RESUMEN
Intussusception, or telescoping of the bowel, is a rare condition in the adult population that can lead to serious complications, such as obstruction or ischemia. Most cases of intussusception are idiopathic and present with a pathognomonic "target sign" on imaging. Rarely, in adults, intussusceptions can be found with lead points, some of which may be neoplastic. Treatments for intussusception include air enemas or surgical intervention if enemas are unsuccessful in resolving the telescoped bowel. This case report discusses an atypical presentation of intussusception in an adult female with a "whirlpool sign" on imaging rather than the typical "target sign." She was found to have incorporation of mesenteric fat into telescoping bowel causing edema and partial bowel obstruction. The affected bowel was removed laparoscopically, and an end-to-end anastomosis was formed. Pathology of the resected bowel revealed a non-immunoreactive inflammatory myofibroblastic neoplasm as the lead point. Most inflammatory myofibroblastic tumors stain positive for desmin, smooth muscle actin, and anaplastic lymphoma kinase (ALK), whereas this patient was non-immunoreactive. The patient tolerated surgery well and is now pain-free with normal gastrointestinal function. This case report hopes to heighten awareness of atypical presentations of intussusceptions, the use of imaging to help aid in uncertain diagnoses, and the appropriate surgical treatment for symptomatic patients.
RESUMEN
Glioblastoma multiforme is an aggressive malignant tumor of the brain with a poor prognosis and no known cure. Current treatment options for this aggressive malignancy include surgical resection, adjuvant radiation therapy, and systemic pharmacological therapy. This case report presents one patient's experience with resolved glioblastoma multiforme treated by surgical resection and radiation therapy and discusses her later development and treatment of a radiation-induced meningioma. Despite developing radiation-induced morbidities, the patient experienced an extended life because of the aggressive treatment. It is thought that the young age of this patient at the time of diagnosis may have contributed to her prolonged survival time. When balancing aggressive treatment plans to increase survival time in glioblastoma multiforme patients, risks and potential consequences of treatment, such as post-surgical changes, vascular dementia, strokes, and meningiomas, should be weighed and discussed with the patient. Furthermore, striving for a high quality of life should be kept at the forefront of every treatment plan in all patients with glioblastoma multiforme.
RESUMEN
Herpes zoster ophthalmicus (HZO) rarely manifests with complications of the optic nerve. The traditional standard of care for sight-threatening HZO infection involves intravenous hospital administration of the antiviral medication acyclovir. This case report entails an HZO complication invading the optic nerve, effectively treated by oral administration of the antiviral medication valacyclovir in an immunocompetent patient. Intravenous administration of antiviral medication may be undesirable for some patients with HZO due to comparative cost, stronger associations to nephrotoxicity, increased dosing frequency, and the need for hospitalization. Oral antiviral tablets have an efficacious route of administration to be considered over intravenous hospital administration when devising treatment for HZO with the rare complication of optic neuritis in immunocompetent patients.
RESUMEN
STUDY OBJECTIVE: Wrong-site nerve blocks (WSBs) are a significant, though rare, source of perioperative morbidity. WSBs constitute the most common type of perioperative wrong-site procedure reported to the Pennsylvania Patient Safety Authority. This systematic literature review aggregates information about the incidence, patient consequences, and conditions that contribute to WSBs, as well as evidence-based methods to prevent them. DESIGN: A systematic search of English-language publications was performed, using the PRISMA process. MAIN RESULTS: Seventy English-language publications were identified. Analysis of four publications reporting on at least 10,000 blocks provides a rate of 0.52 to 5.07 WSB per 10,000 blocks, unilateral blocks, or "at risk" procedures. The most commonly mentioned potential consequence was local anesthetic toxicity. The most commonly mentioned contributory factors were time pressure, personnel factors, and lack of site-mark visibility (including no site mark placed). Components of the block process that were addressed include preoperative nerve-block verification, nerve-block site marking, time-outs, and the healthcare facility's structure and culture of safety. DISCUSSION: A lack of uniform reporting criteria and divergence in the data and theories presented may reflect the variety of circumstances affecting when and how nerve blocks are performed, as well as the infrequency of a WSB. However, multiple authors suggest three procedural steps that may help to prevent WSBs: (1) verify the nerve-block procedure using multiple sources of information, including the patient; (2) identify the nerve-block site with a visible mark; and (3) perform time-outs immediately prior to injection or instillation of the anesthetic. Hospitals, ambulatory surgical centers, and anesthesiology practices should consider creating site-verification processes with clinician input and support to develop sustainable WSB-prevention practices.
