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Surgical Case Reports Jun 2024The rupture of splenic artery pseudoaneurysm (SAP) is life-threatening disease, often caused by trauma and pancreatitis. SAPs often rupture into the abdominal cavity and...
BACKGROUND
The rupture of splenic artery pseudoaneurysm (SAP) is life-threatening disease, often caused by trauma and pancreatitis. SAPs often rupture into the abdominal cavity and rarely into the stomach.
CASE PRESENTATION
A 70-year-old male with no previous medical history was transported to our emergency center with transient loss of consciousness and tarry stools. After admission, the patient become hemodynamically unstable and his upper abdomen became markedly distended. Contrast-enhanced computed tomography performed on admission showed the presence of a splenic artery aneurysm (SAP) at the bottom of a gastric ulcer. Based on the clinical picture and evidence on explorative tests, we established a preliminary diagnosis of ruptured SAP bleeding into the stomach and performed emergency laparotomy. Intraoperative findings revealed the presence of a large intra-abdominal hematoma that had ruptured into the stomach. When we performed gastrotomy at the anterior wall of the stomach from the ruptured area, we found pulsatile bleeding from the exposed SAP; therefore, the SAP was ligated from inside of the stomach, with gauze packing into the ulcer. We temporarily closed the stomach wall and performed open abdomen management, as a damage control surgery (DCS) approach. On the third day of admission, total gastrectomy and splenectomy were performed, and reconstruction surgery was performed the next day. Histopathological studies of the stomach samples indicated the presence of moderately differentiated tubular adenocarcinoma. Since no malignant cells were found at the rupture site, we concluded that the gastric rupture was caused by increased internal pressure due to the intra-abdominal hematoma.
CONCLUSIONS
We successfully treated a patient with intragastric rupture of the SAP that was caused by gastric cancer invasion, accompanied by gastric rupture, by performing DCS. When treating gastric bleeding, such rare causes must be considered and appropriate diagnostic and therapeutic strategies should be designed according to the cause of bleeding.
PubMed: 38884824
DOI: 10.1186/s40792-024-01944-4 -
Cureus May 2024Infectious tenosynovitis can involve both flexor and extensor tendons of the extremities. If left untreated, it can lead to high morbidity and mortality. Most emergency...
Infectious tenosynovitis can involve both flexor and extensor tendons of the extremities. If left untreated, it can lead to high morbidity and mortality. Most emergency providers recognize the signs and symptoms of flexor and extensor tenosynovitis of the hand. However, extensor tenosynovitis of the hallucis longus tendon is a rare condition with a risk of complications similar to infectious tenosynovitis of the hand. This case report describes a presentation of extensor tenosynovitis of the hallucis longus tendon. Clinical suspicion is essential to help the provider not miss this rare condition, which can lead to significant morbidity if not treated promptly or appropriately.
PubMed: 38883076
DOI: 10.7759/cureus.60384 -
Cureus May 2024A spinal epidural abscess is a rare condition characterized by the accumulation of pus between the dura mater and vertebral column, often caused by hematogenous spread...
A spinal epidural abscess is a rare condition characterized by the accumulation of pus between the dura mater and vertebral column, often caused by hematogenous spread from a distant site or local spread from infection in nearby structures. The abscess leads to compression of the spinal cord and can result in neurological damage, including dysfunction or permanent neurological deficits. Treatment of spinal epidural abscesses should not be delayed and requires a combination of decompression by surgical drainage and antibiotic therapy. The authors present a rare case in which a spinal epidural abscess developed from a hospital-acquired pressure ulcer, further complicated by bacteremia.
PubMed: 38882974
DOI: 10.7759/cureus.60379 -
ARYA Atherosclerosis 2023Awareness of the perceptions of patients regarding the nursing services provided during hospitalization can enhance the quality and safety of nursing care. The objective...
INTRODUCTION
Awareness of the perceptions of patients regarding the nursing services provided during hospitalization can enhance the quality and safety of nursing care. The objective of this study was to elucidate the psychological perceptions of patients with bedsores regarding the nursing care they received in the intensive care unit.
