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1.
Urol Case Rep ; 49: 102453, 2023 Jul.
Article in English | MEDLINE | ID: mdl-37323771

ABSTRACT

Renal cell carcinoma is a cancer thought to originate from renal epithelial cells. Commonly seen in patients older than 60 years of age, renal cell carcinoma presents as rare pathological entity seen in urological cancers among the pediatric population. A 17-year-old female patient presented with complaints of intermittency, dysuria, and gross hematuria. Radiological imaging was in favor of a left renal mass. Under general anesthesia, the left kidney was completely laparoscopically resected and sent to pathology, which along with correlating the age group of the patient and the morphology on pathological analysis, was suggestive of microphthalmia family translocation renal cell carcinoma.

2.
Ann Med Surg (Lond) ; 72: 103075, 2021 Dec.
Article in English | MEDLINE | ID: mdl-34849221

ABSTRACT

BACKGROUND: The treatment of unstable fractures of the intertrochanteric region of the hip in the elderly is controversial. Conventionally, internal fixation with intramedullary nail or a dynamic hip screw is the treatment of choice in intertrochanteric fractures. Nowadays, some authors encouraged the use hip arthroplasty for management of these fractures with good outcome. The aim of this study is to compare total hip arthroplasty with hook plate against total hip arthroplasty with cerclage cables in the management of unstable intertrochanteric fractures. MATERIALS AND METHODS: Out of 100 admitted patients to a central university hospital in Beirut between 2013 and 2019 with a diagnosis of unstable intertrochanteric fracture of the hip, only 64 (36 hook plate vs 28 cerclage) patients were selected. This is a retrospective study, patients were excluded if lost to follow up, or if follow up less than one year is available. The data were retrieved from inpatient and outpatient hospital files. Functional outcomes were assessed according to ambulatory capacity. The main clinical measures were early postoperative full weight bearing, postoperative complications, functional outcome and radiologic assessment done by a radiologist in addition to measuring the dysfunction via the Harris Hip Score. RESULTS: The time to full weight bearing, the rate of postoperative complications, radiologic outcome and the functional outcomes were more satisfactory in the hook - plate group than in the cerclage - cable group. CONCLUSION: According to the results, total hip arthroplasty with hook plate is considered the preferred modality of treatment in mobile elderly patients above sixty-five years of age with an unstable intertrochanteric femoral fracture, despite being a bulky foreign material that can lead to trochanteric bursitis.

3.
Arthrosc Tech ; 10(3): e647-e652, 2021 Mar.
Article in English | MEDLINE | ID: mdl-33738197

ABSTRACT

Anterior cruciate ligament (ACL) rupture remains a debilitating orthopaedic pathology with a substantial economic and psychological burden on patients, especially athletes. The purpose of ACL reconstruction is to attain maximum joint stability and functionality, allowing patients to resume their previous level of activity. Several graft options and techniques are available for ACL reconstruction. The all-inside remnant-preservation technique is a minimally invasive approach aiming for improved proprioception, better graft integration, and increased graft strength via ACL augmentation by suture approximation with an optimal anatomic reconstruction. ACL augmentation is associated with a decreased risk of rerupture. Moreover, enhancement of knee proprioception via the presented technique allows an early return to activity by patients because weight bearing (with a brace) can be initiated as early as day 1 postoperatively. Patients can resume running activities by 2 months postoperatively and return to pivot sports by 3 months postoperatively. Despite this surgical procedure being technically demanding, it is associated with improved clinical outcomes and functional capacities. Patients are also found to better tolerate the postoperative rehabilitation protocol.

