ABSTRACT
Intestinal volvulus is defined as a twisting of the bowel on its mesentery. It itself is a rare occurrence, with documented incidence of 1% as the cause of all small bowel obstruction, with further 0.82% of them being associated with intestinal malrotation. The classical radiographic feature described in literatures is the whirlpool sign. We herein report a rare presentation of congenital malrotation causing a small bowel obstruction in a 43-year-old man. The patient presented with acute abdominal pain and underwent an emergency laparotomy and resection of small and large bowel (total of 3 m with primary anastomosis), with an estimated 2.6 m of viable small bowel left. The patient had a prolonged recovery complicated by another relook operation, superior mesenteric vein thrombus and a high-output stoma with subsequent electrolyte derangements and acute kidney injury. He was discharged on Day 26 and had been seen in the outpatient department with good functionality.
ABSTRACT
BACKGROUND: Postoperative follow-up of papillary thyroid cancer includes serial serum thyroglobulin levels. This study aimed to determine whether stimulated thyroglobulin levels measured in the early postoperative period can accurately quantify the risk of recurrence in papillary thyroid cancer. METHODS: We undertook a cohort study of patients who underwent total thyroidectomy for papillary thyroid cancer ≥10 mm in the period 2000 to 2016 with complete biochemical data. All patients had a postoperative stimulated thyroglobulin measured within 3 months after total thyroidectomy. Structural recurrence was defined as disease detected on imaging and confirmed on histology. Biochemical disease was defined as patients with stimulated serum thyroglobulin ≥1 ng/mL with no evidence of structural disease. RESULTS: This study included 502 patients with a mean age of 50 years and median tumor diameter of 20 mm. Median follow-up was 18 months. Stimulated postoperative thyroglobulin was measured before radioiodine-ablation and was categorized into 3 groups: (1) 219 (44%) patients had thyroglobulin <1 ng/mL; (2) 55 (11%) had 1ng/mL ≤ thyroglobulin <2 ng/mL; and (3) 228 (45%) had thyroglobulin ≥2 ng/mL. The structural recurrence rate for each group was 5%, 2%, and 30%, respectively (P < .0001). CONCLUSION: In patients undergoing total thyroidectomy for papillary thyroid cancer, early postoperative stimulated thyroglobulin accurately quantifies the risk of structural disease recurrence.
Subject(s)
Neoplasm Recurrence, Local/epidemiology , Thyroglobulin/blood , Thyroid Cancer, Papillary/therapy , Thyroid Neoplasms/therapy , Thyroidectomy , Adult , Aged , Aged, 80 and over , Disease-Free Survival , Female , Follow-Up Studies , Humans , Iodine Radioisotopes/administration & dosage , Male , Middle Aged , Neoplasm Recurrence, Local/diagnosis , Positron-Emission Tomography , Postoperative Period , Retrospective Studies , Risk Assessment/methods , Thyroid Cancer, Papillary/diagnosis , Thyroid Cancer, Papillary/mortality , Thyroid Gland/diagnostic imaging , Thyroid Gland/surgery , Thyroid Neoplasms/diagnosis , Thyroid Neoplasms/mortality , Time Factors , Tomography, X-Ray Computed , Ultrasonography , Young AdultSubject(s)
Practice Guidelines as Topic , Practice Patterns, Physicians'/statistics & numerical data , Thyroid Cancer, Papillary/surgery , Thyroid Neoplasms/surgery , Thyroidectomy/standards , Australia , Health Care Surveys , Humans , Practice Patterns, Physicians'/standards , Societies, Medical , Thyroidectomy/methods , Thyroidectomy/statistics & numerical data , United StatesSubject(s)
Diverticulitis/diagnosis , Diverticulitis/etiology , Foreign Bodies/complications , Intestinal Perforation/etiology , Meckel Diverticulum , Adult , Diverticulitis/surgery , Foreign Bodies/diagnosis , Foreign Bodies/surgery , Humans , Intestinal Perforation/diagnosis , Intestinal Perforation/surgery , MaleABSTRACT
The ImmuKnow ICFA reports ex vivo CD4 lymphocyte activation to quantify immunosuppression. Limited organ and age-specific data exist for pediatric heart transplant recipients. We sought to examine their normative values and ICFA's association with rejection/infection. A total of 380 ICFAs from 58 heart transplant recipients (6.5/recipient) were studied retrospectively. The median age at the time of their first ICFA was 5.3 yr (IQR 2.4-12.1 yr). ICFA levels during immunologic stability (n = 311) were a median of 305 (IQR: 172-483) and mean of 353 (s.d. ± 224) ng ATP/mL. ICFA levels trended lower with advancing age. ICFA levels during immunologic stability increased over time from transplant after the first six months but were not correlated with calcineurin inhibitor levels or the type used. There is no association between ICFA values during stability and rejection (median 368 ATP ng/mL; IQR 153-527) or infection (median 293 ATP ng/mL; IQR 198-432). In contrast to the manufacturer's suggested ranges, the immunologic stable ranges in pediatric cardiac recipients were very different. ICFA values during immunologic stability are related to time from transplant in pediatric heart recipients. ICFA's ability to discriminate rejection or infection from immunologic stability was not demonstrated.
Subject(s)
Heart Defects, Congenital/surgery , Heart Transplantation , Immunosuppression Therapy/methods , Adenosine Triphosphate/metabolism , Adolescent , Age Factors , CD4-Positive T-Lymphocytes/cytology , Child , Child, Preschool , Female , Graft Rejection , Graft Survival , Heart Defects, Congenital/blood , Heart Defects, Congenital/immunology , Humans , Immunoassay/methods , Immunosuppressive Agents/therapeutic use , Infant , Infant, Newborn , Infections/immunology , Lymphocyte Activation , Male , Pediatrics , Postoperative Complications/diagnosis , Retrospective Studies , Transplant Recipients , Treatment Outcome , Young AdultABSTRACT
Femoral nerve block (FNB) is an accepted mode of analgesia for lower limb procedures but has a documented complication rate. This study compared femoral nerve and fascia iliaca regional anesthesia for total knee arthroplasty (TKA), using fentanyl consumption as the primary outcome measure. Ninety-eight primary unilateral TKA patients were blinded and randomized into fascia iliaca block (FIB) (n = 51) or FNB (n = 47) groups. No significant differences were found in analgesia use (fentanyl and tramadol) at 12 and 36 hours in pain, nausea and range of motion between the groups. There was one case of paresthesia in the femoral nerve in the FNB group. Fascia iliaca block is as effective as FNB as part of a multimodal anesthetic regimen for TKA.
