Analysis of the causes of primary revision after unicompartmental knee arthroplasty: A case series

BACKGROUND Unicompartmental knee arthroplasty(UKA)has great advantages in the treatment of unicompartmental knee osteoarthritis,but its revision rate is higher than that of total knee arthroplasty.AIM To summarize and analyse the causes of revision after UKA.METHODS This is a retrospective case series study in which the reasons for the first revision after UKA are summarized.We analysed the clinical symptoms,medical histories,laboratory test results,imaging examination results and treatment processes of the patients who underwent revision and summarized the reasons for primary revision after UKA.RESULTS A total of 13 patients,including 3 males and 10 females,underwent revision surgery after UKA.The average age of the included patients was 67.62 years.The prosthesis was used for 3 d to 72 months.The main reasons for revision after UKA were improper suturing of the surgical opening(1 patient),osteophytes(2 patients),intra-articular loose bodies(2 patients),tibial prosthesis loosening(2 patients),rheumatoid arthritis(1 patient),gasket dislocation(3 patients),anterior cruciate ligament injury(1 patient),and medial collateral ligament injury with residual bone cement(1 patient).CONCLUSION The causes of primary revision after UKA were gasket dislocation,osteophytes,intra-articular loose bodies and tibial prosthesis loosening.Avoidance of these factors may greatly reduce the rate of revision after UKA,improve patient satisfaction and reduce medical burden.

Using clinical cases to guide healthcare

Evidence-based practice(EBP)has been the gold standard in healthcare for nearly three centuries and aims to assist physicians in providing the safest and most effective healthcare for their patients.The well-established hierarchy of evidence lists systematic reviews and meta-analyses at the top however these methodologies are not always appropriate or possible and in these instances case-control studies,case series and case reports are utilised to support EBP.Case-control studies allow simultaneous study of multiple risk factors and can be performed rapidly and relatively cheaply.A recent example was during the Coronavirus pandemic where case-control studies were used to assess the efficacy of personal protective equipment for healthcare workers.Case series and case reports also play a role in EBP and are particularly useful to study rare diseases such as inflammatory bowel disease in transgender and gender non-conforming individuals.They are also vital in generating and disseminating early signals and encouraging further research.Whilst these methodologies have weaknesses,particularly with regards to bias and loss of patient confidentiality for rare pathologies,they have an important part to play in EBP and when appropriately utilised can significantly impact upon clinical practice.

Arthroscopic M-shaped suture fixation for tibia avulsion fracture of posterior cruciate ligament:A modified technique and case series

BACKGROUND Tibial avulsion fractures of the posterior cruciate ligament(PCL)are challenging to treat and compromise knee stability and function.Traditional open surgery often requires extensive soft tissue dissection,which may increase the risk of morbidity.In response to these concerns,arthroscopic techniques have been evolving.The aim of this study was to introduce a modified arthroscopic tech-nique utilizing an M-shaped suture fixation method for the treatment of tibial avulsion fractures of the PCL and to evaluate its outcomes through a case series.AIM To evaluate the effects of arthroscopic M-shaped suture fixation on treating tibia avulsion fractures of the PCL.METHODS We developed a modified arthroscopic M-shaped suture fixation technique for tibia avulsion fractures of the PCL.This case series included 18 patients who underwent the procedure between January 2021 and December 2022.The patients were assessed for range of motion(ROM),Lysholm score and International knee documentation committee(IKDC)score.Postoperative complications were also recorded.RESULTS The patients were followed for a mean of 13.83±2.33 months.All patients showed radiographic union.At the final follow-up,all patients had full ROM and a negative posterior drawer test.The mean Lysholm score significantly improved from 45.28±8.92 preoperatively to 91.83±4.18 at the final follow-up(P<0.001),and the mean IKDC score improved from 41.98±6.06 preoperatively to 90.89±5.32 at the final follow-up(P<0.001).CONCLUSION The modified arthroscopic M-shaped suture fixation technique is a reliable and effective treatment for tibia avulsion fractures of the PCL,with excellent fracture healing and functional recovery.

