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Ear, Nose, & Throat Journal Jun 2024This case report illustrates a unique presentation of Lemierre's syndrome precipitated by . This case report describes a 20-year-old patient who developed Lemierre's...
This case report illustrates a unique presentation of Lemierre's syndrome precipitated by . This case report describes a 20-year-old patient who developed Lemierre's syndrome secondary to a shoulder hematoma and neck abscess with multiple systemic complications in the absence of tonsillitis or oropharyngeal infection. Two weeks prior to presentation, the patient sustained a right shoulder injury and contracted COVID-19. Due to his Lemierre's syndrome, he developed right internal jugular vein and subclavian vein thrombosis, septic lung emboli, right sided Horner's syndrome, disseminated intravascular coagulation, pelvic collection, septic arthritis of pubic symphysis and osteomyelitis of the right pubic bone, and proximal left femoral shaft. The patient received non-operative and operative management to manage his Lemierre's syndrome including surgical drainage, antibiotics, and anticoagulation; he was discharged following an extended hospital stay. This case report highlights a rare presentation of Lemierre's syndrome secondary to a shoulder hematoma in a COVID-19 positive patient, and its potential systemic and life-threatening complications. Its importance is highly relevant in the context of the COVID-19 pandemic. Further studies are warranted to explore the effect of preceding COVID-19 infections on the microbiological profile in Lemierre's syndrome.
Topics: Humans; Male; COVID-19; Hematoma; Lemierre Syndrome; Young Adult; Shoulder; Fusobacterium necrophorum; Fusobacterium Infections; Abscess; SARS-CoV-2; Anti-Bacterial Agents
PubMed: 38078435
DOI: 10.1177/01455613231215166 -
Cureus Nov 2023Linea nigra is a distinctive presentation of asymptomatic cutaneous hyperpigmentation on the abdomen that usually extends from the umbilicus to the pubic symphysis. It...
Linea nigra is a distinctive presentation of asymptomatic cutaneous hyperpigmentation on the abdomen that usually extends from the umbilicus to the pubic symphysis. It is frequently observed as a physiologic change associated with pregnancy. A primigravida 19-year-old woman began to develop skin darkening during week 24 of gestation. She delivered a healthy infant. Three months postpartum, the hyperpigmentation had not resolved. After the benign characteristics of her cutaneous hyperpigmentation were explained, the patient decided to clinically monitor the dark linear streak. Similar to this patient, clinical studies of pregnant women have observed the incidence of pregnancy-associated linea nigra to range from 32% to 92%; in contrast to this woman, partial or complete spontaneous resolution of the skin darkening commonly occurs after delivery of the newborn. During gestation, the development of linea nigra has been postulated to be caused by elevated estrogen, progesterone, and/or melanocyte-stimulating hormone levels. Linea nigra is not restricted to gestational females; it has also been noted in newborns and children. In addition, it has also been observed in men who had either benign prostate hyperplasia or prostate cancer. In summary, linea nigra is often an acquired longitudinal streak of benign cutaneous hyperpigmentation on the abdomen; when linea nigra is pregnancy-associated, the skin darkening often partially or completely resolves, spontaneously after delivery.
PubMed: 38074022
DOI: 10.7759/cureus.48408 -
Journal of Clinical Medicine Nov 2023The increasing number of late complications described after cesarean sections is prompting a reexamination of the indications for them in pregnant women. The high... (Review)
Review
BACKGROUND
The increasing number of late complications described after cesarean sections is prompting a reexamination of the indications for them in pregnant women. The high percentage of pregnancies terminated by preventive cesarean section for non-obstetric reasons also largely involves orthopedic conditions. A challenge for obstetricians is pregnant patients with orthopedic conditions both before and during pregnancy. Pregnant women with a history of orthopedic surgery require special attention. The lack of consensus in this area, physicians' fear of patients' claims and the skewing of patients' requests for surgical termination of pregnancy have prompted an analysis and systematization of existing knowledge in this field.
METHODS
References published up to 30 June 2023 in five databases Pubmed, Embase are included. Keywords have been checked for the following: pubic symphysis diastasis, lumbar disc herniation, past hip arthroplasty and fractures in the pelvic bones. In the described conditions complicating pregnancy, the mode of delivery was taken into account.
RESULTS
All included studies were screened and reviewed by at least two authors until an overall consensus of 50 articles was reached.