METHOD
This descriptive qualitative study was conducted in 2021. The study population comprised patients admitted to the cardiac intensive care units of Chamran Hospital in Isfahan, Iran. The sample included 10 patients who fulfilled the inclusion criteria. These patients were selected using a purposive sampling technique. Semi-structured interviews were employed for data collection. Sampling continued until data saturation was reached. Data were analyzed using conventional qualitative content analysis.
RESULTS
In this study, the codes obtained were classified into 10 subcategories, which were subsequently merged into three main categories. The main categories included "neglected wound care", "empathetic care", and "patient hope and trust".
CONCLUSION
The findings of this study revealed that the psychological understanding of patients with bedsores was associated with numerous components and challenges that necessitate the attention and consideration of nurses during the provision of care to these patients.
PubMed: 38882646
DOI: 10.48305/arya.2023.11888.2724 -
PloS One 2024This study aimed to explore the application effects of cluster process control and routine nursing on the prevention of pressure injury (PI) in patients undergoing head...
This study aimed to explore the application effects of cluster process control and routine nursing on the prevention of pressure injury (PI) in patients undergoing head and neck cancer surgery and to provide a basis for reducing the occurrence of PI, thereby promoting the safety of the patients. This was a retrospective study. Patients with head and neck cancers who underwent surgical treatment in the Department of Otolaryngology at the Second Affiliated Hospital of Fujian Medical University from July 2022 to June 2023 were selected as the research participants. Participants were classified into experimental and control groups using a convenience sampling method. In the experimental group, cluster process control was implemented, while routine nursing management was applied in the control group. The incidence of PI (p = 0.028) and healing time (p = 0.035) in the experimental group were lower than those in the control group. The process management ability of nurses in the experimental group was significantly improved, with the results for the Braden scale (p = 0.023), effective decompression (p = 0.002), floating heel (p = 0.002), nutrition monitoring (p = 0.005), and patient satisfaction in the experimental group being higher than those in the control group (p = 0.007). This study effectively demonstrated the effect of cluster process control in reducing the incidence of PI in patients undergoing head and neck cancer surgery, thereby determining that cluster process control is suitable for clinical application.
Topics: Humans; Head and Neck Neoplasms; Female; Male; Middle Aged; Retrospective Studies; Pressure Ulcer; Aged; Adult; Incidence
PubMed: 38857240
DOI: 10.1371/journal.pone.0305190 -
Exploration (Beijing, China) Feb 2024Real-time foot pressure monitoring using wearable smart systems, with comprehensive foot health monitoring and analysis, can enhance quality of life and prevent...
Real-time foot pressure monitoring using wearable smart systems, with comprehensive foot health monitoring and analysis, can enhance quality of life and prevent foot-related diseases. However, traditional smart insole solutions that rely on basic data analysis methods of manual feature extraction are limited to real-time plantar pressure mapping and gait analysis, failing to meet the diverse needs of users for comprehensive foot healthcare. To address this, we propose a deep learning-enabled smart insole system comprising a plantar pressure sensing insole, portable circuit board, deep learning and data analysis blocks, and software interface. The capacitive sensing insole can map both static and dynamic plantar pressure with a wide range over 500 kPa and excellent sensitivity. Statistical tools are used to analyze long-term foot pressure usage data, providing indicators for early prevention of foot diseases and key data labels for deep learning algorithms to uncover insights into the relationship between plantar pressure patterns and foot issues. Additionally, a segmentation method assisted deep learning model is implemented for exercise-fatigue recognition as a proof of concept, achieving a high classification accuracy of 95%. The system also demonstrates various foot healthcare applications, including daily activity statistics, exercise injury avoidance, and diabetic foot ulcer prevention.
PubMed: 38854485
DOI: 10.1002/EXP.20230109 -
Clinical Biomechanics (Bristol, Avon) Jun 2024Effectiveness of therapeutic footwear in reducing peak pressure in persons with diabetes and loss of protective sensation to prevent diabetic foot ulcers varies due to...