4.
Case Rep Gastroenterol ; 15(3): 966-971, 2021.
Article in English | MEDLINE | ID: mdl-35082592

ABSTRACT

Omphalitis is an inflammation of the umbilicus and is seldom diagnosed in adults. It is even rarer when it results from an infection of the urachus, an embryological remnant that connects the umbilicus to the dome of the bladder. Patients with omphalitis present with erythema, edema, tenderness, and purulent discharge form the umbilical stump. Workup includes ultrasonography and CT scan of the abdomen and pelvis. Management consists of antibiotics and incision and drainage of the umbilical abscess, followed by surgical resection of the urachal remnant. In this article, we report a case of omphalitis complicated by umbilical abscess in a 20-year-old female with a urachal remnant.

5.
Int J Surg Case Rep ; 73: 90-94, 2020.
Article in English | MEDLINE | ID: mdl-32650261

ABSTRACT

INTRODUCTION: Total knee arthroplasty (TKA) are associated with significant postoperative blood loss. Tranexamic acid (TXA) is a potent agent with antifibrinolytic activity, that can be administered via the intravenous (IV) and/or topical (intra-articular, IA) route, which can possibly interrupt the cascade of events due to hemostatic irregularities close to the source of bleeding. However, the literature contains scarce scientific evidence related to IV only TXA usage in TKA. The current study aims to compare the outcome between patients who were administered IV TXA and a control group in terms of blood loss, transfusion rate, and incidence of deep vein thrombosis (DVT) and thromboembolism (TE). METHODS: 110 patients, who underwent TKA were placed into two groups: 1) 34 patients who received IV TXA; and 2) 76 patients in the control group. In the TXA group, patients received an IV TXA dose of 1 g, 30 min before incision. Two drains were placed. RESULTS: Usage of IV TXA showed better results when compared to the control group in terms of mean blood transfusion (0.5 less transfusion during hospital stay), hemoglobin drop (10%). No cases of DVT or TE were noted among the two study groups. CONCLUSION: Use of IV TXA provided significantly better results compared to no TXA use with respect to all variables related to postoperative blood loss in TKA. Moreover, TXA use is safe in terms of incidence of symptomatic DVT and TE.

6.
Int J Surg Case Rep ; 71: 266-269, 2020.
Article in English | MEDLINE | ID: mdl-32480335

ABSTRACT

INTRODUCTION: Spinoglenoid cysts are a rare cause of suprascapular neuropathy of compressive etiology in which the patient may present with shoulder pain and muscle hypotrophy. MRIs are the imaging modality of choice showing location, size, and extent of the lesion for preoperative assessment. Currently, surgical intervention is the preferred approach for the management of a spinoglenoid cyst with arthroscopy being favored over the open technique. CASE PRESENTATION: A 25-year-old male patient presenting with right posterior shoulder pain and decreased range of motion associated with the development of progressive weakness of the supraspinatus and infraspinatus muscles. Right shoulder MRI showed a posterior tear of the glenoid labrum and a spinoglenoid ganglion cyst. Preoperative electroneuromyography was suggestive of a suprascapular nerve impairment. FOLLOW-UP: Six months postoperatively, the patient has regained full range of motion of his right shoulder with no residue signs of muscle hypotrophy. CONCLUSION: Spinoglenoid cysts can cause compressive neuropathy with associated pain and muscle hypotrophy. MRI and EMG can help in establishing the diagnosis and in the pre-operative assessment. Surgical intervention with arthroscopy is currently the technique preferred by most surgeons.

7.
Arthrosc Tech ; 9(6): e829-e835, 2020 Jun.
Article in English | MEDLINE | ID: mdl-32577359

ABSTRACT

This article aims to describe a modification of the arthroscopic suture bridge technique for repair of a massive (>3 cm) rotator cuff tear. The method uses 2 medial anchors and 2 lateral anchors for rotator cuff repair, as well as double-row biceps tenodesis. This operative modification may impart better tendon healing and fewer rupture complications than the traditional double-row repair techniques.

