Brachial plexus injury during axillary thoracotomy

SummaryBrachial plexus injury is a severe neurologic injury that results in functional impairment of the affected upper limb, and it can be difficult to diagnose and manage. We report a woman aged 51 years who developed brachial plexus injury of the right arm after axillary thoracotomy with removal of a mediastinal tumor. Aggressive rehabilitation was promptly neurologic instituted, and the impairment of her arm recovered completely 69 days after surgery

Spontaneous Migration of Central Venous Catheter to Anterior Mediastinum

Central venous devices are routinely used in delivering chemotherapy and total parenteral nutrition. Spontaneous migration of central venous catheters is a very rare complication, but the etiology of this problem is not clear. We report here a case of migration of a port catheter to the anterior mediastinum in a patient with stage IVC nasopharyngeal cancer during chemotherapy. The patient presented with pulmonary manifestations in form of shortness of breath and chest tightness caused by left massive pleural effusion. The pleural effusion was resolved by thoracocentesis and the migrated catheter was retrieved surgically

Endoscopic Treatment of Vesicoureteral Reflux in Children with Dextranomer/Hyaluronic Acid—A Single Surgeon's 6-Year Experience

Endoscopic treatment for vesicoureteral reflux (VUR) has become an established alternative to long-term antibiotic prophylaxis and ureteral reimplantation. We present the outcome of endoscopic treatment with dextranomer/hyaluronic acid copolymer (Deflux) for VUR in children by a single surgeon at our institute from October 2003 to October 2009. We reviewed the cases of 150 patients (total 239 ureters), 56 girls (37%) and 94 boys (63%), with a mean age of 2.2 years and a median followup of 2.5 years (range 3–68 months). Among the 239 ureters treated, 67.4% (161/239) were cured with a single injection, and a second and third injection raised the cure rate to 86.6% (207/239) and 88.3% (211/239), respectively. None had postoperative ureteral obstruction

Results of one-stage urethroplasty for hypospadias in pediatrics – single surgeon’s experience

Introduction: Hypospadias repair is a challenging technique in pediatric urology with a long learning curve. This study presents the results of urethroplasty performed by a single surgeon to repair hypospadias in children and compares the surgical outcomes at different periods. Materials and Methods: From January 2009 to February 2016, patients who were less than 18 years old and were operated for hypospadias were retrospectively reviewed and divided into two groups: group I (from January 2009 to February 2012) and group II (from March 2012 to February 2016). All operations were performed by the same pediatric surgeon, andsurgical outcomes of the two periods were compared. Results: This study considered150 patients (69 in group I/81 in group II). The Mean operative age was 30.4±32.7 months in group I and 33.6±43.3 months in group II(p=0.309). The selected procedures mainly depended on the subjective anatomical analysis in the operating room and the surgeon’s preference. The mean follow-up duration was 21.7±28.31 months in group I and 13.6±16.6 months in group II (p=0.033).The overall complication rate was 44.9% in group Iand 35.8% in group II (p=0.316). The incidence of glanular disruption significantly decreased from 21.7% to 6.2% (p=0.007) because of the wide dissection of the glanular wings and the deep incision of the urethral plate, which led to tension-free sutures for glanular reconstruction. Conclusions: One-stage repair of hypospadias may achieve satisfactory outcomes in cosmetic appearance and voiding function. Surgical outcomes could be improved by increasing practice

Reduction in patient burdens with graphical computerized adaptive testing on the ADL scale: tool development and simulation