BACKGROUND
Effectiveness of therapeutic footwear in reducing peak pressure in persons with diabetes and loss of protective sensation to prevent diabetic foot ulcers varies due to manual production and possible changing foot structure. A previous two-way approach to address this issue, featuring individualized 3D-printed rocker midsoles and self-adjusting insoles, proved effective in the forefoot but less in the heel. To address this, new insoles incorporating a heel cup are developed.
METHODS
In-shoe pressure was measured, while persons with diabetes and loss of protective sensation with high peak pressure (≥ 200 kPa) in the heel walked on a treadmill with control and individualized rocker shoe paired with control and new insole.
FINDINGS
Generalized estimating equations revealed significant decrease in peak pressure in the proximal heel with the new insole alone and combined with rocker shoe compared to rocker shoe alone. For the distal heel, significant decrease in peak pressure is shown with the combination of new insole and rocker shoe compared to control shoe. For the forefoot and toes (excluding hallux) significant decrease in peak pressure is shown using the rocker shoe alone or combined with the heel cup compared to control shoe.
INTERPRETATION
The new insole paired with rocker shoe is effective in reducing peak pressure in the distal heel. To have similar (or more) success in proximal heel, one could replace the rocker midsole with more compliant materials. The rocker shoe used separately or combined with a heel cup effectively reduces the peak pressure in the forefoot and other toes.
Topics: Humans; Shoes; Heel; Pressure; Foot Orthoses; Male; Female; Middle Aged; Diabetic Foot; Equipment Design; Foot; Aged; Walking
PubMed: 38850882
DOI: 10.1016/j.clinbiomech.2024.106281 -
Journal of Wound Care Jun 2024The aim of this study was to determine the incidence of pressure ulcers (PUs) in patients treated for acute ischaemic stroke (AIS) and to evaluate comorbid/confounding...
OBJECTIVE
The aim of this study was to determine the incidence of pressure ulcers (PUs) in patients treated for acute ischaemic stroke (AIS) and to evaluate comorbid/confounding factors.
METHOD
The study included patients treated for AIS who were divided into three treatment groups: those receiving intravenous tissue plasminogen activator therapy (tPA); patients receiving mechanical thrombectomy (MT); and those receiving both tPA and MT. PUs were classified according to the international classification system and factors that may influence their development were investigated.
RESULTS
A total of 242 patients were included in this study. The incidence of PUs in patients treated for AIS was 7.4%. Most PUs were located on the sacrum (3.7%), followed by the gluteus (3.3%) and trochanter (2.9%). With regards to PU classification: 29% were stage I; 34% were stage II; and the remainder were stage III. Age was not a significant factor in the development of PUs (p=0.172). Patients in the tPA group had a lower PU incidence (2.3%) than patients in the tPA+MT group (15.7%) and MT group (12.1%) (p=0.001). Patients with PUs had a longer period of hospitalisation (18.5±11.92 days) than patients without a PU (8.0±8.52 days) (p=0.000). National Institute of Health Stroke Scale (NIHSS) scores at admission were higher in patients with PUs than in patients without a PU (14.33±4.38 versus 11.08±5.68, respectively; p=0.010). The difference in presence of comorbidities between patients with and without PUs (p=0.922) and between treatment groups (p=0.677) were not statistically significant. The incidence of PUs was higher in patients requiring intensive care, but this difference was not statistically significant (p=0.089).
CONCLUSION
In this study, patients treated for AIS with high NIHSS scores at admission and/or receiving MT were at higher risk for PUs, and so particular attention should be given to these patients in order to prevent PU development.
Topics: Humans; Pressure Ulcer; Male; Female; Ischemic Stroke; Aged; Incidence; Middle Aged; Aged, 80 and over; Tissue Plasminogen Activator; Thrombectomy; Retrospective Studies; Risk Factors; Fibrinolytic Agents
PubMed: 38843015
DOI: 10.12968/jowc.2020.0331 -
Journal of Wound Care Jun 2024The relationship between the healing time of pressure ulcers (PUs) and wound cleaning frequency among older people in homecare settings was investigated.