CONCLUSIONS
Orthopedic indications for cesarean section in many cases should not be treated imperatively, since natural delivery after correct fusion of a pelvic fracture, implantation of a hip endoprosthesis or a limited dissection of the pubic symphysis is possible and is not associated with a higher risk of obstetric or orthopedic complications. Extra-obstetric indications for cesarean section should be determined individually for each pregnant woman in a multidisciplinary team, since orthopedic conditions may overlap with obstetric pathology in the pelvis.
PubMed: 38068388
DOI: 10.3390/jcm12237336 -
Patient Safety in Surgery Dec 2023The disruption of the pubic symphysis during the peripartum period is a rare injury to the pelvic ring. In most cases, conservative treatment is successful. Nonetheless,...
BACKGROUND
The disruption of the pubic symphysis during the peripartum period is a rare injury to the pelvic ring. In most cases, conservative treatment is successful. Nonetheless, there are cases where surgical intervention is necessary. We analyzed five surgical cases treated in our department and performed a literature review.
CASE PRESENTATIONS
Five women, ranging in age from 25 to 38, who experienced peripartum symphysis rupture were primarily treated with a conservative approach. Patients who did not show improvement and met certain criteria, such as experiencing pain starting from childbirth, having a separation in the pubic bone of more than 10 mm, and/or having a vertical instability greater than 5 mm, were recommended to undergo surgery. The average length of time between childbirth and surgery was 5.6 months, ranging from 1 to 14 months. One patient was treated with an external fixator, another patient received a combination of an external fixator and an anterior plate, and three patients were treated with anterior plates. In four cases, we observed a failure in fixation and a partial or complete loss of reduction. The plate and screws were removed in one case, and in three cases, revision surgery was performed. One case involved using a larger plate, while the other used 90-90 plating, known as "box plate fixation." The mean follow-up was 7.4 years. Two cases had good results, and two had excellent results on the Lindahl scale.
CONCLUSION
For patients with peripartum pubic symphyseal dislocation, our case series and literature review demonstrated that early reduction and fixation correlate with improved clinical outcomes and lower implant failure. For patients with subacute/chronic injuries, there was a higher incidence of implant failure. Orthogonal plate fixation and/or pubic symphysiodesis was associated with improved clinical outcomes.
PubMed: 38062457
DOI: 10.1186/s13037-023-00381-w -
Brain & Spine 2023•Key anterior approaches differences in LSTV include vascular (aortic bifurcation/iliocaval confluence), muscular (psoas) and osseus anatomy (inter-crestal... (Review)
Review
•Key anterior approaches differences in LSTV include vascular (aortic bifurcation/iliocaval confluence), muscular (psoas) and osseus anatomy (inter-crestal tangent/pubic symphysis), when compared to non-LSTV.•There are increased surgical deviations but not significantly greater complications for anterior approaches in LSTV.•Vascular awareness while accessing L45 will be in the presence of a more cephalad ABF and ICC with sacralized L5, and access to the deeper L56 level will be in the presence of a more caudal ABF and ICC in lumbarized S1.
PubMed: 38021000
DOI: 10.1016/j.bas.2023.101713 -
BJS Open Nov 2023Pelvic anatomy is critical in challenging rectal resections. This study investigated how pelvic anatomy relates to total mesorectal excision (TME) quality, anastomotic...
BACKGROUND
Pelvic anatomy is critical in challenging rectal resections. This study investigated how pelvic anatomy relates to total mesorectal excision (TME) quality, anastomotic leakage rate, and long-term oncological outcomes.
METHODS
Patients undergoing elective rectal cancer resection from 2008 to 2017 in an Austrian institution were retrospectively reviewed regardless of the surgical approach. CT scans were analysed for pelvic measurements and volumes. The primary outcomes of interest were the correlation between pelvic dimensions and the TME quality and anastomotic leakage. Subanalysis was done by surgical approach (open, laparoscopic, transanal TME). Secondary outcomes were overall and disease-free survivals.