Ocular syphilis:a case series of four patients and a review of the literature

Background:The incidence of syphilis has been increasing in the United States over the last two decades,with a more recent increase among women.Ocular syphilis is an uncommon but important complication of syphilis,most often presenting as posterior or panuveitis in late or latent syphilis of unknown duration.Untreated ocular syphilis may lead to permanent vision loss,underscoring the importance of appropriate evaluation and treatment of ocular syphilis.Case Description:In a retrospective,non-contiguous case series,we highlight four patients diagnosed and treated with ocular syphilis at a single institution.Four presentations of ocular syphilis are illustrated:anterior and intermediate uveitis,optic neuritis,posterior uveitis,and panuveitis.All patients initially presented with a decreased visual acuity(VA).One patient had a previous diagnosis of human immunodeficiency virus(HIV).Three patients were treated with intravenous(IV)penicillin and one patient with IV ceftriaxone.All had a return to their baseline VA after their course of treatment.Conclusions:Syphilis may go undetected without a high index of clinical suspicion due to its nonspecific presentations.All patients with ocular inflammation should have syphilis testing as a part of their infectious workup with both treponemal and non-treponemal testing.Patients diagnosed with syphilis and are not known to be HIV-negative should undergo testing for HIV due to the high rate of co-infection.Early diagnosis and prompt treatment after onset of symptoms may contribute to a more favorable prognosis for ocular syphilis.

Comparison of Oral Manifestations in Hospitalized COVID-19 Positive Patients and COVID-19 Negative Dental Outpatients. A Case Series Study and Literature Review

Background: The Coronavirus disease 2019 (COVID-19) is a respiratory infectious disease, also named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which can cause various systemic manifestations that pose a threat to human life. Oral lesions in patients with COVID-19 may appear during or after the illness and may or may not be a consequence of the viral infection. Objective: In this case series we compare the oral manifestations in hospitalized COVID-19 positive patients and COVID-19 negative dental outpatients. Methods: 60 hospitalized COVID-19 patients and 41 control patients, were examined for oral signs and symptoms. The controls were dental patients who visited the hospital for dental care without complaining of any problems related to the oral cavity itself. Results: We have observed a strong association between certain clinical findings and COVID-19, including alterations in taste (ageusia, dysgeusia, and hypogeusia), anosmia, hairy tongue, tongue imprints, red tongue, erythematous candidiasis, pseudomembranous candidiasis, and exfoliative cheilitis. A trend but not statistically significant association at the level of 5% was also noted for colored tongue, linea alba, and pale mucosa. On the contrary, fissured tongue and oral mucosa pigmentation were more frequent in the controls, statistically significant at the level of 5%. Conclusion: COVID-19 has been found to impact the oral cavity, resulting in various oral lesions that can be attributed to either the direct action of the virus or the patient’s immune response.

Experience with the surgical treatment of hepatic hydatidosis: Case series with follow-up

AIM: To describe patient characteristics and the results of surgical treatment for hepatic hydatidosis (HH) in the Hospital Hernán Henríquez Aravena from December 2001 to March 2005. METHODS: Subjects older than 16 years with suspected HH were included based on the clinical picture and radiological studies. Variables examined included clinical and laboratory aspects, outcome, features of the parasite and surgical aspects. Descriptive statistics were used, calculating central tendency, dispersion and extreme tendency. RESULTS: The series was comprised of 122 patients, with an average age of 44 ± 16.9 years. The most frequently used surgical technique was subtotal cys-tectomy in 90% of the patients, followed by hepatic resection (hepatectomy, segmentectomy and subsegmentectomy) in 5%. In 2%, a combination of subtotal cystectomy and segmentectomy was performed. In addition, 28% of the series presented complications in the postoperative period and mortality was 2%. CONCLUSION: The most frequently used surgical technique for HH was subtotal cystectomy and the morbidity and mortality rates in this Chilean series are comparable to other national and international series.

