMA wall hematoma; angiography identified a dissection 1 cm distal to the SMA origin. An Easy Wallstent was deployed percutaneously, successfully reestablishing SMA patency. The postoperative course was uneventful, and the patient remains asymptomatic with a patent SMA stent and aortic graft at 1 year. CONCLUSIONS: latrogenic SMA dissection should be suspected after suprarenal aortic aneurysm repair if signs of mesenteric ischemia arise. Prompt and thorough imaging studies are necessary to confirm the diagnosis and assess the potential for an endoluminal treatment.- - - - - - - - - - ranking = 0.12911498289118keywords = abdominal pain (Clic here for more details about this article) |
7/100. Delayed recognition of inadvertent gut injury during laparoscopy.Bowel injuries, which may occur as a result of the insertion of an insufflation needle or trocar, are a rare complication of laparoscopy. They are generally recognized either immediately or a few days after the operation. We present a case of laparoscopic perforation of the small intestine in a patient who had undergone previous pelvic surgery for an ovarian carcinoma. On ultrasound (US), the patient had multiple hepatic lesions resembling hepatic metastases. To confirm the diagnosis, laparoscopy with guided liver biopsy was performed on the grounds that this procedure is regarded as more appropriate than CT- or US-guided hepatic biopsy. Veress needle and trocar insertion were performed at a proper distance from the abdominal scar. However, the abdominal cavity was not visible after the trocar's insertion due to the unexpected presence of adhesions. This precluded the continuation of the procedure. In the following days, the patient experienced only mild abdominal discomfort. However, 2 weeks after laparoscopy, the patient presented signs of peritoneal reaction and underwent laparotomy. Adhesion-fixing jejunal loops to the anterior abdominal wall were discovered at the site of the trocar puncture. Moreover, two hiatuses of these loops were observed and sutured. The follow-up was uneventful. As this case illustrates, laparoscopic bowel injuries remain an unpredictable event. Recognition of this complication may occur several days after the procedure, as the tamponating effect of adhesions on the jejunal hiatus delays the involvement of the peritoneum.- - - - - - - - - - ranking = 0.34707901798969keywords = discomfort (Clic here for more details about this article) |
8/100. Iatrogenic hydromediastinum simulating aortic laceration.Widening of the mediastinum after blunt, deceleration injuries to the chest in three patients suggested thoracic aortic lacerations. In each patient, the aorta was found to be intact and the iatrogenic hydromediastinum was caused by malpositioned central venous pressure lines. The radiographic appearance of the central venous pressure catheter is illustrated and clinical characteristics of the malpositioned catheter are discussed.- - - - - - - - - - ranking = 0.28188038340082keywords = chest (Clic here for more details about this article) |
9/100. Ileal conduit perforation-iatrogenic injury and conservative management.The ileal conduit was popularized by Bricker in the 1950s. Since then, surveillance of the upper urinary tract has been accomplished with intravenous urography, ultrasonography, or loopography. Loopography is used as an imaging modality at our institution because of its safety and avoidance of intravenous contrast. We report the first case of an iatrogenic rupture of an ileal conduit during loopography.- - - - - - - - - - ranking = 0.08435763091156keywords = upper (Clic here for more details about this article) |
10/100. staphylococcal scalded skin syndrome developing during burn treatment.We report a case of staphylococcal scalded skin syndrome (SSSS) in a 5-year-old girl who had been hospitalized for burn treatment. When she developed an upper respiratory tract infection, she manifested extensive erythema and exfoliation. There was a purulent discharge from the ulcer caused by the burn, and exfoliation was observed in the surrounding area. Based on clinical symptoms and laboratory data, SSSS was diagnosed and treated with antibiotics, resulting in subsidence. staphylococcus aureus was isolated from the posterior nasopharynx and the skin erosion and was proved to produce exfoliative toxin A (ETA). infection from an asymptomatic carrier of an ET-producing strain was suspected, but we failed to identify the origin, in spite of a thorough inspection of the mother, nurses, and physician. SSSS is occasionally reported as a hospital-acquired infection. We should study the frequency of asymptomatic carriers of ET-producing strains so that we can formulate strategies to prevent such infections.- - - - - - - - - - ranking = 0.08435763091156keywords = upper (Clic here for more details about this article) |
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