Basal ganglia hemorrhage in a case report following spinal surgery

Background

Intracranial hemorrhage is a rare but potentially severe complication of spinal surgery. Most reported post-operative ICH cases consist of cerebellar hemorrhage. There are fewer reported cases of supratentorial ICH following spinal surgery.

Case presentation

A 56-year-old woman underwent spinal surgery complicated by bilateral supratentorial intraparenchymal basal ganglia hemorrhage with both intraventricular extension and subarachnoid hemorrhage in both cerebral hemispheres.

Conclusion

The occurrence of neurological deterioration post-operatively following spinal surgery should alert physicians to the possibility of intracranial hemorrhage in order to facilitate rapid and optimal management. To our knowledge, this is the first case reporting basal ganglia hemorrhage following spinal surgery. Moreover, consideration should be given to the possibility of this complication prior to recommendation of elective spinal surgery.

     

Reversal of childhood idiopathic scoliosis in an adult, without surgery: a case report and literature review

Background

There are no reports describing complications with posterior spinal fusion (PSF) with segmental spinal instrumentation (SSI) using pedicle screw fixation in patients with neuromuscular scoliosis.

Methods

Fifty neuromuscular patients (18 cerebral palsy, 18 Duchenne muscular dystrophy, 8 spinal muscular atrophy and 6 others) were divided in two groups according to severity of curves; group I (< 90°) and group II (> 90°). All underwent PSF and SSI with pedicle screw fixation. There were no anterior procedures. Perioperative (within three months of surgery) and postoperative (after three months of surgery) complications were retrospectively reviewed.

Results

There were fifty (37 perioperative, 13 postoperative) complications. Hemo/pneumothorax, pleural effusion, pulmonary edema requiring ICU care, complete spinal cord injury, deep wound infection and death were major complications; while atelectesis, pneumonia, mild pleural effusion, UTI, ileus, vomiting, gastritis, tingling sensation or radiating pain in lower limb, superficial infection and wound dehiscence were minor complications. Regarding perioperative complications, 34(68%) patients had at least one major or one minor complication. There were 16 patients with pulmonary, 14 with abdominal, 3 with wound related, 2 with neurological and 1 cardiovascular complications, respectively. There were two deaths, one due to cardiac arrest and other due to hypovolemic shock. Regarding postoperative complications 7 patients had coccygodynia, 3 had screw head prominence, 2 had bed sore and 1 had implant loosening, respectively. There was a significant relationship between age and increased intraoperative blood loss (p = 0.024). However it did not increased complications or need for ICU care. Similarly intraoperative blood loss > 3500 ml, severity of curve or need of pelvic fixation did not increase the complication rate or need for ICU. DMD patients had higher chances of coccygodynia postoperatively.

Conclusion

Although posterior-only approach using pedicle screw fixation had good correction rate, complications were similar to previous reports. There were few unusual complications like coccygodynia.     

伊曲康唑治疗胃部真菌感染1例

患者因患陈旧性心肌梗死、脑梗塞,长期服药致胃黏膜损伤,同时合并糖尿病,引发胃部真菌感染,经口服伊曲康唑200mg,2次／d,治疗3周后痊愈。     

伏立康唑联合手术治愈小腿镰刀菌感染1例

目的探讨串珠镰刀菌致小腿溃疡患者临床及实验室特征。方法多次取患者溃疡分泌物作直接镜检和真菌培养,观察真菌形态学特征。取皮损组织病理活检。结果在马铃薯培养基中25℃培养均长出白色棉絮状菌落,显微镜及扫描电镜下见大分生孢子呈镰刀状,小分生孢子链生和假头状着生并存,在沙堡琼脂25℃和37℃均生长良好,经鉴定为串珠镰刀菌。组织病理学显示为慢性炎性肉芽肿改变,PAS及六胺银染色均未见真菌成分。伏立康唑联合特比萘芬治疗有效,整形外科清创植皮后治愈。结论确诊1例串珠镰刀菌引起的小腿溃疡,伏立康唑联合手术治疗皮肤镰刀菌感染疗效好。     

Myasthenia gravis following human papillomavirus vaccination: a case report

DNA methyltransferase 1 (EC 2.1.1.37), encoded by DNMT1 gene, is one of key enzymes in maintaining DNA methylation patterns of the human genome. It plays a crucial role in embryonic development, imprinting and genome stability, cell differentiation. The dysfunction of this group of enzymes can lead to a variety of human genetic disorders. Until now, mutations in DNMT1 have been found to be associated with two distinct phenotypes. Mutations in exon 20 of this gene leads to hereditary sensory and autonomic neuropathy type IE, and mutations in exon 21 cause autosomal dominant cerebellar ataxia, deafness and narcolepsy. Here we report a novel DNMT1 mutation in a sporadic case of a Chinese patient with cerebellar ataxia, multiple motor and sensory neuropathy, hearing loss and psychiatric manifestations. Furthermore, we elucidated its pathogenic effect through molecular genetics studies and revealed that this defective DNMT1 function is responsible for the phenotypes in this individual. Our findings expand the spectrum of DNMT1-related disorders and provide a good example of precision medicine through the combination of exome sequencing and clinical testing.     

