Curēus
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The erector spinae plane (ESP) block is a recently defined regional anesthesia technique which is considered as an effective method in postoperative multimodal analgesia. ESP block is usually performed at the thoracic region in pediatric patients, but it is also possible to perform ESP block at the lumbar region. Femur fracture is one of the most common procedures especially in pediatric orthopedic surgery where postoperative pain management is essential. We aim to present a case of effective postoperative analgesia provided by ultrasound-guided lumbar ESP block in a 6-year-old patient after femur fixation surgery.
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Acquired thrombotic thrombocytopenic purpura is a combination of thrombocytopenia with microangiopathic hemolytic anemia. A 62-year-old female was transferred from an outside hospital for rapidly worsening mental status and severe thrombocytopenia. Laboratory studies were significant for reduced hemoglobin and platelet count along with raised blood urea nitrogen, creatinine, and serum lactate dehydrogenase levels. ⋯ Our patient remained refractory to standard therapies and required rituximab and immunosuppressive agents like cyclosporine. We describe the association of active hepatitis C with acquired thrombotic thrombocytopenic purpura that was refractory to plasma exchange, high dose steroids and rituximab. As per our knowledge, this is the first case in the literature to describe a possible association between active hepatitis C and acquired thrombotic thrombocytopenic purpura.
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Case Reports
Double Bladder Sign: Three Cases of an Ultrasonographic Sign that Indicates Ovarian Torsion.
Ovarian torsion is a surgical emergency that can be difficult to diagnose and can therefore lead to delayed treatment and loss of ovarian function. While the diagnosis of ovarian torsion is based clinically, several sonographic findings can suggest ovarian torsion, including an enlarged ovary, presence of an ovarian cyst or mass, or abnormal ovarian blood flow. Less commonly described is the finding of an abnormal ovarian location in a clinical setting concerning for torsion. We present three cases of ovarian torsion where an ultrasonographic finding of a "double bladder sign" aided in early detection of ovarian torsion.
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Objective The aim of this study was to assess the efficacy and complications of trauma catheter versus mushroom tip catheter placement in the evacuation of chronic subdural hematoma via twist drill craniostomy with closed system drainage. Background Chronic subdural hematoma (cSDH) is one of the most frequent neurosurgical pathologies in patients >70 years of age with an estimated incidence of 8.2 per 100,000 people per year. The most common risk factors for cSDH are advanced age, alcohol abuse, seizures, cerebrospinal fluid (CSF) shunts, coagulopathies, blood thinners, and patients at risk for falling. ⋯ Neither catheter was associated with an increased incidence of hemorrhage with drain placement requiring open surgery (p = 0.12), need for additional drain placement (p = 0.13) or decline in GCS with intervention (p = 0.065). Conclusion Analysis of the 205 patients treated by twist drill craniostomy with closed system drainage for the evacuation of chronic subdural hematoma utilizing either the mushroom tip or trauma catheters revealed that neither catheter was statistically significant in radiographic or clinical improvement in evacuating cSDH. Furthermore, neither catheter was found to be associated with an increased complication risk.
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Traumatic Brain Injury (TBI) is a growing public health issue with an increasing burden of disease globally. TBI can lead to significant motor, cognitive and emotional deficits. Mobile health (mHealth) is a promising technology to help diagnose and manage patients with TBI. ⋯ The median number of patients was seven (1 - 43). There is a small number of mobile apps for TBI, mostly focusing on sports-related concussion. At present, the uptake and application of these apps as a management aid is limited and the evidence for their usefulness in TBI remains low.