ABSTRACT
Introduction Traumatic diaphragmatic injuries (TDIs) are uncommon and the incidence of TDI is difficult to estimate because of the variation in reporting missed or late detected diaphragmatic injuries. Therefore, our study's aim was to investigate the prevalence of traumatic diaphragmatic injury in the thoracoabdominal trauma, discuss the etiological factors, diagnostic investigations, and outcomes in TDIs, and evaluate predictors of mortality in patients who were diagnosed at King Abdulaziz Medical City in Riyadh, Saudi Arabia. Materials and methods This observational retrospective cohort study was conducted at King Abdulaziz Medical City (KAMC), a tertiary hospital in Riyadh, Saudi Arabia. The study included all adult patients aged 18 years or older diagnosed with traumatic diaphragmatic injuries between the years 2016 and 2020. The BESTCare electronic system was used to get the patient's medical records and extract the data. Pearson χ2 test was used for categorical variables, and an independent t-test was used for continuous variables to investigate the association between predictors and outcomes. Results A total of eight patients were involved in this study. The mean age of the patients was 49 years old. Males outnumbered females by 75%. Patients admitted with blunt injuries were greater by 75% compared to penetrating injuries by 25%. The left side of the diaphragm was the most common site of injury. The total number of patients who were admitted to the ICU was five, four of whom had blunt trauma and one had a penetrating injury. Conclusion The demographic data of the patients included in this study corresponded to that in the literature. Although not reaching a statistically significant level, ICU admissions and mortality were mostly associated with blunt injuries. Larger multi-center studies are required to further investigate the incidence of traumatic diaphragmatic injuries (TDI).
ABSTRACT
INTRODUCTION AND IMPORTANCE: Extraskeletal Ewing's sarcoma (EES) is a collection of malignant cells that appear small and round and occur mostly in pediatrics and adolescence. Head and neck EES tumors are considered rare and require multidisciplinary care to achieve ideal results in management. CASE PRESENTATION: A 14-year-old boy who complained of a mass protruding from the back of his neck which gradually increased in size in the last few months prior to the diagnosis. He was referred to a pediatric otolaryngology clinic with a one-year history of chronic painless nape swelling. Ultrasound prior to the referral was done and the findings revealed a well-defined rounded hypoechoic lesion with internal vascularity. MRI was done and the impression was a large subcutaneous, well defined enhancing soft tissue lesion which raised the suspicion of sarcoma. The multidisciplinary team decision was to go for complete resection with a free margin followed by chemoradiation postoperatively. No evidence of recurrence was detected throughout the follow-up. CLINICAL DISCUSSION: The literature review included ages of the pediatric group from 4 months up to 18-year-old. Clinical features are highly dependable on the size and site of the lesion. Complete resection of the tumor plays an important role in the local control and prognosis. CONCLUSION: We present a rare case of extraskeletal Ewing's sarcoma of the nape. Computed tomography and magnetic resonance imaging are frequently used as imaging modalities in evaluating and diagnosing EES. Management commonly includes surgery with adjuvant chemotherapy to decrease recurrence and prolong the survival rate.
ABSTRACT
Background Neuromuscular Scoliosis (NMS) is defined as "a coronal plane spinal curvature of 10 degrees or more, measured by the Cobb method, in the setting of muscle imbalance secondary to an underlying neuropathic or myopathic disease". Patients who have the disease usually manifest with diminished balance, asymmetrical seating, abnormal gait, and decreased pulmonary function, which are related to the change in spine posture. Surgery benefits patients with NMS in terms of stopping disease advancement and improving quality of life, but is known to be associated with certain complications in this population. The aim of this study is to identify the most common complication in NMS patients after surgical correction. Methods This study is a chart review-based retrospective case series that has covered patients' data going from 2015 to 2019. The study focused on patients who underwent scoliosis correction surgery of both genders and mainly of a single ethnicity, with the inclusion of patients aged 9 to 18 years old. Under consecutive sampling, the study has met a sample size of 14 patients. Results Most of the study subjects nine (64%) were female. The age median was 13 years (2.25). The highest documented intraoperative complication was blood loss in 11 (79%) patients. The most prevalent early postoperative complication was urinary tract infection in two (14%) patients. No late postoperative complications were documented in the study. Conclusion The study concluded that blood loss was the most common intraoperative complication. Pulmonary problems were one of the least reported complications. Possible reasons for these findings and prevention methods should be the focus of future studies.