RESULTS
Among 154 eligible patients, 112 were included. The angle between pubic symphysis and promontory significantly correlated with worse TME grades (TME grade 1: mean(s.d.) 102.7(5.7)°; TME grade 2: 92.0(4.4)°; TME grade 3: 91.4(3.6)°; P < 0.001). A significantly lower distance between tumour and circumferential resection margin (CRM) was observed in grade 3 resections, whereas no difference appeared in grade 1 and grade 2 resection (TME grade 1: mean(s.d.) 11.92(9.4) mm; TME grade 2: 10.8(8.1) mm; TME grade 3: 3.1(4.1) mm; P = 0.003). The anastomotic leakage rate was significantly higher in case of a lower CRM (patients with anastomotic leakage: mean(s.d.) 6.8(5.8) mm versus others: 12.6(9.8) mm, P = 0.027), but not associated with pelvimetry measurements. The transanal TME (TaTME) subgroup displayed a wider angle between the pubic symphysis and promontory, younger age and improved TME quality compared to others (respectively, mean TME grades in TaTME versus open versus laparoscopic: 1.0 ± 0.0, 1.5 ± 0.7 and 1.3 ± 0.5, P = 0.013). Finally, oncological survival was not impacted by pelvic measurements or worse TME quality.
CONCLUSION
The angle between the pubic symphysis and promontory and the distance between tumour and CRM were associated with worse TME grades. The anastomotic leakage was associated with a lower CRM but not with pelvimetric measures.
Topics: Female; Humans; Anastomotic Leak; Retrospective Studies; Rectal Neoplasms; Pelvis; Morbidity
PubMed: 38006203
DOI: 10.1093/bjsopen/zrad114 -
American Journal of Translational... 2023To analyze the association between transperineal pelvic floor ultrasound findings and posterior pelvic injury and prolapse in postpartum women.
OBJECTIVE
To analyze the association between transperineal pelvic floor ultrasound findings and posterior pelvic injury and prolapse in postpartum women.
METHODS
A total of 108 postpartum women received treatment from January 2020 and December 2022 were divided into 2 groups, with 53 cases in a pelvic floor disorder (PFD) group and 55 cases in the no PFD group according to whether they developed PFD after delivery. The relationship between ultrasound data and the Pelvic Floor Distress Inventory (PFDI-20) scores was analyzed by Pearson correlation. The diagnostic value of transperineal pelvic floor ultrasound for PFD was analyzed by using the receiver operating characteristic curve, and the relationship between transperineal pelvic floor ultrasound parameters and PFD was analyzed by using the RR hazard ratio.
RESULTS
The distance from the bladder neck to the posterior inferior border of the pubic symphysis, the distance from the cervix to the posterior inferior border of the pubic symphysis, and the shortening rate during retraction were shorter or lower in the PFD group than those in the no PFD group. Additionally, bladder descent, cervical subluxation, urethral rotation, anterior and posterior diameters of the static levator ani muscle (LAM), anterior and posterior diameters of the retracted LAM, anterior and posterior diameters of the LAM in the maximal Valsalva maneuver, and PFDI-20 scores in the PFD group were longer or higher than those of the no PFD group (P<0.01). Shortening rate during retraction, bladder descent, cervical subluxation, urethral rotation, and elongation at maximal Valsalva maneuver were positively correlated with the PFDI-20 score (R = 0.027, 0.053, 0.102, 0.002, 0.011, 0.123, respectively, all P<0.05).
CONCLUSIONS
The degree of bladder descent, cervical subluxation, urethral rotation, shortening rate during retraction, and elongation at maximal Valsalva maneuver are closely related to the PFD I-20 score.
PubMed: 37969208
DOI: No ID Found -
Frontiers in Immunology 2023Imaging can aid in determining potential causes of coccygeal pain and therefore guide clinicians to carry out individualized treatment. We represent a case of postpartum...
Imaging can aid in determining potential causes of coccygeal pain and therefore guide clinicians to carry out individualized treatment. We represent a case of postpartum coccydynia treated by platelet-rich plasma (PRP) which was assessed and followed by MRI. A primipara with uncomplicated labor developed coccygeal pain after delivery that significantly limited her postpartum recovery. On the first MR scan, recorded 6 months after delivery, there were edematous changes of the vertebral endplates of Co1-4 level (Modic type I) with the presence of pronounced precoccygeal venous drainage. Degenerative changes with signs of edema in the area of the pubic symphysis were recorded. The sacroiliac joints had regular morphological features. Since the patient was breastfeeding, PRP therapy was applied with a total of three injections in the area of the coccyx subcutaneously, once every 3 months. The subjective feeling of pain reduction after each injection was about 30%, with the complete withdrawal of pain after one year and still pain-free at the two-year follow-up. One year after the initial MR imaging, a follow-up MR examination was performed, where almost complete resolution of edematous changes in the previously present zones was observed, with residual minor edema of the vertebral endplates at the Co2-3 level. Edema of the pubic bones in the area of the pubic symphysis also subsided. A case of labor-induced coccydynia that was represented as Modic type I changes without neither fracture or luxation was successfully treated with PRP with complete resolution of symptoms.