OBJECTIVE
The relationship between the healing time of pressure ulcers (PUs) and wound cleaning frequency among older people in homecare settings was investigated.
METHOD
This single-centre, prospective cohort study was conducted from April 2018 to March 2019. Patients who used home-visit nursing services, had National Pressure Ulcer Advisory Panel classification stage 2 PUs, and had their wounds cleaned at least twice a week were enrolled in the study. Wound cleaning was performed using tap water and a weakly acidic cleanser. Participants were divided into two groups, determined by the frequency of wound cleaning (twice weekly versus ≥3 times weekly). Duration of PU healing and the increase in care insurance premiums were compared in both groups.
RESULTS
A total of 12 patients were included in the study. The mean healing period of PUs cleaned ≥3 times per week (65.3±24.8 days) was significantly shorter than that of PUs cleaned twice a week (102.6±19.2 days; p<0.05). Furthermore, the increase in care insurance premiums for PUs cleaned ≥3 times per week (¥122,497±105,660 Yen per six months) was significantly lower than that for PUs cleaned twice a week (¥238,116±60,428 per six months) (p<0.05).
CONCLUSION
Our results suggest that frequent cleaning of PUs by health professionals in homecare settings not only shorten PU healing period but also reduces care insurance premiums for PU care.
Topics: Humans; Pressure Ulcer; Male; Female; Prospective Studies; Home Care Services; Wound Healing; Aged; Aged, 80 and over; Time Factors; Cohort Studies
PubMed: 38843007
DOI: 10.12968/jowc.2021.0152 -
Surgical Case Reports Jun 2024Pseudo-Kaposi sarcoma (PKS) is a rare vascular proliferative disease, caused by arteriovenous malformation (AVM) and chronic venous insufficiency. The lesions are...
BACKGROUND
Pseudo-Kaposi sarcoma (PKS) is a rare vascular proliferative disease, caused by arteriovenous malformation (AVM) and chronic venous insufficiency. The lesions are characterized by purple or reddish-brownish papules, plaques, and nodules. Although benign, it is clinically similar to Kaposi's sarcoma (KS), a malignant disease, and must be differentiated by histopathological examination. We report a rare case of PKS with chronic limb-threatening ischemia (CLTI).
CASE PRESENTATION
An 83-year-old man with diabetes mellitus (DM) presented to a local dermatology department with a complaint of a right second toe ulcer and was, thereby, referred to our department due to arterial bleeding during skin biopsy to exclude malignant diseases. Although the pulsation of dorsalis pedis artery of the affected limb was palpable, the skin perfusion pressure was only 20 and 30 mmHg on the dorsum and planter surface, respectively, indicating severe ischemia of toe and forefoot. Ultrasonography and computed tomography revealed an AVM around the right second metatarsophalangeal joint and occlusion of the right dorsalis pedis artery in the middle, indicating CLTI in the background. Pathological findings of the skin biopsy found capillary blood vessel proliferation, hemosiderin deposition, and extravascular red blood cell leakage in the dermal layer, which could be found in KS. However, CD34 was normally stained in the vascular endothelium, and human herpesvirus-8 staining was negative, resulting in the pathological diagnosis of PKS, a proliferative vascular lesion associated with AVM. The ulcer was spontaneously epithelialized, but 2 years later the ulcer recurred and infection developed, necessitating treatment for abnormal blood flow. Transarterial embolization using N-butyl 2-cyanoacrylate for the AVM controlled abnormal perfusion once; however, the procedure exacerbated perfusion of the toe, resulting in foot ulcer progression. Forefoot amputation with surgical excision of AVM was performed, and thereby, wound healing was achieved.
CONCLUSION
This is a rare case of PKS with CLTI complicated with AVM. As there is currently no established consensus on the treatment of PKS, the approach to treatment strategy should be tailored to the specific condition of each patient.
PubMed: 38842785
DOI: 10.1186/s40792-024-01933-7