A 69-year-old female with a history of breast cancer and hypertension presented with a rare case of herpes simplex encephalitis (HSE) isolated to her left parietal lobe. The patient’s first biopsy was negative for herpes simplex virus (HSV) I/II antigens, but less than two weeks later, the patient tested positive on repeat biopsy. This initial failure to detect the virus and the similarities between HSE and symptoms of intracranial hemorrhage (ICH) suggests repeat testing for HSV in the presence of ICH. Due to the frequency of patients with extra temporal HSE, a diagnosis of HSE should be more readily considered, particularly when a patient may not be improving and a concrete diagnosis has not been solidified.
Objectives: Determine if patient satisfaction is greater after delivering postoperative care via telemedicine following minimally invasive gynecologic surgery. Materials and Methods: University-based outpatient clinic; Randomized controlled trial (Canadian Task Force classification I). Females between 18 and 60 years of age scheduled to undergo laparoscopic hysterectomy or laparoscopic excision of endometriosis were invited to participate. Eligible patients were randomized to receive postoperative care either through a traditional office visit or via telemedicine. PSQ-18 satisfaction surveys were performed by phone after the visit. Results: Forty-one patients were analyzed out of which 25 were in the office group and 16 in the telemedicine group. Groups were homogenous to age (41.4 vs. 43.3 p. 48), body mass index (31.9 vs. 30.6 P = 0.52), distance in miles from home (12.7 vs. 12.4 P = 0.92), and parity ( P = 0.51). PSQ-18 questionnaire was scored and each category was compared between the office and telemedicine groups. When comparing medians (interquartile range), the general satisfaction and time spent with doctor categories were significantly higher in the telemedicine group (4.0 [4.0, 4.5] vs. 4.5 [4.5, 5.0] P = 0.05), (4.0 [4.0, 4.5] vs. 4.5 [4.0, 5.0] P = 0.05). The remainder of the categories analyzed were not different between groups Technical Quality (4.0 [3.8, 4.5] vs. 4.5 [3.9, 5.0] P = 0.13), Interpersonal Manner (4.0 [4.0, 4.5] vs. 4.5 [4.0, 5.0] P = 0.34), Communication (4.5 [4.0, 4.5] vs. 4.5 [4.3, 5.0] P = 0.21), Accessibility and Convenience (4.0 [3.5, 4.5] v 4.0 [3.6, 4.5] P = 0.84). A chart review was performed, examining the first 30 days after surgery. One (4%) patient in the office group went to the ER after postoperative visit, and 0 in the telemedicine group ( P = 0.42). Conclusion: Postoperative care via telemedicine after gynecologic surgery results in higher patient satisfaction.
Superior mesenteric artery (SMA) syndrome is a rare clinical entity. We report a female patient presenting with abdominopelvic pain and diagnosed with superior mesenteric artery syndrome. Direct venography revealed a large ovarian varix that was treated with hysterectomy and unilateral oophorectomy. SMA syndrome can have many presentations often with small bowel obstruction. Obstruction of only the ovarian vein with resultant ovarian varix is an unusual presentation.
Once considered anomalous structures, transforaminal ligaments are not widely known and the criteria for identifying and classifying them are not universal. They are, however, of potential importance during neurological procedures, as their entrapment might lead to radicular pain. Transforaminal ligaments are not present in all patients, but when they are, the incidence of all types of ligaments is significantly higher, with the most common type being the superior corporotransverse ligament. By diminishing the overall amount of space available for the spinal nerve to pass, many early studies concluded that transforaminal ligaments were the cause of nerve root entrapment, resulting in radicular pain. However, more recent studies conducted have claimed that the ligaments do not cause radicular pain but rather are more for the protection of nerves and vessels. The contribution of transforaminal ligaments to radicular pain is still a topic of debate, but their role in the protection of nerves and vessels is certain. The clinician who performs interventional procedures directed toward the intervertebral foramen and the surgeon operating in this region should have a good working knowledge of the anatomy and proposed functions of the transforaminal ligaments.
Giant arachnoid granulations (AG) can mimic intracranial lesions. Knowledge of these structures can help avoid misdiagnosis when interpreting imaging. Here, we report a child who presented with a mass within the superior sagittal sinus and an anomalous draining vein. Herein, the diagnosis of a giant AG was made. Clinicians who view or interpret imaging of the head should be aware of these anatomical variants and though when very large, apparently, do not necessarily result in pathology. Based on our case report, giant AG might also demonstrate anomalous draining veins.
Study Objective Determine if patient satisfaction is greater after delivering postoperative care via telemedicine following minimally invasive gynecologic surgery. Design Randomized controlled trial Setting University based outpatient clinic. Patients or Participants Between 18 and 60 years of age scheduled to undergo laparoscopic hysterectomy or laparoscopic excision of endometriosis. Interventions Eligible patients were randomized to receive postoperative care either through a traditional office visit or via telemedicine. Measurements and Main Results 41 patients were analyzed out of which 25 were allocated to the office group and 16 to the telemedicine group. Groups were homogenous to age (41.4 v 43.3 p.48), BMI (31.9 v 30.6 p=.52), distance in miles from home (12.7 v 12.4 p=.92) and parity (p=.51). PSQ-18 questionnaire was scored and each category was compared between the office and telemedicine groups. When comparing medians (IQR), the general satisfaction and time spent with doctor categories were significantly higher in the telemedicine group (4.0 (4.0, 4.5) v 4.5 (4.5, 5.0) p=.05), (4.0(4.0, 4.5) v 4.5(4.0, 5.0) p=.05). The remainder of the categories analyzed were not different between groups (Technical Quality (4.0 (3.8, 4.5) v 4.5 (3.9, 5.0) p=.13), Interpersonal Manner (4.0 (4.0, 4.5) v 4.5 (4.0, 5.0) p=.34), Communication (4.5 (4.0, 4.5) v 4.5 (4.3, 5.0) p=.21) and Accessibility and Convenience (4.0 (3.5, 4.5) v 4.0 (3.6, 4.5) p=.84)). A chart review was performed, examining the first 30 days after surgery. One (4%) patient in the office group visited the ER following the postoperative visit, and 0 in the telemedicine group (p=.42). Regarding phone calls to the clinic after postoperative visit, 5(20%) patients in the office group incurred in at least one call and 4(25%) did so in the telemedicine group (p=.92). Conclusion Postoperative care via telemedicine after gynecologic surgery results in higher patient satisfaction, and does not appear to increase the risk of complications.
Dermoid cysts are rare lesions, particularly in children. Chiari II malformations are seen in patients with myelomeningocele. Here, we present a child with Chiari II malformation who, during a Chiari II decompression, was found to have a dermoid cyst. To the best of our knowledge, this is the first such case ever reported.
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