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I recently read the review article entitled "Pulmonary Fat Embolism Following Liposuction and Fat Grafting: A Review of Published Cases" by Kao et al [...].
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INTRODUCTION AND IMPORTANCE: Congenital diaphragmatic hernia (CDH) is rare, occurring in 1 in 2000 to 4000 live births, and is typically diagnosed in neonates. Bochdalek hernia is the most common type, usually presenting as a left-sided posterolateral defect. Adult presentations of CDH are uncommon and often incidental. This report discusses a young adult with an undiagnosed CDH, emphasizing the importance of clinical awareness. CASE PRESENTATION: A 26-year-old man presented with flu-like symptoms and stable vital signs. He reported chronic postprandial shortness of breath that improved with standing. Physical examination revealed decreased breath sounds on the left side. A chest X-ray identified a left diaphragmatic hernia, confirmed by spiral chest computed tomography. Although advised to undergo surgery, the patient opted for discharge against medical advice. CLINICAL DISCUSSION: Bochdalek hernia, comprising over 95 % of CDH cases, is usually left-sided due to a defect in the pleuroperitoneal membrane. Adults with CDH often present with nonspecific symptoms or the condition is discovered incidentally. Our patient adapted to his symptoms by standing after meals, which provided relief. Surgical intervention is recommended to prevent organ damage, with various techniques available, including open and endoscopic surgery. This case highlights the necessity of clinical vigilance in diagnosing CDH in adults. CONCLUSION: Adult congenital diaphragmatic hernia, though rare, requires prompt surgical treatment to prevent organ damage. Recognizing subtle symptoms is crucial for diagnosis. This report contributes to the limited literature on adult-diagnosed CDH, stressing the need for clinical awareness and timely management.
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High-energy deceleration injuries of the thoracic aorta are associated with high mortality. But among long term survivors, just 2 %-5 % of traumatic aortic injuries fail initial detection and are discovered later (Pozek et al., 2012 [1]). We present a rare case of pseudoaneurysm of the descending aorta in a female with a history of chest blunt trauma 45 days before who presented with chronic severe cough and vocal hoarseness that was treated with endovascular intervention in our center.
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Background: Inguinal hernia repair is the most frequent operation in general surgery. The chance of a person having to undergo an inguinal hernia operation during his/her life is quite high, 27 % in men and 3 % in women. European Hernia Society guidelines state that the Lichtenstein technique (mesh-based repair) is the standard treatment of elective inguinal hernia in adults. Some authors consider the Shouldice technique (tissue-based repair) the best conventional method for open hernia repair. In this study, we compared these two methods. Methods: In This randomized study, 452 patients were randomly allocated into 2 groups. 51 patients were lost during follow-up period and were excluded from further analysis in the study. Finally, the analyzed patients were 183 patients in Shouldice technique group and 218 patients in Lichtenstein technique group. All patients were examined after 1 week, 1, 3 months, 1, 2, and 3 years after the operation date. Results: After 3 years follow up Recurrence of hernia in Shouldice technique group was 7.1 % and in Lichtenstein technique group was 3 % with significant differences (p-value 0.006). No statistically significant differences were found between the groups in wound infection, Seroma, hematoma, Hydrocele, Bladder damage, chronic pain in the inguinal region, and Patient Satisfaction level after surgery. Conclusion: It seems that inguinal hernia treatment by the Lichtenstein technique is better than the Shouldice technique in elective patients.
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BACKGROUND: Recently, neck circumference (NC) has been used to predict the risk of cardiometabolic factors. This study aimed to perform a systematic review and meta-analysis to examine: (i) the sensitivity (SE) and specificity (SP) of NC to predict cardiometabolic risk factors and (ii) the association between NC and the risk of cardiometabolic parameters. METHODS: A systematic search was conducted through PubMed/Medline, Institute of Scientific Information, and Scopus, until 2017 based on the search terms of metabolic syndrome (MetS) and cardio metabolic risk factors. Random-effect model was used to perform a meta-analysis and estimate the pooled SE, SP and correlation coefficient (CC). RESULTS: A total of 41 full texts were selected for systematic review. The pooled SE of greater NC to predict MetS was 65% (95% CI 58, 72) and 77% (95% CI 55, 99) in adult and children, respectively. Additionally, the pooled SP was 66% (95% CI 60, 72) and 66% (95% CI 48, 84) in adult and children, respectively. According to the results of meta-analysis in adults, NC had a positive and significant correlation with fasting blood sugar (FBS) (CC: 0.16, 95% CI 0.13, 0.20), HOMA-IR (0.38, 95% CI 0.25, 0.50), total cholesterol (TC) (0.07 95% CI 0.02, 0.12), triglyceride (TG) concentrations (0.23, 95% CI 0.19, 0.28) and low density lipoprotein cholesterol (LDL-C) (0.14, 95% CI 0.07, 0.22). Among children, NC was positively associated with FBS (CC: 0.12, 95% CI 0.07, 0.16), TG (CC: 0.21, 95% CI 0.17, 0.25), and TC concentrations (CC: 0.07, 95% CI 0.02, 0.12). However, it was not significant for LDL-C. CONCLUSION: NC has a good predictive value to identify some cardiometabolic risk factors. There was a positive association between high NC and most cardiometabolic risk factors. However due to high heterogeneity, findings should be declared with caution.