-
Journal of Orthopaedic Case Reports Nov 2022In this case report, we question the safety associated with high velocity manipulations of the cervical spine. These procedures do not frequently cause catastrophic...
INTRODUCTION
In this case report, we question the safety associated with high velocity manipulations of the cervical spine. These procedures do not frequently cause catastrophic adverse effects but few and rare case reports like this make us aware about the possible complications of the maneuvers.
CASE REPORT
This case report presents an uncommon presentation of acute neurodeficit to a 57-year-old male following a neck manipulation by a barber in the saloon which recovered partially with Intravenous steroid therapy but required active intervention surgically to treat his complete symptomatology. The magnetic resonance imaging (T2-weighted) showed a high signal intensity within the spinal cord at the C4C5 level (cord edema). Here, we discuss the possible mechanism of injury and the need to educate the lesser common risks of performing such sudden and forceful maneuvers.
CONCLUSION
This case report is a reminder that people should be careful while trying alterative types of therapy which use forceful neck manipulations to relieve pain as this maneuver could cause injuries to the disc complex especially when the patient already has a disc prolapse which is asymptomatic, causing the disc to fail again making it symptomatic.
PubMed: 37013247
DOI: 10.13107/jocr.2022.v12.i11.3412 -
Journal of Personalized Medicine Mar 2023Mucopolysaccharidosis (MPS) is a hereditary disorder arising from lysosomal enzymes deficiency, with glycosaminoglycans (GAGs) storage in connective tissues and bones,...
Mucopolysaccharidosis (MPS) is a hereditary disorder arising from lysosomal enzymes deficiency, with glycosaminoglycans (GAGs) storage in connective tissues and bones, which may compromise the airway. This retrospective study evaluated patients with MPS type IVA with airway obstruction detected via endoscopy and imaging modalities and the effects of surgical interventions based on symptoms. The data of 15 MPS type IVA patients (10 males, 5 females, mean age 17.8 years) were reviewed in detail. Fiberoptic bronchoscopy (FB) was used to distinguish adenotonsillar hypertrophy, prolapsed soft palate, secondary laryngomalacia, vocal cord granulation, cricoid thickness, tracheal stenosis, shape of tracheal lumen, nodular deposition, tracheal kinking, tracheomalacia with rigid tracheal wall, and bronchial collapse. Computed tomography (CT) helped to measure the deformed sternal angle, the cross-sectional area of the trachea, and its narrowest/widest ratio (NW ratio), while angiography with 3D reconstruction delineated tracheal torsion, kinking, or framework damage and external vascular compression of the trachea. The NW ratio correlated negatively with age ( < 0.01), showing that airway obstruction progressed gradually. Various types of airway surgery were performed to correct the respiratory dysfunction. MPS type IVA challenges the management of multifactorial airway obstruction. Preoperative airway evaluation with both FB and CT is strongly suggested to assess both intraluminal and extraluminal factors causing airway obstruction.
PubMed: 36983675
DOI: 10.3390/jpm13030494 -
BMC Pregnancy and Childbirth Mar 2023Robert's uterus is a rare congenital anomaly, characterized as an asymmetric septate uterus that has a blind hemicavity with unilateral menstrual fluid retention and a... (Review)
Review
BACKGROUND
Robert's uterus is a rare congenital anomaly, characterized as an asymmetric septate uterus that has a blind hemicavity with unilateral menstrual fluid retention and a unicornuate hemicavity connecting to the cervix unimpededly. Patients with Robert's uterus generally present with menstrual disorders and dysmenorrhea, and some may have reproductive problems as well, including infertility, recurrent miscarriage, preterm labor and obstetric complications. In this case, we describe a successful pregnancy implanted on the obstructed hemicavity and delivered a liveborn girl. Meanwhile, we highlight diagnostic and therapeutic difficulties in patients with atypical symptoms of Robert's uterus.