Fatal subcutaneous aspergillosis following necrotizing fasciitis: a case report

Skin or subcutaneous infection with aspergillus is uncommon. It has been described in disseminated aspergillosis, as localized infection in the immunocompromised host and as a complication of trauma and burns. Described in this paper is a diabetic patient who developed a fatal Aspergillus infection following debridement of a necrotizing fasciitis. "Fruiting bodies," rarely found in vivo, were seen on pathologic examination of subcutaneous tissue. Her course was similar to that of burn patients with invasive fungal disease, where mortality is high and radical debridement is the only chance for cure.     

Cardiac surgery in a patient with essential thrombocythemia: a case report

Patients with essential thrombocythemia (ET) are at increased risk of developing arterial thrombosis. We report a case of a 36-year-man with unstable angina in the presence of occlusion of two coronary arteries with insufficient collateral perfusion. We also found essential thrombocythemia in this patient. The patient underwent coronary artery bypass grafting (CABG). Ten days before surgery, the aspirin was replaced by a prophylactic dose of low-molecular-weight heparin. Postoperative follow-up was complicated by pulmonary embolisms and a cardiac tamponade. We conclude that ET is a risk factor for coronary heart disease that should be treated with aspirin. If a patient needs CABG, aspirin should be continued because of the high risk of thromboembolic events in the high-risk ET patients. (Neth Heart J 2010;18:378-80.)     

Coronary artery dissection following blunt chest trauma: a case report

Coronary artery dissection following blunt chest trauma is rare. We report the case of a 43-year-old woman who was admitted with a subacute inferior myocardial infarction due to dissection of the right coronary artery. Ten days earlier, she had sustained a minimal chest trauma. The literature is reviewed and management is discussed.     

Painful muscle fibrosis following synthol injections in a bodybuilder: a case report

ABSTRACT: INTRODUCTION: Synthol is a site enhancement oil used by bodybuilders to boost the cosmetic appearance ofmuscles. Here, we describe the case of a patient with severe side effects following repeatedintramuscular injections of synthol in his right biceps muscle. CASE PRESENTATION: A 29-year-old Middle Eastern male bodybuilder, following intramuscular injections ofsynthol five years ago, presented with painful pressure in his right upper arm. On presentationto our clinic, his muscle appeared disfigured. Magnetic resonance imaging revealed scatteredcystic fatty lesions in the muscle. The affected part was surgically removed andhistopathology showed inflammatory changes with fibrosis and a so-called Swiss cheesepattern. CONCLUSION: Synthol injections that are used for the short-term enhancement of muscle appearance bybodybuilders bear the danger of long-term painful muscle fibrosis and disfigurement.     

Treatment of massive thoracolumbar wounds and vertebral osteomyelitis following scoliosis surgery

Closure of thoracolumbar wounds and vertebral osteomyelitis after scoliosis surgery often proves difficult due to tautness and lack of usable tissue, and the resulting dead space containing metallic fixation devices is predisposed to infections and complications. The authors present their experience with 33 patients in whom massive thoracolumbar wounds and vertebral osteomyelitis developed following scoliosis surgery. Postoperative infection, due to the lack of vascularized tissue and presence of metallic hardware near the wound, is common and extremely counterproductive; within these cavernous wounds lie infected vertebrae, metallic hardware, and bone graft. The use of a modified and extended latissimus dorsi myocutaneous flap to close and supply blood to wounds in the lower thoracic and thoracolumbar areas is described. This surgical approach, predicated on effective débridement along with reconstruction by transposition of vascularized tissue, allows the wound to close and drastically decreases the risk of postoperative infection. Furthermore, for wounds already infected, the procedure allows for closure and increased blood supply to the area, thus giving the wound a much greater ability to heal. For wounds involving the lumbosacral area, the authors combine this with a transposed gluteus maximus muscle flap to obtain coverage over the caudal extent of the wound. In this study, all flaps accomplished their intended purpose: to secure the healing of once-infected wounds and to allow preservation of orthopedic instrumentation and bone graft. Follow-up revealed no flap losses, pseudarthroses, or loss of orthopedic instrumentation in the study group.