Oxaliplatin-induced severe anaphylactic reactions in metastatic colorectal cancer: Case series analysis

AIM: To investigate oxaliplatin-induced severe anaphylactic reactions (SAR) in metastatic colorectal cancer in a retrospective case series analysis and to conduct a systemic literature review. METHODS: During a 6-year period from 2006 to 2011 at Kaohsiung Veterans General Hospital, a total of 412 patients exposed to oxaliplatin-related chemotherapy were retrospectively reviewed. Relevant Englishlanguage studies regarding life-threatening SAR following oxaliplatin were also reviewed in MEDLINE and PubMed search. RESULTS: Eight patients (1.9%, 8 of 412 cases) were identified. Seven patients were successful resuscitated without any sequelae and one patient expired. We changed the chemotherapy regimen in five patients and rechallenged oxaliplatin use in patient 3. Twenty-three relevant English-language studies with 66 patients were reported. Patients received a median of 10 cycles of oxaliplatin (range, 2 to 29). Most common symptoms were respiratory distress (60%), fever (55%), and hypotension (54%). Three fatal events were reported (4.5%). Eleven patients (16%) of the 66 cases were rechallenged by oxaliplatin. CONCLUSION: SAR must be considered in patients receiving oxaliplatin-related chemotherapy, especially in heavily pretreated patients. Further studies on the mechanism, predictors, preventive methods and management of oxaliplatin-related SAR are recommended.

Utility of positron emission tomography-computed tomography scan in detecting residual hepatocellular carcinoma post treatment:Series of case reports

BACKGROUND Multi-phase computed tomography(CT)or magnetic resonance imaging(MRI)has been the standard of care for hepatocellular carcinoma(HCC)diagnosis for years.CASE SUMMARY We report a case series of four patients in whom positron emission tomographycomputed tomography(PET-CT)scan complemented the conventional CT/MRI scans in evaluating treatment response.In these four cases the conventional multi-phase CT and MRI failed to identify residual HCC disease post-treatment,while PET-CT complemented and aided in treatment response evaluation.In each case,the addition of PET-CT identified and located residual HCC disease,allowed retreatment,and altered medical management.CONCLUSION This case series suggests that PET-CT should perhaps play a role in the HCC management algorithm,in addition to the conventional contrast-enhanced multiphase scans.

Maternal death due to severe and critical COVID-19 in Qom,Iran:A case series

Objective:To report the maternal death due to COVID-19.Methods:A total of 14 maternal deaths due to severe and critical COVID-19 who were referred to the obstetric department of Nekouie-Forghani-Hedayati Hospital,Qom,Iran from December 2019 to May 2022 were collected.The clinical manifestations and maternal and perinatal outcomes were analyzed.Results:Dexamethasone was used in 7 cases,while remdesivir was used in 5 cases.Acute respiratory distress syndrome,multiple organ failure,and sepsis were the main cause of mother death.The pregnancy in 8 cases were terminated by caesarean and only one neonatal death was reported from a mother at 13th week of gestational age,while all other fetus delivered were healthy and alive.Conclusions:COVID-19 in pregnancy is an emergency.Critical appraisal is needed to detect the other comorbidities and positive PCR test by throat swap should be performed as soon as possible.

Long-term experience with debulking surgery in extensive hepatic alveolar echinococcosis:A case series and literature review

Objective:To assess the role of debulking surgery in extensive hepatic alveolar echinococcosis(HAE).Methods:Five cases of extensive HAE undergoing debulking surgery with their long-term follow-ups were reported.Additionally,a systematic review was carried out.Results:The average age of patients in the study was(50.8±17.1)years(range 36 to 77 years).Three cases were female.The median follow-up period was 61 months(range 12 to 84 months).Left liver resections were performed in 2 cases and right hemihepatectomies were undertaken in 2 cases.Two patients(cases 2 and 4)developed early surgical complications,while one of them(case 4)who suffered from the recurrent sub-hepatic abscess died at 12 months postoperatively.Conclusions:This study highlights the importance of debulking surgery for the management of complex symptomatic HAE lesions in patients with no curative option available.