8.
Trauma Case Rep ; 28: 100310, 2020 Aug.
Article in English | MEDLINE | ID: mdl-32577491

ABSTRACT

Combined injuries of the glenohumeral joint that involve biceps tendon subluxation associated with isolated greater tuberosity fracture and bony Bankart lesion are extremely rare. As per our knowledge, this is the first case report that includes such combined injuries that were treated arthroscopically. We present the case of a 48-year-old male patient who sustained shoulder trauma after being thrown against the rocks by a wave, was found to have biceps tendon subluxation associated with isolated greater tuberosity fracture and bony Bankart lesion. The operative management resulted in complete restoration of the range of motion of the shoulder, and uneventful healing of the fracture. The patient recovered normal activity including his surfing.

9.
Case Rep Gastroenterol ; 14(1): 124-130, 2020.
Article in English | MEDLINE | ID: mdl-32355481

ABSTRACT

Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is an autosomal recessive and fatal multisystem metabolic disorder. It presents with wide-ranging gastrointestinal and neurologic symptoms. It is caused by a mutation in the TYMP gene which impairs thymidine phosphorylase (TP) activity, therefore leading to the accumulation of thymidine and deoxyuridine in plasma and tissues. Thus, MNGIE can be diagnosed by findings of high levels of thymidine and deoxyuridine. Herein, we present the case of a 40-year-old male who presented with diarrhea, vomiting, and abdominal pain, severe weight loss, neurologic deficits, and distal motor weakness progressing over a period of 13 years. The combination of this broad clinical picture along with results of magnetic resonance imaging, electromyography, colonic biopsies, genetic testing, and elevated plasma and tissue thymidine and deoxyuridine levels confirmed the diagnosis of MNGIE. TYMP gene mutation impairs TP function. TP mutations in the nuclear DNA lead to mitochondrial DNA deletions causing mitochondrial failure and ultimately cell death. Treatment modalities are targeting the restoration of TP activity or aiming to decrease the high levels of thymidine and pyrimide. However, diagnosing this disease is still a challenge and often overdue. This patient's 13-year delay in diagnosis shows the importance of a complete neurological exam and muscle strength testing in patients with gastrointestinal symptoms. The diagnosis of MNGIE requires interdepartmental collaborative work for diagnosis delay prevention and for optimal patient care.

10.
Adv Orthop ; 2020: 9130462, 2020.
Article in English | MEDLINE | ID: mdl-32373369

ABSTRACT

BACKGROUND: Total hip arthroplasty (THA) is associated with substantial blood loss in the postoperative course. Tranexamic acid (TXA) is a potent antifibrinolytic agent, routinely administered by intravenous (IV) and topical (intra-articular, IA) route, which can possibly interrupt the cascade of events due to hemostatic irregularities close to the source of bleeding. However, scientific evidence of combined administration of TXA in THA secondary to a femoral neck fracture is still meagre. The present study aims to compare the patients who were administered combined IV and topical TXA with a control group in terms of blood loss, transfusion rate, and incidence of deep vein thrombosis (DVT) and thromboembolism (TE). Patients and Methods. 195 patients with femoral neck fracture underwent THA and were placed into two groups: (1) IV and IA TXA group which had 58 patients and (2) no TXA control group which had 137 patients. In the TXA group, 1 g IV TXA was administered 30 minutes before incision, and 1 g IA TXA was administered intraoperatively after fascia closure. No drains were placed, and soft spica was applied to the hip. RESULTS: Combined usage of IV and IA TXA showed better results when compared to the control group in terms of blood transfusion rate (31%) and hemoglobin drop (28%). No cases of DVT or TE were noted among the two study groups. CONCLUSION: Combined use of IV and IA TXA provided significantly better results compared to no TXA use with respect to all variables related to postoperative blood loss in THA. Moreover, TXA use is safe in terms of incidence of symptomatic DVT and TE.