CASE PRESENTATION
A 30-year-old Chinese primigravida sought for emergency treatment at 26 weeks and 2 days of gestation because of preterm premature rupture of membranes (PPROM). At the age of 19, the patient was misdiagnosed with hyperprolactinemia and pituitary microadenoma for showing symptom of hypomenorrhea and was suspected to have a uterine septum in the first trimester. She was diagnosed with Robert's uterus at 22 weeks of gestation by repetitious prenatal transvaginal ultrasonography, which was subsequently confirmed by magnetic resonance imaging. At 26 weeks and 3 days of gestation, the patient was suspected to have oligohydramnion, irregular uterine contraction, and umbilical cord prolapse, and she expressed a strong will of saving the baby. Emergency cesarean delivery was performed and a small hole, together with several weak spots, was found at the lower and back wall of the septum of the patient. The treatment was effective and both the mother and the infant, who had an extremely low birth weight, were discharged in good health conditions.
CONCLUSIONS
Pregnancy in the blind cavity of Robert's uterus with living neonates is incredibly rare. In our case, the favorable outcome may result from the unusual hole found at the septum, which may play a role in communicating amniotic fluid between the two hemicavities so to keep the neonate alive. we highlight the importance of early diagnosis and pre-pregnancy treatment of this uterine malformation, and the timely termination of pregnancy, for improving birth quality and reducing mortality.
Topics: Adult; Female; Humans; Infant, Newborn; Pregnancy; Dysmenorrhea; Infertility; Pelvis; Urogenital Abnormalities; Uterus; Fetal Membranes, Premature Rupture; Magnetic Resonance Imaging; Ultrasonography
PubMed: 36978042
DOI: 10.1186/s12884-023-05541-5 -
Cureus Mar 2023Lumbar disc herniation (LDH) is prevalent among adults aged 25-55 years who spend a considerable proportion of their time sitting or standing with heavy workloads. We...
Lumbar disc herniation (LDH) is prevalent among adults aged 25-55 years who spend a considerable proportion of their time sitting or standing with heavy workloads. We report the case of a 33-year-old male waiter with severe LDH, causing compression of the nerve roots and spinal cord with neurological dysfunction, who presented to a chiropractic clinic. Magnetic resonance imaging (MRI) revealed a radiological differential diagnosis comprising LDH and an epidural mass lesion. To rule out serious pathology, a second MRI with contrast was ordered, which confirmed the diagnosis of severe LDH. Diagnosing large LDH may be challenging, and severe disc herniation often mimics spinal tumors. This study offers insights into the differential diagnosis of LDH and spinal tumors, as well as the design of a treatment strategy for severe LDH in the chiropractic clinic.
PubMed: 36968683
DOI: 10.7759/cureus.36545 -
International Journal of Women's Health 2023Amniotic fluid volumes are tightly regulated, and amniotic fluid derangement can indicate maternal complications or fetal abnormalities. Ultrasound estimate of amniotic... (Review)
Review
Amniotic fluid volumes are tightly regulated, and amniotic fluid derangement can indicate maternal complications or fetal abnormalities. Ultrasound estimate of amniotic fluid provides a tool to evaluate the maternal-fetal-placental interface in real-time. Oligohydramnios and polyhydramnios are associated with adverse maternal and neonatal outcomes. Oligohydramnios is associated with adverse maternal and neonatal outcomes including cesarean delivery, operative vaginal delivery, induction of labor, postpartum hemorrhage, small for gestational age neonate, intrauterine demise, neonatal death, NICU admission, and APGAR less than 7 at. 5 minutes of life Polyhydramnios is associated with adverse outcomes including cesarean delivery, induction of labor, placental abruption, shoulder dystocia, cord prolapse, postpartum hemorrhage, intrauterine fetal demise, NICU admission, neonatal death, APGAR less than 7 at 5 minutes of life, large for gestational age neonate, and respiratory distress syndrome. Therefore, Amniotic fluid should be evaluated when maternal or fetal well-being is in question.