Fabry Disease with Aseptic Meningitis:A Case Series and Literature Review of an Underestimated Clinical Presentation

Objective Fabry disease(FD)is an X-linked lysosomal storage disease caused by the mutation in theα-galactosidase A gene that leads to a consequently decreasedα-galactosidase A enzyme activity and a series of clinical presentations.However,FD accompanied with aseptic meningitis can be relatively scarce and rarely reported,which leads to significant clinical misdiagnosis of this disease.Methods Sixteen patients diagnosed with FD based on a decreased activity ofα-galactosidase A enzyme and/or genetic screening were identified through a 6-year retrospective chart review of a tertiary hospital.Clinical presentations,brain magnetic resonance imaging,cerebrospinal fluid analysis,treatment and outcome data were analyzed in cases of aseptic meningitis associated with FD.Results Three out of 16 cases exhibited aseptic meningitis associated with FD.There was one female and two male patients with a mean age of 33.3 years.A family history of renal failure or hypertrophic cardiomyopathy was found in 3 cases.All cases presented with a persistent or intermittent headache and recurrent ischemic stroke.The cerebrospinal fluid analyses showed mild pleocytosis in 2 patients and an elevated level of protein in all patients.Cerebrospinal fluid cytology revealed activated lymphocytes,suggesting the existence of aseptic meningitis.In the literature review,up to 9 cases presenting with FD and aseptic meningitis were found,which bore a resemblance to our patients in demographic and clinical characteristics.Conclusion Our cases suggested that aseptic meningitis in FD might be under-detected and easily misdiagnosed,and should be more thoroughly examined in further cases.

Case series of COVID-19 patients from the Qinghai-Tibetan Plateau Area in China

BACKGROUND Coronavirus disease 2019(COVID-19)is a serious infection caused by the new coronavirus severe acute respiratory syndrome coronavirus 2.The disease was first identified in December 2019 and has caused significant morbidity and mortality worldwide.AIM To explore the clinical characteristics and treatments for COVID-19 in the Qinghai-Tibetan Plateau Area in China.METHODS We retrospectively analyzed the blood cell counts(neutrophils and lymphocytes),blood gas analysis,and thoracic computed tomography changes of patients from Qinghai Province before,during,and after treatment(January 23,2020 to February 21,2020).In addition,we summarized and analyzed the information of critical patients.All data were analyzed using SPSS 17.0(SPSS Inc.,Chicago,IL,United States).The quantitative and count variables are represented as the mean±SD and n(%),respectively.RESULTS The main symptoms and signs of patients with COVID-19 were fever,dry cough,cough with phlegm,difficulty breathing,and respiratory distress with a respiration rate≥30 times/min,finger oxygen saturation≤93%in the resting state,and oxygenation index less than 200 but greater than 100(after altitude correction).Eighteen patients with COVID-19,of whom three were critical,and the others were in a mild condition,were included.The main manifestations included fever,dry cough,and fatigue.Three patients developed difficulty breathing and had a fever.They were eventually cured and discharged.Adjuvant examinations showed one case with reduced white cell count(6%)(<4×10^(9)/L),six with reduced count of lymphocytes(33%)(<0.8×10^(9)/L),and one with abnormal blood glucose level.All 18 patients were discharged,and no death occurred.CONCLUSION Our findings provide critical insight into assessing the clinical diagnosis and treatment for COVID-19 in the Tibetan plateau area.