Topics: Humans; Pregnancy; Female; Back Pain; Magnetic Resonance Imaging; Platelet-Rich Plasma; Edema; Labor, Induced
PubMed: 37965319
DOI: 10.3389/fimmu.2023.1239741 -
Journal of ISAKOS : Joint Disorders &... Feb 2024Core muscle injury is a debilitating condition that causes chronic groin pain in athletes, particularly common in soccer players. The condition is characterised by pain...
Optimised return to play: high treatment success rate in core muscle injury with surgical release of the anterior tendon of the rectus abdominis muscle and proximal tenotomy of the adductor longus muscle.
OBJECTIVES
Core muscle injury is a debilitating condition that causes chronic groin pain in athletes, particularly common in soccer players. The condition is characterised by pain in the inguinal region and can lead to a significant number of absences from high-intensity physical activity. It is caused by repetitive overload without proper counterbalance from the abdominal muscles, hip flexors, and adductors in susceptible athletes. Surgical indications for core muscle injury consider cases where non-surgical treatments have not provided sufficient relief. The aim of this study was to assess the results of surgical intervention for core muscle injury using the technique employed by the Sports Medicine Group of (Institute of Orthopedics and Traumatology of Hospital das Clínicas - Universidade de São Paulo). The procedure involves releasing the anterior portion of the tendon of the rectus abdominis muscle near the pubic symphysis, along with proximal tenotomy of the adductor longus muscle tendon.
METHODS
This study utilised a consecutive historical cohort analysis of the medical records of 45 male athletes, of which, 75.6% were professional soccer players, who underwent surgical treatment between January 1, 2002, and December 31, 2021. The participants included active athletes aged between 18 and 40 years, with a mean age of 23.9 years, and were diagnosed with myotendinous core muscle injury. These athletes experienced pain in the pubic symphysis and adductor tendon region and had previously undergone medical treatment and physical therapy for a duration of three to six months without significant improvement.
RESULTS
The average time for athletes to return to sport after surgery was 135 days, with a majority of participants being soccer and futsal players. The surgical intervention yielded promising results, with a positive correlation between unilateral injuries and the time taken to return to sport. The complication rate was low, at 6.7%. Notably, the rate of symptom resolution was high, at 93.3%. Furthermore, the analysis indicated that the player's position on the field significantly influenced the discharge period, suggesting that the game position plays a role in the recovery process.
CONCLUSION
The combined surgical procedure involving the release of the rectus abdominis tendon and adductor longus muscle tenotomy demonstrates favourable outcomes for athletes with core muscle injury. This study provides strong support for the effectiveness of this surgical approach in managing the condition and offers a potential path to recovery and return to sports activities.
STUDY DESIGN
Cross-sectional study.
Topics: Humans; Male; Adolescent; Young Adult; Adult; Tenotomy; Rectus Abdominis; Return to Sport; Cross-Sectional Studies; Athletic Injuries; Brazil; Tendons; Chronic Pain
PubMed: 37931748
DOI: 10.1016/j.jisako.2023.10.013 -
IDCases 2023is a Gram-positive, catalase-negative coccus, rarely responsible for urinary tract infections and seldom described for musculoskeletal infections like spondylodiscitis....
is a Gram-positive, catalase-negative coccus, rarely responsible for urinary tract infections and seldom described for musculoskeletal infections like spondylodiscitis. An 86-year-old man presented to our hospital for groin pain without fever. Pelvic CT-guided biopsy revealed an pubic symphysis osteomyelitis. He received a treatment by amoxicillin for six weeks, and did not need any surgery. An eight -month- follow-up showed a favorable evolution. Pubic symphysis infection can be induced by a wide variety of pathogens, and may have very different clinical presentations. Some authors recommend systematic surgery, but in case of susceptible pathogen associated with a low level of joint destruction, medical treatment alone should be sufficient to cure and make surgery unnecessary.
PubMed: 37928817
DOI: 10.1016/j.idcr.2023.e01911