PubMed: 36756186
DOI: 10.2147/IJWH.S378020 -
PloS One 2023Birth injury is harm that a baby suffers during the entire birth process. It includes both birth asphyxia and birth trauma. In Ethiopia, birth injury has become the...
BACKGROUND
Birth injury is harm that a baby suffers during the entire birth process. It includes both birth asphyxia and birth trauma. In Ethiopia, birth injury has become the leading cause of neonatal morbidity and mortality, accounting around 28%-31.6% of neonatal mortality. The study aimed to assess the prevalence and factors associated with birth injuries among newborns delivered in public hospitals Addis Ababa, Ethiopia, 2021.
METHODS
Institution based cross-sectional study was conducted from February 15th to April 20th, 2021 in selected public hospitals of Addis Ababa, Ethiopia. Random sampling and systematic random sampling were used. Data was entered by using Epi data version 4.0.2 and exported in to SPSS Software version 25 for analysis. Both bivariate and multivariable logistic regressions analyses were used. Finally P-value <0.05 was used to claim statistically significant.
RESULT
The prevalence of birth injury was 24.7%. In the final model, birth asphyxia was significantly associated with the short height of the mothers (AOR = 10.7, 95% CI: 3.59-32.4), intrapartal fetal distress (AOR = 4.74, 95% CI: 1.81-12.4), cord prolapse (AOR = 7.7. 95% CI: 1.45-34.0), tight nuchal cord (AOR = 9.2. 95% CI: 4.9-35.3), birth attended by residents (AOR = 0.19, 95% CI: 0.05-0.68), male sex (AOR = 3.84, 95% CI: 1.30-11.3) and low birth weight (AOR = 5.28, 95% CI: 1.58-17.6). Whereas, birth trauma was significantly associated with gestational diabetic mellitus (AOR = 5.01, 95% CI: 1.38-18.1), prolonged duration of labor (AOR = 3.74, 95% CI: 1.52-9.20), instrumental delivery (AOR = 10.6, 95% CI: 3.45-32.7) and night time birth (AOR = 4.82, 95% CI: 1.84-12.6).
CONCLUSION
The prevalence of birth injury among newborns has continued to increases and become life-threatening issue in the delivery and neonatal intensive care unit in the study area. Therefore, considering the prevailing factors, robust effort has to be made to optimize the quality obstetric care and follow up and emergency obstetrics team has to be strengthened to reduce the prevalence of birth injury.
Topics: Pregnancy; Female; Infant, Newborn; Male; Humans; Ethiopia; Prevalence; Cross-Sectional Studies; Asphyxia; Hospitals, Public; Asphyxia Neonatorum; Birth Injuries
PubMed: 36716337
DOI: 10.1371/journal.pone.0281066 -
Zhongguo Dang Dai Er Ke Za Zhi =... Jan 2023To identify the perinatal risk factors for the occurrence of singleton apparently stillborn infants. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
To identify the perinatal risk factors for the occurrence of singleton apparently stillborn infants.
METHODS
This was a case-control study. A total of 154 singleton neonates with gestational age ≥28 weeks and Apgar score of 0-1 who were subsequently successfully resuscitated in the Obstetrics and Gynecology Hospital of Fudan University from January 2006 to December 2015 were enrolled as the case group (apparently stillborn group). A total of 616 singleton infants born from January 2006 to December 2015 (1-minute Apgar score >1) were randomly selected in a 1:4 ratio as the control group. Univariate analysis and multivariate logistic regression were used to analyze the perinatal risk factors for the occurrence of apparently stillborn infants.