11.
Int J Surg Case Rep ; 68: 74-82, 2020.
Article in English | MEDLINE | ID: mdl-32120282

ABSTRACT

OBJECTIVE: This study aims to investigate the presence of any differences between the normal population and patients with rotator cuff tears in term of glenoid morphological parameters. METHOD: For the purpose of this study, 82 shoulder MRIs were evaluated. The individuals included in this study were divided into the patient group (cuff tear group, n = 41) and the control group (control group, n = 41) with respect to the inclusion and exclusion criteria. For the statistical analysis, SPSS software was used. RESULTS: Statistically significant difference was found between the patient group and the control group in terms of Glenoid Version Angle (GVA), Glenoid Axial Width (GAW), Glenoid Axial Depth (GAD), Glenoid Coronal Depth (GCD), and the Glenoid Inclination Angle (GIA). Age was found to have a positive linear correlation with the glenoid coronal height. Moreover, statistically significant difference was found between the males and females, between males with cuff tears and control males, and females with cuff tears and control females in terms of glenoid parameters. When gender was a covariate, statistically significant differences in glenoid parameters was still present between cuff tears patients and individuals with control shoulders. CONCLUSION: The results attained in this study are suggest that the GVA, GAW, GAD, GCD, and GIA in rotator cuff tear patients are different than those found in control patients. These measurements may be helpful in reaching the diagnosis in cases where the clinical diagnosis is equivocal. Moreover, these measurements may be helpful in planning tears management. The influence of gender on glenoid parameters and subsequent impact on shoulder pathology may help to better understand the biomechanism of rotator cuff tears and reach an individualized management for better patient care.

12.
Article in English | MEDLINE | ID: mdl-32161714

ABSTRACT

OBJECTIVE: The aim of this study is to evaluate the presence of significant differences regarding the lateral acromial angle, critical shoulder angle, and the acromial index between patients with and without rotator cuff tears. METHOD: The MRIs (Magnetic Resonnance Imaging) of 82 patients were studied. The rotator cuff tear group (RCT group) included 41 patients while the control group also included 41 patients without rotator cuff tears. Acromial parameters and demographical data were extracted for statistical analysis. RESULTS: No statistical significant difference was found in terms of the studied acromial parameters between patients with and without rotator cuff tears. No correlation was found between age and any of the studied parameters. LAA (Lateral Acromial Angle) was found to be significantly different between males and females of the studied sample. However, no difference was found between patients with and without rotator cuff tears when both genders were studied separately. Moreover, no statistical significant difference was found in terms of the studied acromial parameters between males and females when the RCT group and the control group were studied separately. When gender was the covariate in the one-way MANCOVA test, gender was not significantly dependent on the type of groups (RCT group vs control group). CONCLUSION: The results obtained from this study suggested that the studied acromial parameters in patients with rotator cuff tears were not different from the parameters found in patients without rotator cuff tears. Moreover, gender was not found to influence the acromial parameters, with no subsequent effect on the development of rotator cuff tears. Further studies may be required for better understanding on the biomechanics, taking into consideration age, gender, and the given population.

13.
Trauma Case Rep ; 26: 100286, 2020 Apr.
Article in English | MEDLINE | ID: mdl-32140534

ABSTRACT

The hypermobility of the glenohumeral joint accounts for its anatomic predisposition for instability and dislocation. The stability of the shoulder joint is dependent on static and dynamic soft tissue structures, among which is the labrum. Circumferential labral tears are a rare pathological entity of shoulder instability that have not been commonly reported in the literature. A detailed history and physical examination are crucial for accurate diagnosis since MRIs have a poor sensitivity. A 40-year-old male patient with a history of atraumatic recurrent left shoulder subluxations for 6 years. On physical examination, there was no evidence of motor or sensory deficit. MR images were suggestive of Hills-Sachs lesion with intact rotator cuffs. Pan-labral tear repair via arthroscopy presents a unique challenge, even for the skilled orthopedic surgeon. Hence, the repair demands accessory portals and percutaneous techniques for the adequate placement of anchors. The purpose of this case is the rare presentation of a pan-labral tear repaired arthroscopically.