Retroperitoneal and abdominal bleeding in anticoagulated COVID-19 hospitalized patients:Case series and brief literature review

BACKGROUND Hospitalized and severely ill coronavirus disease 2019(COVID-19)patients necessitate prophylactic or therapeutic anticoagulation to minimize the risk of thrombosis at different sites.Life-threatening bleeding complications include spontaneous iliopsoas hematoma,peritoneal bleeding,and extra-abdominal manifestations such as intracranial hemorrhage.CASE SUMMARY Bleeding in the abdominal wall results in less severe complications than seen with iliopsoas hematoma or peritoneal bleeding.In our case series of 9 patients,we present retroperitoneal and abdominal bleeding complications following anticoagulation in hospitalized COVID-19 patients with severe acute respiratory syndrome coronavirus 2 pneumonia.Contrast-enhanced computed tomography(CE-CT)is the best imaging modality for assessing hematoma secondary to anticoagulation and determines the therapeutic approach,whether interventional,surgical,or conservative management.CONCLUSION We present the role of CE-CT for rapid and precise localization of the bleeding site and prognostic counseling.Finally,we provide a brief review of the literature.

Acute postoperatory visual loss following bilateral lung transplantation surgery:a case series

Dear Editor,I am Rosa Gutiérrez Bonet,former ophthalmology resident at Puerta de Hierro University Hospital,Madrid,Spain.I write to present four cases of cortical blindness（CB）after bilateral lung transplant（LT）.

Neurological manifestations of COVID-19 infection:A case series

Neurological symptoms of COVID-19 infection can be lethal if optimum intervention is not provided at the right time.However,it is extremely important to distinguish the non-specific symptoms of COVID-19 according to its severity directly or indirectly caused by the coronavirus.Here,we present five radiological case studies of COVID-19 to highlight the wide array of neurological manifestations associated with COVID-19.

Case series in Indonesia:B.1.617.2(delta)variant of SARS-CoV-2 infection after a second dose of vaccine

BACKGROUND The B.1.617.2(delta)variant of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)was first discovered in Maharashtra in late 2020 and has rapidly expanded across India and worldwide.It took only 2 mo for this variant to spread in Indonesia,making the country the new epicenter of the delta variant as of July 2021.Despite efforts made by accelerating massive rollouts of current vaccines to protect against infection,cases of fully-vaccinated people infected with the delta variant have been reported.AIM To describe the demographic statistics and clinical presentation of the delta variant infection after the second dose of vaccine in Indonesia.METHODS A retrospective,single-centre case series of the general consecutive population that worked or studied at Faculty of Medicine,Universitas Indonesia with confirmed Delta Variant Infection after a second dose of vaccine from 24 June and 25 June 2021.Cases were collected retrospectively based on a combination of author recall,reverse transcription-polymerase chain reaction(RT-PCR),and whole genome sequencing results from the Clinical Microbiology Laboratory,Faculty of Medicine,Universitas Indonesia.RESULTS Between 24 June and 25 June 2021,15 subjects were confirmed with the B.1.617.2(delta)variant infection after a second dose of the vaccine.Fourteen subjects were vaccinated with CoronaVac(Sinovac)and one subject with ChAdOx1 nCoV-19(Oxford-AstraZeneca).All of the subjects remained in home isolation,with fever being the most common symptom at the onset of illness(n=10,66.67%).The mean duration of symptoms was 7.73 d(±5.444).The mean time that elapsed from the first positive swab to a negative RT-PCR test for SARS-CoV-2 was 17.93 d(±6.3464).The median time that elapsed from the second dose of vaccine to the first positive swab was 87 d(interquartile range:86-128).CONCLUSION Although this case shows that after two doses of vaccine,subjects are still susceptible to the delta variant infection,currently available vaccines remain the most effective protection.They reduce clinical manifestations of COVID-19,decrease recovery time from the first positive swab to negative swab,and lower the probability of hospitalization and mortality rate compared to unvaccinated individuals.

Choroidal neovascularization post macular surgery:a case series

Dear Editor,My name is Georgios Tsokolas and I am currently working as Medical Retina Research Fellow at the Eye Unit of Southampton General Hospital in United Kingdom.

