Int Surg
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Acute fulminant myocarditis may present with cardiogenic shock refractory to inotropics and intra-aortic balloon pumping (IABP). Benefit of extracorporeal membrane oxygenation (ECMO) support has been established. The effectiveness of combination with ECMO or IABP and activated protein C (drotrecogin alpha; Xigris) in treatment has yet to be defined. ⋯ There were no neurologic sequelae in the 3 survivors. Serological test and myocardial biopsy for Parvovirus B19 was positive in 3 of 4 patients. Use of circulatory support and activated protein C is an effective alternative for acute life-threatening myocarditis.
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Case Reports
Emergency surgery for acute respiratory failure secondary to spontaneous thyroid hemorrhage.
A 42-year-old woman was evaluated for an emergency at our surgical department for acute dyspnea associated with a spontaneous and rapidly enlarging mass of the neck. Clinical examination revealed a large, firm, nonfluctuant thyroid swelling on the right side of the neck. An urgent computerized tomography scan showed a hematoma within the right lobe of the thyroid and tracheal deviation with marked luminal narrowing. ⋯ During the operation, the thyroid gland showed a huge, edematous, nonfluctuant, rubbery, firm swelling with easy bleeding on touch, but the capsule appeared to be intact without rupture. Microscopic examination revealed a colloid multinodular goiter with massive parenchymal hemorrhage. Recovery was uneventful, and the patient was discharged 2 days after the operation.
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The liver is the second most traumatized organ in the abdominal cavity. The authors present a retrospective analysis of a group of 78 patients treated for this injury at one institution. In this group, there were 5 (6.41%) penetrating and 73 (93.59%) blunt trauma injuries. ⋯ Overall mortality was 29.48%. The mean period of hospitalization on the intensive care unit was 27.42 days. At present, liver trauma cannot be separated from multiple injuries; morbidity and mortality depend more on the affiliated trauma than on specific liver injury.
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Painful scoliosis is a well-recognized presentation of spinal osteoid osteoma, especially in adolescents, and is thought to be caused by pain-provoked muscle spasm on the side of the lesion. The diagnosis, however, is often initially missed, and prolonged duration of symptoms and rigid spinal curve may result. In this report, we present two cases of adolescent patients with painful scoliosis, subsequently diagnosed with spinal osteoid osteomas. Complete surgical excision resulted in dramatic symptomatic resolution after surgery and improved spinal curve at 1-year follow-up in both cases.
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Randomized Controlled Trial
Influence of synthetic mesh on ilioinguinal nerve motor conduction and chronic groin pain after inguinal herniorrhaphy: a prospective randomized clinical study.
Chronic postherniorrhaphy pain is a significant complication that can ruin a patient's quality of life. Our study aimed to assess the mesh-nerve interactions and the possible effects of this interaction on nerve morphology and function. Ilioinguinal nerve motor transmission studies using electromyelogram (EMG) were performed before the herniorrhaphy procedure, and Lichtenstein (n=50) or Shouldice (n=50) herniorrhaphies were used for repair. ⋯ We found a significant correlation between EMG results and inguinal pain. Our results indicates that nerve graft contact does not influence nerve motor conduction. The etiology of postherniorrhaphy chronic pain may be caused by nerve injury resulting in dissection or compression of the nerves.