14.
Technol Cancer Res Treat ; 18: 1533033819879902, 2019.
Article in English | MEDLINE | ID: mdl-31865865

ABSTRACT

Chronic myeloid leukemia is a myeloproliferative neoplasm that occurs more prominently in the older population, with a peak incidence at ages 45 to 85 years and a median age at diagnosis of 65 years. This disease comprises roughly 15% of all leukemias in adults. It is a clonal stem cell disorder of myeloid cells characterized by the presence of t(9;22) chromosomal translocation, also known as the Philadelphia chromosome, or its byproducts BCR-ABL fusion protein/messenger RNA, leading to the expression of a protein with enhanced tyrosine kinase activity. This fusion protein has become the main therapeutic target in chronic myeloid leukemia therapy, with imatinib displaying superior antileukemic effects, placing it at the forefront of current treatment protocols and displaying great efficacy. Alternatively, nanomedicine and employing nanoparticles as drug delivery systems may represent new approaches in future anticancer therapy. This review focuses primarily on the use of organic nanoparticles aimed at chronic myeloid leukemia therapy in both in vitro and in vivo settings, by going through a thorough survey of published literature. After a brief introduction on the pathogenesis of chronic myeloid leukemia, a description of conventional, first- and second-line, treatment modalities of chronic myeloid leukemia is presented. Finally, some of the general applications of nanostrategies in medicine are presented, with a detailed focus on organic nanocarriers and their constituents used in chronic myeloid leukemia treatment from the literature.


Subject(s)
Antineoplastic Agents/administration & dosage , Drug Carriers/chemistry , Drug Delivery Systems , Nanoparticles/chemistry , Organic Chemicals/chemistry , Protein Kinase Inhibitors/administration & dosage , Animals , Antineoplastic Agents/chemistry , Antineoplastic Agents/pharmacokinetics , Antineoplastic Agents/therapeutic use , Humans , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy , Nanoparticles/classification , Protein Kinase Inhibitors/chemistry , Protein Kinase Inhibitors/pharmacokinetics , Protein Kinase Inhibitors/therapeutic use , Theranostic Nanomedicine
15.
Int J Surg Case Rep ; 65: 193-196, 2019.
Article in English | MEDLINE | ID: mdl-31726256

ABSTRACT

INTRODUCTION: Bilateral proximal humerus fractures are rather rare and occur due to high energetic traumas in young patients and even low energetic traumas in older patients having osteoporosis. Open reduction and internal fixation (ORIF) is the most popular treatment for this type of fracture while other types of treatment such as arthroplasty or conservative treatment are also, but less commonly used. PRESENTATION OF CASE: This report presents the case of an 80 years old female patient with bilateral proximal humerus fractures and a history of hypothyroidism. The patient was treated with simultaneous open reduction and internal fixation and presented a normal and full-range motion in both shoulders after follow-up. DISCUSSION: Frequency of proximal humerus fractures has increased with the increase in life expectancy. Osteoporotic people are at higher risk. Around five percent of all extremity fractures are humerus proximal end fractures for people below 40 years old and 76 % for cases of people over 40 years old, with females being more susceptible. ORIF is the treatment of choice for such fractures. Replacement arthroplasty, minimally invasive techniques and conservative management are other options depending on fracture characteristics. CONCLUSION: This is an interesting rare case of simultaneous bilateral proximal humerus fractures in an elderly female patient, treated operatively with satisfactory results on follow up.