Complexity of Giant GIST Case Series and Review of the Literature

Background: Gastrointestinal stromal tumors are the most common type of mesenchymal tumors of the GI tract, most commonly found in the stomach and intestines. They are thought to grow from the interstitial cells of Cajal (ICCs) or precursors of these cells. They have an insidious onset and may grow to a very large size depending on the site of origin. Material and method: We present a case series of three patients who had very large GISTs that had different presentations and outcomes. Patients were from different backgrounds and all were above 50 years old. Each one had a palpable mass in the abdomen in the initial presentation with a multilobulated mass at imaging devoting malignant behavior and higher risk of the tumor. They are managed according to guidelines and treated with Imatinib, but none of them had genetic and molecular studies of the tumor due to non-availability of the test. Conclusion: As a conclusion, GISTs are not easy to diagnose especially in the early phase of the disease and it may take years for it to become clinically relevant. Thence a thorough medical history and physical exam with imaging and endoscopies are the main diagnostic modalities with the importance of molecular profiling that will guide therapy and predicting prognosis.

Revisiting the upper eyelid blepharoplasty advancement flap:adaptation for the repair of full-thickness upper eyelid defects—a case series

A blepharoplasty flap has been previously reported as a useful reconstruction approach for anterior lamellar defects lying between the lash line and the eyelid crease.We herein describe a variation of the blepharoplasty flap and suggest its use as an adjunct in the reconstruction of full-thickness lateral upper eyelid defects.Technique description and retrospective interventional case series.The reconstruction technique was used by an experienced oculoplastics surgeon(ASL)in 3 adults with malignant lesions involving the lateral upper eyelid margin,resulting in a post-excision 50%full-thickness defect between November 2017 and June 2020.The posterior lamella was reconstructed using an ipsilateral free tarsal graft and an inferiorly hinged transposition periosteal flap.The anterior lamella reconstruction was then performed using a local advancement flap utilizing the principles of upper blepharoplasty and Burow’s triangle.Almost full eyelid excursion and full gentle closure were evident at 1–2 weeks follow-up in all three cases.One case later developed 1–2 mm of gentle closure lagophthalmos and was managed successfully with topical lubricants.In all patients,the final eyelid contour and symmetry were adequate,with only minimal scarring,evident already 3 to 4 months postoperative.There were no major complications or need for revisions.The technique described herein highlights the utility of the blepharoplasty flap for lateral,full-thickness upper eyelid defects.This logical variation enables the reconstruction of significant defects using only local tissue,obeying the“like with like”principle,and helps avoid the need for a bridging flap.We provide preliminary evidence of the potential of a good cosmetic outcome of upper lid appearance and contour,together with a fast recovery of appropriate eyelid function.

Reconstruction of total lower eyelid defect-a case series

Background:Total lower eyelid defect after eyelid malignancy excision poses a challenge in the surgical management of total lower eyelid reconstruction.We describe a technique of reconstructing total lower eyelid defect,using a skin flap and the residual lower forniceal conjunctiva.Methods:A retrospective case series review.Five patients had undergone lower eyelid basal cell carcinoma excision.A 3-4 mm margin excision was performed and specimens were sent for paraffin section histological examination.Reconstruction was performed at the same stage,using a skin flap and the residual lower forniceal conjunctiva.A full thickness skin flap is raised from the lateral cheek,with its base at the lateral canthus.Subcutaneous tissues are not included in the skin flap.The lower forniceal conjunctiva is released from the inferior retractors and advanced superiorly to cover the inner surface of the skin flap.The skin flap is transposed to cover the lower eyelid defect and sutured to the soft tissues at the medial end of the defect.The advanced forniceal conjunctiva is sutured to the superior edge of the skin flap forming the new mucocutaneous junction of the eyelid margin.Results:There were 4 females and 1 male,with a mean age of 74 years(range,68-80 years).Histological clearance was achieved in all cases.None of the patients developed lagophthalmos,symblepharon or dry eye symptoms.None of the patients required any further revision surgery.Conclusions:Total lower eyelid defects can be reconstructed using the residual lower fornix conjunctiva and a skin flap.