RESULTS
The gestational age and birth weight in the apparently stillborn group were significantly lower than those in the control group (<0.05). The incidences of fetal hydrops, cord prolapse, grade III meconium-stained amniotic fluid, placental abruption, breech presentation, severe pre-eclampsia, maternal general anesthesia at delivery, abnormal antenatal fetal heart monitoring and decreased fetal movement were significantly higher in the apparently stillborn group than those in the control group (<0.05). The multivariate logistic analysis showed that the mother had general anesthesia at delivery (=34.520), decreased antenatal fetal movement (=28.168),placental abruption (=15.641), grade III meconium-stained amniotic fluid (=6.365), abnormal antenatal fetal heart monitoring (=5.739), and breech presentation (=2.614) were risk factors for the occurrence of apparently stillborn infants (<0.05), while higher gestational age was a protective factor (=0.686, <0.05).
CONCLUSIONS
Attention needs to be paid to mothers with abnormal prenatal fetal heart monitoring, decreased fetal movement, preterm labor, placental abruption, breech presentation, grade III meconium-stained amniotic fluid, and general anesthesia. Preparations for resuscitation should be done to rescue apparently stillborn infants.
Topics: Female; Humans; Infant; Infant, Newborn; Pregnancy; Abruptio Placentae; Apgar Score; Breech Presentation; Case-Control Studies; Placenta; Pregnancy Complications; Risk Factors; Stillbirth
PubMed: 36655659
DOI: 10.7499/j.issn.1008-8830.2207108 -
Trials Dec 2022Lumbar disc herniation is one of the leading causes of chronic low back pain. Surgery remains the therapy of choice when conservative approaches fail. Full-endoscopic... (Randomized Controlled Trial)
Randomized Controlled Trial
Full-endoscopic versus conventional microsurgical therapy of lumbar disc herniation: a prospective, controlled, single-center, comprehensive cohort trial (FEMT-LDH trial).
BACKGROUND
Lumbar disc herniation is one of the leading causes of chronic low back pain. Surgery remains the therapy of choice when conservative approaches fail. Full-endoscopic approaches represent a promising alternative to the well-established microsurgical technique. However, high-grade evidence comparing these techniques is still scarce.
METHODS
Patients presenting with lumbar disc herniation will be included. The intervention group will obtain full-endoscopic disc decompression, whereas the control group will be treated by microsurgical disc decompression. We will apply a comprehensive cohort study design involving a randomized and a prospective non-randomized study arm. Patients who do not consent to be randomized will be assigned to the non-randomized arm. The primary outcome will be the Oswestry Disability Index (ODI). Secondary outcomes involve the visual analog scale (VAS) of pain and the SF-36 health questionnaire. Furthermore, clinical characteristics including duration of hospital stay, operation time, and complications as well as laboratory markers, such as C-reactive protein, white blood cell counts, and interleukin 6 will be determined and compared.
DISCUSSION
This study will significantly contribute to the current evidence available in the literature by evaluating the outcome of the full-endoscopic technique against the gold standard for lumbar disc herniation in a clinically relevant study setup. Additionally, the study design allows us to include patients not willing to be randomized in a prospective parallel study arm and to evaluate the impact of randomization on outcomes and include. The results could help to improve the future therapy in patients suffering from lumbar disc herniation.
TRIAL REGISTRATION
This study was prospectively registered in The German Clinical Trials Register (DRKS), a German WHO primary registry, under the registration number: DRKS00025786. Registered on July 7, 2021.
Topics: Humans; Intervertebral Disc Displacement; Prospective Studies; Cohort Studies
PubMed: 36476361
DOI: 10.1186/s13063-022-06892-8 -
Diagnostics (Basel, Switzerland) Nov 2022Umbilical cord prolapse can be a life-threatening obstetrical event involving the fetus due to sudden oxygenated blood flow obstruction. These types of events most often...
Umbilical cord prolapse can be a life-threatening obstetrical event involving the fetus due to sudden oxygenated blood flow obstruction. These types of events most often happen in labor and are associated with obstetric maneuvers. Rarely, a clinical examination can diagnose the condition, but the situation is usually detected secondary to an abnormal cardiotocography trace. We present several clinical cases where a CTG trace was used to infer umbilical cord prolapse.
PubMed: 36428904
DOI: 10.3390/diagnostics12112845