<p>Abstract</p> <p>Background</p> <p>The aim of this study was to verify the effectiveness and efficacy of saving time and reducing burden for patients, nurses, and even occupational therapists through computer adaptive testing (CAT).</p> <p>Methods</p> <p>Based on an item bank of the Barthel Index (BI) and the Frenchay Activities Index (FAI) for assessing comprehensive activities of daily living (ADL) function in stroke patients, we developed a visual basic application (VBA)-Excel CAT module, and (1) investigated whether the averaged test length via CAT is shorter than that of the traditional all-item-answered non-adaptive testing (NAT) approach through simulation, (2) illustrated the CAT multimedia on a tablet PC showing data collection and response errors of ADL clinical functional measures in stroke patients, and (3) demonstrated the quality control of endorsing scale with fit statistics to detect responding errors, which will be further immediately reconfirmed by technicians once patient ends the CAT assessment.</p> <p>Results</p> <p>The results show that endorsed items could be shorter on CAT (<it>M </it>= 13.42) than on NAT (<it>M </it>= 23) at 41.64% efficiency in test length. However, averaged ability estimations reveal insignificant differences between CAT and NAT.</p> <p>Conclusion</p> <p>This study found that mobile nursing services, placed at the bedsides of patients could, through the programmed VBA-Excel CAT module, reduce the burden to patients and save time, more so than the traditional NAT paper-and-pencil testing appraisals.</p

Focal Nodular Hyperplasia of the Liver in a 5-year-old Girl

Focal nodular hyperplasia of the liver is a benign tumor that usually affects young women. Traditionally, its treatment in children has been conservative. As a result of its rarity in childhood, its differential diagnosis with other liver tumors is challenging. We present the case of a 5-year-old girl with a 1-week history of fever and abdominal pain. No definite diagnosis could be obtained after serial imaging and liver biopsy. As a result of uncertainty in the imaging and needle biopsy results, the patient underwent complete tumor resection. Pathology showed focal nodular hyperplasia that affected the right lobe of the liver. After surgery, the child was doing well at 24 months of follow-up

Septic Pulmonary Embolism Requiring Critical Care: Clinicoradiological Spectrum, Causative Pathogens and Outcomes

OBJECTIVES: Septic pulmonary embolism is an uncommon but life-threatening disorder. However, data on patients with septic pulmonary embolism who require critical care have not been well reported. This study elucidated the clinicoradiological spectrum, causative pathogens and outcomes of septic pulmonary embolism in patients requiring critical care. METHODS: The electronic medical records of 20 patients with septic pulmonary embolism who required intensive care unit admission between January 2005 and December 2013 were reviewed. RESULTS: Multiple organ dysfunction syndrome developed in 85% of the patients, and acute respiratory failure was the most common organ failure (75%). The most common computed tomographic findings included a feeding vessel sign (90%), peripheral nodules without cavities (80%) or with cavities (65%), and peripheral wedge-shaped opacities (75%). The most common primary source of infection was liver abscess (40%), followed by pneumonia (25%). The two most frequent causative pathogens were Klebsiella pneumoniae (50%) and Staphylococcus aureus (35%). Compared with survivors, nonsurvivors had significantly higher serum creatinine, arterial partial pressure of carbon dioxide, and Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores, and they were significantly more likely to have acute kidney injury, disseminated intravascular coagulation and lung abscesses. The in-hospital mortality rate was 30%. Pneumonia was the most common cause of death, followed by liver abscess. CONCLUSIONS: Patients with septic pulmonary embolism who require critical care, especially those with pneumonia and liver abscess, are associated with high mortality. Early diagnosis, appropriate antibiotic therapy, surgical intervention and respiratory support are essential

Quantum dot-doped porous silicon metal–semiconductor metal photodetector

In this paper, we report on the enhancement of spectral photoresponsivity of porous silicon metal–semiconductor metal (PS-MSM) photodetector embedded with colloidal quantum dots (QDs) inside the pore layer. The detection efficiency of QDs/PS hybrid-MSM photodetector was enhanced by five times larger than that of the undoped PS-MSM photodetector. The bandgap alignment between PS (approximately 1.77 eV) and QDs (approximately 1.91 eV) facilitates the photoinduced electron transfer from QDs to PS whereby enhancing the photoresponsivity. We also showed that the photoresponsitivity of QD/PS hybrid-MSM photodetector depends on the number of layer coatings of QDs and the pore sizes of PS.Published versio