16.
Case Rep Orthop ; 2019: 4608171, 2019.
Article in English | MEDLINE | ID: mdl-31583148

ABSTRACT

Distal radial artery aneurysms are an uncommon pathological entity in the field of surgery. Moreover, distal radial artery aneurysms of idiopathic etiology are even rarer. Herein, we present a rare case of idiopathic/atraumatic left radial artery aneurysm. A 73-year-old female patient presented with a chief complaint of a pulsatile mass located on her left wrist. Radiological imaging showed the presence of a distal radial artery aneurysm which was successfully surgically excised with subsequent ligation of the radial artery. Some of the etiologies and operative management of distal radial artery aneurysm in the anatomical snuffbox to what is in accordance with the literature are discussed. Distal radial artery aneurysms are rare. Hence, their misdiagnosis may lead to wrongful management and increase in morbidity. The appropriate management of distal radial aneurysm is almost always surgical.

17.
BMJ Open Gastroenterol ; 6(1): e000330, 2019.
Article in English | MEDLINE | ID: mdl-31645989

ABSTRACT

OBJECTIVE: Correa's cascade is a 'Model for Gastric Cancer Development' described by Peleyo Correa. The reversibility of Correa's cascade remains debatable. The literature contains insufficient data on the specific stage of the cascade during which Helicobacter pylori is detected, treated, and the effect on prognosis. Herein, we aim to determine the prevalence of various precancerous and cancerous gastric lesions in patients presenting with dyspepsia, the prevalence of gastritis and H. pylori infection, the prevalence of duodenal pathology in patients presenting with dyspepsia, identify the stage of H. pylori detection in relation to Correa's cascade, and investigate a possible relationship between H. pylori and celiac disease. DESIGN: Retrospective cross-sectional study conducted on a middle eastern population at a Lebanese tertiary hospital centre. 1428 patients presenting with dyspepsia underwent gastroscopy with gastric and duodenal biopsies. Variables include age, sex, presence/absence of H. pylori infection, and histopathological analysis of gastric and duodenal biopsies. RESULTS: Being above 40 years of age was associated with increased likelihood of exhibiting abnormal gastric biopsy result. Gastritis and metaplasia were detected more frequently than glandular atrophy (p<0.001) with gastritis being present the most (p<0.001). The presence of H. pylori and the gastric biopsy results were not associated with any of the duodenal biopsy results. CONCLUSION: The burden of H. pylori infection in patients with dyspepsia was high. H. pylori was detected at various precancerous lesions with varying significance. The prevalence of duodenal adenocarcinoma in dyspeptic patients is unexpectedly high. No association between gastric and duodenal pathologies was found.

18.
Technol Cancer Res Treat ; 18: 1533033819853241, 2019.
Article in English | MEDLINE | ID: mdl-31138064

ABSTRACT

Chronic myeloid leukemia is a myeloproliferative disease where cells of myeloid linage display a t(9;22) chromosomal translocation leading to the formation of the BCR/ABL fusion gene and the continuous activation of tyrosine kinases. This malignancy has a peak incidence at 45 to 85 years, accounting for 15% of all leukemias in adults. Controlling the activity of tyrosine kinase became the main strategy in chronic myeloid leukemia treatment, with imatinib being placed at the forefront of current treatment protocols. New approaches in future anticancer therapy are emerging with nanomedicine being gradually implemented. Setting through a thorough survey of published literature, this review discusses the use of inorganic nanoparticles in chronic myeloid leukemia therapy. After an introduction on the basics of chronic myeloid leukemia, a description of the current treatment modalities of chronic myeloid leukemia and drug-resistance mechanisms is presented. This is followed by a general view on the applications of nanostrategies in medicine and then a detailed breakdown of inorganic nanocarriers and their uses in chronic myeloid leukemia treatment.


Subject(s)
Antineoplastic Agents/administration & dosage , Drug Carriers , Drug Delivery Systems , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy , Nanoparticles , Theranostic Nanomedicine , Animals , Drug Carriers/chemistry , Drug Resistance, Neoplasm/drug effects , Fusion Proteins, bcr-abl/antagonists & inhibitors , Fusion Proteins, bcr-abl/genetics , Fusion Proteins, bcr-abl/metabolism , Humans , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/metabolism , Nanoparticles/chemistry
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